Utilization of neonatal sedation and anesthesia: an SPR survey.

Background: There is little data regarding the use of sedation and anesthesia for neonatal imaging, with practice patterns varying widely across institutions.

Objective: To understand the current utilization of sedation and anesthesia for neonatal imaging, and review the current literature and recommendations.

Materials And Methods: One thousand, two hundred twenty-six questionnaire invitations were emailed to North American physician members of the Society for Pediatric Radiology using the Survey Monkey platform.

Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma.

Background: Central nervous system (CNS) germinomas are treatment-sensitive tumors with excellent survival outcomes. Current treatment strategies combine chemotherapy with radiotherapy (RT) in order to reduce the field and dose of RT. Germinomas originating in the basal ganglia/thalamus (BGTGs) have proven challenging to treat given their rarity and poorly defined imaging characteristics.

Single lead VDD pacing in children with complete heart block.

Objective: To evaluate clinically transvenous single lead VDD pacing in children with complete heart block.

Design: Case series.

Setting: Tertiary care unit of a pediatric teaching hospital.

Will a critical level of hyperventilation-induced hypocapnia always induce an absence seizure?

We wished to determine if the degree of hypocapnia correlates with increased frequency of absence seizures and if there is a critical pCO2 at which absence seizures are reliably provoked. Twelve untreated children with newly diagnosed absence epilepsy were continuously monitored by EEG and end-expiratory CO2 recording during quiet respiration and hyperventilation (to absence seizure or exhaustion) while breathing four gas mixtures: (a) room air, (b) 100% O2, (c) 4% CO2 in room air, or (d) 4% CO2 + 96% O2). In quiet respiration, a reduction in number of spike and wave bursts and total seconds of spike and wave was noted in children breathing supplemental CO2 (gases c and d vs.

Transvenous closure of patent ductus arteriosus in a sick 2780g infant.

A three-and-a-half-month-old 2780 g critically ill infant had successful transvenous coil occlusion of a ductus arteriosus. At six-and-a-half months of age the infant died, and autopsy showed coverage of the coil on the aortic aspect and no lumenal narrowing. It was concluded that transvenous coil occlusion of the patent ductus arteriosus in small infants is possible and that th venous route is preferred to be arterial route.

Benign rolandic epilepsy: atypical features are very common.

The objective of this study was to determine the frequency of atypical clinical and electrographic features in children with benign rolandic epilepsy. A retrospective case series design was employed in the setting of a tertiary care pediatric hospital. Forty-two children with benign rolandic epilepsy were seen through our neurology department between January 1, 1991, and December 31, 1993.

Survival in neonatal congenital hernia without extracorporeal membrane oxygenation support.

The experience with high-risk congenital diaphragmatic hernia (CDH) at an institution that does not offer extracorporeal membrane oxygenation (ECMO) was reviewed. Between January 1, 1983 and December 31, 1993, 38 children presented with Bochdalek-type CDH. Excluded were two infants with lethal cardiac anomalies and four presenting after 4 hours of age.

Thrombotic complications of saphenous central venous lines.

Authors of recent publications advocate central venous access by saphenous vein cutdown in the thigh. Even relatively inert SILASTIC catheters are recognized to convey a risk of large vein thrombosis when maintained for long periods. Thrombosis of the inferior vena cava (IVC) and tributaries place the patient at risk for a spectrum of problems not associated with superior vena cava (SVC) cannulation.

Acute and chronic toxicity of antiepileptic medications: a selective review.

Acute and chronic toxicity complicates all antiepileptic medications (AED) and is idiosyncratic. Acute toxicity can be categorized into 1) acute brain dysfunction or 2) acute organ dysfunction when AED's are started. Despite promising in vitro lymphocyte testing, anticipation of acute reactions cannot be offered.

Changing pattern of clinical illness in children with group A streptococcal bacteremia.

Objective: To test the hypothesis that bacteremia caused by group A streptococci (gas) has become more common and the presentation of the infection more severe in the Izaak Walton Killam Hospital for Children during the past decade.

Design: Retrospective analysis by laboratory log and chart review.

Setting: A pediatric teaching hospital providing primary and tertiary care.

Follow-up after patch aortoplasty for coarctation of aorta.

Background: Patch aortoplasty (PA) for coarctation of aorta (COA) can lead to aneurysm formation at the repair site. X-ray, echocardiogram and computed tomography are unreliable for diagnosis of this complication.

Objective: To evaluate prospectively patients with PA for COA by magnetic resonance imaging (MRI) to detect presence of aneurysm at the repair site.

Patients' characteristics and consumer satisfaction on an inpatient child psychiatric unit.

This paper reports the results of a chart review and consumer satisfaction evaluation of referrals to a tertiary care child psychiatric inpatient unit. The evaluation involved an examination of the types of child and family difficulties treated during the period of the study; the nature and extent of assessment, treatment and follow-up; treatment outcome and parental perception of factors related to treatment outcome; and the satisfaction of both the parents and referral sources. Results indicated that children admitted for treatment were a heterogeneous group with severe difficulties from families with a number of problems.

Long term therapy of cytomegalovirus retinitis with ganciclovir in a child with acquired immunodeficiency syndrome.

Cytomegalovirus retinitis is the most severe ophthalmological complication of patients with acquired immune deficiency syndrome (aids). Ganciclovir must be given continuously to control progression of the disease or relapse typically occurs. Data in children are limited; this report describes a nine-year-old boy with transfusion-acquired aids who was treated with ganciclovir for 23 months for control of cytomegalovirus retinitis.

Inhibition of lymphocyte endothelial adhesion and in vivo lymphocyte migration to cutaneous inflammation by TA-3, a new monoclonal antibody to rat LFA-1.

Lymphocyte function-associated Ag-1 (LFA-1) or CD11a/CD18 mediates lymphocyte adhesion to cultured vascular endothelial cells (EC). Thus, LFA-1 likely plays a major role in lymphocyte migration out of the blood, but there is little information on this in vivo. Small peritoneal exudate lymphocytes (sPEL) and lymph node (LN) lymphoblasts adhere to cytokine-activated EC and preferentially migrate to cutaneous inflammatory sites.

Idiopathic dilatation of the aorta with dissection in a family without Marfan syndrome.

Dissection of the aorta is very rare in children, but classically occurs in the presence of Marfan syndrome or other connective tissue disorder. We present a case of spontaneous dissection in a 12-year-old boy whose half brother has an idiopathic dilated aorta and whose mother has also required surgery for dissection of a dilated aorta. No features of connective tissue disorder were present in any family member.

Closing wedges: a technique for repair of midline craniosynostosis.

Description of a surgical technique for sagittal and metopic synostosis utilizing closing skull wedges. The technique and results are outlined. The technique has proven effective when done by 4 months of age.

Syncope in childhood: a case control clinical study of the familial tendency to faint.

We investigated the possibility of an inherited tendency to faint by studying 30 consecutively referred well children with vasodepressor or vasovagal syncope. The family history of each patient was reviewed for syncope and for 24 cases was compared with the family history of the child's best friend. None of the best friends had syncope.

The efficacy of pulse-dosed antibiotic therapy in the management of persistent otitis media with effusion.

Consensus has been achieved supporting the efficacy of antimicrobials in the management of acute otitis media with effusion (OME). No such agreement has been reached into medical management of the patient in whom middle ear effusion (MEE) persists beyond the conventional 10- to 14-day treatment cycle. This study is designed to demonstrate the efficacy of antibiotics administered in a single daily dose in the management of persistent otitis media with effusion (POME).

Large volumes of apple juice preoperatively do not affect gastric pH and volume in children.

The effect on gastric pH and volume of 0, 6 and 10 ml.kg-1, of apple juice given 2.5 hours before surgery to children aged five to ten years was investigated in this prospective, randomized, single-blind study.

Infantile hypertrophic cardiomyopathy with QT prolongation.

A neonate presented with neonatal myocardial dysfunction and long QT interval with subsequent appearance of hypertrophic cardiomyopathy at one week of age. Maternal glucose metabolism was normal. By 15 months of age the hypertrophy had largely resolved but the long QT persisted.

Routine screening of blood and urine for severe reactions to anticonvulsant drugs in asymptomatic patients is of doubtful value.

Severe or fatal reactions to anticonvulsant agents are fortunately rare. We examined the value of routine screening of blood and urine to detect early signs of such reactions in asymptomatic patients. The basic assumptions of this type of screening program have been faulty or unproven, and the results of studies, although not definitive, have not supported the value of such programs.

Bacterial tracheitis in children.

Bacterial tracheitis is a relatively rare cause of respiratory distress in children and is associated with a high morbidity and mortality rate. Three children who have survived this affliction are presented: one developed toxic shock syndrome in the acute phase and two developed late complications. The authors review the pediatric literature and postulate possible etiological factors.

Sinus arrhythmia in children with atrial septal defect: an analysis of heart rate variability before and after surgical repair.

The expression of sinus arrhythmia depends on separation of the systemic and pulmonary venous return to the heart as well as on normal autonomic control mechanisms. Patients with atrial septal defect provide a naturally occurring experiment of communication between the two venous systems. In adults with atrial septal defect sinus arrhythmia is minimal or absent.