A retrospective analysis was performed to describe the course of terminal care provided to dying hospitalized children in terms of symptom assessment and management, and communication and decision-making, at the end of life. Seventy-seven of 236 infants and children who died after hospital admission in Edmonton, Canada between January 1996 and June 1998 met entry criteria. Only children who died after a minimum hospitalization of 24 hours in the case of chronic illness or after a minimum hospitalization of 7 days following an acute event were included. Unanticipated deaths were excluded. Eighty-three percent of children died in intensive care settings (64/77), and 78 % (60/77) were intubated prior to their death. Symptoms were recorded in narrative progress notes. Five of 77 (6%) charts contained specific pain assessment and treatment records. Opioid analgesia was provided in 84 % of all cases (65/77). Six (8 %) patients had do not resuscitate (DNNR) orders preceding final hospital admission and 56/71 (79%) remaining patients had documented discussion resulting in DNR decision during final hospital admission. Median time from DNR to death was < 1 day. Mode of death was withdrawal of therapy in 33/77 (43 %), no cardiopulmonary resuscitation (CPR) in 26/77 (34 %), andfailed CPR in 13/77 (17%). Five children were declared brain dead. In only one case was there evidence in the medical record of the possibility of death being discussed explicitly with the patient. Decision-making regarding end-of-life issues in this pediatric population was deferred very close to the time of death, and only after no remaining curative therapy was available. Acuity of care was very high prior to death. Children are rarely told that they are dying.

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The majority of infants born at gestational age 20 weeks or more weighing <500 g were stillborn. Among live births, neonatal intensive care was withheld in 70% and initiated in 30%. Of the latter, 11% survived to 36 months of age, and of these, 4 infants (31%), most of whom are small for gestational age, female infants, avoided major disabilities but 9 (69%) had one or more major disabilities. Survivors are prone to rehospitalizations early in life, slow growth, feeding problems, and minor visual difficulties; rates of learning-related and behavioral problems at school age are not yet known. Implications. Parents and caregivers faced with the impending delivery of an infant in this gestational age/birth weight category should understand that survival without multiple major disabilities is possible but rare. They should be made aware of local population-based results and not just isolated reports.

The purpose of this study was to compare 2 methods of identifying an appropriate drop height for bounce depth jump (DJ) training, which aimed to improve reactive strength and countermovement jump (CMJ) performance. The maximum jump height (MJH) method was compared to the reactive strength index (RSI) method. The first part of the study identified each participant's drop height for both methods and determined the extent to which both methods differed. The subsequent part of the study used an 8-week bounce DJ training program to compare the effectiveness of the MJH and RSI methods. Twenty-two male participants volunteered. There was a significant difference between the MJH and the RSI methods in the optimal drop height they identified (median = 0.40 and 0.30 m, respectively), with 19 participants exhibiting a difference of 0.10 m or more. These 19 participants were assigned to 1 of 3 training groups: a control, an MJH method, and an RSI method group. The results demonstrated a significant increase in pre to posttraining in reactive strength (MJH: 27.3 +/- 18.7%, p = 0.025; RSI: 11.8 +/- 10.1%, p = 0.019) and CMJ performance (MJH: 9.9 +/- 5.2%, p = 0.009; RSI: 9.2 +/- 4.8%, p = 0.006) in both the MJH and RSI groups, respectively, with no change in the control group. The study concluded that either method can be used to identify the optimal drop height in bounce DJ training to increase CMJ performance, but the MJH method should be used to improve reactive strength.

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The incidence of complications was recorded for 269 consecutive neonatal endotracheal intubations after instituting a routine policy of premedication. Two hundred and fifty-three of the intubations were premedicated with a combination of atropine, fentanyl and succinylcholine, 194 were without incident, 28 required two attempts, 22 required more than two attempts, and 9 required a second attempt with a smaller endotracheal tube. All infants were successfully intubated. We conclude that a policy of routine neonatal premedication for intubation is safe, feasible, and humane.