Pediatric Hospitalist Service Research Articles

Clinicians navigating moral accountability when discussing parental behaviors in the care of the child in the hospital

ObjectiveThe purpose of this study was to explore how moral accountability is navigated when clinicians talk about parental behaviors to support the health of the hospitalized child. MethodsWe conducted a secondary data analysis of 74 conversations during daily rounds video recorded as part of a randomized controlled trial of an intervention to advance family-centered rounds in one children’s hospital. Conversations involving children under the age 18 who were cared for by a pediatric hospitalist service, pulmonary service, or hematology/oncology service were recorded. We used conversation analysis to analyze sequences in which physicians engaged in talk that had implications for parent behavior. ResultsTwo phenomena were apparent in how physicians and parents navigated moral accountability. First, physicians avoided or delayed parental agency in their references to parent behaviors. Second, parents demonstrated and clinicians reassured parental competence of parents caring for their children. ConclusionPhysicians appeared to be oriented toward the potential moral implications of asking about parental behavior. Practice ImplicationsAvoiding attributions of agency and moral accountability as well as providing reassurance for the parents’ competence may be useful for clinicians to maintain a good relationship with the parents of children in their care in the hospital setting.

Experiences of Financial Stress and Supports in Caregivers During Pediatric Hospital Admission.

In Canada and the United States, ∼1 in 5 children live in poverty, contributing to poor health outcomes. Families with children with chronic illness may experience additional financial stress related to hospitalization. This study aimed to capture experiences of financial needs and supports among caregivers with a child admitted to a tertiary care pediatric hospital to inform hospital-based financial services to reduce financial stress in families. We recruited caregivers of children admitted to the general inpatient ward of an academic pediatric center using purposive sampling with no exclusion criteria. Individual, semistructured, in-depth interviews with participants were conducted. Data collected included socio-demographics, financial needs, and experiences with financial supports. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed on NVivo software using a modified-grounded theory approach and summative content analysis. Fifteen caregivers of diverse backgrounds were interviewed, including non-English speakers (n = 4). Three themes and associated subthemes (in parentheses) were identified: (1) financial stress expressed by participants (acute admission-related and chronic financial stress), (2) challenges associated with accessing and utilizing financial supports (caregiver factors, systemic hospital factors, and systemic government factors), and (3) ideas for financial services at the pediatric hospital (services that will provide acute- and chronic financial assistance including education about financial supports and benefits). Our study highlighted acute and chronic financial needs as well as challenges in accessing financial support. Participants were interested in the healthcare system gaining a comprehensive understanding of their financial circumstances and accessing financial services in a hospital setting.

Harti Hauora Tamariki: randomised controlled trial protocol for an opportunistic, holistic and family centred approach to improving outcomes for hospitalised children and their families in Aotearoa, New Zealand.

Health and wellbeing inequities between the Indigenous Māori and non-Māori populations in Aotearoa, New Zealand continue to be unresolved. Within this context, and of particular concern, hospitalisations for diseases of poverty are increasing for tamariki Māori (Māori children). To provide hospitalised tamariki Māori, and their whānau (families) comprehensive support, a wellbeing needs assessment; the Harti Hauora Tamariki Tool (The Harti tool) was developed. The purpose of this study is to determine how effective the Harti tool is at identifying wellbeing needs, ensuring the documentation of needs, enabling access to services and improving wellbeing outcomes for tamariki and their whānau. The study uses a Kaupapa Māori methodology with qualitative and quantitative methods. Qualitative methods include in-depth interviews with whānau. This paper presents an overview of a randomised, two parallel, controlled, single blinded, superiority trial for quantitative evaluation of the Harti programme, and hospital satisfaction with care survey. Participants will be Māori and non-Māori tamariki/children aged 0-4 years admitted acutely to the paediatric medical wards at Waikato Hospital, Hamilton, Aotearoa New Zealand. They will be randomised electronically into the intervention or usual care group. The intervention group will receive usual care in addition to the Harti programme, which includes a 24-section health needs assessment delivered by trained Māori navigators to whānau during the time they are in hospital. The primary endpoint is the relative risk of an acute hospital readmission in the 30 days following discharge for the intervention group patients compared with control group patients. Secondary outcomes include access and utilisation of preventative health services including: oral health care, general practice enrolment, immunisation, healthy home initiatives, smoking cessation and the Well Child Tamariki Ora universal health checks available free of charge for children in Aotearoa New Zealand. Randomised controlled trials are a gold standard for measuring efficacy of complex multifaceted interventions and the results will provide high quality evidence for implementing the intervention nationwide. We expect that this study will provide valuable evidence for health services and policy makers who are considering how to improve the configuration of paediatric hospital services. The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12618001079235.

Assessing the health needs of children and young people accessing paediatric hospital services: a scoping review protocol

IntroductionHealth needs are issues that face a population or specific groups, which can benefit from healthcare and wider social and environmental changes. They are inextricably linked to health inequalities, which...

Exploring Telehealth to Improve Discharge Outcomes in Children.

The inpatient to outpatient transition is critical for patient safety but suffers from lack of standardization and communication. Expanding telehealth use allows unique opportunities to leverage secure video conferencing to streamline communication between families and hospital-based providers (HBPs) after hospital discharge. We conducted a qualitative study to evaluate HBP and caregiver beliefs regarding a proposed telehealth follow-up visit after hospital discharge (THDF). Interviews were conducted with pediatric hospitalists, senior pediatric residents, and caregivers of patients recently hospitalized on the study hospital's pediatric hospitalist service. Authors developed consensus regarding major themes to inform THDF design. These were organized into a conceptual model. We conducted 23 interviews with 6 hospitalists, 6 senior residents, and 11 caregivers. Three primary themes were identified: (1) Caregivers and HBPs agree THDF would be beneficial for patients and families; however, evidence is not robust enough to solidify provider buy-in. (2) Telehealth should supplement and enhance current discharge practices; it should not serve as a bandage for a broken system. Although a key aspect of THDF is to have the hospitalist provide follow-up care, this should be provided in addition to primary care provider follow-up. (3) HBPs expressed concerns about challenging workflows, competing demands, and inadequate resources, which are potential barriers to widespread adoption. THDF leverages expanding telehealth use to provide hospital-based follow-up. While HBPs shared workflow challenges in conducting telehealth, HBPs and caregivers believed potential benefits of THDF outweighed the challenges. This qualitative study will guide implementation of THDF in future studies.

Nursing interventions for pediatric patients with cancer and their families: a scoping review protocol.

This scoping review will identify and map available nursing interventions provided by pediatric oncology hospital services to pediatric patients with cancer and/or their family members. The aim is to develop a comprehensive overview of the characteristics of nursing interventions and to identify potential knowledge gaps. Clinical nursing care is an essential part of pediatric oncology. In pediatric oncology nursing research, a shift from explanatory studies to intervention studies is recommended. The body of research on interventions for pediatric oncology patients and their families has grown in recent years. However, there are no reviews on nursing interventions currently available for pediatric oncology. Studies will be considered for inclusion if they refer to pediatric patients with cancer, and/or family members of a pediatric patient with cancer, who have received non-pharmacological and non-procedural nursing interventions provided by a pediatric oncology hospital service. Studies must also be peer-reviewed, published from the year 2000 onward, and written in English, Danish, Norwegian, or Swedish. The review will be conducted in accordance with the JBI guidelines for scoping reviews. A 3-step search strategy will be followed using the PCC mnemonic (Population, Content, Context). The databases to be searched will include Scopus, PubMed, CINAHL, PsyclNFO, and Embase. The identified studies will be screened based on title and abstract, as well as full text, by 2 independent reviewers. Data will be extracted and managed in Covidence. A summary of the results will be presented as a narrative description, supported by tables.

Association between wildfire smoke exposure and Seattle, Washington Pediatric Hospital services, 2006–2020

Pacific Northwest wildfire smoke events have been increasing in prevalence and severity over the past three decades, resulting in documented negative health outcomes in adults. However, there is less evidence demonstrating the effect of wildfire smoke in pediatric populations. To evaluate the association between wildfire smoke exposure and healthcare utilization in a pediatric tertiary medical center in Seattle, WA. We utilized a case–crossover study to determine the odds of pediatric emergency department (ED) visit/ hospital admission at Seattle Children’s Hospital on wildfire smoke days versus non-wildfire smoke days during wildfire season (June to September), 2006–2020. The health outcomes dataset reports hospital encounters in two categories: ED visits or admissions that are for inpatient or observational purposes. The health outcomes dataset reports hospital encounters in two categories: ED visits or admissions that are for inpatient or observational purposes. The reported encounter types are mutually exclusive. We stratified analyses by individual-level characteristics and examined associations for lagged exposures 0–7 d prior to admission. In adjusted analyses, smoke exposure was associated with a 7.0% (95% CI: 3.0%–12.0%) increase in odds of all-cause hospital admissions and a 0.0% (95% CI: −3.0%, 3.0%) change in odds of all-cause ED visits. We also observed increases in the odds of all-cause hospital admissions ranging from 4.0% to 8.0%, for lagged exposure on days 1–7. When stratified by health outcomes, we found a 9.0% (95% CI: 1.0%–17.0%) and an 11.0% (95% CI:1.0%–21.0%) increase in the odds of ED visits for respiratory and respiratory infection-related concerns, respectively. Our results demonstrate associations between wildfire smoke and negative health effects in children. Similar to other studies, we found that wildfire smoke exposure was associated with an increase in respiratory-related ED visits and all-cause hospital admissions in a pediatric population. These results will help inform patient education and motivate interventions to reduce pediatric morbidity during wildfire season.

Parent Perspectives on Sharing Pediatric Hospitalization Clinical Notes.

Federal guidelines mandate that hospitals provide patients and caregivers with free, online access to their physician's clinical notes. This study sought to identify parent perceptions of the benefits and challenges of real-time note access during their child's hospitalization and strategies to optimize note-sharing at the bedside. This qualitative study was conducted with parents of children aged <12 years admitted to a pediatric hospitalist service in April 2019. Parents were given access to their child's admission and daily progress notes on a bedside tablet (iPad), and interviewed upon discharge. In-depth, 60-minute interviews were audio-recorded and transcribed. Two researchers developed and refined a codebook and coded data inductively and deductively with validation by a third researcher. Thematic analysis was used to identify emergent themes. The 28 interviewed parents described 6 benefits of having note access, which: provided a recap and improved their knowledge about their child's care plan, enhanced communication, facilitated empowerment, increased autonomy, and incited positive emotions. Potential challenges included that notes: caused confusion, hindered communication with the health care team, highlighted problems with note content, and could incite negative emotions. Parents recommended 4 strategies to support sharing: provide preemptive communication about expectations, optimize the note release process, consider parent-friendly note template modifications, and offer informational resources for parents. Findings provide a framework for operationalizing note-sharing with parents during hospitalization. These results have important implications for hospitals working to comply with federal regulations and researchers assessing the effects of increased information transparency in the inpatient setting.

Inpatient albuterol spacing as an indicator of discharge readiness

Introduction In children admitted for asthma exacerbation, multiple evidence-based, clinical practice guidelines exist to identify readiness for discharge. At many institutions, weaning of albuterol is part of the discharge process, though presently there is limited evidence to guide best practice. We sought to determine how many children required escalation of care once placed on every 4-h dosing of albuterol. Methods We performed a consecutive case series of pediatric patients between 5 and 18 years of age admitted to a single tertiary care center’s pediatric hospitalist service between April 2015 and April 2018 with a discharge diagnosis of asthma. Patients admitted to the intensive care unit (PICU) or a subspecialty service were excluded, as has been done previously. Time between albuterol administrations was tracked. “Treatment escalation” was defined as when a patient required more frequent albuterol more dosing after previously tolerating albuterol doses separated by more than 3.5 h. Results A total of 331 patients met inclusion criteria; 136 were female (41.1%), and the average age was 8.8 years. Twenty-six of the 331 patients (7.8%) required escalation of albuterol therapy. Eleven patients returned to the emergency department (ED) following discharge, 2 of which had experienced treatment escalation while admitted. Conclusions Our case series showed that most patients were safe to discharge after spacing albuterol treatments to 4 h, with few returns to the ED and readmissions. Albuterol spacing to every 4 h once appears to be a reasonable discharge criterion, but future studies are needed to determine if this is a safe and efficient.

How Should Pediatric Residents Prepare for a Career in Pediatric Hospital Medicine?

How Should Pediatric Residents Prepare for a Career in Pediatric Hospital Medicine?

Implementation of a Constipation Action Plan for Patients Discharged From a Pediatric Hospitalist Service.

The objective of this study was to determine the effect of a pharmacist-led constipation action plan on the rate of health care utilization. We conducted a prospective research study of patients 2 to 18 years of age admitted to a pediatric hospitalist service for constipation. A study pharmacist developed a patient-specific constipation action plan for each enrolled patient. Data were collected from the electronic medical record, patient/caregiver interview, and follow-up phone calls completed by a pharmacist. The primary outcome was to determine the effect of a pharmacist-led constipation action plan on the rate of health care utilization. Twenty-seven patients were enrolled in the study. Median (range) age was 9 (2-18) years. Health care utilization of the entire study population decreased from approximately 8.7 encounters per month prior to implementation to approximately 3 encounters per month after implementation. Patients also reported an increase in daily bowel movements from approximately 1 per day prior to implementation to 2 per day post implementation. Health care utilization appeared to decrease after implementation of a patient-specific, pharmacist-led constipation action plan.

ISOLAMENTO HOSPITALAR PEDIÁTRICO: práticas e recursos na perspectiva da psicologia

The work’s aim is to identify practices implemented in hospital pediatric isolation in order to reduce psyhcic suffering. It is a qualitative, exploratory and descriptive study. A source triangulation methodology was used: (BVS-BIREME, PubMed, Google acadêmico and PsycINFO) open interviews with experienced professionals who were active in pediatric hospital services was done; and, an online search was done on techniques to humanize pediatric hospital isolation services. The results indicated scarcity of specialized literature, predominance of qualitative studies and tendency to value resources over relational resources, as well as the existence of practices lacking more scientific evidence. The employment of these practices depends on factors related to the lethality of the pathogen, the child’s age and concernment, the responsivity level, the access to material resources and the health team’s flexibility in regard to pondering about risks/benefits, experimenting with idiosyncratic practices.

Clinician experience, perceptions, and acceptance of paediatric complex care nurse practitioner roles

ABSTRACT Background Nurse practitioner (NP) roles are implemented to increase access to care in response to rising demands and pressures in the health system, yet little evaluation is undertaken to assess how these new roles integrate with services. Aim To identify health professionals’ experiences, perceptions, and acceptance of NP roles in complex care medical subspecialties within a paediatric tertiary hospital and health services. Methods The AUSPRAC validated survey was distributed in both electronic and paper forms to a purposeful cohort of multidisciplinary health professionals (n = 208) working directly or collaboratively with both established NPs and novice/in training NPs. Nine medical subspecialties were represented including metabolic, immunisation and oncology. Two reminders were sent to non-responders. All NP roles within nine medical specialties were evaluated. Data were tabulated and descriptively analysed. Findings Ninety-two responses were received (response rate 44%). Services with highest representation were Immunisation (71%), Metabolic Medicine and Palliative Care (45%) each. Responses were received from medical (42%) nursing (30%) and other healthcare providers (27%) including allied health clinicians. Most respondents agreed they understood NP roles (89%), agreed their introduction into the service had been a success (85%) and that NP services met the needs of the patients (91%). Some (9%) respondents reported they feared NP prescribing increased the risk of incorrect treatment with 7% not trusting NPs to diagnose correctly and some (15%) worried that NPs did not have the necessary knowledge to prescribe. Free text comments were generally positive and supportive of the roles, with few negative statements. Discussion While most NP roles were positively viewed, breakdowns in communication processes affected understanding and acceptance of some NP roles. Clearly defining the scope, purpose and benefits of NP roles should be communicated to individual teams and across whole organisations. Conclusion NP roles are largely well accepted within this paediatric tertiary service, which demonstrates a shift in culture from research undertaken at the turn of the century. Attention to implementation factors may improve successful integration of new roles into services.

Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore

BackgroundCoronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore.MethodsWe performed a retrospective review of ED attendances and hospital admissions among children < 18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs).ResultsWe attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline (p < 0.001), attributed largely to a drop in respiratory (% change − 87.9, 95% CI − 89.3 to − 86.3, p < 0.001) and gastrointestinal infections (% change − 72.4, 95%CI − 75.9 to − 68.4, p < 0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change − 40.0, 95%CI − 44.3 to − 35.3, p < 0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p < 0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change − 73.9, 95%CI − 75.9 to − 71.7, p < 0.001).ConclusionsWe highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics.

Pediatric Hospital Services Within a One-Hour Drive: A National Study.

How quickly the 70 million infants, children, and adolescents living in the United States can reach appropriate levels of hospital care for potentially life-threatening illnesses or injuries is a critical, yet understudied, aspect of our nation’s pediatric public health preparedness.1,2 Although US health planning and policy efforts would benefit from a national understanding of how accessible general types of pediatric hospital services (newborn, emergency, and pediatric inpatient) and their more advanced counterparts (NICU, pediatric emergency, and PICU services, respectively) are, available studies have … Address correspondence to Alyna T. Chien, MD, MS, Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: alyna.chien{at}childrens.harvard.edu

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.

Disruption of paediatric orthopaedic hospital services due to the COVID-19 pandemic in a region with minimal COVID-19 illness.

PurposeThis study was designed to evaluate the impact of the COVID-19 pandemic on paediatric orthopaedic services in a paediatric tertiary hospital in South Australia.MethodsA retrospective audit was conducted of orthopaedic activity at a major paediatric tertiary hospital with a Level 1 paediatric trauma centre, where no patients were admitted with COVID-19 illness. Orthopaedic Emergency Department (ED) presentations, outpatient clinics and hospital admissions for the period between 16 March 2020 to 26 April 2020 were studied and compared with the same period in 2019 (18 March 2019 to 28 April 2019). Chi-square tests were performed with p < 0.05 indicating statistical significance.ResultsIn total, 621 patients presented to the ED with orthopaedic complaints during the pandemic (versus 997 in 2019). However, there was minimal change in the number of ED presentations requiring admission (110 in 2020 versus 116 in 2019). Among patients discharged directly from ED, 27.3% received hospital outpatient referral (versus 39.1% in 2019), with the remaining patients referred to community health services or discharged directly.There was a 509.8% increase in telehealth (video and phone) outpatient consultations compared to 2019 and a 60.6% decline in face-to-face appointments. There was a total of 144 orthopaedic admissions (elective and emergency) compared to 184 in 2019. Admissions for children under seven remained unchanged (32.5% reduction in children aged seven and above).ConclusionDespite an overall decline in all paediatric orthopaedic hospital activity, the number of emergency admissions for musculoskeletal conditions did not change. Elective surgery numbers for children aged under seven were also unchanged. Appropriate planning and hospital resources allocation are necessary to meet this service requirement in future pandemics.Level of evidence IV

Characterization Study of Patients Presenting to an Acute Care Pediatric Hospital Identified With Avoidant/Restrictive Food Intake Disorder

Nearly one-quarter of individuals diagnosed with avoidant/restrictive food intake disorder (ARFID) require medical admission. There have been efforts to characterize ARFID in outpatient and intensive day treatment settings; however, authors of few studies have examined this presentation in the inpatient pediatric hospital setting. In this study, we aim to further characterize patients presenting to the hospital with concerns for ARFID. This study involved a retrospective chart review of medically admitted patients with ARFID seen by the psychiatry consultation service at a tertiary care New England pediatric hospital from 2015 to 2016. The typical hospitalized patient with ARFID was a 12.9-year-old, white girl with previous history of outpatient mental health treatment, anxiety disorder, and gastrointestinal-related diagnoses admitted to adolescent medicine or pediatric hospitalist services with >1 year of feeding difficulties often triggered by a precipitating event. Despite >80% of subjects receiving evaluations as outpatients for feeding-related concerns, including 60.5% seeing their primary care provider, <20% were diagnosed with ARFID before hospitalization. The average length of admission was 8 days. All imaging, scopes, and swallow studies conducted during the admission were nonrevealing. Almost half of patients required enteral tube feeds, and 63.2% required psychiatric medications during the admission. Only 31.6% of patients had the ARFID diagnosis documented in their discharge notes. Consistent identification of ARFID remains variable, underrecognized by community providers, and underdocumented by hospital providers. Accurate recognition of ARFID and additional study into contributory factors and treatment approaches may help improve effective health care use and treatment outcomes.

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.