Association between goal nutrition and intubation in patients with bronchiolitis on noninvasive ventilation: A retrospective cohort study.

BACKGROUND: Acute bronchiolitis causes many hospitalizations in children younger than 2 years. Early enteral nutrition is associated with improved outcomes in these patients. However, often nutrition is withheld when patients require noninvasive respiratory support because of the risk of aspiration worsening respiratory failure, possibly requiring intubation. We hypothesize that achieving goal energy intake is associated with a lower intubation rate in hospitalized children with bronchiolitis who require noninvasive ventilation. METHODS: This retrospective cohort study examined the association between goal enteral nutrition (60% of dietary reference energy intake) and intubation rates. We grouped patients by severity of illness and compared intubation rates in those who met goal energy to those who did not. We use stratified analysis methods (for both level of respiratory support and feeding route) to evaluate progression to intubation. RESULTS: Of the 272 patients, 215 met goal feeds. These groups had similar demographics, but the goal-feeds group started on higher respiratory support in the pediatric intensive care unit. We found that 4.65% of the patients who met goal feeds required intubation compared with 24.6% of patients who did not meet goal feeds (P < 0.0001), even after controlling for respiratory status at admission and time of feed initiation and feeding route. CONCLUSION: We observed when adjusting for severity, feeding route, and respiratory support, achieving goal energy intake remained associated with a lower rate of intubation, without higher rates of aspiration. Confounding factors include practice variation and difference in severity of illness that objective scoring may have missed.

PATIENT PERSPECTIVES ON OBESITY MANAGEMENT: NEED FOR GREATER DISCUSSION OF BMI AND WEIGHT-LOSS OPTIONS BEYOND DIET AND EXERCISE, ESPECIALLY IN PATIENTS WITH DIABETES.

Objective: To identify perceptions of obesity management in patients with and without diabetes. Methods: A 48-question survey was administered in 2018 to our Endocrinology Clinic's adult patients with a body mass index (BMI) ≥30 kg/m2. Chi-squared or Fisher's exact tests were used to compare variables between groups. Results: Of 146 respondents, 105 had diabetes and 41 did not. Most respondents were female (61.4%), African American (66.4%), and with an income <$50,000 (58.6%). Those with diabetes had significantly greater comorbidities of hypertension, high cholesterol, and arthritis. Over 90% in both groups agreed that obesity is related to hypertension, diabetes, heart disease, and early death. Only 48% were aware of their BMI, and only 30.5% with diabetes and 41.5% without diabetes perceived themselves to be obese. Over 60% in each group reported discussion of diet and exercise with their providers, whereas few in both groups reported referral to a formal weight-loss program (18.9%) or to a specialty that manages obesity (4.2%), or discussion of anti-obesity medications (11.2%) or bariatric surgery (8.4%). Reported concerns with anti-obesity medications and bariatric surgery included lack of knowledge and side effects or complications. Conclusion: These findings revealed excellent patient awareness of obesity as a health problem but misperception of obese status and unawareness of BMI. Presence of diabetes and other comorbidities did not result in greater discussion of weight-loss methods beyond diet and exercise. Increased patient education and discussion of specific weight-loss services, anti-obesity medications, and bariatric surgery are needed. Abbreviations: BMI = body mass index; DM = diabetes mellitus; HbA1c = hemoglobin A1c; HCP = healthcare provider.

Infected renal hematoma in a healthy adolescent with no renal structural anomaly.

Renal abscesses are uncommon in otherwise healthy children and adolescents who have no underlying renal structural anomalies. A previously healthy, immunocompetent, 14-year-old male without a history of abdominal trauma or urinary tract infection (UTI) was found to have a renal hematoma that became infected and developed into a renal abscess. He presented with a 2-day history of nausea, vomiting, fever and 1-day history of abdominal pain that radiated to the right flank. Clinical examination, blood work, and initial imaging indicated likely infection; however, findings were normal on urinalysis and urine culture had no growth. Complete blood count (CBC) showed a leukocytosis with a left shift. Renal ultrasound showed a 4-cm mass-like area of liquefaction in the upper pole of the right kidney, confirmed by abdominal computed tomography (CT) scan with and without contrast. Intravenous ceftriaxone was started and the patient continued to improve. He was discharged on hospital day 6 after remaining afebrile for over 20 hours and inflammatory markers continued to decrease. Intravenous ceftriaxone was continued, and oral clindamycin was added. Both antibiotics were discontinued on day 24 since onset of illness.