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Critically ill infant

W P de Boode, M Kluckow, P J McNamara, S Gupta
Neonatologist-performed echocardiography (NPE) is an indispensable tool in the haemodynamic management of critically ill newborn infants. NPE is used to facilitate timely diagnosis of a patent ductus arteriosus (PDA) in preterm infants and to assess its haemodynamic significance. Before treatment is considered, it is obligatory to confirm structural cardiac normality. Importantly, NPE offers the ability to guide therapeutic interventions, allowing an individualised haemodynamic management approach to the PDA...
March 7, 2018: Seminars in Fetal & Neonatal Medicine
Tina Tian, Joshua Coons, Hong Chang, Walter J Chwals
BACKGROUND: Injury severity induces a proportionate acute metabolic stress response, associated with increased risk of hyperglycemia. We hypothesized that excess caloric delivery (overfeeding) during high stress states would increase hyperglycemia and disrupt response homeostasis. METHODS: Gestational age, daily weight, total daily caloric intake, serum C-reactive protein (CRP), prealbumin, and blood glucose concentrations in all acutely-injured premature NICU infants requiring TPN over the past 3years were reviewed...
December 27, 2017: Journal of Pediatric Surgery
Nathaly M Sweeney, Shareef A Nahas, Shimul Chowdhury, Miguel Del Campo, Marilyn C Jones, David P Dimmock, Stephen F Kingsmore, Rcigm Investigators
Congenital diaphragmatic hernia (CDH) results from incomplete formation of the diaphragm leading to herniation of abdominal organs into the thoracic cavity. CDH is associated with pulmonary hypoplasia, congenital heart disease and pulmonary hypertension. Genetically, it is associated with aneuploidies, chromosomal copy number variants, and single gene mutations. CDH is the most expensive non-cardiac congenital defect: Management frequently requires implementation of Extracorporeal Membrane Oxygenation (ECMO), which increases management expenditures 2...
March 16, 2018: Cold Spring Harbor Molecular Case Studies
Louiza Sophocleous, Inez Frerichs, Martijn Miedema, Merja Kallio, Thalia Papadouri, Christina Karaoli, Tobias Becher, David G Tingay, Anton van Kaam, Richard H Bayford, Andreas Daniel Waldmann
OBJECTIVE: Critically ill neonates and infants might particularly benefit from continuous chest electrical impedance tomography (EIT) monitoring at the bedside. In this study a textile 32-electrode interface for neonatal EIT examination has been developed and tested to validate its clinical performance. The objectives were to assess ease of use in a clinical setting, stability of contact impedance at the electrode-skin interface and possible adverse effects. APPROACH: Thirty preterm infants (gestational age: 30...
March 8, 2018: Physiological Measurement
Einav Nachman, Peter Clemensen, Katheryn Santos, Alexis R Cole, Brian D Polizzotti, Grace Hofmann, Kristen T Leeman, Sarah J van den Bosch, John N Kheir
BACKGROUND: The accurate measurement of oxygen consumption (VO2) and energy expenditure (EE) may be helpful to optimize the treatment of critically ill patients. However, current techniques are limited in their ability to accurately quantify these end points in infants due to a low VO2, low tidal volume, and rapid respiratory rate. This study describes and validates a new device intended to perform in this size range. METHODS: We created a customized device that quantifies inspiratory volume using a pneumotachometer and concentrations of oxygen and carbon dioxide gas in the inspiratory and expiratory limbs...
March 1, 2018: Anesthesia and Analgesia
Christopher S Parshuram, Karen Dryden-Palmer, Catherine Farrell, Ronald Gottesman, Martin Gray, James S Hutchison, Mark Helfaer, Elizabeth A Hunt, Ari R Joffe, Jacques Lacroix, Michael Alice Moga, Vinay Nadkarni, Nelly Ninis, Patricia C Parkin, David Wensley, Andrew R Willan, George A Tomlinson
Importance: There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. Objective: To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. Design, Setting, and Participants: A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years)...
February 27, 2018: JAMA: the Journal of the American Medical Association
Ingrid Frid, Johan Ågren, Mattias Kjellberg, Erik Normann, Richard Sindelar
AIM: This study evaluated the medical quality of acute airborne transports carried out by a neonatal emergency transport service in a Swedish healthcare region from 2012-2015. METHODS: The transport charts and patient records of all infants transported to the regional centre were reviewed for transport indications and vital parameters and outcomes. RESULTS: We identified 187 acute airborne transports and the main indications for referral were therapeutic hypothermia after perinatal asphyxia, extremely preterm birth and respiratory failure...
February 26, 2018: Acta Paediatrica
Jeanine J Sol, Moniek van de Loo, Marit Boerma, Klasien A Bergman, Albertine E Donker, Mark A H B M van der Hoeven, Christiaan V Hulzebos, Ronny Knol, K Djien Liem, Richard A van Lingen, Enrico Lopriore, Monique H Suijker, Daniel C Vijlbrief, Remco Visser, Margreet A Veening, Mirjam M van Weissenbruch, C Heleen van Ommen
BACKGROUND: In critically ill (preterm) neonates, central venous catheters (CVCs) are increasingly used for administration of medication or parenteral nutrition. A serious complication, however, is the development of catheter-related thrombosis (CVC-thrombosis), which may resolve by itself or cause severe complications. Due to lack of evidence, management of neonatal CVC-thrombosis varies among neonatal intensive care units (NICUs). In the Netherlands an expert-based national management guideline has been developed which is implemented in all 10 NICUs in 2014...
February 23, 2018: BMC Pediatrics
Monica E Lemmon, Pamela K Donohue, Erin P Williams, Debra Brandon, Peter A Ubel, Renee D Boss
OBJECTIVE: To develop a question prompt list tailored to the needs of parents of critically ill infants at risk of neurodevelopmental impairment. STUDY DESIGN: Question content was derived from audio-recorded neonatal intensive care unit family meetings and interviews with parents of infants treated with therapeutic hypothermia. Question content was refined using clinician focus groups. Acceptability testing was performed with parents and clinicians caring for infants in the neonatal intensive care unit...
February 22, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Marine Flechet, Fabian Güiza, Dirk Vlasselaers, Lars Desmet, Stoffel Lamote, Heidi Delrue, Marc Beckers, Michaël P Casaer, Pieter Wouters, Greet van den Berghe, Geert Meyfroidt
OBJECTIVES: To assess whether near-infrared cerebral tissue oxygen saturation, measured with the FORESIGHT cerebral oximeter (CAS Medical Systems, Branford, CT) predicts PICU length of stay, duration of invasive mechanical ventilation, and mortality in critically ill children after pediatric cardiac surgery. DESIGN: Single-center prospective, observational study. SETTING: Twelve-bed PICU of a tertiary academic hospital. PATIENTS: Critically ill children and infants with congenital heart disease, younger than 12 years old, admitted to the PICU between October 2012 and November 2015...
February 19, 2018: Pediatric Critical Care Medicine
Josh E Petrikin, Julie A Cakici, Michelle M Clark, Laurel K Willig, Nathaly M Sweeney, Emily G Farrow, Carol J Saunders, Isabelle Thiffault, Neil A Miller, Lee Zellmer, Suzanne M Herd, Anne M Holmes, Serge Batalov, Narayanan Veeraraghavan, Laurie D Smith, David P Dimmock, J Steven Leeder, Stephen F Kingsmore
Genetic disorders are a leading cause of morbidity and mortality in infants in neonatal and pediatric intensive care units (NICU/PICU). While genomic sequencing is useful for genetic disease diagnosis, results are usually reported too late to guide inpatient management. We performed an investigator-initiated, partially blinded, pragmatic, randomized, controlled trial to test the hypothesis that rapid whole-genome sequencing (rWGS) increased the proportion of NICU/PICU infants receiving a genetic diagnosis within 28 days...
2018: NPJ Genomic Medicine
Iva Hojsak, Valentina Fabiano, Tudor Lucian Pop, Olivier Goulet, Gian Vincenzo Zuccotti, Fugen Cullu Çokuğraş, Massimo Pettoello-Mantovani, Sanja Kolaček
AIM: The use of probiotics has been covered by many guidelines, position papers and evidence-based recommendations, but few have referred to specific patient groups or clinical indications. This European study summarises recommendations and scientifically credited guidelines on the use of probiotics for children and provides practice points. METHODS: An expert panel was convened by the European Paediatric Association in June 2017 to define the relevant clinical questions for using probiotics in paediatric healthcare and review and summarise the guidelines, recommendations, position papers and high-quality evidence...
February 15, 2018: Acta Paediatrica
Yujiro Matsuishi, Haruhiko Hoshino, Nobutake Shimojo, Yuki Enomoto, Takahiro Kido, Subrina Jesmin, Masahiko Sumitani, Yoshiaki Inoue
Aim: Delirium is associated with various negative clinical outcomes, such as decline in cognitive ability, increased length of hospital stay, and higher mortality. For these reasons, early diagnosis of delirium is critical. Unfortunately, there are no reliable diagnostic criteria or tool of delirium for infants and preschool-aged children in Japan. The aim of the present study was to translate a new delirium assessment tool, the Preschool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU), for accurately diagnosing clinically ill infants and preschool-aged children, from English to Japanese...
January 2018: Acute Medicine & Surgery
Padmanabhan Ramnarayan, Konstantinos Dimitriades, Lynsey Freeburn, Aravind Kashyap, Michaela Dixon, Peter W Barry, Kathryn Claydon-Smith, Allan Wardhaugh, Caroline R Lamming, Elizabeth S Draper
OBJECTIVES: International data on characteristics and outcomes of children transported from general hospitals to PICUs are scarce. We aimed to 1) describe the development of a common transport dataset in the United Kingdom and Ireland and 2) analyze transport data from a recent 2-year period. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Specialist pediatric critical care transport teams and PICUs in the United Kingdom and Ireland...
February 9, 2018: Pediatric Critical Care Medicine
Vivek V Shukla, Satvik Bansal, Archana Nimbalkar, Apurva Chapla, Ajay Phatak, Dipen Patel, Somashekhar Nimbalkar
OBJECTIVE: To compare individual efficacy and additive effects of pain control interventions in preterm neonates. DESIGN: Randomized controlled trial. SETTING: Level-3 University affiliated neonatal intensive care unit. PARTICIPANTS: 200 neonates (26-36 weeks gestational age) requiring heel-stick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions...
February 9, 2018: Indian Pediatrics
Esther Arendt, Neha S Singh, Oona M R Campbell
RATIONALE: The lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes...
2018: PloS One
Yueniu Zhu, Xiaodong Zhu, Mengyan Deng, Hongxia Wei, Mingjun Zhang
BACKGROUND: In China, the majority (77%) of urban children die in hospitals. Hospital-based review could provide insight leading to improvements in clinical practice and increase the survival of critically ill children. The aim of the present study is to identify the trends of immediate causes and chronic underlying diseases associated with deaths of children at one of the largest teaching hospitals in China over a period of 10 years (2006-2015). METHODS: A retrospective analysis of data of all children aged 1 month to 11 years who died at Xinhua Hospital between 2006 and 2015...
January 18, 2018: BMC Pediatrics
X H Li, J Ji, S Y Qian
Objective: To analyze the resting energy expenditure and optimal energy supply in different age groups of critically ill children on mechanical ventilation in pediatric intensive care unit (PICU). Methods: Patients on mechanical ventilation hospitalized in PICU of Beijing Children's Hospital from March 2015 to March 2016 were enrolled prospectively. Resting energy expenditure of patients was calculated by US Med Graphic company critical care management (CCM) energy metabolism test system after mechanical ventilation...
January 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Mahdi Mahmoudzadeh, Ghislaine Dehaene-Lambertz, Guy Kongolo, Marc Fournier, Sabrina Goudjil, Fabrice Wallois
Intraventricular Hemorrhage (IVH) is the leading cause of neurological and cognitive impairment in preterm neonates with an incidence that increases with increasing prematurity. In the present study, we tested how preterm neonates with IVH react to external stimulation (i.e. speech syllables). We compared their neural responses measured by electroencephalography (EEG), and hemodynamic responses measured by functional near-infrared spectroscopy (fNIRS), with those of healthy preterms. A neural response to syllables was observed in these infants, but did not induce a vascular response in contrast with healthy neonates...
January 5, 2018: Developmental Cognitive Neuroscience
Nancy E Reichman, Hope Corman, Kelly Noonan, Manuel E Jiménez
Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child's ACE exposures at age 5, controlling for factors that preceded the child's birth, including the mother's sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents' criminal justice system involvement and domestic violence or sexual abuse...
December 28, 2017: Maternal and Child Health Journal
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