DEXAMETHASONE IN CHILDREN MECHANICALLY VENTILATED FOR LOWER RESPIRATORY TRACT INFECTION CAUSED BY RESPIRATORY SYNCYTIAL VIRUS: A RANDOMIZED CONTROLLED TRIAL
Van Woensel JBM, Vyas H. Crit Care Med. 2011;39(7):1779-1183.
This international, multicenter (n = 12), randomized, double-blind placebo-controlled trial sought to determine the efficacy of dexamethasone in patients who were mechanically ventilated for severe lower respiratory tract infections with respiratory syncytial virus. Study objectives also included determining length of duration of mechanical ventilation, length of stay in the pediatric intensive care unit, length of stay in the hospital, and duration of supplemental oxygen.
Children younger than 2 years were included and were stratified into 2 subgroups-those with mild oxygen abnormalities (n = 89) and those with severe oxygen abnormalities (n = 56). Dexamethasone was given intravenously at 0.15 mg/kg per dose for 8 total doses (every 6 hours) or a placebo was started within 24 hours after the start of mechanical ventilation.
The researchers concluded that there was no evidence of a beneficial effect of dexamethasone use in children with mild oxygen abnormalities, and studies on children with severe oxygen abnormalities were inconclusive. The authors also noted that there was no significance noted in the length of stay in the pediatric intensive care unit, length of stay in the hospital, or use of supplement oxygen.
OUTCOME OF BIVENTRICULAR REPAIR IN INFANTS WITH MULTIPLE LEFT HEART OBSTRUCTIVE LESIONS
Cavigelli-Brunner A, Bauerfield U, Kretschmar O, Ovenius A, Buechel ERV. Pediatr Cardiol. 2011. Published online December 11, 2011.
Children who are born with left hypoplastic heart lesions (LHLs) or obstructive left heart lesions present with a wide array of cardiac malformations, from no intervention needed to heart transplantation. The decision to perform biventricular repair for these infants may be controversial. This study sought to assess the mortality and morbidity of children with LHL after biventricular repair and assess the growth of the left-sided cardiac structures.
In the retrospective analysis, 39 patients with LHL who underwent biventricular repair were included in this study, with a median follow-up period of 14 months. During the follow-up period, 23 patients required 39 interventions. At the end of the follow-up period, 24 of 25 patients were doing subjectively well, 10 children received cardiac medication, 12 patients presented with failure to thrive, and 5 presented with pulmonary hypertension. The overall mortality rate was 13% (n = 5).
The researchers concluded that biventricular repair for patients with LHL resulted in sufficient growth of the left-sided cardiac function; however, residual or newly developed obstructive lesions and pulmonary hypertension were frequent and required reintervention.