Inhaled Tobramycin Usage in Critically Ill Pediatric Patients Without Cystic Fibrosis: A Pediatric Pharmacy-Association, Practice-Based Research Network Survey Study.

Objective: The purpose of this study was to characterize reported usage, dosage regimens, and monitoring practices of inhaled tobramycin in health systems with neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and cardiovascular intensive care units (CICUs) from the members of the Pediatric Pharmacy Association (PPA). The primary objective was to identify the number of respondents who use an inhaled tobramycin protocol. The secondary objectives included the main indications, dosage regimens, monitoring parameters used, and administration details for inhaled tobramycin.

Supporting resident well-being: Considerations for residency program directors and pharmacy enterprise leadership.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Pharmacy practice for therapeutic orphans: Current and future reflections for pediatric pharmacy.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Evaluating the Efficacy and Safety of Erythromycin for the Treatment of Gastroparesis in Infants and Children.

Objectives: Erythromycin has been utilized for gastroparesis and feeding intolerance in adults and neonates, but limited studies exist for infants and children. The purpose of this study was to evaluate the safety and efficacy of erythromycin for gastroparesis in pediatric patients. The primary objective was to identify the number of patients with gastroparesis improvement, defined as no additional use of promotility agents, no erythromycin dose increases or need for other interventions (transpyloric or gastrostomy-jejunostomy tube).

Peer Review as a Professional Obligation: Steps and Tips to Becoming a High-Quality Reviewer.

Peer review is an essential step in the publication process and dissemination for scientific information to improve patient care and future research in pediatric patients. It is a professional obligation to ensure high quality, reliable, and relevant information is published. Despite this, many journals face problems finding peer reviewers.

Rates of Stress Ulcer Prophylaxis Deprescribing in Children Receiving Usual versus High-Dose Corticosteroids in the Pediatric Intensive Care Unit with Status Asthmaticus.

To compare deprescribing rates of stress ulcer prophylaxis (SUP) between children receiving "usual-dose" (<4 mg/kg/day methylprednisolone equivalents) versus "high-dose" (≥4 mg/kg/day methylprednisolone equivalents) corticosteroids for status asthmaticus in the pediatric intensive care unit (PICU). This retrospective, cohort study included children <18 years of age receiving corticosteroids for status asthmaticus and SUP from 1/1/2017 to 6/31/2022. The primary objective was to compare the number of children that were deprescribed SUP following transition from the PICU to the floor and at hospital discharge between groups.

Vasopressin induced hyponatremia in infants <3 months of age in the neonatal intensive care unit.

Objectives: Vasopressin is used for shock and acute pulmonary hypertension in the neonatal intensive care unit (NICU) and is associated with hyponatremia. The purpose of this study was to determine the incidence, severity, contributing risk factors associated with vasopressin-induced hyponatremia in neonates and infants <3 months of age in the NICU. The primary objective was to determine the incidence of hyponatremia (<130 mEq/L) and severe hyponatremia (<125 mEq/L).

Gabapentin for Delirium in Infants in the Neonatal Intensive Care Unit.

Objective: A protocol was developed for neonatal intensive care unit (NICU) delirium: Step 1, gabapentin for pain or melatonin for sleep; Step 2, add on other Step 1 agent; Step 3, antipsychotics. The purpose of this study was to describe the utility and dosing of gabapentin for NICU delirium.

Methods: Retrospective evaluation of NICU patients from January 1, 2021-December 31, 2022 who received >1 dose of gabapentin based on the delirium protocol.

A Case Series and Review of Literature Describing the Use of Midodrine for Vasopressor Effects in Infants With Congenital Heart Disease.

Midodrine is an oral vasopressor option that allows for discontinuation of intravenous vasopressors for patients with cardiovascular conditions. It does not have a US Food and Drug Administration-labeled indication for use in children, and there is a paucity of literature in patients ≤6 years of age. This case series describes 2 infants with complex congenital heart diseases initiated on midodrine for augmentation of systolic (SBP) or diastolic blood pressure (DBP) to increase coronary perfusion.

Incidence of gastrointestinal bleeding with hydrocortisone use in neonates and infants less than three months of age in the neonatal intensive care unit.

Objective: The objective of this study was to determine the incidence of hydrocortisone-associated gastrointestinal bleeding (GIB) in infants <3 months and compare rates with or without stress ulcer prophylaxis.

Study Design: Retrospective cohort study of NICU patients <3 months who received hydrocortisone for hypotension. Three logistic regressions were conducted for adjusted associations between GIB, necrotizing enterocolitis (NEC), or infection and clinical characteristics.

Pharmacologic Management of Sialorrhea in Neonatal and Pediatric Patients.

Sialorrhea, defined as an excess flow of saliva or excessive secretions, is common in patients with cerebral palsy and other neurologic disorders and is associated with clinical complications such as increased risk of local skin reactions, infections, aspiration, pneumonia, and dehydration. Upon failure of non-pharmacologic measures, clinicians have several noninvasive pharmacologic options available to manage sialorrhea. This review of the literature provides detailed descriptions of medications used, efficacy, safety, and practical considerations for use of non-injectable pharmacologic agents.

Effect of Phytonadione on Correction of Coagulopathy in Pediatric Patients With Septic Shock.

Objectives: The purpose of this study was to evaluate phytonadione in children with septic shock with disseminated intravascular coagulopathy (DIC). The primary objective was to identify the number of patients with an international normalized ratio (INR), defined as ≤1.2, following phytonadione.

Delirium Assessment Treatment Strategies in Critically Ill Pediatric Patients: A Pediatric Pharmacy Association Practice-Based Research Network Survey Study.

Objectives: The purpose of this study was to describe overall screening, prevention, and treatments for pediatric delirium at various neonatal intensive care units (NICUs), cardiac intensive care units (CICUs), and pediatric intensive care units (PICUs) from the Pediatric Pharmacy Association (PPA) membership. The primary objective was to identify the number of respondents that had a defined delirium-based protocol. The secondary objectives included identification of delirium assessment tools used, first- and second-line delirium treatment options, and monitoring practices for antipsychotics for delirium management.

Melatonin Use in Infants Admitted to Intensive Care Units.

Objectives: Sleep deprivation is a risk factor for delirium development, which is a frequent complication of intensive care unit admission. Melatonin has been used for both delirium prevention and treatment. Melatonin safety, efficacy, and dosing information in neonates and infants is lacking.

Variability in opioid conversion calculators in critically ill children transitioned from fentanyl to hydromorphone.

Purpose: Opioid conversion calculators (OCCs) are used to convert between opioids. The purpose of this study was to describe the variability in OCC results in critically ill children transitioned from fentanyl to hydromorphone infusions.

Methods: This was a descriptive, retrospective study.

Ketamine Use in Adult and Pediatric Patients Receiving Extracorporeal Membrane Oxygenation (ECMO): A Systematic Review.

Analgesia and sedation are often critical elements of therapy for patients undergoing extracorporeal membrane oxygenation (ECMO). Aside from potential drug-drug interactions, the PK changes associated with ECMO make appropriate analgosedative selection challenging. Ketamine is less lipophilic and has lower protein binding than alternative agents, and may be less impacted by the PK changes during ECMO.

Sculpting a teaching and learning curriculum to better meet the career needs of postgraduate year 1 and 2 pharmacy residents.

Purpose: To describe implementation of the University of Oklahoma College of Pharmacy (OUCOP) teaching and learning curriculum (TLC) for postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) residents, including the required components, evaluation structure, residency graduate outcomes and perceptions captured by a survey following program completion, generalizability to other institutions, and opportunities for future directions.

Summary: As part of their residency training, pharmacy residents are required to develop and refine teaching, precepting, and presentation skills. To meet the required and elective competency areas, goals, and objectives on teaching, precepting, and presentation skills, many American Society of Health-System Pharmacists-accredited residency programs have utilized TLC programs.

Azithromycin for Eradication of and Prevention of Bronchopulmonary Dysplasia in Preterm Neonates in the Neonatal Intensive Care Unit.

Azithromycin has been explored as a treatment option for eradication of and prevention of bronchopulmonary dysplasia (BPD) in preterm neonates. However, there is debate about the need for eradication of and whether azithromycin is safe and efficacious for this indication. This literature review provides an overview of the evidence for use of azithromycin for eradication of and prevention of BPD, including dosing and duration of azithromycin used in these studies.

Characterization of early versus late opioid iatrogenic withdrawal syndrome in critically ill children transitioning from fentanyl -infusions to methadone.

Objective: Methadone is used to prevent opioid iatrogenic withdrawal syndrome (IWS) in children, but the optimal dose and overlap time with an opioid infusion have not been elucidated. The purpose was to compare clinical manifestations among patients who developed opioid IWS within 24 hours (early) versus ≥24 hours (late) of fentanyl discontinuation when enteral methadone was initiated.

Design: A retrospective, descriptive study.

Management of Idiopathic Viral Pericarditis in the Pediatric Population.

Idiopathic (viral) pericarditis (IP) is one of the most common etiologies of acute and recurrent pericarditis in children. IP is associated with significant morbidity, and recurrence rates of IP are high and require treatment to decrease risk of recurrence and pericarditis-related chest pain. Despite significant morbidity, sparse guidance exists to comprehensively address management of IP in children.

Publication rates of pharmacy residents involved in a team-based research program.

Purpose: The University of Oklahoma College of Pharmacy (OUCOP) implemented an individualized residency research committee and skill development program to facilitate completion and publication of research projects. The purpose of this study was to evaluate the outcomes the program had on project publication rates and subsequent publications after graduation for postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) residents.

Methods: This study included OUCOP PGY1 and PGY2 residents from classes graduating from 2011 through 2019.

Efficacy and Safety of Prolonged Magnesium Sulfate Infusions in Children With Refractory Status Asthmaticus.

Objectives: There is a paucity of data on the use of intravenous magnesium sulfate infusion in children with refractory status asthmaticus. The purpose of this study was to evaluate the efficacy and safety of prolonged magnesium sulfate infusion as an advanced therapy.

Methods: This is a single center retrospective study of children admitted to our pediatric intensive care unit (PICU) with status asthmaticus requiring continuous albuterol.