Left ventricular dysfunction in the immediate post-natal period.

Background: Our objective was to examine the clinical presentation, echocardiographic findings, and outcomes of newborns presenting with left ventricle (LV) dysfunction in the first 48 hours of life without perinatal asphyxia or structural heart disease. We hypothesize that LV dysfunction may occur due to maladaptation to extrauterine life. Methods: This is a retrospective cohort analysis including infants born in a quaternary perinatal centre. Late preterm and term neonates who were diagnosed with left ventricular dysfunction at less than 48 hours of life were identified using an echocardiography clinical laboratory's database and extracorporeal life support database. LV dysfunction was defined as m-mode fractional shortening (FS) <28% or ejection fraction (EF) <50% on echocardiography or reduced function reported by a cardiologist. Data extracted included patient & maternal demographics, echocardiogram parameters, clinical status, and medications. The primary outcome measure was time to recovery of LV function based on echocardiography. Results: Of the 69 patients identified, 19 patients were included in the final analysis. The mean gestational age was 38 weeks. Thirteen (68%) infants did not have an underlying cause identified despite extensive work-up. Four (21%) infants had exposure to maternal illicit drug use during pregnancy. Three infants died, and all infants without identifiable etiologies had recovery of LV function within 14 days of life. Conclusions: LV dysfunction can occur during the abrupt transition from fetal to neonatal circulation and can be associated with maternal illicit drug use.

Variability in the Follow-up Management of Pediatric Femoral Fractures.

INTRODUCTION: Variability in follow-up has previously been identified in orthopaedic trauma. Variability in follow-up for pediatric femur fractures has not previously been documented. The aim of this study was to document the variability in clinical and radiographic follow-up for pediatric femur fractures based on the fixation method and the treating surgeon. METHODS: This retrospective case series identified isolated femoral fractures in patients younger than 18 years, treated by eight surgeons at a single center from 2010 to 2015. The total number and frequency of clinical visits, radiographic visits and discrete radiograph views, demographic data, fracture classification, treatment method, and presence of complications were extracted. Variability in follow-up was assessed through descriptive statistics and linear and Poisson regression models. RESULTS: One hundred sixty-four femoral fractures in 160 patients were included. Fractures were stratified by the treating surgeon. The mean length of follow-up ranged from 6.5 to 13.6 months. Complications increased follow-up time by mean 1.7 months (1.3 to 2.4). Patients who were treated with rigid locking nails were followed for the shortest amount of time, averaging 9.9 months, while traction followed by rigid locking nails averaged 24.4 (0.5 to 9.3) months of follow-up. DISCUSSION: Variation in the length of follow-up was identified and was associated with the fixation method and the treating surgeon. Few patients were followed long enough to definitively identify complications and sequelae known to occur after femur fractures such as femoral overgrowth or growth arrest. The results of this study indicate a need for additional study and consensus on an appropriate follow-up for pediatric femur fractures.

A Survey of Immunization Practices in Patients With Congenital Heart Disease.

Background: Congenital heart disease, the most common congenital anomaly, often presents in neonates. Because of perceived risks, health care providers may consider deferring immunizations in this population. We sought to understand the perceived risk of immunizations in those providing health care to children with particular heart conditions. Methods: A survey, which included 6 hypothetical scenarios assessing immunization recommendations, was distributed internationally to relevant health care providers, and responses were compared between the different scenarios. Results: Majority of responses (n = 142) were from paediatric cardiologists (n = 98; 69%) and nurse practitioners (n = 27; 19%) located in the United States (n = 77; 54%) or Canada (n = 53; 37%) working in academic teaching hospitals (n = 133; 93.7%). Most favoured vaccinations (n = 107; 75.4%) and less likely to proceed with the first immunization in infants with structural heart disease compared with channelopathy (risk ratio: 0.80, confidence interval: 0.73-0.87; P < 0.001). Only 40% would proceed with immunization as normal in an infant with manifest Brugada type I electrocardiogram. Special precautions after the immunization included longer duration of observation (19%) and administering prophylactic antipyretic medication (92%). Conclusions: Respondents were 20% more likely to defer immunizations in the presence of treatable structural heart disease as compared with channelopathy despite the lack of evidence supporting deferring immunizations in children with structural heart disease. Most were cautious in their response to the scenario involving Brugada syndrome, indicating awareness of the risk of haemodynamic instability in the event of a fever. The majority of respondents still strongly recommend immunizations in this population as the benefits outweigh the potential for adverse events.

Contexte: La cardiopathie congénitale ­ l'anomalie congénitale la plus courante ­ est souvent observée chez les nouveau-nés. En raison des risques perçus, les dispensateurs de soins de santé peuvent parfois envisager de reporter la vaccination chez ces patients. Notre but était de comprendre le risque perçu à l'égard de la vaccination par les dispensateurs de soins de santé traitant des enfants atteints de certaines cardiopathies. Méthodologie: Un sondage comprenant six scénarios hypothétiques visant à évaluer les recommandations de vaccination a été distribué à des dispensateurs de soins de santé pertinents dans différents pays, et leurs réponses pour les différents scénarios ont été comparées. Résultats: La majorité des répondants (n = 142) étaient des cardiologues pédiatriques (n = 98; 69 %) ou des infirmières praticiennes (n = 27; 19 %) des États-Unis (n = 77; 54 %) ou du Canada (n = 53; 37 %) travaillant dans des hôpitaux universitaires (n = 133; 93,7 %). La plupart d'entre eux étaient en faveur de la vaccination (n = 107; 75,4 %), bien que moins enclins à administrer un premier vaccin à des nourrissons présentant une cardiopathie structurelle comparativement à une canalopathie (rapport des risques : 0,80, intervalle de confiance : 0,73-0,87; p < 0,001). Or, seulement 40 % d'entre eux vaccineraient de façon normale un nourrisson présentant un syndrome de Brugada de type 1 à l'ECG. Les précautions particulières prises après la vaccination comprenaient une période d'observation plus longue (19 %) et l'administration d'un antipyrétique à des fins prophylactiques (92 %). Conclusions: À la lumière des réponses obtenues, la probabilité de report de la vaccination était 20 % plus élevée en présence d'une cardiopathie structurelle traitable comparativement à une canalopathie, malgré le manque de données probantes justifiant ce report chez les enfants atteints d'une cardiopathie structurelle. La plupart des répondants ont répondu de façon prudente au scénario du syndrome de Brugada en évoquant un risque d'instabilité hémodynamique en cas de fièvre. La majorité d'entre eux recommandent quand même fortement la vaccination chez ces patients, car les bienfaits escomptés l'emportent sur les risques d'effets indésirables.