Early vs. Delayed Umbilical Cord Clamping

Nearly 4 million infants are born annually in the United States. Events during birth can have life-long implications. Early cord clamping is associated with a decreased risk of jaundice, whereas delayed cord clamping is associated with a decreased risk of anemia. Parents deserve knowledge and autonomy concerning care of their infants

System-Wide Implementation of the Use of an Extended-Infusion Piperacillin/Tazobactam Dosing Strategy: Feasibility of Utilization From a Children\u27s Hospital Perspective

Background Use of extended infusions of piperacillin/tazobactam (PT) in adult patients has been described, but data in children are limited. Objective The goal of this study was to determine the feasibility of using an extended-infusion PT dosing strategy as the standard of care in a children\u27s hospital. Methods This was a prospective observational study of patients aged \u3e30 days who received PT after admission to a freestanding, tertiary care children\u27s hospital. After institution of an extended-infusion PT dosing protocol as the standard dosing option, patients receiving PT were prospectively assessed for presence of and reasons for changes in dosing regimen. Results A total of 332 patients, with a median age of 5 years (interquartile range, 1.9–12 years) and median weight of 19.9 kg (interquartile range, 11.7 – 37.6 kg) received PT (100 mg/kg based on piperacillin component). Extended-infusion PT was used for the duration of PT therapy in 92% (n = 304) of patients. Twenty-eight patients (8%) received a traditional infusion over 30 minutes, with 19 of 28 being changed from extended infusion and 9 of 28 being empirically prescribed traditional infusion PT. The most commonly encountered reason for not using extended infusions was coadministration of vancomycin (17 of 28 [61%]) and lack of compatibility data with PT. Dosing errors, which were voluntarily reported, were infrequent (1.8% [n = 6]). The few observed dosing errors were likely attributable to the overall ordering process at our institution, which requires ordering as the milligram per kilogram dose as total PT rather than based on piperacillin component as is commonly documented in pediatric dosing references. Conclusions Results of this study suggest that extended-infusion PT dosing was feasible in this specific children\u27s hospital. Ninety-two percent of patients received our institution\u27s preferred dosing regimen; a small percentage of patients still needed to receive traditional infusion times

Optimized Antimicrobial Dosing Strategies: A Survey of Pediatric Hospitals

Background Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited. Objective The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA. Study Design, Setting, and Participants A national survey of children’s hospitals was conducted. A single practitioner from each target hospital was identified through the Children’s Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing. Main Outcome Measure The main outcome measure was the percentage utilization of the dosing strategies, with secondary outcomes being the reasons for not using these dosing strategies. Results Seventy-seven of 215 identified practitioners (36 %) participated in the survey. EIAG, EIBL, and CIBL dosing were utilized in 63 %, 24 %, and 13 % of responding hospitals, respectively. The most common reasons for not using EIAG were concern regarding lack of efficacy data (56 %) and concern regarding the duration of the drug-free period (41 %). Respondents who did not utilize EIBL cited concern due to lack of pediatric EIBL efficacy data (54 %), the need for more intravenous access (54 %), intravenous medication compatibility issues (39 %), and the time during which the patient is attached to an intravenous infusion (31 %). Conclusion This survey of children’s hospitals indicates that EIAG is used in over 50 % of hospitals, but there is some lag in adoption of EIBL and CIBL dosing, both of which are used in fewer than 25 % of hospitals. Additional studies may provide much-needed evidence to increase the utilization of these strategies

Determination of Fentanyl in Canine Plasma using HPLC-MS Detection

A simple, easy, and accurate high-performance liquid chromatographic method for the determination of fentanyl concentrations in plasma samples has been developed and validated. Following a liquid extraction with acetonitrile, samples were separated by reversed-phase high-performance liquid chromatography (HPLC) on an XBridge C18 column (2.1 x 50 mm, 3.5μm) and detected by mass spectroscopy. The mobile phase was a mixture of water with 0.1% formic acid, and acetonitrile with 0.1% formic acid (90:10), with a flow rate of 0.6 ml/min. The procedure produced a linear curve over the concentration range of 0.1-25 ng/ml for fentanyl in canine plasma with a LOQ of 0.1 ng/ml. Intra- and inter-assay variability ranged from 2.6%-8.2% and the average recovery for fentanyl was 100%

Determination of Meloxicam in Egg Whites and Yolks Using Reverse Phase Chromatography

A new method of analysis has been developed and validated for the determination of meloxicam in egg whites and yolks. Following a liquid extraction for the whites and a solid phase extraction for the yolks, samples were separated on an XBridge C18 column and quantified using ultraviolet detection at 360 nm. The mobile phase was a mixture of water with glacial acetic acid and aceto- nitrile, with a flow rate of 1 mL/min. The procedure produced a linear graph over the concentration range 5–1500 ng/mL with a lower limit of quantification of 5 ng/mL. Intra- and inter-assay variabil- ity was 10% or less for both the whites and yolks. The average recovery for whites was 96% and the average recovery in yolks was 97%

Determination of Meloxicam in Egg Whites and Yolks Using Reverse Phase Chromatography

A new method of analysis has been developed and validated for the determination of meloxicam in egg whites and yolks. Following a liquid extraction for the whites and a solid phase extraction for the yolks, samples were separated on an XBridge C18 column and quantified using ultraviolet detection at 360 nm. The mobile phase was a mixture of water with glacial acetic acid and aceto- nitrile, with a flow rate of 1 mL/min. The procedure produced a linear graph over the concentration range 5–1500 ng/mL with a lower limit of quantification of 5 ng/mL. Intra- and inter-assay variabil- ity was 10% or less for both the whites and yolks. The average recovery for whites was 96% and the average recovery in yolks was 97%

Outcomes of Extended-Infusion Piperacillin/Tazobactam in Pediatric Patients.

Poster presented at: ID Week 2013, October 2013, San Francisco, California

Linezolid-Associated Thrombocytopenia in Children with Renal Impairment

Poster presented at ID Week, October 2013, San Francisco, California

Implementing Extended-Infusion Cefepime as Standard of Care in a Children’s Hospital: A Prospective Descriptive Study

Background: Extended-infusion cefepime (EIC) has been associated with decreased mortality in adults, but to our knowledge, there are no studies in children. Objective: The objective of this study was to determine the feasibility of implementing EIC as the standard dosing strategy in a pediatric population. Methods: This was a descriptive study of children aged 1 month to 17 years, including patients in the intensive care unit, who received cefepime after admission to a freestanding, tertiary care children’s hospital. Patients were excluded if they were admitted to the neonatal intensive care unit or received cefepime in the outpatient, operating, or emergency department areas. Demographic and clinical data for patients who received cefepime from April through August 2013, the period following EIC implementation, were extracted from the medical records. Results: A total of 150 patients were included in the study, with a median age (interquartile range [IQR]) of 6 years (2-12.3 years) and median weight (IQR) of 20.7 kg (13.2-42.8 kg); 143 patients received cefepime via extended infusions, and 10 (7.0%) of those were changed to a 30-minute infusion during treatment. The most common reasons for infusion time change were intravenous (IV) incompatibility and IV access concerns, responsible for 50% of changes. Dosing errors and reported incidents during therapy were sparse (n = 12, 8.0%) and were most commonly related to renal dosing errors and/or initial dose error by prescriber. Conclusions: Because 93.0% of the patients who initially received EIC remained on EIC, implementation of EIC as the standard dosing strategy was feasible in this pediatric hospital

Free-living dietary intake in tactical personnel and implications for nutrition practice: a systematic review

Tactical personnel (including military, law enforcement, and fire and rescue) are responsible for ensuring national and public safety. Dietary intake is an important consideration to support optimal health and performance. The aims of this systematic review were to: (1) describe the reported free-living dietary intake (energy and macronutrients) of tactical personnel, and (2) describe the practical implications of reported dietary intakes to support the physical and dietary requirements of tactical personnel. A systematic search of databases (MEDLINE, EMBASE, CINAHL and Web of Science) was conducted following the PRISMA guidelines. English and full text research articles were identified and screened against inclusion and exclusion criteria. Demographic and dietary intake data were extracted, tabulated, and synthesized narratively. The quality of the studies was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Twenty-two studies (15 military, 4 law enforcement, and 2 fire and rescue) were eligible to inform this review. The volume of evidence suggested that tactical personnel met dietary protein and exceeded dietary fat recommendations but failed to meet energy and carbohydrate recommendations. Therefore, practical approaches to support optimized energy, fat and carbohydrate intake in tactical personnel is important