Sharon Y Irving

The Children's Hospital of Philadelphia | CHOP · Department of Anesthesia and Critical Care Medicine

Objectives To describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019. Design/Setting Retrospective study using the National Emergency Airway Registry for Children with all TIs performed in PICU and pediatric cardiac ICU bet...

Background Current research highlights the positive impact of nutrition therapy, particularly enteral nutrition, in critical illness. However, little attention is given to the impact of nutrition on skin integrity during critical illness. Skin integrity is at risk in critically ill children owing to necessary clinical therapies and challenges of pr...

Objectives: Poor oral feeding is a known contributor to growth challenges in neonates with complex CHD who require early surgery. Almost 60% of these infants do not achieve full oral feeding by hospital discharge. This study's objective was to identify predictors of the inability to achieve full oral feeding by discharge in neonates with complex C...

Literature suggests the pediatric critical care (PCC) workforce includes limited providers from groups underrepresented in medicine (URiM; African American/Black, Hispanic/Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Additionally, women and providers URiM hold fewer leadership positions regardless of health-care discipl...

This study aimed to describe the process of the development and implementation with report of our 10-year experience with a simulation-facilitated airway management curriculum for pediatric acute care nurse practitioners in a large academic pediatric intensive care unit. This is a retrospective observational study. The study was conducted at a sing...

Post-operative oral feeding difficulties in neonates and infants with CHD is common. While pre-operative oral feeding may be normal, oral feeding challenges manifest in the post-operative period without a clearly defined aetiology. The objective of this scoping review was to examine post-operative oral feeding in full-term neonates and infants with...

Background: Infants with congenital heart disease (CHD) often have poor growth and altered body composition (fat and muscle accretion). Aim: Describe growth patterns in infants with CHD using interval weight, length, head circumference (HC), triceps (TSF), subscapular skinfolds (SSSF), and mid-upper arm circumference (MUAC) measurements. Subjec...

Background Perceptions and practices of parties in pediatric pain are critical in children's access to adequate acute pain management. The personal factors of the child and parents have been shown to be central to pediatric pain management by the Symptom Management Theory. Aim To describe children and parents/guardians' perceptions (knowledge, att...

Background There is very limited clinical and observational data on acute pain experienced by children in sub-Saharan Africa. Aims To report the prevalence and intensity of acute pain, pain management practices, and describe associations between acute pain outcomes, children’s and parents or guardian’s demographics in hospitalized children aged 2...

CONTEXT Prior criteria to define pediatric multiple organ dysfunction syndrome (MODS) did not include gastrointestinal dysfunction. OBJECTIVES Our objective was to evaluate current evidence and to develop consensus criteria for gastrointestinal dysfunction in critically ill children. DATA SOURCES Electronic searches of PubMed and EMBASE were cond...

Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was co...

Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate...

Background: Comparison of bolus (BGF) versus continuous gastric feeding (CGF) with respect to timing and delivery of energy and protein in mechanically ventilated pediatric patients has not been investigated. We hypothesized that bolus delivery would shorten time to goal nutrition and increase the percentage of goal feeds delivered. Methods: Mul...

Purpose: Few studies have examined the role of selenium in anxiety. This study aimed to evaluate the association between serum selenium concentrations and anxiety disorders and symptoms in children. Design and methods: This study utilized data from 831 children participating in the China Jintan Child Cohort Study (mean age = 12.67 years; 46.1% f...

Nutrition status plays a critical role in pressure injury (PI) healing and yet the available literature, especially in pediatric patients, is limited. Critically ill pediatric patients are at an increased risk of skin integrity compromise and PI development. Adequate nutritional intake can often be challenging to achieve in this population and immo...

Objective To examine associations between serum micronutrients and neurobehavioral function and the mediating role of sleep quality in early adolescents. Design In this cross-sectional study, peripheral blood samples were analyzed for iron and zinc levels. The Pittsburgh Sleep Quality Index and Penn Computerized Neurocognitive Battery were used to...

Parents are commonly responsible for making health care decisions for their seriously ill children in the pediatric intensive care unit (PICU); however, the factors influencing their decisions may vary. This integrative review examined the empirical literature between 2013 and 2018 to understand factors pertaining to parents’ decision-making about...

Background and Objective: The provision of nutrition therapy is an integral component of care for the critically ill child. Essential factors to consider include a the child's evolving metabolic needs accounting for age, underlying disease, co-morbidities and the severity of illness. This includes the implications that the stress response has a sig...

Objective To evaluate the effect of a standardized feeding approach using a clinical nutrition pathway on weight-for-age Z score (WAZ) over hospital length of stay (HLOS) for infants with congenital heart disease (CHD). Study design A ten-year retrospective cohort study examined eligible infants who underwent neonatal cardiac surgery between July...

The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sour...

Background Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings. Objective To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improv...

Gastrointestinal physiology involves an intricate network of mechanical, hormonal, and motility functions, including enzymatic secretions, and acid production that work in concert to ensure the breakdown of ingested food for utilization by the body. In critical illness, this delicate interplay is disrupted with marked alterations in absorptive phys...

Objectives: The impact of early enteral nutrition on clinical outcomes in critically ill children has not been adequately described. We hypothesized that early enteral nutrition is associated with improved clinical outcomes in critically ill children. Design: Secondary analysis of the Heart and Lung Failure-Pediatric Insulin Titration randomized...

Objectives: Research has documented that frequent breakfast consumption is associated with better cognition. However, the relationship between breakfast type and cognitive functioning is lesser known. In this study, we examined both breakfast type and consumption frequency in relation to IQ and academic achievement in a sample of 12-year-old Chine...

Optimal nutrition support in critically ill children is associated with improved outcomes and decreased mortality. Nutrition provision often competes with other care priorities in critically ill patients. The 2017 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient supplement clinician kn...

Optimal nutrition support in critically ill children is associated with improved outcomes and decreased mortality. Nutrition provision often competes with other care priorities in critically ill patients. The pediatric critical care nutrition support guidelines supplement clinician knowledge and inform best practices for nutrition therapy in this v...

The placement of a nasogastric tube (NGT) in a pediatric patient is a common practice that is generally perceived as a benign bedside procedure. There is potential risk for NGT misplacement with each insertion. A misplaced NGT compromises patient safety, increasing the risk for serious and even fatal complications. There is no standardized method f...

Objectives: The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis. Design: Secondary analysis of the Sepsis Prevalence, Outcomes, and Therapies study. Patient characteristics, ICU intervention...

Objectives: To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness. Data sources: For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017. Study selection: Include...

This document represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric (> 1 mo and < 18 yr) critically ill pat...

This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and <...

Introduction Obtaining anthropometry measurements in critically ill children is challenging. Our objective was to improve the process of obtaining anthropometry measurements in the pediatric intensive care unit (PICU; even if previously obtained) using a dedicated PICU nutrition support team (NST). Methods PICU staff were trained to perform anthro...

Background: Neonates undergoing heart surgery for CHD are at risk for postoperative gastrointestinal complications and aspiration events. There are limited data regarding the prevalence of aspiration after neonatal cardiothoracic surgery; thus, the effects of aspiration events on this patient population are not well understood. This retrospective...

Results: Responses were obtained from 144 parents and 66 homecare providers. Over half of the children were 12months of age or younger and had a 6 Fr feeding tube. Over 75% (108) had an NGT for 1year or less. Predominantly parents replaced the NGT but a few children self-inserted their tubes. Feeding tube placement was verified by auscultation (44...

Background Anthropometric measurements are vital for safe care in pediatric intensive care units. Objective To identify barriers to anthropometric measurements and determine if perceptions of barriers differ between ordering providers and nurses. Methods A 21-item survey to elicit perceptions of barriers to obtaining anthropometric measurements was...

Malnutrition in the critically ill or injured child is associated with increased morbidities and mortality in the pediatric intensive care unit (PICU), whether present upon admission or acquired during the PICU stay. Particular subpopulations such as those with congenital heart disease or severe thermal injury are at highest risk for malnutrition w...

Growth failure is often observed in infants with congenital heart disease (CHD); it is unclear, however, whether growth failure is due to increased total energy expenditure (TEE). An observational study of infants with CHD and surgical intervention within the first 30 days of life and healthy infants of similar age was undertaken. TEE was measured...

Background Growth failure is common in infants with congenital heart disease (CHD), however it is unclear if it is due to increased total energy expenditure (TEE). Objectives To determine if TEE of infants with CHD post‐surgical intervention differs from healthy infants, and evaluate the accuracy of equations used to calculate TEE. Design Infants...

Background: Temporary enteral access devices (EADs), such as nasogastric (NG), orogastric (OG), and postpyloric (PP), are used in pediatric and neonatal patients to administer nutrition, fluids, and medications. While the use of these temporary EADs is common in pediatric care, it is not known how often these devices are used, what inpatient locati...

Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is a common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD u...

Placement of a nasogastric enteral access device ( NG-EAD), often referred to as a nasogastric tube, is common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD us...

Introduction: Accurate determination of energy needs in chronically ventilated children is vital to prevent harmful consequences associated with underfeeding and overfeeding. Whereas indirect calorimetry (IC) to measure resting energy expenditure (REE) has been well described in acutely critically ill children, the safety and feasibility of IC to o...

Objective Infants with Congenital Heart Disease (CHD) often exhibit growth failure. This can affect anthropometric and neurodevelopmental outcomes well into childhood. To determine the resting energy expenditure (REE), body composition, and growth in infants with CHD at 3 months of age, with the secondary aim to identify predictors of REE as compar...

Objective: Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. Methods:...

Patterns of Weight Change in Infants with Congenital Heart Disease Following Neonatal Surgery: Potential predictors of growth failure Sharon Y Irving DISSERTATION SUPERVISOR: BARBARA MEDOFF-COOPER, RN, PhD Congenital heart disease (CHD) is reported to have an incidence of 9 to 14 per 1000 live births with a prevalence estimated between 650,000 and...

Adequate nutritional support is essential for normal infant growth and development. Infants with congenital cardiac disease are known to be at risk for growth failure. We sought to describe perioperative growth in infants undergoing surgical repair of two-ventricle congenital cardiac disease and assess for predictors of their pattern of growth.Mate...

The purpose of this study was to assess the pattern of weight change from surgical intervention to home discharge and to determine predictors of poor growth in this population of infants with congenital cardiac disease. Neonates with functionally univentricular physiology enrolled in a prospective cohort study examining growth between March, 2003 a...

This study aimed to identify and compare differences in temperament and maternal stress between infants with complex congenital heart disease and healthy controls at 3 months of age. Study sample was drawn from an existing longitudinal study examining growth in infants with congenital heart disease when compared with healthy controls. Infant temper...

Nursing care provided to patients and their families should be based on strong scientific evidence. In the quantitative research paradigm, the highest level of evidence is derived from conclusive randomized controlled clinical trials. Multicenter clinical research allows the accrual of sufficient numbers of diverse participants in a shorter period...

Munchausen syndrome by proxy is difficult to diagnose unless healthcare providers are astute to its clinical features and management. A case is presented to educate nurses and advanced practice nurses, of the nursing, medical, legal, and social complexities associated with Munchausen syndrome by proxy. This article also provides a brief review of t...

Munchausen syndrome by proxy is difficult to diagnose unless healthcare providers are astute to its clinical features and management. A case is presented to educate nurses and advanced practice nurses, of the nursing, medical, legal, and social complexities associated with Munchausen syndrome by proxy. This article also provides a brief review of t...

The requirements of growth and organ development create a challenge in nutrition management for the pediatric patient. The stress of critical illness further complicates the delivery of adequate nutrients. Enteral feeding has several advantages over parenteral nutrition (PN), which include preservation of the gastrointestinal mucosa and decreasing...

The requirements of growth and organ development create a challenge in nutrition management for the pediatric patient. The stress of critical illness further complicates the delivery of adequate nutrients. Enteral feeding has several advantages over parenteral nutrition (PN), which include preservation of the gastrointestinal mucosa and decreasing...

To describe the development and implementation of a pediatric critical care nurse practitioner role in a tertiary academic pediatric intensive care unit. Selected relevant articles from the literature. Over the past two decades, the role of critical care nurse practitioners in neonatal and adult settings has developed. More recently, the role has e...