Journal of Pediatric Infectious Diseases - Volume 4, issue 2
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Journal of Pediatric Infectious Diseases is a peer-reviewed medical journal, publishing articles in the field of child infectious diseases. The journal provides an in-depth update on new subjects and current comprehensive coverage of the latest techniques in diagnosis and treatment of childhood infectious diseases.
The following articles will be considered for publication: editorials, original and review articles, rapid communications, case reports, letters to the editor and book reviews.
The aim of the
Journal of Pediatric Infectious Diseases is to share and disseminate knowledge between all disciplines that work in the field of pediatric infectious diseases.
Abstract: The aim of this paper is to highlight the current trends in the epidemiology, investigation, management and prognosis of neonatal sepsis and septic shock. Despite the historical prevalence of group B streptococcal neonatal infections, due to Centers for Disease Control and Prevention guidelines for the prevention of perinatal group B streptococcal disease, Escherichia coli is currently the most common organism isolated in early-onset neonatal sepsis. Furthermore, there is increasing evidence that…antibiotic resistant strains are on the rise. With respect to late-onset neonatal sepsis, coagulase-negative Staphylococcus is responsible for the majority of late-onset infections, followed by Candida species. An evolving pathogen likely to increase in prevalence is methicillin-resistant Staphylococcus aureus. The clinical presentation of sepsis varies while the presentation of septic shock consists of respiratory distress and poor perfusion especially in the context of antenatal risk factors. There exist a number of ancillary investigations that can be useful in the evaluation of a neonate with sepsis, including C-reactive protein, interleukin-6 and procalcitonin. The utility of these are discussed. The mainstays of management of a neonate with septic shock include empiric then definitive antibiotic therapy, cardiovascular support with fluids and/or inotropes and respiratory support. The prognosis and outcomes for infants with septic shock are guarded and neurodevelopmental functioning may be impaired in survivors.
Abstract: Consensus definitions of pediatric sepsis clearly include viral infections, and yet most studies of sepsis in the intensive care environment specifically exclude viral infections. Viral infections are a common cause of admission to the pediatric or neonatal intensive care. They are probably underestimated, and new techniques of viral identification offer an opportunity to expand our understanding of the true impact of viral infections on critical illness in childhood. Not only are viral infections a cause of…admission, but they may also constitute a significant component and risk of nosocomial infections in the pediatric intensive care unit. Specific antiviral therapies are limited, and in many cases immunization and prevention is the most effective approach to severe viral infections. With climate changes, the distribution of insect borne viral infections is changing across the world and these infections are starting to occur in new geographical areas. Attention has to be paid to the issue of protection of pediatric intensive care staff against viral infections.
Abstract: WHO 2005 data points to sepsis in form of pneumonia, diarrhea, and neonatal sepsis as major killers of children in the resource limited countries of Asia and Africa, However, currently there are no specific published guidelines for treatment of severe sepsis in resource limited circumstances. An expert panel drawn from all over India, met to discuss and draw guidelines for management of pediatric septic shock that are applicable to resource limited countries. The group evaluated strength…of published data and expert opinion for clinical practice and feasibility of delivery of care at various levels of resource constraints, keeping in view unique patient population and limited availability of equipment and resources. Issues for discussion included simplified definitions and reliable clinical indicators of septic shock, fluid resuscitation, graded inotropic and vasopressor support, corticosteroid therapy, timing and indication for endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, correction of hypoglycemia and glycemic control, role of immunoglobulin, and blood and blood products. Evidence has been graded and levels of evidence indicated wherever applicable. The expert group recognized and listed potential barrier to implementation of existing American College of Critical Care Medicine guidelines for treatment of septic shock in resource limited countries, adopted simplified definitions of septic shock, tachycardia, tachypnea and hypotension, and developed step-wise algorithmic approach for treating septic shock. Evidence based treatment recommendations include early oxygen therapy, fluid resuscitation based on blood pressure, use of dopamine in fluid refractory shock, early use of antibiotics, early intubation and assisted ventilation, correction of hypoglycemia and emphasis on use of physical examination for achieving therapeutic endpoints. These interventions have brought the mortality down and can be easily applied even at primary and/or secondary level health facilities. Interventions recommended after above steps were based on consensus rather than evidence. These include stress dose steroid therapy, use of vasopressors and inodilators, and central venous pressure and echocardiography to guide fluid and vasoactive drug infusion, which require transfer to a pediatric intensive care unit. Strict glycemic control is not recommended. Evidence on benefit of several other interventions viz. use of vasopressin as vasopressor, use of intravenous immunoglobulins, renal replacement therapy, use of plasmapheresis etc. is emerging. The expert group observed that further research evaluating individual components of guidelines and relative benefit of each of these interventions in resource limited setting is needed, as also the benefit of adherence with standardized protocol. Pediatric sepsis guidelines suitable for resource limited settings are presented for resource limited settings. Several unresolved issues were identified for further research.
Keywords: Children, emergency care, septic shock, fluid resuscitation, vasoactive drugs