Reducing Patient Length of Stay After Surgical Correction for Neuromuscular Scoliosis.

Background: Surgical correction remains the most effective treatment of patients with severe neuromuscular scoliosis (NMS). However, postoperative inpatient clinical care after spinal surgery for NMS patients is highly complex and variable, depending on the provider and/or institution. Our project used a quality improvement methodology to implement a standardized clinical care pathway for NMS patients during their primary spinal surgery, with the global aim of decreasing postoperative hospitalized length of stay (LOS).

A Retrospective Study Identifying Breast Milk Feeding Disparities in Infants with Cleft Palate.

Background: Breast milk represents the optimal substrate for all infants, including those with a cleft palate for whom growth may be compromised.

Objectives: Frequency of breast milk feeding at the breast and per feeder (bottle, cup, enteral tube) in infants with cleft palate was determined and compared with rates reported by the Centers for Disease Control and Prevention. A secondary aim was to review growth status of the infants.

Prevalence of Vitamin D Deficiency in Pediatric Patients With Scoliosis Preparing for Spinal Surgery.

Background: Establishing prevalence of vitamin D deficiency in elective scoliosis surgery may impact clinical outcomes. The objectives of this study were to document vitamin D status of patients with scoliosis preparing for surgical intervention in order to establish frequency of deficiency and determine characteristics influencing levels.

Methods: Records were queried for patients with scoliosis diagnosis who underwent posterior spinal fusion or initial growing rod placement and had serum vitamin 25 hydroxyvitamin D (D25) recorded in the preoperative period.

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.

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.

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.

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.

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.

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.

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.

A microbiologic study of enteral feeding hang time in a burn hospital: can feeding costs be reduced without compromising patient safety?

Background: Procedural changes for hospitalized patients must always balance safety with fiscal constraints. Microbiologic contamination of enteral feeding solutions has been previously associated with nosocomial infections. Formula manipulation and hang time contribute to microbial load, and there is considerable variation in hang time recommendations in the medical literature.

Hypovitaminosis D in acutely injured pediatric burn patients.

Problem: The prevalence of vitamin D insufficiency, its etiology, and associated sequelae among acutely injured burn patients is unknown.

Objective: This study assessed vitamin D and endocrine status, as well as the effect of anabolic agents, in pediatric patients who had sustained burns in excess of 25% total body surface area (TBSA).

Subjects: Sixty-nine patients with a mean TBSA burn of 50.

Four-year review of burns as an etiologic factor in the development of long bone fractures in pediatric patients.

Reduced bone density has been documented in children after burns. This loss of bone may place children at heightened risk for fractures. The medical records of all acutely injured patients with burns in excess of 40% TBSA burn admitted to our institution between January 1, 1997, through December 31, 2000, were reviewed for fracture incidence.

The 2002 Moyer Award. Metabolic effects of vitamin D on serum calcium, magnesium, and phosphorus in pediatric burn patients.

Severe burn injury results in profound metabolic derangements. Recently, we have shown that vitamin D metabolism is disturbed after burn injury. Vitamin D is essential for calcium and phosphorus homeostasis and skeletal bone integrity.

The 2002 Clinical Research Award. An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns.

Early enteral support is believed to improve gastrointestinal, immunological, nutritional, and metabolic responses to critical injury; however, this premise is in need of further substantiation by definitive data. The purpose of this prospective study was to examine the effectiveness and safety of early enteral feeding in pediatric patients who had burns in excess of 25% total body surface area. Seventy-seven patients with a mean percent total body surface area burn of 52.