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Background: Respiratory syncytial virus (RSV) is a substantial cause of infant morbidity and mortality due to seasonal peaks of bronchiolitis across the United States. Clinical and viral surveillance plays a pivotal role in helping hospital systems prepare for expected surges in RSV bronchiolitis. Existing surveillance efforts have shown a geographic pattern of RSV positivity across the United States, with cases typically starting in the southeast and spreading north and west. Public health measures implemented due to the COVID‐19 pandemic disrupted viral transmission across the nation and altered the expected seasonality of RSV. The impact of these changes on the geographic progression of infant RSV bronchiolitis across the United States has not been described. Methods: Here, we used clinical and viral surveillance data from four health care systems located in different regions of the United States to describe the geographic progression of infant RSV bronchiolitis across the country from 2015 to 2023. Results: Prior to widespread circulation of SARS‐CoV‐2, infant RSV bronchiolitis followed an established geographic pattern associated with seasonal epidemics originating in Florida and spreading north (North Carolina and New York) and later westward (Nevada). Although public health and social measures implemented during the COVID‐19 pandemic disrupted the seasonality of RSV disease, infant RSV bronchiolitis epidemics progressed across the nation in a pattern identical to the prepandemic era. Conclusions: Our findings highlight the importance of ongoing clinical and viral surveillance to optimally track the onset of RSV epidemics and allow health care systems to prepare for expected RSV bronchiolitis surges. [ABSTRACT FROM AUTHOR]

Copyright of DoisPontos is the property of Universidade Federal do Parana, Departamento de Filosofia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives Larger bottle size is associated with faster weight gain in infants, but little is known about acceptability and feasibility of providing bottles in primary care clinics. Methods We randomized parent-infant dyads (N = 40) to receive a set of 4-ounce bottles or to continue using their own bottles. Demographic and anthropometric information were collected at enrollment and one follow-up visit 1-5 months later. The primary aim was to assess feasibility and acceptability of the intervention strategy. We compared components of bottle feeding, including usual bottle sizes used, number and volume of feeds with Wilcoxon rank-sum tests, and changes in weight-for-age and weight-for-length z-scores during the study period with t-tests, using p < 0.05 as an indicator of statistical significance. Results Of participants randomized to receive bottles, 90% were using the 4oz bottles at follow up. The intervention group reported a significantly lower median bottle size (4oz) than the control group (8oz) at follow up, and parents reported acceptability and continued use of the bottles. Conclusions for Practice An intervention to provide smaller bottles was feasible, mostly acceptable, resulted in lower median bottle size. Further research is needed to determine whether it represents a novel way to prevent rapid infant weight gain., Author(s): Charles T. Wood [sup.1] , Janna B. Howard [sup.1] , Eliana M. Perrin [sup.2] Author Affiliations: (1) grid.26009.3d, 0000 0004 1936 7961, Division of General Pediatrics and Adolescent Health [...]

Background and Aims: Policymakers need data about the burden of respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) among infants. This study estimates quality of life (QoL) for otherwise healthy term US infants with RSV‐LRTI and their caregivers, previously limited to premature and hospitalized infants, and corrects for selective testing. Methods: The study enrolled infants <1 year with a clinically diagnosed LRTI encounter between January and May 2021. Using an established 0–100 scale, the 36 infants' and caregivers' QoL at enrollment and quality‐adjusted life year losses per 1000 LRTI episodes (quality‐adjusted life years [QALYs]/1000) were validated and analyzed. Regression analyses examined predictors of RSV‐testing and RSV‐positivity, creating modeled positives. Results: Mean QoL at enrollment in outpatient (n = 11) LRTI‐tested infants (66.4) was lower than that in not‐tested LRTI infants (79.6, p = 0.096). For outpatient LRTI infants (n = 23), median QALYs/1000 losses were 9.8 and 0.25 for their caregivers. RSV‐positive outpatient LRTI infants (n = 6) had significantly milder QALYs/1000 losses (7.0) than other LRTI‐tested infants (n = 5)(21.8, p = 0.030). Visits earlier in the year were more likely to be RSV‐positive than later visits (p = 0.023). Modeled RSV‐positivity (51.9%) was lower than the observed rate (55.0%). Infants' and caregivers' QALYs/1000 loss were positively correlated (rho = 0.34, p = 0.046), indicating that infants perceived as sicker imposed greater burdens on caregivers. Conclusions: The overall median QALYs/1000 losses for LRTI (9.0) and RSV‐LRTI (5.6) in US infants are substantial, with additional losses for their caregivers (0.25 and 0.20, respectively). These losses extend equally to outpatient episodes. This study is the first reporting QALY losses for infants with LRTI born at term or presenting in nonhospitalized settings, and their caregivers. PLAIN ENGLISH SUMMARY: New approaches for preventing respiratory syncytial virus in young children are showing progress. To evaluate their value, policymakers need information about the loss of quality of life from this infection. Currently, the only data relate to cases in premature, hospitalized infants with laboratory‐confirmed infection, but they represent only a tiny minority of the cases. In 2021, during the COVID‐19 pandemic, we enrolled 36 infants treated for lower respiratory tract infection in the Duke University Health System (DUHS). We assessed their quality of life from before the onset of this illness until 2 weeks after enrollment. Some, but not all, were tested for the virus in the course of their care. We developed a statistical model of predicted likelihood of infection to address the variability in laboratory testing. We found that infants who were tested for the virus had lower quality of life compared to those not tested. This fact suggested that doctors prioritized the sicker infants for viral testing. We found that for every 1000 outpatient cases of the virus, infants lost 9.8 quality‐adjusted life years. Due to stress and other factors, their parents or caregivers lost an additional 0.25 such years. The burden of this virus in infants is substantial. To our knowledge, this study is the first to quantify the burden of this disease among infants not hospitalized. [ABSTRACT FROM AUTHOR]

Copyright of Marmara Üniversitesi Hukuk Fakültesi Hukuk Araştırmaları Dergisi is the property of Marmara University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We aimed to capture milk feeding type in real time in a racially and socioeconomically diverse population. An electronic tool to assess milk feeding type at every medical visit for children aged 0 to 2 years was designed and incorporated into nursing workflows. The Milk Box tool was successfully added to the electronic clinical workspace of a large health system. There were eight clinics, with diverse characteristics, which incorporated the use of the Milk Box tool over 12 months. Time to 50% uptake of Milk Box varied from 3 to 5 months. Time to >80% uptake varied from 6 to 8 months. Our results show that Milk Box can be quickly incorporated into a clinical workflow when the team is given appropriate training and support. The tool also allows a primary care practice to study local breast milk consumption trends and to provide both individualized and system-level lactation support. [ABSTRACT FROM AUTHOR]