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Small Children (small + child)

Distribution by Scientific Domains

Medical Sciences	89%
Business, Economics, Finance and Accounting	4%
3 Other Domains	7%

Distribution within Medical Sciences

Anesthesia & Pain Management	21%
Pediatrics	15%
Cardiovascular Disease	13%
Transplantation	4%
12 Other Subdomains	47%

Selected Abstracts

Noncatheter-Based Delivery of a Single-Chamber Lumenless Pacing Lead in Small Children

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2007
DAMIEN KENNY M.B.Ch.B., M.R.C.P.C.H.
Objectives:The model 3830 lead (SelectSecureÔ Medtronic, Minneapolis, MN, USA) is a bipolar, fixed-screw, 4.1-F pacing lead designed for site-selective pacing. Implantation is usually performed using an 8-F deflectable catheter system. This catheter is not ideal for smaller children because of both the sheath size and the relatively large deflected curves. We describe a simpler noncatheter-based delivery system in seven children. Methods:A 4.1-F SelectSecure lead was introduced via a 5-F SafeSheath (Thomas Medical, Malvern, PA, USA) placed in the left subclavian vein. The SelectSecure lead was passed into the inferior vena cava (IVC) and a loop created, which was then withdrawn into the right atrium. Once in position, the lead was screwed into the myocardium, the SafeSheath was peeled off, and the lead connected to the generator. Results:From March 2005 until September 2006, five right atrial leads and two right ventricular leads were implanted in seven patients (six female) with a median weight of 15 kg (8.1,19.4). All leads were successfully placed with excellent pacing thresholds. The median screening time was 7.1 minutes (4.8,11.4) with a median radiation dose of 83 cGy cm2. There were no procedural complications and no lead displacements seen on a median follow-up of 10 months. Conclusions:Delivery of the 4.1-F SelectSecure pacing lead to the right heart is possible using a noncatheter-based delivery system. This is effective and safe and does not require the use of a larger delivery system. This allows these thin isodiametric pacing leads to be used advantageously in small children. [source]

ICD Implantation in Infants and Small Children: The Extracardiac Technique

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2006
THOMAS KRIEBEL M.D.
Background: There is no clear methodology for implantation of an internal cardioverter-defibrillator (ICD) in infants and small children. The aim of this study was to assess efficacy and safety of an extracardiac ICD implantation technique in pediatric patients. Patients and Methods: An extracardiac ICD system was implanted in eight patients (age: 0.3,8 years; body weight: 4,29 kg). Under fluoroscopic guidance a defibrillator lead was tunneled subcutaneously starting from the anterior axillar line along the course of the 6th rib until almost reaching the vertebral column. After a partial inferior sternotomy, bipolar steroid-eluting sensing and pacing leads were sutured to the atrial wall (n = 2) and to the anterior wall of the right ventricle (n = 8). The ICD device was implanted as "active can" in the upper abdomen. Sensing, pacing, and defibrillation thresholds (DFTs) as well as impedances were verified intraoperatively and 3 months later, respectively. Results: In seven of eight patients, intraoperative DFT between subcutaneous lead and device was <15 J. In the eighth patient ICD implantation was technically not feasible due to a DFT >20 J. During follow-up (mean 14.5 months) appropriate and effective ICD discharges were noted in two patients. DFT remained stable after 3 months in four of six patients retested. A revision was required in one patient due to lead migration and in another patient due to a lead break. Conclusions: In infants and small children, extracardiac ICD implantation was technically feasible. Experience and follow-up are still limited. The course of the DFT is unknown, facing further growth of the patients. [source]

Danish parents' experiences when their new born or critically ill small child is transferred to the PICU , a qualitative study

NURSING IN CRITICAL CARE, Issue 2 2005
Elisabeth OC Hall
Abstract The aim of this study was to describe Danish parents' experiences when their newborn or small child was critically ill. Thirteen parents were interviewed. Data were analysed using qualitative content analysis. The child's transfer to the paediatric intensive care unit (PICU) meant either help or death for the parents. The back transfer was experienced as joy and despair. The parents had confidence in most nurses, and they were kind, helpful, informative and capable. Less capable and distressed nurses made the parents feel uncomfortable and insecure. Parents need help and support during their child's transfer to and from the PICU. Critical care nurses have to discuss the policy of family-centred care. [source]

Computer-assisted 2-D agarose electrophoresis of Haemophilus influenzae type B meningitis vaccines and analysis of polydisperse particle populations in the size range of viruses: A review

ELECTROPHORESIS, Issue 4 2007
Dietmar Tietz Dr.
Abstract When protein,polysaccharide conjugated vaccines were first developed for the immunization of small children against meningitis caused by infection with Haemophilus influenzae type b (Hib), the vaccine preparations varied in immunogenicity. Testing for immunogenicity was time-consuming and alternative analytical procedures for determining vaccine quality were unsatisfactory. For example, due to the very high molecular weight of the vaccine particles, immunogens could only be physically characterized as a fraction in the void volume of Sepharose gel filtration. In search of better analytical methods, a computer-assisted electrophoretic technique for analyzing such vaccines was developed in the period from 1983 to 1995. This new approach made it possible to analyze highly negatively charged particles as large as or larger than intact viruses. 2-D gel patterns were generated that varied depending on the conditions of the particular vaccine preparation and were therefore characteristic of each vaccine sample. Thus, vaccine particle populations with a continuous size variation over a wide range (polydisperse) could be characterized according to size and free mobility (related to particle surface net charge density). These advances are reviewed in this article, since the developed methods are still a promising tool for vaccine quality control and for predicting immunogen effectiveness in the production of vaccines. The technique is potentially beneficial for Hib immunogens and other high-molecular-mass vaccines. Additional biomedical applications for this nondenaturing electrophoretic technique are briefly discussed and detailed information about computational and mathematical procedures and theoretical aspects is provided in the Appendices. [source]

A general model for predicting brown tree snake capture rates

ENVIRONMETRICS, Issue 3 2003
Richard M. Engeman
Abstract The inadvertent introduction of the brown tree snake (Boiga irregularis) to Guam has resulted in the extirpation of most of the island's native terrestrial vertebrates, has presented a health hazard to small children, and also has produced economic problems. Trapping around ports and other cargo staging areas is central to a program designed to deter dispersal of the species. Sequential trapping of smaller plots is also being used to clear larger areas of snakes in preparation for endangered species reintroductions. Traps and trapping personnel are limited resources, which places a premium on the ability to plan the deployment of trapping efforts. In a series of previous trapping studies, data on brown tree snake removal from forested plots was found to be well modeled by exponential decay functions. For the present article, we considered a variety of model forms and estimation procedures, and used capture data from individual plots as random subjects to produce a general random coefficients model for making predictions of brown tree snake capture rates. The best model was an exponential decay with positive asymptote produced using nonlinear mixed model estimation where variability among plots was introduced through the scale and asymptote parameters. Practical predictive abilities were used in model evaluation so that a manager could project capture rates in a plot after a period of time, or project the amount of time required for trapping to reduce capture rates to a desired level. The model should provide managers with a tool for optimizing the allocation of limited trapping resources. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Clinical safety surveillance study of the safety and efficacy of long-term home treatment with ReFacto® utilizing a computer-aided diary: a Nordic multicentre study

HAEMOPHILIA, Issue 1 2009
P. PETRINI
Summary., A Nordic multicentre, open-label, non-interventional postmarketing surveillance study was carried out during a period of 24 months evaluating safety and efficacy of ReFacto as prophylactic or on-demand replacement therapy in patients with haemophilia A treated by self-medication. Fifty-seven patients were enrolled and studied for safety; efficacy was evaluated in 39 patients who received ReFacto for 24 months and recorded sufficient diary data on a hand-held computer. The compliance of using the device was good in small children, variable in adults and poor in teenagers. The fact that the overall compliance was low constituted a limitation of the number of patients with reliable diary data. Overall safety was rated as excellent or good by the clinicians for all patients at all visits and overall efficacy at 24 months evaluated to be excellent (74%) or good (26%). It was noticed that ,50% of patients/parents reported no absences from school or work owing to bleeding episodes during the study period. Among patients on regular prophylaxis, 6 of the 30 patients (20%) receiving ReFacto experienced no bleeding episodes. A median of four bleeding episodes occurred during the 24-month study period, and 93% of the episodes were resolved with ,2 ReFacto infusions. In the 7 on-demand patients, there was a median of 18 bleeding episodes, 87% of which resolved with ,2 ReFacto infusions. Interestingly, 42% of the ReFacto infusions taken by the patients classified to the on-demand group were registered as prophylactic treatment. In conclusion, ReFacto demonstrated good safety and efficacy in prophylaxis as well as treatment of bleeding episodes. [source]

Home management of haemophilia

HAEMOPHILIA, Issue 2 2004
J. M. Teitel
Summary., The demonstrated benefits of home care for haemophilia include improved quality of life, less pain and disability, fewer hospitalizations, and less time lost from work or school. Although reduced mortality has not been demonstrated, the substantial increase in longevity since the early 1980s correlates with the introduction of home treatment and prophylaxis programmes. These programmes must be designed and monitored by haemophilia treatment centres (HTC), which are staffed with professionals with broad and complementary expertise in the disease and its complications. In return, patients and their families must be willing to accept the reciprocal responsibilities that come from administering blood products or their recombinant equivalents at home. Patients with inhibitors to factors VIII or IX pose special challenges, but these complications do not obviate participation in home care programmes. Home care was an essential prerequisite to the introduction of effective prophylactic factor replacement therapy. Prophylaxis offers significant improvements in quality of life, but requires a substantial commitment. The use of implantable venous access devices can eliminate some of the difficulty and discomfort of peripheral venous access in small children, but brings additional risks. The future holds the promise of factor concentrates for home use that have longer half-lives, or can be administered by alternate routes. Knowledge of patient genotypes may allow treatments tailored to avoid complications such as inhibitor development. Gene therapy trials, which are currently ongoing, will ultimately lead to gene-based treatments as a complement to traditional protein-based therapy. [source]

Transillumination by light-emitting diode facilitates peripheral venous cannulations in infants and small children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010
K. HOSOKAWA
Background: Transillumination facilitates the visualization of peripheral veins in infants and children. The clinical usefulness of light-emitting diode (LED)-powered devices has not been thoroughly studied. Methods: We randomly assigned 136 infants and children weighing <15 kg, undergoing general anesthesia, to red LED-powered transillumination (TM group, n=67) vs. the usual method (UM group, n=69) of peripheral venous cannulations. Venous puncture was performed following anesthesia induction with sevoflurane and nitrous oxide. The primary and secondary study endpoints were the rate of successful cannulations at initial attempt, and the duration of insertion attempts, respectively. Results: The median score of the estimated cannulation difficulty before attempted puncture was similar in both groups. The success rates at first attempt were 75% and 61% (NS) and mean±SD times to successful venous access were 47±34 and 68±66 s (NS) in the TM and UM groups, respectively. The cannulation procedures were completed significantly earlier in the TM group than in the UM group (hazard ratio, 1.59; 95% confidence interval, 1.03,2.47; P=0.03). In the subgroup of infants and children <2 years old, venous cannulation was successful at first attempt in 73% and 49% in the TM group (n=44) and in the UM group (n=47), respectively (P=0.03). Conclusions: LED-powered transillumination devices facilitated peripheral venous cannulations in small infants and children. [source]

Risk and food: environmental concerns and consumer practices

INTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 8 2001
Bente Halkier
Environmental risks related to food consumption produce needs among consumers to handle such risks through their consumption practices. Consumers' ways of coping with risks are dependent on the social relations of everyday life, of which consumption practices are a part. Risk-handling in food consumption is socio-culturally broader than the cognitive rationality assumed in expert knowledge and administrative procedures on risk and risk-handling. Likewise, risk-handling in food consumption is also characterized by ambivalences. The objective of the article is to show that an important social and cultural source of ambivalence in consumers' handling of risk in food consumption comes from food consumption practices being caught in the tension between desire and control. The article proposes a heuristic theoretical device, called ,the contested space of the body', which is used to discuss the bodily dimension of consumer risk-handling. This is based on a Danish empirical study of parents with small children. A typology of consumers' risk-handling is presented which differs from traditional typologies of consumer segments by allowing for overlaps and shifts between the individual positions in the typology. The three types of risk-handling are the worried, the irritated and the pragmatic. The results suggest that in worried risk-handling control marginalizes desire, in irritated risk-handling desire is openly in conflict with control, and in pragmatic risk-handling relief from the contested space of the body is attempted. [source]

Barriers for dental treatment of primary teeth in East and West Germany

INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2 2009
CHRISTIAN H. SPLIETH
Background., In many countries, restorative treatment in primary teeth is suboptimal. Aim., Thus, this study tried to detect barriers for dentists to restore primary teeth in kindergarten children (3,6 years). Design., For a representative survey, 320 dentists (184 West, 136 East Germany) were randomly selected from the dental associations' registers and asked to answer a questionnaire on their profile, their view of the National Health System, and possible barriers for restoring primary teeth. Results., The analysis (response rate 57.7%) showed that the parents were no barrier and the dentists felt the need of restoring primary teeth. In addition to the children's anxiety, the inadequate reimbursement for fillings were perceived as clear barrier. The comparison of West and East German dentists detected statistically significantly higher barriers in West Germany, where , in contrast to the German Democratic Republic , no structured training in paediatric dentistry was compulsory before unification. Only 35% of the East German dentists rated restorative treatment in 3- to 6-year-olds as stressful in contrast to 65% in West Germany, where especially male dentists found no time to treat children. Conclusion., This study reveals that dentists can also be a considerable barrier to restorative treatment in small children, especially without adequate training in dental schools. [source]

Recent trends of genitourinary endoscopy in children

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2005
KATSUYA NONOMURA
Abstract Downsizing and refinement of the pediatric endoscope in video-monitoring systems have facilitated genitourinary endoscopy even in small children without any traumatic instrumentation. Indications for endoscopy in children with hematuria or tractable urinary tract infection have been tailored for the rareness of genitourinary malignancy or secondary vesicoureteral reflux (VUR) as a result of infravesical obstruction. Most mechanical outlet obstructions can be relieved endoscopically irrespective of sex and age. Endoscopic decompression by puncture or incision of both intravesical and ectopic ureteroceles can be an initial treatment similar to open surgery for an affected upper moiety. Endoscopy is necessary following urodynamic study to exclude minor infravesical obstruction only in children with unexplained dysfunctional voiding. Genitourinary endoscopy is helpful for structural abnormalities before and at the time of repairing congenital urogenital anomalies. Endoscopic injection therapy of VUR has been established as a less invasive surgical treatment. Pediatric endoscopy will play a greater role in the armamentarium for most pediatric urological diseases through the analysis of visual data and discussion on the indications for endoscopy throughout the world. [source]

Incentive effects in the demand for health care: a bivariate panel count data estimation

JOURNAL OF APPLIED ECONOMETRICS, Issue 4 2003
Regina T. Riphahn
This paper contributes in three dimensions to the literature on health care demand. First, it features the first application of a bivariate random effects estimator in a count data setting, to permit the efficient estimation of this type of model with panel data. Second, it provides an innovative test of adverse selection and confirms that high-risk individuals are more likely to acquire supplemental add-on insurance. Third, the estimations yield that in accordance with the theory of moral hazard, we observe a much lower frequency of doctor visits among the self-employed, and among mothers of small children. Copyright © 2002 John Wiley & Sons, Ltd. [source]

A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stress

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009
C. EICH
Background: Classic rapid-sequence induction of anaesthesia (RSI-classic) in infants and small children presents a time-critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI-controlled) that involves gentle mask ventilation until full non-depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI-controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress. Methods: In this controlled, randomized simulator-based study, 30 male trainees and specialists in anaesthesiology performed a simulated anaesthesia induction in a 4-week-old infant with pyloric stenosis. Two different RSI techniques, classic and controlled, were applied to 15 candidates each. We recorded the incidence of hypoxaemia, forced mask ventilation, and intubation difficulties. In addition, we measured individual stress levels by ergospirometry, salivary cortisol, and ,-amylase, as well as a post-trial questionnaire. Results: Hypoxaemia always occurred in RSI-classic but not in RSI-controlled, repeatedly resulting in unsafe actions. Subjective stress perception and some objective stress levels were lower in the volunteers performing RSI-controlled. Conclusions: Our data suggest that RSI-controlled, as compared with RSI-classic, leads to fewer unsafe actions and may reduce individual stress levels. [source]

Performance of a new separator system for routine autologous hematopoietic progenitor cell collection in small children

JOURNAL OF CLINICAL APHERESIS, Issue 6 2007
Volker Witt
Abstract The AMICUSÔ system was recently introduced for peripheral blood stem cell (PBSC) aphereses in adults. We conducted a single center field evaluation to obtain data about the performance of this system in children with a body weight (bw) < 25 kg. Results of blood priming procedures were compared to historical data obtained with the Fenwal CS3000+ (CS 3000). From August, 2001 to February, 2007, 47/178 (26%) PBSC aphereses procedures were performed in our institution with the AMICUSÔ system in 35 small patients (median bw 13.9 kg; range 6.7,24; age 2.78 years; range 0.97,7.06). The patients suffered from various malignant primary diseases or recurrences. We primed the system with packed RBC in case of >30% dilution of the RBC volume (n = 31) or with saline (n = 16). Compared to the CS3000, the AMICUSÔ revealed comparable collection efficiencies (CE) for CD34+ cells (median 67%, range 26,120), lymphocytes (75%, 25,138), monocytes (54%, 23,173), and granulocytes (10%, 1.5,36), MNC (57% 24,125), but a significantly higher erythrocyte and granulocyte, and a lower platelet CE. There was a significant negative correlation between total leukocyte count and CE for MNC (r = ,0.566; P < 0.001) and CD34+ cells (r = ,0.517; P < 0.001). There was no significant statistical or clinical difference between the CE in blood-primed procedures and saline-primed procedures. With the AMICUSÔ we saw statistically less citrate reactions compared to the CS 3000. We conclude that the AMICUSÔ system is safe and efficient to harvest PBSC on a routine basis in pediatric patients, even in children ,10 kg bw. J. Clin. Apheresis, 2007. © 2007 Wiley-Liss, Inc. [source]

Peripheral blood stem cell collection in pediatric patients: Feasibility of leukapheresis under anesthesia in uncompliant small children with solid tumors ,

JOURNAL OF CLINICAL APHERESIS, Issue 2 2006
Fernando Ravagnani
Leukapheresis demands patient's compliance and adequate vascular accesses, which can require invasive methods in very small children whose treatment protocol includes hemopoietic stem cell collection for myeloablative chemotherapy and stem cell rescue. Since 1998, at the Istituto Nazionale Tumori of Milan, in selected uncompliant small children, the placement of peripheral vascular accesses and leukapheresis have been performed at the same time under general anesthesia. Peripheral venous cannulas were positioned for blood collection, while blood was returned through either peripheral cannulas or mono-lumen central catheters previously installed for chemotherapy. A continuous-flow cell separator was used for leukapheresis. Between 1998 and 2003, 47 children with solid tumors underwent anesthesia for a total of 54 leukaphereses. The patients' age ranged from 12.7 to 93 months (median 30.3) and their weight ranged from 7 to 20 kg (median 14.1). Neither metabolic nor anesthesiological complications were recorded. In 89% of cases, the CD 34+ cell target was achieved at a single harvest; the median number of CD 34+ cells was 10.8 × 106/kg/leukapheresis (range 1,117) and the median collection efficiency was 63.4% (range 25,100.6). Leukapheresis under anesthesia is feasible and safe in very low-weight children whose compliance is lacking due to age and disease. J. Clin. Apheresis, 2005 © 2005 Wiley-Liss, Inc. [source]

Optimizing peripheral stem cell mobilization and harvest in very small children

JOURNAL OF CLINICAL APHERESIS, Issue 2 2005
Caron Strahlendorf
No abstract is available for this article. [source]

Autologous peripheral blood stem cell collections in children weighing less than 10 Kg with solid tumors: Experience of a single center

JOURNAL OF CLINICAL APHERESIS, Issue 2 2005
Hyun-Jung Cho
Abstract There have only been a few reports and limited performance of peripheral blood stem cell (PBSC) collection in very small children weighing less than 10 kg. In this study, we intended to evaluate the safety and yield of PBSC collection, with the efficacy of PBSC transplantation (PBSCT) in the smallest children with solid tumors. From January 1998 to February 2004, 173 children underwent PBSC collection in Samsung Medical Center, Korea. Of these, 15 (8.7%) children weighed less than 10 kg and their clinical diagnoses were neuroblastoma (10 cases), rhabdoid tumor (2 cases), rhabdomyosarcoma (2 cases), and Wilms tumor (1 case). PBSCs were collected following chemotherapy plus G-CSF mobilization. The median age and weight at the time of apheresis were 15 months and 9 kg, respectively. The median number of PBSC collection procedures per case was 4 (range, 2,7). The median cell yield per apheresis product was 0.95 (range, 0.01,33.32) × 106/kg CD34+ cells and 1.96 (range, 0.12,23.39) × 108/kg mononuclear cells. No complications associated with citrate toxicity and other adverse effect were observed during the procedures. After high-dose chemotherapy, 14 patients were reinfused with PBSCs alone and all showed successful hematopoietic recovery. We concluded that PBSC collection would be a safe and practical procedure, even when done in the smallest children, provided that adequate intravascular fluid volume and circulating red cell mass were maintained. Also, the use of PBSCs to support high-dose chemotherapy was well tolerated and might enhance hematological recovery in the smallest children showing the excellent efficacy of PBSCT. J. Clin. Apheresis © 2005 Wiley-Liss, Inc. [source]

Paediatric airway management: basic aspects

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009
R. J. HOLM-KNUDSEN
Paediatric airway management is a great challenge, especially for anaesthesiologists working in departments with a low number of paediatric surgical procedures. The paediatric airway is substantially different from the adult airway and obstruction leads to rapid desaturation in infants and small children. This paper aims at providing the non-paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children. Airway obstruction can be avoided by paying close attention to the positioning of the head of the child and by keeping the mouth of the child open during mask ventilation. The use of oral and nasopharyngeal airways, laryngeal mask airways, and cuffed endotracheal tubes is discussed with special reference to the circumstances in infants. A slightly different technique during laryngoscopy is suggested. The treatment of airway oedema and laryngospasm is described. [source]

Probabilities of heart donors arising within specified times for child recipients

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2007
John C Galati
Aim: To determine the availability of donor hearts for children of different blood group and weight needing urgent heart transplantation. Methods: Data maintained by the Australia and New Zealand Organ Donor Registry 1989,2004 were analysed to determine the frequency of donation. Probabilities of suitable donor availability within 10, 20, 30, 40, 60, 90 and 180 days were estimated using a Poisson model with the assumptions that traditional ABO blood compatibilities applied, suitable donors were 0.8,4.0 times the recipient's body weight (BW) and suitable adult donors were aged <40 years. Results: Probabilities of suitable donor availability increase with passage of time from 10 to 180 days and decrease with competition from other needful recipients. Maximum suitable donor availability occurs for children of all blood groups at body weight 20 kg. The probabilities of a donor heart arising within 40 days (maximum safe duration of extracorporeal membrane oxygenation support locally available for young children) for this recipient body weight according to blood group is 0.89, 0.85, 0.73, 0.67 (AB, A, B, O). Probabilities for recipients of BW 3 kg and 60 kg respectively are 0.16, 0.14, 0.10, 0.09 (AB, A, B, O) and 0.66, 0.61, 0.47, 0.42 (AB, A, B, O). Conclusion: Expectation of suitable heart donation arising within 40 days for needful recipients in Australia is low for infants (probability <0.3), moderate for small children (probability 0.5,0.9) and modest for large children (probability 0.4,0.7), with variation at all body weights according to blood group and waiting time. [source]

Serious injuries from dishwasher powder ingestions in small children

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2006
Amy Bertinelli
Aims: To describe patterns and severity of caustic injuries sustained from dishwasher powder ingestion and highlight need for national safety standards. Methods: Retrospective chart review of admissions for caustic ingestion to Starship Children's Hospital from January 2003 to January 2005 and review of New Zealand National Poisons Centre data. Results: Between January 2003 and January 2005, the National Poisons Centre recorded 610 dishwashing powder ingestions, with 88% of children less than 2 years old. Twenty-three children were admitted to Starship Children's Hospital following caustic ingestion, of whom 11 were identified as having ingested dishwasher powder (9 boys and 2 girls) and were aged 11 to 30 months (mean 17.5). Five children (45%) were admitted to the Paediatric Intensive Care Unit over 4 months (October 2004 to January 2005), requiring intubation for airway control. Two children needed tracheostomy. Three of the 11 children (27%) required repeated oesophageal dilatation, and two underwent gastrostomy formation. One brand of dishwasher detergent and container type was implicated in over half of the cases. Conclusions: Dishwasher detergents are highly corrosive substances that cause potentially life-threatening injuries and ongoing morbidity. The recent surge of incidents may be related to change in product constituents or non-compliance with New Zealand safety standards. Efforts to limit product alkalinity, legislative requirement of Child-Resistant Packaging and public education may reduce injuries from these common household substances. [source]

Poverty, underdevelopment and infant mental health,

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2003
LM Richter
Abstract: Very great advances have occurred in disciplinary and professional knowledge of infant development and its influence on subsequent development. This expertise includes the ways in which early experiences affect the capacity of mature individuals for social adjustment and productive competence, and promising methods of intervention to promote infant mental health and prevent adverse sequelae of risk conditions. However, very little of this knowledge has been applied in work among infants and children living in conditions of poverty and underdevelopment. This lack of application continues despite the enormous threats to the well-being of infants and young children brought about by the combined effects of poverty and the AIDS pandemic, especially in southern Africa. Protein,energy malnutrition, maternal depression, and institutional care of infants and small children are cited as illustrative of areas in which interventions, and their evaluation, are desperately needed in resource-poor countries. An argument is made for the critical importance of considering and addressing psychological factors in care givers and children in conditions of extreme material need. An example is provided of a simple intervention model based on sound developmental principles that can be implemented by trained non-professionals in conditions of poverty and underdevelopment. [source]

Fluoroscopic guidance of Arndt endobronchial blocker placement for single-lung ventilation in small children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2008
B. MARCINIAK
Background: Thoracoscopic surgery may require single-lung ventilation (SLV) in infants and small children. A variety of balloon-tipped endobronchial blockers exist but the placement is technically challenging if the size of the tracheal tube does not allow the simultaneous passage of the fibreoptic scope and the endobronchial blocker. This report describes a technique for endobronchial blocker insertion using fluoroscopic guidance in children undergoing SLV. Methods: After approval from the local Medical Ethics Committee and parental consent, 18 patients aged 2 years or younger scheduled for thoracic surgery requiring SLV were prospectively included. Following induction of anesthesia, a 5 Fr endobronchial blocker (Cook® Arndt endobronchial blocker) was inserted first into the trachea under direct laryngoscopy. Correct placement in the main bronchus was assessed by fluoroscopy and tracheal intubation next to the endobronchial blocker. Optimal position and balloon inflation was verified using a fibreoptic scope. The duration and number of insertion attempts as well as age, weight and size of the tracheal tube were recorded. Results: Eighteen patients were studied. Median (range) age and weight were 12 (0.2,24) months and 11.2 (4,15) kg, respectively. SLV was successfully achieved in all patients using a 5 Fr endobronchial blocker outside a 3.5,4.5 mm ID tracheal tube within 11.2 (±2.2) min. No side effects were observed during the procedure. Conclusion: Fluoroscopic-guided insertion of extraluminal endobronchial blocker is an effective and reliable tool to place Arndt endobronchial blockers in small children. [source]

Review article: percutaneous endoscopic gastrostomy in infants and children

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010
T. FRÖHLICH
Aliment Pharmacol Ther,31, 788,801 Summary Background, Percutaneous endoscopic gastrostomy (PEG) placement is widely accepted in children needing long-term gastrostomy feeding and clinical experience has been accumulated using PEG in children for nearly three decades. Aim, To discuss the current knowledge about clinical application of percutaneous endoscopic gastrostomy in children as well as associated complications and special aspects. Methods, We reviewed literature on PEG, primarily in children, with a focus on complications, gastro-oesophageal reflux, potential benefits and parental perceptions. In addition to reviewing scientific literature, we considered clinical experience and judgment in developing recommendations for special aspects concerning PEG in children. Results, Since its introduction in 1980, the use of PEG in paediatric patients has become widely accepted. With expanded experience, the number of medical conditions for which PEG is indicated, as well as the use of new techniques has increased. Published reports have helped improve expertise in dealing with associated complications; however, several key issues remain unresolved such as the implications of gastro-oesophageal reflux associated with PEG placement. Conclusions, Percutaneous endoscopic gastrostomy insertion for enteral nutrition in children and adolescents is an efficient and safe technique, even in small children, and is associated with a tolerable complication rate. [source]

Live donor/split liver grafts for adult recipients: When should we use them?

LIVER TRANSPLANTATION, Issue S2 2005
Peter Neuhaus
Key Points 1Split liver transplantation for a child and an adult recipient is standard today. Living donor liver transplantation for small children should only be necessary in exceptional situations in a country with a well-organized organ donation program. 2True split liver transplantation for two adults is still not very common. In the United States between April 2000 and May 2001, 89 surgical teams transplanted only 15 left lobes and 13 right lobes. Especially left lobes from deceased donors have a poor outcome; in Europe the ELTR shows a 1-year graft survival of 47%. 3While in Asia left lobes, right lateral segments, and dual left lateral segments are more frequently used, living donor liver transplantation for adults in Europe and the United States is predominantly performed with right lobes.7, 8 This carries a significant morbidity and mortality risk for the donor. Outcome compared to deceased donor liver transplantation (DDLTx) is similar with a trend towards more short-term and long-term biliary complications. 4Living donor and split liver transplantation should be used mainly in an elective situation. Candidates are tumor patients, patients with cholestatic liver disease, and elective patients with bile disease. 5Urgent liver transplantation is not a good option for living donor and split liver transplantation. Hepatic assist devices may change the picture in the future. 6Living donor liver transplantation for metabolic disorders like Alpha-1-Antitrypsin deficiency, Hyperoxaluria, and others cannot be recommended at present since the genetically related donor and the patient may carry an unknown risk. (Liver Transpl 2005;11:S6,S9.) [source]

LABOUR MARKET ACTIVITY OF FOREIGN SPOUSES IN TAIWAN: EMPLOYMENT STATUS AND CHOICE OF EMPLOYMENT SECTOR

PACIFIC ECONOMIC REVIEW, Issue 4 2010
Hwei-Lin Chuang
The present study examines the employment status and choice of employment sector of female foreign spouses from Southeast Asia and Mainland China in Taiwan. The conceptual framework is based on the family labour supply model, human and social capital theory, and immigrant assimilation theory. Our findings indicate that in regard to employment status, family background variables, including the presence of small children and husbands' characteristics, play a more significant role in determining the employment probability for these foreign spouses than do human capital variables. In particular, for spouses from Southeast Asia, each additional child is correlated with a decrease in working probability of 11.3%, whereas college education has an insignificant effect on their employment probability. Employment assimilation for these marriage immigrants may be confirmed by the finding that the employment probability of foreign spouses rises rapidly with the number of years that have elapsed since migration. As for the choice of employment sector, a strong linkage between the employment sector of the foreign spouses and their husbands' employment sector is found in this study. [source]

Noncatheter-Based Delivery of a Single-Chamber Lumenless Pacing Lead in Small Children

ICD Implantation in Infants and Small Children: The Extracardiac Technique

Dietary prevention of allergic diseases in infants and small children

PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 1 2008
Amendment to previous published articles in Pediatric Allergy, Clinical Immunology, European Academy of Allergology, Immunology 200, by an expert group set up by the Section on Pediatrics
Because of scientific fraud four trials have been excluded from the original Cochrane meta-analysis on formulas containing hydrolyzed protein for prevention of allergy and food intolerance in infants. Unlike the conclusions of the revised Cochrane review the export group set up by the Section on Paediatrics, European Academy of Allergology and Clinical Immunology (SP-EAACI) do not find that the exclusion of the four trials demands a change of the previous recommendations regarding primary dietary prevention of allergic diseases. Ideally, recommendations on primary dietary prevention should be based only on the results of randomized and quasi-randomized trials (selection criteria in the Cochrane review). However, regarding breastfeeding randomization is unethical, Therefore, in the development of recommendations on dietary primary prevention, high-quality systematic reviews of high-quality cohort studies should be included in the evidence base. The study type combined with assessment of the methodological quality determines the level of evidence. In view of some methodological concerns in the Cochrane meta-analysis, particularly regarding definitions and diagnostic criteria for outcome measures and inclusion of non peer-reviewed studies/reports, a revision of the Cochrane analysis may seem warranted. Based on analysis of published peer-reviewed observational and interventional studies the results still indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is effective in the prevention of allergic diseases in high-risk infants, particularly in early infancy regarding food allergy and eczema. The most effective dietary regimen is exclusively breastfeeding for at least 4,6 months or, in absence of breast milk, formulas with documented reduced allergenicity for at least the first 4 months, combined with avoidance of solid food and cow's milk for the first 4 months. [source]

Isoflurane is associated with a similar incidence of emergence agitation/delirium as sevoflurane in young children , a randomized controlled study

PEDIATRIC ANESTHESIA, Issue 1 2007
ROLAND RICHARD MEYER MD
Summary Background:, Children may be agitated or even delirious especially when recovering from general anesthesia using volatile anesthetics. Many trials have focused on the newer agents sevoflurane and desflurane but for the widely used isoflurane little is known about its potential to generate agitation. We investigated the emergence characteristics of small children after sevoflurane or isoflurane with caudal anesthesia for postoperative pain control. Methods:, After institutional approval and parental consent, anesthesia was randomly performed with sevoflurane (n = 30) or isoflurane (n = 29) in children at the age of 3.8 ± 1.8 years during surgical interventions on the lower part of the body. After induction, all children received caudal anesthesia with bupivacaine (0.25%, 0.8 ml·kg,1). Postoperatively, the incidences of emergence agitation (EA) and emergence delirium (ED) were measured by a blinded observer using a ten point scale (TPS; EA = TPS > 5 ED = TPS > 7) as well as vigilance, nausea/vomiting and shivering. Results:, The two groups were comparable with respect to demographic data, duration of surgery and duration of anesthesia. There were also no differences in the period of time from the end of surgery until extubation, duration of stay in the PACU, postoperative vigilance and vegetative parameters. Incidence of EA was 30% (9/30) for sevoflurane and 34% (10/29) for isoflurane during the first 60 min in the PACU (P = 0.785). Likewise, the incidence of ED was not different between the groups (20% and 24%, respectively). Conclusions:, In our randomized controlled study, we found no difference in the incidence of EA or ED between sevoflurane and isoflurane. Therefore, the decision to use one or the other should not be based upon the incidence of EA or ED. [source]

Flush volumes delivered from pressurized bag pump flush systems in neonates and small children

PEDIATRIC ANESTHESIA, Issue 8 2002
Anita Cornelius MD
SummaryBackground: The aim of this study was to measure the volumes of fluid delivered with a fast flush bolus from a flow regulating device. Methods: In-vitro fast flush bolus volumes, the volumes delivered from a bag pump flush system while opening the flow regulating device for 1, 2 or 5 s, were gravimetrically measured through a 22-G and a 24-G cannula. In-vivo 1- and 2-s fast flush bolus volumes and the volume required to purge the tubing between stopcock and arterial cannula from visible blood after blood sampling were recorded in 12 anaesthetized neonates and infants (mean age 2.17 ± 1.97 months, range 0.26,5.37 months) with a 24-G radial arterial cannula by continuously weighing the bag pump flush system at manometer pressures of 100, 200 and 300 mmHg. Results: In-vitro fast flush bolus volumes ranged from 0.23 ± 0.04 ml (1-s , 100 mmHg, 24-G cannula) to 2.95 ± 0.38 ml (5-s, 300 mmHg, 22-G cannula). Volumes were larger using a 22-G cannula than a 24-G cannula (P < 0.01) and increased with longer flushing periods (P < 0.0001) and higher manometer pressures (P < 0.0001). In-vivo 1- and 2-s fast flush bolus volumes correlated well with driving pressures (infusion pressure minus mean arterial pressure) (r2 = 0.81/0.72). 1-s fast flush bolus volumes delivered (ml) were 0.0025 × mmHg driving pressure and 2-s fast flush bolus volumes delivered (ml) were 0.0043 × mmHg driving pressure. The mean volume delivered to purge blood from the arterial pressure tubing was 0.94 ± 0.18 ml (range 0.61,1.34 ml). Conclusions: Fast bolus flushing from pressurized infusion bag systems, using the flow regulating device tested, can be applied during neonatal and paediatric anaesthesia without delivering uncontrolled amounts of fluid. [source]