Reframing morning report: Cognitive simulation in a safe space.

Background: Various purposes for morning report (MR), in addition to education, have been cited in the literature. Learners can find traditional MR challenging secondary to a perceived lack of psychological safety, the sense that they are being evaluated. Despite the recognition of unsafe learning environments, there is a paucity of literature on how to promote psychological safety in the MR setting.

Pediatric extracorporeal life support for refractory status asthmaticus: ELSO Registry trends from the past decade.

Background: Extracorporeal life support (ECLS) for status asthmaticus (SA) is rare. Increased safety and experience may increase utilization of ECLS for SA.

Methods: We reviewed pediatric (<18 years old) patients requiring ECLS for SA between 1998 and 2019 within the Extracorporeal Life Support Organization (ELSO) Registry and Nemours Children's Health (NCH) system.

Correction: Mycoplasma pneumoniae Associated Acute Transverse Myelitis: An Atypical Clinical Presentation in an Adolescent Child.

[This corrects the article DOI: 10.7759/cureus.17259.

Mycoplasma pneumoniae Associated Acute Transverse Myelitis: An Atypical Clinical Presentation in an Adolescent Child.

We report an atypical case of a 15-year-old pediatric patient diagnosed with Mycoplasma pneumoniaeassociated acute transverse myelitis (ATM). The patient had no prodromal or pulmonary symptoms that are commonly associated with mycoplasma infection. Yet, the patient exhibited acute bilateral lower extremity paralysis, paresthesia, decreased sensation at the level of T11 and below, bowel and bladder dysfunction, and thrombocytopenia.

Altered Mental Status and Respiratory Failure in an 11-Year-Old Female.

Congenital central hypoventilation syndrome (CCHS) is a rare disorder that results in profound hypoventilation that is most prominent during periods of sleep. Caused by a genetic mutation in the gene, CCHS typically presents in the newborn period with symptoms of hypoventilation. However, there is a subset of patients with the same genetic mutation who present much later in life, which is termed late-onset congenital central hypoventilation syndrome (LO-CCHS).

Intravenous Lipid Emulsion Rescue Therapy in a Child with Carisoprodol Overdose.

The use of intravenous lipid emulsion (ILE) therapy in children with carisoprodol toxicity was not described previously. We report the case of an adolescent female who presented to our pediatric intensive care unit with unresponsiveness and respiratory depression. The patient recovered immediately following ILE therapy and subsequently admitted having carisoprodol overdose.

A Prospective Assessment of Optimal Mechanical Ventilation Parameters for Pediatric Catheter Ablation.

Catheter stability, an important factor in ablation success, is affected by ventilation. Optimal ventilation strategies for pediatric catheter ablation are not known. We hypothesized that small tidal volume and positive end-expiratory pressure are associated with reduced ablation catheter movement at annular positions.

Anesthetic Management of a Pediatric Patient With Pelizaeus-Merzbacher Syndrome: A Case Report.

A 3-year-old pediatric patient with previously diagnosed Pelizaeus-Merzbacher syndrome presented for outpatient dental restoration. Given the infrequency of this demyelinating disorder, an anesthetic plan was tailored to address the patient's hypotonia and aspiration risk, as well as minimize potential complications including seizures, hemodynamic instability, and postoperative respiratory support. Multimodal analgesia, along with an appropriate ventilation strategy and normothermia, allowed the patient to successfully undergo a general anesthetic and be safely discharged home the same day.

Neuraxial Anesthesia in Parturients with Low Platelet Counts.

The obstetric anesthesiologist must consider the risk of spinal-epidural hematoma in patients with thrombocytopenia when choosing to provide neuraxial anesthesia. There are little data exploring this complication in the parturient. In this single-center retrospective study of 20,244 obstetric patients, the incidence of peripartum thrombocytopenia (platelet count <100,000/mm) was 1.

Engaging Pediatric Resident Physicians in Quality Improvement Through Resident-Led Morbidity and Mortality Conferences.

Background: Increasingly, medical disciplines have used morbidity and mortality conferences (MMCs) to address quality improvement and patient safety (QI/PS), as well as teach systems-based improvement to graduate trainees. The goal of this educational intervention was to establish a pediatric resident physician–led MMC that not only focused on QI/PS principles but also engaged resident physicians in QI/ PS endeavors in their clinical learning environments.

Methods: Following a needs assessment, pediatric resident physicians at the Stanford University School of Medicine (Stanford, California) established a new MMC model in February 2010 as part of a required QI rotation.

The uncomfortable reality … We simply do not know if general anesthesia negatively impacts the neurocognitive development of our small children.

Annually in the United States more than one million children under the age of 5 years are exposed to anesthetics for therapeutic and diagnostic procedures. Pre-clinical data in animal models has consistently shown that anesthetic exposure to the developing brain results in long-term cognitive deficits. Current clinical data addressing the safety of these pharmaceutical agents on the developing human brain is limited.

Effects of ventilation and catheter position on catheter movement on the tricuspid annulus during ablation in children.

Introduction: There are little data on the effect of catheter position and mechanical ventilation on ablation catheter stability during electrophysiology study in children. We sought to determine the magnitude of catheter movement with mechanical ventilation, the effect of ventilation maneuvers on catheter movement, and to compare the degree of movement observed between the right lateral (RL) and right posteroseptal (RPS) regions.

Methods: From June 2012 to June 2013, patients ≤ 21 years of age undergoing ablation for supraventricular tachycardia with CARTO® 3 (Biosense Webster, Diamond Bar, CA, USA) were included.

Effect of procedure simulation workshops on resident procedural confidence and competence.

Background: Pediatrics residents perform a limited number of some procedures in the clinical setting and may benefit from procedure simulation workshops.

Objective: To examine (1) the number and types of procedures performed by pediatrics residents in the clinical setting, (2) the relationship between the number of procedures performed and self-reported procedural confidence and competence, and (3) the effect of a procedure simulation workshop on self-reported procedural confidence and competence.

Methods: Pediatrics residents at Lucile Packard Children's Hospital at Stanford attended a half-day procedure workshop, rotating between 6 procedure simulation stations: vascular access, airway management, bladder catheterization, chest tube placement, lumbar puncture, and umbilical lines.

Association between maintenance fluid tonicity and hospital-acquired hyponatremia.

Objective: To evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children.

Study Design: Informatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission.

Role of barbiturate coma in the management of focally induced, severe cerebral edema in children.

Barbiturates are widely used in the management of high intracranial pressure (ICP) caused by diffuse brain swelling. The cardiovascular, renal, and immunological side effects of these drugs limit them to last-line therapy. There are few published data regarding the role of barbiturates in focal brain lesions causing refractory elevated ICP and intraoperative brain swelling in the pediatric population.

Medical education in the electronic medical record (EMR) era: benefits, challenges, and future directions.

In the last decade, electronic medical record (EMR) use in academic medical centers has increased. Although many have lauded the clinical and operational benefits of EMRs, few have considered the effect these systems have on medical education. The authors review what has been documented about the effect of EMR use on medical learners through the lens of the Accreditation Council for Graduate Medical Education's six core competencies for medical education.

Severe eczema vaccinatum in a household contact of a smallpox vaccinee.

Background: We report the first confirmed case of eczema vaccinatum in the United States related to smallpox vaccination since routine vaccination was discontinued in 1972. A 28-month-old child with refractory atopic dermatitis developed eczema vaccinatum after exposure to his father, a member of the US military who had recently received smallpox vaccine. The father had a history of inactive eczema but reportedly reacted normally to the vaccine.

Pneumonia and empyema caused by penicillin-resistant Neisseria meningitidis: a case report and literature review.

Pneumonia is an uncommon manifestation of Neisseria meningitidis infection, and empyema is rarely reported. Uniform penicillin susceptibility has been assumed for meningococcal infections for many years, but decreased penicillin susceptibility has been recognized recently with increasing frequency. Breakpoints to define different categories of susceptibility were published recently by the Clinical and Laboratory Standards Institute.

Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy.

Background: Survival after stage I palliation for hypoplastic left heart syndrome or related anomalies remains poor in high-risk neonates. We hypothesized that a less invasive hybrid approach would be beneficial in this patient population.

Methods: The hybrid stage I procedure was performed in the catheterization laboratory.

Extracorporeal membrane oxygenation after stem cell transplant: clinical decision-making in the absence of evidence.

Objective: To discuss the ethical dilemmas that arise in considering innovative therapies for critically ill children when there is little data to support their use.

Design: Case report of a 13-yr-old patient after autologous peripheral blood stem cell transplant for stage III neuroblastoma with sepsis and hemodynamic instability who survived to discharge after a 6-day course of extracorporeal membrane oxygenation (ECMO) support. The case serves as a source of discussion of the following: the use of available data in deciding to proceed with an unproved therapy, the approach to conversations to obtain informed consent, and the need for institutional oversight and hypothesis-driven data collection to advance pediatric critical care.

The effect of premedication with OTFC, with or without ondansetron, on postoperative agitation, and nausea and vomiting in pediatric ambulatory patients.

Background: The purpose of this study was to evaluate, in the pediatric ambulatory surgical population, the efficacy of: (i) oral transmucosal fentanyl citrate (OTFC), when given preoperatively, to reduce postoperative excitement associated with sevoflurane, and (ii) intravenous ondansetron to reduce postoperative nausea and vomiting (PONV) associated with OTFC.

Methods: This randomized, double-blinded, placebo controlled study evaluated the efficacy of OTFC [normal dose (ND) = 10-15 microg x kg(-1) or low dose = 100 microg] compared with placebo in the prevention of postoperative agitation; and the efficacy of ondansetron (0.1 mg x kg(-1) to 4 mg) compared with placebo to reduce PONV associated with OTFC.

Open-heart surgery in pediatric patients with end-stage liver disease.

Little is known about the safety of pediatric cardiac surgery in children with end-stage liver disease. We reviewed our experience with 4 patients with biliary atresia or Alagille's syndrome who underwent repair of ventricular septal defect and tricuspid regurgitation, atrioventricular canal, subaortic stenosis, or supravalvular aortic stenosis. One patient died on postoperative day 2.