Pediatric hospital utilization for patients with avoidant restrictive food intake disorder.

BACKGROUND: Avoidant restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder added to the DSM-5 in 2013 and ICD-10 in 2018. Few studies have examined hospital utilization for patients with ARFID specifically, and none to date have used large administrative cohorts. We examined inpatient admission volume over time and hospital utilization and 30-day readmissions for patients with ARFID at pediatric hospitals in the United States. METHODS: Using data from the Pediatric Health Information System (PHIS), we identified inpatient admissions for patients with ARFID (by principal International Classification of Diseases, 10th Revision, ICD-10 diagnosis code) discharged October 2017-June 2022. We examined the change over time in ARFID volume and associations between patient-level factors (e.g., sociodemographic characteristics, co-morbid conditions including anxiety and depressive disorders and malnutrition), hospital ARFID volume, and hospital utilization including length of stay (LOS), costs, use of enteral tube feeding or GI imaging during admission, and 30-day readmissions. Adjusted regression models were used to examine associations between sociodemographic and clinical factors on LOS, costs, and 30-day readmissions. RESULTS: Inpatient ARFID volume across n = 44 pediatric hospitals has increased over time (ß = 0.36 per month; 95% CI 0.26-0.46; p < 0.001). Among N = 1288 inpatient admissions for patients with ARFID, median LOS was 7 days (IQR = 8) with median costs of $16,583 (IQR = $18,115). LOS and costs were highest in hospitals with higher volumes of ARFID patients. Younger age, co-morbid conditions, enteral feeding, and GI imaging were also associated with LOS. 8.5% of patients were readmitted within 30 days. In adjusted models, there were differences in the likelihood of readmission by age, insurance, malnutrition diagnosis at index visit, and GI imaging procedures during index visit. CONCLUSIONS: Our results indicate that the volume of inpatient admissions for patients with ARFID has increased at pediatric hospitals in the U.S. since ARFID was added to ICD-10. Inpatient stays for ARFID are long and costly and associated with readmissions. It is important to identify effective and efficient treatment strategies for ARFID in the future.

Recent studies indicate that Avoidant Restrictive Food Intake Disorder (ARFID) is a complex feeding and eating disorder often diagnosed in younger children. To date, there are no large studies using administrative data to examine hospital utilization or costs among patients with ARFID. In a geographically diverse cohort of pediatric hospitals in the United States, we found inpatient admissions for ARFID have increased over time and that ARFID is associated with long, costly stays and readmissions which has important implications for identifying efficient treatment strategies. Future studies are needed to explore effective and efficient treatment strategies and prevent readmissions in this patient population.

Memoria episódica verbal en pacientes pediátricos intervenidos de cirugía de la epilepsia del lóbulo temporal: un estudio de seguimiento al año / Verbal episodic memory in children undergoing temporal lobe epilepsy surgery: a one-year follow-up study

Introducción La memoria episódica verbal (MEV) no suele resultar alterada en niños con epilepsia focal sometidos a resecciones del lóbulo temporal izquierdo, a diferencia de lo que cabría esperar si se tratara de un cerebro adulto. Los últimos hallazgos sugieren que la actividad epileptógena en los primeros años de vida disrumpe la lateralización del sistema mnésico, lo que conduce al desarrollo de una representación bilateral de la memoria. El presente estudio pretende analizar si la lateralidad de la epilepsia es un predictor significativo de cara al pronóstico posquirúrgico de la MEV en la cirugía de la epilepsia del lóbulo temporal (ELT) en edad pediátrica. Esta investigación también pretende aportar evidencias sobre la relación de la MEV con otros factores demográficos y clínicos relevantes, como el sexo, la edad de inicio de las crisis, la edad quirúrgica y la duración de la epilepsia, así como estudiar el impacto del rendimiento prequirúrgico en la MEV sobre los resultados posquirúrgicos. Pacientes y métodos Se extrajeron de la base de datos del Hospital Sant Joan de Déu y se analizaron retrospectivamente las puntuaciones prequirúrgicas y al año de seguimiento postoperatorio de una tarea de recuerdo de lista de palabras correspondientes a 25 niños intervenidos de ELT (ELT izquierdo, n = 11; ELT derecho, n = 14). Resultados No se encontraron diferencias intergrupales prequirúrgicas significativas al comparar las puntuaciones en MEV sobre la base de la lateralidad de la epilepsia (p > 0,5). En cuanto al grupo de ELT izquierdo, se encontró una alta correlación negativa entre la edad de inicio y la puntuación prequirúrgica del recuerdo libre a largo plazo (rho = –0,72; p = 0,01). No se encontraron cambios intragrupo significativos entre el pre- y el postoperatorio en relación con el rendimiento en la MEV, independientemente de la lateralidad de la epilepsia (grupo de ELT izquierdo, p > 0,56; grupo de ELT derecho, p > 0,12). Conclusiones ... (AU)

INTRODUCTION Verbal episodic memory (VEM) is often unimpaired in children with focal epilepsy undergoing left temporal lobe resections, unlike what we might expect in the adult brain. The latter findings suggest that epileptiform activity in early life disrupts memory system lateralization, leading to the development of bilateral memory representation. The present study aims to analyze whether the laterality of epilepsy is a major predictor for post-operative VEM prognosis in pediatric temporal lobe epilepsy (TLE) surgery. This research also pretends to provide evidence about the relationship of VEM performance with other relevant demographical and clinical factors such as sex, age at onset of seizures, age at surgery and duration of epilepsy, as well as to study the impact of presurgical VEM performance on postsurgical outcomes. PATIENTS AND METHODS Pre-operative and one-year follow-up post-operative word-list recall scores from 25 children who underwent TLE surgery (left-sided, n = 11; right-sided, n = 14) were extracted from the Hospital Sant Joan de Déu database and were retrospectively analyzed. RESULTS No significant presurgical intergroup differences were found when comparing VEM scores by laterality of epilepsy (p > 0.5). Looking at the left TLE group, a high negative correlation was found between the onset age and the pre-operative long-term free recall score (rho = –0.72, p = 0.01). No significant pre- to post-operative intragroup changes were found regarding VEM performance, regardless of epilepsy laterality (left TLE group, p > 0.56; right TLE group, p > 0.12). CONCLUSIONS The laterality of epilepsy does not show to be a significant factor in and of itself (AU)

Addressing the gap in health economics data to support national cancer control plans in low- and middle-income countries: The Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC-BRIDGE) tool.

BACKGROUND: National cancer control plans (NCCPs) are complex public health programs that incorporate evidence-based cancer control strategies to improve health outcomes for all individuals in a country. Given the scope of NCCPs, small and vulnerable populations, such as patients with childhood cancer, are often missed. To support planning efforts, a rapid, modifiable tool was developed that estimates a context-specific national budget to fund pediatric cancer programs, provides 5-year scale-up scenarios, and calculates annual cost-effectiveness. METHODS: The tool was codeveloped by teams of policymakers, clinicians, and public health advocates in Zimbabwe, Zambia, and Uganda. The 11 costing categories included real-world data, modeled data, and data from the literature. A base-case and three 5-year scale-up scenarios were created using modifiable inputs. The cost-effectiveness of the disability-adjusted life years averted was calculated. Results were compared with each country's projected gross domestic product per capita for 2022 through 2026. RESULTS: The number of patients/total budget for year 1 was 250/$1,109,366 for Zimbabwe, 280/$1,207,555 for Zambia, and 1000/$2,277,397 for Uganda. In year 5, these values were assumed to increase to 398/$5,545,445, 446/$4,926,150, and 1594/$9,059,331, respectively. Base-case cost per disability-adjusted life year averted/ratio to gross domestic product per capita for year 1, assuming 20% survival, was: $807/0.5 for Zimbabwe, $785/0.7 for Zambia, and $420/0.5 for Uganda. CONCLUSIONS: This costing tool provided a framework to forecast a budget for childhood-specific cancer services. By leveraging minimal primary data collection with existing secondary data, local teams obtained rapid results, ensuring that childhood cancer budgeting is not neglected once in every 5 to 6 years of planning processes.

Prevalência de casos graves de covid-19 e fatores associados em um hospital pediátrico / Prevalencia de casos graves de covid-19 y factores asociados en un hospital pediátrico / Prevalence of severe covid-19 cases and associated factors in a pediatric hospital

Objetivo: descrever a prevalência de casos graves pelo SARS-Cov-2 e fatores associados à ocorrência em crianças e adolescentes. Método: estudo transversal, num hospital pediátrico, com 236 crianças e adolescentes com COVID-19 entre março-2020 até fevereiro-2022. Resultados: a prevalência de casos graves da COVID-19 foi de 37%. A maior frequência foram do sexo masculino (41%), até 1 ano de idade (41,8%) e municípios circunvizinhos (46,5%). As manifestações clínicas em até 72 horas após hospitalização, associados aos casos graves foram: desconforto respiratório (RPb: 1,91; IC 95% 1,36 - 2,67), saturação de O2 < 92% (RPb: 9,27 IC 95% 5,99 - 14,35), necessidade de cuidados intensivos (RPb: 5,25; IC 95% 3,87 - 7,12) e comorbidades (RPb: 1,73 IC 95% 1,25 - 2,40). Os desfechos, óbito/transferência, associaram-se com maior proporção de casos graves. Conclusão: conhecer o perfil de casos de COVID-19 na população pediátrica e fatores associados pode contribuir para revisar processos a fim de manejo adequado dos casos.

Objetivo: describir la prevalencia de casos graves por el SARS-Cov-2 y factores asociados a la ocurrencia en niños y adolescentes. Método: estudio transversal, en un hospital pediátrico, con 236 niños y adolescentes con COVID-19 entre marzo-2020 hasta febrero-2022. Resultados: la prevalencia de casos graves de COVID-19 fue del 37%. La mayor frecuencia fueron del sexo masculino (41%), hasta 1 año de edad (41,8%) y municipios circundantes (46,5%). Las manifestaciones clínicas en hasta 72 horas después de la hospitalización, asociados a los casos graves fueron: malestar respiratorio (RPb: 1,91; IC 95% 1,36 - 2,67), saturación de O2 < 92% (RPb: 9,27 IC 95% 5,99 - 14,35), necesidad de cuidados intensivos (RPb: 5,25; IC 95% 3,87 - 7,12) y comorbilidades (RPb: 1,73 IC 95% 1,25 - 2,40). Los resultados, muerte/transferencia, se asociaron con mayor proporción de casos graves. Conclusión: conocer el perfil de casos de COVID-19 en la población pediátrica y factores asociados puede contribuir para revisar procesos a fin de manejo adecuado de los casos.

Objective: to describe the prevalence of severe cases by SARS-Cov-2 and factors associated with the occurrence in children and adolescents. Method: cross-sectional study, in a pediatric hospital, with 236 children and adolescents with COVID-19 between March 2020 and February 2022. Results: the prevalence of severe cases of COVID-19 was 37%. The highest frequency was male (41%), up to 1 year of age (41.8%) and surrounding cities (46.5%). Clinical manifestations within 72 hours of hospitalization, associated with severe cases, were respiratory distress (PRc: 1.91; 95% CI 1.36 -2.67), O2saturation < 92% (PRc: 9.27 95% CI 5.99 - 14.35), need for intensive care (PRc: 5.25; 95% CI 3.7 - 87) and comorbidities (PRc: 1.73 95% CI 1.25 - 2.40). The outcomes death/transfer were associated with a higher proportion of severe cases. Conclusion: knowing the profile of COVID-19 cases in the pediatric population and associated factors can contribute to review processes for proper management of cases.

Antibiotic use in pediatric acute care hospitals: an analysis of antibiotic consumption data from Germany, 2013-2020.

BACKGROUND: Antimicrobial stewardship (AMS) programs are effective tools for improving antibiotic prescription quality. Their implementation requires the regular surveillance of antibiotic consumption at the patient and institutional level. Our study captured and analyzed antibiotic consumption density (ACD) for hospitalized pediatric patients. METHOD: We collected antibacterial drug consumption data for 2020 from hospital pharmacies at 113 pediatric departments of acute care hospitals in Germany. ACD was calculated as defined daily dose (DDD, WHO/ATC Index 2019) per 100 patient days (pd). In addition, we analyzed the trends in antibiotic use during 2013-2020. RESULTS: In 2020, median ACD across all participating hospitals was 26.7 DDD/100 pd, (range: 10.1-79.2 DDD/100 pd). It was higher at university vs. non-university hospitals (38.6 vs. 25.2 DDD/100 pd, p < 0.0001). The highest use densities were seen on oncology wards and intensive care units at university hospitals (67.3 vs. 38.4 DDD/100 pd). During 2013-2020, overall ACD declined (- 10%) and cephalosporin prescriptions also decreased (- 36%). In 2020, cephalosporins nevertheless remained the most commonly dispensed class of antibiotics. Interhospital variability in cephalosporin/penicillin ratio was substantial. Antibiotics belonging to WHO AWaRe "Watch" and "Reserve" categories, including broad-spectrum penicillins (+ 31%), linezolid (+ 121%), and glycopeptides (+ 43%), increased over time. CONCLUSION: Significant heterogeneity in ACD and prescription of different antibiotic classes as well as high prescription rates for cephalosporins and an increased use of reserve antibiotics indicate improvable antibiotic prescribing quality. AMS programs should urgently prioritize these issues to reduce antimicrobial resistance.

A new soft tissue constructed with chitosan for wound dressings-incorporating nanoparticles for medical and nursing therapeutic efficacy.

The skin, being the largest organ in the human body, plays a vital role in shielding internal organs from external physical and chemical factors. However, skin damage caused by various factors such as injuries, surgeries, diabetes, or burns can lead to wounds that diminish the skin's protective function. Monitoring essential physiological parameters like temperature, moisture, and pH is crucial to facilitate antibiotic treatment, remote physician monitoring, patient comfort, cost reduction, and prevention of hospital-acquired infections. To this end, innovative wound coverings made of biological materials like gelatin, carboxymethyl chitosan, and titanium nanoparticles have been developed, mainly for hospital and pediatric applications. These wound coverings come equipped with sensors to monitor temperature, pH, and moisture and are suitable for pediatric hospitals where children experience difficulty in wound healing due to their sensitive skin. The temperature monitoring feature allows physicians to accurately assess the wound's temperature, detect potential infections, and take prompt actions. These wound coverings can significantly enhance wound treatment for patients, as real-time monitoring of physiological parameters enables informed decision-making by physicians, leading to better therapeutic outcomes. Furthermore, the use of these wound coverings can minimize the risk of hospital-acquired infections. Their adaptability and flexibility make them ideal for various wound types and sizes, ensuring patient comfort and compliance with the treatment plan. In conclusion, the development of innovative and flexible wound coverings using biological materials and equipped with sensors represents a significant breakthrough in wound management. The use of these wound coverings has the potential to revolutionize wound care and improve patient outcomes, particularly in pediatric hospitals where wound healing is often challenging.

Pediatric patients with malignant brain tumor treated at children's hospitals: association with fewer unplanned readmissions.

OBJECTIVE: Pediatric primary brain tumors are the leading cause of death among childhood cancers. Guidelines recommend specialized care with a multidisciplinary team and focused treatment protocols to optimize outcomes in this patient population. Furthermore, readmission is a key metric of patient outcomes and has been used to inform reimbursement. However, no prior study has analyzed national database-level records to evaluate the role of care in a designated children's hospital following pediatric tumor resection and its impact on readmission rates. The goal of this study was to investigate whether treatment at a children's hospital rather than a nonchildren's hospital has a significant effect on outcome. METHODS: The Nationwide Readmissions Database records from 2010 to 2018 were analyzed retrospectively to evaluate the effect of hospital designation on patient outcomes after craniotomy for brain tumor resection, and results are reported as national estimates. Univariate and multivariate regression analyses of patient and hospital characteristics were conducted to evaluate if craniotomy for tumor resection at a designated children's hospital was independently associated with 30-day readmissions, mortality rate, and length of stay. RESULTS: A total of 4003 patients who underwent craniotomy for tumor resection were identified using the Nationwide Readmissions Database, with 1258 of these cases (31.4%) treated at children's hospitals. Patients treated at children's hospitals were associated with decreased likelihood of 30-day hospital readmission (OR 0.68, 95% CI 0.48-0.97, p = 0.036) compared to patients treated at nonchildren's hospitals. There was no significant difference in index mortality between patients treated at children's hospitals and those treated at nonchildren's hospitals. CONCLUSIONS: The authors found that patients undergoing craniotomy for tumor resection at children's hospitals were associated with decreased rates of 30-day readmission, with no significant difference in index mortality. Future prospective studies may be warranted to confirm this association and identify components contributing to improved outcomes in care at children's hospitals.

Emergency Care Capacity in Pediatric Hospitals, Khartoum, Sudan

@#Introduction: Critical pediatric patients have specific needs, which require special skills, training, equipment, supplies, personnel, and medications. While the knowledge related to enhance survival rate of newborn and children has improved over the past few decades. This study conducted to assess the emergency care capacity in pediatric hospitals at Khartoum state, Sudan. Methods: This is a descriptive cross-sectional hospital-based study, it was conducted in three hospitals at Khartoum, Sudan 2017-2018, to assess emergency care capacity in pediatric hospitals. Data was collected using open-ended questionnaire, and observational checklist. The data scored using dichotomous indicators (absent or present). Results: The study showed that there is shortage in human resources necessary to provide emergency care. However, much essential equipment for emergency care of children was absent in most hospitals, moreover, only 33% of hospitals had Triage system staffed by a trained person. Further, the clinical practice protocols for managing dehydration, neonatal sepsis, and neonatal resuscitation were not traced at the three hospitals. There are a limited laboratory services in one hospital. Conclusion: It is concluded that pediatric specialized hospitals, in Khartoum state, Sudan, have low capacity to provide emergency care for children. Further efforts are needed to improve the emergency care capacity in Khartoum hospitals.

La madre acompañante en los servicios pediátricos, ejemplo del pensamiento humanista de Fidel / The Accompanying Mother in Pediatric Services, An Example of Fidel's Humanist Thought

Introducción: El desarrollo de la pediatría en Villa Clara tiene una rica historia e importantes contribuciones de grandes personalidades. Una de ellas, fue la incorporación de la madre acompañante en los servicios pediátricos, controversial decisión inicialmente no bien comprendida, que se desarrolló en la provincia en 1968. Objetivo: Explicar el surgimiento de la madre acompañante en los servicios pediátricos de Villa Clara. Métodos: Para analizar el objeto de estudio se realizó una investigación histórica durante el año 2019 mediante el método teórico, que se sustenta en la interacción de lo histórico y lo lógico desde las dimensiones temporal y espacial; y el empírico, consistente en la revisión de fuentes primarias (análisis documental) y secundarias (incluido entrevistas con informantes clave), seguidos por la triangulación metodológica para arribar a consideraciones integradoras. Resultados: Se identificaron destacadas figuras de la especialidad de Pediatría en Villa Clara, y su contribución a la incorporación de la madre acompañante en los hospitales pediátricos. Conclusiones: Los servicios pediátricos de Villa Clara fueron pioneros en la incorporación del modelo de la madre acompañante y su generalización contó con el apoyo del líder histórico de la Revolución, Fidel Castro Ruz(AU)

Introduction: The development of pediatrics in Villa Clara has a rich history and important contributions from great personalities. One of them was the incorporation of the accompanying mother in the pediatric services, a controversial decision initially not well understood, which was developed in the province in 1968. Objective: To explain the emergence of the accompanying mother modality in the pediatric services of Villa Clara. Methods: To analyze the object of study, a historical research was carried out during 2019 using the theoretical method, which is based on the interaction of the historical and the logical from the temporal and spatial dimensions; and the empirical one, consisting in the review of primary sources (documentary analysis) and secondary sources (including interviews with key informants), followed by methodological triangulation to arrive at integrative considerations. Results: Outstanding figures of the specialty of Pediatrics in Villa Clara were identified, and their contribution to the incorporation of the accompanying mother modality in pediatric hospitals. Conclusions: The pediatric services of Villa Clara were pioneers in the incorporation of the accompanying mother model and its generalization had the support of the historical leader of the Revolution, Fidel Castro Ruz(AU)

A study on the correlation between work stressors and the coping styles of outpatients and emergency nurses in 29 pediatric specialty hospitals across China.

Objective: This study aimed to better understand the current situation involving work stressors and the coping styles of outpatient and emergency nurses in 29 pediatric specialty hospitals across China. The study analyzed this correlation to provide a reference for the occupational stress management of pediatric nurses. Methods: From June to September 2020, 1,457 outpatient and emergency nurses in 29 pediatric specialty hospitals across China were selected as study participants, and a questionnaire survey was conducted using the Basic Information Questionnaire, the Chinese version of the Work Stressor Scale for Nurses, and the Simple Coping Style Scale. Results: The assessed stress level of outpatient and emergency nurses in 29 tertiary pediatric specialty hospitals nationwide is lower than the results of the survey of the 2007 domestic norm, p < 0.05. The stressors related to nurses' expectations, family conflicts, the nature of nursing work, patient factors, and workload were lower compared with the national norm (p < 0.05). The positive coping style score on the Simple Coping Style Scale for pediatric outpatient nurses was (36.66 ± 6.16), and work stressors were positively associated with negative coping styles (p < 0.01). Multiple regression analysis showed that the influencing factors of work stressors among pediatric outpatient and emergency nurses correlated with the authorized size, age, working years of nurses, work department, and negative coping styles. Conclusion: Negative coping styles were present among pediatric outpatient and emergency nurses and were associated with work stressors. The influencing factors of stressors mainly correlated with the clinical establishment, age, years of employment as a nurse, work department, and negative coping styles.

Improving the Pediatric Floor Discharge Process Following Tonsillectomy.

OBJECTIVES/HYPOTHESIS: Over 300,000 tonsillectomies are performed nationwide every year. In 2017, half of children undergoing tonsillectomy at our institution were admitted to the pediatric floor, with only 10.4% being discharged before 11 AM on postoperative day 1 (POD1). Our primary objective was to increase the percentage of patients discharged before 11 AM on POD1 to at least 50% within 1 year. STUDY DESIGN: Prospective observational (quality improvement). METHODS: A multidisciplinary quality improvement (QI) team was assembled. The primary outcome was "timely discharges," defined as percentage of patients discharged before 11 AM on POD1; secondary outcomes were percentage of patients discharged before 1 PM and mean length of stay (hours). Seven-day readmission rate served as our balancing measure. Prior year data served as baseline. A process map, Ishikawa diagram, and Pareto chart were utilized to identify specific target areas for improvement. Key interventions included announcement of our initiative, an electronic health record-based handoff text prompt, discharge checklist, automated discharge instructions, encouragement to place discharge orders by 9 AM and implementation of early POD1 rounds. Data were collected on a biweekly basis and the primary and secondary outcomes were plotted on control charts and analyzed using rules for special cause variation. RESULTS: Within 12 months, POD1 discharges before 11 AM and before 1 PM increased to 44.9% and 83.8%, respectively, with sustained improvement for the first 6 months of the subsequent year. Mean length of stay decreased, and 7-day readmission rates were unchanged. CONCLUSIONS: By understanding the factors influencing timely POD1 discharges after tonsillectomy, key interventions were implemented to achieve an increase in timely discharges. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:225-233, 2022.

Vigilancia de la infección por SARS-CoV-2 COVID-19 en un hospital pediátrico / Surveillance of the SARS-CoV-2 COVID-19 infection in a pediatric hospital / Vigilância da infecção por SARS-CoV-2 COVID-19 em um hospital pediátrico

Introducción: a partir de enero de 2020, cuando la OMS declaró la infección por SARS-CoV-2 COVID-19 como una emergencia de interés internacional, en los centros de atención pediátrica se comenzaron a implementar protocolos de actuación y actividades con miras a la preparación y contención de la pandemia. Objetivo: describir los resultados de la vigilancia hospitalaria y las características epidemiológicas-clínicas de niños y adolescentes con infección por SARS-CoV-2 COVID-19 en el período comprendido entre 1/4/2020 y 30/4/2021 en un hospital pediátrico. Material y métodos: se realizó un estudio observacional descriptivo retrospectivo. Período considerado 1/4/2020-30/4/2021. Se incluyeron todos los niños y adolescentes menores de 16 años con diagnóstico de infección por SARS-CoV-2 COVID-19 por test de PCR y captados por el Comité de Infecciones Hospitalarias (CIH) y la Unidad de Epidemiología e Infectología Pediátrica. Se realizó PCR para SARS-CoV-2 a todos los usuarios internados, a los incluidos en la vigilancia IRAG según definición de caso, y a niños y adolescentes con internaciones prolongadas cada 10 días. Fuente de datos: vigilancia activa establecida por el CIH, historias clínicas, laboratorio. Variables: sexo, edad, motivo de testeo, comorbilidad, contacto, presentación clínica, evolución, brotes hospitalarios. Análisis estadístico: distribución de frecuencias y medidas de resumen. Consideraciones éticas: se garantizó el anonimato en todo el proceso de análisis y comunicación. Resultados: en el período considerado se realizaron 10.645 test de PCR. Se identificaron 53 casos positivos, 7 (13, 2%) correspondieron a 2020 (noviembre y diciembre), 46 (86,8%) a 2021 (enero a abril), 30 (56,6%) de sexo femenino. Edad: 23 (43,4%) fueron menores de 1 año. Mediana 2,5 años. 13 pacientes presentaban comorbilidades (24,5%). En 30 casos (56,6%) el motivo del test fue la presencia de síntomas compatibles, mientras que 22 (41,5%) se encontraban asintomáticos. En 40 casos (75%) se identificó contacto conviviente como fuente de contagio. Permanecieron internados 39 casos, 5 requirieron CTI. 14 casos se asistieron en forma ambulatoria. Ninguno falleció. Se identificó un único brote de transmisión intrahospitalaria con tres usuarios en este período, que se controló en forma rápida. No se constataron contagios de usuarios a personal de salud en el período considerado. Conclusiones: las estrategias de vigilancia y control hospitalario han permitido identificar en forma oportuna los casos de COVID-19 y controlar la transmisión. Los casos crecieron en forma exponencial en consonancia con la situación epidemiológica nacional en el período considerado.

Introduction: as of January 2020, when the WHO declared the SARS-CoV-2 COVID-19 infection as a global health emergency, action protocols and activities began to be implemented in pediatric care centers with the purpose preparing and containing the pandemic. Objective: describe the results of hospital surveillance and the epidemiological-clinical characteristics of children and adolescents with a SARS-CoV-2 COVID-19 infection between 4/1/2020 and 4/30/2021 in a pediatric hospital. Material and methods: a retrospective descriptive observational study was carried out. Period: 4/1/2020-4/30/2021. All children and adolescents under 16 years of age with diagnosis of SARS-CoV-2 COVID-19 infection by PCR test and assisted by the In-Hospital Infectious Diseases Center (CIH) and by the Pediatric Epidemiology and Infectiology Unit. A PCR test for SARS-CoV-2 was performed to all hospitalized users and to those included in SARI surveillance as defined for this case, and to children and adolescents with prolonged hospitalizations every 10 days. Data source: active surveillance established by the CIH, medical records, laboratory data. Variables: sex, age, reason for testing, comorbidities, contact, clinical presentation, evolution, hospital outbreaks. Statistical Analysis: frequency distribution and summary measures. Ethical considerations: anonymity throughout the analysis and communication process. Results: in the period analyzed, 10,645 PCR tests were performed. 53 cases were identified as positive, 7 (13.2%) were in 2020 (November and December), 46 (86.8%) in 2021 (January to April), 30 (56.6%) were female. Age: 23 (43.4%) were under 1 year of age. Median 2.5 years. 13 patients had comorbidities (24.5%). In 30 cases (56.6%), the reason for the test was the presence of compatible symptoms, while 22 (41.5%) were asymptomatic. In 40 cases (75%), we identified a home contact as a source of contagion. 39 cases remained hospitalized, 5 required ICU. 14 cases were assisted on an outpatient basis. None died. A single case was caused by an outbreak of nosocomial transmission involving three users in this period, which was controlled timely. No infections were recorded from users to health staff in the period analyzed. Conclusions: hospital surveillance and control strategies have enabled us to identify cases of COVID-19 in a timely manner and control transmission. Cases grew exponentially in line with the national epidemiological situation in the period analyzed.

Introdução: a partir de janeiro de 2020, quando a OMS declarou a infecção por SARS-CoV-2 COVID-19 como emergência de interesse internacional, começaram a ser implementados protocolos de ação e atividades nos centros de atendimento pediátrico com vistas à preparação e contenção da pandemia. Objetivo: descrever os resultados da vigilância hospitalar e as características epidemiológicas-clínicas de crianças e adolescentes com infecção por SARS-CoV-2 COVID-19 entre 01/04/2020 e 30/04/2021 em um hospital pediátrico. Material e métodos: foi realizado um estudo observacional descritivo retrospectivo. O período considerado foi de 01/04/2020 a 30/04/2021. Participaram todas as crianças e adolescentes com menos de 16 anos de idade com diagnóstico da infecção por SARS-CoV-2 COVID-19 por teste de PCR assistidas no Centro de Infectologia Hospitalar (CIH) e Unidade de Epidemiologia e Infectologia Pediátrica. O Teste PCR foi realizado para SARS-CoV-2 para todos os usuários hospitalizados, para aqueles incluídos na vigilância de SARI, conforme definido para o caso, e para crianças e adolescentes com internações prolongadas a cada 10 dias. Fonte de dados: vigilância ativa estabelecida pelo CIH, prontuário, laboratório. Variáveis: sexo, idade, motivo do teste, comorbidade, contato, apresentação clínica, evolução, surtos hospitalares. Análise estatística: distribuição de frequência e medidas sumárias. Considerações éticas: anonimato durante todo o processo de análise e comunicação. Resultados: no período considerado, foram realizados 10.645 testes de PCR. 53 casos foram identificados positivos, 7 (13,2%) corresponderam a 2020 (novembro e dezembro), 46 (86,8%) a 2021 (janeiro a abril), 30 (56,6%) eram do sexo feminino. Idade: 23 (43,4%) eram menores de 1 ano. Média 2,5 anos. 13 pacientes apresentavam comorbidades (24,5%). Em 30 casos (56,6%) o motivo do exame foi a presença de sintomas compatíveis, enquanto 22 (41,5%) foram assintomáticos. Em 40 casos (75%) o contato foi identificado como fonte de contágio. 39 casos permaneceram internados, 5 foram internados na UTI. 14 casos foram atendidos ambulatorialmente. Nenhum morreu. Um único caso foi causado por transmissão hospitalar envolvendo a três usuários neste período, ele foi controlado rapidamente. Não foram encontradas infecções de usuários para profissionais de saúde no período considerado. Conclusões: as estratégias de vigilância e controle hospitalares permitiram identificar casos de COVID-19 em tempo hábil e controle da transmissão. Os casos cresceram exponencialmente de acordo com a situação epidemiológica nacional no período considerado.

The social role of pediatrics in the past and present times.

Pediatrics and society are closely related. This link is as old as the history of Pediatrics, and dates to the second half of the eighteenth century. The vocation of the first European pediatric schools, indeed, was clinical and scientific, as well as social. The founding fathers of Pediatrics were scientists of great talent, and many of them benefactors and philanthropists. They spent their lives assisting the suffering childhood, and became promoters and organizers of social securities for the poorest and most vulnerable categories. The attention to the problems of abandonment was closely linked to study, prevention, and treatment of pathologies (especially infectious, deficiency and neurological ones). The profile and activity of pediatricians grew in the following decades after the birth of the first pediatric schools. The University institutions contributed to provide a further impulse to childcare as well as cultural authority, also thanks to the foundation of the first chairs and scientific journals of Pediatrics. The relevance and prestige of the studies performed rapidly spread throughout Europe, and also reached our country, contributing to a progressive and relevant improvement in the quality of children's care, and in the meantime to the decrease of neonatal and infant mortality rates.Today's pediatricians, as in the past, must spend his efforts to face the needs of children and their families, be their social receptor, interpreter if necessary, and credible and authoritative interlocutor beside institutions. The current coronavirus pandemic dramatically exposed social inequalities and inequities. In this new scenario, the pediatrician's role of defender of all children becomes even more necessary and indispensable. Here we trace the historical steps which led to the birth and development of pediatrics, as independent medical discipline with ethical and social vocation. Its rise within the University institutions is analyzed, as well as the contribution of the greatest European and Italian masters. Finally, the role of today's pediatrician is described, his responsibilities also in dealing with new health critical issues, related to the biological, cultural, and psychological changes of the patients of present days. He must have holistic competences, to effectively take care of all children. In addition, he must socially act to guarantee the best possible context for the well-being of the child.

Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review.

BACKGROUND: Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child's health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken. OBJECTIVE: The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents' engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes. METHODS: This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies. RESULTS: Following the review of 1351 abstracts, 31 (2.29%) studies were selected for full-text review. Of the 31 studies, 6 (19%) studies met the inclusion criteria. Of the 6 studies, 1 (17%) was excluded following the critical appraisal, and the 5 (83%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents' health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge. CONCLUSIONS: In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192386.

Identifying adverse drug events in patients at a pediatric ward in a Brazilian hospital: application and performance of the triggers / Identificação de eventos adversos a medicamentos em pacientes de enfermaria pediátrica em um hospital brasileiro: aplicação e desempenho de rastreadores

Abstract Objectives: to evaluate the performance of a trigger tool in identifying adverse drug events (ADE) in hospitalized children. Methods: a retrospective cohort study review on 133 medical records at a federal maternal and child reference hospital in Rio de Janeiro in 2016. A list of 14 triggers was developed to detect ADE in the pediatric population. Three steps were performed: (1) search for triggers; (2) selection of suspected cases of ADE and (3) final determination of ADE by experts' consensus. Results: 360 triggers were identified in 100 hospitalizations (75.2%), with an average of 2.7 triggers/ hospitalization. The most frequent triggers were "abrupt medication stop" (79.7%); "antiemetics use" (8.9%) and "laxatives use" (7.2%); while the "diphenhydramine use", "phytomenadione use" and "excessive sedation/lethargy/fall/hypotension" obtained the highest performance indicating ADE every time they occurred. Thirty-one ADE were identified in 12.8% of the hospitalizations; 11 (35.5%) ADE were detected without the aid of the triggers thus, pruritus and diarrhea were the most frequent. Conclusion: the trigger tool proved to be useful in identifying ADE in hospitalized children, especially if high performance and high frequency triggers are used in identifying the events. The inclusion of the triggers "diarrhea" and "pruritus", may favor the identification of ADE in patients at pediatric wards.

Resumo Objetivos: avaliar o desempenho de uma ferramenta de rastreamento de eventos adversos a medicamentos (EAM) em crianças hospitalizadas. Métodos: estudo de coorte retrospectivo com revisão de 133 prontuários de hospital federal de referência materno infantil no Rio de Janeiro, em 2016. Uma lista de 14 rastreadores foi usada para detecção de EAM na população pediátrica. Foram realizadas 3 etapas: (1) busca de rastreadores; (2) seleção dos casos suspeitos de EAM e (3) determinação final do EAM por consenso entre especialistas. Resultados: foram identificados 360 rastreadores em 100 internações (75,2%), com média de 2,7 rastreadores/internação. Os rastreadores mais frequentes foram "interrupção abrupta da medicação" (79,7%); "uso de antieméticos" (8,9%) e "uso de laxantes" (7,2%) enquanto que "uso de difenidramina", "uso de fitomenadiona" e "excesso de sedação/letargia/queda/hipotensão" obtiveram o maior rendimento indicando EAM em todas as vezes que ocorreram. Trinta e um EAM foram identificados em 12,8% das internações; 11(35,5%) EAM foram detectados sem auxílio dos rastreadores, sendo prurido e diarreia os mais frequentes. Conclusão: a ferramenta de rastreadores mostrou-se útil para a identificação de EAM em crianças hospitalizadas, principalmente se forem utilizados rastreadores com alto rendimento e alta frequência na identificação de eventos. A inclusão dos rastreadores diarreia e prurido pode favorecer a identificação de EAM em pacientes de enfermaria pediátrica.

Associations of job demands and patient safety event involvement on burnout among a multidisciplinary group of pediatric hematology/oncology clinicians.

BACKGROUND: Workplace burnout can result in negative consequences for clinicians and patients. We assessed burnout prevalence and sources among pediatric hematology/oncology inpatient nurses, ambulatory nurses, physicians (MDs), and advanced practice providers (APPs) by evaluating effects of job demands and involvement in patient safety events (PSEs). METHODS: A cross-sectional survey (Maslach Burnout Inventory) measured emotional exhaustion, depersonalization, and reduced personal accomplishment. The National Aeronautics and Space Administration Task Load Index measured mental demand, physical demand, temporal demand, effort, and frustration. Relative weights analyses estimated the unique contributions of tasks and PSEs on burnout. Post hoc analyses evaluated open-response comments for burnout factors. RESULTS: Burnout prevalence was 33%, 20%, 34%, and 33% in inpatient nurses, ambulatory nurses, and MD, and APPs, respectively (N = 481, response rate 69%). Reduced personal accomplishment was significantly higher in inpatient nurses than MDs and APPs. Job frustration was the most significant predictor of burnout across all four cohorts. Other significant predictors of burnout included temporal demand (nursing groups and MDs), effort (inpatient nurses and MDs), and PSE involvement (ambulatory nurses). Open-response comments identified time constraints, lack of administrator support, insufficient institutional support for self-care, and inadequate staffing and/or turnover as sources of frustration. CONCLUSIONS: All four clinician groups reported substantial levels of burnout, and job demands predicted burnout. The body of knowledge on job stress and workplace burnout supports targeting organizational-level sources versus individual-level factors as the most effective prevention and reduction strategy. This study elaborates on this evidence by identifying structural drivers of burnout within a multidisciplinary context of pediatric hematology/oncology clinicians.

The COVID-19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery.

BACKGROUND: The COVID-19 pandemic is pushing healthcare systems to their limits. Dramatic reductions in the adult elective surgery are ubiquitous, but corresponding changes in pediatric services are not well described. The Swedish Perioperative Registry contains data on all anesthetic procedures in Sweden, and therefore, provides a unique opportunity to analyze the effect of the pandemic on the pediatric anesthesia capacity on a national level. We hypothesized that there would be a significant reduction in pediatric elective procedures. The aim was to determine the effects on pediatric surgical and anesthetic services during the first wave of the COVID-19 pandemic in Sweden. METHODS: For this retrospective registry cohort study, we extracted all procedures performed on patients <18 years of age in 2020 and 2019. Weeks 12 to 26 of 2020 were defined as the first wave, and data were analyzed according to level of care, type of surgery, procedure code, and emergency or elective surgery. RESULTS: We found 7015 fewer procedures during the first wave epoch. Elective cases were reduced by 53.7% while emergency surgery was not significantly affected. During the peak of the first wave in April, there was a 72.8% reduction in elective cases; ENT/maxillofacial surgery showed the greatest reduction (86.7%). The surgical and anesthesia capacity recovered to near-normal levels by the end of June 2020. CONCLUSION: We conclude that the impact of COVID-19 on pediatric surgical procedures in Sweden during the first wave of the pandemic was dramatic, but elective services were restored a few months after the peak.

Association Between Comorbid Psychiatric Disorders and Hospital Resource Use in Physically Ill Pediatric Inpatients: A Case-Matched Analysis.

OBJECTIVE: To understand differences in hospital length of stay and costs associated with the presence of a comorbid psychiatric disorder among physically ill inpatients within a publicly funded pediatric hospital. METHOD: This was a retrospective observational design using administrative data on physically ill inpatients 2 to 18 years old who were admitted over a 5-year period (n = 54,316 admissions). Records with (n = 4,953) and without (n = 49,363) documented comorbid psychiatric disorder were compared for differences in baseline characteristics. To optimize the balance of measured covariates, individuals with comorbid psychiatric disorders were matched on propensity score, case mix group, and Elixhauser comorbidities, resulting in 4,371 pairs of inpatients with and without a comorbid psychiatric disorder. Differences in length of stay and total hospital costs were assessed using generalized estimating equation models on matched patients. RESULTS: Unmatched analyses demonstrated that inpatient admissions with comorbid psychiatric disorders were associated with higher occurrence of previous hospitalizations (69.2% versus 55.0%), unscheduled admissions (66.9% versus 60.9%), medical admissions (75.6% versus 52.7%), urgent admissions (62.5% versus 56.2%), and Elixhauser comorbidities (69.0% versus 39.0%), with standardized differences > |0.1|. Matched analyses demonstrated a 9.6% longer length of stay (95% CI = 5.7-13.7; p < .001) and 9.6% higher costs per admission (95% CI = 5.9-13.4; p < .001) in inpatients with comorbid psychiatric disorders compared to those without. CONCLUSION: The complexity of inpatients with a comorbid psychiatric disorder, in conjunction with the approximate 10% increase in hospital resource use, highlights the need for innovative models of clinical care and research directed at improving patient outcomes and reducing hospital costs.

An electronic medical record-based fall risk assessment tool for pediatric inpatients in South Korea: Improved sensitivity and specificity.

PURPOSE: To develop a fall risk assessment tool to predict fall risk in pediatric inpatients. METHODS: Three tools widely used in clinical practice (Humpty Dumpty Fall Scale, General Risk Assessment for Pediatric Inpatient Falls, and Seoul National University Hospital Pediatric Fall Risk Scale) were examined, and assessment items were extracted. Employing a case-control design, 29 children who experienced falls during hospital stays were selected as the "fall" group, and a control group (93 children) was selected based on age and sex matching. The sensitivity, specificity, and positive and negative predictive values of the newly developed tool (Newfs-PI) were analyzed. RESULTS: The Newfs-PI consisted of seven items: age, activity, history of falls, length of hospital stay, and medication. The total score ranged from 0 to 15. Its sensitivity and specificity were 62.07% and 74.19%, respectively. CONCLUSION: The Newfs-PI has high specificity and sensitivity, which are essential for a fall risk assessment tool that complements existing tools. These values are high relative to those of existing assessment tools and satisfy both sensitivity and specificity criteria. As the EMR enables monitoring of the components of the Newfs-PI, the tool can be used as a fall risk assessment and prevention scale for pediatric inpatients.

Morbilidad por intoxicaciones exógenas en un hospital pediátrico de Santiago de Cuba / Morbidity due to exogenous intoxications in a pediatric hospital from Santiago de Cuba

Introducción: Las intoxicaciones por accidentes constituyen causas crecientes de morbilidad, hospitalización, invalidez e incluso mortalidad. Objetivo: Describir aspectos clínicos y epidemiológicos en niños y adolescentes con intoxicaciones agudas. Métodos: Se realizó un estudio observacional, descriptivo y prospectivo en niños y adolescentes ingresados por intoxicación exógena en los servicios de Atención Continuada a pacientes en estado grave y de Misceláneas del Hospital Infantil Docente Sur Dr. Antonio María Béguez César de Santiago de Cuba, de enero del 2016 a igual mes del 2018. Resultados: Las intoxicaciones presentaron una elevada incidencia en el grupo etario de 15-18 años (61,7 %) y en el sexo femenino (85,1 %); la mayoría se produjo de modo voluntario (85,1 %), principalmente en el hogar (84,1 %) y con predominio de los medicamentos como agente causal (86,9 %). La evolución clínica resultó ser satisfactoria en 68,2 % de los pacientes; en el resto no fue así debido a la aparición de complicaciones, sobre todo de gastritis medicamentosa (30,8 %). Conclusiones: Las intoxicaciones en la infancia y la adolescencia son una causa importante de morbilidad luego de las infecciones respiratorias, y constituyen un motivo usual de urgencia médica en los hospitales pediátricos.

Introduction: Poisonings due to accidents are increasing causes of morbidity, hospitalization, disability and even mortality. Objective: To describe the clinical and epidemiological aspects in children with acute intoxications. Method: An observational, descriptive and prospective study was carried out in children and adolescent patients admitted with the diagnosis of exogenous intoxication in the services of Continuous Care to severely ill and Miscellaneous patients from Dr. Antonio María Béguez César Southern Pediatric Teaching Hospital, in Santiago de Cuba from January, 2016 to January, 2018. Results: Poisoning had a high incidence in the 15 - 18 years group (61,7 %) and in the female sex (85,1 %); most of them took place voluntarily (85,1 %), mainly at home (84,1 %) and with predominance of drugs as causal agent (86,9 %). Clinical course was satisfactory in 68,2 % of the patients; it was not the same in the rest due to the emergence of complications, above all due to drug gastritis (30,8 %) Conclusions: Poisoning in childhood and adolescence is an important cause of morbidity, after the respiratory infections, and constitute an usual reason of medical emergencies in pediatric hospitals.