Articles: child.
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Pediatr Crit Care Me · Feb 2025
Daily Surveillance Blood Cultures in Children Supported With Extracorporeal Membrane Oxygenation: Single-Center, Retrospective Cohort Study, 2021-2023.
Diagnosing bloodstream infections (BSIs) in patients on extracorporeal membrane oxygenation (ECMO) can be challenging due to circuit-controlled temperature, altered hemodynamics, and questionable reliability of inflammatory markers in critically ill patients. As a result, practice variability exists among ECMO centers regarding routine blood cultures for surveillance of BSI. Our study aimed to evaluate daily surveillance blood cultures in pediatric and neonatal ECMO patients. ⋯ Daily surveillance blood cultures are low-yield in our practice with pediatric and neonatal ECMO patients. Our experience shows that changes in clinical status, including abnormal physical or laboratory findings consistent with infection, are associated with BSI, allowing for timely diagnosis. These criteria should prompt as-needed blood cultures, reducing blood draws and preventing costly and unnecessary daily surveillance cultures.
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The traditional management of pregnant patients with Chiari I malformation (CM-I) heavily favors cesarean section and general anesthesia to limit the perceived risk of maternal neurological complications attributed to vaginal delivery and neuraxial anesthesia. The aim of this study was to compare reported neurological symptoms and radiographic presentations before and after childbirth performed by patients with CM-I, with and without associated syrinx. ⋯ Our findings suggest that patients with CM-I may deliver vaginally and receive neuraxial anesthesia with low risk of neurological complications or radiographic worsening. As these patients were not prospectively selected, limitations exist, and it remains important to consider the severity of the patient's clinical and radiographic presentation when selecting anesthetic and delivery modality.
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Observational Study
The Effect of Parental Weight and Genetics on the BMI of Very Low Birth Weight Infants as They Reach School Age.
Prematurely born individuals are usually of low or normal weight in childhood; in adulthood, however, their probability of being overweight is twice that of persons born at full term. There is not yet any way to predict the weight development of premature babies. ⋯ Extreme values of a polygenic BMI score are strongly associated with the weight development of preterm infants as they develop into children aged 10-14. The large effect size implies that this score may aid in the counseling of prematurely born children and their parents.
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Children with Christianson syndrome (CS), an X-linked neurodevelopmental disorder caused by loss-of-function mutations in the alkali cation/proton exchanger SLC9A6/NHE6, display severe cognitive impairments, mutism, and sensory abnormalities such as hyposensitivity to pain. However, it is unclear whether these children display other sensory abnormalities and whether their pain hyposensitivity is the result of an elevated pain threshold or a complete insensitivity to pain. To better characterize the sensory abnormalities in this disorder, we used a combination of a mouse model of CS and pain questionnaires directed at nonverbal patients with CS. ⋯ Surprisingly, CS mice also displayed aversive reactions to innocuous stimuli, which prompted us to examine whether such reactions were also present in children with CS. Indeed, the results from the PSQ revealed that 30% to 50% of these patients showed an aversive response to normally innocuous stimuli like light touch and gusts of air. Our results demonstrate that children with CS have aversive reactions to innocuous stimuli and are hyposensitive to painful stimuli, the latter making them at risk for developing complications from unreported injuries.