Complications In Children Research Articles

Complications in Children From Foreign Bodies in the Airway

Introduction and objectivesForeign body aspiration in childhood is a common and potentially serious problem. Complications may be the result of the aspiration episode itself, delayed diagnosis or treatment. We describe our experience in a paediatric hospital in Argentina. MethodsWe retrospectively evaluated 56 patients with complications due to foreign body aspiration recorded in the Susy Safe Project between January 2010 and November 2013. The clinical variables analysed were sex, age at time of aspiration, foreign body location and type, time elapsed from the event until object removal, extraction technique, complications, need for hospitalisation and circumstances of the event. Results58.9% of the cases described occurred in males, with high presence of adults (76.8%) at the time of aspiration. The incidence was slightly higher in children older than 3 years. In 37 cases (66.1%), the foreign body was located in bronchus; sunflower seeds and ballpoint caps were the most common foreign objects. Only in 10 cases (17.9%) was the object extracted within 24hours of the event. The most common complications were pneumonia (18 cases), granuloma (15 cases) and mucosal erosion (9 cases). Hospitalisation was necessary for 41 patients. ConclusionEarly diagnosis and immediate control through specialised teams are essential to ensure proper treatment, usually endoscopic, without risk of complications.

Children with Severe Acute Malnutrition, Outcome and its Complications in Children admitted at tertiary level Centre (MTC) –A Prospective Study

Children with Severe Acute Malnutrition, Outcome and its Complications in Children admitted at tertiary level Centre (MTC) –A Prospective Study

Infectious Complications in Children With Acute Myeloid Leukemia and Down Syndrome: Analysis of the Prospective Multicenter Trial AML-BFM 2004.

Children with acute myeloid leukemia (AML) and Down syndrome have high survival rates with intensity-reduced chemotherapeutic regimens, although the optimal balance between dose intensity and treatment toxicity has not been determined. We, therefore, characterized infectious complications in children with AML and Down syndrome treated according to AML-BFM 2004 study (ClinicalTrials.gov NCT00111345; amended 2006 for Down syndrome with reduced intensity). Data on infectious complications were gathered from the medical records in the hospital where the patient was treated. Infectious complications were categorized as fever without identifiable source (FUO), or as microbiologically or clinically documented infections. A total of 157 infections occurred in 61 patients (60.5% FUO, 9.6% and 29.9% clinically and microbiologically documented infections, respectively). Almost 90% of the pathogens isolated from the bloodstream were Gram-positive bacteria, and approximately half of them were viridans group streptococci. All seven microbiologically documented episodes of pneumonia were caused by viruses. Infection-related mortality was 4.9%, and all three patients died due to viral infection. Our data demonstrate that a reduced-intensity chemotherapeutic regimen in children with AML and Down syndrome is still associated with high morbidity. Although no patient died due to bacteria or fungi, viruses were responsible for all lethal events. Future studies, therefore, have to focus on the impact of viruses on morbidity and mortality of patients with AML and Down syndrome.

Peripherally Inserted Central Venous Catheter Complications in Children Receiving Outpatient Parenteral Antibiotic Therapy (OPAT).

OBJECTIVE To identify the frequency of and risk factors associated with complications necessitating removal of the peripherally inserted central catheters (PICCs) in patients receiving outpatient parenteral antibiotic therapy (OPAT) and to determine the appropriateness of OPAT in children with OPAT-related complications. METHODS A retrospective cohort of children who had a PICC inserted at the Johns Hopkins Children's Center between January 1, 2003, and December 31, 2013, and were discharged from the hospital on OPAT was assembled. RESULTS A total of 1,465 PICCs were used to provide antibiotic therapy for 955 children after hospital discharge. Among these, 117 PICCs (8%) required removal due to a complication (4.6 of 1,000 catheter days). Children discharged to a long-term care facility were at increased risk of adverse PICC events (incidence risk ratio [IRR], 3.32; 95% confidence interval [CI], 1.79-6.17). For children receiving OPAT, age of the child (adjusted IRR [aIRR], 0.95; 95% CI, 0.92-0.98), noncentral PICC tip location (aIRR, 2.82; 95% CI, 1.66-4.82), and public insurance (aIRR, 1.63; 95% CI, 1.10-2.40) were associated with adverse PICC events. In addition, 34 patients (32%) with adverse events may not have required intravenous antibiotics at the time of hospital discharge. CONCLUSIONS Of children discharged with PICCs on OPAT during the study period, 8% developed a complication necessitating PICC removal. Children discharged to a long-term care facility had an increased rate of complication compared with children who were discharged home. With improved education regarding appropriate duration of antibiotic therapy and situations in which early conversion to enteral therapy should be considered, PICC-related complications may have been avoided in 32% of children. Infect.

Catheter-Related Complications in Children With Cancer Receiving Parenteral Nutrition: Change in Risk Is Moderated by Catheter Type.

Although central venous catheters (CVCs) are essential to pediatric cancer care, complications are common (eg, occlusion, central line-associated bloodstream infection [CLABSI]). Parenteral nutrition (PN) and external CVCs are associated with an increased complication risk, but their interaction is unknown. A retrospective matched cohort study of pediatric oncology patients who received PN through subcutaneous ports or external CVCs. Complication rates were compared between CVC types during PN and non-PN periods (log-negative binomial model). Risk of CLABSI was higher during PN for children with ports (relative risk [RR] = 39.6; 95% confidence interval, 5.0-309) or external CVCs (RR = 2.9; 95% confidence interval, 1.1-7.4). This increased risk during PN was greater for ports than for external CVCs (ratio of relative risks = 13.6). Occlusion risk was higher during PN in both groups (RR = 10.0 for ports; RR = 2.0 for external CVCs), and the increase was significantly greater in ports (ratio of relative risks, 4.9). Overall, complication rates for ports were much lower than for external CVCs during the non-PN period but similar during the PN period. Children with cancer who receive PN have increased risk of CLABSI and occlusion. The risk increase is greatest in children with ports: a 40- and 10-fold increase in infection risk and occlusion, respectively, resulting in similar complication rates during PN regardless of CVC type and negating the usual benefits of ports. Children with cancer who will require PN should have primary insertion of external CVCs where possible.

Treatment-Related Complications in Children With Disseminated Lyme Disease

Treatment-Related Complications in Children With Disseminated Lyme Disease

Ocular Complications in Children with Diabetes Mellitus

The effectiveness of annual eye examinations in diabetic children is unclear. We sought to determine the prevalence and onset of ocular pathology in children with diabetes mellitus (DM), identify risk factors for ocular disease, and recommend a screening regimen for asymptomatic children. Retrospective, consecutive cohort study. Children aged less than 18 years with type 1 or 2 DM examined over a 4-year period. All children underwent a complete eye examination, including dilated fundoscopy and cycloplegic refraction. A literature review was performed, identifying the youngest reported age and shortest reported duration of DM before the diagnosis of diabetic retinopathy (DR). Prevalence of DR, cataract, high refractive error, and strabismus. A total of 370 children (mean age, 11.2 years; range, 1-17.5 years) had 693 examinations, with a mean DM duration of 5.2 years (range, 0.1-16.2 years) and a mean hemoglobin A1c (HbA1c) of 8.6 (range, 5-≥14). No children had DR. A total of 12 children had cataract; 5 required extraction but were identified by decreased vision, not diabetic screening. A total of 19 children had strabismus; only 1 was microvascular paralytic strabismus. A total of 41 children had high refractive error. There were no associations between these conditions and duration or control of DM. In the literature, the youngest age at diagnosis of severe DR was 15 years, and the shortest duration of disease was 5 years. Diabetic retinopathy is rare in children regardless of duration and control of DM. On the basis of our study and literature review, screening examinations for type 1 diabetes could begin at age 15 years or at 5 years after the diagnosis of DM, whichever occurs later, unless the child is judged by the endocrinologist as being at unusually high risk. Other ocular complications are identifiable through existing amblyopia screening methods.

Cohort Study: Central Venous Catheter-Related Complications in Children with Hematologic Diseases at a Single Center.

Objective:This study aims to document and analyze the central venous catheter (CVC)-related complications in children with hematological diseases who were treated within a single institution.Materials and Methods:A retrospective investigation was conducted in 106 pediatric patients in whom 203 CVCs were inserted. A total of 175 catheter-related complications occurred in 5 years.Results:The rates of clinical catheter infections, local catheter infections, venous thromboembolism, bleeding, and mechanical complications were 2.6, 1.1, 0.2, 0.2, and 0.2 per 1000 catheter days. Methicillin-resistant Staphylococcus epidermidis was the predominant infectious organism in blood and catheter cultures. The children with leukemia had a significantly higher frequency of clinical catheter infections (p=0.046). The children who underwent bone marrow transplantation had a significantly lower frequency of clinical catheter infections (p=0.043) and higher frequency of local catheter infections (p=0.003). The children with implanted catheters had a significantly lower frequency of clinical catheter infections (p=0.048). The children with thrombocytopenia had significantly fewer local catheter infections and significantly more clinical catheter infections and catheter-related bleeding (respectively p=0.001, p=0.042, and p=0.024). Conclusion:Leukemia, bone marrow transplantation, and thrombocytopenia are risk factors for CVC-associated complications. The relatively higher number of interventions performed via permanent catheters may be responsible for the significantly increased incidence of systemic infections and mechanical injury.

Ethanol Lock Efficacy and Associated Complications in Children With Intestinal Failure.

Prophylactic ethanol lock therapy (ELT) reduces central line-associated bloodstream infections (CLA-BSIs) in children with intestinal failure (IF). However, the risk of associated complications is unclear. We aim to describe our experience with prophylactic ethanol locks in a cohort of patients with IF. Thirty patients on ELT from 2010-2013 were identified by review of our intestinal rehabilitation registry. Patient demographics, CLA-BSI events, and line complications were extracted. Comparisons in infection and complication rates when on and off ELT were made using a Poisson mixed-effect regression model. CLA-BSIs when on and off ELT were 3.1 and 5.5 per 1000 catheter days, respectively (P <015). Overall complication rates were similar in both groups. In those patients who experienced a complication, the complication rates on ELT compared with time off ELT were significantly lower (P <003). Line perforation or breakage rates declined significantly when on ELT, from 1.8 to 1.53 per 1000 catheter days (P <006). Line occlusion rates also decreased on ELT, from 0.6 to 0.3 per 1000 catheter days (P =056). Infecting organisms were not different on and off ELT, and patients experienced a similar number of polymicrobial infections on or off therapy. Klebsiella pneumoniae was the most common infecting organism in both groups. Ethanol lock therapy use reduces both CLA-BSI and central line complication rates in children with IF. These results underscore the safety and efficacy of ELT use in this population.

Pre-Hematopoietic Stem Cell Transplantation Lung Function and Pulmonary Complications in Children

Pre-Hematopoietic Stem Cell Transplantation Lung Function and Pulmonary Complications in Children

Polymorphisms of asparaginase pathway and asparaginase-related complications in children with acute lymphoblastic leukemia.

Asparaginase (ASNase) is a standard and critical component in the therapy of childhood acute lymphoblastic leukemia (ALL), but it is also associated with several toxicities. We recently reported the results of an association study between ASNase pathway genes and event-free survival (EFS) in childhood patients with ALL. The same polymorphisms were interrogated here in relation to allergies, pancreatitis, and thrombotic events following treatment with E. coli ASNase. Among patients of the discovery group, allergies, and pancreatitis were more frequent in individuals who are homozygous for the triple-repeat allele (3R) of the asparagine synthetase (ASNS) gene, resulting in remarkably higher risk of these toxicities associated with 3R3R genotype [OR for allergies, 14.6; 95% confidence interval (CI), 3.6-58.7; P < 0.0005 and OR for pancreatitis, 8.6; 95% CI, 2.0-37.3; P = 0.01]. In contrast, the ASNS haplotype *1 harboring double-repeat (2R) allele had protective effect against these adverse reactions (P ≤ 0.01). The same haplotype was previously reported to confer reduction in EFS. The risk effect of 3R3R genotype was not replicated in the validation cohort, whereas the protective effect of haplotype *1 against allergies was maintained (P ≤ 0.002). Analysis with additional polymorphisms in ASNS locus in lymphoblastoid cell lines showed that haplotype *1 is diversified in several subtypes of which one was associated with reduced in vitro sensitivity to ASNase (rs10486009, P = 0.01) possibly explaining an association seen in clinical setting. This finding might have implication for treatment individualization in ALL and other cancers using asparagine depletion strategies. Clin Cancer Res; 21(2); 329-34. ©2014 AACR. See related commentary by Avramis, p. 230.

Infectious Complications in Children with ALL Treated with ALL-IC-2009 Protocol: Multicenter National Study of Polish Society of Pediatric Hematology and Oncology

BACKGROUND. Infectious complications are a significant cause of morbidity and mortality in children receiving treatment for ALL. One of the major factors increasing the risk of bacteremia is the widespread use of central venous lines (CVL). In this study we hypothesized if there are any outcome predictors during bacteremia episodes during standard chemotherapy.OBJECTIVE. The aim of the study was to analyze epidemiology and impact of bacteremia as a main cause of death during induction and consolidation therapy of ALL in children. We assessed an influence of following factors: age, sex, time to infection, duration of antibiotic treatment, and relapse on survival in ALL children with bacteremia.METHODS. We reviewed 430 medical charts of children with ALL treated in Pediatric Hematological Centers in Poland according to ALL-IC-2009 protocol between January 2012 and December 2013. The group of 110 children (71 boys, 39 girls) with ALL with at least 1 episode of bacteremia was analyzed. The median age of the children was 7.5 years. Statistical analysis was performed using chi-squared and t-test when applicable to estimate the influence of different factors (age, sex, time to infection, period of treatment) for the outcome.RESULTS. The overall incidence of bacteremia among ALL children was 110/430 (25.6%). The most common cause of bacteremia (20%) was S.epidermidis (22%) and E.Coli ESBL(+). The median time to infection (TTI) was 4.9 months . There was no significant association between TTI and outcome of the patients (p=0.07), but there was a trend towards increased death rate during consolidation therapy. The median duration of infection treatment (MDT) was 13.6 days. MDT did not influence significantly death rate (p=0.31). Among all patients, 14 (12.7%) deaths were observed. The median age of children in that group was 9.1 years. In the analyzed period 19 cases of ALL relapse were observed in this study. In the relapse group there was significantly higher mortality rate than in the group with “de novo ALL” (p<0.01). Mortality rate was significantly higher among boys (p<0.01). There was no correlation between age of children and incidence of deaths (p=0.14).CONCLUSIONS. The incidence of bacteremia in children treated for ALL in Poland is 25.6%. Staphylococcus epidermidis and Escherichia Coli ESBL(+) are the mostcommon pathogens. Bacteria translocation from intestines to the blood might play a key role in development of blood-stream infection (BSI), thus the gut decontamination may be of high value in high-risk patients. Children with ALL relapse are at high risk of mortality due to bacteremia. Boys are more predisposed to life-threatening episodes and higher mortality due to BSI. Age is not a predictor factor for bacteremia related mortality. Children during consolidation chemotherapy of ALL require special attention to avoid bacteremia episodes. DisclosuresNo relevant conflicts of interest to declare.

981Catheter Complications in Children Discharged with Peripherally Inserted Central Catheters (PICCs)

981Catheter Complications in Children Discharged with Peripherally Inserted Central Catheters (PICCs)

PO-0181 Acute Brucellosis: Clinical Presentations And Complications In Children

Brucellosis is a systemic infectious zoonotic disease andit is still an important public health problem in Arabian Peninsula. The clinical presentation of brucellosis is non-specific, and the infection varies in its course and severity. Objective To evaluate common presentations and complications of involvement of acute Brucella infection in children presented to the paediatric emergency unit of Aladanhospital Methods Design: Retrospective study Setting: Paediatric emergency unit and paediatric department of Aladdin hospital, Kuwait between April 2008 and April 2013. Subjects: Sixty two children with acute brucellosis The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination 1/160 titers, and/or the isolation of Brucella species. Complication was defined as the presence of symptoms or physical signs of infection at a particular anatomic site in a patient with active brucellosis. Data of the patients were reviewed in the medical records specially clinical presentation, complications, laboratory results, and treatment given. Results Out of 62 patients, 36(58.1%) were male and 26(41.9%) were female. The mean age was 9.5 ± 3.2 years. Arthritis (42 patients,67.7%) was the most frequent, presentation followed by fever without source (24 patients, 38.7%), and gastrointestinal system (11 patients, 17.7%). The diagnosis depended on increase of brucella titer more than 1/160 in 57 patients (91.9%). Source of infection in patients was mostly ingestion of unpasteurized milk. Conclusion Brucellosisis still an important health problem in Kuwait and must be taken inconsideration in children presented with fever without a source or arthritis.

Thromboembolic complications in children after spinal fusion surgery.

Retrospective review. To identify the incidence of venous thromboembolic (VTE) complications and pulmonary embolism (PE) in children undergoing spinal fusion surgery, to report associated mortality, and to analyze factors associated with their development. The incidence of these complications after pediatric spinal fusion surgery is unknown. The Nationwide Inpatient Sample database was queried from 2001 through 2010 to identify children (≤18 yr) who had spinal fusion surgery. Patients who had deep venous thrombosis or PE during the hospital stay were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Univariate and multivariate logistic regression models were used for analysis; statistical significance was set at P less than 0.05. Depending on the year, the incidence of VTE in children varied from 9.6 to 38.5 events per 10,000 spinal fusions (mean: 21 events per 10,000 spinal fusions), and the incidence of PE varied from 0 to 6 events per 10,000 spinal fusions (mean: 2 events per 10,000 spinal fusions); there were no in-hospital VTE-associated mortalities. On multivariate logistic regression analysis, only patient diagnosis was found to be significantly associated with VTE development. VTE incidence was significantly higher in children with congenital scoliosis, syndromic scoliosis/kyphoscoliosis, and thoracolumbar fractures than in children with idiopathic scoliosis (odds ratios: 4.21, 7.14, and 12.59, respectively). On univariate analysis, in addition to diagnosis, age was also found to be significantly associated with VTE development. For each year of age, the VTE incidence increased 1.37-fold (P < 0.01). The incidence of thromboembolic complications in children was approximately 21 events per 10,000 spinal fusions. A higher incidence of VTE in children was associated with older age and certain diagnoses (congenital scoliosis, syndromic scoliosis/kyphoscoliosis, and thoracolumbar fractures). PE in children was rare and not associated with fatality.

Complications in children and adults with cochlear implant

Complications in Children and Adults with Cochlear Implant Background: Cochlear Implants (CI) are developed in the last 20 years to a regular therapy in congenital deaf children/newborns and deafened teens and adults. The success of speech understanding with the CI in adults is so extraordinary that meanwhile also unilateral deaf, contralateral normal hearing persons are implanted. In case of early implanted children a nearly normal speech development is possible in most of the cases. MATERIAL UND METHODS: Nevertheless the surgical procedures is a challenge concerning the potential complications combined with a foreign body, the CI, in a non-steril part of the ear. This paper reports on the complications in a patients collective, implanted within 21 years. Separated within the severity of the complications and their therapeutic consequences (conservative and surgical) it could be shown that the incidence of severe perioperative complications within the second decade could be reduced from 3.92% (first decade) to 1.8%. Also the companies have learned to construct the products more save. In summary the reliable and complete postoperative control and the modification of therapy concepts leads to a constant reduction of complications.

G91 US National Perspective on Hospitalisations of Children with Pre-existing Tracheostomy

Aims(1) To describe the reasons, duration, and cost of hospitalisations in children with pre-existing tracheostomy, (2) to assess how many of these hospitalisations might be avoidable.MethodsThis is a retrospective cohort...

Ocular Complications in Children with Nephrotic Syndrome on Long Term Oral Steroids

To estimate the burden of ocular complications like posterior subcapsular cataract (PSCC) and raised intra ocular pressure (IOP) in children with nephrotic syndrome on long term steroid therapy and to assess the correlation of cumulative dosage and duration of consumption of steroids with these ocular complications. Children between 4-18 y with nephrotic syndrome, who received steroids for at least six months, were included in this cross sectional study. Demographic, clinical and treatment details were obtained from case records. Detailed ocular evaluation was performed to detect PSCC and to measure IOP. One hundred and eighteen children were screened and 82 with a median (IQR=Interquartile range) follow up of 4.2 y (2.4, 6.3 y) were included in the final analysis. The median (IQR) age of children was 9.3 y (6, 12.5 y) at recruitment. The proportion of children with PSCC and raised IOP were 22/82 (26.8%) and 9/82 (10.97%) respectively. PSCC was associated with older age (p = 0.009). The median cumulative dose of steroids in those with and without cataract was 338.4mg/kg and 343.2mg/kg respectively (p = 0.58). The median duration of steroid theraphy was 58 wk and 59 wk in the two groups respectively (p = 0.73). Of children with PSCC, 9 (42.8%) had mild diminution of vision. One in 4 and 1 in 9 children with nephrotic syndrome in the present study had PSCC and raised IOP respectively. Cumulative dose and duration of steroid therapy were not significantly associated with PSCC or raised IOP. The present study emphasizes the need for regular ocular evaluation and also to explore additional factors in causation of steroid induced ocular complications.

Peripheral IV Stabilization and the Rate of Complications in Children: An Exploratory Study

Peripheral intravascular catheter insertion is the most common invasive procedure performed on the hospitalized child with a significant potential for complications. This study compared complication rates between a standard aseptic taping technique and a commercially-available adhesive anchoring device in 80 hospitalized children ages 2-17 years. Eighteen (18) participants (22.5%) experienced a complication with occlusion being the most common (n=8) followed by infiltration (n=4), leaking (n=3), and dislodgement (n=2). There were no differences in complication rates or types between the two groups. This study provides evidence that a stabilization device may not be necessary in short-duration PIVs in children.

Noninfectious Complications in Children Undergoing Chronic Peritoneal Dialysis

Objectives: To describe the general characteristics and frequency of noninfectious complications in children with end stage renal disease (ESRD) in chronic peritoneal dialysis. Material and methods: A retrospective case series study describing noninfectious complications in the population of children, aged between 1 month and 17 years 11 months, with end stage renal disease from the peritoneal dialysis program at Cayetano Heredia Hospital between 2000 and 2007. Results: We studied 80 children, 41 male and 39 female; 92 catheters were implanted; the average age of the children was 10.3 years and the largest age group was from 5 to 12 years. The leading cause of end stage renal disease was primary glomerulopathy. The Tenckhoff two-cuff spiral catheter was the most commonly used catheter; continuous ambulatory peritoneal dialysis was the most common mode of dialysis; there were 12 catheter replacements, the most frequent causes being peritonitis and catheter obstruction. The frequency of noninfectious complications was 40.3%; the three most common complications were ultrafiltration failure (low transporter type), umbilical hernia, and catheter obstruction. Conclusions: The frequency of noninfectious complications was 40.3%; the most common complication was ultrafiltration failure.