Pediatrics – Critical Care & Emergencies
RCT: Video laryngoscopy improves first-attempt intubation success in neonates compared to direct laryngoscopy – N Engl J Med
11 May, 2024 | 13:37h | UTCStudy Design and Population: This single-center randomized clinical trial investigated the efficacy of video laryngoscopy versus direct laryngoscopy for urgent intubation in neonates. A total of 226 neonates requiring intubation either in the delivery room or neonatal intensive care unit (NICU) were enrolled and stratified by gestational age into two groups: less than 32 weeks and 32 weeks or more. The study primarily focused on the success rate of the first intubation attempt, monitored through exhaled carbon dioxide detection.
Main Findings: The trial included 214 neonates, analyzing the success of intubation on the first attempt. Video laryngoscopy significantly outperformed direct laryngoscopy, achieving a first-attempt success rate of 74% (95% confidence interval [CI], 66 to 82) compared to 45% (95% CI, 35 to 54) in the direct laryngoscopy group. Moreover, the median number of attempts for successful intubation was lower in the video-laryngoscopy group (1 attempt, 95% CI, 1 to 1) versus the direct-laryngoscopy group (2 attempts, 95% CI, 1 to 2). Additionally, neonates in the video laryngoscopy group experienced higher median lowest oxygen saturations and heart rates during intubation.
Implications for Practice: The findings suggest that video laryngoscopy could be more effective than direct laryngoscopy for urgent neonatal intubation, particularly in increasing the likelihood of success on the first attempt. These results recommend reconsidering current intubation techniques in neonatal care settings to incorporate video laryngoscopy, potentially leading to safer and more efficient intubation processes in this vulnerable population.
Reference (link to abstract – $ for full-text):
Prospective Validation Study: High accuracy of PECARN rules in reducing unnecessary CT scans in pediatric blunt trauma – Lancet Child Adolesc Health
5 May, 2024 | 15:08h | UTCStudy Design and Population:
This multicenter prospective validation study tested the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules aimed at reducing unnecessary CT scans for children presenting with blunt abdominal or minor head trauma. Over a nearly five-year period, children and adolescents under 18 from six U.S. emergency departments in cities including Sacramento, Dallas, and Los Angeles were enrolled. Exclusion criteria included pregnancy, pre-existing neurological disorders, penetrating trauma, injuries older than 24 hours, prior CT or MRI scans, or suspicion of non-accidental trauma.
Main Findings:
A total of 7,542 children with blunt abdominal trauma and 19,999 with minor head trauma were enrolled. The intra-abdominal injury rule demonstrated a sensitivity and negative predictive value (NPV) of 100%, confirming its reliability in detecting injuries requiring acute intervention. For head traumas, the sensitivity varied slightly with age; 100% for children under 2 years and 98.8% for those aged 2 years and older, with an NPV of 100% in both groups. Only two cases in the older cohort were misclassified, neither requiring neurosurgery.
Implications for Practice:
The validation of PECARN rules with high sensitivity and NPV supports their use as a safe guideline to minimize unnecessary CT scans in pediatric trauma cases, thereby promoting efficient use of resources and reducing exposure to radiation in children. These results suggest that implementation of these rules should be considered in emergency pediatric care to improve outcomes and healthcare efficiency.
Reference (link to abstract – $ for full-text):
A novel comprehensive algorithm for evaluation of pediatric ICU patients with new fever or instability
7 Aug, 2023 | 14:53h | UTC
Caring for two in the ICU: pharmacologic management of pregnancy-related complications
7 Aug, 2023 | 14:31h | UTCCaring for two in the ICU: Pharmacologic management of pregnancy-related complications – Pharmacotherapy (free for a limited period)
M-A | Exploring perinatal interventions and their impact on severe intraventricular hemorrhage in preterm neonates
4 Aug, 2023 | 11:56h | UTC
Commentary on Twitter
A meta-analysis by @DrAbdulRazak_MD & colleagues on perinatal interventions are associated with a reduction or increase of IVH and PVL #EBNEOalerts #neoEBM #neotwitter https://t.co/SPzNHwy3HD pic.twitter.com/KDQBSYZjdq
— Evidence-Based Neo (@EBNEO) April 26, 2023
RCT – 2ry analysis | Use of NIPPV, NHFOV post-extubation outperforms NCPAP in neonates with severe respiratory failure or extremely preterm
4 Aug, 2023 | 11:48h | UTC
Commentary on Twitter
2nd analysis of NASONE trial in @JAMANetworkOpen examines whether NHFOV is superior in reducing the duration of IMV in comparison to NIPPV and NCPAP in infants born < 28 weeks https://t.co/oWqvO4E5QF
2022 NASONE study: https://t.co/1rfZpaIseN #EBNEOalerts #neoEBM #neotwitter pic.twitter.com/w3Au8s62K7
— Evidence-Based Neo (@EBNEO) July 5, 2023
Systematic Review | NIPPV potentially superior to NCPAP in reducing reintubation in extubated preterm neonates
4 Aug, 2023 | 11:46h | UTC
Practice Guidance | Management of febrile neutropenia in immunocompetent children and youth
3 Aug, 2023 | 13:38h | UTC
Systematic Review | Probiotics’ potential in preventing necrotizing enterocolitis in very preterm, VLBW infants warrants further research
31 Jul, 2023 | 13:51h | UTC
M-A | Early NIPPV likely reduces the risk of respiratory failure and intubation in very preterm infants
25 Jul, 2023 | 13:39h | UTC
RCT | Preterm infants show same feeding tolerance with NCPAP or HHHFNC
20 Jul, 2023 | 11:01h | UTC
Retrospective Analysis | Inconsistencies in pediatric drug dosing found in over half of prehospital emergency drug administrations
17 Jul, 2023 | 13:50h | UTCCommentaries:
Children and Drug Dosing Variations When in Transit to the Hospital – AAP Journals Blog
Variation Seen in Dosing of Meds at Prehospital Pediatric Encounters – HealthDay
Cohort Study | Intermittent hypoxemia is associated with unfavorable respiratory outcomes in extremely preterm infants
17 Jul, 2023 | 13:28h | UTC
M-A | HFNC, CPAP, BiPAP prove more effective than conventional oxygen therapy in minimizing pediatric extubation failure
19 Jun, 2023 | 13:35h | UTC
Commentary on Twitter
Study suggests that CPAP, HFNC, and BiPAP were more effective than conventional oxygen therapy for providing postextubation noninvasive respiratory support in a pediatric population. https://t.co/d56eNkP8QP @abusultaneh @RobyKhemaniMD @PALISInet
— JAMA Pediatrics (@JAMAPediatrics) June 5, 2023
Review | Point-of-care thoracic ultrasound in children: new advances in pediatric emergency setting
16 Jun, 2023 | 13:59h | UTC
AAP Technical Report | Dispensing medications at the hospital upon discharge from an emergency department
14 Jun, 2023 | 14:33h | UTCDispensing Medications at the Hospital Upon Discharge From an Emergency Department – Pediatrics
News Release: Report discusses ways to improve medication adherence after emergency visit – AAP News
Commentary: Dispensing Meds in Emergency Department Likely to Improve Adherence – HealthDay
Current recommendations for the management of pediatric diabetic ketoacidosis
25 May, 2023 | 11:31h | UTC
SR | Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhea and severe dehydration in children
25 May, 2023 | 11:15h | UTC
SR | Videolaryngoscopy vs. direct laryngoscopy for tracheal intubation in neonates
24 May, 2023 | 13:11h | UTCVideolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates – Cochrane Library
Commentary on Twitter
Videolaryngoscopy:
– may increase the success of intubation on 1st attempt and result in fewer intubation attempts, but may not reduce the time required for successful intubation
– likely results in a reduced incidence of airway‐related adverse effectshttps://t.co/ney0pt8PnH pic.twitter.com/lc6bbDME7e— Cochrane Neonatal (@CochraneNeonate) May 12, 2023
SR | Nasal high flow therapy for primary respiratory support in preterm infants
12 May, 2023 | 13:31h | UTCNasal high flow therapy for primary respiratory support in preterm infants – Cochrane Library
Summary: Nasal high flow therapy for breathing support in preterm babies – Cochrane Library
Commentary on Twitter
Nasal high flow therapy for primary respiratory support in preterm infants – 2023 updatehttps://t.co/6UEnZ8fJRS @AmerAcadPeds @ESPR_ESN pic.twitter.com/yLBcQPPPvS
— Cochrane Neonatal (@CochraneNeonate) May 6, 2023
Review | Pediatric pericarditis
9 May, 2023 | 14:42h | UTCPediatric Pericarditis: Update – Current Cardiology Reports
Review | Rapid sequence induction in pediatric anesthesia
4 May, 2023 | 13:26h | UTC
RCT | Cerebral oximetry monitoring fails to reduce death or severe brain injury in extremely preterm infants
25 Apr, 2023 | 14:45h | UTCCerebral Oximetry Monitoring in Extremely Preterm Infants – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In extremely preterm infants, the use of cerebral oximetry monitoring to guide treatment for the first 72 hours after birth did not reduce the risk of death or severe brain injury at 36 weeks’ postmenstrual age. Full study: https://t.co/JX7Ra3OpjM pic.twitter.com/VACbUUAq3i
— NEJM (@NEJM) April 19, 2023
SR | Chest physiotherapy for acute bronchiolitis in pediatric patients between 0 and 24 months old
10 Apr, 2023 | 13:32h | UTC
Review | Use of cardio-pulmonary ultrasound in the neonatal intensive care unit
5 Apr, 2023 | 12:58h | UTCUse of Cardio-Pulmonary Ultrasound in the Neonatal Intensive Care Unit – Children