Pediatrics in Review

September 2019, VOLUME 40 / ISSUE 9

Article DOI: 10.1542/pir.2018-0241

Sudden Cardiac Death: A Pediatrician’s Role

Benjamin H. Hammond, Kenneth G. Zahka, Peter F. Aziz

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Education Gaps

1. There is a broad differential diagnosis to be considered in cases of sudden cardiac arrest, sudden cardiac death.

2. Timely diagnosis can circumvent progression to cardiac arrest in at-risk individuals.

3. All children should be screened and testing should be reserved for those with increased risk.

 

Objectives

After completing this article, readers should be able to:

1. Assess risk of sudden cardiac arrest/sudden cardiac death (SCA/SCD) with a screening history and physical examination.

2. Identify the mechanisms of distinct etiologies of SCA/SCD.

3. Recognize findings consistent with risk of SCA/SCD on a 12-lead electrocardiogram.

4. Address the concerns and questions of individuals and families after SCA/SCD.

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Pediatr Neonatol. 2018 Dec;59(6):543-552. doi: 10.1016/j.pedneo.2018.03.005. Epub 2018 Mar 30.

State-of-the-art acute phase management of Kawasaki disease after 2017 scientific statement from the American Heart Association.

Liu YC1, Lin MT2, Wang JK3, Wu MH3.

Author information

1

Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

2

Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan. Electronic address: mingtailin@ntu.edu.tw.

3

Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.

Abstract

Kawasaki disease (KD) has become the most common form of pediatric systemic vasculitis. Although patients with KD received intravenous immunoglobulin (IVIG) therapy, coronary arterial lesions (CALs) still occurred in 5%-10% of these patients during the acute stage. CALs may persist and even progress to stenosis or obstruction. Therefore, CALs following KD are currently the leading cause of acquired heart diseases in children. The etiology of CALs remains unknown despite more than four decades of research. Two unsolved problems are IVIG unresponsiveness and the diagnosis of incomplete KD. The two subgroups of KD patients with these problems have a high risk of CAL. In April 2017, the American Heart Association (AHA) updated the guidelines for the diagnosis, treatment, and long-term management of KD. Compared with the previous KD guidelines published in 2004, the new guidelines provide solutions to the aforementioned two problems and emphasize risk stratification by using coronary artery Z score systems, as well as coronary severity-based management and long-term follow-up. Therefore, in this study, we merged the AHA Scientific Statement in 2017 with recent findings for Taiwanese KD patients to provide potential future care directions for Taiwanese patients with KD.

Copyright © 2018. Published by Elsevier B.V.

KEYWORDS:

Coronary arterial lesions; Immunoglobulin; Kawasaki disease; Taiwan

PMID:

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29706362

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DOI:

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10.1016/j.pedneo.2018.03.005

[Indexed for MEDLINE] 

Free full text

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BMC Infect Dis. 2019; 19: 919.

Published online 2019 Oct 29. doi: 10.1186/s12879-019-4563-5

PMCID: PMC6820906

PMID: 31664950

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Pertussis hospitalizations among term and preterm infants: clinical course and vaccine effectiveness

Nicoline A. T. van der Maas,1 Elisabeth A. M. Sanders,2 Florens G. A. Versteegh,3 Albertine Baauw,4 Anneke Westerhof,1 and Hester E. de Melker1

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Abstract

Background

Pertussis causes severe disease in young unvaccinated infants, with preterms potentially at highest risk. We studied pertussis in hospitalized infants as related to gestational age (GA) and vaccination history.

Methods

Medical record data of 0-2y old patients hospitalized for pertussis during 2005–2014 were linked to vaccination data. Multivariable logistic regression was used to study the association between GA and vaccination history on the clinical disease course. We compared vaccine effectiveness (VE) against hospitalization for pertussis between term and preterm infants (i.e., <37w GA) using the screening method as developed by Farrington.

Results

Of 1187 records, medical data from 676 were retrieved. Of these, 12% concerned preterms, whereas they are 8% of Dutch birth cohorts. Median age at admission was 3 m for preterms and 2 m for terms (p < 0.001). Preterms more often had received pertussis vaccination (62% vs 44%; p = 0.01) and more often had coinfections (37% vs 21%; p = 0.01). Preterms tended more often to have complications, to require artificial respiration or to need admittance to the intensive care unit (ICU). Preterms had longer ICU stays (15d vs 9d; p = 0.004).

Vaccinated preterms and terms had a lower median length of hospital stay and lower crude risks of apneas and the need for artificial respiration, additional oxygen, and ICU admittance than those not vaccinated. After adjustment for presence of coinfections and age at admittance, these differences were not significant, except the lower need of oxygen treatment in vaccinated terms. Effectiveness of the first vaccination against pertussis hospitalizations was 95% (95% CI 93–96%) and 73% (95% CI 20–91%) in terms and preterms, respectively. Effectiveness of the second dose of the primary vaccination series was comparable in both groups (86 and 99%, respectively).

Conclusions

Infants hospitalized for pertussis suffer from severe disease. Preterms were overrepresented, with higher need for intensive treatment and less VE of first vaccination. These findings stress the need for alternative prevention, in particular prenatal vaccination of mothers, to reduce pertussis in both groups

 

Full text Free https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820135/.