Medical Specialties Commons^™

Dehydrated Hereditary Stomatocytosis Causing Sever Ascites Leading To Pulmonary Hypoplasia And Respiratory Insufficiency In A Neonate, Michael D. Mcdowell Jr, Christopher M. Oermann

Posters

Care Presentation: EM is a 32.5-week EGA infant who was born with sever congenital ascites (following repeated prenatal paracentesis) identified on prenatal ultrasound. Initial chest-abdomen imaging is shown in Figure 1. He required CPAP at delivery but was weaned of high flow nasal cannula with intermittent episodes of prolonged intubation during repeat paracentesis. Paracentesis demonstrated simple ascites rather than chylous fluid. Lymphangiograms demonstrated transient lymphatic leakage with resolution. Genetic evaluation revealed a pathogenic mutation in the PIEZO 1 gene for autosomal dominant DHS. This disorder had reduced penetrance and variable expressivity and symptoms range for absence of clinical features to …

Gonadotropin Releasing Hormone (Gnrh) Agonist Improves Hyperandrogenism In An Adolescent Female With A Novel Insulin Receptor Gene Mutation, Emily Paprocki, Romina Barral, Heidi Vanden Brink, Maria E. Lujan, Tania S. Burgert

Posters

We describe a case of an adolescent female with Type A insulin resistance whose severe hirsutism and hyperandrogenism were improved with leuprolide, despite extreme hyperinsulinemia. Ovarian volume decreased in association with the resolution of hyperandrogenism, consistent with ovarian size reflecting hyperandrogenism in adolescents.

This case allowed us to examine the frequently debated bidirectional relationship between insulin and hyperandrogenism, often deemed independent of gonadotropin activity.

Fetal Ventricular Measurement In Determination For Intrauterine Closure Of Myelomeningoceles, Paige Lundy, Emanuel Vlastos, Paul A. Grabb

Posters

Prenatal closure of myelomeningoceles for fetuses with ventricular width of greater than 15 mm at the time of intrauterine screening (19-25 weeks) has been discouraged, but little is documented regarding the details of ventricle measurement, modality, and timing. This study concludes that ultrasound and MRI provide different results in regards to fetal ventricle size. If treatment recommendations are going to be offered or withheld based on the 15 mm "rule" the method of fetal imaging must be taken into account.

Pediatric Ppi Use And Fractures, Nathan R. Fleishman, Troy Richardson, Thomas M. Attard

Posters

This study compared the rate of fracture among pediatric patients exposed to proton pump inhibitors to the rate among patients without exposure, and also considered the fracture location among children exposed to proton pump inhibitors.

Quality Improvement: Implementing A Foot Exam To Improve Care For Patients With Diabetes Mellitus, Emily Paprocki, Ryan Mcdonough, Tiffany Musick, Joseph Cernich

Posters

The American Diabetes Association guidelines recommend an annual foot exam in patients with type 1 and 2 diabetes who are ten years old or older and who have been diagnosed with diabetes at least five years. Quality improvement tools were used to improve the care provided to our patients by implementing an annual food exam.

Outcomes Following Dynamic Compression Bracing For Pectus Carinatum, Charlene Dekonenko, Robert M. Dorman, Amy L. Pierce, Beth A. Orrick, David Juang, Pablo Aguayo, Jason D. Fraser, Tolulope A. Oyetunji, Charles L. Snyder, Shawn D. St Peter, G W. Holcomb Iii

Posters

We describe our experience with dynamic compression bracing for pectus carinatum patients and their satisfaction with bracing.

Neuroblastoma In Adolescents And Children Older Than 10 Years: Unusual Clinicopathologic And Biologic Features, Laura Mccarthy, Katherine Chastain, Terrie Flatt, Eugenio Taboada, Robert E. Garola, John Herriges, Linda D. Cooley, Atif Ahmed

Posters

This poster describes four cases of neuroblastoma diagnosed since 2008 in children greater than 10 years and presents their clinical, histologic and biologic features, emphasizing unusual clinicopathologic characteristics and the role of DNA microarray analysis and Next Generation Sequencing in their management.

Predictive Performance Of Existing Population Pharmacokinetic Models Of Tacrolimus In Pediatric Kidney Transplant Recipients, Alenka Chapron, Susan M. Abdel-Rahman

Posters

With the goal of developing a clinician-driven tacrolimus (TAC) pharmacokinetic dosing tool, our initial objectives were 1) to examine whether published TAC population pharmacokinetic (popPK) models could serve as a foundation for the dosing tool, and 2) evaluate their performance predicting TAC concentrations in an independent cohort of Children's Mercy patients.

A Nsqip Analysis Of Post-Operative Antibiotic Utilization In Uncomplicated Appendicitis, Charlene Dekonenko, Robert M. Dorman, Janelle R. Noel-Macdonnell, Tolulope A. Oyetunji

Posters

APSA 2010 recommendations do not support antibiotic use post-operatively following appendectomy for uncomplicated appendicitis, but compliance varies by institution. This study determined the rate of post-operative antibiotic use in uncomplicated appendicitis and found that 10% of patients were discharged on antibiotics, using the NSQIP files.

Self-Reported Outcomes Following Cholecystectomy For Pediatric Hyperkinetic Biliary Dyskinesia, Charlene Dekonenko, Joseph A. Sujka, Robert Michael Dorman, Tolulope A. Oyetunji, Shawn D. St Peter

Posters

The aim of this study is to determine if children with hyperkinetic biliary dyskinesia have resolution of symptoms after laparoscopic cholecystectomy at our institution.

Conclusion: Cholecystectomy for hyperkinetic biliary dyskinesia may or may not improve symptoms. Further research should focus on pathophysiology of the disease in order to create an evidence-based definition of biliary dyskinesia in children to determine who will benefit from cholecystectomy.

Improving Discharge Communication With Outpatient Providers On The Hospitalist Service, Nicholas Clark, Julia Simmons, Angela Etzenhouser, Troy Richardson, Patrick Brady, Eugenia K. Pallotto

Posters

Describes a quality improvement project to increase two-way discharge communication between pediatric hospitalists and primary care providers from 7% to >80% within 18 months.

Practice Variations In Sedated Echocardiography And Impact On Repeat Echocardiography In Non-Refractory Kawasaki Disease, Nicholas Clark, Troy Richardson, Jennifer E. Schuster, Anitha Parthiban, Henry T. Puls

Posters

This study discovered significant variation among children's hospitals in the use of sedated echocardiiography for children <30 months of age with non-refractory Kawasaki disease prior to the American Heart Association 2017 Kawasake disease guideline update. Consideration should be given to performing sedated echocardiography as it may reduce the need for repeat echos without impacting length of stay or total costs.

The Effect Of Antihypertensive Dosing On Hypertension In Children With Chronic Kidney Disease, Benjamin A. Matta, Uri S. Alon, Bradley Warady Md, Tarak Srivastava, Darcy Weidemann

Posters

Background

Hypertension (HTN) is a highly prevalent and major risk factor for poor cardiovascular and renal outcomes in chronic kidney disease (CKD). Previous research suggests that HTN is underdiagnosed and undertreated in children with CKD. To our knowledge no studies have investigated the effect of antihypertensive (antiHTN) dose on blood pressure (BP) control in this population.

Objective

To determine the effect of antiHTN dose on HTN status in children with CKD.

Methods

Study population: 255 participants studied in the Chronic Kidney Disease in Children (CKiD) study at their 3rd visit, taking at least 1 antiHTN drug.

Cumulative Drug Dose Index …

Improving Bronchiolitis Care Across Multiple Care Settings Using A Deimplementation Bundle, Amanda Nedved, Kathleen Berg, Troy Richardson, Amanda Montalbano, Matthew B. Johnson

Posters

Despite the availability of a bronchiolitis CPG; variation in care practices still existed at our institution. The aim of our quality improvement (QI) project was to increase overall adherence with our institutional CPG in patients 60 days to 24 months of age diagnosed with bronchiolitis in the urgent care centers (UCC), emergency departments (ED), and general inpatient units from a baseline of 40.9% to 60% by the end of two bronchiolitis seasons.

Total And Free Plasma Bilirubin And Clinical Outcomes In Severe Hyperbilirubinemia, Sean M. Riordan, Jean-Baptiste Lepichon, Steven Shapiro, Tina Slusher, Fatima Abdullahi, Hafsat M. Suleiman, Victor C. Pam, Mamu B. Samuel, Christopher S. Yilgwan, Christian Isichei, Idris Y. Mohammed

Posters

Acute bilirubin encephalopathy (ABE) and kernicterus spectrum disorder (KSD) have become relatively uncommon in high income countries but remain a major cause of morbidity and mortality in low- and middle-income countries. To better understand the relationship between free (Bf) and total (TB) bilirubin levels and the development of ABE and KSD we followed infants born in three large tertiary centers in northern and central Nigeria (Jos, Kano and Zaria).

Weighted Pathway Genetic Load Analysis Of Hyperbilirubinemic Infants Indicates A Potential Genetic Component For Susceptibility To Bilirubin Neurotoxicity, Sean M. Riordan, Jean-Baptiste Lepichon, Steven Shapiro, John Cowden, Monica Villagullen, Laurence Thielemans, Dina Villanueva Garcia, Jesus Aguirre-Hernandez

Posters

Severe kernicterus spectrum disorder (KSD) is described as motor and auditory deficits resulting from brain damage caused by hyperbilirubinemia. The severity of HB does not always predict the severity of injury. The lack of a strong monogenetic link to susceptibility suggests bilirubin-induced brain damage may be due to impaired bilirubin response pathways. This poster describes work to use a modified pathway genetic load (mPGL) score method to perform a targeted genetic analysis of whole exome data from patients with various degrees of neonatal HB, with an ultimate goal of developing a neonatal screen to susceptibiltiy to bilirubin neurotoxicity.

Developing Technologically Advanced Research In Low- And Middle-Income Countries, Isa Abdulkadir, Tina Slusher, Fidelia Bode-Thomas, Sean Riordan, Jean-Baptiste Lepichon, Laila Hassan, Shehu Abdullahi, Akinyemi Ofakunrin, Stephen Oguche, Steven Shapiro, William Ogala

Posters

This poster presents a collaboration between a group of scientists in Nigeria and the USA in developing a genomic research project and the solutions adopted in tackling the ethical implications and partnership equity and ownership of such a project.

Implementing Zero/Neutral Displacement Iv Connectors To Reduce Blood Stream Infections, Kirsten Mitchell, Barbara Mcclaskey

Posters

Catheter related blood stream infections are a major problem in the United States and account for over $225 million each year with over 1,300 infections occurring each day. By researching the most effective type of IV connector, health care providers can provide the best and safest care possible to patients requiring IV access. Zero/neutral IV connectors may be the answer to decreasing these infections as they produce no reflux in the connector which is a breeding ground for bacteria and occlusions. This literature review found that zero/neutral connectors performed better than positive and negative IV connectors when comparing both reflux …

Is The Current Concussion Protocol For Student Athletes Enough?, Trey Morgan, Barbara Mcclaskey

Posters

In the world of sports there are bound to be accidents and one of the most common kinds of accidents are concussions. It has been reported that 10-20% of high school student athletes will experience a concussion. The purpose of this study was to examine the current concussion protocol for student athletes and to identify the best practices for a diagnosis and follow-up to decrease the likelihood of any severe brain damage. The methodology was a literature review. Evidence in the literature reported that individual educational plans (IEP) have been shown to be good at helping student athletes get back …

Implementing The Summer Food Service Program Within The Healthcare Setting, Laura M. Plencner, Margo Quiriconi, Sarah Sentmore, Molly Krager

Posters

The Summer Food Service Program was established to ensure that children continue to receive adequate nutrition while school is out. This poster describes how the program was implemented in the Children's Mercy Kansas City healthcare system from 2016-2018.

Utility Of Point-Of-Care Beta-Hydroxybutyrate Testing For Predicting Diabetic Ketoacidosis In The Pediatric Emergency Department, Michelle Knoll, Kelsee Halpin, Ryan Mcdonough

Posters

The objective of our investigation was to describe the diagnostic characteristics of point-of-care capillary beta-hydroxybutyrate (BOHB) testing to predict diabetic ketoacidosis among pediatric patients presenting with hyperglycemia in the pediatric emergency department.

Global Health Elective: Santo Domingo, Dominican Republic, Joan Strong

Posters

Describes the experiences of a pediatric anesthesiology fellow's time working Medical Aid for Children of Latin America (MACLA) in Santo Domingo, Dominican Republic.

Choosing Catheter Sheath Introducers In Infants-Information You Are Not Provided But Should Have!, Christopher Mathis, Ryan Romans, Abhay Divekar

Posters

Background: The advertised catheter sheath introducer (CSI) size, the internal diameter (ID), defines the maximum size of medical devices that can pass through it. However, the outer diameter (OD) determines the risk of vascular injury, varies considerably between manufacturers, and is not advertised. The highest risk of vascular injury is in infants less than one year of age and 3 - 6Fr CSIs are typically used.

Methods: The OD of 3, 3.3, 4, 5, and 6F CSIs (5 of each size) from different manufacturers were measured using a Mitutoyo Digital Micrometer. CSIs were measured with the dilator in place. Three …

Global Health Experience In Botswana, Sarah Bieser

Posters

Describes experience providing care at the Botswana-Baylor Children's Center of Excellence in Gabarone, Botswana and the Princess Marina Hospital.

Global Health Elective, Philippine Children's Medical Center, Keith J. Martin

Posters

Describes a global health learning experience working in the Philippine Children's Medical Center in Quezon City, Metro Manila, Philippines.

Global Health Elective In San Pedro La Laguna, Guatemala, Page Pomo

Posters

Future outpatient general pediatrician serving bilingual populations describes working in rural Guatemala and opportunities to practice Spanish language skills.

Burnout And Resilience Among Pediatric Residents In Stockholm, Sweden: Findings From A Mixed-Methods Study, Lauren Poull, Sanaz Skyttner-Rahmani, Andrea P. Anderson, Weston T. Powell, Jiaqi Yin, Carolyn C. Foster, Maneesh Batra

Posters

Objective

 To measure the prevalence of burnout among pediatric residents at Karolinska University Hospital (KUH).
 To describe the local drivers of burnout and the protective factors that lead to resilience and workplace engagement.

Conclusions

 Prevalence of burnout among Swedish pediatric residents in this study was 39%, which is lower than reported in the US (50-60%).
 Drivers of burnout were identified across all four domains. They included local features of the learning environment, and many are modifiable.
 Protective factors include perceived control over scheduling, better mental and physical health, lower perceived stress, and being a parent. …

The Lake Clinic Cambodia, A Medpeds Experience . . ., Jeremy Jennings, Jennifer Watts

Posters

Describes global health learning experience providing ambulatory care in Cambodia.

Creating Staff Engagement In Transition Planning Through The Use Of Data, Teresa Hickam, Michelle Bozarth

Posters

In 2017 the Children's Mercy Kansas City Transition Program provided 14 Divisions and 28 programs with data to support their hard work. 2,160 of 3,768 patients (61%) completed readiness assessments and held transition-related discussions with their health care team.

Data reports providing timely, routine feedback on staff success and missed opportunities helps keep staff engaged, their efforts visible and transition planning on a conscious level.

General Philippine Hospital, Manila, Philippines, Cara Cecil

Posters

Describes her experience working in the Philippine General Hospital/University of the Philippines providing care in the pediatric ICU, neonatal ICU, and emergency department.