scholarly journals A Single Institution’s Overweight Pediatric Population and Their Associated Comorbid Conditions

ISRN Obesity ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Sigrid Bairdain ◽  
Chueh Lien ◽  
Alexander P. Stoffan ◽  
Michael Troy ◽  
Donald C. Simonson ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Pediatric Population ◽  
Treatment Options ◽  
Population Data ◽  
Morbidly Obese ◽  
Comorbid Conditions ◽  
Odds Ratios ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Rate Ratios

Background. Obesity studies are often performed on population data. We sought to examine the incidence of obesity and its associated comorbidities in a single freestanding children’s hospital. Methods. We performed a retrospective analysis of all visits to Boston Children’s Hospital from 2000 to 2012. This was conducted to determine the incidence of obesity, morbid obesity, and associated comorbidities. Each comorbidity was modeled independently. Incidence rate ratios were calculated, as well as odds ratios. Results. A retrospective review of 3,185,658 person-years in nonobese, 26,404 person-years in obese, and 25,819 person-years in the morbidly obese was conducted. Annual rates of all major comorbidities were increased in all patients, as well as in our obese and morbidly obese counterparts. Incidence rate ratios (IRR) and odds ratios (OR) were also significantly increased across all conditions for both our obese and morbidly obese patients. Conclusions. These data illustrate the substantial increases in obesity and associated comorbid conditions. Study limitations include (1) single institution data, (2) retrospective design, and (3) administrative undercoding. Future treatment options need to address these threats to longevity and quality of life.

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

2008 ◽  
Vol 18 (2) ◽  
pp. 76-86 ◽  
Author(s):  
Lauren Hofmann ◽  
Joseph Bolton ◽  
Susan Ferry
Keyword(s):  
Tracheostomy Tube ◽  
Pediatric Population ◽  
Interdisciplinary Approach ◽  
Extended Period ◽  
Speech Development ◽  
Tube Placement ◽  
Background Information ◽  
Speaking Valve ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

scholarly journals 1367. Reduced Ceftaroline Susceptibility Among Invasive MRSA Isolates at a Tertiary Children’s HospitalReduced Ceftaroline Susceptibility Among Invasive MRSA Isolates at a Tertiary Children’s Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S693-S694
Author(s):  
Lauren Sommer ◽  
Jesus G Vallejo ◽  
Kristina G Hulten ◽  
Sheldon L Kaplan ◽  
Jonathon C McNeil
Keyword(s):  
Pediatric Population ◽  
Staphylococcal Infection ◽  
Healthcare Associated Infections ◽  
Accessory Gene ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Mrsa Infection ◽  
Group Ii ◽  
Healthcare Associated ◽  
Research Grant

Abstract Background The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in the late 1990s-early 2000s complicated the empiric management of suspected staphylococcal infection in children. Rising clindamycin resistance rates in many communities adds further to management challenges. Ceftaroline, an anti-MRSA cephalosporin, represents an attractive therapy option. Little data are available, however, regarding the frequency of reduced susceptibility (RS) to ceftaroline among MRSA isolates from a general pediatric population. Methods Isolates were selected from an ongoing S. aureus surveillance study at Texas Children’s Hospital. Invasive MRSA isolates from 2015-2018 were included. Isolates were initially screened for ceftaroline RS with E-test; all isolates with a ceftaroline E-test MIC ≥ 1.5µg/ml underwent ceftaroline broth dilution. Ceftaroline RS was regarded as an MIC ≥ 2 µg/ml; full ceftaroline resistance was defined as an MIC ≥ 8 μg/ml. Accessory gene regulator (agr) groups were characterized by PCR. Results 201 viable isolates were included. The ceftaroline MIC50 and MIC90 were 0.5 and 1 µg/ml, respectively (Figure 1). Six isolates had MIC ≥ 2 µg/ml (2.9%) with two having MIC ≥ 8 µg/ml (0.9%). All ceftaroline RS isolates were from healthcare associated infections. Ceftaroline RS isolates were more often associated with clindamycin-resistance and agr group II (Figure 2). Infections with ceftaroline RS were associated with central venous lines, recent ICU admission, preceding antibiotic exposure (specifically cephalosporins) and prior MRSA infection. One subject with MRSA CLABSI had a ceftaroline susceptible MRSA infection followed < 1 month later by a ceftaroline resistant infection (MIC =32 μg/ml); the isolates were identical by PFGE. Only 3 subjects had previously received ceftaroline, none of which subsequently developed a ceftaroline RS isolate. Figure 1. Ceftaroline MIC Distribution Figure 2. Clinical And Microbiologic Associations with Reduced Ceftaroline Susceptibility Conclusion Ceftaroline RS occurs in 2.9% of invasive MRSA isolates in children and is most prominent among healthcare-associated infections. These isolates were associated with clindamycin resistance and agr group II. While ceftaroline RS is rare among invasive MRSA infections, the lack of preceding ceftaroline exposure is concerning and warrants careful surveillance. Disclosures Sheldon L. Kaplan, MD, Allergan (Research Grant or Support)Pfizer (Grant/Research Support) Jonathon C. McNeil, MD, Allergan (Research Grant or Support, Allergan provided ceftaroline powder for use in studies described in this abstract)

Primary and Metastatic Lung Tumors in the Pediatric Population: A Review and 25-Year Experience at a Large Children's Hospital

2008 ◽  
Vol 132 (7) ◽  
pp. 1079-1103 ◽  
Author(s):  
Megan K. Dishop ◽  
Supriya Kuruvilla
Keyword(s):  
Medical Literature ◽  
Pediatric Population ◽  
Case Series ◽  
Lung Tumors ◽  
Malignant Neoplasms ◽  
Primary Tumors ◽  
Children's Hospital ◽  
Pathologic Features ◽  
Metastatic Lung ◽  
Children’S Hospital

Abstract Context.—Primary lung neoplasms are rare in children, but they comprise a broad and interesting spectrum of lesions, some of which are familiar from other tissue sites, and some of which are unique to the pediatric lung. Objective.—To determine the relative incidence of primary and metastatic lung tumors in children and adolescents through a single-institution case series, to compare these data to reports in the medical literature, to discuss the clinical and pathologic features of primary tumors of the tracheobronchial tree and lung parenchyma in children, and to provide recommendations for handling pediatric lung cysts and tumors. Data Sources.—A 25-year single institutional experience with pediatric lung tumors, based on surgical biopsies and resections at Texas Children's Hospital from June 1982 to May 2007, an additional 40 lung tumors referred in consultation, and a review of the medical literature. Conclusions.—A total of 204 pediatric lung tumors were diagnosed at our institution, including 20 primary benign lesions (9.8%), 14 primary malignant lesions (6.9%), and 170 secondary lung lesions (83.3%). The ratio of primary benign to primary malignant to secondary malignant neoplasms is 1.4:1:11.6. The common types of lung cancer in adults are exceptional occurrences in the pediatric population. The most common primary lung malignancies in children are pleuropulmonary blastoma and carcinoid tumor. Other primary pediatric lung tumors include congenital peribronchial myofibroblastic tumor and other myofibroblastic lesions, sarcomas, carcinoma, and mesothelioma. Children with primary or acquired immunodeficiency are at risk for Epstein-Barr virus–related smooth muscle tumors, lymphoma, and lymphoproliferative disorders. Metastatic lung tumors are relatively common in children and also comprise a spectrum of neoplasia distinct from the adult population.

scholarly journals Do Case-Control Studies Always Estimate Odds Ratios?

2020 ◽  
Author(s):  
Jeremy A Labrecque ◽  
Myriam M G Hunink ◽  
M Arfan Ikram ◽  
M Kamran Ikram
Keyword(s):  
Incidence Rate ◽  
Case Control Study ◽  
Case Control ◽  
Small Sample ◽  
Incidence Density ◽  
Odds Ratios ◽  
Case Control Studies ◽  
Rate Ratios ◽  
Study Designs ◽  
Control Study

Abstract Case-control studies are an important part of the epidemiologic literature, yet confusion remains about how to interpret estimates from different case-control study designs. We demonstrate that not all case-control study designs estimate odds ratios. On the contrary, case-control studies in the literature often report odds ratios as their main parameter even when using designs that do not estimate odds ratios. Only studies using specific case-control designs should report odds ratios, whereas the case-cohort and incidence-density sampled case-control studies must report risk ratio and incidence rate ratios, respectively. This also applies to case-control studies conducted in open cohorts, which often estimate incidence rate ratios. We also demonstrate the misinterpretation of case-control study estimates in a small sample of highly cited case-control studies in general epidemiologic and medical journals. We therefore suggest that greater care be taken when considering which parameter is to be reported from a case-control study.

scholarly journals Mucin 4: A Sensitive Diagnostic Marker for Pediatric Mucoepidermoid CarcinomaNick Shillingford

2020 ◽  
pp. 1-12
Author(s):  
Mackenzie Postel M S ◽  
◽  
Julia T Chu ◽  
Henry H Tran ◽  
Shamlal Mangray ◽  
...  
Keyword(s):  
Los Angeles ◽  
Rhode Island ◽  
Predictive Value ◽  
Pediatric Population ◽  
Children's Hospital ◽  
Morphological Heterogeneity ◽  
Muc4 Expression ◽  
Children’S Hospital ◽  
Expression Score ◽  
Sensitive Marker

Background: Pediatric salivary gland-type neoplasms (SGTNs) pose a significant diagnostic problem due to histo-morphological heterogeneity. Previous reports have shown that Mucin 4 (MUC4) expression is associated with adult mucoepidermoid carcinoma (MEC). We hypothesize that MUC4 is also a sensitive marker for distinguishing MEC from other SGTNs in the pediatric population. Objective: To evaluate MUC4 expression in pediatric SGTNs. Methods: A retrospective review of 74 SGTNs diagnosed between 1993–2015 at Children’s Hospital Los Angeles, Boston Children’s Hospital, and Rhode Island Hospital was performed. H&E sections of 31 MECs were compared to 3 adenoid cystic carcinomas (AdCCs), 6 acinic cell carcinomas (AcCCs), 30 pleomorphic adenomas (PAs), 3 mammary analogue secretory carcinomas (MASCs), and one sialoblastoma (SB). Samples underwent immunohistochemical staining for MUC4, with expression score criteria: 0% positivity = 0, 1-10% = +, 11-50% = ++, 51-90% = +++, >90% = ++++. Results: All MECs were MUC4-positive, with 25 (80.65%) having an expression score ≥ +++. AdCCs and PAs demonstrated no to minimal MUC4-positivity. Subsets of AcCCs and MASCs were unexpectedly MUC4-positive. As a novel marker for pediatric MEC, MUC4’s sensitivity = 100%, specificity = 79.41%, positive predictive value = 75.86%, and negative predictive value = 100%. Conclusion: MUC4 is a sensitive marker for pediatric MEC

scholarly journals Changes in the prevalence of index diseases in pediatric surgery: case analysis of single national children’s hospital

2021 ◽  
Vol 64 (3) ◽  
pp. 232-238
Author(s):  
Soo-Hong Kim ◽  
Yong-Hoon Cho ◽  
Hae Young Kim
Keyword(s):  
Acute Appendicitis ◽  
Pediatric Surgery ◽  
Pediatric Population ◽  
Hypertrophic Pyloric Stenosis ◽  
Relative Number ◽  
Emergency Operation ◽  
Absolute Number ◽  
Live Births ◽  
Children's Hospital ◽  
Children’S Hospital

Pusan National University Children’s Hospital (PNUCH) opened in November 2008 as the second National Children’s Hospital in Korea and celebrated its 10th anniversary in 2018. In the last decade, birth rates and pediatric populations have been declining sharply and has been more serious in Busan, Ulsan, and Gyeongsangnam-do where the PNUCH is located, affecting the prevalence of index diseases. The number of the index diseases was investigated by year according to changes in the population. Patients who underwent surgery at PNUCH for 10 years were included. Changes in pediatric population and the number of live births were analyzed using the data from Statistics Korea. The number of the index diseases was analyzed retrospectively through the review of electronic medical records. Statistical analysis was performed through Poisson regression. The number of live births and pediatric population decreased from 69,528 to 48,600 (30.1%) and 1,880,284 to 1,444,961 (23.2%), respectively. Operations of pediatric surgery decreased by 32.3% compared to that during the peak season, but the prevalence rate ratio of the pediatric population increased to 1.03 (<i>P</i><0.001). The number of emergency operation increased due to the largest surge in acute appendicitis operations. Both esophageal atresia and Hirschsprung disease decreased, while hypertrophic pyloric stenosis significantly increased. The absolute number of pediatric surgery cases decreased. However, considering the changes in pediatric population and the number of live births, the relative number of pediatric surgery cases does not changed. The decrease in the number of each disease would be related to the decrease in pediatric population and the number of live births. We should consider the increase of emergency operations such as acute appendicitis.

scholarly journals Use of the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) in X-Linked Myotubular Myopathy: Content Validity and Psychometric Performance

2021 ◽  
Vol 8 (1) ◽  
pp. 63-77
Author(s):  
Tina Duong ◽  
Gale Harding ◽  
Sally Mannix ◽  
Cristina Abel ◽  
Dawn Phillips ◽  
...  
Keyword(s):  
Content Validity ◽  
Pediatric Population ◽  
Neuromuscular Disorders ◽  
Delphi Panel ◽  
Study Drug Administration ◽  
Psychometric Performance ◽  
Myotubular Myopathy ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Neuromuscular Functioning

X-linked myotubular myopathy (XLMTM) is a life-threatening, congenital myopathy characterized by extreme hypotonia, weakness, delayed motor milestones, and respiratory failure, often resulting in pediatric mortality. This study evaluated the content validity and psychometric performance of the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders as a measure of neuromuscular functioning in children with X-linked myotubular myopathy. This study was conducted in two phases. Phase I assessed the content validity of the measure for use in an XLMTM pediatric population through: literature review, clinical expert interviews, caregiver interviews, and a modified-Delphi panel among clinicians. Phase II assessed psychometric performance based on the INCEPTUS observational clinical study and the ASPIRO interventional gene therapy study, including tests of reliability (internal consistency, test-retest, and interrater), validity (construct and criterion), and responsiveness based on observational and interventional clinical trial data analyses. Data established construct validity and reliability of the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders among XLMTM patients before administration of resamirigene bilparvovec, and sensitivity to study drug administration as evidenced by the significant post-administration response in ASPIRO. Findings support the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders as an appropriate neuromuscular functioning assessment in a pediatric X-linked myotubular myopathy patient population.

Abstract T P367: Stable Childhood Stroke Rates Over 17 years: Report From a Population-Based Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jane C Khoury ◽  
Samrat Yeramaneni ◽  
J. Michael Taylor ◽  
Laura Lehman ◽  
Heidi Sucharew ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Case Fatality ◽  
Population Based ◽  
Childhood Stroke ◽  
Stroke Incidence ◽  
Study Region ◽  
Entire Study ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Over Time

Background: We have published rates of childhood stroke using our population-based Greater Cincinnati Northern Kentucky Stroke Study for 1993/4 and 1999. We now report population-based rates from additional study periods of 2005 and 2010, and compare rates over time periods. Methods: We identified all strokes in the Greater Cincinnati/Northern Kentucky (GCNK) region, a biracial population of 1.3 million, during 7/1/93 to 6/30/94 and calendar years 1999, 2005 and 2010. Stroke cases (both hemorrhagic and ischemic) were ascertained by screening for discharge ICD-9 codes 430 - 436 at all local hospitals, 437 - 438, 674 and 747 were also screened at the Children’s Hospital. Childhood stroke is defined as stroke in those <20 years of age at the time of onset. Incidence and overall stroke rates are estimated per 100,000, age-, sex- and race-adjusted to the 2000 US population. Results: There were 14 strokes in children in 1993/4, 24 strokes in 1999, 15 strokes in 2005 and 17 strokes in 2010. Incidence rates by study period, overall, by race, sex and stroke type are reported in the table. We do not detect any significant change in the incidence rate over time. The overall (first ever or recurrent) stroke rate age-, sex- and race-adjusted to the 2000 US population under 20 years of age for the entire study period, is 4.4/100,000 (95% confidence interval: 3.4, 5.4),. Eleven children died within 30 days yielding an all-cause case fatality rate of 16%. Among all childhood stroke cases, 9 (13%) were identified at hospitals other than the Children’s Hospital. Conclusions: The childhood stroke incidence rate of 4.1 per 100,000, in the GCNK study region has not changed significantly over 17 years Any study of pediatric stroke incidence should include screening of non-pediatric hospitals, as we found 13% of cases in adult hospitals.

scholarly journals Trends in Pediatric Candidemia: Epidemiology, Anti-Fungal Susceptibility, and Patient Characteristics in a Children’s Hospital

2021 ◽  
Vol 7 (2) ◽  
pp. 78
Author(s):  
Anabel Piqueras ◽  
Lakshmi Ganapathi ◽  
Jane F. Carpenter ◽  
Thomas Rubio ◽  
Thomas J. Sandora ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Clinical Decision Making ◽  
Species Distributions ◽  
The United States ◽  
Morbidity And Mortality ◽  
Fungal Resistance ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Anti Fungal ◽  
Susceptibility Patterns

Candida bloodstream infections (CBSIs) have decreased among pediatric populations in the United States, but remain an important cause of morbidity and mortality. Species distributions and susceptibility patterns of CBSI isolates diverge widely between children and adults. The awareness of these patterns can inform clinical decision-making for empiric or pre-emptive therapy of children at risk for candidemia. CBSIs occurring from 2006–2016 among patients in a large children’s hospital were analyzed for age specific trends in incidence rate, risk factors for breakthrough-CBSI, and death, as well as underlying conditions. Candida species distributions and susceptibility patterns were evaluated in addition to the anti-fungal agent use. The overall incidence rate of CBSI among this complex patient population was 1.97/1000 patient-days. About half of CBSI episodes occurred in immunocompetent children and 14% in neonatal intensive care unit (NICU) patients. Anti-fungal resistance was minimal: 96.7% of isolates were fluconazole, 99% were micafungin, and all were amphotericin susceptible. Liposomal amphotericin was the most commonly prescribed anti-fungal agent included for NICU patients. Overall, CBSI-associated mortality was 13.7%; there were no deaths associated with CBSI among NICU patients after 2011. Pediatric CBSI characteristics differ substantially from those in adults. The improved management of underlying diseases and antimicrobial stewardship may further decrease morbidity and mortality from CBSI, while continuing to maintain low resistance rates among Candida isolates.

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