Kristen L Jeffreys, Michelle Eckerle, Holly Depinet
OBJECTIVE: The aim of the study was to describe patterns of initiation (and factors associated with delayed initiation) of vasoactive agents among pediatric emergency patients with septic shock. METHODS: Patients with septic shock from November 2013 to September 2016 who had a vasoactive agent initiated for documented hypotension were classified as "guideline adherent" (hypotensive following the final fluid bolus and had vasoactive agents initiated within 60 minutes) or "delayed initiation" (hypotensive after the final bolus and were initiated on vasoactive agents after >60 minutes)...
September 15, 2020: Pediatric Emergency Care
Jean Barrett, Leanne Millar, Deepa Athavale, Reynolds Ben Christopher
In children, haemodialysis is used as a form of renal replacement therapy and is typically delivered via a central venous catheter (CVC). It is necessary to access the CVC for dialysis and blood sampling regularly, and safe line practice is essential to minimise complications associated with CVCs, including infection. The authors had concerns about the rate of CVC infection in their children's haemodialysis unit, which prompted a practice review. A questionnaire was emailed to all other children's haemodialysis units in the UK, which identified variations in practice and training...
September 14, 2020: Nursing Children and Young People
Julie Jaffray, Brian Branchford, Neil Goldenberg, Jemily Malvar, Stacy E Croteau, Michael Silvey, John H Fargo, James D Cooper, Nihal Bakeer, Richard Sposto, Lingyun Ji, Neil A Zakai, E Vincent S Faustino, Amy Stillings, Emily Krava, Guy Young, Arash Mahajerin
OBJECTIVE: To identify pertinent clinical variables discernible on the day of hospital admission that can be used to assess risk for hospital-acquired-VTE (HA-VTE) in children. STUDY DESIGN: The Children's Hospital Acquired Thrombosis (CHAT) Registry is a multi-institutional registry for all hospitalized participants aged 0-21 years diagnosed with a HA-VTE and non-VTE controls. A risk assessment model (RAM) for the development of HA-VTE using demographic and clinical VTE risk factors present at hospital admission was derived using weighted logistic regression and the least absolute shrinkage and selection (Lasso) procedure...
September 10, 2020: Journal of Pediatrics
Jean-François Timsit, Julien Baleine, Louis Bernard, Silvia Calvino-Gunther, Michael Darmon, Jean Dellamonica, Eric Desruennes, Marc Leone, Alain Lepape, Olivier Leroy, Jean-Christophe Lucet, Zied Merchaoui, Olivier Mimoz, Benoit Misset, Jean-Jacques Parienti, Jean-Pierre Quenot, Antoine Roch, Matthieu Schmidt, Michel Slama, Bertrand Souweine, Jean-Ralph Zahar, Walter Zingg, Laetitia Bodet-Contentin, Virginie Maxime
The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts...
September 7, 2020: Annals of Intensive Care
Anne Marie Cahill, Fernando Escobar, Michael R Acord
Central venous lines may require contrast injection under fluoroscopy to evaluate for dysfunction such as occlusion, fibrin sheath development or catheter fracture. Rarely, some patients may be too ill to travel to the interventional radiology suite for this examination. We present a case utilizing contrast-enhanced ultrasound (CEUS) at the bedside to assess catheter integrity in a critically ill infant with a large intra-abdominal fluid collection. CEUS demonstrated extravasation into the collection, confirming catheter fracture and prompting immediate cessation of line use and recommendation for exchange...
September 5, 2020: Pediatric Radiology
Mouri Biswas, Paul M Ryan, Rima Nakrani, Mihir Bhatt, Anthony K C Chan, Tapas Mondal
AIM: To establish the incidence and characteristics of paediatric thrombosis (PT) in a Canadian tertiary care centre during the era of low molecular weight heparin (LMWH). METHODS: A retrospective observational case study of all patients <18 years of age evaluated for arterial and venous thrombosis from May 2008 to July 2018 at McMaster Children's Hospital was conducted through the electronic medical record. RESULTS: The incidence of PT was 52...
August 20, 2020: Acta Paediatrica
Jingyi Shi, Ting Sun, Yun Cui, Chunxia Wang, Fei Wang, Yiping Zhou, Huijie Miao, Yijun Shan, Yucai Zhang
BACKGROUND: Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors and overall mortality for MDR/XDR Acinetobacter baumannii infected pediatric patients. METHODS: This retrospective study included 102 pediatric patients who developed MDR/XDR Acinetobacter baumannii infection in the pediatric intensive care unit (PICU) of Shanghai Children's Hospital in China from December 2014 to May 2018...
August 12, 2020: BMC Infectious Diseases
Alejandrina Cristia, Marvin Lavechin, Camila Scaff, Melanie Soderstrom, Caroline Rowland, Okko Räsänen, John Bunce, Elika Bergelson
In the previous decade, dozens of studies involving thousands of children across several research disciplines have made use of a combined daylong audio-recorder and automated algorithmic analysis called the LENAⓇ system, which aims to assess children's language environment. While the system's prevalence in the language acquisition domain is steadily growing, there are only scattered validation efforts on only some of its key characteristics. Here, we assess the LENAⓇ system's accuracy across all of its key measures: speaker classification, Child Vocalization Counts (CVC), Conversational Turn Counts (CTC), and Adult Word Counts (AWC)...
July 29, 2020: Behavior Research Methods
Valentina Becherucci, Stefano Ermini, Luisa Piccini, Silvia Bisin, Valentina Gori, Francesca Gentile, Riccardo Ceccantini, Elena De Rienzo, Barbara Bindi, Paola Pavan, Vanessa Cunial, Elisa Allegro, Francesca Brugnolo, Daniela Maggio, Daniela Calzolari, Erika Maccarelli, Silvia Galli, Sonia Muricci, Marco Berchielli, Veronica Tintori, Iacopo Sardi, Franco Bambi
BACKGROUND: PBSC collection using a blood cell separator in very low weight patients can be frequently complicated by severe adverse effects and technical difficulties. MATERIAL AND METHODS: From March 2013 to January 2017, 14 PBSC collections were performed in 12 children weighing less than 10 kg, affected by different solid tumours. PBSC collection was performed with a "homemade" aseptically assembled circuit. The circuit is composed by a 150 mL collection bag connected with a 4 stopcock ramp, perfused with ACD...
July 25, 2020: Journal of Clinical Apheresis
Priscila Grizante-Lopes, Marlene Pereira Garanito, Daniele Martins Celeste, Vera Lucia Jornada Krebs, Jorge David Aivazoglou Carneiro
OBJECTIVE: To report a single-center experience with thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) in preterm neonates with severe thrombotic events, in terms of thrombus resolution and bleeding complications. STUDY DESIGN: This retrospective study included 21 preterm neonates with severe venous thrombotic events admitted to the neonatal intensive care unit, identified in our pharmacy database from January 2001 to December 2016, and treated with rt-PA until complete or partial clot lysis, no-response or bleeding complications...
July 25, 2020: Pediatric Blood & Cancer
Verónica De la Maza, Macarena Manriquez, Magdalena Castro, Paola Viveros, María Fernandez, Evelyn Vogel, Erica Peña, María Elena Santolaya, Milena Villarroel, Juan Pablo Torres
OBJECTIVE: To assess the impact of a structured educational programme for caregivers of children with cancer on their level of knowledge about the disease and patient's clinical outcome. METHODS: This prospective, non-randomised, experimental study included caregivers of recently diagnosed children at two hospitals in Chile. Caregivers whose children were treated at the first centre were the structured education programme group (EPG), while the second hospital provided the standard care (SCG)...
July 24, 2020: European Journal of Cancer Care
Gillian L Fell, Bennet S Cho, Lorenzo Anez-Bustillos, Duy T Dao, Meredith A Baker, Prathima Nandivada, Alison A O'Loughlin, Alexis P Hurley, Paul D Mitchell, Shawn Rangel, Kathleen M Gura, Mark Puder
OBJECTIVES: To assess whether a 24-hour length of hospitalization and empiric antibiotic therapy to exclude central line-associated bloodstream infection (CLABSI) in children with intestinal failure is potentially as safe as 48 hours, which is the duration most commonly used but not evidence based. STUDY DESIGN: A prospective single-institution observational cohort study was conducted among pediatric patients with intestinal failure from July 1, 2015 through June 30, 2018 to identify episodes of suspected CLABSI...
July 17, 2020: Journal of Pediatrics
Jacob R Hirschl, Samir K Gadepalli, Brian A Derstine, Sven A Holcombe, Ethan A Smith, Stewart C Wang, Peter F Ehrlich, Marcus D Jarboe
PURPOSE: The key landmark for tip position of a central venous catheter (CVC) is the SVC-RA junction. In adults, localization of the SVC-RA junction may be assessed as a function of vertebral body units (VBU) below the carina during CVC placement. We investigated the relationship between the SVC-RA junction and the carina in children. MATERIALS AND METHODS: 584 CT scans of 0-18 years were analyzed. The carina was marked automatically by software while the SVC-RA junction and vertebrae were marked manually...
July 14, 2020: Pediatric Surgery International
Ryan J Good, Melanie Levin, Susan Feder, Michele M Loi, John S Kim, Brian R Branchford, Angela S Czaja, Todd C Carpenter
OBJECTIVES: Perform a needs assessment by evaluating accuracy of PICU provider bedside ultrasound measurement of femoral vein diameter prior to utilization of the catheter-to-vein ratio for central venous catheter size selection. DESIGN: Prospective observational cohort study. SETTING: PICU within a quaternary care children's hospital. PATIENTS: PICU patients greater than 30 days and less than 6 years without a femoral central venous catheter...
June 22, 2020: Pediatric Critical Care Medicine
Yuanyuan Wang, Rondeline Williams, Laura Dilley, Derek M Houston
Early language environment plays a critical role in child language development. The Language ENvironment Analysis (LENA™) system allows researchers and clinicians to collect daylong recordings and obtain automated measures to characterize a child's language environment. This meta-analysis evaluates the predictability of LENA's automated measures for language skills in young children. We systematically searched reports for associations between LENA's automated measures, specifically, adult word count (AWC), conversational turn count (CTC), and child vocalization count (CVC), and language skills in children younger than 48 months...
September 2020: Developmental Review: DR
J A A S Jayaweera, D Sivakumar
BACKGROUND: Indwelling central venous catheters (CVC) are used to provide long term hemodialysis. The commonest and the severe complication of CVC is the central line-associated bloodstream infection (CLABSI). This study was done to assess the etiology and infectious complications of CVC in children on long term hemodialysis. METHODS: Children newly undergoing hemodialysis and having indwelling CVC were included. They were followed up to a period of 2-years to assess infectious complications...
June 29, 2020: BMC Infectious Diseases
Nital Patel, Tara L Petersen, Pippa M Simpson, Mingen Feng, Sheila J Hanson
OBJECTIVES: Central venous access devices, including peripherally inserted central catheters and central venous catheters, are often needed in critically ill patients, but also are associated with complications, including central-line associated bloodstream infections and venous thromboembolism. We compared different central venous access device types and these complications in the PICU. DESIGN: Multicenter, cohort study. SETTING: One-hundred forty-eight participating Virtual PICU Systems, LLC hospital PICU sites...
June 24, 2020: Critical Care Medicine
Antonio Chiaretti, Mauro Pittiruti, Giovanni Sassudelli, Giorgio Conti, Marco Rossi, Silvia Maria Pulitanò, Aldo Mancino, Angela Pusateri, Antonio Gatto, Federica Tosi
BACKGROUND: Placement of central venous access devices is a clinical procedure associated with some risk of adverse events and with a relevant cost. Careful choice of the device, appropriate insertion technique, and proper management of the device are well-known strategies commonly adopted to achieve an optimal clinical result. However, the environment where the procedure takes place may have an impact on the overall outcome in terms of safety and cost-effectiveness. METHODS: We carried out a retrospective analysis on pediatric patients scheduled for a major neurosurgical operation, who required a central venous access device in the perioperative period...
June 22, 2020: Journal of Vascular Access
Marie-Claude Pelland-Marcotte, Nour Amiri, Maria L Avila, Leonardo R Brandão
BACKGROUND: The prevalence of children diagnosed with thrombotic events has been increasing in the last decades. The most common thrombosis risk factor in neonates, infants and children is the placement of a central venous catheter (CVC). It is unknown if anticoagulation prophylaxis with low molecular weight heparin (LMWH) decreases CVC-related thrombosis in children. This is an update of the Cochrane Review published in 2014. OBJECTIVES: To determine the effect of LMWH prophylaxis on the incidence of CVC-related thrombosis and major and minor bleeding complications in children...
June 18, 2020: Cochrane Database of Systematic Reviews
Austin Sellers, Avner Meoded, Javier Quintana, George Jallo, Ernest Amankwah, Anh Thy H Nguyen, Marisol Betensky, Katie Mills, Neil Goldenberg, Nir Shimony
INTRODUCTION: Cerebral sinovenous thrombosis (CSVT) represents the second most common type of venous thromboembolism (VTE) in children. Current literature includes limited evidence on risk factors for CSVT, particularly in the pediatric population. We sought to determine risk factors for CSVT in pediatric patients through a single-institutional case-control study. In addition, we evaluated thrombophilias, treatments and outcomes in CSVT among cases. METHODS: A case-control study was performed at Johns Hopkins All Children's Hospital on patients admitted from March 31, 2006 through April 1, 2018...
June 9, 2020: Thrombosis Research
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