ABSTRACT. Objective. To compare the additive effect of a helium-oxygen mixture (Heliox) or racemic epinephrine (RE) on croup scores (CSs) in children with moderate to severe croup treated with humidified oxygen and steroids.Design. A prospective, randomized, double-blind trial.Setting. Emergency department and pediatric intensive care unit of an urban level I trauma center.Participants. Randomly assigned, consecutive children ages 6 months to 3 years presenting with moderate to severe croup (CS: >5).Interventions. After cool humidified oxygen and 0.6 mg/kg of intramuscular dexamethasone, patients were randomized to receive either Heliox or RE. Vital signs, oxygen saturation, and CSs were recorded at regular intervals.Outcome/Analysis. Reductions in CSs were compared using repeated-measures analysis of variance.Results. Thirty-three patients were enrolled. Three were excluded because of protocol violations, and 1 was excluded because of lack of documentation, leaving 29 patients for final analysis. The average age was 24.2 months, 20 were male (68.8%). Both Heliox and RE were associated with improvement in CSs over time. There were no significant differences in mean CS, oxygen saturation, respiratory rate, or heart rate between groups at baseline or at the end of the treatment period.Conclusion. In patients with moderate to severe croup, the administration of Heliox resulted in similar improvements in CS compared with patients given RE. Pediatrics 2001;107(6). URL: http://www.pediatrics.org/ cgi/content/full/107/6/e96; helium-oxygen mixture, croup.ABBREVIATIONS. RE, racemic epinephrine; CS, croup score; ED, emergency department. L aryngotracheobronchitis, or croup, is a common respiratory illness in children. Most cases of croup are mild and require only supportive care with humidified oxygen. However, in moderate to severe cases, aggressive therapy may be necessary to avoid exhaustion and subsequent respiratory failure. Although steroids have gained widespread acceptance as a means of attenuating subglottic edema, racemic epinephrine (RE) has long been considered the mainstay of acute therapy for moderate to severe croup. 1 Helium is a biologically inert gas that possesses a very low specific gravity (density) and is one third the viscosity of air. 2 These properties result in a decreased resistance to airflow (lower Reynolds number), and suggest that a helium-oxygen mixture may be a useful adjunct to improve ventilation via enhanced laminar airflow in the face of moderate to severe croup. Recently, mixtures of helium and oxygen have been used successfully in the pediatric intensive care unit setting for treatment of both refractory viral and postextubation croup. [3][4][5] Although both Heliox (AGA Gas, Flint, MI) and RE have been independently shown to decrease the work of breathing and lower croup scores (CSs), 3,4,6 no study to date has compared these modalities in the management of moderate to severe croup. Therefore, the purpose of this study was to compare the relative effect of Heliox and RE on CSs in pe...

Background/Aims: To evaluate the metabolic effects of meals with varying glycemic index (GI). Methods: We measured the glucose, insulin and leptin responses to two contrasting breakfast cereals in a group of 10 young healthy volunteers. Meals were provided on two separate occasions in random order after a 12-hour overnight fast, and consisted of 50 g of available carbohydrate from either Corn Flakes (Kellogg’s), or Fiber One® (General Mills). Blood samples were obtained at rest, and 30, 60, 90 and 120 min after eating. The GI was calculated from the glucose response to the test meal normalized against a 50 g oral glucose load. Results: The GI for Corn Flakes was 125 ± 17 units and 49 ± 8 units for Fiber One®. These meals were classified as high GI and low GI, respectively, and were significantly different from each other (p < 0.0003). The area under the insulin response curve (AUC) following the low glycemic meal was significantly attenuated compared to the high glycemic meal (14,064 ± 2,694 vs. 6,828 ± 1,182 pmol/l·min, p < 0.02). The leptin AUC revealed that circulating leptin was suppressed by the high glycemic meal compared to the low (3.1 ± 1.5 vs. 9.6 ± 3.6 ng/ml·min, p < 0.04). Conclusions: Lower insulin and higher leptin suggests that low glycemic meals promote a postprandial metabolic milieu that is favorable for reduced food consumption; this may be advantageous in the control of obesity and related disorders including insulin resistance and type 2 diabetes.

Moderate increases in RR, HR, and BP occur after naloxone administration to children, but development of more serious complications is rare.