Parental Mental Health and Childhood Respiratory Outcomes in a Severe Bronchiolitis Cohort.

Parental mental health conditions appear to contribute to the development of childhood respiratory illness. We investigated the relationship between parental mental health and childhood respiratory illness using data from a 17-center prospective cohort study of infants hospitalized with bronchiolitis between 2011 and 2014 (n = 921). Among 779 (84.6%) participants with self-reported parental mental health history data, 184 (23.6%) had parental history of depression and 155 (19.9%) had anxiety. Multivariable analyses found that both parental history of depression (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.01-1.99) and anxiety (HR 1.28, 95% CI 1.08-1.52) were associated with an increased risk of recurrent wheezing by age 3 years. However, only parental history of anxiety was associated with asthma by age 5 years (odds ratio 1.79, 95% CI 1.25-2.55). Further research on exposure severity, other early life stressors, and effective methods of parental psychosocial support is needed to develop targeted risk factor prevention strategies to reduce the burden of childhood respiratory illness.

Lung Ultrasound in Children with Respiratory Tract Infections: Viral, Bacterial or COVID-19? A Narrative Review.

Respiratory tract infections (RTIs) are common complaints among patients presenting to the pediatric emergency department. In the diagnostic assessment of children with RTIs, many patients ultimately undergo imaging studies for further evaluation. Point-of-care lung ultrasound (LUS) can be used safely and with a high degree of accuracy in differentiating etiologies of RTIs in pediatric patients. Ultrasonographical features such as an irregular pleural line, subpleural consolidations, focal and lobar consolidation and signs of interstitial involvement can be used to distinguish between several pathologies. This work offers a comprehensive overview of pediatric LUS in cases of the most common pediatric RTIs including bacterial and viral pneumonia, bronchiolitis, and COVID-19.

Feasibility of "rapid" magnetic resonance imaging in pediatric acute head injury.

OBJECTIVE: The objective was to determine the feasibility of "rapid" magnetic resonance imaging (rMRI) versus noncontrast computed tomography (NCCT) for pediatric patients with possible traumatic brain injury and to compare the populations receiving imaging in an urban tertiary care emergency department ED. METHODS: We retrospectively reviewed the electronic medical records of ED patients younger than 19 years with possible traumatic brain injury over 4 years who received an rMRI and then age-matched with NCCT patients. Data collection and analysis included demographic and clinical variables, ED length of stay (LOS), and follow-up outcomes. RESULTS: The final cohort had 45 rMRIs and 45 NCCTs. The mean age was 2.7 years, 63% were male, and 65% sustained a fall. Age, sex, and injury mechanism were similar. Time parameters were longer for rMRI patients: ED arrival to completion of imaging (172 vs 93 minutes, P < .001) and ED LOS (266 vs 225 minutes, P = .008). The NCCT group had higher-acuity patients with higher pediatric intensive care unit admission rates (33% vs 7%, P = .002). No patients returned to the ED within 72 hours. Follow-up was available on 78% patients. No clinically significant intracranial injuries were missed. CONCLUSIONS: Rapid MRI may be a viable imaging modality for moderate-risk pediatric head injury. Although rMRI took longer to obtain during this pilot study, scan time was only 3 to 4 minutes; and LOS was only 41 minutes longer. Further integration of rMRI in patient care should decrease time variation. Future study of rMRI reliability and satisfaction is needed.

Elevated lidocaine serum concentration after subcutaneous lidocaine administration using a needle-free device in pediatric patients.

We report several cases in which pediatric patients at our institution have elevated lidocaine levels in toxicology screens after subcutaneous injection of lidocaine using a needle-free device. The purpose of this article is to report 4 cases in which pediatric patients have elevated lidocaine levels in toxicology screens after J-Tip administration. In particular, the article highlights 2 cases in which children younger than 3 years had lidocaine levels in the toxic range. Although the literature has reported the device to be effective with no significant untoward effects in children as young as 3 years, it seems that no information is available for children younger than 3 years. From a quality assurance/safety perspective, a summary is provided as our institutional response to concerns raised over what is typically thought to be a benign and beneficial intervention in children.

Elevated lidocaine serum levels following the use of a needle free device in healthy adult volunteers.

There is increased concern regarding circulating levels of lidocaine immediately after the use of a needle-free device with buffered lidocaine. As a result, we conducted a prospective study to assess lidocaine circulation after the use of a needle-free device for the delivery of a local anesthetic in 10 healthy adult subjects. After informed consent, 2 peripheral intravenous catheters were placed in the antecubital fossa of each arm. Two milligrams of 1% buffered lidocaine was administered by the study physician via the needle-free device on the dorsum of the subject's hand. Within 2 minutes, a third intravenous catheter was placed in the location of the lidocaine administration and 5 mL of blood was collected from all 3 sites. If blood samples returned positive for lidocaine, they were also collected 1 hour and 2 hours after administration. Toxic levels of lidocaine were found in blood drawn from 2 subjects immediately after lidocaine administration. Results also showed that certain subjects had increasing levels of lidocaine over time. Other subjects also had increasing lidocaine serum levels from blood drawn on the arm opposite the administration site. We concluded that there may be systemic lidocaine levels with the administration of the needle-free device and that these levels may reach the toxic range in adults. Further investigation will be required to determine whether this finding has clinical significance, especially considering the smaller body mass of children.