Pediatrics
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Randomized Controlled Trial
A randomized trial of stylets for intubating newborn infants.
Endotracheal intubation of newborn infants is a common and potentially lifesaving procedure but a skill that trainees find difficult. Despite widespread use, no data are available on whether the use of a stylet (introducer) improves success rates. We aimed to determine whether pediatric trainees were more successful at neonatal orotracheal intubation when a stylet was used. ⋯ Using an endotracheal stylet did not significantly improve the success rate of pediatric trainees at neonatal orotracheal intubation.
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Randomized Controlled Trial
Near-infrared imaging in intravenous cannulation in children: a cluster randomized clinical trial.
Intravenous cannulation is a widespread medical procedure that can be difficult in children. Visualization of veins with near-infrared (NIR) light might support intravenous cannulation. Therefore, we investigated the effectiveness of an NIR vascular imaging system (VascuLuminator) in facilitating intravenous cannulation in children in the operating room. ⋯ Although it was possible to visualize veins with NIR in most patients, the VascuLuminator did not improve success rate or time to obtain intravenous cannulation. There are 3 possible explanations for this result: first, it could be that localization of the vein is not the main problem, and therefore visualization is not a solution; second, the type of system used in this study could be less than optimal; and, third, the choice of the patient population in this study could be inappropriate.
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Randomized Controlled Trial
Association of nutrient-dense snack combinations with calories and vegetable intake.
With other factors such as general diet and insufficient exercise, eating non-nutrient dense snack foods such as potato chips contributes to childhood obesity. We examined whether children consumed fewer calories when offered high-nutrient dense snacks consisting of cheese and vegetables than children who were offered non-nutrient dense snacks (ie, potato chips). ⋯ The combination snack of vegetables and cheese can be an effective means for children to reduce caloric intake while snacking. The effect was more pronounced among children who were overweight or obese and children from low-involvement families.
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Accurate, timely diagnosis of pediatric appendicitis minimizes unnecessary operations and treatment delays. Preoperative abdominal-pelvic computed tomography (CT) scan is sensitive and specific for appendicitis; however, concerns regarding radiation exposure in children obligate scrutiny of CT use. Here, we characterize recent preoperative imaging use and accuracy among pediatric appendectomy subjects. ⋯ Widespread preoperative imaging did not eliminate unnecessary pediatric appendectomies. Controlling for factors potentially associated with referral bias, a CT scan was more likely to be performed in children initially evaluated at community hospitals compared with the children's hospital. Broadly-applicable strategies to systematically maximize diagnostic accuracy for childhood appendicitis, while minimizing ionizing radiation exposure, are urgently needed.
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Case Reports
Successive multisite peripheral nerve catheters for treatment of complex regional pain syndrome type I.
Complex regional pain syndrome (CRPS) type I is a painful and disabling syndrome that is accompanied by physical changes in the affected extremity. It generally occurs after trauma, manifesting as pain that is out of proportion to the inciting event. Treatment of the disorder is difficult, with many patients being refractory to multiple pharmacologic regimens. ⋯ A continuous infusion of 0.1% ropivacaine was infused via the catheters for ~60 hours. The patient was subsequently able to participate in physical therapy as well as activities of daily living with improved eating, sleeping, and mood. Although many therapeutic modalities have been tried in CRPS type I, given the debilitating nature of the disorder and the variable response to therapy, new and alternative therapeutic interventions, such as continuous peripheral nerve catheters, are needed.