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Vasquez-Hoyos P, Jacome-Orozco AL, Rodriguez-Mayorga AP, Sepulveda-Forero LE, Escobar-Serna DP, Barajas JS, Obando-Belalcazar E, Salinas-Jaimes CM, Peralta-Palmezano JJ, Jimenez-Chavez A, Camacho-Jimenez RE, Dominguez-Rojas JA. Can the ROX index predict high-flow nasal cannula failure in children under 2 with lower respiratory tract infection? Pediatr Pulmonol 2024; 59:1246-1255. [PMID: 38305069 DOI: 10.1002/ppul.26895] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE This study evaluates the ROX index's accuracy in predicting the success or failure of high-flow nasal cannula (HFNC) therapy in children under 2 years with acute respiratory failure (ARF) from lower respiratory tract infections. METHODS From January 2018 to 2021 we conducted this multicenter retrospective cohort study, which included patients aged 2-24 months. We aimed to assess HFNC therapy outcomes as either success or failure. The analysis covered patient demographics, diagnoses, vital signs, and ROX index values at intervals from 0 to 48 h after initiating HFNC. We used bivariate analysis, repeated measures ANOVA, multivariate logistic regression, and the area under the receiver operating characteristic (AUC-ROC) curve for statistical analysis. RESULTS The study involved 529 patients from six centers, with 198 females (37%) and a median age of 9 months (IQR: 3-15 months). HFNC therapy failed in 38% of cases. We observed significant variability in failure rates across different centers and physicians (p < .001). The ROX index was significantly associated with HFNC outcomes at all time points, showing an increasing trend in success cases over time (p < .001), but not in HFNC failure cases. Its predictive ability is limited, with AUC-ROC values ranging from 0.56 at the start to 0.67 at 48 h. CONCLUSION While the ROX index is associated with HFNC outcomes in children under 2 years, its predictive ability is modest, impacted by significant variability among patients, physicians, and centers. These findings emphasize the need for more reliable predictive tools for HFNC therapy in this patient population.
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Affiliation(s)
- Pablo Vasquez-Hoyos
- Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia
- Sociedad de Cirugía de Bogota Hospital de San Jose, Bogota, Colombia
- Department of Pediatrics, Fundacion Universitaria de Ciencias de la Salud, Bogota, Colombia
| | | | | | | | - Diana P Escobar-Serna
- Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia
- HOMI Fundacion Hospital Pediatrico la Misericordia, Bogota, Colombia
| | | | | | | | - Juan J Peralta-Palmezano
- Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia
- HOMI Fundacion Hospital Pediatrico la Misericordia, Bogota, Colombia
| | | | | | - Jesus A Dominguez-Rojas
- Hospital Nacional Hipólito Unanue, Lima, Peru
- Instituto Nacional de Salud del Niño, Lima, Peru
- Universidad Nacional Mayor de San Marcos, Lima, Peru
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Karsies T, Shein SL, Diaz F, Vasquez-Hoyos P, Alexander R, Pon S, González-Dambrauskas S. Prevalence of Bacterial Codetection and Outcomes for Infants Intubated for Respiratory Infections. Pediatr Crit Care Med 2024:00130478-990000000-00327. [PMID: 38530103 DOI: 10.1097/pcc.0000000000003500] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To determine the prevalence of respiratory bacterial codetection in children younger than 2 years intubated for acute lower respiratory tract infection (LRTI), primarily viral bronchiolitis, and identify the association of codetection with mechanical ventilation duration. DESIGN Prospective observational study evaluating the prevalence of bacterial codetection (moderate/heavy growth of pathogenic bacterial plus moderate/many polymorphonuclear neutrophils) and the impact of codetection on invasive mechanical ventilation (IMV) duration. SETTING PICUs in 12 high and low/middle-income countries. PATIENTS Children younger than 2 years old requiring intubation and ICU admission for LRTI and who had a lower respiratory tract culture obtained at the time of intubation between December 1, 2019, and November 30, 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 472 analyzed patients (median age 4.5 mo), 55% had a positive respiratory culture and 29% (n = 138) had codetection. 90% received early antibiotics starting at a median of 0.36 hours after respiratory culture. Median (interquartile range) IMV duration was 151 hours (88, 226), and there were 28 deaths (5.3%). Codetection was more common with younger age, a positive respiratory syncytial virus test, and an admission diagnosis of bronchiolitis; it was less common with an admission diagnosis of pneumonia, with admission to a low-/middle-income site, and in those receiving vasopressors. When adjusted for confounders, codetection was not associated with longer IMV duration (adjusted relative risk 0.854 [95% CI 0.684-1.065]). We could not exclude the possibility that codetection might be associated with a 30-hour shorter IMV duration compared with no codetection, although the CI includes the null value. CONCLUSIONS Bacterial codetection was present in almost a third of children younger than 2 years requiring intubation and ICU admission for LRTI, but this was not associated with prolonged IMV. Further large studies are needed to evaluate if codetection is associated with shorter IMV duration.
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Affiliation(s)
- Todd Karsies
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Steven L Shein
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Franco Diaz
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Departamento de Pediatriá, Unidad de Paciente Critico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile
- Unidad de Investigación y Epidemiología Clínica, Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Pablo Vasquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Departamento de Pediatriá, Sociedad de Cirugía de Bogotá Hospital de San José, FUCS, Bogotá, Colombia
| | - Robin Alexander
- Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Columbus, OH
| | - Steven Pon
- Weill Cornell Medical College, New York, NY
| | - Sebastián González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Zurca AD, González-Dambrauskas S, Colleti J, Vasquez-Hoyos P, Prata-Barbosa A, Boothe D, Combs BE, Lee JH, Franklin D, Pon S, Karsies T, Shein SL. Intensivists' Reported Management of Critical Bronchiolitis: More Data and New Guidelines Needed. Hosp Pediatr 2023; 13:660-670. [PMID: 37424406 PMCID: PMC10375032 DOI: 10.1542/hpeds.2023-007120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Existing bronchiolitis guidelines do not reflect the needs of infants admitted to the PICU. This study aimed to identify PICU providers' reported practice variations and explore the need for critical bronchiolitis clinical guidelines. METHODS Cross-sectional electronic survey available in English, Spanish, and Portuguese between November 2020 and March 2021, distributed via research networks from North and Latin America, Asia, and Australia/New Zealand. RESULTS A total of 657 PICU providers responded, including 344 English, 204 Spanish, and 109 Portuguese. PICU providers indicated frequently using (≥25% of time) diagnostic modalities for nonintubated and intubated patients on PICU admission (complete blood count [75%-97%], basic metabolic panel [64%-92%], respiratory viral panel [90%-95%], chest x-ray [83%-98%]). Respondents also reported regularly (≥25% of time) prescribing β-2 agonists (43%-50%), systemic corticosteroids (23%-33%), antibiotics (24%-41%), and diuretics (13%-41%). Although work of breathing was the most common variable affecting providers' decision to initiate enteral feeds for nonintubated infants, hemodynamic status was the most common variable for intubated infants (82% of providers). Most respondents agreed it would be beneficial to have specific guidelines for infants with critical bronchiolitis who are requiring both noninvasive (91% agreement) and invasive (89% agreement) respiratory support. CONCLUSIONS PICU providers report performing diagnostic and therapeutic interventions for infants with bronchiolitis more frequently than recommended by current clinical guidelines, with interventions occurring more frequently for infants requiring invasive support. More clinical research is needed to inform the creation of evidence-based guidelines specifically for infants with critical bronchiolitis.
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Affiliation(s)
| | - Sebastián González-Dambrauskas
- Departamento de Pediatría y Unidad de Cuidados Intensivos de Niñosdel Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Jose Colleti
- Department of Pediatrics, Hospital Israelita Albert Einstein and Hospital Assunção Rede D’Or, São Paulo, Brazil
| | - Pablo Vasquez-Hoyos
- Universidad Nacional de Colombia and Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Arnaldo Prata-Barbosa
- Department of Pediatrics, Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | - David Boothe
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Bryan E. Combs
- Division of Pediatric Critical Care, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | - Jan Hau Lee
- Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital and Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Donna Franklin
- Children’s Critical Care Research Group, Gold Coast University Hospital and Menzies Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - Steven Pon
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Todd Karsies
- Division of Pediatric Critical Care, Nationwide Children’s Hospital, Columbus, Ohio
| | - Steven L. Shein
- Division of Pediatric Critical Care, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
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Domínguez-Rojas J, Coronado Munoz Á, Luna-Delgado Y, Alvarado-Gamarra G, Quispe Flores G, Caqui-Vilca P, Atamari-Anahui N, Muñoz Ramírez CM, Tello-Pezo M, Cruces P, Vasquez-Hoyos P, Díaz F. Lung mechanics in pediatric acute respiratory distress syndrome associated to acute COVID-19 and MIS-C: implications for therapies and outcomes. Andes Pediatr 2023; 94:350-360. [PMID: 37909938 DOI: 10.32641/andespediatr.v94i3.4616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To describe lung mechanics in Pediatric Acute Respiratory Distress Syndrome (PARDS) associated with acute COVID-19 and MIS-C with respiratory failure. METHODS A concurrent multicenter observational study was performed, analyzing clinical variables and pulmonary mechanics of PARDS associated with COVID-19 in 4 Pediatric intensive care units (PICU) in Peru. The subgroup analysis included PARDS associated with multisystem inflammatory syndrome in children (MIS-C), MIS-PARDS, and PARDS with COVID-19 primary respiratory infection, C-PARDS. In addition, receiver operating characteristic (ROC) curve analysis for mortality and lung mechanics was performed. RESULTS 30 patients were included. The age was 7.5 (4-11) years, 60% were male, and mortality was 23%. 47% corresponded to MIS-PARDS and 53% to C-PARDS groups. C-PARDS had positive RT-PCR in 67% and MIS-PARDS none (p < 0.001). C-PARDS group had more profound hypoxemia (P/F ratio < 100, 86% vs. 38%, p < 0.01) and higher driving-pressure [14(10-22) vs 10(10-12) cmH2O], and lower compliance of the respiratory system (CRS) [0.5 (0.3-0.6) vs 0.7(0.6-0.8) ml/ kg/cmH2O] compared with MIS-PARDS (all p < 0.05). The ROC analysis for mortality showed that driving pressure had the best performance [AUC 0.91(95%CI0.81-1.00), with the best cut-off point of 15 cmH2O (100% sensitivity and 87% specificity). Mortality in C-PARDS was 38% and 7% in MIS-PARDS (p = 0.09). MV-free days were 12(0-23) in C-PARDS and 23(21-25) in MIS-PARDS (p = 0.02). CONCLUSION Patients with C-PARDS have lung mechanics characteristics similar to classic moderate to severe PARDS. This was not observed in patients with MIS-C. As seen in other studies, a driving pressure ≥ 15 cmH2O was the best discriminator for mortality. These findings may help guide ventilatory management strategies for these two different presentations.
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Affiliation(s)
- Jesús Domínguez-Rojas
- Departamento de Emergencias y Áreas Críticas, Instituto Nacional de Salud del Niño, Lima, Perú
| | - Álvaro Coronado Munoz
- Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston, Texas, USA
| | | | | | | | - Patrick Caqui-Vilca
- Departamento de Pediatría, Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | | | | | - Mariela Tello-Pezo
- Departamento de Pediatría, Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | | | | | - Franco Díaz
- Red Colaborativa Pediátrica de Latinoamérica
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Caporal P, Vasquez-Hoyos P, Díaz F, Monteverde-Fernández N, Pedrozo L, Carvajal C, Tellechea Rotta A, González-Dambrauskas S. [New morbidity following critical illness in Latin American children under 18 years old with lower respiratory tract infection]. Andes Pediatr 2023; 94:86-93. [PMID: 37906875 DOI: 10.32641/andespediatr.v94i1.4273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/03/2022] [Indexed: 11/02/2023]
Abstract
Acquisition of new morbidity (NM) has become a key clinical outcome measure after pediatric critical illness. Data on Latin American children are still scarce. OBJECTIVE to analyze the development of new morbidities acquired after hospitalization due to lower respiratory tract infection (LRTI) in pediatric intensive care units (PICU). PATIENTS AND METHOD we included patients from 35 PICUs from 8 countries, aged 0 to 18 years with a diagnosis of LRTI, discharged alive, registered between April 2018 and September 2019, and who required some type of ventilatory support (high-flow system, noninvasive ventilation or invasive ventilation), included in the LARed Network registry, which includes the Functional Status Scale (FSS) validated in the pediatric population, which assesses functional status in six domains: mental status, sensory, communication, motor skills, feeding, and respiratory status. NM considered LRTI after hospitalization and was defined as an increase of ≥ 3 points in the FSS. RESULTS Of 3280 children with LRTI, 85 (2.6%) developed NM, associated with diagnoses of sepsis and acute respiratory distress syndrome (ARDS), pneumococcal or adenovirus infection, healthcare-associated infections (HAIs), and invasive mechanical ventilation. Adenovirus infection, ARDS, and HAIs were independently associated with NM. CONCLUSIONS We observed that the development of NM at PICU discharge is infrequent but is associated with modifiable risk factors. These data define certain risk groups for future interventions and initiatives to improve the quality of care.
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Affiliation(s)
- Paula Caporal
- Hospital Interzonal Especializado en Pediatría "Sor María Ludovica", Buenos Aires, Argentina
| | | | - Franco Díaz
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
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Gonzalez-Dambrauskas S, Vasquez-Hoyos P, Camporesi A, Cantillano EM, Dallefeld S, Dominguez-Rojas J, Francoeur C, Gurbanov A, Mazzillo-Vega L, Shein SL, Yock-Corrales A, Karsies T. Paediatric critical COVID-19 and mortality in a multinational prospective cohort. Lancet Reg Health Am 2022; 12:100272. [PMID: 35599855 PMCID: PMC9111167 DOI: 10.1016/j.lana.2022.100272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries. METHODS Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression. FINDINGS 557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old. INTERPRETATION We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19. FUNDING None.
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Affiliation(s)
- Sebastian Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network) and Cuidados Intensivos Pediátricos Especializados (CIPe) Casa de Galicia, Montevideo, Uruguay
| | - Pablo Vasquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Universidad Nacional de Colombia and Sociedad de Cirugía Hospital de San José, FUCS, Bogota, Colombia
| | - Anna Camporesi
- Division of Pediatric Anesthesia and ICU, Department of Pediatrics. Children's Hospital Vittore Buzzi, Milan, Italy
| | - Edwin Mauricio Cantillano
- UCIP. Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras
| | - Samantha Dallefeld
- Pediatric Critical Care Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Jesus Dominguez-Rojas
- Departamento Pediatría Universidad Nacional Federico Villarreal. UCIP Hospital de Emergencia Villa El Salvador, Lima, Perú
| | - Conall Francoeur
- Department of Pediatrics, Division of Pediatric Critical Care, CHU de Québec – Université Laval Research Center, Québec, Québec, Canada
| | - Anar Gurbanov
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Steven L. Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adriana Yock-Corrales
- Emergency Department. Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS. San José, Costa Rica
| | - Todd Karsies
- Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, Ohio, USA
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Hoyos AB, Vasquez-Hoyos P. Transfusion prevention using erythropoietin, parenteral sucrose iron, and fewer phlebotomies in infants born at ≤30 weeks gestation at a high altitude center: a 10-year experience. J Perinatol 2021; 41:1403-1411. [PMID: 33568772 DOI: 10.1038/s41372-021-00945-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/11/2020] [Accepted: 01/19/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Red blood cell transfusions in infants born at ≤30 weeks gestation are frequent. Erythropoietin therapy reduces transfusions. An increase in hematocrit is an adaptive response at high altitudes but a guaranteed source of iron is necessary for adequate erythropoiesis. METHODS A retrospective cohort study was done to compare red blood cell transfusion practices of the 2019 EpicLatino (EPIC) Latin America network database with a single unit at 2650 m above sea level (LOCAL). The data from LOCAL for three time periods were compared over 10 years based on changes in erythropoietin dose and fewer phlebotomies. The number of cases that received transfusions and the total number of transfusions required were compared. Adjustments were made for known risk factors using a multivariate regression analysis. RESULTS Two hundred and twenty-one cases in LOCAL and 382 cases from EPIC were included. Overall basic demographic characteristics were similar. In EPIC a significantly higher rate of infection (28% vs. 15%) and outborn (10% vs. 1%) was found, but less necrotizing enterocolitis (9% vs. 15%) and use of prenatal steroids (62% vs. 93%) than LOCAL (p < 0.05). EPIC patients received more transfusions (2.6 ± 3 vs. 0.6 ± 1 times) than LOCAL (p < 0.001) and received them significantly more frequently (61% vs. 25%). Within the LOCAL time periods, no statistically significant differences were found other than the need for transfusions (1st 32%, 2nd 28%, 3rd 9%, p = 0.005) and the average number of transfusions (1st 0.8 ± 1.6, 2nd 0.7 ± 1.3, 3rd 0.1 ± 0.3, p = 0.004). These differences remained significant after multivariate regression analysis and adjusting for risk variables. CONCLUSION The combination of erythropoietin, parenteral sucrose iron, fewer phlebotomies during the first 72 h, and delayed umbilical cord clamping seem to reduce red blood cell transfusion needs. This can be extremely important in high altitude units where higher hematocrit is desirable but may also be valuable at sea level.
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Affiliation(s)
- Angela B Hoyos
- Division of Neonatology, Clínica del Country, Bogota, DC, Colombia. .,Universidad El Bosque, Bogota, Colombia.
| | - Pablo Vasquez-Hoyos
- Sociedad de Cirugía Hospital de San José, Bogota, Colombia.,Department of Pediatrics, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatrics, Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
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Camacho-Cruz J, Briñez S, Alvarez J, Leal V, Villamizar Gómez L, Vasquez-Hoyos P. Use of the ReSVinet Scale for parents and healthcare workers in a paediatric emergency service: a prospective study. BMJ Paediatr Open 2021; 5:e000966. [PMID: 34131594 PMCID: PMC8166609 DOI: 10.1136/bmjpo-2020-000966] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/08/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Most scales for acute respiratory infection (ARI) are limited to healthcare worker (HCW) use for clinical decision-making. The Respiratory Syncytial Virus network (ReSVinet) Scale offers a version for parents that could potentially help as an early warning system. OBJECTIVE To determine whether or not the ReSVinet Scale for ARI in infants can be reliably used by HCWs and parents in an emergency service. METHODS A prospective study was done of infants with ARI who were admitted to a paediatric emergency room to assess the ReSVinet Scale when used by faculty (paediatric doctor-professors), residents (doctors doing their first specialty in paediatrics) and parents. Spearman's correlation and a weighted kappa coefficient were used to measure interobserver agreement. Internal consistency was also tested by Cronbach's alpha test. RESULTS Overall, 188 patients, 58% male, were enrolled. A Spearman's correlation of 0.92 for faculty and resident scoring and 0.64 for faculty or resident and parent scoring was found. The weighted kappa coefficients were 0.78 for faculty versus residents, 0.41 for faculty versus parents, and 0.41 for residents versus parents. Cronbach's alpha test was 0.67 for faculty, 0.62 for residents and 0.69 for parents. CONCLUSION There was good correlation in the ReSVinet scores between health professionals when used in the paediatric emergency area. Agreement between parents and health professionals was found to be more variable. Future studies should focus on finding ways to improve its reliability when used by parents before the scale is used in the emergency room.
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Affiliation(s)
- Jhon Camacho-Cruz
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Shirley Briñez
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Jorge Alvarez
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Victoria Leal
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Licet Villamizar Gómez
- Research Division, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
| | - Pablo Vasquez-Hoyos
- Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogota, Colombia
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Bustos B R, Jaramillo-Bustamante JC, Vasquez-Hoyos P, Cruces P, Díaz F. Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2: A Case Series Quantitative Systematic Review. Pediatr Emerg Care 2021; 37:44-47. [PMID: 33181794 PMCID: PMC7780931 DOI: 10.1097/pec.0000000000002306] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ABSTRACT Pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS) is infrequent, but children might present as a life-threatening disease. In a systematic quantitative review, we analyzed 11 studies of PIMS-TS, including 468 children reported before July 1, 2020. We found a myriad of clinical features, but we were able to describe common characteristics: previously healthy school-aged children, persistent fever and gastrointestinal symptoms, lymphopenia, and high inflammatory markers. Clinical syndromes such as myocarditis and Kawasaki disease were present in only one third of cases each one. Pediatric intensive care unit admission was frequent, although length of stay was less than 1 week, and mortality was low. Most patients received immunoglobulin or steroids, although the level of evidence for that treatment is low. The PIMS-ST was recently described, and the detailed quantitative pooled data will increase clinicians' awareness, improve diagnosis, and promptly start treatment. This analysis also highlights the necessity of future collaborative studies, given the heterogeneous nature of the PIMS-TS.
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Affiliation(s)
- Raúl Bustos B
- From the Unidad de Cuidados Intensivos Pediátricos, Clínica Sanatorio Alemán y Hospital Guillermo Grant Benavente, Concepción, Chile
| | - Juan Camilo Jaramillo-Bustamante
- Unidad de Cuidados Intensivos Pediátricos, Hospital General de Medellín
- Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín
| | - Pablo Vasquez-Hoyos
- Departamento de Pediatría, Universidad Nacional de Colombia
- Departamento de Pediatría, Fundacion Universitaria de Ciencias de la Salud
| | - Pablo Cruces
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú
| | - Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú
- Unidad de Paciente Crítico Pediátrico, Hospital Clínico La Florida Dra. Eloísa Díaz Insunza
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú
- Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
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