Childhood asthma in the Bronx, NY; the impact of pollutants on length of hospital stay.

OBJECTIVE: The length of hospital stay (LOS) is a proxy of asthma exacerbation severity and healthcare cost. The study aims to estimate the effect of ambient air pollution on pediatric asthma LOS in the Bronx, NY. METHODS: A total of 1,920 children admitted to the hospital in Bronx, NY due to asthma during 2017-2019 period were included in the study. Demographic and clinical parameters were obtained from medical records. Daily ozone (O3) and fine particulate matter (PM2.5) measurements were obtained from local air quality networks. Poisson regression adjusting for gender, age, weight status, respiratory infections including influenza, and ambient temperature was applied to determine whether there was an association of air pollution with length of hospital stay. RESULTS: The mean LOS varied by age, sex, weight status, influenza vaccination status, respiratory viral panel (RVP) results, asthma controller use, and asthma classification. After controlling for these factors in Poisson regression, the mean LOS increased up to 10.62% (95%CI: 0.78-21.41; p = 0.03) for an increase of 10 µg/m3 of PM2.5 exposure on admission day, and 3.90% (95%CI = 0.06-7.88; p = 0.05) for an increase of 10 ppbv of O3 concentration during the previous day. CONCLUSION: Ambient particulate and ozone pollution is associated with lengthier hospital stays for pediatric asthma, potentially indicating more severe asthma exacerbations.

Comparison of Children Hospitalized for Asthma Before and During the COVID-19 Pandemic.

Background: Studies suggest that children with asthma experienced improved symptom control and less frequent inpatient admission during the COVID-19 (coronavirus disease 2019) pandemic. The characteristics of hospitalized children remain less well defined. Methods: This retrospective cohort study compared patients admitted for asthma during the pandemic with patients hospitalized the year prior at a children's hospital in the Bronx, New York. Results: In the year before the pandemic, 667 children were hospitalized for asthma, compared with 177 children the following year. Children admitted during the pandemic were older (7.8 versus 7.0 years, P = 0.04), more likely underweight (P < 0.01), and more likely to have public insurance (P = 0.02). Additionally, children hospitalized during the pandemic required intensive care (P = 0.03) and magnesium sulfate (P = 0.05) more frequently. Despite this, length of stay remained similar. Conclusion: While inpatient utilization for asthma decreased during the pandemic, children hospitalized were sicker on presentation. The cause of this is likely multifactorial and requires further study.

Facial dermatitis in a healthy 9-year-old boy.

ABSTRACT: This case report describes a boy who presented to the hospital with worsening facial rash and fevers. He had previously been prescribed mometasone cream for rosacea, which his mother applied daily for about 45 days. After a biopsy was performed, he was diagnosed with acneiform dermatitis likely secondary to topical corticosteroid use complicated by demodex folliculitis and a superimposed bacterial infection.

A rare cause of a cavitary lung lesion in an infant.

ABSTRACT: Paraesophageal hernias in children are rare, and can occur congenitally or be acquired. Acquired cases most often follow anti-gastroesophageal reflux surgery, or less commonly trauma. In children, elective repair is encouraged at the time of diagnosis to prevent future life-threatening complications.

Comparison of severity of asthma hospitalization between African American and Hispanic children in the Bronx.

Objective: There are racial and ethnic disparities in childhood asthma burden and outcomes. Although there have been comparisons between whites and minorities, there are few between minority groups. This study aimed to compare characteristics of asthma hospitalizations in African American and Hispanic children.Methods: A retrospective chart review was conducted to compare asthma characteristics between African American and Hispanic children aged 2-18 years hospitalized at an urban, tertiary care hospital for an acute asthma exacerbation. Length of stay (LOS), need for intensive care unit (ICU), and need for additional medications or respiratory support were compared between the groups.Results: Of the 925 children that met the inclusion criteria, 64% were Hispanic and 36% were African American. The groups were similar in age, gender, insurance status, and weight classification. African American children were more likely to have severe persistent asthma (12% vs. 7%, p = .02). They were also more likely to require magnesium sulfate (45% vs. 32%, p < .001) and admission to the ICU from the emergency department (ED) (14% vs. 8%, p = .01), which were independent of asthma severity. There was no significant difference in LOS or other characteristics of hospitalization.Conclusions: African American children hospitalized for asthma have more severe exacerbations compared to Hispanic children, which is independent of their asthma severity. However, this was not associated with longer LOS, which may indicate greater responsiveness to inpatient asthma management. Further investigation is needed to understand the mechanisms underlying asthma and exacerbation severity among minority groups.

Variations in Care for Breastfed Infants Admitted to US Children's Hospitals: A Multicenter Survey of Inpatient Providers.

BACKGROUND: Studies have revealed an association between hospitalization of breastfed infants and weaning posthospitalization. It is unknown what steps inpatient providers at children's hospitals are currently taking to support breastfeeding mothers of hospitalized infants, their comfort providing breastfeeding counseling, and what training they receive. METHODS: We conducted a multicenter survey study of pediatric providers who care for infants hospitalized at 3 urban, tertiary-care children's hospitals over a 12-month period. A convenience sample of nurses, residents, and attending physicians agreed to participate. Participants completed a 24-question questionnaire addressing provider practices, comfort with breastfeeding counseling, and previous breastfeeding education. Data were summarized as medians (interquartile ranges) and frequencies (percentages). Kruskal-Wallis and χ2 tests were used to compare between provider types. RESULTS: A total of 361 out of 1097 (33%) eligible providers completed the survey: 133 (21%) nurses, 166 (45%) residents, and 62 (63%) attending physicians. Provider practices varied by provider type. We observed a general trend that providers do not routinely review breastfeeding techniques, directly observe feeds, or use standardized breastfeeding assessment tools. Residents and attending physicians were more likely than nurses to feel comfortable with breastfeeding counseling (P = .02). Residents were more likely than nurses and attending physicians to have received breastfeeding education in the last 3 years (P < .001). CONCLUSIONS: Practices, comfort, and previous education varied by provider type. There was a general pattern that providers do not routinely perform certain practices. Further studies are needed to determine if inpatient provider practices affect weaning posthospitalization and if inpatient quality improvement initiatives will help mothers continue breastfeeding posthospitalization.

Adolescents and Their Parents: Perceptions of Addressing Obesity in the Inpatient Setting.

OBJECTIVES: Extending obesity screening to the inpatient setting may increase adolescent and parent awareness of weight status. Whether this should be a priority given limited resources depends on how interventions would be received by adolescents and their parents. In this study, we aimed to further understand the perception of adolescents and their parents to addressing obesity in the inpatient setting to inform how to better address this issue. METHODS: Pairs of hospitalized adolescents 13 to 18 years old on a general service and their parents were surveyed. The adolescent and parent surveys included 20 and 21 multiple choice and ordered response questions, respectively. Questions assessed perception of adolescent weight status, readiness to discuss weight status in the hospital, and preferences regarding how that should be done. Demographics were self-reported. Adolescent BMI was calculated from medical records and categorized on the basis of Centers for Disease Control and Prevention charts. RESULTS: Analysis was done on 121 of 122 adolescent-parent pair responses. Of the adolescents, 34% were obese and 21% were overweight. Over two-thirds of adolescents and parents wanted to be informed during the hospitalization if the adolescent was overweight or obese, but there was concordance of both wanting to be informed in only 55% of pairs. A majority of adolescents and parents indicated that they preferred receiving information from physicians and through face-to-face discussion. CONCLUSIONS: Although most adolescents and parents want to be informed of weight status in the inpatient setting, providers should be aware of potential differences in adolescent and parent receptiveness.

Impact of Obesity on Asthma Morbidity During a Hospitalization.

BACKGROUND: Asthma and obesity are 2 common pediatric problems. Obesity is a known risk factor for asthma, and obese children with asthma have higher disease burden. However, little is known on how obesity in urban minority children, mainly Hispanic and African American children, impacts morbidity during pediatric asthma hospitalizations. METHODS: A retrospective chart review was conducted on children and adolescents age 2 to 18 years hospitalized at the Children's Hospital at Montefiore for an acute asthma exacerbation. We elucidated the association of overweight or obese status with severity of the exacerbation, quantified by length of stay (LOS) and need for intensive care management. Multivariate analysis was conducted to identify independent predictors of LOS. RESULTS: A total of 975 children met the inclusion criteria, of whom 55% were normal weight and 45% were overweight or obese. Sixty percent were Hispanic, and 37% were African American. The overall average LOS was 2.57 days (range: 0.67-12.92). Overweight or obese status was associated with a higher asthma severity at baseline (P = .021). Overweight or obese children had a longer average LOS compared with normal weight children (2.75 vs 2.39 days; P < .01) with more PICU stays (P = .006), even after adjustment for higher baseline asthma severity. The severity of the exacerbation did not differ by ethnicity. CONCLUSIONS: Obesity in children hospitalized for asthma is associated with more severe asthma exacerbations, longer LOS, and increased use of PICU level care, independent of their higher baseline disease severity and ethnicity.

Acceptance of Routine HIV Testing by Hospitalized Adolescents and Young Adults.

BACKGROUND AND OBJECTIVES: Youth carry a disproportionate burden of new HIV infections. With our study, we aimed to characterize HIV testing experiences among adolescents and young adults admitted to a children's hospital that is located in a high HIV-prevalent community and implemented routine HIV testing for all patients ≥13 years of age. METHODS: A total of 120 patients aged 13 to 24 years old who were admitted to our hospital and had a documented offer of routine HIV testing on admission were invited to complete a self-administered survey that asked about sex, race and/or ethnicity, HIV risk behaviors, and attitudes toward routine HIV testing in the hospital. Date of birth, admission diagnosis, and verification of HIV testing and results were collected by chart review. RESULTS: Study participants (N = 99) were 17.4 ± 2.3 years old, 52% female, 47% Hispanic, and 29% African American. Additional characteristics include the following: 65% had previous sexual activity, 11% had a history of sexually transmitted infections, and 12% were worried about their risk for HIV. Forty-seven percent of participants accepted HIV testing, with older patients (P < .01) and those reporting previous sexual activity (P < .01) and a previous HIV test (P < .01) being more likely to accept testing. A total of 96% of participants agreed that the hospital is a good place to offer HIV testing. CONCLUSIONS: Our findings support offering routine HIV testing to youth admitted to children's hospital. Given the high incidence of new and undiagnosed HIV infections among youth, additional venues for HIV testing are essential.

Physician Perspectives on Obesity Screening in Hospitalized Children.

Nearly one-third of the children in the United States are obese or overweight and face associated physical and mental health issues.(1,2) Parents often misperceive and underreport their child's weight status.(3-5) This misperception is a major barrier to increasing healthy lifestyle choices, such as limiting screen time, increasing physical activity, improving diet, and participating in prevention programs.(6-8) Increasing parental awareness of children's weight status is an important initial step in addressing the obesity epidemic.