Pediatrics
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Obstructive sleep apnea syndrome in children is associated with significant morbidity. Continuous positive airway pressure (CPAP) treats obstructive apnea in children, but is impeded by low adherence. We, therefore, sought to assess the effect of warm humidified air delivered through an open nasal cannula (treatment with nasal insufflation [TNI]) on obstructive sleep apnea in children with and without adenotonsillectomy. ⋯ TNI offers an alternative to therapy to CPAP in children with mild-to-severe sleep apnea. Additional studies will be needed to determine the efficacy of this novel form of therapy.
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Traumatic brain injury is a leading cause of death and disability in children. Guidelines have been established to prevent secondary brain injury caused by hypotension or hypoxia. The purpose of this study was to identify the prevalence, monitoring, and treatment of hypotension and hypoxia during "early" (prehospital and emergency department) care and to evaluate their relationship to vital status and neurologic outcomes at hospital discharge. ⋯ Hypotension and hypoxia are common events in pediatric traumatic brain injury. Approximately one third of children are not properly monitored in the early phases of their management. Attempts to treat hypotension and hypoxia significantly improved outcomes.
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For infant and child resuscitation, current basic life support guidelines recommend a compression depth of one third to one half of the anteroposterior chest diameter. This study was conducted to assess the actual compression depths in infants and children when current guidelines are strictly followed. ⋯ Radiological assessment of infants' and children's chests indicates similar or higher compression depths for infants and children versus the recommended compression depths for adults (3.8-5.1 cm) according to current guidelines. More evidence is needed to guide the proper depth of chest compression in pediatric populations.
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The goal was to examine the feasibility of outpatient management for 1- to 3-month-old infants with febrile urinary tract infections. ⋯ Ambulatory treatment of infants 30 to 90 days of age with febrile urinary tract infections by using short-term, intravenous antibiotic therapy at a day treatment center is feasible.
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Comparative Study
Are outcomes and care processes for preterm neonates influenced by health insurance status?
The purpose of this work was to compare the processes of care and to evaluate outcomes of premature neonates delivered to women with Medicaid managed care versus private insurance. ⋯ We speculate that, in addition to the known impact of insurance status on well-being at birth, Medicaid managed care is independently associated with adverse neonatal outcomes in preterm infants, as well as differences in neonatal intensive care discharge processes.