Lung Ultrasound in Children with Acute Respiratory Failure: Comparison between Chest X-ray, Chest Computed Tomography, and Lung Ultrasound: A Case Series.

Respiratory failure is one of the most common and critical problems in pediatric wards. Assessments by chest X-rays (CXRs) are common and prevalent for determining the cause of respiratory failure in children. However, CXRs can be misinterpretated. Some patients may require further evaluation with other tools, such as chest computed tomography (CCT). Lung ultrasound (LUS) has proven useful for detecting lung abnormalities with respiratory failure in adults, but its usefulness in children is still not clear. We present a series of eight children who were admitted in a tertiary children's hospital. Each child underwent CXR, CCT, and LUS. In seven of eight cases, both LUS and CCT were able to detect abnormal findings. However, the radiological findings in CXRs were not sufficient. These cases included children with pleural effusion that was comorbid with consolidation, or cases with substantial consolidation that required thoracentesis or proper physical therapy. KEY MESSAGES: LUS can be beneficial for evaluating children with respiratory failure that are admitted in pediatric intensive care unit (PICU) and may contribute towards appropriate therapy for children. HOW TO CITE THIS ARTICLE: Fukuhara S, Yamaguchi Y et al. Lung Ultrasound in Children with Acute Respiratory Failure: Comparison between Chest X-ray, Chest Computed Tomography, and Lung Ultrasound: A Case Series. Indian J of Crit Care Med 2019;23(2):95-98.

A Case of Intracardiac Invasion of Hepatoblastoma Diagnosed With Point-of-Care Ultrasound.

Ultrasonography can be useful in the evaluation of children with abdominal complaints and may be the initial imaging modality in patients presenting with a newly recognized abdominal mass. Hepatoblastoma is an uncommon cause of acute abdominal pain in children and can rarely metastasize to the heart through vascular invasion. We report a case in which a 4-year-old girl who presented to the emergency department with abdominal pain promptly underwent point-of-care ultrasound and was subsequently diagnosed with intracardiac invasion of an abdominal tumor.

Decompressive craniectomy 116 h after malignant middle cerebral artery infarction.

The optimal timing of decompressive craniectomy in pediatric patients after presentation with malignant middle cerebral artery infarction is unknown. We report herein the case of a previously healthy 6-year-old Japanese girl who had good outcome after emergency decompressive craniectomy 116 h after malignant middle cerebral artery infarction. This case suggests that the timing of decompressive craniectomy can be delayed until deterioration of neurological findings and, compared with adults, a more prolonged time course for surgical intervention might be acceptable.

Effect of delivery mode on postnatal platelet count dynamics in neonates born to mothers with immune thrombocytopenia.

We aimed to determine the effect of delivery mode on postnatal platelet count dynamics in neonates born to mothers with immune thrombocytopenia (ITP). This single-center, retrospective study included 41 mothers with ITP and their 65 infants born by vaginal delivery (VD, n = 30) and cesarean section (CS, n = 35) between January 1997 and March 2022. The median difference in platelet counts from day 0 to day 2 (ΔPlt [D 0-2]) was significantly lower in the VD group (- 39 × 109/L, interquartile range [IQR]: - 47 to - 24 × 109/L) than the CS group (15 × 109/L, IQR: - 6.5 to 33 × 109/L) (p < 0.001). The median ΔPlt (D 0-5) was significantly lower in the VD group (- 55 × 109/L, IQR: - 85 to - 31 × 109/L) than the CS group (33 × 109/L, IQR: 1-69 × 109/L) (p < 0.001). Multivariate analysis also showed a significant association of delivery mode with ΔPlt (D 0-2) and ΔPlt (D 0-5) (both p < 0.001). VD neonates with platelet counts ≥ 100 × 109/L at birth were significantly more likely than CS neonates to develop thrombocytopenia < 100 × 109/L at nadir (1/26 vs. 6/25) (p = 0.0496). Our findings indicate that mode of delivery is a useful predictor of postnatal platelet count dynamics in neonates born to mothers with ITP.

Late onset group B streptococcus disease manifesting as acute suppurative parotitis.

Few patients with acute suppurative parotitis (ASP) due to group B streptococcus (GBS) have been documented. Limited data on clinical and microbiological features and infectious route are available. We present a 21-day-old boy with invasive GBS disease manifesting as ASP. The patient was admitted because of irritability, fever, and erythematous swelling over the right parotid area. No purulent material exuded from the Stensen's duct. Ultrasonography and computed tomography of the neck showed findings indicative of ASP. On the day after admission, blood culture yielded GBS. The isolate was determined as GBS serotype Ia and sequence type-23, and the patient was successfully treated with intravenous ampicillin for 10 days. A review of the literature revealed 11 GBS ASP infants including ours with age at onset between 13 days and 12 weeks. All infants had bacteremia while pus from the Stensen's duct was detected in only one case. This finding remarkably contrasts with ASP caused by pathogens other than GBS, where the infection usually spreads via a retrograde route from Stensen's duct. The present case and literature review indicate GBS ASP primarily arises from bloodstream infection, and that ASP should be included in an infectious focus as late onset GBS disease.

Small Bowel Obstruction and the Role of Bedside Ultrasonography Performed by a Pediatric Emergency Physician: A Case Report.

Small bowel obstruction (SBO) is a relatively uncommon urgent condition that may require surgical treatment. However, initial symptoms of patients who present with SBO are often nonspecific and may be confused with those of more common pediatric illnesses. Although the number of true SBO cases requiring emergency attention is few, distinguishing SBO from the more common less urgent pediatric abdominal conditions is vital for the most effective patient care. Therefore, immediate and accurate identification of this condition is essential in order to avoid delays in diagnosis that may increase morbidity and mortality. We report a case involving a 7-year-old girl who initially presented with abdominal pain and vomiting. A bedside ultrasonography performed by the pediatric emergency physician allowed for the initiation of appropriate, rapid decision making including extensive examination and management. Although bedside ultrasonography has been used in the past to diagnose SBO in adult patients, this is the first report on diagnosing a pediatric patient with SBO utilizing bedside ultrasonography considering criteria that are different from those for children in the past case series. Here, we also review SBO and its diagnostic modalities and the role of the pediatric emergency physician in performing ultrasonography.

Short and long-term outcomes in children with suspected acute encephalopathy.

BACKGROUND: The time-dependent changes that occur in children after acute encephalopathy are not clearly understood. Therefore, we assessed changes in brain function after suspected acute encephalopathy over time. METHODS: We created a database of children admitted to the pediatric intensive care unit at Kobe Children's Hospital because of convulsions or impaired consciousness with fever between 2002 and 2013. Clinical courses and outcomes were reviewed and patients who met the following criteria were included in the study: (1) 6months to 15years of age, (2) no neurological abnormality before onset, (3) treated for suspected acute encephalopathy, and (4) followed after 1 (0-2) month and 12 (10-17) months of onset. Outcomes were assessed using the Pediatric Cerebral Performance Category (PCPC) scale, with a score of 1 representing normal performance; 2, mild disability; 3, moderate disability; 4, severe disability; 5, vegetative state; and 6, brain death. RESULTS: A total of 78 children (32 male) with a median (range) age at onset of 20 (6-172) months were enrolled. Fifty-one cases scored 1 on the PCPC, 13 scored 2, three scored 3, five scored 4, one scored 5, and five cases scored 6 at discharge. Whereas seven of the 13 cases that scored a 2 on the PCPC recovered normal brain function after 12months, none of the nine cases that scored a 3-5 on the PCPC recovered normal function. CONCLUSIONS: Our findings suggest moderate to severe disability caused by acute encephalopathy had lasting consequences on brain function, whereas mild disability might result in improved function.

Acute lethal encephalopathy in systemic juvenile rheumatoid arthritis.

Macrophage activation syndrome is the most common cause of death in children with systemic juvenile rheumatoid arthritis. We present a first patient with systemic juvenile rheumatoid arthritis in which acute necrotizing encephalopathy developed as a complication of macrophage activation syndrome but not of Reye's syndrome. The suspected mechanism of this lethal complication is discussed.