Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis

Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0–60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants <6mo and children aged 6–60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P < 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight‐for‐length z‐score values, 95% CI: 14.3; 16.9, P < 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P < 0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P < 0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care.     

Cardiac care for infants. Determinants of hospital charges for acute care.

We analyzed hospital use and inpatient charges retrospectively for infants hospitalized at a tertiary referral center in the first year of life for cardiac disease. For 93 infants hospitalized between August 1987 and June 1989, there were 1.8 admissions per patient, with a median stay of 14 days; 24.7% required more than 28 days of acute inpatient care. Total hospital charges (excluding professional fees) in the first year of life were $3,417,612, which represents $36,749 per infant and $35,386 per survivor. Reimbursement totaled 93.2% of charges. Multivariate analysis revealed that complex disease, surgery, and length of stay in the intensive care unit were significantly associated with increased charges, while extracardiac anomalies, birth weight, outcome, and type of insurance were not. The economic benefits of averting infant death outweigh the associated costs by as much as 5.4 to 1. We conclude that current treatment of most infants with cardiac disease is both effective and economically beneficial.     

Managing "healthy" late preterm infants

Background:  Late preterm infants are often managed in nursery rooms despite the risks associated with prematurity. The objective of this study was to determine the risks facing late preterm infants admitted to nursery rooms and to establish a management strategy.
Methods:  A total of 210 late preterm infants and 2648 mature infants were assessed. Infants born at 35 and 36 weeks' gestation weighing ≥2000 grams admitted to a nursery room and not requiring medical intervention at birth were of particular interest. The admission rates to the neonatal intensive care unit were evaluated according to the chart review.
Results:  Infants born at 35 and 36 weeks' gestation weighing ≥2000 grams had significantly higher admission rates than term infants at birth (Cochran–Mantel–Haenszel test, P < 0.001; common risk ratio, 4.27; 95% confidence interval, 2.41–7.55) and after birth ( P < 0.001; common risk ratio, 3.57; 95% confidence interval, 2.40–5.33). More than 80% of admissions from the nursery room to the neonatal intensive care unit after birth were due to apnea or hypoglycemia in neonates born at 35 and 36 weeks' gestation. The admission rates due to apnea increased with decreasing gestational age. The admission rates due to hypoglycemia with no cause other than prematurity accounted for 24.3% of admissions for those born at 35 weeks' gestation and 14.1% of admissions for those born at 36 weeks' gestation; hypoglycemia due to other causes accounted for fewer admissions.
Conclusion:  The management strategy for late preterm infants should be individualized, based on apnea and hypoglycemia. The respiratory state of late preterm infants should be monitored for at least 2 days, and they should be screened for hypoglycemia on postnatal day 0.     

Non-fatal injuries among Pacific infants in Auckland: data from the Pacific Islands families first two years of life study

AIMS: Child injury is the leading cause of mortality and morbidity in developed countries. While Pacific infant death rates are relatively high in New Zealand, little is known about non-fatal injury rates. We seek to describe maternally reported injury in Pacific infants aged between 0-24 months. METHODS: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. Maternal home interviews were conducted at 6 weeks, 12 months and 24 months postpartum and injury events were recalled. Marginal models using generalized estimating equations (GEEs) were used to analysis the longitudinal data. RESULTS: The inception cohort included 1398 infants at 6 weeks, 1241 infants at 12 months and 1161 infants at 24 months. The age-specific injury incidence per 1000 person-years exposure was estimated at 48 (95% CI: 23, 88) injuries for infants aged 0-6 weeks, 106 (95% CI: 88, 127) injuries for infants aged 7 weeks-12 months and 174 (95% CI: 151, 199) injuries for infants aged 13-24 months. In the multivariable GEE model, older infants (P < 0.001), infants who were male (P = 0.01), born to Pacific Island fathers and non-Pacific Island mothers (P < 0.001), and in higher or unknown income groups (P = 0.01) were significantly more likely to suffer injury events. No significant two-factor interaction with infant age was identified. CONCLUSIONS: Among Pacific infants, non-fatal injury is common and injury incidence rates are considerably higher than national levels. Male infants and those born into ethnically mixed families, where the father was of Pacific Island ethnicity and the mother was non-Pacific, were at increased relative risk of injury and might benefit from specific injury prevention targeting. However, given the high injury incidence levels found, we advocate that investigation and targeting of culturally appropriate prevention strategies for all Pacific families with young children is required to reduce injury rates for Pacific infants in New Zealand.     

Use of an observation unit by a pediatric emergency department for common pediatric illnesses.

OBJECTIVE: To describe the use of a pediatric observation unit (OU), including relapse rates for common pediatric illnesses, and to assess effectiveness of OU utilization. DESIGN: Retrospective, cohort of all emergency department (ED) visits, OU and inpatient unit (IU) admissions. SETTING: Tertiary care children's hospital. PARTICIPANTS: All children evaluated in the ED and subsequently admitted to either the OU or IU over a 2-year period. MAIN OUTCOME MEASURE: Rates with 95% confidence intervals (CI) for OU use and need for subsequent IU admission from OU, and odds ratios (OR) with 95% CI for use of the OU for specific pediatric disorders. RESULTS: During 10/1/96-9/30/98, there were 44,459 ED visits, 1798 (4.0%) OU admissions, and 3241 (7.3%) inpatient admissions (IA) from the ED. OU mean length of stay was 15.6 +/- 6.1 hours; mean age was 6 +/- 5.3 years with 31% under 2 years of age. Of the total admissions (IU and OU), diagnoses with high OU utilization were: asthma 274/575, 48%; croup 76/125, 61%; enteritis/dehydration 284/470, 60%; poisonings 82/118, 70%; and seizures 80/204, 39%. The likelihood of an OU admission for these illnesses versus IU (adjusted for subsequent need for IU admission) was: asthma OR 1.3 (1.1, 1.5), P < 0.005; croup OR 2.3 (1.6, 3.3), <0.001; enteritis/ dehydration OR 2.8 (2.1, 3.0), P < 0.001; poisonings OR 3.8 (2.5, 5.7), P < 0.001; and seizures OR 0.8 (0.6, 1.2), P = 0.28. For these diagnoses, OU admissions resulting in IU admission occurred for asthma 45/274, 16.4%; croup 7/76, 9.2%; enteritis/ dehydration 13/284, 4.6%; poisonings 3/82, 3.7%; and seizures 15/80, 18.8%, resulting in an overall need for further hospitalization to the IU for these diagnoses of 83/796, 10.4%, (95% CI 8.3, 12.6). CONCLUSION: Admissions to the observation unit comprised over one third of all admissions from a pediatric ED. Certain pediatric illnesses appear to be well suited for admission to the observation unit, with low likelihood of the need for subsequent admission to the inpatient unit. Given the current trends in third-party payer reimbursements for short (<24 hours) admissions, observation unit use provides a more attractive alternative to inpatient admission for many pediatric patients.     

Prolonged length of stays in pediatric intensive care. Retrospective study of 100 stays]

New issues have arisen in pediatric intensive care units, especially concerning long-stay patients. The aims of the present study were to describe the etiologic factors of these long-stay patients and to recognize the comorbidities. MATERIAL AND METHODS: Ninety-five patients who had a total of 100 hospitalizations of more than 30 days were admitted to the pediatric intensive care unit at Robert-Debre Hospital during a 3-year period (1993-1995); this accounted for 9.1% of total admissions. We retrospectively reviewed these 100 long-stay hospitalizations. RESULTS: Most of these patients were newborns (65%). Patients with severe congenital anomalies (44 patients) and very premature infants (26 patients) constituted the majority of long-stay patients. The mean duration of mechanical ventilation for the 95 patients was 110 days (ranges 17-789 days). Two factors of comorbidity were found: gastroesophageal reflux (41% of cases) and nosocomial infections (89% of cases). CONCLUSION: In order to prevent long stays, pediatric intensive care units must be directed toward these factors.     

Mental Health Service Use Before and After a Suicidal Crisis Among Children and Adolescents in a United States National Medicaid Sample

IntroductionMental health follow-up after an emergency department (ED) visit for suicide ideation/attempt is a critical component of suicide prevention for young people.MethodsWe analyzed 2009 to 2012 Medicaid Analytic EXtract for 62,139 treat-and-release ED visits and 30,312 ED-to-hospital admissions for suicide ideation/attempt among patients ages 6 to 17 years. We used mixed-effects logistic regression models to examine associations between patients’ health care utilization prior to the ED visit and likelihood of completing a 30-day mental health follow-up visit.ResultsOverall, for treat-and-release ED visits, 49% had a 30-day follow-up mental health visit, and for ED-to-hospital admissions, 67% had a 30-day follow-up mental health visit. Having a mental health visit in the 30 days preceding the ED visit was the strongest predictor of completing a mental health follow-up visit (ED treat-and-release: adjusted odds ratio [AOR] 11.01; 95% confidence interval [CI] 9.82–12.35; ED-to-hospital AOR 4.60; 95% CI 3.16–6.68). Among those with no mental health visit in the 30 days preceding the ED visit, only 25% had an ambulatory mental health follow-up visit. Having a general health care visit in the 30 days preceding the ED visit had a much smaller association with completing a mental health follow-up visit (ED treat-and-release: AOR 1.17; 95% CI 1.09–1.24; ED-to-hospital AOR 1.25; 95% CI 1.17–1.34).ConclusionsYoung people without an existing source of ambulatory mental health care have low rates of mental health follow-up after an ED visit for suicide ideation or attempt, and opportunities exist to improve mental health follow-up for youth with recent general health care visits.     

A multisite randomized trial of the effects of physician education and organizational change in chronic-asthma care: health outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II Study

BACKGROUND: Traditional primary care practice change approaches have not led to full implementation of national asthma guidelines. OBJECTIVE: To evaluate the effectiveness of 2 asthma care improvement strategies in primary care. DESIGN: Two-year randomized controlled clinical trial. SETTING: Forty-two primary care pediatric practices affiliated with 4 managed care organizations. PARTICIPANTS: Children aged 3 to 17 years with mild to moderate persistent asthma enrolled in primary care practices affiliated with managed care organizations. INTERVENTIONS: Peer leader education consisted of training 1 physician per practice in asthma guidelines and peer teaching methods. Planned care combined the peer leader program with nurse-mediated organizational change through planned visits with assessments, care planning, and self-management support, in collaboration with physicians. Analyses compared each intervention with usual care. MAIN OUTCOME MEASURES: Annualized asthma symptom days, asthma-specific functional health status (Children's Health Survey for Asthma), and frequency of brief oral steroid courses (bursts). RESULTS: Six hundred thirty-eight children completed baseline evaluations, representing 64% of those screened and eligible. Mean +/- SD age was 9.4 +/- 3.5 years; 60% were boys. Three hundred fifty (55%) were taking controller medication. Mean +/- SD annualized asthma symptom days was 107.4 +/- 122 days. Children in the peer leader arm had 6.5 fewer symptom days per year (95% confidence interval [CI], - 16.9 to 3.6), a nonsignificant difference, but had a 36% (95% CI, 11% to 54%) lower oral steroid burst rate per year compared with children receiving usual care. Children in the planned care arm had 13.3 (95% CI, - 24.7 to -2.1) fewer symptom days annually (-12% from baseline; P =.02) and a 39% (95% CI, 11% to 58%) lower oral steroid burst rate per year relative to usual care. Both interventions showed small, statistically significant effects for 2 of 5 Children's Health Survey for Asthma scales. Planned care subjects had greater controller adherence (parent report) compared with usual care subjects (rate ratio, 1.05 [95% CI, 1.00 to 1.09]). CONCLUSIONS: Planned care (nurse-mediated organizational change plus peer leader education) is an effective model for improving asthma care in the primary care setting. Peer leader education on its own may also serve as a useful model for improving asthma care, although it is less comprehensive and the treatment effect less pronounced.     

A retrospective study of Human Immunodeficiency Virus transmission, mortality and loss to follow-up among infants in the first 18 months of life in a prevention of mother-to-child transmission programme in an urban hospital in KwaZulu-Natal, South Africa

ABSTRACT: BACKGROUND: Follow up of Human Immunodeficiency Virus (HIV)-exposed infants is an important component of Prevention of Mother-to-Child Transmission (PMTCT) programmes in order to ascertain infant outcomes post delivery. We determined HIV transmission, mortality and loss to follow-up (LTFU) of HIV-exposed infants attending a postnatal clinic in an urban hospital in Durban, South Africa. METHODS: We conducted a retrospective cohort study of infants born to women in the PMTCT programme at McCord Hospital, where mothers paid a fee for service. Data were abstracted from patient records for live-born infants delivered between 1 May 2008 and 31 May 2009. The infants' LTFU status and age was based on the date of the last visit. HIV transmission was calculated as a proportion of infants followed and tested at six weeks. Mortality rates were analyzed using Kaplan-Meier (K-M), with censoring on 15 January 2010, LTFU or death. RESULTS: Of 260 infants, 155 (59.6%) remained in care at McCord beyond 28 weeks: one died at < 28 days, three died between one to six months; 34 were LTFU within seven days, 60 were LTFU by six months. K-M mortality rate: 1.7% at six months (95% confidence interval (CI): 0.6% to 4.3%). Of 220 (83%) infants tested for HIV at six weeks, six (2.7%, 95% CI: 1.1% to 5.8%) were HIV-infected. In Cox regression analysis, late antenatal attendance (>= 28 weeks gestation) relative to attending in the first trimester was a predictor for infant LTFU (adjusted hazards ratio = 2.3; 95% CI: 1.0 to 5.1; p = 0.044). CONCLUSION: This urban PMTCT programme achieved low transmission rates at six weeks, but LTFU in the first six months limited our ability to examine HIV transmission up to 18 months and determinants of mortality. The LTFU of infants born to women who attended antenatal care at 28 weeks gestation or later emphasizes the need to identify late antenatal attendees for follow up care to educate and support them regarding the importance of follow up care for themselves and their infants.     

Secondhand smoke exposure, smoking hygiene, and hospitalization in the first 18 months of life

BACKGROUND: Recognizing the suboptimal public health effects of a complete cessation strategy for parents and child caregivers who smoke, some researchers have called for a harm reduction approach; however, the evidence remains scanty and controversial. OBJECTIVE: To examine the effects of secondhand smoke and smoking hygiene on infant health and related health care costs during the first 18 months of life. METHODS: We conducted prospective follow-up on 8327 newborns during April and May of 1997 for 18 months in a population-based birth cohort of infants from Hong Kong, China. MAIN OUTCOME MEASURES: Number of hospital admissions, adjusted odds ratios for ever hospitalization for each secondhand smoke exposure variable, and corresponding population attributable risks. RESULTS: Most secondhand smoke exposure came from fathers and other household contacts, whereas only 2.8% of mothers smoked postpartum. The odds ratio of ever hospitalization due to all illnesses combined for infants living in a household with any (maternal, paternal, or other) smoker who was smoking at least 3 m away from the infant, as reported by a parent, was 1.00 (95% confidence interval, 0.88-1.13) compared with those in a smoke-free household. The corresponding odds ratio for infants living with any smoker at home with poor smoking hygiene (<3 m away) was 1.28 (95% confidence interval, 1.07-1.52), which translated into 2.8% of all inpatient episodes in the first year of life, representing an additional 616 admissions. CONCLUSIONS: Hospital admission was significantly more likely among infants exposed to secondhand smoke if it was accompanied by poor smoking hygiene. Harm reduction strategies should be rigorously adhered to when complete cessation is not possible.     

Diagnostic testing for serious bacterial infections in infants aged 90 days or younger with bronchiolitis.

OBJECTIVES: To describe the different laboratory tests that are performed on young infants aged 90 days or younger with bronchiolitis and to identify historical and clinical predictors of infants on whom laboratory tests are performed. DESIGN: Cross-sectional study whereby information was obtained by retrospective review of medical records from November through March 1992 to 1995 of all infants with a clinical diagnosis of bronchiolitis. SETTING: Urban pediatric emergency department. PATIENTS: Two hundred eleven consecutive infants aged 90 days or younger (median age, 54 days) with 216 episodes of bronchiolitis. MAIN OUTCOME MEASURES: Historical and clinical data on each infant in addition to laboratory data that included a white blood cell count, urinalysis, and blood, urine, and cerebrospinal fluid cultures. RESULTS: Two or more laboratory tests (not including chest radiographs) were obtained in 48% of all infants and 78% of febrile infants. Of the 91 infants with a history of a temperature of 38.0 degrees C or more or temperature on presentation of 38.0 degrees C or more, white blood cell counts were obtained in 77%, blood cultures in 75%, urinalyses in 53%, urine cultures in 60%, and analyses-cultures of cerebrospinal fluid in 47%. Febrile infants were 10 times more likely to get at least 2 laboratory tests than afebrile infants (P<.01). All 6 studies were done in 42 (58%) of 72 febrile infants compared with 7 (16%) of 43 afebrile infants (P<.001). Multiple logistic regression analysis identified a history of a temperature of 38.0 degrees C or more or temperature on presentation of 38.0 degrees C or more (odds ratio [OR] 10.0; 95% confidence interval [CI], 4.8%-21.0%; P<.001), oxygen saturation less than 92% on presentation (OR, 4.7; 95% CI, 1.9%-12.1%; P<.01), and history of apnea (OR, 0.1; 95% CI, 0.02-0.35; P<.001) as significant clinical predictors of whether laboratory studies were obtained. History of preterm gestation, aged younger than 28 days, previous antibiotic use, and presence of otitis media were not associated with obtainment of laboratory studies. No cases of bacteremia, urinary tract infection, or meningitis were found among all infants with bronchiolitis who had blood, urine, and/or cerebrospinal fluid cultures. CONCLUSION: There is wide variability in the diagnostic testing of infants aged 90 days or younger with bronchiolitis. The risks of bacteremia, urinary tract infection, and meningitis in infants with bronchiolitis seems to be low. History or a documented temperature of 38.0 degrees C or more; oxygen saturation of less than 92%, and history of apnea were associated with laboratory testing for bacterial infections.     

Factors affecting the incidence of chronic lung disease of prematurity in 1987, 1992, and 1997.

OBJECTIVE: To determine changes in the incidence of chronic lung disease of prematurity between 1987, 1992, and 1997. METHODS: Observational study based on data derived from a geographically defined population: Trent Health Region, United Kingdom. Three time periods were compared: 1 February 1987 to 31 January 1988 (referred to as 1987); 1 April 1992 to 31 March 1993 (referred to as 1992); 1997. All infants of < or = 32 completed weeks gestation born to Trent resident mothers within the study periods and admitted to a neonatal unit were included. Rates of chronic lung disease were determined using two definitions: (a) infants who remained dependent on active respiratory support or increased oxygen at 28 days of age; (b) infants who remained dependent on active respiratory support or increased oxygen at a corrected age of 36 weeks gestation. RESULTS: Between 1987 and 1992 there was a fall in the birth rate, but a significant increase was noted in the number of babies of < or = 32 weeks gestation admitted to a neonatal unit. There was no significant change in survival when the two groups of infants were directly compared. However, mean gestation and birth weight fell. Adjusting for this change showed a significant improvement in survival (28 day survival: odds ratio (OR) = 1.69; 95% confidence interval (95% CI) = 1.23 to 2.33. Survival to 36 week corrected gestation: OR = 1.45; 95% CI = 1.06 to 1.98). These changes were accompanied by a large increase in the incidence of chronic lung disease even after allowing for the change in population characteristics (28 day definition: OR = 2.20; 95% CI = 1.47 to 3.30. 36 week definition: OR = 3.04; 95% CI = 1.91 to 4.83). Between 1992 and 1997 a different pattern emerged. There was a further increase in the number of babies admitted for neonatal care at 相似文献   

Retrospective comparison of management of gastro-enteritis in hospitalised children

In Hong Kong, bacterial pathogens, the majority of them Salmonellae, cause approximately one-third of paediatric admissions for diarrhoea. This study retrospectively reviewed inpatient gastro-enteritis management, with particular focus on antibiotic use. Antibiotics are generally recommended for Salmonella gastro-enteritis in infants under 3 months of age but not for older infants and children unless they are so toxic that bacteraemia is suspected. Three groups of children admitted with acute gastro-enteritis were randomly identified from a computerised discharge database. Based on pathological reports held in the case records department, the final groups for analysis were Salmonella (n = 86), rotavirus (n = 55) and non-specified (n = 126). Epi Info version 6 (CDC, Atlanta) was used for data entry and analysis. Compared with a combined rotavirus/non-specified group, the Salmonella group were significantly more likely to have blood (OR 6.1, 95% CI 3.2-11.7, p < 0.0001) and mucus (OR 4.8, 95% CI 2.6-8.9, p < 0.0001) in the stool, fever during admission (OR 3.6, 95% CI 1.6-8.4, p = 0.001), more stools per day (median 6.2 vs 4.2, p < 0.0001), a longer stay in hospital (median 3.4 vs 2 days, p < 0.0001) and to be younger (median 7.1 vs 14.6 mths, p < 0.0001). The Salmonella group were more likely to have been given antibiotics (38% vs 15%, OR 3.6, 95% CI 1.9-6.9, p < 0.0001) but age did not influence the likelihood that antibiotics would be given.     

Comorbidities and mortality among children hospitalized with diarrheal disease in an area of high prevalence of human immunodeficiency virus infection

PURPOSE: To describe the profile of comorbidities in children admitted with diarrhea to an urban hospital with high human immunodeficiency virus (HIV) prevalence in South Africa and to examine the contribution of comorbidities to inpatient mortality. METHODS: Data from a retrospective random sample of 319 children were extracted and analyzed from a total of 1145 children hospitalized for diarrhea in 2001. We used multiple logistic regression models to determine the independent effects of HIV infection, malnutrition, pneumonia and bacteremia on inpatient mortality. RESULTS: Overall 68% of the diarrheal admissions were classified as HIV-infected and 61% were classified as malnourished, with 53% having evidence of both. HIV infection was strongly associated with malnutrition, pneumonia and bacteremia. Inpatient mortality was 14% [95% confidence interval (CI), 11-19%]. Mortality was higher among HIV-infected than among uninfected children [crude odds ratio (OR), 6.0; 95% CI 2.1-17.0]. History of low birth weight, previous admission, malnutrition, HIV infection, pneumonia, bacteremia, low hemoglobin, total white blood cell count and serum albumin were significant predictors of mortality in univariate analyses. After adjustment, severe malnutrition (OR 2.1; 95% CI 1.0-4.9), bacteremia (OR 2.9; 95% CI 1.2-7.2) and pneumonia (OR 3.9; 95% CI 1.3-12.0) remained independent predictors of mortality, whereas the association between HIV infection and mortality was significantly diminished (OR 4.0; 95% CI 0.8-18.1). CONCLUSION: In a setting of high HIV prevalence, malnutrition, bacteremia and pneumonia contribute independently to death in children hospitalized with diarrheal disease.     

Epidemiology and impact of rotavirus diarrhoea in Poland

Hospital and laboratory data were analysed in three hospitals to estimate rotavirus disease burden in 1994-96. Community acquired gastroenteritis was diagnosed in 757 children of whom 41% tested positive for rotavirus. A total of 196 children had rotavirus nosocomial infections (39% of all rotavirus community-acquired and nosocomial cases) Infants less than 24 months old and children less than 3 months old comprised 74% and 11.9% of admissions for rotavirus, respectively. Almost 94% of children with rotavirus infection had severe gastroenteritis (score 11). The annual rate of rotavirus associated hospitalization in Poland in 1996 was 3.1/1000 children under the age of 60 months and 5.2/1000 infants under 24 months of age. The mean hospital stay was 9.5 d (±9.8 d). We estimated that 8918 children under 60 months of age were hospitalized for rotavirus gastroenteritis in 1996; they accounted for 84899 inpatient days. We conclude that rotavirus is a leading aetiological agent of severe gastroenteritis in young children in Poland and that the Burden of this infection is significant. Rotavirus vaccine could significantly decrease the hospitalization rate and the financial impact of rotavirus Gastroenteritis in Poland. □ Acute diarrhoea, disease burden, epidemiology, gastroenteritis, rotavirus     

Treatment strategies for bronchopulmonary dysplasia with postnatal corticosteroids in Europe: the EURAIL survey

AIM: To survey practices in 14 European countries and describe strategies for the prevention and treatment of bronchopulmonary dysplasia with postnatal steroids (PNS). METHODS: In 1999-2000 questionnaires covering the use of PNS were sent to every neonatal unit taking very preterm newborns in charge, in population-based areas covering at least 20000 births annually. One questionnaire was sent to surveyed unit. The participating areas were chosen by an expert from each country participating in the Europe Against Immature Lung (EURAIL) study group. RESULTS: Responses to 331 questionnaires were received; the mean response rate by countries was 84% (range 64-100%). Teaching hospitals accounted for 19% of the responding units. The number of extremely premature newborns (less than 28 wk of gestation) admitted yearly to these units was 0 in 16%, < 20 in 62%, 20-39 in 11% and > 39 in 11%. Overall, 67% of the centres used PNS: 48% initiated treatment in non-intubated infants and 53% at 7-14 d. Treatment duration was 4-15 d in 62% and > 15 d in 21%. PNS administration was limited to intubated infants less often in smaller units [odds ratio (OR) 0.2, 95% confidence interval (95% CI) 0.1-0.6] and more often in non-teaching hospitals (OR 2.5, 95% CI 2.5-5.0). CONCLUSIONS: Although PNS have important side effects, they were still widely used in 1999 to treat or prevent chronic lung disease. Surprisingly, steroids are still prescribed in non-ventilated infants. PNS use should be based on guidelines derived from the evidence from randomized controlled trials. This evidence should be regularly updated and disseminated.     

Double blind placebo controlled trial of nebulised budesonide for croup

AIMS: To determine whether nebulised budesonide improves the symptoms or shortens the duration of stay of children admitted to hospital with a clinical diagnosis of croup. METHODS: A prospective, randomised, double blind placebo controlled trial. Patients received either nebulised budesonide or placebo every 12 hours. The main outcome measures were duration of inpatient stay and croup scores at 30 minutes, one, two, four, 12, and 24 hours. RESULTS: 87 patients (89 admissions) aged 7-116 months entered the trial. Nebulised budesonide was associated with a significant improvement in symptoms at 12 hours (95% confidence interval (CI) 1 to 3) and 24 hours (95% CI 0 to 3). Patients with an initial croup score above 3 demonstrated a significant improvement in symptoms at two hours (95% CI 1 to 3). Nebulised budesonide was also associated with a 33% reduction in the length of stay (95% CI 2% to 63%) when the confounding variables of age, initial croup score, and coryzal symptoms were taken into consideration. CONCLUSIONS: Nebulised budesonide is an effective treatment for children admitted to hospital with a clinical diagnosis of croup.     

Does prenatal care at community-based health centers result in infant primary care at these sites?

OBJECTIVES: To describe where women receiving prenatal care (PNC) at community-based health centers (CBHCs) go for infant primary care, and to assess reasons for and factors associated with leaving CBHCs and using other practices for infant care. METHODS: A prospective survey of women receiving PNC at CBHCs from February 2000 to February 2002 was conducted. In-person, prepartum, and postpartum surveys included questions about sociodemographic and health characteristics, and health services use. RESULTS: Among 1,107 primarily low-income, African American mothers, 60% of women left CBHCs and used other practices for their infants due to dissatisfaction, inconvenience, referral to and perceived expertise at other sites, and insurance changes. Leaving CBHCs was associated with being white, Latina, US born, educated beyond high school, single, owning a car, using non-CBHC practices for prepregnancy care, and having child health insurance. Among those who left, 48% used hospital-based clinics (HBCs) and 52% used private practices (PPs). Mothers using HBCs, when compared to those using PPs, were more likely to be African American (AOR = 6.83; 95% CI: 3.82, 12.22) or Latina (AOR = 5.60; 95% CI: 2.79, 11.24), dissatisfied with their PNC (AOR = 2.02; 95% CI: 1.05, 3.89) and to leave CBHCs because of insurance changes (AOR = 2.27; 95% CI: 1.18, 4.39) and perceived pediatric expertise at other sites (AOR = 4.81; 95% CI: 2.53, 9.11). CONCLUSIONS: The majority of women in our study left CBHCs and used other sites for pediatric care. Higher education, having child health insurance, and car ownership were associated with leaving CBHCs. Among women who left, race/ethnicity and perceived pediatric expertise were major factors associated with using HBCs rather than PPs.     

Outcomes in infants listed for liver transplantation: A retrospective cohort study using the United Network for Organ Sharing database

LT in neonates and young infants can be challenging due to a variety of factors. To describe the waitlist mortality rates and outcomes of patients listed and transplanted as infants identified from the UNOS database. Infants listed for LT between January 1985 and September 2010 were identified from the UNOS database. Mortality on the waitlist as well as outcomes post‐LT was compared between infants aged ≤60 days (Group 1), 61–179 days (Group 2), and 180–364 days (Group 3). Of 6763 infants listed for LT (Group 1 n = 496, Group 2 n = 2404, Group 3 n = 3863), mean age at listing was 196 ± 87 days (Group 1, 29 ± 16 days; Group 2, 132 ± 32 days; Group 3, 257 ± 52 days). Waitlist mortality was highest in Group 1 (Group 1 vs. 3 HR 3.01, 95% CI 2.19–4.15, Group 2 vs. Group 3 HR 0.82, 95% CI 0.66–1.03). One‐ and five‐yr graft survival was 59.6% and 42% (Group 1), 66% and 45% (Group 2), and 66.8% and 41% (Group 3) (one‐yr survival p = 0.20; five‐yr survival p = 0.19). Infants listed for LT at age ≤60 days had greater waitlist mortality risk than older infants. Infants undergoing LT at age ≤60 days had similar rates of patient and graft survival to older infants.