Pulmonary Hypertension and Necrotizing Enterocolitis in Neonates Treated with Diazoxide.

OBJECTIVE: This study aimed to evaluate the prevalence of adverse outcomes, specifically pulmonary hypertension (PH) and suspected or confirmed necrotizing enterocolitis (NEC), and their associated risk factors, in neonates treated with diazoxide. STUDY DESIGN: A retrospective study in infants born ≥ 316/7 weeks and admitted between January 2014 and June 2020. Combined adverse outcomes possibly associated to diazoxide were PH (systolic pulmonary pressure of ≥40 mm Hg or an eccentricity index ≥1.3) and suspected or confirmed NEC (suspected: stop feeds and antibiotics and confirmed: modified Bell stage ≥2). Echocardiography data extractors were masked to infants' characteristics. RESULTS: A total of 63 infants were included; 7 (11%) with suspected and 1 (2%) with confirmed NEC. Of the 36 infants with an available echocardiography after initiation of diazoxide treatment, 12 (33%) had PH. All infants with suspected or confirmed NEC were males (p = 0.01), whereas PH occurred mostly in females (75%, p = 0.02). The combined adverse outcome occurred in 14/26 (54%) infants exposed to >10 mg/kg/day, compared to 6/37 (16%) exposed to ≤10 mg/kg/day (p = 0.006). This association remained significant after adjustment for sex, small for gestational age status, and gestational age at birth (odds ratio: 6.1, 95% confidence interval: 1.7-21.7, p = 0.005). Left ventricular dysfunction was found in 19 infants (30%) but was not discriminative for the combined outcome. CONCLUSION: PH and suspected or confirmed NEC were identified frequently in neonates treated with diazoxide. A total dose >10 mg/kg/day was associated with an increased occurrence of these complications. KEY POINTS: · PH and suspected or confirmed NEC were frequently found in neonates treated with diazoxide.. · A total dose >10 mg/kg/day was associated with an increased occurrence of these complications.. · Echocardiography screening should be considered in neonates exposed to diazoxide..

The impact of a lipid injectable emulsion (SMOF) on conjugated bilirubin levels in children receiving prolonged parenteral nutrition: A large single center experience.

BACKGROUND: The SMOFlipid is a composite emulsion that has showed benefits, but limited data is available on children receiving prolonged parenteral nutrition (PN). This study aimed to compare conjugated bilirubin (CB) levels at the end of ILE administration in this population. METHODS: Medical charts of all infants treated with Intralipid (Jan 2012-Sep 2013) or SMOFlipid (Oct 2013-Dec 2016) were reviewed. Only infants that received PN for ≥28 consecutive days were included. Laboratory data were extracted from the closest day of initiation and discontinuation of the ILE (±7 days). For the primary objective, an analysis of covariance was employed, adjusting for initial CB values and total days of ILE administration. CB values were log-transformed to normalize distribution. Statistical tests were two-sided and performed at the significance level <0.05. RESULTS: A total of 150 infants were included: 72 used Intralipid for 82 times and 88 received SMOFlipid in 92 occasions. The incidence of cholestasis was 20% (Intralipid) and 4.5% (SMOFlipid). Infants treated with SMOFlipid had significantly lower CB levels at the end of ILE administration with geometric mean ratio between groups of 1.7 (95% CI:1.0, 2.8; p < 0.05). CONCLUSION: In a large and heterogenous group of infants receiving PN for ≥28 consecutive days the final levels of CB were significantly lower with SMOFlipid when compared to Intralipid suggesting a protective role of this type of ILE in this high-risk population. CLINICAL RELEVANCY STATEMENT: SMOFlipid is an emulsion that has showed benefits, but limited data is available on children receiving prolonged parenteral nutrition (PN). This study compared conjugated bilirubin (CB) levels at the end of ILE administration in infants that received PN for ≥28 consecutive days with either SMOFlipid or Intralipid. In a large number of patients with several gastrointestinal diseases lower CB levels were observed with the use of SMOFlipid with geometric mean ratio between groups of 1.7 (95% CI:1.0, 2.8; p < 0.05). Our results demonstrate a protective role of this type of ILE in this high-risk population.

Assessment of Surgical Antibiotic Prophylaxis Compliance in Pediatrics: A Pre-post Quasi-experimental Study.

OBJECTIVE: Data from rigorous evaluations of the impact of interventions on improving surgical antibiotic prophylaxis (SAP) compliance in pediatrics are lacking. Our objective was to assess the impact of a multifaceted intervention on improving pediatric SAP compliance in a hospital without an ongoing antimicrobial stewardship program. STUDY DESIGN: A multidisciplinary team at the Montreal Children's Hospital performed a series of interventions designed to improve pediatric SAP compliance in June 2015. A retrospective, quasi-experimental study was performed to assess SAP compliance before and following the interventions. Our study included patients under 18 years old undergoing surgery between April and September in 2013 (preintervention) and in 2016 (postintervention). A 10-week washout period was included to rigorously assess the persistence of compliance without ongoing interventions. SAP, when indicated, was qualified as noncompliant, partially compliant (adequate agent and timing) or totally compliant (adequate agent, dose, timing, readministration, duration). RESULTS: A total of 982 surgical cases requiring SAP were included in our primary analysis. The composite partial and total compliance increased from 51.4% to 55.8% [adjusted odds ratio 1.3; 95% confidence interval: 1.0-1.8; P = 0.06]. Although improvements in correct dose and readministration were significant, there was no significant improvement in correct timing, agent selection or duration. CONCLUSION: Our study demonstrated that overall SAP compliance did not significantly improve following a washout period, illustrating the importance of ongoing surveillance and feedback from an antimicrobial stewardship program. Our strict approach in evaluating the timing criterion may also explain the lack of a significant impact on SAP compliance.