Minerva pediatrica
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Therapeutic hypothermia (whole body or selective head cooling) is becoming standard of care for brain injury in infants with perinatal hypoxic ischemic encephalopathy (HIE). Brain cooling reduces the rate of apoptosis and early necrosis, reduces cerebral metabolic rate and the release of nitric oxide and free radicals. Animal models of perinatal brain injury show histological and functional improvement due to of early hypothermia. ⋯ Recent meta-analyses and systematic reviews in human neonates show reduction in mortality and long-term neurodevelopmental disability at 12-24 months of age, with more favourable effects in the less severe forms of HIE. The authors describe their experience in 53 term newborns with moderate-severe HIE treated with whole body cooling between 2001 and 2009, and studied with magnetic resonance imaging (MRI) and general movements (GMs) assessment. The creation of a network connecting the Neonatal Intensive Care Unit with the level I-II hospitals of the reference area, as part of regional network, is of paramount importance to enroll potential candidates and to start therapeutic hypothermia within optimal time window.
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There are many sources of pain for children in the Pediatric Intensive Care Unit (PICU) including underlying pathophysiological processes, surgery, and therapeutic procedures. Historically pain has been a common recollection of children discharged from PICU, and in the past pain has been undertreated in critically ill children. Whilst it has long been recognized that untreated pain can have immediate consequences, recent research has demonstrated that the experience of pain in early life can have significant consequences on sensory processing and the response to pain in later life. ⋯ Clinical guidelines exist for the management of analgesia in critically ill children. Pain should be regularly assessed using an appropriate tool and a therapeutic plan for pain management should routinely be established and regularly reviewed as the clinical condition of the patient changes. Effective analgesia should be provided through the application of multimodal and pre-emptive analgesia utilising both pharmacological and non-pharmacological techniques.
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The aim of this study was to determine the role of parents after extubation of their children affected by Spinal Muscular Atrophy Type 1 (SMA1) in the Pediatric Intensive Care Unit. Currently, children affected by SMA1 are often treated with non-invasive mechanical ventilation and mechanical support of cough. During the first two or three years of life they frequently present severe respiratory failure requiring intubation. Extubation may be at severe risk of failure even because of inadequate care. ⋯ The presence of parents after extubation of SMA1 patients is important for the success of the procedure; otherwise, the presence of a skilled nurse is needed, with a nurse-patient ratio of 1:1.
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The aim of this study was to assess the validity of Narhinel method in the prevention of recurrences of viral rhinitis and of any associated sequelae, in particular acute otitis of the middle ear (AOM) and acute rhinosinusitis (AR). ⋯ In acute rhinites (common cold) both medical devices are effective nevertheless Narhinel method is valid and shows better results in AOM and AR. Moreover Narhinel method was also more appreciated by parents than physiological saline solution. According to authors' experience, the Narhinel method is safe and its performance is valid in the prevention of AOM and AR in children.