scholarly journals Laparoscopic Ureteroureterostomy vs. Common Sheath Ureteral Reimplantation in Children With Duplex Kidney Anomalies

2021 ◽  
Vol 9 ◽  
Author(s):  
Tim Gerwinn ◽  
Ralph Gnannt ◽  
Daniel M. Weber ◽  
Rita Gobet ◽  
Luca Mazzone
Keyword(s):  
Pediatric Population ◽  
Late Complications ◽  
Pediatric Radiologist ◽  
Ureteral Reimplantation ◽  
Duplex Kidney ◽  
Efficacious Treatment ◽  
Parental Counseling ◽  
Invasive Surgical Approach ◽  
Duplex Kidneys ◽  
Tract Infections

Purpose: Laparoscopic ureteroureterostomy (LUU) has been proposed as an alternative to common sheath ureteral reimplantation (CSUR) in children with symptomatic duplex kidneys. However, data is limited for LUU in the pediatric population. The aim of this study was to analyze our experience with LUU and to compare the results with those after CSUR to assess whether a less invasive surgical approach could be a valid alternative.Patients and methods: The data of all children with duplex kidneys who underwent either LUU or CSUR at our center from 2006 to 2018 were reviewed retrospectively. After parental counseling, the option of LUU was provided as an alternative to CSUR for unilateral procedures and in the absence of vesicoureteral reflux to the receiving ureter. Baseline characteristics, indication for surgery, hospitalization and operative times, and intraoperative, post-operative, and late complications were analyzed. Preoperative and 1-year post-operative sonographies were reviewed by a pediatric radiologist. Increasing renal pelvic diameter (Δ >5 mm) was regarded as a sign of ureteral obstruction.Results: Forty children were included in this study, with 16 children receiving LUU and 24 children receiving CSUR. The children had a mean age of 2.7 years (7 months−9.8 years) and were followed up in our outpatient clinic for an average of 3.9 years (3 months−10.6 years) after surgery. The median hospital stay was 2 days shorter after LUU. Initially, a considerably longer time was needed for LUU, but after more experience was gained, similar operative times were observed for both procedures. Complications were encountered in both groups. After LUU, two patients developed anastomotic leakage: one was managed conservatively, and one required temporary nephrostomy. In the CSUR group, one patient developed vesicoureteral obstruction during follow-up and required reoperation with LUU. The occurrence of post-operative urinary tract infections was similar in both groups. No complications related to the ureteral stump after LUU arose.Conclusion: LUU is a safe and efficacious treatment option for children with duplex kidney anomalies and can be used as an alternative to CSUR. All children receiving LUU showed a non-obstructive, patent anastomosis and no signs for stenotic compromise of the receiving ureter.

scholarly journals 1356. Ribavirin Use in Hospitalized Children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S689-S690
Author(s):  
William R Otto ◽  
Giyoung Lee ◽  
Cary Thurm ◽  
Jeffrey Gerber ◽  
Adam Hersh
Keyword(s):  
Diagnosis Related Groups ◽  
Pediatric Population ◽  
Health Information System ◽  
International Classification Of Diseases ◽  
Route Of Administration ◽  
Administrative Database ◽  
Hospitalized Children ◽  
Syncytial Virus ◽  
Tract Infections ◽  
Over Time

Abstract Background Respiratory syncytial virus (RSV) infection is a significant cause of morbidity and mortality in immunocompromised children. Aerosolized ribavirin is approved for treatment of RSV lower respiratory tract infections. However, due to high cost, challenges to administration and uncertainty about benefit, use is limited. Recent studies in adult patients have reported similar outcomes between patients treated with aerosolized and oral ribavirin. We sought to characterize trends in use of ribavirin for hospitalized children. Methods We used the Pediatric Health Information System (PHIS), an administrative database which contains resource utilization data from 52 children’s hospitals, to perform a retrospective analysis of children hospitalized between January 1, 2010 through December 31, 2019 who were billed for ribavirin treatment. Data related to ribavirin use (number of courses, route of administration) and clinical characteristics were abstracted. International Classification of Diseases, 9th Revision (ICD-9) or 10th Revision (ICD-10) codes and All Patients Refined Diagnosis Related Groups (APR DRG) classifications were used to define underlying clinical conditions and illness severity. Summary statistics were used to describe patient characteristics and the use of ribavirin. Results Thirty-eight hospitals reported ribavirin use; 1 hospital was excluded due to inaccuracies in charge coding. We identified 837 children who received 937 courses of ribavirin (Table 1). The overall frequency of ribavirin use was unchanged over the study period, and the number of ribavirin treatment courses per hospital ranged from 1 to 228 (Figure 1). The most frequent routes of administration were inhalation (603/937, 64%) and oral (322/937, 34%). There was a decrease in the use of aerosolized ribavirin over time, with a corresponding increase in the use of oral ribavirin (Figure 2). Table 1: Patient demographics (N=837) Figure 1: Total ribavirin treatment courses over the study period (a) by year and (b) by treating hospital Figure 2: (a) Route of administration (inhalation versus oral), by year during the study period and (b) use of oral ribavirin over time during the study period Conclusion Although overall prescribing rates of ribavirin in hospitalized children have remained stable, use varies widely across centers and the proportion of oral ribavirin use has increased over time. Comparative effectiveness studies are needed in the pediatric population to evaluate outcomes of children treated with aerosolized vs. oral ribavirin. Disclosures All Authors: No reported disclosures

scholarly journals The Role of the Respiratory Microbiome and Viral Presence in Lower Respiratory Tract Infection Severity in the First Five Years of Life

2021 ◽  
Vol 9 (7) ◽  
pp. 1446
Author(s):  
Ivo Hoefnagels ◽  
Josephine van de Maat ◽  
Jeroen J.A. van Kampen ◽  
Annemarie van Rossum ◽  
Charlie Obihara ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Disease Severity ◽  
Lower Respiratory Tract ◽  
Influenza A ◽  
Pediatric Population ◽  
16S Rrna Gene Sequencing ◽  
Rrna Gene ◽  
Detection Rates ◽  
Tract Infections ◽  
Respiratory Microbiome

Lower respiratory tract infections (LRTIs) in children are common and, although often mild, a major cause of mortality and hospitalization. Recently, the respiratory microbiome has been associated with both susceptibility and severity of LRTI. In this current study, we combined respiratory microbiome, viral, and clinical data to find associations with the severity of LRTI. Nasopharyngeal aspirates of children aged one month to five years included in the STRAP study (Study to Reduce Antibiotic prescription in childhood Pneumonia), who presented at the emergency department (ED) with fever and cough or dyspnea, were sequenced with nanopore 16S-rRNA gene sequencing and subsequently analyzed with hierarchical clustering to identify respiratory microbiome profiles. Samples were also tested using a panel of 15 respiratory viruses and Mycoplasma pneumoniae, which were analyzed in two groups, according to their reported virulence. The primary outcome was hospitalization, as measure of disease severity. Nasopharyngeal samples were isolated from a total of 167 children. After quality filtering, microbiome results were available for 54 children and virology panels for 158 children. Six distinct genus-dominant microbiome profiles were identified, with Haemophilus-, Moraxella-, and Streptococcus-dominant profiles being the most prevalent. However, these profiles were not found to be significantly associated with hospitalization. At least one virus was detected in 139 (88%) children, of whom 32.4% had co-infections with multiple viruses. Viral co-infections were common for adenovirus, bocavirus, and enterovirus, and uncommon for human metapneumovirus (hMPV) and influenza A virus. The detection of enteroviruses was negatively associated with hospitalization. Virulence groups were not significantly associated with hospitalization. Our data underlines high detection rates and co-infection of viruses in children with respiratory symptoms and confirms the predominant presence of Haemophilus-, Streptococcus-, and Moraxella-dominant profiles in a symptomatic pediatric population at the ED. However, we could not assess significant associations between microbiome profiles and disease severity measures.

Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population

2016 ◽  
Vol 12 (3) ◽  
pp. 169.e1-169.e6 ◽  
Author(s):  
Angela M. Arlen ◽  
Kristin M. Broderick ◽  
Curtis Travers ◽  
Edwin A. Smith ◽  
James M. Elmore ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Ureteral Reimplantation ◽  
Robot Assisted

MP44-16 INCIDENCE OF URINARY TRACT INFECTIONS AFTER URODYNAMIC STUDIES IN THE PEDIATRIC POPULATION

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Jason P. Van Batavia ◽  
Jennifer J. Ahn ◽  
Julia B. Finkelstein ◽  
Andrew J. Combs ◽  
Sarah M. Lambert ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Pediatric Population ◽  
Urodynamic Studies ◽  
Tract Infections

RADIATION PROTECTION IN DIAGNOSTIC RADIOGRAPHY OF CHILDREN

PEDIATRICS ◽  
1973 ◽  
Vol 51 (1) ◽  
pp. 141-144
Author(s):  
Herman Grossman ◽  
Donald H. Altman ◽  
David H. Baker ◽  
John L. Gwinn ◽  
John A. Kirkpatrick ◽  
...  
Keyword(s):  
Radiation Safety ◽  
Pediatric Population ◽  
Technical Information ◽  
Pediatric Radiologist ◽  
Potential Hazard ◽  
General Philosophy ◽  
Chemical Laboratory ◽  
The Past ◽  
Laboratory Investigations ◽  
Diagnostic Radiography

As is readily apparent, the problem of reducing radiation exposure to the pediatric patient encompasses many areas. In the past, more attention has been devoted to the concrete aspects such as refined radiographic equipment and gonadal shielding. Less attention has been devoted to the abstract aspects which involve the general philosophy and disposition of the referring physician and his radiologic consultant. In this regard, it cannot be overstated that close communication with the radiologist is mandatory. The (pediatric) radiologist is constantly aware of the aspects of radiation safety and utilizes this information when he obtains radiographic examinations. There is a tendency to treat radiographic examinations in the same context as clinical and chemical laboratory investigations. Perhaps this attitude stems from the fact that radiographs are often ordered at the same time as these laboratory tests. Such an orientation is dangerous, and it behooves the referring physician and the radiologist to work in cooperation to remedy this situation. Indeed, it is simple to improve radiographic equipment and not too difficult to shield the child; but, it is difficult to formulate a proper attitude regarding radiographic examinations and their potential hazard to the pediatric population. The Committee on Radiology plans to prepare additional recommendations on radiographic examinations to provide more detailed and technical information which should be helpful to pediatricians and other physicians providing care for children.

scholarly journals Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

2022 ◽  
Vol 23 (2) ◽  
pp. 870
Author(s):  
Anna Kawalec ◽  
Danuta Zwolińska
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Pediatric Population ◽  
Urologic Diseases ◽  
Increased Risk ◽  
Tract Infections ◽  
The Impact

The microbiome of the urinary tract plays a significant role in maintaining health through the impact on bladder homeostasis. Urobiome is of great importance in maintaining the urothelial integrity and preventing urinary tract infection (UTI), as well as promoting local immune function. Dysbiosis in this area has been linked to an increased risk of UTIs, nephrolithiasis, and dysfunction of the lower urinary tract. However, the number of studies in the pediatric population is limited, thus the characteristic of the urobiome in children, its role in a child’s health, and pediatric urologic diseases are not completely understood. This review aims to characterize the healthy urobiome in children, the role of dysbiosis in urinary tract infection, and to summarize the strategies to modification and reshape disease-prone microbiomes in pediatric patients with recurrent urinary tract infections.

scholarly journals Respiratory syncytial virus and airway microbiota -- A complex interplay and its reflection on morbidity

2020 ◽  
Author(s):  
Giovanni Rossi ◽  
Stefania Ballarini ◽  
Michela Silvestri ◽  
Oliviero Sacco ◽  
Andrew Colin
Keyword(s):  
Respiratory Syncytial Virus ◽  
Disease Severity ◽  
Respiratory Infections ◽  
Pediatric Population ◽  
Bacterial Species ◽  
Severe Disease ◽  
Microbial Community Composition ◽  
Positive Role ◽  
Syncytial Virus ◽  
Tract Infections

The immunopathology of respiratory syncytial virus (RSV) infection, the most common cause of lower respiratory tract infections (LRTI) in the pediatric population, with severe disease being the exception. The variability of the clinical presentation is incompletely explained by host, viral and environmental factors but, in infants and young children, disease severity is certainly linked to the physiological immune immaturity. There is evidence that the maturation of the host immune response is, at least in part, promoted by the composition of the nasopharyngeal microbiome that, modulating excessive inflammation, can counteract the predisposition to develop viral respiratory infections and lower the risk of disease severity. However, interaction between the nasopharyngeal microbiota and respiratory viruses can be bidirectional. Microbial dysbiosis can drive disease pathogenesis but may also represents a reflection of the disease-induced alterations of the local milieu. Moreover, viruses like RSV, can also increase the virulence of potential pathogens in nasopharynx, which is a main reservoir of bacteria, and therefore promote their spread to the lower airways causing superinfection. Negative changes in microbial community composition in early life may constitute a heightened risk towards severe RSV respiratory infection and bacterial superinfection, whilst specific groups of microorganisms can be associated with protection. A better understanding into the potential negative and positive role of the different nasopharyngeal bacterial species in disease prevention as well as into the possible benefits of microbiome therapeutic manipulation, may improve patient outcomes.

scholarly journals Did admissions caused by respiratory infections and asthma decrease during the COVID-19 pandemic?

2021 ◽  
Author(s):  
Zeynep Onay ◽  
Deniz Mavi ◽  
Yetkin Ayhan ◽  
Sinem Can Oksay ◽  
Gulay Bas ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Outpatient Clinic ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Pediatric Population ◽  
Pediatric Intensive Care ◽  
Acute Bronchiolitis ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Background: COVID-19 outbreak lead to nationwide lockdown on the March 16th, 2020 in Turkey. We aimed to quantitively determine the change in frequency of upper and lower respiratory tract infections and asthma in pediatric population associated with COVID-19. Methods: The electronic medical record data of pediatric population admitted to the emergency department (ED), outpatient and inpatient clinics and pediatric intensive care unit (PICU) were analyzed with the diagnosis of Influenza, upper and lower respiratory tract infections (URTI, LRTI) acute bronchiolitis and asthma. The data of the first year of the pandemic was compared with the previous year. Results: In total 112496 admissions were made between April 1, 2019 and March 31, 2021 in our hospital. A decline was observed in ED admissions (-73%) and outpatient clinic (-70%) visits, hospitalizations (-41.5%) and PICU admissions (-42%). The admissions with the diagnosis of Influenza and URTI had a decline from 4.26% to 0.37% (p=0.0001), and from 81.54% to 75.62% (p=0.0001), respectively. An increase was observed in the LRTI, acute bronchiolitis and asthma (from 8.22% to 10.01% (p=0.0001), from 2.76% to 3.07% (p=0.027) and from 5.96% to 14% (p=0.0001), respectively). Conclusions: A dramatic decrease was observed in the number of admissions to ED and inpatient clinics and outpatient clinic visits and PICU admissions, and, when the rates of admissions were compared, the general rate of admissions to ED showed a decrease while inpatient, outpatient clinics and PICU admissions demonstrated an increase during the pandemic.

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