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PubMed2000

A cost-utility analysis of pediatric cochlear implantation.

OBJECTIVE/HYPOTHESIS: The aim of this study was to explore the cost-utility of pediatric cochlear implantation, incorporating savings associated with education into the analysis. METHODS: The costs of pediatric cochlear implantation were based on the full costs levied to purchasers, inclusive of complications and maintenance, by a large pediatric cochlear implant program in the United Kingdom. After implantation, profoundly hearing-impaired children have been found to develop hearing threshold levels equivalent to severely hearing-impaired children who wear hearing aids. An independent study calculated the educational costs for severely hearing-impaired and profoundly hearing-impaired children. From this study, savings in educational costs that would result from enabling the profoundly hearing-impaired to function as severely hearing-impaired were determined. Cost-utility was established conservatively by applying to children the known gains in utility reported by adults with cochlear implants. RESULTS: The discounted costs of creating a pediatric cochlear implant user and of maintaining the child over the first 12 years were 48,757 pound silver($78,011). The discounted difference in education costs associated with a profoundly hearing-impaired child (HL >95 dB) as compared with a severely hearing-impaired child (HL 70-95 dB) over the same period was 26,781 pound silver($42,850). These represent the potential savings in educational costs associated with pediatric cochlear implantation. Assuming implantation at age 4 years, the discounted net average cost of pediatric cochlear implantation over compulsory school years (ages 4-16) was 21,976 pound silver ($35,162). Cochlear implants have been shown to improve the quality of life in adults by 0.23 points per annum (where quality of life is rated on a scale from 0 to 1). Applying this weight to children receiving implantation at age 4 years, and assuming a life expectancy of 74 years, the quality-adjusted life-year (QALY) gain is calculated to be 16.33. The cost per undiscounted QALY gain was estimated to be 1,345.70 pound silver ($2153.12) and per discounted QALY gain to be 10,341 pound silver ($16,545.60). CONCLUSION: This study provides evidence, based on conservative assumptions, to support the view that pediatric cochlear implantation is a cost-effective health care intervention in profoundly hearing-impaired young children.

Child↗
PubMed2002

Evaluation of the performance of general emergency physicians in pediatric emergencies: Obstructive airway diseases, seizures, and trauma.

BACKGROUND: In the Lübeck region, as is usual in Germany, hospital-based emergency physicians are called for outside emergencies. They evaluate and stabilize patients and transfer them to hospital facilities of their choice (no emergency department system). These physicians are mainly anesthesiologists, surgeons, and internists-not pediatricians. Numerous quality management studies have shown an overall excellent performance of this system, but it has not been evaluated for pediatric emergencies. PATIENTS AND METHODS: In a prospective, observational study conducted over a 1-year period, all pediatric emergencies (patient age < 15 y) treated by the emergency physician service were studied. A syllabus with standards of care for children with trauma, obstructive airway disease, and seizures was distributed. In accordance with this syllabus, the actions taken were documented by the emergency physicians, and the cases were documented as life threatening or not and were classified as "trauma," "obstructive airway disease," "seizures," or "other" by the admitting pediatric intensivists and surgeons. The admitting attending physician compared these data and evaluated whether the standard management required by the syllabus was followed. RESULTS: A total of 422 pediatric cases out of 11,605 emergencies (3.5%) were recorded (147 [34.8%] trauma patients, 41 [9.7%] patients with obstructive airway disease, and 108 [25.6%] patients with seizures). Of the pediatric patients, 20.5% had life-threatening conditions; three children died before arrival, and the others required treatment in the intensive care unit. In 25% of trauma patients, deficiencies in primary treatment were observed: no documentation of neurologic status in 10.6%, no cervical immobilization in 15% of head trauma patients, and no adequate analgesia in 7%. In 25% of seizure patients, neurologic status was not documented, although treatment was in accordance with the standard of care. The worst results were observed in infants with obstructive airway disease: no documentation of oxygen saturation in 71.4%, no oxygen therapy despite hypoxemia in seven of 12 patients, and overall therapy not in accordance with the standard of care in 50%. CONCLUSIONS: The high quality of the emergency physician service documented for adults is not reproduced in the pediatric population. Trauma and seizures with similarities to adult cases are handled in a fair manner. However, the most important pediatric diagnostic entity of obstructive airway disease is often not treated adequately. Intensified educational programs for emergency physicians are warranted.

Child↗
PubMed2001

Pediatric intramedullary spinal cavernous malformations.

STUDY DESIGN: A retrospective analysis of a large single institution pediatric intramedullary tumor database. The database was searched for all pediatric intramedullary cavernous malformations. OBJECTIVES: To review the authors' experience with three pediatric intramedullary cavernous malformations, review the previous literature, and discuss the surgical management for these rare lesions. SUMMARY OF BACKGROUND DATA: Cavernous malformations can occur throughout the central nervous system; however, the intramedullary spinal cord is a rare location. More recent estimates indicate that cavernous malformations constitute 5% of all vascular malformations. There is no series that reports the management of pediatric intramedullary cavernous malformations. METHODS: There were 181 pediatric intramedullary lesions in the tumor database. A review revealed three children with a mean age of 13.3 years (range, 8-19 years) with intramedullary cavernous malformations. All these children presented with an acute motor deficit that prompted radiographic imaging and diagnosis. All the children underwent laminectomy and gross total removal of the lesion. All the malformations abutted the dorsal pial surface and created a blue discoloration, which was evident after opening the dura. RESULTS: Approximately 10% of all intramedullary cavernous malformations present in the pediatric population. Pediatric lesions, unlike those in adults, have an acute presentation, and the lesions are typically found in the cervical region. The surgical removal of these malformations results in a good functional outcome. The entire neuraxis should be screened because there is a high incidence of multiple lesions. CONCLUSIONS: The surgical removal of these malformations results in a good functional outcome. The entire neuraxis should be screened because there is a high incidence of multiple lesions.

Adolescent↗
PubMed1996

Renal function changes over time in adult recipients of small pediatric kidneys. Evidence against hyperperfusion injury.

There has been considerable debate regarding the use of pediatric donor kidneys in adults with end-stage renal disease. These small kidneys may not be able to deal with the metabolic demands of the large adult size, and thus pediatric kidneys may be at higher risk of loss due to hyperperfusion injury. To study the impact of small kidney size on renal outcome, we studied two groups of patients. This retrospective review of patients at a single institution compared recipients of pediatric renal transplants (age < 7 years, n = 37) to a matched group of adult-kidney recipients (1:2 ratio, n = 74). The groups were matched for age, sex, diabetic status, HLA type, and duration of follow-up. Primary outcomes of interest were: calculated creatinine clearance at 6 months, 1 year, 2 years, and 3 years after transplantation and evidence of hyperperfusion damage as determined by proteinuria, graft biopsy, and late graft loss due to chronic rejection. This study demonstrates no significant difference in calculated creatinine clearance between pediatric and adult transplants at 6 months (43.8 vs. 50.7 ml/min, respectively) or at 3 years after transplantation (56.3 vs. 56.2 ml/min), nor was there any evidence of increased proteinuria or late graft loss in the pediatric-kidney recipients compared with adult-kidney recipients. Our data do not demonstrate the detrimental effects of small kidney size relative to recipient on subsequent renal outcomes, and thus support the practice of pediatric donor kidneys being used in adult recipients when pediatric recipients are not available.

Adult↗
PubMed2003

Advances in the evaluation and management of pediatric dysphagia.

PURPOSE OF REVIEW: Feeding and swallowing problems in the pediatric population, commonly referred to as pediatric dysphagia, are often complex. Multiple disciplines are frequently involved in both the evaluation and the management of symptoms exhibited by an increasing number of infants and children. The efficacy of commonly employed diagnostic and treatment strategies has been largely unexplored, although there has been a steadily increasing amount of research specific to pediatric dysphagia. Recent research efforts are reviewed which contribute data necessary for development of evidence-based evaluation and management methods. RECENT FINDINGS: Research contributions over the past year have included continued work in the classification and categorization of the widely varied causes of pediatric dysphagia. Research efforts have also focused on objective data of swallowing mechanics by use of diagnostic tools such as videofluoroscopy, endoscopy, and electromyography. Recent advances in approaches to the management of pediatric dysphagia symptoms secondary to achalasia and eosinophilic esophagitis are discussed. SUMMARY: Research that contributes to the base of knowledge regarding diagnosis and treatment of pediatric dysphagia has been consistently accumulating in recent years, yet much work remains to be done. Continued research studies, both retrospective and prospective in nature, are clearly needed to continue to build evidence-based evaluation and treatment protocols for pediatric dysphagia.

Child↗
PubMed2002

National survey on the use of sedatives and neuromuscular blocking agents in the pediatric intensive care unit.

OBJECTIVES: To describe the sedative and neuromuscular blocking agents (NMBA) that are currently used in pediatric intensive care units across the country and to assess the use of written protocols for their use, criteria used for selecting these agents, monitoring practices, and clinicians responsible for making therapeutic decisions in the pediatric intensive care units. DESIGN: A questionnaire was mailed to pediatric attending physician members of the Society of Critical Care Medicine practicing in the United States in January 1997. A cover letter was also enclosed that explained the purpose of the survey and asked the respondent to forward the questionnaire to a colleague if unable to complete. RESULTS: A total of 176 questionnaires were returned, which represented 145 pediatric institutions across the country, for a response rate of 51%. The agents reported to be used most often for sedation were the opioids and benzodiazepines, which were used for >72 hrs. The NMBA used were vecuronium and pancuronium, which were used for >48 hrs. Newer agents such as propofol and cisatracurium were being used by some clinicians as well. Respondents primarily use the intravenous route of administration as either intermittent bolus or continuous infusion. Frequently cited indications for sedatives were anxiety, fear, and amnesia and facilitation of intubation and maintenance of mechanical ventilation for NMBA. Only 13.4% indicated using written protocols for sedatives and 26.1% for NMBA. Decisions regarding the choice of agent were usually based on clinician preference and experience and the duration of action of the agent. Respondents most often reported using clinical assessment (57%) or the Glasgow Coma Scale (47.3%) to monitor the depth or adequacy of sedation. Over 80% of those surveyed use a peripheral nerve stimulator to monitor NMBA activity. CONCLUSION: Clinicians continue to use the opioids and benzodiazepines most often for sedation in the pediatric intensive care units, but newer agents are being used more often and warrant further investigation. The use of written protocols is very low, possibly because of the lack of guidelines in the literature on pediatric intensive care unit sedation and neuromuscular blockade. Development and implementation of protocols for the selection, use, and monitoring of sedatives and NMBA through a multidisciplinary team approach may be a beneficial way to provide safe and cost-effective therapy to critically ill pediatric patients.

Journal Article↗
PubMed2004

Advances in pediatric electrophysiology.

PURPOSE OF REVIEW: The pediatric electrophysiology literature during the past year has addressed several topics that are particularly relevant for children and other patients with congenital heart disease. This paper reviews selected studies germane to physicians and health care personnel who treat pediatric and adult congenital heart patients with arrhythmias and electrophysiologic disorders. RECENT FINDINGS: Advances in arrhythmia diagnostics have been reported in pediatrics using loop monitoring, both external and implanted. Diagnostic criteria and risk stratification strategies have been refined for the congenital and inherited rhythm disorders such as cardiomyopathies and long QT syndrome. The use of therapeutic procedures such as catheter ablation for complex arrhythmias in congenital heart disease is discussed. Finally, a summary of articles on implanted devices in pediatrics and congenital heart disease is reviewed, including implantable defibrillators, atrial antitachycardia pacemakers, and cardiac resynchronization therapy in pediatrics. SUMMARY: Pediatric electrophysiology is a rapidly changing field, with advances seen in diagnostic evaluation of arrhythmia, refinement of risk-stratification testing, and therapeutic options such as catheter ablation and cardiac rhythm management devices. The evolution of pediatric electrophysiology from a diagnostic specialty into a therapeutic and interventional subspecialty has advanced the treatment options for children with cardiac arrhythmias and conduction disorders.

Arrhythmias, Cardiac↗
PubMed2005

Pediatric emergencies on a US-based commercial airline.

OBJECTIVES: The purpose of this investigation was to determine the incidence and character of pediatric emergencies on a US-based commercial airline and to evaluate current in-flight medical kits. METHODS: In-flight consultations to a major US airline by a member of our staff are recorded in an institutional database. In this observational retrospective review, the database was queried for consultations for all passengers up to 18 years old between January 1, 1995, and December 31, 2002. Consultations were reviewed for type of emergency, use of the medical kit, and unscheduled landings. RESULTS: Two hundred twenty-two pediatric consultations were identified, representing 1 pediatric call per 20,775 flights. The mean age of patients was 6.8 years. Fifty-three emergencies were preflight calls, and 169 were in-flight pediatric consultations. The most common in-flight consultations concerned infectious disease (45 calls, 27%), neurological (25 calls, 15%), and respiratory tract (22 calls, 13%) emergencies. The emergency medical kit was used for 60 emergencies. Nineteen consultations (11%) resulted in flight diversions (1/240,000 flights), most commonly because of in-flight neurological (9) and respiratory tract (5) emergencies. International flights had a higher incidence than domestic flights of consultations and diversions for pediatric emergencies. CONCLUSIONS: The most common in-flight pediatric emergencies involved infectious diseases and neurological and respiratory tract problems. Emergency medical kits should be expanded to include pediatric medications.

Adolescent↗
PubMed2003

The utility of sentinel lymph node biopsy in head and neck melanoma in the pediatric population.

Intraoperative lymph node mapping and sentinel lymph node biopsy have proven beneficial techniques in staging adult patients with melanoma of the head and neck, where there is great variability in lymphatic drainage. This technique has also been applied to pediatric patients with truncal cutaneous melanomas in an effort to determine nodal status without the morbidity associated with complete lymph node dissection. Nevertheless, the utility of sentinel lymph node biopsy in head and neck melanoma in the pediatric population has not been established. The objective of the authors' study was to determine the clinical utility of intraoperative lymph node mapping and sentinel lymph node biopsy of head and neck melanoma in the pediatric population. The authors reviewed the records of seven pediatric patients with head and neck melanoma or borderline melanocytic proliferations of unknown biologic potential who underwent intraoperative lymph node mapping and sentinel lymph node biopsy between 1998 and 2001. All sentinel lymph node specimens were examined by a melanoma dermatopathologist for the presence of metastatic melanoma. The mean operative time for each case was 3 hours, 8 minutes (range, 2 hours, 15 minutes to 3 hours, 50 minutes). All seven pediatric patients who underwent extirpation of a primary head and neck melanoma and preoperative lymphoscintigraphy had unique and identifiable basins of drainage to regional nodal groups. Four of seven patients had at least one positive sentinel lymph node. Overall, five of 19 sentinel nodes (26 percent) resected had evidence of metastatic melanoma. Of the patients with positive sentinel lymph nodes, two of the primary lesions were diagnosed as melanoma while two were initially considered atypical melanocytic proliferations of uncertain biologic potential with melanoma in the differential diagnosis. Sentinel lymph nodes in pediatric patients with melanoma of the head and neck can be successfully mapped and biopsied, as in adult patients. In addition, this procedure can provide critical diagnostic information for those pediatric patients with diagnostically challenging, controversial, or borderline melanocytic lesions.

Child, Preschool↗
PubMed2003

The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures.

BACKGROUND: Computed tomographic (CT) scanning is sensitive in detecting pelvic fractures in the pediatric patient. Pelvic fractures in the pediatric population rarely require emergent intervention, thus providing time to obtain the optimal imaging study. The objective of this study was to compare pelvic radiographs and abdominal pelvic CT scans of all pediatric trauma patients with pelvic injury to determine the role of pelvic imaging in the immediate trauma resuscitation. METHODS: A retrospective review was performed of pediatric patients (age < 18 years) with a pelvic fracture identified from the registry of a Level I pediatric trauma center for the period 1993 to 2001. Patients with a documented pelvic injury and both a pelvic CT scan and pelvic radiograph available for review were extracted for analysis. For this study, all films were re-reviewed by an attending pediatric radiologist, and the abnormalities were categorized by the area of injury. The data were comparatively analyzed according to the area of injury and the soft tissue findings. RESULTS: For the 8-year period, 130 pediatric patients with a pelvic fracture were identified, including 103 patients with both a pelvic CT scan and radiographs. Of the 151 fractures identified by pelvic CT scan, 81 were also identified by the pelvic radiograph (54%). There were 38 soft tissue hematomas noted by pelvic CT scan and only 2 identified by the pelvic radiograph. The greatest discrepancy was noted in comparison of the sacral region (16 abnormal pelvic CT scans vs. 3 abnormal radiographs); the least discrepancy was noted in the evaluation of the hip (6 abnormal pelvic CT scans vs. 5 abnormal radiographs). CONCLUSION: The pelvic radiograph lacked the sensitivity of the pelvic CT scan for detecting pelvic fractures in all anatomic areas evaluated. Pelvic CT scan also offers additional information regarding soft tissue injury not available on most pelvic radiographs. In the trauma patient that will undergo abdominopelvic CT scanning as part of the trauma evaluation, a pelvic radiograph may be superfluous. Screening pelvic radiography should be reserved for the rare unstable patient or the patient in whom an abdominopelvic CT scan is not otherwise indicated.

Abdominal Injuries↗
PubMed2006

Superiority of pediatric en bloc renal allografts over living donor kidneys: a long-term functional study.

BACKGROUND: Growing waiting list for kidney transplantation in the United States makes it imperative to expand donor pool to use of pediatric kidneys. Because en bloc pediatric kidneys double nephron numbers, it would be interesting to learn how they fare compared to living donor kidneys long term. METHODS: Retrospective chart review was performed on all 72 pediatric en bloc and 75 live adult donor kidney recipients transplanted between January 1990 and December 2001. Long term graft function was assessed with glomerular filtration rate (GFR) using the abbreviated modification of diet in renal disease (MDRD) formula. RESULTS: Pediatric donor was 16.9 +/- 11.2 months old and weighed 10.7 +/- 3.8 kg. Nine en bloc kidneys thrombosed at a mean of 4.2 days posttransplantation. Proteinuria was detected later posttransplantation in en bloc group (45.6 +/- 33.6 months vs. 23.4 +/- 16.3 months, P = 0.002). Pediatric en bloc recipients had significantly higher GFR up to 8 years posttransplantation. One-year graft survival was significantly better in live donor group (93.3% vs. 81.9%, P = 0.041) but five-year graft survival rates were similar (86.7% vs. 76.3%, P = 0.125). One-year and five-year patient survival rates were similar between en bloc and live donor groups (97.3% vs. 98.6%, P = 0.585 and 94.6% vs. 93.0%, P = 0.688, respectively). CONCLUSION: Early postoperative graft thrombosis remain a challenge with pediatric en bloc renal transplants, but once the allografts survive early postoperative course, they provide better long-term function than living donor kidney transplants. In order to alleviate burden on waiting list, pediatric en bloc kidneys should be transplanted more often when available.

Adult↗
PubMed2025

The landscape of structural variation in pediatric cancer.

Structural variants (SVs) account for over 60% of the driver variants in pediatric cancer, and in many cases act as the cancer initiating event. To study SVs from a pan-cancer perspective, we analyzed 1,616 pediatric cancer genomes in 16 major cancer types of hematological malignancies (n = 908), brain tumors (n = 183), and solid tumors (n = 525) and compared their profiles to those of 2,203 adult cancers. The SV burden varied ~100-fold across pediatric cancer types and demonstrated an 8- to 16-fold reduction compared to adult brain and solid tumors but was comparable in pediatric versus adult hematological malignancies. Recurrent SV hotspots occurred uniquely in pediatric acute lymphoblastic leukemias (ALLs) in proximity to RAG-mediated recombination signal sequences (RSS) and disrupted multiple immune-related loci as well as 69 genes, which often involved cryptic RSS sites. By contrast, such hotspots affected only immune-related loci but not driver genes in adult lymphoid cancers. Eight SV signatures extracted from the cohort had varying distributions across cancer types, with clustered translocations reflecting templated insertions in osteosarcoma, and medium-sized deletions (10 kb to 1 Mb) enriched in cancers with RAG-mediated deletions. Intra-patient evolutionary analysis in 13 patients with multiple spatiotemporally distinct samples revealed that RAG-mediated recombination in leukemia and complex rearrangements in solid tumors occurred both early in disease initiation and continuously during later diversification, contributing to clonal heterogeneity. Finally, we found that both driver genes and fragile sites were the two genomic regions most frequently disrupted by SVs. The unique and diverse SV landscapes that emerged from this comprehensive analysis expand the scope of RSS-mediated mutagenesis in pediatric ALL and will be a valuable resource for guiding future functional studies and the design of clinical genomic testing in pediatric cancer.

Journal Article↗
PubMed2005

Liver transplantation utilizing pediatric cadaver donor livers.

This is a review of a unit's experience with the use of pediatric (up to 15 yr of age), cadaver donor livers for orthotopic liver transplantation (OLTx). The records of 86 patients who underwent 90 OLTx with pediatric donor allografts from January 1986 to September 2002 were reviewed. A total of 69 of 90 (77%) allografts from pediatric donors were used for pediatric (P) recipients, and 21 of 90 (23%) for adult (A) recipients. Donor demographics were: mean donor age 8.5 (0-15) yr; donor sex 53 males/37 females; cause of death head injury 55/90 (61%), cerebral ischaemia 14 of 90 (15%), cerebrovascular 13 of 90 (15%), other eight of 90 (9%). Whole OLTx were performed in 44 of 69 (64%) P group and 20 of 21 (95%) A group. Reduced-size OLTx (13 left lateral lobe, 10 left lobe, one right lobe, one split left lateral lobe) were performed in 25 of 69 (36%) P group vs. in one of 21 (5%) A group, (right lobe split) (p < 0.005). The median follow up was 8.8 yr. The graft loss in the P recipients was 19 of 69 (27.5%) vs. eight of 21 (38.1%) in A recipients. Graft loss for reduced size P OLTx was nine of 25 (36%) vs. 10/44 (22.7%) for whole allograft P OLTx (p = NS). Underlying cause of P graft loss were: chronic rejection six (32%); patient mortality six (32%); vascular four (21%); other three (15%). Underlying cause of A graft loss were: patient mortality four (50%), acute rejection two (25%) and vascular two (25%). OLTx-utilizing pediatric cadaver donor allografts provides acceptable outcomes, including use of reduced-size grafts in pediatric recipients. Vascular complications and chronic rejection tend to be more common in pediatric recipients, whilst patient mortality and graft loss from acute rejection are more common in adult recipients.

Adolescent↗
PubMed2006

An assessment of interrater reliability of the ASA physical status classification in pediatric surgical patients.

BACKGROUND: The American Society of Anesthesiologists physical status classification (ASA-PS) is used worldwide by anesthesia providers as an assessment of the preoperative physical status of patients. This assessment score has been inconsistently assigned by anesthesia providers among adult surgical patients. This study tested the reliability of assignment of ASA-PS classification among pediatric anesthesia providers. METHODS: A postal questionnaire was sent to a randomly selected sample of full members of the Society of Pediatric Anesthesiologists. Participants were asked to assign ASA-PS for 10 clinical case scenarios chosen from regular pediatric surgical cases at the investigators' institution. RESULTS: The response rate to our mailing was 54%. There was a moderate overall agreement among pediatric anesthesia providers in assigning ASA-PS for pediatric surgical patients (exact agreement 40.5-78.6%; kappa = 0.479). Exact agreement improved for combined ASA classifications of I and II (83%), and III and IV (95%). CONCLUSION: These findings suggest a moderate agreement among pediatric anesthesia providers in assigning ASA-PS classification to selected pediatric case scenarios. Most disagreement, however, represented a tendency of outside care providers to assign a higher ASA physical status for cases. Furthermore, agreement was excellent for low risk (i.e. ASA I and II) as well as high risk (ASA III and IV) cases.

Adolescent↗
PubMed2000

A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course.

BACKGROUND: Critical pediatric illness or injury occurs infrequently in out-of-hospital settings, making it difficult for paramedics to maintain physical assessment, treatment, and procedure skills. OBJECTIVES: To document the ability of paramedics to retain clinical knowledge over a one-year interval after completing a pediatric resuscitation course and to determine whether clinical experience or retesting improves retention. METHODS: This was a randomized controlled study assessing retention of knowledge in pediatric resuscitation soon after, six months after, and 12 months following completion of a pediatric advanced life support course. Forty-three paramedics participated in pre- and post-pediatric resuscitation course testing and were randomly assigned to one of four groups. Group 1 received a knowledge examination (KE) and mock resuscitation scenarios (MR) at six months. Group 2 received only the KE at six months. Group 3 received the MR only at six months. Group 4 received no intermediate testing. All groups were reassessed at 12 months. RESULTS: Pediatric clinical knowledge (as measured by KE) rose sharply immediately after the course but returned to baseline levels within six months. There was no difference between the groups in knowledge scores at 12 months, despite the interventions at six months. CONCLUSIONS: Although intensive out-of-hospital pediatric education enhances knowledge, that knowledge rapidly decays. Emergency medical services programs need to find novel ways to increase retention and ensure paramedic readiness.

Adolescent↗
PubMed2001

The CGHA asthma management program and its effect upon pediatric asthma admission rates.

Asthma is the most common reason for admission to the hospital for children nationally. This hospitalization rate is stable despite availability of appropriate outpatient treatments. Our Cincinnati Group Health Associates (CGHA) asthma management program has evolved since 1989. We have measured our pediatric population along with asthma admissions since 1993. Our admission pattern is compared to the community in general and to our managed care population in particular. Our urban center's admission pattern is also studied. Our CGHA pediatric asthma admissions have been declining steadily over the 1993-2000 period by 60%. This decrease is in contrast to national trends in this time period. Comparison to total admissions from 1993 through 2000 still shows a 50% decline whether 0-18 years or 0-5 years is studied. Our urban pediatric center also had a fall in pediatric asthma admission rates of 80% in this time frame; all of these results are statistically significant. Our major managed care network also showed a decline of 55% in pediatric asthma admissions from 1996 to 1999. Our CGHA asthma management program has had a positive influence on our pediatric asthma admission rates. This effect is favorable in comparison to national trends in pediatric asthma admissions. This trend is independent of disease acuity, region of the city where patients live, insurance selection, or age.

Adolescent↗
PubMed2004

Clinical activities of an academic pediatric pharmacy team.

BACKGROUND: Pharmacy school faculty, residents, and students have been shown to positively impact patient care in multiple settings. However, their potential role in the care of pediatric patients has not been described. OBJECTIVE: To document the contribution of pharmacy school faculty, residents, and students to the optimization of medical care for pediatric patients. METHODS: All clinical interventions performed by faculty, residents, and students for pediatric patients seen from January through December 2002 were recorded and analyzed. The interventions were concurrently recorded using a handheld and desktop computer-based documentation system, the Pharmacist's Electronic Database for Interventions, developed by the pediatric practice team. Practice sites included general pediatrics, pediatric intensive care, neonatal intensive care, and ambulatory clinics. RESULTS: Four faculty members, 5 residents, and 44 students collected intervention data. A total of 4605 interventions were performed for 3978 patients. The most common interventions performed were drug therapy change, pharmacokinetic monitoring, drug information, and medication histories/patient education. Drug added and drug deleted were the most frequent interventions performed in the drug therapy change category. The most common indications for which interventions were made were infectious (39.6%) and respiratory (23.3%) diseases. A total of 223 adverse drug events or medication errors were prevented or detected during the study period. Errors in dosing (overdose or underdose) were the most commonly encountered adverse events. CONCLUSIONS: Pharmacy school faculty, residents, and students perform numerous clinical activities that play a significant role in the multidisciplinary care of pediatric patients.

Child↗
PubMed2006

Twinning and risk of stillbirth subtypes in pediatric mothers.

We sought to estimate levels of risk for stillbirth subtypes associated with twin gestations among pediatric mothers (10-14 years). Analysis was on twin pregnancies covering the period 1989 to 2000 in the United States. We classified stillbirth as term, preterm, small-for-gestational-age (SGA) or preterm-SGA. We then assessed the risks of these stillbirth subtypes in pediatric mothers using two comparison groups consisting of women aged 15 to 19 years old (adolescent mothers) and 20 to 24 years old (mature mothers). Adjusted risk estimates were by means of hazard ratios generated from a Cox proportional hazards regression model. We adjusted for dependence of observations within twin clusters using the robust sandwich estimator. The rate of stillbirth was highest among pediatric mothers (56/1000), followed by adolescent gravidas (29/1000) and lowest in mature mothers (20/1000; p for trend < .01). Overall, preterm stillbirth was the most frequent stillbirth phenotype while term stillbirth was the least frequent. Not a single case of term stillbirth was recorded in pediatric mothers. Among pediatric gravidas, the risk for preterm stillbirth was more than tripled (adjusted hazard ratio [AHR] = 3.4; 95% confidence interval [CI] = 2.5-4.6), and that of preterm-SGA stillbirth more than doubled (AHR = 2.6; 95% CI = 1.8-3.7) that of mature mothers respectively. The 30% risk elevation for SGA stillbirth among pediatric mothers was not found to be statistically significant (AHR = 1.1; 95% CI = 0.3-4.3). Pediatric motherhood is a risk factor for stillbirth in twin gestation, especially, preterm and preterm-SGA stillbirth phenotypes. Prevention of stillbirth among this category of mothers should target the period preceding full term.

Adolescent↗

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