Plasma electrolyte imbalance in pediatric kidney transplant recipients.

BACKGROUND: In current practice, pediatric kidney transplant recipients receive large volumes of intravenous fluid intraoperatively to establish allograft perfusion, and further fluid to replace urinary and insensible losses postoperatively. Acute electrolyte imbalance can result, with potential for neurological sequelae. We aimed to determine the incidence and severity of postoperative plasma electrolyte imbalance in pediatric kidney transplant recipients managed with the current standard intravenous crystalloid regimen. METHODS: A retrospective analysis of plasma electrolytes in the first 72 hours post-kidney transplant in 76 children transplanted between January 1, 2015, and January 31, 2018, managed with a standard intravenous fluid strategy used in most UK pediatric transplant centers. RESULTS: Of 76 pediatric transplant recipients of median age 9.9 (range 2.2-17.9) years predominantly managed with 0.45% sodium chloride 5% glucose, 45 (59%) developed acute hyponatremia, 23 (30%) hyperkalemia, and 43 (57%) non-anion-gap acidosis in the postoperative period. Hyperglycemia occurred in 74 (97%) patients. Hyperkalemia was more prevalent in deceased than live donor recipients (P = 0.003) and was significantly associated with non-anion-gap acidosis (P < 0.001). Recipient weight was not associated with overt electrolyte imbalance. CONCLUSION: Postoperative plasma electrolyte imbalance is common in pediatric kidney transplant recipients. Current clinical care strategies mitigate the associated risks of neurological sequelae to some degree. Further studies to optimize intravenous fluid therapy and minimize electrolyte disturbance in this group of patients are needed.

Comparison of diagnoses of early-onset sepsis associated with use of Sepsis Risk Calculator versus NICE CG149: a prospective, population-wide cohort study in London, UK, 2020-2021.

OBJECTIVE: We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks' gestation identified >24 hours after birth, in hospitals using the Kaiser Permanente Sepsis Risk Calculator (SRC) with hospitals using the National Institute for Health and Care Excellence (NICE) guidance. DESIGN AND SETTING: Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units colocated with maternity services across London (10 using SRC, 16 using NICE). PARTICIPANTS: All live births ≥34 weeks' gestation between September 2020 and August 2021. OUTCOME MEASURES: EOS was defined as isolation of a bacterial pathogen in the blood or cerebrospinal fluid (CSF) culture from birth to 7 days of age. We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures. RESULTS: Of 99 683 live births, 42 952 (43%) were born in SRC hospitals and 56 731 (57%) in NICE hospitals. The overall incidence of EOS (<72 hours) was 0.64/1000 live births. The incidence of EOS identified >24 hours was 2.3/100 000 (n=1) for SRC vs 7.1/100 000 (n=4) for NICE (OR 0.5, 95% CI (0.1 to 2.7)). This corresponded to (1/20) 5% (SRC) vs (4/45) 8.9% (NICE) of EOS cases (χ=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4.4/1000 (n=187) for SRC vs 2.9/1000 (n=158) for NICE (OR 1.5, 95% CI (1.2 to 1.9)). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals vs 8428 (15%) in NICE hospitals. CONCLUSION: There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life.

Measurement of gut oxygenation in the neonatal population using near-infrared spectroscopy: a clinical tool?

CONTEXT: Near-infrared spectroscopy (NIRS) is a non-invasive bedside monitor of tissue oxygenation that may be a useful clinical tool in monitoring of gut oxygenation in newborn infants. OBJECTIVE: To systematically review literature to determine whether NIRS is a reliable tool to monitor gut oxygenation on neonatal units. DATA SOURCES: PubMed and Embase databases were searched using the terms 'neonate', 'preterm infants', 'NIRS' and 'gut oxygenation' (2001-2018). STUDY SELECTION: Studies were included if they met inclusion criteria (clinical trial, observational studies, neonatal population, articles in English and reviewing regional gut oxygen saturations) and exclusion criteria (not evaluating abdominal NIRS or regional oxygen saturations). DATA EXTRACTION: Two authors independently searched PubMed and Embase using the predefined terms, appraised study quality and extracted from 30 studies the study design and outcome data. LIMITATIONS: Potential for publication bias, majority of studies were prospective cohort studies and small sample sizes. RESULTS: Thirty studies were reviewed assessing the validity of abdominal NIRS and potential application in neonates. Studies reviewed assessed abdominal NIRS in different settings including normal neonates, bolus and continuous feeding, during feed intolerance, necrotising enterocolitis and transfusion with packed red cells. Several observational studies demonstrated how NIRS could be used in clinical practice. CONCLUSIONS: NIRS may prove to be a useful bedside tool on the neonatal unit, working alongside current clinical tools in the monitoring of newborn infants (preterm and term) and inform clinical management. We recommend further studies including randomised controlled trials looking at specific measurements and cut-offs for abdominal NIRS for use in further clinical practice.

Transferring preterm infants into an open cot using a heated mattress at ≤ 1400 g.

OBJECTIVE: The objective of this study is to evaluate the corrected age and weight that infants were transferred into an open cot using a heated mattress, in overall and within the subgroups of early (weight ≤ 1400 g) and standard transfer (weight > 1400 g). DESIGN: Retrospective cohort study in a tertiary neonatal unit RESULTS: One hundred and thirty-five preterm infants were analysed. The mean weight of moving into an open cot was 1370 ± 167 g at a corrected age 33 ± 1.8 weeks. Eighty-three infants (61%) were transferred early at a mean weight 1276 ± 98 g compared with 52 infants of standard transfer with a mean weight 1522 ± 141 g. Infants of the early group had higher weight gain, were discharged earlier and had shorter length of stay. CONCLUSIONS: Stable preterm infants can be safely moved to an open cot at < 33 weeks and weight ≤ 1400 g.

The acceptability of home monitoring technology among community-dwelling older adults and baby boomers.

This pilot study investigated the willingness of two generational cohorts (current baby boomers and older adults) to accept home monitoring technology. Thirty individuals (15 baby boomers and 15 older adults) of both genders and living in the community participated in structured, mixed methods interviews. The participants' opinions and views on various technologies (e.g., personal emergency response systems, fall detection systems) and sensor types (e.g., switches, motion sensors, computer vision) were determined, including locations within the home where they would be willing to install and use such technologies. Overall, it was found that these technologies would be acceptable if they allowed the participants to remain in their own homes and to age in place. Furthermore, a between-group analysis indicated that there were not many statistically significant differences between the opinions of the two cohorts with respect to preferences about types and locations of these technologies.

The need to look beyond the production and provision of relief seed: experiences from southern Sudan.

Free distribution of seeds in selected areas of southern Sudan has been widespread as a way of increasing food security. Field research in areas targeted for seed relief found that farmer seed systems continue to meet the crop and varietal needs of farmers even following the 1998 famine. Donor investments in seed multiplication of improved sorghum have not been sustained due to a lack of effective demand for the improved seed beyond that created by the relief agencies. The article argues that rather than imposing outside solutions, whether through seed provisioning or seed production enterprises, greater attention needs to be given to building on the strengths of existing farmer systems and designing interventions to alleviate the weaknesses. The case is made to support dynamically the process of farmer experimentation through the informed introduction of new crops and varieties that can potentially reinforce the strength and diversity of local cropping systems.

Do farmers need relief seed? A methodology for assessing seed systems.

This article outlines a methodology to help agencies better determine whether or not relief seed is needed by farmers affected by disaster. A brief review of current seed needs assessment procedures in southern Somalia and Mozambique illustrates problems of knowing which crops and households are affected, the importance of seed access (not just availability) and the need to plan interventions earlier than at present. The development of a Seed Systems Profile (SSP) is proposed to understand better both the socio-economic and agro-ecological aspects of farmers' seed systems. A five-step framework for assessing seed systems in disaster situations is also presented. These tools are currently being tested and further refined in Mozambique. A better understanding of farmers' seed systems will allow for the development of relief and rehabilitation interventions that effectively enhance the resilience and reduce the vulnerability of these systems.