Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: A prospective study

ObjectiveOur objective was to define the relationship between surgical technical performance score, intraoperative adverse events, and major postoperative adverse events in complex pediatric cardiac repairs.MethodInfants younger than 6 months were prospectively followed up until discharge from the hospital. Technical performance scores were graded as optimal, adequate, or inadequate based on discharge echocardiograms and need for reintervention after initial surgery. Case complexity was determined by Risk Adjustment in Congenital Heart Surgery (RACHS-1) category, and preoperative illness severity was assessed by Pediatric Risk of Mortality (PRISM) III score. Intraoperative adverse events were prospectively monitored. Outcomes were analyzed using nonparametric methods and a logistic regression model.ResultsA total of 166 patients (RACHS 4-6 [49%]), neonates [50%]) were observed. Sixty-one (37%) had at least 1 intraoperative adverse event, and 47 (28.3%) had at least 1 major postoperative adverse event. There was no correlation between intraoperative adverse events and RACHS, preoperative PRISM III, technical performance score, or postoperative adverse events on multivariate analysis. For the entire cohort, better technical performance score resulted in lower postoperative adverse events, lower postoperative PRISM, and lower length of stay and ventilation time (P < .001). Patients requiring intraoperative revisions fared as well as patients without, provided the technical score was at least adequate.ConclusionsIn neonatal and infant open heart repairs, technical performance score is one of the main predictors of postoperative morbidity. Outcomes are not affected by intraoperative adverse events, including surgical revisions, provided technical performance score is at least adequate

Therapeutic plasma exchange for pediatric nonrenal disease indications and outcomes: A single-center experience

Introduction: Outcome data in pediatric plasma exchange, especially in nonrenal indications are scarce. We aimed to evaluate its role and outcome in our patients. Subjects and Methods: A retrospective study of children admitted in the year 2016 to the Pediatric Intensive Care Unit requiring plasma exchange for nonrenal indications was undertaken. Plasma exchange was given as adjunctive therapy along with primary treatment for the disease concerned. Demographic and clinical data were studied, and descriptive statistical analysis was carried out. Results: Ten children underwent plasma exchange during this 1-year period with a male: female ratio of 3:2 and a mean age of 10 years (range 3–16 years). The indications were acute disseminated encephalomyelitis (n = 2), acute neuromyelitis optica (n = 1), catastrophic antiphospholipid antibody syndrome secondary to systemic lupus erythematosus (SLE) (n = 1), severe SLE with cerebritis/hemophagocytic lymphohistiocytosis (HLH) (n = 2), severe dengue sepsis with HLH/multi-organ dysfunction syndrome (n = 2), and thrombotic microangiopathy secondary to snake bite envenomation (n = 2). All received either 1.5 or 2 times plasma volume exchange (mean sessions – 4, range = 1–6). The mean duration of stay in hospital was 17.2 days (range = 3–40 days), and follow-up was 78 days (range = 3–180 days), with the majority of children (8/10, 80%) survived from the catastrophic illness at the time of discharge. Two children (2/10, 20%) succumbed due to the disease per se in severe dengue sepsis in one and enterobacteriaceae sepsis (hospital-acquired pneumonia) in another. Conclusion: Plasma exchange was found to be beneficial as complementary therapy in a critical care setting, especially for nonrenal indications

Re-imagining Inclusive Urban Futures for Transformation

The complex nature of urbanization across the globe, and the seemingly insurmountable challenges of transforming urban futures require multi-disciplinary, multi-stakeholder research efforts across diverse geographies. The partnership for Re-imagining Inclusive Urban Futures for Transformation (RIUFT) brings together academic, civil society and government actors to advance conceptual and practical understanding of how to reconfigure urban futures. RIUFT builds on existing networks engaged in research and policy influence, but provides additional linkages across three distinct geographical regions, opening space for fresh analysis, critical reflection, and policy engagement. A critical aspect of the RIUFT is that research is embedded within government and civil society institutions in order to ensure that research is grounded in the political and institutional realities that shape state-society relations. A core challenge for RIUFT has been to ensure that the partnership is relevant to needs of diverse partners and that it is greater than the sum of its parts; that there is joint ownership, added value in individual partner's engagement and opportunities for meaningful cross-fertilization, co-production of knowledge that incorporate learning from different partners and locations. This paper focuses on critical elements of the partnership co-design process: facilitating a process of co-production through participatory shared learning exercises; building on working within state and civil society organizations and institutional processes; and creating mechanisms for critical reflection, exchange and learning across partners