Ondansetron Safety Regarding Prolong QTc for Children with Head Trauma.

BACKGROUND: There have been recent reports of increased QT interval after head trauma in concussed athletes and adult patients. Ondansetron, which is widely used in treatment of nausea and vomiting symptoms in head injuries, was issued a safety warning from the U.S. Food and Drug Administration regarding QT prolongation and risk of fatal dysrhythmias. OBJECTIVE: The purpose of this study was to evaluate the safety of ondansetron regarding QT prolongation for patients experiencing nausea or vomiting after head trauma. METHODS: Patients aged 1-20 years presenting to a pediatric emergency department with head trauma and who required a dose of ondansetron for nausea or vomiting were enrolled in the study. Patients received a baseline 12-lead electrocardiogram (ECG) prior to administration of either oral or IV ondansetron. A second post-ondansetron 12-lead ECG was performed after administration of ondansetron. All ECGs were reviewed and the QTc calculated manually by a board-certified pediatric cardiologist. RESULTS: Forty-two patients met enrollment criteria. Five patients received IV ondansetron and 37 received oral ondansetron. Mean QTc pre ondansetron was 387.5 ms and mean QTc post ondansetron was 400.9 ms (p = 0.120). We found no statistically significant difference in other ECG parameters pre and post ondansetron. CONCLUSIONS: Ondansetron is safe in regard to QTc prolongation in patients with head trauma. Based on this research, ondansetron should continue to be used for the treatment of nausea and vomiting in emergency department patients who present with head injury.

Sustained Improvement in Right Ventricular Chamber Dimensions 10 Years Following Xenograft Pulmonary Valve Replacement.

BACKGROUND: The goals following pulmonary valve replacement (PVR) are to optimize right ventricular hemodynamics and minimize the need for subsequent reoperations on the right ventricular outflow tract. We hypothesized PVR using a xenograft valved conduit would result in superior freedom from reoperation with sustained improvement in right ventricular chamber dimensions. METHODS: Xenograft valved conduits placed in patients aged >16 years were reviewed from 2000 to 2010 to allow for a 5-year minimum follow-up. Preoperative, one-year, and the most recent echocardiograms quantified right ventricular chamber dimensions, corresponding Z scores, and prosthetic valve function. Magnetic resonance imaging (MRI) studies compared preoperative and follow-up right ventricular volumes. RESULTS: A total of 100 patients underwent PVR at 24 (19-34) years. Freedom from reintervention was 100% at 10 years. At most recent follow-up, only one patient had greater than mild pulmonary insufficiency. The one-year (17.3 ± 7.2 mm Hg; P < .01) and most recent follow-up (18.6 ± 9.8 mm Hg; P < .01) Doppler-derived right ventricular outflow tract gradients remained significantly lower than preoperative measurements (36.7 ± 27.0 mm Hg). Similarly, right ventricular basal diameter, basal longitudinal diameter, and the corresponding Z scores remained lower at one year and follow-up from preoperative measurements. From 34 MRI studies, the right ventricular end-diastolic indexed volume (161.7 ± 58.5 vs 102.9 ± 38.3; P < .01) and pulmonary regurgitant fraction (38.0% ± 15.9% vs 0.8% ± 3.3%; P < .01) were significantly lower at 7.1 ± 3.4 years compared to the preoperative levels. CONCLUSION: Use of a xenograft valved conduit for PVR results in excellent freedom from reoperation with sustained improvement in right ventricular dimensions at an intermediate-term follow-up.

Combined dyslipidemia in obese children: response to a focused lifestyle approach.

BACKGROUND: Combined dyslipidemia (elevated triglyceride [TG] ± non-high-density lipoprotein cholesterol [non-HDL-C] ± total cholesterol [TC] ± low-density lipoprotein cholesterol [LDL-C] ± reduced high-density lipoprotein cholesterol [HDL-C]) is seen in >40% of obese children. Primary recommended treatment is weight loss with limited reports of any other approach. OBJECTIVE: In children with combined dyslipidemia, evaluate the response to a clinical protocol focused on diet composition change and increased activity with no direct weight loss approach. METHODS: Retrospective review of lipid profile and growth parameter changes in patients 6 to 18 years of age with diagnosis of combined dyslipidemia seen between December 31, 2009, and December 31, 2011, managed with this protocol through 2 follow-up visits. Combined dyslipidemia diagnosed when ≥2 lipid values exceed the upper limit of normal for TC, TG, non-HDL-C, or LDL-C ± HDL-C below the lower limit of normal. RESULTS: Fifty-three patients were identified, 55% male, 92% obese, mean age 12.1 ± 3.4 years with mean follow-up 9.2 months. Lipid parameters (mean ± SD, mg/dL) improved significantly (P < .001): TC 209 ± 39 to 181 ± 32; TG 255 ± 119 to168 ± 99; non-HDL-C 167 ± 35 to 138 ± 30 and LDL-C 121 ± 43 to 106 ± 30. HDL-C was unchanged. Body mass index decreased in 58% and mean body mass index decreased 0.67 kg/m(2) (P < .05). CONCLUSIONS: Focused lifestyle changes significantly improved combined dyslipidemia in obese children. With no direct weight loss approach, body mass index decreased in 58%.