Hospital pediatrics最新文献

{"title":"Intermittent vs Continuous Pulse Oximetry for Bronchiolitis Hospitalizations: A Systematic Review.","authors":"Katherine Salada, Jodi Ehrmann, Kate M Saylor, Sanjay Mahant","doi":"10.1542/hpeds.2024-008293","DOIUrl":"10.1542/hpeds.2024-008293","url":null,"abstract":"<p><strong>Context: </strong>The decision to use pulse oximetry continuously or intermittently for patients admitted to the hospital with bronchiolitis varies among providers and institutions.</p><p><strong>Objective: </strong>To systematically review the effectiveness, safety, and cost-effectiveness of intermittent vs continuous pulse oximetry monitoring in children hospitalized with bronchiolitis.</p><p><strong>Data sources: </strong>The PubMed, EMBASE, CINAHL, Scopus, and Web of Science databases were searched until December 13, 2024.</p><p><strong>Study selection: </strong>Studies of children younger than 2 years admitted with bronchiolitis that reported outcomes of continuous and intermittent pulse oximetry were included.</p><p><strong>Data extraction: </strong>Two reviewers independently screened titles, abstracts, and full texts for eligibility. Study characteristics, study quality, and outcomes were extracted from each article. Studies were heterogeneous in design; therefore, a synthesis without meta-analysis was conducted.</p><p><strong>Results: </strong>Of 2299 citations identified, 187 were reviewed in full text, and 11 studies included. Two multicenter randomized control trials (RCTs) (n = 390) found that intermittent monitoring had similar length of stay (LOS) and supplemental oxygen duration, without increased intensive care unit transfer rates. One economic evaluation found similar health care and societal costs between monitoring strategies. One cohort study found increased alarm burden with continuous monitoring. Cross-sectional studies reported that continuous monitors were helpful and provided security to parents but were associated with increased parental anxiety and fatigue. Quality improvement studies of bundled interventions found reduced or similar LOS with intermittent monitoring, with no change in readmission rates.</p><p><strong>Conclusions: </strong>Based on RCTs, intermittent and continuous pulse oximetry monitoring in hospitalized children with bronchiolitis have similar outcomes of LOS, supplemental oxygen duration, safety, and cost-effectiveness.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e460-e473"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856679","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":"Discordance Between Observed vs Expected Prevalence of UTI in Newborns With Hyperbilirubinemia.","authors":"Krisha Nayak, Miranda Kane, Alan R Schroeder, Thomas B Newman, Sheng-Fang Jiang, Pearl W Chang","doi":"10.1542/hpeds.2025-008400","DOIUrl":"10.1542/hpeds.2025-008400","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e456-e459"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849290","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":"Implementation of an EHR-Based Emergency Information Form for Children With Medical Complexity.","authors":"Todd W Lyons, Kathleen Huth, Stacey C Cook, Jay G Berry, Sangeeta Mauskar, Megan Trexler, John J Porter, Andrew Capraro, Lisa M Rickey, Elaine P Lin, Anne M Stack","doi":"10.1542/hpeds.2025-008396","DOIUrl":"10.1542/hpeds.2025-008396","url":null,"abstract":"<p><strong>Objective: </strong>Timely access to concise, accurate clinical information for children with medical complexity (CMC) may improve emergency department (ED) care. Our objective was to improve ED care of CMC via design and implementation of an electronic health record (EHR)-based Emergency Information Form (EIF).</p><p><strong>Patients and methods: </strong>Using the Model for Improvement, we engaged key stakeholders to develop and implement EIFs. We developed EIFs containing patient summary, prehospital triage instructions, resuscitation status, typical admission diagnoses, medical technologies, critical care needs and plans, and disposition guidelines. We implemented an EHR-based alert to the presence of an EIF. Our primary outcome was time to ED disposition decision. Secondary outcomes were accuracy of EIF and influence on expediting care, measured via clinician survey, and hospital admission rate. Process measures included number of CMC with EIFs, number of ED visits by children with EIFs, and percentage of providers accessing the EIF.</p><p><strong>Results: </strong>From April 1, 2022, to May 31, 2024, we created and maintained EIFs for 311 CMC who experienced 838 ED visits. Ninety-eight percent and 86% of ED providers agreed or strongly agreed that EIFs contained accurate clinical information and that EIFs expedited care, respectively. A clinician leader-led initiative improved use of EIFs from 42% to 64% over 3 months. Although there was no association between EIFs and time to ED disposition decision, there was a modest reduction in hospitalization rates (53.4% to 50.5%).</p><p><strong>Conclusions: </strong>We demonstrate the feasibility/utilization of EIFs in the EHR that provide timely and accurate clinical information when accessed, but did not influence ED disposition efficiency.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"701-710"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776416","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":"Trends in Hospitalizations of Adolescents With Psychiatric Disorders in Acute Care Hospitals.","authors":"Kazue Ishitsuka, Daisuke Shinjo, Kaori Yamawaki, Kiyohide Fushimi","doi":"10.1542/hpeds.2024-008097","DOIUrl":"10.1542/hpeds.2024-008097","url":null,"abstract":"<p><strong>Purpose: </strong>Children with medical and psychiatric disorders often require acute hospital care. This study aimed to investigate 10-year trends in the hospitalization of adolescents with psychiatric diagnoses and examine how these trends vary according to the comorbidity status of psychiatric and medical disorders in acute care settings.</p><p><strong>Methods: </strong>We conducted a retrospective, longitudinal cohort analysis of a Japanese nationwide database of acute care hospitalizations that included data from 1763 hospitals for patients aged 6 through 24 years from 2010 to 2019. Multivariate Poisson regression with robust variance estimation using cluster robust inference was conducted to assess time trends in hospitalizations with psychiatric disorders in the 3 comorbid groups (psychiatric disorders without medical diagnoses, psychiatric disorders with medical disorders, and medical disorders with comorbid psychiatric disorders).</p><p><strong>Results: </strong>Hospitalizations with psychiatric disorders increased from 4.7% to 6.3% between 2010 and 2019 (cumulative percentage growth: 34.1% [95% CI 33.1%-36.9%]). The largest increase was in the medical disorders with comorbid psychiatric disorders group (cumulative percentage growth: 38.1%). Multivariate analysis also showed an increase in hospitalizations with psychiatric disorders (annual percentage change: 3.1%; 95% CI 2.3%-3.9%). The most common psychiatric disorders were anxiety disorders, eating disorders, and autism spectrum disorders. Attention deficit hyperactive disorder increased during the study period in all comorbidity groups.</p><p><strong>Conclusion: </strong>We found that hospitalizations with psychiatric disorders increased by 34.1% from 2010 to 2019, particularly in the comorbid medical disorders with psychiatric disorders group. These findings suggest that health care systems for pediatric hospitalization require multidisciplinary medical and psychiatric services in acute care hospitals.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"769-777"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883995","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":"Use and Outcomes of Peripherally Inserted Central Catheters in Hospitalized Infants.","authors":"Madhuradhar Chegondi, Manette Ness-Cochinwala, Hilary Schreiber, Matthew Pinto, Lee A Polikoff, Harsh Kothari, Jodi Bloxham, Santosh Kaipa, Abigail Bergman-Sieger, Bethany Mancuso, Tyler Harder, Sarah Korn, Cheryl Gillette, Eileen Taillie, Jill Cholette, Elizabeth Kerris, Rachel Johnson, E Vincent S Faustino","doi":"10.1542/hpeds.2024-008246","DOIUrl":"10.1542/hpeds.2024-008246","url":null,"abstract":"<p><strong>Objective: </strong>The optimal strategy to prevent catheter-related thrombosis (CRT) in children remains unclear. We aimed to characterize the appropriateness of peripherally inserted central catheters (PICCs) in hospitalized infants and to explore the feasibility of a randomized clinical trial (RCT) of antiplatelet therapy to prevent CRT in these infants.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study of hospitalized infants younger than 1 year who had a PICC inserted between January 2017 and December 2020. We collected infant and PICC-related data from electronic medical records. Appropriateness of PICCs was assessed using the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics guidelines. Feasibility of the RCT was assessed based on frequency of CRT and availability of patients.</p><p><strong>Results: </strong>A total of 434 infants were studied. Median age was 17 days (IQR: 4, 96 days). Of these, 153 (35.3%) infants were at risk of bleeding with antiplatelet therapy, whereas 103 (23.7%) were nil per os, including medications. PICCs were considered appropriate in 257 (82.6%) infants. Proportions of appropriate PICCs were lower in PICCs with durations of 0 to 7 days (60.6%) and in infants older than 30 days (74.0%) or not admitted to the intensive care unit (75.6%). CRT occurred in 22 (5.1%) infants or 2.2 cases (95% CI: 1.2-4.1 cases) per 1000 PICC-days. CRT was associated with elevated mean platelet volume (risk ratio: 3.14, 95% CI: 1.68-5.84).</p><p><strong>Conclusion: </strong>Opportunities exist to reduce the number of PICCs inserted in hospitalized infants. An RCT of antiplatelet therapy to prevent CRT may be challenging.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"748-757"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790252","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":"Relief of Repeated Intussusception After Repositioning of Postpyloric Feeding Tube.","authors":"Akhila Shapiro, Annique Hogan","doi":"10.1542/hpeds.2024-008254","DOIUrl":"10.1542/hpeds.2024-008254","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e436-e439"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800569","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":"Accurate Documentation as the First Step Toward Pediatric Language Justice.","authors":"Alexandra Gabrielle Kelley, Jessica Lloyd, Amanda Kosack, Deepa Kulkarni","doi":"10.1542/hpeds.2024-008106","DOIUrl":"10.1542/hpeds.2024-008106","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"788-793"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817787","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":"Is Pediatric Catatonia on the Rise?","authors":"Katherine C Soe, Michael J Arnold, Joshua R Smith, Kelli C Dominick","doi":"10.1542/hpeds.2025-008504","DOIUrl":"10.1542/hpeds.2025-008504","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e449-e452"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875712","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":"Simulation-Based Clinical Systems Testing Before Opening a Pediatric Critical Care Building.","authors":"Benjamin T Kerrey, Stephanie Boyd, Jamie Shoemaker, Matthew Zackoff, Aimee Gardner, Brenda Williams, Brant Merkt, Rachel Keller-Smith, Rebecca DeBra, Shawn McDonough, Gina Klein, Sang Hoon Lee, Kelly Ely, Yin Zhang, Michelle Rios, Gary L Geis","doi":"10.1542/hpeds.2024-008312","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008312","url":null,"abstract":"<p><strong>Objective: </strong>We used simulation-based clinical systems testing (SbCST) to identify and mitigate latent safety threats (LSTs) before opening a large critical care building (CCB) at a pediatric institution.</p><p><strong>Methods: </strong>We completed an SbCST project to identify LSTs before opening a 7-floor, 319-bed CCB at a pediatric institution. The extensive preparation process included warehouse planning sessions and a formal intake process. A total of 20 care units/groups had at least one 3-hour in situ simulation session. Each simulation scenario lasted approximately 1 hour (20-minute simulation, 40-minute debriefing). Participants included clinical teams and unit stakeholders. Facilitators received SbCST training, led debriefing using a modified Promoting Excellence And Reflective Learning (PEARLS) format, and documented LSTs along with suggested mitigations. Unit/group stakeholders scored LSTs using failure modes and effect analysis (FMEA) and were responsible for completing mitigations.</p><p><strong>Results: </strong>We completed 128 of 141 (91%) scheduled sessions over a 9-week period. Across all sessions, 238 scenarios were completed. The mean number of scenarios was 2 per session and 12 per unit/care group. We identified 1500 LSTs; the median per scenario was 10 (IQR 7-15, range 0-54). FMEA scores were assigned to 1450 (97%) LSTs. Median FMEA was 8 (IQR 4-16); 76% of scores were low (<16). Mitigations were suggested for 951 (63%) of LSTs.</p><p><strong>Conclusions: </strong>Even at scale, SbCST is an effective tool for identifying LSTs. FMEA scoring and a categorization schema for mitigations enhanced SbCST. Although the scale of this project has limited generalizability, any application of this approach would likely enhance the safety of comparable clinical spaces.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972788","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":"Safety Officer: Hospitalist Support of Safety Practices on a Pediatric Surgical Unit.","authors":"Rachita Gupta, Lauren R Anderson, Heather J Bennett, Richele Koehler, Jonathan P Roach, Michelle Fennell, Jacquelyn Scarberry, Miriam Conant, Jason Zamkoff, Jessica Thysens, Justin M Lockwood","doi":"10.1542/hpeds.2024-008006","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008006","url":null,"abstract":"<p><strong>Introduction: </strong>A quality improvement initiative targeting emergency transfer (ET) rate reduction resulted in the development and implementation of the safety officer (SO) intervention. SO leveraged on-site pediatric hospitalists to promote institutional safety practices around care escalation for all patients admitted to the target unit, including those admitted to surgical subspecialty services.</p><p><strong>Methods: </strong>An interdisciplinary team developed the SO intervention, which included ad hoc support of communication algorithms and attendance at all Rapid Response Team (RRT) activations on the target unit. To evaluate SO implementation, we applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We obtained data through postimplementation surveys, manual case review, and electronic health record reporting. We analyzed survey data using descriptive statistics and clinical data using statistical process control charts.</p><p><strong>Results: </strong>Most SOs completed training (85%). The survey response rate was 30%; 40% were hospitalist clinicians, 24% were RRT participants, 18% were surgeons, and 18% were bedside nurses. Many respondents believed SO improved the unit's safety culture (56%). Nurses reported improved ability to escalate care (94%), and intensive care unit clinicians reported enhanced RRT practices. SO involvement in RRTs increased from 0% to 78%. Non-SO clinicians did not believe SO detracted from ownership of their patients (97%), and SOs felt they could effectively balance competing responsibilities (92%). We did not observe a change in ET rates.</p><p><strong>Conclusion: </strong>By implementing the SO intervention, we successfully integrated hospitalists for managing care escalations and improved perceived safety culture. Further study is needed to evaluate whether SO can improve rare adverse events like ETs.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972838","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}