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Articles 1501 - 1530 of 2695
Full-Text Articles in Medical Specialties
Standardization Of Fertility Preservation Discussion Amongst Pediatric Oncology And Bone Marrow Transplant Patients: A Single Institution Experience, Chandni Dargan, Sarah E. Mc Dermott, Shelby Chesbro
Standardization Of Fertility Preservation Discussion Amongst Pediatric Oncology And Bone Marrow Transplant Patients: A Single Institution Experience, Chandni Dargan, Sarah E. Mc Dermott, Shelby Chesbro
Research Days
Background/Project Intent (Aim Statement): As treatment for pediatric malignancies improves long term survival, physicians are shifting focus to late effects of therapy such as infertility. Currently, options for fertility preservation include cryopreservation of mature oocytes, sperm, and gonadal tissue, although barriers remain present. Within our division, we lacked a standard approach to discussing fertility preservation options prior to initiation of treatment.
Methods (include PDSA cycles): Records from 474 pediatric patients with new oncologic diagnoses at CMH from 2014- 2020 were retrospectively reviewed. We evaluated the frequency that reproductive health discussions were documented in pubertal males and females requiring chemotherapy or …
Esophageal, Gastric, And Duodenal Histologic Findings In Patients With Feeding Difficulties, Amy Issa
Esophageal, Gastric, And Duodenal Histologic Findings In Patients With Feeding Difficulties, Amy Issa
Research Days
Background: The etiology of feeding difficulties in children is often multifactorial including medical, oral motor, and behavioral. Gastrointestinal etiologies have been identified as the primary medical component in children with feeding difficulties, however, there is not substantial information to predict which children will have a particular gastrointestinal disorder. The general consensus has been that children with feeding difficulties should have symptoms such as vomiting or abdominal pain to warrant performing esophagogastroduodenoscopy (EGD), but the validity of this approach has not been established.
Objectives/Goal: The aims of the current study were to describe EGD findings of patients presenting to a large …
Efficacy Of Pediatric Surgery Mobile Application For General Surgery Residents, James Fraser
Efficacy Of Pediatric Surgery Mobile Application For General Surgery Residents, James Fraser
Research Days
Background/Objectives/Goal: Integration of pediatric surgery content into the general surgery curriculum poses unique challenges as the patient population, pathophysiology, and management of surgical disease is distinctive from other subspecialties. Pediatric surgery represents approximately 2% of content on the in-training exam for residents (ABSITE) and is often underemphasized in didactic material, contributing to difficulty with preparation for these clinical rotations. We hypothesize that implementation of a mobile-based application with pertinent clinical algorithms and resources for pediatric surgical education will improve resident performance and enhance learning experiences in the management of pediatric surgery patients.
Methods/Design: Seventeen residents rotating on the pediatric surgery …
Learning From The Past: A Novel Approach To Reducing Unplanned Extubations In The Neonatal Icu, Yonatan Kurland
Learning From The Past: A Novel Approach To Reducing Unplanned Extubations In The Neonatal Icu, Yonatan Kurland
Research Days
Background/Project Intent (Aim Statement): The objective of this quality improvement project is to decrease unplanned extubations in a Level IV NICU to an annual rate of2020.
Methods (include PDSA cycles): We hypothesized that increased awareness of historical ETT position would both prevent unnecessary ETT position adjustments and encourage prophylactic adjustments to adjust for significant weight gain or loss. In December 2019, we implemented a novel intervention to provide readily accessible graphs of historical ETT tube position in each neonate with corrected gestational agecycles, we provided education to all members of the multidisciplinary team, we enlisted the Information Technologies Department to …
Improving The Rate Of Ppsv-23 Vaccination In Children With Type I Diabetes, Henry S. Jeng Dr
Improving The Rate Of Ppsv-23 Vaccination In Children With Type I Diabetes, Henry S. Jeng Dr
Research Days
Background/Project Intent (Aim Statement): The routine use of PCV-13 has resulted in a dramatic reduction in the incidence of pneumococcal infections among young children. However, serious pneumococcal infections caused by additional vaccine serotypes continue to occur in older children with high-risk conditions.1 As per the CDC, children with Diabetes should receive the PPSV-23 vaccine beginning at 2 years of age and at least 8 weeks after their last indicated dose of PCV-13.2 A review of division data from March 2016 to November 2018 revealed that only 2.6% of the eligible patient population with Diabetes have received the PPSV-23 vaccine. More …
Instagram As A Tool To Enhance Virtual Recruitment In The Era Of Covid-19, Sophia Hackman, Zuri Hudson, Christian Oliveros, Kyra Mccarty
Instagram As A Tool To Enhance Virtual Recruitment In The Era Of Covid-19, Sophia Hackman, Zuri Hudson, Christian Oliveros, Kyra Mccarty
Research Days
Problem Statement/Question: Due to the COVID-19 pandemic, resident recruitment will be virtual for the first time. Interviewees will be unable to visit Children’s Mercy for a tour, will spend less time engaging with current residents, and will be unable to visit Kansas City. The Recruitment Committee sought to understand if social media could be utilized to spread awareness of our pediatric residency program and provide insight into the culture of Children’s Mercy and Kansas City.
Background/Project Intent (Aim Statement): Prior to COVID-19, in person interviews would consist of dinner with current residents the day before the interview and a tour …
Refining The Optimal First Treatment For Pediatric Breast Abscesses, Kayla B. Briggs
Refining The Optimal First Treatment For Pediatric Breast Abscesses, Kayla B. Briggs
Research Days
Background: We previously reported treatment and outcomes of children with untreated, not spontaneously draining (UTND) breast abscesses. What has not been well defined however are those with previously treated, not spontaneously draining (PTND) pediatric breast abscesses. In general, a more conservative approach is favored in children with breast abscesses to avoid damage to the developing breast bud.
Objectives/Goal: We sought to determine if care at a pediatric tertiary referral center impacts disease persistence rate.
Methods/Design: Following IRB approval, patientstherapy.
Results: In all, 114 patients met inclusion criteria, 96 in the UTND group and 18 in the PTND group (Figure 1). …
Addressing Hpv And Hbv Immunizations In Pediatric Acute Sexual Assault Care, Katie A. Vandervelde
Addressing Hpv And Hbv Immunizations In Pediatric Acute Sexual Assault Care, Katie A. Vandervelde
Research Days
Problem Statement/Question: Victims of sexual assault are at increased risk for acquiring sexually transmitted infections (STIs), including Hepatitis B virus (HBV) and Human papillomavirus (HPV). These immunizations are not curative, but each are >95% effective at preventing infections by the included viruses. The Center for Disease Control and Prevention recommends that children who are victims of sexual abuse/assault, receive the HPV and HBV immunizations at the time of their initial medical evaluation for sexual abuse/assault. Knowing that child sexual assault victims are at increased risk for repeat assault, number of lifetime sex partners, and of being lostto-follow-up, in addition to …
Comparison Of Nasal Swab And Saliva Specimen For Detection Of Sars-Cov-2 In Children, Aaron Shaw
Comparison Of Nasal Swab And Saliva Specimen For Detection Of Sars-Cov-2 In Children, Aaron Shaw
Research Days
Background: Stemming from the rapid need for COVID-19 testing when supplies were limited, we investigated alternate sample processing methods and sample types for SARS-CoV-2 detection. Respiratory specimen processing using an automated nucleic acid extraction system (easyMAG) provides highly quality of nucleic acid for amplification. Reagents and supplies for easyMAG were on short supply during the pandemic, so alternative sample processing methods were investigated. Due to COVID-19 quarantine and isolation, a home kit for specimen collection was desired, particularly one that was less invasive than nasopharyngeal swabs. We investigated the sensitivity and parent/ child satisfaction of home collection kits evaluating saliva …
Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, Gina Patel, Jenna Miller, Thomas M. Attard, Asdis Finnsdottir Wagner
Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, Gina Patel, Jenna Miller, Thomas M. Attard, Asdis Finnsdottir Wagner
Presentations
Background:
Incidence and management of Gastrointestinal (GI) bleeding on ECMO isn’t well reported Patients on ECMO require systemic anticoagulation making GI bleeding difficult to manage We describe the use of enteral tranexamic acid (TXA) in two pediatric patients with GI hemorrhage on ECMO
Chronic Inflammation In Chronic Kidney Disease Progression: Role Of Nrf2., Peter Stenvinkel, Glenn M. Chertow, Prasad Devarajan, Adeera Levin, Sharon P. Andreoli, Sripal Bangalore, Bradley A. Warady
Chronic Inflammation In Chronic Kidney Disease Progression: Role Of Nrf2., Peter Stenvinkel, Glenn M. Chertow, Prasad Devarajan, Adeera Levin, Sharon P. Andreoli, Sripal Bangalore, Bradley A. Warady
Manuscripts, Articles, Book Chapters and Other Papers
Despite recent advances in the management of chronic kidney disease (CKD), morbidity and mortality rates in these patients remain high. Although pressure-mediated injury is a well-recognized mechanism of disease progression in CKD, emerging data indicate that an intermediate phenotype involving chronic inflammation, oxidative stress, hypoxia, senescence, and mitochondrial dysfunction plays a key role in the etiology, progression, and pathophysiology of CKD. A variety of factors promote chronic inflammation in CKD, including oxidative stress and the adoption of a proinflammatory phenotype by resident kidney cells. Regulation of proinflammatory and anti-inflammatory factors through NF-κB- and nuclear factor, erythroid 2 like 2 (Nrf2)-mediated …
Neonatal Gut Microbiota Alterations And Local Inflammation Induced By Escherichia Coli Infection Are Modified By Lactobacillus Rhamnosus Prophylaxis, Susana Chavez-Bueno, Hao Xuan, Shahid Umar, Concong Zhong, Wei Yu, Venkatesh Sampath
Neonatal Gut Microbiota Alterations And Local Inflammation Induced By Escherichia Coli Infection Are Modified By Lactobacillus Rhamnosus Prophylaxis, Susana Chavez-Bueno, Hao Xuan, Shahid Umar, Concong Zhong, Wei Yu, Venkatesh Sampath
Presentations
Background: E. coli is a leading cause of neonatal sepsis. Newborns ingest E. coli, which transcytoses the gut producing bacteremia. Lactobacillus spp. decrease E. coli gut transcytosis but the mechanisms involved in this protective effect are not well understood.
Objective: To determine the effects of Lactobacillus pretreatment on the intestinal microbiota and inflammation in neonatal rats orally infected with E. coli.
Design/Methods: Newborn rats were orally pretreated on day of life (DOL) 1 and 2 with four doses of 107 colony forming units (CFU) of Lactobacillus rhamnosus GG (LGG) or PBS. On DOL 2, pups received orally 106 CFU of …
Neurodevelopmental Profiles Of Infants Born < 30 Weeks' Gestation At 2 Years Of Age, Marie Camerota, Elisabeth C. Mcgowan, Julie A. Hofheimer, T. Michael O'Shea, Brian S. Carter, Jennifer Helderman, Jennifer Check, Charles R. Neal, Steven L. Pastyrnak, Lynne Smith, Cynthia Loncar, Stephen Sheinkopf, Lynne Dansereau, Sheri A. Dellagrotta, Barry Lester
Neurodevelopmental Profiles Of Infants Born < 30 Weeks' Gestation At 2 Years Of Age, Marie Camerota, Elisabeth C. Mcgowan, Julie A. Hofheimer, T. Michael O'Shea, Brian S. Carter, Jennifer Helderman, Jennifer Check, Charles R. Neal, Steven L. Pastyrnak, Lynne Smith, Cynthia Loncar, Stephen Sheinkopf, Lynne Dansereau, Sheri A. Dellagrotta, Barry Lester
Presentations
Background: Infants born (PMA) are at increased risk for neurodevelopmental impairment by age 2. Prior studies have tended to examine individual outcomes separately, rather than investigating whether there are subgroups of children with distinct neurobehavioral profiles.
Objective: To determine distinct neurodevelopmental profiles in 2 year old children born cognitive, language, motor, and behavioral characteristics.
Design/Methods: NOVI (Neonatal Neurobehavior and Outcomes in Very Preterm Infants) is a multi-center study of infants born (BSID-III) subscale scores, Child Behavior Checklist (CBCL) syndrome scores, diagnosis of cerebral palsy (CP; Gross Motor Function Classification System and abnormal neurologic exam), and positive screen for autism spectrum …
The Association Between Age And Unrecognized And Untreated Hypertension In Children With Chronic Kidney Disease, Chloe Douglas, J Roem, Joseph Flynn, Susan Furth, Bradley A. Warady, Susan Halbach
The Association Between Age And Unrecognized And Untreated Hypertension In Children With Chronic Kidney Disease, Chloe Douglas, J Roem, Joseph Flynn, Susan Furth, Bradley A. Warady, Susan Halbach
Presentations
Background: Younger age has been associated with unrecognized hypertension (HTN) in both the general pediatric population and in children on dialysis. An increased lifetime risk of cardiovascular disease and the association of HTN with chronic kidney disease (CKD) progression make optimal treatment of elevated blood pressure (BP) a key component of CKD management. However, the role of age in the recognition and treatment of HTN in non-dialysis pediatric CKD remains unknown.
Objective: Using data from the Chronic Kidney Disease in Children (CKiD) Cohort Study, we examined the relationship between age and recognized vs. unrecognized HTN, and the frequency with which …
Neonatal Neurobehavior, Medical Risk, And 2-Year Developmental Outcomes In Infants Born <30 Weeks Gestation, Elizabeth Mcgowan, Marie Camerota, Julie A. Hofheimer, Michael O'Shea, Brian S. Carter, Howard Kilbride, Steven Pastyrnak, Charles R. Neal, Lynne Smith, Jennifer Helderman, Jennifer Check, Lynne Dansereau, Sheri A. Dellagrotta, Barry Lester
Neonatal Neurobehavior, Medical Risk, And 2-Year Developmental Outcomes In Infants Born <30 Weeks Gestation, Elizabeth Mcgowan, Marie Camerota, Julie A. Hofheimer, Michael O'Shea, Brian S. Carter, Howard Kilbride, Steven Pastyrnak, Charles R. Neal, Lynne Smith, Jennifer Helderman, Jennifer Check, Lynne Dansereau, Sheri A. Dellagrotta, Barry Lester
Presentations
Background: Among preterm infants, risk of poor outcomes has been linked to neonatal medical illness and neurobehavior. The combined contribution of neonatal medical morbidities and neonatal neurobehavior to 2 year outcomes has yet to be studied.
Objective: To determine associations between NICU Network Neurobehavioral Scale (NNNS) profiles, medical risk, and 2 year developmental outcomes.
Design/Methods: Multi-center study of 704 infants born <30 weeks gestation enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study. NNNS were completed prior to NICU discharge and six profiles of neonatal neurobehavior were calculated by latent profile analysis. Two profiles (5 and 6) were considered atypical. Medical risk included brain injury, CLD, ROP, and NEC/sepsis. Outcomes at 2 years were Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores and Child Behavior Checklist (CBCL) T-scores. Generalized estimating equation (GEE) models were used to test the associations among NNNS profiles, neonatal medical risk, and 2 year developmental outcomes. GEE models accounted for multiple births. Covariates were research site, maternal socioeconomic status (SES), race or ethnicity, maternal primary language, partner status, maternal psychopathology, and infant sex.
Results: Follow-up data were available for 556/704 (78.9%) infants, of which 157 (28.2%) were Profile 5-6. Mother of Profile 5-6 infants were more likely to be non-English speaking and lower SES compared to Profiles 1-4 mothers (Table 1). In …30>
Using Machine Learning To Identify Metabolomic Signatures Based On Pediatric Chronic Kidney Disease Etiology, Arthur Lee, Alison Abraham, Yunwen Xu, Jian Hu, Xia Or, Josef Coresh, Casey Rebholz, J Chen, Eugene Ree, Harold Feldman, Paul Kimmel, Bradley A. Warady, Susan Furth, Michelle Denburg
Using Machine Learning To Identify Metabolomic Signatures Based On Pediatric Chronic Kidney Disease Etiology, Arthur Lee, Alison Abraham, Yunwen Xu, Jian Hu, Xia Or, Josef Coresh, Casey Rebholz, J Chen, Eugene Ree, Harold Feldman, Paul Kimmel, Bradley A. Warady, Susan Furth, Michelle Denburg
Presentations
Background: Untargeted plasma metabolomic profiling combined with novel machine learning (ML) tools may lead to the discovery of metabolic profiles that inform our understanding of pediatric chronic kidney disease (CKD) etiologies and identify potential therapeutic targets.
Objective: We sought to identify metabolomic signatures in pediatric CKD based on etiology: focal segmental glomerular sclerosis (FSGS), obstructive uropathy (OU), aplasia/dysplasia/hypoplasia (A/D/H), & reflux nephropathy (RN).
Design/Methods: Untargeted GC/MS2 and LC/MS2-based metabolomics quantification (Metabolon) was performed on baseline plasma samples from 702 Chronic Kidney Disease in Children (CKiD) participants. Participants per etiology were: FSGS (n=63), OU (n=122), A/D/H (n=109), & RN (n=86). Lasso …
Reducing Alarm Burden By Promoting Judicious Ordering Of Continuous Pulse Oximetry, Kathleen Berg, David Johnson, Ginny Nyberg, Andrew Ausmus, Christine Claeys, Emily Wilkinson, Nicholas Clark
Reducing Alarm Burden By Promoting Judicious Ordering Of Continuous Pulse Oximetry, Kathleen Berg, David Johnson, Ginny Nyberg, Andrew Ausmus, Christine Claeys, Emily Wilkinson, Nicholas Clark
Presentations
Background: Overutilization of continuous pulse oximetry (CPO) contributes to overdiagnosis and prolonged supplemental oxygen utilization. It may also negatively impact patient sleep, mobility, length of stay (LOS), and cost. Response times to actionable alarms increase with the number of non-actionable alarms. Our baseline data revealed an average of 29.6 pulse oximetry monitor alarms sounded for each admitted patient each day of their hospitalization. Most notably, 38.7% of pulse oximetry alarms were for ≥88% which is generally considered non-actionable.
Objective: We aimed to decrease both total pulse oximetry alarms per patient day and alarms for ≥88% per patient day by 20%, …
Impact Of Early Tracheostomy On Neurodevelopmental Outcome Of Infants With Severe Bronchopulmonary Dysplasia Exposed To Postnatal Steroids, Amjad Taha, Gangaram Akangire, Janelle R. Noel-Macdonnell Phd, Tiffany Willis, Winston M. Manimtim
Impact Of Early Tracheostomy On Neurodevelopmental Outcome Of Infants With Severe Bronchopulmonary Dysplasia Exposed To Postnatal Steroids, Amjad Taha, Gangaram Akangire, Janelle R. Noel-Macdonnell Phd, Tiffany Willis, Winston M. Manimtim
Posters
Background: BPD is associated with neurodevelopmental impairment. Tracheostomy is performed in 5-12% of severe BPD for prolonged ventilation. There is evidence that chronic ventilation with tracheostomy in severe BPD may facilitate neurodevelopment and lead to improved outcome. However, there is no consensus on the optimal timing of tracheostomy. A large multicenter study of infants with tracheostomy performed at <120 days of life had better neurodevelopmental outcomes at 18-22 months of age. Use of steroids postnatally to ameliorate the severity of BPD had been controversial due to its negative effect on neurodevelopment. To date, no data has specifically evaluated the impact of early tracheostomy on neurodevelopmental outcome of infants with severe BPD who are exposed to postnatal steroids.
Objective: To compare cognitive, language and motor scores among 3 groups of severe BPD infants who received early vs late vs no tracheostomy. Secondly, evaluate if postnatal steroids had an additive negative effect on neurodevelopmental outcomes.
Design/Methods: IRB approved retrospective cohort of …120>
Association Between Esa Dose And Blood Pressure In Pediatric Patients On Dialysis, Heather A. Morgans, Judith Sebestyen Vansickle, Franz Schaefer, Bradley A. Warady
Association Between Esa Dose And Blood Pressure In Pediatric Patients On Dialysis, Heather A. Morgans, Judith Sebestyen Vansickle, Franz Schaefer, Bradley A. Warady
Posters
Background: Hypertension is a reported side effect of Erythropoiesis Stimulating Agents (ESAs), with a mechanism of action related to elevated hematocrit levels and direct vasopressor effects. Limited information exists on the relationship between ESA dosage and hypertension in children receiving maintenance dialysis.
Objective: The primary aim of this study was to determine whether there is a significant correlation between ESA dose and blood pressure (BP) in pediatric patients on dialysis. The secondary aim was to determine confounding variables in relation to ESA dose and BP.
Design/Methods: Data from the International Pediatric Dialysis Network (IPDN) database was used to retrospectively evaluate …
C-Reactive Protein Values To Predict Sepsis-Induced Inflammatory Response In Premature Infants, Megan Tucker, Hung-Wen Yeh, Daniel K. Oh, Venkatesh Sampath
C-Reactive Protein Values To Predict Sepsis-Induced Inflammatory Response In Premature Infants, Megan Tucker, Hung-Wen Yeh, Daniel K. Oh, Venkatesh Sampath
Posters
Background: C-reactive protein (CRP) is an inflammatory marker that has been recognized as a biomarker of the systemic inflammatory response in preterm neonates. We hypothesized that initial and peak CRP values would correlate with the degree of sepsis-induced acute lung injury (ALI) as measured by the pulmonary severity score (PSS).
Objective: 1) Determine if confirmed (CF) sepsis events are associated with higher initial and peak CRP values than rule out (RO) sepsis events. 2) Investigate if initial and/or peak CRP correlates with severity of sepsis-induced ALI as measured by the PSS.
Design/Methods: In this retrospective case control study, we included …
Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian R. Lee, Rana El Feghaly
Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian R. Lee, Rana El Feghaly
Posters
Background: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. However, most antibiotic stewardship programs have mainly focused on the latter. Children seen in the ambulatory setting for SSTIs often receive >7 days of antibiotics, although current society guidelines recommend 5-7 days for most diagnoses.
Objective: To determine the baseline percentage of patients receiving antibiotic prescriptions for >7 days for SSTIs in urgent care clinics (UCC)s of a pediatric health system and to evaluate factors that influence providers towards longer durations.
Design/Methods: We built a …
Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, Gina Patel, Jenna Miller, Thomas M. Attard, Asdis Finnsdottir Wagner
Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, Gina Patel, Jenna Miller, Thomas M. Attard, Asdis Finnsdottir Wagner
Posters
Hemorrhagic and thrombotic complications on Extracorporeal Membrane Oxygenation (ECMO) support are associated with significant morbidity and mortality. There is a paucity of literature describing the incidence and management of Gastrointestinal (GI) bleeding on ECMO. We describe the use of enteral tranexamic acid (TXA) as an alternative strategy in two pediatric patients with GI hemorrhage on ECMO. Case 1 A 5-year-old with Wilms Tumor required Veno-Venous ECMO due to respiratory failure associated with pulmonary hemorrhage and air-leak syndrome. Her course was complicated by severe GI hemorrhage refractory to IV proton pump inhibitor (PPI), IV TXA and octreotide infusions. Concomitant IV TXA …
Evaluation Of The Hypothesis That Viral Meningitis Is A Mimic Of Abusive Head Trauma, Danielle Horton, Tanya Burrell, James Anderst, Lyndsey Hultman, Mary Moffatt, Henry T. Puls, Rangaraj Selvarangan
Evaluation Of The Hypothesis That Viral Meningitis Is A Mimic Of Abusive Head Trauma, Danielle Horton, Tanya Burrell, James Anderst, Lyndsey Hultman, Mary Moffatt, Henry T. Puls, Rangaraj Selvarangan
Posters
Background: Viral meningitis (VM) has been proposed as an alternative cause of subdural hemorrhage (SDH) in young children diagnosed with abusive head trauma (AHT). It has been proposed that VM may mimic symptoms and clinical features of AHT, resulting in an incorrect diagnosis of abuse.
Objective: We aim to evaluate the hypothesis that VM is a mimic of AHT by comparing the history of present illness (HPI) and initial clinical presentation of young children with proven VM to those with subdural hemorrhage and concomitant suspicious injuries (SDH + CSIs) and to those with SDH and no CSIs (SDH only). We …
Congenital Mitral Valve Regurgitation, The Dilemma Of Repair Versus Replacement, Bianca Cherestal, Doaa Aly
Congenital Mitral Valve Regurgitation, The Dilemma Of Repair Versus Replacement, Bianca Cherestal, Doaa Aly
Posters
Background: Congenital mitral regurgitation is a rare condition and can be challenging to manage when presenting in the neonatal period.
Case: Two week old male presented with poor weight gain, murmur and cardiomegaly on chest X-ray. Echocardiogram showed moderate to severe mitral regurgitation (MR) and suprasystemic pulmonary hypertension (PHN) (fig 1 a, b). The mitral valve (MV) leaflets were thickened and tethered with failure of central coaptation. PHN was classified as WHO I and II (due to persistent PHN of newborn and MR respectively). Inhaled nitric oxide, Enalapril and Furosemide were initiated. Cardiac catheterization revealed PVRi of 8.9 WU x …
Atrial Standstill In A Pediatric Patient With Scn5a Mutation Following Procainamide Challenge, Anmol Goyal, Lindsey Malloy-Walton, Christopher Follansbee
Atrial Standstill In A Pediatric Patient With Scn5a Mutation Following Procainamide Challenge, Anmol Goyal, Lindsey Malloy-Walton, Christopher Follansbee
Posters
Background: Atrial standstill (AS) is a rare arrhythmia characterized by absence of electrical and mechanical atrial activity associated with SCN5A channelopathy.
Case: An 18 year old male with structurally normal heart, frequent sinus pauses, nonsustained atrial tachycardia and high-grade block was found to have SCN5A mutation c.3823G>A (p.Asp1275Asn). An electrophysiology study (EPS) with high density voltage mapping of the right atrium was done (Fig 1a). Nonsustained multifocal atrial tachycardia was induced without ablative targets (Fib 1b). Procainamide challenge was negative for Brugada, however induced AS (Fig 1c-d). No atrial capture could be achieved at maximal output. Empiric atrial lead …
Constrictive Pericarditis After Repair Of A Ruptured Sinus Of Valsalva, Sarah Studyvin, Sanket Shah
Constrictive Pericarditis After Repair Of A Ruptured Sinus Of Valsalva, Sarah Studyvin, Sanket Shah
Posters
Background: Constrictive pericarditis (CP) is a rare complication of cardiac surgery. We report a patient who developed CP after ruptured sinus of Valsalva (RSOV) repair.
Case: A 23-year-old male presented with severe exertional dyspnea one year after RSOV repair. Echocardiogram showed thickened pericardium, ventricular septal bounce (Fig 1A), left atrial enlargement, diastolic hepatic flow reversal (Fig 1B), and trivial mitral regurgitation without stenosis. He underwent cardiac catheterization, which revealed elevated filling pressures (RVEDP 16 mmHg, LVEDP 18 mmHg), RVEDP/RVSP ratio < 0.5, and a low cardiac index (1.65 L/min/m2). Cardiac MRI on the same day confirmed pericardial thickening (Fig D) with paradoxic septal motion, dilated pulmonary veins (Fig 1F) and retrograde flow in the SVC.
Decision‐making: Pericardiectomy of thickened and adherent pericardium was performed without the use of cardiopulmonary bypass. The central venous pressure decreased …
Not-So-Apparent Mixing Lesions: Late Presentation Of Cardioembolic Stroke, Amulya Buddhavarapu, Christopher Mathis, William Gibson, Sanket Shah
Not-So-Apparent Mixing Lesions: Late Presentation Of Cardioembolic Stroke, Amulya Buddhavarapu, Christopher Mathis, William Gibson, Sanket Shah
Posters
Background: Multiple levels of inter-atrial shunting can rarely present late in life with dyspnea and embolic stroke from effects of bidirectional shunting.
Case: A 55-year-old male with history of a patent foramen ovale, atrial fibrillation and embolic stroke presented with worsening fatigue and dyspnea at rest. Echocardiogram showed mildly reduced ventricular function with severe right heart dilation. On transesophageal echo, the coronary sinus (CS) was severely dilated with a persistent left superior vena cava (LSVC). A stress test showed no perfusion defects. CT angiography showed an absence of right SVC and a single LSVC connecting to the CS. There was …
Simulation Based Clinical Systems Testing Of A Pediatric Ed To Improve Staff And Process Readiness For Pediatric Hypoglycemia, Kevin Meilak Md, Christopher S. Kennedy
Simulation Based Clinical Systems Testing Of A Pediatric Ed To Improve Staff And Process Readiness For Pediatric Hypoglycemia, Kevin Meilak Md, Christopher S. Kennedy
Posters
Background: Hypoglycemia is the most common metabolic disorder in children in pediatric emergency department (ED) settings 1. Children may present with nonspecific symptoms, or asymptomatically2. So identification/treatment is very challenging. Delayed recognition and under treatment can lead to poor patient outcomes including seizure, coma, and death. Simulation-based clinical systems tests (SbCSTs) are useful to detect gaps/latent safety threats (LSTs) in system design.3-5
Objective: Our aim was to use SbCSTs combined with rapid cycle training to test system function for ED treatment of hypoglycemia.3-5. The research questions were in 2 frames: 1. Can SbCSTs identify gaps/LSTs and recommendations for improvement and …
Assessing The Effects Of Social Determinants On Serious Safety Events, Lisa L. Schroeder, Jessi Van Roekel, John Cowden
Assessing The Effects Of Social Determinants On Serious Safety Events, Lisa L. Schroeder, Jessi Van Roekel, John Cowden
Posters
Background: We have long known that various social determinants of health (SDH) such as race, gender, socioeconomic status and others can affect health outcomes, such as readmission rates and mortality. To our knowledge, the impact of SDH on safety events has not been studied.
Objective: We sought to understand the role that social determinants may play in contributing to safety events at our institution and to incorporate this information into the creation of corrective action items following the serious safety event.
Design/Methods: The Clinical Safety team partnered with the Office of Equity and Diversity to develop a standard question regarding …
Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Laura Kuzava, Tyler Johnson, Alison Samrany, Nitin Madan, Sanket Shah
Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Laura Kuzava, Tyler Johnson, Alison Samrany, Nitin Madan, Sanket Shah
Posters
Background: Adequate echocardiographic (echo) education is integral to successful cardiology training. Online education is proven to be effective in other specialties, but pediatric echo training data are lacking. Our aim was to design and assess the role of a novel online module-based curriculum to enhance pediatric cardiology fellows’ echo education.
Methods: Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. Content included high quality 2D and 3D echo clips (Fig 1A) as well as interactive quizzes (Fig 1B) and could be accessed from a phone, tablet, or computer. All fellows completed pre- and …