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.

Molecular Analysis Improves Pathogen Identification and Epidemiologic Study of Pediatric Parapneumonic Empyema

Abstract: Parapneumonic empyema (PPE) is a serious complication of bacterial pneumonia that is becoming more common.1 Recently published reports implicate Streptococcus pneumoniae serotypes not contained within the 7-valent pneumococcal conjugate vaccine (PCV-7; Wyeth, Madison, NJ), and Staphylococcus aureus, particularly MRSA as important pathogens. 2, 3 For the most part these data rely on culture-based pathogen identification. Unfortunately, in most children with PPE the bacterial etiology is unknown.3–9 The low rate of pathogen detection complicates clinical care and selection of appropriate antibiotics. There are several factors that contribute to difficulties in isolating bacterial pathogens in patients with PPE. The most significant factor is likely the pre-treatment of children with antibiotics prior to obtaining blood or pleural fluid cultures. In addition, recovery of S. pneumoniae in culture is inherently difficult, due both to its sensitivity to transport conditions and its propensity for autolysis.10 The combination of these factors leads to a high rate of culture-negative disease (up to 60% of cases).3, 4 Thus the reliance on culture-based methodologies may be an impediment to accurately understanding of the epidemiology of PPE. Our institution has had an increasing rate of pediatric PPE for more than a decade. The incidence increased more than 10-fold between 1993 and 2007, from 1/100,000 to 12.5/100,000. 4,11 Previous studies have defined the epidemiology of culture-positive PPE in Utah children,11, 12 however the etiology of culture-negative disease has remained elusive. Recent studies from other centers have shown promising results using culture-independent techniques to determine the etiologic diagnosis of PPE.5, 7, 13–15 We have developed PCR-based assays that can detect and identify the major bacteria thought to be responsible for PPE. Additionally, our collaborators in Spain have developed PCR-based serotypying assays for pneumococci.16 Using these molecular assays we sought to 1) evaluate pleural fluid specimens from children with PPE to better define the etiology and epidemiology of disease 2) compare PCR-based detection of pathogens to culture-based detection and 3) compare data from patients culture-positive for a bacterial pathogen in blood or pleural fluid to data from patients in whom cultures were negative in an effort to identify whether there were differences in pathogens, pneumococcal serotypes, clinical presentation and/or outcomes between culture-positive and culture negative PPE.

ACR Appropriateness Criteria(®) on suspected physical abuse-child.

Abstract: The appropriate imaging for pediatric patients being evaluated for suspected physical abuse depends on the age of the child, the presence of neurologic signs and symptoms, evidence of thoracic or abdominopelvic injuries, and whether the injuries are discrepant with the clinical history. The clinical presentations reviewed consider these factors and provide evidence-based consensus recommendations by the ACR Appropriateness Criteria ® Expert Panel on Pediatric Imaging.

Change in Ventricular Size and Effect of Ventricular Catheter Placement in Pediatric Patients with Shunted Hydrocephalus

Abstract: Objective The multicenter, randomized pediatric cerebrospinal fluid shunt valve design trial found no difference in the rate of shunt failure between a standard valve, a siphon-reducing valve (Delta; Medtronic PS Medical, Goleta, CA), and a flow-limiting valve (Orbis Sigma; Cordis, Miami, FL); however, the valves were expected to have different effects on ultimate ventricular size. Also, the catheter position or local environment of the ventricular catheter tip might have affected shunt failure. Therefore, we performed a post hoc analysis to understand what factors, other than valve design, affected shunt failure and to identify strategies that might be developed to reduce shunt failure. Methods Ventricular size was measured at as many as six different intervals, using a modified Evans' ratio (with incorporation of the frontal and occipital dimensions), in 344 patients. Ventricular catheter location was defined as being in the frontal horn, occipital horn, body of the lateral ventricle, third ventricle, embedded in brain, or unknown. The ventricular catheter tip was described as surrounded by cerebrospinal fluid, touching brain, or surrounded by brain parenchyma within the ventricle (slit ventricle). Repeated measures analysis of variance for unbalanced data was used to analyze ventricular size. A Cox model (with incorporation of time-dependent covariates) was used to evaluate the contribution of age, etiology, shunt design, ventricular size, ventricular catheter location, and environment among the cases. Results Ventricular volume decreased in an exponential fashion, forming a plateau at 14 months, and was similar for the three valves (P = 0.4). Frontal and occipital ventricular catheter tip locations were associated with a reduced risk of shunt failure (hazard ratios, 0.60 [P = 0.02] and 0.45 [P = 0.001], respectively). Ventricular catheter tips surrounded by cerebrospinal fluid or touching the brain were associated with a reduced risk of failure (hazard ratios, 0.21 and 0.33, respectively; P = 0.0001). Patients with myelomeningocele or large ventricles had increased risk of malfunction (hazard ratios, 1.78 [P = 0.006] and 2.33 [P = 0.03], respectively). Conclusion Decline of ventricular size over time is not affected by these different shunt valve designs. This suggests that the mechanical models of hydrocephalus on which the designs were based are inadequate. Ventricular catheter tip location and ventricular catheter environment are important. Techniques to accurately place ventricular catheters and new valve designs that effectively control ventricular size might reduce shunt malfunction.

Sirolimus for progressive neurofibromatosis type 1–associated plexiform neurofibromas: a Neurofibromatosis Clinical Trials Consortium phase II study

Abstract: Results. The estimated median TTP of subjects receiving sirolimus was 15.4 months (95% CI:14.3 –23.7 mo), which was significantly longer than 11.9 months (P , .001), the median TTP of the placebo arm of a previous PN clinical trial with similar eligibility criteria. Conclusions. This study demonstrated that sirolimus prolongs TTP by almost 4 months in patients with NF1-associated progressive PN. Although the improvement in TTP is modest, given the lack of significant or frequent toxicity and the availability of few other treatment options, the use of sirolimus to slow the growth of progressive PN could be considered in select patients.