Outcomes of pediatric patients with therapy-related myeloid neoplasms.

Long-term outcomes after allogeneic hematopoietic cell transplantation (HCT) for therapy-related myeloid neoplasms (tMNs) are dismal. There are few multicenter studies defining prognostic factors in pediatric patients with tMNs. We have accumulated the largest cohort of pediatric patients who have undergone HCT for a tMN to perform a multivariate analysis defining factors predictive of long-term survival. Sixty-eight percent of the 401 patients underwent HCT using a myeloablative conditioning (MAC) regimen, but there were no statistically significant differences in the overall survival (OS), event-free survival (EFS), or cumulative incidence of relapse and non-relapse mortality based on the conditioning intensity. Among the recipients of MAC regimens, 38.4% of deaths were from treatment-related causes, especially acute graft versus host disease (GVHD) and end-organ failure, as compared to only 20.9% of deaths in the reduced-intensity conditioning (RIC) cohort. Exposure to total body irradiation (TBI) during conditioning and experiencing grade III/IV acute GVHD was associated with worse OS. In addition, a diagnosis of therapy-related myelodysplastic syndrome and having a structurally complex karyotype at tMN diagnosis were associated with worse EFS. Reduced-toxicity (but not reduced-intensity) regimens might help to decrease relapse while limiting mortality associated with TBI-based HCT conditioning in pediatric patients with tMNs.

"Don't put that in your mouth." A Discussion of Button Battery Ingestions in the Pediatric Population.

Ingestions are a problem that plagues the pediatric population and can at times be life threatening. Signs, symptoms, and interventions for button battery ingestion will be summarized for the reader. A case presentation from practice will be given to help enhance readers experience and learning.

Feasibility of continuous temperature monitoring in pediatric immunocompromised patients: A pilot study.

Early recognition of fever is paramount in reducing morbidity and mortality in immunocompromised patients. We performed a pilot study to determine the feasibility, safety, and tolerability of continuous temperature monitoring via TempTraq, a continuous temperature monitoring patch. Ten pediatric patients were enrolled and received continuous temperature monitoring over 5 days in addition to episodic monitor (standard of care). Episodic monitoring failed to detect fever in two patients and there was a significant delay (>12 h) of fever detection in two others that was detected with TempTraq. Additionally, caregivers reported TempTraq was tolerable and easy to apply.

Necessity of Intracranial Imaging in Infants and Children With Macrocephaly.

BACKGROUND: Macrocephaly is frequently encountered in pediatrics and often leads to imaging. There are no recommendations from the American Academy of Pediatrics or the American College of Radiology providing imaging guidelines for macrocephaly. The goal of this study is to identify risk factors for pathologic macrocephaly and to aid the clinician in identifying patients that would benefit from imaging. METHODS: We conducted a medical record review throughout a multistate health care system, Sanford Health, from January 1, 2012 to December 31, 2016. Patients with macrocephaly were identified by problem list in children aged less than 36 months. Data collection included basic demographics, imaging modality, developmental delay, prematurity, seizures, focal neurological symptoms, family history of macrocephaly, sedation used, and sedation complications. RESULTS: A total of 169 patients were included in the analysis. Imaging modalities included 39 magnetic resonance imagings (23.1%), 47 cranial computed tomographies (27.8%), and 83 head ultrasounds (49.1%). Imaging results demonstrated 13 abnormal studies with five of those studies being abnormal with high clinical yield. Patients with abnormal studies were more likely to have developmental delay (P = 0.04) or neurological symptoms (P = 0.015). Positive family history of macrocephaly was predictive of normal imaging (P = 0.004). There were no sedation complications. CONCLUSIONS: Intracranial imaging does not appear to be necessary in children with no risk factors and or a positive family history of macrocephaly. Risk factors such as developmental delay or neurological symptoms could identify children at risk for imaging abnormalities that require further management.

Implications of attachment theory and research for developmental-behavioral pediatrics.

This article presents a basic overview of attachment theory, concepts, and research. The review includes a discussion of the nature of the attachment relationship, its origins in human evolutionary history, and common misconceptions about attachment. We describe phases in the development of attachment relationships and review research on factors that influence attachment variations. We discuss the implications of variations in early attachment relationships for later development (adaptation and maladaptation). And finally, we review briefly the implications of attachment theory and research for pediatric practice. Some key points are that (1) virtually all infants become attached to caregivers regardless of quality of care; (2) attachment relationships evolve in phases over time; (3) children with disabilities form attachment relationships in ways comparable to nondisabled children but manifest attachment somewhat differently; (4) the consequences for attachment of out-of-home care, separations, and significant disruptions (e.g., adoption) depend on timing and circumstances; (5) many infant regulatory difficulties, as well as child behavior problems, originate in the caregiving relationship; and finally, (6) change in parent-child relationship disturbances is complex and requires time and effort.