Construct Validity of the Miller Assessment for Preschoolers and the Pediatric Examination of Educational Readiness for Children

The purpose of this study was to investigate the construct validity of the Miller Assessment for Preschoolers (MAP) and the Pediatric Examination of Educational Readiness (PEER), two assessment tools that occupational therapists and physical therapists can use for early identification of children with developmental disabilities. The sample included 84 Israeli children who were tested on the MAP (42 children with pre-academic problems and 42 typically developing children), and 70 children who were tested on the PEER (35 children with pre-academic problems and 35 typically developing children). Out of this pool of subjects, 30 typically developing children and 30 children with pre-academic problems were tested on both tests and the results were used for additional data analysis. We found differences between the groups' MAP and PEER total scores as well as their developmental indices scores. Children with pre-academic problems scored lower. The supplementary behavioral observations of the tests yielded less definite results. A strong correlation existed between the total scores of the MAP and the PEER, and the total scores of the tests correlated significantly with each of the sub-scores of the other test. The findings support the construct validity of both tests, thereby suggesting that either test can be used to identify children with pre-academic problems.     

Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study

BackgroundPlasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries.ObjectiveTo assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population.MethodsThis was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24 h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality.ResultsIn total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P = 0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval = 1.12 [1.02–1.23] and 1.80 [1.23–2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient = 0.31, 0.23, 0.43; P = 0.006, P = 0.047, P < 0.001, respectively). The 24-h lactate level had an area under the receiver operating characteristic curve (AUC) of 0.77 (P = 0.013) for mortality prediction, while admission, peak, and average lactate level had an AUC of 0.69, 0.69, 0.71 (P = 0.086, P = 0.035, P = 0.019), respectively. PIM2, PRISM, and pSOFA score had an AUC of 0.80, 0.78, 0.82 (P = 0.001, P = 0.001, and P < 0.001), respectively. Combining 24-h lactate level with pSOFA demonstrated superior performance (AUC = 0.88).ConclusionBoth 24-h lactate level and pSOAF are useful for prediction of mortality. Incorporating the 24-h lactate level into the pSOFA Score achieved superior prognostic utility.     

The current management of hepatoblastoma: a combination of chemotherapy, conventional resection, and liver transplantation

OBJECTIVE: To review our experience in the management of children who present with hepatoblastoma. STUDY DESIGN: Thirty patients treated for hepatoblastoma at a single institution were reviewed. RESULTS: Ten patients presented with stage I to stage II disease and underwent resection. Seventeen presented with stage III disease; two underwent initial resection of which one required rescue transplantation. The remaining 15 underwent biopsies, which were followed by chemotherapy. Nine patients had a reduction in tumor size and underwent conventional resection. One required rescue transplantation for residual disease. Five patients underwent primary transplantation for unresectable disease. One patient expired during chemotherapy. Three patients presented with stage IV disease and underwent biopsies, which were followed by chemotherapy. One patient responded but required "rescue" transplantation after conventional resection. Seven patients underwent aggressive conventional resection (trisegmentectomy or central liver resection); three had positive surgical margins and underwent transplantation. One developed recurrent disease. Five-year survival was 82.5% +/- 7.1%. There was no operative mortality during surgical therapy. All transplant recipients were tumor free, but one died from lymphoma 7 years post-transplant. CONCLUSION: Chemotherapy may reduce tumor size, allowing for conventional resection. If aggressive resection is necessary or bi-lobar disease persists, primary transplantation is recommended.     

Cost of influenza hospitalization at a tertiary care children's hospital and its impact on the cost-benefit analysis of the recommendation for universal influenza immunization in children age 6 to 23 months

OBJECTIVE: To calculate the costs of influenza hospitalization at a tertiary care children's hospital as the basis of a cost-benefit analysis of the new influenza vaccine recommendation for children age 6 to 23 months. STUDY DESIGN: We reviewed the medical records of all patients admitted to Children's Memorial Hospital (CMH) in 2002 diagnosed with influenza. Total hospital costs were obtained from the Business Development Office. RESULTS: Thirty-five charts were analyzed. Both of the 2 patients requiring mechanical ventilation and 4 of 6 patients admitted to the intensive care unit had high-risk underlying medical conditions. Nine children were age 6 to 23 months; 4 of these 9 had no preexisting medical conditions. Had all 18 high-risk children over age 6 months been protected from influenza, approximately $350,000 in hospital charges could have been saved. CONCLUSIONS: Preventing the additional 4 hospitalizations in the otherwise low-risk children age 6 to 23 months for whom vaccine is currently recommended would have cost approximately $281,000 ($46/child) more than the hospital charges saved. When all children age 6 to 23 months are considered, influenza vaccination is less costly than other prophylactic measures. Addition of indirect costs, deaths, outpatient costs, and the cost of secondary cases would favor the cost:benefit ratio for influenza vaccination of all children age 6 to 23 months.     

Antigonadotropic cell antibodies in the serum of cryptorchid children and infants and of their mothers

An indirect immunofluorescence test allowed us to study circulating antigonadotropin-cell antibodies in patients with cryptorchidism. Antigonadotropin-cell activity was found in the serum in 14 of 23 cryptorchid boys aged 1 to 11 years and in 12 of 23 infants aged 1 to 3 months; in most of them the antibodies persisted during short-term follow-up. Results of paired study of the mother and infant were concordant in 14 of 15 cases. No such antibodies were found in 24 control male children. These data support the possible role of pituitary autoimmunity in the child and the mother as a factor in testicular maldescent. We found no correlation between the presence or absence of antibodies and the partial luteinizing hormone-Leydig cell deficiency usually found in cryptorchidism.