Medicine and Health Sciences Commons^™

Relationship Between Hospital Procedure Volume And Complications Following Congenital Cardiac Catheterization: A Report From The Improving Pediatric And Adult Congenital Treatment (Impact) Registry., Natalie Jayaram, John A. Spertus, Michael L. O'Byrne, Paul S. Chan, Kevin F. Kennedy, Lisa Bergersen, Andrew C. Glatz

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The association between institutional volume and outcomes has been demonstrated for cardiac catheterization among adults, but less is known about this relationship for patients with congenital heart disease (CHD) undergoing cardiac catheterization.

METHODS: Within the IMPACT registry, we identified all catheterizations between January 2011 and March 2015. Hierarchical logistic regression, adjusted for patient and procedural characteristics, was used to determine the association between annual catheterization lab volume and occurrence of a major adverse event (MAE).

RESULTS: Of 56,453 catheterizations at 77 hospitals, an MAE occurred in 1014 (1.8%) of cases. In unadjusted analysis, a MAE occurred in 2.8% (123/4460) …

Should School Boards Discontinue Support For High School Football?, Lewis H. Margolis, Greg Canty, Mark Halstead, John Lantos

Manuscripts, Articles, Book Chapters and Other Papers

A pediatrician is asked by her local school board to help them decide whether to discontinue their high school football program. She reviews the available evidence on the risks of football and finds it hopelessly contradictory. Some scholars claim that football is clearly more dangerous than other sports. Others suggest that the risks of football are comparable to other sports, such as lacrosse, ice hockey, or soccer. She finds very little data on the long-term sequelae of concussions. She sees claims that good coaching and a school culture that prioritizes the health of athletes over winning can reduce morbidity from …

Reference Intervals For Thyroid Stimulating Hormone And Free Thyroxine Derived From Neonates Undergoing Routine Screening For Congenital Hypothyroidism At A University Teaching Hospital In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Ali Kassim, Francis Kiigu, Ra'ana Hussain, Mary Limbe

Pathology, East Africa

Background: In order to accurately interpret neonatal thyroid function tests (TFTs), it is necessary to have population specific reference intervals (RIs) as there is significant variation across different populations possibly due to genetic, environmental or analytical issues. Despite the importance of RIs, globally there are very few publications on RIs for neonatal TFTs primarily due to ethical and technical issues surrounding recruitment of neonates for a prospective study. To the best of our knowledge, this is the first report from Africa on neonatal RIs for TFTs.

Methods: We used hospital based data largely derived from neonates attending the wellness clinic …

The Effect Of Breastfeeding On The Cognitive And Language Development Of Children Under 3 Years Of Age: Results Of Balochistan-Early Childhood Development Project, Meesha Iqbal Iqbal, Ghazala Rafique, Sumera Aziz Ali

Community Health Sciences

Background: Breastfeeding is known to be an important factor in the overall growth and development of children. Breastfeeding is thought to lead to enhance cognitive and language development of a child. However, this association has not yet been scientifically and statistically established. This study aimed to explore this association in children under 3 years of age.
Methods: This was a secondary data-analysis of the baseline data of “Balochistan – Early Childhood Development Project”. The final sample comprised of 604 children less than 3 years of age. The children were selected by three-stage stratified random sampling from three districts of Balochistan …

Investigating The Practice And Capacity Of Paediatric Occupational Therapists To Promote The Physical Activity Levels Of Children In Western Australia, Sally Coombs

Theses: Doctorates and Masters

Reorientation of the Australian health care system to meet the increasing burden of disease requires health workers to develop a focus on disease prevention and health promotion. In Western Australia (WA) a priority area for the promotion of health involves increasing the physical activity levels (PAL) of children in accordance with Australia’s Physical Activity and Sedentary Behaviour Guidelines. There is substantial support in the literature for paediatric occupational therapists, who assist children to participate in a range of meaningful occupations, to incorporate the promotion of children’s PAL into their service. However, there is a dearth of research world-wide regarding occupational …

Community Engagement And Integrated Health And Polio Immunisation Campaigns In Conflict-Affected Areas Of Pakistan: A Cluster Randomised Controlled Trial, Atif Habib, Sajid Soofi, Simon Cousens, Saeed Anwar, Najib Ulhaque, Imran Ahmed, Noshad Ali, Rehman Tahir, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Pakistan faces huge challenges in eradicating polio due to widespread poliovirus transmission and security challenges. Innovative interventions are urgently needed to strengthen community buy-in, to increase the coverage of oral polio vaccine (OPV) and other routine immunisations, and to enhance immunity through the introduction of inactivated polio vaccine (IPV) in combination with OPV. We aimed to evaluate the acceptability and effect on immunisation coverage of an integrated strategy for community engagement and maternal and child health immunisation campaigns in insecure and conflict-affected polio-endemic districts of Pakistan.
Methods: We did a community-based three-arm cluster randomised trial in healthy children …

Acute Necrotizing Encephalopathy Of Childhood Secondary To Dengue Infection: A Case Report From Pakistan, Qalab Abbas, Sidra Kaleem Jafri, Sidra Ishaque, Muhammad T. Jamil

Department of Paediatrics and Child Health

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition mainly affecting children with a distinct clinico-radiologic pattern. Initially thought to be secondary to respiratory viral infections, there have been more insights to the pathogenesis of ANEC including genetics. We present a case of a girl who developed this condition with classical clinico-radiologic findings of ANEC secondary to severe dengue infection and could not survive. We report this case with the aim to raise awareness about this fatal complication of dengue infection as dengue has become a global health-care problem.

Clinical And Laboratory Profile Of Children With Cystic Fibrosis: Experience Of A Tertiary Care Center In Pakistan, Danish Abdul Aziz, Abdul Gaffar Billoo, Ahad Qureshi, Misha Khalid, Salman Kirmani

Department of Paediatrics and Child Health

Objective: To determine the clinical presentation, diagnostic investigations and laboratory workup done in admitted children with cystic fibrosis at Aga Khan University Hospital Karachi, Pakistan.
Methods: This is a three years retrospective study from January 2013 to December 2015 conducted at The Aga Khan University Hospital Karachi Pakistan, enrolling admitted patient from birth to 15 years of either gender, diagnosed with CF on the basis of clinical features and positive sweat chloride test. Different clinical presentations were noted including initial presentations. Sweat chloride values more than 60mmol/L were labeled as positive and consistent with diagnosis of CF. Available Delta F-508 …

Equivalence And Non-Inferiority Trials In A Snapshot, Salima Kerai

Department of Paediatrics and Child Health

No abstract provided.

Ethical Issues In Managing Lysosomal Storage Disorders In Children In Low And Middle Income Countries, Bushra Afroze, Nick Brown

Department of Paediatrics and Child Health

The lysosomal storage diseases are a group of rare, inherited metabolic diseases affecting about 1 in 7000 to 8000 people. In recent years, the introduction of enzyme replacement therapy, substrate reduction therapy and small molecule therapy, has changed the natural course of this otherwise progressive group of disorders leading to severe morbidity and early mortality. These treatment options, however, are extremely expensive and are needed for life thus presenting an economical as well as ethical challenge to the affected families and the health care system of a country. This paper presents a case for the prevention of the lysosomal storage …

Mass Deworming To Improve Developmental Health And Wellbeing Of Children In Low-Income And Middle-Income Countries: A Systematic Review And Network Meta-Analysis, Vivian A. Welch, Elizabeth Ghogomu, Alomgir Hossain,, Shally Awasthi, Zulfiqar Ahmed Bhutta, Chisa Cumberbatch, Robert Fletcher, Jessie Mcgowan, Shari Krishnaratne, Elizabeth Kristjansson

Department of Paediatrics and Child Health

Background: Soil-transmitted helminthiasis and schistosomiasis, considered among the neglected tropical diseases by WHO, affect more than a third of the world’s population, with varying intensity of infection. We aimed to evaluate the eff ects of mass deworming for soil-transmitted helminths (with or without deworming for schistosomiasis or cointerventions) on growth, educational achievement, cognition, school attendance, quality of life, and adverse effects in children in endemic helminth areas.

Methods: We searched 11 databases up to Jan 14, 2016, websites and trial registers, contacted authors, and reviewed reference lists. We included studies published in any language of children aged 6 months to …

Use Of Antibiotics In Children Younger Than Two Years In Eight Countries: A Prospective Cohort Study, Elizabeth T. Rogawski, James A. Platts-Mills, Jessica C. Seidman, Sushil John, Mustafa Mahfuz, Manjeswori Ulak, Sanjaya K. Shrestha, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Objective: To describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics.
Methods: Between 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers’ reports at twice-weekly visits over the children’s first two years of life. We estimated the incidence of antibiotic use and the associations of antibiotic use with child and household characteristics. We described …

Paediatric Inflammatory Bowel Disease: Clinical Presentation And Disease Location, Danish Abdul Aziz, Maryum Moin, Atif Majeed, Kamran Sadiq, Abdul Gaffar Biloo

Department of Paediatrics and Child Health

Objective: To determine different clinical presentationsand disease location demarcatedby upper and lower gastrointestinal endoscopyand relevant histopathologyin children diagnosed with inflammatory bowel disease (IBD).
Methods: This is 5 years (2010 to 2015) retrospective studyconducted at the Aga Khan University Hospitalenrolling65admitted children between 6 months to 15years from either gender, diagnosed with IBD on clinical presentation, endoscopy and biopsy. Different clinical presentations at the time of diagnosis were noted in different categories of the disease. All patients underwent upper and lower (up to the terminal ileum) endoscopy with multiple punch biopsies and histologic assessment of mucosal specimens. All endoscopies were done by …

Mechanisms Of Vasovagal Syncope In The Young: Reduced Systemic Vascular Resistance Versus Reduced Cardiac Output, Julian Stewart, Marvin Medow, R Sutton, Paul Visintainer, D Jardine, W Wieling

NYMC Faculty Publications

BACKGROUND: Syncope is a sudden transient loss of consciousness and postural tone caused by cerebral hypoperfusion. The most common form is vasovagal syncope (VVS). Presyncopal progressive early hypotension in older VVS patients is caused by reduced cardiac output (CO); younger patients have reduced systemic vascular resistance (SVR). Using a priori criteria for reduced CO ( downward arrowCO) and SVR ( downward arrowSVR), we studied 48 recurrent young fainters comparing subgroups of VVS with VVS- downward arrowCO, VVS- downward arrowSVR, and both VVS- downward arrowCO& downward arrowSVR. METHODS AND RESULTS: Subjects were studied supine and during 70-degrere upright tilt with a …

High Levels Of Iron Supplementation Prevents Neural Tube Defects In The Fpn1(Ffe) Mouse Model., Bethany A Stokes, Julia A Sabatino, Irene E. Zohn

Pediatrics Faculty Publications

BACKGROUND: Periconception maternal nutrition and folate in particular are important factors influencing the incidence of neural tube defects (NTDs). Many but not all NTDs are prevented by folic acid supplementation and there is a pressing need for additional strategies to prevent these birth defects. Other micronutrients such as iron are potential candidates, yet a clear role for iron deficiency in contributing to NTDs is lacking. Our previous studies with the flatiron (ffe) mouse model of Ferroportin1 (Fpn1) deficiency suggest that iron is required for neural tube closure and forebrain development raising the possibility that iron supplementation could prevent NTDs.

METHODS: …

Sirt1 Regulates Glial Progenitor Proliferation And Regeneration In White Matter After Neonatal Brain Injury., Beata Jablonska, Marcin Gierdalski, Li-Jin Chew, Teresa Hawley, Mackenzie Catron, Arturo Lichauco, Juan Cabrera-Luque, Tracy Yuen, David Rowitch, Vittorio Gallo

Pediatrics Faculty Publications

Regenerative processes in brain pathologies require the production of distinct neural cell populations from endogenous progenitor cells. We have previously demonstrated that oligodendrocyte progenitor cell (OPC) proliferation is crucial for oligodendrocyte (OL) regeneration in a mouse model of neonatal hypoxia (HX) that reproduces diffuse white matter injury (DWMI) of premature infants. Here we identify the histone deacetylase Sirt1 as a Cdk2 regulator in OPC proliferation and response to HX. HX enhances Sirt1 and Sirt1/Cdk2 complex formation through HIF1α activation. Sirt1 deacetylates retinoblastoma (Rb) in the Rb/E2F1 complex, leading to dissociation of E2F1 and enhanced OPC proliferation. Sirt1 knockdown in culture …

Kinder Ready: Exploring The Role Of Technology In Promoting School Readiness Among Low-Income Parents In A Clinic-Based Setting, Brenda Lu

Master's Projects and Capstones

The Stanford Pediatric Advocacy Program advocates to improve the health status of children in Silicon Valley and the surrounding community. This summer, I worked on a project called Kinder Ready, with the goal of evaluating the feasibility of technology use in promoting school readiness in children ages zero to five. We used a variety of qualitative research methods, including focus groups, one-on-one interviews, and surveys to collect feedback from the community on what their children need to transition into schools. Our local participatory research approach has paved the way for many new partnerships with local organizations, while strengthening existing ones. …

Simplified Antibiotic Regimens For Treatment Of Clinical Severe Infection In The Outpatient Setting When Referral Is Not Possible For Young Infants In Pakistan (Simplified Antibiotic Therapy Trial [Satt]): A Randomised, Open-Label, Equivalence Trial, Fatima Mir, Imran Nisar, Shiyam S. Tikmani, Benazir Baloch, Sadia Shakoor, Fyezah Jehan, Imran Ahmed, Simon Cousens, Anita K M Zaidi

Department of Paediatrics and Child Health

Background: Parenteral antibiotic therapy for young infants (aged 0–59 days) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality. Outpatient treatment could save lives in such settings. We aimed to assess the equivalence of two simplified antibiotic regimens, comprising fewer injections and oral rather than parenteral administration, compared with a reference treatment for young infants with clinical severe infection.
Methods: We undertook the Simplified Antibiotic Therapy Trial (SATT), a three-arm, randomised, open-label, equivalence trial in five communities in Karachi, Pakistan. We enrolled young infants (aged 0–59 days) who either presented at a primary health-care …

Evidence-Based Decision Support For Pediatric Rheumatology Reduces Diagnostic Errors., Michael M. Segal, Balu Athreya, Mary Beth F. Son, Irit Tirosh, Jonathan S. Hausmann, Elizabeth Yn. Ang, David Zurakowski, Lynn K. Feldman, Robert P. Sundel

Department of Pediatrics Faculty Papers

BACKGROUND: The number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists.

METHODS: Using vignettes of actual clinical cases, clinician testers generated a differential diagnosis before and after using diagnostic decision support software. The evaluation used the SimulConsult® DDSS tool, based on Bayesian pattern matching with temporal onset of each finding in each disease. The tool covered 5405 diseases …

Juvenile Idiopathic Arthritis: A Systematic Review Of Occupational Therapy Interventions, Meredith L. Aja, Katie L. Cole, Trenton S. Warning

Pediatrics

Background: The purpose of this systematic review is to describe the current role of occupational therapy (OT) in the treatment of Juvenile Idiopathic Arthritis (JIA). JIA is an umbrella term that encompasses six subtypes of the disease. JIA is one of the most common childhood chronic diseases and can be accompanied by symptoms such as pain, stiffness, and loss of function, as well as psychosocial impacts. JIA participants generally receive pharmacological treatment, but less commonly receive therapeutic interventions to help reduce symptoms. Individualized treatment plans are necessary for clients with JIA due to the diverse nature of the disease. …

Population Pharmacokinetics Of Liposomal Amphotericin B In Immunocompromised Children., Jodi M Lestner, Andreas H Groll, Ghaith Aljayyoussi, Nita L Seibel, Aziza Shad, Corina Gonzalez, Lauren V Wood, Paul F Jarosinski, Thomas J Walsh, William W Hope

Pediatrics Faculty Publications

Liposomal amphotericin B (LAmB) is widely used in the treatment of invasive fungal disease (IFD) in adults and children. There are relatively limited pharmacokinetic (PK) data to inform optimal dosing in children that achieves systemic drug exposures comparable to those of adults. Our objective was to describe the pharmacokinetics of LAmB in children aged 1 to 17 years with suspected or documented IFD. Thirty-five children were treated with LAmB at doses of 2.5 to 10 mg kg(-1) daily. Samples were taken at baseline and at 0.5- to 2.0-h intervals for 24 h after receipt of the first dose (n = …

Detection Of Α-Thalassemia By Using Multiplex Ligation-Dependent Probe Amplification As An Additional Method For Rare Mutations In Southern Turkey, Ozge Ozalp Yuregir, Akif Ayaz, Sinem Yalcintepe, Sezin Canbek, Didar Yanardag Acik, Basak Taburoglu Yilmaz, Tugce B. Balci

Paediatrics Publications

α-thalassemia is the most common single gene disorder in the Cukurova Region in Turkey. It is therefore routinely screened, including premaritally, in our region. The heterogeneous molecular basis of the disease makes α-thalassemia mutation detection difficult and complex. Besides well established methods, multiplex ligation dependent probe amplification (MLPA) is known as an effective, simple and specific method for the detection and characterization of deletions and duplications. We employed MLPA testing to 30 patients with hematological parameters suggestive of α-thalassemia carrier status but was negative for α-thalassemia with conventional reverse dot blot hybridization (RDB). We found α-globin gene deletions in 3 …

Pediatric Emergency Medicine Point-Of-Care Ultrasound: Summary Of The Evidence., Jennifer R Marin, Alyssa M. Abo, Alexander C Arroyo, Stephanie J Doniger, Jason W Fischer, Rachel Rempell, +21 Additional Authors

Pediatrics Faculty Publications

The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting …

Antenatal Renal Pelvic Dilatation And Foetal Outcomes - Review Of Cases From A Tertiary Care Center In Karachi, Pakistan, Ruqiya Afroz, Shafia Shakoor, Muhammad Sohail Salat, Shama Munim

Woman and Child Health

Objective: To determine the incidence of antenatal renal pelvic dilatation to evaluate antenatal resolution/ progression and post-natal outcome.
Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all women found with renal pelvic dilatation in antenatal scans between January 2011 and December 2013. A cut-off of 5mm was used to diagnose renal pelvic dilatation. Renal pelvic dilatation was categorised into three groups: mild (5-6mm in second trimester and 5-9mm in third trimester), moderate (7-10mm in second trimester and 10-15 in third) and severe (more than 10mm in second trimester and more than …

A Quality Improvement Project For The Evaluation And Management Of Possible Necrotizing Enterocolitis In Single Ventricle Patients, Laura Miller-Smith, Jennifer Flint, Lisa Laddish

Posters

Background:

Infants with single ventricle (SV) physiology are at high risk for interstage complications, including necrotizing enterocolitis (NEC). The underlying pathophysiology and age at presentation differs from NEC literature described in premature infants, making NEC in SV patients challenging to diagnose and treat. We perceive significant variability in the approach to possible NEC in SV patients at our institution.

Aims:

To identify variability & standardize the approach to management of NEC

To create a management algorithm for diagnosing and treating NEC

Methods:

After review of current practice and review of medical literature, an algorithm to guide medical decision making specific …

Obstacles To Introducing A Post-Operative Feeding Protocol In The Single Ventricle Population, Lisa Laddish, Laura Miller-Smith, Jennifer Flint

Posters

Objective:

To decrease the morbidity associated with feeding complications by implementing a post-operative feeding protocol for infants with single ventricle physiology

The Role Of Stress In Assessing Life Satisfaction And Self-Efficacy Among Prison Officers, Kamilla Bargiel-Matusiewicz, Paulina Stelmachowska, Hatim A. Omar

Pediatrics Faculty Publications

Stress is a major public health concern. It can be observed in all aspects of life, in everyday family life and work life. The focus of this article is work-related stress. Work stress can be observed in any work environment and in all professions. As a complex condition it affects different people in different ways. The study presented in this article was done on a sample of 59 prison officers who volunteered to participate. Among those 59 participants 34 were males and 25 were females aged between 25 to 52. Each participant received a survey to collect general information about …

Nicotinamide Adenine Dinucleotide Phosphate Oxidase 2 Regulates Lps-Induced Inflammation And Alveolar Remodeling In The Developing Lung., Heather Menden, Sheng Xia, Sherry M. Mabry, Angels Navarro, Michael F. Nyp, Venkatesh Sampath

Manuscripts, Articles, Book Chapters and Other Papers

In premature infants, sepsis is associated with alveolar simplification manifesting as bronchopulmonary dysplasia. The redox-dependent mechanisms underlying sepsis-induced inflammation and alveolar remodeling in the immature lung remain unclear. We developed a neonatal mouse model of sepsis-induced lung injury to investigate whether nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2) regulates Toll-like receptor (TLR)-mediated inflammation and alveolar remodeling. Six-day-old NOX2

Interpreting Measurements Of Cardiac Function Using Vendor-Independent Speckle Tracking Echocardiography In Children: A Prospective, Blinded Comparison With Catheter-Derived Measurements., Suma Goudar, G Hamilton Baker, Shahryar M. Chowdhury, Kimberly J. Reid, Girish S. Shirali, Mark A. Scheurer

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Adult studies demonstrate that echocardiographic measurements of cardiac function using speckle tracking correlate with invasive measurements, but such data in the pediatric population are sparse. Our aim was to compare speckle-derived measures of cardiac function to measurements routinely obtained by cardiac catheterization in children.

METHODS: Echocardiograms were performed on the day of cardiac catheterization. Using Tomtec 2D Cardiac Performance Analysis, longitudinal strain (LS), longitudinal strain rate (LSR), early diastolic LSR, and ejection fraction (EF) for the right and left ventricle (RV and LV) were calculated via speckle tracking. Global LS and LSR were calculated for the LV. These results …

Late Onset Of Pulmonary Hypertension And Sepsis In Omphalocele Infants, Joanne E. Baerg, Arul Thirumoorthi, Whitney Carlton, Shelly Haug, Andrew O. Hopper, Donna Goff, Sandhya Ramlogan, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

A subset of omphalocele infants has respiratory decompensation after the first week of life and PHN is diagnosed. Infection may initiate decompensation. In some, PHN is distinct from pulmonary hypoplasia as they oxygenate on room air for some time after birth. With aggressive treatment and follow-up, PHN can resolve. The late diagnosis of PHN in infants with omphalocele is previously unappreciated and deserves further study.