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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: children (Page 1 of 3)

Can partial splenectomy preserve humoral immunity in pediatric patients?

Abstract

The spleen plays an important role in removing normal and abnormal cells from the blood and in providing an immunologic response to encapsulated bacteria. Surgical splenectomy provides effective treatment for several pediatric disorders, such as congenital and acquired hemolytic anemias, abdominal traumas and immunological and metabolic disorders, but it is associated with an immediate and lifelong risk of overwhelming infection. An alternative to conventional splenectomy is partial splenectomy, recommended especially in children younger than 5 years of age. Recommendations for the prevention of overwhelming post-total splenectomy infection include: Pneumococcal, Haemophilus influenzae type B and Meningococcal immunizations, antimicrobial prophylaxis and prompt antibiotic treatment of acute febrile illness; conversely, there is no clear evidence indicating which prevention measures are to be performed in patients undergoing partial splenectomy.

Key words: partial splenectomy, children, immunization

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Most frequent interventions involving children in prehospital emergency medicine

Abstract

A retrospective study of interventions involving children in the period from 2011 to 2015 was conducted at the Teaching Institute for Emergency Medicine of Zagreb. During this period a total of 18,356 interventions involving children occurred in the field. From 2011 to 2013, 11,576 interventions occurred, which makes up 4.56 % of all interventions in that period. During 2014 and 2015 there were 6,780 interventions which make up 3.69 % of all interventions in the field during that period. There was a 20 % reduction in the number of emergency interventions involving children in the last two years of the study in comparison to the previous period. The greatest number of these emergency interventions is due to injury. From 2011 to 2013, the total number of interventions involving injured children was 24.59 % as opposed to 19.94 % from 2014 to 2015. There is a statistically significant decrease in the number of occurring injuries by 19%, whereas the number of head injuries went down from 12.48 % to 10.01 %. That marks a decrease of 20 % in the second part of the studied period. This is most probably a result of better injury prevention as a result of education programs in preschools, schools, media campaigns, and the use of protective equipment (protective helmets for cyclist, skaters, skiers etc.)

Key words: children, trauma, emergency medical service

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Epinephrine induced cardiomyopathy in a child with anaphylaxis

Abstract

Transient cardiomyopathy is an uncommon occurrence in patients with anaphylaxis. Catecholamine induced direct toxicity is one of the proposed mechanisms. We report a case of cardiomyopathy in a child with anaphylaxis who was treated with multiple doses of epinephrine as well as a continuous infusion of epinephrine. A twenty one month old girl with egg allergy presented to our hospital with anaphylaxis, after multiple doses of epinephrine injections, developed cardiorespiratory dysfunction and required endotracheal intubation and mechanical ventilation. Work up showed depressed cardiac function, which improved with milrinone and furosemide infusions. Conclusion: Epinephrine is the treatment of choice for anaphylaxis however caution should be exercised when administering multiple doses of epinephrine. Myocardial function needs to be assessed in children with persistent hypotension after anaphylaxis and catecholamine-induced cardiomyopathy should be considered in children with anaphylaxis when severe myocardial dysfunction is present.

Key words: anaphylaxis, epinephrine, cardiomyopathy, children

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Acute respiratory distress syndrome in an 11-month-old girl leading to extracorporeal membrane oxygenation

Abstract

Acute respiratory distress syndrome (ARDS) is a condition recognised for almost fifty years, and is related to high morbidity and mortality in children. From its recognition, medical experts tried to make joint efforts to make recommendations and optimize treatment in children and adult population. The new definition of ARDS suggests treatment by introducing three levels of severity, according to PaO2/FiO2 and positive end-expiratory pressure. Lung-protective ventilation remains crucial in achieving better outcome in paediatric acute respiratory distress syndrome (PARDS), but promising therapies based on paediatric studies include non-invasive ventilation, endotracheal surfactant, high-frequency oscillatory ventilation (HFOV), and use of ECMO as „rescue“ therapy. Nevertheless, PARDS is a real challenge for the paediatric critical care provider, and even if current state-of-the-art treatment methods are delivered, this disease often leads to fatal outcome.

We report the case of an 11-month-old female infant who developed ARDS, was treated by current up-to-date treatment methods, including ECMO, and despite this, succumbed to her illness. With this case report we would like once more to bring to consideration the current knowledge on etiology, epidemiology, diagnosis and treatment of ARDS in children, and emphasize the high morbidity and mortality related to this syndrome.

Key words: Acute respiratory distress syndrome (ARDS), children, paediatric, extracorporeal membrane oxygenation (ECMO)

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Influenza A (H1N1)-induced ischemic stroke in a child: case report and review of the literature

Abstract

Ischemic stroke is an important cause of death and long term morbidity in children. Viral respiratory infections are emerging as important risk factors responsible for ischemic stroke in this age group. The direct action of virus against cerebral vessels, autoimmune reactivity, and increased production of cytokines are advocated as the main factors for causing ischemic stroke. This study can be useful for clarifying some molecular aspects of H1N1 virus infection in children.
We report on the case of a H1N1-induced ischemic stroke in a Caucasian 2 year-old female. The cerebrospinal fluid samples showed the positivity of polymerase chain reaction for influenza A (H1N1) infection, confirmed also by pharyngeal swab culture. Increased levels of cerebrospinal fluid interleukin 6 and interleukin 1β were also detected.
H1N1 virus infection has been identified as an important cause of neurological involvement in children. The findings of increased levels of Interleukin 6 and interleukin 1β in the cerebrospinal fluid of this child with H1N1 induced-ischemic stroke seems to validate the role of pro-inflammatory cytokines as crucial mediators of cerebral thrombus formation.

Key words: children, H1N1 influenza virus, interleukins, ischemic stroke

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