Fever at Time of Leukemia Diagnosis in Children: Predictor of Bloodstream Infection or Catheter Removal?

PURPOSE: To assess the incidence of fever at diagnosis in children with leukemia and determine if fever at diagnosis is a predictor of bloodstream infection (BSI) or central venous access device (CVAD) removal for infection either within the first 30 days or between 30 and 90 days after CVAD insertion. MATERIALS AND METHODS: One hundred fifty-one patients with acute leukemia (July 1, 2018, to December 31, 2020) who underwent a CVAD insertion within 2 weeks of diagnosis were included. Patient data included demographic characteristics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1,000 catheter days, and need for catheter removal after CVAD insertion within 30 days and between 30 and 90 days. RESULTS: Patients with fever at diagnosis had a significantly higher incidence of BSI within the first 30 days after CVAD insertion (17/23) than that among patients without fever (6/23) (P = .046) at diagnosis. No statistically significant difference was observed in the incidence of BSI between 30 and 90 days after CVAD insertion between patients with fever (5/11) and those without fever at diagnosis (6/11) (P = .519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients required CVAD removal; 7/9 had fever and 2/9 had no fever) (P = .181) or between 30 and 90 days (4 patients required CVAD removal; 1/4 had fever and 3/4 had no fever at diagnosis) (P = .343) after insertion. CONCLUSIONS: Fever at diagnosis in patients with leukemia is not a predictor of CVAD removal for infection.

What is the variability in urodynamic parameters with position change in children? Analysis of a prospectively enrolled cohort.

PURPOSE: Insufficient data are available regarding the effect of patient position on urodynamic parameters and diagnoses in children. We report on a cohort of pediatric patients, comparing the results of serial urodynamic studies to determine the variability between the supine and sitting positions. MATERIALS AND METHODS: Children referred for urodynamic evaluation were prospectively enrolled based on the ability to tolerate position change. Consecutive studies in supine and sitting positions were performed during a single session by the same nursing team. Volume infused and infusion rate did not differ with position change. RESULTS: A total of 48 children were enrolled in the study. Mean patient age was 10.4 years. No statistically significant difference was noted for maximum cystometric capacity, detrusor leak point pressures or pressure specific volumes at 20 and 30 cm water between the supine and sitting positions. Statistically significant lower values were found for the volume of first sensation and volume at which detrusor overactivity was first detected (p <0.05), with a trend toward significance for abdominal or Valsalva leak point pressure. Statistically significant differences were also noted with position changes in regard to detection of detrusor overactivity and incontinence episodes (p <0.05). CONCLUSIONS: In our study population no significant differences were detected in several urodynamic parameters with position change, suggesting that clinically valid conclusions can be obtained by performing the study in either position. Studies in the sitting position allow for increased detection of detrusor overactivity and incontinence, thus, being favored over the supine position if well tolerated by the child.