Pediatrics Commons^™

Unpacking Developmental Programming: A Conceptual And Historical Analysis In The Context Of Dohad, Andrea Gretchev, Heide S. Temples, Gillian England-Mason, Deborah Dewey, Sara M. Sarasua, Christopher Farrell, Vivian Haley-Zitlin

Publications

The Developmental Origins of Health and Disease (DOHaD) paradigm posits that early environmental factors may influence a child’s development and long-term health outcomes. Developmental programming (DP) is central to this paradigm, whereby specific early life exposures during critical periods of development are associated with changes to physiological and metabolic pathways, potentially predisposing individuals to disease. However, no standard definition of DP exists, and various terms have been used to describe similar processes. This analysis aimed to develop a conceptual definition for DP to inform interdisciplinary research, education, and practice. Walker and Avant’s eight-step method was employed to analyze the literature, …

Gene Expression And Apoptotic Responses To Panobinostat Treatment And Yap Knockdown In Ewing Sarcoma Cells, Luna Collazo-Garcia, Alejandra Favela Santos, Madeline Torres-Salazar, Isabella Toscano

Posters - 2026

Ewing sarcoma is an aggressive pediatric cancer driven by abnormal gene expression caused by the EWS-FLI1 fusion protein

Usually treated with intensive treatments such as chemotherapy and radiation

Outcomes remain poor for metastatic disease, highlighting the need for new therapeutic strategies

The Hippo signaling pathway regulates cell proliferation and survival through the transcriptional co-activator YAP1

Prevalence Of Plasmodium Ovale And Plasmodium Malariae Mixed Infections And Associated Mortality In Children With Severe Falciparum Malaria, Giselle Lima-Cooper, Dibyadyuti Datta, Caitlin Bond, Kagan Mellencamp, Ruth Namazzi, Mahesh Gupta, Andrea Conroy, Robert Opoka, Chandy John

Paediatrics and Child Health, East Africa

The prevalence and clinical significance of mixed Plasmodium infections in children with severe Plasmodium falciparum (P. falciparum) malaria are not well characterized. In a cohort of 440 Ugandan children hospitalized with severe malaria who were diagnosed with Plasmodium species via microscopy, nested polymerase chain reaction (nPCR) testing was used to detect P. falciparum, Plasmodium ovale (P. ovale), Plasmodium malariae (P. malariae), and Plasmodium vivax (P. vivax) infections and assess their association with adverse clinical outcomes during hospitalization. Using nPCR testing, the Plasmodium 18S small-subunit ribosomal RNA gene was detected in 440 children. Plasmodium falciparum mono-infection was identified in 329 (74.8%) …

Clinical And Non-Clinical Factors Associated With Early Discharge In Pediatric Non-Trauma Patients Transported By Rotor Wing, Jordon Mitzelfelt, Lisa Pruitt, Amy Papa, Ashley K. Sherman, David Juang, Sarah Brunner, Asdis Finnsdottir Wagner, Jennifer Flint

Posters

Objective: Helicopter emergency medical services (HEMS) are crucial for transporting critically ill children to definitive care, however, rising costs and relative risks of this type of transportation necessitate careful evaluation of potential over-utilization. Current literature primarily focuses on pediatric trauma patients, leaving a significant gap in data regarding non-trauma pediatric HEMS transports and the influence of non-clinical factors such as referral hospital distance, resources, and capabilities on transport decisions. This study aims to address these gaps by examining non-trauma pediatric HEMS patients and identifying associated clinical and non-clinical factors related to early hospital discharge (< 24 hours). Methods: This retrospective, single-center study includes pediatric patients with medical and non-trauma surgical diagnoses transported by HEMS between April 1, 2021 and March 31, 2024. Clinical data were extracted from transport team records and the hospital’s electronic health records. Analyses were performed to identify factors associated with discharge within 24 hours of admission. To identify predictors of early discharge, we analyzed clinical factors including chief complaint, pre-transport vascular access, transport crew interventions (medication administration and procedures), respiratory assistance, and Pediatric Age-Adjusted Shock Index (SIPA) scores. Additionally, we examined the impact of the initial admit unit, and medical support required within the first 24 hours of hospitalization. Non-clinical predictors included the referring hospital’s status (critical access and/or rural designation) and the time of transport. Results: A total of 568 patients were transported by HEMS, of whom 88 (15%) were discharged within 24 hours. Patients in the early discharge group were more likely to present with neurologic chief complaints (40%), whereas those remaining hospitalized beyond 24 hours more frequently presented with respiratory complaints (40%). Normal SIPA scores both prior to and at the conclusion of transport were significantly associated with early discharge (p=0.012 and p=0.011, respectively). Furthermore, patients requiring no medications or respiratory assistance during transport, or no respiratory support within the first 24 hours of admission, were significantly more likely to be discharged early (p< 0.001). Notably, all patients with central access prior to transport remained admitted for more than 24 hours (p=0.004). Regarding non-clinical factors, patients transported from designated rural hospitals were more likely to experience early discharge (p< 0.001). Conclusion: These results characterize the pediatric non-trauma HEMS population and identify key predictors of early hospital discharge. This data is essential for developing standardized dispatch criteria to mitigate over-utilization and ensure high-acuity transport is reserved for the most appropriate patients.

Does Variation In Systemic Steroid Use Impact Outcomes In Preschoolers Hospitalized With Viral Respiratory Tract Infection?, Smit Shah, Kathryn Kyler, Matt Hall, Jessica Markham

Posters

Background: Systemic corticosteroids (SCS) are a cornerstone of treatment for acute asthma exacerbation. However, the role of SCS in preschool-aged children hospitalized with viral respiratory tract infection (vRTI), including viral induced wheezing, remains uncertain. Clinical trials have reported conflicting results about the benefits of SCS in this population. Objectives: To evaluate hospital-level variation in inpatient management of preschool-aged children admitted with vRTI and to compare clinical and utilization outcomes based on hospital-level SCS use. Methods: We conducted a retrospective cohort study of children aged 24-59 months admitted to US children’s hospitals with vRTI from July 2022-July 2024 using the Pediatric …

Reducing Waste And Cost By Utilizing Tap Water For Laceration Irrigation In The Emergency Department: A Quality Improvement Approach, Alison L. Fowler, Rohan Akhouri, Josaih Galdean, Isabella Dunt, Christopher Kaberline, Viktoriya Stoycheva Mha, Rn, Cpn, Sarah Nienhaus, Leslie Hueschen

Posters

Purpose/Objective: Lacerations requiring closure make up 8 million emergency department (ED) visits annually. Irrigating prior to closure with potable tap water decreases cost and waste without increasing rates of infection compared to sterile fluids. Currently, only 3.5% of lacerations closed in our ED are irrigated with tap water. This project aims to increase the percent age of lacerations closed by ED providers irrigated with tap water from 3.5% to 60% by March 2026 in a freestanding pediatric emergency department across two sites (ED 1, ED 2). Design/Methods: A multidisciplinary team (physicians, nurses, QI consultant, parent advisors) formed in November 2024. …

Cardiac Medication Use In Action For Duchenne Muscular Dystrophy Cardiomyopathy., Carol A. Wittlieb-Weber, Brian Birnbaum, Chesney D. Castleberry, Tyler W. Cunningham, Paul Esteso, Katheryn E. Gambetta, Emily A. Hayes, Daphne T. Hsu, Beth D. Kaufman, Benjamin Kroslowitz, Ashwin K. Lal, Angela Lorts, Hugo Martinez, Deepa Mokshagundam, Deipanjan Nandi, John J. Parent, Frank Raucci, Nelia Soares, Jonathan H. Soslow, Renata Shih, Svetlana Shugh, Chet R. Villa, Sarah J. Wilkens, Bethany L. Wisotzkey, Jennifer Conway

Manuscripts, Articles, Book Chapters and Other Papers

This study seeks to understand cardiac medication use in a large cohort of males with Duchenne Muscular Dystrophy (DMD) followed prospectively with focus on current practices and adherence to consensus directed medical therapy (CDMT). DMD patients have been enrolled in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Dystrophinopathy Registry since 2021. Cardiac medication use was analyzed at enrollment and most recent follow-up. CDMT was defined as concurrent use of angiotensin-converting-enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) /angiotensin receptor-neprilysin inhibitor (ARNI) plus beta-blocker (BB) plus mineralocorticoid receptor antagonist (MRA). Two hundred sixty-five males with DMD (median age 17.5 (IQR 14.5-21.5) …

Impaired Fetal Brain Growth And Neurodevelopmental Deficits At 2 Years: Deep Phenotyping Of Maternal–Fetal Pathophysiology, José Villar, Maria Carvalho, Robert Gunier, Rose Mcgready, Yolotzin Valdespino, Kim Lagerborg, Fernando Barros, Agustin Conde-Agudelo, Shane Norris, R. Ochieng

Obstetrics and Gynaecology, East Africa

Background Impaired fetal cranial growth trajectories, diverging before 20 weeks' gestation, are associated with growth, vision, and neurodevelopment deficits at age 2 years. We aimed to understand the maternal–fetal pathophysiological processes underlying childhood developmental deficiencies.

Methods: Between 2012 and 2019, the INTERBIO-21st Fetal Study enrolled 3598 pregnant women who initiated antenatal care before 14 weeks' gestation. We prospectively measured fetal cranial and linear growth and brain volume, and we monitored the infants' health, growth, and development from birth to age 2 years to identify growth and development phenotypes. We grouped the observed cranial growth into five distinct phenotypes: median growth …

Exploring How Parental Involvement Impacts Police Encounters And Delinquent Behaviors Among Black Adolescent Girls, Danielle Porter, Elizabeth A. Otto, Dyamon Brown, Jasmine Alli, Robyn Douglas, Noni Gaylord-Harden

Presentations

Adolescents’ contact with police is a complex outcome that is influenced by both individual behavior and the broader social context. Specifically, while delinquent behavior can lead to more police contact (Crutchfield et al., 2012), hyper-surveillance often occurs in marginalized communities, increasing unjustified police contact for youth of color (Campos-Manzo et al., 2020; Geller, 2021). Indeed, racial disparities in police contact during adolescence persist even after accounting for delinquent behavior (Campos-Manzo et al., 2020; Crutchfield et al., 2012). Thus, it is important to identify factors that may protect Black youth from contact with police. Parental involvement refers to parents’ active and …

Antibiotic-Pathogen Concordance In Pediatric Complicated Community-Acquired Pneumonia, Makenna Steger Md, Marina Dantas Md, Mscr, Berina Karisik Do, Smit Shah, Alaina Burns Pharmd, Jessica Markham

Presentations

Background Complicated community-acquired pneumonia (cCAP)—defined by effusion, empyema, abscess, cavitation, or necrosis—is associated with worse outcomes than uncomplicated pneumonia. Methicillin resistant Staphylococcus aureus (MRSA) data in cCAP are limited and often merged with uncomplicated cases. Although guidelines recommend MRSA coverage only in select cases, it is empirically used in >70% of encounters. Lack of pathogen identification likely drives overuse due to diagnostic uncertainty. Clarifying Member of AAP, APA, APS, SPR, ASPN, or PIDS? PIDS JM Jessica Markham, MD, MSc Position: Associate Professor of Pediatrics Organization: Children's Mercy Hospitals and Clinics Email: [email protected] Role: Co-Author Disclosure Status: Complete Disclosure: Nothing to …

Adults And Adolescents With High-Intensity Neurologic Impairment Hospitalized At Children’S Hospitals, Charles Maloy, Matt Hall, Joanna Thomson, Jean-Baptist Lepichon, Henry T. Puls

Posters

Introduction: Children with high-intensity neurologic impairment (HINI) account for a sizeable proportion of inpatient resources. As survival into adulthood for children with medical complexity increases, children’s hospitals will likely admit adults with HINI. Understanding adult HINI hospitalization patterns is necessary to develop effective care strategies for this population. Objective: Compare characteristics of adults and adolescents with HINI hospitalized at children’s hospitals and describe hospital-level variation in hospitalizations for adults with HINI. Methods: This retrospective cross-sectional study included discharges of patients with HINI aged 12-29 years from 41 children’s hospitals in the Pediatric Health Information System between 2022-24. Hospitals were excluded …

Variation In Dexamethasone Prescribing Practices For Pediatric Asthma Exacerbations In Acute Care Settings, Hannah Reilly, Natalie J. Kane, Sian Best, Mark A. Hoffman, Kathryn Kyler

Posters

No abstract provided.

Scoliosis, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Cannabinoid Hyperemesis Syndrome, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Population Trends In Infant Mortality Before, During, And After Implementation Of Therapeutic Hypothermia Across Racial And Ethnic Groups: United States Period-Linked Data, 2000-2017, Janardhan Mydam, Nitin Chouthai

Conference Presentation Abstracts

Background: Moderate to severe hypoxic-ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and lifelong morbidity. Following publication of the NICHD Neonatal Research Network trial in 2005, therapeutic hypothermia (TH) became the standard of care for infants with moderate to severe HIE. However, national trends in HIE-related infant mortality before, during, and after TH implementation across racial and ethnic groups have not been comprehensively evaluated.

Objective: To assess the impact of therapeutic hypothermia on HIE-related infant mortality by comparing mortality rates before (2000-2005), during (2006-2009), and after (2010-2017) implementation of TH among different racial and ethnic groups in the …

Comparison Of Gene Up Regulation Between A Mouse Model Of Rop And Extremely Premature Newborns From Days 7 To 14 Of Life, Nitin Chouthai, Nikhlesh K. Singh

Conference Presentation Abstracts

Background: Severe ROP is linked to considerable morbidity in extremely premature newborns. To our knowledge, there are currently no early-phase biomarkers for ROP.

Objective: The objective of this retrospective study was to compare the retinal RNA expression in mouse pups exposed to oxygen-induced retinopathy with the blood RNA profile of extremely premature newborns during the first two weeks of life, specifically from days 7 to 14 of life.

Design/Methods: Bulk RNA transcriptome analysis was conducted using peripheral blood samples from 21 extremely preterm newborns who were born at less than 26 weeks’ gestation and were between 7 and 14 days …

Umbilical Cord Milking Versus Early Cord Clamping In Late Preterm And Term Neonates Who Are Non-Vigorous At Birth: A Cluster-Randomized Controlled Trial (Cordmilk Trial), Zubair H. Aghai, Sangappa M. Dhaded, S Yogeshkumar, Sunil S. Virnekar, Benjamin L. Leiby, Vinita Jain, Yvonne E. Vaucher, Nitin Chouthai, Meenakshi Girish, Seema Parvekar

Conference Presentation Abstracts

No abstract provided.

Exploring Single Celled Rna Biomarkers Using Deconvolution Analysis For Severe Retinopathy Of Prematurity In Extremely Premature Newborns, Vighnesh Ghatpande, Saachi A. Bodas, Nitin Chouthai

Conference Presentation Abstracts

Background: Timely, precise diagnosis of Retinopathy of Prematurity (ROP) is key to implementing appropriate treatment, as distinctions between mild-ROP and severe-ROP are the primary factors in its characterization. Deconvolution analysis of bulk RNA sequencing is an indirect method to identify static and dynamic molecular and physiological associations.

Objective: The objective of this this study was to evaluate if deconvolution analysis can be used to identify cellular biomarkers of ROP.

Design/Methods: This is a prospective study (IRB#086113MP2E) with a convenience sample size of 8 neonates with no ROP, 6 neonates with mild to moderate ROP (M-ROP), and 7 neonates with severe …

Atopic Dermatitis, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Croup: Observation Time Post Racemic Epinephrine, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.