PubMed Health⌕ Search

Biomedical subjects

Robert S Gillespie

Publications and source records attributed to Robert S Gillespie.

7 recordsLinked to original sources
PubMed2005

Sodium ferric gluconate for post-transplant anemia in pediatric and young adult renal transplant recipients.

Post-transplant anemia is a widespread problem among pediatric renal transplant recipients. Many clinicians treat post-transplant anemia in a manner similar to treatment of anemia in dialysis patients, including the use of intravenous iron, such as sodium ferric gluconate (SFG). Data on pediatric dosing of SFG are limited to rare small series containing few or no renal transplant recipients. We conducted a retrospective chart review of practice patterns at our institution to evaluate doses used, hemoglobin response and adverse events. We identified 15 renal transplant recipients who received SFG during the 28-month study period. Data from 14 of these patients were available for analysis. Patients received between one and six doses of SFG to yield a total dose of 100-1000 mg or 2.7-23.7 mg/kg. The largest doses given during a single infusion ranged from 1.9 to 6.4 mg/kg. The mean hemoglobin level increased from 101 +/- 16 to 114 +/- 21 g/L (p = 0.0092) following SFG therapy. Adverse events were recorded for three patients. Treatment with SFG appears to yield some improvement in anemia in renal transplant recipients, but the paucity of published information on this topic highlights the need for stronger data, particularly with respect to pediatric patients.

Adolescent↗
PubMed2004

Intravenous iron therapy in pediatric hemodialysis patients: a meta-analysis.

Dialysis guidelines recommend aggressive management of anemia, including the use of intravenous iron (i.v.Fe) when indicated. However, few published data are available to guide the use of i.v.Fe in children, and studies are difficult to compare. In this meta-analysis we sought to combine evidence by pooling clinical trial data to determine if i.v.Fe therapy helped increase hematocrit, serum levels of hemoglobin, ferritin, and transferrin saturation (TSAT), and reduce erythropoietin use. We searched MEDLINE and other databases, publications, and other sources to identify as many published and unpublished trials as possible. Of 379 possible studies, nine met the criteria for inclusion and analysis. Across all nine studies, 141 patients were studied, for durations of 2 weeks to 12 months. Pooled results identified an increase in hemoglobin, hematocrit, ferritin, and TSAT levels, and reduced use of erythropoietin, with effect sizes (in standardized weighted mean differences) ranging from 0.62 (95% confidence interval 0.11-1.13) to 1.86 (1.58-2.15) standard deviation improvements. Current practice is based largely on extrapolation from adult data and a few small pediatric trials. The pooled pediatric data suggest that i.v.Fe is effective and produces moderate to large effects on the reported outcomes. Prospective, multi-center trials are needed to determine the optimal utilization of i.v.Fe in children.

Adolescent↗
PubMed2004

Effect of fluid overload and dose of replacement fluid on survival in hemofiltration.

Continuous renal replacement therapy (CRRT) is used to treat renal failure in children. Despite widespread use of the technique, little research has evaluated how variations in dose of replacement fluid or degree of fluid overload at initiation relate to outcomes. We conducted a retrospective review of patients treated with convective CRRT at our institution, using a multivariable Cox regression model. Children with high fluid overload (>10%) at CRRT initiation were at 3.02 times greater risk of mortality than those with low or no fluid overload [95% confidence interval (CI) 1.50-6.10, P=0.002]. The hazard ratio for death in children treated with high-dose convective clearance was not statistically significant. Our data support previous findings that volume overload in excess of 10% is strongly correlated with poor outcome. We favor early institution of CRRT, before excessive fluid overload occurs. In contrast to findings in adults, we find no advantage to higher rates of convective clearance. Given the risks and increased complexity associated with high-volume hemofiltration, we recommend further study prior to widespread adoption of high-level convection in children treated with continuous veno-venous hemofiltration.

Adolescent↗
PubMed2003

One size does not fit all: interpreting laboratory data in pediatric patients.

Results of laboratory tests for kidney stone risk factors are reported based on adult reference ranges and are not readily interpretable in children. We have developed a solution which converts laboratory output to appropriate pediatric patient-adjusted relative units, compares results using age-specific reference ranges, and flags out-of-range values. The example presented demonstrates how clinicians with technical skills can use existing computer resources to develop effective solutions to problems they experience in clinical practice.

Child↗
PubMed2002

Peritonitis due to Leuconostoc species in a child receiving peritoneal dialysis.

Leuconostoc species are rarely pathogenic in humans, but may cause infection in patients at risk. A 7-year-old girl with p-ANCA-positive crescentic glomerulonephritis, treated with peritoneal dialysis, developed peritonitis due to Leuconostoc species. She had a history of treatment with vancomycin and a brief course of immunosuppressive therapy. The peritonitis responded well to ampicillin therapy. To date, only 47 cases of Leuconostoc infection, including our patient, have been reported in the medical literature; 25 of the cases occurred in children. Only 1 prior case has been reported in the setting of peritoneal dialysis. The risk factors for Leuconostoc infections are not clear, but commonly associated conditions include immunocompromised status and indwelling medical devices. Leuconostoc species are easily misidentified as streptococci in culture, but they possess inherent resistance to vancomycin despite sensitivity to most other antibiotics. In patients with gram-positive peritonitis, Leuconostoc should be considered as a possible etiological agent, particularly if vancomycin resistance is noted in an organism thought to be a Streptococcus species.

Ampicillin↗
PubMed2002

Primary group A streptococcal peritonitis in a previously healthy child.

Primary peritonitis in a child without underlying medical conditions is rare outside the neonatal period. A girl with no past medical history presented with acute abdominal pain. Laparotomy revealed primary peritonitis due to group A Streptococcus (serotype emm89). She was treated with antibiotics and immune globulin, and recovered fully.

Anti-Bacterial Agents↗