Transient Secondary Hypothyroidism and Thyroid Hormone Replacement Therapy in Pediatric Postoperative Cardiopulmonary Bypass.

BACKGROUND: To develop an understanding of current practices in the management of transient secondary hypothyroidism in pediatric postoperative cardiopulmonary bypass (CPB) patients. METHODS: Electronic survey comprising a 10-item questionnaire was sent to sixty-four high volume pediatric heart centers in the United States and United Kingdom. Survey participants included cardiologists, intensivists, cardiothoracic surgeons, and advanced practice providers. A retrospective chart review was also performed at a large regional referral center in the Midwest on subjects 0-18 years old who underwent CPB from 2005-2015. Information obtained included a unique identifier, date of birth, age, procedure performed, CPB time, date of surgery and date and type of Thyroid Function Test (TFT) ordered. RESULTS: 1,153 individuals from 64 congenital heart centers were contacted via email to participate in the electronic survey. In the 3-month response window, 129 completed surveys were received from cardiologists (55%), intensivists (17%), surgeons (15%), "other" (8%), and advanced practice providers (5%). This yielded a response rate of 11.2%. Of the 129 respondents, only 10 providers routinely order TFTs prior to (n=7) and after (n=1) CPB or when clinically indicated (n=2). All 10 providers order thyroid stimulating hormone test, 7 order thyroxine, and 3 order triiodothyronine. Only 1 provider routinely treats children with prophylactic thyroid hormone replacement therapy after CPB. Our retrospective review included 502 CPB events with 442 unique patients. Of the events, 20 patients received preoperative TFT testing while 11 received postoperative testing. CONCLUSIONS: There is a general lack of uniformity in the evaluation, diagnosis, and treatment of transient secondary hypothyroidism in pediatric postoperative CPB patients.

What nurses need to know about fecal microbiota transplantation: education, assessment, and care for children and young adults.

Fecal microbiota transplantation (FMT) is an emerging experimental therapy for treatment of recurrent Clostridium difficile infection. In the future, FMT has the potential to be a treatment modality in other diseases that involve gut dysbiosis. As use of FMT is likely to expand, pediatric nurses need a clear understanding of FMT to provide appropriate education, assessment, and care for these patients. Pediatric research and clinical nurses are a resource to help children and parents understand the procedure. Important topics include donor screening, patient assessment before, during, and after treatment; routes of administration and positioning; preparation for discharge and followup evaluation.

Sonographic assessment of renal size and growth in premature infants.

BACKGROUND: Low birth-weight infants are at risk for renal disease when renal insults occur in the neonatal period. Renal growth as measured by sonography over time is utilized by many nephrologists as predictors of future renal disease. OBJECTIVE: To identify infants at risk by defining normal renal growth for the very premature infant. MATERIALS AND METHODS: Renal growth was evaluated in 30 infants whose birth weight was 1,500 g or less and gestational age was <31 weeks. During a 2-month time period, three US measurements were taken (first week of life, age 28 days, and age 56 days or earlier if discharged). Infants were divided according to birth weight: the extremely low birth-weight group (ELBW) was <1,000 g (n = 14), and the very low birth-weight group (VLBW) was 1,000-1,500 g (n = 16). RESULTS: In both groups, the right and left renal lengths were similar. In the ELBW group, the initial mean length was 3.25 cm and grew to 4.16 cm, while the mean volume was 4.85 cm and grew to 10.39 cm. In the VLBW group the initial mean length was 3.69 cm and grew to 4.35 cm while the mean volume was 7.25 cm and grew to 11.83 cm. CONCLUSION: These data establish normal expected growth for future studies.

Phenylacetate and benzoate clearance in a hyperammonemic infant on sequential hemodialysis and hemofiltration.

An infant with a suspected inborn metabolism error was treated with a metabolic cocktail of intravenous sodium phenylacetate (NaPh) and sodium benzoate (NaBz) for hyperammonemia. Sequential hemodialysis (HD) then hemofiltration (HF) was performed due to hyperammonemia. Dialytic and convective clearance (K; ml/min) of ammonia, NaPh, and NaBz was measured. The K of ammonia was 57 and 37 for HD and HF, respectively. The K of NaBz was 37 and 12 for HD and HF, respectively. The K of NaPh was 38 and 14 ml/min for HD and HF, respectively. Despite high clearance of both NaPh and NaBz by HD and HF, the hyperammonemia was corrected.