Alterations in cerebral blood flow in preterm infants with intraventricular hemorrhage.

Xenon-133 inhalation hemispheric cerebral blood flow (HCBF) determinations at one to two days and four to six days postnatally and at 37 weeks postconceptual age have been correlated with computed tomography (CT) scan and autopsy findings in 15 preterm infants weighing less than 1,250 gm at birth. Ten of these infants had germinal matrix hemorrhages (GMH) or intraventricular hemorrhages (IVH). Although HCBF obtained at one to two days showed no mean difference between the GMH/IVH group and the nonhemorrhage infants, hemispheric flow ratios showed significant discrepancies in the GMH/IVH group. In addition, in four of five patients in whom the hemorrhage appeared asymmetric on CT scan, the side of higher flow correlated with the hemorrhage. At four to six days HCBF showed a lower mean value in the GMH/IVH patients than in the nonhemorrhage patients and differences in the interhemispheric ratios in the GMH/IVH group persisted. There were no differences in the mean HCBF values or hemispheric ratios between the two groups of infants at 37 weeks postconceptual age.

Psychological stress in families of children in a pediatric intensive care unit.

Hospitalization of a child is stressful for a family. When the illness is severe, when there has been little or no preparation for hospitalization, when the etiology is not clear, and when the outcome is uncertain stress will be increased. Awareness of how families deal with the stress of the ICU allows us to provide support and to help them deal with that stress.

[Mortality in pediatric anesthesia]. / Mortalità in anestesia pediatrica.

UNLABELLED: In last the 50 years many studies have described the causes of mortality. In newborns and infants between 5 and 6 months the risk is higher. The heart is not developed as in older/grown child and these infants need more oxygen than the older ones. Probably, the interaction or interference of positive pressure ventilation with the neonatal circulation is an important cause leading to this pathology. In many studies the authors have identified this risk in the administration of alothane. A more comprehensive literature is needed about sevoflurane in order to know if it is effective. The incidence of complications with an was twice higher than the incidence with a pediatric anesthetists. In the 50s, there have been many changes in our operational METHODS: Actually, we need more randomized and controlled studies to answer the question oh what is the cause of mortality and what we will be able to do in the future to prevent infant mortality in the operation room.

Epiglottitis--duration of intubation and fever.

The present study reviewed the clinical course of 23 pediatric patients with epiglottitis to define criteria for the length of time children require nasotracheal intubation for relief of airway obstruction. All patients had a nasotracheal tube placed in the operating room, were treated with ampicillin or chloramphenicol, and tracheal extubation was performed when the epiglottis was markedly reduced in size to a point where examiners estimated the thickness of the proximal portion of the epiglottis to be 3-4 mm or less. The mean duration of intubation was 36 +/- 14 h (+/- SD), but there was marked variation between patients. There was no significant relationship between reduction in the size of the epiglottis and the febrile nature of the disease. Based on these observations, it would be imprudent to time tracheal extubation by the absence of fever or to establish an arbitrary time period for maintenance of nasotracheal intubation in epiglottis. Direct observation of the epiglottis should determine when airway support is no longer needed.

Pediatric intensive care: factors that influence outcome.

Four hundred sixty-one consecutive admissions to the Pediatric Intensive Care Unit (PICU) were evaluated using the Therapeutic Intervention Scoring System (TISS). Patients requiring an increased level of care, defined as TISS points greater than or equal to 10, accounted for 75% of patient days in the ICU. Within this group, the primary reason for admission to the ICU was congenital heart disease, trauma, malignancy, respiratory failure, and sepsis. Survival was inversely related to TISS points, through TISS itself could not differentiate between survivors and nonsurvivors. The mortality rates for children who had a congenital malformation, a cardiac arrest before admission, or who developed acute failure secondary to other disease processes were significantly increased. Comparison of critically ill children and adults using TISS showed mortality rates that were similar. Assuming that the cost of intensive care is related to both seriousness of illness (assessed by TISS) and length of hospitalization, in this pediatric population the cost of hospitalization was not disproportionately high for nonsurvivors compared to survivors. Reduction in mortality rates in a PICU population will be dependent on factors largely uncontrollable buy ICU practitioners. This will come about by reduction in the numbers of congenital malformations and the prevention of childhood trauma.