Hospital pediatrics最新文献

Objective: Health-related social needs (HRSNs) are associated with pediatric health outcomes. Programs that identify and intervene on unmet HRSNs are growing in pediatric inpatient settings. Research exploring the perspectives of inpatient clinical team members (CTMs) on programs to address unmet HRSNs is currently limited. The objective of this study was to investigate CTM perspectives on a pediatric inpatient HRSN screening, referral, and community health worker (CHW) resource navigation program in an urban tertiary-care pediatric academic hospital.

Methods: Semi-structured interview guides were developed using the Consolidated Framework for Implementation Research. One-on-one interviews were conducted with a purposeful sampling of CTMs. Transcripts were analyzed using a rapid qualitative approach to identify salient themes.

Results: Between August 19 and November 15, 2024, we conducted interviews with 14 CTMs. Analysis identified the following 4 themes: (1) social care is aligned with the goals of inpatient pediatric care; (2) CHWs are a valuable addition to a multidisciplinary inpatient team; (3) there are unique challenges of the inpatient setting, and electronic health record (EHR) integration has the potential to address these challenges; and (4) there is a need for better communication regarding outcomes across all aspects of the intervention to maintain CTM motivation.

Conclusions: Inpatient pediatric CTMs view HRSNs programs as an extension of patient care. CTMs value the role of CHWs as part of the multidisciplinary team to support hospitalized families. Addressing unique inpatient challenges, optimizing EHR integration, and clear communication regarding programmatic impact on families may facilitate program adoption.

Objective: Hypothermia in young infants is often attributed to immature thermoregulation but may be the harbinger of significant pathology. We aimed to determine the prevalence and type of significant pathology in young infants aged 90 days or younger presenting with hypothermia (≤36.0 °C) and explore associations between this outcome and presenting characteristics and evaluation.

Methods: We conducted a multicenter, retrospective cohort study of young infants evaluated in the emergency department (ED) or hospital setting for hypothermia over a 5-year period. Patients aged 90 days or younger with documented or reported hypothermia in the ED or upon admission were included for study. All charts were manually reviewed. Our primary outcome was a diagnosis of significant pathology, infectious or noninfectious, defined as warranting hospitalization for evaluation, care or monitoring. We used a multivariate logistic regression model to test associations with significant pathology.

Results: Among 998 included infants, 32% (n = 318) had significant pathology, 4% with serious bacterial infection or herpes simplex virus (n = 41) and 28% (n = 277) with other diagnoses of significance spanning multiple organ systems and pathologies. Following multivariate logistic regression, presentation at older age (29-60 days [odds ratio {OR}, 6.9; 95% CI, 4.0-11.9] and 61-90 days [OR, 8.1; 95% CI, 3.8-17.0]), ill-appearance (OR, 4.3; 95% CI, 3.0-6.1), repeated temperature instability (OR, 2.0; 95% CI, 1.4-2.8), and abnormal white blood cell count (OR, 2.5; 95% CI, 1.5-4.1) were associated with significant pathology.

Conclusions: Infants presenting with hypothermia often have diagnoses of significance aside from serious or invasive infections. Decision tools for management of hypothermic young infants should account for alternative pathology.

Background and objectives: Aspiration pneumonia is a common cause for hospitalization, especially in children with medical complexity, yet there are no standard definition or clinical practice guidelines for the condition. Our objectives were to assess the validity of the aspiration pneumonia billing code and to describe the demographics, presenting symptoms, diagnostic results, and outcomes of children hospitalized with this condition.

Methods: We performed a retrospective cross-sectional analysis of 200 patients hospitalized with an International Classification of Diseases, tenth revision (ICD-10) diagnosis of aspiration pneumonia from 2016 to 2021. We conducted a standardized medical record review to identify children with a clinician diagnosis of aspiration pneumonia and collected data on patient and hospitalization characteristics across 4 subgroups defined by a combination of clinical and radiographic features.

Results: Among 200 patients identified by ICD-10 code, 138 (69%) also had a clinician diagnosis of aspiration pneumonia. For these 138 patients, the mean age was 8.4 years (SD, 7), and most had an underlying medical complexity. Diagnostic testing, antibiotic selection, and hospitalization outcomes were similar across definition subgroups. Only 18 patients (13%) had aspiration risk factors, fever, and a probable focal opacity on chest imaging at diagnosis.

Conclusions: We observed significant variability in presenting symptoms and diagnostic testing results among patients assigned a clinician diagnosis of aspiration pneumonia. Our study underscores the need for a standardized clinical definition, improved diagnostic criteria, and evidence-based treatment guidelines to optimize clinical care for this patient population.

Objective: Pediatric hospitalizations for respiratory illnesses declined during the SARS-CoV-2 (COVID-19) pandemic, reducing clinical exposure for trainees. A study conducted during this time period demonstrated low skills among pediatric interns related to the assessment and management of impending respiratory failure as measured via performance during a screen-based virtual reality (VR) simulation. However, a key limitation in interpreting the results was a lack of performance data from periods of exposure to normal clinical volumes. The objective of this study is to complete a follow-up to the initial study to assess pediatric intern performance in the same VR simulation during time periods in which interns were exposed to normalized clinical volumes.

Participants and methods: This cross-sectional observational study was conducted at a large, free-standing academic children's hospital. Three cohorts of convenience samples of interns completed the VR simulation. Performance was assessed via video review. Statistical differences among groups were examined through Fischer's exact test.

Results: A total of 22, 11, and 24 interns participated in cohorts 1 (January-May 2021), 2 (January-May 2022), and 3 (April-June 2024), respectively. There were no statistical differences among the performances of cohorts 1, 2, or 3 with regards to identification of altered mental status, impending respiratory failure, or a need for escalation of care.

Conclusions: Although there were no statistically significant differences in the recognition of respiratory failure or proposing an escalation of career among the cohorts of interns across periods of variable clinical volumes, these data prompt further investigation to explore when and how residents gain these critical clinical assessment skills and the role of VR for objectively assessing competency.

Objective: The Family Bridge Program was developed at a single pediatric hospital to improve outcomes for hospitalized children from families of color, who are low income, or who speak a language other than English. The program uses a family navigator ("Guide") that supports families via 6 service domains: Language Access, Orientation to the Hospital, Communication Preferences and Coaching, Addressing Unmet Social Needs, Supportive Check-Ins, and Discharge Follow-Up. This study describes an analysis to translate the program to a second pediatric hospital.

Methods: We interviewed clinical and hospital staff with experience matching the program domains to identify Guide tasks and factors that could influence task performance between the 2 hospitals. The interview format and analysis were framed by a sociotechnical model to identify task-related factors (persons and roles, resources and tools, community and organizational characteristics…) and to develop adaptation and communication strategies for the Guide.

Results: We interviewed 45 participants (22 at Hospital 1, 23 at Hospital 2), representing 14 clinical and staff roles. Analysis identified 57 tasks for the Guide across the 6 program domains. Multiple sociotechnical factors were identified that could impact task performance between and within both hospitals. Additional analysis identified sociotechnical factors and adaptation strategies for integrating the Guide with the clinical team.

Conclusions: The analysis facilitated a task-based adaptation of the Family Bridge Program to a second hospital by identifying and addressing sociotechnical differences between sites. This approach provides a framework for replicating the program at other hospitals.

Objective: Congenital cytomegalovirus (cCMV) is the most common nongenetic cause of congenital sensorineural hearing loss. Hearing-targeted screening (HTS) programs have variable adherence and performance in terms of cCMV detection. Our institution implemented a cCMV HTS program in the newborn nursery with the aim of screening all eligible newborns during the birth hospitalization.

Methods: A bundle of interventions, including a nurse-driven HTS algorithm and process for cCMV screening test follow-up, was implemented in December 2018. cCMV screening was performed by saliva polymerase chain reaction (PCR) with confirmatory urine PCR within 21 days of birth. Our primary outcome was the median percentage of eligible newborns each quarter who completed cCMV screening. Secondary outcomes included the number of patients with confirmed cCMV (saliva +, urine +) and a false-positive saliva screen (saliva +, urine -). An annotated run chart was used to measure the impact of the bundle over time.

Results: Between December 2018 and September 2024, 650 newborns referred on hearing screening. cCMV screening increased from 0% to 94% during the first 14 quarters after implementation and increased further to 100% in the remaining 9 quarters. Thirteen newborns tested positive by saliva; all underwent confirmatory urine testing. Only 1 newborn had confirmed cCMV infection and remained asymptomatic with normal hearing. The remaining 12 were false positives.

Conclusion: We achieved high adherence to HTS but identified only 1 newborn with cCMV infection in 6 years. Alternative approaches to cCMV screening should be considered in regions with low cCMV prevalence that balance feasibility and yield.