Hospital pediatrics最新文献

{"title":"Association of Hospitalization-Level Characteristics With Pediatric Rapid Response Team Outcomes.","authors":"Anisha K Coughlin, Kristen A Smith, Maria C Pliakas, Julie Sturza, Katherine E Bates, Erin F Carlton","doi":"10.1542/hpeds.2025-008428","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008428","url":null,"abstract":"<p><strong>Background and objectives: </strong>Many institutions have implemented rapid response teams (RRTs) to assess deteriorating patients. Acute deterioration events are often used as proxies for mortality in children; however, risk factors for decompensation events are not well defined.</p><p><strong>Methods: </strong>We identified all RRT events for pediatric admissions from January 2019 through June 2024 at a quaternary care hospital. Our primary outcome was acute deterioration within 6 hours of the RRT event, which included intubation or vasoactive medication use. We also report the rate of transfer to an intensive care unit (ICU). We compared patient and hospitalization-level characteristics among those with vs without an acute deterioration event. Finally, we used logistic regression to identify risk factors associated with acute deterioration including age, sex, medical complexity, respiratory support at the time of RRT, and primary service at the time of RRT.</p><p><strong>Results: </strong>We identified 2797 RRTs, of which 212 (7.6%) resulted in an acute deterioration event within 6 hours; 1545 (55%) RRT events resulted in transfer to an ICU. In multivariable logistic regression models accounting for age, sex, patient medical complexity, primary service, and respiratory support, respiratory support at the time of RRT and patient medical complexity were independently associated with an acute deterioration event. Specifically, high-flow nasal cannula at the time of RRT event was associated with lower odds of acute deterioration (odds ratio, 0.50; 95% CI, 0.32-0.79) and complex chronic conditions were associated with higher odds of acute deterioration (odds ratio, 3.11; 95% CI, 1.43-6.80).</p><p><strong>Conclusion: </strong>Hospitalization-level characteristics may be used to assess the role of institutional pediatric RRT systems in preventing acute deterioration events, predicting escalations in care, and informing RRT resource allocation and improvement efforts.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245351","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":"Do Emergency Transfers Reflect Hospital Quality? Preventable Harm and the Next 100 000 Lives.","authors":"Justin M Lockwood, Lalit Bajaj, Sanjiv D Mehta","doi":"10.1542/hpeds.2025-008745","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008745","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233448","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":"Assessing the Impact of Emergency Transfers in Pediatric Cardiology.","authors":"Zachary West, Andrew Jergel, Naveen Muthu, Nikhil Chanani","doi":"10.1542/hpeds.2025-008528","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008528","url":null,"abstract":"<p><strong>Objective: </strong>Cardiopulmonary arrest is rare in pediatrics, but researchers have identified a proxy metric in emergency transfers (ETs) that has not been studied in pediatric cardiology. We aimed to assess the impact of ET on mortality, cardiac intensive care unit (CICU) length of stay (LOS), and hospitalization LOS in pediatric cardiology. We hypothesized that ETs have longer LOS and increased mortality.</p><p><strong>Methods: </strong>This single-center, retrospective, propensity-score-matched cohort study assessed cardiology acute care unit to CICU transfers between February 1, 2019 and May 9, 2024. A propensity score with predetermined risk factors included age, diagnosis, high-risk diagnosis, surgical status, transfer reason, transfer shift/quarter, and pretransfer LOS. Transfers were classified by timing of qualifying intervention (intubation, vasoactive initiation, or large volume fluid bolus [≥60 mL/kg] administration): emergency if within 1 hour of transfer, urgent if within 1 to 12 hours of transfer, or otherwise no intervention. Outcomes included CICU LOS, posttransfer LOS, and in-hospital mortality.</p><p><strong>Results: </strong>A total of 625 transfers were identified and 75 (11.9%) met criteria for ET. After successful matching, ETs demonstrated significantly increased in-hospital mortality (25% vs 10%; P = .001), CICU LOS (12.8 days vs 4.12 days; P < .001), and post-CICU transfer LOS (40.18 days vs 19.81 days; P = .012). Additionally, ETs had higher in-hospital mortality than both urgent (OR 3.6; 95% CI, 1.40-11; P = .011) and no intervention transfers (OR 5.3; 95% CI, 2.8-10; P < .001).</p><p><strong>Conclusions: </strong>ETs are associated with increased LOS and mortality in pediatric cardiology. ETs are a valid proxy measure for clinical deterioration.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233451","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":"Posttraumatic Stress in Parents of Hospitalized Children With Medical Complexity.","authors":"Tammie Dewan, Andrea Whiteley, Kathryn Birnie, Melody Grohs, Isabel Jordan, Megan Miller, Melanie Noel, Jennifer Zwicker, Laurie Lee","doi":"10.1542/hpeds.2025-008390","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008390","url":null,"abstract":"<p><strong>Background/objectives: </strong>Parents of children with medical complexity (CMC) are exposed to repeated episodes of pediatric medical traumatic stress, placing them at risk of posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD). The objectives of this study are (1) to establish the prevalence and severity of PTSS and PTSD in parents of hospitalized CMC and (2) to determine whether a hospitalization influences PTSS and whether PTSS were associated with subjective experiences during the hospitalization.</p><p><strong>Methods: </strong>This prospective cohort study enrolled parents of hospitalized CMC at a Canadian children's hospital and used a validated questionnaire to measure PTSS at baseline and 2 to 6 months later. Potential predictor variables related to demographics, child illness, caregiving, and experiences in hospital were collected. Multivariable regression models were used to determine relevant associations with PTSS.</p><p><strong>Results: </strong>Of 75 enrolled participants, 58 completed baseline questionnaires and 48 completed follow-up. Twenty-nine percent of participants met cutoff for PTSD at baseline and 33% at follow-up. Increased PTSS was found in association with female gender, higher number of previous traumatic events, history of anxiety/depression, higher caregiving responsibilities, insomnia, and anxiety symptoms in hospital. Most subjective experiences of hospitalization showed no relationship with PTSS. For most participants, PTSS was stable and persistent over time.</p><p><strong>Conclusions: </strong>PTSS/PTSD are frequently found among parents of hospitalized CMC. Caregiving responsibilities, anxiety and insomnia are potentially modifiable risk factors. A combination of integrated tangible and mental health supports, in hospital and community, could be an opportunity to mitigate PTSS in this high-risk population.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213972","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":"Social Needs of Children With Medical Complexity and Inpatient Care Utilization.","authors":"Lauren Ondrejka, Edith Allen, Wendy Arafiles, Mehrtash Hashemzadeh, Sandra Gage","doi":"10.1542/hpeds.2024-008142","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008142","url":null,"abstract":"<p><strong>Objective: </strong>Determine whether children with medical complexity (CMC) with positive social needs screens have more readmissions and longer length of stay (LOS).</p><p><strong>Methods: </strong>Retrospective cohort study of CMC aged 0 to 21 years admitted to a tertiary care children's hospital from October 1, 2022, to September 30, 2023. Inclusion required at least 3 subspecialists and medical technology use. Caregivers received a link to the questionnaire via text message. Surveys with at least 1 need reported were deemed positive. Thirty-day readmission rates (RRs), total hospital days, and LOS were compared between CMC with and without a positive screen. Analysis included Mann-Whitney test, χ2/Fisher exact test, mixed-effects model for LOS, and multivariable logistic regression for 30-day RR. All P values are 2-sided; P < .05 is considered statistically significant.</p><p><strong>Results: </strong>Five hundred eighty-three medical records were reviewed; 99 were excluded. Four hundred eighty-four patients remained: 129 positive screens and 355 negative screens. Demographics between groups differed only by race and ethnicity, with more Black/African American and Hispanic/Latinx patients represented in the positive screen group (12.4% vs 7.9%; 45% vs 33.5%; P = .008). CMC with positive screens had a significantly higher 30-day RR (0.36 vs 0.26; odds ratio, 1.56; 95% CI, 1.01-2.40; P = .04) and longer LOS (β = 6; 95% CI, 1-10; P = .01) even after adjusting for potential confounders. They also had more total hospital days (median, 13; IQR, 3-42 vs median, 8; IQR, 3-24), but the difference was not statistically significant (P = .06).</p><p><strong>Conclusion: </strong>CMC with social needs had significantly higher hospital utilization with more 30-day readmissions and longer hospital stays, trending toward increased hospital days. These findings highlight the impact of social needs on CMC and can inform future interventions to support patients and reduce hospital utilization.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208073","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 and Facilitators to a Safe Discharge for High-Risk Children With Congenital Heart Disease.","authors":"Deepika Thacker, Jennie Ryan, Varsha Zadokar, Bridgette Hindt, Samuel S Gidding, Erica Sood","doi":"10.1542/hpeds.2024-008251","DOIUrl":"10.1542/hpeds.2024-008251","url":null,"abstract":"<p><strong>Objective: </strong>Children with congenital heart disease (CHD) often require continued care after hospital discharge by parents and other caregivers (P/CG), many of whom report problems in the transition to home and outpatient settings. Few studies have comprehensively assessed the perspectives of both P/CG and health care personnel (HCP) to identify factors affecting a safe discharge for medically or socially high-risk children with CHD.</p><p><strong>Methods: </strong>Semistructured qualitative interviews concerning discharge processes and procedures were performed with 16 P/CG of medically or socially high-risk children with CHD (eg, receiving tube feeding) who experienced poor discharge outcomes (eg, unplanned 30-day readmissions) and 16 HCPs involved in their care. Interview transcripts were coded and analyzed using a thematic analysis approach.</p><p><strong>Results: </strong>Four themes were constructed from the qualitative data: 1) teaching and communication to promote a safe discharge, 2) complexity of care influences a safe discharge, 3) P/CG presence at the bedside facilitates a safe discharge, and 4) leveraging technology as a tool to promote a safe discharge. For each theme, barriers, facilitators, and recommendations for additional support were identified.</p><p><strong>Conclusion: </strong>Through their experiences, P/CG, as well as HCPs of children with complex medical conditions, can help identify barriers, facilitators, and recommendations for a safe discharge. Incorporating the perspectives of both groups has the potential to inform improvements in patient care and discharge processes for medically and socially high-risk children.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"831-841"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972759","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":"Significant Pathology in Young Infants Presenting With Hypothermia: A Multicenter Study.","authors":"Julie K Wood, Annalise Van Meurs, Kathryn Westphal, Vignesh Doraiswamy, Erinn O Schmit, Stephanie Berger, Saylor McCartor, Meredith Mitchell, Clifton Lee, John M Morrison, Monica D Combs, Kira Molas-Torreblanca, Sumeet L Banker, Jennifer Lee, Joni K Evans, Nicholas M Potisek, Elizabeth E Halvorson","doi":"10.1542/hpeds.2025-008387","DOIUrl":"10.1542/hpeds.2025-008387","url":null,"abstract":"<p><strong>Objective: </strong>Hypothermia in young infants is often attributed to immature thermoregulation but may be the harbinger of significant pathology. We aimed to determine the prevalence and type of significant pathology in young infants aged 90 days or younger presenting with hypothermia (≤36.0 °C) and explore associations between this outcome and presenting characteristics and evaluation.</p><p><strong>Methods: </strong>We conducted a multicenter, retrospective cohort study of young infants evaluated in the emergency department (ED) or hospital setting for hypothermia over a 5-year period. Patients aged 90 days or younger with documented or reported hypothermia in the ED or upon admission were included for study. All charts were manually reviewed. Our primary outcome was a diagnosis of significant pathology, infectious or noninfectious, defined as warranting hospitalization for evaluation, care or monitoring. We used a multivariate logistic regression model to test associations with significant pathology.</p><p><strong>Results: </strong>Among 998 included infants, 32% (n = 318) had significant pathology, 4% with serious bacterial infection or herpes simplex virus (n = 41) and 28% (n = 277) with other diagnoses of significance spanning multiple organ systems and pathologies. Following multivariate logistic regression, presentation at older age (29-60 days [odds ratio {OR}, 6.9; 95% CI, 4.0-11.9] and 61-90 days [OR, 8.1; 95% CI, 3.8-17.0]), ill-appearance (OR, 4.3; 95% CI, 3.0-6.1), repeated temperature instability (OR, 2.0; 95% CI, 1.4-2.8), and abnormal white blood cell count (OR, 2.5; 95% CI, 1.5-4.1) were associated with significant pathology.</p><p><strong>Conclusions: </strong>Infants presenting with hypothermia often have diagnoses of significance aside from serious or invasive infections. Decision tools for management of hypothermic young infants should account for alternative pathology.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"804-813"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016479","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":"Hypothermia in Young Infants: Rethinking Definitions and Clinical Implications.","authors":"Rebecca Dang, Valerie J Flaherman","doi":"10.1542/hpeds.2025-008454","DOIUrl":"10.1542/hpeds.2025-008454","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e512-e514"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016508","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 Inpatient Clinical Team Members Perspectives on a Program to Address Social Needs.","authors":"Hemen Muleta, Elizabeth Messineo, Miya Lemberg, Amanda Klafter, Samuel Woo, Danielle Fernandes, Tara Buckenmyer, Patricia Hametz, Jessica Haughton, Kevin P Fiori","doi":"10.1542/hpeds.2025-008383","DOIUrl":"10.1542/hpeds.2025-008383","url":null,"abstract":"<p><strong>Objective: </strong>Health-related social needs (HRSNs) are associated with pediatric health outcomes. Programs that identify and intervene on unmet HRSNs are growing in pediatric inpatient settings. Research exploring the perspectives of inpatient clinical team members (CTMs) on programs to address unmet HRSNs is currently limited. The objective of this study was to investigate CTM perspectives on a pediatric inpatient HRSN screening, referral, and community health worker (CHW) resource navigation program in an urban tertiary-care pediatric academic hospital.</p><p><strong>Methods: </strong>Semi-structured interview guides were developed using the Consolidated Framework for Implementation Research. One-on-one interviews were conducted with a purposeful sampling of CTMs. Transcripts were analyzed using a rapid qualitative approach to identify salient themes.</p><p><strong>Results: </strong>Between August 19 and November 15, 2024, we conducted interviews with 14 CTMs. Analysis identified the following 4 themes: (1) social care is aligned with the goals of inpatient pediatric care; (2) CHWs are a valuable addition to a multidisciplinary inpatient team; (3) there are unique challenges of the inpatient setting, and electronic health record (EHR) integration has the potential to address these challenges; and (4) there is a need for better communication regarding outcomes across all aspects of the intervention to maintain CTM motivation.</p><p><strong>Conclusions: </strong>Inpatient pediatric CTMs view HRSNs programs as an extension of patient care. CTMs value the role of CHWs as part of the multidisciplinary team to support hospitalized families. Addressing unique inpatient challenges, optimizing EHR integration, and clear communication regarding programmatic impact on families may facilitate program adoption.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"842-851"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132131","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":"Understanding the Risk of Serious Infections in Young Infants With Hypothermia.","authors":"Hoi See Tsao, Alexander J Rogers, Sriram Ramgopal","doi":"10.1542/hpeds.2025-008700","DOIUrl":"10.1542/hpeds.2025-008700","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e509-e511"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065171","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}