Pediatrics Commons^™

Vaccines, Children, And The Public Health Trust, Christopher Chambers, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

1. Review the impact of immunizations on the public health over the past 50 years.
2. Childhood Vaccines Now
3. Describe the challenges associated with trying to eliminate “immunizable” diseases. Examples: Invasive Pneumoccal Disease, Neisseria meningitis
4. The Future

Standards Of Care For Children In Emergency Departments: Executive Summary., Rodrick K Lim, Baljit Cheema, Catherine Cartman, Ffion Davies, Marianne Gausche-Hill, Felix Hay

Paediatrics Publications

No abstract provided.

Parents' Experiences Of Camp For Siblings Of Pediatric Oncology Patients, Kristen Lauren Krueger

Graduate Theses/Dissertations

The diagnosis and treatment of childhood cancer is oftentimes a stressful experience for individuals other than the patient, such as parents and siblings of pediatric oncology patients. Parents and siblings may be impacted in many ways, but there are interventions to help. The purpose of this qualitative study was to understand parents’ lived experiences of having a child who has attended a camp designed for siblings of pediatric oncology patients. Parents (n=5) of siblings that have attended camp for siblings were interviewed with open-ended questions. Data was analyzed using phenomenology procedures. Results from this study indicated that mothers and fathers …

Developing Educational Resources To Support The Use Of The Hippotherapy Evaluation And Assessment Tool, Emily Peoples

Student Capstone Papers

The Hippotherapy Evaluation and Assessment Tool (HEAT) was created in 2011 with the goal of creating an assessment specific to this therapeutic intervention and effectively tracking client progress. Based on the current literature of client progress during hippotherapy intervention, four domains of scoring were created: Static Posture, Dynamic Motor Behavior, Sensory Processing, and Psychosocial/Behavioral. Over the years, many thesis studies have been conducted to confirm the reliability and validity of the HEAT. However, further dissemination was required as many therapists had not yet heard of the tool. A doctoral capstone project was completed in 2019-2020 to create a training program …

Walking Kinematics In Young Children With Limb Loss Using Early Versus Traditional Prosthetic Knee Prescription Protocols, Mark Daniel Geil, Zahra Safaeepour, Brian Giavedoni, Colleen Coulter

Faculty Articles

The traditional treatment protocol for young children with congenital or acquired amputations at or proximal to the knee prescribes a prosthesis without a working knee joint, based in part on the assumption that a child learning to walk cannot properly utilize a passively flexing prosthetic knee component. An alternative to this Traditional Knee (TK) protocol is an “Early Knee” (EK) protocol, which prescribes an articulating prosthetic knee in the child’s first prosthesis, during development of crawling and transitioning into and out of upright positions. To date, no study has compared samples of children with limb loss at or proximal to …

Extracorporeal Membrane Oxygenation As A Bridge To Chimeric Antigen Receptor T-Cell Therapy For Severe Refractory Sepsis In The Setting Of Relapsed Refractory Pediatric Acute Lymphoblastic Leukemia: A Case Report., Alyssa Stoner, Jenna Miller, Terrie Flatt, Jessica S. Wallisch

Manuscripts, Articles, Book Chapters and Other Papers

Pediatric oncology patients with sepsis are at higher risk of morbidity and mortality compared with pediatric patients without malignancy. Historically, patients with relapsed and/or refractory disease were not considered candidates for aggressive life support strategies including extracorporeal membrane oxygenation support.

Case Summary: We report a 4-year-old female with relapsed refractory pre-B cell acute lymphoblastic leukemia preparing for chimeric antigen receptor T cell therapy with tisagenlecleucel who was admitted with fever and neutropenia. She progressed to refractory septic shock secondary to

Conclusion: The ability to provide chimeric antigen receptor T-cell therapy at designated institutions can augment extracorporeal membrane oxygenation candidacy discussions …

Urinary Epidermal Growth Factor As A Marker Of Disease Progression In Children With Nephrotic Syndrome., Debbie S. Gipson, Howard Trachtman, Anne Waldo, Keisha L. Gibson, Sean Eddy, Katherine M. Dell, Tarak Srivastava, Kevin V. Lemley, Larry A. Greenbaum, Sangeeta Hingorani, Kevin E. Meyers, Frederick J. Kaskel, Kimberly J. Reidy, Christine B. Sethna, Cheryl L. Tran, Chia-Shi Wang, Katherine R. Tuttle, Gia Oh, Alicia M. Neu, Elizabeth Brown, Jen-Jar Lin, Jennifer Lai Yee, Therese M M. Roth, Jonathan P. Troost, Brenda W. Gillespie, Matthew G. Sampson, Matthias Kretzler, Wenjun Ju

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Childhood-onset nephrotic syndrome has a variable clinical course. Improved predictive markers of long-term outcomes in children with nephrotic syndrome are needed. This study tests the association between baseline urinary epidermal growth factor (uEGF) excretion and longitudinal kidney function in children with nephrotic syndrome.

Methods: The study evaluated 191 participants younger than 18 years enrolled in the Nephrotic Syndrome Study Network, including 118 with their first clinically indicated kidney biopsy (68 minimal change disease; 50 focal segmental glomerulosclerosis) and 73 with incident nephrotic syndrome without a biopsy. uEGF was measured at baseline for all participants and normalized by the urine …

Pediatric Resident Knowledge, Experience, Comfort, And Perceived Competency In Providing Sibling Psychosocial Support., David Buchbinder, Sonam Sidhu, Melissa A. Alderfer, Anne Lown, Russ C. Kolarik, Tommy Wang

Department of Pediatrics Faculty Papers

This article is the author’s final published version in International Journal of Medical Education, Volume 11, March 2020, Pages 73-75.

The published version is available at https://doi.org/10.5116/ijme.5e63.6a46. Copyright © Buchbinder et al.

Musculoskeletal Pain Outcomes Pre- And Post Intrathecal Baclofen Pump Implant In Children With Cerebral Palsy: A Prospective Cohort Study., Chantel C. Barney, Alyssa M. Merbler, Jean Stansbury, Linda E. Krach, Michael D. Partington, Patrick Graupman, Peter D. Kim, Debbie Song, Frank J. Symons

Manuscripts, Articles, Book Chapters and Other Papers

Objective: To characterize musculoskeletal pain intensity, duration, frequency, and interference with activities of daily living in children with cerebral palsy (CP) before and after intrathecal baclofen pump placement.

Design: Prospective cohort study.

Setting: Children's tertiary hospital.

Participants: Participants were children with CP (N=32; 53% male; mean age, 9.9y; age range, 4-17y). The majority of participants had a CP diagnosis of quadriplegia (76%) and relied on wheeled mobility (91%).

Interventions: Assessments were completed pre- and post intrathecal baclofen pump implant.

Main outcome measures: Because of considerable patient heterogeneity, both pain measures (Brief Pain Inventory, Dalhousie Pain Interview) were completed by proxy …

Therapeutic Potential Of Citrulline As An Arginine Supplement: A Clinical Pharmacology Review, Jahidur Rashid, Shaun S. Kumar, Kathleen M. Job, Xiaoxi Liu, Candice D. Fike, Catherine M. T. Sherwin

Pediatrics Faculty Publications

Supplemental arginine has shown promise as a safe therapeutic option to improve endogenous nitric oxide (NO) regulation in cardiovascular diseases associated with endothelial dysfunction. L-arginine, an endogenous amino acid, was reported in clinical studies in adults to improve cardiovascular function in hypertension, pulmonary hypertension, pre-eclampsia, angina, and mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome. L-citrulline, a natural precursor of L-arginine, is more bioavailable than L-arginine because of hepatic first-pass metabolism avoidance and longer circulation time. Although not yet well studied, arginine/citrulline has immense therapeutic potential in some life-threatening diseases of children. However, optimal clinical development of arginine or …

Concussion, Anthony Shadiack

Sports Medicine

No abstract provided.

Pediatric Congenital Heart Diseases: Patterns Of Presentation To The Emergency Department Of A Tertiary Care Hospital, Surraiya Bano, Saleem Akhtar, Uzma R. Khan

Department of Emergency Medicine

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan.
Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as …

Safety And Efficacy Profile Of Ozenoxacin 1% Cream In Pediatric Patients With Impetigo, Adelaide A Hebert, Theodore Rosen, Núria Albareda López, Ilonka Zsolt, Xavier Masramon

Faculty, Staff and Students Publications

BACKGROUND: Ozenoxacin is a topical antibiotic approved in the United States for treatment of impetigo in adults and children age ≥2 months. This analysis evaluated the efficacy and safety of ozenoxacin in specific pediatric age groups.

METHODS: Data for children aged 2 months to <18 years recruited from eight countries who had participated in phase 1 and 3 trials of ozenoxacin were extracted and analyzed by age range.

RESULTS: Across studies, 644 pediatric patients with impetigo received ozenoxacin 1% cream (n = 287) or vehicle (n = 247). One study included retapamulin 1% ointment as the internal validity control (n = 110). The clinical success rate at the end of treatment and bacterial eradication rates after 3 to 4 days of treatment and at …

A Handoff Protocol For Pediatric Trauma Patients At A Rural Level One Trauma Center Reduces Length Of Stay, Evelyn Coile Md, Kathryn Bailey, Eric J. Clayton Ms, Mph, Tatiana Eversley-Kelso, Heather Macnew Md

General Surgery

No abstract provided.

A Primer On A Comprehensive Genetic Approach To Vascular Anomalies, A. J. Borst, T. A. Nakano, F. Blei, D. M. Adams, J. Duis

Journal Articles

No abstract provided.

Quiet Please: The Effects Of Sleep Quality And Quantity As A Result Of A Qi Project To Minimize Nighttime Sleep Interruptions, Chari Stump, Ashlie Tseng, Jennifer Brigle, Clifton Lee

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Quiet Please! The effects on sleep quality and quantity as a result of QI project to minimize nighttime interruptions

INTRODUCTION: Sleep is a significant component of health that is often overlooked in hospitalized patients. We introduced a QI project in 2016 to minimize nighttime interruptions in clinically stable patients by performing “passive vitals” which eliminated temperature and blood pressure readings at 4am and allowed patients to sleep longer overnight. Despite this intervention, the effects on sleep quality and quantity are unknown.

OBJECTIVE: The objective was to compare total sleep time, sleep interruptions, and sleep quality between patients eligible for passive …

Improving Early Antibiotic Administration For Treatment Of Sepsis At Children’S Hospital Of Richmond At Vcu: 2012-2019, Hannah Miller Md, Ashlie Tseng Md, Perry Taylor Pharmd, Matthew Schefft Do Msha, Sheila Pedigo Pharmd Bcpps, Tracy Lowerre Bsn Ms, Jose Munoz Md, Mark Astoria Md, Jonathan Silverman Md Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: The Surviving Sepsis Campaign recommends initiating IV antibiotic administration within one hour of recognition of severe sepsis. Several studies have shown that prompt blood culture collection, administration of broad-spectrum antibiotics, and fluid resuscitation following recognition improves child survival.

Objective: Our goal was to evaluate effectiveness of sepsis initiatives and institutional changes in the timing of early antibiotic administration at Children’s Hospital of Richmond at VCU.

Methods: We formed a Pediatric Sepsis Committee with representatives from each unit in 2013. In 2016, the committee began tracking time from the order of a first stat dose IV antibiotic to administration as …

Cancer Care Annual Report 2019-2020, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center. This year’s report focuses on tumors that arise in the kidney and illustrates three important areas of focus that a childhood cancer center must possess in this new age of medicine.

Adolescent Sjogren's Syndrome Presenting As Psychosis: A Case Series, E. K. Hammett, C. Fernandez-Carbonell, C. Crayne, A. Boneparth, R. Q. Cron, S. M. Radhakrishna

Journal Articles

No abstract provided.

Turner Syndrome With Y Chromosome: Spontaneous Thelarche, Menarche, And Risk Of Malignancy, E. Dabrowski, E. K. Johnson, V. Patel, Y. Hsu, S. Davis, A. L. Goetsch, R. Habiby, W. J. Brickman, C. Finlayson

Journal Articles

No abstract provided.

Early Oral Colostrum Administration In Preterm Infants, D. Maffei, M. Brewer, C. Codipilly, B. Weinberger, R. J. Schanler

Journal Articles

No abstract provided.

Graduate Medical Education Annual Report 2019-2020, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Incidence Of Initial Renal Replacement Therapy Over The Course Of Kidney Disease In Children., Derek K. Ng, Matthew B. Matheson, Bradley A. Warady, Susan R. Mendley, Susan L. Furth, Alvaro Muñoz

Manuscripts, Articles, Book Chapters and Other Papers

The Chronic Kidney Disease in Children Study, a prospective cohort study with data collected from 2003 to 2018, provided the first opportunity to characterize the incidence of renal replacement therapy (RRT) initiation over the life course of pediatric kidney diseases. In the current analysis, parametric generalized gamma models were fitted and extrapolated for RRT overall and by specific treatment modality (dialysis or preemptive kidney transplant). Children were stratified by type of diagnosis: nonglomerular (mostly congenital; n = 650), glomerular-hemolytic uremic syndrome (HUS; n = 49), or glomerular-non-HUS (heterogeneous childhood onset; n = 216). Estimated durations of time to RRT after …

Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston

Student Capstone Papers

Telehealth; also known as telerehabilitation, telecare, telemedicine, teletherapy, and telepractice; is an emerging healthcare service that is utilized in various healthcare facilities with a span of ages, conditions, and locations (World Federation of Occupational Therapy [WFOT], 2014). Telehealth utilizes information and communication technologies to deliver services to a patient when the healthcare provider is not in the same location (WFOT, 2014). Telehealth can provide an online platform for evaluations, consultations, monitoring, supervision, and intervention with patients and other professionals (WFOT, 2014).

Telehealth is an emerging method of delivering occupational therapy (OT) services to various populations, including: children and youth; productive …

The Early "Unnatural" History Following Surgical Repair Of Ventricular Septal Defects., Sathish M. Chikkabyrappa, Justin T. Tretter, Arpan R. Doshi, Sujatha Buddhe, Puneet Bhatla, Achi Ludomirsky

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Surgical outcomes for simple ventricular septal defects (VSD) have been excellent in the past three decades. For this project, the timing of resolution of left-sided dilation and mitral regurgitation (MR) following VSD repair was assessed.

Methods: Echocardiographic data surrounding surgery of 42 consecutive children who underwent surgical patch repair of a VSD were reviewed. The echocardiograms were reviewed up to a mean of 12 months post-operatively (range 9 - 14 months). Quantitative data indexed to body surface area including left atrial (LA) volume, mitral valve annulus diameter, and left ventricular end-diastolic dimension (LVEDD) was analyzed.

Results: The majority of …

Failure To Rescue As An Outcome Metric For Pediatric And Congenital Cardiac Catheterization Laboratory Programs: Analysis Of Data From The Impact Registry., Michael L. O'Byrne, Kevin F. Kennedy, Natalie Jayaram, Lisa J. Bergersen, Matthew J. Gillespie, Yoav Dori, Jeffrey H. Silber, Steven M. Kawut, Jonathan J. Rome, Andrew C. Glatz

Manuscripts, Articles, Book Chapters and Other Papers

Background Risk-adjusted adverse event (AE) rates have been used to measure the quality of pediatric and congenital cardiac catheterization laboratories. In other settings, failure to rescue (FTR) has demonstrated utility as a quality metric. Methods and Results A multicenter retrospective cohort study was performed using data from the IMPACT (Improving Adult and Congenital Treatment) Registry between January 2010 and December 2016. A modified FTR metric was developed for pediatric and congenital cardiac catheterization laboratories and then compared with pooled AEs. The associations between patient- and hospital-level factors and outcomes were evaluated using hierarchical logistic regression models. Hospital risk standardized ratios …

Special Considerations In Pediatric Burn Patients Regarding Drug Dosage And Administration, Kelsey Lindsley, Maureen Moynihan, Angela Chu, Kristen Yaeger, Karen L. Kier

Pharmacy and Wellness Review

Pediatric burn patients are a high-risk patient population to treat. These patients have altered physiologic function as a result of the burn injury, in addition to their smaller size and developing bodies. This creates unique challenges during treatment. Accommodations for these patients are made through unique drug dosages and routes of administration. When treating pediatric burn patients, properly assessing and treating pain promptly and effectively is of utmost importance. Nurses who utilize accurate and appropriate pain assessment scales will provide the best treatment of pain. Proper assessment allows the patient to receive the correct analgesic regime, ensuring a faster and …

Acetaminophen Protein Adducts In Hospitalized Children Receiving Multiple Doses Of Acetaminophen., Sibo Jiang, Valvanera Vozmediano, Susan M. Abdel-Rahman, Stephan Schmidt, Laura P. James

Manuscripts, Articles, Book Chapters and Other Papers

Previous reports have questioned the safety of multiple doses of acetaminophen administered to ill children. Acetaminophen protein adducts (adducts) are a biomarker of acetaminophen-induced liver injury and reflect the oxidative metabolism of acetaminophen, a known mechanism in acetaminophen toxicity. In this prospective observational study, we analyzed adduct concentrations in 1034 blood samples obtained from 181 hospitalized children (1 to 18 years inclusive) who received 2 or more doses of acetaminophen. Linear regression analysis showed that serum adduct concentrations increased as a function of the cumulative acetaminophen dose, which could be attributed, in part, to a long half-life of adducts (2.17 …

Infant With Protein C Deficiency And Stroke In The Setting Of Iron Deficiency Anemia, Tahseen Jalal Karim, Dustin J Paul, Regina M Troxell, Rajan Patel, Ian J Butler

Faculty, Staff and Student Publications

We report an 18-month-old infant with ischemic stroke, neurocognitive impairment, and psychomotor retardation in the setting of severe iron deficiency anemia. Although an uncommon outcome in anemic children, stroke is important to consider as a cause for developmental delay in children with iron deficiency anemia.

Be On Traq – Cross-Cultural Adaptation Of The Transition Readiness Assessment Questionnaire (Traq 5.0) And Pilot Testing Of The German Version (Traq-Gv-15)., Caroline Culen, Marion Herle, Marianne Konig, Kiana Johnson, David L. Wood, Gabriele Hausler

ETSU Faculty Works

Objective: Transfer from pediatric care into the adult health care system is known to be a vulnerable phase in the lives of youth with special health care needs (YSHCN). Recommendations from the literature favor assessment of transition readiness rather than simply pass over YSHCN from pediatric to adult-centered care by the age of 18. Nevertheless, no validated and disease neutral assessment instrument in German exists to date. Hence, our aim was to cross-culturally adapt and to pilot-test a German version of the Transition Readiness Assessment Questionnaire (TRAQ 5.0). We wanted to provide a tool that can be applied broadly during …