Cuando el relato es demasiado corto

Viviré la muerte de un niño a lo largo de mi carrera profesional? Posiblemente muchos de nuestros jóvenes pediatras se planteen ocasionalmente esta trascendental cuestión. La mortalidad infantil, un nítido indicador de salud infantil, ha disminuido significativamente a lo largo de los años, reduciendo el número de contactos del pediatra con el final de vida de sus pacientes. Desafortunadamente, esta disminución no es homogénea y persisten cifras intolerablemente elevadas en diversas zonas del mundo

The value of procalcitonin as a prognostic indicator in polytraumatized patients in a pediatric critical care unit

Fonament. El politraumatisme (PT) greu té una morbimortalitat elevada. La procalcitonina PCT) podria ser útil com a indicador pronòstic. Objectiu. Definir els nivells de PCT en el pacient poli-traumàtic (PPT) i la seva implicació pronòstica. Mètode. Estudi prospectiu observacional. Criteris d'inclusió: pacients menors de 16 anys, ingressats per PT en una unitat de cures intensives pediàtrica (UCIP), amb determinació de PCT a l'ingrés i al cap de 24-48 hores. Període d'estudi: novembre del 2009 - novembre del 2011. Tractament esta- dístic mitjançant el paquet SPSS® versió 17.0. Resultats. De seixanta-set pacients amb politraumatisme, vint complien criteris. La mitjana d'edat era de 13,6 ± 4,2 anys i 19 (95%) eren homes. La puntuació del Pediatric Risk of Mortality Score Index (PRISM-III) era de 9,8 ± 7,38 i l'Índex de Trauma Pediàtric (ITP) de 5,5 ± 2,08. Els nivells mitjans de PCT a les 24 hores eren de 7,67 ± 18,05 ng/ml. Es van diagnosticar vuit casos d'infecció bacteriana. Cap pacient va ser èxitus. La PCT es va correlacionar amb la puntuació PRISM-III (R 0,6; p = 0,048). Els nivells mitjans de PCT eren significativament superiors en el grup que va necessitar ventilació mecànica respecte als que no en van necessitar(p = 0,046) i en el grup de pacients infectats (p = 0,039). Es va objectivar una tendència a la correlació entre els valors mitjans de PCT a l'ingrés i els dies d'ingrés (R 0,393, p = 0,1). Conclusions. Els valors de la PCT van ser elevats, per la freqüència de la complicació bacteriana en els PPT. La PCT podria ser útil com a factor pronòstic

Risk factors and incidence of invasive bacterial infection in severe bronchiolitis: the RICOIB prospective study

Background: Bacterial infection (BI), both community-acquired (CA-BI) and hospital-acquired (HAI), might present as a severe complication in patients with bronchiolitis. This study aimed to describe BI in children with severe bronchiolitis, and to define risk factors for BI. Methods: This was a prospective, descriptive study that included infants admitted to the pediatric intensive care unit (PICU) due to bronchiolitis between 2011 and 2017. The BROSJOD score was calculated to rate the severity of bronchiolitis. Results: Inclusion of 675 patients, with a median age of 47 days (IQR 25-99). 175 (25.9%) patients developed BI, considered HAI in 36 (20.6%). Patients with BI had higher BROSJOD score, PRISM III, and required invasive mechanical ventilation and inotropic support more frequently (p 12 (OR 2.435, 95%CI 1.379-4.297) and bacterial co-infection (OR 2.294 95%CI 1.051-5.008). Concerning HAI, an independent association was shown with mechanical ventilation longer than 7 days (OR 5.139 95%CI 1.802-14.652). Infants with BI had longer PICU and hospital stay (p 12 may alert the presence of CA-BI, especially pneumonia. Patients with BI have higher morbidity and mortality

Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study

Objective:To assess the usefulness of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide as predictors of need for mechanical ventilation and postoperative complications (need for inotropic support and bacterial infection) in critically ill pediatric patients after cardiopulmonary bypass. Design:A prospective, observational study Setting: Pediatric intensive care unit. Patients: Patients under 18 years old admitted after cardiopulmonary bypass. Measuraments and main results: Serum levels of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide were determined immediately after bypass and at 24-36 hours. Their values were correlated with the need for mechanical ventilation, inotropic support and bacterial infection. One hundred eleven patients were recruited. Septal defects (30.6%) and cardiac valve disease (17.1%) were the most frequent pathologies. 40.7% required mechanical ventilation, 94.6% inotropic support and 15.3% presented invasive bacterial infections. Pro-adrenomedullin and pro-atrial natriuretic peptide showed significant high values in patients needing mechanical ventilation. Cut-off values higher than 1.22 nmol/L and 215.3 pmol/L, respectively for each biomarker, may indicate need for mechanical ventilation with an AUC of 0.721 and 0.746 at admission and 0.738 and 0.753 at 24-36 hours, respectively but without statistical differences. Pro-adrenomedullin and procalcitonin showed statistically significant high values in patients with bacterial infections. Conclusions: After bypass, pro-adrenomedullin and pro-atrial natriuretic peptide are suitable biomarkers to predict the need for mechanical ventilation. Physicians should be alert if the values of these markers are high so as not to progress to early extubation. Procalcitonin is useful for predicting bacterial infection. This is a preliminary study and more clinical studies should be done to confirm the value of pro-adrenomedullin and pro-atrial natriuretic peptide as biomarkers after cardiopulmonary bypass