Deborah Coody

MOPP regimen as primary chemotherapy for brain tumors in infants

SummarySeventeen infants with central nervous system malignancies, all with tissue diagnosis, were treated with the combination chemotherapy nitrogen mustard, vincristine, procarbazine and a steroid (MOPP) as primary therapy following surgery. Diagnoses include: 7 astrocytomas (grade: 3-I, 3-II, 1-III), 6 medulloblastomas, 2 ependymoma/astrocytoma mixed, 1 ependymoma and 1 primitive neuroectodermal tumor. Fourteen were under 2 years of age, 2 between 2 and 3 years of age, and 1 between 3 and 4 years of age. Fifteen responded and 2 failed. Of the responders, 6 are in continuous complete remission (median duration 28.9+ months) and 9 are in relapse (median duration of remission 10.3 months). Of the 2 patients who failed and 9 who relapsed, 4 expired and 6 are living in partial or complete remission. We conclude that MOPP therapy is well tolerated, has effectiveness, and allows postponement of potentially debilitating radiotherapy in infants with brain tumors.

Eye trauma in children: epidemiology, management, and prevention

Eye injuries in children are frequently evaluated by nurse practitioners. The child with serious eye trauma is quickly assessed and referred to an ophthalmologist. However, many of the cases are managed in the ambulatory setting. Appropriate and swift management of eye trauma is essential to ensuring optimal outcome for the child. In addition, pediatric nurse practitioners play a critical role in educating children, families and the public about the prevention of eye trauma, particularly the use of protective eyewear. This article discusses the epidemiology, assessment, and prevention of eye trauma in children.

Shaken baby syndrome: Identification and prevention for nurse practitioners

Shaken baby syndrome is a less widely recognized form of physical child abuse. It is defined as vigorous manual shaking of an infant who is being held by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding and no external signs of head trauma; often identifying shaken baby syndrome is difficult because of the lack of obvious external signs. Shaken baby syndrome should be considered in infants with seizures, failure to thrive, vomiting associated with lethargy or drowsiness, respiratory irregularities, coma, or death. With the increased awareness of child abuse, more attention has been focused on morbidity and death caused by the violent shaking of infants. This article describes the clinical findings of shaken baby syndrome, explores the characteristics of families at risk for abuse, and discusses implications for nurse practitioners.

Early Hospital Discharge and the Timing Of Newborn Metabolic Screening

Cost containment measures have reduced dramatically the length of stay for normal newborns, in some cases jeopardizing the ability to obtain appropriate newborn screens. In our hospital, we found that an unacceptable number of patients had mistakenly been screened before 24 hours of age. As pressures to shorten hospitalization increase, health-care providers must examine the impact of such changes on their ability to obtain adequate newborn screens. Potential solutions include continued vigilance in gathering specimens after 24 hours of age, interpretation of time-sensitive tests in an age-adjusted manner, and repeating newborn screens after 24 hours of age.

Use of Thyroxine-binding Prealbumin in the Nutritional Assessment of Children with Cancer

The level of thyroxine-binding prealbumin was evaluated in 87 pediatric cancer patients ages 1 through 16 years whose cancer was newly diagnosed but untreated, and 39 children with benign disease or no disease. There was no difference in levels of thyroxine-binding prealbumin between the patients with either malignant or benign disease, nor was there a difference between diagnostic categories. Prealbumin values did correlate with age. When the data were compared, there was a correlation between nutritional status and prealbumin level when the total population (N = 126) was age corrected, but not within the malignant disease group by itself. This confirms data that suggest malnutrition in children with cancer is not a result of protein depletion.

Hypertension in children

Early identification of children at risk for hypertension, proper evaluation, and appropriate management is important to prevent the serious long-term complications associated with the condition. This article defines primary and secondary hypertension in children, describes accurate blood pressure measurement techniques in children, presents the evaluation of a child with hypertension, and discusses therapy and prevention.

Update in pediatric dentistry

The pediatric nurse practitioner advises families in proper oral hygiene, fluoride supplementation, prevention of damaging oral habits and tooth decay, and the need for children to see a pediatric dentist. This article presents the issues of oral health for children from infancy through adolescence. Common pathologic conditions, oral trauma, and the use of sealants in children are also described.

There is no such thing as a good tan

Abstract Skin cancer, the most common form of cancer in the United States today, is caused almost entirely by excessive sun exposure. Skin damage is cumulative and begins with a childs first exposure to sunlight. Therefore measures to prevent skin cancer must be started early in a childs life to be most effective. The pediatric nurse practitioner can offer preventive interventions for children and families based on sound assessments of skin types, tanning beliefs and behaviors, and skin protection behaviors.