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OBJECTIVES: We assessed whether initiation of oral enteral nutrition in the emergency department (ED) for patients with bronchiolitis hospitalized on humidified high flow nasal cannula (HHFNC) was associated with a shorter hospital length of stay (LOS) without an increase in return ED visits or hospital readmissions. PATIENTS AND METHODS: This retrospective cohort study included children ≤24 months of age with bronchiolitis hospitalized to the general pediatric floor on HHFNC in two time periods: October 1, 2018 - April 30, 2019, and following implementation of a revised institutional bronchiolitis pathway that encouraged enteral nutrition initiation in the ED, October 1, 2021 - April 30, 2022. The primary outcome of interest was hospital LOS where the exposure was enteral feeding in the ED. RESULTS: We included 391 'fed', 114 'not fed' and 304 'unknown' patients. HHFNC treatment time (25 h for 'fed' vs. 43 h for 'not fed' vs. 35 h for'unknown', p = 0.0001) and hospital LOS (39 h for 'fed' vs. 56 h for 'not fed' vs. 48 h for 'unknown', p = 0.0001) was shorter in the 'fed' group. There were no significant differences in return ED visits or hospital readmissions. Using our median LOS (45.1 h, inter-quartile range 30.2, 64.4 h) while controlling for age, sex, initial HHFNC flow rate, the respiratory oxygenation (ROX) index, viral etiology, and time period, an adjusted logistic regression analysis demonstrated that patients fed in the ED were 1.8 times more likely to have a hospital LOS of <45 h (aOR 1.88, 95% CI 1.11-3.18, p = 0.019). CONCLUSIONS: Initiation of oral enteral nutrition in the ED for patients with bronchiolitis on HHFNC is associated with a shorter hospital LOS without an increase in return ED visits or hospital readmissions. Future prospective studies are needed to develop feeding recommendations for children with bronchiolitis receiving HHFNC support.
Assuntos
Bronquiolite , Serviço Hospitalar de Emergência , Nutrição Enteral , Tempo de Internação , Oxigenoterapia , Humanos , Estudos Retrospectivos , Masculino , Feminino , Lactente , Nutrição Enteral/métodos , Bronquiolite/terapia , Tempo de Internação/estatística & dados numéricos , Oxigenoterapia/métodos , Cânula , Hospitalização/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricosRESUMO
PURPOSE: Our aim was to evaluate the impact of the initial high flow nasal cannula (HFNC) flow rate on clinical outcomes in children with bronchiolitis. METHODS: This secondary analysis of retrospective data included children <2 years who required HFNC for bronchiolitis between 10/01/2018-04/20/2019, and following implementation of a revised institutional bronchiolitis pathway between 10/01/2021-04/30/2022. The new pathway recommended weight-based initiation of HFNC at 1.5-2 L/kg/min. We evaluated the effect of low (<1.0 L/kg/min), medium (1-1.5 L/kg/min) and high (>1.5 L/kg/min) HFNC flow rates on need for positive pressure ventilation (PPV), intensive care unit (ICU) transfer, HFNC treatment time, and hospital length of stay (LOS). RESULTS: The majority of the 885 included children had low initial flow rates (low [n = 450, 50.8%], medium [n = 332, 37.5%] and high [n = 103, 11.7%]). There were no significant differences in PPV (high: 7.8% vs. medium: 9.3% vs. low: 8.2%, p = 0.8) or ICU transfers (high: 4.9% vs. medium: 6.0% vs. low: 3.8%, p = 0.3). The low flow group had a significantly longer median HFNC treatment time (High: 29 [18, 45] vs. medium: 29 [16, 50] vs. low: 39 [25, 63], p < .001) and hospital LOS (High: 41 [27, 59] vs. medium: 42 [29, 66] vs. low: 50 (39, 75), p < .001). Logistic and linear regression models did not demonstrate any associations between HFNC flow rates and PPV or hospital LOS. CONCLUSIONS: Initial HFNC flow rates were not associated with significant changes in clinical outcomes in children in children with bronchiolitis.
Assuntos
Bronquiolite , Cânula , Tempo de Internação , Oxigenoterapia , Humanos , Estudos Retrospectivos , Bronquiolite/terapia , Bronquiolite/fisiopatologia , Lactente , Masculino , Feminino , Tempo de Internação/estatística & dados numéricos , Oxigenoterapia/métodos , Oxigenoterapia/estatística & dados numéricos , Resultado do Tratamento , Respiração com Pressão Positiva/métodos , Recém-NascidoRESUMO
Background. In response to the novel coronavirus disease (COVID-19), the state mandated "Stay At Home" order included closure of schools and public places and physical distancing measures. As a result, social interactions among children were significantly impaired and pediatric outpatient offices and vaccination rates declined. We sought to determine the impact of the COVID-19 pandemic on mental health as well as access to health care in our pediatric population in Wayne County, Michigan. Design/Methods. We conducted a survey through the Wayne County Public School Districts to elicit information regarding subjects' access to pediatric health care as well as experiences pertinent to their child(ren)'s mental health. Results. Approximately 8500 surveys were sent to families and 278 responses were received. Responses revealed that 46% of children spent more time alone during the pandemic, 36.9% had changes in sleep, 25.6% had little pleasure in doing things, and 32.5% were unhappy or sad. 66.2% were able to make new visits during the pandemic, however, 20.1% missed their child's doctors' visits for reasons including clinic cancellations and fear of entering a healthcare setting. Conclusions. The results of this survey demonstrate significant mental health concerns among our pediatric population as approximately 1/3 of families reported changes in behavior or mental health. As school closures persist in response to the ongoing pandemic and social interactions remain limited, it is imperative that pediatricians screen for depression, behavioral problems and other mental health concerns and offer families help to identify appropriate community mental health resources.
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This is a single-center US retrospective study of infection patterns among household sick contacts (HHSCs) of children with confirmed severe acute respiratory syndrome-coronavirus-2 infection in an urban setting. An HHSC was identified in fewer than half (42%) of the patients, and no child-to-adult transmission was identified. This is a single center US retrospective study of infection patterns among household sick contacts of children with confirmed SARS-CoV-2 infection. A household sick contact was identified in fewer than half (42%) of patients and no child-to-adult transmission was identified.
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COVID-19 , SARS-CoV-2 , Adulto , Busca de Comunicante , Características da Família , Humanos , Estudos RetrospectivosRESUMO
OBJECTIVE: Placement of peritoneal drainage catheters intra-operatively has been shown to help prevent fluid overload in children recovering from surgery for two-ventricle heart disease. We aimed to determine whether this practice is also helpful in children recovering from Fontan palliation. MATERIAL AND METHODS: A retrospective review was performed on children with single-ventricle anatomy undergoing Fontan palliation at our institution from 2007 to 2011. Variables in those with peritoneal drainage were compared with those without using t-tests, Mann-Whitney U-tests, chi-square tests, or analysis of variance for repeated measures as appropriate. Data were represented as mean with standard deviation unless otherwise noted. RESULTS: A total of 43 children were reviewed, 21 (49%) with peritoneal drainage catheters. No complications from catheter placement occurred. The groups did not differ with regard to cardiopulmonary bypass duration, dominant ventricle, pre-operative haemodynamic data, fenestration use, and initial intensive care unit ventilation index. Central venous pressures, vasoactive medication use, and diuretic use during the first 48 hours were also not statistically different. At 48 hours, the median fluid balance was -9 (interquartile range : -50, +20) in those with peritoneal drainage and +77 cc/kg (interquartile range : +22, +96) in those without (p < 0.001), yet median duration of mechanical ventilation was 40 hours (range: 19-326) in those with peritoneal drainage and 23 hours (range: 9-92) in those without, p = 0.01. CONCLUSION: Patients with peritoneal drainage recovering from Fontan palliation achieved negative fluid balance as compared with those without peritoneal drainage, although this difference was associated with a longer duration of mechanical ventilation.