Pediatrics Commons^™

Indications For Inpatient Magnetoencephalography In Children - An Institution's Experience, Michael W Watkins, Ekta G Shah, Michael E Funke, Stephanie Garcia-Tarodo, Manish N Shah, Nitin Tandon, Fernando Maestu, Christopher Laohathai, David I Sandberg, Jeremy Lankford, Stephen Thompson, John Mosher, Gretchen Von Allmen

Faculty, Staff and Student Publications

Magnetoencephalography (MEG) is recognized as a valuable non-invasive clinical method for localization of the epileptogenic zone and critical functional areas, as part of a pre-surgical evaluation for patients with pharmaco-resistant epilepsy. MEG is also useful in localizing functional areas as part of pre-surgical planning for tumor resection. MEG is usually performed in an outpatient setting, as one part of an evaluation that can include a variety of other testing modalities including 3-Tesla MRI and inpatient video-electroencephalography monitoring. In some clinical circumstances, however, completion of the MEG as an inpatient can provide crucial ictal or interictal localization data during an ongoing …

Clonidine For The Treatment Of Agitation After Dexmedetomidine Discontinuation In Pediatric Patients: A Retrospective Cohort Study, Thao L Nguyen, Weng Man Lam, Hillary Orr, Brian Gulbis, Riza Mauricio, Eric Tom, Vinai M Modem, Alvaro Coronado-Munoz

Faculty, Staff and Student Publications

OBJECTIVE: Dexmedetomidine has become a widely used drug in PICUs for sedation. We aim to determine the effects of clonidine on pediatric patients after dexmedetomidine use.

METHODS: This was a retrospective cohort study that evaluated all pediatric patients admitted to a tertiary PICU who received dexmedetomidine infusion for >48 hours. Outcomes in patients exposed to clonidine (CLON) were compared with those of patients who were not exposed (NoCLON).

RESULTS: A total of 216 patients were included in this study (43 CLON and 173 NoCLON). The primary outcome, agitation, was less in the CLON cohort (9.3%) than in the NoCLON cohort …

Pediatric Thalassemic Patients Have Higher Incidence Of Asthma: A Nationwide Population-Based Retrospective Cohort Study, Hsin-Yi Hsieh, Lin-Chi Huang, Hong-Ren Yu, Kuang-Che Kuo, Wan-Hsuan Chen, Chung-Hao Su, Chuan-Pin Lee, Ko-Jung Chen, Yao-Hsu Yang, Jiunn-Ming Sheen

Faculty, Staff and Student Publications

INTRODUCTION: Patients with hemoglobinopathies have been reported to have higher rates of pulmonary complications. Few studies have investigated the association between thalassemia and asthma in children.

METHODS: We used the data of one million individuals randomly selected from the Registry for Beneficiaries of the National Health Insurance Research Database. One thalassemic child was matched with four control children without thalassemia according to sex, birth year, birth season, prematurity, and previous enteroviral infection.

RESULTS: A total of 800 hundred thalassemic children and 3200 controls were included. Children with thalassemia had higher rates of developing asthma (41.81 vs 25.70 per 1000 person-years, …

A Preliminary Dti Tractography Study Of Developmental Neuroplasticity 5–15 Years After Early Childhood Traumatic Brain Injury, Elisabeth A Wilde, Ilirjana Hyseni, Hannah M Lindsey, Jessica Faber, James M Mchenry, Erin D Bigler, Brian D Biekman, Laura L Hollowell, Stephen R Mccauley, Jill V Hunter, Linda Ewing-Cobbs, Mary E Aitken, Marianne Macleod, Zili D Chu, Linda J Noble-Haeusslein, Harvey S Levin

Faculty, Staff and Student Publications

Plasticity is often implicated as a reparative mechanism when addressing structural and functional brain development in young children following traumatic brain injury (TBI); however, conventional imaging methods may not capture the complexities of post-trauma development. The present study examined the cingulum bundles and perforant pathways using diffusion tensor imaging (DTI) in 21 children and adolescents (ages 10-18 years) 5-15 years after sustaining early childhood TBI in comparison with 19 demographically-matched typically-developing children. Verbal memory and executive functioning were also evaluated and analyzed in relation to DTI metrics. Beyond the expected direction of quantitative DTI metrics in the TBI group, we …

As Time Goes By: Understanding Child And Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury, Linda Ewing-Cobbs, Janelle J Montroy, Amy E Clark, Richard Holubkov, Charles S Cox, Heather T Keenan

Faculty, Staff and Student Publications

Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes.

Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from …

Can Erythropoietin Reduce Hypoxemic Neurological Damages In Neonates With Congenital Heart Defects?, Sara Ottolenghi, Giuseppina Milano, Michele Dei Cas, Tina O Findley, Rita Paroni, Antonio F Corno

Faculty, Staff and Student Publications

Congenital heart defects (CHD), the most common cause of birth defects with increasing birth prevalence, affect nearly 1% of live births worldwide. Cyanotic CHD are characterized by hypoxemia, with subsequent reduced oxygen delivery to the brain, especially critical during brain development, beginning in the fetus and continuing through the neonatal period. Therefore, neonates with CHD carry a high risk for neurological comorbidities, even more frequently when there are associated underlying genetic disorders. We review the currently available knowledge on potential prevention strategies to reduce brain damage induced by hypoxemia during fetal development and immediately after birth, and the role of …

Hippo-Yap Pathway Orchestrates Neural Crest Ontogenesis, Xiaolei Zhao, Tram P Le, Shannon Erhardt, Tina O Findley, Jun Wang

Faculty, Staff and Student Publications

Neural crest (NC) cells are a migratory stem cell population in vertebrate embryogenesis that can give rise to multiple cell types, including osteoblasts, chondrocytes, smooth muscle cells, neurons, glia, and melanocytes, greatly contributing to the development of different tissues and organs. Defects in NC development are implicated in many human diseases, such as numerous syndromes, craniofacial aberration and congenital heart defects. Research on NC development has gained intense interest and made significant progress. Recent studies showed that the Hippo-Yap pathway, a conserved fundamental pathway with key roles in regulation of cell proliferation, survival, and differentiation, is indispensable for normal NC …

Cost Efficacy Of Rapid Whole Genome Sequencing In The Pediatric Intensive Care Unit, Erica Sanford Kobayashi, Bryce Waldman, Branden M Engorn, Katherine Perofsky, Erika Allred, Benjamin Briggs, Chelsea Gatcliffe, Nanda Ramchandar, Jeffrey J Gold, Ami Doshi, Elizabeth G Ingulli, Courtney D Thornburg, Wendy Benson, Lauge Farnaes, Shimul Chowdhury, Seema Rego, Charlotte Hobbs, Stephen F Kingsmore, David P Dimmock, Nicole G Coufal

Faculty, Staff and Student Publications

The diagnostic and clinical utility of rapid whole genome sequencing (rWGS) for critically ill children in the intensive care unit (ICU) has been substantiated by multiple studies, but comprehensive cost-effectiveness evaluation of rWGS in the ICU outside of the neonatal age group is lacking. In this study, we examined cost data retrospectively for a cohort of 38 children in a regional pediatric ICU (PICU) who received rWGS. We identified seven of 17 patients who received molecular diagnoses by rWGS and had resultant changes in clinical management with sufficient clarity to permit cost and quality adjusted life years (QALY) modeling. Cost …

“Doing What I Can, But I Got No Magic Wand:” A Snapshot Of Early Childhood Educator Experiences And Efforts To Ensure Quality During The Covid-19 Pandemic, April Crawford, Kelly A Vaughn, Cathy L Guttentag, Cheryl Varghese, Yoonkyung Oh, Tricia A Zucker

Faculty, Staff and Student Publications

The COVID-19 pandemic impacted early childhood programs serving infants, toddlers, and preschoolers in dramatic ways. After temporarily closing, many educators quickly adapted their procedures to ensure children's safety as they reopened to provide childcare for essential workers and then the community at large. This manuscript reports on statewide efforts to continue quality improvement initiatives for early childhood programs amidst the COVID-19 pandemic. We first describe the impacts of the COVID-19 pandemic for over 2000 educators-teachers, administrators, and specialists-who completed surveys in the Spring and Fall of 2020. These survey data come from a statewide system called the Texas Early Childhood …

Recognizing A Mis-Chievous Cause Of Acute Viral Gastroenteritis, Rohit Josyabhatla, Ankur A Kamdar, Shabba A Armbrister, Rhea Daniel, Konstantinos Boukas, Keely G Smith, Melissa R Van Arsdall, Kokila Kakarala, Anthony R Flores, Audrey Wanger, Yuying Liu, Jon Marc Rhoads

Faculty, Staff and Student Publications

Historically, children evaluated for vomiting and diarrhea secondary to viral enteritis have symptoms lasting 2-4 days and respond to supportive care, including oral rehydration and anti-emetics if required. Recently, within a 14-day timespan, we encountered three children with severe diarrhea who rapidly became dehydrated and went into hypotensive shock. Although SARS-CoV-2 molecular tests were negative by nasopharyngeal swab, all were later found to have MIS-C. This small case series underscores features reported in previous larger studies and emphasizes the rapid clinical evolution of this condition. We highlight the importance of early recognition of cardinal laboratory findings characteristic of MIS-C (i.e., …

Extensive Mycobacterium Abscessus Pneumonia In An Immunocompetent Infant With No Underlying Lung Pathology, Morouge M Alramadhan, James R Murphy, Michael L Chang

Faculty, Staff and Student Publications

Pulmonary infection due to Mycobacterium abscessus occurs in patients with cystic fibrosis, but rarely in immunocompetent children without underlying lung pathology. Treatment is complicated by frequent resistance to many antibiotics. We present a case report of a 4-month-old female infant with 2 months of cough, difficulty feeding, and failure to thrive, with extensive culture-confirmed M. abscessus pulmonary infection without identified immunodeficiency or underlying lung pathology following multidisciplinary evaluation. We describe our complete evaluation including immunodeficiency evaluation incorporating whole-exome sequencing, describe our antibiotic selection and treatment duration given complicated susceptibility pattern of the M. abscessus isolate, and review literature for nontuberculous …

Disordered Eating, Food Insecurity, And Weight Status Among Transgender And Gender Nonbinary Youth And Young Adults: A Cross-Sectional Study Using A Nutrition Screening Protocol, Whitney R. Linsenmeyer, Ian M. Katz, Jaime L. Reed, Andrea M. Giedinghagen, Christopher B. Lewis, Sarah K. Garwood

Psychology Faculty Publications

Purpose: The purpose of this study was to describe the prevalence of and relationships among disordered eating, food insecurity, and weight status among transgender and gender nonbinary youth and young adults.

Methods: This cross-sectional study involved a screening protocol to assess disordered eating and food insecurity risk from September to December of 2019 at a gender clinic using five validated measures: (1) previous eating disorder diagnosis (yes/no); (2) Sick, Control, One Stone, Fat, Food Questionnaire (SCOFF); (3) Adolescent Binge Eating Disorder Questionnaire (ADO-BED); (4) Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS); and (5) Hunger Vital Sign. Age, assigned sex at …

Nonsuicidal Self-Injury, Suicide Planning, And Suicide Attempt Among High-Risk Adolescents Prior To Psychiatric Hospitalization, Christina M. Sellers, Antonia Díaz-Valdés, Andrew C. Porter, Catherine R. Glenn, Adam Bryant Miller, Adeline Wyman Battalen, Kimberly H. Mcmanama O'Brien

Psychology Faculty Publications

The purpose of this study was to understand the trajectories of nonsuicidal self-injury (NSSI) and suicide plans (SP) in the 90 days prior to inpatient hospitalization, understand the role of NSSI and SP in predicting suicide attempts (SA) on a given day, and to test the interaction between NSSI and SP in predicting same-day SA. Participants included 69 adolescents (77% female, 65% white, 77% Non-Hispanic/Latinx, Mage = 15.77 SDage = 1.00) from an inpatient psychiatric unit. Past 90 day NSSI, SP, and SA were measured using the Columbia Suicide Severity Rating Scale and Timeline Follow Back. First, mixed effect models …

Perceptions Of Integrated Mental And Behavioral Health In Pediatric Specialty Care Settings: A Mixed-Methods Study, Desireé Nicole Williford

Graduate Theses, Dissertations, and Problem Reports (ETD)

Pediatric patients are at an increased risk of experiencing mental and behavioral health concerns, which have direct associations with HRQOL, physiological health, and likelihood that youth will engage in health promoting behavior. Researchers and practitioners have increased their awareness of these concerns and identified strategies for improving the mental and behavioral health of these youth, specifically via implementing organizational efforts (i.e., task forces) and guidelines around integrating psychosocial screening and other services into routine practice. Despite this, there are several identified barriers to families receiving mental/behavioral health care in these settings. These barriers exist at all levels, including at the …

Cardio-Pulmonary Sequelae In Recovered Covid-19 Patients: Considerations For Primary Care, Zouina Sarfraz, Azza Sarfraz, Alanna Barrios, Radhika Garimella, Asimina Dominari, Manish Kc, Krunal Pandav, Juan C. Pantoja, Varadha Retnakumar, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care.
Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords "COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication." We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, …

The Influence Of Coronavirus Disease-2019 (Covid-19) On Parkinson’S Disease: An Updated Systematic Review, Vikash Jaiswal, Danah Alquraish, Zouina Sarfraz, Azza Sarfraz, Shavy Nagpal, Prakriti Singh Shrestha, Dattatreya Mukherjee, Prathima Guntipalli, Diana F. Sánchez Velazco, Arushee Bhatnagar

Department of Paediatrics and Child Health

Background: COVID-19 has affected global communities with multiple neurological complications in addition to other critical medical issues. COVID-19 binds to the host's angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in the neurons and glial cells, acting as an entry port to the central nervous system (CNS). ACE2 receptors are abundantly expressed on dopamine neurons, which may worsen the prognosis of motor symptoms in Parkinson's disease (PD). SARS-CoV-2 may lead to an indirect response via immune-mediated cytokine storms and propagate through the CNS leading to damage. In this systematic review, we aim to provide thorough analyses of associations between COVID-19 …

Teleneurology Based Management Of Infantile Spasms During Covid-19 Pandemic: A Consensus Report By The South Asia Allied West Syndrome Research Group, Priyanka Madaan, Jitendra Kumar Sahu, Jithangi Wanigasinghe, Kanij Fatema, Kyaw Linn, Mimi Lhamu Mynak, Nicolás Garófalo Gómez, Pauline Samia, Prakash Poudel, Prem Chand

Department of Paediatrics and Child Health

With telehealth services rescuing patients with chronic neurological disorders during the COVID-19 pandemic, there is a need for simplified teleneurology protocols for neurological disorders in children. Infantile spasms is an epileptic encephalopathy where treatment lag is a significant predictor of outcome. It is one such condition where telemedicine can make a remarkable difference when in-person consultations are delayed or are not possible. However, the adverse effect profile of the first-line therapeutic options, the need for frequent follow-up, underdeveloped telemedicine services, lack of a rational protocol, poor awareness about infantile spasms, a lesser level of parental understanding, and scarcity of pediatric …

High Flow Nasal Cannula Therapy In Children With Acute Respiratory Insufficiency In The Pediatric Intensive Care Unit Of A Resource-Limited Country: A Preliminary Experience, Bushra Saeed, Asim Azim, Anwar Ul Haque, Qalab Abbas

Department of Paediatrics and Child Health

A retrospective study was performed in children (aged one month - 16 years) receiving HFNC to determine the frequency, efficacy and adverse effects of high flow nasal cannula (HFNC) therapy in the pediatric intensive care unit (PICU), from January to December 2017. Treatment failure was defined as clinical deterioration on HFNC therapy such that mechanical ventilation (MV) was required. Clinical parameters before and after HFNC were assessed using repeated measures analysis of variance. A total of 120 patients received HFNC therapy (21% of total admissions). Primary diagnosis were respiratory disease (50%), central nervous system diseases (14.2%), sepsis (10.8%), and postoperative …

Understanding And Promoting Racial Diversity In Healthcare Settings To Address Disparities In Pandemic Crisis Management, Azza Sarfraz, Zouina Sarfraz, Alanna Barrios, Kuchalambal Agadi, Sindhu Thevuthasan, Krunal Pandav, Manish Kc, Muzna Sarfraz, Pedram Rad, George Michel

Department of Paediatrics and Child Health

Background: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States.
Methods: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: …

Parental Report Of The Association Between Screen Time And Social Emotional Development Of Children Aged 18 And 36 Months Old In The District Of Gombak, Malaysia, Catherine Thamarai Thamarai

Student Works (2020-2029)

The increasing popularity of screen-based media has raised public health concern on potential effects of their excessive usage among developing children. The World Health Organization (WHO) and American Academy of Pediatrics (AAP) call for limitation of screen time to one hour per day for children aged two to five years old and children below the age of two are encouraged for screen time avoidance. This study is aimed to determine the influence of screen-based media on early childhood social emotional development from an ecological techno-subsystem perspective. Divided into two phases, the first phase of study involves translation into Malay language …

An International Study Of Interobserver Variability Of “String Sign” Of Pancreatic Cysts Among Experienced Endosonographers, Wanda Phipatanakul, David T Mauger, Theresa W Guilbert, Leonard B Bacharier, Sandy Durrani, Daniel J Jackson, Fernando D Martinez, Anne M Fitzpatrick, Amparito Cunningham, Susan Kunselman, Lisa M Wheatley, Cindy Bauer, Carla M Davis, Bob Geng, Kirsten M Kloepfer, Craig Lapin, Andrew H Liu, Jacqueline A Pongracic, Stephen J Teach, James Chmiel, Jonathan M Gaffin, Matthew Greenhawt, Meera R Gupta, Peggy S Lai, Robert F Lemanske, Wayne J Morgan, William J Sheehan, Jeffrey Stokes, Peter S Thorne, Hans C Oettgen, Elliot Israel

Faculty, Staff and Students Publications

Asthma remains one of the most important challenges to pediatric public health in the US. A large majority of children with persistent and chronic asthma demonstrate aeroallergen sensitization, which remains a pivotal risk factor associated with the development of persistent, progressive asthma throughout life. In individuals with a tendency toward Type 2 inflammation, sensitization and exposure to high concentrations of offending allergens is associated with increased risk for development of, and impairment from, asthma. The cascade of biological responses to allergens is primarily mediated through IgE antibodies and their production is further stimulated by IgE responses to antigen exposure. In …

Case Report: Dupilumab Successfully Controls Severe Eczema In A Child With Elevated Ige Levels And Recurrent Skin Infections, Tejas P Joshi, Sara Anvari, Meera R Gupta, Carla M Davis, Joud Hajjar

Faculty, Staff and Students Publications

The efficacy of dupilumab in pediatric patients with severe eczema presenting in the setting of elevated immunoglobulin E (IgE) levels and recurrent bacterial skin infections is not well-understood. Here we present the case of a child with elevated IgE levels in whom dupilumab treatment led to remarkable control of his eczema and recurrent skin infections. We also review the use of dupilumab in other patients with molecularly proven cases of hyper IgE (HIGE) syndrome. Our case supports the notion that dupilumab may have a seminal application in treating severe eczema that occurs in the setting of elevated IgE levels and …

Unusual Teenage Growing Pains: If The Genes Fit, Kourtney Rudzinski Do, Rebecca Sharim Md

Department of Pediatrics

No abstract provided.