SHORT ORAL PRESENTATION
Chairs
  • Aparna Hoskote, United Kingdom
  • Peter Rimensberger, Switzerland
Room
Mozart Hall 1
Date
19.06.2019
Session Time
13:40 - 15:10

Session Webcast

METHYLENE BLUE ADMINISTRATION FOR DISTRIBUTIVE SHOCK STATES IN CRITICALLY-ILL CHILDREN

Presenter
  • Yuval Bitterman, Israel
Authors
  • Yuval Bitterman, Israel
  • Amir Hadash, Israel
  • Josef Ben-Ari,
  • Danny Eytan,
Room
Mozart Hall 1
Date
19.06.2019
Session Time
13:40 - 15:10
Duration
7 Minutes

Abstract

Background

Methylene Blue (MB), an inhibitor of Nitric Oxide synthesis and its effects, is a potential effective treatment in distributive shock states such as septic shock, vasoplegic syndrome and during or after cardiopulmonary bypass. MB has been shown to alleviate the vasoplegia, promote an increase in mean arterial pressure (MAP) and might even reduce mortality. However, in the pediatric population, there are only a few case reports on administration of MB in sepsis or shock in general.

Objectives

We present a collection of seven pediatric cases treated with MB for vasoplegic shock, comprising the largest case series published so far in children.

Methods

A retrospective review of charts of patients treated with MB in our pediatric intensive care unit during the past 5 years.

Results

We observed a favorable hemodynamic response with an increase in blood pressure and a reduction in the vasopressor and inotropic support needed following methylene blue administration for most patients (figure 1). Of note, no side effects were encountered in our case series.

figure 1.jpg

Conclusion

Our results add to the small body of evidence in the pediatric population supporting the use of MB for distributive shock states and emphasize the need for larger, randomized trials to test its treatment potential in this context.

Brown, SM, MJ Lanspa, JP Jones, et al., Survival after shock requiring high-dose vasopressor therapy. Chest, 2013 143(3): p. 664-671.10.1378/chest.12-1106
Eytan, D, AJ Goodwin, R Greer, AM Guerguerian,PC Laussen, Heart Rate and Blood Pressure Centile Curves and Distributions by Age of Hospitalized Critically Ill Children. Front Pediatr 2017. 5: p. 52.10.3389/fped.2017.00052

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MYOCARDIAL STRAIN IN VASCULAR ANOMALIES WITH SEVERE UPPER AIRWAY OBSTRUCTION: PRELIMINARY RESULTS

Presenter
  • Anna Claudia Massolo, Italy
Authors
  • Anna Claudia Massolo, Italy
  • Francesco Morini, United States of America
  • Ferdinando Savignoni, United States of America
  • Francesca Monaco, United States of America
  • Paola Giliberti, United States of America
  • Marco Campanale, United States of America
  • Alessandra Toscano, United States of America
  • Pietro Bagolan, United States of America
  • Andrea Dotta, United States of America
  • Annabella Braguglia, United States of America
Room
Mozart Hall 1
Date
19.06.2019
Session Time
13:40 - 15:10
Duration
7 Minutes

Abstract

Background

Vascular anomalies (VA) may cause in some cases severe tracheomalacia. Chronic upper airway obstruction (UAO) is the most common symptom. Increased pulmonary pressure and cardiac dysfunction have been described in patients with chronic UAO, but not in infants with VA-associated UAO.

Objectives

To evaluate myocardial strain in infants with VA-associated UAO.

Methods

Demographic characteristics, respiratory symptoms and the percentage of tracheal obstruction measured on CT were collected. Left and right ventricle (LV, RV) systolic function were measured with speckle tracking longitudinal strain analysis (LS). Pulmonary artery pressure (PAP) was evaluated on tricuspid regurgitation jet (TR) and quantified by end-systolic eccentricity index (EI).

Results

15 cases were included, of which six had a tracheal occlusion <50%, and nine >50%. Cases with tracheal occlusion >50% had significantly more pronounced respiratory symptoms and LV and RV function were significantly reduced compared to those with occlusion <50% (LV -15.9% vs -19.9%; RV -15.7% vs -20.5%, respectively). Degree of UAO did not seem to have a significant impact on PAP.

Conclusion

In cases with VA with severe tracheomalacia RV and LV myocardial strain are reduced, suggesting myocardial impairment. Future studies with larger sample size are needed to confirm these data and investigate cardiac function. Association with lung function test may be investigated too.

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THE ROLE OF CONTINUOUS EEG MONITORING IN CHILDREN ADMITTED TO A CARDIAC INTENSIVE CARE UNIT  

Presenter
  • Davinder Singh, United Kingdom
Authors
  • Davinder Singh, United Kingdom
  • Maria Chalia,
  • Simon Hannam,
  • Aparna Hoskote, United Kingdom
  • Ronit Pressler,
Room
Mozart Hall 1
Date
19.06.2019
Session Time
13:40 - 15:10
Duration
7 Minutes

Abstract

Background

Patients on extracorporeal membrane oxygenation (ECMO) or following cardiac surgery are at a high risk of neurological complications, including intracranial haemorrhage, stroke and seizures and, therefore, at risk of future neurodisability. EEG is often utilised as a neuromonitoring tool in the Cardiac Intensive Care Unit (CICU) as children are sedated and muscle relaxed. However, continuous electroencephalogram (EEG) is not employed routinely.

Objectives

We evaluated our practice with the aim to reach a consensus in duration of EEG monitoring.

Methods

All patients who received EEG monitoring on CICU while on ECMO or following cardiac surgery from 01/11/2017 until 31/10/2018 were included. Data was collected retrospectively from patients’ clinical notes and the Clinical Neurophysiology database.

Results

Sixty-four patients were identified: 29(45%) on ECMO and 35(55%) post-op. Median age was 7 months (1 day-15 years). Out of the 120 EEG recordings, the majority (n=101, 84%) were less than an hour in duration, and 19 (16%) were prolonged ranging from 2 to 72 hours. Seven had seizures detected on EEG with or without clinical signs (3 electrographic and 4 electro-clinical) and 5 were detected during prolonged EEG recordings. Antiepileptic drugs were administered in 9 children following strong clinical suspicion. None of the subsequent recordings detected seizure activity.

Conclusion

This small study highlights the importance of a standardised approach to prolonged or continuous EEG monitoring for certain high-risk patient groups. Not only does it lead to seizure detection but also strengthens the assessment of neurological status and detection of potential asymmetries prompting appropriate neuro-imaging.

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LONG TERM OUTCOMES IN INFANTS DIAGNOSED WITH CHRONIC PULMONARY HYPERTENSION: 10-YEAR RETROSPECTIVE STUDY FROM A SINGLE CENTRE 

Presenter
  • Emma Chen, United Kingdom
Authors
  • Emma Chen, United Kingdom
  • Yogen Singh, United Kingdom
Room
Mozart Hall 1
Date
19.06.2019
Session Time
13:40 - 15:10
Duration
7 Minutes

Abstract

Background

Chronic pulmonary hypertension (PH) has been reported to be associated with high morbidity and mortality.

Objectives

1. To understand the pathophysiology of chronic PH in infancy.

2. To study the long-term outcomes in infants diagnosed with PH during infancy.

Methods

A single centre retrospective observational study involving all infants admitted to NICU between 1/1/07 to 1/8/18 and diagnosed with pulmonary hypertension. Data was collected from electronic patient records. Infants with persistent pulmonary hypertension of the newborn were excluded.

Results

A total of 34 infants were diagnosed with PH during this period. The most common association was bronchopulmonary dysplasia (BPD) in 53% cases; details of pathophysiology are summarised in figure 1.

figure 1 - pathophysiology of pulmonary hypertension.jpg

28 infants (82%) received sildenafil, a pulmonary vasodilator, for treatment of PH in this cohort. It was effective (PH resolved or improved) in 57% cases (table 1).

Table 1: Response to sildenafil treatment
Response Total no. patients Non-BPD associated PH BPD associated PH
Resolved 8 (28.5%) 6 (43%) 2 (14%)
Improved 8 (28.5%) 3 (21.5%) 5 (36%)
Stable 3 (11%) 2 (14%) 1 (7%)
No response 9 (32%) 3 (21.5%) 6 (43%)

Overall mortality was 56% (19/34). The long-term outcomes were poorer in PH associated to BPD, with 67% mortality in the BPD group, compared to 44% in the non-BPD group.

Conclusion

Pulmonary hypertension was most commonly associated with BPD when diagnosed during infancy, and in these cases, the risk of mortality is even higher. There is an urgent need of a screening programme for early detection of PH in infants with BPD and study of their outcomes prospectively.

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WHAT ARE THE NON-CARDIAC PROGNOSTIC FACTORS AFFECTING MORTALITY IN NEONATES WITH AORTOPULMONARY SHUNT

Presenter
  • FERDA Özlü, Turkey
Authors
  • FERDA Özlü, Turkey
  • Sevcan Erdem,
  • Uğur Göçen, Turkey
  • Fadli Demir,
  • Atakan Atalay,
  • Mustafa Akçalı,
  • Nazan Özbarlas,
  • Mehmet Satar,
Room
Mozart Hall 1
Date
19.06.2019
Session Time
13:40 - 15:10
Duration
7 Minutes

Abstract

Background

Systemic to pulmonary shunts (SPS) have proven to be highly effective for the palliation of neonates with cyanotic congenital heart disease. Mortality after SPS surgery in neonates has multifactorial basis

Objectives

We aimed to investigate the clinical results of the SPS in relation to the underlying cardiac disease and to identify the risk factors contributing to an adverse outcome

Methods

All neonates who underwent first shunt insertion for cyanotic congenital heart disease during the study period from 1 January 2014 to 31 December 2017 were included. A retrospective review of patient records was done. Patients were grouped into 2 different categories: survived with or without any reintervention and death before or after any reintervention till discharge

Results

During the study period, 47 patients underwent SPS shunt placement. Preoperative epinephrine requirement and mechanical ventilation and postoperative erythrocyte transfusion need were statistically significant

Conclusion

Although primary cardiac pathology is the most important prognostic factor, some other preoperative and postoperative factors might also affect the prognosis. As there are very few centers in the region that specialize in pediatric cardiac surgery, a multi-center approach will be helpful in reaching reliable conclusion

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