Pediatrics
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Randomized Controlled Trial
Economic evaluation of inhaled nitric oxide in preterm infants undergoing mechanical ventilation.
In the previously reported Nitric Oxide for Chronic Lung Disease (NO CLD) trial, ventilated preterm infants who received a course of inhaled nitric oxide (iNO) between 7 and 21 days of life had a significant improvement in survival without bronchopulmonary dysplasia (BPD), as well as a shorter duration of admission and ventilation. However, the price for the drug may be a barrier to widespread use. We sought to estimate the incremental cost-effectiveness of iNO therapy to prevent BPD in infants of <1250 g birth weight. ⋯ Despite its higher price relative to many other neonatal therapies, iNO in this trial was not associated with higher costs of care, an effect that is likely due to its impact on length of stay and ventilation. Indeed, for infants who receive nitric oxide between 7 and 14 days of life, the therapy seemed to lower costs while improving outcomes.
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Randomized Controlled Trial Multicenter Study
Clinical and economic effects of iNO in premature newborns with respiratory failure at 1 year.
The long-term consequences of inhaled nitric oxide (iNO) use in premature newborns with respiratory failure are unknown. We therefore studied the clinical and economic outcomes to 1 year of corrected age after a randomized controlled trial of prophylactic iNO. ⋯ Subjects in both arms commonly experienced neurodevelopmental and pulmonary morbidity, consuming substantial health care resources. Prophylactic iNO beginning in the first days of life did not lower costs and had a poor cost-effectiveness profile.
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The Increased Flow Utilizing Subcutaneously-Enabled (INFUSE)-Pediatric Rehydration Study was designed to assess efficacy, safety, and clinical utility of recombinant human hyaluronidase (rHuPH20)-facilitated subcutaneous rehydration in children 2 months to 10 years of age. ⋯ rHuPH20-facilitated subcutaneous hydration seems to be safe and effective for young children with mild/moderate dehydration. Subcutaneous access is achieved easily, and the procedure is well accepted by clinicians and parents.
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The objective of this research was to obtain national estimates of exposure to the full spectrum of the childhood violence, abuse, and crime victimizations relevant to both clinical practice and public-policy approaches to the problem. ⋯ The scope and diversity of child exposure to victimization is not well recognized. Clinicians and researchers need to inquire about a larger spectrum of victimization types to identify multiply victimized children and tailor prevention and interventions to the full range of threats that children face.
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The Health and Obesity: Prevention and Education (HOPE) project is a multidisciplinary, healthy living counseling curriculum to educate pediatric clinicians in training on how to recognize children who are at risk for obesity and its comorbidities and how to promote healthy weight among children and their families. Curriculum topics were selected by experts of nutrition, medicine, dentistry, behavioral counseling, and education and incorporate the recent 2007 Expert Committee recommendations regarding the prevention, assessment, and treatment of childhood and adolescent obesity. The HOPE curriculum instructs medical and dental clinicians on the health consequences of childhood obesity and screening techniques to identify children and families at risk, reviews the current evidence for health intervention recommendations, and teaches trainees regarding the theoretical rationale and art of constructive and culturally sensitive weight counseling for behavioral change. ⋯ This educational tool, grounded in understanding of relevant sciences, literature, and research methods, provides clinicians with the skills necessary to identify and counsel patients who are at risk to promote healthy weight among youth. This article discusses the approach and methods used for curriculum development. Future publications will discuss HOPE project implementation and outcomes.