Diagnosis of Serious Conditions Delayed in Association with Ondansetron Treatment for Vomiting in the Pediatric Emergency Department.

OBJECTIVES: We evaluated the characteristics and sought risk factors for hospitalization in children who return to the emergency department within 7 days of discharge after oral or intravenous ondansetron treatment for vomiting. The secondary aim was to determine whether the diagnosis of any serious condition had been delayed as the result of discharge after ondansetron treatment. METHODS: This retrospective analysis of the medical records of children who had been treated for vomiting with ondansetron in a tertiary care pediatric emergency department and revisited the emergency department within 7 days was performed between 2017 and 2019. We compared demographic and clinical features as well as management between hospitalized and discharged patients, focusing upon potentially delayed diagnoses of serious conditions. RESULTS: Fifty of the 89 ondansetron-treated children (56.2%) who revisited the emergency department were discharged home after their second emergency department visit and the remaining 39 (43.8%) were hospitalized. No parameter of the management of the first visit was predictive of the outcome of the revisit. Five revisit patients (5.6%) were newly diagnosed with a serious condition, with intussusception and ovarian torsion being the most substantial time-sensitive delays (the other diagnoses were pneumonia and aseptic meningitis). CONCLUSIONS: Physicians assessing patients who had been treated with ondansetron as supportive care for vomiting at an earlier visit to the pediatric emergency department should consider alternative diagnoses despite initial clinical improvement. No definitive risk factor for readmission was identified, but a high level of alertness to a possible meningeal or acute abdominal source is imperative.

Impact of Maternal Anxiety on Human Milk Macronutrients Content: A Prospective Observational Study.

Objective: The impact of maternal anxiety on the macronutrients content of human milk (HM) is unknown. We hypothesized that maternal stress generated by her infant's hospitalization will affect the mother's breast milk's macronutrients content. Materials and Methods: HM samples (2-3 mL) were collected from 21 mothers whose infants were hospitalized for 2-3 days between August 2016 and November 2017 due to neonatal fever. Samples were provided at three time points: first day of admission, second day of admission, and 1 week after discharge. The maternal anxiety level was measured by the State-Trait Anxiety Inventory (STAI). Milk analyses for macronutrients were performed by infrared transmission spectroscopy. Results: Fat and energy contents of HM on day 7 were significantly higher compared with the day of admission (p = 0.019 and p = 0.022, respectively), whereas they were similar to values on day 2. The maternal anxiety level (STAI) at the time of infant admission was significantly higher than at 1 week after discharge (p < 0.001). There was no significant correlation between the changes in fat content and changes in the STAI score between admission and 1 week after discharge. Conclusion: Short infant hospitalization is associated with a significant rise in maternal stress; however, macronutrients content of HM remained unaffected.