Recurrent acute kidney injury in preterm neonates is common and associated with worse outcomes and higher mortality.

Background: Acute kidney injury (AKI) in preterm neonates is associated with poor outcomes that may worsen in the setting of recurrent episodes of AKI. This study defines and studies the incidence, risk factors, and outcomes of recurrent AKI (rAKI).

Methods: Retrospective chart review of the neonates born at a gestational age of ≤28 weeks admitted to the neonatal intensive care unit (NICU) between January 2014 and December 2018.

Validation of Liquid Chromatography-Tandem Mass Spectrometry-Based 5-Plex Assay for Mucopolysaccharidoses.

Mucopolysaccharidoses (MPSs) are rare lysosomal storage diseases caused by the accumulation of undegraded glycosaminoglycans in cells and tissues. The effectiveness of early intervention for MPS has been reported. Multiple-assay formats using tandem mass spectrometry have been developed.

Pain Management for Nasogastric Intubation in Pediatrics.

Nasogastric (NG) intubation is a common yet one of the most uncomfortable minor procedures done in children and adults alike. A variety of analgesics, such as ketamine, lidocaine, and nitrous oxide, have been shown to reduce pain in various minor pediatric procedures. This retrospective study explores how often various pain management practices are used, either alone or in combination.

A translational cellular model to study the impact of high-frequency oscillatory ventilation on human epithelial cell function.

Unlabelled: High-frequency oscillatory ventilation (HFOV) has been proposed as gentle ventilation strategy to prevent lung injury in the preterm infant. High-frequency jet ventilation leads to dimensional and mechanical airway deformation in animal airway models, which is consistent with translational studies demonstrating the impact of oxygen and biophysical stresses on normal airway cellular function. There is an overall paucity of clinical and cellular data on the impact of HFOV on the conducting airway.

Pediatric anti-NMDA (N-methyl D-aspartate) receptor encephalitis.

Background: We report the clinical features and course of pediatric patients presenting with anti-N-methyl D-aspartate receptor (NMDA-R) encephalitis.

Methods: Single-center 4-year observational study of pediatric encephalitis associated with NMDA-R antibodies in the serum and/or the cerebrospinal fluid.

Results: Three girls with anti-NMDA-R encephalitis were identified.

The role of magnetic resonance imaging in acute cervical spine fractures.

Background Context: The role of magnetic resonance imaging (MRI) in neurologically intact cervical spine fractures is not well defined. To our knowledge, there are no studies that clearly identify the indications for MRI in this particular scenario. Controversy remains regarding the use of MRI in at-risk patients, primarily the obtunded and elderly patients.

Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressure.

Objective: To compare work of breathing (WOB) indices between two nCPAP settings and two levels of HFNC in a crossover study.

Study Design: Infants with a CGA 28-40 weeks, baseline of HFNC 3-5 lpm or nCPAP 5-6 cmH2O and fraction of inspired oxygen ≤40% were eligible. WOB was analyzed using respiratory inductive plethysmography (RIP) for each of the four modalities: HFNC 3 and 5 lpm, nCPAP 5 and 6 cmH2O.

High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model.

Introduction: High-flow nasal cannula therapy (HFNC) has been shown to be more effective than continuous positive airway pressure (CPAP) in reducing intubations and ventilator days. HFNC likely provides mechanisms to support respiratory efficiency beyond application of distending pressure. We reason that HFNC washout of nasopharyngeal dead space impacts CO(2) removal along with oxygenation.

Physiologic implications of helium as a carrier gas for inhaled nitric oxide in a neonatal model of Bethanecol-induced bronchoconstriction.

Objective: To compare heliox to nitrogen-oxygen (nitrox) as a carrier gas for inducible nitric oxide (iNO) in the presence of pharmacologically inhaled bronchoconstriction. We hypothesized that respiratory resistance and gas exchange would improve when iNO is delivered with heliox.

Design: Interventional laboratory study.

Tracheal gas insufflation-augmented continuous positive airway pressure in a spontaneously breathing model of neonatal respiratory distress.

Respiratory distress syndrome (RDS) in neonates is characterized by labored breathing and poor gas exchange, often requiring ventilatory support. Continuous positive airway pressure (CPAP) is a preferred intervention to support spontaneous ventilatory efforts by sustaining lung volume recruitment, while it prevents derecruitment during exhalation by maintaining end-expiratory pressure. However, CO2 retention during CPAP often results in the need for mechanical ventilation.

Teaching prevention in surgery--is it an oxymoron?

Although surgery is not often thought of as the optimal pathway to health, it nonetheless can play a key role in many facets of medical student education involving disease prevention. This article defines the scope of the surgeon's involvement in teaching disease prevention and health promotion to medical students, enumerates possible learning objectives that may be (and often already are) incorporated into their surgical education, and describes seven examples of programs that have used innovative methods to include prevention teaching in their surgery curricula. There should be specific educational standards regarding prevention within the curriculum of each clinical specialty, and educational programs should be evaluated with outcome measures.

Practical approach to bacterial meningitis in childhood.

The classic triad of headache, fever and nuchal rigidity that occurs in adults with bacterial meningitis is often absent in children. Evaluation of the cerebrospinal fluid remains the gold standard for the diagnosis of bacterial meningitis. The choice of antibiotic therapy is dependent on the most likely age-specific pathogen and the drug's bactericidal activity in cerebrospinal fluid.