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Background: Resuscitation with blood products is often required for pediatric cardiac surgery patients following cardiopulmonary bypass. However, data suggest that blood product transfusion is an independent predictor of adverse outcomes. Most studies have specifically found detrimental effects of overall transfusion of red blood cells in particular, but few have analyzed outcomes by the other specific blood product components. Aims: The objective of this study is to analyze adverse outcomes associated with intraoperative transfusion of specific blood product components. Methods: A retrospective review was performed on 643 pediatric patients who underwent cardiac surgery requiring cardiopulmonary bypass to evaluate the risk of selected adverse outcomes associated with intraoperative blood product transfusion. Adverse outcomes included thrombotic complications, stroke, acute kidney injury, prolonged mechanical ventilation, and death. Univariate logistic and linear regression analyses were performed to explore the association between various blood products and the occurrence of postoperative complications. Multiple logistic and linear regression analyses were performed adjusting for age, cyanotic status, The Society of Thoracic Surgeons‐European Association for Cardio‐Thoracic Surgery Score (STAT score), and cardiopulmonary bypass time. Results: Unadjusted analysis using univariate logistic and linear regressions showed statistically significant associations of almost all blood components (per 10 mL/kg dose increments) with multiple postoperative complications, including mortality, thrombotic complications, stroke, and days of mechanical ventilation. After adjusting for patient age, cyanotic status, STAT score, and cardiopulmonary bypass time, multivariable logistic and linear regression analyses revealed no association between transfusion of blood products with acute kidney injury and stroke. Administration of red blood cells was the only category significantly correlated with increased days of mechanical ventilation (0.5 days increase in mechanical ventilation per 10 mL/kg transfusion of red blood cells). The only blood product to show complete lack of a statistically significant association with any of the studied outcomes was cryoprecipitate. Conclusions: Transfusion of blood products following cardiopulmonary bypass is associated with postoperative adverse outcomes. Future studies aimed at strategies to reduce intraoperative bleeding and decrease the amount of blood products administered are warranted. [ABSTRACT FROM AUTHOR]

Background: Pediatric patients are subject to numerous painful procedures during their hospitalization. These procedures can cause pain and anxiety that may be under-estimated and under-treated. Research shows that patients undergoing painful procedures receive suboptimal relief for pain and anxiety (Bice et al., 2014). Methods: A non-experimental design used retrospective chart reviews for comparison of patient care before and after implementation of a new nursing practice guideline (NPG) and order set/power plan (PP) on three inpatient units. An assessment of nursing and provider knowledge of pharmacologic and non- pharmacologic analgesia and the non-sedated procedural pain NPG/PP was completed. A nursing satisfaction survey assessed use and feasibility of the NPG. Findings: After educational implementation, nurses and providers significantly improved their knowledge of peak onset of morphine and oxycodone (p < 0.001). Nurses demonstrated significant improvement in reports of NPG utilization and knowledge of pharmacological and non-pharmacological resources (p < 0.001). Providers gained familiarity with the NPG/PP (p < 0.001). There was no evidence in the electronic health record (EHR) documentation to confirm the transfer of knowledge and compliance related to the NPG/PP. Discussion: This multidisciplinary quality improvement project improved nursing and provider knowledge of non-sedated pediatric procedural pain pharmacologic and non-pharmacologic resources in our organization. EHR documentation limitations may have contributed to the evaluation of resource application. Application to Practice: By improving knowledge of resources, we hope to increase compliance, improve pain control, and continue to evaluate their use during these short procedures. Redesign of the EHR is essential to help facilitate and evaluate NPG/PP compliance. [ABSTRACT FROM AUTHOR]

Background: Pediatric intestinal pseudo‐obstruction is a rare disorder affecting gastrointestinal motility leading to chronic symptoms and hospitalizations. There is limited understanding of the epidemiology and healthcare burden. Methods: We analyzed data from Kids' Inpatient Database from 2016, which includes inpatient discharge records from US hospitals. ICD‐10 codes were used to identify patients 0‐18 years with pediatric intestinal pseudo‐obstruction and comorbid conditions. Multivariable logistic regression and Wilcoxon rank‐sum test were used. Results: In 2016, there were 1671 inpatient discharges from US hospitals for patients 0‐18 years of age with this diagnosis. The incidence of inpatient admission was 29/100 000 patients. After controlling for age, race, income status, and insurance, males vs females (adjusted odds ratio, aOR: 1.10; 95% CI: 0.94‐1.28; P =.241) and caucasians vs other races (aOR: 1.55; 95% CI: 1.27‐1.88; P <.001) were more likely to be admitted. Inpatient admissions incurred significant healthcare burden; median (inter quartile range IQR) cost of hospitalization of US$ 52 079 (US$ 23 530‐120 961) and a median (IQR) length of stay of 6 days (3‐14 days). Gastrostomy (32%) and ileostomy (12.6%) status appeared to incur lower healthcare burden. Parenteral nutrition, malnutrition, and central line/bloodstream infections resulted in higher healthcare burden. Conclusions: Pediatric intestinal pseudo‐obstruction is a rare diagnosis with a high incidence of inpatient admissions and healthcare burden. An aggressive multidisciplinary management is crucial in reducing inpatient admissions in this cohort. [ABSTRACT FROM AUTHOR]