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Obesity and Severe Obesity in Youth Before and During COVID-19. 在COVID-19之前和期间的青少年肥胖和严重肥胖。
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2026-01-01 DOI: 10.1542/peds.2024-070370
Sarah E Messiah, Yujia Guo, Luyu Xie, Deepali K Ernest, Eurídice Martínez Steele, Daniela Neri, Margaret E Sova McCabe, Stacia M DeSantis, Bethany R Cartwright, Steven E Lipshultz, Sarah E Barlow

Background and objectives: Childhood obesity has remained persistently high in the United States. This study aimed to (1) assess changes in obesity prevalence and (2) examine the associations of ultra-processed food (UPF) intake and physical activity (PA) patterns with obesity, by obesity severity, before and during the COVID-19 pandemic among US 2- to 19-year-olds.

Methods: A serial cross-sectional analysis using the National Health and Nutrition Examination Survey compared data from before (2017 to March 2020) and during (August 2021 to August 2023) the COVID-19 pandemic. Obesity was determined using body-mass-index-for-age percentiles: class I obesity (≥95th percentile to <120% of the 95th percentile), class II (≥120% to <140%), and class III (≥140% of the 95th percentile). UPF intake was assessed via 24-hour dietary recalls. Participants self-reported the number of days/week they engaged in moderate to vigorous PA. Survey logistic regression models assessed the odds of increasing obesity severity by UPF intake and PA, age, sex, race, ethnicity, and household income.

Results: Analysis included 4756 participants in the pre-pandemic period and 2501 in the pandemic period. Obesity prevalence was 21.2% pre-pandemic (N = 1072) and 22.6% during the pandemic (N = 694; P = .30). Mean %UPF intake decreased from 66.0% to 62.7% (P < .01). Before the pandemic, adjusted analysis showed youth with higher PA days had lower odds of class II obesity (odds ratio [OR] = 0.86, 95% CI: 0.76-0.97) and overall obesity (OR = 0.91, 95% CI: 0.85-0.97), with a protective effect across class I and III that did not reach significance. During the pandemic, meeting PA guidelines was also protective against overall obesity (OR = 0.86, 95% CI: 0.76-0.99). Although no significant predictors of obesity by class emerged during the pandemic, protective nonsignificant effects of PA were also observed.

Conclusions: Obesity prevalence trended up from before to during the pandemic, and PA was associated with obesity, whereas no distinct associations of UPF and increasing obesity severity emerged.

背景和目的:美国儿童肥胖率居高不下。本研究旨在(1)评估肥胖患病率的变化,(2)研究超加工食品(UPF)摄入量和身体活动(PA)模式与肥胖的关系,根据肥胖严重程度,在美国2至19岁的青少年中,在2019冠状病毒病大流行之前和期间。方法:采用全国健康与营养调查进行系列横断面分析,比较2019冠状病毒病大流行前(2017年至2020年3月)和期间(2021年8月至2023年8月)的数据。肥胖采用年龄体重指数百分位数确定:I类肥胖(≥95百分位数至)结果:分析包括4756名大流行前和2501名大流行期间的参与者。肥胖患病率在大流行前为21.2% (N = 1072),大流行期间为22.6% (N = 694; P = 0.30)。UPF的平均摄入量从66.0%下降到62.7% (P结论:肥胖症患病率从疫情前到疫情期间呈上升趋势,PA与肥胖症相关,而UPF与日益严重的肥胖症之间没有明显的关联。
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引用次数: 0
Outcomes of Universal Newborn G6PD Deficiency Screening in a Large Urban Cohort. 在大型城市队列中新生儿G6PD缺乏筛查的结果
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2026-01-01 DOI: 10.1542/peds.2025-072850
Katherine Dalldorf, Sarah Milburn, Brenton Francisco, Gabriella Ahle, Sharon Arguello-Angarita, Krystal Aris, Mia Bates, Mariana Budge, Delaney Dalldorf, Cindy Jiang, Kelly Lau, Sarah Mink, Daisy Reinoso, Austin Yoders, Olivia Zhong, Vinod Bhutani, Katherine F Guttmann, Andrea S Weintraub

Objective: To describe demographics and explore outcomes of newborns impacted by glucose-6-phosphate dehydrogenase (G6PD) deficiency in our health system during the first year of universal screening following the 2022 New York State mandate.

Methods: In this retrospective review, clinical data were compared across infants with normal, intermediate, and deficient G6PD enzyme levels. Categorical variables were analyzed using χ2 tests. Continuous variables were compared using Kruskal-Wallis and Mann-Whitney U tests. To ascertain whether all G6PD-deficient infants would have been captured by a risk factor-based approach, demographic data were reviewed.

Results: The study cohort comprised 5470 infants. The prevalence of G6PD deficiency and intermediate status were 1.7% and 2.4%, respectively, with 2.9% of male infants testing deficient. G6PD-deficient infants had higher bilirubin levels and were more likely to require phototherapy during birth hospitalization (P < .001) and be readmitted for phototherapy (P = .04) compared with G6PD-sufficient infants. Thirteen percent of infants with G6PD deficiency had parents who identified as "white" and "Ashkenazi Jewish." Twenty-two percent of G6PD-deficient newborns had parents who identified as "Puerto Rican" or "Dominican." Risk factor-based screening would have missed 44% of affected newborns prior to hospital discharge.

Conclusions: G6PD-deficient newborns are more likely to require phototherapy than G6PD-sufficient infants. Exchange transfusion and bilirubin-induced neurotoxicity are rare, likely due to protocolized bilirubin management. Our findings suggest that infants will be missed by risk factor-based screening such as that recommended by New York State.

目的:描述人口统计学特征,并探讨在2022年纽约州规定的全民筛查的第一年,卫生系统中受葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症影响的新生儿的结局。方法:在这项回顾性研究中,比较了正常、中等和缺乏G6PD酶水平的婴儿的临床数据。分类变量分析采用χ2检验。采用Kruskal-Wallis检验和Mann-Whitney U检验比较连续变量。为了确定是否所有g6pd缺陷婴儿都可以通过基于风险因素的方法被捕获,我们回顾了人口统计数据。结果:研究队列包括5470名婴儿。G6PD缺乏症和中等状态的患病率分别为1.7%和2.4%,其中2.9%的男婴检测出G6PD缺乏症。g6pd缺乏的婴儿在出生住院期间胆红素水平较高,更可能需要光疗(P结论:g6pd缺乏的新生儿比g6pd充足的婴儿更可能需要光疗。交换输血和胆红素引起的神经毒性是罕见的,可能是由于胆红素管理方案。我们的研究结果表明,纽约州推荐的基于风险因素的筛查会遗漏婴儿。
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引用次数: 0
Pediatric Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations. 儿科生命支持:2025年国际复苏联络委员会科学共识与治疗建议。
IF 6.4 2区 医学 Q1 PEDIATRICS Pub Date : 2026-01-01 DOI: 10.1542/peds.2025-074853
Barnaby R Scholefield, Jason Acworth, Kee-Chong Ng, Lokesh Kumar Tiwari, Tia T Raymond, Andrea Christoff, Stephan Katzenschlager, Raffo Escalante-Kanashiro, Arun Bansal, Alexis Topjian, Monica Kleinman, Hiroshi Kurosawa, Michelle C Myburgh, Jimena Del Castillo, Joseph Rossano, Jana Djakow, Anne-Marie Guerguerian, Vinay M Nadkarni, Thomaz Bittencourt Couto, Stephen M Schexnayder, Gabrielle Nuthall, Janice A Tijssen, Gene Yong-Kwang Ong, James M Gray, Jesus Lopez-Herce, Ester Shambekela Ambunda, Jerry P Nolan, Katherine M Berg, Laurie J Morrison, Dianne L Atkins, Allan R de Caen

The International Liaison Committee on Resuscitation conducts continuous review of new peer-reviewed published cardiopulmonary resuscitation science and publishes annual summaries. More comprehensive reviews are published every 5 years. The Pediatric Life Support Task Force chapter of the 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations addresses all published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Pediatric Life Support Task Force members in the past year, as well as brief summaries of topics reviewed since 2020, to provide a more comprehensive update. In total, 39 questions related to pre-arrest, intra-arrest, and postarrest resuscitation phases of pediatric cardiac arrest are included, including systematic reviews, scoping reviews, and evidence updates. Members of the task force assessed, discussed, and debated the quality of evidence, based on Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into deliberations of the task force are provided in the Justification and Evidence-to-Decision Framework Highlights sections. The task force has also listed priority knowledge gaps for further research. Key Words: AHA Scientific Statements • cardiac arrest • cardiopulmonary arrest • cardiopulmonary resuscitation • children • ILCOR • pediatrics • resuscitation.

国际复苏联络委员会对新的同行评议的已发表的心肺复苏科学进行持续审查,并出版年度摘要。更全面的评论每5年发表一次。2025年复苏科学共识国际联络委员会儿科生命支持工作组章节涉及国际复苏联络委员会儿科生命支持工作组成员在过去一年中审查的所有已发表的复苏证据,以及自2020年以来审查的主题的简要摘要,以提供更全面的更新。总共包括39个与小儿心脏骤停的骤停前、骤停中和骤停后复苏阶段相关的问题,包括系统综述、范围综述和证据更新。工作组成员根据建议分级、评估、发展和评价标准评估、讨论和辩论证据的质量,他们的声明包括共识治疗建议。关于工作组审议的见解见“论证”和“从证据到决策框架”重点部分。工作组还列出了有待进一步研究的优先知识差距。
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引用次数: 0
Correction to "Supporting Children's Mental Health Needs in Disasters". 更正“支援灾难中儿童的心理健康需要”。
IF 8 2区 医学 Q1 PEDIATRICS Pub Date : 2025-12-23 DOI: 10.1542/peds.2025-074778
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引用次数: 0
Continuous Medicaid Eligibility, Child Insurance, and Health Care Use. 持续医疗补助资格,儿童保险和医疗保健使用。
IF 8 2区 医学 Q1 PEDIATRICS Pub Date : 2025-12-22 DOI: 10.1542/peds.2025-072529
Colleen L MacCallum-Bridges,Lindsay K Admon,Stephen W Patrick,Katy B Kozhimannil,Jamie R Daw
OBJECTIVEHealth insurance gaps are common among publicly insured children, undermining health care access and health. The Families First Coronavirus Response Act halted Medicaid disenrollments during the COVID-19 public health emergency (PHE), offering an opportunity to study the impact of continuous Medicaid eligibility on child health insurance coverage, health care access and use, and health.METHODSUsing 2016-2022 National Survey of Children's Health data (n = 182 910), we applied a difference-in-differences approach to compare changes in health insurance coverage gaps, health care access (unmet health care needs [any, mental health, and specialist]), health care use (preventive care, emergency department [ED]), and general health status before and during the PHE between publicly ("treated") and privately ("untreated") insured children. Adjusted models included child demographics, household characteristics, and state of residence. We also conducted subgroup analyses by child age and special health care need status.RESULTSContinuous Medicaid eligibility was associated with a 3.1 percentage point (pp) decrease in health insurance coverage gaps (95% CI, -3.9 to -2.3) and a 3.9 pp decrease in ED use (95% CI, -5.7 to -2.0) among publicly insured children. Among children with special health care needs (CSHCN), continuous eligibility was associated with a larger decrease in ED use (-7.5 pp, 95% CI, -11.3 to -3.7) and was additionally associated with a 6.4 pp increase (95% CI, 2.7-10.1) in excellent general health status compared with children without special health care needs. No significant associations were observed with other indicators of health care access or use.CONCLUSIONPolicies promoting continuous Medicaid eligibility may improve child health care use and health through improved coverage consistency, particularly among CSHCN.
医疗保险缺口在公共保险儿童中很常见,影响了获得医疗保健和健康。《家庭第一冠状病毒应对法案》在COVID-19突发公共卫生事件(PHE)期间停止了医疗补助计划的退出,为研究持续的医疗补助资格对儿童健康保险覆盖、医疗保健获取和使用以及健康的影响提供了机会。方法使用2016-2022年全国儿童健康调查数据(n = 182 910),我们采用差异中的差异方法来比较公共(“治疗”)和私人(“未经治疗”)保险儿童在健康保险覆盖差距、医疗保健可及性(未满足的医疗保健需求[任何、心理健康和专科])、医疗保健使用(预防保健、急诊科[ED])以及PHE之前和期间的一般健康状况的变化。调整后的模型包括儿童人口统计、家庭特征和居住状态。我们还按儿童年龄和特殊保健需要状况进行了亚组分析。结果:在公共保险儿童中,持续的医疗补助资格与健康保险覆盖差距减少3.1个百分点(95% CI, -3.9至-2.3)和ED使用减少3.9个百分点(95% CI, -5.7至-2.0)相关。在有特殊医疗需求(CSHCN)的儿童中,与没有特殊医疗需求的儿童相比,持续资格与ED使用的较大减少(-7.5 pp, 95% CI, -11.3至-3.7)相关,并且与一般健康状况良好的儿童相比,额外与6.4 pp的增加(95% CI, 2.7-10.1)相关。没有观察到与卫生保健获取或使用的其他指标有显著关联。结论促进持续医疗补助资格的政策可以通过提高覆盖面的一致性来改善儿童医疗保健的使用和健康,特别是在CSHCN中。
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引用次数: 0
Use of a Host-Protein Test for Pediatric Acute Infections at Urgent Care Centers. 在紧急护理中心使用宿主蛋白检测儿科急性感染。
IF 8 2区 医学 Q1 PEDIATRICS Pub Date : 2025-12-19 DOI: 10.1542/peds.2024-069961
Boaz Kalmovich,Ilan Yehoshua,Sara Kivity,Daniella Rahamim-Cohen,Noam Orvieto,Nechama Sharon,Michal Stein,Shirley Shapiro Ben David
OBJECTIVEEvaluate impact of MeMed BV (MMBV) host-protein test on clinical decision-making for children with acute infection in urgent care centers (UCCs).METHODSPragmatic study examining real-world use of MMBV by physicians trained to order the test when facing diagnostic uncertainty in suspected pediatric infections. Study assessed MMBV's impact on 2 decisions: whether to refer to the emergency department (ED), and, for discharged patients, whether to prescribe antibiotics. MMBV scores from 65 to 100 indicated a bacterial infection (or coinfection) and from 0 to 35 indicated viral/nonbacterial. Physicians filled pre- and post-test questionnaires. The outcomes included ED referrals, alignment between prescription and MMBV results, and 7-day post-UCC hospitalizations and antibiotic prescriptions.RESULTSThe MMBV was ordered for 2171 patients. According to post-test questionnaires (n = 1677), MMBV results encouraged referral in 3.9% and discouraged referral in 26.0% of cases. Hospitalization rates were similar when the MMBV result did not impact vs when it discouraged referral (5.5% vs 4.6%; P = .53). Among 1713 nonreferred patients, the prescription aligned with MMBV results in 80.5%. Physicians reported that MMBV results changed or supported prescription decisions in 82.0% of cases. When physicians were undecided pretest, 80.6% of bacterial MMBV and 15.9% of viral MMBV cases were managed. When physicians were likely to prescribe but MMBV results were viral, 61.7% of patients were not treated. Post-UCC hospitalizations (3.3% vs 1.5%; P = .49) and prescriptions (14.7% vs 16%; P = .74) were comparable between not treated vs treated. When unlikely to prescribe but the MMBV results were bacterial, 77.1% of patients were treated. Post-UCC prescriptions were higher among cases not managed at a UCC (33.3% vs 13.2%; P = .02).CONCLUSIONSMMBV aided safe clinical decision-making for pediatric acute infections in UCCs.
目的评价MeMed BV (MMBV)宿主蛋白检测对急诊中心(UCCs)急性感染患儿临床决策的影响。方法一项实用的研究调查了在面对疑似儿童感染的诊断不确定性时,接受过MMBV测试培训的医生在现实世界中使用MMBV的情况。研究评估了MMBV对两项决定的影响:是否转诊到急诊科(ED),以及出院患者是否开抗生素。MMBV评分从65到100表示细菌感染(或合并感染),从0到35表示病毒/非细菌感染。医生填写了测试前和测试后的问卷。结果包括急诊转诊,处方和MMBV结果之间的一致性,ucc后7天住院和抗生素处方。结果2171例患者订购了MMBV。根据测试后问卷(n = 1677), MMBV结果鼓励转诊的占3.9%,不鼓励转诊的占26.0%。当MMBV结果不影响和不鼓励转诊时,住院率相似(5.5%对4.6%;P = 0.53)。在1713名非转诊患者中,处方与MMBV相符的比例为80.5%。医生报告说,在82.0%的病例中,MMBV结果改变或支持处方决定。当医生在检测前犹豫不决时,80.6%的细菌性MMBV和15.9%的病毒性MMBV得到了治疗。当医生可能会开处方,但MMBV结果是病毒性的,61.7%的患者没有得到治疗。ucc后住院率(3.3% vs 1.5%; P =。49)和处方(14.7% vs 16%; P =。74)在未治疗和治疗之间具有可比性。当不太可能开处方但MMBV结果为细菌性时,77.1%的患者接受了治疗。未在UCC管理的病例中,UCC后处方更高(33.3% vs 13.2%; P = 0.02)。结论smmbv有助于UCCs儿童急性感染的安全临床决策。
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引用次数: 0
New Test, Old Dilemma: Distinguishing Viral From Bacterial Infections. 新的测试,旧的困境:区分病毒和细菌感染。
IF 8 2区 医学 Q1 PEDIATRICS Pub Date : 2025-12-19 DOI: 10.1542/peds.2025-073159
Rebecca G Same,Jeffrey S Gerber
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引用次数: 0
Noncirrhotic Portopulmonary Hypertension Due to Hepatoportal Sclerosis in Adams-Oliver Syndrome. 亚当斯-奥利弗综合征中由肝门静脉硬化引起的非肝硬化门脉肺动脉高压。
IF 8 2区 医学 Q1 PEDIATRICS Pub Date : 2025-12-18 DOI: 10.1542/peds.2025-073243
Jennifer Merk,Delphine Yung,Jason N Wright,Raj P Kapur
A 13-year-old girl presented for evaluation of pulmonary hypertension after symptoms of dyspnea and exercise intolerance. Full evaluation was negative except for abdominal ultrasonography with splenomegaly and esophageal varices suggestive of portal hypertension. Cardiac and hepatic vein catheterization confirmed portopulmonary hypertension. Liver biopsy demonstrated sinusoidal dilatation, nodularity, and minimal fibrosis, which was interpreted as possible nodular regenerative hyperplasia but not cirrhosis. Radiographic imaging, including computed tomography venography, demonstrated an elongated and severely stenotic extrahepatic portal vein, and portal hypertension was presumed to be secondary to congenital portal vein hypoplasia. She was treated with ambrisentan with initial improvement in symptoms and estimated pulmonary pressure. Whole-exome sequencing revealed a likely pathogenic missense mutation in Delta-like canonical Notch ligand 4 associated with Adams-Oliver syndrome. After 2 years, pulmonary hypertension and right heart failure symptoms worsened, along with liver failure. She then had fulminant liver failure and cardiorespiratory arrest. Resuscitative efforts included extracorporeal membranous oxygenation (ECMO), but because of hypoxic brain injury, care was compassionately withdrawn. Autopsy limited to the thorax and abdomen revealed high-grade pulmonary plexiform arteriopathy, splenomegaly, esophageal varices, and large splenorenal shunt. The liver was small with a nodular surface but not fibrotic. The entire length of the extrahepatic portal vein was severely stenotic, and intrahepatic portal veins were missing or diminutive-findings diagnostic of hepatoportal sclerosis. Noncirrhotic portopulmonary hypertension is rare and should include evaluation of immunologic, infectious, toxic, thrombotic, and genetic etiologies. Unfortunately, there is no known treatment of hepatoportal sclerosis.
一个13岁的女孩在出现呼吸困难和运动不耐受的症状后,提出了肺动脉高压的评估。除了腹部超声显示脾肿大和食道静脉曲张提示门静脉高压外,其他评价均为阴性。心肝静脉置管证实肺动脉高压。肝活检显示窦状窦扩张、结节性和轻微纤维化,这可能被解释为结节性再生增生,但不是肝硬化。放射影像,包括计算机断层静脉摄影,显示肝外门静脉延长和严重狭窄,门静脉高压被认为是继发于先天性门静脉发育不全。她接受了安布里森坦治疗,最初症状和估计的肺动脉压有所改善。全外显子组测序显示,与Adams-Oliver综合征相关的delta样规范Notch配体4可能存在致病性错义突变。2年后,肺动脉高压和右心衰症状加重,并伴有肝功能衰竭。随后,她出现了暴发性肝衰竭和心肺骤停。复苏努力包括体外膜氧合(ECMO),但由于缺氧脑损伤,护理被同情地退出。尸检局限于胸部和腹部,结果显示高度肺丛状动脉病变、脾肿大、食管静脉曲张和大脾肾分流。肝脏小,表面呈结节状,但未纤维化。肝外门静脉全长度严重狭窄,肝内门静脉缺失或小表现是肝门静脉硬化的诊断。非肝硬化门脉性肺动脉高压是罕见的,应包括免疫、感染性、毒性、血栓性和遗传病因的评估。不幸的是,没有已知的治疗肝门静脉硬化的方法。
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引用次数: 0
Advances in Pediatric Therapeutic Drug Monitoring. 儿童治疗药物监测进展。
IF 8 2区 医学 Q1 PEDIATRICS Pub Date : 2025-12-18 DOI: 10.1542/peds.2025-073013
Sarah A Coggins,Kelly C Wade,Kevin J Downes
Therapeutic drug monitoring (TDM) is indicated for drugs with narrow therapeutic indices, whereby clinicians can adjust drug dosing to promote efficacy while limiting toxicity risk. Such monitoring is particularly important in managing infectious diseases, as both patient- and organism-specific factors must be considered to achieve optimal clinical responses. Innovation in pediatric TDM lags behind adults, largely due to a paucity of data and feasibility issues with lab draws and pharmacy resources. Emerging techniques in pharmacokinetic (PK) modeling, PK study design, flexible sampling strategies, and reduced sample volume requirements are particularly promising for TDM advancement in neonates and children. In this article, we discuss recent advancements in vancomycin TDM as a model case. Vancomycin is commonly used to treat serious gram-positive infections in children, and monitoring was historically performed using trough concentration-based guidance. Emerging data suggest that vancomycin troughs are not reliable surrogates for efficacy or toxicity and that trough-based monitoring is associated with increased risk of nephrotoxicity without clinical benefits. The area under the concentration-time curve (AUC) is the optimal pharmacokinetic-pharmacodynamic metric to measure overall vancomycin exposures, and consensus infectious diseases and pharmacist society guidance has formally recommended a shift toward AUC-based monitoring and away from trough-based monitoring in all age groups-including in neonates and children. We compare approaches to TDM in infectious diseases and summarize the body of literature describing application of vancomycin AUC-guided monitoring in children and neonates. Finally, we highlight opportunities and potential barriers to implementation of AUC-guided TDM in pediatric populations.
治疗性药物监测(TDM)适用于治疗指标较窄的药物,临床医生可以通过调整给药剂量来提高疗效,同时限制毒性风险。这种监测在传染病管理中尤其重要,因为必须考虑到患者和生物体特异性因素,以实现最佳的临床反应。儿童TDM的创新落后于成人,主要是由于缺乏数据以及实验室和药房资源的可行性问题。药代动力学(PK)建模、PK研究设计、灵活采样策略和减少样本量要求等新兴技术对新生儿和儿童TDM的进展尤其有希望。在本文中,我们以万古霉素TDM为例,讨论其最新进展。万古霉素通常用于治疗儿童严重的革兰氏阳性感染,历史上使用以浓度为基础的指导进行监测。新出现的数据表明,万古霉素槽不是疗效或毒性的可靠替代品,基于槽的监测与肾毒性风险增加有关,没有临床益处。浓度-时间曲线下面积(AUC)是衡量万古霉素总体暴露的最佳药代动力学-药效学指标,传染病和药剂师协会的共识指南正式建议在所有年龄组(包括新生儿和儿童)转向以AUC为基础的监测,而不是以槽为基础的监测。我们比较了感染性疾病TDM的治疗方法,并总结了万古霉素auc引导下监测在儿童和新生儿中的应用文献。最后,我们强调了在儿科人群中实施auc引导的TDM的机会和潜在障碍。
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引用次数: 0
Improving Emergency Department Boarding Time: Balancing Efficiency and Safety. 提高急诊科登机时间:平衡效率与安全。
IF 8 2区 医学 Q1 PEDIATRICS Pub Date : 2025-12-17 DOI: 10.1542/peds.2025-072144
Adam A Vukovic,Tricia Purcell,Stephanie Thomas,Michelle A Recto,Patrick S Donahue,Michael Fatten,Sean Bartlett,Amanda Thorne,Brenda Demeritt,Janelle Ballinger,Ginger Coffey,Karen Tucker,DeAnna Hawkins,Christine M White,Angela M Statile,Trisha L Marshall
BACKGROUND AND OBJECTIVEEmergency department (ED) crowding and prolonged boarding times negatively impact care. Our objective was to decrease the average ED boarding time for patients admitted from the ED to any inpatient (IP) acute care unit at our main campus by 35% over 24 months.METHODSOur multidisciplinary team used the Model for Improvement to identify inefficiencies within the existing admission process and created a key driver diagram to guide intervention design. Serial Plan-Do-Study-Act cycles tested and refined interventions initially piloted on one high-volume IP unit before implementation across the institution. Interventions focused on creating shared knowledge of the admission process, optimizing IP room preparation, improving communication between process stakeholders, and streamlining the admission process. We used statistical process control charts to measure the impact of our interventions over time. Our outcome measure was ED boarding time. Very rapid transfer rate, or patients transferred to an intensive care unit within 3 hours of admission, and ED length of stay (LOS) were balancing measures. Our left without being seen (LWBS) rate served as a measure of care access.RESULTSOur average ED boarding time decreased by 40% from 169 to 102 minutes, accompanied by a decrease in ED LOS and LWBS rate. There was no change in our very rapid transfer rate.CONCLUSIONSEngaged institutional and site of care leadership was integral to our project success. By understanding our system, creating clear expectations for process timelines, and streamlining communication, we were able to meaningfully improve transitions of care.
背景与目的急诊科(ED)拥挤和登机时间延长对护理产生负面影响。我们的目标是在24个月内将从急诊科到主校区任何住院急症护理病房的患者的平均急诊科入住时间减少35%。方法我们的多学科团队使用改进模型来识别现有入院流程中的低效率,并创建关键驱动图来指导干预设计。一系列计划-执行-研究-行动循环测试和改进干预措施,最初在一个大容量IP单元进行试点,然后在整个机构实施。干预措施侧重于创建入院流程共享知识,优化IP室准备,改善流程利益相关者之间的沟通,并简化入院流程。我们使用统计过程控制图来衡量我们的干预措施随时间的影响。我们的结果测量是ED登机时间。非常快的转院率,或患者在入院3小时内转至重症监护病房,和急诊科的住院时间(LOS)是平衡措施。我们的左侧未被看到率(LWBS)被用来衡量获得护理的机会。结果我们的平均ED登机时间从169分钟减少到102分钟,减少了40%,同时ED的LOS和LWBS率也有所下降。我们非常快的转移速度没有变化。参与机构和护理场所的领导是我们项目成功的组成部分。通过了解我们的系统,为流程时间表制定明确的期望,并简化沟通,我们能够有意地改善护理的过渡。
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引用次数: 0
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Pediatrics
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