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1.
目的 小儿脓毒症是PICU的常见疾病,具有较高的病死率.本研究旨在了解小儿脓毒症的临床特点及转归,探寻儿童严重脓毒症的死亡危险因素.方法 分析2008年1月至12月收入我院PICU的脓毒症病例,对严重脓毒症患儿作单因素分析,并建立Logistic回归模型,探寻儿童严重脓毒症的死亡危险因素.结果 纳入脓毒症患儿103例,病死率16.5%.严重脓毒症45例,其死亡危险因素是PRISM Ⅲ评分(OR 1.502;95%CI 1.131~1.995)和病程中外周血血小板计数最高值(OR 0.991;95%CI0.982~1.000).小儿严重脓毒症伴随1、2、3、4个及4个以上脏器功能障碍的病死率分别为10.0%、11.1%、44.4%、68.8%,差异具有非常显著性(P<0.001).最常受累的是心血管系统(75.6%)和呼吸系统(66.7%),严重脓毒症伴发MODS死亡危险因素是呼吸系统(OR 23.179;95%CI2.095~256.522)和肾脏(OR 9.637;95%CI 1.698~54.703)功能受累.结论 小儿严重脓毒症的死亡危险因素是PRISM Ⅲ评分和病程中外周血血小板计数最高值.小儿脓毒症合并MODS提示预后不良,其病死率与发生功能障碍的脏器数目呈正相关,呼吸系统和肾脏功能受累是儿童脓毒症死亡的危险因素. 相似文献
2.
Gnanaguru Vijay Anirban Mandal Jhuma Sankar Arti Kapil Rakesh Lodha S. K. Kabra 《Indian journal of pediatrics》2018,85(10):861-866
Objectives
To study the incidence, etiology and risk factors associated with ventilator associated pneumonia (VAP) in children.Methods
This prospective cohort study was conducted on patients admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary care institute of North India, from June 2012 through March 2014, who received mechanical ventilation for more than 24 h. All enrolled children were assessed daily for development of ventilator associated pneumonia (VAP) using the case definition given by Centers for Disease Control and Prevention (CDC). Chest radiograph and microbiologic samplings were performed in children suspected to have VAP. Risk factors associated with VAP were calculated by doing bivariate and multivariate analysis.Results
A total of 128 patients were screened and 86 were enrolled (median age 30 mo 95% CI 4.0–84.0; 72% boys). The most common admitting diagnosis was sepsis (16%) followed by acyanotic congenital heart disease with pneumonia (14%) and the most common indication for ventilation was respiratory failure (45.3%). The incidence of VAP according to CDC criteria was 38.4%, while the incidence of microbiologically confirmed VAP was 24.4%. The incidence of ventilator associated tracheobronchitis (VAT) was found to be 11.6%. Acinetobacter was the most frequently isolated organism (47%) followed by Pseudomonas (28%), Klebsiella (15%), E. coli (5%) and Enterobacter (5%). Risk factors for VAP on bivariate analysis were use of proton pump inhibitor (PPI) (p?=?0.027, OR 5.2, 95% CI 1.1–24.3), enteral feeding (p?<?0.001, OR 6.5, 95% CI 2.1–19.4) and re-intubation (p?=?0.024, OR 3.3 and 95% CI 1.1–9.6). On multivariate analysis, use of PPI (p?=?0.03, OR 8.47, 95% CI 1.19–60.33) and enteral feeding (p?<?0.001, OR 12.2, 95% CI 2.58–57.78) were identified as independent risk factors for VAP.Conclusions
Ventilator associated pneumonia is an important complication in children receiving mechanical ventilation in PICU and Gram negative bacilli (Acinetobacter and Pseudomonas) being the important causative agents. Ventilator associated tracheobronchitis is an emerging entity; recognition and treatment of same might prevent the development of VAP.3.
Nabil E. Hassan Aly S. Mageed Dominic J. Sanfilippo Dianne Reischman Ulrich A. Duffner Surender Rajasekaran 《World journal of pediatrics : WJP》2013,9(2):140-145
Background
Hematopoietic stem-cell transplant (HSCT) is associated with many risk factors for life-threatening complications. Post-transplant critical illness often requires admission to the pediatric intensive care unit (PICU).Methods
A retrospective analysis was made on the risk factors associated with PICU admission and mortality of all HSCT patients at Helen DeVos Children’s Hospital from October 1998 to November 2008.Results
One hundred and twenty-four patients underwent HSCT, with 19 (15.3%) requiring 29 PICU admissions. Fifty patients received autologous, 38 matched sibling, and 36 matched un-related donor HSCT, with 10%, 13% and 25% of these patients requiring PICU admission, respectively (P=0.01). Among the HSCT patients, those who were admitted to the PICU were more likely to have renal involvement by either malignancy requiring nephrectomy or a post transplant complication increasing the likelihood of decreased renal function (21.1% vs. 4.8%, P=0.03). PICU admissions were also more likely to receive pre-transplant total body irradiation (52.6% vs. 27.6%, P=0.03). Among 29 patients with PICU admission, 3 died on day 1 after admission, and 5 within 30 days (a mortality rate of 17%). Thirty days after PICU admission, non-survivors had a higher incidence of respiratory failure and septic shock on admission compared with survivors (80% vs. 16.7%, P=0.01 and 80% vs. 4.2%, respectively, P=0.001). Two survivors with chronic renal failure underwent renal transplantation successfully.Conclusions
Total body irradiation and renal involvement are associated with higher risk for PICU admissions after HSCT in pediatric patients, while septic shock upon admission and post-admission respiratory failure are associated with mortality. 相似文献4.
Objectives
To correlate lactate clearance with Pediatric Intensive Care Unit (PICU) mortality.Methods
45 (mean age 40.15 mo, 60% males) consecutive admissions in the PICU were enrolled between May 2012 to June 2013. Lactate clearance (Lactate level at admission — level 6 hr later × 100 / lactate level at admission) in first 6 hours of hospitalization was correlated to in-hospital mortality and PRISM score.Results
Twelve out of 45 patients died. 90% died among those with delayed/poor clearance (clearance <30%) compared to 8.5% in those with good clearance (clearance >30%) (P<0.001). Lactate clearance <30% predicted mortality with sensitivity of 75%, specificity of 97%, positive predictive value of 90%, and negative predictive value of 91.42%. Predictability was comparable to PRISM score >30.Conclusion
Lactate clearance at six hours correlates with mortality in the PICU. 相似文献5.
Introduction
This study sought to evaluate the outcomes of in-hospital delay and determine associated co-morbidities in the treatment of pediatric acute appendicitis.Methods
This was a retrospective analysis of the national inpatient sample from 2000 to 2008. Immediate treatment was defined as treatment in hospital day 0 or 1. Delay in treatment was defined as treatment in hospital day 2 and beyond.Results
During the study period, 683,016 pediatric appendicitis were identified. 17,737 (2.6?%) experienced a delay in treatment. Multivariate analysis identified associated co-morbidities for delay in treatment: ALL (OR 12.84, CI 11.04–14.94), AML (OR 9.41, CI 7.58–11.68), neutropenia (OR 5.53, CI 4.60–6.65), and ovarian cyst without torsion (OR 3.17, CI 2.94–3.42). Surgical management included more than 13-fold increase in drainage procedures (5.5 vs. 0.4?%), sixfold increase in cecectomy (1.2 vs. 0.2?%), 14-fold increase in hemicolectomy (1.4 vs. 0.1?%), 11-fold increase in small bowel laceration suture repair (1.1 vs. 0.1?%), and 15-fold increase in small bowel resection (1.5 vs. 0.1?%).Conclusions
In-hospital delay beyond 2?days is associated with significant negative outcomes with regard to complications, economic burden, and subsequent surgical management. Using the co-morbidity index, high-risk co-morbidities with associated delay in treatment were identified. 相似文献6.
Hasan Ağın Ilker Devrim Rana İşgüder Utku Karaarslan Esra Kanık İlker Günay Miray Kışla Sultan Aydın Gamze Gülfidan 《Indian journal of pediatrics》2014,81(11):1158-1162
Object?ve
To determine the risk factors for developing candida infections in pediatric intensive care unit (PICU).Methods
The present study was conducted as a case–control study and included the population of patients who were admitted to PICU during the period of March 2010–March 2011.Results
During the study period, a total of 57 patients in PICU had candidemia, 4 cases were excluded due to their PICU stay less than 48 h and one due to the insufficient data. The most commonly isolated Candida species was C. albicans, followed by C. parapsilosis. The median duration of hospitalization in PICU was higher (22.0 d) in candidemia patients compared to control group (13.5 d) (p?=?0.037). The patients with candidemia had higher rates of presence of mechanical ventilation, presence of central venous catheter, and being under total parenteral nutrition; compared to the control group.Conclus?ons
The longer PICU durations, mechanical ventilation, central venous catheter, total parenteral nutrition were the associated factors. Although trials for predicitive models or scoring systems for development of candidemia have been performed; more future studies were required for practical usage in clinics settings in order to prevent candidemia. 相似文献7.
Kinikar AA Kulkarni RK Valvi CT Mave V Gupte N Khadse S Bhardwaj R Kagal A Puranik S Gupta A Bollinger R Jamkar A 《Indian journal of pediatrics》2012,79(4):459-466
Objective
To analyse the factors associated with increased mortality among Indian Children with H1N1.Methods
Data were abstracted from available hospital records of children less than 12?y of age, who were admitted to Sassoon General Hospital in Pune, India, with confirmed pandemic 2009 H1N1 influenza infection from August 2009 through January 2010. Logistic regression analysis was used to identify clinical characteristics associated with mortality.Results
Of 775 pediatric cases admitted with Influenza Like Illness (ILI), 92 (11.8%) had confirmed H1N1 influenza infection. The median age of HIN1 cases was 2.5?y; 13 (14%) had an associated co-morbid condition. Median duration of symptoms was 4?d (interquartile range (IQR), 3?C7?d). All 92 H1N1 cases received oseltamivir and empiric antimicrobials on admission. Intensive care unit (ICU) admission was required for 88 (96%) children, and 20 (23%) required mechanical ventilation.Fifteen children (16%) died; mortality was associated with presence of diffuse alveolar infiltrate on admission chest radiography (odds ratio (OR) 45, 95%CI :5.4?C370; p?0.001), use of corticosteroids in ARDS in children who required mechanical ventilation (OR 8.12, 95%CI: 2.44?C27.05; p?=?0.001), SpO2 <80% on admission (OR 32.8, 95% CI: 5.8?C185.5; p?0.001) and presence of ARDS (OR 345.3, 95% CI :33.5?C3564.1; p?0.001). Necropsy from all children who died showed 9 (60%) had ARDS pattern and necrotizing pneumonitis, diffuse hemorrhage and interstitial pneumonia (n?=?4 each, 27%) with gram positive organisms consistent with severe viral and bacterial co-infection.Conclusions
Hypoxia, ARDS and use of corticosteroids in children with ARDS who were mechanically ventilated were the factors associated with increased odds of mortality. Necropsy also suggested bacterial co-infection as a risk factor. 相似文献8.
Morbidity and mortality of coagulase-negative staphylococcal sepsis in very-low-birth-weight infants
Joseph B. Cantey Kelsey R. Anderson Ram R. Kalagiri Lea H. Mallett 《World journal of pediatrics : WJP》2018,14(3):269-273
Background
Coagulase-negative staphylococci (CoNS) are the most common cause of late-onset sepsis in the neonatal intensive care unit (NICU) and usually require vancomycin treatment. Our objective was to determine whether CoNS are associated with neonatal morbidity and mortality.Methods
This was a retrospective cohort study of very-low-birth-weight (VLBW, ≤ 1500 g) infants from 1989 to 2015. Exclusion criteria were major congenital anomaly or death within 72 h. CoNS was considered a pathogen if recovered from ≥ 2 cultures, or 1 culture if treated for ≥ 5 days and signs of sepsis were present. Logistic regression was used to examine factors associated with morbidity and mortality.Results
Of 2242 VLBW infants, 285 (12.7%) had late-onset sepsis. CoNS (125, 44%), Staphylococcus aureus (52, 18%), and Escherichia coli (36, 13%) were the most commonly recovered organisms. In multivariate analysis, CoNS sepsis was not associated with mortality [OR 0.6 (95% CI 0.2–2.6)), but sepsis with other organisms was [OR 4.5 (95% CI 2.6–8.0)]. CoNS sepsis was associated with longer hospitalization but not risk for bronchopulmonary dysplasia, intraventricular hemorrhage, or retinopathy of prematurity.Conclusion
CoNS sepsis was not associated with mortality or morbidities other than length of stay. These findings support vancomycin-reduction strategies in the NICU.9.
Objectives
To determine predictors of mortality and morbidity in extremely low birth weight neonates (ELBW) from a developing countryStudy design
Prospective observational study.Setting
Level III neonatal unit in Northern India.Subjects
Neonates <1000g born and admitted to intensive care during study period were enrolled. They were analyzed based on survival and development of major morbidity. Multivariable logistic regression model was used to determine independent risk factors.Outcome
Mortality and major morbidity (one or more of the following: Bronchopulmonary dysplasia (BPD), Retinopathy of Prematurity (ROP) requiring laser, grade III or IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC) stage III) during hospital stay.Results
Of 255 ELBW neonates born, 149 received optimal care, of which 78 (52%) survived and 57 (39%) developed morbidities. Mean birth weight and gestational age were 29.1±2.6 weeks and 843±108g. Major causes of mortality were sepsis (46%), birth asphyxia (20%) and pulmonary hemorrhage (19%). Birth weight ≤800g [OR (95% CI)-3.51 (1.39–8.89), P=0.008], mechanical ventilation [4.10 (1.64–10.28), P=0.003] and hypotensive shock [10.75 (4.00–28.89), P<0.001] predicted mortality while birth weight ≤800g [3.75 (1.47–9.50), P=0.006], lack of antenatal steroids [2.62 (1.00–6.69), P=0.048), asphyxia [4.11 (1.45–11.69), P=0.008], ventilation [4.38 (1.29–14.79), P=0.017] and duration of oxygen therapy [0.004 (1.001–1.006), P=0.002] were the predictors of major morbidities.Conclusions
Low birth weight, mechanical ventilation and hypotensive shock predicted mortality in ELBW neonates while low birth weight, lack of antenatal steroids, birth asphyxia, ventilation and duration of oxygen therapy were predictors for major morbidity. 相似文献10.
Vineeta Gupta Akash Kumar Vijai Tilak Isha Saini Baldev Bhatia 《Indian journal of pediatrics》2012,79(12):1587-1591
Objective
To assess the response to antithymocyte globulin based immunosuppressive therapy (IST) in pediatric patients with idiopathic aplastic anemia.Methods
Thirty patients (19 boys and 11 girls) with aplastic anemia received antithymocyte globulin and cyclosporine. Twenty-two patients had severe and 8 had very severe aplastic anemia.Results
Mean age of the patients was 9.19?±?2.56?y. Three patients died within 1?mo of therapy, two due to sepsis and one due to intracranial hemorrhage. Twenty-seven patients were analyzed for response to therapy. Eight patients (29.7%) responded at 3?mo: 3 complete response (CR) and 5 partial response (PR). Six mo after the therapy, overall response (OR) was seen in 9/27 (33.3%), with one more patient in no response group achieving partial response. At 1?year, patients in CR maintained their status and 1 patient in PR group relapsed. He again achieved partial response with repeat course of ATG. Responders had significantly shorter duration of illness and higher absolute neutrophil count as compared to non responders to IST. None of the patients developed acute leukemia in the follow up.Conclusions
The treatment of aplastic anemia in pediatric patients is a challenging task. One third of the patients achieved overall response which included both complete and partial response. 相似文献11.
Objectives
To study the association of fluid overload with mortality and morbidity in critically-ill mechanically ventilated children.Design
Prospective observational study.Setting
Pediatric Intensive Care Unit (PICU) of a tertiary care hospital, New Delhi, India.Participants
118 children (age 1 mo - 15 y) requiring mechanical ventilation.Outcome measures
Primary: Association of fluid overload with mortality. Secondary: Association of fluid overload with oxygenation, organ dysfunction, duration of mechanical ventilation and PICU stay.Results
Cumulative fluid overload of ≥15% was observed in 74 (62.7%) children. About 50% of these children reached cumulative fluid overload of ≥15% within the first 5 days of PICU stay. The mortality was 40.5% in those with ≥15% cumulative fluid compared to 34% in the rest [OR (95% CI): 1.02 (0.97, 1.07)]. On multivariate analysis, after adjusting for confounders, cumulative fluid overload ≥15% was associated with higher maximum PELOD (pediatric logistic organ dysfunction) score (Median: 21 vs. 12; P = 0.03), longer median duration of mechanical ventilation (10 vs. 4 d; P <0.0001) and PICU stay (13.5 vs. 6 d; P <0.0001). There was no significant association of fluid overload with oxygenation index (P=0.32).Conclusion
There is no association of fluid overload with mortality. However, it is associated with poor organ function, longer duration of mechanical ventilation and PICU stay in critically-ill, mechanically ventilated children.12.
Shitanshu Srivastava K. L. Srivastava Shivam Shingla 《Indian journal of pediatrics》2013,80(6):488-491
Objectives
To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and its correlates in school going children of Lucknow.Methods
It is a cross-sectional school based study conducted in a random sample of 1212 school going children of Lucknow belonging to the middle socioeconomic strata. Data was collected via questionnaire designed for parents. Detailed urological history was obtained and physical examination done in the children whose parents answered the questionnaire. The chi-square test was used to compare the categorical/dichotomous indicators and backward logistic regression was used to find out the significant risk factors for monosymptomatic nocturnal enuresis.Results
Study reports the prevalence of PMNE to be 12.6 % (95 % CI?=?10.9–14.3 %) and significant association of enuresis with the presence of home conflicts(adjusted OR?=?38.37, 95 % CI?=?20.04–73.47), stress in children due to enuresis(adjusted OR?=?10.86, 95%CI?=?5.73–20.57), scolding(adjusted OR?=?6.78,95%CI?=?3.69–12.44), parental history of enuresis(adjusted OR?=?3.57, 95%CI?=?1.96–6.50), poor scholastic performance(adjusted OR?=?2.88,95 %?=?1.49–5.56), age 6–8 y (adjusted OR?=?13.80,95%CI?=?4.38–43.45) and living with single parent (adjusted OR?=?0.34, 95%CI?=?0.17–0.68). Prevalence of monosymptmatic nocturnal enuresis MNE was 17.9 % (p?=?0.001) among children who were not exclusively breastfed till 6 mo of age in the index study.Conclusions
Enuresis is a pediatric health problem with high prevalence . Parental awareness needs to be created about this condition. 相似文献13.
Yi Deng David C. Chang Yiyi Zhang Jennifer Webb Alodia Gabre-Kidan Fizan Abdullah 《Pediatric surgery international》2010,26(7):691-696
Purpose
The present study aimed to determine whether children with perforated appendicitis were more likely to present during specific days of the week or seasons of the year.Methods
After obtaining IRB exemption, a retrospective, population-based study of patients <18 with ICD9 codes of acute (540.9) or perforated (540.0, 540.1) appendicitis in the Kids’ Inpatient Database (KID) was performed. Univariate and multivariate analyses were performed analyzing patient and hospital factors.Results
A total of 31,457 children were identified with acute appendicitis, of whom 10,524 (33.5%) were perforated. Mondays [odds ratio (OR): 1.16; 95% Confidence Interval (CI): 1.05?1.28] were significant for increased likelihood as day of presentation with perforation in US children more than any other day of the week. In seasonal analysis, fall (OR: 1.12; 95% CI: 1.04?1.21) and winter (OR: 1.11; 95% CI: 1.03?1.20) were at higher odds for perforation at presentation. Patients with Medicaid (OR: 1.22; 95% CI: 1.03?1.43) and those uninsured (OR: 1.50; 95% CI: 1.16?1.93) were more likely to present with perforation.Conclusion
Perforated appendicitis was more likely to present on Mondays in US children. Although appendicitis is most common in summer months, rates of perforated appendicitis were highest in fall and winter. 相似文献14.
Jonathan S. Karpelowsky Alastair J. W. Millar Nelleke van der Graaf Guido van Bogerijen Heather J. Zar 《Pediatric surgery international》2012,28(10):1007-1014
Purpose
Increasingly HIV-infected children can be expected to require surgery. The aim of this study was to compare the outcome of HIV-infected and HIV-unexposed children undergoing surgery.Patients and methods
A prospective study of children less than or equal to 60?months admitted to a tertiary pediatric surgical service from July 2004 to July 2008. Children underwent age-definitive HIV testing and were followed up postoperatively for complications, length of stay and mortality.Results
Three hundred and twenty-seven children were enrolled: 82 (23?%) HIV-infected and 245 (67?%) were HIV-unexposed. Eighty-four (26?%) children were malnourished, which was higher in the HIV-infected group [41 (50.0?%) vs. 43 (17.5?%), relative risk (RR) 2.9; 95?% confidence interval (CI) 2.0–4.1; p?<?0.0001]. Three hundred and twenty-eight surgical procedures were performed. A similar number of major [28 (34.2?%) vs. 64 (26.1?%); p?=?0.2] and emergency procedures [37 (45.1?%) vs. 95 (38.8?%); p?=?0.34] were performed in each group. HIV-infected children had a higher rate of contamination at surgery [40 (48.7?%) vs. 49 (20?%); RR 2.43 (CI 1.7–3.4); p?<?0.0001]. There were more complications in the HIV-infected group [34 (41.5?%) vs. 14 (5.7?%); RR 7.3 (CI 4.1–12.8); p?<?0.0001]. The most common complications were surgical site complications 30 (55?%), followed by postoperative infections, 19 (34?%). Infections with drug-resistant organisms occurred more commonly in HIV-infected children [11/19 (58?%) vs. 2/13 (15?%); RR 3.8 (CI 1.3–14.2); p?=?0.02]. The median length of hospital stay was longer in the HIV-infected group [4 (IQR 2–14) vs. 2 (IQR 1–4) days; p?=?0.0001]. There was a higher mortality amongst the HIV-infected group [6 (7.3?%) vs. 0 (0?%); p?<?0.0001].Conclusion
HIV-infected children have a higher rate of postoperative complications and mortality compared with HIV-unexposed children. 相似文献15.
Mohd. Aamir Kundan Mittal Jaya Shankar Kaushik Haripal Kashyap Gurpreet Kaur 《Indian journal of pediatrics》2014,81(11):1167-1170
Objective
To determine the sociodemographic and clinical factors leading to stress among parents whose children are admitted in pediatric intensive care unit (PICU).Methods
A prospective observational study was conducted in PICU of a tertiary care hospital of north India. Parents of children admitted to PICU for at least 48 h duration were eligible for participation. At the end of 48 h, parental stress was assessed using parental stress scale (PSS:PICU) questionnaire which was administered to the parents. Baseline demographic and clinical parameters of children admitted to PICU were recorded. The parental stress was compared with demographic and clinical characteristics of children using appropriate statistical methods.Results
A total of 49 parents were finally eligible for participation. Mean (SD) parental stress scores was highest in domains of procedures [1.52 (0.66)] and behavior and emotional [1.32 (0.42)] subscales. Mean (SD) total parental stress score among intubated children [1.31 (0.25)] was significantly more than among non intubated children [0.97 (0.26)] (p?0.001). However, parental stress score were comparable in terms of gender (p?=?0.15) and socioeconomic status (p?=?0.32). On subscale analysis, it was found that professional communication is a significant stressor in age groups 0–12 mo [0.61(0.41)] (p?=?0.02). It was observed that parents of intubated children were significantly stressed by the physical appearance of their children (p?0.001), procedures performed on them (p?=?0.008) and impairment in parental role (p?=?0.002). Total parental stress score had a positive correlation with PRISM score (r?=?0.308).Conclusions
Indian parents are stressed maximally with environment of PICU. Factor leading to parental stress was intubation status of the child and was not affected by gender or socio demographic profile of the parents. 相似文献16.
Rosemary Nabaweesi Laura Morlock Charles Lule Susan Ziegfeld Andrea Gielen Paul M. Colombani Stephen M. Bowman 《Pediatric surgery international》2014,30(11):1097-1102
Purpose
To examine the association of prehospital criteria with the appropriate level of trauma team activation (TTA) and emergency department (ED) disposition among injured children at a level I pediatric trauma center.Methods
Injured children younger than 15 years and transported by emergency medical services (EMS) from the scene of injury between January 1, 2008 and December 31, 2011 were identified using the institution’s trauma registry. Logistic regression was used to study the main outcomes of interest, full TTA (FTTA) and ED disposition.Results
Out of 3,213 children, 1,991 were eligible and analyzed. Only 279 children initiated the FTTA and 73.9 % were admitted. Having a chest injury, abnormal heart rate or Glasgow Coma Scale less than 9 (GCSLT9) in the field was associated with higher odds of initiating the FTTA (odds ratio [OR] = 3.33, 95 % confidence interval [CI] 1.54–7.20; OR = 2.59, CI 1.15–5.79 and OR = 2.67, CI 1.14–6.22, respectively). Children with the criteria above in addition to abdominal injury were more likely to be discharged to the ICU, OR or morgue compared to those without them.Conclusion
Children with GCSLT9, abnormal heart rate, chest and abdominal injury showed a strong association with FTTA and higher resource utilization. 相似文献17.
Venkata Raghava Mohan Srujan Sharma Karthikeyan Ramanujam Sudhir Babji Beena Koshy Joseph Dian Bondu Sushil Mathew John Gagandeep Kang 《Indian pediatrics》2014,51(8):621-625
Objectives
To study the burden and associated risk factors for elevated blood lead levels among pre-school children (15–24 months) in urban Vellore, and to study its effects on child cognition and anemia.Design
An investigative study through Mal-ED cohort.Setting
Eight adjacent urban slums in Vellore, Tamil Nadu.Participants
251 babies recruited through Mal-ED Network.Outcome measures
Blood lead levels using Graphite Furnace Atomic Absorption Spectrophotometry method at 15 and 24 mo; hemoglobin estimation by azidemethemoglobin method; cognitive levels using Bayley Scales of Infant Development III.Results
Around 45% of children at 15 months and 46.4% at 24 months had elevated blood lead levels (>10 μg/dL). Among children who had elevated blood lead levels at 15 months, 69.2% (45/65) continued to have elevated levels at 24 months. After adjusting for potential confounders, children from houses having a piped drinking water supply and houses with mud or clay floors were at significantly higher risk of having elevated blood lead levels at 15 months. Thirty one percent (21/67) of the children with elevated blood lead levels had poor cognitive scores. Children with elevated blood lead levels at 15 months had higher risk (Adjusted OR 1.80; 95% CI 0.80–3.99) of having poorer cognitive scores at 24 months. More than half of the children (57%) were anemic at 15 months of age, and elevated blood lead levels were not significantly associated with anemia.Conclusions
Elevated blood lead levels are common among preschool children living in urban slums of Vellore. Poorer conditions of the living environment are associated with elevated lead levels. 相似文献18.
Purpose
This study examined the national trends in incidence and surgical management of pediatric Clostridium difficle colitis (CDC) hospitalizations.Methods
This was a cross-sectional Nationwide Inpatient Sample (NIS) analysis of pediatric CDC from 2000 to 2008. Data analysis included patient demographics, procedures, length of stay (LOS), total hospital charges (THC), and in-hospital mortality.Results
During the 9-year study period, the total number of CDC hospitalizations per year increased almost twofold, from 2,513 in 2000 to 4,817 in 2008. The rate per 100,000 discharges followed a similar trend, increasing from 38.08 in 2000 to 72.57 in 2008. Abdominal colectomy was performed in 0.35?%, with partial colectomy performed more often than total colectomy. Mortality, mean LOS, and mean THC were not statistically different between partial versus total colectomy. Children with ulcerative colitis were more likely to undergo total colectomy, (OR 35.700, CI 11.025–115.98, P?0.001). Infants under the age of 1?year were less likely to undergo total colectomy (OR 0.568, 0.477–0.677, P?0.001).Conclusion
Pediatric hospitalizations for CDC are on the rise. Partial colectomy is performed more often than total colectomy without statistical compromise of mortality, length of stay, and total hospital charges. Further studies are needed to determine the standard surgical management of pediatric CDC. 相似文献19.
Virus detection in critically ill children with acute respiratory disease: a new profile in view of new technology
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Atsushi Kawaguchi Angela Bates Bonita E. Lee Steven Drews Daniel Garros 《Acta paediatrica (Oslo, Norway : 1992)》2018,107(3):504-510
Aim
To describe the epidemiology of critically ill children admitted to a paediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analysed for the three most prevalent viruses and in those with and without viral co‐infection.Methods
Patients admitted to the PICU (2004–2014) with acute respiratory disease were included. Analyses were performed utilising each respiratory viral infection or multiple viral infections as an exposure.Results
There were 1766 admissions with acute respiratory disease of which 1372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95% CI: 1.06–4.56). Sixty‐three admissions had two or more viruses detected, and the combination of RSV and Rhinovirus/enterovirus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections.Conclusion
Higher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.20.
Elaine M Boyle Isobel Brookes Kathy Nye Mike Watkinson FAndrew I Riordan 《BMC pediatrics》2006,6(1):1-7