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Pediatric life-sustaining treatment

Guillaume Mortamet, Manoelle Kossorotoff, Amandine Baptiste, Nathalie Boddaert, Martin Castelle, Philippe Hubert, Fabrice Lesage, Sylvain Renolleau, Mehdi Oualha
BACKGROUND: The authors aimed to collect all brain magnetic resonance imaging (MRI) performed in critically ill children in the authors' medical pediatric intensive care unit over a 2-year period (2012-2013) to (1) describe the findings and (2) assess its contribution on practical patient care. METHODS: This is a single-center and retrospective study. All children without traumatic brain injury who underwent a brain MRI during pediatric intensive care unit stays were included...
September 2, 2016: Journal of Child Neurology
Stefan Taubenböck, Wolfgang Lederer, Marc Kaufmann, Gunnar Kroesen
OBJECTIVE: The objective of this study was to describe the pediatric emergencies encountered by the Christophorus-1 helicopter emergency medical service (HEMS) during a period of 2 years. METHODS: Emergency treatment of pediatric casualties by HEMS was evaluated at a helicopter base. Children up to 14 years who were treated by HEMS emergency physicians from Christophorus-1 during primary missions in the alpine region were retrospectively enrolled. RESULTS: Of the 1314 HEMS operations conducted during a 2-year investigation period, pediatric emergencies accounted for 114 (8...
September 2016: Wilderness & Environmental Medicine
Nancy A Carney, Gustavo J Petroni, Silvia B Luján, Nicolás M Ballarini, Gabriela A Faguaga, Hugo E M du Coudray, Amy E Huddleston, Gloria M Baggio, Juan M Becerra, Leonardo O Busso, Sureyya S Dikmen, Roberto Falcone, Mirta E García, Osvaldo R González Carrillo, Paula L Medici, Marta B Quaglino, Carina A Randisi, Silvia S Sáenz, Nancy R Temkin, Elida E Vanella
OBJECTIVE: To develop, in partnership with families of children with traumatic brain injury, a postdischarge intervention that is effective, simple, and sustainable. DESIGN: Randomized Controlled Trial. SETTING: Seven Level 1 Pediatric Trauma Centers in Argentina. PATIENTS: Persons less than 19 years of age admitted to one of the study hospitals with a diagnosis of severe, moderate, or complicated mild traumatic brain injury and were discharged alive...
July 2016: Pediatric Critical Care Medicine
Blair J Smart, R Sterling Haring, Anthony O Asemota, John W Scott, Joseph K Canner, Besma J Nejim, Benjamin P George, Hatim Alsulaim, Thomas D Kirsch, Eric B Schneider
BACKGROUND: American tackle football is the most popular high-energy impact sport in the United States, with approximately 9 million participants competing annually. Previous epidemiologic studies of football-related injuries have generally focused on specific geographic areas or pediatric age groups. Our study sought to examine patient characteristics and outcomes, including hospital charges, among athletes presenting for emergency department (ED) treatment of football-related injury across all age groups in a large nationally representative data set...
July 2016: American Journal of Emergency Medicine
Yen-Ni Hung, Tsang-Wu Liu, Dong-Tsamn Lin, Yueh-Chih Chen, Jen-Shi Chen, Siew Tzuh Tang
Aggressive life-sustaining treatments have the potential to be continued beyond benefit, but have seldom been systematically/nationally explored in pediatric cancer patients. Furthermore, factors predisposing children dying of cancer to receive life-sustaining treatments at end of life (EOL) have never been investigated in a population-based study. This population-based study explored determinants of receiving life-sustaining treatments in pediatric cancer patients' last month of life. For this retrospective cohort study, we used administrative data on 1603 Taiwanese pediatric cancer patients who died in 2001 to 2010...
April 2016: Medicine (Baltimore)
Carsten Müller, Konstantin A Krauth, Joachim Gerß, Dieter Rosenbaum
PURPOSE: Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing. METHODS: A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment...
September 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Angelo Polito, Cristiana Garisto, Chiara Pezzella, Claudia Iacoella, Paola E Cogo
OBJECTIVE: To determine epidemiology and proximate causes of death in a pediatric cardiac ICU in Southern Europe. DESIGN: Retrospective chart review. SETTING: Single-center institution. PATIENTS: We concurrently identified 57 consecutive patients who died prior to discharge from the cardiac ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Over the study period, there were 57 deaths for a combined mortality rate of 2...
May 2016: Pediatric Critical Care Medicine
Phillip Minar, Kimberly Jackson, Yi-Ting Tsai, Lee Denson
BACKGROUND: The treatment goal in Crohn's disease (CD) is to rapidly induce clinical remission to quickly improve health-related quality of life and reduce disease related complications. For many, the relapsing and remitting course is exceedingly turbulent as the lack of clinical symptoms may falsely reassure clinicians as silent intestinal inflammation further brews. Treat-to-Target is a novel therapeutic strategy rapidly gaining momentum to prevent disease-related complications by proactively, routinely and noninvasively monitoring biological activity (intestinal injury) during maintenance therapy...
March 2016: Inflammatory Bowel Diseases
Julia Desiree Lotz, Ralf J Jox, Christine Meurer, Gian Domenico Borasio, Monika Führer
BACKGROUND: Decisions about medical indication are a relevant problem in pediatrics. Difficulties arise from the high prognostic uncertainty, the decisional incapacity of many children, the importance of the family, and conflicts with parents. The objectivity of judgments about medical indication has been questioned. Yet, little is known about the factors pediatricians actually include in their decisions. AIM: Our aims were to investigate which factors pediatricians apply in deciding about medical indication, and how they manage conflicts with parents...
February 4, 2016: Palliative Medicine
Alexander Jurko, Milan Minarik, Tomas Jurko, Ingrid Tonhajzerova
The article summarizes current information on blood pressure changes in children during clinic visit. White coat as a general dressing of physicians and health care personnel has been widely accepted at the end of the 19th century. Two problems can be associated with the use of white coat: white coat phenomenon and white coat hypertension. Children often attribute pain and other unpleasant experience to the white coat and refuse afterwards cooperation with examinations. Definition of white coat hypertension in the literature is not uniform...
2016: Italian Journal of Pediatrics
Katherine Anagnostou, Andrew Clark
Peanut allergy is a common disease and the cause of severe, life-threatening allergic reactions and death. It is rarely outgrown; most pediatric patients carry the disease into adulthood. Peanut allergy poses a significant burden on the quality of life of sufferers and their families, which results mainly from the fear of accidental peanut ingestion but is also due to dietary and social restrictions. Current standard management involves avoidance advice, patient education, and provision of emergency rescue medication...
2016: Annual Review of Medicine
Heather Allewelt, Paul L Martin, Paul Szabolcs, Nelson Chao, Rebecca Buckley, Suhag Parikh
BACKGROUND: X-linked hyper-IgM syndrome (X-HIGM) due to mutations in the gene encoding CD40 ligand results in failure of Ig class switching and an increased propensity for recurrent sinopulmonary and other infections, and thus decreased life expectancy. Allogeneic hematopoietic stem cell transplantation (HSCT) is curative, but long-term follow-up data are limited. PROCEDURES: We conducted a retrospective analysis of seven patients who have undergone allogeneic HSCT for HIGM syndrome at Duke University Medical Center...
December 2015: Pediatric Blood & Cancer
V Gonzalo Morales
Pediatric intensive care is a relatively new medical specialty, which has experienced significant technological advances in recent years. These developments have led to a prolongation of the dying process, with additional suffering for patients and their families, creating complex situations, and often causing a painful life extension. The term, limitation of the therapeutic effort refers to the adequacy and/or proportionality of the treatment, trying to avoid obstinacy and futility. The English literature does not talk about limitation of treatments, but instead the terms, withholding or withdrawal of life-sustaining treatment, are used...
January 2015: Revista Chilena de Pediatría
Kunal Varshneya, Christine Carico, Alicia Ortega, Chirag G Patil
BACKGROUND: A high-fat, low-carbohydrate diet, often referred to as a ketogenic diet (KD), has been suggested to reduce frequency and severity of chronic pediatric and adult seizures. A hypoglycemic state, perpetuated by administration of a KD, has been hypothesized as a potential aid to the current standard treatments of high-grade gliomas. METHODS: To understand the effectiveness of the ketogenic diet as a therapy for malignant gliomas, studies analyzing components of a KD were reviewed...
February 2015: Curēus
Lori Brand Bateman, Nancy M Tofil, Marjorie Lee White, Leon S Dure, Jeffrey Michael Clair, Belinda L Needham
OBJECTIVE: The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. METHODS: Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. RESULTS: Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures...
July 12, 2015: American Journal of Hospice & Palliative Care
Elhanan Bar-On, Ehud Lebel, Nehemia Blumberg, Rami Sagi, Yitshak Kreiss
BACKGROUND: Following the 2010 earthquake in Haiti, the Israel Defense Forces Medical Corps deployed a field hospital in Port au Prince. The purpose of this study was to characterize the injuries sustained by the pediatric population treated in the hospital and examine the implications for planning deployment in future similar disasters. METHODS: Medical records of children treated in the hospital were reviewed and compared with medical records of the adult population...
July 2015: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Colm P F O'Donnell, Matteo Bruschettini, Peter G Davis, Colin J Morley, Lorenzo Moja, Maria Grazia Calevo, Simona Zappettini
BACKGROUND: At birth, infants' lungs are fluid-filled; this fluid must be replaced by air to allow for effective breathing. Some infants are judged to have inadequate breathing at birth and are resuscitated with positive pressure ventilation (PPV). Giving prolonged (sustained) inflations at the start of PPV may help clear lung fluid and establish gas volume in the lungs. OBJECTIVES: To assess the efficacy of initial sustained (> one second duration) lung inflation compared to standard inflations (≤ one second) in newly born infants receiving resuscitation with intermittent PPV...
2015: Cochrane Database of Systematic Reviews
Victoria Reynolds, Suzanne Meldrum, Karen Simmer, Shyan Vijayasekaran, Noel French
INTRODUCTION: Dysphonia is a potential long-term complication of preterm birth. Childhood voice disorders caused by vocal hyperfunction resolve with pubertal changes to the vocal mechanism in many cases. In extremely preterm children, whose voice quality is affected by supraglottic hyperfunction adapted secondary to underlying structural laryngeal pathology sustained during neonatal intubation, the prognosis is unknown. METHODS: A pilot study was conducted to assess the incidence and severity of dysphonia in children born at < 25 weeks' gestation...
December 2016: Logopedics, Phoniatrics, Vocology
Daniel J Lovell, Nicolino Ruperto, Richard Mouy, Eliana Paz, Nadina Rubio-Pérez, Clovis A Silva, Carlos Abud-Mendoza, Ruben Burgos-Vargas, Valeria Gerloni, Jose A Melo-Gomes, Claudia Saad-Magalhaes, J Chavez-Corrales, Christian Huemer, Alan Kivitz, Francisco J Blanco, Ivan Foeldvari, Michael Hofer, Hans-Iko Huppertz, Chantal Job Deslandre, Kirsten Minden, Marilynn Punaro, Alan J Block, Edward H Giannini, Alberto Martini
OBJECTIVE: The efficacy and safety of abatacept in patients with juvenile idiopathic arthritis (JIA) who experienced an inadequate response to disease-modifying antirheumatic drugs were previously established in a phase III study that included a 4-month open-label lead-in period, a 6-month double-blind withdrawal period, and a long-term extension (LTE) phase. The aim of this study was to present the safety, efficacy, and patient-reported outcomes of abatacept treatment (10 mg/kg every 4 weeks) during the LTE phase, for up to 7 years of followup...
October 2015: Arthritis & Rheumatology
Matthew Musielak, John McCall
Pain control is a major concern for patients suffering burns. The addition of bupivacaine to the donor site infiltration solution containing epinephrine could offer a safe and effective means to treat postanesthesia pain. Despite the addition of epinephrine to localize the effects, systemic absorption occurs, and there exists the possibility of inadvertent intravascular injection, with potential CNS and cardiac toxicity. The patient is a 6-year-old boy who sustained flame burns to bilateral lower extremities and buttocks...
July 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
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