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Abstract Objective To study the retropharyngeal lymph node status (RPLN) by pretreatment PET-CT imaging in patients with squamous cell carcinomas of the oropharynx (OPSCC). Study Design: Retrospective. Methods 101 patients with a biopsy proven OPSCC were identified. 53 patients meeting inclusion criteria were further analyzed. Results The frequency of RPLN was 20.8% (11/53). Advanced T stage cancer (OR = 5.6250, 95% CI: 1.06 - 29.80, p = 0.0410) and advanced clinical N stage cancer (i.e. N2+) had higher odds (OR = 3.9773, 95% CI: 0.9628 - 16.4291) of being RPLN positive as compared to N0-1 patients. Conclusions Pre-treatment PET-CT can be used as a staging tool to aid in treatment planning of OPSCC, as rates of RPLN and nodal metastasis are consistent with those reported in the literature. Advanced T and N stage are associated with a greater odds ratio of being RPLN positive by PET-CT imaging.

Background: It is challenging to provide optimum nutrition in low-birth-weight (LBW) infants with short-bowel syndrome (SBS) and ostomy. This study aims to evaluate the clinical course of LBW infants with SBS and ostomy in response to enteral feeds, recognize characteristics associated with achievement of enteral autonomy prior to reanastomosis, and evaluate associated short-term outcomes.Methods: A retrospective analysis of 52 LBW neonates with intestinal failure (IF) caused by SBS and ostomy treated in a neonatal intensive care unit from 2012 to 2018 was performed. Clinical characteristics and short-term outcomes were studied in relation to the location of the ostomy and the success with enteral feeding achieved prior to reanastomosis.Results: Of the 52 infants with SBS, jejunostomy, ileostomy, and colostomy were present in 9, 40, and 3 infants, respectively. Fourteen (26.92%) infants achieved enteral autonomy transiently, and 7 (13.46%) sustained until reanastomosis. All 9 infants with jejunostomy were parenteral nutrition dependent, compared with 22 with ileostomy and none with colostomy (P = 0.002). Infants who achieved enteral autonomy showed lower incidence of cholestasis (P = 0.038) and better growth velocity (P = 0.02) prior to reanastomosis.Conclusions: A minority of LBW infants with SBS and ostomy achieved enteral autonomy prior to reanastomosis. Distal ostomy (ileostomy and colostomy), reduced cholestasis, and better growth were associated with achievement of enteral autonomy. Our report highlights the challenges in establishing enteral autonomy in LBW infants with IF and ostomy, and the feasibility of that approach in a minority of patients, with tangible benefits. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of monofilament suture, braided polyester thread, and 5 mm tape suture in reducing preterm birth (PTB).Study design: Women who received a cerclage at Touro Infirmary, New Orleans, LA, USA, between 1 January, 2011 and 31 December, 2016 were identified using ICD-9/10 codes. All charts were reviewed for demographic and obstetrical variables including gestational age (GA) at delivery.Results: Of 145 women who received a cerclage, 36 were excluded due to incomplete charts leaving 109 for analysis. There was no significant difference in gestational age at cerclage placement or delivery among women with monofilament, braided, or 5 mm tape cerclages (p = .936 and p = .919, respectively) nor was there a difference in the proportion who delivered at ≥32, 34, or 37 weeks across groups with differing cerclage material (p = .270, p = .275, and p = .419, respectively). There was no difference in GA at delivery for patients who received 17-OHP compared to those who did not (p = .362). There were also no differences with respect to birth outcomes such as birthweight (p = .938), Apgar scores (p = .477, p = .430) or neonatal intensive care admission rates (NICU) (p = .304). Analysis revealed no difference in characteristics between groups including history of PTB or indication for removal (p = .371, p = .317).Conclusion: We found no difference in pregnancy prolongation when comparing different suture material used for indicated cerclages. We also found no differences with respect to rates of maternal infection or adverse neonatal outcomes among groups.RationaleThis study was conducted to evaluate the efficacy of different suture materials in increasing gestational age at delivery and reducing preterm birth. [ABSTRACT FROM AUTHOR]

Objective: To compare postdischarge growth, adiposity and metabolic outcomes of appropriate for gestational age (AGA) versus small for gestational age (SGA) premature infants fed an exclusive human milk (HM)-based diet in the neonatal intensive care unit.Design: Premature infants (birth weight ≤1250 g) fed an exclusive HM-based diet were examined at 12-15 months corrected gestational age (CGA) (visit 1) for anthropometrics, serum glucose and non-fasting insulin, and at 18-22 months CGA (visit 2) for body composition by dual-energy X-ray absorptiometry.Results: Of 51 children, 33 were AGA and 18 were SGA at birth. The SGA group had weight gain (g/day) equal to AGA group during the follow-up period. SGA had a significantly greater body mass index (BMI) z-score gain from visit 1 to visit 2 (0.25±1.10 vs -0.21±0.84, p=0.02) reflecting catch-up growth. There were no significant differences in total fat mass (FM) and trunk FM between groups. SGA had significantly lower insulin level (5.0±3.7 vs 17.3±15.1 µU/mL, p=0.02) and homeostatic model of assessment-insulin resistance (1.1±0.9 vs 4.3±4.1, p=0.02). Although regional trunk FM correlated with insulin levels in SGA (r=0.893, p=0.04), they had lower insulin level compared with AGA and no difference in adiposity.Conclusions: SGA premature infants who received an exclusive HM-based diet exhibited greater catch-up growth without increased adiposity or elevated insulin resistance compared with AGA at 2 years of age. An exclusive HM-based diet may improve long-term body composition and metabolic outcomes of premature infants with ≤1250 g birth weight, specifically SGA. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to compare complications and mortality in neonates with hypoxic ischemic encephalopathy (HIE) on extracorporeal membrane oxygenation (ECMO) who did and did not receive therapeutic hypothermia (TH). Study Design The Extracorporeal Life Support Organization registry was queried from 2005 to 2013 to identified infants with HIE. Infants ≤30 days of age with HIE on respiratory ECMO were included. Fisher's exact test and the Wilcoxon's rank-sum test were used to compare neonates with and without TH. Logistic regression was used to examine the association of TH with complications and mortality. Results There were no difference between neonates with HIE who did (n = 78) and did not (n = 109) receive TH in demographics, severity of illness, complications, and mortality (p = 0.21). Conclusion No differences in complications or mortality in neonates with HIE and respiratory ECMO were observed between those who did and did not receive TH. We suggest that for neonates requiring respiratory ECMO who also have HIE, TH is not contraindicated. [ABSTRACT FROM AUTHOR]

New carbide burs that are placed on a bur block can be subjected to multiple steam autoclaving cycles prior to their first use. The decision to discard a bur before or during cavity preparation is a subjective one based on operator expectations and experience. This study examined the durability of carbide burs after multiple autoclaving cycles by judging not only their initial sharpness but also their ability to maintain sharpness throughout a cavity preparation. Five experienced operators were given a set of No. 330 carbide burs that had been separated into five blind categories: those not autoclaved at all and those that had been autoclaved one, two, five, or 10 times. Each operator judged the cutting effectiveness of each bur by making an initial plunge cut through the enamel of a freshly extracted tooth. After the initial plunge cut, each operator used the same set of burs to complete an occlusal cavity preparation in molar models fabricated from composite restorative material. Each operator was asked to examine the burs for any visual deterioration and to rate the cutting ability of each bur. The burs were also examined for wear under a scanning electron microscope. Based on the results, this study concluded that up to 10 autoclaving cycles did not significantly affect the perception of either initial sharpness or the bur's effectiveness while completing the preparation. [ABSTRACT FROM AUTHOR]

Introduction: While a patent ductus arteriosus (PDA) helps offload the right ventricle in the acute congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension, its role on long-term outcomes in CDH has not been investigated. Our objective was to examine associations of the PDA with long-term clinical outcomes in CDH. Methods: A single-center retrospective descriptive study of 122 CDH patients dichotomized by duration with PDA, as ≤14 versus >14 postnatal days (PND) and ≤30 versus >30 PND. Fisher’s exact test, Wilcoxon rank-sum test, and multiple linear and logistic regression analyses were used for analyses. Results: In unadjusted and adjusted for CDH severity comparisons, patients with PDA >14 PND and >30 PND had a higher risk of death, longer length of stay, mechanical ventilation duration, and need for tracheostomy, diuretics, and PH medications at discharge. Conclusion: A PDA beyond the newborn period is associated with adverse outcomes in infants with CDH. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to document current practices among pediatric and general dentists who are members of the American Academy of Pediatric Dentistry (AAPD) regarding the use of local anesthesia (LA) on children undergoing dental rehabilitation under general anesthesia (GA). Methods: A survey was administered via e-mail to AAPD members to document the use of LA during dental rehabilitations under GA and the rationales for its use. Results: A total of 952 of 5,599 members responded to this survey; 79 percent of respondents use LA at least part of the time during dental rehabilitations under GA. "Improved patient recovery" was the most commonly cited rationale for administering LA. Extraction of permanent and primary teeth were the two most common procedures cited for the use of LA, respectively. Conclusion: There is no consensus among the respondents on the use of local anesthesia during dental rehabilitation under general anesthesia, but the majority responded that it does play a role in their perioperative patient management. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to measure the incidence of pain and analgesic use following restorative and surgical procedures and preventive fissure sealants in children and adolescents. Methods: One hundred and thirty 2- to 18-year-olds were selected from the Louisiana State University School of Dentistry pediatric dental clinic and appointed for restorative and surgical procedures and preventive fissure sealants. Each child's discomfort was evaluated immediately after the procedure using a Wong-Baker FACES Pain Rating Scale. Parents were contacted by phone within 48 hours following the procedure for a verbal survey to assess discomfort and analgesic use. Results: Thirty-three percent of the children reported discomfort, and 31% were given over-the-counter analgesics by their parents. Compared to all other subjects, patients who had received a primary stainless steel crown were significantly more likely to report discomfort (P<.001). The extraction of primary teeth did not result in a significant increase in reported pain. Conclusions: Postoperative discomfort is significantly associated with stainless steel crown treatment of primary teeth. [ABSTRACT FROM AUTHOR]

Background: Echocardiography is the reference standard for diagnosing pulmonary hypertension (PH) and cardiac dysfunction (CD) in congenital diaphragmatic hernia (CDH). The use of an adjunct non-invasive biomarker would be invaluable. Plasma N-terminal brain Natriuretic Peptide (NT-proBNP) has been evaluated as a biomarker in CDH. Our objective was to investigate the utility of urinary NT-proBNP as an adjunct biomarker in CDH., Methods: Prospective observational study of neonates with CDH. Urinary NT-proBNP and its ratio to urinary creatinine (UNBCR) were analyzed at 24 h of life (HOL). Spearman's correlation was used to quantify the association between the urinary NT-proBNP with corresponding plasma concentrations. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to examine urinary NT-proBNP and UNBCR's association with need for ECMO. The Kruskal-Wallis test was used to compare urinary NT-proBNP concentrations with echocardiography parameters of PH and CD., Results: Urinary NT-proBNP and UNBCR positively correlated with plasma concentrations. Patients with high right ventricular (RV) pressures had higher urinary NT-proBNP concentrations. Both urinary NT-proBNP and UNBCR concentrations increased with worsening left and right ventricular dysfunction on first postnatal echocardiogram., Conclusion: We report the feasibility of urinary NT-proBNP as a non-invasive biomarker to assess PH and CD in CDH., Impact Statement: Non-invasive biomarkers are an important area of research in neonates as they have the potential to decrease the need for blood sampling, which may cause pain, stress, and induce iatrogenic anemia. Use of non-invasive biomarkers could be especially useful in congenital diaphragmatic hernia (CDH) who may need Extra-Corporeal Life Support (ECLS) for their management. We evaluated the potential utility of the urinary NT-proBNP in CDH. Plasma NT-proBNP has been studied in neonates with CDH; however, urinary NT-proBNP has not been explored, making this the first study to examine its potential as a biomarker., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Objective:  This study aimed to compare the clinical endotracheal tube (ETT) depth after initial stabilization of infants with congenital diaphragmatic hernia (CDH) to weight and gestational age-based depth estimates., Study Design:  This retrospective analysis included 58 inborn infants with left-sided CDH. We compared a standard anatomic ETT depth calculated from initial chest radiographs and the clinical depth of the ETT after adjustments to predicted depths using weight and gestational age-based estimates., Results:  The standard anatomic depth was deeper than age (standard deviation 1.29 ± 1.15 cm, p  < 0.001) and weight-based (standard deviation 0.59 ± 0.95 cm, p  < 0.001) estimates. The clinical ETT depth was also deeper than age (standard deviation 1.01 ± 0.77 cm, p  < 0.001) and weight-based (standard deviation 0.26 ± 0.50 cm, p  < 0.001) estimates., Conclusion:  Established strategies to predict ETT depth underestimate the ideal depth in infants with left-sided CDH. These data suggest utilizing caution during initial ETT placement based on standard depth estimates for patients with CDH., Key Points: · CDH patients present unique stabilization challenges.. · Standard ETT depth estimates are too shallow.. · Resuscitation teams should cautiously choose ETT depth.., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Platelet transfusions are routinely administered to neonates in intensive care units when there are concerns of bleeding, including high-risk situations like Extracorporeal Membrane Oxygenation (ECMO). Most platelets in ICUs are transfused prophylactically for thrombocytopenia based solely on the platelet count. Platelet Mass Index (PMI) has been proposed as an alternative to platelet count (PC) as a transfusion trigger. The objective of this study was to determine the relationship between PMI and platelet-specific maximal clot firmness (PMCF) in Rotational thromboelastometry (ROTEM), which gives an indication of platelet contribution to clot firmness and to investigate whether PMI may be a better choice as a trigger for platelet transfusions than PC., Methods: Retrospective review of medical records of neonates with congenital heart disease placed on ECMO support in the cardiovascular intensive care unit (CVICU) from 2015 to 2018 was conducted. Platelet count (PC), platelet mean volume (PMV), ROTEM parameters along with demographic data including gestation age, birth weight, gender and survival were collected. Mixed effects linear models with a first order autoregressive covariance structure were used to assess the associations of PMI, PC, and MPV against PMCF. In addition, generalized estimating equations with a first order auto-regressive covariance structure were used to compare odds of transfusion using PC versus PMI triggers., Results: A total of 92 tests on consecutive days were obtained for 12 ECMO patients (5 male, GA = 38.1 ± 1.6 weeks, BW = 3.1 ± 0.4 kgs, mean ± SD). A variation of 40.1% in PMCF was explained by platelet count (p < 0.001) while 38.5% of the variation in PMCF was explained by PMI (p < 0.001). If the platelet transfusion trigger was PC < 100 x 103 platelets/µL vs. PMI < 800. Using the PC trigger yielded significantly higher odds of transfusion compared to the PMI trigger (odds ratio = 1.31, 95% confidence interval: 1.18 - 1.45, p < 0.001)., Conclusions: While our study failed to demonstrate a superior correlation of PMI with PMCF than PC, our study did reveal that using PMI as transfusion trigger would result in significantly less platelet transfusions, when compared with the current practice of using PC as a trigger.

Introduction: Decision support tools (DST) may aid compliance of teams with the Neonatal Resuscitation Program (NRP) algorithm but have not been adequately tested in this population. Furthermore, the optimal team size for neonatal resuscitation is not known. Our aim was to determine whether use of a tablet-based DST or team size altered adherence to the NRP algorithm in teams of healthcare providers (HCPs) performing simulated neonatal resuscitation., Method: One hundred nine HCPs were randomized into a team of 2 or 3 and into using a DST or memory alone while performing 2 simulation scenarios. The primary outcome was NRP compliance, assessed by the modified Neonatal Resuscitation Performance Evaluation (NRPE). Secondary outcomes were the subcomponents of the NRPE score, cumulative time error (the cumulative time in seconds to perform resuscitation tasks in error, early or late, from NRP guidelines), and the interaction between DST and team size., Results: Decision support tool use improved total NRPE score when compared with memory alone (p = 0.015). There was no difference in NRPE score within teams of 2 compared with 3 HCPs. Cumulative time error was decreased with DST use compared with memory alone but was not significant (p = 0.057). Team size did not affect time error., Conclusions: Teams with the DST had improved NRP adherence compared with teams relying on memory alone in 1 of 2 scenarios. Two and 3 HCP teams performed similarly. Given the positive results observed in the simulated environment, further testing the DST in the clinical environment is warranted.