Anaphylaxis is a serious, life-threatening hypersensitivity reaction. The incidence of anaphylaxis is 4-5 per 100,000 persons per year and is reported to be increasing in recent years. We analysed management of suspected anaphylaxis in children at a DGH and a regional referral center in UK. A retrospective case note analysis was carried out between January 2007 and September 2012, which was compared to NICE (National Institute of Clinical Excellence) guidelines. We identified a total of 81 cases from the DGH of which 71 case notes were analysed and a total of 30 cases from the regional centre. Both centers’ were good at documenting acute clinical features (>95%) and the circumstances prior to symptom onset (>93%). Both hospitals need to improve their documentation of time of onset of reaction (50:30%), informing about biphasic reaction (8.5- 1%) and supply information regarding support groups (1.4-0%). Our study revealed no child received full discharge information according to NICE criteria. The DGH performed better than the tertiary center in referral to specialist allergy services providing adrenaline auto injector and demonstration of auto injector. The DGH outperformed the tertiary center likely due to availability of specialist allergy services. We endeavor to improve our management by establishment of specialist allergy services at the tertiary hospital and anaphylaxis education among all doctors.
Objectives The paediatric intensive care unit changed heparin infusion dosing from a variable weight-based concentration to a fixed concentration strategy, when smart pump-based drug library was introduced. This change meant significantly lower rates of infusion were needed for the same dose of heparin in the neonatal population. We performed a safety and efficacy assessment of this change. Methods We performed a retrospective single-centre evaluation based on data from respiratory VA-extracorporeal membrane oxygenation (ECMO) patients weighing ≤5 kg, pre and post the change to fixed strength heparin infusion. Efficacy was analysed by distribution of activated clotting times (ACT) and heparin dose requirements between the groups. Safety was analysed using thrombotic and haemorrhagic event rates. Continuous variables were reported as median, interquartile ranges, and non-parametric tests were used. Generalised estimating equations (GEE) were used to analyse associations of heparin dosing strategy with ACT and heparin dose requirements in the first 24 h of ECMO. Incidence rate ratios of circuit related thrombotic and haemorrhagic events between groups were analysed using Poisson regression with offset for run hours. Results 33 infants (20 variable weight-based, 13 fixed concentration) were analysed. Distribution of ACT ranges and heparin dose requirements were similar between the two groups during the ECMO run and this was confirmed by GEE. Incidence rate ratios of thrombotic (fixed v weight-based) (1.9 [0.5–8], p = .37), and haemorrhagic events (0.9 [0.1–4.9], p = .95) did not show statistically significant differences. Conclusions Fixed concentration dosing of heparin was at least equally effective and safe compared to a weight-based dosing.
Studies of blood glucose (BG) control during Paediatric Intensive Care Unit (PICU) admission have demonstrated worse outcomes with hyper- and hypoglycemia. The majority of these studies have used intermittent blood sampling protocols, which are inherently prone to sampling frequency bias [1]. Admission BG is a single value, and is therefore immune to sampling frequency bias. The relationship between clinical outcomes and admission BG has been described in critically ill adults [2], but this relationship has not been previously investigated in critically ill children.
Aims
In a cohort of PICU patients to describe: The relationship between admission BG and PICU mortality. The prevalence of admission hypoglycaemia. Setting Mixed medical and surgical PICU in a tertiary children’s hospital.
Methods
Retrospective, analytical, cohort study. BG values obtained from blood gas electronic database. Admission glucose defined as first BG within one hour of admission. Readmissions were excluded. Mortality rate was calculated for each decile of admission BG. Proportion of hypoglycaemia was calculated for whole cohort, and by age and surgical status. The definitions of hypoglycaemia: severe <=2.2 mmol/L; moderate <4.0 mmol/L.
Results
3129 consecutive patients were included. PICU mortality by decile of BG demonstrated a U-shaped curve: higher mortality risk at low and high values (Figure 1). Overall prevalence of admission hypoglycemia: Moderate: 7.6%. Severe: 1.3% Prevalence of admission hypoglycemia was inversely related to age, with highest prevalence in neonates. Admission hypoglycemia was more common in non-surgical patients, compared with surgical patients in all age groups. Highest prevalence of hypoglycaemia was in non-surgical neonates: 23.5%, 2.9% – moderate and severe hypoglycemia, respectively.
Conclusions
Previous studies have focused on the clinical associations of hyperglycaemia. This study shows that admission hypoglycemia is equally important as hyperglycaemia, in terms of PICU mortality. The higher prevalence of hypoglycaemia in non-surgical neonatal patients may reflect reduced or exhausted glycogen stores. Clinicians should be aware of this marker of raised mortality risk when admitting patients to PICU.
References
Plunkett et al. Observational Studies of Glucose Homeostasis are Susceptible to Sampling Frequency Bias. Pediatric Critical Care Medicine 2013 Evans et al. Assessing the relationship between admission glucose levels, subsequent length of hospital stay, readmission and mortality. Clinical Medicine 2012
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)