BACKGROUND AND OBJECTIVESDiffuse alveolar hemorrhage (DAH) is a life threatening condition with very limited, often unsuccessful, therapeutic options. This study aimed at exploring the feasibility and efficacy of nebulized tranexamic acid TXA (n-TXA) and nebulized recombinant factor VIIa (n-rFVIIa) when used in a two-step therapy protocol in children with intractable DAH in a pediatric intensive care unit.METHODSIn a prospective trial, n-TXA (250 mg/dose for children <25 kg and 500 mg/dose for children >25 kg) was administered to 18 children (median age [interquartile range]; 24.0 months [11.3, 58.5]) with intractable DAH. N-rFVIIa (35 μg/kg/dose for children <25 kg, and 50 μg/kg/dose for children >25 kg) was added if no or minimal response was seen after 3 to 4 doses (18 to 24 hours) of n-TXA.RESULTSDAH was stopped in 10 (55.6%) children with n-TXA alone within 24 hours of therapy. Documented concomitant respiratory infection showed a significant negative association with response to n-TXA in a stepwise regression analysis (OR=0.06; 95% CI=0.01–0.74). In the other 8 (44.4%) children, n-rFVIIa was added due to n-TXA failure. Six (75.0%) showed complete cessation of DAH, while two children failed to respond with the addition of n-rFVIIa (25.0%). None of the children who responded to therapy showed recurrence of DAH after therapy termination. No complications related to therapy were recorded.CONCLUSIONSn-TXA and n-rFVIIa were effective and safe when used in a two-step-therapy protocol to control intractable DAH in pediatric patients in intensive care settings. This therapy modality warrants further exploration through larger multicenter clinical trials.

The frequency of neonatal skin disorders has not been well studied in Egypt. Our aim was to address patterns of dermatological changes in a sample of Egyptian newborns. In a descriptive prospective cohort study 600 newborns in Sohag University hospital nursery were dermatologically examined within the first 5 days of birth. Skin disorders were detected in 240 neonates (40.0%). Birthmarks were found in 100 neonates (16.7%), mainly melanocytic type (mongolian spots in 11.7% and congenital melanocytic naevi in 2.7%). Fungal skin infections, including oral moniliasis, fungal infection in the napkin area or candidal intertrigo, were detected in 13.3% and bacterial infections in 1.3% of neonates. Comparisons with other studies worldwide indicated a higher rate of fungal infections and lower rate of birthmarks in our study. Routine neonatal dermatological evaluation is recommended, especially in view of the high rate of fungal skin infections.

Objectives: To highlight the causes of hospitalization among sickle cell diseased (SCD) children in Al-Madinah Al-Munawarah, Saudi Arabia. Methods: A retrospective study conducted at the Maternity and Children’s Hospital, Al-Madinah Al-Munawarah, Saudi Arabia. A data of 739 SCD children admitted to the hematology/oncology unit between October 2010 and September 2015 were collected. The collected data were analyzed using an independent t test and a Chi square test as appropriate. Results: Approximately 49% of the studied children were presented by acute painful crisis. Acute chest syndrome was reported in 20.9%. Infection was the cause of admission in 17.5%, and acute anemia was reported in 8.1% of the studied patients. No significant difference of the reported clinical manifestations by patients’ gender. Children aged <12 years showed significantly high frequency of acute chest syndrome (ACS) (26.5%), while acute painful crisis (66.4%) was significantly more frequent among children aged ≥12 years. Conclusion: This study revealed high rate of hospitalization of SCD children because of acute painful crisis, ACS, infection, and anemia. These admissions causes could potentially be continuously assessed to minimize the rate of hospitalization.

No abstract