RESUMO
BACKGROUND: Sickle cell disease (SCD) patients suffer complications requiring simple and/or exchange transfusion. In 1999 we developed an automated exchange technique using infusion pumps and vascular catheters (IV Pump Method). OBJECTIVE: To prove that IV Pump Method is cost-efficient, and as safe and effective as automated cell separators. METHODS: Retrospective chart review of SCD patients requiring exchange transfusion admitted to PICU from 2003-2009. Evaluated method used, complications, costs, and Hemoglobin S% (HgS%) change, excluding patients not requiring exchange transfusion. RESULTS: Cost-reduction with IV Pump Method is around $1000. Average HgS% reduction using IV Pump Method was 30.3 vs. 28.8 in Blood Cell Separator group (p = 0.84). We had no complications or mortalities, with the majority of patients being male (p = 0.03) and on the oldest age group (11-19 y/o) for both methods. CONCLUSION: The IV Pump Method is a safe, effective, and cost-efficient alternative to perform exchange transfusion.
Assuntos
Anemia Falciforme/terapia , Transfusão Total/economia , Transfusão Total/normas , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Humanos , Masculino , Estudos Retrospectivos , SegurançaRESUMO
Malnutrition is a well-known cause of infant morbidity and mortality. In developed societies malnutrition still exists, especially in patients fed insufficient diets during chronic and critical illnesses. Malnutrition impacts all organs. Skin manifestations are common, and its diagnosis is mostly visual. We present four cases of malnutrition with associated zinc deficiency were the clinical diagnosis proved correct. Acrodermatitis Enteropathica cannot be distinguished histologically form other forms of deficiency dermatitis and psoriasis. A thorough history and physical examination plus the clinical response to therapy are sufficient to make the correct diagnosis.
Assuntos
Desnutrição/complicações , Acrodermatite/diagnóstico , Acrodermatite/etiologia , Criança , Feminino , Humanos , Lactente , Masculino , Zinco/deficiênciaRESUMO
Hemophagocytic Syndrome (HS) is a clinico-pathologic entity characterized by activation of T lymphocytes and macrophages. It may be diagnosed in association with malignant, genetic, or autoimmune diseases, but is most linked with Epstein-Barr virus. There are few reports of association between HS and Dengue in pediatrics. Dengue fever, caused by a flavivirus, is an important mosquito-transmitted disease. It can cause increased vascular permeability that leads to a bleeding diathesis or disseminated intravascular coagulation known as dengue hemorrhagic fever (DHF). We present the case of a 10 month-old-female who developed DHF and dengue shock syndrome, requiring admission to intensive care unit. She developed hemophagocytosis diagnosed by bone marrow aspiration and atypical skin changes that have not been previously described in association with dengue fever. This is an unusual case of dengue related hemophagocytic syndrome that adds to the limited pediatric cases reported in literature.
Assuntos
Dengue/complicações , Linfo-Histiocitose Hemofagocítica/virologia , Feminino , Humanos , LactenteRESUMO
OBJECTIVE: Asses if Abdominal Compartment Syndrome (ACS) increases the morbidity and mortality of the Pediatric Intensive Care Unit patients and if early recognition and intervention with decompressive therapy will alter outcome and decrease mortality. SETTING: Pediatric Intensive Care Unit of the University Pediatric Hospital-UPR. PATIENTS: All patients admitted to the PICU from July 1, 1999 to June 30, 2002 were enrolled in the study. Those having a distended and/or tense abdomen on physical examination were identified at risk for intra-abdominal hypertension (IAH). IAH was diagnosed if the intra-abdominal pressure (IAP) was above 10 mmHg and with ACS if the IAH was accompanied by: hemodynamic instability, oliguria or anuria, metabolic acidosis and respiratory deterioration. MEASUREMENTS AND MAIN RESULTS: 1052 patients were admitted to PICU. Ten patients with evidence of ACS were identified with an incidence of 0.9%. Ages ranged from 6 weeks to 12.3 years. Peak intravesical pressure measurements ranged from 17 to 39 mmHg. Inspiratory pressure was raised from a mean of 21.2 to 32.0 cmH2O. The PCO2 increased from a mean of 35.1 to 63 torr and the pH decreased from a mean of 7.40 to 7.12. Overall mortality was 40% for this patient population. CONCLUSIONS: The outcome of pediatric critical care patients depends on multiple variables. Now there is evidence that in a select group of patients IAH and ACS play a significant role in their morbidity and mortality. This makes it mandatory for clinicians taking care of this population to be increasingly aware of this condition.
Assuntos
Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/terapia , Abdome , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , MasculinoRESUMO
Infection-associated hemophagocytic syndrome is a rare, potentially fatal complication of systemic infection. It occurs most often in immunocompromised patients associated with a viral infection but the spectrum of conditions have been broadened to include virtually every type of infectious pathogen, malignancy and immunosuppressive therapy. We present three pediatric patients with a similar clinical history of pancytopenia, hepatosplenomegaly, and acute liver failure, and discuss the autopsy findings.
Assuntos
Infecções/complicações , Linfo-Histiocitose Hemofagocítica , Autopsia , Biópsia , Medula Óssea/patologia , Estado Terminal , Feminino , Humanos , Lactente , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Linfo-Histiocitose Hemofagocítica/mortalidade , Linfo-Histiocitose Hemofagocítica/patologia , Masculino , Baço/patologia , Síndrome , Fatores de TempoRESUMO
We present the case of an eighteen day old baby boy hospitalized with an abdominal mass, renal insufficiency and jaundice. Multiple radiographic, radionuclear and surgical interventions were required to diagnose renohepaticopancreatic dysplasia, also known as Ivemark II syndrome. In spite of aggressive intensive care support, the patient developed multisystemic organ failure and died. Clinical presentation and autopsy findings are presented.
Assuntos
Injúria Renal Aguda/complicações , Falência Hepática/complicações , Cisto Pancreático/complicações , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/patologia , Autopsia , Diagnóstico Diferencial , Evolução Fatal , Fibrose/patologia , Humanos , Recém-Nascido , Icterícia/etiologia , Icterícia/patologia , Rim/patologia , Fígado/patologia , Falência Hepática/etiologia , Falência Hepática/patologia , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/patologia , Pâncreas/patologia , Cisto Pancreático/patologia , SíndromeRESUMO
A retrospective study of the experience at the University Pediatric Hospital during a six-year period when 2529 patients were admitted to the Pediatric Intensive Care Unit (PICU) and 80 were diagnosed with brain death. Etiologic causes, age and sex distribution and use of confirmatory studies were evaluated. The specific criterias for brain death determination in children are discussed and it was found that 3.1% of all the admissions to PICU were diagnosed with brain death. This diagnosis was most common in the 6 to 12 year old children (35%) and in infants younger than 2 years of age (30%). Trauma accounted for 41.0% of the cases. In babies less than 6 months of age, 71.4% were battered. Only 11% accepted organ donation.
Assuntos
Morte Encefálica/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
A retrospective study of the experience at the University Pediatric Hospital during a six-year period when 2529 patients were admitted to the Pediatric Intensive Care Unit (PICU) and 80 were diagnosed with brain death. Etiologic causes, age and sex distribution and use of confirmatory studies were evaluated. The specific criterias for brain death determination in children are discussed and it was found that 3.1 of all the admissions to PICU were diagnosed with brain death. This diagnosis was most common in the 6 to 12 year old children (35) and in infants younger than 2 years of age (30). Trauma accounted for 41.0 of the cases. In babies less than 6 months of age, 71.4 were battered. Only 11 accepted organ donation.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Morte Encefálica , Estudos RetrospectivosRESUMO
Dengue fever (DF) is endemic and occasionally epidemic in many tropical and subtropical areas inhabited by the mosquito vector Aedes aegypti. Infection with Dengue may present with varied clinical manifestations. Significant morbidity and mortality can result if early recognition and monitoring of its severe forms (DHF and DSS) is not done and if appropriate medical intervention is delayed. This article reviews several critical points in the basic evaluation and management of dengue in the pediatric age group and present our current approach in the form of a therapeutic algorithm.
Assuntos
Humanos , Criança , Dengue , Fatores Etários , Algoritmos , Cuidados Críticos , Dengue , Fatores de TempoAssuntos
Humanos , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Lactatos/sangue , Pediatria , Acidose Láctica/diagnóstico , Acidose Láctica/mortalidade , Doença Aguda , Unidades de Terapia Intensiva Pediátrica , Lactatos/metabolismo , Oxigênio/sangue , Filipinas , PrognósticoRESUMO
Se discute el Croup infeccioso en niños con énfasis en traqueitis bacteriana, una condición seria pero poco reconocida. Reportamos el caso de una niña de un año de edad que comenzó con un cuadro clínico simulado una infección infraglótica viral que progresa en tres días a una obstrucción severa de vía aérea secundaria a una infección por Staphylococcus aureus. Además, desarrolla síndrome de dificultad respiratoria del adulto sugiriendo que en infantes la obstrucción de vía aérea puede ser factor predisponente para este síndrome como lo es edema pulmonar
Assuntos
Lactente , Humanos , Feminino , Crupe/complicações , Síndrome do Desconforto Respiratório/complicaçõesRESUMO
Veintiseis pacientes con el diagnóstico de epiglotitis fueron hospitalizados en la Unidad de Cuidado Intensivo del Hospital Pediátrico Universitario de 1975-1982. La edad fluctuó desde 7 meses a 6 años. La estadía en la Unidad de Cuidado Intensivo fue de uno a cuatro días. La radiografía lateral de cuello fue de gran utilidad para llegar al diagnóstico. Todos los pacientes sobrevivieron. El establecimiento de una vía aérea adecuada mediante la intubación endotraqueal y la institución de antibióticos con cobertura adecuada para Hemophillus influenzae tipo B fue la meta de tratamiento
Assuntos
Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Epiglotite , Intubação Intratraqueal , Epiglotite , Epiglotite/terapiaRESUMO
Un paciente varón de 14 años de edad es hopitalizado con episodios repetidos de debilidad generalizada e hipocalemia (1.3 meq/L). La parálisis desaparece al corregir el potasio con líquidos endovenosos. El paciente permaneció asintomático, excepto por una recaída, mediante dieta y suplementación oral de potasio. La parálisis periódica hipocalémica es una condición rara cuya primera manifestación ocurre en la adolescencia. Es causada por desequilibrios en los niveles de potasio sérico. Las dietas bajas en carbohidratos, suplementos de potasio, espironolactona y acetazolamida se han usado como agentes para estabilizar el potasio sérico y disminuir la frecuencia de los ataques paralíticos