Impact of Nirsevimab on Admission to Pediatric Intensive Care Unit because of RSV Bronchiolitis: unicentric observational study from 2017-2024

Methotrexate (MTX) intrathecal and intravenous administration is associated with neurotoxicity. We report a 15-year old girl diagnosed with large cell B lymphoma. On eighteen-day after intrathecal MTX presented stroke-like symptoms. Magnetic resonance was informed as a possible stroke in the right frontal lobe. The patient does not meet the criteria for fibrinolysis. MTX neurotoxicity was suspected, and theophylline was initiated. She showed complete recovery after three days of treatment. After describing the case, we review MTX neurotoxicity cases from our centre from January 2010 to December 2018. Also, we added to this data the previously published cases in the literature.

The receptor for advanced glycation end products (RAGE) has been studied in several respiratory diseases described as an important inflammatory mediator. The RAGE-axis is activated by multiple endogenous ligands related to pro-inflammatory states, upregulate the RAGE expression. The function of soluble RAGE (sRAGE) is not completely understood, it has been hypothesized an anti-inflamatory role as RAGE decoy receptor. Few studies have explored the RAGE-axis in Cystic Fibrosis (CF) with contradictory results. Based on previously, we present this pilot study with the aim of describe the plasma sRAGE levels in children with cystic CF (CFp), compare with the sRAGE levels in a healthy cohort and study its possible correlation with CFp clinical features. We conducted a single-center, cross-sectional observational study. We included 35 clinically stable CF patients (aged < 18 years). The median plasma sRAGE level in CFp was 1494,75 pg/ml [interquartile range (IQR) 708,75pg/ml], compared with 714,20 pg/ml (IQR 490,50 pg/ml)) in the historical cohort of healthy controls (p < 0,001). A positive correlation was found between plasma sRAGE level and forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC) (p 0,004) and forced expiratory flow between 25% and 75% (FEF25%-75%) (p 0,032). In this preliminary study, the plasma sRAGE level were higher in CFp than in healthy controls. Also, we described a positive correlation between FEV1/FVC and FEF25%-75% and plasma sRAGE. To our knowledge, our study is the largest to describe plasma sRAGE values ​​in CFp and the only one carried out in pediatric CF population.

Background: in recent years, High Flow Nasal Cannula (HFNC) has been considered an alternative to non-invasive mechanical ventilation (NIMV) in severe asthma respiratory management in children. Objective: to describe the use of HFNC in children with severe asthma admitted to pediatric critical care unit (PICU). To compare its clinical characteristic and evolution with those receiving NIMV or other respiratory support. Methods: prospective observational study done in children admitted to PICU with severe asthma (October 2017 to October 2019). Data collected: epidemiological, clinical, respiratory support, thorax x-ray, pharmacological treatments and days of admission. Patients were divided into groups: 1) Only HFNC 2) HFNC and NIMV, and 3) Only NIMV. Results: Seventy-six patients included, 39 girls. The median age was two years and one month (range 160). The median pulmonary score was 5 (range 7). PICU admission lengths a median of 3 days (range 9), hospital 6 days (range 23). There were no epidemiological or clinical differences between groups. Children with only HNFC showed a shorter time of PICU days (p 0,025) and none of them required NIMV. In the group receiving both modalities, NIMV was used first and then HFNC in all cases. Children with HFNC showed higher SaO2/FiO2 ratio (p=0,025) and lower PCO2 level (p=0,032). There were no deaths. Conclusions: in our study the HFNC did not require escalation to NIMV and did not increase the length of PICU or hospital days. Normal initial blood gases and absence of high oxygen requirements were useful to select responders to HNFC.