Julie P. Katkin

Healthcare costs within a year of respiratory syncytial virus among Medicaid infants.

Limited research exists on the economic impact of respiratory syncytial virus lower respiratory infection (RSV LRI) among vulnerable infant populations. This study evaluated healthcare costs of full‐term and late‐preterm Medicaid infants with RSV LRI within 1 year of infection. Medicaid administrative claims were used to conduct a retrospective study of infants born 2003–2005. Full‐term and late‐preterm infants <1 year old were assigned to groups based on RSV LRI and unspecified bronchiolitis/pneumonia (UBP) diagnosis codes and stratified by setting of diagnosis. Infants without evidence of RSV LRI/UBP were selected as a comparison group. Economic and clinical outcomes were analyzed descriptively using propensity score weighting, and logged ordinary least squares models were used to examine relationship between RSV and costs incurred within 1 year of infection. RSV LRI and UBP infants, regardless of gestational age or healthcare setting, were more likely to experience respiratory diagnoses of wheezing and infantile asthma versus comparisons. Adjusted and weighted healthcare costs were significantly higher for all groups of RSV LRI and UBP infants relative to comparison infants (P < 0.001). Among late‐preterm infants with inpatient and outpatient RSV, marginal costs compared with controls were

Preterm Infants With Congenital Heart Disease and Bronchopulmonary Dysplasia: Postoperative Course and Outcome After Cardiac Surgery

17,465 and

Improving Care for Children With Sickle Cell Disease/Acute Chest Syndrome

2,158, respectively. Costs for RSV LRI and UBP Medicaid infants are substantial. While much of the costs result from initial RSV episodes, higher post‐episode costs and rates of respiratory events, procedures, and medications in RSV and UBP infants versus comparisons indicate long‐term economic impact from infection and the impact is greater among late‐preterm compared to full‐term infants. Pediatr. Pulmonol. 2010; 45:772–781.

Guiding Principles for Team-Based Pediatric Care

Objective. Success in treatment of premature infants has resulted in increased numbers of neonates who have bronchopulmonary dysplasia (BPD) and require surgical palliation or repair of congenital heart disease (CHD). We sought to investigate the impact of BPD on children with CHD after heart surgery. Methods. This was a retrospective, multicenter study of patients who had BPD, defined as being oxygen dependent at 28 days of age with radiographic changes, and CHD and had cardiac surgery (excluding arterial duct ligation) between January 1991 and January 2002. Forty-three infants underwent a total of 52 cardiac operations. The median gestational age at birth was 28 weeks (range: 23–35 weeks), birth weight was 1460 g (range: 431–2500 g), and age at surgery was 2.7 months (range: 1.0–11.6 months). Diagnoses included left-to-right shunts (n = 15), conotruncal abnormalities (n = 13), arch obstruction (n = 6), univentricular hearts (n = 4), semilunar valve obstruction (n = 3), Shone syndrome (n = 1), and cor triatriatum (n = 1). Results. Thirty-day survival was 84% with 6 early and 6 late postoperative deaths. Survival to hospital discharge was 68%. There was 50% mortality for patients with univentricular hearts and severe BPD. The median duration of preoperative ventilation was 76 days (range: 2–244 days) and of postoperative ventilation was 15 days (range: 1–141 days). The median duration of cardiac ICU stay was 7.5 days (range: 1–30 days) and of hospital stay was 115 days (range: 35–475 days). Current pulmonary status includes on room air (n = 14), O2 at home (n = 4), and ventilated at home (n = 4) or in hospital (n = 4), and 5 patients were lost to follow-up. Conclusions. BPD has significant implications for children who have CHD and undergo cardiac surgery, leading to prolonged ICU and hospital stays, although most survivors are not O2 dependent. Postoperative mortality was highest among patients with univentricular hearts and severe BPD. Optimal timing of surgery and strategies to improve outcome remains to be delineated.

Protection from Hyperoxia-Induced Cytostatis in H441 Cells by Enhancement of Mitochondrial Glutathione Reductase Activities Via Adenoviral Transfection

BACKGROUND: Acute chest syndrome (ACS) is a leading cause of hospitalization and death of children with sickle cell disease (SCD). An evidence-based ACS/SCD guideline was established to standardize care throughout the institution in February 2008. However, by the summer of 2009 use of the guideline was inconsistent, and did not seem to have an impact on length of stay. As a result, an implementation program was developed. OBJECTIVE: This quality-improvement project evaluated the influence of the development and implementation of a clinical practice guideline for children with SCD with ACS or at risk for ACS on clinical outcomes. METHODS: Clinical outcomes of 139 patients with SCD were evaluated before and after the development of the implementation program. Outcomes included average length of stay, number of exchange transfusions, average cost per SCD admission, and documentation of the clinical respiratory score and pulmonary interventions. RESULTS: Average length of stay decreased from 5.8 days before implementation of the guideline to 4.1 days after implementation (P = .033). No patients required an exchange transfusion. Average cost per SCD admission decreased from

Immunolocalization and Functional Analysis of Human Glutathione Reductase Targeted to the Mitochondria

30 359 before guideline implementation to

Effective Attenuation of Cellular Glutathione Reductase Activities by Transgenic Expression of Dominant Negative Mutants

22 368. Documentation of the clinical respiratory score increased from 31.0% before implementation to 75.5%, which is an improvement of 44.5% (P < .001). Documentation of incentive spirometry and positive expiratory pressure increased from 23.3% before implementation to 50.4%, which is an improvement of 27.1% (P < .001). CONCLUSIONS: Implementation of a guideline for children with SCD with ACS or at risk for ACS improved outcomes for patients with SCD.

Mitochondrially Targeted Gene Transfer of Glutathione Reductase Protects H441 cells from t-BuOOH Induced Oxidant Stresses • 1713

The American Academy of Pediatrics (AAP) recognizes that children’s unique and ever-changing needs depend on a variety of support systems. Key components of effective support systems address the needs of the child and family in the context of their home and community and are dynamic so that they reflect, monitor, and respond to changes as the needs of the child and family change. The AAP believes that team-based care involving medical providers and community partners (eg, teachers and state agencies) is a crucial and necessary component of providing high-quality care to children and their families. Team-based care builds on the foundation of the medical home by reaching out to a potentially broad array of participants in the life of a child and incorporating them into the care provided. Importantly, the AAP believes that a high-functioning team includes children and their families as essential partners. The overall goal of team-based care is to enhance communication and cooperation among the varied medical, social, and educational partners in a child’s life to better meet the global needs of children and their families, helping them to achieve their best potential. In support of the team-based approach, the AAP urges stakeholders to invest in infrastructure, education, and privacy-secured technology to meet the needs of children. This statement includes limited specific examples of potential team members, including health care providers and community partners, that are meant to be illustrative and in no way represent a complete or comprehensive listing of all team members who may be of importance for a specific child and family.

OPTIMIZING THE DOSE OF RECOMBINANT ADENOVIRUS FOR TRANSGENE DELIVERY TO THE LUNG. 2309

Protection from Hyperoxia-Induced Cytostatis in H441 Cells by Enhancement of Mitochondrial Glutathione Reductase Activities Via Adenoviral Transfection

Exogenous Surfactant Enhances the Delivery of Recombinant Adenoviral Vectors to the Lung

Immunolocalization and Functional Analysis of Human Glutathione Reductase Targeted to the Mitochondria