Integrating secondary prevention of rheumatic heart disease into the primary healthcare system in Northern Uganda.

Introduction: Over 46 million people are living with rheumatic heart disease (RHD) globally, resulting in 380 000 premature deaths each year. Effective RHD prevention strategies are known but their implementation in low-resource settings has lagged. This study evaluated the feasibility and effectiveness of integrating secondary antibiotic prophylaxis into primary health centres to improve access and adherence to RHD care.

Modification of the Cardiac Renal Angina Index for Predicting Adverse Kidney Events After Pediatric Cardiac Surgery.

Background: Pediatric cardiac surgery-associated acute kidney injury is common and associated with poor outcomes, but early prediction is challenging. The purpose of this study was to determine the performance of a modified cardiac renal angina index (cRAI) in predicting adverse renal events and whether biomarker integration (urine neutrophil gelatinase-associated lipocalin) enhances cRAI performance.

Methods: This was a 2-center prospective observational study in children ages 0 to 18 years admitted to the intensive care unit after cardiac surgery.

Refining current risk stratification guidelines for pregnant women with Fontan circulation: lessons from PROFAT registry.

Background: Pregnancy in women with a Fontan circulation carries increased risk. Given the relative evidence void, pregnancy counseling requires considerable nuance and experience.

Objectives: This study aimed to identify risk factors for maternal and fetal complications and to contrast risk estimates obtained from existing risk stratification tools, including the modified WHO, CARPREG II, and ZAHARA risk scores.

Baseline terminal ileal CT and MRI measurements are associated with imaging outcomes in pediatric Crohn's disease: a cohort study.

Background: Cross-sectional imaging is increasingly used for both initial diagnosis and long-term monitoring of Crohn's disease. The quantitative morphology of the terminal ileum may predict treatment response.

Objective: We aimed to identify baseline qualitative and quantitative imaging features that are associated with clinical and radiologic treatment response in a large cohort of children with Crohn's disease.

Acute pancreatitis gut dysbiosis persists at 1-year follow-up and is associated with clinical outcomes.

Objectives: Pediatric acute pancreatitis (AP) is associated with gut dysbiosis. We aimed to determine if dysbiosis persisted during follow-up and whether it is associated with clinical outcomes.

Methods: Prospective enrollment of participants <21 years with first AP.

Maternal Diet Quality and BMI as Predictors of Human Milk C-Reactive Protein Concentrations.

Background: Little is known regarding joint associations of maternal diet quality and adiposity in relation to milk concentrations of inflammatory markers.

Objectives: We evaluated whether maternal diet quality and prepregnancy body mass index (BMI) predict C-reactive protein (CRP) concentration in human milk.

Methods: We used Cincinnati data from Global Exploration of Human Milk study, a prospective cohort of healthy mother-infant dyads (n = 100).

Functional Status Trends for Adults and Children on Extracorporeal Membrane Oxygenation at Time of Lung Transplantation.

Poor or worsening functional status of lung transplant (LTx) candidates is a key risk factor for waitlist and post-transplant mortality. As more critically ill adults and children are listed for LTx, the use of extracorporeal membrane oxygenation (ECMO) as bridge to LTx is also increasing. Sustaining optimal functional status while on the waitlist to LTx is crucial for LTx candidates as deterioration in functional status can negatively impact pre- and post-LTx outcomes.

The Impact of the Selective Cytopheretic Device on Neutrophil-to-Lymphocyte Ratios and Hematological Parameters in Acute Kidney Injury: A Pooled Analysis.

Background: The selective cytopheretic device (SCD) is an immunomodulatory cell-directed extracorporeal therapy that reprograms activated neutrophils and monocytes towards immune homeostasis in hyperinflammatory conditions such as acute kidney injury (AKI). However, clinical mechanisms remain unclear.

Methods: We examined the effect of SCD treatment from prior AKI adult clinical studies on systemic inflammation through neutrophil-to-lymphocyte ratios (NLR) and other hematological measures to gain insights into the mechanism of the SCD.

Skin Staphylococcus aureus detection and relationship to atopic dermatitis outcomes using culture and metagenomic sequencing.

Staphylococcus aureus (SA) skin colonization in pediatric atopic dermatitis (AD) increases risk for severe AD and development of other allergic diseases. Despite this, there is no consensus regarding the optimal method to detect SA. Studies comparing metagenomic shotgun sequencing (MSS) and culture-based methods in SA detection and relationships to AD outcomes are lacking.

Hyperglycemia and kidney outcomes in critically ill children and young adults on continuous kidney replacement therapy.

Background: There are limited studies evaluating hyperglycemia in children treated with continuous kidney replacement therapy (CKRT). We evaluated the association of hyperglycemia with kidney outcomes in critically ill children treated with CKRT for acute kidney injury (AKI) or fluid overload.

Methods: Secondary analysis of the multicenter retrospective observational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) study (34 centers, 9 countries).

Thrombocytopenia in Children and Young Adults Undergoing Continuous Renal Replacement Therapy: A WE-ROCK Study.

Introduction: Thrombocytopenia in patients treated with continuous renal replacement therapy (CRRT) in adults is associated with mortality. Pediatric data are limited. The association between pre-CRRT thrombocytopenia and platelet decline at 24 h of CRRT with outcomes was evaluated.

Enhanced support for adherence to rheumatic heart disease prophylaxis for children in the public health system in Uganda (CAMPS): a pragmatic randomised trial.

Background: Secondary antibiotic prophylaxis is the only intervention known to prevent rheumatic heart disease progression, yet delivery of prophylaxis at scale in low-resource settings has proven challenging, undermining many global programmes. We sought to assess whether enhanced prophylaxis support for rheumatic heart disease, administered through community health workers in the public health system, was feasible and a scalable model.

Methods: The CAMPS trial was a pragmatic randomised trial of prophylaxis supports integrated into routine care in Eastern Uganda.

Impact of renal failure requiring postoperative dialysis on lung transplant outcomes: A national registry study in children.

Background: Renal dysfunction is a common postoperative complication following cardiothoracic surgery, including heart and lung transplantation. Among adult lung transplant (LTx) recipients, acute kidney injury is associated with increased morbidity and mortality with those requiring renal replacement therapy having the worst outcome. The prevalence and risk factors for renal failure requiring post-transplant dialysis and its effect on outcomes among children after LTx are unknown, prompting this investigation.

Performance against standardization recommendations for outpatient care of common forms of congenital heart disease.

Background: The American College of Cardiology has published clinical practice algorithms for common congenital heart lesions, including atrial septal defect, patent ductus arteriosus, valvar pulmonary stenosis, aortic coarctation, and ventricular septal defect. The purpose of this study was to define the current practice patterns in the management of these lesions and describe the impact of departure from these recommendations.

Methods: This was a retrospective analysis of the most recent 100 outpatient appointments for each lesion at our centre.

Safety of Ablation Within the Coronary Venous Sinus in Pediatric Patients.

Background: Catheter-based ablation in the coronary venous sinus (CS) can be associated with inadvertent coronary artery (CA) injury. However, a significant gap remains in the literature with regard to safety of such ablation in pediatrics.

Objectives: The primary aim of this study was to describe the safety of catheter-based ablation within the CS.

Changes in Non-invasive Myocardial Stroke Work Related to Variation in Pacing Sites and Heart Rates in Adolescents.

Non-invasive assessment of myocardial work is a newly described technique to assess myocardial energetics. This has not been previously studied to assess the effects of right ventricular pacing at different sites or at different heart rates in children. We aimed to study the effects of right ventricular apical, septal, and His bundle pacing on myocardial work along with the effects of increasing heart rate.

Impact of Functional Status at the Time of Transplant on Short-Term Pediatric Lung Transplant Outcomes in the USA.

Purpose: Poor functional status is associated with pediatric lung transplant (LTx) waitlist mortality. We investigate how pre-transplant functional status affects post-LTx survival.

Methods: A retrospective analysis was performed using The United Network for Organ Sharing (UNOS) Registry data.

Characteristics and Outcomes of Children and Young Adults With Sepsis Requiring Continuous Renal Replacement Therapy: A Comparative Analysis From the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK).

Objectives: Pediatric sepsis-associated acute kidney injury (AKI) often requires continuous renal replacement therapy (CRRT), but limited data exist regarding patient characteristics and outcomes. We aimed to describe these features, including the impact of possible dialytrauma (i.e.

Looking at the full picture, using topic modeling to observe microbiome communities associated with disease.

The microbiome, a complex micro-ecosystem, helps the host with various vital physiological processes. Alterations of the microbiome (dysbiosis) have been linked with several diseases, and generally, differential abundance testing between the healthy and patient groups is performed to identify important bacteria. However, providing a singular species of bacteria to an individual as treatment has not been as successful as fecal microbiota transplant therapy, where the entire microbiome of a healthy individual is transferred.

Prediction of cardiac surgery associated acute kidney injury using response to loop diuretic and urine neutrophil gelatinase associated lipocalin.

Background: Cardiac surgery associated acute kidney injury (CS-AKI) is common. Urine response to loop diuretic and urine neutrophil gelatinase associated lipocalin (uNGAL) are separately associated with CS-AKI. We aimed to determine whether urine response to loop diuretic and uNGAL together were associated with postoperative day 2-4 CS-AKI.

Clinical Risk Assessment and Prediction in Congenital Heart Disease Across the Lifespan: JACC Scientific Statement.

Congenital heart disease (CHD) comprises a range of structural anomalies, each with a unique natural history, evolving treatment strategies, and distinct long-term consequences. Current prediction models are challenged by generalizability, limited validation, and questionable application to extended follow-up periods. In this JACC Scientific Statement, we tackle the difficulty of risk measurement across the lifespan.