Publications by authors named "Rashed A Hasan"

28 Publications

  • Page 1 of 1

The Two-bag System for Intravenous Fluid Management of Children with Diabetic Ketoacidosis: Experience from a Community-Based Hospital.

Glob Pediatr Health 2021 24;8:2333794X21991532. Epub 2021 Jan 24.

Hurley Medical Center, Flint, MI, USA.

Intravenous fluid (IVF) administration using the two-bag system compared with the one-bag system in children with diabetic ketoacidosis (DKA) admitted between January 1, 2015 and December 31, 2016. Retrospective cohort study. Community-based hospital. A total of 109 patients were enrolled with a mean age of 13.24 years. The 2 groups had comparable demographics. Initial laboratory results were similar except for initial PH and Sodium. The two bag system had significantly less number of calls compared to one bag system (25.2 vs 5.2  = .0001). One bag system had fewer hypoglycemia <60 mg/dl (4 vs 12  = .049). No statistically significant observations noted in regards to glucose drop rate, number of intravenous fluid bags used, amount of fluid boluses given, hospital stay and Pediatric ICU stay. The two-bag system has less resource utilization and slower blood glucose drop rate, but higher hypoglycemic events.
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http://dx.doi.org/10.1177/2333794X21991532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841651PMC
January 2021

Pulmonary tuberculosis outbreak in a pediatric population.

Clin Pediatr (Phila) 2013 Jul 25;52(7):589-92. Epub 2013 Feb 25.

Advocate Hope Children's Hospital, Oak Lawn, IL, USA.

Community-based outbreaks of Mycobacterium tuberculosis are uncommon in the United States but represent a dramatic type of epidemic that can lead to considerable investigations. Most of our knowledge regarding spread of tuberculosis (TB) has accumulated from the study of outbreaks. We describe the most recent outbreak of TB in Genesee County, Michigan. In February 2007, isoniazid-sensitive infectious pulmonary TB was identified in a 45-year-old African American grandmother who frequently provided care for her grandchildren and other children. The source case was reported to the Genesee County Health Department, which started an investigation to identify family and social contacts. We reviewed past medical records of contacts and prioritized them for evaluation based on the period of exposure to the index case. Health department staff screened contacts using clinical evaluation, tuberculin skin test, and chest radiography when indicated. Results were reviewed, and data were analyzed using descriptive inferential and epidemiological statistics.
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http://dx.doi.org/10.1177/0009922813477913DOI Listing
July 2013

Plastic bronchitis in children.

Fetal Pediatr Pathol 2012 Apr 16;31(2):87-93. Epub 2012 Feb 16.

Mercy Children's Hospital, Pediatric Intensive Care Unit, Toledo, Ohio 43608, USA.

Cast or plastic bronchitis (PB) is an unusual disorder that is rarely encountered in children. Plastic bronchitis is characterized by widespread formation of casts in the tracheobronchial tree with partial or complete airway obstruction. The pathologist may receive bronchial casts that have been removed by bronchoscopy for gross and histopathologic analysis. We describe two children with PB in the setting of an apparent lower respiratory tract infection, where the bronchoscopic removal of major cast segments was associated with a favorable outcome. Patients' clinical and radiographic features and gross anatomic and histopathologic characteristics of casts are presented.
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http://dx.doi.org/10.3109/15513815.2011.650289DOI Listing
April 2012

Lipoxin A(4) and 8-isoprostane in the exhaled breath condensate of children hospitalized for status asthmaticus.

Pediatr Crit Care Med 2012 Mar;13(2):141-5

Providence Hospital and Medical Center, Toledo, OH, USA.

Objective: To measure levels of 8-isoprostane and Lipoxin A4 in the exhaled breath condensate of children (7-17 yrs old) recovering from status asthmaticus in a pediatric intensive care unit and to compare their respective levels in the exhaled breath condensate collected from age-matched "healthy" children enrolled from an ambulatory pediatric clinic during well-child visits.

Design: Prospective case-controlled study.

Setting: Teaching hospitals and a research laboratory.

Patients: Children recovering from status asthmaticus and age-matched controls.

Interventions: Collection of exhaled breath condensate from patients recovering from status asthmaticus and controls for purpose of measurement of 8-isoprostane and Lipoxin A4.

Measurements And Main Results: There was no difference in age (11.9 ± 3.0 vs. 12.0 ± 3.3 yrs, p = .9) between patients and control subjects. All participants completed the exhaled breath condensate collection without complications. There was no difference in the pulmonary index (3.3 ± 2.2 vs. 3.1 ± 1.9, p = 1.0) after collection of exhaled breath condensate compared with baseline values in patients with status asthmaticus. The level of 8-isoprostane was significantly higher (63 ± 9 vs. 41 ± 13 pg/mL, p < .001), whereas the level of Lipoxin A4 was significantly lower (5.6 ± 2.9 vs. 10.5 ± 3.1 ng/mL, p < .001) in the exhaled breath condensate from children recovering from status asthmaticus compared with control subjects.

Conclusions: 8-Isoprostane was elevated and Lipoxin A4 is decreased in the exhaled breath condensate of children recovering from status asthmaticus in a pediatric intensive care unit. These data may provide new insight into the pathophysiology of asthma in children in this clinical setting.
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http://dx.doi.org/10.1097/PCC.0b013e3182231644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078922PMC
March 2012

Intussusception caused by heterotopic pancreatic tissue in a child.

Fetal Pediatr Pathol 2011 ;30(2):106-10

Inpatient Pediatric Services, Mercy Children's Hospital, Toledo, Ohio 43608, USA.

Intussusception is the leading cause of intestinal obstruction in children and is almost invariably idiopathic. Occasionally, there is a lead point for the intussusception. Intussusception caused by heterotopic pancreas (HPT) as the lead point is exceedingly rare. We report a case of intussusception caused by HPT in a child. Clinical and pathologic features and the successful medical and surgical management of the case are discussed.
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http://dx.doi.org/10.3109/15513815.2010.524688DOI Listing
June 2011

Economic impacts of bronchiolitis.

Authors:
Rashed A Hasan

Pediatrics 2011 Feb;127(2):e514; author reply e515-6

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http://dx.doi.org/10.1542/peds.2010-3630BDOI Listing
February 2011

High-frequency oscillatory ventilation in an infant with necrotizing pneumonia and bronchopleural fistula.

Respir Care 2011 Mar 16;56(3):351-4. Epub 2010 Nov 16.

Pediatric Critical Care Services, Mercy Children's Hospital, Toledo, OH, USA.

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http://dx.doi.org/10.4187/respcare.00697DOI Listing
March 2011

Hospital-acquired hyponatremia in postoperative pediatric patients.

Authors:
Rashed A Hasan

Pediatr Crit Care Med 2011 Jan;12(1):121-2; author reply 122

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http://dx.doi.org/10.1097/PCC.0b013e3181fe3d3bDOI Listing
January 2011

8-Isoprostane in the exhaled breath condensate of children hospitalized for status asthmaticus.

Pediatr Crit Care Med 2011 Jan;12(1):e25-8

Pediatric Critical Care Medicine, Mercy Children's Hospital, Toledo, OH, USA.

Objective: To evaluate the safety and feasibility of exhaled breath condensate (EBC) collection in children recovering from status asthmaticus (SA) in a pediatric intensive care unit (PICU); and to investigate whether 8-isoprostane (8-Iso) could be detected in the EBC of these children and to compare its concentration with that in the EBC collected from healthy children.

Design: Prospective study.

Setting: Multidisciplinary PICU in a teaching hospital.

Patients: Sixteen consecutive patients (7-18 yrs of age) with SA and 16 age- and sex-matched controls.

Interventions: The Wood clinical asthma score and the pulmonary index were used to assess the clinical severity of patients with SA upon admission to the PICU. EBC samples were collected within 24 hrs of admission to the PICU and were analyzed for the concentration of 8-Iso.

Measurements And Main Results: Data are presented as mean ± sd values. There were no differences in age (12 ± 3.3 yrs vs.12 ± 2 yrs, p > .05) or sex (n = 10 males and n = 6 females in each group), between SA patients and controls. All patients with SA and the controls completed the EBC collection without complications. There was no statistically significant difference in the pulmonary index (3.2 ± 2.7 vs. 3.1 ± 2.8, p 0.9) post collection of EBC compared with the baseline values. There was a statistically significant correlation between Wood score and pulmonary index at the time of admission to the PICU in children with SA (r = .7, p < .01). The concentration of 8-Iso was significantly higher in the EBC of children with SA compared with controls (14.3 ± 1.8 pg/mL vs. 5.2 ± 0.7 pg/mL, p < .001). The correlation between the concentration 8-Iso and either the pulmonary index or Wood score at the time admission to the PICU was not statistically significant.

Conclusions: EBC collection is well tolerated by children aged 7-18 yrs who are recovering from SA in a PICU. 8-Iso is elevated in the EBC from children with SA and may provide insight into the biochemical changes of oxidative stress in children in this clinical setting.
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http://dx.doi.org/10.1097/PCC.0b013e3181dbeac6DOI Listing
January 2011

Effects of flow rate and airleak at the nares and mouth opening on positive distending pressure delivery using commercially available high-flow nasal cannula systems: a lung model study.

Pediatr Crit Care Med 2011 Jan;12(1):e29-33

Department of Pediatrics, Mercy Children's Hospital, Toledo, OH, USA.

Objectives: Use of high-flow humidified nasal cannulas to deliver continuous positive airway pressure in children is increasing. Data on the relationship between the flow values and the corresponding pressures are limited. The purpose of this experiment was to evaluate the relationship between the device, intraprong, and proximal airway pressures and the flow values in a neonatal/pediatric test lung model, using the Vapotherm 2000i and Fisher-Paykel humidified nasal cannulas devices.

Methods: Using a pediatric size cannula (2-mm inner diameter), we measured the device, intraprong, and proximal airway pressures at random flow values between 0 L/min and 12 L/min with an FIO2 of 0.21 at a temperature of 37°C and 100% humidity. Measurements were repeated for both devices under simulated minimal and moderate nares-prong leak (leak). Effects of varying mouth leak were also studied.

Results: All three pressures generally increased with increasing flows with both devices, irrespective of leak. In case of minimal leak, the Fisher-Paykel device generated larger pressures than the Vapotherm device for flows of < 8 L/min, whereas this trend was reversed at higher flows due principally to the pressure release feature of the Fisher-Paykel system. Under minimal leak, the intraprong pressure values varied between 22% and 27% and 20% and 32% of the corresponding device pressure value for Fisher-Paykel and Vapotherm, respectively. The proximal airway pressure was further reduced by about 20% to 30% relative to the intrapong pressure values with the two devices. The device pressure was essentially unaffected by nares-prong leaks or mouth leak. The intraprong pressure and particularly the proximal airway pressure were reduced substantially, as either nares or mouth leak increased.

Conclusions: High flow humidified nasal cannulas systems may deliver uncontrolled continuous positive airway pressure to infants. This, along with the potentially large nares and mouth leak effects on any form of continuous positive airway pressure, renders the effective humidified nasal cannulas delivered continuous positive airway pressure particularly unpredictable.
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http://dx.doi.org/10.1097/PCC.0b013e3181d9076dDOI Listing
January 2011

Sedation with propofol for flexible bronchoscopy in children.

Pediatr Pulmonol 2009 Apr;44(4):373-8

St. Vincent Mercy Children's Hospital, Toledo, Ohio, USA.

Background: The purpose of this study was to report our experience with intravenous propofol (IVP) sedation for flexible bronchoscopy (FB) in children.

Methods: The following data were collected: demographics, pre- and post-procedure diagnoses, induction time (IT), sedation time (ST), procedure time (PT), time to discharge from the hospital (TTD), induction dose (ID) of IVP, total dose (TD) of IVP, and complications. HR, RR, systolic BP (SBP), diastolic BP (DBP), and SpO(2) were recorded every 5 min.

Results: One hundred three (66 males, 37 females) consecutive patients (age: 4.7 +/- 4.3 years) and (weight: 21.2 +/- 16 kg) were enrolled over a 3-year-period. Airway Abnormalities were diagnosed in 93 (90%) patients leading to a change in therapy in 68 (66%) patients. In 20 (19.4%) patients abnormalities unrelated to the primary indication for FB were found. IT was 4.64 +/- 2 min, PT was 6.2 +/- 3.1 min, ST was 27 +/- 14 min, and TTD was 80 +/- 44 min.The ID and TD for IVP were 2.8 +/- 0.1 mg/kg, and 3.1 +/- 0.1 mg/kg respectively. Patients 4-7 years of age required higher induction doses (IDs) of propofol (3.5 +/- 1 mg/kg) compared to infants (2.8 +/- 0.9 mg/kg), 1-3 years of age (2.7 +/- 0.78 mg/kg) and 8-17 years of age (2.4 +/- 0.7 mg/kg) (P < 0.001). There was a correlation between the TD of IVP and TTD from the hospital (r = 0.5, P < 0.01). The drop in SBP (104 +/- 15 vs. 92 +/- 13 mm Hg, P < 0.05) and DBP (57 +/- 13 vs. 46 +/- 9 mm Hg, P < 0.05) during IVP were statistically significant compared to baseline, however none of the patients met the criteria for hypotension. Two patients developed short (<20 sec) respiratory pauses without hypoxia. No patient required fluid resuscitation or endotracheal intubation.

Conclusions: FB may be performed successfully in children using IVP and is associated with insignificant cardio-respiratory complications.
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http://dx.doi.org/10.1002/ppul.21013DOI Listing
April 2009

The relationship between asthma and overweight in urban minority children.

J Natl Med Assoc 2006 Feb;98(2):138-42

Michigan State University, Pediatric Critical Care and Pulmonary Medicine, Flint, MI, USA.

Background: This study was performed to determine the relationship between overweight [body mass index (BMI) > or = 85th percentile] and asthma as determined by spirometry.

Method: Spirometry was performed according to the American Thoracic Society guidelines, and BMI was calculated. Asthma was defined as a forced expiratory volume in 1 second (FEV1) <80% predicted and FEV1/forced vital capacity (FVC) >5% lower than predicted for age and sex.

Results: One-hundred-nine children (age 14.7 +/- 1.6 years) were enrolled. Eighty children (73%) were African-American, and 29 children (27%) were white. Fifty-eight (53%) children were overweight. Twelve (11%) children, of whom nine (75%) were overweight, met the criteria for asthma. Baseline FEV1 percent predicted (87 +/- 6% vs. 83 +/- 7%, p=0.03), FEV1/FVC (93 +/- 6 vs. 87 +/- 8, p<0.001), and FEV1 percent predicted following albuterol administration (94 +/- 7 vs. 89 +/- 7%, p=0.03) were all lower in overweight children. Children with asthma were almost 1.5 times more likely to be overweight compared with children without asthma (relative risk: 1.49, 95% confidence interval: 1.015-2.17).

Conclusions: Inner-city children are more likely to be overweight compared to the general population. Asthma is a risk factor for overweight in these children.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2595039PMC
February 2006

Invasive aspergillosis in children with hematologic malignancies.

Paediatr Drugs 2006 ;8(1):15-24

Michigan State University, Hurley Medical Center, Flint, Michigan 48503, USA.

The respiratory tract is the most common system affected by aspergillosis in children with hematologic malignancies. However, Aspergillus spp. tend to invade blood vessels, resulting in systemic dissemination to multiple organs including, but not limited to, the brain, bones, liver, kidneys, and skin. Because early diagnosis and treatment are critical to the patient's outcome, a high index of suspicion should be maintained in children with hematologic malignancies who are neutropenic and have prolonged fever that is unresponsive to systemic antibacterials. Several diagnostic modalities should be used simultaneously in order to establish the diagnosis in an expeditious manner. Detailed radiographic evaluations with plain radiographs, and CT scans of the chest, sinuses, brain, and other organs should be performed as soon as clinical suspicion is raised. Detection of circulating antigens, such as galactomannan and 1,3-beta-glucan, and polymerase chain reaction appear promising in aiding in the diagnosis. A definitive diagnosis requires both a positive culture from a sterile site and evidence of tissue damage demonstrated by imaging studies or microscopic evaluations of sites of infection. Because the mortality rate is very high, empiric systemic antifungal therapy with amphotericin B, or one of its lipid formulations, should be initiated while laboratory investigations to substantiate or refute the diagnosis are continued. Surgical intervention is associated with a high mortality rate but may be of benefit in children with localized disease.
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http://dx.doi.org/10.2165/00148581-200608010-00002DOI Listing
September 2006

Necrotizing fasciitis caused by Aeromonas hydrophilia in an immunocompetent child.

Pediatr Emerg Care 2006 Jan;22(1):48-51

Pediatric Infectious Disease, Hurley Medical Center, Michigan State University, East Lansing, MI 48503, USA.

Necrotizing fasciitis is a rapidly progressive and potentially fatal infection. It is characterized by extensive subcutaneous and muscle necrosis. Aeromonus hydrophilia is a gram-negative faculatively anaerobic bacillus that is part of the normal flora of nonfecal sewage and is found in most water systems, soil, and fresh brackish water. Necrotizing fasciitis caused by A. hydrophilia have occurred in children who had underlying systemic diseases or immune dysfunction. We report a 14-year-old boy without underlying systemic diseases or immunodeficiency who developed necrotizing fasciitis secondary to A. hydrophilia and he was successfully treated with extensive surgical debridement and systemic antibiotics.
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http://dx.doi.org/10.1097/01.pec.0000195755.66705.f8DOI Listing
January 2006

Kawasaki disease hospitalizations in a predominantly African-American population.

Clin Pediatr (Phila) 2005 Oct;44(8):721-5

Pediatric Infectious Disease, Hurley Medical Center--Michigan State University, Flint 48503, USA.

This is a descriptive study of the occurrence of Kawasaki disease (KD) in an urban population that was a majority of African Americans. Records of 189 children (mean age, 2.9 +/- 2.2 years [range: 2 months to 11.1 years]) hospitalized for KD over 8 years (January 1, 1992 to December 31, 1999) were reviewed and data analyzed. One hundred thirty-six (72%) were African American (AA), 43 (23%) were white, and 9 (5%) children were "others.'' The annual frequency was 15 for AA and 7.7 for white per 100,000 5-year-old children. Coronary artery abnormalities (CAA) were reported in 21 (11%) children (18 [13.2%] of 136 AA, and 3 [4.7%] of 43 whites [p=0.095]). AA children with CAA were older than their white counterparts (26 to 24 vs. 5 to 2.8 months, p=0.03). There was a higher occurrence in winter and spring (110 cases [58%] vs. 79 cases [42%]) compared to summer and fall. KD occurrence was positively associated with average monthly snowfall (r=0.35, p=0.004) and inversely associated with average monthly temperature (r = - 0.2, p=0.048). African-American children were more likely to be hospitalized for KD compared to white children. The association of KD with temperature and precipitation suggest that it is influenced by environmental factors.
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http://dx.doi.org/10.1177/000992280504400812DOI Listing
October 2005

Obesity and asthma.

J Pediatr 2005 May;146(5):714; author reply 714-5

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http://dx.doi.org/10.1016/j.jpeds.2004.11.013DOI Listing
May 2005

Variceal hemorrhage 13 years after nephrectomy for Wilms tumor.

J Pediatr Gastroenterol Nutr 2005 May;40(5):600-2

Michigan State University College of Human Medicine, Hurley Medical Center, Flint, Michigan, USA.

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http://dx.doi.org/10.1097/01.mpg.0000155564.87150.c2DOI Listing
May 2005

Group A beta-hemolytic streptococcal bacteremia.

Indian J Pediatr 2004 Oct;71(10):915-9

Michigan State University, Hurley Medical Center, Flint, Michigan, USA.

Objective: The aim of this study was to review the clinical features, laboratory findings and the risk factors associated with invasive group A streptococcal infections in children admitted to our institution over a 9-year period (January 1, 1990 through December 31, 1999).

Methods: Medical records of children who had a positive blood culture for group A beta-hemolytic streptococci and children who had this organism isolated from any other sterile site were identified and retrospectively reviewed.

Results: Forty-one children with invasive GAS were identified, of whom 15 (36%) were diagnosed between 1990 and 1994, while the balance (26 patients, 63%) were diagnosed between 1995 and 1999 (p< 0.05). The mean age was 4.3 +/- 2.5 years (age range: 2 months to 16 years). Thirteen (32%) patients were infants. Sixteen patients had only bacteremia, while 25 patients had in addition to bacteremia the following: cellulitis (n: 13), osteomyelitis (n: 6), pneumonia (n: 3), meningitis (n: 1), pharyngitis (n:3) and Toxic Shock Syndrome (n: 2). Primary varicella infection constituted the most common predisposing factor for invasive GAS infections and occurred in 11 (27%) patients. Leukocytosis (A white blood cell count > 15,000/mm3) occurred in 21 (51 %) patients, while leukopenia (A white blood cell count < 5000/mm3) occurred in 2 patients. Parenteral crystalline penicillin G followed by oral penicillin or amoxicillin were the most common antibiotics administered. The mean hospital length of stay was 8 days (range: 6 -32 days). All, but one patient survived. The one patient who died had malnutrition and died from streptococcal toxic shock syndrome.

Conclusion: More cases of invasive GAS were diagnosed during the second half of the study period, however, the overall rate of occurrence of bacteremia during the study period was consistent with previous reports. Primary varicella infection was the most common predisposing factor for invasive GAS infections. The low occurrence of toxic shock syndrome and fatalities among children with invasive GAS infections are consistent with other pediatric but not with adult series.
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http://dx.doi.org/10.1007/BF02830836DOI Listing
October 2004

Oral dextromethorphan reduces perioperative analgesic administration in children undergoing tympanomastoid surgery.

Otolaryngol Head Neck Surg 2004 Nov;131(5):711-6

Michigan State University, Southfield, MI, USA.

Objective: To determine whether oral dextromethorphan (1 mg/kg) given one hour prior to surgery decreases opioid administration in the perioperative period in children undergoing tympanomastoid surgery.

Methods: This was a prospective randomized double-blinded and placebo-controlled study in which 20 male and 18 female children (age 11.5 +/- 3.5 years) were enrolled. Nineteen children received dextromethorphan (DM), while the other 19 received placebos. Postoperative pain was assessed using a visual analogue scale and a pain score of > or =5 was treated with intravenous morphine sulfate. Patients were discharged home on oral oxycodone.

Results: The total doses of fentanyl administered during surgery were higher in the placebo group compared to the DM group (4.1 +/- 2 vs 2.6 +/- 1.4 microg/kg, P = 0.02) and the total doses of intravenous morphine administered in the postoperative period were also higher in the placebo group compared to the DM group (150 +/- 80 vs 73 +/- 56 microg/kg, P = 0.004). The placebo group had a higher pain score at the time of admission to the Day Surgery Unit (DSU) and a higher maximum pain score, compared to the DM group, during their combined stay in the Post-Anesthesia Care Unit and DSU (7.3 +/- 1.5 vs 3.1 +/- 2.6, P = 0.001).

Conclusions: Premedication with DM reduces the need for opioid administration in the perioperative period in children undergoing tympanomastoid surgery.

Ebm Rating: A.
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http://dx.doi.org/10.1016/j.otohns.2004.06.709DOI Listing
November 2004

Ambulatory tympanomastoid surgery in children: factors affecting hospital admission.

Arch Otolaryngol Head Neck Surg 2004 Oct;130(10):1158-62

Department of Pediatrics, Michigan State University, East Lansing, MI, USA.

Objective: To identify clinical factors associated with postoperative nausea and vomiting (PONV) and failure to discharge from the hospital on the day of surgery in children undergoing tympanomastoid surgery.

Design: Records of 144 children undergoing 152 tympanomastoid surgical procedures from July 1, 2001, through June 30, 2002, were retrospectively reviewed and the data analyzed.

Setting: A tertiary care university-affiliated hospital.

Results: The mean +/- SD age of the cases was 11 +/- 3.7 years. Sixty-eight cases (45%) were middle ear procedures, while 84 cases (55%) were mastoid procedures. Forty-three cases (28%) were discharged home from the postanesthesia care unit (PACU), 55 cases (36%) were discharged on the day of surgery, and 142 cases (92%) were discharged home from the day surgery unit (DSU) within 23 hours after surgery. Patients who underwent mastoid procedures were more likely to require intravenous (IV) morphine sulfate in the PACU (75% vs 56%; P = .02) and were less likely to be discharged from PACU (15% vs 44%; P<.001) compared with patients who had middle ear procedures. In patients who underwent mastoid procedures, the presence of cholesteatoma (odds ratio, 1.9; 95% confidence interval, 1.0-3.7; P = .04) was associated with a higher likelihood of PONV. In both groups, the need for IV morphine sulfate to control pain on admission to DSU was associated with a higher occurrence of PONV. Factors that were significantly associated with failure to discharge from the hospital on the day of surgery were a pain score of 5 or greater, the presence of PONV, and the requirement of IV morphine sulfate on admission to DSU.

Conclusions: Factors associated with higher risks of PONV and failure to discharge from the hospital on the day of surgery include the presence of cholesteatoma, a pain score of 5 or greater, and the requirement of IV morphine sulfate at the time admission to the DSU.
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http://dx.doi.org/10.1001/archotol.130.10.1158DOI Listing
October 2004

Treatment of invasive Aspergillosis in children with hematologic malignancies.

Indian J Pediatr 2004 Sep;71(9):837-43

Pediatric Infectious Disease, Hurley Medical Center, Michigan State University, Hurley Medical Center, Flint, Michigan 48503, USA.

The respiratory tract is the most common organ involved with Aspergillosis in children with hematologic malignancies. Also Aspergillus species tend to invade blood vessels resulting in systemic dissemination to multiple organs. Early diagnosis and treatment are pivotal to the patient's outcome. A high index of suspicion should be maintained in children who have profound neutropenia and present with prolonged fever that is unresponsive to systemic antibiotics. Several diagnostic modalities should be used simultaneously in order to confirm the diagnosis in an expedited manner. Combination and sequential antifungal therapy have been shown to be of added benefit. Surgical intervention is associated with a high mortality rate, but may be indicated in children with a localized disease. In this article the authors review the epidemiology, microbiology, pathology, and clinical manifestations of invasive aspergillosis in children with hematologic malignancies. Current diagnostic approach, medical, and surgical treatment options are discussed.
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http://dx.doi.org/10.1007/BF02730724DOI Listing
September 2004

Neuroleptic malignant syndrome associated with ziprasidone in an adolescent.

Clin Ther 2004 Jul;26(7):1105-8

Department of Emergency Medicine, Wright State University, Ohio, USA.

Background: Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disorder characterized by fever, muscular rigidity, delirium, and autonomic instability. Although the classic presentation of NMS has been most commonly associated with the typical neuroleptic medications, sporadic cases in association with atypical neuroleptic medications have been reported.

Objective: We describe a case report of a pediatric patient with NMS associated with the use of the atypical antipsychotic medication ziprasidone hydrochloride.

Methods: After a MEDLINE search of relevant literature (key terms: atypical antipsychotic, ziprasidone, neuroleptic malignant syndrome, and NMS; years: 1995-2004), no reports of NMS in association with ziprasidone in the pediatric population were identified.

Results: The patient was a 15-year-old male adolescent with a history of schizoaffective disorder treated with ziprasidone capsules, 80 mg QD for 8 weeks prior to presentation. He was brought to the emergency department because the family noted that the child had a tactile fever; was rigid, diaphoretic, tremulous, and difficult to arouse; and had persistent urinary incontinence. The patient was admitted to the pediatric intensive care unit, where he remained rigid and unresponsive except for incoherent speech. He was treated for a presumptive diagnosis of NMS with IV dantrolene sodium (2 mg/kg q6h) to reduce the sequele of NMS; urinary alkalinization with sodium bicarbonate to maintain a urinary pH of 6.5 to 7.0; cardiac, pulse oximetry, and vital sign monitoring; and supportive care, including IV saline hydration.

Conclusion: We present this case to alert physicians of the possibility of NMS in adolescent patients treated with ziprasidone.
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http://dx.doi.org/10.1016/s0149-2918(04)90182-8DOI Listing
July 2004

Clinical outcome of perioperative airway and ventilatory management in children undergoing craniofacial surgery.

J Craniofac Surg 2004 Jul;15(4):655-61

Providence Hospital and Medical Centers, Southfield, Michigan, USA.

Data on the management of perioperative airway and ventilatory support in children undergoing craniofacial surgery are limited. The purpose of this study was to review the authors' experience with airway management and ventilatory support during the perioperative period in children undergoing craniofacial surgery. Ninety-five consecutive children underwent 99 craniofacial procedures from July 1, 1999, through June 30, 2002. Direct laryngoscopy was successfully used to establish an airway in 86 (86.8%) cases, whereas 13 (13.1%) cases required the use of fiberoptic bronchoscopy to establish an airway before surgery. The oral route was used in 82 (83%) cases, and the nasal route was used in 17 (17%) cases. Length of anesthesia was 330 +/- 160 minutes, and the actual surgical time was 246 +/- 151 minutes. The volume of crystalloids infused during surgery was 87 +/- 78 mL/kg body weight (BW), and the volume of packed red blood cells infused during surgery was 10 +/- 14 mL/kg BW (range, 0-60 mL/kg BW). Tracheal extubation was successfully accomplished in the postanesthesia recovery unit (PACU) in 57 (58%) patients, whereas 42 patients were admitted to the pediatric intensive care unit (PICU) and received mechanical ventilation for 10 +/- 9 hours (range, 1-60 hours). Of these, 37 (37%) were extubated in the PICU, whereas 5 patients were extubated in the operating room with the craniofacial surgeon in attendance in the event an emergency tracheostomy was needed. However, none of these patients required tracheostomy to maintain a secure airway. Three patients required reintubation after the first attempt at tracheal extubation in the PICU. All three of those patients subsequently were extubated without the need for tracheostomy. The length of tracheal intubation and mechanical ventilation was longer (24 +/- 13 hours versus 8.6 +/- 7 hours, P < 0.001) in patients who required bronchoscopic intubation than in those who were intubated using direct laryngoscopy. The length of hospital stay, although clinically relevant, did not reach statistical significance between the two groups (5 +/- 7 days versus 3.7 +/- 2.7 days, P = 0.5). A positive correlation was observed between the duration of tracheal intubation and mechanical ventilation and the following perioperative factors: anesthesia time (rho = 0.6, P < 0.01), surgical time (rho = 0.55, P < 0.01), volume of crystalloids (rho = 0.5, P < 0.01), and the volume of packed red blood cells infused (rho = 0.55, P < 0.01) during surgery. No episodes of cardiorespiratory arrest or death occurred in any of the patients. This study demonstrates that when performing complex craniofacial procedures in children, a thorough evaluation of the airway before surgery and continuous communication between specialists during the perioperative period is imperative for a successful outcome. Furthermore, most pediatric patients who require mechanical ventilation during the postoperative period do so for a short period of time following surgery.
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http://dx.doi.org/10.1097/00001665-200407000-00024DOI Listing
July 2004

beta-Hemolytic group F streptococcal bacteremia in children.

Pediatr Infect Dis J 2004 May;23(5):468-70

Michigan State University College of Human Medicine, Hurley Medical Center, Flint, MI, USA.

Group F beta-hemolytic streptococci cause purulent disease and bacteremia in adults. Infections with these organisms are rare in previously healthy children. We report three cases of group F beta-hemolytic streptococcal bacteremia in previously healthy infants and children diagnosed at a single institution during a period of 10 years. Two patients had associated meningitis, and one patient had perforated appendicitis with peritonitis.
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http://dx.doi.org/10.1097/01.inf.0000122610.65705.f2DOI Listing
May 2004

Fulminant hemorrhagic pneumonitis.

Clin Pediatr (Phila) 2004 Mar;43(2):205-7

Department of Pediatrics, Michigan State University, Hurley Medical Center, Flint, MI, USA.

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http://dx.doi.org/10.1177/000992280404300214DOI Listing
March 2004

Cardiorespiratory effects of naloxone in children.

Ann Pharmacother 2003 Nov;37(11):1587-92

Michigan State University, Hurley Medical Center, Flint, MI, USA.

Background: Data on the cardiorespiratory changes and complications following administration of naloxone in children are limited.

Objective: To evaluate the cardiorespiratory changes and complications following naloxone treatment in children.

Methods: The maximal changes in respiratory rate (RR), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and any complications within 1 and 2 hours following naloxone were tabulated.

Results: One hundred ninety-five children received naloxone over 3 years. The mean +/- SD age was 9.7 +/- 6 years. The total doses of naloxone ranged from 0.01 to 7 mg (0.001-0.5 mg/kg body weight), with a median dose of 0.1 mg. Group 1 patients consisted of 116 (60%) children who were postoperative and had been given naloxone by an anesthesiologist; group 2 patients consisted of 79 (40%) children who received naloxone in the emergency department or pediatric intensive care unit. Patients in group 1 were older: 10.6 +/- 5.3 versus 8.2 +/- 6.7 years (p < 0.006), but received significantly lower doses of naloxone (0.09 +/- 0.2 vs. 1.1 +/- 0.76 mg; p < 0.001). When the entire cohort was evaluated, a significant increase in RR (15 +/- 7 vs. 21 +/- 8 breaths/min; p < 0.001), HR (102 +/- 29 vs.107 +/- 29 beats/min; p < 0.001), SBP (109 +/- 17 vs. 115 +/- 15 mm Hg; p < 0.001), and DBP (56 +/- 10 vs. 60 +/- 13 mm Hg; p < 0.001) within 1 hour following naloxone was noted. When the 2 groups were compared, only the changes in RR were greater in group 2 patients (6.8 +/- 7.9 vs. 4.7 +/- 5 breaths/min; p < 0.001) following naloxone. Systolic hypertension occurred in 33 of 195 (16.9%) of all patients, while diastolic hypertension occurred in 13 (6.6%) of all patients after naloxone. Only the incidence of diastolic hypertension was higher in group 2 compared with group 1 patients following naloxone (16% vs. 2%; p < 0.001). Hypertension resolved spontaneously. One child developed pulmonary edema and required positive pressure ventilation for 22 hours.

Conclusions: Moderate increases in RR, HR, and BP occur after naloxone administration to children, but development of more serious complications is rare.
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http://dx.doi.org/10.1345/aph.1C521DOI Listing
November 2003

Deep sedation with propofol for children undergoing ambulatory magnetic resonance imaging of the brain: experience from a pediatric intensive care unit.

Pediatr Crit Care Med 2003 Oct;4(4):454-8

Department of Pediatrics, Michigan State University, Hurley Medical Center, Flint, MI 48503, USA.

Objectives: Use of intravenous propofol sedation to facilitate completion of magnetic resonance imaging of the brain in children.

Design: Retrospective, cross-sectional.

Setting: A university-affiliated pediatric intensive care unit.

Patients: A total of 115 children who received intravenous propofol to complete magnetic resonance imaging of the brain January 1 through December 31, 2001.

Interventions: Intravenous propofol infusion.

Measurements And Main Results: The mean age was 4.2 +/- 3.1 yrs, and there were 63 boys and 52 girls. Sixty-nine percent of patients belonged to ASA physical status class I, and 31% belonged to ASA class II. All studies were completed with satisfactory image quality. The total dose of propofol used to complete a magnetic resonance image of the brain was 4.3 +/- 1.7 mg/kg body weight. The mean duration of sedation induction was 4.5 +/- 3.5 mins. The mean time to recovery (from the end of the procedure) was 20 +/- 15 mins. The duration of the procedure averaged 39 +/- 20 mins, and the time to discharge from the hospital was 50 +/- 21 mins from the end of the procedure. No episodes of hypoxia, apnea, or a need for artificial airway were noted. Systolic blood pressure decreased 10% +/- 13%, but none of the patients met the criteria for hypotension. A telephone call the next day to the family did not reveal any delayed complications.

Conclusions: Propofol can safely facilitate ambulatory magnetic resonance imaging of the brain in children, and it is associated with brief induction, recovery, and discharge times from the hospital. A drop in blood pressure, although mild and transient, does occur. Therefore, appropriate monitoring and preparedness for cardiorespiratory support are essential.
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http://dx.doi.org/10.1097/01.PCC.0000090013.66899.33DOI Listing
October 2003

False aneurysm of the modified Blalock-Taussig shunt mimicking pulmonary disease in an infant.

Clin Pediatr (Phila) 2002 Oct;41(8):617-9

Mercy Children's Hospital, Toledo, Ohio, USA.

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http://dx.doi.org/10.1177/000992280204100811DOI Listing
October 2002