BACKGROUND AND OBJECTIVES: Nontherapeutic medication ingestions continue to be a major pediatric health problem, with recent increases in ingestions despite a number of public health interventions. It is unknown how changes in adult prescription drug use relate to pediatric medication poisonings. The objective of the study was to measure the association between changing adult prescription drug patterns and pediatric medication exposures and poisonings and identify high-risk classes of medications and pediatric age groups. METHODS: We measured monthly pediatric exposures and poisonings using the National Poison Data System and prescriptions written for adults using the National Ambulatory Medical Care Surveys for 2000 through 2009. Associations between adult prescriptions for oral hypoglycemics, antihyperlipidemics, β-blockers, and opioids and exposures and poisonings among children 0 to 5, 6 to 12, and 13 to 19 years were analyzed by using multiple time-series analysis. Emergency department visits, serious injuries, and hospitalizations stemming from these associations were described. RESULTS: Adult medication prescriptions were statistically significantly associated with exposures and poisonings in children of all ages, with the strongest association observed for opioids. Across medications, the greatest risk was among children 0 to 5 years old, followed by 13- to 19-year-olds. Rates of emergency department visits were highest for events related to hypoglycemics (60.1%) and β-blockers (59.7%), whereas serious injuries and hospitalizations occurred most frequently with opioids (26.8% and 35.2%, respectively) and hypoglycemics (19.5% and 49.4%, respectively). CONCLUSIONS: Increasing adult drug prescriptions are strongly associated with rising pediatric exposures and poisonings, particularly for opioids and among children 0 to 5 years old. These associations have sizable impacts, including high rates of serious injury and health care use.

https://pediatrics.aappublications.org/content/pediatrics/132/1/18.full.pdf

Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings

The antipyretic analgesics, paracetamol, and non-steroidal anti-inflammatory agents NSAIDs are one of the most widely used classes of medications in children. The aim of this review is to determine if there are any clinically relevant differences in safety between ibuprofen and paracetamol that may recommend one agent over the other in the management of fever and discomfort in children older than 3 months of age.

/pdf/a-clinical-and-safety-review-of-paracetamol-and-ibuprofen-in-sz2nqhm7yl.pdf

A clinical and safety review of paracetamol and ibuprofen in children

Objective:Acute Poisoning in children is still an important public health problem and represents a frequent cause of admission in emergency units. The epidemiological surveillance specific for each country is necessary to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. Methods: The present retrospective study describes the epidemiology of accidental and suicidal poisoningsina pediatric populationadmitted to the Pediatric Emergency Department of Eskisehir Osmangazi University Hospital during the year 2009 . Findings:Two hundred eighteen childrenwere refferedto the emergency department due to acute poisoning. 48.4% of patients w ere boysand 51.6% were girls. The majority of cases were due to accidental poisoning (73.3% of all patients). Drugs were the most common agent causing the poisoning (48.3%), followed by ingestion of corrosive substance (23.1%) and carbon monoxide (CO) intoxication (12.5%). Tricyclic antidepressant was the most common drug (11.7%). Methylphenidate poisoning, the second common drug. 262 patients were discharged from hospital within 48 hours. Conclusion:Preventable accidental poisonings are still a signific ant cause of morbidity among children in developing countries. Drugs and corrosive agents are the most frequent agents causing poisoning.

https://tspace.library.utoronto.ca/bitstream/1807/59132/1/pe11082.pdf

Acute poisoning in children; data of a pediatric emergency unit.

BACKGROUND AND OBJECTIVES: There has been a rapid increase in the rate of pediatric opioid-related hospitalizations. It is unknown how this increase has impacted the use of pediatric critical care. Our objective in this study was to assess the trends in pediatric hospitalization for opioid ingestions in a cohort of US children’s hospitals and, specifically, to evaluate the impact on pediatric critical care resource use. METHODS: A retrospective cohort study of the Pediatric Health Information System was performed to identify hospitalizations for opioid ingestions from 2004 to 2015. Admission to the PICU and the use of naloxone, vasopressors, and ventilation were assessed by using billing data. The primary outcome measure was the trend in the rate of PICU admission for opioid-related ingestion over time, assessed by using Poisson regression. RESULTS: There were 3647 opioid-related hospitalizations in 31 hospitals; 42.9% required PICU care. The overall mortality was 1.6%, with annual deaths decreasing from 2.8% to 1.3% ( P P CONCLUSIONS: The US opioid crisis is negatively impacting children, and the rate of hospitalization and PICU admission for pediatric opioid ingestions is increasing. Current efforts to reduce adult opioid use have not curtailed the incidence of pediatric opioid ingestions, and additional efforts are needed to reduce preventable opioid exposure in children.

/pdf/opioid-related-critical-care-resource-use-in-us-children-s-28bt0ht2lf.pdf

Opioid-Related Critical Care Resource Use in US Children's Hospitals.

Introduction: Pediatric poisonings represent a major and preventable cause of morbidity and mortality throughout the world. Epidemiologic information about poisoning among children in many lower- and middle-income countries is scarce. This study describes the epidemiology of acute poisonings in children presenting to Ain Shams University’s Poisoning Treatment Center (ASU-PTC) in Cairo and determines the causative agents and characteristics of acute poisoning in several pediatric age groups. Methods: This retrospective study involved acutely poisoned patients, 0–18 years of age, who presented to the ASU-PTC between 1 January 2009 and 31 December 2013. Data were extracted from electronic records maintained by the ASU-PTC. Collected data included demographics, substance of exposure, circumstances of the poisoning, patient disposition, and outcome. Results: During the 5-year study period, 38 470 patients meeting our criteria were treated by the ASU-PTC; 19 987 (52%) were younger than 6 years of age; 4...

Epidemiology of acute poisoning in children presenting to the poisoning treatment center at Ain Shams University in Cairo, Egypt, 2009–2013

OBJECTIVES:: To describe the characteristics of childhood poisoning leading to consultation to 17 pediatric emergency departments in Spain. METHODS:: During a 2-year period (January 2001 to December 2002), accompanying people of 2157 children with acute intoxication who visited consecutively at the emergency room were prospectively surveyed. RESULTS:: Childhood poisoning accounted for 0.28% of all emergency visits during the study period. The median (interquartile range, 25th-75th percentile) age was 24 months (22-60 months); 67% of children were younger than 4 years. Drug ingestion was involved in 54.7% of cases (paracetamol was the most frequent drug), domestic products in 28.9%, alcohol in 5.9%, carbon monoxide in 4.5%, and illicit drugs in 1.5%. A total of 61.3% of patients were admitted within 1 hour after exposure to the toxic substance, and 10.3% had been already treated before arrival; 29.1% of patients were referred for clinical manifestations which were mostly neurological symptoms. Laboratory tests and other investigations were performed in 40.7% of cases. Gastrointestinal decontamination was used in 51.7% of patients, with activated charcoal in 32.3%. Treatment varied significantly according to the individual hospitals. A total of 83.3% of patients were treated as outpatients, 15.2% were hospitalized, and 1.5% were admitted to the intensive care unit. One 11-month-old boy with carbon monoxide intoxication died. Six patients had permanent sequelae (esophageal stenosis in 5 and partial blindness in 1). CONCLUSIONS:: Young children who accidentally ingested drugs and, less frequently, domestic products accounted for most cases of intoxication who presented at the pediatric emergency department. Language: en

/pdf/emergency-visits-for-childhood-poisoning-a-2-year-56az4ghz4d.pdf

Javier Lopez

Papers

Emergency visits for childhood poisoning: a 2-year prospective multicenter survey in Spain.

Association of Genetic Variants With Outcomes in Patients With Nonischemic Dilated Cardiomyopathy