Lehman P.J.,Lurie Childrens Hospital Of Chicago |
Carl R.L.,Lurie Childrens Hospital Of Chicago
Pediatric Annals | Year: 2017
With rising rates of sports participation among children and adolescents, pediatricians are increasingly being called upon to perform preparticipation physical evaluations (PPEs) for young athletes. The purpose of this review article is to discuss the general structure of a comprehensive PPE and how the PPE differs from a typical health maintenance visit. The PPE focuses attention on screening for cardiac conditions that predispose athletes to sudden cardiac death with exercise. This review also addresses the debate over whether electrocardiogram screening should be a routine required part of the PPE. In addition to cardiac screening, evaluation and management of musculoskeletal injury, concussion, and the female athlete triad will be discussed in greater detail. © SLACK Incorporated.
Meyers R.L.,University of Utah |
Tiao G.,Cincinnati Childrens Hospital and Medical Center |
De Ville De Goyet J.,University of Rome Tor Vergata |
Superina R.,Lurie Childrens Hospital of Chicago |
Aronson D.C.,University of Malawi
Current Opinion in Pediatrics | Year: 2014
Purpose of review: This is part two of a two-part state of the art-hepatoblastoma. International hepatoblastoma specialists were brought together to highlight advances, controversies, and future challenges in the treatment of this rare pediatric tumor. Recent findings: Pretreatment extent of disease (PRETEXT) is a grouping system introduced as part of the multicenter international childhood liver tumors strategy group, SIOPEL-1, study in 1990. The system has been refined over the ensuing years and has now come to be adopted for risk stratification by all of the major pediatric liver tumor multicenter trial groups. PRETEXT is being intensively studied in the current ChildrenÊs Oncology Group (COG) AHEP-0731 trial in an attempt to validate interobserver reproducibility and ability to monitor response to neoadjuvant chemotherapy, and determine surgical resectability. PRETEXT is now used to identify those patients who are at risk for having an unresectable tumor and who should be referred to a liver specialty center with transplant capability early in their treatment schema. Summary: International collaborative efforts in hepatoblastoma have led to increased refinements in the use of the PRETEXT and post-treatment extent to define prognosis and surgical resectability. PRETEXT criteria which suggest a possible need for liver transplantation are discussed in detail. © 2014 Wolters Kluwer Health.
Collins Jr. J.W.,Lurie Childrens Hospital of Chicago |
Soskolne G.R.,University of California at San Francisco |
Rankin K.M.,University of Illinois at Chicago |
Bennett A.C.,University of Illinois at Chicago
Maternal and Child Health Journal | Year: 2013
To determine whether maternal nativity (US-born versus foreign-born) is associated with the first year mortality rates of term births. Stratified and multivariable binomial regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files. Only term (37-42 weeks) infants with non-Latina White, African-American, and Mexican-American mothers were studied. The infant mortality rate (<365 days, IMR) of births to US-born non-Latina White mothers (n = 3,684,569) exceeded that of births to foreignborn White mothers (n = 226,621): 2.4/1,000 versus 1.3/1,000, respectively; relative risk (RR) = 1.8 [95 %confidence interval (CI) 1.6-2.0]. The IMR of births to US-born African-American mothers (n = 787,452) exceeded that of births to foreign-born African-American mothers (n = 118,246): 4.1/1,000 versus 2.2/1,000, respectively; RR = 1.8 (1.6-2.1). The IMR of births to US-born Mexican-American mothers (n = 338,337) exceeded that of births to Mexican-born mothers (n = 719,837): 2.4/1,000 versus 1.8/1,000, respectively; RR = 1.3 (1.2-1.4). These disparities were not limited to a singular cause of death and were widest among deaths due to Sudden Infant Death Syndrome. In multivariable binomial regression models, the adjusted RR of infant mortality for non-LBW, term births to US-born (compared to foreign-born) for White, African-American, and Mexican-American mothers equaled 1.5 (1.3-1.7), 1.7 (1.5-2.1) and 1.6 (1.4-1.8), respectively. The IMR of term births to White, African-American, and Mexican-American mothers exceeds that of their counterparts with foreign-born mothers independent of traditional individual level risk factors. © Springer Science+Business Media New York 2012.
Mistry R.D.,Aurora University |
Fischer J.B.,University of Michigan |
Prasad P.A.,University of California at San Francisco |
Coffin S.E.,Children's Hospital of Philadelphia |
And 2 more authors.
Pediatrics | Year: 2014
OBJECTIVE: Data on complications from upper respiratory infection are limited. We examined development of severe complications in children presenting to the emergency department (ED) for moderate to severe influenza-like illness (ILI).RESULTS: There were 241 enrolled subjects with median age of 27.4 months (interquartile range 8.9-68.5); 59.3% were boys and 48.5% were black. High-risk conditions were present in 53.5%. Severe complications developed in 35.3% (95% confidence interval [CI] 29.3-41.3), most frequently pneumonia (26.1%). The risk for severe complications was increased in subjects with neurologic or neuromuscular conditions (relative risk 4.0; 95% CI 1.9-8.2). No specific respiratory virus was associated with development of severe complications. Among patients with influenza, severe complications were greater with subtype H1N1 infection (relative risk 1.45, 95% CI 0.99-2.13, P = .048), and were at highest risk for pneumonia (relative risk 4.2, 95% CI 1.2-15.9).METHODS: Prospective cohort study of children 0 to 19 years presenting to a tertiary care children's hospital ED during peak respiratory viral seasons from 2008 to 2010. Subjects included had moderate to severe ILI, defined by performance of venipuncture and nasopharyngeal multiplex polymerase chain reaction for respiratory viruses. Severe complications (respiratory failure, encephalopathy, seizures, pneumonia, bacteremia, death) were prospectively determined. Risk factors for severe complications were collected, including demographics, comorbidities, and household exposures.CONCLUSION: In children presenting to the ED for moderate to severe ILI, those with neurologic and neuromuscular disease are at increased risk for severe complications. Development of severe complications did not differ by infecting virus; however, risk of severe complications was greater with subtype H1N1 compared with other influenza.
Jain S.,Children's Healthcare Of Atlanta |
Cheng J.,Children's Healthcare Of Atlanta |
Alpern E.R.,Lurie Childrens Hospital of Chicago |
Thurm C.,Childrens Hospital Association |
And 5 more authors.
Pediatrics | Year: 2014
BACKGROUND: Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates. METHODS: Cross-sectional study of neonates with a diagnosis of fever evaluated in 36 PEDs in the 2010 Pediatric Health Information System database. We analyzed performance of recommended management (laboratory testing, antibiotic use, admission to hospital), 48-hour return visits to PED, and diagnoses of SI. RESULTS: Of 2253 neonates meeting study criteria, 369 (16.4%) were evaluated and discharged from the PED; 1884 (83.6%) were admitted. Recommended management occurred in 1497 of 2253 (66.4%; 95% confidence interval, 64.5-68.4) febrile neonates. There was more than twofold variation across the 36 PEDs in adherence to recommended management, recommended testing, and recommended treatment of febrile neonates. There was significant variation in testing and treatment between admitted and discharged neonates (P < .001). A total of 269 in 2253 (11.9%) neonates had SI, of whom 223 (82.9%; 95% confidence interval, 77.9-86.9) received recommended management. CONCLUSIONS: There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations. Copyright © 2014 by the American Academy of Pediatrics.
McNamara E.R.,Harvard University |
Schaeffer A.J.,Harvard University |
Logvinenko T.,Harvard University |
Seager C.,Cleveland Clinic |
And 5 more authors.
Journal of Urology | Year: 2015
Purpose We describe our experience with 2-stage proximal hypospadias repair. We report outcomes, and patient and procedure characteristics associated with surgical complications. Materials and Methods We retrospectively studied patients with proximal hypospadias who underwent staged repair between January 1993 and December 2012. Demographics, preoperative management and operative technique were reviewed. Complications included glans dehiscence, fistula, meatal stenosis, nonmeatal stricture, urethrocele/diverticula and residual chordee. Cox proportional hazards model was used to evaluate the associations between time to surgery for complications and patient and procedure level factors. Results A total of 134 patients were included. Median patient age was 8.8 months at first stage surgery and 17.1 months at second stage surgery, and median time between surgeries was 8 months. Median followup was 3.8 years. Complications were seen in 71 patients (53%), with the most common being fistula (39 patients, 29.1%). Reoperation was performed in 66 patients (49%). Median time from urethroplasty to surgery for complication was 14.9 months. Use of preoperative testosterone decreased risk of undergoing surgery for complication by 27% (HR 0.73, 95% CI 0.55-0.98, p = 0.04). In addition, patients identified as Hispanic were at increased risk for undergoing surgery for complications (HR 2.40, 95% CI 1.28-4.53, p = 0.01). Conclusions We review the largest cohort of patients undergoing 2-stage hypospadias repair at a single institution. Complications and reoperation rates were approximately 50% in the setting of complex genital reconstruction. © 2015 American Urological Association Education and Research, Inc.
Mehta H.M.,Northwestern University |
Glaubach T.,Lurie Childrens Hospital Of Chicago |
Corey S.J.,Northwestern University
Advances in Experimental Medicine and Biology | Year: 2014
Granulocyte differentiation and immune response function is a dynamic process governed by a highly coordinated transcriptional program that regulates cellular fate and function, often in a context-dependent manner. Advances in high-throughput technologies and bioinformatics have allowed us to better understand complex biological processes at the genomic and proteomic levels. Components of the environmental milieu, along with the molecular mechanisms that drive the development, activation, and regulation of granulocytes, have since been elucidated. In this chapter, we present the intricate network in which these elements come together and influence one another. In particular, we describe the critical roles of transcription factors like PU.1, CCAAT/enhancer-binding protein (C/EBPα; alpha), C/EBPε (epsilon), and growth factor independent-1 (Gfi-1). We also review granulocyte colony-stimulating factor (G-CSF) receptor-induced signal transduction pathways, their influence on proliferation and differentiation, and the cooperativity of cytokines and chemokines in this process. © Springer Science+Business Media NewYork 2014.
Merens T.A.,Northwestern University |
Merens T.A.,Lurie Childrens Hospital Of Chicago
Pediatric Annals | Year: 2016
The examination of the newborn is one of the most common yet crucial tasks performed by the pediatrician. The initial hospital visit (immediately after the birth), with the confirmation that an infant is healthy, often sets the tone for the future relationship between the physician and the family. Many routine visits during the first few years also find the parents looking for the same reassurance from their doctor. However, when there is concern for the health of the newborn, toddler, or young child, the physician must balance appropriate medical intervention with words of comfort and consolation. This article delineates the need for when more immediate attention is warranted from those situations where watchful waiting can be advised, with specific attention to the male genitalia of the prepubertal boy. © SLACK Incorporated.
Sweeney M.,Cincinnati Childrens Hospital Medical Center |
Rubin J.,Lurie Childrens Hospital of Chicago |
Hopkins S.E.,Children's Hospital of Philadelphia
Pediatric Neurology | Year: 2014
Background Neurogenic pulmonary edema may be a complication of multiple neurological processes. Although there is debate regarding the underlying pathophysiology, the recognition of neurogenic pulmonary edema is vitally important because of the high-potential for mortality and need for treatment of the underlying disorder. Methods We present an example of recurrent neurogenic pulmonary edema in an adolescent boy with multiple sclerosis who was diagnosed with pneumonia at the time of initial presentation. We also review the presenting symptoms, physiologic parameters, and imaging findings from published reports of patients with multiple sclerosis presenting with neurogenic pulmonary edema. Results Although all 11 cases found via literature review presented with respiratory symptoms, cardiac dysfunction was variable, as was the presence of other neurological findings. All but one case had a documented medullary lesion. Corticosteroids were effective in resolving symptoms. Three patients were not treated with corticosteroids, and one of these died (onset of pulmonary edema during sleep). Conclusions Awareness of these patients may expedite recognition and treatment of future patients, thus minimizing time to appropriate treatment and reducing mortality. © 2014 Elsevier Inc. All rights reserved.
Lavigne J.V.,Lurie Childrens Hospital of Chicago |
Gouze K.R.,Lurie Childrens Hospital of Chicago |
Bryant F.B.,Lurie Childrens Hospital of Chicago |
Hopkins J.,Lurie Childrens Hospital of Chicago
Journal of Abnormal Child Psychology | Year: 2014
There are distinct dimensions of Oppositional Defiant Disorder (ODD) that have been associated with symptoms of other disorders (heterotypic continuity). The present study compared the heterotypic continuity of a two-factor (Pitt-2) model and the three-factor model incorporated into DSM-5 with symptoms of anxiety and depression. Participants were a diverse community sample of 796 children (38.8 % minority, 49.1 % boys) assessed at ages 4, 5 and 6 years. Symptoms were assessed with the dimensional scales of the Diagnostic Interview Schedule for Children-Young Child version and the Child Symptom Inventory. Dimensions of both the two- and three-factor DSM-5 models were associated with later symptoms of anxiety and depression. The association, however, was weak when accounting for initial levels of internalizing symptoms: thus there was little evidence for the unique contributions of ODD dimensions to symptoms of subsequent internalizing disorders for either model. © 2014 Springer Science+Business Media New York.