Analysis of death in children not submitted to cardiopulmonary resuscitation

Abstract Objective Describe the epidemiology of deaths in children not submitted to CPR, compare to a CPR group and evaluate patients' medical records of those not submitted to CPR. Methods Observational cross-sectional study assessing deaths between 2015 and 2018 in a pediatric tertiary hospital, divided into two groups: CPR and no- CPR. The source of data included the cardiorespiratory arrest register, based on Utstein style. Children's medical records in no-CPR group were researched by hand. Results 241 deaths were included, 162 in CPR group and 79 in the no-CPR group. Preexisting diseases were observed in 98.3% of patients and prior advanced intervention in 78%. Of the 241 deaths, 212 (88%) occurred in the PICU, being 138/162 (85.2%) in CPR group and 74/79 (93.7%) in no-CPR group (p= 0.018). Bradycardia as the initial rhythm was five times more frequent in the CPR group (OR 5.06, 95% CI 1.94-13,19). There was no statistically significant difference regarding age, gender, preexisting diseases, and period of the day of the occurrence of death. Medical records revealed factors related to the family decision-making process or the suitability of therapeutic effort. Discrepancies between the practice of CPR and medical records were identified in 9/79 (11,4%) records allocated to the no-CPR group. Conclusion Most deaths with CPR and with the no-CPR occurred in the PICU. Bradycardia as the initial rhythm was five times more frequent in the CPR group. Medical records reflected the complexity of the decision not to perform CPR. Discrepancies were identified between practice and medical records in the no-CPR group.

Analysis of death in children not submitted to cardiopulmonary resuscitation.

OBJECTIVE: Describe the epidemiology of deaths in children not submitted to CPR, compare to a CPR group and evaluate patients' medical records of those not submitted to CPR. METHODS: Observational cross-sectional study assessing deaths between 2015 and 2018 in a pediatric tertiary hospital, divided into two groups: CPR and no- CPR. The source of data included the cardiorespiratory arrest register, based on Utstein style. Children's medical records in no-CPR group were researched by hand. RESULTS: 241 deaths were included, 162 in CPR group and 79 in the no-CPR group. Preexisting diseases were observed in 98.3% of patients and prior advanced intervention in 78%. Of the 241 deaths, 212 (88%) occurred in the PICU, being 138/162 (85.2%) in CPR group and 74/79 (93.7%) in no-CPR group (p = 0.018). Bradycardia as the initial rhythm was five times more frequent in the CPR group (OR 5.06, 95% CI 1.94-13,19). There was no statistically significant difference regarding age, gender, preexisting diseases, and period of the day of the occurrence of death. Medical records revealed factors related to the family decision-making process or the suitability of therapeutic effort. Discrepancies between the practice of CPR and medical records were identified in 9/79 (11,4%) records allocated to the no-CPR group. CONCLUSION: Most deaths with CPR and with the no-CPR occurred in the PICU. Bradycardia as the initial rhythm was five times more frequent in the CPR group. Medical records reflected the complexity of the decision not to perform CPR. Discrepancies were identified between practice and medical records in the no-CPR group.

Acute upper gastrointestinal bleeding due to portal hypertension in children: What is the best timing of endoscopy?

OBJECTIVE: To compare initial clinical/laboratory parameters and outcomes of mortality/rebleeding of endoscopy performed <12 h(early UGIE) versus endoscopy performed after 12-24h(late UGIE) of ED admission in children with acute upper gastrointestinal bleeding(AUGIB) due to portal hypertension. METHODS: This is a retrospective cohort study. From January 2010 to July 2017, medical records of all children admitted to a tertiary care hospital with AUGIB due to portal hypertension were reviewed until 60 days after ED admission. RESULTS: A total of 98 ED admissions occurred from 73 patients. Rebleeding was identified in 8/98(8%) episodes, and 9 deaths were observed. UGIE was performed in 92(94%) episodes, and 53(58%) of them occurred within 12 h of ED admission. Episodes with early UGIE and late UGIE were similar in terms of history/complaints/laboratory data at admission, chronic liver disease associated, AUGIB duration, and initial management. No statistically significant associations were found between early UGIE and the outcomes of death/rebleeding and prevalence of endoscopic hemostatic treatment (band ligation or sclerotherapy) compared to late UGIE. In the multivariable logistic regression model, the endoscopic hemostatic treatment showed a negative association with early UGIE(OR=0.33;95%CI=0.1-0.9;p = 0.04). CONCLUSIONS: This study suggests that in pediatric patients with AUGIB and portal hypertension, UGIE may be performed after 12-24 h without harm to the patient, facilitating better initial clinical stabilization/treatment and optimization of resources.

Conscientização dos pais sobre o estado nutricional de seus filhos: estudo exploratório em adolescentes de baixa renda no Brasil / Parental awareness of overweight and obesity: an exploratory study addressing low-income adolescents in Brazil

To evaluate parental awareness and management of overweight and obesity in a sample of low income adolescents registered in a primary health care center (PHCC) in Brazil METHOD: Among adolescents registered in the PHCC, 142 agreed to participate in this study and their body mass index was calculated. Unaware of the anthropometric data, parents were visited at home and asked to select a descriptor for their offspring's body weight (underweight, about right, overweight, and obese RESULTS: Seventeen adolescents were classified as overweight (12.0%) and 14 as obese (10.0%). Among 17 overweight adolescents, 13 (76.5%) were accurately identified by their parents in that condition, and among 13 obese adolescents, 12 (92.3%) were. Three parents of overweight (23.1%) and five parents (41.6%) of obese adolescents tried to manage their offspring's weight problem with a healthcare provider support CONCLUSIONS: Despite the fact that parental recognition was relatively high in this population, our data revealed a low demand for interventionsto reverse the adolescent's overweight and obesity...

Avaliar o reconhecimento e o manejo por parte dos pais frente a situações de sobrepeso e obesidade de adolescentes MÉTODO: Entre os adolescentes de baixa renda cadastrados em um centro de atenção primária à saúde no Brasil, 142 tiveram seu índice de massa corporal calculado. Sem terem conhecimento dos dados antropométricos, os pais foram solicitados a selecionar um descritor para o peso corporal de seus filhos (baixo peso, peso adequado, sobrepeso e obeso RESULTADOS: Dezessete adolescentes foram classificados como sobrepeso (12.0%) e 14 como obesos (10.0%). Entre os 17 adolescentes com sobrepeso, 13 (76.5%) foram corretamente identificados por seus pais e, entre 13 adolescentes obesos, 12 (92.3%) foram identificados como tal. Três pais de adolescentes com sobrepeso (23.1%) e cinco pais (41.6%) de adolescentes obesos procuraram a ajuda de um profissional de saúde para tratarem o problema de peso de seus filhos CONCLUSÕES: O reconhecimento dos pais foi relativamente alto, porém, houve uma baixa demanda por intervenções que pudessem reverter o sobrepeso e a obesidade dos adolescentes...

Parental awareness of overweight and obesity: an exploratory study addressing low-income adolescents in Brazil / Conscientização dos pais sobre o estado nutricional de seus filhos: estudo exploratório em adolescentes de baixa renda no Brasil

OBJECTIVE: To evaluate parental awareness and management of overweight and obesity in a sample of low income adolescents registered in a primary health care center (PHCC) in Brazil METHOD: Among adolescents registered in the PHCC, 142 agreed to participate in this study and their body mass index was calculated. Unaware of the anthropometric data, parents were visited at home and asked to select a descriptor for their offspring's body weight (underweight, about right, overweight, and obese RESULTS: Seventeen adolescents were classified as overweight (12.0%) and 14 as obese (10.0%). Among 17 overweight adolescents, 13 (76.5%) were accurately identified by their parents in that condition, and among 13 obese adolescents, 12 (92.3%) were. Three parents of overweight (23.1%) and five parents (41.6%) of obese adolescents tried to manage their offspring's weight problem with a healthcare provider support CONCLUSIONS: Despite the fact that parental recognition was relatively high in this population, our data revealed a low demand for interventionsto reverse the adolescent's overweight and obesity.(AU)

OBJETIVO: Avaliar o reconhecimento e o manejo por parte dos pais frente a situações de sobrepeso e obesidade de adolescentes MÉTODO: Entre os adolescentes de baixa renda cadastrados em um centro de atenção primária à saúde no Brasil, 142 tiveram seu índice de massa corporal calculado. Sem terem conhecimento dos dados antropométricos, os pais foram solicitados a selecionar um descritor para o peso corporal de seus filhos (baixo peso, peso adequado, sobrepeso e obeso RESULTADOS: Dezessete adolescentes foram classificados como sobrepeso (12.0%) e 14 como obesos (10.0%). Entre os 17 adolescentes com sobrepeso, 13 (76.5%) foram corretamente identificados por seus pais e, entre 13 adolescentes obesos, 12 (92.3%) foram identificados como tal. Três pais de adolescentes com sobrepeso (23.1%) e cinco pais (41.6%) de adolescentes obesos procuraram a ajuda de um profissional de saúde para tratarem o problema de peso de seus filhos CONCLUSÕES: O reconhecimento dos pais foi relativamente alto, porém, houve uma baixa demanda por intervenções que pudessem reverter o sobrepeso e a obesidade dos adolescentes.(AU)