Cardiac Resynchronization Therapy for Pacing-Related Dysfunction Post Cardiac Surgery in Neonates.

An infant with DiGeorge syndrome, multiple comorbidities, and truncus arteriosus type II underwent repair complicated by heart block necessitating placement of a dual-chamber bipolar pacing system with right ventricular leads and subsequent resynchronization with placement of left ventricular apical pacing leads. Resynchronization therapy improved QRS duration from 180 ms to 100 ms and ejection fraction from 25% to 54% over the course of 4 weeks with gradual return to normal function and eventual discharge.

Impact of congenital heart disease on mortality and other associated outcomes in children hospitalised for acute asthma exacerbation.

Background: Acute asthma exacerbation is one of the most common reasons for paediatric emergency room visits and hospital admissions in the United States of America.

Objective: To assess the impact of CHD on outcomes of children hospitalised for acute asthma exacerbation.

Methods: Children primarily admitted for acute asthma exacerbation were sampled from 2006, 2009, 2012, and 2016 kid inpatient database of the Healthcare Cost and Utilization Project using ICD codes.

Utility of Brain Injury Biomarkers in Children With Congenital Heart Disease Undergoing Cardiac Surgery.

Background: Congenital heart disease (CHD) affects roughly 40,000 children annually. Despite advancements, children undergoing surgery for CHD are at an increased risk for adverse neurological outcomes. At present, there is no gold standard for the diagnosis of cerebral injury during the perioperative period.

The Trend of Urinary N Terminal Probrain Natriuretic Peptide in Extremely Low Birth Weight Infants during the Neonatal Period.

Objective: N-terminal probrain natriuretic peptide (NT-proBNP) is a biomarker of interest in many cardiopulmonary diseases in extremely low birth weight (ELBW) Infants. However, there is a gap in knowledge about the trend of ELBW infant's urinary NT-proBNP during the neonatal period.

Aim: To determine the trend of urinary NT-proBNP during the first 4 weeks of life of an ELBW infant.

Which criteria should be used to select patients for the Fontan operation?

The Fontan operation has improved the survival of children born with single ventricle physiology. Selecting candidates for the Fontan operation may be difficult on borderline cases. No clear criterion has been established on the risk for staged Fontan palliation.

Applying Educational Theory to Interdisciplinary Education in Pediatric Cardiac Critical Care.

At the 14th Annual International Meeting for the Pediatric Cardiac Intensive Care Society, the authors presented a simulation workshop for junior multidisciplinary providers focused on cardiopulmonary interactions. We provide an overview of educational theories of particular relevance to curricular design for simulation-based or enhanced activities. We then demonstrate how these theories are applied to curriculum development for individuals to teams and for novice to experts.

Dilated cardiomyopathy in children: moving beyond traditional pharmacologic therapy.

Purpose Of Review: Dilated cardiomyopathy (DCM) is a rare myocardial disorder characterized by a dilated left ventricle and systolic dysfunction. Globally, it affects around 1 in every 100 000 children. The prognosis is generally poor, with 40% either failing traditional medical therapy within the first 2 years or requiring a heart transplant.

Inadequate oxygen delivery index dose is associated with cardiac arrest risk in neonates following cardiopulmonary bypass surgery.

Aim: To evaluate the Inadequate oxygen delivery (IDO) index dose as a predictor of cardiac arrest (CA) in neonates following congenital heart surgery.

Methods: Retrospective cohort study in 3 US pediatric cardiac intensive units (1/2011- 8/2016). Calculated IDO index values were blinded to bedside clinicians and generated from data collected up to 30 days postoperatively, or until death or ECMO initiation.

Eighteen years of paediatric extracorporeal membrane oxygenation and ventricular assist devices: insight regarding late outcomes.

Background: We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.

Methods: A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan-Meier method.

Risk Factors for Survival After Heart Transplantation in Children and Young Adults: A 22-Year Study of 179 Transplants.

Background: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality.

Methods: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time.

Hypothyroidism in Infants With Congenital Heart Disease Exposed to Excess Iodine.

Thyroid hormone is critical for neonatal brain development, and even transient hypothyroidism can cause adverse neurocognitive outcomes. Infants exposed to excess iodine are at risk of developing hypothyroidism, especially those with congenital heart disease (CHD), because they are routinely exposed to excess iodine from intravenous iodinated contrast media and topical antiseptics. The aim of the present study was to identify the proportion of neonates with CHD exposed to iodine who developed hypothyroidism and to identify the associated risk factors.

A Method to Account for Variation in Congenital Heart Surgery Length of Stay.

Objectives: We sought to develop a risk-adjustment methodology for length of stay in congenital heart surgery, as none exist.

Design: Prospective cohort analysis combined with previously obtained retrospective cohort analysis of a Department of Cardiovascular Surgery clinical database.

Patients: Patients discharged from Boston Children's Hospital between October 1, 2006, and May 31, 2014, that underwent a congenital heart surgery procedure(s) linked to one of 103 surgical procedure types.

Training fellows and residents in paediatric cardiac critical care.

As pediatric cardiac critical care becomes more sub-specialized it is reasonable to assume that dedicated units may provide a better infrastructure for improved multidisciplinary care, cardiac-specific patient safety initiatives, and dedicated training of fellows and residents. The knowledge base required to optimally manage pediatric patients with critical cardiac disease has evolved sufficiently to consider a standardized training curriculum and board certification for pediatric cardiac critical care. This strategy would potentially provide consistency of training and healthcare and improve quality of care and patient safety.

Phosphodiesterase Inhibitor-Based Vasodilation Improves Oxygen Delivery and Clinical Outcomes Following Stage 1 Palliation.

Background: Systemic vasodilation using α-receptor blockade has been shown to decrease the incidence of postoperative cardiac arrest following stage 1 palliation (S1P), primarily when utilizing the modified Blalock-Taussig shunt. We studied the effects of a protocol in which milrinone was primarily used to lower systemic vascular resistance (SVR) following S1P using the right ventricular to pulmonary artery shunt, measuring its effects on oxygen delivery (DO) profiles and clinical outcomes. We also correlated Fick-based assessments of DO with commonly used surrogate measures.

Factors Associated With Mortality in Neonates Requiring Extracorporeal Membrane Oxygenation for Cardiac Indications: Analysis of the Extracorporeal Life Support Organization Registry Data.

Objectives: Survival among neonates supported with extracorporeal membrane oxygenation for cardiac indications is 39%. Previous single-center studies have identified factors associated with mortality, but a comprehensive multivariate analysis is not available for this population. Understanding factors associated with mortality may help design treatment strategies, determine optimal timing for cannulation, and inform patient selection.

Next generation patient monitor powered by in-silico physiology.

The goal of this paper is to introduce a next generation patient monitoring technology that relies on objective and continuous data analytics to alleviate the data overload in the critical care unit. The technology provides the foundation for increasing the consistency and efficacy of data use in clinical practice and improving outcomes. This paper presents results for applying the approach to the hemodynamic monitoring of infants immediately following cardiac surgery and demonstrates its efficacy of estimating the probability of inadequate systemic oxygen delivery, which is an essential risk attribute in the management of critically ill patients.

Theoretical and Evidence-Based Benefit of Afterload Reduction in the Postoperative Pediatric Heart.

Rational use of vasodilators to induce afterload reduction is predicated on a thorough knowledge of the constituents of afterload and of the role ventriculoarterial coupling plays in determining their effects. Afterload reduction therapy should be goal directed with the intent to improve stroke volume and tissue oxygen delivery rather than to decrease blood pressure per se. This review will summarize the components comprising circulatory system afterload and will use ventriculoarterial coupling concepts to demonstrate the variable but predictable effects of vasodilator therapy on hemodynamics and tissue oxygen delivery.

A Review of Systemic Vasodilators in Low Cardiac Output Syndrome Following Pediatric Cardiac Surgery.

Following surgery for congenital heart disease, patients develop a predictable and progressive decline in cardiac output known as low cardiac output syndrome. During low cardiac output states, a compensatory response to increase systemic perfusion occurs both innately and as part of the postoperative pharmacologic support strategies intended to increase or sustain adequate oxygen delivery. The result typically involves a rise in systemic vascular resistance and heart rate.

Intravenous GPIIb/IIIa Inhibitor for Secondary Prevention of Shunt Thrombosis in a Pediatric Patient.

Thrombosis occurs after aortopulmonary shunting in children despite the use of heparin and oral antiplatelet agents. We describe the use of an intravenous antiplatelet agent for secondary prevention of shunt thrombosis without adverse events. Platelet mapping was used to monitor the effects and demonstrated the rapid onset of platelet inhibition.

Extracorporeal membrane oxygenation for the support of adults with acute myocarditis.

Objectives: To characterize survival outcomes for adult patients with acute myocarditis supported with extracorporeal membrane oxygenation and identify risk factors for in-hospital mortality.

Design: Retrospective review of Extracorporeal Life Support Organization registry database.

Setting: Data reported to Extracorporeal Life Support Organization by 230 extracorporeal membrane oxygenation centers.

A method to account for variation in congenital heart surgery charges.

Background: In response to societal pressure to reduce expenditures and increase quality, we sought to develop a methodology to predict hospital charges related to congenital heart surgery.

Methods: Patients undergoing congenital heart surgery at Boston Children's Hospital in fiscal years 2007 to 2009 comprised the derivation cohort. Clinical data, including Current Procedural Terminology coding of the primary surgical intervention, were collected prospectively and linked to total hospital charges for an episode of care.

Development of a charge adjustment model for cardiac catheterization.

A methodology that would allow for comparison of charges across institutions has not been developed for catheterization in congenital heart disease. A single institution catheterization database with prospectively collected case characteristics was linked to hospital charges related and limited to an episode of care in the catheterization laboratory for fiscal years 2008-2010. Catheterization charge categories (CCC) were developed to group types of catheterization procedures using a combination of empiric data and expert consensus.