Effects of Gabapentin on Emergence Delirium in Pediatric Tonsillectomy/Adenoidectomy Patients: A Post-Hoc Analysis.

Emergence delirium (ED) is a significant source of both short- and long-term negative effects in the postoperative pediatric population, most notably following otolaryngology surgeries with an occurrence rate of 17.9%. Gabapentin, a gamma aminobutyric acid agonist, has been used for enhanced recovery in adult patients and for the purpose of decreasing ED in some pediatric patients undergoing strabismus surgery. This secondary analysis examined the effects of preoperative administration of gabapentin on the reduction of postoperative ED in pediatric patients between the ages of 3-18 undergoing elective tonsillectomy and adenoidectomy. The parent study randomized subjects to receive preoperative gabapentin vs placebo. Our chart review encompassed both objective and subjective measures to identify the incidence of ED. While we found no statistical significance between the treatment and control groups, there was a clinically significant reduction of ED behaviors in the gabapentin group. The limitations included nonstandardized intraoperative medication administration, small sample size, and the lack of a validated tool for documenting behaviors associated with ED in the immediate postoperative period. Based on the results of this analysis, further investigation is warranted into the potential benefit of gabapentin to reduce the incidence of postoperative ED in the pediatric patient.

Early mobilization in a pediatric intensive care unit and WeeFIM scores at rehabilitation: A retrospective study.

PURPOSE: The purpose of this study was to examine the relationship between early mobility (EM) of pediatric patients mechanically ventilated and functional outcomes in rehabilitation using WeeFIM scores, as well as hospital length of stay (LOS), ICU LOS, and rehabilitation LOS. METHODS: A retrospective chart review of 189 patients was completed to compare those who received EM interventions to those who did not in the ICU. Data extracted from the years 2015-2019 included: all patients who were between zero and 21 years, were mechanically ventilated via endotracheal tube (ETT) for > 48 hours, and then transferred to the comprehensive inpatient rehabilitation unit (IRU). RESULTS: For respiratory patients, the EM group had higher WeeFIM scores in all categories at admission to IRU compared to the comparison group. Neurosurgery patients had higher cognition and total WeeFIM scores in the EM group at admission to IRU. All diagnoses demonstrated shorter hospital, ICU, and IRU LOS for the comparison group versus the EM group. CONCLUSION: EM of mechanically ventilated pediatric patients with a primary respiratory diagnosis demonstrated improved function at admission to IRU compared to those who did not participate in EM. Prospective research needs to be done to examine this relationship further.

Gabapentin Premedication to Reduce Postoperative Pain for Pediatric Tonsillectomy/Adenoidectomy: A Pilot Study.

PURPOSE: To examine the effects of preoperative gabapentin administration on postoperative pain in pediatric patients undergoing tonsillectomy/adenoidectomy (T/A) in a single ambulatory surgery location within a pediatric healthcare organization. DESIGN: This randomized, controlled pilot study enrolled patients age 3-18 years with American Society of Anesthesiologists (ASA) scores of I-II undergoing T/A. METHODS: Both gabapentin and placebo groups were given study medication preoperatively and received standard opiate regimens intraoperatively and postoperative pain instructions. Outcome measurements included: time to first analgesic medication in the postanesthesia care unit (PACU), mean acetaminophen, ibuprofen, and opiate doses in mg/kg. Additionally, we examined pain scores, medication use, and side effects reported by daily pain diaries completed by patients/families for 3 days postoperatively. FINDINGS: Forty-nine patients were included in final analysis (gabapentin n = 26, placebo n = 23). Demographic and clinical characteristics of both groups were similar; the majority (46 of 49) were under the age of 13. Both groups received opiates in PACU. Some patients in both groups received hydrocodone/acetaminophen postoperatively. There were no reported differences in side effects between groups. Gabapentin group reported less use of opiates, acetaminophen, and ibuprofen post-discharge. We identified small effect sizes for opiates and acetaminophen, and medium effect size for ibuprofen (80.1% gabapentin versus 100% placebo, RR 0.81 [95% CI 0.67-0.97]). Median pain scores were 4 on a scale of 10 for both groups for all 3 days of follow-up. Overall median satisfaction score was 9, with a mean difference of 0.35 (95% CI -0.78 - 1.37). Analysis of variance revealed no difference in pain scores or satisfaction per pain diaries between the groups in general and no difference in score trajectory. CONCLUSIONS: We were able to establish a rigorous process and feasibility to launch a larger, multi-center trial to examine this important issue. There remain few evidence-based options for acute pain relief in pediatric surgical populations besides opiates. Identifying opiate alternatives that are effective, cost efficient and safe are needed for pediatric tonsillectomy patients.

Impact of caloric prescriptions and degree of malnutrition on incidence of refeeding syndrome and clinical outcomes in patients with eating disorders: A retrospective review.

BACKGROUND: For individuals with eating disorders (EDs), medical stabilization is paramount for restoration of body weight. Careful nutritional rehabilitation minimizes risk of refeeding syndrome. Study's purpose: describe clinical outcomes of pediatric/adolescent patients with EDs treated with lower calorie (<1300 kcals/day, n = 137), higher calorie (≥1400 kcals/day, n = 154) diets. METHODS: Retrospective chart reviews conducted for patients with known/suspected EDs. INCLUSION: patients ages 12-21 years with anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), atypical anorexia nervosa (AtAN). EXCLUSION: patients with other EDs, co-morbid medical conditions. Demographic information, length of stay, anthropometrics, prior weight loss were recorded. Malnutrition classifications based on: %mBMI, BMI z-score, prior weight loss percentage. Laboratory data, electrolyte supplementations were collected. Initial calorie intake/calorie intake day 7 were recorded. RESULTS: No significant differences in age, admit weight, BMI, BMI z-score, %mBMI at admission, weight gain between the two groups. Six (4.4%) patients in lower calorie group, 4 (2.6%) in higher calorie group met criteria for severe refeeding syndrome based on ASPEN consensus recommendations (P = .52). Higher calorie group length of stay was significantly shorter than lower calorie group (P = .006). Shorter length of stay associated with increased calorie intake (P < .001), greater %mBMI (P < .001). Higher calorie prescriptions were not associated with different rates of hypomagnesia (P = 1) and hypokalemia (P = .34). There was significant increase in rate of hypophosphatemia in the lower calorie group versus the higher calorie group. CONCLUSION: Higher calorie diets were associated with decreased length of stay without impacting risk of refeeding syndrome.

Family Support Practices to Impact Stress Scores in Parents of Critically Ill Children.

BACKGROUND: When a child becomes critically ill and hospitalized in intensive care, this can be emotionally and physically traumatic for parents. OBJECTIVE: The purpose of the initiative was to utilize a stress screening tool to quantify parental stress and examine the use of family support services as a way to impact stress scores. METHODS: The Family Stress Thermometer (FST) was introduced and parents were asked to circle their stress level at up to three time points. Along with recorded stress scores, resources accessed were documented, how often it was utilized, and parental suggestions that might ease stressors recorded. RESULTS: The results indicate the FST accurately recorded elevated stress levels in parents with critically ill children, analysis showed a statistically significant decrease in the stress levels of parents over time. CONCLUSIONS: This project appears to validate parental distress levels as a modifiable risk factor. IMPLICATIONS FOR NURSING: The FST was cost-effective and easy to administer. As part of comprehensive plans of care for families, interprofessional teams can work to design support services that meet individualized needs of parents with critically ill children. Partnering with parents to quantify their stress and responding to their needs will insure the likelihood of this happening.

Significance of SARS-CoV-2 specific antibody testing during COVID-19 vaccine allocation.

OBJECTIVE: To assess the value of using SARS-CoV-2 specific antibody testing to prioritize the vaccination of susceptible individuals as part of a COVID-19 vaccine distribution plan when vaccine supply is limited. METHODS: An extended susceptible-infected-recovered (SIR) compartmental model was used to simulate COVID-19 spread when considering diagnosis, isolation, and vaccination of a cohort of 1 million individuals. The scenarios modeled represented 4 pandemic severity scenarios and various times when the vaccine becomes available during the pandemic. Eligible individuals have a probability p of receiving antibody testing prior to vaccination (p = 0, 0.25, 0.5, 0.75, and 1). The vaccine was modeled as a single dose vaccine with 90% and 70% efficacy. The value of serology testing was evaluated by comparing the infection attack rate, peak infections, peak day, and deaths. RESULTS: The use of antibody testing to prioritize the allocation of limited vaccines reduces infection attack rates and deaths. The size of the reduction depends on when the vaccine becomes available relative to the infection peak day. The largest percentage reduction in cases and deaths occurs when the vaccine is deployed before and close to the infection peak day. The reduction in the number of cases and deaths diminishes as vaccine deployment is delayed. CONCLUSIONS: Antibody testing as part of the vaccination plan is an effective method to maximize the benefit of a COVID-19 vaccine. Decision-makers need to consider relative timing between the infection peak day and when the vaccine becomes available.

A comparison of first trimester prenatal screening strategies for Down Syndrome with maternal age and preferences considerations.

OBJECTIVE: Screening for Down Syndrome (DS) includes traditional ultrasound and serum-based and cell-free DNA (cfDNA) testing. While cfDNA testing usually has superior performance, it is significantly more costly. As an alternative, a hybrid strategy combining contingent cfDNA with traditional testing is recommended when universal cfDNA screening is not feasible. This study compares the efficacy of traditional, contingent cfDNA, and universal cfDNA screening strategies at various cut-offs based on maternal age and parents' preferences, which may improve testing outcomes and patients' satisfaction. METHOD: Decision trees were used to analyze a cohort of 3 855 500 pregnancies from 12 to 50 years old. The performance of the strategies was compared using the number of adverse outcomes (undetected DS live births and euploid procedure-related losses). RESULTS: Universal cfDNA results in the fewest number of adverse outcomes in every scenario. Contingent cfDNA performs better than traditional screening when the cut-offs used to identify high-risk cases for cfDNA testing are relatively low. These cut-offs change depending on the maternal age and parents' preference. CONCLUSION: Maternal age and parents' preferences should be considered when choosing cut-offs for contingent cfDNA to remain as an effective strategy compared to traditional screening and to improve patient satisfaction.