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Indian Pediatr 2011;48:336 |
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Amit P Shah
Email:
[email protected] |
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2nd Booster Dose of DTaP in Thigh Causes
Less Pain Than in Arm (Pediatrics 2011; 127: e581-e587) |
As per the current recommendations, the deltoid muscle is the preferred
site for intramuscular vaccinations given to children aged 1 year and
older. A retrospective study in USA with 233,616 children aged 4-6 years
was done to compare the risk for local reactions requiring medical
attention to the 2 nd booster dose of DTaP vaccine. In all, 0.4% had
a confirmed medically attended local reaction to the fifth, i.e. 2nd
booster dose of the DTaP vaccine. The rate of those reactions was
significantly higher with vaccinations given in the arm (47.4 per 10000
vaccinations) compared with vaccinations given in the thigh (32.1 per
10000 vaccinations) (P <.001). In a multivariable analysis adjusted
for age, gender, and study site, children vaccinated in the arm had a 78%
higher risk of a local reaction.
So, it is clear that even though the local reactions to
the 2 nd booster dose of the DTaP vaccine that require medical
evaluation are uncommon, the risk of those reactions is significantly
higher when the vaccine is injected in the arm. These findings suggest
that the thigh should be considered as an acceptable site of injection for
this vaccination.
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Fever and Antipyretic Use in Children
(Pediatrics 2011; 127: 580-587) |
Fever is one of the most common symptoms, taken seriously by doctors and
parents alike. Many parents administer antipyretics even when there is
minimal or no fever, to maintain a "normal" temperature. Recently, AAP has
come out with a new guideline to treat fever in pediatric patients.
According to the study authors, there is "no evidence that reducing fever
reduces morbidity or mortality from a febrile illness" or that it
decreases the recurrence of febrile seizures. The guideline outlines
strategies to counsel caregivers about treating febrile illness, stating
that acetaminophen and ibuprofen, "when used in appropriate doses, are
generally regarded as safe and effective agents in most clinical
situations." The appropriate dosing for acetaminophen is 10 to 15 mg/kg
per dose given every 4 to 6 hours orally, which produces an antipyretic
effect within 30 to 60 minutes in approximately 80% of children. The
appropriate dosing for ibuprofen is 10 mg/kg per dose. The study warns
against the use of combination therapy with acetaminophen and ibuprofen
because this approach may place infants and children at increased risk for
dosing errors and adverse outcomes.
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Redefining Outcome of First Seizures by
Acute Illness (Pediatrics. 2010; 126(6): e1477-84) |
In this prospective longitudinal study of children who presented with a
first-time seizure, researchers investigated the viral etiology of
associated infectious illnesses and sought to determine the risk of
recurrent seizures stratified by fever and type of illness. Children (aged
6 months to 6 years) were enrolled at the time of evaluation for their
first seizure and followed monthly for up to 5 years. Children with
nonfebrile illness seizures were more likely than those with febrile
seizures to have acute gastroenteritis (47% and 28%, respectively; P
= .05). No significant differences in seizure recurrence were found
between children with or without a fever at first seizure. Children with
acute gastroenteritis at first seizure, regardless of fever, had a lower
risk of seizure recurrence compared with children with other acute
illnesses (hazard ratio: 0.28; 95% confidence interval: 0.09-0.80). This
study confirms the role of gastrointestinal illness as a distinguishing
feature in childhood seizures. Children with this distinct presentation
have a low rate of seizure recurrence and few neurologic complications.
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