Minimal Changes In Pediatric

Objective: To determine if increasing positive end expiratory pressure (PEEP) leads to a change in cardiac index in children with Pediatric Acute Respiratory Distress Syndrome ranging from mild to severe. Design: Prospective interventional study. Setting: Multidisciplinary Pediatric Intensive Care Unit in a University teaching hospital. Patients: Fifteen intubated children (5 females, 10 males) with a median age of 72 months (IQR 11, 132) and a median weight of 19.3 kg (IQR 7.5, 53.6) with a severity of Pediatric Acute Respiratory Distress Syndrome that ranged from mild to severe with a median lung injury score of 2...

BACKGROUND: Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children. METHODS: Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1...

OBJECTIVES: We performed preclinical validation of intraoperative fiber-optic confocal microscopy (FCM) and assessed its safety and efficacy in an ovine model of the pediatric heart. METHODS: Intraoperative imaging was performed using an FCM system (Cellvizio, Mauna Kea Technology, Paris, France) with specialized imaging miniprobe (GastroFlex UHD, Mauna Kea Technologies). Before imaging, we applied an extracellular fluorophore, sodium fluorescein, to fluorescently label extracellular space...

PURPOSE: The Cerebral Palsy Profile of Health and Function (CP-PRO) Computerized Adaptive Tests (CAT) are quality of life measures developed specifically for use in children with cerebral palsy. This study examined the ability of the upper-extremity (UE) CP-PRO CAT to detect change in function after UE surgery compared with the Pediatric Outcomes Data Collection Instrument (PODCI), ABILHAND-Kids, and Box and Blocks test. METHODS: From 2009 to 2013, children with cerebral palsy who had UE musculoskeletal surgery completed the UE CP-PRO CAT, PODCI-UE, ABILHAND-Kids, and Box and Blocks tests before surgery (97 children) and at 3 postoperative intervals: 6 months (80 children), 12 months (73 children), and 24 months (52 children)...

To compare the newborn infant parasympathetic evaluation system (NIPE) scores with a validated clinical scale using two different nebulizers in children with bronchiolitis admitted to a PICU. Comfort was evaluated using the COMFORT-behavior scale (CBS) before (T1), during (T2) and after (T3) each nebulization. In order to compare NIPE and CBS values during the whole T1 to T3 period, the variable Dif-CBS was defined as the difference between maximal and minimal CBS scores, and Dif-NIPE as the difference between 75th and 25th percentile NIPE values...

Pregnancy presents a window of opportunity for effecting positive change in the lives of women with opioid use disorder (OUD). Care should be empathetic and nonjudgmental with a focus on counseling for initiation and maintenance of beneficial health behaviors as well as development of a strong patient-provider relationship.1 These include adherence to treatment of OUD through pharmacotherapy and behavioral counseling, smoking cessation, healthy nutrition, treatment of coexisting medical and psychosocial conditions, as well as preparation for the postpartum period through breastfeeding education and antenatal discussion of contraception...

BACKGROUND: The use of insulin pumps in pediatric patients with type 1 diabetes (T1D) has expanded; however, data comparing devices remain scarce. We compared glycemic control, technical difficulties, and quality of life (QOL) between pump devices of three companies. METHODS: This prospective observational trial is based on clinical data retrieved during 12 months of follow-up of pediatric patients who started pump therapy as part of their clinical care in four medical centers...

Background: Although the Fitkids Treadmill Test (FTT) has been validated and normative values are available for 6- to 18-year-old children who are healthy, these facts do not automatically imply an uptake of the test in the day-to-day practice of physical therapists. Objective: The objectives of this study were to evaluate the utility of the FTT in different diagnostic groups and to explore potential factors affecting the use of the FTT in clinical practice. Design: Mixed methods with both quantitative and qualitative data were used in this study...

INTRODUCTION: Guidelines recommend true whole body (TWB) FDG-PET/CT scans from vertex to toes in paediatric lymphoma patients, although this suggestion has not been validated in large clinical trials. The objective of the study is to evaluate the incidence and clinical impact of lesions outside the "eyes to thighs" regular field of view (R-FOV) in FDG-PET/CT staging (sPET) and interim (iPET) scans in paediatric lymphoma patients. MATERIALS AND METHODS: TWB sPET and iPET scans were prospectively performed in paediatric lymphoma patients (11 worldwide centres)...

OBJECTIVES: To evaluate the effect of implementation of a comfort algorithm on infusion rates of opioids and benzodiazepines in postneonatal postoperative pediatric cardiac surgery patients. DESIGN: A quality improvement project, using statistical process control methodology. SETTING: Twenty-five-bed tertiary care pediatric cardiac ICU in an urban academic Children's hospital. PATIENTS: Postoperative pediatric cardiac surgery patients...

OBJECTIVES: To characterize the short-term prognosis of a clinical population of pediatric and young adult patients with migraine and explore predictors of clinical worsening while in care. METHODS: This was a retrospective study of all migraine patients seen at the Cincinnati Children's Hospital Headache Center from 09/01/2006 to 12/31/2017, who had at least 1 follow-up visit within 1-3 months of the index visit analyzed. Included data were: age, sex, race, primary ICHD diagnosis, chronic migraine, medication overuse, history of status migrainosus, BMI percentile, headache frequency, headache severity, PedMIDAS score, allodynia, preventive treatment type, lifestyle habits, disease duration, depressive and anxiety symptoms...

OBJECTIVE: To investigate 24-hour ambulatory blood pressure changes 6 months after surgery among children with obstructive sleep apnea. STUDY DESIGN: Prospective interventional study. SETTING: Tertiary medical hospital. SUBJECTS AND METHODS: Children aged 4 to 16 years with symptoms of obstructive sleep apnea (apnea-hypopnea index >1) were recruited. All children underwent adenotonsillectomy and postoperative polysomnography overnight...

Importance: Pediatric guidelines for the management of nonalcoholic fatty liver disease (NAFLD) recommend a healthy diet as treatment. Reduction of sugary foods and beverages is a plausible but unproven treatment. Objective: To determine the effects of a diet low in free sugars (those sugars added to foods and beverages and occurring naturally in fruit juices) in adolescent boys with NAFLD. Design, Setting, and Participants: An open-label, 8-week randomized clinical trial of adolescent boys aged 11 to 16 years with histologically diagnosed NAFLD and evidence of active disease (hepatic steatosis >10% and alanine aminotransferase level ≥45 U/L) randomized 1:1 to an intervention diet group or usual diet group at 2 US academic clinical research centers from August 2015 to July 2017; final date of follow-up was September 2017...

STUDY DESIGN: Single-center retrospective study. OBJECTIVE: To analyze two-year postoperative outcomes following spinopelvic fixation in pediatric patients using the anatomic trajectory (AT) portal for iliac screws. SUMMARY: Iliac fixation is crucial in situations requiring fusion to sacrum. Challenges include complex anatomy, pelvic deformation, severe deformity, and previous surgery. The PSIS portal requires significant dissection, rod connectors, and complex bends...

OBJECTIVES: Pediatric pain management has rapidly changed over the last 2 decades. In this study, we describe the changing practices and adverse events (AEs) related to patient-controlled analgesia (PCA) and/or nurse-controlled analgesia (NCA) over a 22-year period. METHODS: After institutional review board approval, retrospective data from a single tertiary-care pediatric hospital were collected between 1994 and 2016. Subgroup analyses were done for surgical and medical case patients...

Traditionally, drug discovery and development research have been primarily focused on the mitigation of disease treatment for the general adult population, often overlooking the medical needs of pediatric patients. While remarkable progress toward the discovery of better medicines has been made, the pharmacological differences between children and adults are often neglected as part of the translation process. In fact, until recently, children have been considered therapeutic orphans due to the lack of significant drug discovery, formulation development, and dosage form design specifically tailored for pediatric patients...

BACKGROUND: Potential neurocognitive dysfunction after chemotherapy is a worrisome long-term outcome. Our objective was to evaluate the effect on brain metabolism in pediatric patients with non-central nervous system cancer treated with chemotherapy by analyzing brain data from serial whole-body fluorodeoxyglucose positron emission tomography/computed-tomography (FDG-PET/CT) scans taken before and sequentially after therapy. METHODS: Fourteen pediatric patients diagnosed with lymphoma and treated with systemic and prophylactic intrathecal chemotherapy were included...

PURPOSE: Advances in the treatment of pediatric medulloblastoma have led to improved survival rates, though treatment-related toxicity leaves children with significant long-term deficits. There is significant variability in the cognitive outcome of medulloblastoma survivors, and it has been suggested that this variability may be attributable to genetic factors. The aim of this study was to explore the contributions of single nucleotide polymorphisms (SNPs) in two genes, peroxisome proliferator activated receptor (PPAR) and glutathione-S-transferase (GST), to changes in general intellectual functioning in medulloblastoma survivors...

In the United States, youth participation in sports continues to increase yearly. This increase in participation, in conjunction with the trend toward early sports specialization and year round training, has led to a similar increase in athletically developed injuries. These injuries vary in nature and acuity, with the type of injury often related to the athlete's age, sport, and level of training. Endurance athletes are at an elevated risk of injury as they frequently push their body to the limit during their arduous training...

Renal biopsy is an important tool for the diagnosis of acute and chronic glomerular diseases in children. We aimed to analyze the spectrum of clinical indications and histopathological patterns (HPP) in children who underwent renal biopsy (RB). This is a retrospective review of case records of 108 renal biopsies carried out from January 2010 to December 2015 at the Pediatric Nephrology Department, National Institute of Child Health Karachi, Pakistan. RB was performed under Ketamine-Midazolam sedation and real-time ultrasound...