scholarly journals Pediatric Hospitalization for Varicella in an Italian Pediatric Hospital: How Much Does It Cost?

2021 ◽  
Vol 18 (22) ◽  
pp. 12053
Author(s):  
Elena Bozzola ◽  
Giulia Spina ◽  
Maria Rosaria Marchili ◽  
Carla Brusco ◽  
Stefano Guolo ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Herd Immunity ◽  
Health Assessment ◽  
Pediatric Hospital ◽  
Hospitalization Cost ◽  
Compulsory Vaccination ◽  
Pediatric Hospitalization ◽  
The Mean ◽  
Pediatric Infection

Background: Varicella is a common pediatric infection. Even if it generally has a benign course, it may complicate and require hospitalization. The aim of our study was to estimate the acute hospitalization cost (AHC) for varicella in the acute phase in a pediatric population. Methods: We calculated the AHC of pediatric patients admitted for varicella at Bambino Gesù Children Hospital, Rome, Italy, from 1 November 2005 to 1 November 2020. Results: In the study period, 825 pediatric patients affected by varicella were hospitalized. The mean hospitalization cost was EUR 4015.35 (range from EUR 558.44 to EUR 42,608.00). Among patients, 55% were unvaccinable due to either their age or their immunosuppression status. They would benefit from herd immunity, reducing the overall AHC by EUR 182,196,506. Since the introduction of the compulsory vaccination against varicella in Italy, we observed a significant reduction in AHC cost of 60.6% in 2019 and of 93.5% in 2020. Finally, from the beginning of the COVID-19 pandemic, we documented a decline of 81.2% and 76.9% in varicella hospitalization, compared to 2018 and 2019, respectively. Conclusions: Varicella AHC is an important economic and health assessment point and can be useful for improving preventive strategies.

Seven years follow-up of corneal cross-linking (CXL) in pediatric patients: Evaluation of treated and untreated eye

2021 ◽  
pp. 112067212110206
Author(s):  
Iliya Simantov ◽  
Lior Or ◽  
Inbal Gazit ◽  
Biana Dubinsky-Pertzov ◽  
David Zadok ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Uncorrected Distance Visual Acuity ◽  
Mild Reduction ◽  
Change In The Mean ◽  
The Mean

Background: Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes. Methods: Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography. Results: Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years; p = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years; p = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D); p < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm ( p = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D ( p = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL. Conclusion: CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.

Isolation Usage in a Pediatric Hospital

1987 ◽  
Vol 8 (5) ◽  
pp. 195-199 ◽  
Author(s):  
Mee-Hai Marie Kim ◽  
Cathy Mindorff ◽  
Mary Lou Patrick ◽  
Ronald Gold ◽  
E. Lee Ford-Jones
Keyword(s):  
Orthopedic Surgery ◽  
Body Fluid ◽  
Resistant Organism ◽  
Pediatric Hospital ◽  
Infection Control Nurse ◽  
Bed Days ◽  
The Mean ◽  
Time Utilization ◽  
Isolation Requirements ◽  
Pediatric Infection

AbstractIn a prospective 12-month study at a university-affiliated pediatric hospital, isolation usage was quantitated by ward/service, season, isolation category and type of infection (community-acquired vs nosocomial). Such information may be helpful in designing hospitals, recognizing time utilization of the pediatric infection control nurse, and defining educational and isolation needs. Hospitals with multiple bed rooms and inadequate numbers of single rooms may be unable to meet current federal isolation guidelines.The mean number of isolation days was 153 per 1000 patient days or 15.3% of bed days used. This ranged from 18.5% on the infant/toddler/preschool medical ward to 2.8% on child/teenage orthopedic surgery. Isolation requirements vary seasonally and rose to 32% in winter on one ward. Proportional frequencies of isolation category included enteric—29%, protective—28%, strict—16%, barrier (contact)—10%, multiply resistant organism (MRO)—8%, wound—5%, pregnant women (careful handwashing)—3%, blood and body fluid precautions—1%. Isolation of patients with and contacts of nosocomial infections account for 32% of isolation usage. During one third of the 365-day year, the hospital is unable to provide adequate numbers of single rooms for one to 20 patients.

scholarly journals Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

2019 ◽  
Vol 24 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Katherine Lemming ◽  
Gary Fang ◽  
Marcia L. Buck
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Dose Reduction ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Pain Management ◽  
Nuss Procedure ◽  
The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

scholarly journals Esophageal eosinophilia in pediatric patients with cerebral palsy

2015 ◽  
Vol 13 (2) ◽  
pp. 232-237 ◽  
Author(s):  
Ana Carolina Ramos de Nápolis ◽  
Flavia Araujo Alves ◽  
Erica Rodrigues Mariano de Almeida Rezende ◽  
Gesmar Rodrigues Silva Segundo
Keyword(s):  
Cerebral Palsy ◽  
Eosinophilic Esophagitis ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Gastrointestinal Diseases ◽  
High Power Field ◽  
Cross Sectional ◽  
Tertiary Centre ◽  
Tertiary Center ◽  
The Mean

ABSTRACT Objective: To describe the clinical picture, test results, and clinical evolution of patients with cerebral palsy associated with diagnosis of eosinophilic esophagitis, monitored at tertiary centre. Methods: Cross-sectional, retrospective and descriptive study that evaluated the medical records data of pediatric patients with diagnosis of cerebral palsy and eosinophilic esophagitis in a tertiary center of pediatric gastroenterology between August 2005 and August 2013. Results: Seven out of 131 patients with cerebral palsy had the diagnosis of eosinophilic esophagitis. The mean age at diagnosis of eosinophilic esophagitis was 52.3 months and the mean number of eosinophils in esophagus was 35 per high-power field. Symptoms more frequent were recurrent vomiting and disphagia. Endoscopic alterations found were mucosal thickening, vertical lines, mucosal opacificacion and white plaques. Conclusion: The frequency of eosinophilic esophagitis found was higher than in general pediatric population. The investigation of eosinophilic esophagitis should be done regularly in those patients, once this entity could overlap other gastrointestinal diseases.

scholarly journals Primary Intraventricular Hemorrhage in Pediatric Patients: Causes, Characteristics, and Outcomes

2019 ◽  
Author(s):  
Rui Guo ◽  
Chaofeng Fan ◽  
Ruiqi Chen ◽  
Zhiyuan Yu ◽  
Rui Tian ◽  
...  
Keyword(s):  
Intraventricular Hemorrhage ◽  
Arteriovenous Malformations ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Unfavorable Outcome ◽  
Rare Type ◽  
Long Time ◽  
The Mean ◽  
Short Time

Abstract Background: Primary intraventricular hemorrhage is a rare type of stroke and little is known its causes, characteristics and outcomes in children. Methods: We retrospectively analyzed the clinical characteristics of patients aged one month to 21 years during seven consecutive years with primary intraventricular hemorrhage. Primary intraventricular hemorrhage was defined as bleeding confined to the ventricular system without parenchymal or subarachnoid hemorrhage involved. Results: Of the included eighteen patients, 55.6% were female, and the mean age was 13.8 ± 6.0 years. The most common symptoms on presentation were headache (77.8%) and vomiting (33.3%). Fifteen patients (83.3%) were diagnosed with known etiologies, including arteriovenous malformations (66.7%), Moyamoya disease (11.1%), and aneurysms (5.6%). Idiopathic PIVH was diagnosed in only 3 patients (16.7%). Fifteen patients (83.3%) underwent surgical intervention, and 3 patients (16.7%) received conservative treatment. Four patients (28.6%) had an unfavorable outcome at discharge and unfavorable was observed in 3 patients (16.7%) at the 3-month follow-up. Higher Graeb score was associated with an unfavorable outcome both in short-time and long-time follow-up. Conclusions: Most primary intraventricular hemorrhage patients were diagnosed with arteriovenous malformations in the pediatric population. Specific surgical treatment of underlying etiologies should be required to increase clinical improvement. The children with higher Graeb score at admission tended to have poor early and late outcome. Keywords: Primary intraventricular hemorrhage; pediatric; surgery; vascular disorders.

COVID-19 associated multisystem inflammatory syndrome in children mimicking acute appendicitis - how to differentiate and conduct pediatric patients during the pandemic? - Proposal of a management flowchart

2021 ◽  
Vol 48 ◽  
Author(s):  
LORAINE ENTRINGER FALQUETO ◽  
CAROLINA MARTINS VISSOCI ◽  
ISABELLA CRISTINA BONETTO FERREIRA ◽  
AMANDA GINANI ANTUNES ◽  
FERNANDO ANTÔNIO BERSANI AMADO ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Initial Phase ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Pediatric Hospital ◽  
Inflammatory Syndrome

ABSTRACT Introduction: the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil. Discussion: It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms. Conclusion: MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.

Branchial Anomalies in the Pediatric Population

2007 ◽  
Vol 137 (2) ◽  
pp. 289-295 ◽  
Author(s):  
James W. Schroeder ◽  
Nadia Mohyuddin ◽  
John Maddalozzo
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Epithelial Lining ◽  
Pediatric Hospital ◽  
Recurrence Rates ◽  
Branchial Anomalies

OBJECTIVE: We sought to review the presentation, evaluation, and treatment of branchial anomalies in the pediatric population and to relate these findings to recurrences and complications. STUDY DESIGN AND SETTING: We conducted a retrospective study at a tertiary care pediatric hospital. PATIENTS: Ninety-seven pediatric patients who were treated for branchial anomalies over a 10-year period were reviewed. Patients were studied if they underwent surgical treatment for the branchial anomaly and had 1 year of postoperative follow-up; 67 children met criteria, and 74 anomalies were studied. RESULTS: Patients with cysts presented at a later age than did those with branchial anomaly fistulas or sinus branchial anomalies. 32% of branchial anomalies were previously infected. Of these, 71% had more than one preoperative infection. 18% of the BA were first arch derivatives, 69% were second arch derivatives and 7% were third arch derivatives. There were 22 branchial cysts, 31 branchial sinusies and 16 branchial fistulas. The preoperative and postoperative diagnoses differed in 17 cases. None of the excised specimens that contained a cystic lining recurred; all five recurrences had multiple preoperative infections. CONCLUSIONS: Recurrence rates are increased when there are multiple preoperative infections and when there is no epithelial lining identified in the specimen.

scholarly journals Biologic Use in Pediatric Patients With Hidradenitis Suppurativa: A Systematic Review

2021 ◽  
pp. 120347542110497
Author(s):  
Muskaan Sachdeva ◽  
Patrick Kim ◽  
Asfandyar Mufti ◽  
Khalad Maliyar ◽  
Cathryn Sibbald ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complete Resolution ◽  
Hidradenitis Suppurativa ◽  
Large Scale ◽  
Pediatric Patients ◽  
Biologic Therapy ◽  
Pediatric Population ◽  
Safety Data ◽  
Tnf Alpha ◽  
The Mean

Background: There is currently at least 1 biologic (adalimumab) approved in North America for treatment of Hidradenitis Suppurativa in the pediatric population. However, no reviews or clinical trials have specifically analyzed the effectiveness and safety data of biologic use in this population. The objective of this systematic review is to identify and summarize the outcomes of biologic therapy in pediatric patients with HS. Methods: MEDLINE and EMBASE databases were used to conduct the search on Sept 18, 2020. Results: The 15 included studies consisted of 26 patients, with the mean age of 15 ± 2.3 years. Females accounted for 53.8% ( n = 14/26) of cases. The mean duration of HS prior to biologic initiation was 3.5 ± 2.9 years, with the majority having Hurley Stage II. The 26 patients received 34 biologics in total: 85.3% treated with TNF alpha inhibitors (adalimumab n = 17, infliximab n = 10, etanercept n = 1, unspecified n = 1), 5.9% with IL-12/23 inhibitors (ustekinumab n = 2), 5.9% with IL-1 inhibitors (i.e., anakinra n = 2) and 2.9% received IL-23 inhibitors (i.e., guselkumab n = 1) biologics. Of the 26 patients, 23.1% ( n = 6/26) experienced complete resolution (CR), 73.1% ( n = 19/26) experienced partial resolution (PR), and 3.8% ( n = 1/26) had no resolution outcomes reported. The time to resolution of HS lesions after biologic initiation ranged from 10 days to 11.5 months (mean: 5.1 months). No adverse events were reported in the studies. Conclusion: Although anti-TNF alpha were the most common biologics used for HS in pediatric cases, large-scale trials specific to pediatric patients with HS are needed to confirm these findings.

P069 Assessment of diagnostic delay for hip disorders in the pediatric population

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Cherif Ines ◽  
Wafa Triki ◽  
Affes Hassen ◽  
Hanene Ferjani ◽  
Kaouther Maatallah ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Diagnostic Delay ◽  
General Medicine ◽  
Final Diagnosis ◽  
Clinical Findings ◽  
Imaging Findings ◽  
Hip Motion ◽  
The Mean

Abstract Background Hip disorders are highly common among pediatric patients. The diagnosis is based primarily on the clinical findings, the context and the personal and family history of the child. It is in most cases steered by the biological and imaging findings. The latter are usually derived from radiographs, ultrasound imaging and, in some cases, MRI. The main purpose of this study is to evaluate assess the diagnostic delay for hip disorders in the pediatric population. Methods We conducted a retrospective study including pediatric patients from the rheumatology and the orthopedics department, who consulted or were referred to orthopeadics for a suspected hip disorder. For all patients, we collected the following data: age, clinical findings, imaging findings, the number of consultations in general medicine or emergency medicine and the number of consultations in orthopedics department before the diagnosis is made, the final retained diagnosis and, ultimately, the diagnostic delay since onset of symptoms and first consultation. Results We included 81 children (48 boys and 33 girls) with a mean age of 9.9 years old [1.5–16]. Sixty-two patients were symptomatic at admission. The pain was located in the hip in 55.5% of patients (n = 45), in the groin in 7.4% of patients (n = 6) and in the knee in 12.34% of patients (n = 10). One child reported unilateral buttock pain. The other reasons for consultation were limping in 3.7% of cases (n = 3), deformity of the lower limb in 1.23% of cases (n = 1), a crying baby in 1.23% of cases (n = 1) and swelling of the knee in 1.23% of cases (n = 1). On clinical examination, 58 patients had a limitation of the hip motion. Twenty-nine percent of the children had a biological inflammatory syndrome at admission. In total, over one hundred and seventy-one imaging examinations were performed in order to adjust the diagnosis; among them, 7 CT pelvic scan and 23 MRI. The different retained diagnoses of hip involvement are summarized in Table 1. The mean number of consultations in general medicine or emergency medicine before the diagnosis is made was 0,58 ranging from 0 to 2. The mean diagnostic delay since the onset of symptoms was 9,12 months ranging from 3 days to 13 years. The mean diagnostic delay since the first medical check -up was 3,5 months ranging from 0 to 10 years. Conclusion Our study showed that the patient lost an average of 9 months from symptom onset to retaining the final diagnosis. The hip being a prognosis joint, this delay could alter the child's future functional abilities.

scholarly journals Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures

2016 ◽  
Vol 17 (6) ◽  
pp. 639-644 ◽  
Author(s):  
Babatunde J. Akinpelu ◽  
Scott L. Zuckerman ◽  
Stephen R. Gannon ◽  
Ashly Westrick ◽  
Chevis Shannon ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Spinous Process ◽  
High Energy ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Presenting Symptoms ◽  
The Mean

OBJECTIVE Isolated transverse and spinous process fractures (TPFx and SPFx) in the thoracic and/or lumbar region have been deemed clinically insignificant in the adult population. This same rule is often applied to the pediatric population; however, little evidence exists in this younger group. The goal of this study was to describe the clinical, radiographic, and long-term data on isolated TPFx and SPFx in an exclusively pediatric population. METHODS A retrospective chart review at Monroe Carell Jr. Children's Hospital at Vanderbilt University identified 82 pediatric patients with isolated TPFx and/or SPFx following a traumatic event between January 2000 and December 2013. Patient demographic information, presenting symptoms, radiographic characteristics, and follow-up data were collected. Follow-up was used to determine the outcome (presence of neurological deficits) of such injuries via complete physical examination and, when available, radiographic evidence. RESULTS In the 82 identified patients, the mean age was 15.5 ± 3.1 years (mean is expressed ± SD throughout), with 72 injuries (87.8%) resulting from a motor vehicle, motorcycle, or all-terrain vehicle accident. There was a mean of 1.7 ± 1.0 fractured vertebral levels involved and a mean of 1.8 ± 1.1 fractures was identified per patient. Seventy-one patients (86.6%) needed bedside pain control, 7 (8.5%) were prescribed a brace, and 4 patients (4.9%) received a collar. Physical therapy was recommended for 12 patients (14.6%). A total of 84.1% had follow-up, and the mean length of follow-up was 19 ± 37 months. No patients had true neurological deficits at presentation or follow-up as a result of their isolated fractures, whereas 95.1% had other associated system injuries. CONCLUSIONS These data shows that there is no appreciable long-term complication associated with isolated thoracic and/or lumbar TPFx and/or SPFx in an exclusively pediatric population. Because these fractures are, however, associated with high-energy blunt trauma, they often result in associated soft-tissue or other skeletal injury. All pediatric patients in the cohort benefited from conservative management and aggressive treatment of their comorbidities.

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