Pediatric Beds Research Articles

Reduction in the incidence of invasive infections caused by encapsulated bacteria after the onset of the COVID-19 pandemic

Interaction between severe acute respiratory coronavirus 2 (SARS-CoV-2) and IIEB remains under investigation. Objective: to compare IIEB incidence before and during COVID-19 pandemic, and assess incidence of coinfection with COVID-19 and case fatality. A cross-sectional study was performed on data from a centralized microbiology laboratory serving a network of healthcare centers comprising 713 pediatric and adult inpatient beds, expanded by 20% during the pandemic. Three periods were evaluated: (1) pre-pandemic: March 1, 2019–February 29, 2020; (2) pandemic year 1: March 1, 2020–February 28, 2021; (3) pandemic year 2: March 1, 2021–July 31, 2021. Descriptive statistical analysis was performed. 56 502 samples (96% blood cultures) from 27224 patients were analyzed. Of these, 54 samples (from 54 patients) were positive for encapsulated bacteria. IIEB incidence was: 167.4, 32.6, and 50.4 per 100000 samples for periods 1, 2, and 3, respectively. Twelve IIEB episodes occurred during the pandemic period: 10 Streptococcus pneumoniae, and 2 Haemophilus influenzae, of which 7 were SARS-CoV-2/S. pneumoniae coinfections, with an incidence of 5.68 per 10000 COVID-19-related hospitalizations (0.056%). IIEB case fatality was 31%, 29%, and 60% for each period, respectively, 3/7 patients with coinfection died (43%). Case fatality for invasive pneumococcal disease (IPD) in patients without COVID-19, was 32.5%. Significant reduction in IIEB incidence was observed during the pandemic, coinciding with implementation of containment measures. The incidence of SARS-CoV-2/S. pneumoniae coinfection was low, with higher case fatality than IPD patients without COVID-19.

Hospitalization for bronchiolitis in children aged ≤ 1year, Southern Italy, year 2021: need for new preventive strategies?

BackgroundBronchiolitis is a major cause of hospitalization in infants, particularly in the first six months of life, with approximately 60–80% of admissions due to respiratory syncytial virus (RSV) infection. Currently, no prophylactic options are available for healthy infants. The present study aimed at describing the demographic, clinical, and epidemiological characteristics of infants hospitalized for bronchiolitis in the Apulia region of Italy in 2021.MethodsFrom January to December 2021, data on children aged 0–12 months admitted for bronchiolitis in nine neonatal or pediatric units covering 61% of pediatric beds of hospitals in the Apulia region of Italy were analyzed. Demographic data, comorbidities, need for oxygen support, length of hospital stay, palivizumab administration, and outcomes were collected. For the purpose of the analysis, patients were divided into those aged 0–3 months and > 3 months. A multivariate logistic regression model was used to explore associations between the need for oxygen support and sex, age, comorbidities, history of prematurity, length of hospital stay, and palivizumab administration.ResultsThis study included 349 children aged 0–12 months admitted for bronchiolitis, with a peak of hospitalization in November (7.4 cases/1,000 children). Of these patients, 70.5% were RSV positive, 80.2% were aged 0–3 months, and 73.1% required oxygen support. Moreover, 34.9% required observation in the sub-intensive care unit, and 12.9% in the intensive care unit. Of the infants who required intensive care, 96.9% were aged 0–3 months and 78.8% were born at term. Three patients required mechanical ventilation and one, who required Extra Corporeal Membrane Oxygenation, died. Children aged 0–3 months were more likely to show dyspnea, need oxygen support, and have a longer hospital stay.ConclusionsThe present study showed that almost all of the children who required intensive care support were aged ≤ 3 months and most were born at term. Therefore, this age group remains the highest risk group for severe bronchiolitis. Preventive measures such as single-dose monoclonal antibody immunoprophylaxis, and maternal and childhood vaccination against RSV, may reduce the high public health burden of bronchiolitis.

Challenges to Developing and Implementing Policies for Adolescent Online Portal Access.

After enactment of the 21st Century Cures Act, many health care systems offer adolescents and parents access to electronic health information through online portals. Few studies have evaluated adolescent portal access policies since the implementation of the Cures Act. We performed structured interviews with informatics administrators in US hospitals with ≥50 dedicated pediatric beds. We performed thematic analysis of challenges to developing and implementing adolescent portal policies. We interviewed 65 informatics leaders representing 63 pediatric hospitals, 58 health care systems, 29 states, and 14 379 pediatric hospital beds. Most hospitals provided portal access to adolescents (86%) and parents (95%). Filtering of results sent to parental portals ranged widely, with 14% providing unfiltered access, 31% performing minimal filtering for sensitive information, and 43% offering limited access. Portal access policies also varied widely within states. Challenges to developing policies included legislation and compliance issues, tension between confidentiality and usefulness, clinicians' preferences and concerns, limited understanding and investment of institutions in pediatric issues, and limited focus of vendors on pediatric issues. Challenges to implementing policies included technical challenges, educating end-users, potential for parental coercion, harms of bad news, complex enrollment processes, and informatics workforce limitations. Adolescent portal access policies vary widely across and within states. Informatics administrators identified multiple challenges related to developing and implementing adolescent portal policies. Future efforts should strive to develop intrastate consensus on portal policies and to engage parents and adolescent patients to better understand preferences and needs.

A Statewide Assessment of Pediatric Emergency Care Surge Capabilities

Pediatric surge planning is critical in the setting of decreasing pediatric inpatient capacity. We describe a statewide assessment of pediatric inpatient bed capacity, clinical care therapies, and subspecialty availability during standard and disaster operations in Massachusetts. To assess pediatric (<18 years old) inpatient bed capacity during standard operations, we used Massachusetts Department of Public Health data from May 2021. To assess pediatric disaster capacity, therapies, and subspecialty availability in standard and disaster operations, we performed a state-wide survey of Massachusetts hospital emergency management directors from May to August 2021. From the survey, we calculated additional pediatric inpatient bed capacity during a disaster and clinical therapy and subspecialty availability during standard and disaster operations. Of 64 Massachusetts acute care hospitals, 58 (91%) completed the survey. Of all licensed inpatient beds in Massachusetts (n = 11 670), 19% (n = 2159) are licensed pediatric beds. During a disaster, 171 pediatric beds could be added. During standard and disaster operations, respiratory therapies were available in 36% (n = 21) and 69% (n = 40) of hospitals, respectively, with high flow nasal cannula being most common. The only surgical subspecialist available in the majority of hospitals (>50%) during standard operations is general surgery (59%, n = 34). In a disaster, only orthopedic surgery could additionally provide services in the majority hospitals (76%; n = 44). Massachusetts pediatric inpatient capacity is limited in a disaster scenario. Respiratory therapies could be available in more than half of hospitals in a disaster, but the majority of hospitals lack surgical subspecialists for children under any circumstance.

Characteristics of intussusception among children in Hokkaido, Japan, during the pre- and post-rotavirus vaccine eras (2007-2016).

To analyse the epidemiology of intussusception in Hokkaido Prefecture, Japan during a 10-year period spanning the introduction of the rotavirus (RV) vaccine (2007-2016). Using a standard questionnaire, a retrospective surveillance was conducted across 17 hospitals with paediatric beds in Hokkaido Prefecture. We compared the data between the pre-vaccine era (2007-2011) and post-vaccine era (2012-2016). In total, 208 and 110 intussusception cases were in the pre- and post-vaccine eras, respectively. A significant reduction of the intussusception incidence in children aged <1 year was observed from the pre- to the post-vaccine era (102.4-56.5 per 100 000 infants; incidence rate ratio, 0.55; p=0.004). There was a relatively high-positive RV antigen detection rate (29.4%, 5/17) during the RV epidemic period in Japan (March-May) in the pre-vaccine era. None of the intussusception cases in the 31 patients with a history of RV vaccination occurred within 1 month after the administration of an RV vaccine dose. The incidence of intussusception in children aged <1 year decreased significantly after RV vaccine introduction in Japan. Another survey is needed to determine how the incidence of intussusception has changed further since the introduction of routine RV vaccination in 2020.

ОЦЕНКА ГОТОВНОСТИ СТАЦИОНАРОВ К РАБОТЕ В УСЛОВИЯХ ЧРЕЗВЫЧАЙНЫХ СИТУАЦИЙ

Significance. The COVID-19 pandemic has led to a crisis in society and seriously challenged healthcare capabilities around the world. The industry's lack of preparedness for such a large-scale and rapid spread of the virus around the world was one of the major factors in the fight against the pandemic faced by medical organizations and health services around the world. During the pandemic, the Russian Federation (hereinafter referred to as the RF) has radically restructured activities of medical organizations, re-equipped them with modern medical equipment, and intensively developed digitalization, making it possible to prevent the collapse of the industry and ultimately successfully cope with the pandemic. Analysis of the results and consequences of the restructuring the entire industry, medical organizations providing medical care of various types and in different conditions, allows us to assess emergency preparedness of hospitals and develop recommendations for the future. The purpose of the study was to assess hospital emergency preparedness in the Russian Federation based on the analysis of dynamics in bed capacity, structure of beds and utilization indicators in 2019-2022. Material and methods: comparative analysis of the number of beds, its structure and utilization indicators in the pre-COVID period, the pandemic period and the early post-COVID period based on the federal statistical observation form No. 30 “Information about medical organization” in the Russian Federation and in the constituent entities of the Russian Federation. Methods included descriptive statistics, comparative analysis and analytics. Results. A long-term trend towards reducing bed capacity and availability of beds was once interrupted in 2020, with the trend towards reducing the number of beds in rural areas remaining interrupted. In general, during the observation period, the total number beds decreased by more than 30 thousand, the population-to-bed ratio decreased by 3%, and the hospitalization rate dropped by 7%. The shortage of adult infectious disease beds at the beginning of the pandemic associated with the prior reduction of bed capacity against the background of the network restructuring was met by repurposing other beds to serve as infectious disease ones, and deploying additional infectious disease beds in and outside medical organizations to treat patients with COVID-19. The number of adult infectious disease beds increased 7.5-fold by the end of 2020. However, the number of adult infectious disease beds then started to decrease reaching a 59,4% increase by 2022 compared to 2019, but their share in rural areas decreased from 14% to 8%. The number of pediatric disease beds increased against the background of competing dynamics. Overall, during the period, the total number of pediatric and adult infectious disease beds increased by 27%. In the structure of adult infectious disease beds, the share of COVID-19 beds varied from 92% in 2020 to 34% in 2022; additionally deployed COVID-19 beds were also in operation. Over the observation period, the average bed length of stay and average bed occupancy decreased, while hospital mortality increased. Significant variability in hospital performance indicators across regions was registered. Conclusion In 2021-2022, hospital facilities in the Russian Federation were prepared to meet the increased incidence of infectious diseases. However, the renewed processes of bed capacity reduction necessitated forecasting sustainability of hospitals in emergency situations. The undertaken analysis shows that a cut in the number of round-the-clock beds should not be guided by the mere process of reduction. The decision to change the bed capacity and structure should be preceded by a thorough preliminary analysis of specialized care availability by each specialty planned to be reduced. Reducing planned hospitalizations and postponing treatment of patients with chronic non-communicable diseases turned out to be not fully justified, which was confirmed by other studies. Infectious disease beds must function in optimal numbers to cope with the increased flow of patients in early stages of an emergency. The areas where infectious disease beds are deployed must be sufficient to realize the possibility of quickly increasing the capacity of an infectious disease hospital to the required level. Planning a network of hospitals should ensure a comprehensive specialized care delivery to patients with chronic non-communicable diseases during emergencies including planned care. Scope of application: Hospital capacity and structure planning.

Padrões espaciais de mortalidade em recém-nascidos de baixo peso a termo e seus determinantes no Estado de São Paulo, Brasil

ABSTRACT Objective: Low birth weight (LBW) is a public health problem strongly associated with infant mortality. This study aimed to identify the spatial distribution of infant mortality in newborns with LBW (750–2,500 g) at term (≥37 weeks of gestation), due to their being small for gestational age, analyzing its association with mother-related determinants, as well as to identify priority areas of mortality in the State of São Paulo, 2010–2019. Methods: Infant mortality rate was analyzed in the division of neonatal mortality and postneonatal mortality of newborns with LBW at term. The empirical Bayesian method smoothed the rates, the univariate Moran index was used to measure the degree of spatial association between the municipalities, and the bivariate Moran index was employed to identify the existence of a spatial association between the rates and the selected determinants. Thematic maps of excess risk and local Moran were prepared to identify spatial clusters, adopting 5% as a significance level. Results: The excess risk map showed that more than 30% of the municipalities had rates above the state rate. High-risk clusters were identified in the southwest, southeast, and east regions, mainly among more developed municipalities. The determinants of adolescent mothers, mothers over 34 years of age, low education, human development index, social vulnerability index, gross domestic product, physicians, and pediatric beds showed a significant association with the rates evaluated. Conclusions: Priority areas and significant determinants associated with reduced mortality in newborns with LBW were identified, suggesting the need for intervention measures to achieve the Sustainable Development Goal.

Protocol-Driven Initiation and Weaning of High-Flow Nasal Cannula for Patients With Bronchiolitis: A Quality Improvement Initiative.

Bronchiolitis is the most common cause for nonelective infant hospitalization in the United States with increasing utilization of high-flow nasal cannula (HFNC). We standardized initiation and weaning of HFNC for bronchiolitis and quantified the impact on outcomes. Our specific aim was to reduce hospital and ICU length of stay (LOS) by 10% between two bronchiolitis seasons after implementation. A quality improvement (QI) project using statistical process control methodology. Tertiary-care children's hospital with 24 PICU and 48 acute care pediatric beds. Children less than 24 months old with bronchiolitis without other respiratory diagnoses or underlying cardiac, respiratory, or neuromuscular disorders between December 2017 and November 2018 (baseline), and December 2018 and February 2020 (postintervention). Interventions included development of an HFNC protocol with initiation and weaning guidelines, modification of protocol and respiratory assessment classification, education, and QI rounds with a focus on efficient HFNC weaning, transfer, and/or discharge. A total of 223 children were included (96 baseline and 127 postintervention). The primary outcome metric, average LOS per patient, decreased from 4.0 to 2.8 days, and the average ICU LOS per patient decreased from 2.8 to 1.9 days. The secondary outcome metric, average HFNC treatment hours per patient, decreased from 44.0 to 36.3 hours. The primary and secondary outcomes met criteria for special cause variation. Balancing measures included ICU readmission rates, 30-day readmission rates, and adverse events, which were not different between the two periods. A standardized protocol for HFNC management for patients with bronchiolitis was associated with decreased hospital and ICU LOS, less time on HFNC, and no difference in readmissions or adverse events.

644: EPIDEMIOLOGY OF INTRACRANIAL PRESSURE MONITOR USE IN PEDIATRIC ACUTE LIVER FAILURE

Introduction: Globally, Most pediatric critical illness is managed outside of formal intensive care units, as such we lack an understanding of the true prevalence of pediatric critical illness. Global PARITY (Pediatric Acute cRitical Illness point prevalence sTudY) is a prospective, observational, international study designed to measure prevalence of and outcomes associated with pediatric acute critical illness in resource-limited settings. We hypothesized that availability of pediatric critical care resources (formal and informal) impacts clinical outcomes. Data collection completes in Sep 2022; here we describe preliminary findings. Methods: Children 29 days-14 years with acute illness or injury presenting to a hospital in RLS settings were enrolled during 4 sampling periods over 12 months. Participating centers were not required to have a dedicated pediatric ICU. Admitted children were followed for clinical outcomes and critical care resource utilization. The primary outcome was prevalence of acute critical illness, defined as death within 48 hrs of presentation, need for a higher level of care, or requiring intensive care resources (e.g., Vasoactive). Results: study launched in July 2021 with 63 centers; 47 centers completed >3 data collection periods and over 7000 subjects were enrolled. Data completion and quality review for the 4 sampling periods are underway. A subset of data showed the availability of intensive care units: Pediatric high dependency/intermediate care unit (33, 52.4%), PICU (45, 71.4%), Pediatric beds in adult ICU (8, 12.7%), another subset of data showed patient utilization; Invasive Mechanical Ventilation requirement (N=8055): Yes (48, 0.6%), Vasoactives use: Yes (83, 1.0%). admission location (N=885): Inpatient Ward (600, 67.8%), High-Dependency Unit (266, 30.1%), Intermediate Care Unit (6, 0.7%), Intensive Care Unit (6, 0.7%). Conclusions: The majority of sites reported having a formal PICU. However, resource availability varies significantly between PICUs and this analysis, as well as the association between resources and outcomes, is in process. Global PARITY is a necessary step in determining the global burden of pediatric critical illness and availability of critical care resources; it will provide important insights regarding future resource investment and allocation.

Characteristics of Pediatric Patient Transfers From General Emergency Departments in California From 2005 to 2018.

Each year, approximately 300,000 pediatric patients are transferred out of emergency departments (EDs). Emergency department transfers may not only provide a higher level of care but also incur increased resource use and cost. Our objective was to identify hospital characteristics and patient demographics and conditions associated with ED transfer as well as the trend of transfers over time. This was a retrospective cohort study of pediatric visits to EDs in California using the California Office of Statewide Health Planning and Development ED data set (2005-2018). Hospitals were categorized based on inpatient pediatric capabilities. Patients were characterized by demographics and Clinical Classifications Software diagnostic categories. Regression models were created to analyze likelihood of outcome of transfer compared with admission. Over the 14-year period, there were 38,117,422 pediatric visits to 364 EDs in California with a transfer rate of 1% to 2%. During this time, the overall proportion of pediatric transfers increased, whereas pediatric admissions decreased for all hospital types. Transfers were more likely in general hospitals without licensed pediatric beds (odds ratio [OR], 16.26; 95% confidence interval [CI], 15.87-16.67) and in general hospitals with licensed pediatric beds (OR, 3.54; 95% CI, 3.46-3.62) than in general hospitals with pediatric intensive care unit beds. Mental illness (OR, 61.00; 95% CI, 57.90-63.20), poisoning (OR, 11.78; 95% CI, 11.30-12.30), diseases of the circulatory system (OR, 6.13; 95% CI, 5.84-6.43), diseases of the nervous system (OR, 4.61; 95% CI, 4.46-4.76), and diseases of the blood and blood-forming organs (OR, 3.21; 95% CI, 3.62; 95% CI, 3.45-3.79) had increased odds of transfer. Emergency departments in general hospitals without pediatric intensive care units and patients' Clinical Classifications Software category were associated with increased likelihood of transfer. A higher proportion of patients with complex conditions are transferred than those with common conditions. General EDs may benefit from developing transfer processes and protocols for patients with complex medical conditions.

The unmet need for critical care at a quaternary paediatric intensive care unit in South Africa.

Paediatric intensive care, a valuable resource that improves the outcomes of critically ill children, is often scarce. To evaluate the need for paediatric intensive care beds and compare the outcomes of admitted and non-admitted deserving cases. A prospective evaluation of all bed requests, in terms of need for intensive care and outcomes of those admitted and not admitted to a paediatric intensive care unit (PICU), was performed between July 2017 and June 2018. Factors for refusal and for poor outcomes were evaluated. Of the 811 bed requests, 32.6% (n=264, p<0.001) were denied access. Of the 231 deserving cases who were denied access, 85.7% (n=198) were due to unavailability of a PICU bed. Patients not admitted to PICU had a twofold increased risk of dying compared with those admitted (34.4% v. 15.5% respectively, p<0.001), even though the patient characteristics of both groups were similar (age, gender and nutritional status). In those admitted, risk factors for mortality were requiring transfusion of blood and platelets (56.0%, p<0.001), requiring two or more inotropes (52.5%, p<0.001), instability on admission (41.3%, p<0.001), prior cardiac arrest (32.0%, p=0.021), severe acute malnutrition (26.9%, p=0.043), fungal infection (22.2%, p=0.004) and emergency admission (18.0%, p<0.001). In those not admitted, prior cardiac arrest (100%, p<0.001) and emergency referral (42.3%, p<0.001) were associated with adverse outcomes. The need for PICU beds exceeds availability, with a consequent twofold increase in mortality among cases not admitted to PICU. Paediatric critical care services have increased at appropriate sites of need following completion of this study.

Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study

Despite the substantial burden caused by childhood cancer globally, childhood cancer incidence obtained in a nationwide childhood cancer registry and the accessibility of relevant health services are still unknown in China. We comprehensively assessed the most up-to-date cancer incidence in Chinese children and adolescents, nationally, regionally, and in specific population subgroups, and also examined the association between cancer incidence and socioeconomic inequality in access to health services. In this national cross-sectional study, we used data from the National Center for Pediatric Cancer Surveillance, the nationwide Hospital Quality Monitoring System, and public databases to cover 31 provinces, autonomous regions, and municipalities in mainland China. We estimated the incidence of cancer among children (aged 0-14 years) and adolescents (aged 15-19 years) in China through stratified proportional estimation. We classified regions by socioeconomic status using the human development index (HDI). Incidence rates of 12 main groups, 47 subgroups, and 81 subtypes of cancer were reported and compared by sex, age, and socioeconomic status, according to the third edition of the International Classification of Childhood Cancer. We also quantified the geographical and population density of paediatric oncologists, pathology workforce, diagnoses and treatment institutions of paediatric cancer, and paediatric beds. We used the Gini coefficient to assess equality in access to these four health service indicators. We also calculated the proportions of cross-regional patients among new cases in our surveillance system. We estimated the incidence of cancer among children (aged 0-14 years) and adolescents (aged 15-19 years) in China from Jan 1, 2018, to Dec 31, 2020. An estimated 121 145 cancer cases were diagnosed among children and adolescents in China between 2018 and 2020, with world standard age-standardised incidence rates of 122·86 (95% CI 121·70-124·02) per million for children and 137·64 (136·08-139·20) per million for adolescents. Boys had a higher incidence rate of childhood cancer (133·18 for boys vs 111·21 for girls per million) but a lower incidence of adolescent cancer (133·92 for boys vs 141·79 for girls per million) than girls. Leukaemias (42·33 per million) were the most common cancer group in children, whereas malignant epithelial tumours and melanomas (30·39 per million) surpassed leukaemias (30·08 per million) in adolescents as the cancer with the highest incidence. The overall incidence rates ranged from 101·60 (100·67-102·51) per million in very low HDI regions to 138·21 (137·14-139·29) per million in high HDI regions, indicating a significant positive association between the incidence of childhood and adolescent cancer and regional socioeconomic status (p<0·0001). The incidence in girls showed larger variation (48·45% from the lowest to the highest) than boys (36·71% from lowest to highest) in different socioeconomic regions. The population and geographical densities of most health services also showed a significant positive correlation with HDI levels. In particular, the geographical density distribution (Gini coefficients of 0·32-0·47) had higher inequalities than population density distribution (Gini coefficients of 0·05-0·19). The overall proportion of cross-regional patients of childhood and adolescent cancer was 22·16%, and the highest proportion occurred in retinoblastoma (56·54%) and in low HDI regions (35·14%). Our study showed that the burden of cancer in children and adolescents in China is much higher than previously nationally reported from 2000 to 2015. The distribution of the accessibility of health services, as a social determinant of health, might have a notable role in the socioeconomic inequalities in cancer incidence among Chinese children and adolescents. With regards to achieving the Sustainable Development Goals, policy approaches should prioritise increasing the accessibility of health services for early diagnosis to improve outcomes and subsequently reduce disease burdens, as well as narrowing the socioeconomic inequalities of childhood and adolescent cancer. National Major Science and Technology Projects of China, National Natural Science Foundation of China, Chinese Academy of Engineering Consulting Research Project, Wu Jieping Medical Foundation, Beijing Municipal Administration of Hospitals Incubating Program.

243.9: Equality and Equity in Transplant for Children

Introduction: Thomas E. Starzl, conducted the first paediatric liver transplant in 1963, a routine successful clinical procedure today due to his pioneering efforts. India the second most populous country, 41% under 18 yrs of age, has followed on the heels of developed nations with 1522 pediatric transplants from 2013-2020 for all organs but majority done in private sector. To enable equality and equity, Govt of India has proposed establishing department of transplant medicine in major government hospitals, at least one in each state in the latest National Organ Transplant Program Guidelines. Our aim is to develop an SOP for the establishment of paediatric transplant units in line with the Transplantation of Human Organs and Tissues Rules 2014, starting with VMMC & SJH. Materials & Methods: In 2019, India reported 4,49,002 Road traffic accidents(RTA) with resultant 1,51,113 deaths. Delhi accounted for 5610 RTA with 1463 deaths.DD transplants prove to be exceptionally useful in diseases with high risk of recurrence particularly in children. VMMC & SJH is one of the largest govt tertiary care centres in Delhi catering to a large paediatric population and a large proportion of the RTA victims, the greatest source of deceased donor (DD) organs, if tapped. Living Donor Renal transplant is conducted in adult patients on a regular basis by urologists. A paediatric nephrologist being available, the paediatric renal transplant program can be started by a combined team of paediatric surgeons & urologists. Training in paediatric liver transplants can be done either locally in ILBS, Delhi or internationally through TTS-ILTS paired centers program similar to JIPMER, Pondicherry with St.James University hospital Leeds, UK. TTS in collaboration with NOTTO conducted an online survey of intensivists with regard to brain death declaration. The intensivists need to be trained for brain death declaration and donor maintenance to enable DD transplants. Augmentation of pediatric transplant intensive care beds and personnel is required along with round the clock lab facilities. Results: The Govts of Delhi, Tamilnadu, Kerala, Maharashtra, etc have issued have issued GOs for mandatory declaration of brain death in all patients who fulfill the criteria. DGHS has sought monthly submission of brain death data. Intensivist training for brain death declaration and donor maintenance was first started by NOTTO during the CAST 2019 congress and two more have followed. However, progress can only be achieved with implementation of training and establishment of dedicated centers.

A Delphi Survey of Canadian Respiratory Therapists' Practice Statements on Pediatric Mechanical Ventilation.

Pediatric mechanical ventilation practice guidelines are not well established; therefore, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) developed consensus recommendations on pediatric mechanical ventilation management in 2017. However, the guideline's applicability in different health care settings is unknown. This study aimed to determine the consensus on pediatric mechanical ventilation practices from Canadian respiratory therapists' (RTs) perspectives and consensually validate aspects of the ESPNIC guideline. A 3-round modified electronic Delphi survey was conducted; contents were guided by ESPNIC. Participants were RTs with at least 5 years of experience working in standalone pediatric ICUs or units with dedicated pediatric intensive care beds across Canada. Round 1 collected open-text feedback, and subsequent rounds gathered feedback using a 6-point Likert scale. Consensus was defined as ≥ 75% agreement; if consensus was unmet, statements were revised for re-ranking in the subsequent round. Fifty-two RTs from 14 different pediatric facilities participated in at least one of the 3 rounds. Rounds 1, 2, and 3 had a response rate of 80%, 93%, and 96%, respectively. A total of 59 practice statements achieved consensus by the end of round 3, categorized into 10 sections: (1) noninvasive ventilation and high-flow oxygen therapy, (2) tidal volume and inspiratory pressures, (3) breathing frequency and inspiratory times, (4) PEEP and FIO2 , (5) advanced modes of ventilation, (6) weaning, (7) physiological targets, (8) monitoring, (9) general, and (10) equipment adjuncts. Cumulative text feedback guided the formation of the clinical remarks to supplement these practice statements. This was the first study to survey RTs for their perspectives on the general practice of pediatric mechanical ventilation management in Canada, generally aligning with the ESPNIC guideline. These practice statements considered information from health organizations and institutes, supplemented with clinical remarks. Future studies are necessary to verify and understand these practices' effectiveness.

The Impact of COVID-19 on Pediatric Healthcare Utilization and Disease Dynamics: An Observational Study From Western Odisha.

IntroductionChildren were affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus during the first and second waves of the coronavirus disease 2019 (COVID-19 pandemic. Although the severity was less in children, the fear of contracting SARS-CoV-2 at the hospital might have led to a delayed health-seeking attitude. The objective of the study was tailored around emergency health care utilization affecting outcomes. The study was done to compare the trend concerning the utilization of pediatric healthcare and immunization services, changes in the profile of diseases, and the outcomes between the pre-COVID-19 period and the COVID-19 period in a tertiary care hospital.MethodsThis retrospective observational study was conducted in a tertiary care hospital in western Odisha. Data were collected retrospectively from different hospital registers (outpatient register, inpatient register, and immunization records) and analyzed between the pre-COVID-19 period (April 2019 to March 2020) and the COVID-19 period (April 2020 to March 2021) with appropriate statistical procedures.ResultsThere was a 60%, 49.8%, 51.1%, and 25.5% reduction in outpatient attendance, indoor pediatric admissions, nutritional rehabilitation centre admissions, and newborn admissions, respectively in COVID-19 period as compared to the pre-COVID-19 period. The pediatric bed occupancy rate was reduced by 54.5%. Unfavourable outcomes (death, left against medical advice, and referral) were significantly high in hospitalized children (24% vs. 18.1%, p < 0.001). The reduction in hospitalization due to common conditions like acute respiratory tract infections, bronchiolitis and asthma, and acute gastroenteritis during COVID-19 was 76.5%, 86.2%, and 39.5%, respectively. A higher percentage of low birth weight and preterm (<34 weeks) babies were admitted to special neonatal care unit (SNCU) during the pandemic (61.8% vs. 58%, p < 0.05; 18.9% vs. 15.8%; p < 0.05 respectively).ConclusionThe COVID-19 pandemic and the associated lockdown led to a significant decrease in pediatric and neonatal healthcare utilization. The impact of lower care-seeking and attendance resulting in poor patient-related outcomes (malnutrition, upsurge of vaccine-preventable diseases, disease-specific hospitalization, and mortality) post-pandemic is a real threat.

Causes of in-hospital pediatric mortality

The purpose of the study is to determine the trends and causes of in-hospital mortality among the children’s population of the Russian Federation, to establish the relationship of its level with the resource provision of medical care. Materials and methods. The level and structure of the causes of in-hospital mortality in children’s population of the Russian Federation over 2015-2020 were studied. The interrelation between its level and the resource provision of medical care for children (medical personnel, bed fund) was established. Results. Against the background of the revealed decrease in the level of in-hospital mortality, unfavourable trends in mortality of children aged 0-17 years from congenital anomalies, diseases of the nervous, endocrine and genitourinary systems were noted. In its structure, the largest share was accounted for by individual conditions of the perinatal period, congenital anomalies and neoplasms. There were similar trends, i.e. gradual decrease, in the trend in in- hospital mortality among children under the age of 1 year of life. However, there was an increase in mortality of children from diseases of the nervous, endocrine systems and neoplasms. In the structure of in-hospital mortality, the largest proportion were individual conditions of the perinatal period, congenital anomalies and diseases of the nervous system. There was an unstable decrease in daily mortality in all age groups. Among those who died on the first day of admission to the hospital, the overwhelming majority were children under 1 year of life. A statistically significant correlation of the level of in-hospital mortality with the provision of medical personnel (pediatricians, and neonatologists) and with the level of their qualifications was revealed. The greatest degree of inverse correlation of hospital mortality was established with the provision of pathology of newborns and premature babies with beds and less (statistically not significant) with pediatric and specialized beds. Conclusion. The level and structure of pediatric in-hospital mortality should serve as an important criterion in assessing the quality of medical care in inpatient medical institutions and be the basis for the development of differentiated measures to reduce it.

COVID-19 impact on the emergency and hospitalization of a tertiary hospital. Management lessons learned

IntroductionThe objective is to analyze the impact of the COVID-19 pandemic on the pediatric emergencies and hospital admissions. MethodsRetrospective cohort study of patients treated in a tertiary hospital, from March 14 to April 26, 2020, compared to the same period of the previous 3 years. ResultsA notable overall reduction in emergency room visits and admissions is observed in all pediatric areas, maintaining care in neonatology and scheduled admissions in oncology. DiscussionThe reduction in global activity in pediatric emergencies is not only explained by the decrease in contagious diseases. The decrease in inadequate demand and inappropriate income may have contributed. The availability of pediatric beds would make the reduction of programmed surgical activity unnecessary and would allow the redistribution of resources to areas with greater healthcare pressure.

0527 Reasons for Early Polysomnography Termination in Pediatric Patients with Sleep-Disordered Breathing

Abstract Introduction Many children with possible obstructive sleep apnea remain unidentified due to low referral rate. Out of the patients who successfully get referred, scheduled, and show up to their polysomnography (PSG), a proportion fail to complete the study. Our focus is to explore what factors can lead to early PSG termination in hopes of proactively identifying the at-risk groups and implementing strategies in the future to help bridge the gap between scheduled and completed studies. Methods The sleep lab at the Pediatric Sleep Center at UT Southwestern Medical Center includes 20 pediatric beds across two sites, with &amp;gt;4000 pediatric sleep studies run per year. We retrospectively reviewed all studies from January 1, 2017 through December 31, 2019 that were terminated before study completion. We investigated reasons for early termination in each case and gathered patient characteristics such as age, gender, presence of neurocognitive impairment, payor status to identify predictors of unsuccessful studies. We also looked at variability in time of year and testing sites in early study termination. Results From the data review of 138 patients, we identified the 3 main reasons for termination to be intolerance to equipment (n=65), acute illness (n=45), or refusal by parent (n=28). There was a greater proportion of patients who terminated due to illness, relative to the other two reasons, in the winter (p = 0.01 refusal by parent; p = 0.02 intolerance to equipment) and a lesser percentage in the summer (p = 0.003 refusal by parent; p &amp;lt; 0.001 intolerance to equipment). There was a greater proportion of subjects who were neurocognitively impaired that terminated due to intolerance to equipment relative to those that terminated due to illness (p = 0.002). Conclusion In our retrospective analysis of the three main reasons for early PSG termination, we did not notice any difference between location sites, age groups, or payor status. In the future, efforts to prevent underutilization of the lab should focus on illness screening especially in the summer and winter as well as development of tools to assess tolerance especially in the neurologically impaired. Support (If Any)

A study on the efficiency of pediatric healthcare services and its influencing factors in China ——estimation of a three-stage DEA model based on provincial-level data

The rapid development of socio-economic has challenged pediatric health services in the new era. Assessing the efficiency of pediatric health services in China and utilizing them will facilitate the continued and stable development of pediatric health services in the face of these challenges. Based on a Three-stage DEA model of generalized modified panel, this paper uses panel data from 31 provinces and cities in China from 2008 to 2019 to estimate efficiency of pediatric health services and analyze the influential factors influencing the efficiency of pediatric services. The research establishes a multi-dimensional evaluation model of input-output-environment-impact. Fully consider the transformation of input elements such as pediatric beds, technical experts, pediatric finance, and pediatric policies in technical, professional, and economic environments. And with the help of long-term and short-term service effects of pediatrics, pediatric income, pediatric infrastructure, social satisfaction and other factors to output. Objectively summarize the real service effect of pediatrics. The model corrects for the interference of technical and non-administrative factors and obtains the most realistic pediatric performance based on changing social dynamics. The study found: (1) while the efficiency of pediatric healthcare services in China's provincial areas has been increasing year by year, there are specific geographical differences, and further improvements and rational allocation of healthcare resources are needed. Among them, the southern developed regions are 16.25% higher than the average efficiency of the northern regions. The annual floating span is 9.54%. Geography is a key factor that dominates the efficiency gap.(2) There is significant redundancy and disparity in the resources invested in pediatric services, and optimization of the economic, technological, and professional environment will continue to eliminate the impact of redundancy and drive the growth of pediatric service efficiency.The redundant scale of various input elements accounted for 31.81%. It shows that nearly 30% of the input resources have not been fully utilized. Among them, the redundancy of beds is relatively small in China, only 21.77%. It shows that the construction of pediatric beds in China is relatively effective, but the pediatric redundancy in developed areas is only 3.24%, and the adjustment of input resources across regions is the key to the optimization of pediatric services. (3) Increase in the health care price index will have a negative effect on the efficiency of pediatric services. In contrast, an increase in urbanization levels, education levels, and birth rates will drive the optimization of pediatric service efficiency.

Closure of Licensed Pediatric Beds in Health Care Markets Within Illinois.

Our objective was to understand the market characteristics related to closures of licensed pediatric hospital beds that may be related to increasing regionalization of pediatric hospital care. We performed a retrospective descriptive analysis of 110 hospitals with licensed pediatric hospital beds from a statewide survey of health care facilities (2012-2017) and administrative data of hospital admissions (2013-2018) in Illinois. We quantified closures of licensed pediatric hospital beds and categorized hospital bed closures by hospital and market characteristics. From 2012 through 2017, the number of licensed pediatric beds declined from 1706 to 1254 (-26.5%). Over the same time period, annual pediatric inpatient days minimally changed (+1.1%), while annual pediatric inpatient days at hospitals affiliated with the Children's Hospital Association increased (+30.5%). After accounting for re-openings, the 33 hospitals that closed all licensed pediatric beds fit 4 distinct typologies: 1) Hospitals with minimal pediatric volume throughout the study (n=19); 2) Hospitals that sustained at least 50% of their pediatric volume after closure of licensed pediatric beds (n=8); 3) Hospitals with low market share in metropolitan areas (n=5); and 4) Hospital with a decline in pediatric market share, while a nearby hospital saw a corresponding rise in pediatric market share (n=1). In Illinois, licensed pediatric hospital beds declined while pediatrics inpatient days stayed the same over a recent 6-year period. Typologies of closures describe the nuanced dynamics leading to decline of pediatric hospital beds. Understanding these patterns is critical to ensure that children receive quality pediatric-tailored care.