Many infants with complex congenital heart disease (CHD) do not develop the skills to feed orally and are discharged home on gastrostomy tube or nasogastric feeds. We aimed to identify risk factors for failure to achieve full oral feeding and evaluate the efficacy of oral motor intervention for increasing the rate of discharge on full oral feeds by performing a prospective study in the neonatal and cardiac intensive care units of a tertiary children’s hospital. 23 neonates born at ≥ 37 weeks gestation and diagnosed with single-ventricle physiology requiring a surgical shunt were prospectively enrolled and received oral motor intervention therapy. 40 historical controls were identified. Mean length of stay was 53.7 days for the control group and 40.9 days for the study group (p=0.668). 13/23 patients who received oral motor intervention therapy (56.5%) and 18/40 (45.0%) controls were on full oral feeds at discharge, a difference of 11.5% (95% CI −13.9% to 37.0%, p=0.378). Diagnosis of hypoplastic left heart syndrome, longer intubation and duration of withholding enteral feeds, and presence of gastroesophageal reflux disease were predictors of poor oral feeding on univariate analysis. Although we did not detect a statistically significant impact of oral motor intervention, we found clinically meaningful differences in hospital length of stay and feeding tube requirement. Further research should be undertaken to evaluate methods for improving oral feeding in these at-risk infants.

We explored potential risk factors associated with Langerhans cell histiocytosis (LCH) in a predominantly Hispanic population in Los Angeles. Sixty children with LCH (cases) and, 150 randomly selected patients (controls) were interviewed. There was no statistically significant difference between cases and controls in the following: Family history of thyroid disease, smokers in the family, maternal problems during pregnancy, and pesticide exposure. Cases were more likely to report a family history of cancer (OR 2.5), infection during infancy (OR 2.76), and parental occupational exposure to metal, granites, or wood dust (OR 2.48). Pediatr Blood Cancer 2012; 59: 1324–1326. © 2012 Wiley Periodicals, Inc.

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INTRODUCTION:Cardiopulmonary Bypass (CPB) is associated with systemic inflammation, reduction of intestinal perfusion, microcirculatory alterations, and loss of intestinal barrier integrity, which may lead to feeding intolerance and necrotizing enterocolitis (NEC). We hypothesize that postsurgical infants with single ventricle physiology and feeding intolerance and/or NEC would have higher mortality, hospital costs and longer hospital stays. METHODS: Retrospective cohort of Single VentriclePatients less than 1 year old inpatient Texas DSHS, 2017-2019. Primary outcome was mortality, secondary outcomes included gastrointestinal surgical interventions, hospital charges and length of stay (LOS). Frequentist analysis and multivariate regression were performed.RESULTS: 2,628 patients with single ventricle physiology were identified, 518 (19.7%) had a diagnosis of feeding intolerance, and 54 (2.1%) had a diagnosis of NEC. Prematurity was associated with NEC, 26.1% vs 11.9%, p 0.004. Feeding intolerance and NEC were more frequent in patients older than 1 month old, p < 0.001. 171 (6.5%) had an abdominal surgery. NEC was associated with intestinal resection, 5.6% vs 0.7%, p 0.008. Feeding intolerance was associated with insertion of a feeding tube, 6% vs 2.8%, p < 0.001. NEC was not associated with mortality. Patients with Feeding intolerance (FI) had lower odds of mortality in a multivariate model, OR 0.5 (95% CI 0.34-0.76). In survivors, the LOS was longer in patients with FI and/or NEC, mean difference 24 days, p < 0.001. Charges for patients with FI and/or NEC were higher, mean difference USD$ 365,237, p < 0.001. CONCLUSIONS:Post CPB surgery, infants with single ventricle physiology with a diagnosis of feeding intolerance and/or NEC were not associated to higher mortality. However, they have prolonged hospital stays and higher total hospital charges.

A 4-year-old child was transferred to the paediatric intensive care unit with acute respiratory failure following 4 days of fever, nausea and vomiting. Chest X-ray on admission had an enlarged cardiac silhouette and transthoracic echo confirmed a large pericardial effusion. An emergent pericardiocentesis was performed at bedside which drained nearly 1000 mL of purulent fluid. Postdrainage course was complicated by acute systolic and diastolic heart failure, thrombocytopenia and acute renal failure. A chest CT and MRI were concerning for a diffuse mediastinal soft-tissue density, so the patient underwent interventional radiology-guided biopsy complicated by haemorrhage requiring mediastinal exploration and subtotal thymectomy. Histopathology revealed changes consistent with kaposiform lymphangiomatosis and MRI demonstrated involvement of the lumbar spine and right hip. Following a course of intravenous antibiotics, the patient was started on sirolimus and prednisolone and ultimately discharged home.