Evaluation of the vasoactive-inotropic score, mid-regional pro-adrenomedullin and cardiac troponin I as predictors of low cardiac output syndrome in children after congenital heart disease surgery / Evaluación de la escala vasoactiva-inotrópica, pro-adrenomedulina y troponina cardiaca-I como factores predictivos del síndrome de bajo gasto cardiaco en niños tras corrección quirúrgica de cardiopatías congénitas

Objective: To determine the predictive value of the inotropic score (IS) and vasoactive-inotropic score (VIS) in low cardiac output syndrome (LCOS) in children after congenital heart disease surgery involving cardiopulmonary bypass (CPB), and to establish whether mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin I (cTn-I), associated to the IS and VIS scores, increases the predictive capacity in LCOS. Design: A prospective observational study was carried out. Setting: A Paediatric Intensive Care Unit. Patients: A total of 117children with congenital heart disease underwent CPB. Patients were divided into two groups: LCOS and non-LCOS. Interventions: The clinical and analytical data were recorded at 2, 12, 24 and 48h post-CPB. Logistic regression was used to develop a risk prediction model using LCOS as dependent variable. Main outcome measures: LCOS, IS, VIS, MR-proADM, cTn-I, age, sex, CPB time, PIM-2, Aristotle score. Results: While statistical significance was not recorded for IS in the multivariate analysis, VIS was seen to be independently associated to LCOS. On the other hand, VIS>15.5 at 2h post-CPB, adjusted for age and CPB timepoints, showed high specificity (92.87%; 95%CI: 86.75-98.96) and increased negative predictive value (75.59%, 95%CI: 71.1-88.08) for the diagnosis of LCOS at 48h post-CPB. The predictive power for LCOS did not increase when VIS was combined with cTn-I >14ng/ml at 2h and MR-proADM >1.5nmol/l at 24h post-CPB. Conclusions: The VIS score at 2h post-CPB was identified as an independent early predictor of LCOS. This predictive value was not increased when associated with LCOS cardiac biomarkers. The VIS score was more useful than IS post-CPB in making early therapeutic decisions in clinical practice post-CPB

Objetivo: Estudiar el valor predictivo de la escala inotrópica (IS) y la escala vasoactiva-inotrópica (VIS) en el síndrome de bajo gasto cardiaco (SBGC) en niños poscirugía de cardiopatías congénitas mediante bypass cardiopulmonar (BCP). Determinar si adrenomedulina (MR-proADM) y troponina cardiaca-I (cTn-I) asociadas con IS y VIS incrementan su capacidad predictora de SBGC. Diseño: Estudio prospectivo y observacional. Ámbito: Cuidados intensivos pediátricos. Pacientes: Ciento diecisiete pacientes pediátricos con cardiopatías congénitas corregidos mediante BCP, clasificados en función de la presencia o no de SBGC. Intervenciones: Los datos analíticos y clínicos se midieron a las 2, 12, 24 y 48h post-BCP. Las principales variables se analizaron mediante regresión logística multivariante, considerando SBGC como variable dependiente. Variables de interés principales: SBGC, IS, VIS, MR-proADM, cTn-I, edad, sexo, BCP, PIM-2 y escala Aristóteles. Resultados: El IS no alcanzó significación estadística en el estudio multivariante; sin embargo, el VIS se asoció independientemente a SBGC. El VIS>15,5 a las 2h del ingreso en CIP, ajustado por edad y tiempo de CEC, muestra alta especificidad (92,87%; IC 95%: 86,75-98,96%) y alto valor predictivo negativo (75,59%; IC 95%: 71,10-88,08) para predecir SBGC a las 48h post-BCP. La capacidad predictora no se incrementa al incorporar cTn-I>14ng/ml a las 2h y ADM>1,5nmol/l a las 24h del postoperatorio. Conclusiones: El VIS a las 2h post-BCP es un predictor independiente precoz de SBGC. Este valor no se incrementa al asociarse biomarcadores cardiacos de LCOS. La escala de VIS fue más útil que la escala de IS en la toma de decisiones terapéuticas tras la cirugía cardiaca

Analysis of the local and systemic inflammatory response in hospitalized infants with respiratory syncitial virus bronchiolitis

BACKGROUND: Respiratory syncytial virus acute bronchiolitis (RSV-AB) is a major cause of hospital admission among our infants. The immune and inflammatory mechanisms involved in the RSV-AB and factors influencing severity have not been clearly established, although an imbalanced Th1 and Th2 response seems to be crucial. OBJECTIVES: To assess the local and systemic inflammatory response in RSV-AB. To find a possible marker of clinical severity and/or oxygen requirements. PATIENTS AND METHODS: Levels of nine cytokines were measured in nasopharyngeal aspirate (NPA) and peripheral blood (PB) of 45 infants with RSV-AB and 27 peer controls, including IFNγ, TNFα, VEGF, interleukins 4, 6 and 10, and chemokines (IL-8 and macrophage inflammatory proteins 1-α and 1-β). RESULTS: The levels of the analyzed cytokines and chemokines were significantly higher in the NPA of RSV-AB group, with a decrease in IL-4/IFNγ ratio. IL-6 and MIP-1β levels in NPA were directly correlated to oxygen therapy. PB showed an increase in IL-8 and a decrease in MIP-1α and MIP-1β in the RSV-AB group (only MIP-1β associated to the need for oxygen therapy). No correlation was found between cytokines and chemokines levels in NPA and PB. CONCLUSIONS: This study shows that RSV triggers an inflammatory response fundamentally at the respiratory level, with scant systemic repercussion. This local response is characterized by an increase in Th1 and Th2 cytokines, although with a relative predominance of Th1. The determination upon patient admission of IL-6 and MIP-1β levels in NPA, and of MIP-1β in PB could help predict severe forms and the need for oxygenotherapy

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Perfil de ácidos grasos en pacientes oncológicos pediátricos / Plasma fatty acids profile in paediatric cancer patients

El reducido número de casos de cáncer en la edad pediátrica y las dificultades para la investigación, han contribuido a que existan escasos estudios sobre el estado metabólico y nutricional de estos pacientes. El objetivo principal del trabajo ha sido investigar las posibles alteraciones nutricionales y metabólicas en niños oncológicos, y concretamente el perfil de ácidos grasos plasmáticos tras recibir quimioterapia, comparándolo con el de un grupo de niños sanos. Métodos: Se seleccionaron 12 niños oncológicos con edades comprendidas entre 0 y 16 años, que hubieran recibido al menos un ciclo de tratamiento quimioterápico, un mes antes del estudio y que no estuvieran en fase terminal de la enfermedad. Se realizó encuesta nutricional, medición de valores antropométricos, estudio analítico general y perfil de ácidos grasos en plasma. Resultados: No se detectaron alteraciones en los parámetros antropométricos y bioquímicos nutricionales generales. En los ácidos grasos omega-6, se observaron valores más bajos de linoleico y ácido docosapentaenoico, niveles más altos de gamma-linoleico, y niveles de araquidónico normales. En los omega-3, encontramos valores normales de ácido alfa-linolénico y del ácido docohexanoico, y valores más bajos de ácido eicosapentaenoico. Conclusión: Parece vislumbrarse una deficiencia parcial en el metabolismo de los ácidos grasos poliinsaturados en niños oncológicos, con buen estado nutricional y tras recibir al menos un ciclo de quimioterapia. Por ello, son necesarias futuras investigaciones que permitan plantear suplementos específicos (AU)

The small number of cases of cancer in children and the difficulties of research, have contributed to there being few studies on the metabolic and nutritional status of these patients. The main objective of this study was to investigate the nutritional and metabolic alterations in children with cancer, and specifically the plasma fatty acid profile after receiving chemotherapy, compared with a group of healthy children. Methods: We selected 12 children with cancer aged between 0 and 16, who had received at least one cycle of chemotherapy, one month before the study and were not end-stage disease. Nutritional survey was conducted, anthropometric measurements, general biochemical analysis and profile of fatty acids in plasma were evaluated. Results: No changes in anthropometric and nutritional biochemical parameters were detected. In the omega-6 fatty acids, lower values of linoleic and docosapentaenoic acid, and higher levels of gamma-linolenic acid, and normal levels of arachidonic acid were observed. In theomega-3, we found normal values of alpha-linolenic acid and docohexanoic acid, and lower values of eicosapentaenoic acid. Conclusion: It seems glimpsed a partial deficiency in the metabolism of polyunsaturated fatty acids in children with cancer, good nutrition and having received at least one cycle of chemotherapy. Further research is needed to allow specific supplementations (AU)

Factores de riesgo implicados en la necesidad de transfusión sanguínea en recién nacidos de muy bajo peso tratados con eritropoyetina / Risk factors involved in the need for blood transfusion in very low birth weight newborns treated with erythropoietin

Objetivo: Identificar y cuantificar factores de riesgo precoces relacionados con la necesidad de transfundir hemoderivados a prematuros de muy bajo peso, en tratamiento profiláctico con eritropoyetina humana recombinante (EPO). Secundariamente, evaluar la incidencia de retinopatía del prematuro (ROP) en relación con la administración precoz o tardía de EPO y con la transfusión de sangre. Material y métodos: Estudio descriptivo prospectivo de los nacidos de enero de 2006 a marzo de 2009 con peso inferior a 1.500g y edad gestacional (EG) inferior a 32 semanas, incluidos en el estudio de morbimortalidad de los recién nacidos menores de 1.500g de la Sociedad Española de Neonatología (SEN1500) tratados con EPO subcutánea a dosis de 750UI/kg/semana/6 semanas. Material y métodos: Se utilizaron regresiones logísticas univariables y multivariables con el paquete PASW Statistics. Resultados: Se incluyeron un total de 110 recién nacidos (RN) con peso medio de 1.154g y EG media de 29,3 semanas. Precisaron transfusión de sangre 59 RN (53,6%) frente a 51 (46,3%) no transfundidos. La incidencia de ROP grave (grado≥III) fue del 2,7%. Los factores de riesgo (odds ratio [OR]; intervalo de confianza [IC] del 95%) para ser transfundido obtenidos en el análisis multivariable fueron: sexo masculino (OR: 4,41; IC del 95%, 1,24–15,66), EG (OR: 1,64; IC del 95%, 1,14–2,36, disminución 1 semana), valores de hemoglobina (Hb) al ingreso (OR: 1,45; IC del 95%, 1,04–2,04; disminución 1g/dl), sepsis tardía (OR: 7,75; IC del 95%, 2,21–21,11) e inicio tardío del tratamiento con EPO (OR: 6,27; IC del 95%, 1,22–32,35). Todos los RN intervenidos de ductus o enterocolitis necrosante precisaron transfusión. No se ha relacionado la ROP con la administración de EPO precoz o tardía ni con la transfusión sanguínea. Conclusiones: Los requerimientos transfusionales son mayores en varones, en prematuros de menor EG, en los de menor Hb al nacer y en los que tienen sepsis tardía. No se ha demostrado relación entre el momento de la administración de EPO con la ROP (AU)

Objective: To identify and quantify risk factors related to red blood cell transfusion in premature babies weighing<1,500g who received erythropoietin (EPO). Secondly, to assess the relationship between retinopathy of prematurity and rh-EPO. Material and methods: Prospective descriptive study of infants admitted to the Reina Sofía University Hospital between January 2006 and March 2009. Infants reviewed had a birth weight<1,500g and gestational age<32 weeks. Infants were administered rh-EPO 750IU/kg/week subcutaneously 3 days/week/ 6 weeks. Material and methods: We used univariate and multivariate logistic regressions with PASW Statistics 18 for Windows. Results: Data were obtained from 110 infants, with a mean birth weight of 1154grs and mean gestational age of 29.3 weeks. Risk factors (OR; 95% CI) for being transfused were: male sex (4.41; 1.24–15.66), GA (1.64; 1.14–2.36, 1 week), Hb level on admission (1.45; 1.04–2.04; 1g/dl), late onset sepsis (7.75; 2.21–21.11), late onset treatment with rh-EPO (6.27; 1.22–32.35). All surgically treated infants with patent ductus arteriosus ligation or necrotizing enterocolitis needed transfusion. There is no relationship between rh-EPO administration and retinopathy of prematurity (ROP), but there was a relationship with transfusion. Conclusions: Premature infants with the lower gestational age, being male, a lower Hb level on admission and late onset sepsis are those with the greatest risk for blood transfusion (AU)