A pleural ultrasound image of a collapsed lung surrounded by pleural fluid ("jellyfish sign") may correspond to an intrapericardial mass.

Lung ultrasound has been shown to be a valuable diagnostic tool. It has become the main way to get to the diagnosis of pleural effusion with much more specificity and sensibility than the x-ray. The diagnosis of pleural effusion with ultrasound is easily obtained after the visualization of hypoechoic fluid surrounding the lung. Sometimes it appears as an image of a collapsed lung moving with the surrounded pleural fluid ("jellyfish sign"). Until now this sign was almost pathognomonic of pleural effusion, but we explore a case in which this sign could have led to a misleading diagnosis. We present the case of a child admitted to intensive care with respiratory distress. In the point of care lung ultrasound we believed to see a pleural effusion with a collapsed lung moving into the effusion. Due to the enlargement of the pericardial sac, we did not realize that what we thought to be the pleural space was in fact the pericardial space. Unfortunately, there was a more echogenic area inside the pericardial effusion which led to a misleading fake lung atelectasis with pleural effusion ("jellyfish sign"). The correct diagnosis was properly obtained after assessing a cardiac point of care ultrasound using a four chambers view. The left side of the thorax is more difficult to be sonographed than the right due to the presence of the heart fossa that occupies a significant part of that side. Obtaining the diagnosis of pleural effusion on that side is more difficult for this reason and can sometimes be misleading with a pericardial effusion. The presence of the "jellyfish sign" is not pathognomonic and may lead to an error if we are guided only by the presence of that sign. To avoid such a misleading diagnosis, we highly recommend performing a point of care cardiac ultrasound if a pleural effusion is primarily seen in the lung ultrasound.

Evaluation of the vasoactive-inotropic score, mid-regional pro-adrenomedullin and cardiac troponin I as predictors of low cardiac output syndrome in children after congenital heart disease surgery / Evaluación de la escala vasoactiva-inotrópica, pro-adrenomedulina y troponina cardiaca-I como factores predictivos del síndrome de bajo gasto cardiaco en niños tras corrección quirúrgica de cardiopatías congénitas

Objective: To determine the predictive value of the inotropic score (IS) and vasoactive-inotropic score (VIS) in low cardiac output syndrome (LCOS) in children after congenital heart disease surgery involving cardiopulmonary bypass (CPB), and to establish whether mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin I (cTn-I), associated to the IS and VIS scores, increases the predictive capacity in LCOS. Design: A prospective observational study was carried out. Setting: A Paediatric Intensive Care Unit. Patients: A total of 117children with congenital heart disease underwent CPB. Patients were divided into two groups: LCOS and non-LCOS. Interventions: The clinical and analytical data were recorded at 2, 12, 24 and 48h post-CPB. Logistic regression was used to develop a risk prediction model using LCOS as dependent variable. Main outcome measures: LCOS, IS, VIS, MR-proADM, cTn-I, age, sex, CPB time, PIM-2, Aristotle score. Results: While statistical significance was not recorded for IS in the multivariate analysis, VIS was seen to be independently associated to LCOS. On the other hand, VIS>15.5 at 2h post-CPB, adjusted for age and CPB timepoints, showed high specificity (92.87%; 95%CI: 86.75-98.96) and increased negative predictive value (75.59%, 95%CI: 71.1-88.08) for the diagnosis of LCOS at 48h post-CPB. The predictive power for LCOS did not increase when VIS was combined with cTn-I >14ng/ml at 2h and MR-proADM >1.5nmol/l at 24h post-CPB. Conclusions: The VIS score at 2h post-CPB was identified as an independent early predictor of LCOS. This predictive value was not increased when associated with LCOS cardiac biomarkers. The VIS score was more useful than IS post-CPB in making early therapeutic decisions in clinical practice post-CPB

Objetivo: Estudiar el valor predictivo de la escala inotrópica (IS) y la escala vasoactiva-inotrópica (VIS) en el síndrome de bajo gasto cardiaco (SBGC) en niños poscirugía de cardiopatías congénitas mediante bypass cardiopulmonar (BCP). Determinar si adrenomedulina (MR-proADM) y troponina cardiaca-I (cTn-I) asociadas con IS y VIS incrementan su capacidad predictora de SBGC. Diseño: Estudio prospectivo y observacional. Ámbito: Cuidados intensivos pediátricos. Pacientes: Ciento diecisiete pacientes pediátricos con cardiopatías congénitas corregidos mediante BCP, clasificados en función de la presencia o no de SBGC. Intervenciones: Los datos analíticos y clínicos se midieron a las 2, 12, 24 y 48h post-BCP. Las principales variables se analizaron mediante regresión logística multivariante, considerando SBGC como variable dependiente. Variables de interés principales: SBGC, IS, VIS, MR-proADM, cTn-I, edad, sexo, BCP, PIM-2 y escala Aristóteles. Resultados: El IS no alcanzó significación estadística en el estudio multivariante; sin embargo, el VIS se asoció independientemente a SBGC. El VIS>15,5 a las 2h del ingreso en CIP, ajustado por edad y tiempo de CEC, muestra alta especificidad (92,87%; IC 95%: 86,75-98,96%) y alto valor predictivo negativo (75,59%; IC 95%: 71,10-88,08) para predecir SBGC a las 48h post-BCP. La capacidad predictora no se incrementa al incorporar cTn-I>14ng/ml a las 2h y ADM>1,5nmol/l a las 24h del postoperatorio. Conclusiones: El VIS a las 2h post-BCP es un predictor independiente precoz de SBGC. Este valor no se incrementa al asociarse biomarcadores cardiacos de LCOS. La escala de VIS fue más útil que la escala de IS en la toma de decisiones terapéuticas tras la cirugía cardiaca

Evaluation of the vasoactive-inotropic score, mid-regional pro-adrenomedullin and cardiac troponin I as predictors of low cardiac output syndrome in children after congenital heart disease surgery.

OBJECTIVE: To determine the predictive value of the inotropic score (IS) and vasoactive-inotropic score (VIS) in low cardiac output syndrome (LCOS) in children after congenital heart disease surgery involving cardiopulmonary bypass (CPB), and to establish whether mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin I (cTn-I), associated to the IS and VIS scores, increases the predictive capacity in LCOS. DESIGN: A prospective observational study was carried out. SETTING: A Paediatric Intensive Care Unit. PATIENTS: A total of 117children with congenital heart disease underwent CPB. Patients were divided into two groups: LCOS and non-LCOS. INTERVENTIONS: The clinical and analytical data were recorded at 2, 12, 24 and 48h post-CPB. Logistic regression was used to develop a risk prediction model using LCOS as dependent variable. MAIN OUTCOME MEASURES: LCOS, IS, VIS, MR-proADM, cTn-I, age, sex, CPB time, PIM-2, Aristotle score. RESULTS: While statistical significance was not recorded for IS in the multivariate analysis, VIS was seen to be independently associated to LCOS. On the other hand, VIS>15.5 at 2h post-CPB, adjusted for age and CPB timepoints, showed high specificity (92.87%; 95%CI: 86.75-98.96) and increased negative predictive value (75.59%, 95%CI: 71.1-88.08) for the diagnosis of LCOS at 48h post-CPB. The predictive power for LCOS did not increase when VIS was combined with cTn-I >14ng/ml at 2h and MR-proADM >1.5nmol/l at 24h post-CPB. CONCLUSIONS: The VIS score at 2h post-CPB was identified as an independent early predictor of LCOS. This predictive value was not increased when associated with LCOS cardiac biomarkers. The VIS score was more useful than IS post-CPB in making early therapeutic decisions in clinical practice post-CPB.

Terlipresina como tratamiento de rescate de las crisis hipoxímicas en la tetralogía de fallot / Terlipressin as rescue therapy in hypercyanotic spells of fallot tetralogy

Las crisis hipoxémicas, especialmente frecuentes en la tetralogía de Fallot, son una emergencia médica, que pueden originar secuelas neurológicas o incluso la muerte. Se producen por una disminución drástica del flujo pulmonar, con aumento de shunt derecha-izquierda y caída de la saturación arterial sistémica. Su tratamiento incluye α-agonistas (como metoxamina, fenilefrina), que incrementan las resistencias periféricas, forzando la entrada de sangre por el infundíbulo. Sin embargo, en nuestro medio no están comercializados. Una alternativa no descrita aún podría ser terlipresina, un potente vasoconstrictor. Se presenta un lactante de 3 meses de edad, con tetralogía de Fallot e hipoplasia de ramas pulmonares, que desarrolló crisis hipoxémicas graves durante el postoperatorio de cirugía paliativa (Blalock-Taussig), sin respuesta al tratamiento habitual. La administración de terlipresina, hasta en 3 episodios, consiguió revertir las mismas, con un incremento significativo de la saturación arterial. Aunque no existe evidencia actualmente, la terlipresina podría ser una alternativa a los α-agonistas en estos pacientes (AU)

Hypercyanotic spells, very common in Fallot tetralogy, are a medical emergency and can cause neurological damage or even death. They are produced by a dramatic decrease in pulmonary blood flow, with increased right-left shunt and a drop in systemic arterial saturation. Treatment includes α-agonists (such as methoxamine or phenylephrine), which increase peripheral resistance, forcing the entry of blood through the infundibulum. However, they are not available in our environment. An alternative, still not described, could be terlipressin, a potent vasoconstrictor. We report a three months old infant, with Fallot tetralogy and hypoplastic pulmonary branches, who developed a severe hypoxaemic crisis during postoperative palliative surgery (Blalock-Taussig), no responsive to standard therapy. The administration of terlipressin in three hypercyanotic spells, was effective and reversed them, with a significant and sustained increase in arterial saturation. Although there is still no evidence, terlipressin may be an alternative to α-agonists in these patients (AU)

[Terlipressin as rescue therapy in hypercyanotic spells of Fallot tetralogy]. / Terlipresina como tratamiento de rescate de las crisis hipoxémicas en la tetralogía de fallot.

Hypercyanotic spells, very common in Fallot tetralogy, are a medical emergency and can cause neurological damage or even death. They are produced by a dramatic decrease in pulmonary blood flow, with increased right-left shunt and a drop in systemic arterial saturation. Treatment includes alpha.-agonists (such as methoxamine or phenylephrine), which increase peripheral resistance, forcing the entry of blood through the infundibulum. However, they are not available in our environment. An alternative, still not described, could be terlipressin, a potent vasoconstrictor. We report a three months old infant, with Fallot tetralogy and hypoplastic pulmonary branches, who developed a severe hypoxaemic crisis during postoperative palliative surgery (Blalock-Taussig), no responsive to standard therapy. The administration of terlipressin in three hypercyanotic spells, was effective and reversed them, with a significant and sustained increase in arterial saturation. Although there is still no evidence, terlipressin may be an alternative to alpha.-agonists in these patients.

Ventilación mecánica invasiva en fibrosis quística: influencia en el trasplante pulmonar / Invasive mechanical ventilation in cystic fibrosis: Influence in lung transplant

Introducción: La ventilación mecánica invasiva (VMI) en pacientes con fibrosis quística (FQ) y enfermedad pulmonar avanzada es una contraindicación relativa para el trasplante pulmonar (TP) en adultos, sin que se disponga de suficientes datos pediátricos. Pacientes y métodos: Estudio retrospectivo de 8 años en pacientes con FQ a los que se les realizó TP (n = 21), analizando sus resultados según recibiesen (n = 8) o no (n = 13) VMI preTP. Se compararon datos demográficos, quirúrgicos, postoperatorios, de función pulmonar y de supervivencia (inmediata y al año) entre ambos grupos. Se estimó el papel de la VMI preTP como factor de riesgo postoperatorio (odds ratio) y se realizó el análisis de Kaplan-Meier de supervivencia en ambos grupos. Resultados: No hubo diferencias significativas en edad, sexo y parámetros nutricionales entre ambos grupos. El tiempo medio de VMI preTP fue de 7,12 días (de 4 a 12 días). El número medio de rechazos, el tiempo de VMI posTP y la estancia en unidad de cuidados intensivos pediátricos fueron significativamente superiores en pacientes con VMI preTP. Ésta fue un factor de riesgo para la necesidad de circulación extracorpórea, traqueotomía, rechazo del injerto y fallo orgánico postoperatorio asociado. No hubo diferencias significativas en la función del injerto y la supervivencia inmediata y al año tras el TP, pero el análisis de supervivencia a más largo plazo sí difirió significativamente entre ambos grupos. Conclusiones: A partir de la experiencia de los autores de este artículo, los pacientes con FQ que requieren VMI preTP presentan una cirugía y un postoperatorio más complejos. La VMI no influiría en la supervivencia inmediata y al año, pero sí en la supervivencia a más largo plazo (AU)

Introduction: Invasive mechanical ventilation (IMV) in patients with advanced cystic fibrosis (CF) is a relative contraindication for lung transplant (LT) in adults, although there is currently no data on children. Patients and methods: An 8-year retrospective study on 21 children with CF who underwent LT was performed, analysing their results as they were receiving (n=8) or not (n=13) IMV pretransplant. Demographic and surgical data, postoperative course, lung function and survival (immediate and 1-year) were compared between both groups. The role of the IMV pretransplant as a postoperative risk factor was estimated (odds ratio) and Kaplan Meier survival study was performed in both groups. Results: No differences in patient age, sex and nutritional parameters were observed between both groups. Those on IMV who received LT required more frequent and longer bypass, more need for tracheotomy, a higher number of rejection episodes per patient and multiorgan failure, longer PICU stay and longer time on IMV than those who were not on IMV when LT was received. Nevertheless, no differences could be found regarding graft function and immediate and 1-year survivals (62.5% vs. 92.3% with and without IMV respectively). On the other hand, long-term survival was significantly lower than in patients on IMV. Conclusions: In our experience, children with CF on IMV who receive LT have more complicated surgery and immediate postoperative course. Though immediate and 1-year results and survivals may be encouraging, medium and long-term ones are significantly lower (AU)

[Invasive mechanical ventilation in cystic fibrosis: Influence in lung transplant]. / Ventilación mecánica invasiva en fibrosis quística: influencia en el trasplante pulmonar.

INTRODUCTION: Invasive mechanical ventilation (IMV) in patients with advanced cystic fibrosis (CF) is a relative contraindication for lung transplant (LT) in adults, although there is currently no data on children. PATIENTS AND METHODS: An 8-year retrospective study on 21 children with CF who underwent LT was performed, analysing their results as they were receiving (n = 8) or not (n = 13) IMV pretransplant. Demographic and surgical data, postoperative course, lung function and survival (immediate and 1-year) were compared between both groups. The role of the IMV pretransplant as a postoperative risk factor was estimated (odds ratio) and Kaplan Meier survival study was performed in both groups. RESULTS: No differences in patient age, sex and nutritional parameters were observed between both groups. Those on IMV who received LT required more frequent and longer bypass, more need for tracheotomy, a higher number of rejection episodes per patient and multiorgan failure, longer PICU stay and longer time on IMV than those who were not on IMV when LT was received. Nevertheless, no differences could be found regarding graft function and immediate and 1-year survivals (62.5% vs. 92.3% with and without IMV respectively). On the other hand, long-term survival was significantly lower than in patients on IMV. CONCLUSIONS: In our experience, children with CF on IMV who receive LT have more complicated surgery and immediate postoperative course. Though immediate and 1-year results and survivals may be encouraging, medium and long-term ones are significantly lower.

[Care of the critically ill child with heart disease in Spain]. / La asistencia al niño crítico con cardiopatía en España.

INTRODUCTION: The objective of the present study is to present the organization of the resources of paediatric cardiac critical care in Spain. PATIENTS AND METHODS: Data were collected through questionnaires sent by e-mail to Spanish PICUs. RESULTS: 22 PICUs were enrolled. The median number of beds were 9.5 (4-18 beds). Total cardiac admissions represented a 20 % of total PICUs admissions per year, firstly for congenital heart defects, and secondly for respiratory problems. Cardiac surgical activities were carried out in 16 centres, centralized in PICU in 10 cases. Mechanical support of the myocardium was performed in 7 PICUs. A total of 10 participating PICUs considered echocardiograph training necessary and also an increase in the amount of activity for better results. CONCLUSIONS: Paediatric cardiac critical care involves a significant use of resources, including PICUs with no surgical activity. This study is useful for detecting common problems and for improving clinical care.

La asistencia al niño crítico con cardiopatía en España / Care of the critically ill child with heart disease in Spain

Introducción: Los niños con cardiopatía constituyen una causa frecuente de ingreso en UCIP. El objetivo de este estudio es conocer la organización de su asistencia en España. Pacientes y métodos: Se elaboró un cuestionario que se envió por correo electrónico a todas las UCIP englobadas en la Sociedad Española de Cuidados Intensivos Pediátricos. Resultados: Contestaron la encuesta 22 UCIP, con una mediana de camas de 9,5 (rango 4-18). Los ingresos de niños críticos con cardiopatía representaron el 20 % del total de ingresos anuales en las UCIP con actividad cardioquirúrgica y hasta el 10 % en UCIP sin dicha actividad. Las causas de ingreso más frecuentes fueron las cardiopatías congénitas (coartación aórtica y defectos de septo) y, en segundo lugar, problemas no cardiológicos (fundamentalmente infecciones respiratorias). Asisten el postoperatorio de cirugía cardíaca infantil 16 UCIP (4 unidades tienen programa de trasplante cardíaco pediátrico), 10 de ellas de forma centralizada en su centro. Un total de 7 unidades disponen de medios de soporte mecánico miocárdico; 10 de las UCIP encuestadas consideraron muy importante adquirir formación en ecocardiografía, así como la agrupación de los pacientes en áreas especializadas. Conclusiones: La atención al niño crítico con cardiopatía supone una utilización importante de recursos en las UCIP, incluidas aquellas que no atienden postoperatorios cardíacos. Este tipo de estudios permite identificar limitaciones comunes y favorecer la asistencia de este tipo de pacientes (AU)

Introduction: The objective of the present study is to present the organization of the resources of paediatric cardiac critical care in Spain. Patients and methods: Data were collected through questionnaires sent by e-mail to Spanish PICUs. Results: 22 PICUs were enrolled. The median number of beds were 9.5 (4-18 beds). Total cardiac admissions represented a 20 % of total PICUs admissions per year, firstly for congenital heart defects, and secondly for respiratory problems. Cardiac surgical activities were carried out in 16 centres, centralized in PICU in 10 cases. Mechanical support of the myocardium was performed in 7 PICUs. A total of 10 participating PICUs considered echocardiograph training necessary and also an increase in the amount of activity for better results. Conclusions: Paediatric cardiac critical care involves a significant use of resources, including PICUs with no surgical activity. This study is useful for detecting common problems and for improving clinical care (AU)

[External ventricular assist devices as circulatory support in patients with dilated cardiomyopathy]. / Asistencia ventricular externa como soporte circulatorio en un paciente con miocardiopatía dilatada.

Ventricular assist devices have demonstrated their utility in patients with intractable cardiac failure, both as support until complete myocardial recovery and as a bridge to transplantation. Specific pediatric pneumatic paracorporeal systems can be applied even in infants. Long-term survival has been reported although experience is limited. We report the case of an 8-year-old boy with dilated cardiomyopathy awaiting cardiac transplantation. The patient developed profound cardiogenic shock with multiorgan failure while being evaluated for heart transplantation. He was given biventricular assistance with the MEDOS-HIA system (MEDOS-Helmholtz Institute). Maximum stroke volume ventricles of 25 and 22 ml were used, achieving a cardiac output of 2.2 l/min in both ventricles. The patient was supported with ventricular assistance for 9 days, but multiple organ failed to improve and transplantation became impossible. Progressive loss of peripheral circulatory resistance unresponsive to treatment developed and ventricular assistance was discontinued. The previous severe shock and advanced and progressive multiorgan failure could be responsible for the poor outcome of our patient despite maintenance of adequate cardiac output. Nevertheless, the use of ventricular assist devices is a real therapeutic alternative in children with severe cardiogenic shock, allowing them to recover completely or undergo heart transplantation. Patient selection, the choice of a system of appropriate size, and early implantation seem to be the cornerstones for obtaining good results.

Asistencia ventricular externa como soporte circulatorio en un paciente con miocardiopatía dilatada / External ventricular assist devices as circulatory support in patients with dilated cardiomyopathy

La asistencia ventricular ha demostrado su utilidad en adultos con fallo cardíaco intratable, tanto como soporte hasta la recuperación del miocardio como puente al trasplante. El desarrollo de sistemas pediátricos ha hecho posible su aplicación, incluso en niños pequeños, con buenos resultados a largo plazo, aunque existe muy poca experiencia. Se presenta un paciente de 8 años con miocardiopatía dilatada que desarrolló shock cardiogénico con fracaso multiorgánico en el transcurso de la evaluación para trasplante cardíaco. El paciente fue tratado con asistencia biventricular mediante el sistema MEDOS-HIA (MEDOS-Helmholtz Institute), utilizándose ventrículos de 25 y 22 ml de volumen máximo con lo que se consiguió mantener un índice cardíaco de ambos ventrículos superior a 2,2 l/min. Permaneció durante 9 días con asistencia ventricular, sin signos de mejoría del fallo multiorgánico, lo que imposibilitó la realización de trasplante cardíaco. Finalmente se produjo una pérdida de las resistencias vasculares sistémicas sin respuesta al tratamiento, y se decidió retirar la asistencia ventricular. Consideramos que la mala evolución del paciente se debió a la presencia de disfunción multiorgánica severa previa, que fue irreversible pese a mantener un adecuado gasto cardíaco en ausencia de ritmo cardíaco propio efectivo. En cualquier caso, la asistencia ventricular en la edad pediátrica es una realidad que permite a niños con shock cardiogénico severo recuperarse completamente o llegar a trasplante cardíaco. La selección de pacientes, la adecuada elección del tamaño del sistema y la instauración precoz es crucial para obtener buenos resultados (AU)

[Effects of competitive physical exercise on neuroendocrine response and interleukin-6 liberation in children]. / Repercusión del ejercicio físico competitivo en la respuesta neuroendocrina y liberación de interleuquina-6 en niños.

OBJECTIVE: The purpose of this study was to evaluate the effects of physical activity on the secretion of cortisol, melatonin and interleukin-6 (IL-6) in children. PATIENTS AND METHODS: A controlled prospective study was carried out. Based on anthropometrical measurements and physical examination, which excluded those with an organic pathology or that were further than one standard deviation from the 50th percentile, 74 male children aged 6 or 7 years were included in this study. Forty-one children from a public school (PS) and 33 children from a soccer sport school (SS) were selected and asked to perform three different physical activities. A score was made to evaluate their performance and both before and after physical activity salivary samples were obtained to measure cortisol, melatonin and IL-6 concentrations. RESULTS: The children in the SS group had a better global physical performance score than those from the PS. There were no statistically significant differences in biochemical parameters between the two groups before and after exercise. There was a rise in the cortisol, melatonin and IL-6 levels after physical activity in both groups. The increment in melatonin levels after exercise was significantly higher in the SS group. There was a strong positive correlation between the rise of cortisol and IL-6 levels after exercise. CONCLUSIONS: In our study, controlled physical competitive activity in children 6 or 7 years of age showed no negative repercussion on cortisol secretion or in the liberation of IL-6.

[Effects of physical exercise on the cardiorespiratory system in children]. / Repercusión cardiorrespiratoria del ejercicio físico en niños.

OBJECTIVE: Our aim was to perform a prospective study to evaluate the effects of competitive sports on the cardiorespiratory system and physical performance in children. PATIENTS AND METHODS: Male children aged 6 and 7 years were selected from a public school (PS) and from a soccer sports school (SS). They underwent anthropometrical measurement. Those boys who were further than one standard deviation from the 50th percentile were excluded from the study. A total of 74 boys were selected with 41 being from the PS and 33 from the SS. Three different physical competitive activities were performed by the children. Hemodynamic measurements [heart rate (HR), systolic, mean and diastolic blood pressure (SBP, MBP and DBP)] and respiratory measurements [respiratory rate (RR), arterial oxygen saturation (SatO2), peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and the FEV1/FVC relationship] were taken before and after the physical activity. RESULTS: Overall we found a significantly higher physical performance in the SS group (p < 0.001). The HR before and after exercise was significantly lower in the SS group. The comparison between constants before and after physical activity in each group showed a significant increase in HR, SBP, MBP and DBP in the PS group, but there was no difference between the SBP before and after physical activity in the SS group. The SS group had a significantly lower RR and better SatO2 in the basal measurement. The relationship between constants before and after physical activity showed a rise in the PEF in the PS group and a decrease in the SatO2 in the SS group. CONCLUSIONS: We recommend controlled physical competitive activity in children because of its benefits on cardiorespiratory function and the absence of adverse effects.

[Prospective study of Candida-related sepsis in the neonate]. / Estudio prospectivo de sepsis por Candida en el recién nacido.

OBJECTIVE: Our objective was to carry-out a prospective study of newborns with systemic candidiasis admitted to our Neonatology Unit in a teritiary hospital during the period of March 1994-September 1997. PATIENTS AND METHODS: To be included in the study the patient had to have Candida sp recovered from a normally sterile body fluid and clinical signs of sepsis. We analyzed perinatal and neonatal antecedents, risk factors, clinical course, diagnosis, treatment and outcome. RESULTS: The incidence of systemic candidiasis was 0.62% (14 newborns). Two were term infants and 12 preterm infants, 9 of which weighed less than 1500 g. All of the patients had as predisposing factors the use of broad spectrum antibiotics, prolonged intravascular catheterization and parenteral nutrition, while 64% had mechanical ventilation. The mean age at onset of sepsis was 22 days, with non-specific clinical presentation. Four infants were treated with intravenous amphotericin B and 9 with liposomal amphotericin B in association with fluconazole in one patient and with flucytosine and fluconazole in another. No adverse effects were observed. Mortality was 21%. C. parapsilosis was isolated in 7 cases and C. albicans in another 7 patients, with an important increase in C. parapsilosis in the last few years. CONCLUSIONS: Clinical suspicion of invasive candidiasis requires the removal of indwelling catheters and early initiation of systemic ungal therapy to reduce mortality. The increased incidence of species with more epidemic presentation like C. parapsilosis reinforce the importance of control measures such as handwashing for all personnel and aseptic management of intravascular catheters and solutions in order to prevent infections.