By Gershel, Jeffrey C.; Rauch, Daniel A.
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Additional resources for Caring for the hospitalized child : a handbook of inpatient pediatrics
Discharge ultimately depends on the specific etiology of disease and cardiology plan of care. 24 Caring for the Hospitalized Child Bibliography Blume ED, Freed MD, Colan SD. Congestive heart failure. In: Keane JF, Lock JE, Fyler C, eds. Nandas’ Pediatric Cardiology. 2nd ed. Philadelphia, PA: Saunders Elsevier; 2006:83–91 Hsu DT, Pearson GD. Heart failure in children. Part II: diagnosis, treatment, and future directions. Circ Heart Fail. 2009;2:490–498 Kantor PF, Mertens LL. Clinical practice: heart failure in children.
It is significantly cheaper than LMWH, but requires more frequent monitoring. 2 mg/kg (10 mg maximum), as single daily oral doses, over 3 to 5 days. Base subsequent doses on the international normalized ratio (INR) response, measured every 3 to 5 days. When 2 INRs obtained 24 hours apart are between 2 and 3, discontinue the heparin. Continue to measure the INR frequently (weekly) until stable, as well as after any medication change. The Chapter 4: Deep Venous Thrombosis Use UFH specifically in a neurosurgical patient and as an option in all other children.
The goals of treating DVT are to prevent local extension of thrombus and embolization (usually PE), reduce the risk or recurrent thrombosis, and minimize long-term complication (chronic venous insufficiency, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension). There is no consensus on DVT management for children, so that the treatment of choice is individualized to the specific circumstances of the patient and the preference of the consultants. Options include thrombolytic therapy for a massive PE, anticoagulation for at least 3 months, vena cava filter to prevent PE, surgical thrombectomy, and supportive care, including compressive stockings, venous compressing pump, and managing skin ulcers.
Caring for the hospitalized child : a handbook of inpatient pediatrics by Gershel, Jeffrey C.; Rauch, Daniel A.