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OBJECTIVES To identify demographic and clinical characteristics of children with fever and/or respiratory illness associated with a diagnosis of bacterial tracheostomy-associated respiratory tract infections (bTARTI). Secondary objectives included comparison of diagnostic testing, length of stay (LOS), and readmission rates between children diagnosed with bTARTI and others. METHODS We performed a retrospective chart review of encounters over 1 year for fever and/or respiratory illness at a single academic children’s hospital for children with tracheostomy dependence. Patient characteristics, features of presenting illness, and laboratory and imaging results were collected. Generalized linear mixed models were employed to study associations between patient characteristics, diagnosis of bTARTI, and impact on LOS or readmission rates. RESULTS Among 145 children with tracheostomies identified, 79 children contributed 208 encounters. bTARTI was diagnosed in 66 (31.7%) encounters. Significant associations with bTARTI diagnosis included chest radiograph consistent with bacterial pneumonia (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.50–2.08), positive tracheal aspirate culture (OR, 1.3; 95% CI, 1.05–1.61), higher white blood cell count (16.4 vs 13.1 × 103/µ; P = .03), change in oxygen requirement (OR, 1.14; 95% CI, 1.00–1.31), telephone encounter (OR, 1.41; 95% CI, 1.09–1.81), and living at home with family (OR, 1.42; 95% CI, 1.06–1.92). LOS for admitted patients with bTARTI was 2.19 times longer (CI, 1.23–3.88). CONCLUSIONS In our single-center study, we identified several clinical and nonclinical factors associated with a diagnosis of bTARTI. Despite widespread use, few laboratory tests were predictive of a diagnosis of bTARTI. There is need for standardization in diagnosis.

1. Jeanna Auriemma, MD* 2. Cara Haberman, MD* 1. *Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC A 5-month-old previously healthy African American boy presents to the emergency department (ED) with an 8-day history of high-spiking daily fevers between 102°F and 104°F (38.9°C–40.0°C). On his second day of fever, he was diagnosed as having an acute suppurative otitis media by his primary care physician and was started on amoxicillin. Daily fevers continued despite adequate antibiotic compliance. Other than fever his only reported symptom is fussiness. Specifically, he has no cough, congestion, rash, vomiting, diarrhea, or change in appetite. In the ED his temperature is 103.1°F (39.5°C); heart rate, 175 beats/min; respiratory rate, 26 breaths/min; blood pressure, 98/64 mm Hg; and oxygen saturation, 98% on room air. He is ill-appearing and fussy but consolable. Subtle injection of the bulbar conjunctiva is present bilaterally without exudate. His heart rate is tachycardic, with regular rhythm and no murmur. His abdomen is soft and without organomegaly. His extremities are warm, well-perfused, and without edema. His lungs are clear to auscultation with normal respiratory effort. He has no rash or lymphadenopathy. The remainder of his examination findings are normal. Laboratory values obtained in the ED reveal anemia with a hemoglobin level of 7.6 g/dL (76 g/L) and thrombocytosis with a platelet count of 486×103/μL (486×109/L). His white blood cell (WBC) count is normal, C-reactive protein level is elevated at 102 mg/L (971 nmol/L), and erythrocyte sedimentation rate (ESR) is elevated at 61 mm/h. Results …

1. Jeanna Auriemma, MD* 2. Nicholas M. Potisek, MD* 1. *Wake Forest School of Medicine, Winston-Salem, NC Pediatricians may discover a click or a clunk when performing a physical examination of the neonatal hip. Assessment for developmental dysplasia of the hip (DDH) is a routine part of the neonatal examination because failure to detect neonatal hip instability or to respond appropriately to an abnormal examination may result in long-term disability for the child. Developmental dysplasia of the hip covers a wide range of diseases related to abnormal development of the acetabulum and femoral head. The primary cause of DDH is improper fetal or postnatal positioning, which limits contact between the femoral head and the acetabulum, hindering proper growth. The resulting spectrum of disease extends from subtle abnormalities detected only on imaging through more severe manifestations such as dislocated hips that are unstable at rest. With the lack of a standardized definition and the uncertain clinical relevance of particular imaging findings, the true incidence of DDH remains unclear. The incidence of DDH with dislocation is approximated to be 1 in every 1,000 live births; however, this likely represents an underestimate considering the full range of congenital hip disease. If mild dysplasia without dislocation is included, the overall incidence is approximately 1% of newborns; and when including any abnormality detected by screening ultrasonography, the incidence increases to 5% to 7%. Factors that increase the risk of DDH include female sex, breech presentation, DDH in a first-degree relative, and improper swaddling methods. It occurs in females up to 4 times more often than in males. Breech presentation is reported in 17% to 23% of cases. Frank breech presentation confers the highest risk and occurs when the fetal hips are in …

OBJECTIVES:Although hypothermia has long been considered a sign of serious bacterial infection (SBI) in neonates, there is a lack of medical literature on this topic, and little is known about the prevalence of serious infection in these patients. Our primary objective was to assess the prevalence and type of serious infection in neonates with hypothermia. Our secondary objective was to describe the prevalence and type of significant pathology overall in this cohort.METHODS:We examined neonates (≤28 days old) evaluated in the emergency department and/or admitted to the hospital with hypothermia over a 3-year period. Demographics and relevant clinical data were extracted from the medical record. Fisher’s exact test was used to determine differences in the prevalence of clinical and demographic characteristics in patients with and without a diagnosis of serious infection.RESULTS:Sixty-eight neonates met inclusion criteria, and 63 (93%) were admitted. Of those admitted to the hospital, 5 (7.9%) had a diagnosis of serious infection, including SBI (n = 4) and disseminated herpes simplex virus (n = 1). The types of SBI included urinary tract infection, septicemia, and meningitis. Eighty percent and 60% of neonates with hypothermia and diagnosed with serious infection had a temperature ≤34.4°C and ill appearance, respectively. Significant pathology was found in 9 (14.3%) patients and included both infectious and noninfectious diagnoses.CONCLUSIONS:Neonates presenting with hypothermia have a substantial risk for SBI or other significant pathology. This population merits further investigation; a multicenter prospective study should be conducted to better understand associations between risk factors and outcomes.