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fluid therapy pediatric

Guntulu Sık, Asuman Demirbuga, Seda Günhar, Kemal Nisli, Agop Citak
OBJECTIVES: To identify prognostic factors and indications in patients receiving continuous renal replacement therapy (CRRT) in the pediatric intensive care unit (PICU), and to demonstrate their effect on mortality. METHODS: A total of 63 patients admitted between 2011 and 2014 were included in the study. The demographic information, pediatric risk of mortality (PRISM) scores, vasoactive-inotropic score, indication for CRRT, time of starting CRRT, presence of fluid overload, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and non-survivors...
February 11, 2019: Indian Journal of Pediatrics
Mansour Amin, Samaneh Yousef Pour, Tahereh Navidifar
INTRODUCTION: Empyema is one of the important causes of pediatric hospital admissions. AIM: In this study, we had investigated the frequency rates of S aureus, S pneumoniae, H influenzae, and P aeruginosa using PCR and bacterial culture among children suffering from empyema in Ahvaz city, Iran. METHODS: This was a descriptive study conducted on the patients hospitalized in ICUs of two teaching Hospitals of Ahvaz, Iran, between March and September 2018 on 105 pleural fluid (PF) samples of the children less than 16 years of age with the diagnosis of empyema thoracis...
February 9, 2019: Journal of Clinical Laboratory Analysis
Rupesh Raina, Stephanie Lam, Hershita Raheja, Vinod Krishnappa, Daljit Hothi, Andrew Davenport, Deepa Chand, Gaurav Kapur, Franz Schaefer, Sidharth Kumar Sethi, Mignon McCulloch, Arvind Bagga, Timothy Bunchman, Bradley A Warady
Intradialytic hypotension (IDH) is a common adverse event resulting in premature interruption of hemodialysis, and consequently, inadequate fluid and solute removal. IDH occurs in response to the reduction in blood volume during ultrafiltration and subsequent poor compensatory mechanisms due to abnormal cardiac function or autonomic or baroreceptor failure. Pediatric patients are inherently at risk for IDH due to the added difficulty of determining and attaining an accurate dry weight. While frequent blood pressure monitoring, dialysate sodium profiling, ultrafiltration-guided blood volume monitoring, dialysate cooling, hemodiafiltration, and intradialytic mannitol and midodrine have been used to prevent IDH, they have not been extensively studied in pediatric population...
February 8, 2019: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Angela W Palmer, Gregory W Albert
OBJECTIVEVarious surgical techniques have been described to treat subdural fluid collections in infants, including transfontanelle aspiration, burr holes, subdural drain, subduroperitoneal shunt, and minicraniotomy. The purpose of this study was to describe a modification of the minicraniotomy technique that avoids the implantation of external drainage catheters and potentially carries a higher success rate.METHODSIn this retrospective study, the authors describe 11 cases involving pediatric patients who underwent parietal minicraniotomies for the evacuation of subdural fluid collections...
February 1, 2019: Journal of Neurosurgery. Pediatrics
G L Wang, F Yin, Y Wang, W X Zhang, F He, L F Yang, L W Wu, J Peng
Objective: To investigate the clinical features, treatment strategies and long term outcomes of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods: The data of clinical features, auxiliary examinations, treatments and prognosis in children with anti-NMDAR encephalitis in Xiangya Hospital of Central South University from March 2014 to October 2017 were collected and retrospectively analyzed. A total of 71 patients were enrolled, including 33 males and 38 females. The youngest age of onset was 4 months old, and the age of onset was (9±4) years...
February 2, 2019: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Thomas J Walsh, Aspasia Katragkou, Tempe Chen, Christine M Salvatore, Emmanuel Roilides
This paper reviews recent advances in three selected areas of pediatric invasive candidiasis: epidemiology, diagnosis, and treatment. Although the epidemiological trends of pediatric invasive candidiasis illustrate a declining incidence, this infection still carries a heavy burden of mortality and morbidity that warrants a high index of clinical suspicion, the need for rapid diagnostic systems, and the early initiation of antifungal therapy. The development of non-culture-based technologies, such as the T2Candida system and (1→3)-β-d-glucan detection assay, offers the potential for early laboratory detection of candidemia and CNS candidiasis, respectively...
January 24, 2019: Journal of Fungi (Basel, Switzerland)
Thomas B Gillette, Michelle T Cabrera, Katherine Tarlock, Claire E Murphy, Karen M Chisholm, Andrew W Stacey
Purpose: The aim of this paper is to describe a case of relapsed pediatric acute lymphoblastic leukemia (ALL) presenting as a rapidly progressive subretinal infiltrate, as diagnosed by ultrasound-guided fine needle aspiration (FNA). Methods: We conducted a clinical pathological retrospective chart review. Results: Eleven months after documented remission of T-cell ALL while on maintenance therapy, this 17-year-old patient presented with acute open angle glaucoma in the right eye...
June 2018: Ocular Oncology and Pathology
Jader Pereira Almeida, Ivan Ferraz Valente, Marina da Rocha Lordelo
OBJECTIVE: To evaluate the association between acute kidney injury through the pediatric Risk, Injury, Failure, Loss and End Stage Renal Disease score and mortality in a pediatric intensive care unit. METHODS: This retrospective cohort study assessed all children admitted to the pediatric intensive care unit of a reference hospital in Brazil from January to December 2016. Patients were screened for the presence of acute kidney injury through the pediatric Risk, Injury, Failure, Loss and End Stage Renal Disease score...
October 2018: Revista Brasileira de Terapia Intensiva
D Runowski, S Prokurat, J Rubik, R Grenda
OBJECTIVE: There are no specific recommendations for therapeutic plasma exchange (TPE) in children after renal transplantation. The purpose of this study was to report the experience with TPE in a pediatric transplant setting. MATERIALS AND METHODS: 59 patients (mean age 12.5 ± 4.5 years) undergoing renal transplantation. Indications for TPE included the recurrence of nephrotic syndrome (NS; n = 30) and atypical hemolytic uremic syndrome (n = 6), chronic antibody-mediated rejection (cAMR; n = 20), sensitization (n = 2), and immune thrombocytopenia (n = 1)...
December 2018: Transplantation Proceedings
Laura Bianchi, Federica Gaiani, Francesca Vincenzi, Stefano Kayali, Francesco Di Mario, Gioacchino Leandro, Gian Luigi De' Angelis, Claudio Ruberto
BACKGROUND: Shiga-toxin Escherichia coli productor (STEC) provokes frequently an important intestinal damage that may be considered in differential diagnosis with the onset of Inflammatory Bowel Disease (IBD). The aim of this work is to review in the current literature about Hemolytic Uremic Syndrome (HUS) and IBD symptoms at the onset, comparing the clinical presentation and symptoms, as the timing of diagnosis and of the correct treatment of both these conditions is a fundamental prognostic factor...
December 17, 2018: Acta Bio-medica: Atenei Parmensis
Claudio Romano, Valeria Dipasquale, Carmelo Scarpignato
Vomiting is not only unpleasant for both children and families, but can lead to frequent hospital admission. The persistent vomiting hampers oral intake and increases the risk of dehydration so the proper use of antiemetic drugs can be useful. The pharmacological treatment of vomiting in children remains a challenge for the pediatrician because several antiemetics are prescribed as "off-label", outside their authorized drug label. Domperidone and ondansetron are the most commonly known antiemetic drugs...
December 11, 2018: Journal of Pediatric Gastroenterology and Nutrition
Wei-Tsun Kao, Yung-Hao Tseng, Yuh-Jyh Jong, Tai-Heng Chen
BACKGROUND: No previous studies have explored emergency medical care for children with chronic neuromuscular disorders (NMDs). We aimed to determine the major reasons for the emergency room (ER) readmission of pediatric patients with NMDs and suggest changes to the care plan to decrease readmissions. METHODS: Children with chronic NMDs (aged <18 years) who visited a medical center-based ER between January 2005 and January 2015 were included. The following data were extracted from the patient's ER records: presentations; demographic data, including sex and age; NMD diagnosis; triage classification; emergency examination; initial management and outcomes...
October 2, 2018: Pediatrics and Neonatology
Leonard G Feld, Daniel R Neuspiel, Byron A Foster, Michael G Leu, Matthew D Garber, Kelly Austin, Rajit K Basu, Edward E Conway, James J Fehr, Clare Hawkins, Ron L Kaplan, Echo V Rowe, Muhammad Waseem, Michael L Moritz
Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring...
December 2018: Pediatrics
Abdullah M Abunimer, Hussam Abou-Al-Shaar, Mohammed A Azab, Michael Karsy, Jian Guan, John R Kestle, William T Couldwell
OBJECTIVE: Pituitary adenomas are uncommon in the pediatric population. Although medical treatment can be effective in treating prolactinomas and some growth hormone-secreting tumors, resection is indicated in the setting of pituitary apoplexy, large or giant pituitary adenomas causing mass effect or visual loss, or when medical therapy becomes ineffective or intolerable. Modern microsurgical transsphenoidal approaches are potential avenues for resection in pediatric patients. The authors evaluated the outcomes and safety of this approach...
November 23, 2018: World Neurosurgery
Monika Miklaszewska, Przemysław Korohoda, Katarzyna Zachwieja, Alina Sobczak, Krzysztof Kobylarz, Constantinos J Stefanidis, Jolanta Goździk, Dorota Drożdż
BACKGROUND: Acute kidney injury (AKI) occurs in up to 30% of pediatric intensive care unit (PICU) patients and is associated with a high mortality rate. OBJECTIVES: The objective of the study was to evaluate factors associated with the outcome and to identify the prognostic factors in children receiving continuous renal replacement therapy (CRRT). MATERIAL AND METHODS: This was a retrospective, single-center study, including 46 patients. RESULTS: Logistic regression analysis demonstrated significant effects on patient survival exerted by the percentage of fluid overload (FO%) (odds ratio (OR): 1...
November 21, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Rhea Vidrine, Mihir R Atreya, Erika L Stalets
Sepsis is a burdensome public health problem and a leading cause of infant and child morbidity and mortality across the world. Few proven therapies exist to treat septic shock and the mainstay of management remains judicious fluid resuscitation and timely antibiotics. In its most recent iteration, the American College of Critical Care Medicine (ACCM) guidelines on hemodynamic support in pediatric septic shock recommends an institutional approach to the management of septic shock rather than one aimed at the individual practitioner...
October 2018: Translational pediatrics
Prashant Das, Eliram Nof, Israel Amirav, Stavros C Kassinos, Josué Sznitman
Despite the prevalence of inhalation therapy in the treatment of pediatric respiratory disorders, most prominently asthma, the fraction of inhaled drugs reaching the lungs for maximal efficacy remains adversely low. By and large drug delivery devices and their inhalation guidelines are typically derived from adult studies with child dosages adapted according to body weight. While it has long been recognized that physiological (e.g. airway sizes, breathing maneuvers) and physical transport (e.g. aerosol dynamics) characteristics are critical in governing deposition outcomes, such knowledge has yet to be extensively adapted to younger populations...
2018: PloS One
Nicole Glaser, Nathan Kuppermann
The optimal fluid treatment protocol for children with diabetic ketoacidosis (DKA) has long been a subject of controversy. Until recently, there was no high-quality evidence from randomized clinical trials to support an optimal guideline, and recommendations were mainly based on theoretical considerations. As a consequence, fluid treatment protocols for children with DKA vary between institutions (and countries). In June 2018, the results from the Fluid Therapies Under Investigation in DKA Trial conducted in the Pediatric Emergency Care Applied Research Network were published...
February 2019: Pediatric Diabetes
Folafoluwa O Odetola, Renee R Anspach, Yong Y Han, Sarah J Clark
OBJECTIVE: To determine the factors that influence the decision to transfer children in septic shock from level II to level I pediatric intensive care unit (PICU) care. DESIGN: Interviews with level II PICU physicians in Michigan and Northwest Ohio. A hypothetical scenario of a 14-year-old boy in septic shock was presented. BASELINE: 40 mL/kg fluid resuscitation, central venous and peripheral arterial access, and high-dose vasopressor infusions were provided...
December 2018: Journal of Intensive Care Medicine
Ben Gelbart
Sepsis is a leading cause of morbidity and mortality in children with a worldwide prevalence in pediatric intensive care units of approximately 8%. Fluid bolus therapy (FBT) is a first line therapy for resuscitation of septic shock and has been a recommendation of international guidelines for nearly two decades. The evidence base supporting these guidelines are based on limited data including animal studies and case control studies. In recent times, evidence suggesting harm from fluid in terms of morbidity and mortality have generated interest in evaluating FBT...
2018: Frontiers in Pediatrics
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