"Play How We Practice": A Residency Program's Snapshot of Pediatric Resident Perspectives on Education During the COVID-19 Pandemic.

OBJECTIVES: Our objective was to understand the perspectives of current and recently graduated pediatric residents concerning the impact of the COVID-19 pandemic, and subsequent curriculum changes, to their education. INTRODUCTION: Residency programs have experienced unprecedented alterations to education in the form of changing expectations, schedules, and opportunities during the COVID-19 pandemic. Little is known regarding resident perceptions of how these changes impact their education and ultimate career preparation. METHODS: An anonymous and voluntary electronic IRB exempt survey was sent to pediatric residents at a mid-sized residency program in the mid-Atlantic in August of 2020. This cross-sectional study survey consisted of a series of multiple choice questions with optional short answer responses. RESULTS: Twenty-two pediatric residents across all training years completed the survey for a response rate of 36%. The majority of residents, 59.1%, were interested in directly caring for COVID + patients; however, the minority (36%) felt prepared to care for COVID + patients. Most residents (63%) responded that graduate medical education programs should not have authority to exclude residents from taking care of patients with certain diagnoses and 95% of respondents indicated that they would prefer an opt out system instead. CONCLUSION: The majority of resident respondents had a strong interest in caring for COVID + patients and report that they value frequent updates from program leadership to guide their patient care. Residents also overwhelmingly support an opt out system when caring for future patients with particular infectious diagnoses rather than a mandated exclusion approach.

School Nurses on the Front Lines of Health Care: Clinical Presentations Associated With COVID-19 Infection.

Over the past 2 years, COVID-19 has swept through the United States and our world, infecting millions of people. Due to the high transmissibility of this communicable disease, school-age children are at a unique risk because of close contact with others throughout the day. Many children who contract COVID-19 will go on to have asymptomatic or mild noncomplicated symptomatic infections. However, some children will develop severe or persistent symptoms. Given the unique position of school nurses in seeing a large volume of children and adolescents, it is important that they are familiar with the variable presentations and complications of COVID-19. Throughout this article, we discuss three cases of students presenting to the school nurse's office with signs and symptoms associated with COVID-19 infection.

Factors Influencing Pregnancy Screening in the Pediatric Intensive Care Unit.

STUDY OBJECTIVE: The objective of this study was to determine the rate of incidental pregnancy, pregnancy screening frequency, and factors associated with pregnancy screening in the pediatric intensive care unit (PICU). DESIGN: A cross-sectional, descriptive study. SETTING: The research was conducted at Penn State Health Children's Hospital evaluating PICU admissions between January 1, 2011, and January 31, 2019. PARTICIPANTS: Female adolescents 14-21 years of age who were admitted to the PICU. INTERVENTIONS: The study population was divided into 2 groups (Presence and Non-Presence of Pregnancy Screening), and data were collected from the electronic health record. MAIN OUTCOME MEASURES: We evaluated for patient characteristics and for presence and results of urine pregnancy screening. RESULTS: A total of 431 patients were included in the study. Of these, 275 patients (63.8%) had a pregnancy screen performed. No patients with incidental pregnancy were found. There was a statistically significant relationship between pregnancy screening and patient age, type of admission, and origin of transfer (P < .01). Analysis of secondary diagnoses (co-morbidities) indicated lower screening rates in patients with developmental delay, cerebral palsy, and/or mental retardation (15, 5.5%) [p < 0.0001] and chromosomal abnormalities (9, 3.3%) [p =0.021]. CONCLUSION: Incidental pregnancy is uncommon in female adolescents of childbearing age who are admitted to the PICU, but not all patients were screened, thus potentially jeopardizing maternal and fetal care. Clinicians should consider routine pregnancy screening of female patients of childbearing age admitted to the PICU and should be cognizant of individual factors that could preclude screening prior to or during their presentation.

Impact of Body Mass Index and Initial Respiratory Support on Pediatric Subjects in Acute Respiratory Failure.

BACKGROUND: It is unknown how the initial choice of respiratory support by pediatric ICU providers contributes to outcomes of nonintubated obese children with respiratory failure. We hypothesized that body mass index and the type of initial respiratory support applied are associated with poor clinical outcomes in patients who carry respiratory failure-associated diagnoses. METHODS: This is a retrospective analysis of de-identified patient data obtained from the Virtual PICU System database (2009-2018). We included subjects 2-18 y old who received bi-level positive airway pressure/CPAP or high-flow nasal cannula as the initial respiratory support and were assigned respiratory failure-associated diagnoses (ie, acute hypoxic respiratory failure). The study population was divided into 2 body mass index percentile groups, underweight/healthy weight (< 85th percentile) and overweight/obese (≥ 85th percentile), and subjects were evaluated for the following outcomes: endotracheal intubation requirement, medical and physical PICU length of stay, and mortality scores. RESULTS: A total of 1,721 subjects were included: 1,091 (63.4%) underweight/healthy weight and 630 (36.6%) overweight/obese. Body mass index percentile was not associated with the initial respiratory support utilized (odds ratio 0.961 [95% CI 0.79-1.17], P = .73). Multivariable logistic regression analysis demonstrated that the odds of requiring endotracheal intubation (odds ratio 1.60 [95% CI 1.10-2.35], P = .02) were significantly higher in overweight/obese subjects initially placed on high-flow nasal cannula. Body mass index and bi-level positive airway pressure/CPAP therapy were both positively associated with medical and physical PICU length of stay, Pediatric Risk of Mortality Score 3 (PRISM3) scores, and Pediatric Index of Mortality 2 (PIM2) scores when separate multivariable models were fit for these 4 response variables. CONCLUSIONS: The selection of respiratory support may place overweight/obese pediatric patients at higher risk for endotracheal intubation. Due to methodological limitations, we were unable to draw conclusions about the initial approach to the respiratory management of overweight/obese pediatric patients. Further investigation may be warranted.