Babies breaking bad: neonatal and iatrogenic withdrawal syndromes.

PURPOSE OF REVIEW: This review will summarize the symptoms, evaluation, and treatment of neonatal and iatrogenic withdrawal syndromes. RECENT FINDINGS: Buprenorphine is emerging as the drug of choice for maintaining opioid-dependent women during pregnancy, because of its association with less severe withdrawal symptoms. Recent findings suggest it may be the drug of choice for treating the opioid-exposed neonate as well. SUMMARY: Healthcare workers should be cognizant of the risk factors for neonatal abstinence syndrome (NAS), as well as its symptoms, so that nonpharmalogic and pharmacologic therapies can be initiated. With increased emphasis on pain control in children, it is likely that iatrogenic withdrawal will continue to be a concern, and healthcare workers should understand the similarities and differences between this and NAS.

Burnout During the COVID-19 Pandemic: A Report on Pediatric Residents.

BACKGROUND AND OBJECTIVE: The Pediatric Resident Burnout and Resilience Consortium (PRB-RSC) has described the epidemiology of burnout in pediatric residents since 2016. We hypothesized burnout rates during the pandemic would increase. We explored resident burnout during the COVID-19 pandemic and its relationship to resident perception of workload, training, personal life, and local COVID burden. METHODS: Since 2016, PRB-RSC has sent an annual, confidential survey to over 30 pediatric and medicine-pediatrics residencies. In 2020 and 2021, seven questions were added to explore the relationship of COVID-19 and perceptions of workload, training, and personal life. RESULTS: In 2019, 46 programs participated, 22 in 2020, and 45 in 2021. Response rates in 2020 (n = 1055, 68%) and 2021(n = 1702, 55%) were similar to those of previous years (P = .09). Burnout rates in 2020 were significantly lower than in 2019 (54% vs 66%, P < .001) but returned to pre-COVID levels in 2021 (65%, P = .90). In combined 2020-2021 data, higher rates of burnout were associated with reported increased workload (Adjusted Odds Ratio (AOR) 1.38, 95% CI 1.19-1.6) and concerns regarding the effect of COVID on training (AOR 1.35, 95% CI 1.2-1.53). Program-level county COVID burden in combined 2020-2021 data was not associated with burnout in this model (AOR=1.03, 95% CI 0.70-1.52). CONCLUSIONS: Burnout rates within reporting programs decreased significantly in 2020 and returned to prepandemic levels in 2021. Increased burnout was associated with perceived increases in workload and concerns regarding effect of the pandemic on training. Given these findings, programs should consider further investigation into workload and training uncertainty on burnout.

Managing procedural pain in pediatric patients.

PURPOSE OF REVIEW: To review recent research on the management of acute procedural pain in pediatric patients. RECENT FINDINGS: Pediatric patients experience pain with the same or greater intensity as their adult counterparts. Recent studies have acknowledged the importance of people's beliefs about pain and of a multidisciplinary approach to the assessment and treatment of acute pain. SUMMARY: Pediatric patients experience pain from procedures related to their care. Pediatricians should educate themselves regarding the accurate assessment of pain, and the pharmacologic and nonpharmacologic methods of managing acute pain.

Enhancing pediatricians' engagement on social media: the role of board style questions.

This article was migrated. The article was marked as recommended. Background: Social Media is used among medical professionals for collaborative education. Little is known about how case discussions prompt engagement. Objective: To determine the association between item characteristics of board exam-style questions to social media engagement. Methods: This was a prospective cohort study through the American Academy of Pediatrics (AAP) PediaLink FaceBook page, conducted in 2018 over 9 months. Items from the 2017 PREP® questions were ranked in difficulty, then rated in relevance to general pediatrics through content-expert consensus. Thirty-six questions were randomly posted on FaceBook and Twitter weekly. Independent variables included item difficulty rank, difficulty level (easy vs hard), relevance to general pediatrics, and word count. Outcome variables included percent correct responses and total comments under the post. Results: More difficult questions were associated with fewer comments (rho=0.63, p<0.001) and lower correct response percentages (rho=0.39, p=0.02). Easy questions garnered more comments than hard questions (median 18 IQR 13-23 vs median 9.5 IQR 5-14, p=0.001). Correct response percentage was lower for hard questions (90% IQR 85-95% vs. 77% IQR 60-94%, p=0.04). Relevance to general pediatrics and word count did not affect engagement (p > 0.1). Conclusion: Easier practice test items attracted more responses from pediatricians on social media, increasing engagement.

Overcoming barriers to breastfeeding continuation and exclusivity.

PURPOSE OF REVIEW: To review recent research that delineates predictors of breastfeeding duration and exclusivity. RECENT FINDINGS: Many mothers find it difficult to meet personal goals and follow expert recommendations for continued and exclusive breastfeeding despite increased rates of initiation. Recent studies have revealed varied sociodemographic, biomedical, and psychosocial determinants of breastfeeding duration and exclusivity. SUMMARY: In order to help mothers meet personal goals and expert recommendations for breastfeeding, pediatricians should educate themselves regarding predictors of and barriers to successful breastfeeding. Once these predictors and barriers have been identified, targeted anticipatory guidance can be provided to help mothers achieve breastfeeding success.

Optimizing successful breastfeeding in the newborn.

PURPOSE OF REVIEW: The purpose of this article is to present an overview of the state of breastfeeding in the United States and to examine recent evidence for strategies aimed at optimizing successful breastfeeding in the neonatal period. RECENT FINDINGS: Although rates of any and exclusive breastfeeding are rising, American mothers and infants are still unable to meet the Healthy People 2010 objectives. A review of the current literature demonstrates that the 'Ten Steps to Successful Breastfeeding' and the Baby Friendly Hospital Initiative are effective measures to increase breastfeeding initiation, duration, and exclusivity. A recent national survey reveals a significant proportion of pediatricians are not providing evidence-based recommendations for breastfeeding guidance and support. SUMMARY: The Baby Friendly Hospital Initiative, based upon the 'Ten Steps to Successful Breastfeeding', is an effective evidence-based model of perinatal care that protects, promotes, and supports breastfeeding. Pediatricians should aim to provide anticipatory guidance and management consistent with the 'Ten Steps' to optimize breastfeeding outcomes for mothers and their newborns.