[New morbidity following critical illness in Latin American children under 18 years old with lower respiratory tract infection]. / Nueva Morbilidad tras Enfermedad Crítica en Niños Latinoamericanos menores de 18 años con infección severa del tracto respiratorio inferior.

Acquisition of new morbidity (NM) has become a key clinical outcome measure after pediatric critical illness. Data on Latin American children are still scarce. OBJECTIVE: to analyze the development of new morbidities acquired after hospitalization due to lower respiratory tract infection (LRTI) in pediatric intensive care units (PICU). PATIENTS AND METHOD: we included patients from 35 PICUs from 8 countries, aged 0 to 18 years with a diagnosis of LRTI, discharged alive, registered between April 2018 and September 2019, and who required some type of ventilatory support (high-flow system, noninvasive ventilation or invasive ventilation), included in the LARed Network registry, which includes the Functional Status Scale (FSS) validated in the pediatric population, which assesses functional status in six domains: mental status, sensory, communication, motor skills, feeding, and respiratory status. NM considered LRTI after hospitalization and was defined as an increase of ≥ 3 points in the FSS. RESULTS: Of 3280 children with LRTI, 85 (2.6%) developed NM, associated with diagnoses of sepsis and acute respiratory distress syndrome (ARDS), pneumococcal or adenovirus infection, healthcare-associated infections (HAIs), and invasive mechanical ventilation. Adenovirus infection, ARDS, and HAIs were independently associated with NM. CONCLUSIONS: We observed that the development of NM at PICU discharge is infrequent but is associated with modifiable risk factors. These data define certain risk groups for future interventions and initiatives to improve the quality of care.

Cirugía cardíaca correctiva con circulación extracorpórea en lactantes de bajo peso e hiperflujo pulmonar / Cardiac corrective surgery with extracorporeal circulation in lactancy babies of low weight and pulmonary hyperflow

Introducción: tradicionalmente los lactantes portadores de cardiopatías con hiperflujo pulmonar, bajo peso e infecciones respiratorias, eran sometidos a cirugía paliativa (banding de arteria pulmonar) al fracasar el tratamiento médico. Evidencias recientes han mostrado mejores resultados con la cirugía correctiva de primera intención. Material y método: se analizó retrospectivamente la base de datos del Departamento de Cardiopatías Congénitas del Centro Cardiológico Americano durante un periodo de 36 meses con el fin de identificar aquellas cardiopatías con hiperflujo pulmonar y peso < 6 kg sometidos a cirugía correctiva con CEC de primera intención por no responder al tratamiento médico máximo. Se analizó la morbimortalidad antes del alta hospitalaria. Resultados: se incluyeron 22 lactantes corregidos consecutivamente, con una edad promedio de 151 días y 4.405 g de peso. Un 36,3% presentó al menos una complicación postoperatoria y apenas uno falleció (4,5%). Conclusiones: la evolución en el manejo perioperatorio permite efectuar cirugías correctivas con CEC de primera intención en lactantes de bajo peso e hiperflujo pulmonar, con bajo riesgo quirúrgico evitando la cirugía en dos tiempos.

Introduction: after unsuccessful medical treatment, infants with congenital heart disease (large left to right shunt, low weight and pulmonary infections) had palliative surgery (pulmonary artery banding). However, recent evidence suggest excellent results with early corrective surgery. Methods: we reviewed retrospectively the database of the Congenital Cardiac Department at the American Cardiac Center, during a 36-month period in order to identify all infants who weighed less than 6 kg with congenital heart deffect and large left to right shunt, who underwent early surgical repair with cardiopulmonary bypass after unsuccessful medical management. We evaluated the morbidity and mortality before hospital discharge. Results: 22 infants were included; average age and weight were 151 days and 4.405 g respectively. At least one postoperative complication was found in 36,3%; a single death (4,5%) occured. Conclusions: continuous progress in perioperative management encouraged early corrective surgical repair with cardiopulmonary bypass in low weight infants with large left to right shunts decreasing operation risks and avoiding two stage surgeries.