Pediatr Crit Care Me
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Nesiritide (synthetic B-type natriuretic peptide) has been shown to be effective in the management of acute decompensated heart failure in adults. The role of nesiritide in pediatric heart failure has not been examined. In the present study, we reviewed our initial experience with nesiritide in children with primary heart failure or low cardiac output after heart surgery. ⋯ Nesiritide is well tolerated in children with heart failure and is associated with improved diuresis. Further prospective studies will be needed to compare nesiritide with other vasoactive agents and examine the cost-efficacy of this therapy.
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Pediatr Crit Care Me · Sep 2005
Pneumococcal meningitis in a pediatric intensive care unit: prognostic factors in a series of 49 children.
Despite advances in antibiotic therapy strategies and in pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. However, few prognostic studies have been published, especially in pediatric populations. ⋯ S. pneumoniae meningitis remains a devastating childhood disease in developed countries. Three variables were independently associated with the in-hospital death in our series-high Pediatric Risk of Mortality II score, low white blood cells count, and low platelet count-reflecting the main importance of severe sepsis and neurologic presentation in establishing the prognosis of these patients.
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To report two cases of severe early-onset neonatal sepsis due to Streptococcus pneumoniae, including, to our knowledge, the first reported case of sepsis due to penicillin-resistant S. pneumoniae presenting as early-onset neonatal sepsis. ⋯ Clinicians should consider S. pneumoniae as a possible cause of fulminant nonresponsive sepsis in neonates. In areas where antimicrobial-resistant S. pneumoniae is prevalent, when culture results are known, or with a clinical course unresponsive to ampicillin, septic infants may require the addition of a penicillinase-resistant antibiotic to their therapeutic regimen until results of antibiotic sensitivity testing are known. Early transfer to a center with extracorporeal membrane oxygenation should be considered for symptomatic neonates.
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To describe a patient who had been taking ibuprofen for 3 days before the diagnosis of a massive pulmonary embolus without hypoxemia. ⋯ The absence of hypoxemia (including a normal alveolar-arterial oxygen difference) in our patient with a massive pulmonary embolus may have been related to cyclooxygenase inhibition due to ibuprofen, with improvement in ventilation-perfusion mismatch.
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Pediatr Crit Care Me · Sep 2005
Sleep and adverse environmental factors in sedated mechanically ventilated pediatric intensive care patients.
To document the quantity and architecture of sleep using objective electrophysiologic assessment in sedated mechanically ventilated pediatric intensive care unit patients over a 24-hr period and to investigate the effect of noise and staff interventions on sleep pattern in these subjects. ⋯ The above findings suggest a significant electrophysiologic abnormality of sleep in the pediatric intensive care unit patients. Our pediatric intensive care unit environment is characterized by both, high noise levels and frequent staff interventions. This study has several limitations and future studies are needed, with larger sample size and an attempt to manipulate the environmental factors to minimize their negative effects on sleep.