Congenital Diaphragmatic Hernia Repair at the Bedside or Operating Theater.

Background: For critically ill congenital diaphragmatic hernia (CDH) patients on high frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and/or inhaled nitric oxide (iNO), operative repair in the neonatal intensive care unit (NICU) has been proposed to avoid complications during transport to an operating room (OR). This study compared neonates with CDH who received herniorrhaphy in the NICU or OR, with a subgroup analysis considering only patients supported with ECMO.

Methods: Patients admitted to the NICU in the first 2 weeks of life at a free-standing children's hospital between July 2004 and September 2021 were examined.

Extracorporeal Membrane Oxygenation Support for Pediatric Burn Patients: Is It Worth the Risk?

Objectives: Examine the outcomes of pediatric burn patients requiring extracorporeal membrane oxygenation to determine whether extracorporeal membrane oxygenation should be considered in this special population.

Design: Retrospective cohort study.

Setting: All extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization.

Endothelial-Dependent Vasomotor Dysfunction in Infants After Cardiopulmonary Bypass.

Objectives: Cardiopulmonary bypass-induced endothelial dysfunction has been inferred by changes in pulmonary vascular resistance, alterations in circulating biomarkers, and postoperative capillary leak. Endothelial-dependent vasomotor dysfunction of the systemic vasculature has never been quantified in this setting. The objective of the present study was to quantify acute effects of cardiopulmonary bypass on endothelial vasomotor control and attempt to correlate these effects with postoperative cytokines, tissue edema, and clinical outcomes in infants.

Rapid resolution of hyperammonemia in neonates using extracorporeal membrane oxygenation as a platform to drive hemodialysis.

Objective: We aimed to clarify the impact of extracorporeal membrane oxygenation (ECMO) as a platform to drive hemodialysis (HD) for ammonia clearance on outcomes of neonates with severe hyperammonemia.

Study Design: All neonates treated for hyperammonemia at a single children's hospital between 1992 and 2016 were identified. Patient characteristics and outcomes were compared between those receiving medical management or ECMO/HD.

Extracorporeal Cardiopulmonary Resuscitation Among Patients with Structurally Normal Hearts.

Extracorporeal cardiopulmonary resuscitation (eCPR) has been well described as a rescue therapy in refractory cardiac arrest among patients with congenital heart disease. The purpose of this retrospective analysis of data from the Extracorporeal Life Support Organization was to evaluate outcomes of eCPR in patients with structurally normal hearts and to identify risk factors that may contribute to mortality. During the study period, 1,431 patients met inclusion criteria.

Review of 1,000 consecutive extracorporeal membrane oxygenation runs as a quality initiative.

Background: Extracorporeal membrane oxygenation is a resource-intensive mode of life-support potentially applicable when conventional therapies fail. Given the initial success of extracorporeal membrane oxygenation to support neonates and infants in the 1980s, indications have expanded to include adolescents, adults, and selected moribund patients during cardiopulmonary resuscitation. This single-institution analysis was conducted to evaluate programmatic growth, outcomes, and risk for death despite extracorporeal membrane oxygenation across all ages and diseases.

Effect of a Clinical Practice Guideline for Pediatric Complicated Appendicitis.

Importance: Complicated appendicitis is a common condition in children that causes substantial morbidity. Significant variation in practice exists within and between centers. We observed highly variable practices within our hospital and hypothesized that a clinical practice guideline (CPG) would standardize care and be associated with improved patient outcomes.

Smart Multi-Frequency Bioelectrical Impedance Spectrometer for BIA and BIVA Applications.

Bioelectrical impedance analysis (BIA) is a noninvasive and commonly used method for the assessment of body composition including body water. We designed a small, portable and wireless multi-frequency impedance spectrometer based on the 12 bit impedance network analyzer AD5933 and a precision wide-band constant current source for tetrapolar whole body impedance measurements. The impedance spectrometer communicates via Bluetooth with mobile devices (smart phone or tablet computer) that provide user interface for patient management and data visualization.

Neonatal carotid repair at ECMO decannulation: patency rates and early neurologic outcomes.

Purpose: Neonates placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) undergo either carotid repair or ligation at decannulation. Study aims were to evaluate carotid patency rates after repair and to compare early neurologic outcomes between repaired and ligated patients.

Methods: A retrospective study of all neonates without congenital heart disease (CHD) who had VA-ECMO between 1989 and 2012 was completed using our institutional ECMO Registry.

The use of an extracorporeal membrane oxygenation anticoagulation laboratory protocol is associated with decreased blood product use, decreased hemorrhagic complications, and increased circuit life.

Objectives: To determine if a comprehensive extracorporeal membrane oxygenation anticoagulation monitoring protocol results in fewer hemorrhagic complications, reduced blood product usage, and increased circuit life.

Design: In September 2011, we augmented our standard extracorporeal membrane oxygenation laboratory protocol to include anti-factor Xa assays, thromboelastography, and antithrombin measurements. We performed a retrospective chart review to determine outcomes for patients placed on extracorporeal membrane oxygenation prior to and after the initiation of our anticoagulation laboratory protocol.

Proactive enteral tube feeding in pediatric patients undergoing chemotherapy.

Background: To determine feasibility and safety of proactive enteral tube feeding (ETF) in pediatric oncology patients.

Methods: Pediatric patients with newly diagnosed brain tumors, myeloid leukemia or high-risk solid tumors were eligible. Subjects agreeing to start ETF before cycle 2 chemotherapy were considered proactive participants (PPs).

Is preterm delivery indicated in fetuses with gastroschisis and antenatally detected bowel dilation?

Introduction: Due to the controversy surrounding diagnostic ultrasound evaluations and elective preterm delivery of fetuses with gastroschisis, we sought to calculate the predictive value of bowel dilation in fetuses with gastroschisis and evaluate the effect of preterm delivery on neonatal outcomes.

Materials And Methods: Ultrasounds and medical records of 103 mother-infant pairs with fetal gastroschisis were reviewed. Eighty-nine pairs met the criteria.

Central venous catheter placement at the time of extracorporeal membrane oxygenation decannulation: is it safe?

Purpose: Because of concerns for infectious and hemorrhagic complications, methods of obtaining central venous access after extracorporeal membrane oxygenation (ECMO) vary by institution. For infants requiring ECMO, it has been our practice to exchange the venous cannula for a tunneled central venous catheter (Broviac) at the time of decannulation. The purpose of this study is to compare the incidence of catheter-related complications in these patients to a national registry.

Laparoscopic repair of traumatic bowel injury in children.

Purpose: The aim of this study was to evaluate the laparoscopic repair of isolated intestinal injuries in children who sustain focal abdominal trauma.

Methods: A retrospective review was conducted of all patients 16 years and younger who required surgery for traumatic bowel injuries during a 5-year period at 2 university children's hospitals. The study population was composed of hemodynamically stable patients who sustained focal energy transfer to the abdomen and were diagnosed preoperatively with intestinal injury.

Hemorrhagic stress ulceration in a case of appendicitis.

Hemorrhage from stress ulceration in acutely ill children is seen in association with acute respiratory failure, coagulopathy and Pediatric Risk of Mortality Score of 10 or higher. We report an unusual association of clinically significant hemorrhagic stress ulcer with appendicitis in a pediatric patient.

Liver transplantation for childhood hepatic malignancy: a review of the United Network for Organ Sharing (UNOS) database.

Background: Orthotopic liver transplantation (OLT) is the only treatment option for unresectable hepatoblastoma (HB) and hepatocellular carcinoma (HCC) in children. Aggregated outcomes of OLT for these hepatic malignancies have not been evaluated in the United Network for Organ Sharing national database.

Purpose: The purpose of this study was to evaluate graft and patient survival in pediatric OLT recipients with HB and HCC.

Elective intestinal operations in infants and children without mechanical bowel preparation: a pilot study.

Background/purpose: Preoperative mechanical bowel preparation (MBP) for elective intestinal operations has been a long accepted practice. However, MBP is often unpleasant and time-consuming for patients, and clinical trials in adults have not shown improved outcomes. We conducted this pilot study to test whether omitting MBP before elective intestinal operations in infants and children would increase the risk of infectious or anastomotic complications.

Resuscitation of fat embolism syndrome with extracorporeal membrane oxygenation.

Embolization of marrow fat appears to be an inevitable consequence of long bone fractures. Pulmonary fat embolism (FE) with cardiovascular collapse is associated with a high mortality rate because of acute right ventricular failure and hypoxia. Immediate and appropriate resuscitation is required to prevent sudden death.

Congenital diaphragmatic hernia repair on extracorporeal life support: a decade of lessons learned.

Congenital diaphragmatic hernia (CDH) is a vexing anomaly that manifests with variable pulmonary compromise in neonates. More than one-third of neonates with CDH require extracorporeal membrane oxygenation (ECMO) for refractory pulmonary hypertension (PHN). To assess the outcome of neonates having CDH repair on ECMO, we reviewed our experience for babies treated between 1992 and 2003.