|Beatrix Hyemin Choi, Rivfka Shenoy, Dina Levy-Lambert, Jason C Fisher, Sandra S Tomita
Context: Abdominal compartment syndrome in children carries a mortality of 40–60%. Although definitive treatment for this condition traditionally involves decompressive laparotomy, percutaneous catheter drainage of associated ascites is described as an alternative to laparotomy in adults. Aims: We explored the safety and efficacy of percutaneous catheter drainage of intraabdominal fluid for reversing abdominal compartment physiology in a critically-ill cohort of small children. Materials and Methods: We reviewed records of all children undergoing percutaneous catheter drainage for abdominal compartment syndrome from 2014 to 2018 in a single institution, excluding those who required drainage for other indications. Bedside sonogram-guided drainage using Seldinger technique or Penrose drain placement was performed by the pediatric surgical service, with drains removed on the resolution of compartment syndrome physiology and fluid output of <10 mL/day. Primary outcome measures were improvement in compartment physiology over 24 h. Statistical Analysis: Data were analyzed using descriptive statistics and paired Wilcoxon signed-rank tests. Statistical significance was assumed at P < 0.05. Results: Ten children ranging from 1.1 kg to 38 kg underwent 11 percutaneous catheter drainage procedures for abdominal compartment syndrome secondary to blood, serous fluid, air, or a combination. Significant physiologic improvement was seen across multiple variables including pulse rate, pH, and lactate. No patients later required decompressive laparotomy. Four patients died due to their primary disease. Conclusion: Percutaneous catheter drainage is safe and efficacious in reversing abdominal compartment physiology in children with intraabdominal fluid, and can be considered prior to surgical intervention when clinically appropriate.
Pandemics of the coronavirus SARS-Cov-2 has been circulating the world since the beginning of 2020 in several waves leaving behind many millions of affected individuals and very many fatalities. In children, the course of the disease has generally been milder that in adults; however, there was a wide range of possible serious complications observed including the pediatric fatalities. In this article, we review possible complications of COVID-19 in children and also focus on the role of pediatric primary care practitioners in the diagnosis and management of this serious disease.