Inova Childrens Hospital

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Inova Childrens Hospital

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Teo W.-Y.,Inova Childrens Hospital | Myseros J.S.,Inova Childrens Hospital | Myseros J.S.,Childrens National Medical Center
Child's Nervous System | Year: 2014

Purpose: Central nervous system tumors account for the largest number of cancer deaths in childhood. Brain tumors in infants less than 3 years of age are rare; symptoms and signs are often non-specific. Patent anterior fontanelles/unfused cranial sutures in infants can accommodate rising intracranial pressure without acutely compromising the neurological status. We hypothesize that vomiting as the initial symptom, in infants with brain tumors, can possibly lead to extensive gastrointestinal evaluation, delaying the diagnosis of intracranial pathology. Methods: We conducted a retrospective chart review of infants less than 3 years of age diagnosed with brain tumors over the period of 4.7 years from February 2008 to October 2012 at Inova Children's Hospital, Virginia. Results: We identified three of 21 patients (14.3 %) who presented with vomiting and underwent initial or extensive abdominal imaging investigations. All patients were relatively young (median age, 5.4 months). Working diagnoses were pyloric stenosis, viral gastritis, or gastroesophageal reflux. All patients eventually had computed tomography of the head to rule out increased intracranial pressure and were found to have large brain tumors with obstructive hydrocephalus. Tumor locations were cerebral hemispheres (2/3) and posterior fossa (1/3). All patients had biologically aggressive high-grade tumors (glioblastoma multiforme, atypical teratoid rhabdoid tumor, and anaplastic/large cell medulloblastoma) and died within weeks of diagnosis. Conclusions: Our study highlights a clinical challenge of persistent vomiting in infants, which in the absence of convincing gastrointestinal pathology after evaluation should raise the physician's suspicion of an underlying intracranial pathology even if neurological features are absent. © 2014 Springer-Verlag.


Schwartz R.H.,Inova Childrens Hospital | Selvarangan R.,Childrens Mercy Hospitals and Clinics | Selvarangan R.,University of Missouri - Kansas City | Zissman E.N.,Altamonte Pediatric Asso.
Pediatric Emergency Care | Year: 2015

Background During respiratory syncytial virus season, many children present to pediatric offices and urgent care medical facilities with cough, tachypnea, intercostal retraction, wheezing, as well as disturbed appetite and sleep. Identification of the responsible viral pathogen is quite difficult because several pathogens can produce similar signs and symptoms. Methods Nasopharyngeal specimens were collected from symptomatic sick children younger than 6 years, in 8 geographically representative primary care pediatric practices during a 4-month RSV season. Institutional review board approval and signed parental consent were obtained. The primary objective of the study was the estimation of the sensitivity and specificity of the Becton Dickinson (BD) Veritor RSV point-of-care (POC) assay as compared with reverse transcriptase-polymerase chain reaction (RT-PCR). Results Of 523 specimens, 58.3% (n = 305) were from patients younger than 2 years. The BD Veritor RSV POC assay sensitivity and specificity are 81.6% (146/179) and 99.1% (341/344), respectively. When compared with RT-PCR, the BD Veritor RSV POC assay false positive was 0.9% (3/344, with a 95% confidence interval of 0.3%-2.5%) and the false negative was 18.4% (33/179, with a 95% confidence interval of 13.4%-24.5%). The BD Veritor RSV POC assay identified more true positive specimens (n = 146) than viral cell culture (n = 134 positive specimens). Conclusions In 8 participating primary care pediatric offices with 523 evaluable subjects, POC BD Veritor RSV tests performed better than viral cell culture results when RT-PCR was the reference standard. © Wolters Kluwer Health, Inc.


Rogo T.,Brown University | Schwartz R.H.,Inova Childrens Hospital
Ear, Nose and Throat Journal | Year: 2013

We describe the case of a 5-year-old girl with a Pott puffy tumor on her forehead. Computed tomography confirmed frontal sinusitis and an epidural abscess. This case is unusual in that the patient's age at presentation was younger than the age when the frontal sinuses are believed to develop.


Baron I.S.,Fairfax Neonatal Associates | Baron I.S.,Inova Fairfax Hospital | Weiss B.A.,George Washington University | Litman F.R.,Inova Childrens Hospital | And 2 more authors.
Neuropsychology | Year: 2014

Objective: To examine whether a one-factor executive function (EF) model fit data for three groups of children differing in birth criteria (extremely low birth weight [ELBW], late preterm [LPT], and Term) at each of two chronological ages, 3 and 6 years, and whether the latent mean amount of EF differed. Methods: A retrospective observational cohort study of 1,079 participants; 668 aged 3 years born 2000-2009 (93 ELBW, 398 LPT, and 177 Term) and 411 aged 6 years born 1998-2006 (126 ELBW, 102 LPT, and 183 Term). Latent means analysis was conducted using five indicators for EF: noun fluency, action-verb fluency, similarities reasoning, matrices reasoning, and working memory. Results: A one-factor model had acceptable fit for all groups (RMSEA<.06, CFI >0.95, SRMR <0.08). Statistically significant between-groups differences were found for all comparisons except one there were no statistically significant differences between LPT-Term at age 6. At age 3, ELBW was 0.98 and 1.70 SD below LPT and Term, respectively; LPT was 0.61 SD below Term. At age 6, ELBW was 0.70 and 0.78 SD below LPT and Term, respectively; LPT was 0.10 SD below Term. Conclusions: Executive deficit identified early in development after preterm birth could represent a transient developmental delay likely to resolve at older age or a more subtle adverse effect likely to persist over the life span. Study at multiple age points should assist in resolving this dilemma, which has important implications for early age neuropsychological screening and intervention. © 2014 American Psychological Association.


Cunningham B.K.,U.S. National Institutes of Health | Cunningham B.K.,Human Genome Research Institutes | Khromykh A.,Inova Childrens Hospital | Martinez A.F.,Human Genome Research Institutes | And 4 more authors.
Birth Defects Research Part A - Clinical and Molecular Teratology | Year: 2014

Background: VACTERL association refers to a combination of congenital anomalies that can include: vertebral anomalies, anal atresia, cardiac malformations, tracheo-esophageal fistula with esophageal atresia, renal anomalies (typically structural renal anomalies), and limb anomalies. Methods: We conducted a description of a case series to characterize renal findings in a cohort of patients with VACTERL association. Out of the overall cohort, 48 patients (with at least three component features of VACTERL and who had abdominal ultrasound performed) met criteria for analysis. Four other patients were additionally analyzed separately, with the hypothesis that subtle renal system anomalies may occur in patients who would not otherwise meet criteria for VACTERL association. Results: Thirty-three (69%) of the 48 patients had a clinical manifestation affecting the renal system. The most common renal manifestation (RM) was vesicoureteral reflux (VUR) in addition to a structural defect (present in 27%), followed by unilateral renal agenesis (24%), and then dysplastic/multicystic kidneys or duplicated collected system (18% for each). Twenty-two (88%) of the 25 patients with a structural RM had an associated anorectal malformation. Individuals with either isolated lower anatomic anomalies, or both upper and lower anatomic anomalies were not statistically more likely to have a structural renal defect than those with isolated upper anatomic anomalies (p=0.22, p=0.284, respectively). Conclusion: Given the high prevalence of isolated VUR in our cohort, we recommend a screening VCUG or other imaging modality be obtained to evaluate for VUR if initial renal ultrasound shows evidence of obstruction or renal scarring, as well as ongoing evaluation of renal health. © 2014 Wiley Periodicals, Inc.


Gerner G.,Kennedy Krieger Institute | Baron I.S.,Inova Childrens Hospital
Child Neuropsychology | Year: 2015

Pregnancy complications elevate risk of associated adverse medical, socioenvironmental, and behavioral outcomes in children. These are likely to have a substantial impact on neuropsychological functioning and mental health across the childs lifespan. Thus, an understanding of the complex relationships between pregnancy complications and neuropsychological outcomes is critical for both practitioners and researchers. This review summarizes prevalent pregnancy complications and the associated psychological and neuropsychological findings, highlighting methodological challenges that have restricted investigations of these outcomes and identifying opportune areas for future study. © 2014 Taylor and Francis.


Berry K.A.,Inova Childrens Hospital | Baron I.S.,Inova Childrens Hospital | Weiss B.A.,Inova Childrens Hospital | Baker R.,Inova Childrens Hospital | And 2 more authors.
American Journal of Obstetrics and Gynecology | Year: 2013

Objective In vitro fertilization (IVF) is considered a generally safe procedure, although associated with a higher incidence of preterm birth. The literature is inconsistent about the psychological impact of IVF, and we found no reports about outcome in late preterm (LPT) children. Our objective was to study neuropsychological and behavioral outcomes in a cohort of preschoolers born LPT between 2004 and 2007. Study Design Participants were 397 LPT children (mean age, 3.8 years) conceived assisted by IVF (n = 105) or non-IVF (n = 292). Standardized performance-based tests of general conceptual ability (intelligence quotient), executive function, focused/selective attention, visual-spatial perception, visual-motor skill, manual dexterity, learning, and memory were administered. Parents completed behavioral and executive function questionnaires. Results IVF group characteristics included older maternal age (P <.001), lower birthweight (P <.001), and higher maternal education (P <.001). No main-effect significant group differences were found for any variable after controlling for these variables. However, sex differences were demonstrated for the neuropsychological variables in copying (P >.001), nonverbal reasoning (P =.001), manual dexterity (P =.001), and inhibitory capacity (P =.006), all favoring girls. Conclusion Birth following IVF-assisted conception did not increase the risk of intellectual, neuropsychological, or behavioral deficit in LPT preschoolers. As shown in earlier gestational-age participants, girls have selective advantages. These findings should be reassuring for parents who conceive through IVF and deliver infants 1-3 weeks before term gestational age. Future study of these children at elementary school age may detect subtle impairments not yet apparent at age 3 years. © 2013 Mosby, Inc. All rights reserved.


Ta H.,Inova Childrens Hospital | Reid B.,Inova Childrens Hospital | Bhatia D.,Inova Childrens Hospital | Levorson R.,Inova Childrens Hospital
Pediatric Infectious Disease Journal | Year: 2016

We present a previously healthy 16-year-old male with ehrlichiosis-induced aseptic meningitis and subsequent second-degree heart block. © 2016 Wolters Kluwer Health, Inc.


Hansen C.E.,Inova Childrens Hospital
Pediatric Emergency Care | Year: 2016

ABSTRACT: Traumatic abrasions on human extremities as a result of direct contact with sea, lake, river, or aquarium animals or from traumatic injuries sustained in seawater may develop into solitary or linear granulomatous lesions. One of the more common microbial etiologies for such infections is Mycobacterium marinum. An astute pediatrician, family physician, or nurse practitioner should have a high index of suspicion and obtain specific cultures to support the growth of Mycobacterium species. Mycobacterium marinum infections will not respond to antibiotics typically chosen to treat simple skin and soft tissue infections. Rather, M. marinum infections are best treated by prolonged antimicrobial treatment regimens for 3 to 6 months and, in some cases, may require polypharmacologic therapy. We present the case of a 6-year-old girl who suffered a traumatic abrasion on her right ankle in seawater. For 10 days, the skin infection morphed from cellulitis, papules, pustules, and eventually into sporotrichoid linear granuloma. After several failed antibiotic trials, M. marinum was eventually identified from the depth of her lesions. The patient improved after a 3-month course of clarithromycin. This case report is the first to include pictures demonstrating the clinical progression and resolution of M. marinum infection. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Schwartz R.H.,Inova Childrens Hospital
Pediatric Emergency Care | Year: 2014

ABSTRACT: Submasseteric space infections are rare at any age but particularly so in primary school children. The origin of the infection is usually odontogenic, from pericoronitis in a third molar. Submasseteric inflammation is a deep facial space inflammation, often progressing to mature abscess, and usually misdiagnosed as staphylococcal or streptococcal lymphadenitis or pyogenic parotitis. The hallmark of a masticatory space infection is trismus. The cardinal signs of this infection include a firm mass in the body of the masseter muscle with overlying cellulitis with trismus. © 2014 Lippincott Williams & Wilkins, Inc.

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