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1.
Emerg Radiol ; 27(2): 185-190, 2020 Apr.
Article in English | MEDLINE | ID: mdl-31820269

ABSTRACT

PURPOSE: To retrospectively compare the accuracy of interpretation of initial cervical computerized tomography (CCT) by a non-pediatric radiologist (NPR) versus a pediatric radiologist (PR). METHODS: IRB approval and consent waiver were granted to review all injured children from 2010 to 2014 in the trauma registry with CT and magnetic resonance imaging (MRI) of the cervical spine. Patients with negative CCT who subsequently had positive MRI from a single institution comprised the study group. Patients with negative CCT and MRI, matched by age, gender, and severity scores, comprised the control group. The CCTs from both groups were initially interpreted at the time of service by a NPR. Subsequently, a single PR with 20 years of experience blinded to clinical/imaging data reinterpreted these CCT examinations. CT interpretations were then compared with MRI results and evaluated for statistical significance using SSPS software. The data analysis utilized summary statistics, two-tailed binomial test, and univariate χ2 test. Significance for all comparisons was assessed at P < 0.05. RESULTS: The study group was comprised of the 21 patients with negative CCT and positive MRI. Of the cohort included, 76% (16) were male and 24% (5) were female. The age range was 1 month-17 years, with a mean age of 9.7 years. CCT interpretation by NPR had a specificity of 91.7% (sensitivity 71.2%, positive predictive value 81.3%, and negative predictive value 86.3%) compared with results of MRI. Six of the 21 negative CCTs were interpreted by the PR as positive, mainly craniocervical junction injuries, and confirmed by MRI (28.6%, P < .001 compared with the NPR); no control CCT was interpreted by the PR as positive (sensitivity 100%, positive predictive value 100%, and negative predictive value 58.3%). CONCLUSION: In our retrospective study, a pediatric radiologist has improved recognition of pediatric cervical spine injuries on CT compared with non-pediatric radiologist.


Subject(s)
Cervical Vertebrae/injuries , Clinical Competence , Magnetic Resonance Imaging/methods , Spinal Injuries/diagnostic imaging , Tomography, X-Ray Computed/methods , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Injury Severity Score , Male , Pediatricians/standards , Predictive Value of Tests , Radiologists/standards , Registries , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity
2.
Curr Cardiol Rev ; 14(2): 121-127, 2018.
Article in English | MEDLINE | ID: mdl-29485000

ABSTRACT

BACKGROUND: To develop an understanding of current practices in the management of transient secondary hypothyroidism in pediatric postoperative cardiopulmonary bypass (CPB) patients. METHODS: Electronic survey comprising a 10-item questionnaire was sent to sixty-four high volume pediatric heart centers in the United States and United Kingdom. Survey participants included cardiologists, intensivists, cardiothoracic surgeons, and advanced practice providers. A retrospective chart review was also performed at a large regional referral center in the Midwest on subjects 0-18 years old who underwent CPB from 2005-2015. Information obtained included a unique identifier, date of birth, age, procedure performed, CPB time, date of surgery and date and type of Thyroid Function Test (TFT) ordered. RESULTS: 1,153 individuals from 64 congenital heart centers were contacted via email to participate in the electronic survey. In the 3-month response window, 129 completed surveys were received from cardiologists (55%), intensivists (17%), surgeons (15%), "other" (8%), and advanced practice providers (5%). This yielded a response rate of 11.2%. Of the 129 respondents, only 10 providers routinely order TFTs prior to (n=7) and after (n=1) CPB or when clinically indicated (n=2). All 10 providers order thyroid stimulating hormone test, 7 order thyroxine, and 3 order triiodothyronine. Only 1 provider routinely treats children with prophylactic thyroid hormone replacement therapy after CPB. Our retrospective review included 502 CPB events with 442 unique patients. Of the events, 20 patients received preoperative TFT testing while 11 received postoperative testing. CONCLUSIONS: There is a general lack of uniformity in the evaluation, diagnosis, and treatment of transient secondary hypothyroidism in pediatric postoperative CPB patients.


Subject(s)
Cardiopulmonary Bypass/methods , Hormone Replacement Therapy/methods , Hypothyroidism/etiology , Thyrotropin/therapeutic use , Child , Cross-Sectional Studies , Female , Humans , Hypothyroidism/pathology , Male , Postoperative Period , Thyrotropin/pharmacology
4.
Pediatr Nephrol ; 30(8): 1343-8, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25750075

ABSTRACT

BACKGROUND: Left ventricular (LV) systolic dysfunction is a relatively uncommon but serious complication of pediatric chronic kidney disease, and may be related to uremia and uncontrolled hypertension. There is limited information on the strategy for managing these children. In some cases, combined heart-kidney transplant may be considered or kidney transplant delayed until cardiac function improves. It is unknown whether these patients are at increased risk for poor outcomes after kidney transplantation. METHODS: We conducted a retrospective, multicenter study on the outcomes of children with severe and symptomatic cardiomyopathy who underwent kidney transplantation. RESULTS: Eleven patients receiving maintenance dialysis with systolic dysfunction underwent kidney transplantation without simultaneous heart transplant. Nine patients had congestive heart failure in the pre-transplant period. There were no identified complications post-transplant related to the underlying cardiac dysfunction. LV systolic function normalized in all patients and the mean shortening fraction increased from 19.0 ± 4.6 % to 32.0 ± 4.4 % (p < 0.0001). CONCLUSIONS: Kidney transplantation should be considered for children receiving maintenance dialysis with severe LV dysfunction.


Subject(s)
Kidney Transplantation/methods , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/surgery , Ventricular Dysfunction, Left/complications , Adolescent , Child , Child, Preschool , Female , Graft Survival , Humans , Male , Retrospective Studies
5.
J Pediatr Nurs ; 29(4): 354-61, 2014.
Article in English | MEDLINE | ID: mdl-24582649

ABSTRACT

Fecal microbiota transplantation (FMT) is an emerging experimental therapy for treatment of recurrent Clostridium difficile infection. In the future, FMT has the potential to be a treatment modality in other diseases that involve gut dysbiosis. As use of FMT is likely to expand, pediatric nurses need a clear understanding of FMT to provide appropriate education, assessment, and care for these patients. Pediatric research and clinical nurses are a resource to help children and parents understand the procedure. Important topics include donor screening, patient assessment before, during, and after treatment; routes of administration and positioning; preparation for discharge and followup evaluation.


Subject(s)
Clostridium Infections/therapy , Fecal Microbiota Transplantation/methods , Patient Education as Topic , Pediatric Nursing/education , Adolescent , Child , Child, Preschool , Clostridium Infections/diagnosis , Education, Nursing, Continuing/methods , Fecal Microbiota Transplantation/nursing , Female , Humans , Male , Nurse's Role , Nursing Assessment , Patient Positioning , Quality Control , Recurrence , Risk Assessment , Therapies, Investigational , Young Adult
6.
J Pediatr Gastroenterol Nutr ; 56(6): 597-601, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23542823

ABSTRACT

BACKGROUND AND OBJECTIVE: Colonic dysbiosis contributes to the development of colonic inflammation in ulcerative colitis (UC). Fecal microbial transplantation (FMT) is being proposed as a novel treatment for UC because it can eliminate dysbiosis; however, no prospective data exist. We initiated a pilot study to evaluate feasibility and safety of FMT in children with UC. METHODS: Ten children, 7 to 21 years of age, with mild-to-moderate UC (pediatric UC activity index [PUCAI] between 15 and 65) received freshly prepared fecal enemas daily for 5 days. Data on tolerability, adverse events, and disease activity were collected during FMT and weekly for 4 weeks after FMT. Clinical response was defined as decrease in PUCAI by >15, and decrease in PUCAI to <10 was considered clinical remission. RESULTS: No serious adverse events were noted. Mild (cramping, fullness, flatulence, bloating, diarrhea, and blood in stool) to moderate (fever) adverse events were self-limiting. One subject could not retain fecal enemas. Average tolerated enema volume by remaining 9 subjects was 165 mL/day. After FMT, 7 of the 9 (78%) subjects showed clinical response within 1 week, 6 of the 9 (67%) subjects maintained clinical response at 1 month, and 3 of the 9 (33%) subjects achieved clinical remission at 1 week after FMT. Median PUCAI significantly improved after FMT (P = 0.03) compared with the baseline. CONCLUSIONS: Fecal enemas were feasible and tolerated by children with UC. Adverse events were acceptable, self-limiting, and manageable by subjects. FMT indicated efficacy in the treatment of UC.


Subject(s)
Biological Therapy , Colitis, Ulcerative/therapy , Dysbiosis/prevention & control , Feces/microbiology , Therapies, Investigational , Administration, Rectal , Adolescent , Adult , Biological Therapy/adverse effects , Child , Colitis, Ulcerative/microbiology , Colitis, Ulcerative/physiopathology , Donor Selection , Dysbiosis/etiology , Family , Feasibility Studies , Female , Follow-Up Studies , Hospitals, Pediatric , Humans , Male , Michigan , Outpatient Clinics, Hospital , Pilot Projects , Remission Induction , Severity of Illness Index , Therapies, Investigational/adverse effects , Young Adult
7.
Pediatr Radiol ; 40(9): 1505-8, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20217065

ABSTRACT

BACKGROUND: Low birth-weight infants are at risk for renal disease when renal insults occur in the neonatal period. Renal growth as measured by sonography over time is utilized by many nephrologists as predictors of future renal disease. OBJECTIVE: To identify infants at risk by defining normal renal growth for the very premature infant. MATERIALS AND METHODS: Renal growth was evaluated in 30 infants whose birth weight was 1,500 g or less and gestational age was <31 weeks. During a 2-month time period, three US measurements were taken (first week of life, age 28 days, and age 56 days or earlier if discharged). Infants were divided according to birth weight: the extremely low birth-weight group (ELBW) was <1,000 g (n = 14), and the very low birth-weight group (VLBW) was 1,000-1,500 g (n = 16). RESULTS: In both groups, the right and left renal lengths were similar. In the ELBW group, the initial mean length was 3.25 cm and grew to 4.16 cm, while the mean volume was 4.85 cm and grew to 10.39 cm. In the VLBW group the initial mean length was 3.69 cm and grew to 4.35 cm while the mean volume was 7.25 cm and grew to 11.83 cm. CONCLUSION: These data establish normal expected growth for future studies.


Subject(s)
Infant, Very Low Birth Weight , Kidney/diagnostic imaging , Kidney/growth & development , Female , Gestational Age , Humans , Infant, Extremely Low Birth Weight , Infant, Newborn , Infant, Premature , Male , Prospective Studies , Regression Analysis , Risk , Ultrasonography
8.
Pediatr Nephrol ; 22(7): 1062-5, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17277951

ABSTRACT

An infant with a suspected inborn metabolism error was treated with a metabolic cocktail of intravenous sodium phenylacetate (NaPh) and sodium benzoate (NaBz) for hyperammonemia. Sequential hemodialysis (HD) then hemofiltration (HF) was performed due to hyperammonemia. Dialytic and convective clearance (K; ml/min) of ammonia, NaPh, and NaBz was measured. The K of ammonia was 57 and 37 for HD and HF, respectively. The K of NaBz was 37 and 12 for HD and HF, respectively. The K of NaPh was 38 and 14 ml/min for HD and HF, respectively. Despite high clearance of both NaPh and NaBz by HD and HF, the hyperammonemia was corrected.


Subject(s)
Hemofiltration , Hyperammonemia/etiology , Hyperammonemia/therapy , Phenylacetates/pharmacokinetics , Renal Dialysis , Sodium Benzoate/pharmacokinetics , Ammonia/blood , Ammonia/pharmacokinetics , Humans , Infant, Newborn , Phenylacetates/adverse effects , Phenylacetates/blood , Phenylacetates/therapeutic use , Sodium Benzoate/adverse effects , Sodium Benzoate/blood , Sodium Benzoate/therapeutic use
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