Hospital pediatrics最新文献

{"title":"Examination of Donor Human Milk Practices Within Well Newborn Nurseries and Neonatal Intensive Care Units Across the United States.","authors":"La'Toya I James-Davis, Caitlin M Drumm, Jeanne A Krick, Avery Ulrich, Hollyce Tyrrell, Carrie A Phillipi, James K Aden, Rasheda J Vereen","doi":"10.1542/hpeds.2024-008247","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008247","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate access to pasteurized donor human milk (PDHM) among neonatal intensive care units (NICUs) and well newborn nurseries across the United States. We also assessed practices associated with the provision and discontinuation of PDHM within these units.</p><p><strong>Methods: </strong>Medical directors and site leads for NICUs and well newborn nurseries were polled using an online survey regarding PDHM access and their specific practices for provision and discontinuation.</p><p><strong>Results: </strong>Among those surveyed, most US NICUs and well newborn nurseries have access to PDHM. Practices regarding provision and discontinuation vary widely.</p><p><strong>Conclusions: </strong>Variations in provision practices may contribute to inequitable access to PDHM among newly born infants. Further work is needed to discern why these practice variations exist and to ensure equitable access to PDHM among newborns.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influenza Vaccination in the Pediatric Emergency Department: A Missed Opportunity.","authors":"Patrick S Walsh, Matthew J Lipshaw, Wendi-Jo Wendt, Swathi Prasad, Shannon H Baumer-Mouradian","doi":"10.1542/hpeds.2024-008186","DOIUrl":"10.1542/hpeds.2024-008186","url":null,"abstract":"<p><strong>Objective: </strong>To understand the current state of emergency department (ED) influenza vaccine programs across the US and characterize children receiving ED vaccines.</p><p><strong>Methods: </strong>This was a retrospective study of encounters with an influenza vaccine administration in 44 hospitals in the Pediatric Health Information System, from September 2016 to March 2023. We described institutional variation in ED influenza vaccine administration and compared it with rates of vaccination during hospitalizations. We identified demographic factors associated with receiving an influenza vaccine during an ED visit, using generalized linear mixed-effects models.</p><p><strong>Results: </strong>There were 46 901 ED encounters with an influenza vaccine administration, but these were clustered in just a few EDs (96% were administered in 14 EDs). During influenza seasons, the median ED administered 0.4 influenza vaccines per 1000 ED encounters (IQR 0.1-2.1; range 0-39.9 per 1000 encounters). ED vaccination rates were considerably lower than rates for hospitalizations (median 61 per 1000; IQR: 39-94). Compared with ED visits without a vaccine, there were greater odds of influenza vaccination during an ED visit for children that were older, Hispanic (odds ratio [OR] 1.81; 95% CI: 1.73-1.91), Non-Hispanic Black (OR 1.71; 95% CI: 1.62-1.80), Medicaid insured (OR 1.45; 95% CI: 1.39-1.52), and from very low childhood opportunity index areas (OR 1.59; 95% CI: 1.50-1.69).</p><p><strong>Conclusions: </strong>Influenza vaccine administration rates in the ED were low. Although only a few EDs regularly provided influenza vaccines, they reached traditionally undervaccinated pediatric populations. Future work should assess how ED vaccination programs might complement current hospital and primary care efforts to improve vaccine access.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"466-473"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disproportionate Enforcement of a Hospital's Safe Sleep Policy for Racial and Ethnic Minority Families.","authors":"Lauren Titus, Natalie Yass, Anika Nelson, Melodee Liegl, Amy Y Pan, Sarah Corey Bauer","doi":"10.1542/hpeds.2024-007800","DOIUrl":"10.1542/hpeds.2024-007800","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the enforcement of a staff-initiated children's hospital safe sleep policy for evidence of systemic racism.</p><p><strong>Patients and methods: </strong>Retrospective medical record review of staff-initiated safe sleep policy enactments was performed. Demographic data of infants aged 12 months or younger with an unsafe sleep event (USE) documented in the electronic health record were compared with logistic regression to infants without USEs. Time to escalation of USEs was analyzed using survival analysis. Descriptive statistics were used to compare median number of warnings and outcomes of escalation for each demographic group.</p><p><strong>Results: </strong>Of 233 infants with USEs, a disproportionate number were Non-Hispanic Black (NHB) (52%) compared with infants without USEs (23% NHB) (P < .01). When adjusting for confounding variables, NHB infants were 2.42 times more likely to have an USE compared with Non-Hispanic white (NHW) infants (OR, 2.42; 95% CI, 1.63-3.58; P < .01). NHW infants had a significantly longer median time between first and second warnings compared with all other groups (P < .01), and the time to fourth warning for NHW infants was over 6 times that for NHB infants. The only instances of USEs that escalated to hospital security involved NHB infants.</p><p><strong>Conclusion: </strong>Disparities suggestive of systemic racism were identified in the enforcement of a children's hospital safe sleep policy. For hospitals looking to adopt or revise safe sleep policies, the authors suggest careful consideration of potential impacts on already systemically marginalized families. We suggest replacing punitive consequences of policy nonadherence with interventions to facilitate behavior change in the hospital and after discharge.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"483-490"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Financial Performance of Pediatric Hospital Medicine Programs Through Appropriate Critical Care Billing.","authors":"Paul Scalici, Erin E Shaughnessy","doi":"10.1542/hpeds.2025-008385","DOIUrl":"10.1542/hpeds.2025-008385","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e251-e253"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process Improvement for Family-Centered Congenital Heart Disease Deliveries.","authors":"Sarah Gelehrter, Sarah Blonsky, Jasmeet Kataria-Hale, Ian Thomas, Courtney Strohacker, Naomi Laventhal","doi":"10.1542/hpeds.2024-008173","DOIUrl":"10.1542/hpeds.2024-008173","url":null,"abstract":"<p><strong>Background: </strong>Perinatal care coordination for the birth of infants with prenatally detected ductal-dependent congenital heart disease (DDCHD) has historically been limited by the siloing of cardiologists and neonatologists and by singular focus on risk reduction. The aim of this study was to increase time for parent-infant bonding and decrease overutilization of medical resources by developing and implementing a standardized delivery stratification system for infants with CHD.</p><p><strong>Methods/interventions: </strong>Over the course of multiple Plan-Do-Study-Act cycles from 2015 to 2023, we identified risk factors for respiratory intervention immediately after birth among infants with DDCHD, drivers of unnecessary intervention and resource utilization, and barriers to allowing time for parent-infant bonding. This led to development of standardized documentation and communication and a color-coded risk-stratification system that allowed for the identification of a low-risk cohort of infants eligible for demedicalized, immediate postnatal care despite the presence of critical CHD.</p><p><strong>Results: </strong>Through a series of process improvements and implementation of a delivery risk-stratification system, we were able to maintain neonatal safety while decreasing use of the operating room for vaginal deliveries from 100% to 10% and increasing the rate of time for parent-infant bonding in the first hours of life from 62% to 91%.</p><p><strong>Conclusion: </strong>Multidisciplinary collaboration and iterative quality improvement work supported the safe improvement in allowing parent-infant bonding after birth for infants with critical CHD with a decrease in unnecessary respiratory intervention and obstetric resource utilization. Our findings support adoption of a collaborative risk-stratification approach for other congenital anomaly cohorts.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"529-536"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Call to Action: Inadequate Resources for Children in Hospitals.","authors":"Ethan E Pfeifer, James Anthony Lin","doi":"10.1542/hpeds.2025-008350","DOIUrl":"10.1542/hpeds.2025-008350","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e254-e257"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers, Facilitators, and Time Costs of Implementing a Pediatric Clinical Pathway Intervention.","authors":"Sara M Aziz, Kathleen Bonsmith, Ralph Gonzales, Andrew Auerbach, Angela Douglas, Madison Anderson, Sara Thompson, Yeelen Edwards, Sunitha V Kaiser","doi":"10.1542/hpeds.2024-008120","DOIUrl":"10.1542/hpeds.2024-008120","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical pathways can improve care and outcomes for children with respiratory illnesses. The Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children (SIP) trial is a multicenter, randomized trial of a high-efficiency pathway intervention in general and community hospitals. Our objective was to describe implementation fidelity, strategy use, time costs, barriers, and facilitators.</p><p><strong>Methods: </strong>We conducted a mixed-methods study. Hospitals received clinical pathways (intervention) and used 5 implementation strategies: quality improvement (QI) mentor meetings, education, iterative changes, audit and feedback, and clinical decision support via electronic order sets. Data were collected through monthly surveys (11 months) of site leaders and recordings of mentor meetings. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic content analysis.</p><p><strong>Results: </strong>Eighteen site leaders (from 18 hospitals) and 8 QI mentors participated. Monthly survey completion rates were 72% to 100%. Pathway implementation fidelity was high (94%). Implementation strategies with the highest use were QI mentor meetings, iterative changes, and electronic order sets. Audit and feedback had the lowest use, driven by information technology challenges and delays in data collection. Implementation time costs were approximately 14 hours per month, and data collection had the highest time cost. Implementation barriers included time limitations and stakeholder resistance to change. Facilitators included SIP study resources, engagement of multidisciplinary staff, and alignment with institutional goals.</p><p><strong>Conclusions: </strong>Our multicenter study provides detailed guidance on implementation fidelity, strategy use, time costs, barriers, and facilitators for general and community hospitals implementing high-efficiency pediatric pathway interventions.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"457-465"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Learner's Perspective on Upward Feedback in Pediatrics: A Qualitative Thematic Analysis.","authors":"Nicholas McKenzie, Christian Carrier, Sarah Vaughen, Kevin Chi, Helen Wei, Yi Shao, Melody Petty, H Barrett Fromme","doi":"10.1542/hpeds.2024-008160","DOIUrl":"10.1542/hpeds.2024-008160","url":null,"abstract":"<p><strong>Objective: </strong>Attending physicians rarely receive feedback to improve, but residents and medical students directly observe them and are uniquely positioned to provide feedback. This study explored factors impacting upward feedback from the trainee perspective, including the following: (1) domains of feedback that learners felt capable providing, (2) barriers to giving feedback, and (3) supervisor behaviors that facilitate feedback.</p><p><strong>Methods: </strong>Pediatric residents and medical students from 3 institutions participated in focus groups from October 2022 to February 2023. Four open-ended questions on their experience providing upward feedback were asked. Focus groups were examined through a qualitative content analysis, and a social constructionist approach was used to understand individual trainee experiences.</p><p><strong>Results: </strong>A total of 20 residents and 26 medical students participated. Themes identified as impactful factors on upward feedback were as follows: (1) feedback culture, ie, perceived ability to impact change at their institution and beliefs on hierarchy and fear of repercussions; (2) logistics, ie, the timing and location of feedback, as well as lack of guidance providing feedback and assessing attending performance; (3) attending factors, ie, the learning environment, attending openness, availability, perceived investment in trainees, personal goal-sharing, and active requests for feedback; and (4) focus of feedback, ie, feeling uncomfortable providing constructive feedback, especially on topics that attendings are considered experts in.</p><p><strong>Conclusions: </strong>Learners experience logistical, cultural, and attending-specific factors that influence their experience and perception of giving upward feedback regardless of their interest in doing so. Unique and modifiable factors may change the perceived barriers and subsequent comfort in the delivery of effective upward feedback.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"501-510"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Good Grief? Introducing the TEARS Framework for Health Professions Educators to Support Learners Experiencing Grief.","authors":"Hadley Bloomhardt, Sarah Tremallo","doi":"10.1542/hpeds.2024-008096","DOIUrl":"10.1542/hpeds.2024-008096","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e261-e264"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Acute Suppurative Cervical Lymphadenitis: A Condition Ripe for Improved Health Care Value.","authors":"Hannah Rector, Jenn Horton, Payton Erickson, Zachary Daines, Nathan Money","doi":"10.1542/hpeds.2024-008232","DOIUrl":"10.1542/hpeds.2024-008232","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e265-e268"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}