Pediatrics Commons^™

Understanding And Addressing Mental Health Challenges Of Families Admitted To The Neonatal Intensive Care Unit., Ashley D. Osborne, Daphna Yasova Barbeau, Tiffany Gladdis, Kara Hansen, Tonia Branche, Emily R. Miller, Christine C. Pazandak, Margaret K. Hoge, Michelle Spencer, Diana Montoya-Williams, Ryan Barbeau, Heather Padratzik, Stephen Lassen

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This article reviews the psychological distress experienced by NICU families, including anxiety, postpartum depression (PPD), and post-traumatic stress disorder (PTSD), in addition to providing recommendations for clinicians at the individual, institutional, and national level. Currently, mental health screenings, specialized evaluations, and treatment options are not routinely offered to NICU families and are frequently under-utilized when offered. Here we provide expert opinion recommendations to address challenges in supporting universal screening, offering bedside interventions, including trained mental health professionals in care plans, updating neonatology training competencies, and advocating for policies that support the mental health of NICU families. We advocate that mental …

Portal Vein Obstruction In Pediatric Liver Transplant Patients: An Evaluation Of Self-Reported Management Practices., Lydia Sieben, Bader A. Alfares, Ruben H. De Kleine, Barbara E. Wildhaber, Thomas Casswall, Greg Nowak, Martin Delle, Denise Aldrian, Valeria Berchtold, Georg F. Vogel, Piotr Kaliciński, Malgorzata Markiewicz-Kijewska, Adam Kolesnik, Jesús Quintero, María Mercadal Hally, Mauricio Larrarte King, Paolo Marra, Michela Bravi, Domenico Pinelli, Mureo Kasahara, Seisuke Sakamoto, Hajime Uchida, Vidyadhar Mali, Marion Aw, Stéphanie Franchi-Abella, Emmanuel Gonzales, Florent Guérin, Guillermo Cervio, Julia Minetto, Sergio Sierre, Martín De Santibañes, Victoria Ardiles, Jimmy Walker Uño, Helen Evans, David Duncan, John Mccall, Steffen Hartleif, Ekkehard Sturm, Jai V. Patel, Marumbo Mtegha, Raj Prasad, Cristina T. Ferreira, Luiza S. Nader, Marco Farina, Catalina Jaramillo, Manuel I. Rodriguez-Davalos, Peter Feola, Amit A. Shah, Phoebe M. Wood, Michael R. Acord, Ryan T. Fischer, Bhargava Mullapudi, Richard J. Hendrickson, Rajeev Khanna, Viniyendra Pamecha, Amar Mukund, Khalid Sharif, Girish Gupte, Simon Mcguirk, Gilda Porta, Winita Hardikar, Marco Spada, Tommaso Alterio, Giuseppe Maggiore, Marisa Beretta, Rudi A J Dierckx, Reinoud P H Bokkers, Hubert P J Van Der Doef, Portal Registry Investigators

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BACKGROUND AND AIMS: Portal vein obstruction (PVO) is a known complication after pediatric liver transplantation (pLT). Effective management strategies are crucial in improving patient outcomes. This study investigated the various practice patterns related to PVO management to clarify the degree of consensus on the diverse facets of care involved in addressing PVO after pLT.

METHODS: A self-reported evaluation was conducted using a scanned, paper-based survey among specialized pLT centers participating in the Portal vein Obstruction Revascularization Therapy After Liver transplantation (PORTAL) registry. The survey consisted of 30 questions covering the current practices regarding PVO, including experience, team composition, follow-up and …

Spectrum Of Coronary Artery Involvement With Multisystem Inflammatory Syndrome In Children Versus Kawasaki Disease., Simon Lee, Ashraf S. Harahsheh, Geetha Raghuveer, Michael A. Portman, Arash A. Sabati, Michael Khoury, Nagib Dahdah, Marianna Fabi, Supriya S. Jain, Audrey Dionne, Kyle Runeckles, Frederic Dallaire, Nadine F. Choueiter, Tyler H. Harris, Matthew D. Elias, Anji T. Yetman, Balasubramanian Sundaram, Luis M. Garrido-Garcia, Nilanjana Misra, Cedric Manlhiot, Pedrom Farid, Brian W. Mccrindle

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BACKGROUND: There is significant overlap in clinical features between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD). We sought to compare the prevalence, severity, and associated factors for coronary artery (CA) involvement.

METHODS AND RESULTS: From January 1, 2020 through January 31, 2023, 1191 patients with MIS-C and 554 patients contemporaneously diagnosed with KD were enrolled into the International Kawasaki Disease Registry. Demographic and clinical features, laboratory values, maximum Z score in any CA branch +2.5 or greater) were determined separately for each diagnosis using multivariable logistic regression analyses. The prevalence of CA aneurysms was lower for MIS-C …

Navigating Transition To Adulthood In Epilepsy Patients: A Multidisciplinary Approach., Yinchen Song, L David Klemens, Hallie Orton, Audrey R. Kennedy, Jana E. Jones, Sucheta Joshi, Meghann Kelly

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The transition from pediatric to adult healthcare systems is a critical yet complex process for individuals with epilepsy, requiring careful attention to both medical and psychosocial aspects. This review highlights best practices and strategies to facilitate effective transitions, focusing on the roles of multidisciplinary teams, communication strategies, shared decision-making, and transition readiness assessment. Key topics include early and ongoing communication, promoting patient autonomy, addressing mental health comorbidities, and implementing transition readiness assessments such as the Epilepsy Transition Readiness Assessment Questionnaire (EpiTRAQ). Additionally, the review evaluates models for transition clinics, emphasizing the importance of sustainability, collaboration, and tailored interventions. By leveraging …

Trajectories Of Attention Problems In Preschoolers Born Very Preterm., Marie Camerota, Francisco Xavier Castellanos, Brian S. Carter, Jennifer Check, Jennifer Helderman, Julie A. Hofheimer, Elisabeth C. Mcgowan, Charles R. Neal, Steven L. Pastyrnak, Lynne M. Smith, Thomas Michael O'Shea, Carmen J. Marsit, Barry M. Lester

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BACKGROUND: Children born preterm are at heightened risk for neurodevelopmental impairment, including specific deficits in attention. Few studies have investigated change over time in attention problems prior to school entry. The current study aims to describe trajectories of attention problems from age 2 through 5 years in a cohort of children born(GA), identify sociodemographic, medical, and neurobehavioral characteristics associated with attention trajectories, and test whether attention problem trajectories predict the risk of a reported attention-deficit/hyperactivity disorder (ADHD) diagnosis.

METHODS: We studied 608 infants from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study, a prospective, multisite study of …

Changes In Adequacy Of Splanchnic Oxygen Delivery And Splanchnic Artery Doppler After Bolus Feedings In Infants: A Systematic Review And Meta-Analysis., Rohit S. Loomba, Saloni P. Sheth, Joshua Wong, Megan Davis, Juan S. Farias, Enrique G. Villarreal, Saul Flores

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BACKGROUND: Current practice regarding timing of feed initiation and feed tolerance largely relies on anecdotal practice and protocols. This study aims to provide an objective measure to guide clinical practice by analyzing changes in splanchnic regional oxygen saturation and Doppler patterns with feeds.

METHODS: A systematic review was performed. Inclusion criteria were: 1) patients under 1 year of age; 2) splanchnic regional oxygen saturation with near infrared spectroscopy before and after feeds or mesenteric Doppler findings before and after feeds; and 3) clinical parameters must have been presented as either mean and standard deviation or median and range. Endpoints of …

A Scoping Review Of Sexual And Reproductive Health Interventions With Youth In U.S. Juvenile Facilities., April Mcneill-Johnson, Jason Glenn, Nekia Ivory Daniel, Mira Menon, Basil H. Aboul-Enein, Patricia J. Kelly, Megha Ramaswamy

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Youth placed in U.S. juvenile detention facilities face multilevel barriers that contribute to disparate sexual and reproductive health (SRH) outcomes when compared to their peers in the general adolescent population. Minimal information is available about evidence-based interventions that have been effective in changing these outcomes. The aim of this scoping review was to focus on the current state of SRH and identify recommendations for SRH care. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews guidelines, we searched electronic databases for publications published through March 2024. The search terms were designed to find intervention studies focusing …

Accuracy Of Race And Ethnicity Data In The Pediatric Electronic Health Record: A Concordance And System Adequacy Study, John Cowden, Rachel Drake, Jessi Johnson, Kataina Kelty, Mehwish Ahmed

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Introduction: Conventional race and ethnicity categories and analysis are reductive and prone to inaccuracy. Because race and ethnicity data validity is essential to health equity efforts, we measured the accuracy of race and ethnicity data in a pediatric electronic health record (EHR) to identify areas for improvement in data collection and use. Methods: Patients and their caregivers reported patient race and ethnicity via in-person survey in four pediatric settings (inpatient, emergency room, urgent care, and primary care). Race and ethnicity data from the EHR were compared with survey data to calculate four measures of EHR data accuracy. The U.S. Census …

Technology Dependence Among Hospitalized Us Children., Emily J. Goodwin, Isabella Zaniletti, Margaret Wright, Matt Hall, Jeffrey D. Colvin

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No abstract provided.

Enterovirus D68-Associated Respiratory Illness In Children., Benjamin R. Clopper, Adriana S. Lopez, Leah A. Goldstein, Terry Fei Fan Ng, Ariana P. Toepfer, Mary A. Staat, Elizabeth P. Schlaudecker, Leila C. Sahni, Julie A. Boom, Jennifer E. Schuster, Rangaraj Selvarangan, Natasha B. Halasa, Laura S. Stewart, John V. Williams, Marian G. Michaels, Geoffrey A. Weinberg, Peter G. Szilagyi, Eileen J. Klein, Janet A. Englund, Meredith L. Mcmorrow, Heidi L. Moline, Claire M. Midgley

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Enterovirus D68 (EV-D68) typically causes mild to severe acute respiratory illness (ARI). Testing and surveillance for EV-D68 in the US are limited, and important epidemiologic gaps remain.

OBJECTIVE: To characterize the epidemiology and clinical severity of EV-D68 among US children seeking care for ARI from 2017 to 2022, using a multisite, active, systematic surveillance network.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study collected data from the New Vaccine Surveillance Network, an active, prospective, population-based surveillance system of emergency departments (EDs) and hospitals at 7 US academic medical centers. Children with ARI and EV-D68-positive results were enrolled during platform-wide EV-D68 …

Us Infant Formulas Contain Primarily Added Sugars: An Analysis Of Infant Formulas On The Us Market, Audrey R. Rips-Goodwin, Daiil Jun, Adrianne Griebel-Thompson, Kai Ling Kong, Tera L. Fazzino

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Added sugar consumption is contraindicated for infants <  2 years old; however added sugars are present in many US infant formulas. We examined whether US formulas contain primarily added sugars, or whether formulas contain primarily naturally occurring lactose (the sugar in human milk). Data were obtained from the Nutrition Data System for Research and included formulas available on the US market in 2022 (N = 73). Formulas were categorized as: standard (n = 31), gentle (n = 27), and lactose-free (n = 15). Differences across formulas were examined using Bayesian modeling. The median percent added sugars were high in standard (M=59.7 %; IQR=22.0), gentle (M=85.0 %; IQR=39.5), and lactose-free formulas (M=90.0 %; IQR=54.3). Gentle formulas had significantly lower proportional lactose (OR=0.22, 95 % HDI=[0.11,0.44], pd=99.3 %) and > 2 fold higher proportional added sugars compared to standard formulas (ORs=2.11–2.57, HDI>0, pd=99.1–99.99 …

Addressing Structural Violence In School Policies: A Call To Protect Children's Safety And Well-Being., Daniela Brissett, Jacquelin Rankine, Lisa Mihaly, Romina Barral, Maria Veronica Svetaz, Alison Culyba, Marissa Raymond-Flesch

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No abstract provided.

Total Intestinal Atresia In A Neonate: A Case Report., Cory Nonnemacher, Seth Saylors, Naomi-Liza Denning, Vatche Melkonian, Pablo Aguayo

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Intestinal atresias are a common cause of neonatal intestinal obstruction. An extremely rare variant is total intestinal atresia, where no lumen is appreciable from the duodenum through the colon. We describe a case of a 33-week female who was born at an outside hospital and underwent laparotomy for concern for intrauterine perforation and proximal intestinal obstruction. Laparotomy revealed a duodenal perforation and an atresia in the proximal jejunum. Resection of this segment revealed no intestinal lumen distally, and the patient was left in discontinuity and transferred to our tertiary children's hospital. Repeat laparotomy revealed atretic bowel with no lumen through …

Factors Associated With Shock At Presentation In Kawasaki Disease Versus Multisystem Inflammatory Syndrome In Children Associated With Covid-19., Supriya S. Jain, Ashraf S. Harahsheh, Simon Lee, Geetha Raghuveer, Nagib Dahdah, Michael Khoury, Michael A. Portman, Melissa Wehrmann, Arash A. Sabati, Marianna Fabi, Deepika Thacker, Nilanjana Misra, Mark D. Hicar, Nadine F. Choueiter, Matthew D. Elias, Audrey Dionne, William B. Orr, Jacqueline R. Szmuszkovicz, Seda Selamet Tierney, Luis Martin Garrido-Garcia, Frederic Dallaire, Balasubramanian Sundaram, Deepa Prasad, Tyler H. Harris, Elizabeth Braunlin, Elisa Fernandez Cooke, Cedric Manlhiot, Pedrom Farid, Brian W. Mccrindle, International Kawasaki Disease Registry

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BACKGROUND: While clinical overlap between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) has been evident, information regarding those presenting with shock has been limited. We sought to determine associations with shock within and between diagnosis groups.

METHODS: The International KD Registry enrolled contemporaneous patients with either KD or MIS-C from 39 sites in 7 countries from January 1, 2020, to January 1, 2023. Demographics, clinical features and presentation, management, laboratory values, and outcomes were compared between the diagnosis and shock groups.

RESULTS: Shock at presentation was noted for 19 of 672 KD patients (2.8%) and 653 of …

Opioid Prescribing Patterns And The Effect Of Chronic Kidney Disease In Pediatric Urology Population: A Retrospective Cohort Analysis., Kristen M. Meier, Darren Ha, Carter Sevick, Eliza D. Blanchette, Megan A. Brockel, Vijaya M. Vemulakonda, Kyle O. Rove

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BACKGROUND: Significant efforts have been undertaken to decrease opioid prescribing, but there is little research into patient-specific factors presenting as barriers in the pediatric surgical population. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be a safe and effective alternative to opioids for pain control, however, concerns about their impact on renal function limit their use in patients with chronic kidney disease (CKD). Data is limited on the interplay of CKD on opioid prescribing.

OBJECTIVE: We hypothesized that opioid reduction efforts were successful, but patients with CKD would be more likely to receive an opioid prescription than those without CKD. …

Symptom Documentation In Unstructured Palliative Care Notes Of Children And Adolescents With Cancer., Katherine Bernier Carney, Jacob Wilkes, Tumilara Aderibigbe, Kristin Stegenga, Holly Spraker-Perlman, Lauri A. Linder

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CONTEXT: Children and adolescents with cancer experiencing complex symptoms can benefit from subspeciality palliative care. However, standardized methods of symptom documentation by pediatric palliative care teams are lacking. Understanding current approaches to symptom documentation will inform next steps to optimize symptom support.

OBJECTIVE: To explore the documentation of symptom prevalence and characteristics in unstructured clinical notes by pediatric palliative care clinicians caring for children and adolescents with cancer.

METHODS: We reviewed unstructured clinical notes documented by the pediatric palliative care team for 115 children and adolescents with cancer. Symptom-related data were abstracted and evaluated using content analysis based on the …

Genetic Testing Utilization In The U.S. Registry For Childhood Interstitial And Diffuse Lung Diseases., Laura A. Voss, Rebekah J. Nevel, Jennifer A. Wambach, Lawrence M. Nogee, Robin R. Deterding, Alicia M. Casey, Michael G. O'Connor, Daniel I. Craven, Jane B. Taylor, Gail H. Deutsch, Jade B. Tam-Williams, Lea C. Steffes, Steven K. Brennan, Maria T. Santiago, Sara C. Sadreameli, Andrea F. Heras, Michael R. Powers, Antonia P. Popova, Manvi Bansal, Aaron Hamvas, William A. Gower, Fernando Urrego, Lisa R. Young, Child Registry Collaborative

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INTRODUCTION: Childhood interstitial and diffuse lung diseases (chILD) comprise a diverse group of rare disorders. Identifying the underlying cause is crucial for treatment, prognosis, and estimating recurrence risk. The objective of this study was to assess the utilization of genetic testing for subjects enrolled in the United States National Registry for ChILD, a multicenter observational study.

METHODS: Genetic data from participating sites were reviewed and analyzed in relationship to clinical characteristics.

RESULTS: Of 609 children enrolled from 22 centers, genetic testing was performed for 55.5% (n = 338). Genetic testing results were positive (diagnostic) for 22.8% (n = 77), negative …

O The Places Rural Children Will Go…To Get Physical Activity: A Cross Sectional Analysis., Bethany Forseth, Jordan A. Carlson, Adrian Ortega, Chelsea Steel, Brittany Lancaster, Lauren Fitzpatrick, Qianxia Jiang, Ann M. Davis

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PURPOSE: Youth living in rural areas have higher risk for overweight/obesity. It is important to understand where these children engage in moderate-to-vigorous physical activity (MVPA) and sedentary time to encourage or intervene on activity in specific locations. This study compared MVPA and sedentary time across locations among children with overweight/obesity in the rural Midwest of the U.S.

METHODS: Participants wore an accelerometer and Global Positioning System tracker over 7-days to collect data on MVPA, sedentary time, and location. Locations were categorized as Home, Home Neighborhood, School, School Neighborhood, and 'Other'. Differences based on school and non-school days were examined.

RESULTS: …

Pediatric Relapsed/Refractory Alk-Positive Anaplastic Large Cell Lymphoma Treatment And Outcomes In The Targeted-Drug Era., Lianna J. Marks, Victor Ritter, Jennifer E. Agrusa, Kala Y. Kamdar, Julie Rivers, Rebecca Gardner, Matthew J. Ehrhardt, Kaitlin J. Devine, Charles A. Phillips, Anne Reilly, Keith August, Joanna Weinstein, Prakash Satwani, Christopher J. Forlenza, Christine Moore Smith, Chelsee Greer, Zeinab Afify, Carol H. Lin, Jennifer A. Belsky, Hilda Ding, David Hoogstra, Keri Toner, Michael P. Link, Liora M. Schultz, Eric J. Lowe, Catherine Aftandilian

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Treatment options for patients with relapsed or refractory (R/R) anaplastic large cell lymphoma (ALCL) have increased in the era of targeted therapies such as brentuximab vedotin (BV) and anaplastic lymphoma kinase (ALK) inhibitors. However, there is no standard treatment and published data evaluating their use are limited. The goal of this retrospective study was to describe current real-world treatment and outcomes of pediatric, adolescent, and young adult patients with R/R ALK-positive ALCL. We conducted a retrospective, multi-institutional study identifying 81 patients with R/R ALK-positive ALCL aged ≤21 years at initial diagnosis treated between 2011 and 2022 across 18 institutions. Median …

Prevalence Of Psychiatric And Sleep Disorders And Their Impact On Quality Of Life In Children With Hypermobile Ehlers-Danlos Syndrome: An Observational Study., Amanda K. Hertel, Jordan T. Jones, Ashley Lytch, Emily Cramer, Ariana Schroeder, William R. Black

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Hypermobile Ehlers-Danlos Syndrome (hEDS) is the most common connective tissue disorder. However, few studies exist on psychiatric and sleep disorders in pediatric patients with hEDS. This study aims to describe psychiatric and sleep disorders and evaluate their impact on health-related quality of life (HRQoL) in pediatric patients with hEDS. As part of a longitudinal study, a convenience sample of 123 pediatric patients with hEDS, were recruited at a hEDS multidisciplinary clinic in sequential order over a seven-month period. Patient-reported outcomes were completed (Patient Reported Outcomes Measurement Information System Pediatric Profile Version 2 [PROMIS], Generalized Anxiety Disorder-7 [GAD-7], Adolescent Sleep Wake …

Two-Dimensional Speckle Tracking Of The Ascending Aorta: A Novel Approach To Evaluate Arterial Stiffness In Pediatric Patients With Repaired Conotruncal Anomalies Using Echocardiography., Anmol Goyal, Anitha Parthiban, David A. White, Daniel Forsha, Doaa Aly

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BACKGROUND: Children with repaired conotruncal abnormalities (CTA) are at risk of progressive aortic dilation and deteriorating aortic elasticity even after surgical correction. Strain imaging, using a 2-dimensional speckle tracking echocardiography (2D-STE), has been used for arterial stiffness assessment, but pediatric data are still lacking. We investigated the feasibility, reproducibility, and clinical value of 2D-STE derived ascending aorta (AAo) stiffness in children with repaired CTA.

METHODS: 22 pediatric patients with repaired CTA were included along with 25 age- and sex- matched healthy controls (mean age 10.2 ± 4.5 years). Conventional 2D echocardiographic and 2D-STE assessment of AAo mechanics was performed. M-mode …

Parent Feedback On The Reducing Emotional Distress For Childhood Hypoglycemia In Parents (Redchip) Intervention: A Qualitative Analysis., Nicole A. Kahhan, Maryjane S. Campbell, Mark A. Clements, Kimberly A. Driscoll, Amy I. Milkes, Holly K. O'Donnell, Susana R. Patton

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Severe hypoglycemia is more common among young children with type 1 diabetes mellitus (T1DM) than older youth, and parents report significant hypoglycemia fear (HF). Parents experiencing HF describe constant and extreme worry about the occurrence of hypoglycemia and may engage in potentially risky behaviors to avoid hypoglycemia. Our team developed and tested a behavioral intervention, Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP), to decrease HF in parents of young children with T1DM. Here, we qualitatively analyzed parent feedback to refine and optimize future intervention iterations.

METHODS: The randomized pilot study included parents (n = 73) of …

A Scoping Review Of Sleep Disturbances In Children And Adolescents With Abdominal Pain Disorders., Hunter J. Friesen, Neha Singh, Jennifer Verrill Schurman, Amanda D. Deacy, Craig A. Friesen, Jennifer Colombo

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OBJECTIVE/PURPOSE/AIM: Sleep disturbances have been implicated as contributors to chronic pain. We undertook this review to assess the current literature regarding sleep disturbances in youth with chronic abdominal pain. We assessed studies evaluating prevalence, pathophysiology, and/or outcomes to identify gaps in knowledge and to determine whether there is an evidential basis for sleep interventions in this population.

MATERIALS AND METHODS: Utilizing Google Scholar, Pub Med, SCOPUS, and Embase, we searched using the terms "sleep disturbances" AND ("abdominal pain"/exp OR "abdominal pain") AND ([adolescent]/lim OR [school]/lim). Articles were included if they contained data regarding sleep disturbance prevalence, pathophysiology, or relationships to …

Developing And Implementing Pediatric Nephrology Milestones 2.0 As An Efficient Tool For Trainee Evaluation And Just-In-Time Feedback., Caroline V. Jackson, Rebecca Hjorten, Laura Edgar, Beatrice Goilav, Roshan P. George, Darcy K. Weidemann

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In 2013, the Accreditation Council for Graduate Medical Education (ACGME) implemented Milestones 1.0 as a tool to assess trainee progress towards readiness for independent practice. Critiques of Milestones 1.0 suggested its complexity made the tool difficult to quickly understand and implement in a standardized fashion. This was particularly challenging among subspecialties due to inherent differences in clinical practice settings and make-up of procedural and patient care needs. In response, ACGME launched Milestones 2.0 in 2016 to harmonize competencies applicable to all subspecialties and develop new subspecialty specific competencies to facilitate precise feedback on subspecialty specific content domains. We describe how …

Trends In Respiratory Pathogen Testing At Us Children's Hospitals., Matthew J. Molloy, Matthew Hall, Jessica L. Markham, Jillian M. Cotter, Elisha Mccoy, Michael J. Tchou, Megan E. Collins, Michael J. Steiner, John R. Stephens, Andrew G. Yu, Irma T. Ugalde, Rustin B. Morse, Monika K. Goyal, Samantha A. House

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IMPORTANCE: Respiratory pathogen testing has been a common deimplementation focus. The COVID-19 pandemic brought new considerations for respiratory testing; recent trends in testing rates are not well understood.

OBJECTIVE: To measure trends in respiratory testing among encounters for acute respiratory infections among children and adolescents (agedyears) from 2016 to 2023, assess the association of COVID-19 with these trends, and describe associated cost trends.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective serial cross-sectional study included emergency department (ED) encounters and hospitalizations in US children's hospitals among children and adolescents with a primary acute infectious respiratory illness diagnosis. Data were ascertained from the …

Icu Admission Prediction For Patients With Kawasaki Disease Or Mis-C Using Machine Learning., Jiwon Woo, Rebecca Mosier, Rishima Mukherjee, Ashraf S. Harahsheh, Supriya S. Jain, Geetha Raghuveer, Balasubramanian Sundaram, Simon Lee, Michael A. Portman, Nagib Dahdah, Marianna Fabi, Todd T. Nowlen, Audrey Dionne, Mona El Ganzoury, Tyler H. Harris, Benjamin T. Barnes, Frederic Dallaire, Paul Dancey, Kambiz Norozi, Mahmoud Alsalehi, Elif Seda Selamet Tierney, Jacqueline R. Szmuszkovicz, Pei-Ni Jone, Deepa Prasad, Anji T. Yetman, Nilanjana Misra, Mark D. Hicar, Deepika Thacker, Nadine F. Choueiter, Elisa Fernandez Cooke, Daniel Mauriello, Tapas Mondal, Matthew D. Elias, Kimberly E. Mchugh, Shae A. Merves, Luis Martin Garrido-Garcia, Michael Khoury, Guillermo Larios, Bhargava Chinni, Kaashvi Pruthi, Wenyu Yang, Joseph Greenstein, Casey Taylor, Pedrom Farid, Brian W. Mccrindle, Cedric Manlhiot, International Kawasaki Disease Registry

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) show a broad spectrum of clinical severity, from a relatively benign clinical course to requiring admission to the intensive care unit (ICU). With either, clinical deterioration may be rapid and unexpected.

OBJECTIVES: The aim of the study was to develop a machine learning (ML) model to predict future ICU admission for patients with KD or MIS-C to augment clinical decision-making.

METHODS: We developed a prediction model for ICU admission using 2,539 patientsfeatures, we developed predictive snapshot and window ML models with logistic regression, XGBoost, and random forest. Performance was …

Massive Gastroduodenal Trichobezoar Removed With Hydrodissection: A Case Report, Seth Saylors, Cory Nonnemacher, Irene Isabel P. Lim

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Introduction

Case presentation

Cervical Necrotizing Fasciitis And Shock In The Post-Operative Pediatric Patient., Paul Bryan Hankey, Jason R. Brown

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Cervical necrotizing fasciitis (CNF) is a rare infection that can quickly lead to devastating patient outcomes. Considering the vital importance of surrounding neck structures, rapid control of the infection is essential. Infection is most frequently polymicrobial and occurs in the adult patient in the context of certain medical comorbidities. Complications are typically limited to tissue destruction in the form of necrosis. There are no current reports describing CNF complicated by acute shock in the post-operative pediatric patient. Here, we present a pediatric case of CNF complicated by acute shock following Sistrunk procedure for removal of a supposed thyroglossal duct cyst. …

Prevalence Of Pain And Effect Of Joint Strength On Perceived Physical Function In Pediatric Patients With Ehlers–Danlos Syndrome, Nathaniel Garcia, Ashley Lytch, Emily Cramer, William R. Black, Jordan T. Jones

Manuscripts, Articles, Book Chapters and Other Papers

Objective

To identify how pediatric patients with hypermobile-type Ehlers–Danlos syndrome (hEDS) present to physical therapy (PT) and better understand their musculoskeletal dysfunction.

Design

Patients were included in the study if they had a diagnosis of hEDS and at least 1 completed PT evaluation after diagnosis. A chart review was conducted to assess joint strength and pain characteristics at the initial PT assessment. Physical Function Mobility (PF-Mobility; 4 domains with 1-5 scale with higher score representative of better physical function) as part of the Patient-Reported Outcome Measurement Information System and pain intensity score (visual analog scale, 0-10 scale where a lower …

Can Oral Caffeine Decrease Postoperative Opioid Consumption Following Posterior Spinal Fusion In Adolescent Idiopathic Scoliosis? A Randomized Placebo-Controlled Trial., Anne E. Stuedemann, Richard M. Schwend, K Aaron Shaw, Nicolette Saddler, Michon Huston, Michael Benvenuti, Julia Leamon, Ashley K. Sherman, John Anderson

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Current studies have examined the efficacy of opioid-sparing analgesics primarily in adult surgical populations, while fewer guide pediatric postoperative pain treatment. Caffeine exerts most of its biological effects by binding to adenosine receptors, which are important for modifying pain and inflammation. Caffeine's ability to modulate pain following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has not been previously assessed.

METHODS: The hospital investigational drug study (IDS) pharmacy provided either a treatment dose or placebo dose of caffeine to be given to the patient and was also in charge of randomization for the study.

RESULTS: There were 24 …