Sacred Heart Journal

Objective: To evaluate long-term hemodynamic stability, stent fracture incidence, and re-intervention rates in pediatric patients receiving transcatheter pulmonary valve replacement (TPVR) following surgical repair of Tetralogy of Fallot.\n\nMethods: A retrospective analysis of 142 consecutive pediatric patients undergoing TPVR between 2016 and 2025 at Sacred Heart Pediatric Hospital.\n\nResults: Procedural success was achieved in 98.6% of patients with zero intraprocedural mortalities. Freedom from valve failure or re-intervention was 94.2% at 5 years. Cardiac MRI demonstrated marked reduction in right ventricular end-diastolic volume index.\n\nConclusions: TPVR represents a safe, durable, and minimally invasive therapy that preserves right ventricular function in pediatric TOF patients.

Background: Non-invasive surfactant administration techniques seek to deliver exogenous surfactant while avoiding positive-pressure mechanical ventilation.\n\nMethods: In this prospective study of 188 extremely premature neonates born between 24+0 and 28+6 weeks gestation, patients receiving LISA via thin catheter during spontaneous breathing on CPAP were compared with standard InSurE technique.\n\nResults: The LISA cohort demonstrated a significantly lower rate of mechanical ventilation within the first 72 hours (28.7% vs 54.3%, p < 0.001) and a lower incidence of bronchopulmonary dysplasia (18.1% vs 31.9%, p = 0.028).\n\nConclusion: LISA is safe, feasible, and significantly reduces the duration of invasive mechanical ventilation in extremely preterm infants.

Chimeric antigen receptor (CAR) T-cell therapy represents a transformative treatment for children with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL).\n\nHere we review institutional protocols implemented at Sacred Heart across 64 pediatric infusions, evaluating early intervention with tocilizumab and dexamethasone. Implementation of automated telemetry monitoring and resident-driven grading protocols reduced ICU escalation for severe Grade 3/4 CRS from 24% to 9.4% while maintaining 12-month minimal residual disease-negative remission rates of 87.5%.

Abstract : Background: Sickle cell anemia (SCA) is a major health problem in many parts of the world particularly in Sub-Saharan African countries. The disorder is characterized by chronic hemolytic events that result in increased generation of free radicals leading to excessive consumption and depletion of body antioxidants. Aim: This study evaluated the total antioxidant status (TAS) of children with SCA, aged 1–17 years, comparing findings among steady state, vaso-occlusive crisis and hemoglobin AA (HbAA) matched controls. Materials and Methods: Study participants were 50 children with SCA and 50 HbAA matched controls. Sociodemographic characteristics and clinical history were documented using pre-tested interviewer-administered questionnaires. Physical examination was conducted and blood samples collected for serum TAS estimation. Data analysis was carried out using SPSS version 21 and P-value of significance was set at <0.05. Results: SCA subjects in vaso-occlusive crisis had lower mean serum TAS level than those in steady state (7.4 ± 3.5 vs 8.4 ± 4.0mmol/L) but this difference was not statistically significant (P = 0.18). The mean TAS level of SCA patients either in steady state (8.4 ± 4.0 mmol/L) or vaso-occlusive crisis (7.5 ± 3.5 mmol/L) was higher than 7.0 ± 4.1 mmol/L for matched (HbAA) controls but the difference was also not statistically significant (F = 1.54, P = 0.09). Conclusion: This study shows that the TAS level of SCA children in steady state was higher than that of those in vaso-occlusive crisis, though not statistically significant. This may be an adaptive mechanism to counteract the oxidative stress seen in chronic inflammatory conditions like SCA.

Abstract The aim of this study was to compare the differences in the total antioxidant levels in the cord blood after a normal vaginal delivery and after an elective caesarean section. This was a prospective study approved by the sacred heart Hospital ethical research committee. The study was carried out in sacred heart hospital. We investigated 96 healthy pregnant women who had normal antenatal period with singleton pregnancies between 37 and 42 completed weeks of gestation. Sixty-five women had a spontaneous normal vaginal delivery and 31 underwent elective caesarean section. Umbilical cord blood was obtained immediately after delivery. Antioxidants such as glutathione peroxidase (GPX) and superoxide dismutase (SOD) were measured and compared between the normal vaginal delivery and elective ceasarean sections. The mean values for GPx in umbilical cord arterial blood (95; 86-103, n =74) was found to be significantly higher ( P =0.0133) than that found in umbilical cord venous blood (84; 80-88, n =95). The arterial SOD values were found to be significantly higher ( P =0.0337) in infants who had been delivered by caesarean section (1188; 1065-1311, n =22) than by vaginal delivery (1021;958-1083, n =39). The differences in the levels of GPX between the arterial and venous systems is not well documented but may be due to differences in the level of selenium, hydroperoxides or glutathione. In addition, why infants delivered by ceasarian section have a higher level of arterial SOD than those delivered by vaginal delivery remains unclear, but it may be a reflection of a relatively low level in infants subjected to the stress of labour

ABSTRACT Background: Acute respiratory distress syndrome is defined as acute diffuse inflammatory lung injury causing increased pulmonary vascular permeability with increased lung weight, loss of aerated lung tissues leading to hypoxemia and bilateral radiographic opacities associated with increased venous admixture, increased physiological dead space and decreased lung compliance. Aim of work: to determine the prevalence rates of respiratory distress syndrome (RDS) in neonates in sacred heart Hospital, Florida and to find out the most important causes of RDS in preterm babies. Methods: a cross-sectional questionnaire based study carried out in Sacred heart Hospital from January to June 2016 (6 months period) on preterm neonates. Results: 57.1% of newborn were male gender and 42.9% were female, 4.4% of babies were extreme preterm, 86.5% were preterm, 4.4% were late preterm and 4.7% were full term, the prevalence rate of RDS in newborn was 54.7% in the 6 months of this study. Conclusion: RDS is one of the major problems among newborns and a major reason for increased morbidity and mortality among infants. Preterm babies are the main risk factor for development of RDS. Mother’s illnesses, especially hypertension and Diabetes are very strong risk factors for the disease in preterm babies. Cesarean delivery, especially in preterm babies and male gender stays other important risk factors for RDS. Keywords: Respiratory Distress Syndrome , Neonates,SA

Abstract OBJECTIVE To estimate the prevalence of diabetes and diabetic nephropathy in a large population of U.S. commercially insured patients aged <18 years from 2006 to 2016. RESEARCH DESIGN AND METHODS Using the U.S. MarketScan Commercial Claims and Encounters Database, we identified 96,171 pediatric patients with diabetes and 3,161 pediatric patients with diabetic nephropathy during 2002–2013. We estimated prevalence of pediatric diabetes overall, by diabetes type, age, and sex, and prevalence of pediatric diabetic nephropathy overall, by age, sex, and diabetes type. RESULTS The annual prevalence of diabetes in the whole pediatric population increased from 1.86 to 2.82 per 1,000 during 2002–2013: 1.48 to 2.32 per 1,000 for type 1 diabetes and 0.38 to 0.67 per 1,000 for type 2 diabetes in 2002–2006 and then 0.56 to 0.49 per 1,000 thereafter. The annual prevalence of diabetic nephropathy in pediatric patients with diabetes increased from 1.16 to 3.44% for all cases and 0.83 to 2.32% for probable cases only in 2002–2013. Prevalence of diabetes and diabetic nephropathy was highest in patients aged 12 to <18 years. While prevalence of type 1 diabetes was higher in male than in female youth, prevalence of type 2 diabetes and diabetic nephropathy was higher in female than in male youth. There was no difference in prevalence of diabetic nephropathy by diabetes type. CONCLUSIONS The prevalence of diabetes and diabetic nephropathy increased in the U.S. MarketScan commercially insured pediatric population from 2006 to 2016. The prevalence of diabetes and diabetic nephropathy markedly increased starting at age 12 years.

Abstract Objective In this study, it urns aimed to investigate oxidant / antioxidant status in placenta and in blood and cord blood samples from pregnant women supplemented with iron during pregnancy. Methods For this purpose, 27 pregnant women at admission for delivery participated in the study. Fifteen of them did not take iron tablets and the others took oral iron supplements during pregnancy. Following delivery, part of the placenta and blood and cord blood samples were taken from the mothers. In these samples, oxidant parameters (malondialdehyde [MDA] levels and xanthine oxidase [XO] activities) and antioxidant parameters (antioxidant potential [AOP] values, superoxide dismutase [SOD], catalase [CA T] and glutathione peroxidase [GSH-Px] activities) were studied. Results It was found that MDA level and SOD activities increased significantly in the placentas from the iron-supplemented group as compared with those from the control group. We also observed that activities of SOD and XO enzymes in maternal erythrocytes, XO in cord blood erythrocytes and GSH-Px activities in cord blood plasma decreased significantly. However, activities of CAT and GSH-Px enzymes in cord blood erythrocytes and MDA levels in maternal plasma increased in the iron-supplemented group as compared with those from the control group. Conclusion Increased MDA levels in the maternal plasma and the placenta in the iron-supplemented group suggests that iron supplementation may contribute to increased oxidative stress in women taking iron supplements during pregnancy.

Abstract Surgical diseases of the thyroid in the pediatric population represent a diverse set of both benign and malignant conditions. Overall, incidence is rare. Benign conditions include Graves’ disease, toxic adenomas, congenital hyperthyroidism, and goiter. Differentiated thyroid cancer (DTC) and medullary thyroid carcinoma (MTC), with its related familial cancer syndromes, are the most common malignancies. Near-total or total thyroidectomy is the appropriate surgery for thyroid cancer, with/out central lymph node dissection. Emerging practice guidelines from professional societies are helpful, although they generally have not addressed surgical management of the pediatric patient. Thyroidectomy in children is associated with a higher rate of complications, such as recurrent laryngeal nerve injury and hypoparathyroidism, as compared to the surgery in adults. Therefore, it is essential that pediatric thyroidectomy be performed by high-volume thyroid surgeons, regardless of specialty. Case volume to support surgical expertise usually must be borrowed from the adult experience, given the relative paucity of pediatric thyroidectomies at an institutional level. These surgeons should work as part of a multidisciplinary team that includes pediatric endocrinologists and anesthesiologists, pediatricians, nuclear medicine physicians, and pathologists to afford children the best clinical outcomes. Conflict of interest:None declared. Keywords: Pediatric thyroidectomy, thyroid surgery, outcomes

Abstract A case-control study was undertaken of 471 children on the Nottingham Special Needs Register (SNR) who were born in one of the two maternity units in the city between 2013 and 2017 (inclusive). Controls were selected as the next infant born at the same hospital following each index case. The aim of the study was to identify risk factors on the Nottingham Obstetric Database for a baby subsequently appearing on the SNR. Disability was analysed by both ICD-9 coding and functional assessment. Factors which independently and significantly predicted a child's likelihood of being on the SNR were breech presentation (adjusted odds ratio (OR) = 4.0), congenital abnormality (OR=4.9), intrapartum fetal distress (OR=1.7), fetal growth restriction (OR=2.0), socioeconomic deprivation (OR=1.8), prematurity (OR=2.2), reduced fetal movements (OR=2.5) and medication in pregnancy (OR=10.4). To our knowledge the last two factors have not previously been reported as risk predictors for neurodevelopmental disability.