Pediatr Neonatol
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Chronic lung disease continues to be a major complication in premature infants with severe respiratory distress syndrome (RDS). This is despite having advanced ventilatory care, prenatal corticosteroids, and postnatal surfactant therapies. The combined use of intratracheal corticosteroids and surfactant may not only recruit the lungs, but also alleviate pulmonary inflammation in severe RDS. ⋯ Intratracheal instillation of surfactant or surfactant plus budesonide can improve oxygenation and pulmonary histologic outcome in neonatal surfactant-depleted lungs. The additional use of budesonide does not disturb the function of the exogenous surfactant. Intratracheal administration of a corticosteroid combined with surfactant may be an effective method for alleviating local pulmonary inflammation in severe RDS.
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Neonatal tetanus is a rare disease in developed countries, but remains common in developing countries. Pregnant women immigrating to Taiwan from developing countries may carry a risk of neonatal tetanus to the child, because of inadequate tetanus toxoid immunization and inappropriate postnatal cord care. ⋯ After mechanical ventilation for 58 days and a prolonged hospital stay, the infant was discharged in good condition. It is important to maintain a high index of suspicion for neonatal sepsis when infants present with seizure-like symptoms, in order to allow its early diagnosis and appropriate treatment.
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Seizures account for 1% of all pediatric emergency department (ED) visits. The aim of this study was to analyze the clinical spectrum and prevalence rates of various etiologies in children with a first attack of acute seizure disorder in the ED. ⋯ Primary care pediatricians should evaluate children presenting to the ED with a first seizure for age, coexistence of fever, seizure type, associated symptoms and history of head injury. We suggest that electrolytes, blood sugar and emergent brain imaging studies should be arranged based on detailed history-taking and thorough physical examinations, but should not be performed routinely.
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Comparative Study
Frequency of ventilator-associated pneumonia with 3-day versus 7-day ventilator circuit changes.
Ventilator-associated pneumonia (VAP) is a common clinical problem. Previous studies involving adult patient cohorts have assessed various risk factors associated with VAP, including ventilator circuit changes. The objective of this study was to examine the incidence of and risk factors associated with VAP, particularly 3-day versus 7-day ventilator circuit changes, in a pediatric intensive care unit (PICU). ⋯ Weekly circuit change does not contribute to increased rates of VAP in pediatric patients. Long-term studies evaluating risk factors in larger pediatric patient populations are warranted for further conclusive recommendations.
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Excessive noise in nurseries has been found to cause adverse effects in infants, especially preterm infants in neonatal intensive care units (NICUs). The NICU design may influence the background sound level. We compared the sound level in two differently designed spaces in one NICU. We hypothesized that the sound level in an enclosed space would be quieter than in an open space. ⋯ The sound level measured in the enclosed space was quieter than in the open space. The design of bed space should be taken into consideration when building a new NICU. Besides the design of NICU architecture, continuous monitoring of sound level in the NICU is important to maintain a quiet environment.