Pediatrics Commons^™

Assessing The Temporality Of Adverse Effects Of Vaccines In The Nicu, Julia Tonnessen, Pedro Urday, Md

Phase 1

Introduction: Premature infants have an increased risk of contracting vaccine-preventable diseases and experience worse outcomes. Evidence supports keeping them on a regular vaccination schedule, but it is often delayed, partly because preterm infants have an increased incidence of cardiorespiratory events compared to term infants. The aim of our study was to determine if immunizations in the NICU contribute to an increased number of adverse events.

Methods: This was a retrospective, single-center, observational study with the target population infants born at less than 32 weeks gestation at Thomas Jefferson University Hospital who received the two-month vaccination series in the NICU. The …

Effect Of Sustained Attention On Early Start Denver Model Outcomes, Katherine Mcleod, Giacomo Vivanti, Phd

Phase 1

Introduction: There is very little research on the use of sustained attention as an outcome predictor for the Early Start Denver Model (ESDM). We hypothesized that a child’s level of sustained attention prior to therapy will correlate with positive ESDM outcomes.

Methods: 10 pre-preschool age children with a diagnosis of autism spectrum disorder received one year of ESDM therapy. A novel coding scheme was developed to evaluate each child’s pre-treatment level of sustained attention. Mullen Scales of Early Learning were evaluated prior to and after one year of ESDM. Pre-treatment levels of sustained attention were compared to pre-and post-treatment Mullen …

Obesity And Cardiovascular Health Differences Between Urban And Suburban Philadelphia High School Athletes, Peri Levey, Kyle Prochno, Prashant Rao, Md, David Shipon, Md, Facc, Facp, Jeremy Close, Md

Phase 1

Introduction: The strongest risk factor for primary hypertension in children is obesity, and concern for pediatric hypertension rises with the rising prevalence of obesity in American children. Specifically, in urban Philadelphia schools from 2009 to 2012, preparticipation physical evaluations (PPEs) demonstrated a positive correlation between blood pressure measurements demonstrating stage 1 or 2 hypertension and elevated body mass index (P < 0.00001).

Objective: The purpose was to identify potential differences in cardiovascular health and prevalence of obesity between adolescents in the urban and suburban Philadelphia areas.

Methods: Data from PPEs administered to urban Philadelphia high school athletes in 2018 by the Athlete …

Quality Improvement Study Of Behavioral Health Resources Access In 19121 And 19132, Courtney Kaye, Rickie Brawer, Mph, Phd, Mches, Jeanne Felter, Phd, Lpc

Phase 1

Introduction: Children who have experienced four or more ACES (adverse childhood events) are shown to have negative mental health outcomes. Adolescents living in the Philadelphia zip codes 19121 and 19132 have higher ACE scores. This makes it necessary for adolescent providers to screen for behavioral health issues in their patients and refer out to appropriate resources.

Objective: The purpose of this quality improvement study is to see what current barriers exist relating to physician referral and access to behavioral health resources for their patients.

Methods: A guide of behavioral health resources available to adolescents in 19121 and 19132 was …

Advocating For Protective Measures Against Childhood Lead-Poisoning In Philadelphia Rental Homes, Claire Miller, Colleen Mccauley

Phase 1

Introduction: Lead exposure has been linked to delays in development and behavioral problems in children. Over 1,500 children are poisoned by lead each year in Philadelphia; the majority (62%) in rental homes.

Objective: The purpose of this project was to understand the impact of lead poisoning on children in Philadelphia, the current policies in place to protect children and the ways in which various stakeholders can advocate for policy changes that will better protect children.

Methods: A mixed-methods approach was utilized including meetings with councilmembers, stakeholder interviews and data analysis, visualization and presentation. This information was used to gain councilmembers’ …

Comorbidities And Treatments In United States Youth With Chronic Musculoskeletal Pain, Matthew T. Taylor, Sabrina Gmuca, Alexis Boneparth, L. Nandini Moorthy, Daniel B. Horton

Phase 1

Introduction: Chronic musculoskeletal (MSK) pain has been associated with chronic illnesses and high rates of pain medication use, often in referral centers, European populations, or studies focused on single drug classes. We aimed to characterize patterns of comorbidities and treatments associated with chronic MSK pain in a nationally-representative sample of US youth.

Methods: We used the National Ambulatory Medical Care Survey (2002-2015) and National Hospital Ambulatory Medical Care Survey (2002-2011), which contain cross-sectional data for US outpatient visits. The study included all visits for youth age 8-24, excluding those with malignancy or sickle cell disease. We compared comorbidities and drugs …

Obesity And Cardiovascular Health Differences Between Urban And Suburban Philadelphia High School Athletes, Kyle W. Prochno, Peri Levey, Prashant Rao, Md, David M. Shipon, Md, Facc, Facp, Jeremy D. Close, Md

Phase 1

Introduction: Limited data exist regarding hypertension and obesity levels of Philadelphia-area high school student-athletes. We aim to assess their prevalence in an urban population, investigate whether they are correlated with demographic factors, and determine whether urban student-athletes differ in these outcomes compared to their suburban/non-urban counterparts.

Methods: Demographic and physical data were extracted from Athlete Health Organization (AHO) 2018 pre-participation physical exams. Adiposity classifications were made from body mass index (BMI) calculations applied to appropriate Centers for Disease Control and Prevention (CDC) growth charts, while systolic/diastolic measurements were used to classify students’ blood pressure according to current American Academy of …

Gastroschisis, Rebecca M. Rentea, Vikas Gupta

Manuscripts, Articles, Book Chapters and Other Papers

Gastroschisis is a paraumbilical, full-thickness abdominal wall defect associated with protrusion of the bowel through the defect. It is rarely associated with genetic conditions. A membrane does not cover the bowel exposed in utero and, as a result, may be matted, dilated, and covered with a fibrinous inflammatory rind. Infants have a high proportion of intrauterine growth restriction. Diagnosis is often made on the 20-week ultrasound with free-floating bowel loops in the uterine cavity. Maternal serum alpha-fetoprotein (AFP) is elevated in pregnancies with gastroschisis. Compared with other abdominal wall defects diagnosed prenatally such as omphalocele, only 10 percent of cases …

Patent Urachus, Kayla B. Briggs, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

atent urachus refers to one condition in a rare spectrum of disorders referred to as urachal anomalies. These conditions result from the failure of the involution of normal embryologic tissues that serve to empty the fetal bladder. The location and amount of persistent tissue dictate the presenting symptoms. Some of these urachal anomalies are obvious at birth, while others are more subtle and not diagnosed until adulthood or only incidentally discovered after imaging is obtained for other reasons. Historically, surgical resection of urachal anomalies was routinely undertaken, given the potential for malignancy in retained ectopic tissue. Early surgical resection has …

Ileal Atresia, Obiyo O. Osuchukwu, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Ileal and jejunal atresias are usually described together as jejunoileal atresia (JIA). JIA is a common cause of intestinal obstruction in neonates. It is seen in 1 in 5000 to 1 in 14000 live births. Intestinal atresia can occur in any location on the small bowel as a solitary or even multiple lesions. Distally located atresia usually presents with delayed symptoms compared to proximal ones. Occasionally, JIA is associated with other malformations such as cardiac anomalies, gastroschisis, and cystic fibrosis. Evaluation can be initiated before birth with prenatal diagnosis using ultrasound findings of evidence of intestinal obstruction reported in 29% …

Pentalogy Of Cantrell, Muhammad Khawar Sana, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Pentalogy of Cantrell (POC) is a collection of five congenital midline birth anomalies that present a distinctive challenge for clinicians and surgeons. Those five defects are of the heart, pericardium, diaphragm, sternum, and abdominal wall. This condition has been divided into two categories, complete or partial. Complete, as the name indicates, refers to the presence of all five defects, while others may present with only partial defects. It is also referred to as thoracoabdominal ectopia cordis, a condition where the heart is covered by an omphalocele-like membrane. Ectopia cordis (EC) is often found in fetuses with POC. Infants usually have …

Morgagni Hernia, Wendy Jo Svetanoff, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

A Morgagni hernia is one of four types of diaphragmatic hernias; the other types include a Bochdalek hernia, where the defect is posterolateral, a hiatal hernia, where the defect is at the esophageal hiatus, and a paraesophageal hernia, where the defect is located adjacent to the esophageal hiatus. The Morgagni hernia, in which the defect is found in an anterior and retrosternal location, was first described by Morgagni in 1769. It is rarer than the other type of congenital diaphragmatic hernia (Bochdalek hernia) and comprises only 2% to 5% of all congenital diaphragmatic hernias. Morgagni hernias tend to be less …

Ambiguous Genitalia And Disorders Of Sexual Differentiation, Khawar T. Mehmood, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

The birth of an infant with ambiguous genitalia generates difficult multiple medical, surgical, ethical, psychosocial, and physical issues for patients and their parents. Phenotypic sex results from the differentiation of internal ducts and external genitalia under the influence of hormones and other additional factors. When discordance occurs among three process es (chromosomal, gonadal, phenotypic sex determination), a DSD is the result. Terminology such as hermaphrodite, pseudo-hermaphrodite, and intersex, are considered to be pejorative and dated. These terms have been replaced by the term disorders of sexual development (DSD) by the consensus statement on management of intersex disorders. Disorders of sexual …

Torsion Of An Accessory Spleen In A Child With Biliary Atresia Splenic Malformation Syndrome., David A. Simon, Nathan R. Fleishman Md, Pamala Choi, Jason D. Fraser, Ryan T. Fischer

Manuscripts, Articles, Book Chapters and Other Papers

Torsion of an accessory spleen is an exceedingly rare cause of abdominal pain in pediatric patients. The diagnosis is frequently challenging as presentation is variable and diagnostic imaging can be aspecific. The current case describes an unusual presentation of a torted accessory spleen in a 5-year-old girl with biliary atresia splenic malformation syndrome who initially presented with non-specific abdominal symptoms and fever. The diagnosis was made following fine-needle aspiration of a suspected intraabdominal abscess. The case highlights the diagnostic challenge of accessory splenic torsion and stresses the importance of its inclusion on the differential diagnosis of pediatric patients, especially those …

Philippines: An Int-Erupted Experience, Susamita Kesh

Posters

Describes her experience working in the NICU of the Fabella Memorial Hospital in Philippines.

Fit Clinical Decision-Making: Uhl's Anomaly: An Uncommon Cause Of Fetal Cardiomegaly, Bethany Runkel, Atif Ahmed, Tara Swanson, Maria Kiaffas

Posters

No abstract provided.

Association Of Genetic Risks With Autism Spectrum Disorder And Early Neurodevelopmental Delays Among Children Without Intellectual Disability, Nagahide Takahashi, Taeko Harada, Tomoko Nishimura, Akemi Okamura, Damee Choi, Toshiki Iwabuchi, Hitoshi Kuwabara, Shu Takagai, Yoko Nomura, Nori Takei, Kenji J. Tsuchiya

Publications and Research

IMPORTANCE Autism spectrum disorder (ASD) is highly heritable, and modest contributions of common genetic variants to ASD have been reported. However, the association of genetic risks derived from common risk variants with ASD traits in children from the general population is not clear, and the association of these genetic risks with neurodevelopment in infants has not been well understood.

OBJECTIVE To test whether a polygenic risk score (PRS) for ASD is associated with neurodevelopmental progress at age 18 months and ASD traits at age 6 years among children from the general population.

DESIGN, SETTING, AND PARTICIPANTS In this cohort study, …

Comparing Open And Fetoscopic Fetal Surgical Repairs Of Myelomeningocele, Kyra Isaacs

Capstone Showcase

Introduction: There have been great advances in the treatment of myelomeningocele (MMC) spina bifida in the past 20 years. An open surgical repair in-utero has been shown to reduce mortality and morbidity, specifically decreasing the rate of shunt placement and hindbrain herniation compared to a postnatal surgical approach. However, this surgery introduced risks to the mother that were never a consideration in previous surgical approaches.

Methods: This paper compares research on new minimally invasive fetoscopic surgical techniques to open fetal surgery in the prenatal repair of MMC. Searches in PubMed and Clinical Key were conducted to produce papers published on …

Efficacy Of Adjunct Acupuncture (Insertive And Non-Insertive) In The Treatment Of Neonates With Neonatal Abstinence Syndrome, Kali Thibault

Capstone Showcase

Introduction: Neonatal Abstinence Syndrome (NAS) is a condition that affects newborn infants exposed to opioids in utero. NAS is becoming increasingly more prevalent due to the ongoing opioid epidemic. Current treatment for NAS is primarily morphine or buprenorphine. Even on these treatments, infants with NAS often still have symptoms of withdrawal, requiring high doses of medication and extended hospital stays. Acupuncture therapy has been shown to decrease withdrawal symptoms in adults, so researchers are now looking to use this non-pharmacological treatment on infants with NAS.

Methods: A literature search was performed using Google Scholar, PubMed, and EBSCOhost in November of …

Hypomorphic Si Genetic Variants Are Associated With Childhood Chronic Loose Stools., Bruno P Chumpitazi, Jeffery Lewis, Derick Cooper, Mauro D'Amato, Joel Lim, Sandeep Gupta, Adrian Miranda, Natalie Terry, Devendra Mehta, Ann Scheimann, Molly O'Gorman, Neelesh Tipnis, Yinka Davies, Joel Friedlander, Heather Smith, Jaya Punati, Julie Khlevner, Mala Setty, Carlo Di Lorenzo

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The SI gene encodes the sucrase-isomaltase enzyme, a disaccharidase expressed in the intestinal brush border. Hypomorphic SI variants cause recessive congenital sucrase-isomaltase deficiency (CSID) and related gastrointestinal (GI) symptoms. Among children presenting with chronic, idiopathic loose stools, we assessed the prevalence of CSID-associated SI variants relative to the general population and the relative GI symptom burden associated with SI genotype within the study population.

METHODS: A prospective study conducted at 18 centers enrolled 308 non-Hispanic white children ≤18 years old who were experiencing chronic, idiopathic, loose stools at least once per week for >4 weeks. Data on demographics, GI …

Deep Learning For Improved Risk Prediction In Surgical Outcomes, Ali Jalali, Hannah Lonsdale, Nhue Do, Jacquelin Peck, Monesha Gupta, Shelby Kutty, Sharon R Ghazarian, Jeffrey P. Jacobs, Mohamed Rehman, Luis M. Ahumada

Journal Articles: Pediatrics

The Norwood surgical procedure restores functional systemic circulation in neonatal patients with single ventricle congenital heart defects, but this complex procedure carries a high mortality rate. In this study we address the need to provide an accurate patient specific risk prediction for one-year postoperative mortality or cardiac transplantation and prolonged length of hospital stay with the purpose of assisting clinicians and patients' families in the preoperative decision making process. Currently available risk prediction models either do not provide patient specific risk factors or only predict in-hospital mortality rates. We apply machine learning models to predict and calculate individual patient risk …

Omega-3 Long-Chain Polyunsaturated Fatty Acids Intake By Ethnicity, Income, And Education Level In The United States: Nhanes 2003-201414., Caleb A. Cave, Nicholas Hein, Lynette M. Smith, Ann Anderson-Berry, Chesney K. Richter, Karl Stessy M. Bisselou, Adams Kusi Appiah, Penny Kris-Etherton, Ann C. Skulas-Ray, Maranda Thompson, Tara M. Nordgren, Corrine K. Hanson, Melissa K. Thoene

Journal Articles: Pediatrics

Although there are many recognized health benefits for the consumption of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPUFA), intake in the United States remains below recommended amounts. This analysis was designed to provide an updated assessment of fish and n-3 LCPUFA intake (eicosapentaenoic (EPA), docosahexaenoic acid (DHA), and EPA+DHA) in the United States adult population, based on education, income, and race/ethnicity, using data from the 2003-2014 National Health and Nutrition Examination Survey (NHANES) (n = 44,585). Over this survey period, participants with less education and lower income had significantly lower n-3 LCPUFA intakes and fish intakes (p < 0.001 for all between group comparisons). N-3 LCPUFA intake differed significantly according to ethnicity (p < 0.001), with the highest intake of n-3 LCPUFA and fish in individuals in the "Other" category (including Asian Americans). Supplement use increased EPA + DHA intake, but only 7.4% of individuals consistently took supplements. Overall, n-3 LCPUFA intake in this study population was low, but our findings indicate that individuals with lower educational attainment and income are at even higher risk of lower n-3 LCPUFA and fish intake.

Williams Syndrome And Neonatal Cardiac Surgery For Congenital Single Ventricle, Taylor E. Katt, Robert L. Spicer, Anji T. Yetman, Ali N. Ibrahimiye, James M. Hammel, Jeffrey A. Robinson

Journal Articles: Pediatrics

Williams syndrome (WS) is an arteriopathic derangement associated with supravalvular aortic stenosis and branch pulmonary stenosis. We describe double-outlet right ventricle with mitral atresia and aortic arch hypoplasia in an infant with WS. This case demonstrates the difficulty in managing patients with WS with complex cardiac defects. To our knowledge, this is the first reported single-ventricle physiology in a patient with WS. (Level of Difficulty: Advanced.).

The Contribution Of Frequency Discrimination Ability To Auditory Temporal Patterning Tests In Children, Ashley G. Flagge, Tara M. Davis, Victoria Henbest

Ashley Flagge Publications

Purpose: The Pitch Patterns Test (PPT) and Duration Patterns Test (DPT) are clinical auditory processing tests that evaluate temporal patterning skills based on pitch (PPT) or duration (DPT) aspects of sound. Although temporal patterning tests are categorized under the temporal processing domain, successful performance on the PPT also relies on accurate pitch discrimination. However, the relationship between pitch discrimination ability and temporal patterning skills have not been thoroughly evaluated. This study examined the contribution of pitch discrimination ability to performance on temporal patterning in children through the use of a pitch discrimination task and the PPT …

An Unexpected Global Health Experience In Manila, Susan Mcanany

Posters

Describes her experience in the NICU of the Fabella Memorial Hospital in Manila, Philippines.

Global Health Elective In Santiago Atitlan, Guatemala, Sarah Greenberg

Posters

Describes her experience working in Hospitalito Atitlan in Santiago Atitlan, Guatemala.

Fit Clinical Decision-Making Unusual Echocardiographic Findings Of Myocarditis Mimicking An Aortic Runoff Lesion, Sarah Studyvin, Christine Symes, Barbara A. Pahud, Nitin Madan

Posters

No abstract provided.

Sustaining Successful Efforts To Increase Home Visiting Referrals Thornburg Early Childhood Education Grant 2020 Summary Report, Theresa H. Cruz, Ivy Vitanzos Cervantes, Leona K. Woelk

Reports & Documents

No abstract provided.

Allergic Reaction In Hem/Onc Patient, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Neonatal Abstinence Syndrome: Effectiveness Of Targeted Umbilical Cord Drug Screening In Determining Risk Of Withdrawal, Alecia Karr

DNP Projects

Neonatal Abstinence Syndrome (NAS) is a condition in which an infant experiences withdrawal from uterine exposure to various substances such as caffeine, nicotine, amphetamines, THC, opioids, benzodiazepines, and other types of substances. Depending on the severity of the symptoms, these infants may experience a longer hospital stay and may need treatment and monitoring in the neonatal intensive care unit (NICU), resulting in an increase in healthcare costs. The objective of this project was to determine if targeted drug screening of newborns was effective in determining infants at risk of NAS based on a positive screening result. This study utilized a …