This document presents the executive summary of the Latin American Consensus on the Management of Sepsis in Children developed by the Latin American Pediatric Intensive Care Society (SLACIP) Task Force.
The task force was comprised of 27 experts in pediatric sepsis treatment from Latin American countries. Using a modified Delphi method combining expert opinion with evidence from the literature, they developed 62 recommendations for the diagnosis and treatment of pediatric sepsis in low- and middle-income countries, with a focus on Latin America.
The majority of recommendations (56) received a classification of strong recommendation based on low quality evidence, reflecting the limited higher-level research on pediatric sepsis conducted in these resource-limited settings. The consensus provides regionally
This document summarizes the key discussions and outcomes of an international consensus conference on defining sepsis and organ dysfunction in pediatrics. The conference modified existing adult definitions to be age-appropriate for pediatric patients. They established six age groups and age-specific criteria for defining systemic inflammatory response syndrome (SIRS) and organ dysfunction. SIRS in children now requires an abnormal temperature or white blood cell count. Definitions for sepsis, severe sepsis, septic shock, and types of organ dysfunction were also customized for pediatric patients. The goal is to standardize definitions to facilitate research on pediatric sepsis.
Practices of Primary Caregivers about Caring Children with Leukemia at Nation...AI Publications
This research was made to assess practices of primary caregivers about caring for children with acute leukemia at the Pediatric Blood Diseases Department, National Institute of Hematology and Blood Transfusion in 2020. Methods: This was analytical-observational research with the design of cross-sectional. Results: Study on 182 primary caregivers having children with acute leukemia treated at the Pediatric Blood Diseases Department, National Institute of Hematology and Blood Transfusion. The unsatisfactory practice of primary caregivers having children with acute leukemia accounting for 53.8%. There were 32.4% primary caregivers almost performed the wrong diet when their children had diarrhea. 38.5% primary caregivers sometimes clean their hands before and after preparing food and 33% primary caregivers sometimes clean their children’s teeth and gums properly. 28% primary caregivers sometimes encourage your children to participate in social activities. There were relationships between the educational level, the marital status, receiving health educational information and practices of primary caregivers, with p <0.05. Conclusions: The practices of primary caregivers having children with acute leukemia were low. There were relationships between educational level, marital status, receiving health educational information and practices of primary caregivers, with p <0.05.
The document outlines Canada's Rare Disease Strategy, which aims to improve the lives of those affected by rare diseases through 5 key goals: 1) improving early detection and prevention, 2) providing timely, equitable care, 3) enhancing community support, 4) providing sustainable access to therapies, and 5) promoting innovative research. Rare diseases affect over 2.8 million Canadians and early detection is challenging, with many receiving misdiagnoses or facing long wait times. The strategy seeks to establish newborn screening, genetic testing guidelines, clinical expertise centers, and a national rare disease drug program to help ensure Canadians have consistent access to treatments.
The management of pediatric polytrauma -a simple reviewEmergency Live
This Clinical review, published by Libertas Academica, is an interesting commentary about the management of pediatric polytrauma.
This research was realized by
H. Mevius, M. van Dijk, A. Numanogluand A.B. van As between the MC-Sophia Childen's Hospital, Rotterdam, and the Red Cross War memorial Children's Hospital in Cape Town, South Africa.
H. Mevius1, M. van Dijk2–4, A. Numanoglu2,3 and A.B. van As2,3
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
ABSTRACT: Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. The primary goal of this review is to provide a comprehensive overview on current knowledge in the management of pediatric polytrauma patients (PPPs). A database review was conducted based on a search in the Embase, Medline OVID-SP, Web of Science, Cochrane central, and Pubmed databases. Only studies with “paediatric population” and “polytrauma” as criteria were included. A total of 3310 citations were retrieved. Of these, 3271 were excluded after screening, based on title and abstract. The full texts of 39 articles were assessed; further selection left 25 articles to be included in this review. The most crucial point in the
management of PPPs is preparedness of the staff and an emergency room furnished with age-appropriate drugs and equipment combined with a systemic
approach.
KEY WORDS: pediatric population, polytrauma, multiple injuries, current management, review
Introduction
Polytrauma is a medical term that describes the condition of a patient subjected to multiple traumatic injuries and can be a life-threatening condition. These (life threatening) injuries typically affect two or more body regions and present a challenge for diagnosis and treatment.1,2 However, there is no consensus yet about the term polytrauma in both literature and practice.3
Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. Despite its preventability, trauma remains the most common cause of death and disability in children.2 In fact, all over the world, more than 700,000 children under the age of 15 years die each year due to accidental injury.4 Leading causes of polytrauma are road traffic crashes, falls from heights, and
MICYRN is a Canadian non-profit organization established in 2011 to reduce barriers and duplication of effort in multi-jurisdictional pediatric research, particularly for rare diseases. Rare diseases affect over 2.7 million Canadians but each affects fewer than 2000 individuals. MICYRN works to improve diagnosis of rare diseases and develop new therapies through national research networks and collaborating in international research initiatives. MICYRN also supports patient registries and clinical trials infrastructure to study rare diseases and determine drug safety and effectiveness in children through its research informatics platform and partnerships with health organizations and industry.
This document provides an update to the 2012 Surviving Sepsis Campaign guidelines for the management of sepsis and septic shock. A consensus committee of 55 international experts from 25 organizations reviewed evidence and developed recommendations. They addressed 93 statements, including 32 strong recommendations, 39 weak recommendations, and 18 best practice statements. No recommendation was provided for four questions. The guidelines are intended to improve outcomes for patients with sepsis or septic shock in a hospital setting, though clinical judgment is still required given variability in individual patients.
This document summarizes the key discussions and outcomes of an international consensus conference on defining sepsis and organ dysfunction in pediatrics. The conference modified existing adult definitions to be age-appropriate for pediatric patients. They established six age groups and age-specific criteria for defining systemic inflammatory response syndrome (SIRS) and organ dysfunction. SIRS in children now requires an abnormal temperature or white blood cell count. Definitions for sepsis, severe sepsis, septic shock, and types of organ dysfunction were also customized for pediatric patients. The goal is to standardize definitions to facilitate research on pediatric sepsis.
Practices of Primary Caregivers about Caring Children with Leukemia at Nation...AI Publications
This research was made to assess practices of primary caregivers about caring for children with acute leukemia at the Pediatric Blood Diseases Department, National Institute of Hematology and Blood Transfusion in 2020. Methods: This was analytical-observational research with the design of cross-sectional. Results: Study on 182 primary caregivers having children with acute leukemia treated at the Pediatric Blood Diseases Department, National Institute of Hematology and Blood Transfusion. The unsatisfactory practice of primary caregivers having children with acute leukemia accounting for 53.8%. There were 32.4% primary caregivers almost performed the wrong diet when their children had diarrhea. 38.5% primary caregivers sometimes clean their hands before and after preparing food and 33% primary caregivers sometimes clean their children’s teeth and gums properly. 28% primary caregivers sometimes encourage your children to participate in social activities. There were relationships between the educational level, the marital status, receiving health educational information and practices of primary caregivers, with p <0.05. Conclusions: The practices of primary caregivers having children with acute leukemia were low. There were relationships between educational level, marital status, receiving health educational information and practices of primary caregivers, with p <0.05.
The document outlines Canada's Rare Disease Strategy, which aims to improve the lives of those affected by rare diseases through 5 key goals: 1) improving early detection and prevention, 2) providing timely, equitable care, 3) enhancing community support, 4) providing sustainable access to therapies, and 5) promoting innovative research. Rare diseases affect over 2.8 million Canadians and early detection is challenging, with many receiving misdiagnoses or facing long wait times. The strategy seeks to establish newborn screening, genetic testing guidelines, clinical expertise centers, and a national rare disease drug program to help ensure Canadians have consistent access to treatments.
The management of pediatric polytrauma -a simple reviewEmergency Live
This Clinical review, published by Libertas Academica, is an interesting commentary about the management of pediatric polytrauma.
This research was realized by
H. Mevius, M. van Dijk, A. Numanogluand A.B. van As between the MC-Sophia Childen's Hospital, Rotterdam, and the Red Cross War memorial Children's Hospital in Cape Town, South Africa.
H. Mevius1, M. van Dijk2–4, A. Numanoglu2,3 and A.B. van As2,3
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
ABSTRACT: Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. The primary goal of this review is to provide a comprehensive overview on current knowledge in the management of pediatric polytrauma patients (PPPs). A database review was conducted based on a search in the Embase, Medline OVID-SP, Web of Science, Cochrane central, and Pubmed databases. Only studies with “paediatric population” and “polytrauma” as criteria were included. A total of 3310 citations were retrieved. Of these, 3271 were excluded after screening, based on title and abstract. The full texts of 39 articles were assessed; further selection left 25 articles to be included in this review. The most crucial point in the
management of PPPs is preparedness of the staff and an emergency room furnished with age-appropriate drugs and equipment combined with a systemic
approach.
KEY WORDS: pediatric population, polytrauma, multiple injuries, current management, review
Introduction
Polytrauma is a medical term that describes the condition of a patient subjected to multiple traumatic injuries and can be a life-threatening condition. These (life threatening) injuries typically affect two or more body regions and present a challenge for diagnosis and treatment.1,2 However, there is no consensus yet about the term polytrauma in both literature and practice.3
Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. Despite its preventability, trauma remains the most common cause of death and disability in children.2 In fact, all over the world, more than 700,000 children under the age of 15 years die each year due to accidental injury.4 Leading causes of polytrauma are road traffic crashes, falls from heights, and
MICYRN is a Canadian non-profit organization established in 2011 to reduce barriers and duplication of effort in multi-jurisdictional pediatric research, particularly for rare diseases. Rare diseases affect over 2.7 million Canadians but each affects fewer than 2000 individuals. MICYRN works to improve diagnosis of rare diseases and develop new therapies through national research networks and collaborating in international research initiatives. MICYRN also supports patient registries and clinical trials infrastructure to study rare diseases and determine drug safety and effectiveness in children through its research informatics platform and partnerships with health organizations and industry.
This document provides an update to the 2012 Surviving Sepsis Campaign guidelines for the management of sepsis and septic shock. A consensus committee of 55 international experts from 25 organizations reviewed evidence and developed recommendations. They addressed 93 statements, including 32 strong recommendations, 39 weak recommendations, and 18 best practice statements. No recommendation was provided for four questions. The guidelines are intended to improve outcomes for patients with sepsis or septic shock in a hospital setting, though clinical judgment is still required given variability in individual patients.
This document provides guidance on establishing national child maltreatment surveillance systems in European countries. It recommends:
1) Conducting community-based surveys every 4-7 years using standardized questionnaires to measure past-year and lifetime prevalence among nationally representative samples of students aged 13-15.
2) Using one of three established child abuse questionnaires (ICAST, JVQ, ACE-IQ) or a shorter alternative (SCMQ) to allow comparisons across countries.
3) Employing self-report methods, ensuring anonymity, and obtaining passive consent to prioritize ethical standards and participation rates.
4) Optional additional monitoring through parent reports, agency data, or sentinel surveys for situations where student surveys are not feasible.
This document provides an overview of health literacy for healthcare professionals. It defines health literacy and explains its importance for patient outcomes. Limited health literacy is associated with poorer health, less adherence to treatment, and reluctance to engage with healthcare providers due to shame. The presentation measures health literacy, discusses strategies to improve communication and integrate health literacy into work, and advocates for further research on the topic.
R.M.N.C.H. Indicators and Equity Mapping - A Framework for DiscussionPhilippe Monfiston
The document provides an introduction and framework for discussing reproductive, maternal, neonatal, and child health indicators and equity mapping in the Americas region. It summarizes the 11 indicators selected by the Commission on Information and Accountability to track progress on women's and children's health. It notes that while significant progress has been made, inequities remain both between and within countries. The document advocates for an integrated approach across the life course to promote health equity and universal coverage. It also emphasizes the need for improved data quality and analysis to better inform policies and guide efforts to reduce inequities.
Describing the new CDCF project for tagging Systematic reviews - synergistic plan with the MASCOT (Multilateral Association for Studying Health Inequalities and Enhancing North-South And South-South Cooperation – is funded by the European Commission under the Seventh Framework Programme for Research and Technological Development (FP7).f7th project
The document discusses patient empowerment and inclusion through patient-developed registries. It summarizes the Leigh syndrome global patient registry launched by Cure Mito Foundation, which has over 300 participants from 35+ countries. The registry aims to meaningfully involve patients throughout the research process by making data transparent and accessible to researchers. It also emphasizes the importance of open communication, community involvement, and sharing results with patients. In the conclusion, researchers are encouraged to utilize the registry's data and provide feedback to help advance research for rare diseases like Leigh syndrome.
Participation of the population in decisions about their health and in the pr...Pydesalud
Póster presentado por Lilisbeth Perestelo en el congreso Summer Institute for Informed Patient Choice (SIIPC14) celebrado del 25 al 27 de junio de 2014 en Dartmouth, Hanover (EEUU). Web: http://siipc.org
Contacto: lperperr@gobiernodecanarias.org
Paediatricians provide higher quality care to children and adolescents in pri...Javier González de Dios
Hay una pregunta que plantea un debate mantenido: ¿qué profesional médico es el más adecuado para impartir cuidados de salud a niños en Atención Primaria en países desarrollados?. Adecuación medida como mayor calidad en términos de salud de la población infantil, entendiendo la calidad en sus tres dimensiones: científico-técnica, relacional-percibida y organizativo-económica.
No es fácil definir qué indicadores de calidad en salud infantil debemos tener en cuenta, pero desde el Grupo de Trabajo de Pediatría Basada en la Evidencia se ha intentado responder a esa pregunta bajo el formato de una revisión sistemática. Y se ha hecho en dos momentos: en aquel año 2010 con la publicación “¿Qué profesional médico es el más adecuado para impartir cuidados en salud a niños en Atención Primaria en países desarrollados? Revisión sistemática”, publicada en español en la revista de Pediatría de Atención Primaria y este mismo año 2020 con la publicación “Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review” publicado en inglés en la revista Acta Paediatrica, y que se adjunta debajo par su revisión.
Sus conclusiones tienden a reforzar la postura de la Asociación Española de Pediatría, en general, y de sus dos sociedades de Primaria (AEPap y SEPEAP), en particular, de defensa de la Atención Primaria de niños y adolescentes por pediatras en España. Porque en vista de los resultados expuestos, parece recomendable mantener la figura del pediatra en los equipos de Atención Primaria y reforzar su función específica como primer punto de contacto del niño con el sistema sanitario.
This document provides a literature review on community-based microfinance approaches for orphans and vulnerable children. It finds that savings groups that include caregivers and vulnerable children/youth as members can positively impact child well-being. Savings groups are effective at meeting goals, are scalable and inclusive, and provide a platform for complementary programming. However, the risk of increased child labor must be considered. Overall, there is a need for more rigorous research on savings groups directly engaging children/youth, especially orphans, as well as better monitoring of child outcomes in caregiver-focused interventions.
This clinical practice guideline from the American Academy of Pediatrics provides updated recommendations for screening and managing high blood pressure in children and adolescents. Significant changes from previous guidelines include replacing the term "prehypertension" with "elevated blood pressure", using new normative blood pressure tables, simplifying screening and classification of blood pressure, limiting screening to preventive care visits, and revising recommendations for diagnostic testing and treatment. The guideline is based on a comprehensive review of nearly 15,000 articles published between 2004 and 2016. It includes 30 Key Action Statements addressing diagnosis, evaluation, and management of pediatric hypertension. The goal is to improve patient care and outcomes through a patient-centered approach.
Primary Immunodeficiency Diseases in Latin America: The Second Report of the ...Dr. Juan Rodriguez-Tafur
This report summarizes the findings of the Latin American Group for Primary Immunodeficiency Diseases (LAGID) registry, which tracks cases of primary immunodeficiency diseases (PID) across 12 Latin American countries. Some key findings:
- A total of 3,321 PID patients have been registered since the registry began. The most common type of PID was predominantly antibody deficiency (53.2%), with IgA deficiency being most frequent.
- All 12 countries reported an increase in registered PID cases ranging from 10-80% compared to the first LAGID report in 1998.
- Estimated minimal incidence rates of select PID types like X-linked agammaglobulinemia, chronic
This document discusses Nemours' efforts to implement a pediatric patient-centered medical home model in Delaware to improve health outcomes for children. It describes (1) the challenges facing children's health today, including rising rates of chronic disease, (2) the need to address social determinants of health in addition to medical care, which are currently the "blind side" of healthcare, and (3) Nemours' plan to pilot a "medical home plus" model integrating primary care and public health in three communities to achieve the triple aim of better health, better care, and lower costs.
This document provides a summary of a facilitator's guide for a Community-Integrated Management of Childhood Illness (C-IMCI) manual. The manual is divided into two sections: the first covers assessing, classifying, and determining appropriate actions for various diseases and prevention activities; the second provides home care treatment and follow-up guidelines. Each chapter in the first section follows a 7-step process including reflection, definition, recognition of signs, skill development, evaluation and management of cases using a recording form, determining appropriate action, and referral procedures. The guide is intended to train community health workers to identify and manage common childhood illnesses in an integrated manner.
Screening Tool for Developmental Disorders in ChildrenApollo Hospitals
Developmental problems are a diverse group of conditions that affect and limit children and their life-chances. A ready reference for a Paediatrician would be the first six chapters of the latest edition (18th) of the Nelson Textbook of Pediatrics (The Field of Pediatrics, Growth & Development, Psychological Disorders, Social Issues, Children with Special Health Needs and Nutrition and Human Genetics and Metabolic Diseases).
C14 idf diabetes in childhood and adolescence guidelines 2011Diabetes for all
- The document provides guidelines for diabetes care in childhood and adolescence developed by the International Society for Pediatric and Adolescent Diabetes (ISPAD) and the International Diabetes Federation (IDF).
- It estimates that approximately 440,000 children worldwide have diabetes, with 70,000 new cases diagnosed each year. However, many children die before their diabetes is diagnosed due to lack of access to insulin.
- The guidelines are intended to improve diabetes management and outcomes for children and adolescents globally by providing evidence-based care recommendations tailored to different resource settings and levels of care. They cover topics such as education, treatment, complications, and more.
The study aimed to identify barriers to childhood tuberculosis (TB) diagnosis in Lima, Peru. Researchers conducted in-depth interviews with healthcare administrators and pulmonologists, as well as focus groups with primary care providers, community health workers, and parents of pediatric TB patients. Five key barriers to diagnosis were identified: ignorance and stigma in the community, insufficient contact investigation, limited access to diagnostic tests, inadequately trained health center staff, and provider shortages. The researchers concluded that while new diagnostic technologies are being developed, many barriers are rooted in socioeconomic and health system problems that must also be addressed.
This document summarizes a review of research evaluating the effectiveness of semantic feature analysis (SFA) on reducing anomia (word finding difficulties) in individuals with aphasia. The review identified 11 relevant studies that examined SFA as a treatment method for adults with neurological injury and aphasia. The studies were assessed for quality and effect sizes were calculated. The majority of participants showed small effect sizes, indicating SFA did not significantly improve word finding ability for most. Some participants did show medium or high effect sizes. Overall, SFA was found to be effective for reducing anomia based on calculations of percent of non-overlapping data.
IRCM’s Centre on Rare and Genetic Diseases in Adults
Sophie Bernard, M.D., PhD.
Head of the Rare Disease Clinic, IRCM Director, Genetic Dyslipidemias Clinic, IRCM Assistant Professor, Department of Medicine, Montreal University
Rare Disease Day Conference 2020 March 9-10
1) A quality improvement project in a remote African village found that improving children's compliance with a malaria treatment plan by concealing the bad taste of medication increased compliance from 48% to 70%.
2) Quality improvement techniques can work in developing countries with limited resources by setting goals, studying processes, testing changes, measuring progress, and building skills in teamwork and measurement.
3) Initiatives like the Integrated Management of Childhood Illnesses program aim to improve health systems in developing countries by measuring quality of services and using that data to identify successful and unsuccessful innovations for improving care.
The document discusses public health surveillance of rare childhood conditions conducted by the Public Health Agency of Canada. It provides examples of three national surveillance systems - the Canadian Congenital Anomalies Surveillance System, Cancer in Young People in Canada surveillance system, and Canadian Paediatric Surveillance Program. These systems monitor trends in rare childhood diseases and conditions to support public health policies and programs.
This document reviews existing literature on models and tools for disclosing a child's HIV-positive status. It finds that while over 3 million children globally are infected with HIV, few know their status due to fears of stigma and concerns about harming the child. The WHO recommends disclosure by age 6-12, and benefits include increased medication adherence and decreased frustration. The study evaluated grey literature and research databases to identify 15 disclosure books/tools and select the most relevant of 104 journal articles. It concludes that available models and culturally-sensitive tools can help address barriers and sensitively disclose status to improve child health and well-being.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
This document provides guidance on establishing national child maltreatment surveillance systems in European countries. It recommends:
1) Conducting community-based surveys every 4-7 years using standardized questionnaires to measure past-year and lifetime prevalence among nationally representative samples of students aged 13-15.
2) Using one of three established child abuse questionnaires (ICAST, JVQ, ACE-IQ) or a shorter alternative (SCMQ) to allow comparisons across countries.
3) Employing self-report methods, ensuring anonymity, and obtaining passive consent to prioritize ethical standards and participation rates.
4) Optional additional monitoring through parent reports, agency data, or sentinel surveys for situations where student surveys are not feasible.
This document provides an overview of health literacy for healthcare professionals. It defines health literacy and explains its importance for patient outcomes. Limited health literacy is associated with poorer health, less adherence to treatment, and reluctance to engage with healthcare providers due to shame. The presentation measures health literacy, discusses strategies to improve communication and integrate health literacy into work, and advocates for further research on the topic.
R.M.N.C.H. Indicators and Equity Mapping - A Framework for DiscussionPhilippe Monfiston
The document provides an introduction and framework for discussing reproductive, maternal, neonatal, and child health indicators and equity mapping in the Americas region. It summarizes the 11 indicators selected by the Commission on Information and Accountability to track progress on women's and children's health. It notes that while significant progress has been made, inequities remain both between and within countries. The document advocates for an integrated approach across the life course to promote health equity and universal coverage. It also emphasizes the need for improved data quality and analysis to better inform policies and guide efforts to reduce inequities.
Describing the new CDCF project for tagging Systematic reviews - synergistic plan with the MASCOT (Multilateral Association for Studying Health Inequalities and Enhancing North-South And South-South Cooperation – is funded by the European Commission under the Seventh Framework Programme for Research and Technological Development (FP7).f7th project
The document discusses patient empowerment and inclusion through patient-developed registries. It summarizes the Leigh syndrome global patient registry launched by Cure Mito Foundation, which has over 300 participants from 35+ countries. The registry aims to meaningfully involve patients throughout the research process by making data transparent and accessible to researchers. It also emphasizes the importance of open communication, community involvement, and sharing results with patients. In the conclusion, researchers are encouraged to utilize the registry's data and provide feedback to help advance research for rare diseases like Leigh syndrome.
Participation of the population in decisions about their health and in the pr...Pydesalud
Póster presentado por Lilisbeth Perestelo en el congreso Summer Institute for Informed Patient Choice (SIIPC14) celebrado del 25 al 27 de junio de 2014 en Dartmouth, Hanover (EEUU). Web: http://siipc.org
Contacto: lperperr@gobiernodecanarias.org
Paediatricians provide higher quality care to children and adolescents in pri...Javier González de Dios
Hay una pregunta que plantea un debate mantenido: ¿qué profesional médico es el más adecuado para impartir cuidados de salud a niños en Atención Primaria en países desarrollados?. Adecuación medida como mayor calidad en términos de salud de la población infantil, entendiendo la calidad en sus tres dimensiones: científico-técnica, relacional-percibida y organizativo-económica.
No es fácil definir qué indicadores de calidad en salud infantil debemos tener en cuenta, pero desde el Grupo de Trabajo de Pediatría Basada en la Evidencia se ha intentado responder a esa pregunta bajo el formato de una revisión sistemática. Y se ha hecho en dos momentos: en aquel año 2010 con la publicación “¿Qué profesional médico es el más adecuado para impartir cuidados en salud a niños en Atención Primaria en países desarrollados? Revisión sistemática”, publicada en español en la revista de Pediatría de Atención Primaria y este mismo año 2020 con la publicación “Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review” publicado en inglés en la revista Acta Paediatrica, y que se adjunta debajo par su revisión.
Sus conclusiones tienden a reforzar la postura de la Asociación Española de Pediatría, en general, y de sus dos sociedades de Primaria (AEPap y SEPEAP), en particular, de defensa de la Atención Primaria de niños y adolescentes por pediatras en España. Porque en vista de los resultados expuestos, parece recomendable mantener la figura del pediatra en los equipos de Atención Primaria y reforzar su función específica como primer punto de contacto del niño con el sistema sanitario.
This document provides a literature review on community-based microfinance approaches for orphans and vulnerable children. It finds that savings groups that include caregivers and vulnerable children/youth as members can positively impact child well-being. Savings groups are effective at meeting goals, are scalable and inclusive, and provide a platform for complementary programming. However, the risk of increased child labor must be considered. Overall, there is a need for more rigorous research on savings groups directly engaging children/youth, especially orphans, as well as better monitoring of child outcomes in caregiver-focused interventions.
This clinical practice guideline from the American Academy of Pediatrics provides updated recommendations for screening and managing high blood pressure in children and adolescents. Significant changes from previous guidelines include replacing the term "prehypertension" with "elevated blood pressure", using new normative blood pressure tables, simplifying screening and classification of blood pressure, limiting screening to preventive care visits, and revising recommendations for diagnostic testing and treatment. The guideline is based on a comprehensive review of nearly 15,000 articles published between 2004 and 2016. It includes 30 Key Action Statements addressing diagnosis, evaluation, and management of pediatric hypertension. The goal is to improve patient care and outcomes through a patient-centered approach.
Primary Immunodeficiency Diseases in Latin America: The Second Report of the ...Dr. Juan Rodriguez-Tafur
This report summarizes the findings of the Latin American Group for Primary Immunodeficiency Diseases (LAGID) registry, which tracks cases of primary immunodeficiency diseases (PID) across 12 Latin American countries. Some key findings:
- A total of 3,321 PID patients have been registered since the registry began. The most common type of PID was predominantly antibody deficiency (53.2%), with IgA deficiency being most frequent.
- All 12 countries reported an increase in registered PID cases ranging from 10-80% compared to the first LAGID report in 1998.
- Estimated minimal incidence rates of select PID types like X-linked agammaglobulinemia, chronic
This document discusses Nemours' efforts to implement a pediatric patient-centered medical home model in Delaware to improve health outcomes for children. It describes (1) the challenges facing children's health today, including rising rates of chronic disease, (2) the need to address social determinants of health in addition to medical care, which are currently the "blind side" of healthcare, and (3) Nemours' plan to pilot a "medical home plus" model integrating primary care and public health in three communities to achieve the triple aim of better health, better care, and lower costs.
This document provides a summary of a facilitator's guide for a Community-Integrated Management of Childhood Illness (C-IMCI) manual. The manual is divided into two sections: the first covers assessing, classifying, and determining appropriate actions for various diseases and prevention activities; the second provides home care treatment and follow-up guidelines. Each chapter in the first section follows a 7-step process including reflection, definition, recognition of signs, skill development, evaluation and management of cases using a recording form, determining appropriate action, and referral procedures. The guide is intended to train community health workers to identify and manage common childhood illnesses in an integrated manner.
Screening Tool for Developmental Disorders in ChildrenApollo Hospitals
Developmental problems are a diverse group of conditions that affect and limit children and their life-chances. A ready reference for a Paediatrician would be the first six chapters of the latest edition (18th) of the Nelson Textbook of Pediatrics (The Field of Pediatrics, Growth & Development, Psychological Disorders, Social Issues, Children with Special Health Needs and Nutrition and Human Genetics and Metabolic Diseases).
C14 idf diabetes in childhood and adolescence guidelines 2011Diabetes for all
- The document provides guidelines for diabetes care in childhood and adolescence developed by the International Society for Pediatric and Adolescent Diabetes (ISPAD) and the International Diabetes Federation (IDF).
- It estimates that approximately 440,000 children worldwide have diabetes, with 70,000 new cases diagnosed each year. However, many children die before their diabetes is diagnosed due to lack of access to insulin.
- The guidelines are intended to improve diabetes management and outcomes for children and adolescents globally by providing evidence-based care recommendations tailored to different resource settings and levels of care. They cover topics such as education, treatment, complications, and more.
The study aimed to identify barriers to childhood tuberculosis (TB) diagnosis in Lima, Peru. Researchers conducted in-depth interviews with healthcare administrators and pulmonologists, as well as focus groups with primary care providers, community health workers, and parents of pediatric TB patients. Five key barriers to diagnosis were identified: ignorance and stigma in the community, insufficient contact investigation, limited access to diagnostic tests, inadequately trained health center staff, and provider shortages. The researchers concluded that while new diagnostic technologies are being developed, many barriers are rooted in socioeconomic and health system problems that must also be addressed.
This document summarizes a review of research evaluating the effectiveness of semantic feature analysis (SFA) on reducing anomia (word finding difficulties) in individuals with aphasia. The review identified 11 relevant studies that examined SFA as a treatment method for adults with neurological injury and aphasia. The studies were assessed for quality and effect sizes were calculated. The majority of participants showed small effect sizes, indicating SFA did not significantly improve word finding ability for most. Some participants did show medium or high effect sizes. Overall, SFA was found to be effective for reducing anomia based on calculations of percent of non-overlapping data.
IRCM’s Centre on Rare and Genetic Diseases in Adults
Sophie Bernard, M.D., PhD.
Head of the Rare Disease Clinic, IRCM Director, Genetic Dyslipidemias Clinic, IRCM Assistant Professor, Department of Medicine, Montreal University
Rare Disease Day Conference 2020 March 9-10
1) A quality improvement project in a remote African village found that improving children's compliance with a malaria treatment plan by concealing the bad taste of medication increased compliance from 48% to 70%.
2) Quality improvement techniques can work in developing countries with limited resources by setting goals, studying processes, testing changes, measuring progress, and building skills in teamwork and measurement.
3) Initiatives like the Integrated Management of Childhood Illnesses program aim to improve health systems in developing countries by measuring quality of services and using that data to identify successful and unsuccessful innovations for improving care.
The document discusses public health surveillance of rare childhood conditions conducted by the Public Health Agency of Canada. It provides examples of three national surveillance systems - the Canadian Congenital Anomalies Surveillance System, Cancer in Young People in Canada surveillance system, and Canadian Paediatric Surveillance Program. These systems monitor trends in rare childhood diseases and conditions to support public health policies and programs.
This document reviews existing literature on models and tools for disclosing a child's HIV-positive status. It finds that while over 3 million children globally are infected with HIV, few know their status due to fears of stigma and concerns about harming the child. The WHO recommends disclosure by age 6-12, and benefits include increased medication adherence and decreased frustration. The study evaluated grey literature and research databases to identify 15 disclosure books/tools and select the most relevant of 104 journal articles. It concludes that available models and culturally-sensitive tools can help address barriers and sensitively disclose status to improve child health and well-being.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Abstract
Objective: The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in
children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting
of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries.
The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed
based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available
scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed
by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as
well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles.
Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and
Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts
reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 rec-
ommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although
56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and man-
agement of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these
regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the
limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.
Keywords
sepsis, consensus, children, vasopressor agents, fluid therapy, bolus, septic shock, pediatrics, bundle
Introduction
Sepsis is one of the main causes of morbidity and mortality
worldwide.1
In the US, for example, sepsis is the most impor-
tant cause of inpatient mortality and consumes more than 24
billion dollars per year.2
A large study published in 2017 esti-
mated 48.9 million sepsis cases around the world, of which
20.3 million were in children under five years old. Eleven
million people died of sepsis, representing 19.7% of global
deaths. Of these deaths, 2.9 million were in children under
five years old and 454,000 were in children between five and
19 years old. Sepsis incidence and mortality vary widely
between the different regions of the world, with a greater
burden in Sub-Saharan Africa, Oceania, South Asia, East
Asia and Southeast Asia.3
Recent studies have shown that fatal sepsis cases are higher
in middle and low-income countries than in high-income coun-
tries (31.7% vs. 19.3%).4
There is a greater risk of death in con-
tinents with middle and low-income countries (Africa 7.89,
95% CI 6.02-10.32; Asia 3.81, 95% CI 3.60-4.03; South
America 2.91, 95% CI 2.71-3.12) compared with North
America, especially in the youngest children. Among children
under five years old, the most common causes of sepsis in
2017 were diarrheal disease (5.9 million cases of sepsis),
neonatal disorders (5.1 million cases of sepsis) and lower respi-
ratory tract infections (3.3 million cases of sepsis).3,4
All of
these problems are frequent causes of death in countries with
limited resources and health care inequality.5,6
The objective of a recent publication by the Surviving Sepsis
Campaign (SSC) in children carried out by the Society of Critical
Care Medicine (SCCM), European Society of Intensive Care
Medicine (ESICM) and the International Sepsis Forum5
was to
develop evidence-based guidelines and recommendations for
the resuscitation and management of sepsis patients.
Seventy-seven recommendations were issued without taking
available resources into account, except one related to fluid resus-
citation. These guidelines are mostly based on studies in high-
income countries and issue recommendations which seek to
guide “best practice” more than to establish treatment algorithms
or determine different standards of care.
Given that healthcare access limitations, the burden of non-
communicable chronic diseases and the availability of
resources, among others, are determining factors for the out-
comes of children with sepsis in low and middle-income coun-
tries, the SSC guidelines are not completely applicable in the
healthcare context of countries with limited resources.6
Therefore, the Sociedad Latinoamericana de Cuidados
Intensivos Pediátricos (SLACIP) decided to carry out this
26
Red Colaborativa Pediátrica de Latinoamérica (LARed Network) -
Montevideo, Uruguay. Specialized Pediatric Intensive Care, Casa de Galicia,
Montevideo, Uruguay
27
Northwestern University Feinberg School of Medicine, Chicago, IL, USA
28
Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
29
Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de
Medicina, Serviço de Medicina Intensiva e Emergência, Porto Alegre, RS, Brazil
30
Department of Pediatrics, Facultad de Medicina, Universidad Nacional del
Nordeste, Argentina
Received July 28, 2021. Received revised October 2, 2021. Accepted
October 4, 2021.
Corresponding Author:
Jaime Fernández-Sarmiento, MD, Universidad de La Sabana, Campus del Puente
del Común, Km 7 Autopista Norte de Bogotá, Chía – Cundinamarca,
Colombia.
Email: JaimeFe@unisabana.edu.co
754 Journal of Intensive Care Medicine 37(6)
3. first consensus in order to produce recommendations for the
recognition and management of sepsis in children living in
countries with limited resource availability, particularly in
Latin America.
These guidelines seek to generate recommendations based on
the best available evidence, including local and regional studies
in countries with limited resources, which do not replace individ-
ual clinical judgement in the care of children with sepsis. The
intention is not to replace the SSC or other existing guidelines;
on the contrary, the purpose is to contribute through experts
who live in, and are familiar with the reality of, these low and
middle-income countries, providing recommendations using the
best available evidence to improve clinical practice and health
care in children with sepsis in countries with limited resources.
Methods
A formal consensus was designed using the modified Delphi
method, combining the opinions of nominal groups of experts
with the interpretation of the available scientific evidence in a
systematic process of consolidation of a body of recommenda-
tions. The protocol is registered on the Open Science
Framework (https://osf.io/ezxmr).
Consensus planning began with the establishment by the
SLACIP Sepsis Committee of the 10 topical domains. Ten
questions (some with sub-questions) were generated using
the PICO format which describes the Population (P),
Intervention (I), Control (C) and Outcomes (O). A systematic
review of the literature was conducted for each domain, using
the Johanna Briggs Institute guidelines.9
The systematic
search was performed by an expert librarian and included spe-
cific algorithms for the Cochrane, PubMed, Lilacs and Scopus
specialized registry databases and the OpenGrey database for
grey literature. The search results were imported to the
Rayyan tool which was used for screening. Special emphasis
was placed on search engines which included original studies
performed in LMICs. Studies in English, Spanish and
Portuguese were included. The GRADEpro GDT guide was
used for grading each of the selected articles. This grading
was organized in a book of evidence which was submitted
to the experts as a complement for emitting the
recommendations.
Expert Selection
For this consensus, the topical (FSJ, DSD) and methodological
(MA, NV) coordinating groups defined “experts” to be those
who met at least two of the three criteria described below and
who agreed to participate in this consensus: membership in
the SLACIP Sepsis Committee from 2019 to 2021 or 2017 to
2019; principal author or corresponding author of at least one orig-
inal study on sepsis in children in LMICs within the last five years,
published in a Q1, Q2 or Q3 indexed journal; and at least 10 con-
tinuous years of work experience in a middle or low-income
country in intensive care, emergency or pediatric infectious
disease. The Sociedad Latinoamericana de Infectología [Latin
American Society of Infectious Disease] was invited to participate
(specifically on the topic of antibiotics in sepsis), along with the
Sociedad Latinoamericana de Emergencias [Latin American
Society of Emergency Care] and the Instituto Latinoamericano
de Sepsis [Latin American Sepsis Institute] (ILAS), who selected
their participants according to the expert requirements suggested
by the topical and methodological coordinating groups.
The experts’ participation in this study was voluntary and
did not garner any type of compensation. A consent to partic-
ipate and a declaration of conflict of interest were requested,
which were signed and approved by the participants. The
experts’ affiliations did not affect their participation in the
consensus. The experts were organized in 10 nominal
groups coordinated by a spokesperson. Each group developed
a proposal of recommendations based on the working ques-
tions; subsequently, the recommendations were voted on
using the Delphi method and a virtual conference discussion
consensus.
First consultation, returns and defining consensus: An
initial exploratory consultation was performed using the
Delphi method individually and asynchronously. The
experts were given a packet of referenced evidence which
had been previously assessed for quality. They determined
their degree of agreement using a Likert scale from 1 to 9: 1
to 3 against; 4 to 6 neither in favor nor against; and 7 to 9 in
favor. Consensus was defined as a greater than 75% agglutina-
tion. The strength of the recommendation was determined by
the percentage vote of the experts, considered to be weak if the
agreement was between 75% and 79%, and strong if it was
over 80%. The final recommendation was drafted stating the
direction, strength and certainty of the accompanying
evidence.
Consensus conference: Through virtual meetings carried
out from February 2020 to February 2021, the topical and meth-
odological coordinating groups, group spokespersons and the
entire group of experts reviewed the recommendations and sug-
gestions. In order for a recommendation to be accepted it had to
have a vote consensus of more than 75%. A vote under 75%
showed that there was no consensus. If the final vote was
between 75% and 79%, a suggestion was made (discretional
or weak) in favor of or against the intervention. If the vote
was equal to or greater than 80%, it was recommended (strongly
in favor of or against the intervention). This was the task force’s
criterion regarding the strength of the recommendation. These
recommendations are summarized in Supplement 1.
Results
The Consensus provided 62 recommendations for the diagno-
sis and treatment of pediatric sepsis in LMICs. Overall, 60
were strong recommendations, although 56 of these had a
low level of evidence (supplementary file 1). Figure 1 summa-
rizes the recommendations for hemodynamic management and
fluid resuscitation made by the expert panel for these
countries.
Fernández-Sarmiento et al. 755
4. Recommendations
1. DEFINITION
1.1 The definition of sepsis and its clinical (operational) criteria
should be considered as two different concepts (Strong recom-
mendation in favor, low level of evidence.)
1.2 Sepsis is a clinical syndrome characterized by a poten-
tially fatal organ dysfunction caused by an dysregulated host
response to the infection. (Strong recommendation in favor,
low level of evidence.)
1.3 Septic shock is sepsis with especially profound circula-
tory, cellular and metabolic abnormalities associated with a
greater risk of mortality than sepsis alone. (Strong recommen-
dation in favor, low level of evidence.)
2. Sepsis Epidemiology and Prevalence in Latin America
Infections, especially respiratory tract and gastrointestinal
infections hold first and third place among the causes of death
in children under the age of five, and seventh and sixth place
in children from 5 to 14 years old, respectively;6,10
the
highest proportion of these deaths are attributed to sepsis and
septic shock. There is no unified system of regional notification
of morbidity and mortality in Latin America. Epidemiological
data on the burden of sepsis are extracted from private research
initiatives and from mathematical models based on vital statis-
tics. Thus, the actual incidence cannot be estimated.11
In 19 PICUs in Colombia, Jaramillo-Bustamante et al. found an
overall mortality of 18% and a pulmonary focus in 54% of 1051
patients. The groups with the highest risk of mortality were
patients with septic shock, those under two years of age, those
with organ failure, or those with a low socioeconomic status.14
De Souza et al. in a study of patients from 21 regional hospitals
(Brazil, Argentina, Chile, Paraguay and Ecuador), report frequen-
cies of 42.4% for sepsis, 25.9% for severe sepsis and 19.8% for
septic shock among patients hospitalized in the PICU between
June and September 2011.15
Mortality in the different studies
ranged from 13 to 33.7%16
in Latin American countries.
3. Bundles and Initial Care in Countries with Limited
Resources
3.1 We suggest that, once sepsis has been diagnosed, interven-
tions be carried out at the times recommended for each; inter-
ventions which should be reinforced and universally used.
(Strong recommendation in favor, low level of evidence.)
3.2 We recommend requesting advice promptly from the
referral center, whether from the pediatrician, emergency physi-
cian or intensivist, for treatment suggestions. The appropriate
time for transfer, clinical conditions prior to transfer (stabiliza-
tion), transfer team and means of transport should be decided
together with the referral center. (Strong recommendation, low
level of evidence.)
3.3 We recommend systematically using the Pediatric
Assessment Triangle (PAT) for the initial assessment of children
with sepsis. It is recommended that treatment be initiated
Figure 1. Hemodynamic management and fluid resuscitation in sepsis in children living in low- and middle-income countries.
PICU: Pediatric Intensive Care Unit, FOL: fluid overload, LPVR: low peripheral vascular resistance, BP: Blood pressure, UO: urine output, EKG:
electrocardiogram, SCVO2: Central venous oxygen saturation, CO: cardiac output.
756 Journal of Intensive Care Medicine 37(6)
5. without waiting for lab exam results. (Strong recommendation,
low level of evidence.)
3.4 We suggest understanding the context of children with
sepsis (clinical history, healthcare system) to determine the
risk of some viral and parasitic infections prevalent in each
country which may require special interventions and precau-
tions. (Weak recommendation, low level of evidence.)
3.5 We suggest considering the simultaneous application of
the septic shock bundle within the first hour of care. This
package of actions should include the recognition, resuscitation,
stabilization and process control bundles. The first interventions
should include obtaining peripheral venous access (ideally
within the first five minutes), administering oxygen (when
there is hypoxemia), beginning antibiotics within the first
hour along with vasoactive medications (through the peripheral
vein, if central access is not available), and applying the fluid
resuscitation strategy suggested in this consensus (Strong rec-
ommendation, low level of evidence.)
4. Early Recognition and Severity Scales
4.1 For early recognition of sepsis in children, we recommend
taking into account the clinical criteria described in the text, the
medical team and parents’ perception of the severity of the
illness, and the presence of comorbidities. (Strong recommen-
dation, low level of evidence.)
4.2 We suggest using procalcitonin either together with or as
an alternative to C-reactive protein as a complement to clinical
assessment, according to the availability at each healthcare
facility, to guide a possible bacterial sepsis diagnosis. (Strong
recommendation in favor, low level of evidence.)
4.3 The use of ferritin as a priority biomarker in the initial
assessment cannot be recommended, as the cut-off point has
not been determined, it is nonspecific and it is not widely avail-
able. (Strong recommendation against, low level of evidence.)
4.4 The use of serum lactate for patient stratification is not rec-
ommended. Its serial measurement and assessment of change
over time may be useful for follow up and as a guide for resusci-
tation. (Strong recommendation in favor, low level of evidence.)
4.5 We suggest considering the use of an organ dysfunction
score (e.g., pSOFA or PELOD-2) as a predictor of mortality in
the initial assessment and follow up of patients with sepsis.
(Strong recommendation in favor, low level of evidence.)
4.6 We recommend the Pediatric Index of Mortality (PIM3)
as a predictor of mortality on admission to the PICU. (Strong
recommendation in favor, low level of evidence.)
4.7 We recommend using the Functional Status Scale (FSS)
to evaluate morbidity in patients with sepsis, measured at PICU
and hospital discharge. (Strong recommendation in favor, low
level of evidence.)
5. Oxygen Administration Systems and Ventilatory
Management
5.1 We recommend administering oxygen via bubble CPAP or
noninvasive ventilation in children with sepsis with respiratory
failure, in countries with limited resources, when invasive
mechanical ventilation is not possible or safe. (Strong recom-
mendation, low level of evidence.)
5.2 We do not recommend immediate initial intubation in
children with septic shock. It is indicated in cases of apnea
and coma, or lack of response to the initial treatment. (Strong
recommendation, low level of evidence.)
5.3 We recommend performing endotracheal intubation and
invasive respiratory support when there is deterioration of the
respiratory or cardiovascular function, or it does not improve
with the initial support measures in children with septic
shock. A good fluid resuscitation and infusion of vasoactive
medications, if needed, should be ensured prior to intubation.
(Strong recommendation, low level of evidence.)
5.4 The following goals are recommended for children with
sepsis receiving invasive mechanical ventilation: normoxemia
(paO2 ≥ 60 mm Hg or SaO2 ≥ 90%), and 90 to 94% saturation
in patients with mild pARDS with a PEEP <10 cm/H20. For
patients with serious pulmonary disease, and to avoid iatrogenic
(nonprotective) ventilatory parameters, saturations may be kept
≥ 88% (88-92%). (Strong recommendation, low level of
evidence.)
5.5 For children with sepsis receiving mechanical ventila-
tion, we recommend using plateau pressures lower than or
equal to 30 cm H2O with tidal volumes between 5 to 8 mL/
kg in patients with low pulmonary compliance or elevated ela-
stance. In patients with low pulmonary elastance, higher tidal
volumes may be used to reach saturations between 88%
−92%, keeping the plateau pressure lower than or equal to 30
cm H2O. (Strong recommendation, low level of evidence.)
5.6 In children with sepsis on mechanical ventilation, we
recommend using the necessary PEEP to obtain the best possi-
ble compliance and an arterial saturation equal to or greater than
90% or PaO2 of 60 mm Hg, with an FiO2 less than or equal to
.6. (Strong recommendation, moderate quality evidence.)
5.7 We recommend considering the use of high-frequency
oscillatory ventilation (HFOV) in respiratory failure refractory
to other conventional methods, when oxygenation or ventilation
goals are not reached, or when non-protective conventional MV
parameters must be used to achieve these goals, such as: plateau
pressure greater than 30 cm H2O, driving pressure > 15 cm H20
and FiO2 greater than .6. (Strong recommendation, low level of
evidence.)
6. Fluid Resuscitation
6.1 For healthcare systems with limited availability of intensive
care, we recommend not administering bolus fluids for patients
without hypotension, and starting maintenance fluids (Strong
recommendation, high quality evidence.)
6.2 For healthcare systems with ICU availability or limited
availability, during initial resuscitation, when hypotension is
present, we recommend administering a 10 mL/kg bolus (up
to 40 mL/kg) during the first hour. Clinical markers of
cardiac output should be monitored, and the bolus should be
Fernández-Sarmiento et al. 757
6. discontinued if signs of fluid overload develop (Strong recom-
mendation, low level of evidence.)
6.3 For healthcare systems with ICU availability, when
hypotension or signs of serious hypovolemia are absent, or
when there is serious lung injury or myocardial dysfunction,
we recommend considering a lower rate of fluid resuscitation
(5-10 mL/kg boluses). (Strong recommendation, low level of
evidence.)
6.4 We recommend individualizing the fluid administration
strategy for each patient. A higher rate (up to 60 mL/kg with
ICU availability or 40 mL/kg without) should be considered
in cases of evident hypovolemia, elevated losses or third
spacing when accompanied by hypotension. (Strong recom-
mendation, high quality evidence.)
6.5 We recommend using balanced crystalloid solutions
(Ringeŕs lactate or similar solutions) for fluid resuscitation in
children with sepsis. (Strong recommendation, low level of evi-
dence.). Figure 1.
7. VASOACTIVE MANAGEMENT
7.1 We recommend beginning vasoactive medication adminis-
tration after 40 mL/kg of fluid resuscitation, if the patient still
has clinical or monitoring signs of hypoperfusion. It may
even be started before 40 mL/kg of volume expanders have
been administered, if the child shows signs of volume overload
or other limitations to fluid administration. (Strong recommen-
dation, low level of evidence.)
7.2 We recommend using adrenaline as the drug of choice,
reserving noradrenaline for cases with clinical or monitoring
evidence of low peripheral vascular resistance. (Strong recom-
mendation, low level of evidence.)
7.3 We recommend that vasoactive drug administration be
initiated regardless of the area of the hospital in which the
patient is located, using peripheral (diluted vasoactive drugs)
or intraosseous access, and as soon as possible after it is consid-
ered to be required. (Strong recommendation, low level of
evidence.)
8. MONITORING
8.1 We recommend noninvasive monitoring for all patients in
septic shock, including temperature, pulse oximetry, arterial
pressure, urine output and continuous electrocardiogram read-
ings. (Strong recommendation, low level of evidence.)
8.2 For children with septic shock, we recommend using
advanced hemodynamic variables such as invasive arterial pres-
sure, echocardiograms, central venous oxygen saturation
(ScvO2) and, if available, cardiac output monitoring, to guide
resuscitation and treatment changes. (Strong recommendation,
low level of evidence.)
9. Antibiotics
9.1 We recommend starting empirical broad spectrum antibiotic
treatment within the first hour after diagnosis in all cases of
septic shock, basing the choice of antibiotic and dose on the
local antimicrobial resistance patterns (Strong recommenda-
tion, low level of evidence.)
9.2 We recommend starting antibiotic treatment as soon as
possible, within the first three hours after diagnosis, in pediatric
patients with sepsis with organ dysfunction, but without shock
data (Strong recommendation, low level of evidence.)
9.3 We recommend obtaining peripheral blood cultures
(volume according to age and weight), along with samples
from other sites according to the clinical suspicion of the infec-
tious source, prior to beginning antibiotic treatment. If microbi-
ological samples are taken after administering antibiotics, the
time elapsed since the beginning of antibiotic treatment
should be taken into account when interpreting the results.
(Strong recommendation, low level of evidence.)
9.4 Empirical antibiotic treatment should be broad spectrum
and achieve adequate blood and tissue concentrations in order
to provide adequate coverage for all possible microorganisms
causing sepsis or septic shock. (Strong recommendation, low
level of evidence.)
9.5 The choice of empirical antibiotic treatment should be
based on local epidemiological data, age, type of host (underly-
ing diseases), invasive procedures, site of the infection, history
of prior antibiotic treatment, and infection or colonization with
multidrug-resistant microorganisms (Strong recommendation,
low level of evidence.)
9.6 In patients over one month old with community-acquired
septic shock without a clinically apparent source of infection, cov-
erage should be considered for S. pneumoniae, N. meningitidis,
Haemophilus spp and methicillin-resistant Staphylococcus
aureus (MRSA). In areas with a high prevalence of MRSA, empir-
ical treatment may include a third-generation cephalosporin along
with an antibiotic with specific MRSA coverage. (Strong recom-
mendation in favor, low level of evidence.)
9.7 In children with septic shock, coverage of Gram-negative
bacilli should be considered when the initial clinical source of
infection is genitourinary or gastrointestinal. In immunosup-
pressed individuals, initial empirical coverage should be pro-
vided for extended spectrum beta lactamase (ESBL)-producing
enterobacteria (Pseudomonas and methicillin-resistant
Staphylococcus aureus, among others). (Strong recommenda-
tion, low level of evidence.)
9.8 For patients with septic shock and a history of fungal
colonization or possible infection, the addition of lipid or
liposomal amphotericin B or echinocandins, as applicable,
will be considered. (Strong recommendation, low level of
evidence.)
9.9 Once the etiological agent has been confirmed, the defini-
tive treatment will be adjusted to the narrowest spectrum and
lowest toxicity possible, according to the confirmed type of infec-
tion, microorganism and sensitivity. If the cultures are negative,
the clinical source of infection will be evaluated along with the
patient’s clinical situation to determine, together with Infectious
Disease (if available), the antibiotic regimen with the narrowest
possible spectrum, according to the source and type of infection.
(Strong recommendation, low level of evidence.)
758 Journal of Intensive Care Medicine 37(6)
7. 9.10 If an intravascular device-related infection is suspected
(long-term catheters), we recommend obtaining a blood culture
through this device, in addition to the peripheral blood cultures.
If the infection is confirmed, the intravascular device should be
removed. (Strong recommendation, moderate quality evidence.)
10. Adjuvant Therapy
10.1 We recommend considering hydrocortisone administra-
tion in children with septic shock refractory to fluids, inotropes
and vasoactive drugs. (Strong recommendation, low level of
evidence.)
10.2 We recommend monitoring sodium and glucose levels
and assessing muscle weakness in children with septic shock
treated with hydrocortisone. (Strong recommendation, low
level of evidence.)
10.3 We recommend discontinuing hydrocortisone treatment
once inotropes or vasoactive medications are no longer neces-
sary or have been reduced to low doses. We recommend taper-
ing the hydrocortisone treatment when it has been used for
extended periods of time. (Strong recommendation, low level
of evidence.)
10.4 We recommend not routinely measuring thyroid
hormone levels in children with sepsis or septic shock.
(Strong recommendation, low level of evidence.)
10.5 We cannot recommend in favor of or against routine
administration of vitamin C or thiamine in children with
sepsis or septic shock. (Strong recommendation, low level of
evidence.)
10.6 We recommend conducting a nutritional assessment on
admission and periodically thereafter in all children with sepsis;
if possible, with the participation of nutrition specialists.
(Strong recommendation, low level of evidence.)
10.7 We recommend starting enteral nutritional support
within 48 h of admission in children with sepsis who are hemo-
dynamically stable and have an intact gastrointestinal tract.
(Strong recommendation, low level of evidence.)
10.8 We recommend not postponing enteral nutrition solely
based on the administration of inotropes or vasoactive medica-
tions. (Strong recommendation, low level of evidence.)
10.9 We recommend beginning enteral feeding through the
gastric route in children with sepsis, reserving transpyloric
feeding for patients who do not tolerate the gastric route or in
whom it is contraindicated. (Strong recommendation, low
level of evidence.)
10.10 We recommend not using hydrolyzed formulas for
initial enteral feeding in children with sepsis, and not supple-
menting enteral nutrition with omega-3 fatty acids. (Strong rec-
ommendation against, low level of evidence.)
10.11 We recommend not using gastric residual volume as
an indicator for reducing or stopping nutrition in children
with sepsis. We do not recommend the routine use of prokinetic
agents for treating feeding intolerance in children with sepsis.
(Strong recommendation against, low level of evidence.)
10.12 We recommend using parenteral nutrition in children
with sepsis who do not tolerate enteral nutrition or when it is
contraindicated. (Strong recommendation, low level of
evidence.)
10.13 We recommend not making nutritional modifications,
such as changes in glucose, amino acids or the administration of
insulin, to stimulate albumin synthesis in children with sepsis.
(Strong recommendation against, low level of evidence.)
10.14 We recommend not using special lipid emulsions in
the parenteral nutrition of children with sepsis or septic
shock. (Strong recommendation against, low level of evidence.)
10.15 We recommend not routinely supplementing the nutri-
tion of children with sepsis with glutamine, arginine, selenium,
zinc or vitamin D. We recommend only supplementing if there
is a proven deficit of these elements. (Strong recommendation
against, low level of evidence.)
10.16 We recommend not using a liberal strategy of red
blood cell transfusion in children with sepsis. (Strong recom-
mendation against, high level of evidence.)
10.17 We recommend using a hemoglobin (Hgb) count of
less than 7 g/dL to indicate the need for packed red blood cell
transfusion in hemodynamically stabilized children with
sepsis, while also evaluating the rest of the organ dysfunctions.
We recommend transfusing red blood cells which, preferably,
have been stored for fewer than 21 days. (Strong recommenda-
tion, high level of evidence.)
10.18 We cannot make recommendations regarding hemo-
globin thresholds in critically ill children with septic shock
without hemodynamic stability. (Strong recommendation, low
level of evidence.)
10.19 We recommend not prophylactically transfusing plate-
lets in children with septic shock or with sepsis-related organ
dysfunction who do not have bleeding or coagulation disorders,
unless they have counts under 10 000 cells/mm3 and a risk of
central nervous system bleeding. (Strong recommendation
against, low level of evidence.)
10.20 We recommend not transfusing fresh plasma prophylac-
tically or as an expander in children with septic shock or sepsis-
related organ dysfunction. Its use is only recommended when
there are abnormal coagulation tests and a risk of or clinical bleed-
ing. (Strong recommendation against, low level of evidence.)
Discussion
This paper presents the first consensus of recommendations for
the management of sepsis in children living in LMICs. After
conforming to the methodological structure suggested by the
modified Delphi method, 62 recommendations were emitted
by 29 experts (topical and methodological) with extensive
experience and a long track record in managing children with
sepsis in these countries. Given the importance of the context
in the care of children with sepsis, the heterogeneity of health-
care services, the burden of chronic noncommunicable diseases
and the availability of resources in LMICs, we believe these
guidelines will contribute significantly to the improved care
and survival of many children living in these countries.
In this regard, our recommendations have some points in
common and some differences with those published recently
Fernández-Sarmiento et al. 759
8. by the SSC in children.5
Our consensus always had as its
working principle to make recommendations considering the
context and their applicability for LMICs, as well as the impor-
tance of including high quality research studies carried out in
these countries, with no language restriction. We believe that
the reality of sepsis is very different for high-income countries
compared with LMICs, and the differential epidemiological
data on morbidity and mortality support this.4,5
However, the
main aspects in common with the SSC guidelines are related
to ventilatory management, use of vasoactive medications and
fluid resuscitation. In fact, this last recommendation is the
only one in which the SSC takes the available resources into
account.
The main differences between our recommendations and
those of the SSC are related to other very important aspects
of sepsis for LMICs. This consensus, following the recommen-
dation of the SLACIP sepsis committee, worked with 10
domains, while the SSC worked with six. For LMICs, we
believe it is very important to emphasize the definition, sepsis
bundle (highlighting the importance of early recognition) and
relevant epidemiological data from these countries.
Thus, one of the most important aspects mentioned in this
consensus is the adjustment and adaptation of the new defini-
tion of sepsis which has been used in adults and which is
being updated in pediatrics.19
A problem which has arisen
since 2016 is the differentiation between the “definition” and
the “clinical operationalization” of this concept, that is, the clin-
ical criteria to identify it. The indiscriminate use of these has led
to confusion. The Sepsis-3 authors indicated the difference
between these two points. They understood “definition” to be
the “description of a concept of disease;” thus, a definition of
sepsis should describe what sepsis “is,” a matter which allows dis-
cussion regarding biological concepts which are not completely
understood today, such as genetic influence and cellular anoma-
lies.19,20
When the pediatric Sepsis-3 was evaluated in a PICU
in India, which included a smaller population but with a much
higher sepsis mortality (40%), high specificity was found (identi-
fying the most serious cases of sepsis), but with little sensitivity,
because it was unable to identify 18% of the sepsis episodes diag-
nosed by the 2005 Consensus Conference.24
We also differ from the recommendations made by the SSC5
in that, in LMICs, we believe it is important to continue using
bundles for a comprehensive approach to children with sepsis.
In the context of pediatric intensive care, the implementation of
packages of care interventions has been successful in control-
ling ventilator-associated pneumonia as well as other
healthcare-associated infections.25
Infectious diseases and
sepsis are frequent causes of mortality in the pediatric popula-
tion of low and middle-income countries,26
exceeded only by
perinatal complications.27
This is particularly true in Latin
America, a diverse region in terms of geopolitics and economic
and human development, which has a direct impact on the
structure of healthcare systems and their accessibility.
According to the World Health Organization (WHO), the
number of physicians per 100 000 inhabitants may vary up to
almost four times among Latin American countries, and more
than 30 times if the Latin America and Caribbean macroregion
is considered.31
This explains why most seriously ill children in
Latin America are initially seen by general practitioners or non-
medical healthcare professionals in urban and suburban zones.
In rural zones, initial care is often provided by nonprofessional
technical personnel. In light of these reasons, the establishment
of comprehensive strategies like sepsis bundles allows a com-
prehensive approach to children with sepsis living in LMICs.
Likewise, important aspects such as early recognition, initial
laboratory tests, and follow up are mentioned, as well as the use
of severity scales in countries with limited resources.32
The use
of pSOFa or PELOD-2 as predictors of mortality is recom-
mended.37
The importance of using the FSS for evaluating
residual mortality in patients with sepsis is particularly high-
lighted, a practice which is not very common in these coun-
tries.42
Given the frequency of chronic noncommunicable
diseases in the region, an analysis of this topic was considered
to be important.6
Recommendations are also provided regarding oxygen adminis-
tration systems, the parameters for initiating mechanical ventilation
and subsequent adjustments.43
We share some aspects with the
SSC guidelines, but also have some differences. Although high
quality health care is provided in the PICUs of many capital cities
in Latin America, with similar outcomes to those described by high-
income countries, we have a limited number of critical care beds in
our territories. In Latin America, the mortality rate in townships less
than 5 km apart may be up to four times higher, due to difficulties in
accessing high complexity healthcare services.47
In these countries,
patients often spend hours in the emergency room awaiting transfer
to the PICU, due to a lack of immediate availability of this
resource.27,32
Thus, we believe it is important to begin oxygen
support systems early in patients who require them and reserve
advanced airway management only for patients who do not
respond to the initial treatment, always ensuring the availability of
resources and personnel trained in advanced airway management.
Fluid resuscitation and vasoactive management are essential
in the treatment of children with septic shock and
sepsis-associated organ dysfunction. A high percentage of chil-
dren admitted to the PICU are not yet adequately resusci-
tated,48%
and 35% die in the early stage of the disease (< 3
days) due to refractory shock,49
a situation which is more pro-
nounced in LMICs.14,15,27
Factors such as comorbidities, access
to first aid, knowledge of healthcare professionals and the level
of education caregivers may be extremely relevant when deter-
mining fluid resuscitation strategies and should always be eval-
uated. This consensus, as well as the SCCM in children, made
recommendations for hemodynamic resuscitation targeted at
resource-limited regions, particularly for Latin America and
for children with the most frequent pathologies in these
regions. The recommendations were based on studies that dem-
onstrated that an indiscriminate administration of fluids without
considering the context and comorbidities may result in
increased complications, morbidity and mortality.50,51
In pedi-
atrics, the main study is undoubtedly the one carried out by
Maitland et al. in which the administration of fluid boluses sig-
nificantly increased mortality in septic children in Africa.50
760 Journal of Intensive Care Medicine 37(6)
9. However, in hypotensive patients in order to avoid cardiopul-
monary collapse, we strongly recommend that fluids should
be administered urgently (10 mL/Kg bolus to 40 mL/Kg)
without using any predictor of fluid responsiveness. Unlike
the SSC in children, in which most experts did not have per-
sonal experience with caring for children with sepsis in
LMICs, and whose hemodynamic resuscitation recommenda-
tions were mostly weak; in this Consensus, the experts have
lived the reality of inadequate knowledge of sepsis and difficult
care, and their hemodynamic resuscitation recommendations
are strong, despite the low level of evidence.
In addition to the important considerations of crystalloid
doses and time of administration in children with sepsis and
septic shock in LMICs, it is very important to consider their
composition. In a cohort of Latin American children with
sepsis and septic shock who required fluid resuscitation with
crystalloids, it was found that the group receiving balanced
solutions had less acute kidney injury (aOR 0.75: 95% CI
0.65-0.64: p = 0.006), less need for renal replacement
therapy (aOR 0.48: 95% CI 0.36-0.64) and a shorter PICU
stay.52
Thus, according to SSC recommendations for children,
and with the current evidence in adults and studies in high-
income countries53
as well as in LMICs, it seems reasonable
to prefer the use of balanced solutions in the fluid resuscitation
of children with sepsis.
We recommend adrenaline be used as the first line vasoac-
tive and reserve noradrenaline for cases with clinical or moni-
toring evidence of low peripheral vascular resistance. We
recognize that the SSC in children did not issue a recommenda-
tion for a specific first-line vasoactive infusion for children with
septic shock as there are no available studies directly against
adrenaline with noradrenaline. However, we believe this is sup-
ported by a double-blind prospective randomized controlled
trial conducted in Latin America that demonstrated that early
administration of peripheral or intraosseous epinephrine in chil-
dren with fluid-refractory septic shock was associated with
longer survival (OR 6.49), when compared to dopamine.54
Antimicrobial therapy is an important component in the
treatment of sepsis as it directly targets the underlying cause
of sepsis. The guideline of antibiotic administration within the
first hour after the onset of shock is mainly derived from obser-
vational studies in which delayed administration is associated
with greater mortality.55
Therefore, based on the available evi-
dence from observational studies in pediatric tertiary care
centers and recommendations from the experts participating
in this consensus, we consider that antibiotics should be admin-
istered at the latest within the first hour after recognizing septic
shock. Furthermore, early administration within the first hour
has been related to decreased hospital stay and slower progres-
sion of multiple organ failure in children. The group of patients
in whom the “the diagnosis of sepsis is not certain” or who have
sepsis without cardiovascular involvement should be differenti-
ated in countries with limited resources. In these cases, without
shock, beginning antibiotic treatment within three hours after
diagnosis could be adequate, according to studies performed
in high-income countries.
Given the difficulty of treating children with septic shock
refractory to catecholamines due to the difficulty of advanced
hemodynamic monitoring in most services and the difficulty
of performing ECMO in children in Latin America, the
current sepsis guidelines in children recommend considering
hydrocortisone administration in children with septic shock
refractory to fluids, inotropes and vasoactive drugs. However,
there are insufficient data to compare the efficacy of the
various types of corticosteroids in pediatric septic shock.56
Likewise, the optimal dose of hydrocortisone for refractory
septic shock in children is unknown. Other important points
in the treatment of critically ill children with sepsis, such as
nutritional therapy, endocrine and metabolic therapies and
blood products, were recommended in this Consensus in accor-
dance with the SSC recommendations for children, due to the
lack of strong evidence in LMICs.
We believe this consensus may have a few limitations. First, the
participating researchers did not represent absolutely all of the
Latin American countries. However, we sought to have a group
of participating experts who met the criteria described in the mate-
rials and methods section, with special importance given to work
experience in the region and publication of original research on
sepsis in LMICs. Second, the recommendations issued are only
applicable for children living in LMICs, as is the case in the vast
majority of Latin American countries. We believe that the
context and available resources are essential components of the
care of critically ill children with sepsis and should always be con-
sidered. Ultimately, although we have sometopics and recommen-
dations in common with the SCCM consensus, there are
differential factors that we believe are very important for the
care of children living in LMICs and which are supported by
studies performed in these limited resource contexts.
Conclusions
These are the first consensus recommendations for the diagno-
sis and management of pediatric sepsis focused on LMICs,
more specifically, Latin American countries. The Consensus
shows that, in these regions, where the burden of pediatric
sepsis is greater than in high-income countries, there is little
high-level evidence. The Consensus points to numerous per-
spectives to be studied in the diagnosis and treatment of pediat-
ric sepsis in Latin America. Despite the limitations, this
Consensus is an important step forward for the diagnosis and
treatment of pediatric sepsis in Latin America.
Authors’ Note
All authors approved the final manuscript as submitted and
agree to be accountable for all aspects of the work.
Author Contributions
Drs. JF, DCS, and RJ conceived the idea for the manuscript. Drs. JF,
DCS, AM, VN, JL, VSL, MPAL, WB, CFO, JCJ, FD, AY, SR,
MM, PV,RI, MPM, GG, MY, CT, PC, GP, CG, MS, SC, SG, NS,
PG and RJ participated in the writing and voting process with modified
Fernández-Sarmiento et al. 761
10. delphi methodology as described. All the authors drafted the manu-
script and contributed significantly to the article revision. All authors
approved the final manuscript as submitted and agree to be accountable
for all aspects of the work. None of the researchers have conflicts of
interest to declare.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship
and/or publication of this article.
Ethical Approval
Not applicable, because this article does not contain any studies with
human or animal subjects.
ORCID iDs
Jaime Fernández-Sarmiento https://orcid.org/0000-0003-2874-
2949
Juan Camilo, Jaramillo-Bustamante https://orcid.org/0000-0001-
6973-6612
Supplemental Material
Supplemental material for this article is available online.
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