Pediatrics Commons^™

Influence Of Novel Cyp2c-Haplotype On Proton Pump Inhibitor Pharmacokinetics In Children., Kathyrn Kyler, Andrea Gaedigk, Susan Abdel-Rahman, Vincent S. Staggs, Robin E. Pearce, Paul C. Toren, J Steven Leeder, Valentina Shakhnovich

Manuscripts, Articles, Book Chapters and Other Papers

In this brief report, we provide an analysis of the influence of a novel CYP2C haplotype (CYP2C:TG) on proton pump inhibitor (PPI) pharmacokinetics (PK) in children. The CYP2C:TG haplotype has been proposed to be associated with increased CYP2C19 activity. We sought to determine if this CYP2C:TG haplotype resulted in similar alterations in metabolism for proton pump inhibitors, which are primarily metabolized by CYP2C19. In a cohort of 41 children aged 6-21 participating in a PPI pharmacokinetic study, effects of the CYP2C:TG allele were assessed by fitting two linear regression models for each of the six PK outcomes assessed, the second …

Hearing Loss In Children With 22q11.2 Deletion Syndrome, Lori Yaktine, Amanda Moore, Jamie Hamm, Blaine Crowley, Meghan Tracy, Janelle R. Noel-Macdonnell Phd, Kim Graiser, Bernice Marrow, Hansoo Song, Srivats Narayanan, Nikita Raje, Donna Mcdonald-Mcginn, Jill M. Arganbright

Posters

22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome, with most recent published prevalence of 1:2,140 live births. Hearing loss is common in children with 22q11.2DS and has been reported to occur in 32-60% of people. Hearing loss is typically conductive in nature secondary to chronic eustachian tube dysfunction and chronic otitis media with effusion (COME). Close monitoring of hearing and the middle ears is recommended to detect COME and the need for ear tubes. Additionally, there is a high prevalence of speech delay in children with 22q11.2DS, stressing the importance of close audiometric evaluation and medical intervention as …

Anterior Hip Pain In Adolescent Female Wrestler, Melanie Kennedy

Posters

No abstract provided.

Multicenter Study Of Long-Term Outcomes And Quality Of Life In Phace Syndrome After Age 10., Mitchell Braun, Ilona J. Frieden, Dawn H. Siegel, Elizabeth George, Christopher P. Hess, Christine K. Fox, Sarah L. Chamlin, Beth A. Drolet, Denise Metry, Elena Pope, Julie Powell, Kristen Holland, Caden Ulschmid, Marilyn G. Liang, Kelly K. Barry, Tina Ho, Chantal Cotter, Eulalia Baselga, David Bosquez, Surabhi Neerendranath Jain, Jordan K. Bui, Irene Lara-Corrales, Tracy Funk, Alison Small, Wenelia Baghoomian, Albert C. Yan, James R. Treat, Griffin Stockton Hogrogian, Charles Huang, Anita Haggstrom, Mary List, Catherine C. Mccuaig, Victoria Barrio, Anthony J. Mancini, Leslie P. Lawley, Kerrie Grunnet-Satcher, Kimberly A. Horii, Brandon D. Newell, Amy J. Nopper, Maria C. Garzon, Margaret E. Scollan, Erin F. Mathes

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To characterize long-term outcomes of PHACE syndrome.

STUDY DESIGN: Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains.

RESULTS: A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma …

Learning Circles: Promoting Inclusive Care Starting In The Classroom, April Graham, Kindsey Gattman, Tobias Johnson

Articles, Abstracts, and Reports

No abstract provided.

Self-Regulation And Sensory Processing Education Program For Educators, Julianne Mendivil, Tina G. Bhakta, Angela Blackwell

Spring 2024 Virtual OTD Capstone Symposium

Children with low self-regulation skills may face many challenges in the classroom environment that can impact their performance in school-based activities. As teachers play a vital role in the development of young children, this educational program aims to improve teacher competence (knowledge, skills, and attitudes) in applying sensory processing and self-regulating concepts to the school environment.

The Ci-Asd Program: Implementation Of Contextual Interventions For Autism Spectrum Disorder (Ci-Asd) With Latino Families (Preliminary Report), Gabriel Gonzalez, Erik Pérez, Angela Blackwell

Spring 2024 Virtual OTD Capstone Symposium

Children diagnosed with Autism Spectrum Disorder (ASD) experience sensory processing differences that affect their participation in daily activities and routines. Autism affects an estimated 1 in 36 children in the U.S. However, Latino children are diagnosed two years later than white children. Latino families still have the greatest disparities in accessing ASD resources throughout the U.S. compared to white families. The lack of ASD services and resources led to decreased parental self-efficacy, quality of life, and increased child behavioral problems.

Contextual Interventions Adapted for Autism Spectrum Disorder (CI-ASD) are an emerging intervention for occupational therapy (OT) practitioners. Recent literature shows …

Ovarian Torsion, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

A Review Of Shared Decision-Making, Published Protocols, And Post-Desensitization Strategies In Oral Immunotherapy (Oit), Susan Laubach, Edwin H Kim, Matthew Greenhawt, Sally Bailey, Aikaterini Anagnostou

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: The aim of this review is to highlight key published oral immunotherapy (OIT) protocols and post-desensitization strategies for the major food allergens and to cover important concepts to consider when evaluating OIT for food-allergic patients. Shared decision-making should help identify patient and family values which will help influence the type of evidence-based protocol and maintenance strategy to use.

RECENT FINDINGS: With food OIT emerging as a treatment option, there is a pressing need for patients, physicians, and other providers to have a nuanced understanding of the management choices available to them. There are now randomized controlled trials …

Temporary Peripheral Nerve Stimulation For The Treatment Of Greater Occipital Neuralgia, Royce Copeland, Angela Nwankwo, Emanuel Narcis Husu

Faculty, Staff and Students Publications

Background: Greater occipital neuralgia (GON), a cause of chronic headaches, can be debilitating and vastly affect one's quality of life. Recent strides in comprehending the pathophysiology of GON and the ongoing evolution of approaches to the condition's treatment have led to the pursuit of more effective interventions. Among these, temporary peripheral nerve stimulation (PNS) devices have surfaced as an avenue for management, presenting a minimally invasive yet highly efficient alternative in treating other chronic pain conditions. This study discusses a case of GON successfully managed with temporary (60-day) PNS.

Case report: A 35-year-old man presented with a nearly 8-month history …

Improving Frequency Of Peer Review Of Abnormal Genital Exam Findings In Patients Undergoing Sexual Abuse Evaluation, Lyndsey Hultman, Terra N. Frazier, Jennifer Hansen

Presentations

Background/Objectives: 2023 Child Advocacy Center (CAC) accreditation standards require that “all medical professionals providing services to CAC clients must demonstrate that 100% of all findings deemed abnormal or “diagnostic” of trauma from sexual abuse have undergone expert review by an advanced medical consultant”. Prior to program implementation, scheduled Case Review occurred among the authors’ institution child abuse pediatricians (CAPs), but typical practice was to review cases upon CAP request. The authors’ institution faced practice standard implementation barriers of high case volumes and collaboration with multiple different CACs. Our primary aim was to increase peer review of abnormal exams from a …

Antimicrobial Duration Stewardship Project: A Qi Approach, Joshua Saucedo, Rana El Feghaly, Amanda Nedved, Leslie Hueschen, Marsha Dannenburg, Tanis Stewart, Patty Philips, Jennifer Floyd

Presentations

A QI project aimed at increasing the percentage of children discharged home from the emergency department with a diagnosis of community acquired pneumonia (CAP) or acute bacterial rhinosinusitis (ABRS) treated with an optimal antibiotic duration (5 days or less for CAP, 7 days or less for ABRS) from 22% to 70% by July 2025. Additionally, assess for differences in care based on demographic and socioeconomic factors such as the area deprivation index. National guidelines and CMH clinical pathways recommend short antibiotic durations (5-7 days) for most infections (5 days for community acquired pneumonia, 5-7 days for acute bacterial rhinosinusitis). At …

An Increased Failure Rate Of Asparaginase Desensitization With Calaspargase Pegol, Jillian Fry, Erin M. Guest, Keith J. August

Posters

Background: In late 2022, pegaspargase (SS-PEG) became unavailable to patients younger than 22 years in the United States, leaving calaspargase pegol (SC-PEG) as the only available long-acting asparaginase formulation. SC-PEG has been compared to SS-PEG in two randomized, pediatric clinical trials and found to have similar rates of adverse events with comparable rates of event-free survival. Our institution uses a desensitization protocol for patients who experience a hypersensitivity reaction to asparaginase. Here we review our experience with desensitization since the transition to SC-PEG from SS-PEG. Objectives: To compare the rate of hypersensitivity reactions, success of desensitization protocols, and need for …

Diagnosis Of Mosaic Rasopathy In A Child With Rhabdomyosarcoma, Meagan Vacek, Paige Johnson, Midhat S. Farooqi, Kristi M. Canty, Dihong Zhou, Brendan Lanpher, Wendy Allen-Rhoades, Erin M. Guest

Posters

Background: Phacomatosis pigmentokeratotica (PPK) is a subtype of epidermal nevus syndrome characterized by the co-existence of a sebaceous nevus and a speckled lentiginous nevus and described in approximately 30 cases in literature. PPK is now recognized as a mosaic RASopathy due a postzygotic mutation in the Ras-Raf-MEK-ERK pathway. RAS variants are also known to contribute to tumorigenesis, in some pediatric cancers, including rhabdomyosarcoma. Objective: Describe the presentation and evaluation of a child with pelvic rhabdomyosarcoma and evolving skin lesions found to have a rare mosaic-RASopathy. Design/Method: Case Report Results: The patient is a former 32-week premature female who presented to …

Anesthetic And Multidisciplinary Management Of A 2-Staged Liver Transplant​, Kasey Brooks, Lisa Conley, Brandon Layton

Posters

We present a case of a 2 staged liver transplant on a 12-month-old 8kg male with newly diagnosed mitochondrial depletion syndrome causing acute liver failure, refractory lactic acidosis, and cardiopulmonary collapse requiring ECMO. The patient’s past medical history at the time of presentation included history of prematurity at 32 weeks, developmental delay, and a brother with an undiagnosed pancreatic disorder. The patient was brought in by parents to the emergency department with a cough, minimal PO intake for 5 days, and increased fatigue who was found to be URI positive. Initial labs were concerning for anemia, elevated bilirubin, elevated AST/ALT, …

Early Cholestasis And Vitamin K Deficiency Secondary To Biliary Atresia Presenting As Coagulopathy And Thymic Hemorrhage, Abbey Elsbernd, Lauren Amos Md

Posters

Background Bleeding and progressive coagulopathy are established symptoms of early cholestasis, including extrahepatic biliary atresia. We present a patient with bleeding secondary to vitamin K deficiency and cholestasis-induced fat malabsorption with unusual presentation of mediastinal mass. Objective Describe a case of late-onset vitamin K deficiency and cholestasis ¬¬presenting as jaundice and coagulopathy with associated bleeding into thymic structures Design/Method Case report Results A 4-week-old term male infant was brought to the ED with fussiness and bruising. Prior to presentation, he was afebrile and followed regularly with his primary care provider for jaundice below phototherapy thresholds. Infant received vitamin K at …

Single Center Retrospective Comparison Of Bivalirudin And Heparin For Therapeutic Anticoagulation In Pediatric Patients, Clayton Habiger, Shannon L. Carpenter

Posters

Background: The pharmacological choice for continuous anticoagulation therapy in pediatric patients has classically been unfractionated heparin. However, with heparin there are risks of treatment resistance in pediatrics given differences in developmental hemostasis, and contemporary medications such as bivalirudin offer a valuable alternative. Bivalirudin binds to thrombin and has shown encouraging results compared to heparin in pediatric patients receiving ECMO, but no comparison has been made in patients receiving therapeutic anticoagulation. Three years ago, Children’s Mercy Pediatric Hematology department encouraged bivalirudin use over heparin use for therapeutic anticoagulation requiring a continuous infusion. Objectives: Compare clinical and laboratory outcomes in patients receiving …

Transition Skills Lab: A Telehealth Intervention For Improving Healthcare Transition In Youth With Special Health Care Needs, Angela Combs Ma, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Posters

Introduction: Few interventions exist to provide hands-on practice of key health management tasks to youth with special health care needs (YSHCN). The Transition Skills Lab was adapted from Jerlym Porter’s work and piloted as a virtual intervention in YSHCN. Methods: Sixteen young adults participated in the virtual Transition Skills Lab, during which they practiced three key patient competencies pertaining to health care tasks: reading an insurance card, reading a pill bottle label, and scheduling an initial visit with an adult doctor. Participants were then asked to rate their confidence on skills taught within the intervention on a four-point scale from …

Congenital Heart Defects And Autism: Understanding The Breakdown Of Associated Risk Factors In A Clinically Referred Sample, Elizabeth Raines, Amanda Strasser, Amanda Manderfeld, Paul Glasier, Elizabeth J. Willen

Posters

Background: Children with Congenital Heart Disease (CHD) have higher odds of developing social difficulties and/or an Autism Spectrum Disorder (AuSD) than the general population (i.e., ~10% vs. ~1%). However, there is a paucity of nuanced understanding of specific drivers of the increased rates of AuSD in extant literature. The purpose of this study is to identify the rates of co-occurring cardiac, neurological, and genetic conditions to better understand associated risk factors in a patient sample from a medium-size children’s hospital. Methods: Our population includes a clinically referred sample of children (i.e., medical history of CHD and neurodevelopmental risk) under 18 …

Parents’ Perception Of An Intensive Interdisciplinary Pain Treatment For Amplified Pain Syndrome, Jacqueline Pabis Phd, Sabrina Ung, Jenny Scheurich, Dustin Wallace Phd

Posters

Introduction: Intensive interdisciplinary pain treatment (IIPT) is an effective treatment for youth impaired by chronic pain (Claus et al., 2022). IIPT programs incorporate parents in treatment, as parental distress has been found to impact health and functioning in youth with chronic pain. Research has suggested parent satisfaction may be related to increased child adherence, and in turn, reduced pain (Gorodzinsky et al., 2012). There is limited research on parental satisfaction with IIPT and the role of parent-provider communication. Method: Parents (n=99) of children in an IIPT program completed questionnaires related to treatment satisfaction, parent-provider communication (e.g., provider listened carefully, provider …

Accuracy Of Influenza Icd-10 Diagnosis Codes In Identifying Influenza Illness In Children., James W. Antoon, Tess Stopczynski, Justin Z. Amarin, Laura S. Stewart, Julie A. Boom, Leila C. Sahni, Marian G. Michaels, John V. Williams, Janet A. Englund, Eileen J. Klein, Mary A. Staat, Elizabeth P. Schlaudecker, Rangaraj Selvarangan, Jennifer E. Schuster, Geoffrey A. Weinberg, Peter G. Szilagyi, Ariana Perez, Heidi L. Moline, Andrew J. Spieker, Carlos G. Grijalva, Samantha M. Olson, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Studies of influenza in children commonly rely on coded diagnoses, yet the ability of International Classification of Diseases, Ninth Revision codes to identify influenza in the emergency department (ED) and hospital is highly variable. The accuracy of newer International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify influenza in children is unknown.

OBJECTIVE: To determine the accuracy of ICD-10 influenza discharge diagnosis codes in the pediatric ED and inpatient settings.

DESIGN, SETTING, AND PARTICIPANTS: Children younger than 18 years presenting to the ED or inpatient settings with fever and/or respiratory symptoms at 7 …

Quality Of Life In A Cohort Of Kenyan Children With Cerebral Palsy, Pauline Samia, Melissa Tirkha, Amina Kassam, Richard Muindi, Wahu Gitakah, Susan Wamithi, James Orwa, Eugene Were, Michael Shevell

Paediatrics and Child Health, East Africa

Aim: The objective of the study was to evaluate the quality of life in Kenyan children (age 4–18 years) with cerebral palsy (CP).

Methods: A cross-sectional descriptive study was conducted. Children with CP were recruited from the pediatric clinics at the Aga Khan hospital Nairobi (AKUHN). Parent proxy-reports using CPQoL-child and CPQoL-adolescents were obtained. Clinical and demographic data were compiled from medical records and parent interviews. A Likert scale was utilized to determine QoL across several domains.

Results: One hundred and fourteen child–parent dyads with CP were recruited. The median age of study participants was 8 years (IQR 3–13 years), …

The Association Between Mental Health Disorders And Glycemic Control In Adolescents With Type 1 Diabetes, Marcella Pietrzyk

Independent Study Project (ISP) Collection

Adolescence is a very challenging period in a person's life as it is often filled with hormonal changes, emotional turmoil, and time for development socially, emotionally, and mentally. The addition of a chronic illness on top of the transition from child to adult creates a large burden on quality of life. The most common chronic illness diagnosed in adolescence is type 1 diabetes. This is an illness with a significant medical burden as it requires close monitoring of blood glucose levels, constant insulin injections, and diet control. The combination of adolescence and a chronic illness leads to higher rates of …

Recurrent Nontraumatic Subgaleal Hematomas In A Pediatric Patient With Sickle Cell Disease, Irtiza N Sheikh, Olayinka Okeleji, Rabya Afzal, Eliana Bonfante, Monica Kodakandla, Neethu M Menon

Faculty, Staff and Student Publications

Spontaneous subgaleal hematoma in pediatric patients with sickle cell disease (SCD) is a rare occurrence that can present with symptoms mimicking ischemic stroke, a known complication of SCD. However, unlike ischemic stroke, subgaleal hematoma is nonlethal and can be managed conservatively without major sequelae. Here, we present the case of an adolescent with SCD who presented with 2 episodes of subgaleal and epidural hematomas, 2 years apart. The latter episode occurred while on crizanlizumab, an anti-P-selectin antibody, approved for use in SCD in 2019 to reduce the number of acute pain crises. We demonstrate the diagnosis of subgaleal hematoma and …

Identifying Age-Specific Risk Factors For Poor Outcomes After Trauma With Machine Learning, Heather R Kregel, Gabrielle E Hatton, John A Harvin, Thaddeus J Puzio, Charles E Wade, Lillian S Kao

Faculty, Staff and Student Publications

Introduction: Risk stratification for poor outcomes is not currently age-specific. Risk stratification of older patients based on observational cohorts primarily composed of young patients may result in suboptimal clinical care and inaccurate quality benchmarking. We assessed two hypotheses. First, we hypothesized that risk factors for poor outcomes after trauma are age-dependent and, second, that the relative importance of various risk factors are also age-dependent.

Methods: A cohort study of severely injured adult trauma patients admitted to the intensive care unit 2014-2018 was performed using trauma registry data. Random forest algorithms predicting poor outcomes (death or complication) were built and validated …

How Territoriality And Sociality Influence The Habitat Selection And Movements Of A Large Carnivore, K Whitney Hansen, Nathan Ranc, John Morgan, Neil R Jordan, J Weldon Mcnutt, Alan Wilson, Christopher C Wilmers

Faculty, Staff and Student Publications

While territoriality is one of the key mechanisms influencing carnivore space use, most studies quantify resource selection and movement in the absence of conspecific influence or territorial structure. Our analysis incorporated social information in a resource selection framework to investigate mechanisms of territoriality and intra‐specific competition on the habitat selection of a large, social carnivore. We fit integrated step selection functions to 3‐h GPS data from 12 collared African wild dog packs in the Okavango Delta and estimated selection coefficients using a conditional Poisson likelihood with random effects. Packs selected for their neighbors' 30‐day boundary (defined as their 95% kernel …

Congenital Disseminated Malignant Rhabdoid Tumor Mimicking A Vascular Lesion, Scott K Wang, Prabhath Mannam, Katerina Dukleska, Fabiola Balarezo

Faculty, Staff and Student Publications

A congenital disseminated malignant rhabdoid tumor (MRT) is an exceedingly rare and aggressive pediatric cancer marked by the presence of malignant rhabdoid cells in various organs, including the brain, kidneys, and soft tissues, at birth. It is often detected prenatally or shortly post-birth. The malignancy's aggressiveness results in a bleak prognosis, offering limited treatment options and low survival rates. Early diagnosis and comprehensive medical intervention are crucial, but managing this condition is complicated by its rarity. We herein presented a case of a 37 and 1/7 week gestation male infant with a rapidly growing arm soft tissue mass within two …

A Meta-Analysis On The Diagnostic Utility Of Ultrasound In Pediatric Distal Forearm Fractures, Amir Hassankhani, Melika Amoukhteh, Payam Jannatdoust, Parya Valizadeh, Delaram J Ghadimi, Pauravi S Vasavada, Jennifer H Johnston, Ali Gholamrezanezhad

Faculty, Staff and Student Publications

Pediatric distal forearm fractures, comprising 30% of musculoskeletal injuries in children, are conventionally diagnosed using radiography. Ultrasound has emerged as a safer diagnostic tool, eliminating ionizing radiation, enabling bedside examinations with real-time imaging, and proving effective in non-hospital settings. The objective of this study is to evaluate the diagnostic efficacy of ultrasound for detecting distal forearm fractures in the pediatric population. A systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until October 1, 2023, following established guidelines. Eligible studies, reporting diagnostic accuracy measures of ultrasound in pediatric patients …

A Scoping Review Of Artificial Intelligence In Medical Education: Beme Guide No 84, Morris Gordon, Michelle Daniel, Aderonke Ajiboye, Hussein Uraiby, Nicole Y Xu, Rangana Bartlett, Janice Hanson, Mary Haas, Maxwell Spadafore, Ciaran Grafton-Clarke, Rayhan Yousef Gasiea, Colin Michie, Janet Corral, Brian Kwan, Diana Dolmans, Satid Thammasitboon

Faculty, Staff and Students Publications

Background: Artificial Intelligence (AI) is rapidly transforming healthcare, and there is a critical need for a nuanced understanding of how AI is reshaping teaching, learning, and educational practice in medical education. This review aimed to map the literature regarding AI applications in medical education, core areas of findings, potential candidates for formal systematic review and gaps for future research.

Methods: This rapid scoping review, conducted over 16 weeks, employed Arksey and O'Malley's framework and adhered to STORIES and BEME guidelines. A systematic and comprehensive search across PubMed/MEDLINE, EMBASE, and MedEdPublish was conducted without date or language restrictions. Publications included in …

The Impact Of Cognitive Behavioral Therapy On Sleep Problems In Autistic Children With Co-Occurring Anxiety, Holly K Harris, Minjee Kook, Peter Boedeker, Andrew G Gusick, Ariel M Lyons-Warren, Robin P Goin-Kochel, Chaya Murali, Leandra N Berry, Eric A Storch

Faculty, Staff and Students Publications

Purpose: This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT).

Methods: We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children's Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep.

Results: There was a negative association between time in treatment …