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Esteban E.,Pediatric Intensive Care Unit Service | Bujaldon E.,University of Barcelona | Esparza M.,University of Barcelona | Jordan I.,Pediatric Intensive Care Unit Service | Esteban M.E.,University of Barcelona
American Journal of Human Biology | Year: 2015

Objectives: Based on the existing sex differences in mortality rates in children, we would like to explore whether girls and boys respond differently under severe health conditions, in terms of mortality and cause of admission. Methods: We analyzed demographic characteristics (age and sex), causes of admission, clinical parameters, and mortality in a sample of 2,609 patients from a Pediatric Intensive Care Unit (PICU) in a children's hospital in Barcelona, Spain. Results: PICU admittance was significantly higher in boys (57.5% vs. 42.5%) whereas PICU mortality was significantly higher in girls (4.9% vs. 3.3%). Female sex was a risk factor for PICU in-hospital mortality (OR=1.55, P=0.033), while increasing age had a protective effect (OR=0.808, P=0.021). In cases of PICU mortality, girls died from a broader range of causes and boys were more affected by respiratory and polytraumatic injuries. Boys were affected by polytraumatic injuries throughout the year, less frequently in winter, while girls showed a higher occurrence in holiday months. Conclusions: Although more boys were admitted to the PICU, a significantly higher number of girls died. Younger age and higher occurrence of nosocomial infection among girls could explain this finding. More frequent polytraumatic injuries in boys could reflect an increased exposure to risky activities and/or more careless behavior. Am. J. Hum. Biol. 27:613-619, 2015. © 2015 Wiley Periodicals, Inc. Source

Jordan I.,Pediatric Intensive Care Unit Service | Calzada Y.,Pediatric Intensive Care Unit Service | Monfort L.,Pediatric Service | Vila-Perez D.,Pediatric Intensive Care Unit Service | And 4 more authors.
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2016

Background Pneumococcal meningitis (PM) has a high morbidity and mortality. The aim of the study was to evaluate what factors are related to a poor PM prognosis. Methods Prospective observational study conducted on patients admitted to the Pediatric Intensive Care Unit in a tertiary hospital with a diagnosis of PM (January 2000 to December 2013). Clinical, biochemical and microbiological data were recorded. Variable outcome was classified into good or poor (neurological handicap or death). A multivariate logistic regression was performed based on the univariate analysis of significant data. Results A total of 88 patients were included. Clinical variables statistically significant for a poor outcome were younger age (p =.008), lengthy fever (p =.016), sepsis (p =.010), lower Glasgow Score (p <.001), higher score on Pediatric Risk Mortality Score (p = 0.010) and Sequential Organ Failure Assessment (SOFA) (p <.001), longer mechanical ventilation (p =.004), and inotropic support (p =.008) requirements. Statistically significant biochemical variables were higher level of C-reactive protein (p <.001) and procalcitonin (p =.014) at admission, low cerebrospinal (CSF) pleocytosis (p =.003), higher level of protein in CSF (p =.031), and severe hypoglycorrhachia (p =.002). In multivariate analysis, independent indicators of poor outcome were age less than 2 years (p =.011), high score on SOFA (p =.030), low Glasgow Score (p =.042), and severe hypoglycorrhachia (p =.009). Conclusions Patients younger than 2 years of age, with depressed consciousness at admission, especially when longer mechanical ventilation is required, are at high risk of a poor outcome. © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Source

Garcia I.J.,Pediatric Intensive Care Unit Service | Gargallo M.B.,Pediatric Intensive Care Unit Service | Torne E.E.,Pediatric Intensive Care Unit Service | Lasaosa F.J.C.,Pediatric Intensive Care Unit Service | And 3 more authors.
Pediatric Critical Care Medicine | Year: 2012

OBJECTIVE: To determine whether procalcitonin discriminates between postcardiopulmonary bypass inflammatory syndrome and infectious complication in children better than does C-reactive protein. DESIGN: Prospective study of children admitted to the intensive care unit after cardiopulmonary bypass. PATIENTS: Classified according to a diagnosis of systemic inflammatory response syndrome and bacterial infection or systemic inflammatory response syndrome but no bacterial infection. Two hundred thirty-one cases were recruited. MEASUREMENT AND MAIN RESULTS: Procalcitonin, C-reactive protein, and leukocyte count were measured daily from surgery until day 3. Twenty-two patients were infected (9.5%). Significant differences were detected in the procalcitonin values of the infected group vs. the noninfected group, especially at day 2 (p = .000). There were no differences in the C-reactive protein values. The optimal cutoff for procalcitonin was >2 ng/mL at day 1 and above 4 ng/mL at the day 2. There was a greater sensitivity and specificity than with C-reactive protein as an infection predictor. CONCLUSION: Procalcitonin is useful in the diagnosis of bacterial infection after cardiopulmonary bypass. Because procalcitonin kinetics are different in postcardiopulmonary bypass patients, the cutoff to diagnose infection should be different from the normal cutoff. Copyright © 2012 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. Source

Jordan I.,Pediatric Intensive Care Unit Service | Balaguer M.,Pediatric Intensive Care Unit Service | Esteban M.,University of Barcelona | Cambra F.J.,Pediatric Intensive Care Unit Service | And 6 more authors.
Clinical Nutrition | Year: 2016

Background and aims: To determine whether glutamine (Gln) supplementation would have a role modifying both the oxidative stress and the inflammatory response of critically ill children. Methods: Prospective, randomized, double-blind, interventional clinical trial. Selection criteria were children requiring parenteral nutrition for at least 5 days diagnosed with severe sepsis or post major surgery. Patients were randomly assigned to standard parenteral nutrition (SPN, 49 subjects) or standard parenteral nutrition with glutamine supplementation (SPN + Gln, 49 subjects). Results: Glutamine levels failed to show statistical differences between groups. At day 5, patients in the SPN + Gln group had significantly higher levels of HSP-70 (heat shock protein 70) as compared with the SPN group (68.6 vs 5.4, p = 0.014). In both groups, IL-6 (interleukine 6) levels showed a remarkable descent from baseline and day 2 (SPN: 42.24 vs 9.39, p < 0.001; SPN + Gln: 35.20 vs 13.80, p < 0.001) but only the treatment group showed a statistically significant decrease between day 2 and day 5 (13.80 vs 10.55, p = 0.013). Levels of IL-10 (interleukine 10) did not vary among visits except in the SPN between baseline and day 2 (9.55 vs 5.356, p < 0.001). At the end of the study, no significant differences between groups for PICU and hospital stay were observed. No adverse events were detected in any group. Conclusions: Glutamine supplementation in critically-ill children contributed to maintain high HSP-70 levels for longer. Glutamine supplementation had no influence on IL-10 and failed to show a significant reduction of IL-6 levels. © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Source

Perez D.V.,Pediatric Intensive Care Unit Service | Jordan I.,Pediatric Intensive Care Unit Service | Esteban E.,Pediatric Intensive Care Unit Service | Garcia-Soler P.,Pediatric Intensive Care Unit Service | And 6 more authors.
Pediatric Infectious Disease Journal | Year: 2014

BACKGROUND:: Sepsis and septic shock represent up to 30% of admitted patients in pediatric intensive care units, with a mortality that can exceed 10%. The objective of this study is to determine the prognostic factors for mortality in sepsis. METHODS:: Multicenter prospective descriptive study with patients (aged 7 days to 18 years) admitted to the pediatric intensive care units for sepsis, between January 2011 and April 2012. RESULTS:: Data from 136 patients were collected. Eighty-seven were male (63.9%). The median age was a year and a half (P25-75 0.3-5.5 years). In 41 cases (30.1%), there were underlying diseases. The most common etiology was Neisseria meningitidis (31 cases, 22.8%) followed by Streptococcus pneumoniae (16 patients, 11.8%). Seventeen cases were fatal (12.5%). In the statistical analysis, the factors associated with mortality were nosocomial infection (P = 0.004), hypotension (P <0.001) and heart and kidney failure (P < 0.001 and P = 0.004, respectively). The numbers of leukocytes, neutrophils and platelets on admission were statistically lower in the group that died (P was 0.006, 0.013 and <0.001, respectively). Multivariate analysis showed that multiple organ failure, neutropenia, purpura or coagulopathy and nosocomial infection were independent risk factors for increased mortality (odds ratio: 17, 4.9, 9 and 9.2, respectively). CONCLUSIONS:: Patients with sepsis and multiorgan failure, especially those with nosocomial infection or the presence of neutropenia or purpura, have a worse prognosis and should be monitored and treated early. Copyright © 2013 by Lippincott Williams & Wilkins. Source

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