ABSTRACT
BACKGROUND AND AIMS: The need for primary prophylaxis of variceal bleeding in children is unclear due to insufficient evidence of the efficacy of prophylactic therapy and the mortality and morbidity associated with the first bleeding event. Previous studies have provided estimates of mortality. We aimed to investigate the morbidity associated with acute variceal bleeding (AVB) in children and to identify contributing factors. METHODS: We retrospectively reviewed children with chronic liver disease or portal vein thrombosis admitted with acute upper gastrointestinal bleeding between 2000 and 2015. RESULTS: Seventy AVB episodes in 57 children (median age 6 years, 52% girls) were included, 58% with cirrhosis and 30% portal vein thrombosis. Approximately 67% were the patient's first bleed. Post-AVB morbidity was present in 57% of all episodes and in 64% of first bleeds and included: ascites (34%), infection (30%), respiratory complications (24%), intensive care unit admission (20%), rebleed (11%), encephalopathy (7%), acute kidney injury (6%), and failure to control bleed (4%). Two patients died (4% of first bleeds, 8% of cirrhotics' first bleeds) within 6 weeks of bleeding. Median length of stay was 7 days. Overall morbidity was associated with total bilirubin (Pâ=â0.001). Ascites after AVB was associated with pediatric end-stage liver disease (Pâ=â0.0007), total bilirubin (Pâ=â0.001), and cirrhosis (Pâ=â0.006). Median length of stay was longer in patients with morbidities (18 vs 4 days, Pâ<â0.0001). CONCLUSION: Children with AVB suffer significant morbidity but have a low risk of death. Morbidity should therefore be considered in future studies measuring the risks and benefits of primary prophylaxis of first AVB in children.
Subject(s)
Esophageal and Gastric Varices/epidemiology , Gastrointestinal Hemorrhage/epidemiology , Liver Diseases/epidemiology , Venous Thrombosis/epidemiology , Acute Disease , Adolescent , Child , Child, Preschool , Cohort Studies , Comorbidity , Female , Humans , Infant , Male , Portal Vein/pathology , Retrospective StudiesABSTRACT
INTRODUCTION: In Cavernous transformation of portal vein (CTPV), therapeutic options are limited; however the restoration of circulation by mesenteric-portal bypass (MPB) is an option in selected cases. CASE REPORT 1: 13-year-old female with polymalformative syndrome. Admission at 4 months of age to Intensive Care Unit due to severe pneumonia with hemodynamic instability. Follow up due to thrombocytopenia and splenomegalia she was diagnosed CTPV at7-years old. At 13y-old she was submitted to MPB. CASE REPORT 2: 9-years-old male; severe neonatal Rh isoimmunization treated with exsanguinations. Followed-up since 6-months ofage due to thrombocytopenia and splenomegalia, and at 3 years of age he was diagnosed CTPV. Due to disease progression he was proposed as candidate to MBP which was contraindicated due to vascular thrombosis of the Rex recess. COMMENTS: MBP presents as one of the few therapeutic options to CTPV in children; due to its specificity and rigid requirements it is vital the close follow up and early diagnosis.
Subject(s)
Hypertension, Portal , Portal Vein/abnormalities , Adolescent , Child , Female , Humans , Hypertension, Portal/diagnosis , Hypertension, Portal/therapy , MaleABSTRACT
Cough is perhaps the most frequently seen symptom in children and as such one of the most common reasons for physician appointments. The mechanics and causes of cough in children are different to those in adults and imply a different diagnostic and therapeutic management. This article reviews the physiopathology of cough in children, the most frequent causes, the initial evaluation and the treatment slant.
