Pediatric research
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Multicenter Study
Psychosocial and medical adversity associated with neonatal neurobehavior in infants born before 30 weeks gestation.
Psychosocial adversity escalates medical risk for poor outcomes in infants born <30 weeks gestation. Neonatal neurobehavior and maternal psychological and socioenvironmental assessments may identify the earliest specific intervention needs. We hypothesized that maternal prenatal anxiety, depression, and adverse medical and socioenvironmental conditions would be associated with less optimal neonatal neurobehavior at neonatal intensive care unit (NICU) discharge. ⋯ Combined information from the observed associations among adverse prenatal maternal medical and psychosocial conditions, and neonatal complications may assist in the early identification of infants at elevated neurobehavioral risk.
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Multicenter Study
Management and outcomes of childhood Goodpasture's disease.
BackgroundIn an attempt to improve knowledge about childhood Goodpasture's disease, we performed a retrospective analysis of patients with Goodpasture's disease from several pediatric nephrology centers. MethodsWe analyzed the responses to 27 questions that elicited information about the following: incidence, demographics, patient history and clinical presentation, diagnostics performed, acute and chronic therapy, course of disease, and outcome. ResultsGoodpasture's disease, which is extremely rare in this age group, may manifest in 2-year-old toddlers and does not typically present with pulmonary findings before puberty. ⋯ Nearly 50% of children progressed to end-stage renal disease. However, long-term outcome in children might be better than in adults. Aggressive immunosuppressive therapy might be necessary for all affected children, even in patients who require renal replacement therapy or have severe biopsy findings.
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Multicenter Study
Accuracy of weight estimation by the Broselow tape is substantially improved by including a visual assessment of body habitus.
BackgroundThe Broselow tape (BT) has been shown to estimate weight poorly primarily because of variations in body habitus. The manufacturers have suggested that a visual assessment of habitus may be used to increase its performance. This study evaluated the ability of habitus-modified models to improve the accuracy thereof. ⋯ The best dosing model improved dosing accuracy (doses within 10% of correct dose) from 52.0 to 69.6% and reduced critical dosing errors from 16.5 to 4.3%. The best weight-estimation model improved accuracy from 59.4 to 81.9% and reduced critical errors from 11.8 to 1.9%. ConclusionThe accuracy of the BT as a drug-dosing and weight-estimation device can be substantially improved by including an appraisal of body habitus in the methodology.
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Randomized Controlled Trial Multicenter Study Comparative Study
Effect of inborn vs. outborn delivery on neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy: secondary analyses of the NICHD whole-body cooling trial.
The effect of birth location on hypothermia-related outcomes has not been rigorously examined in the literature. In this study, we determined whether birth location had an impact on the benefits of whole-body cooling to 33.5 °C for 72 h in term infants (n = 208) with hypoxic-ischemic encephalopathy (HIE) who participated in the Neonatal Research Network (NRN) randomized controlled trial. ⋯ Although limited by sample size and some differences in baseline characteristics, the study showed that birth location does not appear to modify the treatment effect of hypothermia after HIE.
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Multicenter Study Comparative Study
Cytokine screening identifies NICU patients with Gram-negative bacteremia.
Biomarkers and physiomarkers may be useful adjunct tests for sepsis detection in neonatal intensive care unit (NICU) patients. We studied whether measuring plasma cytokines at the time of suspected sepsis could identify patients with bacteremia in centers in which patients were undergoing continuous physiomarker screening using a heart rate characteristics (HRC) index monitor. ⋯ Seven cytokines were measured in 226 plasma samples from patients >3 d old with sepsis suspected based on clinical signs, abnormal HRC index, or both. Cases were classified as SRO, clinical sepsis (CS), GPBC, or GNB.