Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation.

Objectives: To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates.

Study Design: This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 24 to 27 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group).

MRI scanner-independent specific absorption rate measurements using diffusion coefficients.

Objective: The purpose of this study was to measure specific absorption rate (SAR) during MRI scanning using a human torso phantom through quantification of diffusion coefficients independently of those reported by the scanner software for five 1.5 and 3 T clinical MRI systems from different vendors.

Methods: A quadrature body coil transmitted the RF power and a body array coil received the signals.

Reduced and Compressed Cisplatin-Based Chemotherapy in Children and Adolescents With Intermediate-Risk Extracranial Malignant Germ Cell Tumors: A Report From the Children's Oncology Group.

Purpose To investigate whether event-free survival (EFS) can be maintained among children and adolescents with intermediate-risk (IR) malignant germ cell tumors (MGCT) if the administration of cisplatin, etoposide, and bleomycin (PEb) is reduced from four to three cycles and compressed from 5 to 3 days per cycle. Patients and Methods In a phase 3, single-arm trial, patients with IR MGCT (stage II-IV testicular, II-III ovarian, I-II extragonadal, or stage I gonadal tumors with subsequent recurrence) received three cycles of PEb. A parametric comparator model specified that the observed EFS rate should not be significantly < 92%.

Tight Glycemic Control in Critically Ill Children.

Background: In multicenter studies, tight glycemic control targeting a normal blood glucose level has not been shown to improve outcomes in critically ill adults or children after cardiac surgery. Studies involving critically ill children who have not undergone cardiac surgery are lacking.

Methods: In a 35-center trial, we randomly assigned critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4.

Outcomes of Extremely Preterm Infants Born to Insulin-Dependent Diabetic Mothers.

Background And Objective: Little is known about in-hospital morbidities and neurodevelopmental outcomes among extremely preterm infants born to women with insulin-dependent diabetes mellitus (IDDM). We examined risks of mortality, in-hospital morbidities, and neurodevelopmental outcomes at 18 to 22 months' corrected age between extremely preterm infants of women with insulin use before pregnancy (IBP), with insulin use started during pregnancy (IDP), and without IDDM.

Methods: Infants 22 to 28 weeks' gestation born or cared for at a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network center (2006-2011) were studied.

Pediatric Hospital Discharges to Home Health and Postacute Facility Care: A National Study.

Importance: Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children.

Objective: To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children.

Revised risk classification for pediatric extracranial germ cell tumors based on 25 years of clinical trial data from the United Kingdom and United States.

Purpose: To risk stratify malignant extracranial pediatric germ cell tumors (GCTs).

Patients And Methods: Data from seven GCT trials conducted by the Children's Oncology Group (United States) or the Children's Cancer and Leukemia Group (United Kingdom) between 1985 and 2009 were merged to create a data set of patients with stage II to IV disease treated with platinum-based therapy. A parametric cure model was used to evaluate the prognostic importance of age, tumor site, stage, histology, tumor markers, and treatment regimen and estimate the percentage of patients who achieved long-term disease-free (LTDF) survival in each subgroup of the final model.

Spinal muscular atrophy: therapeutic strategies.

Spinal muscular atrophy is caused by mutations in the survival motor neuron 1 (SMN1) gene, leading to the reduction of SMN protein. The loss of alpha motor neurons in the ventral horn of the spinal cord results in progressive paralysis and premature death. There is no current treatment other than symptomatic and supportive care, although over the past decade, there has been an outstanding advancement in understanding the genetics and molecular mechanisms underlying the physiopathology of SMA.

Cost analysis of tonsillectomy in children using medicaid data.

Objective: To evaluate the cost-effectiveness of adenotonsillectomy (T&A) for adenotonsillar hypertrophy and recurrent tonsillitis through the use of Missouri Medicaid data.

Study Design: Children ages 2-16 years who had a diagnosis of adenotonsillar hypertrophy (based on medical claim codes) in 2006 (n = 4276) were included in this population-based study. The main outcome was direct total costs paid by Medicaid.

Chemotherapy for Generalized Infantile Myofibromatosis With Visceral Involvement.

Infantile myofibromatosis (IM) is most commonly limited to cutaneous lesions that resolve spontaneously. However, generalized IM with visceral involvement, which has a reported mortality rate as high as 73%, has been successfully treated with a combination of methotrexate and vinblastine. Here we report the further efficacy of low-dose methotrexate and vinblastine in 2 pediatric patients with IM and visceral involvement and review the literature describing chemotherapy for these patients.

Recent advances in transplantation for primary immune deficiency diseases: a comprehensive review.

Hematopoietic cell transplantation (HCT) is a curative therapeutic option for severe combined immunodeficiency (SCID), a group of diseases which otherwise carry life expectancies that are of limited duration and quality. Survival following HCT for SCID has improved from approximately 23 to 91 % over the last 40 years. Success with SCID prompted efforts to apply HCT to the therapeutic challenge of well over 20 molecularly defined primary immune deficiency diseases (PID).

Anesthesiology residents' medical school debt influence on moonlighting activities, work environment choice, and debt repayment programs: a nationwide survey.

Background: The amount of education debt incurred by medical school graduates in the United States has grown considerably over the last 30 years; it has outpaced inflation to reach a mean of $158,000. With this dramatic increase in education debt, there has been limited information on how medical school debt loads of anesthesiology physicians impact their decisions concerning moonlighting and future career choices. Our aim was to survey current anesthesiology interns, residents, and fellows to assess the correlation between the amount of medical school debt they had collected and (1) their outlook toward moonlighting activities, (2) future career plans, and (3) choice of employer with a debt repayment program.

Management of single-ventricle patients with Berlin Heart EXCOR Ventricular Assist Device: single-center experience.

There are minimal data regarding chronic management of single-ventricle ventricular assist device (VAD) patients. This study aims to describe our center's multidisciplinary team management of single-ventricle patients supported long term with the Berlin Heart EXCOR Pediatric VAD. Patient #1 was a 4-year-old with double-outlet right ventricle with aortic atresia, L-looped ventricles, and heart block who developed heart failure 1 year after Fontan.

Hospital volume, hospital teaching status, patient socioeconomic status, and outcomes in patients hospitalized with sickle cell disease.

Sickle cell disease (SCD) accounts for ~100,000 hospitalizations in the US annually. Quality of care for hospitalized SCD patients has been insufficiently studied. Therefore, we aimed to examine whether four potential determinants of quality care, [1] hospital volume, [2] hospital teaching status, [3] patient socioeconomic status (SES), and [4] patient insurance status, are associated with three quality indicators for patients with SCD: [1] mortality, [2] length of stay (LOS), and [3] hospitalization costs.

Counterregulation between the FcepsilonRI pathway and antiviral responses in human plasmacytoid dendritic cells.

Plasmacytoid dendritic cells (pDCs) play essential roles in directing immune responses. These cells may be particularly important in determining the nature of immune responses to viral infections in patients with allergic asthma as well those with other atopic diseases. The purposes of this study were 1) to compare the functional capacity of pDCs in patients with one type of allergic disorder, allergic asthma, and controls; 2) to determine whether IgE cross-linking affects antiviral responses of influenza-exposed pDCs; and 3) to determine whether evidence of counterregulation of FcepsilonRIalpha and IFN-alpha pathways exists in these cells.

Secondary nocturnal enuresis caused by central sleep apnea from Chiari malformation type 1.

Objective: To report a novel cause of nocturnal enuresis (NE) and highlight the literature giving insight into this novel mechanism.

Patient: A 12-year-old morbidly obese female with 2-year history of nightly secondary monosymptomatic NE.

Results: On evaluation, a history of severe sleep disturbed breathing was elicited.

Respiratory syncytial virus persistence in the lungs correlates with airway hyperreactivity in the mouse model.

Background: Previous studies in mice showed that respiratory syncytial virus (RSV) infection was associated with RSV RNA persistence. This study was designed to characterize the significance of RSV RNA persistence and its relation to RSV-induced chronic airway disease.

Methods: Mice were inoculated with live RSV, UV light-treated RSV, heat-inactivated RSV, or medium.

Management of penile curvature in children.

Purpose Of Review: Ventral penile curvature occurs in both hypospadias and so-called 'chordee without hypospadias', and so its correction is a topic of relevance to pediatric urologists.

Recent Findings: Dorsal plication and ventral corporal incision with grafting are the two most commonly used methods to straighten ventral penile curvature. Urethral plate elevation from the corpora has previously been reported to reduce bending, and in the past year this maneuver has been combined with ventral corporal grafting or with dissection of the formed urethra to the bulb to achieve straightening while conserving the plate for urethroplasty.

Diagnostic virology practices for respiratory syncytial virus and influenza virus among children in the hospital setting: a national survey.

A survey was sent to the emergency room and laboratory directors of 400 randomly selected US hospitals to assess the diagnostic testing practices for respiratory syncytial virus and influenza virus in children. The results demonstrate that the majority of hospitals routinely perform viral testing for both viruses and use virology testing practices appropriate for the reasons reported for testing.

Scrotal exploration for unilateral nonpalpable testis.

Purpose: We previously reported initial scrotal exploration for unilateral nonpalpable testis, followed by laparoscopy when a viable testis was not found. Although we concluded that scrotal exploration could often make laparoscopy unnecessary, the knowledge that patients with presumed nubbins would undergo laparoscopy meant that the surgeon did not have to decide whether findings were definitive. In a second series of consecutive patients laparoscopy was used only when it appeared indicated.

Bladder neck sling and appendicovesicostomy without augmentation for neurogenic incontinence in children.

Purpose: Most children undergoing bladder neck sling for neurogenic urinary incontinence also have undergone bladder augmentation. However, complications from enterocystoplasty and uncertainty regarding its indication during bladder outlet enhancement led us to perform slings without augmentation. Herein we report outcomes in consecutive patients.

Multivariate analysis of factors predicting success with dextranomer/hyaluronic acid injection for vesicoureteral reflux.

Purpose: Factors influencing outcomes of dextranomer/hyaluronic acid injection for vesicoureteral reflux remain poorly defined. We performed multivariate analysis of the experience of 1 surgeon (WS).

Materials And Methods: The study group contained 168 patients and 259 refluxing units.

Serum response factor regulates a muscle-specific microRNA that targets Hand2 during cardiogenesis.

Gradients of signalling and transcription factors govern many aspects of embryogenesis, highlighting the need for spatiotemporal control of regulatory protein levels. MicroRNAs are phylogenetically conserved small RNAs that regulate the translation of target messenger RNAs, providing a mechanism for protein dose regulation. Here we show that microRNA-1-1 (miR-1-1) and miR-1-2 are specifically expressed in cardiac and skeletal muscle precursor cells.