Case report series of a novel application of neostigmine to successfully relieve refractory ileus status post-pediatric orthotopic liver transplantation.

Post-operative ileus is common after abdominal surgeries. Children undergoing liver transplant are at increased risk of ileus for various reasons including multiple abdominal procedures and use of narcotic medications. Ileus can lead to abdominal compartment syndrome and compromise the integrity of the liver graft. In some of these patients, ileus is resistant to standard therapies including stool softeners, bowel stimulants, enemas, and even methylnaltrexone. Neostigmine has been shown in pediatric case series to be efficacious in some children for refractory post-operative ileus. We report three children (9 months, 3 years, and 12 years old) who developed refractory ileus after liver transplant, with one of them developing abdominal compartment syndrome, who were treated successfully with continuous infusions of neostigmine. Clinical responses included passage of flatus and stool and improvement in abdominal distension. All patients tolerated the infusion without serious adverse effects such as bradycardia or bronchospasm. Neostigmine was used safely in our patients and may be safe and efficacious for the treatment of refractory ileus in pediatric patients after liver transplantation. Neostigmine should be considered early in the treatment of these patients.

Partially Wireless Pulse Oximetry Reduces Loss of Signal Integrity due to Motion in Children.

OBJECTIVES: Continuous pulse oximetry monitoring is routine in many pediatric inpatient units, generating hundreds of alarms per patient per day, up to 90% of which are false (nonactionable). We hypothesized that continuously monitoring pulse oximetry with a partially wireless monitor without physical connection to a wall unit (wireless pox) will decrease episodes of loss of signal integrity (LOSI) generated by motion artifact in healthy pediatric subjects completing age-appropriate activities compared with a traditional wall-connected pulse oximeter (control pox), thereby reducing false alarms. METHODS: Thirty-six healthy children, aged 1 to 17 years, were continuously monitored simultaneously with a wireless pox and a control pox while performing increasing levels of activity for 20 minutes. Continuous pulse oximetry data were recorded in 2 second intervals. Data were analyzed for LOSI. The Wilcoxon signed rank test was then used to compare the control pox to the wireless pox. RESULTS: The wireless pox had fewer mean number of alarms due to LOSI (control 7.86, wireless 4.17, P = .0031) and fewer mean episodes of LOSI not leading to alarms (control 9.94, wireless 6.92, P = .0006). The control pox had a longer percent time in alarm state related to LOSI in all age groups. CONCLUSIONS: This prospective observational study found that the wireless pox has decreased number and duration of events of LOSI compared with the control pox in healthy children. Implementation of partially wireless pulse oximetry in pediatric inpatient units may decrease episodes of LOSI and false alarms from motion artifact.