Surgical Techniques for Tonsillectomy and Perioperative Respiratory Complications in Children

2021 ◽  
pp. 019459982110151
Author(s):  
Rahul G. Baijal ◽  
Karla E. Wyatt ◽  
Teniola Shittu ◽  
Eugenia Y. Chen ◽  
Eric Z. Wei ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Chart Review ◽  
Surgical Techniques ◽  
Retrospective Chart Review ◽  
Airway Disease ◽  
Respiratory Complications ◽  
Patient Factors ◽  
Children's Hospital ◽  
Reactive Airway Disease ◽  
Children’S Hospital

Objectives The aim of this study was to determine the incidence of perioperative respiratory complications in children following tonsillectomy with cold and hot dissection surgical techniques. Study Design The study was a retrospective cohort study. Setting Retrospective chart review was performed for all children presenting for a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. Methods Pre- and intraoperative patient factors, including surgical technique with cold or hot dissection (electrocautery or radiofrequency ablation), and perioperative anesthetic factors were collected to determine the incidence of perioperative respiratory complications. Results A total of 2437 patients underwent a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. The incidence of perioperative respiratory complications was 20.0% (n = 487). Sickle cell disease, cardiac disease, reactive airway disease, pulmonary disease, age >2 and <3 years, and obesity, defined as a body mass index >95th percentile for age, were significant for overall perioperative respiratory complications. There was no difference in the incidence of perioperative respiratory complications in children undergoing tonsillectomy by cold or hot dissection. Conclusion Perioperative respiratory complications following tonsillectomy are more affected by patient factors than surgical technique.

scholarly journals Evaluation of Ventilator-Associated Tracheitis in Children with Pre-Existing Tracheostomies: Organisms and Empiric Coverage

2021 ◽  
Author(s):  
Victoria Urban ◽  
Christopher Campbell ◽  
Jennifer Waller ◽  
Kelley Norris
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Inpatient Treatment ◽  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Causative Organism ◽  
Ventilator Associated Pneumonia ◽  
Treatment Groups ◽  
Children's Hospital ◽  
Children’S Hospital

Evaluation of Ventilator-Associated Tracheitis in Children with Pre-Existing Tracheostomies: Organisms and Empiric Coverage Objectives: This study aims to describe the outcomes, microbiome, and empiric antimicrobial coverage of ventilator associated tracheitis (VAT) in pediatric patients with pre-existing tracheostomies. Patients and Methods: This is a retrospective chart review of pediatric patients with pre-existing tracheostomies admitted to the Children’s Hospital of Georgia for initial inpatient treatment for VAT between January 1, 2007 and February 21, 2021. Patients were evaluated for incidence of ventilator associated pneumonia (VAP), tracheostomy culture results, and antibiotic choice. Results: Thirty-nine patients were included. Across all patients evaluated with pre-existing tracheostomies, 60% developed VAT. There was no difference in the development in VAP between shorter and longer treatment durations (0 vs 1, p = 1). Patients who developed Pseudomonas aeruginosa VAT were likely to have a previous culture of P. aeruginosa (p = 0.003), have a tracheostomy for longer (p = 0.011), and be older than 1 year of age (p = 0.0002). MRSA VAT was associated with a previous culture growing MRSA (p= 0.0042). Conclusions: VAT incidence was higher than what was shown in pediatric patients without pre-existing tracheostomies but VAP incidence was lower and there was no difference between treatment groups. VAT should be treated based on previous cultures and Pseudomonas aeruginosa should be considered as a causative organism.

Oral sodium bicarbonate protocol for high-dose methotrexate urine alkalinization: A pediatric experience

2020 ◽  
pp. 107815522091576
Author(s):  
Mark Diachinsky ◽  
Tracey Tran ◽  
Jennifer Jupp ◽  
Krista McKinnon
Keyword(s):  
Adverse Effects ◽  
Sodium Bicarbonate ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
High Dose ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Urine Alkalinization ◽  
Feasible Alternative ◽  
Oral Sodium

Introduction Methotrexate (MTX) is a cytotoxic antimetabolite. Intravenous (IV) hydration and urine alkalinization with sodium bicarbonate (NaHCO3) can mitigate nephrotoxicity associated with high-dose MTX (HDMTX, doses ≥500 mg/m2). A shortage of IV NaHCO3 in 2017 prompted Alberta Children’s Hospital (ACH) and Stollery Children’s Hospital (SCH) to adopt an alternative protocol including oral NaHCO3 and IV hydration with Lactated Ringer’s (LR). Methods A retrospective chart review was conducted for ACH and SCH inpatients who received HDMTX between January and December 2017. The primary outcome was the proportion of cycles with delayed HDMTX clearance within the IV and oral cohorts. Secondary outcomes include NaHCO3 administered until clearance, NaHCO3 required to reach pH ≥7, time to reach pH ≥7, incidence of pH <7, time to clearance, and time to discharge. Adverse effects associated with delayed clearance or NaHCO3 administration were also reported. Results 112 MTX cycles were included, 50 and 62 from the IV and oral cohorts, respectively. Clearance delays beyond protocol expectations occurred in 10 cycles (8.9%), 5 from each cohort ( p = 0.72). Differences between cohorts were not statistically significant, except the amounts of NaHCO3 required until clearance (383 vs. 277 mmol/m2, p = 0.005) and to reach pH ≥7 (52 vs. 40 mmol/m2, p = 0.004) were lower in the oral cohort. Incidences of adverse effects were not different. Conclusions Oral NaHCO3 with LR is a feasible alternative for urine alkalinization. The total dose of NaHCO3 utilized was lower in the oral cohort, with no additional delays in clearance.

scholarly journals 528. Coronavirus Disease 2019 in Children Cared for at Texas Children’s Hospital: Implications of Repeat Testing on Infection Control Strategies

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S331-S332
Author(s):  
Catherine Foster ◽  
Lucila Marquez ◽  
Tjin Koy ◽  
Ila Singh ◽  
Judith Campbell
Keyword(s):  
Infection Control ◽  
Median Time ◽  
Disease Transmission ◽  
Retrospective Chart Review ◽  
Source Control ◽  
Hospitalized Children ◽  
Rt Pcr ◽  
Repeat Testing ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract Background Accurate diagnosis of coronavirus disease 2019 (COVID-19) is key for source control and interrupting disease transmission. To better understand the length of viral shedding in children and potential infection control implications, we describe 51 children with COVID-19 who underwent repeat testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at Texas Children’s Hospital (TCH). Methods We performed a retrospective chart review of all pediatric patients (&lt; 21 years of age) with ≥ 2 nasopharyngeal specimens tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (rt-PCR) and at least one positive result between 3/13/2020 and 6/7/2020 through the TCH Molecular Microbiology Laboratory. Results Fifty-one patients met inclusion criteria. The median age was 8.6 years (0.02–19.2 years). Sixteen (31%) children were hospitalized. Fourteen (27%) patients underwent testing for surveillance purposes (including 3 admitted patients). Two SARS-CoV-2 tests were performed in 25 (49%) children; while 12 (24%) children had 3 tests, 4 (8%) children had 4 tests, and 10 (20%) children had ≥ 5 tests (including 1 patient with underlying malignancy who had 9 SARS-CoV-2 PCRs performed). SARS-CoV-2 testing timeline for 9 hospitalized children is shown (Fig 1). The median time between collection of tests 1 and 2 was 14 days (n=51, range 1, 53 days). For children with conversion (first detected to first not-detected sample), the median time was 15 days (n=31, range 1, 45 days). For patients with consecutive positive SARS-CoV-2 PCRs, the median time of positivity was 10 days (n=19, range 2, 31). One patient with malignancy had 5 tests over 6 weeks in the outpatient setting and each time alternated between detected and not-detected. Following diagnosis with COVID-19, one patient with sickle cell disease likely had re-infection and had a positive test after having 2 consecutive negative tests; his last SARS-CoV-2 rt-PCR was positive 68 days after initial positive. Fig 1. Timing of Repeat SARS-CoV-2 PCRs in Select Hospitalized Children with COVID-19 Conclusion We observed variation in the duration of SARS-CoV-2 rt-PCR positivity in children with COVID-19. For children with COVID-19, a single negative molecular assay for SARS-CoV-2 may not be predictive of sustained negativity. Disclosures All Authors: No reported disclosures

Palliative care is not associated with decreased intensity of care: Results of a chart review from a large children's hospital

2021 ◽  
Author(s):  
Laura K. Sedig ◽  
Jessica L. Spruit ◽  
Jessica Southwell ◽  
Trisha K. Paul ◽  
Melissa K. Cousino ◽  
...  
Keyword(s):  
Palliative Care ◽  
Chart Review ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Intensity Of Care

scholarly journals Laryngotracheal Stenosis Management: A 16-Year Experience

2019 ◽  
pp. 014556131987359 ◽  
Author(s):  
Jonathan Woliansky ◽  
Paul Paddle ◽  
Debra Phyland
Keyword(s):  
Treatment Outcome ◽  
Endoscopic Treatment ◽  
Chart Review ◽  
Surgical Techniques ◽  
Retrospective Chart Review ◽  
Stepwise Logistic Regression ◽  
Laryngotracheal Stenosis ◽  
Grade 3 ◽  
American Society

In recent years, it has become increasingly apparent that the laryngotracheal stenosis (LTS) cohort comprises distinct etiological subgroups; however, treatment of the disease remains heterogeneous with limited research to date assessing predictors of treatment outcome. We aim to assess clinical and surgical predictors of endoscopic treatment outcome for LTS, as well as to further characterize the disease population. A retrospective chart review of adult patients with LTS presenting over a 16-year period was conducted. Seventy-five patients were identified and subdivided into 4 etiologic subgroups: iatrogenic, idiopathic, autoimmune, and “other” groups. Statistical comparison of iatrogenic and idiopathic groups was performed. Subsequently, stepwise logistic regression was employed to examine the association between clinical/surgical factors and treatment outcome, as measured by tracheostomy incidence and dependence. We demonstrate that patients with iatrogenic LTS were significantly more morbid ( P < .001) and had worse disease, with significantly greater percentage stenosis ( P = .015) and increased incidence of tracheostomy ( P < .001). Analyzing the predictive effect of clinical and surgical variables on endoscopic treatment outcome, we have shown that when adjusted for age, sex, and iatrogenic etiology, patients with an American Society of Anesthesiologist score >2 were significantly more likely to undergo tracheostomy (adjusted odds ratio = 11.23, 95% confidence interval [CI] = 1.47-86.17). Similarly, when compared with their idiopathic counterparts, patients with iatrogenic LTS had higher odds of undergoing tracheostomy (17.33, 95% CI = 1.93-155.66) as were patients with Cotton-Myer grade 3-4 stenosis (9.84, 95% CI = 1.36-71.32). The odds of tracheostomy dependence at time of last follow-up were significantly higher in patients with gastroesophageal reflux disease (15.38, 95% CI = 1.36-174.43) and cerebrovascular accident (9.03, 95% CI = 1.01-81.08), even after adjustment. No surgical techniques were significantly associated with either outcome when adjusted. We present a heterogeneous LTS cohort comprised of homogeneous subgroups with distinct levels of morbidity, disease morphology, and treatment burden. Further our data suggest that the treatment outcome is more dependent on patient factors, rather than surgical technique used.

scholarly journals Frequency and pattern of Paediatric Heart Diseases: Five years experience at The Children’s Hospital, Multan

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Muhammad Sohail Arshad ◽  
Hafiz Muhammad Anwar-ul-Haq ◽  
Mudasser Adnan ◽  
Arif Zulqarnain
Keyword(s):  
Heart Disease ◽  
Heart Diseases ◽  
Acute Myocarditis ◽  
Retrospective Chart Review ◽  
Paediatric Population ◽  
Mortality And Morbidity ◽  
Children's Hospital ◽  
Creative Commons ◽  
Heart Lesion ◽  
Children’S Hospital

Background & Objectives: Heart diseases in paediatric population are considered to be significant contributors to mortality and morbidity. Congenital heart disease (CHD) as well as acquired heart disease (AHD) are frequent causes of hospital admission among children. This study was aimed at finding out frequency and pattern of heart diseases in admitted patients at The Children’s Hospital, Multan. Methods: This study is a retrospective chart review of five years at Paediatric Cardiology Department of The Children’s Hospital and The Institute of Child Health, Multan, Pakistan, from January 2015 to December 2019. Children aged one month to 15 years, admitted as a diagnosed case of heart disease on the basis of echocardiography were included. Results: Out of a total of 4115 confirmed cases of heart disease admitted during the study period, 3250 (79.0%) were CHD while 865 (21.0%) were AHD. Overall, 2861 (69.5%) patients were aged less than one year. VSD followed by ASD were the commonest acyanotic heart lesion seen among 927 (28.5%) and 644 (19.8%) cases while TOF was the commonest cyanotic type heart lesion found in 396 (12.2%). Rheumatic heart disease (RHD) was the commonest type of AHD, seen in 330 (38.2%) cases followed by acute myocarditis found in 230 (26.6%) cases. Conclusion: Burden of heart diseases is rising in our region. VSD, ASD and TOF were the most common types of CHDs while RHD and acute myocarditis were the most frequent types of AHDs. doi: https://doi.org/10.12669/pjms.36.6.2312 How to cite this:Arshad MS , Anwar-ul-Haq HM, Adnan M, Zulqarnain A. Frequency and pattern of Paediatric Heart Diseases: Five years experience at The Children’s Hospital, Multan. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2312 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals The Changing Frequency of Celiac Disease Diagnosed at the Stollery Children’s Hospital

2010 ◽  
Vol 24 (2) ◽  
pp. 109-112 ◽  
Author(s):  
Seema Rajani ◽  
Hien Q Huynh ◽  
Justine Turner
Keyword(s):  
Celiac Disease ◽  
Gastrointestinal Symptoms ◽  
Retrospective Chart Review ◽  
Children's Hospital ◽  
Number Of Children ◽  
Atypical Symptoms ◽  
Wide Range ◽  
Children’S Hospital ◽  
Atypical Presentations

BACKGROUND: Celiac disease (CD) is recognized as one of the most common and important autoimmune gastrointestinal disorders affecting children. There is evidence that a diagnosis of CD during childhood improves health outcomes. The increasing prevalence of CD is due to increased awareness of the wide range of extraintestinal symptoms associated with CD.OBJECTIVE: To determine whether there has been a temporal increase in the diagnosis of CD associated with an increased diagnosis of children without typical gastrointestinal symptoms at the Stollery Children’s Hospital (Edmonton, Alberta).METHODS: Patients with biopsy-proven CD diagnosed at the Stollery Children’s Hospital from 1998 to 2007, were identified by retrospective chart review. Baseline and follow-up data, including demographics, symptoms, risk factors, anthropometrics and laboratory investigations, were collected.RESULTS: An increase in the frequency of diagnosis of CD was noted during the study period, particularly from January 2003 onward. Before January 2003, nine children were diagnosed with CD – all with typical symptoms. Between January 2003 and January 2007, inclusive, 149 children were diagnosed with CD, of whom 46% had absent or atypical symptoms. At follow-up, 96% of patients reported improved symptoms, including 53% of individuals who reported being asymptomatic before diagnosis.CONCLUSIONS: In the last four years of the period studied, the number of children diagnosed with CD at Stollery Children’s Hospital increased 11-fold. Screening children at risk for CD, and those with atypical presentations, contributed to the increased number of diagnoses. Identification of CD and establishment of lifelong, dietary gluten avoidance during childhood has important health benefits and should be encouraged.

scholarly journals Prevalence of Tracheoesophageal Anomaly Cases among Neonates Undergoing Surgery in a Tertiary Care Children’s Hospital

2020 ◽  
Vol 58 (230) ◽  
Author(s):  
Bal Mukunda Basnet ◽  
Prashant Simkhada ◽  
Anupama Thapa ◽  
Rajkumar Singh
Keyword(s):  
Operative Procedure ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Duodenal Atresia ◽  
Cross Sectional ◽  
Children's Hospital ◽  
Urgent Surgery ◽  
Children’S Hospital

Introduction: Tracheo-oesophageal anomaly is the abnormal communication between trachea and oesophagus. The most common type of tracheo-oesophageal anomaly is oesophageal atreasia with distal tracheo oesophageal fistula. Tracheo-oesophageal anomaly is a common neonatal problem requiring an urgent surgery. Tracheo-oesophageal anomaly can be diagnosed as an isolated malformation or as part of polymalformative syndrome with possible vertebrae anomalies also known as Vacterl syndrome. The aim of the study is to find out the prevalence of tracheo-oesophageal anomaly cases among neonates undergoing surgery in a tertiary care childrens hospital in Nepal. Methods: This is a descriptive cross sectional study conducted in a tertiary care children’s hospital in Nepal taking into account the medical records from period of 01 Jan, 2018 to Dec 31, 2019. Study population included the infants undergoing operative procedure in the operation theatre of Kanti Children’s Hospital. The calculated sample size was 306. Data was collected by retrospective chart review technique and listed in performa. Consecutive sampling technique was used. Thus collected data was entered in SPSS version 20 and necessary calculations were done. Results: The prevalence of tracheo-oesophageal anomalies was found out to be 30 (9.8%) at 95% confidence interval. The most common problem, with which infants were brought to Kanti Children’s Hospital, that required urgent neonatal surgical intervention was anorectal malformation constituting 94 (30.72%) of the surgeries followed by intestinal obstruction 76 (24.84%) which included duodenal atresia, jujunal atresia and ileal atresia. Conclusions: Tracheo-oesophageal anomaly constitutes a major portion of neonatal disease condition requiring surgery in Nepal.

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