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Hydrocortisone (Alkindi) - replacement therapy of adrenal insufficiency in infants, children and adolescents (from birth to <18 years old) Published 08 October 2018 1 hydrocortisone 0.5mg, 1mg, 2mg and 5mg granules in capsules for opening (Alkindi ® ) SMC2088 Diurnal Limited 7 September 2018 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice (...) is summarized as follows: ADVICE: following a full submission hydrocortisone (Alkindi ® ) is accepted for restricted use within NHSScotland. Indication under review: replacement therapy of adrenal insufficiency in infants, children and adolescents (from birth to <18 years old). SMC restriction: for the first-line treatment of infants and young children with adrenal insufficiency aged from birth to less than six years of age for whom hydrocortisone must otherwise be individually prepared by manipulation
The Quarter Prone Position Increases Oxygen Saturation in Premature Infants Using Continuous Positive Airway Pressure. A primary problem that occurs in premature infants is oxygenation disorders, thus requiring respiratory support, including continuous positive airway pressure (CPAP). The effectiveness of CPAP can be improved by adjusting the body's position, so the aim of this study was to examine the effect of the quarter prone position on the oxygenation status of preterm infants using CPAP (...) . This study used a randomized controlled trial with a crossover design. A group of 15 preterm infants receiving CPAP was selected, and randomization of allocation was done to divide the respondents into the intervention group (quarter prone) or the control group (supine). Oxygenation status was measured using an observation form, and the result showed a significant difference in the oxygen saturation levels of premature infants using CPAP in the quarter prone group compared to that in the supine group (p
Could a Certain Sitting Position Reduce the Pain Experienced by a Child? The Benefits of Parental Holding and an Upright Position. Intravenous injection is the most feared medical procedure and gives rise to an experience of mild to severe pain in children. Unrestrained pain has a negative effect on the child. Pain management in the form of a convenient sitting position is needed by children who undergo intravenous injection procedures. This study aims to determine the effect of parental
Exploring the acceptability of Option B plus among HIV-positive Nigerian women engaged and not engaged in the prevention of mother-to-child transmission of HIV cascade: a qualitative study The acceptability of lifelong antiretroviral therapy (ART) among HIV-positive women in high-burden Nigeria, is not well-known. We explored readiness of users and providers of prevention of mother-to-child transmission of HIV (PMTCT) services to accept lifelong ART -before Option B plus was implemented (...) in Nigeria. We conducted 142 key informant interviews among 100 PMTCT users (25 pregnant-newly-diagnosed, 26 pregnant-in-care, 28 lost-to-follow-up (LTFU) and 21 postpartum women living with HIV) and 42 PMTCT providers in rural North-Central Nigeria. Qualitative data were manually analyzed via Grounded Theory. PMTCT users had mixed views about lifelong ART, strongly influenced by motivation to prevent infant HIV and by presence or absence of maternal illness. Newly-diagnosed women were most enthusiastic
condition. 1 The only feature of this child that is inconsistent with the diagnosis is his well-nourished appearance. Generally, infants and children with cyanotic heart lesions experience failure to thrive. One speculation for this discrepancy is the artistic preference of the time, which includes depicting their subjects as healthy and robust. 1 What is the pathophysiology of the condition? VSD is an acyanotic heart defect at first. Oxygenated blood from the left ventricle is shunted to the right (...) as Eisenmenger’s syndrome. What is your differential diagnosis? For any infant or young child with cyanosis, it is important to consider the following conditions on your differential diagnosis, and to treat them all empirically and simultaneously to avoid delaying any life-saving therapy. 2 Infectious Sepsis Cardiac Congenital heart defects Congestive heart failure Cardiogenic shock Pulmonary Pneumonia ARDS Pneumothorax Foreign body aspiration Etc. Hemoglobinopathies Polycythemia Methmeglobinemia Hypovolemia
The coverage of continuum of care in maternal, newborn and child health: a cross-sectional study of woman-child pairs in Ghana The continuum of care has recently received attention in maternal, newborn and child health. It can be an effective policy framework to ensure that every woman and child receives timely and appropriate services throughout the continuum. However, a commonly used measurement does not evaluate if a pair of woman and child complies with the continuum of care. This study (...) and children were collected. Multilevel logistic regression was used to estimate the factors associated with the continuum of care and its divergence across 22 areas.Throughout the pregnancy, delivery and post-delivery stages, 7.9% of women and children achieved the continuum of care through continuous visits to health facilities (measurement 1). Meanwhile, 10.3% achieved the continuum of care by receiving all key components of maternal, newborn and child health services (measurement 2). Only 1.8% of them
Cord milking versus immediate clamping in preterm infants: a randomised controlled trial To investigate whether umbilical cord milking (UCM) at birth improves systemic blood flow and short-term outcomes, as compared with immediate cord clamping (ICC).Randomised clinical trial.Single tertiary care centre.Infants born to eligible women presenting in preterm labour between 24 and 31 weeks' gestation.UCM three times at birth or ICC.Primary outcome included systemic blood flow as represented by echo (...) -derived superior vena cava(SVC) flow at 4-6 hours after birth. The echocardiographer and interpreter were blinded to the randomisation. Secondary outcomes included cardiac output, neonatal morbidities and mortality. Analysis was by intention to treat.A total of 73 infants were randomised (37 to UCM and 36 to ICC). Mean (SD) gestational age was 27 (2) weeks and mean (SD) birth weight was 1040 (283) g. Haemoglobin on admission was higher in the UCM than in the ICC group (16.1 vs 15.0 g/L), p=0.049 (mean
Association of Early Introduction of Solids With Infant Sleep: A Secondary Analysis of a Randomized Clinical Trial The World Health Organization recommends exclusive breastfeeding for 6 months. However, 75% of British mothers introduce solids before 5 months and 26% report infant waking at night as influencing this decision.To determine whether early introduction of solids influences infant sleep.The Enquiring About Tolerance study was a population-based randomized clinical trial conducted from (...) January 15, 2008, to August 31, 2015, that included 1303 exclusively breastfed 3-month-old infants from England and Wales. Clinical visits took place at St Thomas' Hospital, London, England, and the trial studied the early introduction of solids into the infant diet from age 3 months.The early introduction group (EIG) continued to breastfeed while nonallergenic and then 6 allergenic foods were introduced. The standard introduction group (SIG) followed British infant feeding guidelines (ie, exclusive
The Effect of Noninvasive High-Frequency Oscillatory Ventilation on Desaturations and Bradycardia in Very Preterm Infants: A Randomized Crossover Trial Noninvasive high-frequency oscillatory ventilation compared with nasal continuous positive airway pressure significantly reduced the number of desaturations and bradycardia in preterm infants. However, noninvasive high-frequency oscillatory ventilation was associated with increased oxygen requirements and higher heart rates.Australian and New
/10665/274286/ WHO-MCA-18.05-eng.pdfviii WHO recommendations on home-based records for maternal, newborn and child health Table 1. Recommendations on home-based records Recommendations 1. The use of home-based records, as a complement to facility-based records, is recommended for the care of pregnant women, mothers, newborns and children, to improve care-seeking behaviours, male involvement and support in the household, maternal and child home care practices, infant and child feeding (...) to a supportive home environment for maternal and child health (MCH) care, improved infant feeding and other child health care practices, improved child growth and development, improved continuity of care across MCH, and improved communication with health providers. However, there was also no significant effect reported on many maternal, newborn and child care-seeking and care practice outcomes. For many outcomes, no studies were found. Although the evidence base has its limitations, the GDG determined
Evaluation of the child with global developmental delay and intellectual disability Global developmental delay (GDD) and intellectual disability (ID) are common concerns in the paediatric setting. Etiologies of both conditions are highly heterogeneous. The American Academy of Pediatrics, the American Academy of Neurology and the British Columbia-based Treatable Intellectual Disability Endeavor (TIDE) protocol have each proposed multitiered investigations of GDD/ID to guide physicians toward
School, child care and camp exclusion policies for chickenpox: A rational approach Widespread varicella vaccination in Canada since 2007 has changed the epidemiology of chickenpox, with a significant decline in varicella-related hospitalizations. However, there will always be a varicella-susceptible population because of immune-compromising treatments or conditions and/or parental vaccine refusal. This document updates and replaces a 1999 statement by the Canadian Paediatric Society. The CPS (...) position on school and child care exclusion policies has not changed since the original statement, but because there have been two published reports of varicella outbreaks associated with summer camp attendance since 1999, this revision provides additional recommendations to mitigate risk for varicella transmission at summer camps. Keywords: Chickenpox; Child care; Exclusion; IMPACT; Summer camp; Vaccine; Varicella
A modified developmental care bundle reduces pain and stress in preterm infants undergoing examinations for retinopathy of prematurity: A randomised controlled trial To determine the comparative efficacy of developmental care versus standard care for reducing pain and stress in preterm infants during examinations for retinopathy of prematurity (ROP).ROP examinations are routinely performed in neonatal intensive care units to detect these lesions. Pain scores recorded during and after eye (...) examinations have revealed physiological and behavioural manifestations of pain and stress.A randomised crossover trial was conducted.Fourteen preterm infants were evaluated. The modified developmental care bundle included environmental modifications, positioning and containment, oxygen supplementation, interaction and approach and cue-based individual care, which were applied before, during and after the ROP examination. The primary outcomes were obtained from pain and stress scores using the premature
Kimura Disease: A differential diagnosis in a nephrotic child Kimura disease presents as benign lesion and is commonly present among the Asian population. It is a disease with a favourable prognosis and a peak age of onset in the third decade. It is a chronic inflammatory disorder of unknown etiology that involves the lymph nodes and subcutaneous tissues of the head and neck region. We report a case of a 15-year-old boy with multiple Kimura lymphadenopathies involving the left posterior
heterogeneity by residence and sex of the child. We then estimated the number and portion of deaths of infants younger than 1 year related to conflict.We identified 15 441 armed conflict events that led to 968 444 combat-related deaths and matched these data with 1·99 million births and 133 361 infant deaths (infant mortality of 67 deaths per 1000 births) between 1995 and 2015. A child born within 50 km of an armed conflict had a risk of dying before reaching age 1 year of 5·2 per 1000 births higher than (...) Armed conflict and child mortality in Africa: a geospatial analysis. A substantial portion of child deaths in Africa take place in countries with recent history of armed conflict and political instability. However, the extent to which armed conflict is an important cause of child mortality, especially in Africa, remains unknown.We matched child survival with proximity to armed conflict using information in the Uppsala Conflict Data Program Georeferenced Events Dataset on the location
A Case of Familial Male-Limited Precocious Puberty in a Child With Klinefelter Syndrome Familial male-limited precocious puberty (FMPP) is an autosomal dominant, male-limited disorder that causes peripheral precocious puberty in boys. Klinefelter syndrome (47, XXY) is the most common chromosomal aberration in males with associated infertility, hypogonadism, and learning disability. We report here a case of Klinefelter syndrome in a patient with FMPP. A 6-year-old boy was referred to our
Carbohydrate supplementation of human milk to promote growth in preterm infants. Preterm infants are born with low glycogen stores and require higher glucose intake to match fetal accretion rates. In spite of the myriad benefits of breast milk for preterm infants, it may not adequately meet the needs of these rapidly growing infants. Supplementing human milk with carbohydrates may help. However, there is a paucity of data on assessment of benefits or harms of carbohydrate supplementation (...) of human milk to promote growth in preterm infants. This is a 2018 update of a Cochrane Review first published in 1999.To determine whether human milk supplemented with carbohydrate compared with unsupplemented human milk fed to preterm infants improves growth, body composition, and cardio-metabolic and neurodevelopmental outcomes without significant adverse effects.We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials
of infants' length-for-age z scores at 1 year according to World Health Organization (WHO) child growth standards. One group received neither prenatal nor postpartum vitamin D (placebo group). Three groups received prenatal supplementation only, in doses of 4200 IU (prenatal 4200 group), 16,800 IU (prenatal 16,800 group), and 28,000 IU (prenatal 28,000 group). The fifth group received prenatal supplementation as well as 26 weeks of postpartum supplementation in the amount of 28,000 IU (prenatal (...) Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth. It is unclear whether maternal vitamin D supplementation during pregnancy and lactation improves fetal and infant growth in regions where vitamin D deficiency is common.We conducted a randomized, double-blind, placebo-controlled trial in Bangladesh to assess the effects of weekly prenatal vitamin D supplementation (from 17 to 24 weeks of gestation until birth) and postpartum vitamin D supplementation on the primary outcome