Scott Adzick

The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

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Publications (11)28.83 Total impact

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    ABSTRACT: To study preschool functional status in children following fetal myelomeningocele (fMMC) surgery. Prior to the NICHD-MOMS trial, 30 fMMC underwent standardized neurodevelopmental examination at 5 years of age. Functional status was determined with the Functional Independence Measure (WeeFIM), which assesses self-care, mobility, and cognitive independence. Evaluations were completed in 26 (87%). Mean cognitive (93.0 ± 21.9), self-care (66.5 ± 23.9), mobility (82.3 ± 19.5), and total (77.9 ± 20.3) functional quotient of fMMC children were significantly lower than age-matched population norms (P < 0.01). Complete caregiver independence was achieved by 22 (84%), 10 (38%), 16 (62%), and 15 (58%) fMMC children for cognition, self-care, mobility, and total functional outcome, respectively. Cognitive, mobility, and total independence were higher in non-shunted than shunted fMMC children (P = 0.02, P = 0.02, and P < 0.01, respectively) and in fMMC children with average neurodevelopmental scores (P < 0.001, P = 0.01, and P < 0.01, respectively). Self-care independence tended to be higher in the non-shunted group and in fMMC children with normal neurodevelopmental outcome (P = 0.07 and P = 0.09, respectively). The majority of fMMC children achieved cognitive and mobility independence, but continue to require significant assistance in self-care. Non-shunted and fMMC children with normal neurodevelopmental outcome were more likely to be independent in daily living activities. Better understanding of the extent of functional limitations following fMMC surgery will allow for more effective early interventions geared toward maximizing independence in everyday tasks in all environments.
    Child s Nervous System 02/2011; 27(7):1083-8. DOI:10.1007/s00381-011-1388-y · 1.16 Impact Factor
  • American Journal of Obstetrics and Gynecology 12/2008; 199(6). DOI:10.1016/j.ajog.2008.09.508 · 3.97 Impact Factor
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    ABSTRACT: The present study investigates a new surgical approach in the treatment of left diaphragmatic hernia in fetal sheep. We postulated that unlike tracheal occlusion where both lungs are occluded, selective left main bronchus occlusion (LMBO) would accelerate growth of only the left lung, reduce left visceral herniation, and recover space in the both thoraces necessary for lung development. Left-sided congenital diaphragmatic hernia (CDH) was surgically created in 8 fetal lambs at approximately 65 days of gestation; in 4 of these animals, LMBO was performed at approximately 118 days. Four sham-operated animals served as controls. Lambs were delivered by hysterotomy at 137 days. We measured lung-to-body weight ratios, alveolar surface area, septal wall thickness, and AE2 cell density in the left and right lungs. Left main bronchus occlusion increased (P < .05) left lung growth causing severe right mediastinal shift but failed to reduce herniated abdominal viscera in 3 of 4 lambs. Wet lung-to-body weight ratio in LMBO group was similar to that of the control group; however, this was achieved by overgrowth of left lung, whereas the right wet lung-to-body weight ratio remained low. In the LMBO group, right lung AE2 cell density was higher than that of control group and not different to that of the CDH group. Left main bronchus occlusion failed to restore normal pulmonary development in CDH.
    Journal of Pediatric Surgery 05/2008; 43(4):620-6. DOI:10.1016/j.jpedsurg.2007.09.071 · 1.31 Impact Factor
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    ABSTRACT: Congenital lung malformation can easily be diagnosed by prenatal ultrasound. Associated extrapulmonary malformations such as heart defects and chromosomal aberrations are rare. The objective of this study was to describe the natural history, outcome and other associated malformations in fetuses with lung lesions and an associated heart defect. Retrospective analysis of 4 cases of prenatally diagnosed fetal CCAMs and hybrid lesions with an associated heart defect and review of 8 cases in the literature. At a single referral center 1.9% of the fetuses with Congenital cystic adenomatoid malformation (CCAM) were diagnosed with an associated heart defect. Seven of the total 12 cases (58%) reviewed had a conotruncal heart abnormality. Chromosomal abnormalities were found in 5 (42%) of the cases. This retrospective review shows that karyotyping in fetal lung lesions with an associated heart defect or isolated large lung lesions is indicated. It also suggests that there is a subpopulation of fetuses with CCAMs who have conotruncal heart defects. This finding may suggest a common genetic background.
    Prenatal Diagnosis 12/2007; 27(12):1123-8. DOI:10.1002/pd.1845 · 2.51 Impact Factor
  • American Journal of Obstetrics and Gynecology 12/2007; 197(6). DOI:10.1016/j.ajog.2007.10.577 · 3.97 Impact Factor
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    ABSTRACT: A morphometric study was performed to examine the effects of prenatal glucocorticoids, which were administered 48 hours before birth, on muscularization of small pulmonary arterioles (<60 microm diameter) in lambs with diaphragmatic hernia (DH) after fetal tracheal occlusion (TO). DH was created in 23 fetal sheep at 65 days gestation. TO was performed in 16 of 24 fetuses between 110 and 140 days of gestation; 9 of the fetuses were exposed prenatally to betamethasone (0.5 mg/kg body weight) 48 hours before delivery. Six sham-operated animals served as controls. Sections of paraffin that were embedded in lung tissues were stained with Elastin-Van Gieson, and the percentage of medial wall thickness (MWT) was determined. The percentage of MWT in DH lambs (29.6% +/- 1.9%) was increased compared with sham animals (18.1% +/- 1.3%) and was not different from that of DH/TO animals (30.3% +/- 1.7%). In DH/TO + glucocorticoid lambs, the percentage of MWT (24.6% +/- 1.2%) was significantly lower than in the DH/TO group but was higher than the sham group. In fetuses who underwent prolonged TO therapy for severe DH, prenatal glucocorticoid treatment decreased medial hypertrophy of pulmonary arterioles by approximately 19%. We speculate that such structural changes may have contributed to improve gas exchange that was observed in this model.
    American journal of obstetrics and gynecology 11/2007; 197(4):381.e1-7. DOI:10.1016/j.ajog.2007.06.061 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 12/2006; 195(6). DOI:10.1016/j.ajog.2006.10.056 · 3.97 Impact Factor
  • American Journal of Obstetrics and Gynecology 12/2006; 195(6). DOI:10.1016/j.ajog.2006.10.636 · 3.97 Impact Factor
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    ABSTRACT: PURPOSE To determine if lung volume (LV) or chest diameters obtained from prenatal magnetic resonance (MR) images is predictive of outcome in fetus with omphalocele. METHOD AND MATERIALS Fetal MR of 32 patients (19-32 wk) with omphalocele performed at single institution were reviewed retrospectively. Twelve patients were excluded because follow up was not available. Following measurements were obtained in the HASTE images: LV, AP= axial anteroposterior at diaphragm, WA= axial width at diaphragm, WC1= coronal width at carina and WC2= coronal width at diaphragm. Omphaloce was classified as giant (containing liver) or small (without liver). Results were correlated with gestational age (GA), severity of omphalocele and outcome. The same measurements were performed in 27 fetuses (19-33 wk) without thoracoabdominal anomalies as a control group. RESULTS Nine of 20 patients are alive without pulmonary complication. Six are alive with chronic lung disease. Four patients died after birth because of pulmonary hypoplasia. One patient was stillborn and had pulmonary hypoplasia. The total LV ranged from 6.7 � 45 ml in omphalocele patients and from 10.7 � 98 ml in control group. Linear increasing in LV was observed with increasing GA in both groups. Chest diameters were 2.2 � 5.4 cm (WA), 1.5 - 4.5 cm (AP), 2.4 � 4.9 cm (WC1) and 2.7 � 5.5 cm (WC2) in omphalocele patients. In the control group, chest diameters were 3 � 7 cm (WA), 2- 5.3 cm (AP), 2.5- 6.4 cm (WC1) and 3.2 � 8 cm (WC2). LV and chest diameters were smaller in patients with giant omphalocele when compared to patients with small omphalocele or control group. Patients with small omphalocele have LV and chest diameters comparable to the control group. Statistical analysis showed that LV proved to be the strongest outcome predictor, followed by coronal width at carina. CONCLUSIONS Patients with smaller lung volume and chest diameters for the GA have higher mortality and morbidity in omphalocele patients. Coronal width at carina seen to be promising in predicting outcome in omphalocele patients.
    Radiological Society of North America 2004 Scientific Assembly and Annual Meeting; 11/2004
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    ABSTRACT: LEARNING OBJECTIVES To show the common and uncommon presentations of congenital lung masses in infants by CT Scan with pathological correlation. ABSTRACT Retrospective review of chest CT scan performed in 95 infants (50 female and 46 male) age 1 day to 2 year-old (average 55 days) from 1996 through 2003 at a single institution. CT scan was performed following administration of 2 cc/Kg intravenous contrast media under sedation. All CT Scan results were correlated with pathological results. Cystic Adenomatoid Malformation (CCAM), sequestration (SEQ), combination of CCAM and SEQ, simple congenital lobar emphysema (CLE), combination of CCAM and bronchial atresia, combination of CCAM and bronchogenic Cyst, combination of CCAM and CLE, CCAM with systemic feeding vessel, CCAM mimicking air trapping, combined CCAM, SEQ and foregut communication are among the masses that will be presented.
    Radiological Society of North America 2004 Scientific Assembly and Annual Meeting; 11/2004
  • American Journal of Obstetrics and Gynecology 12/2003; 189(6). DOI:10.1016/j.ajog.2003.10.307 · 3.97 Impact Factor