Utilization of Diagnostic Testing for Renal Anomalies and Congenital Heart Disease in Patients with Microtia

2020 ◽  
Vol 162 (4) ◽  
pp. 554-558
Author(s):  
Vaibhav H. Ramprasad ◽  
Amber D. Shaffer ◽  
Noel Jabbour
Keyword(s):  
Congenital Heart ◽  
Medical Center ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Case Series ◽  
Standard Of Care ◽  
Renal Ultrasound ◽  
Renal Anomalies ◽  
Children's Hospital ◽  
Children’S Hospital

Objective Congenital ear anomalies are associated with congenital cardiac and renal defects. Renal ultrasounds, electrocardiogram, and echocardiogram can be utilized for diagnosis of these concurrent defects. No standard of care exists for the workup of patients with microtia. The goals of this study were to describe the utilization of diagnostic testing for cardiac and renal anomalies and to identify their prevalence in patients with microtia. Study Design Case series with chart review. Setting Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center. Subjects and Methods This study is an Institutional Review Board–approved retrospective review of consecutive patients born between 2002 and 2016 who were diagnosed with microtia and seen in the otolaryngology clinic at a tertiary care children’s hospital. Demographics, sidedness and grade of microtia, comorbid diagnoses, and details of renal and cardiovascular evaluations were recorded. Factors associated with retroperitoneal ultrasound and cardiac testing were assessed with logistic regression. Results Microtia was present in 102 patients, and 98 patients were included as they received follow-up. Microtia was associated with craniofacial syndrome in 34.7% of patients. Renal ultrasound was performed in 64.3% of patients, and 12.9% of patients with ultrasounds had renal aplasia. Cardiac workup (electrocardiogram or echocardiogram) was completed in 60.2% of patients, and of this subset, 54.2% had a congenital heart defect. Conclusion Diagnostic testing revealed renal anomalies and cardiac defects in patients with isolated microtia at a higher rate than in the general population. This suggests the need for further evaluation of the role of routine screening in patients with microtia.

Use of Emergency-Release, Uncrossmatched O Negative Red Blood Cells (RBCs) in a Tertiary Care Children’s Hospital

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4341-4341
Author(s):  
Jennifer C. Andrews ◽  
Maurene Viele ◽  
Lawrence T Goodnough
Keyword(s):  
Intensive Care Unit ◽  
Congenital Heart Disease ◽  
Intensive Care ◽  
Heart Disease ◽  
Cardiac Catheterization ◽  
Congenital Heart ◽  
Tertiary Care ◽  
Blood Products ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract Abstract 4341 Background: Transfusion services must offer means of issuing blood products quickly for emergent transfusions. At Lucile Packard Children’s Hospital (LPCH), off-site refrigerators were installed in the Neonatal Intensive Care Unit (NICU), the LPCH operating room (OR) and the Cardiovascular Intensive Care Unit (CVICU) inventoried with uncrossmatched O negative RBCs for immediate emergency use. Uncrossmatched O negative RBCs are also provided to children undergoing cardiac catheterization at the discretion of the Pediatric Cardiologist, since these patients commonly do not have type and screen samples drawn until large vessel venous cannulation via insertion of the catheter. Uncrossmatched blood products are also provided for children per our massive transfusion protocol (MTP). The purpose of this study was to assess the utilization of these uncrossmatched blood products in children and its impact on transfusion service (TS) inventory of O negative RBCs. Methods: Orders received for emergency-release uncrossmatched RBCs for patients ages 0 days to 18 years including MTPs from January 1 2011 to March 31 2011 were evaluated retrospectively. Variables collected include: patient demographic information and diagnosis; blood products ordered, released and transfused; location of the patient and location from where blood was dispensed (off-site refrigerator versus [vs] TS). Results: Median patient age was 3.46 years (range 0 days to 15.62 years), and 82% of the patients had congenital heart disease. Sixty four RBCs were issued to 33 patients during the 3-month study period. Of those, 32 RBCs were transfused, 8 RBCs were wasted because temperature parameters were exceeded before return to the TS, and 24 RBCs (38%) were not transfused and returned to TS inventory. Nineteen of the 32 RBCs were transfused, representing 2% of the total 964 O negative RBC units transfused at our institution for that time period. Nineteen (58%) units were for children in the cardiac catheterization suite. Seven patients were in the CVICU, five children were in the NICU, and two were in the Pediatric Intensive Care Unit. Two units of O negative RBCs were dispensed from the emergency off-site refrigerator in the CVICU. Discussion: The majority of children (79%) who received emergency-release uncrossmatched O negative RBCs at LPCH were those with congenital heart disease undergoing cardiac catheterization or being cared for post-operatively in the CVICU. There were 2 instances of children requiring RBCs from off-site refrigerators for an emergent transfusion. Emergency-release, uncrossmatched O negative RBCs at LPCH either from the TS or from three off-site refrigerators caused no undue strain on our supply and inventory of donor O negative RBCs. Disclosures: No relevant conflicts of interest to declare.

scholarly journals 89 The Unintended Consequences and Impact of the COVID-19 Pandemic on Patients, Families and Clinicians in a Children’s Hospital

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e64-e65
Author(s):  
Catherine Diskin ◽  
Julia Orkin ◽  
Blossom Dharmaraj ◽  
Tanvi Agarwal ◽  
Arpita Parmar ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Case Series ◽  
Unintended Consequences ◽  
Pediatric Care ◽  
Full Time ◽  
Negative Consequences ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract Primary Subject area Hospital Paediatrics Background The coronavirus (COVID-19) pandemic has broad implications for children and families. Healthcare experience and delivery has changed significantly, and changes will likely continue for some time. Particular attention has been paid to delays in accessing timely pediatric care leading to unintended morbidity. Objectives This study aimed (1) to describe the broader spectrum of unintended negative consequences by describing the courses of care altered by the COVID-19 pandemic from the clinician's perspectives and (2) to identify thematic similarities to inform clinical practice change. Design/Methods All full-time doctors, dentists, and nurse practitioners working at a tertiary care children’s hospital in Canada were surveyed every two weeks throughout the initial phase of the COVID-19 pandemic. We asked them to identify and describe clinical cases in which they perceived a negative outcome associated with hospital or societal changes due to the COVID-19 pandemic. Analysis followed a qualitative case series methodology using a narrative synthesis approach to determine similarities and associated themes. Results Two-hundred and twelve clinicians reported 116 cases. Several broad themes emerged, including (1) timeliness of care, (2) disruption of child and family-centred care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic. Within each of these themes, subthemes emerged, highlighting its impact on (1) patients, (2) their families and (3) healthcare providers. Table 1 provides examples of cases within each theme. Conclusion The broad consequences of the COVID-19 pandemic impact patients, families, healthcare providers and the healthcare system. Understanding this breadth is necessary as we strive to deliver safe, high quality, family-centred pediatric care in this new era. As the pandemic continues, we need to consider carefully how to provide elective and ambulatory care, including surgery, in this era of social distancing. Particular attention is needed to understand particular aspects, including vulnerable children and the clinician experience of the COVID-19 pandemic.

scholarly journals Pulmonary Hypertension Roundtable: The Crossover From Child to Adult With PH and Congenital Heart Disease

2019 ◽  
Vol 18 (1) ◽  
pp. 25-30
Keyword(s):  
Pulmonary Hypertension ◽  
San Francisco ◽  
Congenital Heart ◽  
Medical Center ◽  
Colorado School ◽  
Children's Hospital ◽  
University Of Colorado ◽  
School Of Medicine ◽  
Children’S Hospital ◽  
The University

Guest editor Dunbar Ivy, MD, Chief of Pediatric Cardiology and Director of the Pediatric Pulmonary Hypertension Program at the University of Colorado School of Medicine and Children's Hospital of Colorado led a discussion among Editor-in-Chief Harrison (Hap) Farber, MD, then Professor of Medicine and Director of the Pulmonary Hypertension Center at Boston University/Boston Medical Center; Mary P. Mullen, MD, PhD, Assistant Professor of Pediatrics at Harvard Medical School, associate cardiologist at Boston Children's Hospital and Associate Director of the Pulmonary Hypertension Service as well as a member of the adult congenital heart program; Jeffrey R. Fineman, MD, Professor and Vice Chair of Pediatrics, Director of Pediatric Critical Care Medicine and Pulmonary Hypertension, University of California, San Francisco, Benioff Children's Hospital; and Gareth Morgan, MD, Associate Professor of Pediatrics-Cardiology at the University of Colorado School of Medicine and Director of the Cardiac Catheterization Lab at Children's Hospital of Colorado.

scholarly journals OUTBREAK OF PANTOEA SPECIES IN A TERTIARY CARE CHILDREN’S HOSPITAL IN NORTH INDIA- A CASE SERIES

2017 ◽  
Vol 6 (47) ◽  
pp. 3664-3667
Author(s):  
Shivani Tyagi ◽  
Satinder Aneja ◽  
Randhawa V S ◽  
Abhijeet Saha ◽  
Ravinder Kaur
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
North India ◽  
Children's Hospital ◽  
Children’S Hospital

Reduction in Rate of Nosocomial Respiratory Virus Infections in a Children’s Hospital Associated With Enhanced Isolation Precautions

2018 ◽  
Vol 39 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Lorry G. Rubin ◽  
Nina Kohn ◽  
Susan Nullet ◽  
Margaret Hill
Keyword(s):  
Respiratory Virus ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Medical Center ◽  
Tertiary Care ◽  
Virus Infections ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Respiratory Virus Infections ◽  
Hospital Days

OBJECTIVETo determine whether the use of enhanced isolation precautions (droplet and contact precautions) for inpatients with respiratory tract viral infections is associated with a reduction in rate of nosocomial viral respiratory infections.DESIGNQuasi-experimental study with the rate of nosocomial respiratory virus infection as the primary dependent variable and rate of nosocomialClostridium difficileinfection as a nonequivalent dependent variable comparator.SETTINGCohen Children’s Medical Center of NY, a tertiary-care children’s hospital attached to a large general hospital.INTERVENTIONDuring years 1 and 2 (July 2012 through June 2014), the Centers for Disease Control and Prevention/Healthcare Infection Control Practices Advisory Committee’s recommended isolation precautions for inpatients with selected respiratory virus infections were in effect. Enhanced isolation precautions were in effect during years 3 and 4 (July, 2014 through June, 2016), except for influenza, for which enhanced precautions were in effect during year 4 only.RESULTSDuring the period of enhanced isolation precautions, the rate of nosocomial respiratory virus infections with any of 4 virus categories decreased 39% from 0.827 per 1,000 hospital days prior to enhanced precautions to 0.508 per 1,000 hospital days (P<.0013). Excluding rhinovirus/enterovirus infections, the rates decreased 58% from 0.317 per 1,000 hospital days to 0.134 per 1,000 hospital days during enhanced precautions (P<.0014). During these periods, no significant change was detected in the rate of nosocomialC. difficileinfection.CONCLUSIONSEnhanced isolation precautions for inpatients with respiratory virus infections were associated with a reduction in the rate of nosocomial respiratory virus infections.Infect Control Hosp Epidemiol2018;39:152–156

scholarly journals Pediatric Infective Endocarditis: HasStaphylococcus aureusOvertaken Viridans Group Streptococci as the Predominant Etiological Agent?

2008 ◽  
Vol 19 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Aisha Alshammary ◽  
Marilou Hervas-Malo ◽  
Joan L Robinson
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Congenital Heart ◽  
Case Series ◽  
Etiological Agent ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Etiological Agents ◽  
Viridans Group Streptococci

BACKGROUND: Viridans group streptococci (VGS) have traditionally been the most common etiological agents of infective endocarditis (IE). Advances in cardiovascular surgery and the increasing use of long-term central venous catheters may have altered the epidemiology of pediatric IE.METHODS: A chart review of children younger than 17 years of age with IE was completed at the Stollery Children’s Hospital (Edmonton, Alberta) between 1985 and 2004. The literature was reviewed to look for changes over time in the most common etiological agents of pediatric IE.RESULTS: There were 31 cases of definite IE and nine cases of possible IE at the Stollery Children’s Hospital, 19 of which were nosocomial. Thirty cases (75%) had congenital heart disease. The etiological agents wereStaphylocccus aureus(n=16), VGS (n=5), coagulase-negative staphylococci (n=3), enterococcus (n=3), other streptococci (n=8),Enterobacter cloacae(n=1) andStenotrophomonas maltophilia(n=1), while three cases were culture negative. Two deaths were due toS aureusIE. Review of the literature identified an increasing number of case series in whichS aureuswas the predominant etiological agent, but VGS still predominated in some recent series.CONCLUSION: Congenital heart disease remains the primary risk factor for pediatric IE. Prospective population-based studies are required to determine whetherS aureushas become the predominant pathogen.

Increased Incidence of Severe Breastfeeding Malnutrition and Hypernatremia in a Metropolitan Area

PEDIATRICS ◽  
1995 ◽  
Vol 96 (5) ◽  
pp. 957-960
Author(s):  
William O. Cooper ◽  
Harry D. Atherton ◽  
Madelyn Kahana ◽  
Uma R. Kotagal
Keyword(s):  
Birth Weight ◽  
Parent Education ◽  
Metropolitan Area ◽  
Tertiary Care ◽  
Case Series ◽  
Average Weight ◽  
Case Review ◽  
Retrospective Case ◽  
Children's Hospital ◽  
Children’S Hospital

Objective: To identify common characteristics among infants with breastfeeding malnutrition in a region with an increasing incidence of breastfeeding malnutrition. Design. Retrospective case series. Setting. A 361-bed regional tertiary care children's hospital in a 1.7 million population metropolitan area. Patients. Case series: five infants with severe breast-feeding malnutrition and hypernatremia admitted to a tertiary care children's hospital over a 5-month period. Retrospective case review: 166 infants admitted between 1990 and 1994 with the diagnosis of dehydration, hypernatremia, or malnutrition. Main Outcome Measures. Maternal characteristics, age at presentation, percent loss from birth weight, serum sodium, average age at birth hospital discharge, neurologic, or cardiovascular complications. Results. Five infants were admitted to a children's hospital over a 5-month period with severe breastfeeding malnutrition and hypernatremia. The average weight loss at time of readmission was 23% (± 8%) from birth weight. The average presenting sodium was 186 ± 19 mmol/L. Three suffered significant complications. From 1990 through 1994, there was a statistically significant (P &lt; .05) annual increase in the number of infants admited with breastfeeding malnutrition and hypernatremia. Conclusions. While breastfeeding malnutrition and hypernatremia is not a new problem, this cluster of infants represents an increase in frequency and severity of the problem and could be a consequence of several factors, including inadequate parent education about breastfeeding problems and inadequate strategies for infant follow-up.

scholarly journals Potential Cytochrome P450 Drug-Drug Interactions among Pediatric Patients Undergoing Tonsillectomy

2018 ◽  
Vol 160 (1) ◽  
pp. 145-149 ◽  
Author(s):  
John Faria ◽  
Matthew Solverson ◽  
Madlin Faria ◽  
Margo Benoit ◽  
Michael McCormick
Keyword(s):  
Cytochrome P450 ◽  
Drug Interactions ◽  
Tertiary Care ◽  
Case Series ◽  
Therapeutic Index ◽  
Systemic Absorption ◽  
Children's Hospital ◽  
Obstructive Sleep ◽  
Children’S Hospital ◽  
Cyp3a4 Inducer

Objective To evaluate the frequency of potential cytochrome P450 (CYP) drug-drug interactions affecting opioid metabolism among children undergoing adenotonsillectomy. Study Design Case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods A retrospective review was conducted of 1000 patients undergoing adenotonsillectomy at Children’s Hospital of Wisconsin. The discharge medication reconciliation form was reviewed. Each patient’s list of medications was compared with various published sources to determine whether medications causing CYP inhibition or induction were present. Results There were 157 unique medications with systemic absorption given postoperatively to this patient cohort. Eight percent of patients were on at least 5 medications after surgery other than their posttonsillectomy medication. The 5 most commonly prescribed medications were albuterol, cetirizine, fluticasone nasal spray, montelukast, and polyethylene glycol. Per a list of known CYP inducers and inhibitors published by the US Food and Drug Administration, 30 (3%) patients were on a medication that inhibited CYP3A4; 1 patient was on a CYP3A4 inducer, prednisone; and 46 (5%) patients were on a medication that inhibited CYP2D6. Conclusions A small fraction of patients undergoing adenotonsillectomy are on medications that potentially alter the metabolism of opioid pain medications. Given the narrow therapeutic index of opioids and increased sensitivity to opioids among patients with obstructive sleep apnea, drug-drug interactions need to be considered as they relate to whether an opioid is appropriate and at what dose.

scholarly journals Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Cassandra C. Brady ◽  
Vidhu V. Thaker ◽  
Todd Lingren ◽  
Jessica G. Woo ◽  
Stephanie S. Kennebeck ◽  
...  
Keyword(s):  
Young Children ◽  
Early Onset ◽  
Severe Obesity ◽  
Medical Center ◽  
Tertiary Care ◽  
Clinical Documentation ◽  
Older Children ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
American Children

Background and Objectives.The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals.Methods.We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children’s Hospital and Cincinnati Children’s Hospital and Medical Center between 2007 and 2014.Results.A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%,p<0.001), African American children (27% versus 19% in whites,p<0.001), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics,p<0.001).Conclusions.There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity.

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