Category Archives: Pediatrics

Pediatrics

Clinician quiz: AAP clinical practice guideline for treatment of children with obesity – Contemporary Pediatrics

Clinician quiz: AAP clinical practice guideline for treatment of children with obesity | Image Credit: Daqota - Daqota - stock.adobe.com.

Welcome to this Contemporary Pediatrics quiz. In this edition, we're asking you 5 questions from the American Academy of Pediatrics' (AAP) "Executive Summary: Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity."

The clinical practice guideline (CPG) was published January 9, 2023.

Authors noted the CPG aimed to inform pediatricians about standard of care for evaluating and treating children with overweight and obesity, along with related comorbidities.

According to the authors, the CPG is based on a "comprehensive evidence review of controlled and comparative effectiveness trials and high-quality longitudinal and epidemiologic studies."

The guideline acknowledges that childhood obesity can result from a multifactorial set of environmental, socioecological, and genetic influences that impact children and families.

At the time of guideline posting, the AAP stated 14.4 million children and adolescents were affected by obesity, both in current and long-term health aspects.

Click through each question below, make your selection and submit the answer.

What is the recommended age for pediatricians and other primary healthcare providers to evaluate children for abnormal glucose metabolism and abnormal liver function in the presence of obesity or overweight?

Interested in another quiz? Try this one:

Quiz: Recommendations for influenza control in children from the American Academy of Pediatrics

Reference:

Hample SE, Hassink SG, Skinner AC, et al. Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. The American Academy of Pediatrics. https://publications.aap.org/pediatrics/article/151/2/e2022060641/190440/Executive-Summary-Clinical-Practice-Guideline-for?searchresult=1?autologincheck=redirected

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Clinician quiz: AAP clinical practice guideline for treatment of children with obesity - Contemporary Pediatrics

Pediatrics

Contributed: Shortcomings and opportunities for health equity in pediatrics – Mobihealth News

Children and young people throughout the United States continue toface some of the biggest hurdles to receiving timely and appropriate healthcare. As incidence rates of mental health and complex medical conditionsrise, the majority of treatment-seeking children face strained health systems, limited affordable treatment options and care that is not personalized to their unique social, cultural and developmental needs.

Whiledigital health solutions have begun to offer some hope, there remains a disconnect between innovators and the health systems that they are solving for, resulting in products that do not fit clinical workflows, fail to meet the diverse needs of pediatric patients and ultimately struggle commercially.

Meeting user needs

A 15-year-old tells her doctor that she feels anxious. The doctor completes a brief assessment and diagnoses the patient with panic disorder. The doctor offers to write a prescription for an anti-anxiety medication and refers the patient to behavioral health services. The patient doesnt want to start taking medication, so she elects to be matched with a behavioral health service provider and is placed on a wait list.

Digital health technologies offer new forms of hope to young people and their families. Digital health interventions and telehealth areincreasing access to mental health and primary care services, making it easier for patients to find support when and where they need it.

To ensure that the right patients have access to the right technologies, hospitals are employing tools like AI to streamline patient referrals, provide more accurate diagnoses and gain insights into patient health trajectories that help them better predict and intervene appropriately. Since more still needs to be done to improve outcomes, reduce costs and improvethe shortcomings of digital health solutions in pediatric care, healthcare leaders from across the country are calling for greater attention to this space.

After struggling to find a therapist for a few months, the patient returns to her doctor. The doctor decides that the patient is a candidate for a new digital therapeutic. After getting set up with the app, the patient goes home and begins her treatment journey, only to find that the app doesnt seem relatable and worse isnt translated into her preferred language, making it difficult to comprehend. After a few days of trying it, she stops using the app.

Incidence rates of mental health conditions, such asdepression and anxiety, continue to rise throughout the United States, alongside the complexity of optimally treating patients with diverse needs. As the racial and ethnic makeup of the United Statescontinues to diversify, many families find it difficult to receive culturally competent care, raising the risk of negative healthoutcomes.

At a time when patients and families are increasinglyamenable to integrating digital solutions into their care experiences, their specific needs and requirements are often not being met. While digital health can address some of the most pressing issues of patient care, cohesive best practices for developing inclusive, culturally competent and ultimately equitablesolutions are largely absent.

To ensure continuity of care, the doctor would like to check their patients progress in the app and monitor any change in symptoms over time. While a dashboard exists to view this information, it is not integrated into the existing electronic health record system. Since this product is not interoperable with existing infrastructure, the provider is unable to use the dashboard and must wait to check in with their patient at her next six-month checkup. Rather than streamlining the providers process, the digital solution becomes yet another cog in their system.

Digital solutions have the potential to improve patient outcomes and supplement care. However, real challenges exist to their integration into clinical workflows and patients daily lives. Rather than delivering on the promise of streamlined care, digital solutions often cause fragmentation and interference in clinicians work, because their input and perspectives are unaccounted for.Without taking the unique needs of patients and clinicians into account, digital health solutions will see low uptake, activation ratesand ultimately struggle to succeed at scale.

Systematic barriers

The patient returns to the doctor after giving up on the app, saying that it was too complicated and difficult to understand. Fortunately, the doctor remembers learning about another app, one that is specifically designed for younger patients and delivers its content in various languages. However, this app isnt covered by the patients insurance and its out-of-pocket expense is too much for the family to afford. Left without a timely and appropriate treatment option, the patient risks worsening symptoms and long-term implications if her struggle to find care persists.

Even if solutions intended for children are built accordingly, they oftenhave a difficult time succeeding on the market. Struggles like this suggest that commercial incentives for pediatric digital health solutions are misaligned. Payers are hesitant to reimburse products with limited real-world evidence, while clinicians and health systems are inundated with a plethora of solutions but feel underprepared to adopt them. Ultimately, children and their families are left with a murky picture of which digital health solutions are available to them and how to pay for them.

Solving these challenges

Digital solutions promise to solve some of the most challenging aspects of care delivery, increase access and improve quality of life. However, when encountered in real settings, these tools often fail to meet diverse patient needs, do not integrate easily into clinical workflows and struggle to define real-world benefits. Ultimately, this perpetuates a cycle of inequitable and fragmented solutions that have no clear path to commercial success.

Delivering on the promise of digitization of pediatric care requires collaborative efforts between stakeholders, including clinicians, researchers, technology companies, investors, payers, policymakers and regulatory bodies.

Ian is a program lead at the Digital Medicine Society, where he leads a multi-stakeholder effort to create The Playbook: Pediatric Digital Medicine, an open access, action-oriented resource intended to catalyze innovation in pediatric healthcare. He has a background in research, operations and strategy related to medical devices and mental health, and is passionate about improving the lives of young people.

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Contributed: Shortcomings and opportunities for health equity in pediatrics - Mobihealth News

Pediatrics

Committed to physician education to enhance children’s health – UChicago Medicine

In 2023, the Department of Pediatrics made an unprecedented number of changes to its residency program to individualize and support residents learning experience.

Pediatric residents here have a personalized learning curriculum, multiple mentors specifically chosen to match residents research and clinical interests, individualized support, and ongoing feedback, allowing trainees to reach their highest potential, said pediatric hospitalist Nicola Orlov, MD, MPH, Residency Program Director and Associate Chair for Education.

The residents and fellows are an essential part of multidisciplinary teams that treat Chicagos most vulnerable kids. With each patient encounter, residents learn how to overcome social determinants of health and support children in getting the best care possible, said Orlov.

Many pediatric residency programs face major barriers in establishing robust mentorship programs, according to recent published research conducted by Orlov and colleagues. In the first-ever survey of U.S. pediatric residency mentorship programs, directors reported that a lack of funding and an inability to protect faculty time hampered their mentorship efforts.

Despite this nationwide trend in mentorship, UChicagos Department of Pediatrics training program recently doubled its leadership team by adding an additional five associate directors. These leaders have dedicated time to mentor their assigned residents in addition to their responsibility of ensuring continued innovation within the residency program.

Residents are paired with a second faculty mentor who serves as an advocate and supports them throughout their training in both their personal and professional lives.

From our research, we have identified and implemented new approaches to mentorship to ensure that our residents achieve their goals over the course of their training, said Orlov. We believe a more individualized approach that encourages trainees to share their personal and professional goals allows for better mentorship overall.

To support residents on their learning path, faculty members recognize that trainees have unique backgrounds and career goals. We are committed to fostering an inclusive environment, valuing the unique contributions of each trainee as we work together to address the health inequities of our patients, said Orlov. One aim of our program is to create psychological safety. Our residents know that we have their backs, that we are all learning, and that we are their advocates as they progress through residency.

In the coming academic year, residents will complete a new, one-month mental health outpatient rotation.

There is currently a huge burden of mental health illness among kids and adolescents, and its critical that pediatricians be able to manage disorders such as anxiety, depression and ADHD in their patients, said Orlov.

Clinical hours have been redistributed so residents spend more time learning in outpatient clinics in anticipation of 2025 requirements by the Accreditation Council for Graduate Medical Education. We have also analyzed previous residents board scores, their in-training exam scores, and the expectations of the American Board of Pediatrics to ensure that residents are well-prepared to take the boards and practice independently, she said.

Residents are being trained as patient safety experts as part of a robust safety curriculum that will include all clinical staff. Residents are expected to report any concerns about the safety of patient care, which will trigger an investigation and lead to strategies to prevent potential patient harm.

Residents will also receive feedback from families, nurses, attendings and clinical staff to help them assess their progress in residency and growth toward their goals.

Sometimes that feedback can be hard to hear, but it is important for residents to understand how they are perceived so they can improve their communication and professionalism skills with patients and better meet the needs of children and their families, said Orlov.

In 2023, 53 pediatric fellows participated in 13 subspecialty programs at Comer Childrens. The childrens hospital just added two more fellowships, Allergy and Immunology and Pediatric Hospital Medicine, for a total of 15 subspecialty fellowships.

Our institution has a wide range of fellowship programs, which enables us to provide immediate, state-of-the-art specialty care to every Comer patient, said neonatologist Bree Andrews, MD, MPH, who oversees the pediatric fellowship programs. Thats a very dynamic way to practice medicine.

Pediatric fellows at Comer are expected to devote 50% of their time to research to develop the expertise to treat clinically intricate problems in their subspecialty. Because the University of Chicago is renowned for the depth and breadth of its research, fellows receive unparalleled experience and exposure.

At UChicago Medicine, we have extensive expertise in bench science, translational science, quality improvement and population health, which is what our fellows want in a research experience, said Andrews.

The strong research component prepares physicians to conduct their own research after fellowship and to understand emerging research and the basic science behind treatments. Our fellows develop the tools and expertise to really make an impact in their fields, added Andrews.

At the other end of the medical-education continuum, Andrews teaches a premed course on the art of practicing medicine.

The Bucksbaum Institute launched the competitive, three-year Clinical Excellence Scholar Track (CEST) in 2013 to introduce undergraduates to the importance of the doctor-patient relationship, humanism and compassion in medical care.

Andrews is a CEST cohort leader as well as Senior Faculty Scholar at the Bucksbaum Institute. CEST requires that students provide 100 hours of volunteer service at UChicago Medicine and shadow physicians for at least 36 hours.

The early-career development program helps undergraduates decide what areas of medicine best suit their talents. Through their volunteer work, research experiences, and clinical shadowing, the undergraduates develop rich experiences, making them amazing candidates for medical school and shaping their interests in specialties such as pediatrics, she said.

Added Orlov: Regardless of where medical trainees are on their path to becoming leaders in pediatric care, our goal is to support their dreams and ambitions, foster their talents, and help them achieve their highest calling as pediatricians.

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Committed to physician education to enhance children's health - UChicago Medicine

Pediatrics

Washington University School of Medicine joins collaboration to improve pediatric heart disease care – News-Medical.Net

Washington University School of Medicine in St. Louis has joined the Pediatric Heart Network, a multicenter collaboration of leading hospitals and research institutions that works to improve care for pediatric heart disease patients.

Washington University School of Medicine in St. Louis has been named one of nine core sites in the Pediatric Heart Network, a national network of leading hospitals and research institutions that works toward improving outcomes and quality of life for children with heart disease.

The Pediatric Heart Network (PHN) is funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH), which will support Washington University named a core site together with Children's Hospital Colorado with $2.4 million over seven years.

The network targets pediatric heart diseases, particularly congenital heart disease in children and, more recently, in adults, unifying a somewhat fragmented research community. Over the past 22 years, the multicenter collaborative effort has supported 25 large studies, including 10 clinical trials, adding treatments and improving care for pediatric heart disease patients.

In the past, Washington University has been an auxiliary site for the network and was invited to participate when specific studies needed more patients. Now, as a core site, Washington University will participate in all PHN-led clinical studies and will have a seat at the table on the executive committee and all other PHN committees, helping to make decisions and shape the future of the network and its work.

Leading the new core site are Washington University's Andrew C. Glatz, MD, the Louis Larrick Ward Professor of Pediatrics and director of the pediatric departments cardiology division; and Jennifer N. Silva, MD, a professor of pediatrics in the cardiology division. From Children's Hospital Colorado, the core site leaders are Shelley Miyamoto, MD, chief of pediatric cardiology; and Emily Bucholz, MD, PhD, an assistant professor of pediatrics. The two centers will work together as the Gateway to the West Consortium, with regular virtual and in-person meetings as well as a shared plan to enhance diversity in research participants, and a shared mentorship model to train the next generation of pediatric cardiology clinical investigators.

For the last two decades, the Pediatric Heart Network has produced extremely influential research in the field of pediatric cardiology and congenital heart disease. Being part of this effort is indicative of the university's clinical and research excellence. We have the infrastructure and the expertise to be a valuable participant in this network, together with our site partner."

Andrew C. Glatz, MD, the Louis Larrick Ward Professor of Pediatrics, Washington University

Congenital heart disease is a birth defect that affects the structure of the heart and sometimes requires medical, surgical or transcatheter intervention to address blood flow and heart performance issues. One in 100 babies is born with this condition, and it is one of the most common causes of birth-defect-related infant death in the United States.

Washington University represents the Midwest, a region that historically has lacked representation in the network, according to Glatz.

Other Washington University investigators involved in the new core site are: Charles E. Canter, MD, a professor of pediatrics in the cardiology division, and the Lois B. Tuttle and Jeanne B. Hauck Chair in Pediatrics; Kory J. Lavine, MD, PhD, an associate professor of medicine, of developmental biology, and of pathology & immunology; Philip R.O. Payne, PhD, director of the Institute for Informatics, Data Science and Biostatistics, the Janet and Bernard Becker Professor, associate dean for health information and data science, and chief data scientist at the School of Medicine; and Adam Wilcox, PhD, a professor of medicine and director of the Center for Applied Clinical Informatics.

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Washington University School of Medicine joins collaboration to improve pediatric heart disease care - News-Medical.Net

Pediatrics

How to Treat Coughs in Kids – Health Matters

What is a cough? A cough is usually a reflex response to an irritant from a virus, to pollen, to cigarette smoke. Coughs are a way for the body to protect itself. They prevent irritants from getting deep into the lungs and help open our airways to exchange oxygen and carbon dioxide. For example, if you swallow water the wrong way, youre going to cough it up.

How do you diagnose whats causing the cough? First, we ask some basic questions. How long has the cough been happening and how often? What triggers it? Does the cough last just a couple of seconds or does it take minutes to recover? What makes it better? All of the information gives us hints to determine the cause of the cough.

With technology available, I also encourage parents to record the cough. Bringing a recording to your physician or the emergency department is very helpful, so we can observe any concerning signs of respiratory distress based on what were seeing on the video or hear on an audio recording.

Then we do a physical exam with a stethoscope to listen for sounds in the chest wall, neck, or the nose. This helps differentiate the cough between an upper respiratory cause versus a lower respiratory condition.

Some causes of cough can be detected with specific tests. Certain conditions like COVID, the flu, RSV, or strep can be checked in the office or emergency room if there is a high likelihood of these illnesses. Other conditions, like asthma, may require special exams like a pulmonary function tests.

How long do coughs usually last? It depends on whats causing of the cough. Most colds take three to five days to peak, but the symptoms can last up to two weeks so coughing for 10 to 14 days for a common cold is not unusual, especially in pediatrics.

With other conditions, like pneumonia, the cough may last a month after the main part of the illness is over. If the cough is lasting beyond the expected time, your provider may ask the child to come in more often to be monitored.

How long is a child contagious? It depends on the virus. In most cases, the first five to seven days of a cold is when your child is contagious. Fever can be an indicator of the contagious period. The likelihood of spreading the virus decreases after a week. Your doctor can give specific advice based on the virus.

When should children see a doctor about a cough? We always think about whether the cough interferes with daily activity. So for children, daily activity means going to school, sleeping, playing, or eating. If it interferes with any of those, that is a reason to see a physician. If the child has a cough and a fever that lasts more than five days, then those are signs to see a doctor too.

Another concern is respiratory distress. If the cough causes your child to breath faster than normal, or parents are noticing the breathing is visible underneath the rib cage or in the neck bone, or the nostrils are flaring to breathe those are signs that the body is working too hard. Many children can breathe 30 breaths per minute. For an adult, that would be way too fast. The older you are, the slower your normal breathing rate is. So if a child is breathing faster than normal, that would be reason to seek medical attention.

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How to Treat Coughs in Kids - Health Matters

Pediatrics

Discontinuing contact precautions for pediatric patients with methicillin-resistant Staphylococcus aureus – Contemporary Pediatrics

Discontinuing contact precautions for pediatric patients with methicillin-resistant Staphylococcus aureus | Image Credit: John Doe - John Doe - stock.adobe.com.

A recent study, published in the Journal of the Pediatric Infectious Diseases Society, analyzed a pediatric health system's experience discontinuing contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA), spanning 4 years.

The findings, indicating sustained infection control success, support the potential extension of this approach to other pediatric facilities.

Key factors include strong adherence to horizontal infection prevention measures and early engagement with stakeholders.

To learn more about the study and its findings, our sister publication Infection Control Today interviewed study authors Michael Sebert, MD, medical director, infection prevention and control, Children's Health Dallas; Zachary Most, MD, assistant professor, Department ofPediatrics, UT Southwestern Medical Center; associate medical director of infection prevention and control, Childrens Health Dallas and serves on the COVID-19 Modeling Group and the Optum Database Research Group at UT Southwestern; and Bethany Phillips, MPH, CIC, MLS (ASCP)CM, director, infection prevention & control at Children's Health, Childrens Health System of Texas, Childrens Medical Center, Dallas, Texas.

Question:

Can you provide an overview of the study's methodology and the specific measures taken when discontinuing contact precautions (CP) for pediatric patients with methicillin-resistantStaphylococcus aureus(MRSA)?

Michael Sebert, MD; Zachary Most, MD; and Bethany Phillips, MPH, CIC, MLS (ASCP)CM:The study was a quasi-experimental retrospective analysis of MRSA infection and colonization rates before and after discontinuation of the requirement for contact precautions for patients with MRSA at our facilities. This change was implemented in September 2019, and outcomes were tracked for 4 years afterwards through August 2023. MRSA infections were measured using the National Healthcare Safety Networks LabID definition. Statistical analyses were conducted using interrupted time series (ITS) and aggregate rate ratios.

Our infection prevention department conducted an evidence-based practice project as part of preparing to discontinue CP for MRSA. This project included a review of local baseline data on health care-associated MRSA infection and colonization, an evaluation of our current and planned horizontal infection prevention measures, and a review of reported experiences from other facilities following the discontinuation of CP for MRSA. We met in advance with physician and nursing leaders from key areas, including pediatric and neonatal intensive care units (PICU and NICU) and hematology/oncology, to discuss the rationale for the change and plans for implementation. Education on the practice change along with proper use of standard precautions was provided to all staff before the change.

Discussion with the NICU led to the decision that CP for MRSA would be selectively continued in that unit due to concerns about the potential for importation of multidrug-resistant organisms from other NICUs in the region that transfer patients into our unit. The open-bay architecture of our NICUthe only area in our hospitals where not all inpatients have single-patient roomsalso contributed to this decision.

Because our electronic health record (EHR) utilized infection control flags to identify patients with a history of MRSA as requiring CP. These flags persisted between encounters, and therefore assistance from our Informatics team was crucial to implement an automated procedure to remove the MRSA flags from the charts of all patients except those in the NICU. For patients who were currently admitted on the date of the change, the infection preventionists worked with the inpatient units to make sure that CP were removed when appropriate but retained if there was another indication for CP such as a resistant gram-negative pathogen or a respiratory viral infection requiring CP.

Question:

What were the key findings of the study regarding the incidence density rate of LabID health care facility-onset MRSA infections after the discontinuation of CP for MRSA in the pediatric health care system?

Sebert, Most, and Phillips:ITS analysis showed no change in the incidence density rate of LabID health care facility-onset MRSA infections associated with the discontinuation of CP for MRSA. Likewise, there was no change in the aggregate incidence density rate of these infections (rate ratio = 0.98, 95% confidence interval 0.74 to 1.28). This provides long-term data for the safety of this approach using a broad measure of MRSA infections, which had previously been lacking in pediatric health care settings.

Question:

The study mentions a decrease in the prevalence rate of contact isolation days. How did the health care system ensure good adherence to horizontal infection prevention measures after discontinuing CP, and what impact did it have on infection rates?

Sebert, Most, and Phillips:

After providing house-wide education about standard precautions, our infection preventionists solicited and trained health care personnel (HCP) volunteers to perform observations of personal protective equipment (PPE) usage by other HCP starting in May 2019.

These observations and feedback focused on appropriate use as indicated by exposure risks as well as when required by transmission-based precautions. Findings were generally favorable and supported the decision to discontinue CP for MRSA later that fall. These observations continued through the beginning of 2022 to ensure that practice did not drift.

Horizontal infection prevention processes at our hospitals that may not be standard everywhere include high-touch surface cleaning by nursing staff of inpatient rooms twice per shift. This process focuses on surfaces such as bedrails and IV pumps that are frequently contacted by patients and/or HCP. Completion of high-touch surface cleaning must be documented, and adherence is reported to unit leadership.

This cleaning is a supplemental measure above and beyond daily cleaning by the environmental services (EVS) department. To monitor the effectiveness of routine cleaning, our infection prevention team has also partnered with EVS to use fluorescent markers as an objective measure of cleaning and to provide feedback to EVS staff.

Other ways that adherence to horizontal infection prevention measures is monitored include hand hygiene observations and audits of prevention bundles for health care-associated infections (HAIs), including central line-associated bloodstream infections and catheter-associated urinary tract infections. Although these measures are subject to bias from the observation process itself (Hawthorne effect), adherence appeared to be high and contributed to our confidence in ending CP for MRSA.

Our observational study cannot address the specific impact of these horizontal infection prevention measures on MRSA infection rates after stopping CP.

The published experiences with successful discontinuation of CP for MRSA at other facilities, however, consistently emphasize the importance of these horizontal measures. Our experience was similar and cannot be extrapolated to facilities where adherence to horizontal infection prevention measures may not be high.

Question:

Were there any unexpected challenges or outcomes observed during the 4-year period after discontinuing CP for MRSA in the pediatric health care settings?

Sebert, Most, and Phillips:The most surprising part of the entire process of discontinuing CP for MRSA was how uneventful it was. Acceptance of the change was high among staff and patient families. Utilizing an evidence-based practice project model for implementing this sort of large-scale change may have assisted in the positive reception from staff. They were engaged throughout the project via questionnaires soliciting feedback on our current practice, participating in the creation of the education, serving as PPE auditors, and, most importantly, they were able to review the rationale behind the practice change. Health care-associated MRSA infection rates were monitored and reported to the hospitals infection control committees on a quarterly basis without concerning trends being identified.

Question:

The study suggests that the experience supports considering the discontinuation of CP for MRSA in similar pediatric health care settings. What factors, in your opinion, contributed to the success of this approach, and what considerations should other pediatric facilities keep in mind when making such decisions?

Sebert, Most, and Phillips:As mentioned above, we believe that strong adherence to horizontal infection prevention measures such as hand hygiene, standard precautions, environmental cleaning, and HAI prevention bundle elements were collectively key to the success of this approach. A review of baseline data before implementing the change showed no recent outbreaks or clusters of health care-associated MRSA infections. Other institutions considering a similar discontinuation of CP for MRSA should conduct a risk assessment, evaluate horizontal infection prevention measures, and review surveillance data to ensure that there have not been unrecognized clusters of health care-associated MRSA infections.

In addition to strong adherence to infection prevention measures, engaging key stakeholders early in the process contributed to the successful implementation of the practice change. Employing our infection preventionists together with our medical director as a physician advocate when initiating discussions with the clinical teams allowed our IP team to ensure that we were able to gain the confidence of medical providers while also providing an approachable forum for the frontline staff to provide their valuable input.

Question:

Given the positive outcomes observed in the pediatric health care system, do you believe the findings could be extrapolated to other pediatric facilities, and what implications might this have for the broader approach to managing MRSA in pediatric health care settings?

Sebert, Most, and Phillips::We are optimistic that our success with discontinuing CP for MRSA might be extended to other pediatric facilities in the setting of good adherence to horizontal infection prevention measures. The strength of our study, however, is qualified in that was a retrospective observational analysis at a single institution. The data supporting this approach in pediatric health care settings remain more limited than what has been published from facilities caring for adults. As more pediatric facilities consider discontinuation of CP for MRSA, multicenter studiesincluding control sites where CP have been maintainedwould shed more light on this still controversial topic.

The issue addressed in our study about the requirement for CP in patients with MRSA is only one aspect of the overall care of these patients.

Timely recognition, diagnosis, and treatment of infection remain critical whether or not an institution has continued CP for MRSA. Unsettled questions also remain regarding whether active surveillance for MRSA in health care settings may provide benefits and about the role for decolonization strategies in patients identified to have MRSA infection or colonization.

Thestudyis titled Discontinuation of Contact Precautions for Methicillin-resistantStaphylococcus aureusin a Pediatric Healthcare System.

This interview was initially published by our sister publication, Infection Control Today.

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Discontinuing contact precautions for pediatric patients with methicillin-resistant Staphylococcus aureus - Contemporary Pediatrics

Pediatrics

COVID-19 vaccination during pregnancy and offspring neurodevelopment – Contemporary Pediatrics

COVID-19 vaccination during pregnancy and offspring neurodevelopment | Image Credit: adipurnatama - adipurnatama - stock.adobe.com.

The increase in COVID-19 vaccination in pregnant people has brought on safety concerns for the unborn child and questions of neurodevelopment. Results of a prospective cohort study published in JAMA Pediatrics suggest that in utero vaccination was safe for the infant regarding neurodevelopment up to 18 months of age.

Pregnant individuals were excluded from early, large-scale clinical trials of COVID-19 vaccines, leaving questions about the impact from vaccine exposure that the offspring could face.

Ranging genetic and environmental factors could underline neurodevelopmental disorders, with fetal exposure to maternal inflammation presenting a potential source for risk.

For example, the authors wrote. In utero exposures to other infections including influenza and rubella have been linked to subsequent increases in lifelong neurodevelopmental and psychiatric impairments including autism spectrum disorder, intellectual disability, schizophrenia, anxiety, and depression."

To determine if in utero exposure to maternal COVID-19 vaccination was associated with risk for neurodevelopmental impairment in 12- and 18-month-old infants, investigators designed the prospective cohort Assessing the Safety of Pregnancy During the Coronavirus Pandemic (ASPIRE) study.

From May 2020 to August 2021, the study enrolled pregnant people aged 18 years and older at 10 weeks gestation or less. Completing study activities remotely, participants were followed up through pregnancy and for up to 2 years postpartum.

Completion of the baseline demographics questionnaire, the Ages and Stages Questionnaire (3rd edition [ASQ-3]) at 12 and 18 months postpartum, and of the vaccine history questionnaire (monthly) were inclusion criteria.

An abnormal screen on the ASQ-3, which would indicate risk for developmental delay, was the primary outcome of the study. The investigators established that, An abnormal screen was defined as falling below the established threshold score (<2 SDs below the normative data average) on any of 5 subdomains: communication, gross motor, fine motor, problem solving, and social skills.

The ASQ-3 featured 30 questions to indicate the frequency in which their child performed expected milestones, as scores ranged from 0 to 60 (worst to best, respectively). According to authors, the screener is valid, reliable, and ubiquitous in clinical and research settings, with sensitivity of 86%, specificity 85%,and positive and negative predictive values of 54% and 78%, respectively.

Vaccination for COVID-19 during pregnancy was the primary exposure, which was indicated by self-report and confirmed by investigators using dates of vaccinations compared to estimated dates of conception and delivery. Any dose of a vaccine series qualified as exposure, with the majority being messenger RNA vaccines.

In all, 2487 pregnant individuals were enrolled at less than 10 weeks gestation. With completed research activities, a total of 2261 aged 12 months and 1940 aged 18 months with neurodevelopmental assessments were included.

At 12 months, the prevalence of abnormal screens for developmental delay (ASQ-3 scores below established cutoff on at least 1 domain) was 30.6% among exposed. The prevalence of abnormal screens for unexposed at 12 months was 23.2% (2= 2.35;P=.13).

No differences were observed in risk of abnormal screen on the ASQ-3 after in utero exposure to vaccination at 12 or 18 months after adjusting for baseline race, ethnicity, maternal age, education, household income, depression, and anxiety (12 months: aRR, 1.14; 95% CI, 0.97-1.33; 18 months: aRR, 0.88; 95% CI, 0.72-1.07).

Without regard to exposure status, investigators observed more abnormal screens for developmental delay among male infants at 12 and 18 months of age compared to female infants, respectively (12 months: 325 of 980 [33.2%] vs 278 of 984 [28.3%]; 2= 5.57;P=.02; 18 months: 210 of 872 [24.1%] vs 161 of 836 [19.3%]; 2= 5.84;P=.02).

For female infants, a divergent pattern was demonstrated, as at 12 months, there was no difference in risk of abnormal ASQ-3 screen among exposed vs unexposed (aRR, 1.02; 95% CI, 0.81-1.30), though a reduction of risk was observed for exposed female infants at age 18 months (aRR, 0.69; 95% CI, 0.51-0.93).

Findings from the cohort study suggest that, maternal vaccination against COVID-19 during pregnancy was safe from the perspective of offspring neurodevelopment through 18 months of age, the study authors concluded.

Reference:

Jaswa EG,Cedars MI,Lindquist KJ, et al. In utero exposure to maternal COVID-19 vaccination and offspring neurodevelopment at 12 and 18 months.JAMA Pediatr.Published online January 22, 2024. doi:10.1001/jamapediatrics.2023.5743

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COVID-19 vaccination during pregnancy and offspring neurodevelopment - Contemporary Pediatrics

Pediatrics

Recent reports of measles in multiple states – Contemporary Pediatrics

Recent reports of measles in multiple states | Image Credit: weerapat1003 - weerapat1003- stock.adobe.com.

In the recent days and weeks, cases of measles have been reported in Delaware, New Jersey, Georgia, Pennsylvania, Virginia, and Washington State, according to an American Academy of Pediatrics (AAP) News report.1

Transmitted through contact of droplets or airborne spread via breathing, coughing, or sneezing from an infected individual, measles can remain in the air for up to 2 hours.1

[These reports are] not really surprising given the decrease in vaccination rates that have been occurring since the pandemic, said Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief,Contemporary Pediatrics; professor of pediatrics, Feinberg School of Medicine, Northwestern University; pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago.

This is not new and demonstrates what is known, in that if vaccination rates do not stay at a level that is protective, outbreaks of vaccine preventable diseases will occur, said Tan.

The acute viral respiratory illness can be characterized by fever as high as 105 degrees Fahrenheit and malaise, coryza, cough, and conjunctivitis, a pathognomonic enanthema followed by a maculopapular rash, according to the Centers for Disease Control and Prevention (CDC).2

The CDC states that up to 9 out of 10 susceptible persons with close contact to an infected measles patient will develop the infectious disease. Infants and children aged younger than 5 years are at high-risk for severe illness and further complications from measles.2

Routine childhood immunization for the measles-mumps-rubella (MMR) vaccine is recommended at 12 to 15 months of age for the first dose, with the second coming at ages 4 through 6 years, or at least 28 days after first dose.2

The MMR-varicella (MMRV) vaccine is available to children 12 months through 12 years of age, with 3 months being the minimal interval between doses.2

Clinicians need to understand that the United Statesand multiple other countries around the worldare currently in an environment where vaccination rates have fallen below protective levels given the significant increase in vaccine hesitancy and major decrease in vaccination rates, Tan told Contemporary Pediatrics. Measles and other vaccine preventable diseases need to be on the differential diagnoses of children presenting with signs and symptoms that may be associated with these diseases.

According to the CDC, evidence of immunity for measles includes at least 1 of the following:2

The AAP News report states a CDC study recently revealed that 93% of kindergartners were fully vaccinated against measles in the 2022 to 2023 school year, marking it the third consecutive year that vaccination rates were below the Healthy People 2030 target of 95%.1

There has been a decrease in vaccination rates here in Chicago and other areas of the United States due to an increase in vaccine hesitancy, added Tan. There has also been an increase in parents seeking notes of medical and philosophical exemption so that they do not have to vaccinate their children.

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Recent reports of measles in multiple states - Contemporary Pediatrics