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Objectives Extracorporeal membrane oxygenation (ECMO) is an increasingly used mode of critical care support for pediatric patients refractory to conventional therapy. We evaluated the characteristics, outcomes, and readmissions rates for pediatric ECMO in the United States. Methods Data was extracted from the Nationwide Readmissions Database, a database designed to support national readmissions analyses, for patients aged 1–18 years undergoing ECMO between 2012–2018. Baseline demographics, comorbidities, and characteristics were identified using International Classification of Diseases codes. Results Out of 897,117 index pediatric hospitalizations, 3706 patients underwent ECMO [median age 9 years (IQR 2,15); 51.6% males]. 2246 (60.6%) patients survived to hospital discharge, with a 30-day readmissions rate of 17% among survivors. Cardiac conditions associated with ECMO were congenital heart disease (25.3%), cardiogenic shock (23.6%), and congestive heart failure (16.2%). The common respiratory associations were sepsis (36.2%), pneumonia (35.6%), and asthma (15.4%). Patients who survived were more likely to have diagnoses of asthma, bronchiolitis, myocarditis, pneumonia, and sepsis. Acute kidney injury (51.5%), disseminated intravascular coagulation (22.5%), and surgical site bleeding (12.7%) were the commonly associated complications. The trend for yearly survival rates was not statistically significant (linear p-trend = 0.38). Conclusions Pediatric ECMO continues to be associated with notable mortality and complication rates. We did not observe a meaningful trend for the yearly survival rates over the study period, and over one-sixth of survivors were readmitted within 30-days. More research is needed to identify patients at high risk of mortality and readmissions, to help target resources more efficiently and improve survival.

Cardiac arrest can complicate infective endocarditis (IE) and is associated with significant in-hospital complications and mortality rates. We report the characteristics, outcomes, and readmission rates for IE patients with cardiac arrest in the United States.We surveyed the Nationwide Readmission Database (NRD), a database designed to support national level readmission analyses, for patients admitted with IE and who had cardiac arrest during index admission between 2016 and 2019. Baseline demographics, comorbidities, surgical procedures, and outcomes were identified using their respective International Classification of Diseases (ICD) codes.There were 663 index admissions (mean age 55.87 ± 17.21 years;34.2 % females) for IE with cardiac arrest in the study period, with an overall mortality rate of 55.3 %. Of these, 270 (40.7 %) had surgical procedures performed during the hospitalization encounter. In patients who had a surgical procedure, 72 (26.8 %) patients had in-hospital mortality while 293 (74.9 %) patients without surgical procedures had in-hospital mortality (p0.001). After coarsened matching for baseline characteristics, surgical valve procedures were less likely to be associated with mortality (OR = 0.09, 95%CI 0.04-0.24; p0.001). Among the 295 alive discharges associated with cardiac arrest, 76 (38.57 %) were readmitted within 30-days, with a mortality rate of 22 % noted for readmissions.Among IE patients who had cardiac arrest, surgical procedures subgroup had low mortality despite having higher complication rates. However, due to chances of bias more randomized trials are needed evaluate the hypothesis.

Literature regarding etiology and trends of incidence of major thoracic vein thrombosis in the United States is limited. To study the causes, complications, in-hospital mortality rate, and trend in the incidence of major thoracic vein thrombosis which could have led to superior vena cava syndrome (SVCS) between 2010 and 2018. Data from the nationwide emergency department sample (NEDS) that constitutes 20% sample of hospital-owned emergency departments (ED) and in-patient sample in the United States were analyzed using diagnostic codes. A linear p-trend was used to assess the trends. Of the total 1082 million ED visits, 37,807 (3.5/100,000) (mean age 53.81 ± 18.07 years, 55% females) patients were recorded with major thoracic vein thrombosis in the ED encounters. Among these patients, 4070 (10.6%) patients had one or more cancers associated with thrombosis. Pacemaker/defibrillator-related thrombosis was recorded in 2820 (7.5%) patients, while intravascular catheter-induced thrombosis was recorded in 1755 (4.55%) patients. Half of the patients had associated complication of pulmonary embolism. A total of 59 (0.15%) patients died during these hospital encounters. The yearly trend for the thrombosis for every 100,000 ED encounters in the United States increased from 2.17/100,000 in 2010 to 5.98/100,000 in 2018 (liner p-trend

Literature regarding outcomes of cardiac arrest with associated NSTEMI is limited. We aim to study the predictors and survival outcomes of cardiac arrest patients presenting to the emergency department who were diagnosed with non-ST elevated myocardial infarction (NSTEMI).Data from the nationwide emergency department sample (NEDS) that constitutes 20% sample of hospital-owned emergency departments in the United States was analyzed for the cardiac arrest related visits from 2009-2018. Cardiac arrest was defined by the ICD codes.Out of 3,235,555 cardiac arrests (mean age 64.0 ± 19.5 years, 40.7% females) there were 163,970 (5.1%) patients diagnosed with NSTEMI during the years 2009-2018. Among cardiac arrest patients, the survival for NSTEMI patients was higher than patients without NSTEMI (46.7% vs. 22.7%). These patients were more likely to be males and elderly. Among the predictors for NSTEMI cardiac arrests, hypertension (OR 1.12, p 0.001), peripheral vascular disease (OR 1.16, p 0.001), prior-coronary artery bypass graft (OR 1.20, p 0.001) were the predominant ones. Cardiovascular interventions were more common in NSTEMI cardiac arrests and were associated with lower mortality rates (p 0.001). However, trend for coronary interventions remained steady over study years. We observed an increase in prevalence of NSTEMI cardiac arrests with a worsening trend in survival from 2009-2018.NSTEMI was not uncommon in patients with cardiac arrest. NSTEMI cardiac arrest had a better prognosis than patients without NSTEMI. Cardiovascular interventions might have survival benefits. More research is required to identify NSTEMI in cardiac arrest patients and further evaluate the effect of cardiovascular interventions on survival.

COVID-19 is a novel highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Immunosuppressed people are at a higher risk for unfavourable outcomes if infected with SARS-CoV-2, as cellular immunity plays a key role in determining the course and outcome in COVID-19. Kidney transplant recipients (KTRs) are thus a distinct subset of the population. We describe our early experience with 2 KTRs requiring hospital admission due to COVID-19 and who recovered well. We conclude that timely intervention in the form of modifying immunosuppression and close monitoring and institution of further measures based on clinical severity is needed in KTRs with COVID-19.

Mucormycosis is an acute life-threatening fungal infection in immunocompromised children. Very few case reports of rhino-orbital mucormycosis have been documented in pediatric age group. We report a case of rhino-orbital mucormycosis with palatal perforation in a child with type 1 diabetes mellitus that was managed with lipid complex amphotericin B coupled with surgical debridement. Early recognition and aggressive treatment have reduced the mortality and morbidity.

Diabetic neuropathy (DN) is a major complication of Type 1 Diabetes Mellitus (T1DM). It is usually subclinical in childhood, but can cause significant impairment with its progression through to adulthood. Current guidelines vary in their recommendation regarding screening for DN in children with T1DM, with some advocating starting screening 5 years after the diagnosis of T1DM. Clinical assessment comprising of history and neurological examination is the most commonly used method for screening, though Nerve Conduction Studies (NCS) provide better sensitivity in picking up early subclinical diabetic neuropathy. We describe an adolescent female with poorly controlled T1DM, presenting with symptomatic diabetic neuropathy within 2 years of disease onset and as the initial long term complication. Thus, guidelines regarding screening for DN may need revision, to start screening earlier than presently recommended, and NCS could play a prominent role in screening children with significant risk factors for developing DN.

The optimal fluid therapy in children with DKA is a matter of debate, especially if we take into account its association with cerebral edema, the most important complication. Hypertonic Saline Solution is used in the treatment of cerebral edema, and also has been used for volume resuscitation in children with shock.To compare the effects of 3% saline and 0.9% saline solutions on changes in vital parameters, sodium and chloride levels, lactate and pH; time needed for the correction of hyperglycemia; time needed for the control of ketoacidosis and incidence of cerebral edema.Open-label prospective RCT in which 40 children with moderate to severe DKA were randomized to receive either 3% saline or 0.9% saline as initial fluid therapy.There was no significant difference between the two groups in the clinical vital parameters, time for the correction of hyperglycemia and the resolution of acidosis. Patients in the 3% saline group had a higher increase in sodium and chloride from baseline compared to the 0.9% saline group. The acidemia was noted to worsen in both groups after the initiation of fluid therapy, which was not associated with clinical deterioration. The frequency of cerebral edema was similar in both groups.Both 0.9% saline and 3% saline were equally effective as initial fluid in children with DKA with respect to hemodynamic improvement, the resolution of acidosis and the correction of hyperglycemia, but the use of 3% saline solution did not preclude the development of cerebral edema and has the potential to cause hypernatremia, hyperchloremia and hyperchloremic metabolic acidosis.Wstęp. Wybór optymalnej metody terapii płynowej cukrzycowej kwasicy ketonowej (DKA) u dzieci pozostaje kwestią dyskusyjną, szczególnie w związku z ryzykiem obrzęku mózgu, najważniejszego powikłania. Hypertoniczny roztwór soli fizjologicznej jest używany w leczeniu obrzęku mózgu oraz był używany w leczeniu wstrząsu u dzieci. Cel badania. Porównanie wpływu leczenia 3% i 0,9% roztworem soli fizjologicznej na stan kliniczny oraz zmiany stężenia sodu, mleczanu i ph krwi, czasu korekty hiperglikemii oraz leczenia kwasicy i występowania obrzęku mózgu u dzieci. Metody. Przeprowadzono randomizowane badanie prospektywne, typu open-label, w grupie 40 dzieci z umiarkowaną do ciężkiej cukrzycową kwasicą ketonową. Dzieci losowano do grupy otrzymującej jako początkową terapię płynową 3% lub 0,9% roztwór soli fizjologicznej. Wyniki. Pomiędzy obiema grupami nie było istotnych różnic w stanie klinicznym, czasie korekty hiperglikemii oraz czasie wyrównania kwasicy. W grupie pacjentów, którzy otrzymali 3% roztwór soli stwierdzono większy wzrost stężenia sodu oraz chloru w porównaniu z grupą, która otrzymywała 0,9% roztwór soli. Obserwowano przejściowe pogorszenie pH po rozpoczęciu terapii płynowej w obu grupach, co jednak nie było związane z pogorszeniem stanu klinicznego. Częstość występowania obrzęku mózgu była podobna w obu grupach. Wnioski. Zarówno 0,9% jak i 3% roztwór soli fizjologicznej są równie efektywne w początkowej terapii płynowej u dzieci z DKA, wpływają na poprawę stanu układu krążenia, poprawę kwasicy i korektę hiperglikemii. Użycie 3% NaCl nie chroni jednak przed rozwojem obrzęku mózgu i może potencjalnie powodować hipernatremię, hiperchloremię oraz hiperchloremiczną kwasicę metaboliczną.

OBJECTIVE To determine the accuracy of commonly used body surface area (BSA) equations and to devise a new equation for BSA calculation in non-edematous severe acute malnourished (NE-SAM) children. METHODS Children aged between 2 months and 5 years fulfilling World Health Organization criteria for NE-SAM were included. Seven commonly used equations were used for calculating the BSA. Mean BSA from the equations was used as reference for comparison. A new equation SAM Mosteller modified was also derived. RESULTS A total of 471 children were included. Of the seven equations, Mosteller had minimum root mean square error (RMSE) value of 2.89. The goodness of SAM Mosteller modified equation was subsequently compared with Mosteller and Boyd in 66 NE-SAM children. The SAM Mosteller modified showed least RMSE (2.65), whereas Boyd had maximum. CONCLUSIONS Among seven equations, Mosteller is useful for BSA calculation in NE-SAM. SAM Mosteller modified equation (164.551 × [Ht × Wt](0.5)) has least error and can serve as best measure of BSA in SAM children.