Pediatric Hospital Units Research Articles

The long-term boomerang effect of COVID-19 on admissions for non-COVID diseases: the ECIEN-2022 study.

Since COVID-19 pandemic started, many changes have been seen in the cycling patterns of pediatric pathologies. On year 2020, we described the initial effects of COVID-19, with a significant decrease in emergency visits and admissions, but 2years later the situation seems to be reversed. Our study bridges a literature gap by exploring the lasting effects of COVID-19 on pediatric non-COVID admissions, particularly the resurgence of respiratory illnesses.ECIEN-2022 is a single-center, retrospective, observational-study conducted 3years after the pandemic onset, to describe the long-term effects of COVID-19 in pediatric admissions for non-COVID diseases. Admissions during year 2022 were compared with the Pre-Pandemic Period (PPP: 2015-2019). Pediatric Emergency Department (P-ED) visits, hospital, and Intensive Care Unit (P-ICU) admissions were compared across pre- and post-pandemic periods. Monthly distribution and year-waves are presented.P-ED monthly visits (mean and Standard deviation (SD) raised from 3521 (533) in the PPP to 3775 (996) in 2022 (p < 0.001). Monthly hospital admissions in the 3rd quarter of the Pre-Pandemic Period were 111.7/month (SD:29), dropped to 88.5(SD:6.5) in 2020 and raised to 149(SD:38.8) in 2022 (p = 0.036). An increase in respiratory illnesses was observed in 2022 compared to PPP; Bronchiolitis increased 38%, bronchitis 56%, and admissions for Respiratory Syncytial Virus 67%. Conclusion: COVID-19 pandemic has had a significant impact on the use and nature of pediatric health services. The initial decrease has been followed by a boomerang effect with an increase of cases, mainly due to an increase in respiratory infections when pandemic control measures and social restrictions have been lifted. It is essential to maintain an active surveillance and monitorization of these patterns to ensure appropriate healthcare access and utilization. What is Known: • COVID-19 pandemic initially led to a significant decrease in emergency visits and admissions for non-COVID diseases. What is New: • ECIEN-2022 study investigated the long-term effects of COVID-19 on pediatric admissions for non-COVID diseases, detecting a "boomerang effect" with an increase in pediatric admissions for non-COVID diseases in year 2022. • Pediatric Emergency Department visits and hospital admissions for non-COVID diseases, especially those due to respiratory infections, increased significantly in 2022 when compared to the Pre-Pandemic Period.

TECNOLOGIAS EDUCACIONAIS PARA CUIDADORES NO CONTEXTO DE UNIDADES HOSPITALARES DE ONCOLOGIA PEDIÁTRICA: REVISÃO DE ESCOPO

ABSTRACT Objective: mapping the scientific evidence about the use of educational technologies for caregivers in the context of Pediatric Oncology hospital units. Method: this is a scoping review based on the PRISMA-ScR recommendations and on the Joanna Briggs Institute methodology. The search was performed by two independent reviewers in 12 national and international data sources. Publications available in full and free of charge in electronic means were included, with no language or time restrictions. Abstracts were excluded, as well as letters to the editor, opinion articles, books, monographies, dissertations, theses, blog postings, and theoretical and reflection articles. Data analysis was descriptive, with elaboration of charts and absolute and relative frequency statistics. Results: the final sample was comprised by 15 studies published between 2010 and 2020 and mainly from developed countries. Apps and videos were the predominant educational technologies, followed by printed materials, contributing to increasing the caregivers' knowledge about the disease and cancer treatment, symptom management and side effects of the chemotherapy drugs. In addition, when compared to printed materials, the videos showed a reduction in the caregivers' anxiety levels. The professionals most involved with the technologies were nurses and physicians. Conclusion: it was possible to map that apps and videos are the main educational technologies that are being developed to instruct caregivers, addressing diagnosis and treatment of child-youth cancer, symptom management and self-care promotion.

Higher Complication Rates for Total versus Partial Thyroidectomy in the Pediatric Population

IntroductionThis study aims to analyze the relative risks for total thyroidectomies by comparing complication rates for total versus partial thyroidectomy in the pediatric population. MethodsWe queried the Kids’ Inpatient Database (KID) 1997-2012 for all cases of total (n = 3253) or partial (n = 2380) thyroidectomy. We then designed a propensity score matching model and compared total versus partial thyroidectomy based on surgical complications and outcomes. ResultsIn our cohort, the median age was 16 years and 79% were females. Those treated at a specialty pediatric hospital or pediatric unit in a general hospital comprised 73% of all patients. The most common indications for surgery were malignancy (46%) and goiter (42%). The most common complications were hypocalcemia and nerve injury with an unweighted incidence of 9% (n = 174) and 3% (n = 57) respectively. When compared to partial thyroidectomy, total thyroidectomy was associated with increased rates of postoperative complications. Additionally, the median length of stay was significantly higher for total thyroidectomy patients. ConclusionsThis is the largest analysis to date comparing outcomes for total versus partial thyroidectomy in the pediatric population. Surgeons should consider the increased rates of hypocalcemia and nerve injury complications when selecting total compared to partial thyroidectomy in children.

Diagnostics of bronchial obstruction syndrome with portal wheezing detector in children

Objective. To determine the efficiency of diagnostics of the clinical syndrome of bronchial obstruction with WheezeScan detector in children, to assess the sensitivity and specificity of this method. Electronic medical devices used for registration and analysis of breath sounds can help to diagnose different syndromes in pediatric pulmonology.&#x0D; Materials and methods. The study involved 15 children aged 1 to 17 years, who were hospitalized to Pulmonology Unit of the Regional Childrens Clinical Hospital. The children were divided into two groups depending on the presence or absence of wheezes in auscultation. The detector WheezeScan HWZ-1000T-E (Omron) was used to study the presence of wheezes. The control group included children without any objective signs of bronchial obstruction.&#x0D; Results. It was detected while examining children that in auscultation 20 % (n=3) of children had dry wheezes, and in detector diagnostics the result was positive in 100 % of cases. In auscultation, 80 % (n=12) of children did not show clinically marked bronchial obstruction syndrome, the result of WheezeScan detector was 73 % (n=11). Diagnostic sensitivity and specificity was 100 %.&#x0D; Conclusions. Screening diagnostics of bronchial obstruction syndrome in children by means of electronic detector of wheezing is effective and can be applied for ambulatory patients of different ages in a pediatric hospital unit.

Proton pump inhibitors are still overprescribed for hospitalized children

ObjectiveThe use of proton pump inhibitors has increased exponentially over the past 20 years. Several side effects have been reported and concerns exist about the consequences of long-term proton pump inhibitors on health, leading to limitation of their use. The present study analyzed prescriptions of proton pump inhibitors at inpatient units and assessed their compliance with current recommendations. MethodsThis single-center, observational, retrospective study reviewed medical file of patients hospitalized at the pediatric medical departments of the Bordeaux University Hospital between April 1 and September 30, 2019. Patients younger than 18 years, hospitalized in the pediatric hospital units and treated with proton pump inhibitors were included. Prescriptions of proton pump inhibitors were compared with French and international guidelines. ResultsProton pump inhibitors were prescribed for 251 of 2237 children (11%), mainly for gastroesophageal reflux disease (47%) and prevention of peptic ulcer disease (32.7%). Proton pump inhibitor prescription complied to recommendations in 34.5% of cases, less often in children aged younger than 1 year (13.5%) than in older children. Compliance to recommendations was lower when proton pump inhibitors were indicated for the prevention of peptic disease (5%) than for gastroesophageal reflux disease (48%). ConclusionsProton pump inhibitors are frequently prescribed for hospitalized children, and indications comply with recommendations in only 35% of the cases. Efforts in spreading awareness of the recommendations on the use of proton pump inhibitors in children are mandatory among hospital pediatricians.

Model for the systematic implementation of therapeutic play in pediatric hospital units

Resumo Existe consenso na literatura sobre a importância do uso do brinquedo terapêutico (BT), recomendando-se a sua sistematização no planejamento do cuidado pediátrico, contudo há lacunas no conhecimento sobre como sistematizar esse cuidado e implementa-lo em unidades hospitalares. Objetivos Propor um modelo de implementação sistemática do BT para unidades pediátricas hospitalares e descrever as etapas desse processo. Método estudo descritivo, de abordagem qualitativa, desenvolvido em unidades de internação e terapia intensiva pediátricas, apoiado pela ferramenta PDCA (Plan, Do, Check e Action). Os dados foram coletados por meio da observação da dinâmica dos atendimentos da unidade e entrevista com onze dos profissionais do grupo de referência de BT e, a seguir procedeu-se a análise temática. Resultados a implementação do BT evidenciou resultados positivos, seja na perspectiva dos integrantes do grupo de referência, seja na percepção de aumento da frequência na prática de realização do BT ou, ainda, pelo reconhecimento da família e da instituição. Conclusão e implicações para a prática As etapas percorridas no processo de implementação do BT em unidades pediátricas fornecem subsídios para direcionar profissionais de diferentes instituições a implementar de forma sistemática esta prática lúdica.

Model for the systematic implementation of therapeutic play in pediatric hospital units

Resumo Existe consenso na literatura sobre a importância do uso do brinquedo terapêutico (BT), recomendando-se a sua sistematização no planejamento do cuidado pediátrico, contudo há lacunas no conhecimento sobre como sistematizar esse cuidado e implementa-lo em unidades hospitalares. Objetivos Propor um modelo de implementação sistemática do BT para unidades pediátricas hospitalares e descrever as etapas desse processo. Método estudo descritivo, de abordagem qualitativa, desenvolvido em unidades de internação e terapia intensiva pediátricas, apoiado pela ferramenta PDCA (Plan, Do, Check e Action). Os dados foram coletados por meio da observação da dinâmica dos atendimentos da unidade e entrevista com onze dos profissionais do grupo de referência de BT e, a seguir procedeu-se a análise temática. Resultados a implementação do BT evidenciou resultados positivos, seja na perspectiva dos integrantes do grupo de referência, seja na percepção de aumento da frequência na prática de realização do BT ou, ainda, pelo reconhecimento da família e da instituição. Conclusão e implicações para a prática As etapas percorridas no processo de implementação do BT em unidades pediátricas fornecem subsídios para direcionar profissionais de diferentes instituições a implementar de forma sistemática esta prática lúdica.

Venous Thromboembolism among Noncritically Ill Hospitalized Children: Key Considerations for the Pediatric Hospital Medicine Specialist.

Venous thromboembolism (VTE) is a leading cause of morbidity and preventable harm among noncritically ill hospitalized children. Several clinical factors relevant to the noncritically ill hospitalized child significantly increase the risk of VTE including the presence of central venous catheters, systemic inflammation, and prolonged immobilization. Although risk mitigation strategies have been described, the diagnosis, treatment, and prevention of VTE require standardization of institutional practices combined with multidisciplinary collaboration among pediatric hospitalists, hematologists, and other care providers. In this narrative review, we summarize the epidemiology of VTE, risk models identifying high-risk conditions associated with VTE, and prevention and treatment strategies. We further describe successful quality improvement efforts implementing institutional VTE risk stratification and thromboprophylaxis procedures. Finally, we highlight unique challenges facing pediatric hospital medicine specialists in the era of the COVID-19 pandemic, including caring for adults admitted to pediatric hospital units, and describe future research opportunities for VTE in the noncritically ill hospitalized child.

Coping Mechanisms For Parents With Children In Pediatric Hospitalization Units: Development Of Multimodal Means To Support Parents (First Phase)

Coping Mechanisms For Parents With Children In Pediatric Hospitalization Units: Development Of Multimodal Means To Support Parents (First Phase)

Decreased Wait Time and Increased Satisfaction With Bedside Pancreatic Enzyme Dosing for the Inpatient Adolescent With Cystic Fibrosis: A Quality Improvement Project Comparing Enzyme Self-Administration to Nurse Administration.

For children with cystic fibrosis (CF), enzymes are essential with meals to absorb nutrients and ensure adequate growth. When hospitalized, CF patients typically rely on nurse-administered medications. Recently, a pediatric hospital unit began allowing adolescents with CF enzymes at the bedside. Postimplementation, a satisfaction questionnaire was administered to participating patients and nurses measuring patient and nurse satisfaction with access to bedside enzymes versus nurse administration and overall time for enzyme delivery. The survey utilized a 5-point Likert scale. The wait time for pancreatic enzymes decreased for self-administered enzymes when compared to those that were nurse administered. All (11/11) patients and 86% (12/14) of nurses preferred the self-administration of enzymes. Hospitalized pediatric CF patients and nurses had higher levels of satisfaction with enzyme self-administration. Immediate access to enzymes in room safes impact patient autonomy, reflecting home self-care practices. Decreases in wait times optimize nutritional growth and healing while hospitalized. As a result, a new limited scope policy allowing patient-administered enzymes is now in place in the pediatric inpatient CF unit.

Changes from COVID-19. A perspective from internal pediatric medicine

The SARS-CoV2 pandemic dimension has affected the Hospital Pediatrics Medicine assistance in our country. New challenges generated by COVID-19 require a series of proactive measures, based on existing scientific knowledge and standards of good practice, that allow the Pediatric Hospital services readiness and operability. Hospital Internal Pediatrics, as responsible of integral care of the hospitalized child, plays a leading role in the new hospital model emerging from this crisis. This review analyzes the impact of the current SARS-CoV2 epidemic on pediatric care, and perspective of new COVID-19 outbreaks in coexistence with other viral infections. Changes secondary to pandemic involved in Hospital pediatric units must be analyzed, and how to prepare for future epidemics, also the involvement of pediatric units in adult care and the possible opportunities for improvement. Assistance of patients with chronic complex conditions in epidemic circumstances, safety aspects, opportunities for teaching and ethical considerations are reviewed. The Spanish Society of Hospital Pediatrics Medicine offers with this article a series of resources for Internal pediatric Medicine practitioners responsible to face next challenges in pediatric hospitalization units.

Patient and Family Member Violent Situations in a Pediatric Hospital: A Descriptive Study

PurposeThe intent of this study is to report on violent situations involving the pediatric patient and/or the patient's family member in the inpatient hospital setting. Design and methodsThis descriptive study used two independent samples: Behavioral Emergency Response Team (BERT) recipients and surveyed pediatric healthcare staff at a pediatric hospital within a large urban Midwestern academic hospital in the United States. ResultsPer BERT recipients (N = 26) and staff survey respondents (N = 91), common physical patient behaviors were, respectively, hitting (60%, 77%) and kicking (53%, 82%). Fifteen (75%) patient BERT responses were for violent situations. The most common mental health condition among patients in violent situations was behavior dyscontrol (n = 8, 53%), which was absent among calls for non-violent situations (n = 5). Seizures, which was the most common medical condition among patients in BERT violent situations (n = 6, 40%), was proportionately slightly greater than among non-violent situations (n = 1, 20%). Staff who reported experience with violent situations (n = 64, 73%) were from general medical units (n = 48, 75%), and registered nurses (n = 53, 79%). ConclusionsThis study helped illuminate demographic, medical and mental health clues about violent situations with patients and family members on pediatric inpatient hospital units. Practice implicationsPediatric patients and families may struggle to cope during hospitalization. Healthcare providers' knowledge about co-occurring conditions, stress related to hospitalization and use of BERT as a resource may help prevent violent situations.

Parental Coronavirus Disease 2019 Testing of Hospitalized Children: Rethinking Infection Control in a Pandemic.

Novel coronavirus disease 2019 (COVID-19) poses a challenge to infection control within hospital systems. Asymptomatic children and their caretakers carry the risk of silently spreading infection in pediatric emergency departments and hospital units. Our current knowledge is evolving, and infection control measures are frequently changing depending on new emerging data. We conducted a point-prevalence study to assess SARS-CoV-2 Real-Time Polymerase Chain Reaction (SARS-CoV-2 RT-PCR) results of hospitalized children, their asymptomatic caretakers, and caretaker-child test concordance at a major community hospital in New York City. We screened Children and caretakers with temperature measurements and the presence of COVID-19 symptoms before pediatric emergency department evaluation. Children requiring hospitalization and their caretakers had nasopharyngeal swabs for SARS-CoV-2 RT-PCR. The paired results are used to identify the infection control level at the appropriate pediatric unit. Forty consecutive asymptomatic caretaker-child pairs had SARS-CoV-2 RT-PCR testing between May 28th to June 22nd, 2020. The rate of asymptomatic COVID-19 was 2.5% in hospitalized children and 7.5% in caretakers. The caretaker-child SARS-CoV-2 RT-PCR test concordance was evident in 95% of the cohort. This cohort had a low asymptomatic SARS-CoV-2 PCR positive rate in children and their caretakers with a high concordance rate of paired test results. It suggests that children's SARS-CoV-2 PCR test result will likely correspond to their accompanying caretaker at healthcare facilities where admission screening is performed.

Clustering acoustical measurement data in pediatric hospital units

The previous hospital acoustic literature has highlighted some important considerations and various complexities regarding objective noise measurements. However, extensive use of conventional acoustical metrics such as logarithmically averaged equivalent sound pressure levels (Leq) do not sufficiently describe hospital acoustical environments and often lack considerations of the room-based activity status that can significantly influence the soundscape. The goal of this study was to explore utilizing statistical clustering techniques in healthcare settings with a particular aim of identifying room-activity conditions. The acoustic measurements were conducted in the patient rooms of two pediatric hospital units and subsequently classified based on two room-activity conditions-active and non-active conditions-by applying statistical clustering analyses with standard k-means and fuzzy c-means algorithms. The results of this study demonstrate the most probable noise levels and degree of associations of the measured noise levels for the two room-activity conditions. The results were further validated in terms of the clustered levels, the number of conditions, and parameter dependency. The clustering approach allows for a more thorough soundscape characterization than single-number level descriptors alone by providing a method of identifying and describing the noise levels associated with typical, intrinsic activity conditions experienced by occupants.

Changes from COVID-19. A perspective from internal pediatric medicine

La dimensión de la pandemia por SARS-CoV-2 ha afectado a la organización asistencial de la pediatría hospitalaria de nuestro país. Los nuevos retos generados por la COVID-19 exigen una serie de medidas proactivas basadas en los conocimientos científicos existentes y las normas de buena práctica que permitan la preparación y la mayor operatividad de los servicios pediátricos hospitalarios. La pediatría interna hospitalaria, como responsable de la atención integral del niño hospitalizado, tiene un papel principal en el nuevo modelo de hospital surgido de esta epidemia. En la presente revisión se analiza la repercusión pediátrica que ha tenido la epidemia por SARS-CoV-2 y la preparación ante futuros rebrotes, en posible coexistencia con otras infecciones virales. Se revisa también la implicación de las unidades pediátricas en la asistencia de adultos y la atención de pacientes crónicos complejos, y se ofrecen recomendaciones sobre aspectos de seguridad, consideraciones éticas y docencia de los futuros pediatras durante la crisis. La Sociedad Española de Pediatría Hospitalaria (SEPHO) pretende con este documento ofrecer a los pediatras internistas hospitalarios una serie de reflexiones y recursos de utilidad en un escenario con muchas incertidumbres.

Practice survey on the use of vancomycin in pediatrics in the New Aquitaine region and guidelines of learned societies

IntroductionVancomycin is an old antibiotic whose use is still being debated today. The objective of this work was to establish an inventory of the use of vancomycin in the various pediatric and neonatal hospital services in the New Aquitaine region. Materials and methodsA declaratory practice survey was conducted in 49 pediatric and neonatal hospital units. These practices were compared with the guidelines of several learned societies. ResultsA total of 36 responses could be analyzed: 12 units (33%) used vancomycin in discontinuous administration, 18 (50%) had opted for continuous infusion, and six used it in both modalities (17%). The reported dosages were highly variable. Blood tests were performed by 26 units (72%), but the target values of the trough serum concentration were also highly variable. After dosing, all units reported adjusting the dosage and re-dosing after modification (26/26). Finally, 21 units (58%) reported taking into account the MIC of the possibly isolated bacterium. ConclusionOur study shows that vancomycin is used in very different ways from one unit to another, within the same region, including in ways not recommended by the main learned societies. Much work remains to be done to determine the optimal dosages of vancomycin in pediatrics, to set the serum trough concentration of vancomycin values, and to determine whether continuous infusion use is comparable to discontinuous administration in terms of efficacy.

Examining the Utility of Perceptual Noise Categorization in Pediatric and Neonatal Hospital Units.

Medical and nursing staff working in hospitals often experience exposure to extreme sound environments, and there is growing evidence of the negative impacts. Previous research highlighted various complexities regarding noise sources in hospitals; however, identifications of intrinsic noise categories that can reveal the complex mixture of existing hospital noise is still limited. The objective of this work was to identify intrinsic categories of the noise sources based on staff perceived annoyance and explore clear associations of these categorized noise sources with psychological perceptions. The staff perceptual responses regarding hospital noise were assessed by conducting surveys at the three pediatric and neonatal care units in two hospitals. Using principle component analysis (PCA), the psychological annoyance responses of 94 participants were used to derive the inherent structural patterns of the existing noise sources. The derived PCA categorization was validated on mixed-model analysis of variances, and employed on regression models to explore potential associations between the categorized noise factors and the staff's psychological perceptions. The results highlighted three intrinsic noise categories and their negative impacts on staff's psychological perceptions including work/rest disturbance and noisiness. Taken as a whole, the findings better reveal problematic noise source categories and establish a framework for hospital noise control that is less source-specific and more broadly generalizable.

Pain assessment in pediatrics.

to investigate how the pain assessment and management process in pediatric patients is performed and suggestions for its improvement. exploratory, qualitative study. Nine professionals from the nursing team of a pediatric hospital unit in Porto Alegre/RS participated in the study. A sociodemographic questionnaire and semi-structured interviews were used with content analysis. the results reinforced the importance of pain assessment with family participation and the need to use tools and process improvements in the training and sensitization of professionals. Final Considerations: after the study was concluded, there was a clear need to address the issue, highlighting its relevance for pain resolution in pediatric patients.

A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on sustainability of a lean intervention in pediatric healthcare

BackgroundIn 2012, the Saskatchewan Ministry for Health mandated a system-wide Lean transformation. Research has been conducted on the implementation processes of this system-wide Lean implementation. However, no research has been done on the sustainability of these Lean efforts. We conducted a realist evaluation on the sustainability of Lean in pediatric healthcare. We used the context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic to explain under what contexts, for whom, how and why Lean efforts are sustained or not sustained in pediatric healthcare.MethodsWe employed a case study research design. Guided by a realist evaluation framework, we conducted qualitative realist interviews with various stakeholder groups across four pediatric hospital units ‘cases’ at one acute hospital. Interview data was analyzed using an integrated approach of CMOc categorization coding, CMOc connecting and pattern matching.ResultsWe conducted thirty-two interviews across the four cases. Five CMOcs emerged from our realist interview data. These configurations illustrated a ‘ripple-effect’ from implementation outcomes to contexts for sustainability. Sense-making and staff engagement were prominent mechanisms to the sustainment of Lean efforts. Failure to trigger these mechanisms resulted in resistance. The implementation approach used influenced mechanisms and outcomes for sustainability, more so than Lean itself. Specifically, the language, messaging and training approaches used triggered mechanisms of innovation fatigue, poor ‘sense-making’ and a lack of engagement for frontline staff. The mandated, top-down, externally led nature of implementation and lack of customization to context served as potential pitfalls. Overall, there was variation between leadership and frontline staff’s perceptions on how embedded Lean was in their contexts, and the degree to which participants supported Lean sustainability.ConclusionsThis research illuminates important contextual factors and mechanisms to the process of Lean sustainment that can be applicable to those implementing systems changes. Future work is needed to continue to develop the science on the sustainability of interventions for healthcare improvement.

Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program in Pediatric Units in Tertiary Care Teaching Hospital in Thailand.

Antimicrobial stewardship programs (ASPs) have been proven to be beneficial in reducing the use of antimicrobial agents, antibiotic resistance, and health care costs. The data supporting the utility of ASPs has come largely from adult hospital units, but few pediatric hospital units have implemented ASPs. Our objective for this study was to assess the impact of ASPs in pediatric units in tertiary care teaching hospitals. We conducted a retrospective chart review to compare antimicrobial use pre- and post-ASP over a 6-month period in a tertiary care hospital in which an ASP had been in use since July 2017. Meropenem, vancomycin, and colistin were selected to be monitored. ASP rounds were conducted twice a week to assess and provide feedback on antimicrobial prescriptions. Antimicrobial use was measured as days of therapy (DOTs) per 1000 patient-days and was compared pre- and post-ASP by using independent t tests. Charts of children hospitalized who were in antimicrobial treatment pre-ASP (44.3%) and post-ASP (41.7%) were reviewed. The percentages of children who received selected antimicrobial agents did not differ between pre- and post-ASP. During the post-ASP period, a significant reduction in DOT with vancomycin and colistin was observed. Vancomycin use decreased from 58.5 to 40.2 DOTs per 1000 patient-days (P = .038), and colistin decreased from 36.3 to 13.8 DOTs per 1000 patient-days (P = .026). Meropenem use decreased from 126.8 to 111.2 DOTs per 1000 patient-days (P = .467). Between the 2 periods, there was no effect on length of stay and mortality. ASPs can lead to a significant reduction in selected antimicrobial use in children who are hospitalized, with no effect on length of stay or mortality rate.