Evaluation of cardiac arrhythmias by electrocardiographic markers in pediatric patients who have tuberous sclerosis without cardiac rhabdomyoma

BackgroundTuberous sclerosis (TS) is an autosomal dominant and hereditary disorder. Cardiac rhabdomyoma and arrhythmias are the most deleterious risk factors linked to TS. Although arrhythmias in pediatric patients with TS who have cardiac rhabdomyoma have been frequently reported, arrhythmia in patients who have TS without rhabdomyoma is rarely reported in the literature. The study aimed to assess the susceptibility of pediatric patients who have TS without cardiac rhabdomyoma to cardiac arrhythmia using electrocardiographic (ECG) markers.MethodsThis prospective study included 10 patients who had TS without cardiac rhabdomyoma. The control group was made up of 30 healthy children of the same age and sex as the patient group. P wave, P wave dispersion, QT dispersion, QTc dispersion, TP-e interval, and TP-e interval dispersion were calculated on 12-lead surface ECGs for each patient in both groups and compared.ResultsP wave, P wave dispersion, QT dispersion, and QTc dispersion were found to be significantly higher in the patient group (P < 0.001). Furthermore, patients had a greater Tp-e interval and Tp-e interval dispersion than healthy children (P < 0.001).ConclusionPediatric patients with TS without cardiac rhabdomyoma might be prone to atrial and ventricular arrhythmias according to their prolonged ECG markers. Our findings suggest that patients with TS without cardiac rhabdomyoma need close monitoring for atrial and ventricular arrhythmias.     

Vitamin D deficiency at pediatric intensive care admission

Objectiveto assess whether 25hydroxivitaminD or 25(OH)vitD deficiency has a high prevalence at pediatric intensive care unit (PICU) admission, and whether it is associated with increased prediction of mortality risk scores.Methodprospective observational study comparing 25(OH)vitD levels measured in 156 patients during the 12 hours after critical care admission with the 25(OH)vitD levels of 289 healthy children. 25(OH)vitD levels were also compared between PICU patients with pediatric risk of mortality III (PRISM III) or pediatric index of mortality 2 (PIM 2) > p75 [(group A; n = 33) vs. the others (group B; n = 123)]. Vitamin D deficiency was defined as < 20 ng/mL levels.Resultsmedian (p25‐p75) 25(OH)vitD level was 26.0 ng/mL (19.2‐35.8) in PICU patients vs. 30.5 ng/mL (23.2‐38.6) in healthy children (p = 0.007). The prevalence of 25(OH)vitD < 20 ng/mL was 29.5% (95% CI: 22.0‐37.0) vs. 15.6% (95% CI: 12.2‐20.0) (p = 0.01). Pediatric intensive care patients presented an odds ratio (OR) for hypovitaminosis D of 2.26 (CI 95%: 1.41‐3.61). 25(OH)vitD levels were 25.4 ng/mL (CI 95%: 15.5‐36.0) in group A vs. 26.6 ng/mL (CI 95%: 19.3‐35.5) in group B (p = 0.800).Conclusionshypovitaminosis D incidence was high in PICU patients. Hypovitaminosis D was not associated with higher prediction of risk mortality scores.     

Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures

Objective

To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents.

Turkish pediatric residents’ knowledge,perceptions, and practices of blood culture sampling

IntroductionPediatrics is one of the medical specialties in which blood cultures for bloodstream infections are performed very frequently. This study aimed to evaluate pediatric residents’ knowledge and perceptions of blood culture sampling.Material and methodsBetween June 2019 and September 2019, a questionnaire comprising 20 questions about blood culture sampling was sent via email to participants who were pediatric residents at five different hospitals in Turkey. There were 11 true/false and nine multiple-choice questions that assessed three aspects of culture sampling: indications, sampling practice and knowledge, and contamination. The percentage of correct answers was used to calculate an overall score and subsection scores.ResultsA total of 132 pediatric residents [102 (77%) female] with a mean age of 28.3 ± 2.8 years completed the questionnaire. Forty-five (35%) were in their 1st year of residency. Sixty (46%) participants reported that they had not performed blood culture sampling in the last week. There was a negative relationship between years in training and the number of cultures performed (Kendal's tau-b = ?0.297, p < 0.001). The overall median score was 65 (range, 35–90) and it seemed to increase with years of training. The lowest median score was in the contamination subscale and only one (0.76%) participant correctly answered all questions concerning contamination.ConclusionResidents who obtained the majority of blood cultures had the lowest knowledge levels. Therefore, it is evident that the knowledge levels of pediatric residents must be increased in order to improve blood culture sampling practices in centers where they perform blood culture sampling.     

Performance of prognostic markers in pediatric sepsis

ObjectiveTo evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), ferritin, lactate, C-reactive protein (CRP), and leukocytes, alone and in combination, in pediatric patients with sepsis admitted to the pediatric intensive care unit (PICU).MethodsA retrospective study was conducted in a PICU in Brazil. All patients aged 6 months to 18 years admitted with a diagnosis of sepsis were eligible for inclusion. Those with ferritin and C-reactive protein measured within 48 h and lactate and leukocytes within 24 h of admission were included in the prognostic performance analysis.ResultsOf 350 eligible patients with sepsis, 294 had undergone all measurements required for analysis and were included in the study. PIM2, ferritin, lactate, and CRP had good discriminatory power for mortality, with PIM2 and ferritin being superior to CRP. The cutoff values for PIM2 (> 14%), ferritin (> 135 ng/mL), lactate (> 1.7 mmol/L), and CRP (> 6.7 mg/mL) were associated with mortality. The combination of ferritin, lactate, and CRP had a positive predictive value of 43% for mortality, similar to that of PIM2 alone (38.6%). The combined use of the three biomarkers plus PIM2 increased the positive predictive value to 76% and accuracy to 0.945.ConclusionsPIM2, ferritin, lactate, and CRP alone showed good prognostic performance for mortality in pediatric patients older than 6 months with sepsis. When combined, they were able to predict death in three-fourths of the patients with sepsis. Total leukocyte count was not useful as a prognostic marker.     

Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass

Objective

Several reports claim that blood pressure (BP) in the radial artery may underestimate the accurate BP in critically ill patients. Here, the authors evaluated differences in mean blood pressure (MBP) between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring.

Assessment of PELOD-2 and PIM-3 scores of children coming from the war in Syria

ObjectivesSince the civil war in Syria began, millions of Syrians have left the country and been forced to migrate to other countries. Turkey is the country with the most refugees hosting 3.6 million refugees. This study aimed to compare the PIM-3 score, PELOD-2 score, PELOD-2 predicted death rate (PDR), mortality rates, demographic data, and outcomes of patients admitted to pediatric intensive care units between refugee children living in Turkey, pediatric patients brought directly from the border by the emergency services, and the general Turkish population.MethodsThis was a retrospective study performed between February 2018 and February 2019 at Hatay State Hospital, very close to the Syrian border. The study included 158 patients. Patients were divided into three groups: Turkish citizens, those living in Turkey as refugees, and those brought from the border.ResultsOf the patients, 57 were Turkish citizens, 33 were refugees, and 68 were brought from the border. For patients, the mean PIM-3 score was 25.62 ± 27.70, the PELOD-2 score was 8.03 ± 4.72, and PELOD2-PDR was 16.07 ± 23.45. The median scores for PIM-3, PELOD-2, and PELOD2-PDR of patients brought from the Syrian border were higher compared with Turkish citizens and refugees. There was no significant difference between refugees and Turkish citizens. Of the patients, 27 died, with the distribution being 15% Turkish citizens, 26% refugees, and 59% brought from the border. The mortality of patients transported from the border was statistically significant (P = 0.03).ConclusionWe consider that the source of the difference between patients brought from the border and those living in Turkey may be associated with the continuing war beyond our borders and children experiencing insufficient care conditions. In conclusion, it is not just weapons that cause death in war, and children unfortunately suffer because of this situation.     

Laparoscopic Palomo varicocele surgery: Lessons learned after 10 years’ follow up of 156 consecutive pediatric patients

ObjectivesTo evaluate our experience using laparoscopic Palomo varicocele ligation in a population under 18 years, and confirm the factors involved in postoperative hydrocele formation.Patients and methodsBetween 1997 and 2007, 156 boys diagnosed as having varicocele were evaluated retrospectively. Outcome variables recorded for analysis were age at presentation, symptoms, varicocele grade (Dubin–Amelar classification), testicular atrophy, length of hospital stay, perioperative complications, recurrence and hydrocele formation after surgery. Mean follow up was 5.6 years (6 months– 9 years).ResultsAge at diagnosis ranged between 9 and 18 years. Mean age at operation was 14.1 ± 1.8 years. There were 153 left-side varicoceles (98%) and three cases were bilateral. All patients had grade II or III varicocele (38%/62%) and testicular atrophy was noted in 43.8%; 8.1% mentioned testicular pain at diagnosis. All boys underwent Palomo laparoscopic ligation of the spermatic vessels. Mean operative time was 38 min (25–82 min). The last 51 surgeries were performed on a two-trocar basis with Ligasure^® vascular sealing device and operative time decreased significantly to 22 min (16–32 min) (P < 0.05). Median hospital stay was 31 ± 8 h. Conversion rate was 1.28%. Twenty-one patients developed hydrocele (13.5%); 11 of these underwent Winkelman–Lord's hydrocelectomy at least 1 year after Palomo (9% of total). Of the remaining 10, two resolved spontaneously and eight were stable at mean 4-year follow up.ConclusionsLaparoscopic Palomo varicocele surgery for pediatric patients is a safe and effective procedure. Recurrence and complication rates are similar to those reported with open surgery.     

Assessment of the performance of the Pediatric Index of Mortality 2 (PIM2) among Egyptian pediatric patients admitted to the intensive care

BackgroundMortality prediction models are useful in pediatric intensive care units (PICUs) as risk assessment tools and as a benchmark for the quality of care.ObjectivesTo assess the performance of the Pediatric Index of Mortality 2 (PIM2) in terms of calibration and discrimination between survivors and non-survivors among pediatric patients.MethodsThis is a cohort prospective study including 317 pediatric patients admitted to two PICU settings in a tertiary care hospital in Egypt over a period of one year (from June 2012 till June 2013). Collected data included personal characteristics, hospital data, diagnosis, outcome and variables included in PIM2 scoring.ResultsNon-survivors constituted 8.5%. Most common diagnosis was respiratory diseases (47.9%). Only CNS morbidities (11.7% of survivors versus 37% of non-survivors, P = 0.001) and a higher PIM2 score (2.39 ± 5.49 in survivors versus 41.38 ± 36.06 in non-survivors, P = 0.001) were associated with increased risk of non-survival. The area under the curve (AUC) for PIM2 is 0.796 (95% CI 0.675–0.916), P < 0.001. The Hosmer–Lemeshow goodness-of-fit was 2.850, 8 df, P = 0.943. PIM2.ConclusionThe calibration and the discriminative ability of PIM2 scoring system aiming to distinguish survivors from non-survivors are satisfactory for this sample of pediatric patients. PIM2 is easily calculated and is freely available. Thus, this tool provides a good incentive for ICU settings in Egypt for admission of high risk patients in the light of the limited PICU bed complement capacity in relation to the demands.     

Prevalence of binge eating disorder among a clinical sample of obese children

IntroductionTherapeutic hypothermia (TH) improves neurological outcome in adults after ventricular fibrillation cardiac arrest and in neonates with hypoxic ischemic encephalopathy. The effect of TH in children is under investigation.ObjectivesTo assess the feasibility, efficacy and safety of a pilot program of TH in pediatric cardiac arrest.Material and methodsProspective study in a pediatric intensive care unit. An external cooling method with a servo system was used on all patients according to an established protocol. Values expressed as median (IQ range).ResultsSix patients were included, of whom 5 had an out of hospital cardiac arrest. The mean age was 33 months (16-120) and Glasgow coma scale 6 (4-7). The T° prior to the induction of TH was 39.2° C (39.1-39.4). The median T° used was 34.0° C (33.5-34.8° C), which was reached in 4 h. (3-7) after the start and maintained for 48 h. (45-54). The rewarming was carried out over a period of 14 h. (12-16). Hypokalemia was the most common adverse event found. Five patients survived to hospital discharge with a Glasgow Coma Scale of 13 (11-14). At 6 months follow up the Pediatric Cerebral Performance Category score was ≤ 2 in three patients.ConclusionIn this pilot study, the use of mild therapeutic hypothermia with a protocol that included rapid sequence induction with an external surface cooling technique was feasible, effective and safe in children with cardiac arrest.     

Prevalencia y valor pronóstico del síndrome del enfermo eutiroideo en niños críticos

Introduction

Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, pediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children.

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.     

Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study

BackgroundPlasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries.ObjectiveTo assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population.MethodsThis was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24 h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality.ResultsIn total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P = 0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval = 1.12 [1.02–1.23] and 1.80 [1.23–2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient = 0.31, 0.23, 0.43; P = 0.006, P = 0.047, P < 0.001, respectively). The 24-h lactate level had an area under the receiver operating characteristic curve (AUC) of 0.77 (P = 0.013) for mortality prediction, while admission, peak, and average lactate level had an AUC of 0.69, 0.69, 0.71 (P = 0.086, P = 0.035, P = 0.019), respectively. PIM2, PRISM, and pSOFA score had an AUC of 0.80, 0.78, 0.82 (P = 0.001, P = 0.001, and P < 0.001), respectively. Combining 24-h lactate level with pSOFA demonstrated superior performance (AUC = 0.88).ConclusionBoth 24-h lactate level and pSOAF are useful for prediction of mortality. Incorporating the 24-h lactate level into the pSOFA Score achieved superior prognostic utility.     

Risk of Death for Medicaid Recipients Undergoing Congenital Heart Surgery

The objective of this study was to explore the effect of insurance type on mortality for congenital heart surgery. We performed a population-based retrospective cohort study using hospital discharge abstract data from five states in 1992 and 1996. The outcome measure was risk-adjusted in-hospital mortality. Cases of pediatric congenital heart surgery were identified and placed into six risk categories using the Risk Adjustment in Congenital Heart Surgery method. Multivariate analyses were used to determine the effect of insurance type on risk-adjusted mortality; regional effects were explored. Using standardized mortality ratios, institutions were grouped by outcome; within and between group differences were examined. Of 11,636 cases, 9656 (83%) were placed in a risk group for analysis. In 1996, children with Medicaid had a higher risk of death than those with commercial or managed care in both unadjusted ( p = 0.002) and adjusted ( p < 0.001) analyses. Overall mortality rates decreased between 1992 and 1996 ( p = 0.001). However, improvement was not consistent among insurance groups. Differences were present within and between low, average, and high-mortality hospitals, suggesting that the adverse effect of Medicaid may be due to both differential referral and other differences in care among patients treated at similar institutions. Children with Medicaid insurance have a higher risk of dying after congenital heart surgery than those with commercial and some managed care insurance. Barriers to access go beyond differences in referral patterns.     

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.     

Pediatric open partial nephrectomy: analysis of contemporary outcomes with a supracostal-12 approach

ObjectiveReports in the literature increasingly have demonstrated a shorter length of stay (LOS) with the laparoscopic approach to partial nephrectomy compared to historic open partial nephrectomy. We present data from the largest open series to date, to provide a more contemporary perspective.MethodsA retrospective review was performed on all pediatric patients who underwent upper pole partial nephrectomy from 1999 to 2011. Using univariate and multivariate linear regression, the associations between multiple explanatory covariates and outcomes such as pain and length of stay were analyzed.ResultsTwenty-five surgeries were performed via a supracostal-12 approach. The mean incision length and operative time was 3.7 cm and 137 min, respectively. The average pain score was 1.7/10 and 72% of patients did not require morphine. The mean LOS was 36 h and all patients with postoperative imaging had normal blood flow. Multivariate analysis demonstrated that a later date of surgery was the only covariate significantly associated with decreased operative time and LOS.ConclusionOpen partial nephrectomy can be performed in a minimally invasive manner via a small supracostal-12 incision with minimal pain and LOS. Surgeon experience is associated with decreased operative time and LOS. These contemporary open results should be considered when comparisons are made with laparoscopic surgery.     

Surgical Volume-to-Outcome Relationship and Monitoring of Technical Performance in Pediatric Cardiac Surgery

A significant inverse relationship of surgical institutional and surgeon volumes to outcome has been demonstrated in many high-stakes surgical specialties. By and large, the same results were found in pediatric cardiac surgery, for which a more thorough analysis has shown that this relationship depends on case complexity and type of surgical procedures. Lower-volume programs tend to underperform larger-volume programs as case complexity increases. High-volume pediatric cardiac surgeons also tend to have better results than low-volume surgeons, especially at the more complex end of the surgery spectrum (e.g., the Norwood procedure). Nevertheless, this trend for lower mortality rates at larger centers is not universal. All larger programs do not perform better than all smaller programs. Moreover, surgical volume seems to account for only a small proportion of the overall between-center variation in outcome. Intraoperative technical performance is one of the most important parts, if not the most important part, of the therapeutic process and a critical component of postoperative outcome. Thus, the use of center-specific, risk-adjusted outcome as a tool for quality assessment together with monitoring of technical performance using a specific score may be more reliable than relying on volume alone. However, the relationship between surgical volume and outcome in pediatric cardiac surgery is strong enough that it ought to support adapted and well-balanced health care strategies that take advantage of the positive influence that higher center and surgeon volumes have on outcome.     

Implementation of a protocol proposed by the Brazilian National Health Surveillance Agency for antibiotic use in very low birth weight infants

ObjectiveTo analyze the implementation of a protocol proposed by the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária – ANVISA) to improve sepsis diagnosis in very low birth weight newborns.MethodsThis was a prospective study that evaluated the implementation of a protocol involving clinical and laboratory criteria (hematologic scoring system of Rodwell and C-reactive protein serial measurements), recommended by ANVISA, to improve the diagnosis of neonatal sepsis in very low birth weight newborns. The study included all patients who were born and remained in the neonatal intensive care unit until discharge or death, and excluded those with congenital diseases. The main outcomes measured in newborns before (2006-2007) and after implementation of the protocol (2008) were the rates of early and late-onset sepsis, use of antibiotics, and mortality. Means were compared by Student's t-test and categorical variables were compared by the chi-squared test; the significance level for all tests was set at 95%.ResultsThe study included 136 newborns with very low birth weight. There was no difference between groups regarding general clinical characteristics in the studied periods. There was, however, a decrease in the number of diagnoses of probable early-onset sepsis (p < 0.001), use of antimicrobial regimens (p < 0.001), and overall mortality and infection-related mortality (p = 0.009 and p = 0.049, respectively).ConclusionThe implementation of the protocol allowed improvement of sepsis diagnosis by reducing the diagnosis of probable early-onset sepsis, thus promoting efficient antimicrobial use in this population.     

Pediatric ocular trauma: Characteristics and outcomes among a French cohort (2007–2016)

Pediatric ocular trauma is a major cause of acquired monocular blindness. Post-traumatic visual impairment can lead to significant handicap. In France, recent data on the epidemiology of pediatric ocular trauma are lacking.AimTo describe the characteristics of a pediatric cohort with ocular trauma and to analyse patient outcomes.Material and methodsThis was a retrospective observational study of pediatric ocular trauma (age < 15 years) presenting to pediatric and ophthalmology emergency units of our tertiary university hospital between January 1, 2007 and December 31, 2016. Data were collected on: age, sex, time and circumstances of trauma, injury type and location, trauma mechanism, other associated injuries, hospitalisation rate and length of stay, treatment, and sequelae (visual impairment). Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system and the Ocular Trauma Score (OTS).ResultsA total of 337 children were included (247 males). The global mean age was 8.4 ± 4.1 years (range 6 months to 14.9 years). The trauma occurred at home (51%) or in a public area (21%). Blunt objects (22%) and direct trauma (17%) were the main mechanisms. According to the BETT, 23% of ocular traumas were open-globe traumas (OGT): penetrating (n = 39), perforating (n = 12), with intraocular foreign body (n = 24). Among closed-globe injuries (CGT), hyphema was the most frequent lesion (22%). Associated injuries were recorded in 32 patients. In all, 63% of patients had an OTS of 5 (good visual prognosis) while 39 children (12%) had an OTS of ≤ 3. In 47 patients, there was an initial surgery; 62% of children were hospitalised. By the end of the ophthalmic follow-up, 32 patients (9.5%) had sequelae. Children aged between 2 and 5 years had the greatest proportion of sequelae (15%). Compared with female patients, male patients were older (P = 0.0007) and were more frequently injured by projectiles (P = 0.036). Compared with CGT, OGT were more frequent among younger children (P = 0.0015). Ocular injuries secondary to a projectile and spring-summer accidents were associated more frequently with a poor visual prognosis (OTS ≤ 3; P = 0.036, OR = 2.5 [1.1–5.8] and P < 0.0001, OR = 5.8 [3.2–10.7] respectively).CommentsThe annual admission for pediatric ocular trauma was stable during the study period (200 cases per 100,000 annual trauma admissions in the first period [2007–2011] and 195 cases per 100,000 during the most recent period [2012–2016]). Projectiles such as Airsoft gun bullets and paintball are still the cause of severe injuries while reports on ocular injuries secondary to blaster or Nerf guns use are starting to be published.ConclusionThe great majority of ocular traumas could be prevented, especially by wearing protective goggles during at-risk activities. French legislation should be stricter about the sale of any Airsoft gun to children under 18 years old. Parents must repeat educational warnings to their children handling sharp objects. The social and psychological burden of relative visual impairment is of importance: One in ten children will have a permanent visual defect.