Association between the respiratory severity score and extubation success in severe bronchopulmonary dysplasia.

Objective: Characteristics associated with extubation success (ES) in established grade 3 bronchopulmonary dysplasia (G3-BPD) are unknown. The respiratory severity score (RSS) is associated with extubation failure in younger preterm infants and adverse outcomes in established BPD. We evaluated the association between the RSS and ES in G3-BPD.

An improvement project standardizing low prophylactic platelet transfusion dosing for infants.

Background: Platelet transfusions are frequently given to preterm infants to prevent bleeding, but randomized trials demonstrated harmful effects from current practices.

Problem: Many platelet transfusions were administered in 15-20 mL/kg doses.

Methods: We sought to decrease platelet exposure among neonates by standardizing 10 mL/kg transfusions for non-bleeding thrombocytopenic infants in a level IV NICU.

Pulmonary vasodilator use in very preterm infants in United States children's hospitals.

Objectives: To describe common pulmonary vasodilators (PV), exposure timing, and characteristics associated with their use in very preterm (VP) infants.

Study Design: Observational study of VP infants discharged from U.S.

Gastroesophageal reflux during postpyloric versus gastric tube feeding in preterm infants with bronchopulmonary dysplasia.

Background: Whether postpyloric feeding reduces gastroesophageal reflux (GER) in very preterm infants with bronchopulmonary dysplasia (BPD) is uncertain.

Methods: Prospective observational study comparing GER profiles measured using 24-h esophageal pH-impedance monitoring in infants with BPD receiving clinically prescribed postpyloric (n = 21) or gastric (n = 24) tube feeding.

Results: Participants (median gestational age 25.

Healthcare-Associated Gastroenteritis: Outbreak Report and Systematic Review of the Literature.

Healthcare-associated gastroenteritis continues to be associated with significant pediatric morbidity and mortality despite the introduction of rotavirus vaccines. Infection prevention (IP) measures are critical in mitigating outbreaks. We describe an outbreak of norovirus and effective IP strategies utilized and calculated the costs associated with the outbreak.

Characteristics associated with death or tracheostomy in infants with bronchopulmonary dysplasia following predominant non-invasive respiratory support.

Objective: Identify characteristics associated with death or tracheostomy (D/T) in preterm infants with bronchopulmonary dysplasia (BPD) predominantly managed with non-invasive respiratory support prior to 36 weeks postmenstrual age (PMA).

Study Design: Retrospective cohort study at Children's Hospital of Philadelphia of 134 infants meeting inclusion criteria between 2010 and 2017. Various clinical characteristics were considered as predictor variables of the primary outcome, D/T; those associated at p < 0.

Pulmonary vasodilator use in very preterm infants in United States children's hospitals.

Objectives: To describe common pulmonary vasodilators (PV), exposure timing, and characteristics associated to their use in very preterm (VP) infants.

Study Design: Observational study of VP infants discharged from U.S.

Risk of Transmission of Vaccine-Strain Rotavirus in a Neonatal Intensive Care Unit That Routinely Vaccinates.

Background And Objectives: Many neonatal intensive care units (NICUs) do not give rotavirus vaccines to inpatients due to a theoretical risk of horizontal transmission of vaccine strains. We aimed to determine incidence and clinical significance of vaccine-strain transmission to unvaccinated infants in a NICU that routinely administers pentavalent rotavirus vaccine (RV5).

Methods: This prospective cohort study included all patients admitted to a 100-bed NICU for 1 year.

Association of furosemide versus chlorothiazide exposures with serum sodium, potassium, and chloride among infants with bronchopulmonary dysplasia.

Objectives: To examine the association of novel furosemide versus thiazide diuretic exposure with changes in serum sodium, potassium, and chloride levels among infants with grade 2/3 bronchopulmonary dysplasia (BPD).

Study Design: Retrospective cohort study of infants admitted to a level IV neonatal intensive care unit (NICU) with grade 2/3 BPD. We measured within-subject change in serum sodium, potassium, and chloride before and after diuretic initiation using multivariable regression to adjust for differences in dosing and clinical covariates.

A quality improvement initiative to reduce excess inhaled therapy use in the neonatal intensive care unit.

Objective: Inhaled medications are commonly used at our single-center, Level IV neonatal intensive care unit (NICU). We lacked a standardized process for measuring efficacy of these medications to guide optimal duration of use, potentially leading to their overuse.

Methods: We utilized quality improvement methodology to reduce the length of inhaled hypertonic saline (HTS) course durations and high frequency albuterol use.

Associations of PM exposure with emergency department visits and readmissions among preterm infants with bronchopulmonary dysplasia.

Objectives: To quantify the association of ambient air pollution (particulate matter, PM) exposure with medically attended acute respiratory illness among infants with bronchopulmonary dysplasia (BPD).

Study Design: Single center, retrospective cohort study of preterm infants with BPD in Metropolitan Philadelphia. Multivariable logistic regression quantified associations of annual mean PM exposure (per μg/m) at the census block group level with medically attended acute respiratory illness, defined as emergency department (ED) visits or hospital readmissions within a year after first hospital discharge adjusting for age at neonatal intensive care unit (NICU) discharge, year, sex, race, insurance, BPD severity, and census tract deprivation.

Childhood outcomes following discharge from a referral bronchopulmonary dysplasia program.

Objectives: The primary objective of this study was to profile the childhood health, development, and health-related quality of life (HR QoL) for children with the most severe bronchopulmonary dysplasia (BPD), those discharged from a quaternary referral program.

Study Design: We collected cross-sectional data through telephone interviews with 282 families of children ages 18 months to 11 years who had been discharged from a BPD referral program.

Results: Respiratory morbidities were near universal, with 42% of children ever having required a tracheostomy and severity of these morbidities correlated with parent-reported health and QoL.

Environmental Determinants of Post-Discharge Acute Respiratory Illness among Preterm Infants with Bronchopulmonary Dysplasia.

Objective: To analyze the association of components of the Centers for Disease Control and Prevention (CDC) Environmental Justice Index (EJI) with respiratory health outcomes among infants with bronchopulmonary dysplasia (BPD) within one year after discharge from the neonatal intensive care unit.

Methods: This was a retrospective cohort study of a cohort of preterm infants with BPD. Multivariable logistic regression models estimated associations of EJI and its components with medically attended acute respiratory illness, defined as an ED visit or inpatient readmission, within one year of discharge from the neonatal intensive care unit.

Leveraging Novel Clinical Decision Support to Improve Preferred Language Documentation in a Neonatal Intensive Care Unit.

Background:  Recognition of the patient and family's diverse backgrounds and language preference is critical for communicating effectively. In our hospital's electronic health record, a patient or family's identified language for communication is documented in a discrete field known as "preferred language." This field serves as an interdepartmental method to identify patients with a non-English preferred language, creating a bolded banner for non-English speakers easily identifiable by health care professionals.

Needs assessment for enhancing pediatric clerkship readiness.

Background: Many students report feeling inadequately prepared for their clinical experiences in pediatrics. There is striking variability on how pediatric clinical skills are taught in pre-clerkship curricula.

Methods: We asked students who completed their clerkships in pediatrics, family medicine, surgery, obstetrics-gynecology and internal medicine to rate their pre-clinical training in preparing them for each clerkship, specifically asking about medical knowledge, communication, and physical exam skills.

Factors associated with discontinuation of pulmonary vasodilator therapy in children with bronchopulmonary dysplasia-associated pulmonary hypertension.

Objective: To evaluate factors associated with discontinuation of pulmonary vasodilator therapy in bronchopulmonary dysplasia-related pulmonary hypertension (BPD-PH).

Study Design: Retrospective study of neonatal, echocardiographic, and cardiac catheterization data in 121 infants with BPD-PH discharged on pulmonary vasodilator therapy from 2009-2020 and followed into childhood.

Result: After median 4.

The association between diuretic class exposures and enteral electrolyte use in infants developing grade 2 or 3 bronchopulmonary dysplasia in United States children's hospitals.

Objective: To evaluate the association between chronic diuretic exposures and enteral electrolyte use in infants developing severe bronchopulmonary dysplasia (sBPD).

Study Design: Retrospective longitudinal cohort study in infants admitted to United States children's hospitals. We identified diuretic exposures and measured enteral NaCl and KCl use during pre-defined exposure risk-interval days.

Loop Diuretics in Severe Bronchopulmonary Dysplasia: Cumulative Use and Associations with Mortality and Age at Discharge.

Objectives: To measure between-center variation in loop diuretic use in infants developing severe bronchopulmonary dysplasia (BPD) in US children's hospitals, and to compare mortality and age at discharge between infants from low-use centers and infants from high-use centers.

Study Design: We performed a retrospective cohort study of preterm infants at <32 weeks of gestational age with severe BPD. The primary outcome was cumulative loop diuretic use, defined as the proportion of days with exposure between admission and discharge.

The Clinical Evaluation of Severe Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia is a common disease of prematurity that presents along a wide spectrum of disease severity. Infants with high severity require prolonged hospitalizations and benefit from multidisciplinary care. We describe our approach to the evaluation of infants with severe bronchopulmonary dysplasia.