Recorded sessions on demand will be available 24 hours after the session ends

Abstract Body

Background, aims

A uniform description of brain MRI findings in severe congenital heart disease (CHD) infants to compare centers, predict outcome, assess risk factors and neuroprotective approaches is lacking. Primary objective was to uniformly describe the spectrum of perioperative brain MRI findings in CHD infants. Secondary aim was to assess differences in brain lesions between CHD subgroups.

Methods

Prospective observational studies were performed at 3 European centers between 2009-2019. Brain MRI was performed preoperatively and/or postoperatively in infants with transposition of the great arteries (TGA), single ventricle physiology (SVP) or left ventricular outflow tract obstruction undergoing cardiac surgery <6 weeks of life. Number, size/volume, location and signal intensity of brain lesions were scored on T1/T2/DWI/SWI/MRV. A subsample of images was assessed jointly to reach consensus. Brain lesions were compared between CHD subgroups.

Results

A total of 348 MRI-scans (180 preoperatively, 168 postoperatively, 146 serial) were performed in 202 infants. Preoperative, new postoperative and cumulative postoperative white matter injury was identified in 25/30/36%, arterial ischemic stroke (AIS) in 6/10/14%, hypoxic-ischemic watershed injury in 2/1/1%, intraparenchymal cerebral hemorrhage in 0/4/5%, cerebellar hemorrhage in 6/2/6%, intraventricular hemorrhage in 14/6/13%, subdural hemorrhage in 29/17/29% and sinovenous thrombosis in 0/10/10%, respectively. No differences in brain lesions among CHD subgroups were observed preoperatively, while new AIS were found more often in SVP infants compared to TGA postoperatively (29 vs 5%, p_FDR=0.01).

Conclusions

A broad spectrum of perioperative brain MRI findings is found in CHD infants. SVP is associated with the highest risk for new AIS postoperatively.

Abstract Body

Background and aims

Ileocolic intussusception is a common cause of bowel obstruction in infants, and enema reduction is the reference standard for its non-operative management. The aim of the study is to estimate if the administration of Midazolam (MDZ) before enema attempt, compared to no premedication, can improve the rate of procedure success.

Methods

We retrospective evaluated charts of all pediatric patients admitted for ileocolic intussusception in two Italian tertiary care Emergency Departments. We reviewed demographic characteristics, clinical presentation, ultrasounds and contrast enema images. Patients were divided into two groups according to the use of MDZ or not (nonMDZ group) before hydrostatic reduction attempt. Outcome measures were success rate of the enema, recurrence and need for surgery.

Results

Sixty-nine patients and 37 were included in MDZ and nonMDZ groups, respectively. No significative differences were found between the two groups in terms of baseline characteristics, including sex, age, clinical characteristics and ultrasound parameters. Intussusception reduction after first enema attempt was observed in 51(75.0%) patients in MDZ group vs 12(32.4%) patients in nonMDZ group (p<.001). Intussusception recurred in 2(3.9%) vs 3(25.0%) patients, respectively (p=.015). Nineteen (27.9%) vs 28(77.8%) patients underwent surgery, respectively (p<.001). Logistic regression analysis showed that MDZ was the only significant favoring factor for reduction (OR 6.250, 95%CI 2.591–15.074, p<.001)

Conclusion

Despite the evidence of the usefulness of analgesic agents for the reduction of intussusception, this procedural sedation is still underperformed. Our results strongly suggest a role of MDZ as favoring factor of enema reduction in ileocolic intussusception.

Abstract Body

Objective: The use of extracorporeal cardiopulmonary resuscitation (E-CPR) is increasing. ECPR is defined by initiation of ECMO during active chest compressions. It's main goal is to provide immediate cardiovascular support for patients who do not react to CPR measures.

Methods: It is a retrospective study of all children with sudden and refractory cardiac arrest who were treated with ECPR at University Hospital Centre Zagreb between January 2011 and June 2019. We retrospectively analyzed data collected from 16 children and have used a demographic data, etiology and location of arrest, location of setting the ECMO run, type of ECMO, the time of bypass, and the use of hemodialysis.

Results: In the observed period, 16 patients were started with ECMO support during CPR. Four of them arrested out-of-hospital (OHCA), and in 12 of them an in-hospital arrest (IHCA) occurred. Median age at starting CPR in our cohort was 5 months (interquartile range; IQR 1 - 67 months), median weight was 4.7 kg (IQR 3.225 - 14.58 kg), height 57 cm (IQR 52 - 95.5 cm) and body surface area 0.275 m² (IQR 0.22 - 0.63 m²). Among all ECPR patients, in four of them ECPR was started by bystanders in out-of hospital settings (OHCA), and three of them were successfully weaned from ECMO. Hemodyalisis was used in 12 patients.

Conclusion: Our overall results are similar to other published studies, which is a key to maintain the ECMO program in our hospital with improvement we are trying to make with every patient.

Abstract Body

Background and aims:

Prolonged seizures are life-threatening emergencies associated with significant morbidity. We aimed to assess the efficacy and safety of levetiracetam in children 0-18 years, compared to other anticonvulsants in the treatment of convulsive status epilepticus.

Methods:

PubMed, EMBASE, the Cochrane Central Register for control trials, and CINAHL was searched for randomized control trials from inception to April 2020. The pooled relative risk or the mean difference for the following outcomes were calculated: clinical cessation and duration to terminate seizure activity, the need for intubation, intensive care unit admission, adverse events, and all-cause mortality.

RESULTS:

11 RCTs (n=2007) identified found no significant differences with regards to cessation of seizures when levetiracetam was compared to; phenytoin (RR= 1.03, 95% CI 0.98 to 1.09), fosphenytoin (RR= 1.16, 95% CI 1.00 to 1.35), or valproate (RR= 1.10, 95% CI 0.94 to 1.27).

No significant differences in duration to abort seizures when levetiracetam was compared to; phenytoin (MD= -0.45, 95% CI -1.83to 0.93), or fosphenytoin (MD= -0.70, 95% CI -4.26 to 2.86).

A significant difference in the need for RSI was found only when levetiracetam was compared to fosphenytoin (RR = 0.28, 95% CI 0.14 to 0.58).

There were no significant differences between levetiracetam and other anticonvulsants in relation to ICU admissions, adverse events, and all-cause mortality.

CONCLUSION:

Levetiracetam is safe and effective compared to other anticonvulsants in the treatment of convulsive status epilepticus.

Abstract Body

Abstract: Ventricular septal defect (VSD) is the most common congenital heart disease. It is known that quality of life (QOL) concept for patients is increasingly used to characterize the course of various chronic forms of heart pathology.

The study aim was to assess the quality of life (QOL) in children operated for VSD.

Method: A survey was conducted of 51 children with VSD of 3-17 years old (median age of 9 years (interquartile range (IQR)ː 5-12 years)), as well as their parents using the Russian-language version of the international tool Pediatric Quality of Life Inventory (PEDsQL) 3.0 Cardiac Module. Most authors have considered a score of less than 70 is an indicator of a reduced QOL.

Results: In children with VSD, the perception of the QOL in the overall score was significantly higher (median = 80.2, IQR = 59.8–88) than the perception of their parents (median = 62.7, IQR = 40.1–77.2) (p = 0.049). In children with VSD, the QOL was significantly higher in terms of heart symptoms (p = 0.017), anxiety associated with treatment (p = 0.006), and communication skills (p = 0.037) than scores assigned by parents.

Conclusions: Children QoL scores were higher than scores assigned by parents. Parents perceive the QOL of children as impaired. In order to provide highly specialized care, in addition to clinical assessment, the quality of life directly determined by the child should be an important aspect in the complex treatment of VSD.