Acta paediatrica
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The aim of this study was to examine the influence of a continuous infusion of epinephrine (adrenaline) on mean arterial blood pressure (MABP), heart rate, urine output and base deficit in very low birthweight infants (VLBWI) with systemic hypotension. In VLBWI who received an infusion of epinephrine for at least 12 h the mean urine output, administered fluid volume, base deficit and administered buffer 12 h before and 12 h during the infusion were recorded. If the infusion was shorter, but given for at least 2 h, the mean heart rate and MABP 2 h before and 2 h during the infusion were recorded. Thirty-one infants with a gestational age of 26 (23-30) wk [median (minimum-maximum)] and birthweight 690 (390-1310) g were included in this retrospective chart review. The patients received an infusion of epinephrine at a postnatal age of 3 (1-21) d. The doses ranged between 0.05 and 2.6 microg kg(-1) per minute within the first 24 h of administration. Three of 31 infants received epinephrine on 2 different occasions. The MABP [+7 (-1 to 13) mmHg, p=0.000001] and the heart rate [+10 (-10 to 42) bpm, p=0.000036] increased significantly (n = 34), whereas total volume administration and urine output remained the same between the 2 periods (Wilcoxon matched pairs test). The base deficit increased significantly [-3 (-10.2 to 2.6), p = 0.0014, n = 19] without a change in the administration of buffer. ⋯ The infusion of epinephrine increased the MABP and the heart rate without decreasing urine output in VLBWI with hypotension not responding to a dopamine infusion up to 15 microg kg(-1) per minute. A potential adverse effect was an increase in metabolic acidosis.
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High levels of serum leptin (LPT) were reported in adult patients with sepsis and a protective role was suggested. LPT was determined in sera from 55 children with severe sepsis at admission (0 h), 6, 24 and 48 h. LPT levels were higher at 0 h than at 24 h (2.80 vs 1.61 ng/ml; p = 0.009) and a negative correlation was found with IL-13 (p = 0.009), and granulocyte counts (p = 0.035), but not with other factors. Infants younger than 12 mo of age had higher LPT levels than older infants (5.88 vs 2.38 ng/ml; p = 0.0005). The increase in LPT levels was higher in non-survivor patients than in survivors, with a maximum difference at 24 h (5.30 vs 1.45 ng/ml; p = 0.0042). However, LPT levels were not associated with shock, multiorgan failure or the severity score. Children who died showed higher percentiles of weight than survivors (p = 0.025). A subgroup with higher LPT (> Pc75) included mainly patients with weight > Pc50 (p = 0.0065), low IL-13 levels (p = 0.007) and low granulocyte counts (p = 0.013), Neisseria meningitidis B being the most frequently isolated germ (p = 0.022). ⋯ Using a model of severe infection, mainly meningococcal, in young children (median 3 y 6 mo old), it was not possible to confirm previous results in adults. A general protective role for LPT in sepsis seems unlikely.
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This study describes the first reported case in a preterm infant of an orbital lymphangioma with non-contiguous cerebral arteriovenous malformation, manifesting with thrombocytopenia (Kasabach-Merritt syndrome) and intracerebral hemorrhage. ⋯ Neonates presenting with orbital lymphangiomas should undergo radiological investigations of the lesion and a detailed cerebral evaluation for associated arteriovenous developmental anomalies.
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The aim of this investigation was to verify whether plasma S100B could be a useful tool in identifying which infants subjected to extracorporeal membrane oxygenation (ECMO) might develop intracranial haemorrhage (ICH). A case-control study of eight infants who developed ICH during ECMO was conducted. Plasma samples collected daily after ECMO insertion were assessed for S100B and compared with those obtained from eight infants supported by ECMO who did not develop ICH. Cerebral ultrasound and Doppler velocimetry waveform patterns in the middle cerebral artery (MCA PI) were also recorded at the same time as blood sampling. S100B blood concentrations were significantly higher in the group of infants with ICH 72 h before any signs of haemorrhage could be detected by ultrasound (ICH: 2.91 +/- 0.91 microg/L vs. control: 0.53 +/- 0.15 microg/L), reaching their peak at day 6, when cerebral ultrasound scan patterns were suggestive of intracranial haemorrhage (ICH: 3.50 +/- 1.03 microg/L vs. control: 0.66 +/- 0.27 microg/L) (p < 0.05, for both). The highest S100B levels were observed in the three ICH infants who expired during the ECMO procedure (3.43 microg/L, 4.0 microg/L, 4.12 microg/L, respectively). MCA PI values in the ICH group were also significantly higher, but only 24 h before any ultrasound pattern of bleeding was detected (ICH: 2.31 +/- 0.22 vs control: 1.81 +/- 0.24) (p < 0.05). ⋯ This study suggests that blood S100B measurement could be a promising tool for the identification of infants at risk of ICH when imaging assessment and clinical symptoms of haemorrhage might still be silent.
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Comparative Study
Acute and postoperative pain in children: a Swedish nationwide survey.
Many studies demonstrate inadequate pain treatment in children. The aim of this nationwide survey was to evaluate the prevalence of acute and postoperative pain in children; extent of, and reasons for, inadequate pain therapy; therapy methods; pain-management structure; and the need for education of healthcare professionals. Questionnaires concerning these points were sent to all departments in Sweden involved in the treatment of children. The response rate was 75% (299/ 395). Answers from physicians and nurses showed that, despite treatment, moderate to severe pain occurred in 23% of patients with postoperative pain and 31% of patients with pain of other origin. Postoperative pain seemed to be a greater problem in units where children were treated along with adults and in departments where fewer children were treated. According to 45% of physicians and nurses, treatment of pain could often or always be managed more efficiently. Pain assessments were performed regularly in 43% of all departments, but pain measurement was less frequent; 3% of the departments had no formal organization for pain management; and 15% never or infrequently used potent opioids. Educational needs were high. Insufficient pain treatment seemed to be mostly related to organizational aspects, such as inadequate prescriptions. Anxiety in children or parents also contributed to ineffective pain treatment. Swedish treatment practices for the management of pain in children roughly follow the published guidelines, but many improvements are still necessary. ⋯ Acute pain in children is still undertreated in Swedish hospitals. This seems to be related mainly to organizational aspects.