Pediatrics最新文献

{"title":"Improving Screening for Social Determinants of Health in an Outpatient Complex Care Clinic.","authors":"Arielle Randolph, Breann Butts, Cynthia White, Amelia Auberger, Meredith Bohache, Carrie Goddard-Roaden, Andrew F Beck, William B Brinkman, Joanna Thomson","doi":"10.1542/peds.2023-063086","DOIUrl":"10.1542/peds.2023-063086","url":null,"abstract":"<p><strong>Background: </strong>Families of children with medical complexity (CMC) may face challenges related to Social Determinants of Health (SDoH). Although standardized SDoH screening has been implemented in numerous medical settings, there has been limited study of screening among CMC. Our global aim is to improve access to institutional and community resources for families of CMC with identified needs. Here, we aimed to establish SDoH screening for families in our outpatient Complex Care Center and attain a screening rate of 80%.</p><p><strong>Methods: </strong>A multidisciplinary team in our clinic used quality improvement methods to implement and study an expanded SDoH screen, which included 3 questions specific to the needs of CMC (ie, emergency planning, social support, and medical equipment concerns). Interventions, informed and refined by 5 key drivers, were tested over a 12-month period. A statistical process control chart tracked key outcome and process measures over time.</p><p><strong>Results: </strong>SDoH screening sustained a mean of 80% after implementation during the study period. Incorporating registration staff in screen distribution was our most impactful intervention. At least 1 SDoH concern was identified on 56% of screens; concerns specific to CMC and mental health were most frequently reported. A total of 309 responses to positive screens were reported in total.</p><p><strong>Conclusions: </strong>Successful implementation of an expanded, tailored SDoH screen revealed a multitude of social needs specific to families of CMC that otherwise may not have been recognized. Our team continues to develop and distribute resources to address identified needs.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11422197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood Opportunity Index and Low-Value Care in Children's Hospitals.","authors":"Irma T Ugalde, Alan R Schroeder, Jennifer R Marin, Matt Hall, Elisha McCoy, Monika K Goyal, Matthew J Molloy, John R Stephens, Michael J Steiner, Michael J Tchou, Jessica L Markham, Jillian M Cotter, Clemens Noelke, Rustin Morse, Samantha A House","doi":"10.1542/peds.2023-065524","DOIUrl":"10.1542/peds.2023-065524","url":null,"abstract":"<p><p></p><p><strong>Background and objective: </strong>Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed the relationship between Childhood Opportunity Index (COI) 2.0 and LVC in children's hospitals.</p><p><strong>Methods: </strong>We applied the Pediatric Health Information System LVC Calculator to emergency and inpatient encounters from July 2021 through June 2022. Proportions with LVC in highest (greatest opportunity) and lowest COI quintiles were compared. Generalized estimating equation logistic regression models were used to analyze LVC trends across COI quintiles.</p><p><strong>Results: </strong>842 463 encounters were eligible for 20 LVC measures. Across all measures, odds of LVC increased across increasing COI quintiles (adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.08). For 12 measures, LVC was proportionally more common in highest versus lowest COI quintile, whereas the reverse was true for 4. Regression modeling revealed increasing LVC as COI increased across all quintiles for 10 measures; gastric acid suppression for infants had the strongest association (OR 1.22, 95% CI 1.17-1.27). Three measures revealed decreasing LVC across increasing COI quintiles; Group A streptococcal testing among children <3 years revealed the lowest OR (0.85, 95% CI 0.73-0.99). The absolute volume of LVC delivered was greatest among low COI quintiles for most measures.</p><p><strong>Conclusions: </strong>Likelihood of LVC increased across COI quintiles for 10 of 20 measures, whereas 3 measures revealed reverse trends. High volumes of LVC across quintiles support a need for broad de-implementation efforts; measures with greater impact on children with lower opportunity warrant prioritized efforts.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Coproduced Family Reporting Intervention to Improve Safety Surveillance and Reduce Disparities.","authors":"Alisa Khan, Jennifer Baird, Sangeeta Mauskar, Helen W Haskell, Alexandra N Habibi, Tiffany Ngo, Alexandra Aldarondo, Jay G Berry, Katherine L Copp, Jessica P Liu, Brynn Elder, Kathryn P Gray, Karen Hennessy, Kate E Humphrey, Donna Luff, Nandini Mallick, Susan Matherson, Amanda G McGeachey, Patrice Melvin, Amy L Pinkham, Bianca Quiñones-Pérez, Jayne Rogers, Sara J Singer, Patricia A Stoeck, Sara L Toomey, K Viswanath, Jayme L Wilder, Mark A Schuster, Christopher P Landrigan","doi":"10.1542/peds.2023-065245","DOIUrl":"10.1542/peds.2023-065245","url":null,"abstract":"<p><strong>Objectives: </strong>Examine family safety-reporting after implementing a parent-nurse-physician-leader coproduced, health literacy-informed, family safety-reporting intervention for hospitalized families of children with medical complexity.</p><p><strong>Methods: </strong>We implemented an English and Spanish mobile family-safety-reporting tool, staff and family education, and process for sharing comments with unit leaders on a dedicated inpatient complex care service at a pediatric hospital. Families shared safety concerns via predischarge surveys (baseline and intervention) and mobile tool (intervention). Three physicians with patient safety expertise classified events. We compared safety-reporting baseline (via survey) versus intervention (via survey and/or mobile tool) with generalized estimating equations and sub-analyzed data by COVID-19-era and educational attainment. We also compared mobile tool-detected event rates with hospital voluntary incident reporting.</p><p><strong>Results: </strong>232 baseline and 208 intervention parents participated (78.2% consented); 29.5% of baseline families versus 38.2% of intervention families reported safety concerns (P = .09). Adjusted odds ratio (95% CI) of families reporting safety concerns intervention versus baseline was 1.6 (1.0-2.6) overall, 2.6 (1.3-5.4) for those with < college education, and 3.1 (1.3-7.3) in the COVID-19-era subgroup. Safety concerns reported via mobile tool (34.6% of enrolled parents) included 42 medical errors, 43 nonsafety-related quality issues, 11 hazards, and 4 other. 15% of mobile tool concerns were also detected with voluntary incident reporting.</p><p><strong>Conclusions: </strong>Family safety-reporting was unchanged overall after implementing a mobile reporting tool, though reporting increased among families with lower educational attainment and during the COVID-19 pandemic. The tool identified many events not otherwise captured by staff-only voluntary incident reporting. Hospitals should proactively engage families in reporting to improve safety, quality, and equity.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update to the Neonatal Early-Onset Sepsis Calculator Utilizing a Contemporary Cohort.","authors":"Michael W Kuzniewicz, Gabriel J Escobar, Heather Forquer, Sherian Li, Di Shu, Patricia Kipnis, Allen Fischer, Karen M Puopolo","doi":"10.1542/peds.2023-065267","DOIUrl":"10.1542/peds.2023-065267","url":null,"abstract":"<p><p></p><p><strong>Background and objectives: </strong>The Kaiser Permanente Neonatal Early-Onset Sepsis (EOS) Calculator has been an effective tool for risk stratification to safely reduce newborn antibiotic exposure. The calculator was derived from data on infants born between 1993 and 2007. Since that time, US obstetric practice has adopted universal antepartum screening for group B Streptococcus and intrapartum antibiotic prophylaxis guidance has changed. Our objective was to update the EOS calculator using a contemporary birth cohort and determine the effect of these changes on EOS case ascertainment and antibiotic recommendations.</p><p><strong>Methods: </strong>The study included infants born at ≥35 weeks' gestation at 14 hospitals between January 2010 and December 2020 (n = 412 595 infants, EOS cases = 113). Model coefficients were re-estimated and the point estimates of the likelihood ratios for clinical status used to calculate the posterior probability of EOS. We compared the number of EOS cases correctly identified by each model (sensitivity) and the proportion of infants for whom empirical antibiotics are recommended.</p><p><strong>Results: </strong>The original model had a sensitivity of 0.76 (95% confidence interval 0.63-0.85), while the updated model had a sensitivity of 0.80 (95% confidence interval 0.68-0.89), P = .15. The recommended empirical antibiotic use was 3.5% with the original model and 3.7% with the updated model, P < .0001. For each additional case identified by the updated model, an additional 158 infants would be treated with antibiotics.</p><p><strong>Conclusions: </strong>Both the original and updated EOS calculators are effective tools for quantifying EOS risk among infants born at ≥35 weeks' gestation.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sickle Cell Disease and Lead Poisoning in New York City, 2005-2019.","authors":"Leah Seifu, Slavenka Sedlar, Ta'Sharee Grant, Andrew Faciano, Jacqueline Ehrlich","doi":"10.1542/peds.2024-067808G","DOIUrl":"10.1542/peds.2024-067808G","url":null,"abstract":"<p><strong>Objectives: </strong>Previous analyses of New York City (NYC) health department's lead registry indicated that, among children with lead poisoning, an increased prevalence of sickle cell disease (SCD) exists. However, SCD is not considered a risk factor for lead poisoning. We assessed the association between SCD and childhood lead poisoning to determine if specific lead poisoning prevention efforts are needed for children with SCD.</p><p><strong>Methods: </strong>We analyzed NYC's lead registry data for children with venous blood lead levels (BLLs) ≥15 mcg/dL during 2005 to 2019. t tests and χ2 tests were performed to compare demographic characteristics, BLLs, and lead exposure risks in non-Hispanic Black children with and without SCD. A t test was used to compare observed SCD prevalence among Black children with BLLs ≥15 mcg/dL with an estimated 0.43% SCD prevalence among Black NYC children.</p><p><strong>Results: </strong>Among 1728 Black children with BLLs ≥15 mcg/dL identified, 37 (2.14%) had SCD. When comparing children with and without SCD, both mean age at peak BLL (62.8 versus 42.7 months; P = .003) and peak BLL (42.59 versus 23.06 mcg/dL; P = .008) were higher for children with SCD. Among risk factors for lead exposure, children with SCD had higher prevalence of pica. Observed SCD prevalence was 1.71% higher than estimated SCD prevalence among Black NYC children (P < .001).</p><p><strong>Conclusions: </strong>We found a potential association between SCD and childhood lead poisoning. Pica emerged as a potentially important risk factor. Our findings might have implications for lead poisoning prevention guidelines for children with SCD.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Statewide Program to Test and Reduce Lead in Drinking Water at Schools and Child Cares.","authors":"Laura T Leonard, Margaret E Talbott","doi":"10.1542/peds.2024-067808L","DOIUrl":"10.1542/peds.2024-067808L","url":null,"abstract":"<p><p>A lead testing act was passed in Colorado mandating that all licensed child care facilities and public schools serving fifth grade and lower test all drinking water locations for lead by May 31, 2023. Colorado's Water Quality Control Division created the Test & Fix Water for Kids program to implement this act. Aspects of the program included establishing a database, outreach and education, technical assistance, lead analyses at the Colorado State Laboratory, remediation, and reimbursement. Of a total of 6000 licensed child care providers and public elementary schools, 4500 entities enrolled and tested 53 000 water samples for lead at drinking water fixtures. Testing results showed that 93% (46 000 total) of the fixtures tested were below the 5 parts per billion (ppb) action level. As a result, 7% (3700) of the fixtures tested were above the action level. Of the fixtures that tested above 5 ppb, 47% were classroom faucets. Many of these faucets had not been used since COVID-19 when several schools switched to using bottle fillers. The program identified all fixtures associated with low usage as well as older fixtures to be replaced with lead-free options to reduce lead levels below 5 ppb. Almost 600 000 children have been protected from potential exposure to lead in drinking water through this program. This article outlines the methods of launching a statewide lead testing program and the importance of testing fixtures for lead in drinking water in early childhood education buildings.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traditional Eye Cosmetics and Cultural Powders as a Source of Lead Exposure.","authors":"Paromita Hore, Slavenka Sedlar","doi":"10.1542/peds.2024-067808O","DOIUrl":"https://doi.org/10.1542/peds.2024-067808O","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to describe the characteristics of traditional eye cosmetics and cultural powders, including the types, lead concentrations, origin, and regional variation in product names, and assess the differences in blood lead levels (BLLs) between product users and non-users.</p><p><strong>Methods: </strong>We analyzed 220 samples of traditional eye cosmetics and cultural powders collected in New York City between 2013 and 2022 during lead poisoning investigations and store surveys. We compared the BLLs of children who used these products with those of non-users.</p><p><strong>Results: </strong>Lead levels in traditional eye cosmetics surma and kohl were much higher than levels in kajal and other cultural powders. Although the terminologies surma, kohl, and kajal are often used interchangeably, findings suggest regional variations in the product names. The majority of the surma in this study were from Pakistan, kohl was from Morocco, and kajal was from India. The results also show that these products can contribute to elevated BLLs in children.</p><p><strong>Conclusions: </strong>Our study reveals that traditional eye cosmetics and cultural powders are used among children as young as newborns, and exposure to these products can significantly add to their lead body burden. The study findings also reveal that lead concentrations in these products can vary by product type and product names can vary by region. Public health officials must be cognizant of these unique variations and use culturally appropriate terminologies for these types of products because such distinctions can be critical when conducting risk assessments, risk communication, and risk reduction activities.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parent Council for a Pediatric Stroke Rehabilitation Clinical Trial.","authors":"Mara M Yale, Torrey Boland Birch, Jennifer Murray, Nicole Dodds, Kimberly Hindery, Amy Darragh, Sharon Landesman Ramey, Warren D Lo","doi":"10.1542/peds.2023-064477","DOIUrl":"10.1542/peds.2023-064477","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11422190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Pediatric Scurvy Hospitalizations: 2006-2021.","authors":"Kathleen Murphy, Quinn Weisman, Spandana Makeneni, Jennifer Faerber, Christopher P Bonafide, Chén C Kenyon","doi":"10.1542/peds.2024-065782","DOIUrl":"10.1542/peds.2024-065782","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11422193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building Up While We Tear Down: An Equity-Centered Approach to Deimplementation in Hospital Care.","authors":"Michelle A Lopez, Ricardo Quiñonez","doi":"10.1542/peds.2024-067544","DOIUrl":"10.1542/peds.2024-067544","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}