Medicine and Health Sciences Commons^™

Children's Mercy Hospital Annual Report 2016, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Medical Genetics And Genomic Medicine In The United States. Part 2: Reproductive Genetics, Newborn Screening, Genetic Counseling, Training, And Registries, Debra S. Regier, Carlos Ferreira, Suzanne Hart, Donald Hadley, Maximilian Muenke

Pediatrics Faculty Publications

eview of genetics in the United States with emphasis on the prenatal, metabolic, genetic counseling, and training aspects of the field.

Nasopharyngeal Microbiome Diversity Changes Over Time In Children With Asthma, Marcos Pérez-Losada, Lamia Alamri, Keith Crandall, Robert J. Freishtat

Pediatrics Faculty Publications

Background

The nasopharynx is a reservoir for pathogens associated with respiratory illnesses such as asthma. Next-generation sequencing (NGS) has been used to characterize the nasopharyngeal microbiome of infants and adults during health and disease; less is known, however, about the composition and temporal dynamics (i.e., longitudinal variation) of microbiotas from children and adolescents. Here we use NGS technology to characterize the nasopharyngeal microbiomes of asthmatic children and adolescents (6 to 18 years) and determine their stability over time.

Methods

Two nasopharyngeal washes collected 5.5 to 6.5 months apart were taken from 40 children and adolescents with asthma living in the …

Prevalence Of Non-Alcoholic Fatty Liver Disease In Overweight And Obese Children Seeking Ambulatory Health Services In Nairobi, Anne Njeri Mburu

Master of Medicine in Paediatrics and Child Health

Introduction: Non-alcoholic fatty liver disease is often an asymptomatic condition one of the leading causes of chronic liver disease and is associated with an increase in cardiovascular morbidity. Being overweight or obese has been positively linked to non-alcoholic fatty liver disease in children. There is evidence to show that when detected early, non-alcoholic fatty liver disease is reversible primarily upon institution of lifestyle changes targeted at weight reduction. Establishing the prevalence of non-alcoholic fatty liver disease in overweight and obese Kenyan children would serve as a benchmark for long term monitoring of associated morbidity and guide in public health policies …

How To Explain Cancer To A Child And The Effects Of Coloring Therapy In Children With Cancer, Alexandra Mauer

Undergraduate Honors Thesis Collection

Did you know that doodling or coloring in a book can have significant therapeutic effects? It has been studied and proven that art therapy can help with anxiety, depression, and even some diseases such as cancer.1 Although coloring may not be able to cure cancer, it can make coping with it more manageable.1 When a child who has cancer is waiting to be seen in a doctor’s office or at the hospital, a coloring book can keep his or her mind off of the diagnosis, provide entertainment, and elicit a relaxing mindset. This coloring book could also have a storyline …

A Case Of Difficult-To-Treat Asthma Due To Uncontrolled Atypical Gastroesophageal Reflux, Alissa Welsh, Andrey Leonov

Research Day

Introduction: 
In uncontrolled asthma, comorbid conditions should be treated in order to achieve better asthma control. The contribution of gastro-esophageal reflux (GER) may be overlooked when its presentation is atypical. 
Case Report: 
11 year-old male with moderate persistent asthma and allergic rhinitis presented with persistent barky cough, diagnosed as spasmodic croup after bronchoscopy, esophagram, swallow study and magnified airway x-ray failed to show anatomical abnormality. Empiric proton pump inhibitor (PPI) treatment was started with improvement in cough. Patient was referred to Gastroenterology for evaluation of GER, despite lack of heartburn or vomiting. Endoscopy revealed esophageal candida infection which was treated. …

Gallbladder Duplication: Case Report Of A Rare Congenital Anomaly Treated By Single-Incision Laparoscopic Cholecystectomy In A Pediatric Patient, Jairo Espinosa M.D., Peter White, Michael Leinwand M.D.

Research Day

Introduction: Gallbladder duplication is a rare congenital anomaly. Preoperative diagnosis is essential for prevention of intra operative complications. Based on our review of the literature, this is the first description of gallbladder duplication treated with single-incision laparoscopic surgery (SILS) in a pediatric patient.

Case Presentation: A 14 year-old girl presented to the pediatric surgery clinic with a 4-month history of right upper quadrant abdominal pain, nausea, and low- grade fevers. Preoperative imaging revealed gallbladder duplication. The single incision laparoscopic technique was employed. Intra operative ndings included two gallbladders that appeared to share a common wall. There were two parallel cystic …

A Case Of Native Valve Staphylococcus Epidermidis Endocarditis With Cardiac Abscess Formation, Emily Cordes, Chris Jacob, Mark Loehrke

Research Day

Introduction: Staphylococcus epidermidis is the most common commensal bacteria of the skin; however it can be pathogenic and is the most frequent cause of medical device associated endocarditis. It is also a well-known cause of endocarditis in IV drug abuse (IVDA). However, in individuals without obvious disruption of the skin barrier, it is a relatively rare, but emerging entity of native valve endocarditis. Coagulase negative staphylococci account for only 1-5% of community acquired native valve infective endocarditis and most resolve with treatment. We report a case of a 56 year old male with an aggressive strain of community acquired Staphylococcus …

Challenges In The Diagnosis And Management Of Pediatric Pulmonary Tuberculosis In Madagascar, Emily Cordes, Richard Roach

Research Day

Introduction: Tuberculosis (TB) remains an important cause of morbidity and mortality in Madagascar. According to the World Health Organization (WHO), in 2015, the estimated incidence of TB was 57,000 and 11,000 of those cases were of patients less than 14 years old. Of the reported cases, 89% were bacteriologically confirmed. However, it is well established that bacteriologic confirmation of TB in children is especially difficult. Therefore, the incidence of TB in the pediatric population in Madagascar, and likely worldwide, is under estimated. We report a case of a 4 year old male that illustrates the challenges in diagnosis and management …

Widening The Differential: A Case Of Hemophagocytic Lymphohistiocytosis Disguised As A Fever Of Unknown Origin, Emily Cordes

Research Day

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is an under recognized, aggressive inflammatory disease characterized by excessive activity of histiocytes and lymphocytes. According to the HLH-2004 guidelines, five of the following eight criteria must be met to diagnose HLH: fever >38.5¡ã C, splenomegaly; cytopenias affecting ¡Ý two cell lines; hypertriglyceridemia/hypofibrinogenemia; evidence of hemophagocytosis in the bone marrow, spleen or lymph nodes; hyperferritinemia; low NK cell activity; or high levels of soluble CD25. Once a diagnosis of HLH is established, investigations for infectious, malignant or autoimmune etiologies must be pursued. We report a case of fever of unknown origin (FUO) that presented multiple times …

Genetic Variation In The Histamine Production, Response, And Degradation Pathway Is Associated With Histamine Pharmacodynamic Response In Children With Asthma, Bridgette L. Jones, Catherine M.T. Sherwin, Xiaoxi Liu, Hongying Dai, Carrie A. Vyhlidal

Pediatrics Faculty Publications

Introduction: There is growing knowledge of the wide ranging effects of histamine throughout the body therefore it is important to better understand the effects of this amine in patients with asthma. We aimed to explore the association between histamine pharmacodynamic (PD) response and genetic variation in the histamine pathway in children with asthma.

Methods: Histamine Iontophoresis with Laser Doppler Monitoring (HILD) was performed in children with asthma and estimates for area under the effect curve (AUEC), maximal response over baseline (Emax), and time of Emax (Tmax) were calculated using non-compartmental analysis and non-linear mixed-effects model with a linked effect PK/PD …

Pre-Implementation Of A Fontan Post-Operative Clinical Pathway: Summary Of 2016 Pdsa Cycles, Sarah M. Lagergren, Bryan Beaven, Suma Goudar, Megan Jensen

Posters

Background/Introduction: Post-operative hospitalization for the Fontan procedure tends to have an extended hospital length of stay (LOS). From 2013-2014, the average LOS at Children’s Mercy for the Fontan procedure is 14 days, whereas the U.S. national reported average is 11 days. Post-operative management of this patient population is often caregiver dependent. It has been theorized that developing a more standardized post-operative management regimen tailored specifically toward the unique physiology of Fontan patients may be able to improve outcomes and decrease LOS.

Methods: A review of literature was performed and revealed three pediatric institutions have published their post-operative Fontan care guidelines. …

Therapeutic Plasma Exchange (Tpe) Performed In Tandem With Crrt And/Or Ecmo: Experience Of One Pediatric Center, Lejla Music Aplenc, Cindy George, Kimberly Marriott

Posters

SUMMARY

The most common indications for starting tandem procedures were ASFA Category III indications, followed by un-categorized indications.

Similar to other reports in literature, hypocalcemia and hypotension were the most common complications. Transfusion reactions were rare, despite the use of large volumes of plasma.

Tandem procedures in critically ill pediatric patients require close monitoring and excellent communication between staff members.

An Expanded Role For Nurses In Laboratory Utilization, Marilyn S. Hamilton, Rangaraj Selvarangan, Michele Fix, Lynn E. Shriver

Posters

Introduction: The majority of laboratory testing errors occur in the pre-analytical stage, including specimen collection. Children provide special challenges including small blood volumes, small veins, and an inability to cooperate. We describe collaboration between laboratorians and nursing staff to improve specimen collection and the reliability of test results.

Methods: We identified three areas for improvement: 1) Volume of blood for culture, 2) Urine collection, and 3) Appropriate blood collection through a line. Base line data was established. Guidelines for specimen collection were updated. Nurse members of the Laboratory Utilization Committee developed educational tools.

Results: Nursing education was effective at improving …

A Mixed Methods Study To Assess The Effectiveness Of Food-Based Interventions To Prevent Stunting Among Children Under-Five Years In Districts Thatta And Sujawal, Sindh Province, Pakistan: Study Protocol, Sumra Kureishy, Gul Nawaz Khan, Shabina Arrif,, Khizar Ashraf, Angela Cespedes, Atif Habib, Imtiaz Hussain, Asmat Ullah, Ali Turab, Imran Ahmed, Shehla Zaidi, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Maternal and child malnutrition is widely prevalent in low and middle income countries. In Pakistan, widespread food insecurity and malnutrition are the main contributors to poor health, low survival rates and the loss of human capital development. The nutritional status trends among children exhibit a continuous deteriorating with rates of malnutrition exceeding the WHO critical threshold. With the high prevalence of maternal and child malnutrition, it is important to identify effective preventative approaches, especially for reducing stunting in children under-five years of age. The primary aim of this study is to assess the effectiveness of food-based interventions to …

Prevalence And Possible Factors Associated With Anaemia, And Vitamin B 12 And Folate Deficiencies In Women Of Reproductive Age In Pakistan: Analysis Of National-Level Secondary Survey Data, Sajid Bashir Soofi, Gul Nawaz Khan, Kamran Sadiq, Shabina Ariff, Atif Habib, Sumra Kureishy, Imtiaz Hussain, Muhammad Umer, Zamir Suhag, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Objective: To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan.
Methods: A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels /dL, vitamin B12 deficiency as serum vitamin B12 levels of /mL (150 pmol/L) and folate deficiency as serum folate levels /mL (10 nmol/L).
Results: A total of 11 751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, …

Necrotizing Fasciitis Secondary To Aeromonas Infection Presenting With Septic Shock, Nikhil Bhatia, Manuel Castro-Borobio, John N. Greene, Sowmya Nanjappa

Pediatrics Faculty Publications

This report describes a case of necrotizing fasciitis presenting with septic shock due to an Aeromonas infection. The patient cut his foot while mowing the lawn and then spent time in a pool with black mold. He began feeling ill and developed swelling and a quarter-sized black area on his right lower extremity. Despite being hemodynamically unstable with systolic blood pressure in the low 70s, the patient was transferred to our facility from outside hospital 100 miles away. Upon arriving to facility, the patient appeared to be septic and the infected area of skin had grown. Irrigation and debridement were …

Tuberous Sclerosis Complex In The Western Cape, South Africa: The Clinical Presentation Features, E. Kija, B. Schlegel, Pauline Samia, M. Wessels, J. M. Wilmshurst

Paediatrics and Child Health, East Africa

Tuberous sclerosis complex (TSC) is a genetic neurocutaneous condition, which affects multiple organ systems. This study aimed to determine the presenting features of children with TSC in Cape Town, South Africa. A cross-sectional study was conducted at a TSC clinic, and clinical features at presentation were prospectively collected. Thirty-nine children (23 boys; median age 10 (range 1 - 26) years; median diagnosis age 16 (0 - 153) months) were recruited. Twenty-one (54%) children presented with focal seizures. Seven (18%) children had epileptic spasms. Skin manifestations led to a diagnosis in 13 (33%) and neuroimaging in 22 (56%) children. Antenatal screening …

Actionable Patient Safety Solution (Apss) #3d: Pediatric Adverse Drug Events, Ron Jordan, Jerika Lam, Nathaniel Sims, Anne Lyren, Coco Yang

Pharmacy Faculty Articles and Research

This report presents a plan of action for introducing a "program to reduce the incidence of pediatric adverse drug events (pADEs) and harm ... [that] combine[s] leadership strategies, software (healthcare IT), hardware (drug compounding systems, drug delivery technology, and physiological monitoring systems), and most importantly people (changes in clinical practice, protocols and education)" to protect pediatric patients.

Unresectable Hepatoblastoma: Current Perspectives., Angela D Trobaugh-Lotrario, Rebecka L Meyers, Allison F O'Neill, James H Feusner

Articles, Abstracts, and Reports

Although rare, hepatoblastoma is the most common pediatric liver tumor. Complete resection is a critical component for cure; however, most patients will have tumors that are not resected at diagnosis. For these patients, administration of neoadjuvant chemotherapy renders tumors resectable in most patients. For patients whose tumors remain unresectable after chemotherapy, liver transplantation is indicated (in the absence of active unresectable metastatic disease). In patients whose tumors remain unresectable after conventional chemotherapy, interventional techniques may serve as a promising option to reduce tumor size, decrease systemic toxicity, decrease need for liver transplantation, and increase feasibility of tumor resection.

Application Of The Multi-Facet Rasch Model To Validate Chief Residents Survey: A Two-Year Study, Kadriye O. Lewis, Ross Newman

Posters

This study compares the Chief Resident candidates' characteristics and leadership qualities within and across two years and further validates the Chief Resident peer selection instrument.

Predicting Tacrolimus Concentrations In Children Receiving A Heart Transplant Using A Population Pharmacokinetic Model, Joseph E. Rower, Chris Stockmann, Matthew W. Linakis, Shaun S. Kumar, Xiaoxi Liu, E. Kent Korgenski, Catherine M.T. Sherwin, Kimberly M. Molina

Pediatrics Faculty Publications

Objective Immunosuppressant therapy plays a pivotal role in transplant success and longevity. Tacrolimus, a primary immunosuppressive agent, is well known to exhibit significant pharmacological interpatient and intrapatient variability. This variability necessitates the collection of serial trough concentrations to ensure that the drug remains within therapeutic range. The objective of this study was to build a population pharmacokinetic (PK) model and use it to determine the minimum number of trough samples needed to guide the prediction of an individual’s future concentrations.

Design, setting and patients Retrospective data from 48 children who received tacrolimus as inpatients at Primary Children’s Hospital in Salt …

Investigating Program Directors' Milestone Assessment Practices In Graduate Medical Education, Kadriye O. Lewis, Susan B. Hathaway, J F. Knapp, Denise Bratcher, Douglas Blowey

Posters

The purpose of this study is to investigate the current assessment practices as well as identify the needs and challenges of the Program Directors in implementing ACGME's Milestones for assessment in graduate medical education at a pediatric hospital. The ultimate outcome of this study will be to fairly deliver our support and services to all programs equally providing expertise/consulting, guiding, mentoring/advising, and distributing resources.

Exploring Pediatrics In The Philippines, Taylor Hansen

Posters

Describes her learning experience in the Philippines with the Jose Fabella Memorial Milk Bank, Fabella's Kangaroo Mother Care Unit, and Talisay Health Center in 2017.

Parents Of Children Who Had Hypoxic-Ischemic Encephalopathy: A Mixed-Methods, Exploratory Study, Natalene Kramer

Electronic Theses and Dissertations

Background: There is scant literature addressing the parents of children who had hypoxic-ischemic encephalopathy (HIE). therefore only inferences may be made as to issues of that experience affecting parents.

Purpose: The purposes of this study was to uncover the lived experiences of parents of children who had HIE, evaluate issues of stress, depression, coping, and impact of neurologic disability in order to better care for them and thus their families

Methods: A parallel, convergent mixed-methods design was used to explore experiences and perceptions of these parents regarding their experiences and life changes. The quantitative strand addressed four research questions which …

Ultrasound-Induced Microbubble Cavitation For The Treatment Of Catheterization-Induced Vasospasm, Shelby Kutty, Na Liu, Jia Zhou, Yunbin Xiao, Juefei Wu, David A. Danford, John Lof, Feng Xie, Thomas R. Porter

Journal Articles: Pediatrics

No abstract provided.

Atrial Fibrillation Induction In A Pediatric Patient During Adenosine Administration, Jeffrey A. Robinson, Christopher S. Snyder

Journal Articles: Pediatrics

Adenosine by rapid intravenous bolus is frequently utilized in clinical practice as both a pharmacologic treatment for supraventricular (reentrant) tachycardia and in provocative testing for the diagnosis of Wolff-Parkinson-White (WPW) syndrome. This is a case report of an otherwise healthy adolescent female who received adenosine during a provocative test for WPW syndrome. Immediately after receiving adenosine, the patient had a self-limited episode of atrial fibrillation. When administering adenosine, teams should be aware of the potential adverse effects and be prepared to treat appropriately.

A Month In Manila, Robin M. Lund

Posters

Describes a global health learning experience at Philippines Children's Medical Center in Manila.

South Africa: Combatting The Rise Of Hiv In Adolescents, Ryan Northrup

Posters

Describes a global health learning experience in South Africa in 2017, focused on educating teenagers in schools about sexual health and AIDS prevention.

Randomized Trial Of Two Doses Of Vitamin D3 In Preterm Infants <32 Weeks: Dose Impact On Achieving Desired Serum 25(Oh)D3 In A Nicu Population., Ann Anderson-Berry, Melissa Thoene, Julie Wagner, Elizabeth Lyden, Glenville Jones, Martin Kaufmann, Matthew Van Ormer, Corrine K. Hanson

Journal Articles: Pediatrics

BACKGROUND: Recommendations for vitamin D supplementation for preterm infants span a wide range of doses. Response to vitamin D supplementation and impact on outcomes in preterm infants is not well understood.

OBJECTIVE: Evaluate serum 25(OH)D3 concentration changes after 4 weeks in response to two different doses of vitamin D3 supplementation in a population of premature infants and quantify the impact on NICU outcomes.

DESIGN: 32 infants born at 24-32 weeks gestation were prospectively randomized to receive 400 or 800 IU/day vitamin D3 supplementation. Serum 25(OH)D3 levels were measured every 4 weeks. The Wilcoxon signed rank test was used to compare …