Pediatric Cardiology最新文献_第10页

Coronary Events Following Dobutamine Stress Cardiac Magnetic Resonance Imaging in Pediatric Patients. 小儿多巴酚丁胺负荷心脏磁共振成像后的冠状动脉事件。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-22 DOI: 10.1007/s00246-024-03632-4

Meaghan Beattie, Rebecca Beroukhim, David Annese, Audrey Dionne, Annette Baker, Andrew J Powell

{"title":"Coronary Events Following Dobutamine Stress Cardiac Magnetic Resonance Imaging in Pediatric Patients.","authors":"Meaghan Beattie, Rebecca Beroukhim, David Annese, Audrey Dionne, Annette Baker, Andrew J Powell","doi":"10.1007/s00246-024-03632-4","DOIUrl":"https://doi.org/10.1007/s00246-024-03632-4","url":null,"abstract":"Dobutamine stress cardiac magnetic resonance (dsCMR) has demonstrated value in identifying patients at risk for adverse cardiovascular events in adults with coronary artery disease, but its prognostic value in younger patients is unknown. This study sought to evaluate the relationship between dsCMR results and the risk of subsequent cardiovascular events in children. Patients age < 23 years who underwent dsCMR at Boston Children's Hospital were eligible for inclusion. Patients were excluded if no follow-up data were available after dsCMR or the dsCMR protocol was not completed. Data regarding the presence of inducible regional wall motion abnormalities and subsequent cardiovascular events during follow-up were analyzed. Cardiovascular events included myocardial infarction, surgical or catheter-based coronary artery intervention, and ischemic symptoms. Among 80 dsCMR studies in 64 patients with median age 5.3 years (range 0.5-22.4 years), 3 patients had a positive dsCMR with inducible regional wall motion abnormalities. Over a median follow-up of 7.4 years (IQR 4.0-11.2), 2 of these patients underwent surgical intervention (coronary artery bypass grafting and unroofing of a myocardial bridge) and the third remained asymptomatic with no interventions. Among 61 patients with a negative dsCMR, none experienced myocardial infarction, death, or aborted sudden death. Four underwent cardiac interventions (cardiac transplantation, coronary artery bypass grafting, and unroofing) due to symptoms or catheterization findings. In pediatric patients undergoing dsCMR, wall motion abnormalities indicating inducible ischemia were uncommon. Those with a negative dsCMR were unlikely to experience an adverse cardiac event or undergo a cardiac intervention on medium-term follow-up.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gut Microbiome in Children with Congenital Heart Disease After Cardiopulmonary Bypass Surgery (GuMiBear Study). 先天性心脏病患儿心肺旁路手术后的肠道微生物组（GuMiBear 研究）。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-22 DOI: 10.1007/s00246-024-03634-2

Fatma Koc, Claire Magner, Kiera Murphy, Sean T Kelleher, Mong H Tan, Molly O'Toole, Dominic Jenkins, Jordan Boyle, Marie Lavelle, Niamh Maguire, Paul R Ross, Catherine Stanton, Colin J McMahon

{"title":"Gut Microbiome in Children with Congenital Heart Disease After Cardiopulmonary Bypass Surgery (GuMiBear Study).","authors":"Fatma Koc, Claire Magner, Kiera Murphy, Sean T Kelleher, Mong H Tan, Molly O'Toole, Dominic Jenkins, Jordan Boyle, Marie Lavelle, Niamh Maguire, Paul R Ross, Catherine Stanton, Colin J McMahon","doi":"10.1007/s00246-024-03634-2","DOIUrl":"https://doi.org/10.1007/s00246-024-03634-2","url":null,"abstract":"The gut microbiome of infants with congenital heart disease (CHD) undergoing cardiopulmonary bypass surgery (CPB) is at risk of profound alteration. The aim of this study was to examine the gut microbiome pre- and post-bypass surgery to explore potential implications of altered gut biodiversity. A prospective cohort study involving infants with CHD who underwent CPB was performed. Faecal samples were collected from infants alongside the collection of demographic and clinical data in order to examine gut microbiome changes before and after surgery. 16S rRNA sequencing analysis was performed on DNA isolated from stool samples to determine changes in gut microbiome composition. Thirty-three patients were recruited, with samples from thirteen of these available for final analysis. Compared with healthy, matched controls, at a genus level, pre-operative samples for infants with CHD demonstrated a higher relative abundance of Escherichia-Shigella (31% vs 2-6%) and a lower relative abundance of Bifidobacterium (13% vs 40-60%). In post-operative samples, the relative abundance of Escherichia-Shigella (35%), Enterococcus (11%), Akkermansia (6%), and Staphylococcus (5%) were higher than pre-op samples. One infant developed post-operative necrotising-enterocolitis (NEC). They displayed a marked abundance of the Enterococcus (93%) genus pre-operatively. This study demonstrates that infants with CHD have an altered gut microbiome when compared with healthy controls and there might be a possible link between an abundance of virulent species and NEC.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perinatal Factors Associated with Successful Pharmacologic Closure of the Patent Ductus Arteriosus in Premature Infants. 与早产儿成功药物闭合动脉导管相关的围产期因素

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-21 DOI: 10.1007/s00246-024-03626-2

Puneet Sharma, Addison Gearhart, Kristyn Beam, Fotios Spyropoulos, Andrew J Powell, Andrew Beam, Philip Levy

{"title":"Perinatal Factors Associated with Successful Pharmacologic Closure of the Patent Ductus Arteriosus in Premature Infants.","authors":"Puneet Sharma, Addison Gearhart, Kristyn Beam, Fotios Spyropoulos, Andrew J Powell, Andrew Beam, Philip Levy","doi":"10.1007/s00246-024-03626-2","DOIUrl":"https://doi.org/10.1007/s00246-024-03626-2","url":null,"abstract":"The patent ductus arteriosus (PDA) is associated with significant morbidity and mortality in preterm infants. While pharmacologic closure of the PDA is common and effective, it can be difficult to identify which patients will respond. As such, the objective of this study was to identify factors associated with successful pharmacologic closure of the PDA. We hypothesized that clinical factors such as gestational age, birth weight, and hypertensive disorders of pregnancy would be associated with successful closure. We performed a retrospective cohort study of preterm infants who received pharmacologic treatment for a PDA at two large neonatal intensive care units in Boston, MA between January 2016 and December 2021. Infants were excluded if they received prophylactic indomethacin, had early termination of therapy, did not have an echocardiogram prior to therapy, or had congenital heart disease. The primary outcome was closure after initial course. Relevant perinatal data were collected on enrolled infants. Of the 215 enrolled infants, 131 (61%) had successful closure. Older gestational age (OR, 1.23; 95% CI,1.03-1.47), male sex (OR, 2.17; 95% CI,1.18-3.99), and maternal preeclampsia (OR, 2.75; 95% CI,1.07-7.02) were associated with successful closure. Infants who received postnatal steroids (OR, 0.49; 95% CI,0.25-0.96) were less likely to have had successful closure. In this study, we identified previously established associations of gestational age and male sex with successful pharmacologic closure. However, the associations with maternal preeclampsia and postnatal steroids are novel. While further investigation is warranted, these associations can help inform decision-making around management of the PDA.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improved Code Team Performance and Outcomes After Implementation of Moderate Fidelity In Situ Simulation in a Pediatric Cardiac Acute Care Unit. 在儿科心脏急症监护室实施中等逼真度的现场模拟后，提高了代码团队的绩效和成果。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-21 DOI: 10.1007/s00246-024-03627-1

Frances K Woodard, Angela S McKeta, Luke Schroeder, Sinai C Zyblewski, Jason R Buckley

{"title":"Improved Code Team Performance and Outcomes After Implementation of Moderate Fidelity In Situ Simulation in a Pediatric Cardiac Acute Care Unit.","authors":"Frances K Woodard, Angela S McKeta, Luke Schroeder, Sinai C Zyblewski, Jason R Buckley","doi":"10.1007/s00246-024-03627-1","DOIUrl":"https://doi.org/10.1007/s00246-024-03627-1","url":null,"abstract":"Children with cardiac disease suffer higher rates of in-hospital cardiac arrest. Cardiac arrest outside of the intensive care unit (ICU) is an infrequent event, which is a threat for suboptimal code team performance. Shorter time to the first epinephrine dose during cardiac arrest has been associated with improved survival and neurologic outcomes. Moderate fidelity in situ simulation training was implemented in the pediatric cardiac acute care unit (PCACU) to improve code team performance in August 2015. A small interprofessional team of simulation facilitators was developed that included nurses, physicians, and advanced practice providers. The primary outcome was time to first epinephrine dose in pulseless electrical activity (PEA) scenarios. Time to epinephrine of all simulation exercises, and actual cardiac arrests, that occurred in the PCACU were reviewed through May 2022. A total of 72 simulations were performed and 42 (58%) were PEA scenarios. A center line shift was observed for time to epinephrine for simulated PEA cardiac arrests (from 5 to 3 min). After implementation of simulation exercises, a center line shift was observed for time to epinephrine for actual cardiac arrests in the PCACU (from 8 to 2 min). Survival to hospital discharge after cardiac arrest improved after implementation of the training (0% vs. 64%, p = 0.02). Code team performance, as measured by time to epinephrine, can be improved following implementation of in situ simulation exercises in a pediatric cardiac acute care unit. Optimizing code team performance may contribute to improved patient outcomes.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Life and Death: A Multicenter Study Evaluating Cardiologists' Approach to Difficult Conversations with Fontan Patients and Families. 生与死：一项多中心研究，评估心脏病专家与丰坦患者及家属进行艰难对话的方法。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-20 DOI: 10.1007/s00246-024-03631-5

Seohyuk Lee, Rahul H Rathod, Anne Marie Valente, Brooke T Davey, Fred Wu, Nancy Drucker, Kristin Lombardi, Nicole St Clair, Nina Azcue, Olga H Toro-Salazar, Robert W Elder

{"title":"Life and Death: A Multicenter Study Evaluating Cardiologists' Approach to Difficult Conversations with Fontan Patients and Families.","authors":"Seohyuk Lee, Rahul H Rathod, Anne Marie Valente, Brooke T Davey, Fred Wu, Nancy Drucker, Kristin Lombardi, Nicole St Clair, Nina Azcue, Olga H Toro-Salazar, Robert W Elder","doi":"10.1007/s00246-024-03631-5","DOIUrl":"https://doi.org/10.1007/s00246-024-03631-5","url":null,"abstract":"Outpatient cardiologists provide longitudinal care for Fontan patients. As these patients age, they face mounting morbidities, necessitating challenging conversations about prognosis and goals of care. We created a novel survey to evaluate cardiologists' attitudes surrounding risk counseling for patients/caregivers. Cardiologists were recruited during concomitant outpatient enrollment of individuals with Fontan operation > age 10. Physician demographic data, expectations of timing in discussing adverse event risk, and perceived barriers were collected. Barriers were analyzed using a thematic approach. 40 cardiologists (9 institutions) responded regarding 155 patients (mean age 21.2 years, SD 7.7). Physicians were mostly male (58%) with mean practice of 21 years post-fellowship (SD 12). Most felt the time was right to have a conversation with patient (55%) and family (62%), and majority thought patient (53%) and family (75%) were ready for such a conversation. Most had previously discussed prognosis with patient (72%) and family (75%). Providers were inclined to discuss risk with caregivers earlier (mean patient age 9 years, SD 11) than patients (mean patient age 17 years, SD 6.4). Nevertheless, 42% of physicians perceived significant barriers and provided 58 narrative comments categorized into 4 major themes: (1) Patient-related (53.4%), including cognitive limitations and mental health; (2) Provider-related (16.4%), including lack of familiarity, preservation of happiness, and discomfort; (3) Family related (12.3%), including protection/denial and psychosocial stressors; (4) Other (26%), including social barriers. Experienced cardiologists are willing to have difficult conversations; nearly half reported largely patient-related barriers. Facilitating these conversations is critical for the adolescent/young adult with Fontan physiology.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Indication for Pediatric Heart Transplant Affects Longitudinal Chronotropy on Cardiopulmonary Exercise Testing. 小儿心脏移植的适应症影响心肺运动测试的纵向时向性

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-17 DOI: 10.1007/s00246-024-03623-5

Sebastian Otto-Meyer, Alan P Wang, Garett J Griffith, Katheryn Gambetta, Kendra Ward

{"title":"Indication for Pediatric Heart Transplant Affects Longitudinal Chronotropy on Cardiopulmonary Exercise Testing.","authors":"Sebastian Otto-Meyer, Alan P Wang, Garett J Griffith, Katheryn Gambetta, Kendra Ward","doi":"10.1007/s00246-024-03623-5","DOIUrl":"https://doi.org/10.1007/s00246-024-03623-5","url":null,"abstract":"Studies have suggested that pediatric patients with heart transplants (HT) due to congenital heart disease (CHD) perform differently on cardiopulmonary exercise testing compared to pediatric patients with HT due to cardiomyopathy (CM). However, it is not known if this relationship changes over time. The aim of this study was to examine the differences in cardiopulmonary exercise test (CPET) parameters over time between patients with HT due to CHD versus CM. A large single-institution CPET database was used for this study. We conducted a retrospective cohort study of 250 total CPETs from 93 unique patients, examining how patients with HT due to CHD (109 CPETs, 40 unique patients) differed in CPET performance from patients with HT due to CM (141 CPETs, 53 unique patients) from < 2 years post-HT, 2 to < 6 years post-HT, and ≥ 6 years post-HT. There were no differences between patients with HT due to CHD compared to CM in CPETs performed < 2 years post-HT. In CPETs performed 2 to < 6 years post-HT, the CM group had higher maximal HR and percentage of age-predicted maximal heart rate (APMHR) achieved. At ≥ 6 years post-HT, the CM group continued to have higher maximal HR and percentage of APMHR achieved, but also improved HR recovery at one minute. Initial indication for transplant may affect performance on CPETs post-transplant. Patients with HT due to CM have improved chronotropic measures compared to patients with HT due to CHD and these differences are more pronounced with increased time post-HT.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patient Driven EKG Device Performance in Adults with Fontan Palliation. 患者驱动的心电图设备在成人方坦缓和术中的表现。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-16 DOI: 10.1007/s00246-024-03614-6

Matthew Laubham, Anudeep K Dodeja, Rohan Kumthekar, Victoria Shay, Nathan D'Emilio, Sara Conroy, May Ling Mah, Chance Alvarado, Anna Kamp

{"title":"Patient Driven EKG Device Performance in Adults with Fontan Palliation.","authors":"Matthew Laubham, Anudeep K Dodeja, Rohan Kumthekar, Victoria Shay, Nathan D'Emilio, Sara Conroy, May Ling Mah, Chance Alvarado, Anna Kamp","doi":"10.1007/s00246-024-03614-6","DOIUrl":"https://doi.org/10.1007/s00246-024-03614-6","url":null,"abstract":"The aim of this study was to evaluate the accuracy of the KardiaMobile (KM) device in adults with a Fontan palliation, and to assess the KM function as a screening tool for atrial arrhythmias. While patient driven electrocardiogram (EKG) devices are becoming a validated way to evaluate cardiac arrhythmias, their role for patients with congenital heart disease is less clear. Patients with single ventricle Fontan palliation have a high prevalence of atrial arrhythmias and represent a unique cohort that could benefit from early detection of atrial arrhythmias. This single center prospective study enrolled adult patients with Fontan palliation to use the KM heart rhythm monitoring device for both symptomatic episodes and asymptomatic weekly screening over a 1-year period. Accuracy was assessed by comparing the automatic KM interpretation (KM-auto) to an electrophysiologist overread (KM-EP) and traditional EKG. Fifty patients were enrolled and 510 follow-up transmissions were received. The sensitivity and specificity of enrollment KM-auto compared to EKG was 65% and 100%, respectively. The sensitivity and specificity of enrollment KM-auto compared to the KM-EP was 75% and 96%, respectively. In the adult Fontan palliation, the accuracy of the KM device to detect a normal rhythm was reliable and best with a physician overread. Abnormal or uninterpretable KM-auto device interpretations, symptomatic transmissions, and any transmissions with a high heart rate compared to a patient's normal baseline should warrant further review.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prolonged Inotrope Use After Surgery for Congenital Heart Disease: A Common Occurrence with a High Burden of Mortality. 先天性心脏病术后长期使用肌注：死亡率高的常见病。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-14 DOI: 10.1007/s00246-024-03619-1

Alicia M Kamsheh, Warren B Bilker, Yuan-Shung Huang, Oluwatimilehin Okunowo, Danielle S Burstein, Jonathan B Edelson, Kimberly Y Lin, Katsuhide Maeda, Constantine D Mavroudis, Matthew J O'Connor, Carol A Wittlieb-Weber, Hillary R Bogner, Joseph W Rossano

{"title":"Prolonged Inotrope Use After Surgery for Congenital Heart Disease: A Common Occurrence with a High Burden of Mortality.","authors":"Alicia M Kamsheh, Warren B Bilker, Yuan-Shung Huang, Oluwatimilehin Okunowo, Danielle S Burstein, Jonathan B Edelson, Kimberly Y Lin, Katsuhide Maeda, Constantine D Mavroudis, Matthew J O'Connor, Carol A Wittlieb-Weber, Hillary R Bogner, Joseph W Rossano","doi":"10.1007/s00246-024-03619-1","DOIUrl":"https://doi.org/10.1007/s00246-024-03619-1","url":null,"abstract":"Outcomes in patients requiring prolonged inotropes (PI) following surgery for congenital heart disease (CHD) have not been well studied. We aimed to describe the burden of PI use in the immediate postoperative period after CHD surgery and identify risk factors for in-hospital mortality. We conducted a retrospective cohort study using the Pediatric Health Information System® (PHIS) database. Patients 0-18 years with CHD who underwent cardiovascular surgery from 2010 to 2020 were included. Patients who received inotropic medications for > 7 consecutive days after surgery were in the PI group and all others in the control group. Patients who died before 7 days were excluded. Multivariable mixed-effect logistic regression was used to examine risk factors for in-hospital mortality. There were 110,271 patients from 48 centers included, 10,292 in the PI group and 99,979 in the control group. In-hospital mortality was significantly higher in the PI group (24.9% vs. 4.6%, p < 0.001). Ventricular assist device use was rare (1.6%). After adjustment, odds of in-hospital mortality in the PI group was 3.5 (95% CI 3.3-3.8) times higher than in controls. Independent risk factors for in-hospital mortality were age, non-White race, class of CHD, number of complex chronic conditions, preoperative inotrope, preoperative extracorporeal membrane oxygenation, sepsis, stroke, renal failure, number of inotropes at 7 days, and discharge year (p < 0.01 for all). Postoperative PI use in CHD is common and carries a considerable burden of mortality. Additional work is needed to understand which risk factors are modifiable and which patients may benefit from reintervention or advanced heart failure therapies.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Routine Infectious Diseases Consultations on a Pediatric Cardiac Unit to Improve Positive Blood Culture Management. 在儿科心脏科进行常规传染病会诊以改善阳性血培养管理。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-12 DOI: 10.1007/s00246-024-03616-4

Caitlin Naureckas Li, Sameer Patel, Catherine Collins

{"title":"Routine Infectious Diseases Consultations on a Pediatric Cardiac Unit to Improve Positive Blood Culture Management.","authors":"Caitlin Naureckas Li, Sameer Patel, Catherine Collins","doi":"10.1007/s00246-024-03616-4","DOIUrl":"https://doi.org/10.1007/s00246-024-03616-4","url":null,"abstract":"Bacteremia can be life-threatening, and highly medicalized patients, such as those with complex congenital heart disease, are at high risk. Infectious diseases (ID) consultation is associated with improved outcomes in bacteremia. We noted an opportunity for improvement in management of positive blood cultures in our cardiac care unit (CCU). We completed a quality improvement project that included a single plan-do-study-act cycle consisting of a policy of routine ID consultation for all positive blood cultures events in the CCU. Our outcome measure of interest was percentage of appropriately managed blood culture events, the process measure was percentage of blood culture events for which the ID service was formally consulted, and the balancing measure was number of individual patients for whom the ID service was formally consulted. Appropriate antimicrobial management was determined via chart review by an ID physician. Data were analyzed via run chart and simple statistics. Following the intervention, the rate of appropriately managed positive blood culture events increased from a baseline of 86% to 98%, and the rate of ID consultation for these events increased from 75% to 98%. A shift was noted in run charts for both the outcome and process measures. There was an increase in patients for whom the ID service was consulted throughout the entire study period. We successfully implemented mandatory ID consultations in a CCU to increase proportion of appropriately managed blood cultures. While this intervention cannot be universally applied, others may find it useful in selected scenarios.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transcatheter Patent Ductus Arteriosus Closure in Premature Infants: Comparison of Echocardiogram and Angiogram Measurements. 早产儿经导管动脉导管未闭：超声心动图与血管造影测量结果的比较。

IF 1.5 4区医学

Pediatric Cardiology Pub Date : 2024-08-12 DOI: 10.1007/s00246-024-03620-8

Bassel Mohammad Nijres, Mohamed Khallaf, Adrianne Rahde Bischoff, Kaitlin Carr, Umang Gupta, Patrick J McNamara, Jimmy Windsor, Osamah Aldoss

{"title":"Transcatheter Patent Ductus Arteriosus Closure in Premature Infants: Comparison of Echocardiogram and Angiogram Measurements.","authors":"Bassel Mohammad Nijres, Mohamed Khallaf, Adrianne Rahde Bischoff, Kaitlin Carr, Umang Gupta, Patrick J McNamara, Jimmy Windsor, Osamah Aldoss","doi":"10.1007/s00246-024-03620-8","DOIUrl":"https://doi.org/10.1007/s00246-024-03620-8","url":null,"abstract":"Transcatheter patent ductus arteriosus (PDA) closure (TCPC) utilizing transthoracic echocardiogram (TTE) as the sole imaging guide could simplify care. This single-center study compares PDA dimensions obtained from the TTE and angiogram images of patients who underwent attempted TCPC at Stead Family Children's Hospital from 10/01/2019 to 10/31/2020. Blinded investigators measured these dimensions solely for this study and had no impact on clinical care. Also, a hypothetical Piccolo device size was chosen based on the TTE dimensions and another on the angiographic dimensions, and then the correlation was analyzed. Sixty-two patients underwent TCPC attempts. TTE tends to overestimate the PDA narrowest dimension and underestimate the PDA length and aortic end dimension. Linear regression analysis revealed a weak correlation between the length and aortic diameter (R = 0.37 and 0.21, respectively). A modest correlation was observed for the smallest dimension without color Doppler (R = 0.57) and with color Doppler, which was utilized when needed (R = 0.6). Bland-Altman analysis revealed a smaller mean difference between the TTE and angiogram measurements of the narrowest diameter without color Doppler (0.4 mm) and with color Doppler (used as needed) (0.4 mm). However, the mean difference is larger for the aortic end (- 1.64 mm) and the length (- 1.73 mm). TTE accurately predicted the Piccolo device size in 43 (72%) patients and overestimated the size in 17 (28%) patients to the next size. Our findings should be verified with further studies, and additional development of protocols is needed to use TTE to guide TCPC without fluoroscopy.","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0