An experience of renal replacement therapy in a combined neonatal and paediatric intensive care unit of Hong Kong.

Intensive care services are expensive. The experience of developing a combined paediatric and neonatal intensive care unit (ICU) in a regional hospital is reported with reference to the provision of renal support for the critically ill patients. The combined unit is staffed by a team of paediatric intensivists, each of whom has special interest in a subspecialty, including cardiology, respiratory medicine, nephrology and neonatology. In the past 7 years, renal replacement therapy (peritoneal dialysis and haemofiltration) was provided to 40 patients, with comparable mortality and complication rates to other reports. This arrangement has been feasible and might be more efficient than running separate paediatric and neonatal ICUs or combining the paediatric ICU with the adult ICU.

Pseudomonas septicaemia in apparently healthy children.

Among 27 cases of Pseudomonas septicaemia in the Department of Paediatrics of Queen Mary Hospital from 1981 to 1988, we have identified 10 children without known predisposing causes before presentation and report their clinical features. Six were infants, of whom 4 developed shock on admission and died. Ecthyma gangrenosum was present in 4 patients. Pseudomonas aeruginosa was isolated in 8 patients. All isolates, except Ps. cepacia, were sensitive to gentamicin. One patient had cyclical neutropenia. Another had an appendicular abscess. Salmonella was cultured from the stool in one patient. Although Pseudomonas septicaemia is normally considered to be associated with underlying immunodeficiency, in 22% it occurred in previously healthy children. Mortality is high especially in infants who develop septicaemic shock. It is advisable to cover for Pseudomonas septicaemia with aminoglycosides or ceftazidime in sick septic infants.