Medical Specialties Commons^™

Identification Of Genetic Disorders Based On Phenotype And Subsequent Medical Management, Sara J. Strandlund, Jotishna Sharma, Bonnie R. Sullivan, Ashley K. Sherman, Laura A. Cross

Research Days

Many genetic disorders in the neonatal period contribute to significant morbidity and mortality. This study evaluates the indications for genetic testing based on phenotype and compares these with the diagnostic yield of symptom driven exome sequencing and chromosome microarray in the NICU. Overall, this study highlights that while there are diagnostic limitations to exome sequencing, genetic testing remains an important adjunct to clinical care.

Health Disparities In Slipped Capital Femoral Epiphysis (Scfe) Presentation, Rithika Ginjupalli, George Thomas, Rohit Siddabattula, Richard M. Schwend, Caleb Grote

Research Days

This study identifies various health disparities in SCFE presentations using neighborhood-level determinants COI and ICE in addition to sociodemographic determinants such as race and gender.

Prognostic Impact Of Cooccurring Mutations In Flt3-Itd Pediatric Acute Myeloid Leukemia., Katherine Tarlock, Robert B. Gerbing, Rhonda E. Ries, Jenny L. Smith, Amanda Leonti, Benjamin J. Huang, Danielle Kirkey, Leila Robinson, Jack H. Peplinksi, Beverly Lange, Todd M. Cooper, Alan S. Gamis, E Anders Kolb, Richard Aplenc, Jessica A. Pollard, Todd A. Alonzo, Soheil Meshinchi

Manuscripts, Articles, Book Chapters and Other Papers

We sought to define the cooccurring mutational profile of FLT3-ITD-positive (ITDpos) acute myeloid leukemia (AML) in pediatric and young adult patients and to define the prognostic impact of cooperating mutations. We identified 464 patients with FLT3-ITD mutations treated on Children's Oncology Group trials with available sequencing and outcome data. Overall survival, event-free survival (EFS), and relapse risk were determined according to the presence of cooccurring risk stratifying mutations. Among the cohort, 79% of patients had cooccurring alterations across 239 different genes that were altered through mutations or fusions. Evaluation of the prognostic impact of the cooccurring mutations demonstrated that patients …

Bridging Services To Evidenced-Based Care: Implementing A Psychology Consult Check-Up Clinic, Jacqueline Pabis Phd, Sabrina Ung Ma, Angela Combs Ma, Mallory Netz Phd, Carisa Parrish Phd, Casey Lawless Phd

Research Days

This quality improvement project examines the feasibility, satisfaction, and preliminary outcomes of a hospital follow-up program for the CMH Inpatient Psychology Consultation & Liaison team.

Improving Awareness And Utilization Of Safety Net Resources After Extremity Firearm Injury, Colleen M. Moreland, Caleb W. Grote, Richard M. Schwend, Julia G. Harris

Research Days

The orthopaedic surgery department can improve follow-on care for pediatric survivors of extremity firearm injuries by creating and implementing a checklist of defined safety net resources.

A Quality Improvement Project To Improve Antibiotic Choice For Children Admitted With Urinary Tract Infections (Utis), Philip Jurasinski Do, Pgy-3, Adrienne Deporre Md, Kathleen Berg Md, Allison Hadley Md, Viktoriya Stoycheva Mha, Rn, Cpn, Rana El Feghaly Md

Research Days

This is an antibiotic stewardship quality improvement project focused on improving antibiotic choices for children with urinary tract infections who are in the Children's Mercy Kansas City system. This project aims to improve the rates of cefazolin or cephalexin for treatment from 27% to 60%. 96% of urinary tract infections in our system are caused by E. Coli that are susceptible to these first generation cephalosporins.

More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Colton Schwarz, Spencer Wittmeyer, Mitch Kinkor, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout, Nicholas Clark

Research Days

Quality improvement project that aims to improve opioid stewardship in acute fracture management.

Characterization Of Nationally Reported Pediatric Deaths Involving Fentanyl Ingestions In Missouri, Margaret Campbell, Mary Moffatt, Emily Killough, Terra Frazier

Research Days

There has been a dramatic rise in pediatric deaths associated with synthetic opioid use, with the most prominent being Fentanyl. This is a retrospective cohort study using data from the National Center for Fatality Review and Prevention with the goal of identifying risk factors that increase the vulnerability of children to Fentanyl ingestion. Ultimately this research may help lead to improved identification of at risk children with the goal of implementation of targeted prevention programming.

How Neonates Die: Mortality Trends And Associations In A Level Iv Neonatal Intensive Care Unit, Erin Bolen, Ashley K. Sherman, Julie Weiner, Jotishna Sharma

Research Days

Background

Modes of neonatal mortality include withdrawal of life-sustaining interventions, non-escalation of interventions, and secondary to a code event. Mortality trends have been examined broadly, but the impact of clinical and demographic factors on the mode of neonatal mortality has yet to be evaluated. A greater understanding of this information would help guide medical decision-making and identify potential inequities. The aim is to evaluate the impact of clinical and demographic factors on the mode of neonatal death in a level IV neonatal intensive care unit (NICU).

Study Design/Methods

Data were collected via retrospective chart review of patients who died at …

Socioeconomic Differences In Penicillin Allergy Label Rates Of Children Evaluated In Pediatric Emergency Departments And Urgent Cares, Zoya Siddiqui, Brian R. Lee, Amanda Nedved, Jennifer Mckinsey, Frances Turcotte Benedict, Brandi Missel, Aarti Pandya, Rana El Feghaly

Research Days

In this retrospective study of 183,692 patients ≤19 years evaluated in urgent cares and emergency departments of a large pediatric academic center July 2022- June 2023, we found that in addition to race, socioeconomic status reflected by insurance and area deprivation index had a large association with penicillin allergy labels.

Improving Nutritional Delivery To Pediatric Patients While Using Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha

Research Days

This quality improvement guide aims to enhance early nutritional delivery to pediatric patients with renal failure who require renal replacement therapy.ng renal replacement therapy.

Understanding Inpatient Diagnostic Imaging Use In Children’S Hospitals To Prioritize Stewardship Efforts, Megan E. Collins, Matt Hall, John Stephens, Jessica L. Markham

Research Days

We utilized the Pediatric Health Information System to perform a retrospective cohort study of hospitalized children across 45 hospitals to describe diagnostic imaging studies among hospitalized children with the highest prevalence, cost, rates of repetition, and hospital variation to help inform de-implementation efforts.

Electrical Stimulation Of The Medial Pin After Insertion Is Safe And Effective In Preventing Iatrogenic Ulnar Nerve Neuropraxias In Type Iii Supracondylar Fractures. A Case Series Of 128 Consecutive Patients., Lucas Georger B.A., Mckenna Noe B.S., Richard M. Schwend M.D.

Research Days

This case series explores the safety and efficacy of using a disposable nerve stimulator for intraoperative stimulation of both medial and lateral pins in Gartland type III supracondylar humerus fractures, revealing no instances of ulnar nerve stimulation response or postoperative iatrogenic ulnar nerve injury, thereby highlighting the potential for this cost-effective approach to ensure stable medial column pin fixation without ulnar nerve complications.

Safety And Efficacy Of Intraoperative Vectored Traction With Gardner-Wells (Gw) Tongs For Pediatric Spine Deformity Surgery - A Series Of 1000 Cases, Lucas Georger B.A., Krish Sardesai B.A., Andrew Dumas B.S., Mckenna Noe B.S., Richard M. Schwend M.D.

Research Days

Conducting an ongoing exploration, this study delves into the safety and efficacy of Gardner-Wells Tongs in pediatric spinal deformity surgery, involving a series of 418 cases, revealing a 5.5% complication rate primarily associated with facial swelling and abrasions, emphasizing the need for further investigation to validate the safety and effectiveness of this intervention.

Disparities In Accessing Specialty Behavioral Health Services During The Covid-19 Pandemic And Why We Need Pediatric Integrated Primary Care., Ayanda Chakawa, Trista Perez Crawford, Leslee Belzer, Hung-Wen Yeh

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Youth unmet behavioral health needs are at public health crisis status and have worsened since the onset of the coronavirus disease 2019 pandemic (Covid-19). Integrating behavioral health services into pediatric primary care has shown efficacy in addressing youth behavioral health needs. However, there is limited guidance on facilitating equitable access to care in this setting, including in triaging access to co-located services (i.e., onsite outpatient behavioral health services with only the behavioral health provider) or to specialty behavioral health services in other clinics within larger health systems.

METHODS: A retrospective, comparative study was conducted to examine variability in access …

Improving Pneumococcal Vaccination Rates In Immunosuppressed Pediatric Patients With Rheumatic Disease., Julia G. Harris, Jordan T. Jones, Leslie Favier, Emily Fox, Michael J. Holland, Amy Ivy, Cara M. Hoffart, Maria Ibarra, Ashley M. Cooper

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Patients with rheumatic diseases are at a high risk of invasive pneumococcal disease due to immunosuppression. We conducted a quality improvement project, and the first aim was to increase the percentage of patients with systemic lupus erythematosus and mixed connective tissue disease that is up to date on pneumococcal vaccinations from 9.6% to 80% within one year. Subsequently, the second aim was to increase the percentage of patients on immunosuppression with systemic lupus erythematosus, mixed connective tissue disease, juvenile dermatomyositis and systemic vasculitis that is up to date on pneumococcal vaccinations from 62.6% to 80% within one year.

METHODS: …

Anxiety Overview And How To Help Your Child, Maggie Mckay, Meghan Kanya

Parent-ish Podcast

Meghan Kanya, PhD, discusses an overview of anxiety, including causes, signs your child may be struggling, and how you as a parent can help.

Click here to stream the podcast episode.

Researching Covid To Enhance Recovery (Recover) Pediatric Study Protocol: Rationale, Objectives And Design., Rachel S. Gross, Tanayott Thaweethai, Erika B. Rosenzweig, James Chan, Lori B. Chibnik, Mine S. Cicek, Amy J. Elliott, Valerie J. Flaherman, Andrea S. Foulkes, Margot Gage Witvliet, Richard Gallagher, Maria Laura Gennaro, Terry L. Jernigan, Elizabeth W. Karlson, Stuart D. Katz, Patricia A. Kinser, Lawrence C. Kleinman, Michelle F. Lamendola-Essel, Joshua D. Milner, Sindhu Mohandas, Praveen C. Mudumbi, Jane W. Newburger, Kyung E. Rhee, Amy L. Salisbury, Jessica N. Snowden, Cheryl R. Stein, Melissa S. Stockwell, Kelan G. Tantisira, Moriah E. Thomason, Dongngan T. Truong, David Warburton, John C. Wood, Shifa Ahmed, Almary Akerlundh, Akram N. Alshawabkeh, Brett R. Anderson, Judy L. Aschner, Andrew M. Atz, Robin L. Aupperle, Fiona C. Baker, Venkataraman Balaraman, Dithi Banerjee, Deanna M. Barch, Arielle Baskin-Sommers, Sultana Bhuiyan, Marie-Abele C. Bind, Amanda L. Bogie, Tamara Bradford, Natalie C. Buchbinder, Elliott Bueler, Hülya Bükülmez, B J Casey, Linda Chang, Maryanne Chrisant, Duncan B. Clark, Rebecca G. Clifton, Katharine N. Clouser, Lesley Cottrell, Kelly Cowan, Viren D'Sa, Mirella Dapretto, Soham Dasgupta, Walter Dehority, Audrey Dionne, Kirsten B. Dummer, Matthew D. Elias, Shari Esquenazi-Karonika, Danielle N. Evans, E Vincent S. Faustino, Alexander G. Fiks, Daniel Forsha, John J. Foxe, Naomi P. Friedman, Greta Fry, Sunanda Gaur, Dylan G. Gee, Kevin M. Gray, Stephanie Handler, Ashraf S. Harahsheh, Keren Hasbani, Andrew C. Heath, Camden Hebson, Mary M. Heitzeg, Christina M. Hester, Sophia Hill, Laura Hobart-Porter, Travis K F Hong, Carol R. Horowitz, Daniel S. Hsia, Matthew Huentelman, Kathy D. Hummel, Katherine Irby, Joanna Jacobus, Vanessa L. Jacoby, Pei-Ni Jone, David C. Kaelber, Tyler J. Kasmarcak, Matthew J. Kluko, Jessica S. Kosut, Angela R. Laird, Jeremy Landeo-Gutierrez, Sean M. Lang, Christine L. Larson, Peter Paul C. Lim, Krista M. Lisdahl, Brian W. Mccrindle, Russell J. Mcculloh, Kimberly Mchugh, Alan L. Mendelsohn, Torri D. Metz, Julie Miller, Elizabeth C. Mitchell, Lerraughn M. Morgan, Eva M. Müller-Oehring, Erica R. Nahin, Michael C. Neale, Manette Ness-Cochinwala, Sheila M. Nolan, Carlos R. Oliveira, Onyekachukwu Osakwe, Matthew E. Oster, R Mark Payne, Michael A. Portman, Hengameh Raissy, Isabelle G. Randall, Suchitra Rao, Harrison T. Reeder, Johana M. Rosas, Mark W. Russell, Arash A. Sabati, Yamuna Sanil, Alice I. Sato, Michael S. Schechter, Rangaraj Selvarangan, S Kristen Sexson Tejtel, Divya Shakti, Kavita Sharma, Lindsay M. Squeglia, Shubika Srivastava, Michelle D. Stevenson, Jacqueline Szmuszkovicz, Maria M. Talavera-Barber, Ronald J. Teufel, Deepika Thacker, Felicia Trachtenberg, Mmekom M. Udosen, Megan R. Warner, Sara E. Watson, Alan Werzberger, Jordan C. Weyer, Marion J. Wood, H Shonna Yin, William T. Zempsky, Emily Zimmerman, Benard P. Dreyer, Recover-Pediatric Consortium

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults.

OBSERVATIONS: We describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of …

What Every New Parents Should Know About Newborns, Maggie Mckay, Katie Mcanany

Parent-ish Podcast

Katie McAnany, MD covers all your frequently asked questions about newborns - from feeding to sleep, soothing to play, so you can feel confident bringing home your new bundle of joy.

Click here to stream the podcast episode.

Sexual Function In Women With Polycystic Ovary Syndrome: A Systematic Review And Meta-Analysis., Hester Pastoor, Aya Mousa, Hanneke Bolt, Wichor Bramer, Tania S. Burgert, Anuja Dokras, Chau Thien Tay, Helena J. Teede, Joop Laven

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common and distressing endocrine disorder associated with lower quality of life, subfertility, diabetes, cardiovascular disease, depression, anxiety, and eating disorders. PCOS characteristics, its comorbidities, and its treatment can potentially influence sexual function. However, studies on sexual function in women with PCOS are limited and contradictory.

OBJECTIVE AND RATIONALE: The aim was to perform a systematic review of the published literature on sexual function in women with PCOS and assess the quality of the research and certainty of outcomes, to inform the 2023 International Guidelines for the Assessment and Management of PCOS.

SEARCH METHODS: …

The Role Of Adverse Childhood Events On The Progression Of Chronic Kidney Disease In Children: A Ckid Study, Ana Cortez, Matthew Matheson, John Cowden, Bradley Warady, Darcy K. Weidemann

Posters

There is a paucity of research on the relationship between adverse childhood events (ACEs) and chronic kidney disease. The effect of ACEs on the long-term health outcomes of cardiovascular disease, cancer, and chronic lung disease first emerged in a paper published in 1998. The National Institutes of Health sponsored the ACE Study, which Kaiser Permanente carried out in California. The study used a 17-question survey addressing seven exposures: psychological, physical, contact-sexual abuse, substance abuse, mental illness, mother being treated violently, and criminal behavior in the household. The results revealed a strong relationship between childhood exposure to ACEs and health outcomes. …

Thyroid Dysfunction In Patients Receiving Immune Checkpoint Inhibitors, Emily Metzinger, Jennifer Boyd, Julia Broussard, Christopher Klockau

Posters

Objectives: The use of immune checkpoint inhibitors (ICIs) in cancer treatment is increasing. Literature about endocrinopathies associated with ICIs in children is limited. This study investigates ICIs and thyroid dysfunction in pediatric patients at one institution.

Methods: Retrospective chart review of patients ages 1 to 19 was completed who received any of the following ICIs between January 2000 and November 2023: PD-1 inhibitors (nivolumab or pembrolizumab), PD-L1 inhibitors (durvalumab or atezolizumab), and CTLA-4 inhibitors (ipilimumab or tremelimumab). Patients were excluded if thyroid function tests (TFTs) were not available to review or if patients passed away within 30 days of ICI …

Brief Resolved Unexplained Event (Brue), Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Understanding Inpatient Diagnostic Imaging Use In Children’S Hospitals To Prioritize Stewardship Efforts, Megan Collins, Matt Hall, John R. Stephens, Jessica Markham

Posters

Background: Healthcare waste, including overuse of treatments or testing such as unnecessary diagnostic imaging, has estimated annual costs of over $760 billion in the United States. The most prevalent and costly imaging studies among hospitalized children are not known. Objective: To describe diagnostic imaging studies among hospitalized children with the highest prevalence, cost, rates of repetition, and hospital variation to help inform de-implementation efforts. Design/Methods: We performed a retrospective cohort study of children <18 years of age hospitalized from 1/1/2021 to 12/31/2022 across 45 hospitals in the Pediatric Health Information System. We identified all radiologic imaging for inpatient and observation encounters using billing codes. We grouped images by modality and body location, and excluded images classified as other/unspecified body location. The intraclass correlation coefficient was used to measure variation across hospitals in imaging use after adjusting for age and severity. Higher numbers indicate a higher degree of variation. Results: We identified 1,523,343 encounters; 59.1% had diagnostic imaging (Table 1). The most prevalent diagnostic imaging studies were chest x-ray (XR), abdominal XR, and echocardiogram. The images most frequently repeated were chest XR, echocardiogram, and abdominal XR. The costliest individual diagnostic imaging studies were echocardiogram, chest XR, and head/brain MRI (Table 2). Although chest XR was among the least expensive imaging modalities per unit cost, given the high prevalence of use and repeat use it was one of the costliest tests overall. Head US, interventional XR, and abdominal US had the highest variability of use between hospitals (Table 2, Figure). Conclusion(s): Chest XR and echocardiograms were among the most prevalent, costly, and frequently repeated imaging studies. Abdominal XR, abdominal ultrasound, bone/joint XR, head/brain CT, and head/brain MRI were high in both prevalence and cost among hospitalized children. Five of the 10 most commonly used imaging techniques and four of the 10 most commonly repeated imaging techniques expose children to ionizing radiation. These results could help identify areas that should be targeted to reduce radiation exposure, improve care, and decrease costs for hospitalized children.

Call Me Telephone Triage Skills For Pediatricians Across Multiple Settings, Cody Clary, Jonathan Ermer, Rebecca Callahan, Kayla Heller, Luke Stephens, Margaret Kirkpatrick, Nehal Parikh, Cody Tigges, Madhuradhar Chegondi

Presentations

Come explore current evidence surrounding telephone triage skills across a variety of settings and learn ways to teach these valuable skills while promoting best practices. Outpatient pediatricians, hospitalists, ICU physicians and ED providers all have telephone calls incorporated into their work. Often physicians are operating with very little training in this area, and methodology about teaching these skills to pediatric trainees is limited. We will highlight educational innovations at a variety of programs designed to improve resident and fellow education, sharing our results and providing opportunities for others to design their own content relevant to their own practice. Participants will …

Variation In Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children's Hospitals, Sian Best, Matt Hall, Jessica L. Bettenhausen, Shelby Chesbro, Nicholas Clark, Megan Collins, Adrienne G. Deporre, Jonathan Ermer, Bridgette Jones, Leah Jones, Jessica Markham, Elisha Mccoy, Maria Newmaster, Laura Plencner, Henry T. Puls, Smit Shah, Kathryn Kyler

Presentations

Asthma exacerbations are a leading cause of pediatric hospitalizations, and systemic corticosteroids remain a key component of inpatient treatment. Emergency department-focused studies have shown dexamethasone to be equivalent to prednisone/prednisolone in terms of outcomes such as readmission rates, but less is known about the trends in dexamethasone use versus other systemic corticosteroids, and associated outcomes in the inpatient setting. Objective (216) To describe variability and trends in inpatient systemic corticosteroid prescribing practices for acute asthma exacerbations, and to determine associations between the prescribed steroid and hospitalization outcomes. Design/Methods (949) This retrospective cross-sectional study utilized the PHIS database to examine patients …

The Impact Of Health-Related Social Needs On Health Outcomes Among Youth Presenting To A Midwest Pediatric Diabetes Clinic Network, Jasmine Roghair, Emily Dewit, Katelyn Evans, Mitchell Barnes, Heather Feingold, Samantha Jacob, Courtney M. Winterer, Jeffrey D. Colvin, Mark A. Clements, Shilpi Relan, Kelsee Halpin

Posters

Objective: Screening for health-related social needs (HRSNs) is recommended as part of routine diabetes care given the strong impact of social factors on health outcomes. Our objective was to compare diabetes-related health outcomes among youth presenting to a tertiary diabetes center based on whether they screened positive or negative for HRSNs at a routine clinic visit. Methods: Baseline data were collected from patients whose parent/guardian completed a HRSN screen as part of their child’s diabetes clinic intake from 9/1/21 to 8/30/22. The screen is a 6-item questionnaire adapted from the Accountable Health Communities HRSNs Screening Tool. Longitudinal data were analyzed …

February In Santiago Atitlan, Guatemala, Grace Milburn

Posters

Describes her experience working in Santiago Atitlan, Guatemala.

Approach For Defining Human Adenovirus Infection And Disease For Central Review Adjudication In Clinical Studies., Brian T. Fisher, Jesse Blumenstock, Craig L K Boge, Sydney Shuster, Alix E. Seif, Michael Green, Marian G. Michaels, Jessie L. Alexander, Monica I. Ardura, Tamara P. Miller, Diego R. Hijano, William J. Muller, Jennifer E. Schuster, Abby M. Green, Daniel E. Dulek, Adriana E. Kajon, Lara Danziger-Isakov

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Pediatric allogeneic hematopoietic cell transplant (allo-HCT) recipients are at risk for morbidity and mortality from human adenovirus (HAdV). HAdV can be detected in an asymptomatic state, referred to as infection or with signs or symptoms of illness, referred to as disease. Standardized case definitions are needed to distinguish infection from disease and allow for consistent reporting in both observational cohort studies and therapeutic clinical trials.

METHODS: A working group of experts in virology, transplant infectious disease, and HCT was assembled to develop HAdV infection and disease definitions with the degree of certainty (i.e., possible, probable, and proven). Definitions were …

Population Pharmacokinetic Analysis Of Atomoxetine And Its Metabolites In Children And Adolescents With Attention-Deficit/Hyperactivity Disorder., Shen Cheng, Mahmoud Al-Kofahi, J Steven Leeder, Jacob T. Brown

Manuscripts, Articles, Book Chapters and Other Papers

Atomoxetine (ATX) is a non-stimulant used to treat attention-deficit/hyperactivity disorder (ADHD) and systemic exposure is highly variable due to polymorphic cytochrome P450 2D6 (CYP2D6) activity. The objective of this study was to characterize the time course of ATX and metabolites (4-hydroxyatomoxetine (4-OH); N-desmethylatomoxetine (NDA); and 2-carboxymethylatomoxetine (2-COOH)) exposure following oral ATX dosing in children with ADHD to support individualized dosing. A nonlinear mixed-effect modeling approach was used to analyze ATX, 4-OH, and NDA plasma and urine, and 2-COOH urine profiles obtained over 24-72 hours from children with ADHD (n = 23) following a single oral ATX dose. Demographics and CYP2D6 …