Legal reform in New Zealand that saw changes to the prosecution of health professionals for gross negligence manslaughter may have important lessons for the UK in light of the recent case of Hadiza ...Bawa-Garba, say Rohan Ameratunga and colleagues
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Abstract
New neurological morbidity post pediatric intensive care (PIC) poses substantial problems, with a need to understand the relationship of outcome to blood pressure (BP) targets. The aim of ...the study is to see whether a change from a higher BP targeted strategy to a permissive one improved outcomes for development of new neurological morbidity, length of stay (LOS), and PIC-acquired infection. A retrospective cohort analysis was undertaken, comparing outcomes before and after the change. The higher BP cohort targets were set using standardized age-based centiles. In the permissive cohort, lower BPs were allowed, dependent on physiological variables. Targeted treatment continued throughout the critical illness. New neurological morbidity was defined as any deterioration from baseline, attributable to the admission, measured by post discharge clinical and records review over a minimum period of 4 years. Results were analyzed with IBM SPSS Statistics v26. Of 123 admissions in the permissive and 214 admissions in the higher BP target cohorts, 88 (72%) and 188 (88%) survived without new neurological morbidity (permissive vs. higher cohort OR 0.348 95% CI 0.197–0.613
p
<0.001). Median LOS was 2 (interquartile IQ range 2–5) and 3 (IQ range 2–6) days for the permissive and higher cohorts, respectively (
p
= 0.127). Three (2.4%) and 7 (3.3%) admissions in the permissive and higher BP cohorts respectively suffered PIC-acquired infection (
p
= 0.666). A higher BP targeted strategy was associated with protection from new neurological morbidity as compared with a permissive strategy, supporting the need for prospective studies into BP targets.
We describe two infants with severe hemolytic disease of the fetus and newborn (HDFN) with hepatosplenomegaly treated with intravenous immunoglobulin. Packed red blood cells (PRBC) were transfused ...resulting in an acute disproportionate increase in hemoglobin with clinical consequences in one case. These cases appear to highlight previously unreported sequelae. We discuss a hypothetical mechanism and suggest that the effect warrants further research as a possible way to decrease the need for and risks of PRBC transfusion in HDFN.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We describe the combined use of inhaled nitric oxide and heliox (79% helium and 21% oxygen) as a rescue therapy for a critically ill infant with localized interstitial pulmonary emphysema and ...pulmonary hypertension. Conventional interventions were ineffective, not feasible, or unlikely to take effect in time, during this infant's acute critical illness. We added heliox based on its known pulmonary effects, and inhaled nitric oxide to improve oxygenation, after echocardiographic evidence of high right-ventricular pressure. The infant made a full recovery. To our knowledge this is the first case report of heliox and inhaled nitric oxide used simultaneously in localized interstitial pulmonary emphysema.
Abstract
Sepsis is an important cause of childhood death in developing countries. The International Pediatric Sepsis Consensus Conference (IPSCC) guidelines for definition has five categories and ...requires complex information, which may be difficult to access in resource poor settings, possibly leading to under-diagnosis and problems with triage, referral and documentation for public health assessments. We aimed to provide a workable system for grading sepsis categories, assess this against the IPSCC definition and use this information to guide further adaptations. We conducted a prospective observational study of consecutive admissions to a pediatric intensive care unit of a public hospital between August and September 2006. We recorded history and demographic, clinical, investigative, treatment and outcome details. We compared the performance of the IPSCC scoring system to the modified system. We studied one hundred consecutive admissions and collected data for the modified format. The distribution of sepsis cases and (deaths) was as follows: systemic inflammatory response syndrome 26 (2), sepsis 30 (5), severe sepsis/septic shock 15 (11), organ dysfunction 2 (2) and no sepsis 27 (3). Overall mortality was 23%. Despite its simplicity, the modified system corresponded well to the IPSCC system except for the systemic inflammatory response syndrome category. We suggest adaptations to improve agreement with IPSCC whilst maintaining ease of use. It is possible to simplify the IPSCC score to provide information in a resource poor setting but only further studies will be able to assess robustness in the field.
The use of NIV has been shown to facilitate discontinuing ventilatory dependence as well as provide support for adult patients with chronic lung disease without the need for endotracheal intubation. ...In fact, NIV has recently described as a potential support strategy following extubation failure. Therefore, using NIV as a bridge to liberation from mechanical ventilation may decrease many of the complications associated with long-term use of invasive airway devices as well complications from reinsertion of an artificial airway. Although firm data supporting the use of NIV in the adult population exists, the use of NIV in the pediatric population is based primarily on a series of case studies, retrospective chart reviews, and extrapolation from the adult data. The use of NIV for infants and children remains controversial. The important question to be asked is why there is a lack of randomized controlled trials on NIV in pediatrics? The answer lies somewhere between the lack of equipment designed specifically for pediatrics and the smaller number of patients available compared with adults. Data from the adult population may be more readily adapted to older children; however, it remains difficult to determine the criteria for noninvasive ventilatory use in infants and young children. In fact, this lack of data makes the formulation of firm selection guidelines for infants and children essentially impossible. However, for a select groups of pediatric patients with acute respiratory failure for whom an appropriate noninvasive device with interface is available, a trial of NIV may be seem reasonable to avoid the known negative effects of intubation and invasive mechanical ventilation.
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