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Laying the groundwork for the future care of children with complex medical conditions

08/12/2014

Researchers observe variation of antibiotic management among pediatric hospitalizations

As a Pediatric Hospitalist at Floating Hospital for Children, JoAnna Leyenaar, MD, collaborates with a number of different physicians to treat children who have been admitted to the hospital. When she joined Floating Hospital, Dr. Leyenaar noticed a variation in how hospitalists approach pneumonia, the most common cause of pediatric hospitalizations, and that outcomes have not been well-documented. This led Dr. Leyenaar to embark on a research project studying patterns of disease management with the goal of improving the patient experience and outcomes, and ensuring all hospitals are making cost-effective decisions when determining the course of treatment.

Dr. Leyenaar and her colleagues evaluated 31,684 children under 18 years of age who were admitted to 284 U.S. hospitals. Using highly-detailed administrative data, which examined every step in the care plan, they assessed how pneumonia management and outcomes differed between children with complex chronic conditions (CCCs) and children without these conditions. CCCs impact several different organs, require specialty pediatric care and, often, frequent hospitalization.

To understand the effect of CCCs, Dr. Leyenaar and her colleagues studied how antibiotic management and outcomes vary among subgroups of children with these conditions. Those observed include children with CCCs including neuromuscular disorders, cardiovascular malformations, chronic respiratory conditions, renal conditions, gastrointestinal conditions, hematologic or immunologic conditions, metabolic conditions, malignant neoplasms and other congenital or genetic disorders.

Dr. Leyenaar and her team found:

  • 11.9% of participants had a CCC and were more likely to be older and have public health insurance compared to participants without a CCC.
  • Children with CCCs were more likely to receive intensive investigations and therapies, were less likely to receive aminopenicillins or third generation cephalosporins, and were more likely to receive antibiotics against methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and anaerobes.
  • Children with CCCs had longer hospital stays and costs, higher odds of broad spectrum antibiotic coverage, and were more likely to have pneumonia complications and hospital readmission within 30 days of discharge.
  • Approximately one-third of all participants had asthma. 
  • Diagnostic testing, intensive therapies including inotropes, mechanical and noninvasive ventilation, and blood transfusions were more common among participants with CCCs compared to those without.

According to Dr. Leyenaar, “this research is important to highlight both the frequency with which children with complex chronic conditions are admitted to the hospital with pneumonia, and to illustrate that they have a significantly higher risk of treatment escalation and adverse outcomes. This work lays the groundwork for future studies to explore the comparative effectiveness of different antibiotic combinations for children with medical complexity that require hospital admission with pneumonia.”

As a next step, Dr. Leyenaar’s and her team plan to characterize pneumonia etiology among children with complex chronic conditions, which will further inform the most appropriate antibiotics for disease management.

The study was funded in part by the National Center for Advancing Translational Sciences, National Institutes of Health and the National Center for Research Resources.

Pediatric nephrologist, Lawrence Milner, MD and his patient at Floating Hospital for Children.

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