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Sedation and analgesia for critically ill children

Paediatrics and Child Health - Mon, 04/15/2019 - 00:00
Effective analgesia and sedation in the paediatric intensive care unit (PICU) encompasses the provision of physical comfort and caring for the psychological well-being of critically ill children. In the UK the most commonly used sedative and analgesic agents for critically ill children are midazolam and either morphine or fentanyl. Consensus clinical practice guidelines for the provision of sedation and analgesia in critically ill children were published in 2006 by the UK Paediatric Intensive Care Society, and an ESPNIC position statement on clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children was published in 2016: Despite this, considerable variation in practice persists.
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Preterm patent ductus arteriosus: what the research tells us

Paediatrics and Child Health - Fri, 04/12/2019 - 00:00
Ductus arteriosus is a fetal blood vessel that connects two elastic arteries, pulmonary artery and aorta, with different resistances. It only becomes pathological if it fails to close after birth. The clinical features of patent ductus arteriosus (PDA) depend upon the gestation at birth, severity of lung disease and the postnatal age of the newborn. In premature infants, PDA is associated with significant morbidity and mortality. However, the current literature on treatment of PDA does not report any improvement in long-term neonatal outcomes.
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The role of ECMO in neonatal and paediatric patients

Paediatrics and Child Health - Fri, 04/12/2019 - 00:00
ECMO or extracorporeal membrane oxygenation has now been part of healthcare for over 40 years. During that time, changes in circuit technology have resulted in improved survival and have facilitated the use of ECMO in more challenging patient groups in whom ECMO was previously considered to be contraindicated. Further advances have allowed ECMO to progress out of the specialist centres and nearer to patients, in the form of mobile ECMO. Patient selection remains key to a successful outcome since ECMO is a supportive therapy utilised whilst waiting for a reversible condition to resolve through other treatment strategies.
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Mechanism of action of inotropes in neonates

Paediatrics and Child Health - Sat, 04/06/2019 - 00:00
Whilst inotropes have been used in the neonatal intensive care unit (NICU) for over 50 years, debate on the optimal management of neonatal hypotension continues. The complex biochemical processes involved often mean these medications produce effects which seem to be contrary to expectations. The changing haemodynamics during the transitional phase of the newborn period, along with the gestation related structural and functional immaturity of the cardiovascular system, makes choosing an inotrope difficult.
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Antibiotic stewardship in the neonatal intensive care unit

Paediatrics and Child Health - Fri, 04/05/2019 - 00:00
Antibiotic stewardship (ABS) refers to the coordinated interventions to appropriately prescribe and administer the most pathogen-specific, narrow-spectrum antibiotic regimens, in the correct doses, for the appropriate duration, and continually evaluate prescriber and administration compliance. The main historical driver for ABS has been antibiotic resistance, which is fuelled by antibiotic therapy. Additionally, short and long term consequences of antibiotic therapy on the developing immune system have emerged as further specific hazards of antibiotic exposure in neonates.
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Neonatal sepsis

Paediatrics and Child Health - Thu, 04/04/2019 - 00:00
Neonatal sepsis is a cause of significant mortality and morbidity. It can be early (less than 72 h) or late onset (more than 72 h age). Group B Streptococcus (GBS) is the leading cause of early onset neonatal sepsis (EONS). Risk factors include maternal sepsis, prolonged rupture of membranes, chorioamnionitis and GBS colonization. Risk-based predictive models are used to identify and screen infants. Late onset neonatal sepsis (LONS) is largely caused by gram positive organisms. Risks for LONS include prematurity, low birth weight and common neonatal interventions and procedures.
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Editorial Board

Paediatrics and Child Health - Mon, 04/01/2019 - 00:00
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Self-assessment

Paediatrics and Child Health - Sat, 03/30/2019 - 00:00
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LGBT Youth, Sex Trafficking, and the Nurse Practitioner's Role

Journal of Pediatric Health Care - Fri, 03/29/2019 - 00:00
Sex trafficking is one of the most profitable forms of transnational crimes (U.S. Department of Homeland Security, 2018). Sex traffickers prey on vulnerable populations to commission these crimes. Lesbian, gay, bisexual, and transgender (LGBT) youth are subject to adversity from an early age, which leaves them especially vulnerable to sex traffickers. Health care providers lack the resources, education, protocols, and policies required to protect these youth members of society. This literature review explores LGBT youth's risk factors for becoming a trafficked child, a provider's role in protecting and treating these youth, the legalities of a provider reporting sex trafficking, and research opportunities pertinent to these issues.
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Case Report: Neuropsychiatric Symptoms in PKU Disease

Journal of Pediatric Health Care - Fri, 03/29/2019 - 00:00
Phenylketonuria is a rare inborn error of metabolism. The build-up of phenylalanine in the blood and body tissues can have significant impact on the brain's development. High phenylalanine levels have been shown to be associated with an increase in neuropsychiatric symptoms, including mood, anxiety, and attention problems; decreased social competence; and low self-esteem. This case report highlights such a presentation in an adolescent with phenylketonuria.
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Management of the potential paediatric organ donor

Paediatrics and Child Health - Thu, 03/28/2019 - 00:00
Paediatric organ donors remain a critically scarce and precious resource at a time of ever increasing demand for donor organs. The early recognition and management of the potential paediatric organ donor can increase the number of viable donor organs available. Managing the cardiovascular instability that follows brain death requires a systematic intensive care approach in order to preserve viability of the potential donor organs. Careful consideration of the fluid status and inotrope requirements in addition to supplementation of the hormonal and haematological axes helps to optimize tissue perfusion.
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Nurse-Led Telephone Follow-Up to Improve Parent Promotion of Healthy Behaviors in Young Children With Motivational Interviewing Techniques

Journal of Pediatric Health Care - Wed, 03/27/2019 - 00:00
The American Academy of Pediatrics (AAP) recommends primary care–based health promotion for obesity prevention at all visits, focusing on nutrition and activity.
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Fifteen-minute consultation: Childhood burns: inflicted, neglect or accidental

Stephen Mullen
Mar 20, 2019; 104:74-78
BEST PRACTICE AND FIFTEEN-MINUTE CONSULTATIONS
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Outcomes of a Brief Cognitive Skills-Based Intervention (COPE) for Adolescents in the Primary Care Setting

Journal of Pediatric Health Care - Wed, 03/20/2019 - 00:00
Approximately 25% of adolescents have behavioral disorders, yet few receive treatment. Primary care (PC) screening for depression and anxiety is recommended; however treatments, such as cognitive behavioral therapy (CBT), are rarely available in PC settings. Our aim was to determine whether the use of a CBT-based intervention (COPE for Teens) is associated with improved outcomes on measures of depression and anxiety, and to understand the patient experience.
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The Pediatric Procedural Holistic Comfort Assessment: A Feasibility Study

Journal of Pediatric Health Care - Tue, 03/19/2019 - 00:00
Holistic comfort is an essential component of pediatric procedural care. However, a main gap in the literature is the ability to measure this. In this study, researchers report the feasibility of implementing a newly developed psychosocial measurement instrument in clinical practice.
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Relationships Between Adolescent Stress, Depressive Symptoms, and Sexual Risk Behavior in Young Adulthood: A Structural Equation Modeling Analysis

Journal of Pediatric Health Care - Tue, 03/19/2019 - 00:00
This study examined longitudinal associations between stressful life events and depressive symptoms, assessed during two time points of adolescence, and sexual risk behavior, assessed during young adulthood.
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Traditional and Nontraditional Collaborations to Improve Population Health Using Geospatial Information SystemMaps: Analysis of the Opioid Crisis

Journal of Pediatric Health Care - Tue, 03/19/2019 - 00:00
The study aims were to analyze interprofessional practice collaborations among traditional and nontraditional health care providers and to educate nurse practitioner preceptors and students on population health, specifically, implementation of geospatial information system (GIS) maps and the correlation with the opioid crisis.
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Screening for the Social and Behavioral Determinants of Health at a School-Based Clinic

Journal of Pediatric Health Care - Tue, 03/19/2019 - 00:00
Screening and providing interventions for adverse social and behavioral determinants of health (SBDOHs) can potentially improve health outcomes. The purpose of this project was to evaluate the feasibility of screening for SBDOHs during an episodic visit at a school-based clinic and to evaluate whether it increased identification of and intervention for adverse SBDOHs.
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Respiratory support in children

Paediatrics and Child Health - Fri, 03/15/2019 - 00:00
Respiratory failure is defined by the inability of the respiratory system to adequately deliver oxygen or remove carbon dioxide from the pulmonary circulation resulting in hypoxemia, hypercapnia or both. A wide variety of disease processes can lead to respiratory failure in children. Multiple interventions can support the paediatric patient with respiratory failure, from simple oxygen delivery devices to high frequency oscillatory ventilation and extracorporeal membrane oxygenation. This article will review available devices to improve oxygenation and ventilation, their advantages and disadvantages, and help guide physicians in the management of children with respiratory failure.
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