ARE RED BLOOD CELL TRANSFUSIONS ASSOCIATED WITH NOSOCOMIAL INFECTIONS IN THE PEDIATRIC INTENSIVE CARE UNITS?
White M, Barron J, Gornbein J, Lin J. Pediatr Crit Care Med. 2010;11(4):464-468.
In this retrospective study, the researchers hypothesized that red blood cell (RBC) transfusions are associated with an increase risk of nosocomial infections in the pediatric intensive care unit (PICU) and may be associated with a decrease in lymphocyte numbers.
Of the 209 subjects enrolled, 21.5% (n = 45) were transfused with RBCs. The infection rate was 51.1% in the RBC group and 5.5% in the nontransfused group. Mortality (8.9% in the RBC group vs1.8% in the control group), presence of mechanical ventilation (64.4% vs 15.2%) and catheters (80.0% vs 39%), and PICU length of stay (11 days vs 1 day) are some of the clinically significant variables between the groups. The researchers used multiple logistic regression analysis, and when controlling for age, sex, PICU length of stay, presence of catheter, mechanical ventilation, and surgical procedure, RBC transfusion remained independently associated with an increased risk of nosocomial infection.
The researchers observed an independent association between RBC transfusion and infection risk in a general medical-surgical population of PICU patients and found a reduction the in the absolute lymphocyte count that may contribute to the infection risk.
PARENTAL ANXIETY ASSOCIATED WITH KAWASAKI DISEASE IN PREVIOUSLY HEALTHY CHILDREN
Chahal N, Clarizia N, McCrindle BW, et al. J Pediatr Health Care. 2009;24(4):250-257.
Kawasaki disease is the leading cause of acquired heart disease in children, and its incidence has been increasing. The cause is unknown and the disease is usually self-limiting; however, severe cardiac complications are possible (mainly coronary artery aneurysms). The long-term effects on the cardiovascular system remain unclear.
Researchers used 3 focus groups that included 25 parents of 17 patients with Kawasaki disease, 7 (41%) of whom had coronary artery complications, to explore the lived experience of parents whose children had Kawasaki disease.
Themes expressed by parents included anxiety related to suddenness of child's illness and delay in obtaining correct diagnosis related to the health care providers' lack of awareness and knowledge. Parents also expressed frustration by the lack of information in lay language and limited scientific knowledge regarding the long-term consequences of the disease. Parents whose children had coronary artery complications expressed persistent anxiety due to uncertainty of long-term prognosis.
The researchers conclude that education for professionals caring for these children should include the impact that this disease has on these families as well as promoting advocacy in the service delivery system.