Pediatric Exposure Research Articles

Nifurtimox for Treatment of Chagas Disease in Pediatric Patients: the Challenges of Applying Pharmacokinetic-Pharmacodynamic Principles to Dose Finding

Theantiparasitic drug nifurtimox was approved in the USA in 2020 for the treatment of patients with Chagas disease aged less than 18 years and weighing at least 2.5 kg, based on outcomes from the phase 3 CHICO study. Accordingly, pediatric patients with Chagas disease take nifurtimox thrice daily with food at one of two body weight–adjusted dose ranges. We investigated possible relationships between pharmacokinetic (PK) data, and pharmacodynamic efficacy and safety data collected in an analysis population of 111 participants in CHICO, using a published population PK model to estimate nifurtimox exposure at the patient level. Pediatric exposure to nifurtimox was benchmarked against levels of nifurtimox exposure known to be effective in adults with Chagas disease. Given the complex dosing regimen for nifurtimox, we also modeled nifurtimox exposure associated with simpler dosing strategies. We found no relationship between exposure to nifurtimox and efficacy measures (e.g., serological response to treatment), or between exposure and safety outcomes (including typical adverse events, e.g., headache, decreased appetite, nausea/vomiting). The analysis population appeared to represent the overall CHICO population based on the similarity of their baseline characteristics and the profiles of adverse events in the two groups. Modeled exposure based on the dosing regimen in CHICO was within the reference range derived from phase 1 data in adults. The relationship between nifurtimox exposure and cure is complex; a simplified pediatric dosing regimen is unlikely to be beneficial.Graphical abstract

Pediatric screen exposure and school related headache disability.

Prolonged screen exposure is often cited as a trigger for pediatric headache. We present initial findings evaluating the association between adolescent screen use type, duration, and school disability. New patients aged 12-17 years presenting to a headache clinic were screened and surveyed regarding headache characteristics, behavioral habits, school attendance, and screen utilization. 99 adolescents (29 M, 70 F) with average age 14.8 years and average headache frequency of 17 days per month completed the survey. Patients missed an average of five full days and three partial days of school due to headaches over the 90 days prior to survey completion.No statistically significant correlation was found between type or duration of screen exposure and monthly headache frequency, school attendance, or school functioning. A small positive association was seen between increasing duration of computer use, total hours screen use, and school absenteeism. While most adolescents reported prolonged screen use (58.6%) and luminosity (64.6%) worsened headaches, no statistical difference was seen in average number of headache days per month. Average monthly headache frequency in an adolescent population was not significantly correlated with type or duration of screen exposure. Further studies are needed to elucidate how screen utilization impacts school related headache disability.

Unintentional Pediatric Lithium Exposure: A 15-Year Retrospective Analysis.

Lithium is an uncommon pediatric exposure, and the effects of accidental or exploratory ingestions are not well characterized. This study examined the clinical effects and outcomes of unintentional lithium ingestions treated in a health care facility for patients up to 16 years old. The database from a single-state Poison Control System was queried for all pediatric lithium exposures managed in a health care facility between January 2006 and December 2021. Inclusion criteria were 16 years or younger and acute lithium exposure treated in a health care facility. Those older than 16 years, nonoral exposures, intentional, chronic, or nonlithium exposures, and out-of-state patients were excluded. One hundred eighteen cases were included, and 619 were excluded. The median age was 2 years (range, 0.5-15 years). One hundred fifteen (97%) were 7 years or younger. Sixty-eight (57.6%) were boys. One hundred thirteen (96%) were exploratory ingestions. Lithium carbonate was the most common formulation, with a median reported dose of 525 mg (range, 100-13,500 mg). Sixty-seven (57%) had serum lithium concentrations available: 19 (28%) were detectable (>0.1 mEq/L) and 4 were supratherapeutic (>1.2 mEq/L).One hundred (85%) patients were coded as having no effects. Four (3%) patients had coded effects-1 mild, 2 moderate, and 1 major; all were polydrug ingestions and recovered fully with basic supportive care. The loss to follow-up rate was 12%.A small minority received treatment with intravenous fluids and/or whole bowel irrigation. Thirteen (11%) were admitted, 3 to the ICU. No morbidity or mortality was reported. The majority of unintentional pediatric lithium ingestions examined were exploratory and resulted in no significant symptoms. Only a small minority had detectable serum lithium concentrations. All isolated lithium exposures were asymptomatic. Unintentional exposures appear to be benign, even with detectable lithium levels. Further study is needed to better risk stratify for home care versus health care facility evaluation.

Analysis of pediatric opioid analgesics prescribed in a large pediatric hospital over a 5-year period

Objective: In this study, we aim to look at opioid prescription patterns in a large pediatric hospital with an emphasis on opioid potency as measured by morphine milligram equivalents (MMEs) to understand physician response to safe prescribing regulations and new research on opioid use in pediatrics.Design: Analgesic prescriptions in a pediatric hospital in California from 2012 to 2016 were included. Prescriptions that contained any type of opioid medication were analyzed total MME in each prescription, and medication prescribed. The MME for each opioid was assigned to the prescription and presented as mean ± standard deviation (SD). Statistical analysis was performed by using IBM SPSS statistics version 25.Setting: A pediatric hospital in California.Participants: All pediatric patients receiving analgesic prescriptions from a single institution between 2012 and 2016.Main outcome measure: Relative frequency of different opioid medications prescribed.Results: Of the 14,194 total opioid prescriptions, hydrocodone (11,247), codeine (2,117), and tramadol (411) were most prescribed. The relative frequency of opioid prescription decreased from 2012 to 2016 due to the decreased prescription of hydrocodone and codeine. Despite the decreased relative frequency of opioid prescription, the mean MME of prescribed opioids increased.Conclusion: The study demonstrated that recent efforts to limit pediatric exposure to opioids have been effective. However, recommendations limiting the use of weak opioids (codeine and tramadol) have caused an increase in average prescribed opioid potency. This may be a contributing factor to the overall increase in opioid-related pediatric hospitalizations. Revision of prescription guidelines for hydrocodone (MME = 1) may protect pediatric patients from unnecessary opioid exposure.

Model-informed bridging of rivaroxaban doses for thromboprophylaxis in pediatric patients aged 9 years and older with congenital heart disease.

Rivaroxaban is approved in various regions for the treatment of acute venous thromboembolism (VTE) in children aged between 0 and 18 years and was recently investigated for thromboprophylaxis in children aged between 2 and 8 years (with body weights <30 kg) with congenital heart disease who had undergone the Fontan procedure. In the absence of clinical data, rivaroxaban doses for thromboprophylaxis in post‐Fontan children aged 9 years and older or ≥30 kg were derived by a bridging approach that used physiologically‐based pharmacokinetic (PBPK) and population pharmacokinetic (popPK) models based on pharmacokinetic (PK) data from 588 pediatric patients and from adult patients who received 10 mg once daily for thromboprophylaxis after major orthopedic surgeries as a reference. Both models showed a tendency toward underestimating rivaroxaban exposure in post‐Fontan patients aged between 2 and 5 years but accurately described rivaroxaban PK in post‐Fontan patients aged between 5 and 8 years. Under the assumption that hepatic function is not impaired in post‐Fontan patients, PBPK and popPK simulations indicated that half of the rivaroxaban doses for the same body weight given to pediatric patients treated for acute VTE would yield in pediatric post‐Fontan patients exposures similar to the exposure observed in adult patients receiving 10 mg rivaroxaban once daily for thromboprophylaxis. Simulation‐derived doses (7.5 mg rivaroxaban once daily for body weights 30–<50 kg and 10 mg once daily for body weights ≥50 kg) were therefore included in the recent US label of rivaroxaban for thromboprophylaxis in children aged 2 years and older with congenital heart disease who have undergone the Fontan procedure.

Sustaining standardized opioid prescribing practices after pediatric tonsillectomy

IntroductionOpioid prescribing patterns after pediatric tonsillectomy are highly variable, and opioids may not improve pain control compared to over-the-counter pain relievers. We evaluated whether a standardized, opioid-sparing analgesic protocol effectively reduced opioid prescriptions without compromising patient outcomes. MethodsA quality improvement project was initiated in July 2019 to standardize analgesic prescribing after hospital-based tonsillectomy with/without adenoidectomy. An electronic order set provided weight-based dosing and defaulted to non-opioid prescriptions (acetaminophen and ibuprofen). Patients ages 0–6 received non-opioid analgesics alone. Patients ages 7–18 received non-opioid analgesics as first-line pain control, and providers could manually add hydrocodone-acetaminophen for breakthrough pain. Opioid prescriptions and quantities were compared for 18 months of cases pre- versus post-standardization. Postoperative returns to the system were reviewed as a balancing measure. ResultsFrom 2018 through 2020, 1817 cases were reviewed. The frequency of opioid prescriptions decreased significantly post-standardization, from 64.9% to 33.5% of cases (P < .001). Opioid prescribing for young children steadily decreased from over 50% to 2.4%. Protocol adherence improved over time; outlier prescriptions were eliminated. Opioid quantities per prescription decreased by 16.3 doses on average (P < .001), and variance decreased significantly post-standardization (P < .001). The incidence of returns to the system did not change (P = .33), including returns for pain or decreased intake (P = .28). ConclusionAn age-based and weight-based analgesic protocol reduced post-tonsillectomy opioid prescriptions without a commensurate increase in returns for postoperative complaints. Standardized protocols can facilitate sustained changes in prescribing patterns and limit potentially unnecessary pediatric opioid exposure.

Unintentional Acute Poisoning Related Emergency Department Visits in Children in a Single-Center: A Nine-Year Prospective Survey.

Pediatric morbidity due to unintentional poison exposure is a significant burden on public health. We prospectively characterize patterns of unintentional poison exposure in a single pediatric emergency department, using a detailed computerized questionnaire for all unintentional injuries admitted during 2009 to 2017. Out of 71,765 visits due to unintentional injuries, 252 children were admitted due to unintentional poison exposure. Most (198/252, 79%) were between 1 and 3 years of age. The majority of events (209/252, 82.9%) occurred at the patient's home and 81% (205/255) were classified as exploratory ingestion. In 41/252 (14%) cases, exposure to more than one substance was reported. Most events 231/293 (79%) involved medications and 21% were due to domestic products. Four medications account for 45% of the events (Paracetamol, Salbutamol, Antihypertensive, and Antidepressants). Opioids were responsible for only 1.7%. By, collaboration between government, public health, educational institutions and commercial companies, can the burden of pediatric unintentional poison exposure be reduced.

Approach to Lower Urinary Tract Reconstruction: A Survey of Adult and Pediatric Urologist Perspectives and Experiences

IntroductionRobotic adoption has rapidly increased within urology. Initial uptake in adult urology has outpaced that seen in pediatric procedures. The aim of this study was to determine adult and pediatric urologist satisfaction with specific procedural steps in lower urinary tract reconstruction (LUTR) using an open versus robotic approach and define drivers and barriers to robotics adoption to inform device development relevant to current needs.MethodsA survey was distributed to practicing urologists. Questions assessed surgeon demographics, technology adoption, satisfaction with anastomotic steps in continent neobladder (CN) and augmentation cystoplasty (AC), and drivers/barriers influencing robotic use.ResultsOf 110 respondents, 49% practiced in academic institutions; 51% reported non-academic, private, or other. Specializations were pediatrics (36%), oncology/robotics (25%), or other (39%). Sixty-eight percent completed training in the past decade. In the past year, 55% completed only open CN or AC, 36% only robotic, and 9% both. Of those that performed robotic procedures, 5% used only an intra-corporeal approach, 85% used only extra-corporeal, and 10% used both. Surgeons who performed robotic LUTR alone expressed high satisfaction with all CN and AC procedural steps evaluated. Overall, of the anastomoses evaluated, urologists found urethrovesical anastomoses more satisfactory using a robotic versus open approach. Pediatric versus adult urologists were overall less satisfied with the robotic approach. In terms of robotic adoption, major drivers for CN were adoption by neighboring institutions, improved perioperative outcomes, and equivalent oncological outcomes; barriers were cost of robotic purchase and maintenance, surgeon support for robotics, and difficult learning curve. Major drivers for AC were adoption by neighboring institutions, decreased operative time, and equivalent oncological outcomes; barriers were increased operative time, cost, and minimal perceived benefit of extracorporeal procedures.ConclusionUrologic oncologists and surgeons performing robotic LUTR alone were highly satisfied with the robotic approach. Pediatric urologists reported lower overall satisfaction with robotic steps in LUTR, potentially corresponding with limitations of current robotic platforms for pediatric application and relative training exposure. Major drivers overall were competition and outcomes; major barriers were cost, operative time, and learning curve. Based on this select surgeon cohort recruited through targeted social media platforms, maximizing surgeon experience through training and innovations to reduce complication rates is anticipated to facilitate broader adoption of robotics in LUTR. Future studies that include a broad international distribution across the specialty may further pinpoint specified needs for adult versus pediatric specialists and drive targeted robotics platform development.

Evaluation of specific absorption rate and heating in children exposed to a 7T MRI head coil.

PurposeTo evaluate specific absorption rate (SAR) and temperature distributions resulting from pediatric exposure to a 7T head coil.MethodsExposure from a 297‐MHz birdcage head transmit coil (CP mode single‐channel transmission) was simulated in several child models (ages 3–14, mass 13.9–50.4 kg) and one adult, using time‐domain electromagnetic and thermal solvers. Position variability, age‐related changes in dielectric properties, and differences in thermoregulation were also considered.ResultsAge‐adjusted dielectric properties had little effect in this population. Head average SAR (hdSAR) was the limiting factor for all models centered in the coil. The value of hdSAR (normalized to net power) was found to decrease linearly with increasing mass (R2 = 0.86); no equivalent relationship for peak‐spatial 10g averaged SAR (psSAR10g) was identified. Relatively small (< 10%) variability was observed in hdSAR for position shifts of ±25 mm in each orthogonal direction when normalized to net power; accounting for B1+ efficiency can lead to much larger variability. Position sensitivity of psSAR10g was greater, but in most cases hdSAR remained the limiting quantity.For thermal simulations, if blood temperature is fixed (i.e., asserting good thermoregulation), maximum temperatures are compliant with International Electrotechnical Commission limits during 60‐min exposure at the SAR limit. Introducing variable blood temperature leads to core temperature changes proportional to whole‐body averaged SAR, exceeding guideline limits for all child models.ConclusionsChildren experienced higher SAR than adults for the 297‐MHz head transmit coil examined in this work. Thermal simulations suggest that core temperature changes could occur in smaller subjects, although experimental data are needed for validation.

Extracorporeal Membrane Oxygenation for Pediatric Toxin Exposures: Review of the Extracorporeal Life Support Organization Registry.

Evidence for the use of extracorporeal membrane oxygenation (ECMO) in children with refractory respiratory failure or shock following ingestion or toxin exposure, has been confined to single-center experiences, individual case reports, and extrapolated from adult cohorts; no pediatric multicenter cohorts exist. The objective of this retrospective review of the Extracorporeal Life Support Organization registry is to describe pediatric ECMO use following ingestion or toxin exposure, and define factors associated with mortality. Twenty-eight children between the ages of 30 days and 18 years met inclusion criteria between January 1, 2008 and December 31, 2017. The primary outcome measure was mortality before hospital discharge, which occurred in 32% of patients. Factors associated with in-hospital mortality included pre-ECMO use of inhaled nitric oxide (44.4% vs. 5.3%, p = 0.026), lower pre-ECMO arterial blood gas pH (6.97 [6.80-7.17] vs. 7.20 [7.15-7.32], p = 0.034), and higher pre-ECMO PaCO2 (79 [57-85] vs. 49 [38-63], p = 0.014). Receipt of inotropic support during ECMO was more common in nonsurvivors (66.7% vs. 21.1%, p = 0.035). Extracorporeal membrane oxygenation should be considered in the most severe pediatric toxin exposures as a bridge to recovery, providing time for both toxin elimination and end-organ recovery.

Edible marijuana products and potential risks for pediatric populations.

In recent years, an increasing number of states have legalized marijuana, also known as cannabis, for recreational use. As marijuana becomes more accessible, adolescent use and accidental pediatric exposures are likely to become broad public health concerns. Edible marijuana products, which are consumable foods or beverages that contain cannabis extract, are particularly enticing to youth, as they come in appealing forms such as candies, cookies, and drinks. The purpose of this review is to provide pediatricians with an overview of the different types and potential dangers associated with edible marijuana products. Edible marijuana products are often indistinguishable in appearance from normal food items and lack the smell and visible smoke associated with inhaled marijuana. Because they are inconspicuous, palatable, and easily accessible, they are increasingly popular among adolescents. Additionally, the packaging of edible baked goods, candies, and drinks is often purposefully very similar to that of mainstream foods, increasing the risk of accidental ingestion by children. An edible marijuana product must be digested before Δ9-tetrahydrocannabinol can enter the bloodstream, so there is a delayed onset of effects when consuming edibles compared with inhaling marijuana. This also predisposes users to accidental overconsumption. Greater knowledge of edible marijuana product consumption by pediatric populations will allow pediatricians to more effectively help patients and advise caregivers in cases of overconsumption, dependence, or accidental ingestion. It is important for parents, guardians, and educators to be able to successfully identify edible marijuana products and recognize signs of cannabis use.

Potential Health Benefit of NO2 Abatement in China's Urban Areas: Inspirations for Source-specific Pollution Control Strategy

Potential Health Benefit of NO2 Abatement in China's Urban Areas: Inspirations for Source-specific Pollution Control Strategy

The impact of tube current and iterative reconstruction algorithm on dose and image quality of infant CT head examination

Computed Tomography (CT) scan examination has been recognized for its potential in contributing high radiation doses, which raised a public concern towards pediatric exposure, especially infants. Thus, the optimization is vital through well-balanced levels of radiation and image quality. Hence, this study aimed to investigate optimized CT acquisition parameter on radiosensitive organs of infant CT head examination and its influence on the image quality. This study utilized a 1-year-old anthropomorphic phantom and thermoluminescence dosimeter (TLD) for organ dose assessment. The examination was performed by using 128 multi-slice CT (Ingenuity Core, Philips, Netherlands) and varying the tube current and iterative reconstruction algorithm (iDose4) levels. During the process, the reference mAs (ref. mAs) were altered while maintaining the tube potential at 100 kVp. Five protocols were established and denoted by P1, P2, P3, P4, and P5. As per measurement, 3 calibrated TLD chips were implanted into the phantom on slab numbers 2, 4, and 7 that represented brain, lens, and thyroid, respectively. Image quality was evaluated by utilizing the objective assessment in terms of signal to noise ratio (SNR) and contrast to noise ratio (CNR) and subjective image quality using the Visual Grading Analysis (VGA) technique in terms of sharpness, noise, and artefact were assessed from each protocol. Notably, the dose was decreased up to 30% along with the reduction of tube current and the improvement of SNR and CNR values for parameters that enable the iterative reconstruction algorithm. Hence, optimization of CT acquisition parameter should be evaluated and monitored accordingly.

Seniors and single-use detergent sacs (SUDS): a review of the National Poison Data System from 2012 to 2020

Introduction Exposure to single-use detergent sacs (SUDS), or laundry pods, have declined in the pediatric population between 2015 and 2018. Older adult exposures are less well described, and it is unclear if there is an increased risk of unintentional exposure to SUDS in older adults, especially in those with dementia. This study aims to review SUDS exposures in adults greater than 60-year-old between 2012 and 2020. Methods Using the National Poison Data System (NPDS), a query was performed for cases involving an acute single substance exposure with substance coded as “laundry detergent unit dose” (Generic code: 0201181, 0201182, and 0201183) in adults greater than 60-years-old between January 1, 2012 and December 31, 2020. Exclusion criteria included unknown age, age less than 60 years, any multi-substance exposure, and chronic or acute-on-chronic acuity. The distribution of cases was analyzed for demographics, exposure circumstances, management, clinical effects, and medical outcome. Results SUDS exposure reported to NPDS increased from 46 cases in 2012 to 219 cases in 2020. Among the 1289 total reported cases, 94.9% (n = 1223) were unintentional exposures with an average age of 75-year-old. The majority of exposures occurred in females (69%, n = 883). More than 1 exposure route was reported in 90 cases (7%), and the most common route of exposure was ingestion (64.9%, n = 836). Major effects were identified in 1% (n = 13) of exposures, and 0.5% (n = 7) of cases resulted in death. Conclusions Despite a declining incidence of pediatric SUDS exposure, older adult exposures have increased over 400% between 2012 and 2020.

2020 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System.

IntroductionThis is the 2020 Annual Report of the Kansas Poison Control Center (KSPCC) at The University of Kansas Health System. The KSPCC receives calls from the public, law enforcement, healthcare professionals, and public health agencies.MethodsEncounters reported to the KSPCC from January 1, 2020 through December 31, 2020 were analyzed for caller location, demographics, exposure substance, nature of exposure, route of exposure, interventions, medical outcome, and location of care. Encounters were classified as human or animal exposure, confirmed non-exposure, or information call (no exposure).ResultsThere were 19,780 total encounters, including 18,492 human exposure cases. These cases were primarily female (53.6%, n = 9,911) and pediatric (19 years of age or less; 59.5%, n = 10,995). Acute cases (82.7%, n = 15,294), unintentional exposures (73.8%, n = 13,643), and ingestions (85.9%, n = 15,901) were most common. The most common reported substance was household cleaning products (n = 937) in pediatric (children ≤ 5) and analgesics (n = 1,335) in adults. An increase in exposures to disinfectants and household cleaning products was seen. Moderate (n = 1,812) or major (n = 482) clinical outcomes were seen in 12.4% of cases. There were 18 deaths in 2020 reported to the KSPCC.ConclusionsOver 18,400 exposures were managed by the KSPCC in 2020. Pediatric exposures remained the most common encounter. An increase in exposures to disinfectants and other household cleaning products was seen. This report supported the continued value of the KSPCC to both public and acute healthcare in the state of Kansas.

Treatments used on teeth of children affected by molar incisor Hypomineralization, a systematic review

Hypomineralization is becoming more frequent every day. If molars containing enamel rupture are found in pediatric patients and present dentin exposure caused by MIH, it is necessary for patients to undergo some treatment to manage this pathogen (5). One of the objectives of this review is to present the different treatments that facilitate the restoration and maintenance of adequate oral health, affected by MIH. Methods: The studies were analyzed from 2017 to 2022, these found in Pubmed, Scopus, Ebsco, Proquest and Science Direct. To carry out the systematic direction, the PRISMA guidelines were followed, the evolution of quality, and the risk of bias was carried out considering the criteria set forth in the National Heart Lung and Blood Institute – NHLBI tool. Results: After applying the keywords for the search, 1498 articles were found, in which exclusion and inclusion criteria were applied, duplicated, in addition, they passed through different filters where 171 were evaluated and 8 of them were chosen. Therefore, The data obtained from these articles were ordered for the extraction of information, and the study standards such as methodology and results were followed. Conclusion: The results obtained from the 8 articles demonstrate the different treatments used in the last 5 years to treat molar-incisor hypomineralization, even so, more studies are needed to investigate more treatments, clinical protocols, therapeutics, used in patients with MIH in the last 5 years.

MO1024: Exposures and Susceptibilities in Paediatric Acute Kidney Injury—Impact on Awareness and Survival

Abstract BACKGROUND AND AIMS Acute kidney injury (AKI) is a growing global healthcare problem in the adult and paediatric population. In comparison with the adult population where the coexisting chronic conditions (e.g. diabetes, hypertension) increase the mortality risk during AKI, in children without chronic conditions one can assess the direct impact of AKI on mortality. Current paediatric studies state the need for increased awareness of AKI, for identifying susceptibilities and for the need to correct modifiable exposures in order to improve outcomes. METHOD We conducted a retrospective observational study in the ‘Louis Turcanu’ Emergency County Hospital for Children in Timisoara, Romania. Data were extracted from the hospital electronic database, between 1 January 2014 and 31 December 2020. The study cohort included 127 457 patients (aged 1 day–18 years) who had at least two serum creatinine levels determined during the same hospital admission. AKI was defined and staged according to Kidney Disease Improving Global Outcome (KDIGO) guidelines (and 2021 Consensus Conference) using Acute Kidney Injury Network (AKIN) criteria. Baseline serum creatinine was considered the nadir serum creatinine in 7 days from admission. AKI awareness in different medical clinics was considered the recognition of AKI diagnosis during admission as noted in the medical records according to ICD-10 Clinical Modification codes (N17.0, N17.1, N17.2, N17.8, N19, N99.0 and P96.0). AKI non-awareness was considered in patients presenting AKI according to AKIN without diagnoses recognition in the medical reports. RESULTS Over the 7-year study, 1867 patients developed AKI (out of 127 457 hospital admissions). The overall AKI incidence was 1.46%. The diagnosis of AKI was lacking (non-awareness) in 72.5% of AKI cases. We evaluated the exposures and susceptibilities of AKI patients and their impact on awareness and mortality. Taking into account the fact that the study addressed paediatric patients, exposures and susceptibilities have been changed accordingly. The considered exposures were: sepsis, critical illness, circulatory shock, burns, trauma, major non-cardiac surgery, nephrotoxic drugs, contact with poisonous plants and mechanical ventilation. Our regression equation proved to be a good fit for the model, explaining only 3.8% of AKI awareness (R2 = 0.038) and 22.9% of death events (R2 = 0.229). AKI awareness increases with the presence of dehydration (by 2.29-fold, P &amp;lt; .05) and heart failure (by 2.54-fold, P &amp;lt; .001). The risk of death increases with the presence of prematurity (by 2.33-fold, P &amp;lt; .0001), cancer (by 2.45-fold, P &amp;lt; .0001), anaemia (by 4.06-fold, P &amp;lt; .0001) and chronic illness (by 2.65-fold, P &amp;lt; .0001). The susceptibilities were: female gender, chronic kidney disease, chronic diseases (heart, lung, liver), diabetes mellitus, cancer, anaemia, very low birth weight, heart failure, arterial hypertension and stem cell transplant. Our regression equation proved to be a good fit for the model, explaining only 9.4% of AKI awareness (R2 = 0.094) and 43.6% of deaths (R2 = 0.436). The awareness increases with the presence of sepsis (by 1.73-fold, P &amp;lt; .0001), of critical illness (by 2.41-fold, P &amp;lt; .0001) and mechanical ventilation (by 1.54-fold, P &amp;lt; .0001). The risk of death increases in the presence of sepsis (by 3.26-fold, P &amp;lt; .0001), of critical illness (by 7.42-fold, P &amp;lt; .0001), of mechanical ventilation (by 10.58-fold, P &amp;lt; .0001) and hypovolemic shock (by 10.58-fold, P &amp;lt; .0001). CONCLUSION The presence of more severe exposures and susceptibilities increased the awareness of AKI but also increased the risk of death. The diagnosis of AKI in our medical records is late, therefore late diagnosis has no benefits concerning the evolution and mortality of paediatric patients with AKI.

Changes in unintentional cannabis exposures in children 6 months to 5 years reported to United States poison centers during the first nine months of the coronavirus-19 pandemic

Introduction Almost half of exposures reported to United States (US) poison centers are exploratory ingestions in children under the age of 5 years. Pediatric cannabis exposures reported to US poison centers have risen over the last twenty years, with greater increases in the last 5 years. In 2020, the Coronavirus disease 2019 (COVID-19) pandemic resulted in widespread stay-at-home orders and subsequent changes in work, education, and daycare. This study describes the changes in pediatric cannabis exposures during the first nine months of the COVID-19 pandemic relative to the three years before the pandemic. Methods Cases were identified from the National Poison Data System. Inclusion criteria was unintentional cannabis exposure in children aged 6 months to 5 years between January 1, 2017 and December 31, 2020. Analysis was performed with segmented regression of interrupted time series analysis comparing January 2017–March 2020 (pre-COVID-19) to April 2020–December 2020 (COVID-19 period). Autocorrelation was assessed using Dubin-Watson test. Results There were 7,679 unintentional pediatric exposures from January 1, 2017 through December 31, 2020. There was a significant increase of 3.1% per month during the pre-COVID-19 period (p < .0001). A statistically significant immediate increase in number of exposures per month occurred in April 2020 (58.4%; p < .0001). The slope in the COVID-19 period was −0.01% (p = .99). No autocorrelation was detected. Discussion and conclusions Unintentional cannabis exposures in children aged 6 months to 5 years reported to United States poison centers increased significantly after the initial COVID-19 stay-at-home orders. This trend may be associated with COVID-19 quarantines, increased time children are spending at home, increased availability of cannabis products in homes, or other reasons. Future efforts should evaluate specific factors that resulted in the observed increases in pediatric exposures.

Pediatric cannabis exposures increased following legalization: Canada study

Pediatric cannabis exposures increased following legalization: Canada study

Critical care interventions in children aged 6 months to 12 years admitted to the pediatric intensive care unit after unintentional cannabis exposures

Background Cannabis exposures in children have risen sharply in recent years, resulting in increased hospital visits and admission to pediatric intensive care units (PICUs). The intent of this study was to describe the proportion of pediatric patients admitted to the PICU after unintentional cannabis ingestion that received critical care interventions (CCIs) along with describing trends over time in hospitalization, admission to the PICU, and clinical effects and treatments outside of the PICU. Methods This was a retrospective database study utilizing the National Poison Data System (NPDS) from 1/1/2000 to 12/31/2020. Children 6 months to 12 years of age with single substance cannabis exposures were included. Results A total of 12,882 cases were included. There was an increase in the proportion of cases seen in a hospital over time from 43.8% in 2000 to 54.6% in 2020 (range 29.1–62.6%). In patients seen in a HCF, the proportion admitted to the PICU was 9.5% in 2000 and 14% in 2020 (range: 5.6–29.0%). The 875 (6.8%) children admitted to the PICU were analyzed for the primary outcome. CCIs were performed in 69/875 (7.9%) cases that were admitted to the PICU. The most common CCIs in the PICU were intubation and sedation, 4.9 and 3.7%, respectively. Conclusions Unintentional pediatric cannabis exposures are associated with clinically significant effects, including respiratory depression, hypotension, and bradycardia, but fewer than 5% of exposures were treated with CCIs, like intubation or vasopressors, in patients admitted to the PICU. Further work should assess specific reasons for admission to the PICU.