Prolonged Dexmedetomidine Infusion and Drug Withdrawal In Critically Ill Children.

To characterise the incidence, symptoms and risk factors for withdrawal associated with prolonged dexmedetomidine infusion in paediatric critically ill patients.info:eu-repo/semantics/publishe

Mycoplasma pneumoniae Infection in a 13-Year-Old Girl With Down’s Syndrome During the COVID-19 Pandemic

We report the case of a 13-year-old girl with Down’s syndrome who presented with cough, fever, and a rapidly evolving respiratory failure leading to intensive care unit transfer during coronavirus disease 2019 (COVID-19) outbreak in Belgium. COVID-19-related acute respiratory distress syndrome (ARDS) is rare in teenagers and its diagnosis remains challenging as reverse transcription-polymerase chain reaction (RT-PCR)-testing sensitivity and radiological criteria still have to be defined in that population. We finally concluded to severe Mycoplasma pneumoniae infection. This case report gives the opportunity to discuss the rare occurrence of that disease, and to review the radiological findings of M. pneumoniae- and COVID-19-related pneumonia in teenagers

Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery: A Randomized Clinical Trial.

BACKGROUND: In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. METHODS: In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml · kg PlasmaLyte or 15 ml · kg FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra- and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. RESULTS: Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml · kg (5.1, 9.4) in the FFP group and 5.7 ml · kg (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (-0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. CONCLUSIONS: The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products

Fresh Frozen Plasma versus

BACKGROUND: In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. METHODS: In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml · kg PlasmaLyte or 15 ml · kg FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra- and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. RESULTS: Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml · kg (5.1, 9.4) in the FFP group and 5.7 ml · kg (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (-0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. CONCLUSIONS: The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products

Esophageal Trachea, a Unique Foregut Malformation Requiring Multistage Surgical Reconstruction: Case Report.

Abnormal connections between the esophagus and low respiratory tract can result from embryological defects in foregut development. Beyond well-known malformations, including tracheo-esophageal fistula and laryngo-tracheo-esophageal cleft, rarer anomalies have also been reported, including communicating bronchopulmonary foregut malformations and tracheal atresia. Herein, we describe a case of what we have called "esophageal trachea," which, to our knowledge, has yet to be reported. A full-term neonate was born in our institution presenting with a foregut malformation involving both the middle esophagus and the distal trachea, which were found to be longitudinally merged into a common segment, 3 cm in length, located just above the carina and consisted of esophageal tissue without cartilaginous rings. At birth, the esophagus and trachea were surgically separated via right thoracotomy, the common segment kept on the tracheal side only, creating a residual long-gap esophageal atresia. The resulting severe tracheomalacia was treated via simultaneous posterior splinting of such diseased segment using an autologous pericardium patch, as well as by anterior aortopexy. Terminal esophagostomy and gastrostomy were created at that stage due to the long distance between esophageal segments. Between ages 18 and 24 months, the patient underwent native esophageal reconstruction using a multistage traction-and-growth surgical strategy that combined Kimura extra-thoracic esophageal elongations at the upper esophagus and Foker external traction at the distal esophagus. Ten months after esophageal reconstruction, prolonged, refractory, and severe tracheomalacia was further treated via anterior external stenting using a semitubular ringed Gore-Tex® prosthesis, through simultaneous median sternotomy and tracheoscopy. Currently, 2 years after the last surgery, respiratory stabilization, and full oral feeding were stably achieved. Multidisciplinary management was crucial for assuring lifesaving procedures, correctly assessing anatomy, and planning for multiple sequential surgical approaches that aimed to restore long-term respiratory and digestive functions

Population pharmacokinetics and dosing simulation of the β-lactam temocillin in liver transplanted pediatric patients

Background Temocillin, a carbapenem-sparing β-lactam antibiotic, is useful for the empirical treatment or prophylaxis of Gram-negative bacterial infections in liver-transplanted children. Here, we characterize the total and unbound plasma pharmacokinetics (PK) of temocillin in this population, to propose optimized and personalized dosing regimens based on patient characteristics. Methods Patients aged 6-36 months received 25 mg/kg/12h (standard dose) or 25 mg/kg/8h (high dose) temocillin intravenously. Blood samples were collected after the 4th and 8th doses and temocillin concentrations in plasma were measured via a validated LC-MS/MS method. Clinical safety was monitored. Non-compartmental and population PK analyses were performed, together with Monte-Carlo simulations. Probability of target attainment (PTA) calculations were based on a PKPD target of >40% fT>MIC (% time of the dosing interval with unbound drug concentrations above the minimal inhibitory concentration) Results For 25 mg/kg/12h, Cmax and Cmin were 108 ± 22 and 8 ± 4 mg/L (total concentrations), and 38 ± 16 and 2 ± 1 mg/L (unbound concentrations), respectively. For 25 mg/kg/8h, Cmax was similar, but Cmin was increased to 22 ± 8 and 5 ± 3 mg/L for total and unbound concentrations, respectively. Temocillin PK was best described by a two-compartment model with first-order elimination, with body weight and glomerular filtration rate (GFR) as significant covariates. Monte-Carlo simulations suggested that PTA was achieved in 90% of the population for (a) MICs 25 mg/kg/8h) could further improve PK/PD target attainment, yet caution is warranted as their clinical safety remains unknow