Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments.

An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.

Closure of patent ductus arteriosus in low-birth weight infants based on three management strategies.

UNLABELLED: There is controversy on the most advantageous management for infants with patent ductus arteriosus (PDA) and whether to favor actively closing the PDA or to conservatively observe. We aimed to describe the outcome of infants with PDA based on three management strategies used for its closure (conservative, indomethacin, ligation). METHODS: Retrospective medical record review of data from LBW infants (< 2000 with PDA admitted to NICU-SJCH. RESULTS: The prevalence of PDA was 16%. Based on management strategies: 31% did not require treatment. 19% resolved with conservative measures, 38% resolved with omethacin treatment, and 12% required ligation. There was no difference in birth weight, gestational, clinical criteria, morbidities and mortality in patients managed with the strategies evaluated. CONCLUSION: Results are consistent with previous reports. Development of PDA management guidelines will help standardize the definition of PDA and management criteria instead of treating on a case-by-case basis.