Medical Specialties Commons^™

The Effects Of Obesity And Diabetes On The Pediatric Population, Keyur Patel, Vrushank Shah, Zachary Harris, Kanad Mukherjee

Rowan-Virtua Research Day

The World Health Organization has declared diabetes (DM) and Obesity to be epidemics due to their rising prevalence. Obesity plays a role in the aetiopathogenesis of type 2 diabetes, the most common type of diabetes in the world, as well as the development of its complications. Obesity and overweight play a growing role in type 1 diabetes. Weight gain is often thought of as a side effect of insulin therapy, but it also has a significant pathophysiological impact at different stages of the disease. (1) In the United States and other nations across the world, childhood obesity has become a …

A Rare Case Of Scalp Swelling In Infancy: Delayed Subaponeurotic Fluid Collection, Shreya Dundumalla

Research Day

Delayed subaponeurotic fluid collection (DSFC) is a rare cause of scalp swelling in infants presenting weeks to months after birth. DSFC is described as a mobile and soft swelling which crosses suture lines in healthy infants with no recent history of trauma or fall. A literature search in the National Library of Medicine revealed fewer than 15 publications on the topic since 2007. The exact etiology and long term consequences of DSFC remain unclear although birth trauma has been implicated as the main mechanism. A healthy 2 month old male infant presented to the ED with a one-day history of …

Maternal Psychiatric Functioning And Maternal-Infant Attachment Among Mothers Of Infants In The Neonatal Intensive Care Unit (Nicu), Elizabeth Greco, Alexa Bonacquisti

Research Day

Introduction: A growing body of research suggests that an infant’s admission to a neonatal intensive care unit (NICU) may adversely impact maternal psychiatric functioning, affecting quality of life, well-being, and patient outcomes. Additionally, there is accumulating evidence that stressful reproductive events related to a NICU admission) may even exacerbate pre-existing maternal psychiatric symptoms. The purpose of the current study was to examine the relationships between maternal mental health symptoms, including anxiety and stress, and maternal-infant attachment among mothers of infants in the NICU. By examining the psychiatric functioning measures both at the time of initial NICU admission and again 2-4 …

Association Between Race And Early Antibiotic Use In Newborns Admitted To The Neonatal Intensive Care Unit, Rodney Morrison Jr, Alvaro Zevallos Barboza, Diana Montoya-Williams, Dustin Daniel Flannery

Research Day

Introduction: Given the risk of early-onset sepsis, providers frequently prescribe empirical antibiotics to newborns admitted to the neonatal intensive care unit (NICU). Early and prolonged use of antibiotics in uninfected newborns is associated with many adverse effects and potentially life-threatening complications, particularly among those with very low birth weight (VLBW; <1500g). Studies of neonatal antibiotic utilization often adjust for race, acknowledged as a social construct, but there is a paucity of data on whether there is an independent association between race and antibiotic use in this population. We hypothesized that Black newborns have higher antibiotic use after adjusting for confounding factors compared to other races.

Design/Methods: Retrospective cohort study including newborns admitted to a NICU from 2012-2021 included in the Premier Health database, which captures inpatient encounters from academic and community hospitals across the US. Early antibiotic initiation was defined as any parenteral antibiotic administered within the first 3 days after birth. Prolonged antibiotic duration …

Perfect Storm? Covid-19, Area Deprivation, And Their Association With Pediatric Trauma, Devon Pace, Paulo Castro, Julia Gong, Brandon George, Russell Mcintire, Charles Paidas, Loren Berman, Rosemary Frasso, Colin Plover

Research Day

Introduction: Social determinants of health (SDOH) affect pediatric injury patterns as vulnerable populations are likely to experience more frequent or severe injuries. This study evaluates the association of COVID-19 and area deprivation with pediatric traumatic injuries.

Methods: We retrospectively evaluated institutional level I pediatric trauma encounters from 1/2018-8/2022. Patients were assessed relative to the U.S. pandemic declaration date (3/11/2020): pre-COVID (<3/11/2020), early post-COVID (3/11/2020-3/11/2021), and late post-COVID (>3/11/2021). The Area Deprivation Index (ADI) measured SDH-related risk at a census block tract group level. Associations between ADI and COVID-19 and injury mechanism and outcomes (intensive care unit [ICU]/ventilator duration, hospital length of stay, and mortality) were assessed …

Association Of Operative Approach With Postoperative Outcomes In Neonates Undergoing Surgical Repair Of Esophageal Atresia And Tracheoesophageal Fistula, Devon Pace, Paulo Castro, Shale J. Mack, David H. Rothstein, Courtney Devin, Emily Sagalow, Allison F. Linden, Matthew Boelig, Loren Berman

Research Day

Introduction: Minimally invasive surgery (MIS) is gaining traction as a first-line approach to repair congenital anomalies. This study aims to evaluate outcomes for neonates undergoing open versus MIS repairs for esophageal atresia/tracheoesophageal fistula (EA/TEF).

Methods: Neonates undergoing EA/TEF repair from 2013-2020 were identified using the National Surgical Quality Improvement Program-Pediatric database. Proportions of operative approach (open vs. MIS) over time were analyzed. A propensity score-matched analysis using preoperative characteristics was performed and outcomes were compared including composite morbidity and reintervention rates (overall, major [thoracoscopy, thoracotomy], and minor [chest/feeding tube placement, endoscopy]) between operative approaches. Pearson’s chi-square or Fisher’s exact test …

Bronchiolitis: Albuterol Use, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Micrognathia, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Intracranial Focal Infections, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Families' Knowledge Change In Paediatric Drug Resistant Epilepsy: A Novel Clinic Model, Michelle Kregel, Sherry Coulson, Maryam N Nouri, Rochelle Sorzano, Andrea Andrade

Paediatrics Publications

BACKGROUND: Epilepsy is a chronic condition that affects approximately 95,000 Ontarians, of whom approximately 15,000 are children under the age of 18. Drug resistant epilepsy (DRE) will affect around 30% of these children who will require more advanced care due to their medical complexities. The purpose of this study is to determine if receiving care in a paediatric Comprehensive Epilepsy Clinic (CEC) is associated with positive outcomes for children living with DRE and their families by looking at three health outcomes: 1) families' knowledge of their child's diagnosis and treatment plan, 2) navigational access to both the hospital and community …

School-Based Study To Assess The Nutritional Status (Bmi Based) Of Adolescents Of Gojra City Of District Toba Tek Singh, Punjab, Pakistan, Shagufta Perveen, Rozina Karmaliani, Rubina Barolia, Rozina Mistry

School of Nursing & Midwifery

Adolescence is the make-or-break stage of life. Major physical, mental, and psychological growth takes place at this age. Adequate and balanced nutrition is a vital requirement to support this phase. Adolescents living in developing and low-income countries are more likely to face nutritional challenges. Poor nutritional status during adolescence is an important determinant of health outcomes.
Objective: To analyze the nutritional status (BMI based) of school-going adolescents in Gojra city, Punjab, Pakistan.
Methods: A school-based cross-sectional survey was carried out covering 635 (6-8 grade) school-going adolescents (boys and girls) from public schools in Gojra city. Data were collected through anthropometric …

The Ethical And Validity Conundrum In Epilepsy Research In Lmic Settings, Pauline Samia, Adeel Shah, Archana Patel, Philip Olielo, Lionel Mudave, Samson Gwer

Paediatrics and Child Health, East Africa

In the last few decades, research in epilepsy has significantly improved understanding of risk factors and etiologies associated with epilepsy, promoting greater access to interventions and medications that have improved health-related outcomes for patients. However, these advances and benefits are not being felt evenly on a global scale due to significant inequalities in access to and utilization of research resources and expertise in Low-and Middle-Income Countries (LMICs).

To promote effective research output, and advance evidence-based practices; the context, disease burden, and challenges that hinder good research need to be re-defined and addressed. This is key in facilitating implementation of coherent …

Effects Of Pubertal Growth Variation On Knee Mechanics During Walking In Female And Male Adolescents, Andrew W. Froehle, Brian A. Edwards, Matthew Peterson, Brian Meyerson, Dana Duren

School of Health and Exercise Sciences Faculty Publications

Introduction: Puberty substantially alters the body's mechanical properties, neuromuscular control, and sex differences therein, likely contributing to increased, sex-biased knee injury risk during adolescence. Female adolescents have higher risk for knee injuries than male adolescents of similar age engaging in similar physical activities, and much research has investigated sex differences in mechanical risk factors. However, few studies address the considerable variation in pubertal growth (timing, pace), knee mechanics, and injury susceptibility within sexes, or the impact of such growth variation on mechanical injury risk.

Objectives: The present study tested for effects of variation in pubertal growth on established mechanical …

The Ethics Of Medical Interventions Against Parental Consent, Corey Carney, Mark C. Navin, Jason Wasserman, Abram Brummett, Kaitlyn Hanson

Posters

Between an adult patient and physician they are the only two people that have a say in the patient’s medical treatment with the patient having the final say. In pediatrics, there is a patient, parent, and physician which adds a third party that is a proxy decision maker for the child but lacks absolute authority over the child’s treatment. The goal of this study is to give a sense of the diversity of the pediatric ethics literature regarding parent/physician disagreements and to address ambiguities about pediatric interventions.

Conceptualization Of Intervention In Pediatrics Systematic Review, Kaitlyn Hansen, Mark C. Navin, Jason Wasserman, Stephanie Swanberg

Posters

Navigating when to intervene against parents’ wishes is a difficult task in pediatrics. Different frameworks have been proposed, but disagreements remain. One problem debated about in pediatric intervention principles often refer to different kinds of interventions (e.g. calling Child Protective Services, consulting the Ethics Committee). This project reports results of a critical scoping review of recent bioethics literature about the concept of pediatric intervention principles.

'Best Interest' In Clinical Medicine: A Critical Scoping Review, Joshua R. Jones, Saketh Akula, Jason Wasserman, Mark Navin

Posters

The Best Interest Standard (BIS) has been a much-debated guidance principle in clinical ethics with ambiguous definition and application. In this study we focus on the conceptions of best interests that differ according to which kinds of interests are included. While there is wide agreement that ‘best interests’ include the physiological welfare of a patient, there is still substantial disagreement about which other interests are included in wider accounts of welfare, the balancing of those other interests, and whether interests are objective or subjective.

Drug Metabolizing Enzymes And Transporters May Help Determine Effective Budesonide Dosing In Eoe, Laurie Mccann, Lisa Harvey, Norah Almahbub, Wendy Y. Wang, Erin C. Boone, Janelle R. Noel-Macdonnell, Rachel Chevalier

Posters

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder diagnosed in children with painful or difficult swallowing, vomiting, or poor weight gain.  Current treatment models adopt a trial-and-error approach in regard EoE treatment, including restrictive elimination diets, proton pump inhibitors, and topical budesonide. This approach can delay effective treatment which increases risk of disease progression and increases medical costs to families for frequent clinic visits and endoscopy.   Objectives/Goal: The objective of this study is to determine the CYP3A5 genotype and expression of patients with eosinophilic esophagitis to discover which patients will respond to standard dosing of topical budesonide treatment (1, …

Mental Health Disorders And Psychotropic Medication: Prevalence And Related Characteristics Among Individuals In Foster Care, Jill Mcleigh, Lauren Malthaner, Madeline Tovar, Mohsin Khan

Behavioral Health/Developmental Delay

This study sought to provide prevalence data for mental health (MH) diagnoses and psychotropic medication prescriptions among individuals in foster care and to examine their relationships with physical health status, maltreatment type, placement type, and demographic variables.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

Introduction Of Probiotics To Improve Eczema Symptoms In Children In One Pediatric Primary Care Practice: A Quality Improvement Project, Christie Potter

Doctor of Nursing Practice Scholarly Projects

Background: There is emerging interest in alternative approaches to treating children with eczema because there is currently no allopathic cure. Non-pharmacological approaches are regarded as generally safe, well tolerated, and cost effective. Eczema is a chronic, relapsing inflammatory, itchy skin condition that adversely affects quality of life in many individuals, including children. Eczema interferes with sleep, leads to secondary skin infections, and causes intractable itching. Topical steroids are the current standard of practice in treating patients but, evidence suggests that they can cause unwanted side effects and can lead to serious systemic reactions. The purpose of this quality improvement project …

Concern For Authenticity In Rational And Relational Autonomy, Joshua J. Daniel, Abram Brummett, Mark C. Navin, Jason A. Wasserman

Posters

The four principles of bioethics described by Beauchamp and Childress are beneficence, nonmaleficence, justice, and autonomy. Two definitions of autonomy are very commonly used: rational autonomy, which refers to a patient making decisions based on their own beliefs and customs, and relational autonomy, which refers to shared decision making with the input of a patient’s close trusted individuals. Beauchamp and Childress described autonomous actions as those with intention, understanding, and lack of controlling factors. A fourth component that is sometimes included is authenticity, or making decisions true to one’s self. The primary goal of this study is to determine whether …

The Meaning Of Pediatric Assent: A Critical Scoping Review, Natalie Liogas, Amelia Najor, Jason Wasserman, Stephanie Swanberg, Abram Brummett, Naomi Levanthal

Posters

The moral obligation to include children and adolescents in medical decisions has been long recognized. Soliciting pediatric assent is a component essential to this effort. Despite the AAP characterization of assent (AAP 1995; AAP 2016), there appears to be a lack of consensus regarding the operational and conceptual meanings of pediatric assent. This this critical scoping review provides an analysis of the varied meanings of pediatric assent in the clinical context.

Pediatric Assent In Clinical Practice: A Critical Scoping Review On The Ethical Justifications For Assent, Amelia Najor, Natalie Liogas, Jason Wasserman, Stephanie Swanberg, Abram Brummett, Naomi Laventhal, Mark C. Navin

Posters

Pediatric assent is an important ethical construct, yet there is little agreement on what precisely it means, including the ethical justifications for assent. The term is used to indicate everything from acquiescence to an analogue of informed consent itself. The primary goal of this study is to assess the range of ways that pediatric assent is specified in the clinical ethics literature, as well as what different conceptions intimate about its moral value. This systematic review will summarize the normative claims about pediatric assent in recent literature. Analysis will map divergent constructs and various moral and ethical justifications for pediatric …

Food Insecurity Screening In People With Cystic Fibrosis, Rebecca Edwards, Lauren Tate, Ana Cairns, Cheryl Coyne, Kathleen Walker, Kim Violette, Ann Ladner, Jessica D'Amico

Costas T. Lambrew Research Retreat 2023

Background: Adequate nutrition is a cornerstone in the management of cystic fibrosis (CF). Malabsorption secondary to pancreatic insufficiency and increased energy demands related to lung disease can increase energy requirements over twofold for a person with CF. Food insecurity (FI) affects approximately 10% of Mainers (1). Per the Cystic Fibrosis Foundation, there may be up to a threefold increase in the prevalence of FI in the CF population (2). To address this issue, we implemented FI screening in the adult and pediatric CF programs to identify the prevalence of FI within our population and to offer immediate interventions.

An Educational Intervention To Improve Pediatric Inter-Rater Reliability Of The Hospital Asthma Severity Score (Hass), Anne Coates, Amanda Gagnon, Noah Diminick

Costas T. Lambrew Research Retreat 2023

Objective: To assess if an inter-professional educational intervention can improve the accuracy and inter-rater reliability of the HASS

Pathways To Care Of Maine Youth With Psychosis, Elizabeth M. Mutina, Rebecca Jaynes, Dave Weiss, Elizabeth Bernier, Kristen A. Woodberry

Costas T. Lambrew Research Retreat 2023

Study clinicians conducted semi-structured interviews to identify the timing and steps of each person’s Pathway to Care (PtC).

Access To Pediatric Type 1 Diabetes Care In Montana, James C. Bohnhoff, Michael Kohut Phd, Chelsea Bodnar, Elizabeth A. Jacobs

Costas T. Lambrew Research Retreat 2023

Introduction: Management of Type 1 Diabetes (T1D) requires significant family effort and specialty support. We aimed to understand how living in a rural state impacts families’ experiences during and after diagnosis.

The Relationship Between Adverse Childhood Experiences And Pediatric Functional Gastrointestinal Disorders, Rachel Coffey, Jackson Bloch, Anya K. Cutler, Sarah M. Gabrielson, Stephen Digiovanni, Julia Fritz

Costas T. Lambrew Research Retreat 2023

Introduction:

• 1 in 4 kids in Maine have 3+ adverse childhood experiences (ACEs)

• ACEs negatively impact health outcomes

• Adult literature shows association between ACEs and irritable bowel syndrome, a functional gastrointestinal disorder (FGID)

The Gender Clinic At The Barbara Bush Children’S Hospital: Demographics, Diagnoses, And Treatment Goals, Brandy Brown

Costas T. Lambrew Research Retreat 2023

Introduction: Program evaluation to better understand patients referred to The Gender Clinic.

Improving Adherence To The American Association Of Pediatrics Clinical Practice Guideline For The Evaluation And Management Of Well-Appearing Febrile Infants At Maine Medical Center: A Quality Improvement Project, Gabriela De Oliveira Md, Sarah M. Gabrielson Mph, Bsn, Rn, Jillian Gregory Do, Lori Travis Ms, Kendall Dapprich Mph, Meredith Jackson Md, Erica Swan Mba

Costas T. Lambrew Research Retreat 2023

Educational interventions sustain increased CRP collection rates for better adherence to the AAP guidelines for evaluating well-appearing febrile infants.

Who’S My Child’S Main Doctor?​ Caregiver Perceptions Of Teaching Teams, Jonathan Ermer, Shelby Chesbro, Jessica Boerner, Jacqueline M. Walker, Joy L. Solano

Posters

Background: At academic medical centers, children are cared for by large medical teams consisting of multi-level learners including medical students, interns, senior residents and fellows on patient-and family-centered rounds (PFCR). The size and structure of these teaching teams can make it difficult for patients and families to know who is caring for them and establish a trusting relationship. Also, research has shown when residents are perceived as a “team leader,” they learn more. Previous literature in adults has shown that patients often perceive the intern as their “main doctor,” but this has not been studied in pediatrics. Objective: We sought …