Safety and Tolerance of Intraoperative Enteral Nutrition Support in Pediatric Burn Patients.

Background: Multiple surgical procedures required by patients with extensive thermal injuries impedes delivery of adequate nutrition support, leading to caloric deficits, weight loss, delayed wound healing, and increased length of stay. The standard practice at our institution for >20 years has been to continuously infuse postpyloric enteral nutrition (EN) during surgery. The purpose of this review was to examine the safety and efficacy of intraoperative EN support.

Pediatric perioperative measures of sleep, pain, anxiety and anesthesia emergence: A healing touch proof of concept randomized clinical trial.

Background And Purpose: The purpose of this study was to determine the impact of healing touch (HT) on sleep, anxiety, anesthesia emergence and pain.

Methods: HT, sham HT, control with an aide (CP) and control groups without the presence of an aide (CNP), underwent polysomnography (PSG) preoperatively. The Yale Preoperative Anxiety Scale (YPAS) score was obtained preoperatively before medications were given and in the preoperative surgery area.

Zolpidem and Sleep in Pediatric Burn Patients with Attention Deficit/Hyperactivity Disorder.

Existing research shows that hospitalized patients, especially pediatric burn patients, are often sleep deprived. A pre-existing diagnosis of attention deficit/hyperactivity disorder (ADHD) further compounds a burn patient's inability to sleep. This retrospective study compared the effectiveness of zolpidem on patients with acute burns with ADHD (n = 23) and patients with acute burns without ADHD (n = 23).

Clinical Trial of Vitamin D vs D Supplementation in Critically Ill Pediatric Burn Patients.

Background: Hypovitaminosis D exists postburn. However, evidence-based guidelines for vitamin D repletion are unknown. This investigation examined differences between D and D supplementation on outcome in children with burn injuries.

Investigation of Bone Health Subsequent to Vitamin D Supplementation in Children Following Burn Injury.

Background: The effect of supplemental vitamin D on fracture occurrence following burn injuries is unclear. The objective of this study was to evaluate postintervention incidence of fractures in children during the rehabilitative phase postburn (PB) following participation in a randomized clinical trial of vitamin D supplementation.

Materials And Methods: Follow-up for fracture evaluation was obtained in 39 of 50 patients randomized to daily enteral vitamin D2, D3, or placebo throughout the acute burn course.

Application of a method used to deconstruct a single dose pharmacokinetic profile from multiple dose data.

With traditional non-compartmental methods, it is challenging to deconstruct plasma concentration versus time curves to assess the influence of individual doses. This study describes the application of a mathematical approach used to deconstruct a single dose curve using data derived from the second, third, fourth or nth dosing interval. Using data from a prospective clinical trial it is demonstrated that this approach reliably estimates pharmacokinetic parameters measured following two doses of zolpidem tartrate.

Clinical safety and efficacy of probiotic administration following burn injury.

Provision of probiotics has been limited postburn by questionable potential for bacterial translocation and risk of infection in an immune-compromised population. The purpose of this study was to evaluate the safety of probiotic administration in acutely burned, pediatric patients. Subjects were randomized to receive probiotic (n = 10) vs placebo (n = 10) twice daily.

Relationship between zolpidem concentrations and sleep parameters in pediatric burn patients.

Zolpidem is a short-acting non-benzodiazepine hypnotic that is used to improve sleep architecture in patients with burn injuries. This study evaluated the relationship between zolpidem administration and sleep parameters in a cohort of children with severe burn injuries. Standard age-based zolpidem dosing practices were employed.

The effect of diphenhydramine on sleep in pediatric burn patients: a secondary analysis.

Adequate sleep is essential for maintaining homeostasis, especially when recovering from an illness; however, studies have shown that sleep disruption and sleep deprivation are common in intensive care unit patients, including children who have sustained burn injury. The purpose of this study was to evaluate the effect of diphenhydramine (DPH) on sleep in pediatric intensive care unit burn patients using Myra Levine's Conservation Model as the organizing framework. For this study, secondary analysis of polysomnography data and retrospective chart review were used.

Preliminary assessment of zolpidem pharmacokinetics in pediatric burn patients.

Purpose: Severely burned patients frequently experience sleep fragmentation and insomnia. This study evaluated the population pharmacokinetics of the sleep-enhancing agent zolpidem among burned children.

Methods: Zolpidem was administered according to the following age-based dosing schedule: 2.

Quantity and quality of nocturnal sleep affect morning glucose measurement in acutely burned children.

Hyperglycemia after severe burn injury has long been recognized, whereas sleep deprivation after burns is a more recent finding. The postburn metabolic effects of poor sleep are not clear despite reports in other populations demonstrating the association between sleep insufficiency and deleterious endocrine consequences. The aim of this study was to determine whether a relationship between sleep and glucose dynamics exists in acutely burned children.

Burn center journal club promotes clinical research, continuing education, and evidence-based practice.

The purpose of this study was to characterize the structure, policy, implementation, and outcome measures of a burn team journal club to assess its effectiveness in promoting multidisciplinary education relative to research competency, clinical knowledge, and evidence-based practice. After 2 years of a new multidisciplinary format, an anonymous quality assurance survey was distributed to staff members of a regional pediatric burn center to evaluate the impact of the journal club on clinical and research indicators. The 24 journal club meetings evaluated in this study included a variety of topics, among which were wound healing, infection, nutrition, metabolism, sleep, medications, alternative medicine, research compliance, and child abuse.

"Remember me" program: bridging the gap between hospital and school.

A major burn injury during childhood interrupts normal school experiences and friendships. The recovery period is difficult for patients and classmates. Recognizing the important role of school-related social networking during convalescence, the "Remember Me" program was initiated to keep the patients in touch with peers while hospitalized.

A pilot review of the long-term impact of burn injury on sleep architecture in children.

Distorted sleep patterns exist in the acutely burned pediatric population. No prior study has used polysomnography to assess sleep proficiency in children years after discharge. The objective of this retrospective, pilot investigation was to examine sleep in children multiple years after burn injury to characterize the long-term impact of burns on sleep.

Comparison of sleep parameters obtained from actigraphy and polysomnography during the rehabilitative phase after burn.

The evaluation of sleep is an important aspect of holistic care. Polysomnographic assessment is not always possible or justified. Actigraphy has gained popularity as an alternative sleep/wake monitor.

The effect of ketamine administration on nocturnal sleep architecture.

Substantial evidence exists in the acute, rehabilitative and outpatient settings demonstrating the presence of significant sleep pattern disturbances after burn injury. Although the etiology is multifactorial and includes environmental, injury, and treatment mediators, previous clinical studies have not analyzed the critically important relationship of various medications to sleep architecture. The purpose of this investigation was to describe the after-effect of ketamine on sleep patterns in seriously ill burn patients.

Clinical assessment of sleep among pediatric burn patients does not correlate with polysomnography.

A vast amount of sleep research relies on subjective, observational assessments of wakefulness and sleep. The authors had the unique opportunity to compare observational and polysomnographic (PSG) determinations of sleep in a randomized crossover study of sleep-inducing medication in a group of pediatric burn patients. Pediatric burn patients were randomized to one of two regimens with sleep-inducing agents over a 2-week period.

Sleep apnea: a risk factor for obese burned children during the rehabilitative phase of injury.

Obesity is associated with sleep disturbances that negatively impact general health. Recent reports indicate a high prevalence of obesity in burned children during the rehabilitative phase of injury. This retrospective review examined the relationship between sleep apnea and obesity in children recovering from burn injury.

Overweight and obesity: overrepresentation in the pediatric reconstructive burn population.

Pediatric burn patients are predisposed to excessive weight gain in the reconstructive period, but the cause is unclear. An overweight (OW) or obese (OB) condition is associated with numerous health risks, decreased physical function, and increased morbidity. The purpose of this study was to compare the frequency of OW status in reconstructive, pediatric burn patients with the prevalence in the US population.

Enhancing patient safety: the effect of process improvement on bedside fluoroscopy time related to nasoduodenal feeding tube placement in pediatric burn patients.

Nutrition support is essential in the care of burn patients. Early in the course of treatment, postpyloric feeding tube placement permits initiation of enteral nutrition, minimizes risk of aspiration, and may also attenuate hypermetabolism. Fluoroscopy aids in postpyloric feeding tube placement, yet concerns remain about safety.

An evaluation of the neuroendocrine response to sleep in pediatric burn patients.

Introduction: Previous work demonstrated reduced stage 3+4 and rapid eye movement (REM) sleep following burn injury. This study evaluated the hormonal effects of drug intervention on measures of endocrine status. A secondary objective examined the relationship between hormones and sleep stage distribution.

Energy requirements of pediatric patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.

Introduction: The primary purpose of this study was to compare the measured resting energy requirements (MREE) of children with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with that of children with burns of similar size. A secondary goal was to develop a predictive equation useful in estimating the energy of children with SJS/TEN.

Methods: This retrospective study included 30 patients admitted to our pediatric burn unit between 12/91 and 03/06.

A randomized, controlled prospective trial of zolpidem and haloperidol for use as sleeping agents in pediatric burn patients.

Children with burn injuries often require hospital treatment where they are subjected to stimuli likely to produce sleep deprivation. Previously demonstrated sleep fragmentation and significantly reduced sleep stage 3/4 and rapid eye movement in this population led to a search for sleep-enhancing interventions. The purpose of this study was to evaluate the effects of selected therapeutic interventions on sleep architecture.

An evaluation of the safety and efficacy of an anti-inflammatory, pulmonary enteral formula in the treatment of pediatric burn patients with respiratory failure.

Respiratory failure is associated with a high mortality rate in burned children. Recently, a specialized pulmonary enteral formula (SPEF) was commercially introduced as an adjunct intervention in acute lung injury management. SPEF contains condition-specific nutrients to modulate the inflammatory response.