Medical Specialties Commons^™

Philippines: An Int-Erupted Experience, Susamita Kesh

Posters

Describes her experience working in the NICU of the Fabella Memorial Hospital in Philippines.

Fit Clinical Decision-Making: Uhl's Anomaly: An Uncommon Cause Of Fetal Cardiomegaly, Bethany Runkel, Atif Ahmed, Tara Swanson, Maria Kiaffas

Posters

No abstract provided.

Association Of Genetic Risks With Autism Spectrum Disorder And Early Neurodevelopmental Delays Among Children Without Intellectual Disability, Nagahide Takahashi, Taeko Harada, Tomoko Nishimura, Akemi Okamura, Damee Choi, Toshiki Iwabuchi, Hitoshi Kuwabara, Shu Takagai, Yoko Nomura, Nori Takei, Kenji J. Tsuchiya

Publications and Research

IMPORTANCE Autism spectrum disorder (ASD) is highly heritable, and modest contributions of common genetic variants to ASD have been reported. However, the association of genetic risks derived from common risk variants with ASD traits in children from the general population is not clear, and the association of these genetic risks with neurodevelopment in infants has not been well understood.

OBJECTIVE To test whether a polygenic risk score (PRS) for ASD is associated with neurodevelopmental progress at age 18 months and ASD traits at age 6 years among children from the general population.

DESIGN, SETTING, AND PARTICIPANTS In this cohort study, …

Comparing Open And Fetoscopic Fetal Surgical Repairs Of Myelomeningocele, Kyra Isaacs

Capstone Showcase

Introduction: There have been great advances in the treatment of myelomeningocele (MMC) spina bifida in the past 20 years. An open surgical repair in-utero has been shown to reduce mortality and morbidity, specifically decreasing the rate of shunt placement and hindbrain herniation compared to a postnatal surgical approach. However, this surgery introduced risks to the mother that were never a consideration in previous surgical approaches.

Methods: This paper compares research on new minimally invasive fetoscopic surgical techniques to open fetal surgery in the prenatal repair of MMC. Searches in PubMed and Clinical Key were conducted to produce papers published on …

Efficacy Of Adjunct Acupuncture (Insertive And Non-Insertive) In The Treatment Of Neonates With Neonatal Abstinence Syndrome, Kali Thibault

Capstone Showcase

Introduction: Neonatal Abstinence Syndrome (NAS) is a condition that affects newborn infants exposed to opioids in utero. NAS is becoming increasingly more prevalent due to the ongoing opioid epidemic. Current treatment for NAS is primarily morphine or buprenorphine. Even on these treatments, infants with NAS often still have symptoms of withdrawal, requiring high doses of medication and extended hospital stays. Acupuncture therapy has been shown to decrease withdrawal symptoms in adults, so researchers are now looking to use this non-pharmacological treatment on infants with NAS.

Methods: A literature search was performed using Google Scholar, PubMed, and EBSCOhost in November of …

Hypomorphic Si Genetic Variants Are Associated With Childhood Chronic Loose Stools., Bruno P Chumpitazi, Jeffery Lewis, Derick Cooper, Mauro D'Amato, Joel Lim, Sandeep Gupta, Adrian Miranda, Natalie Terry, Devendra Mehta, Ann Scheimann, Molly O'Gorman, Neelesh Tipnis, Yinka Davies, Joel Friedlander, Heather Smith, Jaya Punati, Julie Khlevner, Mala Setty, Carlo Di Lorenzo

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The SI gene encodes the sucrase-isomaltase enzyme, a disaccharidase expressed in the intestinal brush border. Hypomorphic SI variants cause recessive congenital sucrase-isomaltase deficiency (CSID) and related gastrointestinal (GI) symptoms. Among children presenting with chronic, idiopathic loose stools, we assessed the prevalence of CSID-associated SI variants relative to the general population and the relative GI symptom burden associated with SI genotype within the study population.

METHODS: A prospective study conducted at 18 centers enrolled 308 non-Hispanic white children ≤18 years old who were experiencing chronic, idiopathic, loose stools at least once per week for >4 weeks. Data on demographics, GI …

The Contribution Of Frequency Discrimination Ability To Auditory Temporal Patterning Tests In Children, Ashley G. Flagge, Tara M. Davis, Victoria Henbest

Ashley Flagge Publications

Purpose: The Pitch Patterns Test (PPT) and Duration Patterns Test (DPT) are clinical auditory processing tests that evaluate temporal patterning skills based on pitch (PPT) or duration (DPT) aspects of sound. Although temporal patterning tests are categorized under the temporal processing domain, successful performance on the PPT also relies on accurate pitch discrimination. However, the relationship between pitch discrimination ability and temporal patterning skills have not been thoroughly evaluated. This study examined the contribution of pitch discrimination ability to performance on temporal patterning in children through the use of a pitch discrimination task and the PPT …

An Unexpected Global Health Experience In Manila, Susan Mcanany

Posters

Describes her experience in the NICU of the Fabella Memorial Hospital in Manila, Philippines.

Global Health Elective In Santiago Atitlan, Guatemala, Sarah Greenberg

Posters

Describes her experience working in Hospitalito Atitlan in Santiago Atitlan, Guatemala.

Fit Clinical Decision-Making Unusual Echocardiographic Findings Of Myocarditis Mimicking An Aortic Runoff Lesion, Sarah Studyvin, Christine Symes, Barbara A. Pahud, Nitin Madan

Posters

No abstract provided.

Neonatal Abstinence Syndrome: Effectiveness Of Targeted Umbilical Cord Drug Screening In Determining Risk Of Withdrawal, Alecia Karr

DNP Projects

Neonatal Abstinence Syndrome (NAS) is a condition in which an infant experiences withdrawal from uterine exposure to various substances such as caffeine, nicotine, amphetamines, THC, opioids, benzodiazepines, and other types of substances. Depending on the severity of the symptoms, these infants may experience a longer hospital stay and may need treatment and monitoring in the neonatal intensive care unit (NICU), resulting in an increase in healthcare costs. The objective of this project was to determine if targeted drug screening of newborns was effective in determining infants at risk of NAS based on a positive screening result. This study utilized a …

The Effect Of A Virtual Child Passenger Safety Educational Intervention On Uk Pediatric Residents' Self-Reported Knowledge, Confidence, And Anticipatory Guidance Beliefs, Brooklyn Johnson

DNP Projects

Background: Motor vehicle crashes are the leading cause of death in children. Car safety seats (CSS), when used properly, have been proven to reduce injuries and deaths in children during motor vehicle accidents. The leading cause of car seat misuse is parental lack of knowledge about proper car seat use and best practice recommendations. Studies have shown that pediatric primary care providers have variable knowledge of the most updated car safety seat recommendations and are not consistently educating parents about child passenger safety during well child checks.

Objective: To evaluate UK pediatric residents' self-reported knowledge, confidence, and anticipatory guidance beliefs …

Effects Of Neonatal Abstinence Syndrome On Long-Term Growth Parameters, Ayoung Kim, Anastasiya Latushko, Md, Zubair H. Aghai, Md

Phase 1

Introduction: Past studies have shown that babies with Neonatal Abstinence Syndrome (NAS) have lower weight, head circumference, and height at birth. This study aims to compare their growth at 9 and 18 months of age, and to compare growth parameter of NAS infants below 10th percentile to those above 10th percentile at birth.

Methods: In this retrospective review, 260 infants admitted to Jefferson Neonatal Intensive Care Unit between 2006 and 2018 were included. The weight, height, and head circumference at birth, 9 months, and 18 months were collected and correlated by Pearson correlation. The growth parameters of infants below …

Impact Of Smartphone Usage On Children’S Horizontal Fusional Amplitudes, Jordan Hamburger, Judith Lavrich, Md, Kammi Gunton, Md

Phase 1

Introduction: Cell phone usage has increased in pediatric patients and little research has been done on its effects on patients’ fusional vergence amplitudes. We aim to study the impact of smartphone usage on healthy pediatric patients’ fusional vergence amplitudes and report findings that may lead to future eye problems.

Methods: This is a prospective randomized study. We are currently recruiting healthy patients between the ages of 8-17 years old with no ocular problems. Data collected include refractive error, ocular alignment in the distance and at near, divergence amplitudes at near and in distance, convergence amplitudes at near and in distance, …

Vaccination Exemptions For School-Aged Children In Delaware, Anna Melnick, Mph, Meghan Gannon, Phd

Phase 1

Background: Current awareness around childhood vaccinations and associated requirements for school entry has been heightened both nationally and internationally as governments work to find a balance between protecting their residents’ health and personal freedoms. Scant research exists examining the characteristics of these vaccine exemptors, but as the percentage of students seeking these exemptions increases yearly, this yields an opportunity to identify trends and inform future policy.

Question: What are the associations between reason for exemption from mandated vaccinations and the demographics of race and gender for school-aged children in the state of Delaware?

Results: Drawing from school nurse vaccine exemption …

Brain Development: Why The Young Sleep Longer, Budhaditya Chowdhury, Orie T. Shafer

Advanced Science Research Center

From absorbing new languages to mastering musical instruments, young children are wired to learn in ways that adults are not (Johnson and Newport, 1989). This ability coincides with periods of intense brain plasticity during which neurons can easily remodel their connections (Hubel and Wiesel, 1970). Many children are also scandalously good sleepers, typically getting several more hours of sleep per night than their parents (Jenni and Carskadon, 2007). As sleep deprivation has negative effects on learning and memory, learning like a child likely requires sleeping like one (Diekelmann and Born, 2010). Yet, how the ability to sleep for longer is …

Be A Hero Too, Samantha S. Rohe, Sophie Cemaj

Books: Pediatrics

This children's book explains COVID-19 and how to decrease the incidence of transmissions.

Sustaining Successful Efforts To Increase Home Visiting Referrals Thornburg Early Childhood Education Grant 2020 Summary Report, Theresa H. Cruz, Ivy Vitanzos Cervantes, Leona K. Woelk

Reports & Documents

No abstract provided.

Burden Of Rare Deleterious Variants In Wnt Signaling Genes Among 511 Myelomeningocele Patients, Luke Hebert, Paul Hillman, Craig Baker, Michael Brown, Allison Ashley-Koch, James E Hixson, Alanna C Morrison, Hope Northrup, Kit Sing Au

Faculty, Staff and Student Publications

Genes in the noncanonical WNT signaling pathway controlling planar cell polarity have been linked to the neural tube defect myelomeningocele. We hypothesized that some genes in the WNT signaling network have a higher mutational burden in myelomeningocele subjects than in reference subjects in gnomAD. Exome sequencing data from 511 myelomeningocele subjects was obtained in-house and data from 29,940 ethnically matched subjects was provided by version 2 of the publicly available Genome Aggregation Database. To compare mutational burden, we collapsed rare deleterious variants across each of 523 human WNT signaling genes in case and reference populations. Ten WNT signaling genes were …

Pediatric Immunization Practices In Nephrotic Syndrome: An Assessment Of Provider And Parental Knowledge, Cheryl L Tran, David T Selewski, Gia J Oh, Jonathan P Troost, Susan F Massengill, Samhar I Al-Akash, Shefali Mahesh, Rasheda Amin, Isa F Ashoor, Rahul Chanchlani, Mahmoud Kallash, Robert P Woroniecki, Debbie S Gipson

Faculty, Staff and Student Publications

Background: Children with nephrotic syndrome (NS) are at high risk for vaccine-preventable infections due to the immunological effects from the disease and concurrent treatment with immunosuppressive medications. Immunizations in these patients may be deferred due to their immunosuppressive treatment which may increase the risk for vaccine-preventable infections. Immunization practices in children with NS continue to vary among pediatric nephrologists. This raises the question of whether children with NS are receiving the recommended vaccinations at appropriate times. Therefore, it is critical to understand the practices and patient education provided by physicians to patients on the topic of vaccinations.

Methods: After informed …

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …

Deep Learning For Improved Risk Prediction In Surgical Outcomes, Ali Jalali, Hannah Lonsdale, Nhue Do, Jacquelin Peck, Monesha Gupta, Shelby Kutty, Sharon R Ghazarian, Jeffrey P. Jacobs, Mohamed Rehman, Luis M. Ahumada

Journal Articles: Pediatrics

The Norwood surgical procedure restores functional systemic circulation in neonatal patients with single ventricle congenital heart defects, but this complex procedure carries a high mortality rate. In this study we address the need to provide an accurate patient specific risk prediction for one-year postoperative mortality or cardiac transplantation and prolonged length of hospital stay with the purpose of assisting clinicians and patients' families in the preoperative decision making process. Currently available risk prediction models either do not provide patient specific risk factors or only predict in-hospital mortality rates. We apply machine learning models to predict and calculate individual patient risk …

Omega-3 Long-Chain Polyunsaturated Fatty Acids Intake By Ethnicity, Income, And Education Level In The United States: Nhanes 2003-201414., Caleb A. Cave, Nicholas Hein, Lynette M. Smith, Ann Anderson-Berry, Chesney K. Richter, Karl Stessy M. Bisselou, Adams Kusi Appiah, Penny Kris-Etherton, Ann C. Skulas-Ray, Maranda Thompson, Tara M. Nordgren, Corrine K. Hanson, Melissa K. Thoene

Journal Articles: Pediatrics

Although there are many recognized health benefits for the consumption of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPUFA), intake in the United States remains below recommended amounts. This analysis was designed to provide an updated assessment of fish and n-3 LCPUFA intake (eicosapentaenoic (EPA), docosahexaenoic acid (DHA), and EPA+DHA) in the United States adult population, based on education, income, and race/ethnicity, using data from the 2003-2014 National Health and Nutrition Examination Survey (NHANES) (n = 44,585). Over this survey period, participants with less education and lower income had significantly lower n-3 LCPUFA intakes and fish intakes (p < 0.001 for all between group comparisons). N-3 LCPUFA intake differed significantly according to ethnicity (p < 0.001), with the highest intake of n-3 LCPUFA and fish in individuals in the "Other" category (including Asian Americans). Supplement use increased EPA + DHA intake, but only 7.4% of individuals consistently took supplements. Overall, n-3 LCPUFA intake in this study population was low, but our findings indicate that individuals with lower educational attainment and income are at even higher risk of lower n-3 LCPUFA and fish intake.

Williams Syndrome And Neonatal Cardiac Surgery For Congenital Single Ventricle, Taylor E. Katt, Robert L. Spicer, Anji T. Yetman, Ali N. Ibrahimiye, James M. Hammel, Jeffrey A. Robinson

Journal Articles: Pediatrics

Williams syndrome (WS) is an arteriopathic derangement associated with supravalvular aortic stenosis and branch pulmonary stenosis. We describe double-outlet right ventricle with mitral atresia and aortic arch hypoplasia in an infant with WS. This case demonstrates the difficulty in managing patients with WS with complex cardiac defects. To our knowledge, this is the first reported single-ventricle physiology in a patient with WS. (Level of Difficulty: Advanced.).

Utilization Of A Continuous Pericapsular Nerve Group (Peng) Block With An Opioid-Sparing Repair Of A Femoral Neck Fracture In A Pediatric Patient, Karla Wyatt, Moustafa Zidane, Chyong-Jy Joyce Liu

Faculty, Staff and Students Publications

In the pediatric population, femoral neck fractures are usually associated with high-impact trauma and often present with pain in the groin area. Regional anesthesia can offer adjunctive therapy for acute pain management. Various techniques have been employed to circumvent pain related to hip fractures and resultant hip surgery. Neuraxial, lumbar plexus, caudal, epidural, fascia iliaca, and femoral continuous nerve block techniques are advantageous in mitigating hip pain. However, these approaches require patient repositioning during placement and carry the potential for motor blockade with resultant weakness. A newly described method, the Pericapsular Nerve Group (PENG) block, allows for analgesia of the …

Incidence Of Initial Renal Replacement Therapy Over The Course Of Kidney Disease In Children., Derek K. Ng, Matthew B. Matheson, Bradley A. Warady, Susan R. Mendley, Susan L. Furth, Alvaro Muñoz

Manuscripts, Articles, Book Chapters and Other Papers

The Chronic Kidney Disease in Children Study, a prospective cohort study with data collected from 2003 to 2018, provided the first opportunity to characterize the incidence of renal replacement therapy (RRT) initiation over the life course of pediatric kidney diseases. In the current analysis, parametric generalized gamma models were fitted and extrapolated for RRT overall and by specific treatment modality (dialysis or preemptive kidney transplant). Children were stratified by type of diagnosis: nonglomerular (mostly congenital; n = 650), glomerular-hemolytic uremic syndrome (HUS; n = 49), or glomerular-non-HUS (heterogeneous childhood onset; n = 216). Estimated durations of time to RRT after …

Clinical Characteristics Of Children With Epilepsy Managed At An Urban Hospital In Africa: A Retrospective Study, Pauline Samia, Arwen Barr, Subira B. Levi, Kirsten A. Donald, Jo M. Wilmshurst, Charles R. Newton

Paediatrics and Child Health, East Africa

Background: Most children with epilepsy reside in resource-limited regions such as sub-Saharan Africa, where the majority of studies have been conducted in rural areas with limited investigations. Medical records from children with epilepsy seen at an urban hospital in Kenya were examined to provide a comprehensive description of epilepsy in children from this hospital.
Methods: A retrospective observational study was conducted which involved reviewing medical records of 426 epilepsy patients (260 males and 166 females) aged 0 - 18 years, seen in Nairobi, Kenya between February 2011 and December 2014. Results: The most frequent age at presentation; documented in 29% …

Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston

Student Capstone Papers

Telehealth; also known as telerehabilitation, telecare, telemedicine, teletherapy, and telepractice; is an emerging healthcare service that is utilized in various healthcare facilities with a span of ages, conditions, and locations (World Federation of Occupational Therapy [WFOT], 2014). Telehealth utilizes information and communication technologies to deliver services to a patient when the healthcare provider is not in the same location (WFOT, 2014). Telehealth can provide an online platform for evaluations, consultations, monitoring, supervision, and intervention with patients and other professionals (WFOT, 2014).

Telehealth is an emerging method of delivering occupational therapy (OT) services to various populations, including: children and youth; productive …

Anticipation, Accompaniment, And A Good Death In Perinatal Care., Bryanna S. Moore, Brian S. Carter, Bryan Beaven, Katie House, Joel House

Manuscripts, Articles, Book Chapters and Other Papers

The ethics of perinatal care, and the experiences of families who receive such care, remains a nascent area of inquiry. It can be hard to see how existing "good death" constructs apply to the experiences of fetal patients and their families. In this paper, we explore two themes raised by a case at our fetal health center: anticipation and accompaniment. In this case, a mother presented to our fetal health center; her unborn son, our fetal patient, was diagnosed with life-threatening hypoplastic left heart syndrome and endocardial fibroelastosis. The parents were told that their son's life expectancy, upon birth, was …

Children’S Cancer Pain In A World Of The Opioid Epidemic: Challenges And Opportunities, Michelle Fortier, Sun Yang, Michael T. Phan, Daniel Tomaszewski, Brooke N. Jenkins, Zeev N. Kain

Psychology Faculty Articles and Research

The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first‐line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.