Primary Children's Hospital

About: Primary Children's Hospital is a healthcare organization based out in Salt Lake City, Utah, United States. It is known for research contribution in the topics: Population & Health care. The organization has 1770 authors who have published 2594 publications receiving 107857 citations. The organization is also known as: Intermountain Primary Children's Medical Center & Intermountain Primary Children's Hospital.

Diffusion tensor imaging of white matter injury in a rat model of infantile hydrocephalus.

Abstract: Diffusion tensor imaging (DTI) is a non-invasive MRI technique that has been used to quantify white matter (WM) abnormality in both clinical and experimental hydrocephalus (HCP). However, no DTI study has been conducted to characterize anisotropic diffusion properties in an animal model of infantile HCP. This DTI study was designed to investigate a rat model of HCP induced at postnatal day 21, a time developmentally equivalent to the human infancy. DTI data were acquired at approximately 4 weeks after the induction of HCP with kaolin injection. Using a 7 Tesla small animal MRI scanner we performed high-resolution DTI on 12 rats with HCP and 6 saline controls. Regions of interest (ROI) examined with quantitative comparisons include the genu, body, and splenium of the corpus callosum (gCC, bCC, and sCC, respectively), anterior, middle, and posterior external capsule (aEC, mEC, and pEC, respectively), internal capsule (IC), and fornix (FX). For each ROI, DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Dax), and radial diffusivity (Drad) were calculated. We found that the anisotropic diffusion properties were abnormal across multiple WM regions in the brains of the HCP rats. Statistically significant differences included: (1) decreased FA and increased MD and Drad values in the gCC and bCC; (2) increased Dax in the sCC; (3) increased FA and Dax in the aEC; (4) increased FA in the mEC; (5) increased MD and Drad in the pEC; (6) increased FA and Dax in IC; (7) increased FA in FX. These preliminary results provide the first evidence of WM injury quantified by DTI in a rat model of infantile HCP. Our data showed that DTI is a sensitive tool to characterize patterns of WM abnormalities and support the notion that WM impairment is region specific in response to HCP.

The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC): rationale, infrastructure, and initial steps

Abstract: Each year, in the USA, approximately 800 babies are born with anorectal malformations (ARM) and roughly the same number with Hirschsprung disease (HD) [1, 2]. Surgical reconstruction and the associated care are important factors in the health of these patients and their quality of life. Despite successful surgical repair, more than 60% of HD and ARM patients will suffer from bowel disorders such as severe constipation and fecal incontinence [3–8], which have detrimental long-term effects on quality of life [7]. Two specific areas in which research is needed are longterm outcomes and disease-specific standardized definitions. The effect of various surgical and medical treatment methods on long-term postoperative outcomes for ARMs and HD is not well understood. In addition, there are no standard definitions for medical treatment failure, appropriate preoperative evaluation, and indications for surgery in cases of functional constipation [9]. Critical barriers to research in these areas include highly variable clinical care, a wide spectrum of poorly defined clinical phenotypes, small sample sizes, a lack of coordinated multicenter effort, incomplete data collection, inconsistent clinical definitions, and a lack of established longterm outcome measures. Current guidelines for surgical treatment, postoperative care, and clinical outcomes for these disorders are based primarily on expert opinion and retrospective studies performed at single institutions. Without common definitions and standardized outcome measures applied consistently across multiple centers, the results from these single-center studies may not be generalizable. As a result, there is no clear best practice for many aspects of care, and practice varies widely between institutions. This report describes the development, organization, and work plan of an international consortium, the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC; http://pcplc .org). The purpose of the PCPLC is to provide the infrastructure needed to conduct rigorous multicenter studies that can overcome many of the previous barriers to research.

Evaluating the Impact of a Feeding Protocol in Neonates before and after Biventricular Cardiac Surgery.

Abstract: Introduction Feeding difficulties and malnutrition are important challenges when caring for newborns with critical congenital heart disease (CCHD) without clear available guidelines for providers. This study describes the utilization of a feeding protocol with the focus on standardization, feeding modality, and total parenteral nutrition (TPN) utilization postoperatively. Methods Patients included neonates with CCHD undergoing complex biventricular repair using cardiopulmonary bypass. Data were collected in 2013 preintervention and from 2015 to 2017 postintervention. The feeding protocol outlined guidelines for and postoperative use of TPN. Adverse outcomes data included rates of central line-associated bloodstream infections, necrotizing enterocolitis, chylothorax, and vocal cord dysfunction. Balance outcomes measured were weight for age Z-score at discharge, number of abdominal radiographs obtained, readmission within 90 days, and central venous line utilization. Results We included a total of 121 neonates: 49 in the preintervention group and 72 in the postintervention group. The protocol standardized feeding practices in CCHD neonates undergoing surgery with improved compliance from 70% early in the study period to 90% at the end of the study. Infants were fed enterally more preoperatively (86% versus 67%; P = 0.023), reached a fluid goal sooner (63 hours versus 72 hours; P = 0.035), and postoperative duration of TPN usage was significantly shorter in the postintervention period (48 hours versus 62 hours; P = 0.041) with no increase in adverse outcome events or unintended consequences. Conclusions By implementing a feeding protocol, we reduced practice variation among providers, increased the number of patients fed enterally preoperatively and reduced postoperative use of TPN without increased complications.