New-onset refractory status epilepticus (NORSE) in paediatric patients: causes, characteristics and outcomes.

Background: New-onset refractory status epilepticus (NORSE) refers to patients without a previous history of seizures who have refractory status epilepticus for at least 72 hours without an identified aetiology. Despite the severe neurological sequelae of NORSE, little is known about this condition in paediatric patients. Objective: To describe the profile of paediatric patients with NORSE, the profile of seizures, possible causes attributed to this condition, treatments offered to patients and the outcomes at discharge from the paediatric intensive care unit (PICU). Methods: This retrospective, multicentre, descriptive study (case series) was conducted in the PICUs of three tertiary hospitals. We reviewed the medical records of all patients aged 0-16 years admitted to the participating PICUs between December 2013 and December 2017 with refractory status epilepticus, without a previous history of seizures or neurological disease. Results: Fifteen patients (2.4%) had NORSE. The median age of patients was 62.3 (IQR 26.2-75.4) months. All patients experienced prodromes before progressing to refractory status epilepticus. Twelve patients (80%) had fever up to 24 hours before seizures. NORSE was classified as cryptogenic in 66% of patients. Twelve patients were treated with complementary therapies, in addition to anticonvulsants. There was no standardisation in the treatment of patients. The overall mortality rate was 20%. Conclusions: NORSE is associated with high morbidity and mortality, without an identified aetiology in most cases and with a wide range of proposed therapies.

Association of nutritional status with clinical outcomes of critically ill pediatric patients with complex chronic conditions.

BACKGROUND & AIMS: There is a high prevalence of children with complex chronic conditions (CCCs) in pediatric intensive care units (PICUs). However, information on the nutritional status (NS) of this specific population is limited. This study aimed to evaluate the NS of critically ill pediatric patients with CCCs and to relate it to clinical outcomes. METHODS: A retrospective cohort study of children admitted to a PICU over a 4-year period. We classified NS according to body mass index-for-age (BMI/A) and height-for-age (H/A) z-scores, using the World Health Organization (WHO) growth curves as a reference. We recorded the presence of CCC according to the definition proposed by Feudtner et al. Severity on admission was measured using the Pediatric Index of Mortality 2 (PIM2). We assessed the following outcomes: mortality, multiple organ dysfunction syndrome during PICU stay, and PICU length of stay (LOS). RESULTS: We included 1753 children in the study. Presence of CCC accounted for 49.8% (873) of the sample. Among children with CCCs, 61.7% (539) had appropriate weight, 19.8% (173) were underweight, and 18.4% (161) were overweight. H/A was considered inadequate in 32.2% (281) of patients with CCCs, a higher rate than in those without CCCs (25.3%; 132) (p < 0.001). Regarding outcomes, underweight children had more organ dysfunctions and prolonged LOS. The association only remained for prolonged LOS when adjusting for confounders. Although underweight children had a higher PIM2-predicted risk of mortality, there was no significant difference in actual mortality between the three NS groups (p = 0.200). CONCLUSIONS: The rates of nutritional inadequacies in patients with CCCs were high. Underweight was independently associated with prolonged LOS in children with CCC.

Enfoque nutricional em unidade de terapia intensiva pediátrica / Nutritional approach in pediatric intensive care unit

Objetivos: Revisar a literatura sobre a abordagem nutricional de crianças criticamente doentes, dando ênfase à desnutrição prévia como fator de gravidade e aos métodos antropométricos de avaliação nutricional normalmente utilizados em Unidades de Terapia Intensiva Pediátricas.Fonte de dados: Elegeram-se os seguintes descritores: desnutrição, unidades de terapia intensiva, pediatria, avaliação nutricional e necessidades nutricionais (e seus correspondentes termos em inglês). Realizou-se uma busca nas bases de dados Medline, Web of Science e SciELO, incluindo o período de 1985 a 2012.Síntese dos dados: A desnutrição ainda persiste principalmente em pacientes pediátricos criticamente doentes, representando um aumento do risco de mortalidade e de tempo de permanência hospitalar. Não foi descrito um método considerado como padrão ouro para a avaliação nutricional em Unidade de Terapia Intensiva Pediátrica. Entretanto, a antropometria é amplamente utilizada e considerada um bom método. Existem várias maneiras de estimar as necessidades nutricionais das crianças criticamente doentes. O peso e a idade são frequentemente utilizados, seguidos pelas equações preditivas.Conclusões: A desnutrição é um agravo que perdura no ambiente hospitalar, principalmente em pacientes pediátricos criticamente doentes. A avaliação nutricional antropométrica é amplamente utilizada em unidades de terapia intensiva pediátricas, sendo normalmente o método de escolha. A equação de Scho é um bom método para ser utilizado, pois estabelece o gasto energético basal.

Aims: To review the nutritional approach of critically ill children, emphasizing prior malnutrition as a factor in its severity, and anthropometric nutritional assessment methods commonly used in pediatric intensive care units.Source of data: The following descriptors were elected: malnutrition, intensive care units, pediatrics, nutrition assessment and nutritional requirements (and their corresponding Portuguese terms). We conducted a search in databases Medical Literature Analysis and Retrieval System Online (Medline), Web of Science and Scientific Electronic Library Online (SciELO), from August 2009 to March 2013.Summary of findings: Malnutrition persists mainly in critically ill pediatric patients, representing an increased risk of mortality and longer hospital stay. A method regarded as the gold standard for assessing nutritional status in Pediatric Intensive Care Unit was not described to date. However, anthropometry is widely used and is considered a good method. There are several ways to estimate the nutritional needs of critically ill children. Weight and age are frequently used, followed by predictive equations.Conclusions: Malnutrition is a problem that remains in the hospital environment, especially in critically ill pediatric patients. The anthropometric nutritional assessment is widely used in Pediatric Intensive Care Units, and is usually the method of choice. The Scho equation is a good method to be used, because it establishes the baseline energy expenditure.