Background

Bacterial meningitis(BM) is a severe complication in oncological patients. Cerebroespinal fluid (CSF) lactate is a prompt indicator of (BM). It is considered that intrathecal treatment or meningeal infiltration, in pediatric oncology patients, can alter lactate levels on CSF. There are no studies on this regard in this type of patients

Objectives

Establish if there is a significant difference between CSF lactate levels in pediatric patients under intrathecal chemotherapy treatment and non-oncological patients

Methods

A prospective analytical study of CSF lactate levels in 50 pediatric oncology patients with intrathecal therapy and 130 non-oncological patients was conducted. A lumbar puncture was performed in all these patients to obtain CSF.

Results

Lactate levels in oncology patients were 11,29 mg/dl (+/- /2.9 mg/dl) whilst in non –oncological patient lactate level results were of 11,43 mg/dl (2,81 mg/dl). No significant differences were discovered (P = 0,784) (CI 95% means difference: 1,11 to 0,85 mmol/L).

Protein , glucose, cell count were similar too in both groups.

Conclusion

No significant differences in CSF lactate between oncological and non-oncological pediatric patients were discovered (found).
This study reveals that lactate CSF levels can be used as an early (prompt) indicator of bacterial meningitis in oncological patients.

Background

Currently most treatments offered on PICU are not evidence based and research in PICU’s have unique challenges¹. Despite its challenges, research has increasingly involved large studies of a multi-centre design. Generating adequate funding for expensive studies is competitive, requiring a highly professional approach. There are currently numerous multi-centre studies being carried out on PICU patients in the UK. Prior to 2018 there was no embedded research unit in PICU at Bristol Royal Hospital for Children and any participation in research was on an ad-hoc basis.

Objectives

To share a single centre’s experience of starting an embedded research team within PICU.

Methods

Charity funding was found to pump prime the initial funding of a clinical research nursing (CRN) team. An overview of the research activity in the first year of starting the research team is presented along with budget requirements.

Results

Two 0.5 WTE band 6 PIC nurses were recruited into the CRN team. From January –December 2018 a total of 647 patients were recruited into 6 National Institute of Health Research (NIHR) studies. Revenue generated has enabled the appointment of trial co-ordinator to support CRN. The CRN’s have been supported to carry out their own research projects.

Conclusion

Embedding a research team into a PICU is paramount to ensure ongoing quality research can be conducted. The team ensured the studies were carried out alongside developing the team.

Background

Periodic infant health screening is useful to assess growth and development in the pediatric population.

Objectives

This study evaluated the prevalence of iron deficiency anemia in infants aged 9–12 months to determine differences in this condition between term and preterm infants.

Methods

This study included infants aged 9–12 months who underwent infant health screening and immunization at the outpatient clinics of Chung-Ang University Hospital between January 2006 and December 2016 (n=165). We defined iron deficiency anemia as a serum ferritin level <15 ug/L.

Results

This study included 165 infants, with a mean gestational age of 36.8±3.9 weeks and a mean birth weight of 2.8±0.7 kg. The mean gestational age of the preterm group (n=39) was 31.5±3.1 weeks, and the mean birth weight of this group was 1.7±0.6 kg. Iron deficiency anemia was diagnosed in 34 infants (26.9%), and of these 34 infants, 32 (36.8%) belonged to the term group and 2 (5.1%) belonged to the preterm group, which was a statistically significant finding (p <0.05). A statistically significant intergroup difference was observed in serum hemoglobin, hematocrit, and iron levels and in the unsaturated iron binding capacity (p<0.05).

Conclusion

Preterm infants may show a lower prevalence of iron deficiency anemia than term infants because they tend to receive prophylactic iron supplementation. Therefore, periodic blood tests need to be performed in infants aged 9–12 months to rule out iron deficiency anemia and provide iron supplementation if necessary to prevent iron deficiency anemia in term infants.

Background

Managing the stress of medical staff has become a priority for the health sector due to the high prevalence of occupational exhaustion, partly caused by stress factors at work. Exhaustion leads to negative consequences in medical activity, including medical errors, low levels of quality of medical care and patient safety, and huge financial costs due to personnel turnover.

Objectives

The aim of this study was to investigate the relationship between emotional intelligence and the perception of stressors at work among neonatologists, in order to determine whether the increase in emotional intelligence of physicians may reduce the negative consequences associated with stress.

Methods

The research sample consisted of 30 Romanian physicians specialized in neonatal intensive care (26 women, 4 men). The participants completed measures of emotional intelligence and occupational stress under the supervision of the authors of this study in a conference room.

Results

Prior to testing the research hypotheses, we conducted a data inspection approach. All the indicators of the asymmetry of the distribution had normal values for all the study variables. We relied on linear bivariate correlation to test the research hypotheses. The findings of the study showed that stress management (a dimension of emotional intelligence) was negatively related to dissatisfaction with resources and communication (a dimension of occupational stress), r = -.41, p < .01.

Conclusion

The results indicate that psychological interventions to develop stress management capabilities could reduce the negative impact of lack of resources and ineffective interactions between physicians and the organization they work in.

Background

Georgia, being a developing country, has made great progress in improving medical education over the last two decades. Still certain shortcomings maintain, such as lack of medical simulations, leading to students learning various skills with real patients, posing obvious risks in highly sensitive fields such as pediatric intensive care and emergency medicine.

Objectives

The purpose of this project is to implement pediatric simulations in the curriculum of Georgian medical universities, enabling students to acquire skills in a safe environment, ensuring not only patient safety, but also students’ confidence and high performance.

Methods

Interested institutions will be offered a trial course of pediatric simulations. Feedback will be evaluated by an extensive questionnaire at the end of the course and various written and practical assessments will be used to measure the effectiveness. If desired to maintain the course, the academic staff will be trained to conduct the simulations independently, ensuring continuity and the long-term result of the project.

Results

In the fall of 2018, New Vision University has participated in the project and with positive feedback, has agreed to maintain the simulations in the curriculum. In the spring of 2019, Tbilisi Medical Academy will also be starting the trial course of simulations and setting up their own simulation lab.

Conclusion

Although some universities have had mannequins, medical simulations are still a novelty in Georgia. By providing the risk-free trial course, the administrations can see the effectiveness of the simulations and implement them in the curriculum, moving closer to achieving high quality pediatric medicine in Georgia.

Background

Sepsis associated acute kidney injury (SA-AKI) is defined by acute kidney injury in the presence of sepsis without another significant contributing factor explaining acute kidney injury, and associated strongly with poor outcome. Early recognition of SA AKI using new biomarker such as Neutrophyl Gelatinase Associated Lipocalin (NGAL) or Cystatin C plays an important role.

Objectives

The study aimed to compare diagnostic value of two biomarkers for early recognition of SA AKI.

Methods

In this study, 23 children between the ages of 1 month to 18 years with sepsis were entered. AKI was classified according to pRIFLE (Pediatric Risk, Injury Failure, Loss, End-stage renal disease). Blood samples were taken from all patients at baseline,12,24 and 48 hours after admission to assess serum creatinine and Cystatin C level, and a urine sample in order to measure NGAL level. We compared area under the receiving operating characteristic (AUROC) curve, sensitivity, and specificity of urine NGAL (uNGAL) and Cystatin C.

Results

A total 23 children with sepsis were included. According to the pRIFLE, 8 (34,7%) were classified as AKI. Area under the ROC curve of uNGAL level in diagnosis of AKI was 0.692 (95% CI: 0.467 to 0.865) and Cystatin C was 0.500 (95% CI: 0.287-0,713). uNGAL had a sensitivity and specificity of 50.0 (15.7 – 84.3) and 93.3 (68.1 – 99.8), and Cystatin C had a sensitivity and specificity of 25.0 (3.2-65.1) and 73.33 (44.9-92.2) respectively.

Conclusion

The study showed that uNGAL level has the better value than serum Cystatin C level in early recognition of AKI.

Background

The purpose of research - to rate the importance of cystatin C in comparison with the calculation of glomerular filtration rate (GFR) based on creatinine levels as a diagnostic marker of renal function disorders in children with acute enteric infections.

Objectives

The study involved 94 children with acute enteric infections. The patients age was from 6 months to 3 years. The study was approved by the local Ethics сommittee. Patients were divided into 3 groups. The first group consisted of 37 (39.4%) children with exsicosis 1 degree. The second group included 32 (34.1%) children with exsicosis 2 degrees. The third group consisted of 25 (26.5%) children with exsicosis 3 degrees.

Methods

For the study of renal function along with clinical tests for all the children measured cystatin C in urine, serum creatinine, produced glomerular filtration rate calculation Schwartz formula for serum creatinine

The content of cystatin C in urine was studied using a set of commercial production firm «Biovendor Human Cystatin C ELISA» (Czech Republic) according to the instructions based on the "sandwich" enzyme immunoassay method.

Results

Thus, the determination of cystatin C concentration revealed early renal dysfunction with varying degrees exsicosis in acute enteric infections in children, which allowed to provide timely treatment of oral rehydration and intravenous injections to replenish lost fluids. The higher the degree of dehydration, the greater the level of cystatin.

Background

The nationwide adoption of a second dose of the measles-mumps-rubella (MMR) vaccine among Taiwanese schoolchildren began in 2001. However, during that time, mumps cases continued to occur.

Objectives

To assess the epidemiology and vaccination policy for mumps in Taiwan.

Methods

We examined the national data on mumps cases collected by the Taiwan Centers for Disease Control (Taiwan CDC) between 2012 and 2017.

Results

Between 2012 and 2017, a total of 5,106 cases of mumps were reported to the Taiwan CDC. Among the patients with known vaccination status, 61% received one dose of the MMR vaccine or no vaccine. The national incidence of mumps ranged from 2.79 to 5.23 per 100,000 population and peaked in 2013. Males had a higher incidence of mumps than females (4.39 vs. 2.90 per 100,000 population; P = 0.023). Children between 5 and 6 years of age had the highest incidence of mumps, and those 20 years and older had the lowest incidence. Compared to those who received two doses of the MMR vaccine, patients who were not vaccinated or received a single dose of the vaccine had a higher risk of suffering from complications and/or hospitalization.

Conclusion

In Taiwan, more than 60% of mumps cases received either no dose or one dose of the MMR vaccine. Continuous monitoring mumps through serological testing and implementing vaccination with a second dose of the MMR vaccine for children is needed for the elimination of mumps in Taiwan.

Background

BACKGROUND Although breast milk fulfills most needs of newborn infants, it is considered a source of cytomegalovirus infection in preterm infants.

Objectives

OBJECTIVE Aim of this study is to confirm that initial administration of native colostrum/breast milk for 5 days does not lead to early virus transmission. For optimal risk assessment, plotting of temporal course of viral load in breast milk is necessary. Correlation between viral load and amount of breast milk should be evaluated.

Methods

PATIENTS AND METHODS The study population consisted of CMV-seropositive mothers and their children born before 32 gestational weeks. Infantile urine and breast milk samples were taken for CMV detection. Breast milk data were collected for statistical analysis.

Results

MAIN RESULTS Breast milk was administered native for the first 5 days of life and afterwards pasteurized until a gestational age of 32 weeks. In one of 3 cases CMV was transmitted early while breast milk was still pasteurized. In this case, virus was not only detectable in breast milk but in maternal sputum. Sputum is another source of infection.

Viral load in breast milk increased after an initial drop until reaching a maximum in week 5.

Correlation between viral load and amount of breast milk was calculated. Due to highly divergent results, no general statement could be made.

Conclusion

CONCLUSION As initial administration of native colostrum/breast milk for 5 days does not seem to result in early virus transmission, indication for pasteurization of breast milk should be strict and administration of native breast milk should be considered.

Background

Bacteraemias are responsible for increased morbidity, mortality, prolonged length of stay in PICU patients.

Objectives

Study of microbiological and epidemiological characteristics of bacteraemia occurring in PICU patients.

Methods

All septicaemias with positive blood cultures (BACTEK 9240) were included. Microbiological and epidemiological data were retrieved retrospectively, based on LIS of Microbiology Department and PICU medical files.

Results

From 2013 to 2017, 1181 patients were admitted. 93 bacteraemia incidents were documented in 67 patients (57% boys, age: 18 days-16 years old). Two strains were isolated in 9 incidents whereas, 16 patients had multiple episodes of bacteraemia (in 10 patients: 2 episodes, in 4 patients: 3 episodes, in 2 patients: 4 episodes). Total length of stay was 1-192 days (median: 33 days), hospitalization days in PICU prior to bacteraemia were 3-120 days (median: 13 days), duration of septicemia was 1-9 days (median: 1 day). In total, 102 strains were isolated: 53 Gram(-) bacteria (Enterobacterspp: 16, Klebsiellaspp: 10, P.aeruginosa: 9, A.baumanii: 5, S.maltophiliα: 5, E.coli: 4, N.meningitidis: 1, E.meningosepticum: 1, S.marcescens: 1, Campylobacter jejuni: 1) and 49 Gram(+) bacteria (staphylococci coagulase negative: 31, S.aureus: 9, Enterococcusspp: 5, Candida albicans: 2, Bacillusspp: 2). Only three strains were carbapenemases producers (A.baumanii, P.aeruginosa, K.pneumoniae) and 2 strains (E.cloacae) were ESBL(+)/cephalosporinases overproducers. In total, 75 incidents of bacteraemia were categorized as nosocomial infections (13.7/1000 hospitalization days).

Conclusion

Multiresistant strains were rarely isolated in our unit. No epidemic was detected, however constant vigilance is required to assure firm compliance to infection control measures.

Background

Pulse oximetry overestimates arterial oxygen saturation (SaO₂) at <90% saturation in cyanotic children. The Masimo Blue sensor is a pulse oximetry sensor developed for use in children with cyanosis. However, there remains a lack of research in actual clinical practice.

Objectives

We evaluated the intraoperative performance of three different pulse oximeters to measure oxyhemoglobin saturation (SpO₂) at low saturations in pediatric patients with cyanotic heart disease and the influence of clinical variables on the accuracy of the sensors.

Methods

This prospective observational study compared SpO₂ measured using three pulse oximeters (Masimo Blue; Masimo LNCS, and Nellcor) at selected SaO₂ ranges. Accuracy was evaluated according to bias and Bland-Altman analysis with appropriate correction for multiple measurements. Relationships between bias and clinical variables were assessed using a generalized estimating equation.

Results

258 samples were analyzed. The mean overall bias (limits of agreement) of Masimo Blue, Masimo LNCS, and Nellcor sensor were -5.3 (-20.9 to 10.3%), -7.4 (-21.9 to 7.1%), and -7.4 (-22.5 to 15.1%), respectively. However, there was no difference in bias among the three sensors at SaO₂ < 60%. Generalized estimating equation showed that SaO₂ value was associated with bias of all sensors. Perfusion index affected the bias of Blue sensor and LNCS sensor, and patients’ weight was associated with bias of Nellcor sensor.

Conclusion

Masimo blue sensor demonstrated overall lower bias compared to the other two sensors. However, the accuracy of all sensors were similarly poor at SaO₂ <60%. Bias was influenced by SaO₂, perfusion index, and body weight.

Background

There are approximately 16,000 transfers of premature and sick babies each year according to the UK Neonatal Transport Group. Neonatal transfers using ambulance vehicles in some cases have resulted in the crash of the ambulance vehicle.

A custom designed Impact Reduction Interface System (IRIS) for use on ambulance trolley’s has being developed by Birmingham City University and Evac+Chair International to reduce the acceleration and deceleration forces acting on a neonate in emergency ambulance transportation and in the event of a crash at speeds of up to 40MPH (65KPH).

Objectives

To reduce the g-Forces caused by excessive braking and acceleration of an ambulance.
To reduce the probability of significant neonatal organ damage caused by an ambulance crash of up to 40MPH/65KPH.

Methods

g-Force data acquisition (emergency ambulance transport): Configured accelerometers to record peak acceleration (g-Forces) exerted on a neonate dummy during normal ambulance transfers were fitted to a standard neonatal National Health Service (NHS) trolley.

g-Forces data acquisition (crash): A crash test at 40MPH/65KMP of a neonate dummy in an incubator was undertaken to record g-Forces and motion of the neonate dummy using high speed film recording.

A custom designed Impact Reduction Interface System (IRIS) was physically built and tested against the
simulation and real data obtained in emergency ambulance transfers for correlation in g-Force reduction.

Results

Significant reduction of g-Forces experienced by a neonate in emergency transport compared to without using IRIS.

New ambulance trolleys for NHS built with IRIS.

Conclusion

Reduction in post care neonatal costs to the NHS following an ambulance crash.

Background

Healthcare informatics is rapidly gaining in importance in the daily and future practice of the neonatologist and pediatric intensivist. The ESPNIC working group Healthcare Informatics, eHealth and Big Data (HIEBID) wants to improve the care of critically ill neonates and pediatric patients with big data, information technology (IT) systems and eHealth solutions.

Objectives

To measure the impact and prioritize a list of (research) topics regarding HIEBID at the Pediatric and Neonatal Intensive Care Unit.

Methods

An online survey was sent by e-mail to the ESPNIC community. The anonymous survey contained questions on demographics, level of IT expertise, the impact of HIEBID on daily and future practice and HIEBID (research) topics to address.

Results

Preliminary results show that participants were mostly pediatric intensivists (86%), who were skilled in the use of IT systems. Clinical decision support, artificial intelligence (AI) and eHealth applications were already used or researched in respectively 57%, 14% and 43%. Within the next five years eHealth wearables, decision support and artificial intelligence were most likely to be clinically implemented. The top-3 suggested activities of the HIEBID working group were decision support, development of a shared data framework and development of a collaborative research framework.

Conclusion

The ESPNIC community foresees that Healthcare Informatics, eHealth and Big data will (increasingly) be used to improve the care of critically ill neonates and pediatric patients. The HIEBID working group should prioritize on providing information on clinical decision support and support the development of a collaborative research and clinical data platform.

Background

Background. Neuro-cognitive deficits affect nearly 50% of children with complex congenital heart diseases (CHD). Newly acquired brain injury in CHD children affect 30% postoperatively.

Objectives

Objective. We determined GFAP levels during surgery and for the first 24h after surgery to find out the pivotal timepoint of brain injury during the perioperative period of CHD surgeries.

Methods

Methods. We studied 43 children: 9 univentricular physiology (UNIV); 16 septal defects (SD); 5 transpositions of the great arteries (TGA), 4 tetralogies of Fallot (TOF), and 9 surgical controls. GFAP was measured by ELISA during surgeries and intensive care stay.

Results

Results. In controls, mean GFAP (ng/ml) before, after at least 30 min from anesthesia induction, and after surgery were 0.14 ± 0.05, 0.13 ± 0.05, 0.16 ± 0.07, respectively. In CHD patients all GFAP levels collected during intensive care stay were significantly lower than the maximum GFAP level recorded during cardiopulmonary bypass (CPB): at 6h 0.26 ± 0.16; 12h 0.25 ± 0.16; 24h 0.27 ± 0.17 vs. the maximum GFAP 1.69 ± 1.74 during surgery (p<0.001, Wilcoxon Signed Rank Test). There were no GFAP differences between time points in all children. In 10% of the intensive care samples (4 patients: 1 SD, 1 TOF, 2 UNIV), GFAP reached the supposed cut-off for clinical evidence of brain injury (0.46 ng/ml).

Conclusion

Conclusions. The highest GFAP values were recorded during the CPB run at the end of rewarming rather than in the early post-operative phase. Neurodevelopmental studies are ongoing to correlate GFAP levels to children outcome.