Macrophage activation syndrome (MAS) is a fatal complication in rheumatic diseases. It is characterized by prolonged fever, pancytopenia, and hepatosplenomegaly, which are consequences of uncontrolled macrophage activation. MAS in children is most commonly associated with systemic juvenile idiopathic arthritis. Its association with systemic lupus erythematosus (SLE) is relatively rare, so we report a Thai boy who initially presented with MAS and eventually was diagnosed as having SLE. He also had recurrent MAS during the course of therapy. Hyperferritinemia is one of the abnormal laboratory findings in MAS and it has been used as an inflammatory marker. However, its correlation with disease activity remains unclear. Therefore, a review of literature regarding MAS-associated SLE in children and ferritin level in this disease was carried out.
There is an association between ventilator-associated condition and infection-related ventilator-associated complication in critically ill children with acute kidney injury, ventilatory support, and neuromuscular blockade. Attention should be given by clinical practitioners to recognize these modifiable risk factors and to implement strategies to decrease the prevalence of ventilator-associated events.
Background Traumatic injury (TBI) is a major cause of pediatric morbidity and mortality. Secondary injury that occurs as a result of a direct impact plays a crucial role in patient prognosis. The guidelines for the management of severe TBI target treatment of secondary injury. Posttraumatic seizure, one of the secondary injury sequelae, contributes to further damage to the injured brain. Continuous electroencephalography (cEEG) helps detect both clinical and subclinical seizure, which aids early detection and prompt treatment. Objective To examine the relationship between cEEG findings in pediatric traumatic brain injury and neurocognitive/functional outcomes. Methods This study focuses on a subgroup of a larger prospective parent study that examined children admitted to a level-1 trauma hospital. The subgroup included sixteen children admitted to the pediatric intensive care unit (PICU) who received cEEG monitoring. Characteristics included demographics, cEEG reports, antiseizure medication. We also examined outcome scores at time of discharge and 4–6 weeks post-discharge using the Glasgow Outcome Scale-Extended Pediatrics and a center-based speech pathology neurocognitive/functional evaluation scores. Results Sixteen patients were included in this study. Patients with severe TBI made up the majority of those that received cEEG monitoring. Non-accidental trauma was the most frequent TBI etiology (75%) and subdural hematoma was the most common lesion diagnosed by CT scan (75%). Fifteen patients received anti-seizure medication and levetiracetam was the medication of choice. Four patients (25%) developed seizures during PICU admission and 3 patients had subclinical seizures that were detected by cEEG. One of these patients also had both a clinical and subclinical seizure. Non-accidental trauma was an etiology of TBI in all seizure patients. Characteristics of a non-reactive pattern, severe/burst suppression and lack of sleep architecture, on cEEG were associated with poor neurocognitive/functional outcome. Conclusion Continuous electroencephalography demonstrated a pattern that associated seizures and poor outcomes in patients with moderate to severe traumatic brain injury, particularly in a subgroup of non-accidental trauma patients. Best practice should include institutional based TBI cEEG protocols, which may detect early of seizure activity and promote outcomes. Future studies should include examination of individual cEEG characteristics to help improve outcomes in pediatric TBI.
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