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.

Initiative to Improve Postintubation Sedation in a Pediatric Emergency Department.

BACKGROUND: Previous research has shown that appropriate pediatric postintubation sedation (PIS) after rapid sequence intubation only occurs 28% of the time. Factors such as high provider variability, cognitive overload, and errors of omission can delay time to PIS in a paralyzed patient. PURPOSE: To increase the proportion of children receiving timely PIS by 20% within 6 months. METHODS: A multidisciplinary team identified key drivers and targeted interventions to improve timeliness of PIS. The primary outcome of "sedation in an adequate time frame" was defined as a time to post-Rapid Sequence Intubation sedative administration less than the duration of action of the RSI sedative agent. Secondary outcomes included the proportion of patients receiving any sedation and time to PIS administration. RESULTS: Pediatric postintubation sedation in an adequate time was improved from 27.9% of intubated patients to 55.6% after intervention (p = .001). The number of patients receiving any PIS improved from 74% to 94% (p = .006). The median time from RSI to PIS was reduced from 13 to 9 minutes (p < .001). Process control charts showed a reduction in PIS variability and a centerline reduction from 19 to 10 minutes. CONCLUSIONS: Implementation of an intubation checklist and a multidisciplinary approach improved the rate of adequate pediatric PIS.

Evaluating infant core temperature response in a hot car using a heat balance model.

PURPOSE: Using a 1-year old male infant as the model subject, the objectives of this study were to measure increased body temperature of an infant inside an enclosed vehicle during the work day (8:00 am-4:00 pm) during four seasons and model the time to un-compensable heating, heat stroke [>40 °C (>104 °F)], and critical thermal maximum [>42 °C (>107.6 °F)]. METHODS: A human heat balance model was used to simulate a child's physiological response to extreme heat exposure within an enclosed vehicle. Environmental variables were obtained from the nearest National Weather Service automated surface observing weather station and from an observational vehicular temperature study conducted in Austin, Texas in 2012. RESULTS: In all four seasons, despite differences in starting temperature and solar radiation, the model infant reached heat stroke and demise before 2:00 pm. Time to heat stroke and demise occurred most rapidly in summer, at intermediate durations in fall and spring, and most slowly in the winter. In August, the model infant reached un-compensable heat within 20 min, heat stroke within 105 min, and demise within 125 min. The average rate of heating from un-compensable heat to heat stroke was 1.7 °C/h (3.0 °F/h) and from heat stroke to demise was 4.8 °C/h (8.5 °F/h). CONCLUSIONS: Infants left in vehicles during the workday can reach hazardous thermal thresholds quickly even with mild environmental temperatures. These results provide a seasonal analogue of infant heat stroke time course. Further effort is required to create a universally available forensic tool to predict vehicular hyperthermia time course to demise.

Threat of paediatric hyperthermia in an enclosed vehicle: a year-round study.

OBJECTIVE: To describe temperature change throughout the workday in an enclosed vehicle in Austin, Texas across the calendar year while accounting for heat index. METHODS: In this observational study, vehicular temperature was measured 1 day per month during 2012 in Austin, Texas. Data were recorded at 5-min intervals via an EL-USB-1-PRO digital temperature sensor from 8:00 to 16:00. Selected days were primarily cloud-free (with 'clear' or 'few clouds') with a predicted ambient temperature high within ±20°F of the 30-year normal high. Referent temperature and 30-year normal data were collected via the nearest National Weather Service (NWS) weather station. The NWS heat index and corresponding hazard levels were used as a guideline for this study. RESULTS: Per NWS guidelines, the enclosed vehicle temperature rose to 'danger' levels of ≥105°F (41°C) in all months except January and December and to 'extreme caution' levels of ≥90°F (32°C) in every month of the year. In June, the vehicle rose to ≥105°F (41°C) by 9:25. The hottest vehicular temperature achieved was 137°F (58°C). In 9 months of the year, the vehicle reached ≥90°F (32°C) by noon. We also found that an ambient temperature as low as 68°F was associated with vehicular temperatures ≥105°F (41°C). CONCLUSIONS: Infants and children in states that experience mild winter temperatures face the threat of vehicular hyperthermia disability and death across the calendar year. Prevention efforts that focus on awareness of a childhood heat vulnerability, parental perception of susceptibility to forgetting a child in a vehicle and universal availability of vehicular safety devices may reduce paediatric vehicular hyperthermia death.