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Background and aims: Optimal fluid resuscitation in paediatric septic shock is critical to prevent fluid overload. Current practice is not supported by robust clinical evidence. We aim to present and discuss the findings of clinical studies evaluating fluid resuscitation in septic shock.

Methods: In accordance with the PRISMA guidelines, we performed a search of MEDLINE via PubMed, yielding 1659 results, which were independently reviewed to identify papers which met our eligibility criteria: We included studies conducted in paediatric populations, where at least one cohort received a fluid bolus as treatment for septic shock. Non-English studies and those where the full-text was unavailable were excluded. Data was extracted from eligible studies for analysis.

Results: 13 studies met our selection criteria, including 6 observational studies, 4 RCTs, 2 feasibility studies and 1 sub-analysis. The 1991 landmark study advocated volume boluses in excess of 40mL/kg, but emerging evidence recommends a moderate fluid bolus of 20-40mL/kg in the first hour. The recent FEAST RCT reported increased 48-hour mortality with saline-bolus compared to fluid maintenance (10.5% vs. 7.3%). Early vasopressor use was associated with reduced mortality (1.5 vs. 7.4h). Two studies found crystalloids and colloids equally effective, achieving similar haemodynamic stability and mortality rates (saline vs. gelatin polymer; 29% vs. 31%). There was significant heterogeneity in outcomes between studies, rendering collective interpretation unreliable.

Conclusion: We recommend the use of an initial controlled crystalloid bolus, followed by escalation to a fluid-sparing strategy commencing inotropes early in paediatric septic shock.

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Background/aims: Child maltreatment has a negative impact on individuals and society and remains difficult to identify. We evaluated the different policies to recognize child maltreatment in emergency departments (EDs) in Europe in order to define areas of improvement.

Methods: A survey was conducted on child maltreatment recognition in European EDs focusing on screening methods, training, parental risk factors and hospital policies. The survey was distributed through REPEM, EuSEN and EUSEM key members. A score based on the NICE guideline (4 questions on child characteristics, 4 questions on parental characteristics, 5 questions on hospital policy) was calculated.

Results: We analysed 185 completed surveys, representing 148 hospitals from 29 European countries. Of the respondents, 51% had a standardized child maltreatment policy, 29% used a screening tool, and 32% had guidelines on parental risk factors. 42% did not follow training on child characteristics, nor did 58% on parental characteristics. 72% of the respondents indicated that there was a need for training. Translating survey results to NICE scores revealed that, of the EDs in Europe, 26% (34/133) met most (≥75% of maximum score) and 52% (69/133) met few (<50% of maximum score) of the NICE guideline recommendations on child maltreatment.

Conclusion: There is a high variability in policies for child maltreatment detection and only a quarter of the EDs met most of the NICE guideline recommendations. There is a need for screening tools, training of ED staff and implementation of local hospital policies in order to improve recognition of child maltreatment in the ED.

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Background and aims

Poor parent socioeconomic status is associated with adverse birth outcomes, such as preterm birth and small for gestational age (SGA). However, it is not clear whether medical advances and changes in perinatal care have led to decreased associations between socioeconomic inequalities and adverse birth outcomes over the past decades.

Methods

Data from three UK cohort studies were used: the 1958 National Child Development Study (NCDS58), the 1970 British Cohort Study (BCS70), and the 2000-2002 Millennium Cohort Study (MCS2000). Preterm birth was categorised as birth < 37 weeks of gestation. SGA was calculated using information on birth weight and gestational age. Information on family socioeconomic characteristics, parental education, and other potential risk factors, such as cohabiting, maternal age, multiple birth, and maternal smoking during pregnancy, were included.

Results

Lower parental education and low family socioeconomic status were independently associated with preterm birth in the NCDS58 and BCS70, respectively. Further, low family socioeconomic status but not lower parental education were independently associated with SGA in both the NCDS58 and BCS70. In the MCS2000, which included births 30 years later, neither low family socioeconomic status nor lower parental education were associated with a higher risk for preterm birth or SGA in adjusted models (ps > 0.05).

Conclusions

Lower socioeconomic status and parental education were important risk factors for preterm birth and SGA in 1958 and 1970. However, these associations have diminished between the birth years 1970 and 2000.

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Aim: This study describes the epidemiology of severe injuries related to trauma in children and assesses potential preventive areas.

Methods: Single-center retrospective study of pediatric trauma patients admitted to a pediatric Intensive Care Unit (ICU) in a tertiary university hospital in Europe, from 2009 to 2019.

Results: 358 patients were included (age 11±4,9 years; 67% male); of which 269 (75%) were involved in road traffic accidents, 108 (30%) as car occupants, 89 (25%) pedestrians, and 36 (10%) cyclists and motorcyclists each. Falls from height injured 68 (19%) children, 14 (4%) during sports activities. Main lesions were head and neck (n=260 patients, 73%) and extremities (n=151 patients, 42%) injuries. All fatalities (n=6; 1,7%) were related to head and neck injuries. Car occupant accidents affected younger children (9 vs 12 years, p=0,001), resulted in higher need for blood transfusion (9 vs 2 mL/kg, p=0,006) and the highest ICU-mortality (n=5, 83%). Children in motorcycle accidents had longer ICU length-of-stay (6,4 vs 4,2 days, p=0,036). Compared to other road traffic and fall accidents, pedestrians had 25% higher risk of head and neck injuries (RR 1,25; 1,07-1,46; p=0,004), and higher incidence of severe brain injury (46% vs 34%, p=0,042). Most children in motor-vehicle/bicycle accidents were not using restraints/protective devices (45%) or were using them inappropriately (13%).

Conclusion: Road traffic accidents remain the leading cause of severe pediatric trauma. Motor-vehicle injuries are associated with longer ICU care and higher mortality. Pedestrians are at greatest risk for head/neck injuries. Appropriate use of child restraints and protective equipment remain key for prevention.