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Knell J.,Brigham and Womens Hospital | Koning J.L.,University of California at San Diego | Grabowski J.E.,Ann and Robert Lurie Childrens Hospital of Chicago
Pediatric Surgery International | Year: 2016

Purpose: Breast masses in children and adolescents are uncommon and the vast majority are benign. There are currently limited analyses of breast masses in this population and clinical management is highly variable between institutions and providers. The purpose of our study is to analyze the demographics, pathology and management of 119 pediatric patients with breast masses; one of the largest studies to date. Methods: We performed a retrospective review of patients who underwent excision of a breast mass at a single pediatric center from June 2009 to November 2013. Demographics, imaging, pathology and management were reviewed. Results: Average patient age was 15.3 years, average mass size was 3.15 cm and 20.3 % had a family history of breast cancer. 68 % of patients had pre-operative ultrasound, and 31.9 % underwent a period of observation. The most common indication for resection was patient and family anxiety. All masses were benign, with fibroadenoma being the most common histopathology (75.2 %). Conclusions: In our cohort there were no cases of malignancy. Only 31.9 % of patients underwent some form of observation and patient or family anxiety was the most common indication for proceeding with surgery. This suggests that patient anxiety may result in unnecessary operation. Our data may help reassure patients, families and providers that the risk of malignancy is low and could help develop more optimal management strategies. © 2015, Springer-Verlag Berlin Heidelberg.

Coelingh K.,MedImmune | Olajide I.R.,Astrazeneca | MacDonald P.,MedImmune | Yogev R.,Ann and Robert Lurie Childrens Hospital of Chicago
Expert Review of Vaccines | Year: 2015

Evidence of high efficacy of live attenuated influenza vaccine (LAIV) from randomized controlled trials is strong for children 2-6 years of age, but fewer data exist for older school-age children. We reviewed the published data on efficacy and effectiveness of LAIV in children ≥5 years. QUOSA (Elsevier database) was searched for articles published from January 1990 to June 2014 that included FluMist, LAIV, CAIV, cold adapted influenza vaccine, live attenuated influenza vaccine, live attenuated cold adapted or flu mist. Studies evaluated included randomized controlled trials, effectiveness and indirect protection studies. This review demonstrates that LAIV has considerable efficacy and effectiveness in school-age children. © 2015 Informa UK, Ltd.

Trosman I.,Ann and Robert Lurie Childrens Hospital of Chicago
Pediatric Annals | Year: 2013

On a busy day at the pediatric office, child health care practitioners may see children of different ages present with symptoms such as inattentiveness, hyperactivity, aggression, behavioral problems, excessive sleepiness, difficulty waking up in the morning, learning problems, frequent awakening at night, restless sleep, morning headaches, and nocturnal enuresis. Children with these symptoms may be underweight or morbidly obese; healthy; or suffering from asthma, seasonal allergies, or other ailments. What they will likely have in common is a fairly well-known and yet under-recognized condition - obstructive sleep apnea syndrome (OSA). The American Academy of Pediatrics first published "Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome" in 2002. However, with the increase in obstructive sleep apnea syndrome research, they revised these guidelines in 2012. These new guidelines evaluate obstructive sleep apnea syndrome diagnostic techniques, describe available treatment options, and provide follow-up recommendations. This article explores those revisions.

Pritchett C.V.,Ann and Robert Lurie Childrens Hospital of Chicago | Pritchett C.V.,Northwestern University | Rietz M.F.,Presbyterian Medical Services | Ray A.,University of Michigan | And 2 more authors.
JAMA Otolaryngology - Head and Neck Surgery | Year: 2016

IMPORTANCE Tracheostomy is a critical and often life-saving intervention, but associated risks are not negligible. The vulnerability of the pediatric population underlies the importance of caregiver comfort and competence in tracheostomy care. OBJECTIVE To assess inpatient nursing staff and parental perspectives in managing tracheostomy care. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of survey data from (1) a volunteer sample of inpatient nurses in a tertiary care, freestanding pediatric hospital in the Midwest, assigned to clinical wards that provide care for children with tracheostomy tubes and (2) a consecutive sample of families whose child underwent tracheostomy tube placement at the same institution between March 1 and December 31, 2013. MAIN OUTCOMES AND MEASURES Nurse and parental comfort in managing acute and established tracheostomy tubes. Nursing data were analyzed with attention to years' experience and primary unit of practice. RESULTS Respondents included 129 of 820 nurses (16%response rate) and family members of 19 of 38 children (50% response rate). When queried about changing established tracheostomies, 59 of 128 nurses (46%) reported being' totally comfortable, including 46 of 82 intensive care unit (ICU) nurses (56%) vs 13 of 46 floor nurses (28%) (P = .002) and 48 of 80 nurses with at least 5 years' experience (60%) vs 12 of 49 less experienced nurses (24%) (P < .001). For managing accidental decannulation of a fresh tracheostomy, 61 nurses (47%) described being completely uncomfortable, including 27 of 83 ICU nurses (33%) vs 34 of 46 floor nurses (73%) (P = .006), and 33 of 80 nurses with at least 5 years' experience (41% ) vs 28 of 49 less experienced nurses (57%) (P = .03). Most families felt prepared for discharge (16 of 17 [94%]) and found the health care team accessible (16 of 17 [94%]), although only 5 of 18 families (28%) indicated that tracheostomy teaching was consistent. CONCLUSIONS AND RELEVANCE Nurses' comfort with tracheostomy was higher among nurses with at least 5 years' experience and primary ICU location. Whereas parental comfort with tracheostomy care was high, lack of consistent instruction highlights the role for standardized education in tracheostomy care. Copyright 2016 American Medical Association. All rights reserved.

Puligandla P.S.,McGill University | Grabowski J.,Ann and Robert Lurie Childrens Hospital of Chicago | Austin M.,University of Houston | Hedrick H.,Childrens Hospital of Philadelphia | And 11 more authors.
Journal of Pediatric Surgery | Year: 2015

Objective Variable management practices complicate the identification of optimal strategies for infants with congenital diaphragmatic hernia (CDH). This review critically appraises the available evidence to provide recommendations. Methods Six questions regarding CDH management were generated. English language articles published between 1980 and 2014 were compiled after searching Medline, Cochrane, Embase and Web of Science. Given the paucity of literature on the subject, all studies irrespective of their rank in the levels of evidence hierarchy were included. Results Gentle ventilation with permissive hypercapnia provides the best outcomes. Initial high frequency ventilation may be considered but its overall efficacy is unproven. Routine inhaled nitric oxide (iNO) or other medical adjuncts for acute, severe pulmonary hypertension demonstrate no benefit. Evidence does not support routine administration of pre- or postnatal glucocorticoids. Mode of extracorporeal membrane oxygenation (ECMO) has little bearing on outcomes. While the overall timing of repair does not impact outcomes, early repair on ECMO has benefits. Open repair leads to significantly fewer recurrences. Polytetrafluoroethylene (PTFE) is the most durable patch repair material. Conclusions Limited high-level evidence prevents the development of robust management guidelines for CDH. Prospective, multi-institutional studies are needed to identify best practices and optimize outcomes. © 2015 Elsevier Inc. All rights reserved.

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