Publications by authors named "Matt Zinter"
Background: Pediatric respiratory syncytial virus (RSV)-related acute lower respiratory tract infection (LRTI) commonly requires hospitalization. The Clinical Progression Scale Pediatrics (CPS-Ped) measures level of respiratory support and degree of hypoxia across a range of disease severity, but it has not been applied in infants hospitalized with severe RSV-LRTI.
Methods: We analyzed data from a prospective surveillance registry of infants hospitalized for RSV-related complications across 39 U.
Article Synopsis
- Diffuse alveolar hemorrhage (DAH) is a serious lung complication that can occur after hematopoietic cell transplantation (HCT) in patients under 21, with a low incidence rate of about 1% in this population.
- A study analyzed data from nearly 7,000 patients to identify risk factors for developing DAH, finding that nonmalignant hematologic disease, specific transplant medication regimens, and severe acute graft-versus-host disease significantly increased the risk.
- Critical care patients with DAH also showed higher instances of various health issues, including systemic and pulmonary hypertension, and other serious conditions like renal failure.
Objective: To describe characteristics associated with survival for pediatric patients with an oncologic diagnosis or hematopoietic cell transplant (HCT) supported with extracorporeal membrane oxygenation (ECMO).
Design: Multicenter, retrospective study.
Setting: Sixteen PICUs in the United States and Israel.
Key Points: The cumulative incidence of AKI diagnosis post–hematopoietic stem cell transplantation was 12.9%. Calcineurin inhibitor use was associated with the highest cumulative incidence, 21.
View Article and Find Full Text PDFArticle Synopsis
- A study examined the incidence, risk factors, and outcomes of pulmonary hypertension (PH) in pediatric patients after hematopoietic stem cell transplants (HCT) conducted in a PICU setting from 2008 to 2014.
- Out of nearly 7,000 HCT patients, 29 developed PH, revealing a low overall incidence of 0.42%, but a higher prevalence of 2.72% among patients needing intensive care post-transplant.
- Key risk factors for developing PH included being Black/African American, having metabolic disorders, and a lower functional status prior to transplant, with patients experiencing significant complications and a 6-month survival rate of only 51.7% after PH diagnosis.
Hematopoietic cell transplantation (HCT) uses cytotoxic chemotherapy and/or radiation followed by intravenous infusion of stem cells to cure malignancies, bone marrow failure and inborn errors of immunity, hemoglobin and metabolism. Lung injury is a known complication of the process, due in part to disruption in the pulmonary microenvironment by insults such as infection, alloreactive inflammation and cellular toxicity. How microorganisms, immunity and the respiratory epithelium interact to contribute to lung injury is uncertain, limiting the development of prevention and treatment strategies.
View Article and Find Full Text PDFPediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021-October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19-related hospitalization and critical illness among U.S.
View Article and Find Full Text PDFDiagnosing and Grading of Sinusoidal Obstructive Syndrome after Hematopoietic Stem Cell Transplant of Children, Adolescent and Young Adults treated in a Pediatric Institution with Pediatric Protocols.
Transplant Cell Ther
July 2024
Sinusoidal obstructive syndrome (SOS), or veno-occlusive disease, of the liver has been recognized as a complex, life-threatening complication in the posthematopoietic stem cell transplant (HSCT) setting. The diagnostic criteria for SOS have evolved over the last several decades with a greater understanding of the underlying pathophysiology, with 2 recent diagnostic criteria introduced in 2018 (European Society of Bone Marrow Transplant [EBMT] criteria) and 2020 (Cairo criteria). We sought out to evaluate the performance characteristics in diagnosing and grading SOS in pediatric patients of the 4 different diagnostic criteria (Baltimore, Modified Seattle, EBMT, and Cairo) and severity grading systems (defined by the EBMT and Cairo criteria).
View Article and Find Full Text PDFArticle Synopsis
- A study investigated the impact of pre-existing immunocompromising conditions (ICCs) on pediatric patients with acute COVID-19 admitted to intensive care across 55 hospitals in the U.S.!
- Out of 1,274 patients, 105 had ICCs, which were linked to higher in-hospital mortality (11.4% vs. 4.6%) and longer hospital stays, although initial disease severity was similar between those with and without ICCs.!
- Despite the challenges, most patients with ICCs survived and left the hospital without new severe health issues, highlighting a positive aspect of the outcomes for these vulnerable patients.!
Objectives: To describe family healthcare burden and health resource utilization in pediatric survivors of acute respiratory distress syndrome (ARDS) at 3 and 9 months.
Design: Secondary analysis of a prospective multisite cohort study.
Setting: Eight academic PICUs in the United States (2019-2020).
Article Synopsis
- A study analyzed the clinical characteristics and vaccination status of young children hospitalized for acute COVID-19 across 28 pediatric hospitals in the U.S. from September 2022 to May 2023.
- Of the 597 children examined, only 4.5% had completed their primary COVID-19 vaccination series, while 7.0% had started but not completed it, with the majority being unvaccinated.
- Most children admitted with severe COVID-19, including those requiring intensive care, were previously healthy and had not initiated vaccination, highlighting a concerning gap in immunization among vaccine-eligible young kids.
Article Synopsis
- Allogeneic hematopoietic cell transplantation (HCT) in pediatric patients can lead to serious complications, requiring intensive care for a notable percentage of patients post-transplant.
- A study analyzing data from multiple centers found that about 15.3% of patients needed ICU care within 5 years, with factors like patient demographics and pre-existing conditions influencing this need.
- Although survival to discharge from the ICU is high (85.7%), many patients face ongoing health issues, resulting in a significant drop in long-term survival rates, especially among those with malignancies and poor organ function.
Article Synopsis
- Lung injury is really important for kids' survival after getting special treatments for blood diseases, and scientists want to learn more about how germs and the body work together in the lungs.
- In a big study, researchers looked at lung samples from 229 kids at 32 hospitals over 8 years and found 4 different groups of patients based on their lung microbe makeup.
- Each group had different health outcomes: one group had low infection rates and low death rates, while others had high infection and death rates, showing that the type of lung microbes can greatly affect survival.
Background: Sepsis is a highly heterogeneous syndrome, which has hindered the development of effective therapies. This has prompted investigators to develop a precision medicine approach aimed at identifying biologically homogenous subgroups of patients with septic shock and critical illnesses. Transcriptomic analysis can identify subclasses derived from differences in underlying pathophysiological processes that may provide the basis for new targeted therapies.
View Article and Find Full Text PDFBackground: Vascular thromboses (VT) are life-threatening events after pediatric liver transplantation (LT). Single-center studies have identified risk factors for intra-abdominal VT, but large-scale pediatric studies are lacking.
Methods: This multicenter retrospective cohort study of isolated pediatric LT recipients assessed pre- and perioperative variables to determine VT risk factors and anticoagulation-associated bleeding complications.
Objective: To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.
Methods: Across 25 U.S.
Effectiveness of Maternal mRNA COVID-19 Vaccination During Pregnancy Against COVID-19-Associated Hospitalizations in Infants Aged <6 Months During SARS-CoV-2 Omicron Predominance - 20 States, March 9, 2022-May 31, 2023.
MMWR Morb Mortal Wkly Rep
September 2023
Article Synopsis
- Infants under 6 months are not eligible for COVID-19 vaccines, but maternal vaccination during pregnancy can help protect these infants from being hospitalized due to COVID-19.
- A study found that vaccinated mothers showed a 35% effectiveness in preventing COVID-19-related hospitalizations in infants under 6 months and 54% for those under 3 months.
- Vaccinated mothers had lower rates of severe outcomes for their infants, such as intensive care unit admissions and the need for mechanical ventilation, highlighting the importance of vaccination for expectant mothers.*
Article Synopsis
- This study investigates two subphenotypes of acute respiratory distress syndrome (ARDS) in children, specifically hypoinflammatory and hyperinflammatory types, to better understand their clinical significance.* -
- Researchers used latent class analysis on two large pediatric cohorts, revealing that hyperinflammatory cases had greater severity, higher rates of sepsis, and increased mortality compared to hypoinflammatory cases.* -
- Findings indicate that these pediatric subphenotypes align with adult ARDS classifications, suggesting that future studies should incorporate biomarker-defined subphenotypes for improved treatment strategies.*
Background: Sepsis is a highly heterogeneous syndrome, that has hindered the development of effective therapies. This has prompted investigators to develop a precision medicine approach aimed at identifying biologically homogenous subgroups of patients with septic shock and critical illnesses. Transcriptomic analysis can identify subclasses derived from differences in underlying pathophysiological processes that may provide the basis for new targeted therapies.
View Article and Find Full Text PDFImportance: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.
Objective: To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.
Design, Setting, And Participants: This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states.
Article Synopsis
- Allogeneic hematopoietic cell transplantation (HCT) can lead to complications requiring intensive care, but the risk factors for these complications are not well understood due to differences among treatment centers.
- The study analyzed data from 6,995 pediatric HCT patients and found that 1,067 of them needed intensive care, with higher admission rates linked to factors like younger age, lower income, and certain pre-existing health conditions.
- Among those who were admitted to intensive care, the survival rate to discharge was 85.7%, but many experienced readmissions, and overall long-term survival rates were significantly worse for patients with certain risk factors, particularly those with malignant diseases or existing organ dysfunction.*
Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of hematopoietic cellular therapy (HCT). This study aimed to evaluate the effect of DAH treatments on outcomes using data from consecutive HCT patients clinically diagnosed with DAH from 3 institutions between January 2018-August 2022. Endpoints included sustained complete response (sCR) defined as bleeding cessation without recurrent bleeding, and non-relapse mortality (NRM).
View Article and Find Full Text PDFObjectives: Extracorporeal membrane oxygenation (ECMO) has been used successfully to support adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiac or respiratory failure refractory to conventional therapies. Comprehensive reports of children and adolescents with SARS-CoV-2-related ECMO support for conditions, including multisystem inflammatory syndrome in children (MIS-C) and acute COVID-19, are needed.
Design: Case series of patients from the Overcoming COVID-19 public health surveillance registry.
Article Synopsis
- This study focused on children and adolescents hospitalized for COVID-19, evaluating the prevalence of bacterial coinfections and the use of empiric antibiotics during their stay.
- Of the 532 patients analyzed, 63.3% received antibiotics, but only 7.1% had bacterial coinfections, with just 3.0% having respiratory bacterial coinfections.
- The results indicate that while antibiotic use is common in these cases, bacterial coinfections are rare, suggesting that more careful antibiotic prescribing and quicker assessment for coinfection could be beneficial.