RESUMO
Objective@#This pilot study investigated whether serum B-type Natriuretic Peptide (BNP), bioelectrical impedance analysis (BIA), and left ventricular end-diastolic diameter (LVEDD) can be used to predict fluid overload and clinical outcomes in pediatric sepsis. @*Methods@#Pediatric sepsis patients were enrolled. BNP, BIA, and LVEDD were obtained on admission and on Day 3. Diagnostic performances of BNP, BIA, LVEDD and correlation with fluid status were obtained.@*Results@#Twenty-two patients were enrolled. Day 3 BNP was higher in non-survivors (9241 vs. 682.2 pg/mL, p=0.04) and day 3 LVEDD Z-score was lower in non-survivors (-3.51 vs. -0.01, p=0.023). There was no difference in the fluid balance between survivors and non-survivors. Admission BNP >670.34pg/mL predicted vasopressor use with a sensitivity of 85.71% and specificity of 86.67% while ΔBNP>5388.13pg/mL predicted mortality with 100% sensitivity. Day 3 LVEDD <22mm predicted mortality with a sensitivity of 94.74%. Cumulative fluid balance was strongly correlated with BIA and LVEDD (r=0.65, p=0.001; r=0.74, p<0.001 respectively). The median length of stay in hospital days for non-survivors was not significantly different from survivors (4 [1-12] vs. 8 [6-12] days,p=0.21). @*Conclusion@#Rise in BNP levels appear to be independent of fluid status and is a good predictor of mortality, vasopressor, and mechanical ventilator use but not of length of hospital stay. LVEDD and BIA are good estimates of cumulative fluid balance but not as predictors of mortality, vasopressor, mechanical ventilator use, and length of hospital stay. Significance of the outcomes of the study was limited due to the small sample size.
Assuntos
Peptídeo Natriurético Encefálico , EcocardiografiaRESUMO
@#<p style="text-align: justify;"><strong>Introduction.</strong> In resuscitating children, actual weight should be obtained before intervention. However, this is not always possible in the emergency setting. Identifying a simple, accurate, and precise method of weight estimation is essential in the delivery of optimal care for Filipino children seen at the emergency department.</p><p style="text-align: justify;"><strong>Objectives.</strong> To evaluate and compare the accuracy and precision of different weight estimation methods in Filipino children.</p><p style="text-align: justify;"><strong>Methods.</strong> A cross-sectional, single-center study was conducted among patients aged >28 days-12 years seen at the Philippine General Hospital Emergency Room. The traditional and updated Advanced Pediatric Life Support (APLS), Broselow tape, and Mercy Method were used for weight estimation. Bland Altman analysis was performed to see the mean difference and limits of agreement between actual and estimated weights of the children.</p><p style="text-align: justify;"><strong>Results.</strong> Broselow tape gave the closest average weight estimate, overestimating it by 0.7 kg, followed by Mercy method at 0.955 kg higher than actual. Traditional APLS yielded 1.565 kg and the Updated APLS 3.299 kg. Mercy Method had the narrowest limit of agreement.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Among the four weight estimation methods, Broselow tape is the most accurate while the Mercy method is the most precise. Traditional APLS performed better than the updated APLS. Length-based methods and anthropometric surrogates proved to be more reliable than age-based formulae.</p>
Assuntos
PediatriaRESUMO
@#<p style="text-align: justify;"><strong>Objective:</strong> This paper aims to determine the respiratory manifestations, radiologic findings, and management of coronavirus-19 (COVID-19) among the hospitalized children of different age groups based on a systematic review of literature.</p><p style="text-align: justify;"><strong>Methodology:</strong> We searched the MEDLINE, Google Scholar, Cochrane, and MedRvrix databases for relevant studies on pediatric COVID-19 done between January 1 to May 25, 2020. Data on demographic features, pulmonary symptoms, chest imaging findings, and oxygen support were extracted in a data abstraction form and analyzed among the different pediatric age groups.</p><p style="text-align: justify;"><strong>Results:</strong>?Sixteen studies were included in this systematic review, with a total of 61 patients. Thirty-nine patients (64%) belong to the 2 to 12 year age group. Cough was the most commonly reported respiratory symptoms among children older than one month. Most of the patients, particularly adolescents, had asymptomatic or mild infection. On chest imaging, infiltrates and ground-glass opacities were the most common abnormalities. Oxygen supplementation via nasal cannula, non-invasive ventilation, and mechanical ventilation was noted in three cases.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Our systematic review shows that COVID-19 can present with a spectrum of respiratory manifestations and disease severity as well as a variety of radiologic abnormalities across different pediatric age groups. Whilemost children do not develop hypoxemia warranting oxygen supplementation, a severe respiratory infection can still manifest in children. Asymptomatic and milder infections are common and highlight the need for appropriate respiratory precautions. More pediatric studies on the pulmonary manifestations and management of children with COVID-19 can aid in a better understanding of this novel disease.</p>