Papers by Marielena Rodriguez
Nutrition in Clinical Practice, 2016
BACKGROUND Postabdominal intestinal surgery (PAIS) infants pose many complex management issues. U... more BACKGROUND Postabdominal intestinal surgery (PAIS) infants pose many complex management issues. Utilization of feeding guidelines has been shown to improve outcomes in preterm and low-birth-weight infants. We propose that standardization of feeding for PAIS infants is safe. METHODS We identified 163 PAIS infants: 93 prior to and 70 after implementation of a feeding guideline. The primary outcome was time to full enteral nutrition (EN). A propensity score-matched analysis was performed. RESULTS The preimplementation and postimplementation PAIS infants were similar at baseline. No significant differences were seen in matched groups for time to full EN, parenteral nutrition days, or time to discharge, but cholestasis was less severe in the postimplementation group and breast milk use increased. Good compliance (67%) to daily guideline use was achieved during the initial 2 years. CONCLUSIONS Utilization of a feeding guideline is safe and standardizes care within an institution, improving compliance to evidence-based practices and outcomes.
The Journal of Pediatrics, 2017
Objective To assess regional practices in management of cryptorchidism with regard to timely fixa... more Objective To assess regional practices in management of cryptorchidism with regard to timely fixation by the current recommended age of 18 months. Study design A retrospective study was performed. Charts of all patients who underwent surgical correction for cryptorchidism by a pediatric general surgeon or urologist within a tertiary pediatric hospital in an urban setting were systematically reviewed. Results We identified 1209 patients with cryptorchidism. The median age of surgical correction was 3.7 years (IQR: 1.4, 7.7); only 27% of patients had surgical correction before 18 months of age. Forty-six percent of our patients were white, 40% were African American, and 8% were Hispanic. African American and Hispanic patients were less likely to undergo timely repair (P = .01), as were those with public or no insurance (P < .0001). A majority (72%) of patients had no diagnostic imaging prior to surgery. A majority of patients had palpable testes at operation (85%) and underwent inguinal orchiopexy (76%); 82% were operated on by a pediatric urologist. Only 35 patients (3%) experienced a complication; those repaired late were significantly less likely to develop a complication (P = .03). There were no differences in age at time of surgery by surgeon type. Conclusions A majority of our patients were not referred for surgical intervention in a timely manner, which may reflect poor access to care in our region. Public and self-pay insurance status was associated with delayed repair. Education of community physicians and families could be potentially beneficial.
The American Journal of Surgery, 2017
Background: Firearm injuries have the highest case-fatality rate among pediatric trauma related d... more Background: Firearm injuries have the highest case-fatality rate among pediatric trauma related deaths. We sought to determine whether demographics, mechanism of injury, and outcomes were age specific. Methods: We performed a 5 year retrospective analysis of patients 0-19 years old with firearm related injuries. Children were divided into two cohorts based on age. Mann-Whitney and Pearson's X 2 were used to compare continuous and categorical variables, respectively. Significance was established at p <0.05. Data: Compared to their younger counterparts, children >15 years old were more likely to be male (82% vs. 90%, p=0.02), African-American (71% vs 89%, p<0.0001), and injured due to assault (76.9% vs 44.6%, p<0.0001). Mortality rates for children <14 was 1.4 times the national average (10.7% vs. 7.5%) while the rate for children >15 was 3.9 times the national average (12.4% vs. 3.2%). Conclusion: Firearm injuries continue to be a prevalent public health concern greatly affecting African-American adolescent males. Prevention strategies and trauma related healthcare resource utilization should target this group in order to reduce the risk of injury and improve outcomes and case-fatality in our population.
The American Journal of Surgery, 2017
BACKGROUND This study investigates whether health disparities exist in infants with hypertrophic ... more BACKGROUND This study investigates whether health disparities exist in infants with hypertrophic pyloric stenosis (HPS), to identify factors affecting definitive treatment, and if more morbidity occurs. METHODS A 6-year retrospective analysis was performed on infants with HPS. Analysis of variance was used to evaluate the impact of socioeconomic factors on disease severity and hospitalization. General linear models were used to assess the impact of risk factors on the outcomes. RESULTS There were a total of 584 infants. African-American's had lower serum chloride (P < .001), higher bicarbonate (P = .001), and sodium levels (P = .006), adding to longer hospitalization than whites (P = .03). Uninsured infants had lower sodium and chloride (P < .001) and higher bicarbonate (P < .001), resulting in a longer time to operation (P = .05) than privately insured infants. In multivariable analyses, African-American's were associated with chloride (P = .002) and higher bicarbonate (P = .009), and uninsured status remained significantly associated with all electrolyte abnormalities. CONCLUSIONS African-American and poorly insured infants with HPS had greater risk of metabolic derangements. This required more time to correct dehydration and electrolytes, adding to longer hospitalizations.
Journal of Trauma and Acute Care Surgery, 2016
Hemorrhage is a major cause of preventable death secondary to traumatic injury. Diagnosis often r... more Hemorrhage is a major cause of preventable death secondary to traumatic injury. Diagnosis often requires multiple blood draws, which are psychologically stressful in pediatric patients. The Pronto device is a pulse co-oximeter that measures the total hemoglobin level using multiple wavelengths of light. The purpose of this study was to evaluate the accuracy of the noninvasive hemoglobin measurements relative to current invasive and point of care testing methods in pediatric trauma patients. METHODS: We performed a prospective observational trial involving patients younger than 17 years presenting to a Level I pediatric trauma center. Following admission, blood was sampled from each patient for testing using an i-Stat device (point-of-care hemoglobin) and a complete blood count within our core laboratory (invasive hemoglobin). Noninvasive hemoglobin analysis was performed within 15 minutes of phlebotomy. Data were evaluated using Spearman correlation and Bland-Altman analysis. RESULTS: Over 2 years, 114 patients had attempted noninvasive hemoglobin measurements, with a success rate of 89%. Mean ± SD age was 9.2 ± 5.1 years. Ninety percent of admissions were for blunt injury, 3% penetrating, 5% near drowning, and 1% burns. Mean invasive hemoglobin was 12.6 ± 1.9 g/dL, mean point-of-care hemoglobin was 12.2 ± 2.0 g/dL, and mean noninvasive hemoglobin was 12.3 ± 1.6 g/dL. Noninvasive hemoglobin values were strongly correlated with both invasive and point of care measurements (R = 0.672 and R = 0.645, respectively; p < 0.001). Bland-Altman analysis comparing noninvasive to point-of-care and invasive hemoglobin levels resulted in an estimated bias of −0.39 and −0.49, respectively. CONCLUSION: Noninvasive hemoglobin values had excellent correlation with both invasive and point-of-care hemoglobin measurements, although the device was not successful for all patients. Given the rapid availability of results and the lack of requirement of venipuncture, noninvasive hemoglobin monitoring may be a valuable adjunct in the initial evaluation and monitoring of pediatric trauma patients.
Journal of the American College of Surgeons, 2015
INTRODUCTION: Pediatric liver transplantation outcomes improve with size-matched donor livers. We... more INTRODUCTION: Pediatric liver transplantation outcomes improve with size-matched donor livers. We hypothesized that graft failure and mortality would be lower when children receive age-matched donor livers. METHODS: The United Network of Organ Sharing database was reviewed for pediatric patients(18 years) undergoing liver transplantation from 1987 to 2013. Primary outcomes examined included rejection, graft failure, and mortality in adult-to-pediatric and pediatric-to-pediatric transplants. Data were analyzed using Fisher's test, Cox regression, and logistic regression. Multivariate analysis (MA) controlled for height, warm (WIT) and cold ischemia time (CIT), and split-liver grafts; p<0.05 was significant. RESULTS: Of 11,256 patients, 3,709 received adult donor livers (ADL), 7,547 got livers from pediatric donors (PDL). Adult donor liver recipients were older (6.9 years vs 4.2 years; p<0.001), and more likely to receive split liver (p<0.001). Cold and warm ischemia times were longer with PDL (p<0.001). The entire cohort showed decreased graft failure and mortality in PDL compared with ADL (p<0.001). Univariate analysis for recipients <13 years old receiving PDL showed lower graft failure (26.49% vs 31.13%, p <0.001) and mortality (13.64% vs 16.41%, p¼0.001). Higher rates of 6-month and 1-year rejection (p<0.001) and vascular thrombosis (p<0.001) were observed with PDL. Of these findings, only graft failure (odds ratio [OR] 0.53; 95% CI 0.41-0.68; p<0.001) and mortality (OR 0.58; 95% CI 0.43-0.80; p<0.001) remained significant on MA. Rejection rates on MA were affected by WIT (p<0.001) and CIT (p<0.001). In recipients aged 13 to 18 years, there was no difference in mortality (p¼0.15), rejection (p¼0.28 to p¼0.31), or vascular thrombosis (p¼0.86) between ADL and PDL. Graft failure was lower with PDL (p¼0.005) for recipients aged 13 to 18 years, but did not maintain significance on MA (OR 0.82; 95% CI, 0.60-1.11; p¼0.21). CONCLUSIONS: Age-matched donor livers in children <13 years are associated with less graft failure and decreased mortality.
Injury, 2017
Non-powder guns (NPG) are viewed as toys for children by the general public. Literature on firear... more Non-powder guns (NPG) are viewed as toys for children by the general public. Literature on firearm injuries in the pediatric population is increasing, however there are still large gaps in the published literature regarding NPG. We intended to identify and compare the epidemiology, circumstances of injury and outcomes of children with NPG versus powder-gun injuries (GSW). We performed a 6-year retrospective analysis of children 0-14 years old treated for NPG and GSW injuries at our level one pediatric trauma center. Mann-Whitney U test and Pearson's X(2) were used to compare continuous and categorical variables, respectively. There were 43 NPG and 112 GSWs. Patients were predominantly male (36 children; 84%) NPG vs. 92 children; 82% GSW) with a median age in both groups of 11 years. Analysis of residential zip codes showed that 74% (32 children) NPG injuries and 85% (95 children) GSW lived in regions with higher poverty than the national level. Children with NPG injuries were mo...
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Papers by Marielena Rodriguez