A prospective placebo-controlled study on the efficacy of onion extract in silicone derivative gel for the prevention of hypertrophic scar and keloid in median sternotomy wound in pediatric patients.

BACKGROUND: New topical treatments studied in adults have been published to be potentially effective in the treatment of hypertrophic scar and keloids. There is still no study in Thai children. OBJECTIVE: To study the efficacy of 10% onion extract in silicone derivative gel for the prevention of hypertrophic scar and keloid in median sternotomy wound from open heart surgery in pediatric patients. MATERIAL AND METHOD: Thirty-nine pediatric patients who had median sternotomy were recruited in this prospective randomized, double-blinded, placebo-controlled split-scar experimental study. The wound in each patient was divided into upper and lower parts, and the treatment with, either onion extract gel or placebo was randomly applied by block randomization onto each part of the wound twice daily after the seventh day postoperatively for six months. The incidence of scars, serial photographs of the wound, Vancouver Scar Scale (VSS), and adverse effect were assessed at each visit. RESULTS: Thirty patients with the mean age of 4.3 years completed the 6-month study period. Six patients (20%) in onion extract gel group had no scar compared to one patient (3.3%) in placebo group (p = 0.04). Of the 27 patients with hypertrophic scar nine were from onion extract gel group and 18 from the placebo group (p = 0.02). Keloid was not statistically significant diferent in both groups (p = 0.29). VSS was not statistically significant different in all visits. One case had a pustule on the part of the onion extract in silicone derivative application at the sixth month. CONCLUSION: Onion extract in silicone derivative gel can significantly decreased the incidence of hypertrophic scar from median sternotomy wound in pediatric patients. Keloid did not show statistically significant differences in both groups.

Incidence and risk factors of upper gastrointestinal bleeding in mechanically ventilated children.

OBJECTIVE: To identify the incidence and factors related to upper gastrointestinal (UGI) bleeding in children requiring mechanical ventilation for longer than 48 hrs. DESIGN: Prospective analytic study. SETTING: Ten-bed-pediatric intensive care unit of a tertiary care University Hospital. PATIENTS: A total of 110 patients requiring mechanical ventilation for longer than 48 hrs from January 1, 2005 to December 31, 2005. MEASUREMENTS AND RESULTS: UGI bleeding was defined by evidence of blood in nasogastric aspirates, hematemesis, or melena within 5 days of pediatric intensive care unit admission. We prospectively collected data on patient demographics, admission diagnosis, operative status, and pediatric risk of mortality score. UGI bleeding and the potential risk factors including organ failure, coagulopathy, maximum ventilator setting, enteral feeding, stress ulcer prophylaxis as well as sedation were daily monitored. Of the 110 patients who required mechanical ventilation for >48 hrs, the incidence of UGI bleeding was 51.8%, in which 3.6% of the cases presented with clinically significant bleeding (shock, requiring blood transfusion and/or surgery). Significant risk factors were thrombocytopenia, prolonged partial thromboplastin time, organ failure, high pressure ventilator setting >/=25 cm H2O, and pediatric risk of mortality score >/= 10 using univariate analysis. However, the independent factors of UGI bleeding in the multivariate analysis were organ failure (relative risk = 2.85, 95% confidence interval 1.18-6.92) and high pressure ventilator setting >/=25 cm H2O (relative risk = 3.73, 95% confidence interval 1.59-8.72). CONCLUSION: The incidence of UGI bleeding is high in children requiring mechanical ventilation. Organ failure and high pressure ventilator setting are significant risk factors for UGI bleeding.