Total vascular resistance increases during volume-unloading in asymptomatic single ventricle patients.

Objective: While the surgical stages of single ventricle (SV) palliation serve to separate pulmonary venous and systemic venous return, and to volume-unload the SV, staged palliation also results in transition from parallel to series circulation, increasing total vascular resistance. How this transition affects pressure loading of the SV is as yet unreported.

Methods: We performed a retrospective chart review of Stage I, II, and III cardiac catheterization (CC) and echocardiographic data from 2001-2017 in all SV pts, with focus on systemic, pulmonary, and total vascular resistance (SVR, PVR, TVR respectively).

Prospective evaluation of a clinical decision tool to reduce childhood admissions to PICUs for poisoning: ReCAP.

To prospectively validate a pediatric clinical prediction model to identify children at low risk of clinically significant ingestions to prevent unnecessary pediatric intensive care unit (PICU) admissions. Calls received by the Georgia Poison Center about children for acute ingestions between May 25, 2017 and May 17, 2018 were scored in real time using the full, age-stratified, and simplified clinical scoring tool to educe hildhood dmissions to ICUs for oisoning (RECAP). Clinically significant ingestions with a poison center recommendation of PICU admission are defined in the simple RECAP model as ingestion of clonidine, ethanol, an oral anti-hyperglycemic agent, or exposure to carbon monoxide, as well as the presence of symptoms occurring within 2 h for an immediate release, or 4 h for an extended release, medication exposure.

Importance of Compliance Audits for a Pediatric Complicated Appendicitis Clinical Practice Guideline.

Clinical practice guidelines (CPG) have been shown to decrease practice variation, reduce resource use, and improve patient outcomes. The purpose of this study was to audit compliance of a pediatric complicated appendicitis CPG to identify areas for continued improvement. A comprehensive complicated appendicitis CPG was implemented in a children's hospital system.

Implementing a surgeon-reported categorization of pediatric appendicitis severity.

Purpose: The purpose of this study was to implement a novel surgeon-reported categorization (SRC) for pediatric appendicitis severity and determine if SRC was associated with outcomes.

Methods: We conducted a retrospective review of appendectomies by 15 surgeons within a single center from January to December 2016. The SRC was defined as: simple (category 1), gangrenous or adherent (category 2A), perforation with localized abscess (category 2B), and perforation with gross contamination (category 2C).

Echocardiographic parameters associated with biventricular circulation and right ventricular growth following right ventricular decompression in patients with pulmonary atresia and intact ventricular septum: Results from a multicenter study.

Background: In patients with pulmonary atresia, intact ventricular septum (PA/IVS) following right ventricular (RV) decompression, RV size and morphology drive clinical outcome. Our objectives were to (1) identify baseline and postdecompression echocardiographic parameters associated with 2V circulation, (2) identify echocardiographic parameters associated with RV growth and (3) describe changes in measures of RV size and changes in RV loading conditions.

Methods: We performed a retrospective analysis of patients who underwent RV decompression for PA/IVS at four centers.

Temporomandibular joint involvement in children with juvenile idiopathic arthritis: a preliminary report.

Objective: Children with juvenile idiopathic arthritis (JIA) are at risk for temporomandibular joint (TMJ) arthritis. This can lead to pain, limited mouth opening, facial asymmetry, and malocclusion. Our objective was to characterize patients with JIA and TMJ involvement in a single center.

Primary versus secondary anastomosis in intestinal atresia.

Purpose: Neonates with intestinal atresia (IA) undergo either primary anastomosis (PA) or ostomy creation with secondary anastomosis (SA). Our purpose was to compare outcomes for PA and SA and to assess factors influencing procedure selection.

Methods: We conducted a retrospective cohort study of neonates with IA between 2009 and 2015.

Ramifications of the Children's Surgery Verification Program for Patients and Hospitals.

Background: The American College of Surgeons in 2015 instituted the Children's Surgery Verification program delineating requirements for hospitals providing pediatric surgical care. Our purpose was to examine possible effects of the Children's Surgery Verification program by evaluating neonates undergoing high-risk operations.

Study Design: Using the Kid's Inpatient Database 2009, we identified infants undergoing operations for 5 high-risk neonatal conditions.

Reducing Childhood Admissions to the PICU for Poisoning (ReCAP2) by Predicting Unnecessary PICU Admissions After Acute Intoxication.

Objective: To derive and validate clinical prediction models to identify children at low risk of clinically significant intoxications for whom intensive care admission is unnecessary.

Design: Retrospective review of data in the National Poison Data Systems from 2011 to 2014 and Georgia Poison Center cases from July to December 2016.

Setting: United States PICUs and poison centers participating in the American Association of Poison Control Centers from 2011 to 2016.

Urban-Rural Differences in Tubal Ligation Incidence in the State of Georgia, USA.

Purpose: To evaluate the difference in tubal ligation use between rural and urban counties in the state of Georgia, USA.

Methods: The study population included 2,160 women aged 22-45. All participants completed a detailed interview on their reproductive histories.

Analysis of Interventions Required in 12,021 Children With Acute Intoxications Admitted to PICUs.

Objectives: Acute intoxications in children account for 4.6% of annual admissions to the PICU. We aimed to describe the interventions and monitoring required for children admitted to the PICU following intoxications with the ultimate goal of determining patient and intoxication characteristics associated with the need for PICU interventions.

Temporal Trends in Utilization of Transthoracic Echocardiography for Common Outpatient Pediatric Cardiology Diagnoses over the Past 15 Years.

Background: No data exist regarding the temporal trends in utilization of transthoracic echocardiography (TTE) in an outpatient pediatric cardiology setting. This study evaluates the trends in utilization of TTE for common diagnoses known to have low diagnostic yield and the factors influencing these trends.

Methods: Patients evaluated at our pediatric cardiology clinics from January 2000 to December 2014 and discharged with final diagnoses of innocent murmur, noncardiac chest pain, benign syncope, and palpitations were included.

Characterization of Myocardial Dysfunction in Fluid- and Catecholamine-Refractory Pediatric Septic Shock and Its Clinical Significance.

Purpose:: Myocardial dysfunction is a known complication in patients with pediatric septic shock (PSS); however, its clinical significance remains unclear. The purpose of this study was to characterize left ventricular (LV) and right ventricular (RV) dysfunction and their prevalence in patients with PSS using echocardiography (echo) and to investigate their associations with the severity of illness and clinical outcomes.

Methods:: Retrospective chart review between 2010 and 2015 from 2 tertiary care pediatric intensive care units.

Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: Is intervention necessary?

Background: There are no widely accepted guidelines for management of pediatric patients who have evidence of solid organ contrast extravasation ("blush") on computed tomography (CT) scans following blunt abdominal trauma. We report our experience as a Level 1 pediatric trauma center in managing cases with hepatic and splenic blush.

Methods: All pediatric blunt abdominal trauma cases resulting in liver or splenic injury were queried from 2008 to 2014.

Outcomes following implementation of a pediatric procedural sedation guide for referral to general anesthesia for magnetic resonance imaging studies.

Background/aims: Guidelines for referral of children to general anesthesia (GA) to complete MRI studies are lacking. We devised a pediatric procedural sedation guide to determine whether a pediatric procedural sedation guide would decrease serious adverse events and decrease failed sedations requiring rescheduling with GA.

Methods: We constructed a consensus-based sedation guide by combining a retrospective review of reasons for referral of children to GA (n = 221) with published risk factors associated with the inability to complete the MRI study with sedation.