Pediatrics Commons^™

Pediatric Idiopathic Intracranial Hypertension (Iih), Jourdan Valkner Krause

Presentations

A case presentation on a 17 year old patient with IIH and severe papilledema unresponsive to max dose of Acetazolamide referred to neurosurgery for surgery intervention. A re-read of MRV revealed stenosed transverse sinus. A stent was placed and the patient's condition significantly improved.

Treatment Of Post-Operative Pain In Children With Severe Neurological Impairment, Jordan Keys

Presentations

Background: The assessment of pain in children with severe neurologic impairment (SNI) can be more challenging than in neurotypical children.

Objective: To describe the type, number of classes, and duration of post-operative pain medications for procedures common among children with SNI. Secondarily, to describe the variability in pain management strategies across children’s hospitals, specifically for opioid administration.

Design/Methods: This retrospective cohort study of the Pediatric Health Information System included children hospitalized with SNI aged 0-21 years old who underwent common procedures during 2019. We defined SNI using previously described high-intensity neurologic impairment (HINI) diagnosis codes and identified six common ( …

Leadership Across The Career Continuum: Using Self-Reflection Effective Leadership Practices For Optimal Team Functioning, Emily Bonanni, Grant M. Latta, Michael Platt, Christine Irvin, Angela Etzenhouser, Megan Collins, Sian Best, Jonathan Ermer, Joy L. Solano, Jacqueline M. Walker

Presentations

Have you ever found yourself in a formal or informal leadership role and felt underprepared because of a lack of formal leadership training? Have you noticed unused potential in those around you and wondered how you maximize it? As academic pediatricians, we are identified as leaders by patients and their families, trainees of all levels, members of our multi-disciplinary care teams, and our peers. We are a group of passionate clinician educators who have found ourselves in both formal and informal leadership roles and have found success in these roles with leadership training. Our interactive workshop will give you the …

Parent Satisfaction With Same Day Discharge After Laparoscopic Appendectomy For Non Perforated Appendicitis, Nelimar Cruz-Centeno, James Fraser, Shai Stewart Md, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Richard J. Hendrickson, Charles L. Snyder, Bhargava Mullapudi, Shawn D. St.Peter, Jason D. Fraser, Tolulope A. Oyetunji

Presentations

Background: Same-day discharge (SDD) after laparoscopic appendectomy for acute non-perforated appendicitis is safe, without an increased rate of postoperative complications, emergency department visits, or re-admissions. We aimed to evaluate caregiver satisfaction with this protocol. Materials and Methods: Patients discharged on the day of laparoscopic appendectomy for non-perforated acute appendicitis were identified between January 2022-August 2022. Surveys to evaluate satisfaction with the protocol were distributed to the caregivers via e-mail or text message 96 hours after discharge. Telephone surveys were conducted if there were no responses to the initial online survey. The surveys assessed comfort with SDD, post-operative pain control adequacy, …

Hypertrophic Pyloric Stenosis Protocol: A Single Center Study, Nelimar Cruz-Centeno, James A. Fraser Md, Shai Stewart Md, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Richard J. Hendrickson, Charles L. Snyder, Shawn D. St.Peter, Jason D. Fraser, Tolulope A. Oyetunji

Presentations

Introduction: Initial management of hypertrophic pyloric stenosis (HPS) is correction of electrolyte disturbances with fluid resuscitation. In 2015, our institution implemented a fluid resuscitation protocol based on previous data that focused on minimizing blood draws and allowing immediate ad libitum feeds postoperatively. Here we describe the protocol and subsequent outcomes. Methods: We conducted a single-center retrospective review of patients diagnosed with HPS from 2016-2020. All patients were managed per the protocol outlined in Figure 1. All were given formula or breast milk after the post-anesthesia care unit and discharged home after tolerating three consecutive feeds. Feedings were given every 2-3 …

Persistent Pediatric Breast Abscesses Following Initial Treatment At Tertiary And Community Centers, Derek Marlor, Kayla B. Briggs, Shai Stewart Md, Nelimar Cruz-Centeno, Charlene Dekonenko, Tolulope A. Oyetunji, Jason D. Fraser

Presentations

Introduction: Our institution previously reported on outcomes of children with untreated and not spontaneously draining breast abscesses. This study aimed to evaluate the outcomes of all patients with breast abscesses who were evaluated at our institution. Methods: Following IRB approval, all patients < 18-years-old with breast abscesses were included. A total of 145 patients treated from January 2008-December 2018 were identified. Patients were divided into 2 groups; Group 1 included patients initially evaluated at our institution and Group 2 included patients who were initially evaluated at referring centers. The primary outcome was disease persistence. Secondary outcomes were antibiotic utilization, number and type of procedures performed, and risk factors for recurrence. Statistical analysis was performed using STATA® 17 with a p-value of <0.05 indicating significance. Results: A total of 145 patients were identified: 111 (76.6%) in Group 1 and 34 (23.4%) in Group 2. Demographics were similar between groups. Of the 111 patients in Group 1, 2 (1.8%)) were treated with observation alone, 58 (52.3%) were treated with antibiotics alone, 26 (23.4%) were treated with aspiration, and 25 (22.5%) were treated with incision and drainage. Of the 34 patients in Group 2, 4 (11.8%) were treated initially with observation, 22 (64.7%) with antibiotics alone, 5 (14.7%) with manual expression, 2 (5.9%) with incision and drainage, and 1 (2.9%) with warm compresses. Patients in Group 1 were more likely to receive needle aspiration (23.4% vs. 0%; p<0.001) or incision and drainage (22.5.% vs. 5.9%; p<0.001) as initial treatment. Compared to Group 2, patients in Group 1 were more likely to be prescribed clindamycin when treated with antibiotics alone (69.9% vs 18.2%; p<0.001). They also had a 12.6% persistent disease rate (n=14). Second treatment in those with persistent disease included aspiration in 50% (n=7), incision and drainage 45.5% (n=5), antibiotics 7.1% (n=1), and manual expression 7.1% (n=1). No patients had persistent disease following second treatment. Patients in Group 2 were more likely to be treated with antibiotics alone (64.7% vs. 52.3%; p<0.001), with trimethoprim/sulfamethoxazole being the most commonly prescribed antibiotic (54.6%). In patients with persistent disease treated at our institution following initial evaluation at a referring center, 50.0% were treated with antibiotics alone, 26.5% with aspiration, 17.7% with incision and drainage, and 5.9% with manual expression. Following treatment at our institution, the rate of persistent disease was similar between groups (12.6% vs 11.8%;). Conclusions: Persistent breast abscesses may be treated with antibiotics alone in community and tertiary care centers. Disease persistence is similar regardless of the initial treatment setting.

Clinical Features And Outcomes In Pediatric Severe Scald Burn Patients, Ashley Daniel

Presentations

Introduction/Hypothesis Young children with scald burns experience severe complications compared to older children. A paucity of data exists to support these observations. This study compares clinical features and complications of younger versus older pediatric patients with scald burns at four children’s hospitals participating in the Pediatric Injury Quality Improvement Collaborative (PIQIC). This collaborative includes five pediatric burn centers that utilize research to improve quality of burn care. 485 Methods This is a retrospective cohort study of scald burn patients admitted from 2010 to 2020 to four pediatric hospitals participating in PIQIC. Patients with total body surface area (TBSA) < 15% were excluded. Patients were categorized by age into three groups: toddlers (0–3 years), children (3-10 years), and adolescents (>10 years). …

Pediatric In-Hospital Cardiac Arrests: We Have More To Learn About Patient Demographics And Outcomes, Nathan Lavoy, John Cowden, Jenna Miller, Asdis Finnsdottir Wagner, Shekinah Hensley, Stephen Pfeiffer

Presentations

Introduction: Prior pediatric studies show an association between patient demographics and mortality after in-hospital cardiac arrests (IHCA). To our knowledge, this has not been assessed in pediatric intensive care units (PICU). This study aims to evaluate the impact of demographics and code characteristics on outcomes after IHCA in a quaternary referral PICU. Methods: A single center retrospective review of PICU IHCA events from 2010-2021 was performed. Patient demographics included age, gender, race/ethnicity, and language. Primary diagnosis was defined as cardiac or non-cardiac. The use of ECMO, CRRT, or defibrillation were included as code characteristics. The primary outcome was survival to …

Get Smart: Implementation Of Updated Asthma Guidelines For Pediatric Hospitalists, Alexander Hogan, Kathryn Kyler, Claire Seguin

Presentations

Prescription of Single Maintenance And Reliever Therapy (SMART) for moderate and severe persistent asthma is the most important and actionable improvement in the National Heart Lung Blood Institute (NHLBI) asthma guidelines for pediatric hospitalists. SMART is the use of a single inhaled corticosteroid/long acting beta agonist inhaler both as a daily preventive inhaler and as-needed for asthma symptoms. As hospitalists, we treat patients with poorly controlled asthma who will benefit from SMART asthma action plans. Despite ample evidence supporting use of SMART, implementation of such large changes in practice is challenging. Implementation science and quality improvement principles can be used …

Financial Outcomes By Severity Across Children's Hospitals, Jonathan Hartley, Jessica L. Bettenhausen, Matt Hall, David C. Synhorst, Jessica L. Markham, James Gay

Presentations

Background: Hospitalizations represent a significant driver of healthcare costs for children. Little is known about how payor type and the severity of children cared for on the general pediatric inpatient floor impact a hospital’s financial outcomes. Objective: The primary objective of this study is to compare financial outcomes of pediatric hospitalizations to the general floor across patient severity quartiles. Secondary objectives included financial outcomes stratified by payor type across severity quartiles. Methods: Retrospective cohort study included children aged 0-18 years discharged during calendar year 2019 from hospitals that reported clinical information to the Pediatric Health Information System database and financial …

Financial Outcomes By Severity Across Children's Hospitals, Jonathan Hartley, Jessica L. Bettenhausen, Matt Hall, James Gay, David C. Synhorst, Jessica L. Markham

Presentations

Background: Hospitalizations represent a significant driver of healthcare costs for children. Little is known about how payor type and the severity of children cared for on the pediatric medical inpatient floor impact a hospital’s financial outcomes. Objective: The primary objective of this study is to compare financial outcomes of pediatric hospitalizations to the medical inpatient floor across patient severity quartiles. Secondary objectives included financial outcomes stratified by payor type across severity quartiles. Methods: Retrospective cohort study included children aged 0-18 years discharged during calendar year 2019 from hospitals that reported clinical information to the Pediatric Health Information System database and …

Parental Teach Back In The Ed Setting For Non-English Speaking Families, Rohan Akhouri

Presentations

90 million Americans have low health literacy1.in Missouri 35% of adults have prose literacy at or below basic skill level2. Literacy, more specifically health literacy, is a modifiable social determinant of health that has a large impact on patient care and outcome. Poor health literacy in adults is associated with a higher number of ED visits and worse health outcomes3,4. Teach back is a method used in multiple pediatric and adult settings, shown to improve patient outcomes and comfort with discharge instructions5. There is limited data regarding teach back in non-English speaking patients and its efficacy with this group of …

Outpatient Emergency Preparedness, Mary Haywood

Presentations

It is commonly believed that medical emergencies do not present to general pediatric offices. However, it has been estimated that 0.9-42 emergencies per office site/year occur. The most common presentations are respiratory in nature. However, children can also present with dehydration, seizure, psychiatric or behavioral complaints. Despite this, most offices are not prepared to handle these presentations for various reasons. Multiple studies have showed that preparedness in inpatient settings is improved with education, implementation, or protocols and deliberate practice with mock codes. However, there have been few studies in the outpatient setting. One study utilized simulation as a tool to …

Spending On Public Benefit Programs And Exposure To Adverse Childhood Experiences, Megan Collins, Matt Hall, P J. Chung, Jessica L. Markham, Jessica L. Bettenhausen, L M. Plencer, Molly Krager, Kathyrn Kyler, D Bard, Kayla R. Heller, Roxana Guggenmous, Jordan Keys, Henry T. Puls

Presentations

Background: Adverse childhood experiences (ACEs) have been shown to be associated with poor health outcomes, and children living in poverty are more likely to experience ACEs. Our objective was to estimate the association between spending on benefit programs and cumulative exposure to ACEs among children. Methods: This cross-sectional study examined state and federal spending, at the state-level, on 5 categories of public benefit programs: cash, housing, and in-kind assistance; housing infrastructure; childcare assistance; refundable Earned Income Tax Credit; and Medical Assistance Programs (e.g., Medicaid). The primary exposure was median annual spending per person living below the federal poverty limit across …

Rates Of Physical Abuse Screening And Detection In Infants With Brief Resolved Unexplained Events (Brues), Angela Doswell, James Anderst, Joel Tieder, Henry T. Puls, Brue Research And Quality Improvement Network

Presentations

Background: “Apparent Life-Threatening Events” (ALTEs) have been associated with child physical abuse (CPA). In 2016, “Brief Resolved Unexplained Event” (BRUE) and the development of its clinical guidelines and risk-stratification replaced ALTE. However, it is unknown if there is a similar association between BRUEs and CPA. Hypothesis/Objectives: To determine the rate of CPA in infants presenting with a BRUE, examine differences between infants with and without CPA, and to examine rates of diagnostic testing used to detect CPA. Methods: This study was part of the BRUE Research and Quality Improvement Network, composed of 15 hospitals. Subjects were infants presenting with BRUE …

Patient Attitudes, Perceptions, Knowledge, And Beliefs Regarding Immigration Status In The Healthcare Setting, Anik Patel

Presentations

No abstract provided.

Examining Diagnostic Variability Among Pediatric Subspecialists In Case Examples Of Infant Head Injury, Angela Doswell, Emily Killough, James Anderst, Timothy Zinkus, Ashley Sherman

Presentations

Background: Clinical presentation, imaging, and ophthalmologic findings are important factors in distinguishing between noninflicted and abusive head trauma (AHT) in infants. However, little is known about agreement between pediatric subspecialists regarding diagnosis and timing of AHT in infants. Hypothesis/Objects: The primary outcome was differences in rates of AHT diagnosis among different types of pediatric subspecialists using case examples of infant head injury. The secondary outcome was qualitative trends in clinical reasoning related to injury timing. Methods: Four case examples of infant head injury were developed into an online survey. Cases were categorized as: (1) “bilateral mixed density subdural hemorrhages (SDHs)”; …

Assessing And Addressing Barriers To Fertility Preservation In Pediatric And Adolescent Patients At Risk For Infertility, Emily Burnett, Tennille Hilyard, Julie Strickland

Presentations

Fertility consultation is a recognized standard that should be offered to pediatric patients with fertility threatening diagnoses or undergoing fertility threatening therapy. The primary objective of this study is to determine how patients who did proceed with fertility preservation differ from those who declined the procedure. This study aims to assess barriers that may contribute to the underutilization of fertility preservation procedures after a formal consultation is completed.

Umbilical Access In Laparoscopic Surgery In Infants Less Than 3 Months: Single Institution Retrospective Review, James Fraser, Kayla B. Briggs, Wendy Jo Svetanoff, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St Peter, Tolulope A. Oyetunji

Presentations

PURPOSE: Umbilical access in laparoscopic surgery has been cited as a potential factor for increased complications in low birth weight infants and those less than three months old. Previous series noted a self-reported complication rate of 10.6% among 329 pediatric surgeons via anonymous survey, citing carbon dioxide (CO2) embolism as the most common complication. We report four-year outcomes with blunt transumbilical laparoscopic access to examine the safety of this technique. METHODS: Following IRB approval, a retrospective database of patients less than three months of age who underwent laparoscopic pyloromyotomy or inguinal hernia repair from 2016-2019 at a tertiary care academic …

Congenital Abnormalities Of The Lower Airways And Lungs, Christopher M. Oermann

Presentations

Goals and Objectives. Participants will be able to: Describe the 5 stages of fetal lung development. Summarize the prenatal identification and management of congenital abnormalities of the lower airways and lung (CALAL). Explain the classification of CALAL. Compare the clinical characteristics, pathology, and management of common CALAL. Discuss the long-term prognosis of CALAL.

Getting Back On Track With Cancer Prevention And Adolescent Immunizations, Sharon Humiston

Presentations

Objectives:

1.Explain why HPV vaccine is important enough to be routinely recommended for young people (i.e., HPV cancer prevention).

2. Give an HPV vaccination recommendation that is effective and succinct using the same way, same day approach to the introduction of HPV vaccine.

3. Answer the most frequently asked questions about HPV vaccine accurately and succinctly.

Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, Gina Patel, Jenna Miller, Thomas M. Attard, Asdis Finnsdottir Wagner

Presentations

Background:

Incidence and management of Gastrointestinal (GI) bleeding on ECMO isn’t well reported Patients on ECMO require systemic anticoagulation making GI bleeding difficult to manage We describe the use of enteral tranexamic acid (TXA) in two pediatric patients with GI hemorrhage on ECMO

Neonatal Gut Microbiota Alterations And Local Inflammation Induced By Escherichia Coli Infection Are Modified By Lactobacillus Rhamnosus Prophylaxis, Susana Chavez-Bueno, Hao Xuan, Shahid Umar, Concong Zhong, Wei Yu, Venkatesh Sampath

Presentations

Background: E. coli is a leading cause of neonatal sepsis. Newborns ingest E. coli, which transcytoses the gut producing bacteremia. Lactobacillus spp. decrease E. coli gut transcytosis but the mechanisms involved in this protective effect are not well understood.

Objective: To determine the effects of Lactobacillus pretreatment on the intestinal microbiota and inflammation in neonatal rats orally infected with E. coli.

Design/Methods: Newborn rats were orally pretreated on day of life (DOL) 1 and 2 with four doses of 107 colony forming units (CFU) of Lactobacillus rhamnosus GG (LGG) or PBS. On DOL 2, pups received orally 106 CFU of …

Neurodevelopmental Profiles Of Infants Born < 30 Weeks' Gestation At 2 Years Of Age, Marie Camerota, Elisabeth C. Mcgowan, Julie A. Hofheimer, T. Michael O'Shea, Brian S. Carter, Jennifer Helderman, Jennifer Check, Charles R. Neal, Steven L. Pastyrnak, Lynne Smith, Cynthia Loncar, Stephen Sheinkopf, Lynne Dansereau, Sheri A. Dellagrotta, Barry Lester

Presentations

Background: Infants born (PMA) are at increased risk for neurodevelopmental impairment by age 2. Prior studies have tended to examine individual outcomes separately, rather than investigating whether there are subgroups of children with distinct neurobehavioral profiles.

Objective: To determine distinct neurodevelopmental profiles in 2 year old children born cognitive, language, motor, and behavioral characteristics.

Design/Methods: NOVI (Neonatal Neurobehavior and Outcomes in Very Preterm Infants) is a multi-center study of infants born (BSID-III) subscale scores, Child Behavior Checklist (CBCL) syndrome scores, diagnosis of cerebral palsy (CP; Gross Motor Function Classification System and abnormal neurologic exam), and positive screen for autism spectrum …

The Association Between Age And Unrecognized And Untreated Hypertension In Children With Chronic Kidney Disease, Chloe Douglas, J Roem, Joseph Flynn, Susan Furth, Bradley A. Warady, Susan Halbach

Presentations

Background: Younger age has been associated with unrecognized hypertension (HTN) in both the general pediatric population and in children on dialysis. An increased lifetime risk of cardiovascular disease and the association of HTN with chronic kidney disease (CKD) progression make optimal treatment of elevated blood pressure (BP) a key component of CKD management. However, the role of age in the recognition and treatment of HTN in non-dialysis pediatric CKD remains unknown.

Objective: Using data from the Chronic Kidney Disease in Children (CKiD) Cohort Study, we examined the relationship between age and recognized vs. unrecognized HTN, and the frequency with which …

Neonatal Neurobehavior, Medical Risk, And 2-Year Developmental Outcomes In Infants Born <30 Weeks Gestation, Elizabeth Mcgowan, Marie Camerota, Julie A. Hofheimer, Michael O'Shea, Brian S. Carter, Howard Kilbride, Steven Pastyrnak, Charles R. Neal, Lynne Smith, Jennifer Helderman, Jennifer Check, Lynne Dansereau, Sheri A. Dellagrotta, Barry Lester

Presentations

Background: Among preterm infants, risk of poor outcomes has been linked to neonatal medical illness and neurobehavior. The combined contribution of neonatal medical morbidities and neonatal neurobehavior to 2 year outcomes has yet to be studied.

Objective: To determine associations between NICU Network Neurobehavioral Scale (NNNS) profiles, medical risk, and 2 year developmental outcomes.

Design/Methods: Multi-center study of 704 infants born <30 weeks gestation enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study. NNNS were completed prior to NICU discharge and six profiles of neonatal neurobehavior were calculated by latent profile analysis. Two profiles (5 and 6) were considered atypical. Medical risk included brain injury, CLD, ROP, and NEC/sepsis. Outcomes at 2 years were Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores and Child Behavior Checklist (CBCL) T-scores. Generalized estimating equation (GEE) models were used to test the associations among NNNS profiles, neonatal medical risk, and 2 year developmental outcomes. GEE models accounted for multiple births. Covariates were research site, maternal socioeconomic status (SES), race or ethnicity, maternal primary language, partner status, maternal psychopathology, and infant sex.

Results: Follow-up data were available for 556/704 (78.9%) infants, of which 157 (28.2%) were Profile 5-6. Mother of Profile 5-6 infants were more likely to be non-English speaking and lower SES compared to Profiles 1-4 mothers (Table 1). In …

Using Machine Learning To Identify Metabolomic Signatures Based On Pediatric Chronic Kidney Disease Etiology, Arthur Lee, Alison Abraham, Yunwen Xu, Jian Hu, Xia Or, Josef Coresh, Casey Rebholz, J Chen, Eugene Ree, Harold Feldman, Paul Kimmel, Bradley A. Warady, Susan Furth, Michelle Denburg

Presentations

Background: Untargeted plasma metabolomic profiling combined with novel machine learning (ML) tools may lead to the discovery of metabolic profiles that inform our understanding of pediatric chronic kidney disease (CKD) etiologies and identify potential therapeutic targets.

Objective: We sought to identify metabolomic signatures in pediatric CKD based on etiology: focal segmental glomerular sclerosis (FSGS), obstructive uropathy (OU), aplasia/dysplasia/hypoplasia (A/D/H), & reflux nephropathy (RN).

Design/Methods: Untargeted GC/MS2 and LC/MS2-based metabolomics quantification (Metabolon) was performed on baseline plasma samples from 702 Chronic Kidney Disease in Children (CKiD) participants. Participants per etiology were: FSGS (n=63), OU (n=122), A/D/H (n=109), & RN (n=86). Lasso …

Reducing Alarm Burden By Promoting Judicious Ordering Of Continuous Pulse Oximetry, Kathleen Berg, David Johnson, Ginny Nyberg, Andrew Ausmus, Christine Claeys, Emily Wilkinson, Nicholas Clark

Presentations

Background: Overutilization of continuous pulse oximetry (CPO) contributes to overdiagnosis and prolonged supplemental oxygen utilization. It may also negatively impact patient sleep, mobility, length of stay (LOS), and cost. Response times to actionable alarms increase with the number of non-actionable alarms. Our baseline data revealed an average of 29.6 pulse oximetry monitor alarms sounded for each admitted patient each day of their hospitalization. Most notably, 38.7% of pulse oximetry alarms were for ≥88% which is generally considered non-actionable.

Objective: We aimed to decrease both total pulse oximetry alarms per patient day and alarms for ≥88% per patient day by 20%, …

Neonatal Dna Methylation As A Predictor Of Cognitive, Language, And Motor Performance At 24 Months Adjusted Age, Among Children Born Very Preterm, Stefan Graw, Marie Camerota, Brian S. Carter, Jennifer Helderman, Julie A. Hofheimer, Elizabeth C. Mcgowan, Charles R. Neal, Steven Pastyrnak, Lynne Smith, Michael O'Shea, Barry Lester, Carment Marsit, Todd M. Everson

Presentations

Background: Infants born prematurely are at increased risk for neurodevelopmental impairments during childhood and early neurodevelopment can be influenced by multiple factors (perinatal and environmental exposures, genetics). DNA methylation (DNAm) can also be influenced by these factors and be reflective of health and development, and thus may provide an integrated measure of early life risk for neurodevelopmental outcomes.

Objective: To test whether neonatal DNAm is predictive of cognitive, language, and/or motor performance at 24 months of age in children that were born very preterm.

Design/Methods: We studied 433 neonates born < 30 weeks postmenstrual age in the Neonatal Neurobehavioral Outcomes in Very Preterm Infants (NOVI) study. Neonatal DNAm was measured from buccal swabs at NICU discharge via the Illumina MethylationEPIC BeadArray. Cognitive, motor, and language performance were assessed by the Bayley Scales of Infant and Toddler Development-III (BSID-III) at 24 months adjusted age, with mild and moderate impairment defined as composite scores < 85 and < 70. We used an elastic net regression and leave-one-out cross-validation to limit overfitting and selection bias, to identify sets of DNAm sites that were predictive of composite Bayley scores. For the leave-one-out cross-validation, a model was trained on all but one sample to make a prediction on that held-out sample. This step is repeated until each sample was held out and predicted once. In addition, for a given hold-out sample, all siblings were removed from its training set. The performance of predicted composite scores were evaluated by their correlation with the measured Bayley scores and the area under the receiver operating characteristic (ROC) curve (AUC) based on dichotomized Bayley scores (< 85 and < 70).

Results: We identified sets of DNAm sites (including 33-306 sites) …

Medicaid Expenditures Among Children With Documented Obesity, Kathyrn Kyler, Matt Hall, Jessica L. Bettenhausen, Sarah Hampl, Ann M. Davis

Presentations

Background: Obesity rates continue to rise among children, but knowledge regarding spending patterns of Medicaid enrollees with documented obesity are lacking.

Objective: We aimed to describe Medicaid expenditure patterns and determine the degree to which specific clinical characteristics and conditions contribute to high expenditures among children with obesity.

Design/Methods: We performed a retrospective cross-sectional analysis of children aged 2-17 years with a diagnosis code (ICD-10) for obesity continuously enrolled in the nationally-representative 2017 Medicaid Marketscan database. Expenditures were measured as median per member per year (PMPY) spending and categorized based on prior literature from low to high PMPY expenditure groups: …