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1.
Pediatr Pulmonol ; 55(2): 360-368, 2020 02.
Article in English | MEDLINE | ID: covidwho-1064413

ABSTRACT

BACKGROUND: The use of medications to treat respiratory conditions of extreme prematurity is often based upon studies of adults or children over 2 years of age. Little is known about the spectrum of medications used or dosing ranges. To inform the design of future studies, we conducted a prospective analysis of respiratory medication exposure among 832 extremely low gestational age neonates. METHODS: The prematurity and respiratory outcomes program (PROP) enrolled neonates less than 29-week gestation from 6 centers incorporating 13 clinical sites. We collected recorded daily "respiratory" medications given along with dosing information through 40-week postmenstrual age or neonatal intensive care unit discharge if earlier. RESULTS: PROP participants were exposed to a wide range of respiratory medications, often at doses beyond published recommendations. Nearly 50% received caffeine and furosemide beyond published recommendations for cumulative dose. Those who developed bronchopulmonary dysplasia were more likely to receive treatment with respiratory medications. However, more than 30% of PROP subjects that did not develop bronchopulmonary dysplasia also were treated with diuretics, systemic steroids, and other respiratory medications. CONCLUSION: Extremely preterm neonates in PROP were exposed to high doses of medications at levels known to generate significant adverse effects. With limited evidence for efficacy, there is an urgent need for controlled trials in this vulnerable patient population.


Subject(s)
Infant, Premature , Intensive Care Units, Neonatal , Bronchopulmonary Dysplasia/drug therapy , Child , Child, Preschool , Female , Gestational Age , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature, Diseases/drug therapy , Male , Patient Discharge , Prospective Studies , Respiratory Tract Diseases/drug therapy , Steroids/therapeutic use
2.
Pediatr Pulmonol ; 56(2): 539-550, 2021 02.
Article in English | MEDLINE | ID: covidwho-1023306

ABSTRACT

Coronavirus disease 2019 (COVID-19) has been an unprecedented and continuously evolving healthcare crisis. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spread rapidly and initially little was known about the virus or the clinical course for infected children. In the United States of America, the medical response has been regionalized, based on variation in community transmission of the virus and localized outbreaks. Pediatric pulmonary and sleep divisions evolved in response to administrative and clinical challenges. As the workforce transitioned to working remotely, video conferencing technology and multicenter collaborative efforts were implemented to create clinical protocols. The COVID-19 pandemic challenges the framework of current medical practice but also highlights the dynamic and cooperative nature of pediatric pulmonology and sleep medicine. Our response to this pandemic has laid the groundwork for future challenges.


Subject(s)
COVID-19 , Lung Diseases/drug therapy , Sleep Wake Disorders/drug therapy , Child , Consensus , Humans , Pandemics , SARS-CoV-2
4.
Pediatr Pulmonol ; 55(8): 1859-1867, 2020 08.
Article in English | MEDLINE | ID: covidwho-597152

ABSTRACT

Unprecedented opportunities and daunting difficulties are anticipated in the future of pediatric pulmonary medicine. To address these issues and optimize pediatric pulmonary training, a group of faculty from various institutions met in 2019 and proposed specific, long-term solutions to the emerging problems in the field. Input on these ideas was then solicited more broadly from faculty with relevant expertise and from recent trainees. This proposal is a synthesis of these ideas. Pediatric pulmonology was among the first pediatric specialties to be grounded deliberately in science, requiring its fellows to demonstrate expertise in scientific inquiry (1). In the future, we will need more training in science, not less. Specifically, the scope of scientific inquiry will need to be broader. The proposal outlined below is designed to help optimize the practices of current providers and to prepare the next generation to be leaders in pediatric care in the future. We are optimistic that this can be accomplished. Our broad objectives are (a) to meet the pediatric subspecialty workforce demand by increasing interest and participation in pediatric pulmonary training; (b) to modernize training to ensure that future pediatric pulmonologists will be prepared clinically and scientifically for the future of the field; (c) to train pediatric pulmonologists who will add value in the future of pediatric healthcare, complemented by advanced practice providers and artificial intelligence systems that are well-informed to optimize quality healthcare delivery; and (d) to decrease the cost and improve the quality of care provided to children with respiratory diseases.


Subject(s)
Pediatrics , Pulmonary Medicine , Artificial Intelligence , Child , Delivery of Health Care , Health Workforce , Humans , Pediatrics/education , Pulmonary Medicine/education
5.
Med Educ Online ; 25(1): 1772014, 2020 Jan 01.
Article in English | MEDLINE | ID: covidwho-555208

ABSTRACT

Our personal views about the challenges of continuing to deliver peer teaching during a pandemic. We are a group of 4th year medical students who are part of a student society which has delivered structured, highly formulaic peer-led teaching sessions for the past three years. During the COVID-19 pandemic, the reduced access to our normal clinical teaching highlighted the importance of peer-led teaching sessions. We wanted to continue with our peer-taught sessions but knew we would have to devise a new format to make our teaching accessible to our peers wherever they were. Here, we describe the challenges of online peer teaching during the COVID-19 pandemic and our reflections of the future implications to our group.


Subject(s)
Coronavirus Infections/epidemiology , Education, Distance , Education, Medical, Undergraduate , Pandemics , Peer Group , Pneumonia, Viral/epidemiology , Students, Medical/psychology , Teaching , COVID-19 , Humans
6.
Pediatr Pulmonol ; 55(7): 1598-1600, 2020 07.
Article in English | MEDLINE | ID: covidwho-155146

ABSTRACT

The 2019 novel coronavirus (SARS-CoV-2) is endangering human health worldwide; scarcity of published pediatric cases and current literature and the absence of evidence-based guidelines necessitate international sharing of experience and personal communication. On 31 March 2020 the International Committee of the American Thoracic Society Pediatrics Assembly recorded an online podcast, during which pediatric pulmonologists worldwide shared their experience on the novel coronavirus disease (COVID-19) in children. The aim was to share personal experience in organizing pediatric care in different health care settings globally, protecting health care workers, and isolation practices. This manuscript summarizes the common themes of the podcast which centered around three main topics: more benign clinical disease and progression in pediatric cases compared to adults, a strong need for strategies to protect health care workers, and social or economic disparities as a barrier to successful pandemic control.


Subject(s)
Coronavirus Infections/epidemiology , Pediatrics/trends , Pneumonia, Viral/epidemiology , Webcasts as Topic , Adult , Betacoronavirus , COVID-19 , Child , Chronic Disease , Communicable Disease Control/methods , Coronavirus Infections/complications , Disease Progression , Global Health , Healthcare Disparities , Hospitalization , Hospitals, Pediatric/organization & administration , Humans , Internationality , Occupational Health , Pandemics , Pediatrics/methods , Pneumonia, Viral/complications , Pulmonary Medicine , Quarantine , Respiration Disorders/complications , SARS-CoV-2 , United States
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