PEDIATRICS (Pediatrics)

Publications in this journal

• Article: Lyme Chondritis Presenting as Painless Ear Erythema.

  Hemalatha Srinivasalu, Annemarie C Brescia, Carlos D Rose
  [show abstract] [hide abstract]
  ABSTRACT: Erythema of the ear lobe in the context of Lyme disease is caused by either borrelial lymphocytoma or localized erythema migrans. Here we present a case of chondritis limited to the ear cartilage caused by Lyme disease. The patient was treated with ceftriaxone with complete resolution of symptoms.
  PEDIATRICS 05/2013;
• Article: Bacteremia Risk and Outpatient Management of Febrile Patients With Sickle Cell Disease.

  Marc N Baskin, Xin Lyn Goh, Matthew M Heeney, Marvin B Harper
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND AND OBJECTIVES:Previous studies have indicated that febrile children with sickle cell disease (SCD) had a 3% to 5% risk of being bacteremic due to compromised immune function. The introduction of routine penicillin prophylaxis and conjugate vaccines may have lowered the risk of bacteremia. Our goals were to determine the rate of bacteremia among children with SCD per febrile episode and to estimate the safety of outpatient management among these febrile SCD patients.METHODS:This 18-year retrospective cohort study included febrile SCD patients who presented to Boston Children's Hospital between 1993 and 2010.RESULTS:A total of 1118 febrile episodes were evaluated. Nine blood specimens had growth of a pathogen in culture (0.8%; 95% confidence interval: 0.3%-1.3%). Of the 466 febrile patients initially managed as outpatients, 3 were bacteremic (0.6%). All 3 received intravenous ceftriaxone at the initial outpatient visit and returned when contacted after growth of bacteria was detected in the blood culture. Upon return to the hospital, none were "ill appearing," required supportive care, or were admitted to an ICU.CONCLUSIONS:Our rate of bacteremia among febrile children with SCD is much lower than previous estimates, and there was no associated morbidity or mortality among the patients managed as outpatients. A well-appearing febrile child with SCD may be managed as an outpatient after blood is obtained for bacterial culture and parenteral antibiotics are administered, provided there are no other reasons for admission and the patient is able to return promptly for worsening condition or for growth of a pathogen from their blood culture.
  PEDIATRICS 05/2013;
• Article: International Adoption, "Early" Puberty, and Underrecorded Age.

  Peter Hayes
  PEDIATRICS 05/2013;
• Article: Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk Infants: An RCT.

  Valerie J Flaherman, Janelle Aby, Anthony E Burgos, Kathryn A Lee, Michael D Cabana, Thomas B Newman
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND AND OBJECTIVES:Recent public health efforts focus on reducing formula use for breastfed infants during the birth hospitalization. No previous randomized trials report the effects of brief early formula use. The objective of the study was to determine if small formula volumes before the onset of mature milk production might reduce formula use at 1 week and improve breastfeeding at 3 months for newborns at risk for breastfeeding problems.METHODS:We randomly assigned 40 exclusively breastfeeding term infants, 24 to 48 hours old, who had lost ≥5% birth weight to early limited formula (ELF) intervention (10 mL formula by syringe after each breastfeeding and discontinued when mature milk production began) or control (continued exclusive breastfeeding). Our outcomes were breastfeeding and formula use at 1 week and 1, 2, and 3 months.RESULTS:Among infants randomly assigned to ELF during the birth hospitalization, 2 (10%) of 20 used formula at 1 week of age, compared with 9 (47%) of 19 control infants assigned during the birth hospitalization to continue exclusive breastfeeding (P = .01). At 3 months, 15 (79%) of 19 infants assigned to ELF during the birth hospitalization were breastfeeding exclusively, compared with 8 (42%) of 19 controls (P = .02).CONCLUSIONS:Early limited formula may reduce longer-term formula use at 1 week and increase breastfeeding at 3 months for some infants. ELF may be a successful temporary coping strategy for mothers to support breastfeeding newborns with early weight loss. ELF has the potential for increasing rates of longer-term breastfeeding without supplementation based on findings from this RCT.
  PEDIATRICS 05/2013;
• Article: Prevalence of Use of Human Milk in US Advanced Care Neonatal Units.

  Cria G Perrine, Kelley S Scanlon
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND AND OBJECTIVE:The American Academy of Pediatrics recommends all preterm infants receive human milk. The objective of this study was to describe the use of human milk in advanced care neonatal units of US maternity hospitals.METHODS:We used Centers for Disease Control and Prevention's national Maternity Practices in Infant Nutrition and Care survey from 2007, 2009, and 2011 to analyze 2 questions to describe the prevalence of US advanced care (special/level 2 or intensive/level 3) neonatal units routinely providing human milk to infants, and the use of any donor milk in these units.RESULTS:In 2011, 30.8% of maternity hospitals reported that most infants (≥90%) were routinely provided human milk in advanced care units, compared with 26.7% in 2009 and 21.2% in 2007 (trend P < .001). States in the Northwest and Northeast had a higher prevalence of hospitals routinely providing human milk to ≥90% of infants in advanced care units. In 2011, 22.0% of maternity hospitals providing advanced care used banked donor milk, compared with 14.4% in 2009 and 11.5% in 2007 (trend P < .001). Most of this increase occurred in intensive care units (25.1% 2007 vs 45.2% 2011; trend P < .001). There was substantial geographic variation in the prevalence of advanced care units using donor milk; generally the prevalence was higher in the West and in states with a milk bank in the state or a neighboring state.CONCLUSIONS:The use of human milk in US advanced care neonatal units is increasing; however, only one-third of these units are routinely providing human milk to most infants.
  PEDIATRICS 05/2013;
• Article: Neonatal End-of-Life Care: A Single-Center NICU Experience in Israel Over a Decade.

  Smadar Eventov-Friedman, Hana Kanevsky, Benjamin Bar-Oz
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVES:To follow changes in the causes of neonatal deaths in the NICU at Hadassah Medical Center, Jerusalem, Israel, over a decade; to examine trends regarding types of end-of-life-care provided (primary nonintervention, maximal intensive, and redirection of intensive care, including limitation of care and withdrawal of life-sustaining treatment); and to assess the parental role in the decision-making process given that the majority of the population is religious.METHODS:All neonates who died between 2000 and 2009 were identified. The causes and circumstances of death were abstracted from the medical records. Trends in end-of-life decisions were compared between 2 time periods: 2000-2004 versus 2005-2009.RESULTS:Overall, 239 neonates died. The leading cause of death in both study periods was prematurity and its complications (76%). Among term infants, the leading cause of death was congenital anomalies (48%). Fifty-six percent of the infants received maximal intensive care; 28% had redirection of intensive care, of whom 10% had withdrawal of life-sustaining treatment; and 16% had primary nonintervention care. Over the years, maximal intensive care decreased from 65% to 46% (P < .02), whereas redirection of care increased from 19.2% to 37.5% (P < .0005). An active parental role in the end-of-life decision process increased from 38% to 84%.CONCLUSIONS:Even among religious families of extremely sick neonates, redirection of care is a feasible treatment option, suggesting that apart from survival, quality-of-life considerations emerge as an important factor in the decision-making process for the infant, parents, and caregivers.
  PEDIATRICS 05/2013;
• Article: Intussusception After Rotavirus Vaccines Reported to US VAERS, 2006-2012.

  Penina Haber, Manish Patel, Yi Pan, James Baggs, Michael Haber, Oidda Museru, Xin Yue, Paige Lewis, Frank Destefano, Umesh D Parashar
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:In 2006 and 2008, 2 new rotavirus vaccines (RotaTeq [RV5] and Rotarix [RV1]) were introduced in the United States.METHODS:We assessed intussusception events reported to the Vaccine Adverse Event Reporting System from February 2006 through April 2012 for RV5 and from April 2008 through April 2012 for RV1. For RV5, we conducted a self-controlled risk interval analysis using Poisson regression to estimate the daily reporting ratio (DRR) of intussusception comparing average daily reports 3 to 6 versus 0 to 2 days after vaccination. We calculated reporting rate differences based on DRRs and background rates of intussusception. Sensitivity analyses were conducted to assess effects of differential reporting completeness and inaccuracy of baseline rates. Few reports were submitted after RV1, allowing only a descriptive analysis.RESULTS:The Vaccine Adverse Event Reporting System received 584 confirmed intussusception reports after RV5 and 52 after RV1, with clustering 3 to 6 days after both vaccines. The DRR comparing the 3- to 6-day and the 0- to 2-day periods after RV5 dose 1 was 3.75 (95% confidence interval = 1.90 to 7.39). There was no significant increase in reporting after dose 2 or dose 3. Over all 3 doses, the excess risk of intussusception was 0.79 events (95% confidence interval = -0.04 to 1.62) per 100 000 vaccinations. From the sensitivity analyses, we conclude that under a worst-case scenario, the DRR could be 5.00 and excess risk per 100 000 doses could be 1.36.CONCLUSIONS:We observed a persistent clustering of reported intussusception events 3 to 6 days after the first dose of RV5 vaccination. This clustering could translate to a small increased risk of intussusception, which is outweighed by the benefits of rotavirus vaccination.
  PEDIATRICS 05/2013;
• Article: Internet-Based Therapy for Adolescents With Chronic Fatigue Syndrome: Long-term Follow-up.

  Sanne L Nijhof, Loudy P Priesterbach, Cuno S P M Uiterwaal, Gijs Bleijenberg, Jan L L Kimpen, Elise M van de Putte
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE:Cognitive behavioral therapy (CBT) is known to be an effective treatment of adolescents with chronic fatigue syndrome (CFS), but its availability is limited. Fatigue in Teenagers on the Internet (FITNET), an Internet-based CBT program for adolescents with CFS, has been developed as an alternative to face-to-face CBT. Recently, its short-term effectiveness has been proven in a randomized clinical trial. Here we aimed to assess the long-term outcome of CFS in adolescents after FITNET treatment and after usual care. In addition, factors related to recovery at long-term follow-up (LTFU) for adolescents treated with the FITNET program were investigated.METHODS:The study was an LTFU of participants of the FITNET trial. Data were completed for 112 (88.2%) of 127 approached FITNET study participants. Primary outcomes were fatigue severity (Checklist Individual Strength-20), physical functioning (87-item Child Health Questionnaire), and school/work attendance.RESULTS:After a mean follow-up of 2.7 years, 66 (58.9%) adolescents had recovered from CFS. Most adolescents who recovered directly after treatment with FITNET were still recovered at LTFU. At LTFU there was no difference between the recovery rates for the different treatment strategies (original randomization: FITNET [64%] versus any form of usual care [52.8%]). Per additional month of "pretreatment disease duration," the odds for recovery were 4% lower (odds ratio: 0.96; 95% confidence interval: 0.93-0.99; P = .016), and per added point on "focus on bodily symptoms" (Body Consciousness Scale) of the mother (0-20 points) the odds for recovery were 11% lower (odds ratio: 0.89; 95% confidence interval: 0.80-0.99; P = .029).CONCLUSIONS:The short-term effectiveness of Internet-based CBT on adolescent CFS is maintained at LTFU. At LTFU, usual care led to similar recovery rates, although these rates were achieved at a slower pace.
  PEDIATRICS 05/2013;
• Article: Texting While Driving and Other Risky Motor Vehicle Behaviors Among US High School Students.

  Emily O'Malley Olsen, Ruth A Shults, Danice K Eaton
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE:To assess the prevalence of texting/e-mailing while driving (TWD) and association of TWD with other risky motor vehicle (MV) behaviors among US high school students.METHODS:Data were used from the Centers for Disease Control and Prevention's 2011 national Youth Risk Behavior Survey, which assessed TWD during the 30 days before the survey among 8505 students aged ≥16 years from a nationally representative sample of US high school students. TWD frequency was coded into dichotomous and polychotomous variables. Logistic regression assessed the relationship between TWD and other risky driving behaviors, controlling for age, race/ethnicity, and sex.RESULTS:The prevalence of TWD on ≥1 days during the 30 days before the survey was 44.5% (95% confidence interval: 40.8%-48.2%). Students who engaged in TWD were more likely than their non-TWD counterparts to not always wear their seatbelt (prevalence ratio; 95% confidence interval: 1.16; 1.07-1.26), ride with a driver who had been drinking alcohol (1.74; 1.57-1.93), and drink alcohol and drive (5.33; 4.32-6.59). These other risky MV behaviors were most likely to occur among students who frequently engaged in TWD.CONCLUSIONS:Nearly half of US high school students aged ≥16 years report TWD during the past 30 days; these students are more likely to engage in additional risky MV behaviors. This suggests there is a subgroup of students who may place themselves, their passengers, and others on the road at elevated risk for a crash-related injury or fatality by engaging in multiple risky MV behaviors.
  PEDIATRICS 05/2013;
• Article: Early Limited Formula Is Not Ready for Prime Time.

  Lydia Furman
  PEDIATRICS 05/2013;
• Article: Elevated Blood Lead Levels and Reading Readiness at the Start of Kindergarten.

  Pat McLaine, Ana Navas-Acien, Rebecca Lee, Peter Simon, Marie Diener-West, Jacqueline Agnew
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE:To evaluate the relationship between blood lead levels (BLLs) and reading readiness at kindergarten entry, an early marker of school performance, in a diverse urban school population.METHODS:Kindergarten reading readiness test scores for children attending public kindergarten in Providence, Rhode Island, were linked to state health department records of blood lead testing by using individual identifiers. The study population (N = 3406) was 59% Hispanic. For each child, the geometric mean BLL was estimated by using all previously reported BLLs. Analyses were adjusted for gender, age, year enrolled, race, child language, and free/reduced lunch status as a measure of socioeconomic status.RESULTS:The median geometric mean BLL was 4.2 µg/dL; 20% of children had at least 1 venous BLL ≥10 µg/dL. Compared with children with BLLs <5 µg/dL, the adjusted prevalence ratios (95% confidence interval [CI]) for failing to achieve the national benchmark for reading readiness were 1.21 (1.19 to 1.23) and 1.56 (1.51 to 1.60) for children with BLLs of 5 to 9 and ≥10 µg/dL, respectively. On average, reading readiness scores decreased by 4.5 (95% CI: -2.9 to -6.2) and 10.0 (95% CI: -7.0 to -13.3) points for children with BLLs of 5 to 9 and ≥10 µg/dL, respectively, compared with BLLs <5 µg/dL.CONCLUSIONS:BLLs well below 10 µg/dL were associated with lower reading readiness at kindergarten entry. The high prevalence of elevated BLLs warrants additional investigation in other high-risk US populations. Results suggest benefits from additional collaboration between public health, public education, and community data providers.
  PEDIATRICS 05/2013;
• Article: Dr Watson and the Case of Observation-Level Care.

  Jack Martin Percelay
  PEDIATRICS 05/2013;
• Article: Current Status of Transition Preparation Among Youth With Special Needs in the United States.

  Margaret A McManus, Lauren R Pollack, W Carl Cooley, Jeanne W McAllister, Debra Lotstein, Bonnie Strickland, Marie Y Mann
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE:To examine current US performance on transition from pediatric to adult health care and discuss strategies for improvement.METHODS:The 2009-2010 National Survey of Children with Special Health Care Needs is a nationally representative sample with 17 114 parent respondents who have youth with special health care needs (YSHCN) ages 12 and 18. They are asked about transition to an adult provider, changing health care needs, increasing responsibility for health care needs, and maintaining insurance coverage. We analyzed the association of selected characteristics with successful transition preparation.RESULTS:Overall, 40% of YSHCN meet the national transition core outcome. Several factors are associated with transition preparation, including female gender; younger age; white race; non-Hispanic ethnicity; income ≥400% of poverty; little or no impact of condition on activities; having a condition other than an emotional, behavioral, or developmental condition; having a medical home; and being privately insured.CONCLUSIONS:Most YSHCN are not receiving needed transition preparation. Although most providers are encouraging YSHCN to assume responsibility for their own health, far fewer are discussing transfer to an adult provider and insurance continuity. Although changes in sample design limit trend analysis, there have been no discernible improvements since this transition outcome was measured in the 2005-2006 National Survey of Children with Special Health Care Needs. The 2011 release of the American Academy of Pediatrics/American Academy of Family Physicians/American College of Physicians clinical recommendations on transition, new transition tools, and the spread of medical home should stimulate future improvements in transition performance.
  PEDIATRICS 05/2013;
• Article: Resource Utilization for Observation-Status Stays at Children's Hospitals.

  Evan S Fieldston, Samir S Shah, Matthew Hall, Paul D Hain, Elizabeth R Alpern, Mark A Del Beccaro, John Harding, Michelle L Macy
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND AND OBJECTIVE:Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation-status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System.METHODS:This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals.RESULTS:Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observation-status stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay.CONCLUSIONS:Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.
  PEDIATRICS 05/2013;
• Article: Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease.

  J Bryan Carmody, Jennifer R Charlton
  [show abstract] [hide abstract]
  ABSTRACT: Thanks to remarkable advances in neonatal intensive care, infants who once had little chance for survival can now enter adulthood. Yet the consequences of premature birth or low birth weight (LBW) on nephrogenesis, final nephron number, and long-term kidney function are unclear. This review focuses on the theory, experimental evidence, and observational data that suggest an increased risk of chronic kidney disease (CKD) for infants born prematurely. Many premature and LBW infants begin life with an incomplete complement of immature nephrons. They are then exposed to a variety of external stressors that can hinder ongoing kidney development or cause additional nephron loss such as hemodynamic alterations, nephrotoxic medications, infections, and suboptimal nutrition. Acute kidney injury, in particular, may be a significant risk factor for the development of CKD. According to Brenner's hypothesis, patients with decreased nephron number develop hyperfiltration that results in sodium retention, hypertension, nephron loss, and CKD due to secondary focal segmental glomerulosclerosis. Because the risk of CKD in premature and LBW infants has not been accurately determined, there are no evidence-based recommendations for screening or management. Yet with the first generation of infants from the surfactant era only now reaching adulthood, it is possible that there is already an unrecognized epidemic of CKD. We suggest individualized, risk-based assessments of premature and LBW infants due to the increased risk of CKD and call for additional research into the long-term risk for CKD these infants face.
  PEDIATRICS 05/2013;
• Article: Family-Centered, Evidence-Based Phototherapy Delivery.

  Kinga A Szucs, Marc B Rosenman
  [show abstract] [hide abstract]
  ABSTRACT: Jaundice develops in most newborn infants and is one of the most common reasons infants are rehospitalized after birth. American Academy of Pediatrics clinical practice guidelines strongly support the recommendation that clinicians promote and support breastfeeding. Recognizing that the disruptions associated with phototherapy interfere with breastfeeding, the challenge often faced by clinicians is how to provide effective phototherapy while supporting evidence-based practices, such as rooming-in, skin-to-skin contact, and breastfeeding. We report here on a case that reflects a common clinical scenario in newborn medicine in order to describe a technique for providing phototherapy while maintaining evidence-based practices. This approach will assist clinicians in providing best-practices and family-centered care.
  PEDIATRICS 05/2013;
• Article: A Tale of Two Hospitals: The Evolution of Phototherapy Treatment for Neonatal Jaundice.

  Elliott Mark Weiss, Sol S Zimmerman
  PEDIATRICS 05/2013;
• Article: Disparities in Disability After Traumatic Brain Injury Among Hispanic Children and Adolescents.

  Nathalia Jimenez, Beth E Ebel, Jin Wang, Thomas D Koepsell, Kenneth M Jaffe, Andrea Dorsch, Dennis Durbin, Monica S Vavilala, Nancy Temkin, Frederick P Rivara
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE:To compare the extent of disability in multiple areas of functioning after mild, moderate, and severe traumatic brain injury (TBI) between Hispanic and non-Hispanic white (NHW) children.METHODS:This was a prospective cohort study of children aged <18 years treated for a TBI between March 1, 2007, and September 30, 2008. Hispanic (n = 74) and NHW (n = 457) children were included in the study. Outcome measures were disability in health-related quality of life, adaptive skills, and participation in activities 3, 12, 24, and 36 months after injury compared with preinjury functioning. We compared change in outcome scores between Hispanic and NHW children at each follow-up time. All analyses were adjusted for age, gender, severity and intent of injury, insurance, family function at baseline, parental education, and income.RESULTS:The health-related quality of life for all children was lower at all follow-up times compared with baseline. Although NHW children showed some improvement during the first 3 years after injury, Hispanic children remained significantly impaired. Significant differences were also observed in the domains of communication and self-care abilities after TBI. Differences between groups in scores for participation in activities were also present but were only significant 3 months after injury.CONCLUSIONS:Hispanic children with TBI report larger and long-term reductions in their quality of life, participation in activities, communication, and self-care abilities compared with NHW children. The reasons for these differences need to be better understood and interventions implemented to improve the outcomes of these children.
  PEDIATRICS 05/2013;
• Article: Allergen-Specific Immunotherapy for Pediatric Asthma and Rhinoconjunctivitis: A Systematic Review.

  Julia M Kim, Sandra Y Lin, Catalina Suarez-Cuervo, Yohalakshmi Chelladurai, Murugappan Ramanathan, Jodi B Segal, Nkiruka Erekosima
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND AND OBJECTIVE:Subcutaneous immunotherapy (SCIT) is approved in the United States for the treatment of pediatric asthma and rhinitis; sublingual immunotherapy (SLIT) does not have regulatory approval but is used in clinical practice. The objective of this study was to systematically review the evidence regarding the efficacy and safety of SCIT and SLIT for the treatment of pediatric asthma and allergic rhinoconjunctivitis.METHODS:Two independent reviewers selected articles for inclusion, extracted data, and graded the strength of evidence for each clinical outcome. All studies were randomized controlled trials of children with allergic asthma or rhinoconjunctivitis treated with SCIT or an aqueous formulation of SLIT. Data sources were Medline, Embase, LILACS, CENTRAL, and the Cochrane Central Register of Controlled Trials through May 2012.RESULTS:In 13 trials, 920 children received SCIT or usual care; in 18 studies, 1583 children received SLIT or usual care. Three studies compared SCIT with SLIT head-to-head in 135 children. The strength of evidence is moderate that SCIT improves asthma and rhinitis symptoms and low that SCIT improves conjunctivitis symptoms and asthma medication scores. Strength of evidence is high that SLIT improves asthma symptoms and moderate that SLIT improves rhinitis and conjunctivitis symptoms and decreases medication usage. The evidence is low to support SCIT over SLIT for improving asthma or rhinitis symptoms or medication usage. Local reactions were frequent with SCIT and SLIT. There was 1 report of anaphylaxis with SCIT.CONCLUSIONS:Evidence supports the efficacy of both SCIT and SLIT for the treatment of asthma and rhinitis in children.
  PEDIATRICS 05/2013;
• Article: A Quality-Improvement Collaborative Project to Reduce Pressure Ulcers in PICUs.

  Marty Visscher, Alice King, Ann Marie Nie, Pat Schaffer, Teresa Taylor, David Pruitt, Mary Jo Giaccone, Marshall Ashby, Sundeep Keswani
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND AND OBJECTIVE:Pediatric patients are at risk for developing pressure ulcers (PUs) and associated pain, infection risk, and prolonged hospitalization. Stage III and IV ulcers are serious, reportable events. The objective of this study was to develop and implement a quality-improvement (QI) intervention to reduce PUs by 50% in our ICUs.METHODS:We established a QI collaborative leadership team, measured PU rates during an initial period of rapid-cycle tests of change, developed a QI bundle, and evaluated the PU rates after the QI implementation. The prospective study encompassed 1425 patients over 54 351 patient-days in the PICU and NICU.RESULTS:The PU rate in the PICU was 14.3/1000 patient-days during the QI development and 3.7/1000 patient-days after QI implementation (P < .05), achieving the aim of 50% reduction. The PICU rates of stages I, II, and III conventional and device-related PUs decreased after the QI intervention. The PU rate in the NICU did not change significantly over time but remained at a mean of 0.9/1000 patient-days. In the postimplementation period, 3 points were outside the control limits, primarily due to an increase in PUs associated with pulse oximeters and cannulas.CONCLUSIONS:The collaborative QI model was effective at reducing PUs in the PICU. Pediatric patients, particularly neonates, are at risk for device-related ulcers. Heightened awareness, early detection, and identification of strategies to mitigate device-related injury are necessary to further reduce PU rates.
  PEDIATRICS 05/2013;