Hospital pediatrics最新文献

{"title":"Systemic Corticosteroids for Acute Viral Bronchiolitis: A Retrospective Multicenter Cohort Study.","authors":"Kayla Delaney, Alexa R Roberts, John M Morrison, Jennifer W Leiding, Anthony A Sochet","doi":"10.1542/hpeds.2024-008221","DOIUrl":"10.1542/hpeds.2024-008221","url":null,"abstract":"<p><strong>Background: </strong>The American Academy of Pediatrics (AAP) 2014 clinical practice guidelines for acute viral bronchiolitis caution against systemic corticosteroid administration. We sought to estimate corticosteroid prescribing rates among critically ill children hospitalized for bronchiolitis and characterize clinical features by corticosteroid prescription.</p><p><strong>Patients and methods: </strong>We performed a retrospective, multicenter cohort study using the Pediatric Hospital Information System database that included children aged 1 to 23 months admitted for acute viral bronchiolitis within 48 pediatric intensive care units from 2013 to 2023. Corticosteroid prescription rates were assessed by year, season, and institution. Patient characteristics, treatments, and clinical outcomes were compared using cohorts defined by corticosteroid prescription.</p><p><strong>Results: </strong>Of 81 376 encounters studied, 30 509 (37.5%) were prescribed corticosteroids. Joinpoint regression of annual prescribing rates yielded a single breakpoint model with prescribing rates decreasing by 2.9% per year before and increasing by 2.1% after 2018. Prescription rates ranged widely by center (17.8%-60.9%). Greater corticosteroid prescription was observed in summer as compared to winter months. Compared to those not prescribed corticosteroids, those prescribed corticosteroids were older (mean age: 10.1 ± 6.3 vs 6.9 ± 5.8 months), had a greater median Pediatric Medical Complexity Algorithm classification (2 [interquartile range, IQR: 1-3] vs 1 [IQR: 1-2]), experienced a longer median length of stay (5 [IQR: 3-10] vs 4 [IQR: 3-6] days), had greater invasive mechanical ventilation rates (33.3% vs 11.8%), and greater albuterol prescription rates (29.6% vs 3.9%; all P < .001).</p><p><strong>Conclusions: </strong>Corticosteroid use among critically ill children with acute viral bronchiolitis remains modest in lieu of AAP recommendations. Prospective research is needed to delineate clinical efficacy for this indication and offer insight for future guidelines.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"590-597"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318232","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 Blood Culture Contamination Rates and Risk Factors in a Large Integrated Health System.","authors":"Kelsey Childress, Michael Hartmann, Giselle Fernandes, Nancy Fong, Peter Cooch, Marilyn L Kwan","doi":"10.1542/hpeds.2024-008184","DOIUrl":"10.1542/hpeds.2024-008184","url":null,"abstract":"<p><strong>Introduction: </strong>Contaminated blood cultures result in unnecessary use and antibiotic exposure. US studies have found contamination rates of 0.6 to 6; however, the rates and risk factors of blood culture contamination (BCC) across age groups in children are not well understood.</p><p><strong>Objective: </strong>The objective of this study was to calculate rates of BCC by pediatric age groups and identify risk factors for BCC.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 89 948 blood cultures obtained from 2014 to 2022 in outpatient and hospital settings within a multicenter health care system. Cultures with commensal organisms were considered contaminated after excluding patients with immunodeficiencies, history of malignancy, and indwelling catheters. Multivariable logistic regression models estimated odds ratios (OR) and 95% CIs for the association of risk factors and odds of BCC.</p><p><strong>Results: </strong>Among 89 948 total blood cultures, 1594 (1.8%) were identified as likely contaminants. The BCC rate was greatest in infants: 2.0% in the 0- to 28-day-old age group, 5.4% in 29- to 90-day-old age group, and 2.7% in the 90-day- to 1-year age group. Emergency department (ED) nurses had the highest odds of contamination compared with phlebotomists (OR = 2.79, 95% CI: 2.47-3.15). Inpatient nurses had lower odds of contamination compared with phlebotomists for newborns aged 0 to 28 days (OR = 0.36, 95% CI: 0.28-0.46) but had higher odds for patients aged older than 1 year. Inpatient nurses had the highest odds compared with phlebotomists for patients aged 5 to 12 years (OR = 6.90, 95% CI: 4.08-11.75).</p><p><strong>Conclusions: </strong>Younger patient age and ED nurse blood cultures had greater odds of contamination. Results can inform focused training on quality collection and testing techniques, as well as the creation of enhanced staffing models to increase phlebotomist collections.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e286-e292"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286667","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":"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":"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":"616-622"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","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":"Quality Improvement Reduces Excessive Serum Bilirubin Laboratory Draws in a Community Hospital Nursery.","authors":"Emily Pak, Arvinder Thiara, Haeli Park, Julia Marlow, Lidia Park, Thomas Hood, Nicole Bettencourt, Michelle Hamline","doi":"10.1542/hpeds.2024-008180","DOIUrl":"10.1542/hpeds.2024-008180","url":null,"abstract":"<p><strong>Background: </strong>Newborn jaundice is common and requires appropriate monitoring and treatment to prevent acute bilirubin encephalopathy and kernicterus. Minimizing total serum bilirubin (TsB) draws has many benefits, including decreasing blood loss and painful procedures, as well as saving time and costs.</p><p><strong>Objective: </strong>The objective of this study was to test an iterative quality improvement process to reduce the percentage of newborns receiving TsB draws by half, ie, from 30.6% to 15.3%, at a community hospital nursery over 18 months.</p><p><strong>Methods: </strong>Baseline data were collected retrospectively, and intervention period data were collected prospectively. Root cause analysis revealed a lack of consensus for when a TsB draw is needed. Interventions included the following: (1) dissemination of 2022 American Academy of Pediatrics hyperbilirubinemia guidelines, (2) physician journal club and consensus on practice changes, (3) monthly team meetings to review data and troubleshoot barriers, (4) use of the BiliTool calculator, and (5) nursing education. The primary outcome was percentage of newborns who had a TsB draw. Secondary outcomes were percentage of newborns requiring phototherapy, average length of stay, and average number of TsB draws per newborn who had a TsB draws. The balancing measure was the 7-day readmission rate. Outcome measures were analyzed using statistical process control.</p><p><strong>Results: </strong>The percentage of newborns receiving a TsB draw declined from 30.6% to 17.3%. The percentage of newborns receiving phototherapy decreased from 7.6% to 5.2%. Average length of stay, average number of TsB draws per patient who had a TsB draw, and readmission rate remained unchanged.</p><p><strong>Conclusions: </strong>An iterative quality improvement process effectively decreases unnecessary newborn TsB draws. This process may be used by other community hospitals to affect change in their nurseries.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"582-589"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486389","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":"We Have New Sepsis Criteria for Children…Now What?","authors":"Sarah B Walker, Justin M Lockwood, Halden F Scott, L Nelson Sanchez-Pinto, Tellen D Bennett","doi":"10.1542/hpeds.2025-008421","DOIUrl":"10.1542/hpeds.2025-008421","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e315-e317"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369321","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":"Rapid Implementation of Updated Guidelines for Neonatal Hyperbilirubinemia.","authors":"Elizabeth L Nguyen, Neha S Joshi","doi":"10.1542/hpeds.2024-008283","DOIUrl":"10.1542/hpeds.2024-008283","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e309-e311"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250105","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":"Searching for the Best Recipe for Complex Care Services for Children With Neurologic Impairment.","authors":"Stefanie G Ames, Ryan J Coller","doi":"10.1542/hpeds.2025-008587","DOIUrl":"10.1542/hpeds.2025-008587","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e312-e314"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303063","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":"Impact of the 2022 AAP Guidelines on Neonatal Hyperbilirubinemia Admissions: A PHIS Study.","authors":"Aisha Jameel, Troy Richardson, Jonathan L Slaughter","doi":"10.1542/hpeds.2024-008205","DOIUrl":"10.1542/hpeds.2024-008205","url":null,"abstract":"<p><strong>Objectives: </strong>The American Academy of Pediatrics (AAP) 2022 update on the management of hyperbilirubinemia in neonates at or more than 35 weeks of gestation is a clinical practice guideline that sought to safely reduce unnecessary phototherapy in newborns. We assessed hyperbilirubinemia-related hospitalizations and length of stay (LOS) at freestanding US children's hospitals in the year following the guideline's release.</p><p><strong>Patients and methods: </strong>This cohort study used data from the Pediatric Health Information System database to identify infants aged 2 to 14 days who were hospitalized during the 12 months preceding and following the publication of the revised AAP hyperbilirubinemia guideline. We analyzed changes in the probability of hospitalization for jaundice, following the publication of the guidelines using interrupted time series regression.</p><p><strong>Results: </strong>There was a significant decrease in the probability of hospitalization for jaundice immediately after the publication of the guidelines (5051 admissions to 3778 admissions; P < .001). Although LOS slightly increased (from 29 to 32 hours [P < .001]) for all infants, there was no difference in LOS for infants without comorbidities. Utilization of intravenous immunoglobulin, exchange transfusions, and the incidence of kernicterus were unchanged pre- and post-guidelines.</p><p><strong>Conclusions: </strong>Hospitalization for jaundice decreased in children's hospitals during the year immediately following the release of the 2022 hyperbilirubinemia guidelines. LOS did not change in infants without comorbidities. Further studies are needed to evaluate outcomes such as kernicterus and hospitalization over time.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"537-544"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250104","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":"Family Perceptions of Pediatric Acute Hospital Care at Home in the United States: A Qualitative Analysis.","authors":"Ryan C L Brewster, R Thomas Day, Alex Butler, Elaine Lin, David M Levine, Jay G Berry","doi":"10.1542/hpeds.2025-008334","DOIUrl":"10.1542/hpeds.2025-008334","url":null,"abstract":"<p><strong>Objective: </strong>Acute hospital care at home has emerged as an alternative to conventional hospitalization with comparable, if not better, clinical outcomes and patient experience in adults and internationally. To date, no programs serve a pediatric population in the United States. We aimed to qualitatively assess the perceptions of patient caregivers toward pediatric home hospital (HH) to inform family-centered design and implementation.</p><p><strong>Patients and methods: </strong>Semistructured interviews were performed with a purposive sample of family caregivers of children who were recently hospitalized at an urban freestanding children's hospital. Interviews focused on experiences with previous hospitalization along with perceptions of pediatric HH that emphasized potential benefits and challenges. Qualitative data were coded and analyzed using thematic analysis to construct core themes.</p><p><strong>Results: </strong>Among 20 caregiver participants, we identified 3 central themes. Relative to inpatient hospitalization, which was associated with disruptions to family routine and psychosocial stressors among other challenges, (1) family caregivers were largely receptive to the HH concept and described numerous potential benefits, including improved physical comfort, patient behavior, and hospital capacity management; (2) concerns about caregiver burden, clinical monitoring and safety, and scalability to different geographies and household conditions were noted as barriers to HH implementation; and (3) participants emphasized the importance of pediatric expertise among HH clinicians.</p><p><strong>Conclusions: </strong>HH was perceived to address many of the unintended consequences of conventional hospitalization with the potential to deliver more family-centered care. However, attention to unique clinical, psychosocial, and operational challenges are required to adapt existing models to the pediatric population in the United States.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"607-615"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508755","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":"Cancer Risk Associated With Radiation Doses Used for CT Scans in Pediatric and General Hospitals.","authors":"Malini Mahendra, Matthew N Malekhedayat, Philip W Chu, Carly Stewart, Yifei Wang, Naomi S Bardach, Rebecca Smith-Bindman","doi":"10.1542/hpeds.2024-008256","DOIUrl":"10.1542/hpeds.2024-008256","url":null,"abstract":"<p><strong>Objective: </strong>Describe radiation doses used in common computed tomography (CT) scans by hospital type and estimate the impact of observed dose differences on associated lifetime cancer risk.</p><p><strong>Patients and methods: </strong>Retrospective cohort study in patients aged <21 years undergoing 192 185 CT scans included in a large CT dose registry. Scans were assigned to CT category based on body region imaged, clinical indication, and radiation doses used (routine head, low-dose head, neck, routine chest, routine abdomen). Median radiation doses were compared among hospital types. Excess cancer risks were estimated using the National Cancer Institute Cancer Risk calculator.</p><p><strong>Results: </strong>For routine head and abdomen and pelvis CT in children aged 12 to <21 years (45% of all scans), radiation doses were 20% to 30% lower in pediatric hospitals (P < .001). In children aged <12 years, routine head doses were 20% lower in pediatric hospitals; abdomen doses varied by age. Pediatric hospitals used radiation doses 30% to 100% higher in children <12 undergoing chest CT (P < .001). An estimated 5500 excess cancers are associated with radiation from CT performed annually in children. An estimated 1200 cancers are associated with differences in dosing.</p><p><strong>Conclusions: </strong>Radiation doses used for pediatric CT are associated with the development of an estimated 5500 future cancers annually. Differences in radiation doses are associated with an excess estimated 1200 radiation-associated cancers. Further study is needed to determine why dose variation exists in children and adolescents and if optimal doses are being used for the clinical indication of the examination.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"598-606"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235480","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}