Cynthia D Downard
Prominent publications by Cynthia D Downard
Importance: Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.
Objective: To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based ...
|Known for Opioid Prescribing | Children Surgery | Perioperative Period | Review Articles | Practice Guidelines|
Challenging surgical dogma in the management of proximal esophageal atresia with distal tracheoesophageal fistula: Outcomes from the Midwest Pediatric Surgery Consortium
[ PUBLICATION ]
PURPOSE: Perioperative management of infants with esophageal atresia and tracheoesophageal fistula (EA/TEF) is frequently based on surgeon experience and dogma rather than evidence-based guidelines. This study examines whether commonly perceived important aspects of practice affect outcome in a contemporary multi-institutional cohort of patients undergoing primary repair for the most common type of esophageal atresia anomaly, proximal EA with distal TEF.
METHODS: The Midwest Pediatric ...
|Known for Esophageal Atresia | Primary Repair | Postoperative Complications | Transanastomotic Tube | Prosthetic Material|
OBJECTIVE: To assess the postnatal outcome and complications that arise in infants with the prenatal diagnosis of gastroschisis.
METHODS: Prenatal sonograms with the diagnosis of gastroschisis were identified. Maternal age, indication for sonography, gestational age at diagnosis, other sonographic abnormalities, and postnatal outcome were recorded.
RESULTS: Twenty-six fetuses at 16 to 36 weeks' gestational age had gastroschisis diagnosed on sonography. In 5 cases, other fetal anomalies ...
|Known for Postnatal Outcome | Prenatal Diagnosis | Gastroschisis Maternal Age | Newborn Length | Bowel Dilatation|
Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review
[ PUBLICATION ]
OBJECTIVE: The optimal treatment of necrotizing enterocolitis (NEC) is a common challenge for pediatric surgeons. Although many studies have evaluated prevention and medical therapy for NEC, few guidelines for surgical care exist. The aim of this systematic review is to review and evaluate the currently available evidence for the surgical care of patients with NEC.
METHODS: Data were compiled from a search of PubMed, OVID, the Cochrane Library database, and Web of Science from January ...
|Known for Necrotizing Enterocolitis | Nec Premature Infant | Surgical Treatment | Human Milk | Evidence Probiotics|
BACKGROUND: The maternal variables that affect fetal development and correlate with necrotizing enterocolitis (NEC), the most common gastrointestinal emergency in premature infants, are not well defined. We hypothesized that maternal risk factors were the primary determinant of future development of NEC.
METHODS: Patients with NEC were identified from an established NICU database and were control-matched with 2 neonates treated at the same institution. The medical records of each patient ...
|Known for Necrotizing Enterocolitis | Maternal Cigarette Smoking | Premature Infant | Medical Records | Fetal Development|
Altered intestinal microcirculation is the critical event in the development of necrotizing enterocolitis
[ PUBLICATION ]
PURPOSE: The pathophysiology of necrotizing enterocolitis (NEC) includes prematurity, enteral feeds, hypoxia, and hypothermia. We hypothesized that vasoconstriction of the neonatal intestinal microvasculature is the essential mechanistic event in NEC and that these microvascular changes correlate with alterations in mediators of inflammation.
METHODS: Sprague-Dawley rat pups were separated into groups by litter. Necrotizing enterocolitis was induced in experimental groups, whereas ...
|Known for Necrotizing Enterocolitis | Intestinal Microcirculation | Nec Animals | Newborn Disease Models | Terminal Ileum|
BACKGROUND/PURPOSE: Congenital diaphragmatic hernia (CDH) is a condition associated with significant mortality. This study examines the survival rate of neonates with CDH treated by a multidisciplinary team in a single pediatric hospital. Actual survival rate is compared with predicted outcome based on severity of illness.
METHODS: A consecutive series of neonates with CDH was evaluated beginning January 1, 2000. There were no excluded patients. A treatment protocol emphasizing minimal ...
|Known for Congenital Diaphragmatic Hernia | Neonates Cdh | Predicted Survival | Pulmonary Hypertension | Hospital Mortality|
Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula
[ PUBLICATION ]
BACKGROUND/PURPOSE: Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a rare congenital anomaly lacking contemporary data detailing patient demographics, medical/surgical management and outcomes. Substantial variation in the care of infants with EA/TEF may affect both short- and long-term outcomes. The purpose of this study was to characterize the demographics, management strategies and outcomes in a contemporary multi-institutional cohort of infants diagnosed with EA/TEF to ...
|Known for Perioperative Management | Tracheoesophageal Fistula | Esophageal Atresia | Substantial Variation | Study Treatment Study|
Severe obesity among youth is an "epidemic within an epidemic" and portends a shortened life expectancy for today's children compared with those of their parents' generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple comorbid states, including increased cardiometabolic risk resulting in end-organ damage in ...
|Known for Bariatric Surgery | Severe Obesity | Pediatric Metabolic | Current Evidence | Practice Guidelines|
OBJECTIVE: Ovarian torsion in pediatric patients is a rare event and is primarily managed by pediatric general surgeons. Torsion can be treated with detorsion of the ovary or oopherectomy. Oopherectomy is the most common procedure performed by pediatric general surgeons for ovarian torsion. The purpose of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee was to examine evidence from the medical literature and provide ...
|Known for Ovarian Torsion | Pediatric Patients | Torsed Ovary | Child Female | 4 Adolescent|
BACKGROUND: Gastroschisis is an increasingly common congenital abdominal wall defect. Due to advances in neonatal critical care and early surgical management, mortality from gastroschisis and associated complications has decreased to less than 10% in most series. However, it has been recognized that the outcome of gastroschisis has a spectrum and that the disorder affects a heterogeneous cohort of neonates. The goal of this study is to predict morbidity and mortality in neonates with ...
|Known for Neonates Gastroschisis | Parenteral Nutrition | Newborn Infant | Mechanical Ventilation | Birth Weight|
Direct peritoneal resuscitation augments ileal blood flow in necrotizing enterocolitis via a novel mechanism
[ PUBLICATION ]
PURPOSE: Endothelin-1, prostaglandins (PGs), and nitric oxide (NO) have been implicated in the intestinal microvascular dysfunction of necrotizing enterocolitis (NEC). We hypothesized that direct peritoneal resuscitation (DPR) dilates the intestinal microvasculature and improves blood flow independent of these mechanisms.
METHODS: Rat pups were assigned by litter to experimental NEC or CONTROL groups. Laser Doppler flowmetry evaluation of intestinal microvascular blood flow was studied ...
|Known for Blood Flow | Enterocolitis Nec | Nitric Oxide | Ileum Infusions | Increased Ileal|
Intestinal Microcirculatory Flow Alterations in Necrotizing Enterocolitis are Improved by Direct Peritoneal Resuscitation
[ PUBLICATION ]
Vasoconstriction of the neonatal intestinal microvasculature is a central mechanistic event in development of necrotizing enterocolitis. We hypothesized that topical treatment of the intestine with dialysate fluid would ameliorate the vasoconstriction in necrotizing enterocolitis (NEC). NEC was induced in experimental groups. Control animals were delivered vaginally and dam-fed (control group). Neonatal pups underwent laser Doppler flow study of the terminal ileum to determine real-time ...
|Known for Necrotizing Enterocolitis | Blood Flow | Direct Peritoneal Resuscitation | Terminal Ileum | Peritoneal Cavity|
Asymptomatic malrotation: Diagnosis and surgical management An American Pediatric Surgical Association outcomes and evidence based practice committee systematic review
[ PUBLICATION ]
OBJECTIVE: Patients with malrotation, or an intestinal rotation abnormality (IRA), can experience serious adverse events. Increasingly, asymptomatic patients are being diagnosed with malrotation incidentally. Patients with symptomatic malrotation require surgery in an urgent or semiurgent manner to address their symptoms. The treatment of asymptomatic or incidentally discovered malrotation remains controversial.
METHODS: Data were compiled from a broad search of Medline, Cochrane, Embase ...
|Known for Asymptomatic Malrotation | Laparoscopic Approach | Pediatric Surgical | Intestinal Volvulus | Congenital Heart|
PURPOSE: Preliminary studies have shown aminocaproic acid (AMICAR), an inhibitor of fibrinolysis, reduced the incidence of intracranial hemorrhage and significant surgical site bleeding in patients on extracorporeal membrane oxygenation (ECMO). The purpose of this analysis is to determine if these benefits remain when AMICAR is used in a large population.
METHODS: ECMO patients from a single pediatric institution, with routine use of AMICAR for "high-risk" patients, were evaluated ...
|Known for Diaphragmatic Hernias | Hemorrhagic Complications | Ecmo Patients | Intracranial Hemorrhage | Aminocaproic Acid|
Cynthia D Downard: Influence Statistics
|vital organ flow||#1|
|lung tlr4 myd88||#1|
|dpr lung injury||#1|
|peritoneal fluid administration||#1|
|88 protein myd88||#1|
|lung tlr4 trif||#1|
|tlr4 88 protein||#1|
|ep4 agonist pg||#2|
|rank order criteria||#2|
|direct peritoneal resuscitation||#2|
|nec1xrlxn necall feeds||#2|
|level practice committee||#2|
|15 dextrose solution||#2|
|brain death dpr||#2|
|player leadership skills||#2|
|kidneys reduced macrophages||#2|
|control nec protocol||#2|
|operative skills patient||#2|
Key People For Brain Death
Cynthia D Downard:Expert Impact
Concepts for whichCynthia D Downardhas direct influence:Brain death, Pediatric surgery, Direct peritoneal resuscitation, Esophageal atresia, Ovarian torsion, Hemorrhagic shock, Benzoic acid, Fecal continence.
Cynthia D Downard:KOL impact
Concepts related to the work of other authors for whichfor which Cynthia D Downard has influence:Congenital diaphragmatic hernia, Esophageal atresia, Bariatric surgery, Necrotizing enterocolitis, Preterm infants, Pediatric patients, Intestinal malrotation.
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