Pediatric Day Research Articles

Respiratory Syncytial Virus and US Pediatric Intensive Care Utilization

Bronchiolitis is the most common diagnosis necessitating respiratory support and pediatric intensive care, and respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. In 2023, the monoclonal antibody nirsevimab and the maternal RSVpreF vaccine were implemented to prevent RSV in infants. To determine the potential association of novel RSV prevention strategies with pediatric intensive care unit (ICU) utilization. This retrospective cross-sectional study examined US pediatric ICU encounters with and without RSV from January 1, 2017, to June 1, 2023. Data were from Oracle Cerner RealWorld Data, a national electronic health record database. All children (aged >1 day and <18 years) admitted to an ICU during the study period were included in the analysis. Statistical analysis was performed from February to May 2024. The primary outcomes were ICU encounters with RSV and ICU encounters with RSV eligible for RSV prevention. There were 119 782 ICU encounters from 53 hospitals; 65 757 encounters (54.9%) were male; median (IQR) age was 4.5 (1.1-12.5) years, median (IQR) ICU length of stay was 1.8 (1.0-3.9) days; 13 702 ICU encounters (11.4%) had RSV, of which 38.6% (5217) were eligible for prevention (4.4% of total ICU encounters). Encounters with RSV accounted for 21.1% (109 334) of ICU days, of which 43.8% (47 888) were eligible for prevention (9.2% of total ICU days). Encounters with RSV were associated with a greater use of positive pressure ventilation (4074 [29.7%] vs 18 821 [17.7%]; P < .001) and vasoactive medications (3057 [22.3%] vs 18 570 [17.5%]; P < .001) compared with those without RSV. The findings of this retrospective cross-sectional study of RSV and US pediatric intensive care utilization suggest that if 65% to 85% of eligible children received RSV prevention, an estimated 2.1% to 2.8% reduction in pediatric ICU encounters and an estimated 4.5% to 5.9% reduction in pediatric ICU days could be achieved.

70926 - Early discharge from Paediatric day surgery unit

70926 - Early discharge from Paediatric day surgery unit

Machine Learning-Based Approach to Predict Last-Minute Cancellation of Pediatric Day Surgeries.

The last-minute cancellation of surgeries profoundly affects patients and their families. This research aimed to forecast these cancellations using EMR data and meteorological conditions at the time of the appointment, using a machine learning approach. We retrospectively gathered medical data from 13 440 pediatric patients slated for surgery from 2018 to 2021. Following data preprocessing, we utilized random forests, logistic regression, linear support vector machines, gradient boosting trees, and extreme gradient boosting trees to predict these abrupt cancellations. The efficacy of these models was assessed through performance metrics. The analysis revealed that key factors influencing last-minute cancellations included the impact of the coronavirus disease 2019 pandemic, average wind speed, average rainfall, preanesthetic assessments, and patient age. The extreme gradient boosting algorithm outperformed other models in predicting cancellations, boasting an area under the curve value of 0.923 and an accuracy of 0.841. This algorithm yielded superior sensitivity (0.840), precision (0.837), and F1 score (0.838) relative to the other models. These insights underscore the potential of machine learning, informed by EMRs and meteorological data, in forecasting last-minute surgical cancellations. The extreme gradient boosting algorithm holds promise for clinical deployment to curtail healthcare expenses and avert adverse patient-family experiences.

The need for practice enhancements and parental empowerment during their child’s day surgery process: A pilot study

Background: Perioperative experiences leave a lasting psychosocial impact on the parents of children undergoing surgery. Methods: A phenomenological study design recruited parents of children undergoing day surgery using purposive sampling. Semi-structured face to face interviews were conducted two weeks postoperatively. Results: Thematic analysis revealed 6 main themes with 12 sub-themes. Although the parents acknowledged the emotional support and tangible assistance from the healthcare team, mostly the themes revealed negative perceptions of the unique processes within paediatric day surgery. Conclusions: Parents’ feelings of anxiety, stress, helplessness and the pressure to be seen as a resource of physical and emotional support during their child’s perioperative period were expressed by them as their needs for additional information and counselling, remote access to the primary healthcare team postoperatively and advice on coping strategies. Practice enhancements using technology and innovative playtherapy in combination with active parental participation may make day surgery a positive experience for both parents and children. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 &amp; 2): 5-14

Mortality in Patients with Leukemia and Lymphoma Urgently Admitted to the PICU: Secondary Analysis of Data from a Cluster Randomized Controlled Trial

AbstractObjectives were to describe the severity of illness in patients with leukemia or lymphoma urgently admitted to pediatric intensive care and explores the risk factors for mortality. A secondary analysis was performed of prospectively collected data from a cluster-randomized controlled trial in 21 children's hospitals from 2011 to 2015. Eligible patients were urgently admitted to intensive care and had a diagnosis of leukemia or lymphoma. Associations with intensive care mortality (primary outcome) were determined with multivariable generalized estimating equation with a logit link, accounting for clustering by site. Associations with time to intensive care mortality (secondary outcome) were determined with multivariable proportional hazards models. A total of 109 patients were included, age 115 (interquartile range [IQR] 42, 168) months and intensive care length of stay was 3 (IQR 2, 6) days. During the first hour in intensive care 36 (33%) were ventilated, and during intensive care 45 (41.3%) had at least 1 technology day. Day 1 Pediatric Logistic Organ Dysfunction (PELOD) score was ≥ 20 in 37 (33.9%), Pediatric Index of Mortality 2 mortality risk was &gt; 10% in 35 (32.1%), and Children's Resuscitation Intensity Scale (RISC) was ≥ 3 (late admission to intensive care) in 32 (31.7%). Intensive care mortality was 20/109 (18.3%); with intensive care stay ≥ 20 days mortality was 51%. Previous urgent pediatric intensive care unit (PICU) admission, mechanical ventilation, and day 1 PELOD score were associated with higher PICU mortality. Mechanical ventilation, day 1 PELOD score, and late admission to the PICU (RISC ≥ 2) were associated with time to death. Patients with leukemia and lymphoma urgently admitted to intensive care had mortality of 18.3%, an improvement from historical cohorts. Risk factors were not accurate enough to make individual patient care decisions.

Nurses' views on the presence of family members during invasive procedures in hospitalised children: A questionnaire survey.

(I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient-and family-centred care model. Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence. Observational, descriptive, cross-sectional study. Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire. A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions. The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills. The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient-and family-centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears.

Demonstrating the safety profile of ketamine as procedural conscious sedation in infants; a prospective cohort study of 904 cases

Background: Conscious sedation has both a sedative and an analgesic effect. Ketamine is an increasingly popular choice for procedural conscious sedation in a paediatric day surgery. Ketamine is also cheaper than general anaesthetic. The objective of our study is to investigate the number of adverse events when using ketamine for procedural conscious sedation and demonstrate its safety profile for use in paediatric day surgery in a community setting in infants. Methods: A single-centre, single surgeon, single procedure 5-year longitudinal prospective review of 904 infants undergoing elective day-care surgery using ketamine for procedural conscious sedation between 2016 and 2020. Patients were stratified for pre-anaesthetic co-morbidities based on the American Society of Anesthesiologists (ASA) classification system. Results: All patients were between 4 weeks and 1 year and 98.7% were ASA Class 1. Most children received ketamine intramuscularly and only one child required additional ketamine to maintain procedural conscious sedation. There were no serious adverse events and there were 27 mild adverse events in 26 patients (2.88% patients). The most common adverse event was hypersalivation, which occurred in 11 infants. Conclusions: Ketamine is a safe drug for procedural conscious sedation and should be considered more for infants undergoing elective day-care surgery provided that all staff conducting procedures have advanced training in paediatric and neonatal airway management and resuscitation.

Establishing a safe pediatric surgery day unit: Process, procedures, and performance

Abstract Background: Ambulatory surgery for babies and infants is commonly practiced worldwide. There are no reports on this special service from the UAE. A Pediatric Surgery Day Unit (PSDU) has been in operation at Danat Al Emarat Hospital Women and Children since the hospital opened in 2016. Objective: To describe the day-to-day structure and functioning of the PSDU, the technical aspects of the four main procedures delivered (Circumcision, Release of Tongue Tie, Excision of Umbilical Granuloma, and Excision of Accessory Digits) and the outcomes for the babies. Materials and Methods: The hospital’s Health Information System was interrogated for the relevant diagnostic and procedural codes for all babies operated between January 1st, 2016, and December 31st, 2019. Data were analyzed for basic demographics, biostatistics, procedures performed, and follow-up encounters. Results: The PSDU has a core team, including a coordinator/scheduler, one practical nurse, two staff nurses, and two surgeons. Up to 10 sessions are offered per week, and out-of-hours cover is provided for emergencies or advice on a 24/7 basis. A total of 5262 medical records were examined and data on 3891 procedures for 3801 babies were analyzed. Babies of 68 nationalities were operated and 65% were local Emirati. Circumcision was performed at a median age of 16 days and a weight of 3.5 kg. Bleeding occurred in 1.4% and retention of the ring occurred in 1%. Significant factors associated with bleeding are age, weight, and ring size. There is no difference in bleeding rates between surgeons. There is a learning curve for the technique. Retention of the ring on the glans is associated with the size of ring chosen and retention rates vary significantly between surgeons. The remaining procedures were performed without complication, giving an overall adverse event rate of 2.75%. Conclusion: A well-structured and consistently staffed PSDU results in a safe and effective service.

Recovery Time From Severe Community Acquired Pneumonia and Risk Factors Among Pediatrics, Ethiopia: A Retrospective Follow-Up Study.

Introduction. Severe community acquired pneumonia (CAP) is a life-threatening condition, with high rates of morbidity and mortality. This study aimed to determine the recovery time from severe CAP and risk factors among pediatric patients. Methods. A retrospective follow-up study was conducted among 412 pediatric medical charts with severe CAP enrolled at Asella Referral and Teaching Hospital between January 01, 2021 and December 31, 2022. EpiData version 4.6.0.6 and STATA version 14.2 were used for data entry and statistical analysis, respectively. Bivariable and multivariable Cox proportional hazards regression analyzes were performed. Result. The median recovery time from severe CAP among pediatric patients was 5 days (IQR = 3-8 days). IDR of recovery from severe CAP was 13.089 per 100 [95%CI: 11.82, 14.49] pediatric days observations. The cumulative incidence of recovery from severe CAP was 89.56% [n = 369, 95%CI: 86.20, 92.18]. Age [AHR = 1.55, 95%CI: 1.12, 2.13, P = .007], vaccination status [AHR = 1.29, 95%CI: 1.03, 1.63, P = .027], presence of danger signs [AHR = 1.61, 95%CI: 1.26, 2.05, P = .000], presence of comorbidity [AHR = 1.67, 95%CI: 1.33, 2.10, P = .000], duration of seeking care [AHR = 1.71, 95%CI: 1.18, 2.47, P = .004], and oxygen therapy [AHR = 1.45, 95%CI:1.12, 1.87, P = .004] were statistically significant risk factors for recovery time from severe CAP. Conclusions. The median recovery time of patients with severe CAP is relatively high. Age, vaccination status, presence of danger signs, presence of comorbidities, duration of seeking care, and oxygen therapy were statistically significant risk factors of recovery time from severe CAP.

时效性激励联合快速康复模式在小儿腹股沟疝日间手术护理中的应用

时效性激励联合快速康复模式在小儿腹股沟疝日间手术护理中的应用

Inkendaal Paediatric Partial Day Hospitalisation

Inkendaal Rehabilitation Hospital is a neurorehabilitation hospital in Flanders (Belgium) with 178 in-patient beds subserving 15 defined rehabilitation trajectories for adults and children. The rehabilitation trajectories are also organised within an outpatient department for adults and children. The children's outpatient department offers an integrated programme that includes education, interdisciplinary therapy and care. The target groups of the outpatient paediatric operation are children with acquired brain injury, cerebral palsy, neuromuscular disorders, spinal cord disorders, autism spectrum disorder, other developmental disabilities and deconditioning following a period of intensive care or long-term hospitalisation. &#x0D; Within the paediatric partial day hospitalisation, intensive, transdisciplinary rehabilitation is offered in combination with care and education, for children and adolescents with complex rehabilitation needs, whose development as well as school and societal participation is at risk. Management and care are designed and delivered within the ICF-framework.&#x0D; The partial day hospitalisation for children and adolescents accommodates 80 children aged, every year, 1 to 12 and 16 adolescents aged 13 to 18. An average of 80 children attends daily.&#x0D; The children attend the partial day hospitalisation and hospital school daily for a full school year or two school years. Funding is from the rehabilitation hospital budget (BRZ) by the federal government of Belgium, supplemented by federal hospital nomenclature for monodisciplinary services. However, the BRZ only provides funding for 60.&#x0D; Through intensive collaboration between the Ministries of Care, Health and Education, financial resources can be pooled (infrastructure), staff deployment can be handled flexibly and a transdisciplinary rehabilitation offer can be pursued throughout the school day. &#x0D; The children spend the entire school day in a rehabilitation class with their regular class instructor. The different disciplines (nursing, teaching, rehabilitation: speech and language, physical, occupational therapy) pursue the shared objectives with a child (as determined in discussion with the child and family) during individual therapy, group therapy or in the classroom with the teacher, based on the needs of the child and the parents, and taking the environment in to account. In this way, efforts are made to increase the child's opportunities for participation in order to achieve social integration, optimal educational opportunities and increased self-reliance. In the evening, the children return home, so that the home context can also be mobilised and involved in the pursuit of the child's rehabilitation goals. Every 3 months, there is a team meeting and a meeting with the parents to monitor progress with respect to the goals and requests for help, and eventual update of the goals. Medical follow-up can be provided on the service by the presence of a paediatric neurologist and nursing staff. &#x0D; &#x0D; Within the partial day hospitalisation, 16 teachers are present daily, together with 11 care staff (first level and specialist nurses) and 1 paediatric neurologist. There are 6 FTE physiotherapists, 5 FTE speech therapists, 3 FTE psychologists, 5 FTE occupational therapists and 1 conductor (conductive education) working weekly.&#x0D; The department is managed by the doctors, the head therapist, the head nurse and the director of the hospital school.&#x0D;

Comparison of intravenous ibuprofen and paracetamol for peri-operative analgesia in paediatric day care tonsillectomy.

To determine the effectiveness of intravenous ibuprofen and acetaminophen as perioperative analgesics in paediatric patients undergoing day- care tonsillectomy with general anaesthesia. The quasi-experimental stud y was conduc ted at the Ana esthe sia D epartment of Pa k Emirates M ilitary Hospital, Rawalpindi , Pak ist an, from July 20 21 to June 2022, and comp rised paediatric pa t ients aged 5-12 yea r s undergoing day- care tonsil lec tomy with gen era l anaesthesia. The sub jec ts were divid ed into two equa l groups. Patients in Group I received intravenous ibuprofen 7mg/kg and patients in Group P received intravenous paracetamol 10mg/kg im media t ely after induction of anaesthesi a. All patients recei ved standard general anaesthesia with endotracheal intubation. The primary outcome measured was revised faces pain score immediately after recovery and at the time of discharge 6 hours later. Adverse events were also noted. Data was analysed using SPSS 26. Of the 100 patients, there were 50(50%) in Group I; 21(42%) boys and 29(58%) girls with mean age 7.82±1.903 years. The remaining 50(50%) subjects were in Group P; 25(50%) boys and 25(50%) girls with mean age 7.68±1.812 years. At baseline, 44(88%) patients in Group I and 42(84%) in Group P reported no pain, while 6(12%) and 8(16%) patients in the two groups, respectively, reported pain (p=0.56). At discharge, 35(70%) patients in Group I and 18(36%) in Group P reported no pain (p<0.001). Adverse events were not significantly different between the groups (p>0.05). I ntravenous ibuprofen was found to b e a superior pain-killer than intravenous paracetamol for perioperative care of paediatric patients in day- care tonsillectomy.

Effectiveness of a Mobile App Intervention for Preparing Preschool Children and Parents for Day Surgery: Randomized Controlled Trial.

Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children. This study aims to evaluate the effectiveness of a mobile app intervention on preschool children's fear and pain and parents' anxiety and stress in preparing children for day surgery. This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents' and children's outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material. Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children's pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children's fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81). The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods. ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303.

44 Ceftriaxone Prescribing Patterns in an Outpatient Hospital Setting: A Quality Improvement Study

Abstract Background Ceftriaxone is a commonly administered antibiotic in paediatric medical day hospitals (MDH) for certain conditions where it may be considered first-line. Its long half-life permits once-daily dosing, thus potentially avoiding inpatient admission. However, administration of ceftriaxone requires intravenous line insertion, daily follow-up, and time spent by the family. There is a perception among healthcare providers in our tertiary hospital that ceftriaxone use is frequently inappropriate in the outpatient setting, and that more narrow-spectrum oral agents could be prescribed instead. Objectives Our primary objective was to evaluate the appropriateness of ceftriaxone use according to centre-specific first-line indications, in children between the ages of 3 months and 18 years in the MDH. Design/Methods Data were collected retrospectively for one winter season (Nov 2, 2019 to Jan 11, 2020) and one summer season (June 2, 2020 to Sept 25, 2020). All patients initially referred by the emergency department (ED) to the MDH were reviewed. Inclusion criteria included children (age 3 months to 18 years) who received ceftriaxone in the MDH or the ED. Patients with pre-existing immunodeficiency were excluded. Appropriateness was assessed according to the empiric antimicrobial guide available at our centre. In cases where ceftriaxone appropriateness was unclear, a detailed chart review was conducted by two parties including a resident and a staff trained in paediatric infectious diseases. Results Among eligible patients referred to the MDH from the ED (n=196), ceftriaxone was inappropriate in 113 cases (57.7%). Inappropriateness was more prevalent in the summer than the winter (76% vs 41.3%, p&amp;lt;0.0001). The most frequent inappropriate indications for ceftriaxone were: cellulitis with a skin portal of entry, including pre-septal cellulitis (54.0%); non-severe pneumonia (11.5%); and acute lymphadenitis (11.5%). Cellulitis was more prevalent in the summer (38.7% vs 16.3%), whereas pneumonia was more prevalent in the winter (20.2% vs 2.2%). Ceftriaxone was almost always initially prescribed in the ED (95.4%), and was continued in 164/187 (87.7%) of first MDH visits. An average of 2.9 doses of ceftriaxone was given per patient. Only one patient was documented to be initially unwell looking in the ED, and 50% were afebrile. Conclusion Ceftriaxone is overused in the MDH at our institution, largely due to skin and soft tissue infections and non-severe pneumonia. Targeted antimicrobial stewardship interventions to reduce ceftriaxone use in both the ED and MDH could improve the patient experience (less broad-spectrum antibiotics, less invasive procedures) and the efficient use of the MDH.

Prophylactic Antibiotics Use in Pediatric Day Case Surgery: Is it Really Necessary?

Prophylactic Antibiotics Use in Pediatric Day Case Surgery: Is it Really Necessary?

Radiological Features of Zoledronic Acid Therapy in Saudi Children with Osteogenesis Imperfecta

Background: The majority of osteogenesis imperfecta (OI) cases have an autosomal dominant pattern of inheritance and are usually caused by mutations in genes encoding type I collagen. Patients with OI may have blue sclerae, dentinogenesis imperfecta, and growth deficiency. Zoledronic acid is a third-generation bisphosphonate which was reported to inhibit osteoclast-mediated bone resorption, improve bone density, and reduce incidence of fractures. Aim: To describe the radiographic features of cyclic Zoledronic acid administration on the growing skeleton in children with OI and to report the efficacy of Zoledronic acid on bone mineral density. Methods: We retrospectively reviewed the radiographs of 11 children treated with Zoledronic acid. The age of these children ranged from one to 13 years. Zoledronic acid was administrated intravenously at 6 months intervals at the Pediatric Endocrinology Day Medical Unit, King Faisal Specialist Hospital and Research Centre, and Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia for 2 years. Results: During the course of treatment, a gradual increase in bone density was observed. The baseline mean lumbar BMDz score was -4.9SD + 1.3, which improved to a mean score of -2.7SD + 1.1, and a mean whole body BMDz score was -2SD +1.2 and improved to a mean score of -1.1SD + 1.3 by the end of therapy. Post treatment, there were multiple sclerotic metaphyseal bands seen in all children in the long bones paralleling to the growth plates and corresponding to the number of treatment cycles. Conclusion: Intravenous Zoledronic acid in children with osteogenesis imperfecta improved the bone mineral density and resulted in permanent sclerotic metaphyseal bands.

Pediatric Mental Health Hospitalizations at Acute Care Hospitals in the US, 2009-2019

Approximately 1 in 6 youth in the US have a mental health condition, and suicide is a leading cause of death among this population. Recent national statistics describing acute care hospitalizations for mental health conditions are lacking. To describe national trends in pediatric mental health hospitalizations between 2009 and 2019, to compare utilization among mental health and non-mental health hospitalizations, and to characterize variation in utilization across hospitals. Retrospective analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative database of US acute care hospital discharges. Analysis included 4 767 840 weighted hospitalizations among children 3 to 17 years of age. Hospitalizations with primary mental health diagnoses were identified using the Child and Adolescent Mental Health Disorders Classification System, which classified mental health diagnoses into 30 mutually exclusive disorder types. Measures included number and proportion of hospitalizations with a primary mental health diagnosis and with attempted suicide, suicidal ideation, or self-injury; number and proportion of hospital days and interfacility transfers attributable to mental health hospitalizations; mean lengths of stay (days) and transfer rates among mental health and non-mental health hospitalizations; and variation in these measures across hospitals. Of 201 932 pediatric mental health hospitalizations in 2019, 123 342 (61.1% [95% CI, 60.3%-61.9%]) were in females, 100 038 (49.5% [95% CI, 48.3%-50.7%]) were in adolescents aged 15 to 17 years, and 103 456 (51.3% [95% CI, 48.6%-53.9%]) were covered by Medicaid. Between 2009 and 2019, the number of pediatric mental health hospitalizations increased by 25.8%, and these hospitalizations accounted for a significantly higher proportion of pediatric hospitalizations (11.5% [95% CI, 10.2%-12.8%] vs 19.8% [95% CI, 17.7%-21.9%]), hospital days (22.2% [95% CI, 19.1%-25.3%] vs 28.7% [95% CI, 24.4%-33.0%]), and interfacility transfers (36.9% [95% CI, 33.2%-40.5%] vs 49.3% [95% CI, 45.9%-52.7%]). The percentage of mental health hospitalizations with attempted suicide, suicidal ideation, or self-injury diagnoses increased significantly from 30.7% (95% CI, 28.6%-32.8%) in 2009 to 64.2% (95% CI, 62.3%-66.2%) in 2019. Length of stay and interfacility transfer rates varied significantly across hospitals. Across all years, mental health hospitalizations had significantly longer mean lengths of stay and higher transfer rates compared with non-mental health hospitalizations. Between 2009 and 2019, the number and proportion of pediatric acute care hospitalizations due to mental health diagnoses increased significantly. The majority of mental health hospitalizations in 2019 included a diagnosis of attempted suicide, suicidal ideation, or self-injury, underscoring the increasing importance of this concern.

Preoperative clear fluid fasting and endoscopy-measured gastric fluid volume in children.

In light of new recommendations to shorten clear fluid fasting time before anesthesia, our study aimed at exploring residual fluid volume in the stomach after different fasting times. We intended to perform direct endoscopic aspiration of stomach contents under vision, as part of routine gastroscopy assessment. Hereby we would be able to quantify true residual gastric fluid volume and acidity in children and measure their correlation with fasting times. The study was performed as a single-center, prospective study in pediatric perioperative day care at a university-affiliated tertiary care center. Aspiration of gastric fluid contents was performed in anesthetized children aged 1-18 years undergoing an elective gastroscopy. Recorded data included patient fast time, last meal content, last clear fluid content, and aspirated gastric volume and pH, as well as patient characteristics. We included 253 gastroscopies, performed in 245 children. Mean fasting time for clear fluids was 6.9h (range 1h 40 min - 18 h 35 min) (SD 4.5). Mean age was 9.8 years (SD 5.1) and mean body weight was 33.2kg (SD 18.7). Mean residual gastric volume was 12 mL (0-90) (SD 13.5) or 0.34 mL/kg (SD 0.37) and mean pH was 1.5 (SD 0.9). No significant correlation was observed between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight (r= -.103, p= .1), nor between clear fluid fasting time and the pH of the residual gastric fluid (r= -.07, p= .3). In more than half of the patients the residual gastric volume was less than 10mL, unrelated to fasting time. In children undergoing gastroscopy, we could not demonstrate any association between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight. Since we did not see a clinically relevant association between clear fluids fasting time and gastric residual volume, this study may support the recommendation to shorten clear fluids fasting time.

Increasing capacity in acute day care settings: patients' experiences of a pop-up day care unit

The unit operated fortnightly between December 2020 and March 2021. Family feedback on the service was collated via an online survey. 72 respondents found NHB acceptable; 70 (97%) would be happy to return; 63 (90.3%) preferred the NHB to attending Bristol Royal Hospital for Children or had no preference for their appointments. Positive comments focused on service organisation and clinical environment. Families valued the availability of the close, free parking. The minimal negative comments related to travel directions, lack of catering facilities and the small number of toilets. The pop-up service model was highly acceptable to families. This highlights the need for appropriate hospital services to explore similar initiatives beyond traditional healthcare settings in order to ensure that the provision of equitable health care is in line with the NHS Long Term Plan.

Comparison of duration of Postoperative Analgesia after Caudal Block with or without Intravenous Dexamethasone in Paediatric Day Care Infraumbilical Surgeries under General Anaesthesia

Background: Pain is defined as a subject’s conscious perception of modulated nociceptive impulses that generate an unpleasant experience associated with actual or potential tissue damage. General anaesthesia, when combined with regional anaesthesia provides effective perioperative analgesia. Aim of the study was to study the effect of intravenous dexamethasone on duration of post-operative analgesia when given along with intra operative caudal block in paediatric day care infra umbilical surgeries under general anesthesia.&#x0D; Methods: Sixty paediatric patients, American Society of Anesthesiologist’s class I and II, patients were randomly divided in to two groups. In Group D - 30 paediatric patients who were given intravenous dexamethasone in a dose of 0.2 mg/kg iv in 5 ml normal saline along with caudal block with 0.75ml/kg of 0.25% bupivacaine. Group S - 30 paediatric patients who were given 5 ml of normal saline intravenously along with caudal block with 0.75ml/kg of 0.25% bupivacaine. Primary objective of the study was to determine the duration of post-operative analgesia.&#x0D; Results: The demographic data were comparable in both groups. There were no significant difference of mean (SD) Heart Rate and Mean arterial pressure (mmHg) at baseline, post-operative 1st hour, post-operative 2nd hour, post-operative 3rd hour, post-operative 4th hour (p value &gt;0.05). Time for rescue analgesia (minutes) to be given was more in group D when compared to group S (190.67 ± 41.76 versus 181.17± 37.97) however it was not statistically significant. Total duration of analgesia(minutes), i.e., including both intra-operative and post-operative period was more in group D when compared to group S (266.83 ± 37.69 versus 255.73 ± 42.83). However, there was no significant difference between them. (p value=0.188).&#x0D; Conclusion: We conclude that a single bolus dose of intravenous dexamethasone (0.2 mg/kg) given along with caudal block with 0.75 ml/kg of 0.25% bupivacaine did not prolong the duration of postoperative analgesia in paediatric patients.