Medicine and Health Sciences Commons^™

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Understanding Clinical Application, Edward Lyon

Research Days

Background: Tracheal aspirate cultures (TA) are regularly obtained in the pediatric intensive care unit (PICU) when clinical changes in intubated or tracheostomy dependent children occur. Positive TA results are often unable to distinguish infection from colonization. There is no data describing the frequency and impact of repeated TAs on patients in the PICU.

Goal: Our objectives were to describe the frequency of repeated TAs in PICU children and emergence of multidrug resistant organisms (MDRO), identify bacterial profile of TAs, and examine antibiotic prescribing patterns related to these cultures.

Methods: A retrospective chart review occurred on 15 patients in the PICU …

Iv Sotalol Use In Pediatric And Congenital Heart Patients: A Multicenter Registry Study., Lindsey Malloy-Walton, Nicholas H. Von Bergen, Seshadri Balaji, Peter S. Fischbach, Jason M. Garnreiter, S Yukiko Asaki, Jeffrey P. Moak, Luis A. Ochoa, Philip M. Chang, Hoang H. Nguyen, Akash R. Patel, Christa Kirk, Ashley K. Sherman, Jennifer N. Avari Silva, J Philip Saul

Manuscripts, Articles, Book Chapters and Other Papers

Background There is limited information regarding the clinical use and effectiveness of IV sotalol in pediatric patients and patients with congenital heart disease, including those with severe myocardial dysfunction. A multicenter registry study was designed to evaluate the safety, efficacy, and dosing of IV sotalol. Methods and Results A total of 85 patients (age 1 day-36 years) received IV sotalol, of whom 45 (53%) had additional congenital cardiac diagnoses and 4 (5%) were greater than 18 years of age. In 79 patients (93%), IV sotalol was used to treat supraventricular tachycardia and 4 (5%) received it to treat ventricular arrhythmias. …

Iv Sotalol Use In Pediatric And Congenital Heart Patients: A Multicenter Registry Study, Lindsey E Malloy-Walton, Nicholas H Von Bergen, Seshadri Balaji, Peter S Fischbach, Jason M Garnreiter, S Yukiko Asaki, Jeffrey P Moak, Luis A Ochoa, Philip M Chang, Hoang H Nguyen, Akash R Patel, Christa Kirk, Ashley K Sherman, Jennifer N Avari Silva, J Philip Saul

Faculty, Staff and Student Publications

Background There is limited information regarding the clinical use and effectiveness of IV sotalol in pediatric patients and patients with congenital heart disease, including those with severe myocardial dysfunction. A multicenter registry study was designed to evaluate the safety, efficacy, and dosing of IV sotalol. Methods and Results A total of 85 patients (age 1 day-36 years) received IV sotalol, of whom 45 (53%) had additional congenital cardiac diagnoses and 4 (5%) were greater than 18 years of age. In 79 patients (93%), IV sotalol was used to treat supraventricular tachycardia and 4 (5%) received it to treat ventricular arrhythmias. …

Rates Of Physical Abuse Screening And Detection In Infants With Brief Resolved Unexplained Events (Brues), Angela Doswell

Research Days

Watch recording of live presentation

Background: “Apparent Life-Threatening Events” (ALTEs) have been associated with child physical abuse (CPA). In 2016, “Brief Resolved Unexplained Event” (BRUE) and development of its clinical guidelines and risk-stratification replaced ALTE. It is unknown if there is a similar association between BRUEs and CPA.

Objectives: To determine the rate of CPA in infants presenting with a BRUE, examine differences between infants with/without CPA, and examine rates of diagnostic testing used to detect CPA.

Methods/Design: This study was part of the BRUE Research and Quality Improvement Network, composed of 15 academic and community hospitals. Subjects were infants …

A Mixed-Methods Examination Of Transgender Youth Desistence, Mirae J. Fornander

Research Days

Watch recording of live presentation

Background: Access to gender-affirming medical care (GAMC) for transgender/gender diverse (TGD) individuals is one of the most pressing social justice issues of our time. Research has begun to identify the benefits of GAMC. However, little is known about the healthcare needs of TGD youth, especially those who discontinue GAMC. Available literature lacks clear and consistent terms to define TGD youth who stop care. Further, a significant criticism of current research is the assumption that discontinuing care is equivalent to detransitioning. There are no studies, to our knowledge, that differentiate between TGD youth who choose to …

Healthcare Utilization Of Victims Of Commercial Sexual Exploitation Compared To Non-Victims, Cree Kachelski

Research Days

Watch recording of live presentation

Background: Approximately 17,000 US children are victims of Commercial Sexual Exploitation of Children (CSEC) annually. Nearly 75% of adolescent CSEC victims received medical care within 6 months prior to identification. Screening tools have been developed based on known characteristics of CSEC victims; however, little is known about how CSEC victims compare to non-CSEC adolescents in healthcare utilization. Thus, appropriate medical CSEC screening settings are unknown.

Objectives/Goal: We aimed to identify where and how often adolescents presented to medical care in the 12 months prior to CSEC identification. We hypothesized that compared to controls, CSEC positive …

Self-Reported Sexual Behavior In A Pediatric Gender Clinic Sample, Mirae J. Fornander

Research Days

Watch recording of live presentation

Background: Previous studies of transgender/gender diverse (TGD) youth indicate differences in rates of sexual behaviors between TGD youth and their cisgender peers. However, few studies have reported the sexual behavior and preferences of TGD youth in a large clinic sample, and no studies, to our knowledge, have utilized questionnaires that do not assume the sex or gender of one’s sexual partner.

Objectives/Goal: The current study aims to explore the self-reported sexual behavior of TGD youth presenting for gender-affirming medical care.

Methods/Design: Retrospective chart review of 589 patients (ages 12-22, M= 15.92, SD= 1.54; 72.9% assigned …

Behavioral Parent Training For Adhd And Sleep: A Dream Pair, Whitney Rolling

Research Days

Background: Estimates for children with attention-deficit/hyperactivity disorder (ADHD) and comorbid sleep disorders range from 25-75% (4,5,10). Among childhood sleep disorders, behavioral insomnia is one of the most common, with the treatment of choice being behavioral parent training (BPT) (4). BPT therefore is a common treatment element for both sleep disturbance and ADHD and presents a unique opportunity for more holistic pediatric care.

Objectives/Goal: Our objective was to implement and evaluate a behavioral sleep intervention in an ADHD behavioral parent training (BPT) program. Goals of the intervention were to decrease behavioral sleep symptoms, increase sleep duration, and decrease ADHD impairment.

Methods/Design: …

Improving Adolescent Sexual And Mental Health Care Access Through Community Outreach, Anna Bitely

Research Days

Background: In the pandemic’s wake, marginalized adolescents face exacerbated barriers to accessing sexual and reproductive health (SRH) and mental health (MH) care. Telemedicine access for SRH/MH care has increased, but disparities remain.

Objectives/Goal: We assessed the impact of our intervention (AccessKCTeen) on care access.

Methods/Design: We trained four peer leaders to share SRH/MH information and mobilize their networks to attend AccessKCTeen outreach events. We partnered with community organizations to host events where we demonstrated telemedicine, shared resources for SRH/MH care, and discussed and distributed free health items (e.g. emergency contraception (EC), condoms, pregnancy tests, hand sanitizer). Teens completed surveys prior …

Cvst As A Rare Complication Of Acute Pediatric Covid-19, Erin Bolen

Research Days

Background: A previously healthy 13-year-old male was admitted to the hospital for a bacterial superinfection in the setting of recent COVID-19, including orbital cellulitis and pansinusitis with subgaleal, epidural, and subdural empyema. Further workup identified an occult, non-occlusive cerebral venous sinus thrombosis (CVST) along the length of the superior sagittal sinus.

Objectives/Goal: To evaluate the reported cases of CVST as a potential complication of COVID-19 in the pediatric population and identify meaningful trends in demographics, presentation, and diagnostic course.

Methods/Design: A literature search was run with various combinations of the following terms, always including “COVID”: “pediatric,” “adolescent,” “CVST,” “cerebral venous …

Evaluation Of A Hirschsprung Disease Systemwide Enterocolitis De-Escalation Strategy, Albert Aickareth

Research Days

Problem Statement/Question: Components of systems that identify, treat and prevent enterocolitis are not well described. In addition, for patients with HSCR both pre and post pull-through, questions regarding a child’s clinical status occur through several different medical access points and may occur outside of colorectal center clinic hours.

Background/Project Intent (Aim Statement): Hirschsprung associated enterocolitis (HAEC) is a severe and potentially life-threatening complication of Hirschsprung Disease (HSCR) that can present with a variety of symptoms from mild abdominal pain to fulminant colitis. We evaluated our system-wide enterocolitis de-escalation strategy for both hospital staff and patient caregivers. Our primary analysis was …

Impact Of A Mental Health Screening Process In A Pediatric Ed, Bryan Stocker Do, Shobhit Jain Md, Kathryn Worland Msw, Celeste Tarantino Md, Lina Patel Md, Shayla Sullivant Md

Research Days

Background: Up to 20% of children in the United States experience a mental health disorder and suicide is the second leading cause of death among adolescents. Children presenting with mental health concerns to the Emergency Department (ED) can be challenging due to lack of access to trained professionals and long lengths of stay. Specialized teams have shown to be beneficial, but little is known about their impact in the ED.

Objectives/Goal: This study explored the impact of specialized social workers partnering with emergency medicine providers to provide care during an acute mental health crisis.

Methods/Design: We performed this work at …

X-Linked Nephrogenic Syndrome Of Inappropriate Antidiuresis Secondary To Vasopressin Receptor 2 Mutation, Erica Zarse

Research Days

Background: X-linked nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a rare cause of hyponatremia with a similar biochemical evaluation to the syndrome of inappropriate antidiuretic hormone secretion but with suppressed vasopressin (AVP) levels.

Objectives: We present a case of hyponatremia due to NSIAD.

Results: A 25-month-old male with developmental delay became unresponsive 30 minutes after falling off a couch onto a hardwood floor. He presented with tonic-clonic movements and eye deviation requiring antiepileptics. Serum laboratories noted hyponatremia (123 mmol/L), hypoosmolality (262 mOsm/kg) and hypochloremia (90 mmol/L) prompting endocrine consult. Head imaging normal. Urine dilute with specific gravity 1.004, osmolality 160 …

Covid-19: Perspectives From Youth In Detention, April Mcneill-Johnson

Research Days

Background: The COVID-19 pandemic amplified health disparities among youth in detention. Understanding perspectives of these youth on the pandemic and COVID-19 vaccination may identify strategies to mitigate pandemic-related health disparities in this group.

Objectives/Goal: To explore perspectives on the COVID-19 pandemic, effect on detention experience and the COVID vaccine among youth in detention.

Methods/Design: This is a secondary analysis of a study examining healthcare needs and experiences of youth in detention. We recruited a convenience sample of youth (14-17 years) detained in urban midwestern juvenile detention centers from January-November 2021. We conducted semistructured individual interviews & used a thematic analysis …

Gastrointestinal Fibromatosis: A Case Of Successful Oral Tyrosine Kinase Inhibitor Delivery To An Infant With Proximal Duodenal Obstruction, Darius Blanding

Research Days

Background: Infantile myofibromatosis (IM) is a rare disorder characterized by the fibrous proliferation of the skin, bone, muscle, and viscera that usually presents at birth, or soon after. Although IM is a benign condition, significantly higher morbidity and mortality have been reported when the viscera is involved. This case report is of a 6-week-old female who presented with poor feeding along with subcutaneous nodules that were diagnosed as IM. Upper and lower endoscopy were performed for worsening feeding intolerance showing marked nodularity throughout the gastrointestinal (GI) tract, including partial obstruction of the proximal duodenum by biopsy-proven myofibromas, confirming visceral IM …

Subclinical Status Epilepticus In The Setting Of An Acute Covid-19 Infection, Thomas Rieth

Research Days

Background: While COVID-19 commonly presents as an upper respiratory infection, acute COVID infections has the potential to have multisystem involvement. Neurological symptoms, which have mainly been reported in adults, are rare in children and are not well recognized. Better understanding of the neurological manifestations of COVID-19 in children can lead to earlier detection of COVID-19 and help with medical decision making and treatment.

Objectives/Goal: To describe an unusual presentation of COVID-19 in a previously healthy female and explore the neurological presentations of COVID-19.

Results: A 10 year old previously healthy female presented with a 1 day history of altered mental …

Soft Palate Teratoma: 5 Month Old Presenting With Failure To Thrive And Severe Obstructive Sleep Apnea, Anna Lawrence

Research Days

Introduction: Oropharyngeal teratomas are an extremely rare congenital tumor. They are often diagnosed prenatally and can cause significant airway obstruction and feeding difficulties at birth. We present a 5-month old female that was diagnosed with a palatal teratoma that presented with failure to thrive, difficulty feeding and eventually with severe obstructive sleep apnea.

Case Description: We present a 5 month old term, otherwise healthy female who initially was breastfeeding well. After an episode of RSV at one month old she become stridulous and had difficulties with feeding. She was seen by an otolaryngologist at 3 months old who performed both …

A Case Of Fibrous Hamartoma In Term Neonate, Elizabeth Perry

Research Days

Case report abstract: Fibrous hamartoma of infancy (FHI) is a rare, benign lesion characterized as a tumor of myofibroblastic origin that has characteristic features of triphasic histology. FHI was first described in 1956 by Reye and formally named by Enzinger in 1965 (1, 2). The lesion is defined as a hamartoma due to the histologic presentation of disorganized mesenchymal, fibrous, and adipose tissue with absence of mitotic figures; this combination of derived tissue without evidence of anaplasia is diagnostic for FHI. These lesions typically arise as a single, solitary mass, are most commonly located on the extremities, trunk, sacrum, or …

Early Onset Obesity In A 4-Year-Old Female Found To Have Variants In Both The Single-Minded Homolog 1 And Sh2b Adaptor Protein 1 Genes, Erica Zarse

Research Days

No abstract provided.

The Influence Of Blm And The Death Of George Floyd On Medical And Pre-Med Students And Their Views On Institutional Racism, Asia Susko, Jason A. Wasserman

Posters

INTRODUCTION
Racial inequalities present in medical education in a multitude of ways, including basing disease prevalence on majority populations and using images that disproportionately represent white patients. George Floyd’s death was not only a sentinel event of police violence, but underscored broader systemic racism, including medicine’s potential for complicity. This study highlights the perspectives of premedical and medical students in light of George Floyd’s death and the Black Lives Matter movement. Their views help elaborate ways to better support students and staff of color in medical education.

Emergency Department Recidivism Due To Skin Lesions Among The Homeless Population, Kylee Jb Kus, Jason A. Wasserman

Posters

INTRODUCTION
Ample research supports the correlation between homelessness and poor health generally. Individuals experiencing homelessness face a higher risk of dermatological health problems due to exposure and sanitation concerns and comprise a disproportionately large share of emergency department (ED) visits. This study assesses whether and how the interaction between homelessness and dermatological health contributes to ED recidivism.

The Divergence Of Medical Ethics And State Laws Regarding Life Sustaining Treatment, Hannah Vandusen, Jason A. Wasserman

Posters

INTRODUCTION
Research reveals that cardiopulmonary resuscitation (CPR) rarely leads to prolonged survival in patients with chronic illnesses in whom death is expected in the relative near-term. There is strong ethical consensus favoring a physician’s right to refuse to provide CPR when it is physiologically futile or medically inappropriate. State laws governing medical treatment, however, sometimes diverge from this guidance. This study examines laws related to life sustaining treatment, analyzing both physician and surrogate authority in decision making about resuscitation orders in the national context.

Prospective Qualitative Analysis Of Minimally Invasive Repair Of Pectus Excavatum, Timothy Elton, Diane Studzinski, Robert S. Morden, Pavan Brahmamdam

Posters

INTRODUCTION
Pectus Excavatum is the most common chest wall deformity and is frequently corrected with the Nuss procedure. Although this procedure has existed for several decades, new strategies are being adapted to reduce complications and improve efficiency. The aim of this study is to perform a qualitative review of the patient experience after minimally invasive repair of Pectus Excavatum.

Spontaneous Pneumomediastinum In Children Is Not Associated With Esophageal Perforation, Kevin Roby, Catherine Barkach, Diane Studzinski, Nathan Novotny, Begum Akay, Pavan Brahmamdam

Posters

INTRODUCTION
We hypothesize that esophageal perforation is not a common etiology for spontaneous pneumomediastinum (SPM), and that SPM is a self-limited disease not requiring routine admission.

Perioperative Antibiotic Use In Neonatal Surgery, Lior Kopel, Patrick Karabon, Nathan Novotny, Begum Akay, Pavan Brahmamdam

Posters

INTRODUCTION
The ideal duration of perioperative antibiotic prophylaxis to prevent surgical site infection (SSI) in neonates is undetermined. The aim of this study is to evaluate the association between the duration of perioperative antibiotics and SSIs in the neonatal surgical population.

Blunt Trauma And Diaphragm Injury In Children: An Analysis Of The National Trauma Data Bank, Sammie Lai, Patrick Karabon, Patrick Modren, Begum Akay, Anthony Stallion, Pavan Brahmamdam

Posters

INTRODUCTION
Trauma is the leading cause of mortality and morbidity in children. Traumatic diaphragm rupture (TDR) is a rare but serious injury that can be difficult to identify. The current literature includes individual case reports and single center case series only, which limits our ability to generalize those findings. The purpose of this study is to use the National Trauma Data Bank (NTDB) in order to examine the clinical outcomes of blunt TDR in the pediatric population.

Gauging The Impact Of Interactions With Autistic Children Early In Medical Education, Emily W. Yuen, Helen E. Huetterman, Jessica Korneder, Jason A. Wasserman, Mary O. Dereski

Posters

INTRODUCTION
One in fifty-nine children in the United States are currently diagnosed with Autism Spectrum Disorder (ASD). Despite this high prevalence, medical students receive little training on this unique population. This project aims to determine the impact on first-year medical students’ attitudes toward treatment of children diagnosed with ASD following small group interactions in an Applied Behavior Analysis (ABA) clinic.

Development Of Verbal Behavior In Early, Intensive Behavioral Therapy For Autism Spectrum Disorder, Mthya Jayakumar, Lesly Hendershot, Lori Warner, James F. Grogan

Posters

INTRODUCTION
The current study will explore the relationships between motor imitation (MI) and verbal requesting skills in children who are diagnosed with autism spectrum disorder (ASD). With nearly half of children with ASD evidencing minimal verbal skills, supporting language development is crucial in interventions. Early, intensive behavioral intervention (EIBI) is recommended to help children achieve better developmental outcomes. Functional language training often begins with the verbal requesting skill, MAND. Research suggests that a series of rapid motor imitations before a vocal model could facilitate vocal speech, but little is known about how MI can longitudinally influence functional language development. This …

Pediatric Obesity: A Survey Study Of Patients And Caregivers’ Concern And Interest In Specialized Programs, Dina Abdo, Ryan Rogers, Susan Edlibi, Aimee Pollak, Stacey Shubeck, Kerry P. Mychaliska

Posters

INTRODUCTION
Body mass index (BMI) ≥ the 85th percentile for age and sex is considered overweight in the pediatric population. Pediatric obesity is defined as a BMI at or above the 95th percentile. According to the Centers for Disease Control (CDC), obesity prevalence has tripled over the past 50 years; 1 in 5 school-aged children has a diagnosis of obesity. The purpose of this study is to survey caregivers’ perceptions and concerns about their child’s weight and patient and caregiver interest in a comprehensive healthy lifestyle program.

Effect Of Sars-Cov2 On Adolescent Phq-9 Screening Result, Anisah Hashmi, Aimee Pollak, Leah Ludwig, Kerry P. Mychaliska, Mara Rubenstein, Olufunke Adeyemo, Stacey Shubeck, Liu Qu, Mary Coffey

Posters

INTRODUCTION
The SARS-COV2 pandemic created numerous stressors for adolescents including financial insecurities, family illness or death, home schooling, discontinuation of group activities, and decreased peer interaction. Prior studies have shown an increased risk for self-reported depression symptoms in pediatric patients following traumatic events. The purpose of this study is to compare rates of newly diagnosed depression in adolescents and self-reported depression symptoms prior to and during the pandemic.