The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased.Objectives: We investigated whether this trend in SAA PICU admissions is present in the Netherlands.Methods: A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2‐18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality.Results: In the 11‐year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P < 0.001) and fewer children needed invasive ventilation (P < 0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1 mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P = 0.005). The proportion of steroid‐naïve patients increased from 35% to 54% (P = 0.004), with a significant increase in both age groups (2‐4 years [P = 0.026] and 5‐17 years [P = 0.036]).Conclusions: The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid‐naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Despite their potential benefits many eHealth innovations studied in major studies fail to integrate into organizational routines and implementation of these innovations remains problematic. Objective: The purpose of this study was to describe health care professionals’ self-identified perceived barriers and facilitators for the implementation of a web-based portal to monitor asthmatic children online as a substitution for routine outpatient care. Also, we assessed patient (and/or their parents) satisfaction with this eHealth innovation. Methods: Between April and November 2015, 76 healthcare professionals were recruited to participate. During a period of six months, participants received three questionnaires to identify factors that facilitate or impede the use of this eHealth innovation. Questionnaires for patients (and/or parents) were sent once after a period of 6 months. Results: perceived barriers included concerns about the lack of structural financial reimbursement for online monitoring, lack of integration of this eHealth innovation with electronic medical records, the burden of web-based portal use on clinician workload and altered patient-professional relationship (due to fewer face-to-face contacts). Major perceived facilitators included enthusiastic and active initiators, a positive attitude of professionals towards eHealth, the possibility to tailor care to the individual patient (so-called ‘personalized eHealth’) and to easily deliver care according to current guidelines by using the virtual asthma clinic (VAC) and long-term profit and efficiency. Conclusions: Implementation of an eHealth innovation is complex, dynamic and influenced by multiple factors at the levels of the innovation itself, individual professionals, patients, social context, organizational context and economic and political context. Understanding and defining the barriers and facilitators that influence the context appears to be important for successful implementation and sustainability of eHealth innovations.

Chest CT is not a suitable screening tool to rule out COVID 19 in children

Objectives: To prospectively evaluate quality of life (QoL) and psychosocial outcomes in children with severe acute asthma (SAA) after pediatric intensive care (PICU) admission compared to children with SAA who were admitted to a general ward (GW). In addition, we assessed posttraumatic stress (PTS) and asthma‐related QoL in the parents.Methods: A preplanned follow‐up of 3 to 9 months of our nationwide prospective multicenter study, in which children with SAA admitted to a Dutch PICU (n = 110) or GW (n = 111) were enrolled between 2016 and 2018. Asthma‐related QoL, PTS symptoms, emotional and behavioral problems, and social impact in children and/or parents were assessed with validated web‐based questionnaires.Results: We included 100 children after PICU and 103 after GW admission, with a response rate of 50% for the questionnaires. Median time to follow‐up was 5 months (range: 1‐12 months). Time to reach full schooldays after admission was significantly longer in the PICU group (mean of 10 vs 4 days, P = .001). Parents in the PICU group reported more PTS symptoms (intrusion P = .01, avoidance P = .01, arousal P = .02) compared to the GW group.Conclusion: No significant differences were found between PICU and GW children on self‐reported outcome domains, except for the time to reach full schooldays. PICU parents reported PTS symptoms more often than the GW group. Therefore, monitoring asthma symptoms and psychosocial screening of children and parents after PICU admission should both be part of standard care after SAA. This should identify those who are at risk for developing PTSD, to timely provide appropriate interventions.

Background: Large birth cohort studies are extremely valuable in assessing associations between early life exposures and long‐term outcomes. Establishing new birth cohorts is challenging due to declining participation rates. Online methods of data collection may increase feasibility, but have not been evaluated thoroughly.Objective: The primary objective of the ongoing PRegnancy and Infant DEvelopment (PRIDE) Study is to identify exposures during pregnancy and in early life that may affect short‐term or long‐term health of mother and/or child. In this manuscript, we aimed to evaluate methods of recruitment and online data collection applied.Population: Dutch women aged ≥18 years in early pregnancy.Design: Prospective cohort study.Methods: Initially, only prenatal care providers recruited participants, but alternative recruitment methods were added as a result of disappointing participation rates, including collaboration with “Moeders voor Moeders” (organisation that visits women in early pregnancy) and Facebook advertisements. Data on demographic characteristics, obstetric history, maternal health, life style factors, occupational exposures, nutrition, pregnancy complications, and infant outcomes are primarily collected through Web‐based questionnaires at multiple time points during and after pregnancy. Additional data collection components include paternal questionnaires, blood and saliva sampling, and linkage to medical records.Preliminary results: By September 2019, 9573 women were included in the PRIDE Study, of which 1.3% completed paper‐based questionnaires. Mean age of the women analysed was 30.6 years, 71.1% had a high level of education, 57.2% were primiparae, and mean gestational age at enrolment was 9.9 (range 3, 37) weeks, with slight differences between recruitment methods. Pregnancy outcome was known for 89.8%. Retention rate at 6 months after the estimated date of delivery was estimated at 70%. Multiple validation studies conducted within the PRIDE Study indicated high data quality.Conclusion(s): Although challenging and time‐consuming, online methods for recruitment and data collection may enable the establishment of new birth cohort studies.

Most pediatric asthma guidelines offer evidence-based or best practice approaches to the management of asthma exacerbations but struggle with evidence-based approaches for severe acute asthma (SAA). We aimed to investigate current practices in children with SAA admitted to European pediatric intensive care units (PICUs), in particular, adjunct therapies, use of an asthma severity score, and availability of a SAA guideline. We designed a cross-sectional electronic survey across European PICUs. Thirty-seven PICUs from 11 European countries responded. In 8 PICUs (22%), a guideline for SAA management was unavailable. Inhaled beta-agonists and anticholinergics, combined with systemic steroids and IV MgSO₄was central in SAA treatment. Seven PICUs (30%) used a loading dose of a short-acting beta-agonist. Eighteen PICUs (49%) used an asthma severity score, with 8 different scores applied. Seventeen PICUs (46%) observed an increasing trend in SAA admissions.Conclusion: Variations in the treatment of children with SAA mainly existed in the use of adjunct therapies and asthma severity scores. Importantly, in 22% of the PICUs, a SAA guideline was unavailable. Standardizing SAA guidelines across PICUs in Europe may improve quality of care. However, the limited number of PICUs represented and the data compilation method are constraining our findings. What is Known:•Recent reports demonstrate increasing numbers of children with SAA requiring PICU admission in several countries across the world.•Most pediatric guidelines offer evidence-based approaches to the management of asthma exacerbations, but struggle with evidence-based approaches for SAA beyond these initial steps.What is New:•A large arsenal of adjunct therapies and 8 different asthma scores were used.•In a large number of PICUs, a written guideline for SAA management is lacking.