Massive thymic hemorrhage and hemothorax occurring in utero

Background: Thymic enlargement is a common and physiological finding in children and neonates' X-rays, but it is usually asymptomatic. Occasionally it can cause respiratory distress. In most cases the aetiology of this expansion remains unclear and it is diagnosed as a thymic hyperplasia. True thymic hyperplasia is defined as a gland expansion, both in size and weight, while maintaining normal microscopic architecture. Often it is a diagnosis of exclusion and prognosis is good. Thymic haemorrhage is an unusual condition related to high foetal and neonatal mortality. Case Presentation: We report a case of spontaneous massive thymic haemorrhage in a newborn developing at birth acute respiratory distress associated with severe bilateral haemothorax. Thymic enlargement was evident after pleural evacuation and confirmed by radiographic, Computed Tomography (CT) images and Magnetic Resonance Imaging (MRI) sequences. The spontaneous resolution of this enlargement seen with CT scan and MRI sequences suggested a thymic haemorrhage; surgery was not necessary. Conclusion: Thymic haemorrhage should be considered in newborn infants with pleural effusion, mediastinal space enlargement and Respiratory Distress

What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence?

The bone disease that occurs as a result of chronic kidney disease (CKD) is not only debilitating but also linked to poor growth and cardiovascular disease. It is suspected that abnormal bone turnover is the main culprit for these poor outcomes. Plasma parathyroid hormone (PTH) levels are used as a surrogate marker of bone turnover, and there is a small number of studies in children that have attempted to identify the range of PTH levels that correlates with normal bone histology. It is clear that high PTH levels are associated with high bone turnover, although the range is wide. However, the ability of PTH levels to distinguish between low and normal bone turnover is less clear. This is an important issue, because current guidelines for calcium and phosphate management are based upon there being an “optimum” range for PTH. This editorial takes a critical look at the evidence upon which these recommendations are based

Correct positioning of central venous catheters in pediatrics. Are current formulae really useful?

Correct positioning of a central venous catheter (CVC) tip in pediatric patients is very important. Malpositioning may lead to direct complications, such as arrhythmia and increase the risk of thrombosis, infections, valve failures or pericardial tamponade. The aim of this review was to identify and summarize published formulae for the correct positioning of the CVC tip in children and to discuss the benefits of these formulae for the daily routine. A systematic and standardized search in Medline and PubMed was performed to identify published formulae. Formulae for insertion depth of the CVC tip over the right internal jugular vein are discussed. The keywords pediatric or pediatric, children, central venous catheter, CVC, central venous, length, insertion, optimal, formula, depth, correct position and right position, internal jugular vein were used to identify the formulae. A total of 854 publications were found and 127 publications were analyzed. The publications were subsequently assessed and classified independently by a specialist in anesthesiology and a specialist in pediatrics. A total of six publications described different body height-based formulae for calculation of a CVC insertion depth. No prospective evaluation of these formulae was performed to show if it is possible to place a CVC tip at the optimal position. The benefit of a formula for daily practice is very limited due to the problem of choosing the right insertion point. The recommended insertion depth should be considered as an indicator and a verification of the CVC tip position should be done using an imaging technique

Topographical Anatomy of Central Venous System in Extremely Low-Birth Weight Neonates Less Than 1000 Grams and the Effect of Central Venous Catheter Placement

Central venous catheterization is widely used in neonatology. Although ultra-sonic guidance for central venous catheter placement is available, complications occur significantly more frequently in infants, especially neonates, than in adults. This study seeks to determine the characteristics, topographical conditions, regional relationships, and diameters of the venous structures of the upper extremity and the thoracic central venous system in extremely small preterm neonates (mean: 900 g). Nine formaldehyde-fixed preterm stillborns were prepared (mean 27 2/7 weeks' gestational age). The anatomical preparation involved the complete thoracic wall, neck and shoulder region, and preparation of the upper extremities. It was shown that the course of the internal jugular vein can be influenced by rotation of the head. Maximum head rotation (80 degrees) to the contralateral side leads the internal jugular vein to overlap the common carotid artery and sharpens the confluence angle of the internal jugular into the brachiocephalic vein. We propose that this has the potential to result in dislocation of the catheter. Less rotation of the head (<30 degrees) is favorable as the internal jugular vein and common carotid artery run in parallel. Commonly used central venous catheters (2F-4F) may not occlude the vascular lumen completely. Small central venous cannulation using a single-orifice catheter through arm veins (1F) may also not occlude peripheral vessels of the upper extremity (cephalic and basilic veins). The right internal jugular vein has a straight course, appears suitable for central venous access and less hazardous, especially when using stiff catheters. The use of small straight wire guides is recommended. Clin. Anat. 24:711-716, 2011. (C) 2011 Wiley-Liss, Inc

Evacuation of a neonatal intensive care and intermediate care unit

Background The evacuation of an intensive care unit, or even an entire hospital, is a rare event. Nevertheless, due to multiple challenging logistical efforts, intensive preliminary planning for such a scenario is obligatory since, in the event of an occurrence, it presents a high potential risk for the patients. Evacuation of a neonatal intensive unit is particularly vulnerable to risks and, due to the lack of alternatives, much more difficult to manage. Action In the late evening of 19 September 2014, serious water damage on the third floor of the obstetrics department of the University Hospital of Cologne took place. The most severely affected ward was the neonatal intensive care unit with 10 beds, together with the immediate care unit (premature ward) with 16 beds, both located directly below. The whole area was so severely affected by the flow of water that the entire area had to be evacuated. Fortunately, all 26 patients were able to be moved within the campus of the university hospital. Of these, 6 children were moved to the infant station located in the same building on the 6th floor. The remaining 20 patients had to be transferred to other buildings on the campus via underground passages, which are not normally used. All transfers of patients took place without incident. Conclusion Evacuation scenarios must be an essential part of a hospital emergency plan. In particular for high-risk areas, e.& x202f;g. intensive care stations, such a scenario should be planned in advance. In case of an emergency, it is important to have a predefined management structure