29th International Conference on Pediatric Nursing & Healthcare August 16-17, 2018 Madrid, Spain

Silvana Daniela Espinoza Manjarrez has the vocation to improve the care of children with cancer. Together with a great team at the Hospital Infantil Teletón de Oncología and the support of Children’s Hospital Boston, she started this project. She received intensive training with a group of nurses at the Dana Farber to replicate this in Mexico with the staff of HITO. She is an active member of the Steering Committee of EVAT in the multisite implementation of EVAT lead by St. Jude Children’s Research Hospital in Memphis, TN. She has trained staff at numerous centers in Honduras, Culiacan, Morelos, San Luis Potosí, Campeche, La Paz and Tijuana. \r\nSeeking to provide the best care for pediatric patients with cancer, she is continuing this project to share this score with many more hospital.\r\n

INTRODUCTION: Early warning scores use clinical parameters to generate a scores that allows to identify patients at risk for clinical deterioration. \r\nOBJETIVE: Evaluate the use of the PEWS (Pediatric Early Warning Score) score as a marker of early clinical deterioration in pediatric oncology patients that require evaluation by the intensive care team. \r\nMETHODS: 128 events were reviewed, corresponding to 71 patients with a diagnosis of cancer, that required evaluation by the pediatric intensive care unit (PICU) team between December 2013 and October 2015. A PEWS score was assigned in a retrospective manner to each one of the events up to 10 hours before the evaluation by the PICU team. A score of greater than 4 was classified as critical based on vital signs. The events were classified based on the intervention as: PICU consult, medical response team activation and code team activation. \r\nRESULTS: Before evaluation by the PICU team, 78% of the patients had a critical PEWS. PICU evaluation ranged from 10 hours before the event to the moment of the event. Of the 182 events, 79 patients (85.9%) that were transferred to the PICU had critical PEWS before the event. Of the remaining 90 events that did not require transfer to the PICU, 65 patients (72.2%) require an intervention to improve their critical condition. \r\nCONCLUSIONS: The use of an early warning score is useful to identify clinical deterioration early. The results suggest that the us early warning score would allow for the objective identification of patients at risk for deterioration. \r\n

Kazuto Taniguchi has his expertise in pediatrics and molecular biology, and has passion in improving the children’s health and wellbeing. He was raised in Kyusyu, Japan and became a pediatrician. He completed a PhD at Saga University. He worked at Saga University Community Medical Support Institute. He then moved to the University of Exeter Medical School (UK) as a postdoctoral fellow and studied under Professor Noel G Morgan. He serves as a pediatrician and the vice director of the Tara Town Hospital since returning to Japan.

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is characterized by periodic high fever lasting 3 to 6 days and recurring regularly every 2 or 8 weeks. The fever is also associated with aphthous stomatitis, pharyngitis, and cervical adenitis. The etiology of PFAPA syndrome remains unclear. Although various treatments, such as tonsillectomy and the use of cimetidine, prednisolone, colchicine, thalidomide, anakinra, and non-steroidal anti-inflammatory drug, have been reported, the effectiveness of these treatments is still controversial. We here show 3 thought-provoking cases. A 1-year-old girl with PFAPA syndrome received oral cimetidine treatment and febrile attacks were reduced. No side effect was detected due to oral cimetidine treatment. Tonsillectomy was successfully performed on a 3-year-old girl and a 6-year-old boy with PFAPA syndrome and febrile attacks were reduced. Cimetidine, which is renowned as therapeutic agent of a gastroduodenal ulcer, is a common H2 antagonist that inhibits suppressor CD8+ T-lymphocyte activation and chemotaxis. Tonsillectomy is generally recommended for patients aged 3 years and older for safety reasons (to avoid postoperative complications), whereas oral medications can be used in younger patients. Our experience shows that oral cimetidine treatment and tonsillectomy are effective against PFAPA syndrome. We suggest that tonsillectomy be considered as early as possible in patients with PFAPA syndrome. We also propose the use of cimetidine to reduce the febrile attacks of PFAPA syndrome until the age of 3 years.