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Describes the case of a 12-week-old girl with acute oligoric renal failure related to raised intra-abdominal pressure due to massive hepatomegaly from stage IVs neuroblastoma. Administration of platelets and fresh frozen plasma; Successful treatment with continuous veno-venous hemodiafiltration during the critical phase of the disease.

Background: Neurotoxicity of anaesthetics in developing brain cells is well documented in preclinical studies, yet results are conflicting in humans. The use of many and different outcome measures in human studies may contribute to this disagreement.Methods: We conducted a systematic review to identify all measures used to assess long-term neurocognitive outcomes following general anaesthesia (GA) and surgery in children. The quality of studies was assessed according to the Newcastle-Ottawa Scale (NOS) for observational studies. PubMed/MEDLINE, EMBASE, Cinahl, Web of Science, and the Cochrane Library were searched for studies investigating neurocognitive outcome after GA in children <18 yr.Results: Sixty-seven studies were identified from 19 countries during 1990-2017. Most assessments were performed within cognition, sensory-motor development, academic achievement or neuropsychological diagnosis. Few studies assessed other outcomes (magnetic resonance imaging, serum-biomarkers, mortality, neurological examination, measurement of head circumference, impairment of vision). Rating according to the NOS rewarded a mean of six stars out of nine. Some concerns prevail regarding potential inter-rater variability because of equivocal description of rating criteria. Specific features such as stability over lifetime and inter-relations of outcomes (e.g. prediction of subsequent development or diagnosis of neuropsychological conditions) are discussed. The importance of validity and reliability of the various test instruments are described. The studies vary immensely in important characteristics.Conclusions: Future observational studies should be more consistent in the choice of study population, age at exposure, follow-up, indication for and type of surgery, and outcomes. Assessment of sensory-motor development seems feasible in young children (age <4 yr), and intelligence/cognition in older children. [ABSTRACT FROM AUTHOR]

Introduction: Each year millions of neonates, infants and young children worldwide are exposed to anaesthetic drugs. The last 5 years concerns have been raised regarding a possible association of anaesthesia and neuro-degeneration in young children, which represents an enormous potential burden to public health. Animal data is compelling and involves a variety of anaesthetic drugs, settings and species, including most recently primates. Implicated are n-methyl-d-aspartate receptor antagonists and γ-amino-butyric acid agonists, including most of the commonly used anaesthetics for both children and adults. However, as yet, it is not clear whether the effects observed in animals are clinical relevant in humans [1]. The scientific approach to solve this question is difficult. One approach is the use of epidemiological methods, which have proven in many setting to be powerful tools for exploring the relationship between exposure and disease. Methods: We are currently conducting an epidemiological study in Denmark comparing the educational achievement of all children operated before the age of 1 year during the period 1977–1990, ( n = 45.000+) to the background Danish population. The study, which has been approved by the Danish Data Protection Agency, is based on linkage of a series of available registries. The Danish civil registration system identifies individuals by unique social security numbers, which can be linked to a number of thematically organized population databases, called registers. Information from three registers is used: (1) the Danish Demographic Database, which includes information on parental identities, deaths, migrations, adoptions and education, (2) the National Hospital Discharge Register, which includes information on overnight hospital stays for non-psychiatric illnesses and (3) the Register of Compulsory School Completion Assessment and Test Scores, which is compiled from school reports by the Ministry of Education (at ninth grade, aged 15–16 years). The primary outcome in this study is academic achievements rather than IQ. The use of this cohort has several strengths: it is of unprecedented size, it is population-based, and the important covariates such as: age, gestational age, birth weight, parental age and parental education are available for practically all participants in the study. Discussion: The data is currently being analyzed and will be presented at the 2009 APA Meeting in Brighton, as will pitfalls and strengths of epidemiological studies over randomized clinical studies for addressing this paediatric anaesthetic challenge. This challenge may, however, extend beyond paediatric anaesthesia because the implicated drugs are widely used in a variety of other settings in infants and young children around the world. [ABSTRACT FROM AUTHOR]

Background: Adolescents with Developmental Language Disorder (DLD) are at risk of emotional health problems and low self-esteem. However, little is known about their self-compassion (SC) and satisfaction with life (SWL). The present study compared self-compassion and satisfaction with life reported by Danish adolescents with DLD compared to typically developing (TD) peers, and whether severity of language difficulty is associated with SC and SWL., Methods: Results were obtained from 10 Danish adolescents with DLD compared with 14 age-matched TD adolescents and 132 TD peers, aged 15 years., Results: For SC and SWL results showed that adolescents with DLD reported more positive feelings compared to the TD adolescents. Interestingly for SC, the negative, but not the positive, domain differentiated the two groups, as adolescents with DLD reported less symptoms on self-judgment, isolation and overidentification. SC and SWL was strongly correlated with language abilities for the DLD group, but not for the TD group., Conclusions: Results from our pilot study showed that Danish adolescents with DLD reported being less harsh on themselves. Language abilities were associated with self-compassion for the DLD, but not for the TD group. Whether these group differences are due to environmental factors such as the specific Danish school setting of the DLD group or internal factors are discussed and requires further research., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Clonidine is used increasingly in paediatric anaesthetic practice to prolong the duration of action of caudal block with a local anaesthetic agent. Which route of administration of clonidine is the most beneficial remains unknown. We compared the effects of caudal and i.v. clonidine on postoperative analgesia produced by caudal bupivacaine after hypospadias repair., Methods: Forty-six children (ASA I or II) aged 24-104 months received standardized premedication with midazolam, a general anaesthetic and a caudal block with bupivacaine 0.25%, 0.5 ml kg(-1). The children were randomized in a double-blind fashion to two groups: the i.v. group received clonidine 2 micro g kg(-1) i.v. and simultaneously the same volume of saline caudally. The caudal group received clonidine 2 micro g kg(-1) caudally and a similar volume of saline i.v. After surgery, all children received acetaminophen 20 mg kg(-1) rectally or orally 6-hourly and were given a patient-controlled or nurse-controlled analgesia (PCA/NCA) pump with i.v. morphine (bolus of 25 micro g kg(-1) and an 8-min lockout period with no background infusion). Monitoring of scores for pain, sedation, motor block, and postoperative nausea and vomiting was performed by nurses blinded to the study allocations. Time to first activation of the PCA/NCA pump and 0-24 h and 24-48 h morphine consumption were also recorded., Results: Forty-four children completed the study. Age, weight and duration of anaesthesia and surgery were similar in the two groups. The median (range) time to first activation of the PCA/NCA pump was similar in the two groups: 425 (150-1440) min in the i.v. group and 450 (130-1440) min in the caudal group. The number of children not requiring postoperative morphine was four and seven respectively. Morphine consumption during 0-24 h and 24-48 h was similar between groups., Conclusions: The analgesic effect of clonidine 2 micro g kg(-1) as an adjunct to caudal block with bupivacaine 0.25%, 0.5 ml kg(-1) is similar whether administered i.v. or caudally.

The clinical efficacy and pharmacokinetics of long-term epidural ropivacaine infusion were investigated in 18 postoperative children aged between 0.3 and 7.3 yr. A lumbar or thoracic epidural catheter was inserted after the anaesthetic induction. Sixty minutes following a bolus dose of ropivacaine 1 mg kg-1, 0.2% ropivacaine was infused at a fixed rate of 0.4 mg kg-1 h-1 for a mean of 61.3 h (range 36-96 h). Clinical evaluation comprised hourly recording of pain, sedation, motor block, nausea/vomiting, pruritus-scores, SpO2, pulse and respiratory rates, and recording of non-invasive arterial pressure every 4 h. Total and free plasma concentrations were measured by high-performance liquid chromatography at 0, 1, 6, 12, 24, 36, 48, 72 and 96 h. Analgesia was of high quality and side effects were minor. No clinical signs of local anaesthetic toxicity were seen. Total (100-3189 micrograms litre-1) and free (10-56 micrograms litre-1) ropivacaine concentrations were within the range reported to be 'safe' in previous studies in adults. Mean (95% CI) volume of distribution was 3.1 litre kg-1 (2.1-4.2 litre kg-1), total clearance was 8.5 ml kg-1 min-1 (5.8-11.1 ml kg-1 min-1), free clearance was 220 ml kg-1 min-1 (170-270 ml kg-1 min-1) and elimination half-life was 4.9 h (3.0-6.7 h).