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Epidemiologic research in pediatric heart failure (HF) is limited, focused on hospitalized children identified from administrative databases. Challenges in HF case ascertainment and lack of outpatient data constrain the estimates of HF incidence. Aims: to estimate a regional incidence of pediatric HF and describe cohort characteristics. In an observational retrospective cohort, children with HF were identified from the Electronic Data Warehouse (EDW) of a tertiary referral center 01/2010-12/2020. Inclusion criteria: Utah address; 31 days - 19 years old at receipt of a HF ICD code. Patients were included if assigned 2 or more HF ICD codes or assigned a code in an inpatient encounter and treated with a HF-specific medication; methods previously described. EDW data were linked with the Society of Thoracic Surgeons National Database. Patients undergoing VSD or AVSD repair, PDA closure were eligible only if HF ICD codes were assigned post-procedure. 763 patients were included. Chart review of 37% (282/763) demonstrated 80% diagnostic accuracy in identifying HF patients. Based on census data, the incidence of HF was 7.0 per 100,000 patient-years (95% CI 6.5, 7.5). Nearly 20% (152) of the cohort was diagnosed with HF while outpatient and 25% (38/152) were not hospitalized during follow-up. Congenital heart disease (CHD) was most prevalent (464; 61%). Patients had a median of 3 comorbidities at the time of HF diagnosis (IQR 2,4). Median time to hospitalization/rehospitalization following diagnosis was 2.4 months (IQR 1.2,7.2), similar across all subgroups: CHD, cardiomyopathy (CM), CHD+CM, other diagnoses (p= 0.57). Mechanical support was required by 106 (14%) and heart transplant (tx) by 46 (6%) patients. Median time to tx was shortest among CM patients (p<0.001). There were 140 deaths (18%), most taking place during the index HF admission. Younger age at diagnosis, increased number of comorbidities, simple biventricular CHD vs CM were associated with risk of hospitalization (p=0.029, <0.001, 0.035 respectively). Diagnoses of hypertrophic cardiomyopathy or complex biventricular CHD were associated with risk of death or tx (p< 0.028, 0.22 respectively). This contemporary study describes the estimated regional incidence of pediatric HF using granular single-center data. Risk of mortality and rehospitalization are confirmed to be high in this population. [ABSTRACT FROM AUTHOR]

Objectives: To describe the proportion of children screened by the Modified Checklist for Autism in Toddlers (M-CHAT), identify characteristics associated with screen completion, and examine associations between autism spectrum disorder (ASD) screening and later ASD diagnosis., Methods: We examined data from children attending 18- and 24-month visits between 2013 and 2016 from 20 clinics within a health care system for evidence of screening with the M-CHAT and subsequent coding of ASD diagnosis at age >4.75 years. We interviewed providers for information about usual methods of M-CHAT scoring and ASD referral., Results: Of 36 233 toddlers, 73% were screened and 1.4% were later diagnosed with ASD. Hispanic children were less likely to be screened (adjusted prevalence ratio [APR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), and family physicians were less likely to screen (APR: 0.12, 95% CI: 0.09-0.15). Compared with unscreened children, screen-positive children were more likely to be diagnosed with ASD (APR: 10.3, 95% CI: 7.6-14.1) and were diagnosed younger (38.5 vs 48.5 months, P < .001). The M-CHAT's sensitivity for ASD diagnosis was 33.1%, and the positive predictive value was 17.8%. Providers routinely omitted the M-CHAT follow-up interview and had uneven referral patterns., Conclusions: A majority of children were screened for ASD, but disparities exist among those screened. Benefits for screen-positive children are improved detection and younger age of diagnosis. Performance of the M-CHAT can be improved in real-world health care settings by administering screens with fidelity and facilitating timely ASD evaluations for screen-positive children. Providers should continue to monitor for signs of ASD in screen-negative children., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Campbell discloses that she is an inventor on a patent related to screening for autism spectrum disorder; the other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Objective: The purpose of this study was to identify the risk factors during the incident Clostridium difficile infection (CDI) episode, associated with developing recurrent CDI within 60 days, among hospitalized children that may be amenable to intervention., Methods: This was a retrospective cohort study of pediatric patients hospitalized at a freestanding children's hospital from January 1, 2003, to December 31, 2010. Patients were eligible if they were <18 years of age at admission and had a new diagnosis of CDI. Patients <1 year of age and those with a history of CDI in the previous 60 days were excluded. Age, gender, race, complex chronic conditions, and other information were collected. Multivariable logistic regression was used to evaluate predictors of recurrent CDI., Results: During the study period, there were 612 unique patients with an incident CDI episode; 65 (10.6%) experienced at least 1 recurrence. Patients with any complex chronic condition were 4.0 (95% confidence interval [CI]: 1.2-13.9) times more likely to experience recurrence. Patients with a malignancy and those who received non-CDI antibiotics at any time during CDI treatment were 2.3 (95% CI: 1.3-4.0) and 2.8 (95% CI: 1.2-6.9) times more likely to experience recurrence, respectively., Conclusions: The presence of underlying comorbidities, malignancies, and treatment with non-CDI antibiotics during CDI treatment were the most important risk factors for recurrence. Efforts to reduce unnecessary courses of non-CDI antibiotics could lower the risk of CDI recurrence., (Copyright © 2016 by the American Academy of Pediatrics.)

Objectives: To (1) identify the major expenses for same-day adenotonsillectomy (T&A) and the costs for postoperative complication encounters in a children's hospital and (2) compare differences for variations in costs by surgeon., Study Design: Observational cohort study., Setting: Tertiary children's hospital., Subjects and Methods: A standardized activity-based hospital accounting system was used to determine total hospital costs per encounter (not including professional fees for surgeons or anesthetists) for T&A cases at a tertiary children's hospital from 2007 to 2012. Hospital costs were subdivided into categories, including operating room (OR), OR supplies, postanesthesia care unit (PACU), same-day services (SDS), anesthesia, pharmacy, and other. Costs for postoperative complication encounters were included to identify a mean total cost per case per surgeon., Results: The study cohort included 4824 T&As performed by 14 different surgeons. The mean cost per T&A was $1506 (95% confidence interval, $1492-$1519, with a range of $1156-$1828 for the lowest and highest cost per case per surgeon; P < .01). Including the cost for postoperative complications, the mean cost increased to $1599 ($1570-$1629). The largest cost categories included OR (31.9%), SDS (28.1%), and OR supplies (15.6%)., Conclusion: A large portion of T&A expenses are due to OR and supply costs. Significant differences in costs between surgeons for outpatient T&A were identified. Studies to understand the reasons for this variation and the impact on outcomes are needed. If this variation does not affect patient outcomes, then reducing this variation may improve health care value by limiting waste.

Objective: A subset of necrotizing enterocolitis (NEC) cases is fulminant, characterized by rapid progression to death with massive bowel necrosis found at laparotomy or autopsy. We sought to identify and report all such cases in a multihospital healthcare system during the past 9 years and to characterize this entity using case-control methodologies., Study Design: This was a multicentered, cross-sectional, historic cohort study conducted using Intermountain Healthcare hospital patient data. All neonates who died of NEC within 48 h of onset, during 2001 to 2009, were compared with two matched control groups: (1) demographically matched controls who developed non-fulminant NEC, (2) demographically matched controls that did not develop NEC., Result: During this period, 2 71 327 live births occurred in the Intermountain Healthcare hospitals. Of these, 318 had a diagnosis of NEC (Bell stage ≥II). Also during this period, 205 other neonates were transferred into an Intermountain hospital for treatment of NEC. Of these 523 NEC cases, 35 (6.7%) had a fulminant course. Compared with the non-fulminant cases, the fulminant group were born at lower weight (1088±545 vs 1652±817 g, P=0.000) and earlier gestational age (27.5±3.3 vs 31.1±4.4 weeks, P=0.000), and were more likely to have: (1) radiographic evidence of portal venous air (P=0.000), (2) hematocrit <22% (P=0.000), (3) increase in feeding volume >20 ml/kg/day (P=0.003), (4) immature to total (I/T) neutrophil ratio >0.5 (P=0.005), (5) blood lymphocyte count <4000/μl (P=0.018), (6) an increase in concentration of human milk fortifier within 48 h before developing NEC (P=0.020)., Conclusion: Portal venous air, anemia, rapid feeding escalation, a high I/T neutrophil ratio, a low lymphocyte count and recent increases in fortifier may all be associated with fulminant NEC.