PMID- 32686136
OWN - NLM
STAT- MEDLINE
DCOM- 20210105
LR  - 20210105
IS  - 1365-4632 (Electronic)
IS  - 0011-9059 (Linking)
VI  - 60
IP  - 1
DP  - 2021 Jan
TI  - Intensive care needs and long-term outcome of pediatric toxic epidermal 
      necrolysis - A 10-year experience.
PG  - 44-52
LID - 10.1111/ijd.15054 [doi]
AB  - BACKGROUND: Toxic epidermal necrolysis (TEN) is a life-threatening severe 
      cutaneous adverse reaction. Data on pediatric TEN is limited. METHODS: Case 
      records of 44 children, 1 month-12 years with a diagnosis of TEN (>30% body 
      surface area [%BSA] detachment) admitted to a tertiary pediatric intensive care 
      unit (PICU) between 2009 and 2018 were analyzed retrospectively. The primary 
      outcome was mortality, and secondary outcomes were organ dysfunction, length of 
      stay (LOS), and long-term sequelae. RESULTS: Median (IQR) age was 6.5 (3.6, 
      8.0) years, and 25 (57%) were boys. Median (IQR) %BSA involved, SCORTEN score, 
      and PRISM-III were 65% (45, 80); 2 (2, 3) and 13 (10, 16), respectively. 
      Antiepileptics (n = 24, 54.6%) and antimicrobials (n = 8, 18.2%) were the most 
      common offending agents. Twenty-four (54.5%) children had culture positive 
      sepsis. Immunomodulatory therapy was provided in 35 (79.5%) and conservative 
      management in nine (20.5%) children. Intravenous immunoglobulin (IVIG) was given 
      in 22 (50%), steroids in three (6.8%), and both IVIG and steroids in 10 (22.7%) 
      children. Respiratory failure (n = 14, 31.8%) was the commonest organ failure. 
      Mortality was 15.9% (n = 7), and median (IQR) PICU-LOS in survivors was 8 (4, 
      11.75) days. There was no association between IVIG, steroids, or conservative 
      management with mortality or LOS. Ocular sequelae (n = 20, 54.1%) were the most 
      common long-term complication followed by skin (18, 40.1%). CONCLUSION: 
      Immunomodulation with IVIG or steroids was not associated with any mortality 
      benefit as compared to conservative management alone. Further research is 
      required to determine the most effective treatment in pediatric TEN.
CI  - (c) 2020 the International Society of Dermatology.
FAU - Williams, Vijai
AU  - Williams V
AD  - Division of Pediatric Critical Care, Department of Pediatrics, Advanced 
      Pediatrics Centre, Postgraduate Institute of Medical Education and Research 
      (PGIMER), Chandigarh, India.
FAU - Reddy, Mounika
AU  - Reddy M
AD  - Division of Pediatric Critical Care, Department of Pediatrics, Advanced 
      Pediatrics Centre, Postgraduate Institute of Medical Education and Research 
      (PGIMER), Chandigarh, India.
FAU - Bansal, Arun
AU  - Bansal A
AUID- ORCID: 0000-0001-6212-6889
AD  - Division of Pediatric Critical Care, Department of Pediatrics, Advanced 
      Pediatrics Centre, Postgraduate Institute of Medical Education and Research 
      (PGIMER), Chandigarh, India.
FAU - Baranwal, Arun K
AU  - Baranwal AK
AD  - Division of Pediatric Critical Care, Department of Pediatrics, Advanced 
      Pediatrics Centre, Postgraduate Institute of Medical Education and Research 
      (PGIMER), Chandigarh, India.
FAU - Nallasamy, Karthi
AU  - Nallasamy K
AD  - Division of Pediatric Critical Care, Department of Pediatrics, Advanced 
      Pediatrics Centre, Postgraduate Institute of Medical Education and Research 
      (PGIMER), Chandigarh, India.
FAU - Angurana, Suresh K
AU  - Angurana SK
AD  - Division of Pediatric Critical Care, Department of Pediatrics, Advanced 
      Pediatrics Centre, Postgraduate Institute of Medical Education and Research 
      (PGIMER), Chandigarh, India.
FAU - Handa, Sanjeev
AU  - Handa S
AD  - Department of Dermatology, Venereology and Leprology, Postgraduate Institute of 
      Medical Education and Research (PGIMER), Chandigarh, India.
FAU - Ram, Jagat
AU  - Ram J
AD  - Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of 
      Medical Education and Research (PGIMER), Chandigarh, India.
FAU - Jayashree, Muralidharan
AU  - Jayashree M
AD  - Division of Pediatric Critical Care, Department of Pediatrics, Advanced 
      Pediatrics Centre, Postgraduate Institute of Medical Education and Research 
      (PGIMER), Chandigarh, India.
FAU - Singhi, Sunit
AU  - Singhi S
AD  - Pediatrics, Medanta, The Medicity, Gurugram, NCR, India.
LA  - eng
PT  - Journal Article
DEP - 20200720
PL  - England
TA  - Int J Dermatol
JT  - International journal of dermatology
JID - 0243704
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunologic Factors)
RN  - 0 (Steroids)
RN  - 7S5I7G3JQL (Dexamethasone)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - IM
MH  - Anti-Inflammatory Agents/therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - Conservative Treatment
MH  - *Critical Care
MH  - Dexamethasone/therapeutic use
MH  - Eye Diseases/etiology
MH  - Female
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Immunologic Factors/therapeutic use
MH  - Immunomodulation
MH  - Infant
MH  - Intensive Care Units, Pediatric
MH  - Length of Stay
MH  - Male
MH  - Methylprednisolone/therapeutic use
MH  - Respiratory Insufficiency/etiology
MH  - Retrospective Studies
MH  - Sepsis/microbiology
MH  - Severity of Illness Index
MH  - Steroids/therapeutic use
MH  - Stevens-Johnson Syndrome/complications/mortality/*therapy
MH  - Survival Rate
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2020/07/21 06:00
MHDA- 2021/01/06 06:00
CRDT- 2020/07/21 06:00
PHST- 2019/11/29 00:00 [received]
PHST- 2020/05/28 00:00 [revised]
PHST- 2020/06/17 00:00 [accepted]
PHST- 2020/07/21 06:00 [pubmed]
PHST- 2021/01/06 06:00 [medline]
PHST- 2020/07/21 06:00 [entrez]
AID - 10.1111/ijd.15054 [doi]
PST - ppublish
SO  - Int J Dermatol. 2021 Jan;60(1):44-52. doi: 10.1111/ijd.15054. Epub 2020 Jul 20.