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Fever without a source in children:international comparison of guidelines

World Journal of Pediatrics 2023年第2期19卷 120-128页

作者： sanne graaf Maya Wietske Keuning Dasja Pajkrt Frans Berend Plötz Department of Pediatrics Tergooi HospitalRijksstraatweg 11261 ANBlaricumThe Netherlands Department of Pediatrics Amsterdam University Medical CentersLocation Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands Department of Pediatric Infectious Diseases Amsterdam University Medical CentersLocation Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

Background Fever without a source(FWS)in children poses a diagnostic *** distinguish a self-limiting infection from a serious infection,multiple guidelines have been developed to aid physicians in the management of ***,there is no comparison of existing FWS *** This comparative review describes consistencies and differences in guideline definitions and diagnostic and therapeutic recommendations.A literature search was performed to include secondary care FWS guidelines of high-income countries,composed by national or regional pediatric or emergency care associations,available in English or *** Ten guidelines of five high-income countries were included,with varying age ranges of children with *** children younger than one month with FWS,the majority of the guidelines recommended laboratory testing,blood and urine culturing and antibiotic treatment irrespective of the clinical condition of the *** for blood culture and antibiotic treatment varied for children aged 1–3 *** children aged above three months,urine culture recommendations were inconsistent,while all guidelines consistently recommended cerebral spinal fluid testing and antibiotic treatment exclusively for children with a high risk of serious *** We found these guidelines broadly consistent,especially for children with FWS younger than one *** variation was seen most in the targeted age ranges and in recommendations for children aged 1–3 months and above three months of *** findings of the current study can assist in harmonizing guideline development and future research for the management of children with FWS.

关键词： Children Fever Guideline

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Predictors for Massive Haemorrhage during Caesarean Delivery Due to Placenta Praevia

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International Journal of Clinical Medicine 2015年第2期6卷 96-104页

作者： Mara Burgers Katrien Oude Rengerink sanne J. Eschbach Moira M. Muller Marielle G. van Pampus Ben W. J. Mol Irene M. de graaf Department of Obstetrics and Gynaecology Academic Medical Centre University of Amsterdam Amsterdam The Netherlands Department of Obstetrics and Gynaecology Leiden University Medical Center Leiden The Netherlands Department of Obstetrics and Gynaecology Spaarne Ziekenhuis Hoofddorp The Netherlands Department of Obstetrics and Gynaecology Onze Lieve Vrouwe Gasthuis Amsterdam The Netherlands Department of Obstetrics and Gynaecology School of Paediatrics and Reproductive Health University of Adelaide Adelaide Australia

Objectives: To describe the incidence and predictive factors for massive haemorrhage during a caesarean delivery in women with placenta praevia. Methods: We performed a retrospective cohort study among consecutive women with a placenta praevia planned for a caesarean delivery between 2001-2011 in one academic centre and two teaching hospitals in the Netherlands. Massive haemorrhage was defined as ≥1000 mL blood loss during caesarean section. We used logistic regression analysis to assess which maternal and pregnancy characteristics were predictors for massive haemorrhage during caesarean delivery. Results: Of 54,794 deliveries, we identified 215 (0.39%) women with placenta praevia who underwent a Caesarean delivery, of whom 94 (44%) had massive haemorrhage at or after surgery. After univariable preselection, multivariable logistic regression indicated that higher maternal age (OR 2.09;95% CI 1.17 - 3.74), no Caucasian ethnicity (OR 1.73;95% CI 0.92 - 3.27), multiple pregnancy (OR 3.92;95% CI 0.72 - 21.28), lower systolic blood pressure during pregnancy (OR 1.03;95% CI 1.00 - 1.07) and the placenta located at the anterior wall (OR 2.21;95% CI 1.20 - 4.04) were independent predictors for massive haemorrhage during a caesarean delivery in women with placenta praevia. Predicted probabilities varied between 22% and 71%. The model has a reasonable discriminative ability and acceptable calibration. Conclusions: Women with placenta praevia are at high risk for massive haemorrhage during caesarean delivery. The risk profile can be used to identify extreme high-risk women in whom extensive preventive measures are justified.

关键词： Placenta Praevia Massive Haemorrhage Caesarean Section Predictors

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