Pediatr Crit Care Me
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Pediatr Crit Care Me · Feb 2013
Central diabetes insipidus in pediatric severe traumatic brain injury.
To determine the occurrence rate of central diabetes insipidus in pediatric patients with severe traumatic brain injury and to describe the clinical, injury, biochemical, imaging, and intervention variables associated with mortality. ⋯ The incidence of central diabetes insipidus in pediatric patients with severe traumatic brain injury is 18%. Mortality was associated with early central diabetes insipidus onset and cerebral edema on head computed tomography. Central diabetes insipidus nonsurvivors were less likely to have received intracranial pressure monitoring, thiopental coma and decompressive craniectomy.
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Pediatr Crit Care Me · Feb 2013
Diagnostic performance of triggering receptor expressed on myeloid cells-1 and CD64 index as markers of sepsis in preterm newborns.
CD64 index and triggering receptor expressed on myeloid cells-1 are biomarkers on neutrophil polymorphonuclear cells with crucial role in sepsis. The study aim is to assess diagnostic performance, individually and combined, of CD64 index and triggering receptor expressed on myeloid cells-1 (surface marker/soluble form), in late-onset sepsis of preterm infants. ⋯ Despite limited sample size, CD64 index demonstrated to be a promising biomarker, with high specificity, to diagnose late-onset sepsis. Further investigations are needed to substantiate these findings. Triggering receptor expressed on myeloid cells-1 showed less valuable diagnostic role.
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Pediatr Crit Care Me · Feb 2013
No change in antibiotic susceptibility patterns in the neonatal ICU over two decades.
To identify trends in early-onset sepsis and late-onset sepsis neonatal rates and to evaluate the appropriateness of the empirical antibiotic protocols. ⋯ Our empiric antibiotic protocols are appropriate despite their continuous use over the last 17 yrs. This may have been achieved by the use of a controlled antibiotic program and infection control efforts.
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Pediatr Crit Care Me · Feb 2013
Ethics, choices, and decisions in acute medicine: a national survey of Norwegian physicians' attitudes.
To study the attitudes of Norwegian physicians to resuscitation of hypothetical patients all at risk of neurological sequelae. ⋯ There appear to be differences in medical thinking about best interest, surrogate decision making, and the relative value of lives as far as these are applied to acute, life-saving treatment.
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Pediatr Crit Care Me · Feb 2013
Dopamine prevents impairment of autoregulation after traumatic brain injury in the newborn pig through inhibition of Up-regulation of endothelin-1 and extracellular signal-regulated kinase mitogen-activated protein kinase.
Traumatic brain injury contributes to morbidity in children and boys are disproportionately represented. Autoregulation is impaired more in male compared with female piglets after traumatic brain injury through sex-dependent up-regulation of the spasmogen endothelin-1 and extracellular signal-regulated kinase (ERK) mitogen-activated protein kinase (MAPK), a family of three kinases: ERK, p38, and JNK). Elevation of mean arterial pressure leading to increased cerebral perfusion pressure via phenylephrine improves impairment of autoregulation after traumatic brain injury in female but not male piglets through modulation of endothelin-1 and ERK MAPK up-regulation, blocked in females, but aggravated in males. We hypothesized that pressor choice to elevate cerebral perfusion pressure is important in improving cerebral hemodynamics after traumatic brain injury and that dopamine will prevent impairment of autoregulation in both male and female piglets through blockade of endothelin-1 and ERK MAPK. ⋯ These data indicate that dopamine is protective of autoregulation after fluid percussion injury in both sexes. These observations advocate for the consideration of development of sex based therapies for treatment of hemodynamic sequalae of pediatric traumatic brain injury.