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Sepsis AND Pediatric

İlknur Tolunay, R Dinçer Yıldızdaş, Hüseyin Elçi, Derya Alabaz
Tolunay İ, Yıldızdaş RD, Elçi H, Alabaz D. Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit. Turk J Pediatr 2018; 60: 63-69. In catheter-using units as pediatric intensive care, it is important to know the complications that may occur during the insertion and use of central venous catheterization (CVC), and to take appropriate measures in order to reduce the mortality and morbidity of critical patients. The aim of this study was to evaluate CVC and catheter related complications in our tertiary pediatric intensive care unit...
2018: Turkish Journal of Pediatrics
Yun Cui, Xi Xiong, Fei Wang, Yuqian Ren, Chunxia Wang, Yucai Zhang
BACKGROUND: Liver dysfunction is an independent risk factor for poor prognosis of patients with sepsis. The aim of this study is to evaluate the effects of continuous hemofiltration in patients with bacterial sepsis complicated by liver dysfunction. METHODS: We retrospectively analyzed the medical records of 27 cases of bacterial sepsis with liver dysfunction admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital between January 2013 and December 2016...
August 11, 2018: BMC Pediatrics
Lauren Brin Hermans, Bridget E Shields, Catharine B Garland, Beverly Aagaard-Kienitz, David Wargowski, Carrie Kovarik, Lisa M Arkin
Most infantile hemangiomas (IHs), the most common vascular tumors of childhood, evolve without complications; however 10% to 12% require specialty referral for treatment. To emphasize the complications of late referral, we present a case of necrotizing infection within a segmental IH leading to sepsis. Early evaluation by a pediatric dermatologist could have prevented this life-threatening and disfiguring complication. We discuss how teledermatology would enable rapid triage of such critical cases in underserved areas, increasing access to high-value care and optimizing outcomes for our most vulnerable patients...
August 10, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Mary K Dahmer, Michael W Quasney, Anil Sapru, Ginny Gildengorin, Martha A Q Curley, Michael A Matthay, Heidi Flori
OBJECTIVES: To test whether plasma interleukin-1 receptor antagonist or variants within the gene encoding for interleukin-1ra (IL1RN), or proteins involved in regulating interleukin-1β levels or interleukin-1β response, are associated with pediatric acute respiratory distress syndrome or outcomes in mechanically ventilated children with parenchymal lung disease. DESIGN: Prospective cohort study. SETTING: Twenty-two PICUs participating in the multisite clinical trial, Randomized Evaluation of Sedation Titration for Respiratory Failure (U01 HL086622)...
August 7, 2018: Pediatric Critical Care Medicine
Sharon Y Irving, Bridget Daly, Judy Verger, Katri V Typpo, Ann-Marie Brown, Alexandra Hanlon, Scott L Weiss, Julie C Fitzgerald, Vinay M Nadkarni, Neal J Thomas, Vijay Srinivasan
OBJECTIVES: The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis. DESIGN: Secondary analysis of the Sepsis Prevalence, Outcomes, and Therapies study. Patient characteristics, ICU interventions, and outcomes were compared across nutrition status categories (expressed as age- and sex-adjusted body mass index z scores using World Health Organization standards)...
August 7, 2018: Critical Care Medicine
María Fernández-Ibieta
Case Report  An 11-month-old female infant presented on the first postoperative (PO) day following an elective pyeloplasty, a dark bluish erythema of her lumbotomy wound, plus a satellite lesion of the same characteristics. Fever and sepsis developed, and despite broad spectrum antibiotics (meropenem and vancomycin) were started, a diagnosis of necrotizing soft-tissue infection (NSTI or necrotizing fasciitis) was established. Surgical debridement of both lesions was performed on day 3 PO, and a surgical contamination (ring retractor blade) was suspected, due to the particular geography of the lesion...
July 2018: Surgery Journal
Hai Peng Yan, Miao Li, Xiu Lan Lu, Yi Min Zhu, Wen-Xian Ou-Yang, Zheng Hui Xiao, Jun Qiu, Shuang Jie Li
BACKGROUND: The mortality rate due to severe sepsis is approximately 30-60%. Sepsis readily progresses to septic shock and multiple organ dysfunction, representing a significant problem in the pediatric intensive care unit (PICU). The aim of this study was to explore the value of plasma mitochondrial DNA (mtDNA) for early diagnosis and prognosis in children with sepsis. METHODS: A total of 123 children with sepsis who were hospitalized in the Hunan Children's Hospital PICU from July 2013 to December 2014 were divided into the general sepsis group (n = 70) and severe sepsis group (n = 53) based on diagnostic standards...
August 9, 2018: BMC Pediatrics
Claudia S López-Reyes, Lilia N Baca-Velázquez, Miguel A Villasis-Keever, Jessie N Zurita-Cruz
Introducción: La sepsis en pediatría es la principal causa de muerte hospitalaria. Se han intentado crear herramientas que faciliten su identificación, como el índice de choque (IC), definido como el cociente entre frecuencia cardíaca y tensión arterial sistólica. El objetivo de este trabajo fue identificar el mejor momento del IC para predecir la mortalidad en pacientes pediátricos con sepsis grave y choque séptico. Métodos: Cohorte retrospectiva con 165 pacientes pediátricos que desarrollaron sepsis grave y choque séptico en la Unidad de Terapia Intensiva Pediatrica...
2018: Boletín Médico del Hospital Infantil de México
Kris M Mahadeo, Sajad J Khazal, Hisham Abdel-Azim, Julie C Fitzgerald, Agne Taraseviciute, Catherine M Bollard, Priti Tewari, Christine Duncan, Chani Traube, David McCall, Marie E Steiner, Ira M Cheifetz, Leslie E Lehmann, Rodrigo Mejia, John M Slopis, Rajinder Bajwa, Partow Kebriaei, Paul L Martin, Jerelyn Moffet, Jennifer McArthur, Demetrios Petropoulos, Joan O'Hanlon Curry, Sarah Featherston, Jessica Foglesong, Basirat Shoberu, Alison Gulbis, Maria E Mireles, Lisa Hafemeister, Cathy Nguyen, Neena Kapoor, Katayoun Rezvani, Sattva S Neelapu, Elizabeth J Shpall
In 2017, an autologous chimeric antigen receptor (CAR) T cell therapy indicated for children and young adults with relapsed and/or refractory CD19+ acute lymphoblastic leukaemia became the first gene therapy to be approved in the USA. This innovative form of cellular immunotherapy has been associated with remarkable response rates but is also associated with unique and often severe toxicities, which can lead to rapid cardiorespiratory and/or neurological deterioration. Multidisciplinary medical vigilance and the requisite health-care infrastructure are imperative to ensuring optimal patient outcomes, especially as these therapies transition from research protocols to standard care...
August 6, 2018: Nature Reviews. Clinical Oncology
Amanda B Hassinger, Stacey L Valentine
OBJECTIVES: Observational studies have shown that fluid overload is independently associated with increased morbidity in critically ill children, especially with respiratory pathology. It is unknown if recent evidence has influenced clinical practice. We sought to describe current IV fluid management in pediatric acute respiratory distress syndrome. DESIGN: Multinational, cross-sectional electronic survey. SETTING: Pediatric Acute Lung Injury and Sepsis Investigators Network...
August 2, 2018: Pediatric Critical Care Medicine
Maria Punchak, Kaitlin Hall, Amir Seni, W Chris Buck, Daniel A DeUgarte, Emily Hartford, Robert B Kelly, Valéria I Muando
OBJECTIVES: Delivery of pediatric critical care in low-income countries is limited by a lack of infrastructure, resources, and providers. Few studies have analyzed the epidemiology of disease associated with a PICU in a low-income country. The aim of this study was to document the primary diagnoses and the associated mortality rates of patients presenting to a tertiary PICU in Mozambique in order to formulate quality improvement projects through an international academic partnership. We hypothesized that the PICU mortality rate would be high and that sepsis would be a common cause of death...
July 30, 2018: Pediatric Critical Care Medicine
Neal J Thomas, Debbie Spear, Emily Wasserman, Steven Pon, Barry Markovitz, Aalok R Singh, Simon Li, Shira J Gertz, Courtney M Rowan, Allen Kunselman, Robert F Tamburro
OBJECTIVE: To assess if calfactant reduces mortality among children with leukemia/lymphoma or following hematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS) DESIGN: Multicenter, randomized, placebo-controlled, double-blinded trial SETTING: Seventeen pediatric intensive care units (PICU) of tertiary care children's hospitals PATIENTS: Patients age 18 months to 25 years with leukemia/lymphoma or having undergone HCT who required invasive mechanical ventilation for bilateral lung disease with an oxygenation index (OI) >10 and < 37...
July 27, 2018: Biology of Blood and Marrow Transplantation
Marisa Tucci, Jacques Lacroix, Dean Fergusson, Allan Doctor, Paul Hébert, Robert A Berg, Jaime Caro, Cassandra D Josephson, Stéphane Leteurtre, Kusum Menon, Kenneth Schechtman, Marie E Steiner, Alexis F Turgeon, Lucy Clayton, Tina Bockelmann, Philip C Spinella
BACKGROUND: The "Age of Blood in Children in Pediatric Intensive Care Unit" (ABC PICU) study is a randomized controlled trial (RCT) that aims to determine if red blood cell (RBC) unit storage age affects outcomes in critically ill children. While RBCs can be stored for up to 42 days in additive solutions, their efficacy and safety after long-term storage have been challenged. Preclinical and clinical observational evidence suggests loss of efficacy and lack of safety of older RBC units, especially in more vulnerable populations such as critically ill children...
July 28, 2018: Trials
Eric Giannoni, Philipp K A Agyeman, Martin Stocker, Klara M Posfay-Barbe, Ulrich Heininger, Ben D Spycher, Sara Bernhard-Stirnemann, Anita Niederer-Loher, Christian R Kahlert, Alex Donas, Antonio Leone, Paul Hasters, Christa Relly, Thomas Riedel, Claudia Kuehni, Christoph Aebi, Christoph Berger, Luregn J Schlapbach
OBJECTIVE: To assess the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS). STUDY DESIGN: All newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015 were included in the study. We defined EOS as infection occurring <3 days after birth, and LOS as infection ≥3 days after birth. Infants with LOS were classified as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission...
July 24, 2018: Journal of Pediatrics
Rahul Gupta
Context: Pneumoperitoneum is typically a surgical emergency, particularly in neonates. However, pneumoperitoneum can rarely present without gastrointestinal perforation which is known as spontaneous pneumoperitoneum. Aims: This study aims to analyze the outcome of pediatric patients with spontaneous pneumoperitoneum and describe our experience. Settings and Design: A retrospective study performed from January 2014 to May 2017. Materials and Methods: The study included all pediatric patients admitted in a tertiary care institute...
July 2018: Journal of Indian Association of Pediatric Surgeons
Felix Oberender, Anusha Ganeshalingham, James D Fortenberry, Michael J Hobson, Robert J Houmes, Kevin P Morris, Andrew Numa, Mohammad M Hoq, Susan Donath, John Beca, Warwick Butt
OBJECTIVES: The role of venoarterial extracorporeal membrane oxygenation in the treatment of severe pediatric septic shock continues to be intensely debated. Our objective was to determine whether the use of venoarterial extracorporeal membrane oxygenation in severe septic shock was associated with altered patient mortality, morbidity, and/or length of ICU and hospital stay when compared with conventional therapy. DESIGN: International multicenter, retrospective cohort study using prospectively collected data of children admitted to intensive care with a diagnosis of severe septic shock between the years 2006 and 2014...
July 25, 2018: Pediatric Critical Care Medicine
Idris V R Evans, Gary S Phillips, Elizabeth R Alpern, Derek C Angus, Marcus E Friedrich, Niranjan Kissoon, Stanley Lemeshow, Mitchell M Levy, Margaret M Parker, Kathleen M Terry, R Scott Watson, Scott L Weiss, Jerry Zimmerman, Christopher W Seymour
Importance: The death of a pediatric patient with sepsis motivated New York to mandate statewide sepsis treatment in 2013. The mandate included a 1-hour bundle of blood cultures, broad-spectrum antibiotics, and a 20-mL/kg intravenous fluid bolus. Whether completing the bundle elements within 1 hour improves outcomes is unclear. Objective: To determine the risk-adjusted association between completing the 1-hour pediatric sepsis bundle and individual bundle elements with in-hospital mortality...
July 24, 2018: JAMA: the Journal of the American Medical Association
Amory de Roulet, Rita V Burke, Joanna Lim, Stephanie Papillon, David W Bliss, Henri R Ford, Jeffrey S Upperman, Kenji Inaba, Aaron R Jensen
BACKGROUND/PURPOSE: Acute Respiratory Distress Syndrome (ARDS) results in significant morbidity and mortality in pediatric trauma victims. The objective of this study was to determine risk factors and outcomes specifically related to pediatric trauma-associated ARDS (PT-ARDS). METHODS: A retrospective cohort (2007-2014) of children ≤18 years old from the American College of Surgeons National Trauma Data Bank (NTDB) was used to analyze incidence, risk factors, and outcomes related to PT-ARDS...
July 11, 2018: Journal of Pediatric Surgery
Chin Seng Gan, Judith Ju-Ming Wong, Rujipat Samransamruajkit, Soo Lin Chuah, Yek Kee Chor, Suyun Qian, Nattachai Anantasit, Xu Feng, Jacqueline Soo May Ong, Phan Huu Phuc, Suwannee Phumeetham, Rehena Sultana, Tsee Foong Loh, Lucy Chai See Lum, Jan Hau Lee
OBJECTIVES: Extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome are poorly described in the literature. We aimed to describe and compare the epidemiology, risk factors for mortality, and outcomes in extrapulmonary pediatric acute respiratory distress syndrome and pulmonary pediatric acute respiratory distress syndrome. DESIGN: This is a secondary analysis of a multicenter, retrospective, cohort study...
July 20, 2018: Pediatric Critical Care Medicine
Anusha Lekshminarayanan, Parth Bhatt, Vijay Gandhi Linga, Riddhi Chaudhari, Brian Zhu, Mihir Dave, Keyur Donda, Sejal Savani, Samir V Patel, Zeenia C Billimoria, Smita Bhaskaran, Samer Zaid-Kaylani, Fredrick Dapaah-Siakwan, Neel S Bhatt
OBJECTIVE: To assess the trends of inpatient resource use and mortality in pediatric hospitalizations for fever with neutropenia in the US from 2007 to 2014. STUDY DESIGN: Using National (Nationwide) Inpatient Sample (NIS) and International Classification of Diseases, Ninth Revision, Clinical Modification codes, we studied pediatric cancer hospitalizations with fever with neutropenia between 2007 and 2014. Using appropriate weights for each NIS discharge, we created national estimates of median cost, length of stay, and in-hospital mortality rates...
July 17, 2018: Journal of Pediatrics
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