Outcome of Noninvasive Respiratory Support in Pediatric High-Dependency Units for Acute Respiratory Distress.

BACKGROUND: Noninvasive respiratory support (NRS) is widely used in pediatric ICUs (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDUs), identify predictors of NRS failure, quantify adverse events, and assess outcomes. METHODS: We included infants and children (> 7 d to < 13 y old) admitted to PHDU in 2 tertiary hospitals for acute respiratory distress over a 19-month period. Collected data included diagnosis, type and duration of NRS, adverse events, and the need for PICU transfer or invasive ventilation. RESULTS: Two hundred and ninety-nine children were included, with a median age of 7 (interquartile range [IQR] 3-25) months and a median weight of 6.1 (IQR 4.3-10.5) kg. Bronchiolitis (37.5%), pneumonia (34.1%), and asthma (12.7%) were the most frequent diagnoses. Median NRS duration was 2 (IQR 1-3) d. At baseline, median SpO2 was 96% (IQR 90-99); median pH was 7.36 (IQR 7.31-7.41), and median PCO2 was 44 (IQR 36-53) mm Hg. Overall, 234 (78.3%) children were successfully managed in PHDU, whereas 65 (21.7%) required transfer to PICU. Thirty-eight (12.7%) needed invasive ventilation on a median time of 43.5 (IQR 13.5-108.0) h. On multivariable analysis, maximum FIO2 > 0.5 (odds ratio 4.49 [95% CI 1.36-14.9], P = .01) and PEEP > 7 cm H2O (odds ratio 3.37 [95% CI 1.49-7.61], P = .004) were predictors for NRS failure. Significant apnea, cardiopulmonary resuscitation, and air leak syndrome were reported in 0.3, 0.7, and 0.7% children, respectively. CONCLUSIONS: In our cohort, we found NRS in PHDU safe and effective; however, maximum FIO2 > 0.5 post treatment and PEEP > 7 cm H2O were associated with NRS failure.

Blalock-Taussig Shunt versus Ductal Stenting as Palliation for Duct-Dependent Pulmonary Circulation.

Objectives: There is limited data published from outside North America and Europe comparing the outcomes of a modified Blalock-Taussig shunt (MBTS) and ductal stenting as the first palliative procedure for infants with duct-dependent pulmonary circulation. This study reports the National Heart Center's, in Muscat, Oman, experience in comparing the outcomes of these 2 interventions. Methods: This retrospective study included all infants with duct-dependent pulmonary circulation who received either a MBTS or ductal stenting from 2016-2019. The primary outcomes were death or re-interventions. Secondary outcomes included death, subsequent re-interventions, survival to subsequent surgical intervention, survival to hospital discharge, post-procedural mechanical ventilation and duration of intensive care unit stay. Results: A total of 71 patients were included in the study, 33 (46%) of whom received ductal stenting. The prevalence of the primary outcome (death or re-intervention) in the patent ductus arteriosus (PDA) stent group was 54.5% versus 31.6% in the MBTS group but this was not statistically significant (P = 0.06). There was no difference between the 2 groups in terms of time to next surgical intervention (P = 0.233). The PDA stent group had shorter post-procedural, mechanical ventilation and intensive care unit stay durations (P <0.05). Syndromic patients were at higher risk of mortality compared to non-syndromic patients. Conclusion: MBTS and ductal stenting are both acceptable modalities as a palliative intervention for infants with duct-dependant pulmonary circulation. Syndromic patients are at higher risk of mortality. This can be considered an important factor for patient selection.

Severe Pneumonitis in Omani Infants During An In-Hospital Measles Outbreak: A report of three cases.

Measles is a highly contagious infectious disease. Despite aggressive national initiatives to eradicate measles, outbreaks have occurred in recent years. We report three infants who presented to a tertiary care hospital in Muscat, Oman, in 2019 with measles and then developed pneumonitis, received intensive care treatment and made full recoveries. Infants can have an atypical presentation and develop severe symptoms. Pneumonitis is a serious complication and the management strategies are controversial. The early detection of measles and isolation of affected individuals play major roles in the elimination of measles outbreaks.

Outcomes of Infants Undergoing Modified Blalock-Taussig Shunt Procedures in Oman: A retrospective study.

OBJECTIVES: A modified Blalock-Taussig (mBT) shunt procedure is a common palliative surgery used to treat infants and children with cyanotic congenital heart disease (CCHD). This study aimed to report the outcomes of infants and children undergoing mBT shunt procedures in Oman. In addition, risk factors associated with early mortality, inter-stage mortality and reintervention were assessed. METHODS: This retrospective cohort study was conducted from January 2016 to December 2018 at the National Heart Centre, Muscat, Oman. All paediatric patients with CCHD undergoing mBT shunt procedures as a primary palliative procedure during this period were included. Data were retrieved from electronic hospital records. Kaplan-Meier survival curves were used to describe overall survival. RESULTS: A total of 50 infants and children were included in this study. The in-hospital mortality and interstage mortality rates were 10% and 6.7%, respectively. Preoperative mechanical ventilation (odds ratio [OR] = 3.00, 95% confidence interval [CI]: 1.98-4.76; P = 0.007) and cardiopulmonary bypass (OR = 4.09, 95% CI: 2.44-6.85; P = 0.002) were significant risk factors for early mortality. In-hospital and interval surgical reintervention rates were 12% and 13.3%, respectively. Following the primary shunt procedure, the median time to second-stage surgery was 15.5 months (range: 5.0-34.0 months). CONCLUSION: The findings of this study support those reported in international research regarding the risks associated with mBT shunt surgeries. In particular, preoperative mechanical ventilation and cardiopulmonary bypass were significant risk factors for early mortality.

Efficacy of breast milk gastric lavage in preterm neonates.

OBJECTIVE: To evaluate effects of gastric lavage with mother's milk starting 4 hours after birth, in hospitalized preterm newborns otherwise on exclusive parenteral fluids. STUDY DESIGN: Randomized controlled trial. Sick preterm babies were assigned to receive in addition to parenteral fluids, either gastric lavage with mother's milk within 4 hours of birth and subsequently every 3 hours till tolerance of nutritive enteral feeds (intervention or BML group, n = 40), or remain nil per orally till tolerance of nutritive enteral feeds (control or NPO group, n = 40). The main outcome was the mean number of days of parenteral fluids till successful tolerance of nutritive enteral feeds. They were also evaluated for mean duration of hospital stay, development of new complications, and mortality. RESULT: Despite sicker babies in the BML group at baseline, the mean duration of exclusive parenteral fluid was significantly less (P = 0.003) in BML (3.9 +/- 1.5 days as compared to 5.4 +/- 2.6 days in NPO). In the NPO group 60% of the babies stayed longer than 3 weeks in hospital compared to only 30% in the BML group. The risk of development of new complication after randomization was also significantly less in BML group [RR 0.61 (95% CI 0.40-0.95) (P=0.03)]. Incidence of sepsis was 44% less in BML group [30% in BML, 55% in NPO group; RR 0.58; 95% CI 0.35-0.97; P = 0.02]. On multivariate logistic regression, BML group, birth weight and absence of complication at the time of hospitalization were strong predictors of improved outcome. There was no difference in mortality between 2 groups. CONCLUSION: This study showed that early exposure to even small amounts of mother's milk in sick preterm neonates significantly reduced the days on parenteral fluids, risk of sepsis and the duration of hospital stay without any adverse effect.