Journal of Pediatric Health Care最新文献

Introduction: Premature infants are a vulnerable population with an increased risk for health problems and developmental delays. Breast milk has been positively linked to improved development and is widely recommended as the exclusive infant nutrition source for the first 6 months of life. The purpose of this quality improvement project was to decrease breastfeeding attrition rates through both provider and caregiver education.

Method: The project took place at an outpatient developmental practice following infants recently discharged from the NICU. Breast milk attrition by 4 months postconception age (PCA) was 45%. A provider education session was conducted, a reliable breast milk data collection method was workshopped, and a caregiver education packet was developed and distributed to caregivers at their intake visit to reach the project goal of 35% attrition.

Results: Breast milk attrition decreased from 45% to 35% throughout the project's duration. Healthcare staff reported 100% satisfaction with provided education, higher than the project goal of 80%. Quantitative and qualitative parental feedback strongly supported the project's interventions.

Discussion: A focused conversation about breast milk and its benefits with the child's caregiver and a child's developmental provider, combined with ongoing support, demonstrated an increase in the length of time for which the child received breast milk.

There is a need for more pediatric nurse practitioners, and most programs are facing significant difficulties sourcing willing preceptors. Among the issues surrounding clinical placement, programs have variable processes for affiliation agreements, locating preceptors, and policies surrounding paying stipends. This practice issue calls for immediate evaluation of the preceptor shortage and creative strategic planning to mitigate ongoing placement concerns. A lack of resolution will lead to additional shortages of prepared clinicians and perpetuate the cycle of difficulty obtaining mandatory clinical practice hours.

Advanced practice nurses (APNs) have gained increasing responsibilities over the last 50 years. Depending on when and where the APN was trained and the types of continuing education they have attended, they may not be fully aware of issues related to professional liability insurance (PLI), licensure, and tort law as they relate to malpractice, medical malpractice, and medical malpractice stress syndrome (MMSS). The purpose of this article is to provide a brief overview of these topics and highlight key points through a case study approach.

Introduction: Many children in state custody require concurrent hospitalization each year, but little is known about best practices in caring for them. This study explored healthcare providers' experiences working with and perceptions of the needs of hospitalized children in state custody.

Methods: Twenty-five healthcare providers from an urban children's hospital completed semi-structured interviews that were audio-recorded, transcribed, and analyzed using an inductive, thematic coding approach.

Results: Two sets of five themes emerged. First: (1) stressors associated with the Department of Children's Services, (2) emotional distress for providers, (3) limited support resources, (4) multidisciplinary care and coordination, and (5) patient-centered care. Second: (1) building relationships and forming attachments, (2) medical and developmental complexity, (3) isolation, (4) extended (sometimes medically unnecessary) hospitalization, and (5) lack of control.

Conclusions: Participants identified the many challenges associated with hospitalization for this population. By prioritizing collaborative care coordination and trauma-informed practices, teams can enhance outcomes for these children.

One in 13 children in the United States have diagnosed food allergies, the most severe of which result in anaphylaxis. These reactions are trauma inducing, and can invoke a generalized level of anxiety for those affected by these allergies. For children, this fear is often realized through accidental exposures to allergens, or during regular oral food challenges that result in anaphylaxis. These concerns are then reinforced by tireless caregiver surveillance. This case study examines the experience of a preschool-aged child during an oral food challenge, and the anxiety that she and her caregiver experience relative to her food allergies.

Background: A lack of standardized neonatal circumcision pain management guidelines leads to inconsistencies across pediatric settings and poor outcomes, such as feeding and sleep disturbances, which can increase costs, lead to longer hospital stays, or require closer observation outside of parents' presence. Nurse practitioners (NP) are well-equipped to lead evidence-based quality improvement (QI) initiatives.

Aim: To evaluate an evidence-based neonatal circumcision pain protocol across the care continuum from preprocedural to recovery.

Methods: The Knowledge-to-Action framework and QI methodologies guided the initiative and evaluation of the new protocol's impact on neonates' pain scores and sustainability.

Intervention: Acetaminophen pre-circumcision, white noise procedural, standardized pain assessment, and acetaminophen or nonpharmacologic measures during recovery.

Results: Neonates' pain scores significantly decreased from 3.14 to 1.12 (p <.001) after implementation, which relied on provider compliance. Process aims were achieved in Plan-Do-Study-Act cycle 3 and sustained; 100% of providers agreed that the new protocol improved neonatal pain management.

Conclusions: Effective circumcision pain management relies on a comprehensive approach. This QI initiative highlights NP leadership in driving evidence-based change.

Background: Although numerous studies have documented the high prevalence of malnutrition in children with congenital heart disease (CHD), variability in findings has made it difficult to estimate true risk. This meta-analysis aimed to estimate the pooled prevalence of malnutrition by age group and examine its association with CHD-specific disease characteristics.

Methods: Following PRISMA guidelines, a meta-analysis was conducted to determine the pooled prevalence of underweight, stunting, and wasting, stratified by age group. The odds of malnutrition were also analyzed based on CHD disease characteristics.

Results: Thirty-seven studies were included. The pooled prevalence of underweight was 34.3% (N = 83,321), stunting 30.8% (N = 84,033), and wasting 25.5% (N = 72,283). Prevalence differed by age and malnutrition subtype: underweight was most common in infants (38.3%), while stunting (32.5%) and wasting (27.8%) were highest in the toddler-to-preschool age group. Children with pulmonary arterial hypertension (PAH) had significantly higher odds of being underweight (Odds Ratio, OR = 4.24), stunted (OR = 3.11), and wasted (OR = 1.32). Children with cyanosis also had elevated odds of stunting (OR = 1.38), though not statistically significant.

Conclusion: Malnutrition is common among children with CHD and varies by malnutrition type, age group, and disease characteristics. The elevated risk in children with PAH and cyanosis suggests the importance of disease-specific monitoring and intervention strategies. Tailored approaches based on patient age and clinical profile may help improve growth outcomes in this vulnerable population.

Introduction: This systematic review examined how the COVID-19 pandemic influenced parental barriers to routine childhood vaccination in the United States, with attention to changes in vaccine access, concern, and perceived importance.

Methods: Guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched PubMed, CINAHL, PsycINFO, Scopus, and Web of Science for United States-based studies published January 2015 through May 2024. Eligible studies were conducted before March 2020 (prepandemic) or after (pandemic era). Two reviewers independently screened, extracted data, and assessed quality using the Mixed Methods Appraisal Tool.

Results: Of 4,813 records screened, 21 met inclusion criteria (14 prepandemic, seven pandemic era). Access barriers, especially among low-income, immigrant, and underrepresented racial/ethnic groups, persisted across timeframes. Pandemic-era studies reported heightened parental anxiety, misinformation, and reduced prioritization of vaccination.

Conclusions: The pandemic intensified existing barriers. Public health strategies should address misinformation, rebuild trust, and reduce structural inequities to improve postpandemic childhood vaccination coverage.