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Pubblicazioni recenti - pediatric cardiac
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Safety and Outcomes of Transcatheter Closure of Patent Ductus Arteriosus in Children With Pulmonary Artery Hypertension.
Tex Heart Inst J2020 Aug;47(4):250-257. doi: 10.14503/THIJ-19-6982.
Salavitabar Arash, Krishnan Usha S, Turner Mariel E, Vincent Julie A, Torres Alejandro J, Crystal Matthew A,
Abstract
To investigate whether transcatheter device closure of patent ductus arteriosus (PDA) is safe in children with pulmonary artery hypertension, we retrospectively analyzed our experience with 33 patients who underwent the procedure from January 2000 through August 2015. Pulmonary artery hypertension was defined as a pulmonary vascular resistance index (PVRI) >3 WU · m2. All 33 children (median age, 14.5 mo; median weight, 8.1 kg) underwent successful closure device implantation and were followed up for a median of 17.2 months (interquartile range [IQR], 1.0-63.4 mo). During catheterization, the median PVRI was 4.1 WU · m2 (IQR, 3.6-5.3 WU · m2), and the median mean pulmonary artery pressure was 38.0 mmHg (IQR, 25.5-46.0 mmHg). Premature birth was associated with pulmonary vasodilator therapy at time of PDA closure ( P=0.001) but not with baseline PVRI (P=0.986). Three patients (9.1%) had device-related complications (one immediate embolization and 2 malpositions). Two of these complications involved embolization coils. Baseline pulmonary vasodilator therapy before closure was significantly associated with intensive care unit admission after closure (10/12 [83.3%] with baseline therapy vs 3/21 [14.3%] without; P <0.001). Of 11 patients receiving pulmonary vasodilators before closure and having a device in place long-term, 8 (72.7%) were weaned after closure (median, 24.0 mo [IQR, 11.0-25.0 mo]). We conclude that transcatheter PDA closure can be performed safely in many children with pulmonary artery hypertension and improve symptoms, particularly in patients born prematurely. Risk factors for adverse outcomes are multifactorial, including coil use and disease severity. Multicenter studies in larger patient populations are warranted.
© 2020 by the Texas Heart® Institute, Houston.
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Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Management of Dyslipidemia and Prevention of Cardiovascular Disease Algorithm - 2020 Executive Summary.
Endocr Pract2020 Oct;26(10):1196-1224. doi: S1530-891X(20)48204-7.
Handelsman Yehuda, Jellinger Paul S, Guerin Chris K, Bloomgarden Zachary T, Brinton Eliot A, Budoff Matthew J, Davidson Michael H, Einhorn Daniel, Fazio Sergio, Fonseca Vivian A, Garber Alan J, Grunberger George, Krauss Ronald M, Mechanick Jeffrey I, Rosenblit Paul D, Smith Donald A, Wyne Kathleen L,
Abstract
The treatment of lipid disorders begins with lifestyle therapy to improve nutrition, physical activity, weight, and other factors that affect lipids. Secondary causes of lipid disorders should be addressed, and pharmacologic therapy initiated based on a patient's risk for atherosclerotic cardiovascular disease (ASCVD). Patients at extreme ASCVD risk should be treated with high-intensity statin therapy to achieve a goal low-density lipoprotein cholesterol (LDL-C) of <55 mg/dL, and those at very high ASCVD risk should be treated to achieve LDL-C <70 mg/dL. Treatment for moderate and high ASCVD risk patients may begin with a moderate-intensity statin to achieve an LDL-C <100 mg/dL, while the LDL-C goal is <130 mg/dL for those at low risk. In all cases, treatment should be intensified, including the addition of other LDL-C-lowering agents (i.e., proprotein convertase subtilisin/kexin type 9 inhibitors, ezetimibe, colesevelam, or bempedoic acid) as needed to achieve treatment goals. When targeting triglyceride levels, the desirable goal is <150 mg/dL. Statin therapy should be combined with a fibrate, prescription-grade omega-3 fatty acid, and/or niacin to reduce triglycerides in all patients with triglycerides ?500 mg/dL, and icosapent ethyl should be added to a statin in any patient with established ASCVD or diabetes with ?2 ASCVD risk factors and triglycerides between 135 and 499 mg/dL to prevent ASCVD events. Management of additional risk factors such as elevated lipoprotein(a) and statin intolerance is also described.
© 2020 American Association of Clinical Endocrinologists. Published by Elsevier, Inc. All rights reserved.
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Correction to: mechanisms underlying pathological Ca handling in diseases of the heart.
Pflugers Arch2021 Jan;():. doi: 10.1007/s00424-021-02519-0.
Lahiri Satadru K, Aguilar-Sanchez Yuriana, Wehrens Xander H T,
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Cardiac remodeling and hypertension in HIV uninfected infants exposed in utero to antiretroviral therapy.
Clin Infect Dis2021 Jan;():. doi: ciab030.
GarcÍa-Otero Laura, LÓpez Marta, GoncÉ Anna, Fortuny Claudia, Salazar Laura, Valenzuela-Alcaraz Brenda, Guirado Laura, CÉsar Sergi, GratacÓs Eduard, Crispi Fátima,
Abstract
BACKGROUND:
We aimed to assess the postnatal pattern of cardiovascular remodeling associated with intrauterine exposure to maternal HIV and antiretroviral treatment (ART).
METHODS:
Prospective cohort including 34 HIV-exposed uninfected (HEU) infants and 53 non-HIV-exposed infants evaluated from fetal life up to 6 months postnatally. A cardiovascular evaluation was performed including echocardiography, blood pressure and carotid intima media thickness (cIMT) measurement.
RESULTS:
ART regimens during pregnancy included two nucleoside reverse transcriptase inhibitors (Abacavir+Lamivudine (32.4%), Emtricitabine+Tenofovir (41.2%) and Zidovudine+Lamivudine (20.6%)). At 6 months of age, HIV-exposed uninfected infants showed thicker myocardial walls (septal wall thickness mean 5.02 mm (SD 0.85) vs 3.98 mm (0.86); p<0.001) and relative systolic dysfunction with decreased mitral ring displacement (8.57 mm (2.03) vs 10.34 mm (1.84); p=0.002) and decreased tricuspid S' (9.71 cm/s (1.94) vs 11.54 cm/s (2.07); p=0.003) together with relative diastolic dysfunction showed by prolonged left isovolumic relaxation time (58.57 ms (13.79) vs 47.94 (7.39); p<0.001). Vascular assessment showed significantly higher systolic and diastolic blood pressure (102 mmHg (16.1) vs 80 mmHg (13.9); p<0.001 and 64 mmHg (14.4) vs 55 mmHg (10.2); p=0.045 respectively), with 50% of HIV-exposed children meeting criteria for hypertension vs 3.77% of the non-HIV-exposed group (p<0.001) and thicker mean cIMT in the HIV-exposed group (0.62 µm (0.09) vs 0.51 µm (0.09); p=0.015).
CONCLUSIONS:
Subclinical cardiac impairment together with higher blood pressure and thicker cIMT were observed in HIV-exposed infants at 6 months of age. Half of them presented hypertension. Our findings support a possible increased cardiovascular risk in HIV uninfected infants exposed in utero to ART.
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
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Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound.
J Perinat Med2020 Dec;():. doi: 10.1515/jpm-2020-0457.
Kesrouani Assaad, Abdallah Wael, Kharrat Roland, Choueiry Elie, Daou Linda, Nasr Bernard,
Abstract
Objectives:
To report the normal fetal cardiac axis (CA) values at the time of the first trimester screening ultrasound.
Methods:
Standardized images and measurement of the CA were obtained from 100 healthy fetuses between 11+0 and 13+6 weeks of gestation along with the nucal thichkness (NT), Crown-rump length (CRL) and other measurements. We excluded cases with abnormal NT, later diagnosis of abnormalities, and suspected fetal cardiopathy during the pregnancy follow-up. Data analysis was performed after all the patients delivered and cardiopathy was excluded.
Results:
CA was measurable in all the cases. Higher CRL was associated with a decrease in the CA. The mean ± SD embryonic/fetal CA was 48±5,2°, ranging from 39 to 60°, The 2.5 percentile was defined at 40° and the 97.5 percentile at 59°. The Pearson test resulted in a significant correlation between CA and CRL with a coefficient R of 70% and p-value <0.01.
Conclusions:
CA tends to decrease at the 11 to 13+6 gestational ages. We defined 2.5 and 97.5% curves for the normal values of CA in our Middle Eastern population. A larger study will be required to differentiate normal and abnormal values for the early detection of heart abnormalities.
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Neonatal lupus erythematosus - practical guidelines.
J Perinat Med2021 Jan;():. doi: 10.1515/jpm-2020-0543.
Derdulska Julia Marta, Rudnicka Lidia, Szykut-Badaczewska Agata, Mehrholz Dorota, Nowicki Roman, Bara?ska-Rybak Wioletta, Wilkowska Aleksandra,
Abstract
Background:
Neonatal lupus erythematosus is an autoimmune disease acquired during fetal life as a result of transplacental passage of maternal anti-Sjögren's-syndrome-related antigen A (anti-SSA/Ro), anti-Sjögren's-syndrome-related antigen B (anti-SSB/La) or anti-U1 ribonucleoprotein (anti-U1-RNP) antinuclear autoantibodies.
Contents:
Clinical manifestations include skin lesions, congenital heart block, hepatobiliary involvement and cytopenias. Most of the disorders disappear spontaneously after clearance of maternal antibodies. Cardiac symptoms, however, are not self-resolving and often pacemaker implantation is required. Diagnosis is based on clinical presentation and the presence of typical antibodies in the mother's or infant's serum.
Outlook:
Neonatal lupus erythematosus may develop in children born to anti-SSA/Ro or anti-SSB/La women with various systemic connective tissue diseases. However, in half of the cases, the mother is asymptomatic, which may delay the diagnosis and have negative impact on the child's prognosis. Testing for antinuclear antibodies should be considered in every pregnant woman since early treatment with hydroxychloroquine or intravenous immunoglobulin (IVIG) has proven to be effective in preventing congenital heart block.
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Learning from tragedy-The Jessica Barnett story: challenges in the diagnosis of long QT syndrome.
Diagnosis (Berl)2021 Jan;():. doi: 10.1515/dx-2020-0113.
Graber Mark L, Olson Andrew P J, Barnett Tanya,
Abstract
We describe the case of Jessica Barnett, an adolescent girl whose repeated episodes of syncope and near-syncope were ascribed to a seizure or anxiety disorder. The correct diagnoses (congenital long QT syndrome; arrythmogenic right ventricular cardiomyopathy) were established by autopsy and genetic studies only after her death at age 17. The perspective of the family is presented, along with an analysis of what went right and what went wrong in Jessica's diagnostic journey. Key lessons in this case include the value of family as engaged members of the diagnostic team, that a 'hyperventilation test' should not be used to exclude cardiac origins of syncope or pre-syncope, and the inherent challenges in the diagnosis of the long QT syndrome.
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Precision in Cardiovascular Care Using Targeted Neonatal Echocardiography in Lethal Neonatal Disseminated Herpes Infection: A Case Series.
Pediatr Infect Dis J2021 Jan;():. doi: 10.1097/INF.0000000000003071.
Bhattacharya Soume, McNamara Patrick J, Giesinger Regan E,
Abstract
Neonates with disseminated neonatal herpes simplex virus infection often present with cardiorespiratory failure. The pathophysiological contributors to the disease phenotype, biologic mechanisms underlying the hemodynamic instability and optimal approach to cardiovascular treatment have not been well described. We describe clinical and echocardiography features of cardiovascular dysfunction, in a case series of neonates with disseminated herpes simplex virus, and response to physiology-based hemodynamic management. The biologic phenotype includes low systemic vascular resistance state, hypovolemia secondary to third space losses, myocardial dysfunction and pulmonary hypertension. Early targeted neonatal echocardiography provided hemodynamic insights on blood flow, shunt characterization, vascular resistance and cardiac function, that were difficult to gauge clinically (eg, differentiating parenchymal from pulmonary vascular disease) thereby positively impacted clinical care. All patients were stabilized hemodynamically without utilizing extracorporeal membrane oxygenation, although all patients died of multiorgan failure.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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"Compassionate" Cases of the Jarvik 2015 Ventricular Assist Device.
ASAIO J2021 Jan;():. doi: 10.1097/MAT.0000000000001351.
Spinner Joseph A, Tunuguntla Hari P, Tume Sebastian C, Elias Barbara A, Mcmullen Jason, John Rija, Choudhry Swati, Price Jack F, Denfield Susan W, Dreyer William J, Adachi Iki,
Abstract
The Jarvik 2015 Ventricular Assist Device (VAD) (Jarvik Inc, New York, NY) is the first and currently only continuous-flow VAD specifically designed for small children, and it is being evaluated in the so-called Pump for Kids, Infants, and Neonates (PumpKIN) trial. Due to the strict inclusion criteria of the trial, there have been a group of patients who failed to meet the criteria and therefore received the Jarvik 2015 VAD under the designation of "compassionate use." This is the same phenomenon seen previously during the Berlin Heart EXCOR trial. While we await the results of the PumpKIN trial, which will report the device performance in a strictly selected population, the compassionate use cases represent actual "real world" experiences. We describe herein our experience of two compassionate use cases. In particular, this report has a special emphasis on the power consumption and hemolysis and inflammatory lab profile of the Jarvik 2015 VAD as hemocompatibility was the primary focus of the developmental and the preclinical phases.
Copyright © 2021 by the American Society for Artificial Internal Organs.
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Are the Pediatric Index of Mortality 2 and 3 equal predictors of mortality? An intensive care unit-based concordance study.
Rev Bras Ter Intensiva;32(4):578-584. doi: S0103-507X2020000400578.
Patino-Hernandez Daniela, López Alba Deyanira Quiñonez, Zuluaga César Augusto, García Ángel Alberto, Muñoz-Velandia Oscar Mauricio,
Abstract
OBJECTIVE:
To determine the concordance of mortality risk classification through the use of the Pediatric Index of Mortality (PIM) 2 and 3.
METHODS:
Through a retrospective cohort, we evaluated patients admitted to the pediatric intensive care unit between April 2016 and December 2018. We calculated the mortality risk with the PIM 2 and 3. Analyses were carried out to determine the concordance between the risk classification obtained with both scales using unweighted and linearly weighted kappa.
RESULTS:
A total of 722 subjects were included, and 66.6% had a chronic condition. The overall mortality was 3.7%. The global kappa concordance coefficient for classifying patients according to risk with the PIM 2 and 3 was moderate at 0.48 (95%CI 0.43 - 0.53). After linear weighting, concordance was substantial at 0.64 (95%CI 0.59 - 0.69). For cardiac surgery patients, concordance for risk classification was fair at 0.30 (95%CI 0.21 - 0.39), and after linear weighting, concordance was only moderate at 0.49 (95%CI 0.39 - 0.59). The PIM 3 assigned a lower risk than the PIM 2 in 44.8% of patients in this subgroup.
CONCLUSION:
Our study proves that the PIM 2 and 3 are not clinically equivalent and should not be used interchangeably for quality evaluation across pediatric intensive care units. Validation studies must be performed before using the PIM 2 or PIM 3 in specific settings.
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Impact of the use of nephrotoxic drugs in critically ill pediatric patients.
Rev Bras Ter Intensiva;32(4):557-563. doi: S0103-507X2020000400557.
Almeida Jáder Pereira, João Paulo Ramos David, Sylvestre Lucimary de Castro,
Abstract
OBJECTIVE:
To evaluate the association between the use of nephrotoxic drugs and acute kidney injury in critically ill pediatric patients.
METHODS:
This was a retrospective cohort study involving all children admitted to the intensive care unit of a pediatric hospital during a 1-year period. Acute kidney injury was defined according to the KDIGO classification. Patients with a length of hospital stay longer than 48 hours and an age between 1 month and 14 years were included. Patients with acute or chronic nephropathy, uropathy, congenital or acquired heart disease, chronic use of nephrotoxic drugs, rhabdomyolysis and tumor lysis syndrome were excluded. Patients were classified according to the use of nephrotoxic drugs during their stay at the pediatric intensive care unit.
RESULTS:
The sample consisted of 226 children, of whom 37.1% used nephrotoxic drugs, 42.4% developed acute kidney injury, and 7.5% died. The following drugs, when used alone, were associated with acute kidney injury: acyclovir (p < 0.001), vancomycin (p < 0.001), furosemide (p < 0.001) and ganciclovir (p = 0.008). The concomitant use of two or more nephrotoxic drugs was characterized as an independent marker of renal dysfunction (p < 0.001). After discharge from the pediatric intensive care unit, renal function monitoring in the ward was inadequate in 19.8% of cases.
CONCLUSION:
It is necessary for intensivist physicians to have knowledge of the main nephrotoxic drugs to predict, reduce or avoid damage to their patients.
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[The management of adult congenital heart disease in the emergency department. The Task Force from the Italian Society of Pediatric Cardiology and Congenital Heart Disease].
G Ital Cardiol (Rome)2021 Feb;22(2):152-166. doi: 10.1714/3514.35031.
Barracano Rosaria, Palmieri Rosalinda, Chessa Massimo, Ferraris Laurenzia, Sarubbi Berardo, D'Alto Michele, Egidy Assenza Gabriele, Donti Andrea, Gagliardi Maria Giulia,
Abstract
Over recent years, thanks to remarkable advances in pediatric cardiology, cardiac surgery and catheter interventions, survival of children with congenital heart disease has significantly increased with the majority of patients surviving into adulthood. Therefore, the prevalence of adult patients with congenital heart disease has dramatically increased, as well as the need for specific and dedicated programs. Acute heart failure, infective endocarditis and arrhythmias represent the most common causes of visit in the emergency department in this population. Our task force aimed at guiding physicians taking care of this peculiar cohort of patients in the emergency department.
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Pneumocystis Pneumonia with Hypogammaglobulinemia in a Pediatric Patient Who Underwent Heart Transplantation.
Transpl Infect Dis2021 Jan;():e13571. doi: 10.1111/tid.13571.
Takajo Daiji, Sehgal Swati, Blake Jennifer, Aggarwal Sanjeev,
Abstract
A 23-month-old Caucasian female who had heart transplantation at 11 days of age was diagnosed with Pneumocystis pneumonia (PCP) in the setting of secondary hypogammaglobulinemia (HGG). She was diagnosed with HGG at 5 months of age and had been receiving monthly intravenous immunoglobulin infusion. This is the first case report describing the clinical course of PCP in a pediatric patient with HGG. She developed PCP 23 months after the heart transplantation even when she was off steroids and was receiving timely IVIG. The case posed some clinical questions regarding PCP prophylaxis and HGG management.
This article is protected by copyright. All rights reserved.
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Genome-wide chromatin occupancy of BRDT and gene expression analysis suggest transcriptional partners and specific epigenetic landscapes that regulate gene expression during spermatogenesis.
Mol Reprod Dev2021 Jan;():. doi: 10.1002/mrd.23449.
Her Yoon Ra, Wang Li, Chepelev Iouri, Manterola Marcia, Berkovits Binyamin, Cui Kairong, Zhao Keji, Wolgemuth Debra J,
Abstract
BRDT, a member of the BET family of double bromodomain-containing proteins, is essential for spermatogenesis in the mouse and has been postulated to be a key regulator of transcription in meiotic and post-meiotic cells. To understand the function of BRDT in these processes, we first characterized the genome-wide distribution of the BRDT binding sites, in particular within gene units, by ChIP-Seq analysis of enriched fractions of pachytene spermatocytes and round spermatids. In both cell types, BRDT binding sites were mainly located in promoters, first exons, and introns of genes. BRDT binding sites in promoters overlapped with several histone modifications and histone variants associated with active transcription, and were enriched for consensus sequences for specific transcription factors, including MYB, RFX, ETS, and ELF1 in pachytene spermatocytes, and JunD, c-Jun, CRE, and RFX in round spermatids. Subsequent integration of the ChIP-seq data with available transcriptome data revealed that stage-specific gene expression programs are associated with BRDT binding to their gene promoters, with most of the BDRT-bound genes being upregulated. Gene Ontology analysis further identified unique sets of genes enriched in diverse biological processes essential for meiosis and spermiogenesis between the two cell types, suggesting distinct developmentally stage-specific functions for BRDT. Taken together, our data suggest that BRDT cooperates with different transcription factors at distinctive chromatin regions within gene units to regulate diverse downstream target genes that function in male meiosis and spermiogenesis.
© 2021 Wiley Periodicals LLC.
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Genetics of agenesis/hypoplasia of the uterus and vagina: narrowing down the number of candidate genes for Mayer-Rokitansky-Küster-Hauser Syndrome.
Hum Genet2021 Jan;():. doi: 10.1007/s00439-020-02239-y.
Mikhael Sasha, Dugar Sonal, Morton Madison, Chorich Lynn P, Tam Kerlene Berwick, Lossie Amy C, Kim Hyung-Goo, Knight James, Taylor Hugh S, Mukherjee Souhrid, Capra John A, Phillips John A, Friez Michael, Layman Lawrence C,
Abstract
PURPOSE:
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome consists of congenital absence of the uterus and vagina and is often associated with renal, skeletal, cardiac, and auditory defects. The genetic basis is largely unknown except for rare variants in several genes. Many candidate genes have been suggested by mouse models and human studies. The purpose of this study was to narrow down the number of candidate genes.
METHODS:
Whole exome sequencing was performed on 111 unrelated individuals with MRKH; variant analysis focused on 72 genes suggested by mouse models, human studies of physiological candidates, or located near translocation breakpoints in t(3;16). Candidate variants (CV) predicted to be deleterious were confirmed by Sanger sequencing.
RESULTS:
Sanger sequencing verified 54 heterozygous CV from genes identified through mouse (13 CV in 6 genes), human (22 CV in seven genes), and translocation breakpoint (19 CV in 11 genes) studies. Twelve patients had???2 CVs, including four patients with two variants in the same gene. One likely digenic combination of LAMC1 and MMP14 was identified.
CONCLUSION:
We narrowed 72 candidate genes to 10 genes that appear more likely implicated. These candidate genes will require further investigation to elucidate their role in the development of MRKH.
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Effects of Immunization With the Soil-Derived Bacterium on Stress Coping Behaviors and Cognitive Performance in a "Two Hit" Stressor Model.
Front Physiol2020 ;11():524833. doi: 10.3389/fphys.2020.524833.
Foxx Christine L, Heinze Jared D, González Antonio, Vargas Fernando, Baratta Michael V, Elsayed Ahmed I, Stewart Jessica R, Loupy Kelsey M, Arnold Mathew R, Flux M C, Sago Saydie A, Siebler Philip H, Milton Lauren N, Lieb Margaret W, Hassell James E, Smith David G, Lee Kyo A K, Appiah Sandra A, Schaefer Evan J, Panitchpakdi Morgan, Sikora Nicole C, Weldon Kelly C, Stamper Christopher E, Schmidt Dominic, Duggan David A, Mengesha Yosan M, Ogbaselassie Mikale, Nguyen Kadi T, Gates Chloe A, Schnabel K'loni, Tran Linh, Jones Joslynn D, Vitaterna Martha H, Turek Fred W, Fleshner Monika, Dorrestein Pieter C, Knight Rob, Wright Kenneth P, Lowry Christopher A,
Abstract
Previous studies demonstrate that NCTC 11659 (), a soil-derived bacterium with anti-inflammatory and immunoregulatory properties, is a potentially useful countermeasure against negative outcomes to stressors. Here we used male C57BL/6NCrl mice to determine if repeated immunization with is an effective countermeasure in a "two hit" stress exposure model of chronic disruption of rhythms (CDR) followed by acute social defeat (SD). On day -28, mice received implants of biotelemetric recording devices to monitor 24-h rhythms of locomotor activity. Mice were subsequently treated with a heat-killed preparation of (0.1 mg, administered subcutaneously on days -21, -14, -7, and 27) or borate-buffered saline vehicle. Mice were then exposed to 8 consecutive weeks of either stable normal 12:12 h light:dark (LD) conditions or CDR, consisting of 12-h reversals of the LD cycle every 7 days (days 0-56). Finally, mice were exposed to either a 10-min SD or a home cage control condition on day 54. All mice were exposed to object location memory testing 24 h following SD. The gut microbiome and metabolome were assessed in fecal samples collected on days -1, 48, and 62 using 16S rRNA gene sequence and LC-MS/MS spectral data, respectively; the plasma metabolome was additionally measured on day 64. Among mice exposed to normal LD conditions, immunization with induced a shift toward a more proactive behavioral coping response to SD as measured by increases in scouting and avoiding an approaching male CD-1 aggressor, and decreases in submissive upright defensive postures. In the object location memory test, exposure to SD increased cognitive function in CDR mice previously immunized with . Immunization with stabilized the gut microbiome, attenuating CDR-induced reductions in alpha diversity and decreasing within-group measures of beta diversity. Immunization with also increased the relative abundance of 1-heptadecanoyl-sn-glycero-3-phosphocholine, a lysophospholipid, in plasma. Together, these data support the hypothesis that immunization with stabilizes the gut microbiome, induces a shift toward a more proactive response to stress exposure, and promotes stress resilience.
Copyright © 2021 Foxx, Heinze, González, Vargas, Baratta, Elsayed, Stewart, Loupy, Arnold, Flux, Sago, Siebler, Milton, Lieb, Hassell, Smith, Lee, Appiah, Schaefer, Panitchpakdi, Sikora, Weldon, Stamper, Schmidt, Duggan, Mengesha, Ogbaselassie, Nguyen, Gates, Schnabel, Tran, Jones, Vitaterna, Turek, Fleshner, Dorrestein, Knight, Wright and Lowry.
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Continuous chest compressions with asynchronous ventilations increase carotid blood flow in the perinatal asphyxiated lamb model.
Pediatr Res2021 Jan;():. doi: 10.1038/s41390-020-01306-4.
Vali Payam, Lesneski Amy, Hardie Morgan, Alhassen Ziad, Chen Peggy, Joudi Houssam, Sankaran Deepika, Lakshminrusimha Satyan,
Abstract
BACKGROUND:
The neonatal resuscitation program (NRP) recommends interrupted chest compressions (CCs) with ventilation in the severely bradycardic neonate. The conventional 3:1 compression-to-ventilation (C:V) resuscitation provides 90 CCs/min, significantly lower than the intrinsic newborn heart rate (120-160 beats/min). Continuous CC with asynchronous ventilation (CCCaV) may improve the success of return of spontaneous circulation (ROSC).
METHODS:
Twenty-two near-term fetal lambs were randomized to interrupted 3:1 C:V (90 CCs?+?30?breaths/min) or CCCaV (120 CCs?+?30?breaths/min). Asphyxiation was induced by cord occlusion. After 5?min of asystole, resuscitation began following NRP guidelines. The first dose of epinephrine was given at 6?min. Invasive arterial blood pressure and left carotid blood flow were continuously measured. Serial arterial blood gases were collected.
RESULTS:
Baseline characteristics between groups were similar. Rate of and time to ROSC was similar between groups. CCCaV was associated with a higher PaO (partial oxygen tension) (22?±?5.3 vs. 15?±?3.5?mmHg, p?
CONCLUSIONS:
In a perinatal asphyxiated cardiac arrest lamb model, CCCaV showed greater carotid blood flow and cerebral oxygen delivery compared to 3:1 C:V resuscitation.
IMPACT:
In a perinatal asphyxiated cardiac arrest lamb model, CCCaV improved carotid blood flow and oxygen delivery to the brain compared to the conventional 3:1 C:V resuscitation. Pre-clinical studies assessing neurodevelopmental outcomes and tissue injury comparing continuous uninterrupted chest compressions to the current recommended 3:1 C:V during newborn resuscitation are warranted prior to clinical trials.
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Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom.
Clin J Am Soc Nephrol2021 Jan;():. doi: CJN.11020720.
Plumb Lucy A, Sinha Manish D, Casula Anna, Inward Carol D, Marks Stephen D, Caskey Fergus J, Ben-Shlomo Yoav,
Abstract
BACKGROUND AND OBJECTIVES:
Pre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:
A cohort study using prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ?16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with specified covariates.
RESULTS:
Analysis was performed on 2160 children (41% females), with a median age of 3.8 years (interquartile range, 0.2-9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters, greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95% confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95% confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95% confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model.
CONCLUSIONS:
Socioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children from more affluent areas were more likely to receive a pre-emptive transplant.
Copyright © 2021 by the American Society of Nephrology.
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Impact of a transition education program on health-related quality of life in pediatric patients with congenital heart disease: study design for a randomised controlled trial.
Health Qual Life Outcomes2021 Jan;19(1):23. doi: 10.1186/s12955-021-01668-1.
Werner Oscar, Bredy Charlene, Lavastre Kathleen, Guillaumont Sophie, De La Villeon Gregoire, Vincenti Marie, Gerl Cristelle, Dulac Yves, Souletie Nathalie, Acar Philippe, Pages Laurence, Picot Marie-Christine, Bourrel Gerard, Oude Engberink Agnes, Million Elodie, Abassi Hamouda, Amedro Pascal,
Abstract
BACKGROUND:
Recent advances in the field of congenital heart disease (CHD) led to an improved prognosis of the patients and in consequence the growth of a new population: the grown up with congenital heart disease. Until recently, more than 50% of these patients were lost to follow up because of the lack of specialized structures. The critical moment is the transition between paediatric and adult unit. Therapeutic education is crucial to solve this issue by helping patients to become independent and responsible. The TRANSITION-CHD randomized trial aims to assess the impact of a transition education program on health-related quality of life (HRQoL) of adolescents and young adults with CHD.
METHODS:
Multicentre, randomised, controlled, parallel arm study in CHD patients aged from 13 to 25 years old. Patients will be randomised into 2 groups (education program vs. no intervention). The primary outcome is the change in self-reported HRQoL between baseline and 12-month follow-up. A total of 100 patients in each group is required to observe a significant increase of the overall HRQoL score of 7?±?13.5 points (on 100) with a power of 80% and an alpha risk of 5%. The secondary outcomes are: clinical outcomes, cardiopulmonary exercise test parameters (peak VO2, VAT, VE/VCO2 slope), level of knowledge of the disease using the Leuven knowledge questionnaire for CHD, physical and psychological status.
DISCUSSION:
As the current research is opening on patient related outcomes, and as the level of proof in therapeutic education is still low, we sought to assess the efficacy of a therapeutic education program on HRQoL of CHD patients with a randomized trial.
TRIAL REGISTRATION:
This study was approved by the National Ethics Committee (South-Mediterranean IV 2016-A01681-50) and was registered on Clinicaltrials.gov (NCT03005626).
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Evaluating a longitudinal point-of-care-ultrasound (POCUS) curriculum for pediatric residents.
BMC Med Educ2021 Jan;21(1):64. doi: 10.1186/s12909-021-02488-z.
Brant Julia Aogaichi, Orsborn Jonathan, Good Ryan, Greenwald Emily, Mickley Megan, Toney Amanda G,
Abstract
BACKGROUND:
POCUS is a growing field in medical education, and an imaging modality ideal for children given the lack of ionizing radiation, ease of use, and good tolerability. A 2019 literature review revealed that no US pediatric residency programs integrated obligatory POCUS curricula. Our objective was to provide a formalized POCUS curriculum over multiple years, and to retrospectively assess improvement in resident skills and comfort.
METHODS:
During intern year, pediatric residents received didactics and hands-on scanning opportunities in basic POCUS applications. Their evaluation tools included pre- and post-surveys and tests, and a final performance exam. In the second and third years of residency, all participants were required to complete 8 hours per year of POCUS content review and additional hands-on training. An optional third-year curriculum was offered to interested residents as career-focused education elective time.
RESULTS:
Our curriculum introduced POCUS topics such as basic and advanced cardiac, lung, skin/soft tissues and procedural based ultrasound to all pediatric residents. Among first-year residents, application-specific results showed POCUS comfort level improved by 61-90%. Completed evaluations demonstrated improvement in their ability to recognize and interpret POCUS images. Second- and third-year residents reported educational effectiveness that was rated 3.9 on a 4-point Likert scale. Four third-year residents took part in the optional POCUS elective, and all reported a change in their practice with increased POCUS incorporation.
CONCLUSIONS:
Our longitudinal pediatric residency POCUS curriculum is feasible to integrate into residency training and exhibits early success.
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