Children fulfilling the diagnostic criteria for Kawasaki disease should be treated with IVIG (2 gm/kg single dose) within 10 days of onset of symptoms.
Aim-To compare the eVects of patient triggered ventilation (PTV) with conventional ventilation (IMV) in preterm infants ventilated for respiratory distress syndrome (RDS).Methods-Nine hundred and twenty four babies from 22 neonatal intensive care units were assessed. They were under 32 weeks of gestation and had been ventilated for respiratory distress syndrome (RDS) for less than 6 hours within 72 hours of birth. The infants were randomly allocated to receive either PTV or IMV. Analysis was on an "intention to treat" basis. Death before discharge home or oxygen therapy at 36 weeks of gestation; pneumothorax while ventilated; cerebral ultrasound abnormality nearest to 6 weeks; and duration of ventilation in survivors were the main outcome measures. Results-There was no significant diVerence in outcome between the two groups. Unadjusted rates for death or oxygen dependency at 36 weeks of gestation were 47.4% and 48.7%, for PTV and IMV, respectively; for pneumothorax these were 13.4% and 10.3%; and for cerebral ultrasound abnormality nearest to 6 weeks these were 35.4% and 36.9%. Median duration of ventilation for survivors in both groups was 6 days. Overall, 79% of babies received only their assigned ventilation. PTV babies were more likely to depart from their intended ventilation (27% vs 15%). The trend towards higher pneumothorax rates with PTV occurred only in infants below 28 weeks of gestation (18.8% vs 11.8%). Conclusions-There was no observed benefit from the use of PTV, with a trend towards a higher rate of pneumothorax under 28 weeks of gestation. Although PTV has a similar outcome to IMV for treatment of RDS in infants of 28 weeks or more gestation, within 72 hours of birth, it was abandoned more often. It cannot be recommended for infants of less than 28 weeks' gestation with the ventilators used in this study.
SUMMARY Fifty parents of 36 consecutive children admitted to hospital with their first febrile convulsion were interviewed shortly after the event. Very few parents voluntarily said that they had thought their child was dying, but when asked specifically the majority said they had thought the child was dying or likely to die. This common fear should be kept in mind when discussing febrile convulsions with parents, who are unlikely to volunteer the information. RÉSUMÉ Les parents pensent habituellement que lew enfant va mourir, lorsqu'ils observent chez lui la premiére convulsion hyperthermique 50 parents de 36 enfants admis consécutivement à l'hôpital aprés une premiere crise convulsive hyperthermique ont été interrogés peu apres l'evenement. Trés peu de parents mentionerent spontanement qu'ils avaient pense que leur enfant allait mourir mais en réponse à une question précise la majorité des parents précisèrent qu'ils avaient effectivement pensé que leur enfant était mourant ou allait mourir. Cette crainte commune doit être gardee à l'esprit dans une discussion sur les convulsions fébriles avec des parents qui cachent plus volontiers qu'ils ne révèlent leur sentiment sur ce point. ZUSAMMENFASSUNG Eltern, die den ersten Fieberkrampf ihres Kindes erleben, denken meistens, daβ es sterben wird 50 Eltern von 36 wegen ihres ersten Fieberkrampfes im Krankenhaus nacheinander aufgenommenen Kindern wurden kurz nach dem Vorfall interviewed. Sehr wenige Eltern erwähnten von sich aus, daß sie geglaubt haben, ihr Kind wiirde sterben, wenn sie aber speziell danach gefragt würden, sagte die Mehrheit der Eltern, sie haben gedacht, ihr Kind wiirde sterben oder sei nahe daran zu sterben. Diese allgemeine Furcht sollte man im Auge behalten, wenn man mit Eltern uber Fieberkrampfe spricht, da sie die Information dariiber eher fur sich behalten als sie offen auszusprechen. RESUMEN Generalmente los padres piensan que su hijo se estd muriendo al verlo con una primera convulsidn febril Cincuenta padres de 36 niños consecutivos ingresados en el hospital à causa de padecer una primera convulsión febril fueron entrevistados poco después del acontecimiento. Muy pocos padres dijeron voluntariamente que habian pensado que su hijo se estaba muriendo, pero cuando fueron preguntados especificamente, la mayoria dijeron que habian pensado que el nifio se estaba muriendo o à punto de morir. Este temor común debe debe ser recordado cuando se discute las convulsiones febriles con los padres, los cuales tienen mas tendencia à ocultarlo que ha ofrecer información voluntariamente acerca del hecho.
Objective:To investigate to what extent prenatal, early postnatal, and late postnatal growth predicts risk of childhood obesity. Methods: This was a historical cohort study of 1335 full term singletons born in southwest England in 1989. The main outcome measure was body mass index (BMI) at age 7. Absolute weights at birth, 6 weeks, and 18 months, and change in weights during the intervening periods were measured. Measures were examined as z scores standardised to the 1990 UK reference population. Results: BMI at age 7 was positively associated with z scores for weight at all ages. Regression coefficients (95% confidence intervals) were: 0.16 (0.11 to 0.22), 0.19 (0.15 to 0.24), and 0.29 (0.26 to 0.33) for weights at birth, 6 weeks, and 18 months, respectively. Regression coefficients for birth weight, early weight gain (change in weight z score between birth and 6 weeks), and late weight gain (change in weight z score between 6 weeks and 18 months), adjusted for each other were: 0.32 (0.27 to 0.38), 0.31 (0.26 to 0.37), and 0.28 (0.23 to 0.32), respectively. There was no statistical evidence for interaction among weights, weight gains, or social deprivation. Social deprivation independently predicted BMI at age 7, the major influence being weight gain after 6 weeks of life. Conclusions: These data suggest that obesity risk is acquired gradually over the perinatal and postnatal periods, instead of during a prenatal or early postnatal critical window. The association of obesity risk with social circumstances and the timing of its origin offer pointers to some underlying determinants of obesity.
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