Incidence Of Complications In Children Research Articles

Effect of Bedside Ultrasound-Guided Versus Fluoroscopy-Guided Transvenous Cardiac Temporary Pacing in Children with Bradyarrhythmia.

To compare the efficacy and safety of bedside ultrasound-guided and fluoroscopy-guided transvenous cardiac temporary pacing in the treatment of bradyarrhythmia in children. Children treated by temporary intravenous cardiac pacing from January 2016 to June 2023 in Hunan Provincial Children's Hospital were enrolled, and the characteristics and data of the cases were summarized. Patients were divided into bedside ultrasound-guided group (ultrasound group) and fluoroscopy-guided group (fluoroscopy group) according to the implantation guidance methods. The efficacy, safety, and incidence of complications in children were compared, and follow-up analysis was carried out. A total of 30 children were enrolled, including 18 males and 12 females, with a median age of 5.5 (2.9, 10.0) years and a median weight of 18.7 (12.7, 32.7) kg. The most common primary diseases were fulminant myocarditis (13/30 cases) and congenital high-grade AVB (10/30 cases). Among them, the proportion of congenital high AVB in the fluoroscopy group was significantly higher than that in the ultrasound group, and the difference was statistically significant (p = 0.007). The implantation process was successful in all 30 children. From the time of pacing decision to implantation, the median time of ultrasound group was 56 (30, 60) min and that of fluoroscopy group was 154 (78,180) min, with a statistically significant difference (P < 0.001). A total of 5 cases developed complications. There was no statistically significant difference between the two groups (P > 0.05). Compared with traditional fluoroscopic temporary pacing, bedside ultrasound-guided temporary pacing technology can effectively shorten the operation time and reduce the occurrence of complications and has become a better choice for children's emergency and critical care treatment. The right internal jugular vein is preferred for intravenous implantation.

Analysis of etiology and complications in children with stage 5 chronic kidney disease

Objective: To investigate the etiology, complications, and prognostic factors of stage 5 chronic kidney disease (CKD5) in children. Methods: A case series study was conducted to retrospectively analyze the general situation, clinical manifestations, laboratory tests, genetic testing, and follow-up data (until October 2022) of 174 children with CKD5 who were diagnosed and hospitalized at the Children's Hospital of Chongqing Medical University from April 2012 to April 2021. The characteristics of complications in the children were compared based on age, gender, and etiology. Based on the presence or absence of left ventricular hypertrophy (LVH), patients were divided into LVH group and non LVH group for analyzing the influencing factors of cardiovascular disease. Patients were also divided into death group and survival group, peritoneal dialysis group and hemodialysis group based on the follow-up data for analyzing the prognostic factors. The chi-square test, independent sample t-test, Fisher exact probability test, Mann-Whitney U test and Kruskal Wallis test were used to analyze data among different groups. Multivariate Logistic regression analysis was used to identify the prognostic factors. Results: A total of 174 children with CKD5 were enrolled in the study (96 boys and 78 girls), aged 11.2 (8.2, 13.0) years. Congenital kidney and urinary tract malformations (CAKUT) were the most common causes of the CKD5 (84 cases, 48.3%), followed by glomerular diseases (83 cases, 47.7%), and among which 28 cases (16.1%) were hereditary glomerular diseases. The common complications of CKD5 included anemia (98.2%, 165/168), mineral and bone disorder in chronic kidney disease (CKD-MBD) (97.7%, 170/174), lipid metabolism disorders (87.5%, 63/72), hypertension (81.4%, 127/156) and LVH (57.6%,57/99). The incidences of hypertension in primary glomerular disease were higher than that in CAKUT(93.8%(30/32) vs.73.7%(56/76),χ2=5.59,P<0.05). The incidences of hypertension in secondary glomerular disease were higher than that in CAKUT and that in hereditary kidney disease (100.0%(20/20) vs. 73.7%(56/76), 68.2%(15/22), both P<0.05). The incidence of hypocalcemia in CAKUT, primary glomerular disease, and hereditary kidney disease was higher than that in secondary glomerular disease (82.1%(69/84), 88.2%(30/34), 89.3%(25/28) vs. 47.6%(10/21), χ2=10.21, 10.75, 10.80, all P=0.001); the incidence of secondary hyperparathyroidism in women was higher than that in men (80.0%(64/80) vs. 95.0%(57/60), χ2=6.58, P=0.010). The incidence of LVH in children aged 6-<12 was higher than that in children aged 12-18 (73.5%(25/34) vs. 43.1%(22/51), χ2=7.62, P=0.006). Among 113 follow-up children, the mortality rate was 39.8% (45/113). Compared to the survival group, the children in the death group had lower hemoglobin, higher blood pressure, lower albumin, lower alkaline phosphatase and higher left ventricular mass index ((67±19) vs. (75±20) g/L, 142 (126, 154) vs. 128(113, 145) mmHg(1 mmHg=0.133 kPa), (91±21) vs. (82±22) mmHg, 32 (26, 41) vs. 40 (31, 43) g/L, 151 (82, 214) vs. 215 (129, 37) U/L, 48 (38, 66) vs. 38(32, 50) g/m2.7,t=2.03, Z=2.89, t=2.70, Z=2.49, 2.79, 2.29,all P<0.05), but no independent risk factors were identified (all P>0.05). The peritoneal dialysis group had better alleviation for anemia, low calcium, and high phosphorus than the hemodialysis group ((87±22) vs. (72±16) g/L, (1.9±0.5) vs. (1.7±0.4) mmol/L, (2.2±0.7) vs. (2.8±0.9) mmol/L, t=2.92, 2.29, 2.82, all P<0.05), and the survival rate of the peritoneal dialysis group was significantly higher than that of the hemodialysis group (77.8% (28/36) vs. 48.4% (30/62), χ2=8.14, P=0.004). Conclusions: CAKUT is the most common etiology in children with CKD 5, and anemia is the most common complication. The incidence of complications in children with CKD 5 varies with age, gender and etiology. Anemia, hypertension, hypoalbuminemia, reduced alkaline phosphatase and elevated LVMI may be the prognostic factors in children with CKD5. Peritoneal dialysis may be more beneficial for improving the long-term survival rate.

Penggantian Kateter Intravena Perifer sesuai Indikasi Klinis terhadap Kejadian Komplikasi pada Anak

This study aims to determine the effect of peripheral intravenous catheter replacement on clinical indications of complications in children. The method used is a review of eight articles on the impact of intravenous catheter replacement on clinical presentations on the incidence of complications in children using the ScienceDirect, ProQuest, Ebscohost, and Scopus databases. The inclusion criteria for the articles reviewed were research articles published in 2002-2022, accessible in full text and English. The exclusion criteria were articles not accessible in full text and check reports. The study's results obtained eight pieces that followed the study's objectives. The results of a systematic review of complications, 4 of 8 research articles showed that intravenous catheter replacement according to clinical indications did not significantly increase the risk of intravenous catheter complications; three research articles showed no significant difference to intravenous catheter complications.Regarding the survival time of intravenous catheters, of the eight articles reviewed, three reports stated that those replaced based on clinical indications had a longer survival time than those replaced routinely. Meanwhile, from cost efficiency, three articles said that routine catheter replacement increased hospital expenses. In conclusion, replacing intravenous catheters according to clinical indications has a more positive effect on pediatric patients. If surveillance for signs and symptoms of intravenous catheter complications is carried out regularly, signs of intravenous catheter complications can be detected early.&#x0D; &#x0D; Keywords: Extravasation, Phlebitis, Infection, Infiltration, Peripheral Intravenous Catheter, Intravenous Catheter Replacement

Ostomy complications and clinical profile of children attending in a reference hospital

Objective: The aim was to study the incidence of ostomy complications in children, as well as characterize the sociodemographic and clinical profile of the children seen in the outpatient clinic. Methods: This is a quantitative, descriptive, prospective character study performed with 37 children between February and August 2016 at an outpatient clinic of a public hospital in Brasília, Federal District. For the statistical analysis, the categorical variables were described by absolute and relative frequencies and the quantitative variables were described by means of average and standard deviation. The chi-square test was used to verify associations between qualitative variables. Results: From the studied children, 56,7% had ostomy complications. The most frequent complication was contact dermatitis. Conclusion: Not that many studies are directed towards the children with ostomy. It is expected that the data obtained from this research can subsidize action planning on behalf of health professionals to reduce and/or avoid the complications incidence.

Outcomes after appendectomy in children with acute appendicitis treated at a tertiary paediatric centre: results from a retrospective cohort study

PurposeIn general, an appendectomy is presumed to have a limited burden of disease. However, in current literature, reported complication rates vary. This study aims to provide additional insights in the incidence of post-appendectomy complications in children with acute appendicitis.MethodsThis retrospective cohort study included children (0–17 years old) that underwent appendectomy at our tertiary referral centre for suspected acute appendicitis (January 2011–December 2018). Children referred to our centre, and those that underwent non-operative treatment were excluded. Post-appendectomy complications were recorded from electronic medical charts using predefined definitions and classified as severe (Clavien-Dindo III–IV) or less severe (Clavien-Dindo I–II).ResultsA total of 131 children were included. Simple and complex appendicitis was diagnosed in 66 (50%) and 60 (46%) children, respectively. A non-inflamed appendix was seen in five (4%) children. One or more complications were identified in 33 (25%) patients. Eight (12%) children with simple appendicitis developed a complication, three of these were severe. In children with complex appendicitis, 23 (38%) children developed a complication, 14 of these were severe.ConclusionThis study shows a high rate of complications compared with current literature, both in children with simple and complex appendicitis. This is probably the result of our definition of complications and being a tertiary referral centre receiving more severe appendicitis cases. However, these results still show that appendectomy is not always a routine procedure with only few complications. Substantiating the need to keep optimizing treatment for children with appendicitis.

10 Mechanical Complications Associated with Central Venous Catheters at a Canadian Tertiary Care Centre

Abstract Background The administration of life-saving treatment through central venous catheters (CVC) has significantly improved the quality of life and outcomes for patients, especially for those requiring long-term care. While CVC-associated bacteremia is a standard patient outcome measure, little is known about the incidence of mechanical complications in children. Although common, large data on mechanical complications are scarce and generally limited to specific paediatric populations from modest single center series. Objectives To determine the incidence of mechanical complications among paediatric patients with CVCs. Design/Methods In this retrospective study we analyzed data from all paediatric patients (0-19 years) who required a CVC between 2001 and 2016 at our health care center, which services patients from regional hospitals in a shared care model. Details on CVC insertions and daily records of catheter function while in hospital have been collected prospectively and stored in a dedicated database. Patient demographics, catheter characteristics, and complications were abstracted from the database. Complications were defined through clinician documentation of CVC mechanical failures such as disconnect, leakage, fracture, and blockage. Complication rates were expressed per 1,000 line days. Results A total of 8,747 CVCs were placed in 5,743 patients during the study period for a total of 780,448 line days. Neonatal patients required the most CVC insertions and made up 41% of the cohort studied. Total mechanical complication rates were the highest over the 15-year period in 2001 (12 per 1,000 line days) and lowest in 2013 (3.8 per 1,000 line days). Peripherally inserted central catheters were used in the majority of patients (56%), while port-a-caths made up the vast majority of line days (78%). Mechanical complications occurred more frequently in non-tunneled catheters and were least likely to occur in port-a-caths (43 and 3.1 per 1,000 line days, respectively). Tunneled catheters failed mechanically at a rate of 8.0 per 1,000 line days and the peripherally inserted central catheter complication rate was 17 per 1,000 line days. Conclusion We provide a novel description of the incidence of mechanical complications in the setting of commonly used CVCs in a large paediatric cohort. Our findings help convey the true frequency of mechanical failures and create a benchmark for mechanical CVC complications in children. Recognizing the mechanical limitations of indwelling catheters will assist clinicians in optimizing catheter choice. Future study is planned to identify risk factors associated with CVC complications.

Complications of therapeutic plasma exchange: A retrospective study of 1201 procedures in 435 children.

Therapeutic plasma exchange (TPE) is now widely used in therapy of multiple diseases in children, by removing the plasma with pathogenic agents from patients. However, adverse reactions may limit its application.A retrospective cohort study of 435 hospitalized children treated with 1201 plasma exchange procedures between January 2013 and July 2018 were enrolled.Complications occurred in 152 procedures (12.7%); 90 procedures (7.5%) had ≥2 complications. No death occurred. The most common complications were pruritus and urticaria (7%), followed by hypertension (1.92%) and hypotension (1.17%). One child had an outbreak of disseminated cryptococcosis neoformans infection, another child developed anaphylactic shock, and 3 children presented toxic epidermal necrolysis after TPE. The incidence of pruritus and urticaria was higher in children of the 6∼15 year group (P < .05) compared with other age groups. There was no significant difference in the incidence of hypertension and hypotension in children at different ages and weights (P > .05). Compared with other diseases, anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis led to a higher incidence of complications in children (P < .05).The results suggest that TPE is a relatively safe procedure for children, and most of the complications are mild. The most common complication is pruritus and urticaria. However, serious complications such as toxic epidermal necrolysis and infection should still be taken seriously.

Pulmonary Complications in Pediatric and Adolescent Patients Following Allogeneic Hematopoietic Cell Transplantation.

Pulmonary complications after hematopoietic cell transplantation (HCT) can lead to significant morbidity and mortality. Limited evaluation of the true incidence of these complications in children and subsequent outcomes of these complications have not been evaluated recently. In April 2018, the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and the National Cancer Institute cosponsored a meeting of experts to describe the status of pulmonary complications in children after HCT, identify critical gaps in knowledge, and explore avenues for research to advance care and optimize outcomes. The Center for International Blood and Marrow Transplant Research was used to evaluate the cumulative incidence of pulmonary complications in children and their respective survival. Of the 5022 children included in this analysis who received allogeneic HCT from 2010 to 2016, 606 developed pulmonary complications within the first year after HCT. Pneumonitis occurred in 388 patients, 125 patients developed pulmonary hemorrhage, and 200 patients had lung graft-versus-host disease (GVHD). For those developing pulmonary complications within 1 year, overall survival 100 days after diagnosis of pulmonary complications was 49% (95% confidence interval [CI], 43% to 54%) for patients with pneumonitis, 23% (95% CI, 16% to 31%) in patients with pulmonary hemorrhage, and 87% (95% CI, 81% to 91%) in patients with pulmonary GVHD. This study demonstrates the approximate incidence of these complications, as well as their significant effects on survival, and can serve as a baseline for future research.

Nursing care in water injection stage of pediatric external ear reconstruction dilator of congenital microtia

Objective Share nursing experience in water injection stage of pediatric external ear reconstruction dilator in 33 cases. Methods Nursing interventions were used among 33 children with external ear reconstruction that treated in our hospital, to enhance nursing care of patients. Results After nursing, there was 1 case of dermatomyositis, 1 case of hemodynamic disorder and 1 case of pain symptom, and because those complications were found timely and treated properly, so the results of operation were not affected. The other children had no obvious complications. Conclusions Nursing intervention in the water injection stage of external ear reconstruction dilator can reduce the incidence of complications in children, and improve the quality of nursing care, so it is worthy of promotion. Key words: Congenital microtia; Nursing; Children; External ear reconstruction dilator; Water injection

Peripheral Nerve Catheters in Children

Background Peripheral nerve catheters (PNCs) are used with increasing frequency in children. Although adult studies have demonstrated safety with this technique, there have been few safety studies in children. The main objective of the current investigation was to examine the incidence of PNC complications in children undergoing surgery. Methods This is an observational, multi-institutional study using the Pediatric Regional Anesthesia Network (PRAN) database. Data pertaining to PNCs were entered prospectively into a secure, online database by each participating centre. Patient characteristics, anatomic location, localization techniques, medications used, and complications were recorded for each catheter. All complications and any sequelae were followed until resolution. Results There were 2074 PNCs included in the study. 251 adverse events and complications were recorded, resulting in an overall incidence (95% CI) of complications of 12.1% (10.7–13.5%). The most common complications were catheter malfunction, block failure, infection, and vascular puncture. There were no reports of persistent neurologic problems, serious infection, or local anaesthetic systemic toxicity, resulting in an estimated incidence (95% CI) of 0.04% (0.001–0.2%). Patients who developed an infection had used the catheters for a greater number of days, median (IQR) of 4.5 (3–7) days compared with 3 (1–3) days in the patients who did not develop an infection, P Conclusions Our data support the safety of placing PNCs in children, with adverse event rates similar to adult studies. Catheter problems are common, yet minor, in severity.

Second intraocular surgery after primary pediatric cataract surgery: indications and outcomes during long-term follow-up at a tertiary eye care center.

PurposeAlthough pediatric cataract surgery has become standardized and safe, further surgical interventions are not uncommon. The purpose of this study was to analyze the incidence of complications in children who required an intraocular intervention.MethodsA retrospective review of medical records of children (<7 years) with cataract who underwent cataract surgery with or without primary posterior chamber intraocular lens (IOL) placement between January 2006 and December 2014 was carried out. Data were collected regarding visual axis opacification (VAO), glaucoma, IOL decentration, intraocular infections, and other indications that required a second intraocular surgery.ResultsOut of 814 (570 pseudophakic and 244 aphakic) eyes of 620 operated children, 45 eyes of 40 children (5.5%, 45/814) needed a second surgery. The most common indication being VAO (2.9%, 24/814), followed by glaucoma (0.73%, 6/814). Incidence of complications was higher in children <1 year (VAO 6.1%, 19/308 and glaucoma 6%, 6/308). Among all children, repeat interventions and VAO were slightly less frequent in pseudophakics (4.91%, 28/570) vs aphakics (6.91%, 17/244) (P=0.31). As VAO was more common in pseudophakic eyes in infants, glaucoma was equally common in both groups. Best-corrected visual acuity improved from 1.6±0.56 LogMAR preoperatively to 0.80±0.50 LogMAR postoperatively.ConclusionsOur study suggests that overall incidence of second intraocular surgery is low after primary pediatric cataract surgery. VAO remains the most common indication followed by secondary glaucoma. Incidence of complications is higher in children <1 year of age at initial surgery.

Percutaneous Nephrolithotomy in Children: 17 Years of Experience

We analyzed factors that might affect outcome in terms of success and incidence of complications in children up to 17 years after undergoing percutaneous nephrolithotomy. The data of 346 renal units (294 patients) were analyzed in terms of postoperative outcome. Factors investigated that might affect outcome were patient gender, age, stone laterality, largest stone size, stone burden, number of stones, location of a single stone, previous intervention and instrument size. Mean ± SD patient age was 8.51 ± 4.91 years, and male-to-female ratiowas 209:137. Mean ± SD stone burden was 3.49 ± 3.3 cm(2). Stone-free rates after a single procedure were 84.4% and 73.1% in patients with and without clinically insignificant residual stones, respectively. On univariate and multivariate analyses stone burden and number of stones affected the stone-free rate. Complications consisted of bleeding in 41 patients (11.8%), postoperative urinary tract infection in 21 (6%), urosepsis in 4 (0.1%) and hydrothorax in 4(0.1%). One patient died of multiple organ failure. Through the years blood transfusion and complication rates decreased, and the use of smaller instruments increased significantly. Although bleeding occurred less often in caseswhere a 14Fr sheath was used rather than a larger sheath (5% vs 12%, p=0.142), the difference was not significant. No significant factor affecting complication rates was detected. As in adults, percutaneous nephrolithotomy can be used in children with acceptable complication rates and good success rates for surgical treatment of complex renal stones. Number of stones and stone burden are predictive of postoperative stone-free rate.

Low incidence of complications after cephalic vein cutdown for pacemaker lead implantation in children weighing less than 10 kilograms: A single-center experience with long-term follow-up.

Only a few studies on the cephalic vein cutdown technique for pacemaker lead implantation in children weighing ≤10 kg have been reported even though the procedure is widely accepted in adults. The purpose of this study was to prove that cephalic vein cutdown for pacemaker lead implantation is a reliable technique with a low incidence of complications in children weighing ≤10 kg. The study included 44 children weighing ≤10 kg with an endocardial pacemaker. Cephalic, subclavian, and axillary vein diameters were measured by ultrasound before implantation. The measured diameters were used to select either an endocardial or epicardial surgical technique. Regular 6-month follow-up visits included pacemaker interrogation and clinical and ultrasound examinations. Two dual-chamber and 42 single-chamber pacemakers were implanted. Mean weight at implantation was 6.24 kg (range 2.25-10.40 kg), and mean age was 11.4 months (range 1 day-47 months). In 40 children (90.1%), the ventricular leads were implanted using the cephalic vein cutdown technique, and implantation was accomplished via the prepared right external jugular vein in 4 of the children (9.9%). The atrial leads were implanted using axillary vein puncture and external jugular vein preparations. Mean follow-up was 8.9 years (range 0-20.9 years). Only 1 pacemaker-related complication was detected (a lead fracture near the connector that was successfully resolved using a lead repair kit). The cephalic vein cutdown technique is feasible and reliable in children weighing ≤10 kg, which justifies the application of additional surgical effort in the treatment of these small patients.

Management of congenital neck lesions in children

A retrospective clinical trial was conducted to evaluate the clinical features and treatment outcomes and to determine the incidence of complications in children with congenital neck lesions (CNLs) treated at our institution with a special emphasis on thyroglossal duct remnant (TGDR), branchial cleft anomaly (BCA), and dermoid cyst (DC). This series had 72 patients with CNL. The diagnosis of CNL was made by physical examination, ultrasound (US) in most, and for a potential extension of the mass computed tomography (CT) or magnetic resonance imaging (MRI) in a few patients and confirmed by histopathological examination in all of the children. Of the patients in this series, 39 (54.2%) children had thyroglossal duct remnant (TGDR). The most common surgical procedure (n=36) in these children was Sistrunk's procedure. Four children (10.3%) with TGDR had associated anomalies including Turner syndrome and Morgagni hernia. During the study period, 25 (34.7%) children with branchial cleft anomaly (BCA) were treated and most of these were second branchial anomalies. There were eight children (11.1%) with dermoid cyst (DC). TGDR is the most common CNL and is presented clinically rather late with regard to BCA and DC in this series. Surgical resection is optimal choice of therapy in CNLs not only for aesthetic reasons but also for the recurrent infections and the potential danger of malignancy. Definitive surgery may be associated with high morbidity, especially recurrence. Associated anomalies may be observed, especially in children with TGDR. Although the Sistrunk's procedure is a safe and successful technique, life-threatening complications should also be kept in mind during the management of these lesions and early and adequate surgical treatment is suggested.

Predictive factors for complications in children with esophageal atresia and tracheoesophageal fistula

The objective of this study was to describe the incidence of complications in children with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) at a tertiary pediatric hospital and to identify predictive factors for their occurrence. A retrospective chart review of 110 patients born in or transferred to Sydney Children's Hospital with EA/TEF between January 1999 and December 2010 was done. Univariate and multivariate regression analyses were performed to identify predictive factors for the occurrence of complications in these children. From univariate analysis, early esophageal stricture formation was more likely in children with 'long-gap' EA (odds ratio [OR] = 16.32). Patients with early strictures were more likely to develop chest infections (OR = 3.33). Patients with severe tracheomalacia were more likely to experience 'cyanotic/dying' (OR = 180) and undergo aortopexy (OR = 549). Patients who had gastroesophageal reflux disease were significantly more likely to require fundoplication (OR = 10.83) and undergo aortopexy (OR = 6.417). From multivariate analysis, 'long-gap' EA was a significant predictive factor for late esophageal stricture formation (P = 0.007) and for gastrostomy insertion (P = 0.001). Reflux was a significant predictive factor for requiring fundoplication (P = 0.007) and gastrostomy (P = 0.002). Gastrostomy insertion (P = 0.000) was a significant predictive factor for undergoing fundoplication. Having a prior fundoplication (P = 0.001) was a significant predictive factor for undergoing a subsequent aortopexy. Predictive factors for the occurrence of complications post EA/TEF repair were identified in this large single centre pediatric study.

Clinical characteristics of respiratory virus infection in children admitted to an intensive care unit

Purpose: To investigate the clinical characteristics and the risk factors for mechanical ventilator treatment and incidence of complications in children admitted to an intensive care unit (ICU) with detected respiratory viruses. Methods: Eighty-two patients who were detected respiratory viruses by multiplex real-time polymerase chain reaction from nasopharyngeal aspirates were enrolled among the 123 children admitted to ICU with acute respiratory manifestations during the study period from January 2006 to December 2012. Results: Detection rate of respiratory viruses were 66% and 13 patients (16%) had two viruses isolated. The most common respiratory virus isolated was respiratory syncytial virus (RSV) (35%) followed by rhinovirus (19%), adenovirus (13%), parainfluenza virus (11%), influenza virus (11%), human metapneumovirus (6%), and human coronavirus (5%). Pneumonia (70%) was the most common clinical diagnosis. The mean age of patient with RSV infection was the youngest and with influenza virus infection was the oldest among other viruses infection (mean ± standard deviation, 5.9 ± 10.1 months vs. 51.0 ± 26.1 months; P= 0.01). Forty Patients (49%) who had the underlying diseases were not associated with incidence of mechanical ventilator treatment and complications. Bacterial coinfection with respiratory virus was the significant risk factor of mechanical ventilator care and incidence of complications (odds ratio [OR], 50.003; 95% confidence interval [CI], 3.955–632.144; P= 0.003, and OR, 15,569; 95% CI, 1.803–134.452; P= 0.013). Conclusion: The significant morbidity of pediatric patient admitted to ICU with respiratory virus infection (RVI) was associated with bacterial coinfection. Furthermore, multicenter study should be performed to investigate the epidemiology of RVI in pediatric patients admitted to ICU in domestic. (Allergy Asthma Respir Dis 2013;1:370-376)

Factors Influencing Outcome and Incidence of Late Complications in Children who Underwent Allogeneic Hematopoietic Stem Cell Transplantation for Hemoglobinopathy

Background: Hematopoietic stem cell transplantation (HSCT) remains the only potentially curative treatment for severe hemoglobinopathy (HGP). Late complications (LCs) are all events occurring beyond two years post-HSCT. We retrospectively analyzed prevalence, factors influencing occurrence, and prognosis of LCs post-HSCT for HGP. Patients and Methods: Between 2000 and 2011, 47 patients (21 males, 26 females; 43 with beta thalassemia major, four with sickle cell disease) who had survived more than two years post-HSCT for HGP were retrospectively reviewed. Mean age at HSCT was 7.7 years (1.1–32 years); mean follow-up was 7.1 years (2–11.6 years); 11 patients were splenectomized; mean ferritin level was 3022 ng/mL (350–10900); and seven patients underwent a second HSCT. Results: Endocrinological complications were observed with primary gonadal failure in 16/20 mature females and 4/11 mature males, in five patients with primary hypothyroidism and in four with insulin-dependent diabetes mellitus (DM). Skeletal complications were observed in 10 with secondary osteoporosis; 22 patients had elevated transaminase levels; two had hepatitis B reactivation. Neurological, cardiac and ocular manifestations were relatively rare. A higher incidence of LCs was observed in splenectomized than in nonsplenectomized patients: cGVHD −64% versus 13% (P = .003); endocrine abnormalities –91% versus 30.5%, (P = .001); elevated transaminase levels −73% versus 33% (P = .043); mortality –18% versus 2.7% (NS). Conclusions: LCs post-HSCT for HGP are common and heterogeneous. Etiology is multifactorial with iron overload (IO), class, splenectomy, age, chronic GVHD, and corticosteroid (CS) treatment. Our data may help build follow-up guidelines to limit, detect, and treat any LCs and improve quality of life.

Influence of In-house Pediatric Intensivist Supervision on Complications of Emergent Intubations

PURPOSE: In adult populations, implementation of in-house, full-time (24 hour/day, 7 day/week) supervision by intensivists is thought to reduce mortality and decrease complication rates. Little is known about the impact of in-house intensivist supervision in children's hospitals. We recently began providing such coverage in our children's hospital, and have evaluated its relationship to patient outcomes. Specifically, we sought to determine the influence of in-house intensivist supervision on the incidence of complications in children requiring emergent intubations.

Impact of Hydroxyurea On Peri-Operative Management and Outcomes in Children with Sickle Cell Anemia.

Abstract 2567Poster Board II-544Surgical procedures in children with sickle cell anemia (SCA) can be complicated by vasoocclusive events (VOE) such as acute chest syndrome (ACS) and pain. Peri-operative management requires a multidisciplinary approach to provide appropriate pre-operative intravenous hydration and intra- and post-operative monitoring. Transfusion therapy has been controversial. Our institution previously described a low incidence of complications in children who received serial transfusions over 3-4 weeks prior to surgery. Subsequently, an increasing number of children have been prescribed hydroxyurea (HU) to prevent SCA complications. In general, children on HU at our institution only receive a single top-off transfusion the day prior to surgery if their hemoglobin is less than 10 g/dL. We hypothesized that children in the HU group would have a lower number of serial transfusion compared to the non-HU group and that there would be no difference in complications or days to discharge between the two groups. We conducted a single-institution retrospective cohort study of children with SCA, who were age less than 18 years and underwent at least one surgical procedure at Duke University Medical Center between January 1, 2003 and April 30, 2008. Data were abstracted from electronic and written medical records. Descriptive statistics were used to characterize the cohort. Wilcoxon test was used to compare continuous variables and Pearson test was used to compare categorical variables between the non-HU and HU groups. Fifty-three subjects were included (Table 1). The non-HU group was significantly younger than the HU group, but children in the non-HU group were significantly more likely to be transfused pre-operatively, primarily with serial transfusions or erythrocytopheresis, compared to the HU group. One subject in the non-HU group developed a pre-operative delayed hyperhemolytic transfusion reaction. Post-operative complications are detailed in Table 1; the overall rate was low. Two subjects in the HU group developed acute chest syndrome despite pre-operative transfusion; one episode was likely related to underlying asthma and poor response to hydroxyurea; the second was likely related to pain and hypoventilation after laparoscopic splenectomy and tonsillectomy/adenoidectomy. Overall, there were no significant differences in complications and no significant difference in days to discharge between the two groups. In summary, children with SCA on HU may safely undergo surgery without significantly reducing their percent HbS. Nonetheless, attention should still be made towards multidisciplinary effort to reduce intra- and post-operative complications, and clinicians should consider response to HU, pulmonary status and type of surgery when planning peri-operative management in children with SCA on HU.Table 1Comparison of HU and non-HU groups.non-HUHUPN2330Age, years; mean±SD8.0±4.511.8±4.20.001Males, N (%)12 (52)18 (60)NSProcedures, N (%)..NSCholecystectomy6 (26.1)8 (26.7)Splenectomy1 (4.3)1 (3.3)Ears, Nose, Throat12 (52.2)8 (26.7)Orthopedic07 (23.3)Central Lines2 (8.7)1 (3.3)Other2 (8.7)5 (16.7)Procedure characteristics, N (%)..NSEmergency2 (8.7)1 (3.3)Multiple procedures3 (13)7 (23)Peri-op transfusions, N (%)..0.006No transfusion2 (8.7)8 (26.7)Serial transfusions*19 (82.6)11 (36.7)Top-off transfusion2 (8.7)11 (36.7)Transfusion complications, N (%)1, 4.30Time to discharge, days; mean±SD1.4±11.8±1.5NSPost-op complications, N(%)..NSACS02 (6.7)Isolated fever02 (6.7)Vaso-occlusive pain00Bleeding at incision site01 (3.3)*including erythrocytopheresis Disclosures:Off Label Use: hydroxyurea in young children.

In praise of the epidural space for analgesia in neonates

Epidural analgesia in neonates is now an accepted technique for intraoperative and postoperative pain management in major paediatric centres (1–3). However, its use still creates controversy and discussion. The potential benefits of the intervention must be weighed against the ability of an institution to perform and manage the technique safely. This review will concentrate on the advantages of epidural analgesia in neonates, making recommendations for safe practice, and outline the disadvantages of continuous intravenous morphine infusions. Advantages of epidural analgesia IntraoperativelyReduction of MAC for volatile agents Resulting in: • faster and clearer recovery • reduced side effects which may be associated with higher concentrations of volatile agents • reduced need for muscle relaxants (4) Reduction in postoperative ventilation Epidural analgesia has been shown to be especially suited for specific neonatal conditions such as oesophageal atresia (5), Nissens fundoplication (6) and repair of congenital diaphragmatic hernia (7), particularly in reducing the need for postoperative ventilation. Even if ventilation is required, this period is shorter and less problematic than if opioids are employed (8). The degree of muscle relaxation provided by epidural analgesia will facilitate the reduction of gastroschisis or exomphalos (9). Epidural analgesia can also provide excellent pain relief following thoracic surgery (10). Decrease in stress response The stress of surgery is known to result in compromise of the cardiovascular system, protein metabolism and the immune system, all of which may have significant detrimental effects on the high-risk neonate (11). Epidural analgesia has been demonstrated to reduce this stress response (12), whereas the use of morphine, with its immunosuppressive effect, would amplify this. Haemodynamic stability Epidural analgesia is associated with haemodynamic stability, whereas anaesthesia, with parenteral analgesics, often results in a rise in blood pressure compared. There is also some evidence that bleeding is reduced and operative times are shorter with regional anaesthesia (13). Postoperatively Epidural analgesia decreases, or indeed, removes the need to administer opioid analgesia, thereby reducing the incidence of postoperative respiratory complications. Not only is this safer for the child, it also allows the child to be nursed in ward areas, once adequate education of nursing staff has occurred (3). Gastric function rapidly returns to normal when epidural analgesia is used. This facilitates the re-establishment of feeding and earlier discharge (14). The lack of sedation associated with epidural analgesia enables the parents to be actively involved in the care of their child, thereby increasing parental satisfaction. Economics The use of epidural analgesia produces cost savings for hospitals: • faster discharge • reduced Intensive care stay • efficient use of ward nurses time Safety of regional analgesia in children The complication rate of epidural analgesia in neonates is low. However, there are a number of recommendations that should be followed: (a) the technique should be used only when clinically indicated, nerve blocks are safer than central techniques (15) (b) the technique should be restricted to experienced practitioners. minimising the number of attempts required to achieve successful catheter placement. (c) there should be no contraindications to the technique (d) if possible a caudal catheter technique is safer than a lumbar or thoracic approach (e) loss of resistance techniques using saline are safer than those employing air (f) safer epidural delivery systems should be used (g) utilisation of newer local anaesthetic solutions, i.e. Ropivacaine (3,16), and Chirocaine (h) adherence to the dose recommendations (17) (i) to use epidural infusions for less than 48 hours (18) (j) staff need to be thoroughly educated and assessed to enable them to effectively care for children receiving epidural analgesia Is it safe to use regional analgesia in neonates? There are no studies of complications of regional analgesia in neonates, information can only be derived from studies including older children. The studies by ADARPEF, both retrospective and prospective, demonstrated a low incidence of complications in children. The retrospective study (19) described five tragedies out of 10 000 patients following regional analgesia. The prospective study (15) described 23 incidents in 15 000 central blocks. This incidence is similar to that found in a US study of 15 000 caudal blocks. There is also evidence that bacterial colonisation of caudal or lumbar epidural catheters is not significant for up to 48 hours following the start of the infusion (20).