Outcomes of Children With Critical Bronchiolitis Living in Poor Communities

Slain, Katherine; Shein, Steven L.; Stormorken, Anne; Broberg, Meredith; Rotta, Alexandre T.

doi:10.1177/0009922817740666

Cited by 27 publications

(18 citation statements)

References 38 publications

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“…Arabs in Israel generally have a lower socioeconomic status than do Jews, and more than 50% of the Arab population lives under the national poverty line [24]. Slain et al found that living in a poorer community (as expressed by a lower Federal Poverty Threshold) was significantly associated with longer PICU LOS, longer hospital LOS, higher odds of needing mechanical ventilation, and increased hospital charges in children with bronchiolitis [25].…”

Section: Discussionmentioning

confidence: 99%

Factors predicting length of stay in bronchiolitis

Masarweh

Gur

Leiba

et al. 2020

Respiratory Medicine

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Section: Discussionmentioning

confidence: 99%

Factors predicting length of stay in bronchiolitis

Masarweh

Gur

Leiba

et al. 2020

Respiratory Medicine

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“…9 This later subset of patients is termed to have "critical bronchiolitis." 10,11 The treatment of bronchiolitis is largely supportive, with evidence-based guidelines focusing on provision of fluids, comfort measures, and oxygen supplementation to correct hypoxemia. 12 Patients with critical bronchiolitis and acute respiratory failure, however, may require more advanced treatments, such as instrumentation with arterial or central venous catheters, inotropic and vasoactive infusions, noninvasive respiratory support, and mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

Cesar

Bispo

Felix

et al. 2020

J Pediatr Intensive Care

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We conducted a randomized controlled pilot study in infants with critical bronchiolitis (n = 63) comparing high-flow nasal cannula (HFNC, n = 35) to continuous positive airway pressure (CPAP, n = 28). The primary outcome was treatment failure, defined as the need for bilevel positive pressure ventilation or endotracheal intubation. Treatment failure occurred in 10 patients (35.7%) in the CPAP group and 13 patients (37.1%) in the HFNC group (p = 0.88). Pediatric intensive care unit length of stay was similar between the CPAP and HFNC groups (5 [4–7] days and 5 [4–8] days, p = 0.46, respectively). In this pilot study, treatment with HFNC resulted in a rate of treatment failure similar to CPAP.

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“…Poverty is linked to adverse health outcomes across multiple pediatric conditions. [1][2][3][4][5][6][7][8][9][10] For the 13 million children currently growing up in poverty in the United States, the adverse exposures, heightened stress, and diminished access to healthpromoting resources that accompany a lower socioeconomic status negatively affect health and development through their entire lifetimes. [11][12][13][14] Socioeconomic disparities extend to pediatric critical illness.…”

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confidence: 99%

“…[11][12][13][14] Socioeconomic disparities extend to pediatric critical illness. Although the relationships between poverty and critical illness have not been thoroughly explored, available evidence suggests that children from lower-income families and communities are more likely to be admitted to the PICU because of both acute and chronic illnesses, 1,15 are more gravely ill at the time of admission, 15,16 and are more likely to die before PICU or hospital discharge. 17,18 We recently used the inpatient bedday (IPBD) rate to calculate and evaluate the burden of acute childhood illnesses across neighborhoods in our region.…”

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confidence: 99%

Neighborhood Poverty and Pediatric Intensive Care Use

et al. 2019

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BACKGROUND: Disparities in health service use have been described across a range of sociodemographic factors. Patterns of PICU use have not been thoroughly assessed. METHODS: This was a population-level, retrospective analysis of admissions to the Cincinnati Children's Hospital Medical Center PICU between 2011 and 2016. Residential addresses of patients were geocoded and spatially joined to census tracts. Pediatric patients were eligible for inclusion if they resided within Hamilton County, Ohio. PICU admission and bed-day rates were calculated by using numerators of admissions and bed days, respectively, over a denominator of tract child population. Relationships between tract-level PICU use and child poverty were assessed by using Spearman's r and analysis of variance. Analyses were event based; children admitted multiple times were counted as discrete admissions. RESULTS: There were 4071 included admissions involving 3129 unique children contributing a total of 12 297 PICU bed days. Child poverty was positively associated with PICU admission rates (r = 0.59; P , .001) and bed-day rates (r = 0.47; P , .001). When tracts were grouped into quintiles based on child poverty rates, the PICU bed-day rate ranged from 23.4 days per 1000 children in the lowest poverty quintile to 81.9 days in the highest poverty quintile (P , .001). CONCLUSIONS: The association between poverty and poor health outcomes includes pediatric intensive care use. This association exists for children who grow up in poverty and around poverty. Future efforts should characterize the interplay between patient-and neighborhoodlevel risk factors and explore neighborhood-level interventions to improve child health. WHAT'S KNOWN ON THIS SUBJECT: Poverty adversely affects health. The health impacts of socioeconomic status and poverty occur at the individual and community levels. Socioeconomic disparities in PICU use have not been as robustly assessed compared with other medical disciplines. WHAT THIS STUDY ADDS: Socioeconomic disparities extend to pediatric critical illness. Neighborhood poverty affects children' s need for intensive care. We argue that this association represents more than an aggregate of individual risk factors, and the interplay of individual and community demographics merits further investigation.

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Outcomes of Children With Critical Bronchiolitis Living in Poor Communities

Cited by 27 publications

References 38 publications

Factors predicting length of stay in bronchiolitis

Factors predicting length of stay in bronchiolitis

High-Flow Nasal Cannula versus Continuous Positive Airway Pressure in Critical Bronchiolitis: A Randomized Controlled Pilot

Neighborhood Poverty and Pediatric Intensive Care Use

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