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关键词： Sepsis   Adrenomedullin   Procalcitonin   Paediatric   Diagnosis   Stratification  

摘要： Early diagnosis of sepsis and its severity stratification at admission is critical to improve patient outcomes and to ensure the optimal use of health care resources. In order to assess the diagnostic potential of mid-regional pro-adrenomedullin (MR-proADM) in septic paediatric patients in comparison with procalcitonin (PCT), and to evaluate the usefulness of a single early determination of MR-proADM as a stratification and severity prediction tool, a prospective observational study was conducted. Seventy-three paediatric patients with a suspicion of sepsis were included. A single blood test was carried out at initial time to analyse infection biomarkers. PCT values were significantly higher in septic patients in comparison with non-septic patients (p = 0.03) with an AUC of 0.748 (p = 0.003). Levels of MR-proADM significantly increased in patients with severe sepsis (p = 0.048), with an AUC of 0.729 (p = 0.013). MR-proADM showed a positive correlation with pSOFA, PRISM III, and PELOD-2 severity scores. Levels of MR-proADM were significantly higher in patients who required vasoactive drugs (p = 0.02) or presented renal dysfunction (p = 0.004). Conclusion: PCT appeared to be superior to MR-proADM in diagnosing sepsis. Determining MR-proADM plasma levels at the initial phase of sepsis could be a useful tool for sepsis stratification and morbidity prediction before organ failure occurs. The present results need to be assessed with larger sample size *** is Known:center dot CRP and PCT are already included in clinical practice to assess sepsis and estimate disease severity, although their sensitivity and specificity are lower than *** dot ADM is a protein that has immune and vascular modulation actions, and its blood levels are increased in adult and paediatric *** dot ADM is a promising tool for early diagnosis and prognostic assessment in adult *** is New:center dot PCT appeared to be superior to MR-proADM in diagnosing paediatric

关键词： acute lymphoblastic leukaemia   childhood leukaemia   immunotherapy  

摘要： Keywords: acute lymphoblastic leukaemia; childhood leukaemia; immunotherapy EN acute lymphoblastic leukaemia childhood leukaemia immunotherapy e53 e56 4 07/01/20 20200701 NES 200701 Paediatric patients with refractory or relapsed (r/r) B-cell acute lymphoblastic leukaemia (BALL) are facing therapeutic challenges, considering their poor five year disease-free survival.[[1]] Immunotherapy could improve their survival and reduce adverse events. Lymphocyte subpopulations were studied in four patients: B-cell aplasia post InO was documented as soon as day 8 of cycle 1 and as late as day 16 after the last injection (Table SII). Loss of I CD19 i was also described with blinatumomab or CAR-T cell therapy.[[8]] InO can be effective and safe in r/r I CD22 i -positive B-ALL paediatric patients. [Extracted from the article]

关键词： Endotracheal suction   Adverse events   Clinical audit   Paediatric   Intensive care   Normal saline  

摘要： Objective: The objective of this study was to determine the incidence of endotracheal tube (ETT) suction erelated adverse events (AEs) and to examine associations between AEs and patient and suction characteristics. Secondary objectives were to describe ETT suction practices in an Australian paediatric intensive care unit (PICU). Methods: A prospective, observational study was undertaken in a mixed cardiac and general PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (indication for ETT suction, number of suction episodes per mechanical ventilation episode, indication for normal saline instillation [NSI] and NSI dose) including potential predictive variables (age, Paediatric Index of Mortality 3 [PIM3], NSI, positive end-expiratory pressure, and hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE. Main results: A total of 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions. Suction-related AEs were not associated with age, diagnostic category, or index of mortality score. Desaturation was the most common AE (180 suctions;19%), with 69% of desaturation events requiring clinician intervention. Univariate logistic regression showed the odds of desaturation decreased as the internal diameter of the ETT increased (odds ratio [OR]: 0.59;95% confidence interval [CI]: 0.37-0.95;p = 0.028). Multivariable modelling revealed NSI was significantly associated with an increased risk of desaturation (adjusted OR [aOR]: 3.23;95% CI: 1.99-5.40;p < 0.001) and the occurrence of an AE (aOR: 2.76;95% CI: 1.74-4.37;p < 0.001). Presuction increases in fraction of inspired oxygen (FiO(2)) was significantly associated with an increased risk of experiencing an AE (aOR: 2.0;95% CI: 1.27-3.15;p = 0.003). Conclusions: ETT suctionerelated AEs are common and associated with NSI and the requirement for presuction increases in FiO(2). Cl

关键词： anaemia   blood transfusion services   donor blood pack   haematocrit   haemoglobin  

摘要： Background and Objectives Paediatric blood transfusion for severe anaemia in hospitals in sub-Saharan Africa remains common. Yet, reports describing the haematological quality of donor blood or storage duration in routine practice are very limited. Both factors are likely to affect transfusion outcomes. Materials and Methods We undertook three audits examining the distribution of pack types, haematological quality and storage duration of donor blood used in a paediatric clinical trial of blood at four hospitals in Africa (Uganda and Malawi). Results The overall distribution of whole blood, packed cells (plasma-reduced by centrifugation) and red cell concentrates (RCC) (plasma-reduced by gravity-dependent sedimentation) used in a randomised trial was 40 center dot 7% (N = 1215), 22 center dot 4% (N = 669) and 36 center dot 8% (N = 1099), respectively. The first audit found similar median haematocrits of 57 center dot 0% (50 center dot 0,74 center dot 0), 64 center dot 0% (52 center dot 0,72 center dot 5;P = 0 center dot 238 vs. whole blood) and 56 center dot 0% (48 center dot 0,67 center dot 0;P = 0 center dot 462) in whole blood, RCC and packed cells, respectively, which resulted from unclear pack labelling by blood transfusion services (BTS). Re-training of the BTS, hospital blood banks and clinical teams led to, in subsequent audits, significant differences in median haematocrit and haemoglobins across the three pack types and values within expected ranges. Median storage duration time was 12 days (IQR: 6, 19) with 18 center dot 2% (537/2964) over 21 days in storage. Initially, 9 (2 center dot 8%) packs were issued past the recommended duration of storage, dropping to 0 center dot 3% (N = 7) in the third audit post-training. Conclusion The study highlights the importance of close interactions and education between BTS and clinical services and the importance of haemovigilance to ensure safe transfusion practice.

关键词： paediatric   refractory   mediastinal   B-Cell lymphoma  

摘要： Primary mediastinal large B-cell lymphoma in paediatric and adolescent patients: emerging questions in the era of immunotherapy Keywords: paediatric; refractory; mediastinal; B-Cell lymphoma EN paediatric refractory mediastinal B-Cell lymphoma e114 e117 4 07/20/20 20200715 NES 200715 Relapsed/refractory primary mediastinal large B-cell lymphoma (PMLBCL) is rare among paediatric patients and is associated with a dismal prognosis. None of these patients had prior CAR T-cell therapy or checkpoint inhibitors.13 Remission consolidation post-CAR T-cell therapy with allogeneic HCT in patients with PMLBCL remains an active debate. [Extracted from the article]

关键词： CRE   Active screening   Patient placement   CC17   CC11   Carbapenemase genes  

摘要： Background: With the increasing use of carbapenems in clinical practice, carbapenemresistant Enterobacterales (CRE) has also increased, posing a significant threat to human health. Aim: To assess the effects of CRE colonization active screening and various CRE patient placements implemented in decreasing CRE infection risk. Methods: CRE colonization screening and various CRE patient placements were performed across CRE high-risk departments (paediatric intensive care unit, neonatal intensive care unit, neonatal wards and haematology departments) between 2017 and 2018. Findings: In 2018, more than 80% of neonatal CRE-positive patients were isolated using single-room or same-room isolation, and more than 50% of non-neonatal patients were isolated with no cohort placement. The CRE nosocomial infection incidences decreased from 1.96% to 0.63% in the neonatal intensive care unit, and from 0.57% to 0.30% in neonatal wards (all P<0.05) while no significant changes were found in the other departments. The CRE colonization incidence at different lengths of hospital stay (LOSs) decreased at eight to 14 days and >14 days LOS in CRE high-risk departments (all P< 0.05). In addition, 62.5% clinical strains, 66.7% screening strains, and 74.1% nosocomial infection strains belonged to the CC17 complex group in neonatal isolates;while, 56.6%, 47.5% and 100% strains mentioned above belonged to the CC11 complex group in non-neonatal isolates. The predominant carbapenemase gene was bla(NDM-1) (98%) in neonatal and bla(KPC-2) (70%) in non-neonatal carbapenem-resistant Klebsiella pneumoniae (CR-KP) stains. Conclusions: Active CRE colonization surveillance and CRE-positive appropriate patient placement may decrease the CRE infection risk. Neonatal and non-neonatal CR-KP isolates showed different CRE molecular characteristics, which could further benefit CRE infection precaution and antibiotic therapy. (C) 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

关键词： speech and language therapy   children   paediatric   palliative care  

摘要： Background The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus-based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics. Aims This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices. Methods & Procedures An anonymous cross-sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information, (2) caseload information, (3) service provision and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed-ended survey responses and content analysis of open-ended responses are presented. Outcomes & Results A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for <= 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC client

摘要： Background Paediatric localized scleroderma is a severe inflammatory disorder associated with tissue atrophy, often leading to disability. Assessing disease activity and response to treatment has always been challenging and remains an important difficulty in clinical practice. Objectives To investigate prospectively the efficacy of systemic treatment with corticosteroids and methotrexate in children with localized scleroderma and the validity of infrared thermography, laser Doppler flowmetry and high-frequency ultrasound in assessing disease activity. Methods Children with localized scleroderma were prospectively treated with corticosteroids (initially pulsed IV methylprednisolone 30 mg/kg/day, maximum 500 mg/day and/or oral prednisolone 0.5-1 mg/kg/day) and methotrexate (15 mg/m(2) weekly). Treatment response was evaluated using a clinical activity score. Skin temperature, blood flow, dermal thickness and dermal echogenicity of clinically active skin lesions were determined in relation to the unaffected contralateral site at baseline and after 3, 6, 12 and 18 months. Patient charts were later reviewed for long-term follow-up. Results Twenty-two patients were included [age 6.0 (0.2-14.4] years;female-to-male ratio 3.4 : 1) All responded well to therapy. Disease reversibility was demonstrated in the majority of children with partial resolution of skin sclerosis and regrowth of hair. Laser Doppler flowmetry and high-frequency ultrasound findings correlated with disease activity at baseline. Thermography had no added value in this cohort. The recurrence rate was 36% in the follow-up period. Conclusions Corticosteroids and methotrexate are highly effective as first-line therapy in paediatric localized scleroderma, leading to partial reversal of skin manifestations. However, the recurrence rate is substantial and affected children require long-term follow-up. Laser Doppler flowmetry and high-frequency ultrasound correlate with disease activity in the acute phase and may

关键词： antibiotic   cellulitis   children   odontogenic  

摘要： Background Facial cellulitis of odontogenic origin (FCOO) can lead to systemic complications in children. Research on factors leading to improvement of outcomes is limited. Aim The aim of this study was to investigate patient characteristics, treatment modalities (antibiotics and route of administration), length of stay in the hospital, time till definitive treatment, and factors related to early treatment of FCOO. Design A retrospective review was performed to identify children presenting to the emergency department of a paediatric hospital with FCOO over a 5-year period. Data were extracted from records of included patients. Results Sixty-four records were included for analysis with mean age of 8.19 +/- 4.5 years. Significantly more patients received clindamycin (79.7%) than penicillin-based antibiotic (18.8%) with P < .0001. Forty-four (68.8%) children were admitted to the hospital and received parenteral clindamycin. The average hospital stay was 2.5 +/- 1.2 days, and average days till dental treatment was 5.2 +/- 8.9 days. Children who received intravenous antibiotic or had a primary tooth involved received dental treatment sooner, with P = .0036 and P = .03, respectively. Conclusions Oral antibiotics were prescribed for children who were discharged from the emergency department. Children who received intravenous antibiotics or had an infected primary tooth received early definitive treatment.

关键词： children   clearance   covariates   dose   heart failure   NONMEN   trough   variability  

摘要： This is a PROSPERO registered systematic review (CRD42018105207), conducted to summarize the available knowledge regarding the population pharmacokinetics of digoxin in paediatrics and to identify the sources of variability in its disposition. PubMed, ISI Web of Science, SCOPUS and Science Direct databases were searched from inception to January 2019. All paediatric population pharmacokinetic studies of digoxin that utilized the nonlinear mixed-effect modelling approach were incorporated in this review, and data were synthesized descriptively. After application of the inclusion-exclusion criteria 8 studies were included. Most studies described digoxin pharmacokinetics as a 1-compartment model with only 1 study describing its pharmacokinetics as 2-compartments. Age was an important predictor of clearance in studies involving neonates or infants, other predictors of clearance were weight, height, serum creatinine, coadministration of spironolactone and presence of congestive heart failure. Congestive heart failure was also associated with an increased volume of distribution in 1 study. The estimated value of apparent clearance in a typical individual standardized by mean weight ranged between 0.24 and 0.56 L/h/kg, the interindividual variability in clearance ranged between 7.0 and 35.1%. Half of the studies evaluated the performance of their developed models via external evaluation. In conclusion, substantial predictors of digoxin pharmacokinetics in the paediatric population in addition to model characteristics and evaluation techniques are presented. For clinicians, clearance could be predicted using age especially in neonates or infants, weight, height, serum creatinine, coadministration of medications and disease status. For future researchers, designing pharmacokinetic studies that allow 2-compartment modelling and linking pharmacokinetics with pharmacodynamics is recommended.