ABSTRACT
We report three children with obstructive sleep apnea syndrome, two secondary to pharyngeal obstruction and the third secondary to laryngomalacia. All patients presented important respiratory efforts with inspiratory stridor during sleep, frequent obstructive apneas with important hipoxemia, sweating, and arousal episodes. Two patients suffered excessive daytime sleepiness, behavioral disturbances and development delay, and the third, intelligence in the borderline retardation range, and important heart arritmias (bradycardia with ventricular extrasystoles) during obstructive apneas. In two children the Obstructive Sleep Apnea Syndrome and the secondary symptoms disappeared after adenotonsillectomy. The patient with laryngomalacia required tracheostomy.
Subject(s)
Sleep Apnea Syndromes/etiology , Adenoidectomy , Adolescent , Airway Obstruction/complications , Airway Obstruction/etiology , Child, Preschool , Humans , Larynx/abnormalities , Respiratory SoundsSubject(s)
Charcoal/therapeutic use , Theophylline/adverse effects , Administration, Oral , Female , Humans , InfantABSTRACT
Complications in 322 percutaneous subclavian vein catheters placed in 272 children by the infraclavicular approach were investigated prospectively. Ages ranged from 4 days to 15 years. Incidents during catheter introduction occurred in 13 cases, and were more common when insertion was on the right side (p less than 0.01). Nine (2.8%) required urgent treatment: (6 pneumothorax, 1 hydrothorax, and 2 hemothorax). Anomalous lodging of the catheter tip was more common when insertion was on the right side (p less than 0.05). Complications during catheter maintenance were 3 venous thromboses, 3 catheter obstructions, and 7 migrations out of position. There was no significant difference in complications related to age. Catheter cultures were positive in 33 (17%) of 190 catheters cultured (27 through colonization and 6 through catheter-related sepsis). Staph. epidermidis was the organism most frequently isolated (19 cases; 58%). Catheterization time of more than 5 days and catheter-related sepsis were statistically associated (p less than 0.05). Staph. epidermidis isolation and duration of cannula use were statistically related (p less than 0.01). No catheter-related deaths occurred. We conclude that subclavian vein catheterization is a simple and useful procedure that entails relatively few serious complications when performed by experienced pediatricians.
Subject(s)
Catheterization, Central Venous/standards , Critical Illness , Pediatrics/standards , Subclavian Vein , Adolescent , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Child , Child, Preschool , Cross Infection/epidemiology , Cross Infection/etiology , Evaluation Studies as Topic , Female , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Male , Pediatrics/methods , Pneumothorax/epidemiology , Pneumothorax/etiology , Prospective Studies , Thrombosis/epidemiology , Thrombosis/etiologyABSTRACT
Naloxone clorhidrate was administered intravenously to 15 patients with endotoxic shock and refractary hypotension, following meningococcal sepsis. Doses used were between 0.01-0.2 mg/kg. Three patients (two of them with moderate shock) showed an increase in sistolic arterial pressure, which was maintained and above 20 mm/Hg. Among the rest of them (except one with severe shock) naloxone action was non-existent in nine cases, or with short action and without answer to next doses in other three. Eleven patients died. A blood pressure increase was maintained only in two of the four survivors. Usefulness of naloxone in this kind of patients is not clear. Presence in endotoxin shock of a variety of refractory factors besides beta endorphins, greatly limits therapeutic efficiency of this drug.
Subject(s)
Naloxone/therapeutic use , Shock, Septic/drug therapy , Adolescent , Child , Child, Preschool , Endorphins/antagonists & inhibitors , Humans , Hypotension/drug therapy , Infant , Meningococcal Infections/complications , Naloxone/pharmacology , Shock, Septic/etiology , Shock, Septic/physiopathologyABSTRACT
Adult respiratory distress syndrome is becoming more frequent in pediatric age. There are several factors involved in its' etiology. Sepsis is almost invariably present in all patients. Basic mechanism is an increase of pulmonary capillary permeability with production of acute non cardiogenic oedema. The decrease in compliance and functional residual capacity produce a respiratory failure with hypoxemia non-responsive to the increase in FiO2. Pulmonary hypertension and low cardiac output appear once the syndrome has developed. In its' management, cardiorespiratory monitoring is essential. Prophylaxis is based on early treatment of the essential pathological process. Corticoids are only effective if they are administered before development of pulmonary oedema. The treatment is based on: a) Moderate water restriction. b) Early respiratory assistance using PEEP or CPAP. c) Maintenance of adequate oxygen transport. The extracorporeal oxygenation guarantees the oxygen exchange but it does not affect survival. Mortality is 95%. Patients who survive have minimal pulmonary sequelae.
Subject(s)
Respiratory Distress Syndrome , Carbon Dioxide/metabolism , Child , Humans , Lung/physiopathology , Oxygen/metabolism , Oxygenators , Prognosis , Pulmonary Circulation , Respiration, Artificial , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/therapy , Shock, Septic/complications , Water-Electrolyte BalanceSubject(s)
Dehydration/complications , Infant, Newborn, Diseases/complications , Acidosis/etiology , Acute Kidney Injury/etiology , Dehydration/chemically induced , Female , Humans , Hypertonic Solutions , Infant Food/adverse effects , Infant, Newborn , Infant, Newborn, Diseases/chemically induced , Peritoneal Dialysis , Respiratory Insufficiency/etiology , Seizures/etiology , Shock/etiologySubject(s)
Parenteral Nutrition, Total/methods , Parenteral Nutrition/methods , Body Weight , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , MaleABSTRACT
Two newborns with abdominal perforation during peritoneal dialysis are presented. The first probably before dialysis and the second iatrogenic. Both needed surgical intervention. Incidence in children in comparation with adults is discussed. Severe clinic complications of both patients that needed complete parenteral nutrition, mechanic ventilation and treatment of Candida sepsis are comented. Both survived without sequels in spite of severe complications.
