Pediatrics Commons^™

Demographic Factors Contributing To Nas Treatment, Meg Curran, Emma Freeman

Costas T. Lambrew Research Retreat 2022

Infants that were formula fed, had unpartnered parents, birthing parents who used illicit substances, and multiple medication exposures were more likely to be treated for NAS

Improving Car-Bed Discharge Process And Follow Up, Haley Pelletier, Gina Trachimowicz

Costas T. Lambrew Research Retreat 2022

The car seat challenge test is most commonly performed on premature infants prior to discharge home from the hospital. Infants who fail the car seat test twice at MMC are discharged home in a carbed. The process of discharging an infant home in a car-bed and the subsequent re-testing prior to transitioning safely to a rear-facing car seat is neither widely understood or standardized among Maine Health providers.

Implementing Trauma-Informed Developmental Care In Nicu/Ccn: Findings From A Pre-Intervention Care Team Survey, Megan Flynn

Costas T. Lambrew Research Retreat 2022

Priorities Identified by Care Team in NICU/CCN Provide Path to Improving Patient Care

The Shifting Role And Expectations Of Physical Therapy In The Pediatric Cystic Fibrosis Clinic During A Global Pandemic, Ana Cairns, Colby Wyatt, C Chaloner, J Takatsuki-Jordan, A Williams

Costas T. Lambrew Research Retreat 2022

In January 2020, a CFF supported quality improvement study to optimize physical therapy (PT) services in our pediatric CF clinic was underway. •An initial survey had been completed in 2019 to assess family satisfaction with the current provision of PT services. •In March 2020 the COVID-19 pandemic caused a major shift in clinical care in the midst of our project. •Care was changed to telehealth and “hybrid” clinic visits, thereby altering the context of our study, necessitating a change in the focus.

Pediatric Dermatology Econsult Program With Dermoscopy: Sub Analysis Of Infantile Hemangiomas, Peggy R. Cyr, Madeline Prentiss, Laura Houk, Elizabeth Seiverling

Costas T. Lambrew Research Retreat 2022

There are no pediatric dermatologists in Maine. Greater distance from a dermatologist is associated with delays in care and nonadherence to treatment. Timely care is especially crucial for patients with infantile hemangiomas (IH) due to a narrow “window of opportunity” for optimal treatment. A store and forward electronic consultation eConsult ) platform was implemented within our electronic medical record (Epic) to triage referrals from primary care providers ( PCPs). Here we present an analysis of the program outcomes in respect to pediatric eConsults with emphasis on treatment for IH.

Sleep Patterns & Sleep Problems Vary By Age In Children With Autism, Charles F Reynolds, Matthew Siegel, Briana Taylor

Costas T. Lambrew Research Retreat 2022

Adolescence is a time of increased vulnerability for youth with autism spectrum disorder (ASD).1 • In non-ASD youth, sleep and circadian rhythms demonstrate marked changes during adolescence that delay the biological propensity for sleep.2 • In combination with early school start times, these agerelated changes in sleep and circadian rhythms result in insufficient sleep duration, circadian misalignment, daytime sleepiness, and numerous behavioral and psychiatric problems.3 • Age-related changes in sleep and circadian rhythms, and their relevance for behavioral and psychiatric health have not been examined in youth with ASD.

Telemedicine Consultation To Assess Neonatal Encephalopathy In Rural Community Hospitals And Tertiary Care Centers, Rachel Coffey, Misty Melendi, Anya K. Cutler, Alexa K. Craig

Journal of Maine Medical Center

Introduction: Teleconsultation is used in tertiary care hospitals to evaluate neonatal encephalopathy. Neonates born in community hospitals, however, often experience delayed evaluation due to transport to the tertiary care center. We studied teleconsultations in community hospitals to decrease this disparity.

Methods: Prospective observational study in 9 community hospitals and 1 neonatal intensive care unit. Inclusion criteria: gestational age greater than or equal to 35 weeks and one of the following: umbilical cord pH less than or equal to 7.2, 5-minute Apgar less than 7, prolonged respiratory support, perinatal event, or abnormal neurological exam. We performed synchronized, unscheduled telemedicine consults with …

The Dangers Of Aces, Olivia Carey, Thea Forrest, Adna Abdi

MaineHealth Maine Medical Center

ACEs stands for Adverse Childhood Experiences, included (but not limited to) physical, emotional, and sexual abuse, substance abuse, neglect, dysfunctional families, and mental illness'. ACEs impacts childhood development and increases chances of future health implications.

A Rare Entity: Case Report Of Recurrent Hypertrophic Pyloric Stenosis, Astrid A. Gleaton, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Hypertrophic pyloric stenosis (HPS) is well known in pediatric surgery and has good outcomes after pyloromyotomy.1 Emesis in the immediate postoperative period occurs in 40% of patients with HPS and is attributed to gastroparesis from prolonged gastric distention.2 Emesis presenting weeks to months after pyloromyotomy prompts an evaluation that often yields pathology unrelated to HPS. Because recurrent HPS is rare, making this diagnosis highlighted the importance of practicing broad differential diagnoses, ruling out most common causes, and including obscure etiologies.

Clinical Findings: A 3-week-old male born after full-term gestation with a history of HPS underwent an uncomplicated laparoscopic pyloromyotomy. …

Implementing A Clinical Practice Guideline For Pediatric Appendicitis Safely Reduced Health Care Use And Improved Antimicrobial Stewardship, Jack Vernamonti, Robin Cotter, Jennifer Jubulis, Kartikey Pandya

Journal of Maine Medical Center

Introduction: Appendicitis is the most common emergency surgical disease in children. Those with perforated appendicitis have a more complicated and varied course. Through a clinical practice guideline (CPG), we sought to reduce computed tomography scans, laboratory draws, and exposure to broad-spectrum antibiotics without adversely affecting length of stay, hospital readmission, or repeat antibiotic administration.

Methods: Electronic records were retrospectively reviewed before and after CPG implementation, and data was collected in REDCap.

Results were reported as mean or percent incidence, and statistical analysis was done using a Student’s t-test, Mann-Whitney U test, or Pearson’s χ2 with P < .05 considered significant. Results: One hundred patients with a perforated appendix (50 before and 50 after CPG implementation) were included in our analysis. Length of stay (4.98 vs 4.46 days; P = .25), hospital readmission rate (10% vs 14%; P = .54), and additional antibiotic administration (2% vs 4%; P = .56) did not change. We observed no difference in the Pediatric Appendicitis Score (9 vs 9; P = .48) and a trending increase in evaluation at an outside hospital (56% vs 74%; P = .06). Rates of computed tomography scans did not differ overall (50% vs 40%; P = .31), but showed a decreasing trend at our institution (30% vs 12%; P = .06). We also found fewer post-operative laboratory studies (90% vs 38%; P < .01) and patients who received broad-spectrum intravenous antibiotics (92% vs 18%; P < .01).

Discussion: Through implementing the …

Development Of Maine Ongoing Outreach Simulation Education (Moose), A Novel Telesimulation Program, To Improve Neonatal Resuscitation In A Rural Community Hospital, Allison Zanno, Misty Melendi, Micheline Chipman, Jeffrey Holmes, Alexa Craig, Samantha Piro, Anna Gilbert, Sarah Gabrielson, Leah Mallory, Anya Culter, Mary Ottolini

Costas T. Lambrew Research Retreat 2021

Objective- To implement monthly neonatal resuscitation telesimulation team training sessions in a rural community hospital delivery room that is feasible, sustainable, and replicable at other sites.

Plasma Concentrations Of Per- And Polyfluoroalkyl Substances And Body Composition From Mid-Childhood To Early Adolescence, Jaclyn Janis, Sheryl Rifas-Shiman, Shravanthi M. Seshasayee, Clifford J Rosen, Abby F Fleisch, Sharon Sagiv, Emily Oken

Costas T. Lambrew Research Retreat 2021

BACKGROUND

• Per- and polyfluoroalkyl substances (PFAS) may alter body composition by lowering anabolic hormones and increasing inflammation.

Prior studies have found positive, inverse, and null associations of PFAS concentrations with adiposity among children and adolescents.

Few studies have examined associations of PFAS concentrations with changes in body composition longitudinally.

No study has examined the association of PFAS plasma concentrations with lean mass.

A Simulation-Based Outreach Program Improves Delivery Room Team Confidence In Neonatal Resuscitation At Rural Community Hospitals, Allison Zanno, Misty Melendi, Micheline Chipman, Jeffrey Holmes, Alexa Craig, Samantha Piro, Anna Gilbert, Sarah Gabrielson, Leah Mallory, Anya Culter, Mary Ottolini

Costas T. Lambrew Research Retreat 2021

Objective- Our goal is to pilot the use of an onsite Neonatal Community Outreach Education Program to improve provider confidence with procedural skills and neonatal resuscitation in the delivery room.

Multifocal Bone Pain, Recurrent Fevers And Anemia In A 15-Year-Old, Anna M. Martens, Catherine Ezzio, Amanda Goddard, Leah Mallory

Journal of Maine Medical Center

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder that primarily affects children with recurrent episodes of sterile osteomyelitis in one or more bones. Patients usually present with recurrent bone pain, though it is often a diagnosis of exclusion with most patients undergoing extensive work-up to arrive at a diagnosis.

Clinical Findings: This 15-year-old female presented with months of progressive multifocal bone pain, 22-pound weight loss and recurrent fevers. Work-up as an outpatient included a positive screening assay and IgM Western blot Panel positive for Lyme disease, treated with a 28-day course doxycycline without resolution of the symptoms, …

Improving Patient Flow By Increasing Early Discharges On A Mother & Baby Unit, Faye Weir, Joy Moody, Kathleen Cyr, Cathy Palleschi, Stephen Tyzik, Joseph East, Heidi Morin, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Discharging patients early in the day has many advantages amongst which is increased bed availability. However, the experience in a large academic tertiary medical center demonstrated that most discharges occurred early to mid afternoon. A care team on a mother /baby unit established a quality improvement project to increase the number of discharges by 11AM and streamline key discharge planning activities.

A root cause analysis identified multiple barriers to attaining he established goals. To address these barriers, a multi prong approach was instituted to include a discharge education KPI for all unit staff.

Data collection post countermeasure implementation demonstrated some …

Increase Staff Utilization Of Occlusive Interface In Micro-Preemie Babies On Bcpap, Deborah A. Igo, Kimberly Kingsley, Faythe Henry, Misty Melendi, Amy Mcbee, Valerie Cook, Christopher Woods, Angela Rojecki, Lauren Walley, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Premature neonates born before 26 weeks gestation present many care challenges as they need special precautions to be taken to overcome their fragility. Intubation is often needed for this patient population as their lungs are not fully developed. However, due to their high susceptibility for skin breakdown invasive ventilation often can create subsequent problems. A respiratory therapist team in an academic tertiary medical center wanted to explore the use of an occlusive interface for intubation while providing various forms of non-invasive ventilation in their NICU with the hopes for fewer complications.

The objective of this project was to reduce the …

Using Physician Champions To Extend The Reach Of The Let’S Go! 5-2-1-0 Obesity Prevention Program In Clinical Practice, Michael Dedekian, Jackie Vine, Jonathan Fanburg, Naomi Anderson Schucker, Victoria Rogers

Journal of Maine Medical Center

ABSTRACT

Introduction: There is limited evidence for large scale interventions to address childhood obesity. Let’s Go! is a Maine-based obesity prevention program that deploys a consistent message across multiple community settings to encourage children and families to make healthy choices. This report describes implementation of Let's Go! in primary care offices.

Methods: Consideration for physician champion recruitment included previous involvement with Let’s Go! and ensuring statewide geographic coverage. Champions received standardized training and became local leaders in obesity prevention and treatment. 13 champions engaged 99 practices at baseline; 71 practices were engaged all 4 years (2012-2015). Data were analyzed on …

Pediatric Interfacility Transfers – Association Of Pre-Transfer Vital Signs With Length Of Stay At A Tertiary Care Center, Sarah Bunting, Leah Mallory, Logan Murray

Journal of Maine Medical Center

Objective: Determine which abnormal pre-transfer vital signs predict longer length of stay (LOS) for pediatric patients transferred to a tertiary care center.

Patients and Methods: A retrospective study of all patients transferred between Aug 2016 and Jan 2017 to Maine Medical Center’s pediatric inpatient units, PICU, and Emergency Department with pediatric consult. Charts were examined for pre-transfer vital signs and diagnosis. The primary outcome of interest was LOS. Vital signs were determined to be normal or abnormal using the 2015 PALS Guidelines.

Results: Two hundred thirty-six pediatric patients were included. Median LOS was 42.5 hours; median age was 68.0 months. …

Delayed Initiation Of Therapeutic Hypothermia For Outborn Infants Is Associated With Adverse Outcomes, Nabeel Hashmi, Max Sale, Leah Fox, Jay Kerecman, Lauren Mcallister, Misty Melendi, Frances Lucas

MaineHealth Maine Medical Center

Delayed Initiantion of Therapeutic Hypothermia for Outborn Infants is Associated with Adverse Outcomes

Feasibility Of Pre-Operative Mtor Inhibitor Sirolimus In Children And Young Adults With Desmoid Tumor, Stephanie Verwys, Clara Magyar, Kathleen Glick, Douglas Hawkins, Archana Sharma, Brenda Weigel, Katherine Chastain, Joseph Khoury, Michele Manalang, Sarah Dry, Noah Federman, Aaron Weiss

MaineHealth Maine Medical Center

Background:

• Desmoid tumor represents an intermediate grade neoplasm with a striking predilection for locally invasive growth and recurrence following resection

• More effective, well-tolerated non-surgical treatment options are needed

• Current approaches

• If feasible, watchful waiting is the preferred approach

• 20-30% spontaneous regression

• In situations where treatment is indicated, the following approaches are utilized

• Surgery is the primary approach if minimal morbidity is anticipated

• Medical therapies

• Cytotoxic drugs

• Tyrosine kinase inhibitors

• Hydroxyurea

• Gamma secretase inhibitors

• mTOR Inhibitor Rationale

• Desmoid tumor is well-known to be associated with deregulation of …

Outcomes Of Implementation Of An Evidence-Based Enteral Feeding Protocol In Neonates Weighing Less Than 1800g At Birth, Rebecca Edwards

MaineHealth Maine Medical Center

Background:

Several studies have demonstrated that the implementation of standardized enteral feeding guidelines can lead to positive outcomes in the neonatal intensive care unit (NICU), including improved nutrition, decreased need for parenteral nutrition (PN), central lines and decreased costs. Furthermore, implementation of standard feeding regimens have significantly reduced the incidence of necrotizing enterocolitis (NEC), a devastating gastrointestinal emergency in neonates. It has been reported that NEC has an iatrogenic component related to variations in feeding practices. While the exact mechanism of the reduced risk of NEC and implementation of feeding protocols is unclear, standard feeding regimens likely improve consistency in …

Per- And Polyfluoroalkyl Substances And Bone Mineral Density In Mid-Childhood, Shravanthi M. Seshasayee, Rachel Cluett, Lisa B. Rokoff, Sheryl L. Rifas-Shiman, Diane R. Gold, Brent Coull, Catherine M. Gordon, Clifford J. Rosen, Emily Oken, Sharon K. Sagiv, Abby F. Fleisch

MaineHealth Maine Medical Center

Background:

• Identifying factors that impair bone accrual during childhood is a critical step toward osteoporosis prevention.

• One potential risk factor not well characterized in childhood is the role of chemicals in the environment.

• Perfluoroalkyl substances (PFASs) are synthetic additives used to make clothing, furniture, and cookware stain repellant and are detectable in almost all US adults.

• PFASs act as PPAR-γ agonists,2 androgen receptor antagonists, and directly intercalate into bone, raising the possibility that they may lead to low bone accrual.

• While two population-based studies in adults have shown associations between PFASs and low areal bone …

Improving Communication Between Child Life Services And Nursing On An Inpatient Pediatric Unit, Sherryann St. Pierre, Elizabeth Shaughnessy, Bethany Kay, Barbara Bush Children's Hospital, Mark Parker, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks

Operations Transformation

IMPROVING COMMUNICATION BETWEEN CHILD LIFE SERVICES AND NURSING ON AN INPATIENT HOSPITAL UNIT

Effective communication between patient caregivers has been shown to reduce stress and trauma related to hospitalization and subsequent improved outcomes. An HCAHP score for a 30 bed acute inpatient pediatric unit illustrated the confusion faced by children as a result of nursing and care life specialists not working together as a team.

A root cause analysis identified a number of issues as to why patients were not benefitting fully from child life services. Several counter measures were instituted with the goals of improving the HCAHP score and …

Strategies To Improve Interdisciplinary Communication In An Acute Care Inpatient Pediatric Unit, Sarah Thompson, Haley Pelletier, Barbara Bush Children's Hospital-Inpatient, Maine Medical Center, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

Interdisciplinary patient rounding has been shown to improve patient and family satisfaction as well as reduce patient length of stay and readmission rates. In an acute care inpatient pediatric unit, baseline metrics demonstrated that 100% of the time, nursing was not included in these rounds thus resulting in sub optimal communication.

The goal of this performance improvement project was to attain increased nursing participation. Data collection demonstrated several reasons for lack of participation and corrective actions were instituted. After undertaking this KPI goal and utilizing operational excellence, 95% of the time, nurses were called to morning rounds with the medical …

A View From The Sun Parlor: A History Of Pediatrics In Portland, Maine, J Daniel Miller

Histories

Publication includes a written history, posters, photographs, and charts pertaining to the early years of pediatrics in Portland, Maine.