Children Hospitalized Research Articles

Hospitalizations Following Complex Hip Surgery in Children with Intellectual Disability: A Self-Controlled Case Series Analysis.

To evaluate the associations between complex hip surgery and subsequent hospitalizations in children with intellectual disability, including a subset of children with cerebral palsy. We: conducted a retrospective cohort study using linked administrative, health, and disability data from Western Australia. Children born between 1983 and 2009 who underwent complex hip surgery by end 2014 were included (intellectual disability, n=154; subset with cerebral palsy, n=91). A self-controlled case series analysis using Poisson regression was used to estimate the age-adjusted associations of complex hip surgery on all-cause hospitalizations and when the principal diagnosis was lower respiratory tract infection (LRTI) or epilepsy, for periods following the individual's first major hip surgery, compared with the year before surgery. Age adjusted incidence of all-cause hospitalizations decreased after surgery (year 1: incidence rate ratio [IRR] 0.87 [95% CI, 0.74-1.02]; year 6: IRR 0.57 [95% CI, 0.46-0.72]). The incidence of hospitalizations for LRTI increased (year 1: IRR,1.03 [95% CI, 0.72-1.51]; year 6: IRR 2.08 [95% CI, 1.18-3.68]). The incidence of hospitalizations for epilepsy decreased (year 1: IRR 0.93 [95% CI, 0.57, 1.54]; year>6: IRR 0.72 [95% CI, 0.34-1.55]) after surgery. A similar pattern was observed for the subset of children with or without cerebral palsy. Complex hip surgeries are associated with fewer hospitalizations overall but not respiratory hospitalizations for children with intellectual disability. Fewer hospitalizations suggest benefits for better musculoskeletal alignment.

Impact of the Amount of Intravenous Glucose Administration on Hospitalization for Acute Gastroenteritis in a Pediatric Emergency Department.

In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established. The main objective of this study was to evaluate the association between the amount of intravenous glucose provided and hospitalization for children with acute gastroenteritis. Another objective was to evaluate practice variation regarding the amount of glucose provided for IV rehydration in a pediatric emergency department (ED). We conducted a retrospective cohort study from 2019 to 2022 in a Canadian pediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease, or diabetes were excluded. The IV glucose administered during the initial 4 hours of rehydration was quantified. The primary outcome was hospitalization, and return visit within the following week was a secondary outcome. Ten percent of the charts were evaluated in duplicate to assess interrater reliability. We examined glucose distribution at 1 and 4 hours and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions. Among 6939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent interrater reliability. Notable variations existed in glucose quantities provided, both at 1 hour (first quartile, 87 mg/kg; third quartile, 294 mg/kg) and 4 hours (first quartile, 681 mg/kg; third quartile, 1174 mg/kg) of rehydration. Multiple logistic regression showed a negative association between hospitalization and glucose administration during the initial hour (OR for each 100 mg/kg increment, 0.60; 95% CI, 0.42-0.84) and 4 hours (OR, 0.76; 95% CI, 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were less likely of having a return visit (OR for each 100 mg/kg increment: 0.52; 95% CI, 0.35-0.78), as well as during the first 4 hours (OR for each 100 mg/kg increment, 0.83; 95% CI, 0.73-0.94). There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.

Antibiotic Choice and Outcomes for Respiratory Infections in Children With Tracheostomies.

Respiratory infections are a major cause of hospitalization in children with tracheostomies, contributing significantly to hospital expenses. Limited data exist to describe optimal diagnostic strategies or management recommendations for these infections. This study aimed to explore factors associated with antibiotic therapy, including usage, administration route, duration, variables influencing the decision to prescribe antibiotics, and outcomes in children with tracheostomies experiencing episodes of respiratory infection other than pneumonia (tracheobronchitis and nonspecific respiratory episodes [NSRE]). We conducted a retrospective cohort study using the medical records of 83 children who underwent tracheostomy and received treatment at a tertiary hospital from 2010 to 2021. A total of 164 episodes of tracheobronchitis and 98 episodes of NSRE were analyzed. Children with tracheobronchitis were more frequently treated with antibiotics: 75% in nonhospitalized cases and 76% in hospitalized cases. In NSRE, antibiotic prescription dropped to 40% and 29%, respectively. Out of 51 tracheobronchitis and 15 NSRE initially treated with oral antibiotics, a switch to intravenous administration was deemed necessary in only 7 tracheobronchitis cases (14%). Fever was significantly associated with antibiotic prescription in tracheobronchitis and NSRE, regardless of hospitalization status. Two children died within the 28-day period following the onset of tracheobronchitis symptoms. Many cases identified as tracheobronchitis, along with a greater number of NSRE cases, resolved without requiring antibiotics. Although fever was associated with increased antibiotic prescription, it does not necessarily indicate severity. Therefore, careful consideration should be given before prescribing antibiotics, especially in febrile cases, to avoid unnecessary treatments.

Serum GFAP and UCH-L1 for the identification of clinically important traumatic brain injury in children in France: a diagnostic accuracy substudy

Many children with mild traumatic brain injury (mTBI), defined by a Glasgow Coma Scale (GCS) score between 13 and 15, undergo hospitalisation or cranial CT (CCT) scans despite the absence of clinically important traumatic brain injury (ciTBI; ie, hospitalisation >2 days associated with intracranial lesions on CCT, neurosurgical intervention, intensive care admission, or death). Clinical algorithms have reduced CCT scans and hospitalisations by 10%. We aimed to established age-appropriate reference values for GFAP and UCH-L1 and evaluate their diagnostic test performance in identifying ciTBI in children. This study was a diagnostic test accuracy substudy within the PROS100B stepped wedge cluster randomised trial that included children aged 16 years or younger, clinically managed within 3 h of mTBI, with a GCS score of 15 requiring hospitalisation or CCT scan according to French Pediatric Society guidelines (equivalent to the intermediate risk group of the PECARN algorithm). Enrolment for PROS100B occurred from Nov 1, 2016, to Oct 31, 2021, at 11 hospital emergency departments in France. Stored blood samples collected from March 1, 2015, to Oct 31, 2015, from children aged 16 years or younger who were outpatients for allergic conditions unrelated to mTBI and free of neurological disease were used as a control group to calculate reference values of GFAP and UCH-L1 across four age groups (<6 months, 6 months to <2 years, 2 years to <4 years, and 4 years to <16 years). The diagnostic test performance of GFAP and UCH-L1, both above the reference range to identify ciTBI, was evaluated in the children with mTBI. GFAP and UCH-L1 were measured with the Alinity analyser (Abbott, Chicago, IL, USA). Reference values were calculated from GFAP and UCH-L1 measured in samples from 718 control children (378 [53%] boys and 340 [47%] girls). 531 children (334 [63%] boys and 197 [37%] girls) aged 0-16 years with mTBI were included. By applying our reference values for GFAP and UCH-L1 across four age groups the biomarker combination (both biomarkers above reference ranges) had a sensitivity of 100% (95% CI 69-100), a negative predictive value of 100% (99-100), a specificity of 67% (63-71), a positive likelihood ratio of 3·01 (2·67-3·40), a negative likelihood ratio of 0, and an area under the curve of 0·83 (0·81-0·85) in identifying ciTBI. Serum GFAP and UCH-L1 identify ciTBI in children with 100% sensitivity and 67% specificity, which could potentially reduce unnecessary CCT scans and hospitalisations in children with mTBI if implemented. French Ministry of Health.

Clinical outcomes and severity of laboratory-confirmed RSV compared with influenza, parainfluenza and human metapneumovirus in Australian children attending secondary care

IntroductionAcute lower respiratory infections (ALRIs) are a major contributor to the global infectious disease burden and a common cause of hospitalisation for children under 2 years. We compared clinical severity...

Caesarean section and risk of infection in offspring: systematic review and meta-analysis of observational studies

ObjectiveTo compare the risk of hospital admissions with infections and infections not in hospital in children born by caesarean section with children born by vaginal birth.Data sourcesMedline, Embase, and PubMed...

Continuity of primary care and avoidable hospitalization in a young population with asthma: a population-based cohort study

Existing evidence regarding the impact of continuity of care (COC) in asthma patients is limited, and its quality is low to moderate. This study aimed to investigate associations between relational COC within primary care and asthma-related hospitalizations in children using a robust methodology. This study is a population-based cohort study that utilized a national claims database in South Korea. The study comprised 136,296 individuals under 20 years old who were newly diagnosed with asthma between 2015 and 2016. These were classified into high, medium, and low continuity groups based on the continuity of care index (COCI). The primary outcome measure was the incidence of asthma-related hospitalizations. During a two-year follow-up period, 10,922 patients (8.01%) were hospitalized: 2520 (5.59%) in the high-continuity group, 3188 (6.98%) in the medium-continuity group, and 3867 (8.48%) in the low-continuity group. After adjusting for confounding covariates, patients in the low- and medium-continuity groups exhibited significantly higher risks of hospital admission (adjusted hazard ratio (aHR) = 1.30 [95% confidence interval = 1.24–1.37] and aHR = 1.14 [1.08–1.20], than those in the high-continuity group. Sensitivity and subgroup analyses findings were consistent. In a young population with asthma increased continuity of primary care was associated with less hospitalization.

A study of the correlation between meteorological factors and hospitalization for acute lower respiratory infections in children

BackgroundThe study focuses on the effect of temperature and relative humidity on hospitalization for acute lower respiratory tract infections (LRTI) in children, respectively.MethodsIn this study, the Distributed Lag Nonlinear Model (DLNM) based on quasi-Poisson distribution was used to investigate the effect of temperature and relative humidity on LRTI hospitalization in children, and subgroup analyses were conducted to identify sensitive populations by gender and age.ResultsA total of 43,951 children were hospitalized for LRTI from 1 January 2014 to 31 December 2019 in Lanzhou. The mean temperature during the study period was 11.34 °C and the mean relative humidity was 51.03%. With reference to the median temperature of 12.7 °C during the study period, both low (-4.1 °C) and high (25.43 °C) temperature had a detrimental effect on LRTI hospitalization, and the maximum effect was reached at lag0-10 and lag0-9, respectively, with RR values of 1.645 (95%CI: 1.533, 1.764) and 1.098 (95%CI: 1.018, 1.184). With a reference to the median relative humidity of 51.17% during the study period, both low relative humidity (26.71%) and high relative humidity (76.70%, P95) had a detrimental effect on LRTI hospitalization, and the maximum effect was reached at lag0-21 and lag21, respectively, with RR values of 1.235 (95% CI: 1.163, 1.311) and 1.044 (95% CI: 1.036, 1.051). The results of subgroup analyses showed that changes in meteorological factors had a stronger effect on Female and children aged 5–14 years.ConclusionsThe meteorological factors all have different degrees of influence on LRTI hospitalization in children. Girls and the children aged 5–14 years are more sensitive. Attention to these meteorological risks can inform targeted interventions.

Practice in bronchiolitis management in Polish hospitals—a multicenter retrospective cohort study

Bronchiolitis is one of the main reasons for the hospitalization of young children. Based on updated recommendations, only supportive therapy is recommended for treatment. In Poland, many children that are hospitalized with bronchiolitis undergo a treatment that is not supported by current research. The study aimed to assess clinicians’ adherence to the guidelines. This was a multicenter retrospective study of hospitalized infants with bronchiolitis; a cohort study design was utilized. Data were collected in four Pediatric Departments in Poland. All infants aged less than 24 months that had been hospitalized for their first and subsequent episodes of acute bronchiolitis from January 1, 2021, to December 31, 2022, were included. The exclusion criterion was an age over 24 months. A total of 629 infants with a median age of 8.5 months were included in this study. The medical interventions and treatments varied between the four hospitals. Laboratory blood tests were run for almost all children (99.5%), and the percentage of children for which a chest X-ray was performed ranged from 1.3% to 44%. The other measures were the use of intravenous hydration (51.3%-93.3%), use of hypertonic saline nebulization (1.3%-43.6%), use of normal saline nebulization (10%-95.1%), use of oxygen (7.3%-42%), use of beta-mimetics (19.1%-89.4%), use of nebulized steroids (8%-76.9%), use of systemic steroids (0.9%-42%), use of nebulized adrenaline (0%-8.1%), and use of antibiotics (12%-21.8%).Conclusions: In total, 70% of infants who were hospitalized in four hospitals in Poland underwent examinations and treatment methods that are not supported by current guidelines and evidence-based research. This study shows that non-recommended medications are overused in bronchiolitis treatment, and there is a need to take action to implement the guidelines into healthcare providers’ work.What is Known:• Bronchiolitis is a lower respiratory tract viral infection and is one of the main reasons for hospitalization among young children.• Only supportive therapy is recommended in the guidelines.• Bronchodilators, nebulized adrenaline, nebulized or systemic steroids, and antibiotics are not recommended.What is New:• Non-recommended medications are overused in bronchiolitis treatment in Poland.• Up to 70% of hospitalized children in the studied centers underwent treatment that is not supported by guidelines.

Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary

BackgroundSevere acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV.MethodsWe collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed.ResultsOur results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4–7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43–7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14–6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29–8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35–4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days.ConclusionsOur research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics.

Respiratory Syncytial Virus associated hospitalisations in children up to 6 years of age in Italy: a systematic review.

Respiratory syncytial virus is a leading cause of respiratory hospitalisations in infants. This systematic review (registration number: CRD42021248309) aims to synthesise the available evidence on Respiratory Syncytial Virus-related hospitalisations among children aged 0 to 6 years in Italy. The literature search was conducted on PubMed, Embase, Scopus, and International HTA, covering the period from January 2000 to July 2022, with a focus on studies that reported information on Respiratory Syncytial Virus-associated hospitalisation in children aged 0-6 years in Italy. Eight articles were included after screening 20,845 records. These retrospective studies reported that most hospitalisations were among those <1 year (71.5%-88.8%), infants aged <1 year were also at higher risk of hospitalisation in intensive care unit. Respiratory Syncytial Virus infections typically peaked December-February, with an atypical early start in August 2021. Subtype analysis showed alternating prevalence of Respiratory Syncytial Virus-A and Respiratory Syncytial Virus-B across different seasons. Coinfections were not uncommon (1.1%-37.4%), with rhinovirus and bocavirus being the most frequent. All infants at their first Respiratory Syncytial Virus season showed an increased risk of severe infection and hospitalisation, regardless of the gestational age at birth, compared to older participants. This systematic review will enrich the understanding about Respiratory Syncytial Virus disease and help support decisions regarding prevention efforts in Italy.

Risk factors for unintentional injury hospitalisation among Aboriginal and non-Aboriginal children in Australia's Northern Territory: A data linkage study.

Unintentional injuries are a leading cause of hospitalisation for children. This study investigated the incidence and associated risk factors for unintentional injury hospitalisation (UIH) among Aboriginal and non-Aboriginal children aged under 5 years in Australia's Northern Territory. This was a retrospective cohort study using linked data from a perinatal register, hospital admissions, school enrolment and child protection services. The outcome variable was a first UIH. Potential risk factors included gender, pregnancy and birth outcomes, maternal education level, child protection service contact and geographic remoteness. Modified Poisson regression was used for multivariate modelling. A cohort of 21,189 children (54.0% Aboriginal) born between 2000 and 2010 were followed to the age of 5 years. The overall incidence of first UIH was 25.8 per 1,000 person-years, which was 28.6% higher among Aboriginal than non-Aboriginal children (28.8 and 22.4 per 1000 person-years, respectively). Risk factors identified in the full model included: being male (incidence rate ratio (IRR) 1.26, 95%CI: 1.17-1.36); living in a remote (IRR 1.26, 95%CI: 1.14-1.40) or very remote area (IRR 1.44, 95%CI: 1.29-1.59); having a notification or substantiated notification for abuse (IRR 1.42, 95%CI: 1.27-1.58 and IRR 1.60, 95%CI: 1.41-1.82, respectively); or neglect (IRR 1.32, 95%CI: 1.17-1.48 and IRR 1.28, 95%CI: 1.11-1.47, respectively). After adjustment, there was no difference in UIH rates between Aboriginal and non-Aboriginal children. In both stratified models, being male, living in remote or very remote areas and having a notification or substantiated notification for child maltreatment were identified as risk factors. Our study found high UIH incidence rates and evidence for an association between UIH and child maltreatment. This suggests child maltreatment and UIH have shared determinants and points to the need for clinicians to be aware of the overlap between these conditions and the importance of cross-agency collaboration in prevention and management.

Dexamethasone regime and clinical outcomes in children hospitalized with croup: A cohort study.

High-quality trial evidence supports the use of one dose of dexamethasone in the outpatient management of croup; however, there are no inpatient trials, and the optimal treatment regimen for the inpatient management of croup remains uncertain. Significant practice variability exists in the corticosteroid treatment of children hospitalized for croup. To evaluate the association of dexamethasone treatment regimen (1 vs. >1 dose) with hospital length of stay (LOS) and 30-day return to emergency department (ED) visits among children hospitalized for croup. A cohort study of children hospitalized for croup at a children's hospital between 2010 and 2022. Children less than 10 years old, without known airway anomalies and who received dexamethasone for croup treatment were included. Children who received 1 dose versus >1 dose of dexamethasone were compared. Propensity score analyses, using inverse probability of treatment weighting, were conducted to estimate the treatment effects of dexamethasone regimen on hospital LOS and all-cause 30-day return to ED visit. Of 471 children hospitalized for croup, 229 (49%) received 1 dose of dexamethasone; 242 (51%) received >1 dose. In the propensity-weighted analyses, children receiving >1 dose of dexamethasone had a longer mean LOS by 59.6 h (95% CI 44.8-74.5, p < .001) compared with those receiving >1 dose. There was no statistically significant difference in the odds of all-cause 30-day return to ED visit; OR 1.30, (95% CI 0.76-2.22, p = .33). Among children hospitalized for croup, children who received >1 dose of dexamethasone had a longer LOS compared with children who received 1 dose of dexamethasone; however, there was no statistically significant difference in the 30-day return to ED visits. Randomized clinical trials are needed to determine the optimal dexamethasone treatment regimen for children hospitalized with croup.

Clinical characteristics and in-hospital outcomes associated with RSV-ALRI compared to other viral ALRI in hospitalised children under two years old.

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRIs) associated hospitalisations in children. It is unclear if hospitalized RSV-ALRI differs in clinically from other viral ALRIs. We aimed to compare the disease impact of hospitalised RSV with other viral ALRI in children under 2 years. We conducted a retrospective study using electronic medical records of children under 2 hospitalized with ALRIs at Sydney Children's Hospitals Network from 2020-2022. We compared demographics and clinical features between RSV-positive and RSV-negative (positive for other viruses) cases. Poisson quasi-likelihood regression was used to estimate adjusted prevalence ratios (aPRs) for three in-hospital outcomes: length of stay, need for respiratory support and intensive care. We examined 330 children under 2 years hospitalized with RSV-positive ALRIs and 330 with RSV-negative ALRIs (positive for other viruses). RSV-positive cases were older (12 vs. 8 months, p<0.001) and more often presented with cough (99% vs. 92%), fever (80% vs. 58%), crackles (89% vs. 76%), hypoxia (50% vs. 36%), and lethargy (36% vs. 20%). They were also more likely to undergo chest x-rays (74% vs. 49%) and receive antibiotics (65% vs. 35%). Adjusted analysis showed RSV-positive children had a higher likelihood of LOS > 2 days (aPR 1.95, 95% CI 1.14-3.36).). However, there were no differences in the need for intensive care or respiratory support. Children with RSV-ALRI exhibited more severe symptoms, received more antibiotics, and had longer hospital stays compared to those with other viral ALRIs, underscoring the need for effective prevention and treatment strategies for RSV.

Evaluating the Economic and Epidemiological Impact of RSV Hospitalizations in Southern Austria [Southern Austria Respiratory Syncytial Virus INpatient Investigation (ARNI Study)

RSV bronchiolitis is a leading cause of hospitalization in infants and young children. We aimed to document the economic burden and epidemiology of RSV over seven seasons in Southern Austria. All RSV-associated hospitalized (PCR-proven) children ≤ 5 years of age between 1 October 2015 and 30 April 2022 were collected retrospectively. Demographic and epidemiologic data, along with hospitalization costs (direct and indirect), were calculated. Among 976 children hospitalized due to RSV infection, 87% were healthy term infants, and 79% were < 12 months old. Prematurity (13%) and pre-existing conditions (11%) significantly impacted older children-59% of cases in the 2nd compared with 68% in the 1st year of live. RSV-related hospital costs were approximately €2.0 millions per year (of a total of 60 millions per year). RSV accounted for 19% of hospitalizations due to acute respiratory illness (ARI) in children ≤ 5 years, 37% of all ARI < 6 months, 28% of all ARI < 12 and 6.3% of all-cause hospitalizations < 12 months of age, respectively. Every 5th hospitalization due to respiratory illness in children ≤ 5 years of age was associated with RSV, representing 7.9% of all hospitalizations and 3.3% of all paediatric hospitalization costs.

Implementation of Direct Admission to the Operating Room Procedure for Children Transported With Airway Emergencies

ObjectiveChildren with airway emergencies, such as aspirated foreign bodies (FBs), who present to community emergency departments usually require expeditious transfer to centers with pediatric expertise. In 2018, our hospital's transport team implemented a multidisciplinary direct admission to the operating room (OR) protocol for children transferred for emergent surgical intervention, which bypassed typical hospital entry points. We aimed to assess its impact on time to definitive care and patient outcomes. MethodsWe performed a retrospective chart review of all patients aged ≤18 years with suspected aspirated FB transferred to our institution for emergent surgical intervention between July 1, 2013 and March 1, 2023. We determined whether they were taken to the OR post-transfer after first being evaluated in our pediatric emergency department/intensive care unit (Standard protocol) or transported directly to the OR by the transport team (OR Transport protocol). Demographics, transport/surgical times, and clinical data were compared between the groups using t-test and Mann-Whitney U test. ResultsOf the 27 children who met the inclusion criteria, 14 (51.9%) were transported via the Standard protocol and 13 (48.1%) via the OR Transport protocol. Demographics, referring hospital characteristics, time of transfer request, need for mechanical ventilation pretransport, and transport mode were not different; rates of critical care transports were higher for the OR Transport group than for the Standard group (P = .016). Compared with the Standard group, the OR Transport group had shorter median (interquartile range) times from transport arrival to start of surgery (8 [0-15.5] vs. 94.5 [25.75-148.75] minutes, P < .001) and from transport dispatch to surgery (103 [64.25-144] vs. 179 [115.5-265] minutes, P = .035). Although not statistically significant, the OR Transport group had a lower hospitalization rate after the surgery compared with the Standard group (38.5% vs. 64.3%). ConclusionImplementation of a direct admission to the OR protocol seems to expedite definitive treatment and may be associated with a decreased need for hospitalization for children with airway FBs who require interhospital transport for emergent surgical intervention.

Using outcome measures in sub-national level performance management: When and under what circumstances?

There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems. We have integrated empirical population-based data with key health system expert perspectives to evaluate the appropriateness of two population health indicators – amenable mortality and ambulatory-sensitive hospitalization of young children. Our assessment focused on two key aspects: (i) the technical validity of these indicators, ensuring they accurately measure these outcomes, and (ii) the functionality and legitimacy of performance information, determining whether it meets stakeholders' program or policy needs and supports strategic decision-making. Overall, we found that the 'intermediate' outcome measure, childhood ambulatory sensitive hospitalization, was more useful for identifying district-level health system performance variation than the 'end' outcome measure, amenable mortality. Performance information based on childhood ambulatory-sensitive hospitalization is more appropriate for improving decision-making, and it is more likely to be accepted by a wide range of stakeholders involved in health system performance improvement.

Housing tenure and acute lower respiratory tract infection admissions in two Scottish birth cohorts

Abstract Introduction Early-life acute lower respiratory tract infections (LRTI) have been associated with increased morbidity and mortality. Despite young children spending much of their time at home, the contribution of home ownership status, on LRTI hospital admissions is unknown. Objectives To estimate the association between housing tenure and the odds of LRTI hospitalization in children &amp;lt;2 years in two birth cohorts. Methods De-identified Scottish birth records were linked to maternal Census data (2001 and 2011) and to hospital admission data to construct two birth cohorts (Cohort 1 (C1), born 2000-2002; Cohort 2 (C2), 2010-2012). Using logistic regression we estimated the association of housing tenure (owned, social rented, private rented, rent-free) with the odds of LRTI hospital admission, before and after adjustment for maternal age, residential area, and maternal qualification level. Results Over the 2-year follow-up, there were 14,833 LRTI admissions in 12,527 children (10,832 children had 1 LRTI admission and 1,695 &amp;gt;1 LRTI admission). 75.6 % of all LRTI admissions were due to bronchiolitis. In C1 and C2, 4.0% and 5.3% children, respectively, had one or more LRTI admission. Compared to children living in owned housing, the odds of LRTI admission were higher in children living in social rented housing (C1: Odds ratio=1.40, 95% confidence interval: 1.31-1.49; C2: 1.23, 1.16-1.31), private rented (C1:1.24, 1.11,1.39; C2: 1.14, 1.06-1.21), and rent-free housing (C1: 1.53, 1.35,1.74; C2: 1.04, 0.80-1.36) after confounder adjustment. Conclusions We found an association between non-owned housing and higher odds of LRTI admission which was more marked in C1 than in C2. Further research is warranted to unpick the mechanisms underlying the association between housing tenure and LRTI admission. Interventions to prevent LRTI admissions could usefully target children living in non-owned housing. Key messages • This study demonstrates the value of administrative and health data linkage in improving our understanding of how socio-environmental factors might impact children’s respiratory health. • Children living in social and private rented housing (compared to owned housing) have a higher risk of LRTI hospital admission and could benefit the most from LRTI-lowering interventions.

Validation of Fat Mass Metrics in Pediatric Obesity

Introduction: Hudda-Index is a prediction model for fat mass (FM) based on simple anthropometric measures. FM is a crucial factor in the development of comorbidities, i.e., type 2 diabetes. Hence, Hudda-Index is a promising tool to facilitate the identification of children at risk for metabolic comorbidities. It has been validated against deuterium dilution assessments; however, independent validation against the gold standard for body composition analysis, magnetic resonance imaging (MRI), is lacking. The aim of this study was to validate FM calculated by Hudda-Index against FM measured by MRI. The secondary aim was to compare Hudda-Index to other anthropometric measures including body mass index (BMI), BMI-standard deviation score (BMI-SDS), waist/hip-ratio, waist circumference (WC), and skinfold thickness. Methods: The study cohort consists of 115 individuals between the age of 9 and 15 years, recruited at Paracelsus Medical University Hospital in Salzburg (Austria) and Uppsala University Children’s Hospital (Sweden). Anthropometry, blood samples, and oral glucose tolerance tests followed standard procedures. MRI examinations were performed to determine visceral adipose tissue (VAT) and subcutaneous adipose tissue. Results: BMI and WC showed slightly stronger associations with the reference standard VAT (r = 0.72 and 0.70, p < 0.01, respectively) than Hudda-Index (r = 0.67, p < 0.01). There is an almost perfect linear association between BMI and Hudda-Index. Accordingly, BMI and Hudda-Index both showed an acceptable association with cardiometabolic parameters. VAT was strongly associated with markers of liver status (LFF r = 0.59, p < 0.01) and insulin resistance (HOMA-IR r = 0.71, p < 0.01) and predicted metabolic dysfunction-associated steatotic liver disease. Conclusion: BMI, although an imperfect measure, remains the most reliable tool and estimates cardiometabolic risk more reliably than other anthropometry-based measures.

New advances in RSV: Is prevention attainable?

Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI), hospitalization, and mortality in infants and young children globally. The greatest burden of severe disease and mortality occurs in low-middle income countries (LMICs), with large and vulnerable childhood populations. The highest rates of RSV-hospitalization occur in healthy-term infants under 3 months of age. Preterm infants, children with chronic lung disease of prematurity, Down's syndrome, congenital heart disease, or immunodeficiency also have a higher risk of severe RSV-LRTI. Early-life RSV-LRTI has also been associated with chronic sequelae, including recurrent LRTI, recurrent wheezing, asthma, and lung function impairment. A RSV pre-fusion (F) maternal vaccine and long-acting monoclonal antibody (nirsevimab) have been licensed for the prevention of RSV-LRTI in infants and young children. Studies show high efficacy and effectiveness particularly for preventing severe RSV-LRTI. Maternal RSV vaccine given at 24-36 weeks of pregnancy was effective in preventing RSV medically attended LRTI and severe RSV-LRTI through 6 months after birth in a phase 3 study conducted in 18 countries over two RSV seasons. Vaccination was safe with no significant difference in adverse events between infants born to mothers who received RSV preF vaccine compared to placebo. A numerical imbalance in preterm births that occurred predominantly in South Africa, unrelated to vaccine timing or gestational age at vaccination and unassociated with mortality, coincided with COVID-19 delta and omicron waves. Nirsevimab, given as a single dose prior or during the RSV season, had high efficacy in preventing RSV-LRTI hospitalization in infants in preterm and in full-term infants, as well as in young children with underlying conditions through 150 days post administration in phase 2 and 3 trials. High effectiveness against hospitalization or severe disease in infants and in at-risk children up to 2 years of age has also been reported in several countries where implementation has occurred. RSV-LRTI is now a preventable disease in infants and young children. Rapid implementation of these highly effective interventions has occurred in many high-income countries, but access remains very limited in LMICs. Access to such RSV preventive interventions is urgently needed for all children to strengthen child health and promote global equity.