Medical Specialties Commons^™

Assessment And Management Of Dehydration, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

The Burden Of Unintentional Drowning: Global, Regional And National Estimates Of Mortality From The Global Burden Of Disease 2017 Study, Richard Charles Franklin, Amy E. Peden, Erin B. Hamilton, Catherine Bisignano, Chris D. Castle, Zachary V. Dingels, Simon I. Hay, Zichen Liu, Ali H. Mokdad, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017.
Methods: Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality …

Burden Of Injury Along The Development Spectrum: Associations Between The Socio-Demographic Index And Disability-Adjusted Life Year Estimates From The Global Burden Of Disease Study 2017, Juanita A. Haagsma, Spencer L. James, Chris D. Castle, Zachary V. Dingels, Jack T. Fox, Erin B. Hamilton, Zichen Liu, Lydia R. Lucchesi, Nicholas L S. Roberts, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.
Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of …

Balloon Atrial Septostomy As Initial Therapy In Pediatric Pulmonary Hypertension, Paul J. Critser, Patrick D. Evers, Eimear Mcgovern, Michelle Cash, Russel Hirsch

Pediatrics Faculty Publications

Balloon atrial septostomy is a palliative procedure currently used to bridge medically refractory pulmonary hypertension patients to lung transplantation. In the current report, we present balloon atrial septostomy as an initial therapy for high-risk pediatric pulmonary hypertension patients at our institution. Nineteen patients with median age of 4.3 years (range 0.1-14.3 years) underwent balloon atrial septostomy during initial admission for pulmonary hypertension. There were no procedural complications or deaths within 24 h of balloon atrial septostomy. Patients were followed for a median of 2.6 years (interquartile range 1.0-4.8 years). Three (16%) patients died, 3 (16%) underwent lung transplantation, and 1 …

Acute Symptomatic Seizures In Critically Ill Children: Frequency, Etiology And Outcomes, Sanam B. Rajper, Mujtaba Moazzam, Arsheen Zeeshan, Qalab Abbas

Department of Paediatrics and Child Health

Background: Critically ill individuals have an increased risk of acute symptomatic seizures secondary to systemic illnesses; unrecognized or untreated seizures can quickly convert into status epilepticus, which is associated with high morbidity and mortality.
Objective: The aim of this study was to determine frequency, etiology, and outcome of seizures in critical ill children admitted in intensive care unit of a tertiary care hospital.
Materials and methods: Retrospective review of medical records of all children admitted in pediatric intensive care unit (PICU) of the Aga Khan University from January 2016 to December 2018 and who had a new-onset seizure irrespective of …

A Novel Technique For Extraction Of A Leadless Pacemaker That Embolized To The Pulmonary Artery In A Young Patient: A Case Report., Sanjaya Gupta, Ken Cho, John Papagiannis, Svjetlana Tisma-Dupanovic, John Borsa

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

A Unique Cause Of Elbow Pain And Loss Of Range Of Motion In A 13-Year-Old, Thomas Munro, Brian S. Harvey

Posters

A 13-year-old right hand dominant young lady presented to a pediatric sports medicine clinic for evaluation of decreased ROM and pain in her left elbow with an associated locking sensation that had been occurring for over a year. Two weeks prior to presentation, these symptoms had been acutely worsening as she was practicing for over 10 hours per day for an upcoming dance competition. The patient’s pain is described as a “tightness” and is localized to her antecubital fossa medial to her biceps tendon. The feeling of tightness occurs most prominently with end extension and flexion of the elbow. She …

Measures Of Pediatric Function And Physical Activity In Arthritis, Anna E. Greer, Maura D. Iversen

Exercise Science Faculty Publications

Physical function can be assessed through physical examination with the use of performance-based measures and patient-reported outcome measures (PROMs). Each form of assessment provides a unique contribution to the understanding of the impact of rheumatologic conditions on the patient. PROMs of physical function (PF) are an important component of the assessment of children with arthritis and have been included in the recommended core set of measures for childhood arthritis and musculoskeletal conditions. These measures provide the child’s or parent’s perspective of function within the context of daily living. Measures of PF include both generic measures, which are designed for use …

Serially Assessed Bisphenol A And Phthalate Exposure And Association With Kidney Function In Children With Chronic Kidney Disease In The Us And Canada: A Longitudinal Cohort Study., Melanie H. Jacobson, Yinxiang Wu, Mengling Liu, Teresa M. Attina, Mrudula Naidu, Rajendiran Karthikraj, Kurunthachalam Kannan, Bradley A. Warady, Susan Furth, Suzanne Vento, Howard Trachtman, Leonardo Trasande

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Exposure to environmental chemicals may be a modifiable risk factor for progression of chronic kidney disease (CKD). The purpose of this study was to examine the impact of serially assessed exposure to bisphenol A (BPA) and phthalates on measures of kidney function, tubular injury, and oxidative stress over time in a cohort of children with CKD.

METHODS AND FINDINGS: Samples were collected between 2005 and 2015 from 618 children and adolescents enrolled in the Chronic Kidney Disease in Children study, an observational cohort study of pediatric CKD patients from the US and Canada. Most study participants were male (63.8%) …

Sirolimus For Kaposiform Hemangioendothelioma And Kasabach-Merritt Phenomenon In A Neonate, Trevor B Cabrera, Allison L Speer, Matthew R Greives, Donna A Goff, Neethu M Menon, Eric W Reynolds

Faculty, Staff and Student Publications

We present a case of a neonate born with kaposiform hemangioendothelioma (KHE), complicated by Kasabach-Merritt phenomenon (KMP) and other serious conditions, who was successfully treated with sirolimus. In addition to complications from thrombocytopenia and fluid overload, during the course of therapy, our patient experienced supratherapeutic drug levels at the commonly accepted starting dose of sirolimus. Patients with KHE and KMP should be closely monitored for potential complications of both the initial disease and unexpected side effects of treatments.

Ultrasound-Guided Peripheral Vascular Catheterization In Pediatric Patients: A Narrative Review, Yoshinobu Nakayama, Jun Takeshita, Yasufumi Nakajima, Nobuaki Shime

Publications and Research

Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this …

Race, Ethnicity, And Insurance: The Association With Opioid Use In A Pediatric Hospital Setting, Louis Ehwerhemuepha, Candice D. Donaldson, Zeev N. Kain, Vivian Luong, Michelle A. Fortier, William Feaster, Michael Weiss, Daniel Tomaszewski, Sun Yang, Michael Phan, Brooke N. Jenkins

Psychology Faculty Articles and Research

Background

This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting.

Methods

Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children’s hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering.

Results

There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric …

Ontogeny Related Changes In The Pediatric Liver Metabolome., Christopher M. Wilson, Qian Li, R Gaedigk, Chengpeng Bi, Saskia N. De Wildt, J Steven Leeder, Brooke L. Fridley

Manuscripts, Articles, Book Chapters and Other Papers

Background: A major challenge in implementing personalized medicine in pediatrics is identifying appropriate drug dosages for children. The majority of drug dosing studies have been based on adult populations, often with modification of the dosing for children based on size and weight. However, the growth and development experienced by children between birth and adulthood represents a dynamically changing biological system, with implications for effective drug dosing, efficacy as well as potential drug toxicity. The purpose of this study was to apply a metabolomics approach to gain preliminary insights into the ontogeny of liver function from newborn to adolescent.

Methods: Metabolites …

Differences In Adolescent Activity And Dietary Behaviors Across Home, School, And Other Locations Warrant Location-Specific Intervention Approaches., Adrian Ortega, Carolina M. Bejarano, Christopher C. Cushing, Vincent S. Staggs, Amy Papa, Chelsea Steel, Robin P. Shook, Debra K. Sullivan, Sarah C. Couch, Terry L. Conway, Brian E. Saelens, Karen Glanz, Lawrence D. Frank, Kelli L. Cain, Jacqueline Kerr, Jasper Schipperijn, James F Sallis, Jordan A. Carlson

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Investigation of physical activity and dietary behaviors across locations can inform "setting-specific" health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in young adolescents.

METHODS: Participants were adolescents aged 12-16 years from the Baltimore-Washington, DC and the Seattle areas from a larger cross-sectional study. Participants (n = 472) wore an accelerometer and Global Positioning Systems (GPS) tracker (Mean days = 5.12, SD = 1.62) to collect location-based physical activity and sedentary data. Participants (n = 789) completed 24-h …

Instituting Robotic Pediatric Urologic Surgery In The Canadian Healthcare System: Evaluating The Feasibility And Outcomes Of Robot-Assisted Pyeloplasty And Ureteric Reimplantation, Noah Stern, Peter Wang, Sumit Dave

Paediatrics Publications

Introduction: Robotic pediatric urologic surgery has gained widespread adoption over the last decade. This article describes our experience in instituting the first pediatric urologic robotic surgery program in Canada. We evaluated the feasibility and safety of instituting pediatric robot-assisted urologic surgery and report our early outcomes for robot-assisted pyeloplasty (RAP) and ureteric reimplantation (RUR). Methods: We prospectively evaluated all patients undergoing RAP and RUR by a single surgeon from June 2013 to March 2019. Demographic and clinical data were prospectively collected and included sex, age, and preoperative grade of hydronephrosis or reflux. Descriptive statistics were performed, and comparisons were made …

Malnutrition And Food Insecurity In Child Labourers In Sindh, Pakistan: A Cross-Sectional Study, Meesha Iqbal, Zafar Fatmi, Kausar S. Khan, Yusra Jumani, Neelma Amjad, Asaad Ahmed Nafees

Community Health Sciences

Background: Child labour is common in low- and middle-income countries. Although child labour is widespread in Pakistan, no data are available on the health of child labourers.
Aims: This study aimed to assess the food security, food intake and nutritional status of child labourers aged 5-14 years working in lower Sindh, Pakistan.
Methods: Child labourers aged 5-14 years working in agriculture, manufacturing industry, hotels and restaurants, domestic work and migrant child labourers working in vegetable markets were recruited using a respondent-driven sampling technique. Sociodemographic and nutrition information was obtained by an interviewer questionnaire. The children's height and weight were measured …

Intratumoral Translocation Positive Heterogeneity In Pediatric Alveolar Rhabdomyosarcoma Tumors Correlates To Patient Survival Prognosis, Katrina Gleditsch, Jorge Peñas, Danielle Mercer, Ayesha Umrigar, James Briscoe, Matthew Stark, Fern Tsien, Andrew D. Hollenbach

School of Medicine Faculty Publications

Alveolar rhabdomyosarcoma (ARMS) is characterized by one of three translocation states: t(2;13) (q35;q14) producing PAX3-FOXO1, t(1;13) (p36;q14) producing PAX7-FOXO1, or translocation-negative. Tumors with t(2;13) are associated with greater disease severity and mortality than t(1;13) positive or translocation negative patients. Consistent with this fact, previous work concluded that a molecular analysis of RMS translocation status is essential for the accurate determination of prognosis and diagnosis. However, despite this knowledge, most diagnoses rely on histology and in some cases utilize fluorescence in situ hybridization (FISH) probes unable to differentiate between translocation products. Along these same lines, diagnostic RT-PCR analysis, which can differentiate …

Characterization Of The Intraarticular Cytokine Response In Children With Septic Arthritis, Walter Dehority, Kathryn Helmig, Scott Plaster, Nathan Huff, Andrew Parsons, Selina Silva

2020 Pediatric Research Forum Session

Background:

Acute septic arthritis (ASA) is the most common pediatric orthopaedic infection, and may be associated with severe sequelae. An improved understanding of the intra-articular inflammatory response in ASA may facilitate the use of immunomodulatory agents to attenuate the deleterious effects of the host immunological response on synovial tissue, help monitor disease progression and differentiate ASA from non-infectious arthritides. To our knowledge, no study has characterized the intra-articular cytokine response in children with ASA in detail. Given this, we attempted to validate a multi-plex cytokine assay for use in the blood and synovial fluid of children with ASA.

Methods:

Twelve …

Effects Of Race/Ethnicity On Appendicitis Pain Management, Alfonso Belmonte, Christal Chow, Maria Heubeck, Deirdre Hill, Harry Snow

2020 Pediatric Research Forum Session

Background:

Race is a well-researched factor that contributes to variation in care of multiple diagnoses such as asthma, antibiotic prescribing, and pain control. This is also true for appendicitis. As the 6th most common cause for inpatient stay, it costs on average of $7,800 per patient. Despite efforts to standardize care, race and ethnicity continue to play a role in treatment and outcomes on pediatric appendicitis.

We hope to further explore the effects that race/ethnicity have in medical care, diagnosis and complications of acute pediatric appendicitis. We hope that identifying these effects will help providers to actively address race/ethnic health …

Cinematic Portrayal Of Infectious Disease Outbreaks, Walter Dehority

2020 Pediatric Research Forum Session

Background:

Movies are a shared cultural experience. Films likely reflect societal fears, and may provide insight into how the public perceives infectious disease outbreaks.

Methods:

A search of IMDb.com was conducted in February/March 2020 (updating a 2017 search) using 163 infection-related search terms to identify films with an emphasis on infectious diseases (as assessed by review of plot synopses on IMDb, the American Film Institute database, or Wikipedia) through December 31, 2019. Films featuring an outbreak or pandemic (as defined by the CDC, with the outbreak/pandemic required to be an important component of the story) were then selected. Cultural relevance …

Pathogen-Specific Neurocognitive Outcomes In Tropical Childhood Encephalitis, Christal Chow, Ashan Jayawickrama, Jithangi Wanigasinghe, Piyadasa Kodituwakku, Kurt Schwalm, Darrell Dinwiddie, John Phillips, Walter Dehority

2020 Pediatric Research Forum Session

Background:

Childhood encephalitis causes long-term neurocognitive disability, which may lead to secondary disabilities such as poor academic achievement and social isolation. This is particularly problematic in resource limited, tropical countries, where the burden of vector-borne viral encephalitis is substantial, yet the resources for identifying the myriad of pathogens involved and characterizing the resulting neurocognitive sequelae are limited. To our knowledge, comprehensive assessments of neurocognitive function following tropical childhood encephalitis have not been performed. We hypothesize that the risk of neurocognitive sequelae is pathogen-specific, and that the use of portable, on-site metagenomic Next Generation Sequencing of CSF in Sri Lankan children …

Ambivalence In How To Address Adolescent Marijuana Use Among School-Based Health Center Providers, Rachel A. Sebastian, Lara M. Gunderson, Cathleen E. Willging, Mary M. Ramos

2020 Pediatric Research Forum Session

Objective:

As part of a larger study to evaluate the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) at school-based health centers (SBHCs), we interviewed SBHC providers regarding their perceptions of substance use among adolescents seen at their SBHCs, experiences providing care for students with substance use and other mental health issues, and their concerns around marijuana specifically.

Methods:

We interviewed 12 primary and behavioral health providers who worked at five SBHCs in New Mexico. The interviews lasted approximately 1 hour and were digitally recorded and professionally transcribed. Two research team members independently analyzed the transcripts. We undertook …

An Institutional Experience With Emicizumab In Pediatric Patients With Heophilia A, Shirley Abraham, Lisa Jung, Janet Ratte, Valerie Lowe

2020 Pediatric Research Forum Session

Background: Emicizumab is a recombinant, humanized, bispecific monoclonal antibody that substitutes for the function of FVIII by binding to activated factor IX and X. It is currently indicated for routine prophylaxis in adults and children of all ages with hemophilia A, with or without inhibitors. Despite basic guidelines provided by MASAC and the drug package insert, there is significant inter-institutional variability regarding monitoring and follow up in patients on emicizumab.

Objective: To outline our institutional experience in pediatric patients on emicizumab.

Method: Retrospective and prospective chart review of our patients on emicizumab. Information collected included age of patient, hemophilia severity, …

Increased Incidence Of Asthma In Children With Prenatal Opioid Exposure, Isabella Cervantes, Shikhar Shrestha, Sharon Ruyak, Jessie R. Maxwell

2020 Pediatric Research Forum Session

Prenatal opioid exposure (POE) has increased dramatically in the last 10 years, with nearly 100 babies born daily in the United States with Neonatal Opioid Withdrawal Syndrome (NOWS). The impact on long-term outcomes continues to be investigated. Given the proinflammatory state that results from POE, we hypothesized that infants with POE or NOWS diagnoses during the newborn hospitalization would have an altered immune reactivity that persisted into childhood, defined by asthma diagnosis within the first 8 years.

A retrospective cohort design utilizing a comprehensive CERNER HealthFacts U.S. national database was completed, which accesses clinical data from 800 hospitals across the …

A Technical Assistance Model To Facilitate Use Of The School Health Index To Assess Chronic Health Condition Management In Schools, Grace L. Mccauley, Sarah Sanders, Anne Marlow-Geter, Elizabeth Yakes Jimenez

2020 Pediatric Research Forum Session

Introduction:

Chronic health conditions, such as asthma and food allergies, affect a substantial proportion of school-aged children in New Mexico (NM). School health services, policies, programs, and practices can affect daily management of chronic pediatric health conditions. The Center for Disease Control and Prevention’s School Health Index (SHI) is a self-assessment and planning guide that evaluates school services, policies, and programs for promoting health and safety. Our aim was to determine if a technical assistance (TA) model could effectively support school districts in using the SHI to complete a chronic disease needs assessment (CDNA).

Methods:

Seven public and one charter …

Comparison Of Virulence Gene Carriage In Staphylococcus Aureus Isolates Colonizing Human Skin And Those Associated With Soft Tissue Osteoarticular Infections, Kylie Disch, Jon Femling, Parisa Mortaji, Kurt Schwalm, Aimee Yousey, Rebekkah Varjabedian, Darrell Dinwiddie, Walter Dehority

2020 Pediatric Research Forum Session

Background:

Osteoarticular infections (OAI), most commonly caused by S. aureus, cause extreme morbidity in children and may result in permanent sequelae (e.g. limb-length discrepancies). However, S. aureus is also a common colonizing bacteria of skin and a cause of soft tissue abscesses. Virulence determinants for S. aureus are likely complex, and may include the genetic composition of the isolate, the host immune response and the transcriptomic profile of the organism. A necessary first-step in characterizing these virulence factors includes assessing virulence gene carriage between S. aureus isolates from children with OAIs and from less virulent isolates.

Methods:

S. aureus …

Baseline Results From The Strategic Implementation Of Screening, Brief Intervention And Referral To Treatment (Sbirt) In School‐Based Health Centers Initiative, Grace Mccauley, Timothy Ozechowski, Julia Martinez, Elizabeth Yakes Jimenez, Mary M. Ramos

2020 Pediatric Research Forum Session

Introduction:

The rates of substance use among teens in NM are among the highest in the US. Regular use of illicit drugs during adolescence can compromise mental and physical health and contribute to poorer longer-term outcomes. The Strategic Implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT) in School‐Based Health Centers (SBHCs) [SISS] initiative implements and evaluates the SBIRT model, with a goal of identifying, reducing, and preventing substance use in New Mexico (NM) adolescents. For this analysis, we describe baseline data on the provision of SBIRT to adolescents at‐risk for substance abuse.

Methods:

From October to December 2019, …

The Window Ductus, A Rare Finding, And The Importance Of Perinatal Echocardiography, Storm Dorrough, Gavin Mccullough, Michelle Grenier

2020 Pediatric Research Forum Session

Category: Case Report

We present a case of an unusual form of the ductus arteriosus termed “window ductus,” and highlight the importance of early recognition echocardiogram. The patient presented as a 22 week fetus due to advanced maternal age, maternal cardiomyopathy, and an abnormal 4-chamber view on the fetal anatomy ultrasound. Fetal images were consistent with polyvalvular disease with redundancy of the mitral, tricuspid and aortic valves. There was an extremely abnormal pulmonic valve that was thickened, stenotic, and regurgitant due to relative immobility of the cusps, creating a narrow, tunnel-like orifice and post-stenotic dilated main pulmonary artery. The right …

Prenatal Alcohol Exposure And Placental Insufficiency Results In Reduced Neuronal Complexity In The Rat Prefrontal Cortex, Nathaniel Pavlik, Jessie Newville, Clement P. Jose, Suzy Davies, Jennifer Wagner, Jonathan Brigman, Daniel Savage, Jessie R. Maxwell

2020 Pediatric Research Forum Session

Prenatal Alcohol Exposure (PAE) can produce long-term neurodevelopmental deficits and impaired executive function. Alcohol exposure during gestation is associated with impaired fetal development caused by placental insufficiency. The impact following PAE and placental insufficiency (PI) remains unknown. Utilizing a three-dimensional (3D) Sholl analysis, we hypothesized that PAE+PI will result in decreased neuronal complexity within the frontal cortex, a region critical to executive functioning.

Pregnant Long-Evans rats voluntarily drank 5% ethanol or saccharin water until embryonic day 18 (E18) to mimic moderate PAE. On E19, a laparotomy was performed to occlude the uterine artery for 60 minutes to induce PI. The …

Ocho Pasos: A Quality Improvement Pilot To Improve Outpatient Clinic Breastfeeding Support, Julia M. Martinez, Timothy J. Ozechowski, Rachel A. Sebastian, Emilie A. Sebesta, Mary M. Ramos

2020 Pediatric Research Forum Session

Purpose of Study:

Only a third of US mothers achieve three months of exclusive breastfeeding (BF) despite the American Academy of Pediatrics (AAP) recommendation to exclusively BF for six months. National experts have recently published evidence-based guidelines for outpatient clinics to support longer durations of BF. Our pilot study sought to evaluate the feasibility of an intervention to improve support for BF in outpatient primary care clinics.

Methods Used:

We compared evidence-based BF-friendly guidelines from the AAP, Academy of Breastfeeding Medicine, California’s 9 Steps, and Washington’s 10 Steps to create Ocho Pasos (Eight Steps),guidelines tailored to the New Mexico population. …