Vasoactive–inotropic score after pediatric heart transplant: A marker of adverse outcome

VIS , a quantitative index of pressor support, has been shown to be a predictor of morbidity and mortality in infants younger than six months who underwent CPB . Data on its prognostic utility following pediatric OHT are lacking. This study compared clinical outcomes in children with differential VIS after pediatric OHT . A retrospective cohort study of 51 consecutive heart transplants from 2004 to 2011 was performed at a pediatric tertiary care facility. Peak VIS was computed within initial 24 and 48 h after OHT and was weighted for peak dose and administration of any or all of six pressors. Patients with peak VIS ≥ 15 constituted high VIS group. Children who persistently required a higher magnitude of pressor support for the first 48 h after OHT , as reflected by high peak VIS , had significantly longer ICU stay (30.2 vs. 15.9 days, p = 0.01), pressor (11.4 vs. 6.8 days, p = 0.02) and ventilatory durations (12.4 vs. 5.9 days, p = 0.05), and higher rates of short‐term morbidities. Patients with longer CPB (213 vs. 153 min, p = 0.005) time have higher peak VIS . High peak VIS at 48 h is an effective, yet simple clinical marker for adverse outcomes in pediatric OHT recipients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99070/1/petr12112.pd

Biventricular function on early echocardiograms in neonatal hypoxic–ischaemic encephalopathy

AimTo compare early (<24 hours) echocardiograms (ECHOs) in infants with perinatal hypoxic–ischaemic encephalopathy (HIE) undergoing (i) therapeutic hypothermia (TH), (ii) normothermia and (iii) normal controls.MethodsThis was a single‐centre retrospective review of clinical early ECHOs of term infants with moderate or severe HIE and controls (with a normal ECHO <72 hours of age). Right (RVO) and left ventricular output (LVO), RV and LV myocardial performance index (MPI), systolic to diastolic duration ratio (S/D) and eccentricity indices (EI) in systole and diastole were compared using ANOVA.ResultsAmong infants with HIE (n = 56, 38 in the TH and 18 in normothermia groups), 14 (25%) infants died and 42 survived. Significantly elevated biventricular MPI, lower RVO and LVO and pulmonary hypertension (abnormal EI, higher RV S/D and bidirectional or right‐to‐left ductal shunt) were found in groups with HIE, compared to controls (n = 35). LV MPI was lower in HIE‐TH, compared to the HIE‐normothermia group. Infants with HIE who died (n = 14) had a significantly lower EId [0.77 (0.09) vs. 0.83 (0.08), p = 0.021] compared to survivors (n = 42).ConclusionInfants with perinatal HIE have ventricular dysfunction; those who died had significantly lower EId than survivors; this association needs to be further validated.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137559/1/apa13866_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137559/2/apa13866.pd

Single‐center Experience of Outcomes of Tracheostomy in Children with Congenital Heart Disease

Objective A subset of children with repaired congenital heart disease ( CHD ) may require tracheostomy for ongoing ventilatory support. Data on outcomes of children with CHD and tracheostomy are scarce. Our objectives were to describe indications for tracheostomy and outcomes, including readmission data in this population. Methods This is a retrospective chart review of children (<18 years old) with CHD who underwent tracheostomy at a single center over a 12‐year period. Exclusion criteria were prematurity with isolated patent ductus arteriosus ligation. Outcomes until discharge and data on all readmissions after the initial discharge were reviewed. Results A total of 21 subjects with CHD underwent tracheostomy at a median (range) age of 4 (1–84) months and mean (standard deviation) weight of 7.2 (5.9) kg. The most common indication for tracheostomy was tracheomalacia with ventilator‐dependent respiratory failure (14/21 subjects), followed by subglottic stenosis (5) and vocal cord palsy (2). Genetic syndromes were present in 13 (62%) subjects. The mean (standard deviation) post‐tracheostomy length of stay was 55 (35) days. All subjects survived to discharge; 17 (81%) required home ventilation. A total of 11 (52%) subjects died during follow‐up, all of whom were mechanically ventilated while three (14%) children underwent successful decannulation. The mean number of nonelective readmissions decreased from 2.4/patient‐year in the first year to 1.4/patient‐year in the second year, respectively. The commonest reasons for readmission were respiratory deterioration, infections, and mechanical tracheostomy‐related problems. Conclusions The majority of children with CHD who underwent tracheostomy did so for ventilator dependence and tracheomalacia and had coexisting genetic syndromes. About half the cohort died; among survivors, readmissions were common but decreased after the first year. These results underscore the ongoing mortality and morbidity risks faced by this vulnerable population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102228/1/chd12048.pd

Functional Critical Aortic Stenosis with Transient Retrograde Flow in a Neonate with Left Diaphragmatic Hernia

We report a neonate with left congenital diaphragmatic hernia and severe left ventricular dysfunction, in whom the blood flow in the transverse arch and its branches was supported in a retrograde fashion by patent ductus arteriosus. There was only minimal antegrade flow across the aortic valve and hemodynamic physiology resembled critical aortic stenosis, necessitating the immediate use of prostaglandin E1 infusion to maintain the patent ductus arteriosus.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98145/1/chd679.pd

A Quantitative Model for CRM Performance Evaluations

This paper identifies important performance measurements for the operation of CRM units in the call center industry, and then uses Data Envelopment Analysis (DEA) to compare the performances of a selected set of call centers. The results provide several managerial insights that will assist CRM managers in effective decision making, especially in the areas of increasing efficiencies and improving customer service. Overall, this paper contributes towards managing resources and processes that would aid in the acquisition and support of information technology within a firm

Effect of teriparatide in fracture healing of intertrochanteric fracture: a prospective study

Background: Intertrochanteric fracture is a relatively common and serious medical issue in geriatric trauma result in serious health problems and decrease health related quality of life. Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture-healing. The purpose of the present prospective, randomized, controlled study was to evaluate the effect of teriparatide on the course of intertrochanteric fracture-healing.Methods: Forty patients of intertrochanteric fractures who underwent surgical intervention between June 2016 and May 2017 were enrolled in this prospective study and followed for minimum of six months. Group A included patients who received only calcium supplementation; patients in Group B received teriparatide along with calcium supplementation postoperatively.Results: The mean time to fracture healing was between 8-12 weeks for the treatment group, compared with 12-16 weeks for the control group. There was also significant effectiveness with regards to Parker and Palmer mobility score at 6 months.Conclusions: Postoperative use of teriparatide for 6 months appears to be an effective adjunct therapy in the treatment of patients with intertrochanteric fractures. However, because of the limited power of the study a large-scale cohort study is still required for determining the efficacy of teriparatide

Orthotopic Heart Transplant: A Therapeutic Option for Unresectable Cardiac Fibroma in Infants

Primary cardiac tumors are rare lesions in childhood, with the two most common being rhabdomyoma and fibroma. We report two infants who successfully underwent orthotopic heart transplant for massive interventricular septal cardiac fibromas. For unresectable infantile cardiac fibroma, orthotopic heart transplant may be considered a therapeutic option.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92445/1/chd577.pd

B‐type natriuretic peptide levels in preterm neonates with bronchopulmonary dysplasia: A marker of severity?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109265/1/ppul22942.pd