Management of meconium aspiration syndrome with high frequency oscillatory ventilation

High-frequency oscillatory ventilation [HFOV] has been advocated for use to improve lung inflation while potentially decreasing lung injury. There were few data on the early use of HFOV in hypoxemic term neonates. To evaluate the effectiveness of HFOV, used as the initial mode of ventilation, in neonates with severe meconium aspiration syndrome [MAS]. In a tertiary care paediatric intensive care unit, 17 term neonates with severe MAS were managed with HFOV, used as the initial mode of ventilation, and prospectively evaluated. Ventilator settings, blood gases, oxygenation index [OI] and alveolar-arterial oxygen difference [P[A-a]O2] were prospectively recorded during HFOV treatment and compared at the multiple time intervals. Target ventilation was easily achieved with HFOV. Initiation of HFOV caused a significant decrease in FIO2, achieved as early as 1 hour [from 0.93 +/- 0.11 to 0.78 +/- 0.25; p=0.031] and the improvement was sustained during the 1-32 hours period. There were a significant decreases in P [A-a] O2 and OI, respectively, at 4 hours [from 562.5 +/- 71.7 to 355.4 +/- 206 mm Hg; p=0.03] and 8 hours [from 23.3 +/- 17 to 14.6 +/- 16.3; p=0.04], that were sustained up to 16 and 40 hours. Three neonates [17.6%] developed pneumothorax on HFOV. One patient required oxygen support at 28 days. No significant others complications associated with HFOV were detected. Sixteen infants [94%] were successfully weaned from HFOV and 15 [88%] survived to hospital discharge. Use of HFOV as the initial mode of ventilation in neonates with severe MAS is an effective strategy

Community-acquired methicillin-resistant Staphylococcus aureus infections requiring admission to a Tunisian paediatric intensive care unit

There is limited literature describing severe community acquired methicillin-resistant S aureus [CA-MRSA] in children admitted to an intensive care unit. To review clinical features and outcome of children admitted in a Tunisian pediatric intensive care with CA-MRSA. Retrospective chart review of patients coded for CAMRSA over 10 years. There were 14 [0.32% of all admissions] patients identified with severe CA-MRSA. The median age was 3 months [range, 0.5-156 months]. All patients had pulmonary involvement. Six children [42.8%] developed septic shock. Two [14.3%] patients had multifocal infection with deep venous thrombosis. Two [14.3%] patients died. Severe CA-MRSA pneumonia dominated presentation. The mortality of CA-MRSA infection in our series is lower than reported in the literature

[Acute respiratory distress syndrome in infants at term and near term about 23 cases]

Aim: to precise the incidence of acute respiratory distress syndrome in infants at term and near term and the clinical characteristics of this disease not yet well recognised

Methods: retrospective study of the medical records of infants admitted in the paediatric intensive care unit for ARDS along a period of 4 years. Diagnosis of ARDS was based on the following criterias: 1] Gestational age >/= 35 weeks of gestation; 2] Severe and immediate respiratory distress requiring mechanical ventilation with PEEP >/=4 cm H2O and FiO[2] >/= 0.5 during at least 6 hours ; 3] Dependence on oxygen >/= 48 hours; 4] Diffuse alveolar damage in the chest radiograph; 5] PaO[2] /= 0.5

Results: During the period of the study, 23 infants [gestational age = 36 +/- 1.1 weeks of gestation; birth weight = 2756 +/- 453 gr] were included in the study. Their mean age at admission was 16.5 +/- 14.6 hours. The majority of infants [91.3%] were born by caesarean section before the onset of labour in 78.3% cases. All infants had a severe acute hypoxemic respiratory failure [D[A- a]O2 = 468 +/- 165; OI = 19 +/- 8.4]. Five infants [21.7%] improved their oxygenation parameters under conventional mechanical ventilation [CMV] [p<0.001; p = 0.002 et p=0.003 respectively for D[A - a] O[2], OI and PaO2/FiO[2]]. Eighteen infants [78.2%] required high frequency oscillatory ventilation [HFOV] with a rapid and persistant improvement of oxygenation parameters. Five patients [21.7%] developed pulmonary air leak

One infant died

Conclusion:ARDS represents 6.8% of etiology of respiratory distress in infants at term and near term. Caesarean section before the onset of labour seems to be a triggering factor. The outcome seems to be favourable [rate of survival = 95.7%] if the management is suitable