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Sepsis AND Pediatric

Thansinee Saetae, Krit Pongpirul, Rujipat Samransamruajkit
BACKGROUND: Assessing adherence to Early goal-directed therapy (EGDT) is challenging and might account for the negative findings and generalisability of the major trials to a real-life setting. This study was aimed (1) to extract key components of pediatric EGDT guidelines potentially becoming adherence criteria; (2) to classify adherence criteria into complete, clinically important, and feasible; and (3) to compare percent adherence to selected guidelines using the three approaches. METHODS: This study started with review of existing evidence to extract key components of pediatric EGDT guidelines...
2019: PloS One
Vishrut Gulhati, Jeremy Soo, Doris G Ransy, Jason Brophy, Fatima Kakkar, Ari Bitnun, Lindy Samson, Stanley Read, Hugo Soudeyns, Michael T Hawkes
BACKGROUND: Systemic inflammation, platelet dysfunction, and endothelial activation persist in people living with HIV despite sustained virologic suppression (SVS) with combined antiretroviral therapy (cART) and may lead to complications such as atherosclerosis and cardiovascular disease. Angiopoietin-1 (Ang-1) is a key regulator of angiogenesis and endothelial activation and has been studied as an objective biomarker in disease states such as atherosclerosis, sepsis, and severe malaria...
April 15, 2019: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Gull Zareen Khan Sial, Saadiya Javed Khan
PURPOSE: Although cancer is uncommon, it is a significant cause of pediatric morbidity and mortality in the developing world. The need for intensive care in pediatric oncology has increased with more intense chemotherapeutic interventions. It is important to identify patients who will benefit from management in the intensive care unit (ICU), given the resource limitation in developing countries. In this review, we examine our institutional experience with pediatric patients with cancer needing ICU care...
March 2019: Journal of Global Oncology
Hadley S Sauers-Ford, Michelle Y Hamline, Leah Tzimenatos, Heather McKnight, Charlaine M Hamilton, Maureen G McKennan, Jennifer L Rosenthal
BACKGROUND: Our 121-bed children's hospital is a quaternary care referral center for a 33-county region. Referring hospitals asked for Pediatric Acute Care Education Sessions (PACES). To determine which topics to prioritize for these sessions, nominal group technique (NGT) methods were used to obtain stakeholder-prioritized consensus on education topics. METHODS: Five NGT sessions were conducted over 6 weeks at referring hospitals throughout central and northern California...
March 8, 2019: Hospital Pediatrics
Surumi Shajahan, Sreedurga Thottanchery Sasidharan, Sudhindran Surendran, Veena Shenoy, Uma Devi Padma
BACKGROUND: Although, ABO-incompatible (ABOi) liver transplantation is considered a high-risk procedure, using newer and more effective preoperative B cell desensitisation techniques, many transplant centres are routinely performing ABOi living donor liver transplantation (LDLT). METHODS: This was a retrospective study of 12 patients (adult:pediatric = 10:2; M:F = 9:3; median age, 45.5 years [range 1 to 56 years]) who underwent ABOi LDLT at a tertiary care centre...
March 8, 2019: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
J W Heizer, T Q Schardt, M E Murphy, B R Branchford
BACKGROUND: Critically ill neonates with inflammation secondary to SIRS or sepsis often develop an acquired pro-thrombotic state. Unfractionated heparin (UFH) is commonly prescribed in this population, but these subjects often remain sub-therapeutic or require very high doses of UFH to achieve and sustain therapeutic anti-Xa activity. This is due, in part, to the unique pharmacokinetics/dynamics of this population but may also be influenced by the degree of inflammation. OBJECTIVE: To evaluate UFH dosing requirements in neonates and infants <6 months of age with variable degrees of systemic inflammation...
February 27, 2019: Thrombosis Research
Xiong Xie, Ming Li, Tian-Tian Xiong, Rui Wang, Liang Xiao
BACKGROUND: Currently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score (PEWS) is a disease risk assessment system that is simple and easy to operate, which has good sensitivity and specificity in disease recognition among children. Because detection indicators vary widely in children, a single indicator is difficult to assess the post-treatment status of children with sepsis. AIM: To investigate the relationship between serological markers, Brighton PEWS, and death in children with sepsis after treatment...
February 26, 2019: World Journal of Clinical Cases
Giulia Menchinelli, Flora Marzia Liotti, Barbara Fiori, Giulia De Angelis, Tiziana D'Inzeo, Liliana Giordano, Brunella Posteraro, Michela Sabatucci, Maurizio Sanguinetti, Teresa Spanu
Blood culture (BC) is still the standard for diagnosing bloodstream infections (BSIs), especially those caused by bacteria and fungi. Infection-complicating sepsis or septic shock often occurs at BSI onset, making necessary to improve the diagnostic yield of positive BCs. Among the BC systems currently available, the BACT/ALERT® VIRTUO® (VIRTUO) system has been developed to shorten time to detection (TTD) of positive BCs. In this study, we assessed TTD for 330 clinically relevant species including 14 Gram-positive, 14 Gram-negative, and 5 yeast isolates in spiked human blood samples that were tested in parallel with VIRTUO BACT/ALERT® 3D (BTA3D) and BACTEC™ FX (BACTEC) systems...
2019: Frontiers in Microbiology
I Ghorbel, F Bouaziz, K Loukil, S Moalla, M Gassara, K Ennouri
INTRODUCTION: Burns are among the most frequent injuries in children. They are a major cause of morbidity and mortality in low- and middle-income countries. This study aimed to describe the epidemiological aspects of burns in this environment and to propose preventive measures. PATIENTS AND METHODS: A retrospective study was conducted between 1 January 2012 and 31 December 2013. It included children less than 16 years old who were hospitalized for burn injuries in our department...
February 27, 2019: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Andrew J Prout, Victor B Talisa, Joseph A Carcillo, Derek C Angus, Chung-Chou H Chang, Sachin Yende
BACKGROUND AND OBJECTIVES: The decline in hospital mortality in children hospitalized with sepsis has increased the number of survivors. These survivors are at risk for adverse long-term outcomes, including readmission and recurrent or unresolved infections. We described the epidemiology of 90-day readmissions after sepsis hospitalization in children. We tested the hypothesis that a sepsis hospitalization increases odds of 90-day readmissions. METHODS: Retrospective cohort analysis of the Nationwide Readmissions Database...
March 1, 2019: Hospital Pediatrics
Laura A Boomer, Alexander Feliz
Sepsis is a life-threatening condition that requires aggressive, timely, and multi-disciplinary care. Understanding the changes in national guidelines regarding definitions, diagnosis and the management of pediatric sepsis is critical for the pediatric surgeon participating in the care of these patients. The purpose of this article is to review the essential steps for the timely management of pediatric sepsis, including fluid resuscitation, antibiotics, vasopressors, and steroids. This includes a description of the key adjunct modalities of treatment, including renal replacement therapy and extracorporeal life support (ECLS)...
February 2019: Seminars in Pediatric Surgery
Samuel E Rice-Townsend, Jennifer H Aldrink
Adequate nutritional support for critically ill pediatric patients is an essential component of optimal care in the intensive care unit. For select patient populations in this setting, the enteral delivery of nutrients can bring unique challenges and potential risks. The focus of this paper is to provide a review of existing literature concerning the safety, efficacy and benefits of enteral nutrition in select surgical patient populations for whom these discussions are most controversial: patients with traumatic brain injury, patients receiving extracorporeal life support (ECLS), and patients receiving vasopressor therapy, such as in sepsis...
February 2019: Seminars in Pediatric Surgery
R Houston, C Gagliardo, S Vassallo, P Wynne, C A Mazzola
BACKGROUND: Spinal epidural abscess (SEA) is a rare but serious infection that develops in the epidural space anywhere along the spinal cord. Early diagnosis is imperative to prevent permanent neurological sequelae. SEA should be considered in patients with backache, fever, neurological deficits and/ or spinal tenderness. Although these are non-specific symptoms, delayed diagnosis increases the risk of development of sepsis, which may be life threatening, or result in varying degrees of permanent neurological impairment...
February 21, 2019: World Neurosurgery
Jeffrey Cheng, Beiyu Liu, Hui-Jie Lee
OBJECTIVE: To quantify complications and rates of adverse events associated with surgical excision of hemangiomas in children using a national surgical database. DATA SOURCE: Pediatric American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® -pediatric), years 2012-2016. METHODS: Subjects included children under 18 years with a postoperative diagnosis of International Classification of Diseases (ICD), 9th revision code: 228...
February 22, 2019: Pediatric Dermatology
A Sasidharan, C J Harrison, D Banerjee, R Selvarangan
Among known parechovirus (PeV) types infecting humans, PeV-A3 (formerly HPeV3) and PeV-A1 (formerly HPeV1) are associated with pediatric central nervous system (CNS) infections. The prevalence of PeV-A3 among hospitalized infants with sepsis-like illness and viral CNS infection is well described; however, the contribution of PeV-A4 to infant CNS infection is relatively unexplored. We report the first 11 U.S. cases of PeV-A4 CNS infections occurring in Kansas City infants during 2010-2016 and compare the clinical presentation with that of PeV-A3...
February 20, 2019: Journal of Clinical Microbiology
Rick D Vavolizza, David F Grabski, Daniel E Levin, Jeffrey W Gander
BACKGROUND: Gastrostomy tube (GT) placement is a common pediatric surgical procedure typically indicated for oral aversion. This may develop in patients with congenital heart disease (CHD) who require an orthotopic heart transplant (OHT). The safety profile of GT placement in OHT patients who are immunosuppressed is unknown. Given the potential increased risk of wound site complications on a patient receiving immunosuppression, we sought to determine the safety profile of GT placement in pediatric patients with OHT...
February 20, 2019: Pediatric Transplantation
Anna C Sick-Samuels, Charlotte Z Woods-Hill, James C Fackler, Pranita D Tamma, Sybil A Klaus, Elizabeth E Colantuoni, Aaron M Milstone
Blood cultures are essential for the evaluation of sepsis. However, they may sometimes be obtained inappropriately, leading to high false-positive rates, largely due to contamination.1 As a quality improvement project, clinician decision-support tools for evaluating patients with fever or signs and symptoms of sepsis were implemented in April 2014 in our pediatric intensive care unit (PICU). This initiative resulted in a 46% decrease in blood culture obtainment2 and has been replicated in other institutions...
February 15, 2019: Infection Control and Hospital Epidemiology
Elliot Melendez, Jane E Whitney, Jackson S Norton, Melanie Silverman, Susanna Harju-Baker, Carmen Mikacenic, Mark M Wurfel, W Conrad Liles
Background: Angiopoietin-1 and -2 are vascular growth factors that exert opposing effects on endothelial activation and dysfunction. The aim of this study was to assess the association of these biomarkers with outcomes in children with sepsis. Methods: Biomarkers were assayed from the blood collected in an emergency department prior to any intervention. Predictor variables were Ang-1 and Ang-2 levels and the Ang-2/Ang-1 ratio. Outcomes included mortality, length of time on vasopressors, and ICU and hospital lengths of stay...
2019: International Journal of Medical Sciences
Indah K Murni, Mulyadi M Djer, Piprim B Yanuarso, Sukman T Putra, Najib Advani, Jusuf Rachmat, Aries Perdana, Rubiana Sukardi
Background: Evaluating outcome and identifying predictors of major complications among children undergoing cardiac surgery are essential to improve care. We evaluated short-term outcomes of postcardiac surgery and predictors of major complications in a national referral hospital in Indonesia. Methods: A prospective cohort study was conducted from April 2014 to March 2015 on all children undergoing cardiac surgery. Participants were followed up from the time of surgery until hospital discharge and 30-day mortality...
January 2019: Annals of Pediatric Cardiology
Bobby Tan, Judith Ju-Ming Wong, Rehena Sultana, Janine Cynthia Jia Wen Koh, Mark Jit, Yee Hui Mok, Jan Hau Lee
Importance: The global patterns and distribution of case-fatality rates (CFRs) in pediatric severe sepsis and septic shock remain poorly described. Objective: We performed a systematic review and meta-analysis of studies of children with severe sepsis and septic shock to elucidate the patterns of CFRs in developing and developed countries over time. We also described factors associated with CFRs. Data Sources: We searched PubMed, Web of Science, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central systematically for randomized clinical trials and prospective observational studies from earliest publication until January 2017, using the keywords "pediatric," "sepsis," "septic shock," and "mortality...
February 11, 2019: JAMA Pediatrics
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