Evaluation of Inpatient Starter Parenteral Nutrition Use in the Neonatal Intensive Care Unit
Objective: Parenteral nutrition (PN) promotes growth and development in neonatal patients while avoiding malnutrition and metabolic derangements. Very low birth weight premature infants should be started on PN within 24 to 48 hours after birth. The objective of this study was to compare starter PN solution use at a freestanding children's hospital health care system before and after the development of a standard starter PN protocol. The secondary objective was to evaluate the estimated annual cost savings due to a standard protocol.
Methods: A single-center, retrospective chart review of neonates who received starter PN in the NICU setting from October through December 2020 after the implementation of the protocol was conducted. The protocol was developed based on usage trends from October through December 2019. Starter PN use was compared within neonatology groups before and after the development of a standardized protocol.
Results: In 2019, 108 neonates weighing <1.8 kg were admitted to the NICUs, while 101 were admitted in 2020. However, 170 neonates received starter PN in 2019, while only 94 neonates received starter PN in 2020. Overall, protocol adherence was 88%. The mean gestational age for patients who were initiated on starter PN decreased from 31 weeks in the pre-protocol group to 28 weeks in the post-protocol group (p < 0.001). The mean birth weight pre-protocol was 1.61 kg, which decreased to a mean of 1.23 kg in the post-protocol group (p < 0.001). The estimated annual cost savings for the inpatient pharmacy department was approximately $13,000 with the initiation of a standard protocol.
Conclusions: The implementation of a standard starter PN protocol decreased usage and variability in NICU practice and aligned more with the American Society for Parenteral and Enteral Nutrition recommendations.
Kayla Novick
M Petrea Cober
J Pediatr Pharmacol Ther
. 2022;27(6):524-528. doi: 10.5863/1551-6776-27.6.524. Epub 2022 Aug 19.
2022
English
The effect of stiffness and hole size on nipple compression in infant suckling
During infant feeding, the nipple is an important source of sensory information that affects motor outputs, including ones dealing with compression of the nipple, suction, milk bolus movement, and swallowing. Despite known differences in behavior across commercially available nipples, little is known about the in vivo effects of nipple property variation. Here we quantify the effect of differences in nipple stiffness and hole size on an easily measured metric representing infant feeding behavior: nipple compression. We bottle-fed 7-day old infant pigs (n = 6) on four custom fabricated silicone nipples. We recorded live X-ray fluoroscopic imaging data of feeding on nipples of two levels of hardness/stiffness and two hole sizes. We tested for differences in nipple compression at the nipple's maximum compression across different nipple types using a mixed model analysis of variance. Stiffer nipples and those with smaller holes were compressed less than compliant nipples and nipples with larger holes (p < 0.001). We also estimated the force applied on the nipple during feeding and found that more force was applied to the compliant nipple with disproportionately larger strains. Our results suggest that infant pigs' nipple compression depends on material type and hole size, which is likely detected by the infant pigs' initial assessment of compressibility and flow. By isolating nipple properties, we demonstrated a relationship between properties and suckling behavior. Our results suggest that sensory information affects feeding behaviors and may also inform clinical treatment of poor feeding performance.
Khaled Adjerid
Maxwell L Johnson
Chloe E Edmonds
Kendall S Steer
Francois D H Gould
Rebecca Z German
Christopher J Mayerl
J Exp Zool A Ecol Integr Physiol
. 2023 Jan;339(1):92-100. doi: 10.1002/jez.2657. Epub 2022 Sep 19.
2022
English
Providers' Ability to Identify Sentinel Injuries Concerning for Physical Abuse in Infants.
A statewide collaborative focused on sentinel injuries administered a survey to pediatric health care providers and social workers in the emergency department, urgent care, and primary care. The survey contained 8 case scenarios of infants under 6 months of age with an injury, and respondents were asked if they would consider the injury to be a sentinel injury requiring a physical abuse evaluation. Respondents were then presented with several factors and asked how much each influences the decision to perform a physical abuse evaluation.
The objectives of this study were to assess the ability of pediatric health care providers and social workers to recognize sentinel injuries in infants under 6 months of age and to determine what factors influence their decision to evaluate for physical abuse.
Eismann EA; Shapiro RA; Thackeray J; Makoroff K; Bressler CJ; Kim GJ; Vavul-Roediger L; McPherson P; Izsak E; Spencer SP
Pediatric Emergency Care
2021
2021-05-01
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.1097/PEC.0000000000001574">http://doi.org/10.1097/PEC.0000000000001574</a></td>
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Preterm Birth Impacts the Timing and Excursion of Oropharyngeal Structures during Infant Feeding
Swallowing in mammals requires the precise coordination of multiple oropharyngeal structures, including the palatopharyngeal arch. During a typical swallow, the activity of the palatopharyngeus muscle produces pharyngeal shortening to assist in producing pressure required to swallow and may initiate epiglottal flipping to protect the airway. Most research on the role of the palatopharyngeal arch in swallowing has used pharyngeal manometry, which measures the relative pressures in the oropharynx, but does not quantify the movements of the structures involved in swallowing. In this study, we assessed palatopharyngeal arch and soft palate function by comparing their movements in a healthy population to a pathophysiological population longitudinally through infancy (term versus preterm pigs). In doing so, we test the impact of birth status, postnatal maturation, and their interaction on swallowing. We tracked the three-dimensional (3D) movements of radiopaque beads implanted into relevant anatomical structures and recorded feeding via biplanar high-speed videofluoroscopy. We then calculated the total 3D excursion of the arch and soft palate, the orientation of arch movement, and the timing of maximal arch constriction during each swallow. Soft palate excursion was greater in term infants at both 7 and 17 days postnatal, whereas arch excursion was largely unaffected by birth status. Maximal arch constriction occurred much earlier in preterm pigs relative to term pigs, a result that was consistent across age. There was no effect of postnatal age on arch or soft palate excursion. Preterm and term infants differed in their orientation of arch movement, which most likely reflects both differences in anatomy and differences in feeding posture. Our results suggest that the timing and coordination of oropharyngeal movements may be more important to feeding performance than the movements of isolated structures, and that differences in the neural control of swallowing and its maturation in preterm and term infants may explain preterm swallowing deficits.
Edmonds CE; Catchpole EA; Gould FDH; Bond LE; Stricklen BM; German RZ; Mayerl CJ
Integrative Organismal Biology
2020
2020-08-27
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.1093/iob/obaa028">http://doi.org/10.1093/iob/obaa028</a></td>
</tr></tbody></table>
Increased viscosity of milk during infant feeding improves swallow safety through modifying sucking in an animal model.
Aspiration, the entry of food or liquid into the airway, is especially prevalent in infant mammals relative to adults (Jadcherla, 2016; Stricklen, Bond, Gould, German, & Mayerl, 2020). High rates of aspiration can have detrimental health impacts, and in the most extreme cases result in aspiration pneumonia and death (Logemann, 2007; Prasse & Kikano, 2009). One of the most commonly accepted methods of reducing the occurrence of aspiration in infants is increasing the viscosity of ingested material (Cichero, Nicholson, & September, 2013; Newman, Vilardell, Clavé, & Speyer, 2016). The clinical outcomes of increased viscosity in infants are fairly well understood, and include reduced occurrence of regurgitation and aspiration, and increased weight gain (Krummrich, Kline, Krival, & Rubin, 2017; Salvatore et al., 2018). However, most research on the impact of viscosity on infant feeding has focused on the rheologic properties of the liquid, and how time, temperature, and thickening agent impact viscosity (Gosa & Dodrill, 2017; September, Nicholson, & Cichero, 2014; Yoon & Yoo, 2017). As a result, we have very little insight into the physiologic mechanisms driving differences in performance due to changes in viscosity.
Infants experiencing frequent aspiration, the entry of milk into the airway, are often prescribed thickened fluids to improve swallow safety. However, research on the outcomes of thickened milk on infant feeding have been limited to documenting rates of aspiration and the rheologic properties of milk following thickening. As a result, we have little insight into the physiologic and behavioral mechanisms driving differences in performance during feeding on high viscosity milk. Understanding the physiologic and behavioral mechanisms driving variation in performance at different viscosities is especially critical, because the structures involved in feeding respond differently to sensory stimulation. We used infant pigs, a validated animal model for infant feeding, to test how the tongue, soft palate, and hyoid respond to changes in viscosity during sucking and swallowing, in addition to measuring swallow safety and bolus size. We found that the tongue exhibited substantive changes in its movements associated with thickened fluids during sucking and swallowing, but that pharyngeal transit time as well as hyoid and soft palate movements during swallowing were unaffected. This work demonstrates the integrated nature of infant feeding and that behaviors associated with sucking are more sensitive to sensorimotor feedback associated with changes in milk viscosity than those associated with the pharyngeal swallow, likely due to its reflexive nature.
Mayerl CJ; Edmonds CE; Gould FDH; German RZ
Journal Of Texture Studies
2021
2021-03-30
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.1111/jtxs.12599">http://doi.org/10.1111/jtxs.12599</a></td>
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Clinical and electrophysiological outcomes after eye muscle surgery in 81 adults with infantile nystagmus syndrome
METHODS:This was a prospective, single-center, interventional case series analysis of clinical and electro-phyisological data before and after surgery. Outcome measures included: clinical characteristics, surgical procedure, and preoperative and postoperative binocular best corrected visual acuity (BCVA) in the null position, anomalous head posture (AHP), contrast sensitivity, strabismic deviation, and nystagmus acuity function (NAFX). Postoperative data used were collected for a minimum of 12 months after surgery. Parametric and non-parametric statistical analysis of the outcome measures was performed.
PURPOSE:To characterize the effects of eye muscle surgery on patients older than 18 years with infantile nystagmus syndrome (INS) who have had only optical treatment.
Hertle RW; Curtis M; Boydstun I; Juric A; Evliyaoglu F; Ricker I
Journal Of Pediatric Ophthalmology & Strabismus
2021
2021-03-01
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.3928/01913913-20210105-01">http://doi.org/10.3928/01913913-20210105-01</a></td>
</tr></tbody></table>
Increased viscosity of milk during infant feeding improves swallow safety through modifying sucking in an animal model.
physiology; dysphagia; infant; animal model; suckling; viscosity
Infants experiencing frequent aspiration, the entry of milk into the airway, are often prescribed thickened fluids to improve swallow safety. However, research on the outcomes of thickened milk on infant feeding have been limited to documenting rates of aspiration and the rheologic properties of milk following thickening. As a result, we have little insight into the physiologic and behavioral mechanisms driving differences in performance during feeding on high viscosity milk. Understanding the physiologic and behavioral mechanisms driving variation in performance at different viscosities is especially critical, because the structures involved in feeding respond differently to sensory stimulation. We used infant pigs, a validated animal model for infant feeding, to test how the tongue, soft palate, and hyoid respond to changes in viscosity during sucking and swallowing, in addition to measuring swallow safety and bolus size. We found that the tongue exhibited substantive changes in its movements associated with thickened fluids during sucking and swallowing, but that pharyngeal transit time as well as hyoid and soft palate movements during swallowing were unaffected. This work demonstrates the integrated nature of infant feeding and that behaviors associated with sucking are more sensitive to sensorimotor feedback associated with changes in milk viscosity than those associated with the pharyngeal swallow, likely due to its reflexive nature.
Mayerl CJ; Edmonds CE; Gould FDH; German RZ
Journal Of Texture Studies
2021
2021-03-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/jtxs.12599" target="_blank" rel="noreferrer noopener">10.1111/jtxs.12599</a>
Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.
Humans; Male; Female; Unnecessary Procedures; Infant; Adolescent; Child; Sensitivity and Specificity; Child Preschool; Retrospective Studies; Tomography X-Ray Computed; Observer Variation; Bronchoscopy; Bronchoscopy; Computed tomography; Foreign Bodies/diagnostic imaging/therapy; Foreign body aspiration; Respiratory System/diagnostic imaging
BACKGROUND: Bronchoscopy is the standard of care for diagnosis and treatment of foreign body aspiration (FBA). Drawbacks of this approach include its invasiveness, the potential for exacerbation of reactive airway disease, and the need for general anesthesia. Computed tomography (CT) can potentially identify patients with FBA, thereby avoiding unnecessary bronchoscopies in patients with at-risk reactive airways. METHODS: A retrospective review was performed to identify patients who underwent CT and/or bronchoscopy for suspected foreign body aspiration (FBA) from June 2012 to September 2018. Variables included clinical history, exam findings, radiographic findings, and operative findings. A telephone survey was performed for patients who had a CT without bronchoscopy. Three radiologists performed rereads of all CTs. RESULTS: A total of 133 patients were evaluated for FBA, and 84 were treated with bronchoscopy. For those with a CT demonstrating a foreign body, findings were confirmed on bronchoscopy in 17/18 (94.4%). For those with bronchoscopy alone, 39/64 (60.9%) were found to have a foreign body (p < 0.01). CT excluded FBA in 49 patients. Sensitivity was 100%, specificity was 98%, and interobserver reliability was excellent (κ = 0.88). CONCLUSION: CT is an accurate and reliable diagnostic tool in the evaluation of FBA that can increase the rate of positive bronchoscopy. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.
Gibbons AT; Casar BAM; Hanke RE; McNinch NL; Person A; Mehlman T; Rubin M; Ponsky TA
Journal of Pediatric Surgery
2020
2020-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.jpedsurg.2019.09.045" target="_blank" rel="noreferrer noopener">10.1016/j.jpedsurg.2019.09.045</a>
Critical Care Helicopter Overtriage: A Failure Mode and Effects Analysis.
Aged; Humans; Male; Adult; Female; Aged 80 and over; Middle Aged; Infant; Adolescent; Child; Emergency Medical Services; Young Adult; Child Preschool; Quality Improvement; Aircraft; Healthcare Failure Mode and Effect Analysis/methods; Triage/standards; Air Ambulances
OBJECTIVE: Overtriage (OT) of helicopter emergency medical services (HEMS) poses significant burden to multiple stakeholders. The project aims were to identify the following: 1) associated factors, 2) downstream effects, and 3) focus areas for change. METHODS: We undertook a failure mode and effects analysis (FMEA) to evaluate our HEMS interfacility transport process. Data were collected from organizational finances and 3 key stakeholder groups: 1) interfacility patients transferred by HEMS in 2017 who were discharged from the receiving facility within 24 hours (n = 149), 2) flight registered nurses (n = 19), and 3) referring emergency medicine providers (EMPs) (n = 30) from the top HEMS users of 2017. The completed FMEA identified failure modes, the frequency and severity of effects, and unique risk profile numbers (RPNs). RESULTS: Twelve failure modes were identified with 30 potential causes. Leading failure modes included inappropriate HEMS requests by EMPs (RPN = 343), inappropriate activation by EMS for interfacility transport (RPN = 343), and minimizing patient/family involvement in decision making (RPN = 315). Significant burdens to organizational finances and flight registered nurse satisfaction were identified. CONCLUSION: Associated factors for interfacility HEMS OT, downstream effects, and areas for change were identified. EMP and emergency medical services practices, HEMS processes, and shared decision making may affect regional OT rates.
Grabowski RL; McNett M; Ackerman MH; Schubert C; Mion LC
Air Medical Journal
2019
2019-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.amj.2019.07.012" target="_blank" rel="noreferrer noopener">10.1016/j.amj.2019.07.012</a>
SENTINEL1: Two-Season Study of Respiratory Syncytial Virus Hospitalizations among U.S. Infants Born at 29 to 35 Weeks' Gestational Age Not Receiving Immunoprophylaxis.
Humans; Male; Female; Infant; Infant Newborn; Odds Ratio; Multivariate Analysis; Antiviral Agents/therapeutic use; United States/epidemiology; Intensive Care Units Pediatric; Community-Acquired Infections/epidemiology; Respiration Artificial; Hospitalization/statistics & numerical data; Infant Premature; Respiratory Syncytial Virus Human; Infant Premature Diseases/epidemiology/prevention & control/therapy; Palivizumab/therapeutic use; Respiratory Syncytial Virus Infections/epidemiology/prevention & control/therapy
OBJECTIVE: The SENTINEL1 observational study characterized confirmed respiratory syncytial virus hospitalizations (RSVH) among U.S. preterm infants born at 29 to 35 weeks' gestational age (wGA) not receiving respiratory syncytial virus (RSV) immunoprophylaxis (IP) during the 2014 to 2015 and 2015 to 2016 RSV seasons. STUDY DESIGN: All laboratory-confirmed RSVH at participating sites during the 2014 to 2015 and 2015 to 2016 RSV seasons (October 1-April 30) lasting ≥24 hours among preterm infants 29 to 35 wGA and aged <12 months who did not receive RSV IP within 35 days before onset of symptoms were identified and characterized. RESULTS: Results were similar across the two seasons. Among infants with community-acquired RSVH (N = 1,378), 45% were admitted to the intensive care unit (ICU) and 19% required invasive mechanical ventilation (IMV). There were two deaths. Infants aged <6 months accounted for 78% of RSVH observed, 84% of ICU admissions, and 91% requiring IMV. Among infants who were discharged from their birth hospitalization during the RSV season, 82% of RSVH occurred within 60 days of birth hospitalization discharge. CONCLUSION: Among U.S. preterm infants 29 to 35 wGA not receiving RSV IP, RSVH are often severe with almost one-half requiring ICU admission and about one in five needing IMV.
Anderson EJ; DeVincenzo JP; Simões EAF; Krilov LR; Forbes ML; Pannaraj PS; Espinosa CM; Welliver RC; Wolkoff LI; Yogev R; Checchia PA; Domachowske JB; Halasa N; McBride SJ; Kumar VR; McLaurin KK; Rizzo CP; Ambrose CS
American Journal of Perinatology
2020
2020-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1055/s-0039-1681014" target="_blank" rel="noreferrer noopener">10.1055/s-0039-1681014</a>
A novel method for fabricating nasoalveolar molding appliances for infants with cleft lip and palate using 3-dimensional workflow and clear aligners.
Humans; Infant; India; Preoperative Care; Cleft Lip; Cleft Palate; Orthodontic Appliances Removable; Nose; Workflow
INTRODUCTION: Nasoalveolar molding (NAM) was introduced over 20 years ago as adjunctive therapy for the correction of cleft lip and palate. In the current study, we propose a new approach using a digital workflow and 3-dimensional printing to fabricate clear aligner NAM devices. METHODS: A polyvinyl siloxane (PVS) impression of an infant with a unilateral complete cleft lip and palate (UCLP) is acquired and poured, and the stone model is scanned with an intraoral scanner. The stereolithography file is digitized, and the alveolar segments are digitally segmented and moved to the desired final position. The total distance moved is divided into a sequence of 1-1.5 mm increments, creating a series of digital models. The models are 3-dimensionally printed along with button templates to allow free form positioning of the button on each model. A Vacuform machine (Taglus, Mumbai, India) was used to fabricate a 0.040-in aligner for each stage. RESULTS: We present 1 case that was treated successfully with this approach. Appointments for the NAM adjustments were primarily to monitor progress and counseling with less time spent adjusting the appliance. The appointment length was reduced by over 30 minutes. Benefits of the aligner are improved fit, more precise increments of activation, reduced chairside time, and potentially minimized number of visits. CONCLUSIONS: NAM custom aligners may provide similar benefits to the traditional approach while reducing the burden of care by reducing the number of visits and appointment duration. Further studies with a sample and longitudinal observations are needed to investigate the benefits of the proposed digital approach.
Bous RM; Kochenour N; Valiathan M
American Journal of Orthodontics and Dentofacial Orthopedics
2020
2020-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.ajodo.2020.02.007" target="_blank" rel="noreferrer noopener">10.1016/j.ajodo.2020.02.007</a>
Sucking vs swallowing coordination, integration and performance in preterm and term infants.
feeding; physiology; infant; preterm; Sensorimotor integration
Mammalian infants must be able to integrate the acquisition, transport, and swallowing of food in order to effectively feed. Understanding how these processes are coordinated is critical, as they have differences in neural control and sensitivity to perturbation. Despite this, most studies of infant feeding focus on isolated processes, resulting in a limited understanding of the role of sensorimotor integration in the different processes involved in infant feeding. This is especially problematic in the context of preterm infants, as they are considered to have a pathophysiological brain development and often experience feeding difficulties. Here, we use an animal model to study how the different properties of food acquisition, transport, and swallowing differ between term and preterm infants longitudinally through infancy in order to understand which processes are sensitive to variation in the bolus being swallowed. We found that term infants are better able to acquire milk than preterm infants, and that properties of acquisition are strongly correlated with the size of the bolus being swallowed. In contrast, behaviors occurring during the pharyngeal swallow, such as hyoid and soft palate movements, show little to no correlation with bolus size. These results highlight the pathophysiological nature of the preterm brain and also demonstrate that behaviors occurring during oral transport are much more likely to respond to sensory intervention than those occurring during the 'pharyngeal phase'.
Mayerl CJ;Edmonds CE;Catchpole EA;Myrla AM;Gould FDH;Bond LE;Stricklen BM;German RZ
Journal of Applied Physiology
2020
2020-10-15
journalArticle
<a href="http://doi.org/10.1152/japplphysiol.00668.2020" target="_blank" rel="noreferrer noopener">10.1152/japplphysiol.00668.2020</a>
Pediatric airway management in COVID-19 patients: consensus guidelines from the society for pediatric anesthesia's pediatric difficult intubation collaborative and the Canadian Pediatric Anesthesia Society.
Adolescent; Humans; Child; Preschool; Infant; Newborn; Guidelines as Topic; Pneumonia; Intubation; Infection Control; Infectious Disease Transmission; Consensus; Pandemics; Airway Management/ methods; Anesthesia/methods; Anesthesiology/ methods/standards; Coronavirus Infections/ therapy; Pediatrics/ methods/standards; Intratracheal/ methods/standards; Patient-to-Professional/prevention & control; Viral/ therapy
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the
Matava CT; Kovatsis PG; Lee JK; Castro P; Denning S; Yu J; Park R; Lockman JL; Von Ungern-Sternberg B; Sabato S; Lee LK; Ayad I; Mireles S; Lardner D; Whyte S; Szolnoki J; Jagannathan N; Thompson N; Stein ML; Dalesio N; Greenberg R; McCloskey J; Peyton J; Evans F; Haydar B; Reynolds P; Chiao F; Taicher B; Templeton T; Bhalla T; Raman VT; Garcia-Marcinkiewicz A; Gálvez J; Tan J; Rehman M; Crockett C; Olomu P; Szmuk P; Glover C; Matuszczak M; Galvez I; Hunyady A; Polaner D; Gooden C; Hsu G; Gumaney H; Pérez-Pradilla C; Kiss EE; Theroux MC; Lau J; Asaf S; Ingelmo P; Engelhardt T; Hervías M; Greenwood E; Javia L; Disma N; Yaster M; Fiadjoe JE
Anesthesia and Analgesia
2020
2020-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1213/ANE.0000000000004872" target="_blank" rel="noreferrer noopener">10.1213/ANE.0000000000004872</a>
Maternal Body Dissatisfaction and Accuracy of Infant Weight Perception in Families From Low-Income Backgrounds.
body dissatisfaction; infant; low-income; mother; weight perception
OBJECTIVE: To examine the association between maternal body dissatisfaction and mother's (mis)perception of their infant's weight classification among families from low-income households. METHODS: Mother-infant dyads were recruited during well-child visits from 2 urban primary care clinics. Maternal body dissatisfaction was measured using the Stunkard Figure Rating Scale. Perception of infant weight was assessed using a 5-point Likert scale. Infant weight-for-length percentiles were calculated using World Health Organization growth charts. Associations between maternal body dissatisfaction score and mother's (mis)perception of their infant's weight classification were examined using logistic regression allowing for nonlinear associations via restricted cubic splines. RESULTS: Mothers (n = 180) were 26.6 +/- 5.1 years old and 72% Black; infants were 8.8 +/- 2.1 months old. Mean infant weight-for-length percentile was 64 +/- 26. On average, mothers wanted to be one body figure smaller than their perceived current body size. Most mothers (82%) accurately perceived their infant's weight classification while few overestimated (7%) or underestimated (11%) their child's weight category. The probability of mothers misperceiving their infant's weight classification increased as maternal body dissatisfaction increased in either extreme in unadjusted (P < .05) and adjusted analysis (P = .06). CONCLUSIONS: Increased maternal body dissatisfaction may be associated with mother's misperception of infant weight classification. Future studies should examine this relationship in a heterogeneous population.
Khalsa Amrik Singh; Copeland Kristen A; Misik Lauren; Brown Callie L; Kharofa Roohi Y; Ollberding Nicholas J
Academic pediatrics
2020
2020-04-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.acap.2020.03.009" target="_blank" rel="noreferrer noopener">10.1016/j.acap.2020.03.009</a>
Variation In The Timing And Frequency Of Sucking And Swallowing Over An Entire Feeding Session In The Infant Pig Sus Scrofa
activity; anesthesia; Animal model; Deglutition; disorders; dysphagia; Feeding; food transport; Infant; intraoral transport; laryngeal nerve lesion; model; muscle; Otorhinolaryngology; Pediatric; reflex pharyngeal swallow; rhythmic oral; validation
Gierbolini-Norat E M; Holman S D; Ding P; Bakshi S; German R Z
Dysphagia
2014
2014-08
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1007/s00455-014-9532-y" target="_blank" rel="noreferrer noopener">10.1007/s00455-014-9532-y</a>
Stability Of Extemporaneously Prepared Acetylcysteine 1% And 10% Solutions For Treatment Of Meconium Ileus
Acetylcysteine; Chromatography; Color; Compounding; Concentration; cystic fibrosis; Diluents; edta; equivalent; Hydrogen ion concentration; Hydrogen sulfide; Ileus; Infant; liquid; management; Mucolytic agents; n-acetylcysteine; nonoperative treatment; obstruction; Odors; Pharmacology & Pharmacy; Sodium chloride; Stability; Storage
Fohl A L; Johnson C E; Cober M P
American Journal of Health-System Pharmacy
2011
2011-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.2146/ajhp100214" target="_blank" rel="noreferrer noopener">10.2146/ajhp100214</a>
Overview of FEED, the Feeding Experiments End-user Database
Biology; coordination; evolution; fishes; infant; jaw; motor control; muscle; patterns; vertebrates; Zoology
The Feeding Experiments End-user Database (FEED) is a research tool developed by the Mammalian Feeding Working Group at the National Evolutionary Synthesis Center that permits synthetic, evolutionary analyses of the physiology of mammalian feeding. The tasks of the Working Group are to compile physiologic data sets into a uniform digital format stored at a central source, develop a standardized terminology for describing and organizing the data, and carry out a set of novel analyses using FEED. FEED contains raw physiologic data linked to extensive metadata. It serves as an archive for a large number of existing data sets and a repository for future data sets. The metadata are stored as text and images that describe experimental protocols, research subjects, and anatomical information. The metadata incorporate controlled vocabularies to allow consistent use of the terms used to describe and organize the physiologic data. The planned analyses address long-standing questions concerning the phylogenetic distribution of phenotypes involving muscle anatomy and feeding physiology among mammals, the presence and nature of motor pattern conservation in the mammalian feeding muscles, and the extent to which suckling constrains the evolution of feeding behavior in adult mammals. We expect FEED to be a growing digital archive that will facilitate new research into understanding the evolution of feeding anatomy.
Wall C E; Vinyard C J; Williams S H; Gapeyev V; Liu X H; Lapp H; German R Z
Integrative and Comparative Biology
2011
2011-08
Journal Article
<a href="http://doi.org/10.1093/icb/icr047" target="_blank" rel="noreferrer noopener">10.1093/icb/icr047</a>
Homozygosity for a mutation affecting the catalytic domain of tyrosyl-tRNA synthetase (YARS) causes multisystem disease
Adult; Biochemistry & Molecular Biology; Catalytic Domain; Child; Female; gene; Genetic Diseases; Genetic Predisposition to Disease; Genetics & Heredity; Hearing Loss; Heterozygote; Homozygote; Humans; impairment; Inborn; Infant; lactic-acidosis; Loss of Function Mutation; Male; mechanisms; Mutation; myopathy; Newborn; onset; Pedigree; Phenotype; phenotypic variability; Preschool; recessive mutations; Sensorineural; Severity of Illness Index; swiss-model; Tyrosine-tRNA Ligase; variant; Whole Exome Sequencing; Yeasts
Aminoacyl-tRNA synthetases (ARSs) are critical for protein translation. Pathogenic variants of ARSs have been previously associated with peripheral neuropathy and multisystem disease in heterozygotes and homozygotes, respectively. We report seven related children homozygous for a novel mutation in tyrosyl-tRNA synthetase (YARS, c.499C > A, p.Pro167Thr) identified by whole exome sequencing. This variant lies within a highly conserved interface required for protein homodimerization, an essential step in YARS catalytic function. Affected children expressed a more severe phenotype than previously reported, including poor growth, developmental delay, brain dysmyelination, sensorineural hearing loss, nystagmus, progressive cholestatic liver disease, pancreatic insufficiency, hypoglycemia, anemia, intermittent proteinuria, recurrent bloodstream infections and chronic pulmonary disease. Related adults heterozygous for YARS p.Pro167Thr showed no evidence of peripheral neuropathy on electromyography, in contrast to previous reports for other YARS variants. Analysis of YARS p.Pro167Thr in yeast complementation assays revealed a loss-of-function, hypomorphic allele that significantly impaired growth. Recombinant YARS p.Pro167Thr demonstrated normal subcellular localization, but greatly diminished ability to homodimerize in human embryonic kidney cells. This work adds to a rapidly growing body of research emphasizing the importance of ARSs in multisystem disease and significantly expands the allelic and clinical heterogeneity of YARS-associated human disease. A deeper understanding of the role of YARS in human disease may inspire innovative therapies and improve care of affected patients.
Williams Katie B; Brigatti Karlla W; Puffenberger Erik G; Gonzaga-Jauregui Claudia; Griffin Laurie B; Martinez Erick D; Wenger Olivia K; Yoder Mark A; Kandula Vinay V R; Fox Michael D; Demczko Matthew M; Poskitt Laura; Furuya Katryn N; Reid Jeffrey G; Overton John D; Baras Aris; Miles Lili; Radhakrishnan Kadakkal; Carson Vincent J; Antonellis Anthony; Jinks Robert N; Strauss Kevin A
Human Molecular Genetics
2019
1905-7
<a href="http://doi.org/10.1093/hmg/ddy344" target="_blank" rel="noreferrer noopener">10.1093/hmg/ddy344</a>
Temporal artery temperature measurements in healthy infants, children, and adolescents.
Female; Male; Ohio; Child; Infant; Analysis of Variance; Confidence Intervals; Temporal Arteries; Human; Convenience Sample; Descriptive Research; Descriptive Statistics; Funding Source; Data Analysis Software; Adolescence; Blacks; Whites; Preschool; Newborn; Body Temperature Determination – In Adolescence; Body Temperature Determination – In Infancy and Childhood
Roy S; Powell K; Gerson L W
Clinical pediatrics
2003
2003-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992280304200508" target="_blank" rel="noreferrer noopener">10.1177/000992280304200508</a>
Predictors of nonattendance at the first newborn health supervision visit.
Adult; Female; Ohio; Socioeconomic Factors; Infant; Risk Factors; Sensitivity and Specificity; Age Factors; Outpatients; Hospitals; Patient Compliance; Appointments and Schedules; Confidence Intervals; Mothers; Human; Chi Square Test; Funding Source; Logistic Regression; Newborn; Models; Statistical; Record Review; Telephone; Predictive Research; Relative Risk; Adolescent Mothers; Infant Care; Marital Status; Maternal Age; Parity; Pediatric – Ohio; Ambulatory Care Facilities – Utilization; Child Health Services – Utilization; Physical Examination – In Infancy and Childhood
Specht E M; Bourguet C C
Clinical pediatrics
1994
1994-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992289403300504" target="_blank" rel="noreferrer noopener">10.1177/000992289403300504</a>
Unexplained fever in infants and young children: when is it serious?
Infant; Body Temperature; Age Factors; Physical Examination; Clinical Assessment Tools; Diagnosis; Newborn; Laboratory; Patient History Taking; Bacterial Infections – Diagnosis – In Infancy and Childhood; Blood – Analysis – In Infancy and Childhood; Fever – Etiology – In Infancy and Childhood; Urinalysis – In Infancy and Childhood
When an infant or child younger than 36 months presents with fever that has no obvious source, the major concern is overlooking a serious bacterial infection. Ask about underlying medical problems, previous hospitalizations, recent infectious contacts, current or recent antibiotic therapy, previous infectious illnesses, and immunization status. Determine whether an infant younger than 60 days was premature, received perinatal antibiotics, or had unexplained hyperbilirubinemia. The cutoff temperature varies by age for fever that signals the need for further evaluation: 38 degrees C (100.4 degrees F) or greater for infants younger than 60 days, and 39 degrees C (102.2 degrees F) or greater for children 60 days to 36 months of age. A white blood cell (WBC) count between 5000/microL and 15,000/microL in infants younger than 60 days indicates a very low risk of serious bacterial infection. In older infants and children who have high fever, a WBC count greater than 15,000/microL raises the relative risk of bacteremia 5-fold.
Bower J R; Powell K R
Consultant (00107069)
2001
2001-04-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Unexplained fever in infants and young children: how to manage.
Child; Infant; Practice Guidelines; Preschool; Bacterial Infections – Diagnosis – In Infancy and Childhood; Fever – Therapy – In Infancy and Childhood; Primary Health Care – In Infancy and Childhood
If an infant 60 days old or younger who presents with unexplained fever (temperature 38 degrees C [100.4 degrees F] or greater) appears ill, evaluate for sepsis, hospitalize, and give parenteral antibiotics. For well-appearing infants whose temperature is 38 degrees ( (100.4 degrees F) or greater, order a complete blood cell count, urinalysis and, when indicated, stool examination. If the peripheral white blood cell (WBC) count is greater than 15,000/microL or less than 5000/miroL, urine contains more than 10 WBCs per high-power field or a dipstick reagent strip is positive, or fecal analysis shows more than 5 WBCs per high-power field, hospitalize the infant, obtain blood and urine cultures, order lumbar puncture, and administer parenteral antimicrobials. Risk criteria for serious bacterial infection are more flexible for children aged 61 days to 36 months: the cutoff temperature is 39 degrees C (102.2 degrees F) or higher, greater reliance is placed on physical examination findings, and laboratory findings can be interpreted with greater leeway. If the WBC count is less than 15,000/miroL, only follow-up is required; if the count is higher, obtain a blood culture and administer a dose of ceftriaxone.
Bower J R; Powell K R
Consultant (00107069)
2001
2001-04-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Outcomes in pharyngoplasty: a 10-year experience.
Adult; Female; Male; Ohio; Child; Infant; Risk Factors; Prospective Studies; Age Factors; Sex Factors; Hospitals; Sample Size; Reoperation; Speech; Confidence Intervals; Human; Descriptive Statistics; Middle Age; Adolescence; Retrospective Design; T-Tests; Surgical Flaps; Preschool; Treatment Outcomes; Record Review; Cleft Lip; Cleft Palate; Pediatric – Ohio; Mouth Abnormalities – Surgery; Pharyngeal Diseases – Surgery; Pharynx – Surgery
Objective: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation.Design: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes.Participants: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency.Results: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p \textgreater .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low.Conclusions: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.
Pryor LS; Lehman J; Parker M G; Schmidt A; Fox L; Murthy AS
Cleft Palate-Craniofacial Journal
2006
2006-03
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<a href="http://doi.org/10.1597/04-115" target="_blank" rel="noreferrer noopener">10.1597/04-115</a>
Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department.
Female; Male; Ohio; Child; Infant; Human; Descriptive Statistics; Adolescence; Retrospective Design; Random Sample; Preschool; Record Review; Antibiotics – Administration and Dosage – In Infancy and Childhood; Emergency Care – Standards – In Infancy and Childhood; Penicillins – Administration and Dosage; Pharyngitis – Drug Therapy – In Infancy and Childhood; Practice Guidelines – Utilization
Diaz MCG; Symons N; Ramundo ML; Christopher NC
Archives of Pediatrics & Adolescent Medicine
2004
2004-10
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<a href="http://doi.org/10.1001/archpedi.158.10.977" target="_blank" rel="noreferrer noopener">10.1001/archpedi.158.10.977</a>
A thyroglossal duct cyst causing apnea and cyanosis in a neonate.
Male; Infant; Tomography; Newborn; X-Ray Computed; Apnea; Cyanosis; Cysts – Diagnosis; Thyroid Gland – Physiopathology
This is a case of a 3-week-old male who presented to the emergency department with intermittent apnea and cyanosis. While in the emergency department, he had respiratory compromise with stress and required intubation. Further evaluation confirmed the diagnosis of a thyroglossal duct cyst. Congenital lesions causing extrinsic airway compression should be considered in all neonates with apnea, cyanosis, and respiratory compromise. Knowledge of pediatric airway anatomy and physiology is important in all cases where obstructive apnea is suspected.
Diaz MCG; Stormorken A; Christopher NC
Pediatric emergency care
2005
2005-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.pec.0000150987.19228.c8" target="_blank" rel="noreferrer noopener">10.1097/01.pec.0000150987.19228.c8</a>
Inhaled corticosteroid use in asthmatic children receiving Ohio Medicaid: trend analysis, 1997-2001.
Female; Male; Ohio; Child; Infant; United States; Sex Factors; Human; Cross Sectional Studies; Adolescence; Retrospective Design; Regression; Preschool; Newborn; Administration; Inhalation; Ambulatory Care – Statistics and Numerical Data; Emergency Service – Statistics and Numerical Data; Blacks – Statistics and Numerical Data; Whites – Statistics and Numerical Data; Medicaid – Statistics and Numerical Data; Hospitalization – Statistics and Numerical Data; Adrenal Cortex Hormones – Therapeutic Use; Adrenal Cortex Hormones – Administration and Dosage; Asthma – Diagnosis; Asthma – Drug Therapy; Asthma – Ethnology; Drug Utilization – Statistics and Numerical Data; Drug Utilization – Trends
BACKGROUND: In 1997, national guidelines emphasized that inhaled corticosteroids (ICSs) are key therapy for individuals with all classes of persistent asthma, including children. OBJECTIVE: To examine the effect of these guidelines via time-trend analysis of ICS dispensation among children with asthma and Ohio Medicaid insurance. METHODS: A retrospective cross-sectional analysis by yearly cohorts was performed. From January 1, 1997, to December 31, 2001, all children from birth to the age of 18 years with 6 months of Ohio Medicaid enrollment or more, 1 or more asthma diagnoses associated with a provider claim, and 1 or more prescription claims for an asthma medication in a given calendar year were identified using claims data. The daily beclomethasone equivalent (BME) dose, the daily albuterol equivalent dose, and asthma-related health care use were calculated for each child within each yearly cohort. A time-trend regression analysis of subjects enrolled in all 5 years examined factors associated with BME. RESULTS: A total of 77,557 children met the study criteria. Among the 1,475 children enrolled during all 5 years, year of enrollment was a positive independent predictor of BME after adjustment for age, race, sex, systemic steroid bursts, albuterol equivalent dose, and health care use (P \textless .001). CONCLUSIONS: The daily BME dose significantly increased for children with asthma insured by Ohio Medicaid from 1997 to 2001. However, the percentages of children receiving both ICS and a therapeutic BME dose were alarmingly low. The mean BME dose was particularly low among children with 1 or more emergency department visits, no hospitalizations, and 3 or fewer physician visits for asthma per year, suggesting that broader efforts to target this group are needed.
Stevenson MD; Heaton PC; Moomaw CJ; Bean JA; Ruddy RM
Annals of Allergy, Asthma & Immunology
2008
2008-06
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<a href="http://doi.org/10.1016/s1081-1206(10)60049-x" target="_blank" rel="noreferrer noopener">10.1016/s1081-1206(10)60049-x</a>
Diagnosis at a glance.
Male; Aged; Infant; Neoplasms; Ear – Abnormalities; Fibrous Tissue – Diagnosis; Hearing Disorders – Diagnosis – In Infancy and Childhood
Park Y W; Park KK; Cordova R; Schleicher S
Emergency Medicine (00136654)
2009
2009-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cocooning: Influenza Vaccine for Parents and Caregivers in an Urban, Pediatric Medical Home.
Adult; Female; Male; Aged; Child; Infant; Caregivers; Parents; Nurse Practitioners; Human; Chi Square Test; Funding Source; Middle Age; Fisher's Exact Test; Adolescence; Pearson's Correlation Coefficient; Preschool; McNemar's Test; Pediatricians; Wilcoxon Rank Sum Test; Influenza – Prevention and Control – In Infancy and Childhood; Influenza – Risk Factors; Influenza Vaccine – Administration and Dosage
White PC; Baum DL; Ross H; Falletta L; Reed MD
Clinical pediatrics
2010
2010
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<a href="http://doi.org/10.1177/0009922810374353" target="_blank" rel="noreferrer noopener">10.1177/0009922810374353</a>
Extracorporeal membrane oxygenation survivors and pulmonary function: encouraging outcomes early in life.
Infant; Newborn; Extracorporeal Membrane Oxygenation; Lung – Physiology
McBride John T; Stone Robert T; Anas Nick G
Pediatric Critical Care Medicine
2011
2011-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/PCC.0b013e3181f268ce" target="_blank" rel="noreferrer noopener">10.1097/PCC.0b013e3181f268ce</a>
Efficacy of intravenous lidocaine to reduce pain and distress associated with propofol infusion in pediatric patients during procedural sedation.
Female; Male; Child; Infant; Prospective Studies; Pain Measurement; Analysis of Variance; Placebos; Injections; Human; Chi Square Test; Preschool; Intravenous; Anesthetics; Treatment Outcomes; Double-Blind Studies; Hypnotics and Sedatives – Administration and Dosage; Lidocaine – Administration and Dosage; Local – Administration and Dosage; Propofol – Administration and Dosage
BACKGROUND: Research suggests that young children experience an increased incidence and severity of discomfort during propofol infusion. Evaluations of varied interventions to reduce or eliminate this discomfort with adult subjects suggest that premedication with intravenously administered lidocaine (0.5 mg/kg) offers the best overall effectiveness. OBJECTIVE: Because this regimen's efficacy in a pediatric population is undocumented, we conducted a randomized, double-blind, placebo-controlled study to determine the effectiveness of intravenous lidocaine pretreatment to alleviate pain in pediatric subjects before propofol infusion. METHODS: Subjects (aged 2-7 years) scheduled for painless diagnostic procedures received either a saline placebo or 1 of 2 lidocaine doses before administering propofol. To capture the patient's baseline behavioral state, a trained observer administered the validated Face, Legs, Activity, Cry, Consolability Pain Assessment Scale before propofol infusion. During deep sedation induction, the sedating physician, a trained research assistant, and the patient's parent documented maximum distress using a 100-mm visual analog scale (VAS). RESULTS: Ninety-one subjects participated. We found no difference in VAS pain scores between groups pretreated with lidocaine 0.25 mg/kg, lidocaine 0.5 mg/kg, and placebo. Statistical analysis also found no interrater differences between parents, physician, or observer VAS scores. CONCLUSIONS: Our data do not support using lidocaine pretreatment to alleviate pain/discomfort in pediatric patients during propofol infusion.
Depue K; Christopher NC; Raed M; Forbes ML; Besunder J; Reed MD
Pediatric emergency care
2013
2013-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/PEC.0b013e31827b227e" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e31827b227e</a>
Encephalitis from Chikungunya Virus: An Increasingly Recognized Syndrome.
Aged; Incidence; Infant; Age Factors; France; Chikungunya Virus; Chikungunya Fever – Complications; Encephalitis – Epidemiology – France; Encephalitis – Etiology; Encephalitis – Risk Factors
The article focuses on the retrospective cohort study of the outbreak of the chikungunya virus (CHIKV) which causes the encephalitis and the central nervous system (CNS) involvement after a large CHIKV outbreak that occurred on Reunion Island between September 2005 and June 2006. It mentions that CHIKV infection shows the neurological symptoms such as lumbar puncture with a positive cerebral spinal fluid (CSF) and the CHIKV can cause severe neurological disease.
Watkins Richard R
Infectious Disease Alert
2016
2016-01
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A Short Course of Antibiotics for Acute Otitis Media in Children Leads to Worse Outcomes Compared to Standard Course Therapy.
Infant; Amoxicillin; Antiinfective Agents; Randomized Controlled Trials; Treatment Duration; Otitis Media – Drug Therapy – In Infancy and Childhood
The author discusses the study which involved children aged six to twenty three months diagnosed with acute otitis media (AOM) basing on indications such as onset of symptoms in the preceding 48 hours, the presence of a middle-ear suffusion and slight bulging accompanied by otalgia. Discussed are the outcomes of the treatment which include the rates of recurrence of AOM, rates of nasopharyngeal colonization and parental satisfaction with the treatment.
Watkins Richard R
Infectious Disease Alert
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Limitations of the obstetric group B Streptococcus protocol.
Adult; Female; Humans; Adolescent; Infant; Pregnancy; Follow-Up Studies; Anti-Bacterial Agents/*therapeutic use; Guideline Adherence; Antibiotic Prophylaxis; *Pregnancy Outcome; Obstetrics/methods; Primary Prevention/methods; Streptococcal Infections/diagnosis/*drug therapy/*prevention & control; Streptococcus agalactiae/*drug effects/*isolation & purification; Pregnancy Complications; Newborn; Infectious/diagnosis/*drug therapy
OBJECTIVE: To assess compliance with the Centers for Disease Control and Prevention (CDC) screening-based protocol for obstetric group B Streptococcus (GBS) and to determine an acceptable threshold for protocol failure. STUDY DESIGN: A retrospective chart review was carried out for all deliveries performed through the resident-run community clinic from January through June 1999. Compliance with the CDC protocol was assessed by reviewing collected data from patient charts and comparing it to CDC requirements. Data were collected regarding patient demographics, antenatal GBS status, gestational age at screening, time of rupture of the membranes, time the antibiotic was given and time of delivery. RESULTS: A total of 248 charts were reviewed. Elective cesarean deliveries were excluded (25 charts). Unknown culture status was found for 22 (9.9%) patients. Cultures were collected before 35 weeks' gestation in 39 (17.5%) patients and at \textgreater 37 weeks' gestation in 28 (12.6%) patients. Of those with known positive GBS status, 4 (7.0%) were not treated, and antibiotics were given less than four hours before delivery in 13 (24.5%) patients. Of those with unknown status, six (27.2%) were not treated. Overall, there was 70% compliance with the culture collection arm of the protocol and 87% compliance with the treatment arm. CONCLUSION: Fulfillment of CDC guidelines in this community setting is imperfect. There are several areas beyond physician control, including precipitous delivery and patient non-compliance. However, perhaps an acceptable threshold for limitations of adherence to the protocol can be reached.
Nemunaitis-Keller Jennifer; Gill Prabacharan
The Journal of reproductive medicine
2003
2003-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cytomegalovirus infections of the neonate and infant.
Humans; Infant; *Cytomegalovirus Infections; Newborn
Cytomegalovirus is ubiquitous. While most infections are asymptomatic, infants and children acquiring CMV may excrete the virus for years in spite of significant antibody responses. CMV may be transmitted vertically or horizontally. Transplacental passage of CMV leads to congenital infection of the neonate. The most severely affected infants are born to mothers who develop a primary infection early in pregnancy and have a suboptimal cell-mediated response. During the perinatal period, the virus may be acquired by the infant from infected breast milk, passage through an infected birth canal, or by blood transfusion. Full-term infants infected during the perinatal period, though usually asymptomatic, may present with rash, hepatomegaly, lymphadenopathy, and/or pneumonia. Perinatally acquired infections in sick preterm infants may cause significant morbidity and mortality. Although specific therapy for infected individuals is currently unavailable, the outlook for an effective vaccine is promising.
Nankervis G A; Bhumbra N A
Advances in pediatric infectious diseases
1986
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Delays in immunizations of high-risk infants during the first two years of life: special care for the high-risk infant should not mean special immunization schedules.
Female; Humans; Male; Time Factors; Infant; Gestational Age; Follow-Up Studies; Risk Factors; Intensive Care Units; Physicians; Family; Parents/psychology; *Immunization Schedule; Immunization/*statistics & numerical data; Infant Care/*standards; Primary Health Care/*standards; Newborn; Practice Patterns; Physicians'; Premature; Neonatal
Because experience in our newborn intensive care unit follow-up clinic since 1982 suggested that immunizations of newborn intensive care unit graduates in the first 2 years of life were inappropriately delayed, questionnaires were sent to families and to the four categories of primary care providers (family practitioners, pediatricians, local health clinics, and neonatalogists) in our region to assess immunization rates and practices. Delays in the first diphtheria, tetanus, and pertussis immunization and the polio vaccine were greater the less the birth weight and less the gestational age of the infant. Delays in subsequent immunizations were considerable and did not correlate with gestational age. A substantial proportion of primary care providers are not immunizing infants in compliance with the American Academy of Pediatrics recommendation, but some improvement is seen when the time period 1982 to 1986 is compared with 1987 to 1991.
Magoon M W; Belardo L J; Caldito G
Journal of perinatology : official journal of the California Perinatal Association
1995
1995-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Botulin therapy in pediatric ophthalmology.
Adult; Humans; Child; Infant; Cooperative Behavior; Botulinum Toxins/administration & dosage/*therapeutic use; Eye Movements; Informed Consent; Ketamine; Preanesthetic Medication; Strabismus/*therapy; Preschool
Magoon E H
International ophthalmology clinics
1989
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00004397-198902910-00011" target="_blank" rel="noreferrer noopener">10.1097/00004397-198902910-00011</a>
Monoamine-activated alpha 2-macroglobulin inhibits neurite outgrowth, survival, choline acetyltransferase, and dopamine concentration of neurons by blocking neurotrophin-receptor (trk) phosphorylation and signal transduction.
Humans; Animals; Cell Survival/drug effects; Phosphorylation/drug effects; Signal Transduction/*drug effects; Infant; Neurons/physiology; Rats; Species Specificity; Choline O-Acetyltransferase/metabolism; Dopamine/metabolism; alpha-Macroglobulins/*pharmacology; Biogenic Monoamines/*pharmacology; Neurites/physiology; Prosencephalon/cytology/*physiology; Receptor Protein-Tyrosine Kinases/*drug effects; Newborn; Receptors; Nerve Growth Factor/*drug effects
Koo P H; Liebl D J; Qiu W S; Hu Y Q; Dluzen D E
Annals of the New York Academy of Sciences
1994
1994-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Prenatal diagnosis of obstructed normally connected pulmonary veins by a single orifice to the common atrium in a fetus with right isomerism.
Adult; Female; Humans; Male; Infant; Pregnancy; *Ultrasonography; Fetal Heart/diagnostic imaging/*pathology; Heart Atria/*abnormalities/diagnostic imaging/embryology; Levocardia/diagnostic imaging/embryology; Pulmonary Veins/*abnormalities/diagnostic imaging/embryology; Newborn; Prenatal
Patel Chandrakant R; Waight David J; Spector Michael L; Smith Philip C
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2007
2007-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7863/jum.2007.26.4.525" target="_blank" rel="noreferrer noopener">10.7863/jum.2007.26.4.525</a>
Adherence to Endotracheal Tube Depth Guidelines and Incidence of Malposition in Infants and Children.
Female; Humans; pediatrics; Male; Ohio; Random Allocation; Incidence; Chi-Square Distribution; Child; Guideline Adherence/*statistics & numerical data; Infant; intubation; Medical Errors/*statistics & numerical data; NRP; PALS; Radiography/*statistics & numerical data; Trachea/diagnostic imaging; tracheal tube malposition; United States; Odds Ratio; Intensive Care Units; Hospitals; Guideline Adherence; Radiography; Intubation; ROC Curve; Confidence Intervals; Inpatients; Human; Chi Square Test; Descriptive Statistics; P-Value; Data Analysis Software; Practice Guidelines; Retrospective Design; Preschool; Thoracic; Intratracheal/adverse effects/standards/*statistics & numerical data; Intratracheal – Standards – United States; Pediatric – Ohio
BACKGROUND: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. METHODS: In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record. Chest radiographs of poor quality and with spinal or skeletal deformities were excluded. We defined adherence to Pediatric Advanced Life Support or Neonatal Resuscitation Program guidelines as the difference between predicted and actual ETT markings at the lip as +/- 0.25, +/- 0.50, or +/- 1.0 cm for ETTs of 2.5-4, 4.5-6.0, or \textgreater6.5 mm inner diameter, respectively. We defined the proper position as the ETT tip being below the thoracic inlet (superior border of the clavicular heads) and \textgreater/=1 cm above the carina. Descriptive statistics reported demographics, guideline adherence, and malposition incidence. The chi-square test was used to assess relationships among intubation setting, malposition, and depth guideline adherence (P \textless .05, significant). RESULTS: We reviewed 507 records, 477 of which met inclusion criteria and had sufficient data for analysis. Fifty-six percent of the subjects were male, with median (interquartile range) age 15.2 (3.4-59.4) months, and 330 ETTs (69%) were malpositioned: 39 above the thoracic inlet, and 291 \textless 1 cm above the carina. Of 79 ETTS (17%) that adhered to depth guidelines, 56 (74%) were malpositioned. Three-hundred seventy-three ETTs (83%) did not meet guidelines. Two-hundred sixty-four (68%) were malpositioned. The intubation setting did not influence malposition or guideline adherence (P = .54). CONCLUSIONS: In infants and children, a high proportion of ETTs were malpositioned on the first postintubation chest radiograph, with little influence of guideline adherence.
Volsko Teresa A; McNinch Neil L; Prough Donald S; Bigham Michael T
Respiratory Care
2018
2018-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4187/respcare.06024" target="_blank" rel="noreferrer noopener">10.4187/respcare.06024</a>
Update on antiviral therapy for genital herpes infection.
Female; Humans; Male; Infant; Pregnancy; Recurrence; 2-Aminopurine/analogs & derivatives/therapeutic use; Acyclovir/analogs & derivatives/therapeutic use; Antiviral Agents/*therapeutic use; Famciclovir; Valacyclovir; Valine/analogs & derivatives/therapeutic use; Pregnancy Complications; Herpes Genitalis/diagnosis/*drug therapy; Herpes Simplex/transmission; Virus Shedding; Newborn; Infectious Disease Transmission; Infectious/drug therapy; Vertical
For the primary infection of genital herpes, antiviral therapy with acyclovir is the gold standard. For recurrences, there are two options: antiviral treatment of each outbreak as it arises, or suppression of outbreaks with daily oral therapy. Patients tend to prefer the latter because it can decrease the number and severity of outbreaks, but it increases asymptomatic viral shedding and, therefore, the risk of unwittingly transmitting herpes simplex virus to uninfected sexual partners.
Geers T A; Isada C M
Cleveland Clinic journal of medicine
2000
2000-08
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<a href="http://doi.org/10.3949/ccjm.67.8.567" target="_blank" rel="noreferrer noopener">10.3949/ccjm.67.8.567</a>