Supply Chain Disruption's Impact on Children's Hospitals

Hurricane Helene’s devastation in North Carolina is no longer making news, but children’s hospitals are continuing to experience severe supply chain disruptions months after the storm.

Nearly 80% of people admitted to a hospital need IV fluids during their stay. At children’s hospitals, IV fluids provide critical nutrition for babies in neonatal intensive care units and provide support during life-threatening infections in children, among many other uses.

Though critical for care, hospitals don’t routinely stockpile a large inventory of IV fluids. The heavy bags take up considerable storage space, and they have short expiry dates.

That’s why the flooding of Baxter International’s North Carolina manufacturing plant on Sept. 27 was devastating for children’s hospitals and continues to challenge pediatric care.

As the Baxter facility was brought back online late last year, higher-demand products were prioritized. Those in lower demand — like those used in pediatrics — have yet to return to market fully. Many specialty fluids important to pediatric care are not expected to be at capacity until mid-February.

The seasonal influx of pediatric patients with respiratory illnesses and norovirus has only exacerbated the shortage. These patients often need IV fluids, putting an incredible demand on the nation’s children’s hospitals.

What hospitals are doing

With limited supplies on hand, hospitals have sought conservation and mitigation strategies to ensure adequate supply for patient care. During the disruption’s peak, children’s hospitals took steps such as:

• Rescheduling elective surgeries.
• Dividing bags of fluid into smaller syringes for specific uses.
• Reducing NPO time and allowing patients to be hydrated orally before surgical procedures.
• Limiting IV fluid use for all but the most critical patients.

Many of these mitigation measures are no longer needed, but children’s hospitals continue to look for ways to offset shortages of specialty fluids. For example, demand for the fluid used for heparin flushes has increased but the amount being manufactured has not. Similarly, Anticoagulant Citrate Dextrose Solution A (ACD-A), used to prevent blood clots, is also in limited supply, forcing children’s hospitals to seek alternative therapeutic solutions.

What CHA is doing

Since the disruption began, Children’s Hospital Association (CHA) has worked to connect hospitals with timely information and fluid conservation strategies. Shortly after the storm, our pharmacy services team convened a call with leaders from our member hospitals and Baxter International. Next, our team scheduled weekly calls where hospitals could get up-to-date information and learn from peers’ emerging conservation strategies. We compiled members’ conservation ideas to a member-facing webpage, allowing any CHA hospital to access the strategies.

CHA also worked with Baxter to guarantee pediatric hospitals were allotted 100% allocation of available supply. This action also ensured Baxter evaluated the allocation exception requests for neonatal and pediatric needs at system-based hospitals. As the shortage continues, we are providing Baxter specific product codes to prioritize to provide needed pediatric support.  

Along with the American Medical Association, the American Society of Hospital Pharmacists, and other sister organizations, CHA urged the federal government to invoke the Defense Production Act to help Baxter get cleaning and rebuilding materials. The FDA also temporarily approved the importation of IV fluids from Baxter’s global manufacturing network and approved fluids to be used for up to two years instead of the typical one year.

CHA member hospitals can access our IV Fluid Resources page. Clinical professionals can find resources from Baxter International.