Life-threatening complications of streptococcal sepsis: a PICU contemporary series.

BACKGROUND: Life-threatening streptococcal sepsis nowadays represents an uncommon event in previously healthy infants and children. Critically ill patients suffering from severe streptococcal sepsis complications may present with pre-antibiotic era clinical pictures and require a timely clinical approach to achieve restitutio ad integrum. RESULTS: We report a series of four patient groups affected by an uncommon life-threatening streptococcal sepsis, each of them exhibiting some distinct features. Streptococcus Agalactiae sepsis was associated with cerebral thrombotic/ischaemic lesions, whereas severe cardiogenic shock was prominent in the Streptococcus Viridans group; Streptococcus Faecalis and ß-hemolytic group A Streptococcus patients mostly reported lung complications. CONCLUSIONS: Previous antibiotic treatments should not delay aggressive treatment in the intensive care setting. Early diagnostic suspicion, as well as appropriate and aggressive treatment provided within an intensive care setting are crucial for the clinical outcome.

Kidney injury owing to Streptococcus pneumoniae infection in critically ill infants and children: report of four cases.

Streptococcus pneumoniae sepsis has high morbidity, particularly if complicated by renal injury. Four patients with S. pneumonia invasive infections complicated by renal disorders are presented. The first case was an 18-month-old girl with pneumococcal empyema complicated by haemolytic uraemic (HUS) syndrome. She made a full recovery after mechanical ventilation, inotropic support and haemodiafiltration. The second was a 4-year-old boy who presented with acute post-infectious glomerulonephritis associated with bilateral pneumococcal pneumonia. He too made a complete recovery. The third was a newborn girl with pneumococcal meningitis complicated by acute respiratory distress syndrome and acute renal failure. The fourth patient was an 8-month-old boy with pneumococcal pneumonia and meningitis complicated by HUS and with fulminant thrombotic thrombocytopenic purpura. Despite full support including mechanical ventilation and haemodiafiltration, he died 4 days after admission. On follow-up, all three survivors recovered completely from their pulmonary symptoms and had normal renal function and cardio-circulatory status in the mid-term.

Ventilation mode and outcome of premature infants with congenital chylothorax.

BACKGROUND: Congenital chylothorax (CC) is a rare and potentially life-threatening condition. Over 50% occurs at birth and is considered as the most common cause of neonatal thoracic fluid collection. OBJECTIVES: To analyse the main clinical and respiratory features of a contemporary group of CC infants. METHODS: Databases for CC diagnosed between 2004 and 2009 were reviewed: 10 consecutive cases were retrieved and analysed. RESULTS: Median gestational age of CC patients was 31.8 weeks. Most patients were diagnosed prenatally (7/10 pts, median GA at diagnosis 28 weeks). Severe respiratory distress at birth required respiratory support: 7/10 newborns received high-frequency oscillatory ventilation (HFOV) electively. Large effusions and/or early-onset pneumothorax did not influence the outcome, while prematurity did not impact significantly on mortality (death rate <33 weeks: 28%). The overall ICU survival rate was 70%. CONCLUSION: CC still carries a significant risk of perinatal mortality. Continuous advances in foetal/neonatal medicine and intensive care have considerably improved the prognosis in the last decades, mostly in critically ill infants. HFOV improves lung opening and volume maintenance, possibly shortening the lymph flow over time. It can play a fundamental role both to prevent hypoxic and chronic lung damage and to improve lung recruitment in neonates born with CC.

Early erythropoietin influences both transfusion and ventilation need in very low birth weight infants.

OBJECTIVE: The primary outcome measure of this study was the ability of rHuEPOα therapy to reduce transfusion needs, whereas secondary outcome measures were NICU-LOS and ventilation need. METHODS: All babies with BW <1250 g and GA <30 were eligible. Thirty premature neonates were enrolled in the study (10 treated, 20 controls). rHuEPOα was administered as 300 IU/kg/dose 3 times/week subcutaneously. Iron, folic acid and Vitamin E supplementation were administered in both groups. Hematologic variables and blood sampling were recorded during the study. RESULTS: In rHuEPO group, only four (40%) premature infants required a transfusion, averaging 0.4 ±â€Š0.52 transfusions/pts. A total of 23 transfusions were administered to controls; 11 (55%) infants received one transfusion at least, 55% required multiple transfusions. The average number of transfusions/pts was statistically different (1.15  ±â€Š 1.46 vs. 0.4 ±â€Š0.52; p = 0.02), as the cumulative number of transfused patients (55% vs. 40%; p<0.001). NICU stay was not statistically different, whereas ventilation-free days were increased in EPO group (p<0.05). CONCLUSIONS: R-Hu-EPO treatment in first post-natal weeks markedly enhanced erythropoiesis in severely premature infants compared with matched controls, with a significant impact on transfusion needs. EPO group experienced also a reduction of ventilation time and, possibly, a decreased occurrence of clinical BPD.

Microangiopathic hemolytic anemia complicating a postneonatal pertussis pneumonia.

The authors describe a 2-month-old female with microangiopathic hemolytic anemia complicating a pertussis pneumonia. The baby was admitted to the Pediatric Intensive Care Unit for monitoring and treatment. Remission occurred without sequelae, but multiple hemotransfusions were needed in the acute phase. This represents the first reported case of such a complication in childhood.

Pulmonary oedema caused by "liquid ecstasy" ingestion.

In this case report we describe the first recorded case of alveolar gas exchange impairment caused by "liquid ecstasy" ingestion, and perhaps inhalation, by a 4 year old child. The pulmonary gas diffusion disturbance was sufficiently prolonged to raise the suspicion of a direct toxic effect on the alveolar-capillary membrane.