Touran Chegeni, M. Olfat, B. Yaghmaie, Seyed Abbas Hassani, Meisam Sharifzadeh, Z. Najafi, M. Mohammadpour
Background: Mechanical ventilation (MV) is among the most common therapeutic modalities in pediatric intensive care units (PICU), which works based on a defined ventilation mode. Nowadays, conventional and alternative modes including adaptive pressure control (APC) and non-APC modes are frequently employed. Although MV can be helpful in many cases, it may cause some complications resulting in significant morbidity and mortality. Objectives: This study aimed to investigate the demographic features and complications of mechanically ventilated children in a PICU in Iran, as well as to compare different ventilation modes. Methods: A retrospective case-control study was conducted in PICUs of children’s medical center hospital - a tertiary referral pediatric hospital. Results: Of 66 patients included in this study, 33 patients were treated with APC modes, whereas 33 patients were treated with non-APC modes. The most common indications for intubation were respiratory failure (53%) and loss of consciousness (13.6%). The mean duration for intubation in patients with and without underlying disorder were 11.7 and 5.2 days, respectively (P-value < 0.01). The means of time for intubation in the APC and non-APC groups were 10 and 11.9 days, respectively (P-value 0.145). A total of 23 (34.8%) patients had complications, including death, misplacement of the endotracheal tube, atelectasis, unplanned extubation, etc. There was no significant difference between groups regarding the rates of complications, except for atelectasis. Thirteen (19.7%) patients had atelectasis (2 patients in APC group (6%) and 11 patients in non-APC group (33.3%)) (P-value = 0.022). The mortality rate was the same for the both groups (P-value = 1). Conclusions: In sum, the most common indication for intubation was respiratory failure. No significant difference was observed among patients treated with the APC, and non-APC modes in terms of the complications occurred, except for atelectasis which occurred more frequently in the non-APC group. Therefore, it was concluded that there was no difference between conventional and alternative modes of mechanical ventilation in terms of morbidity and mortality.
背景:机械通气(MV)是儿科重症监护病房(PICU)最常见的治疗方式之一，其工作基于确定的通气模式。目前，常规和替代模式包括自适应压力控制(APC)和非APC模式经常被采用。虽然MV在许多情况下是有帮助的，但它可能引起一些并发症，导致显著的发病率和死亡率。目的:本研究旨在调查伊朗PICU中机械通气儿童的人口学特征和并发症，并比较不同的通气模式。方法:对某三级转诊儿科医院儿童医学中心医院picu进行回顾性病例对照研究。结果:本研究纳入的66例患者中，33例采用APC模式，33例采用非APC模式。最常见的插管指征是呼吸衰竭(53%)和意识丧失(13.6%)。有基础疾病和无基础疾病患者的平均插管时间分别为11.7天和5.2天(p值< 0.01)。APC组和非APC组插管时间平均分别为10和11.9 d (p值0.145)。共有23例(34.8%)患者出现并发症，包括死亡、气管插管错位、肺不张、意外拔管等。除肺不张外，两组间并发症发生率无显著差异。发生肺不张13例(19.7%)，其中APC组2例(6%)，非APC组11例(33.3%)，p值= 0.022。两组患者的死亡率相同(p值= 1)。结论:综上所述，最常见的插管指征是呼吸衰竭。除非APC组肺不张发生率较高外，APC组与非APC组在并发症发生方面无显著差异。因此，我们得出结论，在发病率和死亡率方面，常规和替代机械通气模式没有差异。
{"title":"Clinical Characteristics and Complications of Mechanically Ventilated Children in a Pediatric Intensive Care Unit in Iran: Comparing Different Modes","authors":"Touran Chegeni, M. Olfat, B. Yaghmaie, Seyed Abbas Hassani, Meisam Sharifzadeh, Z. Najafi, M. Mohammadpour","doi":"10.5812/ijp-119875","DOIUrl":"https://doi.org/10.5812/ijp-119875","url":null,"abstract":"Background: Mechanical ventilation (MV) is among the most common therapeutic modalities in pediatric intensive care units (PICU), which works based on a defined ventilation mode. Nowadays, conventional and alternative modes including adaptive pressure control (APC) and non-APC modes are frequently employed. Although MV can be helpful in many cases, it may cause some complications resulting in significant morbidity and mortality. Objectives: This study aimed to investigate the demographic features and complications of mechanically ventilated children in a PICU in Iran, as well as to compare different ventilation modes. Methods: A retrospective case-control study was conducted in PICUs of children’s medical center hospital - a tertiary referral pediatric hospital. Results: Of 66 patients included in this study, 33 patients were treated with APC modes, whereas 33 patients were treated with non-APC modes. The most common indications for intubation were respiratory failure (53%) and loss of consciousness (13.6%). The mean duration for intubation in patients with and without underlying disorder were 11.7 and 5.2 days, respectively (P-value < 0.01). The means of time for intubation in the APC and non-APC groups were 10 and 11.9 days, respectively (P-value 0.145). A total of 23 (34.8%) patients had complications, including death, misplacement of the endotracheal tube, atelectasis, unplanned extubation, etc. There was no significant difference between groups regarding the rates of complications, except for atelectasis. Thirteen (19.7%) patients had atelectasis (2 patients in APC group (6%) and 11 patients in non-APC group (33.3%)) (P-value = 0.022). The mortality rate was the same for the both groups (P-value = 1). Conclusions: In sum, the most common indication for intubation was respiratory failure. No significant difference was observed among patients treated with the APC, and non-APC modes in terms of the complications occurred, except for atelectasis which occurred more frequently in the non-APC group. Therefore, it was concluded that there was no difference between conventional and alternative modes of mechanical ventilation in terms of morbidity and mortality.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"2 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90951587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Narges Lashkarbolouk, Ali Ahani Azar, Mahdi Mazandarani, Lobat Shahkar
Introduction: A double aortic arch (DAA) is a congenital anomaly of the aortic arch, which is also the most common type of complete vascular ring. This vascular ring can compress the trachea and esophagus, as well as cause respiratory, gastrointestinal, and cardiac symptoms. Case Presentation: In the present case report, a 10-year-old boy with recurrent cough, fever, shortness of breath, chest pain, and a history of recurrent respiratory infections was examined. According to the results of bronchoscopic evaluation, he was found to have a localized tracheomalacia. DAA and dextrocardia condition were also confirmed for this patient by performing a computed tomography angiography of the thorax and the three-dimensional reconstruction of CT angiography. Conclusions: The diagnosis of double aortic arch may be confused with upper respiratory tract infections or foreign body aspiration. Therefore, it was recommended that a particular attention should be paid to the double aortic arch when evaluating cases of stridor in children with unknown causes or recurrent respiratory infections. CT angiography and cardiac MRI were the diagnostic methods of choice for examining vascular rings.
{"title":"Double Aortic Arch as a Rare Condition in a 10-year-old Boy with Recurrent Pneumonia: A Case Report Study","authors":"Narges Lashkarbolouk, Ali Ahani Azar, Mahdi Mazandarani, Lobat Shahkar","doi":"10.5812/ijp-128473","DOIUrl":"https://doi.org/10.5812/ijp-128473","url":null,"abstract":"Introduction: A double aortic arch (DAA) is a congenital anomaly of the aortic arch, which is also the most common type of complete vascular ring. This vascular ring can compress the trachea and esophagus, as well as cause respiratory, gastrointestinal, and cardiac symptoms. Case Presentation: In the present case report, a 10-year-old boy with recurrent cough, fever, shortness of breath, chest pain, and a history of recurrent respiratory infections was examined. According to the results of bronchoscopic evaluation, he was found to have a localized tracheomalacia. DAA and dextrocardia condition were also confirmed for this patient by performing a computed tomography angiography of the thorax and the three-dimensional reconstruction of CT angiography. Conclusions: The diagnosis of double aortic arch may be confused with upper respiratory tract infections or foreign body aspiration. Therefore, it was recommended that a particular attention should be paid to the double aortic arch when evaluating cases of stridor in children with unknown causes or recurrent respiratory infections. CT angiography and cardiac MRI were the diagnostic methods of choice for examining vascular rings.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"11 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82527218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Mani, M. Nasiri, H. Amoozgar, A. Amirghofran, V. Nejati
Background: Improving surgical and interventional modalities for treating congenital heart disease has increased these children’s life expectancy, leading to increased cognitive and behavioral problems. Objectives: This study compared executive function between surgically and interventionally treated congenital heart disease children and their age-matched controls. Methods: In this retrospective cross-sectional study, we enrolled 30 children treated with surgery, 30 interventionally treated patients, and 30 healthy controls. These participants were compared in the executive function domains by the Stroop test, trail making test, cancellation test, visual and auditory memory span test, and behavioral problems using the parental form of strengths and difficulties questionnaire. Results: Executive function in memory span and sustained attention was lower in the surgical group than in the intervention group (P < 0.05). Both groups had lower flexibility, memory recall, simple and complex working memory, visual attention, and simple and complex selective attention performance (P < 0.05). The effect of behavioral problems on daily life was higher in surgical patients than in the intervention group (P < 0.0001). Both groups of patients had higher emotional, conduct, and communication problems than the control group (P < 0.0001). Conclusions: Interventionally treated patients had better performance than surgically treated patients. Regardless of disease severity or treatment, patients with congenital heart disease had poor performance than normal subjects and suffered from behavioral disorders affecting their daily lives. Therefore, it is essential to include diagnostic and therapeutic interventions for treating these patients’ executive function and behavioral problems.
{"title":"Comparing Executive Function Between Surgically and Interventionally Treated Children with Congenital Heart Disease","authors":"A. Mani, M. Nasiri, H. Amoozgar, A. Amirghofran, V. Nejati","doi":"10.5812/ijp-128179","DOIUrl":"https://doi.org/10.5812/ijp-128179","url":null,"abstract":"Background: Improving surgical and interventional modalities for treating congenital heart disease has increased these children’s life expectancy, leading to increased cognitive and behavioral problems. Objectives: This study compared executive function between surgically and interventionally treated congenital heart disease children and their age-matched controls. Methods: In this retrospective cross-sectional study, we enrolled 30 children treated with surgery, 30 interventionally treated patients, and 30 healthy controls. These participants were compared in the executive function domains by the Stroop test, trail making test, cancellation test, visual and auditory memory span test, and behavioral problems using the parental form of strengths and difficulties questionnaire. Results: Executive function in memory span and sustained attention was lower in the surgical group than in the intervention group (P < 0.05). Both groups had lower flexibility, memory recall, simple and complex working memory, visual attention, and simple and complex selective attention performance (P < 0.05). The effect of behavioral problems on daily life was higher in surgical patients than in the intervention group (P < 0.0001). Both groups of patients had higher emotional, conduct, and communication problems than the control group (P < 0.0001). Conclusions: Interventionally treated patients had better performance than surgically treated patients. Regardless of disease severity or treatment, patients with congenital heart disease had poor performance than normal subjects and suffered from behavioral disorders affecting their daily lives. Therefore, it is essential to include diagnostic and therapeutic interventions for treating these patients’ executive function and behavioral problems.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"2 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90842529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Mucormycosis is rare in urinary tract infections. Renal mucormycosis is considered in immunocompromised patients and is associated with a high mortality rate. Herein, we presented the first case of a non-invasive fungus ball caused by a Rhizopus species confined to the unilateral kidney in a healthy boy for approximately ten years. The etiology was identified using next-generation deoxyribonucleic acid (DNA) sequencing. The patient recovered completely after nephrectomy without bladder irrigation. Therefore, clinicians must have a high index of suspicion for fungal infections in refractory urinary tract infections. Next-generation DNA sequencing technology can be used for an accurate diagnosis.
{"title":"Renal Mucormycosis in a Healthy Boy for Ten Years: A Novel Case Report","authors":"Yufeng Li, Yaju Zhu, Ping Li, Xiaoliang Fang, Lisu Huang, Feng-Yang Chen","doi":"10.5812/ijp-120856","DOIUrl":"https://doi.org/10.5812/ijp-120856","url":null,"abstract":": Mucormycosis is rare in urinary tract infections. Renal mucormycosis is considered in immunocompromised patients and is associated with a high mortality rate. Herein, we presented the first case of a non-invasive fungus ball caused by a Rhizopus species confined to the unilateral kidney in a healthy boy for approximately ten years. The etiology was identified using next-generation deoxyribonucleic acid (DNA) sequencing. The patient recovered completely after nephrectomy without bladder irrigation. Therefore, clinicians must have a high index of suspicion for fungal infections in refractory urinary tract infections. Next-generation DNA sequencing technology can be used for an accurate diagnosis.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"11 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87694752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: This study was carried out to systematically evaluate the efficacy and safety of pre-exchange transfusion (pre-ET) albumin infusion on neonatal hyperbilirubinemia. Methods: A comprehensive search of relevant studies from EMBASE, Medline, Cochrane Register of Controlled Trials, ClinicalTrials.gov, China National Knowledge Infrastructure, Wei Pu Information, Wan Fang Data, and Chinese Biomedical Literature Database was conducted from inception to December 2021. Two different authors screened the titles, abstracts, and full texts of the articles. The quality of the included trials was assessed independently by two different authors according to the Cochrane Collaboration’s Risk of Bias. The data were analyzed and compiled using Review Manager software (RevMan version 5.3). Results: In total, four studies enrolling 195 neonates were included in this review. The quality of the included studies was deemed fair to good. The meta-analysis showed that pre-ET albumin infusion was superior to exchange transfusion (ET) alone for reducing the need for repeating ET (risk ratio (RR) = 0.25, 95% confidence interval (CI): 0.09 - 0.72, I-squared (I2) = 8%; fixed effects model) and shortening the duration of phototherapy (PT) (mean difference (MD) = -11.46 hours, 95% CI: -16.56 to -6.36, I2 = 93%; random effects model (REM)). No significant differences were detected between the two groups for post-ET total serum bilirubin (TSB) at 6 hours (MD = -3.51 mg/dL, 95% CI: -7.93 - 0.93, I2 = 97%; REM) and 12 hours (MD = -4.21 mg/dL, 95% CI: -9.08 - 0.65, I2 = 99%; REM). None of the patients developed acute bilirubin encephalopathy in any of the trials. No death prior to hospital discharge was reported in any trials, and no adverse effects were observed in intervention groups. Conclusions: Based on four studied trials, pre-ET albumin infusion appears to be safe and effective in reducing the need for repeating ET and shortening PT duration. These potential benefits, including the reduction of post-ET TSB, need to be revalidated in future trials using rigorous methodology.
{"title":"Effect of Pre-exchange Transfusion Albumin Infusion on Neonatal Hyperbilirubinemia: A Meta-Analysis of Randomized Clinical Trials","authors":"Fang Pan, Y. Wang, Juan Xie, Yan Liu, Xin He","doi":"10.5812/ijp-129271","DOIUrl":"https://doi.org/10.5812/ijp-129271","url":null,"abstract":"Objectives: This study was carried out to systematically evaluate the efficacy and safety of pre-exchange transfusion (pre-ET) albumin infusion on neonatal hyperbilirubinemia. Methods: A comprehensive search of relevant studies from EMBASE, Medline, Cochrane Register of Controlled Trials, ClinicalTrials.gov, China National Knowledge Infrastructure, Wei Pu Information, Wan Fang Data, and Chinese Biomedical Literature Database was conducted from inception to December 2021. Two different authors screened the titles, abstracts, and full texts of the articles. The quality of the included trials was assessed independently by two different authors according to the Cochrane Collaboration’s Risk of Bias. The data were analyzed and compiled using Review Manager software (RevMan version 5.3). Results: In total, four studies enrolling 195 neonates were included in this review. The quality of the included studies was deemed fair to good. The meta-analysis showed that pre-ET albumin infusion was superior to exchange transfusion (ET) alone for reducing the need for repeating ET (risk ratio (RR) = 0.25, 95% confidence interval (CI): 0.09 - 0.72, I-squared (I2) = 8%; fixed effects model) and shortening the duration of phototherapy (PT) (mean difference (MD) = -11.46 hours, 95% CI: -16.56 to -6.36, I2 = 93%; random effects model (REM)). No significant differences were detected between the two groups for post-ET total serum bilirubin (TSB) at 6 hours (MD = -3.51 mg/dL, 95% CI: -7.93 - 0.93, I2 = 97%; REM) and 12 hours (MD = -4.21 mg/dL, 95% CI: -9.08 - 0.65, I2 = 99%; REM). None of the patients developed acute bilirubin encephalopathy in any of the trials. No death prior to hospital discharge was reported in any trials, and no adverse effects were observed in intervention groups. Conclusions: Based on four studied trials, pre-ET albumin infusion appears to be safe and effective in reducing the need for repeating ET and shortening PT duration. These potential benefits, including the reduction of post-ET TSB, need to be revalidated in future trials using rigorous methodology.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"14 9","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72539140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Khademian, H. Saneian, Maryam Riahinezhad, Victoria Chegini, F. Tavakoli, F. Famouri, Peiman Nasri, Mehri Khoshhali, R. Kelishadi
Background: Eosinophilic esophagitis (EoE) is a disease involving the esophagus due to an immune system reaction and has clinical symptoms similar to gastroesophageal reflux disease (GERD). Currently, the only definitive way to diagnose this disease is the endoscopy and biopsy of the esophageal tissue. Objectives: In this study, we investigated the diagnostic value of ultrasound to differentiate EoE from GERD and normal patterns. In addition, we assessed the possibility of replacing ultrasound with an invasive endoscopic method for the diagnosis and follow-up of EoE. Methods: This cross-sectional study was conducted on 4-12-year-old children in three groups of definitely diagnosed GERD, EoE, and healthy controls. Each group consisted of 30 participants who were evaluated for ultrasound parameters. The obtained values were compared between groups. The sensitivity and specificity of ultrasound findings were determined by receiver operating characteristic curve analysis. Results: Ultrasound findings, including wall thickness and distensibility of the cervical and abdominal esophagus, gastric wall thickness, and cervical esophagus diameter had significant differences between the three groups. The EoE group had the highest mean ± SD abdominal esophageal wall thickness of 2.73 ± 0.66 mm, gastric wall thickness of 4.30 ± 0.79 mm, and cervical esophageal wall thickness of 2.32 ± 1.21 mm. The GERD group had the lowest mean ± SD cervical esophagus diameter and distensibility of the abdominal esophagus. On the other hand, this group had the highest mean distensibility of the cervical esophagus. The highest area under the curve (AUC) for discriminating EoE from controls were 0.83 and 0.80 for gastric wall thickness and abdominal esophageal wall thickness, respectively. Moreover, the highest AUCs for discriminating EoE from GERD were 0.80 and 0.71 for gastric wall thickness and cervical esophageal wall thickness, respectively. Conclusions: Although the mean of ultrasound findings in the EoE group was significantly different from the control and GERD group, the ability to discriminate EoE from the control and GERD groups was moderate (0.70
{"title":"Diagnostic Value of Ultrasound Findings in Eosinophilic Esophagitis Versus Gastroesophageal Reflux Disease in Children","authors":"M. Khademian, H. Saneian, Maryam Riahinezhad, Victoria Chegini, F. Tavakoli, F. Famouri, Peiman Nasri, Mehri Khoshhali, R. Kelishadi","doi":"10.5812/ijp-126981","DOIUrl":"https://doi.org/10.5812/ijp-126981","url":null,"abstract":"Background: Eosinophilic esophagitis (EoE) is a disease involving the esophagus due to an immune system reaction and has clinical symptoms similar to gastroesophageal reflux disease (GERD). Currently, the only definitive way to diagnose this disease is the endoscopy and biopsy of the esophageal tissue. Objectives: In this study, we investigated the diagnostic value of ultrasound to differentiate EoE from GERD and normal patterns. In addition, we assessed the possibility of replacing ultrasound with an invasive endoscopic method for the diagnosis and follow-up of EoE. Methods: This cross-sectional study was conducted on 4-12-year-old children in three groups of definitely diagnosed GERD, EoE, and healthy controls. Each group consisted of 30 participants who were evaluated for ultrasound parameters. The obtained values were compared between groups. The sensitivity and specificity of ultrasound findings were determined by receiver operating characteristic curve analysis. Results: Ultrasound findings, including wall thickness and distensibility of the cervical and abdominal esophagus, gastric wall thickness, and cervical esophagus diameter had significant differences between the three groups. The EoE group had the highest mean ± SD abdominal esophageal wall thickness of 2.73 ± 0.66 mm, gastric wall thickness of 4.30 ± 0.79 mm, and cervical esophageal wall thickness of 2.32 ± 1.21 mm. The GERD group had the lowest mean ± SD cervical esophagus diameter and distensibility of the abdominal esophagus. On the other hand, this group had the highest mean distensibility of the cervical esophagus. The highest area under the curve (AUC) for discriminating EoE from controls were 0.83 and 0.80 for gastric wall thickness and abdominal esophageal wall thickness, respectively. Moreover, the highest AUCs for discriminating EoE from GERD were 0.80 and 0.71 for gastric wall thickness and cervical esophageal wall thickness, respectively. Conclusions: Although the mean of ultrasound findings in the EoE group was significantly different from the control and GERD group, the ability to discriminate EoE from the control and GERD groups was moderate (0.70","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"57 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84545026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Critically ill paediatric patient (CIPP) care may be required in the adult intensive care unit (aICU) of hospitals in cases where there is no paediatric intensive care unit (pICU) or when the pICU bed capacity is insufficient. Objectives: This is a retrospective evaluation of CIPPs who were accommodated in aICUs over the last 10 years to determine the type of hospital admission, indications for hospitalization, presence of comorbidities, treatments, causes of mortality, and effects of these parameters on mortality. Methods: We retrospectively analysed the medical records of 600 patients aged 28 days to 17 years who had been cared for at least 24 hours in aICUs between 2011 and 2021. Results: The average age of the CIPPs ((252 female (42%), 348 male (58%)) was 6 (7.4 ± 5.4) years. The mortality rate was 14.7%, and trauma (31.8%) was the most common cause of mortality, followed by respiratory diseases and septic shock. The independent risk factors found to be associated with mortality were as follows: Lower age, admission to ICUs from emergency departments of hospitals, higher Pediatric Risk of Mortality III and Pediatric Logistic Organ Dysfunction II scores, duration of hospital stay and of mechanical ventilation, vasopressor/inotropic agent requirement in the first 24 hours, higher total transfusion requirement, presence of nosocomial infection, thrombocytopenia, and lower haemoglobin level. Conclusions: It is important to achieve the best results and better outcomes for CIPPs in pICUs. However, a significant proportion of CIPPs currently hospitalized in aICUs are admitted with trauma. A close follow-up of mortality scores and clinical parameters in the early period of CIPP care in the aICU is critical as some mortality risk factors are preventable.
{"title":"Evaluation of Critically Ill Paediatric Patients in the Adult ICU","authors":"M. Sevdi, K. Erkalp","doi":"10.5812/ijp-121462","DOIUrl":"https://doi.org/10.5812/ijp-121462","url":null,"abstract":"Background: Critically ill paediatric patient (CIPP) care may be required in the adult intensive care unit (aICU) of hospitals in cases where there is no paediatric intensive care unit (pICU) or when the pICU bed capacity is insufficient. Objectives: This is a retrospective evaluation of CIPPs who were accommodated in aICUs over the last 10 years to determine the type of hospital admission, indications for hospitalization, presence of comorbidities, treatments, causes of mortality, and effects of these parameters on mortality. Methods: We retrospectively analysed the medical records of 600 patients aged 28 days to 17 years who had been cared for at least 24 hours in aICUs between 2011 and 2021. Results: The average age of the CIPPs ((252 female (42%), 348 male (58%)) was 6 (7.4 ± 5.4) years. The mortality rate was 14.7%, and trauma (31.8%) was the most common cause of mortality, followed by respiratory diseases and septic shock. The independent risk factors found to be associated with mortality were as follows: Lower age, admission to ICUs from emergency departments of hospitals, higher Pediatric Risk of Mortality III and Pediatric Logistic Organ Dysfunction II scores, duration of hospital stay and of mechanical ventilation, vasopressor/inotropic agent requirement in the first 24 hours, higher total transfusion requirement, presence of nosocomial infection, thrombocytopenia, and lower haemoglobin level. Conclusions: It is important to achieve the best results and better outcomes for CIPPs in pICUs. However, a significant proportion of CIPPs currently hospitalized in aICUs are admitted with trauma. A close follow-up of mortality scores and clinical parameters in the early period of CIPP care in the aICU is critical as some mortality risk factors are preventable.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"58 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75893012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Mohajerzadeh, M. Khalili, A. Shirvani, M. Sarafi, Amin Hajesmaeili, Gholamreza Ebrahimi, M. Mohkam, R. Dalirani, Mohamadtaghi Tabatabaee, N. Esfandiar, N. Mahdavi, Sayeh Hatefi
Background: New parameters called the pelvis-cortex (P/C) ratio, and percentage of pelvic improvement (PI) in the anteroposterior diameter (APD) are used for patients with ureteropelvic junction obstruction who have undergone pyeloplasty. Early improvement in these ultrasonic parameters can prevent isotope scanning for a successful repair. Methods: The data of pediatric patients (age range: 0 - 14 years) who underwent open pyeloplasty in Mofid Children Hospital pediatric surgery ward from 2017 to 2021 with follow-up longer than 12 months were analyzed retrospectively. This study encompassed only those children whose ultrasound and Technetium-99m diethylene triamine pentaacetic acid (DTPA) renal information were available before and after surgery. Results: A total of 67 patients meeting inclusion criteria were registered. The mean age at operation was 30 ± 37.44 months. The mean pelvic APD before surgery was 33.93 mm. The mean kidney cortex diameter before surgery was 5.26 ± 2.07 mm. The mean P/C ratio before surgery was 7.56 ± 4.38. The mean preoperative split renal function was documented at 42.23%. The mean follow-up duration was 32 months. The mean APD 3 months after surgery was 18.1 mm. The mean kidney cortex diameter 3 months after surgery was 6.72 mm. The mean P/C ratio 3 months after surgery was 3.09. The PI in APD 3 months after surgery was 43.29%. The mean APD 6 months after surgery was 15.43 mm. The mean kidney cortex diameter 6 months after surgery was 7.24 mm. The mean P/C ratio 6 months after surgery was 2.8. The mean PI in APD 6 months after surgery was 50.83%. The mean postoperative tracer clearance half-time in diuretic renography was 20.77 minutes. In receiver operating characteristic curve analysis, it was observed that PI in APD > 12% in 3 months after surgery versus DTPA 6 months after surgery could predict successful pyeloplasty with sensitivity, specificity, and area under the curve (AUC) equal to 98.44%, 66.67%, and 0.87, respectively. The PI in APD > 26% 6 months after surgery versus DTPA 6 months after surgery could strongly predict successful pyeloplasty with sensitivity and specificity of 100% and AUC of 1. Conclusions: This study identified that PI in APD > 26% at 6 months after surgery can strongly predict successful pyeloplasty and is a strong predictor of surgical outcome. Unnecessary repeated nuclear scans 6 months after surgery can be avoided using the aforementioned parameter.
{"title":"Comparison of Reliability of Kidney Ultrasound Findings After Pyeloplasty Versus Kidney Isotope Scans for Success in Patients with Ureteropelvic Junction Obstruction","authors":"L. Mohajerzadeh, M. Khalili, A. Shirvani, M. Sarafi, Amin Hajesmaeili, Gholamreza Ebrahimi, M. Mohkam, R. Dalirani, Mohamadtaghi Tabatabaee, N. Esfandiar, N. Mahdavi, Sayeh Hatefi","doi":"10.5812/ijp-122728","DOIUrl":"https://doi.org/10.5812/ijp-122728","url":null,"abstract":"Background: New parameters called the pelvis-cortex (P/C) ratio, and percentage of pelvic improvement (PI) in the anteroposterior diameter (APD) are used for patients with ureteropelvic junction obstruction who have undergone pyeloplasty. Early improvement in these ultrasonic parameters can prevent isotope scanning for a successful repair. Methods: The data of pediatric patients (age range: 0 - 14 years) who underwent open pyeloplasty in Mofid Children Hospital pediatric surgery ward from 2017 to 2021 with follow-up longer than 12 months were analyzed retrospectively. This study encompassed only those children whose ultrasound and Technetium-99m diethylene triamine pentaacetic acid (DTPA) renal information were available before and after surgery. Results: A total of 67 patients meeting inclusion criteria were registered. The mean age at operation was 30 ± 37.44 months. The mean pelvic APD before surgery was 33.93 mm. The mean kidney cortex diameter before surgery was 5.26 ± 2.07 mm. The mean P/C ratio before surgery was 7.56 ± 4.38. The mean preoperative split renal function was documented at 42.23%. The mean follow-up duration was 32 months. The mean APD 3 months after surgery was 18.1 mm. The mean kidney cortex diameter 3 months after surgery was 6.72 mm. The mean P/C ratio 3 months after surgery was 3.09. The PI in APD 3 months after surgery was 43.29%. The mean APD 6 months after surgery was 15.43 mm. The mean kidney cortex diameter 6 months after surgery was 7.24 mm. The mean P/C ratio 6 months after surgery was 2.8. The mean PI in APD 6 months after surgery was 50.83%. The mean postoperative tracer clearance half-time in diuretic renography was 20.77 minutes. In receiver operating characteristic curve analysis, it was observed that PI in APD > 12% in 3 months after surgery versus DTPA 6 months after surgery could predict successful pyeloplasty with sensitivity, specificity, and area under the curve (AUC) equal to 98.44%, 66.67%, and 0.87, respectively. The PI in APD > 26% 6 months after surgery versus DTPA 6 months after surgery could strongly predict successful pyeloplasty with sensitivity and specificity of 100% and AUC of 1. Conclusions: This study identified that PI in APD > 26% at 6 months after surgery can strongly predict successful pyeloplasty and is a strong predictor of surgical outcome. Unnecessary repeated nuclear scans 6 months after surgery can be avoided using the aforementioned parameter.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"6 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88415746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: We aimed to test the hypothesis that using lung ultrasound (LUS) to assess the severity of transient tachypnea in newborns can predict the mode of respiratory support that will be needed. Methods: We conducted a prospective study on late-preterm and term infants at more than 34 weeks of gestation. LUS was performed on admission by an investigator, and basic demographic data, LUS scores, respiratory mode and parameters were measured after admission. A receiver operator curve was utilized to assess the ability to predict the respiratory mode that would be needed. A correlation analysis was performed between the LUS scores and the artery blood gas results. Results: The mean age at the first LUS examination was 1.22 ± 0.81 hours on admission. Significant differences (P < 0.05) were revealed among the three groups in the left anterior area, right lateral area, left lateral area and total LUS scores. The LUS scores in the NRS group were lower than those in the other groups. The infants with NIV and MV were more likely to have higher LUS scores (P < 0.05). The LUS scores were negatively correlated with the PaO2 results (r = -0.25, P = 0.073), positively correlated with the PaCO2 results (r = 0.41, P = 0.003), and significantly correlated with SaO2 (r = 0.35, P = 0.015). LUS scores of > 6 (AUC = 0.85, P < 0.001) show the requirement of respiratory support in newborns. Conclusions: We conclude that LUS scores are correlated with the severity of transient tachypnea of the newborn and can predict an infant’s required respiratory support.
背景:我们的目的是验证使用肺超声(LUS)评估新生儿短暂性呼吸急促的严重程度可以预测所需的呼吸支持模式的假设。方法:我们对妊娠34周以上的晚期早产儿和足月儿进行了前瞻性研究。入院时由调查员进行LUS，入院后测量基本人口学资料、LUS评分、呼吸方式及参数。采用接受者操作者曲线来评估预测所需呼吸模式的能力。对LUS评分与动脉血气结果进行相关性分析。结果:首次LUS检查的平均年龄为入院时的1.22±0.81小时。三组患者左前区、右外侧区、左外侧区及LUS总分比较，差异均有统计学意义(P < 0.05)。NRS组的LUS得分低于其他组。NIV和MV患儿的LUS评分较高(P < 0.05)。LUS评分与PaO2呈负相关(r = -0.25, P = 0.073)，与PaCO2呈正相关(r = 0.41, P = 0.003)，与SaO2呈显著相关(r = 0.35, P = 0.015)。LUS评分>.6 (AUC = 0.85, P < 0.001)表明新生儿对呼吸支持的需求。结论:我们得出结论，LUS评分与新生儿短暂性呼吸急促的严重程度相关，可以预测婴儿所需的呼吸支持。
{"title":"Lung Ultrasound Scores Predict the Respiratory Support Needs of Late Preterm and Term Neonates with Transient Tachypnea","authors":"Jun Chen, Xiaoling Fang, Y. Dai","doi":"10.5812/ijp-121367","DOIUrl":"https://doi.org/10.5812/ijp-121367","url":null,"abstract":"Background: We aimed to test the hypothesis that using lung ultrasound (LUS) to assess the severity of transient tachypnea in newborns can predict the mode of respiratory support that will be needed. Methods: We conducted a prospective study on late-preterm and term infants at more than 34 weeks of gestation. LUS was performed on admission by an investigator, and basic demographic data, LUS scores, respiratory mode and parameters were measured after admission. A receiver operator curve was utilized to assess the ability to predict the respiratory mode that would be needed. A correlation analysis was performed between the LUS scores and the artery blood gas results. Results: The mean age at the first LUS examination was 1.22 ± 0.81 hours on admission. Significant differences (P < 0.05) were revealed among the three groups in the left anterior area, right lateral area, left lateral area and total LUS scores. The LUS scores in the NRS group were lower than those in the other groups. The infants with NIV and MV were more likely to have higher LUS scores (P < 0.05). The LUS scores were negatively correlated with the PaO2 results (r = -0.25, P = 0.073), positively correlated with the PaCO2 results (r = 0.41, P = 0.003), and significantly correlated with SaO2 (r = 0.35, P = 0.015). LUS scores of > 6 (AUC = 0.85, P < 0.001) show the requirement of respiratory support in newborns. Conclusions: We conclude that LUS scores are correlated with the severity of transient tachypnea of the newborn and can predict an infant’s required respiratory support.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"241 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76978500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Radovanovic, S. Obradovic, A. Simovic, Snežana Radovanović, Rasa H. Medovic, S. Markovic
Background: Periventricular/intraventricular hemorrhage (PVH/IVH) has a major impact on neurodevelopment due to its complications and sequelae. Objectives: This study aimed to determine the frequency of neurosonographic examination and the length of the monitoring period in children diagnosed with PVH/IVH. Methods: This clinical observational analytical retrospective cohort study was performed on 102 children diagnosed with PVH/IVH. The examinations were done on the third, seventh, fourteenth, and twenty-first days after birth and then in the fourth and sixth weeks and the third and sixth months after birth. The results of the examinations performed over time were subjected to the kappa measure of agreement test, with a significance threshold of 0.05, to determine the period when the most significant changes occur in the patient’s condition, as well as to determine the optimum frequency of the examination. Results: There was statistically significant agreement between the results of all the examinations performed in the observed moments (P < 0.0005). However, it is indicative that the agreement was excellent for the fourth week (kappa agreement was more than 0.85), followed by the sixth week that was very good (kappa agreement was 0.79); however, the agreement for the sixth week and the third month was very small (kappa agreement was less than 0.1). Also, there were no major changes (kappa agreement between results from the third and sixth months was 0.88). Conclusions: The first neurosonographic examination should be conducted in the first 7 days after birth, and the control examination should be conducted at the age of 4 - 6 weeks. If a pathological finding is observed, the examination is repeated after the specified period until a stationary finding is observed. After the third month, no new changes in the finding are observed.
{"title":"Evolution of Neurosonographic Findings After Periventricular/Intraventricular Hemorrhage","authors":"M. Radovanovic, S. Obradovic, A. Simovic, Snežana Radovanović, Rasa H. Medovic, S. Markovic","doi":"10.5812/ijp-114437","DOIUrl":"https://doi.org/10.5812/ijp-114437","url":null,"abstract":"Background: Periventricular/intraventricular hemorrhage (PVH/IVH) has a major impact on neurodevelopment due to its complications and sequelae. Objectives: This study aimed to determine the frequency of neurosonographic examination and the length of the monitoring period in children diagnosed with PVH/IVH. Methods: This clinical observational analytical retrospective cohort study was performed on 102 children diagnosed with PVH/IVH. The examinations were done on the third, seventh, fourteenth, and twenty-first days after birth and then in the fourth and sixth weeks and the third and sixth months after birth. The results of the examinations performed over time were subjected to the kappa measure of agreement test, with a significance threshold of 0.05, to determine the period when the most significant changes occur in the patient’s condition, as well as to determine the optimum frequency of the examination. Results: There was statistically significant agreement between the results of all the examinations performed in the observed moments (P < 0.0005). However, it is indicative that the agreement was excellent for the fourth week (kappa agreement was more than 0.85), followed by the sixth week that was very good (kappa agreement was 0.79); however, the agreement for the sixth week and the third month was very small (kappa agreement was less than 0.1). Also, there were no major changes (kappa agreement between results from the third and sixth months was 0.88). Conclusions: The first neurosonographic examination should be conducted in the first 7 days after birth, and the control examination should be conducted at the age of 4 - 6 weeks. If a pathological finding is observed, the examination is repeated after the specified period until a stationary finding is observed. After the third month, no new changes in the finding are observed.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"48 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76273559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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