Hospital pediatrics最新文献

{"title":"Time to Blood Culture Positivity Supports Shorter Rule Outs in a Level IV NICU.","authors":"Amanda L Hurst, Marijo Roiko, Emily Tisler, Lauritz R Meyer, Margaret Free","doi":"10.1542/hpeds.2026-009368","DOIUrl":"10.1542/hpeds.2026-009368","url":null,"abstract":"<p><strong>Objective: </strong>Antibiotic therapy is typically initiated and continued for 36 or 48 hours in neonatal patients while awaiting blood culture results. Our study aims to determine time to positivity (TTP) of positive blood cultures in a level IV neonatal intensive care unit (NICU) to determine the appropriate duration of empiric antibiotics.</p><p><strong>Patients and methods: </strong>This is a retrospective study of all patients admitted to the NICU with a positive blood culture from January 2021 to March 2025. Only the first positive blood culture per patient was included in the analysis unless a new organism was identified in subsequent cultures or if 14 days had passed since the previous positive blood culture. Polymicrobial cultures were excluded from analysis unless a subsequent culture demonstrated continued positivity with a single organism.</p><p><strong>Results: </strong>A total of 63 positive blood cultures from 59 patients were included in the analysis. The median TTP for gram-negative and gram-positive definite pathogens was 9 hours (IQR 7.79, 10.52) and 16.2 hours (IQR 13.76, 18.57), respectively. At 24 hours, 97% (30/31) of definite pathogens were reported as positive, and at 36 hours, 100% (52/52) of definite and possible pathogens were reported as positive.</p><p><strong>Conclusions: </strong>All blood cultures with definite and possible pathogens were reported as positive by 36 hours. A 36-hour course of empiric antibiotics should be considered in neonates without signs of site-specific infection and without other pending cultures. Shortening courses to 24 hours may also be reasonable, particularly for gram-negative pathogens.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e761-e767"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563228","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":"Inpatient Childhood Asthma Controller Medication Escalation and Increased Time-to-Readmission.","authors":"Arsala Syed, Jade McCurvin, Allyson Larkin, Gabriella Butler, Allen Joe, Catherine Forster, Juan C Celedón, Yueh-Ying Han, Franziska Rosser","doi":"10.1542/hpeds.2025-009049","DOIUrl":"10.1542/hpeds.2025-009049","url":null,"abstract":"<p><strong>Background: </strong>Childhood asthma readmission rates are unacceptably high. Whether increasing asthma therapy during hospitalization prevents readmission is unknown.</p><p><strong>Objective: </strong>To determine if an asthma medication escalation in children hospitalized for an asthma exacerbation is associated with increased time-to-readmission for asthma.</p><p><strong>Methods: </strong>Retrospective cohort study of children aged 5 to 17 years admitted for an asthma exacerbation at our institution from 2021 to 2023. An escalation in asthma controller medication was defined as initiation of an asthma controller, increase in step therapy, or addition of a new controller class. The primary outcome was time-to-readmission for an asthma exacerbation.</p><p><strong>Results: </strong>Among 986 children admitted for an asthma exacerbation, asthma medication was escalated in 33%, not escalated in 47%, and undetermined in 20%; 25% were readmitted for asthma. Children who were readmitted were younger and more likely to live in a ZIP code with high asthma rates, have public insurance, a previous emergency department visit, identify as Black, and a higher therapy on discharge than those not readmitted. In adjusted analyses (n = 790), an escalation was associated with lower risk of readmission (hazard ratio [HR] = 0.65, 95% CI  0.46-0.91, P = 0.01). In stratified analyses, an escalation was associated with a reduced HR of readmission if discharged by the pulmonary (HR = 0.43, 95% CI 0.27-0.69) but not by hospital medicine (HR = 1.05, 95% CI 0.68-1.63) service.</p><p><strong>Conclusion: </strong>Inpatient escalation of controller therapy is associated with reduced hazard of readmission for asthma. Further studies are needed to determine optimal discharge asthma therapy management.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"896-905"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550665","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":"Agreement and Performance of Intermittent and Continuous Vital Signs in Critically Ill Children.","authors":"Colleen M Badke, L Nelson Sanchez-Pinto","doi":"10.1542/hpeds.2026-009387","DOIUrl":"10.1542/hpeds.2026-009387","url":null,"abstract":"<p><strong>Background: </strong>Intermittent vital sign (VS) documentation is the standard of care in pediatric wards and pediatric intensive care units (PICUs). However, intermittent capture of VS values may miss important trajectories and extreme values, particularly for patients at risk of organ dysfunction.</p><p><strong>Objective: </strong>Determine the agreement between intermittently charted and high-frequency (continuous) bedside monitor VS measurements, as well as the performance of the 2 types of VS measurements to predict cardiorespiratory dysfunction.</p><p><strong>Methods: </strong>This was a single-center, retrospective study of children admitted to the PICU. We examined agreement by comparing the range of high-frequency VS measurements with the corresponding intermittently charted VS measurements. To assess the performance for predicting cardiorespiratory dysfunction, both sets of VS measurements were summarized as the worst values at an hourly level. The dataset was temporally divided into training and test sets, and XGBoost models were trained using either the intermittent or high-frequency values. The area under the receiver operating characteristic (AUROC) curve of both models was compared using the DeLong methods.</p><p><strong>Results: </strong>There were 12 189 PICU encounters, with over 1.5 million paired VS observations. Agreement varied based on the VS, with 21% to 33% of all intermittently charted VS measurements out of range from the high-frequency VS measurements. Cardiorespiratory dysfunction occurred in 36.4% of encounters. High-frequency VS measurements had a small but significantly higher performance at predicting cardiorespiratory dysfunction compared with intermittently charted VS measurements (AUROC, 0.64 vs 0.63; P < .001).</p><p><strong>Conclusions: </strong>About 20% to 30% of intermittently charted VS measurements do not fall into the expected high-frequency, bedside monitor range. High-frequency VS measurements are weakly but significantly better than intermittently charted VS measurements in predicting cardiorespiratory dysfunction.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e781-e786"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761983","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":"Enhancing EHR Usability for Children With Medical Complexity Using a Structured Summary Tool.","authors":"Averi E Wilson, Stephanie Arar, Christopher Menzies, Selby Chu, Jennifer Mayor, Christoph U Lehmann, Katherine Maddox","doi":"10.1542/hpeds.2026-009238","DOIUrl":"10.1542/hpeds.2026-009238","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children with medical complexity (CMC) require multidisciplinary care and generate extensive, fragmented electronic health record (EHR) data that make medical record review difficult and time-consuming. We aimed to develop a Medical Complexity Summary to support information retrieval for clinicians caring for CMC and hypothesized that the summary would improve usability of the EHR for medical record review of this patient population.</p><p><strong>Methods: </strong>We conducted a mixed-methods evaluation at a large tertiary children's hospital. A multidisciplinary team iteratively designed the Medical Complexity Summary using stakeholder input. After implementation, we extracted usage metrics including unique users, encounters, patients, and encounter characteristics. A follow-up REDCap survey assessed usability among clinicians who reported using the tool, using 6 items from the National Usability-Focused Health Information System Scale and 1 original satisfaction question. Usability and satisfaction ratings were compared with preimplementation survey data.</p><p><strong>Results: </strong>During the first 5 months, 257 users accessed the tool across 1010 encounters involving 973 patients. Most uses occurred during inpatient encounters. Survey response rate was 36% (60 of 167), and 40 respondents (67%) reported using the tool. Compared with preimplementation data, users reported significant improvements in 4 of 6 usability domains and higher satisfaction with medical record review for CMC (P < .001). Ratings did not change for data completeness, timeliness, or physician-to-physician communication.</p><p><strong>Conclusions: </strong>Early evaluation demonstrates strong adoption and improved usability associated with the Medical Complexity Summary. This structured EHR summary may reduce information-retrieval burden and support safer, more efficient care for CMC.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"880-888"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449789","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":"Neutrophil-to-Lymphocyte Ratio in Children With STEC-HUS: A Prognostic Study.","authors":"Alejandro Balestracci, Luciana Meni Battaglia, Milena Rivero Segura","doi":"10.1542/hpeds.2026-009300","DOIUrl":"10.1542/hpeds.2026-009300","url":null,"abstract":"<p><strong>Background and objectives: </strong>Early identification of children with Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) at risk of a complicated course may optimize management. The neutrophil-to-lymphocyte ratio (NLR) is a simple, widely available marker of inflammatory imbalance with prognostic value in several diseases; however, its prognostic performance in children with STEC-HUS remains unexplored.</p><p><strong>Methods: </strong>In this retrospective observational prognostic study, we reviewed the medical records of patients hospitalized with STEC-HUS at a tertiary hospital in Argentina between 2000 and 2024. Demographic, clinical, and laboratory variables were compared between patients with complicated (dialysis >10 days and/or extrarenal complications and/or death) and uncomplicated disease. The prognostic performance of laboratory variables was calculated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Of 214 patients, 70 (32.7%) had complicated disease. Patients who developed complicated disease had significantly higher NLR values than those who did not (4.8 vs 1.4, P < .001). In multivariable analysis, NLR (odds ratio [OR], 2.7, 95% CI, 2.03-3.58; P < .001) and C-reactive protein (OR, 1.01, 95% CI, 1.0006-1.02; P = .04) remained independent predictors of a complicated episode. The prognostic performance of NLR assessed by ROC curve analysis was 0.91 (95% CI, 0.87-0.96). At a cutoff value of at least 3.7, sensitivity was 88.6% (95% CI, 78.7%-94.9%) and specificity was 94.4% (95% CI, 89.3%-97.6%). Posttest probability of complications was 88.6% for NLR greater than or equal to 3.7 and 5.5% for NLR less than 3.7.</p><p><strong>Conclusion: </strong>The NLR demonstrated strong predictive value for a complicated disease course in children with STEC-HUS. External validation in independent cohorts is required before routine clinical implementation.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e768-e776"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722255","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":"Postoperative Interventions and Cost Associated With Disposition After Tonsil and Adenoidectomy.","authors":"Vanessa Toomey, Julia A Heneghan, Matt Hall, Jason M Kane, Colin M Rogerson, Leslie A Dervan, Adam C Dziorny, Joseph G Kohne, Nadia Roumeliotis, Daniel Garros, Cara Cecil, Denise M Goodman, Daniel H Choi, Anoop Bhalla","doi":"10.1542/hpeds.2026-009276","DOIUrl":"10.1542/hpeds.2026-009276","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate postoperative disposition and resource use among patients admitted to the inpatient unit or pediatric intensive care unit (PICU) following tonsillectomy, adenoidectomy, and tonsillectomy/adenoidectomy (T/A).</p><p><strong>Patients and methods: </strong>This retrospective cohort study featured patients aged 18 years or less after T/A procedures in 38 children's hospitals in the Pediatric Health Information System database (2016-2023). Patients were categorized by postoperative disposition: ambulatory, inpatient unit, inpatient unit with subsequent PICU transfer, or PICU; inpatient admissions were analyzed. Primary outcomes were the frequency of urgent interventions (racemic epinephrine administration and noninvasive ventilation) and emergent interventions or outcomes (invasive mechanical ventilation, cardiopulmonary resuscitation, hemorrhage, blood transfusion, or return to operating room). The secondary outcome was median daily hospital cost.</p><p><strong>Results: </strong>A total of 388 071 T/A procedures were identified, including 316 323 ambulatory and 71 748 inpatient. Among the patients in the inpatient unit and PICU, 2% and 16% received an urgent intervention, and, in both locations, 2% received an emergent intervention or outcome. For patients without interventions, the median daily cost difference between PICU and inpatient unit admissions was $1774. Based on the difference between PICU and inpatient costs for patients with no interventions, we estimate that $2.6 million could be saved if 50% of these patients in the PICU were admitted to the inpatient unit.</p><p><strong>Conclusions: </strong>A minority of PICU admissions following T/A procedures require urgent or emergent interventions. This suggests that deimplementation of routine T/A PICU admissions may facilitate transitioning patients to the inpatient unit, reducing costs and optimizing PICU use.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"872-879"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723002","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":"Adolescent Hospital Visits for Sexual and Reproductive Health Outcomes After the Dobbs Decision.","authors":"Christina Bonaparte, Matt Hall, Cheryl L Errichetti, Monika K Goyal, Lauren S Chernick, Elizabeth Hovel, Vanessa McFadden, Melissa K Miller, Stephani Stancil, Abbey R Masonbrink","doi":"10.1542/hpeds.2025-009017","DOIUrl":"10.1542/hpeds.2025-009017","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate changes in adolescent sexual and reproductive health (SRH)-related hospital encounters post-Dobbs and compare by state abortion policies.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adolescent pediatric hospital encounters from June 2021 to December 2024 and used an interrupted time series analysis to measure the impact of Dobbs on SRH outcomes. Encounters included any hospital encounter of patients aged 11 to 18 years from 42 children's hospitals nationwide. SRH outcomes included pregnancy diagnosis, sexually transmitted infection (STI) testing and diagnosis, emergency contraception (EC) provision, or abortion, based on billing codes.</p><p><strong>Results: </strong>Of 3 448 158 pediatric hospital encounters, 1 584 397 (45.9%) occurred in abortion-restricted states. In abortion-restricted states, there was an increase in pregnancy diagnosis during encounters at the time of Dobbs (June 2022) (odds ratio [OR], 1.26; 95% CI, 1.02-1.55; P = .029). Encounters with STI testing (OR, 0.99; 95% CI, 0.99-1.00; P = 0.027), STI diagnoses (OR, 0.98; 95% CI, 0.97-1.00; P = .017), and EC (OR, 0.98; 95% CI, 0.96-1.00; P = .028) decreased post-Dobbs compared with pre-Dobbs in restricted states. Of 1 863 761 (54.1%) pediatric hospital encounters in permissive states, pregnancy encounters decreased pre-Dobbs (OR, 0.98; 95% CI, 0.96-1.00; P = .021) and then slightly increased post-Dobbs (OR, 1.03; 95% CI, 1.01-1.05; P = .006), whereas STI trends in testing and diagnosis remained stable across all 3 time periods.</p><p><strong>Conclusion: </strong>In abortion-restricted states post-Dobbs, we found a 26% increase in the odds of pregnancy-related encounters, as well as a decrease in STI testing, diagnosis, and EC administration. Further efforts are needed to offset the disparate risk for outcomes for youth living in abortion-restricted states.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"831-838"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473442","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 Value Failure of Pediatric Mental Health Boarding.","authors":"Ryan Brogan","doi":"10.1542/hpeds.2026-009477","DOIUrl":"10.1542/hpeds.2026-009477","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e812-e814"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537166","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 Pediatric Hospitalist: A Survey of How We Are Doing.","authors":"Kelsey Jackson, H Barrett Fromme, Elizabeth Nguyen, Kristen Wroblewski, Thomas B Mike","doi":"10.1542/hpeds.2026-009648","DOIUrl":"10.1542/hpeds.2026-009648","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e790-e792"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809278","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":"Patterns in Secure Messaging Among Hospitalists at a Large Children's Hospital.","authors":"Emma Milne, John M Morrison, Jamee Walters","doi":"10.1542/hpeds.2026-009410","DOIUrl":"10.1542/hpeds.2026-009410","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e793-e796"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680400","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}