Pediatrics Commons^™

Leappt: Leveraging Generative Artificial Intelligence-Pediatric Pulmonology Training. Curriculum And Content Development., Alvin Singh, Erin Khan, Mary Moffatt

Manuscripts, Articles, Book Chapters and Other Papers

After redesigning the curriculum of the pediatric pulmonology fellowship program at Children's Mercy-Kansas City, leadership continued to make changes based on feedback from a faculty survey concerned about the quality and structure of didactics. These changes included leveraging generative artificial intelligence to create a detailed course content outline containing specific objectives and study points for each subject related to pediatric pulmonology. Using the content outline as a foundational reference for learners, fellowship leadership continues to enhance the curriculum by creating testing questions, flipped classroom sessions and evaluations, and hope that these specific changes will help address decreased passing rates on …

Hyperacute Effects Of Non-Code Dose Bolus Epinephrine In Paediatric Cardiac Intensive Care Patients: Insights From High-Fidelity Physiologic Data., Wesam Sourour, Michael Evans, Kevin Le, Saul Flores, Juan S. Farias, Rohit Seth Loomba

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Non-code dose boluses of epinephrine are utilised in critically ill paediatric patients during periods of hemodynamic deterioration, often with the hopes of preventing a cardiac arrest. Data regarding the physiologic effects of these administrations are limited. The primary aim of this study was to use high-fidelity physiologic data to characterise the effects of intravenous non-code dose bolus epinephrine.

METHODS: Paediatric patients in the cardiac ICU who received non-code dose bolus epinephrine were identified. Those who received fluid boluses or chest compressions within 2 minutes of bolus epinephrine were excluded. Autoregressive integrated moving average analyses with exogenous variables were conducted …

Sepsis At Children's Mercy: A Descriptive Study, Katlyn Mayer, Leslie Hueschen, Grace E. Arends Md, Ashley Sherman

Presentations

No abstract provided.

Prospective Validation Of Selective Serotonin Reuptake Inhibitor Pharmacokinetic Models For Precision Dosing In Children And Adolescents, Ethan A. Poweleit, Whitney Sparks Ms, Catherine Koertje, Addison Pritchett Ms, Gail Robertson, Lindsey Malloy-Walton, Stephani Stancil, Jeffrey R. Strawn, Alexa L. Pagano, Kathryn Kyler, Jonathan B. Wagner, Brandon Retke, Paul C. Toren, J Steven Leeder Pharmd, Phd, Laura B. Ramsey

Posters

Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to children and adolescents with anxiety and depression. However, their clinical use is complicated by marked interindividual variability in exposure, which contributes to differences in treatment response and side effects. Further, SSRIs are commonly dosed using a trial-and-error approach. Model-informed precision dosing could improve treatment outcomes, yet existing SSRI population pharmacokinetic (PK) models have not been prospectively validated and may not generalize to pediatric patients. This study aims to evaluate how accurately these models predict exposure for three SSRIs—escitalopram (ESC), sertraline (SRT), and fluoxetine (FLX)—and refine them to develop tools for …

Trauma: Blunt Solid Organ Injury, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Enhancing Pediatric Tube Weaning With Remote Patient Monitoring: A Pilot Quasi-Experimental Study, Sarah T. Edwards, Dana Bakula, Kristina Nash, Saiyara Baset, Amy Ricketts, Julianne Brogren, Ryan M. Thompson, Sarah Bullard, Rachel Graham, Janelle R. Noel-Macdonnell Phd, Brenda Fetter, Lori A. Erickson

Manuscripts, Articles, Book Chapters and Other Papers

Objective: Feeding-tube weaning is conducted in both inpatient and outpatient settings, with significant logistical, financial, and structural barriers to both approaches. We sought to assess whether remote patient monitoring (RPM), using a mobile application, which would overcome many of these barriers, could be effective in helping patients tube wean. Methods: We prospectively enrolled patients with a feeding tube, aged 0–3 years. Enrolled families entered data daily into the remote application. Data were monitored by a nurse and reviewed weekly by a multidisciplinary team. A standard hunger provocation protocol was used, paired with medical, behavioral, oral motor, and nutrition interventions, as …

Pharmacogenetics Of Cyp3a5 In Pediatric Patients With Eosinophilic Esophagitis., Janelle R. Noel-Macdonnell Phd, Norah Almahbub, Erin C. Boone, Wendy Y. Wang, Dilyara Cheranova, Lisa Harvey, Valentina Shakhnovich, Rachel Chevalier

Manuscripts, Articles, Book Chapters and Other Papers

Eosinophilic esophagitis (EoE) is an atopic inflammatory disease with limited treatment options. Though swallowed topical steroids are commonly used, they are not effective in all patients. We investigated the presence of CYP3A4/5 and ABCB1 (P-glycoprotein) mRNA in esophageal tissue and its differential expression by genotype in pediatric patients. Esophageal tissue biopsies were obtained from pediatric patients undergoing standard of care endoscopy. Levels of CYP3A4, CYP3A5, and ABCB1 mRNA were measured using droplet digital PCR and compared across patients with and without EoE. Genotypes for common, clinically relevant CYP3A5 variants were evaluated in a cohort of individuals with and without EoE. …

Increasing Ketamine Administration In Children's Hospitals For Youth With Sickle Cell Disease., Ashley M. Jenkins, Erin Hendry, Alexandra Power-Hays, Marin Valentino, Matthew Hall, Kathyrn Kyler, James W. Antoon, Sonya Tang Girdwood, Jennifer Goldman, Armand N. Morel, Timothy J. Savage, Lucas E. Orth, Natasha M. Archer

Manuscripts, Articles, Book Chapters and Other Papers

Ketamine is recommended as an opioid-sparing adjunct for sickle cell disease (SCD)-related pain management. Little is known regarding its use in hospitalized youth with SCD. We aimed to describe trends in ketamine administration and examine associations between ketamine administration and outcomes in hospitalized youth with SCD. We conducted a cross-sectional, multicenter study examining hospital admissions for youth with SCD from 44 children's hospitals in the United States from 2016 to 2023. Youth aged ≥6 months with SCD were identified using International Classification of Diseases tenth revision codes. Exposures included age, sex, race, payor, childhood opportunity index, hydroxyurea administration, and concomitant …

Quantitative Echocardiography Markers To Denote Severity Of Tricuspid Regurgitation Compared To Cardiac Mri In Single Right Ventricle Variants, Tony Zunica, Daniel Forsha, Janelle Noel-Macdonnell, Anmol Goyal

Posters

Background: Single right ventricle and Hypoplastic Left Heart Syndrome (HLHS) are congenital heart diseases that require multiple palliative surgeries to create a single right ventricular system. 25-30% of these patients develop significant tricuspid regurgitation (TR), which is associated with worse outcomes among all stages of palliation. Echocardiography remains the cornerstone imaging modality for serial evaluation in these patients. However, estimating tricuspid regurgitation is highly subjective in the pediatric population, necessitating need for reliable and reproducible quantitative echocardiography markers. Currently, cardiac magnetic resonance (CMR) is considered the gold standard for quantification of tricuspid regurgitation with good accuracy and reproducibility. Objectives/Goal: Our …

Intraoperative Care And Complications Of Symptomatic Adolescent And Young Adult Patients Undergoing Laparoscopy To Diagnose And/Or To Treat Endometrioses: A Multi-Institutional Review., Jacquelyn R. Evans, Katherine Bergus, Lindsey Asti, Lesley L. Breech, Ruiqi Cen, Yuan Yuan Gong, S Paige Hertweck, Holly R. Hoefgen, Anne H. Horne, Ashli A. Lawson, Seema Menon, Kathleen E. O'Brien, Shashwati Pradhan, Brenna Rachwal, Yolanda R. Smith, Priya Suvarna, Sarah Van Son, Geri Hewitt

Manuscripts, Articles, Book Chapters and Other Papers

STUDY OBJECTIVE: This multi-institutional, retrospective study explores the risks of laparoscopy for diagnosis and treatment of endometriosis to facilitate shared medical decision-making in patients age < 22 years old with chronic pain considering surgery.

METHODS: A retrospective review of patients less than 22 years old who had surgically proven endometriosis at eight pediatric hospitals was completed. Patient demographics, operative interventions, concurrent procedures, and complications were evaluated.

RESULTS: There were 284 patients with pathologically confirmed endometriosis with a median age of 16.86 years (15.51, 18.06). During the index procedure, diagnostic biopsy alone was performed (35.92%), followed by ablation (29.93%), excision (20.07%), excision and ablation (12.68%), and cryoablation (1.41%). Most common …

Diagnostic Challenges Of Anomalous Left Coronary Artery From The Right Pulmonary Artery., Lavina Desai, Sanket Shah, Edo Bedzra, Christopher Mathis

Manuscripts, Articles, Book Chapters and Other Papers

• ALCAPA is a rare congenital heart defect seen in about one in 300,000 live births. • ALCARPA is an even rarer subset of ALCAPA with the LCA originating from the RPA. • Few cases report ALCARPA associated with coarctation of the aorta. • Coarctation and VSD may cause PH with antegrade LCA flow. • These defects are hard to diagnose and require coronary imaging before surgery.

The Influence Of Preoperative Bowel Preparation On Surgical Site Infection In Pediatric Colorectal Surgery., Katlyn G. Mckay, Naomi-Liza Denning, Rebecca M. Rentea, Eunice Y. Huang

Manuscripts, Articles, Book Chapters and Other Papers

Surgical site infection (SSI) is one of the most common nosocomial infections that occur in pediatric patients in the United States, with colorectal procedures consistently demonstrating the highest rates of SSI. Strategies to reduce SSI in colorectal surgery include standardized perioperative colorectal care bundles, which commonly incorporate preoperative bowel preparation. Robust adult literature exists supporting the use of mechanical bowel preparation in combination with oral antibiotics to mitigate SSI; however, pediatric evidence remains less definitive. Current pediatric literature shows heterogeneity of bowel preparation use amongst surgeons, with existing literature consisting primarily of small retrospective studies. A well-designed pediatric randomized controlled …

Perioperative Anaphylaxis In A Healthy Adolescent After First Lifetime Surgery, Shayan Sazdar, Salman Aljubran

Posters

Introduction: Perioperative anaphylaxis is a rare life-threatening event. Its evaluation poses complex considerations inherent to the use of multiple medications. Patient presentation: A healthy 11-year-old boy developed anaphylaxis shortly after discharge home from first lifetime surgery for orchiopexy. Perioperative medications included rocuronium, propofol, fentanyl, bupivacaine, sugammadex, ondansetron, dexamethasone, dexmedetomidine, and ketorolac. No antibiotics. After surgery, he consumed fast food dinner and ice cream. Within 2 hours after discharge home, he returned to our Emergency Department (ED) with facial and tongue angioedema, hives, and respiratory distress. He received multiple doses of intramuscular epinephrine and briefly required epinephrine drip in the ED. …

Asthma Phenotypes And Control In 22q11.2 Deletion Syndrome: A Single-Center Retrospective Study, Cody Shopper, Katey Campbell, Nikita S. Raje

Posters

Background: Patients with 22q11.2 deletion syndrome have increased rates of atopy and immune dysregulation and may experience a higher burden of asthma; however, real-world data describing asthma control, severity, and treatment patterns in this population are limited. We hypothesized that asthma control and severity patterns in patients with 22q11.2 deletion syndrome differ from those observed in the general asthma population. Objectives/Goal: To characterize asthma control, severity, and treatment patterns among patients with 22q11.2 deletion syndrome and to compare observed patterns with those typically reported in the general asthma population. Methods/Design: We conducted a retrospective observational cohort study of patients with …

Pericardial Effusion, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Total Hip Replacement Eras, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Kawasaki Disease, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Acute Otitis Media: Antibiotic Length, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Cleft Feeding: Practical Tips For Pediatricians, Michael Smith, Leah Hunt, Brenda Fetter, Hannah J. Bergman

Pediatrics in Practice: A CME Podcast

Feeding infants with cleft lip and palate can be challenging. In this episode, a pediatric surgeon, occupational therapist, and speech pathologist share practical strategies for pediatricians—from pre- and post-surgery care to therapy techniques and key red flags. Learn how to guide families and collaborate effectively for the best outcomes.

Note: This episode is not awarded CME.

Click here to stream the podcast episode.

Beyond The Exam Room: Pediatricians Advocating Through State Aap, Heidi Sallee, Kelly Kreisler, Thuylinh Pham

Grand Rounds

1. Evaluate the current political climate and effects on child health at a National and State level.
2. Identify key child health policy issues for the states of Missouri and Kansas.
3. Use different forms of advocacy to share personal expertise.
4. Partner with state AAP Chapters to improve child health outcomes locally.

Liberalizing Hospital Proximity Requirements For Children/Young Adults With Low-Burden B-All Receiving Tisagenlecleucel., Lauren E. Appell, Christina Baggott, Khanh Nguyen, Snehit Prabhu, Holly Pacenta, Samuel John, Vanessa A. Fabrizio, Christine L. Phillips, Jenna Rossoff, Julie-An Talano, Amy Moskop, Rachel Phelan, Susanne H C Baumeister, Michael R. Verneris, Erin Hall, Gary Douglas Myers, Nicole A. Karras, Stacy L. Cooper, Muna Qayed, Sunil S. Raikar, Lena Winestone, Michelle Hermiston, Prakash Satwani, Christa Krupski, Amy K Keating, Danielle N. Friedman, Kevin J. Curran, Alex Hoover, Margaret L. Macmillan, Christen L. Ebens, Archana Ramgopal, April L. Rahrig, Crystal L. Mackall, Theodore W. Laetsch, Kevin Mcnerney, Liora M. Schultz

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Blood Product Transfusion And Coagulopathy In Children With Traumatic Brain Injury: A Narrative Review., Robert Marcel T. Huibonhoa, Niranjan Vijayakumar, Daniel Kelly, Oliver Karam, Madhuradhar Chegondi

Manuscripts, Articles, Book Chapters and Other Papers

Traumatic brain injury (TBI) is a leading cause of critical illness and mortality in children. Transfusion of blood products, a common intervention in the management of pediatric TBI, has important implications for related principles, including trauma-induced coagulopathy, cerebral perfusion, and cerebral oxygen delivery. Knowledge gaps persist due to the limited availability of pediatric-specific data regarding blood product transfusion in TBI. In particular, there is a lack of prospective studies defining appropriate specific laboratory thresholds and transfusion targets, as well as insufficient evidence to guide the weighing of potential benefits against transfusion-related risks in this population. Although blood product transfusion in …

Developing A Multidisciplinary Approach To Complex Pediatric Areodigestive Care- Where We've Been, Where We're Going, And What We've Learned Along The Way, Jason R. Brown

Grand Rounds

1. Enhance competence and expand expertise in pediatric surgical conditions prevalent in our geographical area and nationally.
2. Develop strategies to enhance communication and collaboration among interdisciplinary team members addressing pediatric surgical conditions.
3. List barriers to multidisciplinary care.

Optimizing Kidney Allograft Years: Underutilization Of Pediatric Donors, Nicholas Herrera, Ana Cortez, Diane Cibrik, Bradley A. Warady

Manuscripts, Articles, Book Chapters and Other Papers

Background. 

The Kidney Donor Profile Index (KDPI) score drives kidney allocation in the United States for both adult and pediatric donors, despite the calculation being primarily derived from adult donor data. A KDPI of ≤20% is considered to have the longest graft survival potential and is typically prioritized for recipients who have a low Estimated Posttransplant Survival (EPTS) score. Using KDPI to assess pediatric donor quality may underestimate graft survival and result in underutilization of these kidneys for recipients with a low EPTS score.

Methods. 

Using Scientific Registry of Transplant Recipients data, we analyzed 5-y posttransplant death-censored graft survival of …

Association Of N-Terminal Pro-Brain Natriuretic Peptide With Ckd Progression In The Ckd In Children Study., Alexander Kula, David K. Prince, Joseph T. Flynn, Susan L. Furth, Bradley A. Warady, Tamara Isakova, Derek Ng, Jeese Seegmiller, Rob Christenson, Nisha Bansal

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Iv Contrast For Mri And Ct In Patients With Kidney Disease, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Differences Of Sex Development (Dsd), Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Investigation Of A Global Mouse Methylome Atlas Reveals Subtype-Specific Copy Number Alterations In Pediatric Cancer Models., Melanie Schoof, Tuyu Zheng, Martin Sill, Roland Imle, Alessia Cais, Lea Altendorf, Alicia Fürst, Nina Hofmann, Kati Ernst, Dominik Vonficht, Kenneth Chun-Ho Chan, Tim Holland-Letz, Andreas Postlmayr, Ryo Shiraishi, Wanchen Wang, Alaide Morcavallo, Michael Spohn, Carolin Göbel, Judith Niesen, Levke-Sophie Peter, Franck Bourdeaut, Zhi-Yan Han, Yanxin Pei, Najiba Murad, Fredrik J. Swartling, Jessica Taylor, Monika Yadav, Garrett R. Gibson, Richard J. Gilbertson, Matthias Dottermusch, Rajanya Roy, Kornelius Kerl, Rainer Glass, Jiying Cheng, Martin A. Horstmann, Gerrit Wolters-Eisfeld, Haotian Zhao, Dominik Sturm, Viveka Nand Yadav, Louis Chesler, Simon Haas, William A. Weiss, Paul A. Northcott, Lena M. Kutscher, Ana Guerreiro Stucklin, Olivier Ayrault, Julia E. Neumann, Daisuke Kawauchi, David T W Jones, Kristian Pajtler, Ana Banito, Stefan M. Pfister, Ulrich Schüller, Marc Zuckermann

Manuscripts, Articles, Book Chapters and Other Papers

Copy number alterations (CNAs) are hallmarks of cancer, yet investigation of their oncogenic role has been hindered by technical limitations and missing model systems. Here we generated a genome-wide DNA methylation and CNA atlas of 106 genetic mouse models across 31 pediatric tumor types, including 18 new models for pediatric glioma. We demonstrated their epigenetic resemblance to human disease counterparts and identified entity-specific patterns of immune infiltration. We discovered that mouse tumors harbor highly recurrent CNA signatures that occur distinctly based on the tumor subgroup and driving oncogene and showed that these CNAs share syntenic regions with the matching human …

Hypoplastic Left Heart Syndrome: Key Insights For Pediatricians, Michael Smith, Pezad Doctor

Pediatrics in Practice: A CME Podcast

Join Pezad Doctor, MD for a focused discussion on hypoplastic left heart syndrome (HLHS). Learn what pediatricians need to know about early detection, surgical stages, interstage monitoring, and supporting families through this complex journey. Practical tips and emerging updates will help you feel confident in managing HLHS in your practice.

Click here to stream the podcast episode.

Using A Heuristic Tool To Improve Symptom Self-Management In Adolescents And Young Adults With Cancer: Protocol For A Randomized Controlled Trial., Suzanne Ameringer, Grace Hodges, R K Elswick, Lauri Linder, Catherine Fiona Macpherson, Kristin Stegenga

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Adolescents and young adults (AYAs) with cancer experience multiple distressing symptoms during treatment, yet few developmentally relevant resources have been developed to help them self-manage their symptoms. Empowering patients to have a more active role in self-management during cancer treatment may lessen their symptom severity and distress.

OBJECTIVE: The aim of this study is to test an intervention designed to improve symptom self-management, the Computerized Symptom Capture Tool (C-SCAT), by helping AYAs understand their unique symptom experience and discuss it with their health care providers.

METHODS: We are conducting a multisite, 2-group randomized controlled trial to evaluate the effects …