RESUMO
BACKGROUND: Observational studies have yielded inconsistent findings for the relation between vitamin D level and total IgE or allergic sensitization. OBJECTIVE: To determine whether vitamin D supplementation reduces levels of total IgE and IgE to each of 2 common indoor allergens in children with asthma and low vitamin D levels. METHODS: Total IgE, IgE to Dermatophagoides pteronyssinus, and IgE to Blattella germanica were measured at the randomization and exit visits for 174 participants in the Vitamin D Kids Asthma Study, a multicenter, double-blind, randomized placebo-controlled trial of vitamin D3 supplementation (4000 IU/d) to prevent severe exacerbations in children with persistent asthma and vitamin D levels less than 30 ng/mL. Multivariable linear regression was used for the analysis of the effect of vitamin D supplementation on change in each IgE measure. RESULTS: Participants were followed for an average of 316 days. At the exit visit, more subjects in the vitamin D arm achieved a vitamin D level equal to or more than 30 ng/mL compared with those in the placebo arm (87% vs 30%; P < .001). In a multivariable analysis, vitamin D3 supplementation had no significant effect on change in total IgE, IgE to Dermatophagoides pteronyssinus, or IgE to Blattella germanica between the exit and randomization visits (eg, for log10 total IgE, ß = 0.007; 95% CI, -0.061 to 0.074; P = .85). CONCLUSIONS: Vitamin D supplementation, compared with placebo, has no significant effect on serum levels of total IgE, IgE to dust mite, or IgE to cockroach in children with asthma and low vitamin D levels.
Assuntos
Alérgenos/imunologia , Antígenos de Dermatophagoides/imunologia , Proteínas de Artrópodes/imunologia , Asma/tratamento farmacológico , Cisteína Endopeptidases/imunologia , Imunoglobulina E/sangue , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Animais , Asma/sangue , Asma/imunologia , Criança , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Humanos , MasculinoAssuntos
Ingestão de Alimentos , Corpos Estranhos , Antipiréticos/intoxicação , Aspirina/intoxicação , Criança , Qualidade de Produtos para o Consumidor/legislação & jurisprudência , Embalagem de Medicamentos/legislação & jurisprudência , História do Século XX , Humanos , Imãs/efeitos adversos , Pediatria/história , Centros de Controle de Intoxicações , Intoxicação/epidemiologia , Editoração , Estados UnidosRESUMO
OBJECTIVE: To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) syndromes and identify admission variables predictive of disease severity. STUDY DESIGN: We conducted a multicenter, retrospective, and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at 8 sites in New York, New Jersey, and Connecticut. RESULTS: We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. In multivariable analyses, obesity (OR 3.39, 95% CI 1.26-9.10, P = .02) and hypoxia on admission (OR 4.01; 95% CI 1.14-14.15; P = .03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR 8.33 per unit decrease in 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater C-reactive protein (OR 1.06 per unit increase in mg/dL, 95% CI 1.01-1.12, P = .017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity. CONCLUSIONS: We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.
Assuntos
COVID-19/epidemiologia , Hospitalização , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adolescente , Biomarcadores/análise , Proteína C-Reativa/análise , COVID-19/sangue , Criança , Pré-Escolar , Connecticut/epidemiologia , Feminino , Humanos , Hipóxia/epidemiologia , Lactente , Unidades de Terapia Intensiva , Contagem de Linfócitos , Masculino , Análise Multivariada , New Jersey/epidemiologia , New York/epidemiologia , Obesidade Infantil/epidemiologia , Pró-Calcitonina/sangue , Estudos Prospectivos , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Troponina/sangue , Adulto JovemRESUMO
OBJECTIVE: To describe the rapid implementation of an adult coronavirus disease 2019 (COVID-19) unit using pediatric physician and nurse providers in a children's hospital and to examine the characteristics and outcomes of the first 100 adult patients admitted. STUDY DESIGN: We describe our approach to surge-in-place at a children's hospital to meet the local demands of the COVID-19 pandemic. Instead of redeploying pediatric providers to work with internist-led teams throughout a medical center, pediatric physicians and nurses organized and staffed a 40-bed adult COVID-19 treatment unit within a children's hospital. We adapted internal medicine protocols, developed screening criteria to select appropriate patients for admission, and reorganized staffing and equipment to accommodate adult patients with COVID-19. We used patient counts and descriptive statistics to report sociodemographic, system, and clinical outcomes. RESULTS: The median patient age was 46 years; 69% were male. On admission, 78 (78%) required oxygen supplementation. During hospitalization, 13 (13%) eventually were intubated. Of the first 100 patients, 14 are still admitted to a medical unit, 6 are in the intensive care unit, 74 have been discharged, 4 died after transfer to the intensive care unit, and 2 died on the unit. The median length of stay for discharged or deceased patients was 4 days (IQR 2, 7). CONCLUSIONS: Our pediatric team screened, admitted, and cared for hospitalized adults by leveraging the familiarity of our system, adaptability of our staff, and high-quality infrastructure. This experience may be informative for other healthcare systems that will be redeploying pediatric providers and nurses to address a regional COVID-19 surge elsewhere.
Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Hospitais Pediátricos/organização & administração , Unidades de Terapia Intensiva/organização & administração , Pneumonia Viral/terapia , Capacidade de Resposta ante Emergências/estatística & dados numéricos , Adulto , Betacoronavirus , COVID-19 , Cuidados Críticos/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Medicina Interna/normas , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Respiração Artificial , SARS-CoV-2RESUMO
OBJECTIVE: To describe the clinical profiles and risk factors for critical illness in hospitalized children and adolescents with coronavirus disease 2019 (COVID-19). STUDY DESIGN: Children 1 month to 21 years of age with COVID-19 from a single tertiary care children's hospital between March 15 and April 13, 2020 were included. Demographic and clinical data were collected. RESULTS: In total, 67 children tested positive for COVID-19; 21 (31.3%) were managed as outpatients. Of 46 admitted patients, 33 (72%) were admitted to the general pediatric medical unit and 13 (28%) to the pediatric intensive care unit (PICU). Obesity and asthma were highly prevalent but not significantly associated with PICU admission (P = .99). Admission to the PICU was significantly associated with higher C-reactive protein, procalcitonin, and pro-B type natriuretic peptide levels and platelet counts (P < .05 for all). Patients in the PICU were more likely to require high-flow nasal cannula (P = .0001) and were more likely to have received Remdesivir through compassionate release (P < .05). Severe sepsis and septic shock syndromes were observed in 7 (53.8%) patients in the PICU. Acute respiratory distress syndrome was observed in 10 (77%) PICU patients, 6 of whom (46.2%) required invasive mechanical ventilation for a median of 9 days. Of the 13 patients in the PICU, 8 (61.5%) were discharged home, and 4 (30.7%) patients remain hospitalized on ventilatory support at day 14. One patient died after withdrawal of life-sustaining therapy because of metastatic cancer. CONCLUSIONS: We describe a higher than previously recognized rate of severe disease requiring PICU admission in pediatric patients admitted to the hospital with COVID-19.
Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estado Terminal , Hospitalização , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Adolescente , Alanina/análogos & derivados , Alanina/uso terapêutico , Antivirais/uso terapêutico , Asma/epidemiologia , Nitrogênio da Ureia Sanguínea , Proteína C-Reativa/análise , COVID-19 , Criança , Pré-Escolar , Infecções por Coronavirus/sangue , Infecções por Coronavirus/tratamento farmacológico , Creatinina/sangue , Dispneia/virologia , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Peptídeo Natriurético Encefálico/sangue , Cidade de Nova Iorque/epidemiologia , Pandemias , Obesidade Infantil/epidemiologia , Contagem de Plaquetas , Pneumonia Viral/sangue , Pneumonia Viral/tratamento farmacológico , Pró-Calcitonina/sangue , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Sepse/epidemiologia , Choque Séptico/epidemiologia , Centros de Atenção Terciária , Adulto JovemAssuntos
Centros Médicos Acadêmicos/organização & administração , Betacoronavirus , Infecções por Coronavirus/psicologia , Docentes de Medicina/psicologia , Hospitais Pediátricos/organização & administração , Saúde Ocupacional , Pediatria/organização & administração , Pneumonia Viral/psicologia , COVID-19 , Infecções por Coronavirus/terapia , Emoções , Docentes de Medicina/organização & administração , Humanos , New York , Pandemias , Pediatras/organização & administração , Pediatras/psicologia , Pediatria/educação , Pneumonia Viral/terapia , SARS-CoV-2 , Apoio SocialAssuntos
Ingestão de Alimentos , Comportamento Alimentar , Alimentos Infantis/análise , Cloreto de Sódio na Dieta , Ingestão de Energia , História do Século XX , Humanos , Lactente , Alimentos Infantis/normas , Fenômenos Fisiológicos da Nutrição , Necessidades Nutricionais , Pediatria/história , Estados UnidosAssuntos
Neoplasias/diagnóstico , Neoplasias/terapia , Pediatria/métodos , Adolescente , Negro ou Afro-Americano , Neoplasias Ósseas/mortalidade , Criança , Pré-Escolar , Glioblastoma/mortalidade , Disparidades nos Níveis de Saúde , História do Século XX , Doença de Hodgkin/mortalidade , Humanos , Lactente , Oncologia/história , Neuroblastoma/mortalidade , Pediatria/história , Retinoblastoma/mortalidade , Estados Unidos/epidemiologia , População Branca , Tumor de Wilms/mortalidade , Adulto JovemRESUMO
OBJECTIVE: To use a quantitative approach to evaluate the literature for quantity, quality, and consistency of studies of maternal and infant characteristics in association with breastfeeding initiation and continuation, and to conduct a meta-analysis to produce summary relative risks (RRs) for selected factors. STUDY DESIGN: A systematic review using PubMed and CINAHL through March 2016 was conducted to identify relevant observational studies in developed nations, reporting a measure of risk for 1 or more of 6 quantitatively derived, high impact factors in relation to either breastfeeding initiation or continuation. One author abstracted data using a predesigned database, which was reviewed by a second independent author; data evaluation and interpretation included all co-authors. These factors were summarized using standard meta-analysis techniques. RESULTS: Six high impact factors were identified (smoking [39 papers], mode of delivery [47 papers], parity [31 papers], dyad separation [17 papers], maternal education [62 papers], and maternal breastfeeding education [32 papers]). Summary RR from random-effects models for breastfeeding initiation were highest for high vs low maternal education (RR 2.28 [95% CI 1.92-2.70]), dyad connection vs not (RR 2.01 [95% CI 1.38-2.92]), and maternal nonsmoking vs smoking (RR = 1.76 [95% CI 1.59-1.95]); results were similar for breastfeeding continuation. CONCLUSIONS: Despite methodological heterogeneity across studies, relatively consistent results were observed for these perinatally identifiable factors associated with breastfeeding initiation and continuation, which may be informative in developing targeted interventions to provide education and support for successful breastfeeding in more families.
Assuntos
Aleitamento Materno/métodos , Aleitamento Materno/estatística & dados numéricos , Educação em Saúde/métodos , Saúde do Lactente , Aleitamento Materno/psicologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Gravidez , Medição de Risco , Fatores de Tempo , Estados UnidosRESUMO
OBJECTIVE: To determine if clinical pathways affect care and outcomes for children hospitalized with asthma using a multicenter study. STUDY DESIGN: This was a retrospective, multicenter cohort study using an administrative database, the Pediatric Health Information System. We evaluated the impact of inpatient pediatric asthma pathways on children age 2-17 years admitted for asthma from 2006 to 2015 in 42 children's hospitals. Date of pathway implementation for each hospital was collected via survey. Using generalized estimating equations with an interrupted time series approach (to account for secular trends), we determined the association of pathway implementation with length of stay (LOS), 30-day readmission, chest radiograph utilization, ipratropium administration >24 hours, and administration of bronchodilators, systemic steroids, and antibiotics. All analyses were risk-adjusted for patient and hospital characteristics. RESULTS: Clinical pathway implementation was associated with an 8.8% decrease in LOS (95% CI 6.7%-10.9%), 3.1% decrease in hospital costs (95% CI 1.9%-4.3%), increased odds of bronchodilator administration (OR 1.53[1.21-1.95]) and decreased odds of antibiotic administration (OR 0.93[0.87-0.99]) (n = 189 331). We found no associations between pathway implementation and systemic steroid administration, ipratropium administration for >24 hours, chest radiograph utilization, or 30-day readmission. CONCLUSIONS: Clinical pathways can decrease LOS, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.