Journal of Pediatric Intensive Care - Volume 1, issue 3
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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: Respiratory syncytial virus (RSV) is among the primary pathogens of bronchiolitis. The mortality rate among hospitalized children with RSV bronchiolitis is approximately 1 to 3%. As reported by various authors, the severity of this viral disease is linked to immune response. Thus, it is important that treatment for RSV bronchiolitis be immunologically targeted. The virus activates intracellular signaling in respiratory epithelial cells via receptors known as Toll-like receptors. After this stimulation, primary RSV infection generates a mixed Th1/Th2 response, which is regulated by gamma interferon. An exacerbated Th2 response would lead to a more severe infection. Herein we review the…immunologic mechanisms behind RSV bronchiolitis in order to correlate each treatment with a corresponding immunological response.
Abstract: Sepsis is an important cause of childhood death in developing countries. The International Pediatric Sepsis Consensus Conference (IPSCC) guidelines for definition has five categories and requires complex information, which may be difficult to access in resource poor settings, possibly leading to under-diagnosis and problems with triage, referral and documentation for public health assessments. We aimed to provide a workable system for grading sepsis categories, assess this against the IPSCC definition and use this information to guide further adaptations. We conducted a prospective observational study of consecutive admissions to a pediatric intensive care unit of a public hospital between August and…September 2006. We recorded history and demographic, clinical, investigative, treatment and outcome details. We compared the performance of the IPSCC scoring system to the modified system. We studied one hundred consecutive admissions and collected data for the modified format. The distribution of sepsis cases and (deaths) was as follows: systemic inflammatory response syndrome 26 (2), sepsis 30 (5), severe sepsis/septic shock 15 (11), organ dysfunction 2 (2) and no sepsis 27 (3). Overall mortality was 23%. Despite its simplicity, the modified system corresponded well to the IPSCC system except for the systemic inflammatory response syndrome category. We suggest adaptations to improve agreement with IPSCC whilst maintaining ease of use. It is possible to simplify the IPSCC score to provide information in a resource poor setting but only further studies will be able to assess robustness in the field.
Keywords: Sepsis scores, infections, child deaths, infant mortality, primary health
Abstract: The aim of this study was to evaluate the plasma levels of N-Terminal pro-brain natriuretic peptide (N-BNP), N-Terminal pro-atrial natriuretic peptide (N-ANP) and antidiuretic hormone (ADH) over time and their relationship to clinical indicators in hospitalized children with bronchiolitis. Prospective crossover clinical investigation. Hospitalized children in a university-affiliated hospital. Twenty-seven children (birth to 24 mo) with first episode of bronchiolitis and 34 age-matched healthy controls. Daily blood samples up to five consecutive days were obtained for N-BNP, N-ANP and ADH in the bronchiolitis group and on the initial blood draw in the control group. Daily total fluid intake, net fluid…balance and clinical bronchiolitis severity levels were recorded. N-BNP and N-ANP levels were measured by enzyme-linked immunosorbent assay. ADH levels were measured by a double antibody technique. The mean age (months ± SD) in the bronchiolitis group was 4.2 ± 5.9 mo and 12.0 ± 6.1 mo in the control group; 51.9% of bronchiolitis patients were positive for respiratory syncytial virus (RSV). In patients with bronchiolitis on admission, plasma N-BNP measurements (mean ± SD) were elevated (996.0 ± 570.2 fmol/mL) compared to controls (552.7 ± 264.7 fmol/mL P < 0.005). Serum N-ANP levels were also initially elevated (3,889 ± 1,769.7 fmol/mL) compared to controls (2,173 ± 912 fmol/mL P < 0.005). The serum levels of N-BNP and N-ANP remained significantly elevated from day 2 through day 5. Similarly, ADH levels were significantly higher on admission in the bronchiolitis group (10 ± 7.49 pg/mL) vs. the control group (5.8 ± 5.5 pg/mL P < 0.05), but quickly decreased from day 2 through day 5. N-BNP, N-ANP and ADH concentrations were elevated in hospitalized children with bronchiolitis at admission. Based on our observation, judicious fluid management is indicated in children hospitalized with bronchiolitis.
Keywords: Brain natriuretic peptide, atrial natriuretic peptide, arginine vasopressin, antidiuretic hormone, bronchiolitis, respiratory distress, fluid management, intensive care unit, pediatric
Abstract: To determine the cardiovascular changes in children with dengue shock syndrome. Echocardiography was performed in 8 children (5 females) with dengue shock syndrome, median age 6.5, 4.2–13.7 yr and weight 34, 12–66 kg. All had massive bleeding with low initial hematocrit in most cases (median 31%), thrombocytopenia (median platelet 37,000/μL), and coagulopathy with massive pleural effusion. Seven (87.5%) developed acute renal failure and hepatic failure. All patients were in either compensate or decompensate shock with alteration of consciousness, tachycardia, poor tissue perfusion, and prolonged capillary refill (>4 s) with mean arterial pressure 65, 39–94 mm Hg. The cardiac dimension was…normal to low normal except one had dilated left ventricle. Seven patients had normal left ventricular systolic function (5 with inotrope infusion). One patient had impaired systolic function even with inotrope. All had normal cardiac index (4.14, 3.51–6.37 L/min/m2 ) with increased heart rate (141.5, 110–160/min) but low stroke volume index (30.72, 25.37–42.49 mL/m2 ) and low systemic vascular resistance index (1,072, 223–2,880 dyne/sec/cm−5 /m2 ). Decreased preload from bleeding and vascular leakage into the third space play an important role in shock in Dengue. However, decreased stroke volume and low systemic vascular resistance may be additional causes of shock.
Abstract: Umbilical venous pH is claimed to mirror fetal acid-base status. Importantly, it is easier to perform. The aim of this study is to : 1. Evaluate the umbilical venous blood gas (UVBG) profile of normal newborns and to compare UVBG in the following situations: presence or absence of asphyxia presence or absence of meconium-stained amniotic fluid presence or absence of respiratory distress: and in newborns that did and did not survive and 2. To study the peripheral venous blood gas (PVBG) profile of newborns that develop cardio-respiratory insufficiency (CRI). Venous blood gas (VBG) was performed in 961 newborns consecutively admitted…to the neonatal nursery over one year and in 100 controls. PVBG was also performed in 370 admissions to the nursery that developed signs of CRI. Demographic, clinical and outcome data were collected. Mean UVBG parameters (pH, pCO2 , HCO3 , base deficit, pO2 and SO2 %) were compared between different groups of newborns using t test. This study had ethical approval. Of the 3349 live births over one year, 961 (28.7%) needed intensive care. Of these, 123 (12.8%) died. All the mean cord gas parameters differed significantly between who died and who survived. Metabolic acidosis and hypoxemia were conspicuous on PVBG among babies with CRI. Except for PO2 all the mean parameters of UVBG differed significantly with asphyxia and meconium-stained amniotic fluid. When similar comparison was made among newborns that did or that did not develop respiratory distress, the difference was significant for all the parameters except SO2 %. UVBG gives useful information about common neonatal morbidities and appears to be a useful tool for neonatal assessment. PVBG gives objective information about babies with CRI that may need special interventions.
Abstract: Within hours of accidental instillation of a popular diaper rash protector spray, a 23 day old male developed severe chemical pneumonitis, acute respiratory failure and pneumomediastinum. Despite optimal ventilatory management, the unconventional use of frequent bronchial saline lavages was necessary to maintain oxygenation and ventilation. The only listed active ingredient, 10% dimethicone was a non-toxic inhalant, but the undisclosed inactive ingredients included mineral oil and balsam of peru which may cause chemical pneumonitis and allergic reactions. This case serves as a warning on OTC product designs and formulations, and cautions us to search beyond the listed active ingredients for potential…toxicity.
Keywords: Chemical pneumonitis, pneumomediastinum, over the counter products design, unintended use, toxicity, neonate
Abstract: Hyponatremia is a common electrolyte abnormality among children and adults. Visual disturbance associated with hyponatremia has been described in the past; however, all of these cases presented primarily with other classical signs and symptoms of hyponatremia, such as seizures, gastrointestinal upset, lethargy, or headache. We present a child who developed blindness on post-operative day #6 after resection of a brain tumour. Computed tomography of the head showed no new bleed, mass lesion, edema, or occipital lobe pathology. Laboratory evaluation revealed acute hyponatremia (115 mmol/L). No other obvious symptoms of hyponatremia were present prior to its identification. As her hyponatremia was…gradually corrected, her blindness completely resolved. This is the first reported patient with acute hyponatremia to present primarily with blindness; a “precondition” of chronically increased intracranial pressure (first hit) compounded by acute hyponatremia (second hit) may have induced reversible visual loss. Checking electrolytes should be the standard of care for neurosurgical patients with acute visual disturbance or other unexplained symptoms. It is a simple measure that quickly identifies a dangerous but reversible condition.
Abstract: Pulmonary artery sling is a rare congenital condition often associated with congenital tracheal stenosis. Untreated pulmonary sling carries a high morbidity and mortality, most of which is due to the airway and other associated anomalies rather than the aberrant artery itself. We report the case of an infant presenting progressive respiratory distress after a viral infection. The workup revealed a left pulmonary sling with concomitant tracheal stenosis. This anomaly was successfully corrected by slide tracheoplasty and left pulmonary artery reinsertion. Conclusion pulmonary artery sling is a rare entity with a nonspecific clinical presentation, a high degree of clinical…suspicion is needed in order to obtain the correct diagnosis.