RESUMEN
BACKGROUND: In 2002 and 2007, the American College of Critical Care Medicine (ACCCM) provided clinical guidelines for hemodynamic support of pediatric and neonatal patients in septic shock. In 2008 and 2013, the Surviving Sepsis Campaign (SSC) Guidelines Committee offered up-to-date clinical guidelines for the management of severe sepsis and septic shock in adults and in pediatric patients. The aim of this study was to assess the standard of care of neonates with severe sepsis and septic shock in German neonatal intensive care units (NICUs) with regard to variability in management and guideline conformity. METHODS: 199 pediatric clinics in Germany were asked to describe their management of septic neonates in a telephone survey. The questionnaire that was used for the preliminary survey was designed based on the ACCCM and SSC clinical guidelines. RESULTS: A total of 90 (45%) surveys were completed and analyzed. Among all hospitals, the guidelines most commonly included in current practice patterns were obtaining cultures before administering antibiotics (100%), determining capillary refill time (99%), and using crystalloids for initial fluid therapy (97%). The guidelines least commonly included in current practice were determination of ammoniac to rule out inborn errors of metabolism (51%) and the use of dopamine as the first choice of hemodynamic support (48%). CONCLUSIONS: The management of sepsis, severe sepsis, and septic shock in neonates is not always guideline consistent, but quite a number of ACCCM and SSC guidelines were included in the current practice pattern.
Asunto(s)
Adhesión a Directriz/normas , Unidades de Cuidado Intensivo Neonatal/normas , Choque Séptico/terapia , Alemania , Encuestas de Atención de la Salud , Humanos , Recién Nacido , Choque Séptico/diagnóstico , Nivel de Atención/normas , Encuestas y CuestionariosRESUMEN
BACKGROUND: Umbilical vein catheterisation is a common and useful procedure in the care of critically ill newborns, but several complications may occur. PATIENTS: We report on a newborn, who developed sepsis and necrotizing pneumonia of the right middle lobe due to extended spectrum beta lactamase (ESBL) Klebsiella following malposition of an umbilical vein catheter into a right pulmonary vein. RESULTS: Due to failed conservative treatment the child required lobectomy of the right middle lobe. CONCLUSION: Our case highlights the importance of exact determination of the position of central catheters by x-ray and/or ultrasound immediately after placement.
Asunto(s)
Cateterismo Venoso Central/instrumentación , Infecciones por Klebsiella/etiología , Klebsiella pneumoniae , Absceso Pulmonar/etiología , Neumonía Bacteriana/etiología , Venas Pulmonares , Sepsis/etiología , Venas Umbilicales , Alemania , Humanos , Recién Nacido , Infarto/diagnóstico por imagen , Infarto/etiología , Infarto/cirugía , Infecciones por Klebsiella/diagnóstico por imagen , Infecciones por Klebsiella/cirugía , Pulmón/irrigación sanguínea , Absceso Pulmonar/diagnóstico por imagen , Absceso Pulmonar/cirugía , Masculino , Errores Médicos , Necrosis , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/cirugía , Venas Pulmonares/diagnóstico por imagen , Sepsis/diagnóstico por imagen , Sepsis/cirugía , Tomografía Computarizada por Rayos X , Venas Umbilicales/diagnóstico por imagenAsunto(s)
Articulación Atlantooccipital/lesiones , Procesamiento de Imagen Asistido por Computador , Luxaciones Articulares/diagnóstico , Imagen por Resonancia Magnética , Traumatismos Vertebrales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Imagen de Cuerpo Entero , Articulación Atlantooccipital/patología , Articulación Atlantooccipital/cirugía , Preescolar , Femenino , Humanos , Luxaciones Articulares/cirugía , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/cirugía , Ligamentos Articulares/lesiones , Ligamentos Articulares/patología , Ligamentos Articulares/cirugía , Examen Neurológico , Rotura , Cinturones de Seguridad/efectos adversos , Traumatismos Vertebrales/cirugía , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/cirugíaRESUMEN
An infant with combined methylmalonic aciduria and homocystinuria (cblC/D defect) presented with significant VSD. She underwent successful cardiac surgery at 53 days.
Asunto(s)
Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/cirugía , Homocistinuria/complicaciones , Ácido Metilmalónico/orina , Femenino , Ácido Fólico/administración & dosificación , Defectos del Tabique Interventricular/diagnóstico , Homocisteína/sangre , Homocistinuria/diagnóstico , Homocistinuria/terapia , Humanos , Hidroxocobalamina/administración & dosificación , Recién Nacido , Ácido Láctico/sangre , Errores Innatos del Metabolismo/complicaciones , Errores Innatos del Metabolismo/diagnóstico , Errores Innatos del Metabolismo/terapia , Metionina/sangreRESUMEN
Methylmalonic acidemia with associated homocystinuria is a rare inborn error of amino acid metabolism affecting energy supply on the cellular level. Its effects on recovery from surgically induced organ ischemia are largely unknown. We report the successful closure of a nonrestrictive ventricular septal defect by following a normothermic strategy combined with ample metabolic substrate supply.
Asunto(s)
Errores Innatos del Metabolismo de los Aminoácidos/cirugía , Defectos del Tabique Interventricular/cirugía , Homocistinuria/cirugía , Ácido Metilmalónico/orina , Errores Innatos del Metabolismo de los Aminoácidos/orina , Implantación de Prótesis Vascular , Femenino , Defectos del Tabique Interventricular/orina , Homocistinuria/orina , Humanos , Recién Nacido , Atención PerioperativaRESUMEN
Cardiac hemangiomas in infancy are very rare. We report on a newborn, in whom a tumor of the right artrium was diagnosed in the prenatal period. After complete surgical resection histologic workup showed a cardiac hemangioma.