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Huber AM, Kim S, Reed AM, Carrasco R, Feldman BM, Hong SD, Kahn P, Rahimi H, Robinson AB, Vehe RK, Weiss JE, Spencer C. Childhood Arthritis and Rheumatology Research Alliance Consensus Clinical Treatment Plans for Juvenile Dermatomyositis with Persistent Skin Rash. J Rheumatol 2016; 44:110-116. [PMID: 27803135 DOI: 10.3899/jrheum.160688] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Juvenile dermatomyositis (JDM) is the most common form of idiopathic inflammatory myopathy in children. While outcomes are generally thought to be good, persistence of skin rash is a common problem. The goal of this study was to describe the development of clinical treatment plans (CTP) for children with JDM characterized by persistent skin rash despite complete resolution of muscle involvement. METHODS The Childhood Arthritis and Rheumatology Research Alliance, a North American consortium of pediatric rheumatologists and other healthcare providers, used a combination of Delphi surveys and nominal group consensus meetings to develop CTP that reflected consensus on typical treatments for patients with JDM with persistent skin rash. RESULTS Consensus was reached on patient characteristics and outcome assessment. Patients should have previously received corticosteroids and methotrexate (MTX). Three consensus treatment plans were developed. Plan A added intravenous immunoglobulin (IVIG) if it was not already being used. Plan B added mycophenolate mofetil, while Plan C added cyclosporine. Continuation of previous treatments, including corticosteroids, MTX, and IVIG, was permitted in plans B and C. CONCLUSION Three consensus CTP were developed for use in children with JDM and persistent skin rash despite complete resolution of muscle disease. These CTP reflect typical treatment approaches and are not to be considered treatment recommendations or standard of care. Using prospective data collection and statistical methods to account for nonrandom treatment assignment, it is expected that these CTP will be used to allow treatment comparisons, and ultimately determine the best treatment for these patients.
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Affiliation(s)
- Adam M Huber
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA. .,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University.
| | - Susan Kim
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Ann M Reed
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Ruy Carrasco
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Brian M Feldman
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Sandy D Hong
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Philip Kahn
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Homaira Rahimi
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Angela Byun Robinson
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Richard K Vehe
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Jennifer E Weiss
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Charles Spencer
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
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