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.

Diagnostic Use of C-Reactive Protein (CRP) in Assessment of Neonatal Sepsis

Abstract: After completing this article, readers should be able to: 1. Explain factors that render neonatal blood culture results less reliable when neonatal sepsis is suspected. 2. Describe the factors that confound results of C-reactive protein (CRP) measurement. 3. Explain the relevance of two negative CRP results within 48 hours in a stable patient when bacterial sepsis is being considered. 4. Delineate promising new markers for neonatal sepsis. A 2005 National Library of Medicine PubMed literature search on C-reactive protein (CRP) limited to human neonates and English language identified about 160 citations. Only two of these articles referenced a randomized, controlled clinical trial. Despite the large body of literature on CRP, there is no established standard of practice for the use of CRP in assessment of neonatal sepsis. Data from the National Institute of Child Health and Human Development Neonatal Research Network indicate that the rate of early-onset sepsis is 1.5% in very low-birthweight (VLBW) infants; almost half (46%) of neonates born at less than 25 weeks’ gestation develop late-onset sepsis. Current recommendations for the treatment of neonates who have possible or proven sepsis are intravenous antibiotics for 48 to 72 hours for stable infants who have negative blood culture results and for 7 to 14 days for blood culture-positive or clinically probable infection. It has been estimated that this approach results in treatment of up to 30 uninfected infants for every 1 infected infant. In addition, since the implementation of the Centers for Disease Control and Prevention guidelines for maternal intrapartum antibiotic prophylaxis, blood culture results as the “gold standard” are often unreliable. Identification of a diagnostic sepsis marker that has high negative predictive value may reduce the short- and long-term adverse effects of antibiotics and reduce health care costs and length of hospital stay. CRP was described initially in 1930 by Tillet and …

Near-infrared spectroscopy in the critical setting.

Abstract: Near-infrared spectroscopy is a noninvasive means of determining real-time changes in regional oxygen saturation of cerebral and somatic tissues. Hypoxic neurologic injuries not only involve devastating effects on patients and their families but also increase health care costs to the society

Epidemiology of Acute Kidney Injury After Neonatal Cardiac Surgery: A Report From the Multicenter Neonatal and Pediatric Heart and Renal Outcomes Network.

Abstract: Objectives Cardiac surgery-associated acute kidney injury occurs commonly following congenital heart surgery and is associated with adverse outcomes. This study represents the first multicenter study of neonatal cardiac surgery-associated acute kidney injury. We aimed to describe the epidemiology, including perioperative predictors and associated outcomes of this important complication. Design This Neonatal and Pediatric Heart and Renal Outcomes Network study is a multicenter, retrospective cohort study of consecutive neonates less than 30 days. Neonatal modification of The Kidney Disease Improving Global Outcomes criteria was used. Associations between cardiac surgery-associated acute kidney injury stage and outcomes (mortality, length of stay, and duration of mechanical ventilation) were assessed through multivariable regression. Setting Twenty-two hospitals participating in Pediatric Cardiac Critical Care Consortium. Patients Twenty-two-thousand forty neonates who underwent major cardiac surgery from September 2015 to January 2018. Interventions None. Measurements and main results Cardiac surgery-associated acute kidney injury occurred in 1,207 patients (53.8%); 983 of 1,657 in cardiopulmonary bypass patients (59.3%) and 224 of 583 in noncardiopulmonary bypass patients (38.4%). Seven-hundred two (31.3%) had maximum stage 1, 302 (13.5%) stage 2, 203 (9.1%) stage 3; prevalence of cardiac surgery-associated acute kidney injury peaked on postoperative day 1. Cardiac surgery-associated acute kidney injury rates varied greatly (27-86%) across institutions. Preoperative enteral feeding (odds ratio = 0.68; 0.52-0.9) and open sternum (odds ratio = 0.76; 0.61-0.96) were associated with less cardiac surgery-associated acute kidney injury; cardiopulmonary bypass was associated with increased cardiac surgery-associated acute kidney injury (odds ratio = 1.53; 1.01-2.32). Duration of cardiopulmonary bypass was not associated with cardiac surgery-associated acute kidney injury in the cardiopulmonary bypass cohort. Stage 3 cardiac surgery-associated acute kidney injury was independently associated with hospital mortality (odds ratio = 2.44; 1.3-4.61). No cardiac surgery-associated acute kidney injury stage was associated with duration of mechanical ventilation or length of stay. Conclusions Cardiac surgery-associated acute kidney injury occurs frequently after neonatal cardiac surgery in both cardiopulmonary bypass and noncardiopulmonary bypass patients. Rates vary significantly across hospitals. Only stage 3 cardiac surgery-associated acute kidney injury is associated with mortality. Cardiac surgery-associated acute kidney injury was not associated with any other outcomes. Kidney Disease Improving Global Outcomes criteria may not precisely define a clinically meaningful renal injury phenotype in this population.

Fontan-associated protein-losing enteropathy and heart transplant: A Pediatric Heart Transplant Study analysis.

Abstract: Background Post-Fontan protein-losing enteropathy (PLE) is associated with significant morbidity and mortality. Although heart transplantation (HTx) can be curative, PLE may increase the risk of morbidity before and after HTx. This study analyzed the influence of PLE influence on waiting list and post-HTx outcomes in a pediatric cohort. Methods Fontan patients listed for HTx and enrolled in the Pediatric Heart Transplant Study from 1999 to 2012 were stratified by a diagnosis of PLE, and the association of PLE with waiting list and post-HTx mortality, rejection, and infection was analyzed. Results Compared with non-PLE Fontan patients ( n = 260), PLE patients listed for HTx ( n = 96) were older (11.9 years vs 7.6 years; p = 0.003), had a larger body surface area (1.1 m 2 vs 0.9 m 2 ; p = 0.0001), had lower serum bilirubin (0.5 vs 0.9 mg/dl; p = 0.01), lower B-type natriuretic peptide (59 vs 227 pg/ml; p = 0.006), and were less likely to be on a ventilator (3% vs 13%; p = 0.006). PLE patients had lower waiting list mortality than non-PLE Fontan patients ( p Conclusions In this multicenter cohort, the diagnosis of PLE alone was not associated with increased waiting list mortality or post-HTx morbidity or mortality. Given the limitations of our data, this analysis suggests that PLE patients in the pediatric age group have outcomes similar to their non-PLE counterparts. Additional multicenter studies of PLE patients with targeted collection of PLE-specific information will be necessary to fully delineate the risks conferred by PLE for HTx.