Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia

Pediatric Emergency Care • October 2020

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Wolf MF, Childers J, Gray KD, Chivily C, Glenn M, Jones L, Kpa M, McMannen T, Reyes I, Zimmerman KO, Clark RH, Greenberg RG

This study aimed to characterize the prevalence of exchange transfusion (ET), clinical characteristics of infants receiving ET, and ET-associated morbidity and mortality. It was a multicenter cohort study of infants ≥23 weeks of gestational age (GA) with hyperbilirubinemia who underwent ET within 30 days of birth from 1997 to 2016. Infants ≤ 29 weeks of GA had greater odds of death following ET compared with term infants. These data will support clinicians in evaluating risks and prognosis for infants who require ET.

Safety of Metronidazole in Late Preterm and Term Infants With Complicated Intraabdominal Infections

Pediatric Infectious Disease Journal • September 2020

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Commander SJ, Gao J, Zinkhan EK, Heresi G, Courtney SE, Lavery AP, Delmore P, Sokol GM, Moya F, Benjamin DK Jr, Bumpass TG, Debski J, Erinjeri J, Sharma G, Tracy ET, Cohen-Wolkowiez M, Hornik CP; on behalf of the Best Pharmaceuticals for Children Act – Pediatric Trials Network Steering Committee

Metronidazole is frequently used off-label in infants with complicated intra-abdominal infections (cIAI) to provide coverage against anaerobic organisms, but its safety and efficacy in this indication are unknown. Metronidazole safety was evaluated by reporting of adverse events (AEs) and safety events of special interest. In a cohort of late pre-term and term infants with cIAIs, combination antibiotic therapy that included metronidazole was safe, and therapeutic success was high.

Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Children: A Prospective Natural History and Case-Control Study

Pediatric Infectious Disease Journal • August 2020

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Ericson JE, McGuire J, Michaels MG, Schwarz A, Frenck R, Deville JG, Agarwal S, Bressler AM, Gao J, Spears T, Benjamin DK, Smith PB, Bradley, JS

We examined laboratory and clinical features that might improve pediatric hospital-acquired and ventilator-associated bacterial pneumonias (HABP/VABP) trial efficiency by identifying risk factors predisposing children to HABP/VABP and describing the epidemiology of pediatric HABP/VABP. Food and Drug Administration-defined HABP/VABP occurred in 10%-12% of pediatric patients admitted to ICUs. Risk factors vary by age group.

Probiotic Use and Safety in the Neonatal Intensive Care Unit: A Matched Cohort Study

Journal of Pediatrics • July 2020

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Gray KD, Messina JA, Cortina C, Owens T, Fowler M, Foster M, Gbadegesin S, Clark RH, Benjamin DK, Zimmerman KO, Greenberg RG

This study sought to determine the prevalence of probiotic administration in infants born preterm over time, as well as the association between probiotic administration and select adverse outcomes. Probiotic use increased over the study period and varied among neonatal intensive care units. Probiotic administration was associated with a decrease in NEC and death, and an increase in Candida infection, but no increase in bloodstream infection or meningitis.

Authors’ response to thrombocytopenia following exchange transfusion in neonates

Journal of Perinatology • July 2020

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Wolf MF, Childers J, Gray KD, Chivily C, Glenn M, Jones L, Kpa M, McMannen T, Reyes I, Zimmerman KO, Clark RH, Greenberg RG

A letter from the author in response to comment on “Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia.”

Impact of Personal Protective Equipment on Pediatric Cardiopulmonary Resuscitation Performance: A Controlled Trial

Pediatric Emergency Care • June 2020

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Donoghue A, Kou M, Good G, Eiger C, Nash M, Henretig F, Stacks H, Kochman A, Debski J, Chen JY, Sharma G, Hornik C, Gosnell L, Siegel D, Krug S, Adler M, on behalf of the Best Pharmaceuticals for Children Act – Pediatric Trials Network

This study aimed to determine whether personal protective equipment (PPE) results in deterioration in chest compression (CC) quality and greater fatigue for administering health care providers (HCPs). HCPs completed 2 sessions. In session 1 (baseline), HCPs wore normal attire; in session 2, HCPs donned full PPE. We enrolled 108 HCPs. During a clinically appropriate 2-minute period, neither CC quality nor self-reported fatigue worsened to a significant degree in providers wearing PPE. Our data suggest that Pediatric Basic Life Support recommendations for CC providers to switch every 2 minutes need not be altered with PPE use.

Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Procedures by Prehospital Providers

Disaster Medicine and Public Health Preparedness • May 2020

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Kou M, Donoghue AJ, Stacks H, Kochman A, Semiao M, Nash M, Siegel D, Ku L, Debski J, Chen J-Y, Sharma G, Gosnell L, Krug S, Adler MD

This study examined the effects of personal protective equipment (PPE) on the ability of prehospital providers (PHPs) to perform resuscitation procedures on pediatric patients. This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.

CYP2B6 Genotype Affects Methadone Disposition in Children as Demonstrated by Physiologically-Based Pharmacokinetic (PBPK) Modeling

Clinical Pharmacology and Therapeutics • March 2020

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Gerhart JG, Edginton A, Watt KM, Cohen-Wolkowiez M, Harper B, Muller W, Delmore P, Atz A, Gonzalez D; on behalf of the Best Pharmaceuticals for Children Act – Pediatric Trials Network Steering Committee

Meeting abstract from Annual Meeting of the American-Society-for-Clinical-Pharmacology-and-Therapeutics on March 18-21, 2020.

Systemic Timolol Exposure Following Topical Application to Infantile Hemangiomas (research letter)

Journal of the American Academy of Dermatology • March 2020

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Drolet BA, Boakye-Agyeman F, Harper B, Holland K, Lewandowski A, Stefanko N, Melloni C

Off-label ophthalmic timolol has been rapidly adopted for treatment of infantile hemangioma since topical application of β-blockers was presumed to have an improved safety profile compared with that of oral administration. We examined timolol plasma concentrations in children receiving ophthalmic preparations applied to skin hemangiomas. Timolol was detected in 86 of 92 plasma samples (93%). We predicted that young infants would have higher plasma concentrations but found that older infants (6-12 months) had the highest concentrations. Subsequently, we analyzed the effect of hemangioma size and thickness on plasma concentrations. Only hemangioma thickness significantly predicted plasma concentrations.

Medications and In-hospital Outcomes in Infants Born at 22-24 Weeks Gestation

Journal of PerinatologyFebruary 2020

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Puia-Dumitrescu M, Younge N, Benjamin DK, Lawson K, Hume C, Hill K, Mengistu J, Wilson A, Zimmerman ZO, Ahmad K, Greenberg RG; on behalf of the Best Pharmaceuticals for Children Act – Pediatric Trials Network

This study evaluated the most commonly used medications and in-hospital morbidities and mortality in infants born 22-24 weeks of gestation. It was a multicenter retrospective cohort study of infants born 22-24 weeks of gestation, from 2006-2016, without major congenital anomalies and with available medication data obtained from neonatal intensive care units managed by the Pediatrix Medical Group. A large number of medications were used in periviable infants. There was a high prevalence of in-hospital morbidities, and survival of this population increased over the study period.