BackgroundSerious burns produce plasma extravasation which develops an important loss of immunoglobulins (Ig). In patients with a burned surface area (BSA) >15% IgG plasmatic levels decrease until 40 hours’ post-burn.PurposeTo evaluate the use of non-specific Ig in burned paediatric patients based on the current protocol of the hospital.Material and methodsRetrospective observational study, which includes all paediatric patients with ≥15% BSA hospitalised between August 2012 and July 2017.Biodemographic data were registered as: (sex, age, weight), burn data (BSA) and Ig administration data (plasmatic levels, dose and number of administrations).The existing protocol about the use of Ig in burned paediatric patients (BSA ≥15%) was analysed. It recommends the determination of IgG 24 to 48 hours’ post-burn and the infusion of non-specific Ig (400 mg/kg) if patients have below-normal levels.ResultsThirty-one patients (12 females) with a median age of 2 years (8 m – 15 y) and a weight of 13 kg (7.5–67 kg) were enrolled in the study. The median BSA was 20% (15%–55%).Eighteen patients (58%) accomplished all the recommendations specified in the protocol.Determination of IgG levels was made in 26 patients (83.9%). Eighteen (69.2%) had below-normal levels and a median BSA of 23.5% (15–55). In the subgroup of patients with BSA ≥20% (20–55) the determination was done in the 94% (15/16) and 14 (93%) who had below-normal levels.Non-specific Ig was administered in 61% (19) of the patients at a dose of 400 mg/kg. No IgG determination was repeated after the first infusion in six patients (31.6%). Seven patients with a median BSA of 46% (16–55) needed more than one Ig infusion.ConclusionAll patients received the dose of Ig indicated in the protocol (400 mg/kg).In patients with BSA>20%, determination of plasmatic levels is essential because it was detected that more than 90% of the patients had below–normal levels of IgG.No IgG determination after the first infusion was repeated in more than 30% of the patients, therefore a proposal to improve the protocol is the need to repeat IgG determination in all the patients who have received an infusion to corroborate the achievement of normal IgG levels.References and/or AcknowledgementsThanks to all authorsNo conflict of interest
BackgroundIntravenous immunoglobulin (IVIG) is the standard of care for humoral immunodeficiencies (HID) and several systemic autoimmune diseases. Its chronic administration represents an important economic and logistical impact.PurposeTo assess the real time of infusion of IVIG compared to the established maximums and to analyse which factors could affect it, in order to find out if the infusion rate could be higher.Material and methodsAn observational, ambispective study with patients chronically receiving IVIG was conducted at the day hospital of a tertiary hospital (December 2016 to March 2017).Biodemographic data (sex, age, weight) and clinical data (primary diagnosis, dose, frequency of administration) were obtained from medical records. Infusion and premedication times were collected from the nursing management software (Gacela®)The primary endpoint was infusion time expressed as mean and standard deviation (SD) for each commercial preparation. The influence of demographic covariates, IVIg dose, commercial preparation and the need and type of premedication was also analysed (ANOVA test was performed with Stata®).ResultsOne hundred and seventy-five patients were included (51% females, mean age of 55 (20–91)). Sixty-nine patients had HID, 89 had neurological disease and 17 had systemic autoimmune diseases.The dose administered, need of premedication and commercial preparation had an impact on the time of infusion. However, it was not affected by sex, weight or age.Logically at higher doses, more infusion time was required. Moreover, the infusion rate was higher in the case of Intratec® (9.14 g/h, SD 0.98 g/h, n=3), Octagamocta® (8.48 g/h, SD 1.81 g/h, n=25) and Privigen® (8.39 g/h, SD 2.30 g/h, n=84). Flebogamma-Plangamma5%® (7.33 g/h, SD 1.76 g/h, n=36) and Flebogamma10%® (7.61 g/h, SD 1.54 g/h, n=16) achieved intermediate velocities. The preparations with the lowest IVIg infusion rate values were Kiovig® (7.30 g/h, SD 2.60 g/h, n=6) and Gammagard® (644 g/h, SD 2.08 g/h, n=5).All preparations were infused at a lower rate (p<0. 05) than the maximum set in the technical sheet.Premedication was necessary in 72 patients (41%) oral acetaminophen being the most commonly used. However, premedication combinations were also effective (31 patients, 18%) with acetaminophen +dexchlorpheniramine (11 patients) the most used.ConclusionAdministration of IVIG is performed at an infusion rate that is below the established maximums. Despite this fact, many patients need premedication to avoid infusion reactions. In the light of the results, increasing the rate of IVIG administration should be considered for those patients with good tolerance, saving time and money invested in day hospitals.References and/or AcknowledgementsThanks to all authors for their involvementNo conflict of interest
BackgroundEarly aggressive parenteral nutrition (APN), consisting of high protein (2.5–3.5 g/kg/day) and high lipid (2 g/kg/day) administration from birth onwards, has proven to be safe in very-low-birthweight-preterm (VLBWP) infants.However, Bonsante F et al.1 hypothesised that APN administration induces an anabolic state in the cell promoting potassium and phosphorus intake, decreasing their plasma concentration, which leads to an increase in plasma calcium levels.PurposeTo report the prevalence of potassium, phosphorus and calcium imbalance during the first weeks of life in a population of VLBWP infants receiving APN from day 1.Material and methodsRetrospective, observational study conducted at a third-level childrens’ hospital from January to December 2016, including preterm infants (<33 weeks’ gestational age, weight <1500 g), who received parenteral nutrition (PN) and were hospitalised in the intensive care unit within the first 24 hours of life.Gestational age, birthweight, daily parenteral intake composition and blood concentrations of potassium, phosphate and calcium during the administration of PN were collected from the electronic health record Centricity Critical Care®.The main data evaluated were the mean potassium, phosphorus and calcium concentrations in plasma during treatment with PN.ResultsThe study included a total of 116 VLBWP infants, average 29±2.7 weeks’ gestational age, main weight 1102±321 g.The mean duration of PN administration was 7.7 (1–68) days, with an average amino-acid and lipid intake of 2.82±0. 79 g/kg/day and 1.81±0. 68 g/kg/day, respectively.Hypokalaemia (K<3 mmol/L) occurred in 108 (93%) infants, hypophosphatemia (p<1 mmol/L) in 22 (18%), and hypercalcaemia (Ca >2. 8 mmol/L) in two infants (1.7%). Mean plasma levels of potassium, phosphate and calcium were 1>13±0.18 mmol/L, 0.77±0.17 mmol/L and 2.91±0.017 mmol/L, respectively.ConclusionPrevalence of hypokalaemia and hypophosphataemia were 93% and 18%, respectively, similar trends as in Bonsante et al’s study. 1 Therefore, they could be explained by the hypothesis of the anabolic-state-cell. Nevertheless, hypercalcaemia occurred in 1.7% versus 30.2% of infants in Bonsante et al’s group. 1 Apparently, calcium imbalance was detected earlier and corrected in our cohort.Close monitoring of the analytical determinations by the pharmacist would allow anticipation and correction of electrolyte imbalances by proposing changes in PN composition.Reference and/or Acknowledgements1. Bonsante F, et al. Initial amino acid intake influences phosphorus and calcium homeostasis in preterm infants – it is time to change the composition of the early parenteral nutrition. PLoS ONE2013;8(8):1–9.No conflict of interest
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