Assessing the accuracy of prognostic scales in children with neuroinfections

The article is devoted to the use of ultrasound diagnostics methods to assess the functional state of the cardiovascular system in critical conditions in children and the choice of optimal hemodynamic support. The need for careful detailed monitoring in patients in pediatric intensive care units has been demonstrated, the low sensitivity and specificity of the currently widely used clinical signs are reflected, which limits their use in the choice of treatment methods. As an alternative, it is proposed to use ultrasound diagnostics that assess cardiac output, allowing you to make an informed decision on medical measures taking into account the current clinical situation. The wide possibilities and numerous advantages of ultrasonic navigation in providing assistance to patients with a wide variety of life-threatening conditions are described. The main advantage is the possibility of obtaining information in real time, directly at the bedside. A clinical case of a target-oriented intensive therapy of left ventricular systolic dysfunction in a nine-year-old child against the background of a septic process using methods of ultrasonic assessment of hemodynamic status is presented. The use of ultrasound imaging methods made it possible to identify the cause of the deterioration of the condition and conduct a reasonable treatment correction, which ensured the fastest regression of hemodynamic disorders and contributed to a favorable outcome of the disease. The simplicity and accessibility of the Teicholz estimate of the ejection fraction was noted, which allows it to be used in routine practice to select the optimal hemodynamic support and assess the effectiveness of treatment over time.

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Role of ultrasound diagnostics in pediatric septic shock intensive care: a review and a clinical case

Ermolenko

Пшениснов

Alexandrovich

et al. 2022

Pediatr (SPb)

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Multiple-organ dysfunction in children with central nervous system infections

Ermolenko,

Pshenisnov,

Aleksandrovich

et al. 2024

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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BACKGROUND: Multiple-organ dysfunction syndrome is one of the most dangerous complications of critical illness in children, which helps determine the disease outcomes. AIM: This study aimed to examine the features of multiple-organ dysfunction syndrome in children with severe central nervous system (CNS) infection and identify factors that determine disease outcomes. MATERIALS AND METHODS: This single-center, retrospective, observational study enrolled 98 patients, which included 66 (67%) boys and 32 (33%) girls. The average age was 3.6 ± 2.5 years. The Glasgow coma scale (GCS) score was 8.8 ± 2.4 points. Shock was diagnosed in 43 (44%) patients. The average treatment duration in the intensive care unit (ICU) was 9.5 ± 6.2 days, the duration of mechanical ventilation was 6.0 ± 3.9 days, and the mortality rate was 9%. Depending on the outcome, the children were divided into groups I (recovery, n = 88) and II (death, n = 10). All indicators were recorded in the first 12 h from ICU admission. RESULTS: The most pronounced phenomena of cardiovascular dysfunction, such as decreased Teicholtz ejection fraction (62.3 L/min), were observed when the pSOFA scale score was 10 points, which was statistically significant when compared with the indicators in children with a pSOFA scale score of 8 points. In all patients, regardless of age, a negative correlation of moderate strength was found between the pSOFA scale score and the Teicholtz ejection fraction, and it was pronounced in children aged 7–17 years (R = –0.41; p = 0.008). A positive correlation was found between heart rate and pSOFA scale score in children aged 7–17 years (R = 0.72; p = 0.009). In the evaluation of the discriminatory ability of the pSOFA scale and Phoenix sepsis scores regarding the outcome on the first day of treatment in the ICU, the latter has greater prognostic significance (area under the curve, 0.866 vs 0.838; sensitivity, 76% vs 72%; specificity, 82% vs 79%). CONCLUSIONS: Low cardiac output syndrome and systemic hypoxia are key factors associated with fatal outcomes in children with severe CNS infections. The high clinical significance of the ejection fraction in predicting the outcomes of severe CNS infections in children, regardless of age, allows the use of this parameter for goal-oriented therapy.

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Predictors of severe forms of rotaviral infection in children

Ермоленко¹,

Konev

Ermolenko³

et al. 2021

jour

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Rotavirus infection (RVI) is one of the most common childhood diseases. The study of predictors of severe forms of this disease is of undoubted interest.Aim. Based on the study of the characteristics of the premorbid background, life history and clinical and laboratory parameters, determine predictors of severe forms of RVI.Patients and methods. In the departments of intestinal infections and resuscitation and intensive care of Pediatric Research and Clinical Center for Infectious Diseases in the period 2018 – 202. a retrospective study of 962 children aged 2 months to 2 years with rotavirus infection was carried out. he severity of the condition was assessed using the Clarke scale. To identify the most significant predictors of the development of severe forms of RVI, two groups of patients were compared: severe (> 16 points) and moderate (≤16 points) forms of RVI. Comparison of the frequency of occurrence of signs in the groups was performed using the Pearson χ2 test and Fisher’s exact method. The forecasting model was developed using discriminant analysis of the statistical package Statistica for Windows.Results. Severe forms of RVI were detected in 65 children. Among the patients with severe forms of RVI, there were no patients with completed preventive vaccination. Patients with severe forms of RVI were admitted to the hospital in the late stages of the disease and had a higher score on the CDS scale. Based on the research carried out, a model for predicting severe forms of RVI was developed. The features included in the model were: the day of illness at admission, the patient’s age, prehospital prescription of antibacterial drugs, the absence of completed vaccination against RVI, and the severity of dehydration. Assessment of the quality of the created model showed that the classification ability was 97.7%.Conclusion. Predictors of severe forms of RVI include admission to a hospital in the late stages of the disease with severe dehydration, early age, prehospital antibiotics and forced transfer to artificial feeding, and absence of completed prophylactic vaccination.

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Assessing the accuracy of prognostic scales in children with neuroinfections

Cited by 3 publications

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Role of ultrasound diagnostics in pediatric septic shock intensive care: a review and a clinical case

Role of ultrasound diagnostics in pediatric septic shock intensive care: a review and a clinical case

Multiple-organ dysfunction in children with central nervous system infections

Predictors of severe forms of rotaviral infection in children

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