Browsing by Author "Rsovac, Snežana (8279362900)"

Introduction. Coronavirus disease 2019 (COVID-19) pneumonia is a potentially life-threatening condition that can require the use of mechanical ventilation (MV) and is rare in the neonatal population. Giant pneumatocele is an extremely rare complication of MV, which is practically unknown in neonates. Case report. We report a case of a two-week-old premature infant who developed severe acute respiratory distress syndrome (ARDS) due to COVID-19 and pneumatocele as a complication of MV. The newborn was admitted in a life-threatening condition with persistent hypercapnia, which, therefore, required pro-longed MV. Chest computed tomography (CT) was done to assess the degree of fibrosis caused by COVID-19, and as an accidental finding, a pneumatocele was observed. The patient was immediately started on high-frequency oscilla-tory ventilation as a way of conservative treatment. After prolonged duration and gradual separation from MV, the patient was extubated, and oxygen therapy was gradually discontinued. The patient was discharged in good condi-tion, and the follow-up chest CT showed complete regres-sion of pneumatocele. Conclusion. Optimization of MV parameters and adequate treatment of complications such as ARDS or giant pneumatocele in neonates is an area that still requires further research, primarily due to the specificity of the neonatal age compared to adult pa-tients. © 2024 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction. Intracranial complications of otitis media still occur, despite great progress in the treatment of all forms of inflammation. These are serious conditions which are still life-threatening and require a fast and accurate diagnosis and an adequate treatment. We present an illustrative case of an acute, foudroyant, pneumococcal, suppurative otitis media with infection spreading into endocranium and development of meningoencephalitis and otic hydrocephalus. Case report. A 6-year-old girl was admitted to the University Children's Clinic in Belgrade, Serbia, because of fever, headache, vomiting and disorder of consciousness. Computed tomography scan of the endocranium and temporal bone revealed brain edema and hypodense content in the left mastoid and tympanic cavity. The diagnosis of acute otitis media with meningoencephalitis was made and we started with intensive antibiotic treatment. Lumbar puncture and hemoculture confirmed a pneumococcal infection. Otosurgical treatment was conducted, too, due to an inadequate reaction to the conservative treatment. Firstly, left mastoidectomy with the implantation of a ventilation tube was performed, followed by a radical tympanomastoidectomy, because there was no improvement. Three weeks after the second operation, a magnetic resonance imaging of the endocranium was performed and an otic hydrocephalus was diagnosed. A neurosurgical operation was performed on the same day with the setting of the ventriculoperitoneal shunt. Conclusion. Intracranial complications of acute otitis media in children are extremely rare and they require a multidisciplinary treatment. Surgical treatment of the ear should not be postponed and the choice of the type of otosurgical intervention should be individually adapted. Audiological and neurological complications of the disease are frequent and they further prolong and impair the treatment. © 2021 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Purpose: The aim of this study was to assess the association between oxygenation index (OI) and outcome in children with acute respiratory distress syndrome (ARDS). Patients and Methods: Patients (age, >30 days) in the pediatric intensive care unit from April 2011 to March 2016 with ARDS and who were mechanically ventilated were included. Patients were divided into two age groups: infants (<12month) and older children. Lowest PaO2/FiO2 and SpO2/FiO2 ratios and highest mean airway pressure (MAP) were recorded on the first day of ARDS and after 72 h. OI was calculated on the first and third days of mechanical ventilation (MV) and its association with OI (first and third days) and short-term mortality evaluated at 28 days. Results: MV was initiated a mean of 2.3 days after admission (median, 1.0 day; maximum 14 days). The average MV duration for all patients was 11.8 (median, 7.0) days. Mean (95% confidence interval (CI)) OI values on the first day of MV were 14.17 (11.94–16.41), 12.72 (10.68–14.75), and 13.24 (11.73–14.74) for infants, older children, and all participants, respectively. In survivors (n=39) mean OI was 11.66 (9.64–13.68) compared with 15.22 (13.03–17.40) in non-survivors (n=31). Logistic regression analysis revealed that OI on day 3 had highly significant prognostic value for mortality (odds ratio, 256.5, 95% CI 27.1–2424, p<0.001), with an AUC of 0.919 (cut-off value, 17; positive predictive value, 0.905; negative predictive value, 0.964; p=0.0001). In contrast, OI on day 1 did not have significant prognostic value (AUC, 0.634; p=0.056) for short-term mortality. Different modes of MV were not significantly associated with outcome (p>0.05). Conclusion: OI is a simple, highly accurate, and sensitive predictor of the survival (short-term mortality) of children mechanically ventilated for ARDS. © 2020 Rsovac et al.