Severe and fatal forms of COVID-19 in children

ObjectivesThe aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging findings, as well as the disease management and outcomes.MethodsThis was a retrospective, single-center, observational study conducted in a pediatric intensive and high-dependency care unit (PICU, HDU) in an urban hospital in Paris. All patients, aged from 1 month to 18 years, admitted for confirmed or highly suspected SARS-CoV-2 were included.ResultsWe analyzed the data of 27 children. Comorbidities (n = 19, 70%) were mainly neurological (n = 7), respiratory, (n = 4), or sickle cell disease (n = 4). SARS-CoV-2 PCR results were positive in 24 children (nasopharyngeal swabs). The three remaining children had a chest CT scan consistent with COVID-19. Respiratory involvement was observed in 24 patients (89%). Supportive treatments were invasive mechanical ventilation (n = 9), catecholamine (n = 4), erythropheresis (n = 4), renal replacement therapy (n = 1), and extracorporeal membrane oxygenation (n = 1). Five children died, of whom three were without past medical history.ConclusionThis study highlighted the large spectrum of clinical presentation and time course of disease progression as well as the non-negligible occurrence of pediatric life-threatening and fatal cases of COVID-19 mostly in patients with comorbidities. Additional laboratory investigations are needed to further analyze the mechanism underlying the variability of SARS-Cov-2 pathogenicity in children.     

Mortality of children aged 5–15 years in a tertiary care center in Yaoundé, Cameroon

IntroductionAlthough sub-Saharan Africa accounts for only 21% of the global population of children and adolescents aged 5–15 years, 55% of deaths among children in this age group occur in this region. This seems to be related to infectious diseases. We hypothesized that besides infectious diseases, in our context, a chronic underlying condition increases mortality. Our goal was to describe the leading causes of mortality among this age group.Patients and methodsWe conducted a retrospective study in a tertiary care center in Yaoundé. We included the medical files of children who died between January 2013 and December 2017.ResultsThe in-hospital mortality rate was 10.3 per 1000. Coma and/or convulsion was the main cause of death (70.6%), followed by severe anemia (64.7%) and respiratory distress (56.8%). We identified a chronic illness in 62.2% of cases: HIV infection (39.2%) and sickle cell disease (24.5%) were the most prevalent. The main diagnoses were severe malaria, severe sepsis, and meningitis (Cryptococcus sp. included) in 25 (n = 35), 16.4 (n = 27), and 10.3% (n = 17) of cases, respectively.ConclusionHIV infection and sickle cell disease are the most prevalent chronic diseases related to the patients’ death in the age group studied. Specific interventions focusing on this age group are recommended including intensification of impregnated bednet usage as well as HIV and sickle cell disease management.     

The appendix as ureteral substitute: a report of 10 cases

BackgroundUreteric replacement in part or in total is rarely needed in children. We present our experience in using the appendix to replace the ureter.MethodsA retrospective case note review was carried out at Sheffield Children's Hospital (UK), Ekta Institute of Child Health (Raipur, Chhattisgarh, India) and Christian Medical College Hospital (Vellore, India) of all cases of ureteric substitution using the appendix.ResultsTen patients were identified, operated in 2002–2007: seven males and three females with a median age of 2.5 years (range 2.5 months to 12 years). The reasons for ureteric replacement were traumatic ureteric avulsion (n = 1), congenital ureteric stenosis (n = 5), non-drainage following previous pyeloplasty for pelvi-ureteric junction obstruction (n = 3) and ureteric stricture following reimplantation for vesico-ureteric reflux (n = 1). The appendix was used in an anti-peristaltic manner in all cases, and in one case a transureteroureterostomy was performed. At a median follow up of 16 months (1–72 months), all the patients were well except one whose kidney function had deteriorated.ConclusionsTotal or partial replacement of the ureter using the appendix, even in the first year of life, preserved renal function in nine cases. Ureteric continuity can be successfully restored in children using the appendix.     

Risk factors for progression to end-stage renal disease in children with posterior urethral valves

ObjectiveTo identify the variables which affect long-term renal outcome in children with posterior urethral valves (PUV).Materials and methodsRetrospective analysis of 260 children with PUV who underwent ablation of valves in 1992–2008 at our tertiary care center. The following risk factors for progression to end-stage renal disease (ESRD) were analyzed: nadir serum creatinine greater than 1.0 mg/dl, bilateral grade 3 or higher VUR at diagnosis, recurrent febrile UTIs, and severe bladder dysfunction. Patients were divided into two groups: those who developed ESRD (group 1) and those who did not (group 2).ResultsForty (17.62%) patients had nadir serum creatinine >1 mg/dl. At time of initial presentation, high-grade VUR was seen in 63.1% and 33.5% of groups 1 and 2, respectively (P = 0.002). Overall, 77 (34%) of the boys developed breakthrough urinary tract infections: 37.03% and 33.5% in groups 1 and 2, respectively (P = 1). Fifty-nine (26%) patients were found to have severe bladder dysfunction: 77.8% and 19% in groups 1 and 2, respectively (P < 0.0001). Twenty-seven (11.89%) patients progressed to ESRD, at mean age of 11.21 years (5–16). On univariate analysis, the risk-predicting variables were: nadir serum creatinine value greater than 1 mg/dl (P < 0.0001), bilateral high-grade VUR (P = 0.002) and severe bladder dysfunction (P < 0.0001). On multivariate logistic regression analysis, nadir serum creatinine greater than 1 mg/dl (OR 23.79; CI 8.20–69.05) and severe bladder dysfunction (OR 5.67; CI 1.90–16.93) were found to be independent risk factors predictive of ultimate progression to ESRD.ConclusionsNadir serum creatinine and bladder dysfunction are the main factors affecting long-term renal outcome in cases of PUV. Early identification and treatment of bladder dysfunction may thus be beneficial.     

Physical activity assessment in children and adolescents with juvenile idiopathic arthritis compared with controls

ObjectiveWe aimed to assess physical activity (PA) in children with juvenile idiopathic arthritis (JIA) compared with healthy peers and to determine factors influencing PA level.MethodsThis was a cross-sectional study of the measured level of PA in children with JIA, compared with age- and gender-matched healthy schoolchildren. PA was estimated using a physical activity questionnaire for children and for adolescents (cPAQ/aPAQ). Disease activity was evaluated with the Juvenile Arthritis Disease Activity Score (JADAS). Functional ability was assessed with the Childhood Health Assessment Questionnaire (CHAQ).ResultsA total of 55 children with JIA and 55 healthy control schoolchildren were included. Children with JIA had significantly lower levels of PA compared with their healthy peers as assessed with the cPAQ/aPAQ (P = 0.0121). In total, 76% of the JIA group spent the day sleeping and sitting, which was significantly higher compared with the reference group (P = 0.001 and P = 0.055, respectively). Low PA level was associated with systemic JIA (P = 0.002, OR = 2.123), polyarticular JIA with positive rheumatoid factor (P = 0.001, OR = 2.014), JADAS-27 ≥ 6 (P = 0.001, OR = 2.524), patients undergoing treatment (P = 0.001, OR = 1.271), and higher CHAQ (P = 0.002, OR = 2.461).ConclusionChildren with JIA were less physically active than their healthy peers and less active than recommended for general health.     

Voiding school for children with idiopathic urinary incontinence and/or bladder dysfunction

ObjectiveIndividually applied urotherapy is first-line treatment in children with bladder dysfunction. A new concept of treatment for small groups of children was applied and evaluated.Patients and MethodsTwo hundred children, 116 of them girls, aged 3–14 years (median 7.2) with bladder dysfunction and incontinence received urotherapy in small groups (2–5), called voiding school (VS). Outcome was evaluated after 3 and 12 months by voiding/leakage diary and questionnaire, and at 3 months by uroflow and post-void residual urine as well.ResultsThe outcome of VS was independent of age and gender. At follow up at 3 and 12 months, respectively, 35% and 40% of the children were cured and another 30% and 34% improved (P ≤ 0.0001). Compared with the year before start of VS, urinary tract infections decreased from 34% to 6% (P < 0.0001). Median residual urine decreased from 15 ml before VS to 6 ml after 3 months (P < 0.001).ConclusionThe concept of VS is a good alternative to individual urotherapy, with the outcome of fewer urinary tract infections and improved continence. Urotherapy for groups of children compared to individual treatment is also expected to have financial benefits.     

Smoothing the transition of adolescents with CF from pediatric to adult care: Pre-transfer needs

IntroductionIn France, the cystic fibrosis (CF) care pathway is performed in 45 CF centers, the life expectancy of patients has steadily increased, but to date there are no national recommendations for the transition from pediatric to adult care. The transition to an adult CF center still raises questions about the relevance of its organizational arrangements. The “SAFETIM need” study aimed to identify the organizational needs both of patients and of parents before the transfer to an adult CF center.MethodsThis was a prospective, observational, multicenter study conducted between July 2017 and December 2018, involving the three CF centers of a regional network in southeastern France. Each adolescent registered with the center and his or her parents were interviewed individually, on the same day, during the 6 months leading up to transfer. They participated in semi-structured interviews during one of their routine consultations at the CF center. The interview manual, based on literature reviews and targeting national recommendations, was tested and validated by the national CF therapeutic education group (GETheM). All interviews were transcribed and checked by two different people, and analyzed by two researchers individually. The results were classified by topic according to content categorization.ResultsOverall, 43 adolescents and 41 parents were interviewed, respectively, who were followed up by CF centers: 14% (n = 6) in a mixed CF center (pediatric and adult); 19% (n = 8) and 67% (n = 29), respectively, in two different pediatric CF centers. Adolescents were between 16 and 19 years old. For adolescents, the average interview time was 5.11 min. (standard deviation [SD]: 3.8 min; minimum: 2.53 min; maximum: 17.14 min). For parents, the average interview time was 7.99 min (SD: 3.56 min, minimum: 3.43 min; maximum: 22.50 min).DiscussionOur study enquired only about the preparation and organization of the transfer. We identified three areas of actions matching the needs of adolescents and parents before transfer. The first one is to anticipate team change to prepare follow-up in their future CF center: acquire new skills, consider the future CF center according to the adolescent's curriculum, be involved in the transition process. The second area is to accompany the upcoming change. The care team could help by providing information and support during the start of teenagers’ transition toward autonomy. And parents were aware that the CF center change will reverse roles. They must provide their own knowledge and manage the ambivalence of this as well as letting go. The third one is to announce the transition process and functioning of the future adult CF center, because the transition would require time to find their place (patients and parents) with the new team.ConclusionThe “SAFETIM needs” pre-transfer study results show that we can identify the main criteria to be developed and strengthened, to promote a smooth, high-quality transition from pediatric to adult CF care for patients in France. For most patients, the transition cannot be prepared at the last minute. Caregivers need to develop specific skills in adolescent and young adult care and follow-up. Each team must consider the transition as a normal part of the patient care cycle. While it must be structured, some flexibility must be allowed so as to give everyone the chance to be prepared and to personalize the care.     

Évaluation clinique des pratiques intégratives dans les troubles du spectre autistique (EPIGRAM) : méthodologie,population à l’inclusion et satisfaction des familles à 12 mois

BackgroundIntegrative care practices (ICPs) in the management of autism spectrum disorders (ASDs) do not currently receive sufficient rigorous evaluation. Moreover, they lack formalisation despite their important place in clinical practice, particularly in France, where they are implemented in day care hospital structures. We present here the methodology of the EPIGRAM study financed by the French General Directorate of Healthcare Organisations (PREPS 2013), the profile of the inclusive population (M0), and the experience of families after 12 months of care.MethodIn order to homogenise practices, a manual has been formalised following the methodology of the clinical pathway and the recommendations of the High Authority of health. We then conducted an open, multi-centre, observational study in a natural environment in routine care evaluating ICPs in ASDs for children aged 3 to 6 years. The main inclusion criteria were the diagnosis (typical or atypical autism, according to the ICD10) and the duration of care (2 to 4 half-days per week) during the first year of care. The children were clinically assessed using several instruments including the PEP-3 (Psychoeducational Profile-3) and the CARS (Children Autism Rating Scale). In order to maintain a blind assessment for the main variable, randomly assigned videos of the PEP-3 were rated by two independent psychologists. A questionnaire, completed separately by the families and the professionals at inclusion and at one year, complemented the study.ResultsWe included 89 children demonstrated to have severe autism through the CARS (mean = 44; SD = 6.51) and moderate autism through he PEP-3 maladaptive behaviour category (CAT MB) (mean = 30; SD = 29.89). The children were all diagnosed before the age of 3 years 6 months. Most of the children had severe language impairments. With PEP-3, the impairment is more pronounced in gross motor skills and characteristic verbal behaviours. Thirty percent of the families had a low socioeconomic status and 56 % were first generation immigrants. Seventy-seven percent of the children were enrolled in kindergarten with school life support. Children of immigrant parents have more severe autism (CARS : mean = 45.8 (± 6.51) vs. 41.2 (± 5.58), t-test, P = 0.001) in addition to a more marked cognitive deficit (CVP : median = 24.5 [min–max: 9.75–45.5] vs. 52 [min–max: 26–76], Wilcoxon, P = 0.001). At entry, the collection of the signs at the structured clinical observation met the signs noted by the families as being the object of their concern. With standardised tools, these observations constituted an efficient functional and multidimensional analysis for the integrative care project. At 12 months, the families’ level of satisfaction was high and consistent with that of the practitioners.ConclusionOur results show that the day units take care of a population of children with predominantly severe and complex ASDs, for the most part, from families with low socioeconomic status and first-generation immigration. The relevance of the multidimensional observation and the care project of the ISPs were confirmed by the families at entry and after 12 months of care.     

Exposition des enfants à la violence conjugale : troubles mentaux et facteurs de résilience. Étude transversale tunisienne

Conjugal violence is a social problem whose impact extends beyond the couple, to the children who are exposed.ObjectiveTo study the psychological impact of exposure to conjugal violence in children and adolescents in child psychiatry consultation and the factors associated with their capacity for resilience.Patients and methodsWe conducted a cross-sectional study on a sample of 30 children and adolescents, aged between 6 and 18 years and exposed to conjugal violence. Patients were recruited from the child psychiatry unit of the Hospital University of HediChaker of Sfax. We conducted clinical interviews to identify the psychological impact of conjugal violence on children. The resilience evaluation was done by self or hetero passation of the Child and Youth Resilience Measure (CYRM).ResultsChildren and adolescents exposed to conjugal violence suffered from trauma-related disorders and stressors in 40% of cases, mood disorders in 33.3% of cases and externalized disorders in 6.6% of cases. We found that children were more resilient than adolescents in the area of emotional care provided by their parents (12.66 ± 2.02 vs. 9.46 ± 2.69 among adolescents; P = 0.001). In contrast, adolescents were significantly more resilient than children in the area of contextual factors including spirituality (6.46 ± 1.4 vs. 4.53 ± 1.06; P = 0.000), education (11.13 ± 2.13 vs. 8.4 ± 1.54; P = 0.000) and culture (11.13 ± 2.13 vs. 8.4 ± 1.54; P = 0.000). The child's education and good mental health for the mother were associated with better resilience in the children. The child's exposure to conjugal violence by being both a witness and a victim was associated with a reduced capacity for resilience.ConclusionExposure to conjugal violence has a significant impact on the mental health of children exposed. The study of resilience and associated factors could thus be useful in order to limit the deleterious repercussions on children and provide them with harmonious development both on the somatic and psychological levels.     

Determinants of neonatal death with emphasis on health care during pregnancy,childbirth and reproductive history

ObjectiveTo identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history.MethodsThis was a case-control study conducted in Maceió, Northeastern Brazil. The sample consisted of 136 cases and 272 controls selected from official Brazilian databases. The cases consisted of all infants who died before 28 days of life, selected from the Mortality Information System, and the controls were survivors during this period, selected from the Information System on Live Births, by random drawing among children born on the same date of the case. Household interviews were conducted with mothers.ResultsThe logistic regression analysis identified the following as determining factors for death in the neonatal period: mothers with a history of previous children who died in the first year of life (OR = 3.08), hospitalization during pregnancy (OR = 2.48), inadequate prenatal care (OR = 2.49), lack of ultrasound examination during prenatal care (OR = 3.89), transfer of the newborn to another unit after birth (OR = 5.06), admittance of the newborn at the ICU (OR = 5.00), and low birth weight (OR = 2.57). Among the socioeconomic conditions, there was a greater chance for neonatal mortality in homes with fewer residents (OR = 1.73) and with no children younger than five years (OR = 10.10).ConclusionSeveral factors that were associated with neonatal mortality in this study may be due to inadequate care during the prenatal period and childbirth, and inadequate newborn care, all of which can be modified.     

Laparoscopic management and outcomes in non-functioning moieties of duplex kidneys in children

AimsRetroperitoneal laparoscopic hemi-nephrectomy (RLHN) is a well tolerated, minimally invasive, although technically demanding, procedure for children with a non-functioning moiety in a duplex kidney. There is very little published data on the long-term follow up of such patients. We collected data to assess outcomes from our experience.MethodsData were retrospectively gathered on all patients who underwent RLHN at our institution between February 2003 and July 2008. Follow-up ultrasounds were obtained in all patients.ResultsRLHN was performed in 42 patients. All had a non-functioning moiety of a duplex kidney and in addition recurrent urinary tract infections (n = 36), incontinence (n = 5) or vesico-ureteric reflux (n = 1). Median age at surgery was 3 years, 7 months (4 months–13 years, 10 months). One patient required conversion to open procedure due to low (pelvic) kidney. The median operating time was 90 min (45–150 min). Urine leak developed postoperatively in one patient and loss of function of the remaining moiety occurred in another patient. They were followed up for a median period of 11 months (1–51 months).ConclusionRLHN is a feasible and safe technique for the experienced paediatric laparoscopic urologist. Results compare very favourably with open heminephrectomy in terms of operating time and outcomes. Long-term follow up is mandatory.     

Safety and one-year efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy

BackgroundProspective studies that address both efficacy and safety of continuous infusion of intrathecal baclofen (CITB) in children with spastic cerebral palsy (CP), and that use outcome measures beyond muscle tone are lacking.AimsTo study the efficacy at 12 months and safety up to 24 months after start of CITB in children with intractable spastic CP.MethodsNine girls and eight boys, aged 13.7 years (SD 2.9), received a SynchroMed pump for CITB. We prospectively recorded effects and adverse events at regular follow-up visits up to 24 months. Outcome measures included the 0–10 visual analogue scale (VAS) for individual problems, Gross Motor Function Measure (GMFM) and health related quality of life as measured with the Child Health Questionnaire-PF50.ResultsCITB for 12 months significantly improved the VAS for individual problems with 4.7 (SD 2.0; p = 0.000), VAS for ease of care with 5.2 (SD 2.1; p = 0.000), VAS for pain with 5.4 (SD 2.7; p = 0.002); GMFM sitting dimension with 3.3 (range ?4.0 to 22.0; p = 0.022), GMFM goal dimension with 4.0 (range 0.0–26.0; p = 0.007); and Child Health Questionnaire-PF50 domains of bodily pain/discomfort with 25.6 (SD 35.9; p = 0.016) and mental health with 9.8 (SD 11.3; p = 0.007). During a mean follow-up of 18.4 months (range 12–24), we recorded 80 adverse events. Eight adverse events were serious, but not life-threatening.ConclusionsCITB was effective at 12 months and safe up to 24 months for carefully selected children with intractable spastic CP. CITB relieved pain, facilitated ease of care and improved mental health. The majority of children could extend their activities and participation.     

Epidemiology of invasive early-onset neonatal infection in a French administrative district: A 10-year population-based study

BackgroundIn light of the pending update of the French guidelines for the management of neonatal infections, knowing the current epidemiology of early-onset neonatal infection (EONI) is essential.ObjectivesThe aim of this study was to assess the current epidemiology of a French administrative district population of proven EONI, including umbilical cord blood procalcitonin levels.MethodsWe conducted a retrospective population-based study in the Nantes metropolitan area. We included all infants treated for proven EONI in the maternity, neonatology, and intensive care wards between 1 January 2006 and 31 December 2015 in the Nantes University Hospital.ResultsAmong the 140,502 children born during the study period, 61 cases of EONI were documented. The overall incidence of confirmed EONI was 0.43/1000 live births, with 0.23/1000 GBS (group B streptococcus) infections and 0.08/1000 Escherichia coli infections. The majority of infected newborns were full-term or late-preterm infants (67% were ≥ 34 weeks of gestation), 88% had symptoms of EONI in the first 24 h of life, most of which were respiratory. The mortality rate was 8% (in premature infants). Available in 51% of the population, the cord blood PCT value could contribute to an earlier diagnostic screening in 10% of cases but with a very low sensitivity.ConclusionsThe incidence of confirmed EONI is low in this French district. The diagnostic value of PCT umbilical blood cord should be assessed based on further studies before confirming its value. We suggest that a national registry of these rare but serious cases of EONI could contribute to monitoring the epidemiological progression as well as to optimizing our diagnostic and therapeutic strategies.     

Emergency department visits for pediatric traumatic injuries during general confinement: A single-center study in an urban setting

BackgroundThe first case of SARS-CoV-2 was detected in France in January 2020 and the government decided on national confinement from March 17 to May 11, 2020. Our aim was to analyze the incidence of pediatric emergency department (ED) visits and hospitalizations for traumatic injuries during this period.MethodsAny visit with an ICD-10 discharge diagnosis code of burn, fracture, traumatic wound, or sprain/bruise contusion was recorded within the 2 weeks before (weeks 10 and 11) and during the confinement (weeks 12 and 19). The visits with the same ICD-10 discharge diagnosis code during similar weeks of the previous 2 years were also included. For each of those visits, the number of hospitalizations was counted.ResultsThe number of recorded visits between week 10 and 19 in 2018, 2019, and 2020 was, respectively, 2657, 2625, and 1106 children. The average number of visits per day during the confinement (13 ± 5) was significantly different from the average number of visits per day during the same weeks in 2018 and 2019 (38 ± 8 vs. 39 ± 9, P < 0.0001). The average number of visits per day was significantly lower during confinement compared with 2018/2019 for three categories of diagnoses (P < 0.0001) but not for burns (1.7 vs. 1.8, P = 0.23). The average number of hospitalizations per day was significantly lower during the confinement than during 2018/2019 (1.6 ± 1.3 vs. 2.6 ± 1.8, P < 0.0001).ConclusionConfining children in an urban setting appears to decrease the incidence of injuries, except for burns. These data may be useful in reorganizing caregiver supervision and hospital units. These results will need to be consolidated in a multicenter study.     

Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight

Objectiveto establish the influence of late-onset sepsis on neurodevelopment of preterm infants with very low birth weight (VLBW), according to the etiologic agent.Methodthis was a cohort of newborns with birth weight < 1,500 g and gestational age less than 32 weeks, admitted to the institutional intensive care unit (ICU) with up to 48 hours of life, and followed-up at the outpatient follow-up clinic for preterm infants with VLBW until 2 years of corrected age. Exclusion criteria: death within the first 72 hours of life, congenital malformations and genetic syndromes, children with congenital infection by the human immunodeficiency virus (HIV), congenital infection (STORCH), presence of early-onset sepsis and cases with more than one pathogen growth in blood cultures. Septic and non-septic infants were compared regarding neonatal outcomes and mortality. Neurodevelopment was assessed using the Bayley Scale (BSDI-II) at 18 to 24 months of corrected age.Results411 preterm infants with VLBW were eligible; the mean gestational age was 29 ± 2.2 weeks and mean birth weight was 1,041 ± 281grams. Late-onset sepsis occurred in 94 preterm infants with VLBW (22.8%). VLBW infants with Gram-positive infection showed motor deficit when compared to the non-septic group, 68.8% vs. 29.3%, respectively (OR 6; 1.6-21.8, p = 0.006); the cognitive development was similar between the groups. The overall mortality rate from infection was 26.7%; considering the pathogens, the rates were 18.7% for coagulase-negative Staphylococcus, 21.8% for Gram-positive bacteria, and 50% for Gram-negative bacteria and fungi.Conclusionneonatal sepsis has a significant influence on late neurodevelopment at 2 years of corrected age in preterm infants with VLBW, and Gram-positive infections are associated with motor deficit.     

Predictive factors of recurrence after pediatric acute pericarditis

ObjectiveThe predisposing factors for pericarditis recurrence in the pediatric population have not yet been established. This study aimed to define the risk factors for the unfavorable prognosis of pediatric acute pericarditis.MethodsThis was a retrospective study that included all patients with acute pericarditis treated from 2011 to 2019 at a tertiary referent pediatric center.ResultsThe study included 72 children. Recurrence was observed in 22.2% patients. Independent risk factors for recurrence were: erythrocyte sedimentation rate ≥ 50 mm/h (p = 0.003, OR 186.3), absence of myocarditis (p = 0.05, OR 15.2), C-reactive protein ≥ 125 mg/L (p = 0.04, OR 1.5), and non-idiopathic etiology pericarditis (p = 0.003, OR 1.3). Corticosteroid treatment in acute pericarditis was associated with a higher recurrence rate than treatment with non-steroid anti-inflammatory therapy (p = 0.04). Furthermore, patients treated with colchicine in the primary recurrence had lower recurrence rate and median number of repeated infections than those treated without colchicine (p = 0.04; p = 0.007, respectively).ConclusionIndependent risk factors for recurrence are absence of myocarditis, non-idiopathic etiology pericarditis, C-reactive protein ≥ 125 mg/L, and erythrocyte sedimentation rate ≥ 50 mm/h. Acute pericarditis should be treated with non-steroid anti-inflammatory therapy. A combination of colchicine and non-steroid anti-inflammatory drugs could be recommended as the treatment of choice in recurrent pericarditis.     

Evaluación de las intubaciones endotraqueales en una unidad de cuidados intensivos pediátricos

IntroductionTracheal intubation is a frequent procedure in paediatric intensive care units that carries a risk of complications that can increase morbidity and mortality.Patients and methodsProspective, longitudinal, observational study in patients intubated in a level iii paediatric intensive care unit between January and December 2020. We analysed the risk factors associated with failed intubation and adverse events.ResultsThe analysis included 48 intubations. The most frequent indication for intubation was hypoxaemic respiratory failure (25%). The first attempt was successful in 60.4% of intubations, without differences between procedures performed by staff physicians and resident physicians (62.5 vs. 56.3%; P = .759). Difficulty in bag-mask ventilation was associated with failed intubation in the first attempt (P = .028). Adverse events occurred in 12.5% of intubations, and severe events in 8.3%, including one case of cardiac arrest, 2 cases of severe hypotension and one of oesophageal intubation with delayed recognition. None of the patients died. Making multiple attempts was significantly associated with adverse events (P < .002). Systematic preparation of the procedure with cognitive aids and role allocation was independently associated with a lower incidence of adverse events.ConclusionsIn critically ill children, first-attempt intubation failure is common and associated with difficulty in bag-mask ventilation. A significant percentage of intubations may result in serious adverse events. The implementation of intubation protocols could decrease the incidence of adverse events.