North Carolina Childrens Hospital

Carolina Beach, NC, United States

North Carolina Childrens Hospital

Carolina Beach, NC, United States
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PubMed | University of North Carolina at Chapel Hill and North Carolina Childrens Hospital
Type: Journal Article | Journal: Hospital pediatrics | Year: 2015

Oral medications are commonly used to treat acute and chronic conditions, but formal evaluation of a childs pill-swallowing ability rarely occurs. In this pilot study, the Pediatric Oral Medication Screener (POMS) was used to physically assess a childs pill swallowing ability and identify children who would benefit from a targeted intervention.We identified children 3 to 17 years old admitted to a general pediatric service over a 3-month period in 2014. Patients were asked to swallow several different-sized placebo formulations. If subjects did not meet age-based goals, they were referred for pill swallowing interventions (POMS+). Follow-up parental surveys were performed for patients completing the intervention.The prospective pilot study recruited 34 patients. Twenty-eight patients (82%) passed the screening, and a majority of this group started or continued taking pill medications. Six did not pass the screen. Three of the 6 completed the intervention, improved their pill swallowing ability, and were taking oral pill medications at discharge. Parent prediction of pill swallowing was accurate only 56% of the time. Follow-up survey of the 3 families who completed POMS+ reported satisfaction with the program, and 2 of the patients had continued success with swallowing pills 5 months later.The POMS was effective at identifying children who could benefit from an intervention to improve pill-swallowing ability. Our analysis demonstrated that POMS has the potential to improve patient satisfaction and discharge planning.


Longo G.,Institute for Maternal and Child Health | Berti I.,Institute for Maternal and Child Health | Burks A.W.,North Carolina Childrens Hospital | Krauss B.,Boston Childrens Hospital | Barbi E.,Institute for Maternal and Child Health
The Lancet | Year: 2013

Food allergy is a serious health issue aff ecting roughly 4% of children, with a substantial eff ect on quality of life. Prognosis is good for the most frequent allergens with almost all children outgrowing their allergy. However, the long-term implications for disease burden are substantial for children with persistent allergies (eg, peanuts, tree nuts, fi sh, and shellfi sh) and for those with high concentrations of milk, egg, and wheat IgE. Antigen avoidance has been the time-honoured approach both for prevention and treatment. However, fi ndings from studies done in the past 5 years show that early contact with food can induce tolerance and desensitisation to foods. We review the epidemiology, natural history, and management of food allergy, and discuss the areas of controversy and future directions in research and clinical practice.


PubMed | North Carolina Childrens Hospital, Divisions of General Pediatrics and Adolescent Medicine and, University of North Carolina at Chapel Hill and Divisions of General Pediatrics and Adolescent Medicine and.
Type: Journal Article | Journal: Pediatrics | Year: 2015

Pediatric patients commonly have difficulty swallowing pills. Targeted interventions have shown to improve medication administration and treatment compliance. The objective was to evaluate studies performed on pill swallowing interventions in the pediatric population since 1987.We performed a comprehensive PubMed search and a bibliography review to identify articles for our review. We selected articles published in English between December 1986 and December 2013 that included >10 participants aged 0 to 21 years with pill swallowing difficulties without a comorbid condition affecting their swallowing. Reviewers extracted the relevant information and rated the quality of each study as poor, fair, or good based on the sample size and study design.We identified 4 cohort studies and 1 case series that met our criteria. All 5 studies found their intervention to be successful in teaching children how to swallow pills. Interventions included behavioral therapies, flavored throat spray, verbal instructions, specialized pill cup, and head posture training. Quality ratings differed between the articles, with 3 articles rated as fair, 1 article as good, and 1 article as poor.Pill swallowing difficulties are a barrier that can be overcome with a variety of successful interventions. Addressing this problem and researching more effective ways of implementing these interventions can help improve medication administration and compliance in the pediatric population.


Brandon D.H.,Duke University | Coe K.,Durham Regional Hospital | Hudson-Barr D.,North Carolina Childrens Hospital | Oliver T.,Brenner Childrens Hospital | Landerman L.R.,Duke University
Journal of Perinatology | Year: 2010

Objective:The purpose of this study was to evaluate the effects of No-Sting skin protectant and Aquaphor, a water-based emollient, on skin integrity measured by Neonatal Skin Condition Score (NSCS) and transepidermal water loss (TEWL) in premature infants. In addition, with no data regarding the use of No-Sting in the neonatal population and its desirability because it requires less infant manipulation and less nursing time, it was important to evaluate the use of this product.Study Design:In all, 69 premature infants born at < 33 weeks gestation were randomly assigned to one of the two treatment groups: (1) No-Sting or (2) Aquaphor for a total of 14 days.Result:Gestational age and total fluid intake were related to NSCS whereas gestational age, incubator humidity levels and total daily fluid intake were significantly related to TEWL. Infants receiving Aquaphor had significantly higher NSCS, but the mean scores in both groups over the 14-day period were in the normal range (<4). There were no differences between Aquaphor and No-Sting in the rate of TEWL over the 14-day period.Conclusion:This study provides the first information regarding the use of No-Sting in the neonatal population. This skin protectant seems as effective as Aquaphor in decreasing TEWL and maintaining skin integrity, and is less resource intensive. © 2010 Nature Publishing Group All rights reserved.


Malowitz J.R.,Duke University | Hornik C.P.,Duke University | Laughon M.M.,North Carolina Childrens Hospital | Testoni D.,Duke University | And 4 more authors.
American Journal of Perinatology | Year: 2015

Objective Congenital diaphragmatic hernia (CDH) is fatal in 20 to 40% of cases, largely due to pulmonary dysmaturity, lung hypoplasia, and persistent pulmonary hypertension. Evidence for survival benefit of inhaled nitric oxide (iNO), extracorporeal membrane oxygenation (ECMO), and other medical interventions targeting pulmonary hypertension is lacking. We assessed medical interventions and mortality over time in a large multicenter cohort of infants with CDH. Study Design We identified all infants ≥ 34 weeks' gestation with CDH discharged from 29 neonatal intensive care units between 1999 and 2012 with an average of ≥ 2 CDH admissions per year. We examined mortality and the proportion of infants exposed to medical interventions, comparing four periods of time: 1999-2001, 2002-2004, 2005-2007, and 2008-2012. Results We identified 760 infants with CDH. From 1999-2001 to 2008-2012, use of iNO increased from 20% of infants to 50%, sildenafil use increased from 0 to 14%, and milrinone use increased from 0 to 22% (p < 0.001). Overall mortality (28%) did not significantly change over time compared with the earliest time period. Conclusion Despite changing use of iNO, sildenafil, and milrinone, CDH mortality has not significantly decreased in this population of infants. Copyright © 2015 by Thieme Medical Publishers, Inc.


PubMed | Sunrise Medical, Duke University and North Carolina Childrens Hospital
Type: Journal Article | Journal: American journal of perinatology | Year: 2015

Congenital diaphragmatic hernia (CDH) is fatal in 20 to 40% of cases, largely due to pulmonary dysmaturity, lung hypoplasia, and persistent pulmonary hypertension. Evidence for survival benefit of inhaled nitric oxide (iNO), extracorporeal membrane oxygenation (ECMO), and other medical interventions targeting pulmonary hypertension is lacking. We assessed medical interventions and mortality over time in a large multicenter cohort of infants with CDH.We identified all infants34 weeks gestation with CDH discharged from 29 neonatal intensive care units between 1999 and 2012 with an average of2 CDH admissions per year. We examined mortality and the proportion of infants exposed to medical interventions, comparing four periods of time: 1999-2001, 2002-2004, 2005-2007, and 2008-2012.We identified 760 infants with CDH. From 1999-2001 to 2008-2012, use of iNO increased from 20% of infants to 50%, sildenafil use increased from 0 to 14%, and milrinone use increased from 0 to 22% (p<0.001). Overall mortality (28%) did not significantly change over time compared with the earliest time period.Despite changing use of iNO, sildenafil, and milrinone, CDH mortality has not significantly decreased in this population of infants.


PubMed | Stony Brook Childrens Hospital, University of North Carolina at Chapel Hill and North Carolina Childrens Hospital
Type: Journal Article | Journal: American journal of medical quality : the official journal of the American College of Medical Quality | Year: 2015

Inadequate communication between medical teams and families can lead to errors and poor-quality care. The objective was to understand why communication between the clinical team and families was not occurring consistently in the pediatric intensive care unit and improve the system using a multidisciplinary improvement team including a family advisor. This improvement project used Lean Six Sigma. The team observed updates and collected documented communication, survey, interview, and focus group data from families and staff. Root causes of failures included lack of assigned responsibility, lack of defined daily update, and lack of a daily communication standard. Process changes were implemented, resulting in an increased mean documented communication rate from 13% pre intervention to 65% post intervention that was sustained for more than 2 years (P < .001). Including a family advisor as an equal member of an improvement team provides family empowerment and a greater chance of success in complex areas.


Cook S.H.,North Carolina Childrens Hospital | Fielding J.R.,University of North Carolina at Chapel Hill | Phillips J.D.,North Carolina Childrens Hospital
Journal of Pediatric Surgery | Year: 2010

Purpose: We hypothesized that pediatric blunt trauma patients, initially evaluated at nontrauma centers with abdominal computed tomography (CT) scans, often undergo repeat scans after transfer. This study was designed to quantify this phenomenon, assess consequences, and elucidate possible causes. Methods: This article is an institutional review board-approved, retrospective chart review of pediatric blunt abdominal trauma patients transferred to a level I trauma center from 2002 to 2007 and evaluated with abdominal CT at the trauma center or at a referring facility. Results: A total of 388 patients met the study criteria, with 6 patients being excluded because of inability to verify outside records resulting in study group of 382 patients. Of those 382 patients, 199 (52%) underwent abdominal CT before transfer. Thirty-six (18%) of those 199 patients underwent repeat CT scanning at our level I trauma center. Of these 36 patients, 19 (53%) were transferred without their outside CT scans, with 10 (53%) of these 19 having significant abdominal injuries. Of the remaining 17, 6 (17%) had repeat scans to assess changes in vital signs, or patient condition, or because of inadequate outside imaging. The remaining 11 (30%) were repeated despite an acceptable outside CT and no change in patient condition. Only 2 of 11 resulted in changed management. Additional radiation delivered from these repeat scans totaled 180 mSv, and additional patient charges totaled more than $110,000. There was an apparent trend toward increased repeat scanning (from 6.7% in 2002 to 16.7% in 2007). Conclusions: Abdominal CT scans, for evaluation of pediatric blunt trauma, are frequently repeated after transfer from outside hospitals. In many cases, repeat scans provide useful diagnostic information. However, more than 80% of repeat scanning is potentially preventable with better education of transport personnel (paramedics, emergency medical technicians, and nurses) and emergency department physicians. © 2010 Elsevier Inc. All rights reserved.


Patel A.,University of North Carolina at Chapel Hill | Jacobsen L.,North Carolina Childrens Hospital | Jhaveri R.,North Carolina Childrens Hospital | Bradford K.K.,North Carolina Childrens Hospital
Pediatrics | Year: 2015

BACKGROUND AND OBJECTIVE: Pediatric patients commonly have difficulty swallowing pills. Targeted interventions have shown to improve medication administration and treatment compliance. The objective was to evaluate studies performed on pill swallowing interventions in the pediatric population since 1987. METHODS: We performed a comprehensive PubMed search and a bibliography review to identify articles for our review. We selected articles published in English between December 1986 and December 2013 that included .10 participants aged 0 to 21 years with pill swallowing difficulties without a comorbid condition affecting their swallowing. Reviewers extracted the relevant information and rated the quality of each study as "poor," "fair," or "good" based on the sample size and study design. RESULTS: We identified 4 cohort studies and 1 case series that met our criteria. All 5 studies found their intervention to be successful in teaching children how to swallow pills. Interventions included behavioral therapies, flavored throat spray, verbal instructions, specialized pill cup, and head posture training. Quality ratings differed between the articles, with 3 articles rated as "fair," 1 article as "good," and 1 article as "poor." CONCLUSIONS: Pill swallowing difficulties are a barrier that can be overcome with a variety of successful interventions. Addressing this problem and researching more effective ways of implementing these interventions can help improve medication administration and compliance in the pediatric population. Copyright © 2015 by the American Academy of Pediatrics.


PubMed | University of North Carolina at Chapel Hill and North Carolina Childrens Hospital
Type: Journal Article | Journal: Clinical pediatrics | Year: 2016

Sacral dimples are common physical examination findings among newborns and are rarely associated with spinal dysraphism. Screening ultrasonography for simple sacral dimples in the absence of other physical findings leads to unnecessary health care costs and undue stress on families. This study was a retrospective chart review of infants with a sacral dimple on examination who underwent spinal ultrasonography in the first week of life. The documented indication for ultrasonography was compared to standard guidelines. Among 151 infants in the study, 80% had a normal spinal ultrasound. Of infants with abnormal ultrasonography, 7 (5%) had abnormal spinal magnetic resonance imaging and 2 infants (1%) required neurosurgical intervention. Our study revealed that nearly one-third of infants who underwent spinal ultrasonography had a simple sacral dimple and low likelihood of spinal dysraphism according to existing guidelines. Among patients who underwent spinal ultrasonography in accordance with guidelines, only a small percentage required neurosurgical intervention indicating that guidelines may need to be revised. Larger studies involving multiple centers are necessary to assess this need.

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