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Hassinger AB, Mody K, Gomez R, Wrotniak BH, Falkowski K, Breuer R, Mennie C, Flagg LK. Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU). J Clin Sleep Med 2024. [PMID: 38456806 DOI: 10.5664/jcsm.11116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
STUDY OBJECTIVES Observational data suggest pediatric intensive care unit-related sleep and circadian disruption (PICU-SCD) affects many critically ill children. Multi-center trials exploring PICU-SCD have been impractical as measuring sleep in this setting is challenging. This study validates a questionnaire for caregivers to describe children's sleep in the PICU. METHODS This prospective, multi-center, case-control study enrolled caregivers of children in four PICUs or in a hospital-based sleep lab (controls). Survey items were compiled from validated adult ICU and pediatric in- and outpatient sleep questionnaires. Control responses were compared to polysomnography to determine accuracy. A score was calculated by summing the level of disruption of sleep timing, duration, efficiency, quality, and daytime sleepiness and irritability. RESULTS In 152 PICU and 61 sleep lab caregivers, sleep survey items had acceptable internal reliability (α=0.75) and reproducibility on re-test surveys (ICC>0.600). Caregivers could not assess sleep of sedated children. Factor analysis identified three sub-scales of PICU-SCD. Control parents had good agreement with polysomnography sleep onset time (κ=0.823) and sleep onset latency (κ=0.707). There was a strong correlation between sleep scores derived by parental reporting to those by polysomnography (r=0.844, p<0.001). Scores had a linear association with caregiver-reported child sleep quality. There were no site-specific differences in sleep quality. Nearly all respondents found the survey easy to understand and of appropriate length. CONCLUSIONS The SSqPICU provides a reliable, accurate description of inpatient sleep disruption in non-sedated children, generalizable across PICUs. It offers practical means to quantify PICU-SCD daily in future investigations.
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Affiliation(s)
- Amanda B Hassinger
- Clinical Associate Professor, University at Buffalo School of Medicine and Biomedical Sciences, Department of Pediatrics, Division of Pulmonology and Sleep Medicine; Attending Physician, John R. Oishei Children's Hospital, Buffalo, NY
| | - Kalgi Mody
- Clinical Assistant Professor, Robert Wood Johnson Medical School, Department of Pediatrics, Division of Pediatric Critical Care Medicine; Attending Physician, Bristol-Myers Squibb Children's Hospital, New Brunswick, NJ
| | - Raquel Gomez
- Medical Student, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Brian H Wrotniak
- Research Scientist, University at Buffalo School or Medicine and Biomedical Sciences, Department of Pediatrics, Buffalo, NY
| | - Kim Falkowski
- Student, Daemen University Master of Public Health Program, Amherst, NY
| | - Ryan Breuer
- Clinical Associate Professor, University at Buffalo School of Medicine and Biomedical Sciences, Department of Pediatrics, Division of Pediatric Critical Care Medicine; Attending Physician, John R. Oishei Children's Hospital, Buffalo, NY
| | - Colleen Mennie
- Senior Research Nurse, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lauren K Flagg
- Nurse Practitioner, Pediatric Intensive Care Unit, Yale New Haven Children's Hospital, New Haven, CT
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Bacon BR, Hassinger AB, Varavenkataraman G, Gould E, Sahlollbey N, Carr MM. Comparison of Epworth Sleepiness Scale and OSA-18 Scores With Polysomnography in Children. Otolaryngol Head Neck Surg 2024. [PMID: 38426572 DOI: 10.1002/ohn.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Our goal is to determine if there is a correlation between Modified Epworth Sleepiness Scale (M-ESS) scores, obstructive sleep apnea (OSA)-18 scores, and polysomnography (PSG) outcomes in children. STUDY DESIGN Retrospective chart review. SETTING Pediatric otolaryngology clinic. METHODS Charts of consecutive children presenting from July 2021 to July 2023 were reviewed. Demographics, body mass index (BMI), BMI Z score, M-ESS score, OSA-18 score, PSG results, and sleep apnea severity were included. One-way analysis of variance and Pearson/Spearman correlation coefficients were calculated. RESULTS Three hundred sixty-seven children were included, 162 (44.1%) girls and 205 (55.9%) boys. Mean patient age was 7.8 (95% confidence interval [CI]: 7.3-8.3) years. M-ESS score was 6.3 (n = 348, 95% CI: 5.8-6.8), mean OSA-18 score was 56.2 (n = 129, 95% CI: 53.0-59.4). Mean apnea-hypopnea index (AHI) was 10.1 (95% CI: 8.7-11.4) events/h, obstructive AHI 9.3 (95% CI: 8.0-12.7) events/h, respiratory distress index 14.6 (95% CI: 8.4-20.8) events/h, and oxygen saturation nadir 89.8% (95% CI: 89.1-90.4). Sixty-two children (17.2%) had mild, 192 (53.5%) moderate, and 105 (29.2%) severe sleep apnea. M-ESS score correlated weakly to AHI (r = .19, P = <.001), and OSA-18 score to oxygen saturation nadir (r = -.16, P = .002). After logistic regression adjusted for age and BMI, neither clinical scores were independently associated with AHI. CONCLUSION M-ESS and OSA-18 scores have a weak correlation with OSA severity in children. More reliable, age-appropriate screening tools are needed in pediatric sleep apnea.
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Affiliation(s)
- Beatrice R Bacon
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Amanda B Hassinger
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gaayathri Varavenkataraman
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Erin Gould
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | | | - Michele M Carr
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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DiNardo LA, Reese AD, Raghavan M, Ma AC, Behar P, Hassinger AB, Carr MM. How Pediatric Sleep Disordered Breathing Impacts Parental Fatigue. Ann Otol Rhinol Laryngol 2024; 133:152-157. [PMID: 37551041 DOI: 10.1177/00034894231191824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Previous research has indicated that sleep disordered breathing (SDB) can lead to a decreased quality of life in children and their families as compared to children who do not have SDB. The purpose of this study was to examine fatigue levels in parents who had young children who were impacted by sleep symptoms as determined by the OSA-18 scale. STUDY DESIGN Survey. SETTING Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. METHODS Fatigue levels for parents of children with OSA-18 ≥ 60 were assessed using the Fatigue Severity Scale and the Chalder Fatigue Scale. Consecutive parents with at least one child between the ages of 1 and 10 were recruited. Parents scored their youngest child on the OSA-18 scale. RESULTS Of the 261 respondents included, 37 parents had a child with an OSA-18 score ≥60. The majority, 211 (82.1%), of participants reported 2 caregivers in the household while 30 (11.7%) had 1 caregiver in the household. Parents of children with OSA-18 ≥60 had a significantly higher mean fatigue score, 16.5 ± 5.8, compared to their counterparts, 11.9 ± 5.2, on the Chalder Fatigue Scale (P < .001). Similar results were reported for the total score on the Fatigue Severity Scale, 34.7 ± 10.8 compared to 28.9 ± 12.0 (P = .004). CONCLUSION Parents of children with OSA-18 score ≥60 are significantly more fatigued than parents of children with lower scores. Recognition of this is important for the health care community as it impacts not just the child with OSA but also their family.
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Affiliation(s)
- Lauren A DiNardo
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Alyssa D Reese
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Maya Raghavan
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Alison C Ma
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Philomena Behar
- Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Amanda B Hassinger
- Division of Pulmonology and Sleep Medicine, Department of Pediatrics, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Michele M Carr
- Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
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Hassinger AB, Velez C, Wang J, Mador MJ, Wilding GE, Mishra A. Association between sleep health and rates of self-reported medical errors in intern physicians: an ancillary analysis of the Intern Health Study. J Clin Sleep Med 2024; 20:221-227. [PMID: 37767811 PMCID: PMC10835772 DOI: 10.5664/jcsm.10820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
STUDY OBJECTIVES Reduced sleep duration and work hour variability contribute to medical error and physician burnout. This study assesses the relationships between physician performance, burnout, and the dimensions of sleep beyond hours slept. METHODS This was an ancillary analysis of 3 years of data from an international prospective cohort study: the Intern Health Study. Actigraphy data from 3,654 intern physicians capturing sleep timing, regularity, efficiency, and duration were used individually and combined as a composite sleep health index to measure the association of multidimensional sleep patterns on self-reported medical errors and burnout. RESULTS From 2017-2019, interns' work hours decreased by 4 hours per week and total sleep time also decreased (6.7 to 5.99 hours), and sleep efficiency, timing, and regularity all worsened (all P < .05). In the 21.2% of participants who committed an error, there was no difference in sleep duration, timing, or regularity. Lower sleep efficiency was associated with higher odds of committing an error (P = .003) and higher burnout scores (P < .001). Although overall sleep quality was poor in the entire cohort, interns in the lowest quintile of sleep duration, regularity, and efficiency had higher burnout scores than those in the best quintile. CONCLUSIONS Sleep efficiency, not duration, was associated with increased self-reported medical errors and burnout in intern physicians. Overall sleep quality and duration worsened despite fewer hours worked. Future studies on physician burnout should measure all aspects of sleep health. CITATION Hassinger AB, Velez C, Wang J, Mador MJ, Wilding GE, Mishra A. Association between sleep health and rates of self-reported medical errors in intern physicians: an ancillary analysis of the Intern Health Study. J Clin Sleep Med. 2024;20(2):221-227.
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Affiliation(s)
- Amanda B. Hassinger
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children’s Hospital, Buffalo, New York
| | - Chiara Velez
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jia Wang
- Department of Biostatistics, University at Buffalo, Buffalo, New York
| | - M. Jeffery Mador
- Department of Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Gregory E. Wilding
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, New York
| | - Archana Mishra
- Department of Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
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Spyhalsky AM, Kim SJ, Meaney CJ, Smith NM, Shah DK, Hassinger AB, Fusco NM. Urinary biomarkers as indicators of acute kidney injury in critically ill children exposed to vancomycin. Pharmacotherapy 2024; 44:163-170. [PMID: 37974531 DOI: 10.1002/phar.2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
STUDY OBJECTIVE The standard of care for detecting acute kidney injury (AKI) is change in serum creatinine (SCr) and urine output, which are limited. This study aimed to compare urinary biomarkers neutrophil gelatinase-associated lipocalin (uNGAL) with kidney injury molecule-1 (uKIM-1) in critically ill children exposed to vancomycin who did and did not develop AKI as defined by changes in SCr. DESIGN Single-center, prospective, clinical, observational cohort study. SETTING Tertiary care children's hospital in an urban setting. PATIENTS Children aged 0 (corrected gestational age 42 weeks) to 18 years admitted to the intensive care unit who received vancomycin were included. INTERVENTION None. MEASUREMENTS The primary outcome was mean change in uNGAL and uKIM-1 between AKI and no-AKI groups. AKI was defined as a minimum 50% increase in SCr from baseline over a 48 h period, within 7 days of first vancomycin exposure. Three urine samples were collected: baseline (between 0 and 6 h of first vancomycin dose), second (18-24 h after the "baseline"), and third (18-24 h after the second sample). Concentrations of uKIM-1 and uNGAL were measured in each sample. MAIN RESULTS Forty-eight children (52% male; median age 6 years) were included. Eight (16.7%) children developed AKI. Mean changes in uNGAL (713.196 ± 1,216,474 vs. 16.101 ± 37.812 pg/mL; p = 0.0004) and uKIM-1 (6060 ± 11.165 vs. 340 ± 542 pg/mL; p = 0.0015) were greater in children with AKI versus no-AKI, respectively. CONCLUSIONS uNGAL and uKIM-1 concentrations increased significantly more in critically ill children with AKI compared with those with no-AKI during the first 48-72 h of vancomycin exposure and may be useful as prospective biomarkers of AKI.
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Affiliation(s)
- Autumn M Spyhalsky
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Se Jin Kim
- Department of Pharmaceutical Sciences, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Calvin J Meaney
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Nicholas M Smith
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Dhaval K Shah
- Department of Pharmaceutical Sciences, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Amanda B Hassinger
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Nicholas M Fusco
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
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Hassinger AB, Afzal S, Rauth M, Breuer RK. Pediatric Intensive Care Unit related Sleep and Circadian Dysregulation: a focused review. Semin Pediatr Neurol 2023; 48:101077. [PMID: 38065630 DOI: 10.1016/j.spen.2023.101077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 12/18/2023]
Abstract
The pediatric intensive care unit (PICU) is bright, loud, and disruptive to children. Strategies to improve the sleep of adults in the ICU have improved delirium and mortality rates. Children need more sleep than adults for active growth, healing, and development when well; this is likely true when they are critically ill. This review was performed to describe what we know in this area to date with the intent to identify future directions for research in this field. Since the 1990s, 16 articles on 14 observational trials have been published investigating the sleep on a total of 312 critically ill children and the melatonin levels of an additional 144. Sleep measurements occurred in 9 studies through bedside observation (n = 2), actigraphy (n = 2), electroencephalogram (n = 1) and polysomnography (n = 4), of which polysomnography is the most reliable. Children in the PICU sleep more during the day, have fragmented sleep and disturbed sleep architecture. Melatonin levels may be elevated and peak later in critically ill children. Early data suggest there are at-risk subgroups for sleep and circadian disruption in the PICU including those with sepsis, burns, traumatic brain injury and after cardiothoracic surgery. The available literature describing the sleep of critically ill children is limited to small single-center observational studies with varying measurements of sleep and inconsistent findings. Future studies should use validated measurements and standardized definitions to begin to harmonize this area of medicine to build toward pragmatic interventional trials that may shift the paradigm of care in the pediatric intensive care unit.
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Affiliation(s)
- Amanda B Hassinger
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences; Division of Pulmonary and Sleep Medicine, John R. Oishei Children's Hospital of Buffalo, Buffalo, NY.
| | - Syeda Afzal
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences; Division of Pediatric Critical Care, John R. Oishei Children's Hospital of Buffalo, Buffalo, NY
| | - Maya Rauth
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences; John R. Oishei Children's Hospital of Buffalo, Buffalo, NY
| | - Ryan K Breuer
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences; Division of Pediatric Critical Care, John R. Oishei Children's Hospital of Buffalo, Buffalo, NY
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Hassinger AB, Monegro A, Perez G. Parental survey of the sleep patterns and screen time in US school children during the first 6 months of the COVID-19 pandemic. BMC Pediatr 2023; 23:65. [PMID: 36750939 PMCID: PMC9905756 DOI: 10.1186/s12887-023-03875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND This study compared sleep duration, screen exposure and sleep quality in school-aged children before COVID-19 to that during school closures and again when schools re-opened in fall 2020. METHODS Cross-sectional anonymous, online survey of parents of children 5-13 years old. Questions elicited information about sleep timing and quality, screen time, and schooling at three distinct periods: before the pandemic, when schools first closed and then re-opened in the fall. RESULTS Respondents described 101 children who were an average of 8.5 years old and 51% male. In lockdown, children slept 25 min more (95%CI 00:13-00:38) due to later wake times (75 min, 95% CI 0:57-1:34) with later bedtimes (29 min, 95%CI 0:00-0:58). When schools re-opened, sleep duration returned to pre-pandemic levels, but sleep onset and offset times remained later. Despite more sleep, sleep quality and habits (e.g. bedtime refusal) worsened during lockdown and did not normalize in fall 2020. During lockdown, screen time increased in 65% of all children, and 96% of those in private schools. When schools reopened, 78% of children in hybrid/virtual learning had more than 4 h of screen exposure daily. Less screen time was associated with twofold higher odds of better sleep (OR 2.66, 95%CI 1.15-6.14). CONCLUSIONS Although school-aged children had more total sleep when schools were closed, sleep quality and habits worsened. Upon return to school, sleep times and quality did not normalize and were linked to screen time.
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Affiliation(s)
- Amanda B. Hassinger
- grid.273335.30000 0004 1936 9887Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 1001 Main Street, 5Th Floor, Buffalo, NY 14203 USA
| | - Alberto Monegro
- grid.273335.30000 0004 1936 9887Department of Internal Medicine and Pediatrics, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Geovanny Perez
- grid.273335.30000 0004 1936 9887Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 1001 Main Street, 5Th Floor, Buffalo, NY 14203 USA
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Hassinger AB, Monegro A, Perez G. Introduction to the pediatric sleep medicine special issue. Progress in Pediatric Cardiology 2023. [DOI: 10.1016/j.ppedcard.2023.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Hassinger AB, Berger JA, Aljohani OA, Kudchadkar SR. Post-operative sleep and activity patterns in critically ill children after cardiac surgery. Progress in Pediatric Cardiology 2022. [DOI: 10.1016/j.ppedcard.2022.101603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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DiNardo LA, Reese AD, Raghavan M, Seeley J, Pandit S, Behar P, Hassinger AB, Carr MM. Parental Knowledge of Obstructive Sleep Apnea Symptoms and Tonsillectomy in Children. Ann Otol Rhinol Laryngol 2022:34894221112911. [PMID: 35861206 DOI: 10.1177/00034894221112911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is present in approximately 2% to 5% of children; however, only 15% of parents are reported to be knowledgeable about OSA in children. Sleep apnea in children can lead to cardiopulmonary disease, abnormal weight gain, failure to thrive, or learning difficulties. The purpose of our study is to assess parental knowledge of pediatric OSA to identify any knowledge gaps. STUDY DESIGN Survey. SETTING Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. METHODS In June of 2021, parents of pediatric (0-18 years) otolaryngology patients completed a survey on their knowledge of OSA. Parents were asked to rank their concern about OSA and identify symptoms of OSA. Parental demographic data collected included gender, age, race, and educational level. Respondents were asked if their child had undergone a sleep study or tonsillectomy. RESULTS Of the 246 parents included, 77 (31.4%) parents had a child who had a tonsillectomy, 40 (16.3%) had a child who had a sleep study done, and 25 (10.2%) had a child with both done. For recognizing the symptoms of pediatric OSA the mean was 6.3 (95% CI 5.8-6.8) out of 13 total. Symptoms least likely recognized were nocturnal enuresis and hyperactivity, 65 (27%) and 91 (37%) of parents correctly identifying these symptoms, respectively. Greater concern about OSA correlated with greater cumulative knowledge score (P < .001). Parents whose child had undergone a tonsillectomy were more likely to be concerned about OSA in children compared to non-tonsillectomy parents (P = .003), and sleep study parents were also more likely to be concerned about OSA than non-sleep study parents (P = .045). CONCLUSION Parents who attended a pediatric otolaryngology clinic have knowledge gaps about pediatric sleep.
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Affiliation(s)
- Lauren A DiNardo
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Alyssa D Reese
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Maya Raghavan
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Jeffrey Seeley
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Supriya Pandit
- Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Philomena Behar
- Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Amanda B Hassinger
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Michele M Carr
- Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
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Fitzgerald JC, Basu RK, Fuhrman D, Gorga SM, Hassinger AB, Sanchez-Pinto LN, Selewski DT, Sutherland SM, Arikan AA. Renal Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference. Pediatrics 2022; 149:S66-S73. [PMID: 34970682 PMCID: PMC9722270 DOI: 10.1542/peds.2021-052888j] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 01/03/2023] Open
Abstract
CONTEXT Renal dysfunction is associated with poor outcomes in critically ill children. OBJECTIVE To evaluate the current evidence for criteria defining renal dysfunction in critically ill children and association with adverse outcomes. To develop contemporary consensus criteria for renal dysfunction in critically ill children. DATA SOURCES PubMed and Embase were searched from January 1992 to January 2020. STUDY SELECTION Included studies evaluated critically ill children with renal dysfunction, performance characteristics of assessment tools for renal dysfunction, and outcomes related to mortality, functional status, or organ-specific or other patient-centered outcomes. Studies with adults or premature infants (≤36 weeks' gestational age), animal studies, reviews, case series, and studies not published in English with inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were extracted from included studies into a standard data extraction form by task force members. RESULTS The systematic review supported the following criteria for renal dysfunction: (1) urine output <0.5 mL/kg per hour for ≥6 hours and serum creatinine increase of 1.5 to 1.9 times baseline or ≥0.3 mg/dL, or (2) urine output <0.5 mL/kg per hour for ≥12 hours, or (3) serum creatinine increase ≥2 times baseline, or (4) estimated glomerular filtration rate <35 mL/minute/1.73 m2, or (5) initiation of renal replacement therapy, or (6) fluid overload ≥20%. Data also support criteria for persistent renal dysfunction and for high risk of renal dysfunction. LIMITATIONS All included studies were observational and many were retrospective. CONCLUSIONS We present consensus criteria for renal dysfunction in critically ill children.
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Affiliation(s)
- Julie C. Fitzgerald
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Rajit K. Basu
- Department of Pediatrics, Emory School of Medicine, Atlanta, GA
| | - Dana Fuhrman
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Stephen M. Gorga
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Amanda B. Hassinger
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children’s Hospital, Buffalo, NY
| | - L. Nelson Sanchez-Pinto
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - David T. Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Scott M. Sutherland
- Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Stanford, CA
| | - Ayse Akcan Arikan
- Department of Pediatrics, Sections of Critical Care and Renal, Baylor College of Medicine, Houston, TX
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Bembea MM, Agus M, Akcan-Arikan A, Alexander P, Basu R, Bennett TD, Bohn D, Brandão LR, Brown AM, Carcillo JA, Checchia P, Cholette J, Cheifetz IM, Cornell T, Doctor A, Eckerle M, Erickson S, Farris RW, Faustino EVS, Fitzgerald JC, Fuhrman DY, Giuliano JS, Guilliams K, Gaies M, Gorga SM, Hall M, Hanson SJ, Hartman M, Hassinger AB, Irving SY, Jeffries H, Jouvet P, Kannan S, Karam O, Khemani RG, Niranjan K, Lacroix J, Laussen P, Leclerc F, Lee JH, Leteurtre S, Lobner K, McKiernan PJ, Menon K, Monagle P, Muszynski JA, Odetola F, Parker R, Pathan N, Pierce RW, Pineda J, Prince JM, Robinson KA, Rowan CM, Ryerson LM, Sanchez-Pinto LN, Schlapbach LJ, Selewski DT, Shekerdemian LS, Simon D, Smith LS, Squires JE, Squires RH, Sutherland SM, Ouellette Y, Spaeder MC, Srinivasan V, Steiner ME, Tasker RC, Thiagarajan R, Thomas N, Tissieres P, Traube C, Tucci M, Typpo KV, Wainwright MS, Ward SL, Watson RS, Weiss S, Whitney J, Willson D, Wynn JL, Yeyha N, Zimmerman JJ. Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Contemporary Organ Dysfunction Criteria: Executive Summary. Pediatrics 2022; 149:S1-S12. [PMID: 34970673 PMCID: PMC9599725 DOI: 10.1542/peds.2021-052888b] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 01/20/2023] Open
Abstract
Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was composed of 88 members representing 47 institutions and 7 countries. We conducted systematic reviews of the literature to derive evidence-based criteria for single organ dysfunction for neurologic, cardiovascular, respiratory, gastrointestinal, acute liver, renal, hematologic, coagulation, endocrine, endothelial, and immune system dysfunction. We searched PubMed and Embase from January 1992 to January 2020. Study identification was accomplished using a combination of medical subject headings terms and keywords related to concepts of pediatric organ dysfunction. Electronic searches were performed by medical librarians. Studies were eligible for inclusion if the authors reported original data collected in critically ill children; evaluated performance characteristics of scoring tools or clinical assessments for organ dysfunction; and assessed a patient-centered, clinically meaningful outcome. Data were abstracted from each included study into an electronic data extraction form. Risk of bias was assessed using the Quality in Prognosis Studies tool. Consensus was achieved for a final set of 43 criteria for pediatric organ dysfunction through iterative voting and discussion. Although the PODIUM criteria for organ dysfunction were limited by available evidence and will require validation, they provide a contemporary foundation for researchers to identify and study single and multiple organ dysfunction in critically ill children.
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Affiliation(s)
- Melania M. Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Agus
- Division of Medical Critical Care, Boston Children’s Hospital, Harvard Medical School, Boston Children’s Hospital, Boston, MA
| | - Ayse Akcan-Arikan
- Department of Pediatrics, Sections of Critical Care and Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Peta Alexander
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Rajit Basu
- Division of Pediatric Critical Care, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA
| | - Tellen D. Bennett
- Sections of Informatics and Data Science and Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - Desmond Bohn
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto
| | - Leonardo R. Brandão
- Division of Hematology-Oncology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ann-Marie Brown
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Joseph A. Carcillo
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Paul Checchia
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
| | - Jill Cholette
- Department of Pediatrics, University of Rochester Golisano Children’s Hospital, Rochester, NY
| | - Ira M. Cheifetz
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Timothy Cornell
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Allan Doctor
- University of Maryland School of Medicine, Center for Blood Oxygen Transport and Hemostasis
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati OH USA and Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Simon Erickson
- Department of Paediatric Critical Care; Perth Children’s Hospital and University of Western Australia; Perth, Western Australia, Australia
| | - Reid W.D. Farris
- Department of Pediatrics, University of Washington and Seattle Children’s Hospital; Seattle, WA
| | - E. Vincent S. Faustino
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Yale School of Medicine, New Haven CT
| | - Julie C. Fitzgerald
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Dana Y. Fuhrman
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - John S. Giuliano
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Kristin Guilliams
- Department of Neurology, Division of Pediatric and Development Neurology, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, MI
| | - Michael Gaies
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | | | - Mark Hall
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Sheila J. Hanson
- Department of Pediatrics, Critical Care Section, Medical College of Wisconsin/Children’s Wisconsin, Milwaukee, WI
| | - Mary Hartman
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Amanda B. Hassinger
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children’s Hospital, Buffalo, NY
| | - Sharon Y. Irving
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Howard Jeffries
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA
| | - Philippe Jouvet
- Department of Paediatrics; Sainte-Justine Hospital and University of Montreal; Montreal, Québec, Canada
| | - Sujatha Kannan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA
| | - Robinder G. Khemani
- Department of Anesthesiology and Critical Care Medicine; Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine; Los Angeles, CA
| | - Kissoon Niranjan
- Division of Critical Care, Department of Pediatrics, University of British Columbia and BC Children’s Hospital
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Centre Hospitalier Universitaire de Sainte-Justine, Université de Montreal, Canada
| | - Peter Laussen
- Department of Cardiology, Boston Children’s Hospital and Department of Anesthesia, Harvard Medical School, Boston, MA
| | - Francis Leclerc
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Jan Hau Lee
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, and, Duke-NUS Medical School, Singapore
| | - Stephane Leteurtre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Katie Lobner
- Welch Medical Library, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Patrick J. McKiernan
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Kusum Menon
- Division of Pediatric Critical Care, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Paul Monagle
- Department of Clinical Haematology, Royal Children’s Hospital, Victoria, Australia, and Haematology Research, Murdoch Children’s Research Institute, Victoria, Australia
| | - Jennifer A. Muszynski
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | | | - Robert Parker
- Department of Pediatrics (Emeritus), Hematology/Oncology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY
| | - Nazima Pathan
- Department of Paediatrics, University of Cambridge; Clinical Research Associate, Kings College, Cambridge, UK
| | - Richard W. Pierce
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Jose Pineda
- Department of Anesthesiology and Critical Care Medicine; Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine; Los Angeles, CA
| | - Jose M. Prince
- Department of Surgery and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Karen A. Robinson
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Courtney M. Rowan
- Department of Pediatrics, Division of Pediatric Critical Care; Indiana University School of Medicine and Riley Hospital for Children; Indianapolis, IN
| | | | - L. Nelson Sanchez-Pinto
- Departments of Pediatrics (Critical Care) and Preventive Medicine (Health & Biomedical Informatics), Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Luregn J Schlapbach
- Pediatric and Neonatal Intensive Care Unit, Children`s Research Center, University Children`s Hospital Zurich, Zurich, Switzerland
| | - David T. Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Lara S. Shekerdemian
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
| | - Dennis Simon
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Lincoln S. Smith
- Department of Pediatrics, University of Washington and Seattle Children’s Hospital; Seattle, WA
| | - James E. Squires
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Robert H. Squires
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Scott M. Sutherland
- Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Stanford, CA
| | - Yves Ouellette
- Division of Critical Care Medicine, Department of Pediatrics, Mayo Clinic, Rochester, MN
| | | | - Vijay Srinivasan
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Marie E. Steiner
- Department of Pediatrics, Critical Care Medicine & Hematology, University of Minnesota, Minneapolis, MN
| | - Robert C. Tasker
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston MA
| | - Ravi Thiagarajan
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Neal Thomas
- Department of Pediatrics and Public Health Science, Division of Pediatric Critical Care Medicine; Penn State Hershey Children’s Hospital; Hershey, PA
| | - Pierre Tissieres
- Pediatric Intensive Care, AP-HP Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Chani Traube
- Department of Pediatrics, Division of Critical Care Medicine, Weill Cornell Medical College, NY
| | - Marisa Tucci
- Division of Pediatric Critical Care Medicine, Centre Hospitalier Universitaire de Sainte-Justine, Université de Montreal, Canada
| | - Katri V. Typpo
- Department of Pediatrics and the Steele Children’s Research Center, University of Arizona College of Medicine, Tucson, AZ
| | - Mark S. Wainwright
- Department of Neurology, Division of Pediatric Neurology, University of Washington, Seattle, WA
| | - Shan L. Ward
- Department of Pediatrics, Division of Critical Care, UCSF Benioff Children’s Hospitals, San Francisco and Oakland, CA
| | - R. Scott Watson
- Department of Pediatrics, University of Washington and Seattle Children’s Hospital; Seattle, WA
| | - Scott Weiss
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Jane Whitney
- Division of Medical Critical Care, Boston Children’s Hospital, Harvard Medical School, Boston Children’s Hospital, Boston, MA
| | - Doug Willson
- Division of Pediatric Critical Care Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA
| | - James L. Wynn
- Department of Pediatrics and Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Nadir Yeyha
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Jerry J. Zimmerman
- Department of Pediatrics, Seattle Children’s Hospital, Seattle Children’s Research Institute, University of Washington School of Medicine, Seattle, WA
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Hassinger AB, Breuer RK, Mishra A. Sleep patterns of US healthcare workers during the first wave of the COVID-19 pandemic. Sleep Breath 2021; 26:1351-1361. [PMID: 34664182 PMCID: PMC8523119 DOI: 10.1007/s11325-021-02515-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/15/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
Purpose
During the first few months of the COVID-19 outbreak, healthcare workers (HCW) faced levels of personal risk, emotional distress, and professional strain not seen in their lifetimes. This study described how these stressors influenced various aspects of their sleep patterns. Methods From May 19 to June 20, 2020, an electronic, cross-sectional survey was administered to a convenience sample of in- and outpatient HCW in a large, nonprofit healthcare system. Respondents described the pandemic’s initial impact on personal and professional life and various sleep dimensions: regularity, efficiency, duration, timing, quality, and daytime sleepiness. Results Two hundred seven providers responded, representing 17 different healthcare roles. Most (82%) were women with a median age of 39 years (IQR1–3, 31–53). A majority of respondents (81%) worked in an inpatient setting, with half (46%) primarily on the “frontline.” Approximately one-third of respondents (37%) were physicians and one-quarter (28%) were nurses. Overall, 68% of HCW reported at least one aspect of sleep worsened during the beginning of the pandemic; the most impacted were daytime sleepiness (increased in 43%) and sleep efficiency (worse in 37%). After adjusting for COVID exposure and burnout, frontline providers had twofold higher odds of poor pandemic sleep, aOR 2.53, 95%CI 1.07–5.99. Among frontline providers, physicians were fivefold more likely to develop poor pandemic sleep compared to nurses (OR 5.73, 95%CI 1.15–28.57). Conclusions During the initial wave of COVID-19, a majority of HCW reported a decline in sleep with an increase in daytime sleepiness and insomnia. Frontline workers, specifically physicians, were at higher risk. Supplementary Information The online version contains supplementary material available at 10.1007/s11325-021-02515-9.
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Affiliation(s)
- Amanda B Hassinger
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 955 Main Street, Buffalo, NY, 14203, USA.
| | - Ryan K Breuer
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 955 Main Street, Buffalo, NY, 14203, USA
| | - Archana Mishra
- Department of Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 955 Main Street, Buffalo, NY, 14203, USA
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14
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Rowan CM, Klein MJ, Hsing DD, Dahmer MK, Spinella PC, Emeriaud G, Hassinger AB, Piñeres-Olave BE, Flori HR, Haileselassie B, Lopez-Fernandez YM, Chima RS, Shein SL, Maddux AB, Lillie J, Izquierdo L, Kneyber MCJ, Smith LS, Khemani RG, Thomas NJ, Yehya N. Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome: A PARDIE Study. Am J Respir Crit Care Med 2020; 201:1389-1397. [PMID: 32130867 DOI: 10.1164/rccm.201909-1807oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Rationale: Few data exist to guide early adjunctive therapy use in pediatric acute respiratory distress syndrome (PARDS).Objectives: To describe contemporary use of adjunctive therapies for early PARDS as a framework for future investigations.Methods: This was a preplanned substudy of a prospective, international, cross-sectional observational study of children with PARDS from 100 centers over 10 study weeks.Measurements and Main Results: We investigated six adjunctive therapies for PARDS: continuous neuromuscular blockade, corticosteroids, inhaled nitric oxide (iNO), prone positioning, high-frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation. Almost half (45%) of children with PARDS received at least one therapy. Variability was noted in the median starting oxygenation index of each therapy; corticosteroids started at the lowest oxygenation index (13.0; interquartile range, 7.6-22.0) and HFOV at the highest (25.7; interquartile range, 16.7-37.3). Continuous neuromuscular blockade was the most common, used in 31%, followed by iNO (13%), corticosteroids (10%), prone positioning (10%), HFOV (9%), and extracorporeal membrane oxygenation (3%). Steroids, iNO, and HFOV were associated with comorbidities. Prone positioning and HFOV were more common in middle-income countries and less frequently used in North America. The use of multiple ancillary therapies increased over the first 3 days of PARDS, but there was not an easily identifiable pattern of combination or order of use.Conclusions: The contemporary description of prevalence, combinations of therapies, and oxygenation threshold for which the therapies are applied is important for design of future studies. Region of the world, income, and comorbidities influence adjunctive therapy use and are important variables to include in PARDS investigations.
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Affiliation(s)
- Courtney M Rowan
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Margaret J Klein
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles and University of Southern California, Los Angeles, California
| | - Deyin Doreen Hsing
- Department of Pediatrics, New York Presbyterian Hospital and Weill Cornell Medical College, New York, New York
| | - Mary K Dahmer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan
| | - Philip C Spinella
- Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Guillaume Emeriaud
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal, Quebec, Canada
| | - Amanda B Hassinger
- Division of Pediatric Critical Care, Department of Pediatrics, Oishei Children's Hospital and University of Buffalo, Buffalo, New York
| | | | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan
| | - Bereketeab Haileselassie
- Division of Pediatric Critical Care, Department of Pediatrics, Stanford University, Palo Alto, California
| | | | - Ranjit S Chima
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Steven L Shein
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio
| | - Aline B Maddux
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado, Aurora, Colorado
| | - Jon Lillie
- Evelina London Children's Hospital, London, United Kingdom
| | - Ledys Izquierdo
- Department of Pediatrics, Hospital Militar Central, Bogotá, Colombia
| | - Martin C J Kneyber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital and University of Groningen, Groningen, the Netherlands
| | - Lincoln S Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles and University of Southern California, Los Angeles, California
| | - Neal J Thomas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Science, Penn State Hershey Children's Hospital, Hershey, Pennsylvania and
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Abstract
INTRODUCTION Chronic insomnia, whether it is primary or in combination with another medical or psychiatric disorder, is a prevalent condition associated with significant morbidity, reduced productivity, increased risk of accidents, and poor quality of life. Pharmacologic and behavioral treatments have equivalent efficacy with each having its own advantages and limitations. AREAS COVERED The purpose of this perspective is to delineate the limitations encountered in implementing cognitive behavioral therapy (CBT) and to review the pharmacological treatments designed to target the different phenotypes of insomnia. The discussions address how to choose the optimal medication or combination thereof based on patients' characteristics, available medications, and the presence of comorbid conditions. Selective nonbenzodiazepine sedative 'Z-drug' hypnotics, melatonin receptor agonist-ramelteon, and low-dose doxepin are the agents of choice for treatment of primary and comorbid insomnia. EXPERT OPINION A pharmacological intervention should be offered if cognitive behavioral therapy for insomnia is not available or has failed to achieve its goals. Increasing evidence of the significant adverse consequences of long-term benzodiazepines should limit the prescription of these agents to specific conditions. Testing novel dosing regimens with a combination of hypnotic classes augmented with CBT deserve further investigation.
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Affiliation(s)
- Amanda B Hassinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Nikolas Bletnisky
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Rizwan Dudekula
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA
| | - Ali A El-Solh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY, USA.,VA Western New York Healthcare System , Buffalo, NY, USA.,Department of Epidemiology and Environmental Health, Research and Development, School of Public Health, University at Buffalo , Buffalo, NY, USA
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16
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Islam S, Mannix MK, Breuer RK, Hassinger AB. Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department. Clin Pediatr (Phila) 2020; 59:21-30. [PMID: 31609128 DOI: 10.1177/0009922819879462] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pediatric antibiotic prescriptions originate from an increasingly broad range of ambulatory settings. In this retrospective study, pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infection cases, at 11 primary care offices, 2 independent urgent care centers (UCCs), and a pediatric emergency department in Western New York, were analyzed relative to medical society practice guidelines and antibiotic utilization. Of 2358 eligible visits across all sites, 25% were for study diagnoses, with 38% at UCC (P < .01). Across all sites, 26% of pharyngitis cases given antibiotics did not have diagnostic evidence of bacterial infection. At primary care offices and UCCs, guideline recommended first-line agents for pharyngitis and otitis media were used in only 58% and 63% of treated cases, respectively. Overall, an estimated 9855 to 12 045 avoidable antibiotic and 8030 non-guideline antibiotic courses annually are represented by the 14 sites studied. These and other study findings highlight numerous opportunities for outpatient pediatric antibiotic stewardship.
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Affiliation(s)
- Shamim Islam
- Pediatric Infectious Diseases, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Mary Kathryn Mannix
- Pediatric Infectious Diseases, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ryan K Breuer
- John R. Oishei Children's Hospital, Buffalo, NY, USA.,Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Amanda B Hassinger
- John R. Oishei Children's Hospital, Buffalo, NY, USA.,Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY, USA
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17
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Breuer RK, Carnevale F, Donhauser J, Iwano M, Kramer B, Marthia V, Nutty K, Patankar N, Wilkowski S, Hassinger AB. Pediatric Sepsis in Our Community: A Point Prevalence Study. J PEDIAT INF DIS-GER 2019. [DOI: 10.1055/s-0039-1698442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Objective Hospital-based studies are the main sources of epidemiologic data on pediatric sepsis, underrepresenting those managed as outpatients. This may disadvantage community providers, especially when determining triage, referral, and follow-up. Our objective was to characterize sepsis in nonhospitalized children and describe resources allocated to their care.
Methods This was a point prevalence study conducted in 11 primary care (PC) offices, 2 urgent care (UC) centers, and 1 pediatric emergency department (ED) serving Western New York. Patients aged 18 years and younger evaluated at a participating site on one of four study dates over a 12-month period were eligible to participate. Patients were included if temperature and heart rate and/or respiratory rate were documented during their visit. The primary outcome was the prevalence of sepsis in participating sites.
Results Of 3,269 eligible children, 52.6% (n = 1,719) met inclusion criteria, 91% of whom (n = 1,576) were evaluated for acute infection. Sepsis criteria were met by 8.8% of these patients (22.4% in ED, 13.0% in UC centers, and 1.6% in PC offices). Most (74%) patients with sepsis were managed solely by initial site and sent home. However, meeting sepsis criteria was associated with higher odds of escalation of care beyond initial site (adjusted odds ratio [aOR]: 2.59, 95% confidence interval [CI]: 1.62–4.17). The presence of tachycardia (aOR: 2.88, 95% CI: 1.70–4.90) or a lower respiratory tract infection (aOR: 3.69, 95% CI: 2.28–5.99) was also independently associated with higher odds of care escalation.
Conclusion Nearly 1 in 10 children seeking outpatient evaluation for infection met sepsis criteria. While most were managed without transfer or hospital admission, the diagnosis did carry higher odds of care escalation. Tachycardia and lower respiratory tract infections also conveyed an increased likelihood, suggesting additional screening possibilities for outpatient clinicians.
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Affiliation(s)
- Ryan K. Breuer
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
| | - Frank Carnevale
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
- Department of Emergency Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
| | - Jessica Donhauser
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
| | - Mika Iwano
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
| | - Bree Kramer
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
| | - Vanessa Marthia
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
| | - Kirsten Nutty
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
| | - Nikhil Patankar
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
- Beacon Children’s Hospital Critical Kids, Indiana University School of Medicine, South Bend, Indiana, United States
| | - Scott Wilkowski
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
| | - Amanda B. Hassinger
- Division of Critical Care, Division of Hospitalist Medicine and Department of Emergency Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences (formerly Women & Children's Hospital of Buffalo), Buffalo, New York, United States
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18
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Abstract
BACKGROUND Use of negative pressure ventilation is neither well described nor widespread in pediatric critical care; existing data are from small, specialized populations. We sought to describe a general population of critically ill subjects with acute respiratory failure supported with negative pressure ventilation to find predictors of response or failure. METHODS We conducted a retrospective cohort study of subjects 0-18 y old admitted to a single (non-cardiac) pediatric ICU who received acute respiratory failure support via negative pressure ventilation from May 2015 through May 2016. RESULTS In 118 subjects, the most common causes of acute respiratory failure were viral bronchiolitis (86.4%) and pneumonia (15.3%). A majority of subjects (68.6%) stabilized with negative pressure ventilation and did not need a change of respiratory support; in those who failed with negative pressure ventilation, median time to respiratory support change was 5.1 h (interquartile range 1.9-11.0). Subjects stabilized with negative pressure ventilation did not differ from those needing a change of respiratory support in terms of age, comorbidities, or FIO2 at initiation of ventilation. Compared to those who did not respond to negative pressure ventilation, mean SpO2 /FIO2 was higher at 1 h after start of negative pressure ventilation (218.8 vs 131.7) in those who did respond. Subjects with SpO2 /FIO2 < 192 after 1 h on negative pressure ventilation support had 5-fold higher odds of needing a respiratory support change (odds ratio 5.143, 95% CI 1.17-22.7, P = .031). Analysis of SpO2 /FIO2 was limited by 81.3% (96/118) of subjects who had an SpO2 > 97% at 1 h after the start of negative pressure ventilation. CONCLUSIONS Negative pressure ventilation successfully supported 69% of pediatric subjects with all-cause acute respiratory failure. Oxygen requirement was lower in subjects who were responsive to negative pressure ventilation within 1 h of initiation. Standardized negative pressure ventilation protocols should include weaning of supplemental oxygen to determine responsiveness.
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Affiliation(s)
- Crystal A Nunez
- Department of Pediatrics, University of Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Amanda B Hassinger
- Division of Pediatric Critical Care, John R Oishei Children's Hospital, Buffalo, New York.
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19
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Abstract
BACKGROUND The objective of this work was to describe the use of negative-pressure ventilation (NPV) in a heterogeneous critically ill, pediatric population. METHODS A retrospective chart review was conducted of all patients admitted to a pediatric ICU with acute respiratory failure supported with NPV from January 1, 2012 to May 15, 2015. RESULTS Two hundred thirty-three subjects at a median age of 15.5 months were supported with NPV for various etiologies, most commonly bronchiolitis (70%). Median (interquartile range) duration of support was 18.7 (8.7-34.3) h. The majority were NPV responders (70%), defined as not needing escalation to any form of positive-pressure ventilation. In non-responders, escalation occurred at a median (interquartile range) of 6.9 (3.3-16.6) h. More NPV non-responders had upper-airway obstruction (P = .02), and fewer had bronchiolitis (P = .008) compared with responders. A bedside scoring system developed on these data was 98% specific in predicting NPV failure by 4 h after NPV start (area under the curve 0.759, 95% CI 0.675-0.843, P < .001). Complications from NPV were rare (3%); however, delayed enteral nutrition (33%) and continuous intravenous sedation use (51%) in children while receiving NPV were more frequent. The annual percentage of pediatric ICU admissions requiring intubation declined by 28% in the 3 y after NPV introduction, compared with the 3 y prior. CONCLUSIONS NPV is a noninvasive respiratory support for pediatric acute respiratory failure from all causes with few complications and a 70% response rate. Children receiving NPV often required intravenous sedation for comfort, and one third received delayed enteral nutrition. Those who required escalation from NPV worsened within 6 h; this may be predictable with a bedside scoring system.
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Affiliation(s)
- Amanda B Hassinger
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Ryan K Breuer
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kirsten Nutty
- Division of Pediatric Critical Care, Women and Children's Hospital of Buffalo, Buffalo, New York
| | - Chang-Xing Ma
- Department of Biostatistics, School of Public Health and Health Professions University at Buffalo, Buffalo, New York
| | - Omar S Al Ibrahim
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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20
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Abstract
The diagnostic power of procalcitonin (PCT) in the pediatric intensive care unit (PICU) is uncertain. This study aimed to determine the diagnostic ability of PCT to detect serious bacterial infections (SBI) in a heterogeneous PICU population. This was a retrospective cohort study of patients on whom a PCT level was obtained within 48 hours of admission to a PICU from 2013 to 2015. Discriminatory ability of PCT to predict SBI was examined by test and receiver operating characteristics (AUC [area under the curve]-ROC). Seventy-five patients were included and 28 (37%) had an SBI (median PCT = 6.48 ng/mL) compared with 47 (63%) in the noninfection group (median PCT = 0.23 ng/mL, P < .0001). PCT was able to adequately predict SBI (AUC-ROC = 0.83, 95% CI 0.74-0.93; P < .0001), and a PCT ≥1.28 ng/mL was the optimal threshold to detect SBI with a positive predictive value of 76.7% and negative predictive value of 88.9%. PCT adequately predicted SBI in a heterogeneous PICU population and may be useful for minimizing antibiotic consumption.
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21
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Hassinger AB, Garimella S. Refractory hypotension after bilateral nephrectomies in a Denys-Drash patient with phenylketonuria. Pediatr Nephrol 2013; 28:345-8. [PMID: 22992984 DOI: 10.1007/s00467-012-2311-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Denys-Drash (DDS) syndrome is a rare genetic syndrome resulting from a mutation in the Wilms' tumor suppressor gene 1 (WT1), which presents with early onset nephrotic syndrome progressing rapidly to end-stage kidney disease (ESKD), pseudohermaphroditism, and high rates of Wilms' tumor. CASE-DIAGNOSIS/TREATMENT We present the case of an infant born with DDS and phenylketonuria with neonatal ESKD and dependence on peritoneal dialysis (PD). This patient developed refractory hypotension after elective bilateral nephrectomies at 10 months of age. Despite outpatient management with sodium supplements and changes in PD fluid removal, the patient was hospitalized for refractory post-prandial hypotension with concurrent lactic acidosis. Blood pressure control and feeding tolerance was achieved using intermittent doses of midodrine, an oral alpha-adrenergic agonist. CONCLUSIONS We discuss this case to offer a therapeutic option for the rare occurrence of persistent post-nephrectomy hypotension.
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Affiliation(s)
- Amanda B Hassinger
- Department of Pediatrics, Division of Critical Care Medicine, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA.
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