Pain-related hospitalization and emergency room visit following initial analgesic prescription after outpatient surgery.

Purpose: Our study examined the association between outpatient postsurgical analgesic prescription and risk of insufficiently managed pain characterized by pain-associated hospital admission and emergency room (ER) visit.

Methods: Eligible individuals were children 1-17 years of age who filled an incident analgesic following an outpatient surgery during 2013-2018. Pain-associated hospital admission or ER visit were measured within 30 days following the outpatient surgical procedure.

Ketamine for Pain in Sickle Cell Disease Reduces Opioid Usage.

Context: Pain attributable to sickle cell disease (SCD) is often unpredictable, recurrent, and requires complex treatments. Subanesthetic ketamine infusion has been studied in other diseases and disorders, but there is still limited data on its efficacy in pain management for SCD.

Objectives: The primary objective is to determine if subanesthetic ketamine infusion reduces pain scores and opioid requirements in hospitalized pediatric patients with SCD.

Trends in Repeat Opioid Analgesic Prescription Utilization for Acute Pain in Children: 2013-2018.

Objective: Our study examined the change in repeat opioid analgesic prescription trends in children and adolescents experiencing acute pain between 2013 and 2018.

Methods: Eligible individuals were children and adolescents between 1 and 17 years of age enrolled in a Medicaid Managed Care plan and filled an incident opioid analgesic prescription from 2013 to 2018. A repeat opioid prescription was defined as receiving a subsequent opioid prescription within 30 days from the end of the incident opioid prescription.

Association Between Initial Opioid Prescription Duration and 30-Day Risk of Receiving Repeat Opioid Among Children.

Objective: Our study evaluated the association between initial opioid prescription duration and receipt of a repeat opioid prescription in children.

Methods: Eligible individuals were children between 1 and 17 years of age who enrolled in a Medicaid Managed Care plan and filled an incident opioid prescription during 2013 to 2018. An incident prescription was defined as receipt of an opioid analgesic without a prior use for 12 months.

Pediatric Palliative Care Pharmacy Pearls-A Focus on Pain and Sedation.

Determining the optimal dosing regimen for pediatric patients is a challenge due to the lack of dosing guidelines and studies. In addition, many developmental pharmacology changes that occur throughout childhood that have profound impacts on the absorption, distribution, metabolism, and elimination of medications are commonly used in palliative care. Adding to that complexity, certain medications have different effects in the pediatric patient compared to the adult patient.

Intranasal Fentanyl Use in Neonates.

The recent addition of intranasal medication options for procedural sedation and analgesia has decreased the need for additional painful procedures such as intravenous lines for medication administration. Intranasal fentanyl (INF) has been used in the prehospital setting, as well as in the emergency department for several years, and is increasingly utilized in other locations such as the neonatal intensive care unit (NICU). A paucity of data exists in these smallest children, so we sought to explore trends in INF use in our NICU.

Human Milk Use in the Preoperative Period Is Associated with a Lower Risk for Necrotizing Enterocolitis in Neonates with Complex Congenital Heart Disease.

Objective: To evaluate the hypothesis that feeding volumes exceeding 100 mL/kg/d and exposure to cow's milk formula preoperatively increase the risk for preoperative necrotizing enterocolitis (NEC) in infants with complex congenital heart disease.

Study Design: All infants, of any gestational age, with an isolated cardiac lesion at high risk for NEC (ductal-dependent lesions, transposition of the great arteries, truncus arteriosus, and aorto-pulmonary window) admitted to Texas Children's Hospital from 2010 to 2016 were included. NEC was defined based on the modified Bell criteria.

Effect of Exogenous Antithrombin Administration on Anti-Xa Levels in Infants Treated With Enoxaparin.

Objectives: Determine the effect of exogenous antithrombin III administration on low molecular weight heparin anti-Xa levels in the context of enoxaparin dosing in infants.

Methods: A retrospective chart review of infants receiving concomitant antithrombin III and enoxaparin. The primary objective of this study was to determine the median change in anti-Xa level with antithrombin III supplementation.

Pharmaceutical considerations with conjoined twins.

Sharing of the vascular system in conjoined twins creates pharmaceutical dilemmas that require individualization of protocols. One of the major goals for the medical team is to determine how medications should be administered, dosed, and monitored in each set of conjoined twins. In order to achieve these goals, the team must determine the extent of shared circulation, volume of distribution, effectiveness of enteral absorption, renal clearance, and develop processes to ensure medication safety.

Phenobarbital population pharmacokinetics across the pediatric age spectrum.

Objective: Phenobarbital is frequently used in pediatric patients for treatment and prophylaxis of seizures. Pharmacokinetic data for this patient population is lacking and would assist in dosing decisions.

Methods: A retrospective population pharmacokinetic analysis was designed for all pediatric patients <19 years of age initiated on phenobarbital at our institution from January 2011 to June 2017.

Organochlorine pesticides in surface waters from Reloncaví Fjord and the inner sea of Chiloé (~39.5°S - 43°S), Chilean Patagonia.

Surface water samples from the environmental continuum spanning rivers (Petrohue, Cochamo, Puelo), fjord (Reloncaví), and the inner sea of Chiloé in Chilean Patagonia were analyzed to estimate concentration and distribution of dissolved Organochlorine pesticides (OCPs). High concentrations of HCHs, DDTs and endosulfan found in surface waters from rivers suggest that rivers are the major source of dissolved OCPs to coastal marine ecosystems. We interpret variations in the distribution and concentration as an apparent oscillation between rain and snow-scavenging processes that might determine the type of OCPs that can be preferentially deposited on mountains, glaciers, rivers, estuaries, and finally transferred to the marine realm.

Occurrence and Distribution of Deltamethrin and Diflubenzuron in Surface Sediments from the Reloncaví Fjord and the Chiloé Inner-Sea (~ 39.5ºS -43ºS), Chilean Patagonia.

Surface sediments from Reloncaví Fjord and the Chiloé inner sea in Chilean Patagonia were extracted and analyzed to estimate deltamethrin and diflubenzuron levels. These antiparasitary pesticides have been used for decades in the salmon industry. Relationships were determined between pesticide concentrations and organic carbon percent in sediments.

Use of Vasopressin in Neonatal Intensive Care Unit Patients With Hypotension.

Objective: To evaluate the safety and efficacy of vasopressin for the treatment of hypotension in patients admitted to neonatal intensive care units (NICUs).

Methods: Vasopressin use in 69 infants admitted to our NICU between 2011 and 2014 was examined. Data evaluated included demographics; serum creatinine, sodium, and lactate concentrations; urine output; and systolic, diastolic, and mean blood pressures (BPs).

Evaluation of the Effects of Extracorporeal Membrane Oxygenation on Antiepileptic Drug Serum Concentrations in Pediatric Patients.

Objectives: Patients supported on extracorporeal membrane oxygenation (ECMO) have an increased incidence of seizures. Phenobarbital (PB) and fosphenytoin (fos-PHT) are common antiepileptic drugs (AEDs) used to manage seizures in the pediatric population; however, it is unknown what effect ECMO has on the serum concentrations of AEDs. The purpose of this study is to evaluate the effect of ECMO on AED serum concentrations.

Stability and Sterility of Enoxaparin 8 mg/mL Subcutaneous Injectable Solution.

Enoxaparin is often diluted to accurately deliver doses to neonatal and infant patients. Current recommendations for dilutions may not be adequate for the smallest patients. Review of dosing at our institution occurred, and an 8 mg/mL concentration of enoxaparin was chosen.

Evaluating the safety of intermittent intravenous sildenafil in infants with pulmonary hypertension.

Objective: To compare the occurrence of hypotension following administration of intermittent intravenous (IV) and enteral sildenafil for treatment of pulmonary hypertension (PH) in infants. We hypothesized there may be more adverse effects associated with intermittent IV sildenafil compared with enteral sildenafil.

Methods: This was a retrospective matched-cohort study conducted in a tertiary care children's hospital.

Should we still use vitamin A to prevent bronchopulmonary dysplasia?

Bronchopulmonary dysplasia (BPD) is associated with significant short- and long-term morbidity in preterm infants, and it can be prevented in some infants with vitamin A prophylaxis. Vitamin A, once widely used in neonatal intensive care, was scarce for the last few years, but has become available again at a much higher price, leading to dilemmas about its routine use. In this review we discuss experimental, clinical and socioeconomic evidence related to BPD, and provide a framework for clinicians and policy-makers to evaluate the value of vitamin A treatment and make decisions about its use for prevention of BPD.

Micronutrient requirements of high-risk infants.

Micronutrient requirements are well-established for healthy full-term infants. However, few such recommendations exist for high-risk infants, including full-term infants with a variety of medical disorders or very preterm infants. Key micronutrients considered in this review are calcium, phosphorus, magnesium, iron, and zinc.

Inhibitory effects on esterase enzymes buche and ache in rainbow trout (Oncorhyncus mykiss) produced by the slow release insecticide chitosan diethyl phosphate.

The study on the toxicity of chitosan diethyl phosphate (ChDP), a controlled release insecticide, on the activities of butyrylcholinesterase (BuChE) and acetylcholinesterase (AChE) in rainbow trout exposed to this pesticide was carried out. It was found that ChDP reduced BuChE activity in O. mykiss by a factor of eight at 6 days, with high fluctuation to the end of the exposition time at 12 days.