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Biomedical subjects

E C Suddaby

Publications and source records attributed to E C Suddaby.

17 recordsLinked to original sources
PubMed1999

The state of pediatric heart transplantation.

Heart transplantation is now an accepted method for treatment of heart disease in children, but transplantation in pediatric recipients continues to present unique challenges. The differences in indications and the complexity of surgery for congenital heart disease are only two of those challenges. A successful means of mechanical support is not available, which puts children at special risk of dying while waiting for transplantation. In addition, physiologic differences produce issues about management after transplantation, including use of immunosuppressive agents, control of infection, identification of transplant coronary artery disease, and posttransplant lymphoproliferative disease. Because of the longer life expectancy desired from pediatric transplantation, measurement of quality of life must be more comprehensive. This broad range of special demands means that although the state of pediatric heart transplantation is positive, there are areas for continued improvement.

Child↗
PubMed1999

No simple answers: ethical conflicts in pediatric heart transplantation.

Ethical issues in pediatric heart transplantation are encountered daily in the work of the transplant coordinator. Issues such as use of resources in a just world, less-than-ideal candidates, and informed consent are challenges to the transplant professional. This article explores those issues using the language of ethics to analyze the conflicts they present. Resolutions will not necessarily be offered, as there are no simple answers.

Adolescent↗
PubMed1999

Unique considerations for the pediatric heart transplant recipient: the role of the school nurse.

Heart transplantation has become an accepted therapy for terminal heart conditions in children. With the increasing incidence of pediatric heart transplantation, school nurses may find cardiac recipients in their schools. The article discusses physical and psychological considerations for managing these students. Among the physical considerations are work capacity, appearance, organ rejection, and infection. The psychological considerations are emotions, cognitive functioning, quality of life, and behavioral concerns. The school nurse is a key resource in informing staff about the unique concerns of pediatric transplant recipients and in ensuring they are integrated into the school setting.

Activities of Daily Living↗
PubMed1998

Analysis of organ donors in the peripartum period.

This study was a retrospective review of 252 brain-dead potential donors from 1990 to 1996, including 5 organ donors in the peripartum period. The purpose of the study was to determine the effects of pregnancy on organ donor management and recipient outcome. Case analysis of 5 pregnant donors identified problems with hemodynamic stability and electrolyte abnormalities, including hypernatremia, hyperchloremia, and hypocalcemia. In addition, blood glucose was frequently elevated. Two donors were treated for diabetes insipidus. All 5 donors produced organs for 20 transplant recipients. Five heart recipients (including 1 heart-lung), 4 liver recipients, 4 kidney recipients, and 4 pancreas-kidney recipients have reported excellent outcomes. The use of organs from brain-dead organ donors in the peripartum period has minimal impact on donor management and recipient outcome.

Adolescent↗
PubMed1998

Analysis of donor versus nondonor demographics.

A retrospective analysis of the demographic features of all potential organ donors over a 3-year period (1994-1996) at one organ procurement organization was conducted. The potential donor pool of 495 people was 42% female and 58% male, with a slight difference in consent by gender. The mean income difference between donors and nondonors was less than $3000 per year (obtained from zip code census data). Educational achievement affected donation at the lowest educational levels. Cause of death influenced donation, with motor vehicle crash victims donating more often. The strongest factor in consent for donation was ethnicity; whites were more likely to donate than were other ethnic groups. The combination of gender, ethnicity, and cause of death improved the probability of determining a positive outcome to 63%. Demographic information on donors and nondonors can increase public and professional understanding as well as influence decision making to improve donation.

Adult↗
PubMed1997

Stress and coping among parents of children awaiting cardiac transplantation.

Psychosocial support during the waiting period for pediatric transplant recipients and their families is vital. This study describes the stress levels and coping techniques among parents of children awaiting cardiac transplant. Twenty-six parents of 18 children demonstrated a range of stress with 77% scoring at a moderate stress level. They perceived transplantation neutrally and used a similar number of coping mechanisms as did a normative group of adults. Use of coping mechanisms significantly decreased over the 3-month study period. A moderate correlation between a negative perception of transplantation and parental stress was found. Parents of girls viewed transplant more negatively than did boys' parents. This study provides a beginning for assisting families during the waiting period.

Adaptation, Psychological↗
PubMed1997

Developmental concerns in children with congenital heart disease.

Neurodevelopmental outcome of children with congenital heart disease includes a wide spectrum of developmental disorders from language and learning disabilities to mental retardation, delayed development, and cerebral palsy. Numerous studies of cardiopulmonary bypass show that this procedure alone does not affect IQ, but length of circulatory arrest and pH management are associated with decreased IQ. Described here is a behavioral phenotype of children with cardiac disease with a low normal IQ and perceptual-motor delays who are temperamentally more difficult. Further investigation of the vulnerability of specific cardiac lesions, mode of treatment, and the behavioral phenotype of children with congenital heart disease along with the influences of family functioning, socioeconomic status, and chronic medical care is warranted.

Cardiopulmonary Bypass↗
PubMed1996

Neurodevelopmental outcome of infant cardiac transplant recipients.

Normal growth and development are indicators of the success of infant cardiac transplantation. The clinical transplant coordinator must be aware of age-appropriate milestones in gross motor, fine motor, language, cognitive, and social skills, so that accurate assessment and early intervention can be instituted. In this review of five cases, gross motor development was the only category with consistently lower scores. Gross motor development did improve in the two cases tested more than once. Length of hospitalization before and after transplantation and use of sedative medications during the waiting period may have affected developmental outcome scores.

Child, Preschool↗
PubMed1996

Viral myocarditis in children.

Viral myocarditis is the result of a viral infection that produces myocardial necrosis and triggers an immune response to eliminate the viral agent. Many pathogenic mechanisms may contribute to myocardial cell loss including the following: cytokine production contributing to disease severity; viral persistence, which may produce an autoimmune response to cardiac myosin; and viral invasion of vascular endothelium causing vascular spasm with reperfusion injury. The compensatory response of the myocardium to these mechanisms of cell loss is hypertrophy, which results in fibrosis, scarring, and dilation. The myocardial cell loss and physiological response produces a child with fever, lethargy, symptoms of congestive heart failure, cardiogenic shock, or new onset arrhythmias. The initial presentation may be subtle, but if left untreated will go on to produce severe symptoms. The focus of diagnostic studies is to evaluate cardiac function, identify the viral agent, and eliminate other causes of global cardiac dysfunction. Treatment must provide for support of cardiac function through inotropic and afterload-producing agents while providing rest for the stressed cardiac muscle. The nursing care of children with viral myocarditis must focus on continual assessment of the cardiovascular system while supporting the recovery of myocardial function.

Age Factors↗
PubMedDate not supplied

The embryology of congenital heart defects.

The embryological development of the heart is an awesome and complex process. The heart is formed from groups of cells that coalesce into sheets of tissue. These sheets fuse to form a tube that grows into the atria and ventricles. The twists and turns of the developing heart tissue and the simultaneous septation of atria, ventricles, and truncus, along with a shifting of the atrioventricular canal and conus then position the portions of the heart in alignment to allow normal blood flow. Errors at any stage of embryological formation can result in specific congenital defects. Understanding the development of the heart in utero can provide the pediatric nurse a basis for understanding the physiological effects of embryological failures that result in congenital heart defects in the infant and child.

Embryonic and Fetal Development↗
PubMedDate not supplied

ECG interpretation: what is different in children?

While the electrical waveforms and basic approach to electrocardiogram (ECG) interpretation are similar for pediatric and adult patients, some important differences must be recognized to provide appropriate care for infants and children. Maturational changes that occur over the early childhood years result in differences in normal heart rates, interval durations, and ventricular dominance. Any arrhythmia seen in adults can occur in the pediatric patient; however, the most common variations from normal rhythms are sinus arrhythmia, bradycardia, and supraventricular tachycardia. Nurses caring for infants and children must recognize the important similarities and differences in rhythm strip interpretation between the adult and the pediatric patient.

Adolescent↗
PubMedDate not supplied

Contemporary thinking for congenital heart disease.

Understanding congenital heart disease (CHD) in terms of three physiologic categories provides the pediatric nurse with practical, effective interventions for sick children. Children with increased pulmonary blood flow require support for congestive heart failure (CHF) symptoms including medications, increased caloric intake, and organization of care. Children with significantly decreased pulmonary blood flow need surgical intervention to create a path for pulmonary blood supply. Children with obstruction to systemic blood flow require support for both CHF symptoms and poor ventricular contractility. Shifting the focus of understanding from cyanotic and acyanotic defects to these three physiologic categories improves the pediatric nurse's capability to plan and care for children with CHD.

Female↗
PubMedDate not supplied

Defibrillation and cardioversion in children.

This article overviews the indications for cardioversion or defibrillation by reviewing normal conduction, common arrhythmias, and hemodynamic assessment in children requiring this treatment approach. The procedure for each is outlined in detail.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Continuous hemofiltration in infants and children.

Continuous arterio-venous hemofiltration has been successfully used in pediatric patients for whom lower mean arterial pressure, vascular access, control of ultrafiltration rates, and blood lost to the extracorporeal circuit are important considerations.

Child↗
PubMedDate not supplied

ECMO for cardiac support in children.

Extracorporeal membrane oxygenation (ECMO), designed to support the lungs in respiratory failure, is less familiar to the nurse who cares for ECMO patients when it is used to support the smaller child or neonate after cardiac surgery. An overview of ECMO, a description of the physiologic response to the ECMO circuit, and a discussion of myocardial function of the patient receiving ECMO are presented. The article focuses on the challenges posed by cardiac ECMO and the nursing care required to meet them. The unique problems addressed include variations in patient cannulation, left ventricular venting, hemostasis issues, the need for hemofiltration, and problems associated with evaluating cardiac function of the patient receiving ECMO.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Impact of prolonged waiting times of neonates awaiting heart transplantation.

OBJECTIVES: This study analyzed waiting times and outcomes of neonates listed for heart transplantation at two medical centers from 1991 through 1994. STUDY DESIGN: Retrospective analysis was performed to examine waiting times, charges, morbidity, and outcomes. RESULTS: Of the 30 neonates listed for transplantation, 15 received hearts, with 10 late survivors. Waiting time increased from 25 +/- 8 days in 1991 and 1992 to 58 +/- 7 days in 1993 and 1994 (p < 0.01), and the hospital charge per patient increased from $118,300 +/- $31,500 to $198,700 +/- $25,400 (p < 0.05). Freedom from sepsis predicted receiving heart transplantation (p < 0.01). Lack of a preoperative central intravenous catheter, no preoperative mechanical ventilation, and A-negative blood type predicted heart transplantation survival (p < 0.05). The chances of receiving and surviving transplantation were the same in the two periods. There was a trend toward greater morbidity among neonates waiting more than 35 days. CONCLUSIONS: Waiting times and charges have increased significantly over the last 4 years. Patients who are free of sepsis, lack a preoperative central intravenous catheter, are not mechanically ventilated preoperatively, and have A-negative blood type have better outcomes.

Graft Survival↗