Search Results (151)

Background/Objective(s): Post-discharge clinical needs of extremely preterm (EP) infants are not well defined. The aim of this study is to evaluate healthcare utilization after discharge in infants born EP and compare it to the general pediatric population. Methods: This study involved a post hoc analysis of infants born 24-0/7 to 27-6/7 weeks’ gestation enrolled in the Preterm Erythropoietin Neuroprotection (PENUT) Trial who had at least one follow-up survey representing their course between 24 and 60 months of age. The results were compared to the general population data from the Kids’ Inpatient Database, Nationwide Emergency Department Sample, and National Health and Nutrition Examination Survey. Results: Maternal, infant, and hospitalization characteristics for PENUT infants who survived to discharge (n = 828) compared to those with follow-up (n = 569) were similar except for race and maternal age. Overall, EP infants had an overall lower rate of ED visits (31% vs. 68%) but a higher rate of hospitalizations (11% vs. 3%). EP infants were less likely to go to the ED for gastrointestinal (5% vs. 12%) and dermatologic (1% vs. 6%) concerns but more likely to go to the ED for procedures (7% vs. <1%). EP infants had a higher rate of medication use (56% vs. 14%) in all categories except psychiatric medications. Conclusions: While EP infants had higher rates of specialty healthcare utilization relative to the general pediatric population, they were less likely to visit the ED overall, particularly for common concerns in this age range. This may reflect improved access and navigation of the healthcare system by EP caregivers. Full article

Background/Objectives: Falls in hospitalized pediatric patients are frequent and can lead to serious complications and increased healthcare costs. Nurses typically assess fall risk using structured tools such as the Humpty Dumpty Fall Scale (HDFS), alongside nursing diagnoses such as Fall risk ND, which are based on clinical reasoning. However, the degree of alignment between the HDFS and the nursing reasoning-based diagnostic approach in assessing fall risk remains unclear. This study aims to assess the alignment between the HDFS and Fall risk ND in identifying fall risk among hospitalized pediatric patients. Methods: A retrospective observational study was conducted in a tertiary pediatric hospital in Italy, including all pediatric patients admitted in 2022. Fall risk was assessed within 24 h from hospital admission using two approaches, the HDFS (risk identified with the standard cutoff, score ≥ 12) and Fall risk ND, based on the nurse’s clinical reasoning and recorded through the PAIped clinical nursing information system. Discriminative performance was analyzed using receiver operating characteristic curve analysis. The area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A confusion matrix evaluated classification performance at the cutoff (≥12). Results: Among 2086 inpatients, 80.9% had a recorded Fall risk ND. Of the 1853 patients assessed with the HDFS, 52.7% were classified as at risk (HDFS score ≥ 12). The HDFS showed low discriminative ability in detecting patients with a Fall risk ND (AUC = 0.568; 95% CI: 0.535−0.602). The PPV was high (85.1%), meaning that most patients identified as at risk by the HDFS were also judged to be at risk by nurses through Fall risk ND. However, the NPV was low (20.1%), indicating that many patients with low HDFS scores were still diagnosed with Fall risk ND by nurses. Conclusions: The HDFS shows limited ability to discriminate pediatric patients with Fall risk ND, capturing a risk profile that does not fully align with nursing clinical reasoning. This suggests that standardized tools and clinical reasoning address distinct yet complementary dimensions of fall risk assessment. Integrating the HDFS into a structured nursing diagnostic process—guided by clinical expertise and supported by continuous education—can strengthen the effectiveness of fall prevention strategies and enhance patient safety in pediatric settings. Full article

Introduction: Hospitalization of children creates significant emotional and psychological stress for parents, highlighting the importance of addressing their needs in pediatric care settings. Aims: This study examines the perceptions of both parents and pediatric nurses regarding the needs of hospitalized children. Method: A cross-sectional survey using the validated Needs of Parents of Hospitalized Children (NPQ) was administered to 218 parents and 218 pediatric nurses in four hospitals in Jeddah, Saudi Arabia. Key domains assessed included trust, information, and support. Group differences were evaluated using non-parametric statistical analyses. Results: Trust was prioritized more by parents (83.9%) than nurses (72.4%) (p < 0.05). Both groups deemed information important, but parents (87.2%) rated it as more necessary than nurses (74.1%) (p = 0.02). Parents (79.8%) expressed a greater need for support compared to nurses (67.3%) (p = 0.03). Conclusions: This study identified perceptual differences between parents and nurses regarding trust, communication, and support. Some differences were statistically significant at the p < 0.01 level, while others were suggestive (p-value between 0.01 and 0.05) and require further investigation. These disparities suggest a need to foster mutual understanding and improve communication practices to better align healthcare delivery with family expectations and strengthen family-centered care. Full article

Background: Postoperative sepsis (POS) is a serious pediatric safety event tracked by the Agency for Healthcare Research and Quality’s Pediatric Quality Indicator 10 (PDI 10). Purpose: This study examined POS in United States inpatient care. Methods: Using the 2019 Kids’ Inpatient Database (KID), a nationally representative sample of U.S. pediatric discharges, we performed multivariable logistic regression to examine patient- and hospital-level predictors of POS. Results: Among approximately 5.24 million weighted discharges, 577,625 (12.65%) were flagged with POS. Key independent risk factors included undergoing major surgery, being treated in large urban teaching hospitals, and admission for surgical or injury-related care. Hospital characteristics such as Western region location, for-profit ownership, and large bed size were associated with increased POS odds, while rural and small hospitals showed protective effects. Race/ethnicity showed mixed findings; Native American and “Other” race patients had elevated POS risk, while Hispanic children had slightly reduced odds compared to White peers. Conclusions: Contrary to prior assumptions, neither age nor sex was a significant independent predictor. This study expands upon prior pediatric adverse event research by delineating the distinct risk profile of POS. The findings underscore the need for targeted infection control strategies in high-risk environments and support ongoing quality improvement efforts to reduce the surgical sepsis burden in children. Full article

Pediatric palliative care (PPC) is an evolving field that focuses on supporting children with life-limiting conditions, where the quality of care is vital. This study is a retrospective observational investigation that examines the experiences of caregivers to inform health and social service planning and enhance PPC quality. Methods: Data of pediatric patients aged 3 months to 18 years admitted to a PPC inpatient unit over two years were retrospectively reviewed. Sociodemographic characteristics of primary caregivers, including age, gender, number of siblings, education, income, occupation, and marital status, were recorded. Caregiver burden and burnout were assessed using the Zarit Burden Interview and the Maslach Burnout Inventory, respectively. Associations between caregiver characteristics and these measures were analyzed. Results: A total of 118 patients and caregivers were evaluated; 54.2% of patients were male. The most common diagnoses were neurological diseases (44.9%), followed by syndromic–genetic disorders (28.8%). About 34% of patients required more than three medical devices. Most caregivers were female (91.5%), mainly mothers and 53% had only primary education. No significant differences in care burden or burnout were found based on caregiver gender, marital status, or child’s diagnosis. However, the use of nasogastric tubes and multiple medical devices was associated with higher burnout. Lower income was significantly linked to higher care burden, while longer caregiving duration correlated with both increased burden and burnout. A moderate positive correlation was found between Zarit and Maslach scores. Conclusions: The complexity of PPC patients’ care increases caregiver burden and burnout. Expanding specialized PPC services is crucial to support caregivers and sustain home-based care. Full article

Background: Malnutrition is increasingly prevalent due to rising life expectancy, oncological cases, and chronic diseases. Early detection is crucial for rehabilitation, complication prevention, and cost reduction. However, nutritional support is often suboptimal. This study aimed to determine malnutrition prevalence and nutritional support status within our hospital. Methods: A point prevalence study was conducted in adult inpatient clinics (excluding pediatrics, infectious diseases, and intensive care) by a 12-member team following ethical approval. NRS-2002 scores, arm/calf circumferences, BMI, and laboratory data (albumin, leukocytes, lymphocytes, neutrophils, hemoglobin, CRP, creatinine) were assessed. Enteral and parenteral nutrition treatments were recorded. Patients with NRS-2002 scores ≥ 3 were classified as at risk of malnutrition. Results: Among 178 patients, 24.7% were at risk of malnutrition. Surgical clinics had a higher malnutrition risk (32.3%) than internal medicine clinics (20.3%). Only 27.1% of at-risk patients received nutritional support (surgical: 19%, internal medicine: 44%). Patients at risk of malnutrition exhibited significantly lower arm circumference (p: 0.000), calf circumference (p: 0.002), lymphocyte counts (p: 0.000), hemoglobin (p: 0.018), albumin (p: 0.001), and BMI (p: 0.038), as well as significantly higher age (p: 0.000) and CRP levels (p: 0.000). Conclusions: Nutritional support remains inadequate despite increased attention to malnutrition. Intensified nutrition education, particularly in surgical inpatient clinics, is needed to improve patient rehabilitation and outcomes. Full article

Background/Objectives: Pediatric postoperative respiratory failure in the United States is increasingly considered a significant adverse event due to the increased risk of co-morbidities, suffering, and cost of healthcare. This study investigates associations between pediatric adverse events (PAEs) and hospital and patient characteristics within the inpatient hospital setting, focusing solely on the framework of pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ). Specifically, the study focuses on PDI 09-Postoperative Respiratory Failure (PORF). Methods: This quantitative research analyzed the inpatient discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Databases (KID) for 2019. We performed multivariate logistic regression to analyze patient-level encounters with PORF. Results: The results indicate that smaller, rural, and non-teaching hospitals exhibit significantly lower odds of PDI 09 than large, urban, and urban teaching hospitals, reflecting a concentration of operative procedures. In comparison, the Western United States exhibits higher odds of PDI 09. Various individual factors such as gender, age, race, service lines, payment sources, and major operating room procedures demonstrate differing levels of significance concerning PDI 09, warranting further investigation into confounding factors. In contrast, hospital ownership consistently shows lower odds of PORF risk for private, investor-owned hospitals. Conclusions: This study provides contextual expansion on the findings and offers valuable insights into PAEs in the inpatient hospital setting. It highlights areas for developing evidence-based interventions and guidelines for clinicians and policymakers. Ultimately, the findings contribute to the growing understanding of factors influencing PORF and emphasize the importance of targeted strategies for improving pediatric patient safety. Full article

The COVID-19 pandemic has revealed significant disparities in health outcomes across various populations, with children being no exception. Objective: This study aimed to identify factors associated with hospital length of stay and intensive care unit (ICU) utilization among children hospitalized with COVID-19. Methods: The project evaluated inpatient COVID-19 hospitalization data of children aged 0 to 17 years between 2020 and 2021 with a positive PCR COVID-19 test 14 days prior to or during hospitalization. Using a multivariate linear regression model, hospital length of stay and ICU utilization were evaluated by sociodemographic factors, including age, gender, race/ethnicity, primary payer status, comorbidities, CDC Social Vulnerability Index (SVI), and clinical factors. Results: Among 376 hospitalized pediatric patients, 62.2% were non-White minorities, 4.3% had at least one comorbidity, and 58.5% were covered by public insurance. Additionally, 67.6% scored high on the SVI. The average hospital stay was 3.89 days (standard deviation (SD) = 4.8), and 25% of children utilized the ICU during their hospitalization (SD = 0.43). After adjusting for sociodemographic and clinical characteristics, minority patients were more likely to have a longer length of stay by 1.09 days compared to White patients. Minority patients were also 72% more likely to use the ICU than White patients. Conclusions: These findings demonstrate that non-White children experience more severe outcomes related to COVID-19, supporting the need for culturally specific mitigation and intervention strategies for children and families during a pandemic. Full article

Background/Objectives: Invasive Streptococcus pneumoniae disease (IPD) and invasive Haemophilus influenzae (IHI) infections cause disease in pediatric patients. The COVID-19 pandemic brought about a change in the rates of common viral illnesses that can lead to superimposed bacterial infections. Methods: A repeated monthly cross-sectional study was performed using inpatient data from the Military Health System Data Repository (MDR) to observe differences in IPD and IHI hospitalization rates before and during the COVID-19 pandemic starting in March 2018 and continuing to February 2023. Our study included a cohort of 1.27 million children under the age of 5 years old. Results: A total of 200 unique cases of IPD and 171 unique cases of IHI were identified. In Year 1 of the pandemic, the hospitalization rates for IHI and IPD decreased. In Year 2, IPD returned to the pre-pandemic baseline, and IHI remained below the baseline. In Year 3, IPD increased above the baseline, and IHI returned to the baseline. Conclusions: These data support the notion that the interventions implemented to reduce the spread of COVID-19, such as hand hygiene and social distancing, likely led to a reduction in the incidence of invasive disease. The subsequent relaxation of these mitigation strategies likely led to a resurgence of IHI and an increase in IPD in our population. Full article

The etiology and resistance pattern of bacterial conjunctivitis varies depending on the patient’s care setting and age. A retrospective, observational study was conducted in a tertiary care teaching hospital. A total of 126 patients—76 adults and 50 children—diagnosed with conjunctival infection during inpatient or ambulatory care were analyzed. In the samples of adult patients, isolates were represented by Gram-positive cocci (57.7%; Staphylococcus spp., S. pneumoniae) followed by Enterobacterales (17.97%; P. mirabilis, E. coli, Klebsiella spp.), and non-fermenters (7.69%; Pseudomonas spp., A. baumannii). Multidrug-resistant (52.17%) and extensively drug-resistant (21.73%) pathogens (predominantly Gram-negative bacilli) were identified in conjunctival swabs of hospitalized adult patients. The main isolates (55.77%) identified in children’s conjunctival swabs belonged to S. aureus, H. influenzae, and S. pneumoniae, followed by Enterobacterales (19.22%; E. coli, P. mirabilis, M. morganii) and fungi (3.48%). Methicillin-resistant S. aureus (35.71%) and extended-spectrum beta-lactamase-producing K. pneumoniae (8.7%) were identified in the pediatric subgroup of patients. In critically ill adult patients assisted in the intensive care or burn functional units, bacterial conjunctivitis followed the pattern of infections and antimicrobial resistance specific to these categories of patients. In the case of hospitalized children, conjunctivitis was an integral part of the age-related pathology. Full article

Rare cancers pose significant diagnostic challenges, leading to more tests and higher healthcare expenditures (HEs). Understanding the financial implications of diagnosing rare cancers is crucial, particularly in Canada, where overall HEs are high (12% of the GDP in 2023). We investigated the pre-diagnostic hospital–based HE for patients with malignant central nervous system (CNS) tumours and compared it to patients with common cancers across Canadian provinces, using in-patient and ambulatory care data (2010–2014) from the Canadian Institute for Health Information. Pre-diagnostic HE was calculated as the change in total HE (in-patient and out-patient) during the 12 months before diagnosis, calculated as the HE within this period minus the average annual HE estimated over the two preceding years. Comparison groups included pediatric patients diagnosed with leukemia and patients aged over 15 diagnosed with colorectal cancer and lung cancer. We used quantile regression to estimate the adjusted effect of diagnosis with a CNS tumour on pre-diagnostic HE. The results indicated that HE for CNS patients was higher compared to those with common cancers. The top three factors contributing to HE variation were encounter type (in-patient/out-patient), province (Alberta/Ontario), and comorbidities (yes/no). Further investigation is warranted to understand the drivers of the cost differences. Full article

Background: During the COVID-19 pandemic, we continuously monitored the epidemiology of influenza virus among pediatric patients from January 2021 to December 2023 in Hainan Island, China. Methods: In this study, we collected 54,974 nasopharyngeal swab samples for influenza A Virus (IAV) testing and 53,151 samples for influenza B Virus (IBV) testing from pediatric outpatients. Additionally, we also collected 19,687 nasopharyngeal swab samples from pediatric inpatients for IAV and IBV testing. Outpatient samples were screened for influenza viruses (IVs) infection by the colloidal gold method. Targeted Next-Generation Sequencing (tNGS) was used to detect influenza virus infections in inpatients. Influenza virus types were identified by analyzing the HA/NA partial regions. Results: The findings revealed a significant decrease in the infection rate of IBV over the specified period, while the infection rate of IAV exhibited a rising trend. Additionally, B/Victoria lineage was the dominant epidemic strain in 2021, while the epidemic strains in 2022 and 2023 underwent a dynamic transformation from A/H3N2 to A/H1N1. Phylogenetic analysis revealed close relationships among the circulating strains. Nonetheless, because the sample size is limited, additional research is required. Conclusions: Our findings suggest that the predominant types of influenza viruses in the pediatric population are undergoing dynamic changes, influenced by the implementation and relaxation of non-pharmaceutical intervention measures. These findings highlight the need for adaptive influenza vaccination and containment strategies, particularly in tropical regions like Hainan, where climate and public health policies significantly impact viral transmission patterns. The insights gained from this study could inform more effective public health strategies in similar regions to mitigate the impact of influenza outbreaks in the future. Full article

Objectives: To analyze the clinical characteristics, trends in hospitalization, and healthcare resource utilization of pediatric patients with fecal impaction. Methods: We utilized the Healthcare Cost and Utilization Project (HCUP) databases, including the National Inpatient Sample (NIS) and the Kids Inpatient Database (KID) datasets from 2011 to 2019, to include all hospitalizations of patients up to 18 years of age with a primary diagnosis of (1) fecal impaction or (2) a primary diagnosis of abdominal pain or constipation with a secondary diagnosis of fecal impaction. The study analyzed various comorbid factors and clinical characteristics of these patients. For healthcare resource utilization, we analyzed the length of hospital stays and total hospital charges, adjusted for inflation. Results: A total of 23,570 admissions due to fecal impactions in children between the years 2011 and 2019 were analyzed, contributing to 0.18% of the total pediatric admissions. Hospitalization rates nearly doubled from 2011 (0.15%) to 2019 (0.29%). The mean hospitalization charges also trended upwards from 15,234 USD in 2011 to 22,487 USD in 2019. The inflation-adjusted annual rate of increase in hospital charges during this period was 5.9% per year. Aggressive fecal disimpaction procedures (either manual or surgical) were performed in approximately 3% of these admissions. Multivariate regression showed that older children (13–18 years of age) were more likely to require aggressive disimpaction. Female children, those with Hispanic ethnicity, and those with obesity were less likely to be associated with the need for disimpaction. Conclusions: Hospitalizations for fecal impaction have increased significantly over the past decade, creating a substantial burden on healthcare resources. Our study highlights the importance of aggressive outpatient management strategies with close follow-up for fecal impactions, which will potentially minimize these hospitalizations. Full article

This study investigates the process of planning for future inpatient resources (beds, staff and costs) for maternity (pregnancy and childbirth) services. The process of planning is approached from a patient-centered philosophy; hence, how do we discharge a suitably rested healthy mother who is fully capable of caring for the newborn baby back into the community? This demonstrates some of the difficulties in predicting future births and investigates trends in the average length of stay. While it is relatively easy to document longer-term (past) trends in births and the conditions relating to pregnancy and birth, it is exceedingly difficult to predict the future nature of such trends. The issue of optimum average bed occupancy is addressed via the Erlang B equation which links number of beds, average bed occupancy and turn-away. Turn-away is the proportion of times that there is not an immediately available bed for the next arriving inpatient. Data for maternity units show extreme and unexplained variation in turn-away. Economy of scale implied by queuing theory (and the implied role of population density) explains why many well intended community-based schemes fail to gain traction. The paper also addresses some of the erroneous ideas around the dogma that reducing length of stay ‘saves’ money. Maternity departments are encouraged to understand how their costs are calculated to avoid the trap where it is suggested by others that in reducing the length of stay, they will reduce costs and increase ‘efficiency’. Indeed, up to 60% of calculated maternity ‘costs’ are apportioned from (shared) hospital overheads from supporting departments such as finance, personnel, buildings and grounds, IT, information, etc., along with depreciation charges on the hospital-wide buildings and equipment. These costs, known as ‘the fixed costs dilemma’, are totally beyond the control of the maternity department and will vary by hospital depending on how these costs are apportioned to the maternity unit. Premature discharge, one of the unfortunate outcomes of turn-away, is demonstrated to shift maternity costs into the pediatric and neonatal departments as ‘boomerang babies’, and then require the cost of avoidable inpatient care. Examples are given from the English NHS of how misdirected government policy can create unforeseen problems. Full article

Background/Objectives: We aim to describe the changing inpatient epidemiology of NAFLD in the U.S. and identify major risk factors associated with mortality in the disease among hospitalized pediatric patients. Methods: Hospitalization data from the 1998–2020 National Inpatient Sample were utilized. ICD-9 and ICD-10 codes were used to identify pediatric patients (age less than 18 years old) with NAFLD, and risk factors for mortality were analyzed by logistic regression. Results: We identified 68,869 pediatric hospitalizations involving NAFLD. Among those, 970 (1.4%) died during hospitalization. Hospitalization rates have been rapidly increasing from 1998 to 2020 (incidence rate ratio (IRR): 1.07; 95% CI: 1.06–1.07; p < 0.001). There was a significant difference in mortality based on the type of hospital (rural, non-teaching urban, or teaching urban) in pediatric patients with NAFLD (p < 0.05). Coagulopathy was significantly associated with increased odds of mortality, while age ≥ 12 years, diabetes and obesity were associated with decreased odds of mortality (p < 0.05). Sex, race/ethnicity, hepatitis B, hepatitis C, HIV, and IV drug use were not significantly associated with mortality. Conclusions: Our study has shown ever increasing hospitalization rates for NAFLD in pediatric populations and well as significant risk factors associated with mortality. Further studies should be performed as more data on this patient population are collected. Full article