Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2012
Randomized Controlled Trial Multicenter Study Comparative StudyFirst intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis.
Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are, to date, still matter of debate. We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed. ⋯ We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support, surfactant therapy, and reintubation, and shortened neonatal intensive care unit and hospital stay, thus reducing unit and hospital costs. These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population, such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids.
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Pediatr Crit Care Me · Jan 2012
Randomized Controlled Trial Multicenter Study Comparative StudyTemperature profile and outcomes of neonates undergoing whole body hypothermia for neonatal hypoxic-ischemic encephalopathy.
Decreases below the target temperature were noted among neonates undergoing cooling in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Trial of whole body hypothermia for neonatal hypoxic-ischemic encephalopathy. ⋯ Term infants with a lower birth weight are at risk for decreasing temperatures of <32.0°C while undergoing body cooling using a servo-controlled system. This information suggests extra caution during the application of hypothermia as these lower birth weight infants are at risk for overcooling. Our findings may assist in planning additional trials of lower target temperature for neonatal hypoxic-ischemic encephalopathy.
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Pediatr Crit Care Me · Jan 2012
Randomized Controlled Trial Multicenter StudyIntracranial pressure and cerebral perfusion pressure responses to head elevation changes in pediatric traumatic brain injury.
To determine the effect of and dynamic interaction between head elevation on intracranial pressure and cerebral perfusion pressure in severe pediatric traumatic head injury. ⋯ In severe pediatric traumatic brain injury, the relationship between change in head of the bed and change in intracranial pressure was negative and linear. The lowest intracranial pressure was usually, but not always, achieved at highest head-of-the-bed angles. The effect size of a head-of-the-bed angle change depended, in part, on the subject's height. In contrast, cerebral perfusion pressure was mostly unaffected by head-of-the-bed changes.