Medical Specialties Commons^™

Cvst As A Rare Complication Of Acute Pediatric Covid-19, Erin Bolen

Research Days

Background: A previously healthy 13-year-old male was admitted to the hospital for a bacterial superinfection in the setting of recent COVID-19, including orbital cellulitis and pansinusitis with subgaleal, epidural, and subdural empyema. Further workup identified an occult, non-occlusive cerebral venous sinus thrombosis (CVST) along the length of the superior sagittal sinus.

Objectives/Goal: To evaluate the reported cases of CVST as a potential complication of COVID-19 in the pediatric population and identify meaningful trends in demographics, presentation, and diagnostic course.

Methods/Design: A literature search was run with various combinations of the following terms, always including “COVID”: “pediatric,” “adolescent,” “CVST,” “cerebral venous …

Evaluation Of A Hirschsprung Disease Systemwide Enterocolitis De-Escalation Strategy, Albert Aickareth

Research Days

Problem Statement/Question: Components of systems that identify, treat and prevent enterocolitis are not well described. In addition, for patients with HSCR both pre and post pull-through, questions regarding a child’s clinical status occur through several different medical access points and may occur outside of colorectal center clinic hours.

Background/Project Intent (Aim Statement): Hirschsprung associated enterocolitis (HAEC) is a severe and potentially life-threatening complication of Hirschsprung Disease (HSCR) that can present with a variety of symptoms from mild abdominal pain to fulminant colitis. We evaluated our system-wide enterocolitis de-escalation strategy for both hospital staff and patient caregivers. Our primary analysis was …

Impact Of A Mental Health Screening Process In A Pediatric Ed, Bryan Stocker Do, Shobhit Jain Md, Kathryn Worland Msw, Celeste Tarantino Md, Lina Patel Md, Shayla Sullivant Md

Research Days

Background: Up to 20% of children in the United States experience a mental health disorder and suicide is the second leading cause of death among adolescents. Children presenting with mental health concerns to the Emergency Department (ED) can be challenging due to lack of access to trained professionals and long lengths of stay. Specialized teams have shown to be beneficial, but little is known about their impact in the ED.

Objectives/Goal: This study explored the impact of specialized social workers partnering with emergency medicine providers to provide care during an acute mental health crisis.

Methods/Design: We performed this work at …

X-Linked Nephrogenic Syndrome Of Inappropriate Antidiuresis Secondary To Vasopressin Receptor 2 Mutation, Erica Zarse

Research Days

Background: X-linked nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a rare cause of hyponatremia with a similar biochemical evaluation to the syndrome of inappropriate antidiuretic hormone secretion but with suppressed vasopressin (AVP) levels.

Objectives: We present a case of hyponatremia due to NSIAD.

Results: A 25-month-old male with developmental delay became unresponsive 30 minutes after falling off a couch onto a hardwood floor. He presented with tonic-clonic movements and eye deviation requiring antiepileptics. Serum laboratories noted hyponatremia (123 mmol/L), hypoosmolality (262 mOsm/kg) and hypochloremia (90 mmol/L) prompting endocrine consult. Head imaging normal. Urine dilute with specific gravity 1.004, osmolality 160 …

Covid-19: Perspectives From Youth In Detention, April Mcneill-Johnson

Research Days

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.

Objectives/Goal: To explore perspectives on the COVID-19 pandemic, effect on detention experience and the COVID vaccine among youth in detention.

Methods/Design: 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 semistructured individual interviews & used a thematic analysis …

Gastrointestinal Fibromatosis: A Case Of Successful Oral Tyrosine Kinase Inhibitor Delivery To An Infant With Proximal Duodenal Obstruction, Darius Blanding

Research Days

Background: Infantile myofibromatosis (IM) is a rare disorder characterized by the fibrous proliferation of the skin, bone, muscle, and viscera that usually presents at birth, or soon after. Although IM is a benign condition, significantly higher morbidity and mortality have been reported when the viscera is involved. This case report is of a 6-week-old female who presented with poor feeding along with subcutaneous nodules that were diagnosed as IM. Upper and lower endoscopy were performed for worsening feeding intolerance showing marked nodularity throughout the gastrointestinal (GI) tract, including partial obstruction of the proximal duodenum by biopsy-proven myofibromas, confirming visceral IM …

Subclinical Status Epilepticus In The Setting Of An Acute Covid-19 Infection, Thomas Rieth

Research Days

Background: While COVID-19 commonly presents as an upper respiratory infection, acute COVID infections has the potential to have multisystem involvement. Neurological symptoms, which have mainly been reported in adults, are rare in children and are not well recognized. Better understanding of the neurological manifestations of COVID-19 in children can lead to earlier detection of COVID-19 and help with medical decision making and treatment.

Objectives/Goal: To describe an unusual presentation of COVID-19 in a previously healthy female and explore the neurological presentations of COVID-19.

Results: A 10 year old previously healthy female presented with a 1 day history of altered mental …

Soft Palate Teratoma: 5 Month Old Presenting With Failure To Thrive And Severe Obstructive Sleep Apnea, Anna Lawrence

Research Days

Introduction: Oropharyngeal teratomas are an extremely rare congenital tumor. They are often diagnosed prenatally and can cause significant airway obstruction and feeding difficulties at birth. We present a 5-month old female that was diagnosed with a palatal teratoma that presented with failure to thrive, difficulty feeding and eventually with severe obstructive sleep apnea.

Case Description: We present a 5 month old term, otherwise healthy female who initially was breastfeeding well. After an episode of RSV at one month old she become stridulous and had difficulties with feeding. She was seen by an otolaryngologist at 3 months old who performed both …

A Case Of Fibrous Hamartoma In Term Neonate, Elizabeth Perry

Research Days

Case report abstract: Fibrous hamartoma of infancy (FHI) is a rare, benign lesion characterized as a tumor of myofibroblastic origin that has characteristic features of triphasic histology. FHI was first described in 1956 by Reye and formally named by Enzinger in 1965 (1, 2). The lesion is defined as a hamartoma due to the histologic presentation of disorganized mesenchymal, fibrous, and adipose tissue with absence of mitotic figures; this combination of derived tissue without evidence of anaplasia is diagnostic for FHI. These lesions typically arise as a single, solitary mass, are most commonly located on the extremities, trunk, sacrum, or …

Early Onset Obesity In A 4-Year-Old Female Found To Have Variants In Both The Single-Minded Homolog 1 And Sh2b Adaptor Protein 1 Genes, Erica Zarse

Research Days

No abstract provided.

Association Of Satisfaction With Treatment Decision And Failure Of Nonoperative Management Of Appendicitis In Children., Rebecca M. Rentea, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

The Burden Of Mental Health Conditions In Children With Ckd., Katherine L. Kurzinski, Darcy K. Weidemann

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Skin And Soft Tissue Infection, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Clinical Practice Guidelines)

No abstract provided.

Urinary Tract Infection-Cystitis/Pyelonephritis, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Clinical Practice Guidelines)

No abstract provided.

Toddler Tibia Fracture, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Concurrent Covid19 Pneumonia And Systemic Inflammatory Syndrome In A Two-Week-Old Requiring Ecmo, Jennie Godwin, Ayan Rajgarhia, Johanna I. Orrick, Jenna Miller, John M. Daniel Iv

Posters

Objectives: * Initially, newborns seemed to be relatively spared from severe COVID-19. However, with the emergence of the B.1.617.2 (Delta) variant hospitalization rates among children aged 0-4 years increased by 10-fold by the middle of August 2021. We present a case of a 2-week-old previously healthy preterm, twin, male infant who developed severe COVID-19 pneumonia, subsequent acute respiratory distress syndrome (ARDS), and an inflammatory syndrome requiring VA – ECMO support for 22 days. Methods: * A retrospective chart review was performed after successful weaning from ECMO. Parental permission for a case report was obtained in compliance with institutional standards. Results: …

Treatment Of Recurrent Wilms Tumor With Irinotecan/Temozolomide, Meagan Vacek, Terrie Flatt

Posters

Background: Despite improvement in relapse free survival (RFS) in recurrent Wilms tumor, the 4-year RFS rate for patients treated with vincristine/dactinomycin/doxorubicin is approximately 40%. Ifosfamide, carboplatin and etoposide are commonly used in relapsed solid tumors, but have significant toxicities and require hospital admission for administration. Our patient focused on quality of life, and this led to exploration of other treatment options. Objective: Describe a case of multiply relapsed Wilms tumor with management on oral irinotecan/temozolomide for improved quality of life and remission for almost 1 year. Design/Method: Case Report Results: The patient is an 11-year-old female diagnosed with Wilms tumor …

Memory T Cell Populations In Human Leukemia, Sara Mcelroy, Fang Tao, John Szarejko, John M. Perry

Posters

Background Incorporating the immune system into cancer management is an area of robust research. Treatment modalities aimed at activating cytotoxic T cells against malignancies include immune checkpoint inhibitors, bispecific T-cell engagers, and chimeric antigen receptor (CAR) tumor-specific T cells. Most anti-cancer T cell research is narrowly focused, but knowledge about the nature of diverse sub-populations of T cells in cancer, particularly memory T cells, is vital prior to potential incorporation into therapies. T memory stem cells (Tscm) are of interest due to their longevity and powerful abilities of self-renewal and creating the full spectrum of memory CD8+ T cells, including …

Case Presentation: Pulpal Obliteration In Primary Dentition Of An 8-Year-Old, Differential Diagnosis Dental Dysplasia Type Ii., Tara Craven, Amy Burleson, Brenda S. Bohaty, Jenna Sparks, Neena Patel, Aparna Naidu

Posters

Tooth development anomalies can happen at many stages of cell development and are relatively common. These anomalies can be isolated findings however, they may also indicate minor or major associated syndromes and identification of these findings are essential to providing comprehensive care for patients. Dentin Dysplasia Type II is a rare autosomal dominant disease resulting from a disruption in the apposition stage of cell development. This disease affects the primary teeth and clinical manifestations can include bulbous crowns, cervical constriction, mild discoloration (amber color) and pulp obliteration. Permanent teeth tend to look typical but can demonstrate thistle-tube shaped pulps and/or …

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). …

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

Posters

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

Posters

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

Posters

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 …

Health And Dental Insurance And Health Care Utilization Among Children, Adolescents, And Young Adults With Ckd: Findings From The Ckid Cohort Study., Andrea R. Molino, Maria Lourdes G. Minnick, Judith Jerry-Fluker, Jacqueline Karita Muiru, Sara A. Boynton, Susan L. Furth, Bradley A. Warady, Derek K. Ng, Chronic Kidney Disease In Children Study

Manuscripts, Articles, Book Chapters and Other Papers

Rationale & Objective: To understand the association between health and dental insurance status and health and dental care utilization, and their relationship with disease severity in a population with childhood-onset chronic kidney disease (CKD).

Study Design: Observational cohort study.

Settings & Participants: Nine hundred fifty-three participants contributing 4,369 person-visits (unit of analysis) in the United States enrolled in the Chronic Kidney Disease in Children (CKiD) Study from 2005 to 2019.

Exposures: Health insurance (private vs public vs none) and dental insurance (presence vs absence) self-reported at annual visits.

Outcomes: Self-reported suboptimal health care utilization in the past year, defined separately …

Outstanding Outcomes In Infants With Kmt2a-Germline Acute Lymphoblastic Leukemia Treated With Chemotherapy Alone: Results Of The Children's Oncology Group Aall0631 Trial, Erin M. Guest, John A. Kairalla, Joanne M. Hilden, Zoann E. Dreyer, Andrew J. Carroll, Nyla A. Heerema, Cindy Y. Wang, Meenakshi Devidas, Lia Gore, Wanda L. Salzer, Naomi J. Winick, William L. Carroll, Elizabeth A. Raetz, Michael Borowitz, Mignon L. Loh, Stephen P. Hunger, Patrick A. Brown

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Natural Killer Cells In Liver Transplantation: Can We Harness The Power Of The Immune Checkpoint To Promote Tolerance?, Jennifer Halma, Stephen Pierce, Rebecca Mclennan, Todd Bradley, Ryan T. Fischer

Manuscripts, Articles, Book Chapters and Other Papers

The roles that natural killer (NK) cells play in liver disease and transplantation remain ill-defined. Reports on the matter are often contradictory, and the mechanisms elucidated are complex and dependent on the context of the model tested. Moreover, NK cell attributes, such as receptor protein expression and function differ among species, make study of primate or rodent transplant models challenging. Recent insights into NK function and NK-mediated therapy in the context of cancer therapy may prove applicable to transplantation. Of specific interest are immune checkpoint molecules and the mechanisms by which they modulate NK cells in the tumor micro-environment. In …

Decreased Physical Activity Among Youth Resulting From Covid-19 Pandemic-Related School Closures: Natural Experimental Study., Amanda Grimes, Joseph S. Lightner, Katlyn Eighmy, Chelsea Steel, Robin P. Shook, Jordan A. Carlson

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The COVID-19 pandemic has resulted in the closure of schools and may have inadvertently resulted in decreased physical activity for youth. Emerging evidence suggests that school closures due to the COVID-19 pandemic could have hastened the inactivity of youth, possibly due to a lack of structure outside of school and increased access to sedentary activities.

OBJECTIVE: The purpose of this study was to assess changes in physical activity from pre-school closure (before the pandemic) to post-school closure (during the pandemic) among youth in spring 2020.

METHODS: This study used a natural experimental design; youth were enrolled in a physical …

Multisystem Inflammatory Syndrome In Children (Mis-C): Emergency Department, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

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

Posters

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 …