Myocardial injury in infants ventilated on the paediatric intensive care unit: a case control study.

INTRODUCTION: Cardiac troponin T (cTnT) has been used to assess prevalence of myocardial injury in critically ill children. The majority of studies investigated patients undergoing cardiac surgery. Myocardial injury has been associated with increased mortality. Our objectives were to investigate whether cTnT levels are elevated in infants without congenital heart disease admitted to the paediatric intensive care unit (PICU) and whether levels are associated with increased disease severity. METHODS: We measured cTnT in consecutive infants (<12 months old) without congenital heart disease admitted to the PICU and healthy infants. The Paediatric Index of Mortality (PIM) score was determined in patients on the PICU. RESULTS: We recruited 107 infants: 47 infants admitted to the PICU and 60 healthy controls. Controls were, with a median (interquartile range (IQR)) age of 20 (12 to 34) weeks, significantly older than cases, with a median age of 6.5 (0.3 to 20.6) weeks. CTnT levels were, with a median (IQR) of 18 (10 to 60) pg/ml, significantly higher in admissions to the PICU than in controls, with a median level of 10 (10 to 10) pg/ml (95th centile of 20 pg/ml) (p < 0.001). There was a significant positive correlation (r = 0.41, p = 0.004) between PIM score and cTnT levels. Admissions under one month old had higher cTnT levels than older patients (p = 0.013) but the PIM score was not significantly different between them. When corrected for age and weight the correlation of PIM and cTnT was no longer significant. CONCLUSION: Infants on the PICU in the neonatal period have higher cTnT levels compared to older infants despite not having more severe disease.

Neonatal brain abscess--potential pitfalls of CT scanning.

CASE REPORT. A 6-day-old preterm infant collapsed on the neonatal unit and was found to have enterobacter meningitis. Cranial ultrasounds had been normal in the first few days of life, but an ultrasound on day 9 of life showed a well-defined lesion, which was thought to be an abscess in view of his underlying illness. This finding could not be confirmed on CT scanning, which showed oedematous frontal lobes with a lack of grey-white differentiation. OUTCOME. The correct diagnosis and treatment were delayed until a follow-up CT scan showed more typical features of an abscess 4 days later.