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PCT and Nt-pro-BNP on day 1 may be associated with severe SIRS and predict the length of stay. A biomarker approach combining PCT, CRP and BNP is superior to a traditional single marker for predicting ICU stay.

Background: Hickman-Broviac catheters have improved the care of young children needing frequent and prolonged venous access, but at the same times it has substantial morbidity, particularly in a resource-constrained setup. Our study aims to describe the experience of a Tunisian hospital and investigate the main risk factors for complications. Methods: In this study, we included all the neonates and infants who underwent Broviac catheter insertion in the pediatric surgery department. The patients were divided into 2 groups according to the presence of complications. We compared these two groups and univariate logistic regression analyses were used to determine the risk factors for complications. Results: Forty-three children were included in the study. The incidence of complicated catheters was 60.4%. The following factors were significantly associated with an increased risk of complications: age 6 months [OR 3.5, 95% CI: 0.6-19.3], weight 6 kg [OR 1.54, 95% CI: 0.46-5.2], emergency circumstances [OR 1.62, 95% CI: 0.8-5.4], and antibiotic-therapy as an indication for Broviac catheter insertion [OR 1.8, 95% CI: 0.5-6.2]. Conclusion: Complications seem to be more frequent in patients younger than 6 months and those with a weight of less than 6Kg. To reduce the morbidity related to the catheters, the indications should be carefully chosen.

The aim of this study was to assess the impact and effectiveness of vaccination among the pregnant population on maternal, obstetrical, and fetal outcomes. Material and Methods:In this study we included all parturients tested positive for COVID 19 during pregnancy and who needed hospitalization at any stage of gestation. Then, patients were divided into 2 groups according to their vaccination status: M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o nThe Vaccinated Group: included pregnant women with completed vaccination by receiving 3 doses of mRNA Vaccine or 2 doses on condition that the second dose received within the last 6 months.The non-vaccinated group: included pregnant women who had no vaccination against COVID 19.We collected data about obstetrical and fetal outcomes with 3 months of follow-up.Results: 145 parturients were admitted for COVID 19 in the maternity of Sfax in Tunisia. The vaccinated group included 45 patients and the non-vaccinated group included 100 patients. Demographic parameters were comparable in both groups. The vaccination reduced the rate of hospitalization in Intensive care units from 23% to 4.3%; p<0.001. Cesarean section delivery was seen in 56 cases from 76 patients who delivered while infected (73%) versus 11 cases from 33 who delivered in the vaccinated group (33.3%) with p<0.001. The vaccination reduced the risk of prematurity from 35% to 6.6% with p<0.001. No cases of vertical transmission were noted in either group. Conclusions:Pregnant women seem to be protected from severe forms and severe complications of COVID 19. Obstetrical and neonatal outcomes appear to be improved with vaccination.

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Near-infrared spectroscopy (NIRS) allows continuous noninvasive monitoring of in vivo oxygenation in selected tissues. It has been used primarily as a research tool for several years, but it is seeing wider application in the clinical arena all over the world. It was recently used to monitor brain circulation in cardiac surgery, carotid endarteriectomy, neurosurgery and robotic surgery. According to the few studies used NIRS in pregnancy, it may be helpful to assess the impact of severe forms of preeclampsia on brain circulation, to evaluate the efficacy of different treatments. It may also be used during cesarean section to detect earlier sudden complications. The evaluation of placental function via abdominal maternal approach to detect fetal growth restriction is a new field of application of NIRS.

Background: Because of the high rates of Broviac catheter complications, we started an urgent quality process to reduce this morbidity. The aim is to assess the efficiency of the main actions we have taken in enhancing our practice and improving Broviac outcomes. Methods: We included all neonates and young infants requiring surgical central venous access using a Broviac tunneled catheter. We compared the catheters’ outcomes before and after the implementation of a quality program based on a nurse teaching program, patient selection, and catheter management multidisciplinary protocol. The significance threshold was set at p<0.05. Results: We included 94 patients: 51 in the protocol group and 43 in the control group. The complication rate was reduced from 60.3% to 25.5% with p=0.001. The lifetime of the catheter was improved from 11.3 ± 4.3 days to 19.1 ± 9 days with p=0.007. The catheter infection was reduced from 65.3% to 46.1% with p≤0.001. Conclusion: This quality improvement project shows the utility of a quality assurance program based on careful indications and patient selection, a nursing teaching program, and a multidisciplinary catheter management protocol, in reducing Broviac catheter-related morbidity.