Medicine and Health Sciences Commons^™

Association Of Time-Varying Blood Pressure With Chronic Kidney Disease Progression In Children., Ben Christopher Reynolds, Jennifer Lynn Roem, Derek Kai Sing Ng, Mina Matsuda-Abedini, Joseph Thomas Flynn, Susan Lynn Furth, Bradley A. Warady, Rulan Savita Parekh

Manuscripts, Articles, Book Chapters and Other Papers

Importance: Optimal blood pressure (BP) management in children with chronic kidney disease (CKD) slows progression to end-stage renal disease. Studies often base progression risk on a single baseline BP measurement, which may underestimate risk.

Objective: To determine whether time-varying BP measurements are associated with a higher risk of progression of CKD than baseline BP measurements.

Design, Setting, and Participants: The ongoing longitudinal, prospective cohort study Chronic Kidney Disease in Children (CKID) recruited children from January 19, 2005, through March 19, 2014, from pediatric nephrology centers across North America, with data collected at annual study visits. Participants included children aged 1 …

Ethnic Disparity And Exposure To Supplements Rather Than Adverse Childhood Experiences Linked To Preterm Birth In Pakistani Women, Kiran Shaikh, Shahirose Sadrudin Premjib, Sharifa Bashir Lalani, Ntonghanwah Forcheh, Aliyah Dosanic, Ilona S. Yim, Pauline Samia, Christopher Naugler, Nicole Letourneau, The Maternal Infant Global Health Team (Might) Collaborators In Research

Paediatrics and Child Health, East Africa

Background: Adverse childhood experiences (ACEs) are associated with prenatal mental health and negative pregnancy outcomes in high income countries, but whether the same association exists in Pakistan, a low- to middle-income (LMI) country, remains unclear.

Methods: Secondary data analyses of a prospective longitudinal cohort study examining biopsychosocial measures of 300 pregnant women at four sites in Karachi, Pakistan. A predictive multiple logistic regression model for preterm birth (PTB; i.e., <37 weeks’ gestation) was developed from variables significantly (P < 0.05) or marginally (P < 0.10) associated with PTB in the bivariate analyses.

Results: Of the 300 women, 263 (88%) returned for delivery and were included in the current analyses. The PTB rate was 11.1%. We found no association between ACE and PTB. Mother's …

Chloraprep Dry Time, Nikki Jones, Chelsea Dennison, Becca Millard, Kristin Sapp

Nurse Presentations

Describes a project to increase the dry time compliance for solutions used in general surgery in the operating room.

Insights Image For "Evidence Of Increased Hypoxia Signalling In Fetal Liver From Maternal Nutrient Restriction In Mice"., Bethany N Radford, Victor K M Han

Paediatrics Publications

No abstract provided.

Evidence Of Increased Hypoxia Signaling In Fetal Liver From Maternal Nutrient Restriction In Mice., Bethany N Radford, Victor K M Han

Paediatrics Publications

BACKGROUND: Intrauterine growth restriction (IUGR) is a pregnancy condition where fetal growth is reduced, and offspring from IUGR pregnancies are at increased risk for type II diabetes as adults. The liver is susceptible to fetal undernutrition experienced by IUGR infants and animal models of growth restriction. This study aimed to examine hepatic expression changes in a maternal nutrient restriction (MNR) mouse model of IUGR to understand fetal adaptations that influence adult metabolism.

METHODS: Liver samples of male offspring from MNR (70% of ad libitum starting at E6.5) or control pregnancies were obtained at E18.5 and differential expression was assessed by …

Successful Recovery In A Paediatric Patient With Polytrauma Following Multiple Gunshot Wounds: Case Report And Review Of Literature, Areej Saleem, Rida Ahmed, Abeer Aziz, Sohail Asghar Dogar

Section of Paediatric Surgery

Our case report evaluates a 2½ year old boy who presented to emergency care, following multiple gunshot injuries and was managed emergently using a multidisciplinary surgical approach at our center. The patient was unresponsive, had poor perfusion, bilaterally decreased air entry, a distended abdomen, and multiple entry and exit wounds. A multidisciplinary team including Paediatric Surgery, Cardiothoracic Surgery, Paediatric anaesthesiology team and Orthopaedic surgery were taken on board. Following effective immediate management and stabilization, the patient was admitted to the ward under careful observation. He was discharged on post-operative day 28 after a successful recovery and on his 6 month …

Age Of Acquisition Impacts The Brain Differently Depending On Neuroanatomical Metric, Hannah Claussenius-Kalman, Kelly A Vaughn, Pilar Archila-Suerte, Arturo E Hernandez

Faculty, Staff and Student Publications

Although researchers generally agree that a certain set of brain areas underlie bilingual language processing, there is discrepancy regarding what effect timing of language acquisition has on these regions. We aimed to investigate the neuroanatomical correlates of age of acquisition (AoA), which has been examined previously, but with inconsistent results, likely influenced by methodological differences across studies. We analyzed gray matter density, volume, and thickness using whole-brain linear models in 334 bilinguals and monolinguals. Neuroanatomical correlates of AoA differed depending on gray matter metric. Relative to early bilinguals, late bilinguals had thicker cortex in language processing and cognitive control regions, …

Incidental Diagnosis Of Dual Arterial Supply Of The Right Lower Lobe, Christopher Mathis, Jay Crockett, Maria Kiaffas

Posters

Description of Clinical Presentation: A 15 year old male with a 2 week history of fever and abdominal pain had an abdominal/pelvic MRI demonstrating osteomyelitis of his right hip. Incidentally an anomalous vessel arising from the abdominal aorta and coursing to the vasculature of the lower right lung lobe was identified and he was referred to cardiology for further evaluation. He is an athlete with no history of cardiac or respiratory symptoms and his cardiac physical examination was within normal limits. Diagnostic Techniques and Their Most Important Findings: An echocardiogram was initially obtained; imaging was difficult due to suboptimal acoustic …

Diarrhoeal Disease And Subsequent Risk Of Death In Infants And Children Residing In Low-Income And Middle-Income Countries: Analysis Of The Gems Case-Control Study And 12-Month Gems-1a Follow-On Study, Myron M. Levine, Dilruba Nasrin, Sozinho Acácio, Quique Bassat, Helen Powell, Sharon M. Tennant, Samba O. Sow, Anita K. M. Zaidi, Shahida Qureshi, Farheen Quadri

Department of Paediatrics and Child Health

Background: The Global Enteric Multicenter Study (GEMS) was a 3-year case-control study that measured the burden, aetiology, and consequences of moderate-to-severe diarrhoea (MSD) in children aged 0-59 months. GEMS-1A, a 12-month follow-on study, comprised two parallel case-control studies, one assessing MSD and the other less-severe diarrhoea (LSD). In this report, we analyse the risk of death with each diarrhoea type and the specific pathogens associated with fatal outcomes.
Methods: GEMS was a prospective, age-stratified, matched case-control study done at seven sites in Africa and Asia. Children aged 0-59 months with MSD seeking care at sentinel health centres were recruited along …

Rationale And Design Of The Steroids To Reduce Systemic Inflammation After Infant Heart Surgery (Stress) Trial, Kevin D Hill, H Scott Baldwin, David P Bichel, Ryan J Butts, Reid C Chamberlain, Alicia M Ellis, Eric M Graham, Jesse Hickerson, Christoph P Hornik, Jeffrey P Jacobs, Marshall L Jacobs, Robert Db Jaquiss, Prince J Kannankeril, Sean M O'Brien, Rachel Torok, Joseph W Turek, Jennifer S Li, Stress Network Investigators

Faculty, Staff and Students Publications

For decades, physicians have administered corticosteroids in the perioperative period to infants undergoing heart surgery with cardiopulmonary bypass (CPB) to reduce the postoperative systemic inflammatory response to CPB. Some question this practice because steroid efficacy has not been conclusively demonstrated and because some studies indicate that steroids could have harmful effects. STRESS is a randomized, placebo-controlled, double-blind, multicenter trial designed to evaluate safety and efficacy of perioperative steroids in infants (age < 1 year) undergoing heart surgery with CPB. Participants (planned enrollment = 1,200) are randomized 1:1 to methylprednisolone (30 mg/kg) administered into the CPB pump prime versus placebo. The trial is nested within the existing infrastructure of the Society of Thoracic Surgeons Congenital Heart Surgery Database. The primary outcome is a global rank score of mortality, major morbidities, and hospital length of stay with components ranked commensurate with their clinical severity. Secondary outcomes include several measures of major postoperative morbidity, postoperative hospital length of stay, and steroid-related safety outcomes including prevalence of hyperglycemia and postoperative infectious complications. STRESS will be one of the largest trials ever conducted in children with heart disease and will answer a decades-old question related to safety and efficacy of perioperative steroids in infants undergoing heart surgery with CPB. The pragmatic "trial within a registry" design may provide a mechanism for conducting low-cost, high-efficiency trials in a heretofore-understudied patient population.

Validation And Human Factor Analysis Study Of An Infant Weight Estimation Device., Susan M. Abdel-Rahman, Ian M. Paul, Paula Delmore, Jia-Yuh Chen, Mary Mills, Rachel G. Greenberg, Best Pharmaceuticals For Children Act – Pediatric Trials Network

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Weight is critical for the medical management of infants; however, scales can be unavailable or inaccessible in some practice settings. We recently developed and validated a robust infant weight estimation method based on chest circumference (CC) and head circumference (HC). This study was designed to determine the human factors (HF) experience with, and predictive performance of, an infant weight estimation device that implements this method.

METHODS: Prospective, multi-center, observational, masked study of 486 preterm and term infants (0-90 days) assessed by 15 raters. Raters measured the infant using calibrated scales/measures and masked versions of the device. Raters also evaluated …

Prioritization And Management Recommendations Of Pediatric Urology Conditions During The Covid-19 Pandemic, Daniel T. Keefe, Mandy Rickard, Peter Anderson, Darius Bagli, Anne Sophie Blais, Stéphane Bolduc, Luis H. Braga, Natasha Brownrigg, Michael Chua, Sumit Dave, Joana Dos Santos, Luis Guerra, Allen H. Hayashi, Mélise A. Keays, Soojin Kim, Martin A. Koyle, Linda C. Lee, Armando J. Lorenzo, Dawn Maclellan, Landan Macdonald, Andrew E. Macneily, Peter D. Metcalfe, Katherine Moore, Rodrigo L.P. Romao, Peter Z.T. Wang

Paediatrics Publications

No abstract provided.

Neurodevelopment Outcome Of Neonates Treated With Intraventricular Colistin For Ventriculitis Caused By Multiple Drug-Resistant Pathogens-A Case Series, Kashif Hussain, Muhammad Sohail Salat, Gul Ambreen, Javaid Iqbal

Department of Biological & Biomedical Sciences

Background: Multiple-drug-resistant Gram-negative bacteria (MDR-GNB)-associated neonatal ventriculitis is a life-threatening complication that needs timely diagnosis and effective treatment with broad-spectrum antimicrobials in critical-care settings. Inadequate penetration of antibiotics through the blood-brain barrier also demands an intraventricular (IVT) route of administration. This study reports mortality and neurodevelopmental sequelae of neonates till 18 months of age, who received IVT-colistin for treating MDR-GNB associated ventriculitis.
Methods: In a case series of seven neonates with ventriculitis due to MDR-GNB at NICU of Aga Khan University Hospital, Pakistan, between June 2015 and 2018, we reviewed IVT-colistin therapy in critically ill neonates. Treatment outcomes were assessed …

Assessment Of Activity Of Daily Life In Mucopolysaccharidosis Type Ii Patients With Hematopoietic Stem Cell Transplantation., Yasuyuki Suzuki, Madeleine Taylor, Kenji Orii, Toshiyuki Fukao, Tadao Orii, Shunji Tomatsu

Department of Pediatrics Faculty Papers

The effectiveness of hematopoietic stem cell transplantation (HSCT) for mucopolysaccharidosis type II (MPS II, Hunter disease) remains controversial although recent studies have shown HSCT provides more clinical impact. This study aims to evaluate the long-term effectiveness of HSCT using the activity of daily living (ADL) scores in patients with MPS II. Sixty-nine severely affected MPS II patients (19 patients who received HSCT and 50 untreated patients) and 40 attenuated affected patients (five with HSCT and 35 untreated) were investigated by a simplified ADL questionnaire. The frequency of clinical findings and the scores of ADL (verbal, gross motor, and the level …

Outcomes In Pediatric Studies Of Medium-Chain Acyl-Coa Dehydrogenase (Mcad) Deficiency And Phenylketonuria (Pku): A Review., Michael Pugliese, Kylie Tingley, Andrea Chow, Nicole Pallone, Maureen Smith, Alvi Rahman, Pranesh Chakraborty, Michael T Geraghty, Julie Irwin, Laure Tessier, Stuart G Nicholls, Martin Offringa, Nancy J Butcher, Ryan Iverson, Tammy J Clifford, Sylvia Stockler, Brian Hutton, Karen Paik, Jessica Tao, Becky Skidmore, Doug Coyle, Kathleen Duddy, Sarah Dyack, Cheryl R Greenberg, Shailly Jain Ghai, Natalya Karp, Lawrence Korngut, Jonathan Kronick, Alex Mackenzie, Jennifer Mackenzie, Bruno Maranda, John J Mitchell, Murray Potter, Chitra Prasad, Andreas Schulze, Rebecca Sparkes, Monica Taljaard, Yannis Trakadis, Jagdeep Walia, Beth K Potter

Paediatrics Publications

BACKGROUND: Inherited metabolic diseases (IMDs) are a group of individually rare single-gene diseases. For many IMDs, there is a paucity of high-quality evidence that evaluates the effectiveness of clinical interventions. Clinical effectiveness trials of IMD interventions could be supported through the development of core outcome sets (COSs), a recommended minimum set of standardized, high-quality outcomes and associated outcome measurement instruments to be incorporated by all trials in an area of study. We began the process of establishing pediatric COSs for two IMDs, medium-chain acyl-CoA dehydrogenase (MCAD) deficiency and phenylketonuria (PKU), by reviewing published literature to describe outcomes reported by authors, …

A Novel Histological Index For Evaluation Of Environmental Enteric Dysfunction Identifies Geographic-Specific Features Of Enteropathy Among Children With Suboptimal Growth, Ta-Chiang Liu, Kelley Vanbuskirk, Syed Asad Ali, M. Paul Kelly, Lori R. Holtz, Omer H. Yilmaz, Kamran Sadiq, Najeeha Talat Iqbal, Beatrice Amadi, Sana Syed

Department of Paediatrics and Child Health

Background: A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity.
Methods: Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists …

Increased Episodes Of Aspiration On Videofluoroscopic Swallow Study In Children With Nasogastric Tube Placement., Sarah T. Edwards, Linda Ernst, Ashley K. Sherman, Ann M. Davis

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Given the limited evidence available, the impact of nasogastric (NG) tube placement on swallowing in children is not well understood. When a child needs to be fed enterally, the current standard is to initially place an NG tube and leave it in place for the first few months of supplemental or total enteral nutrition. It is important to understand if placement of NG tubes has a negative effect on a patient's swallow.

METHODS: We retrospectively reviewed the charts of those children who had videofluoroscopic swallow studies (VFSS) to identify all children who had an NG tube in place at …

Fatigue In Young People With Duchenne Muscular Dystrophy, Basmah El-Aloul, Kathy N Speechley, Yi Wei, Piotr Wilk, Craig Campbell

Paediatrics Publications

AIM: To describe fatigue in Duchenne muscular dystrophy (DMD) from patients' and parents' perspectives and to explore risk factors for fatigue in children and adolescents with DMD.

METHOD: A multicentre, cross-sectional study design was used. Seventy-one patients (all males; median age 12y, age range 5-17y) identified via the Canadian Neuromuscular Disease Registry, and their parents completed questionnaires. Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale by child self-report and parent proxy-report.

RESULTS: Patients with DMD across ages and disease stages experienced greater fatigue compared to typically developing controls from published data. Sleep disturbance symptoms …

Prevalence Of Sensorineural Hearing Loss In Children With Palliated Or Repaired Congenital Heart Disease., Lalitha Gopineti, Mane Paulpillai, Andrea Rosenquist, Andrew H. Van Bergen

Manuscripts, Articles, Book Chapters and Other Papers

Background Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental deficits, and the presence of sensorineural hearing loss (SNHL) may further lead to poor language skills acquisition and speech delays. Prevalence of SNHL in the general pediatric population is estimated to be 0.2% at birth to 0.35% during adolescence. Very few studies have attempted to estimate SNHL prevalence in children who have undergone congenital heart surgery. Methods This retrospective study aimed to estimate SNHL prevalence in children who underwent congenital heart surgery in our institution and were followed up in our high-risk pediatric cardiology clinics for four …

Facing Covid-19 In The Icu: Vascular Dysfunction, Thrombosis, And Dysregulated Inflammation, De Leisman, Cs Deutschman, M Legrand

Journal Articles

No abstract provided.

Varying Presentations And Favourable Outcomes Of Covid-19 Infection In Children And Young Adults With Sickle Cell Disease: An Additional Case Series With Comparisons To Published Cases., A Appiah-Kubi, S Acharya, C Fein Levy, A Vlachos, G Ostovar, K Murphy, A Farrell, D Brower, Jm Lipton, B Aygun, +1 Additional Authors

Journal Articles

No abstract provided.

A Pediatric Infectious Disease Perspective Of Sars-Cov-2 And Covid-19 In Children., A. L. Shane, A. I. Sato, C. Kao, F. C. Adler-Shohet, S. B. Vora, J. Ery, J. Auletta, S. Nachman, M. K. Kainth, K. Kotloff, +15 Additional Authors

Journal Articles

Understanding the role that children play in the clinical burden and propagation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for novel coronavirus (COVID-19) infections is emerging. While the severe manifestations and acute clinical burden of COVID-19 has largely spared children compared to adults, understanding the epidemiology, clinical presentation, diagnostics, management, and prevention opportunities as well as the social and behavioral impacts on child health is vital. Foremost is clarifying the contribution of asymptomatic and mild infections to transmission within the household and community and the clinical and epidemiologic significance of uncommon severe post-infectious complications. Herein we summarize the …

Management Of Neonates After Postpartum Discharge And All Children In The Ambulatory Setting During The Coronavirus Disease 2019 (Covid-19) Pandemic, K. L. Harriel, D. Nolt, S. Moore, S. Kressly, H. H. Bernstein

Journal Articles

PURPOSE OF REVIEW: The present coronavirus disease 2019 (COVID-19) pandemic has created additional challenges with an increased number of presumed healthy, full-term newborns being discharged at 24 h after delivery. Short lengths of stay raise the possibility of mother-infant dyads being less ready for discharge, defined as at least one of the three informants (i.e., mother, pediatrician, and obstetrician) believing that either the mother and/or infant should stay longer than the proposed time of discharge. This public health crisis has reduced the number of in-person well child visits, negatively impacting vaccine receipt, and anticipatory guidance. RECENT FINDINGS: Extra precautions should …

Cytokine Elevation In Severe And Critical Covid-19: A Rapid Systematic Review, Meta-Analysis, And Comparison With Other Inflammatory Syndromes., D. E. Leisman, L. Ronner, R. Pinotti, M. D. Taylor, P. Sinha, C. S. Calfee, A. V. Hirayama, F. Mastroiani, C. J. Turtle, C. S. Deutschman, +2 Additional Authors

Journal Articles

The description of a so-called cytokine storm in patients with COVID-19 has prompted consideration of anti-cytokine therapies, particularly interleukin-6 antagonists. However, direct systematic comparisons of COVID-19 with other critical illnesses associated with elevated cytokine concentrations have not been reported. In this Rapid Review, we report the results of a systematic review and meta-analysis of COVID-19 studies published or posted as preprints between Nov 1, 2019, and April 14, 2020, in which interleukin-6 concentrations in patients with severe or critical disease were recorded. 25 COVID-19 studies (n=1245 patients) were ultimately included. Comparator groups included four trials each in sepsis (n=5320), cytokine …

Clinical Characteristics And Outcomes Of Critically Ill Patients With Covid-19 Admitted To An Intensive Care Unit In London: A Prospective Observational Cohort Study, R. J. Thomson, J. Hunter, J. Dutton, J. Schneider, M. Khosravi, A. Casement, K. Dhadwal, D. Martin

Journal Articles

© 2020 Thomson et al. Background Cohorts of severely ill patients with COVID-19 have been described in several countries around the globe, but to date there have been few published reports from the United Kingdom (UK). Understanding the characteristics of the affected population admitted to intensive care units (ICUs) in the UK is crucial to inform clinical decision making, research and planning for future waves of infection. Methods We conducted a prospective observational cohort study of all patients with COVID-19 admitted to a large UK ICU from March to May 2020 with follow-up to June 2020. Data were collected from …

A Primer On A Comprehensive Genetic Approach To Vascular Anomalies, A. J. Borst, T. A. Nakano, F. Blei, D. M. Adams, J. Duis

Journal Articles

No abstract provided.

Sé Un Héroe Tú También, Samantha S. Rohe, Sophie Cemaj

Books: Pediatrics

This children's book explains COVID-19 and how to decrease the incidence of transmissions.

Quiet Please: The Effects Of Sleep Quality And Quantity As A Result Of A Qi Project To Minimize Nighttime Sleep Interruptions, Chari Stump, Ashlie Tseng, Jennifer Brigle, Clifton Lee

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Quiet Please! The effects on sleep quality and quantity as a result of QI project to minimize nighttime interruptions

INTRODUCTION: Sleep is a significant component of health that is often overlooked in hospitalized patients. We introduced a QI project in 2016 to minimize nighttime interruptions in clinically stable patients by performing “passive vitals” which eliminated temperature and blood pressure readings at 4am and allowed patients to sleep longer overnight. Despite this intervention, the effects on sleep quality and quantity are unknown.

OBJECTIVE: The objective was to compare total sleep time, sleep interruptions, and sleep quality between patients eligible for passive …

Improving Early Antibiotic Administration For Treatment Of Sepsis At Children’S Hospital Of Richmond At Vcu: 2012-2019, Hannah Miller Md, Ashlie Tseng Md, Perry Taylor Pharmd, Matthew Schefft Do Msha, Sheila Pedigo Pharmd Bcpps, Tracy Lowerre Bsn Ms, Jose Munoz Md, Mark Astoria Md, Jonathan Silverman Md Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: The Surviving Sepsis Campaign recommends initiating IV antibiotic administration within one hour of recognition of severe sepsis. Several studies have shown that prompt blood culture collection, administration of broad-spectrum antibiotics, and fluid resuscitation following recognition improves child survival.

Objective: Our goal was to evaluate effectiveness of sepsis initiatives and institutional changes in the timing of early antibiotic administration at Children’s Hospital of Richmond at VCU.

Methods: We formed a Pediatric Sepsis Committee with representatives from each unit in 2013. In 2016, the committee began tracking time from the order of a first stat dose IV antibiotic to administration as …

Quiet A Puzzle: A Case Report Of 15 Year Old Female With Severe Anemia Due To Scurvy, Shaikha Alqahtani, Wang Zhihong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Scurvy is historically thought of a disease affecting sailors in the seventeenth century. Vitamin C deficiency is rare in the developed world. It is mainly found in patients with poor nutrition and specifically those with developmental delay. The spectrum of scurvy is varied and includes dermatological, dental, bone and systemic manifestations. We present to you a case of a 15 year old female with a history of trisomy 21 presenting with severe anemia as a direct cause of vitamin C deficiency.

She presented with a one month history of progressive bilateral lower extremity bruising and inability to walk. Physical exam …