The most cost-effective method for identifying children at risk for renal scarring is still debated. In this meta-analysis, Shaikh and colleagues pool individual patient data from 9 cohort studies to model predictors of the 16% of children who develop renal scars. A model that included temperature of at least 39°C, etiologic organism other than Escherichia coli, and abnormal ultrasonographic findings was only 3% to 5% less predictive than models requiring a blood draw of a voiding cystourethrogram. The editorial by Roberts discusses that renal damage matters more than reflux found on a voiding cystourethrogram.
Preventing infections is critical to improving rates of survival without neurodevelopmental impairment in preterm infants. In this randomized clinical trial, Kaufman and colleagues seek to determine whether there is added benefit in the use of nonsterile gloves in addition to that of hand hygiene alone in the care of 120 infants younger than 29 weeks’ gestation. Late-onset infections or necrotizing enterocolitis occurred in 32% of the intervention infants compared with 45% of the control infants, with 53% fewer gram-positive bloodstream infections and 64% fewer central line–associated bloodstream infections. An accompanying editorial by Coffin discusses the implications of this work and the need for additional research before universal gloving is adopted.
Continuing Medical Education and Journal Club
Weekend admission is associated with increased inpatient mortality in adult patients with leukemia. Using data from 43 freestanding children’s hospitals, Goodman and colleagues study 12 043 patients with leukemia, 16.7% of whom were admitted on a weekend. There was no difference in mortality rates during the first admission, but patients with weekend admissions had longer total lengths of stay, longer times to initiation of chemotherapy, and 50% increased odds of respiratory failure. Hagan’s related editorial discusses the virtues of creating a uniform and consistent hospital environment 24 hours a day 7 days a week all year through leveling of demand for services.
Clinical Review & Education
No widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This article by Berry and colleagues outlines a framework within which to organize the diverse activities, starting with admission, that constitute discharge care. This series of care processes involves the child, family, and health care professionals in an integrated interaction to maximize the goals of the hospitalization and improve outcomes. The 2 related editorials, one by Faultner, the parent of a child with complex medical problems, and the other by physician administrators Apkon and Friedman, discuss their respective perspectives on the proposed framework.
Editorials 1 and 2