Интересные ссылки по педиатрии

[cactus1972]

Обновленные рекомендации American Academy of Pediatrics по ведению детей с синдромом Дауна от рождения до 21 года

[Ссылки доступны только зарегистрированным пользователям ]

[doctorus]

[Ссылки доступны только зарегистрированным пользователям ]

Очень полезная ссылка для родителей про автобезопасность детей.

[cactus1972]

Еще один документ от ААР

[Ссылки доступны только зарегистрированным пользователям ]

[easl]

Review Article

Febrile Urinary Tract Infections in Children
Giovanni Montini, M.D., Kjell Tullus, M.D., Ph.D., and Ian Hewitt, M.B., B.S.

N Engl J Med 2011; 365:239-250July 21, 2011
[Ссылки доступны только зарегистрированным пользователям ]

Acute pyelonephritis is the most common serious bacterial infection in childhood; many affected children, particularly infants, have severe symptoms. Most cases are readily treated, provided diagnosis is prompt, though in some children fever may take several days to abate.

Approximately 7 to 8% of girls and 2% of boys have a urinary tract infection during the first 8 years of life.1,2 Febrile urinary tract infections have the highest incidence during the first year of life in both sexes, whereas nonfebrile urinary tract infections occur predominantly in girls older than 3 years.2 After infancy, urinary tract infections confined to the bladder are generally accompanied by localized symptoms and are easily treated. In contrast, the presence of fever increases the probability of kidney involvement (sensitivity, 53 to 84%; specificity, 44 to 92%)3 and is associated with an increased likelihood of underlying nephrourologic abnormalities and a greater risk of consequent renal scarring.4 ...

Conclusions
The management of febrile urinary tract infections in children is changing. Oral and intravenous antibiotics appear to be equally effective in most children. Improved prenatal ultrasonography has revealed that major kidney damage in children is frequently related to the presence of hypodysplasia, associated with urologic abnormalities. However, infection-related renal scarring develops in some children; this causes further damage in dysplastic kidneys, with the potential for late effects in previously normal kidneys. The value of antibiotic prophylaxis has been questioned in recent studies (Figure 4). Further data are needed to determine which children might benefit from antibiotic prophylaxis. Studies in progress may help to answer these questions.

[cactus1972]

Давно я с педиатрами ссылками не делилась

В European Respiratory Journal опубликованы результаты [Ссылки доступны только зарегистрированным пользователям ], в которое были включены 5368 детей. Целью исследование было установления взаимосвязи между продолжительностью грудного вскармливания и частотой развития бронхиальной астмы у детей в в первые 4 года жизни.

Shorter duration and non-exclusivity of breastfeeding were associated with increased risks of asthma-related symptoms in preschool children.
During the first 4 years, children who were never breast-fed had overall greater risks of wheezing, shortness of breath, dry cough, and persistent phlegm than children who were breast-fed for 6 months. Odds ratios (ORs) were 1.44 (95% confidence interval [CI], 1.24 - 1.66), 1.26 (95% CI, 1.07 - 1.48), 1.25 (95% CI, 1.08 - 1.44), and 1.57 (95% CI, 1.29 - 1.91), respectively.

[Chevychelov]

JPGN Journal of Pediatric Gastroenterology and Nutrition Publish Ahead of Print
DOI: 10.1097/MPG.0b013e3182227e90

Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in children

[Ссылки доступны только зарегистрированным пользователям ]

[cactus1972]

СDC опубликовал рекомендации по вакцинации против гриппа на сезон 2011-2012 г.г.

[Ссылки доступны только зарегистрированным пользователям ]

[Chevychelov]

Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. August 11, 2011
[Ссылки доступны только зарегистрированным пользователям ]

Licensure of a Meningococcal Conjugate Vaccine for Children Aged 2 Through 10 Years and Updated Booster Dose Guidance for Adolescents and Other Persons at Increased Risk for Meningococcal Disease --- Advisory Committee on Immunization Practices (ACIP), 2011
[Ссылки доступны только зарегистрированным пользователям ]

[easl]

A Look Back at the Effect of Varicella Vaccination on Varicella Deaths
In just over a decade, the average annual mortality rate for varicella-related deaths in the U.S. has declined 88%.

During the first 6 years after the 1995 licensure of the varicella vaccine, varicella-related mortality in the U.S. dropped 66% (from 105 annual deaths to 39 deaths). This study examined varicella mortality from 2002 through 2007 — a period when vaccine coverage increased to about 90% of children aged 19 to 35 months.

In 2002, varicella was listed in 32 records as the underlying cause of death. The annual number of varicella deaths in 2003 through 2007 ranged from 13 to 19; this represents an 88% decline in the average mortality rate from 0.41 per million in the immediate prevaccine years (1990–1994) to 0.05 per million in 2005–2007. The decline was greatest in patients younger than 20 (97%) but was also apparent in older patients (age, 20–49: 90%; age, >50: 67%). Only 11% of patients whose deaths were related to varicella had preexisting high-risk medical conditions (all were malignancies).
[Ссылки доступны только зарегистрированным пользователям ]

Near Elimination of Varicella Deaths in the US After Implementation of the Vaccination Program.
[Ссылки доступны только зарегистрированным пользователям ]

[easl]

[Ссылки доступны только зарегистрированным пользователям ]
A New Approach to Managing Young Non–Toxic-Appearing Febrile Children
Researchers suggest an emphasis on more-limited evaluation, now that vaccines have greatly reduced the likelihood of serious bacterial infections.

Since the 1970s, considerable attention has been paid to the management of febrile children aged 3 years without an obvious focus of infection. Recommendations have emphasized detection of serious bacterial infections (SBIs), including occult bacteremia (OB), and empirical antibiotic treatment for children considered to be at high risk. Management has been determined using a combination of clinical appearance, age, and laboratory tests, with more testing recommended for infants aged <3 months than for those aged 3 to 36 months.

Effective vaccines against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae, the two major causes of occult SBIs, have been universally available in the U.S. since 1988 and 2000, respectively. The incidence of invasive Hib infection in children aged <5 years dropped by 99% between 1987 and 2007, and the incidence of pneumococcal OB is currently <0.5%. Urinary tract infections (UTIs) are now the most common SBI in febrile children without localizing signs. Considering these changes, researchers from four major pediatric departments suggest that recommendations for managing such children be updated.

These researchers state that new guidelines should emphasize the importance of immediate antimicrobial therapy for an infant who is seriously ill or toxic appearing and a complete clinical and laboratory evaluation for high-risk febrile infants aged 30 days, as we have been doing. However, for intermediate-risk infants aged 31 to 90 days, acceptable management can range from complete evaluation to simply observation and follow-up. And for infants aged 3 to 36 months who have received 2 doses of both Hib and pneumococcal conjugate vaccines, evaluation only for UTI is warranted.

Comment: Although these recommendations don't carry the stamp of any official organization, they are supported by evidence. If they are put into practice, venipunctures, lab tests, cultures, and hospitalizations would all be reduced.
— Robert S. Baltimore, MD

[cactus1972]

Рекомендации ААР по обеспечению безопасности при занятиях спортом в жаркую погоду

[Ссылки доступны только зарегистрированным пользователям ]

Основные положения

•Before, during, and after activity, drinking fluids should be readily available and their consumption encouraged at regular intervals.
•Participants should be gradually introduced and permitted to adapt to the climate, uniform/protective gear, and intensity and duration of activities.
•Physical activity should be modified as necessary, for example, by reducing duration and/or intensity, increasing the frequency and duration of breaks and moving them to the shade if possible, and canceling the activity if weather is severe, or rescheduling it to a cooler time.
•Between same-day sessions, games, or matches, youth should be given longer rest and recovery time (at least 2 hours).
•Children or adolescents who are currently or who were recently ill, and those with other risk factors, should be permitted only limited or postponed participation.
•Participants should be closely monitored for signs and symptoms of developing heat-related illness.
•Trained personnel and facilities to effectively treat heat illness should be readily available on site.
•Children or adolescents with moderate or severe heat-related stress should promptly receive emergency medical services and rapid cooling.
•Coaches, trainers, and other adults should receive risk-reduction training.
•Children and adolescents should be educated about preparing for the heat.
•An emergency action plan should be developed and implemented.

[cactus1972]

Institute of Medicine опубликовал [Ссылки доступны только зарегистрированным пользователям ], изучавшей частоту развития побочных эффектов после применения 8 наиболее распространенных вакцин (против кори, краснухи, паротита (MMR), столбняка, менингококковой инфекции, ветряной оспы, ВПЧ, гепатитов А и В, гриппа (не H1N1)). В подавляющем большинстве случаев не удалось получить убедительных доказательств связи развития разного рода побочных эффектов с применением вакцины. Опровергнута и теория Эндрю Уэйкфилда (Andrew Wakefield) о взаимосвязи между вакцинацией MMR-вакциной и аутизмом.

Основные выводы комиссии

The group decided that the evidence "convincingly" supports a link between
•anaphylaxis and MMR, varicella, influenza, hepatitis B, meningococcal, and tetanus toxoid vaccines;
•febrile seizures and MMR vaccine (such seizures almost always have no long-term consequences);
•syncope and the injection of any vaccine;
•deltoid bursitis and the injection of any vaccine;
•disseminated Oka-strain varicella zoster virus, along with Oka-strain varicella zoster virus viral reactivation (both with and without other organ involvement) and varicella vaccine; and
•measles inclusion body encephalitis and MMR vaccine in individuals with severe immune system deficiencies.

According to another set of committee conclusions with a lower certainty level, scientific evidence favors accepting a causal relationship between
•anaphylaxis and HPV vaccine,
•transient arthralgia in adult women and MMR vaccine,
•transient arthralgia in children and MMR vaccine, and
•a mild and temporary oculorespiratory syndrome and certain trivalent influenza vaccines in Canada.

Conversely, the committee stated that the evidence favors rejecting a causal relationship between
•type 1 diabetes and MMR vaccine;
•type 1 diabetes and diphtheria, tetanus, and pertussis vaccine;
•Bell's palsy and inactivated influenza vaccine;
•asthma exacerbation or reactive airway disease episodes and inactivated influenza vaccine; and
•autism and MMR vaccine.

Более подробная информация
[Ссылки доступны только зарегистрированным пользователям ]

[cactus1972]

Обновленные рекомендации ААР по лечению ИМП у детей в возрасте 2-24 месяцев

[Ссылки доступны только зарегистрированным пользователям ]

Основные положения гайдлайна

•Compared with parenteral therapy, oral antimicrobial therapy is as effective in treating UTI.
•Evidence from published, randomized controlled trials suggests that when voiding cystourethrography (VCUG) shows vesicoureteral reflux (VUR), antimicrobial prophylaxis is not recommended to prevent febrile UTI.
•The sensitivity of urinary tract ultrasonography after the first UTI is poor.
•The risk for renal damage from UTI may be reduced by early antimicrobial therapy.

•Diagnosis of UTI is made from an appropriately collected urine specimen based on the presence of pyuria as well as 50,000 colonies per mL or more of a single uropathogenic organism.
•To facilitate prompt diagnosis and treatment of recurrent UTIs, close clinical follow-up monitoring should be maintained after 7 to 14 days of antimicrobial therapy.
•To diagnose anatomic abnormalities, ultrasonography of the kidneys and bladder should be performed.
•Because evidence from the most recent 6 studies does not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without VUR or with grade 1 to 4 VUR, VCUG is not recommended routinely after the first UTI.
•However, VCUG is indicated if renal and bladder ultrasonography results show hydronephrosis, scarring, or other evidence of high-grade VUR or obstructive uropathy, as well as in other atypical or complex clinical circumstances.
•Infants and children who have recurrence of a febrile UTI should also undergo VCUG.

[cactus1972]

Гайд по диагностике и лечению внебольничной пневмонии у детей старше 3 месяцев

[Ссылки доступны только зарегистрированным пользователям ]

Даны рекомендации по диагностике и стартовой АБ-терапии, определены показания к госпитализации. Рассмотрен вопрос о необходимости вакцинации

All children and adolescents at least 6 months old should be immunized annually with vaccines for influenza virus to prevent CAP, which the study authors state is a strong recommendation, based on high-quality evidence.

Parents of children younger than 6 months should be vaccinated against influenza because these children cannot receive the preventive vaccine.

[Chevychelov]

Recommendations for Prevention and Control of Influenza in Children, 2011–2012
[Ссылки доступны только зарегистрированным пользователям ]