Science and Mathematics Education Commons^™

Association Of Respiratory Viral Testing And Antibiotic Use For Pediatric Patients Admitted For Acute Respiratory Illness Between 2017-2021 At Children’S Mercy-Kansas City, Edward Lyon, Brian Lee, Rangaraj Selvarangan, Jennifer Schuster

Research Days

Retrospective comparison of hospitalized pediatric patients who did or did not have clinical viral respiratory testing performed to understand if antibiotics were used differently between these groups.

Transition Skills Lab: A Telehealth Intervention For Improving Healthcare Transition In Youth With Special Health Care Needs, Angela Combs, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Research Days

The goal of this abstract is to evaluate youth skill-building and confidence across health care tasks through the virtual Transition Skills Lab.

Long-Term Physical And Emotional Functioning In Children Following Intensive Interdisciplinary Pain Treatment For Amplified Pain Syndrome, Sabrina Ung, Jacqueline Pabis Phd, Jenny Scheurich Phd, Dustin Wallace Phd

Research Days

The current study aimed to examine the efficacy of pediatric interdisciplinary pain treatment (IIPT) several years after treatment completion by exploring mean-level changes of physical and mental health functioning pre-intervention, post-intervention, and at follow-up 2 to 6 years after IIPT completion.

Delirium On Admission To The Cicu, Spencer Wittmeyer, Jaime Silva-Gburek, Kelly S. Tieves

Research Days

Background: Delirium is increasingly recognized in the pediatric cardiac intensive care unit (CICU) with an incidence up to 67% and is associated with worse outcomes including increased mortality, prolonged hospitalization, and increased rates of intubation and mechanical circulatory support. The Cornell Assessment for Pediatric Delirium (CAPD) is the only validated tool for the diagnosis of delirium in the pediatric population. The CAPD may be limited in children with developmental disabilities as it does not account for baseline ability in scoring. Prior work has identified low specificity for the CAPD in children with developmental disabilities and those requiring mechanical ventilation. This …

Reducing Sharps Disposal In The Operating Room, Kasey Brooks, Brandon Layton

Research Days

Used an education program to reduce the amount of sharps waste in the operating room within the anesthesia department.

The Impact Of Childhood Opportunity Index On Treatment Outcomes Of Osteochondritis Dissecans Of The Knee, Colton Schwarz, Kennedy J. Morey, Brian R. Lee, Angie Vanderpool, Kevin Latz, Natalie C. Stork, Donna Pacicca, Brian Harvey

Research Days

This study aims to explore the relationship that Childhood Opportunity Index (COI), a validated measure of socioeconomic status, has on the outcomes of treatment of osteochondritis dissecans (OCD) of the medial femoral condyle (MFC) of the knee in pediatric patients age 0-18 years.

Thyroid Dysfunction In Patients Receiving Immune Checkpoint Inhibitors, Emily Metzinger, Jennifer Boyd, Julia Broussard, Christopher Klockau

Research Days

The use of immune checkpoint inhibitors (ICI) is increasing in the treatment of different cancers. This study investigates ICI and thyroid dysfunction in pediatric patients at Children's Mercy Kansas City. This is a retrospective chart review that looked at development of thyroid disorders in patients who received PD-1 inhibitors, PD-L1 inhibitors, or CTLA-4 inhibitors in 19 pediatric patients. Results showed that hypothyroidism developed in 3 patients who received any of these medications. Additionally, 2 patients had thyroid dysfunction prior to starting ICI therapy, and 1 of these patients developed hyperthyroidism shortly after beginning ICI therapy. Thyroid dysfunction can be seen …

Characteristics And Clinical Outcomes Of Iud Insertion Under Conscious Sedation In Pediatric And Adolescent Patients, Alleana Corpin, Madeline Ross, Anne-Marie Priebe, Ashli A. Lawson

Research Days

Intrauterine devices (IUDs) are a favorable option for adolescents for contraception and menstrual suppression. However, few choose this option citing anxiety and concern for pain related to insertion procedure. Our institution proposes utilizing conscious sedation techniques for anxiolysis and analgesia during IUD insertion. The objective of this study was to identify characteristics of teens choosing conscious sedation for this procedure and likelihood of successful insertion.

Key Words: Intrauterine device (IUD), adolescent, conscious sedation

An Increased Failure Rate Of Asparaginase Desensitization With Calaspargase Pegol, Jillian Fry, Erin Guest, Keith August

Research Days

BACKGROUND: Pegaspargase (SS-PEG) became unavailable to younger patients in 2022, leaving calaspargase pegol (SC-PEG) as the only available long-acting asparaginase formulation. SC-PEG has been compared to SS-PEG and found to have similar rates of adverse events and event-free survival. Our institution uses a desensitization protocol for those with asparaginase hypersensitivity reactions. Here we review our experience with desensitization since the transition to SC-PEG. OBJECTIVES: To compare the rate of hypersensitivity reactions, success of desensitization, and need for alternative asparaginase preparations between patients receiving SC-PEG and SS-PEG. METHOD: This is a retrospective, single center study of pediatric patients who received >2 …

Effects Of Drug Delivery On Ppi-Responsive Esophageal Eosinophilia, Alex Biller, Rachel Chevalier, Amornluck Krasaelap, Janelle R. Noel-Macdonnell

Research Days

Determine if formulation of proton pump inhibitory (pill/capsule vs liquid) affects eosinophilic infiltration of esophagus in patients with PPI-Responsive Esophageal Eosinophilia.

Simultaneous Vertical Sleeve Gastrectomy And Deceased Donor Liver Transplant In A Pediatric Patient With Cirrhosis And Class 3 Obesity, Lakshmi Kunam, Voytek Slowik, Brooke Sweeney, Ryan T. Fischer, Jason D. Fraser, Bhargava Mullapudi, Richard J. Hendrickson

Research Days

Background: Liver transplantation is a life saving procedure for children with end-stage liver disease with the goal of returning to a normal healthy life. Obesity and weight gain can lead to post-transplant steatosis and contribute to patient morbidity and mortality. In patients with obesity, simultaneous bariatric surgery can lead to reduced body mass index (BMI) and decrease allograft steatosis and patient metabolic syndrome.

Methods: After obtaining patient and family assent/consent, patient records were reviewed and analyzed.

Results: The patient was initially evaluated at 8 years of age for right upper quadrant pain. Imaging consistent with cirrhosis and portal hypertension prompted …

Variation In Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children's Hospitals, Sian Best, Kathryn Kyler, Matt Hall, Jessica L. Bettenhausen, Shelby Chesbro, Nicholas Clark, Adrienne Deporre, Jonathan Ermer, Leah Jones, Jessica Markham, Maria Newmaster, Laura Plencner, Henry T. Puls, Smit Shah, Bridgette Jones, Megan Collins, Elisha Mccoy

Research Days

This abstract describes the variability and trends in inpatient systemic corticosteroid prescribing practices for acute asthma exacerbations in children's hospitals, and aims to determine associations between the prescribed steroid and hospitalization outcomes.

Therapeutic Efficacy Of B7-H3 Car T Cell Therapy In Pediatric High-Grade Gliomas With H3g34r/V Mutation., Monika Yadav, Siddharth Subham, John Szarejko, Douglas Myers, David Akhavan, Viveka Nand Yadav

Research Days

Background: Pediatric high-grade gliomas (pHGGs) are aggressive brain tumors responsible for significant childhood mortality. These tumors often carry mutations in the H3F3A gene, which encodes histone H3.3 proteins. However, current treatment options are limited, underscoring the need for innovative approaches. Chimeric antigen receptor (CAR) therapy, which was successful in treating certain childhood cancers, holds promise for pHGGs with H3G34R/V mutations. This study aims to assess the potential of anti-B7-H3 CAR T cell therapy in treating the challenging pHGG tumors.

Method and Results: Here, we examined the expression of B7-H3 in various pHGG cell lines, encompassing those with H3G34V/R and H3K27M …

Increasing Feedback From Endocrinology Faculty To Fellows: A Quality Improvement Initiative, Emily Metzinger, Emily Griffing, Michelle Knoll

Research Days

Feedback is essential in medical training. Our aim is to increase the frequency of feedback that CMH endocrinology fellows receive in both the inpatient and outpatient settings. We noted initial success of increasing feedback in the inpatient setting however later decreased to below goal. Frequency of feedback in the outpatient setting has remained below goal. Tracking feedback has been challenging, but a recent survey showed that fellows perceive that they receive more feedback.

Central Venous Catheter-Associated Complications In Pediatric Patients With Acute Myeloid Leukemia, J Allyson Hays, Maggie Ziegler

Research Days

Background

Central venous catheters (CVCs) are a mainstay of pediatric cancer treatment for but have risks. CVCs can cause local site infections and systemic infections, known as central-line-associated bloodstream infections (CLABSIs). Analyzing rates of complications associated with different CVCs may inform future decisions about CVC choice. Hypotheses We hypothesized that tunneled cuffed (tunneled) catheters will have higher rates of CLABSIs compared to implanted ports (port) and ports will have higher rates of local site infections compared to tunneled.

Methods

Retrospective chart review of patients with acute myeloid leukemia (AML) at Children’s Mercy Hospital (CMH) identified patients treated from 2010 to …

To Bpd Or Not To Bpd: A Comparison Of The 2022 Versus 2011 Nichd Web-Based Risk Estimator For Bronchopulmonary Dysplasia, Mitch Kinkor, Jake Schneider, Farhath Sulthana, Janelle R. Noel-Macdonnell Phd, Alain Cuna

Research Days

This study compares the performance of the 2022 National Institute of Child Health and Human Development (NICHD) Bronchopulmonary Dysplasia (BPD) Outcome Estimator and its original 2011 version in identifying high-risk infants.

Nrp, Pals, And Their Utilization During Code Events In A Pediatric Quaternary Hospital: A 'Compressed' Analysis, Mitch Kinkor, Deepa Kumar, Allison Taber, Stephen Pfeiffer, Jessica Brunkhorst, Danielle Reed

Research Days

Both the Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP) algorithms are utilized for resuscitation during pediatric codes. The optimal time period to transition from NRP to PALS is not well studied. This study describes the utilization of chest compressions, prescribed medications, and patient outcomes during and after code events organized by the algorithm used to direct resuscitation (PALS or NRP) in a similarly aged patient population.

Oscillometry In Term Neonates Without Respiratory Disease, Anna Nelson, Cheri Gauldin, Brooke Smith, Venkatesh Sampath, Winston Manimtim

Research Days

This feasibility study aims to determine normative values of oscillometry for neonates without respiratory disease.

Increasing The Rate Of Infants Rooming In With Their Mothers With Low-Acuity Congenital Heart Disease, Anna Nelson, Amy Marks, Ekta Patel

Research Days

This quality improvement study aimed to increase the number of infants with low-acuity congenital heart disease that could room-in with their mothers in a high-risk delivery center.

Automate Isolation Infection-Prevention Precautions (Aid-Ip): Improving The Efficiency Of Hospital Isolation With Viral Respiratory Infections, Timothy Burchard, Michael Platt, La'sonya Buford

Research Days

The AID-IP project is a QI study working to improve the process of isolation and de-isolation regarding respiratory viruses at Children's Mercy Hospital. Specifically, we aim to improve adherence to proper isolation precautions, minimize cognitive workload regarding the maintenance of isolation for staff, and improve family satisfaction with isolation practice.

Improving Awareness And Utilization Of Safety Net Resources After Extremity Firearm Injury, Colleen M. Moreland, Caleb W. Grote, Richard M. Schwend, Julia G. Harris

Research Days

The orthopaedic surgery department can improve follow-on care for pediatric survivors of extremity firearm injuries by creating and implementing a checklist of defined safety net resources.

A Quality Improvement Project To Improve Antibiotic Choice For Children Admitted With Urinary Tract Infections (Utis), Philip Jurasinski Do, Pgy-3, Adrienne Deporre Md, Kathleen Berg Md, Allison Hadley Md, Viktoriya Stoycheva Mha, Rn, Cpn, Rana El Feghaly Md

Research Days

This is an antibiotic stewardship quality improvement project focused on improving antibiotic choices for children with urinary tract infections who are in the Children's Mercy Kansas City system. This project aims to improve the rates of cefazolin or cephalexin for treatment from 27% to 60%. 96% of urinary tract infections in our system are caused by E. Coli that are susceptible to these first generation cephalosporins.

More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Colton Schwarz, Spencer Wittmeyer, Mitch Kinkor, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout, Nicholas Clark

Research Days

Quality improvement project that aims to improve opioid stewardship in acute fracture management.

Characterization Of Nationally Reported Pediatric Deaths Involving Fentanyl Ingestions In Missouri, Margaret Campbell, Mary Moffatt, Emily Killough, Terra Frazier

Research Days

There has been a dramatic rise in pediatric deaths associated with synthetic opioid use, with the most prominent being Fentanyl. This is a retrospective cohort study using data from the National Center for Fatality Review and Prevention with the goal of identifying risk factors that increase the vulnerability of children to Fentanyl ingestion. Ultimately this research may help lead to improved identification of at risk children with the goal of implementation of targeted prevention programming.

Understanding Inpatient Diagnostic Imaging Use In Children’S Hospitals To Prioritize Stewardship Efforts, Megan E. Collins, Matt Hall, John Stephens, Jessica L. Markham

Research Days

We utilized the Pediatric Health Information System to perform a retrospective cohort study of hospitalized children across 45 hospitals to describe diagnostic imaging studies among hospitalized children with the highest prevalence, cost, rates of repetition, and hospital variation to help inform de-implementation efforts.

How Neonates Die: Mortality Trends And Associations In A Level Iv Neonatal Intensive Care Unit, Erin Bolen, Ashley K. Sherman, Julie Weiner, Jotishna Sharma

Research Days

Background

Modes of neonatal mortality include withdrawal of life-sustaining interventions, non-escalation of interventions, and secondary to a code event. Mortality trends have been examined broadly, but the impact of clinical and demographic factors on the mode of neonatal mortality has yet to be evaluated. A greater understanding of this information would help guide medical decision-making and identify potential inequities. The aim is to evaluate the impact of clinical and demographic factors on the mode of neonatal death in a level IV neonatal intensive care unit (NICU).

Study Design/Methods

Data were collected via retrospective chart review of patients who died at …

Magnetic Resonance Image-Based Estimates Of Hepatic Blood Flow In Children With And Without Obesity; Implications For Physiologically-Based Pharmacokinetic Models, Yoon Cho, Sherwin S. Chan, Chance S. Friesen, Valentina Shakhnovich

Research Days

Background: Physiologically based pharmacokinetic models for simulating drug pharmacokinetics are useful to guide drug dosing for pediatric patients. Hepatic blood flow could be a useful variable to use in these models.

Objectives/Goal: In this study, we explored 2-D phase contrast non-invasive magnetic resonance imaging (MRI) to measure hepatic blood flow in children with and without obesity.

Methods/Design: In this IRB-approved study, we imaged pediatric patients with abdominal MRI with 2D phase contrast imaging of the descending aorta (AO) at the diaphragm, the inferior vena cava (IVC) at the right atrium, and inferior to hepatic drainage above the renal vein confluence …

Persistent Pediatric Breast Abscesses Following Initial Treatment At Tertiary And Community Centers, Derek Marlor, Kayla Briggs-Groves, Shai Stewart Md, Nelimar Cruz-Centeno, Charlene Dekonenko, Jason D. Fraser

Research Days

Introduction: Little data exist on the management of pediatric breast abscesses that fail initial treatment. Therefore, this study aimed to evaluate and report outcomes in these patients.

Methods: All patients <18-years-old treated for a breast abscess between January 2008 and December 2018 were included. Patients were divided into 2 groups: initial treatment at our institution (Group 1) and initial treatment at referring centers (Group 2). The primary outcome was disease persistence following treatment at our institution. Secondary outcomes included treatment modalities and patient characteristics.

Results: In total, 145 patients were identified: 111 in Group 1 and 34 in Group 2. Antibiotics alone were the initial treatment in 52.3% (n=58) of Group 1 patients and 64.7% (n=22) of Group 2 patients. Invasive treatment was more common in Group 1 (45.9% vs 5.8%; p<0.00001). Patients with persistent disease in Group 1 were treated with aspiration (n=7, 50%), I&D (n=5, 35.7%), antibiotics (n=1, 7.14%), and manual expression (n=1, 7.14%.), while Group 2 patients were treated with antibiotics (50%, n=17), aspiration (26.47%, n=9), I&D (17.65%, n=6), and manual expression (5.88%, n=2). Group 2 patients with persistent disease were more likely to be treated with antibiotics or a change in antibiotics (50% vs 7.14%; p=0.005). Following treatment at our institution, the rate of persistent disease was similar between groups (12.6% vs 11.8%).

Conclusions: Persistent breast abscesses may be treated with antibiotics in appropriate cases. Damage to the developing breast bud should be minimized. Disease …

Respiratory Pathogen Panel Use In Hospitalized Infants <2 Months Of Age And Impact On Patient Management., Edward Lyon

Research Days

Background: Respiratory pathogen panels (RPP) are multiplex PCR platforms able to simultaneously detect several respiratory viruses. RPP utilization is not well described in infants < 2 months of age, who frequently require hospitalization for management of acute respiratory illness (ARI) and/or fever. Detection of a viral pathogen in this age group could impact the clinician’s decision to perform additional evaluation and administer antimicrobials.

Objectives/Goal: We sought to understand predictive features and clinical management impact of RPP use in infants < 2 months of age.

Methods/Design: Between October 2017 to September 2021, participants, aged < 18 years, hospitalized with an acute respiratory infection (ARI) were enrolled in Kansas City’s New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, had symptoms consistent with ARI (e.g., cough, fever, nasal congestion) lasting < 14 days, and enrolled within 48 hours of admission. For this study, only participants < 2 months of age were included. All participants had a research RPP, but results were not available to the clinician. Per provider discretion, some infants also received a clinical RPP (cRPP). Demographic characteristics, laboratory evaluations, and antimicrobial management were compared between infants with and without a cRPP.

Results: Of the 139 participants < 2 months of age, 57 (41%) had a cRPP (table 1). A cRPP was more frequently obtained in infants < 1 month of age (n=34 [47%]) compared with infants 1-2 months of age (n=23 [35%]; p=0.17). 35 (61%) participants with a cRPP had a parental report of fever while 41 (50%) of those without a cRPP had one reported. Only 20 (35.1%) of White, non-hispanic participants had a cRPP compared to 42 (51.2%) p=0.082 who did not have a cRPP. Participants who had blood or CSF culture collected were more likely to have a cRPP obtained, 47 (82.5%) p=

Conclusions: Overall, < 50% of infants < 2 months of age hospitalized with ARI received cRPP testing. Obtaining a blood or CSF culture was associated with increased cRPP usage. The length of stay was not different between the two groups. 35 viral infections went undetected in participants without a cRPP even with accounting for positive rapid NAAT testing, further investigation is needed to understand how this may influence clinical care.

Association Between Remote Monitoring And Interstage Morbidity And Mortality In Single Ventricle Patients Across Socioeconomic Groups, Bianca Cherestal

Research Days

Background: Despite improvements in outcomes over time, morbidity and mortality for infants with single ventricle (SV) heart disease remains high. Among other risk factors for mortality, infants of low socioeconomic status (SES) are known to be particularly vulnerable following stage 1 palliation.

Objectives/Goal: We sought to determine whether use of a novel remote monitoring program, CHAMP (Cardiac High Acuity Monitoring Program), mitigates differences in outcomes by SES for infants with SV during the interstage period.

Methods/Design: Using the CHAMP database, we identified 610 infants across 11 institutions enrolled in the program between 2014–2021. All enrolled patients’ families were provided with …