Retinopathy of Prematurity and Possible Relation Between Postnatal Cytomegalovirus Infection.

Retinopathy of prematurity (ROP) is an eye disorder characterized by abnormal development of retinal blood vessels in premature infants. It has been associated with several risk factors, but the main factor is gestational age. Several studies have recently reported a possible link between ROP and postnatal cytomegalovirus (CMV) infection. The authors present 4 patients who developed severe ROP following postnatal CMV infection. ROP was successfully resolved with antiviral treatment in all 4 cases. Postnatal CMV infection could be responsible for the worsening of ROP. Antiviral therapy may improve the prognosis of ROP and avoid the need for more aggressive therapies.

Lung ultrasound to predict pediatric intensive care admission in infants with bronchiolitis (LUSBRO study).

It is extremely difficult to stratify bronchiolitis and predict the need for admission to the pediatric intensive care unit (PICU). We aimed to evaluate the capacity of a new lung ultrasound score (LUSBRO) to predict the need for admission to the PICU compared to a clinical score. This was a prospective observational single-center study that includes infants < 6 month of age admitted to a hospital due to acute bronchiolitis. Both scores were calculated at admission. The main outcome was PICU admission. Second endpoints were the need for mechanical ventilation, respiratory support duration, and the length of stay in the hospital. Eighty patients were included, with a median age of 53 days (IQR 29-115). Forty-four patients (55%) required PICU admission. LUSBRO score showed a better AUC compared to the clinical score to predict PICU admission: 0.932 (95% CI 0.873-0.990) vs. 0.675 (95% CI 0.556-0.794) and a positive correlation with the hospital length of stay. The best cut-off point for predicting the need for PICU admission for LUSBRO score was 6, showing a sensitivity of 90.91% and a specificity of 88.89%.Conclusions: The LUSBRO score is a useful tool to predict the need for admission to the PICU. What is Known • It is extremely difficult to stratify which patients affected by bronchiolitis should be precociously transferred to a third level hospital and will require pediatric intensive care unit (PICU) admission. • Clinical scores have been created but neither of them is accurate. What is New • The LUSBRO score is a useful tool to predict the need for admission to the PICU of patients with bronchiolitis and, consequently, to predict the patients who should be transferred to a tertiary hospital to optimize respiratory support.

Experiencia con la utilización del ócido nitroso en procesos dolorosos en urgencias / Experience with the use of nitrous oxide in painful procedures in the emergency department

Fundamento. El óxido nitroso (N2O) es un gas con efecto analgésico, ansiolítico y amnésico que se utiliza mezclado con 50% de oxígeno en técnicas diagnóstico-terapéuticas que provocan dolor y/o ansiedad. Objetivo. 1) Evaluar la efectividad del N2O en procedimientos dolorosos realizados en urgencias. 2) Describir los efectos secundarios detectados. Método. Estudio prospectivo descriptivo de una serie de casos recogidos desde el 1/05/08 al 31/12/08 en los cuales se utilizó N2O. Resultados. Se recogieron 74 casos, 48 (64%) de ellos eran del sexo masculino, siendo la mediana de edad de 7,5 años. Fue utilizado en los siguientes procedimientos: punciones lumbares (33; 45%), reducción de fracturas (16; 22%), venopunciones (10; 13%), drenaje de abscesos (9; 12%) y sutura de heridas (6; 8%). En 60 casos (81%) se asoció con analgesia local, en 11 (15%) con analgesia sistémica y en 3 (4%) se utilizó el N2O como único analgésico. La efectividad se valoró según el análisis de la conducta del paciente durante el procedimiento; se clasificó cualitativamente como mala en 4 casos (5%), aceptable en 16 (22%) y buena o muy buena en 54 (73%). Cabe decir que los casos valorados como malos o aceptables se trataban de procedimientos muy dolorosos. La valoración del efecto analgésico por parte del equipo médico fue muy satisfactoria en 60 casos (81%). Se constataron efectos secundarios en 10 casos (13,5%): mareo (3), vómitos (2), ansiedad (2), euforia (2) y cefalea (1). En todos los casos estos efectos se resolvieron en pocos minutos. Conclusiones. 1) Según nuestra experiencia, el N2O es un método analgésico y ansiolítico coadyuvante efectivo en muchos procedimientos dolorosos realizados en urgencias pediátricas. 2) Los efectos secundarios en nuestra serie son leves. 3) El equipo médico está muy satisfecho, aunque se deben consensuar las indicaciones para optimizar su uso(AU)

Background. Nitrous oxide (N2O) is a gas with analgesic, ansiolytic and amnesic effect. 50% nitrous oxide oxygen mixture is used in procedures that cause pain or anxiety. Objective. 1) To evaluate the efficacy of N2O in painful procedures in a pediatric emergency department. 2) To determine the adverse effects of this treatment. Method. Prospective descriptive study from May 2008 to December 2008. Results. 74 cases were analyzed; 48 (64%) were male and the median age was 7.5 years. The procedures performed with N2O inhalation were: lumbar punctures (33; 45%), reduction of fractures (16; 22%), venipunctures (10; 13%), abscess drainage (9; 12%) and laceration repairs (6; 8%). Local analgesia was given in 60 (81%) cases; systemic analgesia in 11 (15%) and N2O alone in 3 (4%). A behavioral scale was used to evaluate efficacy; it was bad in 4 cases (5%), acceptable in 16 (22%) and good or very good in 54 (73%). All cases assessed as bad o acceptable were very painful procedures. Medical staff was very satisfied with the sedation effect in 60 cases (81%). Adverse effects were observed in 10 cases (13.5%): dizziness (3), emesis (2), anxiety (2), euphoria (2) and headache (1). All these side effects resolved in a few minutes. Conclusions. 1) In our experience, the N2O is an effective analgesic and ansiolytic coadjuvant method to provide analgesia in a variety of procedures; 2) Side effects are infrequent and minor; 3) Medical staff was very satisfied; however, it is necessary to define specific indications for an optimum use(AU)