Study Objective To determine whether aerosolized intranasal or buccal midazolam reduces the distress of pediatric laceration repair compared to oral midazolam. Methods Children 0.5–7 years old needing non-parenteral sedation for laceration repair were randomized to receive oral, aerosolized intranasal, or aerosolized buccal midazolam. Patient distress was rated by blinded review of videotapes using the Children’s Hospital of Eastern Ontario Pain Score. Secondary outcomes included activity scores, sedation adequacy, sedation onset, satisfaction, and adverse events. Results For the 169 subjects (median age 3.1 years) evaluated for the primary outcome, we found significantly less distress in the buccal midazolam group compared to oral route (p=0.04; difference −2, 95% CI −4, 0), and a corresponding non-significant trend for the intranasal route (p=0.08; difference −1, 95% CI −3, 1). Secondary outcomes (177 subjects) favored the intranasal group, including a greater proportion with an optimal activity score (74%), a greater proportion of parents wanting this sedation in the future, and faster sedation onset. Intranasal was the route least tolerated at the time of administration. Adverse events were similar between groups. Conclusions When comparing the administration of midazolam by 3 routes to facilitate pediatric laceration repair, we noted slightly less distress in the aerosolized buccal group. The intranasal route demonstrated a greater proportion with optimal activity scores, greater proportions of parents wanting similar sedation in the future and faster onset, but was also the most poorly tolerated at the time of administration. Aerosolized buccal or intranasal midazolam represent effective and useful alternatives to oral midazolam for sedation for laceration repair.

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BackgroundIn 2010, researchers using novel laboratory techniques found that US-licensed rotavirus vaccines contain DNA or DNA fragments from Porcine circovirus (PCV), a virus common among pigs but not believed to cause illness in humans. We sought to understand pediatricians' and mothers' perspectives on this finding.MethodsWe conducted three iterations of focus groups for pediatricians and non-vaccine hesitant mothers in Seattle, WA, Cincinnati, OH, and Rochester, NY. Focus groups explored perceptions of rotavirus disease, rotavirus vaccination, and attitudes about the detection of PCV material in rotavirus vaccines.ResultsPediatricians understood firsthand the success of rotavirus vaccines in preventing severe acute gastroenteritis among infants and young children. They measured this benefit against the theoretical risk of DNA material from PCV in rotavirus vaccines, determining overall that the PCV finding was of no clinical significance. Particularly influential was the realization that the large, randomized clinical trials that found both vaccines to be highly effective and safe were conducted with DNA material from PCV already in the vaccines.Most mothers supported the ideal of full disclosure regarding vaccination risks and benefits. However, with a scientific topic of this complexity, simplified information regarding PCV material in rotavirus vaccines seemed frightening and suspicious, and detailed information was frequently overwhelming. Mothers often remarked that if they did not understand a medical or technical topic regarding their child's health, they relied on their pediatrician's guidance.Many mothers and pediatricians were also concerned that persons who abstain from pork consumption for religious or personal reasons may have unsubstantiated fears of the PCV finding.ConclusionsPediatricians considered the detection of DNA material from PCV in rotavirus vaccines a "non-issue" and reported little hesitation in continuing to recommend the vaccines. Mothers desired transparency, but ultimately trusted their pediatrician's recommendation. Both vaccines are currently approved for their intended use, and no risk of human PCV illness has been reported. Communicating this topic to pediatricians and mothers requires sensitivity to a broad range of technical understanding and personal concerns.

Results suggest that therapy services that focus on improvement of upper extremity function, self-care skills, and social skills are associated with participation in postsecondary education. Longer follow-up is needed to effectively examine paid employment.