Vestibular Testing in Children

Vestibular evaluation in the pediatric population has in the past taken several forms. For the most part, the pediatric vestibular evaluation has been more subjective than objective. One of the primary reasons for this has been the obvious difficulties encountered in trying to conduct a standard, adult electronystagmography (ENG) procedure on a pediatric patient population not capable of performing in a manner conducive to a good ENG recording. The purpose of this paper is to suggest certain modifications of the standard adult ENG battery for use with young children and infants. Discussion consists of modifications in the areas of various ocular movement tests including sinusoidal pursuit, calibration, optokinetics and gaze testing. In addition, procedures relative to peripheral vestibular output from perrotational and caloric stimulation are discussed. Topics also include the use of a closed-loop caloric irrigator and simultaneous caloric irrigation as viable alternatives to standard, alternate water irrigation when testing the vestibular output of a young child or infant.

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Fluoroscopically guided, transoral, closed reduction, and halo vest immobilization for an atypical C-1 fracture

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.1.peds10384 ◽

2011 ◽

Vol 7 (4) ◽

pp. 380-382 ◽

Cited By ~ 2

Author(s):

Matthew R. Sanborn ◽

Michael L. DiLuna ◽

Robert G. Whitmore ◽

Phillip B. Storm

Keyword(s):

Pediatric Patient ◽

Conservative Management ◽

Closed Reduction ◽

Patient Population ◽

Pediatric Population ◽

Halo Vest ◽

Anterior Arch ◽

Pediatric Patient Population ◽

Displaced Fracture

Fractures through the ring of the C-1 vertebrae are very rare in the pediatric patient population. In this report, the authors describe the case of a widely displaced fracture of the C-1 anterior arch in a 6-year-old boy. The fracture was initially treated using a fluoroscopy-guided, transoral, closed reduction with subsequent halo vest immobilization. Although conservative management of C-1 fractures is generally adequate and efficacious in the pediatric population, mechanistic and anatomical considerations in this case were concerning for potential instability in extension, and prompted an unusual method of closed reduction followed by treatment in a halo vest.

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Prevalence and Molecular Characterization of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in a Pediatric Patient Population

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00666-12 ◽

2012 ◽

Vol 56 (9) ◽

pp. 4765-4770 ◽

Cited By ~ 39

Author(s):

Lakshmi Chandramohan ◽

Paula A. Revell

Keyword(s):

Pediatric Patient ◽

Patient Population ◽

Pediatric Patients ◽

Pediatric Population ◽

Tertiary Care ◽

Content Type ◽

Extended Spectrum ◽

Pediatric Patient Population ◽

Pediatric Infections ◽

Relative Prevalence

ABSTRACTVery little is known about the prevalence and composition of various types of extended-spectrum β-lactamases (ESBL) in pediatric patients. The aims of this study were the following: (i) to determine the prevalence of ESBLs amongEnterobacteriaceaein a tertiary-care pediatric population; (ii) to characterize the genetic composition of the identified ESBL enzymes; and (iii) to determine the relative prevalence of CTX-M enzymes andEscherichia coliST131 strains among ESBL-producing isolates in the same pediatric patient population. Among the 1,430Enterobacteriaceaeisolates screened for elevated MICs to cefotaxime and/or ceftazidime from pediatric patients during a 1-year period, 94 isolates possessed at least one ESBL gene. CTX-M was the most commonly isolated ESBL type, consisting of 74% of all ESBLs versus 27% TEM and 24% SHV enzymes. Sequence analysis and probe-specific real-time PCR revealed that the majority (80%) of the CTX-M-type ESBLs were CTX-M-15 enzymes, followed by CTX-M-14 (17%) and CTX-M-27(2.8%). Multilocus sequence typing (MLST) and repetitive PCR analyses revealed that the relative prevalence of ST131 among ESBL-producingE. coliisolates is 10.2%. This study highlights the growing problem of ESBL resistance in pediatricEnterobacteriaceaeisolates and demonstrates a transition toward the predominance of CTX-M-type enzymes among ESBL-producingEnterobacteriaceaeorganisms causing pediatric infections.

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Thromboembolic Complications in a Pediatric Patient Population: Treatment with Direct Oral Anticoagulants. Monitoring of Treatment Efficiency with D-Dimer Levels and Safety Profile By Thromboelastogram

Blood ◽

10.1182/blood-2021-146948 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4270-4270

Author(s):

Afshin Ameri ◽

Courtney M Anderson ◽

Joetta H Smith ◽

Julisa Patel

Keyword(s):

Pediatric Patient ◽

Patient Population ◽

Conflicts Of Interest ◽

Pediatric Population ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Coagulation Factor ◽

Thrombin Inhibitor ◽

Pediatric Patient Population ◽

D Dimer

Abstract Direct oral anticoagulants (DOAC) such as the thrombin inhibitor Dabigatran and the coagulation factor Xa inhibitors Apixaban and Rivaroxaban have been in clinical use for the past 5-6 years. Familiarity with their use in the general pediatric population with thrombosis secondary to inflammatory disorders and rheumatologic disease is currently not as prevalent due to the widespread more conventional anticoagulation practice with the fractionated heparins in particular Lovenox. In this report we would like to summarize our experience in a pediatric patient population ranging from 3- 17 years with thrombotic disease. Of 55 patients with various thrombotic events 16 patients were treated with DOAC. There were 5 patients who had underlying inflammatory disease including COVID. Thrombotic complications included arterial as well as venous thrombotic events. All patients had elevated D-Dimer levels ranging from 360-4000 mcg/ml on diagnosis and normalized with successful anticoagulation. All patients had resolution of thrombosis. Thrombelastogram (TEG) were obtained on isolated patients during therapy and were useful to balance anticoagulation to prevent hemorrhagic complications. In conclusion, DOAC are a safe and effective alternative to LMW Heparin in pediatric patients with arterial or venous thrombosis. Monitoring should include determination of D-Dimer levels for efficacy of treatment and TEG in cases with arterial disease where bleeding may be a secondary complication of therapy. Disclosures No relevant conflicts of interest to declare.

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