Pediatrics Commons^™

Healthier Together: A Holistic Office Protocol Addressing The Chronic Nature Of Children And Adolescents With Adhd, Kimberly Olmos

Evidence-Based Practice Project Reports

Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent, chronic condition with symptoms that include inattention, hyperactivity, and impulsivity. ADHD affects six million children in the United States (Tran et al., 2021). The purpose of this evidence-based practice project was to implement a holistic office protocol that addressed the chronicity and future health outcomes of children and adolescents, ages 2-17 years with ADHD through stimulant or non-stimulant medication prescriptions, behavioral therapy referrals, and education surrounding diet, and exercise. A comprehensive, systematic literature search yielded 16 articles to determine best practice when treating children and adolescents with ADHD in primary or …

The Effect Of Using A Meal Tracking Smartphone Application In Overweight And Obese Adolescents With Prediabetes Or Type 2 Diabetes To Improve Bmi And Hba1c, Lauren Torhorst

Evidence-Based Practice Project Reports

Obesity has become one of the most common chronic pediatric illnesses worldwide and is closely linked to the onset of prediabetes and subsequent Type 2 Diabetes (T2D); therefore, preventing and treating childhood obesity has become a high priority (Hampl et al., 2023). The purpose of this Evidence-Based Practice (EBP) project is to lower Glycosylated Hemoglobin A1c (HbA1C) and Body Mass Index (BMI) in overweight and obese youth with prediabetes and T2D using a meal tracking smartphone application. The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was utilized to pilot this project between two pediatric endocrinology offices located in Southeast Wisconsin. …

Prognostic Values Of Serum Lactate-To-Bicarbonate Ratio And Lactate For Predicting 28-Day In-Hospital Mortality In Children With Dengue Shock Syndrome, Thanh Nguyen Tat, Nhu Vo Hoang-Thien, Dat Nguyen Tat, Phuc Hoang Nguyen, Lien Thi Ho, Duong Hung Doan, Dung Tuan Phan, Yen Nguyen-Hoang Duong, Truc Huynh Nguyen, Tuyet Kim Nguyen, Ha Thi-Thu Dinh, Thuy Thi-Diem Dinh, Anh Thi-Mai Pham, Viet Do Chau, Tung Huu Trinh, Luan Vo Thanh

Faculty, Staff and Student Publications

This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of …

Perception Of Pediatric Readiness Across A Health System's Emergency Departments, Rebekah L. Sabo

Doctoral Dissertations & Projects

The recent pandemic and pediatric respiratory syncytial virus surge have reinvigorated pediatric care readiness conversations. National strategies and associations exist to guide health systems in improving the quality of emergency care offered to pediatric populations by first assessing readiness for care. These research strategies center on survey implementation and staff engagement in general emergency departments with the goal to improve staff readiness to care for pediatric patients that may present for treatment. What impact would developing a consolidated pediatric readiness program that includes: pediatric emergency care coordinator designation for each emergency department, pediatric readiness education and committee engagement have on …

Learning Circles: Promoting Inclusive Care Starting In The Classroom, April Graham, Kindsey Gattman, Tobias Johnson

Articles, Abstracts, and Reports

No abstract provided.

The Impact Of Kangaroo Care On The Weight Gain Of Premature Infants, Heather Vincequere

SACAD: Scholarly Activities

Premature birth remains a global health concern, affecting approximately 15 million infants annually (WHO, 2023). Kangaroo Care (KC), involving skin-to-skin contact between caregivers and infants, was developed as a promising intervention to mitigate the adverse effects of prematurity. This study aimed to investigate the impact of KC on weight gain among preterm infants in the neonatal intensive care unit (NICU) at Doctors Hospital of Augusta (DHOA). A quasi-experimental quantitative posttest-only design was employed, with eight preterm infants (< 37 weeks gestation) participating in KC for at least 30 minutes daily. Daily weight measurements were collected over a four-week period and compared to the expected weight gain for infants receiving traditional incubator care. Results revealed a statistically significant increase in weight gain among infants receiving KC compared to the historical average for infants in traditional incubator care (t (7) = 2.443, p = 0.022). A large effect size (Cohen's d = 0.864) further supported the significance of these findings. Despite limitations such as a small sample size and convenience sampling, this study emphasizes that KC enhances weight gain in preterm infants, thus improving overall health outcomes. Implementation of KC requires ongoing support from nurse leaders to ensure proper education and successful integration into routine care practices. Nonetheless, continued research with larger samples and improved randomization is warranted to fully understand the long-term benefits of KC in neonatal care settings.

Effective Non-Pharmacological Pain Relief Interventions Among Neonates: An Integrative Research Review, Staci Shaw

Providence Nursing Research Conference 2023 – Present

Background:

Newborns encounter many painful events, including heel sticks, venous blood sampling, peripheral intravenous insertions, and more. Newborns cannot verbally express pain, and caregivers rely on changes in vital signs (increased heart rate, decreased oxygen saturations) behavior (long periods of inconsolable crying), and facial expressions to grade newborn pain. Pain management in neonates is critical to preserve neurodevelopment. Due to adverse effects of pharmacological pain management interventions in neonatal populations, non-pharmacological pain management interventions are often utilized in newborns, such as swaddling, non-nutritive sucking, kangaroo care, oral sucrose, holding, touching, music, and breastfeeding. However, the most effective pain management intervention, …

Comparison Of Data On Preterm Neonatal Growth Measures In The Neonatal Intensive Care Unit, Madison Baty, Emily Faerber, Cayenne Sirois

Providence Nursing Research Conference 2023 – Present

Background:

Extrauterine Growth Restriction (EUGR) has been defined as infant weight-for-age z-score (WAZ) of less than -1.28 standard deviations (SD), at discharge or 36–40 weeks (about 9 months) postmenstrual age. In 2018, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition published indicators of neonatal malnutrition, including a decline in WAZ over time. Mild, moderate, and severe neonatal malnutrition is defined as a WAZ decline of 0.8-1.2 SD; >1.2-2 SD; >2 SD, respectively, and it is unclear how widely revised neonatal malnutrition indicators are being used.

Purpose/aim:

To investigate the sensitivity and specificity …

Do Pediatric Patients That Receive Dexmedetomidine As Premedication Experience Less Emergence Delirium Than Pediatric Patients That Receive Midazolam As Premedication?, Shelby Mccloud

Theses, Dissertations and Capstones

Title: Do pediatric patients that receive dexmedetomidine as premedication experience less emergence delirium than pediatric patients that receive midazolam as premedication?

Problem Statement: Midazolam remains the current choice within the practice for premedication in the prevention of emergence delirium, however as research continues there could possibly be a gap between the research and current practice. Throughout the practice of pediatric anesthesia most providers choose to premedicate with midazolam while there may be a more beneficial option of dexmedetomidine.

Results: The study found a significant variance in the incidence of emergence delirium among pediatric patients, ranging from 18.1% to 89%, depending …

Development Of A Positive Urinalysis Criteria Using A Machine Learning Approach, Kari Flicker, Jessica Parrott, Tammy Speerhas, Turaj Vazifedan, Theresa Guins, Jeffrey Bobrowtiz, Anne Mcevoy, Jade Eves, Debra Conrad, Benjamin Klick

Ellmer School of Nursing Faculty Publications

Background: Urinary tract infections (UTIs) are a commonly encountered diagnosis at pediatric urgent care (UC) centers. The urinalysis (UA) is usually the initial study in UC settings used to guide decisions regarding initiating empiric antibiotics and/or pursuing urine culture. However, studies in pediatric UC settings examining the ideal threshold for a positive result are lacking.

Methods: UA result data were extracted from the records of 6,327 pediatric patients, which were collected as part of a previous QI project. Logistic regression was used to determine the predictors of positive urine cultures. Decision trees for a positive UA result for both clean …

Post-Discharge Malaria Chemoprevention In Children Admitted With Severe Anaemia In Malaria-Endemic Settings In Africa: A Systematic Review And Individual Patient Data Meta-Analysis Of Randomised Controlled Trials, Kamija Phiri, Carole Khairallah, Titus Kwambai, Kalifa Bojang, Aggrey Dhabangi, Robert Opoka, Richard Idro, Kasia Stepniewska, Michael Boele Van Hensbroek, Chandy C John

Paediatrics and Child Health, East Africa

Background: Severe anaemia is associated with high in-hospital mortality among young children. In malaria-endemic areas, surviving children also have an increased risk of mortality or readmission after hospital discharge. We conducted a systematic review and individual patient data meta-analysis to determine the efficacy of monthly post-discharge malaria chemoprevention in children recovering from severe anaemia.

Methods: This analysis was conducted according to PRISMA-IPD guidelines. We searched multiple databases on Aug 28, 2023, without date or language restrictions, for randomised controlled trials comparing monthly post-discharge malaria chemoprevention with placebo or standard of care among children (agedyears) admitted with severe anaemia in malaria-endemic …

The Impact Of Workplace Stressors On Anxiety Levels And Mental Health Among Pediatric Intensive Care Nurses, Kelsey Ericah Ang

Nursing | Student Research Posters

Background: Pediatric Intensive Care Unit (PICU) nurses work in a high-stress environment where they are exposed daily to traumatic situations. The demanding emotional and physical challenges contribute to significant psychological burdens, including increased stress and anxiety. Purpose: The current paper proposes a research design to examine the outcomes of stress, anxiety levels, and mental well-being on PICU nurses when workplace support and structured debriefing sessions take place following a traumatic event. Methods: Participants will be recruited from PICU hospitals in Northern California. Participation will be voluntary, and informed consent will be obtained prior to the study. The selection criteria will …

Unleashing Wellness: Exploring The Impact Of Pet Therapy On Anxiety Reduction, Quality Of Life, And Treatment Adherence In Pediatric Oncology Patients, Karina Brouwer

Nursing | Senior Theses

Pet therapy is a complementary intervention that involves the interaction between a person and animal, with the focus of improving psychological well-being within diverse populations. In particular, children with oncological disorders have increases in anxiety and stress levels, therefore it is imperative to study the impact of animal interventions within this population. This literature critique explores the impact of pet therapy interventions on anxiety, stress, and quality of life perceptions in pediatric oncology patients. This research proposal will investigate how animal therapy interactions within pediatric oncology patients influence their anxiety levels and perceptions of quality of life and how these …

Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan

Nursing | Senior Theses

Background: Currently, mandated health screenings in California schools are limited to vision, hearing, and scoliosis; this leaves several other body systems unmonitored during the crucial years of childhood development. One such system is the gastrointestinal (GI) system, which plays a vital role in the normal growth, nutrition status, development, and overall health of children. Objective: By developing and implementing a GI-specific screening tool in the outpatient school setting, this research aims to increase the detection of GI disorders in children. Not only that, but school nurses can use this novel screening tool to promote early diagnosis, intervention, and …

Unleashing Wellness: Exploring The Impact Of Pet Therapy On Anxiety Reduction, Quality Of Life, And Treatment Adherence In Pediatric Oncology Patients, Karina Brouwer

Nursing | Student Research Posters

Pet therapy is a complementary type of therapeutics in which a person and animal have a guided interaction with the purpose of helping someone cope with physical and/or mental illness. Animal-assisted therapy is used in numerous settings and has been shown to reduce stress, lower blood pressure and heart rate, and decrease anxiety and depression (Husson University, 2022). In particular, pediatric oncology patients have enormous amounts of stress in their lives, which leads to increased anxiety and decreased quality of life (Children's Cancer Cause, 2023). While evidence shows that integrating pet therapy in pediatric oncology patients produces significant benefits on …

Effectiveness Of Early Intervention Programs For Children With Autism Spectrum Disorder, Milan Grace Mendoza Baccay

Nursing | Student Research Posters

Background: Autism spectrum disorder is one of the most common developmental disorders, which affects the way a child learns and gains certain skills. Intervention programs aid in the development of these skills and allow children with autism to reach their full potential. Purpose: The following paper examines the effectiveness of early intervention programs on the social, behavior, and cognitive skills for children with autism spectrum disorder. Methods: Participants will be recruited from local schools and community based organizations and their parents will be highly encouraged to participate. They will be separated into two groups: experimental and control. …

Improving Health Outcomes In Children And Adolescents With Asthma, Elizabeth Kate Coffey Moore

Theses and Dissertations (ETD)

Asthma is among the most prevalent chronic illnesses found in the United States, affecting millions of people under the age of 18 each year. The disease burden for affected children, adolescents, their families, and the healthcare system is immense. Finding ways to mitigate its impact is critical to improving the lives of affected children, adolescents, and their families. The three chapters included in this dissertation aimed to document the asthma triggers that children and adolescents are exposed to and strategies for reducing them and to demonstrate using Imogene King’s conceptual framework to guide nursing practice to care for and nursing …

An Educational Intervention To Improve Neonatal Icu Nurses’ Breastfeeding Support Knowledge, Self-Efficacy, And Breastfeeding Rates At Discharge, Sarah Money

DNP Projects

Background: The benefits of breastfeeding for both mother and baby are known. It is recommended that all infants be exclusively breastfed until six months (Meek & Noble, 2022; North et al., 2021). Despite this, breastfeeding rates remain low, especially in medically fragile infants requiring care in the neonatal intensive care unit (NICU) (Rollins et al., 2016). Receipt of evidence-based breastfeeding support by healthcare providers has been shown to improve breastfeeding success; however, many healthcare providers report not being comfortable or knowledgeable enough to offer support consistently (Mulcahy et al., 2022; Rollins et al., 2016).

Purpose: This study aims …

Rising Prevalence Of Mild Chronic Gastritis In Children: A Single Center Experience, Rohit Josyabhatla, Mary Lauren Wood, Amber Gafur, Nina Tatevian, Amanda S Tchakarov, Syed Shahrukh Hashmi, Jon Marc Rhoads, Melissa Renee Van Arsdall

Faculty, Staff and Student Publications

OBJECTIVES AND METHODS: We analyzed upper endoscopic and histological findings in 3 cohorts of children undergoing upper gastrointestinal endoscopy over a 10-year period. Five hundred seventy-nine patients were identified, with 244 (42%), 199 (35%), and 136 (23%) in the 2011, 2015, and 2019 cohorts, respectively. The most common symptoms and signs were abdominal pain, vomiting, failure to thrive, and diarrhea.

RESULTS: The number of patients who had histological evidence of chronic gastritis increased from 2011 (n = 70, 29%) to 2015 (n = 106, 53%) and 2019 (n = 92, 68%;

CONCLUSIONS: There has been a significant rise in the …

Cohesion: A Core Outcome Set For The Treatment Of Neonatal Encephalopathy, Fiona A. Quirke, Shabina Ariff, Malcolm R. Battin, Caitlin Bernard, Linda Biesty, Frank H. Bloomfield, Mandy Daly, Elaine Finucane, Maira Niaz, Farhana Tabassum

Department of Paediatrics and Child Health

Background: Heterogeneity in outcomes reported in trials of interventions for the treatment of neonatal encephalopathy (NE) makes evaluating the effectiveness of treatments difficult. Developing a core outcome set for NE treatment would enable researchers to measure and report the same outcomes in future trials. This would minimise waste, ensure relevant outcomes are measured and enable evidence synthesis. Therefore, we aimed to develop a core outcome set for treating NE.
Methods: Outcomes identified from a systematic review of the literature and interviews with parents were prioritised by stakeholders (n = 99 parents/caregivers, n = 101 healthcare providers, and n = 22 …

Implementing Community Health Workers To Improve The Management Of Chronic Non-Communicable Diseases In Children, Julia L. Newell

Doctor of Nursing Practice (DNP) Projects

Background: Childhood obesity, asthma, and untreated mental health conditions are three examples of chronic non-communicable diseases (CNDs) that pose a host of negative consequences later in life. Minority children from low-income families, especially those with environmental disadvantages, face additional risk factors for the development of these diseases. Community health workers (CHWs) are in a unique position to help address these negative health externalities by being attuned with the linguistic, cultural, and socioemotional needs of members of their communities. Research has demonstrated success in CHW-led interventions curtailing the negative impacts associated with these diseases in low-income, minority communities.

Methods: A literature …

Facility-Based Audit System With Integrated Community Engagement To Improve Maternal And Perinatal Health Outcomes In Rural Pakistan: Protocol For A Mixed Methods Implementation Study, Zahid Memon, Wardah Ahmed, Shah Muhammad, Sajid Bashir Soofi, Shanti Chohan, Arjumand Rizvi, Paul Barach, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Maternal and newborn mortality in Pakistan remains as a major public health challenge. Pakistan faces significant infrastructure challenges and inadequate access to quality health care, exacerbated by sociocultural factors. Facility-based audit systems coupled with community engagement are key elements in achieving improved health system performance. We describe an implementation approach adapted from the World Health Organization audit cycle in real-world settings, with a plan to scale-up through mixed methods evaluation plan.
Objective: This study aims to implement a locally acceptable and relevant audit system and evaluate its feasibility within the rural health system of Pakistan for scale-up.
Methods: The …

Oral Sucrose And The Relation To Neonatal Pain Perception, Meagan L. Burns

MSN Capstone Projects

Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Treede, 2018). The phenomenon of pain is a personal and unique experience that many of the world’s population has experienced in some form or fashion throughout their lifetime. Neonates are exposed to many painful procedures and/or situations due to various medical ailments that may require a neonatal intensive care unit (NICU) admission. Infants have a special place in the hearts of adults all over the world, and any interventions that would increase the likelihood of diminishing or removing perceived pain in this population are likely …

Access To Pediatric Neurology Training And Services Worldwide:A Survey By The International Child Neurology Association, Jo M Wilmshurst, Coriene Catsman- Berrevoets, Donald L. Gilbert, Lakshmi Nagarajan, Pauline Samia, Esra Serdaroglu Serdaroglu, Chahnez Triki, Jorge Vidaurre, Biju Hameed

Paediatrics and Child Health, East Africa

Pediatric neurology is the medical subspecialty responsible for diagnosing and managing diseases and disorders of the nervous system in childhood and adolescence. In many, but not all, regions of the world, the discipline of pediatric neurology is recognized as a specialty or subspecialty of either neurology or pediatrics. Significant knowledge and competencies in this area are necessary to be effective in clinical practice. The need for this is driven by the high burden of disease from neurologic conditions in children and the effect on their families. As the first part of a multistaged project under the auspices of the International …

World Allergy Organization (Wao) Diagnosis And Rationale For Action Against Cow's Milk Allergy (Dracma) Guidelines Update – X – Breastfeeding A Baby With Cow's Milk Allergy, Vicki Mcwilliam, Merryn Netting, Evelyn Volders, Debra Palmer, Ignacio Ansotegui, Stefania Arasi, Amal H. Assa'ad, Sami L. Bahna, Antonio Bognanni, Rose Kamenwa

Paediatrics and Child Health, East Africa

Cow’s milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow’s milk allergy, it is critical to examine the evidence for and against any form of cow’s milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow’s milk proteins detectable in human milk cause infant cow’s milk allergy symptoms. Current clinical practice recommendations advise a 2–4 week trial of maternal cow’s milk dietary elimination for: a) IgE-mediated cow’s milk allergy only if …

Blood Culture Versus Antibiotic Use For Neonatal Inpatients In 61 Hospitals Implementing With The Nest360 Alliance In Kenya, Malawi, Nigeria, And Tanzania: A Cross-Sectional Study, Sarah Murless-Collins, Kondwani Kawaza, Nahya Salim, Elizabeth Molyneux, Msandeni Chiume, Jalemba Aluvaala Aluvaala, William Macharia, Veronica Chinyere Ezeaka, Opeyemi Odedere, Donat Shamba

Paediatrics and Child Health, East Africa

Background: Thirty million small and sick newborns worldwide require inpatient care each year. Many receive antibiotics for clinically diagnosed infections without blood cultures, the current ‘gold standard’ for neonatal infection detection. Low neonatal blood culture use hampers appropriate antibiotic use, fuelling antimicrobial resistance (AMR) which threatens newborn survival. This study analysed the gap between blood culture use and antibiotic prescribing in hospitals implementing with Newborn Essential Solutions and Technologies (NEST360) in Kenya, Malawi, Nigeria, and Tanzania.

Methods: Inpatient data from every newborn admission record (July 2019–August 2022) were included to describe hospital-level blood culture use and antibiotic prescription. Health Facility …

Can Machine Learning Methods Be Used For Identification Of At-Risk Neonates In Low-Resource Settings? A Prospective Cohort Study, Babar S. Hasan, Zahra Hoodbhoy, Amna Khan, Mariana Nogueira, Bart Bijnens, Devyani Chowdhury

Department of Paediatrics and Child Health

Introduction: Timely identification of at-risk neonates (ARNs) in the community is essential to reduce mortality in low-resource settings. Tools such as American Academy of Pediatrics pulse oximetry (POx) and WHO Young Infants Clinical Signs (WHOS) have high specificity but low sensitivity to identify ARNs. Our aim was assessing the value of POx and WHOS independently, in combination and with machine learning (ML) from clinical features, to detect ARNs in a low/middle-income country.
Methods: This prospective cohort study was conducted in a periurban community in Pakistan. Eligible live births were screened using WHOS and POx along with clinical information regarding pregnancy …

Poster: Nicu Reading Club: Promoting Early Reading In The Nicu, Hsiang-Fen Su, Irma Duke, Roxanne Arcinue

2023 South Division Nursing Research Conference

No abstract provided.

Clinical Practice Panel: Improvements In Pediatric Food Insecurity Screening; A Qi Project To Increase Pediatric Food Insecurity Screening, Casey Katzman, Brandy Rachel Frye, Hsiang-Fen Su

2023 South Division Nursing Research Conference

No abstract provided.

Treatment Of Seizures In The Neonate: Guidelines And Consensus-Based Recommendations—Special Report From The Ilae Task Force On Neonatal Seizures, Ronit Pressler, Nicholas Abend, Stéphan Auvin, Geraldine Boylan, Francesco Brigo, Maria Roberta Cilio, Linda De Vries, Maurizio Elia, Pauline Samia

Paediatrics and Child Health, East Africa

Seizures are common in neonates, but there is substantial management variability. The Neonatal Task Force of the International League Against Epilepsy (ILAE) developed evidence-based recommendations about antiseizure medication (ASM) management in neonates in accordance with ILAE standards. Six priority questions were formulated, a systematic literature review and meta-analysis were performed, and results were reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 standards. Bias was evaluated using the Cochrane tool and risk of Bias in non-randomised studies - of interventions (ROBINS-I), and quality of evidence was evaluated using grading of recommendations, assessment, development and evaluation (GRADE). …