scholarly journals The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America

2011 ◽  
Vol 53 (7) ◽  
pp. e25-e76 ◽  
Author(s):  
John S. Bradley ◽  
Carrie L. Byington ◽  
Samir S. Shah ◽  
Brian Alverson ◽  
Edward R. Carter ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Care Management ◽  
Expert Panel ◽  
Hospital Medicine ◽  
Community Acquired Pneumonia ◽  
Infants And Children ◽  
Healthy Infants ◽  
Inpatient Settings ◽  
Evidenced Based ◽  
In Infants And Children

Abstract Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

scholarly journals 1139. Multidisciplinary Initiative to Increase Guideline-Concordant Antibiotic Prescriptions at Discharge for Hospitalized Children with Uncomplicated Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S405-S406
Author(s):  
Alexandra B Yonts ◽  
Michael Jason Bozzella ◽  
Matthew Magyar ◽  
Laura O’Neill ◽  
Nada Harik
Keyword(s):  
Infectious Diseases ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Hospital Medicine ◽  
Community Acquired Pneumonia ◽  
Antibiotic Prescribing ◽  
Hospitalized Children ◽  
Median Percentage ◽  
Common Diagnosis ◽  
The Impact

Abstract Background Community-acquired pneumonia (CAP) is the most common diagnosis in hospitalized children. The Pediatric Infectious Diseases Society and the Infectious Diseases Society of America published evidenced-based clinical practice guidelines for the management of CAP in children 3 months of age or older in 2011. These guidelines are not consistently followed. Our objective was to evaluate if quality improvement (QI) methods could improve guideline-concordant antibiotic prescribing, specifically addressing the use of oral third-generation cephalosporins, at hospital discharge for children with uncomplicated CAP. Methods QI interventions, implemented at a single tertiary care children’s hospital in Washington, D.C., focused on key drivers targeting hospital medicine resident teams. Multiple plan-do-study-act (PDSA) cycles were performed. Initial interventions included educational sessions (in small group and lecture formats) aimed at pediatric resident physicians, as well as visual job aids (Figure 1) and guideline summaries posted in resident physician work areas. Interventions were implemented in series to allow for statistical analysis via run chart. Medical records of eligible patients were reviewed monthly after each intervention to determine the impact on appropriate discharge antibiotic prescribing. Results At baseline, the median percentage of children with a diagnosis of uncomplicated CAP discharged with guideline-concordant antibiotics was 50%. Median rates of guideline-concordant antibiotic prescribing improved to 87.5% after initial interventions (Figure 2). Conclusion A fellow-led multidisciplinary QI initiative was successful in decreasing rates of non-guideline-concordant antibiotic prescribing at discharge. These interventions can be tailored for use at other institutions and for other infectious processes with established treatment guidelines. To ensure sustained improvement in guideline-concordant prescribing, future planned interventions include additional educational sessions with residents, faculty, and pharmacists, EMR order set modification and physician benchmarking. These tactics are intended to address the anticipated challenge of resident/faculty turnover and automate antibiotic choice for uncomplicated CAP. Disclosures All authors: No reported disclosures.

scholarly journals The Role of TLR4 Asp299Gly and TLR4 Thr399Ile Polymorphisms in the Pathogenesis of Urinary Tract Infections: First Evaluation in Infants and Children of Greek Origin

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Panagiota Karananou ◽  
Despoina Tramma ◽  
Socrates Katafigiotis ◽  
Anastasia Alataki ◽  
Alexandros Lambropoulos ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Infections ◽  
Pediatric Population ◽  
Infants And Children ◽  
Healthy Children ◽  
Healthy Infants ◽  
Tract Infections ◽  
In Infants And Children

Urinary tract infections are one of the most common and serious bacterial infections in a pediatric population. So far, they have mainly been related to age, gender, ethnicity, socioeconomic level, and the presence of underlying anatomical or functional, congenital, or acquired abnormalities. Recently, both innate and adaptive immunities and their interaction in the pathogenesis and the development of UTIs have been studied. The aim of this study was to assess the role and the effect of the two most frequent polymorphisms of TLR4 Asp299Gly and Thr399Ile on the development of UTIs in infants and children of Greek origin. We studied 51 infants and children with at least one episode of acute urinary tract infection and 109 healthy infants and children. We found that 27.5% of patients and 8.26% of healthy children carried the heterozygote genotype for TLR4 Asp299Gly. TLR4 Thr399Ile polymorphism was found to be higher in healthy children and lower in the patient group. No homozygosity for both studied polymorphisms was detected in our patients. In the group of healthy children, a homozygote genotype for TLR4 Asp299Gly (G/G) as well as for TLR4 Thr399Ile (T/T) was showed (1.84% and 0.92 respectively). These results indicate the role of TLR4 polymorphism as a genetic risk for the development of UTIs in infants and children of Greek origin.

scholarly journals Fecal S100A12 in Healthy Infants and Children

2013 ◽  
Vol 35 ◽  
pp. 295-299 ◽  
Author(s):  
A. S. Day ◽  
M. Ehn ◽  
R. B. Gearry ◽  
D. A. Lemberg ◽  
S. T. Leach
Keyword(s):  
Young Children ◽  
Elevated Level ◽  
Gastrointestinal Symptoms ◽  
Infants And Children ◽  
Healthy Children ◽  
Term Infants ◽  
Healthy Infants ◽  
Stool Samples ◽  
Serial Samples ◽  
In Infants And Children

Background and Aims. Fecal S100A12 is shown to be a useful noninvasive marker of gut inflammation. However, the studies to date have not characterised the patterns of expression in healthy young children. This study aimed to determine S100A12 levels in infants and children without symptoms of underlying gut disease.Methods. Stool samples were collected from healthy infants (<12 months) and children without gastrointestinal symptoms. Faecal S100A12 was measured by immunoassay.Results. Fifty-six children were recruited. Serial samples were obtained from seven term infants over the first 6 months of life. Single samples were obtained from 49 healthy children ranging from 0.16 to 13.8 years of age. Median S100A12 levels were 0.5 mg/kg (ranging from 0.39 to 25) in the healthy children, with high values (>10 mg/kg) in five infants only. There was no variation between gender. Median S100A12 levels in healthy infants remained below the established normal cut-off from birth to six months of age.Conclusion. S100A12 levels in well infants and children are almost exclusively lower than the standard cut-off. Transiently higher levels may be seen in early infancy. An elevated level of S100A12 in children older than 12 months of age is likely to represent organic gut disease.

scholarly journals Community acquired pneumonia (CAP): Epidemiology, clinical presentation, management and outcomes in infants and children presenting to Al Wakra Pediatric Emergency Department (PED)

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Ibtihal S Abdelgadir ◽  
Haider Almawashi ◽  
Fawzia M Elgharbawy ◽  
Abdo M Alghazali ◽  
Kryzl D Ponce ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Pediatric Emergency ◽  
Community Acquired Pneumonia ◽  
Infants And Children ◽  
Pediatric Emergency Department ◽  
Reactive Protein ◽  
Amoxicillin Clavulanic Acid ◽  
In Infants And Children

Background: Community acquired pneumonia (CAP) is defined clinically as the presence of signs and symptoms of pneumonia in a previously healthy child due to an infection that has been acquired outside the hospital. There is no previous data available from children in Qatar on CAP.Objectives: To evaluate the incidence, clinical features, management, outcomes and, complications in infants and children presenting to Al Wakra Hospital, Qatar with CAP. Methods: This is a prospective, observational, non-interventional study that assessed all children aged 3 months to 14 years, during a period of 12 months, from November 2017 to November 2018. Results: The incidence of CAP was found to be 2.8 per 1000 of all patients presenting to Al Wakra Pediatric Emergency Department Qatar (328 of 116,761patients). The majority of cases were children 1-5 years (58.2%). Fifty-one percent and 61.3% of children admitted to inpatient wards had dyspnoea and tachypnea respectively. This is to be compared to 88.5% and 96.2% of patients respectively admitted to the Pediatric Intensive Care Unit (PICU) with dyspnoea and with tachypnea. C-reactive protein (CRP) more than 50 mg/L was noted in 48.2% of patients admitted to inpatient wards and 26.7% of patients admitted to PICU. Oral amoxicillin was prescribed for 1.5% of patients, amoxicillin/clavulanic acid for 18% of patients, a further 18% had cefuroxime, and 29% had clarithromycin. Intravenous (IV) cefuroxime was the most used IV medication (29.6% of all patients). Nearly 50% of patients were admitted to inpatient wards, with 7.9% transferred to PICU, and only 39.3% discharged home without admission. Conclusion: Community acquired pneumonia represents 0.28% of all studied patients. More than 60% of the patients with CAP were admitted either to inpatient wards or to PICU.

Naloxone Use in Newborns

PEDIATRICS ◽  
1980 ◽  
Vol 65 (3) ◽  
pp. 667-669
Author(s):  
Sydney Segal ◽  
Walter R. Anyan ◽  
Reba M. Hill ◽  
Ralph E. Kauffman ◽  
Howard Mofenson ◽  
...  
Keyword(s):  
Respiratory Depression ◽  
Opiate Receptors ◽  
Endogenous Opioids ◽  
Infants And Children ◽  
Narcotic Antagonist ◽  
Narcotic Analgesics ◽  
Antagonist Activity ◽  
Drug Of Choice ◽  
Healthy Infants ◽  
In Infants And Children

Naloxone hydrochloride (Narcan) is a pure narcotic antagonist that is the drug of choice in the treatment of central nervous system and cardiores-piratory depression due to narcotic agonist drugs. It has virtually no agonist activity and therefore produces no narcotic effect even when administered in greater than recommended doses, in contrast to nalorphine hydrochloride and levallorphan tartrate, which have mixed agonist-antagonist activity. In 1975 the FDA approved a dosage form of naloxone in a concentration of 0.02 mg/ml that was specifically designed for use in newborns whose mothers receive narcotic analgesics during labor and who are born with narcotic-induced respiratory depression; this drug was marketed for general prescription use. Three years after its introduction, the role of naloxone in the management of the depressed newborn merits clarification. In addition, recent information regarding opiate receptors and endogenous opioids raises questions concerning the long-term safety of naloxone in neonates. A review of available published and unpublished data pertaning to naloxone use in the newborn infant by the Committee on Drugs forms the basis for the following commentary and recommendations. EFFICACY The potent narcotic antagonist activity of naloxone is well documented in infants and children as well as in adults. Naloxone has been effectively used postoperatively to reverse respiratory depression in infants and children who received narcotics for analgesia.1,2 Additional cases have been reported in which naloxone was successfully and safely used to treat children who were poisoned with narcotic agonists such as diphenoxylate hydrochloride (Lomotil),3,4 methadone hydrochloride, 57 and propoxyphene hydrochloride (Darvon).8 Most of the controlled clinical trials to study the safety and efficacy of naloxone in treating respiratory depression in the narcotic-exposed newborn have been carried out on full-term, healthy infants whose mothers received morphine or meperidine hydrochloride during labor, but who showed no overt clinical evidence of respiratory or CNS depression at birth.

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