Impact of multiple organ system dysfunction and nosocomial infections on survival of children treated with extracorporeal membrane oxygenation after heart surgery.

Objectives: To evaluate whether cardiac and noncardiac variables may be used to predict survival in children treated with extracorporeal membrane oxygenation (ECMO) after cardiopulmonary bypass and to determine when to discontinue ECMO support.

Design: Retrospective review.

Setting: Neonatal and pediatric intensive care units of Kosair Children's Hospital.

Can peak expiratory flow predict airflow obstruction in children with asthma?

Study Objectives: A recent trend in the treatment of asthma has been the widespread, independent use of peak expiratory flow (PEF). We examined whether PEF monitoring creates inaccuracies in assessment of children with moderate to severe asthma.

Methods: We compared the negative predictive value of PEF in relation to the forced expiratory volume in 1 second (FEV(1)), and to the forced expiratory flow between 25% and 75% of the vital capacity (FEF(25-75%)) at different levels of air trapping as determined by the residual volume over total lung capacity ratio (RV/TLC).

Orbital ganglioglioma arising from ectopic neural tissue.

Purpose: To report a case of neonatal orbital ganglioglioma originating from ectopic neural tissue.

Method: Case report.

Results: An African-American male presented at birth with proptosis and expansion of the left orbit.

Oral ketamine/midazolam is superior to intramuscular meperidine, promethazine, and chlorpromazine for pediatric cardiac catheterization.

Unlabelled: An IM combination of meperidine, promethazine, and chlorpromazine (DPT) has been given as sedation for pediatric procedures for more than 40 years. We compared this IM combination to oral (PO) ketamine/midazolam in children having cardiac catheterization. A total of 51 children, ages 9 mo to 10 yr, were enrolled and randomized in this double-blinded study.

Fetal membrane histology in preterm premature rupture of membranes: comparison to controls, and between antibiotic and placebo treatment. The National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network, Bethesda, MD, USA.

The objectives of this study were to test the hypotheses that antibiotic therapy will alter the histologic appearance of fetal membranes in preterm premature rupture of membranes (pPROM), and that the membrane histology will demonstrate distinct differences between term and preterm rupture of membranes. We also wished to test interobserver variability of pathologists. Placental membranes were sampled from 268 women participating in a randomized placebo-controlled trial of antibiotic therapy for pPROM at 24-32 weeks of gestation (cases) and from 4 control groups who were not in the randomized trial: (1) preterm labor without pPROM (n = 21), (2) term labor (n = 65), (3) term PROM (n = 21), and (4) term cesarean section (n = 27).

Auditory brainstem evoked responses and temperature monitoring during pediatric cardiopulmonary bypass.

Purpose: To examine the effects of temperature on auditory brainstem responses (ABRs) in infants during hypothermic cardiopulmonary bypass for total circulatory arrest (TCA). The relationship between ABRs (as a surrogate measure of core-brain temperature) and body temperature as measured at several temperature monitoring sites was determined.

Methods: In a prospective, observational study, ABRs were recorded non-invasively at normothermia and at every 1 or 2 degrees C change in ear-canal temperature during cooling and rewarming in 15 infants (ages: 2 days to 14 months) that required TCA.

Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane.

We prospectively studied one hundred ASA physical status I-II children, ages six months to six years, undergoing myringotomy surgery. Children were randomly assigned to one of four anaesthetic groups receiving either halothane or sevoflurane for anaesthesia and oral midazolam premedication or no premedication. We found that children anaesthetized with sevoflurane had significantly faster recovery times and discharge home times than those who received halothane.

Treatment of childhood acute immune thrombocytopenic purpura with anti-D immune globulin or pooled immune globulin.

Objective: To evaluate the effectiveness of initial treatment of children with acute immune thrombocytopenic purpura (ITP) with anti-D immune globulin (anti-D) or pooled IgG immune globulin (IVIg).

Study Design: The medical charts of 33 children diagnosed with acute ITP from May 1995 to October 1997 were reviewed. Patient data were eligible for analysis if, for the new diagnosis of acute ITP, the patient had received either anti-D at 45 to 50 microg/kg (WinRho SD, NABI) or IVIg at 0.

Ivemark's renal-hepatic-pancreatic dysplasia: analytic approach to a perinatal autopsy.

A case of Ivemark's renal-hepatic dysplasia syndrome is presented. The findings are suggestive of a ductal obstructive process anatomically located at the junction of ducts with the parenchyma. The differential diagnosis includes Meckel syndrome, short rib polydactyly syndromes, and glutaric aciduria type 2.

Endometrial stromal sarcoma involving the placenta.

This report presents two cases of endometrial sarcoma tumor detected in decidua submitted with placentas for pathologic evaluation. The first patient had low-grade endometrial stromal sarcoma discovered in the omentum and decidua at the time of a cesarean section for placenta previa. The second patient underwent a cesarean section for breech presentation and was noted to have a mass beneath the placenta that was histologically compatible with low-grade endometrial stromal sarcoma.

Parent relationships and compliance in cystic fibrosis.

Introduction: Marital adjustment, family characteristics, and parent-child stress and compliance with treatment were investigated in 41 families with a preadolescent child (age 3 to 11 years) who had cystic fibrosis (CF).

Method: Mothers completed the Dyadic Adjustment Scale, the Family Adaptability and Cohesion Evolution Scale, and the short form of the Parenting Stress Index. Parents and medical staff completed questionnaires assessing the child's compliance with diet/nutritional intake, vitamins, pancreatic enzymes, other medications (such as oral antibiotics), and chest physiotherapy.

Central venous catheter bloodstream infections in the neonatal intensive care unit.

Purpose: The goal of this study was to identify symptoms and signs related to central venous catheter (CVC) bloodstream infections (BSI) in neonatal intensive care unit (NICU) patients that would predict infection and to identify factors that might influence CVC longevity.

Methods: This was a retrospective cohort study evaluating 268 lines representing a total of 5,212 CVC days placed in 157 NICU patients over 29 months by the pediatric surgery and neonatology services at one children's hospital. Centers for Disease Control (CDC) criteria were used to determine laboratory-confirmed BSI.

Standardizing the care of bronchiolitis.

Objective: To study the effect of an educational intervention on the management of hospitalized infants with bronchiolitis.

Design: Sequential, prospective cohort study.

Setting: A 235-bed children's hospital with nearly all private rooms.

Two fetal deaths associated with maternal sepsis and with thrombosis of the intervillous space of the placenta.

The placental pathology in two second trimester fetal losses associated with mild maternal disseminated intravascular coagulation are reported. Case one had a dental abscess, a leukocytosis of 36300 white blood cells/m, and evidence of mild consumptive coagulopathy at 20 weeks. Case two had septic findings including disseminated intravascular thrombosis associated with pyelonephritis.

Humoral factor in children with neonatal Bartter syndrome reduces bone calcium uptake in vitro.

The neonatal Bartter syndrome (NBS) is associated with a complex disorder of mineral metabolism in children, including hypercalciuria, nephrocalcinosis, and diminished bone mineral density. Although cyclooxygenase inhibition usually brings about improvement in these findings, there is a variable component which is resistant to such therapy in many children. The factor mediating this disorder has not been identified.

Varicella-zoster virus: infection, control, and prevention.

Varicella-zoster virus is a herpes virus that produces a primary infection, chickenpox, manifested by a vesicular eruption and is considered one of the common childhood infectious diseases. After the initial infection the virus becomes latent, then when activated it is manifested as herpes zoster, commonly known as shingles. This highly communicable human disease is associated with serious morbidity and significant mortality, particularly among the immunocompromised.

Evaluation of post extracorporeal membrane oxygenation follow-up testing.

The purpose of this study was to evaluate all post extracorporeal membrane oxygenation (ECMO) tests for their ability to detect any change in the incidence of unanticipated medical problems, and their charge to the patient. The current post ECMO protocol consists of the following tests: brain stem auditory evoked response, head computed tomography, cerebral blood flow, head ultrasonography, electroencephalography, eye examination for retinopathy of prematurity, and pneumocardiography. A retrospective review was conducted for all surviving neonatal ECMO patients treated from January, 1985, to December, 1994.

Diagnosis and management of congenital hypothyroidism.

Thyroid hormones are integral to the development and maturation of the central nervous system as well as normal growth and development. Comprehensive knowledge of the maturation and function of the thyroid gland is essential to understanding the pathophysiology of thyroid dysfunction. Early diagnosis and appropriate treatment in thyroid disease are imperative for normalization of thyroid hormone ratios.

Specimen collection and preparation in fine-needle aspirations in children.

Fine-needle aspiration is of proven benefit in the pediatric population. For the procedure to be of maximum benefit, several aspects unique to children and pediatric lesions must be taken into account. Based on the experience of approximately 2,500 fine-needle aspirations performed in children over a 17-year period, we discuss techniques pertaining to specimen collection and preparation, including adequate control of the patient and selective triage of aspirates.

Survival of patients with congenital diaphragmatic hernia during the ECMO era: an 11-year experience.

Background/purpose: Congenital diaphragmatic hernia (CDH) is associated with significant mortality and morbidity. To evaluate the impact of extracorporeal membrane oxygenation (ECMO) on survival, a review of our experience with CDH patients was initiated.

Methods: The authors performed a retrospective nonrandomized analysis of 98 consecutive CDH patients who were ECMO candidates, and were symptomatic within the first day of life, and underwent repair between May 1985 and May 1996.

Perioperative considerations in a newly described subtype of congenital long QT syndrome.

An infant with a newly-described subtype of congenital long QT syndrome is presented, along with her perioperative management on three separate occasions. During each anaesthetic characteristic arrhythmias occurred. The available literature and rational approaches to these high risk patients are reviewed.