In This Issue
Research Spotlight:
New AAP Policy Statement Provides Guidance for Pediatric Antibiotic Stewardhip
CPCE In the News:
COVID-19 News
Upcoming Events
Recent Publications
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New AAP Policy Statement Provides Guidance for Pediatric Antibiotic Stewardship |
A recently released Policy Statement from the American Academy of Pediatrics (AAP) provides guidance for Antibiotic Stewardship in Pediatrics. Lead authors include CPCE Core Faculty members Jeffrey Gerber, MD, PhD, MSCE and Theoklis Zaoutis MD, MSCE for the AAP’s Committee on Infectious Diseases.
Research conducted at CHOP and elsewhere has shown the importance of antibiotic stewardship programs (ASPs), which aim to ensure that antibiotics are used only when necessary, in the right dose, via the right route, for the right duration, and target the right spectrum of activity. Inappropriate or overuse of antibiotics may cause unwanted side effects, increase healthcare costs, and contribute to antimicrobial resistance.
The AAP Policy Statement includes a history of antibiotic stewardship programs in pediatric inpatient settings and outpatient settings, and strategies for each. It also discusses various ways of measuring success of antibiotic stewardship programs, outlines remaining knowledge gaps, and provides nine specific recommendations for pediatric ASPs.
Read the full policy statement here. Dr. Gerber also summarized the guidance for AAP News, which you can read here. |
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COVID-19 News
WHYY profiled Heather Burris, MD, MPH and work that she and colleagues at CHOP and Penn are doing to investigate racial disparities in preterm births in the context of the COVID-19 pandemic. A research letter in JAMA late last year reported no significant differences in the rates of preterm births or stillbirths in Philadelphia during the COVID-19 pandemic. The study compared deliveries in March through June of 2018, 2019, and 2020 using data from the Hospital of the University of Pennsylvania and Pennsylvania Hospital. New grants will allow Dr. Burris and colleagues from Yale University, Nemours Children’s Health System, and Northwestern University to expand this work geographically, as well as look at pandemic-related changes to perinatal healthcare delivery. Read the WHYY article here.
Work we reported in our last issue which indicates antibodies to SARS-CoV-2 transfer from mothers to babies in utero continues to receive attention in popular press. CPCE members Dustin Flannery, DO, MSCE, Miren Dhudasia, MPH, Sagori Mukhopadhyay, MD, MMSc, Jeffrey Gerber, MD, PhD, and Karen Puopolo, MD, PhD contributed to this work along with other CHOP and Penn colleagues. Dr. Puopolo recently told Philadelphia Magazine, "this past year has been a humbling reminder of how hard it is to face a new virus — one that is extremely transmissible, one that has killed so many folks in such a short amount of time. It’s why people need a stronger understanding of how COVID-19 can impact various facets of life. In our case, we’re doing everything we can to learn more about that impact, so we can counsel and take care of mothers and their babies in this 'new normal.'" Read the full interview here. Drs. Flannery and Puopolo also recently reviewed the process of and challenges in developing national guidance for management of infants born to mothers with COVID-19.
COVID-19 cases are on the decline in the Philadelphia region and across most of the U.S. after a December peak.
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Upcoming Events
CPCE/PolicyLab Virtual Seminar Series*
Date: February 19, 2021
Time: 12:00 - 1:00 pm
Rachel L. J. Thornton, MD, PhD will present "Harnessing History and Evidence to Address Disparities and Inequities Child Health." Dr. Thornton is an Associate Professor of Pediatrics at Johns Hopkins University in the Division of General Pediatrics and Adolescent Medicine. She is a board certified pediatrician and public health researcher who previously served as a Health Policy Advisor to the U.S. Department of Housing and Urban Development and has worked on the National Prevention Strategy and Implementation Plan. Her research focuses on childhood obesity and cardiovascular disease risk, health disparities, and social determinants of health.
Kids and COVID-19
Date: February 24, 2021
Time: 4:30 - 6:00 pm
Join the Monell Center for a webinar to learn how COVID-19 manifests in kids, how they may or may not contribute to the spread of the disease, as well as what is and what can be done about smell and taste loss among children. Experts in pediatric infectious disease, pediatric otolaryngology, chemosensory science, and psychology will provide a picture of the current knowledge to help children and parents make sense of COVID-19. Panelists include Susan Coffin, MD, MPH. Register here.
Epidemiology and Race: Why and How We Study Racial Health Disparities
- PART 1, Thursday, February 25, 4:30-6:00 pm: The panel (Wayne Giles, Chanelle Howe, Sherman James, and Jennifer Manly) will explore the history of census data, how data on race are collected and studied, and the implications of how these data are used in population health science.
- PART 2, Friday, February 26, 10:00-11:30 am: The panel (Amani Allen, Ndidiamaka Amutah-Onukagha, Joseph Graves, Pat O’Campo) will address whether epidemiology has made a difference in race-related health disparities.
- PART 3, Friday, February 26, 12:30-2:00 pm: The panel (Anjum Hajat, John Jackson, Arjumand Siddiqi, John Rich) will suggest the big unanswered questions for epidemiology with respect to race and how this can guide the future of the field.
Cohosted by Boston University School of Public Health and Society of Epidemiologic Research. Learn more and register here.
Drexel University Dornsife School of Public Health 2021 Population Health Symposium
Dates: April 7-8, 2021
This year’s inaugural symposium will bring together researchers, health practitioners, students, and the public at large to learn about the intersection of racism and health and discuss how we can collectively propose sustainable solutions towards health equity. Learn more and register here.
13th Annual University of Pennsylvania Conference on Statistical Issues in Clinical Trials
Date: April 12, 2021
Time: 8:30 am - 4:30 pm
Continuing its longstanding collaboration with the Department of Biostatistics, Epidemiology and Informatics at the University of Pennsylvania, the ASA, NISS and SCT is delighted to announce the 13th Annual Conference on Statistical Issues in Clinical Trials: Cluster Randomized Trials (CRTs) - Challenges and Opportunities. Learn more and register here.
*For CPCE/PolicyLab Virtual Seminar Series: If you would like to participate in any of the virtual events and did not receive an Outlook invitation, please contact crosss2@email.chop.edu.
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Recent Publications
Joseph W. Rossano, MD, MS and colleagues conducted a retrospective database analysis to examine national estimates of ventricular assist device (VAD)-related emergency department (ED) visits and characterize their demographic, clinical, and outcomes profile. Additionally, they tested the hypotheses that resource use increased and mortality improved over time. During the past decade, admission and mortality rates decreased but remain substantial; in 2017 ≈1 in every 40 VAD ED encounters resulted in death, making it critical that clinical decision-making be optimized for patients with VAD to maximize good outcomes.
Understanding the relationship between systemic antimicrobial exposure and toxicity is necessary to enable providers to take a proactive approach to prevent undesired drug effects. In this review, Kevin Downes, MD and his colleague examine the relationship between exposures and toxicities for antibiotic, antifungal and antiviral agents. They classify these relationships into four categories. Further work to define exposure-toxicity thresholds and integrate effective therapeutic drug monitoring (TDM) strategies has the potential to minimize many of the observed antimicrobials toxicities.
Little is known about the impact of chest dysphoria on transmasculine youth or the optimal timing of masculinizing chest surgery (MCS). Resulting from a fall 2018 CPCE Pilot Grant, Jamie Mehringer, MD (now at the University of Rochester), Nadia Dowshen, MD, MSHP and their team conducted semistructured qualitative interviews to explore youth experiences of chest dysphoria and the impact of MCS. They observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth. MCS performed during adolescence, including before age 18, can alleviate suffering and improve functioning.
Quality improvement efforts have focused on reducing interstage mortality for infants with hypoplastic left heart syndrome (HLHS). The discharge medications of neonates with HLHS undergoing Norwood operation were studied by Michael O’Byrne, MD, MSCE, Andrew Glatz, MD, MSCE, and their team. Mixed effects models were calculated to evaluate the hypothesis that the likelihood of digoxin prescription increased. Following publication of studies describing an association between digoxin and improved interstage survival, the likelihood of receiving digoxin at discharge increased without similar changes for furosemide or aspirin. Despite concerted efforts to standardize interstage care, interhospital variation in pharmacotherapy in this vulnerable population persists.
The American Academy of Pediatrics (AAP) convened a writing group in March 2020 to develop guidance for the management of their newborns. As further data emerged, AAP has issued serial updates to newborn guidance. A review written by Dustin Flannery, DO, MSCE and Karen Puopolo, MD, PhD sought to describe the process of and challenges in developing national guidance for management of infants born to mothers with COVID-19. Evolving knowledge on the epidemiology of perinatal COVID-19 has informed newborn guidance. The most recent guidance focuses on the use of infection control measures to support maternal-newborn contact and breastfeeding.
A team of researchers including Scott Lorch, MD, MSCE and Nicolas Bamat, MD, MSCE ran a retrospective longitudinal cohort study to evaluate the association between chronic diuretic exposures and enteral electrolyte use in infants developing severe bronchopulmonary dysplasia (sBPD). All common diuretic classes and class combinations were associated with increased NaCl and KCl use. Thiazide monotherapy was associated with greater electrolyte use than loop monotherapy. The addition of potassium-sparing diuretics was associated with a limited reduction in KCl use compared to thiazide monotherapy.
Many hospitals use rapid response systems (RRSs) to identify and intervene on hospitalized children at risk for deterioration. Christopher Bonafide, MD, MSCE and his colleagues developed a survey to describe RRS characteristics across hospitals in the Pediatric Research in Inpatient Settings (PRIS) network. The response rate was 72% (79 of 109). Respondents represented diverse hospital types and were primarily physicians (97%) with leadership roles in care escalation. RRS characteristics varied across PRIS hospitals.
Intrapartum antibiotic prophylaxis (IAP) reduce a newborn's risk of group B streptococcal infection (GBS) but may lead to an increased childhood body mass index (BMI). Researchers including Sagori Mukhopadhyay, MD, MMSc and Karen Puopolo, MD, PhD ran a retrospective cohort study of infants born 2007-2015 in an integrated healthcare system. In vaginal deliveries, GBS-IAP was associated with higher BMI from 0.5 to 5.0 years of age compared to no antibiotics. Other antibiotics were associated with higher BMI from 0.3 to 5.0 years of age. In Cesarean deliveries, GBS-IAP was associated with increased BMI from 0.7 years to 5.0 years of age compared to other antibiotics. Breastfeeding did not modify these associations.
The range of clinical presentation and severity of both Autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD is much wider than was once recognized. Pediatric and adult nephrologists are likely to care for individuals with both diseases in their lifetimes. This article by Erum Hartung, MD, MTR reviews genetic, clinical, and imaging predictors of kidney and liver disease progression in ADPKD and ARPKD and summarizes pharmacologic therapies to prevent progression.
Hansel Otero, MD and his colleagues sought to characterize the normal progression of quantitative CT paramaters in normal children from birth to adulthood. The following parameters were obtained: mean lung density, kurtosis, skewness, lung volume, and mass. Linear and exponential regression models were calculated with age and height as independent variables. Quantitative CT parameters of the lung parenchyma demonstrate changes from birth to adulthood. As children grow, the mean lung density decreases, and the lung parenchyma becomes more homogenous.
Another recent study by Hansel Otero, MD and others ran a retrospective review to evaluate changes in the utilization of computed tomography angiography (CTA) for evaluating suspected pulmonary embolism (PE) and the positive rate of ancillary for those studies negative for PE in the last 13 years. 307 chest CT angiographies for suspected PE were included. 50 (16%) were reported as positive for PE and 91 (30%) were negative for PE but positive for ancillary findings. The most frequent ancillary findings were pneumonia (n = 26) and pleural effusion (n = 11).
Electrocardiographic telemetry monitors are ubiquitous in hospitals. Dedicated monitor watchers, either on the unit or in a centralized location, are often responsible for observing telemetry monitors and responding to their alarms. Halley Ruppel, PhD, RN and her team evaluated the association of monitor-watcher use with (1) nurses' knowledge of electrocardiographic (ECG) monitoring and (2) accuracy of arrhythmia detection. Of the 37 units, 13 (35%) had monitor watchers. Use of monitor watchers was not independently associated with ECG-monitoring knowledge (P = .08). The presence of monitor watchers also was not significantly associated with the accuracy of arrhythmia detection (P = .94).
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About CPCE
We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing and centralizing the performance of clinical effectiveness research -- research aimed at understanding the best ways to prevent, diagnose and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.
CPCE E-News is edited by Holly Burnside. Please feel free to contact us with questions or feedback. |
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