The Effect of Levosimendan Versus Milrinone on the Occurrence Rate of Acute Kidney Injury Following Congenital Heart Surgery in Infants: A Randomized Clinical Trial.

Objectives: It has been shown that, in contrast to other inotropic agents, levosimendan improves glomerular filtration rate after adult cardiac surgery. The aim of this study was to investigate the efficacy of levosimendan, compared with milrinone, in preventing acute kidney dysfunction in infants after open-heart surgery with cardiopulmonary bypass.

Design: Two-center, double-blinded, prospective, randomized clinical trial.

The effect of sildenafil on pleural and peritoneal effusions after the TCPC operation.

Background: We evaluated whether the administration of sildenafil in children undergoing the TCPC operation shortened the interval from the operation to the removal of the pleural and peritoneal drains.

Methods: We retrospectively reviewed the data of 122 patients who had undergone the TCPC operation between 2004 and 2014. Patients were divided into two groups on the basis of their treatments.

Complete Atrioventricular Septal Defect: Evolution of Results in a Single Center During 50 Years.

Background: Operative mortality after complete atrioventricular septal defect (cAVSD) repair has improved vastly. Less improvement has been demonstrated regarding late mortality and reoperation rates, however. There is evident lack of comprehensive population-based studies analyzing the history and progress of the ever-changing operative results.

Congenital diaphragmatic hernia with heart defect has a high risk for hypoplastic left heart syndrome and major extra-cardiac malformations: 10-year national cohort from Finland.

Introduction: Congenital diaphragmatic hernia (CDH) has a well-known risk of congenital heart defects with poor prognosis. This study was conducted to determine the national total prevalence and prenatal detection rates of CDH with heart defects and its association with major extra-cardiac malformations and to further evaluate the impact of the heart defect severity on survival.

Material And Methods: A 10-year national cohort was derived from four national registries, including live births, stillbirths, and terminations of pregnancy for fetal anomalies.

Heart-Type Fatty Acid Binding Protein and High-Dose Methylprednisolone in Pediatric Cardiac Surgery.

Objectives: Corticosteroids possess cardioprotection in experimental cardiac ischemia/reperfusion. The authors hypothesized that if cardioprotection of corticosteroids occured during pediatric cardiac surgery, then methylprednisolone used in cardiopulmonary bypass prime would reduce postoperative concentrations of heart-type fatty-acid-binding protein, a cardiac biomarker.

Design: A double-blind, placebo-controlled, randomized clinical trial.

Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations: A Randomized Controlled Trial.

Background: Corticosteroids can improve the hemodynamic status of neonates with postoperative low cardiac output syndrome after cardiac operations. This study compared a prophylactically administered stress-dose corticosteroid (SDC) regimen against placebo on inflammation, adrenocortical function, and hemodynamic outcome.

Methods: Forty neonates undergoing elective open heart operations were randomized into two groups.

The Hemodynamic Effects and Safety of Repetitive Levosimendan Infusions on Children With Dilated Cardiomyopathy.

Background: Limited treatment options are available for children with decompensated dilated cardiomyopathy (DCM), while they wait for either functional recovery or heart transplantation. We evaluated the safety of repetitive levosimendan infusions and short-term and long-term impacts of the therapy in this patient population.

Methods: Eighty-one repetitive levosimendan infusions administered to 20 patients with DCM at severe or end stage of the disease in the pediatric intensive care unit were analyzed retrospectively.

The effect of continuous wound infusion of ropivacaine on postoperative pain after median sternotomy and mediastinal drain in children.

Background: Postoperative pain after median sternotomy is usually treated with i.v. opioids.

High-Dose Methylprednisolone Has No Benefit Over Moderate Dose for the Correction of Tetralogy of Fallot.

Background: The optimal dose of methylprednisolone during pediatric open heart surgical procedures is unknown. This study compared the antiinflammatory and cardioprotective effects of high and lower doses of methylprednisolone in children undergoing cardiac operations.

Methods: Thirty children, between 1 and 18 months old and undergoing total correction of tetralogy of Fallot, were randomized in double-blind fashion to receive either 5 or 30 mg/kg of intravenous methylprednisolone after anesthesia induction.

Relation of Medical History to the Pediatric Out-of-Hospital Cardiac Arrest Managed by Emergency Medical Services.

Objective: The aim of this study was to examine the medical history of the pediatric out-of-hospital cardiac arrest (OHCA) patients to determine preexisting conditions that may relate to a later OHCA.

Methods: The study was a retrospective population-based cohort study in Helsinki (population 595,000) served by a single emergency medical service (EMS) system. All OHCA patients aged between 0 and 17 met by the local EMS from 2002 to 2011 were included.

Effect of a simulation-based workshop on multidisplinary teamwork of newborn emergencies: an intervention study.

Background: Video analyses of real-life newborn resuscitations have shown that Neonatal Resuscitation Program (NRP) guidelines are followed in fewer than 50% of cases. Multidisciplinary simulation is used as a first-rate tool for the improvement of teamwork among health professionals. In the study we evaluated the impact of the crisis resource management (CRM) and anesthesia non-technical skills instruction on teamwork during simulated newborn emergencies.

The Effect of Methylprednisolone on Plasma Concentrations of Neutrophil Gelatinase-Associated Lipocalin in Pediatric Heart Surgery.

Objectives: Plasma neutrophil gelatinase-associated lipocalin is a kidney injury marker used in pediatric heart surgery. Neutrophil gelatinase-associated lipocalin is also a constituent of specific granules of neutrophils. Corticosteroids are widely used in pediatric heart surgery.

Effect of timing and route of methylprednisolone administration during pediatric cardiac surgical procedures.

Background: We compared the antiinflammatory and cardioprotective effects of the two most common regimens of corticosteroid administration in pediatric cardiac surgical procedures: a single dose delivered either at anesthesia induction or by cardiopulmonary bypass (CPB) prime.

Methods: Forty-five children, aged between 1 and 18 months and undergoing ventricular septal or atrioventricular septal defect correction, were randomized in double-blind fashion into three groups. The anesthesia induction group received 30 mg/kg methylprednisolone intravenously after anesthesia induction, and the CPB-prime group received 30 mg/kg methylprednisolone by CPB circuit.

Neurocognitive long term follow-up study on drowned children.

Aim Of The Study: Report cognitive and neurological outcome later in life of surviving drowned children who had received CPR either from bystanders or from emergency medical services (EMS) units.

Methods: Forty children who had drowned and admitted to pediatric intensive care unit after successful CPR between 1985 and 2007, were eligible for the study. Of those 21 gave a consent for neurological and neuropsychological examinations.

Resection of the stenotic segment with individually tailored anastomosis for symptomatic congenital tracheal stenosis in infants.

Objectives: To analyse retrospectively population-based results of congenital tracheal stenosis (CTS) repair in infants in Finland.

Methods: Data on infants who were operated on for CTS in Helsinki Children's Hospital between August 1988 and May 2013 were analysed retrospectively. Fibreoptic bronchoscopy was performed perioperatively and in follow-up of all the surviving patients.

Methylprednisolone in neonatal cardiac surgery: reduced inflammation without improved clinical outcome.

Background: Corticosteroids are widely used in pediatric open-heart surgery to reduce systemic inflammatory response and to mediate possible cardioprotective effects. However, the optimal dosing of corticosteroids is unknown and their administration varies considerably between different institutions.

Methods: Forty neonates undergoing open-heart surgery were randomized in a double-blind fashion equally into 2 groups.

Neurologic long term outcome after drowning in children.

Drowning is a major source of mortality and morbidity in children worldwide. Neurocognitive outcome of children after drowning incidents cannot be accurately predicted in the early course of treatment. Therefore, aggressive out-of-hospital and in-hospital treatment is emphasized.

Single-center experience with levosimendan in children undergoing cardiac surgery and in children with decompensated heart failure.

Background: Levosimendan has pharmacologic and hemodynamic advantages over conventional intravenous inotropic agents. It has been used mainly as a rescue drug in the pediatric intensive care unit or in the operating room. We present the largest single-center experience of levosimendan in children.

Horner's syndrome secondary to internal jugular venous cannulation.

Horner's syndrome is a rare complication following insertion of a central catheter into the internal jugular vein (IJV). A 5-year-old boy, who developed unilateral Horner's syndrome postoperatively following IJV cannulation, is presented. The Horner's syndrome resolved completely after 5 months.

Unrecognized mediastinal tumor causing sudden tracheal obstruction and out-of-hospital cardiac arrest.

We report a case of a 13-year-old boy with a presumed neck cyst who developed sudden tracheal obstruction and out-of-hospital cardiac arrest. Cardiorespiratory collapse occurred due to an improperly diagnosed mediastinal tumor. This report serves to alert Emergency Physicians and emergency medical services personnel of the rare and rapidly progressive nature of respiratory compromise caused by a mediastinal tumor, which may have lethal consequences if not recognized and treated promptly.

The effect of temperature correction of blood gas values on the accuracy of end-tidal carbon dioxide monitoring in children after cardiac surgery.

We evaluated accuracy of end-tidal carbon dioxide tension (PETco2) monitoring and measured the effect of temperature correction of blood gas values in children after cardiac surgery. Data from 49 consecutive mechanically ventilated children after cardiac surgery in the cardiac intensive care unit were prospectively collected. One patient was excluded from the study.

Comparison of the properties of EEG spindles in sleep and propofol anesthesia.

Electroencephalogram spindle patterns corresponding to two different phenomena-natural sleep and propofol anesthesia-are compared. The spindles are extracted from 5 overnight sleep recordings and 10 recordings of deep propofol anesthesia. Mean frequency, angle of the trend in instant frequency as well as 3 nonlinear parameters-spectral entropy, approximate entropy, and Higuchi fractal dimension- are calculated to characterize the spindle waveforms.

The air-leak test is not a good predictor of postextubation adverse events in children undergoing cardiac surgery.

Objective: The air-leak test is recommended as a method of assessing the appropriate size of an uncuffed endotracheal tube (ETT) in children. The authors' primary objective was to determine whether the air-leak test would predict adverse events and reintubations after the removal of the ETT in children who have undergone cardiac surgery.

Design: Prospective, observational, clinical study.

Transcranial Doppler-revealed retrograde cerebral artery flow during Norwood 1 operation.

We describe a 6-week-old girl with a hypoplastic left heart syndrome in whom multimodal neuromonitoring was used during Norwood stage I palliation. After placement of modified Blalock-Taussig shunt, transcranial Doppler measurements revealed retrograde flow in the right middle cerebral artery throughout the cardiac cycle. Further examination showed that the change in cerebral blood flow was secondary to shunt runoff and clinical correlation was noted in near infrared spectroscopy measurements of regional cerebral oxygenation saturation.