Search

Pediatric and adult asthma account for increased healthcare utilization. Preventative measures such as ongoing adherence of preventative medications from childhood to adulthood are essential for positive outcomes. To identify potential challenges for optimal pediatric asthma care, we surveyed adult patients to reflect on their asthma management practices, and education and treatment barriers when they were a child. A descriptive cross sectional survey of specific and open-ended questions in an urban academic medical center. Adult asthmatics (18–30 years old) who participated in a previous pediatric asthma study or received care from the adult emergency department (ED) were enrolled. Forty-one adult asthmatic patients (mean (S.D.) age 22.5 (3.5) years and 65.9% females) participated in the survey. Reported childhood asthma related experiences include never attended an asthma education session in almost two-thirds surveyed; their mother or grandmother as the primary person responsible for administering their medications (95.1%); inhaled short-acting beta-agonist (SABA) use information was not helpful (46.3%); wanted to learn more about allergic triggers (78%); and the need for additional asthma educational sessions (48.7%). All healthcare providers are encouraged to provide continuous asthma education to their pediatric patients and their family members or guardian. [ABSTRACT FROM AUTHOR]

OBJECTIVES Clinical practice guidelines for eradication of Pseudomonas aeruginosa (PA) in patients with cystic fibrosis (CF) have been established, but current studies have not assessed how these guidelines translate into clinical practice. This study aimed to characterize the real-world eradication strategies, eradication rates, and microbiologic outcomes of patients with first acquisition of PA at an urban pediatric CF center. METHODS The Cystic Fibrosis Foundation Patient Registry was used to identify patients with CF who received care between January 2014 and September 2018 and had PA isolated from an airway culture. Patients were included if they had a first positive PA culture or the first positive culture in 2 years. Data regarding patient demographics, timing and results of airway cultures, and treatment regimens were collected. RESULTS Over a 3.75-year period, 75 patients had an initial positive culture for PA. Of those patients, 74 (98.7%) received eradication treatment. Tobramycin inhalation solution (TIS) monotherapy was the most common regimen prescribed (52.7%) followed by TIS plus an oral fluoroquinolone (28.4%) (TIS + FQ). Of those treated, 62 (83.8%) patients had eradication of PA at first follow-up culture (median, 58 days; IQR, 49- 77 days). Eradication rates (84.6% vs 76.2%, p = 0.421) and times to recurrence (6.37 months vs 5.1 months, p = 0.726) were comparable between TIS and TIS + FQ cohorts. CONCLUSIONS The eradication rate for PA in clinical practice is similar to that published in the literature. Consistent with published guidelines, these microbiologic outcomes do not support the addition of an oral FQ to TIS for initial PA eradication. [ABSTRACT FROM AUTHOR]

Objectives: To describe the percentage of pediatric outpatient pharmacy prescriptions with inappropriate prescribing identified by a pharmacist that resulted in a change to the prescription. Secondary objectives include describing types of inappropriate prescribing errors, prevalence of Institute of Safe Medication Practices high-alert medications, patient demographics, prescriber origin, and prescription origin.Methods: This retrospective outpatient prescription record review was approved by an institutional review board and performed at an outpatient pharmacy located in an academic teaching hospital. The study reviewed pediatric outpatient prescriptions for a 6-month period. Prescriptions with prescribing errors were identified from pediatric prescriptions sent to the problem queue and documented with appropriate pharmacist notes.Results: This study demonstrated the impact of a dose checking procedure and pharmacist interventions on pediatric prescriptions. Initial results show that 3% of all pediatric prescriptions required a pharmacist intervention. Of these prescriptions, 50% resulted in a change to the original prescription.Conclusion: Weight-based dose checking in a pediatric outpatient pharmacy proactively prevents potential adverse events among the pediatric population. Despite this study's limitations, we believe that a pediatric dose checking procedure in community pharmacies will reduce adverse events. Further study is warranted in this field. [ABSTRACT FROM AUTHOR]

Presents a study that assessed the baseline medication error rate and the effects of handheld prescription writing (HPW) tool on error rate and prescribing practices in an urban pediatric emergency department and clinic. Background on personal digital assistants used in medical care; Impact of HPW on prescribing performance and efficiency; Examination of medication errors in ambulatory care.

AbstractObjectiveMethodsResultsConclusionsPediatric asthma management faces challenges in medication delivery through oral inhalation devices. While dry powder inhalers (DPIs) are increasingly prescribed to children, many do not receive their prescribed dosage due to insufficient inspiratory flow. This study investigates the utilization of metered-dose inhalers (MDIs) and DPIs among pediatric patients with asthma, focusing on medication delivery challenges.Two survey cohorts comprising a total of 42 caregivers of patients with asthma were conducted. Modifications in the second cohort addressed neutral Likert scale responses to obtain more nuanced feedback.Caregivers expressed concerns about uncertainties in their child’s ability to use both MDIs and DPIs and challenges in ensuring proper dosage. Notably, 42% of caregivers in the second cohort rated their child’s inhaler usage as unable, indicating a significant worry about the efficacy of current delivery methods. Additionally, 50% of caregivers across both cohorts expressed uncertainties about their child receiving the full medication dosage. In response to identified challenges with DPIs, an adaptor device emerged as a potential solution, with caregivers exhibiting positive perceptions post-exposure. Features prioritized for the device include ease of use and assurance of dose delivery.The study highlights caregiver preferences and the need for innovations to ensure effective medication delivery for pediatric asthma patients. A DPI adaptor device shows promise in addressing technical issues and alleviating caregiver concerns, ultimately contributing to more effective asthma management. Future research should refine these devices based on caregiver feedback to meet the evolving needs of the pediatric asthma population. [ABSTRACT FROM AUTHOR]

Discusses a case of a patient with transient anisocoria due to improperly administered nebulized ipratropium bromide. Popularity of ipratropium bromide; Difficulty of administering nebulized drugs to pediatric patients; Medical history of the boy.

Most individuals with cystic fibrosis (CF) carry one or two mutations that result in a maturation defect of the full-length protein. One such mutation, ΔF508, results in a mutant membrane glycoprotein that fails to progress to the apical membrane, where the wild-type protein normally functions as a cyclic AMP-regulated chloride channel. 4-Phenylbutyrate (Buphenyl), an orally bioavailable short chain fatty acid, modulates heat shock protein expression and restores maturation of the ΔF508 protein in vitro and in vivo. We performed a randomized, double-blind, placebo-controlled, dose-escalation and safety study of Buphenyl in 19 adults with CF (homozygous ΔF508) to test the hypothesis that Buphenyl would be safe, well-tolerated, and associated with an increase in chloride transport in nasal epithelia. Three dose levels (20, 30, or 40 g divided t.i.d.) of drug or placebo were given for 1 week. Serial measurements of chloride transport by nasal potential difference (NPD) testing and metabolic safety testing were performed. A maximum tolerated dose of 20 g was defined based on minimal adverse reactions, the safety profile, and a statistically significant induction of chloride transport that was maximal by day 3. This short-term phase I/II study demonstrates proof of principle that modulation of ΔF508 CFTR biosynthesis and trafficking is a viable therapeutic approach for cystic fibrosis. [Copyright &y& Elsevier]

Objective: To determine whether an enteral, clonidine-based sedation strategy (CLON) during therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy would decrease opiate use while maintaining similar short-term safety and efficacy profiles to a morphine-based strategy (MOR)., Study Design: This was a single-center, observational study conducted at a level IV neonatal intensive care unit from January 1, 2017, to October 1, 2021. From April 13, 2020, to August 13, 2020, we transitioned from MOR to CLON. Thus, patients receiving TH for hypoxic-ischemic encephalopathy were grouped to MOR (before April 13, 2020) and CLON (after August 13, 2020). We calculated the total and rescue morphine milligram equivalent/kg (primary outcome) and frequency of hemodynamic changes (secondary outcome) for both groups., Results: The MOR and CLON groups (74 and 25 neonates, respectively) had similar baseline characteristics and need for rescue sedative intravenous infusion (21.6% MOR and 20% CLON). Both morphine milligram equivalent/kg and need for rescue opiates (combined bolus and infusions) were greater in MOR than CLON (P < .001). As days in TH advanced, a lower percentage of patients receiving CLON needed rescue opiates (92% on day 1 to 68% on day 3). Patients receiving MOR received a greater cumulative dose of dopamine and more frequently required a second inotrope and hydrocortisone for hypotension. MOR had a lower respiratory rate during TH (P = .01 vs CLON)., Conclusions: Our CLON protocol is noninferior to MOR, maintaining perceived effectiveness and hemodynamic safety, with an apparently reduced need for opiates and inotropes., Competing Interests: Declaration of Competing Interest Supported by National Institutes of Health (KO8NS096115 [R.C.-V.], R01NS126549, R01 HD110091, R21NS123814 [R.C.-V. and F.N.]), the Thomas Wilson Foundation [R.C.-V.], and JHU Department of Pediatrics Innovation Grant [F.N. and R.C.-V.]. The authors have no conflicts of interest relevant to this article to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Study Objective: Newly diagnosed pediatric patients with type 1 diabetes mellitus (T1D) can be underweight, overweight, or normal weight at presentation. Study objectives were to determine if, across weight categories, admission body weight (ABW)-based initial insulin glargine dosing resulted in similar fasting blood glucose responses on day of discharge, how initial ABW-based doses differed from doses at outpatient follow-up, and whether an ideal body weight (IBW) would provide a better estimate of body weight after discharge., Design: Retrospective chart review., Setting: Urban tertiary academic medical center., Patients: Eighty-one pediatric patients newly diagnosed with T1D who started therapy with subcutaneous insulin glargine between October 2014 and October 2016; patients were categorized by weight using body mass index (BMI) percentiles (underweight, normal weight, or overweight/obese)., Measurements and Main Results: Data on patient parameters from hospitalization to outpatient physician follow-up were collected. The McLaren, Moore, and BMI IBW methods were used to calculate IBW for each patient; these IBWs were compared with weights at outpatient follow-up. Initial insulin glargine doses were similar among all weight groups: median (range) 0.299 (0.227-0.4), 0.297 (0.204-0.421), and 0.291 (0.194-0.394) units/kg/dose, respectively, for the underweight, normal weight, and overweight/obese groups. No significant differences in discharge fasting glucose level or insulin glargine dose change from admission to first outpatient follow-up visit were noted. Underweight patients gained significantly more weight within 60 days after discharge compared with normal and overweight/obese patients, (median 16.3% vs 7.7% and 5.7%, respectively; p=0.002), aligning closest with the McLaren IBW. ABW was the best estimate of weight at outpatient follow-up in the overweight/obese patient group., Conclusion: For children who presented underweight, the McLaren IBW method was the best predictor of outpatient dose and body weight, whereas ABW was the best estimate in overweight and obese patients. Further investigation of the role of IBW- or ABW-based dosing methods in underweight pediatric patients with T1D may assist in optimal dosing., (© 2019 Pharmacotherapy Publications, Inc.)

Objectives: American Congress of Obstetricians and Gynecologists recommends a single dose of antibiotic prophylaxis before all cesarean sections (C/S). This recommendation is based on pharmacokinetic studies that include only non-obese patients. We sought to evaluate 1) cefazolin plasma concentrations among obese and non-obese patients after administration of a 2-g cefazolin dose for prevention of surgical wound infections, and 2) whether cefazolin concentration in fetal circulation may be protective against pathogens that cause early onset neonatal sepsis., Methods: Maternal and fetal cefazolin plasma concentrations were compared between obese (body mass index [BMI] ≥ 30 kg/m 2 ) and non-obese (BMI < 25 kg/m 2 ) healthy, term pregnant women undergoing scheduled C/S. Liquid chromatographic-tandem mass spectrometric (LC-MS/MS) methods were used for quantification of total and free cefazolin concentrations in maternal blood (MB) and umbilical cord blood (UCB)., Results: Eight women were screened and consented. There was no difference between groups in MB total and free cefazolin concentrations. All MB samples had total and free cefazolin concentrations greater than the minimum inhibitory concentration 90 (MIC90) for Group B Streptococcus (GBS), Staphylococcus aureus, and Escherichia coli. All UCB samples had total and free cefazolin concentrations greater than MIC90 for GBS and S aureus, even when administered as briefly as 18 minutes before delivery. A lower concentration of total cefazolin was detected in UCB of neonates of obese women compared to non-obese women (p > 0.05)., Conclusions: Administration of 2 g of cefazolin to women undergoing scheduled C/S might be an adequate prophylactic dose for surgical wound infection in both non-obese and obese patients; and cefazolin concentration in fetal circulation may be protective against GBS and S aureus., Competing Interests: Disclosure The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Objective: To identify whether therapeutic hypothermia in newborns with hypoxic ischemic encephalopathy affects gentamicin pharmacokinetics., Study Design: Retrospective case-control study consisting of 16 neonates who underwent therapeutic hypothermia and received gentamicin with interpretable peak and trough serum levels obtained during the period of cooling and at steady state; comparator group consisting of 7 neonates met the criteria but did not undergo therapeutic hypothermia., Results: Significant differences in gentamicin pharmacokinetics were noted between the therapeutic hypothermia group and the comparator group in elimination rate constant (0.08/h versus 0.11/h; P < 0.01), elimination half-life (9.16 hours versus 6.56 hours; P < 0.01), and clearance (0.04 L/kg.h(-1) versus 0.05 L/kg.h(-1); P < 0.01), respectively. Higher gentamicin trough serum concentrations were seen with the therapeutic hypothermia group (1.68 mcg/mL versus 0.77 mcg/mL; P < 0.01)., Conclusions: Therapeutic hypothermia is associated with alterations in gentamicin pharmacokinetics, reducing gentamicin clearance by 25.5% in neonates with hypoxic ischemic encephalopathy, which may result in increased trough serum concentrations.

Objectives: To determine the type and frequency of and indications for medications used during pediatric medical emergency team (PMET) events and to describe a PMET pharmacist training model, creation of a standardized "pharmacist PMET supply," and the pharmacist's role in implementation and ongoing improvement of a PMET., Methods: This is a retrospective observational cohort study of 210 PMET events in 172 patients in a tertiary care, academic pediatric hospital, from September 15, 2005, to September 15, 2007. We focused on the types and sources of medications used during PMET events., Results: The medications most commonly used were lorazepam (11%), neuromuscular blockers (10.5%), atropine (9.5%), epinephrine bolus (9%), and albuterol or levalbuterol (9%). However, 49 distinct medications were used in 53.8% of all PMET events. Of all medications requested during a PMET event, only 40% originated from an institutionally standardized emergency medication box, while an additional 35% were readily available at the patient's bedside as part of the "pharmacist PMET supply.", Conclusions: A wide variety of medications are required to care for children who suffer acute in-hospital deterioration. The pharmacist's medication supply and expertise ensured immediate availability of therapies for clinical entities ranging from seizures and anaphylaxis to rapid sequence intubation, regardless of the PMET event location.