Pediatrics Commons^™

Small Finger Reverse Ulnar Digital Artery Hypothenar Perforator Flap For Small Finger Proximal Interphalangeal Joint Reconstruction, Nicholas Kunda, Alexander Dagum

Stony Brook Orthopaedic and Musculoskeletal Journal

Purpose: Local flaps are commonly used for digital reconstruction for soft tissue defects. There remains a paucity of options available for small finger volar proximal interphalangeal joint coverage. The purpose of this study was to analyze perforators along the hypothenar eminence arising from the artery of the ulnar side of the small finger as it comes off the superficial palmer arch for consistency and potential to be used for perforator-based flap reconstruction of the small finger proximal interphalangeal joint.

Methods: Four cadaveric upper extremities were injected with Microfil® silicone injection compound. Dissection was performed from the superficial palmer arch to …

Diagnosis And Management Of Cyclic Vomiting Syndrome, Sara Read

Capstone Showcase

Cyclic vomiting syndrome (CVS) is a chronic and debilitating condition that can be encountered in a multitude of clinical settings. It is classified as a functional gastrointestinal disorder and is often misdiagnosed. Proper identification and management of this condition are crucial to patient care and quality of life. This article reviews the hypothesized etiologies, clinical presentation, and diagnosis of CVS as well as recommendations for management in a variety of settings. As an understudied and underdiagnosed condition, it is important that clinicians have a basic understanding of this disorder.

School-Based Intervention Impacts Availability Of Vegetables And Beverages In Participants’ Homes, Erin A Hudson, Marissa Burgermaster, Sophia M Isis, Matthew R Jeans, Sarvenaz Vandyousefi, Matthew J Landry, Rebecca Seguin-Fowler, Joya Chandra, Jaimie Davis

Faculty, Staff and Student Publications

As rates of metabolic syndrome rise, children consume too few vegetables and too much added sugar. Because children tend to eat what is available at home, the home environment plays a key role in shaping dietary habits. This secondary analysis evaluated the effects of a school-based gardening, cooking, and nutrition education intervention (TX Sprouts) compared to control on the availability of vegetables, fruit juice, and sugar-sweetened beverages (SSBs) at home. In the TX Sprouts cluster-randomized trial, 16 schools were randomized to TX Sprouts (

Characteristics Of Pediatric Covid-19 Infections And The Impact Of Influenza And Covid-19 Vaccinations During The First Two Years Of The Pandemic, Mahmoud Ali, Lynette Phillips, David C Kaelber, Hulya Bukulmez

Faculty, Staff and Student Publications

The data regarding the demographics of SARS-CoV-2 in the pediatric population has been published based on several single-center experiences or on metanalyses over short time frames. This article reports data on the demographics of pediatric patients with COVID-19 on a global scale using the TriNetX COVID-19 Research Network. In addition, we examined the risk of COVID-19 infection in relation to the body mass index (BMI) category and the protective value of influenza and COVID-19 immunization against COVID-19 infection. The incidence of COVID-19 infection was higher in the younger age group (≤6 years old), but no gender differences. The incidence of …

The Heads-Ed: A Psychosocial Screening For Pediatric Patients In Emergency Departments: A Systematic Review, Jessica Burns

Theses and Dissertations

The rates of mental health (MH) conditions among the pediatric population are rising steadily (Abramson, 2022; Clark et al., 2019). Given that MH symptoms and concerns frequently present in the emergency department (ED)-particularly since the onset of the COVID-19 pandemic-the ED setting may be a practical and effective setting to implement screening measures to identify youth at risk for mental illness and suicide (Leeb et al., 2020; Leff et al., 2021). This integrative systematic review examined the extent to which the HEADS-ED, one specific psychosocial screening measure, has been administered in the ED setting with youth and which healthcare professionals …

A Comparison Of Chief Complaints, Specific Diagnoses, And Demographics Of Pediatric Urgent Care Visits Before And During The Covid-19 Pandemic: A Retrospective Study, Zaharoula A. Viennas, Julie Martin, Benjamin Klick, Tammy Speerhas, Turaj Vazifedan, Danielle Millspaugh, Jennifer Ferris, Margret Bedle, Lauren Paluch, Theresa Guins

Ellmer School of Nursing Faculty Publications

There was an increased incidence of pediatric patients who presented with injuries caused by falls not related to sports or other recreational activities, as well as for animal bites, during the early pandemic period of April 2020. Education of parents and caregivers of young children is warranted to raise awareness of the even greater potential for falls and animal bites when children are confined at home for longer than typical periods of time, as occurred with the stay-at-home government orders during the initial period of the COVID-19 pandemic.

Something Smells Fishy: How Lipid Mediators Impact The Maternal-Fetal Interface And Neonatal Development, Maranda Thompson, Arzu Ulu, Maheswari Mukherjee, Ana G. Yuil-Valdes, Melissa K. Thoene, Matthew Van Ormer, Rebecca Slotkowski, Teri Mauch, Ann Anderson-Berry, Corrine K. Hanson, Tara M. Nordgren, Sathish Kumar Natarajan

Journal Articles: Pediatrics

Normal pregnancy relies on inflammation for implantation, placentation, and parturition, but uncontrolled inflammation can lead to poor maternal and infant outcomes. Maternal diet is one modifiable factor that can impact inflammation. Omega-3 and -6 fatty acids obtained through the diet are metabolized into bioactive compounds that effect inflammation. Recent evidence has shown that the downstream products of omega-3 and -6 fatty acids may influence physiology during pregnancy. In this review, the current knowledge relating to omega-3 and omega-6 metabolites during pregnancy will be summarized.

Ventricular Tachycardia In A Pediatric Patient With High-Risk Thrombotic Thrombocytopenia Purpura, Taylor J. Kratochvil, Jeffrey A. Robinson

Journal Articles: Pediatrics

An 8-year-old previously healthy male was diagnosed with thrombotic thrombocytopenic purpura (TTP) and increased serum cardiac troponin I. Telemetry recorded non-sustained ventricular tachycardia, without ST-segment changes or other abnormalities on serial electrocardiogram. This case illustrates that cardiac monitoring by telemetry should be considered in high-risk TTP with elevated cardiac troponin.

Retinol And Pro-Vitamin A Carotenoid Nutritional Status During Pregnancy Is Associated With Newborn Hearing Screen Results, Rebecca Slotkowski, Matthew Van Ormer, Anum Akbar, Olivia Paetz, Taija Hahka, Maranda Thompson, Alyssa Freeman, Alexandra Hergenrader, Sarah Sweeney, Zeljka Korade, Thiago Genaro-Mattos, Corrine K. Hanson, Ann Anderson-Berry, Melissa K. Thoene

Journal Articles: Pediatrics

The prenatal period is critical for auditory development; thus, prenatal influences on auditory development may significantly impact long-term hearing ability. While previous studies identified a protective effect of carotenoids on adult hearing, the impact of these nutrients on hearing outcomes in neonates is not well understood. The purpose of this study is to investigate the relationship between maternal and umbilical cord plasma retinol and carotenoid concentrations and abnormal newborn hearing screen (NHS) results. Mother-infant dyads (n = 546) were enrolled at delivery. Plasma samples were analyzed using HPLC and LC-MS/MS. NHS results were obtained from medical records. Statistical analysis …

Plasma Retinol Concentrations And Dietary Intakes Of Mother-Infant Sets In Singleton Versus Twin Pregnancy, Anum Akbar, Sarah Duvall, Matthew Van Ormer, Rebecca Slotkowski, Taija Hahka, Thiago Genaro-Mattos, Zeljka Korade, Corrine K. Hanson, Ann Anderson-Berry, Melissa K. Thoene

Journal Articles: Pediatrics

Vitamin A (retinol) is essential for normal fetal development, but the recommendation for maternal dietary intake (Retinol Activity Equivalent, RAE) does not differ for singleton vs. twin pregnancy, despite the limited evaluation of retinol status. Therefore, this study aimed to evaluate plasma retinol concentrations and deficiency status in mother-infant sets from singleton vs. twin pregnancies as well as maternal RAE intake. A total of 21 mother-infant sets were included (14 singleton, 7 twin). The HPLC and LC-MS/HS evaluated the plasma retinol concentration, and data were analyzed using the Mann-Whitney U test. Plasma retinol was significantly lower in twin vs. singleton …

Evaluation Of Vitamin E Isoforms In Placental Tissue And Their Relationship With Maternal Dietary Intake And Plasma Concentrations In Mother-Infant Dyads, Ishani Jhamb, Alyssa Freeman, Michelle R. Lotfi, Matthew Van Ormer, Corrine K. Hanson, Ann Anderson-Berry, Melissa K. Thoene

Journal Articles: Pediatrics

α-tocopherol is a vitamin E isoform with potent antioxidant activity, while the γ-tocopherol isoform of vitamin E exerts more pro-inflammatory effects. In maternal-fetal environments, increased plasma α-tocopherol concentrations are associated with positive birth outcomes, while higher γ-tocopherol concentrations are linked with negative pregnancy outcomes. However, little is known about tocopherol concentrations in placental tissue and their role in modulating placental oxidative stress, a process that is implicated in many complications of pregnancy. The objectives of this research are to evaluate the concentrations of α- and γ-tocopherol in placental tissue and assess relationships with maternal and umbilical cord plasma concentrations. A …

The Relationship Between Nutrition, Gut Dysbiosis, And Pediatric Sickle Cell Pain Outcomes: A Pilot Study, Chinenye R. Dike, Corrine K. Hanson, Dele Davies, Stephen Obaro, Fang Yu, James L. Harper, Helen Grace, Jeffrey Lebensburger, Chittalsinh M. Raulji, Jihyun Ma, Peter Mannon

Journal Articles: Pediatrics

BACKGROUND: Nutritional deficiencies are prevalent in sickle cell disease (SCD) and may be associated with worse pain outcomes. Gut dysbiosis has been reported in patients with SCD and may contribute to both nutritional deficiencies and pain.

OBJECTIVES: We tested the association of nutrition, fat-soluble vitamin (FSV) deficiency, and gut microbiome composition on clinical outcomes in SCD. Second, we measured the association between diet and exocrine pancreatic function on FSV levels.

METHODS: Using case control design, we enrolled children with SCD (n = 24) and matched healthy controls (HC; n = 17, age, sex, race/ethnicity). Descriptive statistics summarized demographic and clinical …

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 …

Philippines Global Health, Thomas Rieth, Kourtney Bettinger, Ryan Northup

Posters

Provides reflections on resident's experience working with cardiologists and neonatologists in Manila.

Clinical And Radiographic Outcomes For Femoral Neck Fracture Fixation With Femoral Neck System Versus Multiple Cannulated Screws, Samer M. Al-Humadi, D’Arcy Marsh, Michael Doany, David Swanson, David E. Komatsu, Stephen A. Kottmeier, Nicholas Divaris

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The There are few studies in the orthopaedic surgery literature that examine clinical outcomes for femoral neck system (FNS) fixation of femoral neck fractures. The purpose of this study was to compare primary outcome of non-union for femoral neck fracture fixation using FNS versus multiple cannulated screws (MCS).

Methods: Retrospective electronic medical record search for patients 18 years or older who underwent surgery between March 01, 2018 and September 01, 2021 for femoral neck fracture fixation. Two reviewers examined radiographic and clinical data reaching consensus. Patients were called via telephone to complete Short Form 12-item (SF-12) surveys with consent. …

Alcohol And Opiate Abuse Are Risk Factors For Dislocation After Primary Reverse Shoulder Arthroplasty, Ryan P. Tantone, Kenny Ling, Michael E. Doany, Rosen Jeong, Emma Smolev, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: As indications for reverse total shoulder arthroplasty (RTSA) expand and patients present with increasing comorbidities, complications have become more frequent. Dislocation and instability are devastating complications and have become one of the leading causes of revision surgery. Current literature suggests multifactorial causes for dislocation, but studies are limited to physiologic and mechanical risk factors. The purpose of this study was to investigate social risk factors, including alcohol and drug abuse, and their association with dislocation after RTSA.

Methods: A retrospective cohort of all RTSA performed at a single center by the senior author between January 2012 and March 2021 …

Pectus Excavatum With Bar Placement Eras, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Gastric Sleeve Enhanced Recovery After Surgery, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Genital Ulcers (Painful, Aphthous) In Females, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Core Muscle Injuries: Functional Outcomes And Return To Sport In A Consecutive Series Of Twenty Athletes, Nicholas Tsouris, Jack Tesoriero, James A. Vosswinkel, James Penna

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Core muscle injury can cause significant dysfunction in athletes. A variety of surgical procedures have been described. This study examines an orthopaedic and general surgeon’s technique and patient reported outcomes of adductor tenotomy and rectus abdominus imbrication with ilioinguinal nerve neurolysis.

Hypothesis: Surgical treatment of core muscle injuries with adductor tenotomy and rectus abdominus imbrication with ilioinguinal nerve neurolysis will result in decreased symptoms and high rates of return to play.

Study Design: Operative technique; retrospective case series.

Methods: Our electronic medical record system was searched for patients who underwent core muscle injury surgery by the treating surgeons. The …

The Utility Of The Axillary Shoulder Radiograph In The Management Of Clavicle Fractures, Stephen Bowen, Ryan Tantoe, Daniel Botros, Samer Al-Humadi, Nicholas Tsouris, Nicholas Divaris

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Prior literature is mixed on the necessity of an axillary shoulder radiograph in the setting of presumably isolated clavicle fractures, with some authors endorsing its need for any shoulder girdle trauma and others stating it is unnecessary. However, no studies to date have specifically evaluated this.

Hypothesis: We hypothesize that an axillary shoulder radiograph will offer no management changing information in the setting of clavicle fractures.

Methods: Ninety-five patients presented for follow-up for management of a clavicle fracture. Analysis was performed to determine if the axillary view was useful based on the discovery of a glenohumeral dislocation or a …

Outcomes In Early Versus Delayed Management Of Pediatric Femoral Shaft Fractures, Daniel Botros, Sofia Hidalgo Perea, Rachel Loyst, James Barsi

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: There is a paucity of literature regarding the timing of treatment for pediatric femur fractures.

Purpose: The purpose of this study was to analyze whether early versus delayed management of pediatric femoral shaft fractures would impact outcomes regarding time to union and return to baseline function.

Methods: Pediatric patients presenting with femoral shaft fractures from 01/01/2010-01/01/2021 were identified using the Database at a single level one Trauma Center and retrospectively reviewed. Demographic information, surgical details, associated injuries, length of follow-up, time to union, and return to baseline function was collected. Patients were then divided into two groups; the early …

Suture Tape Stabilization Of The Distal Ulna Following Darrach Procedure. A Biomechanical Study, Miles S. Parsons, Evan C. Olsen, David E. Komatsu, Samantha Muhlrad

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: The Darrach procedure (complete resection of distal ulna) is commonly used for definitive treatment of end- stage distal radioulnar joint (DRUJ) arthritis. This resection alone often results in treatment failure due to ulnar stump instability in a dorsal-palmar direction and ulnar convergence. Modified Darrach procedures with tenodesis have improved outcomes, but none have completely resolved these issues. Thus, we propose a novel technique of fixation via an internal brace.

Purpose: To evaluate stability and degree of dorsal-palmar displacement with an internal brace fixation (IBF) versus a modified extensor carpi ulnaris tenodesis (ECUT) following a Darrach procedure.

Methods: We tested …

Beyond Breathless: Unravelling The Enigma Of Pulmonary Arteriovenous Malformations, Sri Mounya Jampala, Jagadish Kumar K Dr., Manjunath V G, Nandish H R

Digital Journal of Clinical Medicine

Pulmonary Arteriovenous Malformations (AVMs) are abnormal connections between the pulmonary arteries and veins, leading to a direct shunting of blood without passing through the normal capillary bed. These AVMs can be associated with a rare genetic disorder called Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome. HHT is an autosomal dominant disorder characterized by the development of fragile telangiectasias in various organs, including the skin and mucous membranes. These telangiectasias are prone to bleeding, leading to recurrent nosebleeds and mucocutaneous bleeding. In patients with HHT, the most common site of AVMs is in the lungs. Pulmonary AVMs can cause …

Changes In Distribution Of Severe Neurologic Involvement In Us Pediatric Inpatients With Covid-19 Or Multisystem Inflammatory Syndrome In Children In 2021 Vs 2020., Kerri L. Larovere, Tina Y. Poussaint, Cameron C. Young, Margaret M. Newhams, Suden Kucukak, Katherine Irby, Michele Kong, Stephanie P. Schwartz, Tracie C. Walker, Melania M. Bembea, Kari Wellnitz, Kevin M. Havlin, Natalie Z. Cvijanovich, Mark W. Hall, Julie C. Fitzgerald, Jennifer E. Schuster, Charlotte V. Hobbs, Natasha B. Halasa, Aalok R. Singh, Elizabeth H. Mack, Tamara T. Bradford, Shira J. Gertz, Adam J. Schwarz, Katri V. Typpo, Laura L. Loftis, John S. Giuliano, Steven M. Horwitz, Katherine V. Biagas, Katharine N. Clouser, Courtney M. Rowan, Aline B. Maddux, Vijaya L. Soma, Christopher J. Babbitt, Cassyanne L. Aguiar, Amanda R. Kolmar, Sabrina M. Heidemann, Helen Harvey, Laura D. Zambrano, Angela P. Campbell, Adrienne G. Randolph, Overcoming Covid-19 Investigators

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complications.

OBJECTIVE: To provide an update on the spectrum of SARS-CoV-2-related neurologic involvement among children and adolescents in 2021.

DESIGN, SETTING, AND PARTICIPANTS: Case series investigation of patients reported to public health surveillance hospitalized with SARS-CoV-2-related illness between December 15, 2020, and December 31, 2021, in 55 US hospitals in 31 states with follow-up at hospital discharge. A total of 2253 patients were enrolled during the investigation period. Patients suspected of having …

Concussion, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Pediatric Diarrhea Patients Living In Urban Areas Have A Higher Incidence Of Clostridioides Difficile Infection, Ayodele T Adesoji, Osaro Mgbere, Charles Darkoh

Faculty, Staff and Student Publications

Clostridioides difficile infection (CDI) is a major cause of antibiotic-associated diarrhea and an unappreciated contributor to child mortality in low- and middle-income countries where the diagnosis may be difficult. There is little information about the prevalence of CDI among infants, children, and adolescents in Africa. Using a cross-sectional design, seventy-six samples were collected from pediatric patients presenting with diarrhea, including infants (≤ 2 years old), children (2-12 years), and adolescents (13 ≤17 years) from three hospitals between January and December 2019. Demographic data, medical history, and prior antibiotic use were recorded. Toxigenic culture and PCR were used to detect and …

When Seeing Is Believing: A Framework For Reflective Conversations In Remote And Face-To-Face Coaching Approaches, Cheryl Varghese, April Crawford, Linda Morgan-Dorsey, Maram Ahmed, Laura Prendergast, Tracy Osborn

Faculty, Staff and Student Publications

Reflective conversations between teachers and coaches are critical to helping teachers improve their classroom instruction. Coaches who encourage teachers to "see, think, and do" are better able to facilitate meaningful reflective conversations with teachers. The "See, Think, Do" framework consists of six steps (observe, describe, process, analyze, draw conclusions, and plan) that can be used to help coaches engage in reflective conversations with teachers. The framework can be readily implemented in remote and face-to-face coaching modalities and in one-on-one and small group delivery formats. Suggestions and strategies for implementing the framework in ongoing coach-teacher conversations are provided.

Feasibility Of And Experience Using A Portable Mri Scanner In The Neonatal Intensive Care Unit., Maura Sien, Amie L. Robinson, Houchun H. Hu, Christopher R. Nitkin, Ara Hall, Marcie G. Files, Nathan S. Artz, John T. Pitts, Sherwin S. Chan

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: A portable, low-field MRI system is now Food and Drug Administration cleared and has been shown to be safe and useful in adult intensive care unit settings. No neonatal studies have been performed. The objective is to assess our preliminary experience and assess feasibility of using the portable MRI system at the bedside in a neonatal intensive care unit (NICU) at a quaternary children's hospital.

STUDY DESIGN: This was a single-site prospective cohort study in neonates ≥2 kg conducted between October and December 2020. All parents provided informed consent. Neonates underwent portable MRI examination in the NICU with support …

Hypofibrinogenemia Following Injury In 186 Children And Adolescents: Identification Of The Phenotype, Current Outcomes, And Potential For Intervention, Justin Gerard, Jan-Michael Van Gent, Jessica Cardenas, Christian Gage, David E Meyer, Charles Cox, Charles E Wade, Bryan A Cotton

Faculty, Staff and Student Publications

OBJECTIVES: Recent studies evaluating fibrinogen replacement in trauma, along with newly available fibrinogen-based products, has led to an increase in debate on where products such as cryoprecipitate belong in our resuscitation strategies. We set out to define the phenotype and outcomes of those with hypofibrinogenemia and evaluate whether fibrinogen replacement should have a role in the initial administration of massive transfusion.

METHODS: All patients/17-4/21 were reviewed. We then evaluated all patients who received emergency-release and massive transfusion protocol (MTP) products. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen(r-TEG) angleHYPOFIB, the impact on outcomes, and whether early replacement improved mortality. …