Impact of drug exposure on neonates requiring ECMO: A retrospective cohort study.

The incidence of drug exposure (IUDE) and neonatal extracorporeal membrane oxygenation (ECMO) utilization have both increased over the past decade. However, there are no studies to date that examine the impact that IUDE has on neonates requiring ECMO. In this retrospective cohort study, we compared the clinic course and outcomes of neonates who were placed on ECMO with IUDE vs.

Case series of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy during extracorporeal life support.

Therapeutic hypothermia initiated within 6 hours of birth is currently the standard of care for the management of neonates with hypoxic-ischemic encephalopathy. Neonates undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy are also at risk for severe respiratory failure and need for extracorporeal life support. The risks and benefits of therapeutic hypothermia for hypoxic-ischemic encephalopathy during extracorporeal life support are still not well defined.

Hollow Fiber Oxygenator Composition Has a Significant Impact on Failure Rates in Neonates on Extracorporeal Membrane Oxygenation: A Retrospective Analysis.

In extracorporeal life support (ECLS), there are two main types of oxygenators in clinical use for neonates: polymethylpentene (PMP) hollow fiber and polypropylene (PP) hollow fiber. A retrospective study was performed on neonates (  = 44) who had undergone ECLS for noncardiac indications from 2009 to 2015. Between the two groups (PMP  = 21, PP  = 23), the PP oxygenators failed 91% of the time, whereas the PMP oxygenators failed 43% of the time (  < 0.

Elevated high-sensitivity C-reactive protein in preterm infants with pulmonary colonization with Ureaplasma.

Background: A link between pulmonary Ureaplasma spp. colonization in premature infants and bronchopulmonary dysplasia (BPD) exists and could possibly contribute to systemic inflammation.

Methods: A prospective cohort study was performed from July 2006 to July 2007 where very low birth weight (VLBW) premature infants were screened at birth.

Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry.

Background/purpose: There are few studies comparing venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) in pediatric noncardiac sepsis patients.

Methods: Following approval, we reviewed the Extracorporeal Life Support Organization registry data from 1990 to 2008 for patients 0 to 18 years with a diagnosis of sepsis and without diagnosis of congenital heart disease. Survival to discharge was compared between VA and VV ECMO using χ(2) analysis and multivariable logistic regression.

Ambulatory venovenous extracorporeal respiratory support as a bridge for cystic fibrosis patients to emergent lung transplantation.

Venovenous extracorporeal membrane oxygenation (VV ECMO) is a therapeutic option to bridge patients with advanced lung disease to lung transplantation. The use of VV ECMO avoids the use of mechanical ventilation while allowing patients to participate in physical therapy and to eat normally while receiving respiratory support. We describe the successful use of ambulatory single-venous VV ECMO as a bridge to bilateral lung transplantation in 4 patients with end-stage lung disease due to cystic fibrosis who developed acute hypercapnic respiratory failure.

Pulmonary function outcomes in bronchopulmonary dysplasia through childhood and into adulthood: implications for primary care.

Bronchopulmonary dysplasia (BPD) results from prematurity and surfactant deficiency with contributing factors from barotrauma, volutrauma, and oxygen toxicity from supportive mechanical ventilation care and infection. These factors result in chronic inflammation with recurring cycles of lung damage and repair that impair alveolarisation and vascularisation in developing infant lungs. With advancement in the understanding of its pathophysiology and resulting therapy, BPD has evolved into a different disorder which has been coined the 'new' BPD.

Use of azithromycin for the prevention of bronchopulmonary dysplasia in preterm infants: a randomized, double-blind, placebo controlled trial.

Objective: Since preventive therapies for bronchopulmonary dysplasia (BPD) are limited we treated preterm infants with azithromycin to decrease the incidence of BPD.

Methods: Infants less than 1,250 g birth weight were randomized to azithromycin or placebo within 12 hr of beginning mechanical ventilation and within 72 hr of birth. The treatment group received azithromycin 10 mg/kg/day for 7 days followed by 5 mg/kg/day for a maximum of 6 weeks.

Acyclovir use in sick infants.

Background: Infantile herpes simplex virus encephalitis (HSVE) infection remains a significant cause of morbidity and mortality. Diagnosis is often difficult in this population, where a specific pattern of clinical and laboratory signs are lacking. This often results in unnecessary treatment of infants with empiric acyclovir.

Frequent ventricular premature beats in children with a structurally normal heart: a cause for reversible left ventricular dysfunction?

Ventricular premature beats (VPBs) in a structurally normal heart generally are a benign condition. Rarely, however, reversible cardiomyopathy may develop. This study aimed to evaluate the incidence of cardiomyopathy among pediatric patients in a cohort with frequent VPBs and to examine the characteristics of the ventricular ectopic beats as well as therapeutic options.

Inhaled morphine for palliation of dyspnea in end-stage cystic fibrosis.

Purpose: The successful use of inhaled morphine to relieve dyspnea in a patient with end-stage cystic fibrosis (CF) lung disease is described.

Summary: A 48-year-old man with CF was hospitalized for a pulmonary exacerbation caused by infection with Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). His medical history included long-standing depression, chronic pain, spinal stenosis, benign prostatic hypertrophy, iron-deficiency anemia, and colectomy.

Epistaxis due to Wegener's granulomatosis in a pediatric patient.

Epistaxis is a common problem in children that typically is not severe and seldom requires hospitalization. The nose is a highly vascular structure with a large surface area; subsequently, it is highly predisposed to bleeding. Childhood vasculitides are very rare and are commonly diagnosed by characteristic lesions on imaging studies along with syndrome recognition by clinicians.

Varicose bronchiectasis and bronchopulmonary dysplasia.

As a result of improved therapies and technology, including the use of surfactant replacement, the features of bronchopulmonary dysplasia (BPD) have changed, and a "new BPD" is emerging that is substantially different from the classical form of the disease. As the pathogenesis of BPD is evolving, so are other features of the disorder, including radiologic features. We describe varicose bronchiectasis with a bulbous appearance in a 6-year-old child with a complicated course including BPD during the neonatal period.

Pathogenesis of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) refers to a heterogeneous group of lung disorders in infants that is commonly associated with prematurity and surfactant deficiency. BPD results from the complex interplay between impairments in the premature lung such as surfactant deficiency, perinatal insults such as infection, and damage resulting from supportive care of the infant due to barotrauma or volutrauma from mechanical ventilation and oxygen toxicity from supplemental oxygen administration. These factors result in chronic inflammation in the infant lung with recurring cycles of lung damage and repair that may impair alveolarization and vascularization in the developing lungs.

Variability of ASA physical status class assignment among pediatric sedation practitioners.

Our goal was to determine the consistency of the Society of Anesthesiologists Physical Status (ASA-PS) Classification Scale with respect to different training, experience, and activity levels. A questionnaire comprised of 10 pediatric sedation scenarios was distributed via electronic mailing lists. Data were collected on training, experience, annual sedations performed, and ASA-PS score assigned.

Novel animal model for teaching chest tube placement.

Background: The number of procedures available to pediatric residency trainees is few in number and patient size leaves little margin for error. Artificial simulation labs have not been developed for neonatal chest tubes. Use of live animal models is coming under increased scrutiny and is expensive.

Diabetic HDL-associated myristic acid inhibits acetylcholine-induced nitric oxide generation by preventing the association of endothelial nitric oxide synthase with calmodulin.

In the current study, we examined whether diabetes affected the ability of HDL to stimulate nitric oxide (NO) production. Using HDL isolated from both diabetic humans and diabetic mouse models, we found that female HDL no longer induced NO synthesis, despite containing equivalent amounts of estrogen as nondiabetic controls. Furthermore, HDL isolated from diabetic females and males prevented acetylcholine-induced stimulation of NO generation.

Azithromycin protects against hyperoxic lung injury in neonatal rats.

Bronchopulmonary dysplasia (BPD) is a pulmonary disorder that causes significant morbidity and mortality in premature infants. BPD is pathologically characterized by inflammation, fibrosis, and mucosal necrosis, which leads to emphysematous coalescence of alveoli. We tested the hypothesis that azithromycin, a macrolide antibiotic, would decrease the severity of lung injury in an animal model of BPD.

Azithromycin in the extremely low birth weight infant for the prevention of bronchopulmonary dysplasia: a pilot study.

Background: Azithromycin reduces the severity of illness in patients with inflammatory lung disease such as cystic fibrosis and diffuse panbronchiolitis. Bronchopulmonary dysplasia (BPD) is a pulmonary disorder which causes significant morbidity and mortality in premature infants. BPD is pathologically characterized by inflammation, fibrosis and impaired alveolar development.

Neonatal research and the validity of informed consent obtained in the perinatal period.

Background: Consent for participation in clinical research is considered valid if it is informed, understood, and voluntary. In the case of minors, parents give permission for their child to participate in research studies after being presented with all information needed to make an informed decision. Although informed consent is a vital component of clinical research, there is little information evaluating its validity in neonatal intensive-care populations.