Pediatrics最新文献_第7页

Risks of Water Bead Ingestion.

IF 6.2 2区医学

Pediatrics Pub Date : 2025-01-28 DOI: 10.1542/peds.2024-069447

Patrick T Reeves, Eric A Pasman

引用次数: 0

Intestinal Obstruction and Neurotoxicity Associated With Water Bead Ingestion.

IF 6.2 2区医学

Pediatrics Pub Date : 2025-01-28 DOI: 10.1542/peds.2023-065575

Ashley Haugen, Elizabeth Friedman, Irina Duff

{"title":"Intestinal Obstruction and Neurotoxicity Associated With Water Bead Ingestion.","authors":"Ashley Haugen, Elizabeth Friedman, Irina Duff","doi":"10.1542/peds.2023-065575","DOIUrl":"https://doi.org/10.1542/peds.2023-065575","url":null,"abstract":"<p><p>Water beads are superabsorbent polymer balls. They were originally marketed for agricultural and decorative applications and are now sold as sensory toys. They can be harmful to children in 2 ways. Upon ingestion, water beads absorb liquid and, because they can increase in volume by more than a hundredfold, intestinal obstruction can result. In addition, they are made of polymerized acrylamide monomer. Acrylamide monomer can be toxic at high levels. Here, we present a case of intestinal obstruction in the setting of water bead ingestion temporarily associated with signs of neurotoxicity. The patient presented to the emergency department at 13 months of age with vomiting, lethargy, weight loss over several weeks, insomnia, and facial dermatitis. Due to worsening clinical signs and imaging findings suggestive of intestinal obstruction, she underwent an exploratory laparotomy. A mass consisting of water beads was removed from the distal small intestine. After removal of the mass, the patient's facial dermatitis resolved; however, the patient's speech, gross and fine motor, sensory, and neurological functions continued to worsen. After reevaluation, a second surgical procedure led to removal of multiple fragments of water bead material from the patient's large intestine. This case highlights the potential dangers of acrylamide in consumer products that may be accessible to children.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051899","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}

引用次数: 0

October 2024 ACIP Meeting Update: Influenza, COVID-19, RSV and Other Vaccines.

IF 6.2 2区医学

Pediatrics Pub Date : 2025-01-24 DOI: 10.1542/peds.2024-069926

Claudia Gaviria-Agudelo, Alexandra B Yonts, David W Kimberlin, Sean T O'Leary, Grant C Paulsen

引用次数: 0

Evaluating Young Children With Fractures for Child Abuse: Clinical Report. 评估幼儿骨折儿童虐待：临床报告。

IF 8 2区医学

Pediatrics Pub Date : 2025-01-21 DOI: 10.1542/peds.2024-070074

Suzanne Haney,Susan Scherl,Linda DiMeglio,Jeannette Perez-Rossello,Sabah Servaes,Nadia Merchant,,,,,

引用次数: 0

Quality Improvement for Pediatric Acute Mental Health Care: Opportunities and Challenges. 提高儿童急性精神卫生保健的质量：机遇与挑战。

IF 8 2区医学

Pediatrics Pub Date : 2025-01-21 DOI: 10.1542/peds.2024-069597

Jennifer A Hoffmann,Shilpa J Patel

引用次数: 0

Stabilizing Pediatric Patients During Psychiatric Boarding: A Quality Improvement Project. 在精神科寄宿期间稳定儿科病人：一个质量改进项目。

IF 8 2区医学

Pediatrics Pub Date : 2025-01-21 DOI: 10.1542/peds.2023-063262

Saira Afzal,Claire Gunnison,Adam Rudofker,Jeremy Esposito,Weston Geddings

{"title":"Stabilizing Pediatric Patients During Psychiatric Boarding: A Quality Improvement Project.","authors":"Saira Afzal,Claire Gunnison,Adam Rudofker,Jeremy Esposito,Weston Geddings","doi":"10.1542/peds.2023-063262","DOIUrl":"https://doi.org/10.1542/peds.2023-063262","url":null,"abstract":"BACKGROUND AND OBJECTIVESPsychiatric boarding has implications for youth, their families, and hospital systems. We undertook a quality improvement (QI) project to address boarding at our institution. We aimed to stabilize patients who were boarding in our emergency department (ED) observation unit and to decrease the percentage of patients admitted to psychiatric facilities.METHODSA multidisciplinary team created a stabilization protocol focused on enhancing coping strategies and family communication and providing psychoeducation and safety planning. This program was piloted in a group of patients experiencing boarding beginning in March 2021. Implementing the protocol involved additional staffing, plans for structured daily activities, and enhancements to the electronic health record.RESULTSDuring the baseline period (January 2019-February 2021), 65.7% (n = 498) of encounters in which patients boarded in the ED observation unit resulted in the patient being admitted to a psychiatric facility compared with 49.0% (n = 373) of encounters during the intervention period, reflecting a centerline shift on a statistical process control chart. From March 2021 to May 2022 (intervention period), 159 patients participated in the stabilization protocol across 164 encounters. Compared with similar nonpilot encounters (n = 446) occurring during the same period, pilot encounters (n = 164) were less likely to result in admission to a psychiatric facility (22.6% vs 58.2%) and were more likely to result in the patient being discharged home (75.0% vs 31.4%).CONCLUSIONThis QI project resulted in fewer patients being transferred to inpatient psychiatric care. This program illustrates that medical hospitals can creatively improve care for patients experiencing boarding.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"18 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991752","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}

引用次数: 0

A Quality Improvement Initiative to Decrease Behavioral Health Unit Readmission Rates. 降低行为健康单位再入院率的质量改进倡议。

IF 8 2区医学

Pediatrics Pub Date : 2025-01-21 DOI: 10.1542/peds.2023-064917

Katherine Winner,Kelly Sandberg,Brandon Saia,Megan Calabro,Kelly Blankenship

{"title":"A Quality Improvement Initiative to Decrease Behavioral Health Unit Readmission Rates.","authors":"Katherine Winner,Kelly Sandberg,Brandon Saia,Megan Calabro,Kelly Blankenship","doi":"10.1542/peds.2023-064917","DOIUrl":"https://doi.org/10.1542/peds.2023-064917","url":null,"abstract":"OBJECTIVEYouth behavioral health inpatient beds are limited during a time of crisis. Around one-third of youth admitted to a behavioral health unit (BHU) will be readmitted within 1 year of discharge, with 8% to 13% being admitted within 30 days. In one study, they found that more than one-third of patients initially admitted for suicidal ideation or attempt were readmitted within 7 days. Our objective was to decrease 7-day and 30-day readmission rates to our BHU by 20% by May of 2023.METHODSWe collected baseline data through medical record review for our pediatric BHU readmissions from July 2020 until July 2021. Interventions, such as standardized workflows and checklists, were trialed with Plan-Do-Study-Act (PDSA) cycles beginning October 2021 until November 2022. Performance was analyzed using statistical process control charts (U-charts). Sustainment was tracked through December 2023. Length of stay (LOS) was tracked as a balancing measure. Compliance with our readmission checklist was tracked as a process measure.RESULTSBoth 7-day and 30-day readmission rates to the pediatric BHU decreased as interventions were initiated and adopted. The rates of patients readmitted within 7 and 30 days decreased from a baseline mean of 5.54 to 2.83 (49%) and 11.52 to 7.38 (36%) per 100 hospitalizations, respectively. The LOS for the BHU decreased from 5.58 to 5.09 days. The readmission checklist was used for 81 out of 83 patients, or 97.5%.CONCLUSIONAdoption of multiple interventions produced a decrease in readmissions to a pediatric BHU.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"14 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991809","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}

引用次数: 0

Environmental Issues in Global Pediatric Health: Policy Statement. 全球儿科健康中的环境问题：政策声明。

IF 8 2区医学

Pediatrics Pub Date : 2025-01-21 DOI: 10.1542/peds.2024-070075

Lauren Zajac,Philip J Landrigan,

{"title":"Environmental Issues in Global Pediatric Health: Policy Statement.","authors":"Lauren Zajac,Philip J Landrigan,","doi":"10.1542/peds.2024-070075","DOIUrl":"https://doi.org/10.1542/peds.2024-070075","url":null,"abstract":"Pediatricians and pediatric trainees in North America are increasingly involved in caring for children and adolescents in or from low- and middle-income countries (LMICs). In many LMICs, hazardous environmental exposures-notably outdoor and household air pollution, water pollution, lead, pesticides, and other manufactured chemicals-are highly prevalent and account for twice the proportion of disease and deaths among young children as in North America. Climate change will likely worsen these exposures. It is important that pediatricians and other pediatric health professionals from high-income countries who work in LMICs be aware of the disproportionately severe impacts of toxic environmental hazards, become knowledgeable about the major local/regional environmental threats, and consider environmental factors in their differential diagnoses. Likewise, pediatricians in high-income countries who care for patients who have emigrated from LMICs need to be aware that these children may be at elevated risk of toxic environmental diseases from past exposures to toxic environmental hazards in their countries of origin as well as ongoing exposures in products imported from their home countries, including traditional foods, medications, and cosmetics. Because diseases of toxic environmental origin seldom have unique physical signatures, pediatricians can utilize the environmental screening history, supplemented by laboratory testing, as a diagnostic tool. To prepare pediatricians to care for children in and from LMICs, pediatric organizations could increase the amount of environmental health and climate change content offered in continuing medical education (CME) credits, maintenance of certification (MOC) credits, and certification and recertification examinations. Broadly, it is important that governments and international agencies increase resources directed to pollution prevention, strengthen the environmental health workforce, and expand public health infrastructure in all countries.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"32 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991753","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}

引用次数: 0

Environmental Issues in Global Pediatric Health: Technical Report. 全球儿科健康中的环境问题：技术报告。

IF 8 2区医学

Pediatrics Pub Date : 2025-01-21 DOI: 10.1542/peds.2024-070076

Lauren Zajac,Philip J Landrigan,

{"title":"Environmental Issues in Global Pediatric Health: Technical Report.","authors":"Lauren Zajac,Philip J Landrigan,","doi":"10.1542/peds.2024-070076","DOIUrl":"https://doi.org/10.1542/peds.2024-070076","url":null,"abstract":"Pediatricians and pediatric trainees in North America are increasingly involved in caring for children and adolescents in or from low- and middle-income countries (LMICs). In many LMICs, toxic environmental exposures-notably outdoor and household air pollution, water pollution, lead, hazardous waste disposal, pesticides, and other manufactured chemicals-are highly prevalent and account for twice as great a proportion of disease and deaths among young children as in North America. Climate change will likely worsen these exposures. It is important that pediatricians and other pediatric health professionals from high-income countries who plan to work in LMICs be aware of the disproportionately severe impacts of environmental hazards, become knowledgeable about the major toxic threats to children's health in the countries and communities where they will be working, and consider environmental factors in their differential diagnoses. Likewise, pediatricians in high-income countries who care for children and adolescents who have emigrated from LMICs need to be aware that these children may be at elevated risk of diseases caused by past exposures to toxic environmental hazards in their countries of origin as well as ongoing exposures in products such as traditional foods, medications, and cosmetics imported from their original home countries. Because diseases of toxic environmental origin seldom have unique physical signatures, the environmental screening history, supplemented by laboratory testing, is the principal diagnostic tool. The goal of this technical report is to enhance pediatricians' ability to recognize, diagnose, and manage disease caused by hazardous environmental exposures, especially toxic chemical exposures, in all countries and especially in LMICs.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"121 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991754","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}

引用次数: 0

Resource Utilization and Cost in Management of Febrile Infants After the 2021 Clinical Guideline. 2021年临床指南实施后发热婴儿管理的资源利用与成本

IF 8 2区医学

Pediatrics Pub Date : 2025-01-17 DOI: 10.1542/peds.2024-068028

Elena Dingle,Jonathan H Pelletier,Michael L Forbes,Prabi Rajbhandari

{"title":"Resource Utilization and Cost in Management of Febrile Infants After the 2021 Clinical Guideline.","authors":"Elena Dingle,Jonathan H Pelletier,Michael L Forbes,Prabi Rajbhandari","doi":"10.1542/peds.2024-068028","DOIUrl":"https://doi.org/10.1542/peds.2024-068028","url":null,"abstract":"OBJECTIVEThe 2021 American Academy of Pediatrics clinical practice guideline (CPG) for well-appearing febrile infants aims to promote evidence-based care, reduce practice variability, enhance care quality, and optimize cost. We aimed to examine the trends in resource utilization and cost associated with the evaluation and management of febrile infants aged 8 to 60 days before and after the CPG's publication.METHODSWe performed a retrospective cross-sectional study using the Pediatric Health Information Systems Database, covering the periods of August 2019 to July 2021 (pre-CPG) and August 2021 to July 2023 (post-CPG). We analyzed the use of antibiotics, acyclovir, laboratory studies, lumbar punctures (LPs), and hospitalizations before and after the CPG publication.RESULTSWe identified 33 736 encounters (12 220 pre-CPG and 21 516 post-CPG). After the CPG, there was a decrease in hospitalization (42.6% vs 34.7%, -7.9% [-9.0% to -6.8%]), antibiotic and acyclovir administration (41.9% vs 33.1%, -8.8% [-9.9% to -7.7%]; 9.7% vs 7.3%, -2.4% [-3.1% to -1.8%]), and LP (31.7% vs 21.8%, -9.9% [-10.9% to -8.9%]). Conversely, the use of C-reactive protein (23.7% vs 32.3%, 8.6% [7.6% to 9.5%]) and procalcitonin (40.1% vs 64.5%, 24.4% [23.3% to 25.5%]) increased. Cost remained unchanged. Age-stratified analysis revealed a significant reduction in hospitalization, antibiotic use, and LP in infants aged older than 22 days, whereas infants younger than 28 days experienced a slight increase in delayed diagnosis of bacteremia and sepsis after the CPG.CONCLUSIONSAfter the CPG, hospitalization, antimicrobial use, and LPs decreased in infants aged older than 22 days, indicating that the CPG may be effective in reducing resource utilization. There was a slight increase in delayed diagnosis of bacteremia and sepsis in infants younger than 28 days.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"55 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988866","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}

引用次数: 0