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Calgary, Canada

Rabi Y.,University of Calgary | Singhal N.,University of Calgary | Nettel-Aguirre A.,Alberta Childrens Hospital
Pediatrics | Year: 2011

OBJECTIVE: We conducted a blinded, prospective, randomized control trial to determine which oxygen-titration strategy was most effective at achieving and maintaining oxygen saturations of 85% to 92% during delivery-room resuscitation. METHODS: Infants born at 32 weeks' gestation or less were resuscitated either with a static concentration of 100% oxygen (high-oxygen group) or using an oxygen-titration strategy starting from a concentration of 100% (moderate-oxygen group), or 21% oxygen (low-oxygen group). In the moderate- and low-oxygen groups, the oxygen concentration was adjusted by 20% every 15 seconds to reach a target oxygen saturation range of 85% to 92%. Treatment failure was defined as a heart rate slower than 100 beats per minute for longer than 30 seconds. RESULTS: The moderate-oxygen group spent a greater proportion of time in the target oxygen saturation range (mean: 0.21 [95% confidence interval: 0.16-0.26]) than the high-oxygen group (mean: 0.11 [95% confidence interval: 0.09-0.14]). Infants in the low-oxygen group were 8 times more likely to meet the criteria for treatment failure than those in the high-oxygen group (24% vs 3%; P=.022). The 3 groups did not differ significantly in the time to reach the target oxygen saturation range. CONCLUSIONS: Titrating from an initial oxygen concentration of 100% was more effective than giving a static concentration of 100% oxygen in maintaining preterm infants in a target oxygen saturation range. Initiating resuscitation with 21% oxygen resulted in a high treatmentfailure rate. Copyright © 2011 by the American Academy of Pediatrics. Source

Twilt M.,Birmingham Childrens Hospital | Benseler S.,Alberta Childrens Hospital
Current Opinion in Rheumatology | Year: 2014

PURPOSE OF REVIEW: The purpose of this review is to discuss the most recent published literature in childhood antineutrophil cytoplasmic antibodies (ANCA) associated vasculitides and to identify the important issues arisen in the adult literature. This review will discuss the literature on new treatment regimens and outcome measurements. RECENT FINDINGS: Antineutrophil cytoplasmic antibodies are a hallmark of ANCA-associated vasculitides and are likely to be integral to the pathogenesis and have recently become a therapeutic target. In paediatrics, international collaborations have led to the development of childhood classification criteria, advanced understanding of the clinical phenotypes of childhood ANCA-associated vasculitides and improved our ability to capture disease severity, activity and damage. Treatment safety and efficacy data are mainly derived from adult studies and there is a lack of specific paediatric data. There are small case series on the efficacy of adult regimens in paediatric patients. SUMMARY: International multicentre studies are necessary for the evaluation of efficacy and safety of adult-derived treatment regimens in childhood ANCA-associated vasculitides. Specific childhood outcome measurements are recently developed for research purposes and enhance clinical care. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins. Source

Morgan L.A.,Ann and Robert H. Lurie Childrens Hospital of Chicago | Buchhalter J.,Alberta Childrens Hospital
Pediatric Neurology | Year: 2015

Abstract Background Paroxysmal nonepileptic events are common in children. Events with a psychological basis, historically referred to as pseudoseizures, are a large subset of paroxysmal nonepileptic events. Methods A review of the relevant pediatric and adult literature was performed. Results It was found that these events have many semioloigc features similar to epileptic events and can be challenging to correctly identify. The use of a detailed history in combination with video encephalography and knowledge of psychogenic paroxysmal nonepileptic events will facilitate making the correct diagnosis. Paroxysmal nonepileptic events are important to identify as comorbid disorders such as depression, anxiety disorder, family discord, and school issues are frequent. In addition, prior sexual, emotional, and/or physical abuse may be present. Conclusions Pediatric patients with paroxysmal nonepileptic events need to be recognized in order to avoid unnecessary antiepileptic drugs and emergency department or hospital visits and to facilitate appropriate psychological intervention to address the underlying etiologies. This review will focus on evaluation and identification of paroxysmal nonepileptic events, in addition to reviewing the various comorbidities, effective treatments, and outcomes for pediatric patients. The key differences between pediatric and adult patients with paroxysmal nonepileptic events are addressed. © 2015 Elsevier Inc. Source

Perinatal stroke is presented as the ideal human model of developmental neuroplasticity. The precise timing, mechanisms, and locations of specific perinatal stroke diseases provide common examples of well defined, focal, perinatal brain injuries. Motor disability (hemiparetic cerebral palsy) constitutes the primary adverse outcome and the focus of models explaining how motor systems develop in health and after early injury. Combining basic science animal work with human applied technology (functional magnetic resonance imaging, diffusion tensor imaging, and transcranial magnetic stimulation), a model of plastic motor development after perinatal stroke is presented. Potential central therapeutic targets are revealed. The means to measure and modulate these targets, including evidence-based rehabilitation therapies and noninvasive brain stimulation, are suggested. Implications for clinical trials and future directions are discussed. © 2013 Elsevier Inc. All rights reserved. Source

Guilfoyle F.J.,Alberta Childrens Hospital
CJEM : Canadian journal of emergency medical care = JCMU : journal canadien de soins médicaux d'urgence | Year: 2011

To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED). This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded. There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n=115, 35%), trauma (n=50, 15%), sepsis (n=36, 11%), seizures (n=37, 11%), and cardiac disease (n=22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions. Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed. Source

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