Vasopressin associated hyponatremia in critically ill children: A cross-sectional study.

Background: The association of hyponatremia with vasopressin therapy in children is controversial. We aimed to evaluate the incidence and severity of hyponatremia associated with the administration of vasopressin in critically ill pediatric patients. Methods: This retrospective cross-sectional study included children younger than 14 years who were admitted to the pediatric or pediatric cardiac intensive care units and received vasopressin for at least 24 h. Results: In total, 176 critically ill pediatric patients were enrolled, with a median age of 22 days (7.3-146). The mean sodium level was notably decreased from 143.5 mEq/L ± 7.15 at the baseline to 134.3 mEq/L ± 7.7 at the 72-hour measurement after the initiation of vasopressin and varied significantly at all intervals from the baseline measurement (P < 0.001). Twenty-four hours after the discontinuation of vasopressin, more than half of the patients had hyponatremia. The highest proportion had mild hyponatremia (32.8%), followed by moderate hyponatremia (13.1%), and profound hyponatremia (7.5%). The incidence of hyponatremia was independent of gender (P = 0.94) or age group (P = 0.087). However, more than two-thirds of the moderate-profound cases and more than one-third of mild cases were observed in the neonate group (P = 0.043). The vasopressin dose did not affect the incidence (P = 0.25) or the severity of the hyponatremia (P = 0.56). Notably, all laboratory and hemodynamic parameters varied significantly at the end of therapy, compared to the baseline. Conclusions: Continuous monitoring for hyponatremia when children are placed on vasopressin is essential to protect against more severe complications.

Ebstein cardiac anomaly, functional pulmonary atresia and isovaleric acidemia: A case report.

In this report, we present a rare association between Ebstein anomaly (EA) and isovaleric acidemia (IVA) in a newborn who was admitted to our cardiac center. He underwent for PDA stenting to maintain adequate pulmonary blood flow, later he developed recurrent metabolic acidosis, prominent sweaty feet odor, neutropenia and thrombocytopenia. His organic acids profile in the urine confirmed the diagnosis of IVA. To the best of our knowledge, there is no association between these two rare diseases. We are presenting this case report to highlight this rare association.

Impact of chylothorax on the early post operative outcome after pediatric cardiovascular surgery.

BACKGROUND AND AIM: Chylothorax is the accumulation of chyle in the pleural cavity, which usually develops after disruption of the thoracic duct along its intra-thoracic route. In the majority of cases, this rupture is secondary to trauma (including cardio thoracic surgeries). Chylothorax is a potentially serious complication after cardiovascular surgeries that require early diagnosis and adequate management. This study aims to determine the risk factors and the impact of chylothorax on the early postoperative course after pediatric cardiac surgery. METHODS: A retrospective study of all cases complicated with chylothorax after pediatric cardiac surgery was conducted at King Abdulaziz Cardiac Center between January 2007 and December 2009. RESULTS: There were 1135 cases operated on during the study period. Of these, 57 cases (5%) were complicated by chylothorax in the postoperative period. Thirty patients (54%) were males, while 27 (47%) were females. Ages ranged from 4 to 2759 days. The most common surgeries complicated by chylothorax were the single ventricle repair surgeries (15 cases, 27%); arch repairs (10 cases, 18%); ventricular septal defect repairs (10 cases, 18%); atrioventricular septal defect repairs (7 cases, 12%); arterial switch repair (6 cases, 11%), and others (8 cases, 14%). The intensive care unit (ICU) and the length of hospital stays were significantly longer in the chylothorax group. Additionally, some early postoperative parameters such as incidence of sepsis, ventilation time, and inotropes duration and number were higher in the chylothorax group. CONCLUSION: Chylothorax after pediatric cardiac surgery is not a rare complication. It occurs more commonly with single ventricle repair and aortic arch repair surgeries, and has a significant impact on the postoperative course and post operative morbidity.

Chloral hydrate versus midazolam as sedative agents for diagnostic procedures in children.

OBJECTIVE: To compare sedation outcomes for chloral hydrate (CH) and midazolam (MD) as sedative agents for diagnostic procedures in children. METHODS: A prospective, randomized, double-blinded study conducted between July 2005 and October 2006, at the Pediatric Day Care Unit (DCU), King Abdulaziz Medical City, Riyadh, Saudi Arabia. After meeting the inclusion criteria and getting informed consent, patients were randomized, given the study drug, and monitored for sedation outcomes. RESULTS: Two hundred and seventy-five patients who had 292 sedation sessions for diagnostic procedures were included in the study. Due to missing data, 286 sedations were included in the final analysis; 144 in the CH and 142 in the MD group. Both groups were comparable with respect to demographic and baseline characteristics. The CH compared to MD group, had a higher sedation success rate, shorter time to achieve sedation, shorter length of stay in DCU, and longer sedation duration. In both study groups, patients who required a second dose tended to be older and heavier. No major side effects were encountered. The CH group had a significantly higher mean sedation scores at 15, 30, 45, and 60 minutes. CONCLUSION: Chloral hydrate compared to MD, had a shorter time to achieve sedation, a higher success rate, less need for a second dose, and decreased the time spent in the DCU. Older and heavier patients are more likely to require a second dose of the study drug to be sedated.

Effect of submersion injury on water safety practice after the event in children, Saudi Arabia.

OBJECTIVE: To bring to light issues surrounding water safety practices and the impact of such incidents on these practices in our community. METHODS: We conducted a prospective observational study at King Abdul-Aziz Medical City, Riyadh, Kingdom of Saudi Arabia of all children <12 years of age presenting with submersion injury in the period between January 1999 through December 2004 noting the demographics and the pattern of water safety practices prior to and after event. RESULTS: A total of 29 patients were included. The majority of incidents took place in swimming pools. Water safety practices were lacking in most cases as evidenced by the fact that 87% of the victims were not properly supervised at the time of the event. None of swimming pools met the required safety regulations. Cardiopulmonary resuscitation knowledge was virtually nonexistent. The event did not have a positive impact on the water safety practices of the affected families. CONCLUSION: Submersion injury is also prevalent in land locked areas. Water safety practices are deficient in our community. Submersion injury was not enough to have a consistent positive impact on water safety practices of the affected families. Much can be carried out to improve water safety and save lives.

Chloral hydrate. An effective agent for sedation in children with age and weight dependent response.

OBJECTIVE: Diagnostic and therapeutic procedures in children are made easier using sedation. However, there is no consensus about which drug should be used to achieve this. Furthermore, none of the drugs used for sedation are risk free. The aim of this work is to study sedation indications, effectiveness, and safety at our center. METHODS: A prospective observational study conducted at the Pediatric Day Care Unit, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. The study covered 17.5 weeks in 2 periods: May 9th 1999 to June 13th 1999 and October 31st 2001 to February 11th 2002. Children <12 years were included. Collected data included demographics, indication, drug dosing and outcome. Data were reported as mean +/- SD. RESULTS: We included 148 patients, age 38 +/- 30 months. Adequate sedation was achieved in 79% after initial chloral hydrate (CH) dose of 56.9 +/- 9.3 mg/kg, in 95% after adding 18.5 +/- 6.4 mg/kg CH and in 96% after adding second drug. Compared to nonrespondents, first CH dose respondents were younger and lower in weight. The CH side effects were few and mild. CONCLUSION: Chloral hydrate is a safe and effective agent for sedation in children with an age and weight dependent response.