Factors Associated With Infant Death After Apparent Life-threatening Event (alte)

Objective: To detect factors associated with greater risk of death in infants after an apparent life-threatening event (ALTE). Methods: This cross-sectional, retrospective, descriptive and analytic study evaluated infants younger than 12 months who had a sudden event of cyanosis, pallor, hypotonia or apnea and were seen in the emergency department of a tertiary university hospital. Forward stepwise logistic regression (Wald) was used to calculate and adjust odds ratios to evaluate associations. Results: Mean age of the 145 patients included in the study was 105 days (median = 65 days). Eleven (7.6%) died, and their mean age was 189 days (median = 218 days). Mean age of survivors was 98 days (median = 62 days) (p = 0.003). Activity before the event, prematurity and number of events were not associated with death. A significant association was found with pallor. Of the 11 infants, 3 had spontaneous resolution of ALTE, whereas 8 patients [27.6%; p < 0.001; OR = 14.3 (95%CI 3.51-58.3)] did not. The associations with respiratory or cardiovascular disease were also significant. In multivariate analysis, immediate spontaneous resolution [p = 0.015; OR = 6.06 (95%CI 1.02-35.94)] and diagnosis of cardiovascular disease [p = 0.047; OR = 164.27 (95%CI 7.34-3.673.78)] remained statistically significant. Conclusion: Infants who experienced an ALTE had a higher risk of subsequent death when their age was greater than 6 months and the event had a long duration, particularly when ALTE was associated with cardiovascular disease. Copyright © 2010 by Sociedade Brasileira de Pediatria.866515519National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986 (1987) Pediatrics, 79, pp. 292-299Davies, F., Gupta, R., Apparent life threatening events in infants presenting to an emergency department (2002) Emergency Medicine Journal, 19 (1), pp. 11-16Anjos, A.M., Nunes, M.L., Perfil epidemiológico de crianças com apparent life-threatening event (ALTE) e avaliação prospectiva da etiologia determinante do episódio (2009) Rev Bras Saude Matern Infant, 9, pp. 301-309Edner, A., Wennborg, M., Alm, B., Langercrantz, H., Why do ALTE infants not die in SIDS? (2007) Acta Paediatr, 96, pp. 191-194Dewolfe, C.C., Apparent life-threatening event: A review (2005) Pediatr Clin North Am, 52, pp. 1127-1146. , ixKiechl-Kohlendorfer, U., Hof, D., Peflow, U.P., Traweger-Ravanelli, B., Kiechl, S., Epidemiology of apparent life threatening event (2004) Arch Dis Child, 90, pp. 297-300Shah, S., Sharieff, G.Q., An update on the approach to apparent life-threatening events (2007) Current Opinion in Pediatrics, 19 (3), pp. 288-294. , DOI 10.1097/MOP.0b013e32815745a9, PII 0000848020070600000010Zuckerbraun, N.S., Zomorrodi, A., Pitetti, R.D., Occurrence of serious bacterial infection in infants aged 60 days or younger with an apparent life-threatening event (2009) Pediatr Emerg Care, 25, pp. 19-25Gibb, S.M., Waite, A.J., The management of apparent life threatening events (1998) Current Paediatrics, 8 (3), pp. 152-156Brand, D.A., Altman, R.L., Purtill, K., Edwards, K.S., Yield of diagnostic testing in infants who have had an apparent life-threatening event (2005) Pediatrics, 115, pp. 885-893McGovern, M.C., Smith, M.B., Causes of apparent life threatening events in infants: A systematic review (2004) Arch Dis Child, 89, pp. 1043-1048Rivarola, M.R., Nunes, M.L., Jenik, A., Follett, F., Borghini, M., Mazzola, M.E., Pinho, A.P.S., Kanopa, V., Consensus document for the clinical evaluation and follow up of infants with an apparent life threatening event (ALTE) and its differential diagnosis with first seizure (2007) Journal of Epilepsy and Clinical Neurophysiology, 13 (2), pp. 51-57. , http://www.scielo.br/pdf/jecn/v13n2/a03v13n2.pdfEtxaniz, J.S., Burruchaga, M.S., Hermosa, A.G., Serrano, R.R., Beobide, E.A., Mantín, M.I., Características epidemiológicas y factores de riesgo de los episodios aparentemente letales (2009) An Pediatr, 71, pp. 412-418. , BarcAl-Kindy, H.A., Gélinas, J.F., Hatzakis, G., Côté, A., Risk factors for extreme events in infants hospitalized for apparent life-threatening events (2009) J Pediatr, 154, pp. 332-337Altman, R.L., Li, K.I., Brand, D.A., Infections and apparent life-threatening events (2008) Clin Pediatr, 47, pp. 372-378. , PhilaClaudius, I., Keens, T., Do all infants with apparent life-threatening events need to be admitted? (2007) Pediatrics, 119, pp. 679-683Vellody, K., Freeto, J.P., Gage, S.L., Collins, N., Gershan, W.M., Clues that aid in the diagnosis of nonaccidental trauma presenting as an apparent life-threatening event (2008) Clin Pediatr, 47, pp. 912-918. , PhilaPitetti, R.D., Whitman, E., Zaylor, A., Accidental and nonaccidental poisonings as a cause of apparent life-threatening events in infants (2008) Pediatrics, 122, pp. e359-62Bonkowsky, J.L., Guenther, E., Filloux, F.M., Srivastava, R., Death, child abuse and adverse neurological outcome of infants after an apparent life-threatening event (2008) Pediatrics, 122, pp. 125-131Steinschneider, A., Richmond, C., Ramaswamy, V., Curns, A., Clinical characteristics of an Apparant Life-Threatening Event (ALTE) and the subsequent occurrence of prolonged apnea or prolonged bradycardia (1998) Clinical Pediatrics, 37 (4), pp. 223-230Geib, L.T., Nunes, M.L., The incidence of sudden death syndrome in a cohort of infants (2006) J Pediatr, 82, pp. 21-26. , Rio JSemmekrot, B.A., Van Sleuwen, B.E., Engelberts, A.C., Joosten, K.F., Mulder, J.C., Liem, K.D., Survillance study of apparent life-threatening events (ALTE) in the Netherlands (2010) Eur J Pediatr, 169, pp. 229-236Ramanathan, R., Corwin, M.J., Hunt, C.E., Lister, G., Tinsley, L.R., Baird, T., Silvestri, J.M., Keens, T.G., Cardiorespiratory events recorded on home monitors: Comparison of healthy infants with those at increased risk for SIDS (2001) Journal of the American Medical Association, 285 (17), pp. 2199-2207Duffty, P., Bryan, M.H., Home apnea monitoring in "near-miss" sudden infant death syndrome (SIDS) and in siblings of SIDS victims (1982) Pediatrics, 70, pp. 69-74De Piero, A.D., Teach, S.J., Chamberlain, J.M., ED Evaluation of Infants after an Apparent Life-Threatening Event (2004) American Journal of Emergency Medicine, 22 (2), pp. 83-86. , DOI 10.1016/j.ajem.2003.12.00

Reexpansion Pulmonary Edema In Children [edema Pulmonar De Reexpansão Em Crianças]

Objective: To present a case of a patient with clinical and radiological features of reexpansion pulmonary edema, a rare and potentially fatal disease. Case description: An 11-year-old boy presenting fever, clinical signs and radiological features of large pleural effusion initially treated as a parapneumonic process. Due to clinical deterioration he underwent tube thoracostomy, with evacuation of 3,000 mL of fluid; he shortly presented acute respiratory insufficiency and needed mechanical ventilation. He had an atypical evolution (extubated twice with no satisfactory response). Computerized tomography findings matched those of reexpansion edema. He recovered satisfactorily after intensive care, and pleural tuberculosis was diagnosed afterwards. Comments: Despite its rareness in the pediatric population (only five case reports gathered), the knowledge of this pathology and its prevention is very important, due to high mortality rates. It is recommended, among other measures, slow evacuation of the pleural effusion, not removing more than 1,500 mL of fluid at once.313411415Mahfood, S., Hix, W.R., Aaron, B.L., Blaes, P., Watson, D.C., Reexpansion pulmonary edema (1988) Ann Thorac Surg, 45, pp. 340-345Genofre, E.H., Vargas, F.S., Teixeira, L.R., Vaz, M.A., Marchi, E., Reexpansion pulmonary edema (2003) J Pneumol, 29, pp. 101-106Sohara, Y., Reexpansion pulmonary edema (2008) Ann Thorac Cardiovasc Surg, 14, pp. 205-209Gleeson, T., Thiessen, R., Müller, N., Reexpansion pulmonary edema: Computed tomography findings in 22 patients (2011) J Thorac Imaging, 26, pp. 36-41Kesieme, E.B., Dongo, A., Ezemba, N., Irekpita, E., Jebbin, N., Kesieme, C., Tube thoracostomy: Complications and its management (2012) Pulm Med, , http://www.hindawi.com/journals/pm/2012/256878/cta/, [serial on the Internet] 2012 [cited 2012 Feb 20]. Available fromEchevarria, C., Twomey, D., Dunning, J., Chanda, B., Does re-expansion pulmonary oedema exist? (2008) Interact Cardiovasc Thorac Surg, 7, pp. 485-489Paksu, M.S., Paksu, S., Akgün, M., Kalayci, A.G., Baysal, K., Bilateral reexpansion pulmonary edema associated with pleural empyema: A case report (2011) Eur J Pediatr, 170, pp. 1205-1207Jardine, D.S., Reexpansion pulmonary edema (1991) Am J Dis Child, 145, pp. 1092-1094Chiang, M.C., Lin, W.S., Lien, R., Chou, Y.H., Reexpansion pulmonary edema following patent ductus arteriosus ligation in a preterm infant (2004) J Perinat Med, 32, pp. 365-367Ozlu, O., Kiliç, A., Cengizlier, R., Bilateral re-expansion pulmonary edema in a child: A reminder (2000) Acta Anaesthesiol Scand, 44, pp. 884-885Tung, Y.W., Lin, F., Yang, M.S., Wu, C.W., Cheung, K.S., Bilateral developing reexpansion pulmonary edema treated with extracorporeal membrane oxygenation (2010) Ann Thorac Surg, 89, pp. 1268-1271Fischer, G.B., Andrade, C.F., Lima, J.B., Pleural tuberculosis in children (2011) Paediatr Respir Rev, 12, pp. 27-30Cruz, A.T., Ong, L.T., Starke, J.R., Childhood pleural tuberculosis: A review of 45 cases (2009) Pediatr Infect Dis J, 28, pp. 981-984Conde, M.B., Melo, F.A., Marques, A.M., Cardoso, N.C., Pinheiro, V.G., Dalcin, P.T., III Diretrizes para tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia (2009) J Bras Pneumol, 35, pp. 1018-1048Krenke, R., Korczyński, P., Use of pleural fluid levels of adenosine deaminase and interferon gamma in the diagnosis of tuberculous pleuritis (2010) Curr Opin Pulm Med, 16, pp. 367-37

Exigências de lisina digestível e de energia metabolizável para codornas de corte em crescimento Digestible lysine and metabolizable energy requirements of growing meat quails

O objetivo neste trabalho foi estimar as exigências de lisina digestível e de energia metabolizável (EM) para codornas de corte (Coturnix coturnix sp) em crescimento. Foram utilizadas 1.680 codornas de 4 a 35 dias de idade, não-sexadas, em delineamento experimental inteiramente casualizado em esquema fatorial 4 × 4 (LD = 0,92; 1,12; 1,32 e 1,52% × EM = 2.800; 2.900; 3.000 e 3.100 kcal/kg de ração), totalizando 16 dietas, avaliadas com 3 repetições de 35 codornas por unidade experimental. O aumento dos níveis de lisina digestível na ração provocou aumento linear do peso corporal, do ganho de peso, do consumo de lisina e do rendimento de peito e redução do teor de água nos cortes. Quando houve aumento dos níveis de energia metabolizável na ração, observou-se redução linear no consumo de lisina e aumento do peso corporal e do rendimento de gordura abdominal. O aumento simultâneo dos níveis de lisina e energia metabolizável na ração, no entanto, provocou redução linear no consumo de ração e melhora linear da conversão alimentar no período de 4 a 35 dias, mas aumentou o teor de gordura nos cortes. A exigência nutricional de lisina digestível para máximo crescimento de codornas de corte é maior ou igual a 1,52%. O nível de 2.800 kcal/kg de EM na ração é suficiente para bom desempenho das aves, contudo, para melhor conversão alimentar, são necessário níveis mais elevados.<br>The objective of this experiment was to estimate the digestible lysine and metabolizable energy (ME) requirements for growing meat quails (Coturnix coturnix sp). A total of 1,680 quails from 4 to 35 days of age of both sexes were used in a complete random experimental design in a 4 × 4 factorial scheme (DL = 0.92; 1.12; 1.32 and 1.52% × ME = 2,800; 2,900; 3,000 and 3,100 kcal/kg of the ration) totaling 16 diets evaluated with 3 replications of 35 quails per experimental diet. Increase of the levels of digestible lysine in the diet linearly increased body weight, weight gain, lysine intake and breast yield and reduced water content in the cuts. When levels of metabolizable energy were increased in the diet, it was observed a linear reduction on consumption of lysine and an increase of body weight and abdominal fat yield. However, The simultaneous increase of levels of lysine and metabolizable energy in the diet linearly reduced feed intake and linearly improved feed conversion in the 4-35 day period, but it increased fat content in the cuts. The nutritional requirement of digestible lysine for maximum growth of meat quails is greater than or equal to 1.52%. The level of 2,800 kcal/kg ME in ration is sufficient to allow a good performance of the birds, however, for a better feed conversion, greater levels are needed