Positive biopsies (Bx+) have been found late in children during their annual study and have been considered subclinical rejection. This study retrospectively evaluated the long-term outcome of patients (pts) who had one or more Bx+ during their annual study compared to those biopsy negative (Bx-).

Intravascular ultrasound (IVUS) assists in the early diagnosis of cardiac allograft vasculopathy (CAV). Early on, we found that CAV was less prevalent in infant recipients. This study extends the follow-up period to determine if that difference persists.

Intravascular ultrasound (IVUS) has been used routinely in the diagnosis of cardiac allograft vasculopathy (CAV) in heart transplant recipients of all ages. This retrospective study evaluates our experience with IVUS in our pediatric population over a 10-year period (7/97 – 6/08).

The procurement of donor organs with prolonged ischemic time for pediatric heart transplant recipient has raised some concern over the potential increased risk of using organs with long ischemic time. We hypothesized that there would be no difference in outcome based on prolonged donor ischemic time.

Perinatal asphyxia is a common cause of neurologic morbidity in neonates who are born at term. Asphyxiated neonates are frequently treated with analgesic medications, including opioids, for pain and discomfort associated with their care. On the basis of previous laboratory studies suggesting that opioids may have neuroprotective effects, we conducted a retrospective review of medical records of 52 neonates who were admitted to our neonatal intensive care unit between 1995 and 2002 and had undergone magnetic resonance imaging (MRI) of the brain. Our review revealed that 33% of neonates received morphine or fentanyl. The neonates who received opioids also had experienced hypoxic/ischemic insults of greater magnitude as suggested by higher plasma lactate levels and lower 5-min Apgar scores. It is interesting that the MRI studies of neonates who were treated with opioids during the first week of life demonstrated significantly less brain injury in all regions studied. More important, follow-up studies of a subgroup of opioid-treated neonates whose MRI scans were obtained in the second postnatal week had better long-term neurologic outcomes. Our results suggest that the use of opioids in the first week of life after perinatal asphyxia have no significant long-term detrimental effects and may increase the brain's resistance to hypoxic-ischemic insults.

Post-transplant coronary artery disease (TxCAD) is a known complication in children after heart tranplantation requiring retransplantation (retx). The purpose of this study was to describe the incidence and outcome of recurrent TxCAD in children after retx. All children who were retransplanted due to TxCAD were evaluated (1995-present). Outcome variables evaluated included intimal thickening based on intravascular ultrasound (IVUS), graft loss, recurrent TxCAD, and early and late acute rejection. Variables were compared using chi-square analysis and outcome was evaluated by Kaplan-Meier. Results are given as mean± SD.

Background: Acute rejection commonly occurs within the first year after heart transplantation, and then decreases in frequency with time. Recently, the long-term utility of endomyocardial biopsy during routine annual catheterization has been questioned. The purpose of this study was to retrospectively review the prevalence of biopsy-proven rejection during routine annual catheterization in our patient population, determine whether biopsies late after transplant are useful, and identify factors that correlate with late unsuspected rejection.Methods: Biopsy results from the annual catheterization were evaluated from 1986 to August 2000. The prevalence of moderate rejection was evaluated and compared with the patient's immunosuppressive regimen; the prevalence of late rejection; and how late rejection correlated with recipient age, number of first-year rejections and presence of sub-therapeutic cyclosporine.Results: A total of 1,108 biopsies were performed in 269 children with a mean follow-up of 5 +/- 3 years (median 5 years, range 1 to 11 years). Three-drug immunosuppressive therapy, including steroids, was used in 93 patients. There was a persistent 8% to 10% prevalence of moderate rejection at up to 10 years post-transplantation. Moderate rejection was more likely in patients: (1) on 3-drug immunosuppressive therapy; (2) with a recipient age >1 year; and (3) with a relatively lower cyclosporine level. I.Conclusions: These data suggest that continued surveillance of pediatric transplant patients for acute rejection is indicated for long-term follow-up..

IVUS has been used with increasing frequency to diagnose PTCAD in pediatric htx recipients. The predictive value of IVUS has not been assessed. The purpose of this study was to evaluate the predictive value of IVUS in our htx population. All IVUS data obtained from 7/96 to the present was reviewed. Morphometric analysis was performed on each study resulting in a Stanford Classification (SC) as previously described. SC 1 or 2 were considered to have no significant thickening. SC 3 or 4 were considered to have significant thickening. Outcome endpoints evaluated were re-htx/death, re-htx only, death only, PTCAD, angiographic evidence of PTCAD (angio+). Chi square analysis was performed comparing SC 1/2 to SC 3/4. Sensitivity (Sn), specificity (Sp), positive preditive value (PV+), and negative predictive value (PV-) were calculated. A p-value of ≤0.05 was considered significant. The results comparing the two Stanford groups are shown in the following table. Tabled 1 p-value Sn Sp PV+ PV− Re-htx/death <0.001 0.63 0.86 0.43 0.93 Re-htx 0.05 0.60 0.83 0.13 0.98 Death 0.001 0.64 0.84 0.3 0.94 PTCAD 0.001 0.67 0.82 0.52 0.93 Angio+ <0.001 1.00 0.85 0.44 1.00 Open table in a new tab

OBJECTIVE To compare iron sufficiency in premature infants receiving high-dose recombinant human erythropoietin (r-HuEPO), 1200 IU/kg per week, supplemented with 6 or 12 mg/kg per day of enteral iron. DESIGN We conducted a prospective, double-blind, controlled study of premature infants receiving r-HuEPO therapy, randomly assigned to receive 2 different doses of iron. Measurements of ferritin, iron, total iron-binding capacity, reticulocyte count, hemoglobin level, and hematocrit were obtained at baseline, 4, and 6 weeks. Transferrin saturation was calculated; the number of blood transfusions and the incidences of sepsis were recorded. SETTING This study was performed in the neonatal intensive care unit at Loma Linda University Children's Hospital, Loma Linda, Calif. SUBJECTS Infants with a gestational age of 32 weeks or younger, older than 7 days, and receiving r-HuEPO therapy from March 1, 1997, to June 30, 1998, were eligible for the study. Infants were randomly assigned to receive 6 mg/kg per day or 12 mg/kg per day of enteral iron during a course of r-HuEPO therapy for 4 to 6 weeks. RESULTS Sixty-four infants were enrolled in the study. Twelve infants did not complete the study; 52 completed 4 weeks and 41 completed 6 weeks of the study. While ferritin levels and transferrin saturation decreased in both groups over the study period, there were no differences between the 2 study groups. CONCLUSIONS Infants receiving high-dose r-HuEPO therapy (1200 IU/kg per week) decrease their ferritin levels (measure of iron stores) even when receiving high enteral iron supplementation. Given that the ferritin levels were similar between the 2 groups, we speculate that the additional iron either was not absorbed or was not stored.

Concerns regarding the safety of nifedipine emerged in 1995 with the report of an increased risk of myocardial infarction associated with adult patients receiving short-acting calcium channel blockers. There have been few case reports of adverse events in children. The purpose of this study is to investigate the effect on blood pressure (BP) and the incidence of adverse events associated with nifedipine in our pediatric population.We conducted a retrospective chart review of pediatric patients who received nifedipine. We recorded the dose administered, all BP measurements and all adverse events reported within six hours of a nifedipine dose regardless of the likelihood that those events were related to the nifedipine dose.1,746 doses of nifedipine in 166 pediatric patients were reviewed. Systolic BP decreased by a mean of 17% and a maximum of 63%. Diastolic BP decreased by a mean of 28% and a maximum of 89%. Adverse events included: a) change in neurologic status, six cases; b) hypotension, two cases; c) oxygen desaturation, 16 cases. Neurologic events occurred in 33% of patients with acute CNS injury and 3.6% of all patients. Short-acting nifedipine is an important and effective oral antihypertensive agent which can be safely used for the treatment of hypertensive emergencies in children. It should be used with caution in children with acute CNS injury.

OBJECTIVES The study purposes were to determine 1) whether intravascular ultrasound (IVUS) was more sensitive than angiography for the detection of post-transplant coronary artery disease (PTCAD) in pediatric patients; and 2) whether those transplanted as neonates reacted differently than older patients.BACKGROUND Experience with IVUS for the diagnosis of PTCAD in children is limited.METHODS Patients were divided into two groups: those transplanted as neonates (early group) and those transplanted in infancy or childhood (late group). Morphometric analysis was performed, including maximal intimal thickness (MIT) and intimal index (II). Stanford classification was used to grade lesion severity. Acute rejection and cytomegalovirus (CMV) status were correlated with MIT and II.RESULTS Thirty children were studied (early group, n = 13; late group, n = 17). All segments studied were angiographically normal. Mean MIT and mean II were significantly greater in the late group (0.26 +/- 0.14 vs. 0.13 +/- 0.03 mm, p < 0.001 and 0.11 +/- 0.07 vs. 0.07 1 0.03 mm, p = 0.04, respectively). There was a significant correlation between MIT and II in those who had acute rejection in the late group. Patients in the late group who were CMV-positive had a significantly higher MIT compared with those in the late group with negative serology (p = 0.04).CONCLUSIONS Intravascular ultrasound was more sensitive than angiography in detecting PTCAD after pediatric heart transplantation. There is a possible role for acute rejection and CMV in the development of PTCAD. (C) 2000 by the American College of Cardiology.