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At least 181 records · Page 10Linked to original sources

PubMed2006

Biological activity of paediatric cerebral cavernomas: an immunohistochemical study of 28 patients.

OBJECTIVE: According to the hypothesis that paediatric cerebral cavernomas may have different biological activity compared to adult cavernomas, immunohistochemical analysis was used to elucidate the biological nature of paediatric cavernomas. PATIENTS AND METHODS: We examined the histological features and the proliferative and angiogenic capacity of the tissue specimens acquired from 28 paediatric patients. Normal paediatric brain tissues obtained from paediatric autopsy cases were used as a control group. The proliferative activity of the endothelium and the neoangiogenetic capacity were investigated by immunohistochemistry for proliferating cell nuclear antigen (PCNA), Ki-67 epitope (MIB-1), Flk-1 receptor, vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF)-1 alpha, and endoglin antibody, respectively. Afterwards, the results of the paediatric lesions were analysed and compared with the correspondent values of previously reported immunohistochemical analysis in adult cavernomas. RESULTS: Positive immunostaining of VEGF was detected significantly less in paediatric cavernomas compared to adult cases (p<0.05). In contrast, endoglin, a protein that is upregulated during an increased vascular shear stress, was expressed more often in paediatric cavernomas (p<0.05). Neither the expression of the PCNA nor the expression of the HIF-1alpha was found significantly different between paediatric and adult cavernomas. However, the positive immunoreaction for MIB-1 occurred more often in the paediatric cases (p<0.05). CONCLUSIONS: The immunohistochemical study indicates that paediatric cavernomas are dynamic lesions. The VEGF/Flk-1 associated neoangiogenesis may play a minor role for the biology of paediatric cavernomas, while endoglin seems to act more prominently than previously thought, particularly for the biology of paediatric cavernomas.

Adolescent↗

PubMed2004

Ambulance alerting of paediatric emergencies to a general hospital.

BACKGROUND: There are at present only a small number of dedicated paediatric emergency departments in the UK. Severely ill and injured children are often taken by ambulance to the nearest general hospital. Efforts have been made to provide better care for these sickest children pending the establishment of dedicated paediatric emergency services within general emergency departments by 2004 [Royal College of Paediatrics and Child Health; Accident and Emergency Services for Children-Report of a Multidisciplinary Working Party, June 1999]. To learn more of the staffing implications for the establishment of dedicated paediatric emergency units within the general hospital, 30 months of paediatric alert call data are presented. METHODS: A prospective review of paediatric alert calls over 30 months, (from January 1999 until June 2001). All alert calls from the ambulance service to a large urban emergency department were recorded on a specific form. Data from these forms is presented. RESULTS: There were 1754 alert calls of all types during this 30-month period, of which 153 (9%) were for patients under the age of 16 (mean 1.2 each week). Of these, 102 (66%) were for medical conditions and 51 (34%) were for trauma. The mean estimated time of arrival from the time of the alert call was 6 min. The majority of both medical and trauma paediatric alert calls occur in the afternoon and progress well into the night. The 51.6% of paediatric medical alert calls and 64.4% of paediatric trauma alert calls occur 'out of normal hours'. There was little reduction in the frequency of alert calls at the weekend. There were no paediatric trauma alert calls between 2 a.m. and 10 a.m., although medical paediatric alert calls continued throughout the night. CONCLUSIONS: Resident senior trauma personnel to manage injured children should be provided until at least midnight. Hospitals that maintain a facility for the reception of sick children must be able to provide a rapid response to paediatric medical emergencies on a 24 h basis. Guidelines for alert calls for ambulance crews are required.

Adolescent↗

PubMed2002

A study of triage of paediatric patients in Australia.

OBJECTIVES: To describe the triage of children in a sample of mixed and paediatric emergency departments in Australia in 1999 and to measure the inter-rater reliability of the National Triage Scale when used by triage nurses for the triage of paediatric patients. METHODS: A questionnaire was sent to 11 hospitals, including one paediatric and one mixed emergency department, in each state studied. Triage nurses were asked to assess 25 paediatric patient profiles and to assign appropriate triage categories to each profile. The number of responses within the modal triage category (concurrence), the percentage of responses with a concurrence of at least 50% and the number of responses within one triage category of the modal response (spread) of responses were measured. Triage data for 1999 from the same emergency departments were collected and numbers of children seen and admitted in each triage category were described. The patterns of distribution of triage categories for specific paediatric diagnoses (triage 'footprints') were also described. Data from mixed emergency departments were grouped and compared with data from paediatric emergency departments and any differences were described. RESULTS: Seventy-eight nurses in 10 hospitals responded to the questionnaire. Sixty-three per cent of all responses had a concurrence of greater than 50%. Ninety-four per cent of patient profiles were triaged to within one triage category of their modal response. Nurses in paediatric emergency departments (concurrence greater than 50% for 79% of responses) were significantly more consistent in their use of the National Triage Scale compared with nurses in mixed emergency departments (concurrence greater than 50% for 50% of responses). Paediatric emergency department triage nurses were more likely to use the full range of the National Triage Scale and were fourfold as likely to allocate triage categories 4 and 5 to patient profiles. Paediatric hospitals allocated patients to triage categories 4 and 5 for an average of 710 of presentations compared with 47% for mixed emergency departments. Specific diagnoses had characteristic distributions of triage categories, with similar differences seen when comparisons were made between mixed and paediatric emergency departments. CONCLUSION: Use of the National Triage Scale for the triage of paediatric patients by triage staff is not consistent and there are significant differences between the triage practices of paediatric and mixed emergency departments.

Australia↗

PubMed1983

Paediatric neurology in the United Kingdom.

The author visited ten paediatric neurology departments in the U.K. as part of a travelling scholarship. He was particularly interested in the way services were organized, and was able to make comparisons and note those features which seemed desirable. It seemed to him that: there should be a considerable overlap between paediatric neurology and handicapped childrens' services with the paediatric neurologist an active member of the local child development centre team; paediatric neurologists should be closely involved in the diagnosis and treatment of acute neurological disorders; minimum staffing for a regional paediatric neurology service for a total population of 2 million or more would be two consultant paediatric neurologists and appropriate supporting staff; different centres have opted for inpatient facilities either in a separate paediatric neurology ward, or in general paediatric wards: there are advantages and disadvantages for each option; school clinics and clinics in other hospital centres are valuable; neuroradiology, neurosurgery, neurophysiology and neuropathology should ideally be present in the hospital providing the paediatric neurology service; regular professional contact with other doctors in the neurosciences is important; junior posts in paediatric neurology would usually be filled by paediatricians in training but certain centres could be asked to appoint a career senior registrar from time to time depending on consultant paediatric neurologist requirements; and creation of lecturerships in paediatric neurology would help to encourage academic research in the subject.

Career Mobility↗

PubMed2003

Epidural analgesia in children. A survey of current opinions and practices amongst UK paediatric anaesthetists.

BACKGROUND: Despite the widespread use of epidural analgesia in children its place in paediatric pain management has not been clearly established. In order to investigate the current practice of paediatric epidural analgesia in the UK paediatric anaesthetists and paediatric pain management teams were surveyed. METHODS: Questionnaires were sent to the members of the Association of Paediatric Anaesthetists (APA) working within the UK and to lead clinicians and clinical nurse specialists for acute pain in the 26 designated major paediatric centres. RESULTS: The response rate was 72%. There was little consensus regarding drugs and drug combinations used for epidural analgesia. A total of 36% of paediatric centres did not audit their epidural practice, and of those that did the reported incidences of side-effects showed wide variation. Important differences in practice were also identified in the areas of patient selection, informed consent, the use of epidural test doses, drug delivery systems, monitoring and the management of side-effects. Twelve per cent of specialist paediatric hospitals did not have an acute pain team and elsewhere the provision was often limited to staff with few or no specialist skills. CONCLUSION: There is wide variation in the practice of paediatric epidural analgesia in the UK. Inconsistencies are likely to be related to the poor evidence base available to guide clinical decision making and the lack of a specialized paediatric acute pain service in some centres. More research is required to determine the optimal management of epidural analgesia, and suitable clinical support for paediatric pain control should be more widely available.

Analgesia, Epidural↗

PubMed2003

Dosing information for paediatric patients: are they really "therapeutic orphans"?

OBJECTIVES: To review the approved product information (PI) of prescription medicines to determine the extent and nature of information available on paediatric dosing and the availability of paediatric dosage formulations in Australia. METHODS: The PIs for all prescription medicines listed in the Australian Monthly Index of Medical Specialties (MIMS) were reviewed. Dosing information for each PI was categorised according to age groupings. PIs claiming suitability for use in paediatric patients were reviewed for information on the availability of paediatric dosage forms. MAIN OUTCOME MEASURES: Proportion of PIs providing paediatric dosing information; availability of dosage forms suitable for children. RESULTS: A total of 1497 PIs were reviewed. The proportions, for each age group, of PIs with inadequate paediatric dosing information were: < 1 month (80.5%), 1-3 months (79.1%), 3 months-2 years (77.5%), 2-6 years (73.2%), and 6-12 years (71.6%). The proportions, for each age group, of PIs that gave specific paediatric dosing information but did not provide a paediatric dosage form were: < 1 month (26.5%), 1-3 months (25.1%), 3 months-2 years (23.3%), 2-6 years (21.9%), and 6-12 years (24.0%). CONCLUSIONS: The PIs for many prescription products listed in MIMS do not adequately detail paediatric doses. Many medicines for which specific paediatric dosing information is given are not available in dosage forms appropriate for children.

Australia↗

PubMed1992

The Paediatric Board of the Royal College of Physicians of London: its role in the college.

Conscious of its responsibilities to its Fellows and Members who are paediatricians, the Royal College of Physicians (RCP) is anxious to play its part, along with others, in maintaining and improving standards in paediatrics. Recognising the importance and prominence of the specialty within the generality of specialist medicine, and alongside general internal medicine, it has established a Paediatric Board, reporting directly to Council, which will deal with and advise on all matters concerning paediatrics and child health, and thus enhance the autonomy and influence of the specialty both within the College and on medical affairs in general. It will do this in close association with the British Paediatric Association (BPA) which will nominate members of the Board. In particular the RCP will continue to set standards in paediatrics through examinations, accreditation, representatives on consultant advisory appointment committees, and its membership of the GMC and the Conference of Medical Royal Colleges and their Faculties, to which the Paediatric Board will make a substantial contribution. The network of regional paediatric advisers to the RCP will ensure that the Board is kept in touch with paediatric opinion throughout England, Wales and Northern Ireland. Relationships with Scottish paediatrics and paediatricians will be important, for example, in the organisation and development of the MRCP(UK) examination and its paediatric Part II. Links with paediatricians in the Irish Republic exist through the Joint Committee on Higher Medical Training.

Curriculum↗

PubMed2000

Split liver is an effective tool to transplant paediatric patients.

Transplantation activity is dependent upon organ procurement; although great efforts are made to enlarge the cadaver donors' pool, it still remains far too small to meet the recipients' need. Waiting time is a particular problem for paediatric patients, and mortality on the waiting list for liver transplantation is very high. The number of paediatric donors is far too small to satisfy the request. To enlarge the liver pool, the split-liver procedure was introduced in several Transplant Centers. In November 1997, the North Italy Transplant program (NITp) Working Group for Liver Transplantation decided to start an official Split-liver Program. A protocol was therefore defined and criteria for donor's and recipient's eligibility were established to minimize the risk. The Working Group also standardized the technical procedure and defined collaboration between centers. Out of 410 cadaver liver donors used in the NITp, from 1 November 1997 until 31 May 1999, 49 patients (37 males and 12 females) were chosen for the split-liver procedure. Mean age was 29.9 +/- 17.5 years. Mean ICU stay of the donors was considerably short (2.5 +/- 2.1 days), and the other conditions foreseen for donor eligibility were met. In all cases (except two) an "in situ" technique was performed. Forty-nine adult recipients and 43 children were transplanted by the split-liver technique in our Transplant Centers. One right lobe and five left liver lobes were sent to Transplant Centers outside the NITp. Adult recipient age ranged from 18 to 60 years (mean 46.4 +/- 11.7 years), and the paediatric one from 2 to 144 months (mean 24.8). Mean patient follow-up was 8.3 +/- 5.5 months. In the paediatric group, the graft was successful in 34 cases (79%), five patients (10.2%) died and four (9.3%) were re-transplanted. In the adult group, graft survival was 67.3%, 11 (22%) patients died and 5 (10%) were re-transplanted. On 1 November 1997, 30 paediatric patients were on the liver waiting list. In the preceding 19 months, 52 patients were newly enrolled, and 36 transplants were performed. The mean waiting time of paediatric patients was 259 days (range 1-919 says). From 1 November 1997 to 31 May 1999, 61 paediatric patients were newly enrolled. In this period 70 patients were transplanted. The mean waiting time was 185 days (1-1010 days). At present, the liver waiting list includes eight paediatric patients. Split-liver transplantation is a successful procedure, effective in reducing waiting time for paediatric patients. It should be established if this may be a tool to enlarge the organ pool also for adult liver transplantation.

Adolescent↗

PubMed1999

Paediatric neurosurgery in India.

In a vast country like India, with children constituting 40% of a total population of 900 million people, the need and scope for paediatric neurosurgery is enormous. Initial organised attempts to focus attention on the need for paediatric neurosurgery as a subspecialty were made in 1983 and 1987, respectively, by holding symposia on infections and tumours in children. However, when the Annual Conference of ISPN was held in Bombay this served as a great impetus to the development of paediatric neurosurgery as a subspecialty in this country. It led to the formation of the Indian Society for Paediatric Neurosurgery in the following year, which now has 90 neurosurgeons in full membership. It has held annual meetings ever since its inception and has held CME programmes with international faculty in 1992, 1994, 1996, 1997 and 1998. Half a dozen neurosurgeons have already devoted themselves mainly to the practice of paediatric neurosurgery. Paediatric neurosurgery is best developed in a large multi-disciplinary paediatric institute. We have been able to establish a neurosurgical service at Jerbai Wadia Hospital for Children, a paediatric institute of repute in Mumbai, and hope to have training programmes and fellowships in the near future for both general and paediatric neurosurgeons, as they will have to continue treating cases of spina bifida and hydrocephalus for several years to come.

Child↗

PubMed2006

Thirty years of the Union of National European Paediatric Societies and Associations (UNEPSA).

BACKGROUND: The Union of National European Paediatric Societies and Associations was founded in 1976 in Rotterdam. Thirty years later, the authors--former presidents and secretaries general--present a retrospective on the activities and achievements of UNEPSA. In 2006, 36 of 46 (78%) European countries, including some countries of the former Soviet Union, were members of UNEPSA. UNEPSA has created a forum for the mutual discussion of matters concerning paediatrics. UNEPSA is closely linked with the International Pediatric Association (IPA). It was never UNEPSA's ambition to promote a uniform European paediatrics. In the 30 years of its existence, it became clear that the diversity of paediatric care in different countries in Europe is extreme. During the "cold war", UNEPSA was able to cross boundaries between socialist and capitalist countries in Europe, and it was due to the activity of individual members of the UNEPSA council that clinical co-operation and research activities were initiated crossing many political borders. Annual meetings of national paediatric presidents focus on the most urgent problems of paediatric health care. "Europaediatrics" became the tri-annual congress for all general paediatricians and paediatric sub-specialists in Europe. The main research activities of UNEPSA concentrated on identifying the demography of primary, secondary and tertiary care paediatrics in Europe. CONCLUSION: UNEPSA is an active paediatric association representing more than three quarters of all European countries. After 30 years, it is still an expanding and vital instrument in improving the medical care of all children and the co-operation of their carers in Europe.

Europe↗

PubMed2006

Assessing outcomes in paediatric trauma populations.

INTRODUCTION: Assessing outcomes in the paediatric trauma population is important. Identifying suitable instruments can be problematic. This article highlights the commonly used outcome measures for assessing functional status and health related quality of life in paediatric trauma patients. Child specific characteristics which impact upon instrument development and selection are reviewed. METHODS: An electronic database search was conducted to identify suitable English language measures used for outcome assessment in paediatric trauma patients from 1966 to present. RESULTS: Nine suitable instruments were identified, the child health questionnaire (CHQ), Glasgow outcome scale (GOS), paediatric overall performance category (POPC), PedsQL 4.0 generic core scales, paediatric evaluation of disability inventory (PEDI), functional independence measure (FIM), WeeFIM and an unnamed paediatric trauma specific measure [Gofin R, Hass T, Adler B, The development of disability scales for childhood and adolescent injuries. J Clin Epidemiol 1995;48:977-84]. Each instrument was found to have advantages and disadvantages for assessing outcomes in a paediatric trauma population. CONCLUSION: The PedsQL 4.0 generic core scale could be feasible for administration as a routine outcome measure for paediatric trauma groups. For very young children an additional measure such as that proposed by Gofin et al. [Gofin R, Hass T, Adler B, The development of disability scales for childhood and adolescent injuries. J Clin Epidemiol 1995;48:977-84] may be indicated. Future use of these instruments in the paediatric population would benefit from further psychometric evaluation.

Adolescent↗

PubMed1997

More education in paediatric audiology needed for child welfare clinic nurses and doctors.

Opinions on formal and further education in paediatric audiology were surveyed by interviewing nurses and doctors in 28 Finnish child welfare clinics. Over half of the nurses recalled that they had been taught hearing screening during their period of practical training. Regarding formal teaching in paediatric audiology, the majority of doctors referred to courses in either otolaryngology, paediatrics or both. None of the doctors and only three of the nurses had taken part in any updating courses dealing with paediatric audiology during the last three years, and it turned out that no such courses had been arranged in three of the five hospital districts. However, 17 out of the 27 doctors and 23 out of the 28 nurses expressed their interest in further education. The present amount of formal education in paediatric audiology was ascertained from all five Finnish medical faculties and the five nursing schools in the provinces of Oulu and Lapland. The university departments of otolaryngology carry the major responsibility for teaching in paediatric audiology, which includes one to two hours of lectures and none to four hours of tutorials, depending on the faculty concerned. The amount of audiometric training at nursing schools varies from none to five hours and that of lectures in otolaryngology from three to twenty hours. Better co-ordination between departments of otolaryngology, general practice and paediatrics is needed when arranging teaching in paediatric audiology for medical students. Trainee child welfare nurses seem to need more guided practice in audiometry, and there is an obvious need for increasing the amount of practice in audiological departments. Specialist clinics should plan and implement a programme for updating training in paediatric audiology, including evaluation of the programme.

Audiology↗

PubMed1998

The cost of treating paediatric malaria admissions and the potential impact of insecticide-treated mosquito nets on hospital expenditure.

OBJECTIVE: To calculate the costs at Kilifi District Hospital (KDH) and Malindi Sub-district Hospital (MSH) of treating paediatric malaria admissions including three common presentations of severe paediatric malaria, i.e. cerebral malaria, severe malaria anaemia and malaria-associated seizures; and to estimate the implications for hospital expenditure of a reduction in paediatric malaria admissions. METHODS: Patient data were obtained from hospital records. All costs were allocated to departments that provided direct patient care by a four-stage step-down procedure. Laboratory and drug costs of treating paediatric malaria admissions were separately identified. RESULT: Unit recurrent costs per admission in KDH ranged from US $57 for 'other' paediatric malaria to US $105 for cerebral malaria, and in MSH from US $33 to US $44 for the same categories. The annual recurrent cost of treating all paediatric malaria admissions to KDH prior to the trial was estimated at US $78 900. Adjusting for preintervention differences in malaria admission rates and age between intervention and control areas, the ITBN trial found a 41% reduction in paediatric malaria admissions. The reduction in admissions resulted in an estimated saving of US $6240 in the cost of treating paediatric malaria admissions from the intervention area. CONCLUSION: There would be a substantial reduction in costs of treating paediatric malaria admissions if the intervention were introduced in the whole catchment area of the hospital. Actual savings would depend on the proportion of potential savings that can in practice be realised, and on the effectiveness of the intervention when routinely implemented.

Anemia↗

PubMedDate not supplied

Creating and being created: the changing panorama of paediatric rehabilitation.

Paediatric rehabilitation as a discipline is rapidly changing, especially during the last decades. In the past, paediatric rehabilitation was characterized by merely adult intervention strategies in a miniaturized form, delivered by a merely adult patients-oriented profession. Theories on childhood development, however, changed, as did the focus of interventions: from impairments to function, from the child itself to family, community and peers. The call for outcome-oriented and evidence-based medicine lastly, changed paediatric rehabilitation into a mature paediatric profession with it's own scientific framework. This is reflected among other things in the increasing number of paediatric measures and instruments specifically geared to the paediatric rehabilitation profession, for example the Gross Motor Function Measure, Paediatric Evaluation of Disability Inventory and Movement ABC. More recently, paediatric exercise physiologists are pointing to the benefits of an active lifestyle and training for patients with chronic diseases and disabilities. Several studies have evaluated the effects of such training programmes and came up with positive results. It shows that paediatric rehabilitation continues to develop as a dynamic profession, having growth, childhood development and childhood activities as it's core business.

Child↗

PubMed2003

The administration of beta2-agonists for paediatric asthma and its adverse reaction in Australian and New Zealand emergency departments: a cross-sectional survey.

AIM: To determine the current use of beta2-agonists, in particular salbutamol, for the management of acute asthma in children in emergency departments throughout Australia and New Zealand. METHODS: A cross-sectional survey using a questionnaire that sought to determine the current use of salbutamol and any adverse drug reactions in paediatric emergency departments. RESULTS: Out of 37 hospitals eligible as paediatric emergency departments, 33 (89.1%) responded to the survey, 54.5% having guidelines for the management of acute asthma. Of the paediatric emergency departments surveyed, 45.5% used metered-dose inhaler spacer combination in the treatment of mild to moderate asthma. All paediatric emergency departments used nebulized salbutamol for acute severe asthma. In addition, 85% of paediatric emergency departments used continuous-infusion intravenous salbutamol in unresponsive patients, 63.6% administering a single-dose intravenous salbutamol bolus before commencing the infusion. District paediatric emergency departments were more likely to treat with continuous-infusion intravenous salbutamol outside of the intensive care unit. Clinical unresponsiveness to inhaled salbutamol and clinical improvement were the reported criteria in all paediatric emergency departments for the use and cessation of intravenous salbutamol. Adverse drug reactions were common: tremor (90%), hypokalaemia (45.5%) and supraventricular tachycardia (21%), particularly if continuous-infusion intravenous salbutamol administered. Eight deaths from asthma were reported, none being related to adverse drug reactions. CONCLUSION: We report a wide variation of salbutamol use in paediatric emergency departments and a high prevalence of type A adverse drug reactions when continuous-infusion intravenous salbutamol therapy was administered. More evidence is needed on the clinical significance of the adverse effects reported in this study and optimal doses for the safe use of continuous-infusion intravenous salbutamol therapy in paediatric emergency departments.

Adolescent↗

PubMed2006

Recent developments in airway management of the paediatric patient.

PURPOSE OF THE REVIEW: During the last two years, several studies have enhanced our knowledge about the influence of pharmacological agents and routine airway management manoeuvres on the airway of paediatric patients. New supraglottic airway devices have been introduced into routine paediatric anaesthesia practice, and the design of paediatric endotracheal tubes has been modified. This review summarizes the most recent and relevant scientific developments in paediatric airway management. RECENT FINDINGS: Strong evidence has been gained that the lateral position is the best to ensure a clear airway in anaesthetized or sedated spontaneously breathing children. Remifentanil has emerged as an appealing drug for airway management in anaesthetized or sedated children. The paediatric ProSeal-Laryngeal mask airway offers important advantages over the Classic-Laryngeal mask airway for supraglottic airway management. The newly designed Microcuff paediatric endotracheal tube offers an improved age-appropriate design. SUMMARY: Remifentanil has found a place in airway management in paediatric patients. Recent improvements in the design of paediatric supraglottic airway devices and endotracheal tubes are promising. Further research is needed to consolidate their role in improving the perioperative outcome in paediatric patients.

Analgesics, Opioid↗

PubMed1997

Cyclosporin pharmacokinetics in paediatric transplant recipients.

Cyclosporin is an essential component of the antirejection drug protocol used in the long term management of paediatric organ transplant recipients. This article looks at the pharmacokinetics of cyclosporin in paediatric kidney, heart, liver and bone marrow transplant recipients and critically evaluates its relationship to pharmacokinetic data in adult transplant recipients. There are limited data on the pharmacokinetics of cyclosporin in paediatric transplant recipients (14 publications provide the database) as compared with the adult transplant population. Study design, analytical methodology and age ranges of the individuals differ between studies, making comparative interpretation of pharmacokinetic data difficult. However, significant trends are noteworthy and these may influence dose administration guidelines and therapeutic monitoring standards for cyclosporin in the paediatric organ transplant recipient. The bioavailability of the oral formulations of cyclosporin is highly variable as with the adult population, but there appears to be a correlation between cyclosporin bioavailability and age with both the traditional oral formulation (Sandimmun) and the new microemulsion formulation (Neoral) in young liver transplant patients. Bowel length, presystemic metabolism in the gut wall, type of transplant and time since transplant are contributing factors in the variation of bioavailability patterns in paediatric transplant patients. The volume of distribution of cyclosporin does not appear to differ between paediatric and adult transplant recipients, but systemic clearance is comparatively higher in the paediatric population. In general, paediatric patients require higher doses of cyclosporin to achieve target blood concentrations of the drug which are equivalent to the values used in the adult population. Younger patients (less than 8 years of age) may be managed more effectively with a 3 times daily administration schedule rather than the twice daily schedule which is universally used for cyclosporin in the transplant population. The comparatively higher doses and more frequent administration schedule used in paediatric transplant recipients are the consequence of age-related differences in bioavailability and the possibility of increased metabolic clearance of the drug in younger patients.

Adolescent↗

PubMed2005

A 9-year study comparing risk factors and the outcome of paediatric and adults with nosocomial candidaemia.

Although there are numerous studies of candidaemia in adults, data on paediatrics are still limited. The aim of this study was to compare risk factors, aetiology, therapy, and the outcome of nosocomial candidaemia among paediatric and adult patients in a large Brazilian tertiary hospital (1995-2003). During this period, 78 paediatrics and 113 adults were studied. Species other than Candida albicans caused 78.2% of episodes of candidaemia in paediatrics. Compared to adults, paediatrics received more frequently broad-spectrum antibiotics, vasopressors, blood transfusions, arterial catheter, chest tube, cardiothoracic surgery, mechanical ventilation, and parenteral nutrition. Candidaemia caused by Candida parapsilosis was more common in paediatrics, as was the isolation of Candida spp. from catheters. Amphotericin B treatment was more common in paediatrics. Mortality rate was higher in adults than in paediatrics with nosocomial candidaemia. We reinforce the necessity of continuous epidemiologic surveillance to follow the dynamics of candidaemia.

Adolescent↗