Use of Aminophylline to Reverse Acute Kidney Injury in Pediatric Critical Care Patients.

Objective: Acute kidney injury (AKI) is a complication encountered in 18% to 51% of pediatric critical care patients admitted for treatment of other primary diagnoses and is an independent risk factor for increased morbidity and mortality. Aminophylline has shown promise as a medication to treat AKI, but published studies have shown conflicting results. Our study seeks to assess the reversal of AKI following the administration of aminophylline in critically ill pediatric patients.

Analyzing Relationships Between Economic and Neighborhood-Related Social Determinants of Health and Intensive Care Unit Length of Stay for Critically Ill Children With Medical Complexity Presenting With Severe Sepsis.

Objectives: Of the Social Determinants of Health (SDoH), we evaluated socioeconomic and neighborhood-related factors which may affect children with medical complexity (CMC) admitted to a Pediatric Intensive Care Unit (PICU) in Shelby County, Tennessee with severe sepsis and their association with PICU length of stay (LOS). We hypothesized that census tract-level socioeconomic and neighborhood factors were associated with prolonged PICU LOS in CMC admitted with severe sepsis in the underserved community.

Methods: This single-center retrospective observational study included CMC living in Shelby County, Tennessee admitted to the ICU with severe sepsis over an 18-month period.

SMAD2 and SMAD3 differentially regulate adiposity and the growth of subcutaneous white adipose tissue.

Adipose tissue is the primary site of energy storage, playing important roles in health. While adipose research largely focuses on obesity, fat also has other critical functions, producing adipocytokines and contributing to normal nutrient metabolism, which in turn play important roles in satiety and total energy homeostasis. SMAD2/3 proteins are downstream mediators of activin signaling, which regulate critical preadipocyte and mature adipocyte functions.

The Early STEPS Pilot Study: The Impact of a Brief Consultation Session on Self-reported Parenting Satisfaction.

Introduction: Evidence-based parenting interventions can augment parental knowledge and skills to reduce parental stress and increase self-efficacy, leading to improved developmental outcomes for children. However, parenting interventions are often multi-session and require considerable time commitments from parents and primary care physicians. We conducted a pilot study to evaluate the effect of a brief consultation session on self-reported parental satisfaction and to assess the feasibility and effectiveness of incorporating occupational therapists (OTs) into a low-income urban pediatric primary care setting to conduct developmental screenings.

Waitlist management in a pediatric weight management clinic: implementing an orientation session.

Background: This study evaluates implementation of an orientation session to address a waitlist of more than 2000 referrals to a pediatric weight management clinic in the Mid-South United States.

Methods: An hour-long group-based orientation to the pediatric weight management clinic was implemented to provide information about the structure and expectations of the clinic as well as education on healthy lifestyle recommendations. Families were contacted from the waitlist by telephone and invited to attend an orientation session prior to scheduling a clinic appointment.

Physiological Responses to Active Video Games Compared to Treadmill Walking and TV Watching in Obese Children and Adolescents.

The purpose of this study was to examine the physiological responses to playing different active video games (AVG), as well as document the activity level exerted during AVG in relation to treadmill walking (TM) and watching television (TV). 20 youth (age 11-17 yr) with obesity were recruited from the Healthy Lifestyle Clinic and underwent testing under six randomized conditions: 1) TM, 2) TV, 3) Fitnexx, 4) river rush (RRH), 5) reflex ridge (RFR), and 6) space pop (SP). RRH, RFR, and SP are active video games for the Xbox 360.

Particulate matter exposure predicts residence in high-risk areas for community acquired pneumonia among hospitalized children.

Particulate matter exposure is a risk factor for lower respiratory tract infection in children. Here, we investigated the geospatial patterns of community-acquired pneumonia and the impact of PM (particulate matter with an aerodynamic diameter ≤2.5 µm) on geospatial variability of pneumonia in children.

Health-Related Quality of Life of Children with Congenital Adrenal Hyperplasia: A Mixed Methods Study.

Purpose: The purpose of this study was to examine the health-related quality of life (HRQOL) of female children with CAH as reported by children and their caregivers.

Design And Methods: A convergent mixed methods design was selected whereby quantitative and qualitative results were merged to provide a comprehensive understanding of HRQOL of children. Semi-structured interviews were conducted with 20 child-caregiver dyads.

Predictors of an Extended Length of Stay following an Elective Craniotomy in Children and Young Adults.

Background: Length of stay (LOS) is now a generally accepted clinical metric within the USA. An extended LOS following an elective craniotomy can significantly impact overall costs. Few studies have evaluated predictors of an extended LOS in pediatric neurosurgical patients.

Evaluation of Outcomes Before and After Implementation of a Standardized Postoperative Care Pathway in Pediatric Posterior Spinal Fusion Patients.

Background: Standardized pathways decrease variability and improve outcomes and safety.

Purpose: The article aims to evaluate outcomes of a standardized postoperative care pathway compared with individual surgeon preference.

Methods: A review of patients prestandardization and poststandardization was performed.

Factors Associated With Return Visits at 7 Days After Hospital Discharge.

Objective: To identify variables associated with return visits to the hospital within 7 days after discharge.

Methods: We performed a retrospective study of 7-day revisits and readmissions between October 2012 and September 2015 using the Pediatric Health Information System database supplemented by electronic medical record data from a tertiary-care children's hospital. We examined factors associated with revisits among the top 10 most frequent indications for hospitalization using generalized estimating equations.

Concordance Between Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (MRI) Derived Localization of Language in a Clinical Cohort.

Transcranial magnetic stimulation (TMS) is a newer noninvasive language mapping tool that is safe and well-tolerated by children. We examined the accuracy of TMS-derived language maps in a clinical cohort by comparing it against functional magnetic resonance imaging (MRI)-derived language map. The number of TMS-induced speech disruptions and the volume of activation during functional MRI tasks were localized to Brodmann areas for each modality in 40 patients with epilepsy or brain tumor.

A hospital-based analysis of pseudomeningoceles after elective craniotomy in children: what predicts need for intervention?

Objective: In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Most will resolve with time, but some may require intervention. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or craniectomy and identified factors associated with the need for intervention.

Respiratory Syncytial Virus Disease Severity Is Associated with Distinct CD8 T-Cell Profiles.

Respiratory syncytial virus (RSV) causes significant morbidity and mortality in infants worldwide. Although T-helper type 2 (Th2) cell pathology is implicated in severe disease, the mechanisms underlying the development of immunopathology are incompletely understood. We aimed to identify local immune responses associated with severe RSV in infants.

Shunt Failure-The First 30 Days.

Background: Incontrovertible predictors of shunt malfunction remain elusive.

Objective: To determine predictors of shunt failure within 30 d of index surgery.

Methods: This was a single-center retrospective cohort study from January 2010 through November 2016.

Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department.

Introduction: Pain management is a critical aspect of effective long bone fracture treatment. Pediatric patients frequently report suboptimal pain management, which is an area of growing public concern. The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures ≤47 minutes of emergency department arrival.

Elevated Levels of Type 2 Respiratory Innate Lymphoid Cells in Human Infants with Severe Respiratory Syncytial Virus Bronchiolitis.

Studies of the immune responses at the site of respiratory syncytial virus (RSV) infection are sparse despite nearly five decades of research into understanding RSV disease. To investigate the role of mucosal innate immune responses to RSV and respiratory viral load in infants hospitalized with the natural disease. Cytokines, viral load, and type 2 innate lymphoid cell (ILC2) levels in nasal aspirates, collected within 24 hours of enrollment, from infants hospitalized with RSV infection were quantified.

Peripheral venous hypertension in chronic venous disease.

Background: Microvascular venous hypertension has emerged as a central feature of chronic venous disease (CVD). Yet, the incidence and severity of peripheral venous hypertension in the clinical setting have not been reported. This is an observational study of venous hypertension in the lower limb of a large cohort of patients with suspected CVD referred to a single referral center during a 16-year period.

Big Data Research in Pediatric Neurosurgery: Content, Statistical Output, and Bibliometric Analysis.

Background/aims: We sought to describe pediatric "big data" publications since 2000, their statistical output, and clinical implications.

Methods: We searched 4 major North American neurosurgical journals for articles utilizing non-neurosurgery-specific databases for clinical pediatric neurosurgery research. Articles were analyzed for descriptive and statistical information.

High acetylsalicylic acid dosing in infants after modified Blalock-Taussig shunt.

Objective: Shunt-related adverse events are frequent in infants after modified Blalock-Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock-Taussig.

Psychosocial Functioning After One Year of Interdisciplinary Pediatric Weight Management.

Youth with obesity are more likely than normal-weight peers to experience psychosocial problems. Empirically-based recommendations for addressing pediatric obesity include intensive interdisciplinary weight management comprising medical, behavioral health, nutrition, and exercise components. The present study examined changes in psychosocial functioning associated with frequency of participation in an interdisciplinary pediatric weight management program.

Lowering systolic blood pressure does not increase stroke risk: an analysis of the SPRINT and ACCORD trial data.

Objective: Traditional neurology teaching states that when mean arterial pressure dips below a 60 mm Hg threshold, there is an increase in stroke risk due to cerebral hypoperfusion. The aim of this study was to determine whether intensive lowering of systolic blood pressure increases adverse cardiovascular outcomes by examining the association between achieved blood pressure values, specifically mean arterial pressure and pulse pressure, and risk of stroke.

Methods: Data from participants in the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure (BP) trial were examined, using survival analysis to model minimal arterial pressure and average pulse pressure during the study period against risk of stroke, hypotension, and syncope, with death as a competing risk.

Socio-demographic, maternal, and child indicators of socioemotional problems in 2-year-old children: A cohort study.

Throughout infancy and early childhood, stable and secure relationships with caregivers are needed to promote optimal socioemotional (SE) and cognitive development.The objective is to examine socio-demographic, maternal, and child indicators of SE problems in 2-year-olds living in an urban-suburban community in the southern United States.Mother-infant pairs enrolled in a prospective pregnancy cohort study.

The Preventable Shunt Revision Rate: A Multicenter Evaluation.

Background: The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric.

Objective: To evaluate the PSRR across multiple centers and determine associated variables.

Methods: Nine participating centers in North America provided at least 2 years of consecutive shunt operations.

Platelet Transfusions in the PICU: Does Disease Severity Matter?

Objectives: Pediatric intensivists frequently prescribe platelet transfusions to critically ill children, but there are limited data on platelet transfusion practice and platelet transfusion-related outcomes in the PICU. In this study, we evaluated the current platelet transfusion practice and platelet transfusion-related outcomes in the PICU.

Design: Institutional review board-approved, retrospective cohort study from January 2010 to March 2016.