Diagnostic accuracy of a calibrated abdominal compression to predict fluid responsiveness in children.

BACKGROUND: Fluid administration to increase stroke volume index (SVi) is a cornerstone of haemodynamic resuscitation. We assessed the accuracy of SVi variation during a calibrated abdominal compression manoeuvre (ΔSVi-CAC) to predict fluid responsiveness in children. METHODS: Patients younger than 8 yr with acute circulatory failure, regardless of their ventilation status, were selected. SVi, calculated as the average of five velocity-time integrals multiplied by the left ventricular outflow tract surface area, was recorded at four different steps: baseline, after an abdominal compression with a calibrated pressure of 25 mm Hg, after return to baseline, and then after a volume expansion (VE) of 10 ml kg-1 lactated Ringer solution over 10 min. Patients were classified as responders if SVi variation after volume expansion (ΔSVi-VE) increased by at least 15%. RESULTS: The 39 children included had a median [inter-quartile range (IQR)] age of 9 [5-31] months. Twenty patients were fluid responders and 19 were non-responders. ΔSVi-CAC correlated with ΔSVi-VE (r=0.829; P<0.001). The area under the receiver operating characteristic curve (ROCAUC) was 0.94 [95% confidence interval (CI), 0.85-0.99]. The best threshold for ΔSVi-CAC was 11% with a specificity of 95% [95% CI, 84-100] and a sensitivity of 75% [95% CI, 55-95]. ROCAUC of respiratory variation of IVC diameter (ΔIVC) was 0.53 [95% CI, 0.32-0.72]. CONCLUSION: ΔSVi-CAC during abdominal compression was a reliable method to predict fluid responsiveness in children with acute circulatory failure regardless of their ventilation status. CLINICAL TRIALS REGISTRATION: CPP Lyon sud est II: n° ANSM 2015-A00388-41 Clinicaltrial.gov: NCT02505646.

Tiny pills, big impacts: A systematic review on the endocrine disrupting effects of paediatric pharmaceuticals.

Endocrine disrupting chemicals (EDCs) may impact children's health, with medicines as a possible exposure source. Objective: to assess the potential impact of substances in paediatric medications and essential oils on children as EDC. It is a systematic review of five databases including Medline following the PECOT approach. The review focused on publications about children exposed to medication (active ingredients or excipients of interest) and having developed clinical signs of endocrine dysfunction. Out of 946 studies identified, 28 studies were included. They revealed that parabens, lavender essential oils and anti-epileptics are the most identified pharmaceutical products. The reported outcomes relate to puberty, thyroid disorders, obesity and growth. The evidence indicates potential risks, but the overall quality of available data is limited. This systematic review exposes a lack of robust evidence linking paediatric medication exposure to EDC, predominantly relying on case reports. It cautions about potential conflicts of interest.