Background Acute chest syndrome (ACS) is a leading cause of morbidity and mortality among children with sickle cell disease (SCD). Preventing hypoxemia by optimizing lung aeration during sleep remains a challenge. Objectives To explore safety, feasibility, and tolerability of noninvasive, bi‐level positive airway pressure ventilation (BiPAP) as preventative, supportive care for hospitalized, medically stable children with SCD on a general pediatric inpatient unit. Methods Retrospective chart review of patients ≤22 years of age with SCD admitted to the general pediatric inpatient unit from February 1, 2017 to March 1, 2020 for whom BiPAP was recommended as supportive care. Hospitalizations were excluded if patients were admitted to the pediatric intensive care unit (PICU), required BiPAP for respiratory failure, or used BiPAP at home for obstructive sleep apnea. Results Twenty‐three patients had 53 hospitalizations in which BiPAP was recommended. Fifty‐two (98%) hospitalizations included acute SCD pain. Indications for BiPAP included prior ACS (94%), chest or back pain (79%), and/or oxygen desaturation (66%). On 17 occasions, patients already had mild to moderate ACS but were stable when BiPAP was recommended. BiPAP was used successfully during 75% of hospitalizations for a median of two nights. There were no adverse effects associated with BiPAP. PICU transfer for respiratory support occurred during three hospitalizations. In 26 hospitalizations of children at risk for ACS who tolerated BiPAP, 23 (88%) did not develop ACS. Conclusions BiPAP is safe, feasible, and well tolerated as supportive care for hospitalized children with SCD. Next steps include an intervention trial to further assess the efficacy of BiPAP on ACS prevention.
to screen for child care. In total, six adverse SDH (food insecurity, housing instability, lack of after school activities, lack of heat, lack of high school degree or college enrollment, and unemployment) were selected. Available community resources were also identified by a multidisciplinary care team; information sheets for adolescents with needs were accessible via the EMR. To vet the adapted screener, we interviewed adolescent patients over the course of three days in the adolescent clinic waiting room. The interviews assessed the face validity of the screener and adolescents reviewed the screener for understandability, ease to complete, feasibility, and acceptability. Participants' suggestions were incorporated into the final version. The study screener readability was at the third-grade level using the Flesh-Kincaid grade level formula. Overall, it took participants <2 minutes to complete the screener. The screener was then piloted with adolescents. Results: During the 3 day interview period (n¼27), 33% of adolescents reported at least one of the needs included in the WE CARE screener; 30% of adolescents also reported having a friend with at least one of those needs. The most common self-reported unmet needs were with food (22%) and housing (22%), followed by after school activities (19%), utilities (19), employment (15%), and education (3%). 100% of adolescents reported that the screener was easy or very easy to fill out. 89% reported that they felt somewhat comfortable, comfortable, or very comfortable filling it out. Lastly, 93% of adolescents reported that the screener was somewhat useful, useful, or very useful. Conclusions: The adaptation of the pediatric WE CARE screener to address the needs of adolescents in an urban clinic was feasible and acceptable. The adolescent WE CARE intervention identified patients' unmet needs and requests for help with SDH.
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