ABSTRACT
The paper reports 40 cases of lethal outcomes in children with croup syndrome treated in Morozov Children's Moscow City Hospital in 1985-1998. 92.5% of them died of severe pneumonia complications, 7.5%--of sepsis. 70% of the deceased were infants aged 0-2 years, 75% of them were boys. All the children had aggravated premorbid background. The sputum and organ tissues contained in most cases association of viruses with staphylococci and streptococci resistant to standard antibiotics (penicillin, ampicillin, cefazoline). The conclusion is made that children with croup died primarily of severe pneumonia complications in low systemic reactivity and bacterial-viral association of the agents resistant to the antibacterial therapy.
Subject(s)
Croup/complications , Croup/mortality , Pneumonia/etiology , Pneumonia/mortality , Child , Child, Preschool , Drug Resistance, Microbial , Humans , Infant , Infant, NewbornABSTRACT
OBJECTIVE: Comparative assessment of pediatric intensive care. DESIGN: Prospective multicenter study. SETTING: Four pediatric intensive care units in Moscow, the Russian Federation. PATIENTS: Consecutive unselected admissions (n = 583), < or = 14 yrs of age, in a 6-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Effectiveness was defined as the ratio of observed to predicted mortality, based on prediction by Pediatric Risk of Mortality (PRISM) severity of illness scoring. Efficiency (on the day of admission only) depended on either a mortality risk of > 1% or the administration of intensive care unit-dependent therapies. In all four hospitals, observed mortality rates were higher than expected, with a range of standardized mortality ratios between 1.10 and 1.83 (mean 1.32). The excess mortality was found in the low- and medium-risk strata (risk of mortality of < 1% to 15%). Admission efficiency ratings did not fluctuate greatly between institutions (mean 60.4%, range 55.7 to 65.9). CONCLUSIONS: We provided a quantitative description and assessment of pediatric intensive care in Moscow. Moderate efficiency may reflect a low threshold for ICU admission due to poor nurse/patient ratios on the wards. Effectiveness in the low- and medium-risk strata is below standard, as compared with a Western reference population. Excess mortality was concentrated in the low- and medium-risk strata, and can only partially be explained by the inclusion of co-morbidity. Future analysis should focus on specific treatment protocols, protocol adherence, and the determination of infectious and therapeutic complications.
Subject(s)
Intensive Care Units, Pediatric/statistics & numerical data , Mortality , Outcome Assessment, Health Care , Child , Child, Preschool , Data Collection , Humans , Infant , Intensive Care Units, Pediatric/standards , Moscow , Prospective Studies , Risk FactorsABSTRACT
In 39 children with coma caused by infectious toxicosis, purulent meningoencephalitis and closed head trauma the brain-specific antigens (L1M and L2M globulins) contents were studied in the blood serum and cerebrospinal fluid (CSF). On days 3 to 5 after the head trauma L1M and L2M were found irregularly. In meningoencephalitis L1M and L2M were detected with a lesser delay. In infectious toxicosis L1M and L2M appeared in blood serum and CSF regularly and early. The data suggest that appearance of brain-specific antigens in blood and CSF in coma reflect a rise in the blood-brain barrier permeability to CSF-blood transport.
