Did A Rising Tide Lift All Boats? The NIH Budget And Pediatric Research Portfolio

This paper examines National Institutes of Health (NIH) pediatric research spending in absolute terms and relative to the doubling of the NIH overall budget between fiscal years 1998 and 2003. Pediatric spending increased by an average annual rate of 12.8 percent during the doubling period (almost on par with the NIH average annual growth rate of 14.7 percent). However, the proportion of the total NIH budget devoted to the pediatric portfolio declined from 12.3 to 11.3 percent. We offer recommendations for implementing existing commitments to strengthen the pediatric research portfolio and to protect the gains of the doubling period

Doppler forward flow profiles of St. Jude Medical prosthetic valves in pediatric patients

In summary, this data on baseline and follow-up Doppler flow characteristics of small caliber SJM prosthetic valves should be extremely valuable for identifying valve dysfunction in children. Because of the high risk of developing valve obstruction, these children should be closely monitored with serial Doppler examinations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31454/1/0000375.pd

Pressure-Regulated Volume Control vs Volume Control Ventilation in Infants After Surgery for Congenital Heart Disease

The objective of this investigation was to compare how two modes of positive pressure ventilation affect cardiac output, airway pressures, oxygenation, and carbon dioxide removal in children with congenital heart disease in the immediate postoperative period. The investigation used a one group pretest–post-test study design and was performed in the pediatric cardiac intensive care unit in a university-affiliated children's hospital. Nine infants were enrolled immediately after repair of tetralogy of Fallot (2) or atrioventricular septal defects (7) with mean weight = 5.5 kg (4.2–7.3 kg). Children were admitted to the pediatric cardiothoracic intensive care unit after complete surgical repair of their cardiac defect and stabilized on a Siemen's Servo 300 ventilator in volume control mode (VCV1) (volume-targeted ventilation with a square flow wave pattern). Tidal volume was set at 15 cc/kg (total). Hemodynamic parameters, airway pressures and ventilator settings, and an arterial blood gas were measured. Patients were then changed to pressure-regulated volume control mode (PRVC) (volume-targeted ventilation with decelerating flow wave pattern) with the tidal volume set as before. Measurements were repeated after 30 minutes. Patients were then returned to volume control mode (VCV2) and final measurements made after 30 minutes. The measurements and results are as follows:Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42385/1/246-22-3-233_10220233.pd

DNA and Inflammatory Mediators in Bronchoalveolar Lavage Fluid From Children With Acute Inhalational Injuries:

Assess the feasibility of using serial bronchoalveolar lavage fluids (BALF) to characterize the course of cell damage and inflammation in airways of pediatric patients with acute burn or inhalation injury

Diastolic function in neonates after the arterial switch operation: effects of positive pressure ventilation and inspiratory time

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41894/1/134-26-7-950_00260950.pd

DNA and Inflammatory Mediators in Bronchoalveolar Lavage Fluid From Children With Acute Inhalational Injuries

OBJECTIVE: Assess the feasibility of using serial bronchoalveolar lavage fluids (BALF) to characterize the course of cell damage and inflammation in airways of pediatric patients with acute burn or inhalation injury. DESIGN: Prospective, longitudinal descriptive pilot study. SETTING: Burn and Pediatric Intensive Care Units in a tertiary-care medical center. SUBJECTS: Six consecutive intubated, mechanically ventilated pediatric patients with acute inhalational injuries were studied. INTERVENTIONS: Serial BALF specimens from clinically-indicated bronchoscopies were used to measure DNA and cytokine levels. MEASUREMENTS AND MAIN RESULTS: BALF DNA levels for the 6 pediatric burn subjects were highest within the first 72 hours after burn injury and declined thereafter. At the early stages after injury, BALF DNA levels (median [min, max] 3789 [1170,11917] ng/ml) were similar to those in adult burn patients and pediatric cystic fibrosis or bronchiectasis patients, and higher than those in pediatric recurrent pneumonia patients. BALF DNA levels in children and adults with inhalation injury correlated significantly with BALF IL-6, IL-8, and TGF-β1 levels. The patient with the most severe early visible airway mucosal damage and soot pattern at bronchoscopy, as well as the most extensive burns, also had the highest average early BALF DNA level (11917ng/ml) and the longest ventilator course and hospital stay. Procedures were well tolerated. CONCLUSIONS: In children with acute burn and inhalational injury, airway cellular damage and inflammation (reflected in high BALF DNA levels) appear to peak during the first 72 hours after burns or inhalation injury followed by a slow decline. Serial analysis of factors in airway secretions is feasible and has the potential to reveal important pathophyisiologic pathways and therapeutic targets for treatment of acute inhalational injuries