Entérocolite nécrosante : prise en charge à Genève entre 1991 et 2011 et place des scores dans la prise en charge

L'entérocolite nécrosante (NEC) est la principale urgence chirurgicale néonatale, sa prise en charge est complexe et sa mortalité élevée. L'aide de scores combinant des éléments cliniques, biologiques et radiologiques a été explorée. Cette étude rétrospective portant sur 20 ans (1991-2011) vise à évaluer la prise en charge de ces patients dans un centre. Trois scores spécifiques aux NEC et décrits dans la littérature ont été appliqués aux patients selon la méthodologie des publications originales afin d'évaluer l'existence d'un accord entre l'évolution clinique prévue par le score et l'outcome réel (besoin de chirurgie et mortalité). Aucun accord entre la prédiction des scores et l'issue réelle de ces patients n'a pu être mis en évidence. Au final cette étude est la première à évaluer ces trois scores dans une autre population que celle des publications originales, mais leur utilité n'a pas pu être soulignée

Plasma in the PICU: why and when should we transfuse?

Whereas red blood cell transfusions have been used since the 19th century, plasma has only been available since 1941. It was originally mainly used as volume replacement, mostly during World War II and the Korean War. Over the years, its indication has shifted to correct coagulation factors deficiencies or to prevent bleeding. Currently, it remains a frequent treatment in the intensive care unit, both for critically ill adults and children. However, observational studies have shown that plasma transfusion fail to correct mildly abnormal coagulation tests. Furthermore, recent epidemiological studies have shown that plasma transfusions are associated with an increased morbidity and mortality in critically ill patients. Therefore, plasma, as any other treatment, has to be used when the benefits outweigh the risks. Based on observational data, most experts suggest limiting its use either to massively bleeding patients or bleeding patients who have documented abnormal coagulation tests, and refraining for transfusing plasma to nonbleeding patients whatever their coagulation tests. In this paper, we will review current evidence on plasma transfusions and discuss its indications

Are Scores Reliable in Predicting the Need for Surgery and Mortality in Necrotizing Enterocolitis?

Background Management of children with necrotizing enterocolitis (NEC) remains challenging. Various scores try to facilitate therapeutic decision-making. We aim to assess the agreement of three scores intending to predict the need for surgery and/or mortality in our patient cohort, and analyze agreement between the different scores. Methods This study is a retrospective analysis of patients with NEC Bell's stage II and III, managed in a single institution (1991-2011). Three existing scores (Metabolic Derangement Acuity score, NEC score, Detroit score) were calculated individually for each patient. The agreement between predicted outcome by scores and real outcome was evaluated with kappa statistic. Results Of 57 children, 46% presented with NEC stage II, 54% with stage III, 46% were treated with surgery, 54% conservatively, and survival was 58%. The kappa indexes for "need for surgery" were 0.41, 0.13, and 0.12 and kappa indexes for "mortality" were 0.27, 0.04, and 0.1 for the Metabolic Derangement Acuity score, the NEC score, and the Detroit score, respectively. Conclusion In our cohort, the agreement between the predicted outcomes by scores and the real need for surgery and/or mortality was poor. There was a lack of clinical usefulness of the tested scores. We must continue to better identify parameters to help guide the management of these patients

Ketosis After Cardiopulmonary Bypass in Children Is Associated With an Inadequate Balance Between Oxygen Transport and Consumption

Hyperglycemia after cardiac surgery and cardiopulmonary bypass in children has been associated with worse outcome; however, causality has never been proven. Furthermore, the benefit of tight glycemic control is inconsistent. The purpose of this study was to describe the metabolic constellation of children before, during, and after cardiopulmonary bypass, in order to identify a subset of patients that might benefit from insulin treatment

Effects of plasma transfusions on antithrombin levels after paediatric liver transplantation

Thrombotic complications affect 3-10% of patients after liver transplantation (LT), leading to potentially life-threatening complications. In the days following LT, antithrombin (AT) is decreased longer than pro-coagulant factors, thus favouring a pro-thrombotic profile. Plasma transfusions are given empirically in some centres to correct AT levels following LT. We assessed the effect of plasma transfusion on AT levels after paediatric LT

Diagnosis and Management of Necrotizing Enterocolitis: An International Survey of Neonatologists and Pediatric Surgeons

Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Currently, there is limited evidence to guide investigation and treatment strategies