Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7%) had UTIs after cardiac surgery (UTI group), and 384 (93%) were free from UTIs (control group). All UTI cases were catheter-associated UTIs (CAUTIs). A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (p<0.001), presence of congenital abnormalities of kidney and urinary tract (CAKUT) (p<0.0041) and the presence of certain syndromes (Down, William, and Noonan) (p<0.02). Gram-negative bacteria accounted for 63% of the CAUTI. The main causes of CAUTI were Klebsiella (27%), Candida (24%) and Escherichia coli (21%). Resistant organisms caused 34% of CAUTI. Two patients (7%) died in the UTI group compared with the one patient (0.3%) who died in the control group (p<0.05). Based on these findings, we concluded that an increased duration of the urinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study.

Introduction: During tetralogy of Fallot repair, leaving or even create an interatrial communication may facilitate post-operative course particularly with right ventricle restrictive physiology. The aim of our study is to assess the influence of atrial communication on post-operative course of tetralogy of Fallot repair. Methods: Retrospectively, we studied all children who had tetralogy of Fallot repair (2003–2018). We divided them into two groups: tetralogy of Fallot repair with interatrial communication (TOFASD) group and tetralogy of Fallot repair with intact atrial septum (TOFIAS) group. We performed propensity match score for specific pre- or intra-operative variables and compared groups for post-operative outcome variables. Secondarily, we looked for right ventricle restrictive physiology incidence and influence of early repair performed before 3 months of age on post-operative course. Results: One hundred and sixty children underwent tetralogy of Fallot repair including (93) cases of TOFIAS (58%) and (67) cases of TOFASD (42%). With propensity matching score, 52 patients from each group were compared. Post-operative course was indifferent in term of positive pressure ventilation time, vasoactive inotropic score, creatinine and lactic acid levels, duration and amount of chest drainage and length of intensive care unit and hospital stay. Right ventricle restrictive physiology occurred in 38% of patients with no effects on outcome. 12/104 patients (12%) with early repair needed longer pressure ventilation time (p = 0.003) and intensive care unit stay (p = 0.02). Conclusion: Leaving interatrial communication in tetralogy of Fallot repair did not affect post-operative course. As well, right ventricle restrictive physiology did not affect post-operative course. Infants undergoing early tetralogy of Fallot repair may require longer duration of positive pressure ventilation time and intensive care unit stay.

Background Uvular injury is a rare complication of endotracheal intubation. It presents as a triad of sore throat, foreign body sensation in pharynx, and halitosis. Case presentation A 26-year-old male who underwent endotracheal intubation for general anesthesia developed sore throat and foreign body sensation after the procedure. The patient was diagnosed as a case of iatrogenic uvular necrosis (grade III uvular injury) leading to auto-amputation (grade IV uvular injury) attributed to compression of the uvula due to the endotracheal tube placement. The patient was counseled regarding the etiology of the disease and was treated conservatively. Conclusions Uvular injury is a rare complication that can easily be prevented by corrections in technique and experience. This report emphasizes the establishment of principles of diagnosis, prevention, and treatment of uvular injury.

Results There were a significant difference in the levels of HDL (1,2 ± 0,31 mmmol/l to 69 ± 0,01 mmol/l, p < 0,001). In these children were indicated increase level of total cholesterol by LDL fraction to 2,35 ± 0,18 mmol/l. IA was in 2.97times higher in patients with mountainous region to according the control group (2.67 and 0.90). Changes in hemostasiogramme were identificated in 54% children (an increase of activated recalcification time (74,76 ± 5,06 s and 64,76 ± 2,04 s, p < 0.05), an increase of concentration of fibrinogen (17,53 ± 1,63 s and 11,32 ± 0,77 s, p < 0.001). According to our research were higher levels of Antiphospholipid IgM, than IgG (2,73 ± 0,34 to 2,03 ± 0,24, U/ml, p < 0.02), which varies within the reference values, but have different signs with dates of the control group. Conclusion These dates presented the risk of thrombogenesis, but non significant. The levels of IL-1 and IL -6 were in the range of control values, but have a tendency to decline, according to our data. This fact indicated about the decrease in production of interleukins of child's organism in the mountains region. Introduction Urinary tract infection (UTI) can prolong hospitalisation, and increase morbidity. Catheter associated UTI (CAUTI) is a major cause of UTI. Objective To determine the incidence, risk factors, aetiology and outcome of UTI in postoperative cardiac children. Patients and methods This is retrospective cohort study. All post-operative patients admitted to PCICU during 2012 were included. Patients were divided into: group (1) Patients who developed and group (2) patients who did not develop UTI. The two groups were compared for demographic and other variable predictors for UTI. Results 413 post-cardiac surgical children were included. Group (1) had 29 patients (7%) all had CAUTI. Foley catheter utilisation ratio was 44%. CAUTI density rate was 18 per 1000 catheter days. Logistic regression analysis demonstrated that risk factors for developing UTI were: duration of Foley (p < 0.002), associated syndrome (p = 0.01) and prolonged PCICU and hospital stay (p < 0.05). Gram-negative were responsible for 63% and Candida for (24%) of the CAUTI. ESBL caused 30% and MDRO caused 10% of our patients CAUTI. Conclusion Foley catheter duration, presence of syndrome and prolonged PCICU and hospital stay were the main risk factors for CAUTI in postoperative paediatric cardiac patients. Resistant Gram-negative were the main cause for CAUTI with one third of CAUTI cases caused by MDRO or ESBL organisms. The cases with CAUTI were generally sicker and with more morbidity. The study will establish a baseline clinical indicator for monitoring quality improvement and the future measures to minimise CAUTI incidence, and its co-morbidity. Background and aims Echocardiograms are a major resource for diagnosing congenital and acquired heart disease. Paediatricians with special expertise in Paediatric Cardiology are now at the forefront of the paediatric cardiac care service. The aim of this audit was to report on the quality of...