Raquel García Romero

Was not provided for this article.

Background: Hospital-at-home (HAH) programs deliver hospital-level care in patients’ homes, improving satisfaction and optimizing resource use. While widely adopted in adults, pediatric HAH remains limited. At Sant Joan de Déu Hospital (Barcelona, Spain), the pediatric HAH program for acutely ill children has expanded to include more clinically complex cases. Family involvement is essential, as caregivers are trained to administer treatments, monitor clinical status, and support telematic follow-ups, supporting the healthcare team’s workload. Objective: To identify patient characteristics influencing healthcare workload and develop a predictive model to enhance resource allocation. Methods: This single-center, prospective cohort study included all patients admitted to the pediatric HAH program for one year. Primary variables were caregiver training time, home visiting time, patient age, type of care provided, and clinical complexity. Secondary variables included referral specialty and team composition. Data were collected using digital time-tracking, manual records, and clinical databases. Analyses included Kruskal–Wallis and Dunn’s multiple comparison tests. Results: All variables showed significant differences in training and visiting times. Training time ranged from 19 to 157 min; visiting time from 6.2 to 157 min. A predictive model using five key variables estimated visiting time, and another model based on care type estimated training time were created. Conclusions: Patient characteristics and caregiver involvement significantly affect direct care workload. These findings can inform strategies to optimize staffing and scale pediatric HAH programs effectively.

Background/objectives: Infections caused by carbapenem-resistant Enterobacterales (CRE) are progressively increasing in Pediatric Intensive Care Units (PICUs). Its treatment is challenging due to the lack of pediatric trials. CRE infections are associated with significantly poor outcomes, but ceftazidime–avibactam (CAZ-AVI) has been reported to be successful in their treatment. This study aimed to describe the use and outcome of CAZ-AVI in a PICU. Results: Ten patients were included, with 12 episodes of clinical suspicion or confirmed multidrug-resistant (MDR) bacterial infections treated with CAZ-AVI for surgical prophylaxis, suspicion of sepsis, pneumonia, and surgical wound infection. Of these patients, 80% received empirical treatment because of previous MDR bacterial colonization, and 60% were administrated combination therapy with aztreonam for Metallo-β-Lactamases (MBL)strains. No bacteria were resistant to CAZ-AVI. The average duration of the treatment was 3 days when cultures turned negative and 7 days when MDR bacteria were isolated. Methods: This was an observational prospective study of children treated with CAZ-AVI in the PICU of a tertiary hospital in 2022. Epidemiological, clinical, microbiological, and outcome data were collected. Conclusions: The most frequent use of CAZ-AVI in our PICU was the short-term empirical treatment for patients with previous MDR bacterial colonization and clinical suspicion of bacteremia or sepsis. Furthermore, the combination of CAZ-AVI plus aztreonam could be more effective for CRE infections, especially type Ambler class B as MBL strains.

Purpose: On the 14th of March 2020, the Spanish government decreed a state of alarm due to the coronavirus disease 2019 (COVID-19) pandemic, directly affecting healthcare. This situation led to delayed diagnosis of several serious diseases, and its impact on many diseases such as the onset of type 1 diabetes mellitus (T1DM) remains unknown. The aim of this study is to determine the impact of the COVID-19 pandemic on the onset of T1DM in children.Methods: A descriptive-observational study was performed using data from children younger than 18 years (n=115) admitted with diagnosis of T1DM. We compared the 8 months from May–December 2020 to the same timeframe in 2019.Results: Our data show an increase of newly attended cases of T1DM in 2020, due to referral of Catalan children with onset of diabetes to our centre. Moreover, fewer patients presented with simple hyperglycaemia at the onset of the COVID-19 period. Delay in consulting the hospital, decreased access to the healthcare system, and avoidance of hospitals to minimize exposure to COVID-19 could have contributed to this finding. There were no differences in the number of days of hospitalization (including days in the paediatric intensive care uniy) between the years.Conclusion: The effects of the lockdown during the COVID-19 pandemic not only delayed the diagnosis of diabetes, but also its allowed time for its severity to increase. Future studies should focus on the influence of new variants of COVID-19 on the onset of T1DM during the postvaccination period.