Medicine and Health Sciences Commons^™

Cvst As A Rare Complication Of Acute Pediatric Covid-19, Erin Bolen, Jonathan Ermer, Mukta Sharma

Posters

A case report and literature-review derived case series of pediatric central venous sinus thrombosis as a late complication of COVID-19.

Wilms Tumor (Wt) Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen, Kathyrn Kyler

Posters

Wilm’s Tumor (WT) is the most common renal malignancy of childhood. The initial presentation of WT may mimic infection or other malignancies with nonspecific symptoms including fever, abdominal/flank pain, or hematuria. We describe a case of WT with spontaneous necrosis obscured by overlying Clostridium perfringens infection. A previously healthy 5-year-old girl presented to the emergency department with a two-day history of flank pain and fevers. She was tachycardic (130 bpm), hypertensive (116/75), and febrile (101.7F). Her abdomen was distended with left-sided flank tenderness without a palpable mass. Initial laboratory testing revealed elevated CRP (70mg/dL) and leukocytosis (22.56 x 109 /L). …

Improvement In Follow-Up Communication For Resident-Identified Patient Safety And Hospital Process Issues, Ross Newman, Angela Etzenhouser, Emily Killough, Danielle Reed, Allison Adam, Michelle Brown, Kelly Meyer, Denise Bratcher, Nicholas Clark

Posters

BACKGROUND: Lean concepts, including Daily Management Systems (DMS), have been adopted by health systems to prioritize high-quality and efficient care. Since 2018, our residency program has utilized a daily readiness huddle (key component of DMS) to prepare inpatient residents for their workday. This is a time when residents can raise administrative and/or clinical patient safety concerns. Concerns unable to be immediately resolved locally are designated as Quick Hits (QH) and escalated through residency and hospital leadership with resolutions cascaded back to frontline providers. With <10% of residents on inpatient services each month, a gap in overall resident awareness of findings from resolved QH exists, posing potential patient safety risks. OBJECTIVE/AIM: We aimed to improve the weekly percentage of findings from resolved QH communicated to every resident (rather than only those in attendance at the daily readiness huddle) from 0% to >95% within 6 months. METHODS: A core team was created consisting of residency program leadership (DIO, …

Characteristics Of High-Acuity Patient Transfers To The Picu For Status Asthmaticus, Lilah Melzer, Marc Sycip, Jade B. Tam-Williams

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No abstract provided.

A Rare Case Of Suspected Generalized Arterial Calcification Of Infancy (Gaci) In An Infant Presenting With Respiratory Failure In An Infant Presenting With Respiratory Failure And Arterial Calcification, Lilah Melzer, Catharine Kral, Bonnie Sullivan, Eric T. Rush, Erin Khan

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No abstract provided.

Recurrent Primary Spontaneous Pneumothorax Masquerading As A Congenital Pulmonary Airway Malformation In A Young Female, Chandra Swanson, Justin Sobrino, Tolulope A. Oyetunji Md Mph, Erin Khan

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Introduction: Spontaneous pneumothoraxes in children are uncommon, may be idiopathic or associated with underlying pulmonary disease, and can present management challenges. We present a 12-year-old female with recurrent right sided spontaneous pneumothorax in the setting of an asymptomatic SARS-Co-V2 (COVID) infection and imaging concerning for congenital lobar overinflation (CLO) versus congenital pulmonary airway malformation (CPAM), prompting surgical intervention. Case: A 12-year-old pre-menstrual female with remote history of eczema, asthma, and environmental allergies presented from an outside facility with four-days of progressive chest pain and dyspnea on exertion and diagnosis of right-sided spontaneous pneumothorax, improving after pigtail chest tube placement. Physical …

Myelin Oligodendrocyte Glycoprotein Associated Demyelinating Disorder Presenting As Acute Disseminated Encephalomyelitis After Sars-Cov-2 Vaccination: A Case Report, Jesse Lou, Dustin Sielski, Hanan Saleh, Brandon Trivax, Julie Ferris, Ronald Taylor

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No abstract provided.

Sarcoid Myelitis Masking As Multiple Sclerosis In An Otherwise Healthy 45-Year-Old: A Case Report, Jesse Lou, Brandon Trivax

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No abstract provided.

Right Arm Weakness And Vaginal Spotting: A Curious Case Of Paraneoplastic Necrotizing Myopathy Associated With Endometrioid Adenocarcinoma, Jesse Lou, Julie Ferris

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No abstract provided.

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

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Introduction Previous studies of transgender/gender diverse (TGD) youth indicate differences in rates of sexual behaviors between TGD youth and their cisgender peers. However, few studies have reported the sexual behavior and preferences of TGD youth in a large clinic sample, and no studies, to our knowledge, have utilized questionnaires that do not assume the sex or gender of one’s sexual partner. The current study aims to explore the self-reported sexual behavior of TGD youth presenting for gender-affirming medical care. Methods Retrospective chart review of 589 patients (ages 12-22, M= 15.92, SD= 1.54; 72.9% assigned female sex at birth (SAB)) presenting …

Identifying Predictive Factors For Patients Transferred From Floor To Picu Within 24 Hours Of Admission By A Pediatric Critical Care Transport Team, Gina Patel, Lisa Carney, Brian S. Olsen, Jennifer Flint

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Abstract Objectives: Appropriate triage and disposition during transport can reduce the need for unplanned transfers to the pediatric intensive care unit (PICU) within 24 hours of admission. The pediatric early warning score (PEWS) is utilized to monitor for inpatient clinical deterioration and acuity during transport at our hospital. We sought to determine predictive factors of patients admitted to the inpatient ward who required PICU transfer within 24 hours following transport by Children’s Mercy Critical Care Transport (CMCCT) team. We hypothesized patients with respiratory illness and PEWS > 4 during interfacility transport are at higher risk of PICU transfer within 24 hours …

Ultrasound Guided Peripheral Iv Access Curriculum For The Pediatric Emergency Department: A Pilot Study., Samuel Dillman, Frances Turcotte Benedict, Christopher S. Kennedy

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Ultrasound Guided Peripheral IV Access Curriculum for the Pediatric Emergency Department: a pilot study. Background: Up to 50% of children have difficult venous access. Studies in the Pediatric Emergency department (PED) have shown that ultrasound guided peripheral IV (USGPIV) access has decreased IV access time and ED length of stay.  Barriers for use include lack of training and comfort with the procedure. Objectives/Goal: Our objectives are to pilot and evaluate USGPIV training for Pediatric Emergency Medicine (PEM) physicians and nurses.  Methods/Design: The course included a 4-hour, hands-on session with US IV training using a blue phantom task trainer in conjunction …

Rare Variants In Renal Developmental Genes And The Risk Of Hypertension And Ckd: A Uk Biobank Study, Benjamin Spector, Byunggil Yoo, Neil Miller, Laurel K. Willig

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Background: Prior studies show chronic kidney disease (CKD) is heritable but only a few common variants have been associated with CKD and kidney dysfunction. Much of CKD heritability remains unknown and limited studies have explored the role of rare genetic variants in this missing heritability. Objectives: Identify rare genetic variants in renal developmental genes associated with hypertension and CKD. Methods: We examined the association between rare variants in 58 candidate genes from five renal developmental compartments and presence of CKD and elevated blood pressure (BP) in 49,989 individuals using whole exome sequencing and phenotypic data from the UK Biobank. Criteria …

Rates Of Physical Abuse Screening And Detection In Infants With Brief Resolved Unexplained Events (Brues), Angela Doswell, James Anderst, Joel Tieder, Henry T. Puls

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Background: “Apparent Life-Threatening Events” (ALTEs) have been associated with child physical abuse (CPA). In 2016, “Brief Resolved Unexplained Event” (BRUE) and the development of its clinical guidelines and risk-stratification replaced ALTE. However, it is unknown if there is a similar association between BRUEs and CPA. Objectives: To determine the rate of CPA in infants presenting with a BRUE, examine differences between infants with and without CPA, and to examine rates of diagnostic testing used to detect CPA. Methods: This study was part of the BRUE Research and Quality Improvement Network, which is composed of 15 academic and community hospitals. Subjects …

Caregiver Mental Health Screening In A Pediatric Feeding Clinic, Dana Bakula, Laura Slosky, Kelsey Dean, Ann M. Davis, Sarah T. Edwards

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Introduction: One in four adults have mental health (MH) problems. Caregivers of children with feeding problems are at even higher risk for mental health (MH) problems, including depression, anxiety, and posttraumatic stress. Caregiver MH concerns have a negative impact on caregiver and child quality of life and are specifically linked to suboptimal child feeding practices. Thus, it is critical to identify caregiver MH problems in pediatric feeding settings. However, it can be challenging to comprehensively screen for caregiver MH in a busy pediatric feeding clinic. This emphasizes the importance of a feasible and brief method for screening caregiver MH. Methods: …

17-Year-Old Ballet Dancer With 4 Years Of Right Upper Extremity Pain, Mariah Sisson, Brian S. Harvey

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History:No known injury. Intermittent, dull, radiating. Starting at the shoulder and moving to the medial elbow, but sometimes only at the medial elbow with numbness of the 4th/5th digits. No limitations in ballet. Extended course to see Sports Medicine. PCP - failed treatment for herpetic whitlow, referred to dermatology. Dermatology - bilateral Raynaud's syndrome & Pernio, referred to rheumatology. Rheumatology - having RUE numbness, referred to neurology & PT. Neurology - tenderness to palpation at the anterior shoulder, referred to Sports Medicine. PT - getting stronger, but symptomatically making minimal improvement. PE:Cardiac: capillary refill normal. MSK: RUE: Inspection: No erythema, …

A Rare Cause Of Elbow Pain With A Controversial Name, Thomas Munro, Brian Harvey

Posters

History: 13-year-old right hand dominant male presenting with 1-year concerns of bilateral elbow locking, popping, and pain. Right elbow tends to be affected more frequently than left. Patient states that at random, when he is trying to extend at the elbow joint, his elbows will "lock up". He will not be able to extend past this region and has significant pain when this occurs. He has to proceed back into elbow flexion and again try to "push through" into full extension. This will result in a loud pop followed by about 5-10 minutes of pain which slowly resolves. This happens …

Healthcare Needs And Experiences Of Detained Youth, April Mcneill-Johnson, Zuri Hudson, Brittany Moore, Dumebi Okocha, Megha Ramaswamy, Kimberly A Randell

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COVID-19 : Perspectives from Youth in Detention Background: The COVID-19 pandemic amplified health disparities among youth in detention. Understanding perspectives of these youth on the pandemic and COVID-19 vaccination may identify strategies to mitigate pandemic-related health disparities in this group. Objective: To explore perspectives on the COVID-19 pandemic, effect on detention experience & the COVID vaccine among youth in detention. Methods: This is a secondary analysis of a study examining healthcare needs and experiences of youth in detention. We recruited a convenience sample of youth (14-17 years) detained in urban midwestern juvenile detention centers from January-November 2021. We conducted semi-structured …

Trends In Proportions Of Female Representation At American Society Of Pediatric Nephrology Pediatric Academic Society Meetings 2012-2021, Bahar Barani Najafabadi, Dave Selewski, Danielle Soranno, Darcy Weidemann

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No abstract provided.

Potassium Status In Pediatric Chronic Kidney Disease: A Preliminary Report From The Chronic Kidney Disease In Children (Ckid) Study, Katherine L. Kurzinski, Yunwen Xu, Derek Ng, Susan Furth, George Schwartz, Bradley A. Warady

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No abstract provided.

Pre And Postnatal Magnetic Resonance Imaging Of Ventriculomegaly, Ryan Kelsch, Megan Moore, Anant Krishnan

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Purpose or Case Report: The purpose of this research was to analyze our institution’s large database of fetal magnetic resonance (MR) for cases of ventriculomegaly in order to understand trends in pre and postnatal MR.
Methods & Materials: In this retrospective study, 316 individual fetal MR exams from the past 10 years at our institution were reviewed. Of those, 86 patients had fetal MRs with findings of either ventriculomegaly or an ordering indication of ventriculomegaly. Our inclusion criteria of a diagnosis of ventriculomegaly (lateral ventricle measured at the trigone on coronal imaging of over 10mm) on fetal MR with a …

Impact Of Soy-Based Versus Composite Lipid Emulsion (Soybean, Medium Chain Triglycerides, Olive And Fish Oil) In Critically Ill Patients, Sandra Kless, Lisa Hall Zimmerman, Olaf Kroneman

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No abstract provided.

The Incidence Of New Or Worsening Oab Symptoms In Patients With Prior Sars Cov-2 Infection, Ly Hoang Roberts, Bernadette Zwaans, Kenneth M. Peters, Michael Chancellor, Priya Padmanabhan

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No abstract provided.

Standardizing The Pelvic Floor Exam: Is It Reproducible And Durable?, Ly Hoang Roberts, Bernadette Zwaans, Daniel T. Fortney, Steven A. Kessler, Hailey Eisner, Lauren Tennyson, Kenneth M. Peters

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No abstract provided.

Timing Of Testing For Ige-Mediated Food Allergy After Systemic Reaction, Jordan Pitt, Paul J. Dowling, Christopher Miller, Ashley Sherman, Salman Aljubran

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Rationale: A refractory period of falsely negative testing can occur following a systemic allergic reaction to Hymenoptera sting. As a result, blood specific IgE and/or skin prick tests (SPT) for other allergens are often delayed. This retrospective chart review aims to identify the proportion of patients with falsely negative test results in the 6 weeks following an allergic reaction to food, and factors that may affect it. Methods: One hundred fourteen pediatric subjects met inclusion criteria. Each had a convincing history of food allergy with a systemic allergic reaction and was tested to the culprit food within 6 weeks. The …

Evaluation Of The Outcomes Of Oral Challenges To Azithromycin, Cephalexin And Trimethoprim-Sulfamethoxazole In Pediatrics, Hannah N. Neuhaus, Jordan Heath Md, Salman Aljubran

Posters

Rationale: Antibiotic hypersensitivity complicates treatment for various infections and leads to long-term healthcare costs and antibiotic resistance. Data regarding the outcomes of oral challenges to trimethoprim-sulfamethoxazole, azithromycin and cephalexin are limited in Pediatrics.  The goal of this study was to characterize the outcomes and safety of oral challenges to these antibiotics in Pediatrics.

Methods: A retrospective chart review was performed of pediatric patients who underwent oral challenges to cephalexin, azithromycin and trimethoprim-sulfamethoxazole in Allergy Clinic over the last 12 years.

Results: Ten patients underwent oral challenge to trimethoprim-sulfamethoxazole and all were successful. Thirteen patients underwent oral challenge to azithromycin and …

Extubated Vv-Ecmo For Covid-19 Ards In An Immunosuppressed Pediatric Renal Transplant Patient., Johanna I. Orrick, Cara Holton, Tara Benton, Jenna Miller

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Extracorporeal membrane oxygenation (ECMO) for coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS) in adults is common, and outcomes are similar to those for non-COVID-19 ARDS on ECMO1. However, children are much less likely to have severe COVID-19 disease, and thus the need for extracorporeal support is rare2,3. Even pediatric solid organ transplant recipients with active COVID-19 infections typically do not require ECMO.4 We present the case of an immunosuppressed pediatric patient with COVID-19-related ARDS who had an excellent outcome on VV-ECMO. An 11-year-old female with a history of polycystic kidney disease status post renal transplant three years …

Getting Back To Global Health; Lake Atitlan, Guatemla, Kyra L. Mccarty

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Describes pediatric resident's exposure to the Guatemala health service and medical education system.

Evaluation Of Cost Savings Opportunity With The Use Of An Alternative Factor Vii Product Within A Tertiary Academic Medical Center And Health System, Kevin Rivera Jr., Pharmd, Anthony Renzoni Pharmd, Bcps, Bcemp, Evan Zahn Pharmd, Bcccp, Bcemp

Posters

• Eptacog alpha is the factor VII product on formulary
• It is approved by the FDA to treat bleeding in adults or children with hemophilia A or B with inhibitors •
• Additional approved uses include Glanzmann’s Disease, and factor VII deficiency and off label uses include cardiac surgery, and trauma salvage therapy
• Eptacog beta is an alternative recombinant factor VII product approved by the Food and Drug Administration in 2020 to treat bleeding in patients 12 years old or greater with hemophilia A or B with inhibitors
• In evaluating contracting pricing for each of these factor agents eptacog beta is potentially …

Elevated Stool Inflammatory Markers In Early Onset Polymorphic Post-Transplant Lymphoproliferative Disease Following Orthotopic Heart Transplant, Jeremy Stewart, Keith August, Thomas M. Attard

Posters

Acute gastrointestinal hemorrhage in the context of a recent organ transplant with immunosuppression, antibiotic exposure, drug exposures and other comorbidities is a challenging clinical scenario with coordinated multidisciplinary effort needed to optimize management and outcomes. We present a patient with recent solid organ transplant with severe acute gastrointestinal bleeding attributable to EBV associated post-transplant lymphoproliferative disease. The patient is a 13-year-old Female with Williams syndrome who is EBV negative and CMV positive who received an EBV/CMV positive orthotopic heart transplant 5.5 months prior to presentation. She presented with bloody diarrhea, anemia (7.8 gm/dL), hypovolemia, and acute kidney injury (BUN 25 …