Abstracts "Pediatrics"
Abril 2007
Abstract 1 of 16
Multidrug-Resistant Bacteria in Hospitalized
Children: A 5-Year Multicenter Study
Josette Raymond et als
Hôpital Cochin-Saint Vincent de Paul, Paris, France
OBJECTIVE. The objective of this study was to
determine the incidence of multidrug-resistant bacteria in
hospitalized children
METHODS. This multicenter study was conducted in 5
hospitals in the Paris area from 1999 to 2003. We recorded all
isolations of multidrug-resistant bacteria from clinical samples
that were obtained from hospitalized children. Strains that were
isolated during systematic screening for carriers were excluded.
RESULTS. The mean incidences were 0.9 per 1000
hospitalization-days for methicillin-resistant Staphylococcus
aureus, 0.45 for extended-spectrum ß-lactamase–producing
Klebsiella pneumoniae, 0.32 for extended-spectrum ß-lactamase–producing
Enterobacteriaceae other than Klebsiella pneumoniae, 0.40 for
Enterobacter species with derepressed cephalosporinase, and
0.01 for vancomycin-resistant Enterococcus. The incidences per
1000 hospitalization-days of methicillin-resistant Staphylococcus
aureus, extended-spectrum ß-lactamase–producing
Klebsiella pneumoniae, extended-spectrum ß-lactamase–producing
Enterobacteriaceae other than Klebsiella pneumoniae, and
Enterobacter species with derepressed cephalosporinase
decreased significantly from 1999 to 2003, whereas the incidence
of vancomycin-resistant Enterococcus remained very low.
The proportion of resistant strains within the species did not
vary significantly for methicillin-resistant Staphylococcus
aureus (11% to 9.6%), extended-spectrum ß-lactamase–producing
Enterobacteriaceae other than Klebsiella pneumoniae (1.1%),
and vancomycin-resistant Enterococcus (0.03% to 0.023%). In
contrast, the frequency of extended-spectrum ß-lactamase–producing
Klebsiella pneumoniae decreased from 31.6% to 7.4%, and that
of Enterobacter species with derepressed cephalosporinase
decreased from 38.8% to 18.5%.
CONCLUSIONS. We report significant decreases in the
incidence of methicillin-resistant Staphylococcus aureus,
extended-spectrum ß-lactamase–producing Klebsiella pneumoniae,
extended-spectrum ß-lactamase–producing Enterobacteriaceae
other than Klebsiella pneumoniae, and Enterobacter species
with derepressed cephalosporinase in hospitalized children during
a 5-year period.
Abstract 2 of 16
Perinatal Risk Factors for Hospitalization
for Pneumococcal Disease in Childhood: A Population-Based Cohort Study
Barbara E. Mahon, MD, et als
Department of Epidemiology, Boston
University School of Public Health, Boston, Massachusetts
OBJECTIVE. The objective of this study was to
examine the relation of factors that are present at birth to
subsequent hospitalization for childhood pneumococcal disease.
METHODS. We conducted a cohort study of all
singletons born in 3 counties in western Denmark from 1980
through 2001, using population-based registries to obtain data on
pregnancy- and birth-related variables and hospitalizations
through age 12. We calculated incidence rates of pneumococcal
disease hospitalization overall and within strata of study
variables and used Poisson regression to estimate rate ratios for
pneumococcal disease hospitalization while accounting for other
birth characteristics.
RESULTS. Among 338504 eligible births, 1052
children were later hospitalized for pneumococcal disease.
Pneumonia accounted for most hospitalizations (81.9%). The
pneumococcal disease hospitalization rate was highest among 7- to
24-month-olds, followed by 0- to 6-month-olds and 25- to 60-month-olds.
The highest rates, typically over 200 hospitalizations per 100
000 person-years, were in 0- to 6- and 7- to 24-month-old
children who were born preterm or with low birth weight, a low
5-minute Apgar score, or birth defects. The hospitalization rate
was lower for first-born children at 0 to 6 months but not at
older ages. At older ages, hospitalization rates were not
substantially different for children whose mothers smoked during
pregnancy, but at 0 to 6 months, the rate was higher for children
of multiparous nonsmokers than for others. Adjusted rate ratios
were elevated across all age categories for several variables,
including low birth weight, presence of birth defects, and low
5-minute Apgar. For several others, including preterm birth,
maternal multiparity, age 
20 years,
and non-Danish/European Union citizenship, adjusted rate ratios
were elevated only for 0- to 6-month-olds.
CONCLUSIONS. This large cohort study of
hospitalization for childhood pneumococcal disease clarifies the
roles of some gestation and birth factors while raising new
questions about how these factors work.
Abstract 3 of 16
Breastfeeding and Hospitalization for
Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort
Study
Maria A. Quigley, MSc
et als National
Perinatal Epidemiology Unit, Oxford University, Oxford, United Kingdom
OBJECTIVE. The objective of this study was to
measure the effect of breastfeeding on hospitalization for
diarrheal and lower respiratory tract infections in the first 8
months after birth in contemporary United Kingdom.
METHODS. The study was a population-based survey (sweep
1 of the United Kingdom Millennium Cohort Study). Data on infant
feeding, infant health, and a range of confounding factors were
available for 15890 healthy, singleton, term infants who were
born in 2000–2002. The main outcome measures were parental
report of hospitalization for diarrhea and lower respiratory
tract infection in the first 8 months after birth.
RESULTS. Seventy percent of infants were breastfed
(ever), 34% received breast milk for at least 4 months, and 1.2%
were exclusively breastfed for at least 6 months. By 8 months of
age, 12% of infants had been hospitalized (1.1% for diarrhea and
3.2% for lower respiratory tract infection). Data analyzed by
month of age, with adjustment for confounders, show that
exclusive breastfeeding, compared with not breastfeeding,
protects against hospitalization for diarrhea and lower
respiratory tract infection. The effect of partial breastfeeding
is weaker. Population-attributable fractions suggest that an
estimated 53% of diarrhea hospitalizations could have been
prevented each month by exclusive breastfeeding and 31% by
partial breastfeeding. Similarly, 27% of lower respiratory tract
infection hospitalizations could have been prevented each month
by exclusive breastfeeding and 25% by partial breastfeeding. The
protective effect of breastfeeding for these outcomes wears off
soon after breastfeeding cessation.
CONCLUSIONS. Breastfeeding, particularly when
exclusive and prolonged, protects against severe morbidity in
contemporary United Kingdom. A population-level increase in
exclusive, prolonged breastfeeding would be of considerable
potential benefit for public health.
Abstract 4 of 16
Neuromotor Outcome at 2 Years of Very Preterm
Infants Who Were Treated With High-Frequency Oscillatory Ventilation or
Conventional Ventilation for Neonatal Respiratory Distress Syndrome
Patrick Truffert, MD, PhD et
als Department of
Neonatology, Lille University Hospital, Lille, France
OBJECTIVE. In a previous multicenter, randomized
trial, elective use of high-frequency oscillatory ventilation was
compared with the use of conventional ventilation in the
management of respiratory distress syndrome in preterm infants
<30 weeks. No difference in terms of respiratory outcome was
observed, but concerns were raised about an increased rate of
severe intraventricular hemorrhage in the high-frequency
ventilation group. To evaluate outcome, a follow-up study was
conducted until a corrected age of 2 years. We report the results
concerning neuromotor outcome.
METHODS. Outcome was able to be evaluated in 192 of
the 212 infants who survived until discharge from the neonatal
unit: 97 of 105 infants of the high-frequency group and 95 of 104
infants of the conventional ventilation group.
RESULTS. In the infants reviewed, mean birth weight
and gestational age were similar in the 2 ventilation groups. As
in the overall study population, the following differences were
observed between the high-frequency ventilation group and the
conventional ventilation group: lower 5-minute Apgar score, fewer
surfactant instillations, and a higher incidence of severe
intraventricular hemorrhage. At a corrected age of 2 years, 93 of
the 97 infants of the high-frequency group and 79 of the 95
infants of the conventional ventilation group did not present any
neuromotor disability, whereas 4 infants of the high-frequency
group and 16 infants of the conventional ventilation group had
cerebral palsy.
CONCLUSIONS. Contrary to our initial concern about
the increased rate of severe intraventricular hemorrhage in the
high-frequency ventilation group, these data suggest that early
use of high-frequency ventilation, compared with conventional
ventilation, may be associated with a better neuromotor outcome.
Because of the small number of patients studied and the absence
of any explanation for this finding, we can conclude only that
high-frequency oscillatory ventilation is not associated with a
poorer neuromotor outcome.
Abstract 5 of 16
Preterm Birth–Associated Cost of Early
Intervention Services: An Analysis by Gestational Age
Karen M. Clements, ScD
et als Center for
Community Health, Massachusetts Department of Public Health, Boston,
Massachusetts
OBJECTIVES. Characterizing the cost of preterm
birth is important in assessing the impact of increasing
prematurity rates and evaluating the cost-effectiveness of
therapies to prevent preterm delivery. To assess early
intervention costs that are associated with preterm births, we
estimated the program cost of early intervention services for
children who were born in Massachusetts, by gestational age at
birth.
METHODS. Using the Pregnancy to Early Life
Longitudinal Data Set, birth certificates for infants who were
born in Massachusetts between July 1999 and June 2000 were linked
to early intervention claims through 2003. We determined total
program costs, in 2003 dollars, of early intervention and mean
cost per surviving infant by gestational age. Costs by plurality,
eligibility criteria, provider discipline, and annual costs for
children's first 3 years also were examined.
RESULTS. Overall, 14033 of 76901 surviving infants
received early intervention services. Program costs totaled
almost $66 million, with mean cost per surviving infant of $857.
Mean cost per infant was highest for children who were 24 to 31
weeks' gestational age ($5393) and higher for infants who were 32
to 36 weeks' gestational age ($1578) compared with those who were
born at term ($725). Cost per surviving infant generally decreased
with increasing gestational age. Among children in early intervention,
mean cost per child was higher for preterm infants than for
term infants. At each gestational age, mean cost per surviving
infant was higher for multiples than for singletons, and annual
early intervention costs were higher for toddlers than for infants.
CONCLUSIONS. Compared with their term counterparts,
preterm infants incurred higher early intervention costs. This
information along with data on birth trends will inform budget
forecasting for early intervention programs. Costs that are
associated with early childhood developmental services must be
included when considering the long-term costs of prematurity.
Abstract 6 of 16
Declines in Low Birth Weight and Preterm
Birth Among Infants Who Were Born to HIV-Infected Women During an Era of
Increased Use of Maternal Antiretroviral Drugs: Pediatric Spectrum of HIV
Disease, 1989–2004
Joann Schulte, DO, MPH, et
als for the Pediatric Spectrum of HIV Disease Consortium
Division of HIV/AIDS Prevention, Centers for
Disease Control and Prevention, Atlanta, Georgia
OBJECTIVE. Our goal was to determine trends in low
birth weight and preterm birth among US infants born to HIV-infected
women.
METHODS. We used data from the longitudinal
Pediatric Spectrum of HIV Disease, a large HIV cohort, to assess
trends in low birth weight and preterm birth from 1989 to 2004
among 11321 study infants. Among women with prenatal care, we
also assessed risk factors, including maternal antiretroviral
therapy during pregnancy, that were predictive of low birth
weight and preterm birth using univariate and multivariate
logistic regression models.
RESULTS. Overall, 11231 of 14464 infants who were
enrolled in Pediatric Spectrum of HIV Disease were tested during
the neonatal period. From 1989 to 2004, testing increased from
32% to 97%. The proportion of HIV-exposed infants who had low
birth weight decreased from 35% to 21% and occurred in all
racial/ethnic groups. Prevalence of preterm birth decreased from
35% to 22% and occurred in all groups. Any maternal
antiretroviral therapy use increased from 2% to 84%. Among 8793
women who had prenatal care, low birth weight was associated with
a history of illicit maternal drug use, unknown maternal HIV
status before delivery, symptomatic maternal HIV disease, black
race, Hispanic ethnicity, and infant HIV infection.
Antiretroviral therapy or lack of it was not associated with low
birth weight. Among women with prenatal care, preterm birth was
associated with a history of illicit maternal drug use,
symptomatic maternal HIV disease, no antiretroviral therapy,
receipt of a 3-drug highly active antiretroviral therapy regimen
with protease inhibitors, black race, and infant HIV infection.
CONCLUSIONS. The proportion of infants who had low
birth weight or were born preterm declined during an era of
increased maternal antiretroviral therapies. These Pediatric
Spectrum of HIV Disease trends differ from the overall increases
in both outcomes among the US population.
Abstract 7 of 16
Follow-up Care for Infants With Chronic Lung
Disease: A Randomized Comparison of Community- and Center-Based Models
T. Michael O'Shea, MD, et als
Departments of a
Pediatrics Wake Forest University School of Medicine, Winston-Salem, North
Carolina
OBJECTIVES. Premature infants with chronic lung
disease benefit from comprehensive care, which typically is based
in tertiary medical centers. When such centers are not easily
accessible, alternative models of care are needed. The purpose of
this work was to compare community-based follow-up, provided via
telephone contacts, to traditional center-based follow-up of
premature infants with chronic lung disease.
PATIENTS AND METHODS. After discharge from neonatal
intensive care, 150 premature infants with chronic lung disease
were randomly assigned to either community-based (n = 75)
or center-based (n = 75) follow-up. In community-based
follow-up, a nurse specialist maintained telephone contact with
the infant's primary caregiver and health care providers. Center-based
follow-up consisted of visits to a medical center–based
multidisciplinary clinic staffed by a neonatologist, a nurse
specialist, and a social worker. The outcomes of interest were
Bayley Scales of Infant Development mental developmental index
and psychomotor developmental index, Vineland Adaptive Behavioral
Composite, and growth delay (weight for length <5th percentile)
at 1-year adjusted age and respiratory rehospitalizations through
1-year adjusted age.
RESULTS. In each randomization group, 73 infants
survived, and 69 were evaluated at 1-year adjusted age. The
median mental development index (corrected for gestational age)
was 90 for both groups. The median psychomotor developmental
index was 82 for the center-based group and 81 for the community-based
group. The median Vineland Adaptive Behavioral Composite was
100 and 102 for the center-based and community-based groups,
respectively. In the center-based and community-based groups,
respectively, the proportions with growth delay were 13% and
26%, and the proportions rehospitalized for respiratory illness
were 33% and 29%.
CONCLUSIONS. Infants randomly assigned to community-based,
as compared with those randomly assigned to center-based follow-up,
had similar developmental and health outcomes. The former approach
might be a preferred alternative for families in rural settings
or families for whom access to a tertiary care medical center
is difficult.
Abstract 8 of 16
Association Between Congenital Heart Defects
and Small for Gestational Age
Sadia Malik, MD, et als
Arkansas Center for Birth Defects
Research and Prevention
OBJECTIVES. Infants with congenital heart defects
may experience inhibited growth during fetal life. In a large
case-control study, we addressed the hypothesis that infants with
congenital heart defects are more likely to be small for
gestational age than infants without congenital heart defects
after controlling for selected maternal and infant
characteristics.
METHODS. Using data from population-based birth
defect registries, the National Birth Defects Prevention Study
enrolled infants with nonsyndromic congenital heart defects (case
subjects) and infants without congenital heart defects or any
other birth defect (control subjects). Small for gestational age
was defined as birth weight below the 10th percentile for
gestational age and gender. Association between congenital heart
defects and small for gestational age was examined by conditional
logistic regression adjusting for maternal covariates related to
fetal growth.
RESULTS. Live-born singleton infants with
congenital heart defects (case subjects, n = 3395) and
live-born singleton infants with no birth defect (control
subjects, n = 3924) were included in this study. Case
subjects had lower birth weights compared with control subjects.
Small for gestational age was observed among 15.2% of case
subjects and among only 7.8% of control subjects. Congenital
heart defect infants were significantly more likely to be small
for gestational age than control infants.
CONCLUSIONS. Infants with congenital heart defects
are approximately twice as likely to be small for gestational age
as control subjects. Small for gestational age status may affect
clinical management decisions, therapeutic response, and
prognosis of neonates with congenital heart defects. Although the
etiology of growth retardation among infants with congenital
heart defects is uncertain, further exploration may uncover a
common pathogenesis or causal relationship between congenital
heart defects and small for gestational age.
Abstract 9 of 16
A New Phenotypical Variant of Intrauterine
Growth Restriction?
Claudio DeFelice, MD et
als Neonatal Intensive Care
Unit, Azienda Ospedaliera Universitaria Senese
OBJECTIVES. A link between intrauterine growth
restriction and major adult-onset diseases has been reported. In
this study we observed a series of hitherto-unrecognized clinical
features in a population of children with intrauterine growth
restriction.
PATIENTS AND METHODS. A total of 77 Italian
children (aged 9.45 ± 2.08 years) with antenatally diagnosed
intrauterine growth restriction and small-for-gestational-age
birth, along with their parents, were examined. The children with
intrauterine growth restriction and were small for gestational
age were subdivided into 2 groups ("variant" versus control
subjects) according to evidence of auricle morphology deviation
from normal. The following variables were determined: (1)
external ear auricle geometry; (2) function of the posterior
communicating arteries of the circle of Willis, as assessed by
transcranial Doppler ultrasonography; (3) articular mobility, as
assessed by Beighton's 9-point scale; (4) skin softness; and (5)
distortion product–evoked otoacoustic emissions.
RESULTS. Intrauterine growth restriction–variant
children (n = 27) showed a significant female predominance, a
lower proportion of maternal pregnancy-induced hypertension/
preeclampsia, and a higher head circumference as compared with
intrauterine growth restriction control subjects. Mothers of
small-for-gestational-age–variant children showed significantly
different auricular geometry parameters as compared with the
intrauterine growth restriction controls mothers. An excess of
bilaterally nonfunctioning posterior communicating arteries was
observed both in the children with the intrauterine growth
restriction–variant phenotype and their mothers as compared with
the control groups. Significantly increased proportions of joint
hypermobility and skin softness were observed in the intrauterine
growth restriction–variant children as compared with controls
subjects. Children with the intrauterine growth restriction–variant
phenotype and their mothers showed bilateral distortion product–evoked
otoacoustic emissions notches versus none in the control subjects,
with an associated reduction of the area under the curve in both
the intrauterine growth restriction–variant children and
their mothers. No significant differences between the variant and
control groups regarding the fathers were observed.
CONCLUSIONS. We propose that the observed
phenotypical constellation may represent an unrecognized variant
of intrauterine growth restriction.
Abstract 10 of 16
Inflammatory Markers and Mediators in
Tracheal Fluid of Premature Infants Treated With Inhaled Nitric Oxide
William E. Truog, MD et als
Section of
Neonatology, Children's Mercy Hospitals and Clinics, University of
Missouri-Kansas City School of Medicine, Kansas City, Missouri
OBJECTIVE. We compared serial measurements of
inflammatory mediators and markers in infants treated with
inhaled nitric oxide or placebo to assess the effects of inhaled
nitric oxide therapy on lung inflammation during bronchopulmonary
dysplasia. We investigated relationships between respiratory
severity scores and airway concentrations of inflammatory markers/mediators.
METHODS. As part of the Nitric Oxide (to Prevent)
Chronic Lung Disease trial, a subset of 99 infants (52 placebo-treated
infants and 47 inhaled nitric oxide-treated infants; well matched
at baseline) had tracheal aspirate fluid collected at baseline,
at 2 to 4 days, and then weekly while still intubated during
study gas treatment (minimum of 24 days). Fluid was assessed
for interleukin-1ß, interleukin-8, transforming growth
factor-ß, N-acetylglucosaminidase, 8-epi-prostaglandin F2
,
and hyaluronan. Results were normalized to total protein and
secretory component of immunoglobulin A.
RESULTS. At baseline, there was substantial
variability of each measured substance and no correlation between
tracheal aspirate fluid levels of any substance and respiratory
severity scores. Inhaled nitric oxide administration did not
result in any time-matched significant change for any of the
analytes, compared with the placebo-treated group. There was no
correlation between any of the measured markers/mediators and
respiratory severity scores throughout the 24 days of study gas
administration. In the posthoc analysis of data for inhaled
nitric oxide-treated infants, there was a difference at baseline
in 8-epi-prostaglandin F2
levels for infants who did (n = 21) and did not (n
= 26) develop bronchopulmonary dysplasia at postmenstrual age of
36 weeks.
CONCLUSIONS. Inhaled nitric oxide, as administered
in this study, seemed to be safe. Its use was not associated with
any increase in airway inflammatory substances.
Abstract 11 of 16
Do All Infants With Apparent Life-Threatening
Events Need to Be Admitted?
Ilene Claudius, MDa
and Thomas Keens, MDb
Divisions of Emergency and Transport Medicine
b Pulmonary Medicine, Keck School of Medicine, Childrens Hospital
Los Angeles, Los Angeles, California
OBJECTIVE. The goal was to identify criteria that
would allow low-risk infants presenting with an apparent life-threatening
event to be discharged safely from the emergency department.
METHODS. We completed data forms prospectively on
all previously healthy patients <12 months of age presenting to
the emergency department of an urban tertiary care children's
hospital with an apparent life-threatening event over a 3-year
period. These patients were then observed for subsequent events,
significant interventions, or final diagnoses that would have
mandated their admission (eg, sepsis).
RESULTS. In our population of 59 infants, all 8
children who met the aforementioned outcome measures, thus
requiring admission, either had experienced multiple apparent
life-threatening events before presentation or were in their
first month of life. In our study group, the high-risk criteria
of age of <1 year and multiple apparent life-threatening events
yielded a negative predictive value of 100% to identify the need
for hospital admission.
CONCLUSIONS. Our study suggests that >30-day-old
infants who have experienced a single apparent life-threatening
event may be discharged safely from the hospital, which would
decrease admissions by 38%.
Abstract 12 of 16
Outcome at 2 Years of Age of Infants From the
DART Study: A Multicenter, International, Randomized, Controlled Trial of
Low-Dose Dexamethasonef
Lex W. Doyle, MD et als
Departments of Obstetrics and
Gynaecology , University of Melbourne, Melbourne, Australia
OBJECTIVE. Low-dose dexamethasone facilitates
extubation in chronically ventilator-dependent infants with no
obvious short-term complications. The objective of this study was
to determine the long-term effects of low-dose dexamethasone.
METHODS. Very preterm (<28 weeks' gestation) or
extremely low birth weight (birth weight <1000 g) infants who
were ventilator dependent after the first week of life for whom
clinicians considered corticosteroids were indicated were
eligible. After informed consent, infants were randomly assigned
to masked dexamethasone (0.89 mg/kg over 10 days) or saline
placebo. Survivors were assessed at 2 years' corrected age by
staff blinded to treatment group allocation to determine
neurosensory outcome, growth, and health.
RESULTS. The trial was abandoned well short of its
target sample size because of recruitment difficulties. Seventy
infants were recruited from 11 centers, 35 in each group: 59
survived to 2 years of age, and 58 (98%) were assessed at follow-up,
but data for cerebral palsy were available for only 56 survivors.
There was little evidence for a difference in the major end
point, the rate of the combined outcome of death, or major disability
at 2 years of age (dexamethasone group: 46%; controls: 43%).
Rates of mortality before follow-up (11% vs 20%), major disability
(41% vs 31%), cerebral palsy (14% vs 22%), or of the combined
outcomes of death or cerebral palsy (23% vs 37%) were not
substantially different between the groups. There were no obvious
effects of low-dose dexamethasone on growth or readmissions to
hospital after discharge.
CONCLUSIONS. Although this trial was not able to
provide definitive evidence on the long-term effects of low-dose
dexamethasone after the first week of life in chronically
ventilator-dependent infants, our data indicate no strong
association with long-term morbidity.
Abstract 13 of 16
Quantification of Deep Gray Matter in Preterm
Infants at Term-Equivalent Age Using Manual Volumetry of 3-Tesla Magnetic
Resonance Images
Latha Srinivasan, et
als . Department of Pediatrics,
Hammersmith Hospital, London, United Kingdom
OBJECTIVE. Nonhypothesis-based MRI-analysis
techniques including deformation-based morphometry and automated
tissue segmentation have suggested that preterm infants at term-equivalent
age have reduced tissue volume in the basal ganglia and thalami,
which is most apparent among infants with supratentorial lesions.
The aim of our study was to test this hypothesis by direct measurement
of thalamic and lentiform nuclei volumes in preterm infants
at term-equivalent age and term-born controls using manual volumetry.
DESIGN/METHODS. Forty preterm infants at term-equivalent
age (median gestational age: 29.5 weeks; median birth weight: 1.3
kg) and 8 term-born controls were examined using a 3-T Philips
(Best, Netherlands) system. T1-weighted volume images and T2-weighted
fast-spin echo pseudovolumes were acquired. There was no significant
difference in postmenstrual age at image acquisition between
the 2 groups. ImageJ 1.34 (National Institutes of Health, Bethesda,
MD) was used for manual segmentations.
RESULTS. The median thalamic and lentiform nuclei
volumes for preterm infants at term-equivalent age were 13.6 and
3.07 cm3, respectively, significantly smaller than
term-control volumes of 16.3 and 5.6 cm3, respectively.
Ten preterm infants at term-equivalent age had supratentorial
lesions (intraventricular hemorrhage, periventricular
leukomalacia, or hemorrhagic parenchymal infarction), and the
median thalamic and lentiform volumes for this group were 10.4
and 1.7 cm3, respectively. When this group was excluded,
the remaining infants who had mild or moderate diffuse excessive
high signal intensity in the white matter on T2-weighted images
had a smaller, yet significant, volume reduction compared with
controls. Tissue volumes were not related to weight and gestational
age at birth.
CONCLUSIONS. Manual volumetry confirms that preterm
infants at term-equivalent age have reduced thalamic and
lentiform volumes compared with controls. This was most marked
among infants with supratentorial lesions but was also seen among
those with nonfocal white matter abnormalities.
Abstract 14 of 16
Antifungal Therapy in Children With Invasive
Fungal Infections: A Systematic Review
Christopher C. Blyth, et als
Department of Immunology and
Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales,
Australia
Invasive fungal infections are associated with
significant morbidity and mortality. Differences between children
and adults are reported, yet few trials of antifungal agents have
been performed in pediatric populations. We performed a
systematic review of the literature to guide appropriate
pediatric treatment recommendations. From available trials that
compared antifungal agents in either prolonged febrile
neutropenia or invasive candidal or Aspergillus infection,
no clear difference in treatment efficacy was demonstrated,
although few trials were adequately powered. Differing antifungal
pharmacokinetics between children and adults were demonstrated,
requiring dose modification. Significant differences in toxicity,
particularly nephrotoxicity, were identified between classes of
antifungal agents. Therapy needs to be guided by the pathogen or
suspected pathogens, the degree of immunosuppression, comorbidities
(particularly renal dysfunction), concurrent nephrotoxins, and
the expected length of therapy.
Abstract 15 of 16
Executive Summary of the Workshop on Oxygen
in Neonatal Therapies: Controversies and Opportunities for Research
Rosemary D. Higgins, MDa,
Eduardo Bancalari, MDb, Marian Willinger, PhDa
and Tonse N.K. Raju, MDa
a Pregnancy and Perinatology Branch,
Center for Developmental Biology and Perinatal Medicine, National Institute
of Child Health and Human Development, National Institutes of Health,
Bethesda, Maryland
b Department of Pediatrics, University of Miami College of
Medicine, Miami, Florida
One of the most complex areas in perinatal/neonatal
medicine is the use of oxygen in neonatal therapies. To address
the knowledge gaps that preclude optimal, evidence-based care in
this critical field of perinatal medicine, the National Institute
of Child Health and Human Development organized a workshop,
Oxygen in Neonatal Therapies: Controversies and Opportunities for
Research, in August 2005. The information presented at the
workshop included basic and translational oxygen research; a
review of completed, ongoing, and planned clinical trials; oxygen
administration for neonatal resuscitation; and a review of the
collaborative home infant monitoring evaluation study. This
article provides a summary of the discussions, focusing on major
knowledge gaps, with prioritized suggestions for studies in this
area.
Abstract 16 of 16
Family-Centered Bedside Rounds: A New
Approach to Patient Care and Teaching
Stephen E. Muething, et als
Department of General and Community
Pediatrics , Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
ABSTRACT
The importance of patient-centered care and the
role of families in decision-making are becoming more recognized.
Starting with a single acute care unit, a multidisciplinary
improvement team at Cincinnati Children's Hospital developed and
implemented a new process that allows families to decide if they
want to be part of attending-physician rounds. Family involvement
seems to improve communication, shares decision-making, and
offers new learning for residents and students. Despite initial
concerns of staff members, family-centered rounds has been widely
accepted and spread throughout the institution. Here we report
our experiences as a potential model to improve family-centered
care and teaching.