Prevalence, Risk Factors and Impact of Nutrition Interruptions in Critically Ill Children.

Background: Enteral nutrition interruptions (ENI) are prevalent in the pediatric intensive care unit (PICU), but there is little evidence of their characteristics. Methods: This is a cross-sectional multicenter study including critically ill children on enteral nutrition. ENIs were classified as PICU procedures, procedures performed outside the PICU (PPOP), feeding intolerance and other criteria. The number and features of ENIs were collected. Results: A total of 75 children were enrolled. There were 41 interruptions affecting 37.3% of the patients with a median duration of 5 ± 9.4 h. The most common reason for ENI was PPOP (41.5%), followed by other criteria. Interruptions were considered preventable in 24.4% of the cases, but only eight were compensated. ENIs were more prevalent among children with cardiac disease (p = 0.047), higher PRISM (p = 0.047) and longer PICU stay (p = 0.035). There was association between PRISM and total interruption time (p = 0.02) and lower caloric intake (p = 0.035). Patients with respiratory illness (p = 0.022) and on noninvasive ventilation (p = 0,028) had fewer ENIs. ENI total time was associated with lower caloric (p = 0.001) and protein (p = 0.02) intake. Conclusions: ENIs are prevalent in PICU, especially in children with higher PRISM, longer PICU stays and cardiac disease, and result in lower caloric and protein intake.

Effectiveness of steroids versus placebo in preventing upper airway obstruction after extubation in critically ill children: rationale and design of a multicentric, double-blind, randomized study.

BACKGROUND: Post-extubation upper airway obstruction (UAO) is a frequent complication causing stridor and respiratory distress, which occasionally require reintubation, thereby increasing morbidity and mortality rates. Contradictory results have been obtained in studies assessing the effectiveness of steroids in preventing post-extubation UAO, and the available evidence is limited. We designed a multicentric randomized, placebo-controlled study to explore the effectiveness of dexamethasone in preventing post-extubation UAO in children. METHODS: A multicentric, prospective, double-blind, randomized, placebo-controlled, phase IV clinical trial has been designed. The sample will include pediatric patients who are between 1 month and 16 years of age and who have been intubated for more than 48 h. Patients who have airway disorders or who have received steroids within the previous seven days will be excluded. Patients will be randomly assigned to receive either placebo or a therapy with dexamethasone 0.25 mg/kg every 6 h to be started 6 to 12 h prior to extubation (to a total of four doses). Randomization will be performed at a 1:1 ratio. Follow-up of patients will be carried out for 48 h after extubation. The main objective of this study is to access the reduction in the incidence of moderate to severe UAO symptoms following extubation. Secondary objectives include assessing the decrease in the incidence of reintubation, evaluating the use of additional therapies for UAO, and monitoring potential side effects of dexamethasone. DISCUSSION: The results of this study will contribute to the existing evidence on prophylaxis for post-extubation airway obstruction. TRIAL REGISTRATION: EudraCT identifier: 2009-016596-30. Registered on May 11, 2010.

Cobalamin disorder CblC presenting with hemolytic uremic syndrome and pulmonary hypertension / Aciduria metilmalónica con homocistinuria tipo CblC como causa de síndrome hemolítico urémico e hipertensión pulmonar

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Valoració dels criteris diagnòstics de la icterícia colestàtica durant el primer any de vida / Valoración de los criterios diagnósticos de la ictericia colestásica durante el primer año de vida / Evaluation of diagnostic criteria for cholestatic jaundice during the first year of life

Fonament. La icterícia és un motiu habitual de consulta en els lactants. És important detectar les colestàtiques per establir precoçment el diagnòstic i millorar el pronòstic. Objectius. Analitzar les diferències clíniques i de les exploracions complementàries dels lactants amb colèstasi segons l’etiologia, per determinar quines haurien de guiar l’especialista per a un diagnòstic precoç. Material i mètodes. Estudi retrospectiu dels nadons ingressats per icterícia colestàtica entre gener de 1997 i desembre de 2001. Resultats. Es recullen setze casos, onze masculins, de disset dies a onze mesos d’edat. Es diagnostiquen: sis hepatitis (H), cinc atrèsies de vies biliars (AVB), dos dèficits d’alfa-1-antitripsina (Dα1AT), un ARC-I (síndrome caracteritzada per presentar artrogriposi, tubulopatia renal, colèstasi i ictiosi), una malaltia de Wolman (W) i una colèstasi extrahepàtica amb cirrosi micronodular (CM). Nou pacients presenten hipocòlia, set colúria, i tres estancament ponderal. Quatre nens amb baix pes en néixer tenen H. Es detecta hepatomegàlia en cinc pacients i esplenomegàlia només en el cas de W. La bilirubina (Br) total, directa i gammaglutamiltranspeptidasa (GGT) en les AVB són més elevades que en les H. L’ecografia abdominal no objectiva bufeta biliar en quatre AVB, una H i a la CM. Es fa gammagrafia i és diagnòstica a les AVB, surt alterada en un Dα1AT i en la CM i és normal en una H. Comentaris. L’hepatitis idiopàtica es relaciona més freqüentment amb baix pes en néixer que l’AVB. Una colèstasi amb Br total > 7 mg/dl i GGT > 300 UI/L suggereix AVB. L’ecografia abdominal és la primera prova d’imatge a fer davant una colèstasi; la gammagrafia es reserva per als casos amb alta sospita d’AVB (AU)

Fundamento. La ictericia es motivo habitual de consulta en los lactantes. Es importante detectar las colestásicas para establecer precozmente el diagnóstico y mejorar el pronóstico. Objetivos. Analizar las diferencias clínicas y de las exploraciones complementarias de los lactantes con colestasis según la etiología, para determinar cuales tendrían que guiar al especialista para un diagnóstico precoz. Material y métodos. Estudio retrospectivo de los lactantes ingresados por ictericia colestásica entre enero de 1997 y diciembre de 2001. Resultados. Se recogen 16 casos, 11 masculinos, de 17 días a 11 meses de edad. Se diagnostican: 6 hepatitis (H), 5 atresias de vías biliares (AVB), 2 déficits de alfa-1-antitripsina, (Dα1AT), un ARC-I (síndrome caracterizado por artrogriposis, tubulopatía renal, colestasis e ictiosis), una enfermedad de Wolman (W) y una colestasis extrahepática con cirrosis micronodular (CM). Presentan hipocolia 9 pacientes, coluria 7 y estancamiento ponderal 3. Hay 4 niños con bajo peso al nacer tienen H. Se detecta hepatomegalia en 5 pacientes y esplenomegalia sólo en W. La bilirrubina (Br) total, directa y gamma-glutamiltranspeptidasa (GGT) en las AVB son más elevadas que en las H. La ecografía abdominal no objetiva vesícula biliar en 4 AVB, una H y en la CM. Se realiza gammagrafía y es diagnóstica en las AVB, está alterada en un Dα1AT y en la CM y es normal en una H. Comentarios. La hepatitis idiopática se relaciona más frecuentemente con bajo peso al nacer que la AVB. Una colestasis con Br total > 7 mg/dl y GGT > 300 UI/L sugiere AVB. La ecografía abdominal es la primera prueba de imagen a realizar ante una colestasis; la gammagrafía se reserva para los casos con alta sospecha de AVB (AU)

Background. Jaundice is a common reason for consultation in infants. Early detection of cholestatic jaundice may result in improved prognosis. Objectives. To analyze the distinct clinical features of the different types of cholestatic jaundice that can assist in an early diagnosis. Material and methods. Retrospective study of infants with cholestatic jaundice admitted between January 1997 and December 2001. Results. Sixteen infants (11 males), aged 17 days to 11 months, were included. Distribution by diagnosis was as follows: Hepatitis, 6 cases; Biliary atresia, 5 cases, alpha 1αantitrypsine deficiency, 2 cases; ARC-1 syndrome (arthrogryposis, renal tubulopathy, cholestasis and ichthyosis), 1 case; Wolman disease, 1 case; extrahepatic cholestasis with micronodular chirrosis, 1 case. Nine patients had hypocholia, 7 patients had choluria, and 3 patients had failure to thrive. The 4 patients with low birth weight had hepatitis. Five patients had hepatomegaly, and splenomegaly was only present in the case with Wolman syndrome. Total and direct bilirubin and gamma-glutamyltranspeptidase (GGT) were higher in biliary atresia than in hepatitis. Abdominal ultrasound failed to identify the gallbladder in 4 cases of biliary atresia, in one case of hepatitis, and in the case of micronodular chirrosis. A scintigraphy was diagnostic in the cases of biliary atresia, was abnormal in the cases of alpha-1-antitrypsine deficiency and micronodular chirrosis, and was normal in one case of hepatitis. Comments. Idiopatic hepatitis is more commonly associated with low birth weight than biliary atresia. A cholestasis with a total bilirrubin of > 7 mg/dl and GGT > 300 IU/L suggests biliary atresia. Abdominal ultrasound is the first imaging study that should be performed; the scintigraphy should be performed in those cases highly suspicious of biliary atresia (AU)

Autorefractòmetre / No disponible

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Ultrasonografia falàngica / Phalangeal ultrasonography

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