Occurrence of early epilepsy in children with traumatic brain injury: a retrospective study.

BACKGROUND: Early post-traumatic seizures (EPTS) refer to epileptic seizures occurring within one week after brain injury. This study aimed to define the risk factors of EPTS and the protective factors that could prevent its occurrence. METHODS: This is a single-center retrospective study in the PICU, Beijing Children's Hospital. Patients diagnosed with traumatic brain injury (TBI), admitted with and without EPTS between January 2016 and December 2020 were included in the study. RESULTS: We included 108 patients diagnosed with TBI. The overall EPTS incidence was 33.98% (35/108). The correlation between EPTS and depressed fractures is positive (P = 0.023). Positive correlations between EPTS and intracranial hemorrhage and subarachnoid hemorrhage had been established (P = 0.011and P = 0.004, respectively). The detection rates of EPTS in the electroencephalogram (EEG) monitoring was 80.00%. There was a significant difference in the EEG monitoring rate between the two groups (P = 0.041). Forty-one (37.86%, 41/108) post-neurosurgical patients were treated with prophylactic antiepileptic drugs (AEDs), and eight (19.51%, 8/41) still had seizures. No statistical significance was noted between the two groups in terms of prophylactic AEDs use (P = 0.519). Logistic regression analysis revealed that open craniocerebral injury and fever on admission were risk factors for EPTS, whereas, surgical intervention and use of hypertonic saline were associated with not developing EPTS. CONCLUSIONS: Breakthrough EPTS occurred after severe TBI in 33.98% of pediatric cases in our cohort. This is a higher seizure incidence than that reported previously. Patients with fever on admission and open craniocerebral injuries are more likely to develop EPTS.

Chinese guidelines for the assessment and provision of nutrition support therapy in critically ill children.

BACKGROUND: This document represents the first evidence-based guidelines to describe best practices in nutrition therapy in critically ill children (> 1 month and < 18 years), who are expected to require a length of stay more than 2 or 3 days in a Pediatric Intensive Care Unit admitting medical patients domain. METHODS: A total of 25,673 articles were scanned for relevance. After careful review, 88 studies appeared to answer the pre-identified questions for the guidelines. We used the grading of recommendations, assessment, development and evaluation criteria to adjust the evidence grade based on the quality of design and execution of each study. RESULTS: The guidelines emphasise the importance of nutritional assessment, particularly the detection of malnourished patients. Indirect calorimetry (IC) is recommended to estimate energy expenditure and there is a creative value in energy expenditure, 50 kcal/kg/day for children aged 1-8 years during acute phase if IC is unfeasible. Enteral nutrition (EN) and early enteral nutrition remain the preferred routes for nutrient delivery. A minimum protein intake of 1.5 g/kg/day is suggested for this patient population. The role of supplemental parenteral nutrition (PN) has been highlighted in patients with low nutritional risk, and a delayed approach appears to be beneficial in this group of patients. Immune-enhancing cannot be currently recommended neither in EN nor PN. CONCLUSION: Overall, the pediatric critically ill population is heterogeneous, and an individualized nutrition support with the aim of improving clinical outcomes is necessary and important.

Epidemiological features and risk factor analysis of children with acute lung injury.

BACKGROUND: Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) represents a devastating complication observed in critical care medicine. The purpose of this study is to investigate the epidemiological aspects of ALI/ARDS in pediatric intensive care unit (PICU) and risk factors of mortality. METHODS: Patients with ALI/ARDS in PICU of Beijing Children's Hospital, a tertiary medical center from November 1, 2005 to October 31, 2006 were included in this prospective study. We identified the risk factors for underlying diseases and mortality during a 3-month followup using multivariate logistic regression analysis. RESULTS: In 562 critically ill patients admitted to PICU of Beijing Children's Hospital, there were 15 ALI-non ARDS patients and 29 ARDS patients, resulting in an incidence of 7.8% (44/562). The mortality rate of ARDS was 24.1% (7/29) and that of ALI/ARDS was 18.2% (8/44). At a 3-month follow-up, 12 patients died after being discharged from PICU and the total mortality rate was 45.5% (20/44). ALI/ARDS patients with pulmonary disease had better outcomes than those with extra-pulmonary involvements (P<0.05). Discharge against medical advice, low PaO(2)/FiO(2) during hospital stay and high PaCO2 on PICU admission were risk factors of mortality. CONCLUSIONS: ARDS has a high mortality rate in PICU, especially in those with extra-pulmonary diseases. In addition to aggressive medical management of comorbidity, lung protection and avoidance of discharge against medical advice will decrease the mortality.

Comorbid presentation of severe novel influenza A (H1N1) and Evans syndrome: a case report.

One 22-month-old boy who was admitted for a fever lasting 6 days as well as a cough and wheezing lasting 2 days was reported. He was diagnosed with influenza A (H1N1, severe type), severe pneumonia, acute respiratory distress syndrome (ARDS), Evans syndrome and multiple organ failure. This is the first case of novel influenza A (H1N1) and Evans syndrome. The pathogenesis is still unknown.