farinaz amirikar

Community-acquired pneumonia (CAP) in childhood is an acute lung infection in a child caused by a pathogen originating outside the hospital, i.e., in the community. This disease is a significant cause of illness in developed countries and a major cause of death in developing countries.

This study aims to assess the factors predicting the incidence of pulmonary complications in children with community-acquired pneumonia.

This study involved all children hospitalized in Zahra Mardani Azari Children's Hospital in Tabriz due to CAP between October 2022 and October 2023. Patients were compared in terms of demographic information, prescription records, medicines prescribed during hospitalization, clinical signs and symptoms, laboratory findings at admission and during hospital treatment; imaging results, and the clinical course of the disease. The study data was analyzed using SPSS version 23 software; and we used logistic regression analysis for identifying the related risk factors.

We included 361 patients, of which 104 (28.8%) were in the case group, and 257 (71.2%) were in the control group. The frequent complication was parapneumonic effusion (81.7%) following necrotizing pneumonia (27.9%), empyema (20.2%), and lung abscess (6.7%). Risk factors for pulmonary complications in children with CAP were weight (OR = 1.129), height (OR = 1.112), Body Mass Index (BMI) (OR = 1.112), administration of oral and intravenous acetaminophen during hospitalization (OR = 1.112, 1.209), Tachypnea (OR = 5.178), duration of Fever (OR = 1.290), ESR (OR = 1.312) and HRAD (OR = 3.473).

We found that high weight and BMI, receiving acetaminophen during hospitalization, Tachypnea, and Fever duration until hospitalization, as well as high WBC and ESR, were predictive factors of pulmonary complications in children with CAP.

In the process of intubation, inappropriate placement of the endotracheal tube can lead to hypoxemia, aspiration, insufficient ventilation, atelectasis, barotrauma and pneumothorax. The above complications may be difficult for a patient with severe disease to tolerate; especially when inappropriate placement is not detected by the specialist in the initial evaluation and the diagnosis lasts until the confirmatory chest x-ray is performed. This study evaluated the validity of three formulas in measuring the depth of endotracheal intubation in children under mechanical ventilation. 60 intubated children aged 2 months to 12 years were included in this study. The patients were randomly divided into three study groups. Endotracheal tube length for each patient was calculated on the basis of the endotracheal tube length formulas (12 + age (years) / 2; endotracheal tube diameter * 3; and 5 + height (cm) / 10). The ideal depth of the endotracheal tube based on chest x-ray was measured as the median distance between the first thoracic vertebra (T1) and the carina in cm. The distance between the ideal depth of the endotracheal tube and the end location of the endotracheal tube was also measured and recorded. The mean age of the patients was 42.90 months and 58.3% of them were boys. The most common indication for intubation was pneumonia, along with respiratory distress (33.3%). Considering the difference in endotracheal tube depth between the two values calculated using the formula and chest X-ray equal to± 0.5 cm, formula 12 + (2 / age) in 55% of patients, formula 3 * endotracheal tube length in 70% patients and formula 5 + (10 / height) in 85% of patients, were correctly estimated endotracheal tube length. On the other hand, it was observed that in 15%, 45% and 40% of the patients, the formula predicted the correct length of the endotracheal tube for correct intubation without any difference while compared to the chest X-ray. In evaluating the results obtained from the formula and length of the endotracheal tube measured by chest X-ray, it was also observed that the formulas 12 + (2 / age), 3 * length of the endotracheal tube and 5 + (10 / height) were significantly correlated with CXR. According to the obtained results, it can be concluded that the formulas used to estimate the depth of endotracheal tube placement in children have low accuracies compared to the gold standard of measurement (chest X-ray). Of course, in comparison to the three formulas (height, weight and diameter of the ETT), the height formula was more accurate than others.

Respiratory diseases are the most common cause of death in the pediatric population and acute or progressive respiratory failure, which requires mechanical ventilation, is the most common cause of children’s hospitalization in the intensive care unit. Despite advances in recent decades regarding the treatment of acute respiratory diseases in children and innovative settings in mechanical ventilation, there are no clear and comprehensive guidelines for the use of mechanical ventilation in children. This research aimed to evaluate the correlation between oxygenation and ventilation indices in predicting the duration of mechanical ventilation in children aged two months to 14 years old admitted to PICU. In this cross-sectional study, 56 patients were included. The required information was extracted from the patients' clinical records and entered into the prepared questionnaires. They included age, sex, and diagnosis, duration of intubation, extubation time, mechanical ventilation parameters, and blood gas parameters. Patients' blood and ventilation data were collected and calculated from the first day of mechanical ventilation until 7 days later to calculate Oxygenation (OI) and Ventilation (VI) indices. Pneumonia, the most common cause of hospitalization in the intensive care unit and the need for intubation, was present in our population (82%) due to aspiration and Covid-19 disease. There was a significant relationship between higher levels of FiO2 and longer duration of patients' intubation (P <0.001). The amount of PIP in each of the first days of intubation was significantly correlated with the duration of the study. A significant direct relationship was found between the ventilation index and oxygenation index. (P <0.05) Except for the sixth day, oxygenation index and duration of intubation were significantly correlated. (P <0.05) This means that along with the increase in oxygenation index, the duration of intubation was also increased. Ventilation index and duration of intubation were also significantly correlated, except on the fourth and fifth days (P <0.05). None of the extubated patients required re-intubation. Eventually, a very weak statistical correlation was found between the intubation period and the final result in the form of discharge and recovery of the patient or his death. Using variables such as gender, PIP and oxygenation, and ventilation indices, in the early days of mechanical ventilation, the prognosis of these patients and better management of their treatment can be judged. It is, finally, emphasized that further studies on larger populations, with more variables and long-term follow-ups are required.

This case report describes a 30-month-old child with primary pulmonary rhabdomyosarcoma with a congenital cystic adenomatoid malformation (CCAM). In the current literature, primary pulmonary neoplasms have been reported for similar cases. The tumor was located in the anterior-basal segment of the left lower lobe with a thin-walled cystic appearance and lobulated margins. A histology examination showed rhabdomyosarcoma origin with an embryonal subtype. Postoperative systemic chemotherapy was carried out. After a 6-month follow-up, the patient had no residual or recurrent disease.

Background :

Today few studies have focused on using calprotectin as an effective biomarker for monitoring the exacerbation of pulmonary complications in cystic fibrosis (CF). Thus, the present study aimed to assess the diagnostic value of the changes in the calprotectin level of patient's serum and sputum during responding to the therapy of exacerbated CF in children.

The cross-sectional study was conducted among 21 CF patients, which received required supportive and therapeutic procedures based on the protocol related to pulmonology ward in the Children Medical Research and Training Center of Tabriz University of Medical Sciences. The sputum and serum samples of all patients were collected to evaluate calprotectin level at 1-2 days after starting therapy with routine antibiotics such as cephalosporin and macrolides, and they were again gathered at the end of therapy process.

Assessing outcome in 21 patients under study represented complete and partial recovery in 12 (57.2%), and 9 (42.8%) ones, respectively. The mean decrease in calprotectin level in the serum and sputum of the patients was respectively obtained as 40.7289.08 μg/ml and 99.03225.94 μg/ml. The calprotectin decrease in serum with the cutoff point of 15.70 μg/ml possessed the sensitivity of 66.7% and specificity of 55.6% in predicting complete recovery outcome; while that of sputum with the cutoff point of 26.20 μg/ml had the sensitivity and specificity of 66.7 and 22.2%, respectively.

The mean age of participants were 8.61±4.19 years. It can be concluded that serum and sputum calprotectin decrease with cutoff point of 15.70 μg/ml and 26.20 μg/ml, respectively in have high sensitivity for determining response to treatment in cystic fibrosis exacerbation.

Background:

 Influenza viral infections lead to a wide range of respiratory diseases which have an annual pattern and are responsible for significant morbidity and mortality among children. It was found that influenza among children has significant rates of mortality and morbidity. We aimed to evaluate the diagnostic value of Pediatric Risk of Mortality (PRISM) III scoring system in children with influenza for clinical outcomes of patients.

In this cross-sectional study, 50 children referred to the Children's Hospital of Tabriz (Iran) with flu symptoms who were admitted to the ward or pediatric intensive care unit (PICU) were evaluated through the PRISM III model.

In this study, 50 children (48% female and 52% male) with a mean age range of 70.28 ±22.46 months with the flu were studied. The mean PICU of patients’ hospitalization was 34.2 ±36.5 days and the mortality rate was 16%. There was no statistically significant relationship between patient mortality and the variables of age, gender, length of hospitalization in PICU and the length of general hospitalization (p <0.05). However, only a statistically significant inverse relationship was observed between blood urea nitrogen (BUN) level and patient mortality among other variables evaluated in the PRISM III model (p = 0.016). In addition, there was a statistically significant relationship between PRISM III model score and mortality in the studied patients (p = 0.002).

 Conclusion:

 In the present study, considering the cut-off point 14, the sensitivity and specificity of the PRISM III model in estimating the mortality of children with influenza are equal to 87.5% and 85.7%, respectively; so the PRISM III model had excellent diagnostic and estimation power.

Pulse-oximetry (Spo2) widely uses as a help tools for therapeutic interventions in the pediatric intensive care units (PICU). The aim of this study was to evaluate the validity of Spo2 in measuring of oxygenation index (OI) in children.
In a descriptive analytical study, 100 patients who were admitted to PICU Tabriz Children's Hospital were studied. Oxygenation index measured by using two methods, including SpO2 which obtained from Spo2 and partial pressure of oxygen in arterial blood (PaO2) which obtained from Arterial Blood Gases analysis.
Based on findings, there was a linear correlation between SpO2 and PaO2, and also about OI which measured with Spo2 and PaO2. Based on Receiver Operating Curve (ROC), sensitivity and specificity of OI with considering PaO2 as denominator and in values less or more than 0.145, were 100%, and 76.9%, respectively; and with considering SpO2 as denominator and in values less or more than 0.145, were 98.6%, and 67.7%, respectively.
This study indicates that SpO2 instead of pao2 for measuring OI can be useful.