First name
Peter
Last name
Mattei

Title

Guideline for Children With Cancer Receiving General Anesthesia for Procedures and Imaging.

Year of Publication

2022

Date Published

2022 Mar 01

ISSN Number

1536-3678

Abstract

<p>Children with cancer and those undergoing hematopoietic stem cell transplantation frequently require anesthesia for imaging as well as diagnostic and therapeutic procedures from diagnosis through follow-up. Due to their underlying disease and side effects of chemotherapy and radiation, they are at risk for complications during this time, yet no published guideline exists for preanesthesia preparation. A comprehensive literature review served as the basis for discussions among our multidisciplinary panel of oncologists, anesthesiologists, nurse practitioners, clinical pharmacists, pediatric psychologists, surgeons and child life specialists at the Children's Hospital of Philadelphia. Due to limited literature available, this panel created an expert consensus guideline addressing anesthesia preparation for this population.</p>

DOI

10.1097/MPH.0000000000002430

Alternate Title

J Pediatr Hematol Oncol

PMID

35235547

Title

Successful treatment of pulmonary mucormycosis in two pediatric hematopoietic stem cell transplant patients.

Year of Publication

2018

Number of Pages

e13270

Date Published

2018 Nov

ISSN Number

1399-3046

Abstract

<p>Pulmonary mucormycosis diagnosed immediately after hematopoietic stem cell transplantation frequently portends a poor prognosis. However, here we describe two cases in children that were treated successfully to highlight the efficacy of a multidisciplinary approach. Despite diagnosis in the immediate post-transplant period and requirement for ongoing immunosuppression to prevent or treat GVHD, both are long-term survivors due to early surgical debridement with transfusion support and prompt initiation of targeted antifungal therapy. In the absence of evidence-based treatment guidelines, survival of pulmonary mucormycosis is achievable even in high-risk patients with a multidisciplinary team to guide management.</p>

DOI

10.1111/petr.13270

Alternate Title

Pediatr Transplant

PMID

30014584

Title

Outcomes of laparoscopic and open surgery in children with and without congenital heart disease.

Year of Publication

2017

Number of Pages

1980-1988

Date Published

2018 Oct

ISSN Number

1531-5037

Abstract

<p><strong>BACKGROUND: </strong>Children with congenital heart disease (CHD) often require noncardiac surgery. We compared outcomes following open and laparoscopic intraabdominal surgery among children with and without CHD.</p>

<p><strong>METHODS: </strong>We performed a retrospective cohort study using the 2013-2015 National Surgical Quality Improvement Project-Pediatrics. We matched 45,012 children &lt;18years old who underwent laparoscopic surgery to 45,012 children who underwent open surgery. We determined the associations between laparoscopic (versus open) surgery and 30-day mortality, in-hospital mortality, 30-day morbidity, and postoperative length-of-stay.</p>

<p><strong>RESULTS: </strong>Among children with minor CHD, laparoscopic surgery was associated with lower 30-day mortality (Odds Ratio [OR] 0.34 [95% Confidence Interval 0.15-0.79]), inhospital mortality (OR 0.42 [0.22-0.81]) and 30-day morbidity (OR 0.61 [0.50-0.73]). As CHD severity increased, this benefit of laparoscopic surgery decreased for 30-day morbidity (ptrend=0.01) and in-hospital mortality (ptrend=0.05), but not for 30-day mortality (ptrend=0.27). Length-of-stay was shorter for laparoscopic approaches for children at cost of higher readmissions. On subgroup analysis, laparoscopy was associated with lower odds of postoperative blood transfusion in all children.</p>

<p><strong>CONCLUSIONS: </strong>Intraabdominal laparoscopic surgery compared to open surgery is associated with decreased morbidity in patients with no CHD and lower morbidity and mortality in patients with minor CHD, but not in those with more severe CHD.</p>

<p><strong>LEVEL-OF-EVIDENCE: </strong>Level III: Treatment Study.</p>

DOI

10.1016/j.jpedsurg.2017.10.052

Alternate Title

J. Pediatr. Surg.

PMID

29157923

Title

Mortality and Morbidity after Laparoscopic Surgery in Children with and without Congenital Heart Disease.

Year of Publication

2017

Date Published

2017 Mar 03

ISSN Number

1097-6833

Abstract

<p><strong>OBJECTIVES: </strong>To determine the risk of morbidity and mortality after laparoscopic surgery among children with congenital heart disease (CHD).</p>

<p><strong>STUDY DESIGN: </strong>Cohort study using the 2013-2014 National Surgical Quality Improvement Program-Pediatrics, which prospectively collected data at 56 and 64 hospitals in 2013 and 2014, respectively. Primary exposure was CHD. Primary outcome was overall in-hospital postoperative mortality. Secondary outcomes included 30-day mortality and 30-day morbidity (any nondeath adverse event). Among 34?543 children who underwent laparoscopic surgery, 1349, 1106, and 266 had minor, major, and severe CHD, respectively. After propensity score matching within each stratum of CHD severity, morbidity and mortality were compared between children with and without CHD.</p>

<p><strong>RESULTS: </strong>Children with severe CHD had higher overall mortality and 30-day morbidity (OR 12.31, 95% CI 1.59-95.01; OR 2.51, 95% CI 1.57-4.01, respectively), compared with matched controls. Overall mortality and 30-day morbidity were also higher among children with major CHD compared with children without CHD (OR 3.46, 95% CI 1.49-8.06; OR 2.07, 95% CI 1.65-2.61, respectively). Children with minor CHD had similar mortality outcomes, but had higher 30-day morbidity compared with children without CHD (OR 1.71, 95% CI 1.37-2.13).</p>

<p><strong>CONCLUSIONS: </strong>Children with major or severe CHD have higher morbidity and mortality after laparoscopic surgery. Clinicians should consider the increased risks of laparoscopic surgery for these children during medical decision making.</p>

DOI

10.1016/j.jpeds.2017.02.011

Alternate Title

J. Pediatr.

PMID

28410089

Title

Management of adrenal masses in patients with Beckwith-Wiedemann syndrome.

Year of Publication

2017

Date Published

2017 Jan 09

ISSN Number

1545-5017

Abstract

<p>Beckwith-Wiedemann syndrome (BWS) is a genetic overgrowth and cancer predisposition syndrome, associated with both benign and malignant adrenal findings. Literature review and an institutional case series elucidate the wide spectrum of adrenal findings in BWS patients. The altered expression of the 11p15 region is likely related to adrenal gland hyperplasia and growth dysregulation. Given the absence of guidelines for managing adrenal findings in BWS, we propose a systematic approach to adrenal findings in BWS patients, to allow for maximum detection of potentially malignant pathology without posing additional risk to patients.</p>

DOI

10.1002/pbc.26432

Alternate Title

Pediatr Blood Cancer

PMID

28066990

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