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Volume IV
Issue 6

              Weekly Updates in Pediatrics         February 6, 2013

EDITOR:  Jack Wolfsdorf, MD, FAAP                   

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Day 1 oxygenation index (OI) as a predictor of survival in congenital diaphragmatic hernia (CDH)

 

A small study of 24 CDH patients diagnosed antenatally had their OIs measured at 6, 12, 24 and 48 hours from birth and survival data compared to non-survivor information.

 

It appears that OI done serially during the first day of life on babies with CDH correlates well with subsequent survival.

 

Fio2: fraction of inspired oxygen

 

MAP: Mean airway pressure

 

PaO2: Partial pressure of arterial oxygen

 

OI = Fio2 x MAP x 100/PaO2

 

Azithromycin therapy for hospitalized infants with Bronchiolitis

 

A study of infants (< 12 months of age) diagnosed with viral bronchiolitis who required oxygen, and who were orally treated with either azithromycin or a placebo for 7 days, indicates that there appears to be no benefit to treating viral bronchiolitis in young infants with azithromycin.

 

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Intracranial pressure (ICP) monitoring in traumatic brain injury

While IPC monitoring is considered "standard of care" for severe traumatic brain injury, the efficacy of treatment based on monitoring has not apparently being rigorously assessed.

 

A multi center trial of 324 patients, 13 years or older with severe traumatic brain injury, compared randomly assigned groups to be managed on protocols based on ICP measurements, or on clinical/radiological examination, and measured functional and cognitive status outcomes at 3 and 6 months.

 

ICP monitoring in severe head injury does not appear to provide superior outcomes for functional and cognitive status, 6 months mortality, median length of stay in ICU, compared to a protocol utilizing clinical and imaging examinations.

 

Source: The New England Journal of Medicine

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Treatment of community-acquired pneumonia (CAP)

 

Current guidelines suggest treating non-complicated CAP in hospitalized infants (3 months - 2 years) with IV penicillin or ampicillin. As adherence to this regimen appears poor, a comparison study utilizing IV cefuroxime as the 1st-line treatment of choice was undertaken comparing a variety of different measured parameters.

 

In hospital IV cefuroxine treatment of CAP in previously healthy children appears to have no advantage over parenteral penicillin or ampicillin treatment.

 

Source:  Pediatric Pulmonology 

ED Propofol Use for migraine headaches  

 

To abort a severe migraine headache in children presenting to an ED, remains difficult.

 

A retrospective study of matched children discharged from a pediatric ED with a diagnosis of migraine headache was analyzed to investigate the outcome of a sub anesthetic dose of propofol vs. a standard migraine therapy (combined use of a non-steroidal anti inflammatory medication, diphenhydramine-benadryl - and prochlorperazine-compazine).

 

Popofol given in an ED for migraine headaches achieves significantly greater pain control, and a shorter ED stay than a standard migraine protocol, with apparently no significant adverse effects.

 

Parental stress in a NICU 

Mothers report more stress related to their infants appearance/behavior during their very premature infant's stay in the NICU than fathers do. Stress reduction intervention appear more effective for mothers-perhaps because fathers may required different stress related interventions.


Neonatal Intensive Care Unit
 

Photo Credit: ChildrensCentralCal.org