Medicine and Health Sciences Commons^™

Evaluation Of The Hypothesis That Viral Meningitis Is A Mimic Of Abusive Head Trauma, Danielle Horton, Tanya Burrell, James Anderst, Lyndsey Hultman, Mary Moffatt, Henry T. Puls, Rangaraj Selvarangan

Posters

Background: Viral meningitis (VM) has been proposed as an alternative cause of subdural hemorrhage (SDH) in young children diagnosed with abusive head trauma (AHT). It has been proposed that VM may mimic symptoms and clinical features of AHT, resulting in an incorrect diagnosis of abuse.


Objective: We aim to evaluate the hypothesis that VM is a mimic of AHT by comparing the history of present illness (HPI) and initial clinical presentation of young children with proven VM to those with subdural hemorrhage and concomitant suspicious injuries (SDH + CSIs) and to those with SDH and no CSIs (SDH only). We …

Outpatient Antimicrobial Stewardship Programs In Children’S Hospitals: Status, Needs, Barriers, Rana El Feghaly, Elizabeth Monsees, Alaina N. Burns, Brian Lee, Ann L. Wirtz, Adam L. Hersh, Jason Newland

Posters

Background: Antimicrobial stewardship programs (ASPs) are an essential tool to combat the increasing threat of antibiotic resistance. ASPs traditionally reside in acute care settings with a focus on inpatient prescribing. However, in 2016, the Centers for Disease Control and Prevention affirmed the importance of outpatient ASP through its 4 core elements. Incorporation of these elements requires time, personnel, and funding, which may not be available in many institutions.


Objective: This study aimed to evaluate the current state of outpatient ASP in a large network of children’s hospitals and inform a programming agenda.


Design/Methods: This cross-sectional study used an investigator-developed survey …

Educating Providers: Timely Post-Operative Pain Management In A Level Iv Neonatal Intensive Care Unit (Nicu), Jamesia Donato, Darian Younger, Rebecca Palmer, Denise Smith, Alexandra Oschman, Meredith Kopp, Daphne Reavey, Eugenia K. Pallotto

Posters

Background: NICU patients often encounter painful procedures and can have significant short and long-term consequences from inadequately treated pain. Ensuring adequate pharmacological and non-pharmacological pain management while minimizing associated risks is paramount. Our NICU is part of the Children’s Hospitals Neonatal Consortium “Erase Pain” collaborative to improve management of postop pain in neonates.


Objective: SMART

Aim: Increase the percentage of patients receiving acetaminophen within one hour after surgery to greater than 70% by July 2020.


Design/Methods: A multidisciplinary team developed pain treatment algorithms and postop order plans to standardize the approach to postop pain management. Providers were educated about their …

Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Laura Kuzava, Tyler Johnson, Alison Samrany, Nitin Madan, Sanket Shah

Posters

Background: Adequate echocardiographic (echo) education is integral to successful cardiology training. Online education is proven to be effective in other specialties, but pediatric echo training data are lacking. Our aim was to design and assess the role of a novel online module-based curriculum to enhance pediatric cardiology fellows’ echo education.

Methods: Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. Content included high quality 2D and 3D echo clips (Fig 1A) as well as interactive quizzes (Fig 1B) and could be accessed from a phone, tablet, or computer. All fellows completed pre- and …

Registration Of Newly Diagnosed Children With Autism Spectrum Disorder And Developmental Disabilities At State Regional Offices, Whitney Rolling, Rachel Goodson

Posters

• In fiscal year 2020, 39,220 Missouri residents utilized developmental disability services through the Missouri Department of Mental Health.1 • Developmental disability services account for 53% of Missouri’s state mental health funding (about 1.3 billion dollars annually).

• Physicians and psychologists are required for making eligible diagnoses, but registration for state support is patient dependent and can be perceived as an extensive paperwork process.

• Project Goal: Measure and increase the percentage of eligible patients registered for their state mental health resource offices.

Improving The Rate Of Emergency Department Physician Pre-Procedure Time-Out Documentation For Deep Sedation And Cutaneous Abscess Incision And Drainage, Arjun Sarin, Nikita Sharma, Shobhit Jain

Posters

Background: The pre-procedure time-out, an important safety measure to verify patient identity and accuracy of a planned procedure, and Joint Commission requirement, is not documented consistently by physicians in our emergency department (ED). Deep sedation and cutaneous abscess incision and drainage (I&D) are two high-risk procedures performed in the ED, supporting the use of a time-out in this setting. Between June 2018 and May 2019, a pre-procedure time-out was documented in the physician procedure note of the electronic medical record (EMR) for 75% of deep sedations, and 94% of I&Ds.


Objective: We aimed to improve ED physician pre-procedure time-out documentation …

Human Lactoferrin And The Siderophore Aerobactin Independently Impact Intestinal Invasion By Neonatal Escherichia Coli Bacteremia Isolates, Susana Chavez-Bueno, Joshua Wheatley, Jennifer Tabakh

Posters

Background: E. coli is a major cause of neonatal sepsis. After ingestion, E. coli translocates the neonatal gut causing bacteremia. E. coli virulence depends on iron acquisition mechanisms, including siderophore systems. Lactoferrin (LF) protects against neonatal sepsis through immunomodulatory and antimicrobial effects which include iron chelation. However, it is not known whether siderophores in neonatal E. coli strains have an impact on LF’s effects on bacterial invasion and survival in intestinal epithelium.


Objective: To investigate the effects of human LF and the siderophore aerobactin on intestinal invasion and survival of septicemia-producing neonatal E. coli.


Design/Methods: Neonatal E. coli septicemia isolates …

Recurrent Neonatal Herpes Simplex Virus Infection Associated With Irf7 And Unc93b1 Variants, Venkatesh Sampath, Megan H. Tucker, Heather Menden, Sheng Xia, Wei Yu, Nikita Raje

Posters

Background: Neonatal herpes simplex virus (HSV) is a devastating disease with high mortality. In adults and children, genetic variants in the toll-like receptor 3 (TLR3) pathway increase susceptibility to herpes simplex encephalitis (HSE), but the genetic basis of susceptibility to neonatal HSV is unknown. We hypothesized that deleterious variants in the TLR3 pathway increased vulnerability to HSE in neonates. We investigated immunogenetic studies in an infant with neonatal skin, eye, mouth (SEM) HSV followed by HSE.


Objective: To combine exome sequencing with in vivo and in vitro immune functional analysis to discover the immunogenetic basis of HSV vulnerability in proband. …

Parental Health Literacy And Acute Care Utilization In Children With Medical Complexity, Emily J. Goodwin, Joy L. Solano, Jessica L. Bettenhausen, Ryan Coller, Adrienne G. Deporre, Rupal Gupta, Kayla R. Heller, Lauren Jones, Leah Jones, Kathyrn Kyler, Ingrid Larson, Laura Plencner, Margaret Queen, Timothy Ryan Smith, Tyler Smith, Jacqueline M. Walker, Margaret Wright, Isabella Zaniletti, Jeffrey D. Colvin

Posters

Background: Inadequate health literacy, defined as inadequate ability to find, understand and use health information is associated with poor health outcomes and high health care costs. Children with medical complexity (CMC) have high rates of acute care utilization. Understanding parental health literacy in CMC and its relationship to acute care utilization may inform interventions designed to lower utilization.


Objective: To examine parental health literacy for CMC and determine its association with acute care utilization.


Design/Methods: In this single-site cross-sectional study, 250 parents of CMC completed a self-administered survey (response rate of 66.1%). CMC were included if they had a complex …

Impact Of Early Tracheostomy On Neurodevelopmental Outcome Of Infants With Severe Bronchopulmonary Dysplasia Exposed To Postnatal Steroids, Amjad Taha, Gangaram Akangire, Janelle R. Noel-Macdonnell Phd, Tiffany Willis, Winston M. Manimtim

Posters

Background: BPD is associated with neurodevelopmental impairment. Tracheostomy is performed in 5-12% of severe BPD for prolonged ventilation. There is evidence that chronic ventilation with tracheostomy in severe BPD may facilitate neurodevelopment and lead to improved outcome. However, there is no consensus on the optimal timing of tracheostomy. A large multicenter study of infants with tracheostomy performed at <120 days of life had better neurodevelopmental outcomes at 18-22 months of age. Use of steroids postnatally to ameliorate the severity of BPD had been controversial due to its negative effect on neurodevelopment. To date, no data has specifically evaluated the impact of early tracheostomy on neurodevelopmental outcome of infants with severe BPD who are exposed to postnatal steroids.


Objective: To compare cognitive, language and motor scores among 3 groups of severe BPD infants who received early vs late vs no tracheostomy. Secondly, evaluate if postnatal steroids had an additive negative effect on neurodevelopmental outcomes.


Design/Methods: IRB approved retrospective cohort of …

Where Are They Now? Spanish Utilization And Career Direction Of Graduates Of A Pediatric Bilingual Continuity Clinic, Jodi Dickmeyer, Katie Mcanany, Sarah Stone, John Cowden

Posters

Background: The Clínica Hispana de Cuidados de Salud (CHiCoS) Program was created in 2009 to prepare bilingual (English-Spanish) pediatric residents to independently give safe, effective care to Spanish-speaking families. By providing 1:1 support from a culture and language coach over three years of residency, CHiCoS has improved residents’ cultural and linguistic skills and families' perceptions of care. The effects of such training on residents’ future careers have not been formally studied.


Objective: To describe the careers of former CHiCoS residents, the impact of culture and language training on their practice, and opportunities for post-CHiCoS cultural and language training.


Design/Methods: In …

Peripartum Antibiotics Induce Dysbiosis And Predispose The Neonatal Gut Towards Inflammation, Alain Cuna, Marianne N. Nsumu, Venkatesh Sampath

Posters

Background: Broad-spectrum antibiotics in preterm infants have been associated with necrotizing enterocolitis (NEC), but the exact mechanisms that explain this association remain poorly defined.


Objective: To examine the impact of peripartum antibiotics on gut microbiota and intestinal inflammation in the developing gut.


Design/Methods: C57BL6 dams were administered broad spectrum antibiotics mixed with sterile drinking water from E15 to postnatal day (P)14 (Fig 1). Gut microbiota were analyzed by targeted 16S PCR for total bacterial density and relative abundance of major bacterial phyla. Effects of antibiotics on inflammatory TLR-signaling and injury in the neonatal gut were evaluated with PCR and histology. …

Prenatal Diagnosis Of An Uncommon Form Of A Hypoplastic Left Heart Syndrome Variant., Anmol Goyal, Kelsey Pinnick, Rita France, Maria Kiaffas

Posters

Background: Mitral valve dysplasia syndrome (MVDS) is a rare form of congenital heart disease, similar to hypoplastic left heart syndrome (HLHS). Prenatal identification is important for counseling, delivery planning and postnatal management.

Case: A 39 year-old woman underwent fetal echocardiography at ~34 weeks gestation for evaluation of fetal cardiomegaly and hydrops revealing: biatrial enlargement, mild-to-moderate mitral and tricuspid valve insufficiency, echobright mitral valve apparatus, biventricular dilation, severe LV fibroelastosis (EFE) and systolic dysfunction, mild hypoplasia of aortic valve annulus and aortic arch, and a thick restrictive atrial septum (RAS) with left to right flow (Fig 1a-c).

Decision‐making: Although critical aortic …

Not-So-Apparent Mixing Lesions: Late Presentation Of Cardioembolic Stroke, Amulya Buddhavarapu, Christopher Mathis, William Gibson, Sanket Shah

Posters

Background: Multiple levels of inter-atrial shunting can rarely present late in life with dyspnea and embolic stroke from effects of bidirectional shunting.

Case: A 55-year-old male with history of a patent foramen ovale, atrial fibrillation and embolic stroke presented with worsening fatigue and dyspnea at rest. Echocardiogram showed mildly reduced ventricular function with severe right heart dilation. On transesophageal echo, the coronary sinus (CS) was severely dilated with a persistent left superior vena cava (LSVC). A stress test showed no perfusion defects. CT angiography showed an absence of right SVC and a single LSVC connecting to the CS. There was …

Teaching Pediatric Procedural Pain And Anxiety Management To Residents: Early Outcomes Of A Newly Developed Curriculum, Jennifer J. Dilts, Brian R. Lee, Shobhit Jain, Ross Newman, Sarah Fouquet, Michael Brancato, Kadriye O. Lewis

Posters

Background: Poorly managed pediatric pain has negative long-term outcomes, including needle phobia, increased pain and anxiety with subsequent procedures, and healthcare avoidance in adulthood. Evidence-based interventions to reduce procedural pain and anxiety are vastly underutilized, and a literature search revealed no specific curriculum to teach residents optimal skills for pain and anxiety management in minor procedures (e.g. venipuncture, laceration repair). Thus, we developed a multimedia-based lecture with PowerPoint, utilizing results from a focus group interview (conducted with 7 pediatric residents, to determine educational content and identify residents’ needs and learning preferences).


Objective: To measure residents’ learning outcomes (knowledge, attitudes, perceived …

Household Income, Psychosocial Stressors, And Risk Factors For Sleep-Related Infant Deaths, Jeffrey D. Colvin, Isabella Zaniletti, Carolyn Ahlers-Schmidt, Vicki Collie-Akers, Christy Schunn, Rosemary Nabaweesi, Debbie Cheney, Rachel Y. Moon

Posters

Background: Sleep-related infant deaths (e.g., SIDS, accidental suffocation, undetermined) are the leading cause of postneonatal mortality. Infants from low income families have higher rates of sleep-related deaths. Other risk factors for sleep-related death include nonsupine sleep position, bedsharing, maternal smoking, sleeping in separate room, soft bedding, and breastfeeding <8 weeks. Little is known about how these risk factors vary by income or if psychosocial stressors, social services, and education of parents from healthcare providers about risk factors influence these risks among low income families.


Objective: Aim 1: Describe differences in risk factors for sleep-related infant death by family income. Aim 2: Among low income families, describe differences in risk factors by psychosocial stressors, services, and risk-factor education.


Design/Methods: We analyzed 2016-2017 CDC Pregnancy Risk Assessment Monitoring Study (PRAMS) data in 47 states. PRAMS questions mothers of …

Medical Neglect: Trends In Reporting Practices And Patient Characteristics, Danielle Horton, Emily Killough, Mary Moffatt

Posters

Background: Medical neglect has significant consequences on child health and well-being. Improved processes for defining, recognizing, and reporting medical neglect are needed, however there is limited published data on the subject. Insight into patient characteristics and current reporting practices will help identify areas for intervention to improve outcomes for children at risk for medical neglect.


Objective: To describe characteristics of children identified for concern of medical neglect and trends in reporting of cases to child protective services (CPS).


Design/Methods: We performed a 1-year retrospective descriptive study of subjects < 18 years of age at a single, tertiary-care, academic pediatric institution for whom a Patient at Risk (PAR) assessment was completed exclusively for the concern of medical neglect. The PAR is a unique institutional process by which health professionals and social workers document concerns for child maltreatment. Medical records were reviewed for data regarding demographics, medical history, health care utilization and psychosocial risk factors. The role of the initiating provider and healthcare setting in which the PAR was recorded were also obtained.


Results: Of 270 children with a PAR completed for medical neglect concerns, …

Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, Gina Patel, Jenna Miller, Thomas M. Attard, Asdis Finnsdottir Wagner

Posters

Hemorrhagic and thrombotic complications on Extracorporeal Membrane Oxygenation (ECMO) support are associated with significant morbidity and mortality. There is a paucity of literature describing the incidence and management of Gastrointestinal (GI) bleeding on ECMO. We describe the use of enteral tranexamic acid (TXA) as an alternative strategy in two pediatric patients with GI hemorrhage on ECMO. Case 1 A 5-year-old with Wilms Tumor required Veno-Venous ECMO due to respiratory failure associated with pulmonary hemorrhage and air-leak syndrome. Her course was complicated by severe GI hemorrhage refractory to IV proton pump inhibitor (PPI), IV TXA and octreotide infusions. Concomitant IV TXA …

Pediatric Resident Reflections From A Non-Medical Home Visit Of A Child With Medical Complexity, Emily J. Goodwin, Sheryl Chadwick, Deejo Miller, Kathryn Taff, Amanda Montalbano

Posters

Background: Pediatric residents typically only interact with patients and families in healthcare settings which limits the opportunity to fully understand the patient and family experience. Encounters with children with medical complexity (CMC) that only relate to illness or health monitoring can anchor residents to false preconceptions and limit their ability to practice patient- and family-centered care (PFCC). The core principles of PFCC include acknowledging patient and family expertise and strengths, encouraging their input, and appreciating the value of their observations and perceptions.


Objective: To explore how a home visit program with patients and families serving as faculty could instill the …

Physicians’ Burnout: A First Step To Development Of A Wellness Curriculum, Tyler Smith, Katherine E. Mason, David D. Williams, Kadriye O. Lewis

Posters

Background: Prevalence of burnout among physicians is a critical issue impacting all career levels. Identifying burnout begins in medical training with trainees and early career physicians at risk for depression and burnout1. Participation in wellness programs may mitigate burnout perhaps during the COVID-19 pandemic. Online physician wellness activities i.e., coaching and training are offered at a free-standing children’s hospital in the Midwest USA. These programs are well received, but there is no specific curriculum addressing physicians’ wellness needs within the Division of General Academic Pediatrics (GAP). In designing a meaningful program, we conducted a needs assessment survey to gauge GAP …

Efficacy And Safety Of Bardoxolone Methyl In Pediatric Patients With Alport Syndrome In Cardinal Phase 3 Trial, Bradley A. Warady, Sharon Andreol, Vimal Chadha, Melanie Chin, Rasheed Gbadegesin, Keisha Gibson, Debbie Gipson, Angie Goldsberry, Kenneth Lieberman, Colin Meyer, Kevin Meyers, Nozu Kandai, Megan O'Grady, Michelle Rheault, Clifford Kashtan

Posters

Background: Alport syndrome accounts for an estimated 3% of children with end-stage kidney disease in the US (USRDS, 2014). Whereas current management recommendations include the use of renin-angiotensin-aldosterone system inhibitors (RAASi) in patients with proteinuria, no specific therapies have been approved for this disease.


Objective: A Phase 3 study (CARDINAL; NCT03019185) evaluated the safety and efficacy of bardoxolone methyl (Bard) in adult and adolescent patients with Alport syndrome.


Design/Methods: CARDINAL was an international, multicenter, double-blind, placebo-controlled, randomized trial conducted over two years in patients with confirmed diagnosis of Alport syndrome. Patients aged 12 to 70 years old with baseline eGFR …

Differences In Ed And Inpatient Utilization By Location Of Primary Care: Co-Location At A Head Start Center Vs. Academic Primary Care Clinic Setting, Rupal Gupta, Jeffrey D. Colvin

Posters

Background: Children (ED) and inpatient utilization. Co-location of a primary care clinic within a Head Start center (HSC) includes nursing surveillance of classrooms and same-day primary care access, which allows students at the HSC to be seen immediately for acute care during the day. Consequently, co-location of primary care within a HSC may reduce barriers to acute care for those students, thereby lowering their ED and inpatient utilization.


Objective: To compare ED and inpatient utilization of students from a HSC with co-located primary care to patients treated at an academic primary care clinic (APCC).


Design/Methods: In this retrospective cross-sectional study, …

Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian R. Lee, Rana El Feghaly

Posters

Background: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. However, most antibiotic stewardship programs have mainly focused on the latter. Children seen in the ambulatory setting for SSTIs often receive >7 days of antibiotics, although current society guidelines recommend 5-7 days for most diagnoses.


Objective: To determine the baseline percentage of patients receiving antibiotic prescriptions for >7 days for SSTIs in urgent care clinics (UCC)s of a pediatric health system and to evaluate factors that influence providers towards longer durations.


Design/Methods: We built a …

A Smarter Way To Round, Charles Maloy, Adrienne G. Deporre, Erica Adams, Jessica Olson, Amber Hunley, Darcy K. Weidemann

Posters

Background: Communication is a key driver of health care outcomes. Poor communication practices contribute to sentinel safety events, poor family/patient experiences, and delays in care. Use of checklists in the healthcare setting is important to the development of high reliability and is increasingly common, however, the development and implementation of medical checklists for the standard patient floor are inadequately described.


Objective: To develop a sustainable rounding checklist for multidisciplinary discussion of patient safety measures and clinical plans.


Design/Methods: Key stakeholders in the rounding process (subspecialty and general pediatrics physicians, resident physician, bedside nurses, and nursing leadership) created a rounding checklist …

Prevalence Of Mycoplasma Genitalium And Macrolide Resistance In Adolescent Females Receiving Care At A Pediatric Hospital, Kayla Barnes, Bishnu Adhikari, Rangaraj Selvarangan, Christopher J. Harrison, Melissa K. Miller

Posters

Background: Mycoplasma genitalium is an established sexually transmitted cause of nongonococcal urethritis in males and macrolide resistance is increasing. The pathogenic role is less well-defined in adolescent females and guidelines recommend M. genitalium testing only be considered in cases of persistent or recurrent cervicitis and pelvic inflammatory disease (PID). We lack understanding of the prevalence and macrolide resistance of M. genitalium in adolescent females.


Objective: To determine the prevalence of M. genitalium and rate of detected macrolide resistance among adolescent females seeking care at a pediatric children’s hospital.


Design/Methods: We collected 200 salvaged urogenital samples (56 urine and 144 vaginal) …

Learning From The Past: A Novel And Sustainable Initiative To Reducing Unplanned Extubations In A Level Iv Neonatal Intensive Care Unit, Yonatan Kurland, Dena Hubbard, Eugenia K. Pallotto

Posters

Background: Unplanned extubations (UPEs) are a cause of significant morbidity and mortality in neonates. Multiple successful interventions had been previously implemented in our NICU including standardized endotracheal tube (ETT) securement procedures, bedside checklists, and multi-disciplinary debriefing. In our unit greater than 65% of UPEs occur in neonates under 1.5kg who are particularly sensitive to small adjustments in tube position. We designed a novel approach to reducing UPEs in this patient population.

Objective:


Design/Methods: We hypothesized that increased awareness of historical ETT position would both prevent unnecessary ETT position adjustments and encourage prophylactic adjustments to adjust for significant weight gain or …

C-Reactive Protein Values To Predict Sepsis-Induced Inflammatory Response In Premature Infants, Megan Tucker, Hung-Wen Yeh, Daniel K. Oh, Venkatesh Sampath

Posters

Background: C-reactive protein (CRP) is an inflammatory marker that has been recognized as a biomarker of the systemic inflammatory response in preterm neonates. We hypothesized that initial and peak CRP values would correlate with the degree of sepsis-induced acute lung injury (ALI) as measured by the pulmonary severity score (PSS).


Objective: 1) Determine if confirmed (CF) sepsis events are associated with higher initial and peak CRP values than rule out (RO) sepsis events. 2) Investigate if initial and/or peak CRP correlates with severity of sepsis-induced ALI as measured by the PSS.


Design/Methods: In this retrospective case control study, we included …

Atrial Standstill In A Pediatric Patient With Scn5a Mutation Following Procainamide Challenge, Anmol Goyal, Lindsey Malloy-Walton, Christopher Follansbee

Posters

Background: Atrial standstill (AS) is a rare arrhythmia characterized by absence of electrical and mechanical atrial activity associated with SCN5A channelopathy.

Case: An 18 year old male with structurally normal heart, frequent sinus pauses, nonsustained atrial tachycardia and high-grade block was found to have SCN5A mutation c.3823G>A (p.Asp1275Asn). An electrophysiology study (EPS) with high density voltage mapping of the right atrium was done (Fig 1a). Nonsustained multifocal atrial tachycardia was induced without ablative targets (Fib 1b). Procainamide challenge was negative for Brugada, however induced AS (Fig 1c-d). No atrial capture could be achieved at maximal output. Empiric atrial lead …

Multimodal Pain Control In Common Neonatal Surgeries: Post-Operative Pain Protocol Reduces Opiate Exposure And Side Effects, Jamesia Donato, Nefertari Terrill-Jones, Ashley K. Sherman, Warren Teachout, Stephanie Prince, Alexandra Oschman, Daphne Reavey, Darian Younger, Tamorah R. Lewis

Posters

Background: Opioids are the primary post-operative (post-op) analgesic in neonates. Side effects include hypotension, apnea and ileus. Previous studies show IV acetaminophen decreases opiate need in specific populations including cleft palate repair, cardiac surgery. The effect of IV acetaminophen as part of a post-op pain algorithm is not known in common neonatal surgical procedures.


Objective: To determine if (a) a post-op pain algorithm including IV acetaminophen and (b) IV acetaminophen exposure reduces cumulative opioid requirements in neonates undergoing common surgeries in the NICU.


Design/Methods: This is a retrospective cohort study comparing cumulative post-operative opiate exposure between infants with common surgeries …

Association Between Esa Dose And Blood Pressure In Pediatric Patients On Dialysis, Heather A. Morgans, Judith Sebestyen Vansickle, Franz Schaefer, Bradley A. Warady

Posters

Background: Hypertension is a reported side effect of Erythropoiesis Stimulating Agents (ESAs), with a mechanism of action related to elevated hematocrit levels and direct vasopressor effects. Limited information exists on the relationship between ESA dosage and hypertension in children receiving maintenance dialysis.


Objective: The primary aim of this study was to determine whether there is a significant correlation between ESA dose and blood pressure (BP) in pediatric patients on dialysis. The secondary aim was to determine confounding variables in relation to ESA dose and BP.


Design/Methods: Data from the International Pediatric Dialysis Network (IPDN) database was used to retrospectively evaluate …