The implications of platelet count changes during hospitalization in the disease management of pediatric patients with bronchiolitis

Abstract Background: The clinical implications of platelet count changes in patients with bronchiolitis throughout hospitalization have not been extensively investigated. We aimed to investigate the significance of platelet count on admission and platelet count changes during hospitalization in pediatric patients with bronchiolitis. Methods: Clinical data from 559 consecutive patients hospitalized for bronchiolitis were collected and compared after grouping according to the platelet count on admission and the delta platelet count during hospitalization (the platelet count on discharge minus the platelet count on admission; Group A, delta platelet count ≤ -50 × 109/L; Group B, -50 × 109/L < delta platelet count ≤ 50 × 109/L; Group C, delta platelet count > 50 × 109/L). Results: Thrombocytosis was found in 122 (21.8%) patients, while 437 (78.2%) patients had a normal platelet count on admission. There was no difference in disease severity between these two groups. Groups A, B, and C comprised 79 (14.1%), 179 (32.0%), and 301 (53.9%) patients, respectively. The patients from Group A had a higher platelet count on admission, a lower platelet count on discharge, and a longer hospitalization duration. These patients had a lower concentration of C-reactive protein, longer periods of oxygen therapy and stay in the pediatric intensive care unit (PICU), and a greater frequency of mechanical ventilation than the patients from Group B or Group C. Notably, among all the patients, the delta platelet count [63 (-3–142) × 109/L] negatively correlated with the numbers of days of oxygen therapy [4.0 (3.0–6.0), day] (r = -0.186, P = 0.027) and stay in the PICU [5.0 (3.0–6.0), day] (r = -0.391, P = 0.001). Conclusions: Repeated assessment of platelet count during hospitalization in pediatric patients with bronchiolitis may provide useful information for disease management.

Download Full-text

Thrombocytosis and thrombocytopenia are markers of poor outcome in pediatric patients with community-acquired pneumonia

10.21203/rs.2.9536/v1 ◽

2019 ◽

Author(s):

Huiming Sun ◽

Shuxiang Li ◽

Canhong Zhu ◽

Yongdong Yan ◽

Yuqing Wang ◽

...

Keyword(s):

Platelet Count ◽

Pediatric Patients ◽

Laboratory Data ◽

Community Acquired Pneumonia ◽

Multivariate Logistic Regression Model ◽

Respiratory Complications ◽

Reactive Protein ◽

Normal Platelet Count ◽

Normal Platelet ◽

Length Of Hospitalization

Abstract Abstract Background: This study aimed to investigate the prevalence of thrombocytopenia and thrombocytosis in hospitalized pediatric patients with community-acquired pneumonia (CAP), and determine whether thrombocytopenia and thrombocytosis are associated with patient outcome. Methods: A total of 9,372 consecutive patients, who were 1-168 months old, diagnosed with CAP and admitted in the Children’s Hospital of Soochow University, were enrolled in the present retrospective observational study. Their clinical and laboratory data were collected. According to the platelet count on admission, these patients were divided into three groups: thrombocytopenia, normal platelet count, and thrombocytosis groups. The clinical characteristics and etiologic pathogens were compared among these groups. The multivariate logistic regression model was applied to identify risk factors for severe CAP, length of hospitalization ≥10 days and respiratory complications. The correlations between platelet count and clinical features were determined by Spearman’s correlation. Results: Thrombocytosis and thrombocytopenia were found in 3,376 (36.0%) and 43 (0.5%) patients, respectively. Normal platelet count was observed in 5,953 (63.5%) patients. Thrombocytopenia was an independent risk factor of severe CAP (OR, 6.206; 95% CI, 2.209-17.436; P=0.001), while thrombocytosis was associated with length of hospitalization of ≥10 days (OR, 1.315; 95% CI, 1.177-1.470; P<0.001). In addition, thrombocytosis was associated with respiratory complications (OR, 1.658; 95% CI, 1.171-2.346; P=0.004). Platelet count (median 350.0 [IQR 270.2-447.0] × 109/L) was positively correlated with length of hospitalization (median 7.0 [IQR 6.0-9.0] days) (r = 0.101, P<0.001), but negatively correlated with age (median 12.0 [IQR 3.0-36.0] months) (r = -0.401, P<0.001) and C-reactive protein (median 2.0 [IQR 0.3-10.7] mg/dl) (r = -0.191, P<0.001). Conclusion: Thrombocytosis is highly prevalent, while thrombocytopenia has low prevalence in pediatric CAP patients. Both thrombocytosis and thrombocytopenia are associated with clinical outcomes in pediatric CAP patients.

Download Full-text

The effect of external ventricular drain tunneling length on CSF infection rate in pediatric patients: a randomized, double-blind, 3-arm controlled trial

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.9.peds20748 ◽

2021 ◽

pp. 1-8

Author(s):

Esmaeil Mohammadi ◽

Sara Hanaei ◽

Sina Azadnajafabad ◽

Keyvan Tayebi Meybodi ◽

Zohreh Habibi ◽

...

Keyword(s):

Infection Rate ◽

Pediatric Patients ◽

Controlled Trial ◽

External Ventricular Drain ◽

Hazard Ratio ◽

Spontaneous Discharge ◽

Standard Group ◽

Double Blind ◽

Group A ◽

Group B

OBJECTIVE The role of tunneling an external ventricular drain (EVD) more than the standard 5 cm for controlling device-related infections remains controversial. METHODS This is a randomized, double-blind, 3-arm controlled trial done in the Children’s Medical Center in Tehran, Iran. Pediatric patients (< 18 years old) with temporary hydrocephalus requiring an EVD and no evidence of CSF infection or prior EVD insertion were enrolled. Patients were randomly assigned (1:1:1) into the following arms: 5-cm (standard; group A); 10-cm (group B); or 15-cm (group C) EVD tunnel lengths. The investigators, parents, and person performing the analysis were masked. The surgeon was informed of the length of the EVD by the monitoring board just before operation. Patients were followed until the EVD’s fate was established. Infection rate and other complications related to EVDs were assessed. RESULTS A total of 105 patients were enrolled in three random groups (group A = 36, group B = 35, and group C = 34). The EVD was removed because there was no further need in most cases (67.6%), followed by conversion to a new EVD or ventriculoperitoneal shunt (15.2%), infection (11.4%), and spontaneous discharge without further CSF diversion requirement (5.7%). No statistical difference was found in infection rate (p = 0.47) or EVD duration (p = 0.81) between the three groups. No group reached the efficacy point sooner than the standard group (group B: hazard ratio 1.21, 95% CI 0.75–1.94, p = 0.429; group C: hazard ratio 1.03, 95% CI 0.64–1.65, p = 0.91). CONCLUSIONS EVD tunnel lengths of 5 cm and longer did not show a difference in the infection rate in pediatric patients. Indeed, tunneling lengths of 5 cm and greater seem to be equally effective in preventing EVD infection. Clinical trial registration no.: IRCT20160430027680N2 (IRCT.ir)

Download Full-text

Effect of hyperbaric oxygen therapy on esophagojejunal anastomosis healing in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502008000600004 ◽

2008 ◽

Vol 23 (6) ◽

pp. 491-496 ◽

Cited By ~ 3

Author(s):

João Domingos Lionço ◽

Lívia Caprara Lionço ◽

Lucas Torely Filippi ◽

Clarissa Caprara Lionço ◽

Bernardo Volkweiss ◽

...

Keyword(s):

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Breaking Strength ◽

Suture Line ◽

Collagen Concentration ◽

Esophagojejunal Anastomosis ◽

Group A ◽

Anastomotic Fistula ◽

Group B

PURPOSE: To evaluate hyperbaric oxygen therapy (HBO) after esophagojejunal anastomosis in a rat experimental model and the effect of HBO on the healing of esophagojejunal anastomosis in gastrectomized rats. METHODS: Forty adult male Wistar rats, weighing 322 g to 506 g, were divided into two random groups. In group A (control group), 20 rats were subjected to total gastrectomy. In group B, 20 rats were similarly gastrectomized, but also received postoperative HBO treatment for 90 minutes/day for seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables: a) presence of anastomotic fistula; b) evaluation of esophagojejunal anastomosis healing by measuring the breaking strength at the suture line as per Hendriks & Mastboom; and c) determining the collagen concentration in the anastomosis, as per Kovács criteria. For the comparative statistical analysis between groups, Student's "t" test was used. A value of p<0.05 was considered significant. RESULTS: There was a 20% mortality rate. There were five deaths in group A and three in group B (p=N.S.). There was only one anastomotic fistula in each group, and neither caused any morbidity or death. Breaking strength measured at the suture line (p=0.528) and collagen concentration determined at the esophagojejunal anastomosis (p=0.89) were not significantly different between Groups A and B. CONCLUSION: Hyperbaric oxygen therapy did not affect the healing process of esophagojejunal anastomosis.

Download Full-text

Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial (Preprint)

10.2196/preprints.23446 ◽

2020 ◽

Author(s):

Aya Sedky Adly ◽

Mahmoud Sedky Adly ◽

Afnan Sedky Adly

Keyword(s):

Health Care ◽

Clinical Trial ◽

Physical Therapy ◽

Randomized Clinical Trial ◽

Health Care System ◽

Oxygen Therapy ◽

Early Stage ◽

Home Based ◽

Group A ◽

Group B

BACKGROUND With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. OBJECTIVE The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. METHODS In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO2 and PaCO2, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. RESULTS Analysis of the results showed a significant difference between the two groups (P<.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (P<.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. CONCLUSIONS It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. CLINICALTRIAL ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923

Download Full-text

ALBUMIN VERSUS FRESH FROZEN PLASMA IN MANAGING DIURETIC RESISTANT EDEMA IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i1.1677 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Vishwajeet Singh ◽

P K Berwal ◽

T C Saini ◽

Narender Mishra

Keyword(s):

Nephrotic Syndrome ◽

Pediatric Patients ◽

Idiopathic Nephrotic Syndrome ◽

Dry Weight ◽

Fresh Frozen Plasma ◽

Fresh Frozen ◽

Double Number ◽

Group A ◽

Group B ◽

Frozen Plasma

Background: This study was carried out to compare the efficacy and outcome of albumin with fresh frozen plasma (FFP) in the treatment of diuretic resistant edema in nephrotic syndrome Methods: Sixty patients with idiopathic NS were enrolled in this prospective analytic study. Patients with moderate to severe edema with serum albumin <1.5 gm/dl were given albumin and FFP dividing into two groups. Group-A, received intravenous albumin- 1 gm/kg/day and Group-B intravenous FFP 15ml/kg/day. Total number of albumin and FFP infusion were determined by edema reduction. Results: Diagnosis of NS and biochemical parameters were same in both groups. Dry weight was achieved in Group-A in 6.62± 3.15 days and in Group-B 6.65 ± 3.18 days. In GroupA the number of albumin infusion required was 1.42±0.62 and Group-B FFP infusion required was 3.11± 1.05 (p=0.0001). No significant complications were observed in both the groups. Conclusion: FFP cost half than albumin and same duration required to reduce edema but with double number of infusion and it is safe in pediatric patients with NS presenting with moderate to severe edema. Keywords: NS, Oedema, FFP, Albumin

Download Full-text

The Effect of Endotoxin on Haemostasis in Normal and Leukemic Rats

10.1055/s-0039-1680768 ◽

1977 ◽

Author(s):

H. Rasche ◽

D. Hoelzer

Keyword(s):

Platelet Count ◽

Early Phase ◽

Elevated Level ◽

Single Injection ◽

Final Phase ◽

Phase Group ◽

Group A ◽

Group B ◽

Leukemia L 5222 ◽

Normal Controls

Platelet count, fibrinogen and antithrombin levels were studied in normal rats (group A), in rats with the experimental rat leukemia L 5222 in an early phase (group B) and in a final phase (group C) of the disease. The animals were randomized and treated with o.5 mg endotoxin or placebo as a single i.v.injection. Four hours later blood samples were taken for laboratory tests. The results were as follows: 1. Groups A and B did not differ in the laboratory parameters under investigation 4 hours after injection of saline as a placebo. 2. Leukemic rats of group C treated with saline had significantly elevated levels of fibrinogen and antithromin as well as reduced platelet count compared to their normal counterparts. 3. The injection of endotoxin resulted in a comparable decrease of platelets in normal and leukemic animals. 4. The injection of endotoxin led to a decrease of fibrinogen levels in all groups. The most pronounced decrease was observed in group B, while there was only a slight fall in group C. The antithrombin levels of group A and B were not influenced by endotoxinaemia. The elevated level of antithrombin in group C, however, was completely normalized after a single injection of endotoxin.It can be concluded from these results that the haemostatic system of rats in the early phase of the leukemia L 5222 is more susceptible to endotoxin than that of normal controls. Possibly due to marked elevated levels of antithrombin rats in the final phase of the disease seem to be protected against the aggravation of the haemostatic defect by endotoxin.

Download Full-text

Correlation of plasma concentrations of cystatin C and creatinine to inulin clearance in a pediatric population

Clinical Chemistry ◽

10.1093/clinchem/44.6.1334 ◽

1998 ◽

Vol 44 (6) ◽

pp. 1334-1338 ◽

Cited By ~ 66

Author(s):

Douglas Stickle ◽

Barbara Cole ◽

Karl Hock ◽

Keith A Hruska ◽

Mitchell G Scott

Keyword(s):

Correlation Coefficient ◽

Cystatin C ◽

Linear Correlation ◽

Pediatric Patients ◽

Plasma Concentrations ◽

Age Groups ◽

Inulin Clearance ◽

Blood Concentrations ◽

Group A ◽

Group B

Abstract Measurement of blood concentrations of cystatin C (cysC), a cysteine protease inhibitor present in human plasma, has been suggested for use as an indicator of glomerular filtration rate (GFR) in a manner analogous to the use of plasma creatinine (SCR). In this study, cysC and SCR were measured in plasma from pediatric patients (4–19 years) with renal disease for whom a “gold standard” measurement of GFR via inulin clearance (CIN) was available. The data analyses were divided into two age groups: group A (4–12 years, n = 26) and group B (12–19 years, n = 34). For both age groups, the linear correlation coefficient of [cysC]−1 vs CIN (mL/min/1.73 m2) (r = 0.765 for group A and r = 0.869 for group B) was less than that of the linear correlation coefficient of [SCR]−1 vs CIN (r = 0.841 for group A and r = 0.892 for group B). As a single measurement for detection of abnormal GFR, however, the optimum receiver-operator characteristic point for cysC measurement (for group A at cysC >1.2 mg/L, sensitivity = 80%, specificity = 91%; and for group B at cysC >1.4 mg/L, sensitivity = 87%, specificity = 100%) was numerically superior to that for SCR measurement (for group A at SCR >8.0 mg/L, sensitivity = 67%, specificity = 100%; and for group B at SCR >9.0 mg/L, sensitivity = 91%, specificity = 91%), using a reference value for normal GFR of CIN > 90 mL/min/1.73 m2. However, these differences were not statistically significant. CysC measurement appears to be broadly equivalent to SCR measurement for estimation of GFR in pediatric patients.

Download Full-text

Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques

Perfusion ◽

10.1177/026765910101600408 ◽

2001 ◽

Vol 16 (4) ◽

pp. 313-318 ◽

Cited By ~ 20

Author(s):

Silvia Cirri ◽

Luca Negri ◽

Marco Babbini ◽

Giorgio Latis ◽

Boutros Khlat ◽

...

Keyword(s):

Platelet Count ◽

Cardiopulmonary Bypass ◽

Centrifugal Pump ◽

Statistical Significance ◽

Postoperative Bleeding ◽

Haemoglobin Concentration ◽

Venous Drainage ◽

Valvular Surgery ◽

Group A ◽

Group B

To facilitate mini-access for cardiac surgery, two different methods of active venous drainage are used: vacuum assisted drainage and centrifugal pump aspiration on the venous line. The aim of this study was to compare the haemolysis produced using these two techniques. From June to December 1999, 50 consecutive patients were operated on using a ministernotomy. All of these patients had valvular surgery for either valve repair or valve replacement (9 MVRepair, 11 MVR, 29 AVR, 1 AVR+MVR). They were randomized into two groups: Group A, 25 patients who underwent surgery where vacuum assisted drainage was used, and Group B, 25 patients where kinetic asssisted venous drainage with centrifugal pump venous aspiration was used. Patient characteristics of both groups were similar for age, gender, body weight, body surface area, height, cardiopulmonary bypass (CPB) time, aortic crossclamp time, priming volume, cardioplegia volume, haemoglobin concentration, haematocrit, serum creatinine, bilirubin, lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (sGOT), serum glutamic pyruvic transaminase (sGPT), aptoglobin, reticulocytes, and platelet count. We checked all these laboratory parameters preoperatively, at the end of CPB, and 2 and 24 h after operation. We also checked haemoglobinuria at these same time points. We assessed blood loss at 6, 12, and 24 h after the operation and calculated total postoperative bleeding. There was a tendency towards a greater increase in LDH, sGOT and sGPT in Group A more than in Group B, but these data did not reach statistical significance. Platelet count was always lower in Group A and aptoglobin increased in Group A more than in Group B. More patients in Group A had haemoglobinuria. These findings indicate that haemolysis is increased more in patients treated with vacuum assisted drainage, when compared to the rise in haemolysis in those treated with centrifugal pump venous drainage. Total bleeding is also greater in Group A.

Download Full-text

Traditional Versus Room Service Menu Styles For Pediatric Patients

Canadian Journal of Dietetic Practice and Research ◽

10.3148/67.2.2006.92 ◽

2006 ◽

Vol 67 (2) ◽

pp. 92-94 ◽

Cited By ~ 15

Author(s):

Krista Wadden ◽

Bernice Wolf ◽

Alain Mayhew

Keyword(s):

Patient Satisfaction ◽

Pediatric Oncology ◽

Pediatric Patients ◽

Hemodialysis Patients ◽

Pediatric Hospital ◽

Group A ◽

Quality Of Food ◽

Room Service ◽

Group B

Purpose: To compare patient satisfaction with a room service (RS) menu style versus a traditional menu (TM) in a Canadian pediatric hospital. Methods: A sample of 20 subjects (Group A) was surveyed before implementation of the RS menu and a second sample of 20 subjects (Group B) was surveyed after implementation. Results: All subjects in Group B rated overall satisfaction with meals as greatly exceeding or exceeding expectations after implementing the new menu style. Also, 65% of Group B subjects rated quality of food as greatly exceeding or exceeding their expectations after the intervention. Conclusions: To improve meal satisfaction for pediatric oncology and hemodialysis patients, the RS menu style is a worthwhile option.

Download Full-text

Lusutrombopag is effective and safe in patients with chronic liver disease and severe thrombocytopenia: a multicenter retrospective study

BMC Gastroenterology ◽

10.1186/s12876-020-01573-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hiroaki Nomoto ◽

Naoki Morimoto ◽

Kouichi Miura ◽

Shunji Watanabe ◽

Yoshinari Takaoka ◽

...

Keyword(s):

Platelet Count ◽

Liver Disease ◽

Chronic Liver Disease ◽

Platelet Transfusion ◽

Chronic Liver ◽

Severe Thrombocytopenia ◽

Invasive Procedures ◽

Significance Level ◽

Group A ◽

Group B

Abstract Background Chronic liver disease (CLD) is often complicated by severe thrombocytopenia (platelet count < 50,000/µL). Platelet transfusion has been a gold standard for increasing the platelet count to prevent hemorrhagic events in such patients. Lusutrombopag, a thrombopoietin receptor agonist, can increase the platelet count in such patients when invasive procedures are scheduled. Former studies on lusutrombopag included patients with a platelet count of > 50,000/µL at baseline: the proportions of patients who did not require platelet transfusion were 84–96%, which might be overestimated. Methods The efficacy and safety of lusutrombopag were retrospectively investigated in CLD patients with platelet count of < 50,000/µL, a criterion for platelet transfusion, in real-world settings. We examined the proportion of patients who did not require platelet transfusion in 31 CLD patients, which exceeded a minimum required sample size (21 patients) calculated by 80% power at a significance level of 5%. Lusutrombopag, 3 mg once daily, was administered 8–18 days before scheduled invasive procedures. Results Among 31 patients who received lusutrombopag, 23 patients (74.2%) patients showed a platelet count of ≥ 50,000/µL (Group A) and did not require platelet transfusion. The remaining 8 patients (25.8%) did not reached platelet ≥ 50,000/µL (Group B). The means of platelet increase were 38,000/µL and 12,000/µL in groups A and B, respectively. A low platelet count at baseline was a characteristic of patients in group B. Among 13 patients who repeatedly used lusutrombopag, lusutrombopag significantly increased the platelet count as the initial treatment. When all repeated uses of lusutrombopag were counted among these 13 patients, platelet transfusion was not required in 82.1% (23/28) of treatments. Although one patient showed portal thrombosis after lusutrombopag treatment, the thrombosis was disappeared by anticoagulant treatment for 35 days. The degree of platelet increase with lusutrombopag was larger than that in their previous platelet transfusion. Conclusions The proportion of patients who did not require platelet transfusion was 74.2%, which is smaller than that in former studies which included CLD patients with a platelet count of > 50,000/µL. However, lusutrombopag is effective and safe for CLD patients with a platelet count of < 50,000/µL.

Download Full-text