Background : While overall 5-year survival has improved by approximately 50% in pediatric AML patients in the last twenty years with intensification of antineoplastic therapy and advancement in antimicrobial therapy, treatment-related complications continue to be a major problem. Prior studies have demonstrated that mandatory hospitalization during profound neutropenia did not reduce infections or significantly reduce nonrelapse mortality (NRM). The aim of this study was to evaluate the effect of our supportive care measures on treatment-related mortality (TRM), event free survival (EFS), and overall survival (OS). Secondary aims of this study were to document infectious complications of AML therapy, which organisms were isolated most frequently from blood cultures, quantify the number of antibiotic modifications made for each patient throughout treatment and observe how many patients were admitted to the pediatric intensive care unit (PICU) for septic shock and acute respiratory distress syndrome (ARDS). Methods and Materials : A retrospective chart review of 35 pediatric AML patients treated at Rady Children's Hospital of San Diego (RCHSD) from January 2006 and July 2013 were examined. The OS, EFS and TRM were determine for this cohort and compared to the outcomes of those pediatric AML patients treated under the Children's Oncology Group (COG) AAML0531 and CCG2961. Results : Of the 35 patients analyzed, the OS for AML patients treated at RCHSD was 75%, EFS was 59% and TRM was calculated as 3%. These values were compared to the OS, EFS and TRM of patients treated on the COG AAML0531 and CCG2961 protocols. Only one individual died from treatment related causes making TRM 3%. Additionally, infectious complications were also examined and among this cohort of patients, bacteremia (46.7%) and diarrhea due to C. difficile (16.5%) were the most common infectious complications throughout treatment. Of the organisms that grew from blood cultures, Streptococcus viridans (22%) and Staphylococcus epidermidis (20%) were th.

Objective

To determine whether a moderate-to-large patent ductus arteriosus (PDA) is responsible for vasopressor-dependent hypotension, occurring at the end of the first postnatal week.

Study design

We performed a retrospective, double cohort controlled study of infants delivered at ≤27⁺⁶ weeks' gestation (n = 313). From January 2004 through April 2011, all infants were treated with prophylactic indomethacin ([PINDO] epoch). From May 2011 through December 2015, no infant was treated with indomethacin until at least 8 postnatal days (conservative epoch). Echocardiograms were performed on postnatal days 6 or 7. Hypotension was managed by a predefined protocol. The primary outcome was the incidence of dopamine-dependent hypotension, defined as having received at least 6 µg/kg/min dopamine for at least 24 hours during postnatal days 4-7.

Results

As expected, the incidence of moderate-to-large PDA at the end of the first week differed significantly between epochs (PINDO = 8%; conservative = 64%). In multivariate analyses, infants in the PINDO epoch had a significantly lower incidence of vasopressor-dependent hypotension (11%) than infants in the conservative epoch (21%; OR = 0.40, 95% CI 0.20-0.82). Infants in the PINDO epoch also required less mean airway pressure, had a lower respiratory severity score, and lower mode of ventilation score than infants in the conservative epoch during postnatal days 4-7. The effects of PINDO on both the incidence of vasopressor-dependent hypotension and the need for respiratory support were no longer significant when analyses were adjusted for "presence or absence of a moderate-to-large PDA."

Conclusion

PINDO decreases vasopressor-dependent hypotension and the need for respiratory support at the end of the first postnatal week. These effects are mediated by closure of the PDA.

Background: Children with relapsed/refractory cancer have a myriad of palliative care needs. While pediatric oncology clinicians meet many of these needs, studies suggest that these children often have distressing symptoms and that families feel unprepared for their childs end-of-life (EOL). Oncology clinicians cite barriers to pediatric palliative care (PPC) consultation, including concerns that PPC teams will upset families with EOL discussions. This study evaluated topics addressed by PPC teams over the course of their relationship with children who died from cancer. Methods: Retrospective chart review of children who were diagnosed with relapsed/refractory cancer, received PPC consultation at an academic childrens hospital, and died between January 2008 and January 2017. Information was extracted regarding the childs treatment, EOL care, and the content of PPC consultation over the course of the teams relationship with the child/family. Results: Fifty-six children were included in the analysis. The most frequent reasons for the initial consult were pain (n = 31, 55%) and non-pain symptom management (n = 18, 32%). At the initial consult, the PPC team most often discussed symptom management and psychosocial support. Prognosis was not discussed in any initial consult. Over subsequent visits, the PPC team expanded their scope of discussion to include goals of care, advance care planning, and hospice. Discussion: Concerns from oncology clinicians that PPC teams will extend beyond the reasons for initial consult into prognostic/EOL discussions at the first visit may be unfounded. Greater familiarity with PPC team practices may facilitate more timely consultation of PPC and its complementary set of services.