American journal of diseases of children (1960)
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Night-float systems have recently been proposed as a way to reduce resident stress resulting from irregular sleep patterns. We prospectively evaluated the effects of a night-float system in which designated residents relieved on-call senior residents and interns of routine admissions of patients in medically stable condition during the late-night period (11 PM to 7 AM). Senior residents (3.7 vs 2.4 hours) and interns (3.7 vs 3.2 hours) reported sleeping more under the night-float system than under the traditional system. ⋯ When educators disagreed with residents, the most common reasons were the patient's potential educational value or medical instability. The night-float system did not affect interns' ratings of the educational value of late-night admissions or parents' ratings of satisfaction with medical care. We conclude that the night-float system can increase resident sleep with little cost to parent satisfaction, but standards for selective use may be needed to avoid compromising patient care and resident education.
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Randomized Controlled Trial Clinical Trial
Benefits of a lower hematocrit during extracorporeal membrane oxygenation?
To determine the possible benefits of maintaining a lower hematocrit than that normally used (0.35 vs 0.45) in neonates treated with extracorporeal membrane oxygenation. ⋯ Neonates' hematocrits can be maintained safely at 0.35 during extracorporeal membrane oxygenation with significantly less exposure to packed red blood cells and less clotting in the circuit.
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The records of 97 infants and children with pneumococcal meningitis treated in Dallas, Tex, from 1984 to 1990 were reviewed to determine whether corticosteroid therapy improved disease outcome as has been demonstrated in patients with Haemophilus meningitis. Forty-one patients received corticosteroid therapy, 39 of whom were given dexamethasone in the conventional 4-day regimen. There were no significant differences in the demographic and clinical characteristics of steroid- and non-steroid-treated patients. ⋯ Among 86 survivors examined, significantly fewer steroid-treated patients had an adverse neurologic long-term outcome, including hearing impairment, compared with non-steroid-treated patients (four of 35 vs 14 of 43). This was also true for those patients with overwhelming meningeal infection. We believe that corticosteroid therapy is also beneficial in infants and children with pneumococcal meningitis.
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Review Case Reports
Commotio cordis. The single, most common cause of traumatic death in youth baseball.
Two cases of blunt chest trauma caused by a baseball are reported, including one death. At least one of these was in consequence of cardiac concussion or commotio cordis, an entity not described in teh pediatric literature. Concussion of the heart is a functional injury, in contrast to cardiac contusion or cardiac rupture, which pertains to structural injury. ⋯ There appears to be an increased pediatric susceptibility to this type of injury. Unfortunately, these cases are quite resistant to resuscitative therapy. Devices and techniques for primary and secondary prevention exist, but have yet to be systematically verified and implemented.
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Pulse oximetry is a valuable, noninvasive technique for assessing oxygen saturation that has gained wide clinical acceptance despite little available information concerning normal values in the newborn, especially at an altitude different than sea level. We performed serial pulse oximetry studies on 150 term, appropriate-weight-for-gestational-age, clinically healthy infants at an altitude of 1610 m (5280 ft) at 24 to 48 hours, 1 month, and 3 months of age to define a reference range for oxygen saturation as a guideline in clinical care. ⋯ With increasing postnatal age, there is a tendency for increased oxygen saturation during the awake states to 93% to 94%, while oxygen saturation during sleep stays the same or even decreases slightly. The lower end of the reference range (2 SDs below the mean) is as low as 85% during feeding at 24 to 48 hours of age, and as low as 86% during quiet sleep at 1 and 3 months of age, with 88% to 89% the lower limit in other activities at all ages.