Management of central venous catheters in pediatric onco-hematology using 0.9% sodium chloride and positive-pressure-valve needleless connector

PurposeTo describe, in a sample of pediatric onco-hematological patients, the rate of occlusions in unused central venous catheters (CVC) flushed once a week with a 0.9% sodium chloride solution through a positive-pressure-valve needleless connector.MethodRetrospective cohort study. Subjects aged 0–17 years were identified through a manual search in medical and nursing records and were observed for two years or until the occurrence of one of the following events: start or resume of continuous infusion; CVC removal; death. The primary study outcome was the frequency of CVC occlusion (partial or complete).ResultsFifty-one patients were identified (median age 6 years). The median duration of follow-up was 169 days (IQR 111–305). During the follow up period, 14 patients (27%) had one CVC occlusion, in 2 cases (4%) the occlusion was complete, in 12 (23%) partial. All the occlusions were solved without the need for catheter removal. The lumen diameter ≤4.2 vs > 4.2 French showed a statistically significant association with occlusion at multivariate analysis (OR 4.0; 95% CI 1.1–14.7).ConclusionsOur findings are reassuring with respect to the management of the CVC using the adopted protocol. The study provides useful information for patient care, by verifying the performance of the adopted CVC management protocol and by identifying critical areas for nursing care.     

Vulvar embryonal rhabdomyosarcoma: A case report

Embryonal rhabdomyosarcoma (ERMS) is a rare malignant neoplasm found in both male and female children. It typically presents as a protruding vaginal mass with vaginal bleeding in girls less than 8 years of age. It is often seen as the sarcoma botryoides histologic sub type. This report represents the first case study of ERMS presenting as a vulvar mass. The article further explores the etiologies of pediatric vulvar masses, including ERMS, and the suggested diagnostic and treatment modalities.     

The effect of rate stress on the auditory brainstem response in autism: A preliminary report

Abstract

Efforts to correlate peripheral neurophysiologic function with perceptional deficits seen in autistic disorder (AD) have resulted in mixed findings, reflecting the high degree of heterogeneity observed in these individuals. We used the auditory brainstem response to study the effect of stress (high click presentation rate) on the auditory system in 20 children with AD (7–13 years) and 20 age-matched typically developing (TD) children. We report latency prolongations in children with AD vs. TD at waves I, III, and V that differed by ear of presentation: overall, left ear showed significant prolongations by group while right ear did not. The ‘stressed’ condition produced prolongations for both groups at each wave. At wave V, children with AD showed significant prolongations vs. TD, particularly for the right ear. For children with AD, wave V latency prolongations corresponded to language outcome as measured by VIQ, with longer prolongations associating with lower VIQ. Preliminary results provide evidence for reduced synaptic efficiency in auditory pathways in children with AD, which may form the neural bases for sensory reactivity and language impairment.

Sumario

Los esfuerzos para correlacionar la función neurofisiológica periférica con los déficits de percepción que se observan en el trastorno autístico (AD) han producido hallazgos mixtos que reflejan el alto grado de heterogeneidad que se aprecia en estos individuos. Usamos la respuesta auditiva de tallo cerebral para estudiar el efecto de tasas elevadas de presentación de clicks al sistema auditivo de 20 niños con AD (7-13 años) y de otros 20, pareados en edad, con desarrollo típico (TD). Reportamos latencias prolongadas en niños con AD vs. TD en las ondas I, III y V que difirieron según el oído estimulado. Globalmente, el oído izquierdo mostró prolongaciones significativas por grupo, mientras que no fue así con el oído derecho. La condición de “alta estimulación” produjo prolongaciones en ambos grupos y con cada una de las ondas. En la onda V, los niños con AD mostraron prolongaciones significativas vs. los niños TD, particularmente con el oído derecho. En niños con AD, las prolongaciones de latencia de la onda V, correspondieron a resultados lingüísticos medidos con VIQ, con prolongaciones aun mayores que se asociaron con niveles VIQ más bajos. Los resultados preliminares proporcionan evidencias de eficiencia sináptica reducida en las vías auditivas de niños con AD, que pueden ser el fundamento neural de la reactividad sensorial y de los impedimentos del lenguaje.