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Pediatric Center (pediatric + center)
Selected AbstractsEffects of socioeconomic status on presentation with acute lower respiratory tract disease in children in Salvador, Northeast BrazilPEDIATRIC PULMONOLOGY, Issue 4 2002Cristiana M. Nascimento-Carvalho MD Abstract Two different socioeconomic groups of children with pneumonia were studied, and their clinical and demographic aspects were evaluated. The diagnosis of pneumonia was based on findings of cough and tachypnea, or on crackles on auscultation or on radiologically confirmed infiltrate. This was a prospective cross-sectional study conducted at the Professor Hosannah de Oliveira Pediatric Center, which cares for children of lower socioeconomic status (PHOPC), and at one private hospital which cares for children from middle to high socioeconomic status (Aliança Hospital, AH). Demographics and clinical differences were assessed by the Pearson chi-square test or Fisher's exact test as appropriate; means of continuous variables were compared by Mann-Whitney U-test. In a 26-month period, 3,431 cases were recruited. The 2,476 cases identified at the PHOPC were younger than the 955 identified at AH (2.2,±,2.3 vs. 4.5,±,3.1 years, P,<,0.0001) and had higher scores for severity (3.5,±,1.5 vs. 2.7,±,1.7, P,<,0.0001), duration of hospitalization (days) (10.9,±,12.1 vs. 6.2,±,7, P,<,0.0001), frequency of tobacco smoker in the household (48% vs. 31%, P,<,0.0001), cardiopathy (15.3% vs. 5.9%, P,=,0.003), fever (44.4% vs. 36.3%, P,=,0.0001), tachypnea (67.6% vs. 32.3%, P,<,0.0001), crackles (69.5% vs. 64.9%, P,=,0.02), somnolence (19.9% vs. 10.4%, P,<,0.0001), malnutrition (13.7% vs. 5%, P,<,0.0001), hospitalization rate (27.4% vs. 22.5%, P,=,0.003), and death (0.9% vs. 0.1%, P,=,0.009). However, other features were more frequent among AH cases: parent's university level of education (38.2% vs. 1.0%, P,<,0.0001), underlying chronic illness (40.6% vs. 28.5%, P,<,0.0001), asthma (62.7% vs. 50.8%, P,=,0.01), rhinitis (9.2% vs. 0.4%, P,<,0.0001), previous use of antibiotics (34.3% vs. 27.1%, P,=,0.001), and wheezing (53.1% vs. 42.2%, P,<,0.0001). Children of lower socioeconomic status have more serious lower respiratory tract disease, whereas children with pneumonia of middle to high socioeconomic status have more allergic diseases (rhinitis, asthma) and wheezing. Pediatr Pulmonol. 2002; 33:244,248. © 2002 Wiley-Liss, Inc. [source] Infliximab improves inflammation and anthropometric measures in pediatric Crohn's diseaseJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2010Daniel M Sinitsky Abstract Background and Aim:, Infliximab (IFX) is a monoclonal antibody licensed to treat medically refractory Crohn's disease (CD). Our aim was to elucidate the effects of IFX therapy on clinical, growth and serum parameters in children with CD in a single pediatric center in Sydney, Australia. Methods:, A retrospective case series review of children treated with IFX for CD at Sydney Children's Hospital, Australia was undertaken, with a review of outcomes after starting IFX. Main outcome measures were response and remission (as measured according to improvements in Pediatric Crohn's Disease Activity Index scores and Physician Global Assessment), laboratory markers (C-reactive protein, erythrocyte sedimentation rate, hemoglobin, white cell count, lymphocytes, neutrophils, platelets, albumin) and growth (Z scores). Results:, The 16 patients included had a mean age at first infusion of 13.0 years (1.25,17.5 years). Six of 12 patients (with adequate data available) were in remission at 2 weeks following the first infusion. At 1 year, 10 of 12 patients (83%) were in remission. Mean C-reactive protein and erythrocyte sedimentation rate had fallen significantly (P < 0.05) at 2 weeks (from 29 to 7 mg/L and 40 to 19 mm/h, respectively). Positive trends were observed for all other parameters, excluding lymphocytes and white cell count. At 1 year, mean Z score for body mass index improved significantly from ,0.9 to ,0.1 (P < 0.01). Conclusions:, Disease activity subsides in most children treated with IFX for CD. IFX therapy also improves some growth parameters. The pattern of improvement requires further elucidation, as the results in the present study suggest differing dosing frequency of infusion may achieve better efficacy. [source] Acute adenitis in children: Clinical course and factors predictive of surgical drainageJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5-6 2005Thuy Mai Luu Objectives:, To describe clinical course of children hospitalized for a first episode of acute unilateral infectious adenitis and to identify factors predictive of surgical lymph node drainage. Methods:, We reviewed medical records of children from 0 to 17 years of age discharged from a tertiary care pediatric center with a diagnosis of adenitis between 1 April 1996 and 31 March 2001. Patients were included if they had acute (,10 days) unilateral lymph node swelling greater or equal to 2.5 cm on initial physical examination. Exclusion criteria were: bilateral adenitis or adenitis at more than one site; prior adenitis; underlying chronic disease. Results:, Two hundred and eighty-four patients were included in this study. The mean age was 4.0 years (3.1 SD). Twenty-three per cent of infected nodes were >5 cm in size and 92.6% were cervical. Thirteen of 252 blood cultures were positive (5.2%), of which one showed Streptococcus pneumoniae and 12 contaminants. Mean length of stay was 4.2 days (2.2 SD). Surgical node drainage was performed in 60 (21.1%) patients. Factors significantly associated with increased risk of surgical drainage were age <1 year (adjusted OR: 14.5; 95% CI: 5.0,42.2) and node involvement >48 h (adjusted OR: 2.9; 95% CI: 1.2,7.2). There were no major complications. Follow-up was documented in 183 patients, of whom 92.3% achieved complete healing. Conclusions:, Children hospitalized for a first episode of acute unilateral infectious adenitis generally do well. Younger patients and those with longer duration of node involvement before admission have an increased risk of surgical node drainage. [source] Day hospital versus inpatient management: An economic initiative of a pediatric center, examplified on uncomplicated vaso-occlusive crises of children with sickle cell diseasePEDIATRIC BLOOD & CANCER, Issue 3 2008Paul Imbach MD No abstract is available for this article. [source] Outcomes of kidney transplantation in children with nephronophthisis: An analysis of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) RegistryPEDIATRIC TRANSPLANTATION, Issue 8 2008Lorraine A. Hamiwka Abstract:, NPHP is an autosomal recessive chronic tubulointerstitial nephropathy that progresses to ESRD. In the 2006 NAPRTCS report, NPHP was the primary diagnosis in 2.8% of all renal transplant patients. At our pediatric center, that covers a population in which the NPHP1 gene is prevalent, 24% of transplant recipients had a primary diagnosis of NPHP. Since no previous literature reports have documented kidney transplant outcomes in patients with NPHP, a review of the 2006 NAPRTCS database was performed. The results of this review illustrate that patients with NPHP as their underlying kidney disease have a significantly better overall graft survival when compared with all other patients registered in the NAPRTCS database. Sub-analysis demonstrated that this benefit is statistically significant only for LD kidney transplant recipients. CrCl was better in NPHP at all time points from transplant up to five-yr follow-up. Moreover, in NPHP LD transplant recipients the decline of CrCl over five yr was slower compared with non-NPHP LD transplant recipients. Rates of thrombosis, acute, and chronic rejection as well as causes of graft failure were similar in NPHP patients and all other patients. This review demonstrates that NPHP transplant recipients have excellent outcomes that are shown to be better compared with the general pediatric transplant population. [source] Current Kidney Allocation Rules and Their Impact on a Pediatric Transplant CenterAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009E. C. Abraham In 2005, kidney allocation rules in the United States were updated to enhance access to kidneys from young adult deceased donors (DDs) for pediatric recipients. We studied how this rule change affected transplant activity at our pediatric center. We retrospectively compared kidney transplant activity at our center since the rule change (until December 31, 2007) to before the change (n = 36 each), focusing on those recipients directly affected by it, that is, younger than 18 years. There were no significant differences in recipients' age, gender or ethnicity before versus after the rule change. Percentages of preemptive transplants and retransplants were similar in both groups, as was the percentage of sensitized patients. There was a significant decrease in overall, but not DD, mean donor age. Mean wait time for DD kidneys decreased for pediatric recipients. Increases were found in percentage of DD transplants and in mean HLA mismatches after the rule change. Patient and short-term graft survival were not significantly different. These data suggest that the allocation rule change was not only followed by improvement in overall access to kidney transplantation for children, but also by decreases in living donor transplants and HLA matching. Larger studies are needed to evaluate the long-term impact of the change. [source] External Validation of the Clinical Dehydration Scale for Children With Acute GastroenteritisACADEMIC EMERGENCY MEDICINE, Issue 6 2010Benoit Bailey MD Abstract Objectives:, The objective was to validate the clinical dehydration scale (CDS) for children with gastroenteritis in a different pediatric emergency department (ED) from where it was initially derived and validated. Methods:, A prospective cohort study was performed in a tertiary care pediatric ED over a 1-year period. A sample of triage nurses were trained in applying the CDS. The CDS consists of four clinical characteristics (general appearance, eyes, mucous membranes, and tears), each of which are scored 0, 1, or 2 for a total score of 0 to 8, with 0 representing no dehydration; 1 to 4, some dehydration; and 5 to 8, moderate/severe dehydration. Children 1 month to 5 years of age with vomiting and/or diarrhea who had the CDS documented at triage and a final diagnosis of gastroenteritis, gastritis, or enteritis were enrolled. Exclusion criteria included a chronic disease, treatment with intravenous (IV) rehydration within the previous 24 hours, visit to the ED for the same illness in the 7 days prior to arrival, and diarrhea of more than 10 days' duration. The primary outcome was the length of stay (LOS) in the ED from the time of seeing a physician to discharge, analyzed with a Kruskal-Wallis test. Results:, From April 2008 to March 2009, 150 patients with a mean (±SD) age of 22 (±14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26,175 minutes), 128 minutes (IQR = 25,334 minutes), and 425 minutes (IQR = 218,673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001). Conclusions:, The CDS has been further validated in children with gastroenteritis in a different pediatric center than the original one where it was developed. It is a good predictor of LOS in the ED after being seen by a physician. ACADEMIC EMERGENCY MEDICINE 2010; 17:583,588 © 2010 by the Society for Academic Emergency Medicine [source] Liver transplantation in neonatesLIVER TRANSPLANTATION, Issue 8 2003Shikha S. Sundaram Orthotopic liver transplantation (OLT) has evolved over the past two decades to become the standard of care for end-stage liver disease in infants and children. Technical advances, particularly the use of technical variant allografts, have permitted extension of OLT into a much younger and smaller population than previously possible. Major centers around the world now routinely perform OLT in infants with survival success equivalent to that in older children and adults. We are beginning to see a small population of school-aged children who were infant OLT recipients. The further extension of OLT into neonates is more recent, with only a few pediatric centers reporting survival success. Very little is known about this frontier of transplantation. Our intent is to provide an overview of neonatal OLT using all available data and our experience in the field [source] Familial neuroendocrine cell hyperplasia of infancy,,PEDIATRIC PULMONOLOGY, Issue 8 2010J. Popler MD Abstract Background Neuroendocrine cell hyperplasia of infancy (NEHI) is a recently described children's interstitial lung disease (chILD) disorder of unknown etiology. It manifests clinically with tachypnea, retractions, hypoxemia, and crackles. The characteristic radiographic appearance consists of pulmonary hyperexpansion and ground-glass densities on high-resolution computed tomography (HRCT). Lung histology shows hyperplasia of bombesin-immunopositive neuroendocrine cells within distal bronchioles and alveolar ducts without other identifiable lung pathology or developmental anomaly. Methods We describe four families with multiple siblings diagnosed with NEHI. Cases were identified at three pediatric centers. Inclusion criteria included clinical findings consistent with NEHI, lung biopsy confirmation in the index case, and a diagnostic HRCT or biopsy in other siblings. Results Each family had a proband diagnosed with NEHI based upon pathologic review, and at least one additional sibling diagnosed either by pathologic review or HRCT. All patients presented between 2 and 15 months of age. Both male and female children were affected. The majority of the patients underwent both HRCT and lung biopsy. There were no deaths among affected children. No environmental exposures or other potential etiologies were identified as a cause of presenting symptoms. Conclusions The familial occurrence of NEHI suggests the possibility of a genetic etiology for this disorder and highlights the importance of taking a complete family medical history for infants presenting with a suggestive clinical picture. Identification of familial NEHI patients allows for the opportunity to further our understanding of this disorder, its natural history, the phenotypic spectrum, and potential genetic causes. Pediatr. Pulmonol. 2010; 45:749,755. © 2010 Wiley-Liss, Inc. [source] A national conference to determine research priorities in pediatric solid organ transplantationPEDIATRIC TRANSPLANTATION, Issue 2 2008Sharon M. Bartosh Abstract:, The need for evidence-based practice guidelines requires high quality, carefully controlled clinical research trials. This multidisciplinary conference attempted to: identify urgent clinical and research issues, identify obstacles to performing clinical trials, develop concepts for organ-specific and all-organ research and generate a report that would serve as a blueprint for future research initiatives. A few themes became evident. First, young children present a unique immunologic environment which may lead to tolerance, therefore, including young children in immunosuppression withdrawal and tolerance trials may increase the potential benefits of these studies. Second, adolescence poses significant barriers to successful transplantation. Non-adherence may be insufficient to explain poorer outcomes. More studies focused on identification and prevention of non-adherence, and the potential effects of puberty are required. Third, the relatively naive immune system of the child presents a unique opportunity to study primary infections and alloimmune responses. Finally, relatively small numbers of transplants performed in pediatric centers mandate multicenter collaboration. Investment in registries, tissue and DNA repositories will enhance productivity. The past decade has proven that outcomes after pediatric transplantation can be comparable to adults. The pediatric community now has the opportunity to design and complete studies that enhance outcomes for all transplant recipients. [source] Children with Bacterial Meningitis Presenting to the Emergency Department during the Pneumococcal Conjugate Vaccine EraACADEMIC EMERGENCY MEDICINE, Issue 6 2008Lise E. Nigrovic MD Abstract Background:, The epidemiology of bacterial meningitis in children in the era of widespread heptavalent conjugate pneumococcal vaccination (PCV7) is unknown. Objectives:, The objective was to describe the epidemiology of bacterial meningitis in children presenting to the emergency department (ED) during the era of widespread PCV7 vaccination. Methods:, The authors retrospectively reviewed the medical records of all children aged 1 month to 19 years with bacterial meningitis who presented to the EDs of 20 U.S. pediatric centers (2001,2004). Bacterial meningitis was defined by a positive cerebrospinal fluid (CSF) culture for a bacterial pathogen or CSF pleocytosis (CSF white blood cell [WBC] count ,10 cells/mm3) in association with either a positive blood culture or a CSF latex agglutination study. Results:, A total of 231 children with bacterial meningitis were identified. The median age was 0.6 years (interquartile range [IQR] = 0.2,4.2). Eight patients (3% of all patients) died. The following bacterial pathogens were identified: Streptococcus pneumoniae (n = 77; 33.3%), Neisseria meningitidis (67; 29.0%), Group B Streptococcus (42; 18.2%), Escherichia coli (17; 7.4%), nontypeable Haemophilus influenzae (10; 4.3%), other Gram-negative bacilli (7; 3.0%), Listeria monocytogenes (5; 2.2%), Group A Streptococcus (5; 2.2%), and Moraxella catarrhalis (1; 0.4%). S. pneumoniae serotypes were determined in 37 of 77 patients; of these, 62% were due to nonvaccine serotypes (including 19A). Conclusions:, Although now a rare infectious disease in United States, bacterial meningitis still causes substantial morbidity in affected children. Despite the introduction of PCV7, S. pneumoniae remains the most common cause of bacterial meningitis in U.S. children, with approximately half of cases due to nonvaccine serotypes. [source] Executive Summary: The Institute of Medicine Report and the Future of Academic Emergency Medicine: The Society for Academic Emergency Medicine and Association of Academic Chairs in Emergency Medicine Panel: Association of American Medical Colleges Annual Meeting, October 28, 2006ACADEMIC EMERGENCY MEDICINE, Issue 3 2007Daniel A. Handel MD The findings in the Institute of Medicine's Future of Emergency Care reports, released in June 2006, emphasize that emergency physicians work in a fragmented system of emergency care with limited interhospital and out-of-hospital care coordination, too few on-call specialists, minimal disaster readiness, strained inpatient resources, and inadequate pediatric emergency services. Areas warranting special attention at academic medical centers (AMCs), both those included within the report and others warranting further attention, were reviewed by a distinguished panel and include the following: 1) opportunities to strengthen and leverage the educational environment within the AMC emergency department; 2) research opportunities created by emergency medicine (EM) serving as an interdisciplinary bridge in the area of clinical and translational research; 3) enhancement of federal guidelines for observational and interventional emergency care research; 4) recognition of the importance of EM residency training, the role of academic departments of EM, and EM subspecialty development in critical care medicine and out-of-hospital and disaster medicine; 5) further assessment of the impact of a regional emergency care model on patient outcomes and exploration of the role of AMCs in the development of such a model (e.g., geriatric and pediatric centers of EM excellence); 6) t e opportunity to use educational loan forgiveness to encourage rural EM practice and the development of innovative EM educational programs linked to rural hospitals; and 7) the need to address AMC emergency department crowding and its adverse effect on quality of care and patient safety. Strategic plans should be developed on a local level in conjunction with support from national EM organizations, allied health care, specialty organizations, and consumer groups to help implement the recommendations of the Institute of Medicine report. The report recommendations and other related recommendations brought forward during the panel discussions should be addressed through innovative programs and policy development at the regional and federal levels. [source] Arterial-venous fistulas following pediatric liver transplant case studiesPEDIATRIC TRANSPLANTATION, Issue 6 2007Kathleen Falkenstein Abstract:, AV fistula is a rare but serious complication following pediatric liver transplant and may lead to graft loss. Our aim was to describe two pediatric centers' experience with the diagnosis, treatment and outcomes of children who presented with AV fistulas post-liver transplantation We report five cases of late arterio-portal fistula following liver transplantation. Four children were successfully treated with coil embolization. All of the children in this series had liver biopsies within 2,6 months of their AV fistula diagnosis. All biopsies were performed using a Bard Monopty 18 gauge needle with no ultrasound guidance and only one pass per biopsy. Two children also had PTC 4,8 months prior to their diagnosis of AV fistula. Three of the five children in this series had GI bleeds requiring banding or sclerotherapy. The other two had varices found on CT scan. All five cases in this series had ascites on their initial presentation. Four out of the five children had a history of non-compliance and the other child had a history of malabsorption and chronic diarrhea. [source] | ||||||||||