Digital Commons Network^™

A Comparative Analysis Estimating Aspergillosis And Histoplasmosis Encounters Among Inpatients In The United States Using Multi-Regional Electronic Health Record And National Discharge Data, 2014-2020., Brittany L. Morgan Bustamante, Juliana G E Bartels, Aidan Lee, Natalie J. Kane, Rose Reynolds, Theodore C. White, Mark A. Hoffman, Jennifer Head, Justin V. Remais

Manuscripts, Articles, Book Chapters and Other Papers

Fungal diseases are an emerging public health threat, yet their epidemiology remains poorly understood due to limited surveillance. Electronic health record (EHR) datasets offer opportunities for studying fungal diseases, but their national representativeness is unclear. We compared inpatient encounters for aspergillosis and histoplasmosis between Oracle EHR Real World Data (OERWD) and the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS), a nationally representative discharge-derived database. We analyzed inpatient encounters from both databases and applied calibration weights to OERWD to improve alignment with national benchmarks. Relative differences (RDs) in encounter counts were compared using Wald tests. Survey-weighted quasibinomial models …

Clostridioides Difficile Colonization And Infection In Pediatric Oncology And Stem Cell Transplant Patients, Daniel N. Willis, Erik R. Dubberke, Robert J. Hayashi, Phillip I. Tarr, David B. Haslam, Tiffany Hink, Jingqin Luo, Yu Tao, Amruta Padhye, Erin Hall, Gregory A. Storch

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Pediatric oncology and hematopoietic stem cell transplant (HSCT) patients have elevated risk for Clostridioides difficile infection (CDI), which can prolong hospitalization and delay chemotherapy. Colonization is an important prelude to symptomatic CDI. We sought to characterize colonization status in these patients.

METHODS: We retrospectively studied 276 stools longitudinally collected over 34 months from 32 HSCT and 12 oncology patients treated at a single tertiary center. Specimens were cultured for C difficile and compared by whole genome sequencing. The fecal microbiome was characterized by 16S rRNA gene sequencing.

RESULTS: Baseline cultures were positive in 16 (50%) HSCT patients and 2 …

Using Gloves Wisely: Rethinking Glove Use For Health, Safety, And Environmental Sustainability., M Lauren Lalakea, Radhika Sheth, Elizabeth Cerceo, Yvonne Huckleberry, Preeti Jaggi, Vidya Mony, Elizabeth Monsees

Manuscripts, Articles, Book Chapters and Other Papers

Non-sterile gloves (NSG) are essential for reducing transmission of pathogens and for protecting patients and staff. Their overconsumption can lead not only to an increased risk of cross-contamination but also increased plastic waste and downstream environmental effects. Glove reduction campaigns worldwide have safely and successfully reduced their inappropriate use and associated waste. In this multidisciplinary commentary, we discuss the sweeping public health and environmental consequences of NSG overuse and strategies to implement a successful glove stewardship campaign.

Interim Estimates Of 2025-26 Seasonal Influenza Vaccine Effectiveness - United States, September 2025-February 2026., Patrick Maloney, Emily L. Reeves, Kristina Wielgosz, Ashley M. Price, Karthik Natarajan, Malini B. Desilva, Kristin Dascomb, Nicola P. Klein, Sara Y. Tartof, Stephanie A. Irving, Shaun J. Grannis, Toan C. Ong, Zachary A. Weber, Jennifer E. Schuster, Danielle M. Zerr, Marian G. Michaels, Julie A. Boom, Natasha B. Halasa, Mary A. Staat, Geoffrey A. Weinberg, Stacey L. House, Elie A. Saade, Krissy Moehling Geffel, Manjusha Gaglani, Karen J. Wernli, Vel Murugan, Emily T. Martin, Natalie A B Bontrager, Marie K. Kirby, Amanda B. Payne, Fatimah S. Dawood, Ayzsa Tannis, Heidi L. Moline, Sifang Kathy Zhao, Katherine Adams, Jennifer Decuir, Samantha M. Olson, Jessie R. Chung, Nathaniel Lewis, Brendan Flannery, Carrie Reed, Shikha Garg, Sascha Ellington, Cdc Influenza Vaccine Effectiveness Collaborators

Manuscripts, Articles, Book Chapters and Other Papers

In the United States, annual influenza vaccination has been recommended for all persons aged ≥6 months, including during the 2025-26 season. Interim influenza vaccine effectiveness (VE) estimates were calculated for patients with acute respiratory illness-associated outpatient visits and hospitalizations from three U.S. respiratory virus VE networks during the 2025-26 influenza season, using a test-negative case-control design. Among children and adolescents aged < 18 years, VE was 38%-41% against influenza outpatient visits and 41% against influenza-associated hospitalization. Among adults aged ≥18 years, VE was 22%-34% against influenza outpatient visits and 30% against influenza-associated hospitalization. Among children and adolescents, VE against influenza A ranged from 37% (against outpatient visits) to 42% (against hospitalization) across settings; among adults, VE against influenza A ranged from 30% (against hospitalization) to 34% (against outpatient visits) across settings. Among children and adolescents, VE against influenza A(H3N2)-associated outpatient visits was 35% and against influenza A(H3N2)-associated hospitalization was 38%. VE against influenza B outpatient visits ranged from 45%-71% among children and adolescents and was 63% among adults. Other estimates of VE were not statistically significant or were not reportable. Although interim influenza VE is lower during the 2025-26 influenza season than it was during recent influenza seasons, these findings demonstrate that influenza vaccination still provides protection against influenza. CDC recommends influenza vaccination; U.S. influenza vaccines remain available for persons aged ≥6 months.

Characteristics Of Young Children Hospitalized With Acute Respiratory Failure From Infection With Respiratory Syncytial Virus, Sars-Cov-2, Or Both, November 2023-March 2024., Regina M. Simeone, Margaret M. Newhams, Laura D. Zambrano, Jemima M. Calixte, Katherine Lindsey, Amber Orzel-Lockwood, Amanda B. Payne, Natasha B. Halasa, Satoshi Kamidani, Aline B. Maddux, Kathleen Chiotos, Hillary Crandall, Jennifer E. Schuster, Danielle M. Zerr, Lora M. Martin, Melissa A. Cameron, Katherine Irby, Shira J. Gertz, Steven L. Shein, Ryan A. Nofziger, Samina S. Bhumbra, Janet R. Hume, Michele Kong, Mia Maamari, Bria M. Coates, Judith A. Guzman-Cottrill, Mary Allen Staat, Thomas J. Connors, Matt S. Zinter, Jigar C. Chauhan, Tamara T. Bradford, Kari Wellnitz, Angela P. Campbell, Adrienne G. Randolph, Overcoming Covid-19 Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Respiratory syncytial virus (RSV) and SARS-CoV-2 can cause acute respiratory failure in children. We compared characteristics and outcomes of children aged < 2 years with respiratory failure from infection with RSV, SARS-CoV-2, or both viruses.

METHODS: We used data from a US pediatric respiratory virus hospitalization surveillance network including children with ICU admission for acute respiratory failure (receiving high-flow oxygen or mechanical ventilation) with RSV and/or SARS-CoV-2 during November 2023-March 2024. Demographic, clinical characteristics, and hospitalization outcomes were stratified by a positive test for RSV, SARS-CoV-2, or both viruses, and compared using chi-squared or Kruskal-Wallis tests. Multivariable analyses assessed independent associations between outcomes and infection.

RESULTS: Overall, 1406 children were included: 1253 (89.1%) …

Defining The Society Of Pediatric Liver Transplantation (Split) Research Agenda: A Delphi Consensus Project., Sharad I. Wadhwani, Pooja Reddy Spector, Amy G. Feldman, Katryn N. Furuya, Kayla Hartjes, Chaowapong Jarasvaraparn, Beau Kelly, Stacee M. Lerret, Krupa Mysore, Arti Pawaria, Philip Rosenthal, Amy Shui, Voytek Slowik, Sarah Taylor, Jennifer Vittorio, Pamela L. Valentino, Society Of Pediatric Liver Transplantation (Split)

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite major advances in surgical and medical management, only one-third of pediatric liver transplant (LT) recipients remain morbidity-free at 10 years. The Society of Pediatric Liver Transplantation (SPLIT) published a research agenda over 10 years ago, and much progress has been made since then. An updated consensus-driven SPLIT research agenda could guide future research and funding priorities. We aimed to identify and prioritize key research needs across the continuum of pediatric LT care using a modified Delphi consensus approach.

METHODS: We conducted a three-round modified Delphi process among SPLIT members. In round 1, participants submitted open-ended research priorities. In …

Use Of A Cystatin C-Based Gfr Equation In A Population Pharmacokinetic Model Of Methotrexate Clearance In Adult Patients With Lymphoma., Zachary L. Taylor, Erin F. Barreto, Kristin C. Cole, Andrew D. Rule, Kianoush B. Kashani, Nelson Leung, Carrie A. Thompson, Thomas E. Witzig, Laura Ramsey, Jason N. Barreto

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: High-dose methotrexate (HDMTX) is a key treatment for lymphoma with central nervous system involvement. Whether incorporating cystatin C into glomerular filtration rate estimation improves methotrexate (MTX) clearance prediction remains unclear.

OBJECTIVES: We aimed to evaluate whether cystatin C-inclusive glomerular filtration rate equations improve MTX clearance prediction and to explore the relationship between MTX exposure and acute kidney injury (AKI) in adult patients with lymphoma receiving HDMTX.

METHODS: This was a prospective single-center study performed on 80 adult patients with lymphoma receiving HDMTX (1.5-8 g/m²) over a 4-h infusion. A population pharmacokinetic model was constructed using data from …

Trauma: Blunt Solid Organ Injury, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Epidemiology Of Aspergillosis Diagnoses In Us Adults Using A National Ehr Database, 2013-2023., Brittany L. Morgan Bustamante, Elijah G. Martinez, Aidan Lee, Natalie J. Kane, Simon K. Camponuri, Rose M. Reynolds, Theo T. Snow, Juliana G E Bartels, Mark A. Hoffman, Theodore C. White, Justin V. Remais

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Aspergillosis is a fungal infection associated with rising hospitalizations and substantial morbidity and mortality. In the United States, data remain fragmented due to the absence of centralized surveillance. This study aimed to evaluate demographic, geographic, and temporal trends in aspergillosis diagnoses across the United States and evaluate changes in those patterns following the emergence of COVID-19.

METHODS: We conducted a retrospective cohort study using electronic health record data from 142 US healthcare systems (Oracle Health), including adults aged ≥18 years who received care between 2013 and 2023. The cohort included over 76 million patients and 127 million person-years. Aspergillosis …

Increasing Ketamine Administration In Children's Hospitals For Youth With Sickle Cell Disease., Ashley M. Jenkins, Erin Hendry, Alexandra Power-Hays, Marin Valentino, Matthew Hall, Kathyrn Kyler, James W. Antoon, Sonya Tang Girdwood, Jennifer Goldman, Armand N. Morel, Timothy J. Savage, Lucas E. Orth, Natasha M. Archer

Manuscripts, Articles, Book Chapters and Other Papers

Ketamine is recommended as an opioid-sparing adjunct for sickle cell disease (SCD)-related pain management. Little is known regarding its use in hospitalized youth with SCD. We aimed to describe trends in ketamine administration and examine associations between ketamine administration and outcomes in hospitalized youth with SCD. We conducted a cross-sectional, multicenter study examining hospital admissions for youth with SCD from 44 children's hospitals in the United States from 2016 to 2023. Youth aged ≥6 months with SCD were identified using International Classification of Diseases tenth revision codes. Exposures included age, sex, race, payor, childhood opportunity index, hydroxyurea administration, and concomitant …

Ecmo Is Often Required In Pediatric Trimethoprim-Sulfamethoxazole (Tmp-Smx) Associated Severe Respiratory Failure, Youya Wang, Jenna Miller, Mandy Morgan, Jennifer Goldman

Presentations

Background

Recent publications describe severe disease in pediatric patients with TMP-SMX associated respiratory failure progressing to extracorporeal membrane oxygenation (ECMO), lung transplantation and/or death. ECMO characteristics in this patient population remain poorly defined.

Methods

This is a retrospective observational report from our institutional referral Redcap database reviewing ECMO characteristics for pediatric patients (age ≤ 18 years old) patients. This includes presumed TMPSMX associated severe respiratory failure, following 6 or more days of TMP-SMX exposure and lack of other diagnostic explanation.

Results

To date, at our institution we have identified 32 total adult and pediatric with clinical criteria for TMP-SMX severe …

Clinical Evaluation Of Nasal Swab Specimens In Vtm/Utm And Respdirect Estm Using The Panther Fusion Sars-Cov-2/Flu A/B/Rsv Assay., Salika M. Shakir, Robert K. Mccall, Rangaraj Selvarangan, Dithi Banerjee, Yitz Goldstein, Christine Lansang, Rachel Bogh, Carmelle V. Remillard, Respdirect Clinical Study Group

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Respiratory viral infections by SARS-CoV-2, influenza A and B viruses, and RSV overlap in disease signs and symptomology, but differ in treatment modality. Nasal swab specimens have been shown to be an effective alternative specimen type for SARS-CoV-2 detection.

OBJECTIVES: This study evaluated the performance of the Panther Fusion® SARS-CoV-2/Flu A/B/RSV assay in anterior nasal swab specimens (self- or healthcare professional [HCP]-) collected in either viral/universal (VTM/UTM) transport media or the Hologic® RespDirect® collection kit (RespDirect swab in enhanced specimen transport media [eSTM]).

STUDY DESIGN: A multicenter study was conducted from October 2022 to March 2024. A total of …

Kawasaki Disease, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Acute Otitis Media: Antibiotic Length, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

An Open-Source Application For Self-Service, Health Insurance And Portability Accountability Act-Compliant Geocoding., Harpreet Gill, Kevin Power, Catherine Jackson, Jared Johnson, Matthew Llewelyn, Kushal Vallambhatla, Natalie J. Kane, Jeffrey Thompson, Kelechi Anuforo, Cole Brokamp, Mark A. Hoffman

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: DeGAUSS is a privacy-preserving application that ingests addresses and generates output that includes latitude, longitude, census tract, deprivation index and drive times to major hospitals. The application uses a complex command line interface and a container management platform to perform analysis. Our objective was to develop a user-friendly DeGAUSS-based application that simplifies place-based analysis. We also enabled automated geomarker generation by providing an API modality to DeGAUSS.

METHODS: We developed a self-service platform based on the DeGAUSS application. The application was linked to user authentication platforms. The self-service application can be implemented as an API, enabling high-volume geocoding transactions. …

Beyond The Exam Room: Pediatricians Advocating Through State Aap, Heidi Sallee, Kelly Kreisler, Thuylinh Pham

Grand Rounds

1. Evaluate the current political climate and effects on child health at a National and State level.
2. Identify key child health policy issues for the states of Missouri and Kansas.
3. Use different forms of advocacy to share personal expertise.
4. Partner with state AAP Chapters to improve child health outcomes locally.

Bromodomain And Extra-Terminal Protein Inhibitors Modulate Natural Killer Cell Function And Differentiation., Eric S. Geanes, Gage Greening, Maria Aggelakopoulou, Linh Huyen Truong, Santosh Khanal, Cas Lemaster, Marc L. Herman, Rebecca Mclennan, Persephone Borrow, Todd Bradley

Manuscripts, Articles, Book Chapters and Other Papers

Natural killer (NK) cells are integral to the innate immune system, playing a crucial role in immune surveillance and the rapid response to virally infected and tumor cells. Epigenetic gene expression regulation significantly influences NK cell function and differentiation. Using a high-throughput small-molecule drug screening approach, we identified bromodomain and extra-terminal domain (BET) inhibitors (BETi) as potent modulators of NK cell function, reducing proinflammatory cytokine secretion while increasing markers of NK cell maturation and cytotoxicity. During NK lineage specification from hematopoietic stem cells, we demonstrated that BETi reduced NK cell fate and promoted increased myeloid cell differentiation. Moreover, differentiated NK …

Bovine Lactoferrin Maintains Antibacterial Effect Against Neonatal Escherichia Coli Septicaemia Isolates Despite The Presence Of Iron Acquisition Genes, Matthew Mayorga, Joshua Wheatley, Brianna N. Maldonado, Susana Chavez-Bueno

Manuscripts, Articles, Book Chapters and Other Papers

Introduction. Escherichia coli is a dominant cause of neonatal sepsis for which no prevention measures currently exist. Lactoferrin (LF) is an iron-sequestering antibacterial protein that has been noticed to decrease neonatal late-onset sepsis.Hypothesis/Gap Statement. LF's effect on in vitro growth of neonatal E. coli clinical isolates causing septicaemia is unknown. The prevalence of iron acquisition virulence genes which contribute to pathogenicity outcomes in these strains has also not been described in detail.Aim. To evaluate bovine lactoferrin's (bLF) effects on the in vitro growth of neonatal septicaemia E. coli isolates, and to determine the presence of iron acquisition virulence …

Updating The Epidemiology Of Blastomycosis And Histoplasmosis In The United States, Using National Electronic Health Record Data, 2013-2023., Juliana G E Bartels, Simon K. Camponuri, Theo T. Snow, Brittany L Morgan Bustamante, Natalie J. Kane, Rose Reynolds, Aidan Lee, Mark A. Hoffman, Theodore C. White, Justin V. Remais, Jennifer R. Head

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Where surveillance data are limited, nationally representative electronic health records allow for geographic, temporal, and demographic characterization of the fungal diseases blastomycosis and histoplasmosis.

METHODS: We identified incident blastomycosis and histoplasmosis cases from 2013 to 2023 within Oracle EHR Real-World Data, which comprises 1.6 billion healthcare encounters nationally. To characterize spatiotemporal incidence trends, we used generalized estimating equations weighted for nonrepresentativeness of electronic health record-reporting facilities. We computed standardized incidence rate ratios (sIRRs), which relay relative differences in standardized incidence rates between regions, race/ethnicity, gender, and age subgroups and the national population.

RESULTS: National incidence rates in 2023 were …

Rsv In Pediatrics: Immunization Strategies And Treatment Insights, Mike Smith, Maria Deza Leon

Pediatrics in Practice: A CME Podcast

Respiratory Syncytial Virus (RSV) remains a leading cause of hospitalization in infants and young children. In this episode, we sit down with Dr. Maria Deza Leon to explore the latest in RSV prevention and treatment. From maternal immunization and monoclonal antibodies like Nirsevimab to practical guidance on managing severe cases, we’ll cover what pediatricians need to know this season. Tune in for evidence-based strategies, emerging therapies, and tips to navigate supply and coverage challenges—helping you protect your patients and stay ahead of RSV trends.

Click here to stream the podcast episode.

Editorial: Advancing Understanding Of Neonatal Bacterial Infections., Susana Chavez-Bueno, Shelley M. Lawrence

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Consensus-Based Expert Recommendations For Diagnosis And Clinical Management Of Vanishing White Matter., Romy J. Van Voorst, Daphne H. Schoenmakers, Joshua L. Bonkowsky, Adeline Vanderver, Ingeborg Krägeloh-Mann, Geneviève Bernard, Enrico Bertini, Ali Fatemi, Paulo V. Sgobbi, Nicole I. Wolf, Samuel Groeschel, Davide Tonduti, Caroline Sevin, Jennifer L. Orthmann-Murphy, Ludger Schöls, Ettore Salsano, Bernard Brais, Nicole Jaffe, Kasper W. Ter Horst, Sabine E. Hannema, Katherine G. Hayes, Jochen Meyburg, Marc Van Heerde, Anne Marie Sbrocchi, Rosalina Van Spaendonk, Isabelle Thiffault, Geesje H. Hofsteenge, Carolina Sudmeier-Broek, Corrie Timmer, Donna Skwirut, Allyson Buck, Bret Hollberg, Ron Chapleau, Hanka Dekker, Susan G. Campbell, Truus E M Abbink, Prisca S. Leferink, Marjo S. Van Der Knaap

Manuscripts, Articles, Book Chapters and Other Papers

Vanishing white matter (VWM) is a rare disorder, characterized by degeneration of CNS white matter, clinically often exacerbated by stressors such as fever and minor head trauma. VWM is caused by biallelic pathogenic variants in the EIF2B1-5 genes, causing reduced activity of eukaryotic initiation of translation factor 2B, resulting in dysregulation of the integrated stress response (ISR). New scientific insights and increased clinical trials in experimental therapies highlight the need for clinical guidelines to improve and standardize care for patients with VWM worldwide. Standardized care is important for therapy development, as it lessens clinical variability of trial participants at study …

Adenovirus Types In Us Children Hospitalized Or Seen In The Emergency Department With Acute Respiratory Illness, 2016-2019., Tess Stopczynski, Varvara Probst, Adam Gailani, Justin Z. Amarin, Olla Hamdan, Haya Hayek, Laura S. Stewart, Herdi K. Rahman, Rangaraj Selvarangan, Jennifer E. Schuster, Christopher J. Harrison, Mary E. Moffatt, Marian G. Michaels, John V. Williams, Julie A. Boom, Leila C. Sahni, Vasanthi Avadhanula, Mary Allen Staat, Elizabeth P. Schlaudecker, Christina Quigley, Geoffrey A. Weinberg, Peter G. Szilagyi, Janet A. Englund, Eileen J. Klein, Aaron T. Curns, Heidi L. Moline, Ariana P. Toepfer, James D. Chappell, Andrew J. Spieker, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Human adenovirus (HAdV) is a common cause of pediatric acute respiratory illness (ARI), contributing to 5-13% of cases worldwide. Clinical manifestations vary by HAdV species and type; therefore, delineating type-specific disease presentations and understanding severity of specific HAdV types' disease may help develop targeted interventions.

METHODS: We conducted a multicenter, prospective study within the New Vaccine Surveillance Network to characterize HAdV types. Children < 18 years old with ARI were enrolled in the emergency department or inpatient setting at 7 US children's hospitals from 1 December 2016 to 30 November 2019. Respiratory specimens were collected and tested for HAdV and other viruses. Subsequently, typing was conducted on HAdV specimens using single-plex real-time PCR assays targeting sequences in the hexon gene. Comparisons between HAdV types were performed to determine differences in characteristics and outcomes. Generalized linear mixed effects models were used to evaluate severity.

RESULTS: Among the 1843 HAdV-positive cases, 1402 specimens (76%) were typed. The most common types detected were HAdV-C1 (n = 439), HAdV-C2 (n = 393), and HAdV-B3 (n = 221). Children with HAdV-B7 (n = 78) …

Clinical Long-Read Sequencing Test For Genetic Disease Diagnosis., Isabelle Thiffault, Emily G. Farrow, Cassandra Barrett, Meadow Scott, Amy Ross, John C. Means, Warren A. Cheung, Adam F. Johnson, Boryana Koseva, Rebecca Mclennan, Elin Grundberg, Chengpeng Bi, Carl F. Schreck, Byunggil Yoo, Jeffrey J. Johnston, Florencia Del Viso, Vitoria Paolillo, John Herriges, Lei Zhang, Margaret Gibson, Ana S A Cohen, Joseph Alaimo, Carol J. Saunders, Tomi Pastinen

Manuscripts, Articles, Book Chapters and Other Papers

This diagnostic study examines the diagnostic yield and turnaround time of long-read sequencing compared to standard-of-care approaches.

Nirsevimab Effectiveness Against Intensive Care Unit Admission For Respiratory Syncytial Virus In Infants - 24 States, December 2024-April 2025., Laura D. Zambrano, Regina M. Simeone, Margaret M. Newhams, Amanda B. Payne, Natasha B. Halasa, Amber O. Orzel-Lockwood, Jemima M. Calixte, Satoshi Kamidani, Hillary Crandall, Melissa A. Cameron, Jennifer E. Schuster, Aline B. Maddux, Kathleen Chiotos, Katherine Irby, Steven L. Shein, Mary Allen Staat, Lora M. Martin, Samina S. Bhumbra, Ryan A. Nofziger, Jigar C. Chauhan, Danielle M. Zerr, Shira J. Gertz, Judith A. Guzman-Cottrill, Michele Kong, Janet R. Hume, Bria M. Coates, Kelly N. Michelson, Emily R. Levy, Tamara T. Bradford, Stephanie P. Schwartz, Tracie C. Walker, Melissa S. Stockwell, Austin Biggs, Alexander H. Hogan, Katherine Lindsey, Angela P. Campbell, Adrienne G. Randolph, Overcoming Rsv Investigators

Manuscripts, Articles, Book Chapters and Other Papers

Respiratory syncytial virus (RSV) is a leading cause of intensive care unit (ICU) admission and respiratory failure among infants (children aged < 1 year) in the United States. In August 2023, CDC's Advisory Committee on Immunization Practices recommended nirsevimab, a long-acting monoclonal antibody, to protect against RSV-associated lower respiratory tract infection among all infants aged < 8 months born during or entering their first RSV season. Following licensure, nirsevimab effectiveness has been demonstrated against RSV-associated infant hospitalization, but evidence regarding effectiveness against RSV-associated critical illness is limited. In a 27-hospital case-control investigation, nirsevimab effectiveness against both RSV-associated infant ICU admission and acute respiratory failure (illness requiring continuous positive airway pressure, bilevel positive airway pressure, or invasive mechanical ventilation) after hospital admission was evaluated during December 1, 2024-April 15, 2025. Among 457 case-patients who received a positive RSV test result and 302 control patients who received a negative RSV test result admitted to an ICU with respiratory symptoms, 14% and 45%, respectively, had received nirsevimab ≥7 days before symptom onset. Nirsevimab was 80% effective (95% CI = 70%-86%) against RSV-associated ICU admission and 83% effective (95% CI = 74%-90%) against acute respiratory failure when received a median of 52 days (IQR = 32-89 days) and 50 days (IQR = 32-86 days) before onset for each respective endpoint. These estimates support the recommendation for use of nirsevimab as a prevention strategy to protect infants against severe outcomes from RSV infection.

Human Sex Trafficking, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Laceration, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Skin Soft Tissue Infection: Antibiotics For Abscesses, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Real-World Data For Tisagenlecleucel In Patients With R/R B-All: Subgroup Analyses From The Cibmtr Registry., Samuel John, Kevin J. Curran, Erin Hall, Amy K. Keating, Susanne H C Baumeister, Sarah Nikiforow, Timothy Driscoll, Amy Moskop, Kevin O. Mcnerney, Christine L. Phillips, Michael A. Pulsipher, Emily M. Hsieh, Rayne H. Rouce, Marcelo C. Pasquini, Ranjan Tiwari, Jennifer Willert, Roberto Ramos, Joerg Krueger, Erin Guest, Stephan A. Grupp

Manuscripts, Articles, Book Chapters and Other Papers

Since the first approval of tisagenlecleucel in 2017, pediatric and young adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) may receive this CD19-directed chimeric antigen receptor T-cell therapy. We report real-world data from the Center for International Blood and Marrow Transplant Research (>2.5 years of follow-up). As of 4 May 2022, 768 patients with B-ALL had received tisagenlecleucel. Patients aged ≥18 and < 18 years of age (including those < 3 years) were treated during first relapse (26.6% and 26.7% [< 3 years, 44.8%], respectively) or primary refractory disease (12.4% and 12.1% [< 3 years, 15.5%], respectively) with 17.6% and 11.6% (< 3 years, 13.8%), respectively, having high disease burden (≥50% bone marrow [BM] blasts) and 20.2% and 20.2% (< 3 years, 13.8%), respectively, having low disease burden (>0 to < 5% BM blasts). Among patients with ≥12 months postinfusion follow-up (n = 578; median follow-up, 32.1 months), the best overall response of complete remission/complete remission with incomplete blood count recovery was 86.0%. The 12-month relapse-free survival (RFS) and overall survival (OS) were 61.8% and 79.4%, respectively, whereas the 24-month RFS and OS were 50.3% and 63.8%, respectively. Age (< 18 years) and disease burden (< 50% BM blasts) were associated with better outcomes. Previous inotuzumab therapy and KMT2A rearrangement were associated with worse outcomes. Older patients (≥18 years) experienced a higher rate of any-grade cytokine release syndrome (CRS) associated with higher disease burden before infusion. Any-grade CRS and neurotoxicity were lower in patients aged < 3 years. Extended follow-up continues to demonstrate high rates of RFS and favorable safety in this population.

Interventions To Minimize Unnecessary Antibiotic Use For Acute Otitis Media: A Meta-Analysis., Theresa L. Morin, Amy B. Stein, Rana El Feghaly, Amanda Nedved, Sophie E. Katz, Amy Keith, Heather E. Laferriere, Timothy C. Jenkins, Holly M. Frost

Manuscripts, Articles, Book Chapters and Other Papers

Backgrounds/Objectives: Acute otitis media (AOM) is the leading reason antibiotics are prescribed to children. Despite guidelines advocating for watchful waiting and shorter antibiotic durations, overprescribing remains a concern. This meta-analysis aims to quantify potential reduction in antibiotic days of therapy (DOT) for AOM if prescribers adhered to guidelines. Methods: Cochrane databases were sourced for studies on ear infections, diagnostic accuracy, antibiotic duration, and watchful waiting. Randomized clinical trials, observational studies, and quality improvement reports of children aged 6 months-17 years with uncomplicated AOM published between 2000 and 2024 from the U.S., Canada, and Europe. Of 4187 studies, 425 met selection …