RESUMEN
OBJECTIVE: Necrotizing fasciitis is a highly lethal soft tissue infection rarely reported in childhood. The initiating site is usually a local trauma or a surgical wound. We observed five cases of necrotizing fasciitis the initiating site for which was the mammary region and discuss their management. STUDY DESIGN: We describe these five patients and review the clinical characteristics of their presentation. RESULTS: Staphylococcal necrotizing fasciitis was observed in the mammary region in all five cases. Four children were newborn infants with a mammitis preceding the onset of necrotizing fasciitis. Surgical débridement was done only after the fourth day from onset of illness. All children were discharged in good condition after 1 month. Two have been followed until puberty, with destruction of the mammary gland in one case and good development in the other one. CONCLUSION: Mammitis may be the initiating event for necrotizing fasciitis in neonates. Necrotizing fasciitis is a life-threatening disease; patients require early intensive care, parenteral antibiotic therapy, and surgical débridement. In a few instances surgery can be carefully delayed until the necrotic area is more delineated if the condition is diagnosed early during disease evolution and appropriate treatment is instituted in intensive care units.
Asunto(s)
Fascitis Necrotizante/microbiología , Mastitis/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus , Antibacterianos/uso terapéutico , Preescolar , Terapia Combinada , Desbridamiento , Fascitis Necrotizante/terapia , Femenino , Humanos , Recién Nacido , Mastitis/terapia , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas/terapiaRESUMEN
OBJECTIVE: To assess the efficacy and reliability of neonatal high-frequency ventilators. DESIGN: Bench evaluation of neonatal high-frequency ventilators. SETTING: Physiology department and university hospital neonatal intensive care unit. INTERVENTIONS: HFV-Babylog 8000 (Dräger Medical), OHF 1 (Dufour), and SensorMedics 3100A (Sensor-Medics) ventilators were connected to a neonatal test-lung. Tidal volume, peak-to-peak pressure amplitude, and mean airway pressure were measured for several ventilator settings, endotracheal tube sizes, and lung compliances. MEASUREMENTS AND RESULTS: Increasing peak-to-peak pressure resulted in a linear increase in tidal volume delivery in the 0-30% range of maximum amplitude. No significant increase in tidal volume was observed with the HFV-Babylog 8000 when pressure amplitude was above 50%. The maximum tidal volume delivered was substantially smaller with the HFV-Babylog 8000 than with the OHF 1 or SensorMedics 3100A. Tidal volume increased with endotracheal tube size with all three ventilators. Increasing test-lung compliance resulted in lower tidal volumes only with OHF 1. Decreasing mean airway pressure was responsible for a decrease in tidal volume delivery with HFV-Baby-log 8000. CONCLUSION: We found that under our test conditions two of the three ventilators delivered adequate tidal volumes at the usual frequency of 15 Hz, regardless of the size of the endotracheal tube and of the mechanical properties of the respiratory system. When lung compliance increased or mean airway pressure decreased, both of which are common events during the recovery phase of hyaline membrane disease, we found that the intrinsic properties of two of the ventilators tested were responsible for a decrease in tidal volume. This decrease may account for some cases of heretofore unexplained hypercapnia.
Asunto(s)
Ventilación de Alta Frecuencia , Cuidados Críticos , Estudios de Evaluación como Asunto , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Modelos Biológicos , Volumen de Ventilación PulmonarRESUMEN
BACKGROUND: Cyanosis associated to low oxygen saturation may reveal hemoglobin pathology. CASE REPORT: A 3 year-old child had a nephroblastoma with pleural effusion. He suddenly developed persistent cyanosis despite pleural effusion drainage; transcutaneous and measured oxygen saturations were low and PaO2 on arterial blood gases was high. Methemoglobinemia was diagnosed, due to prilocaine-lignocaine cream used for local anesthesia, associated to partial G6PD deficiency. The methemoglobinemia disappeared after methylene blue treatment. CONCLUSION: Cyanosis with low oxygen saturation and high or normal PaO2 should lead to the search of a hemoglobin pathology, especially methemoglobinemia, by appropriate methods.
Asunto(s)
Metahemoglobinemia/fisiopatología , Anestésicos Locales/efectos adversos , Monitoreo de Gas Sanguíneo Transcutáneo , Preescolar , Combinación de Medicamentos , Humanos , Lidocaína/efectos adversos , Combinación Lidocaína y Prilocaína , Masculino , Metahemoglobinemia/inducido químicamente , Oximetría , Prilocaína/efectos adversosRESUMEN
OBJECTIVE: To analyze efficiency and reliability of 4 modern neonatal ventilators under difficult test conditions. The ventilators tested were: Babylog 8000 (Dräger Medical), BP 2001 (Bear Medical Systems), Sechrist IV 100 B (Sechrist Industries), Infant Star (Infrasonics INC). MEASUREMENTS AND RESULTS: Gas flow generation was tested by comparison of preset flow values with no resistance in the circuit to flow values obtained during interposition of a resistance in the inspiratory circuit. A decrease in gas flow was observed when interposition of a resistance in the inspiratory circuit increased peak inspiratory pressure to 60 cmH2O (gas flow decreased by 8% to 24% depending on the ventilator tested). The pressure limiting valve and the positive end-expiratory pressure valve were also evaluated in order to test their behaviour under different flow conditions. Flow-dependence of the pressure was noted for all ventilators except Babylog 8000. Assessment of the reliability of pressure monitoring revealed either 'under' or 'over' estimation of peak inspiratory pressure and positive end-expiratory pressure depending on the ventilator tested. CONCLUSION: For the best clinical use of mechanical ventilators, neonatologists should be aware of these limitations. Therefore a regular assessment of ventilator performance and monitoring reliability is recommended.
Asunto(s)
Cuidado Intensivo Neonatal , Ventiladores Mecánicos/normas , Falla de Equipo , Seguridad de Equipos , Humanos , Recién Nacido , Monitoreo Fisiológico , Control de Calidad , Reproducibilidad de los Resultados , Ventiladores Mecánicos/provisión & distribuciónAsunto(s)
Síndrome de Dificultad Respiratoria del Recién Nacido , Enfermedad Aguda , Adolescente , Niño , Preescolar , Femenino , Francia/epidemiología , Mortalidad Hospitalaria , Humanos , Incidencia , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Masculino , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
Pediatric intensive care units use sophisticated medical technology and are staffed by deeply committed nurses who are subjected to significant psychological stress. This stress varies with the type of patient and influences the style and quality of care. With this respect, children and adolescents admitted after a suicidal attempt are considered catalysts. However, there have been no systematic studies of how pediatric intensive care nurses respond emotionally to their interactions with these patients. This epidemiological study conducted in five Parisian Teaching Hospital pediatric intensive care units used a specially designed questionnaire to evaluate nurses' responses on the basis of style of care. Children under 16 years of age admitted after attempted suicide were studied comparatively with same age children admitted for status asthmaticus or encephalopathy with seizures. Results highlighted the differences in nurses' psychological responses to these situations and their difficulties in interacting with patients. This study provides strict methodological guidelines for investigating an issue often discussed emotionally or on the basis of anecdotal data.
Asunto(s)
Actitud del Personal de Salud , Unidades de Cuidado Intensivo Pediátrico , Relaciones Enfermero-Paciente , Enfermería Pediátrica , Intento de Suicidio/psicología , Adolescente , Encefalopatías/enfermería , Encefalopatías/psicología , Niño , Familia , Humanos , Relaciones Interprofesionales , Enfermedades Profesionales/etiología , Paris , Cooperación del Paciente , Relaciones Profesional-Familia , Estudios Prospectivos , Convulsiones/enfermería , Convulsiones/psicología , Estrés Psicológico/etiología , Intento de Suicidio/prevención & control , Encuestas y CuestionariosRESUMEN
Fourteen hypertensive patients hospitalized in a paediatric intensive care unit were studied to evaluate safety and hypotensive efficacy of intravenous nicardipine. Systolic and diastolic blood pressure significantly decreased 1 h after the beginning of the treatment (1 microgram/kg per minute). Mean decrease in systolic blood pressure during the first 24 h was between 9.9% and 13.4% of the initial value. Mean lowering of diastolic blood pressure was between 16.7% and 25.6%. Nicardipine did not significantly affect heart rate with dose of 1 microgram/kg per minute. No clinical side-effects were observed. Nicardipine could be a first line drug for the treatment of hypertension in paediatric intensive care units.
Asunto(s)
Hipertensión/tratamiento farmacológico , Nicardipino/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Niño , Preescolar , Evaluación de Medicamentos , Femenino , Humanos , Hipertensión/fisiopatología , Lactante , Recién Nacido , Infusiones Intravenosas , Unidades de Cuidados Intensivos , Masculino , Nicardipino/uso terapéuticoRESUMEN
During the last few years, our knowledge of Pierre Robin syndrome has benefited from advances in embryonic neurobiology. It has been shown that the syndrome is related to an anomalous development of the foetal brainstem. A multidisciplinary study makes it possible to value prospectively the various anomalies with which it may be associated and to decide on a coherent treatment. This type of management should reduce the mortality and prevent the sequelae of Pierre Robin syndrome.
Asunto(s)
Síndrome de Pierre Robin , Humanos , Lactante , Recién Nacido , Síndrome de Pierre Robin/clasificación , Síndrome de Pierre Robin/diagnóstico , Síndrome de Pierre Robin/fisiopatología , Síndrome de Pierre Robin/terapiaRESUMEN
The case of a 14 month-old infant presenting with hereditary lymphohistiocytosis is reported. After several days of post-chemotherapy aplasia a peritoneal, cutaneous (blackish necrosis), then pleuropulmonary involvement occurred. Fiberendoscopy showed an esophageal necrosis responsible for a pleural fistula. The child died after a few weeks, despite antifungal treatment. Post mortem examination found disseminated abscesses related to mucormycosis. The 41 pediatric cases in the world-wide literature are recorded.
Asunto(s)
Mucormicosis/patología , Femenino , Humanos , Tolerancia Inmunológica , Lactante , Mucormicosis/inmunologíaAsunto(s)
Artritis Juvenil/complicaciones , Varicela/complicaciones , Infecciones por Coxsackievirus/complicaciones , Histiocitosis de Células no Langerhans/etiología , Adolescente , Preescolar , Enterovirus Humano B , Femenino , Humanos , Masculino , Síndrome de Stevens-Johnson/etiología , Factor de Necrosis Tumoral alfa/análisisAsunto(s)
Lesiones Encefálicas/complicaciones , Adolescente , Niño , Preescolar , Humanos , Lactante , Recién Nacido , PronósticoRESUMEN
Consecutive admissions to two pediatric intensive care units (PICUs) in France (n = 93) and the United States (n = 248) were compared using admission demographics, and daily therapeutic and severity of illness data. Analysis of the major demographic characteristics revealed that patients in the French PICU were younger (median age; 3 months vs. 31 months, P less than 0.001), and more commonly admitted for emergency reasons (92% vs. 66%, P less than 0.05). General resource utilization was similar in both units. However, important differences in the incidences of use of individual monitoring and therapeutic modalities were present. The United States PICU had higher incidences of invasive monitoring modalities (arterial catheters, 66% vs. 4%, P less than 0.001; central venous catheters, 38% vs. 11%, P less than 0.001; pulmonary artery catheters, 8% vs. 1%, P less than 0.01), while the French PICU had higher incidences of labor-intensive monitoring modalities (strict input/output, 75% vs. 47%, P less than 0.0001; greater than 3 stat blood studies/shift, 69% vs. 45%, P less than 0.0001). Patients in France were more likely to receive mechanical ventilation (81% vs. 56%, P less than 0.0001) and nutritional support (40% vs. 7%, P less than 0.05). Mortality rates in both PICUs were similar and accurately predicted by admission-day severity of illness scores. We conclude that differential resource utilization, possibly arising from different care philosophies, may result in equivalent care.
Asunto(s)
Unidades de Cuidados Intensivos , Pediatría , Cuidados Críticos , Francia , Recursos en Salud , Humanos , Mortalidad , Admisión del Paciente , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Estados UnidosAsunto(s)
Unidades de Cuidado Intensivo Neonatal/tendencias , Ética Médica , Familia , Francia , Humanos , Recién NacidoRESUMEN
Rhombencephalic failure of the suction-swallowing, excess of central and obstructive ventilatory arrests with hypoxia and hypercapnia, vagal hypertonia and esophagogastric motor abnormalities are the new clinical signs observed in children presenting with the Pierre Robin's syndrome. A therapeutic management adapted to each of the types I, II, III of the syndrome were defined and a good nursery-nursing allowed a reduction in the mortality-rate from 27 to 5%. Still considered by some as a malformative and glossoptosing disorder whose etiology is only bucco-pharyngeal in origin, this syndrome, common to numerous embryopathies, is a precocious embryonal abnormality of the brain stem neurogenesis, expressed by the dramatic failure of the physiological oro-ventilation system. This syndrome appears to be a peculiar form of dysautonomia of the brain stem development with an uncertain future, often transitory, isolated or associated but in the heart of pediatric internal medicine and its multi-disciplinarity.
Asunto(s)
Síndrome de Pierre Robin/clasificación , Asfixia/diagnóstico , Enfermedades de los Nervios Craneales/fisiopatología , Trastornos de Deglución/diagnóstico , Femenino , Humanos , Hipoxia/diagnóstico , Lactante , Recién Nacido , Masculino , Síndrome de Pierre Robin/embriología , Síndrome de Pierre Robin/terapia , Pronóstico , Nervio VagoRESUMEN
The authors report 18 children with toxic epidermal necrolysis (T.E.N.). The clinical and laboratory signs, the development of complications and sequelae and the drugs presumed to be responsible are compared with those of T.E.N. in adults. The onset was generally marked by a influenza-like state with development of mucosal signs between the first and the seventh days. The lips and buccal cavity were involved in 16 cases and the eyelids and conjunctiva were involved in 15 cases. Epidermal loss occurred after a variable interval of between one and eight days after the appearance of the erythema. The severity of the epidermal loss, expressed as a percentage of the body surface area, was a poor prognostic factor. Hypoproteinaemia was the most frequently observed laboratory abnormality. The complications were infectious and the 2 deaths in this series were due to septicaemia. Ocular complications were also observed: keratitis, responsible for sequelae such as distichiasis, conjunctival adhesions, sicca syndrome. As in adults, these children were frequently taking multiple drugs. Among the drugs prescribed during the classical interval of imputability, two drugs were particularity noted: phenobarbital and oxyphenbutazone. Treatment should only be undertaken in a specialized unit and is based on the principles of intensive care of burns patients: control of hypovolemia and infection. Ocular sequelae should be prevented by local treatments several times a day.