Pediatrics
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The objective of this study was to determine the relationship between the frequency and total volume of intravascular volume administration and the development of intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation. ⋯ The number and total volume of intravascular volume administration in the first 8 and 24 hours of venoarterial extracorporeal membrane oxygenation treatment are statistically significantly related to the development of intracranial hemorrhage.
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The goal was to examine the factors influencing parental satisfaction with neonatal intensive care for moderately premature infants in 10 hospitals in Massachusetts and California. ⋯ Although we included variables across the full spectrum of neonatal intensive care, we found that the major predictor of parental satisfaction with neonatal intensive care was child health at the time of the interview, followed by sociodemographic factors and previous infertility treatment. However, the variance explained was limited, which suggests that research is needed on the factors influencing satisfaction.
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Pediatric quality indicators were developed in 2006 by the Agency for Healthcare Research and Quality to identify potentially preventable complications in hospitalized children. Our objectives for this study were to (1) apply these algorithms to an aggregate children's hospital's discharge abstract database, (2) establish rates for each of the pediatric quality indicator events in the children's hospitals, (3) use direct chart review to investigate the accuracy of the pediatric quality indicators, (4) calculate the number of complications that were already present on admission and, therefore, not attributable to the specific hospitalization, and (5) evaluate preventability and calculate positive predictive value for each of the indicators. In addition, we wanted to use the data to set priorities for ongoing clinical investigation. ⋯ A subset of pediatric quality indicators derived from administrative data are reasonable screening tools to help hospitals prioritize chart review and subsequent improvement projects. However, in their present form, true preventability of these complications is relatively low; therefore, the indicators are not useful for public hospital comparison. Identifying which complications are present on admission versus those that occur within the hospitalization will be essential, along with adequate risk adjustment, for any valid comparison between institutions. Infection caused by medical care and decubitus ulcers are clinically important indicators once the present-on-admission status is determined. These complications cause significant morbidity in hospitalized children, and research has shown a high level of preventability. The pediatric quality indicator software can help children's hospitals objectively review their cases and target improvement activities appropriately. The postoperative-respiratory-failure indicator does not represent a complication in the majority of cases and, therefore, should not be included for hospital screening or public comparison. Chart review should become part of the development process for quality indicators to avoid inappropriate conclusions that misdirect quality-improvement resources.
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The initial presentation of congenital and acquired heart disease in children can present a diagnostic challenge. We sought to evaluate B-type natriuretic peptide as a marker of critical heart disease in children at presentation in the acute care setting. ⋯ B-type natriuretic peptide levels were markedly elevated at presentation in the acute care setting for all patients in this cohort of children with newly diagnosed congenital or acquired heart disease. B-type natriuretic peptide levels from noncardiac patients were significantly lower, with no overlap to the cardiac disease group. B-type natriuretic peptide level can be useful as a diagnostic marker to aid in the recognition of pediatric critical heart disease in the acute care setting.