La Pediatria medica e chirurgica : Medical and surgical pediatrics
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Extracorporeal membrane oxygenation (ECMO) has become a nearly standard treatment for neonates with refractory hypoxemic respiratory failure due to various disease. Even though in the non-neonatal age the experience is less extensive, an increased widespread interest on the possible applications in children with severe life-threatening respiratory or cardiovascular insufficiency is well documented in the literature. ⋯ At present, nonetheless, more than 10.000 newborns and 1.000 children with severe respiratory insufficiency at high mortality risk have received an ECMO treatment, with a survival rate of more than 80% and 50%, respectively. The initial results of our ECMO program for both neonatal and pediatric patients with refractory respiratory failure are encouraging, both in terms of mortality and morbidity, and they will be briefly discussed.
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The epidemiology of hepatitis A, a disease endemic in various countries, is in a state of continuous change. Adults are more exposed to infection and considering the frequent absence of immunity, in contrast to children in whom the disease is almost always asymptomatic, the disease is often serious and prolonged with a mortality of up to 2.5%. The mode of transmission of HAV is predominantly the fecal-oral route; the virus is isolated during the prodromic period of the disease from the feces, blood, bile and seminal fluid. ⋯ The protection of the vaccine begins 14 days after administration and lasts from one month to one year. Numerous studies have been conducted which have shown that the vaccine is effective when given in 2 doses and confers protection against HAV for at least one year. The results have shown that the vaccination causes seroconversion in approximately 100% of subjects, and does not cause serious side effects and the acceptance of the vaccination worldwide has been good.
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Inhaled nitric oxide (NO) has been recently proposed as a new treatment in newborns and children with severe hypoxemic respiratory failure. Differently from other vasodilators, inhaled nitric oxide selectively lowers pulmonary vascular resistance and pulmonary arterial pressure, and improves the ventilation/perfusion matching by directing pulmonary blood flow toward better ventilated areas, ultimately improving systemic oxygenation. ⋯ Nonetheless, the underlying disease and the clinical conditions before NO treatment seem to maintain a crucial role in the ultimate prognosis of these patients. Further studies are needed in order to better define indications, dosages, and safety of nitric oxide treatment, and to verify its authentic prognostic value in neonates and children with acute respiratory failure.
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Pediatric intensive care units (PICUs) have been developed to provide intensive care for children between post-neonatal age and adolescence. These units have largely been developed in North America, mainly in tertiary hospitals. In Italy, critically ill children are still often nursed on adult ICU's, where medical and nursing staff often lack pediatric training. Here we report the first 5-year experience of the multidisciplinary PICU developed at the Department of Pediatrics, University of Padua, focusing on PICU and patients characteristics, as well as on the evaluation of outcome by means of the Pediatric Risk of Mortality (PRISM) score.
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Advance in the science and technology of neonatal and pediatric critical care have resulted in improved outcome for high risk newborn and children. Effective interhospital transport programmes are necessary for the appropriate use of resources and has become an integral component of regionalized perinatal care. It is now well established that use of an organized neonatal and pediatric transport team results in a fall in mortality and morbidity of infant. ⋯ Training of personnel, selection of equipment, organization and communication between hospitals are critical elements of a successful transport system. We present an overview of the role, principles and operating procedures of such neonatal-pediatric transport team and the basis of clinical stabilization before and during transfer. We also discuss data of the first 17 month experience of the Neonatal-Pediatric Transport Service of the Department of Pediatrics, University of Padua.