Outcomes of Isolated Neutropenia Referred to Pediatric Hematology Oncology Clinic

Introduction: Patients with absolute neutrophil count (ANC) <1500 x10^9/L are frequently referred to Pediatric Hematology Oncology. Scant literature exists on outcomes and interventions for isolated neutropenia. We hypothesize that most patients will have resolved neutropenia without the need for an intervention from Pediatric Hematology Oncology. Methods: We performed a five-year IRB-approved, retrospective chart review of patients referred to a Pediatric Hematology-Oncology clinic for isolated neutropenia. Patients were excluded if they also had anemia or thrombocytopenia at the time of the referral. Degree of neutropenia was categorized: 1) at the time of referral, 2) at the lowest value, and 3) at the current ANC as Mild: 1.001-1.500 x109/L, Moderate: 0.501-1.000 x109/L, Severe: 0.201-0.5 x109/L, or Very Severe ≤0.2 x109/L. Descriptive statistics and odds ratios were performed. Results: Among 154 patients referred with isolated neutropenia over five years, 45 (29%) had mild neutropenia, 65 (42%) had moderate neutropenia, 29 (19%) had severe neutropenia, and 15 (10%) had very severe neutropenia. Only 29 (19%) patients progressed to a lower ANC category than their referral ANC category. At a median follow-up of 12 months, 101 (66%) patients had resolved neutropenia, 40 (26%) patients had mild, ten (6%) patients had moderate, three patients had severe, and one patient had very severe neutropenia. Most patients (54%) were not identified with a specific diagnosis. The most common diagnoses included viral suppression (16%), autoimmune neutropenia (14%) and drug induced neutropenia (8%). The most common medications reported as responsible for neutropenia were either anti-epileptic medications or immunosuppressant medications. No patients were diagnosed with a malignancy. Black patients had a 3.5 times higher odds of having persistent, mild, undiagnosed neutropenia which, for some patients, may be benign ethnic neutropenia. Seven (4.5%) patients received G-CSF therapy. Five patients were either managed by a Rheumatologist or an Immunologist. Finally, there were 16 hospitalizations that occurred in 10 patients for a prevalence of one admission for every 21 patient years. The most common admission diagnosis was febrile neutropenia without subsequent bacteremia (n=13). Conclusion: Most pediatric patients referred for isolated neutropenia do not progress, develop leukemia, or require sub-specialty interventions. Hospitalization of patients referred for isolated neutropenia is rare as is bacteremia. This study provides important outcome data that can improve our counseling of pediatric patients identified with isolated neutropenia. Disclosures Howard: Novartis: Consultancy. Lebensburger:Novartis: Consultancy; Pfizer: Research Funding.

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LINC-39. PERFORMANCE STATUS OF PEDIATRIC PATIENTS WITH CENTRAL NERVOUS SYSTEM TUMORS TREATED IN MEXICO, A SINGLE-CENTER EXPERIENCE

Neuro-Oncology ◽

10.1093/neuonc/noaa222.472 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii385-iii386

Author(s):

Claudia Madrigal-Avila ◽

Alfonso Perez-Bañuelos ◽

Rafael Ruvalcaba-Sanchez ◽

Lourdes Vega-Vega ◽

Gabriela Escamilla-Asiain

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Multidisciplinary Approach ◽

Pediatric Patients ◽

Performance Status ◽

Retrospective Chart Review ◽

Cns Tumors ◽

Surgical Morbidity ◽

Tertiary Center

Abstract BACKGROUND Central nervous system (CNS) tumors are the most common solid neoplasms in the pediatric age, they comprise about a quarter of all cancers at this age. Little is known about the specific epidemiology of this group in Mexico and there are no reports of results focused on the Performance Status of patients who are treated in a multidisciplinary setting. OBJECTIVE To describe the Performance Status of CNS pediatric patients after being treated with a multidisciplinary approach in a tertiary center. METHODS We report a retrospective chart review of all pediatric patients who presented to the Neuro-Oncology Clinic at Teleton Pediatric Oncology Hospital in Queretaro, Mexico, from December 2014 to January 2020. We analyzed age, gender, the extent of surgical resection and histopathology. Performance Status was assessed using ECOG and Karnofsky/Lansky scores during every patient’s last follow-up visit. RESULTS A total of 56 patients were treated, epidemiology and histopathology variants are similar to those described in the international literature. With a median follow-up of 33 months, 35 patients are alive (62.5%), 28 of them (74.2%) have an excellent Performance Status (ECOG score 0 or Lansky/Karnofsky ≥ 90), 5 (14.2%) scored ECOG 1–2 and only 4 (11.4%) scored ECOG 3–4. CONCLUSIONS A multidisciplinary approach with a focus on Performance Status and the potential for neurological recovery is essential in the management of pediatric patients with CNS tumors. Efforts should be aimed at reducing post-surgical morbidity and early rehabilitation to reintegrate patients into society in the long term.

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Enoxaparin Utilization Evaluation and Its Clinical and Laboratory Outcomes in Pediatric Patients in a Children’s Teaching Hospital

Journal of Pharmaceutical Care ◽

10.18502/jpc.v8i3.4547 ◽

2020 ◽

Author(s):

Uldooz Samadi Bahrami ◽

Alieh Safari Sharari ◽

Hadis Pourkarami ◽

Toktam Faghihi

Keyword(s):

Teaching Hospital ◽

Pediatric Patients ◽

Demographic Data ◽

Thrombotic Event ◽

Bleeding Event ◽

Evaluation Study ◽

Outcome Data ◽

Clinical Response Rate ◽

Duration Of Treatment

Backgrounds: In recent years, low molecular weight heparin use has increased in children. Dose of enoxaparin to achieve target anti-Xa and time to achieve anti-Xa are evolving and efficacy outcome data in terms of laboratory and clinical response rate in children still remains to be elucidated. Thus, in this drug utilization and evaluation study, we assessed patterns of enoxaparin use, its concordance with guidelines and laboratory and clinical outcomes in pediatric patients in a Children’s teaching hospital. Methods: In a prospective observational study, all pediatric patients with a thrombotic event who underwent treatment with enoxaparin were included. Demographic data, clinical outcome data based on follow-up sonography results, laboratory response based on anti-Xa and concordance with guidelines in terms of initial daily dose, duration of treatment, performing sonography to evaluate response, anti Xa check and time of anti-Xa check were evaluated. Results: During a 9-month period, 41 pediatric patients suffered a thrombotic event and received enoxaparin. Median age of participants was 18.5 months. The anti-Xa level became therapeutic on mean day 4.7 with a mean enoxaparin dose of 1.24 mg/kg. Among participants 42% achieved therapeutic anti-Xa with initial empirical dosing. Less than 25 % of participants had a follow-up sonography and among them, 77% demonstrated complete thrombosis resolution after 4-6 weeks of enoxaparin therapy. We observed one major bleeding event. Concordance with guidelines was low in the aspects of duration of treatment, performing sonography to evaluate response and anti-Xa check. Conclusion: With initial empiric dosing, it may take several days before anti-Xa become therapeutic. Among half of the children, a higher than recommended 1 mg/kg dose was required to achieve therapeutic anti-Xa level. Educational processes are mandatory regarding enoxaparin use and monitoring among clinicians to improve concordance with guidelines.

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Long-Term Surveillance and Life-Time Care for Pediatric Patients Suffering from Hydrocephalus

Journal of Pediatric Neurology ◽

10.1055/s-0040-1715497 ◽

2020 ◽

Vol 18 (06) ◽

pp. 297-300

Author(s):

Matthias Krause ◽

Andreas Merkenschlager ◽

Cynthia Vanessa Mahr ◽

Matthias K. Bernhard ◽

Ekkehard M. Kasper ◽

...

Keyword(s):

Pediatric Patients ◽

Life Time ◽

Outcome Data ◽

Continuous Treatment ◽

Childhood And Adolescence ◽

Long Term Follow Up ◽

Optimal Setting ◽

Screening Intervals

AbstractEven though shunt surgery has been an established and widely accepted treatment for congenital hydrocephalus for five decades, long-term follow-up and functional outcome data are scarce. Based on our experience, we advocate a very rigid follow-up regimen throughout life for every hydrocephalus patient encountered with individual screening intervals not longer than 1 year in childhood and adolescence and surveillance intervals of 2 years in adulthood. A continuous treatment of the patients at the primary institution that performed hydrocephalus surgery provides an optimal setting to be prepared for the detection of adverse events of shunt malfunctioning. However, some patients may still encounter catastrophic events resulting in persistent deficits or death.

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LO26: The efficacy of high dose cephalexin in the outpatient management of moderate cellulitis for pediatric patients

CJEM ◽

10.1017/cem.2017.88 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S36

Author(s):

B. Farley St-Amand ◽

E. D. Trottier ◽

J. Autmizguine ◽

M. Vincent ◽

S. Tremblay ◽

...

Keyword(s):

Treatment Failure ◽

Success Rate ◽

Pediatric Patients ◽

Day Treatment ◽

Hospital Setting ◽

Retrospective Chart Review ◽

Treatment Center ◽

High Dose ◽

Return Visit

Introduction: Children with moderate cellulitis are often treated with IV antibiotics in the hospital setting, as per recommendations. Previously in our hospital, a protocol using daily IV ceftriaxone with follow-up at the day treatment center (DTC) was used to avoid admission. In 2013, a new protocol was implanted and suggested the use of high dose (HD) oral cephalexin with follow-up at the DTC for those patients. The aim of this study was to evaluate the safety and efficacy of the HD cephalexin protocol to treat moderate cellulitis in children as outpatient. Methods: A retrospective chart review was conducted. Children were included if they presented to the ED between January 2014 and 2016 and were diagnosed with a moderate cellulitis sufficiently severe to request a follow up at DTC and who were treated according to the standard of care with the HD oral cephalexin (100 mg/kg/day) protocol. Descriptive statistics for clinical characteristics of patients upon presentation, as well as for treatment characteristics in the ED and DTC were analyzed. Treatment failure was defined as: need for admission at the time of DTC evaluation, change for IV treatment in DTC or return visit to the ED. Outcomes were compared to historic controls treated with IV ceftriaxone at the DTC, where admission was avoided in 80% of cases. Results: During the study period, 682 children with cellulitis were diagnosed in our ED. Of these, 117 patients were treated using the oral HD cephalexin outpatient protocol. Success rate was 89.5% (102/114); 3 patients had an alternative diagnosis at DTC. Treatment failure was reported in 12 cases; 10 patients (8.8%) required admission, one (0.9%) received IV antibiotics at DTC, and one (0.9%) had a return visit to the ED without admission or change to the treatment. This compares favorably with the previous study using IV ceftriaxone (success rate of 80%). No severe deep infections were reported or missed; 4 patients required drainage. The mean number of visits per patient required at the DTC was 1.6. Conclusion: Treatment of moderate cellulitis requiring a follow-up in a DTC, using an oral outpatient protocol with HD cephalexin is a secure and effective option. By reducing hospitalization rate and avoiding the need for painful IV insertion, HD cephalexin is a favourable option in the management of moderate cellulitis for pediatric patients, when no criteria of toxicity are present.

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Age at Decannulation after Pediatric Tracheostomy.

10.46940/jecor.02.1006 ◽

2020 ◽

pp. 1-8

Keyword(s):

Airway Obstruction ◽

Medical Records ◽

Chart Review ◽

Pediatric Patients ◽

Upper Airway ◽

Retrospective Chart Review ◽

Upper Airway Obstruction ◽

Neurological Condition ◽

Neurological Conditions

Background: Parents of tracheostomized infants often enquire when their children will undergo decannulation. However, there are few studies on the decannulation of children who are tracheotomized in infancy. Therefore, this study investigated when decannulation should be performed in children by retrospectively analysing medical records. Methods: We performed a retrospective chart review of tracheostomy, decannulation and tracheostoma closure in 48 children who underwent tracheostomy before the age of 3 years. The indications for tracheostomy included upper airway obstruction, neurological conditions, cardiopulmonary conditions, craniofacial conditions and trauma. Result: Nineteen (33.3%) patients were decannulated during the follow-up period: 12 had upper airway obstruction, four had cardiopulmonary conditions, one had a neurological condition and two had craniofacial conditions. The average age at tracheostomy was 13.6 months. The average age at the start of the decannulation therapy was 5.4 years. The average age at decannulation was 7.2 years. The average age at tracheostoma closure was 9.2 years. Conclusion: This description of ages at decannulation after pediatric tracheostomy may be useful when explaining the prognoses and timelines of decannulation to parents and caretakers of pediatric patients who need to undergo tracheostomy.

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Significance of Crooke's Hyaline Change in Nontumorous Corticotrophs of Patients With Cushing Disease

Frontiers in Endocrinology ◽

10.3389/fendo.2021.620005 ◽

2021 ◽

Vol 12 ◽

Author(s):

Amit Akirov ◽

Vincent Larouche ◽

Ilan Shimon ◽

Sylvia L. Asa ◽

Ozgur Mete ◽

...

Keyword(s):

Remission Rate ◽

Retrospective Chart Review ◽

Pituitary Surgery ◽

Serum Cortisol ◽

Outcome Data ◽

Cushing Disease ◽

Persistent Disease ◽

Feedback Suppression ◽

Biochemical Testing

BackgroundGlucocorticoid excess in Cushing disease (CD) leads to negative feedback suppression, resulting in Crooke's hyaline change (CC) of nontumorous pituitary corticotrophs. We aimed to determine the predictive value of CC of nontumorous corticotrophs in CD.MethodsThe retrospective chart review study included patients with clinical, biochemical, radiologic and outcome data and evaluable histopathology specimens from pituitary surgery for CD. The main outcome was remission of CD, defined by clinical features, biochemical testing, and corticosteroid dependency.ResultsOf 144 CD patients, 60 (50 women, mean age 43.6±14) had clinical follow-up, biochemical data and histopathology specimens that included evaluable nontumorous adenohypophysis. Specimens from 50 patients (83.3%) demonstrated CC in nontumorous corticotrophs, and 10 (16.7%) had no CC (including 3 with corticotroph hyperplasia). One patient with CC was lost to follow-up and one without CC had equivocal outcome results. During a mean (SD) follow-up period of 74.9 months (61.0), recurrent or persistent disease was documented in 18 patients (31.0%), while 40 (69.0%) were in remission. In patients with CC, the remission rate was 73.5% (95% CI, 59.7%-83.7%) (36/49), whereas it was 44.4% (95% CI, 18.9%-73.3%) (4/9) in patients with no CC. The combination of serum cortisol >138 nmol/L within a week of surgery coupled with absence of nontumorous CC greatly improved the prediction of recurrent or persistent disease.ConclusionsCC of nontumorous corticotrophs was observed in 83% of patients with CD, and most patients with CC experienced remission. Absence of CC in nontumorous corticotrophs may serve as a predictor of reduced remission in patients with CD.

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Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.2.1 ◽

2007 ◽

Vol 22 (2) ◽

pp. 1-5 ◽

Cited By ~ 62

Author(s):

Gabriel Zada ◽

Mark D. Krieger ◽

Sean A. McNatt ◽

Ira Bowen ◽

J. Gordon McComb

Keyword(s):

Los Angeles ◽

Arachnoid Cyst ◽

Pediatric Patients ◽

Clinical Signs ◽

Retrospective Chart Review ◽

Signs And Symptoms ◽

Arachnoid Cysts ◽

P Value ◽

Clinical Signs And Symptoms

Object Arachnoid cysts can cause a variety of clinical signs and symptoms in infants. The authors sought to determine whether the clinical presentation of pediatric patients younger than 2 years old and harboring arachnoid cysts influenced the type of intervention that would be required. Methods A retrospective chart review was conducted for all patients younger than 2 years of age who had undergone craniotomy for fenestration of an arachnoid cyst at the Childrens Hospital Los Angeles between 1995 and 2006. Forty-two patients were included in the study. The mean age was 10.4 months. The median follow-up time was 33 months. Clinical presentations were as follows: macrocephaly without ventriculomegaly (21 patients, 50%), hydrocephalus (six patients, 14%), and other symptoms (15 patients, 36%). After fenestration of the arachnoid cyst, 12 of 21 patients (57%) presenting with nonspecific macrocephaly required placement of a cystoperitoneal or ventriculoperitoneal shunt, compared with 1 of 15 patients (7%) presenting with other symptoms (p value = 0.0039). Five of six patients with hydrocephalus (83%) were shunt dependent following fenestration. Overall, 18 of 42 patients (43%) were shunt dependent after fenestration. Ten of these patients (55%) required revisions during the follow-up period. Conclusions Patients younger than 2 years of age and harboring an arachnoid cyst commonly present with macrocephaly. These patients are more likely to require shunts than are those presenting with other findings, such as seizu

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Early exit from neonatal therapeutic hypothermia: A single institution experience using MRI to guide decision-making

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200458 ◽

2020 ◽

Vol 13 (4) ◽

pp. 441-447

Author(s):

Y.N. White ◽

P.E. Grant ◽

J.S. Soul ◽

T. Inder ◽

M. El-Dib

Keyword(s):

Therapeutic Hypothermia ◽

Chart Review ◽

Retrospective Chart Review ◽

Outcome Data ◽

Neonatal Encephalopathy ◽

Early Exit ◽

Treatment Groups ◽

Magnetic Resonance Imaging Mri ◽

Electroencephalogram Eeg

BACKGROUND: To evaluate the feasibility of a protocol using combined magnetic resonance imaging (MRI), clinical data, and electroencephalogram (EEG) to identify neonates with mild neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH) who are eligible for “early exit”. METHODS: Retrospective chart review of TH cases at a single Level III NICU over a 5-year period was used to describe the demographic, clinical, and outcome data in neonates that received early exit in contrast to 72 hour TH treatment. RESULTS: Two hundred and eight TH cases, including 18 early exit cases (9%) and 9 cases (4%) evaluated for early exit with MRI but continued on 72 hours of TH, were identified. Early exit and 72 hour treatment groups did not differ in demographics or cord gas measures, although early exit neonates had a shorter length of stay (p < 0.05). Consistent with the early exit protocol, no early exit infants had evidence of moderate or severe encephalopathy on EEG or evidence of hypoxic ischemic injury on MRI at 24 hours of life. Neurology follow up between age 1 and 18 months was available for 10 early exit infants, 8 of whom had a normal examination. CONCLUSIONS: Early MRI at 24 hours of age, alongside clinical and EEG criteria, is feasible as part of a protocol to identify neonates eligible for early exit from therapeutic hypothermia.

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Radioactive iodine therapy for pediatric Graves’ disease: a single-center experience over a 10-year period

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0316 ◽

2020 ◽

Vol 33 (3) ◽

pp. 383-389 ◽

Cited By ~ 3

Author(s):

Paul B. Kaplowitz ◽

Jiji Jiang ◽

Priya Vaidyanathan

Keyword(s):

Chart Review ◽

Pediatric Patients ◽

Radioactive Iodine ◽

Thyroid Tissue ◽

Retrospective Chart Review ◽

Definitive Treatment ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Single Center Experience

AbstractIntroductionOnly about 30% of pediatric patients with Graves’ hyperthyroidism achieve remission with medical therapy, and therefore radioactive iodine (RAI) therapy is often used as a definitive treatment. Although the goal of RAI is permanent hypothyroidism, this is not consistently achieved. We conducted a chart review to determine the factors associated with the success of RAI. We also tried to determine optimal follow-up post RAI and if there was an optimal L-thyroxine dose that would normalize the hypothyroid state quickly.MethodsThis is a retrospective chart review of Graves’ patients who underwent RAI between 2008 and 2017. We included age, sex, time from diagnosis, thyroid gland size, total dose of I-131 and dose in μCi/g of thyroid tissue. Patients were grouped based on outcome and analyzed using univariate and multivariate logistic regression. Follow-up thyroid levels post RAI and after starting l-thyroxine were analyzed.ResultsThere were 78 ablations including six repeat ablations. Seventy-three percent became hypothyroid, 23% remained overtly or subclinically hyperthyroid, and 4% were euthyroid. Smaller thyroid size (36.5 vs. 47.4 g; p = 0.037) and higher dose of I-131 (242 vs. 212 μCi/g thyroid tissue; p = 0.013) were associated with a higher likelihood of hypothyroidism. Most patients remained hyperthyroid at 1 month post RAI, but by 3 months the majority became hypothyroid. There was no clear L-thyroxine dose that normalized hypothyroidism quickly.ConclusionsAn I-131 dose close to 250 μCi/g of thyroid tissue has a higher likelihood of achieving hypothyroidism. Testing at 2–3 months after RAI is most helpful to confirm response to RAI.

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Diagnostic Value of Mid-esophageal Biopsies in Pediatric Patients With Eosinophilic Esophagitis

Pediatric and Developmental Pathology ◽

10.1177/1093526620961359 ◽

2020 ◽

pp. 109352662096135

Author(s):

Elizaveta Chernetsova ◽

Amisha Agarwal ◽

Arielle Weir ◽

Irina Oltean ◽

Janet Barkey ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

High Power ◽

Chart Review ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Diagnostic Value ◽

Histologic Examination ◽

Initial Assessment ◽

Future Studies

Introduction Eosinophilic esophagitis (EoE) is histologically defined as the presence of 15 or more intraepithelial eosinophils per high-power fields. Limited consensus exists on where to sample the esophagus in pediatrics. This study aimed to identify whether endoscopic and histologic examination of the mid esophagus offers diagnostic value compared to proximal/distal esophageal biopsies. Methods A retrospective chart review of pediatric patients with EoE was performed. Endoscopic and histologic parameters were assessed at the initial and follow-up visits, and concordance between proximal/distal biopsy and mid biopsy was determined. Results A total of 100 patients with a mean age of 9.6 ± 4.07 years were included. Endoscopic parameters between proximal/distal and mid esophagus were concordant in 84% to 97% of patients (initial assessment) and in 80% to 97% of patients (at follow-up). Mid esophagus showed endoscopic abnormalities, which were absent at the proximal/distal esophagus in 1% to 5% of patients, as well as histologic abnormalities in 2% to 8% of patients overall at initial and follow-up examinations. Conclusions We recommend continued endoscopic and histologic assessment of the proximal/distal biopsy; however, examination of the mid esophagus does offer small diagnostic value in our subset of patients. Future studies need to be conducted before conclusive recommendations supporting the use of mid-esophageal biopsies can be made.

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