Hospital for Sick Children

About: Hospital for Sick Children is a healthcare organization based out in Toronto, Ontario, Canada. It is known for research contribution in the topics: Population & Medicine. The organization has 4097 authors who have published 3746 publications receiving 129066 citations. The organization is also known as: Sick Kids Hospital & SickKids.

The development of regional functional connectivity in preterm infants into early childhood

Abstract: Introduction Resting state networks are proposed to reflect the neuronal connectivity that underlies cognitive processes. Consequently, abnormal behaviour of these networks due to disease or altered development may predict poor cognitive outcome. To understand how very preterm birth may affect the development of resting state connectivity, we followed a cohort of very preterm-born infants from birth through to 4 years of age using resting state functional MRI.

Variants of the SFTPA1 and SFTPA2 genes and susceptibility to tuberculosis in Ethiopia

Abstract: Lungs are the central organ affected and targeted by Mycobacterium tuberculosis and immune processes in the lung are of critical importance in the pathogenesis of tuberculosis. A major lung defense against invading pathogens is provided by surfactant protein A, a multi-chain protein encoded by the SFTPA1 and SFTPA2 genes. Here, we investigated polymorphisms in the SFTPA1 and SFTPA2 genes for association with tuberculosis in 181 Ethiopian families comprising 226 tuberculosis cases. Four polymorphisms, SFTPA1 307A, SFTPA1 776T, SFTPA2 355C, and SFTPA2 751C, were associated with tuberculosis (P=0.00008; P=0.019, P=0.029 and P=0.042, respectively). Additional subgroup analysis in male, female and more severely affected patients provided evidence for SFTPA1/2-covariate interaction. Finally, out of five intragenic haplotypes identified in the SFTPA1 gene and nine identified in the SFTPA2 gene, 1A 3 was most significantly associated with tuberculosis susceptibility (P=0.026). These findings suggest that SFTPA1 and SFTPA2 modify the risk of tuberculosis susceptibility and that this risk is influenced by additional covariates.

Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children—a systematic review of prospective trials

Abstract: There is no consensus on whether therapeutic intensity can be reduced safely in children with low-risk febrile neutropenia (FN). Our primary objective was to determine whether there is a difference in efficacy between outpatient and inpatient management of children with low-risk FN. Our secondary objective was to compare oral and parenteral antibiotic therapy in this population. We performed electronic searches of Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials, and limited studies to prospective pediatric trials in low-risk FN. Percentages were used as the effect measure. From 7,281 reviewed articles, 16 were included in the meta-analysis. Treatment failure, including antibiotic modification, was less likely to occur in the outpatient setting compared with the inpatient setting (15 % versus 28 %, P = 0.04) but was not significantly different between oral and parenteral antibiotic regimens (20 % versus 22 %, P = 0.68). Of the 953 episodes treated in the outpatient setting and 676 episodes treated with oral antibiotics, none were associated with infection-related mortality. Based on the combination of results from all prospective studies to date, outpatient and oral antibiotic management of low-risk FN are effective in children and should be incorporated into clinical care where feasible.

Airway pressure release ventilation improves pulmonary blood flow in infants after cardiac surgery.

Abstract: monary blood flow increased from 2.4 to 2.9 Lmin 1 M 2 (p .02). Oxygen delivery increased from 594 to 774 mL/min/m 2 (p .05) in the patients with tetralogy of Fallot patients and from 473 to 518 Lmin 1 M 2 (p .07) in the cavopulmonary shunt group. Conclusion: Ventilation with airway pressure release ventilation (at comparable mean airway pressure) improves lung perfusion compared with pressure control ventilation in children after tetralogy of Fallot repair and cavopulmonary shunt operations. Although this study focused on tetralogy of Fallot and cavopulmonary shunt operations, the improved cardiopulmonary interactions may be beneficial in other situations in which hemodynamics are impaired by positive pressure ventilation. (Crit Care Med 2011; 39:2599‐2604)

Impact of radiation avoidance on survival and neurocognitive outcome in infant medulloblastoma.

Abstract: Purpose: Concerns regarding radiotherapy-related neurocognitive sequelae in young children have led to deferral and/or avoidance of radiation in contemporary treatment for this fragile group of patients. We sought to compare survival and neurocognitive outcome of two groups of infants with medulloblastoma who received adjuvant conventional craniospinal irradiation (CSI), versus reduced or no radiotherapy during an era of change in infant medulloblastoma treatment philosophy. Patients and Methods: From 1985 to 2007, 29 patients 3 years of age were diagnosed and treated with curative intent in our institution. Children treated prior to 1994 received adjuvant radiation with chemotherapy; subsequently, radiation was essentially prescribed for disease progression or relapse. Results: Median age at diagnosis was 24 months (range 1-36); 15 patients (52%) presented with metastatic disease at diagnosis. Eight children received adjuvant radiotherapy with chemotherapy and 21 children received post-operative chemotherapy only as part of their initial treatment. Five children treated with chemotherapy alone are in prolonged remission. Five years EFS and OS were 35.9% (+/-9.8%) and 50.2% (+/- 9.6%) respectively. Extent of resection, metastatic status and desmoplastic histology were not found to be significant prognostic factors. On serial neurocognitive evaluations, patients treated with chemotherapy +/- reduced radiotherapy demonstrated improvement of intellectual function overtime. Patients treated with conventional craniospinal irradiation (CSI) exhibited significantly lower IQ and academic performances except for receptive vocabulary. Conclusion: Avoidance of conventional CSI in treatment of very young children with medulloblastoma appears to be associated with preserved neurocognitive profile. Neurocognitive evaluation should be integrated in the primary objectives of future infant protocols.