Blank Children's Hospital

Background: Routine chest X-rays (CXR) are not recommended by the American Academy of Pediatrics in bronchiolitis, yet remain a mainstay in diagnostics. We aimed to understand the impact of obtaining CXRs in patients with critical bronchiolitis, assessing intensive care unit length of stay (ICU-LOS) and intensive care unit level of respiratory support (ICU-LRS). Methods/Design: This single-center retrospective cohort study assessed children less than three years of age admitted to the PICU, pediatric step-down ICU, and pediatric cardiac ICU. Two groups were used for analysis: patients with CXR and no-CXR. The primary outcome was the difference in ICU-LOS and ICU-LRS between the groups. The critical bronchiolitis score (CBS) was used to calculate a predicted ICU-LOS and ICU-LRS. The secondary outcome was the difference between actual and predicted ICU-LOS and ICU-LRS, comparing the groups. Results: Of the 107 patients included, 65 patients (61%) received a CXR. Patients who received a CXR had significantly longer ICU-LOS (p = 0.01) and ICU-LRS (p = 0.02), despite no difference in predicted illness severity (ICU-LOS, p = 0.4; ICU-LRS, p = 0.3). The difference between actual and predicted ICU-LOS was greater in the no-CXR group (–1.4 days) compared to the CXR group (–0.8 days; p = 0.04). A similar trend was observed in ICU-LRS (–0.1 vs. –0.6 days; p = 0.1), though not statistically significant. Conclusions: Routine CXRs are common in critically ill bronchiolitis patients and may be associated with longer ICU-LOS and ICU-LRS, despite similar illness severity.

Cavernous sinus thrombosis is a rare but potentially life-threatening condition, especially in children. Given high mortality of this condition, rapid diagnosis and early treatment are important and can reduce the risk of a poor outcome or death. Clinical presentation is described mainly in adults. The main signs include fever (sometimes with spikes typical for septic thrombophlebitis), tachycardia or hypotension. Ocular symptoms are almost universal and include periorbital edema (initially unilateral, but usually bilateral), eyelid hyperemia, conjunctival chemosis, upper eyelid ptosis, exophthalmos (caused by impaired venous outflow from the orbit), limited or painful eye movements, and less commonly, optic disc edema, retinal hemorrhages, and decreased visual acuity. Most publications on this topic include an analysis of clinical cases; there is very little pooled data on anticoagulant therapy in the publications. As the condition is rare, treatment is based on expert judgment. In general, therapy includes two main strategies—antimicrobial and antithrombotic. Published data on the treatment of children is limited. The article presents a clinical case of cavernous sinus and orbital vein thrombosis associated with sphenoiditis in a child. The patient had complaints several months before the onset of clear clinical manifestations. He had left upper eyelid edema, severe headaches accompanied by pain in the left eye, and increased body temperature. Otolaryngologists carried out a surgery for urgent indications the day after the diagnosis. A sphenoidotomy was performed using video endoscopic equipment to debride the left sphenoid sinus. On the day of surgery, sodium heparin was administered as anticoagulant therapy followed by sodium enoxaparin and then long-term rivaroxaban. The case outcome was a complete recovery. The presented clinical case demonstrates challenging timely diagnosis of cavernous sinus thrombosis in children. It highlights the importance of a detailed medical history and a comprehensive ophthalmological examination for diagnosis. The clinical case features include long-lasting manifestations with many nonspecific complaints from the patient, prolonged diagnosis from the first symptoms, and the onset of symptoms during the COVID-19 pandemic.

Vaccine hesitancy is a significant global issue and is recognized by the World Health Organization (WHO) as one of the most pressing threats to public health. Defined as the delay in acceptance or refusal of vaccines despite their availability, vaccine hesitancy undermines decades of progress in preventing vaccine-preventable diseases. The issue is complex, influenced by misinformation, distrust in healthcare systems, cultural beliefs, and access barriers. These challenges require innovative and empathetic solutions to increase vaccine acceptance. Addressing this growing epidemic requires a multifaceted approach, which involves broader strategies and policymaking and in addition, effective communication tools for clinicians. Motivational Interviewing (MI), a patient-centered communication technique, offers an effective strategy to address pediatric vaccine hesitancy by fostering trust, understanding, and informed decision-making. This review aims to explore the problem of pediatric vaccine hesitancy in the United States, examine its underlying factors, and highlight evidence-based strategies, including Motivational Interviewing, to address this growing concern in clinical and public health settings. It offers practical guidance for healthcare providers and pediatricians to tackle this growing problem effectively and emphasizes the need for a combined effort of communication, community outreach, education, and systemic policy to overcome vaccine hesitancy.

To establish normative data for selected ocular diagnostic tests and commensal conjunctival microflora and describe the incidence of ocular pathology in Chilean flamingos. A total of 41 Chilean flamingos were examined at the Blank Park Zoo in Des Moines, Iowa. In 20 flamingos, blink rate was assessed undisturbed in their exhibit, then gentle manual restraint was used to assess palpebral fissure length (PFL), aqueous tear production (phenol red thread test [PRTT] in one eye, endodontic absorbent paper point tear test [EAPPTT] in the other), intraocular pressure (IOP; rebound tonometry), and fluorescein staining. Twenty-one other flamingos were brought to a darkened area for neuro-ophthalmic examination, slit lamp biomicroscopy, and indirect ophthalmoscopy. Swabs from seven flamingos were used for ocular microbiome evaluation. Results are presented as mean ± standard deviation (range). Flamingos comprised 23 females/18 males, aged 11 ± 9.1 (0.7-40) years. Test results: blink rate, 3.7 ± 2 (1-9) blinks/min; PFL, 11.2 ± 1.2 (9-14) mm; IOP, 14 ± 3.2 (10-22) mmHg; EAPPT, 10.2 ± 2.8 (9-14) mm/min; PRTT, 6.8 ± 2.5 (3-13) mm/15 s. Dazzle reflex was positive in four birds examined. Pathologies included cataracts (n = 7 birds), corneal fibrosis (n = 3), endothelial pigment (n = 2), uveal cysts (n = 1), lens luxation (n = 1), and uveitis (n = 1). Ocular microbiome showed high diversity of taxa. Baseline ocular parameters and incidence of ophthalmic pathology assist veterinarians with disease screening for Chilean flamingos, while the ocular microbiome showed high diversity.

Neonatal gentamicin dosing algorithms are not designed to achieve serum trough concentrations ≤1 mcg/mL. The purpose of our study was to evaluate a new gentamicin algorithm based on serum creatinine (SCr) and gestational age (GA) designed to achieve serum gentamicin trough concentrations ≤1 mcg/mL. A retrospective cohort study was conducted in a level IIIB neonatal intensive care unit. The incidence of elevated serum gentamicin troughs for this study was compared with the center's previously published results to evaluate the proposed dosing algorithm. Patients were included if gentamicin was administered within the first 7 days of life and a serum gentamicin trough concentration and a baseline SCr concentration were obtained. Patients were further subdivided into groups based on GA for data analysis: ≤30 weeks (group 1), 30-34 weeks (group 2), and ≥35 weeks (group 3). The SCr was considered mildly elevated (0.81-0.99 mg/dL) or elevated (≥1 mg/dL). The respective outcomes between the post-algorithm and control groups were examined using intention-to-treat analysis and Bayesian modeling to calculate rate differences. Of the 2377 patients evaluated, 366 met the inclusion criteria. Significantly lower percentages of elevated serum gentamicin troughs were noted in groups 2 and 3 subsequent to the implementation of the dosing algorithm with 16% and 15% lower rate differences, respectively. Regardless of GA, there were significantly fewer elevated serum troughs in the post-implementation groups than in the control with mildly elevated and elevated SCr p < 0.001. Using a dosing algorithm based on SCr significantly reduced the number of elevated serum trough rates in neonates with a GA greater than 30 weeks.

Abstract Communication is vital to the management of serious illness in children. While the definition of serious illness in pediatrics is not yet agreed upon, these different acute, chronic, complex, and sometimes life‐limiting or life‐threatening illnesses present many communication challenges and barriers. These challenges are particularly evident for parents and legal guardians who are often charged with the responsibilities of managing their child's care and coordinating it with various healthcare clinicians. New caregiving responsibilities for parents create a host of uncertainties for them and their child that require a collaborative discussion with their child's healthcare team. The involvement of a pediatric palliative care team can facilitate successful collaborations that promote shared decision making, empower the sick child and his or her family, and facilitate difficult conversations weighing the risks and benefits of medical interventions, including but not limited to care in emergency medical situations – as may be outlined in an advance care planning document. Noting the complexity of the health information, it is of utmost importance that clinicians take into consideration the families' health literacy, culture, and language in order to ensure clear, transparent, and supportive communication.

To evaluate for weight-based differences in clinical outcomes and antibiotic dosing variability for children hospitalized with acute hematogenous osteomyelitis (AHO). We performed a retrospective cohort study of children aged 2 to 17 years and hospitalized with a primary AHO International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision diagnosis code between 2010 and 2017 using the Cerner Health Facts database. Weight categories (healthy, overweight, obesity) were determined by using Centers for Disease Control and Prevention age- and sex-specific BMI percentiles. Rates of procedures, complications, and length of stay (LOS) were compared between groups. Dosing variability between groups was assessed by comparing the initial milligrams per kilogram per day of prescribed antibiotics. We identified 755 children with AHO for inclusion. Children with overweight and obesity were more likely to undergo surgical procedures (19% and 17%, respectively) compared with children with a healthy weight (10%; P = .009). They also had a longer LOS (5.7 and 5.8 days) than children with a healthy weight (4.9 days; P = .03). There were no differences in complication rates between weight categories. Mean weight-adjusted daily dose for the most frequently prescribed antibiotics was different by weight category, with children in higher weight categories more likely to receive lower weight-based doses. Children with overweight and obesity hospitalized for AHO were more likely to undergo procedures, have longer LOS, and receive lower weight-based antibiotic dosing compared with children with a healthy weight. Our findings suggest that weight should be carefully considered when treating children with AHO.