Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Miranda Hester

Although mastitis is more often connected to new mothers who are breastfeeding, the condition can occur in infants. A 

 offered information on the clinical presentation, prevalence, and outcomes of a simultaneous serious bacterial infection with mastitis.

The investigators reviewed the records of infants aged ≤90 days who were treated for mastitis at 28 sites in the United States, Canada, and Spain that were part of the Pediatric Emergency Medicine Collaborative Research Committee. The infants had been seen in the emergency department.

There were 657 infants included in the study and nearly all of them were well-appearing at the time of presentation. There was a history of fever either at home or the emergency department for 138 of the infants and 63 of them had reported poor feeding or fussiness. Blood was collected in 581 infants; Urine was collected in 274 infants; and cerebrospinal fluid cultures were taken for 216 infants. There were pathogens in 0.3%of (95% [CI] 0.04–1.2) of blood, 1.1% (95% CI 0.2–3.2) of urine, and 0.4% (95% CI 0.01–2.5) of cerebrospinal fluid cultures. Site of infection cultures were collected for 335 infants and 77% of those cultures grew a pathogen. The most commonly grown pathogen was methicillin-resistant 

were the other commonly grown pathogens. Ninety percent of the infants were admitted to inpatient care at the hospital and 22 had to be admitted to the intensive care unit. There were 10 (1.5% [95% CI 0.7–2.8]) cases that had either sepsis or shock and 2 (0.3% [95% CI 0.04–1.1]) had severe cellulitis or necrotizing soft tissue infection. No cases required the use of vasopressors or endotracheal intubation and no infant died.

The investigators concluded that in most cases of neonatal the condition was mild and localized. A serious bacterial infection and adverse outcomes were highly uncommon. When presented with an afebrile, well-appearing infant with mastitis, evaluating for serious bacterial infection is likely not necessary.

1. Kaplan R, Cruz A, Michelson K. Neonatal mastitis and concurrent serious bacterial infection. 

. July 1, 2021. Epub ahead of print. doi:10.1542/peds.2021-051322

Articles

A report examines the prevalence of neonatal mastitis and the outcomes of a concurrent serious bacterial infection.

Treating neonatal mastitis

It’s recommended that children have at least 20 minutes of seated time for lunch, but there are no widespread regulations that ensure that children get this and many schools have reduced lunch periods to add time to educational periods. A

 looked into whether a lunch period of 20 seated minutes led to better nutrient intake and less waste than a 10 seated minute lunch period.

Investigators invited children who were participating in a summer camp at the University of Illinois at Urbana-Champaign. The children were elementary or middle school-age and were given a lunch that met National School Lunch Program nutrition standards. There were 5 menus served during the course of the study and a 20-minute or 10-minute seated lunch period was randomly assigned to each day. Primary outcomes were food waste, food consumption, and dietary intake, which was separated into meal component and assessed for calories, fat, carbohydrates, fiber, protein, vitamin D, calcium, iron, and potassium.

A total of 241 lunch trays for 38 were observed. The investigators noted that during the 10 minutes of seated lunch time, children consumed a significantly less amount of vegetables (−14.1 percentage points; 95% CI, −22.7 to −5.7) and fruits (−11.3 percentage points; 95% CI, −18.1 to −4.5) than in the 20 minutes of seated lunch time. Waste as well as entrée and beverage consumption showed no differences between either lunch condition. Additionally, during the 20-minute seated lunch period, children consumed more and wasted significantly less dietary fiber (−0.51 g; 95% CI, −0.81 to −0.19 g), protein (−1.11 g; 95% CI, −2.17 to −0.04 g), iron (−0.20 mg; 95% CI, −0.38 to −0.02 mg), potassium (−53.49 mg; 95% CI, −84.67 to −22.32 mg), carbohydrates (−3.81 g; 95% CI, −6.20 to −1.42 g), and calories (−22.03 kcal; 95% CI, −39.47 to −4.61 kcal).

The investigators concluded that a longer lunch period led to children eating more fruits and vegetables. They believe that the findings support the creation of policies that ensure children have at least 20 minutes of seated lunch time to ensure children get nutritious lunches.

1. Burg X, Metcalfe J, Ellison B, Prescott M. Effects of longer seated lunch time on food consumption and waste in elementary and middle school–age children: a randomized clinical trial. 

. 2021;4(6):e2114148. doi:10.1001/jamanetworkopen.2021.14148

With the need to pack as much time in the classroom, many school districts have taken time away from the lunch period. A report illuminates why that may be hurting children’s nutrition.

Longer lunch periods could improve nutrition

Over the past several years, access to pediatric care has shifted and families may find themselves living in an area with a lack of pediatric inpatient units. A

examines the trends in both pediatric inpatient unit capacity and access, as well as a look at what units are risk of closure.

The investigators used the 2008-2018 American Hospital Association survey to do a retrospective study of 4720 hospitals in the United States. They compared by state the trends in pediatric inpatient days and bed counts. Changes in access to care were measured by calculating the distance to the nearest pediatric inpatient services by census block group. Trends in pediatric inpatient unit and pediatric intensive care unit capacity were described using linear regression.

They found that during the studied time that pediatric inpatient units decreased by (34 units per year; 95% CI 31 to 37) as well as a decrease of 11.8% in the number of pediatric inpatient unit beds (407 beds per year; 95% CI 347 to 468). There was an increase in pediatric intensive care unit beds of 16.0% (66.9 beds per year; 95% CI 53 to 81), but this increase was mostly seen in children’s hospitals rather than general hospitals. Most states in the country saw decreases in pediatric inpatient days (median state −10.0%) and pediatric inpatient unit beds (median state −18.5%). Unsurprisingly, rural areas saw steeper declines in pediatric inpatient unit beds than nonrural areas (−26.1% vs −10.0%). Roughly 25% of all children in the United States saw a distance increase to the nearest pediatric inpatient unit. The highest risk of closing was noted for units that had low volume as well as those that did not have an associated pediatric intensive care unit.

The investigators concluded that overall pediatric inpatient unit capacity is declining across the United States. Access to this care is becoming increasingly unavailable to an increasing number of children, many in rural areas who already face care access issues.

1. Cushing A, Bucholz E, Chien A, Rauch D, Michelson K. Availability of pediatric inpatient services in the United States. 

. June 14, 2021. Epub ahead of print. doi:10.1542/peds.2020-041723

The regionalizing of pediatric care and a decline in pediatric hospitalizations has led to shifts in pediatric inpatient care. A report looks at the current inpatient care trends.

How available is pediatric inpatient care?

Extremely preterm infants often require support following delivery to breathe. A system with low imposed work of breathing and an interface that has short binasal prongs was recently introduced. An

 examined whether this new system decreased the need for intubation in the delivery room or death during the stabilization process.

Investigators performed this unblinded randomized clinical trial in 7 neonatal intensive care units in 5 European countries from March 2016 to May 2020. They screened mothers who were indicating they would deliver preterm before week 28 of gestation. The infants were randomized before birth to the intervention group that used the new respiratory support system with short binasal prongs or into the control group of standard care, which was a standard T-piece system with face mask. Regardless of the group, the infants were given continuous positive airway pressure for 10 to 30 minutes along with positive pressure ventilation, if required.

There were 246 liveborn infants who received treatment. The average gestational age was 25.9 weeks. Forty-one infants who received treatment with the new respiratory support system were either intubated or died in the delivery room. By comparison, 55 infants who received standard care were intubated or died in the delivery the room. No significant differences in safety variables or secondary outcomes were noted. The adjusted odd ratio was statistically significant even after adjusting for stratification variables (adjusted odds ratio, 0.53; 95% CI, 0.30-0.94; 

The investigators concluded that the new respiratory support system did lead to a reduction in the need to intubate extremely preterm infants in the delivery room. Furthermore, the use of low imposed work of breathing and binasal prongs appears to be a safe and feasible practice.

1. Donaldsson S, Drevhammar T, Li Y, et al. Comparison of respiratory support after delivery in infants born before 28 weeks’ gestational age. 

. June 14, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.1497

An investigation looks into whether a new respiratory support system reduces intubation or death in the delivery room.

Miranda Hester

Articles

Treating neonatal mastitis

Longer lunch periods could improve nutrition

How available is pediatric inpatient care?

Comparing delivery room respiratory support for extremely preterm infants