Central venous catheterization related complications in Pediatric Intensive Care Unit at Queen Sirikit National Institute of Child Health.

BACKGROUND: Central venous catheterization (CVC) is an indispensable route of venous access in management of critically ill patients. Potential CVC related complications include mechanical and infectious complications. OBJECTIVE: To determine type, incidence and risk factor of CVC related complications in pediatric patients. MATERIAL AND METHOD: Prospective observational study of all patients who underwent CVC in pediatric intensive care unit (PICU) at Queen Sirikit National Institute of Child Health, over a 1-year period. RESULTS: The study included 137 patients, of whom 63.5% were males. The mean age was 36.7 ± 4.4 months. There were 204 CVC attempts with total indwell time of 2,002 days. The rate of mechanical complication was 19%, including failure to place catheter (9.3%), hematoma (4.9%), arterial puncture (2%) and pneumothorax (1.5%). Patient body mass index (BMI) > 30 kg/m2, internal jugular venous catheterization, and longer insertion time (> 30 minutes) were associated with high mechanical complication rates. The incidence density of catheter related blood stream infection (CRBSI) was 7.5/1,000 catheter-days. Femoral vein placement had significant higher incidence of CRBSI. CONCLUSION: CVC related complications are comparable to previous studies. Risk factors of mechanical complications include high BMI, internal jugular venous catheterization and longer insertion time. Femoral venous catheterization is the only risk factor for CRBSI.

The effectiveness of brief psychosocial screening in identifying behavioral problems in children.

BACKGROUND: Using screening tools to enhance early detection of psychosocial problems can lead to timely intervention and appropriate referral to general practices. OBJECTIVE: To assess whether the Thai version of Pediatric Symptom Checklist (PSC) is suitable for screening of psychosocial dysfunction. MATERIAL AND METHOD: A cross sectional study was conducted among 160 children aged 6-11 years seeking care at Queen Sirikit National Institute of Child Health from November 2006 to December 2007. Parents were asked to complete the Thai version of the Pediatric Symptom Checklist (PSC) questionnaire and the Thai Youth Behavior Checklist (TYC). Sensitivity specificity, positive and negative predictive value were analyzed and reported. RESULTS: The area under the receiver operation characteristic (ROC) curve, using the TYC as a gold standard, was 0.895. The cut-off score of 16 was appropriate for early detection of the psychosocial dysfunction. At this cut-off score, the sensitivity was 83.51%, the specificity was 79.37%, the positive predictive value was 86.17% and the negative predictive value for detecting psychosocial dysfunction among children was 75.76%. CONCLUSION: The authors' findings suggested that the Thai version, parent completed, PSC may be a useful psychosocial screening tool for the children aged 6-11 years with the recommended cut-off score of 16.

A randomized trial of non-synchronized Nasopharyngeal Intermittent Mandatory Ventilation (nsNIMV) vs. Nasal Continuous Positive Airway Pressure (NCPAP) in the prevention of extubation failure in pre-term < 1,500 grams.

OBJECTIVE: To compare the rate of reintubation within 7 days after extubation and study the complications in premature infants who were randomized in the immediate postextubation period to either nsNIMV or NCPAP. MATERIAL AND METHOD: This study was conducted in the neonatal unit of Queen Sirikit National Institute of Child Health between June 1 and November 30, 2006. Intubated premature infants born at GA < or = 34 weeks or with birth weight < or = 1500 gm, ready to be extubated before 4 weeks of age were recruited. Infants were randomized to either nsNIMV or NCPAP after extubation. Non-synchronized NIMV setting was the same as ventilator setting before extubation and NCPAP pressure was set at the same mean airway pressure of pre extubation ventilator value. Extubation was performed after intravenous loading dose of aminophylline. Primary outcome measurement was reintubation within 7 days of initial extubation and the secondary outcome was possible complications such as apnea, abdominal distension, gastrointestinal (GI) perforation, necrotizing enterocolitis (NEC), sepsis and death. RESULTS: A total of 70 VLBW infants were admitted to the neonatal unit during the study period. A total of 57 infants were intubated of which 48 infants were recruited for the study; 24 were in the nsNIMV group and 24 were in the NCPAP group. Infants in the nsNIMV group had mean birth weight and body weight at the start of study less than that in the NCPAP group (984.8 +/- 218 vs. 1067 +/- 214 and 1185 +/- 219 vs. 1205 +/-191, p = 0.003, 0.02). The nsNIMV group also had a higher rate of RDS and antenatal steroid used when compared to the NCPAP group (19/24 vs. 12/24 and 17/24 vs. 8/24, p = 0.03, 0.01). The nsNIMV group had fewer males than in the NCPAP group (8/24 vs. 17/24, p = 0.01). Reintubation was similar in both groups but atelectasis and sepsis were statistically significant risk factor for reintubation in NCPAP group. There were no significant differences in treatment related complications between the two groups, with respect to incidence of apnea (41.7% in nsNIMV vs. 62.5% in NCPAP), abdominal distensions (8.3% in nsNIMVvs. 16.7% in NCPAP), NEC (4.2% in nsNIMVvs. 12.5 in NCPAP), sepsis (4.2% in nsNIMVvs. 8.3% NCPAP). No GI perforation was observed in both groups. CONCLUSION: Non-invasive mode of ventilation, both NIMV and NCPAP, for weaning ofpre-term infants from ventilator may reduce the rate of reintubation in this group. Both modes seem to be equally safe. We believe that the use of non-invasive ventilator techniques will significantly reduce neonatal morbidity in the future. Additional prospective evaluation of these approaches should be conducted in the future.