Medical Specialties Commons^™

Bivalirudin Versus Heparin In Patients With Congenital Diaphragmatic Hernias Requiring Extracorporeal Life Support, Cory Nonnemacher, Seth Saylors, Vatche Melkonian, Richard Hendrickson, Inna Lobeck

Research Days

Introduction

Congenital Diaphragmatic Hernia (CDH) is a rare congenital anomaly. The pulmonary hypoplasia, pulmonary hypertension and altered cardiac function associated with CDH may result in early cardiorespiratory failure requiring life-saving extracorporeal life support (ECLS). Early repair of CDH on ECLS has shown to improve survival, but poses an increased bleeding risk due to anticoagulation. Heparin has traditionally been the anticoagulant of choice for ECLS. Recent data has suggested that the use of bivalirudin may result in lower bleeding rates and transfusion requirements. This study aims to stratify complications for patients with CDH repaired on heparin versus bivalirudin, hypothesizing that complications …

Spinal Deformity Characteristics Associated With Intraspinal Anomalies In A Population Of Presumed Ais, Connor Mathes, Aaron Shaw, Bill Woodhams, John Anderson, Michael Benvenuti, Richard Schwend

Research Days

This study aims to identify an association between pre-operative radiographic criterion and the presence of an underlying intraspinal anomaly in patients presenting with presumed adolescent idiopathic scoliosis undergoing posterior spinal fusion.

Adherence To Oral Iron In Adolescent Females With Iron Deficiency Secondary To Heavy Menstrual Bleeding, Kennedy Sheedy, Lauren Amos Md, Ms

Research Days

Iron deficiency is an important, but often minimized issue among adolescent females. While treat with oral iron is generally first-line treatment, IV iron has been shown to be safe and effective. Our study looks at adherence and barriers to oral iron treatment and assesses current use of IV iron for iron deficiency at Children's Mercy, in hopes of helping move towards utilizing the most beneficial treatment for each individual patient.

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Research Days

Background: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or ABRS treated with an optimal antibiotic duration (3-5 days for CAP, 5-7 days for ABRS) from 13% to 70% by July 25.

Methods: Outcome metric is the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics include use of order set, "Quick Discharge” order set, and clinical pathway QR codes. Balancing metric is the number of return visits with the same diagnosis < 14 days. Plan-Do-Study-Act methodology was used. In Aug 23, our ASP disseminated a handbook that emphasized shorter durations. A new multidisciplinary team (infectious diseases, ED, and urgent care physicians, advanced practice providers, nurses, and pharmacy) formed in Dec 23. We utilized cause-and-effect analysis, driver diagram, and prioritization matrix, which helped identify other impactful interventions, including implementation of new internal CAP clinical pathway order set (April 24) and “Quick Discharge” order sets (May 24). Next, we surveyed prescriber comfort (June 24) with shorter duration identifying barriers and providing education, leading to posted evidence for lower duration treatment in practitioner workrooms and developing a new ABRS clinical pathway (Sept 24). Top prescribers providing optimal duration received email acknowledgement (Oct 24) and resident rotators received antibiotic handbook and CAP clinical pathway QR codes (Nov 24). New best treatment practices for ABRS were elucidated and disseminated through clinical pathway and internal article publishing to our hospital and associated clinics (Dec 24).

Results: We saw shifts in the outcome metric’s center line in Sept 23 …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative., Allison Adam, Leslie Hueschen, Lina Patel, Christopher Kaberline, Ibad Siddiqi

Research Days

Background: Guidelines published by the National Heart, Lung and Blood Institute recommend that patients with sickle cell disease who present in acute pain crisis receive narcotic medication < 60 minutes from arrival. Multi-center studies indicate approximately 50% of institutions are adherent to this level 1a recommendation. From October 2022-October 2023, our institutional median time to narcotic was 61 minutes.

Objective: Our aim was to decrease the time to narcotic administration by 10% (61 min to 55 min) in patients with Sickle Cell Disease presenting to the emergency department for acute pain crisis while simultaneously decreasing disparities in our patient population by Oct 2024. Additionally, we sought to increase the percentage of patients within this population to receive their first narcotic in 60 min from 49% to 70%, by Oct 2024.

Methods: We …

Same Day Discharge Following Minimally Invasive Repair Of Pectus Excavatum Following An Eras Protocol, Cory Nonnemacher, Seth Saylors, Meredith Elman, Pablo Aguayo, Charles Snyder, David Juang, Beth A. Orrick, Amy L. Pierce, Shawn St. Peter, Tolulope Oyetunji

Research Days

Background/Purpose

Corrective surgery for Pectus Excavatum comes primarily via the Nuss procedure. Pain control contributes significantly to the postoperative length of stay (LOS). Optimization of pain control can be achieved in multiple ways in the form of an Enhanced Recovery After Surgery (ERAS) protocol. The purpose of our study is to assess the success of same-day discharge with a ERAS protocol for same-day discharge (SDD) of patients undergoing Pectus Excavatum repair.

Methods

A retrospective review of patients from August 2022 to August 2024 at a stand-alone tertiary care children’s hospital who underwent minimally invasive repair of Pectus Excavatum was performed. …

A Single Center Qualitative Study To Improve Coordination Of Follow-Up Care For Patients Diagnosed With Abusive Head Trauma, Ruairi Smith-Dewey, Elise Wright, Daniella Donofrio, Hannah Goebel, Sara Kilbride

Research Days

Background/Project Intent: Review of cases identified 16 possible follow-up needs. A single patient had a maximum of 12 potential needs. Needs not being addressed included written documentation for need of follow-up without subsequent referral placed/appointment scheduled or need not addressed at all. The goal of this project was to have all follow-up needs addressed for at least 50% of children diagnosed with AHT by January 2025.

Methods: All children admitted to CMH from January 2024-December 2024 and diagnosed with AHT by the Safety, Care & Nurturing (SCAN) team were included. Interventions were designed and implemented by a multidisciplinary team to …

Implementing Balanced Fluid Resuscitation For Sepsis Patients In A Tertiary Care Pediatric Emergency Department, Grace E. Arends Md, Christopher Kaberline, Ibad Siddiqi, Sarah Nienhaus, Viktoriya Stoycheva Mha, Rn, Cpn, Leslie Hueschen

Research Days

Background

National data supports balanced fluid during volume resuscitation in the setting of sepsis as it improves morbidity and mortality, particularly preventing acidosis and kidney injury. Despite this recommendation, the CMH ED still has not implemented balanced fluid resuscitation.

Aim

The aim of the project is to increase the percentage of patients with positive sepsis screen treated in the CMH Adele Hall Emergency Department receiving lactated ringer’s fluid resuscitation from 4.6% to 15% by June 2024.

Methods

Primary outcome measures were percentage of patients with suspected sepsis who received at least one LR fluid bolus, as well as percentage of …

Ecmo Without Compressions Versus Ecpr For Lcos Following Cardiac Surgery, Amjad Halloum, Apurva Panchal, Sarah Tabbutt, Martina Steurer, Mousumi Banerjee, John Charpie, Javi Lasa, Amy Mccammond, Katie Moynihan, Nancy Ghanayem, Tia Raymond

Research Days

A retrospective study looking into ECMO vs eCPR outcomes in the CICU. By refining the approach to postoperative ECMO initiation, this study aims to contribute valuable insights that could improve survival and reduce complications in pediatric cardiac surgery patients.

Respiratory Failure In Pediatric Hematology And Oncology Patients On Extracorporeal Membrane Oxygenation: A Comparative Analysis, Michelle Brown Do, Jenna Miller, Asdis Finnsdottir Wagner, Erin Hall, Maya Dewan Md, Christopher Dandoy Md, Kalee Grassia Md, Bin Zhang Phd

Research Days

This project was a retrospective comparative analysis between two tertiary care pediatric institutions. The primary objective entailed examining survival outcomes in the oncologic and hematopoetic stem cell transplant patient populations with respiratory failure in the presence and absence of ECMO support.

A Case Of Heterotaxy And Common Atrioventricular Canal With Bradycardia, Mohamed Aashiq Abdul Ghayum, Jenna Schermerhorn, Hayley S. Hancock, Kelsey Brattrud, Melanie Kathol, Maria Kiaffas

Research Days

Background

Heterotaxy-polysplenia syndrome (otherwise known as left atrial isomerism) should be suspected in the presence of complete atrioventricular canal defect (CAVC) with interruption of the inferior vena cava (IVC), atrioventricular block (AVB), and viscero-cardiac heterotaxy. The prognosis remains dismal for the fetus with such entity, especially in the presence of major structural heart disease and high-grade atrioventricular block. Early diagnosis, close follow up, and appropriate delivery planning, allows for effective stabilization of the baby after birth and might improve survival.

Methods

A 26-year-old mother at 26 weeks gestational age was referred for cardiac evaluation of cardiomegaly, suspected CAVC and bradycardia. …

Utilization Of Physical Activity As A Vital Sign (Pavs) To Improve Personalized Exercise Assessment And Counseling In Pediatric Cardiology Patients, Lavina Desai, Josh Holbert, Jessica S. Watson, Amanda Mcintosh, David A. White, Megan Jensen

Research Days

Background: Physical activity is a known preventative effort that has a clear role in improving cardiorespiratory fitness and health outcomes. Low levels of habitual physical activity (PA) in children and adolescents with congenital heart disease (CHD) leads to various negative health outcomes, yet review of the literature indicates that physicians, caregivers, and patients restrict physical activity owing to safety concerns [1]. Root cause analysis (Fig 1.1) identified a lack of readily available data to provide assessment of baseline PA in patients presenting to the cardiology clinic. Therefore, this project aims to implement physical activity as vital sign (PAVS) via a …

Bisphosphonate Treatment In Pediatric Patients With Rare Ovarian Malignancy And Hypercalcemia: A Case Series, Samhita Bhattarai, Seth Lamb, Jennifer W. Boyd

Research Days

Objectives

To describe the presentation, management, and outcomes of severe hypercalcemia in two adolescent females secondary to ovarian malignancy.

Methods

The case series includes two adolescent female patients, aged 11 and 16, diagnosed with rare ovarian malignancies and associated hypercalcemia. Both patients presented with abdominal pain, nausea and constipation. The 11-year-old received zoledronic acid while the 16-year-old received pamidronate. Serum calcium levels, symptoms and medication side effects were monitored before and after bisphosphonate therapy.

Results

Both girls presented with severe hypercalcemia. Patient 1 was an 11-year old girl who presented with serum calcium of 15.0 mg/dL. She began hyperhydration with …

Assessing Ecg Abnormalities In Pediatric Athletes: A Retrospective Study On Incidence And Implications For Screening Protocols, Arkadeep Ghosh, Mark Gelatt, Lindsey Malloy-Walton, Ashley K. Sherman

Research Days

Background: Utilization of Electrocardiogram (ECG) screening in pediatric athletes remains controversial. The American Heart Association (AHA) hasn't supported the use of mandatory ECG screening for pediatric sports evaluations. The financial burden universal ECG screening in pediatric athletes poses on the healthcare system has supported that screening may not be justified given the low incidence of significant cardiac disease.

Objectives/Goal: This study aimed to examine the incidence, type of ECG abnormalities, and associated risk factors in healthy pediatric athletes.

Methods/Design: A single center retrospective cohort study was conducted on a local male youth competitive soccer program, ages 11-18. Exempt status was …

Temperature Monitoring In The Cardiac Operating Room, Abby Pint, Clint Humpherys, Dave Stubler, Nathaniel Lata

Research Days

Background: The goal of this project is to improve the accuracy of temperature readings in the cardiac operating room and, in turn, improve patient safety.

Methods: The project obtained nasopharyngeal, tympanic, and bladder/rectal temperature measurements from twenty CPB cases. Measurements were obtained at six critical points: time of incision, initiation of CPB, aortic cross clamping, removal of aortic cross clamping, CPB termination, sternal closure. Data was analyzed to determine discrepancies among methods of measuring temperature for each type of probe utilized. Plan: Tympanic probes are unreliable and provide lower temperature measurements when compared to other probes Do: Temperatures recorded from …

Academic Half Days Dedicated To Phone Triage Improves Resident Confidence To Independently Triage Calls, Sarah Gwazdacz, Kelsey Gavin, Cati Kral

Research Days

We aim to improve Children’s Mercy residents’ confidence and competence to independently triage admission phone calls, and to help residents develop a system to obtain information during a transport phone call through dedicated academic half days.

A needs assessment at the beginning of the 2024-25 academic year was completed to assess the need for triage education. Then, curriculum design, goals & objectives, educational strategies, and implementation of the half day were discussed with leaders in medical education, admission hub physicians, and hospital medicine. Pediatric residents of all training levels were divided into 5 cohorts of 10-15 participants, which rotated through …

Favorability Of Progesterone With Estrogen Among Physicians In Transgender Adolescents: A Survey, Samhita Bhattarai, Michelle Knoll

Research Days

To evaluate the current perspective and clinical practices of physicians regarding the use of synthetic progestins as an adjunct to estrogen therapy in transfeminine adolescents. The survey focuses on perceived benefits, risks and overall efficacy in gender affirming hormone therapy.

Low-Dose Bevacizumab Treatment For Retinopathy Of Prematurity, Makayla Ayres, Katherine Brown Md

Research Days

Background: Retinopathy of prematurity (ROP) is an eye disease that affects very premature infants and causes blindness. Treatment for ROP consists of anti-VEGF intravitreal injections (e.g., bevacizumab), laser therapy, and cryotherapy. The concern of anti-VEGF intravitreal injections is systemic toxicity and potential detrimental effects on these developing infants. In research trials, doses as low as 0.031 mg of bevacizumab have been shown to be effective in treating ROP. However, in clinical practice, the most common doses used are 0.125-0.25 mg.

Objectives/Goal: At CMKC, 0.075 mg doses of bevacizumab have been used to treat Type 1 ROP since 2022. We aim …

Navigating The Fallout: How Pediatric Spine Surgeons Cope, Recover, And Persevere After Major Surgical Complications, Sandeep Yanamala, Richard M. Schwend, Hannah Geoffroy, Gary Sutkin

Research Days

Hypothesis: We hypothesized that surgeons who continue practicing after a major complication are more likely to have strong institutional and peer support, a growth mindset, and access to coping mechanisms that mitigate distress and legal pressures. Study Design:
Qualitative study using Constructivist Grounded Theory (CGT) based on semi-structured interviews with pediatric spine surgeons who have experienced major surgical complications.
Introduction:
Complications in pediatric spine surgery have significant emotional, ethical, and legal
consequences. However, little is known about the factors that differentiate surgeons who continue performing spine surgery from those who transition away.
Methods:
33 pediatric spine surgeons were interviewed (28 …

Early Cholestasis And Vitamin K Deficiency Secondary To Biliary Atresia Presenting As Coagulopathy And Thymic Hemorrhage, Abbey Elsbernd, Lauren Amos Md

Research Days

Background

Bleeding and progressive coagulopathy are established symptoms of early cholestasis, including extrahepatic biliary atresia. We present a patient with bleeding secondary to vitamin K deficiency and cholestasis-induced fat malabsorption with unusual presentation of mediastinal mass.

Objective

Describe a case of late-onset vitamin K deficiency and cholestasis presenting as jaundice and coagulopathy with associated bleeding into thymic structures Design/Method

Case report

Results

A 4-week-old term male infant was brought to the ED with fussiness and bruising. Prior to presentation, he was afebrile and followed regularly with his primary care provider for jaundice below phototherapy thresholds. Infant received vitamin K at …

Pain Outcomes In Adolescents With Surgically Confirmed Endometriosis: A Single Site Retrospective Cohort Analysis, Madeline Ross, Samantha Janssen, Priya Suvarna, Adam Booser, Ashli Lawson

Research Days

Background: In adolescents with significant dysmenorrhea, empiric therapy via analgesics and hormonal medications is considered gold standard. However, those with refractory pain may have endometriosis. Thus, it is recommended to engage in shared medical decision making with these patients regarding diagnostic laparoscopy. If endometriosis is detected intraoperatively, these lesions are often fulgurated or excised. There currently is a paucity of data regarding the benefits of diagnostic laparoscopy and destruction of lesions in the adolescent population.

Objectives/Goal: To evaluate long-term pain management outcomes and care patterns in adolescent patients undergoing surgical evaluation for endometriosis.

Methods/Design: This was a single-site, retrospective cohort …

Association Of Respiratory Viral Testing And Antibiotic Use For Pediatric Patients Admitted For Acute Respiratory Illness Between 2017-2021 At Children’S Mercy-Kansas City, Edward Lyon, Brian Lee, Rangaraj Selvarangan, Jennifer Schuster

Research Days

Retrospective comparison of hospitalized pediatric patients who did or did not have clinical viral respiratory testing performed to understand if antibiotics were used differently between these groups.

Transition Skills Lab: A Telehealth Intervention For Improving Healthcare Transition In Youth With Special Health Care Needs, Angela Combs, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Research Days

The goal of this abstract is to evaluate youth skill-building and confidence across health care tasks through the virtual Transition Skills Lab.

Long-Term Physical And Emotional Functioning In Children Following Intensive Interdisciplinary Pain Treatment For Amplified Pain Syndrome, Sabrina Ung, Jacqueline Pabis Phd, Jenny Scheurich Phd, Dustin Wallace Phd

Research Days

The current study aimed to examine the efficacy of pediatric interdisciplinary pain treatment (IIPT) several years after treatment completion by exploring mean-level changes of physical and mental health functioning pre-intervention, post-intervention, and at follow-up 2 to 6 years after IIPT completion.

Comparing Bilateral And Unilateral Metal Stabilizers: Incision Complications In Pectus Repair, Seth Saylors, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph, Nelimar Cruz-Centeno, Nitin Nadella

Research Days

Introduction: The use of metal stabilizers in minimally invasive pectus excavatum repair (MIPER) has been previously associated with multiple postoperative complications. We aimed to identify if bilateral metal stabilizers increase the risk of incision complications when compared to unilateral stabilizers.

Methods: Institutional Review Board approval was obtained. Patients that underwent MIPER with metal stabilizers from 2019 to 2022 and currently had the bar in place, at a single tertiary care pediatric center, were included. A telephone survey evaluated if they had incision-associated symptoms, and if the location was congruent with the stabilizer site. A retrospective chart review was performed to …

Rare Complications Associated With Use Of Bovine Pericardium, Mohamed Aashiq Abdul Ghayum, Nitin Madan, William J. Gibson, Sanket Shah

Research Days

Background

Bovine Pericardium (BP), with numerous and improving preparation techniques, has been used extensively for over 50 years in repair of simple and complex congenital heart defects. It has several advantages over other surgical materials. However, there is a paucity of data in the pediatric population regarding complications associated with BP. Herein, we report two rare complications noted with BP use.

Case Description

Case 1. A 14-month-old male, with trisomy 21 and complete Atrioventricular canal defect, repaired using BP. A routine surveillance echocardiogram showed a mass attached to the atrial septum and atrial aspect of the left atrioventricular valve (Figure …

Exploring The Role Of Pain On Physical Activity Among Youth With Acute Lymphoblastic Leukemia Using The Biopsychosocial Model, Anna E. Van Asselt, Renee Gilbert, Meghan Tokala, Jacee Weber, Meredith L. Dreyer Gillette, Robert C. Gibler, Carolyn R. Bates, Keith August

Research Days

The Role of Pain on Physical Activity in Pediatric ALL

Keywords: Biopsychosocial model, pediatric Acute Lymphoblastic Leukemia, pain, physical activity

Introduction: Engaging in physical activity (PA) during cancer treatment benefits a child’s physical and mental well-being (McLaughlin et al., 2021). However, engaging in PA may be challenging due to treatment and disease-related pain (Uhl et al., 2020). Pediatric cancer research has primarily focused on management of procedural and chronic pain, with fewer studies examining how pain may interfere with PA during treatment (Clews et al., 2022). The current study qualitatively investigated the impact of pain on PA using a …

Reducing Sharps Disposal In The Operating Room, Kasey Brooks, Brandon Layton

Research Days

Used an education program to reduce the amount of sharps waste in the operating room within the anesthesia department.

Delirium On Admission To The Cicu, Spencer Wittmeyer, Jaime Silva-Gburek, Kelly S. Tieves

Research Days

Background: Delirium is increasingly recognized in the pediatric cardiac intensive care unit (CICU) with an incidence up to 67% and is associated with worse outcomes including increased mortality, prolonged hospitalization, and increased rates of intubation and mechanical circulatory support. The Cornell Assessment for Pediatric Delirium (CAPD) is the only validated tool for the diagnosis of delirium in the pediatric population. The CAPD may be limited in children with developmental disabilities as it does not account for baseline ability in scoring. Prior work has identified low specificity for the CAPD in children with developmental disabilities and those requiring mechanical ventilation. This …

Pain Management In Perforated Appendicitis: Transitioning To A Minimal Narcotic Strategy, Seth Saylors, Meredith Elman, Pablo Aguayo, Rebecca M. Rentea, Richard J. Hendrickson, David Juang, Charles L. Snyder, Jason D. Fraser, Tolulope A. Oyetunji Md Mph, Shawn D. St Peter, Nelimar Cruz-Centeno, Charles Marchese

Research Days

Introduction: Patient controlled analgesia (PCA) was previously standard for postoperative pain control in children with perforated appendicitis at our institution. We previously reported the equivocal outcome of intravenous (IV) acetaminophen as a pain control adjunct used to transition from PCA to oral narcotics. We have since transitioned to a PCA-free, multi-modal pain control regimen postoperatively in perforated appendicitis. Through observational study, we aim to describe the impact of our new pain control regimen on postoperative narcotic use.

Methods: Children– June 2020 at a single freestanding children’s hospital were reviewed. Details of their hospitalization, including demographic, operative, anesthesia, pain management, and …