Science and Mathematics Education Commons^™

Drug Metabolizing Enzymes And Transporters May Help Determineeffective Budesonide Dosing In Eoe, Laurie Mccann, Lisa Harvey, Norah Almahbub, Wendy Y. Wang, Erin C. Boone, Janelle R. Noel-Macdonnell Phd, Rachel Chevalier

Research Days

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder diagnosed in children with painful or difficult swallowing, vomiting, or poor weight gain. Current treatment models adopt a trial-and-error approach in regard EoE treatment, including restrictive elimination diets, proton pump inhibitors, and topical budesonide. This approach can delay effective treatment which increases risk of disease progression and increases medical costs to families for frequent clinic visits and endoscopy.

Objectives/Goal: The objective of this study is to determine the CYP3A5 genotype and expression of patients with eosinophilic esophagitis to discover which patients will respond to standard dosing of topical budesonide treatment (1, …

Genes Predictive Of Aggressive Infant Acute Lymphoblastic Leukemia, Meghana Bhumireddy

Research Days

Background: Acute Lymphoblastic Leukemia (ALL) is a rapidly progressive cancer in which the bone marrow makes too many immature leukocytes that divide uncontrollably. KMT2A, or MLL, is a methyltransferase found in many types of leukemia, whose rearrangement (KMT2A-r) is present in approximately 2/3 of infants with ALL. KMT2A-r is associated with a very poor prognosis: roughly ⅔ of patients relapse within 1 year of diagnosis, and the relapsed KMT2A-r ALL is resistant to treatment (having nearly 100% morality). We explored gene expression in patient samples from three groups at diagnosis: KMT2A-r patients who relapsed, KMT2A-r patients who did not relapse, …

Degree Of Uncertainty In Reporting Imaging Findings For Necrotizing Enterocolitis: A Secondary Analysis From A Pilot Randomized Diagnostic Trial, Disa Rathore, Kira Bourrett, Sherwin S. Chan, Erin Opfer, Alain Cuna

Research Days

Background: Uncertainty in reporting of imaging findings for necrotizing enterocolitis (NEC) can be challenging for clinicians and result in ambiguity, miscommunication, and potential diagnostic errors. The degree to which uncertainty complicates diagnostic imaging for NEC has not been characterized.

Objective: To determine the degree of uncertainty in diagnostic imaging for NEC.

Methods: We conducted a retrospective study using data from a previously completed pilot diagnostic randomized clinical trial (RCT). The study population comprised of preterm infants with suspected NEC who were randomized to either standard imaging with abdominal radiographs (AXR) alone or experimental imaging with AXR + add-on bowel ultrasound …

Pilot Study Using Sideline Hand-Grip Dynamometry To Assess Strength Changes In A High School Baseball Season: A Feasibility Study, Thomas Munro, Jason D. Yoderq, Brian R. Lee, Brian S. Harvey

Research Days

Background: Upper extremity injuries are common in baseball players. Objective measurements could assist in determining early signs of fatigue before injury occurs. Using HGD to measure strength changes may help identify early signs in the injury process. To our knowledge, HGD has not been tested on high school baseball players in the sideline setting. It is feasible to perform hand-grip dynamometry on-site at the high school level and HGD measurements will change throughout the season in varsity baseball athletes. Secondary aim: Asses HGD measurement in the context of injury/pain/fatigue/pitching.

Objectives/Goal: It is feasible to perform hand-grip dynamometry on-site at the …

Management Of Primary Spontaneous Pneumothorax In Children: A Single Institution Protocol Analysis, Shai Stewart Md, James Fraser, Nelimar Cruz-Centeno, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Research Days

Background: Primary spontaneous pneumothorax (PSP) affects 3.4 per 100,000 children in the United States. Regardless of the initial management, additional procedures, and prolonged hospital length of stay (LOS) may occur. There is currently no consensus in the pediatric surgical community on the optimal management of these patients, which has resulted in marked variability in management. The Midwest Pediatric Surgery Consortium (MWPSC), of which our site is a participant, suggested a management algorithm to include simple aspiration upon presentation, and if this fails, VATS should be considered.

Objectives/Goal: The purpose of this study was to evaluate the outcomes of instituting a …

Antibiotic Monotherapy Vs Dual-Drug Therapy In Perforated Appendicitis: Single Center Retrospective Review, Shai Stewart Md, Nelimar Cruz-Centeno, Derek Marlor, Dae H. Kim, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph

Research Days

Background: The optimal antibiotic regimen in perforated appendicitis to reduce intraabdominal abscess (IAA) formation has not yet been agreed upon in the pediatric surgery community. We aimed to evaluate the outcomes of patients with perforated appendicitis when intravenous antibiotic monotherapy with Piperacillin-Tazobactam (PT) versus dual-drug therapy with Ceftriaxone and Metronidazole (CM) are administered. We hypothesized there is no difference in the rate of IAA formation with antibiotic monotherapy, as opposed to our once-daily dosed, institutional standard dual-drug therapy.

Objectives/Goal: The goal was to determine if our current management protocols for acute appendicitis were delivering the best possible results for our …

A Novel Approach For Laparoscopic Direct Inguinal Hernia Repair In Children, Shai Stewart Md, Charlene Dekonenko, Nelimar Cruz-Centeno, Derek Marlor, Jason D. Fraser

Research Days

Background: Inguinal hernia repair is one of the most common operations performed by pediatric surgeons, and the frequency of laparoscopy for repair is increasing. The vast majority of these are indirect hernias and therefore how to best repair a direct defect when seen during laparoscopy is still unknown. Simple high ligation of the hernia sac (as is done in an indirect hernia) does not repair the inguinal floor weakness/defect seen in a direct hernia.

Objectives/Goal: We therefore present a case of laparoscopic bilateral indirect and direct inguinal hernia repair, commonly known as pantaloon hernia, repaired without mesh and utilizing the …

Institutional Outcomes Of Blunt Liver & Splenic Injury In The Atomac Era, Shai Stewart Md, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline (PMG) was created to standardize management of blunt liver or spleen injury (BLSI) across pediatric trauma centers. Evaluations of institutional outcomes after its adoption remain scarce. We describe our outcomes since PMG adoption at our institution.

Objectives/Goal: The purpose of this study was to assess patient outcomes and resource utilization after implementation of this protocol. We hypothesized there is no difference in length of stay (LOS) or complications regardless of grade of isolated injuries to the liver or spleen. In addition, there is limited guidance on the management of concurrent injuries to …

A Comparison Of Large Tbsa Scald Versus Flame Burns In Young Children, Ashley Daniel

Research Days

Background: It is generally accepted that of children with the same total body surface area of burns, those with flame burns seem to have longer lengths of stay and more complications than those with scald burns. Anecdotally we have seen the opposite to be true. Among a consortium of five US pediatric burn centers participating in the Pediatric Injury Quality Improvement Collaborative (PIQIC), young children with scald burns seem to experience disproportionately more frequent and severe complications compared to their older counterparts and compared to patients of a similar age with flame burns.

Objectives/Goal: In this multi-institutional study, we compared …

Relationship Between Rurality And Access To Care For Families Of Hospitalized Children, Zoetta L. Mcloughlin Md

Research Days

Background: At Children’s Mercy Hospital, greater than 1 in 5 hospitalized children are from rural areas. Rural families often travel long distances for hospitalization at free-standing children’s hospitals, a median of 70 miles according to recent work. Rural families are more likely than non-rural families to experience financial insecurity, and these baseline hardships may be intensified during hospitalization due to out-of-pocket costs, lost work, inability to meet family needs, and removal from social support. However, little is known about the differences in healthcare access and resulting burdens between rural and non-rural families.

Objectives/Goal: To describe differences in demographics, health care …

Rural And Urban Caregiver Experiences Of Financial Strain And Food Insecurity During Pediatric Hospitalizations, Rachel E. Granberg

Research Days

Background: Stress is common among caregivers of hospitalized children. In addition to stress related to their child’s illness, caregivers experience stress related to financial strain and food insecurity during their child’s hospitalization. The burden of financial strain and food insecurity related to pediatric hospitalizations may vary between rural and urban populations.

Objectives/Goal: To identify financial strain and food insecurity experienced by caregivers of hospitalized children and to describe differences between rural and urban populations.

Methods/Design: A prospective cross-sectional survey enrolled a random sample of caregivers of hospitalized children between 8/31/2021 and 12/2/2022 at a single children’s hospital. Demographic information was …

Female Authorship Concordance In Academic Pediatrics, Roxana Guggenmous, Jessica L. Bettenhausen, Jessica L. Markham

Research Days

Background: Gender disparities are well described in medicine and academia. Despite a catalyzed movement towards gender equity, female physician-scientists remain at risk for experiencing biases in hiring practices, compensation, promotion, appointment to leadership positions, and achievement of extramural funding through the National Institutes of Health. In pediatrics, the female workforce has grown consistently over time, with female physicians comprising 72.3% of the workforce as of 2021, yet prior work suggests that this growth is not fully reflected in academic publications. Achieving gender parity in academic publication may help reduce gender-based disparities impacting career advancement. Therefore, we sought to describe the …

Supporting Families Impacted By Adverse Childhood Experiences (Aces), Jennifer Paumen, Laura Plencner, Jacqueline Kitchen

Research Days

Background: Adverse childhood experiences (ACEs) impact a majority of individuals, with approximately two-thirds of adults having experienced 1 or more ACE.1 The health consequences of ACEs are significant, including cardiovascular disease, cancer, autoimmune diseases, and mental illnesses.1 These health impacts can even start as early as childhood, leading to an increased risk of learning and behavioral concerns.2,3 Recent evidence has also identified the impact that parental ACEs may have on parenting and child development,4,5,6 which in turn may lead to an intergenerational transmission of ACEs.4,7 As a nurturing caregiver relationship is key for buffering adversity,2,8 it is imperative to address …

Socioeconomic Factors And Picu Interventions In High Mortality Risk Asthmatics, Hanh Ho, Paul N. Bauer, Jade B. Tam-Williams

Research Days

Background: Asthma mortality rates are overall lower in children, but studies estimate 5-10% of asthmatics have refractory mortality prone asthma. Asthmatics with repeat pediatric intensive care unit (PICU) admissions are believed to be at high mortality risk with increased health care utilization and socio-economic challenges.

Objectives/Goal: We aim to identify patients with repeat PICU admissions for status asthmaticus and characterize the levels of interventions and socio-economic status.

Methods: A retrospective chart review was done on patients with the following inclusion criteria: age 0- 18, PICU admission between January 2010 to December 2015, and a diagnosis of status asthmaticus on admission. …

Influencing Influenza Immunization: Qi Project In A Pediatric Resident Continuity Clinic, Brittany Moore

Research Days

Problem Statement/Question: There have been a multitude of approaches to vaccine hesitancy in regard to childhood vaccinations. In light of the COVID-19 pandemic there was a noticeable decline in influenza vaccination among children aged 6 months to 18 years. The influenza vaccination rate in the pediatric resident continuity clinic at Children’s Mercy Hospital was below the national average for pediatric patients.

Background/Project Intent (Aim Statement): The aim of this study is to increase the percentage of patients aged 6 month and older currently enrolled in ROYAL clinic receiving at least one influenza vaccine from 38.6% to 55% by January 1, …

Increasing Utilization Of Gestational Age Based Table For Initial Intubation In A Level Iv Neonatal Intensive Care Unit, Maribel Martinez, Dianne Lee, Christopher R. Nitkin

Research Days

Problem Statement/Question: Most providers in our unit are not using the NRP recommended method to determine the initial ETT insertion depth in neonates.

Background/Project Intent (Aim Statement): Endotracheal tube (ETT) depth in neonates is of critical importance due to significant adverse events when malpositioned. While randomized trials comparing different methods have not shown superiority of any particular method, the weight-based method (weight (kg) +6) has been found to be highly inaccurate in extremely low birth weight neonates. Furthermore, the Neonatal Resuscitation Program (NRP) recommends using gestational age (GA)-based table (Kempley ST, et al, Resuscitation 2008) or nasal-tragal length for initial …

Hypereosinophilia With An Anterior Mediastinal Mass, Sonya Parashar, Aarti Pandya

Research Days

Background: Hypereosinophilia is defined as 1500 eosinophils/mL or above with evidence of end-organ damage due to the eosinophils at least 4 weeks apart.

Objectives/Goal: We describe a case of steroid resistant hypereosinophilia.

Methods/Design: A 3-year-old male was admitted for newly found anterior mediastinal mass and left pleural effusion. About 6 weeks prior to admission, he was seen in his primary care office for difficulty breathing. Despite the appropriate treatment for his symptoms, the patient continued to have significant respiratory symptoms and a chest x-ray showed a large left pleural effusion. He was immediately transferred to a tertiary care center and …

Improving Fluid Management Of Extreme Premature Infants By Providing A Restrictive Fluid Management Algorithm In The Nicu, Jacob S. Ward, Dena Hubbard, Nicholas Clark

Research Days

Problem Statement/Question: At our institution we found wide variability in and a lack of an evidence-based standard for fluid management in premature infants.

Background/Project Intent (Aim Statement): Excessive fluid intake in premature infants during the first week of life increases the risk of adverse events and overall mortality. Fluid restriction is recommended to help decrease morbidity and mortality in this patient population. We aimed to improve the fluid management of premature infants born < 29 weeks gestation admitted to our intensive care nursery (ICN) by implementing a fluid restriction protocol with the goal of >70% compliance over a 16-month period.

Methods (include PDSA cycles): Institution of daily weights started at beginning of baseline period. In April of 2021, we implemented a …

Unique Endoscopic Retrieval Of A Large Rectal Foreign Body, Laurie Mccann, Jose Cocjin

Research Days

Introduction: Large rectal foreign bodies are usually difficult to extract, usually requiring operative management.

Case: A 14-year-old male presented to the ER for a rectal foreign body. Earlier in the day, he had rectal itching and inflammation. He used a cylindrical reusable ice stick (for water bottles) for topical relief, which did not work, so he placed the tube in his rectum, then he was unable to retrieve it and sought medical help. Physical exam was significant for lower abdominal pain and palpable mass just below his umbilicus, which was painful to palpate. CT abdomen/pelvis showed a large foreign body …

Improving Frequency Of Peer Review Of Abnormal Genital Exam Findings In Patients Undergoing Sexual Abuse Evaluation, Lyndsey Hultman, Julia G. Harris, Terra N. Frazier, Jennifer B. Hansen

Research Days

Problem Statement/Question: Child Advocacy Centers (CACs) coordinate child abuse MDTs, and 2023 CAC accreditation standards require that “all medical professionals providing services to CAC clients must demonstrate that 100% of all findings deemed abnormal or “diagnostic” of trauma from sexual abuse have undergone expert review by an advanced medical consultant.” Scheduled Case Review occurs among Children’s Mercy child abuse pediatricians (CAPs), but current practice is to review cases only upon CAP request.

Background/Project Intent (Aim Statement): Appropriate interpretation of sexual abuse exam findings is crucial for accurate diagnosis and provision of medical information to multidisciplinary child protection teams (MDTs). Medical …

Variation In Thiopurine Metabolism In Hispanic Children, Kayeleigh Higgerson Do

Research Days

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Overall survival rate is > 90% in the United States. However, ethnic and racial disparities remain. Hispanic patients have an inferior overall survival compared to non-Hispanics. The reasons for these differences remain unclear. Mercaptopurine (6MP) is a crucial drug in ALL treatment. Variations in the TMPT and NUDT15 genes lead to altered 6MP metabolism and accumulation of toxic metabolites (6TGN or 6MMPN). Each metabolite is associated with specific dose-limiting toxicities. The accumulation of 6TGN causes myelosuppression, and increased 6MMPN causes GI toxicity. While variants in these genes have been identified …

Potassium Status In Pediatric Chronic Kidney Disease, Katherine L. Kurzinski

Research Days

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Background: Potassium trends are well described in adult chronic kidney disease (CKD) and hyperkalemia is known to be associated with increased disease progression, morbidity, and mortality. Large scale studies assessing potassium trends and the prevalence of hyperkalemia in pediatric CKD have not been performed.

Objectives/Goal: We aimed to characterize median serum potassium levels and the prevalence of hyperkalemia for each CKD stage using the CKiD cohort. The relationship of serum potassium and hyperkalemia with patient demographics, CKD etiology (glomerular or non-glomerular), presence of acidosis, and degree of proteinuria was also evaluated.

Methods/Design: Median serum potassium …

Association Of Rare Variants In Kidney Developmental Genes With Hypertension And Ckd: A Uk Biobank Study, Benjamin L. Spector

Research Days

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Background: Prior studies show chronic kidney disease (CKD) is heritable but only a few common variants have been associated with CKD and kidney dysfunction. Much of CKD heritability remains unknown and limited studies have explored the role of rare genetic variants in this missing heritability.

Objectives/Goal: Identify rare genetic variants in renal developmental genes associated with hypertension and CKD.

Methods/Design: We examined the association between rare variants in 58 candidate genes from five renal developmental compartments and presence of CKD and elevated blood pressure (BP) in 49,989 individuals using whole exome sequencing and phenotypic data …

Treatment Of Recurrent Wilms Tumor With Irinotecan/Temozolomide, Meagan Vacek

Research Days

Background: Despite improvement in relapse free survival (RFS) in recurrent Wilms tumor, the 4- year RFS rate for patients treated with vincristine/dactinomycin/doxorubicin is approximately 40%. Ifosfamide, carboplatin and etoposide are commonly used in relapsed solid tumors but have significant toxicities and require hospital admission for administration. Our patient focused on quality of life, and this led to exploration of other treatment options.

Objectives/Goal: Describe a case of multiply relapsed Wilms tumor with management on oral chemotherapy for improved quality of life and remission for almost 1 year.

Methods/Design: Case Report

Results: The patient is an 11-year-old female diagnosed with Wilms …

Wilms Tumor Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen

Research Days

Background: Wilm’s Tumor (WT) is the most common renal malignancy of childhood. The initial presentation of WT may mimic infection or other malignancies with nonspecific symptoms including fever, abdominal/flank pain, or hematuria. This poses a diagnostic challenge for providers, particularly when both infection and malignancy are observed. We describe a case of WT with spontaneous necrosis initially obscured by overlying Clostridium perfringens infection, making diagnosis of the cancer difficult.

Case Description: A previously healthy 5-year-old girl presented to the emergency department with a two-day history of left flank pain and fevers. In the emergency department, she was tachycardic (130 bpm), …

Acute Complications In Pediatric Patients With Diabetes Admitted With Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, And Mixed Hyperosmolar Diabetic Ketoacidosis, Erica Zarse

Research Days

Background: Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and mixed DKA and HHS (hyperosmolar DKA) are hyperglycemic emergencies for which children with diabetes mellitus (DM) are admitted to the hospital. To date, there is little evidence to guide the management of pediatric diabetic patients with hyperosmolarity.

Objectives: The objective of this study is to compare the in-hospital complications at our institution in patients who have isolated DKA to those with a component of hyperosmolarity.

Methods: We reviewed medical records of patients from 01/2019 through 12/2020 admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality …

Acute Kidney Injury In Youth With Diabetes Admitted With Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, And Hyperosmolar Diabetic Ketoacidosis: A Single Center Experience, Erica Zarse

Research Days

Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies for which children are admitted to the hospital.

Objectives/Goal: Our objective was to compare acute kidney injury (AKI) between youth with isolated DKA to those with hyperosmolarity and explore associations to risk of AKI.

Methods/Design: Charts were reviewed from 01/2019 through 12/2020 for youth admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality ≥320 mOsm/kg). Isolated HHS youth were combined with hyperosmolar DKA for analysis. AKI was defined as elevated creatinine level for age. The total amount of isotonic fluids administered was …

Memory T Cell Populations In Human Leukemia, Sara Mcelroy

Research Days

Background: Incorporating the immune system into cancer management is an area of robust research. Treatment modalities aimed at activating cytotoxic T cells against malignancies include immune checkpoint inhibitors, bispecific T-cell engagers, and chimeric antigen receptor (CAR) tumor-specific T cells. Most anti-cancer T cell research is narrowly focused, but knowledge about the nature of diverse sub-populations of T cells in cancer, particularly memory T cells, is vital prior to potential incorporation into therapies. T memory stem cells (Tscm) are of interest due to their longevity and powerful abilities of self-renewal and creating the full spectrum of memory CD8+ T cells, including …

Evaluating Caretaker Satisfaction With Same-Day Discharge After Gastrostomy Tube Placement, James A. Fraser Md, Shai Stewart Md, Kayla B. Briggs Md, Shawn D. St. Peter Md, Tolulope A. Oyetunji Md Mph

Research Days

Background: Same-day discharge (SDD) after outpatient laparoscopic gastrostomy tube (G-tube) placement has been our standard institutional practice since 2017, following written and video-based preoperative education regarding G-tube use, maintenance, and exchange at the time of consultation.

Objectives/Goal: We aim to evaluate caretaker satisfaction with our same day discharge protocol following laparoscopic gastrostomy tube placement.

Methods/Design: Following IRB approval, all patients planned for SDD after G-tube placement from FebruarySeptember 2021 at a tertiary care academic center were identified. Retrospective chart review was performed to identify demographic information, successful same-day discharge or reason for postoperative admission, time to first postoperative feed, length …

Recurrent Primary Spontaneous Pneumothorax Masquerading As A Congenital Pulmonary Airway Malformation In A Young Female, Chandra Swanson

Research Days

Background: Spontaneous pneumothoraxes in children are uncommon, may be idiopathic or associated with underlying pulmonary disease, and can present management challenges.

Objectives/Goal: We present a 12-year-old female with recurrent right sided spontaneous pneumothorax in the setting of an asymptomatic SARS-Co-V2 (COVID) infection and imaging concerning for congenital lobar overinflation (CLO) versus congenital pulmonary airway malformation (CPAM), prompting surgical intervention.

Methods/Design: A literature review and chart review were completed for this case report.

Results: A 12-year-old pre-menstrual female with remote history of eczema, asthma, and environmental allergies presented from an outside facility with four-days of progressive chest pain and dyspnea on …