Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 44
Filtrar
Más filtros

Banco de datos
País/Región como asunto
Tipo del documento
País de afiliación
Intervalo de año de publicación
1.
J Korean Med Sci ; 39(3): e33, 2024 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-38258365

RESUMEN

BACKGROUND: Over the last decade, extracorporeal membrane oxygenation (ECMO) use in critically ill children has increased and is associated with favorable outcomes. Our study aims to evaluate the current status of pediatric ECMO in Korea, with a specific focus on its volume and changes in survival rates based on diagnostic indications. METHODS: This multicenter study retrospectively analyzed the indications and outcomes of pediatric ECMO over 10 years in patients at 14 hospitals in Korea from January 2012 to December 2021. Four diagnostic categories (neonatal respiratory, pediatric respiratory, post-cardiotomy, and cardiac-medical) and trends were compared between periods 1 (2012-2016) and 2 (2017-2021). RESULTS: Overall, 1065 ECMO runs were performed on 1032 patients, with the annual number of cases remaining unchanged over the 10 years. ECMO was most frequently used for post-cardiotomy (42.4%), cardiac-medical (31.8%), pediatric respiratory (17.5%), and neonatal respiratory (8.2%) cases. A 3.7% increase and 6.1% decrease in pediatric respiratory and post-cardiotomy cases, respectively, were noted between periods 1 and 2. Among the four groups, the cardiac-medical group had the highest survival rate (51.2%), followed by the pediatric respiratory (46.4%), post-cardiotomy (36.5%), and neonatal respiratory (29.4%) groups. A consistent improvement was noted in patient survival over the 10 years, with a significant increase between the two periods from 38.2% to 47.1% (P = 0.004). Improvement in survival was evident in post-cardiotomy cases (30-45%, P = 0.002). Significant associations with mortality were observed in neonates, patients requiring dialysis, and those treated with extracorporeal cardiopulmonary resuscitation (P < 0.001). In pediatric respiratory ECMO, immunocompromised patients also showed a significant correlation with mortality (P < 0.001). CONCLUSION: Pediatric ECMO demonstrated a steady increase in overall survival in Korea; however, further efforts are needed since the outcomes remain suboptimal compared with global outcomes.


Asunto(s)
Reanimación Cardiopulmonar , Oxigenación por Membrana Extracorpórea , Recién Nacido , Humanos , Niño , Estudios Retrospectivos , Corazón , República de Corea/epidemiología
2.
J Korean Med Sci ; 38(33): e252, 2023 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-37605494

RESUMEN

BACKGROUND: Ralstonia mannitolilytica is a causative organism of nosocomial infections, particularly associated with contaminated water, and resistant to various antibiotics, including carbapenems. Several clusters of R. mannitolilytica infections appeared in children at our institute from August 2018 to November 2019. METHODS: From March 2009 to March 2023, all patients admitted to Asan Medical Center Children's Hospital in Seoul, Korea, with culture-confirmed R. mannitolilytica and corresponding clinical signs of infection were identified. Epidemiological and environmental investigations were conducted. Polymerase chain reaction (PCR) was performed for the genes of OXA-443 and OXA-444 on R. mannitolilytica isolates. RESULTS: A total of 18 patients with R. mannitolilytica infection were included in this study, with 94.4% (17/18) and 5.6% (1/18) being diagnosed with pneumonia and central line-associated bloodstream infection, respectively. All-cause 30-day mortality rate was 61.1% (11/18), and seven of the fatal cases were caused by R. mannitolilytica infection itself. The resistance rates to meropenem and imipenem werew 94.4% (17/18) and 5.6% (1/18), respectively. Although four out of nine meropenem-resistant R. mannitolilytica isolates had positive PCR results for OXA-443 and OXA-444 genes, there were no significant differences in antimicrobial susceptibility patterns. Environmental sampling identified R. mannitolylica at two sites: a cold-water tap of a water purifier and an exhalation circuit of a patient mechanical ventilator. After implementing and improving adherence to infection control policies, no additional R. mannitolilytica infection cases have been reported since December 2019. CONCLUSION: R. mannitolilytica can cause life-threatening infections with high mortality in fragile pediatric populations. To prevent outbreaks, healthcare workers should be aware of R. mannitolilytica infections and strive to comply with infection control policies.


Asunto(s)
Antibacterianos , Brotes de Enfermedades , Humanos , Niño , Meropenem/uso terapéutico , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Hospitales Pediátricos
3.
Liver Transpl ; 28(6): 1011-1023, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-34536963

RESUMEN

Living donor liver transplantation (LDLT) is a significant advancement for the treatment of children with end-stage liver disease given the shortage of deceased donors. The ultimate goal of pediatric LDLT is to achieve complete donor safety and zero recipient mortality. We conducted a retrospective, single-center assessment of the outcomes as well as the clinical factors that may influence graft and patient survival after primary LDLTs performed between 1994 and 2020. A Cox proportional hazards model was used for multivariate analyses. The trends for independent prognostic factors were analyzed according to the following treatment eras: 1, 1994 to 2002; 2, 2003 to 2011; and 3, 2012 to 2020. Primary LDLTs were performed on 287 children during the study period. Biliary atresia (BA; 52%), acute liver failure (ALF; 26%), and monogenic liver disease (11%) were the leading indications. There were 45 graft losses (16%) and 27 patient deaths (7%) in this population during the study period. During era 1 (n = 81), the cumulative survival rates at 1 and 5 years after LDLT were 90.1% and 81.5% for patients and 86.4% and 77.8% for grafts, respectively. During era 2 (n = 113), the corresponding rates were 92.9% and 92% for patients and 89.4% and 86.7% for grafts, respectively. During era 3 (n = 93), the corresponding rates were 100% and 98.6% for patients and 98.9% and 95.4% for grafts, respectively. In the multivariate analyses, primary diagnosis ALF, bloodstream infection, posttransplant lymphoproliferative disease, and chronic rejection were found to be negative prognostic indicators for patient survival. Based on generalized care guidelines and center-oriented experiences, comprehensive advances in appropriate donor selection, refinement of surgical techniques, and meticulous medical management may eventually realize a zero-mortality rate in pediatric LDLT.


Asunto(s)
Trasplante de Hígado , Donadores Vivos , Niño , Supervivencia de Injerto , Humanos , Trasplante de Hígado/métodos , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento
4.
Pediatr Res ; 90(5): 1016-1022, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-33504965

RESUMEN

BACKGROUND: There has been a growing interest in the association between mitochondrial dysfunction and sepsis. However, most studies have focused on mitochondrial structural damage, functional aspects, or the clinical phenotypes in sepsis. The purpose of this study was to evaluate mitochondrial DNA (mtDNA) gene mutations in critically ill pediatric patients with septic shock. METHOD: Thirteen patients with severe sepsis or septic shock admitted to the pediatric intensive care unit (PICU) of a tertiary children's hospital were enrolled in this prospective observational study. Clinical data from electronic medical records were obtained. Whole-blood samples were collected within 24 h of PICU admission to perform PBMC isolation, mtDNA extraction, and mtDNA sequencing using next-generation sequencing. RESULTS: mtDNA sequencing revealed mutations in 9 of the 13 patients, presenting 27 point mutations overall, with 15 (55.6%) located in the locus related to adenosine triphosphate production and superoxide metabolism, including electron transport. CONCLUSION: In this pilot study, significant numbers of mtDNA point mutations were detected in critically ill pediatric patients with septic shock. These mutations could provide promising evidence for mitochondrial dysfunction in sepsis and a basis for further large-scale studies. IMPACT: This study is the first to examine mitochondrial DNA mutations in pediatric patients with septic shock using next-generation sequencing. A high frequency of mitochondrial DNA mutations was detected in these patients indicating an association with septic shock. This pilot study may provide a potential explanation for the association between mitochondrial dysfunction and septic shock on a genetic basis.


Asunto(s)
Genoma Mitocondrial , Mutación Puntual , Choque Séptico/genética , Adolescente , Niño , Preescolar , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Masculino , Proyectos Piloto , Estudios Prospectivos , Choque Séptico/sangre
5.
Pediatr Crit Care Med ; 22(2): e135-e144, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33031351

RESUMEN

OBJECTIVES: To develop a modified pediatric Sequential Organ Failure Assessment score using the acute kidney injury diagnostic criteria and evaluate its performance in predicting mortality. DESIGN: A single-center retrospective study. SETTING: Fourteen-bed PICU in a tertiary care academic children's hospital. PATIENTS: Critically ill children admitted to the PICU between January 2017 and September 2019 with at least more than two serum creatinine measurements-one for baseline and the other within the first 48 hours of PICU admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 755 patients were included. Overall, 265 patients were diagnosed with acute kidney injury using the current acute kidney injury diagnostic criteria. The overall PICU mortality was 5.8%. Patients with acute kidney injury required more vasoactive-inotropic drugs and showed higher illness severity scores, including the Pediatric Risk of Mortality III, Pediatric Logistic Organ Dysfunction 2, pediatric Sequential Organ Failure Assessment, and modified pediatric Sequential Organ Failure Assessment scores, as well as higher PICU mortality than patients without acute kidney injury (p < 0.001). As acute kidney injury stages increase, PICU mortality also increased (p < 0.001). Based on multivariable logistic regression analysis adjusted for age and sex, the modified pediatric Sequential Organ Failure Assessment score was an independent prognostic factor of PICU mortality. The modified pediatric Sequential Organ Failure Assessment score showed better performance in predicting PICU mortality (area under the receiver operating characteristic curve, 0.821; 95% CI, 0.759-0.882) than other severity scores (area under the receiver operating characteristic curve [95% CI] of Pediatric Risk of Mortality III, Pediatric Logistic Organ Dysfunction 2, and pediatric Sequential Organ Failure Assessment scores: 0.788 [0.723-0.853], 0.735 [0.663-0.807], and 0.785 [0.718-0.853], respectively). CONCLUSIONS: Acute kidney injury is prevalent and associated with poor clinical outcomes in critically ill children. The modified pediatric Sequential Organ Failure Assessment score, based on the acute kidney injury diagnostic criteria, showed improved performance in predicting PICU mortality. The modified pediatric Sequential Organ Failure Assessment score could be a promising prognostic factor for critically ill children.


Asunto(s)
Lesión Renal Aguda , Puntuaciones en la Disfunción de Órganos , Lesión Renal Aguda/diagnóstico , Niño , Enfermedad Crítica , Mortalidad Hospitalaria , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Estudios Retrospectivos
6.
Pediatr Crit Care Med ; 21(8): e522-e529, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32453925

RESUMEN

OBJECTIVES: Accurate assessments of energy expenditure are vital for determining optimal nutritional support, especially in critically ill children. We evaluated current methods for energy expenditure prediction, in comparison with indirect calorimetry, and developed a new estimation equation for mechanically ventilated, critically ill Korean children. DESIGN: Single-center retrospective study. SETTING: Fourteen-bed pediatric medical ICU in a tertiary care children's hospital. PATIENTS: Pediatric patients admitted to the PICU between October 2017 and September 2019 with a measured energy expenditure by indirect calorimetry. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total 95 pediatric patients (70 in derivation cohort for development of a new predictive equation and 25 in validation cohort) were included. Mean measured energy expenditure of group A was 66.20 ± 15.35 kcal/kg/d. All previously established predictive equations underestimated the predicted energy expenditure, compared with the measured energy expenditure, except the Food and Agriculture/World Health Organization/United Nations University equation. The Schofield-Height and Weight equation showed the best performance among the tested predictive equations for the entire cohort (least bias, -68.58 kcal/d; best percentage, 108.46% ± 33.60%) compared with the measured energy expenditure. It was also the best performing predictive equation in subgroup analysis by age, sex, nutritional status, and organ failure. Because some discrepancies remained between the measured energy expenditure and predicted energy expenditures, we developed a new estimation equation using multiple regression analysis and those variables significantly associated with our current measured energy expenditures: Energy expenditure = -321.264 + 72.152 × (body weight, kg)-1.396 × (body weight) + 5.668 × height (cm) + organ dysfunction* (*hematologic, 76.699; neurologic, -87.984). This new estimation equation showed the least bias and best percentage compared with previous predictive equations (least bias, 15.51 kcal/d; best percentage, 102.30% ± 28.10%). CONCLUSIONS: There are significant disparities between measured and calculated energy expenditures. We developed a new estimation equation based on measured energy expenditure data that shows better performance in mechanically ventilated Korean children than other equations. This new estimation equation requires further prospective validation in pediatric series with a range in body habitus.


Asunto(s)
Metabolismo Energético , Respiración Artificial , Calorimetría Indirecta , Niño , Humanos , República de Corea , Estudios Retrospectivos
7.
BMC Pediatr ; 18(1): 58, 2018 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-29439683

RESUMEN

BACKGROUND: Central venous pressure (CVP) is an important factor affecting capillary blood flow, and it is associated with poor outcomes in adult septic shock patients. However, whether a similar association exists in pediatric patients remains unclear. METHODS: We retrospectively analyzed data from patients admitted to our pediatric intensive care unit (PICU) between February 2009 and July 2015. Patients were divided into two groups-survivors and nonsurvivors-according to 28-day mortality. The associations between (a) mortality and CVP at 6, 24, 48, and 72 h after initiating treatment for established septic shock was analyzed and (b) initial serum lactic acid levels and 6-h CVP. RESULTS: Two hundred twenty-six patients were included in this study, and the mortality rate was 29.6% (67 deaths, nonsurvivor group). Initial serum lactic acid levels, Pediatric Risk of Mortality (PRISM) III score, and Vasoactive-Inotropic Score (VIS) within 24 h after PICU admission were significantly higher in the nonsurvivors than in survivors (1.3 [0.9, 2.4] vs. 3.9 [1.6, 8.0] mmol/l, 11.0 [7.0, 15.0] vs. 17.0 [10.0, 21.5], 12.0 [7.0, 25.0] vs. 22.5 [8.0, 55.0], respectively with p-values < 0.001, < 0.001, and 0.009, respectively). In addition, compared to survivors, a greater percentage of nonsurvivors required mechanical ventilation (92.5% vs. 51.6%, p <  0.001) and showed a greater extent of fluid overload at 48 h after admission (3.9% vs. 1.9%, p = 0.006), along with higher 6-h CVP (10.0 [7.0, 16.0] vs. 8.0 [5.0, 11.0] mmHg, p <  0.001). Patient survival according to levels of CVP (CVP < 8 mmHg, CVP 8-12 mmHg, or CVP > 12 mmHg) showed that the CVP > 12-mmHg group had significantly greater mortality rates (50.0%, p = 0.002) than the other groups (21.3% and 27.5%). Furthermore, multivariate analysis identified significant associations of CVP > 12 mmHg, serum lactic acid levels, and the need for mechanical ventilation with mortality (OR: 2.74, 1.30, and 12.51, respectively; 95% CI: 1.11-6.72, 1.12-1.50, and 4.12-37.96, respectively). CONCLUSIONS: Elevated CVP is an independent risk factor for mortality in pediatric septic shock patients.


Asunto(s)
Presión Venosa Central , Hipertensión/etiología , Choque Séptico/mortalidad , Adolescente , Niño , Preescolar , Femenino , Humanos , Hipertensión/diagnóstico , Lactante , Masculino , Pronóstico , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Choque Séptico/diagnóstico , Choque Séptico/fisiopatología
8.
J Korean Med Sci ; 33(49): e308, 2018 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-30505252

RESUMEN

BACKGROUND: The aim of this study was to describe the structure, organization, management, and staffing of pediatric critical care (PCC) in Korea. METHODS: We directed a questionnaire survey for all Upper Grade General Hospitals (n = 43) in Korea in 2015. The first questionnaire was mainly about structure, organization, and staffing and responses were obtained from 32 hospitals. The second questionnaire was mainly about patients and management. Responses to second questionnaire were obtained from 18 hospitals. RESULTS: Twelve from 32 Upper Grade General Hospitals had pediatric intensive care units (PICUs) and 11 of them had the PICU which was exclusive for children. Total number of PICU beds in Korea was 113. The ratio of the number of PICU beds to the number of children was 1:77,460 in Korea and this ratio is lower than that of other developed countries. The mean number of beds in the PICUs was 9.4 ± 9.3 (range, 2-30). There were 16 medical doctors who were assigned for PCC and only 5 of them were full time pediatric intensivists. In the 18 Upper Grade General Hospitals that responded to the second questionnaire survey, there were 97 patients in the PICUs with an average number of 5.7 ± 7.2 (range, 0-22) on the survey day. The mean age of the patients was 3.4 ± 5.6 years. The mean length of hospital stay was 82 ± 271 days. The mean Pediatric Risk of Mortality score III was 9.4 ± 7.8 at the time of admission to the PICUs. CONCLUSION: There is a considerable shortage of PICU beds compared to those in developed countries. In addition, the proportion of PICUs with PCC specialists is much lower than those in the US and European countries.


Asunto(s)
Cuidados Críticos/estadística & datos numéricos , Niño , Preescolar , Cuidados Críticos/organización & administración , Femenino , Hospitales Generales , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Tiempo de Internación , Masculino , República de Corea , Encuestas y Cuestionarios
9.
Pediatr Crit Care Med ; 18(2): e56-e61, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-28157807

RESUMEN

OBJECTIVES: To analyze the epidemiology of pediatric acute kidney injury requiring continuous renal replacement therapy and identify prognostic factors affecting mortality rates. DESIGN: Retrospective analysis. SETTING: PICU of a tertiary medical center. PATIENTS: One hundred-twenty three children diagnosed with acute kidney injury requiring continuous renal replacement therapy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Vasoactive-Inotropic Score, arterial blood gas analysis, blood chemistry at continuous renal replacement therapy initiation, the extent of fluid overload 24 hours prior to continuous renal replacement therapy initiation, Pediatric Risk of Mortality III score at admission, and need for mechanical ventilation during continuous renal replacement therapy were compared in survivors and nonsurvivors. Out of 1,832 patient admissions, 185 patients (10.1%) developed acute kidney injury during the study period. Of these, 158 patients were treated with continuous renal replacement therapy, and finally, 123 patients were enrolled. Of the enrolled patients, 50 patients died, corresponding to a mortality rate of 40.6%. The survivor group and the nonsurvivor group were compared, and the following factors were associated with an increased risk of mortality: higher Pediatric Risk of Mortality III score at admission and Vasoactive-Inotropic Score when initiating continuous renal replacement therapy, increased fluid overload 24 hours before continuous renal replacement therapy initiation, and need for mechanical ventilation during continuous renal replacement therapy. The percentage of fluid overload difference between the survivors and the nonsurvivors was 1.2% ± 2.2% versus 4.1% ± 4.6%, respectively. Acidosis, elevated lactic acid and blood urea nitrogen, and lower serum creatinine level were laboratory parameters associated with increased mortality. On multivariate analysis, Vasoactive-Inotropic Score, need for mechanical ventilation, blood urea nitrogen, and creatinine level were statistically significant. (Odds ratio: 1.040, 6.096, 1.032, and 0.643, respectively.) CONCLUSIONS:: A higher Vasoactive-Inotropic Score, need for mechanical ventilation, elevated blood urea nitrogen, and lower creatinine level were associated with increased mortality in pediatric acute kidney injury patients who underwent continuous renal replacement therapy. Lower creatinine levels may be associated with increased mortality in the context of fluid overload, which is correlated with a reduced chance of survival.


Asunto(s)
Lesión Renal Aguda/terapia , Mortalidad Hospitalaria , Terapia de Reemplazo Renal/mortalidad , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/mortalidad , Adolescente , Niño , Preescolar , Enfermedad Crítica , Femenino , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Modelos Logísticos , Masculino , Análisis Multivariante , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
10.
Macromol Rapid Commun ; 37(24): 2057-2063, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27859895

RESUMEN

A new random copolymer consisting of similarly shaped donor-acceptor building blocks of diketopyrrolopyrrole-selenophene-vinylene-selenophene (DPP-SVS) and DPP-thiophene-vinylene-thiophene (DPP-TVT) is designed and synthesized. The resulting P-DPP-SVS(5)-TVT(5) with an equal molecular ratio of the two building blocks produced significantly enhanced solubility when compared to that of the two homopolymers, PDPP-SVS and PDPP-TVT. More importantly, despite the maximum segmental randomness of the PDPP-SVS(5)-TVT(5) copolymer, its crystalline perfectness and preferential orientation are outstanding, even similar to those of the homopolymers thanks to the similarity of the two building blocks. This unique property produces a high charge carrier mobility of 1.23 cm2 V-1 s-1 of PDPP-SVS(5)-TVT(5), as determined from polymer field-effect transistor (PFET) measurements. The high solubility of PDPP-SVS(5)-TVT(5) promotes formulation of high-viscosity solutions which could be successfully processed to fabricate large-areal PFETs onto hydrophobically treated 4 in. wafers. A total of 269 individual PFETs are fabricated. These devices exhibit extremely narrow device-to-device deviations without a single failure and demonstrate an average charge carrier mobility of 0.66 cm2 V-1 s-1 with a standard deviation of 0.064. This is the first study to report on successfully realizing large-areal reproducibility of high-mobility polymeric semiconductors.


Asunto(s)
Cetonas/química , Polímeros , Pirroles/química , Semiconductores , Transistores Electrónicos , Polímeros/síntesis química , Polímeros/química
11.
Pediatr Crit Care Med ; 17(5): e239-46, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-27028791

RESUMEN

OBJECTIVES: Disseminated intravascular coagulation is a complex systemic thrombohemorrahgic disorder, which may contribute to organ failure. We aimed to compare the detection rate of the disseminated intravascular coagulation, early in the course of ICU admission, of the two disseminated intravascular coagulation scoring systems defined by International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine criteria and the prognostic value of disseminated intravascular coagulation scores in critically ill pediatric patients. DESIGN: Single-center retrospective observational study. SETTING: PICU in a tertiary care children's hospital. PATIENTS: Pediatric patients admitted in the PICU between January 2013 and December 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 191 patients were included. Among them, 15.7% and 29.8% of the patients were diagnosed with disseminated intravascular coagulation by International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine criteria, respectively. The diagnostic concordance rate between the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems was 52.6%. As the Pediatric Risk of Mortality III, the modified Sequential Organ Failure Assessment, and the Pediatric Multiple Organ Dysfunction Syndrome scores increased, the percentage of patients with disseminated intravascular coagulation increased stepwise. The disseminated intravascular coagulation scores correlated well with these severity scores. Overall, the 28-day mortality was 9.9%. There were significant differences in most variables consisting of the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems between survivor and nonsurvivors. Patients detected to have disseminated intravascular coagulation by the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems showed higher mortality than patients without disseminated intravascular coagulation. The areas under the receiver operating characteristic curve of the Japanese Association for Acute Medicine score and International Society on Thrombosis and Hemostasis score were 0.788 (95% CI, 0.675-0.900) and 0.716 (95% CI, 0.598-0.834), respectively. CONCLUSIONS: Both the International Society on Thrombosis and Hemostasis and the Japanese Association for Acute Medicine scoring systems are useful for detection of the disseminated intravascular coagulation in critically ill pediatric patients. These scores correlate well with other severity scores, including Pediatric Risk of Mortality III, modified Sequential Organ Failure Assessment, and Pediatric Multiple Organ Dysfunction Syndrome. Disseminated intravascular coagulation scores are also significantly associated with 28-day mortality, suggesting that these could be promising prognostic factors.


Asunto(s)
Coagulación Intravascular Diseminada/diagnóstico , Índice de Severidad de la Enfermedad , Adolescente , Niño , Preescolar , Enfermedad Crítica , Coagulación Intravascular Diseminada/mortalidad , Femenino , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Modelos Logísticos , Masculino , Pronóstico , Curva ROC , Estudios Retrospectivos , Adulto Joven
12.
J Korean Med Sci ; 31(5): 817-21, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27134508

RESUMEN

From 2006 to 2011, an outbreak of a particular type of childhood interstitial lung disease occurred in Korea. The condition was intractable and progressed to severe respiratory failure, with a high mortality rate. Moreover, in several familial cases, the disease affected young women and children simultaneously. Epidemiologic, animal, and post-interventional studies identified the cause as inhalation of humidifier disinfectants. Here, we report a 4-year-old girl who suffered from severe progressive respiratory failure. She could survive by 100 days of extracorporeal membrane oxygenation support and finally, underwent heart-lung transplantation. This is the first successful pediatric heart-lung transplantation carried out in Korea.


Asunto(s)
Humidificadores , Enfermedades Pulmonares Intersticiales/inducido químicamente , Enfermedades Pulmonares Intersticiales/terapia , Trasplante de Pulmón , Preescolar , Desinfectantes/toxicidad , Oxigenación por Membrana Extracorpórea , Femenino , Humanos , Pulmón/efectos de los fármacos , Pulmón/patología , Enfermedades Pulmonares Intersticiales/patología , República de Corea , Frecuencia Respiratoria , Estudios Retrospectivos , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X
13.
J Pediatr Gastroenterol Nutr ; 58(1): 68-73, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23942007

RESUMEN

OBJECTIVE: The aim of our study was to review the experiences of a living donor-dominant transplantation program for children with acute liver failure (ALF). METHODS: Data were derived from the retrospective chart review of 50 children with ALF in a major liver center in the Republic of Korea. RESULTS: A total of 50 children with ALF underwent 47 (94%) primary living donor liver transplantations and 3 (6%) cadaveric liver transplantations. The cumulative survival rates of the grafts at 1 and 5 years were 81.9% and 79.2%, respectively. The overall retransplantation rate was 12%. The cumulative survival rates of these patients at 1 and 5 years were all 87.9%. Most incidents of mortality followed the failure of the preceding graft. We observed no mortalities among donors. Based on multivariate analysis, children who had pretransplant thrombocytopenia or had to use the molecular adsorbent recycling system preoperatively were related to the graft loss. Age younger than 2 years and a hyperacute onset (within 7 days) of hepatic encephalopathy were associated with pretransplant thrombocytopenia. CONCLUSIONS: Living donor-dominant transplantation program in the present study demonstrates tolerable achievements in terms of clinical outcomes of recipients and donors; however, putative factors, such as pretransplant thrombocytopenia, seem to play unclear roles in a poor prognosis following transplantation.


Asunto(s)
Supervivencia de Injerto , Fallo Hepático Agudo/cirugía , Trasplante de Hígado , Donadores Vivos , Factores de Edad , Niño , Preescolar , Femenino , Encefalopatía Hepática/etiología , Humanos , Lactante , Fallo Hepático Agudo/mortalidad , Trasplante de Hígado/mortalidad , Masculino , Análisis Multivariante , Reoperación , República de Corea/epidemiología , Estudios Retrospectivos , Tasa de Supervivencia , Trombocitopenia/complicaciones , Resultado del Tratamiento
14.
Pediatr Nephrol ; 29(6): 1089-95, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24469438

RESUMEN

BACKGROUND: The sequential organ failure assessment (SOFA) score is easy to calculate and has been well validated as an outcome predictor in critically ill adult patients. However, its use in children has been limited, mainly because of differences in basal reference levels of serum creatinine. METHODS: Data include 87 patients requiring continuous renal replacement therapy (CRRT) between January 2005 and July 2011. We modified the SOFA score by excluding the renal component to an extrarenal SOFA score, based on the assumption that CRRT may mitigate the renal effect on outcome and investigated the utility in predicting outcome with comparison with pediatric risk of mortality (PRISM) III, pediatric logistic organ dysfunction (PELOD), and SOFA scores. RESULTS: Results showed that 95.4 % (n = 83) had multiple organ dysfunction syndrome with an overall mortality of 50.6 %. The extrarenal SOFA score at CRRT initiation and ≥20 % fluid overload were significantly associated with mortality. In comparison with the predictive power of various scoring systems, the extrarenal SOFA score showed the largest area under the receiver operating characteristic curve (extrarenal SOFA 0.774, SOFA 0.770, PRISM III 0.660, and PELOD 0.650). CONCLUSIONS: The extrarenal SOFA score may be a useful prognostic marker in critically ill children treated with CRRT.


Asunto(s)
Insuficiencia Multiorgánica , Puntuaciones en la Disfunción de Órganos , Terapia de Reemplazo Renal , Área Bajo la Curva , Niño , Femenino , Humanos , Masculino , Insuficiencia Multiorgánica/fisiopatología , Insuficiencia Multiorgánica/terapia , Curva ROC , Resultado del Tratamiento
15.
Mol Genet Metab ; 108(1): 18-24, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23246278

RESUMEN

Type 1 citrullinemia (CTLN1) often presents as a hyperammonemic encephalopathy in the neonatal period, but it can also develop in the late-infantile period and in adults. In addition, some patients can be identified in the presymptomatic period by neonatal or family member screening. In this study, twenty Korean patients with CTLN1 (19 families) were examined; fourteen patients with neonatal-onset, three with late-onset, and three that were identified presymptomatically. The 13 patients with hyperammonemic encephalopathy received continuous venovenous hemofiltration (CVVH) or peritoneal dialysis (PD). Although the hyperammonemia was relieved more effectively in the six patients on CVVH than the seven on PD, most of these patients suffered from severe neurologic deficits. Recurrent hyperammonemic episodes (7 pts, 35%), recurrent and reversible acute hepatic dysfunction (5 pts, 25%), and focal cerebral infarction (2 pts, 10%) were noted. The neonates with hyperammonemic encephalopathy had extensive brain injuries at the onset of hyperammonemia, followed by encephalomalacia and brain atrophy at quite an early age. Genetic testing for the ASS1 gene revealed a different mutation spectrum from those of other ethnicities; Three common mutations, c.421-2A>G (37.8%), c.1128-6_1188dup67 (18.9%), and p.Gly324Ser (16.2%), accounted for 73% of the mutations. The poor outcome was expected in patients with the peak ammonia level at onset over 600µmol/L, whose proportion was higher in the neonatal presentation group than in the presymptomatic/late presentation group. Our findings add to the current understanding of the ethnic diversity of CTLN1 from both clinical and genetic perspectives.


Asunto(s)
Citrulinemia/epidemiología , Mutación , Encéfalo/patología , Citrulinemia/genética , Femenino , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Prevalencia , República de Corea/epidemiología
16.
J Korean Med Sci ; 28(6): 915-23, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23772158

RESUMEN

Interstitial lung disease in children (chILD) is a group of disorders characterized by lung inflammation and interstitial fibrosis. In the past recent years, we noted an outbreak of child in Korea, which is possibly associated with inhalation toxicity. Here, we report a series of cases involving toxic inhalational injury-associated chILD with bronchiolitis obliterans pattern in Korean children. This study included 16 pediatric patients confirmed by lung biopsy and chest computed tomography, between February 2006 and May 2011 at Asan Medical Center Children's Hospital. The most common presenting symptoms were cough and dyspnea. The median age at presentation was 26 months (range: 12-47 months), with high mortality (44%). Histopathological analysis showed bronchiolar destruction and centrilobular distribution of alveolar destruction by inflammatory and fibroproliferative process with subpleural sparing. Chest computed tomography showed ground-glass opacities and consolidation in the early phase and diffuse centrilobular nodular opacity in the late phase. Air leak with severe respiratory difficulty was associated with poor prognosis. Although respiratory chemicals such as humidifier disinfectants were strongly considered as a cause of this disease, further studies are needed to understand the etiology and pathophysiology of the disease to improve the prognosis and allow early diagnosis and treatment.


Asunto(s)
Desinfectantes/toxicidad , Enfermedades Pulmonares Intersticiales/patología , APACHE , Bronquios/patología , Preescolar , Tos/etiología , Ciclofosfamida/uso terapéutico , Disnea/etiología , Inhibidores Enzimáticos/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Inmunoglobulinas/uso terapéutico , Lactante , Inhalación , Enfermedades Pulmonares Intersticiales/inducido químicamente , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Pronóstico , Estudios Retrospectivos , Esteroides/uso terapéutico , Tomografía Computarizada por Rayos X
17.
PLoS One ; 18(7): e0288615, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37450547

RESUMEN

OBJECTIVES: Among pediatric patients with septic shock, culture-negative septic shock (CNSS) is common but there have been limited data on its clinical characteristics and prognosis. We compared the clinical characteristics and clinical outcomes between culture-positive septic shock (CPSS) and CNSS in pediatric patients. DESIGN: Retrospective single-center study. SETTING: Pediatric intensive care unit (PICU) of a tertiary referral hospital. PATIENTS: All pediatric patients who were admitted to the PICU due to septic shock between January 2010 and November 2021, except for those with fungal or viral infections and those who expired on the day of admittance to the PICU. The primary outcome was 30-day mortality and in-hospital mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 294 patients (CPSS group, n = 185 [62.9%]; CNSS group, n = 109 [37.1%]) were included. The rates of 30-day mortality and in-hospital mortality (30-day mortality 22.7% vs 22%, in-hospital mortality 29.7% vs 25.7%) were not significantly different between the CPSS group and the CNSS group. The two groups showed comparable results in clinical outcomes such as the requirement for mechanical ventilator and renal replacement therapy, PICU stay duration, and the duration of MV and vasopressor/inotrope support. Among the CPSS group, 98 (53%) patients who were infected with multi-drug resistance (MDR) bacteria had significantly higher rates of 30-day mortality and in-hospital mortality than those infected with non-MDR bacteria. CONCLUSIONS: Among pediatric patients, the CPSS group and CNSS group did not show significant differences in clinical features and mortality. Among the CPSS group, those with MDR bacteria had poorer prognosis.


Asunto(s)
Choque Séptico , Niño , Humanos , Estudios Retrospectivos , Unidades de Cuidado Intensivo Pediátrico , Pronóstico
18.
Transplant Proc ; 55(9): 2171-2175, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37806866

RESUMEN

BACKGROUND: Disseminated intravascular coagulation (DIC) is a serious complication in critically ill pediatric patients. This study aimed to evaluate the association between pretransplant DIC and perioperative clinical outcomes of liver transplantation (LT) in pediatric patients with Kasai portoenterostomy (KPE) failure. METHODS: We enrolled pediatric patients who received LT after KPE failure between January 2005 and April 2021. We retrospectively reviewed the electronic medical records of included patients and evaluated the presence of DIC using the International Society on Thrombosis and Hemostasis (ISTH) criteria and association with perioperative clinical outcome. RESULTS: The study included 106 patients. Their median age and body weight at the time of pediatric intensive care unit (PICU) admission were 28.7 months and 9.25 kg, respectively. Of these patients, 23 had undergone pretransplant DIC (22%). Patients with pretransplant DIC required significantly more blood transfusions during operation. They had significantly higher serum lactate levels, pediatric end-stage liver disease scores, pediatric risk for mortality III (PRISM III) scores, longer durations of mechanical ventilator support, and longer PICU stays (all P < .05). CONCLUSIONS: The presence of pretransplant DIC in pediatric patients requiring LT after KPE failure was associated with poor clinical outcomes, which required more intensive and meticulous supportive management in the perioperative period of LT. DIC would be a promising prognostic factor in these patients.


Asunto(s)
Coagulación Intravascular Diseminada , Enfermedad Hepática en Estado Terminal , Trasplante de Hígado , Humanos , Niño , Coagulación Intravascular Diseminada/etiología , Estudios Retrospectivos , Trasplante de Hígado/efectos adversos , Enfermedad Hepática en Estado Terminal/complicaciones , Índice de Severidad de la Enfermedad , Factores de Riesgo
19.
Pediatr Transplant ; 16(7): E281-5, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22093921

RESUMEN

Massive pulmonary hemorrhage and other serious cardiopulmonary diseases in patients with fulminant hepatitis result not only in graft failure but also mortality after LT. ECMO is used to treat children with cardiorespiratory failure refractory to conventional intensive care. We describe a five-yr-old girl with genetically confirmed fulminant Wilson disease and severe pulmonary hemorrhage who underwent successful primary LT following veno-arterial ECMO. To our knowledge, this is the first report of successful primary LT in a patient using veno-arterial ECMO. The present case demonstrates that ECMO, as a bridging modality to LT, may be necessary to manage both massive pulmonary hemorrhage and possible graft loss because of hypoxemia.


Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Degeneración Hepatolenticular/terapia , Trasplante de Hígado/métodos , Pulmón/patología , Preescolar , Femenino , Supervivencia de Injerto , Hemorragia/terapia , Humanos , Hipoxia , Oxígeno/metabolismo , Radiografía Torácica/métodos , Insuficiencia Respiratoria/complicaciones
20.
Kidney Res Clin Pract ; 41(3): 322-331, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35172537

RESUMEN

BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill children. However, the common lack of baseline serum creatinine values affects AKI diagnosis and staging. Several approaches for estimating baseline creatinine values in those patients were evaluated. METHODS: This single-center retrospective study enrolled pediatric patients with documented serum creatinine measurements within 3 months before admission and more than two serum creatinine measurements within 7 days after admission to the pediatric intensive care unit of a tertiary care children's hospital between January 2016 and April 2020. Four different approaches for estimating AKI using serum creatinine measurements were compared: 1) back-calculation using age-adjusted normal reference glomerular filtration rates, 2) age-adjusted normal reference serum creatinine values, 3) minimum values measured within 7 days after admission, and 4) initial values upon admission. RESULTS: The approach using minimum values showed the best agreement with the measured baseline value, with the largest intraclass correlation coefficient (0.623), smallest bias (-0.04), and narrowest limit of agreement interval (1.032). For AKI diagnosis and staging, the minimum values were 80.8% and 76.1% accurate, respectively. The other estimated baseline values underestimated AKI and showed poor agreement with baseline values before admission, with a misclassification rate of up to 42% (p < 0.001). CONCLUSION: Minimum values of serum creatinine measured within 7 days after hospital admission showed the best agreement with creatinine measured within 3 months before admission, indicating the possibility of using it as a baseline when baseline data are unavailable. Further large-scale studies are required to accurately diagnose AKI in critically ill children.

SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA