Monroe Carell Jr. Children's Hospital at Vanderbilt

About: Monroe Carell Jr. Children's Hospital at Vanderbilt is a based out in . It is known for research contribution in the topics: Population & Medicine. The organization has 1046 authors who have published 1262 publications receiving 28063 citations. The organization is also known as: Vanderbilt Children's Hospital.

Airway Hyperresponsiveness Does Not Predict Morbidity in Children with Sickle Cell Anemia

Abstract: Sickle cell anemia (SCA) is one of the most common inherited blood disorders in the world, characterized by chronic hemolytic anemia and recurrent vasoocclusive pain episodes. Pulmonary complications are a major cause of morbidity and mortality. Individuals with SCA have been shown to have a high prevalence of asthma, wheezing, and airway hyperresponsiveness (AHR) (1, 2). Increased AHR has been demonstrated in individuals with SCA, both with and without a concomitant diagnosis of asthma (2, 3). Although previous studies have looked at the association between a history of acute chest syndrome (ACS) episodes and AHR to methacholine (4), investigators have not examined whether AHR to methacholine is a risk factor for future SCA-related morbidity (pain and ACS). Therefore, the aim of this study was to examine the association between AHR to methacholine and future rates of hospitalization for pain and ACS.

Articular Sinus Tract with Mycobacterium fortuitum Osteomyelitis After Anterior Cruciate Ligament Reconstruction: A Case Report.

Abstract: Case: Three weeks after transphyseal anterior cruciate ligament reconstruction with a hamstring autograft, a fourteen-year-old boy presented with fevers, joint effusion, and elevated inflammatory markers. Cultures from an operative debridement grew Mycobacterium fortuitum , for which he received six months of antibiotics. Continued drainage prompted magnetic resonance imaging, which revealed osteomyelitis of the tibial tunnel. Conclusion: This case report describes a postoperative infection with an atypical organism that had a protracted course despite early diagnosis. Complete resolution was achieved following tibial tunnel debridement with a high-speed burr and bone-grafting with an antibiotic-laden allograft.

Pediatric subcutaneous treprostinil site maintenance and pain control strategies from the Pediatric Pulmonary Hypertension Network.

Abstract: Pulmonary arterial hypertension is a chronic, progressive, and life-threatening disease in children with diverse causes of pulmonary arterial hypertension. The most severe cases of pulmonary arterial hypertension require aggressive treatments with systemic administration of continuous prostacyclin therapy, including treprostinil and epoprostenol. The successful use of continuous subcutaneous treprostinil therapy eliminates the need for an indwelling central venous catheter and its associated risks. However, pain at the subcutaneous infusion site, an expected side effect of this therapy, is often a deterrent to its widespread use. Effective subcutaneous treprostinil site maintenance and pain management is essential to achieve success with this therapy, but strategies surrounding site maintenance and pain control vary significantly between pediatric pulmonary hypertension treatment centers. In an attempt to standardize practice, a survey on the use of subcutaneous treprostinil and site maintenance and pain management strategies, as well as its perceived effectiveness, was disseminated to 13 pediatric pulmonary hypertension centers of the Pediatric Pulmonary Hypertension Network. Responses to the survey were collected and analyzed and were developed into a set of formalized strategies to facilitate knowledge sharing and standardization of practice.

Impact of institutional routine surveillance endomyocardial biopsy frequency in the first year on rejection and graft survival in pediatric heart transplantation.

Abstract: BACKGROUND Routine surveillance biopsy (RSB) is performed to detect asymptomatic acute rejection (AR) after heart transplantation (HT). Variation in pediatric RSB across institutions is high. We examined center-based variation in RSB and its relationship to graft loss, AR, coronary artery vasculopathy (CAV), and cost of care during the first year post-HT. METHODS We linked the Pediatric Health Information System (PHIS) and Scientific Registry of Transplant Recipients (SRTR, 2002-2016), including all primary-HT aged 0-21 years. We characterized centers by RSB frequency (defined as median biopsies performed among recipients aged ≥12 months without rejection in the first year). We adjusted for potential confounders and center effects with mixed-effects regression analysis. RESULTS We analyzed 2867 patients at 29 centers. After adjusting for patient and center differences, increasing RSB frequency was associated with diagnosed AR (OR 1.15 p = 0.004), a trend toward treated AR (OR 1.09 p = 0.083), and higher hospital-based cost (US$390 315 vs. $313 248, p < 0.001) but no difference in graft survival (HR 1.00, p = 0.970) or CAV (SHR 1.04, p = 0.757) over median follow-up 3.9 years. Center RSB-frequency threshold of ≥2/year was associated with increased unadjusted rates of treated AR, but no association was found at thresholds greater than this. CONCLUSION Center RSB frequency is positively associated with increased diagnosis of AR at 1 year post-HT. Graft survival and CAV appear similar at medium-term follow-up. We speculate that higher frequency RSB centers may have increased detection of clinically less important AR, though further study of the relationship between center RSB frequency and differences in treated AR is necessary.