Associated medical conditions among 10-year-old children with oral clefts - a retrospective review across three cleft centres: Part 2.

Introduction In many cases, children with oral clefts present with accompanying medical conditions. These associated conditions can add complexity to the patient's dental management, both in terms of their treatment need and risk. Recognition and careful consideration of associated medical conditions is therefore crucial in providing safe and effective care for these patients.

Dental anomalies in cleft lip and/or palate children at age 10 - a retrospective review across three cleft centres: Part 1.

Introduction Children with oral clefts often present with dental anomalies which can impact function, aesthetics and complicate the patient's dental treatment and needs. An understanding of potential anomalies, along with early recognition and planning, is thus essential for effective care.Aim This paper is the first in a two-part three-centre series.

Cost analysis of hospitals performing continuous albuterol in non-intensive care settings.

Objective: To compare hospital costs and resource utilization for pediatric asthma admissions based on the hospitals' availability of continuous albuterol aerosolization administration (CAA) in non-intensive care unit (ICU) settings.

Methods: We conducted a retrospective cohort study of children ages 2-17 years admitted in 2019 with a principal diagnosis of asthma using the Pediatric Health Information System. Hospitals and hospitalizations were categorized based on location of CAA administration, ICU-only versus general inpatient floors.

Reducing Avoidable Transfer Delays in the Pediatric Intensive Care Unit for Status Asthmaticus Patients.

Introduction: Status asthmaticus (acute severe asthma) is one of the most common reasons for Pediatric Intensive Care Unit (PICU) admission. Accordingly, ensuring optimal throughput for patients admitted with status asthmaticus is essential for optimizing PICU capacity. Few studies specifically address effective methods to reduce delays related to PICU discharge.

Sugammadex to Reverse Neuromuscular Blockade Prior to Withdrawal of Life Support.

In certain end-of-life scenarios, pharmacologic reversal of neuromuscular blockade may be indicated. However, given the depth of blockade frequently necessitated in the ICU setting, rapid reversal of neuromuscular blockade is generally not feasible with conventional reversal agents such as neostigmine that inhibit acetylcholinesterase. Sugammadex is a novel pharmacologic agent for the reversal of neuromuscular blockade that acts by directly encapsulating steroidal neuromuscular blocking agents and providing effective 1:1 binding of rocuronium or vecuronium.

Elevated endotracheal tube cuff pressure in the pediatric emergency department.

Objective: The objective of this study was to evaluate endotracheal tube cuff pressure after emergency intubation and identify variables associated with an elevated cuff pressure.

Methods: This was a prospective cohort study of intubated patients in the emergency department of Nationwide Children's Hospital. The primary study outcome, cuff pressure, was measured via manometer.

Safe Interfacility Transport of Pediatric Patients: Medical Control Training, an Interdisciplinary Approach.

Introduction: Critically ill children who require transfer to tertiary care centers often require transport by specialized transport teams (TT). These interfacility transports require a medical control physician (MCP). Traditionally this role is assigned to fellows who are taught "on-the-job", but achieving competency in communication for those trained this way may not be optimal.

Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal.

Objectives: Dexmedetomidine use in pediatric critical care is increasing. Its prolonged effects as a single continuous agent for sedation are not well described. The aim of the current study was to describe prolonged dexmedetomidine therapy without other continuous sedation, specifically the hemodynamic effects, discontinuation strategies, and risk factors for withdrawal.

Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation.

Pediatric lung transplantation is a life-saving intervention for children with irreversible end-stage lung disease. Access to transplant can be limited by geographic isolation from a center or the presence of comorbidities affecting transplant eligibility. Extracorporeal membrane oxygenation (ECMO)-supported patients are an uncommon but historically high-risk cohort of patients considered for lung transplant.

Pediatric Extracorporeal Membrane Oxygenation Transport by EC-145 With a Custom-Built Sled.

Indications for the use of extracorporeal membrane oxygenation (ECMO) in pediatrics has expanded beyond the initial historic treatment of neonates with respiratory failure. Patients with severe refractory cardiopulmonary failure may benefit from ECMO support until the primary insult has subsided or been treated. More recently, ECMO has been used by some centers as a bridge to transplant for irreversible organ failure.

Baclofen Toxicity Responsive to Hemodialysis in a Pediatric Patient with Acute Kidney Injury.

 Baclofen (para-chlorophenyl-gamma-aminobutyric acid) is widely used for its therapeutic effect of providing muscle relaxation from the persistent muscle spasms and posturing often related to spinal and central nervous system injuries. However, baclofen is also a potent neuronal depressant which is most evident in cases of toxicity. In severe toxicity, respiratory failure and obtundation may occur.

Dexmedetomidine Infusion to Control Agitation due to Anticholinergic Toxidromes in Adolescents, a Case Series.

Dexmedetomidine is an α2-adrenergic agonist approved by the US Food and Drug Administration for the sedation of adults who are intubated on mechanical ventilation and in non-intubated adults who are undergoing surgical procedures. However, it has also recently become a commonly used sedative agent in varied clinical settings for the pediatric patient as well. We present the use of dexmedetomidine for sedation in a unique clinical scenario, the severely agitated and combative patient following the intentional misuse of anticholinergic drugs.

The lethargic diabetic: cerebral edema in pediatric patients in diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) is the leading cause of hospitalizations for pediatric patients with diabetes mellitus. The most severe complication of DKA is cerebral edema that may lead to brain herniation. We present a case report that highlights the subclinical presentation of DKA-related cerebral edema in a pediatric patient and review the acute care management of suspected cerebral edema during transport.

Listeria meningitis-associated bradyarrhythmia treated with isoproterenol.

In the setting of increased intracranial pressure (ICP), various rhythm disturbances have been associated, ranging from tachyarrhythmias to bradyarrhythmias with atrioventricular dissociation. Although most of these observations have been in patients with traumatic brain injuries, it is known that children with acute bacterial meningitis may also have severe intracranial hypertension. We present the case of a previously healthy 2-year-old boy diagnosed with listeria meningitis.

High-efficiency transduction of liver cancer cells by recombinant adeno-associated virus serotype 3 vectors.

Recombinant vectors based on a non-pathogenic human parvovirus, the adeno-associated virus 2 (AAV2) have been developed, and are currently in use in a number of gene therapy clinical trials. More recently, a number of additional AAV serotypes have also been isolated, which have been shown to exhibit selective tissue-tropism in various small and large animal models. Of the 10 most commonly used AAV serotypes, AAV3 is by far the least efficient in transducing cells and tissues in vitro as well as in vivo.

Human hepatocyte growth factor receptor is a cellular coreceptor for adeno-associated virus serotype 3.

Adeno-associated viruses (AAVs) use a variety of cellular receptors/coreceptors to gain entry into cells. A number of AAV serotypes are now available, and the cognate receptors/coreceptors for only a handful of those have been identified thus far. Of the 10 commonly used AAV serotypes, AAV3 is by far the least efficient in transducing cells in general.