References 1. Baraff LJ. Management of infants and young children with fever without source. Pediatr Ann. 2008;37:673-9. 2. Galetto Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referralcenter. Paediatrics. 2003;112:1054-60. 3. Craig JC, Williams GJ, Jones M, et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ. 2010
Diana Aniela Moldovan, Maria Despina Baghiu, Alina Balas and Sorana Teodora Truta
Maria Livia Ognean, Oana Boantă, Simona Kovacs, Corina Zgârcea, Raluca Dumitra, Ecaterina Olariu and Doina Andreicuţ
R eferences 1. Kaemmerer H, Meisner H, Hess J, Perloff JK. Surgical treatment of patent ductus arteriosus: a new historical perspective. Am J Cardiol. 2004;94:1153-4. 2. Schneider DJ, Moore JW. Patent Ductus Arteriosus. Circulation 2006;114:1873-82. DOI: 10.1161/CIRCULATIONAHA.105.592063. 3. Hillman M, Meinarde L, Rizzotti A, Cuestas E. Inflammation, High-sensitivity C-reactive Protein, and Persistent Patent Ductus Arteriosus in Preterm Infants. Rev Esp Cardiol (Engl Ed). 2016;69:84-5. doi: 10.1016/j.rec.2015.09.014. 4. Al Nemri AMH
Lorena Elena Meliţ, Cristina Oana Mărginean, Anca Georgescu and Carmen Duicu
Sepsis is a systemic inflammatory response (SIRS) characterized by two or more of the following: fever > 38.5 °C or <36 °C, tachycardia, medium respiratory frequency over two SD for age, increased number of leukocytes.
The following is a case of an eight months old, female infant, admitted in to the clinic for fever (39.7 C), with an onset five days before the admission, following trauma to the inferior lip and gum. Other than the trauma to the lip and gum, a clinical exam did not reveal any other pathological results. The laboratory tests showed leukocytosis, positive acute phase reactants (ESR 105 mm/h, PCR 85 mg/dl), with positive blood culture for Staphylococcus aureus MSSA. at 24 hours. Three days from admission, despite the administration of antibiotics (Vancomycin+Meronem), there was no remission of fever, and the infant developed a fluctuant collection above the knee joint. This was drained, and was of a serous macroscopic nature. A decision was made to perform a CT, which confirmed the diagnosis of septic arthritis. At two days after the intervention, the fever reappeared, therefore the antibiotic regime were altered (Oxacillin instead of Vancomycin), resulting in resolution of the fever. Sepsis in infant is a complex pathology, with non-specific symptoms and unpredictable evolution.
Maria Livia Ognean, Silvia-Maria Stoicescu, Oana Boantă, Leonard Năstase, Carmen Gliga and Manuela Cucerea
R eferences 1. Chard T, Soe A, Costeloe K. The risk of neonatal death and respiratory distress syndrome in relation to birth weight of preterm infants. Am J Perinatol. 1997;14:523–6. 2. Hack M, Horbar JD, Malloy MH, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network. Pediatrics 1991;87:587–97. 3. Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 1971
Laura Mihaela Suciu, Manuela Cucerea, Marta Simon, Andreea Avasiloaiei, Olimpia Petrescu and Suciu Bogdan Andrei
R eferences 1. Ahn Y, Jun Y. Measurement of pain-like response to various NICU stimulants for high-risk infants. Early Hum Dev. 2007;83:255-62. 2. Gradin M, Schollin J. The role of endogenous opioids in mediating pain reduction by orally administered glucose among newborns. Pediatrics. 2005;115:1004-7. 3. Lucas-Thompson R, Townsend EL, Gunnar MR, et al. Developmental changes in the responses of preterm infants to a painful stressor. Infant Behav Dev. 2008;31:614-23. 4. Johnston CC, Collinge JM, Henderson SJ, Anand KJS. A cross
Mihaela Patriciu, Andreea Avasiloaiei, Mihaela Moscalu and Maria Stamatin
;39:890–900. 7. Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart 2006;92:1298–302. 8. Acharya G, Sitras V, Maltau JM, et al. Major congenital heart disease in Northern Norway: shortcomings of preand postnatal diagnosis. Acta Obstet Gynecol Scand. 2004;83:1124-9. 9. Ewer AK, Furmston AT, Middleton LJ, et al. Pulse oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of
M. Anthony Cometa, Scott M. Wasilko and Adam L. Wendling
Uterine and placental pathology can be a major cause of morbidity and mortality in the parturient and infant. When presenting alone, placental abruption, uterine rupture, or placenta accreta can result in significant peripartum hemorrhage, requiring aggressive surgical and anesthetic management; however, the presence of multiple concurrent uterine and placental pathologies can result in significant morbidity and mortality. We present the anesthetic management of a parturient who underwent an urgent cesarean delivery for nonreassuring fetal tracing in the setting of chronic hypertension, preterm premature rupture of membranes, and chorioamnionitis who was subsequently found to have placental abruption, uterine rupture, and placenta accreta.
Zsuzsanna Szöke, András Suciu, Géza Jeszenszky and Piroska György
Truncus arteriosus (TA) or common arterial trunk is a rare malformation, accounting for 0.21 to 0.34% of congenital heart diseases, which, if left untreated, leads to increased mortality rates. The condition is characterized by the presence of a unique arterial trunk that overrides the interventricular septum. Despite an overall poor outcome, few subjects present in emergency settings with signs suggestive for pulmonary arterial hypoplasia and associated heart failure. We report the case of a 31-year-old female patient who had been previously diagnosed with pulmonary atresia and severe scoliosis as an infant, presenting in the emergency department with clinical sings of decompensated heart failure which were demonstrated to be attributable to the severe cyanogenic heart malformation and were reversible after initiation of appropriate therapeutic measures.
István Kovács, Sebastian Condrea, Ioana Rodean and Daniel Cernica
References 1. Martinez-Jimenez S, Heyneman LE, McAdams HP, et al. Nonsurgical Extracardiac Vascular Shunts in the Thorax: Clinical and Imaging Characteristics. RadioGraphics. 2010;10.1148/rg.e41. 2. Martinez-Jimenez S, Heyneman LE, McAdams HP, et al. The science and practice of pediatric cardiology. Radiographics. 2010;30:e41. doi: 10.1148/rg.e41. 3. Sapire DW, Lobe TE, Swischuk LE, Casta A, Schwartz MZ, Droge M. Subclavian-artery-to-innominate-vein fistula presenting with congestive failure in a newborn infant
Simina-Elena Rusu, Daniela Toma, Cristina Blesneac, Laura Matei, Claudiu Ghiragosian and Rodica Togănel
, Frommelt PC. Carotid-subclavian artery index: new echocardiographic index to detect coarctation in neonates and infants. Invited commentar. Ann Thorac Surg. 2005;80:1657-1658. 8. Dodge-Khatami A, Ott S, Di Bernardo S, Berger F. Carotidsubclavian artery index: new echocardiographic index to detect coarctation in neonates and infants. Ann Thorac Surg. 2005;80:1652-1621. 9. Lu CW, Wang JK, Chang CI, et al. Noninvasive diagnosis of aortic coarctation in neonates with patent ductus arteriosus. J Pediatr. 2006;148:217-221. doi: 10.1016/j