Clinical and pathologic characteristics of pancreatic necrosis in critically ill children

BACKGROUND：Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis.METHODS： We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children＇s Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed. RESULTS： The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein （CRP）. B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis （AHNP）; children 3-5 died of multiple organ dysfunction syndrome （MODS） due to pancreatic necrosis. CONCLUSION： Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.

Management of Pediatric Emergencies on the General Hospital

Due to the lack of casuistry, the management of the pediatric patient remains a source of stress and high risk of errors for the personnel working in the Territorial Emergency Service, General First Aid and Multipurpose ICU （intensive care unit）, In order to facilitate the management of emergent or urgent pediatric casuistry, a specific training course, which involves all medical and paramedical staff; has begun in the reality of Pordenone Hospital. The new work strategy consists of an organized equipment according to the Broselow method, adapting the American model to our reality. A dedicated course was created to become confidential with the new operative strategy, to reduce mistakes and stress from the staff. After, a questionnaire was given to nurses working on ICU Dept. to assess the level of confidence with the new method introduced. It showed an improved confidence with the method, easier management of the pediatric emergency, fewer stress and better communication between health workers. Subsequently an updating course was created dedicated to the medical and nursing staff working on the Emergency Department of the entire province to start the integration between the hospitals in the area. The fmal project includes the drafting of a provincial protocol for the use of both intra and extra hospital pediatric material. The goal is to ensure that they do not create unevenness, errors or lack of care and communication between the professionals involved in the management of the pediatric emergency, from taking charge on the territory to hospitalization or transfer to the center Hub.