Proceedings of ESPGHAN Monothematic Conference 2020

Abstract

Objectives:The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) aims to educate pediatric gastroenterologists, members of ESPGHAN and professionals from other specialties promoting an exchange of clinical expertise in the field of pediatric hepatology. Herewith we have concentrated on detailing the recent advances in acute liver failure in infants and children.Methods:The 2020 ESPGHAN monothematic three-day conference on pediatric hepatology disease, entitled “acute liver failure” (ALF), was organized in Athens, Greece. ALF is a devastating disease with high mortality and most cases remain undiagnosed. As knowledge in diagnosis and treatment of ALF in infants and children has increased in the past decades, the objective was to update physicians in the field with the latest research and developments in early recognition, curative therapies and intensive care management, imaging techniques and treatment paradigms in these age groups.Results:In the first session, the definition, epidemiology, various causes of ALF, in neonates and older children and recurrent ALF (RALF) were discussed. The second session was dedicated to new aspects of ALF management including hepatic encephalopathy (HE), coagulopathy, intensive care interventions, acute on chronic liver failure, and the role of imaging in treatment and prognosis. Oral presentations by experts in various fields are summarized highlighting key learning points.Conclusions:The current report summarizes the major learning points from this meeting. It also identifies areas where there is gap of knowledge, thereby identifying the research agenda for the near future.

Impact of Continuous Kidney Replacement Therapy and Hemoadsorption with CytoSorb on Antimicrobial Drug Removal in Critically Ill Children with Septic Shock: A Single-Center Prospective Study on a Pediatric Cohort

“…Data were recorded using an electronic case report form (eCRF). Data collection at admission (enrolment) included demographics, comorbidities, etiologies of infection, site of infection, primary diagnoses, Pediatric Logistic Organ Dysfunction 2 score (PELOD-2) [ 21 ], vasoactive inotropic score (VIS) [ 22 ], Acute Kidney Injury (AKI) stage [ 23 ] and Acute Liver Failure [ 24 , 25 ]. Septic shock was defined according to the International Pediatric Consensus Conference and treated following the latest therapeutic guidelines [ 26 ].…”

Future directions in acute liver failure

“…These efforts have enabled generally agreed on approaches to the diagnosis and management of these critically ill children. [26][27][28][29][30] Despite improvements in diagnosis, the cause of PALF for roughly one-third of children remains indeterminate (iPALF). [30] In these children, outcomes are generally poorer, with over 50% of iPALF progressing to death or LT. [31] iPALF occurs more frequently in children between 1 and 10 years of age (~60%), and recent studies have supported a hypothesis that a hyperinflammatory host immune response propagates…”

“…Over time, the general adaptation of these study criteria has improved our ability to compare descriptive, diagnostic, therapeutic, and mechanistic studies performed by investigators worldwide. These efforts have enabled generally agreed on approaches to the diagnosis and management of these critically ill children 26–30 …”

Impact of CKRT and Hemoadsorption with CytoSorb on Antimicrobials Drugs Removal in Critically Ill Children with Septic Shock: A Single Center Prospective Study in a Pediatric Cohort

“…Data were recorded using an electronic case report form (eCRF). Data collection at admission (enrolment) included demographics, comorbidities, etiologies of infection, site of infection, primary diagnoses, Pediatric Logistic Organ Dysfunction 2 score (PELOD-2) [21], vasoactive inotropic score (VIS) [22], Acute Kidney Injury (AKI) stage [23] and Acute Liver Failure [24,25]. Septic shock was defined according to the International Pediatric Consensus Conference and treated following the latest therapeutic guidelines [26].…”