Age <1 month and longer duration of surgery were independently associated with hospitalized SSI after CV surgery in children.
Summary:Purpose. To describe the clinical characteristics of children with a first-time nonfebrile seizure in the setting of mild illness and to test the hypothesis that these seizures are associated with illness characterized by diarrhea.Methods. This retrospective cohort study was performed in a pediatric emergency department. Patients ages 6 months to 6 years who were evaluated with first-time seizures were eligible for inclusion. Subjects were divided into three groups on the basis of symptoms accompanying their seizure: febrile (temperature, >38.0• C with seizure), unprovoked (no symptoms of illness), and nonfebrile illness (no fever at the time of seizure, but other symptoms of illness present).Results. Of the 323 children with first-time seizures, 247 (76%) had febrile seizure, 37 (12%) had unprovoked seizures, and 39 (12%) had nonfebrile illness seizures. Children with nonfebrile illness seizures were more likely than children with febrile seizures to have diarrheal illnesses accompanying their seizure (44 vs. 16%; p = 0.001). Frequency of cough, rhinorrhea, and rash did not differ significantly between children with febrile and nonfebrile illness seizures. Diagnostic testing for infectious etiologies was not performed frequently in either group.Conclusions. Nonfebrile illness seizures may represent a distinct group of seizures with unique epidemiology. Further study to define this seizure group better is warranted.The distinction between febrile seizures and unprovoked seizures has led to major changes in the clinical management of young children with a first seizure. By definition, a febrile seizure must be accompanied with a temperature of ≥100.4• F (38 • C), whereas children with unprovoked seizures are afebrile and have no significant signs of illness (1,2). Children having illnesses with minimal to no elevation of temperature are in a grey area and traditionally have not been thought to belong in either of the aforementioned groups; accordingly, they have been largely excluded from prognostic studies of first-time seizures. As a result, little descriptive information about these patients is available, and virtually no information exists that would inform clinical management and parent counseling.Recently, Lee and Ong (3) published the first controlled study of nonfebrile seizures occurring in the setting of illness. This study was performed in Singapore and demonstrated that diarrhea occurred more frequently in the setting of first-time nonfebrile illness seizures than in firsttime febrile seizures. In addition, several case reports have been published of nonfebrile seizures occurring with mild gastroenteritis where medically significant electrolyte abnormalities and dehydration were absent (4-7). These studies raise intriguing questions about the epidemiology and etiology of first-time nonfebrile seizures occurring in the setting of mild illness.We performed a retrospective pilot study with two aims: (a) to compare the clinical features of children with a firsttime nonfebrile seizure in the settin...
ABSTRACT. Background. Hospital-associated infections are an important cause of patient morbidity and death. Little is known about the variability of infection rates and infection control practices among pediatric hospitals.Methods. This cross-sectional study was performed with the Pediatric Health Information System database, which includes demographic and diagnostic data for 35 freestanding, noncompeting, children's hospitals, and with data from a survey of the hospitals, which yielded additional information on infection control policies and practices. Patients undergoing elective surgical procedures were included in this study.Results. Of the 35 eligible hospitals, 31 (89%) chose to participate in the survey component of this study. A total of 48 278 patients met the inclusion criteria for the study; 2.3% of these patients had respiratory infections and 0.8% had gastrointestinal infections. The frequency of patients diagnosed with respiratory or gastrointestinal infections varied considerably among the hospitals and ranged from <1% to 6%. Certain infection control processes also varied among the hospitals during the study period. For instance, of the 31 hospitals, 12 monitored hand hygiene, 19 had administrative support of hand hygiene, and 16 had alcohol hand gel present for the entire study period. The presence of alcohol hand gel for the entire study was strongly and independently associated with lower odds of gastrointestinal infections (adjusted odds ratio: 0.64; 95% confidence interval: 0.49-0.85).Conclusions. H ospital-associated infections represent a serious and growing health problem. 1,2 The Centers for Disease Control and Prevention (CDC) estimates that ϳ2 million people acquire hospital-associated infections each year and that ϳ90 000 of these patients die as a result of their infections. A variety of hospital-based strategies aimed at preventing such infections have been proposed, and some have been tested. On the basis of such data and expert opinion, the CDC has developed and regularly updates specific guidelines aimed at preventing the transmission of pathogens within the hospital setting. 3 An important component of these guidelines involves hand hygiene. 4 How broadly these recommendations have been implemented in pediatric hospitals is not known. Moreover, despite the quantity of data supporting the use of infection control measures to prevent hospital-associated infections, there have been few multicenter studies examining the variability of infection rates and infection control policies among institutions and investigating which infection control measures might be more important, especially in pediatric settings. Therefore, we conducted this study with 3 objectives, ie, (1) to describe the variation in the infection control practices in a large diverse sample of children's hospitals, (2) to describe the variation in the rates of hospital-associated infections in these institutions, and (3) to determine which infection control policies were associated with lower rates of hospital-associate...
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