Search

Objective: To determine the prevalence of COVID‐19 in a cohort of children undergoing tonsillectomy through assessment of B cell immune responses to SARS‐CoV‐2 in both peripheral blood and tonsil tissue. Methods: In this cohort study at a tertiary pediatric hospital (Children's National Hospital) in Washington, DC, we recruited 100 children undergoing tonsillectomy from late September 2020 to January 2021. Serum, peripheral blood cells, and tonsil tissue were collected and examined for immune reactivity to SARS‐CoV‐2. Parent‐reported clinical histories were compared to antibody and B‐cell responses. Results: Among 100 children undergoing tonsillectomy, 19% had evidence of immune responses to SARS‐CoV‐2 (CoV2+), indicating prior COVID‐19. In all seropositive participants, we detected SARS‐CoV‐2 specific B cells in both peripheral blood mononuclear cells and tonsils, providing evidence for tissue‐specific immunity in these children. Of the 19, 63% reported no known history of COVID‐19, and an additional 3 were asymptomatic or unaware of an acute infection when detected on pre‐surgery screen. Hispanic children represented 74% of CoV2+ subjects compared to 37% of the full cohort. 100% of CoV2+ children lived in a zip code with poverty level >10%. Conclusions: Nearly one‐fifth of children undergoing tonsillectomy at an urban U.S. hospital had evidence of prior COVID‐19 during the early pandemic, with the majority unaware of prior infection. Our results underscore the ethnic and socio‐economic disparities of COVID‐19. We found concordant evidence of humoral immune responses in children in both blood and tonsil tissue, providing evidence of local immune responses in the upper respiratory tract. Level of Evidence: 3 Laryngoscope, 133:1993–1999, 2023 [ABSTRACT FROM AUTHOR]

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]

Healthcare disparities have been shown to impact outcomes of various acute pediatric conditions. We sought to examine the impact of race, ethnicity and insurance status on the presentation, management and outcome of testicular torsion. A retrospective review of a prospectively maintained testicular torsion database was performed. Patients ≤18 years of age evaluated in our pediatric institution's emergency room between April 2016–April 2020 with US diagnosed and OR confirmed testicular torsion were included. Basic demographics, timing of presentation, referral rate, time to OR and orchiectomy rate were extracted and compared. P < 0.05 was considered statistically significant. A total of 206 patients were included. 114 (56.2%) were Black or African American (Black/AA), 43 were (21.2%) Hispanic/Latino, 22 (10.8%) were Caucasian, and 24 (11.8%) were designated as Other races. Ninety-eight (48.3%) patients had Medicaid, 90 (44.3%) had private insurance, and 15 (7.4%) patients were uninsured. Sixty-eight (33.0%) presented in a delayed fashion (>24 h). Compared to the Caucasian patients, Black/AA patients were 2.1 years (95% CI: 0.5, 3.8; P = 0.010) older at the time of presentation. When compared to those with Medicaid insurance, uninsured patients had 6.26 times (95% CI: 1.58, 41.88; P = 0.021) higher odds to be referred from an outside hospital for management. In those patients presenting acutely (<24 h, N = 138), there were no significant differences in the odds of orchiectomy for Black/AA or Hispanic/Latino patients when compared to Caucasian patients, however, the odds of orchiectomy in Other races (non-Caucasian, non-Black/AA, non-Hispanic/Latino) was significantly higher (OR: 10.38; 95% CI: 1.13, 246.96; P = 0.049). While the mean time in minutes from ED to OR was longer in those with Medicaid insurance (141 vs 125.4 private vs 115 uninsured, p = 0.042), this did not impact orchiectomy rate (39.8% vs 40.9% vs 46.7%, p = 0.88). We found no differences in the orchiectomy rates by race with the exception of a higher rate in the diverse and heterogeneous Other race (non-Caucasian, non-Black/AA, non-Hispanic/Latino) group. Those uninsured had a higher referral rate highlighting the potential existence of disparities for those uninsured and the need for further investigation. Summary Table Adjusted analysis to explore the association of race and insurance status with testicular torsion presentation, hospital course, and outcome (acute presentation only). Summary Table Injury presentation Race Insurance Race groups Coefficient (95% CI) P value Insurance groups Coefficient (95% CI) P value Age presentation (years) White A. American Latino Other Ref 1.2 (−0.7, 3.1) −0.7 (−2.9, 1.4) 0.5 (−1.9, 2.9) Ref 0.210 0.506 0.664 Medicaid Private Uninsured Ref 0.6 (−0.6, 1.7) 1.3 (−1.0, 3.5) Ref 0.320 0.260 Delay in presentation (hours) † White A. American Latino Other Ref −1.0 (−2.9, 0.9) 2.0 (−0.2, 4.2) −1.0 (- 4.8, 2.8) Ref 0.310 0.080 0.600 Medicaid Private Uninsured Ref −1.0 (−2.8, 0.8) −2.0 (−4.9, 0.9) Ref 0.260 0.180 Time ED to US (min) † White A. American Latino Other Ref −4.0 (−17.7, 9.7) −4.0 (−19.9, 11.9) −1.0 (−19.0, 17.0) Ref 0.560 0.620 0.910 Medicaid Private Uninsured Ref −1.0 (−7.9, 5.9) −3.0 (−30.9, 24.9) Ref 0.770 0.830 Time ED to OR (min) White A. American Latino Other Ref 3.4 (−19.0, 25.8) 6.6 (−18.7, 31.9) −5.2 (−33.3, 23.0) Ref 0.764 0.606 0.717 Medicaid Private Uninsured Ref −16.2 (−29.5, −2.90) −23.2 (−49.4, 3.1) Ref 0.017 0.083 OR (95% CI) P value OR (95% CI) P value Location (OSH) White A. American Latino Other Ref 0.49 (0.12, 1.79) 0.47 (0.10, 2.05) 0.55 (0.10, 2.73) Ref 0.295 0.326 0.469 Medicaid Private Uninsured Ref 1.27 (0.60, 2.69) 10.65 (1.75, 206.10) Ref 0.523 0.032 Orchiectomy White A. American Latino Other Ref 3.35 (0.48, 71.38) 3.42 (0.42, 75.13) 10.38 (1.13, 246.96) Ref 0.306 0.323 0.049 Medicaid Private Uninsured Ref 1.74 (0.60, 5.23) 2.29 (0.28, 13.69) Ref 0.309 0.386 ED – Emergency Department, US – Ultrasound, OR – Operating Room, OSH – Outside Hospital, CI – Confidence Interval. Analysis was adjusted for age of presentation, location of presentation, and presentation type (acute/delayed) as well as race and insurance status themselves. † Median (95% CI) values were reported using quantile regression analysis. [ABSTRACT FROM AUTHOR]