European journal of pediatrics
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The Hartwig score was designed to assess pain in ventilated newborns and infants. It comprises the acceptance of mechanical ventilation and the reaction to endotracheal suctioning (grimacing, gross motor movements, eye-opening). The aim of this study was to validate the Hartwig score in terms of concurrent validity, internal consistency, inter-rater correlation and to define a cut-off value with respect to the need for analgesic therapy. ⋯ Conclusion The Hartwig score showed satisfactory agreement with the VAS and good agreement with the Comfort scale. It is a reliable tool for assessing pain in ventilated newborns and infants. The cut-off value was found to be at 13 points.
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Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections and hospitalizations in children aged < 2 years. The aim of this retrospective, single-centre study was to examine the characteristics of patients admitted to a paediatric intensive care unit (PICU) with RSV infection following the implementation of a RSV prophylaxis programme. Electronic hospital medical records of all PICU admissions for RSV infection were searched from 2003 to 2009. ⋯ RSV infection occurred in 3.3% (n = 6) children who had received palivizumab prophylaxis, and there were two deaths. The results indicate that > 88% of all PICU admissions would not qualify for RSV prophylaxis under our established guidelines and 66% of the children aged ≤ 2 years were > 36 weeks gestation and are not currently targeted for prophylaxis. The number of high-risk infants admitted to PICU with RSV infection has likely plateaued, and further reductions in admission rates may only be realised with the use of universal, vaccine immunization programmes.
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Spinal epidural abscess (SEA) is a rare infection associated with well-established risk factors mainly in adults. We describe an 11-year-old girl without any known risk factors who presented with fever and localized spinal tenderness in the lumbar area and was diagnosed with spinal MRI as suffering from a posterior SEA extending between T11 and L4. ⋯ Methicillin-sensitive Staphylococcus aureus was the responsible pathogen isolated at surgery. Immediate institution of antibiotics, spinal MRI, and well-timed neurosurgical consultation are mandatory for a favorable outcome in cases of SEA in children.