scholarly journals One Year in the Life of a Rapid Syndromic Panel for Meningitis/Encephalitis: a Pediatric Tertiary Care Facility's Experience

2018 ◽  
Vol 56 (5) ◽  
Author(s):  
Samia N. Naccache ◽  
Maryann Lustestica ◽  
Margil Fahit ◽  
Javier Mestas ◽  
Jennifer Dien Bard

ABSTRACTEarly establishment of infectious processes allows for expedited clinical management of meningitis and encephalitis. The FilmArray meningitis/encephalitis (FA-M/E) panel provides rapid detection of potential pathogens associated with encephalitis/meningitis in both immunocompetent and compromised patients. Here, we conducted a 1-year review of the performance of the FA-M/E panel at a tertiary care children's hospital. Two hundred sixty-five samples from 251 patients were tested. We found 87.25% (219/251) were negative, 9.96% (25/251) were positive for viral analytes, and 3.19% (8/251) were positive for bacterial analytes. When possible, positive results were confirmed by alternate testing; 4/6 available bacterial positives and 17/20 available viral positives were confirmed by retrospective culture or molecular testing.

2012 ◽  
Vol 32 (3) ◽  
pp. 152-157 ◽  
Author(s):  
Rajni Sharma ◽  
Suraj Gohain ◽  
Jagdish Chandra ◽  
Virendra Kumar ◽  
Abhishek Chopra ◽  
...  

PEDIATRICS ◽  
1985 ◽  
Vol 76 (1) ◽  
pp. 104-109
Author(s):  
Ronald L. Poland ◽  
Robert O. Bollinger ◽  
Mary P. Bedard ◽  
Sanford N. Cohen

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those sub-groups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.


PEDIATRICS ◽  
1993 ◽  
Vol 92 (3) ◽  
pp. 358-364
Author(s):  
Peter T.C. Ho ◽  
Judy A. Estroff ◽  
Harry Kozakewich ◽  
Robert C. Shamberger ◽  
Craig W. Lillehei ◽  
...  

Objectives. To assess the relative frequency of, the clinical and pathological correlates in, and the prognosis of the subset of infants with neuroblastoma who were identified initially by prenatal ultrasonography. Design. Retrospective review of all patients with neuroblastoma evaluated between 1982 and 1992. Setting. Large, urban, tertiary care children's hospital in Boston, Massachusetts. Patients. Eleven infants with neuroblastoma initially detected with prenatal sonograms were identified. Results. Nine patients had adrenal tumors; two had thoracic paraspinal tumors. Typical diagnostic evidence for neuroblastoma including a palpable abdominal mass and elevations in urinary catecholamines were not commonly seen postnatally. These patients had multiple favorable prognostic indicators including low stage of disease (10/11), favorable biological markers including cellular DNA content (5/5) and N-myc oncogene copy number (5/5), and histopathology suggestive for neuroblastoma in situ (7/11). All patients were treated by surgical resection. One patient exhibited progression of disease postoperatively, but demonstrated a complete clinical response to multiagent chemotherapy. Overall survival in our population was excellent with no deaths seen at a mean follow-up of 37 months (range 3 to 120 months). Conclusions. Patients with neuroblastoma identified by prenatal ultrasonography generally, although not exclusively, follow a clinically favorable course in which surgical resection is curative. Chemotherapy is not indicated unless substantial progression of disease occurs.


2021 ◽  
Vol 1 (S1) ◽  
pp. s43-s44
Author(s):  
Caitlin McGrath ◽  
Matthew Kronman ◽  
Danielle Zerr ◽  
Brendan Bettinger ◽  
Tumaini Coker ◽  
...  

Background: Systemic racism results in health inequities based on patient race, ethnicity, and language preference. Whether these inequities exist in pediatric central-line–associated bloodstream infections (CLABSIs) is unknown. Methods: This retrospective cohort study included patients with central lines hospitalized from October 2012 to June 2019 at our tertiary-care children’s hospital. Self-reported race, ethnicity, language preference, demographic, and clinical factors were extracted from the electronic health record. The primary outcome was non–mucosal barrier injury (non-MBI) CLABSI episodes as defined by the NHSN. CLABSI rates between groups were compared using χ2 tests and Cox proportional hazard regression. We adjusted for care unit, age, immunosuppressed status, diapered status, central-line type, line insertion within 7 days, daily CLABSI maintenance bundle compliance, number of blood draws and IV medication doses, and need for total parental nutrition, extracorporeal membrane oxygenation, and renal replacement therapy. In mid-2019, we engaged stakeholders in each care unit to describe preliminary findings and to identify and address potential drivers of observed inequities. Results: We included 337 non-MBI CLABSI events over 230,699 central-line days (CLDs). The overall non-MBI CLABSI rate during the study period was 1.46 per 1,000 CLDs. Unadjusted CLABSI rates for black or African American (henceforth, “black”), Hispanic, non-Hispanic white, and Asian (the 4 largest race or ethnicity groups by CLDs) patients were 2.74, 1.53, 1.42, 1.24 per 1,000 CLDs, respectively (P < .001) (Table 1). Unadjusted CLABSI rates for patients with limited-English proficiency (LEP) and English-language preference were 1.98 and 1.38 per 1,000 CLDs, respectively (P = .014). After adjusting for covariates, the hazard ratio (HR) point estimate for CLABSI rate remained higher for black patients (HR, 1.50; 95% CI, 0.99–2.28) and patients with LEP (HR, 1.33; 95% CI, 0.87–2.05), compared to the reference group based on largest CLD. The differences in CLABSI rate by race or ethnicity and language were more pronounced in 2 of our 6 care units. Stakeholder engagement and analysis of hospital data revealed opportunities on those units for improved (1) interpreter utilization and (2) line maintenance observation practices by race/ethnicity and language preference (data not shown). These findings and CLABSI rates over time by race/ethnicity and language preference (Figures 1 and 2) were shared with frontline staff. Conclusions: In our children’s hospital, CLABSI rates differed based on patients’ self-reported race, ethnicity, and language preference, despite controlling for factors commonly associated with CLABSI. Identifying inequities in CLABSI rates and mitigating their determinants are both essential to the goal of achieving equitable care.Funding: NoDisclosures: None


2010 ◽  
Vol 17 (03) ◽  
pp. 464-471
Author(s):  
MUHAMMAD SALEEM ◽  
MUHAMMAD ASIF QURESHI ◽  
MUHAMMAD ASIF I QURESH

Empyema as a complication of community acquired pneumonia (CAP) is relatively common occurrence in developing countries. Study Design: Prospective study. Period: 4 year Jan 2001- Dec 2004. Setting: Department of Pediatric surgery the Children’s hospital Lahore. Patients & Method: A total of 114 cases of empyema thoracic secondary to CAP were dealt with during this period, while in the same duration a total of 1768 cases of pneumonia were treated at the Children’s hospital Lahore. Results: Majority of the patients with CAP (59.61%) were below one year of age whereas the patients who developed empyema, were mainly (45.67%) between 2 to 5 years of age. Patients above 5 years of age having CAP (31.70%) and having repeated attacks of respiratory tract infection were most susceptible to develop empyema. Staphylococcus aureus was the most common organism found (40.35%) in this series. Vaccination, poverty and gender did not significantaffected the development of empyema among the patients of CAP. Antibiotic resistance had no role in the development of empyema. Ibuprofen may be a risk factor. All the patients were initially managed with tube thoracostomy and antibiotics. Forty-eight patients (42.10%) needed subsequently operative management. Three patients (2.63%) had fatal course in this series same as seen in patients of CAP (2%). Conclusions: Immunization against causative organism and modification of out patient treatment may affect the incidence of empyema in children and should be studied prospectively.


PEDIATRICS ◽  
1963 ◽  
Vol 32 (6) ◽  
pp. 1077-1077
Author(s):  
NORMAN J. SISSMAN

Despite the vast experience accumulated during the past decade with all aspects of the lives and deaths of patients with congenital heart disease, there is still room for the clarification and direction that careful, informed, imaginative analysis of the results of pathological examination of postmortem material can give to the clinical management of these patients. Dr. Sherman has made a notable contribution in this area with the present volume. The atlas was compiled from 503 specimens collected in the Museum of Congenital Heart Disease at the Children's Hospital in Pittsburgh since 1954.


2022 ◽  
Vol 4 (1) ◽  
pp. 2-3
Author(s):  
Amina Al Halwany ◽  
Hadir Hassouna ◽  
Yasmine El Chazli ◽  
Neveen Mikhael ◽  
Mohamed Abdelgalil

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