For CMA to be maximally useful in prenatal diagnosis, parental DNA samples as well as robust datasets to provide predictive phenotypic information are required. The most common reason for undertaking CMA was to evaluate an ultrasound anomaly, and benign familial variants were a common finding. Genetic services are required to provide pre- and post-test genetic counseling and help families interpret results.

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Introduction Nonoperative management of hemodynamically stable patients with blunt splenic and/or hepatic injury has been widely accepted in the pediatric population. However, variability exists in the utilization and timing of repeat imaging to assess for delayed complications during index hospitalization. Recent level-IV evidence suggests that repeat imaging in children should be performed based on a patient’s clinical status rather than on a routine basis. The aim of this study is to examine the rate of delayed complications and interventions in pediatric trauma patients with blunt splenic and/or hepatic injuries who undergo repeat imaging prompted either by a clinical change (CC) or non-clinical change (NCC). Methods A 9-year (2011-2019), retrospective, dual-institution study was performed of children (0-17 years) with blunt splenic and/or hepatic injuries. Patients were grouped based on reason for repeat imaging: CC or NCC. The rate of organ-specific delayed complications and interventions was examined by reason for scan. Results A total of 307 injuries were included in the study period (174 splenic, 113 hepatic, and 20 both). Of 194 splenic injuries, 30(15.5%) underwent repeat imaging (CC = 19; NCC = 11). Of 133 hepatic injuries, 27(20.3%) underwent repeat imaging (CC = 21; NCC = 6). There was no difference in the incidence of organ-specific delayed complications between the CC and NCC groups. Of the 4 patients with complications necessitating intervention, only one was identified based on NCC. Conclusions Our data suggest routine repeat imaging is unnecessary in children with blunt splenic and/or hepatic injuries; therefore, practitioners may rely on a patient’s clinical change.

Background: Cardiopulmonary bypass (CPB) is associated with an inflammatory response that increases morbidity and mortality. Previous studies demonstrate that the air-blood interface plays an important role in CPB induced inflammation. Nitric oxide (NO) is known to mitigate the inflammatory response. We sought to examine the effect of NO on the inflammatory response resulting from a large air-blood interface during CPB in a porcine model. Methods: Twenty-one healthy swine (40-50 kg) were placed on CPB for 2h using central cannulation through a right mini thoracotomy. Following placement of an aortic cross clamp, the myocardium was preserved with antegrade cold del Nido cardioplegia. Cardiac arrest was maintained for 45min. Group 1 (n=11), swine supported on CPB with a controlled 20% air blood shunt at 3-4:1 air:blood ratio. Group 2 (n=10), as group 1 with the addition of NO (500 ppm) mixed in the sweep gas of the oxygenator. Following weaning from CPB, animals were recovered and monitored for 2d. Survival, clinical outcomes, and blood assays for inflammatory markers were collected prior, during, and postCPB. Mann -Whitney U test and log rank test were performed to determine statistical significance in both groups.Results: There was no difference in our ability to wean from CPB between Groups. Two-day survival rate was superior in Group 2 (80% vs 54%, p=0.24). Immediately after CPB the time to extubation (95.3 ±32.6min vs 70.6 ±13.7min, p=0.07) and lung compliance (LC) (86.1% vs 75.3%, p=0.056) were better in Group 2. Troponin-I levels were higher in group 2 overall (21,7702+/-18,108 pg/ml vs 8491+/-6,686 p=.055). Preliminary results (n=2 in each group) show elevated IL-6 (3.89 pg/ml vs 3.3pg/ml) in Group 1 and 2 respectively. At necropsy LC was 82.6% in group 1 vs 86.4% in group 2, p= 0.43. There were no differences in P-selectin or Cd11-b. Conclusions: Nitric oxide administration at high dose during CPB with a large air-blood interface attenuates components of the IL-6 pathway. NO was associated with decrease in overall mortality post bypass and improved lung compliance. Further studies are needed to characterize these findings and optimize NO dosing prior to clinical application.