Fournier gangrene in an infant, complicated with severe sepsis and liver dysfunction: A case report.

BACKGROUND: Fournier gangrene is a rare, life-threatening infection characterized by necrotizing fasciitis in the perineal, genital and/or lower abdominal regions. Despite its rarity, the unfavorable prognosis associated with this disease is dependent on the timing of medical care. CASE SUMMARY: A 3-month-old boy was admitted to our pediatric intensive care unit in critical condition after a 5-day history of fever and scrotal erythema with breaching skin lesions and swelling. Despite ambulatory antibiotic treatment, the child's clinical condition deteriorated. At the time of admission, the child had necrotizing scrotal fasciitis that had spread to the abdomen. Following reanimation, the surgeon decided on an immediate intervention to rule out testicular torsion and to debride the affected area. Despite optimal antibiotic and supportive therapy, the patient developed severe sepsis with liver dysfunction, making treatment more challenging. CONCLUSION: Recognizing Fournier gangrene, prompt referral to pediatric surgery, and appropriate antibiotic coverage are critical for avoiding sepsis and multiorgan dysfunction.

Clinical efficacy of IgM-enriched immunoglobulin as adjunctive therapy in neonatal and pediatric sepsis: a systematic review and meta-analysis.

Background: Sepsis is a major cause of mortality and morbidity globally, with around one-quarter of all sepsis-related deaths occurring in children under the age of 5. We conducted a meta-analysis and systematic review of the literature to evaluate the clinical effectiveness of an IgM-enriched immunoglobulin preparation in pediatrics patients and neonates with sepsis. Methods: Systematic searches of PubMed, the Cochrane Library and Embase databases were performed in November 2022, with no date limitations, to identify studies in which IgM-enriched immunoglobulin was used as adjunctive therapy in neonatal and pediatric patients with sepsis. Results: In total, 15 studies fulfilled the eligibility criteria, 13 neonatal studies and 2 pediatric studies. Pooled estimates from all studies indicated that mortality rates were significantly lower in patients who received treatment with the IgM-enriched immunoglobulin compared with controls (OR 0.41; 95% CI 0.32-0.55). Further analyses in neonatal studies, alone, showed a significant benefit with longer treatment durations (>3 days) vs. the recommended treatment duration (3 days) (OR 0.32; 95% CI 0.22-0.47) vs. (OR 0.61; 95% CI 0.41-0.92). Treatment with IgM-enriched immunoglobulin was associated with a lower mortality risk compared with controls in prospective studies vs. retrospective analyses (OR 0.37; 95% CI 0.27-0.51) vs. (OR 0.73; 95% CI 0.41-1.30). Conclusions: This systematic review suggests that adjunctive treatment with IgM-enriched immunoglobulin may reduce the risk of mortality in neonatal and pediatric populations. However, large randomized controlled trials are required to further substantiate and evaluate these findings.

The management of fever in children.

Fever is an abnormal increase in body temperature that occurs as part of a specific biologic response mediated and controlled by the central nervous system. Despite the fact that most fevers are viral in origin, approaching a febrile child is always a concern for any physician. There is still a significant gap between current practice and scientific evidence. According to research, we are at a crossroad, with strong research evidence accumulating over the last few decades supporting a positive role for fever and the ongoing pressures of current practice to lower body temperature. Despite the fact that most pediatricians agree that treating a febrile child with antipyretics is primarily for the relief of fever symptoms, many continue to prescribe antipyretics for any child with fever, ignoring important research messages. By prescribing antipyretics to children who are only mildly febrile, pediatricians may contribute to fever phobia. We give parents the impression that fever is harmful and that antipyresis is beneficial when we focus on treating the fever. The purpose of this review is to present the evidence that is currently available regarding the management of the febrile child.

Atraumatic splenic rupture in a child with COVID 19.

BACKGROUND: The majority of children with COVID-19 have only minor symptoms or none at all. COVID-19, on the other hand, can cause serious illness in some children, necessitating hospitalization, intensive care, and invasive ventilation. Many studies have revealed that SARS-CoV-2 affects not only the respiratory system, but also other vital organs in the body. We report here a child with an atraumatic splenic rupture as the initial and only manifestation of COVID-19. CASE PRESENTATION: A 13-year-old boy with clinical signs of acute abdomen, left-sided abdominal pain, and hemodynamic instability was admitted to the PICU in critical condition. His parents denied any trauma had occurred. In addition to imaging tests, a nasopharyngeal swab was taken for COVID-19 testing, which was positive. The thoracic CT scan was normal, whereas the abdominal CT scan revealed hemoperitoneum, splenic rupture, and free fluid in the abdomen. CONCLUSIONS: The spleen is one of the organs targeted by the SARS-CoV-2. Splenic rupture, a potentially fatal and uncommon complication of COVID-19, can be the first and only clinical manifestation of the disease in children. All pediatricians should be aware of the possibility of atraumatic splenic rupture in children with COVID-19.

Neonatal Morbidity in Late Preterm Infants Associated with Intrauterine Growth Restriction.

AIM: This study aims to compare the neonatal morbidity of Intrauterine growth restricted (IUGR) Late Preterm (LP) babies, to those born Late Preterm but evaluated as Appropriate for Gestational Age (AGA). METHODS: The study is a 2-year prospective one that used data from the Neonatal Intensive Care Unit (NICU) charts of LP neonates born in our tertiary maternity hospital "Koço Gliozheni" in Tirana. Congenital anomalies and genetical syndromes are excluded. Neonatal morbidity of IUGR Late Preterm is compared to those born Late Preterm but evaluated as AGA. OR and CI, 95% is calculated. RESULTS: Out of 336 LP babies treated in NICU, 88 resulted with IUGR and 206 AGA used as a control group. We found significantly higher morbidity in the IUGR group for hypoglycemia, polycythemia, feeding intolerance, birth asphyxia and seizures, secondary sepsis have higher morbidity but the difference is not significant. No differences were found for hyperbilirubinemia in both groups. No neonatal deaths were observed in both groups. CONCLUSION: Our study showed that late preterm IUGR has a significantly higher risk for neonatal morbidity when compared to late preterm AGA babies.