Background

Historically, the ILCOR recommendations have included the ABC (Airway, Breathing, Circulation) acronym for cardiopulmonary resuscitation (CPR) management. However, fear of delaying chest compressions and prolonging no-flow periods during resuscitation has recently raised the question of whether changing to CAB could benefit survival.

Pediatric cardiac arrest (CA) is different to adult arrests, as it is mostly due to asphyxia. This could justify the need to keep the algorithm as it was.

Objectives

To discuss whether resuscitation should start with ventilations or directly with chest compressions in pediatric CA.

Methods

Evidence review.

Results

Starting CPR as soon as the patient collapses is mandatory in terms of survival. Bystander CPR performance influences outcome. Teaching a universal CPR algorithm could increase correct performance by rescuers who treat infants, children and adults, and for whom ventilation can prove to be much more difficult to learn.

Evidence of whether resuscitation beginning ABC or CAB impacts survival is controversial. With no randomized controlled trials to look at, observational studies comparing chest compressions only vs chest compressions plus ventilation and animal studies analyzing optimal ventilation rates in asphyxial CA are our only substrate to determine which attitude is best.

Finally the scenario in which resuscitation is attempted is equally significant. In-hospital CA is easier and quicker to diagnose and treat by trained medical staff whereas in out-of-hospital CA this has to be trusted upon lay rescuers.

Should we plead for consistency for all populations? Or consider pediatric patients different?

Conclusion

Survival to pediatric CA needs ventilation. Further evidence is needed.

Background

Scholars are not clear about the role that a leader must endorse in an emergency team during an adverse event. Should the leader manage both team activity and perform medical treatments, with possibly task overloading and interferences, or should he focus on team management?

Objectives

We proposed to test this latter option. This leader, named “coordinator”, will be in charge of supervising the activity of the team members on three dimensions: information processing and sharing, task management, patient care. Our objectives were to propose a job description of the coordinator and to test the contribution of this position in the context of a paediatric training program within a medical paediatric department.

Methods

Eight teams of 6 or 7 caregivers participated to this study. Each team was immersed in a high-fidelity simulation setting with a mannequin representing a patient and realistic emergency scenarios. Four teams including an explicit position of coordinator were compared with four teams without explicit coordinator. Based on the job description, the distributions of coordination behaviours among physicians in all teams were coded and team performances were assessed.

Results

When a single physician takes over the largest proportion of coordination behaviours in the team, then the team performance is high (β=.84; t=3.67; p<.02). When this physician performs no technical task, then the team performance is significantly high (Mann-Whitney=16, p<.03).

Conclusion

The presence of a single physician in charge of the largest proportion of coordination behaviours and able to inhibit technical gestures during a paediatric emergency allows the improvement of the team's performance.

Background

Injury is the leading cause of morbidity and mortality among children older than 1 year. Each year, approximately 950,000 children and teenagers die as a result of injury around the world. Moreover, for every child who dies from an injury, 10 others acquire disabilities each year. Hence, pediatric trauma is still one of the biggest threats of the health of children [1].

Objectives

To evaluate epidemiology, type and mechanics of injury and its outcomes and compare data in different age groups.

Methods

Retrospective study was performed in Jan 2010-Dec 2017. Criteria for patient’s enrollment: all children <18 years; trauma <48 hours prior hospitalization; NISS≥9.

Results

Out of 878 patients 585(66.6%) were boys. Mean age-8.7 years. Division according age groups: 19.5% in<3 years group, 34.4% in 3–9 years, 25.3% in 10–14 years and 20.8% in ≥15 years. 82.1% experienced blunt trauma, 9.2%-thermal. Mainly children experienced trauma due to fall(39.2%), traffic accidents(29.8%), chemical/thermal burns(11.1%). Children <3 years old–mostly experienced thermal/chemical burns(39.2%) and falls(33.9%). Children ≥15 years most commonly suffered due to traffic accidents(41%). 73.2% children fully recovered, moderate disability was acquired by 19.9%, severe–4.6%, vegetative state–0.5% and 1.8% died.

Conclusion

Boys were injured more frequently. Blunt trauma was the most common in all age groups. Most frequent injuries in children were due to fall, traffic accidents and thermal/chemical burns. Youngest children usually suffered from burns or fall, while the oldest–from traffic accidents. Most of the children fully recovered, however, almost 25% of all severely injured children acquired moderate/severe disability.

Background

Children, neonates and pregnant women are most vulnerable population in disasters. However there were few pediatricians, neonatologists and obstetricians in Japan DMAT (Disaster Medical Assistance Team), so disaster medical headquarters had limited intelligence to treat these problems. We trained pediatric and perinatal disaster medical liaison (PPDML) to improve disaster medical managements for children and pregnant women since 2016.

Objectives

We analyze and report medical management of Osaka earthquake 2018.

Methods

We reviewed the records of PPDML in disaster drills and Osaka earthquake 2018.

Results

Japan DMAT had annual disaster drills, and PPDML participated the drill for the first time in July 2017. In the drill, PPDML coordinated the pediatric and perinatal issues with Japan DMAT and JGSDF (Japan Ground Self-Defense Force) in disaster headquarters. And of this disaster, PPDML coordinated the transport of 22 children and babies with congenital heart disease from damaged National Cerebral and Cardiovascular Center Hospital. The operation was finished within 5 hours after request transportation.

Conclusion

To protect children and pregnant women, cooperation between disaster medical network and pediatric and perinatal network is absolutely important of any phase in disaster. Because PPDML had attended in the disaster drills before the earthquake occurred, the experience could make PPDML to achieve good performance in real disaster. So we conclude cooperation between disaster medical network and PPDML is very useful to manage the disaster issues for children and pregnant women, and the most important thing is to cooperate not only in disaster, but also in ordinary days.

Background

Approximately 10% of infants at birth require some assistance to breathe and 1% require vigorous resuscitation. As such, midwives need appropriate education and training on newborn life support (NLS) techniques.

Objectives

In this study, we conducted a survey on Italian territory about the correlation between obstetric education and the management of the neonatal resuscitation in the delivery room.

Methods

The study was conducted with a web survey based on 23 questions, given anonymously online through Google Drive platform.

Results

272 women aged from 19 to 59 years were enrolled (83% midwives and 17% midwifery students). 93% of them concluded a NLS course before graduation, while only 57% have repeated it afterwards once or more times. The midwives working in hospitals with neonatal intensive care units (NICU) experienced more involvement within the emergency neonatal resuscitation team than in other hospitals (hospital with NICU 79%, hospital without NICU 57%, private hospital 48%; p<0,001). Moreover, the midwives’ years of experience at work are much more related with the prompt execution of primary resuscitation maneuvers (more than 10 years of experience 74%, 5-10 years 48%, less than 5 years 30%; p<0,001). Power analysis showed an adequate sample size of the study population.

Conclusion

In spite of NLS techniques are mainly taught to near all midwives, only the hospital work within a NICU and longer experience at work are directly related with a greater involvement of a midwife in the neonatal resuscitation team.

Background

Dengue fever is often fatal disease and predicting outcome in dengue infections remains challenging. Identification of modifiable predictors related to outcome of Dengue infection may help in developing new treatment strategies and to potentially decrease in-hospital mortality.

Objectives

To study the mortality prediction parameters at admission in children with dengue fever admitted in PICU

Methods

All children (1month to 18 years) with laboratory-confirmed dengue infection were enrolled between 1 July 2016 to31 December 2018. The medical records of all the recruited patients were reviewed retrospectively. In univariate analysis, parameters significantly associated with mortality were tested for interaction with multiple logistic regression analysis. Odds ratios and 95% confidence intervals were calculated.

Results

148 patients with laboratory confirmed dengue fever were admitted in PICU. 70 patients were between 1-10years of age. 103 (69.6%) were male. Eighty patients had dengue fever with warning signs while 68 cases had severe dengue fever. In univariate analysis high admission SGOT, SGPT, Inotropic score, S. Lactate, PELOD score and presence of AKI and PRISM 12 score were independent predictor of mortality (p value 0.0001). These variables were not included in multivariate logistic regression as the Pearson correlation was more than 0.5. While other variables, need for mechanical ventilation, platelet transfusion at admission and fluid balance ≥5% after 24 hours of admission were independent predictor of mortality.

Conclusion

Indices of organ dysfunction and fluid overload may be better predictors of mortality than traditional markers like platelet count, leucocyte count and hematocrit.