Mucosal barrier injury-associated bloodstream infections in pediatric oncology patients.
Humans; Male; Female; Child; Child Preschool; Bacterial Infections/epidemiology/therapy; bloodstream infections; CLABSI; Databases Factual; hematology; mucosal barrier injury; Neoplasms/epidemiology/therapy; Neutropenia/epidemiology/therapy; oncology; pediatric; transplant; Mucous Membrane/injuries
BACKGROUND: Single-center reports of central line-associated bloodstream infection (CLABSI) and the subcategory of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) in pediatric hematology oncology transplant (PHO) patients have focused on the inpatient setting. Characterization of MBI-LCBI across PHO centers and management settings (inpatient and ambulatory) is urgently needed to inform surveillance and prevention strategies. METHODS: Prospectively collected data from August 1, 2013, to December 31, 2015, on CLABSI (including MBI-LCBI) from a US PHO multicenter quality improvement network database was analyzed. CDC National Healthcare Safety Network definitions were applied for inpatient events and adapted for ambulatory events. RESULTS: Thirty-five PHO centers reported 401 ambulatory and 416 inpatient MBI-LCBI events. Ambulatory and inpatient MBI-LCBI rates were 0.085 and 1.01 per 1000 line days, respectively. Fifty-three percent of inpatient CLABSIs were MBI-LCBIs versus 32% in the ambulatory setting (P < 0.01). Neutropenia was the most common criterion defining MBI-LCBI in both settings, being present in ≥90% of events. The most common organisms isolated in MBI-LCBI events were Escherichia coli (in 28% of events), Klebsiella spp. (23%), and viridans streptococci (12%) in the ambulatory setting and viridans streptococci (in 29% of events), E. coli (14%), and Klebsiella spp. (14%) in the inpatient setting. CONCLUSION: In this largest study of PHO MBI-LCBI inpatient events and the first such study in the ambulatory setting, the burden of MBI-LCBI across the continuum of care of PHO patients was substantial. These data should raise awareness of MBI-LCBI among healthcare providers for PHO patients, help benchmarking across centers, and help inform prevention and treatment strategies.
Hakim H; Billett AL; Xu J; Tang L; Richardson T; Winkle C; Werner EJ; Hord JD; Bundy DG; Gaur AH
Pediatric Blood & Cancer
2020
2020-08
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/10.1002/pbc.28234" target="_blank" rel="noreferrer noopener">10.1002/pbc.28234</a>
"Living life as if i never had cancer": A study of the meaning of living well in adolescents and young adults who have experienced cancer
childhood; definition; quality of life; advance care planning; cancer; adolescent; advance care
Background Cancer diagnoses pose challenges to adolescents' and young adults' (AYA) physical, mental, and emotional health, and developmental tasks. In order for AYAs, caregivers, clinicians, and other collaborators to optimize health outcomes (coproduction of health), understanding what living well means for AYAs who have experienced cancer is necessary. The objective was to develop an empirical definition of "living well" for AYAs who have experienced cancer to broadly understand AYA values and priorities. This definition may ultimately guide future conversations between caregivers and AYAs, eliciting thorough, personal definitions of living well from individual AYAs. Such conversations may enhance AYA participation in coproducing their health. Procedure Qualitative analysis using a phenomenological approach of N = 30 structuredRespecting Choicesinterviews conducted with AYAs (14-21 years; mean 84.2 [SD 69] months postcancer diagnosis with 21% on active treatment) from four tertiary pediatric hospitals in the context of a primary study of a pediatric advance care planning intervention trial. Results AYAs who have experienced cancer conceptualized "living well" as maintaining physical, mental, and emotional health, as well as engaging in purposeful, age-appropriate activities with people important to them. Living well had three components: living mindfully, living an identity as a healthy AYA, and spending time with friends and family. Conclusions Conversations with AYAs who have experienced cancer elicited rich, complex concepts of "living well." Provider initiation of discussions about living well may facilitate personalized goals of care conversations. This study may serve as the basis to design and prototype future clinical interventions to enhance AYA engagement.
Schreiner K; Grossoehme DH; Friebert S; Baker JN; Needle J; Lyon ME
Pediatric Blood & Cancer
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/10.1002/pbc.28599" target="_blank" rel="noreferrer noopener">10.1002/pbc.28599</a>
Chemotherapy Strategies for Young Children Newly-Diagnosed with Medulloblastoma up to the Era of Molecular Profiling - A Comparative Outcomes Analysis
Finlay J; Mynarek M; Dhall G; Lafay-Cousin L; Mazewski C M; Ashley D; Cohen B H; von Bueren A O; Gerber N; Leary S; Geyer J R; Tait D; Gajjar A; Rutkowski S
Pediatric Blood & Cancer
2019
2019-12
Journal Article
<a href="http://doi.org/10.1093/neuonc/noz175.767" target="_blank" rel="noreferrer noopener">10.1093/neuonc/noz175.767</a>
Relapsed Perinatal Neuroblastoma After Expectant Observation
age; Hematology; heterogeneity; infants; neuro-blastoma; neuro-blastoma; neuroblastoma biology; Oncology; Pediatrics; regression; relapse
The Children's Oncology Group (COG) study ANBL00P2 showed that expectant observation of patients younger than six months of age with perinatal neuroblastoma presenting as a small adrenal mass yields excellent overall survival and spares surgical resection to the majority of patients. We report a 5-year-old female who was initially diagnosed with a perinatal neuroblastoma. The patient was observed on COG study ANBL00P2. By nine months of age she had no ultrasonographic or biochemical evidence of disease. She presented four years later with abdominal pain and was found to have high-risk stage 4 MYCN amplified neuroblastoma. Pediatr Blood Cancer 2015;62:160-162. (c) 2014 Wiley Periodicals, Inc.
Salloum R; Garrison A; von Allmen D; Sheridan R; Towbin A J; Adams D; Weiss B
Pediatric Blood & Cancer
2015
2015-01
Journal Article
<a href="http://doi.org/10.1002/pbc.25218" target="_blank" rel="noreferrer noopener">10.1002/pbc.25218</a>
Growth hormone therapy for short stature in Diamond Blackfan anemia.
Adolescent; Anemia; Body Height; Diamond-Blackfan/*complications; Growth Disorders/*drug therapy/*etiology; Human Growth Hormone/pharmacology/*therapeutic use; Humans; Male; Treatment Outcome
BACKGROUND: We report a 13-year-old male with Diamond Blackfan anemia and short stature. He had a normal biochemical response to growth hormone (GH) stimulation, but his bone age was delayed, his insulin-like growth factor 1 (IGF-1) was low, and he had a poor growth velocity. He was started on daily GH injections. METHODS: From the patient's medical record the following data were collected: serial heights, serial weights, hemoglobin, hematocrit, bone age, IGF-1, and steroid dose. RESULTS: This patient had an increase in growth velocity up to 8.2 cm/year. CONCLUSIONS: Growth hormone therapy should be considered in children with DBA, short stature and poor growth velocity.
Scott Emily Gale; Haider Anzar; Hord Jeffrey
Pediatric blood & cancer
2004
2004-10
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/10.1002/pbc.20075" target="_blank" rel="noreferrer noopener">10.1002/pbc.20075</a>