Montreal Children's Hospital

About: Montreal Children's Hospital is a healthcare organization based out in Montreal, Quebec, Canada. It is known for research contribution in the topics: Population & Poison control. The organization has 3842 authors who have published 4816 publications receiving 200198 citations.

Oral non-steroidal anti-inflammatory drug therapy for lung disease in cystic fibrosis

Abstract: Background Progressive lung damage causes most deaths in cystic fibrosis. Non-steroidal anti-inflammatory drugs (such as ibuprofen) may prevent progressive pulmonary deterioration and morbidity in cystic fibrosis. Objectives To assess the effectiveness of treatment with non-steroidal anti-inflammatory drugs in cystic fibrosis. Search methods We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, hand searches of relevant journals and abstract books of conference proceedings. We contacted manufacturers of non-steroidal anti-inflammatory drugs. Latest search of the Group's Trials Register: 04 February 2016. Selection criteria Randomized controlled trials comparing oral non-steroidal anti-inflammatory drugs, at any dose for at least two months, to placebo in people with cystic fibrosis. Data collection and analysis Two authors independently assessed trials for inclusion the review and their potential risk of bias. Main results The searches identified 10 trials; four are included (287 participants aged five to 39 years; maximum follow up of four years) and one is currently awaiting classification pending publication of the full trial report. Three trials compared ibuprofen to placebo (two from the same centre with some of the same participants); one trial assessed piroxicam versus placebo. The three ibuprofen trials were deemed to have good or adequate methodological quality, but used various outcomes and summary measures. Reviewers considered measures of lung function, nutritional status, radiological assessment of pulmonary involvement, intravenous antibiotic usage, hospital admissions, survival and adverse effects. Combined data from the two largest ibuprofen trials showed a significantly lower annual rate of decline for lung function, percent predicted forced expiratory volume in one second mean difference 1.32 (95% confidence interval 0.21 to 2.42); forced vital capacity mean difference 1.27 (95% confidence interval 0.26 to 2.28); forced expiratory flow (25-75%) mean difference 1.80 (95% confidence interval 0.15 to 3.45). The post-hoc analysis of data from two trials split by age showed a statistically significant slower rate of annual decline of percent predicted forced expiratory volume in one second and forced vital capacity in the ibuprofen group in younger children, mean difference 1.41% (95% confidence interval 0.03 to 2.80) and mean difference 1.32% (95% confidence interval 0.04 to 2.60) respectively. In one trial, long-term use of high-dose ibuprofen was associated with reduced intravenous antibiotic usage, improved nutritional and radiological pulmonary status. No major adverse effects were reported, but the power of the trials to identify clinically important differences in the incidence of adverse effects was low. We did not have any concerns with regards to risk of bias for the trial comparing piroxicam to placebo. However, the trial did not report many data in a form that we could analyse in this review. No data were available for the review's primary outcome of lung function; available data for hospital admissions showed no difference between the groups. No analysable data were available for any other review outcome. Authors' conclusions High-dose ibuprofen can slow the progression of lung disease in people with cystic fibrosis, especially in children, which suggests that strategies to modulate lung inflammation can be beneficial for people with cystic fibrosis.

Prolonged and unsoothable crying bouts in infants with and without colic.

Abstract: .: The authors sought to determine which features of early distress were "excessive" and specific to the first months of life as described by diary recordings. In a short-term, longitudinal, controlled study, total daily amount, frequency, and bout duration of fussing, crying, and unsoothable crying were derived from validated diaries kept by parents of infants with and without diary-defined colic at 6 weeks and 5 months recruited from primary pediatrics practices. By definition, infants with colic demonstrated more distress at 6 weeks, but they also had a much greater reduction in distress by 5 months and more distress during the fifth month. However, bout frequencies and bout durations showed different patterns. Bout duration was longer for the colic group only at 6 weeks; the difference completely disappeared by 5 months. Bout frequency was higher for the colic group at 6 weeks and 5 months, but the reduction across ages was similar in infants with and without colic. These patterns were true for all distress modalities (fussing, crying, and unsoothable crying). Unsoothable crying was present in significant amounts only at 6 weeks but virtually disappeared by 5 months. The authors conclude that prolonged distress bouts and unsoothable crying are specific to the first few months and more common, though not unique, in infants with colic. This implies that our understanding of colic may depend more on why these infants cry longer once started than what makes infants cry. These features of parental experience may be important in preventive efforts to reduce negative impacts of early increased crying such as shaken baby syndrome.

Neonatal hydronephrosis—the controversy and the management

Abstract: Neonatal hydronephrosis is being detected with increasing frequency. The majority of these cases have a tendency to resolve during infancy. Hydronephrosis is an anatomical entity that is not synonymous with obstruction. Review of the pathoembryology, the pathophysiology, the diagnostic techniques currently used and the natural history of hydronephrosis is given. The management and the controversies involved are discussed.

Brainstem Gliomas. A 10-year institutional review.

Abstract: Case records of 37 patients with a diagnosis of brainstem glioma treated at the Montreal Children's Hospital from June 1989 to June 1999 were reviewed. 15 patients had diffuse pontine gliomas and 22 patients had focal forms of brainstem gliomas. The two groups were compared with respect to age, clinical evolution, radiological appearance, type of surgery practised, histological diagnosis, adjuvant treatments and survival. A non-pontine brainstem location, a cystic or exophytic component, bright enhancement with gadolinium injection, a histological diagnosis of pilocytic astrocytoma or ganglioglioma were favourable prognostic factors. Progression-free survival and overall survival were significantly worse in the group of patients with diffuse pontine gliomas. The relative impact of radical surgery and/or radiotherapy is analysed. Surgery coupled to adjuncts such as navigation, ultrasound and monitoring plays an important role for focal brainstem lesions. Focal/conformal radiotherapy has an adjuvant role but better treatments are needed for the diffuse pontine brainstem lesions.