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Inpatient Food Insecurity and Hospital Length of Stay in Pediatric Patients With Asthma. 儿童哮喘患者的住院食物不安全与住院时间
IF 2.1 Q1 Nursing Pub Date : 2026-02-01 DOI: 10.1542/hpeds.2025-008639
Benjamin A Peterson, Callie Brown, Kimberly Montez, Leila H DeWitt
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引用次数: 0
Pediatric Emergency Department Visits for Opioid Overdose in the United States. 美国阿片类药物过量儿科急诊科就诊情况
IF 2.1 Q1 Nursing Pub Date : 2026-02-01 DOI: 10.1542/hpeds.2025-008620
Gabriel Devlin, Mia Kanak, Matt Hall, Diane Tanaka, Jenny Bohorquez, Megan Gribbons, Pradip P Chaudhari

Background: Fatal opioid overdoses among children have increased 4-fold since 2018, driven by unintentional fentanyl overdoses in adolescents. Detailed descriptions profiling nonfatal overdoses that present to emergency departments (EDs) amidst this surge in deaths are lacking.

Methods: We performed a retrospective cross-sectional study of the Pediatric Health Information System, an administrative database of tertiary-care children's hospitals. We included children and youths aged 0 to 19 years who had an ED visit for opioid overdose from 2017 to 2022 using International Classification of Diseases, Tenth Revision codes. We excluded incomplete encounters. We examined temporal trends using Poisson regression models or quasi-Poisson models if data was overdispersed.

Results: We identified 4550 ED visits for opioid overdose. ED visits for opioid overdose rose 20.2% (incidence rate ratio [IRR], 1.0001; P < .001) from 2017 to 2022. Increases were highest among patients aged 0 to 4 and 15 to 19 years; male; those self-identifying as Black, Hispanic or multiracial; urban; and publicly insured. Children aged 0 to 4 and 15 to 19 years accounted for most visits (45.7% and 35.2%, respectively). Although synthetic opioid overdoses increased (IRR, 1.0002; P < .001) and were the predominant agent among children aged 0 to 4 years, prescription opioid overdoses were more common overall. Most adolescent overdoses were intentional. Rates of intensive care admission increased (IRR, 1.0004; P < .001). Fatal overdoses rose 200% (IRR, 1.0008; P = .02).

Conclusion and relevance: Increasing numbers of children are presenting to pediatric EDs for opioid overdose and in increasingly critical condition. Unlike fatal overdoses, most pediatric ED visits are for young children experiencing synthetic opioid overdose and adolescents with intentional prescription opioid overdose.

背景:自2018年以来,致命的阿片类药物过量在儿童中增加了4倍,这是由于青少年无意中过量使用芬太尼造成的。在死亡人数激增的情况下,急诊室(EDs)缺乏对非致命性过量用药的详细描述。方法:我们对儿童健康信息系统(一个三级保健儿童医院的管理数据库)进行了回顾性横断面研究。我们使用国际疾病分类第十次修订代码纳入了2017年至2022年因阿片类药物过量而就诊的0至19岁的儿童和青少年。我们排除了不完全接触。如果数据过度分散,我们使用泊松回归模型或准泊松模型检查时间趋势。结果:我们确定了4550例阿片类药物过量就诊。阿片类药物过量的急诊科就诊人数上升了20.2%(发病率比[IRR], 1.0001; P结论及相关性:越来越多的儿童因阿片类药物过量而到儿科急诊科就诊,病情越来越危急。与致命的过量用药不同,大多数儿科急诊科就诊是针对合成阿片类药物过量的幼儿和故意处方阿片类药物过量的青少年。
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引用次数: 0
Transitions of Care From Birth to Outpatient Care for Infants Who Have Been Prenatally Substance-Exposed. 产前物质暴露婴儿从出生到门诊护理的转变。
IF 2.1 Q1 Nursing Pub Date : 2026-02-01 DOI: 10.1542/hpeds.2025-008551
Kathleen E Hannan, Venice Ng Williams, Sunah S Hwang

Objective: The birth hospitalization for infants prenatally substance-exposed (IPSEs) is a critical opportunity to connect with families and optimize the transition of care from inpatient to outpatient settings. Through qualitative interviews with clinicians and clinical staff, we sought to identify multilevel factors that impact care transitions from birth hospital to home for IPSEs and their families.

Methods: We recruited inpatient and outpatient clinicians and clinical staff (N = 17) from hospitals participating in the Colorado Hospital Substance Exposed Newborn Quality Improvement Collaborative (CHoSEN QIC), a state-based perinatal quality initiative focused on standardizing the care of IPSEs, for semistructured interviews. Multiple coders engaged in inductive thematic analysis, using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to generate thematic memos across participants.

Results: We identified facilitators and barriers within and across levels of the outer and inner context. Outer-context themes included the need for standardized patient identification, integrated care systems for effective transitions, and sociopolitical context, including challenges with changing laws and lagging policies. Inner-context themes included the value of rapport building with families, optimization of medical team communication, critical role of nonmedical team members for care coordination, and the importance of early identification of discharge disposition.

Conclusions: Participants across inner and outer contexts highlighted the importance of de-siloing clinical care groups serving families affected by substance use, including the need for enhanced communication among groups and the importance of incorporating key nonmedical personnel. Integrating care and communication across systems will be crucial next steps for optimization of care of this population.

目的:产前物质暴露(IPSEs)婴儿的出生住院是与家庭联系和优化从住院到门诊护理过渡的关键机会。通过对临床医生和临床工作人员的定性访谈,我们试图确定影响IPSEs及其家庭从出生医院到家庭护理转变的多层次因素。方法:我们从参加科罗拉多州医院物质暴露新生儿质量改善协作(选定的QIC)的医院招募住院和门诊临床医生和临床工作人员(N = 17)进行半结构化访谈,该协作是一项基于州的围产期质量倡议,重点是标准化IPSEs的护理。多名编码员从事归纳主题分析,使用探索、准备、实施、维持(EPIS)框架在参与者之间生成主题备忘录。结果:我们确定了外部和内部环境的内部和跨层次的促进因素和障碍。外部背景主题包括对标准化患者识别的需求,有效过渡的综合护理系统,以及社会政治背景,包括不断变化的法律和滞后的政策带来的挑战。内部背景主题包括与家庭建立融洽关系的价值,医疗团队沟通的优化,非医疗团队成员在护理协调中的关键作用,以及早期识别出院处置的重要性。结论:来自内部和外部背景的与会者强调了消除为受药物使用影响的家庭提供服务的临床护理小组的重要性,包括需要加强小组之间的沟通以及纳入关键非医务人员的重要性。跨系统整合护理和沟通将是优化这一人群护理的关键下一步。
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引用次数: 0
Shining a Spotlight on Food Insecurity Research and Innovation. 聚焦粮食不安全研究与创新。
IF 2.1 Q1 Nursing Pub Date : 2026-01-27 DOI: 10.1542/hpeds.2025-009161
Patrick W Brady
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引用次数: 0
When a Meal Train Isn't an Option. 当餐车不是一个选择时。
IF 2.1 Q1 Nursing Pub Date : 2026-01-26 DOI: 10.1542/hpeds.2025-009159
Katherine A Auger
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引用次数: 0
Identifying Hospitals With High Performance in Pediatric Safety for All Children. 确定在所有儿童的儿科安全方面表现优异的医院。
IF 2.1 Q1 Nursing Pub Date : 2026-01-09 DOI: 10.1542/hpeds.2025-008786
Katherine A Nash, Matt Hall, Sunitha V Kaiser, Kavita Parikh

Introduction: Adverse safety events cause significant morbidity and mortality. The Agency for Healthcare Research and Quality's (AHRQ) seven pediatric-specific quality indicators (termed PDIs) measure severe and preventable adverse outcomes. We previously demonstrated that PDI safety events disproportionately impact Black and Hispanic patients and that these disparities vary across hospitals. Positive deviance methods propose studying high performing hospitals to identify interventions that may improve care broadly. Our goal was to adapt methods used by the Centers for Medicare and Medicaid Services (CMS) to identify hospitals that excel in pediatric safety equity defined as achieving both high overall safety and low disparities. Future studies of high-performing hospitals will explore potential best practices for advancing equity in pediatric safety.

不良安全事件导致显著的发病率和死亡率。医疗保健研究和质量机构(AHRQ)的七个儿科特定质量指标(称为pdi)衡量严重和可预防的不良后果。我们之前证明了PDI安全事件对黑人和西班牙裔患者的影响不成比例,这些差异因医院而异。积极偏差方法建议研究高绩效医院,以确定可能广泛改善护理的干预措施。我们的目标是采用医疗保险和医疗补助服务中心(CMS)使用的方法,以确定在儿科安全公平方面表现出色的医院,即实现高总体安全性和低差异。未来对高绩效医院的研究将探索促进儿科安全公平的潜在最佳实践。
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引用次数: 0
The Appropriate Use of High-Flow Nasal Cannula in Bronchiolitis: A Delphi Approach. 高流量鼻插管在毛细支气管炎中的正确应用:德尔菲入路。
IF 2.1 Q1 Nursing Pub Date : 2026-01-01 DOI: 10.1542/hpeds.2025-008398
Clea D Harris, Jennifer D Treasure, Kimberly Albanowski, Matthew J Lipshaw, Christopher P Bonafide, Alan R Schroeder, Michelle Noelck, Courtney Byrd, Erika L Stalets, Rachel Cane, Kelly Menachof, Amanda C Schondelmeyer

Objectives: There is considerable practice variation nationally for using high-flow nasal cannula (HFNC) to treat hospitalized children with bronchiolitis, despite an abundance of literature supporting specific practices. We developed recommendations for using HFNC based on available evidence and expert opinion.

Methods: Following the Research and Development (RAND)/University of California, Los Angeles Appropriateness Method, we conducted an exhaustive literature search for studies regarding the use of HFNC in bronchiolitis and drafted proposed use recommendations based on these findings. We convened an expert panel composed of nominees from national professional organizations with a range of professions (nursing, respiratory therapy, medicine) and clinical expertise (intensive care, emergency medicine, hospital-based care). Panelists rated recommendations for appropriateness and necessity in 3 sequential rating sessions and a moderated meeting.

Results: The 15-member panel evaluated 60 recommendations for the initiation, reassessment, escalation, and de-escalation of HFNC in bronchiolitis. The panel reached agreement on the appropriateness of HFNC for 52 of 60 recommendations and on necessity for 46 of 52. The panel agreed with practices that may curtail HFNC use, including initiating HFNC only for refractory hypoxemia or impending respiratory failure, initiating HFNC at flow rates of 1.5 to 2 L/kg/min, and discontinuing HFNC once a patient is stable on fraction of inspired oxygen of 0.21 for 1-4 hours.

Conclusions: A national expert panel agreed on the appropriateness and necessity of parameters for HFNC use in bronchiolitis. These recommendations allow for standardization of practice that may optimize outcomes and curb indiscriminate use of this respiratory support modality.

目的:使用高流量鼻插管(HFNC)治疗住院儿童毛细支气管炎在全国范围内存在相当大的实践差异,尽管有大量文献支持具体的实践。我们根据现有证据和专家意见制定了使用HFNC的建议。方法:根据研究与开发(RAND)/加州大学洛杉矶分校适当性方法,我们对有关HFNC在毛细支气管炎中使用的研究进行了详尽的文献检索,并根据这些发现起草了拟议的使用建议。我们召集了一个专家小组,由来自国家专业组织的提名人组成,他们具有一系列专业(护理、呼吸治疗、医学)和临床专业知识(重症监护、急诊医学、医院护理)。小组成员在3次连续评分会议和一次主持会议中对适当性和必要性的建议进行了评分。结果:由15名成员组成的小组评估了60项关于HFNC在毛细支气管炎中的起始、重新评估、升级和降级的建议。小组就60项建议中的52项是否适当以及52项建议中的46项是否必要达成了协议。专家组同意可减少HFNC使用的做法,包括仅在难治性低氧血症或即将发生的呼吸衰竭时启动HFNC,以1.5至2l /kg/min的流速启动HFNC,当患者吸入氧分数0.21稳定1-4小时后停止使用HFNC。结论:国家专家小组同意HFNC在毛细支气管炎中使用参数的适宜性和必要性。这些建议允许标准化的做法,可能优化结果和遏制滥用这种呼吸支持方式。
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引用次数: 0
Switch to Oral Antibiotics for Infective Endocarditis in Children. 儿童感染性心内膜炎改用口服抗生素。
IF 2.1 Q1 Nursing Pub Date : 2026-01-01 DOI: 10.1542/hpeds.2025-008463
Daniel Pak, Derry R McDonald, Adam W Brothers, Jessica Colyer, Matthew P Kronman, Scott J Weissman, Victoria Konold

Background and objectives: Although adult clinical trials support the use of partial enteral antibiotic therapy for infective endocarditis (IE), evidence supporting oral therapy for pediatric IE is lacking. Our antimicrobial stewardship program, in partnership with local stakeholders, developed a protocol in 2023 to manage pediatric IE with enteral antibiotics following initial intravenous therapy. Here we describe the clinical course and outcomes of patients treated with partial enteral antibiotic therapy for IE after protocol implementation.

Methods: We performed a retrospective review of the first 7  months of patients treated using the IE partial oral therapy protocol. A historical comparator group was included for reference. We identified patients with IE using electronic health record International Classification of Diseases, Tenth Revision diagnoses and excluded patients with fungal endocarditis or endovascular infection without vegetations. We collected patient microbiological and laboratory data, surgical procedures, echocardiogram findings, antibiotic use, length of stay, and readmissions.

Results: We identified 12 total patients with IE during the study period; 4 patients were excluded. Eight included patients were treated with partial enteral antibiotic therapy: 4 transitioned to enteral antibiotics within the first 7  days of IE treatment, and 3 transitioned after approximately 21  days. No patient exhibited treatment failure or IE recurrence during a 90-day follow-up period. Three patients experienced adverse drug reactions that required therapy modification. There was 1 unrelated mortality.

Conclusions: All patients in this retrospective review were successfully transitioned to enteral antibiotic therapy. Partial oral treatment of pediatric IE is an emerging treatment strategy that requires future investigation.

背景和目的:虽然成人临床试验支持使用部分肠内抗生素治疗感染性心内膜炎(IE),但支持口服治疗儿科IE的证据缺乏。我们的抗菌药物管理项目与当地利益相关者合作,于2023年制定了一项协议,以管理首次静脉注射后使用肠内抗生素的儿科IE。在这里,我们描述了在方案实施后接受部分肠内抗生素治疗的IE患者的临床过程和结果。方法:我们对使用IE部分口服治疗方案的前7个月患者进行了回顾性研究。包括一个历史比较国组以供参考。我们使用电子健康记录国际疾病分类第十版诊断来确定IE患者,并排除真菌性心内膜炎或无植物的血管内感染患者。我们收集了患者的微生物学和实验室数据、手术程序、超声心动图结果、抗生素使用、住院时间和再入院情况。结果:我们在研究期间共确定了12例IE患者;排除4例患者。8例纳入的患者接受部分肠内抗生素治疗:4例在IE治疗的前7天过渡到肠内抗生素治疗,3例在大约21天后过渡到肠内抗生素治疗。在90天的随访期间,没有患者出现治疗失败或IE复发。3例患者出现药物不良反应,需要调整治疗方案。有1例无关死亡。结论:本回顾性研究中所有患者均成功过渡到肠内抗生素治疗。部分口服治疗儿科IE是一种新兴的治疗策略,需要进一步的研究。
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引用次数: 0
Patient and Employee Safety Events-Are They Related by Common Hospital Unit Factors? 患者和员工安全事件-它们是否与常见的医院单位因素相关?
IF 2.1 Q1 Nursing Pub Date : 2026-01-01 DOI: 10.1542/hpeds.2024-008323
Nancy M Daraiseh, Chunyan Liu, William Vidonish, Bin Zhang, Alycia Bachtel, Wendy Ungard, Barbara Giambra, Maurizio Macaluso

Objective: Health care environments pose risks to both patients and care providers. This study investigates unit working conditions potentially impacting patient and provider safety concurrently to identify common risk factors for targeted interventions.

Methods: Zero-inflated negative binomial models analyzed associations between select working conditions (eg, overtime, patient census) and patient/employee safety event rates. Multivariable regression models explored adjusted effects.

Results: Patient and employee safety event rates showed little correlation, with units having higher rates in one category often showing lower rates in the other. Significant associations were found between safety events and select working conditions; however, results were inconsistent across indicators and did not apply uniformly to both safety event types.

Conclusions: Although patient and employee safety event rates were not correlated, evidence suggests common factors (unit group, registered nurse vacancy) jointly influence both outcomes. Further research on specific safety outcomes may reveal more causal associations.

目的:卫生保健环境对患者和护理提供者都构成风险。本研究调查了单位工作条件可能同时影响患者和提供者的安全,以确定有针对性干预的共同风险因素。方法:采用零膨胀负二项模型分析特定工作条件(如加班、患者普查)与患者/员工安全事件发生率之间的关系。多变量回归模型探讨调整效应。结果:患者和员工的安全事件率显示出很少的相关性,在一个类别中具有较高比率的单位通常在另一个类别中显示较低的比率。安全事件与选择的工作条件之间存在显著关联;然而,结果是不一致的指标,并不是统一适用于两种安全事件类型。结论:尽管患者和员工安全事件发生率不相关,但有证据表明,共同因素(单位组、注册护士空缺)共同影响两种结果。对具体安全结果的进一步研究可能会揭示更多的因果关系。
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引用次数: 0
Forming Community Partnerships to Create Social Needs Referral Programs. 建立社区伙伴关系,创建社会需求转介项目。
IF 2.1 Q1 Nursing Pub Date : 2026-01-01 DOI: 10.1542/hpeds.2025-008507
Kelly Kovaric, Ada Earp, Sanyukta Desai, Alexandria Daggett, Yinchao Yuan, Sai Kaushika, Sarah Tarrance, Adya Das, Abinaya Kannapiran, Jeff Cary, Jen Freeman, Jessica Venson
{"title":"Forming Community Partnerships to Create Social Needs Referral Programs.","authors":"Kelly Kovaric, Ada Earp, Sanyukta Desai, Alexandria Daggett, Yinchao Yuan, Sai Kaushika, Sarah Tarrance, Adya Das, Abinaya Kannapiran, Jeff Cary, Jen Freeman, Jessica Venson","doi":"10.1542/hpeds.2025-008507","DOIUrl":"10.1542/hpeds.2025-008507","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e45-e48"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811029","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}
引用次数: 0
期刊
Hospital pediatrics
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