[Non-invasive continuous positive airways pressure for post-extubation laryngitis in pediatric patients]. / Utilización de la CPAP de forma no invasiva en la laringitis postextubación del paciente pediátrico. Estudio controlado y aleatorizado.

UNLABELLED: Post-extubation laryngeal edema (PLE) is a common complication (10-15%) in pediatric intensive care units, and some authors have reported high failure rates for conventional treatment. HYPOTHESIS: Non-invasive continuous positive airways pressure (CPAP) in children with PLE may have a lower failure rate than conventional management. PATIENTS AND METHOD: Twenty-five patients were needed to detect a difference between the two treatment groups. The patients were assigned to receive the conventional treatment (nebulized epinephrin and humidified oxygen) or the experimental treatment (non-invasive CPAP treatment for 18 hours), using a randomized block design (10-patient blocks). After 9 months, the study was halted when a significant difference emerged between the two groups. RESULTS: Of 270 children extubated during the study, 28 (10.3%) developed PLE and 25 met the enrollment requirements. Thirteen were assigned to conventional therapy and 12 to CPAP. General characteristics, time of intubation, FiO2 upon admission, use of corticoids before extubation and scores for respiratory difficulty upon admission were similar in the two groups (p > 0.05). With conventional therapy, 5 (38.5%) children improved and 8 patients worsened or remained the same. Eleven (91.7%) of the patients receiving CPAP improved (p = 0.01). Those who failed on conventional treatment were prescribed CPAP and all then improved, although one had to be re-intubated. CONCLUSION: The hypothesis was confirmed. CPAP treatment reduced the failure rate by 53.2% in comparison with conventional therapy.

[Manifestations of paralytic ileus in infants hospitalized for acute diarrheal syndrome]. / Manifestaciones de íleo paralítico en lactantes hospitalizados por síndrome diarreico agudo.

In order to assess and characterize adynamic ileus (AI) complicating acute diarrhoea (AD) in infants, 802 consecutive admissions were studied. Diagnosis was suspected in 23 patients with abdominal distension and confirmed by radiological study in 16 whose age range was 14 ds to 6 mo. Of these late patients, 9/16 were malnourished. Age was less than, but nutritional status similar to that of all patients admitted with ADD. Vomiting (14/16), silent or almost silent abdomen (10/16), protracted course of diarrhoea (9/16) and increased gastric content (6/16) were the most common clinical findings in addition to abdominal distension and X Ray films suggestive of AI (inclusion criteria). Lack of constipation was a relevant finding. Treatment included temporal discontinuance of oral feedings, intravenous fluids administration, nasogastric and rectal tube and antibiotics. Lethality rate was 4/16. Duration of AI was an average of 2 days in survivors and 4 days in the remainder infants. It is concluded that AI is an infrequent complication of AD (0.19% of cases), which should be suspected in infants less that 6 mo old with diarrhoea and abdominal distension.

[Intestinal cryptosporidiosis: a case of hospital infection]. / Cryptosporidiosis intestinal: un caso de infección intrahospitalaria.

A hospital acquired case of human cryptosporidiosis is reported in a pediatric patient with prolonged diarrhea, whose previous investigation was negative for the agent. Cryptosporidium was isolated from feces in coincidence with admission, to the same hospital room, of an additional patient with acute diarrhea in whom infection by the same agent had been demonstrated. Infant to infant transmission in hospital wards is thus a possibility.

[Cholestyramine in the treatment of refractory diarrhea of the newborn]. / Colestiramina en el tratamiento de la diarrea refractaria del lactante.

Eleven infants with severe protracted diarrhea were studied. All of them were treated with cholestyramine, 2 g/kg/day in three or four doses. Feces became normal in two to four days in ten out of eleven infants. Tolerance to cholestyramine was good. Fat balance was performed in five patients showing steatorrhea in all of them, ranging from 15 to 42%. Reduction in resin doses was followed by normal fat excretion. Three infants died. One of them did not show improvement with cholestyramine therapy and developed Salmonella typhimurium sepsis. The other two, even though they normalized their stools, died because of Salmonella typhimurium and bacteroides sepsis respectively.