Response to Concerns Raised About the New American Academy of Pediatrics Febrile Infant Guideline
Racial-ethnic disparities in outcomes of children hospitalized for COVID-19: A virus registry report [Meeting Abstract]
INTRODUCTION: Adult racial and ethnic minorities in the U.S. with COVID-19 are known to have worse outcomes. The CDC reported higher incidence of COVID-19 among minority children, but data regarding disparities in pediatric COVID-19 outcomes remains limited.
METHOD(S): A total of 837 children < 18 years of age hospitalized with COVID-19 in the U.S. were entered into the SCCM VIRUS Registry from 03/2020 to 01/2021. They were grouped into either of the following: Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Other or Unknown. Demographic and clinical characteristics, interventions and outcomes were compared. Critical illness was defined using a composite index of in-hospital mortality and organ support requirement, including vasopressors/inotropes, ECMO and CRRT. Comparisons were made using ANOVA, Kruskal-Wallis or Pearson's Chi-square. We used multivariable logistic and linear regression analysis to examine associations between race and ethnicity and critical illness, hospital and ICU length of stay and hospital mortality.
RESULT(S): Fever was reported in 67%, with no difference among the groups. MIS-C was reported with a significantly higher proportion in non-Hispanic Blacks (36%) than in non- Hispanic Whites (26%) [p=0.02]. Adjusting for age, sex, obesity, immune compromise and asthma, the non-Hispanic Asian group was significantly associated with higher odds of critical illness [OR=5.83, 95% CI=2.13-15.81]. Non-Hispanic Blacks also had higher odds of critical illness than non-Hispanic Whites, though not significant [OR=1.59, 95% CI=0.99-2.54]. With each yearly increase in age, the odds of critical illness was higher [OR=1.04, 95% CI=0.99-1.07] given all other covariates remain the same. While there was a higher proportion of obesity in the Hispanic group, this did not increase their odds of critical illness. Non- Hispanic Blacks had longer hospital length of stay compared to non-Hispanic Whites, though not significant [OR=1.76, 95% CI=-0.17-3.68]. ICU length of stay and mortality were not significantly associated with race or ethnicity.
CONCLUSION(S): Racial and ethnic disparities in pediatric COVID-19 outcomes exist that are not associated with preexisting conditions. These findings may guide the allocation of critical care resources towards minority groups at higher risk for severe disease
The Toll of Racism on African American Mothers and Their Infants [Comment]
Integrating Health Care Strategies to Prevent Poverty-Related Disparities in Development and Growth: Addressing Core Outcomes of Early Childhood
Poverty-related disparities appear early in life in cognitive, language, and social-emotional development, and in growth, especially obesity, and have long-term consequences across the life course. It is essential to develop effective strategies to promote healthy behaviors in pregnancy and the early years of parenthood that can mitigate disparities. Primary preventive interventions within the pediatric primary care setting offer universal access, high engagement, and population-level impact at low cost. While many families in poverty or with low income would benefit from preventive services related to both development and growth, most successful interventions have tended to focus on only one of these domains. In this manuscript, we suggest that it may be possible to address both development and growth simultaneously and effectively. In particular, current theoretical models suggest alignment in mechanisms by which poverty can create barriers to parent-child early relational health (i.e., parenting practices, creating structure, and parent-child relationship quality), constituting a final common pathway for both domains. Based on these models and related empirical data, we propose a strength-based, whole child approach to target common antecedents through positive parenting and prevent disparities in both development and growth; we believe this approach has the potential to transform policy and practice. Achieving these goals will require new payment systems that make scaling of primary prevention in health care feasible, research funding to assess efficacy/effectiveness and inform implementation, and collaboration among early childhood stakeholders, including clinicians across specialties, scientists across academic disciplines, and policy makers.
Child Poverty and Health in the United States: Introduction and Executive Summary
Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old
This guideline addresses the evaluation and management of well-appearing, term infants, 8 to 60 days of age, with fever â‰¥38.0Â°C. Exclusions are noted. After a commissioned evidence-based review by the Agency for Healthcare Research and Quality, an additional extensive and ongoing review of the literature, and supplemental data from published, peer-reviewed studies provided by active investigators, 21 key action statements were derived. For each key action statement, the quality of evidence and benefit-harm relationship were assessed and graded to determine the strength of recommendations. When appropriate, parents' values and preferences should be incorporated as part of shared decision-making. For diagnostic testing, the committee has attempted to develop numbers needed to test, and for antimicrobial administration, the committee provided numbers needed to treat. Three algorithms summarize the recommendations for infants 8 to 21 days of age, 22 to 28 days of age, and 29 to 60 days of age. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
Social Capital as a Positive Social Determinant of Health: A Narrative Review
Social determinants of health influence child health behavior, development, and outcomes. This paper frames social capital, or the benefits that a child receives from social relationships, as a positive social determinant of health that helps children exposed to adversity achieve healthy outcomes across the life course. Children are uniquely dependent on their relationships with surrounding adults for material and non-material resources. We identify and define three relevant aspects of social capital: 1) social support, which is embedded in a 2) social network, which is a structure through which 3) social cohesion can be observed. Social support is direct assistance available through social relationships and can be received indirectly through a caregiver or directly by a child. A child's social network describes the people in a child's life and the relationships between them. Social cohesion represents the strength of a group to which a child belongs (e.g. family, community). Pediatric primary care practices play an important role in fostering social relationships between families, the health care system, and the community. Further research is needed to develop definitional and measurement rigor for social capital, to evaluate interventions (e.g. peer health educators) that may improve health outcomes through social capital, and to broaden our understanding of how social relationships influence health outcomes.
Pediatric primary care and partnerships across sectors to promote early child development
Poverty remains a critical predictor of children's school readiness, health and longer term outcomes. Early relational health (ERH) (i.e., parenting practices and relationship quality) mediates the impact of poverty on child development, and thus has been the focus of many parenting interventions. Despite the documented efficacy of parenting interventions at reducing poverty-related disparities in child health and development, several key barriers prevent achieving population-level reach to families with young children. In the current paper we highlight several of these barriers including gaining population-level access to young children and families, reaching families only through single points of access, addressing the significant heterogeneity of risk that exists among families living in poverty, as well as addressing each of these barriers in combination. We suggest that understanding and confronting these barriers will allow family-centered interventions to more effectively address issues related to ERH at a population level, which in turn will reduce poverty-related disparities in child development.
Characteristics of Hospitalized Children With SARS-CoV-2 in the New York City Metropolitan Area
Association Between Parent Comfort With English and Adverse Events Among Hospitalized Children
Importance/UNASSIGNED:Children of parents expressing limited comfort with English (LCE) or limited English proficiency may be at increased risk of adverse events (harms due to medical care). No prior studies have examined, in a multicenter fashion, the association between language comfort or language proficiency and systematically, actively collected adverse events that include family safety reporting. Objective/UNASSIGNED:To examine the association between parent LCE and adverse events in a cohort of hospitalized children. Design, Setting, and Participants/UNASSIGNED:This multicenter prospective cohort study was conducted from December 2014 to January 2017, concurrent with data collection from the Patient and Family Centered I-PASS Study, a clinician-family communication and patient safety intervention study. The study included 1666 Arabic-, Chinese-, English-, and Spanish-speaking parents of general pediatric and subspecialty patients 17 years and younger in the pediatric units of 7 North American hospitals. Data were analyzed from January 2018 to May 2020. Exposures/UNASSIGNED:Language-comfort data were collected through parent self-reporting. LCE was defined as reporting any language besides English as the language in which parents were most comfortable speaking to physicians or nurses. Main Outcomes and Measures/UNASSIGNED:The primary outcome was adverse events; the secondary outcome was preventable adverse events. Adverse events were collected using a systematic 2-step methodology. First, clinician abstractors reviewed patient medical records, solicited clinician reports, hospital incident reports, and family safety interviews. Then, review and consensus classification were completed by physician pairs. To examine the association of LCE with adverse events, a multivariable logistic regression was conducted with random intercepts to adjust for clustering by site. Results/UNASSIGNED:Of 1666 parents providing language-comfort data, 1341 (80.5%) were female, and the mean (SD) age of parents was 35.4 (10.0) years. A total of 147 parents (8.8%) expressed LCE, most of whom (105 [71.4%]) preferred Spanish. Children of parents who expressed LCE had higher odds of having 1 or more adverse events compared with children whose parents expressed comfort with English (26 of 147 [17.7%] vs 146 of 1519 [9.6%]; adjusted odds ratio, 2.1; 95% CI, 1.2-3.7), after adjustment for parent race and education, complex chronic conditions, length of stay, site, and the intervention period. Similarly, children whose parents expressed LCE were more likely to experience 1 or more preventable adverse events (adjusted odds ratio, 2.3; 95% CI, 1.2-4.2). Conclusions and Relevance/UNASSIGNED:Hospitalized children of parents expressing LCE were twice as likely to experience harms due to medical care. Targeted strategies are needed to improve communication and safety for this vulnerable group of children.