CMV PNEUMONIA IN HIV-INFECTED VENTILATED INFANTS

Goussard P, Kling S, Gie RP, Nel ED, Heyns L, Rossouw GJ, Janson JT. Pediatr Pulmonol. 2010;45:650-655.

This prospective descriptive study was done in a pediatric intensive care unit in South Africa to determine the role of cytomegalovirus (CMV) as the coinfection in HIV-infected infants being ventilated for suspected PJP (Pneumocystis jiroveci pneumonia). The authors state that lung disease is a common cause of morbidity and mortality in HIV-infected children. In many countries, there remains a lack of programs to help prevent vertical transmission of HIV, and primary prevention of PJP is not implemented. It remains common for infants younger than 6 months to have PJP.

Twenty-five HIV-infected children (mean age, 3.3 months) were included in this study. These infants had not improved after day 5 of ventilation and were referred for lung biopsy. After evaluation of the lung tissue, the mostly likely causes of pneumonia included CMV and PJP dual infection, 36% (n = 9); CMV infection, 36% (n = 9); and PJP, 24% (n = 6). The pediatric intensive care unit mortality rate was 72% (n = 18). Of the surviving infants, 71% (n = 4) died in the hospital. One infant transferred from the private sector was treated with ganciclovir before admission.

The authors recommend that all HIV-infected infants who are being ventilated for suspected PJP be empirically treated for CMV infection with ganciclovir until CMV infection is excluded.

SIBLING'S EXPERIENCES AFTER A MAJOR CHILDHOOD BURN INJURY

Lehna C. Pediatr Nurs. 2010;36(5):245-251.

The purpose of this mixed-methods qualitative dominant design was to explore and gain an understanding from the child's perspective, primarily from the sibling, the effect of a child's major burn injury had on the sibling. Caring for a child with a major burn injury requires long rehabilitation, multiple surgeries and hospitalizations, and painful physical therapy many times away from close proximity of their home.

Participants (n = 40) from 22 cases were interviewed, and participants from 11 cases (n = 19) were reinterviewed to clarify information. In the second interviews, the Sibling Relationship Questionnaire-Revised was used because the siblings had not been talkative.

The central thermatic pattern for the sibling relationship was normalization (process of establishing a pattern of daily living that minimizes the consequences of the chronic illness) and process of adjustment. The process of adjustment was varied and often gradual and at times seemed to change life perspectives.

Clinical implications are for family-centered care and assessment and support to siblings. The author also stressed the importance of promoting normalization as a way of supporting the family.