Assessing Agreement of Transcutaneous Carbon Dioxide Monitoring and Blood Gas Analysis in a Neonatal Population

Objective: To assess agreement between transcutaneous carbon dioxide (TcCO2) monitoring and blood gas analysis in neonates. Study Design: This was a prospective observational study performed in a tertiary neonatal intensive care unit. 19 infants with a mean postmenstrual age of 35+3 weeks were included. Agreement was assessed by Bland-Altman analysis and concordance correlation coefficient. End-user feedback was collected from staff and infants were assessed for evidence of skin damage. Results: Overall bias from 698 paired samples was -0.30 (SD 1.21, p<0.0001) with good concordance (CCC 0.80). 69% (95% CI 65%-72%, p=0.0003) of samples fell within the predefined clinically acceptable difference of 1kPa. Agreement was more favorable for non-invasively ventilated infants (bias -0.11, CCC 0.91). Staff feedback was positive, and no infants suffered skin damage. Conclusion: TcCO2 monitoring is a reliable assessment tool for both invasively and non-invasively ventilated neonates. It can be used as an adjunct to blood gas analysis, reducing the frequency of invasive blood tests.

PICU Chronic Lung Disease Mortality and Morbidity (PLUM)

Background: Children with Bronchopulmonary dysplasia (BPD) have increased incidence of respiratory illness, often necessitating Pediatric ICU admission. Little is known about the outcome of these admissions. Aim: This study aimed to determine clinical and demographic data of this cohort and determine factors affecting mortality and length of ICU stay. Oxygen requirement following a year after ICU admission was determined. Methods: Retrospective case-note review was performed. Patients with congenital cardiac abnormalities or chronic respiratory conditions like cystic fibrosis were excluded. Data were presented as descriptive statistics. Predictors of death and LOS were determined using Fisher’s exact test and univariate regression analyses. Results: Small numbers of deaths prohibited strong conclusions. Inotrope use (p<0.001), blood transfusion (p<0.001), use of inhaled nitric oxide (p=0.003) and a diagnosis of sepsis (p=0.004) were related to mortality. Age at admission, gestational age at birth, weight, oxygen requirement prior to admission or length of stay did not increase the odds of mortality. Inotrope usage (p=0.027), transfusion requirements (p=0.044) and a sepsis diagnosis (p=0.005) were significantly associated with length of ICU stay >7 days. More than half the patients, who were followed up, had an oxygen requirement at 6-month and 12-month follow up. Conclusion: Patients admitted with chronic lung disease to PICU with pulmonary hypertension and sepsis has long ICU stay and more odds of dying. More than half of the children who survive to 6-month and 12-month follow up have ongoing oxygen requirement. Studies in larger populations of children with BPD will help in more accurate prognostication following PICU admission.

Urinary Klotho Abnormalities in Children with Sickle Cell Disease

Background: Klotho is a trans membrane protein expressed in the renal tubules and serves as an obligatory co-receptor for fibroblast growth factor 23(FGF23) to aid in phosphorus excretion. Prior studies have shown FGF23 resistance in sickle cell disease (SCD). The purpose of the study is to investigate urinary klotho/creatinine (Ur Kl/Cr) in pediatric SCD with normal traditional markers of renal function (eGFR > 90 ml/min and no micro albuminuria) and to compare it with the healthy control population. Methods: Cross-sectional observational study to compare Ur Kl/Cr in pediatric SCD and controls. To do a subgroup analysis among the study population to assess the effect of hydroxyl urea (HU) on Ur Kl/Cr. Results: 20 controls and 22 pediatric SCD were enrolled. In the SCD group, 13 were on treatment with HU. The baseline characteristics of the study and control group were the same. Wilcoxon rank-sum test was used to compare the levels of Ur Kl/Cr ratio between SCD and control. For P value of 0.05, the levels of Ur Kl/Cr were statistically significantly higher in the sickle cell group (752.7 ± 1101.0) over the control group (216.8 ± 225.3). Subgroup analysis in the SCD group showed high Urinary Kl excretion in the non-HU group (1346.7 ± 1523.4) vs. non HU group (341.4 ± 355.3) but not statistically significant. Conclusion: Children with SCD tend to have increased secretion of Ur Kl/Cr compared to control likely due to tubular receptor resistance. HU may reverse this phenomenon by its effect on preventing tubular damage.

Premature Baby of 32 Weeks Has Sars-Cov-2 Infection: Case Report

In December 2019, a new coronavirus called “severe acute respiratory syndrome coronavirus-2” (SARS-CoV-2), children of all ages can be infected with SARS-CoV-2, appeared in China. The objective of this study to report the case of a premature baby of 32 weeks has Sars-Cov-2 infection, admitted to a Pediatric Intensive Care Unit. Case: Premature baby, 32 weeks, male, admitted to the Pediatric Intensive Care Unit of a University Hospital that after worsening of the clinical picture collected viral panel (PCR) its result: PCR positive for SARS-CoV-2. Conclusion: In critically ill patients using mechanical pulmonary ventilation, adopting a strategy with an emphasis on protective ventilation and effective weaning may guide the treatment of pediatric patients with SARS-CoV-2 infection.

Influence of the Bed Head Positioning on the Current Expiratory Volume of Pediatric Patients in Mechanical Ventilation: A Pilot Clinical Controlled Trial

he elevated bed head position is an important therapeutic intervention that can reduce respiratory complications associated with mechanical ventilation. The objective of this study was to evaluate the effects of elevation at the head of the bed on the tidal volume, pressure variables, hemodynamic data and peripheral oxygen saturation in pediatric patients on mechanical ventilation. Methods: In a before-and-after clinical trial, 52 patients of both sexes, with a chronological age of 28 days to 14 years old, were admitted to the pediatric intensive care unit for more than 24 hours. These were positioned at 0º, 30º, 45º and 60º of elevation of the head of the bed. For each position, the expiratory tidal volume, pressure variables, hemodynamic data and peripheral oxygen saturation were evaluated. Results: The patients presented an increase in the expired tidal volume, with the bed head angulation at 30º and 45º. Heart rate increased when the head was positioned at 60º. The peripheral oxygen saturation variable increased in the 30º and 45º positions. The systolic blood pressure variables and diastolic blood pressure showed a progressive increase in the 30º, 45º and 60º positions respectively. Significant effects on increasing the SatO2/FiO2 ratio were observed in the 30º and 45º positions. Conclusion: This study demonstrated a significant increase in expired tidal volume and an increase in the SatO2/FiO2 ratio with the patient positioned at 30º and 45º of elevation of the head of the bed. The peripheral oxygen saturation variable increased in the 30º and 45º positions. The elevated bed head position should be considered when monitoring children during mechanical ventilation.