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Poster 377 Acute Postoperative Complications With Intrathecal Baclofen Pump Placement at a Regional Pediatric Specialty Hospital: A Case Series
PM&R
was apparent only based on parent-report, which demonstrates the importance of using data from multiple observers in studies of TBI sequelae. The association of adolescent- and parent-report of sleepiness with self-report of poorer executive functioning suggests that sleep may be related to select aspects of functional recovery after TBI. Poster 377 Acute Postoperative Complications With Intrathecal Baclofen Pump Placement at a Regional Pediatric Specialty Hospital: A Case Series. Angela M. Sinner, DO (Gillette Children’s Specialty Healthcare, Saint Paul, MN, United States); Sarah J. Kiesling, MD, Linda E. Krach, MD. Disclosures: A. M. Sinner, none. Patients or Programs: 253 consecutive charts of individuals under age 30 undergoing intrathecal baclofen (ITB) pump primary placement or revision from 2004-2011 were reviewed. Twenty-three individuals (9%) experiencing acute postoperative complications were identified with diagnoses of quadriplegic cerebral palsy (CP) (n⫽18), triplegic CP (n⫽1), diplegic CP (n⫽2), transverse myelitis (n⫽1), and an unknown neurodegenerative disorder (n⫽1). Program Description: 22 individuals had postoperative bradycardia (n⫽13), hypotension (n⫽19), and/or bradypnea (n⫽12); 3 with epilepsy had increased seizures, 1 of these with normal vitals. Onset was 1 to 22 hours after surgery, with 1 outlier showing gradual onset of symptoms POD 2. Eight individuals required supplemental oxygen, 1 a nasal trumpet, and 1 BiPAP. Twenty subjects had their ITB dose decreased; of these, pumps of 9 were turned off. Setting: Regional pediatric specialty hospital. Results: 1 individual had an overdose due to programming error; 5 individuals received narcotics and/or benzodiazepines that contributed to their symptoms. Intraoperative medications appeared consistent with facility standards for ITB pump placement. Ten individuals had a history of pulmonary disease. The group with complications had significantly higher GMFCS levels and trended toward having pulmonary disease and/or lower weight. Discussion: A subset of subjects undergoing ITB pump surgery is at risk for sedation, bradycardia, hypotension, and bradypnea in the immediate postoperative period. These complications have not been well described in the medical literature. Anticipation of and monitoring for these complications will improve patient care. Conclusions: The complications described are multifactorial. Consideration should be given to starting with a low dose of ITB, limiting narcotics and benzodiazepines, and close monitoring for respiratory depression, particularly in children with a history of pulmonary disease, weight ⬍20 kg, and/or GMFCS 4 or 5. We recommend a low threshold for turning the ITB down or off for several hours to minimize the contribution of the baclofen. Poster 378 Functional Changes Observed During Inpatient Rehabilitation in Children With Encephalitis of Nonbacterial Origin. Yogita Tailor, DO (Sinai Hospital of Baltimore, Baltimore, MD, United States); Ellen DeMatt, Leigh Sepeta, Beth S. Slomine, PhD, Stacy J. Suskauer, MD, Melissa Trovato, MD. Disclosures: Y. Tailor, none.
Vol. 3, Iss. 10S1, 2011
S305
Objective: To understand the patterns and predictors of recovery from encephalitis of nonbacterial origin by examining functional outcomes. Design: An observational, cohort study. Setting: A pediatric inpatient rehabilitation facility in Baltimore, Maryland. Participants: Children (n⫽14) over 2 years of age who presented to a pediatric inpatient rehabilitation facility between 1996 and 2010 with presumed encephalitis of nonbacterial origin. Mean age was 10 years (range, 5-15 years). Interventions: All the patients participated in daily physical therapy, occupational therapy, and neuropsychology evaluation. Main Outcome Measures: We examined the Functional Independence Measure for Children (WeeFIM) Self-care, Mobility, Cognitive, and Total developmental functional quotient scores (DFQ, % of age-appropriate function) at admission and discharge. Results: Mean WeeFIM Total DFQ at admission was 41 (range, 15-90) and at discharge was 66 (range, 16-96). The average change in WeeFIM Total DFQ from admission to discharge was 25 (range, 0-55). At both admission and discharge, Mobility DFQs were significantly higher than Cognitive DFQs (admission, P⬍.05; discharge, P⬍.001). At discharge, mean Mobility DFQ was 74 and Cognitive DFQ was 55; 64% of children showed motor impairments, and 93% showed cognitive impairments (WeeFIM DFQ, ⬍85). Conclusions: Results suggest that recovery from encephalitis of nonbacterial origin is variable, with greater improvement in functional mobility compared with cognitive outcomes. Future research is necessary to identify predictors of outcome in encephalitis of nonbacterial origin. Poster 379 Implementation of a Program of Growth and Nutrition Surveillance With Anthropometric Measurements for Children With Cerebral Palsy. Amanda Bartos (Akron Children’s Hospital, Akron, OH, United States); Micah Baird, MD. Disclosures: A. Bartos, none. Objective: (1) To facilitate the identification of growth and nutrition problems in children with cerebral palsy by providing clinicians with accurate information through anthropometric measurements, and (2) to assess the feasibility of obtaining these data in the context of a multidisciplinary subspecialty pediatric clinic. Design: Prospective practice improvement study. Setting: Integrated multidisciplinary pediatric subspecialty clinic. Participants: 19 patients with cerebral palsy, ages 4-19. Interventions: Measurement of triceps skinfold thickness and tibial length during routine physiatry, neurology, and developmental pediatrics follow-up visits. Main Outcome Measures: Triceps skinfold thickness (mm) and estimated height and body mass index (BMI) calculated by extrapolation of measured tibial length. Results: Four patients were classified GMFCS I, 4 GMFCS II, 4 GMFCS III, 5 GMFCS IV, and 2 GMFCS V. The average BMIwas 19.6 kg/m2 (GMFCS I), 17.6 kg/m2 (GMFCS II), 18.0 kg/m2 (GMFCS III), 19.4 kg/m2 (GMFCS IV), and 13.9 kg/m2 (GMFCS V). The average triceps skinfold thickness was 19.9 mm (GMFCS I), 18.7 mm (GMFCS II), 15.4 mm (GMFCS III), 14.3 mm (GMFCS IV), and 9.4 mm (GMFCS V). The average height was 132.3 cm (GMFCS I),
was apparent only based on parent-report, which demonstrates the importance of using data from multiple observers in studies of TBI sequelae. The association of adolescent- and parent-report of sleepiness with self-report of poorer executive functioning suggests that sleep may be related to select aspects of functional recovery after TBI. Poster 377 Acute Postoperative Complications With Intrathecal Baclofen Pump Placement at a Regional Pediatric Specialty Hospital: A Case Series. Angela M. Sinner, DO (Gillette Children’s Specialty Healthcare, Saint Paul, MN, United States); Sarah J. Kiesling, MD, Linda E. Krach, MD. Disclosures: A. M. Sinner, none. Patients or Programs: 253 consecutive charts of individuals under age 30 undergoing intrathecal baclofen (ITB) pump primary placement or revision from 2004-2011 were reviewed. Twenty-three individuals (9%) experiencing acute postoperative complications were identified with diagnoses of quadriplegic cerebral palsy (CP) (n⫽18), triplegic CP (n⫽1), diplegic CP (n⫽2), transverse myelitis (n⫽1), and an unknown neurodegenerative disorder (n⫽1). Program Description: 22 individuals had postoperative bradycardia (n⫽13), hypotension (n⫽19), and/or bradypnea (n⫽12); 3 with epilepsy had increased seizures, 1 of these with normal vitals. Onset was 1 to 22 hours after surgery, with 1 outlier showing gradual onset of symptoms POD 2. Eight individuals required supplemental oxygen, 1 a nasal trumpet, and 1 BiPAP. Twenty subjects had their ITB dose decreased; of these, pumps of 9 were turned off. Setting: Regional pediatric specialty hospital. Results: 1 individual had an overdose due to programming error; 5 individuals received narcotics and/or benzodiazepines that contributed to their symptoms. Intraoperative medications appeared consistent with facility standards for ITB pump placement. Ten individuals had a history of pulmonary disease. The group with complications had significantly higher GMFCS levels and trended toward having pulmonary disease and/or lower weight. Discussion: A subset of subjects undergoing ITB pump surgery is at risk for sedation, bradycardia, hypotension, and bradypnea in the immediate postoperative period. These complications have not been well described in the medical literature. Anticipation of and monitoring for these complications will improve patient care. Conclusions: The complications described are multifactorial. Consideration should be given to starting with a low dose of ITB, limiting narcotics and benzodiazepines, and close monitoring for respiratory depression, particularly in children with a history of pulmonary disease, weight ⬍20 kg, and/or GMFCS 4 or 5. We recommend a low threshold for turning the ITB down or off for several hours to minimize the contribution of the baclofen. Poster 378 Functional Changes Observed During Inpatient Rehabilitation in Children With Encephalitis of Nonbacterial Origin. Yogita Tailor, DO (Sinai Hospital of Baltimore, Baltimore, MD, United States); Ellen DeMatt, Leigh Sepeta, Beth S. Slomine, PhD, Stacy J. Suskauer, MD, Melissa Trovato, MD. Disclosures: Y. Tailor, none.
Vol. 3, Iss. 10S1, 2011
S305
Objective: To understand the patterns and predictors of recovery from encephalitis of nonbacterial origin by examining functional outcomes. Design: An observational, cohort study. Setting: A pediatric inpatient rehabilitation facility in Baltimore, Maryland. Participants: Children (n⫽14) over 2 years of age who presented to a pediatric inpatient rehabilitation facility between 1996 and 2010 with presumed encephalitis of nonbacterial origin. Mean age was 10 years (range, 5-15 years). Interventions: All the patients participated in daily physical therapy, occupational therapy, and neuropsychology evaluation. Main Outcome Measures: We examined the Functional Independence Measure for Children (WeeFIM) Self-care, Mobility, Cognitive, and Total developmental functional quotient scores (DFQ, % of age-appropriate function) at admission and discharge. Results: Mean WeeFIM Total DFQ at admission was 41 (range, 15-90) and at discharge was 66 (range, 16-96). The average change in WeeFIM Total DFQ from admission to discharge was 25 (range, 0-55). At both admission and discharge, Mobility DFQs were significantly higher than Cognitive DFQs (admission, P⬍.05; discharge, P⬍.001). At discharge, mean Mobility DFQ was 74 and Cognitive DFQ was 55; 64% of children showed motor impairments, and 93% showed cognitive impairments (WeeFIM DFQ, ⬍85). Conclusions: Results suggest that recovery from encephalitis of nonbacterial origin is variable, with greater improvement in functional mobility compared with cognitive outcomes. Future research is necessary to identify predictors of outcome in encephalitis of nonbacterial origin. Poster 379 Implementation of a Program of Growth and Nutrition Surveillance With Anthropometric Measurements for Children With Cerebral Palsy. Amanda Bartos (Akron Children’s Hospital, Akron, OH, United States); Micah Baird, MD. Disclosures: A. Bartos, none. Objective: (1) To facilitate the identification of growth and nutrition problems in children with cerebral palsy by providing clinicians with accurate information through anthropometric measurements, and (2) to assess the feasibility of obtaining these data in the context of a multidisciplinary subspecialty pediatric clinic. Design: Prospective practice improvement study. Setting: Integrated multidisciplinary pediatric subspecialty clinic. Participants: 19 patients with cerebral palsy, ages 4-19. Interventions: Measurement of triceps skinfold thickness and tibial length during routine physiatry, neurology, and developmental pediatrics follow-up visits. Main Outcome Measures: Triceps skinfold thickness (mm) and estimated height and body mass index (BMI) calculated by extrapolation of measured tibial length. Results: Four patients were classified GMFCS I, 4 GMFCS II, 4 GMFCS III, 5 GMFCS IV, and 2 GMFCS V. The average BMIwas 19.6 kg/m2 (GMFCS I), 17.6 kg/m2 (GMFCS II), 18.0 kg/m2 (GMFCS III), 19.4 kg/m2 (GMFCS IV), and 13.9 kg/m2 (GMFCS V). The average triceps skinfold thickness was 19.9 mm (GMFCS I), 18.7 mm (GMFCS II), 15.4 mm (GMFCS III), 14.3 mm (GMFCS IV), and 9.4 mm (GMFCS V). The average height was 132.3 cm (GMFCS I),