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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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June 29, 2022 | Volume 13 | Issue 26 |
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Association of inappropriate outpatient pediatric antibiotic prescriptions with adverse drug events and healthcare expenditures |
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“Approximately 29% of outpatient antibiotics prescribed to children in the US are inappropriate. These include a large proportion of children inappropriately prescribed an antibiotic agent for a viral infection or a non-first-line antibiotic…”
Inappropriate antibiotic therapy enhances antimicrobial resistance, is associated with adverse drug events (ADE’s) – such as allergic reactions and “microbe disruption-related conditions” (e.g. clostridium difficile infection) plus generating increased medical costs.
A Commercial database (2015-2018) containing longitudinal patient-level data on enrollment and insurance payments for outpatient and pharmacy dispensed medications, was utilized to identify children 6 months-17 years, appropriately or inappropriately treated (using National guidelines) for a variety of commonly diagnosed bacterial or viral infections, documenting adverse incidences and costs.
31%-36% of children in an outpatient setting are prescribed inappropriate antibiotics for bacterial infections and 4-70% for viral infections with a concomitant increase in drug related adverse events and costs (Nationally; $ 25.0 million for otitis media, $21.3 million for pharyngitis and $19.1 million for viral upper respiratory tract infections).
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Read the full article at JAMA Network Open
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Tricuspid valve prolapse as an early predictor for severe phenotype in children with Marfan Syndrome |
Marfan syndrome is an inherited (75%) genetic disorder caused by a defect in the FBN1 gene (prenatal testing is possible) which controls the structure of connective tissue. Clinical defects which result include the heart, blood vessels, eyes, skin, lung, bones and joints. Children with Marfan syndrome are usually tall and thin with long arms, long double-jointed fingers and very long legs. Cardiovascular pathologies (aortic dilatation and mitral valve) determine the course of the disease.
A retrospective, longitudinal, observational cohort of 138 children diagnosed with Marfan syndrome (mean age 10.7 years) examined whether the presence of tricuspid valve prolapse (TVP) is predictive of other cardiovascular, ocular and/or systemic pathologies.
Children with Marfan syndrome should have their tricuspid valve routinely examined (by echocardiography) as it is a marker for disease severity and is associated with a higher incidence of systemic manifestations, aortic root dilatation and mitral valve prolapse.
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Prevalence and risk factors of discomfort in infants with severe bronchiolitis |
“Bronchiolitis is the most common diagnosis in children <2 years of age” with 6-16% requiring pediatric intensive care (PICU) admission.
Non-invasive ventilation (NIV) is the provision of ventilatory support through the use of a mask or similar device. Infants with severe bronchiolitis are increasingly being managed with NIV (as opposed to immediate endotracheal intubation and mechanical ventilation) which appears to be effective in 80%.
A single center retrospective observational study assessed the prevalence of discomfort (utilizing the EDIN scale; 5 Behavioral characteristics each allocated 0-3 points with a composite score >6 indicating marked pain) in 91 infants (median age: 34 days – 57% boys) with severe bronchiolitis supported by NIV.
Infants with severe bronchiolitis supported by any type of noninvasive ventilation appear to have little discomfort during the first 3 days of PICU stay (Bilevel positive airway pressure – BiPAP is somewhat less comfortable).
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Cough medication prescription for children |
According to the American Academy of Pediatrics (AAP) pharmacists, physicians and families should avoid advising, prescribing or using cough and cold medications in children <6 years of age; should refrain from using antihistaminics to treat colds and should avoid cough medications containing opioids in children <18 years of age. In spite of this, US utilization studies of cough medications for children 2-6 years of age indicate no significant decrease in usage since 2008.
A study from Finland which utilized a systemic intervention to reduce prescriptions for cough medications indicates that after a “Guideline publication", and electronic and printed materials sent as a “general reminder” to prescribing physicians, a “personalized letter” sent to those that continue to prescribe, followed up by direct phone calls to recalcitrant providers, significantly enhances guideline compliance (and appears cost-effective!).
Videos
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Objective confirmation of asthma diagnosis, treatment adherence and outcomes in children/adolescents |
“Poor adherence to inhaled medication is a commonly encountered problem among children with asthma”, with adherence rates (at base-line) varying between 28-67%.
A retrospective medical records study of 88 children (5-18 years of age) diagnosed with asthma assessed whether objective confirmation of asthma diagnosis (Lung function testing, bronchodilator response, etc.) is associated with improved medication adherence and patient outcomes.
“Children with objective confirmation of the diagnosis of asthma are more likely to redeem short-acting beta-2 agonist prescriptions and more likely to adhere to inhaled corticosteroid treatment”. Conducting objective lung function testing in asthmatic children enhances treatment adherence.
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Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2–24-month-old infants |
From a study of 1678 infants, 2-24 months of age with an initial urinary tract infection which investigated infants (voiding cystourethrogram, 99mTc dimercaptosuccinic acid scan and ultrasound) for clinically significant urological anomalies (high-grade reflux, obstruction and abnormal urinary tract lesions, need for surgical intervention, renal hypoplasia and scarring) it appears that significant urological anomalies are associated with non-E. coli infections and an elevated serum creatinine level.
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The respiratory consequences of COVID-19 in a cohort of children ages 2-18 years of age |
From a National Czech multi-center study of the clinical presentations, severity and prognosis of 39 children (mean age 13.5 years; 56.4% girls) seen by pediatric pulmonologists for persistent respiratory symptoms >12 weeks post COVID-19, it appears exertional dyspnea (76.9%), chronic cough (48.7%), dyspnea at rest (30.8%) and chest pain 17.9%) are the most prevalent. 53.8% have >1 symptom and recovery takes 4 months (median).
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REGISTER - LEARN - EARN CME CREDIT |
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Fetal MRI for Problem Solving: Case Examples from the Body
At the completion of this activity, participants are expected to: [1] Understand general definitions, [2] Learn about the International Classification of Function Model, [3] Review the Disability Laws, [4] Understand the role of Pediatric Physical Medicine and Rehabilitation providers.
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Underwriting Opportunities
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