Do Febrile Neonates with COVID-19 Need a Full Workup?
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This systematic review and meta-analysis of almost 4,000 febrile infants ≤ 90 days old diagnosed with COVID-19 indicated that these patients have a low prevalence of invasive bacterial infection (IBI), especially the subgroup >28 days old.
Oxy-PICU RCT – Oxygenation Targets in Ventilated Children
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A conservative (SpO2 88-92%) oxygenation target resulted in a small but significant greater probability of better outcome compared to a liberal (SpO2 >94%) target in children admitted to the PICU on invasive mechanical ventilation.
Source
Conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU): a UK multicentre, open, parallel-group, randomised clinical trial. Lancet. 2023 Dec 1:S0140-6736(23)01968-2. doi: 10.1016/S0140-6736(23)01968-2. Epub ahead of print.
Best Articles of 2023
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These are the top articles from 2023. Enjoy!
Direct Oral Challenge – Bye-Bye Penicillin Allergy!
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While removing low risk amoxicillin allergies in the pediatric ED setting by direct oral challenge (DOC) may be effective, numerous factors play a role in reliable implementation.
Source
Multisite Oral Amoxicillin Challenges During Pediatric Emergency Department Visits. JAMA Pediatr. 2023 Oct 2:e233659. doi: 10.1001/jamapediatrics.2023.3659. Online ahead of print.
Septic Kids (And Their Kidneys) Like Balanced Fluids
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The use of balanced crystalloid (PlasmaLyte A) rather than normal saline (0.9% sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock.
Source
Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial. Crit Care Med. 2023 Nov 1;51(11):1449-1460. doi: 10.1097/CCM.0000000000005952. Epub 2023 Jun 9.
Viruses LOWER Procalcitonin? Impact of Viral Infection on PCT in Febrile Infants
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Procalcitonin (PCT) is suppressed in young febrile infants in the presence of confirmed viral infection (CVI), which lowers its sensitivity to detect bacterial infection (BI). Infants meeting the AAP cutoff of 0.5 ng/mL, even in the presence of CVI, should undergo full diagnostic workup for BI.
Source
Effect of Viral Illness on Procalcitonin as a Predictor of Bacterial Infection in Febrile Infants. Hosp Pediatr. 2023 Nov 1;13(11):961-966. doi: 10.1542/hpeds.2022-007070.
Hemolytic Uremic Syndrome from Shiga-Toxin Producing E. coli
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This article provides a review of hemolytic-uremic syndrome (HUS) associated with Shiga toxin-producing Escherichia coli (STEC) infection. This condition, which disproportionately impacts children under five, is defined by thrombocytopenia, non-immune hemolytic anemia, and azotemia caused by thrombotic microangiopathy.
Updates on Neonatal Resuscitation from the American Heart Association
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The American Heart Association updated their neonatal resuscitation recommendations based on new evidence. The update focuses on umbilical cord management and best practices for administering positive pressure ventilation. Check-out these videos on neonatal resuscitation on Journal Feed!
Bulb vs Suction Gadget – Does Type of Nasal Suctioning Help Infants with Bronchiolitis?
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In a randomized control trial of discharged infants with bronchiolitis, enhanced home nasal suctioning with a mechanical device did not lead to reduced unscheduled health care revisits as compared to standard bulb suctioning.
Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(10):e2337810. Published 2023 Oct 2.
How to Manage Precipitous Delivery and Complications
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Although infrequent, precipitous vaginal deliveries in the ED occur and are associated with higher rates of maternal and fetal complications. Here's how you can be prepared to manage these deliveries and common complications.