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Trautmannsberger I, Plagg B, Adamek I, Mader S, de Luca D, Esposito S, Silfverdal SA, Zimmermann LJI, Tischer C. The Multifaceted Burden of Respiratory Syncytial Virus (RSV) Infections in Young Children on the Family: A European Study. Infect Dis Ther 2024; 13:1531-1573. [PMID: 38767780 PMCID: PMC11219685 DOI: 10.1007/s40121-024-00989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Since the majority of hospitalisations due to RSV occur in young children, the illness profoundly influences the entire family. However, comprehensive evidence regarding its overall effects remains limited. The ResQ Family study aims to investigate the burden of RSV-induced pediatric hospitalisation on affected families. METHODS Spanning the 2022-2023 RSV season, an interdisciplinary, observational study was conducted in Germany, France, Italy and Sweden. Using an online questionnaire, parents and caregivers of children (< 24 months of age) with an RSV-induced hospitalisation were recruited. Information was gathered on topics related to RSV and parental health-related quality of life (HRQoL) during the acute infection phase (t0) and 6 weeks later (t1). Descriptive evaluations of the data set were performed during t0 and regarding a potential change over the observation period (t0 vs. t1). Subgroup analysis aimed to further identify differences across the countries. RESULTS A total set of 138 affected parents/caregivers were included in the study, with 59 participants responding to the follow-up survey (t1). Particularly during the acute infection phase, parental HRQoL was shown to be negatively influenced by the child's RSV infection [total score (p < 0.001, d = 0.54), parent HRQoL summary score (p < 0.001, d = 0.67) and family functioning summary score (p = 0.007, d = 0.33)]. Significant disparities in disease awareness and support structures were observed across Europe, with France and Sweden showing notably higher levels. CONCLUSION The ResQ Family study provides convincing evidence that RSV-associated hospitalisations in young children across Europe generate a multifaced burden for the entire family, partly even beyond the acute infection phase. Standardised approaches for disease prevention at societal, educational and policy levels are needed to guarantee every newborn the best possible start into life. TRIAL REGISTRATION ClinicalTrials.gov, identifier, NCT05550545.
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Affiliation(s)
- Ilona Trautmannsberger
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany
- Department of Paediatrics, Research School for Oncology and Reproduction, Maastricht UMC+, 6229 ER, Maastricht, The Netherlands
| | - Barbara Plagg
- Institute of General Practice and Public Health, Provincial College for Health Professions Claudiana, 39100, Bolzano, Italy
| | - Ina Adamek
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany.
| | - Daniele de Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
| | - Susanna Esposito
- Paediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | | | - Luc J I Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany
- Department of Paediatrics, Research School for Oncology and Reproduction, Maastricht UMC+, 6229 ER, Maastricht, The Netherlands
| | - Christina Tischer
- European Foundation for the Care of Newborn Infants (EFCNI), Hofmannstraße 7a, 81379, Munich, Germany
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Assathiany R, Sznajder M, Cahn-Sellem F, Dolard C, Werner A. Effects of infant bronchiolitis on family life. Front Pediatr 2024; 12:1343045. [PMID: 38962572 PMCID: PMC11220111 DOI: 10.3389/fped.2024.1343045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/29/2024] [Indexed: 07/05/2024] Open
Abstract
Background Bronchiolitis is a respiratory infection of viral origin and is often linked to syncytial respiratory virus. It is the most frequent cause of hospitalisation in children aged under 2 years and sometimes requires transfer to intensive care. Infectious complications may also arise in the short term, and longer-term progression towards asthma is also possible. The occurrence of bronchiolitis in children may affect families in different ways, and may have psychological, organisational, employment-related, and possibly financial consequences. Objective The aim of the study was to determine the familial and socioeconomic repercussions of bronchiolitis in infants. Setting Parents with a child with bronchiolitis between January 2021 and May 2022, who were registered at the site of the Association Française de Pédiatrie Ambulatoire (Mpedia site) or at the site of the Malin Programme, which serves families experiencing financial difficulties, were included in the study. Participants All parents consenting to participate in the study. Results A total of 2,059 valid questionnaires were retrieved: 1,318 (64%) were obtained from parents through the Mpedia website and 741 (36%) were obtained through the Malin Programme. Parents associated with the Malin Programme had more children, as well as higher rates of unemployment and financial difficulties, and required greater medical assistance. Hospitalisation was necessary in 37% of cases and was comparable between groups. During the illness, moderate to severe anxiety was present in 73% of parents; this percentage rose to 87% if the child required hospitalisation. Many parents reported effects on daily home (84%) and work life (90%), and 60% had taken a leave of absence from work. Conclusion Beyond the immediate or longer-term medical consequences of bronchiolitis in infants, the illness affects families in multiple ways and can lead to anxiety, as well as changes in day-to-day home and work life. Physicians should have greater awareness of these consequences and should strive to decrease their impact.
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Affiliation(s)
- Rémy Assathiany
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis, France
| | - Marc Sznajder
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis, France
| | | | | | - Andreas Werner
- Association Française de Pédiatrie Ambulatoire (AFPA), Ancenis, France
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Custovic A, Mestre-Ferrandiz J, Kragten-Tabatabaie L, Laurent J, Sellem L, Koslap-Petraco M, Cadeddu C. Parent's perception of respiratory syncytial virus and subsequent wheezing burden: A multi-country cross-sectional survey. Pediatr Allergy Immunol 2024; 35:e14169. [PMID: 38837464 DOI: 10.1111/pai.14169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization in infants. RSV bronchiolitis is associated with an increased risk of subsequent wheezing. We aimed to document the parents' perception of the link between RSV infection and subsequent wheezing, wheezing-related healthcare and family resources use, and its impact on family daily life. METHODS This cross-sectional online survey enrolled 1200 parents with at least one child ≤6y living in the United States, United Kingdom, Spain, and Italy. Children diagnosed with RSV bronchiolitis before age of 2 years were included in the RSV group, and those never diagnosed with RSV bronchiolitis in the Reference group. RESULTS The odds of wheezing were 4.5-fold (95%CI 3.5-5.9) higher in the RSV than in the Reference group. The odds increased to 7.7-fold (95%CI 5.4-11.1) among children who were hospitalized, and 9-fold (95%CI 5.1-16.6) among those admitted to pediatric intensive care with RSV bronchiolitis. Similar trends were observed across all countries. In total, 57% of parents reported their child's wheezing to have moderate to severe impact on their emotional well-being, and 53% on their daily life activities and/or social life. 64% of parents reported moderate-severe impact of wheezing on child's quality of sleep and 49% and 46% reported a moderate-severe impact on their children's emotional well-being and physical activities. CONCLUSIONS This survey suggests an association between RSV infection and subsequent wheezing in children across different countries. Wheezing, especially in association with RSV infection, was associated with increased healthcare utilization and costs, and significantly impacted parents' and children daily life.
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Affiliation(s)
- Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | | | | | | | - Chiara Cadeddu
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Neri M, Mewes JC, de Almeida FA, Stoychev S, Minarovic N, Charos A, Shea KM, Steuten LMG. Impact of including productivity costs in economic analyses of vaccines for C. difficile infections and infant respiratory syncytial virus, in a UK setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:34. [PMID: 38689331 PMCID: PMC11059668 DOI: 10.1186/s12962-024-00533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES It has been estimated that vaccines can accrue a relatively large part of their value from patient and carer productivity. Yet, productivity value is not commonly or consistently considered in health economic evaluations of vaccines in several high-income countries. To contribute to a better understanding of the potential impact of including productivity value on the expected cost-effectiveness of vaccination, we illustrate the extent to which the incremental costs would change with and without productivity value incorporated. METHODS For two vaccines currently under development, one against Cloistridioides difficile (C. difficile) infection and one against respiratory syncytial disease (RSV), we estimated their incremental costs with and without productivity value included and compared the results. RESULTS In this analysis, reflecting a UK context, a C. difficile vaccination programme would prevent £12.3 in productivity costs for every person vaccinated. An RSV vaccination programme would prevent £49 in productivity costs for every vaccinated person. CONCLUSIONS Considering productivity costs in future cost-effectiveness analyses of vaccines for C. difficile and RSV will contribute to better-informed reimbursement decisions from a societal perspective.
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Lane JE, Foster BA. Patient-Centered Outcomes in Bronchiolitis. Hosp Pediatr 2024; 14:172-179. [PMID: 38343331 DOI: 10.1542/hpeds.2023-007264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES We examined the impact of hospitalization for bronchiolitis on patient-centered outcomes across patients with varying levels of support. METHODS The participants included primary caregivers of children aged 0 to 24 months hospitalized for bronchiolitis at an 150-bed tertiary care children's hospital. Data were collected using a 30-item questionnaire examining quality of life impact, adapted from the previously validated survey, the Impact of Bronchiolitis Hospitalization Questionnaire.1 The survey contained questions asking to what extent the hospitalization interfered with different aspects of care. After all surveys were collected, the patients were split into groups categorized by level of support and defined as no support, low support (low-flow nasal cannula only or nasogastric [NG] only), moderate support (high-flow nasal cannula without NG), high support (high-flow nasal cannula with NG support), and positive pressure (with or without NG support). Descriptive statistics were used to examine the distribution of mean impact scores across these groups. RESULTS A total of 92 caregivers and their children were included. The mean impact score for variables of difficult to hold, difficult to bond, and breastfeeding disruption increased with greater levels of support with P values of P = .003, P = .04, and P < .001, respectively. CONCLUSIONS We found that the impact on patient-reported outcomes varied by level of support, as defined here, among children hospitalized with bronchiolitis, with significant impacts being in areas of caregiver bonding, caregiver holding, and breastfeeding.
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Affiliation(s)
- Jennifer E Lane
- Division of Pediatric Hospital Medicine, Oregon Health and Science University
| | - Byron A Foster
- Division of Pediatric Hospital Medicine, Oregon Health and Science University
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon
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Wrotek A, Wrotek O, Jackowska T. The Estimate of Parental Quality of Life Loss Due to Respiratory Syncytial Virus (RSV) Hospitalization. Diseases 2023; 11:126. [PMID: 37873770 PMCID: PMC10594483 DOI: 10.3390/diseases11040126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is one of the leading causes of pediatric hospitalizations, mainly in children under 2 years of age. Hospitalization affects the caregivers' quality of life (QoL). We assessed the caregivers' QoL during RSV-confirmed hospitalizations of children under 2 years old, identified the most affected QoL dimensions and calculated utilities focusing on the assessment methods and potential confounders. METHODS The caregivers filled out the EQ-5D questionnaire, consisting of a descriptive system (assessing 5 QoL dimensions) and a visual analog scale (EQ VAS). Utility, utility loss and quality-adjusted life years (QALY) loss were calculated, and a concordance between the two systems was assessed. RESULTS A disturbance in any of the five assessed dimensions was reported by 42% (55 out of 132) of the caregivers, mostly anxiety/depression (37%) and pain/discomfort (17%). The utilities varied between 0.17 and 1 in the descriptive system and 0.33-1 (median 0.86) in the EQ VAS, with a utility loss of 0.14 (IQR: 0.1-0.2). The calculated QALY loss reached a median of 2.45 × 10-3 (IQR: 1.37 × 10-3-4.56 × 10-3) and was not influenced by the patient's age or the final clinical diagnosis (QALY loss for bronchiolitis: 2.74 × 10-3, pneumonia: 1.84 × 10-3, bronchitis: 1.78 × 10-3, differences statistically insignificant). Only a moderate concordance between the descriptive system and the EQ VAS was seen (Spearman's rank correlation coefficient = 0.437, p < 0.05), with the latter revealing a higher degree of QoL disturbances. CONCLUSIONS RSV hospitalization influences parental QoL significantly, and anxiety/depression is the most commonly reported issue. Utility impairment scores depend on the assessment method but not on the patient's age or final diagnosis. Thus, the impact of RSV on caregivers' QoL cannot be underestimated.
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Affiliation(s)
- August Wrotek
- Department of Pediatrics, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland;
- Department of Pediatrics, Bielanski Hospital, Cegłowska 80, 01-809 Warsaw, Poland
| | - Oliwia Wrotek
- Student Research Group, Bielanski Hospital, Cegłowska 80, 01-809 Warsaw, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland;
- Department of Pediatrics, Bielanski Hospital, Cegłowska 80, 01-809 Warsaw, Poland
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Wrotek A, Wrotek O, Jackowska T. The Impact of RSV Hospitalization on Children's Quality of Life. Diseases 2023; 11:111. [PMID: 37754307 PMCID: PMC10528181 DOI: 10.3390/diseases11030111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is one of the most frequent etiological factors of lower respiratory tract infections in children, potentially affecting patients' quality of life (QoL). We aimed to asses QoL in children under 2 years of age hospitalized due to laboratory-confirmed RSV infection. METHODS A QoL was assessed by parents/tutors with the use of the 100-point visual analog scale and compared against a disease-free period. We evaluated the median utility, QoL loss (reported in days), and quality-adjusted life years (QALY) loss in relation to RSV hospitalization. RESULTS We included 132 patients aged from 17 days to 24 months (median 3.8 months). The mean utility during the hospitalization varied between 0.418 and 0.952, with a median of 0.679 (95%CI: 0.6-0.757) and median loss of 0.321 [0.243-0.4], which further translated into a loss of 2.2 days (95%CI: 1.6-3.1). The QALY loss varied between 0.526 × 10-3 and 24.658 × 10-3, with a median of 6.03 × 10-3 (95%CI: 4.38-8.48 × 10-3). Based upon the final diagnoses, the highest QALY loss was 6.99 × 10-3 (95%CI: 5.29-13.7 × 10-3) for pneumonia, followed by bronchiolitis-5.96 × 10-3 (4.25-8.41 × 10-3) and bronchitis-4.92 × 10-3 (2.93-6.03 × 10-3); significant differences were observed only between bronchitis and pneumonia (p = 0.0171); the QALY loss was not age-dependent. Although an increasing tendency in the utility score was observed, a strong cumulative effect related to the length of stay was noted until day 13. CONCLUSIONS RSV contributes significantly to the utility deterioration and QALY loss in the case of RSV hospitalization, and the patient-reported data should be used in pharmacoeconomic assessments of the impact of RSV.
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Affiliation(s)
- August Wrotek
- Department of Pediatrics, Centre of Postgraduate Medical Education, 99/103 Marymoncka Str., 01-813 Warsaw, Poland;
- Department of Pediatrics, Bielanski Hospital, 80 Cegłowska Str., 01-809 Warsaw, Poland
| | - Oliwia Wrotek
- Student Research Group, Bielanski Hospital, 80 Cegłowska Str., 01-809 Warsaw, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, 99/103 Marymoncka Str., 01-813 Warsaw, Poland;
- Department of Pediatrics, Bielanski Hospital, 80 Cegłowska Str., 01-809 Warsaw, Poland
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Keary IP, Ravasio R, Fullarton JR, Manzoni P, Lanari M, Paes BA, Carbonell-Estrany X, Baraldi E, Tarride JÉ, Rodgers-Gray B. A new cost-utility analysis assessing risk factor-guided prophylaxis with palivizumab for the prevention of severe respiratory syncytial virus infection in Italian infants born at 29-35 weeks' gestational age. PLoS One 2023; 18:e0289828. [PMID: 37561741 PMCID: PMC10414677 DOI: 10.1371/journal.pone.0289828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
Since the last Italian cost-utility assessment of palivizumab in 2009, new data on the burden of respiratory syncytial virus (RSV) and an International Risk Scoring Tool (IRST) have become available. The objective of this study was to provide an up-to-date cost-utility assessment of palivizumab versus no prophylaxis for the prevention of severe RSV infection in otherwise healthy Italian infants born at 29-31 weeks' gestational age (wGA) infants and those 32-35wGA infants categorized as either moderate- or high-risk of RSV-hospitalization (RSVH) by the IRST. A decision tree was constructed in which infants received palivizumab or no prophylaxis and then could experience: i) RSVH; ii) emergency room medically-attended RSV-infection (MARI); or, iii) remain uninfected/non-medically attended. RSVH cases that required intensive care unit admission could die (0.43%). Respiratory morbidity was considered in all surviving infants up to 18 years of age. Hospitalization rates were derived from Italian data combined with efficacy from the IMpact-RSV trial. Palivizumab costs were calculated from vial prices (50mg: €490.37 100mg: €814.34) and Italian birth statistics combined with a growth algorithm. A lifetime horizon and healthcare and societal costs were included. The incremental cost-utility ratio (ICUR) was €14814 per quality-adjusted life year (QALY) gained in the whole population (mean: €15430; probability of ICUR being <€40000: 0.90). The equivalent ICURs were €15139 per QALY gained (€15915; 0.89) for 29-31wGA infants and €14719 per QALY gained (€15230; 0.89) for 32-35wGA infants. The model was most sensitive to rates of long-term sequelae, utility scores, palivizumab cost, and palivizumab efficacy. Palivizumab remained cost-effective in all scenario analyses, including a scenario wherein RSVH infants received palivizumab without a reduction in long-term sequelae and experienced a 6-year duration of respiratory morbidity (ICUR: €27948 per QALY gained). In conclusion, palivizumab remains cost-effective versus no prophylaxis in otherwise healthy Italian preterm infants born 29-35wGA. The IRST can help guide cost-effective use of palivizumab in 32-35wGA infants.
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Affiliation(s)
- Ian P. Keary
- Violicom Medical Limited, Aldermaston, Berkshire, United Kingdom
| | | | | | - Paolo Manzoni
- Department of Public Health and Pediatric Sciences, University of Torino School of Medicine, Turin, Piedmont, Italy
- Division of Paediatrics and Neonatology, Degli Infermi Hospital, Ponderano, Italy
| | - Marcello Lanari
- Paediatric Emergency Unit, IRCCS-Policlinico Ospedaliero-Universitario di Bologna, Bologna, Italy
| | - Bosco A. Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | | | - Eugenio Baraldi
- Department of Women’s and Children’s Health, University Hospital of Padova, Veneto, Italy
- Institute of Pediatric Research, "Città della Speranza", Padova, Veneto, Italy
| | - Jean-Éric Tarride
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
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Hariharan D, Kumar VSS, Glaser EL, Crown WH, Wolf ZA, Fisher KA, Wood CT, Malcolm WF, Nelson CB, Shepard DS. Quality of life burden on United States infants and caregivers due to lower respiratory tract infection and adjusting for selective testing: Pilot prospective observational study. Health Sci Rep 2023; 6:e1338. [PMID: 37334041 PMCID: PMC10273330 DOI: 10.1002/hsr2.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
Background and Aims Policymakers need data about the burden of respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) among infants. This study estimates quality of life (QoL) for otherwise healthy term US infants with RSV-LRTI and their caregivers, previously limited to premature and hospitalized infants, and corrects for selective testing. Methods The study enrolled infants <1 year with a clinically diagnosed LRTI encounter between January and May 2021. Using an established 0-100 scale, the 36 infants' and caregivers' QoL at enrollment and quality-adjusted life year losses per 1000 LRTI episodes (quality-adjusted life years [QALYs]/1000) were validated and analyzed. Regression analyses examined predictors of RSV-testing and RSV-positivity, creating modeled positives. Results Mean QoL at enrollment in outpatient (n = 11) LRTI-tested infants (66.4) was lower than that in not-tested LRTI infants (79.6, p = 0.096). For outpatient LRTI infants (n = 23), median QALYs/1000 losses were 9.8 and 0.25 for their caregivers. RSV-positive outpatient LRTI infants (n = 6) had significantly milder QALYs/1000 losses (7.0) than other LRTI-tested infants (n = 5)(21.8, p = 0.030). Visits earlier in the year were more likely to be RSV-positive than later visits (p = 0.023). Modeled RSV-positivity (51.9%) was lower than the observed rate (55.0%). Infants' and caregivers' QALYs/1000 loss were positively correlated (rho = 0.34, p = 0.046), indicating that infants perceived as sicker imposed greater burdens on caregivers. Conclusions The overall median QALYs/1000 losses for LRTI (9.0) and RSV-LRTI (5.6) in US infants are substantial, with additional losses for their caregivers (0.25 and 0.20, respectively). These losses extend equally to outpatient episodes. This study is the first reporting QALY losses for infants with LRTI born at term or presenting in nonhospitalized settings, and their caregivers.
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Affiliation(s)
- Dhwani Hariharan
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - V. S. Senthil Kumar
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - Elizabeth L Glaser
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | - William H. Crown
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
| | | | | | - Charles T. Wood
- Duke University School of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - William F. Malcolm
- Duke University School of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | | | - Donald S. Shepard
- Heller School for Social Policy and ManagementBrandeis UniversityWalthamMassachusettsUSA
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Trautmannsberger I, Bösl S, Tischer C, Kostenzer J, Mader S, Zimmermann LJI. ResQ Family: Respiratory Syncytial Virus (RSV) Infection in Infants and Quality of Life of Families-Study Protocol of a Multi-Country Family Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5917. [PMID: 37297526 PMCID: PMC10252710 DOI: 10.3390/ijerph20115917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/25/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
(1) Respiratory syncytial virus (RSV) infection in infants not only affects the child itself, but also their families. Nevertheless, information on the overall impact is scarce. A comprehensive caregiver-specific approach covering essential (health) dimensions and relevant stakeholders was initiated under the ResQ Family study conducted in Germany, France, Italy and Sweden. The primary objective is to investigate the health-related quality of life of parents and/or caregivers of children (<24 months) hospitalised for RSV. (2) Each participant completes an online questionnaire disseminated via social media and printed material in hospitals. Using the PedsQLTM FIM as well as further self-designed questions, parent and patient characteristics as well as potential stressors and preventive factors are recorded at baseline and after six weeks. Multivariate regression models with health-related quality of life as main outcome parameter will be conducted. (3) The study is currently in the recruitment process. A full analysis will be performed once the data collection phase is complete. First results are to be expected in late 2023. (4) Publishing the results in the form of scientific papers but also non-scientific (information) material will help us raise awareness for RSV and the importance of prevention among healthcare professionals, patient representatives and decision-makers.
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Affiliation(s)
| | - Sabina Bösl
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
| | - Christina Tischer
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
- Department of Health Security, Finnish Institute for Health and Welfare, FIN-70701 Kuopio, Finland
| | - Johanna Kostenzer
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
| | - Luc J. I. Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), 81379 Munich, Germany
- Department of Paediatrics, Research School for Oncology and Reproduction, Maastricht UMC+, 6229 ER Maastricht, The Netherlands
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Rodgers-Gray BS, Fullarton JR, Carbonell-Estrany X, Keary IP, Tarride JÉ, Paes BA. Impact of using the International Risk Scoring Tool on the cost-utility of palivizumab for preventing severe respiratory syncytial virus infection in Canadian moderate-to-late preterm infants. J Med Econ 2023; 26:630-643. [PMID: 37067826 DOI: 10.1080/13696998.2023.2202600] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND AND OBJECTIVE To assess the cost-utility of palivizumab versus no prophylaxis in preventing severe respiratory syncytial virus (RSV) infection in Canadian moderate-to-late preterm (32-35 weeks' gestational age) infants using an: i) International Risk Scoring Tool (IRST); ii) Canadian RST (CRST). METHODS A decision tree was developed to assess cost-utility. Infants assessed at moderate- and high-risk of RSV-related hospitalization (RSVH) by the IRST or CRST received palivizumab or no prophylaxis and then progressed to either: i) RSVH; ii) emergency room/outpatient medically attended RSV-infection (MARI); or, iii) were uninfected/non-medically attended. Infants admitted to intensive care could incur mortality (0.43%). Respiratory morbidity was accounted in all uninfected surviving infants for 6 years or 18 years (RSVH/MARI). Palivizumab efficacy (72.2% RSVH reduction) and hospital outcomes were from the Canadian CARESS, PICNIC and RSV-Quebec studies. Palivizumab costs (50mg: CAN$752; 100mg: $1,505) were calculated from Canadian birth statistics combined with a growth algorithm. Healthcare/payer and societal costs (May 2022; 1.5% discounting) were included. RESULTS Cost per quality-adjusted life year (QALY) was $29,789 with the IRST (0.79 probability of being <$50,000) and $15,833 with the CRST (0.96 probability). The model was most sensitive to utility scores, long-term sequelae, and palivizumab cost. Vial sharing improved the incremental cost-utility ratio (IRST: $22,319; CRST: $9,231). CONCLUSIONS Palivizumab was highly cost-effective (vs no prophylaxis) in Canadian moderate-to-late preterm infants using either the IRST or CRST. The IRST has fewer risk factors than the CRST (3 vs 7, respectively), captures more potential RSVHs (85% vs 54%) and provides another option to guide cost-effective RSV prophylaxis in Canada.
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Affiliation(s)
| | | | | | - Ian P Keary
- Violicom Medical Limited, Aldermaston, United Kingdom
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
| | - Bosco A Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Canada
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12
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Valencia-Ramos J, Ochoa Sangrador C, García M, Oyagüez P, Arnaez J. Impact of different nebulisation systems on patient comfort in bronchiolitis: a randomised controlled cross-over trial. Arch Dis Child 2022; 107:1122-1127. [PMID: 36162958 DOI: 10.1136/archdischild-2021-323161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To test the hypothesis that greater comfort is achieved using a nebuliser integrated into a high-flow nasal cannula (nebulisation system integrated in high-flow nasal cannula (NHF)) than using a jet nebuliser (JN), and to explore differences in analgesia requirement and the possibility of feeding during nebulisation. DESIGN Randomised cross-over trial. SETTING Paediatric intensive care unit. PATIENTS Children aged <24 months diagnosed with bronchiolitis between November 2016 and May 2017. INTERVENTIONS Nebulisations using NHF and JN. MAIN OUTCOME MEASURES COMFORT-Behaviour Scale (CBS) and Numerical Rating Comfort Scale (NRSc) were used to measure comfort, and Numerical Rating Satisfaction Scale (NRSs) was used to assess satisfaction before, during and after nebulisation. Other variables included feeding, analgesia, need for being held and respiratory and heart rates. RESULTS Thirty-three children with 233 nebulisations were included in the study. The median age was 3.0 (IQR 2-9) months. Comfort and satisfaction were greater with NHF than with JN. The median staff-recorded CBS, NRSc and NRSs scores for NHF versus JN were 13 (IQR 9-15) vs 17 (IQR 13-23), 8 (IQR 7-0) vs 7 (IQR 4-8), and 4 (IQR 3-4) vs 2 (IQR 2-3), respectively; and caregiver-recorded scores were 12 (IQR 10-15) vs 19 (IQR 13-24), 9 (IQR 7-10) vs 4 (IQR 1-6), and 4 (IQR 3-4) vs 2 (IQR 1-3), respectively (p<0.001). Children who received NHF had lower cardiac and respiratory rates, needed to be held less often during therapy and required less analgesia (p<0.001). CONCLUSION Nebulisation through NHF appears to be a better alternative to JN in terms of comfort and satisfaction as well as making feeding possible during nebulisation.
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Affiliation(s)
- Juan Valencia-Ramos
- Paediatric Intensive Care Unit, Complejo Asistencial Universitario de Burgos, Burgos, Spain .,Ciencias de la Salud, University of Burgos, Burgos, Spain
| | | | - María García
- Paediatric Intensive Care Unit, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Pablo Oyagüez
- Paediatric Intensive Care Unit, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Juan Arnaez
- Neonatology, Complejo Asistencial Universitario de Burgos, Burgos, Spain.,Fundación NeNe, Burgos, Spain
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13
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Simões EAF. The Burden of Respiratory Syncytial Virus Lower Respiratory Tract Disease in Infants in the United States: A Synthesis. J Infect Dis 2022; 226:S143-S147. [PMID: 35968867 PMCID: PMC9377025 DOI: 10.1093/infdis/jiac211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eric A F Simões
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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14
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Glaser EL, Hariharan D, Bowser DM, Gervasio RM, Rowlands KR, Buckley L, Nelson CB, Shepard DS. OUP accepted manuscript. J Infect Dis 2022; 226:S236-S245. [PMID: 35968873 PMCID: PMC9377042 DOI: 10.1093/infdis/jiac183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background Respiratory syncytial virus (RSV), a leading cause of lower respiratory tract infection in US children, reduces quality of life (QOL) of children, their caregivers, and families. Methods We conducted a systematic literature review in PubMed, EconLit, and other databases in the United States of articles published since 2000, derived utility lost per RSV episode from cohort studies, and performed a systematic analysis. Results From 2262 unique citations, 35 received full-text review and 7 met the inclusion criteria (2 cohort studies, 4 modeling studies, and 1 synthesis). Pooled data from the 2 cohort studies (both containing only hospitalized premature infants) gave quality-adjusted life-year (QALY) losses per episode of 0.0173 at day 38. From the cohort study that also assessed caregivers' QOL, we calculated net QALYs lost directly attributable to RSV per nonfatal episode from onset to 60 days after onset for the child, caregiver, child-and-caregiver dyad of 0.0169 (167% over prematurity alone), 0.0031, and 0.0200, respectively. Conclusion Published data on QOL of children in the United States with RSV are scarce and consider only premature hospitalized infants, whereas most RSV episodes occur in children who were born at term and were otherwise healthy. QOL studies are needed beyond hospitalized premature infants.
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Affiliation(s)
- Elizabeth L Glaser
- Correspondence: E. L. Glaser, PhD, RN, The Heller School for Social Policy and Management (c/o Donald S. Shepard, PhD), Brandeis University, 415 South Street, MS 035 Waltham, MA 02453 ()
| | - Dhwani Hariharan
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Diana M Bowser
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Raíssa M Gervasio
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Katharine R Rowlands
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Lauren Buckley
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | | | - Donald S Shepard
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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15
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Butel T, Angoulvant F, Filipovic-Pierucci A, Milcent K, Teglas JP, Bellêttre X, Claudet I, Gras-le Guen C, de Pontual L, Minodier P, Dubos F, Brouard J, Soussan-Banini V, Degas-Bussiere V, Gatin A, Schweitzer C, Epaud R, Ryckewaert A, Cros P, Marot Y, Flahaut P, Saunier P, Babe P, Patteau G, Delebarre M, Titomanlio L, Vrignaud B, Trieu TV, Tahir A, Regnard D, Micheau P, Charara O, Henry S, Ploin D, Panjo H, Vabret A, Bouyer J, Durand-Zaleski I, Gajdos V. Clinical course and cost assessment of infants with a first episode of acute bronchiolitis presenting to the emergency department: Data from the GUERANDE clinical trial. Pediatr Pulmonol 2021; 56:3802-3812. [PMID: 34516722 DOI: 10.1002/ppul.25621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Bronchiolitis is the leading cause of hospitalization for infants but its economic burden is not well documented. Our objective was to describe the clinical evolution and to assess the 1-month cost of a first episode of acute bronchiolitis presenting to the emergency department (ED). METHODS Our study was an epidemiologic analysis and a cost study of the cohort drawn from the clinical trial GUERANDE, conducted in 24 French pediatric EDs. Infants of 6 weeks to 12 months of age presenting at pediatric EDs with a first episode of bronchiolitis were eligible. The costs considered were collected from a societal viewpoint, according to the recommendations of the French National Health Authority. RESULTS A total of 777 infants were included with a median age of 4 months. A total of 57% were hospitalized during the month following the first consultation in the ED, including 28 (3.6%) in an intensive care unit. The mean length of stay was 4.2 days (SD = 3.7). The average time to relief of all symptoms was 13 days (SD = 7). Average total cost per patient was €1919 (95% confidence interval: 1756-2138) from a societal perspective, mostly due to hospitalization cost. The estimated annual cost of bronchiolitis in infants was evaluated to be between €160 and €273 million in France. DISCUSSION Bronchiolitis represent a high cost for the health care system and broadly for society, with hospitalizations costs being the main cost driver. Thus significant investments should be made to develop innovative therapies, to reduce the number of hospitalizations and length of stay.
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Affiliation(s)
- Thibault Butel
- The Clinical Research Unit of Health Economics, APHP, Paris, France
| | - François Angoulvant
- Department of Pediatric Emergency, The Necker-Enfants Malades University Hospital, APHP, Paris, France
| | | | - Karen Milcent
- Department of Pediatric Emergency, Antoine Béclère University Hospital, APHP, Clamart, France.,CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France
| | - Jean-Paul Teglas
- CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France
| | - Xavier Bellêttre
- Department of Pediatric Emergency, Robert Debré University Hospital, APHP, Paris, France
| | - Isabelle Claudet
- Department of Pediatric Emergency, Toulouse University Hospital, Toulouse, France
| | | | - Loïc de Pontual
- Department of Pediatric Emergency, Jean Verdier University Hospital, APHP, Bondy, France
| | - Philippe Minodier
- Department of Pediatric Emergency, Marseille Nord University Hospital, APHM, Marseille, France
| | - François Dubos
- Department of Pediatric Emergency, Lille University Hospital, Lille, France
| | - Jacques Brouard
- Department of Pediatric Emergency, Caen University Hospital, Caen, France
| | - Valérie Soussan-Banini
- Department of Pediatric Emergency, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | | | - Amélie Gatin
- Department of Pediatric Emergency, Nancy University Hospital, Nancy, France
| | - Cyril Schweitzer
- Department of Pediatric Emergency, Nancy University Hospital, Nancy, France
| | - Ralph Epaud
- Department of Pediatric Emergency, Creteil Intercommunal Hospital, Creteil, France
| | - Amélie Ryckewaert
- Department of Pediatric Emergency, Rennes University Hospital, Rennes, France
| | - Pierrick Cros
- Department of Pediatric Emergency, Brest University Hospital, Brest, France
| | - Yves Marot
- Department of Pediatric Emergency, Tours University Hospital, Tours, France
| | - Philippe Flahaut
- Department of Pediatric Emergency, Rouen University Hospital, Rouen, France
| | - Pascal Saunier
- Department of Pediatric Emergency, Fontainebleau Hospital, Fontainebleau, France
| | - Philippe Babe
- Pediatric Emergency Department, Lenval University Hospital, Nice, France
| | - Géraldine Patteau
- Department of Pediatric Emergency, The Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Mathilde Delebarre
- Department of Pediatric Emergency, Lille University Hospital, Lille, France
| | - Luigi Titomanlio
- Department of Pediatric Emergency, Robert Debré University Hospital, APHP, Paris, France
| | - Bénédicte Vrignaud
- Department of Pediatric Emergency, Nantes University Hospital, Nantes, France
| | - Thanh-Van Trieu
- Department of Pediatric Emergency, Jean Verdier University Hospital, APHP, Bondy, France
| | - Abdelilah Tahir
- Department of Pediatric Emergency, Limoges University Hospital, Limoges, France
| | - Delphine Regnard
- Department of Pediatric Emergency, Bicêtre University Hospital, APHP, Kremlin-Bicêtre, France
| | - Pascale Micheau
- Department of Pediatric Emergency, Toulouse University Hospital, Toulouse, France
| | - Oussama Charara
- Department of Pediatric Emergency, André Mignot Hospital, Le Chesnay, France
| | - Simon Henry
- Department of Pediatric Emergency, Laennec Hospital, Quimper, France
| | - Dominique Ploin
- Department of Pediatric Emergency, Mother Child University Hospital, HCL, Bron, France
| | - Henri Panjo
- CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France
| | - Astrid Vabret
- Department of Pediatric Emergency, Caen University Hospital, Caen, France
| | - Jean Bouyer
- CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France
| | | | - Vincent Gajdos
- Department of Pediatric Emergency, Antoine Béclère University Hospital, APHP, Clamart, France.,CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France
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16
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Cahal M, Amirav I, Diamant N, Be'er M, Besor O, Lavie M. Real-time effects of COVID-19 pandemic lockdown on pediatric respiratory patients. Pediatr Pulmonol 2021; 56:1401-1408. [PMID: 33729709 PMCID: PMC8250588 DOI: 10.1002/ppul.25310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/06/2021] [Accepted: 01/30/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A national lockdown was implemented in Israel to slow the viral spread of COVID-19. We assessed the real-time effects of the lockdown on disease expression and lifestyle modifications in pediatric patients with chronic respiratory disorders. METHODS An anonymous electronic questionnaire was distributed during lockdown (March-May 2020) to caregivers of patients with chronic respiratory disorders. The primary outcome was change in disease expression and the secondary outcomes were changes in lifestyle and caregivers' emotional status. RESULTS The clinical status of one-third of the 445 participating patients (age 0-18 years) reportedly improved, including decreased respiratory symptoms (n = 133, 33%), exacerbation frequency (n = 147, 35%), and use of reliever medications (n = 101, 27.4%). The condition of ~10% of the patients worsened. Clinical improvement was noted mostly in young patients <5 years (p = .001), asthmatic patients (p = .033), and patients with multiple underlying respiratory disorders (p = .015). Patients whose condition significantly worsened were more likely to be >5 years (p < .001), had increased screen time, decreased physical activity, and shorter sleep duration compared to their younger counterparts (p = .008, <.001, and .001, respectively). Caregivers' reports (n = 236 [58%]) of their own anxiety levels and perceptions of the patients' elevated health risk were increased, regardless of the children's actual clinical status. CONCLUSION COVID-19 lockdown was associated with clinical improvement/stability for most of the surveyed children; however, their caregivers' anxiety level was heightened. An increased sedentary lifestyle was reported mostly in older children.
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Affiliation(s)
- Michal Cahal
- Pediatric Pulmonology Unit, Dana‐Dwek Children's Hospital, Tel‐Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Israel Amirav
- Pediatric Pulmonology Unit, Dana‐Dwek Children's Hospital, Tel‐Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Nir Diamant
- Pediatric Pulmonology Unit, Dana‐Dwek Children's Hospital, Tel‐Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Moria Be'er
- Pediatric Pulmonology Unit, Dana‐Dwek Children's Hospital, Tel‐Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Omri Besor
- Pediatric Pulmonology Unit, Dana‐Dwek Children's Hospital, Tel‐Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Moran Lavie
- Pediatric Pulmonology Unit, Dana‐Dwek Children's Hospital, Tel‐Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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17
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Young M, Smitherman L. Socioeconomic Impact of RSV Hospitalization. Infect Dis Ther 2021; 10:35-45. [PMID: 33656651 PMCID: PMC7926081 DOI: 10.1007/s40121-020-00390-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022] Open
Abstract
Respiratory syncytial virus (RSV) disease is a significant cause of morbidity and socioeconomic burden worldwide among young children. The majority of RSV-associated lower respiratory tract infections (LRTI) and mortality occurs in developing countries and is associated with various sociodemographic risk factors. Independent risk factors for severe RSV disease include age and premature birth. While RSV mortality in developed countries is lower relative to developing countries, high-risk infants with comorbidities experience higher rates of mortality. RSV LRTI is often severe and is associated with hospitalization, increased need for intensive care unit admission and mechanical ventilation, long-term complications, and caregiver stress and loss of work productivity. Overall, these factors translate to higher health care resource utilization and costs and should be factored into the consideration for RSV prophylaxis. Multiple vaccine candidates and long-acting monoclonal antibodies are in various stages of clinical development. Currently, palivizumab is the only approved RSV immunoprophylaxis available for use in specific high-risk pediatric populations. This review will discuss the socioeconomic impact and health care resource utilization of RSV-related hospitalization (RSVH) as well as various sociodemographic risk factors that can be used to identify children at high risk of developing severe RSV disease.
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Affiliation(s)
- Michal Young
- Department of Pediatrics and Child Health, Howard University Hospital, Washington, DC, USA.
| | - Lynn Smitherman
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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18
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Staebler S, Blake S. Respiratory Syncytial Virus Disease: Immunoprophylaxis Policy Review and Public Health Concerns in Preterm and Young Infants. Policy Polit Nurs Pract 2021; 22:41-50. [PMID: 33050785 PMCID: PMC7802052 DOI: 10.1177/1527154420965543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Globally, respiratory syncytial virus (RSV) is a leading cause of hospitalization due to severe respiratory infections in infants of all gestational ages and children aged 5 years and younger, and it is associated with a substantial health care burden. Approximately, 1% to 3% of infants younger than 1 year are hospitalized with severe RSV disease in the United States. With no specific treatment or vaccine, palivizumab is the only licensed immunoprophylaxis for the prevention of severe RSV disease in high-risk pediatric populations, including infants born at or before 35 weeks' gestational age (wGA). In the United States, the American Academy of Pediatrics (AAP) periodically publishes its recommendation for the use of RSV immunoprophylaxis, which is largely followed by health care professionals and payers. In 2014, the AAP Committee on Infectious Diseases stopped recommending RSV immunoprophylaxis for otherwise healthy infants born at or after 29 wGA and stated that the RSV hospitalization rates in infants 29 to 34 wGA and full-term infants were similar. Several studies have demonstrated that a significant decline in palivizumab use following the AAP 2014 recommendations was accompanied by increases in rates of RSV hospitalization and disease severity and hospital costs in infants 29 to 34 wGA versus full-term infants. Despite the growing evidence demonstrating high RSV morbidity in infants 29 to 34 wGA, the AAP reaffirmed its 2014 policy in 2019. This article will discuss the critical roles and strategies of advocacy groups and nurses in providing the maximum protection with RSV immunoprophylaxis to all high-risk and label-eligible preterm infants.
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Affiliation(s)
- Suzanne Staebler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - Stephanie Blake
- Department of Pediatrics, Division of Neonatology, Duke University Medical Center, Durham, North Carolina, United States
- School of Nursing, Duke University, Durham, North Carolina, United States
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19
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Campbell A, Hartling L, Louie-Poon S, Scott SD. Parent Experiences Caring for a Child With Bronchiolitis: A Qualitative Study. J Patient Exp 2021; 7:1362-1368. [PMID: 33457588 PMCID: PMC7786786 DOI: 10.1177/2374373520924526] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Bronchiolitis is an acute lower respiratory infection, with significant impacts on children and families and strains on the health care system. Understanding parents’ experiences and information needs caring for a child with bronchiolitis is crucial to highlight misconceptions or issues contributing to the high burden. The objective of this qualitative study was to describe parents’ experiences caring for a child with bronchiolitis. Methods: Qualitative description guided this study. Participants were recruited from the Stollery Children’s Hospital emergency department (ED), a specialized pediatric ED in a major Canadian urban center. Semi-structured interviews were conducted with 15 parents. Results: Five major themes were identified: (a) their children’s symptoms and behaviors, (b) bronchiolitis affects the entire family, (c) factors influencing parent’s decision to go to ED, (d) ED experience for parents and their children, and (e) bronchiolitis treatment and management. Interviews revealed bronchiolitis has significant effects on both children and families and parents are generally unaware of bronchiolitis symptoms, treatment, and management. Conclusions: Our study highlights that parents have knowledge deficits when it comes to recognizing the presence and severity of bronchiolitis symptoms. Parents would benefit from having more evidence-based resources to enhance their knowledge about the nature of bronchiolitis.
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Affiliation(s)
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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20
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A Survey of Parental Knowledge of Respiratory Syncytial Virus and Other Respiratory Infections in Preterm Infants. Neonatal Netw 2021; 40:14-24. [PMID: 33479007 DOI: 10.1891/0730-0832/11-t-693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Evaluate parental knowledge of respiratory syncytial virus (RSV) and other respiratory infections in preterm infants. DESIGN Survey. SAMPLE Five hundred and eighty-three parents of preterm infants with generalized, Canadian provincial representation. MAIN OUTCOME Knowledge of RSV infection, sources of information, and parental understanding of disease risk. RESULTS 97.9 percent (571/583) of the parents had heard about RSV, since they all had a preterm infant. Sixty-one percent reported having good knowledge of RSV; 19.4 percent had very good knowledge; 19.7 percent had little or no awareness of RSV-related infection. Most (86.3 percent) believed that RSV illness was a very serious condition; 13 percent recognized that it could be a major problem for their child. Principal sources of information were the nurse, doctor and pamphlets. Over 480 participants cited 3 or more sources of additional information-Internet, social media platforms, and educational sessions. Respiratory syncytial virus prophylaxis was a priority, but knowledge regarding the eligibility criteria for prophylaxis is essential.
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21
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Carbonell-Estrany X, Rodgers-Gray BS, Paes B. Challenges in the prevention or treatment of RSV with emerging new agents in children from low- and middle-income countries. Expert Rev Anti Infect Ther 2020; 19:419-441. [PMID: 32972198 DOI: 10.1080/14787210.2021.1828866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes approximately 120,000 deaths annually in children <5 years, with 99% of fatalities occurring in low- and middle-income countries (LMICs). AREAS COVERED There are numerous RSV interventions in development, including long-acting monoclonal antibodies, vaccines (maternal and child) and treatments which are expected to become available soon. We reviewed the key challenges and issues that need to be addressed to maximize the impact of these interventions in LMICs. The epidemiology of RSV in LMICs was reviewed (PubMed search to 30 June 2020 inclusive) and the need for more and better-quality data, encompassing hospital admissions, community contacts, and longer-term respiratory morbidity, emphasized. The requirement for an agreed clinical definition of RSV lower respiratory tract infection was proposed. The pros and cons of the new RSV interventions are reviewed from the perspective of LMICs. EXPERT OPINION We believe that a vaccine (or combination of vaccines, if practicable) is the only viable solution to the burden of RSV in LMICs. A coordinated program, analogous to that with polio, involving governments, non-governmental organizations, the World Health Organization, the manufacturers and the healthcare community is required to realize the full potential of vaccine(s) and end the devastation of RSV in LMICs.
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Affiliation(s)
- Xavier Carbonell-Estrany
- Neonatology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain
| | | | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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22
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Schroeder AR, Destino LA, Ip W, Vukin E, Brooks R, Stoddard G, Coon ER. Day of Illness and Outcomes in Bronchiolitis Hospitalizations. Pediatrics 2020; 146:peds.2020-1537. [PMID: 33093138 DOI: 10.1542/peds.2020-1537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bronchiolitis is often described to follow an expected clinical trajectory, with a peak in severity between days 3 and 5. This predicted trajectory may influence anticipatory guidance and clinical decision-making. We aimed to determine the association between day of illness at admission and outcomes, including hospital length of stay, receipt of positive-pressure ventilation, and total cough duration. METHODS We compiled data from 2 multicenter prospective studies involving bronchiolitis hospitalizations in patients <2 years. Patients were excluded for complex conditions. We assessed total cough duration via weekly postdischarge phone calls. We used mixed-effects multivariable regression models to test associations between day of illness and outcomes, with adjustment for age, sex, insurance (government versus nongovernment), race, and ethnicity. RESULTS The median (interquartile range) day of illness at admission for 746 patients was 4 (2-5) days. Day of illness at admission was not associated with length of stay (coefficient 0.01 days, 95% confidence interval [CI]: -0.05 to 0.08 days), positive-pressure ventilation (adjusted odds ratio: 1.0, 95% CI: 0.9 to 1.1), or total cough duration (coefficient 0.33 days, 95% CI: -0.01 to 0.67 days). Additionally, there was no significant difference in day of illness at discharge in readmitted versus nonreadmitted patients (5.9 vs 6.4 days, P = .54). The median cough duration postdischarge was 6 days, with 65 (14.3%) patients experiencing cough for 14+ days. CONCLUSIONS We found no associations between day of illness at admission and outcomes in bronchiolitis hospitalizations. Practitioners should exercise caution when making clinical decisions or providing anticipatory guidance based on symptom duration.
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Affiliation(s)
- Alan R Schroeder
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California;
| | - Lauren A Destino
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Wui Ip
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Elizabeth Vukin
- Department of Pediatrics, Primary Children's Hospital and School of Medicine, University of Utah, Salt Lake City, Utah
| | - Rona Brooks
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California.,Department of Pediatrics, John Muir Health, Walnut Creek, California; and
| | - Greg Stoddard
- Division of Biostatistics, Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Eric R Coon
- Department of Pediatrics, Primary Children's Hospital and School of Medicine, University of Utah, Salt Lake City, Utah
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Yasin F, Afridi ZS, Mahmood Q, Khan AA, Condon S, Khan RA. Role of nebulized epinephrine in moderate bronchiolitis: a quasi-randomized trial. Ir J Med Sci 2020; 190:239-242. [PMID: 32651768 DOI: 10.1007/s11845-020-02293-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Bronchiolitis is the most common lower respiratory illness that characteristically affects the children below 2 years of age accounting about 2-3% of patients admitted to hospital each year [1-4]. We compared the effect of racemic epinephrine (RE) and 3% hypertonic saline (HS) nebulization on the length of stay (LOS) in the hospital. METHODS We looked at the infants with moderate bronchiolitis, from October 2013 to March 2014. Out of eighty cases, 16 in HS and 18 in RE groups were enrolled. At the time of admission, 0.2 ml of RE added to 1.8 ml of distilled water was nebulized to RE group, as compared with 2 ml of 3% HS in nebulized form. RE was re-administered if needed on 6 h in comparison with 3% HS at the frequency of 1 to 4 h. RESULTS One infant from RE group and three infants from HS group were excluded due to progression towards severe bronchiolitis. The LOS in RE group ranged between 18 and 160 h (mean 45 h), while in HS group, LOS was 18.50-206 h (mean 74.3 h). The LOS was significantly short in RE group (p value 0.015) which was statistically significant. CONCLUSION Racemic epinephrine nebulization as first-line medication may significantly reduce the length of hospital stay in infants with moderate bronchiolitis in comparison with nebulized HS.
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Affiliation(s)
- Faiza Yasin
- Department of Paediatric Medicine, University Hospital Kerry, Tralee, Ireland.
| | - Zahir Shah Afridi
- Department of Paediatric Medicine, University Hospital Kerry, Tralee, Ireland
| | - Qasim Mahmood
- Department of Paediatric Medicine, University Hospital Kerry, Tralee, Ireland
| | - Akhter Ali Khan
- Department of Paediatric Medicine, University Hospital Kerry, Tralee, Ireland
| | - Sharon Condon
- Department of Paediatric Medicine, University Hospital Kerry, Tralee, Ireland
| | - Rizwan Ahmed Khan
- Department of Paediatric Medicine, University Hospital Kerry, Tralee, Ireland
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Campbell A, Hartling L, Louie-Poon S, Scott SD. Parents' information needs and preferences related to bronchiolitis: a qualitative study. CMAJ Open 2019; 7:E640-E645. [PMID: 31690651 PMCID: PMC6944130 DOI: 10.9778/cmajo.20190092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bronchiolitis affects more than one-third of children less than age 2 years and can cause substantial anxiety for parents, leading them to seek information on how to care for their sick child. The aim of our qualitative study was to explore the information needs and preferences of parents caring for a child with bronchiolitis. METHODS We used a qualitative descriptive approach. Participants were recruited by means of purposive sampling from Oct. 1, 2017, to Mar. 15, 2018 from the Stollery Children's Hospital emergency department, a specialized pediatric emergency department in Edmonton. Individual semistructured interviews were conducted. RESULTS Fifty-three parents were recruited to participate, of whom 30 could not be reached after 4 contact attempts and 8 refused. Thus, 15 parents participated (16 children). Three major themes were identified: 1) parents' information needs about bronchiolitis, 2) parents' preferred information sources and 3) parents' preferred information delivery formats. Participants indicated that they want and require credible, easy-to-understand information about bronchiolitis in a variety of formats, and especially valued information obtained directly from a health care professional or an evidence-based website. INTERPRETATION This study provides important information about parents' information needs concerning bronchiolitis in children. Identifying the information that parents want and value in relation to acute pediatric illnesses is imperative to developing innovative educational approaches for parents that reflect patient-centred care.
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Affiliation(s)
- Alyson Campbell
- Evidence in Child Health to Advance Outcomes (Campbell, Louie-Poon, Scott), Faculty of Nursing, University of Alberta; Alberta Research Centre for Health Evidence (Hartling), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - Lisa Hartling
- Evidence in Child Health to Advance Outcomes (Campbell, Louie-Poon, Scott), Faculty of Nursing, University of Alberta; Alberta Research Centre for Health Evidence (Hartling), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - Samantha Louie-Poon
- Evidence in Child Health to Advance Outcomes (Campbell, Louie-Poon, Scott), Faculty of Nursing, University of Alberta; Alberta Research Centre for Health Evidence (Hartling), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - Shannon D Scott
- Evidence in Child Health to Advance Outcomes (Campbell, Louie-Poon, Scott), Faculty of Nursing, University of Alberta; Alberta Research Centre for Health Evidence (Hartling), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.
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Auger KA, Shah SS, Huang B, Brady PW, Weinberg SH, Reamer E, Tanager KS, Zahn K, Davis MM. Discharge Medical Complexity, Change in Medical Complexity and Pediatric 30-day Readmission. J Hosp Med 2019; 14:474-481. [PMID: 31386613 PMCID: PMC6686738 DOI: 10.12788/jhm.3222] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/04/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND While medical complexity is associated with pediatric readmission risk, less is known about how increases in medical complexity during hospitalization affect readmission risk. METHODS We conducted a five-year retrospective, case-control study of pediatric hospitalizations at a tertiary care children's hospital. Cases with a 30-day unplanned readmission were matched to controls based on admission seasonality and distance from the hospital. Complexity variables included the number of medications prescribed at discharge, medical technology, and the need for home healthcare services. Change in medical complexity variables included new complex chronic conditions and new medical technology. We estimated odds of 30-day unplanned readmission using adjusted conditional logistic regression. RESULTS Of 41,422 eligible index hospitalizations, we included 595 case and 595 control hospitalizations. Complexity: Polypharmacy after discharge was common. In adjusted analyses, being discharged with ≥2 medications was associated with higher odds of readmission compared with being discharged without medication; children with ≥5 discharge medications had a greater than four-fold higher odds of readmission. Children assisted by technology had higher odds of readmission compared with children without technology assistance. Change in complexity: New diagnosis of a complex chronic condition (Adjusted Odds Ratio (AOR) = 1.75; 1.11-2.75) and new technology (AOR = 1.84; 1.09-3.10) were associated with higher risk of readmission when adjusting for patient characteristics. However, these associations were not statistically significant when adjusting for length of stay. CONCLUSION Polypharmacy and use of technology at discharge pose a substantial readmission risk for children. However, added technology and new complex chronic conditions do not increase risk when accounting for length of stay.
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Affiliation(s)
- Katherine A Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Healthcare Improvement, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Katherine A Auger, MD, MSc; E-mail: Katherine. ; Telephone: 513-636-0409; Twitter: @KathyAugerpeds
| | - Samir S Shah
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Healthcare Improvement, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Bin Huang
- University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick W Brady
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Healthcare Improvement, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Steven H Weinberg
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Elyse Reamer
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio
| | - Kevin S Tanager
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois
| | - Katelin Zahn
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Matthew M Davis
- Departments of Pediatrics, Medicine, Medical Social Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Academic General Pediatrics and Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children’s Research Institute, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
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Pokrzywinski RM, Swett LL, Pannaraj PS, Yi J, Pavilack MS, Kumar VR, McLaurin KK. Impact of Respiratory Syncytial Virus-Confirmed Hospitalizations on Caregivers of US Preterm Infants. Clin Pediatr (Phila) 2019; 58:837-850. [PMID: 31007050 PMCID: PMC6552118 DOI: 10.1177/0009922819843639] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed the impact of respiratory syncytial virus-confirmed hospitalizations (RSVH) on caregivers of high-risk preterm infants. Caregivers for infants born at 29 to 35 weeks' gestational age and hospitalized for confirmed RSV disease responded to measures of self-rated and perceived infant stress (1-7; 7 = very stressful), perceived infant health (0-100; 100 = best imaginable health), and productivity impairment. Data were collected at hospital discharge through 1 month post-discharge. Caregiver responses indicated high stress levels, poor health, and productivity loss were reported at discharge; however, steady improvements were seen through 1 month post-discharge: caregiver-rated stress (from 6 to 2), infant stress (5 to 1), caregiver-perceived infant health (64 to 84), and productivity loss (mothers: 91% to 31%; fathers: 81% to 18%). Qualitative results indicated emotional impact, family routine disruption, financial concerns, and medical concerns persisted at 1 month post-discharge. This study found the caregiver burden of RSVH persists at least 1 month beyond discharge.
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Affiliation(s)
| | | | - Pia S. Pannaraj
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
- University of Southern California, Los Angeles, CA, USA
| | - Jumi Yi
- Emory University School of Medicine, Atlanta, GA, USA
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Gates M, Shulhan-Kilroy J, Featherstone R, MacGregor T, Scott SD, Hartling L. Parent experiences and information needs related to bronchiolitis: A mixed studies systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:864-878. [PMID: 30573297 DOI: 10.1016/j.pec.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To inform evidence-based knowledge products (i.e., infographics, videos, eBooks) of relevance to parents, we systematically reviewed evidence on parent experiences and information needs related to bronchiolitis. METHODS We searched Medline, CINAHL, PsycINFO, and ProQuest Dissertations & Theses Global, and scanned reference lists for studies published post-2000. We appraised quality in duplicate using the Mixed Methods Appraisal Tool (MMAT) and synthesized findings narratively. RESULTS We retrieved 797 records and included 29; 14 (48%) met >50% of MMAT criteria. Studies predominantly enrolled mothers. Most reported quantitatively on hospitalization experiences (n = 9, 31%), treatments (n = 5, 17%), or respiratory syncytial virus (RSV) prophylaxis (n = 9, 31%). Ten (34%) studies reported on information needs; 3 contributed qualitative data. Parents could not always identify bronchiolitis symptoms. During hospitalization, parents endured guilt and anxiety. Mothers wanted to take an active role in their child's care but often felt uninvolved. Barriers to RSV prophylaxis included transportation, scheduling, and insurance issues. CONCLUSIONS Evidence focused primarily on hospitalization, which parents found frightening. More information is needed on home care experiences and information preferences. PRACTICE IMPLICATIONS Timely education and support from healthcare providers may help to alleviate parents' fears and enhance involvement in their child's care.
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Affiliation(s)
- Michelle Gates
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Jocelyn Shulhan-Kilroy
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Tara MacGregor
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Shannon D Scott
- Evidence in Child Health to Advance Outcomes (ECHO), Faculty of Nursing, University of Alberta, Canada.
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
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Paes B, Carbonell-Estrany X. Respiratory syncytial virus prophylaxis for children with chronic lung disease: have we got the criteria right? Expert Rev Anti Infect Ther 2019; 17:211-222. [DOI: 10.1080/14787210.2019.1581062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suner (IDIBAPS), Barcelona, Spain
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Ginsberg GM, Somekh E, Schlesinger Y. Should we use Palivizumab immunoprophylaxis for infants against respiratory syncytial virus? - a cost-utility analysis. Isr J Health Policy Res 2018; 7:63. [PMID: 30554570 PMCID: PMC6296113 DOI: 10.1186/s13584-018-0258-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/18/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Passive immunization against RSV (Respiratory Syncytial Virus) is given in most western countries (including Israel) to infants of high risk groups such as premature babies, and infants with Congenital Heart Disease or Congenital Lung Disease. However, immunoprophylaxis costs are extremely high ($2800-$4200 per infant). Using cost-utility analysis criteria, we evaluate whether it is justified to expand, continue or restrict nationwide immunoprophylaxis using palivizumab of high risk infants against RSV. METHODS Epidemiological, demographic, health service utilisation and economic data were integrated from primary (National Hospitalization Data, etc.) and secondary data sources (ie: from published articles) into a spread-sheet to calculate the cost per averted disability-adjusted life year (DALY) of vaccinating various infant risk groups. Costs of intervention included antibody plus administration costs. Treatment savings and DALYs averted were estimated from applying vaccine efficacy data to relative risks of being hospitalised and treated for RSV, including possible long-term sequelae like asthma and wheezing. RESULTS For all the groups RSV immunoprophylaxis is clearly not cost effective as its cost per averted DALY exceeds the $105,986 guideline representing thrice the per capita Gross Domestic Product. Vaccine price would have to fall by 48.1% in order to justify vaccinating Congenital Heart Disease or Congenital Lung Disease risk groups respectively on pure cost-effectiveness grounds. For premature babies of < 29 weeks, 29-32 and 33-36 weeks gestation, decreases of 36.8%, 54.5% and 83.3% respectively in vaccine price are required. CONCLUSIONS Based solely on cost-utility analysis, at current price levels it is difficult to justify the current indications for passive vaccination with Palivizumab against RSV. However, if the manufacturers would reduce the price by 54.5% then it would be cost-effective to vaccinate the Congenital Heart Disease or Congenital Lung Disease risk groups as well as premature babies born before the 33rd week of gestation.
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Affiliation(s)
- Gary M. Ginsberg
- Department of Technology Assessment, Public Health Service, Ministry of Health, Jerusalem, Israel
| | - Eli Somekh
- Department of Pediatrics, Wolfson Hospital, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany
| | - Yechiel Schlesinger
- Department of Pediatrics, Shaarae Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Solan LG, Beck AF, Shardo SA, Sauers-Ford HS, Simmons JM, Shah SS, Sherman SN. Caregiver Perspectives on Communication During Hospitalization at an Academic Pediatric Institution: A Qualitative Study. J Hosp Med 2018; 13:304-310. [PMID: 29345256 DOI: 10.12788/jhm.2919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/11/2017] [Accepted: 08/18/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Communication among those involved in a child's care during hospitalization can mitigate or exacerbate family stress and confusion. As part of a broader qualitative study, we present an in-depth understanding of communication issues experienced by families during their child's hospitalization and during the transition to home. METHODS Focus groups and individual interviews stratified by socioeconomic status included caregivers of children recently discharged from a children's hospital after acute illnesses. An open-ended, semistructured question guide designed by investigators included communication-related questions addressing information shared with families from the medical team about discharge, diagnoses, instructions, and care plans. By using an inductive thematic analysis, 4 investigators coded transcripts and resolved differences through consensus. RESULTS A total of 61 caregivers across 11 focus groups and 4 individual interviews participated. Participants were 87% female and 46% non-white. Analyses resulted in 3 communication-related themes. The first theme detailed experiences affecting caregiver perceptions of communication between the inpatient medical team and families. The second revealed communication challenges related to the teaching hospital environment, including confusing messages associated with large multidisciplinary teams, aspects of family-centered rounds, and confusion about medical team member roles. The third reflected caregivers' perceptions of communication between providers in and out of the hospital, including types of communication caregivers observed or believed occurred between medical providers. CONCLUSIONS Participating caregivers identified various communication concerns and challenges during their child's hospitalization and transition home. Caregiver perspectives can inform strategies to improve experiences, ease challenges inherent to a teaching hospital, and determine which types of communication are most effective.
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Affiliation(s)
- Lauren G Solan
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- University of Rochester Medical Center, Division of Pediatric Hospital Medicine, Rochester, New York
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, Ohio
| | - Stephanie A Shardo
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- Summa Akron City Hospital, Cooper Cancer Center, Akron, Ohio
| | - Hadley S Sauers-Ford
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- UC Davis Health System, Pediatric Telemedicine, Sacramento, California
| | - Jeffrey M Simmons
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, Cincinnati, Ohio
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Carbonell-Estrany X, Dall'Agnola A, Fullarton JR, Rodgers-Gray BS, Girardi E, Mussa A, Paniagua N, Pieretto M, Rodríguez-Fernandez R, Manzoni P. Interaction between healthcare professionals and parents is a key determinant of parental distress during childhood hospitalisation for respiratory syncytial virus infection (European RSV Outcomes Study [EROS]). Acta Paediatr 2018; 107:854-860. [PMID: 29341239 PMCID: PMC5947668 DOI: 10.1111/apa.14224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/15/2017] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
Abstract
Aim We characterised the distress that parents experienced when their child was hospitalised for respiratory syncytial virus (RSV) infection. Methods This survey‐based, observational study was conducted during 2014–2015. Meetings were held in Spain and Italy, with 24 parents of RSV hospitalised infants and 11 healthcare professionals experienced in RSV, which identified 110 factors related to parental distress. The resulting questionnaire was completed by another 105 Spanish and Italian parents and 56 healthcare professionals, to assess the impact these factors had on parental distress, using a scale from 0 to 10 (very unimportant to very important). Results The five most important factors for parents were: healthcare professionals’ awareness of the latest developments, readmission, reinfections, painful procedures and positive experiences with healthcare professionals. Healthcare professionals associated only medical factors with a meaningful impact on parents. Half of the six medical factors were given similar importance by both groups and the overall scoring for the 110 factors was comparable, with a correlation coefficient of 0.80. A primary concern on discharge was ongoing support. Conclusion The relationship between parents and healthcare professionals was a significant factor in determining parental distress. Healthcare professionals appeared to have a good understanding of the overall impact on parents, particularly the key medical factors.
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Affiliation(s)
- Xavier Carbonell-Estrany
- Neonatology Service, Hospital Clinic; Institut d'Investigacios Biomediques August Pi Suñer (IDIBAPS); Barcelona Spain
| | - Alberto Dall'Agnola
- Paediatrics and Neonatology; “Silvio Orlandi” Hospital; Bussolengo, Verona Italy
| | | | | | - Elisa Girardi
- Paediatrics and Neonatology; “Silvio Orlandi” Hospital; Bussolengo, Verona Italy
| | | | - Natalia Paniagua
- Servicio de Urgencias de Pediatría del Hospital Universitario Cruces; Bilbao Spain
| | | | | | - Paolo Manzoni
- Neonatology and NICU; S. Anna Hospital; Torino Italy
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Stafler P, Weinreb S, Mussaffi H, Mei-Zahav M, Prais D, Steuer G, Bar-On O, Hoshen M, Blau H. Feasibility of multiple breath washout measurements in infants with bronchiolitis: A pilot study. Pediatr Pulmonol 2017; 52:763-770. [PMID: 28221737 DOI: 10.1002/ppul.23674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lung clearance index (LCI) reflects ventilation inhomogeneity and is raised in obstructive airway disease. Feasibility of multiple breath washout (MBW) measurement during acute lung disease in infants is unknown. As a further measure of disease, exhaled nitric oxide (eNO) may paradoxically decrease in acute bronchiolitis. We hypothesized that MBW measurements were attainable in infants with bronchiolitis and that LCI was raised and eNO reduced, compared to normal controls. METHODS Infants with acute bronchiolitis were tested with sulfur hexafluoride (SF6 ) MBW during hospitalization and compared to controls. Tidal breathing and eNO parameters were obtained. Measurements were performed during natural sleep. RESULTS Twenty-nine infants with bronchiolitis aged 3.7 ± 2.3 months (mean ± SD) and 23 controls aged 4.2 ± 2.5 months (P = 0.07) were evaluated. Fifteen of 29 (52%) infants with bronchiolitis and 19/23 (83%) controls achieved ≥2 valid MBW measurements. Reasons for test failure included waking up during facemask application and an irregular respiratory pattern. LCI was 8.4 ± 0.8 in the study group and 7.3 ± 0.7 in controls (P < 0.001). ENO was 2.3 ± 2.7 ppb in the study group and 7.9 ± 6.9 ppb in controls (P = 0.004). CONCLUSION MBW measurements during natural sleep are feasible but technically challenging in infants with acute bronchiolitis. LCI is raised compared to healthy controls. Larger trials, possibly using sedation protocols and shortened washout periods, are required to corroborate these findings. LCI can potentially serve as an objective indicator of severity and could be considered as a biomarker for future interventional trials.
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Affiliation(s)
- Patrick Stafler
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Weinreb
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Huda Mussaffi
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Steuer
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ophir Bar-On
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | - Hannah Blau
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Anderson EJ, Carbonell-Estrany X, Blanken M, Lanari M, Sheridan-Pereira M, Rodgers-Gray B, Fullarton J, Rouffiac E, Vo P, Notario G, Campbell F, Paes B. Burden of Severe Respiratory Syncytial Virus Disease Among 33-35 Weeks' Gestational Age Infants Born During Multiple Respiratory Syncytial Virus Seasons. Pediatr Infect Dis J 2017; 36:160-167. [PMID: 27755464 PMCID: PMC5242218 DOI: 10.1097/inf.0000000000001377] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Moderate-late preterm infants, 33-35 weeks' gestational age (wGA), are at increased risk for respiratory syncytial virus hospitalization (RSVH). The objective of this study is to quantify the burden of RSVH in moderate-late preterm infants. METHODS A pooled analysis was conducted on RSVH from 7 prospective, observational studies in the Northern Hemisphere from 2000 to 2014. Infants' 33-35 wGA without comorbidity born during the respiratory syncytial virus season who did not receive respiratory syncytial virus immunoprophylaxis were enrolled. Data for the first confirmed RSVH during the season (+1 month) were analyzed. Incidence and hospitalization rate per 100 patient-seasons, intensive care unit admission and length of stay (LOS), oxygen support, mechanical ventilation and overall hospital LOS were assessed. RESULTS The pooled analysis comprised 7,820 infants; 267 experienced a confirmed RSVH at a median age of 8.4 weeks. The crude pooled RSVH incidence rate was 3.41% and the rate per 100 patient-seasons was 4.52. Median hospital LOS was 5.7 days. A total of 22.2% of infants required intensive care unit admission for a median LOS of 8.3 days. A total of 70.4% received supplemental oxygen support for a median of 4.9 days, and 12.7% required mechanical ventilation for a median of 4.8 days. CONCLUSIONS The burden of RSVH in moderate-late, 33-35 weeks' wGA preterm infants without comorbidities born during the viral season in Northern Hemisphere countries is substantial. Severe cases required prolonged and invasive supportive therapy.
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Affiliation(s)
- Evan J. Anderson
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Xavier Carbonell-Estrany
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Maarten Blanken
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Marcello Lanari
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Margaret Sheridan-Pereira
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Barry Rodgers-Gray
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - John Fullarton
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Elisabeth Rouffiac
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Pamela Vo
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Gerard Notario
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Fiona Campbell
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Bosco Paes
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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Figueras-Aloy J, Manzoni P, Paes B, Simões EAF, Bont L, Checchia PA, Fauroux B, Carbonell-Estrany X. Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Preterm Infants Without Chronic Lung Disease or Congenital Heart Disease. Infect Dis Ther 2016; 5:417-452. [PMID: 27628014 PMCID: PMC5125133 DOI: 10.1007/s40121-016-0130-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The REGAL (RSV Evidence-a Geographical Archive of the Literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This second publication covers the risk and burden of RSV infection in preterm infants born at <37 weeks' gestational age (wGA) without chronic lung disease or congenital heart disease. METHODS A systematic review was undertaken for articles published between January 1, 1995 and December 31, 2015. Studies reporting data for hospital visits/admissions for RSV infection among preterm infants as well as studies reporting RSV-associated morbidity, mortality, and risk factors were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. RESULTS 2469 studies were identified of which 85 were included. Preterm infants, particularly those born at lower wGA, tended to have higher RSV hospitalization (RSVH) rates compared with otherwise healthy term infants (high SOE). RSVH rates ranged from ~5 per 1000 children to >100 per 1000 children with the highest rates shown in the lowest gestational age infants (high SOE). Independent risk factors associated with RSVH include: proximity of birth to the RSV season, living with school-age siblings, smoking of mother during pregnancy or infant exposure to environmental smoking, reduced breast feeding, male sex, and familial atopy (asthma) (high SOE). Predictive models can identify 32/33-35 wGA infants at risk of RSVH (high SOE). CONCLUSION RSV infection remains a major burden on Western healthcare systems and is associated with significant morbidity. Further studies focusing on the prevalence and burden of RSV in different gestational age cohorts, the changing risk of RSVH during the first year of life, and on RSV-related mortality in preterm infants are needed to determine the true burden of disease. FUNDING AbbVie.
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Affiliation(s)
- Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | | | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Eric A F Simões
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital Houston, Texas, USA
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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The experiences, unmet needs and outcomes of parents of severely injured children: a longitudinal mixed methods study protocol. BMC Pediatr 2016; 16:152. [PMID: 27599987 PMCID: PMC5012009 DOI: 10.1186/s12887-016-0693-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Being the parent of a severely injured child involves many stressors throughout the trauma journey. Internationally, little is known about the experiences or levels of emotional distress, parenting stress, quality of life, and resilience for parents of injured children. The aim of this study is to investigate the experiences, unmet needs and outcomes of parents of physically injured children 0-12 years over the 2 year period following injury. METHODS/DESIGN This is a prospective longitudinal study using an embedded mixed methods design. This design has a primary qualitative strand which incorporates supplementary quantitative data on child quality of life, and parental quality of life, parenting stress, emotional distress, and resilience at four time points; the acute hospitalisation phase, and at 6, 12 and 24 months following injury. The primary sample are parents of injured children 0-12 years hospitalised in the Australian states of New South Wales, Queensland, Victoria and South Australia. Primary data sources are child and parent demographic data; survey data; and semi-structured interview data across a 24 month period. DISCUSSION This study aims to address the existing gap in knowledge on the experiences and unmet support needs of parents in the 2 years following child injury to provide guidance for care provision for these families. There is a lack of evidence-based recommendations for supporting parents and families of injured children and strengthening their capacity to address the challenges they face.
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Curtis K, Foster K, Mitchell R, Van C. Models of Care Delivery for Families of Critically Ill Children: An Integrative Review of International Literature. J Pediatr Nurs 2016; 31:330-41. [PMID: 26699441 DOI: 10.1016/j.pedn.2015.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED Critical illness in children is a life changing event for the child, their parents, caregivers and wider family. There is a need to design and evaluate models of care that aim to implement family-centred care to support more positive outcomes for critically ill children and their families. Due to a gap in knowledge on the impact of such models, the present review was conducted. ELIGIBILITY CRITERIA Primary research articles written in English that focused on children hospitalised for an acute, unexpected, sudden critical illness, such as that requiring an intensive care admission; and addressed the implementation of a model of care in a paediatric acute care hospital setting. SAMPLE Thirteen studies met the inclusion criteria. RESULTS The models of care implemented were associated with positive changes such as reduced parental anxiety and improved communication between parents/caregivers and health professionals. However, no model provided intervention throughout each phase of care to (or post) hospital discharge. CONCLUSIONS Models of care applying family-centred care principles targeting critically ill children and their families can create positive changes in care delivery for the family. However a model which provides continuity across the span of care is required. IMPLICATIONS There is need to describe how best to design, implement and sustain models of care for critically ill children and their families. The success of any intervention implementation will be dependent on the comprehensiveness of the strategy for implementation, the relevance to the context and setting, and engagement with key stakeholders.
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Affiliation(s)
- Kate Curtis
- Sydney Nursing School, The University of Sydney, Sydney, Australia; St George Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kim Foster
- Sydney Nursing School, The University of Sydney, Sydney, Australia; Faculty of Health, University of Canberra, Canberra, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Connie Van
- Sydney Nursing School, The University of Sydney, Sydney, Australia.
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A Validated Method for Identifying Unplanned Pediatric Readmission. J Pediatr 2016; 170:105-12.e1-2. [PMID: 26743495 DOI: 10.1016/j.jpeds.2015.11.051] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/26/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To validate the accuracy of pre-encounter hospital designation as a novel way to identify unplanned pediatric readmissions and describe the most common diagnoses for unplanned readmissions among children. STUDY DESIGN We examined all hospital discharges from 2 tertiary care children's hospitals excluding deaths, normal newborn discharges, transfers to other institutions, and discharges to hospice. We performed blinded medical record review on 641 randomly selected readmissions to validate the pre-encounter planned/unplanned hospital designation. We identified the most common discharge diagnoses associated with subsequent 30-day unplanned readmissions. RESULTS Among 166,994 discharges (hospital A: n = 55,383; hospital B: n = 111,611), the 30-day unplanned readmission rate was 10.3% (hospital A) and 8.7% (hospital B). The hospital designation of "unplanned" was correct in 98% (hospital A) and 96% (hospital B) of readmissions; the designation of "planned" was correct in 86% (hospital A) and 85% (hospital B) of readmissions. The most common discharge diagnoses for which unplanned 30-day readmissions occurred were oncologic conditions (up to 38%) and nonhypertensive congestive heart failure (about 25%), across both institutions. CONCLUSIONS Unplanned readmission rates for pediatrics, using a validated, accurate, pre-encounter designation of "unplanned," are higher than previously estimated. For some pediatric conditions, unplanned readmission rates are as high as readmission rates reported for adult conditions. Anticipating unplanned readmissions for high-frequency diagnostic groups may help focus efforts to reduce the burden of readmission for families and facilities. Using timing of hospital registration in administrative records is an accurate, widely available, real-time way to distinguish unplanned vs planned pediatric readmissions.
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Solan LG, Beck AF, Brunswick SA, Sauers HS, Wade-Murphy S, Simmons JM, Shah SS, Sherman SN. The Family Perspective on Hospital to Home Transitions: A Qualitative Study. Pediatrics 2015; 136:e1539-49. [PMID: 26620060 DOI: 10.1542/peds.2015-2098] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transitions from the hospital to home can be difficult for patients and families. Family-informed characterization of this vulnerable period may facilitate the identification of interventions to improve transitions home. Our objective was to develop a comprehensive understanding of hospital-to-home transitions from the family perspective. METHODS Using qualitative methods, focus groups and individual interviews were held with caregivers of children discharged from the hospital in the preceding 30 days. Focus groups were stratified based upon socioeconomic status. The open-ended, semistructured question guide included questions about communication and understanding of care plans, transition home, and postdischarge events. Using inductive thematic analysis, investigators coded the transcripts, resolving differences through consensus. RESULTS Sixty-one caregivers participated across 11 focus groups and 4 individual interviews. Participants were 87% female and 46% nonwhite; 38% were the only adult in their household, and 56% resided in census tracts with ≥15% of residents living in poverty. Responses from participants yielded a conceptual model depicting key elements of families' experiences with hospital-to-home transitions. Four main concepts resulted: (1) "In a fog" (barriers to processing and acting on information), (2) "What I wish I had" (desired information and suggestions for improvement), (3) "Am I ready to go home?" (discharge readiness), and (4) "I'm home, now what?" (confidence and postdischarge care). CONCLUSIONS Transitions from hospital to home affect the lives of families in ways that may affect patient outcomes postdischarge. The caregiver is key to successful transitions, and the family perspective can inform interventions that support families and facilitate an easier re-entry to the home.
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Affiliation(s)
- Lauren G Solan
- Division of Pediatric Hospital Medicine, University of Rochester Medical Center, Rochester, New York;
| | - Andrew F Beck
- Divisions of General and Community Pediatrics, Hospital Medicine, and
| | | | | | | | - Jeffrey M Simmons
- Hospital Medicine, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
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Patrick SW, Burke JF, Biel TJ, Auger KA, Goyal NK, Cooper WO. Risk of Hospital Readmission Among Infants With Neonatal Abstinence Syndrome. Hosp Pediatr 2015; 5:513-9. [PMID: 26427919 PMCID: PMC5110214 DOI: 10.1542/hpeds.2015-0024] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that may last for months. Our objective was to determine if infants with NAS are at increased risk for hospital readmission compared with uncomplicated term and late preterm newborns. METHODS In this longitudinal retrospective cohort study, administrative data were used for all births from 2006 to 2009 in the New York State Inpatient Database. We identified infants with NAS, born late preterm or uncomplicated term, as independent groups using diagnostic codes and determined readmission rates. We fit a multivariable logistic regression model with 30-day readmission after discharge as the outcome and infant characteristics, clinical morbidities, insurance type, and length of birth hospitalization as predictors. RESULTS From 2006 to 2009 in New York State, 700 613 infants were classified as uncomplicated term, 51 748 were born late preterm, and 1643 infants were diagnosed with NAS. After adjusting for confounders, infants with NAS (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.75-3.55) were more likely than uncomplicated term infants to be readmitted within 30 days of birth hospitalizations. The risk of readmission was similar to late preterm infants (OR 2.26, 95% CI 2.09-2.45). Length of birth hospitalization in days was inversely related to odds of being readmitted within 30 days of birth hospitalization (OR 0.94 95% CI 0.92-0.96). CONCLUSIONS When compared with uncomplicated term infants, infants diagnosed with NAS were more than twice as likely to be readmitted to the hospital. Future research and state-level policies should investigate means to mitigate risk of hospital readmission for infants with NAS.
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Affiliation(s)
- Stephen W Patrick
- Departments of Pediatrics, and Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy, and
| | | | - Terry J Biel
- School of Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Katherine A Auger
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Neera K Goyal
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - William O Cooper
- Departments of Pediatrics, and Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy, and
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Pinto JP, Mandetta MA, Ribeiro CA. A família vivenciando o processo de recuperação da criança pós-alta hospitalar. Rev Bras Enferm 2015; 68:510-7, 594-602. [DOI: 10.1590/0034-7167.2015680404i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: compreender o significado atribuído pela família à sua vivência no processo de recuperação da criança acometida por doença aguda, após a alta hospitalar e elaborar um modelo teórico a respeito dessa experiência. O Interacionismo Simbólico foi adotado como referencial teórico e a Grounded Theory como metodológico. Método: os dados foram coletados por meio de entrevista e observação participante com 11 famílias, totalizando 15 entrevistas. A análise levou à formulação de um Modelo Teórico composto por dois fenômenos interativos: Mobilizando-se para resgatar o equilíbrio de seu funcionamento e Sofrendo com a possibilidade de reintegrar a criança. Resultados: estes revelaram que a família mantém-se em alerta para identificar precocemente alterações de saúde da criança na tentativa de evitar uma reinternação. Conclusão: os efeitos da doença e hospitalização continuam a manifestar-se no funcionamento familiar, gerando sofrimento mesmo após a alta e a recuperação da criança.
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Wicker S, Rabenau HF, Groneberg DA, Gottschalk R. [Occupationally acquired infections among health care workers: Respiratory diseases]. ZENTRALBLATT FUR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2014; 59:82-91. [PMID: 32288301 PMCID: PMC7123063 DOI: 10.1007/bf03344206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In some medical departments, healthcare workers (HCWs) are at risk for aerogene transmitted infectious diseases. Numerous fatal causalities were described in the international environment. For example fatal causalities during the SARS-Epidemic as well as cases of death caused by influenza. METHODS AND RESULTS Selective literature review of occupationally acquired aerogene infections like SARS-coronavirus, influenza virus, parainfluenza virus, RSV, adenovirus, tuberculosis as well as pertussis. Currently available data demonstrate that personal protective measures (e.g. appropriate use of hand washing and oronasal mask), as well as vaccinations (if available) reduces the risk for transmission of infectious diseases. DISCUSSION The risk for occupationally acquired infections is sometimes an unavoidable part of daily patient care. From occupational medicine point of view and for control of infectious diseases preventive measures should be implemented to provide the best possible protection of HCW involved. With regard to a possible pandemic (e.g. influenza pandemic) this procedure is absolutely required.
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Affiliation(s)
- Sabine Wicker
- Betriebsärztlicher Dienst, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Deutschland
- Institut für Medizinische Virologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Paul-Ehrlich-Str. 40, 60596 Frankfurt am Main, Deutschland
| | - Holger F. Rabenau
- Institut für Medizinische Virologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Paul-Ehrlich-Str. 40, 60596 Frankfurt am Main, Deutschland
| | - David A. Groneberg
- Institut für Arbeitsmedizin, Charité — Universitätsmedizin Berlin, Zentrum für Human- und Gesundheitswissenschaften, Freie Universität & Humboldt-Universität zu Berlin, Thielallee 69-73, 14195 Berlin, Deutschland
| | - René Gottschalk
- Institut für Medizinische Virologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Paul-Ehrlich-Str. 40, 60596 Frankfurt am Main, Deutschland
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Botngård A, Skranes LP, Skranes J, Døllner H. Multimedia based health information to parents in a pediatric acute ward: a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2013; 93:389-393. [PMID: 23684375 DOI: 10.1016/j.pec.2013.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/03/2013] [Accepted: 04/20/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine whether multimedia based health information presented to parents of children with breathing difficulties in a pediatric acute ward, is more effective than verbal information, to reduce parental anxiety and increase satisfaction. METHODS This randomized controlled trial was conducted in a pediatric acute ward in Norway, from January to March 2011. Parents were randomly assigned to a multimedia intervention (n=53), or verbal health information (n=48). Primary outcome measure was parental anxiety, and secondary outcome measures were parental satisfaction with nursing care and health information. RESULTS Parental anxiety decreased from arrival to discharge within both groups. At discharge the anxiety levels in the intervention group were no lower than in the control group. There was no difference in satisfaction with nursing care between the groups, but parents in the intervention group reported higher satisfaction with the health information given in the acute ward (p=.005). CONCLUSION Multimedia based health information did not reduce anxiety more than verbal information, among parents to children with breathing difficulties. However, after discharge the parents were more satisfied with the multimedia approach. PRACTICE IMPLICATIONS More research is needed to recommend the use of multimedia based information as a routine to parents in pediatric emergency care.
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Affiliation(s)
- Anja Botngård
- Department of Pediatrics, St. Olav's University Hospital, Trondheim, Norway.
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Strategies for reducing the risk of respiratory syncytial virus infection in infants and young children: a Canadian nurses' perspective. Neonatal Netw 2013; 31:357-68. [PMID: 23134643 DOI: 10.1891/0730-0832.31.6.357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory syncytial virus (RSV) infections are prevalent globally and can cause substantial morbidity in infants and young children. The virus is easily transmitted by direct hand-to-hand contact and can lead to serious respiratory disease and hospitalization, particularly in premature infants and children with certain medical conditions. Educating families with young children, especially those in remote rural regions, regarding the potential adverse health outcomes of RSV infection and measures to reduce the risk of transmitting or acquiring RSV has been a key focus of the health care system in Canada. Geographic, cultural, and socioeconomic factors present formidable challenges to the execution of this endeavor. Therefore, it is critical to develop and systematically implement effective educational programs for both families and health care providers. In Canada, nurses play a critical role in education and counseling. In this review, we share our perspectives and suggest empirical practices that may be applicable worldwide.
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Yael Kopacz N, Predeger E, Kelley CM. Experiences of Alaskan parents with children hospitalized for respiratory syncytial virus treatment. J Pediatr Nurs 2013; 28:e19-21. [PMID: 23531460 DOI: 10.1016/j.pedn.2013.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 12/17/2012] [Accepted: 01/27/2013] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to describe the experiences of Alaskan parents with children hospitalized for the treatment of the respiratory syncytial virus (RSV). Six parents participated in a qualitative descriptive study composed of individual interviews. Using content analysis, three major themes emerged: "RSV is scary," "Lots of stress; little rest" and "At what point does it become a Bingo? He's going to the hospital." Findings provided further insight into the educational needs of the participants. Advanced practice registered nurses can translate insights provided by the participants into crucial knowledge needed for the care of families at heightened risk and currently experiencing RSV.
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Lapillonne A, Regnault A, Gournay V, Gouyon JB, Benmedjahed K, Anghelescu D, Arnould B, Moriette G. Development of a questionnaire to assess the impact on parents of their infant's bronchiolitis hospitalization. BMC Health Serv Res 2013; 13:272. [PMID: 23849687 PMCID: PMC3717097 DOI: 10.1186/1472-6963-13-272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/04/2013] [Indexed: 12/04/2022] Open
Abstract
Background Bronchiolitis is a distressing respiratory condition and the most common cause of hospitalization during the first year of life. The hospitalization of an infant is a stressful event for parents and deserves careful consideration. The objective of this work was to develop and validate a self-administered instrument that comprehensively assesses the impact on parents of the hospitalization of their infant for bronchiolitis. Methods The Impact of Bronchiolitis Hospitalization Questionnaire (IBHQ©) was developed using a literature review and pre-study interviews with both parents and clinicians. For finalization and psychometric validation, it was included in a multicenter, longitudinal, observational study conducted in France. Parents of infants under the age of 1 year and hospitalized for bronchiolitis were asked to complete the questionnaire at hospital discharge, and 3 months after. Results Seven hundred and seven questionnaires were completed by the parents of the 463 eligible infants. After finalization, based on principal component analyses, the IBHQ included 30 core items allowing the calculation of 7 dimension core scores (Worries and distress; Fear for future; Guilt; Impact on daily organization; Physical impact; Impact on behavior with hospitalized infant; Financial impact), as well as 16 optional items, allowing the calculation of 5 optional dimension scores (Disturbed breastfeeding; Physical reaction of hospitalized infant; Impact on feeding; Impact on behavior with other infants; Siblings’ reaction). Internal consistency reliability and construct validity of the IBHQ were satisfactory. The highest impact was observed for “Worries and distress”, “Fear for future” and “Impact on daily organization” scores. Conclusions The IBHQ is a reliable and valid instrument for assessing the multifaceted impact on parents of the hospitalization of their infant for bronchiolitis.
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Kamban SW, Svavarsdottir EK. Does a therapeutic conversation intervention in an acute paediatric setting make a difference for families of children with bronchiolitis caused by respiratory syncytial virus (RSV)? J Clin Nurs 2013; 22:2723-33. [PMID: 23763441 DOI: 10.1111/j.1365-2702.2012.04330.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To measure the benefit of a short-family therapeutic conversation (STC) intervention in an acute paediatric unit. BACKGROUND Studies of children with bronchiolitis caused by respiratory syncytial virus (RSV) have shown that this virus may have an impact on their respiratory system in the form of a wheezing disorder, asthma and even allergy during their childhood. Studies of the parents of these children indicate that they experience distress, vulnerability and anxiety through the illness period and therefore need support from healthcare professionals. However, little is known about what intervention is of most benefit for these parents. DESIGN Quasi-experimental. METHOD Data were collected from a convenience sample from February throughout April 2009 at an acute unit at a children's hospital in Iceland. Parents of infants diagnosed with bronchiolitis caused by RSV were invited to attend. In total, there are 41 participants: 21 in the intervention group (n = 21) and 20 in the control group (n = 20). Parents in both groups answered questionnaires about perceived support and family expressive functioning both before the intervention and on an average of 11 days after the intervention. RESULTS The main findings showed that mothers in the intervention group perceive significantly higher support after the intervention compared with the control group. The findings also showed a significant difference between the genders (mothers and fathers) in the intervention group. The mothers perceived higher cognitive support than the fathers. CONCLUSIONS Despite the often chaotic environment in an acute care setting, the research findings give paediatric nurses reason to conclude that a STC intervention benefits mothers of infants with bronchiolitis caused by RSV. RELEVANCE TO CLINICAL PRACTICE A STC intervention offered by a nurse within an acute paediatric unit can support families in handling the illness experience.
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Affiliation(s)
- Sólrún W Kamban
- Children's Hospital at Landspitali University Hospital, Reykjavik, Iceland
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Weisgerber MC, Lye PS, Nugent M, Li SH, De Fouw K, Gedeit R, Simpson P, Gorelick MH. Relationship between caloric intake and length of hospital stay for infants with bronchiolitis. Hosp Pediatr 2013; 3:24-30. [PMID: 24319832 DOI: 10.1542/hpeds.2012-0032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Poor oral intake is a common presenting symptom among infants hospitalized with bronchiolitis. The prevalence, degree, and duration of iminished caloric intake in these infants have not been studied. Our goal was to determine the daily caloric intake among infants admitted with bronchiolitis and to evaluate the relationship between early hospital caloric intake and length of stay (LOS). METHODS We conducted a retrospective chart review of infants aged <1 year admitted to Children's Hospital of Wisconsin with bronchiolitis who were placed in the bronchiolitis treatment protocol during the 2004-2005 season. Patient-, disease-, respiratory-, and nutrition-specific data were abstracted. RESULTS A total of 273 patients with bronchiolitis were admitted between November 1, 2004, and April 15, 2005; placed on the bronchiolitis protocol; and included in the study. Median caloric intake was diminished on day 1 (53 kcal/kg per day) and day 2 (64 kcal/kg per day). Caloric intake was slower to normalize in infants with progressively longer LOS, and a slower rate of increase from day 1 to day 2 was significantly correlated with longer LOS (r= -0.18; P= .002). Subgroup analysis revealed significant correlations between hospital day 2 caloric intake and LOS in formula-fed infants, breastfed infants, infants aged <183 days, and infants aged > or =183 days. CONCLUSIONS Caloric intake was diminished in the early course of hospitalization for infants who had bronchiolitis and slowest to normalize in infants with the longest LOS. Interventions aimed at decreasing LOS among infants admitted with bronchiolitis should consider the potential significance of nutrition for severely affected infants with this condition.
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Affiliation(s)
- Michael C Weisgerber
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Lapillonne A, Regnault A, Gournay V, Gouyon JB, Gilet H, Anghelescu D, Miloradovich T, Arnould B, Moriette G. Impact on parents of bronchiolitis hospitalization of full-term, preterm and congenital heart disease infants. BMC Pediatr 2012; 12:171. [PMID: 23114197 PMCID: PMC3506487 DOI: 10.1186/1471-2431-12-171] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 10/23/2012] [Indexed: 12/04/2022] Open
Abstract
Background The objective of this work was to explore the impact on parents of the bronchiolitis hospitalization of their infant using the Impact of Bronchiolitis Hospitalization Questionnaire (IBHQ©). Methods Four hundred sixty-three infants aged less than 1 year and hospitalized for bronchiolitis were included in a French observational study during the 2008–2009 season. Parents were asked to complete the IBHQ at hospital discharge and 3 months later. IBHQ scores, ranging from 0 (no impact) to 100 (highest impact), were compared according to gestational age (full-term, 33–36 wGA, ≤ 32 wGA) and the presence of congenital heart disease (CHD). The potential drivers of impact were explored using multivariate linear regressions. Results The study included 332 full-terms, 71 infants born at 33–36 wGA, and 60 at ≤ 32 wGA; 28 infants had a CHD. At hospital discharge, 9 of the 12 IBHQ mean scores were above 40, indicating a marked impact on parents. Three months later, all mean scores were lower but 5 were still greater than 40. At discharge, the length of hospitalization had a significant effect on IBHQ worries and distress, fear for future, guilt and impact on daily organization scores (p<0.01); the parents’ educational level had a significant effect on IBHQ worries and distress, fear for future, impact on daily organization and financial impact scores (p<0.05). The only statistically significant difference found between the parents of preterm and full-term infants was for the physical impact score at discharge (p=0.004). Conclusions Bronchiolitis hospitalization has conspicuous emotional, physical and organizational consequences on parents and siblings, which persist 3 months after hospital discharge. The main drivers of the impact were length of hospital stay and parents’ educational level, while infants’ gestational age or the presence of a CHD had little influence.
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Embleton ND, Dharmaraj ST, Deshpande S. Cost-effectiveness of palivizumab in infancy. Expert Rev Pharmacoecon Outcomes Res 2012; 7:445-58. [PMID: 20528390 DOI: 10.1586/14737167.7.5.445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory syncytial virus is the most common cause of bronchiolitis, a lower respiratory tract infection occurring in infancy. It is responsible for several rehospitalizations, substantial morbidity and occasional deaths in the UK every year. Palivizumab is a recombinant monoclonal antibody that has been shown to reduce hospitalizations in infected infants. It is licensed for high-risk infants, primarily those born pre-term or with chronic pulmonary or cardiac conditions. Palivizumab is expensive, but several economic analyses have determined highly discrepant costs. This article reviews the limitations of the available efficacy and economic data, and highlights problems in interpretation and extrapolation. We also present the results of a cost-effectiveness analysis relevant to populations of high-risk infants in the UK.
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Affiliation(s)
- Nicholas D Embleton
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
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Mahadevia PJ, Masaquel AS, Polak MJ, Weiner LB. Cost utility of palivizumab prophylaxis among pre-term infants in the United States: a national policy perspective. J Med Econ 2012; 15:987-96. [PMID: 22574798 DOI: 10.3111/13696998.2012.690013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The cost-effectiveness of palivizumab has previously been reported among certain guideline-eligible, high-risk premature infants in Medicaid. Because guideline authorities base decisions on a national perspective, the economic model of palivizumab was adapted to include all infants, that is, public and privately insured patients (60% of palivizumab use is public, 40% is private). METHODS This study examined four groups of premature infants without chronic lung disease of prematurity or congenital heart disease: (1) <32 weeks gestational age (wGA) and ≤ 6 months chronologic age (CA); (2) 32-34 wGA, ≤ 3 months CA, with 2009 American Academy of Pediatrics (AAP) risk factors (RFs); (3) 32-35 wGA, ≤ 6 months CA, with 2006 AAP RFs; and (4) 32-35 wGA, ≤ 6 months CA, with ≤ 1 RF. An average estimate was used between public and private payors for (1) background rates of respiratory syncytial virus hospitalization (RSV-H), (2) direct medical costs associated with RSV-H, and (3) cost of palivizumab. Incremental cost-effectiveness ratios (ICERs) are reported in cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed. RESULTS Palivizumab saved costs and improved QALYs among infants <32 wGA. Palivizumab was cost-effective in infants 32-34 wGA with 2009 AAP RFs ($44,774 per QALY) and in infants 32-35 wGA with 2006 AAP RFs ($79,477 per QALY). The ICER for infants 32-35 wGA with ≤ 1 RF was $464,476 per QALY. Influential variables in the sensitivity analysis included background rate of RSV-H and cost and efficacy of palivizumab. LIMITATIONS The results are not generalizable to populations outside of the US. The model did not examine all RFs. The wholesale acquisition cost was used as a payment benchmark; actual price paid by end providers varies. CONCLUSIONS From a national policy perspective, palivizumab remained cost-effective for publically and commercially insured, guideline-eligible, high-risk premature infants. Palivizumab was not cost-effective in infants of 32-35 wGA with ≤ 1 RF.
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