Objective: Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in pediatric intensive care units (PICUs), but its definite diagnosis remains controversial. The CDC Ventilator-Associated Event (VAE) module (validated in adults) constitutes a new approach for VAP surveillance. Design: We described epidemiological characteristics of PICU VAE cases, investigated possible risk factors, and evaluated 3 different sets of diagnostic VAE criteria. Setting: This study was conducted in a PICU in a tertiary-care general hospital in northern Greece during 2017–2019. Patients: The study included patients aged 35 days–16 years who received mechanical ventilation. Methods: From medical records, we retrieved epidemiological data, clinical data, and laboratory characteristics as well as ventilator settings for our analysis. We assessed “oxygen deterioration” for the tier 1 CDC VAE module using 3 sets of diagnostic criteria: (1) CDC adult VAE criteria [increase of daily minimum fraction of inspired oxygen (FiO2) ≥ 0.2 or positive end expiratory pressure (PEEP) ≥ 3 cmH2O for 2 days], (2) the US pediatric VAE criteria [increase of FiO2 ≥ 0.25 or mean airway pressure (MAP) ≥ 4 cmH2O for 2 days], and (3) the European pediatric VAE criteria (increase of FiO2 ≥ 0.2 or PEEP ≥ 2 cmH2O for 1 day or increase of FiO2 ≥ 0.15 and PEEP ≥ 1 cm H2O for 1 day). Results: Among 326 children admitted to the PICU, 301 received mechanical ventilation. The incidence rate according to the CDC adult VAE criteria was 4.7 per 1,000 ventilator days. For the US pediatric VAE criteria the incidence rate was 6 per 1,000 ventilator days. For the European pediatric VAE criteria the incidence rate was 9.7 per 1,000 ventilator days. These results revealed statistically significant correlation of all 3 algorithms with adverse outcomes, including mortality. Conclusions: All VAE algorithms were associated with higher mortality rates. Our findings highlight the need for a unified pediatric VAE definition to improve preventive strategies.
BackgroundMyofasciitis is a rare disease of the muscles and its fascia, which is most common in adults and is very rarely found in children.AimDescription of a case of myositis-peritonitis(fasciitis) in a 4 year old female toddler and arise the awareness of the hospital and general paediatrician for the clinical presentation of this rare disease.Method-material-case descriptionIn November of 2016 a 4 year old toddler of greek origin from the state of Magnesia, Greece, was admitted to the emergency department of our hospital. The toddler presented claudication 12 hours prior to the admission and symptoms of upper and lower respiratory tract infection with cough from several days. At the admission the toddler presented claudication, limitation of the active and passive motility of both hips, especially the right, limited motility of the truncus and limbs, swelling of right cheek and right temple. Imaging studies revealed swelling of the soft tissues around the right hip joint and swelling of multiple intra-parotid and neck lymph nodes. The blood examination at the admission revealed leukocytosis, mild increase of the indicators of inflammation, of creatine phosphokinase (CPK) and increased coagulation time. Because of the clinical picture of the patient intravenous antibiotics were givenB(ceftriaxone and clindamycin).The differential diagnosis included myositis, fasciitis, septic arthritis of right hip joint and invasive general microbe infection.ResultsBecause of the rapid deterioration of the clinical and laboratory picture in the next 12 hours (further increase of CPK, indicators of inflammation) the toddler was transferred to a tertiary Hospital of Athens. The imaging studies revealed a consolidation of the basis of the right lung and mild consolidation behind the heart. The MRI revealed swelling and inflammation of the majority of the muscles of the haunches, the thighs (especially the right), swelling of the subcutaneous tissue of both haunches and its fascias. The clinical and imaging picture was compatible with myofasciitis. The general status of the patient was improved and the antibiotic therapy was continued for 14 days in total. The metabolic and rheumatologic results are still pending.ConclusionsThe data in literature for myofasiitis are not enough but we believe that it is localised histological inflammation that may be caused by a previous immunisation with alluminium adjuvants contained vaccines, rather than a primary inflammatory muscle disease. The histological hallmark of myofasciitis is the infiltration of the muscle and its fascia by macrophage cells. The symptoms include joint pain, muscle weakness, fatigue, fever and pain on the palpation of the muscles.
IntroductionNeutropenia is the decrease of neutrophil count in the blood. It is classified as mild, when the Absolute Neutrophil Count (ANC) is 1000–1500 cells/µL, or<1.100 cells/µL in infants 1 month-2years old, moderate (ANC=500–1000 cells/µL), and severe neutropenia (ANC<500 cells/µL). The causes can be congenital or acquired, most frequently related with infections and drugs and the clinical significance is major because of the increased risk of infections.AimIncidence and causes of neutropenia in hospitalised children in our Paediatric Clinic during the year 2016.MethodsAll the hospitalised children from 01-01-2016 to 31-12-2016 were screened for the presence of neutropenia during their hospitalisation. The type of neutropenia, the causes and the other blood cells counts were recorded for every neutropenic child.ResultsAmong 784 children hospitalised during 2016, 35 were found to be neutropenic (4,46%). None of these children had known neutropenia in their history. Viral infections were the first cause of neutropenia, with the second cause (14%) being the use of antimicrobial drugs. The majority of neutropenias were mild to moderate (83%), whereas 6 children presented with severe neutropenia. Among them, three patients were diagnosed with viral infections, two had autoimmune diseases and the other remained undiagnosed. A percentage of 8,5% had also reduction in other blood cells.ConclusionThe most common form of neutropenia in hospitalised children is mild-moderate neutropenia of viral aetiology, which resolves itself. However, major systematic diseases should always be excluded.
BackgroundDiabetes Mellitus (DM) involves a variety of metabolic disorders, caused by ‘hyperglycemia’ (secretion insufficiency or reduced insulin activity). Diabetes Mellitus type 1 (absolute insulin quantitative deficiency) is one of the four DM types. DM type 1a is autoimmune (most common) and DM type 1b is idiopathic.AimEpidemiological recording of hospitalised children suffering from DM type 1 (2012–2016) based on demographic and other characteristics (age, sex, residence, duration of hospitalisation, body weight, HbA1c levels, first-diagnosis or deregulation, presence or no of hereditary background, presence or no of diabetic acidosis).Method/Material31 children suffering from DM type 1 have been hospitalised in our clinic through the past five years. Cause of hospitalisation was either the disease itself or its complications (diabetic acidosis, hypoglycemia, deregulation) and more rarely another disease, usually infectious. The reference data and correlates were: sex (boys/girls), age (toddlers/preschoolers/school-age children/adolescents), residence (Volos, rest of Magnesia region, Pelion, Sporades), year of hospitalisation, body weight (over or under 50th percentile), HbA1c levels, duration of hospitalisation and presence or no of DM type 1 or 2 hereditary background.Results31 children have been recorded (17 boys). Sorted by age groups: 19 school-age children (6–12 y.o.), 6 adolescents (>13 y.o.), 3 preschoolers (3–5 y.o.) and 3 toddlers (1–3 y.o.). Sorted by year of hospitalisation: (2012–2016) (2,9,6,7,7 respectively). Most of them were residents of Volos and Pelion. Hospitalisation lasted 1–14 days (average: 5 days). HbA1c levels have been recorded in 25 children, 12 of whom HbA1c was over 10. 24 out of the 31 children were first diagnosed with DM type 1 (10 of whom presented with diabetic acidosis) and 7 of them presented with deregulation. In 10 children hereditary background of DM type 1 or 2 was revealed.ConclusionsBased on the recordings, boys are more frequently affected (in contrast with recent epidemiological findings). The often affected age group is once more proved to be school-age children (6–12 y.o.). The highest number of hospitalised children is noted in 2013 and the number of Pelion and Sporades diabetic children is higher compared to these areas’ total populations (but our sample is small, for general results). HbA1c levels are indicative of glycemic control through the past 3 months, a fact which proves that the disease creeps weeks before being diagnosed. Aproximately 1/3 of the children have first-degree relatives suffering from DM type 1 or 2, a fact which evinces the role of heredity in DM’s type 1 pathogenesis.
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