BACKGROUND Myocardial damage in myocarditis is mediated, in part, by immunological mechanisms. High-dose intravenous gamma-globulin (IVIG) is an immunomodulatory agent that is beneficial in myocarditis secondary to Kawasaki disease, as well as in murine myocarditis. Since 1990, the routine management of presumed acute myocarditis at Children's Hospital, Boston, and Children's Hospital, Los Angeles, has included administration of high-dose IVIG. METHODS AND RESULTS We treated 21 consecutive children presenting with presumed acute myocarditis with IVIG, 2 g/kg, over 24 hours, in addition to anticongestive therapies. A comparison group comprised 25 recent historical control patients meeting identical eligibility criteria but not receiving IVIG therapy. Left ventricular function was assessed during five time intervals: 0 to 7 days, 1 to 3 weeks, 3 weeks to 3 months, 3 to 6 months, and 6 to 12 months. At presentation, the IVIG and non-IVIG groups had comparable left ventricular enlargement and poor fractional shortening. Compared with the non-IVIG group, those treated with IVIG had a smaller mean adjusted left ventricular end-diastolic dimension and higher fractional shortening in the periods from 3 to 6 months (P = .008 and P = .033, respectively) and 6 to 12 months (P = .072 and P = .029, respectively). When adjusting for age, biopsy status, intravenous inotropic agents, and angiotensin-converting enzyme inhibitors, patients treated with IVIG were more likely to achieve normal left ventricular function during the first year after presentation (P = .03). By 1 year after presentation, the probability of survival tended to be higher among IVIG-treated patients (.84 versus .60, P = .069). We observed no adverse effects of IVIG administration. CONCLUSIONS These data suggest that use of high-dose IVIG for treatment of acute myocarditis is associated with improved recovery of left ventricular function and with a tendency to better survival during the first year after presentation.

, 492 infants with ductus arteriosus-dependent congenital heart disease (385 cyanotic and 107 acyanotic) received prostaglandin E, (PGE,) in 56 centers in the United States as part of a protocol sponsored by the Upjohn Company. In the infants with cyanotic congenital heart disease, the mean Pao2 for the group increased from 26.7 mm Hg before to 38.5 mm Hg during infusion (p < 0.001). Infants older than age 4 days had a higher preinfusion Pao2 and a smaller increase in Pao2. Infants weighing more than 4 kg at birth and alkalotic infants (pH > 7.45) had a smaller increase in Pao2. No differences in response were found with respect to mode of administration (intra-arterial or i.v.), gender, maternal age, or preinfusion Paco2. PGE, provides excellent palliation for infants with ductus arteriosus-dependent cyanotic congenital heart disease.Of the 107 infants with acyanotic congenital heart disease, 46 had juxtaductal coarctation and 34 had interruption of the aortic arch. Clinical improvement occurred in about 80% in each group. In the infants with aortic interruption, descending aortic blood pressures increased and the pressure differences across the ductus arteriosus decreased markedly. In the infants with coarctation, descending aortic blood pressures increased and ascending aortic pressure decreased. The systolic pressure difference across the coarctation decreased markedly, from 45 to 9 mm Hg. Infants in whom the ductus arteriosus was closed before the infusion showed no beneficial effects. In infants in whom a constricted ductus arteriosus relaxed, the effect occurred more slowly than in infants with cyanotic heart disease. PGE, also provides excellent palliation in infants with aortic obstruction in which lower body perfusion is dependent on the ductus arteriosus.

BackgroundPatients with congenital heart disease are at risk of motor, cognitive, speech, and feeding difficulties after cardiac surgery. Rehabilitation therapy could improve functional outcomes in this population if applied in the acute postcardiac surgical in‐hospital stay. However, information on the types of acute postcardiac surgery therapy needs in children is scarce. Our goal was to describe rehabilitation therapy following congenital heart surgery and pre/intraoperative factors associated with need for therapy.Methods and ResultsThis is a retrospective cohort study of patients <18 years undergoing heart surgery at our center from January 1, 2013 to January 31, 2015. Demographic, and pre‐, intra‐, and postoperative clinical and rehabilitation therapy (physical, occupational, speech, feeding therapy, and neurodevelopment intervention) data were collected. Need for rehabilitation therapy in the acute postoperative period, particularly following palliative repair, was the outcome variable in a multivariable logistic regression model to identify independent pre‐ and intraoperative factors associated with therapy. A total of 586 out of 1415 (41%) subjects received rehabilitation therapy postsurgery. Certain subgroups had increased rehabilitation therapy use such as neonates (80%). On multivariable analysis, palliative repair, prematurity, genetic syndrome, presurgical hospital stay of more than 1 day, and prolonged cardiopulmonary bypass time were independently associated with rehabilitation therapy.ConclusionsNearly half of patients who underwent post–congenital heart surgery received rehabilitation therapy. Frequency of use and types of therapy vary according to patient characteristics; however, certain pre‐ and intraoperative factors are associated with need for rehabilitation therapy, and may aid decision‐making for appropriate resource allocation.

The purpose of this article is to explain the use of technology as a tool to aid the school nurse's decision-making process. This article demonstrates how decision support tools improve school nurses' decision making regarding client care and nursing practice. Various decision support systems are discussed, examples provided, and the underlying technology explained. A listing of decision support systems and specific applications for school nurses are reviewed.