Multi-center retrospective study of children with sickle cell disease admitted to pediatric intensive care units in the United States.

Data on outcomes and interventions for children with sickle cell disease (SCD) admitted to a pediatric intensive care units (PICU) are unknown. We provide the first comprehensive multi-center report on PICU interventions associated with death, the need for invasive respiratory support or stroke among critically ill children with SCD. We collected retrospective multi-center cohort data from January 1, 2012 to December 31, 2019 utilizing the Virtual Pediatric Systems, LLC database. We identified 3388 unique children with SCD, accounting for a total of 5264 PICU admissions from 138 PICUs. The overall mortality rate for the PICU admissions cohort was 1.8% (95/5264 PICU admissions, 95/3388 [2.8%] of all unique patients), the rate of needing of needing Invasive Respiratory Support (IRS, a composite category of exposure) was 21.3% (872/4093 PICU admissions with complete data) and the overall rate of stroke (ischemic or hemorrhagic) was 12.5% (657/5264 PICU admissions). In multivariable analysis adjusting for admission age category, sex, race/ethnicity, PRISM-3 score at admission, exposure to IRS, quartile of unit volume of patients with SCD, and patient origin, admitted children who needed invasive respiratory support (IRS) had higher adjusted odds ratios for mortality (adjusted odds ratio [aOR], 19.72; 95% confidence interval [CI] 8.98-43.29; p < 0.001), although admitted children > 2 years old had decreased aOR for needing IRS (aOR 0.25-0.62; 95% CI 0.16-0.94; p < 0.001-0.025). By contrast, admitted children > 2 years old had a strikingly increased aOR for stroke (aOR 7.57-16.32; 95% CI 2.25-52.15; p < 0.001). These groups may represent PICU-specific subsets of patients with SCD who are at higher risk for more serious illness and should deserve early consideration for referral to a pediatric institution providing comprehensive care for patients with SCD.

Addressing Pain With Inpatient Integrative Medicine at a Large Children's Hospital.

BACKGROUND: Pediatric integrative medicine (IM) includes the use of therapies not considered mainstream to help alleviate symptoms such as pain and anxiety. These therapies can be provided in the inpatient setting. METHODS: This 10-week study involved the integration of acupuncture, biofeedback, clinical hypnotherapy, guided imagery, meditation, and music therapy to address pain in children admitted to a large US children's hospital. RESULTS: Of 51 patients enrolled, 60% of the patients, 66% of their mothers, and 56% of their fathers used CAM (complementary and alternative medicine) in the preceding 1 year. Although 51 families requested integrative therapies, only 18 patients received them because of inadequate provider availability. All recorded pain scores improved with integrative therapies. One parent reported a possible side effect of irritability in the child after clinical hypnotherapy while 5 children reported opiate side effects. All participating families interviewed responded that IM services helped their child's pain and helped their child's mood, and that our hospital should have a permanent IM consult service. CONCLUSION: Integrative therapies can be helpful to address pain without significant side effects. Further studies are needed to investigate the integration, cost, and cost-effectiveness of integrative therapies in pediatric hospitals.

Complementary and Alternative Medicine Use in Uninsured Children in Texas.

Use of complementary and alternative medicine (CAM) among US children is 12% according to the 2012 National Health Interview Study. Certain pediatric populations have higher CAM use. We studied an uninsured population because limited access to care likely results in higher CAM use. We surveyed 250 uninsured patients in a free pediatric mobile clinic program. In the largely Hispanic population, rate of CAM use in the preceding 12 months was 45% among children and 59% among parents. Ninety-one percent of children who used CAM had parents who used CAM while only 32% of parents used CAM for themselves but did not use CAM for their children ( P < .001). Seven parents (3%) and 4 children (2%) had ever discussed their CAM use with a physician. Since CAM use is significant in this uninsured population and families do not generally discuss CAM with physicians, health care providers must ask about CAM use and provide guidance.

Survey of Complementary and Alternative Medicine (CAM) Services in Freestanding US Children's Hospitals.

Complementary and alternative medicine (CAM) use among US children in 2012 was 11.6%, and studies show CAM use as high as 76% in certain pediatric populations. Children's hospitals offer varied CAM services. This survey aimed to identify CAM services offered, the structure of CAM departments, and supplement use policies in freestanding US children's hospitals. In our survey, 92% of responding children's hospitals offered CAM services, and 38% had hospital-based CAM centers; 60% of responders had policies for supplement use during hospitalization, whereas only 40% had policies for supplement use surrounding surgery. CAM services are widely offered in freestanding US children's hospitals, but most do not have CAM departments. Many hospitals do not have written policies about supplement use. A better understanding of CAM services, programs, and supplement use policies are needed to bring more coordinated services and safer policies to children's hospitals.