ABSTRACT
BACKGROUND: Inflation of the gastrointestinal lumen is vital for proper visualization during endoscopy. Air, insufflated via the endoscope, is gradually being replaced with carbon dioxide (CO 2 ) in many centers, with the intention of minimizing post-procedural discomfort due to retained gas. Recent studies suggest that the use of CO 2 during pediatric esophagogastroduodenoscopy (EGD) with an unprotected airway is associated with transient elevations in exhaled CO 2 (end-tidal CO 2 , EtCO 2 ), raising safety concerns. One possible explanation for these events is eructation of insufflation gas from the stomach. OBJECTIVES: To distinguish eructated versus absorbed CO 2 by sampling EtCO 2 from a protected airway with either laryngeal mask airway (LMA) or endotracheal tube (ETT), and to observe for changes in minute ventilation (MV) to exclude hypoventilation events. METHODS: Double-blinded, randomized clinical trial of CO 2 versus air insufflation for EGD with airway protection by either LMA or ETT. Tidal volume, respiratory rate, MV, and EtCO 2 were automatically recorded every minute. Cohort demographics were described with descriptive characteristics. Variables including the percent of children with peak, transient EtCO 2 ≥ 60 mmHg were compared between groups. RESULTS: One hundred ninety-five patients were enrolled for 200 procedures. Transient elevations in EtCO 2 of ≥60 mmHg were more common in the CO 2 group, compared to the air group (16% vs 5%, P = 0.02), but were mostly observed with LMA and less with ETT. Post-procedure pain was not different between groups, but flatulence was reported more with air insufflation ( P = 0.004). CONCLUSION: Transient elevations in EtCO 2 occur more often with CO 2 than with air insufflation during pediatric EGD despite protecting the airway with an LMA or, to a lesser degree, with ETT. These elevations were not associated with changes in MV. Although no adverse clinical effects from CO 2 absorption were observed, these findings suggest that caution should be exercised when considering the use of CO 2 insufflation, especially since the observed benefits of using this gas were minimal.
Subject(s)
Intubation, Intratracheal , Laryngeal Masks , Humans , Child , Intubation, Intratracheal/adverse effects , Laryngeal Masks/adverse effects , Endoscopy, Gastrointestinal , StomachABSTRACT
We report a case of disseminated tularemia in a previously healthy 8-month-old male. This case highlights an atypical presentation of tularemia with multisystem organ involvement. The diagnosis was complicated by concurrent primary cytomegalovirus infection. Bronchoalveolar lavage culture confirmed the diagnosis. The patient was successfully treated with gentamicin. Pertinent literature reviewed.
Subject(s)
Cytomegalovirus Infections , Tularemia , Cytomegalovirus , Gentamicins/therapeutic use , Humans , Infant , Male , Tularemia/diagnosis , Tularemia/drug therapyABSTRACT
The association of Down's syndrome with aplastic anemia is extremely rare with only six such cases reported in world literature. Herein, we report a child of Down's syndrome with pancytopenia and hypocellular marrow. There was associated hypothyroidism and the pancytopenia resolved with thyroxine treatment. The child made uneventful recovery.
Subject(s)
Anemia, Aplastic/complications , Down Syndrome/complications , Hypothyroidism/complications , Pancytopenia/complications , Anemia, Aplastic/therapy , Anti-Bacterial Agents/therapeutic use , Child , Erythrocyte Transfusion , Female , Humans , Hypothyroidism/therapy , Pancytopenia/therapy , Platelet Transfusion , Thyroxine/therapeutic use , Treatment OutcomeSubject(s)
Enterococcus faecalis , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/therapy , Infant, Premature, Diseases/microbiology , Intensive Care, Neonatal , Vancomycin Resistance , Female , Gram-Positive Bacterial Infections/diagnosis , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/therapyABSTRACT
BACKGROUND: There are no evidence-based guidelines for the treatment of neonatal sepsis although standard text books recommend 14 days of antibiotics for blood culture-proven neonatal sepsis. OBJECTIVE: The present study compared the effectiveness of a 10-day course of antibiotic therapy with the conventional 14-day course in blood culture-proven neonatal sepsis. METHODS: Infants ≥ 32 weeks and ≥ 1.5 kg weight with blood culture-proven sepsis were randomized to either 10-day (study group) or 14-day (control group) therapy on Day 7 of appropriate antibiotic therapy, if they were in clinical remission and were C-Reactive Protein (CRP) negative. The primary outcome was treatment failure within 28 days defined by either positive CRP or positive blood culture or clinical relapse. RESULTS: The baseline characteristics were comparable between the two groups. There was one treatment failure in each group. The duration of hospital stay was significantly shorter in the 10-day treatment group. CONCLUSION: Ten-day antibiotic therapy is as effective as 14-day therapy in blood culture-proven neonatal sepsis, if the infant has achieved clinical remission by Day 7 of therapy.
