Feasibility and safety of transradial access for pediatric neurointerventions

BackgroundDiagnostic cerebral angiograms are increasingly being performed by transradial access (TRA) in adults, following data from the coronary literature supporting fewer access-site complications. Despite this ongoing trend in neuroangiography, there has been no discussion of its use in the pediatric population. Pediatric TRA has scarcely been described even for coronary or other applications. This is the first dedicated large study of transradial access for neuroangiography in pediatric patients.MethodsA multi-institutional series of consecutively performed pediatric transradial angiograms and interventions was collected. This included demographic, procedural, outcomes, and safety data. Data was prospectively recorded and retrospectively analyzed.ResultsThirty-seven diagnostic angiograms and 24 interventions were performed in 47 pediatric patients. Mean age, height, and weight was 14.1 years, 158.6 cm, and 57.1 kg, respectively. The radial artery measured 2.09+/-0.54 mm distally, and 2.09+/-0.44 mm proximally. Proximal and distal angiography were performed for both diagnostic and interventional application (17 distal angiograms, two distal interventions). Clinically significant vasospasm occurred in eight patients (13.1%). Re-access was successfully performed 11 times in seven patients. Conversion to femoral access occurred in five cases (8.2%). The only access-related complication was a small asymptomatic wrist hematoma after TR band removal.ConclusionsTransradial access in pediatric patients is safe and feasible. It can be performed successfully in many cases but carries some unique challenges compared with the adult population. Despite the challenge of higher rates of vasospasm and conversion to femoral access, it is worth exploring further, given the potential benefits.

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Transradial approach for pediatric interventions: A review and analysis of the literature

The Journal of Vascular Access ◽

10.1177/1129729820948688 ◽

2020 ◽

pp. 112972982094868

Author(s):

Derrek Schartz ◽

Emily Young ◽

Stephen Guerin

Keyword(s):

Complication Rate ◽

Pediatric Patients ◽

Surgical Intervention ◽

Pediatric Population ◽

Adult Population ◽

Pooled Analysis ◽

Transradial Access ◽

Lower Complication ◽

Lower Complication Rate ◽

Pediatric Interventions

Background: Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population. Methods: We conducted a systematic literature review and gathered and synthesized all of the available data into a cohesive resource for review and analysis of the topic. Results: Pooled analysis of the available data shows that transradial access in pediatric patients has a success rate of 91%, a vasospasm rate of 11.4%, and loss of pulse rate of 3.0% for a total complication rate of 14%. No permanent complications, or complications requiring surgery, were observed in any study. After stratifying for indication of intervention, neurological indications were associated with a lower complication rate compared to cardiac indications (0.1 vs 0.43, respectively, p = 0.004). In addition, studies published after 2013 were associated with a lower complication rate compared to those published during or before 2013 (0.11 vs 0.33, respectively, p = 0.01). Conclusion: Compared to prior studies on pediatric transfemoral access, transradial access has a higher complication rate. But there may be a lower rate of complications that require surgical intervention. Further studies are needed to clarify any advantages that transradial access may have over transfemoral access for pediatric patients.

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MR-Proadrenomedullin as biomarker of renal damage in urinary tract infection in children

BMC Pediatrics ◽

10.1186/s12887-021-02765-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rafael Peñalver Penedo ◽

Marta Rupérez Lucas ◽

Luis Antonio Álvarez-Sala Walther ◽

Alicia Torregrosa Benavent ◽

María Luisa Casas Losada ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Pediatric Patients ◽

Pediatric Population ◽

Adult Population ◽

Roc Curves ◽

Renal Scintigraphy ◽

Reactive Protein ◽

Sensitivity Specificity

Abstract Background Midregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population. Methods A prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and follow-up stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated. Results 62 pediatric patients (34 female) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, the median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66–1.59), while in patients without RS were 0.48 nmol/L (0.43–0.63) (p < 0.01). The AUC in this case was 0.92 (95% CI 0.77–0.99). We established an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%. Conclusion MR-ProADM has demonstrated a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM proved to be a very reliable biomarker for RS prediction.

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Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

Neurosurgical FOCUS ◽

10.3171/2011.8.focus11177 ◽

2011 ◽

Vol 31 (5) ◽

pp. E5 ◽

Cited By ~ 16

Author(s):

Geoffrey Appelboom ◽

Stephen D. Zoller ◽

Matthew A. Piazza ◽

Caroline Szpalski ◽

Samuel S. Bruce ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pediatric Patients ◽

Pediatric Population ◽

Adult Population ◽

Pediatric Trauma ◽

Anatomical Variations ◽

Decompressive Surgery ◽

Pediatric Populations ◽

The Impact

Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

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Gamma Knife surgery for cerebral arteriovenous malformations in children: a 13-year experience

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/4/296 ◽

2008 ◽

Vol 1 (4) ◽

pp. 296-304 ◽

Cited By ~ 55

Author(s):

David Hung-Chi Pan ◽

Yu-Hung Kuo ◽

Wan-Yuo Guo ◽

Wen-Yuh Chung ◽

Hsiu-Mei Wu ◽

...

Keyword(s):

Gamma Knife ◽

Pediatric Patients ◽

Pediatric Population ◽

Statistical Significance ◽

Adult Population ◽

Gamma Knife Surgery ◽

Morbidity Rate ◽

Obliteration Rate

Object Studies on the efficacy of arteriovenous malformation (AVM) radiosurgery have largely been conducted in the adult population. Clinically, the results may not always be applicable to pediatric patients. Moreover, studies involving the pediatric population have largely comprised small- (< 3 cm3) and medium-sized (3–10 cm3) AVMs. For large (> 10 cm3) AVMs in children, sparse radiosurgical results are available. The current study was conducted to further clarify the role of radiosurgery in the treatment of pediatric AVMs. Methods A retrospective analysis was performed of data obtained in 105 pediatric patients (< 18 years of age) with cerebral AVMs treated by Gamma Knife surgery (GKS) between 1993 and 2006. For statistical comparison the authors studied data acquired in 458 adult patients with AVMs treated during the same period. The patients underwent follow-up magnetic resonance imaging at 6-month intervals. Cerebral angiography was used to confirm the obliteration of the AVM. Results In pediatric patients, the AVM obliteration rate at 48 months after a primary GKS was 65%. Repeated GKS in those in whom primary treatments failed further ablated some AVMs, for an overall obliteration rate of 81%. The efficacy of GKS correlated with the size of the AVM: 91% for small, 86% for medium, and 64% for large AVMs. The treatments were associated with an 8% morbidity rate and < 1% mortality rate. Posttreatment hemorrhage occurred in 4 (4%) of 105 patients. Obliteration rates at 48 months of small and extremely large (> 20 cm3) AVMs were similar in the pediatric and adult groups, whereas AVMs between 3 and 10 cm3 responded less efficaciously in children (p = 0.042). The AVMs with volumes ranging from 10 to 20 cm3 were also associated with a lower obliteration rate in children at 48 months, but statistical significance was not reached (p = 0.279). Conclusions Gamma Knife surgery is an effective and safe treatment alternative for pediatric AVMs. The medium (3–10-cm3) and large (10–20-cm3) AVMs tend to respond less efficaciously than those of comparable size in adults.

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Similar frequency of atrial perforation between atrial and bicaval dual lumen veno-venous ECMO cannulas in a pediatric population

Perfusion ◽

10.1177/02676591211030767 ◽

2021 ◽

pp. 026765912110307

Author(s):

Akila Ramaraj ◽

Guy Jensen ◽

Samuel Rice-Townsend ◽

Robert DiGeronimo ◽

Larissa Yalon ◽

...

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Median Sternotomy ◽

Related Complication ◽

Free Standing ◽

Similar Frequency ◽

Treatment Groups ◽

Pericardial Effusions ◽

Entire Duration ◽

Vv Ecmo

Purpose: Complications associated with use of dual-lumen venovenous extracorporeal membrane oxygenation (VV-ECMO) cannulas are of concern in pediatric patients. While the risk of atrial perforation is believed to be higher with bicaval cannulas, direct comparison of complication rate between atrial and bicaval cannulas has not been conducted in this population. Methods: A retrospective review was conducted at a free-standing children’s hospital of all patients 0–18 years old, placed on VV-ECMO with a dual-lumen cannula from January 2009 to December 2018. Patients were grouped based on cannula type. Complications were assessed over the entire duration of the ECMO run. Logistic regression analyses were used to evaluate for an association between cannula type and risk of pericardial effusion or cannula-related complication requiring median sternotomy or pericardial drain placement. Results: During the study period 119 patients were placed on VVECMO using a dual-lumen cannula. Eighty-two patients (69%) were <2 years old, 19 (16%) were 2–10 years old, and 18 (15%) were 11–18 years old. Seventy-three were cannulated with an atrial cannula and 46 patients received a bicaval cannula. Pericardial effusions were seen in 30% and 24% of these patients respectively while severe complications were seen in 9.6% and 8.7% of patients respectively. Compared to patients treated with a bicaval cannula, those who received an atrial cannula had similar odds of effusions (OR: 1.41, 95% CI: 0.62–3.36) and severe complications (OR 0.89, 95% CI: 0.27–3.18). After adjusting for age, weight, cannula and circuit manipulations, and use of echocardiography, the OR of effusion was 1.91 (95% CI: 0.65–6.42), and the adjusted OR of severe complication was 0.69 (95% CI: 0.16–3.33). Conclusions: There were no significant differences in frequency of pericardial effusions or severe cannula-related complications between the treatment groups across all pediatric patients and within the subgroup of patients under 2 years of age.

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Stroke as Presenting Feature of COVID-19 in a Pediatric Patient

Journal of Pediatric Neurology ◽

10.1055/s-0041-1731396 ◽

2021 ◽

Author(s):

Shanna Swartwood ◽

Gary R. Nelson ◽

Audie C. Espinoza

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Adult Population ◽

Acute Onset ◽

Cerebrovascular Complications ◽

Novel Virus ◽

Polymerase Chain ◽

Diagnostic Work ◽

Novel Coronavirus ◽

Work Up

AbstractNeurologic manifestations of severe acute respiratory syndrome coronavirus 2, the virus responsible for novel coronavirus 2019 (COVID-19) infection, have been frequently reported in the adult population but remain relatively rare in pediatric patients, specifically in regard to cerebrovascular accidents (CVAs). We present the case of a previously healthy 16-year-old adolescent boy with no preceding infectious symptoms who developed acute onset of left-sided weakness and slurred speech subsequently diagnosed with acute ischemic stroke (AIS). After performing a thorough diagnostic work-up, no clear etiology for AIS was identified. He was found to be COVID-19 positive by reverse transcription polymerase chain reaction upon admission. Accumulating evidence supports a link between COVID-19 and a systemic prothrombotic state suggesting pediatric patients who present with AIS and no other risk factors should be screened for this novel virus and potentially for extracranial sources of thrombi. As the rates of positive COVID-19 infection increase in the pediatric population, pediatricians and other pediatric subspecialists should be aware of the potential neurological and cerebrovascular complications of this novel virus to avoid delays in evaluation and intervention.

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Evaluation of thyroid nodule in pediatric population in a tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20193743 ◽

2019 ◽

Vol 6 (5) ◽

pp. 2152

Author(s):

Mukul Singh ◽

Manju Kumari

Keyword(s):

Thyroid Nodule ◽

Pediatric Patients ◽

Pediatric Population ◽

Adult Population ◽

Tertiary Care ◽

Needle Aspiration ◽

Care Hospital ◽

Pediatric Age Group ◽

Thyroid Cytopathology ◽

Rule Out

Background: Thyroid nodules are commonly present in adult population but are rare in pediatric age group. Inspite of being rare, thyroid nodule have a higher chance of malignancy in children. Thus, pediatric patients presenting with thyroid nodule found clinically or incidentally should be worked up to rule out any possibility of malignancy. The besthesda system for reporting thyroid cytopathology (TBSRTC) is widely used for reporting in adults. The present study aims to use TBSRTC for pediatric thyroid lesions reporting.Methods: All pediatric patients with age ≤ 18 years presenting with thyroid nodule during January 2018 to April 2019 were included in the study, fine needle aspiration (FNA) was done and findings were compared with histology. Statistical analysis was done using SPSS version 18.Results: 42 pediatric patient were included in the study, out of which 2.38% were malignant and suspicious for nmalignant each and 83% were benign.Conclusion: TBSRTC is quite sensitive and specific reporting guideline in pediatric population as in adult population with 100% accuracy in diagnosing benign and malignant cases. This is useful for avoiding unnecessary surgeries.

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Blunt cerebrovascular injury in pediatric trauma: a national database study

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.5.peds18765 ◽

2019 ◽

Vol 24 (4) ◽

pp. 451-460 ◽

Cited By ~ 1

Author(s):

Dominic A. Harris ◽

Danielle E. Sorte ◽

Sandi K. Lam ◽

Andrew P. Carlson

Keyword(s):

Risk Factors ◽

Skull Base ◽

Pediatric Patients ◽

Motor Vehicle ◽

Pediatric Population ◽

Adult Population ◽

Pediatric Trauma ◽

National Database ◽

Blunt Cerebrovascular Injury ◽

Cerebrovascular Injury

OBJECTIVEThe incidence of blunt cerebrovascular injury (BCVI) has not been well characterized in the pediatric population. The goal of this study was to describe the incidence, patient characteristics, and risk factors for pediatric patients with cerebrovascular injuries.METHODSThe authors collected data from the Kids’ Inpatient Database (KID), a nationally representative database of pediatric admissions, for years 2000, 2003, 2006, 2009, and 2012.RESULTSAmong an estimated 646,549 admissions for blunt trauma, 2150 were associated with BCVI, an overall incidence of 0.33%. The incidence of BCVI nearly doubled from 0.24% in 2000 to 0.49% in 2012. Patients 4 to 13 years of age were less likely to have BCVI than those in the youngest (0–3 years) and oldest age groups comprising adolescents (14–17 years) and young adults (18–20 years). BCVIs were associated with cervical (adjusted OR [aOR] 4.6, 95% CI 3.8–5.5), skull base (aOR 3.0, 95% CI 2.5–3.6), clavicular (aOR 1.4, 95% CI 1.1–1.8), and facial (aOR 1.2, 95% CI 1.0–1.5) fractures, as well as intracranial hemorrhage (aOR 2.7, 95% CI 2.2–3.2) and traumatic brain injury (aOR 2.0, 95% CI 1.7–2.3). Mechanism of injury was also independently associated with BCVI: motor vehicle collision (aOR 1.7, 95% CI 1.3–2.2) and struck pedestrian (aOR 1.4, 95% CI 1.0–1.9). Among pediatric patients with BCVI, 37.4% had cerebral ischemic infarction with an in-hospital mortality of 12.7%, and patients with stroke had 20% mortality.CONCLUSIONSThe incidence of pediatric BCVI is increasing, likely due to increased use of screening, but remains lower than that in the adult population. Risk factors include the presence of cervical, facial, clavicular, and skull base fractures, similar to that of the adult population. Diagnosed BCVI is associated with a relatively high incidence of stroke with increased morbidity and mortality. The use of adult screening criteria is likely reasonable given the similarity in the risk factors identified in this study. Further studies are needed to investigate the role of treatment with antiplatelet agents or anticoagulation.

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State-of-the art review: Noncompaction cardiomyopathy in pediatric patients

Heart Failure Reviews ◽

10.1007/s10741-021-10089-7 ◽

2021 ◽

Author(s):

Sofie Rohde ◽

Rahatullah Muslem ◽

Emrah Kaya ◽

Michel Dalinghaus ◽

Jaap I. van Waning ◽

...

Keyword(s):

Pediatric Patients ◽

American Heart ◽

State Of The Art ◽

Heart Diseases ◽

Pediatric Population ◽

Adult Population ◽

Neuromuscular Diseases ◽

Heart Association ◽

Noncompaction Cardiomyopathy

AbstractNoncompaction cardiomyopathy (NCCM) is a disease characterized by hypertrabeculation, commonly hypothesized due to an arrest in compaction during fetal development. In 2006, NCCM was classified as a distinct form of cardiomyopathy (CMP) by the American Heart Association. NCCM in childhood is more frequently familial than when diagnosed in adulthood and is associated with other congenital heart diseases (CHDs), other genetic CMPs, and neuromuscular diseases (NMDs). It is yet a rare cardiac diseased with an estimated incidence of 0.12 per 100.000 in children up to 10 years of age. Diagnosing NCCM can be challenging due to non-uniform diagnostic criteria, unawareness, presumed other CMPs, and presence of CHD. Therefore, the incidence of NCCM in children might be an underestimation. Nonetheless, NCCM is the third most common cardiomyopathy in childhood and is associated with heart failure, arrhythmias, and/or thromboembolic events. This state-of-the-art review provides an overview on pediatric NCCM. In addition, we discuss the natural history, epidemiology, genetics, clinical presentation, outcome, and therapeutic options of NCCM in pediatric patients, including fetuses, neonates, infants, and children. Furthermore, we provide a simple classification of different forms of the disease. Finally, the differences between the pediatric population and the adult population are described.

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Antiphospholipid antibodies and cerebrovascular thrombosis in the pediatric population: Few answers to many questions

Lupus ◽

10.1177/09612033211021488 ◽

2021 ◽

pp. 096120332110214

Author(s):

Georges El Hasbani ◽

Ali T Taher ◽

Nadine Sunji ◽

Savino Sciascia ◽

Imad Uthman

Keyword(s):

Antiphospholipid Antibodies ◽

Pediatric Patients ◽

Pediatric Population ◽

Adult Population ◽

Placental Barrier ◽

Neurological Outcomes ◽

Cerebrovascular Events ◽

Sinovenous Thrombosis ◽

The Relationship

Most of the knowledge in pediatric antiphospholipid syndrome (APS) is derived from studies performed on the adult population. As in adults, antiphospholipid antibodies (aPL) can contribute to thrombosis, especially cerebrovascular thrombosis, in neonates and children. Since aPL have the potential to cross the placental barrier, and since the pediatric population is prone to infections, re-testing for their positivity is essential to specify their role in cerebrovascular thrombosis. In this review, we aimed at assessing the prevalence of aPL, criteria or non-criteria, in neonatal and childhood ischemic stroke and sinovenous thrombosis trying to find an association between aPL and cerebrovascular thrombosis in the neonatal and pediatric population. Also, we looked into the effect of aPL and anticoagulants/antiplatelets on the long term neurological outcomes of affected neonates or children. The questions regarding the prevalence of aPL among pediatric patients with cerebrovascular thrombosis, the relationship between the titers of aPL and incidence and recurrence of cerebrovascular events, the predictability of the long term neurological outcomes, and the most optimal anticoagulation plan are still to be answered. However, it is crucial for clinicians to screen neonates and children with cerebrovascular thrombosis for aPL and confirm their presence if positive.

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