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Paediatric intensive care

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https://www.readbyqxmd.com/read/28641582/a-multicentre-randomised-controlled-trial-of-levetiracetam-versus-phenytoin-for-convulsive-status-epilepticus-in-children-protocol-convulsive-status-epilepticus-paediatric-trial-consept-a-predict-study
#1
Stuart R Dalziel, Jeremy Furyk, Megan Bonisch, Ed Oakley, Meredith Borland, Jocelyn Neutze, Susan Donath, Cynthia Sharpe, Simon Harvey, Andrew Davidson, Simon Craig, Natalie Phillips, Shane George, Arjun Rao, Nicholas Cheng, Michael Zhang, Kam Sinn, Amit Kochar, Christine Brabyn, Franz E Babl
BACKGROUND: Convulsive status epilepticus (CSE) is the most common life-threatening childhood neurological emergency. Despite this, there is a lack of high quality evidence supporting medication use after first line benzodiazepines, with current treatment protocols based solely on non-experimental evidence and expert opinion. The current standard of care, phenytoin, is only 60% effective, and associated with considerable adverse effects. A newer anti-convulsant, levetiracetam, can be given faster, is potentially more efficacious, with a more tolerable side effect profile...
June 22, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28640510/paediatric-intensive-care-nurses-decision-making-around-gastric-residual-volume-measurement
#2
Lyvonne N Tume, Lynne Latten, Lindsay Kenworthy
BACKGROUND: Measuring gastric residual volume (GRV) to guide enteral feeding is a common nursing practice in intensive care units, yet little evidence supports this practice. In addition, this practice has been shown to potentially contribute to inadequate energy delivery in intensive care, which remains a problem in critically ill children. AIMS: We aimed to explore paediatric intensive care nurses' decision-making surrounding this practice. METHODS: This is a cross-sectional electronic survey in a single mixed general and cardiac surgical PICU in the UK...
June 22, 2017: Nursing in Critical Care
https://www.readbyqxmd.com/read/28637741/the-closed-trial-clonidine-compared-with-midazolam-for-sedation-of-paediatric-patients-in-the-intensive-care-unit-study-protocol-for-a-multicentre-randomised-controlled-trial
#3
Antje Neubert, Manuel Alberto Baarslag, Monique van Dijk, Joost van Rosmalen, Joseph F Standing, Yucheng Sheng, Wolfgang Rascher, Deborah Roberts, Jackie Winslade, Louise Rawcliffe, Sara M Hanning, Tuuli Metsvaht, Viviana Giannuzzi, Peter Larsson, Pavla Pokorná, Alessandra Simonetti, Dick Tibboel
INTRODUCTION: Sedation is an essential part of paediatric critical care. Midazolam, often in combination with opioids, is the current gold standard drug. However, as it is a far-from-ideal agent, clonidine is increasingly being used in children. This drug is prescribed off-label for this indication, as many drugs in paediatrics are. Therefore, the CLOSED trial aims to provide data on the pharmacokinetics, safety and efficacy of clonidine for the sedation of mechanically ventilated patients in order to obtain a paediatric-use marketing authorisation...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28637734/pregnancy-specific-stress-fetoplacental-haemodynamics-and-neonatal-outcomes-in-women-with-small-for-gestational-age-pregnancies-a-secondary-analysis-of-the-multicentre-prospective-observational-trial-to-optimise-paediatric-health-in-intrauterine-growth-restriction
#4
Terri A Levine, Ruth E Grunau, Ricardo Segurado, Sean Daly, Michael P Geary, Mairead M Kennelly, Keelin O'Donoghue, Alyson Hunter, John J Morrison, Gerard Burke, Patrick Dicker, Elizabeth C Tully, Fergal D Malone, Fiona A Alderdice, Fionnuala M McAuliffe
OBJECTIVES: To examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive care unit admission and adverse obstetric outcomes in women with small for gestational age pregnancies. It was hypothesised that maternal pregnancy-specific stress would be associated with fetoplacental haemodynamics and neonatal outcomes...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28631089/targeted-temperature-management-in-the-icu-guidelines-from-a-french-expert-panel
#5
REVIEW
Alain Cariou, Jean-François Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28626956/markedly-increased-incidence-of-critical-illness-in-adults-with-type-1-diabetes
#6
R A Marrie, E A C Sellers, H Chen, R Fransoo, C N Bernstein, C A Hitchon, C A Peschken, A Garland
AIMS: To compare the incidence of and mortality after intensive care unit admission in adults with paediatric-onset Type 1 diabetes vs the general population. METHODS: Using population-based administrative data from Manitoba, Canada, we identified 814 cases of paediatric-onset Type 1 diabetes, and 3579 general population controls matched on age, sex and region of residence. We estimated the incidence of intensive care unit admission in adulthood, and compared the findings between populations using incidence rate ratios and multivariable Cox proportional hazards regression, adjusting for age, sex, comorbidity and socio-economic status...
June 19, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/28624987/congenital-cytomegalovirus-infection-in-central-germany-an-underestimated-risk
#7
Hannah Rütten, Anke Rissmann, Birgit Brett, Serban-Dan Costa, Birgit Doßow, Jacqueline Färber, Stefan Fest, Christiane Fritzsch, Anke Lux, Ilona Päge, Claudia Spillner, Anke Redlich
PURPOSE: This is the first study to determine the cytomegalovirus (CMV) seronegativity rate for women of childbearing age in Saxony-Anhalt and to determine the prevalence of clinically relevant congenital CMV (cCMV) infection in Central Germany, because there are no valid data available. METHODS: The retrospective study was undertaken between January 2005 and December 2015. For the first time in Germany, the following seven data sources were used to analyze the prevalence of clinically relevant cCMV infection and the rate of CMV seronegative women of childbearing age: CMV Screening in maternity unit, University Women's Hospital, Social Paediatrics Centre (SPC), Malformation Monitoring Centre (MMC), Newborn Hearing Screening (NHS), Neonatal Intensive Care Unit (NICU), and In-house Doctor Department...
June 17, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28610502/-my-job-challenges-me-every-day
#8
(no author information available yet)
After qualifying as a children's nurse at the end of 1990, Brian McGowan worked as a staff nurse in paediatric intensive care before moving on to work in burns and reconstructive surgery. He developed the clinical educator post in Belfast, Northern Ireland and, after a brief stint as a research nurse, was appointed as a lecturer at Ulster University in 2001. He and his wife Fiona have two children, Jack and Sarah.
June 14, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28606907/first-line-support-for-assistance-in-breathing-in-children-first-abc-protocol-for-a-multicentre-randomised-feasibility-trial-of-non-invasive-respiratory-support-in-critically-ill-children
#9
Padmanabhan Ramnarayan, Paula Lister, Troy Dominguez, Parviz Habibi, Naomi Edmonds, Ruth Canter, Paul Mouncey, Mark J Peters
INTRODUCTION: Over 18 000 children are admitted annually to UK paediatric intensive care units (PICUs), of whom nearly 75% receive respiratory support (invasive and/or non-invasive). Continuous positive airway pressure (CPAP) has traditionally been used to provide first-line non-invasive respiratory support (NRS) in PICUs; however, high-flow nasal cannula therapy (HFNC), a novel mode of NRS, has recently gained popularity despite the lack of high-quality trial evidence to support its effectiveness...
June 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28604209/a-literature-review-exploring-role-transitions-in-caring-for-a-child-requiring-long-term-ventilationin-recent-years-the-uk-and-other-high-income-countries-have-seen-an-increase-in-the-use-of-long-term-ventilation-ltv-in-paediatric-intensive-care-neupane-et
#10
Emily Goss
Government policies advocate that children should be cared for at home ( Noyes et al 2006 ), although medically stable LTV children often stay in hospital months longer than is necessary ( NHS England 2015 ). Research shows that parents of these children develop a dual role as parents and nurses, which leads to role conflict and ambiguity ( Hewitt-Taylor 2011 ).
June 12, 2017: Nursing Children and Young People
https://www.readbyqxmd.com/read/28602938/-let-s-bring-her-home-first-patient-characteristics-and-place-of-death-in-specialized-pediatric-palliative-home-care
#11
Hans Ulrich Bender, Martin Bernhard Riester, Gian Domenico Borasio, Monika Führer
CONTEXT: Specialized pediatric palliative home care (SPPHC) is the main pediatric palliative care structure in Germany. Detailed data on patient characteristics and care are sparse. Describing this population in terms of diagnoses and care needs is essential for further development of palliative care services for these patients. OBJECTIVES: We asked whether the population at our center (i) was representative compared with national mortality statistics; (ii) showed differences in the clinical course among the four diagnostic categories established by the Association for Children with Terminal Conditions/Royal College of Paediatrics and Child Health (ACT/RCPCH), and (iii) was different to published populations in pediatric palliative care regarding diagnoses, care and place of death...
June 7, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28601795/the-role-of-nurses-clinical-impression-in-the-first-assessment-of-children-at-the-emergency-department
#12
Joany M Zachariasse, Dominique van der Lee, Nienke Seiger, Evelien de Vos-Kerkhof, Rianne Oostenbrink, Henriëtte A Moll
OBJECTIVE: To assess the diagnostic value and determinants of nurses' clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED). DESIGN: Secondary analysis of a prospective cohort. SETTING AND PATIENTS: 6390 consecutive children <16 years of age presenting to a paediatric ED with a non-surgical chief complaint and complete data available. MAIN OUTCOME MEASURES: Diagnostic accuracy of nurses' clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission...
June 10, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28596289/paediatric-sepsis-the-under-recognised-killer-quality-improvement-initiative-of-outreach-teaching-in-paediatric-sepsis
#13
Claire Elizabeth Stewart, Trisha Radia, Kazim Ghafoor
Sepsis is the leading cause of child's death, yet it is well known that the rapid initiation of simple, timely interventions reduces morbidity and mortality. This paper shares our findings on the barriers doctors in training have identified to delivering such care. We also share the results of a pilot paediatric intensive care unit outreach teaching programme designed to directly address these highlighted concerns.
June 8, 2017: Archives of Disease in Childhood. Education and Practice Edition
https://www.readbyqxmd.com/read/28595614/a-multicentre-randomised-intervention-study-of-the-paediatric-early-warning-score-study-protocol-for-a-randomised-controlled-trial
#14
Claus Sixtus Jensen, Hanne Aagaard, Hanne Vebert Olesen, Hans Kirkegaard
BACKGROUND: Patients' evolving critical illness can be predicted and prevented. However, failure to identify the signs of critical illness and subsequent lack of appropriate action for patients developing acute and critical illness remain a problem. Challenges in assessing whether a child is critically ill may be due to children's often uncharacteristic symptoms of serious illness. Children may seem relatively unaffected until shortly before circulatory and respiratory failure and cardiac arrest...
June 8, 2017: Trials
https://www.readbyqxmd.com/read/28584925/peripherally-inserted-central-catheters-are-associated-with-lower-risk-of-bloodstream-infection-compared-with-central-venous-catheters-in-paediatric-intensive-care-patients-a-propensity-adjusted-analysis
#15
Ricardo Silveira Yamaguchi, Danilo Teixeira Noritomi, Natalia Viu Degaspare, Gabriela Ortega Cisternas Muñoz, Ana Paula Matos Porto, Silvia Figueiredo Costa, Otavio T Ranzani
PURPOSE: Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children. METHODS: We have carried out a retrospective multicentre study in four PICUs in São Paulo, Brazil...
June 5, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28572120/burden-of-disease-and-change-in-practice-in-critically-ill-infants-with-bronchiolitis
#16
Luregn J Schlapbach, Lahn Straney, Ben Gelbart, Janet Alexander, Donna Franklin, John Beca, Jennifer A Whitty, Subodh Ganu, Barry Wilkins, Anthony Slater, Elizabeth Croston, Simon Erickson, Andreas Schibler
Bronchiolitis represents the most common cause of non-elective admission to paediatric intensive care units (ICUs).We assessed changes in admission rate, respiratory support, and outcomes of infants <24 months with bronchiolitis admitted to ICU between 2002 and 2014 in Australia and New Zealand.During the study period, bronchiolitis was responsible for 9628 (27.6%) of 34 829 non-elective ICU admissions. The estimated population-based ICU admission rate due to bronchiolitis increased by 11.76 per 100 000 each year (95% CI 8...
June 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28569202/a-health-partnership-to-reduce-neonatal-mortality-in-four-hospitals-in-rwanda
#17
Placide Ntigurirwa, Kathy Mellor, Daniel Langer, Mari Evans, Emily Robertson, Lisine Tuyisenge, Alan Groves, Tom Lissauer
BACKGROUND: A health partnership to improve hospital based neonatal care in Rwanda to reduce neonatal mortality was requested by the Rwandan Ministry of Health. Although many health system improvements have been made, there is a severe shortage of health professionals with neonatal training. METHODS: Following a needs assessment, a health partnership grant for 2 years was obtained. A team of volunteer neonatologists and paediatricians, neonatal nurses, lactation consultants and technicians with experience in Rwanda or low-income countries was assembled...
June 1, 2017: Globalization and Health
https://www.readbyqxmd.com/read/28566361/effectiveness-of-%C3%AE-2agonists-for-sedation-in-paediatric-critical-care-study-protocol-for-a-retrospective-cohort-observational-study
#18
John C Hayden, Ian Dawkins, Cormac Breatnach, Finbarr P Leacy, June Foxton, Martina Healy, Gráinne Cousins, Paul J Gallagher, Dermot R Doherty
INTRODUCTION: Mechanically ventilated children in paediatric intensive care units are commonly administered analgesics and sedative agents to minimise pain and distress and facilitate cooperation with medical interventions. Opioids and benzodiazepines are the most common analgesic and sedative agents but have safety concerns. The α2 agonists clonidine and dexmedetomidine are alternative sedatives in use despite neither having robust evidence to support their use. Studies evaluating effectiveness of α2 agonists to date have not focused on sedation-based outcomes instead focusing on opioid-sparing properties and ventilation outcomes...
May 30, 2017: BMJ Open
https://www.readbyqxmd.com/read/28559125/respiratory-syncytial-virus-and-rhinovirus-related-bronchiolitis-in-children-aged-2-years-in-an-english-district-general-hospital
#19
S P Paul, A Mukherjee, T McAllister, M J Harvey, B A Clayton, P C Turner
BACKGROUND: Bronchiolitis is the most common reason for hospitalization in young children. In addition to respiratory syncytial virus (RSV), other viruses have been increasingly implicated. Guidance on testing has also changed. AIMS: To compare clinicopathological outcomes in young children admitted with bronchiolitis due to RSV in comparison with rhinovirus (RV), and identify associated risk/epidemiological factors. METHODS: Children aged less than two years admitted to hospital with a clinical diagnosis of bronchiolitis with positive results for either RSV or RV were included in this study...
May 3, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28557682/an-infant-presenting-with-failure-to-thrive-and-hyperkalaemia-owing-to-transient-pseudohypoaldosteronism-case-report
#20
Marieke De Clerck, Johan Vande Walle, Evelyn Dhont, Joke Dehoorne, Werner Keenswijk
A 3-month-old boy presented with failure to thrive and a history of a prenatally detected unilateral hydroureteronephrosis which was confirmed after birth. His growth and developmental milestones had been normal during the first 2 months but in the third month his appetite was poor with reduced intake but no vomiting. At presentation, his temperature was normal, there was mild dehydration and there was weight loss (his weight had decreased by 270 g in the past month). Haemoglobin was 11.9 g/dL, total white cell count 20...
May 30, 2017: Paediatrics and International Child Health
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