Journal of Pediatric Pharmacology and Therapeutics最新文献

{"title":"Requests to Be a Content Expert Reviewer for Journals I Am Not Affiliated With: A Major, Ongoing Problem for the Academic Community.","authors":"William D Figg","doi":"10.5863/1551-6776-29.6.674","DOIUrl":"https://doi.org/10.5863/1551-6776-29.6.674","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 6","pages":"674-675"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epinephrine Versus Dopamine in Children, What Is the Current Evidence and What Do We Need? A Systematic Review and Meta-analysis.","authors":"Rohit S Loomba, Riddhi D Patel, Enrique G Villarreal, Juan S Farias, Saul Flores","doi":"10.5863/1551-6776-29.6.578","DOIUrl":"10.5863/1551-6776-29.6.578","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric patients often receive vasoactive agents following cardiothoracic surgery or when in shock. The use of vasoactive agents varies between different settings and has largely changed because of anecdotal observations or small observational studies. Although vasoactive agents are frequently used, there are limited studies in pediatric populations comparing them to one another. The purpose of this systematic review is to quantify the comparative effects of epinephrine and dopamine while identifying gaps in knowledge.</p><p><strong>Methods: </strong>A systematic review of published manuscripts was completed to identify full-text manuscripts in English using PubMed, Embase, and Cochrane databases. Studies were included if they included clinical data using dopamine and epinephrine in different patients and included data for the same end points for patients receiving epinephrine or dopamine.</p><p><strong>Results: </strong>A total of 5 studies with 397 patients were included. Of the included patients, 187 received epinephrine and 210 received dopamine. The mean age for all the patients was 45 months. When all patient data were pooled, a significantly lower mortality was associated with epinephrine compared with dopamine (risk ratio, 0.74; 95% CI, 0.55-0.99). When only neonatal data were pooled, epinephrine was associated with a significantly higher average heart rate (10 bpm; 95% CI, 2.0-18.7) and a significantly lower average mean arterial blood pressure (-2.5 mm Hg; 95% CI, -4.6 to -0.4).</p><p><strong>Conclusion: </strong>Limited data are available comparing dopamine to epinephrine in pediatric patients. The -available data demonstrate an apparent mortality benefit associated with the use of epinephrine.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 6","pages":"578-586"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Prescribers' Knowledge of the Ew Meds^™ List and Taste Masking.","authors":"Dafne Espinal Peña, Jill A Morgan, Amy Kruger Howard","doi":"10.5863/1551-6776-29.6.624","DOIUrl":"10.5863/1551-6776-29.6.624","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study was to determine pediatric prescribers' knowledge and confidence in identifying bad tasting liquid medications. The secondary objective examined the techniques used to mask the taste of liquid medications and whether any of the masking techniques recommended by prescribers were reported to be effective in children.</p><p><strong>Methods: </strong>Nationally, health care prescribers were invited to participate in an online survey about medication tastes and masking practices. Participants included physicians, physician assistants, and nurse practitioners who prescribe oral liquid medications. They were asked to complete a 17-question survey consisting of 4 demographic questions, 6 about their practice; 1 on confidence identifying bad tasting medications; 1 on knowledge of Ew Meds^TM; 4 on taste masking; and 1 on potential taste tools.</p><p><strong>Results: </strong>Seventy-five prescribers completed the survey. Prescribers correctly identified Ew Meds^TM 27.9% of the time (median score 3.35/12) and 34.7% (26/75) of prescribers felt confident with their knowledge of bad tasting medications. Thirty percent (21/71) of prescribers reported educating patients about masking bad tasting medications \"most of the time\" or \"always\" and 12.7% (9/71) never educate patients. Almost all prescribers who responded about masking indicated they recommend mixing the medication in food or drink (55/58, 95%). In general, taste masking techniques reported by pediatric prescribers had mixed effectiveness.</p><p><strong>Conclusion: </strong>Based on prescribers' limited confidence and knowledge regarding medication taste, education about bad tasting liquid medications and appropriate taste masking should be readily available, including the dangers of altering medication efficacy when mixing in food and drink.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 6","pages":"624-629"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Stress Ulcer Prophylaxis in Pediatric General Medicine Patients After Transfer From the Intensive Care Unit and at Discharge.","authors":"Lamees Loubani, Jenna W Bartlett, Brent Mothner, Rathi Asaithambi, Surin Lee","doi":"10.5863/1551-6776-29.6.630","DOIUrl":"10.5863/1551-6776-29.6.630","url":null,"abstract":"<p><strong>Objectives: </strong>The primary aim of this study was to determine continuation rates of stress ulcer prophylaxis (SUP) upon transfer from a pediatric intensive care unit (PICU) to a general medicine unit and upon hospital discharge. The secondary aim was to identify patient characteristics or concomitant medications that were associated with continuation of SUP at transfer from the PICU.</p><p><strong>Methods: </strong>This retrospective chart review included patients who were initiated on acid suppression for SUP in the PICU between June 2021 and May 2022 and subsequently transferred to a general medicine unit prior to discharge. Patients were excluded if they were receiving acid suppressant therapy prior to admission or were started on acid suppressants for an indication other than SUP.</p><p><strong>Results: </strong>Two hundred three patients (median age, 3.3 years) were included. The rates of SUP continuation at the time of transfer from the PICU to a general medicine unit and at hospital discharge were 61.6% and 9.9%, respectively. Patients continued on SUP at the time of transfer from the PICU were more likely to be prescribed concomitant corticosteroids (p < 0.01), anticoagulants or antiplatelet medications (p < 0.01).</p><p><strong>Conclusions: </strong>The continuation of SUP from the PICU to the general medicine unit is common at our institution and calls into question the appropriateness of this practice. Future research is warranted to investigate the appropriateness of the continuation of SUP at transitions of care. Additionally, implementation of institutional protocols standardizing review of SUP may help reduce unnecessary prescribing of acid suppressants in general medicine units and at discharge.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 6","pages":"630-635"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caution: ChatGPT Doesn't Know What You Are Asking and Doesn't Know What It Is Saying.","authors":"S Casey Laizure","doi":"10.5863/1551-6776-29.5.558","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.558","url":null,"abstract":"","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 5","pages":"558-560"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Levetiracetam vs Phenobarbital as First Line Therapy for the Treatment of Neonatal Seizures.","authors":"Destini Long, Courtney Sutton, Jennifer Hale","doi":"10.5863/1551-6776-29.5.482","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.482","url":null,"abstract":"<p><strong>Objective: </strong>Seizures are one of the most common neurologic complications seen in a neonate. Historically, phenobarbital has been the agent of choice, but can lead to adverse neurologic outcomes, which has contributed to the use of other agents. Levetiracetam has proven great efficacy with an excellent safety profile in older patients, causing interest of its use in neonates. The objective of this study was to determine if levetiracetam would provide similar neonatal seizure resolution rates as phenobarbital.</p><p><strong>Methods: </strong>The study was a single-center, retrospective, cohort study from August 1, 2020 to August 31, 2022 investigating the efficacy and safety of using levetiracetam compared with phenobarbital as a first line treatment for neonatal seizures. The primary outcome was to assess overall seizure resolution after administration of levetiracetam or phenobarbital, without addition of a second antiseizure medication.</p><p><strong>Results: </strong>There were 87 patients included in the study. Fifteen neonates (27.78%) achieved seizure resolution with phenobarbital compared with 9 neonates (27.27%) who received levetiracetam first line (p = 0.959). Neonates who received phenobarbital had higher rates of adverse effects. Neonates who received a benzodiazepine prior to administration of levetiracetam had lower seizure resolution rates (p = 0.021).</p><p><strong>Conclusions: </strong>These findings suggest there is no difference in using phenobarbital over levetiracetam to achieve complete seizure resolution in a neonate. Higher rates of adverse events were seen in the phenobarbital group. The use of a benzodiazepine prior to administration of levetiracetam may reduce the efficacy of levetiracetam.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 5","pages":"482-486"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review.","authors":"Mahi K Singh, Jason M Kane, Sana J Said","doi":"10.5863/1551-6776-29.5.544","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.544","url":null,"abstract":"<p><p>Lead poisoning in children has the potential for devastating neurodevelopmental consequences. There is significant socioeconomic disparity in children with lead poisoning. Specific lead chelation regimens have been approved for children by the US Food and Drug Administration, however in the United States, there has been a recent national shortage of the primary therapy, edetate calcium disodium (CaNa2 EDTA). This case report presents a 23-month-old child with severe symptomatic lead poisoning during a national shortage of CaNa2 EDTA to highlight the need for advocacy regarding critical medication shortages, especially for antidote therapy. The infant's initial blood lead level was 364 mcg/dL and he received a continuous infusion of CaNa2 EDTA (1000 mg/m²/day), as well as dimercaprol (4 mg/kg intramuscularly every 4 hours). The supply of CaNa2 EDTA was exhausted on day 3 of therapy so he was transitioned to enteral succimer monotherapy. Initial parenteral therapy of 72 hours achieved a lead level of 72 mcg/dL; he then completed his enteral course of succimer along with environmental mitigation. However, elevated blood lead levels persisted and he subsequently required 3 more courses of enteral succimer, and he continues to have detectable blood lead levels 2 years after initial presentation. In the face of medication shortages including CaNa2 EDTA, and now also dimercaprol, clinicians must create and study alternative chelation therapy regimens for pediatric lead toxicity. Furthermore, public policy initiatives, including the development of a national supply stockpile of chelation agents, must be created in order to minimize supply chain disruption and ensure adequate and equitable antidote therapy for lead poisoning outbreaks.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 5","pages":"544-549"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Carnitine Concentrations and Cardiac Function in Pediatric, Adolescent and Young Adult Oncology Patients Receiving High-Dose Anthracyclines.","authors":"Christine Lin, Hari K Narayan, Erin Trovillion, Saro Armenian, Lawrence Alejandro, Dennis John Kuo","doi":"10.5863/1551-6776-29.5.475","DOIUrl":"10.5863/1551-6776-29.5.475","url":null,"abstract":"<p><strong>Objective: </strong>Anthracycline chemotherapy agents have significant dose-dependent cardiotoxic effects. -Carnitine, a non-essential amino acid, is involved in long chain fatty acid oxidation, and carnitine deficiency can result in cardiomyopathy and cardiac arrhythmias. If administered concurrently with chemotherapy, carnitine supplementation could be a potential strategy to prevent cardiotoxicity. However, the association between serum carnitine concentrations and anthracycline cardiotoxicity during cancer treatment in the childhood, adolescent, and young adult (CAYA) age range has not been established.</p><p><strong>Methods: </strong>This prospective pilot cohort study characterized changes in serum carnitine concentrations and cardiac function before, during, and approximately 1 year after large-dose anthracycline therapy in newly diagnosed CAYA cancer patients.</p><p><strong>Results: </strong>Among 21 patients with a mean cumulative anthracycline dose exposure of 409 mg/m² of -doxorubicin equivalents, left ventricular ejection fraction and relative wall thickness decreased, indicating an overall decline in cardiac function. A reversible decrease in serum carnitine concentrations was also observed. A non-statistically significant positive correlation was observed; for every 1 mmol/L decrease in serum carnitine concentration, there was a 0.09% decrease in LVEF (p = 0.2).</p><p><strong>Conclusions: </strong>These findings from this small pilot study suggest that there may be a relationship between serum carnitine concentrations and cardiac function after anthracycline therapy that should be evaluated in larger studies.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 5","pages":"475-481"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Benefit Analysis of a Pediatric ICU Sedation Weaning Protocol.","authors":"Chiara Velez, Jessica J Anderson, J Jackson Resser, Dandan Liu, Kristina A Betters","doi":"10.5863/1551-6776-29.5.501","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.501","url":null,"abstract":"<p><strong>Objective: </strong>A risk stratified sedation weaning protocol improved patient outcomes in a pediatric intensive care unit (PICU). We sought to determine the protocol effect on medication costs.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study in an academic tertiary care children's hospital PICU (2018-2020) comparing the cost when weaning benzodiazepine, alpha agonist, and/or opioid infusions in intubated children <18 years of age.</p><p><strong>Results: </strong>There were 84 total sedation weaning instances (pre-protocol n = 41 and post-protocol n = 41); 2 patients had 2 encounters, 1 in each phase. The total cost (in 2022 United States Dollars) of sedation weaning was $400,328.87 ($15,994.44/kg) pre-protocol compared with $170,458.85 ($11,227.52/kg) post-protocol. The median cost of sedation wean per patient for pre-protocol patients was $3197.42 (IQR: $322.66-$12,643.29) and post-protocol patients was $1851.44 (IQR: $425.05-$5355.85; p = 0.275). A linear regression model estimated the expected cost of sedation wean for post-protocol patients to be $5173.20 lower than for pre-protocol patients of the same weight and overall drug risk (p = 0.036). The proportion of withdrawal symptoms in the pre-protocol patients (16%) was not significantly different from the proportion in the post-protocol patients (14%; p = 0.435).</p><p><strong>Conclusions: </strong>Implementation of a PICU sedation weaning protocol in a single-center conferred cost benefit without negatively impacting patient outcomes. A larger multicenter study would provide insight to the applicability to PICUs in varied settings with differing patient populations.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 5","pages":"501-507"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Targeted Single-Dose Antibiotics to Reduce the Occurrence of Pediatric Central Line-Associated Bloodstream Infections Post Alteplase Administration.","authors":"Patrick Watchorn, Robert Kavanagh, Kevin Mulieri, Theodore DeMartini, Gary Ceneviva, Lindsay Trout","doi":"10.5863/1551-6776-29.5.508","DOIUrl":"https://doi.org/10.5863/1551-6776-29.5.508","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies have shown an association between alteplase for line clearance and central line-associated bloodstream infections (CLABSIs). The objective of this study was to evaluate the use of post-alteplase antibiotics as a CLABSI reduction strategy in pediatric intensive care unit (PICU) patients.</p><p><strong>Methods: </strong>This was a single center, retrospective, observational study evaluating PICU patients from -January 1, 2014, through August 1, 2021, conducted at a tertiary academic PICU. Included in this study were critically ill patients who had 1 or more central venous lines (CVLs) requiring alteplase for line clearance. The primary objective was incidence of CLABSI occurrence post alteplase administration for CVL clearance, with or without targeted single-dose antibiotics (piperacillin-tazobactam or vancomycin) post alteplase. Secondary outcomes included evaluation of total alteplase administrations and risk factors associated with CLABSI occurrence.</p><p><strong>Results: </strong>Two hundred fifty patients were included, with 156 receiving alteplase only, 82 piperacillin--tazobactam, and 12 vancomycin, and with median ages of 2.8, 3.8, and 3.8 years, respectively. Seven -CLABSIs occurred in the alteplase-only group, with 0 incidences in both the piperacillin-tazobactam (exact OR, 0.12; exact 95% CI, <0.01-0.59; p < 0.01) and vancomycin (exact OR, 1.20; exact 95% CI, 0.03-9.80; p = 1.00) groups. Patients in the piperacillin-tazobactam group achieved statistical significance for CLABSI risk factors that may benefit by decreasing CLABSI incidence (p values <0.01-0.02).</p><p><strong>Conclusions: </strong>Alteplase use has been associated with CLABSIs. Providing a single dose of post-alteplase antibiotics targeting the most likely site-specific pathogens may reduce the incidence of CLABSIs.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"29 5","pages":"508-513"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11472401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}