1
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Cabrero-Hernández M, García-Salido A, Leoz-Gordillo I, González-Brabin A, Iglesias-Bouzas MI, Unzueta-Roch JL, De Lama Caro-Patón G, Nieto-Moro M. Prospective observational pilot study on bedside lung ultrasound in patients with severe acute bronchiolitis and pediatric intensive care admission. Pediatr Pulmonol 2024. [PMID: 38656611 DOI: 10.1002/ppul.27026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Affiliation(s)
| | - Alberto García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Inés Leoz-Gordillo
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | | | - Montserrat Nieto-Moro
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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2
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Tagarro A, Domínguez-Rodríguez S, Mesa JM, Epalza C, Grasa C, Iglesias-Bouzas MI, Fernández-Cooke E, Calvo C, Villaverde S, Torres-Fernández D, Méndez-Echevarria A, Leoz I, Fernández-Pascual M, Saavedra-Lozano J, Soto B, Aguilera-Alonso D, Rivière JG, Fumadó V, Martínez-Campos L, Vivanco A, Pilar-Orive FJ, Alcalá P, Ruiz B, López-Machín A, Oltra M, Moraleda C. Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies. Eur J Pediatr 2023; 182:461-466. [PMID: 36282324 PMCID: PMC9595092 DOI: 10.1007/s00431-022-04649-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 01/21/2023]
Abstract
Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p = 0.013), but with a higher probability of needing second-line therapy compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p = 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p = 0.011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p < 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG. Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment. What is Known: • Steroids plus intravenous immunoglobulin, compared with intravenous immunoglobulin alone for multi-system inflammatory syndrome (MIS-C) might reduce the need for hemodynamic support and the duration of fever, but the certainty of the evidence is low. What is New: • Intravenous immunoglobulin, steroids, and their combination for MIS-C may have different outcomes. • In this study, intravenous immunoglobulin increased the probability of discharge over time, steroids reduced persistent fever, while combination therapy reduced the need for second-line treatments.
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Affiliation(s)
- Alfredo Tagarro
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.
- RITIP (Translational Research Network On Paediatric Infectious Diseases), Madrid, Spain.
- Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain.
| | - Sara Domínguez-Rodríguez
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Juan Miguel Mesa
- Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain
- Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Grasa
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), RITIP (Translational Research Network On Paediatric Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Elisa Fernández-Cooke
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
| | - Cristina Calvo
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), RITIP (Translational Research Network On Paediatric Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - Serena Villaverde
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - David Torres-Fernández
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
| | - Ana Méndez-Echevarria
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Inés Leoz
- Paediatrics Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Soto
- Paediatrics Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - David Aguilera-Alonso
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jacques G Rivière
- Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Victoria Fumadó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu, Barcelona, Spain
| | - Leticia Martínez-Campos
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Torrecárdenas, Almeria, Spain
| | - Ana Vivanco
- Paediatrics Intensive Care Unit, Hospital Central de Asturias, Asturias, Spain
| | | | - Pedro Alcalá
- Paediatrics Department, Hospital General de Alicante, Alicante, Spain
| | - Beatriz Ruiz
- Paediatrics Department, Hospital Reina Sofía, Córdoba, Spain
| | | | - Manuel Oltra
- Paediatrics Department, Hospital La Fe, Valencia, Spain
| | - Cinta Moraleda
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
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3
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Moreno-Jiménez JE, Demerouti E, Blanco-Donoso LM, Chico-Fernández M, Iglesias-Bouzas MI, Garrosa E. Passionate healthcare workers in demanding intensive care units: its relationship with daily exhaustion, secondary traumatic stress, empathy, and self-compassion. Curr Psychol 2022; 42:1-16. [PMID: 36406844 PMCID: PMC9667444 DOI: 10.1007/s12144-022-03986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/17/2022]
Abstract
This study focuses on Intensive Care Units (ICU) and aims to test whether daily job demands are related to daily emotional exhaustion and secondary traumatic stress (STS) after work through the experience of passion at work and whether personal resources in ICU, such as empathy and self-compassion, moderate these relationships. A diary study was designed to assess day-level job demands, passion, empathy, self-compassion at work; and day-level emotional exhaustion and STS after work. The sample was 97 healthcare workers from ICU from different Spanish hospitals being selected by the snowball technique. This sample was assessed 5 days x two moments per day through a diary questionnaire. The multilevel analysis showed a negative mediational effect of harmonious passion between daily job demands and both emotional exhaustion and STS. Also, in predicting emotional exhaustion, a moderator effect of empathy on harmonious passion was found, as well as a moderator effect of self-compassion on obsessive passion. In predicting STS, a direct positive effect was found in empathy. Our findings highlight the vocational work of these healthcare workers, considering job demands as challenging and enhancing their harmonious passion to overcome the drawbacks. Moreover, empathy revealed to have a negative effect whereas self-compassion the contrary. Thus, increase the awareness on these personal resources and how to train them could be considered as valuable preventative measures.
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Affiliation(s)
- Jennifer E. Moreno-Jiménez
- Faculty of Education and Psychology, Universidad Francisco de Vitoria, Ctra. Pozuelo-Majadahonda KM 1.800, 28223 Pozuelo de Alarcón, Madrid Spain
- Faculty of Psychology, Autonomous University of Madrid, C/ Ivan Pavlov, 6, 28049 Madrid, Spain
| | - Evangelia Demerouti
- Human Performance Management Group, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
- Department of Industrial Psychology and People Management, University of Johannesburg, Johannesburg, 2006 South Africa
| | | | - Mario Chico-Fernández
- Service of Intensive Medicine, Hospital Universitario Doce de Octubre de Madrid, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - María Isabel Iglesias-Bouzas
- Service of Intensive Medicine in Pediatric Units, Hospital Niño Jesús, Avda Menéndez Pelayo 65, 28042 Madrid, Spain
| | - Eva Garrosa
- Faculty of Psychology, Autonomous University of Madrid, C/ Ivan Pavlov, 6, 28049 Madrid, Spain
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4
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García-Salido A, Leoz-Gordillo I, García-Teresa MÁ, Iglesias-Bouzas MI, Martínez de Azagra-Garde A, Nieto-Moro M. Descriptive analysis of SARS-CoV-2 pandemia impact on pediatric intensive care unit admissions. Medicina Intensiva (English Edition) 2022; 46:350-352. [PMID: 35527192 PMCID: PMC9069302 DOI: 10.1016/j.medine.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/25/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- A García-Salido
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - I Leoz-Gordillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - M Á García-Teresa
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - M I Iglesias-Bouzas
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - M Nieto-Moro
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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5
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García-Salido A, Leoz-Gordillo I, González Brabin A, García-Teresa MÁ, Martínez-de-Azagra-Garde A, Iglesias-Bouzas MI, Cabrero-Hernández M, De Lama Caro-Patón G, Unzueta-Roch JL, Castillo-Robleda A, Ramirez-Orellana M, Nieto-Moro M. PIMS-TS immunophenotype: description and comparison with healthy children, Kawasaki disease and severe viral and bacterial infections. Infect Dis (Lond) 2022; 54:687-691. [PMID: 35394410 DOI: 10.1080/23744235.2022.2059561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND A new clinical syndrome named Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) has been described. This new disease is a leading cause of hospital and paediatric intensive care unit (PICU). It has been related to immunity dysregulation. METHODS Prospective-retrospective observational study to describe the innate cell signature and immunophenotype of children admitted to PICU because of PIMS-TS (from March 2020 to September 2020). The immunophenotype was done through the expression analysis of these proteins of mononuclear cells: CD64, CD18, CD11a and CD11b. They were compared with previous healthy controls and children admitted to PICU because of bacterial infection, viral infection and Kawasaki disease (KD). Two hundred and forty-seven children were studied: 183 healthy controls, 25 viral infections, 20 bacterial infections, 6 KD and 13 PIMS-TS. RESULTS PIMT-TS showed the lowest percentage of lymphocytes and monocytes with higher relative numbers of CD4+ (p = .000). Monocytes and neutrophils in PIMS-TS showed higher levels of CD64 expression (p = .000). Also, CD11a and CD11b were highly expressed (p =,000). CONCLUSION We observed a differential cell innate signature in PIMS-TS. These findings are consistent with a proinflammatory status (CD64 elevated expression) and lymphocyte trafficking to tissues (CD11a and CD11b). More studies should be carried out to confirm our results.
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Affiliation(s)
- Alberto García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Inés Leoz-Gordillo
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | | | | | | | | | - Ana Castillo-Robleda
- Pediatric Oncohematology Unit, Flow Cytometry Laboratory, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Manuel Ramirez-Orellana
- Pediatric Oncohematology Unit, Flow Cytometry Laboratory, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Montserrat Nieto-Moro
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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6
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Aguilera-Alonso D, Epalza C, Sanz-Santaeufemia FJ, Grasa C, Villanueva-Medina S, Melendo Pérez S, Cervantes Hernández E, Urretavizcaya-Martínez M, Pino R, Gómez M, Orive J, González Zárate A, Vidal Lana P, González Montero R, Ruiz González S, Calvo C, Iglesias-Bouzas MI, Caro-Teller JM, Domínguez-Rodríguez S, Ballesteros Á, Mesa J, Cobos-Carrascosa E, Tagarro A, Moraleda C. Antibiotic Prescribing in Children Hospitalized With COVID-19 and Multisystem Inflammatory Syndrome in Spain: Prevalence, Trends, and Associated Factors. J Pediatric Infect Dis Soc 2022; 11:225-228. [PMID: 35188190 PMCID: PMC8903467 DOI: 10.1093/jpids/piac003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
Abstract
The SARS-CoV-2 pandemic has caused an increase in antibiotic use in different settings. We describe the antibiotic prescribing prevalence, associated factors and trends, as well as concomitant bacterial infections in children hospitalized with COVID-19 or multisystemic inflammatory syndrome related to SARS-CoV-2 in Spain.
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Affiliation(s)
- David Aguilera-Alonso
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Unidad de Investigación Maternoinfantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain,CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain,Corresponding Author: Cristina Epalza, MD, Hospital Universitario 12 de Octubre, Servicio de Pediatría, Avenida de Córdoba s/n, 28041 Madrid, Madrid, Spain. E-mail:
| | | | - Carlos Grasa
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain,Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Sara Villanueva-Medina
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Susana Melendo Pérez
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall dʹHebron, Vall dʹHebron Research Institute, Barcelona, Spain
| | | | | | - Rosa Pino
- Pediatrics Department, Hospital Sant Joan de Déu (HSJD), Barcelona, Spain
| | - Marisa Navarro Gómez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Unidad de Investigación Maternoinfantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain,CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Pilar Orive
- Pediatric Critical Care Service, Hospital Universitario Cruces, Barakaldo, Spain,Pediatric Critical Care Group, BioCruces Health Research Institute, Barakaldo, Spain
| | - Ana González Zárate
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Universidad Europea, Madrid, Spain
| | - Paula Vidal Lana
- Department of Pediatrics, Hospital Lozano Blesa, Zaragoza, Spain
| | | | - Sara Ruiz González
- Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Cristina Calvo
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain,Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | | | | | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Álvaro Ballesteros
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Juan Mesa
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain,Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Universidad Europea, Madrid, Spain
| | - Elena Cobos-Carrascosa
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
| | - Alfredo Tagarro
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain,Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Universidad Europea, Madrid, Spain
| | - Cinta Moraleda
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain,Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain,Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases), Madrid, Spain
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7
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Tagarro A, Sanz-Santaeufemia FJ, Grasa C, Cobos E, Yebra J, Alonso-Cadenas JA, Baquero-Artigao F, Mesa-Guzmán JM, Pérez-Seoane B, Calvo C, Herreros ML, Epalza C, Melendo S, Dominguez-Rodriguez S, Vidal P, Pacheco M, Ballesteros A, Bernardino M, Villanueva-Medina S, Rodríguez-Molino P, Miragaya Castro S, Rivière J, Garcés R, Santiago B, Fumadó V, Urretavizcaya-Martínez M, García-García ML, Penín M, Cava F, Sáez E, Iglesias-Bouzas MI, Herrero B, Reinoso TDJ, Moraleda C. Dynamics of Reverse Transcription-Polymerase Chain Reaction and Serologic Test Results in Children with SARS-CoV-2 Infection. J Pediatr 2022; 241:126-132.e3. [PMID: 34571020 PMCID: PMC8463102 DOI: 10.1016/j.jpeds.2021.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the time to reverse transcription-polymerase chain reaction (RT-PCR) negativity after the first positive RT-PCR test, factors associated with longer time to RT-PCR negativity, proportion of children seroconverting after proven severe acute respiratory syndrome coronavirus 2 infection, and factors associated with the lack of seroconversion. STUDY DESIGN The Epidemiological Study of Coronavirus in Children of the Spanish Society of Pediatrics is a multicenter study conducted in Spanish children to assess the characteristics of coronavirus disease 2019. In a subset of patients, 3 serial RT-PCR tests on nasopharyngeal swab specimens were performed after the first RT-PCR test, and immunoglobulin G serology for severe acute respiratory syndrome coronavirus 2 antibodies was performed in the acute and follow-up (<14 and ≥14 days after diagnosis) phase. RESULTS In total, 324 patients were included in the study. The median time to RT-PCR negativity was 17 days (IQR, 8-29 days), and 35% of patients remained positive more than 4 weeks after the first RT-PCR test. The probability of RT-PCR negativity did not differ across groups defined by sex, disease severity, immunosuppressive drugs, or clinical phenotype. Globally, 24% of children failed to seroconvert after infection. Seroconversion was associated with hospitalization, persistence of RT-PCR positivity, and days of fever. CONCLUSIONS Time to RT-PCR negativity was long, regardless of the severity of symptoms or other patient features. This finding should be considered when interpreting RT-PCR results in a child with symptoms, especially those with mild symptoms. Seroprevalence and postimmunization studies should consider that 11 in 4 infected children fail to seroconvert.
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Affiliation(s)
- Alfredo Tagarro
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain,Pediatrics Research Group, Europea University of Madrid, Madrid, Spain,Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | | | - Carlos Grasa
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Elena Cobos
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Julia Yebra
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | - Fernando Baquero-Artigao
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Juan Miguel Mesa-Guzmán
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Beatriz Pérez-Seoane
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Calvo
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - María Luisa Herreros
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Epalza
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain,Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Susana Melendo
- Infectious Diseases and Pediatric Immunology Unit, Department of Pediatrics, Hospital Universitario Vall d’Hebron, Madrid, Spain
| | - Sara Dominguez-Rodriguez
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Paula Vidal
- Pediatrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Aragón, Spain
| | - Mónica Pacheco
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Alvaro Ballesteros
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - María Bernardino
- Pediatrics Research Group, Europea University of Madrid, Madrid, Spain
| | | | - Paula Rodríguez-Molino
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | | | - Jacques Rivière
- Infectious Diseases and Pediatric Immunology Unit, Department of Pediatrics, Hospital Universitario Vall d’Hebron, Madrid, Spain
| | - Rosa Garcés
- Pediatrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Aragón, Spain
| | - Begoña Santiago
- Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Victoria Fumadó
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | | | | | - María Penín
- Pediatrics Departament, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Fernando Cava
- Microbiology Department, UR Salud, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Elena Sáez
- Microbiology Department, UR Salud, Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | - Blanca Herrero
- Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Teresa de Jesús Reinoso
- Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
| | - Cinta Moraleda
- Fundación de Investigación Biomédica Hospital 12 de Octubre. Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain,Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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González-Brabin A, Cabrero-Hernández M, García-Salido A, Leoz-Gordillo I, Iglesias-Bouzas MI, Nieto-Moro M. [Use of thoracic ultrasound in the assessment and follow-up of seriously ill children due to pediatric inflammatory multisystemic syndrome: Observational prospective study]. Med Intensiva 2021; 46:477-480. [PMID: 34658473 PMCID: PMC8502041 DOI: 10.1016/j.medin.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A González-Brabin
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M Cabrero-Hernández
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A García-Salido
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - I Leoz-Gordillo
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M I Iglesias-Bouzas
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M Nieto-Moro
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
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García-Salido A, Leoz-Gordillo I, García-Teresa MÁ, Iglesias-Bouzas MI, Martínez de Azagra-Garde A, Nieto-Moro M. [Descriptive Analysis Of Sars-Cov2 Pandemia Impact On Pediatric Intensive Care Unit Admissions]. Med Intensiva 2021; 46:350-352. [PMID: 34226780 PMCID: PMC8241680 DOI: 10.1016/j.medin.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A García-Salido
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - I Leoz-Gordillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M Á García-Teresa
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M I Iglesias-Bouzas
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | - M Nieto-Moro
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
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10
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Marcos-Morales A, García-Salido A, Leoz-Gordillo I, de Lama Caro-Patón G, Martínez de Azagra-Garde A, García-Teresa MÁ, Iglesias-Bouzas MI, Nieto-Moro M, Serrano-González A, Casado-Flores J. Respiratory and pharmacological management in severe acute bronchiolitis: Were clinical guidelines not written for critical care? Arch Pediatr 2020; 28:150-155. [PMID: 33339722 DOI: 10.1016/j.arcped.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/15/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The treatment applied for children admitted to the pediatric intensive care unit (PICU) for severe acute bronchiolitis may differ from general recommendations. The first objective of our study was to describe the treatments offered to these children in a Spanish tertiary PICU. The second objective was to analyse the changes in management derived from the publication of the American Academy of Pediatrics (AAP) bronchiolitis guideline in 2014. METHODS This was a retrospective-prospective observational study conducted during two epidemic waves (2014-2015 and 2015-2016). The AAP guidelines were distributed and taught to PICU staff between both epidemic waves. RESULTS A total of 138 children were enrolled (78 male). In the first period, 78 children were enrolled. The median age was 1.8 months (IQR 1.1-3.6). There were no differences between the management in the two periods, except for the use of high-flow oxygen therapy (HFOT); its use increased in the second period. Overall, 83% of patients received non-invasive ventilation or HFOT. Children older than 12 months received HFOT exclusively. In comparison, continuous positive airway pressure and bi-level positive airway pressure were used less during the period 2015-2016 (P=0.036). Regarding pharmacological therapy, 70% of patients received antibiotics, 23% steroids, 33% salbutamol, 31% adrenaline, and 7% hypertonic saline. The mortality rate was zero. CONCLUSIONS Our PICU did not follow the AAP recommendations. There were no differences between the two periods, except in the use of HFOT. All children older than 12 months received HFOT exclusively. The rate of using invasive mechanical ventilation was also low.
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Affiliation(s)
- A Marcos-Morales
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - A García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
| | - I Leoz-Gordillo
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - G de Lama Caro-Patón
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - A Martínez de Azagra-Garde
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - M Á García-Teresa
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - M I Iglesias-Bouzas
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - M Nieto-Moro
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - A Serrano-González
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - J Casado-Flores
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
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Iglesias-Bouzas MI, Serrano González A. How can we improve the care of paediatric trauma? An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Iglesias-Bouzas MI, Serrano González A. ¿Cómo mejorar la asistencia al trauma pediátrico. An Pediatr (Barc) 2017; 87:299-300. [DOI: 10.1016/j.anpedi.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022] Open
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13
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García-Salido A, Nieto-Moro M, Iglesias-Bouzas MI, González-Vicent M, Serrano-González A, Casado-Flores J. Critically ill pediatric hemato-oncology patient: What we do is what we should do? Anales de Pediatría (English Edition) 2016. [DOI: 10.1016/j.anpede.2015.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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García-Salido A, Nieto-Moro M, Iglesias-Bouzas MI, González-Vicent M, Serrano-González A, Casado-Flores J. [Critically ill pediatric hemato-oncology patient: What we do is what we should do?]. An Pediatr (Barc) 2015; 85:61-69. [PMID: 26619931 DOI: 10.1016/j.anpedi.2015.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Primary objective, to describe the management and monitorization of critically ill pediatric hemato-oncology patient (CIPHO) in the Spanish pediatric intensive care units (PICU). Secondary objective, through a literature review, to identify possible areas of improvement. MATERIAL AND METHODS Observational transversal descriptive study. An anonymous web-based survey was sent to 324 Spanish pediatric intensivists from April 2011 to May 2011. None of them were pediatric residents. RESULTS The survey was answered by 105 intensivists, 59/105 always agreed their treatment with the oncologist. In case of hemodynamic instability, non-invasive blood pressure monitoring is always done by 85/105 and almost always optimized by intra-arterial measuring (85/105) and central venous pressure (70/105). If respiratory failure the use of non-invasive ventilation (NIPPV) is always (36/105) or frequently (60/105) established prior to conventional mechanical ventilation. To replace or withdraw non-invasive ventilation only 44/96 of the respondents to this question use a clinical protocol. Before the instauration of conventional mechanical ventilation the oncological prognosis is considered by 72/105. In case of acute oliguric renal failure the renal replacement techniques are widely used (74/105). The withdrawal of sustaining life support is frequently discussed (75/103) and agreed with the oncologist (91/103) and caregivers (81/103). CONCLUSIONS In our study, despite there is not a defined standard-of-care, the respondents showed similar therapeutics and monitorization choices. The use of NIPPV as first respiratory assistance is extended. Prospective, observational and multicenter studies should be developed to establish the results of this management in this population.
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Affiliation(s)
- Alberto García-Salido
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - Montserrat Nieto-Moro
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | - Marta González-Vicent
- Unidad de Trasplante de progenitores hematopoyéticos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Ana Serrano-González
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Juan Casado-Flores
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
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de Lama Caro-Patón G, García-Salido A, Iglesias-Bouzas MI, Guillén M, Cañedo-Villaroya E, Martínez-Romera I, Serrano-González A, Casado-Flores J. [Extreme reactive thrombocytosis in a healthy 6 year-old child]. An Pediatr (Barc) 2013; 81:318-21. [PMID: 24315421 PMCID: PMC7105075 DOI: 10.1016/j.anpedi.2013.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 09/26/2013] [Accepted: 10/07/2013] [Indexed: 10/31/2022] Open
Abstract
Thrombocytosis is usually a casual finding in children. Reactive or secondary thrombocytosis is the more common form, being the infections diseases the most prevalent cause of it. Regarding the number of platelets there are four degrees of thrombocytosis; in its extreme degree the number of platelets exceeds 1,000,000/mm(3). We describe a case of extreme reactive thrombocytosis in a healthy 6-year-old child. He required critical care admission for diagnosis and treatment (maximum number of platelets 7,283,000/mm(3)). We review the different causes of thrombocytosis in childhood, the differential diagnosis, and the available treatments in case of extreme thrombocytosis.
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Affiliation(s)
- G de Lama Caro-Patón
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A García-Salido
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España; Unidad de Cuidados Paliativos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - M I Iglesias-Bouzas
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - M Guillén
- Unidad de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - E Cañedo-Villaroya
- Unidad de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - I Martínez-Romera
- Unidad de Oncohematología Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - A Serrano-González
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - J Casado-Flores
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España
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García-Salido A, Iglesias-Bouzas MI, Nieto-Moro M, Lassaleta-Atienza A, Serrano-González A, Casado-Flores J. Management of unstable pediatric hemato-oncology patient: results of a Web-based survey to pediatric oncologists in Spain. Eur J Pediatr 2013; 172:51-8. [PMID: 23015044 DOI: 10.1007/s00431-012-1840-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 09/10/2012] [Indexed: 12/21/2022]
Abstract
UNLABELLED The current management and monitoring of unstable pediatric hemato-oncology patient (UPHOP) in the oncology ward is not well defined. To evaluate this concept, an anonymous Web-based survey was sent to the 150 Spanish pediatric oncologists registered in the Spanish Society of Pediatric Hemato-Oncology. The response rate was 57 %, with the following main results: Pediatric intensive consulting was available for 97 %, and it was made in case of UPHOP by 37 % of oncologists, up to 65 % if hemodynamic instability. In case of inotropic support initiation, 32 % of respondents never consulted the intensivist. Dopamine is first chosen inotropic; 28 % of surveyed considered there is no limit in its dosage or it is superior to 20 μg/kg/min before an intensivist consulting. Pediatric intensive care admission was considered necessary in case of fever with hemodynamic instability by 15 % of respondents. Respiratory monitoring was mainly done by clinical signs (67 %). In case of respiratory insufficiency, the noninvasive respiratory support by high-flow ventilation with nasal cannula was applied by 57 % in the oncology ward. In case of acute kidney injury, diuretics were generally the initial therapy. The anticonvulsive drugs most frequently applied were valproic acid (93 %), diazepam (88 %), and phenytoin (81 %). CONCLUSION A consensus should be achieved among oncologists and intensivists. The creation and training of rapid response teams could be useful to improve the UPHOP management.
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Affiliation(s)
- Alberto García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain.
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Cabeza B, García Ruíz S, González-Abad MJ, Nieto-Moro M, Martínez de Azagra A, Iglesias-Bouzas MI, Casado-Flores J. [Staphylococcus aureus infections in the intensive care unit: clinical and epidemiological characteristics]. An Pediatr (Barc) 2012; 77:403-12. [PMID: 22748965 DOI: 10.1016/j.anpedi.2012.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 05/10/2012] [Accepted: 05/13/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION There has been an increase in invasive Staphylococcus Aureus infections over the last few years, which have required admission to the pediatric intensive care unit (PICU). PATIENTS AND METHODS All patients with S. aureus infection who were admitted to PICU were enrolled in a retrospective study (January 2006-June 2010). The patients were classified into 2 groups: community-acquired infection (Group 1) and nosocomial infection (Group 2). We recorded epidemiological data, type of S. aureus (methicillin-susceptible S. aureus [MSSA], methicillin-resistant S. aureus [MRSA]), risk factors, site of infection, presence of hemodynamic instability, respiratory support, and mortality. RESULTS A total of 51 patients were enrolled, 21 belonging to Group 1 and 30 to Group 2. The median age was lower in Group 1 (1.6 years vs 3.2 years; P=.009). MSSA was isolated in 88% of cases. MRSA was detected in 6/51 (12%) of cases, which were isolated in the later study period (January 2009-June 2010). The risk factors for infection were: immunosuppression, venous catheter, institutionalization, mechanical ventilation, previous surgery, previous trauma and chronic osteomyelitis. A large majority (83%) of the patients with MRSA infection had risk factors. The type of infection was varied, with respiratory tract infection being the most common (75%). Hemodynamic instability was observed in 43% of patients. Most patients (86%) required respiratory support. One patient in Group 1 died of necrotizing pneumonia caused by MSSA. CONCLUSIONS Infections by S. aureus in children are severe and have a high morbidity. Respiratory infection was the most common in our series. Isolation of MSSA is common in these infections, although, an increase in the number of infections by MRSA was observed during the latter part of the study.
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Affiliation(s)
- B Cabeza
- Servicio de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
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