Variation in Care of Well-Appearing Hypothermic Young Infants: A Multisite Study.

Autor:	Combs MD; Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California., Mitchell M; Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia., Molas-Torreblanca K; Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California., Lee C; Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia., Raffaele JL; Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina., Sharma M; Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama., Berger S; Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama., Morrison J; Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida.; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland., Prasad M; Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida., Wood JK; Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Van Meurs A; Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregan., Mullin R; Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregan., Doraiswamy V; Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio.; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio., Ingram E; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio., Banker SL; Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York., Lee J; Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York., Tan X; School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina., Potisek NM; Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina.; Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Halvorson EE; Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Jazyk:	angličtina
Zdroj:	Hospital pediatrics [Hosp Pediatr] 2023 Aug 01; Vol. 13 (8), pp. 742-750.
DOI:	10.1542/hpeds.2023-007199
Abstrakt:	Background and Objectives: Numerous decision tools have emerged to guide management of febrile infants, but limited data exist to guide the care of young infants presenting with hypothermia. We evaluated the variation in care for well-appearing hypothermic young infants in the hospital and/or emergency department setting between participating sites. Methods: This is a retrospective cohort study of well-appearing infants ≤90 days old across 9 academic medical centers from September 1, 2016 to May 5, 2021. Infants were identified via billing codes for hypothermia or an initial temperature ≤36.0°C with manual chart review performed. Primary outcomes included assessment of variation in diagnostic evaluation, disposition, empirical antimicrobial therapy, and length of stay. Results: Of 14 278 infants originally identified, 739 met inclusion criteria. Significant interhospital variation occurred across all primary outcomes. Across sites, a full serious bacterial illness evaluation was done in 12% to 76% of hypothermic infants. Empirical antibiotics were administered 20% to 87% of the time. Performance of herpes simplex viral testing ranged from 7% to 84%, and acyclovir was empirically started 8% to 82% of the time. Hospital admission rates ranged from 45% to 100% of patients. Conclusions: Considerable variation across multiple aspects of care exists for well-appearing young infants presenting with hypothermia. An improved understanding of hypothermic young infants and their risk of infection can lead to the development of clinical decision tools to guide appropriate evaluation and management. (Copyright © 2023 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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