Neuropeptide Y (NPY) Y1 and Y5 receptor subtypes mediate many of NPY's diverse actions in the central nervous system. The present studies use polyclonal antibodies directed against the Y1 and Y5 receptors to map and compare the relative distribution of these NPY receptor subtypes within the rat brain. Antibody specificity was assessed by using Western analysis, preadsorption of the antibody with peptide, and preimmune serum controls. Immunostaining for the Y1 and Y5 receptor subtypes was present throughout the rostral-caudal aspect of the brain with many regions expressing both subtypes: cerebral cortex, hippocampus, hypothalamus, thalamus, amygdala, and brainstem. Further studies using double-label immunocytochemistry indicate that Y1R immunoreactivity (-ir) and Y5R-ir are colocalized in the cerebral cortex and caudate putamen. Y1 receptor ir was evident in the central amygdala, whereas both Y1- and Y5-immunoreactive cells and fibers were present in the basolateral amygdala. Corresponding with the physiology of NPY in the hypothalamus, both Y1R- and Y5R-ir was present within the paraventricular (PVN), supraoptic, arcuate nuclei, and lateral hypothalamus. In the PVN, Y5R-ir and Y1R-ir were detected in cells and fibers of the parvo- and magnocellular divisions. Intense immunostaining for these receptors was observed within the locus coeruleus, A1-5 and C1-3 nuclei, subnuclei of the trigeminal nerve and nucleus tractus solitarius. These data provide a detailed and comparative mapping of Y1 and Y5 receptor subtypes within cell bodies and nerve fibers in the brain which, together with physiological and electrophysiological studies, provide a better understanding of NPY neural circuitries.

OBJECTIVE: To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS: Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS: Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. CONCLUSIONS: Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.

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BACKGROUND Patient discharge from the hospital is linked to physician‐led rounds, whereas discharge from the emergency department (ED) is more fluid. The relationship between rounding and length of stay (LOS) has not been quantitatively described. OBJECTIVES To describe the arrival and discharge patterns in the ED and inpatient settings for children with respiratory illnesses and to explore how the timing and frequency of rounding could impact LOS. DESIGN/SETTING Retrospective administrative data analyses of visits for respiratory illnesses to a tertiary care pediatric ED from May 2007 to April 2010. METHODS ED visits for common respiratory conditions were selected based on International Classification of Diseases, 9th Revision, Clinical Modification codes, excluding complex comorbid conditions, severe illness, and intensive care unit admission. Discharge time was plotted against arrival time for the ED and inpatient unit. LOS was calculated. A Monte Carlo simulation model was developed to explore the influence of additional rounds on inpatient LOS. RESULTS Of the 5503 included visits, 1285 (23.4%) resulted in inpatient care. Discharges from the ED typically occurred 2 to 5 hours after arrival, whereas most inpatient discharges occurred between 11 am and 6 pm regardless of admission time. Simulating 1 additional rounding session decreased predicted inpatient LOS by approximately 5 hours. CONCLUSIONS In contrast to ED discharges that occurred around the clock, inpatient discharges for children with respiratory illnesses were concentrated during afternoon hours. Increasing rounding frequency may improve hospital efficiency but could result in unintended consequences such as fewer opportunities for patient education. Journal of Hospital Medicine 2013;8:678–683. © 2013 Society of Hospital Medicine