Pediatrics
-
Review Meta Analysis
The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review.
Pediatric and intensive care patients are particularly at risk for medication errors. Computerized physician order entry systems could be effective in reducing medication errors and improving outcome. Effectiveness of computerized physician order entry systems has been shown in adult medical care. However, in critically ill patients and/or children, medication prescribing is a more complex process, and usefulness of computerized physician order entry systems has yet to be established. ⋯ Introduction of computerized physician order entry systems clearly reduces medication prescription errors; however, clinical benefit of computerized physician order entry systems in pediatric or ICU settings has not yet been demonstrated. The quality of the implementation process could be a decisive factor determining overall success or failure.
-
We conducted a prospective, observational study in a tertiary care pediatric center to determine risk factors for the development of and outcomes from ventilator-associated pneumonia. ⋯ In mechanically ventilated, critically ill children, those with ventilator-associated pneumonia had a prolonged need for mechanical ventilation, a longer ICU stay, and a higher mortality rate. Female gender, postsurgical diagnosis, the use of narcotics, and the use of enteral feeds were associated with an increased risk of developing ventilator-associated pneumonia in these patients.
-
The diagnostic labeling of presumed nonbacterial lower respiratory tract infection is unclear. Our objective was to identify patterns of specific diagnoses and treatments that were given to children who presented with lower respiratory tract infection to US academic emergency departments. ⋯ For children who are age <2 years and present to an emergency department with lower respiratory tract infection symptoms, there is large variability in the assigned diagnosis. Children who present to emergency departments that more commonly diagnose lower respiratory tract infection as "asthma" are more likely to receive corticosteroids. As clinicians, we need to develop evidence- and outcome-based definitions for lower respiratory tract infections to guide diagnosis and treatment better.
-
To calculate the prevalence of developmental coordination disorder at 7 years of age by using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria in a large UK birth cohort. ⋯ This is the first study to use strict criteria to define the prevalence of developmental coordination disorder in a representative cohort of UK children. A prevalence of 1.7% is lower than studies that have not taken into account the impact of poor motor coordination on daily living but indicates that poor coordination is an important, and often hidden, cause of disability in childhood.
-
The effects of the Born-Alive Infants Protection Act of 2002, which defines the legal status of live-born infants have not been evaluated. ⋯ The Born-Alive Infants Protection Act clarified the legal status of "born-alive" infants, but enforcement guidelines fail to clarify what measures are appropriate when survival is unlikely. The Act may constrain resuscitation options offered to parents, because neonatologists anticipate medicolegal threats if they pursue nonintervention. If this legislation were enforced, respondents predicted more aggressive resuscitation potentially increasing risks of disability or delayed death. Until outcomes for infants of <24 weeks' gestation improve, legislation that changes resuscitation practices for extreme prematurity seems an unjustifiable restriction of physician practice and parental rights.