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关键词： Mechanical circulatory support   Ventricular assist device   Paediatric patients   Registry   End-stage heart failure   Congenital heart disease  

摘要： OBJECTIVES: A second paediatric report has been generated from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The purpose of EUROMACS, which is operated by the European Association for Cardio-Thoracic Surgery, is to gather data related to durable mechanical circulatory support for scientific purposes and to publish reports with respect to the course of mechanical circulatory support therapy. Since the first report issued, efforts to increase compliance and participation have been extended. Additionally, the data provided the opportunity to analyse patients of younger age and lower weight. METHODS: Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (<= 19years of age) performed from 1 January 2000 to 1 July 2019 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events including neurological dysfunction, device malfunction, major infection and bleeding. RESULTS: Twenty-nine hospitals contributed 398 registered implants in 353 patients (150 female, 203 male) to the registry. The most frequent aetiology of heart failure was any form of cardiomyopathy (61%), followed by congenital heart disease and myocarditis (16.4% and 16.1%, respectively). Competing outcomes analysis revealed that a total of 80% survived to transplant or recovery or are ongoing;at the 2-year follow-up examination, 20% died while on support. At 12months, 46.7% received transplants, 8.7% were weaned from their device and 18.5% died. The 3-month adverse events rate was 1.69 per patient-year for device malfunction including pump exchange, 0.48 for major bleeding, 0.64 for major infection and 0.78 for neurological events. CONCLUSIONS: The overall survival rate was 81.5% at 12months following ventricular assist de

关键词： Left atrial appendage   membrane   congenital heart disease  

摘要： Left atrial appendage membrane is a rare anomaly. Its implications on clinical course are unknown. We report the first paediatric case in association with a congenital heart disease.

摘要： With the use of newly issued guidelines, King's College Hospital has developed new standard operating procedures specifically for the COVID-19 pandemic. Given the unprecedented nature of the current global pandemic, this paper highlights how paediatric dental emergencies can be managed safely and efficiently, as well as new measures which can help reduce transmission of the virus. Furthermore, an audit of the current paediatric dental emergencies attending the hospital is presented. Seventy-six percent of patients attending met the agreed local criteria for urgent treatment, with the most common presentation being irreversible pulpitis. This highlights the types of cases that practitioners enrolled in urgent dental care centres (UDCs) can expect to encounter and how to effectively manage this challenging group of patients.

关键词： airway management   emergency medicine   child   intubation  

摘要： Objectives To describe the epidemiology, clinical practice and outcomes of paediatric ED intubation in Australia and New Zealand. Method Prospectively collected airway management audit data from 43 EDs in Australia and New Zealand that was submitted to the Australia and New Zealand Emergency Department Airway Registry between 2010 and 2015. Results Paediatric cases accounted for 4.94% (270/5463) of cases (median age = 3, interquartile range [IQR] = 2-9). A median of 5 (IQR = 2-9) intubations were reported per department per year. Most intubations were performed for medical indications (72.2%), including seizure (25.2%) and respiratory failure (15.2%). Patients were physiologically compromised prior to intubation with 69.5% comatose, 50.9% outside of the normal age-adjusted range for respiratory rate, 15.9% hypoxic and 12.6% hypotensive. Complication rate was 33.3% and desaturation was the most common (18.5%). The ED mortality rate was 3.8%. First pass success (FPS) was 80% (95% CI 75.2-84.8). Infants less than 1 year of age had lower FPS, higher rates of difficult laryngoscopy and higher rates of desaturation than other age groups. Conclusion Paediatric intubation in Australasian EDs is rare from a departmental and individual provider viewpoint. Success rates are similar to contemporary international registries. Complications are common and ongoing collaborative multicentre audit with resultant quality improvement is desirable to facilitate improved success and reduced complications.

关键词： Adenovirus   Viral burden   Transplant   AUC   Non-relapse mortality  

摘要： Background Adenoviraemia occurs in 15 to 30% of paediatric allogeneic haematopoietic stem cell transplant (HSCT) recipients, and is a significant cause of morbidity and mortality which lacks satisfactory therapeutic options. The relationship between burden of adenovirus and mortality is poorly defined in this patient *** To determine the relationship between adenoviraemia and mortality in paediatric HSCT *** Design A retrospective review of blood adenovirus PCR results in paediatric HSCT recipients spanning February 2003 to September 2016 was conducted. Three measures of adenovirus burden were defined; number of days with significant viraemia, peak adenovirus load and Area under the Curve and related to outcome *** A total of 62 patients with episodes of positive blood adenovirus PCR were identified for analysis. Adenoviraemia of more than 7 days, peak viral load of >8000 copies/ml and higher 16 week Area under the Curve were all significantly associated with higher non-relapse mortality in paediatric HSCT *** This retrospective analysis highlights the important predictive value of adenoviral load for non-relapse mortality in young allogeneic HSCT recipients. These data also suggest a possible role for use of these measures as end points in trials of novel adenoviral therapies.

关键词： Paediatric sports cardiology   Paediatric athlete   Athletic adaptation   Paediatric arrhythmia   Paediatric cardiomyopathy   Paediatric exercise  

摘要： The success of systematic early age talent development has led to the professionalisation of youth sports academies used by clubs and governing bodies alike, and sports physicians are nowadays commonly confronted with paediatric cardiological problems. Medical cardiac care of the paediatric athlete is however in its infancy, and the international guidelines that are present for adult athletes, are not yet available. Similarly, reference data for ECG and echocardiography are incomplete. The aim of this article is to provide and introduction to the cardiac care of the paediatric athlete to facilitate healthy and above all, safe talent development, but also provide guidance on how to distinguish adaptive, beneficial cardiovascular remodelling from underlying pathology of congenital or inherited cardiovascular disease. Differences in presentation, diagnosis and treatment between childhood and adult athletes are highlighted and can educate the reader in the emerging field of paediatric sports cardiology.

关键词： discharge planning   home visit   hospital discharge   medication safety   nurses   nursing   paediatrics   postdischarge   transitions  

摘要： Aim To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge. Design Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re-use. Methods We analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected. Results Overall, nurses documented at least one concern in 56% (N = 367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N = 58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N = 49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N = 56). Nurses completed referrals to other providers/services in 12% of visits (N = 78), most frequently to primary care providers. In 13% of visits (N = 85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation. Conclusion Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families' medication administration practices and anticipate social needs after paediatric discharge. Impact Little empirical data are available describing concerns manifesting immediately after paediatric hospital discharge. Concerns about medication safety were most frequent followed by concerns related to housing and general safety. The results are important for clinicians preparing children and families for discharge and for community cl

摘要： The COVID-19-pandemic forces hospitals to reorganize into a dual patient flow system. Healthcare professionals are forced to make decisions in patient prioritization throughout specialties. Most pediatric urology pathologies do not require immediate or urgent care, however, delay may compromise future renal function or fertility. Contact with patients and parents, either physical in safe conditions or by (video)telephone must continue. The Paediatric-Urology-Guidelines-panel of the EAU proposes recommendations on prioritization of care. Pediatric-Urology program directors must ensure education, safety and attention for mental health of staff. Upon resumption of care, adequate prioritization must ensure minimal impact on outcome.

关键词： Biliary ascariasis   Ascaris lumbricoides   Sepsis   Liver abscess  

摘要： Introduction: Biliary ascariasis, although uncommon, can lead to infectious complications and severe outcomes. This study reported three patients with biliary ascariasis and who were admitted to a paediatric hospital in Salvador, Brazil. Case reports: Case 1: A 1-year-old boy, with HIV, hospitalised with diarrhoea, fever, pain, and abdominal distension. He underwent an exploratory laparotomy, which showed peritonitis secondary to a perforation of the hepatic duct by ascaris. Case 2: A 3-year-old boy admitted with fever, abdominal pain and jaundice. Imaging examination was suggestive of ascaris in the intrahepatic biliary tract and a hepatic abscess. Case 3: A 7-year-old boy who was hospitalised with a history of abdominal colic, jaundice and fever, with a suggestive image of ascaris in the biliary tract and evolution to sepsis. Discussion: Three cases of biliary ascariasis were reported with severe infectious complications involving peritonitis, hepatic abscess and sepsis. Conclusion: In endemic regions, biliary ascariasis should be considered in cases with jaundice, abdominal pain and fever, due to its morbidity and risk of (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

摘要： Calculation errors are the most common dosing errors in paediatrics. While health information technology has been advocated to improve patient safety, the broad implementation of computer-calculated dosing in the paediatric setting is delayed for the lack of computable, explicit and unambiguous paediatric dosing guidelines. The structured digital dosing guidelines of the Dutch Paediatric Formulary permitted the development of a paediatric dosing calculator that combines drug dosing recommendations of the formulary with patient variables. We took into account the European Union Medical Devices Directive (EEC 93/43) and international standards describing the requirements for the development and maintenance of medical software, the risk management in relation to medical devices and the application of usability engineering to medical devices. As key steps in the development and risk management of software, we first specified the intended use and primary operating functions, then identified potential failures and resolved failures by corrective measures. The paediatric dosing calculator calculates an individual dose based on specified patient characteristics and the dose recommendations provided in the formulary. This is a step-by-step process where a user first enters patient variables (date of birth, weight) and then selects drug variables (indication, route of administration). Based on the selected patient and drug variables, an individual dose is calculated. In addition, the calculated dose in weight units (grams, milligrams) can be converted to a volume-based dose (millilitres) of a fluid product. We successfully developed and implemented a dosing calculator in our national web-based Dutch Paediatric Formulary, which so far has been used more than 65,000 times monthly.