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2.
Marques, Heloisa Helena de Sousa; Pereira, Maria Fernanda Badue; Santos, Angélica Carreira dos; Fink, Thais Toledo; Paula, Camila Sanson Yoshino de; Litvinov, Nadia; Schvartsman, Claudio; Delgado, Artur Figueiredo; Gibelli, Maria Augusta Bento Cicaroni; Carvalho, Werther Brunow de; Odone Filho, Vicente; Tannuri, Uenis; Carneiro-Sampaio, Magda; Grisi, Sandra; Duarte, Alberto José da Silva; Antonangelo, Leila; Francisco, Rossana Pucineli Vieira; Okay, Thelma Suely; Batisttella, Linamara Rizzo; Carvalho, Carlos Roberto Ribeiro de; Brentani, Alexandra Valéria Maria; Silva, Clovis Artur; Eisencraft, Adriana Pasmanik; Rossi Junior, Alfio; Fante, Alice Lima; Cora, Aline Pivetta; Reis, Amelia Gorete A. de Costa; Ferrer, Ana Paula Scoleze; Andrade, Anarella Penha Meirelles de; Watanabe, Andreia; Gonçalves, Angelina Maria Freire; Waetge, Aurora Rosaria Pagliara; Silva, Camila Altenfelder; Ceneviva, Carina; Lazari, Carolina dos Santos; Abellan, Deipara Monteiro; Santos, Emilly Henrique dos; Sabino, Ester Cerdeira; Bianchini, Fabíola Roberta Marim; Alcantara, Flávio Ferraz de Paes; Ramos, Gabriel Frizzo; Leal, Gabriela Nunes; Rodriguez, Isadora Souza; Pinho, João Renato Rebello; Carneiro, Jorge David Avaizoglou; Paz, Jose Albino; Ferreira, Juliana Carvalho; Ferranti, Juliana Ferreira; Ferreira, Juliana de Oliveira Achili; Framil, Juliana Valéria de Souza; Silva, Katia Regina da; Kanunfre, Kelly Aparecida; Bastos, Karina Lucio de Medeiros; Galleti, Karine Vusberg; Cristofani, Lilian Maria; Suzuki, Lisa; Campos, Lucia Maria Arruda; Perondi, Maria Beatriz de Moliterno; Diniz, Maria de Fatima Rodrigues; Fonseca, Maria Fernanda Mota; Cordon, Mariana Nutti de Almeida; Pissolato, Mariana; Peres, Marina Silva; Garanito, Marlene Pereira; Imamura, Marta; Dorna, Mayra de Barros; Luglio, Michele; Rocha, Mussya Cisotto; Aikawa, Nadia Emi; Degaspare, Natalia Viu; Sakita, Neusa Keico; Udsen, Nicole Lee; Scudeller, Paula Gobi; Gaiolla, Paula Vieira de Vincenzi; Severini, Rafael da Silva Giannasi; Rodrigues, Regina Maria; Toma, Ricardo Katsuya; Paula, Ricardo Iunis Citrangulo de; Palmeira, Patricia; Forsait, Silvana; Farhat, Sylvia Costa Lima; Sakano, Tânia Miyuki Shimoda; Koch, Vera Hermina Kalika; Cobello Junior, Vilson; HC-FMUSP Pediatric COVID Study Group.
Clinics ; 76: e3488, 2021. tab, graf
Article in English | LILACS | ID: biblio-1350619

ABSTRACT

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.


Subject(s)
Humans , Infant, Newborn , Child , Adolescent , COVID-19/complications , Cross-Sectional Studies , Cohort Studies , Systemic Inflammatory Response Syndrome , Tertiary Care Centers , SARS-CoV-2
3.
Intensive Care Med ; 43(8): 1097-1104, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28584925

ABSTRACT

PURPOSE: Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children. METHODS: We have carried out a retrospective multicentre study in four PICUs in São Paulo, Brazil. We included patients aged 0-14 years, who needed a CVC or PICC during a PICU stay from January 2013 to December 2015. Our primary endpoint was CLABSI up to 30 days after catheter placement. We defined CLABSI based on the Center for Disease Control and Prevention's National Healthcare Safety Networks (NHSN) 2015 surveillance definitions. To account for potential confounders, we used propensity scores with inverse probability weighting. RESULTS: A total of 1660 devices (922 PICCs and 738 CVCs) in 1255 children were included. The overall CLABSI incidence was 2.28 (95% CI 1.70-3.07)/1000 catheter-days. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR 2.20, 95% CI 1.05-4.61; p = 0.037) compared with PICCs. In a sensitivity analysis, CVCs remained associated with higher risk of CLABSI (adjHR 2.18, 95% CI 1.02-4.64; p = 0.044) after adding place of insertion and use of parenteral nutrition to the model as a time-dependent variable. CONCLUSIONS: PICC should be an alternative to CVC in the paediatric intensive care setting for CLABSI prevention.


Subject(s)
Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Central Venous Catheters/adverse effects , Adolescent , Bacteremia/epidemiology , Bacteremia/prevention & control , Catheter-Related Infections/epidemiology , Catheterization, Central Venous/methods , Catheterization, Peripheral/methods , Catheterization, Peripheral/statistics & numerical data , Central Venous Catheters/statistics & numerical data , Child , Child, Preschool , Female , Humans , Incidence , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Male , Propensity Score , Proportional Hazards Models , Retrospective Studies , Risk Factors , Time Factors
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