Publications by authors named "T Allen Merritt"

303 Publications

Influenza outbreaks in aged care facilities in New South Wales in 2017: impact and lessons for surveillance.

Commun Dis Intell (2018) 2021 Apr 30;45. Epub 2021 Apr 30.

Respiratory Epidemiologist, Health Protection NSW.

Introduction: A record number of influenza outbreaks in aged care facilities (ACFs) in New South Wales (NSW) during 2017 provided an opportunity to measure the health impact of those outbreaks and assess the quality of routinely available surveillance data.

Methods: Data for all ACF influenza outbreaks in NSW in 2017 were extracted from the Notifiable Conditions Information Management System. The numbers of outbreaks, residents with influenza-like illness (ILI), hospital admissions and deaths were assessed. For each outbreak the attack rate; duration; timeliness of notification; resident and staff influenza vaccination coverage; and antiviral use for treatment or prophylaxis were analysed. Data were considered for NSW in total and separately for seven of the state's local health districts. Data completeness was assessed for all available variables.

Results: A total of 538 ACF outbreaks resulted in 7,613 residents with ILI, 793 hospitalisations and 338 deaths. NSW outbreaks had a median attack rate of 17% and median duration of eight days. Data completeness, which varied considerably between districts, limited the capacity to accurately consider some important epidemiological and policy issues.

Discussion: Influenza outbreaks impose a major burden on the residents and staff of ACFs. Accurate assessment of the year-to-year incidence and severity of influenza outbreaks in these facilities is important for monitoring the effectiveness of outbreak prevention and management strategies. Some key data were incomplete and strategies to improve the quality of these data are needed, particularly for: the number of influenza-related deaths among residents; resident and staff vaccination coverage prior to outbreaks; and recorded use of antiviral prophylaxis.
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http://dx.doi.org/10.33321/cdi.2021.45.22DOI Listing
April 2021

Improved Outcomes of Infant Lung Transplantation Over Three Decades.

Ann Thorac Surg 2021 Apr 27. Epub 2021 Apr 27.

Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine/St Louis Children's Hospital, St Louis, MO. Electronic address:

Background: Lung transplantation is the definitive surgical treatment for end-stage lung disease. However, infants comprise less than 5% of pediatric cases. We sought to provide an overview of infant lung transplantation outcomes over the past three decades using linked United Network for Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) data.

Methods: Infants undergoing lung transplant from 1989-2020 in UNOS were reviewed. UNOS and PHIS records for patients transplanted from 1995-2020 were linked using date of birth, gender, and date of surgery ± 3 days. We assessed underlying diagnoses, pre- and post-transplant extracorporeal membrane oxygenation support, re-transplant-free survival to discharge, hospital experience (≥1 annual transplant for ≥4 years in a five-year period), operative decade, bronchiolitis obliterans syndrome, long-term survival, and functional status at latest follow-up.

Results: 112 lung transplants were performed in 109 infants over 31 years. 21 patients died pre-discharge, and 2 were re-transplanted during the same admission. We linked 80.6% (83/103) of UNOS and PHIS records. Hospital survival was lower for infants with idiopathic pulmonary hypertension and those transplanted at less experienced centers. All seven infants requiring postoperative extracorporeal membrane oxygenation support died. Median freedom from bronchiolitis obliterans syndrome was 8.1 (4.6-11.6) years. Following discharge, median survival was 10.3 (6.3-14.4) years, with improved ten-year survival for those transplanted from 2010-2020 (87.3%) versus 2000-2009 (52.4%, p=0.098) and 1989-1999 (34.1%, p=0.004). 84.6% (33/39) of survivors had minor or no restrictions at latest follow-up.

Conclusions: Carefully selected infants experience promising short- and long-term outcomes following lung transplant.
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http://dx.doi.org/10.1016/j.athoracsur.2021.04.032DOI Listing
April 2021

Toxic metals in human milk in relation to tobacco smoke exposure.

Environ Res 2021 Mar 31;197:111090. Epub 2021 Mar 31.

Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, 30 Dojazd Street, 60-631, Poznan, Poland. Electronic address:

Several reports confirm the deleterious effects of tobacco smoking and exposure to second-hand smoke (SHS) resulting in changes in the composition of breast milk. The aim of our study was to compare the levels of selected essential, as well as, toxic metals found in colostrum (collected at day 1 ± 2 post-birth) and mature milk (1 month ± 7 days post-birth) of nonsmoking women (n = 52) compared to those found in women who smoke tobacco (n = 51) and women exposed to second-hand smoke during pregnancy and lactation (n = 47). Women's non-smoking or smoking status was determined by their responses to a questionnaire, including questions about others who may smoke in the home environment, and confirmed by measurement of cotinine in the blood serum by high performance liquid chromatography with diode array detector (HPLC-DAD). Inductively coupled plasma mass spectrometry (ICP-MS) and flame atomic absorption spectroscopy (F-AAS) techniques were used to determine the metal concentrations in colostrum and mature milk previously digested by a microwave mineralizer. We confirmed that exposure to tobacco smoke increases concentrations of heavy metals (cadmium and lead) in colostrum and mature milk. These increased concentrations of heavy metals may disturb the action of bioactive substances necessary for the optimal growth and development of newborns and infants. These findings support the need for increased concern and information to lactating women about preventing their exposure to cigarette smoking and SHS due to the adverse effects of tobacco smoke on breast milk with added risks to their infants.
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http://dx.doi.org/10.1016/j.envres.2021.111090DOI Listing
March 2021

Management of patent ductus arteriosus in very premature infants: An ongoing conundrum.

Authors:
T Allen Merritt

Acta Paediatr 2021 Mar 15. Epub 2021 Mar 15.

Loma Linda University School of Medicine, Loma Linda, CA, USA.

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http://dx.doi.org/10.1111/apa.15833DOI Listing
March 2021

A comparison of cardiopulmonary bypass versus extracorporeal membrane oxygenation: Does intraoperative circulatory support strategy affect outcomes in pediatric lung transplantation?

Clin Transplant 2021 Mar 13:e14289. Epub 2021 Mar 13.

Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA.

Objective: Data on adult lung transplantation suggest perioperative benefits of intraoperative extracorporeal membrane oxygenation (ECMO) compared to cardiopulmonary bypass (CPB). Information regarding their pediatric counterparts, however, is limited. This study compares outcomes of intraoperative ECMO versus CPB in pediatric lung transplantation.

Methods: We reviewed all pediatric lung transplants at our institution from 2014 to 2019 and compared those supported intraoperatively on ECMO (n = 13) versus CPB (n = 22), plus a conditional analysis excluding re-transplantations (ECMO [n = 13] versus CPB [n = 20]). We evaluated survival, surgical times, intraoperative transfusions, postoperative support, complications, and duration of hospitalization.

Results: Total time on ECMO support was significantly less than that of CPB support (P = .018). Intraoperatively, the ECMO group required fewer transfusions of fresh-frozen plasma (8.9 [5.8-22.3] vs 16.6 [11.4-39.0] mL/kg, P = .049) and platelets (4.2 [0.0-6.7] vs 8.0 [3.5-14.0] mL/kg, P = .049). When excluding re-transplantations, patients on ECMO required fewer packed red blood cells intraoperatively (12.6 [2.1-30.7] vs 28.2 [14.0-54.0] mL/kg, P = .048). There were no differences in postoperative support requirements, complications, or mortality at one, six, and twelve months.

Conclusions: Intraoperative ECMO support during pediatric lung transplantation appears to decrease intraoperative transfusion requirements when compared to CPB. Data from additional institutions may strengthen these observations.
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http://dx.doi.org/10.1111/ctr.14289DOI Listing
March 2021