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Arvedson J.C.,Childrens Hospital of Wisconsin
European Journal of Clinical Nutrition | Year: 2013

Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions. © 2013 Macmillan Publishers Limited All rights reserved.

Hahr J.Y.,Childrens Hospital of Wisconsin
Medical Hypotheses | Year: 2013

Autism as we know it, is caused iatrogenically and occurs reportedly one in 88 live birth [3]. Now national survey pegs autism prevalence one in 50 school-age children and the incidence is rising much fast in recent years. The author is hypothesizing idiopathic autism is caused by feeding of infant formula. Majorities of formula in the world are milk based and the molecular weight of the cow's milk is much higher than that of human breast milk. These increased solutes contributes to increased osmolality of the environment of the newborn infant, is directly affecting hemodynamics of normal homeostasis of the developing human brain cells. Formula makers fortified new substances in the process of formula making whenever they found previous unknown substances in the breast milk, for past several decades. When those solid substances were added in the process of formula making to make 20. cal/oz of infant formula, this resulted displacing free water in the formula. When new substances were added, same amount of free water has to be displaced from the formula. That is why we are seeing more autism in recent years, compared to previous several decades. © 2013 Elsevier Ltd.

Strasburger J.F.,Childrens Hospital of Wisconsin | Wakai R.T.,University of Wisconsin - Madison
Nature Reviews Cardiology | Year: 2010

The human fetal heart develops arrhythmias and conduction disturbances in response to ischemia, inflammation, electrolyte disturbances, altered load states, structural defects, inherited genetic conditions, and many other causes. Yet sinus rhythm is present without altered rate or rhythm in some of the most serious electrophysiological diseases, which makes detection of diseases of the fetal conduction system challenging in the absence of magnetocardiographic or electrocardiographic recording techniques. Life-threatening changes in QRS or QT intervals can be completely unrecognized if heart rate is the only feature to be altered. For many fetal arrhythmias, echocardiography alone can assess important clinical parameters for diagnosis. Appropriate treatment of the fetus requires awareness of arrhythmia characteristics, mechanisms, and potential associations. Criteria to define fetal bradycardia specific to gestational age are now available and may allow detection of ion channelopathies, which are associated with fetal and neonatal bradycardia. Ectopic beats, once thought to be entirely benign, are now recognized to have important pathologic associations. Fetal tachyarrhythmias can now be defined precisely for mechanism-specific therapy and for subsequent monitoring of response. This article reviews the current and future diagnostic techniques and pharmacologic treatments for fetal arrhythmia. © 2010 Macmillan Publishers Limited. All rights reserved.

Oldham K.T.,Childrens Hospital of Wisconsin
Journal of the American College of Surgeons | Year: 2014

In summary, the Task Force does understand that change is difficult and, in the circumstance of the US health care environment, quite complex. Having acknowledged this, the Task Force firmly believes that if optimal resource standards are clear, providers will act in the best interests of their patients, infants, and children undergoing surgery in this circumstance. We intend to provide evidence to this point, to define optimal resources, and to facilitate this process. The hope and the underlying intent of these recommendations is to insure that every infant and child undergoing a surgical procedure in the United States will receive his or her care in an environment that offers all of the facilities, equipment, and, most especially, access to the professional providers who have the appropriate background and training to provide optimal care. This mustbe done while balancing the issues of access, staff, and the need to improve the value proposition. The Task Force is unanimous in its intent to advocate for this agenda.

Loomba R.S.,Childrens Hospital of Wisconsin
Annals of Pediatric Cardiology | Year: 2016

Arterial desaturation may occur after the Kawashima procedure and, in the absence of venovenous collaterals is usually due to pulmonary arteriovenous malformations. Stenting of the pulmonary arteries, oxygen therapy, and pulmonary vasodilators such as sildenafil have not been able to resolve the arterial desaturation and the only way to do this has been Fontan completion. The time course of the formation of these malformations after the Kawashima and the progression of cyanosis and its resolution after the Fontan has only been demonstrated in case reports and small case series. We pool the available data to model arterial saturations in patients with pulmonary arteriovenous malformations after the Kawashima procedure. © 2016 Annals of Pediatric Cardiology | Published by Wolters Kluwer - Medknow.

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