HFNP therapy has dramatically changed ventilatory practice in infants <24 months of age in our institution, and appears to reduce the need for intubation in infants with viral bronchiolitis.
SUMMARY1. Measurements of evaporative sweat loss were made on fifty-six premature and full-term babies 1-67 days after birth with an infra-red analyzer and a ventilated capsule placed on the thigh. Measurements were also made of total evaporative water loss while in a closed metabolic chamber and of the regional distribution of sweating with starch-iodine paper.2. No sweating to thermal stimuli could be detected in infants of less than 210 days post-conceptual age, even when rectal temperature rose as high as 37.8°C. In older infants sweat was detected first on the forehead and temple, later on the chest, and usually by 240-260 days post-conceptual age on the legs (term 268 days). Generalized sweating on the limbs appeared at an earlier post-conceptual age in the more prematurely born infants.3. The response of sweat glands on the thigh to an intradermal injection of 2 ,tg acetylcholine (ACh) was tested. No sweat response was detected in infants under 225 days post-conceptual age, while all infants born within 2 weeks of term responded. The response was often augmented after 2-5 tests at 5-10 min intervals; all the eight infants born within 2 weeks of term who were examined twice in the first 2 weeks of life showed a greater response on the second occasion.4. An average of 414 active sweat glands/cm2 were detected on the thigh in eight babies 7-10 days old born within 2 weeks of term. This was 61 times the number found in adults. The mean peak sweat rate to chemical stimulation was however only 2 4 nl./gland. min, which was 3 times lower than the maximum rate recorded in adults.
ObjectivesCT of the brain (CTB) for paediatric head injury is used less frequently at tertiary paediatric emergency departments (EDs) in Australia and New Zealand than in North America. In preparation for release of a national head injury guideline and given the high variation in CTB use found in North America, we aimed to assess variation in CTB use for paediatric head injury across hospitals types.MethodsMulticentre retrospective review of presentations to tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016. Children aged <16 years, with a primary ED diagnosis of head injury were included and data extracted from 100 eligible cases per site. Primary outcome was CTB use adjusted for severity (Glasgow Coma Scale) with 95% CIs; secondary outcomes included hospital length of stay and admission rate.ResultsThere were 3072 head injury presentations at 31 EDs: 9 tertiary (n=900), 11 urban/suburban (n=1072) and 11 regional/rural EDs (n=1100). The proportion of children with Glasgow Coma Score ≤13 was 1.3% in each type of hospital. Among all presentations, CTB was performed for 8.2% (95% CI 6.4 to 10.0) in tertiary hospitals, 6.6% (95% CI 5.1 to 8.1) in urban/suburban hospitals and 6.1% (95% CI 4.7 to 7.5) in regional/rural. Intragroup variation of CTB use ranged from 0% to 14%. The regional/rural hospitals admitted fewer patients (14.6%, 95% CI 12.6% to 16.9%, p<0.001) than tertiary and urban/suburban hospitals (28.1%, 95% CI 25.2% to 31.2%; 27.3%, 95% CI 24.7% to 30.1%).ConclusionsIn Australia and New Zealand, there was no difference in CTB use for paediatric patients with head injuries across tertiary, urban/suburban and regional/rural EDs with similar intragroup variation. This information can inform a binational head injury guideline.
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