Packed red blood cell transfusions in critically ill infants and children: is it time for a restructive transfusion strategy?

Although a restrictive transfusion policy is being increasingly advocated during critical illness in the past few years, the optimal hemoglobin level for red blood cell [RBC] transfusions is not known in critically ill infants and children. We conducted a prospective comparative randomized trial to test the hypothesis that a restrictive RBC transfusion strategy would be as safe as liberal transfusion strategy in the pediatric intensive care unit [PICU]. The primary outcome measure was PICU mortality following randomization, three hundred and nine patients with a hemoglobin concentration

Detection of bordetella pertussis by PCR in infants with respiratory failure

Despite being under-reported, Bordetella pertussis injection remains a severe disease of high incidence world-wide. No cases were reported in Egypt since 2001. Different immunization protocols exist in different countries with variable vaccination coverage ratios. This prospective investigation study was conducted in the PICU of Mansoura University Children Hospital. Mansoura, Egypt identifying cases of B. pertussis infection among mechanically ventilated infants presenting with respiratory failure and features compatible with pertussis [bronchopneumonia, apnoea, acute life threatening event]. Infants less than one year of age were enrolled over a period of 12 months. Sixty one specimens of endotracheal secretions were examined by PCR for the presence of a 262-bp target sequence from IS481 specific for B. pertussis. Nine specimens were positive for B. pertussis, five infants in this group did not survive. All non survivors were younger than 6 months of age. Infants in the PCR-positive group had a younger age [p = 0.038], a longer duration of illness prior to PICU admission [p < 0.01] and a higher mortality rate [p = 0.045] compared to the PCR - negative infants. It is crucial to raise awareness, among medical professionals, of clinical picture, complications and treatment of pertussis, If immunization program of Egypt was to be reviewed, there may be a need for a more accelerated primary immunization program against pertussis with booster doses for young adults

Extubation failure: a study of risk factors and outcomes in an Egyptian PICU

To determine failed extabation rate, risk factors, and consequences of extubation failure in paediatric intensive care unit [PICU] in Mansoura University Children's Hospital [MUCH]. Twelve-month prospective, observational clinical study. The study extended from Dec 2004 to Dec 2005. PICU in MUCH. Ninety two children [43 girls, 49 boys], age 1-S3, months were enrolled. Neonates, post surgery tracheostomy, non invasive ventilation and unplanned extubation were the exclusion criteria. Sixty six children were directly extubated from 2 level pressure ventilation and 26 children underwent a spontaneous breathing trial before extubation. The diagnoses were; respiratory conditions [n=41] cardiac conditions [n= 30], neurological conditions [n=18] and miscellaneous conditions [n=3]. The extubation failure rate was 25% [23/92]. Patients failing extubation had a longer mechanical ventilation prior to attempted extubation [p=.002], higher cumulative fluid balance [p= .001] and a lower serum K+ [p<.00l]. Logistic regression revealed only the last two variables independently predicted extubation failure. Among the 66 children with SET, tidal volume on spontaneous breaths and the fraction of mandatory minute volume to total minute volume were, with the previous three parameters, independent predictors of extubation failure. Children who failed extubation had higher mortality [43.5%] compared to 8.7% in the group with successful extubation [p<.001]. Survivors had a longer PICU stay in the failure group [median 14.5, IQR 8 days] compared to the success group [median 9, IQR 5 days] with p<.001. The variables associated with extubation failure have to be considered during extubation trying to reduce the high extubation failure rate. The burden of extubation failure needs to be evaluated in terms of ventilation days and financial cost

Lymphocyte apoptosis and proliferation related gene products in childhood acute lymphoblastic leukemia

The aim of the study is to characterize markers of apoptosis in children with ALL in relation to treatment outcome of the disease. The study was performed on 34 children with ALL and 60 healthy children as a control group. Apoptosis was assessed by cell morphology; DNA fragmentation; ELISA and RT-PCR for CD95, CD95L, BcL2 and NF-KB; and flowcytometry for CD95, CD40, CD49d, and CD11a. Apoptosis was significantly lower in cases than controls. Apoptosis detected by CD95 ligand was significantly lower in cases with no remission after treatment than those with remission. Antiapoptotic factors: CD40, BcL2, and NF-KB were all found to be higher in cases than controls and in cases with no remission than those with remission, CD49d was significantly lower in cases than controls, and significantly lower in cases with no remission. CD11a levels were not different among various groups. Delayed apoptosis of ALL cells is genetically controlled either directly or indirectly by a network of oncogenes and tumor suppressor genes. CD40 appeared to stimulate both T and lineage and is considered the most potent influencer and predictor to resistance to therapy. Inhibitors for the activity of CD40, 8c/2 and NF-kB as well as stimulants to CD95 could have a potential therapeutic benefit