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OBJECTIVES: To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. METHODS: A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. RESULTS: Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. CONCLUSIONS: Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.
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Introduction: West syndrome (WS) is the most frequent epileptic encephalopathy in the first year of life and is strongly correlated with prenatal and perinatal brain injury. Objective: To analyze the relationship between prematurity and birth asphyxia (cerebral hypoxia) with WS. Methods: This is an observational and cross-sectional study. All the patients with WS treated at Pediatric Neurology Service of Pequeno Príncipe Children?s Hospital from January 2010 to January 2015 were analyzed. The patients underwent magnetic resonance imaging (MRI) of the brain and electroen- cephalogram (EEG). Results: Thirty-eight patients with WS, 23 (60.53%) females; ages ranging from 9 to 27 months (±16.6 months). Twenty (52.63%) patients had a history of hypoxia/anoxia perinatal, 8 (21.05%) were premature, 8 (21.05%) had brain malformations, 4 (10.53%) had Down syndrome, 4 (10.53%) had tuberous sclerosis, and 2 (5.26%) had no comorbidities. MRI showed: 9 (23.68%) multi-cystic encephalomalacia, 4 (10.53%) periventricular leukomalacia, 4 (10.53%) periventricular leukomalacia with cerebral atrophy, 4 (10.53%) periventricular nodules, 3 (7.89%) brain atrophy, 2 (5.26%) pachygyria associated with agenesis of corpus callosum, one (2.63%) agenesis of the corpus callosum, one (2.63%) right frontal dysplasia, one (2.63%) left frontal dysplasia, one (2.63%) right frontoparietal dysplasia, one (2.63%) left frontoparietal dysplasia, and one (2.63%) pachygyria. Conclusion: The history of hypoxia/anoxia perinatal and prematurity is very frequent in WS. Improved care during pregnancy and childbirth is very important to reduce perinatal brain injury, premature birth, and neurological morbidity.
Introdução: A síndrome de West (SW) é a mais frequente encefalopatia epiléptica do primeiro ano de vida e está fortemente relacionada com lesões cerebrais pré-natais e perinatais. Objetivo: Analisar a relação entre prematuridade e asfixia perinatal (hipóxia cerebral) e SW. Métodos: Este é um estudo observacional e transversal. Todos os pacientes com SW tratados no Serviço de Neurologia Pediátrica do Hospital Infantil Pequeno Príncipe entre janeiro de 2010 e janeiro de 2015 foram analisados. Os pacientes foram submetidos a ressonância magnética (RM) do encéfalo e eletroencefalograma (EEG). Resultados: Trinta e oito pacientes com SW, 23 (60,53%) do sexo feminino; idade entre 9 a 27 meses (±16,6 meses). Vinte (52,63%) pacientes tinham história de hipóxia/anóxia perinatal, 8 (21,05%) eram prematuros, 8 (21,05%) tinham malformações cerebrais, 4 (10,53%) tinham síndrome de Down, 4 (10,53%) tinham esclerose tuberosa e 2 (5,26%) não apresentavam nenhuma comorbidade. A RM mostrou: 9 (23,68%) casos de encefalomalácia multicística, 4 (10,53%) leucomalácia periventricular, 4 (10,53%) leucomalácia periventricular com atrofia cerebral, 4 (10,53%) nódulos periventriculares, 3 (7,89%) atrofia cerebral, 2 (5,26%) paquigiria associada à atrofia de corpo caloso, um (2,63%) agenesia de corpo caloso, um (2,63%) displasia frontal direita, um (2,63%) displasia frontal esquerda, um (2,63%) displasia frontoparietal direita, um (2,63%) displasia frontoparietal esquerda e um (2,63%) paquigiria. Conclusão: A história de hipóxia/anóxia perinatal e prematuridade é muito frequente na SW. A melhora dos cuidados durante a gestação e o parto é muito importante para reduzir lesões cerebrais perinatais, nascimentos prematuros e consequentemente, a morbidade neurológica.
Introducción: El síndrome de West (SW) es la más frecuente encefalopatía epiléptica del primer año de vida y está fuertemente relacionado con lesiones cerebrales prenatales y perinatales. Objetivo: Analizar la relación entre prematuridad y asfixia perinatal (hipoxia cerebral) y SW. Métodos: Este es un estudio observacional y transversal. Fueron analizados todos los pacientes con SW tratados en el Servicio de Neurología Pediátrica del Hospital Infantil Pequeno Príncipe entre enero de 2010 y enero de 2015. Los pacientes fueron sometidos a resonancia magnética (RM) del encéfalo y electroence- falograma (EEG). Resultados: Treinta y ocho pacientes con SW, 23 (60,53%) del sexo femenino; edad entre 9 a 27 meses (±16,6 meses). Veinte (52,63%) pacientes tenían historia de hipoxia/anoxia perinatal, 8 (21,05%) eran prematuros, 8 (21,05%) tenían malformaciones cerebrales, 4 (10,53%) tenían síndrome de Down, 4 (10,53%) tenían esclerosis tuberosa y 2 (5,26%) no presentaban ninguna comorbilidad. La RM mostró: 9 (23,68%) casos de encefalomalacia multiquística, 4 (10,53%) con leucomalacia periventricular, 4 (10,53%) con leucomalacia periventricular con atrofia cerebral, 4 (10,53%) con nódulos periventriculares, 3 (7,89%) con atrofia cerebral, 2 (5,26%) con paquigiria asociada a la atrofia de cuerpo calloso, uno (2,63%) con agenesia de cuerpo calloso, uno (2,63%) con displasia frontal derecha, uno (2,63%) con displasia frontal izquierda, uno (2,63%) con displasia frontoparietal derecha, uno (2,63%) con displasia frontoparietal izquierda y uno (2,63%) con paquigiria. Conclusión: La historia de hipoxia/anoxia perinatal y prematuridad es muy frecuente en SW. La mejora de los cuidados durante la gestación y el parto es muy importante para reducir lesiones cerebrales perinatales, nacimientos prematuros y consiguientemente, la morbilidad neurológica.
