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Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series
Leonardo Milella,
Maria Teresa Ficarella,
Gerolmina Calabrese,
Michele Sisto,
Rita Luana Grieco,
Paola Moliterni,
Pasquale Raimondo,
Fabiana Cito,
Vito Bellino,
Antonio Ranieri,
Mario Giordano
Issue:
Volume 5, Issue 2, June 2019
Pages:
34-42
Received:
20 February 2019
Accepted:
9 April 2019
Published:
6 May 2019
Abstract: Objective: Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. Compared to filtration-based methods mainly used for renal replacement therapy, newest adsorptive approaches have shown to specifically target the inflammatory cascade by the effective removal of relevant mediators. In the neonatal and pediatric setting however, the application of these methods brings with it various challenges but also profound technical difficulties. Recently, a promising extracorporeal device for cytokine adsorption (CytoSorb) was introduced. However, data for its application in critically ill pediatric patients remains sparse. Design: Single center retrospective case study; Setting: Tertiary neonatal and pediatric general intensive care unit; Patients: The study comprised 10 critically ill pediatric patients; Interventions: We describe the use of CytoSorb in combination with standard therapy, continuous renal replacement therapy (CRRT) and plasmapheresis in ten severely ill pediatric patients with multiple organ failures of various etiologies; Measurements: The aim was to assess the effects on the inflammatory status, hemodynamics, and clinically relevant outcome parameters as well as the feasibility and safety of CytoSorb application in pediatrics; Main Results: We observed a marked decrease in inflammatory mediators, a reduction in catecholamine dosages and an improvement in organ functions, which was particularly pronounced in patients who survived. An early onset of treatment (at best within 24-48 hours after diagnosis of sepsis) seemed to be beneficial for eventual survival. Conclusions: The present case series is the first documentation of a set of pediatric/neonatal patients in which a combined therapeutic approach of hemoadsorption and renal replacement therapy showed promising results with regard to hemodynamic stabilization, control of the inflammatory response, improvement in organ functions as well as safety and feasibility. Further prospective randomized controlled studies in the pediatric field are necessary to elucidate the full potential of hemoadsorption in this set of patients.
Abstract: Objective: Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. Compared to filtration-based methods mainly used for renal replacement therapy, newest adsorptive approaches have shown to specifically target the inflammatory cascade by the effective removal of relevant mediators. In the neonat...
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Parental Satisfaction on Multiple Daily Injections, Insulin Pump and Flexible Multiple Daily Injections Used for Children with Type 1 Diabetes Mellitus
Anutosh Shee,
Sarah Prior,
Nicole Reeves,
Maria Smith,
Sharon Luccisano
Issue:
Volume 5, Issue 2, June 2019
Pages:
43-50
Received:
16 December 2018
Accepted:
28 January 2019
Published:
10 May 2019
Abstract: Aims: This study aims to identify differences in parental satisfaction between three distinct types of intensive insulin therapies used for children with type 1 diabetes (T1D) namely multiple daily injection (MDI), continuous subcutaneous insulin infusion (CSII) and flexible multiple daily injection (fMDI). Materials and Methods: Data was collected over a 6-month period during the quarterly clinic visits. Two modified versions of validated tools- Insulin Treatment Satisfaction Questionnaire (ITSQ) and Diabetes Treatment Satisfaction Questionnaire (DTSQ), were electronically filled in by the parents of children with T1D. This provided information on parental satisfaction on the following areas: inconvenience of regimen, lifestyle flexibility, impression of glycaemic control, fear of hypoglycaemia, diabetic symptoms, treatment barriers, worry, treatment adherence and communication. Results: 34 parents completed the electronic data forms on iSurvey. Parents of the fMDI group were the most confident to avoid severe hypoglycaemia whereas MDI-parents being the least confident, t (21) = 2.12, p = 0.046. There was no statistical difference noted on how confident parents felt to avoid asymptomatic hypoglycaemia, their worry about nocturnal hypoglycaemia, convenience and ease of using insulin in public places, nor was there statistically significant difference in the pain and discomfort felt by their children. Parents of children with fMDI felt the time their children spent with hyperglycemia was higher than the MDI, t (21) = 2.11, p = 0.047. Parents of the CSII group were most likely to continue their current treatment and were also, most likely to recommend the treatment regimen to others. Parents of MDI were least likely to do so, t (20) = 2.12, p =.047 and t (18) = 2.35, p = 0.031. Conclusion: Although this study was conducted with a very small sample size, it has revealed no significant difference in parental satisfaction among MDI, CSII and fMDI groups including parental anxiety and stress, ease of use in public places, convenience, flexibility, parental perception of pain and discomfort experienced by their children and fear of nocturnal hypoglycaemia. However, parents indicated greater confidence in avoiding severe hypoglycaemia in fMDI albeit there was higher glycaemic variability. Parents with CSII were more satisfied with treatment and more likely to recommend their current treatment option to others, than fMDI and MDI, as the preferred mode of treatment.
Abstract: Aims: This study aims to identify differences in parental satisfaction between three distinct types of intensive insulin therapies used for children with type 1 diabetes (T1D) namely multiple daily injection (MDI), continuous subcutaneous insulin infusion (CSII) and flexible multiple daily injection (fMDI). Materials and Methods: Data was collected...
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Grape Seed Proanthocyanidin Extract Adjusts NeuN/GFAP in a Murine Model of Neonatal Hypoxic-ischemic Brain Injury
Li Luo,
Xing Tu,
Xuexia Zhang,
Jing Liu,
Yilin Liu,
Wenyan Zhao,
Ke Niu,
Junhua Yang,
Guoying Li,
Mengxia Wang
Issue:
Volume 5, Issue 2, June 2019
Pages:
51-55
Received:
20 March 2019
Accepted:
22 April 2019
Published:
10 May 2019
Abstract: Objective: To investigate the neuroprotective effects of grape seed proanthocyanidin extract（GSPE）on a model of neonatal hypoxic ischemic encephalopathy (HIE), we investigated the changes in neuronal cells and astrocytes after pre-treatment with GSPE. Methods: Seven-day-old pups were randomly divided into sham, HI, and GSPE+HI groups. The HIE model was established using a modified Rice-Vannucci method. GSPE was injected intraperitoneally 20 min before surgery. The change in markers of neuronal cells and astrocytes (NeuN/GFAP) were detected by immunofluorescence and Western blot. Results: Compared with the sham group, the expression of NeuN in the HI group was significantly reduced, and the expression of NeuN was significantly increased after GSPE pre-treatment. The expression of GFAP was opposite to NeuN. Conclusion: Our study showed that GSPE pre-treatment significantly protected neurons and inhibited astrocyte over-proliferation. Therefore, we believe that GSPE is a potential drug for the treatment of HIE and can prevent brain damage caused by hypoxia and ischemia.
Abstract: Objective: To investigate the neuroprotective effects of grape seed proanthocyanidin extract（GSPE）on a model of neonatal hypoxic ischemic encephalopathy (HIE), we investigated the changes in neuronal cells and astrocytes after pre-treatment with GSPE. Methods: Seven-day-old pups were randomly divided into sham, HI, and GSPE+HI groups. The HIE model...
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Drug-Induced Liver Diseases in Children and Adolescents
Sergey Postnikov,
Nataliya Teplova,
Aleksey Ermilin,
Anna Gratzhianskaya,
Marya Kostyleva
Issue:
Volume 5, Issue 2, June 2019
Pages:
56-63
Received:
9 March 2019
Accepted:
22 April 2019
Published:
20 May 2019
Abstract: Many drugs (now it’s known more than 1200) are associated with hepatic side effects. Children (especially newborns and infants) are unique population with specific characteristics of absorption, metabolism and elimination of drugs that can predispose to hepatotoxicity. Aim of this review is to estimate risk factors of hepatotoxicity related to the patients’ peculiarities and drug itself, also to describe some mechanisms and types of drug-induced liver disease (DILD) and beside this to offer some methods of the treatment and prevention of hepatotoxicity. In children the most often mentioned drugs caused DILD are antibiotics, psychotropics and NSAIDs and the main type of DILD is acute hepatitis with mortality of 10%. To conclude it’s highly important to monitor activity of hepatic enzymes (ALT, AST, AP) during treatment by potentially hepatotoxic drugs in patients from risk groups (early age, any liver disease, diabetes mellitus, obesity, poor nutritional status) in order to timely withdraw offending drug and prescribe hepatoprotectors or even perform liver transplantation.
Abstract: Many drugs (now it’s known more than 1200) are associated with hepatic side effects. Children (especially newborns and infants) are unique population with specific characteristics of absorption, metabolism and elimination of drugs that can predispose to hepatotoxicity. Aim of this review is to estimate risk factors of hepatotoxicity related to the ...
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The Effect of Bladder and Lumbar Stimulation Technique for Collection of Urine in Newborns
Rajbanshi Mamta,
Karn Basant Kumar,
Yadav Upendra,
Shah Sunita,
Yadav Satish
Issue:
Volume 5, Issue 2, June 2019
Pages:
64-69
Received:
11 April 2019
Accepted:
10 May 2019
Published:
4 June 2019
Abstract: Background: Sign and symptoms of urinary tract infections (UTI) are not specific in infants and young children, fever being the commonest sign. Therefore, collecting urine samples for culture is required to diagnose or exclude UTI. Obtaining a clean catch urine sample in neonates and infants is a great challenge as it is unpredictable, time consuming and requires lot of patience. Objectives: The objectives of the study were to determine the effect of bladder and lumbar stimulation technique (BLST) for collection of midstream urine in newborns and to evaluate contamination rates of urine samples collected. Methods: An experimental research was conducted in BPKIHS, Dharan, Nepal including total of 54 term newborns. Urine culture was indicated for different reasons to the admitted newborns. They were randomly assigned either to the experimental group or the control group. Twenty-five minutes after feeding, the genitals and perineal area of the babies were cleaned. The newborns were held under the armpits with legs dangling. Bladder and Lumbar stimulation technique was only applied to the newborns in the experimental group. Success was defined as collection of urine sample within 5 minutes (<300s) of starting the stimulation maneuver in the experimental group and of holding under the armpits in the control group. Results: The success rate of urine collection was significantly higher in the experimental group (88.88%) than in the control group (25.92%) p<0.001. The median time for sample collection was 1.07 minutes (64.2s) [IQR=1.52minutes (91.2s)] in experimental group and 1.52minutes (91.2s) [IQR= 2.78 minutes (166.8s) for control group (p=0.069). Contamination was not found in urine samples collected by BLST in experimental group. Conclusion: The study suggests that bladder and lumbar stimulation technique is safe, quick and effective way of collecting midstream clean catch urine in newborns.
Abstract: Background: Sign and symptoms of urinary tract infections (UTI) are not specific in infants and young children, fever being the commonest sign. Therefore, collecting urine samples for culture is required to diagnose or exclude UTI. Obtaining a clean catch urine sample in neonates and infants is a great challenge as it is unpredictable, time consumi...
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Burden of Malaria in Children Presenting with Anaemia at Ola During’s Children’s Hospital in Freetown Sierra Leone
Yaguo Ide Lucy Eberechukwu,
Lannes Namusa Susan Kamara
Issue:
Volume 5, Issue 2, June 2019
Pages:
70-73
Received:
11 March 2019
Accepted:
20 May 2019
Published:
13 June 2019
Abstract: Malaria is a serious public health problem in sub-Saharan Africa, where it affects entire populations especially children. Indeed over 80% of the worldwide cases of malaria occur in Africa. Anemia secondary to malaria is much more common in younger children, with high mortality rates. Malaria is endemic throughout Sierra Leone and it is often associated with haemoglobin level below 8.0 grams per decilitre in malaria-endemic regions such as Sierra Leone. Sixteen percent of children age 6-59 months in Sierra Leone had a haemoglobin count lower than 8.0 g/dl. The aim of this study was to describe the burden of malaria in children aged one to five years presenting with Anaemia at Ola During children’s Hospital (ODCH) in Freetown Sierra Leone. This study was a hospital-based descriptive cross-sectional study, carried out over a period of two months. Data obtained from the study was analyzed using descriptive statistics, where discrete variables were summarized using frequencies and percentages; continuous variables were summarized using measures of central tendency such as mean, median, mode and standard deviation; while measures of association were analyzed using chi square. Eighty-eight percent of the children in this study had anaemia, mean hemoglobin concentration of enrolled children was 6.9g/dl Fifty-seven-point two percent of the study population had positive blood slide for malaria and the only plasmodium specie detected was plasmodium falciparum. Only 53% of the study population slept under insecticide treated bed nets Parents and caregivers with no formal education were as much as 11.8%. A little over a quarter of the parents/caregivers earned less than 200,000leones which is equivalent to < 50USD.
Abstract: Malaria is a serious public health problem in sub-Saharan Africa, where it affects entire populations especially children. Indeed over 80% of the worldwide cases of malaria occur in Africa. Anemia secondary to malaria is much more common in younger children, with high mortality rates. Malaria is endemic throughout Sierra Leone and it is often assoc...
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Prediction of Upper Limits of Normal Values of Anti Streptolysin ‘O’ Titres in Normal Healthy School Going Children of 6–16 Years
Chikkanarasa Reddy Parthihally Sanjeevaiah,
Mohammedmusthaq Ahamed,
Basavarajaiah Doddagangavadi Mariyappa
Issue:
Volume 5, Issue 2, June 2019
Pages:
74-77
Received:
27 February 2019
Accepted:
11 April 2019
Published:
20 June 2019
Abstract: Antistreptolysin O test, an internationally gold standard test is widely used in detection of group A streptococcal infections and their sequelae at global level. An observational study was conducted at Bengaluru city during 2015-16. A total 454 children were randomly selected from the different schools in Bangalore city. As per the results, the sex ratio was 1:1(Male 230/454, Female 224/454) with mean age 12.58±2.63 years. The titre mean ASO value was 275.93±248.73 IU, median value was 202 IU. The average cut of ASO value was 256.53IU with good specificity (95.0%), sensitivity (88.05%), PPV (85.33%), NPV (68.93%); AUC was 0.93. The resulted findings was found to be statistically significant (P<0.01) and also this mean value will help for detection of streptococcal infections at population level (p<0.01). Majority of the cases were suffering from acute rheumatic fever (80%). Test algorithms was formulated by ROC analysis, the results showed that, the AUC of non-suppurative sequelae of Group-A streptococcal (GAS) infection of the throat (63.0%). The summing of the results concludes that, the ASO is a gold standard for the investigation of the disease progression at early stage (streptococcal and rheumatic fever). This present study will help to clinician’s for diagnose streptococcal infection at greater accuracy.
Abstract: Antistreptolysin O test, an internationally gold standard test is widely used in detection of group A streptococcal infections and their sequelae at global level. An observational study was conducted at Bengaluru city during 2015-16. A total 454 children were randomly selected from the different schools in Bangalore city. As per the results, the se...
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