Adrenocortical status in infants and children with sepsis and septic shock

AbstractBackgroundThe benefit from corticosteroids remains controversial in sepsis and septic shock and the presence of adrenal insufficiency (AI) has been proposed to justify steroid use.AimTo determine adrenal state and its relation with outcome in critical children admitted with sepsis to PICU of Cairo University, Children Hospital.MethodsThirty cases with sepsis and septic shock were studied. Cortisol levels (CL) were estimated at baseline and after high-dose short ACTH stimulation in those patients and in 30 matched controls. Absolute AI was defined as basal CL<7μg/dl and peak CL<18μg/dl. Relative AI was diagnosed if cortisol increment after stimulation is <9μg/dl.ResultsOverall mortality of cases was 50%. The mean CL at baseline in cases was higher than that of controls (51.39μg/dl vs. 12.83μg/dl, p=0.000). The mean CL 60min after ACTH stimulation was higher than that of controls (73.38μg/dl vs. 32.80μg/dl, p=0.000). The median of %rise in cases was lower than that of controls (45.3% vs. 151.7%). There was a positive correlation between basal and post-stimulation cortisol with number of system failure, inotropic support duration, mechanical ventilation days, and CO2 level in blood. There was a negative correlation between basal and post stimulation cortisol with blood pH and HCO3.ConclusionRAI is common with severe sepsis/septic shock. It is associated with more inotropic support and has higher mortality. Studies are warranted to determine whether corticosteroid therapy has a survival benefit in children with RAI and catecholamine resistant septic shock

Prevalence of Human rhinovirus infection in young children with acute wheezing

Introduction: Recurrent wheezing is one of the leading causes of chronic illness in childhood. We aimed to evaluate the prevalence of Human Rhinovirus (HRV) infection in the acute attack of wheezy chest which began after a respiratory illness. Methodology: The study was conducted on 200 children aged 2 months to 5 years presenting to the emergency department with an acute wheezy episode either for the first time or recurrent wheeze defined as >2 reports of wheezing in the first 3 years of life. All subjects were subjected to a complete history and clinical examination. Chest X-ray was done to all subjects. Nasopharyngeal and oropharyngeal swabs were obtained from all subjects and the presence of HRV was determined by PCR examination. Results: By PCR method, 163 patients (81.5%) were positive for viral infection. Due to viral co-infection, 49.5% (99 cases) were +ve for Respiratory Syncytial virus followed by HRV 43.5% (87 cases). Conclusion: HRV was the second common viral infection in children with wheezes. Its prevalence was more in winter with higher incidence of recurrence. Compared to the other respiratory viruses, it had the higher mortality 43.7%. Keywords: Asthma, Rhinovirus infection, Wheeze

Occult blood in stool in exclusively formula fed infants versus exclusively breast fed infants in the first six months of life

Background: Since most of infant’s formula are based on cow’s milk to which allergy can occur, and considering the neurodevelopmental consequences of iron deficiency during infancy; we aimed to verify the occurrence of occult intestinal blood loss during the first 6 months of life in response to being fed cow’s milk based formula versus breast milk. We also studied the iron status in order to assess prevalence of iron deficiency anemia. Methods: Healthy full term infants from birth to 6 months who were either exclusively breast fed (BF) (n = 50) or formula fed (FF) (n = 50) were considered for enrollment. Detailed questionnaire describing perinatal period was taken from the mothers. Complete blood count, serum iron, total iron binding capacity (TIBC), serum transferrin and occult blood in stool were requested for each infant. Results: We reported no significant differences in hemoglobin, hematocrit and MCV between both groups. FF infants had higher levels of TIBC. We found that 4/50 FF infants had positive occult blood in stool; while only 1/50 BF infants was positive. The prevalence of iron deficiency anemia was higher in the FF group (14%) rather than in the BF group (8%). Conclusion: Although iron content in formula is higher than breast milk, BF infants attained better iron status than FF infants and the prevalence of anemia among the FF group was higher

Application of different scoring systems and their value in pediatric intensive care unit

Background: Little is known on the impact of risk factors that may complicate the course of critical illness. Scoring systems in ICUs allow assessment of the severity of diseases and predicting mortality. Objectives: Apply commonly used scores for assessment of illness severity and identify the combination of factors predicting patient’s outcome. Methods: We included 231 patients admitted to PICU of Cairo University, Pediatric Hospital. PRISM III, PIM2, PEMOD, PELOD, TISS and SOFA scores were applied on the day of admission. Follow up was done using SOFA score and TISS. Results: There were positive correlations between PRISM III, PIM2, PELOD, PEMOD, SOFA and TISS on the day of admission, and the mortality rate (p < 0.0001). TISS and SOFA score had the highest discrimination ability (AUC: 0.81, 0.765, respectively). Significant positive correlations were found between SOFA score and TISS scores on days 1, 3 and 7 and PICU mortality rate (p < 0.0001). TISS had more ability of discrimination than SOFA score on day 1 (AUC: 0.843, 0.787, respectively). Conclusion: Scoring systems applied in PICU had good discrimination ability. TISS was a good tool for follow up. LOS, mechanical ventilation and inotropes were risk factors of mortality

Fatal acute myocarditis and fulminant hepatic failure in an infant with pandemic human influenza A, H1N1 (2009) virus infection

We report the clinical presentation of a 10 month-old infant who succumbed with acute myocarditis and fulminant hepatic failure associated with a virologically confirmed human influenza A, H1N1 (2009) virus infection. To date, this is the first pediatric patient presenting with this fatal combination of complications during the current H1N1 pandemic. Therefore, we recommend meticulous assessment and follow up of the cardiac status, liver enzymes and coagulation profile in all pediatric patients with severe H1N1 influenza infection

Blood zinc levels in children hospitalized with pneumonia: A cross sectional study

Background: Recent works have provided conflicting evidence on the role of zinc in acute lower respiratory infection (ALRI). Objective: We aimed to study the relation between blood zinc levels and severity of pneumonia. Patients and methods: A retrospective study was conducted in the Cairo University Pediatric Hospital, to assess serum zinc levels in 40 Egyptian children, aged 3–144 months, admitted with the diagnosis of pneumonia. Half of them were admitted in the general ward and the other half were admitted in the pediatric ICU. Results: Males (67.5%) were more affected by ALRI than females. The mean serum zinc in patients was normal (80.33 + 25.3 μg/dL) yet, the mean serum zinc level in PICU patients was lower than that of general ward patients (p = 0.001). Conclusion: We concluded that the lower the serum zinc level, the higher the grade of respiratory distress among children with pneumonia