Objective: Splanchnic oximetry, as measured by near-infrared spectroscopy (NIRS), correlates with gastric tonometry as a means of assessing regional (splanchnic) oxygenation and perfusion. Design: Prospective, data-gathering study. Setting: Pediatric cardiac intensive care unit in a tertiary care children's hospital. Subjects: Neonates and infants with congenital heart disease who underwent catheter intervention or surgical repair requiring cardiopulmonary bypass. Interventions: None. Measurements and Main Results: Twenty neonates and infants were studied within 48 hrs of surgery. We measured somatic saturation (rSO2) via NIRS sensors placed over the anterior abdomen (splanchnic bed) and dorsal lateral flank (renal bed). Somatic rSO2 readings were paired with simultaneous points of intramucosal gastric pH (pHi), measured by tonometry. The rSO2 readings were paired with serum lactate and measurements of systemic mixed venous saturation (So2). There was strong correlation between the abdominal rSO2 and pHi (r = .79; p < .0001) as well as between abdominal rSO2 and So2 (r = .89; p < .0001). There was also significant negative correlation between the abdominal rSO2 and serum lactate (r = .77; p < .0001). Correlations between the dorsal lateral (renal) rSO2 measurements and serum lactate and So2 were also significant but not as strong. Conclusions: Abdominal site rSO2, measured in infants with either single or biventricular physiology, exhibits a strong correlation with gastric pHi as well as with serum lactate and So2. The results indicate that rSO2 measurements over the anterior abdominal wall correlate more strongly than flank rSO2 with regard to systemic indices of oxygenation and perfusion. This study suggests that the NIRS monitor is a valid modality to obtain an easy, immediate, and noninvasive measurement of splanchnic rSO2 in infants following cardiac surgery for congenital heart disease.
Objectives: To assess if morphine pharmacokinetics are different in children with Down syndrome when compared with children without Down syndrome. Design: Prospective single-center study including subjects with Down syndrome undergoing cardiac surgery (neonate to 18 yr old) matched by age and cardiac lesion with non-Down syndrome controls. Subjects were placed on a postoperative morphine infusion that was adjusted as clinically necessary, and blood was sampled to measure morphine and its metabolites concentrations. Morphine bolus dosing was used as needed, and total dose was tracked. Infusions were continued for 24 hours or until patients were extubated, whichever came first. Postinfusion, blood samples were continued for 24 hours for further evaluation of kinetics. If patients continued to require opioid, a nonmorphine alternative was used. Morphine concentrations were determined using a unique validated liquid chromatography tandem-mass spectrometry assay using dried blood spotting as opposed to large whole blood samples. Morphine concentration versus time data was modeled using population pharmacokinetics. Setting: A 16-bed cardiac ICU at an university-affiliated hospital. Patients: Forty-two patients (20 Down syndrome, 22 controls) were enrolled. Interventions: None. Measurements and Main Results: The pharmacokinetics of morphine in pediatric patients with and without Down syndrome following cardiac surgery were analyzed. No significant difference was found in the patient characteristics or variables assessed including morphine total dose or time on infusion. Time mechanically ventilated was longer in children with Down syndrome, and regarding morphine pharmacokinetics, the covariates analyzed were age, weight, presence of Down syndrome, and gender. Only age was found to be significant. Conclusions: This study did not detect a significant difference in morphine pharmacokinetics between Down syndrome and non-Down syndrome children with congenital heart disease.
Abstract Background Although survival to hospital discharge among children requiring extracorporeal membrane oxygenation support for medical and surgical cardio-circulatory failure has been reported in international registries, extended survival and re-hospitalisation rates have not been well described in the literature. Material and methods This is a single-institution, retrospective review of all paediatric patients receiving extracorporeal membrane oxygenation for primary cardiac dysfunction over a 5-year period. Results A total of 74 extracorporeal membrane oxygenation runs in 68 patients were identified, with a median follow-up of 5.4 years from hospital discharge. Overall, 66% of patients were decannulated alive and 25 patients (37%) survived to discharge. There were three late deaths at 5 months, 20 months, and 6.8 years from discharge. Of the hospital survivors, 88% required re-hospitalisation, with 63% of re-admissions for cardiac indications. The median number of hospitalisations per patient per year was 0.62, with the first re-admission occurring at a mean time of 9 months after discharge from the index hospitalisation. In all, 38% of patients required further cardiac surgery. Conclusions Extended survival rates for paediatric hospital survivors of cardiac extracorporeal membrane oxygenation support for medical and post-surgical indications are encouraging. However, re-hospitalisation within the first year following hospital discharge is common, and many patients require further cardiac surgery. Although re-admission hospital mortality is low, longer-term follow-up of quality-of-life indicators is required.
Searching for evidence of inflation by measuring B-modes in the cosmic microwave background (CMB) polarization at degree angular scales remains one of the most compelling experimental challenges in cosmology. BICEP2 and the Keck Array are part of a program of experiments at the South Pole whose main goal is to achieve the sensitivity and systematic control necessary for measurements of the tensor-to-scalar ratio at σ(r) ~0:01. Beam imperfections that are not sufficiently accounted for are a potential source of spurious polarization that could interfere with that goal. The strategy of BICEP2 and the Keck Array is to completely characterize their telescopes' polarized beam response with a combination of in-lab, pre-deployment, and on-site calibrations. We Sereport the status of these experiments, focusing on continued improved understanding of their beams. Far-field measurements of the BICEP2 beam with a chopped thermal source, combined with analysis improvements, show that the level of residual beam-induced systematic errors is acceptable for the goal of σ(r) ~ 0:01 measurements. Beam measurements of the Keck Array side lobes helped identify a way to reduce optical loading with interior cold baffles, which we installed in late 2013. These baffles reduced total optical loading, leading to a ~ 10% increase in mapping speed for the 2014 observing season. The sensitivity of the Keck Array continues to improve: for the 2013 season it was 9:5 μK _/s noise equivalent temperature (NET). In 2014 we converted two of the 150-GHz cameras to 100 GHz for foreground separation capability. We have shown that the BICEP2 and the Keck Array telescope technology is sufficient for the goal of σ(r) ~ 0:01 measurements. Furthermore, the program is continuing with BICEP3, a 100-GHz telescope with 2560 detectors.
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The purpose of this retrospective medical chart review was to describe dosing regimens and outcomes in children who received continuous pentobarbital therapy for refractory status epilepticus. Thirty patients (age = 6.5 ± 5.1 years; 67% male) received a mean loading dose of 5.4 ± 2.8 mg/kg with an initial infusion of 1.1 ± 0.4 mg/kg/h. Maximum infusion dose was 4.8 ± 2 mg/kg/h. Thirty-three percent of patients achieved sustained burst suppression without relapse; 66.7% experienced relapse, but 60% of those (n = 12) eventually reachieved burst suppression. Children achieving burst suppression within 24 hours of pentobarbital initiation and those older than age 5 years were 1.5 times more likely to have a positive outcome. None of these variables, however, achieved significance (Fisher exact test). Ninety-three percent of patients required inotropes; 66% acquired an infection; 10% had metabolic acidosis; and 10% experienced pancreatitis. Poor outcomes (death, encephalopathy) were observed in 33% of patients.
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