Pediatrics
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This clinical report provides current recommendations regarding the selection and use of drugs in preparation for pediatric emergencies. It is not intended to be a comprehensive list of all medications that may be used in all emergencies. When possible, dosage recommendations are consistent with those used in current emergency references such as the Advanced Pediatric Life Support and Pediatric Advanced Life Support textbooks and the recently revised American Heart Association resuscitation guidelines.
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Thimerosal is a mercurial preservative that was widely used in multidose vaccine vials in the United States and Europe until 2001 and continues to be used in many countries throughout the world. We conducted a pharmacokinetic study to assess blood levels and elimination of ethyl mercury after vaccination of infants with thimerosal-containing vaccines. ⋯ The blood half-life of intramuscular ethyl mercury from thimerosal in vaccines in infants is substantially shorter than that of oral methyl mercury in adults. Increased mercury levels were detected in stools after vaccination, suggesting that the gastrointestinal tract is involved in ethyl mercury elimination. Because of the differing pharmacokinetics of ethyl and methyl mercury, exposure guidelines based on oral methyl mercury in adults may not be accurate for risk assessments in children who receive thimerosal-containing vaccines.
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Not enough is known about the national prevalence of racial/ethnic disparities in children's medical and dental care. ⋯ Many significant disparities were noted; for example, uninsurance rates were 6% for whites, 21% for Latinos, 15% for Native Americans, 7% for African Americans, and 4% for Asians or Pacific Islanders, and the proportions with a usual source of care were as follows: whites, 90%; Native Americans, 61%; Latinos, 68%; African Americans, 77%; and Asians or Pacific Islanders, 87%. Many disparities persisted for > or = 1 minority group in multivariate analyses, including increased odds of suboptimal health status, overweight, asthma, activity limitations, behavioral and speech problems, emotional difficulties, uninsurance, suboptimal dental health, no usual source of care, unmet medical and dental needs, transportation barriers to care, problems getting specialty care, no medical or dental visit in the past year, emergency department visits, not receiving mental health care, and not receiving prescription medications. Certain disparities were particularly marked for specific racial/ethnic groups: for Latinos, suboptimal health status and teeth condition, uninsurance, and problems getting specialty care; for African Americans, asthma, behavior problems, skin allergies, speech problems, and unmet prescription needs; for Native Americans, hearing or vision problems, no usual source of care, emergency department visits, and unmet medical and dental needs; and for Asians or Pacific Islanders, problems getting specialty care and not seeing a doctor in the past year. Multiracial children also experienced many disparities. CONCLUSIONS; Minority children experience multiple disparities in medical and oral health, access to care, and use of services. Certain disparities are particularly marked for specific racial/ethnic groups, and multiracial children experience many disparities.
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This study describes the burden and epidemiologic features of infectious disease hospitalizations among infants in the United States. ⋯ Infectious disease hospitalizations among infants account for substantial health care expenditures and hospital time in the United States, with respiratory disease hospitalizations constituting more than one half of all hospitalizations. Younger infants, boys, and nonwhite infants were at increased risk for infectious disease hospitalization. Measures to reduce racial disparities and the occurrence of respiratory tract infections should substantially decrease the infectious disease burden among infants.
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Late-preterm infants (34-36 weeks' gestation) account for nearly three quarters of all preterm births in the United States, yet little is known about their morbidity risk. We compared late-preterm and term (37-41 weeks' gestation) infants with and without selected maternal medical conditions and assessed the independent and joint effects of these exposures on newborn morbidity risk. ⋯ Late-preterm birth and, to a lesser extent, maternal medical conditions are each independent risk factors for newborn morbidity. Combined, these 2 factors greatly increased the risk for newborn morbidity compared with term infants who were born without exposure to these risks.