OBJECTIVE: To assess lung function and bronchodilator reversibility via the impulse oscillometry system (IOS) in 3- to 6-year-old children with bronchopulmonary dysplasia, a population historically difficult to evaluate...OBJECTIVE: To assess lung function and bronchodilator reversibility via the impulse oscillometry system (IOS) in 3- to 6-year-old children with bronchopulmonary dysplasia, a population historically difficult to evaluate via spirometry. STUDY DESIGN: A retrospective review of IOS in 3- to 6-year-old children was conducted. Clinical data were abstracted from electronic medical records, including a modified St George's Respiratory Questionnaire scored according to symptoms, activity, and impact. RESULTS: We analyzed 103 IOS reports in 73 patients (median age 4.1 years; IQR 3.5-5.0); of these, 52.4% were acceptable and repeatable. At least 1 parameter was abnormal in 78% of reports, including elevated resistance with median z scores for R (1.8; IQR 0.9-2.8) and R (1.4; IQR 0.8-2.2) and decreased reactance with median AX (2.6; IQR 0.8-3.3), F (1.4 IQR; 0.6-2.4), and X (-2.4 IQR; -3.7 to -1.4]). Median z scores for the cohort normalized after the administration of albuterol. Improved resistance and reactance were observed on clinic follow-up IOS in children treated with inhaled corticosteroid/long-acting beta-agonists. The cohort had increased morbidity, with total St George's Respiratory Questionnaire score of 12.1 (IQR 7.6-25.6), symptom score of 32.5 (IQR 17.2-46.8), activity score of 7.6 (IQR 0-29.8), and impact score of 7.4 (IQR 0-17.1). CONCLUSIONS: IOS can be performed by one-half of preschool-aged children with bronchopulmonary dysplasia and reveals abnormal lung function characterized by elevated airway resistance and decreased reactance that is bronchodilator-responsive. IOS is a feasible technique to evaluate objectively the early, critical changes in respiratory health and response to medical therapy in a population in whom other methods are not available.
Farrar DS, Huang RS, Donner EJ
… +17 more, Bettinger JA, Campigotto AJ, Di Chiara C, Drouin O, Embree JE, Halperin SA, Jadavji T, Kazmi K, Moore Hepburn C, Papenburg J, Purewal R, Sadarangani M, Sauvé L, Top KA, Kakkar F, Morris SK, Canadian Immunization Monitoring Program, Active (IMPACT) Investigators
OBJECTIVE: To estimate the association between chronic neurologic disorders (NDs) and severe COVID-19 among hospitalized children and youth, and assess how multimorbidity (ie, ≥2 chronic comorbidities) modifies this asso...OBJECTIVE: To estimate the association between chronic neurologic disorders (NDs) and severe COVID-19 among hospitalized children and youth, and assess how multimorbidity (ie, ≥2 chronic comorbidities) modifies this association. STUDY DESIGN: We conducted a national surveillance study at 13 children's hospitals in Canada from April 2020 to December 2022, via the Canadian Paediatric Surveillance Program and Canadian Immunization Monitoring Program, ACTive. Eligible cases were aged <17 years old and hospitalized for COVID-19. Chronic comorbidities were classified using the Medical Dictionary for Regulatory Activities. Severe COVID-19 was defined as intensive care unit admission, ventilatory/hemodynamic support, systemic complications, and/or death. Mixed-effects robust Poisson regression was conducted to estimate adjusted prevalence ratios (aPRs) between NDs and severe COVID-19, with interaction terms accounting for multimorbidity. RESULTS: Among 3218 cases hospitalized for COVID-19, 601 (18.7%) had NDs. Most cases with NDs had ≥2 chronic comorbidities (n = 476/601, 79.2%). Severe COVID-19 was more common among cases with cerebral palsy (aPR 1.30, 95% CI 1.08-1.57), epilepsy (aPR 1.50, 95% CI 1.14-1.96), genetic disorders with neurologic abnormalities (aPR 1.41, 95% CI 1.18-1.67), and neuromuscular disorders (aPR 1.37, 95% CI 1.08-1.75). Compared with cases without comorbidities, there was a dose-response relationship among ND cases in which additional comorbidities increased associations with severe COVID-19 (eg, aPR 1.29 [95% CI 1.03-1.62] for cases with 1 comorbidity; aPR 2.86 [95% CI 2.11-3.87] for cases with ≥ 4 comorbidities). CONCLUSIONS: Children and youth with NDs are disproportionately affected by severe COVID-19, and patients with multimorbidity were at greatest risk. Many cases with NDs remained unvaccinated against SARS-CoV-2 and may benefit from efforts to encourage vaccine uptake.
A 15-year retrospective cohort study of 53 830 children 6-59 months old in a Federally Qualified Health System identified 10 febrile seizures 7-14 days after measles vaccination (incidence rate 2.05 [95% CI 0.98, 3.77] p...A 15-year retrospective cohort study of 53 830 children 6-59 months old in a Federally Qualified Health System identified 10 febrile seizures 7-14 days after measles vaccination (incidence rate 2.05 [95% CI 0.98, 3.77] per 100 000 person-days); all had concurrent illnesses and co-administered vaccines. To date, no child has developed epilepsy.
OBJECTIVE: To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia in neonatal intensive care units (NICUs) across Europe. STUDY DESIGN: Between March and July 2024, a web-based surve...OBJECTIVE: To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia in neonatal intensive care units (NICUs) across Europe. STUDY DESIGN: Between March and July 2024, a web-based survey was sent to European NICUs caring for infants born preterm with gestational age <28 weeks. RESULTS: We received replies from 447 of 721 (62%) NICUs across 24 European countries. Almost 16% of NICUs routinely intubate at birth, especially if the gestational age is <24 weeks. During transition most NICUs use continuous positive airway pressure ≥5 cmHO and start with an FiO 0.3. Volume-targeted ventilation is the primary ventilation mode in 60% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96%). Surfactant is used in all NICUs, mostly rescue (74%) via less invasive administration (81%). Prophylactic inhaled nitric oxide is not used. Treatment of patent ductus arteriosus varies; half of NICUs pharmacologically treat patent ductus arteriosus early, based on echocardiographic findings. Ureaplasma screening is done in 22% of NICUs. Most (97%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65%) and starting 2-3 weeks after birth. Only 5% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent. CONCLUSIONS: This large survey shows considerable practice variation in preventing and treating evolving bronchopulmonary dysplasia across Europe, especially for interventions with limited evidence.
OBJECTIVE: To evaluate in children the cytotoxic and mutagenic effects of exposure to drinking water contaminated with potentially toxic elements (PTEs). STUDY DESIGN: Forty-nine children (6 and 14 years), residing in a...OBJECTIVE: To evaluate in children the cytotoxic and mutagenic effects of exposure to drinking water contaminated with potentially toxic elements (PTEs). STUDY DESIGN: Forty-nine children (6 and 14 years), residing in a region with environmental PTE contamination, and 19 children from an unexposed region were assessed. Cytotoxicity and mutagenicity were analyzed by the micronucleus assay in exfoliated buccal mucosal cells. Water contamination was evaluated by inductively coupled plasma mass spectrometry. The Mann-Whitney U test was applied to compare the exposed and unexposed groups. Principal component analysis and Spearman's correlation test were used to evaluate the association between cellular effects and each PTE. RESULTS: Significantly higher mean values of binucleated cells and karyolysis were observed in the exposed group, while micronuclei, karyorrhexis, pyknosis, and normal cells were significantly reduced compared with the unexposed group (P ≤ .002). Analysis of drinking water samples from the exposed area revealed lead (Pb), antimony (Sb), arsenic (As), and cadmium (Cd) concentrations below the maximum permitted values. There was a moderate association between binucleated cells and Pb (r = 0.64) and between karyolysis and As (r = 0.61) and Sb (r = 0.61). Pyknosis and karyorrhexis were negatively correlated with As (r = -0.65 and -0.52) and Sb (r = -0.64 and -0.53). CONCLUSIONS: Children residing in areas with PTE-contaminated water, even at minimal levels, exhibited elevated frequencies of karyolysis and binucleated cells. Although the levels of PTE do not exceed the permitted limits, chronic exposure was associated with DNA damage.
Antimicrobial resistance is life-threatening to pediatric patients with medical complexity who receive multiple courses of broad-spectrum antibiotics. Bacteriophages offer a safe treatment alternative when our antibiotic...Antimicrobial resistance is life-threatening to pediatric patients with medical complexity who receive multiple courses of broad-spectrum antibiotics. Bacteriophages offer a safe treatment alternative when our antibiotic armamentarium is no longer sufficient. We describe successful use of bacteriophage therapy on a patient with a recalcitrant Pseudomonasaeruginosa infection after receiving a multiorgan transplant.
OBJECTIVE: To quantify the impact of nonhemodynamically significant patent ductus arteriosus (non-hsPDA) on pulmonary function in neonates. STUDY DESIGN: We analyzed a retrospective cohort of very low birthweight (<1500...OBJECTIVE: To quantify the impact of nonhemodynamically significant patent ductus arteriosus (non-hsPDA) on pulmonary function in neonates. STUDY DESIGN: We analyzed a retrospective cohort of very low birthweight (<1500 g) infants born <32 weeks' gestation admitted to a single tertiary neonatal intensive care unit between 2019 and 2023 who underwent both echocardiography and pulmonary function testing at approximately 34 weeks postmenstrual age. Infants with ventricular or atrial septal defects were excluded. Passive respiratory compliance (Crs) was compared among infants with hsPDA, non-hsPDA, and age-matched controls without PDA using one-sided t-tests and ANOVA, with multivariable regression controlling for birth weight and length. RESULTS: Twenty-four infants were analyzed (8 hsPDA, 8 non-hsPDA, 8 controls). Mean Crs was significantly reduced in both hsPDA (0.83 ± 0.34 mL/cmHO/kg) and non-hsPDA (0.92 ± 0.21) groups compared with controls (1.23 ± 0.34; P < .05). The presence of PDA demonstrated a stepwise inverse relationship with Crs that persisted after adjustment for covariates. CONCLUSIONS: Even non-hsPDAs are associated with measurable reductions in pulmonary compliance among preterm infants. These findings suggest that current binary classifications of PDA significance may underestimate pulmonary impact and support re-evaluation of management thresholds for "non-significant" shunts.
OBJECTIVE: To evaluate the risks of incident dyslipidemia and abnormal body mass index (BMI) during the 28-179-day postacute phase after documented SARS-CoV-2 infection in a large pediatric sample. STUDY DESIGN: A retros...OBJECTIVE: To evaluate the risks of incident dyslipidemia and abnormal body mass index (BMI) during the 28-179-day postacute phase after documented SARS-CoV-2 infection in a large pediatric sample. STUDY DESIGN: A retrospective cohort study using the Researching COVID to Enhance Recovery pediatric electronic health record datasets from 25 US children's hospitals and health institutions, from March 2020 to September 2023. This study included 384 289 COVID-19-positive patients aged 0-21 years for dyslipidemia analyses and 285 559 aged 2-21 years for BMI analyses, each with at least 6 months of follow-up. COVID-19-negative controls included 1 080 413 and 817 315 patients, respectively. SARS-CoV-2 infection was defined by a positive polymerase chain reaction, antigen, or serologic test; a clinical diagnosis of COVID-19; or a documented diagnosis of post-acute sequelae of SARS-CoV-2. Incident dyslipidemia and abnormal BMI were identified using age-specific laboratory or anthropometric thresholds. Adjusted relative risks (aRRs) were estimated using propensity-score-stratified modified Poisson regression with multiple sensitivity analyses. RESULTS: During the postacute phase, the COVID-19-positive cohort had higher rates of new-onset composite dyslipidemia (aRR 1.24; 95% CI 1.18-1.29) and abnormal BMI (aRR 1.15; 95% CI, 1.12-1.18). Results were robust to sensitivity and stratified analyses. CONCLUSIONS: Children and adolescents with documented COVID-19 infection were associated with an increased risk of new-onset dyslipidemia and abnormal BMI during the postacute phase, highlighting the need for metabolic monitoring after infection.
OBJECTIVE: To investigate the effect of fetal growth restriction (FGR) on cardiovascular structure and function in childhood in a growth-discordant identical twin model, thereby adjusting naturally for genetic, obstetric...OBJECTIVE: To investigate the effect of fetal growth restriction (FGR) on cardiovascular structure and function in childhood in a growth-discordant identical twin model, thereby adjusting naturally for genetic, obstetric, and environmental confounding factors. STUDY DESIGN: This study is part of the LEMON cohort study of growth-discordant identical twins born at the Leiden University Medical Center, The Netherlands. Echocardiography was prospectively performed in 42 twin pairs aged between 5 and 17 years. Growth discordance was defined as a birth weight discordance ≥20%. Outcome measures were compared between the smaller and larger twin and included structural measures (left ventricular [LV] dimensions and carotid intima-media thickness) as well as functional measures (LV systolic and diastolic function using Doppler and LV strain imaging, and aortic pulsed wave velocity). RESULTS: Median gestational age at birth was 34.1 weeks (IQR 31.6-36.0) with median birth weights of 1471 g (IQR 1114-1876) and 2025 g (IQR 1623-2705) for the smaller and larger twin, respectively. Median age at echocardiography was 11 years (IQR 9-14). Smaller twins presented with significantly lower LV global longitudinal strain (-19.6% vs -20.7%), and higher mitral peak E and A velocities, and mitral E/e' ratio compared with larger co-twins. No within-pair differences were found regarding structural cardiovascular parameters, carotid intima-media thickness and aortic pulsed wave velocity. CONCLUSIONS: In a growth-discordant identical twin model, FGR is associated with subclinical changes in myocardial structure and systolic and diastolic LV function in the smaller growth-restricted twin compared with the larger appropriately-grown co-twin. This finding indicates that adverse cardiovascular remodeling after FGR persists into childhood, potentially influencing long-term risk of cardiovascular disease. TRIAL REGISTRATION: International Clinical Trial Registry Platform ID NL9833 (https://trialsearch.who.int/).
OBJECTIVE: To assess associations between exposure to intrauterine SARS-CoV-2 and subsequent child neurodevelopment in a large, diverse cohort with confirmation of maternal SARS-CoV-2 status. STUDY DESIGN: The Researchin...OBJECTIVE: To assess associations between exposure to intrauterine SARS-CoV-2 and subsequent child neurodevelopment in a large, diverse cohort with confirmation of maternal SARS-CoV-2 status. STUDY DESIGN: The Researching COVID to Enhance Recovery (RECOVER) Pregnancy Cohort enrolled adults with and without SARS-CoV-2 during pregnancy and their offspring born January 2020 through December 2023 at 23 sites across the US. Neurodevelopment was assessed at 12 months with the Ages & Stages Questionnaire, 3rd edition (ASQ-3) and at 18 months with the ASQ Social-Emotional (ASQ-SE) and the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). We compared exposed and unexposed infants' ASQ-3 total and subdomain scores, ASQ-SE and M-CHAT-R scores, and proportions meeting published referral thresholds, using multivariable linear and logistic regression. RESULTS: Among 1179 participants enrolled, 1008 (85.5%) had exposure, with 806 (80.0%) exposed during Omicron predominance. Of those with known timing, 349 (41.4%) and 295 (35.0%) were exposed in the second and third trimesters of pregnancy, respectively. Exposure was not associated with differences in the ASQ-3 (adjusted difference -0.61, 95% CI -10.03 to 8.81) or ASQ-3 subdomains at 12 months, ASQ-SE at 18 months (adjusted difference 0.19, 95% CI -4.02 to 4.41), or M-CHAT-R scores. Findings were similar for proportions meeting referral thresholds and when stratified by variant or by trimester. CONCLUSIONS: In this multicenter cohort largely exposed since Omicron and in second or third trimester, intrauterine SARS-CoV-2 exposure was not associated with neurodevelopmental screening outcomes through 18 months of age. Further assessments of the impact of intrauterine SARS-CoV-2 on neurodevelopment beyond 18 months of age are needed.
McClure DL, Hanson KE, Sundaram ME
… +12 more, Kieke BA, Duffy J, McNeil MM, Glanz JM, Irving SA, Williams JTB, Kharbanda EO, Xu S, Zerbo O, Nelson JC, Belongia EA, Weintraub ES
OBJECTIVE: To assess any potential associations between epilepsy and up-to-date (UTD) vaccination status or cumulative aluminum exposures from vaccines among children aged less than 4 years. STUDY DESIGN: We conducted a...OBJECTIVE: To assess any potential associations between epilepsy and up-to-date (UTD) vaccination status or cumulative aluminum exposures from vaccines among children aged less than 4 years. STUDY DESIGN: We conducted a case-control study in the Vaccine Safety Datalink cohort from 2008 through 2018. Epilepsy cases were identified up to 4 years of age by diagnosis codes with accompanying by antiseizure medication prescriptions. Controls had no diagnosis codes for epilepsy/seizures and no antiseizure medication before 4 years of age. Each case was matched to up to 10 controls. Cases and controls were matched on birthdate, sex, and Vaccine Safety Datalink site. Th exposures were age-specific UTD vaccination status categories and continuous, cumulative aluminum content per adjuvant formulation from vaccination. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals for the associated risk of epilepsy. Secondary analyses were performed by age subgroups and limited to children with epilepsy of unknown etiology.e RESULTS: The primary analysis included 2089 cases and 20 139 matched controls. No adjusted odds ratio for risk of epilepsy was greater than 1 either for UTD immunization status or for cumulative exposure to aluminum per mg increase per adjuvant formulation. In addition, there was no statistically significant relationship in analyses by age group or limitation to children with epilepsy of unknown etiology. CONCLUSIONS: Incident epilepsy was not associated with UTD vaccination status or cumulative vaccine aluminum exposure among children aged less than 4 years.
OBJECTIVE: To build a time-series machine learning (ML) model that improves bronchopulmonary dysplasia (BPD) prediction compared with published online calculators. STUDY DESIGN: We used a single-center, extremely low ges...OBJECTIVE: To build a time-series machine learning (ML) model that improves bronchopulmonary dysplasia (BPD) prediction compared with published online calculators. STUDY DESIGN: We used a single-center, extremely low gestational age newborn cohort (inborn, birth year 2016-2021, n = 438). The primary outcome was a 5-level class outcome for BPD as defined by the Neonatal Research Network (NRN) in 2019. Flowsheet data were extracted from the electronic medical record. Time-series data were generated from birth onward, with 14 static and 35 dynamic input attributes. Iterative static (regression) and dynamic (ML) modeling was performed, comparing model performance with the NRN BPD calculator at several time points (postnatal day 1, 3, 7, 14, and 28) and ranking feature leverage at each time point. RESULTS: Of the original cohort, 92 infants met all inclusion criteria (gestational age 25.6 ± 1.4 weeks). Static models performed comparably with the NRN BPD calculator (area under the curve = 0.7460), improving to 0.7978 with forward/backward selection. In contrast, dynamic long short-term memory (LSTM) models outperformed static models at all time points, reaching a peak area under the curve of 0.8400 on postnatal day 28. LSTM models performed best for no BPD and severe disease/death. Principal component analysis revealed that respiratory support, ventilator settings, supplemental oxygen requirements, medications, and prenatal/postnatal growth were major factors driving BPD severity. CONCLUSIONS: LSTM-based ML time-series analysis substantially outperformed static approaches for predicting BPD and death among extremely low gestational age newborns. Integrating ML methods into clinical applications holds promise for enhancing real-time BPD trajectory mapping.
OBJECTIVE: To evaluate repetitive motor behaviors (RMBs) in non-autistic toddlers using direct observational methods. STUDY DESIGN: This cohort study assessed RMBs in a community sample of 679 toddlers at 24 and 36 month...OBJECTIVE: To evaluate repetitive motor behaviors (RMBs) in non-autistic toddlers using direct observational methods. STUDY DESIGN: This cohort study assessed RMBs in a community sample of 679 toddlers at 24 and 36 months of age. Initial analyses examined rates of RMBs in autistic (n = 65) vs nonautistic (n = 614) participants. Subsequent analyses focused on participants without autism, first examining clinical correlates of RMBs in the full non-autistic group and then comparing rates of RMBs in 2 non-autistic subgroups: 104 participants with other developmental concerns (ODC) and 510 participants with no developmental concerns. RESULTS: A total of 36% of non-autistic children demonstrated RMB at 24 and/or 36 months of age. RMBs were significantly more likely in the ODC (55%) than the no developmental concerns (33%) group. Non-autistic participants with RMBs had significantly lower communication scores at 24 months and, at both ages, significantly higher scores on 2 measures of autism-related symptomatology than those without RMBs; however, group means fell within the average range and effect sizes were small. There were no RMB differences based on sex. CONCLUSIONS: RMBs are not uncommon in 24- to 36-month-old children who do not meet diagnostic criteria for autism. Among non-autistic children, RMBs are most likely to occur in those with other developmental challenges but are also present in some typically developing children. The presence of RMBs in toddlers should be evaluated within the context of Diagnostic and Statistical Manual of Mental Disorders, fifth edition ASD criteria, and RMBs alone without social communication challenges core to ASD should not be viewed as automatically indicative of autism.
Laptook AR, Czynski A, Chahine R
… +32 more, Greenberg RG, Smith PB, Oliveira E, Gabrio J, Eggleston B, Das A, Lee J, Lester B, Clark D, Walsh M, Ko H, Asher CC, Friedman H, Gentle S, Rao K, Katheria A, Benninger K, Jani S, Smith MC, Khan A, Talati A, Lodhi S, Mena F, England A, Parimi P, Kylat R, Harmon H, Mannan J, Howell MP, Wright T, Snowden J, ACT NOW Collaborative
OBJECTIVE: To determine if newborns receiving morphine or methadone as the primary pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS) tolerate and receive fewer days of opioid using an accelerated wea...OBJECTIVE: To determine if newborns receiving morphine or methadone as the primary pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS) tolerate and receive fewer days of opioid using an accelerated wean protocol (15% decrements) compared with using a slower wean protocol (10% decrements). STUDY DESIGN: Newborns ≥36 weeks of gestation receiving morphine or methadone for NOWS were enrolled in a pragmatic blinded, randomized multicenter trial. Newborns underwent protocol-driven weaning with decreasing opioid doses of either 15% or 10% decrements. Weaning was encouraged every 24 hours, and if signs of NOWS worsened, the preceding dose was resumed. To maintain blinding, the last 3 dose levels of the 15% decrements were placebo. The primary outcome was the number of days of opioid treatment from the first weaning dose to cessation of opioids. RESULTS: Slow enrollment prompted early trial closure; 189 newborns were randomized, 98 (51.9%) to 15% decrements (mean ± SD, 38.8 ± 1.2 weeks gestation, 59.8% male) and 91 (48.1%) to 10% decrements (38.8 ± 1.3 weeks gestation, 61.5% male). Morphine was used most commonly. Intention-to-treat analysis included all but 4 infants withdrawn in the 15% decrement group. The durations of opioid treatment during weaning were 8.2 (7.2, 9.5) (adjusted mean [95% CI]) and 11.2 (9.7, 12.9) days for 15% and 10% decrement groups, respectively (P < .001). Adverse events were few in both groups. CONCLUSION: Pharmacologic treatment of NOWS using an accelerated wean protocol (15% decrements) was well tolerated with fewer days of opioid treatment compared with 10% decrements. TRIAL REGISTRATION: ClinicalTrials.gov number: NCT04214834.
OBJECTIVE: To evaluate the effectiveness and safety of short (≤8 days) vs long (≥9 days) duration of antibiotic therapy for uncomplicated gram-negative (GN) bloodstream infections (BSI) among infants in the neonatal inte...OBJECTIVE: To evaluate the effectiveness and safety of short (≤8 days) vs long (≥9 days) duration of antibiotic therapy for uncomplicated gram-negative (GN) bloodstream infections (BSI) among infants in the neonatal intensive care unit (NICU). STUDY DESIGN: Retrospective analysis of infants treated for GN BSI at 7 NICUs within 2 health care systems. Infants were identified by review of positive blood cultures from the microbiology laboratory and electronic health records. Patients were excluded if they had polymicrobial BSI, meningitis/osteomyelitis/endocarditis, or died before completion of therapy as ordered. The primary outcome was recurrence of BSI with the same organism within 14 days of discontinuation of effective antimicrobial therapy ("treatment failure.") Secondary outcomes were emergence of GN multidrug-resistant organisms (MDRO) and mortality. RESULTS: In all, 76 infants (39 short duration; 37 long duration) were included; 15 (38%) and 25 (69%) infants had a central venous catheter in place at onset of BSI in the short and long duration groups, respectively. Escherichia coli was the most common pathogen in both groups (27 [69%], short duration; 18 [49%], long duration). There were 2 recurrences of BSI, both in the long duration group. Among study infants, 5 had a subsequent GN MDRO infection; all were in the long duration group. CONCLUSIONS: Treatment failure and GN MDROs occurred among infants who received ≥9 days of antibiotic therapy. Shorter antibiotic duration (≤8 days) appeared to be an effective intervention that could reduce antibiotic exposure and its adverse consequences among NICU infants.
OBJECTIVE: To evaluate psychosocial functioning among youth with hereditary polyposis syndromes (HPS) and their caregivers. STUDY DESIGN: Data on health-related quality of life (HRQOL), illness uncertainty (Child Illness...OBJECTIVE: To evaluate psychosocial functioning among youth with hereditary polyposis syndromes (HPS) and their caregivers. STUDY DESIGN: Data on health-related quality of life (HRQOL), illness uncertainty (Child Illness Uncertainty Scale/Parent Illness Uncertainty Scale), caregiver psychological distress, and caregiver-perceived blame/fault were collected as part of standard care visits to a multidisciplinary polyposis clinic. RESULTS: Psychosocial data were obtained from 33 youth ages 8-18 and 63 caregivers. About 15% of youth and 13% of caregivers endorsed elevated illness uncertainty. HRQOL was poorest in emotional and school functioning. Mean (±SD) caregiver distress scores were 1.03 ± 1.59 and mean blame/fault scores were 2.56 ± 2.53, with 21% of caregivers feeling at fault for their child's HPS. Significant correlations were found between child- and caregiver-reported illness uncertainty (r = 0.52, P < .01) and caregiver perceived fault was significantly correlated with caregiver distress (r = 0.26, P = .04). Caregivers with a shared diagnosis endorsed feeling at fault for their child's HPS diagnosis and endorsed significantly greater distress. Caregivers of youth with minority status endorsed significantly greater distress (H(4) = 10.54, P = .03) and caregiver perceived fault was higher for male youth. CONCLUSIONS: Findings suggest that youth with HPS are at risk of poor HRQOL and elevated illness uncertainty, and caregivers similarly show elevated risk for psychological distress, perceived fault for the youth's HPS diagnosis, and elevated illness uncertainty. Some socioeconomic factors also have significant implications for caregiver's overall functioning. These findings highlight the need for psychosocial functioning to be a primary target and consideration in HPS care.