Acute kidney failure: a pediatric experience over 20 years.

Background: Acute kidney failure in children is a catastrophic, life-threatening event.

Objective: To compare and contrast 2 decades of data, analyzing the underlying causes, associated multiple organ system failures, outcome of dialysis procedures, and other variables of interest.

Design: Retrospective examination of clinical data collected between January 1, 1979, and December 31, 1998.

Pediatric organ donation: impact of medical examiner refusal.

Objectives: To examine the national Pediatric Intensive Care Unit (PICU) experience regarding Medical Examiner (ME) refusal of organ procurement from potential donors. To review our experience regarding PICU mortalities, organ donation, and impact of the ME on the organ donation process.

Design: National survey of PICU directors requesting demographics, type of ME system, perceptions of ME responsiveness to organ donation, and data regarding potential donors and their outcomes.

Methemoglobin levels during prolonged combined nitroglycerin and sodium nitroprusside infusions in infants after cardiac surgery.

Nitroglycerin (NTG) and sodium nitroprusside (SNP) are routinely used perioperatively in infants with congenital heart defects. In this study, NTG and SNP were infused in the operating room to increase venous capacitance, reduce systemic and pulmonary afterload, facilitate weaning off cardiopulmonary bypass, stabilize hemodynamics for transport to the intensive care unit (ICU), and reduce the fluid resuscitation needed upon arrival in the ICU. Because of the risk for accumulation of methemoglobin (MetHb) and cyanmethemoglobin (cyan-MetHb) during prolonged continuous infusion of NTG and SNP, it was decided to (1) quantify ICU use, (2) measure % MetHb at 12-hour intervals, and (3) look indirectly for the accumulation of cyan-MetHb by comparing simultaneous pulse oximetry (SpO2) (Nellcor N-100 [Nellcor, Haywood, CO]) and CO-oximetry (SaO2) (Corning 270 [Corning, Medfield, MA]).

Atlantooccipital subluxation in a neonate with Down's syndrome. Case report and review of the literature.

Atlantooccipital subluxation (AOS) occurs in up to 63% of patients with Down's syndrome. However, presenting symptoms and the age at which preoperative screening becomes necessary have not been clearly delineated. Recently, a 16-day-old female with Down's syndrome and AOS presented to our institution.