Royal Oak, MI, United States
Royal Oak, MI, United States

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PubMed | Baylor University, Children's Medical Center Dallas and Beaumont Childrens Hospital
Type: Comparative Study | Journal: Journal of pediatric surgery | Year: 2016

Button gastrostomy is the preferred feeding device in children and can be placed open or laparoscopically (LBG). Alternatively, a percutaneous endoscopic gastrostomy (PEG) can be placed initially and exchanged for a button. Endoscopic-assisted button gastrostomy (EBG) combines both techniques, using only one incision and suturing the stomach to the abdominal wall. The long-term outcomes and potential costs for EBG were compared to other techniques.Children undergoing EBG, LBG, and PEG (2010-2013) were compared. Patient demographics, procedure duration/complications, and clinic and emergency room (ER) visits for an eight-week follow-up period were compared.Patient demographics were similar (32 patients/group). Mean procedure time (min) for EBG was 38 9, compared to 58 20 for LBG and 31 10 for PEG (p<0.0001). The most common complications were granulation tissue and infection with a trend toward fewer infections in EBG group. Average number of ER visits was similar, but PEG group had fewer clinic visits. 97% of PEG patients had subsequent visits for exchange to button gastrostomy.EBG is safe and comparable to LBG and PEG in terms of complications. It has a shorter procedure time than LBG and does not require laparoscopy, device exchange, or subsequent fluoroscopic confirmation, potentially reducing costs.

Doherty A.N.,Beaumont Childrens Hospital | Kring E.A.,Beaumont Childrens Hospital | Posey Y.F.,Oakland University | Maisels M.J.,Beaumont Childrens Hospital
Journal of Pediatrics | Year: 2014

Objective To define normal levels of glucose-6-phosphate dehydrogenase (G6PD) activity in a population of North American white newborns. Study design We studied 2 white newborn populations, 35 weeks of gestation. In the retrospective study, G6PD activity was measured (on clinical indication) in 242 newborns aged ≤7 days. In the prospective study, we measured G6PD activity in umbilical cord blood samples in 347 newborns and daily transcutaneous bilirubin levels in these infants. Results The mean G6PD activity level was 12.3 ;plusmn 3.1 units per gram hemoglobin (U/gHb) in the retrospective population and 13.3 ;plusmn 1.8 U/gHb in the prospective population, and there was no difference between males and females. The distribution of values suggested that infants with activity levels <7 U/gHb should be considered deficient and 8 infants (6 males and 2 females), all in the retrospective population had such levels. Conclusions As in other ethnic populations, the mean G6PD activity in white newborn infants is substantially greater than that of white adults. The lower limits of normal are also similar to those of other newborn ethnic groups and of adults. The diagnosis of G6PD deficiency should be considered in any white infant whose G6PD activity is <7 U/gHb. © 2014 Elsevier Inc. All rights reserved.

Delaroche A.,Beaumont Childrens Hospital | Riggs T.,Beaumont Hospital Research Institute | Maisels M.J.,Beaumont Childrens Hospital | Maisels M.J.,Oakland University
Clinical Pediatrics | Year: 2014

Objective. To assess the impact of the 16-duty hour restriction on pediatric interns' neonatal education. Method. Survey of interns clinical and educational experiences during their neonatal rotations. Results. A total of 316 respondents in 2011, who worked >16 hours, were compared with 509 respondents in 2012, who worked ≤16 hours. The average work week decreased from 67.3 ± 9.6 to 59.3 ± 8.1 hours (P <.0001). The 2012 cohort attended fewer didactic lectures (-16%, P <.0001), grand rounds (-27%, P <.0001), and mock resuscitations (-16%, P <.005). There were no significant differences in the number of (1) patients on service, (2) deliveries attended, or (3) procedures. There was no significant difference in the median number of correct responses (4) on 10 knowledge-based multiple-choice questions. Conclusions. The decrease in duty hours was achieved without significantly affecting interns' knowledge or clinical experience. © The Author(s) 2013.

PubMed | Beaumont Childrens Hospital and Oakland University
Type: | Journal: Clinical pediatrics | Year: 2016

To document the intake of exclusively formula-fed newborns during the first 2 days of life. We enrolled a cohort of 50 healthy newborns 37 weeks gestation and documented their daily formula intake until discharge. We surveyed pediatricians regarding their assessment of the intake of formula fed infants. In all, 37 of 50 newborns stayed for at least 48 hours. The mean SD gestational age was 39.5 0.88 weeks. Mean SD formula intake for the first 48 hours (n = 37) was 57.2 20.4 mL/kg/d and mean weight loss at 45.7 8.8 hours, was 2.7% of birth weight. Pediatricians underestimated the amounts taken by these infants. In the first 2 days, healthy term newborns, fed formula ad lib, consume about 115 mL/kg, about 2 to 3 times as much as breastfed infants, and they lose only 2.7% of their birthweight by 48 hours. Most pediatricians underestimate the intake of formula-fed infants.

Lee W.,William Beaumont Hospital | Riggs T.,Beaumont Childrens Hospital | Riggs T.,Beaumont Research Institute | Amula V.,Beaumont Childrens Hospital | And 4 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2010

Objectives: The main goal was to develop new z-score reference ranges for common fetal echocardiographic measurements from a large referral population. Methods: A retrospective cross-sectional study of 2735 fetuses was performed for standard biometry (biparietal diameter (BPD) and femoral diaphysis length (FDL)) and an assessment of menstrual age (MA). Standardized fetal echocardiographic measurements included aortic valve annulus and pulmonary valve annulus diameters at endsystole, right and left ventricular diameters at end-diastole, and cardiac circumference from a four-chamber view of the heart during end-diastole. Normal z-score ranges were developed for these echocardiographic measurements using MA, BPD and FDL as independent variables. This was accomplished by using first standard regression analysis and then weighted regression of absolute residual values for each parameter in order to adjust for inconstant variance. Results: A simple, linear regression model was the best description of the data in each case and correlations between fetal cardiac measurements and the independent variables were excellent. There was significant heteroscedasticity of standard deviation with increasing gestational age, which also could be modeled with simple linear regression. After this adjustment, the residuals conformed to a normal distribution, validating the calculation and interpretation of z-scores. Conclusion: Development of reliable z-scores is possible for common fetal echocardiographic parameters by applying statistical methods that are based on a large sample size and weighted regression of absolute residuals in order to minimize the effect of heteroscedasticity. These normative ranges should be especially useful for the detection and monitoring of suspected fetal cardiac size and growth abnormalities. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

PubMed | University of Michigan, Baylor College of Medicine, Indiana University, Stanford University and 8 more.
Type: Journal Article | Journal: The Journal of adolescent health : official publication of the Society for Adolescent Medicine | Year: 2015

Psychopharmacologic medications are often prescribed to patients with restrictive eating disorders (EDs), and little is known about the frequency of use in adolescents. We examined the use of psychopharmacologic medications in adolescents referred for treatment of restrictive ED, potential factors associated with their use, and reported psychiatric comorbidities.Retrospective data from the initial and 1-year visits were collected for patients referred for evaluation of restrictive ED at 12 adolescent-based ED programs during 2010 (Group 1), including diagnosis, demographic information, body mass index, prior treatment modalities, and psychopharmacologic medications. Additional data regarding patients comorbid psychiatric conditions and classes of psychopharmacologic medications were obtained from six sites (Group 2).Overall, 635 patients met inclusion criteria and 359 had 1-year follow-up (Group 1). At intake, 20.4% of Group 1 was taking psychopharmacologic medication and 58.7% at 1year (p.0001). White, non-Hispanic race (p= .020), and prior higher level of care (p < .0001) were positively associated with medication use at 1 year. Among Group 2 (n= 256), serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors use was most common, and 62.6% had a reported psychiatric comorbidity. Presence of any psychiatric comorbidity was highly associated with medication use; odds ratio, 10.0 (5.6, 18.0).Adolescents with restrictive ED treated at referral centers have high rates of reported psychopharmacologic medication use and psychiatric comorbidity. As more than half of this referral population were reported to be taking medication, continued investigation is warranted to ensure the desired outcomes of the medications are being met.

Bennett J.T.,University of Washington | Vasta V.,University of Washington | Zhang M.,University of Washington | Narayanan J.,University of Washington | And 2 more authors.
Molecular Genetics and Metabolism | Year: 2015

Genetic sequencing has become a critical part of the diagnosis of certain forms of pancreatic beta cell dysfunction. Despite great advances in the speed and cost of DNA sequencing, determining the pathogenicity of variants remains a challenge, and requires sharing of sequence and phenotypic data between laboratories. We reviewed all diabetes and hyperinsulinism-associated molecular testing done at the Seattle Children's Molecular Genetics Laboratory from 2009 to 2013. 331 probands were referred to us for molecular genetic sequencing for Neonatal Diabetes (NDM), Maturity-Onset Diabetes of the Young (MODY), or Congenital Hyperinsulinism (CHI) during this period. Reportable variants were identified in 115 (35%) patients with 91 variants in one of 6 genes: HNF1A, GCK, HNF4A, ABCC8, KCNJ11, or INS. In addition to identifying 23 novel variants, we identified unusual mechanisms of inheritance, including mosaic and digenic MODY presentations. Re-analysis of all reported variants using more recently available databases led to a change in variant interpretation from the original report in 30% of cases. These results represent a resource for molecular testing of monogenic forms of diabetes and hyperinsulinism, providing a mutation spectrum for these disorders in a large North American cohort. In addition, they highlight the importance of periodic review of molecular testing results. © 2014 Elsevier Inc.

Gunnarsson G.L.,Telemark Hospital | Jackson I.T.,Beaumont Childrens Hospital | Thomsen J.B.,University of Southern Denmark
European Journal of Plastic Surgery | Year: 2014

Background: Perforators are a constant anatomical finding in the facial area and any known flap can in theory be based on the first perforator located at the flap rotation axis. Methods: A case series of single stage reconstruction of moderate sized facial defects using 21 perforator based local flaps in 19 patients from 2008-2013. Results: A sufficient perforator was located in every case and the flap rotated along its axis (76 %) or advanced (24 %). Reconstruction was successfully achieved with a high self reported patient satisfaction. Two minor complications occurred early on in the series and corrective procedures were performed in four patients. Conclusions: The random facial perforator flap seems to be a good and reliable option for the reconstruction of facial subunits, especially the periorbital, nasal and periocular area with a minimal morbidity and a pleasing result in a one stage outpatient setting. Level of Evidence: Level IV, therapeutic study © 2014 Springer-Verlag.

Riggs T.,Beaumont Childrens Hospital | Riggs T.,Beaumont Hospital | Saini A.P.,Beaumont Childrens Hospital | Comstock C.H.,Beaumont Hospital | Lee W.,Beaumont Hospital
Ultrasound in Obstetrics and Gynecology | Year: 2011

Objective To determine the best screening tests for discriminating early indicators of cardiac hypoplasia in congenital heart disease (CHD) from normal variations in fetal cardiac growth. Methods We retrospectively examined fetal echocardiograms from 90 infants with confirmed CHD: Group 1 (n = 35) with right-sided obstructive lesions and Group 2 (n = 55) with left-sided obstructive lesions. Our control group comprised 2735 normal fetuses, from which we determined fetal cardiac Z-scores of right ventricle (RV), left ventricle (LV), aorta (Ao) and pulmonary artery (PA) diameters and ratios of right to left ventricle (RV:LV) and pulmonary artery to aorta (PA:Ao) size. We compared our control group to Groups 1 and 2 using ANOVA and area under receiver-operating characteristics curve (AUC) analysis. Results For Group 1, RV:LV ratio, RV-Z-score and PA:Ao ratio were the best screening tests, with highest AUCs (0.879, 0.868 and 0.832, respectively). For Group 2, the Ao-Z-score, PA:Ao and RV:LV ratios were the best screening tests, with AUCs of 0.770, 0.723 and 0.716, respectively. Conclusion None of the screening tests was found to be a perfect early discriminator for the cardiac lesions tested. Although ratios of PA:Ao and RV:LV are useful, they should be combined with fetal cardiac Z-scores to maximize screening sensitivity. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Dekelbab B.H.,St John Hospital | Dekelbab B.H.,Beaumont Childrens Hospital | Abou Ouf H.A.,St John Hospital | Jain I.,Beaumont Childrens Hospital
Endocrine Practice | Year: 2010

Objective: To determine the prevalence of elevated thyroid-stimulating hormone (TSH) levels in obese children and adolescents referred to pediatric endocrinology clinics. Methods: We undertook a retrospective review of medical records of 191 obese and 125 nonobese children (younger than 18 years old). Data about age, sex, body mass index, TSH, thyroid functions, thyroid antibodies, thyroid size, and medications were collected. Results: Six obese patients had Hashimoto disease and TSH values from 0.73 to 12.73 mIU/L; they were excluded from the study analyses. Of the remaining 185 obese subjects, 20 (10.8%) had TSH levels >4 mIU/L, but no control subject measurement exceeded this TSH value. The highest TSH concentration in an obese study subject was 7.51 mIU/L. When obese children with TSH levels >4 mIU/L were classified in a third group, the mean TSH in the rest of the obese children was comparable with that in the control group (1.98 ± 0.84 [SD] and 1.95 ± 0.80 mIU/L, respectively; post hoc analysis of variance, P = .945). Obese subjects with increased TSH values had a mean body mass index similar to that for obese subjects with normal TSH levels (34.98 ± 6.12 [SD] and 34.29 ± 7.84 kg/m2, respectively). Conclusion: Mild elevation of TSH values in the absence of autoimmune thyroid disease is not uncommon in some obese children and adolescents. This is the second study in the United States to report this observation. Our study did not identify any special characteristics of obese subjects with TSH elevation in comparison with obese children with normal TSH levels and the control group. Current medical knowledge does not support routine screening for thyroid dysfunction in obese children. © 2010 AACE.

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