scholarly journals The Impact of Breastfeeding on the Childhood Acute Leukemia Risk Among Children Attending Alexandria University Children's Hospital

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3733-3733
Author(s):  
Mohamed NZ Massoud ◽  
Hoda MA Hassab ◽  
Aida M M Ali ◽  
Doha N Mohamed
Keyword(s):  
High Risk ◽  
Acute Leukemia ◽  
Breast Feeding ◽  
Bottle Feeding ◽  
Risk Level ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Duration Of Breastfeeding ◽  
The Impact ◽  
Breast Fed

Abstract Objective: The present study was conducted to investigate the impact of breastfeeding on the risk of development of acute leukemia among children Admitted to Alexandria University Children's Hospital. METHODS: A case control study included 134 ALL&AML cases & 134 matched controls for age & sex from the same family relatives to evaluate socioeconomic & genetic causes of the disease. The mothers were interviewed for the completion of interview format that included: duration & patterns of breastfeeding. RESULTS: lower proportion of acute leukemia cases 59.7% were exclusively breast-fed babies as compared to 89.6% of the control subjects. However, higher proportions of index children were either predominant breast-fed 19.4% or complementary-fed 10.4%. Nearly 10.4% were bottle-fed babies as compared to none of their controls. The differences between cases & controls as regards pattern of breast feeding were statistically significant where p<0.001. As regards duration of breastfeeding 75.4% of index children were breast-fed for more than 6 months as compared to vast majority of their controls (97.8%). The difference between cases & controls was statistically significant where p <0.001. The association also was statistically significant when 2 groups (standard & high risk) were considered as regards pattern of breastfeeding where x2=13.055, p =0.004. The multivariate logistic regression analysis indicated that bottle feeding had the odds of 7.76 of being at high risk level for acute leukemia (OR=7.76, 95% CI 1.9-33.8). CONCLUSION: Exclusive breast-feeding and breast-feeding for one year are protective against acute childhood leukemia. Table 1. Bivariate and multivariate analysis for pattern & duration of breastfeeding of the studied children with acute leukemia and their controls. Pattern and duration of breastfeeding Bi variant variable Multivariate variable Type of feeding during the first 6 month of life. Cases (n=134) Control (n=134) Significance OR (95% CI) Significance No. % No. % X2 = 37.6 P>0.0001* 1 Exclusive BF 80 59.7 120 89.6 Predominant BF 26 19.4 13 9.7 1.67 (1.26 - 2.2)* X2 = 9.4 P=0.002* Complementary feeding 14 10.4 1 0.7 21 (2.8 - 436.4)* X2 = 16.13 P>0.0001* Bottle feeding 14 10.4 0 0 2.5 (2.1 - 2.9)* X2 = 19.12 P>0.0001* Duration of breastfeeding 0-≤ 3 month 2 1.7 0 0 X2 =15.331 MC P=0.0001* AN- FEP=0.18 =13.06 P=0.0003* X2=0.38 P=0.537 3-≤ 6 month 17 14.2 3 2.2 7.6 (2.1 - 33.8)* 6-12 month 16 13.3 17 12.7 1.26 0.6-2.8 More than 12 month 85 70.8 114 85.1 1 - X2: Chi-Square test FEP: Fisher's Exact test -NA-: Not Applicable *significant at P≤0.0 Disclosures No relevant conflicts of interest to declare.

Impact of Infant Feeding Practices on Caries Experience of Preschool Children

2010 ◽  
Vol 34 (4) ◽  
pp. 297-301 ◽  
Author(s):  
Morenike Folayan ◽  
Christiana Sowole ◽  
Foluso Owotade ◽  
Elizabeth Sote
Keyword(s):  
Preschool Children ◽  
Breast Feeding ◽  
Feeding Habits ◽  
Strong Association ◽  
Bottle Feeding ◽  
Caries Experience ◽  
Night Feeding ◽  
Duration Of Breastfeeding ◽  
The Impact ◽  
Rampant Caries

Aim: This study investigated the association between breastfeeding, bottle feeding, night feeding, age, and sex of the child on the caries experience. Method: Information was collected from the mothers of preschool children. Information included the age of the child, sex of the child, form of breastfeeding (whether exclusive,almost exclusive or mixed), duration of breastfeeding, night feeding habits of the child, and duration and content of bottle feeding. Intraoral examination was done to assess the dmft. The impact of the variables on the caries experience (rampant caries, no caries and the dmft) was then assessed. Results: The duration of breast feeding (p=0.002), and form of breast feeding (p=0.03) were significant predictors of the dmft. The dmft was highest in children who were breastfeed for longer than 18 months and highest for children who were exclusively breastfed. There is a strong association between rampant caries and duration of breast feeding only (p&lt;0.001). The risk of having rampant caries increases by 10% (p = 0.012) with every month increase in the duration of breastfeeding. Conclusion: The duration of breastfeeding increased the risk for rampant caries in preschool children in Nigeria. The longer the duration, the higher the risk for caries.

Decision Aids for Generating Analytical Review Alternatives: The Impact of Goal Framing and Audit-Risk Level

2002 ◽  
Vol 14 (1) ◽  
pp. 157-177 ◽  
Author(s):  
Jennifer M. Mueller ◽  
John C. Anderson
Keyword(s):  
High Risk ◽  
Cognitive Load ◽  
Information Search ◽  
Decision Aid ◽  
Decision Aids ◽  
Risk Level ◽  
Audit Risk ◽  
Goal Framing ◽  
Analytical Review ◽  
The Impact

An auditor generating potential explanations for an unusual variance in analytical review may utilize a decision aid, which provides many explanations. However, circumstances of budgetary constraints and limited cognitive load deter an auditor from using a lengthy list of explanations in an information search. A two-way between-subjects design was created to investigate the effects of two complementary approaches to trimming down the lengthy list on the number of remaining explanations carried forward into an information search. These two approaches, which represent the same goal (reducing the list) but framed differently, are found to result in a significantly different number of remaining explanations, in both low- and high-risk audit environments. The results of the study suggest that the extent to which an auditor narrows the lengthy list of explanations is important to the implementation of decision aids in analytical review.

scholarly journals Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach

2021 ◽  
pp. 000313482110111
Author(s):  
Ryan C. Pickens ◽  
Angela M. Kao ◽  
Mark A. Williams ◽  
Andrew C. Herman ◽  
Jeffrey S. Kneisl
Keyword(s):  
Pediatric Surgery ◽  
Elective Surgery ◽  
Surgical Care ◽  
Children's Hospital ◽  
Protocol Development ◽  
Balanced Approach ◽  
Projective Curves ◽  
Children’S Hospital ◽  
The Impact ◽  
Emergent Surgery

Background In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry. Methods The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases. Results Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking. Conclusion Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.

Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Justin B. Searns ◽  
Manon C. Williams ◽  
Christine E. MacBrayne ◽  
Ann L. Wirtz ◽  
Jan E. Leonard ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interrater Reliability ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Primary Treatment ◽  
Treatment Team ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact ◽  
Made In

AbstractObjectivesFew studies describe the impact of antimicrobial stewardship programs (ASPs) on recognizing and preventing diagnostic errors. Handshake stewardship (HS-ASP) is a novel ASP model that prospectively reviews hospital-wide antimicrobial usage with recommendations made in person to treatment teams. The purpose of this study was to determine if HS-ASP could identify and intervene on potential diagnostic errors for children hospitalized at a quaternary care children’s hospital.MethodsPreviously self-identified “Great Catch” (GC) interventions by the Children’s Hospital Colorado HS-ASP team from 10/2014 through 5/2018 were retrospectively reviewed. Each GC was categorized based on the types of recommendations from HS-ASP, including if any diagnostic recommendations were made to the treatment team. Each GC was independently scored using the “Safer Dx Instrument” to determine presence of diagnostic error based on a previously determined cut-off score of ≤1.50. Interrater reliability for the instrument was measured using a randomized subset of one third of GCs.ResultsDuring the study period, there were 162 GC interventions. Of these, 65 (40%) included diagnostic recommendations by HS-ASP and 19 (12%) had a Safer Dx Score of ≤1.50, (Κ=0.44; moderate agreement). Of those GCs associated with diagnostic errors, the HS-ASP team made a diagnostic recommendation to the primary treatment team 95% of the time.ConclusionsHandshake stewardship has the potential to identify and intervene on diagnostic errors for hospitalized children.

The impact of a complex care clinic in a children's hospital

2010 ◽  
Vol 36 (4) ◽  
pp. 574-582 ◽  
Author(s):  
E. Cohen ◽  
J. N. Friedman ◽  
S. Mahant ◽  
S. Adams ◽  
V. Jovcevska ◽  
...  
Keyword(s):  
Complex Care ◽  
Care Clinic ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact

CHANGING PRESCRIBING CULTURE – A FOCUS ON CODEINE POSTPARTUM

2016 ◽  
Vol 101 (9) ◽  
pp. e2.12-e2 ◽  
Author(s):  
Noor Al-Adhami ◽  
Karen Whitfield ◽  
Angela North
Keyword(s):  
Breast Feeding ◽  
Medical Staff ◽  
Successful Outcome ◽  
Postpartum Women ◽  
Limited Data ◽  
Training And Education ◽  
Key Stakeholders ◽  
Postpartum Analgesia ◽  
The Impact ◽  
Breast Fed

AimTo eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1 MethodsThe evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff.ResultsThe evidence that was presented to key stakeholders included:▸ Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding▸ Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).▸ Recommendations from the Australian Medicines Handbook to avoid in breast feeding2 ▸ Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data–probably compatible) to L4 (limited data–possibly hazardous).3 Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their ‘as required’ analgesic regimen.Since the intervention, codeine combination products have now been almost completely eliminated on medication charts for postpartum women (less than 5%). Those that are prescribed are ceased once highlighted to medical staff. The obstetric pharmacist now presents a session on postpartum analgesia at every new resident medical officer orientation outlining suitable medications to prescribe. In addition all new pharmacists to the women's and new born's team receive training about postpartum analgesia.ConclusionThis study highlights the impact that can be achieved when health care professionals work together to change the culture and prescribing habits in a hospital setting, to enhance patient safety. Evaluating the evidence and presenting to stakeholders as well as providing ongoing training and education to medical, nursing and pharmacy staff are all essential to a successful outcome.

Analysis of the Effects of Applying Federal Diagnosis-Related Grouping (DRG) Guidelines to a Population of High-Risk Newborn Infants

PEDIATRICS ◽  
1985 ◽  
Vol 76 (1) ◽  
pp. 104-109
Author(s):  
Ronald L. Poland ◽  
Robert O. Bollinger ◽  
Mary P. Bedard ◽  
Sanford N. Cohen
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Geometric Mean ◽  
Tertiary Care ◽  
Newborn Infants ◽  
Frequency Distributions ◽  
Federal Register ◽  
Children's Hospital ◽  
Lengths Of Stay ◽  
Children’S Hospital

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those sub-groups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.

Nipple Confusion

PEDIATRICS ◽  
1993 ◽  
Vol 92 (2) ◽  
pp. 300-301
Author(s):  
DOREN FREDRICKSON
Keyword(s):  
Breast Feeding ◽  
Statistical Power ◽  
White Women ◽  
Small Sample Size ◽  
False Negative ◽  
Small Sample ◽  
Bottle Feeding ◽  
Feeding Duration ◽  
Breast Feed ◽  
The Impact

To the Editor.— I wish to comment on the study reported by Cronenwett et al,1 which was a fascinating prospective study among married white women who planned to breast-feed. Women were randomly selected to perform either exdusive breast-feeding or partial breast-feeding with bottled human milk supplements to determine the impact of infant temperament and limited bottle-feeding on breast-feeding duration. The authors admit that small sample size and lack of statistical power make a false-negative possible.

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