Live Vaccine and Varicella Postexposure Prophylaxis in Pediatric Liver Transplant Recipients: A Survey of Practice in Australia and New Zealand.

BACKGROUND: Administration of live vaccines following liver transplant (LT) has historically not been recommended due to concerns regarding risk of vaccine-attenuated disease. However, there is evidence suggesting that in select transplant recipients live vaccinations can be administered safely. Studies in other regions have indicated that despite this evidence many clinicians remain hesitant to administer live vaccinations. METHOD: A REDCap survey was distributed to gastroenterologists, pediatricians, and infectious diseases physicians at pediatric centers across Australia and New Zealand via email between September and November 2023. The survey included a series of questions regarding live vaccine and varicella postexposure prophylaxis (PEP) practices in pediatric LT recipients and barriers to live vaccine administration in this cohort. RESULTS: There was a total of 16 responses to the survey, from 10 different pediatric centers, including 10/11 pediatric gastroenterology centers and all four pediatric LT centers in the region. Only 31% (5/16) of respondents (from 3/10 different centers) offer live vaccines. The main barrier to live vaccine administration was clinician reluctance and the main reason for not offering live vaccines was insufficient safety data. Sixty-nine percent (11/16) of respondents take vaccination status and/or serology into account when deciding whether to offer varicella PEP to this cohort. Respondents universally offer varicella zoster immunoglobulin as PEP, though 31% (5/16) also offer antiviral medication. CONCLUSIONS: Many clinicians in our region remain hesitant to provide live vaccines to pediatric LT recipients, with concerns regarding insufficient safety data. Updated local guidelines may help to address this.

Implicit memory formation using the word stem completion task during anesthesia in children.

AIMS: To determine whether there is evidence of implicit memory formation during pediatric anesthesia using the word stem completion task. BACKGROUND: In adults, there is mixed evidence for implicit memory formation during anesthesia; however, there is no evidence in children. Implicit memory in adults has been detected using the word stem completion task. This test has not been used in a pediatric anesthetic setting. METHODS: A total of 200 patients aged 7-12 were randomized to hear one of the two lists of 10 words played continuously while anesthetized. Group 1 heard List A and Group 2 heard List B. Postoperatively, 194 completed a word stem completion task where they were required to complete the stems (the first part of words) corresponding to the words on the two word lists combined, with the first word that came to mind. RESULTS: Group 1 completed a mean of 2.78 words correctly from List A and a mean of 2.70 words correctly from List B. Group 2 completed a mean of 3.29 words correctly from List A and a mean of 3.66 words correctly from List B. For List A, there was no evidence (P = 0.70) for an association between intraoperative exposure to this list and the odds of successfully completing a stem from this list with the corresponding target word. There was little evidence (P = 0.09) for an association with List B. CONCLUSION: This study found no strong evidence that children form implicit memories for auditory words during anesthesia. Given the difference between lists, future research is warranted using carefully chosen word stems.