Effects of a surfactant-based gel on acute and chronic paediatric wounds: a panel discussion and case series.

On 20 November 2018, following the International Society for Paediatric Wound Care conference, a closed panel meeting took place in which the use of a surfactant-based gel (PluroGel (PMM), Medline Industries, Illinois, US) in paediatric wound care was discussed. The authors shared their experiences, thoughts, experimental data and clinical results. The panel identified the need for a product that can gently cleanse paediatric wounds and remove devitalised tissue without causing discomfort or skin reactions, as well as potentially promote healing. In adults, PMM has been shown to assist healing by hydrating the wound, controlling exudate and debriding non-viable tissue. Islands of neo-epithelium have also been reported to appear rapidly in different parts of the wound bed. No adverse effects on these proliferating cells have been observed. In vitro data suggest that PMM can remove biofilm, as well as potentially promote healing through cell salvage. The panel, therefore, set out to discuss their experiences of using PMM in the paediatric patients and to establish a consensus on the indications for its use and application in this population. This article will describe the main outcomes of that discussion and present case studies from paediatric patients with a variety of wound types, who were treated with PMM by members of the panel.

Neonatal case studies using active leptospermum honey.

PURPOSE: Treatment of the neonatal patient with clinically complex wounds creates a challenge due to the safety and efficacy issues associated with the use of many advanced wound care products. The purpose of this case series was to present outcomes of 3 neonates with wounds of differing etiologies managed by Active Leptospermum Honey (ALH). DESIGN: Clinical case series. SUBJECTS AND SETTINGS: Clinical experiences with 3 neonates, 1 male and 2 females, are described. These premature infants received care at Rush University Medical Center, Houston, Texas, or Driscoll Children's Hospital, Corpus Christi, Texas. RESULTS: Each neonate presented with dissimilar wounds and differing treatment goals. For a premature infant with left foot ischemia, ALH dressings allowed for removal of nonviable tissue and facilitated the granulation of the open wounds. This removal of nonviable tissue coupled with the facilitation of granulation tissue enabled the premature infant's toe tips to be salvaged without requiring aggressive surgical intervention. For the 2 preterm infants with extravasation of intravenous solutions, ALH dressings allowed healing and increased tissue granulation without any noted toxicity to the wound bed. Further, the method of action of ALH includes an osmotic pull effect that reduced periwound erythema and edema. CONCLUSION: Although the use of ALH has been well documented in adult care, these case studies demonstrate its potential use in different wound etiologies in 3 neonatal patients.

Agrobacterium radiobacter bacteremia in pediatric patients: case report and review.

Agrobacterium radiobacter is an opportunistic pathogen often associated with indwelling catheters. We report five children with central venous catheter-associated A. radiobacter bacteremia and review the characteristics of pediatric Agrobacterium infections. Cure was achieved with appropriate antibiotics, often ticarcillin-clavulanate and gentamicin, and removal of the catheter.

Lipodystrophy syndrome in human immunodeficiency virus-infected children.

BACKGROUND: Lipodystrophy syndrome in HIV-infected adults is characterized by a variety of physical and/or metabolic abnormalities, including fat redistribution, hyperlipidemia (hypercholesterolemia and/or hypertriglyceridemia) and peripheral insulin resistance. Many studies suggest that antiretroviral therapy is the underlying cause of the condition. Few data exist for HIV-infected children. METHODS: This is a cross-sectional study evaluating HIV-infected children age 2 to 16 years. Fat redistribution was identified by physical examination and parental questionnaire. Fasting blood analysis included cholesterol, triglycerides, high density lipoprotein, low density lipoprotein, glucose, insulin and C-peptide. RESULTS: Forty HIV-infected children were recruited. Seven children (18%) exhibited physical signs of fat redistribution. Twenty-seven (68%), 11 (28%) and 3 (8%) children exhibited evidence for hypercholesterolemia, hypertriglyceridemia and insulin resistance, respectively. Eleven children (28%) had no physical signs or laboratory evidence of lipodystrophy. Statistical analysis did not reveal any significant association between the presence of lipodystrophic features and patient age, HIV-1 viral load, exposure to specific antiretroviral medications or duration of protease inhibitor or nucleoside reverse transcriptase inhibitor therapy. Drug dosing was significantly associated with the development of lipodystrophy features. Children receiving pediatric dosing regimens vs. adult dosing regimens were less likely to develop lipodystrophy (P = 0.003). CONCLUSIONS: Features associated with lipodystrophy syndrome arise in some HIV-infected children. Subjects receiving pediatric dosing regimens were less likely than those receiving adult regimens to develop lipodystrophy.

Healthy elderly people lack neutrophil-mediated functional activity to type V group B Streptococcus.

OBJECTIVES: To determine the function of capsular polysaccharide (CPS)-specific immunoglobulin-G (IgG) and neutrophils from older adults in increasing ingestion and killing of type V group B Streptococcus (GBS). DESIGN: Cross-sectional study. SETTING: Outpatient clinic at Baylor College of Medicine. PARTICIPANTS: The subjects were 40 healthy, community-dwelling adults aged 65 and older from Houston, Texas. MEASUREMENTS: The serum level of type V GBS CPS-specific IgG was measured using an enzyme-linked immunosorbent assay. Functional activity was evaluated using an opsonophagocytosis assay. RESULTS: Sera from four subjects promoted efficient neutrophil-mediated phagocytosis and killing of type V GBS (mean log10 reduction+/-standard deviation in colony-forming units (cfu)=1.51+/-0.39). Each had serum CPS-specific IgG concentrations exceeding 1 microg/mL. Sera from 36 subjects did not promote neutrophil-mediated functional activity (mean log10 reduction in cfu=-0.09+/-0.06; P=.025). Only one of these 36 had a CPS-specific IgG concentration exceeding 1 microg/mL. When pooled sera from young adults given type V GBS conjugate vaccine was added at CPS-specific IgG concentrations of 4 microg/mL or 0.4 microg/mL, sera from all subjects promoted neutrophil-mediated killing of type V GBS. No impairment was evident in the neutrophil function of elderly subjects when it was compared with that of young adults. CONCLUSION: CPS-specific IgG and neutrophils from healthy older adults function to ingest and kill type V GBS, but these antibodies are not present in sufficient amounts in most individuals. Further studies should determine whether a type V GBS vaccine induces functionally active antibodies in older people.

Gardnerella vaginalis bacteremia in a premature neonate.

Gardnerella vaginalis is a normal component of the human vaginal flora and commonly associated with bacterial vaginosis. Invasive infection in obstetrical patients due to G. vaginalis has also been reported. In the pediatric age range, infection due to G. vaginalis is extremely rare and limited to neonates. We describe a 23-week premature infant with G. vaginalis bacteremia and review the characteristics of neonatal G. vaginalis infection reported in the literature. Antibiotic susceptibility testing of G. vaginalis isolates has shown that penicillin, ampicillin, erthromycin, clindamycin, and vancomycin are effective in vitro.