Biomedical subjects

S Ashwal

Publications and source records attributed to S Ashwal.

111 records · Page 7Linked to original sources

PubMedDate not supplied

Availability and selection of donors for pediatric heart transplantation.

METHODS: Applying generally accepted criteria for selection of adult heart donors, we conducted a retrospective study of brain-dead infants and children for assessment of suitability as donors for heart transplantation. Cardiac histopathologic studies were evaluated in all subjects undergoing autopsy. RESULTS: In 5 years there were 58 such patients, the majority of whom had head injury, near-drowning, near-miss sudden infant death syndrome, infection, or asphyxia. Of these, only five met the proposed clinical criteria. Most prospective donors were eliminated on the basis of prolonged cardiac arrest (n = 33), pressor dependency (n = 25), and/or infection (n = 10). Forty-two subjects underwent autopsy, of whom 36 would not have been excluded as donors except on the basis of ischemic cardiac insult. Of these, 18 subjects were found to have essentially normal myocardium, nine had abnormal but potentially reversible microscopic changes, and nine had myocardial infarction. The pathologic findings were not predicted by the selection criteria, but severe chest trauma was not associated with infarction, eight of the nine patients with infarction had had cardiac arrest, and most of those with infarction had drowned or had had sudden infant death syndrome. CONCLUSIONS: The supply of donor organs for pediatric heart transplantation is very limited if selection criteria used for adult donors are applied. These criteria, however, do not correlate well with myocardial pathologic findings in infants and children. More accurate predictors of donor suitability are needed.

Adolescent↗

PubMedDate not supplied

Brain death in early infancy.

Guidelines for the determination of brain death in infants and children are now well established. Coma, absence of cranial nerve reflexes, and apnea are required in all patients. In children less than 1 year of age, supportive neurodiagnostic studies (electroencephalograms and cerebral blood flow) are recommended. Data on 52 pediatric heart donor patients were reviewed to assess whether current criteria and procedures were used in the determination of brain death. The mean age of the donors (14.3 months) was higher than that of the recipients (2.6 months). In all patients the hospital records documented coma, fixed dilated pupils, absent brain stem reflexes, apnea, and verification of the diagnosis of brain death by two physicians who were not part of the transplantation team. In 27 of 52 patients, apnea challenge tests were performed; the mean PCO2 was 73.3 torr. Thirty-three of 52 patients had electroencephalograms performed; electrocerebral silence was found in 28 of 33 studies. Twenty-two of 52 patients had cerebral blood flow studies; in 19 of 22 studies the absence of flow was observed. Of the 52 patients the following number of organs were transplanted: heart (52), liver (34), kidneys (15), corneas (6), lung (4), and pancreas (2). These data indicate that the diagnosis of brain death is being made accurately and in a timely manner as is the harvesting of organs. Improvements could be made by requiring, if possible, the performance of an apnea challenge test in all patients. The data also suggest the potential to increase the donor yield.

Age Factors↗

PubMedDate not supplied

Growth and neurodevelopmental outcome of infants undergoing heart transplantation.

The purpose of this study was to examine the long-term growth and developmental outcome of infants undergoing heart transplantation. We studied weight, length, and head circumference from birth to 12 months after surgery in 110 infant recipients less than 6 months of age. Forty-eight early transplant recipients (0 to 30 days) were compared with 62 late transplant recipients (31 to 180 days). Late transplant recipients showed less growth in all parameters at the time of transplant. However, by 6 months after transplantation, there were no differences between the two groups. Growth in 20 infants, now 3 to 7 years old, appears normal. Neurodevelopmental outcome was evaluated prospectively in 57 infants. Four months after transplantation, 11 infants (19%) had abnormal neurologic examinations, with generalized hypotonia (64%) being the most common finding. The Bayley Scale of Infant Development was administered to 48 of 57 infants. The Mental Developmental Index averaged 87 (+/- 21) and the Psychomotor Developmental Index averaged 90 (+/- 21). Of 140 infants who have undergone heart transplantation, transient postoperative seizures occurred in 23 survivors (21%) and 10 nonsurvivors (33%). Our findings suggest that growth, neurologic outcome, and development are normal in the majority of infants who undergo transplantation before 6 months of age.

Child↗