Browsing by Author "Lanier, Lane"
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Item Correlative Findings of Maternal and Placental Health with Congenital Heart Disease and Post-Operative Acute Kidney Injury(2023) George, Ann; Hamby, Tyler; Lanier, LanePurpose: Acute kidney injury (AKI) is a common complication in pediatric patients with congenital heart disease (CHD) who undergo cardiopulmonary bypass (CPB). Besides established risk factors such as time on CPB, factors affecting fetal development may contribute to the prevalence of AKI within this population. Adverse intrauterine microenvironments associated with certain maternal conditions have been shown to impact nephrogenesis. These factors also increase the risk of preterm delivery, shortening the timeframe for nephrogenesis. Thus, infants that develop in these microenvironments may be predisposed to develop AKI when subjected to secondary insults such as CPB. This study aims to examine the incidence of AKI in this patient population and determine whether maternal or fetal variables predict the development of AKI. Methods: Retrospective review of electronic medical records of pediatric patients at Cook Children’s Medical Center (CCMC) between 3/1/2022 and 4/14/2022. Inclusion criteria were as follows: patients aged 0-12 months who underwent surgical repair or palliation of CHD with care in the cardiac intensive care unit (CICU). Data collected included maternal variables such as pre-eclampsia, gestational diabetes, obesity, and smoking status; individual variables such as gestational age and other congenital factors; and surgical variables such as CPB time and average PAO2 during CPB. AKI was determined using creatinine levels from established Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: Twenty patients met inclusion criteria. No statistical significance was noted between maternal and surgical variables. Twenty percent of patients developed at least Stage 1 AKI. Conclusions: Identification of maternal risk factors for AKI in the pediatric population may allow further insight into the mechanisms of the development of AKI. Our results were impacted by the low power of our study. Inclusion of more patients into our study will positively impact our power.Item Efficacy of Gastrostomy-Button for Weight Gain in Patients with Hypoplastic Left Heart Syndrome(2022) Ghimire, Ojaswi; Hamby, Tyler; Lanier, LanePurpose & Background: Hypoplastic left heart syndrome (HLHS) is a congenital heart defect (CHD) in which the left side of the heart is underdeveloped. HLHS makes up 2-3% of all CHD; 25-40% of neonatal cardiac death is due to untreated HLHS. One of the biggest challenges in palliative care of HLHS is weight gain and gastrostomy-button (GB) may be beneficial. To evaluate GB insertion during Norwood admission on increase in body mass index (BMI), height, and weight between Norwood discharge to Glenn discharge. Design/Methods: A retrospective cohort study of patients with HLHS at Cook Children's Medical Center (CCMC) between 2007 and 2021 was performed. Patients were excluded for not undergoing Norwood procedure; remaining inpatient between Norwood and Glenn procedures; having GB inserted after Norwood discharge; or not completing Glenn procedure at CCMC. Gender and GB status were recorded. Age, height, and weight were recorded for at Norwood surgery, GB Insertion, Norwood discharge, Glenn surgery and Glenn discharge. World Health Organization growth charts were used to compute age- and gender-adjusted z-scores for BMI, height, and weight. Change in growth variables were then compared between patients with and without GB using a two-tailed independent sample t-tests. Results: Of 146 patients meeting inclusion criteria, 56 patients were excluded: 3 did not undergo Norwood procedure; 21 remained inpatients between Norwood and Glenn procedures; 2 had G-Button inserted after Norwood discharge; and 30 did not complete Glenn procedure at CCMC. Of the remaining 90 patients, 31 (34%) had GB. Patients with GB gained significantly more (p=0.011) weight than patients without GB from Norwood discharge to Glenn discharge. There were no significant differences in height or BMI changes during that period (see Figure 1). Conclusion: Patients after Norwood procedure undergoing GB placement demonstrate greater weight gain than those without GB placement. The present research should be replicated using a larger sample.Item Maternal Risk Factors Do Not Correlate With AKI in Patients With Congenital Heart Disease (CHD)(2024-03-21) Carl, Christopher; Najjar, Sam; Ogunyankin, Fadeke; Modem, Vinai; Lanier, LanePurpose: Acute kidney injury (AKI) is a common complication in children who undergo cardiopulmonary bypass (CPB) and is correlated with longer hospital courses and worse outcomes. Several risk factors exist which increase the risk of AKI in pediatric populations, including premature birth, congenital heart disease (CHD), and prolonged CPB time. Maternal risk factors can impair nephrogenesis in utero, thereby increasing the likelihood for developing AKI. However, it is yet to be shown if maternal risk factors lead to an increased incidence in AKI in pediatric patients with CHD who undergo CPB. We examine the incidence of four maternal risk factors—pre-eclampsia, maternal hypertension, gestational diabetes mellitus, and maternal smoking—in 252 pediatric CHD patients who underwent CPB surgery. The purpose of this project was to examine the incidence and predictors of AKI in pediatric patients who underwent cardiopulmonary bypass (CPB) surgery at our institution. We hypothesize an association between maternal risk factors and AKI incidence in pediatric patients with CHD who underwent CPB surgery. Methods: We performed a retrospective study on 252 patients who underwent CPB for repair of a CHD between March1, 2020, and March 1, 2022. Patients were between ages 0-12 months at time of surgery and received care in the cardiac intensive care unit (CICU). P-value of 0.05 was used to determine statistical significance. NGAL levels and Cystatin C levels were also obtained. Results: Forty-four patients (17.5%) developed AKI by KDIGO criteria, with only 2.4% of those meeting stage 2 or 3 AKI. Fifty-one (24%) patients demonstrated elevated urine NGAL levels after bypass (>125). Eighteen patients (8.4%) had elevated levels of Cystatin C. Pre-eclampsia was not protective in regards to AKI in our population. Maternal smoking, maternal gestational diabetes and maternal hypertension did not correlate with development of AKI in children with CHD undergoing CPB. Conclusion: We found no association between maternal risk factors and AKI incidence in CHD patients undergoing CPB surgery in this cohort. Elevated NGAL levels and Cystatin C levels following CPB did not individually correlate with increased odds of developing AKI.Item SecurAcath Device Safety and Efficacy in Pleural Tube Placement in Children(2024-03-21) Patrick, Kara; Lanier, Lane; Debs, Fouad; Ogunyankin, Fadeke; Duncan, JayBackground: Patients in the cardiac intensive care unit (CICU) may develop complications such as pneumothorax (PTX) or pleural effusion (PE), which may be bloody, chylous, or serous in composition. PTX or PE may require placement of a percutaneous chest tube (CT) to evacuate air or fluid in the pleural space. Historically, CTs are sutured to the skin, but migration and removal of CTs can occur inadvertently due to external factors. The securAcath device is a single-use securement device indicated for securement of percutaneous indwelling catheters/tubes and is in use at the Cook Children’s Medical Center (CCMC) CICU. In this study, we introduce a novel use for this securAcath device in CT securement and aim to determine the effectiveness of the securAcath device in CT securement by assessing the incidence in catheter/tube dislodgement and migration. We compared the efficacy of securAcath device to the typical suturing practice for patients admitted to the CICU at CCMC. Case Information: This is a retrospective cohort of patients undergoing CT placement while admitted to the CCMC CICU from March 1, 2018 to March 31, 2023. Patients under 18 years of age using the securAcath device or suture in CT placement while on admission were included. Initial screening for patient encounters yielded 176 subjects. 140 patients met inclusion/exclusion criteria with 204 CT insertions. The data collected included diagnosis prior to chest tube insertion, chromosome abnormalities, type of congenital heart disease, surgical history, chest tube insertions, date of insertion and removal, SecurAcath or suture usage, complications, inadvertent removal, infection, and bleeding. Differences in duration of CT insertion between the securAcath device group and suture group were analyzed by independent sample t-test for continuous data. Chi square test of independence was used to evaluate the association between dependent and independent variables. All statistical tests were two-sided. P-value of less than 0.05 was utilized as a cutoff for statistical significance. Information: Two hundred and four 8.5 French chest tubes were inserted by intensivists in the CICU on 140 patients. There was no statistical difference in gender, diagnosis or type of congenital heart disease between the securAcath device group and suture group. There was no significance in the number of CTs inserted or the duration of the CTs between groups. No significance was found between groups with infection at the CT site or bleeding complications. The securAcath device group was noted to have a lower incidence of inadvertent removal of the CT compared to the suture group. Conclusions: The securAcath device is as safe as suture securement in children in the CICU who require CT insertion. The securAcath device demonstrates a lower incidence of inadvertent removal compared to suture securement of CTs in children in the CICU.