Pediatrics
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Multicenter Study
The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients.
Computerized physician order entry (CPOE) has the potential to reduce patient injury resulting from medication errors. We assessed the impact of a CPOE system on medication errors and adverse drug events (ADEs) in pediatric inpatients. ⋯ The introduction of a commercially available physician computer order entry system was associated with a significant decrease in the rate of medication errors but not ADEs in an inpatient pediatric population.
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Neonatal candidemia is often fatal. Empirical antifungal therapy is associated with improved survival in neonates and patients with fever and neutropenia. Although guidelines for empirical therapy exist for patients with fever and neutropenia, these do not exist for neonates. ⋯ We developed a clinical predictive model for neonatal candidemia with high sensitivity and moderate specificity for candidemia. On the basis of our model, when a physician obtains a blood culture, the physician should consider providing antifungal therapy to neonates who are <25 weeks' estimated gestational age and to neonates who have thrombocytopenia at the time of blood culture. In addition, if a physician obtains a blood culture from a child who is 25 to 27 weeks' estimated gestational age and is not thrombocytopenic but has a history of third-generation cephalosporin or carbapenem exposure in the 7 days before the blood culture, then the physician should consider administration of empirical antifungal therapy.
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Multicenter Study
Admission to the intensive care unit for respiratory syncytial virus bronchiolitis: a national survey before palivizumab use.
Preterm infants, especially those with chronic lung disease (CLD), are considered more susceptible to severe respiratory illness from respiratory syncytial virus (RSV) infection than healthy term infants, and are therefore targeted for prophylactic administration of immune globulins. The impact of this practice on the more severe cases of bronchiolitis (i.e., pediatric intensive care unit [PICU] admission, mechanical ventilation, mortality) has not been reported to date. The aim of this study was to evaluate PICU admissions, need for mechanical ventilation, and mortality attributable to RSV bronchiolitis in Israel before the introduction of RSV prophylaxis to the country. ⋯ Most of the infants with severe RSV bronchiolitis were born at term and did not have CLD. The great majority of patients admitted to the PICU for bronchiolitis were not candidates for RSV prophylaxis. Administration of RSV prophylaxis to the predefined high-risk population could be expected to yield no significant change in PICU admissions or number of infants needing mechanical ventilation. New risk-stratified guidelines for RSV prophylaxis are needed.
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Multicenter Study
Efficacy of implantable loop recorders in establishing symptom-rhythm correlation in young patients with syncope and palpitations.
To evaluate efficacy of the recently introduced implantable loop recorder (ILR) in establishing symptom-rhythm correlation in young patients with syncope, near syncope, palpitations, and acute life-threatening events (ALTEs). ⋯ ILR is useful in determining the presence or absence of an arrhythmia during symptoms of syncope, near syncope, and palpitations as well as ALTEs in patients with and without structural heart disease when conventional diagnostic testing, such as electrocardiogram, Holter monitoring, and/or external loop recording, is inconclusive.
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To assess vancomycin utilization at children's hospitals, to determine risk factors for vancomycin use and length of therapy, and to facilitate adapting recommendations to optimize vancomycin prescribing practices in pediatric patients. ⋯ At children's hospitals, vancomycin is initiated for therapy in patients who have vascular catheters and compromised host factors. Only 7% had laboratory-confirmed beta-lactam-resistant organisms isolated at the time vancomycin was prescribed. Efforts to modify empiric vancomycin use in children's hospitals should be targeted at intensivists, neonatologists, and hematologists. Initiatives to decrease length of therapy by decreasing the number of surgical prophylaxis doses and days of therapy before laboratory results may decrease vancomycin exposure.