Publications by authors named "Steven Shein"
Background: Characteristics of children with impaired development who have acute appendicitis are not well described in the literature.
Methods: We reviewed the National Surgical Quality Improvement Program-Pediatric and the multicenter Pediatric Health Information System for patients with acute appendicitis. Comparisons for demographics, clinical outcomes, and hospital charges between children with impaired development versus neurotypical children were made using independent t test or Wilcoxon rank sum tests.
Background And Objectives: High-flow nasal cannula (HFNC) for bronchiolitis increased over the past decade without clear benefit. This quality improvement collaborative aimed to reduce HFNC initiation and treatment duration by 30% from baseline.
Methods: Participating hospitals either reduced HFNC initiation (Pause) or treatment duration (Holiday) in patients aged <24 months admitted for bronchiolitis.
Article Synopsis
- The study aimed to find out how common respiratory bacterial codetection is in children under 2 years old who are intubated for acute lower respiratory tract infections, mainly viral bronchiolitis, and to see how it affects the duration of mechanical ventilation.
- It analyzed 472 children, finding that 29% had bacterial codetection, with younger age and positive RSV tests linked to higher rates, while codetection didn't show a clear connection to longer mechanical ventilation duration.
- The research suggests that while bacterial codetection is common, it may not significantly impact the length of time patients need invasive mechanical ventilation.
Over 20,000 children are hospitalized in the United States for asthma every year. Although initial treatment guidelines are well established, there is a lack of high-quality evidence regarding the optimal respiratory support devices for these patients. The objective of this study was to evaluate institutional and temporal variability in the use of respiratory support modalities for pediatric critical asthma.
View Article and Find Full Text PDFObjectives: To describe rates and associated risk factors for functional decline 6 months after critical bronchiolitis in a large, multicenter dataset.
Design: Nonprespecified secondary analysis of existing 6-month follow-up data of patients in the Randomized Evaluation of Sedation Titration for Respiratory Failure trial ( RESTORE , NCT00814099).
Setting: Patients recruited to RESTORE in any of 31 PICUs in the United States, 2009-2013.
Objective: To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.
Methods: Across 25 U.S.
Objectives: Children with status asthmaticus refractory to first-line therapies of systemic corticosteroids and inhaled beta-agonists often receive additional treatments. Because there are no national guidelines on the use of asthma therapies in the PICU, we sought to evaluate institutional variability in the use of adjunctive asthma treatments and associations with length of stay (LOS) and PICU use.
Design: Multicenter retrospective cohort study.
Importance: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.
Objective: To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.
Design, Setting, And Participants: This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states.
Background: Influenza virus is responsible for a large global burden of disease, especially in children. Multiple Organ Dysfunction Syndrome (MODS) is a life-threatening and fatal complication of severe influenza infection.
Methods: We measured RNA expression of 469 biologically plausible candidate genes in children admitted to North American pediatric intensive care units with severe influenza virus infection with and without MODS.
Objectives: Existing bronchiolitis guidelines do not reflect the needs of infants admitted to the PICU. This study aimed to identify PICU providers' reported practice variations and explore the need for critical bronchiolitis clinical guidelines.
Methods: Cross-sectional electronic survey available in English, Spanish, and Portuguese between November 2020 and March 2021, distributed via research networks from North and Latin America, Asia, and Australia/New Zealand.
Objectives: Describe the frequency with which transfusion and medications that modulate lung injury are administered to children meeting at-risk for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria and evaluate for associations of transfusion, fluid balance, nutrition, and medications with unfavorable clinical outcomes.
Design: Secondary analysis of the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study, a prospective point prevalence study. All enrolled ARF-PARDS patients were included unless they developed subsequent pediatric acute respiratory distress syndrome (PARDS) within 24 hours of PICU admission or PICU length of stay was less than 24 hours.
Objectives: The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS.
Design: Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study.
Background And Objectives: There is a paucity of multicenter data on rates of high flow nasal cannula (HFNC) usage in bronchiolitis in the United States, largely because of the absence of standardized coding, with HFNC often subsumed into the larger category of noninvasive mechanical ventilation.
Methods: We examined HFNC utilization in patients with bronchiolitis from a sample of hospitals participating in a national bronchiolitis quality improvement collaborative. Medical records of patients aged <2 years admitted November 2019 to March 2020 were reviewed and hospital-specific bronchiolitis policies were collected.
Unlabelled: Pediatric acute respiratory distress syndrome (PARDS) is a prevalent condition in the PICU with a high morbidity and mortality, but effective preventative strategies are lacking.
Objectives: To examine associations between early enteral nutrition (EN) and PICU outcomes in a cohort of children meeting the 2015 Pediatric Acute Lung Injury Consensus Conference "at-risk" for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria.
Design Setting And Participants: This was a single-center, electronic health record-based retrospective chart review.
Article Synopsis
- - The study investigates whether disparities in hospital utilization, specifically length of stay (LOS) and costs, are linked to ZIP codes in children with traumatic brain injury (TBI) using the Child Opportunity Index (COI).
- - Conducted as a multicenter retrospective cohort study using data from the Pediatric Health Information System (PHIS), it analyzed 8,055 children aged 0-18 years with TBI admitted to PICUs between 2016 and 2020.
- - Results showed that children from very low COI ZIP codes had a 10.2% longer average hospital stay compared to those from very high COI areas, but COI did not correlate with hospital costs and was not predictive for children with
Objectives: In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) provided the first pediatric-specific definitions for acute respiratory distress syndrome (pediatric acute respiratory distress syndrome [PARDS]). These definitions have since been operationalized in cohort and interventional PARDS studies. As substantial data have accrued since 2015, we have an opportunity to assess the construct validity and utility of the initial PALICC definitions.
View Article and Find Full Text PDFBackground: Hospitalization for severe influenza infection in childhood may result in postdischarge sequelae.
Objective: To evaluate inpatient management and postdischarge sequelae in children with critical respiratory illness owing to influenza with or without preexisting asthma.
Methods: This was a prospective, observational multicenter study of children (aged 8 months to 17 years) admitted to a pediatric intensive care or high-acuity unit (in November 2019 to April 2020) for influenza.
The field of pediatric critical care has been hampered in the era of precision medicine by our inability to accurately define and subclassify disease phenotypes. This has been caused by heterogeneity across age groups that further challenges the ability to perform randomized controlled trials in pediatrics. One approach to overcome these inherent challenges include the use of machine learning algorithms that can assist in generating more meaningful interpretations from clinical data.
View Article and Find Full Text PDFContinuous positive airway pressure (CPAP) and heated humidified high-flow nasal cannula (HFNC) are commonly used to treat children admitted to the PICU who require more respiratory support than simple oxygen therapy. Much has been published on these two treatment modalities over the past decade, both in Pediatric Critical Care Medicine (PCCM ) and elsewhere. The majority of these studies are observational analyses of clinical, administrative, or quality improvement datasets and, therefore, are only able to establish associations between exposure to treatment and outcomes, not causation.
View Article and Find Full Text PDFObjectives: To map the literature regarding assessment of neurocognitive outcomes in PICU survivors. Secondary objectives were to identify literature gaps and to provide data for development of a Core Outcome Measures Set in the domain.
Methods: Planned, analysis was performed of data from an over-all scoping review of Post-Intensive Care Syndrome-pediatrics (PICS-p) functional outcomes.
Objectives: To characterize the prevalence of pediatric critical illness from multisystem inflammatory syndrome in children (MIS-C) and to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain on outcomes.
Design: Retrospective cohort study.
Setting: Database evaluation using the Virtual Pediatric Systems Database.
Background: Seasonal influenza virus infection causes a range of disease severity, including lower respiratory tract infection with respiratory failure. We evaluated the association of common variants in interferon (IFN) regulatory genes with susceptibility to critical influenza infection in children.
Methods: We performed targeted sequencing of 69 influenza-associated candidate genes in 348 children from 24 US centers admitted to the intensive care unit with influenza infection and lacking risk factors for severe influenza infection (PICFlu cohort, 59.