Journal of Pediatric Intensive Care - Volume 1, issue 1
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Journal of Pediatric Intensive Care is an English multidisciplinary peer-reviewed international journal publishing articles in the field of pediatric intensive care.
Journal of Pediatric Intensive Care is written for the entire intensive care team: pediatric intensivist, pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are followed in neonatal and pediatric intensive care units.
Journal of Pediatric Intensive Care provides an in-depth update on new subjects, and current comprehensive coverage of the latest techniques in intensive care in childhood.
Journal of Pediatric Intensive Care encourages submissions from all authors throughout the world.
The following articles will be considered for publication: editorials, original and review articles, short report, rapid communications, letters to the editor, and book reviews. The aim of the journal is to share and disseminate knowledge between all disciplines that work in the field of pediatric intensive care.
Abstract: Objective . To summarize clinical research related to the effect of clonidine on sedation, signs and symptoms of withdrawal, and other adverse events among mechanically ventilated children. Data Sources . We searched MEDLINE, EMBASE, CINAHL, LILACS and the Cochrane Central Register of Controlled Trials, trial registries and conference proceedings. Study Selection . We included all observational and experimental studies that reported the transdermal, intravenous or enteral administration of clonidine to mechanically ventilated, critically ill pediatric patients. Data Extraction . We extracted data on the effect of clonidine on sedation, withdrawal, duration of ventilation and adverse effects and…did not attempt to quantitatively combine the results due to the heterogeneous study design and patient populations. Data Synthesis . This review includes 4 case reports, two retrospective cohort studies (total of 58 children), two prospective uncontrolled studies (total of 55 children) and one randomized controlled trial (69 children). In general, efforts to minimize known sources of bias were modest and all studies used non-validated tools for measuring withdrawal. Small observational studies suggest an improvement in withdrawal symptoms and adequacy of sedation with clonidine therapy; however, the small randomized trial found no effect on these or on the duration of ventilation. Results of these small studies have limited generalizability and provide imprecise estimates of treatment effects. Conclusions . Clonidine has been used as a sedative and analgesic agent to prevent and treat withdrawal in critically ill intubated children. Current clinical studies are inadequate to assess its benefits and harms, and do not support current widespread use.
Abstract: Objective : To examine the applicability of the 2002 International Pediatric Sepsis Consensus Conference definitions of the systemic inflammatory response syndrome (SIRS) and sepsis to term and preterm newborns in the diagnosis of early (EOS) and late onset sepsis (LOS). Methods : Retrospective cohort study including 1) all newborns with hospitalization within the first 72 hours of life and 2) infants with episodes of suspected LOS at a tertiary care neonatal intensive care unit between 2004 and 2008, and correlating the definitions of SIRS and sepsis with culture proven and clinical EOS and LOS. Results : Association with…EOS: Among term newborns SIRS and sepsis definitions applied to 62 and 39/245 newborns (25% and 16%, respectively) and to 5/13 cases of culture proven EOS (38%) and 34/66 cases of clinical EOS (52%), respectively. Among preterm newborns SIRS and sepsis definitions applied to 202 and 124/505 newborns (40% and 25%, respectively) and to 17/24 cases of culture proven EOS (71%) and 107/160 cases of clinical EOS (67%), respectively. Sensitivity of SIRS and sepsis definitions was higher in preterm compared to term newborns in case of culture proven and clinical EOS (p=.047 and p=0.03, respectively). Association with LOS : SIRS and sepsis definitions applied to 5/5 episodes of culture proven LOS (100%) and to 4/9 episodes of clinical LOS (44%) in newborns who were term at onset of sepsis (corrected gestational age) and to 14/19 episodes of culture proven LOS (74%) and 24/28 episodes of clinical LOS (86%) in preterm newborns. Conclusion : The definitions of SIRS and sepsis correlated well with LOS but poorly with EOS, where nearly two thirds of term and one quarter of preterm newborns would have been missed. Postnatal age rather than gestational age had a positive influence on the correlation.
Keywords: Systemic inflammatory response syndrome, bacterial infections, preterm and term newborns, neonatal sepsis
Abstract: Purpose . Nurse staffing levels in neonatal paediatric intensive care units (NPICU) are often inadequate. Malta is a small Island in the centre of the Mediterranean (total population around 400,000) with a birth rate of just under 4000/annum, with one NPICU. This study analysed nurse staffing levels for a 1 year period in order to ascertain whether said levels are adequate or not. Methods . Daily ward occupancies were classified by level of dependency, and ideal nursing requirements were estimated using internationally approved standards, on a daily basis, for the period 12 month period from 01/04/2008 to 31/03/2009. These…were compared with the actual daily morning nursing levels to estimate deficit/s. Results . There were a total of 373 admissions to the unit resulting in a total of 5464 patient days (daily census at 0700 hrs) and 1471 free bed days (occupancy 78.8%). Occupancy varied between 8 and 23 patients (mean 15). Staffing levels ranged between 7 and 17 nurses (mean 11). The overall mean deficit was of 3.3 nurses, but this ranged from a maximum of 11 to a rare surplus of 7 nurses. Conclusions . This study only focused on a daily morning snapshot where the nursing staff is at its peak number – the nocturnal deficit is naturally worse. Furthermore, experience levels vary due to short rotations through the unit of inexperienced midwifery staff. Moreover, there are no staff designated as responsible for further education and training, extra staff for unpredictable high dependency situations, to compensate for leave, sickness, maternity leave, study leave, staff training and attendance at meetings. Clearly, the Maltese NPICU is overall understaffed.
Keywords: Hospital bed capacity/statistics & numerical data, humans, infant, newborn, intensive care units, neonatal/manpower/*statistics & numerical data, personnel staffing and scheduling/statistics & numerical data, workload/statistics & numerical data
Abstract: Objective . To determine if there is an increased risk of pediatric drowning accidents when visiting relatives or friends compared with the risk at home. Methods . Retrospective review of a database of 100 consecutive drowning accidents presenting to a community hospital in Tampa, Florida between July 1993 and July 2007. Results . Over a 14-year period of time, 100 drowning accidents presented to our hospital, of which 19 occurred while visiting family or friends from out-of-town. Sixty percent of the total drowning accidents involved males, whereas 68.5% of the visitor drowning accidents involved males. The overall mortality…was 10% (10 out of 100) with all survivors having complete neurologic recovery, and 2/19 (10.5%) visiting victims did not survive. Factors associated with the visitor drowning accidents included lack of proper pool fencing, distraction of supervising adults, unfamiliarity with surroundings, and inability to swim. Conclusions . Nineteen percent of pediatric drowning accidents presenting to a community hospital in Tampa, Florida involved victims who were visiting relatives or friends from out of town. This represents a six-times increased risk when visiting family or friends compared to the risk of drowning at home. 79% of the visitor drowning incidents occurred in a home swimming pool of the friend or relative.
Keywords: Drowning, swimming pools, swimming, accident prevention, prevention of drowning, pediatric age group
Abstract: Neurological dysfunction may occur after corrective cardiac surgery using cardio-pulmonary bypass (CPB) with or without circulatory arrest. Different neurophysiological monitoring systems have been employed to detect neurological complications and possible brain injury in infants and children during and after cardiac surgery. The value of EEG in infants and children at risk for neurological sequelae has not been systematically studied. Sequential performance of 2 EEGs before and after cardiac surgery at a tertiary University Hospital to screen for possible brain injury after cardiac surgery. In addition, a complete neurological examination was performed. In 313 patients (age: 54.2±55.7 months; normal…initial EEG) after cardiac surgery CPB (duration of surgery: 146.0±58.9 minutes; aortic cross clamp time: 34.1±19.1 minutes) a 19-channel EEG recording was performed 2.4±1.8 days prior and 11.6±5.3 days after cardiac surgery. An abnormal EEG was detected in only 8 of 313 patients (2.5%; focal slowing(1), generalised slowing (5), epiletiform discharges(2)) after cardiac surgery, while the EEG was normal in the remaining 305 patients (97.5%). In one patient, an intra-cerebral pathology was seen on MRI (ischemic); in 5 patients follow-up EEGs were performed, which revealed normalised findings. None of the 8 patients demonstrated new focal neurological deficits on physical examination, but 33 (9.7%) children demonstrated minor abnormalities (eg, subtle motor asymmetry, increase in muscle tone, etc.), which were unrelated to abnormal EEG findings. According to the used protocol pathological EEG findings were very infrequent in our study cohort. The routine and indiscriminative recording of EEGs in children before and after corrective or palliative cardiac surgery for congenital heart disease using CPB is not recommended. Further intra-operative neuromonitoring methods with immediate intervention should be evaluated.
Abstract: Neonatal mastitis and abscess are an uncommon entity with an uncertain mechanism of onset. Ultrasonography can be useful in detecting early stage of abscess formation and hence in expedition of definitive treatment, as it was proved in our case, in which a diagnosis of neonatal breast abscess was made based on ultrasound examination of breast.