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OBJECTIVES: Rapid response teams (RRTs) can improve outcomes in both adult and pediatric hospitals. Most pediatric hospitals have RRT-type systems; however, little is known about stakeholders' perspectives regarding how to optimize RRT quality and efficiency. We aimed to better understand multidisciplinary stakeholder perspectives on how to improve the RRT process. METHODS: We held 4 stakeholder focus groups including floor nurses, pediatric trainees (interns and residents), pediatric hospitalists, and the responding PICU team (PICU fellows and nurses). We used deductive coding to identify potential solutions and subsequent themes. RESULTS: Focus groups identified 10 potential solutions within 3 major themes. Themes included (1) the value of a standardized RRT workflow based on stages, (2) the benefit of promoting a safety culture, and (3) the need to implement ongoing RRT education. Stakeholders described a shared mental model of RRT workflow with important events or tasks occurring within each stage. These stages were coded as 1: trigger, 2: team arrival and information sharing, 3: intervention, and 4: disposition and follow-up. Additional proposed solutions included waiting for the entire team to arrive, a systematic information sharing process, and closed loop communication for follow-up plans for patients remaining on the general care floor. CONCLUSIONS: RRT stakeholder focus groups provide valuable insight into efforts to optimize RRT events. Standardizing RRT workflow into a staged process may facilitate communication and information sharing. Promoting a culture of safety and implementing ongoing education may help reinforce RRT standardization.
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OBJECTIVE: This study aimed to describe the type and frequency of enteral and parenteral fluids and medications used during the transport of neonates by a regional pediatric critical care transport team. METHODS: We performed a retrospective analysis of neonates transported by a regional neonatal transport team affiliated with a level IV neonatal intensive care unit within a large care network between 2020 and 2021. Demographic and clinical data were collected from the electronic medical record. Standard frequency tabulation and summary statistics were used to report demographics, transport characteristics, and fluid and medication use; results were then stratified by preterm (37 weeks) and term births. RESULTS: In the 628 included transports, more term than preterm infants received at least 1 fluid or medication (53% vs. 43%, respectively). The most commonly administered medications were antibiotics (ampicillin and gentamicin), prostaglandin, and opiates (morphine sulfate and fentanyl). In addition, term infants received more analgesic medications, antimicrobials, and prostaglandin, whereas preterm infants received total parenteral nutrition more often. There were over 38 different medications provided on the transports studied. CONCLUSION: This study of a single transport team revealed that a wide variety of medications and fluids were used in the transport of neonates, with term infants receiving more medications than preterm infants. These data could be used by transport teams in making or updating their standardized medication lists or in creating simulations.
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Transporte de Pacientes , Humanos , Recién Nacido , Estudios Retrospectivos , Femenino , Masculino , Cuidados Críticos , Unidades de Cuidado Intensivo Neonatal , Recien Nacido Prematuro , Ambulancias Aéreas , Fluidoterapia/métodos , Antibacterianos/uso terapéuticoRESUMEN
OBJECTIVE: This study aimed to examine fetal and neonatal inflammatory and neurologic complications associated with maternal coronavirus disease 2019 (COVID-19) infection. STUDY DESIGN: Case-series using a convenience sample of neonates cared for in a large referral-based children's hospital neonatal intensive care unit between September 2021 and May 2022. RESULTS: We identified seven neonates with exposure to maternal severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) and a presentation consistent with inflammatory complications. All had some degree of neurologic injury with neuroimaging findings including restricted diffusion indicating injury in the white matter, cortex, deep gray structures, and splenium of the corpus callosum as well as intracranial hemorrhage. In addition, many infants had cytopenia and abnormal coagulation studies. Placental pathology, when available, revealed inflammation, clot with calcifications, and hematomas with associated infarcts. CONCLUSION: Neonates born to mothers with SARS-CoV-2, even when negative for the virus themselves, may have complications consistent with a systemic inflammatory syndrome. Placental pathology as well as neurologic imaging in infants with neurologic findings may help to support this diagnosis. KEY POINTS: · A systemic inflammatory response may cause illness in babies born to mothers with a history of COVID-19.. · Inflammatory markers and placental pathology are helpful in supporting this diagnosis.. · Consider neuroimaging in infants of mothers with a history of COVID-19 with neurologic findings..
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COVID-19 , Complicaciones Infecciosas del Embarazo , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica , Humanos , COVID-19/complicaciones , Femenino , Embarazo , Recién Nacido , Complicaciones Infecciosas del Embarazo/virología , Masculino , Placenta/patología , Placenta/virología , Adulto , Transmisión Vertical de Enfermedad Infecciosa , NeuroimagenAsunto(s)
Dolor Abdominal , Cefalea , Masculino , Humanos , Niño , Cefalea/etiología , Dolor Abdominal/etiología , Fatiga/etiologíaAsunto(s)
Pancitopenia , Masculino , Humanos , Lactante , Pancitopenia/etiología , Fiebre/etiología , TransaminasasRESUMEN
BACKGROUND: Two-generational trauma-informed assessment (TIA) helps providers conduct holistic family well-being assessment (FWbA). This tool makes it possible to use families' trauma history in the case-finding process. OBJECTIVE: This study compares the documentation and frequency of adverse childhood experiences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC). PARTICIPANTS AND SETTING: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013. METHODS: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers. RESULTS: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,pâ¯<⯠0.0001) and caretakers (60.7 % vs 7.3 % pâ¯<⯠0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % pâ¯<⯠0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, pâ¯=⯠0.110). Both children and caretakers were referred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, pâ¯<⯠0.0001). CONCLUSIONS: In families evaluated for child abuse and neglect, conducting TIA in addition to conventional psychosocial evaluation increased documentation regarding trauma history, which led to increased referral rates.