Pediatrics Commons^™

Minimalistic Approach To Enhanced Recovery After Pediatric Scoliosis Surgery, Scott A. Barnett, Bryant M. Song, Matthew Bauer, Matthew E. Nungesser, Claudia Leonardi, Michael J. Heffernan

School of Medicine Faculty Publications

Purpose: Prior studies of enhanced recovery protocols (ERP) have been conducted at large institutions with abundant resources. These results may not apply at institutions with less resources directed to quality improvement efforts. The purpose of this study was to assess the value of a minimalistic enhanced recovery protocol in reducing length of stay (LOS) following PSF for adolescent idiopathic scoliosis. We hypothesized that accelerated transition to oral pain medications and mobilization alone could shorten hospital length of stay in the absence of a formal multimodal pain regimen. Methods: AIS patients aged 10–18 who underwent PSF at a tertiary pediatric hospital …

Cognitive Sparing In Proton Versus Photon Radiotherapy For Pediatric Brain Tumor Is Associated With White Matter Integrity: An Exploratory Study, Lisa E Mash, Lisa S Kahalley, Kimberly P Raghubar, Naomi J Goodrich-Hunsaker, Tracy J Abildskov, Marianne Macleod, Kelley Parsons, Brian Biekman, Nilesh K Desai, David R Grosshans, Arnold C Paulino, Zili D Chu, William E Whitehead, Mehmet Fatih Okcu, Murali Chintagumpala, Elisabeth A Wilde

Faculty, Staff and Student Publications

Radiotherapy for pediatric brain tumors is associated with reduced white matter structural integrity and neurocognitive decline. Superior cognitive outcomes have been reported following proton radiotherapy (PRT) compared to photon radiotherapy (XRT), presumably due to improved sparing of normal brain tissue. This exploratory study examined the relationship between white matter change and late cognitive effects in pediatric brain tumor survivors treated with XRT versus PRT. Pediatric brain tumor survivors treated with XRT (

Risk And Resilient Functioning Of Families Of Children With Cancer During The Covid-19 Pandemic., Renee Gilbert, Carolyn R Bates, Devanshi Khetawat, Meredith Dreyer Gillette, Rachel Moore

Manuscripts, Articles, Book Chapters and Other Papers

Previous literature highlights the impact of COVID-19 on family functioning. Less is known about the impact of the pandemic on families of pediatric cancer patients. In order to determine universal and unique risk and resilience factors of these families during the pandemic, a qualitative analysis was conducted on families currently receiving cancer treatment at a Midwestern hospital. Results of the data analysis depict ways in which these families have been impacted by and have adapted to COVID-19. These findings suggest that families of pediatric cancer patients have unique experiences in the context of COVID-19, in addition to universal experiences outlined …

How Have Researchers Defined Institutions, Politics, Organizations And Governance In Research Related To Epidemic And Pandemic Response? A Scoping Review To Map Current Concepts, Laura Jane Brubacher

Faculty, Staff and Student Publications

In recent years, the literature on public health interventions and health outcomes in the context of epidemic and pandemic response has grown immensely. However, relatively few of these studies have situated their findings within the institutional, political, organizational and governmental (IPOG) context in which interventions and outcomes exist. This conceptual mapping scoping study synthesized the published literature on the impact of IPOG factors on epidemic and pandemic response and critically examined definitions and uses of the terms IPOG in this literature. This research involved a comprehensive search of four databases across the social, health and biomedical sciences as well as …

Performance Of Six Clinical Physiological Scoring Systems In Predicting In-Hospital Mortality In Elderly And Very Elderly Patients With Acute Upper Gastrointestinal Bleeding In Emergency Department, Cheng-Ting Hsiao, Chiao-Hsuan Hsieh, Kai-Hsiang Ku, Kai-Hsiang Wu

Faculty, Staff and Student Publications

Background and Objectives: The aim of this study is to compare the performance of six clinical physiological-based scores, including the pre-endoscopy Rockall score, shock index (SI), age shock index (age SI), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS), in predicting in-hospital mortality in elderly and very elderly patients in the emergency department (ED) with acute upper gastrointestinal bleeding (AUGIB). Materials and Methods: Patients older than 65 years who visited the ED with a clinical diagnosis of AUGIB were enrolled prospectively from July 2016 to July 2021. The six scores were calculated …

Qualification Of Hemophilia Treatment Centers To Enable Multi-Center Studies Of Gene Expression Signatures In Blood Cells From Pediatric Patients, Elizabeth Donnachie, Deborah L Brown

Faculty, Staff and Student Publications

Hemophilia A is a rare congenital bleeding disorder caused by a deficiency of functionally active coagulation factor VIII (FVIII). Most patients with the severe form of the disease require FVIII replacement therapies, which are often associated with the development of neutralizing antibodies against FVIII. Why some patients develop neutralizing antibodies while others do not is not fully understood. Previously, we could demonstrate that the analysis of FVIII-induced gene expression signatures in peripheral blood mononuclear cells (PBMC) obtained from patients exposed to FVIII replacement therapies provides novel insights into underlying immune mechanisms regulating the development of different populations of FVIII-specific antibodies. …

Differences In Clinical Presentation At First Hospitalization And The Impact On Involuntary Admissions Among First-Generation Migrant Groups With Non-Affective Psychotic Disorders, Kelly Anderson, Rebecca Rodrigues

Data and Test Instruments

No abstract provided.

Impact Of In Utero Drug Exposure On Neonates Requiring Ecmo: A Retrospective Cohort Study, Hallie Walther, Aric Schadler, Karen Garlitz, John Anthony Bauer, Lindsay Kohler, Erika Waldsmith, Hubert O. Ballard

UK CARES Faculty Publications

The incidence of in utero drug exposure (IUDE) and neonatal extracorporeal membrane oxygenation (ECMO) utilization have both increased over the past decade. However, there are no studies to date that examine the impact that IUDE has on neonates requiring ECMO. In this retrospective cohort study, we compared the clinic course and outcomes of neonates who were placed on ECMO with IUDE vs. neonates without IUDE. Analysis included data extracted from medical records from all neonatal ECMO runs between January 2014 and January 2021 at the University of Kentucky Children’s Hospital. A total of 56 neonatal patients were placed on ECMO …

Body Mass Index Percentiles Versus Body Composition Assessments: Challenges For Disease Risk Classifications In Children, Jody L. Clasey, Elizabeth Ann Easley, Margaret O'Bryan Murphy, Stefan G. Kiessling, Arnold Stromberg, Aric Schadler, Hong Huang, John A. Bauer

UK CARES Faculty Publications

Background: Identifying at-risk children with optimal specificity and sensitivity to allow for the appropriate intervention strategies to be implemented is crucial to improving the health and well-being of children. We determined relationships of body mass indexes for age and sex percentile (BMI%) classifications to actual body composition using validated and convenient methodologies and compared fat and non-fat mass estimates to normative cut-off reference values to determine guideline reliability. We hypothesized that we would achieve an improved ability to identify at-risk children using simple, non-invasive body composition and index measures.

Methods: Cross-sectional study of a volunteer convenience sample of 1,064 (537 …

If We Know Better, Why Don’T We Do Better? A Qi Project Aimed At Addressing Pain Related To Vaccinations, Haley J. Killian, Amanda D. Deacy, Elizabeth Edmundson, Lucy Raab, Jennifer Verrill Schurman

Posters

Introduction: Evidenced-based tools have long existed to combat pain and anxiety associated with needle sticks, yet the gap between knowledge and uptake persists. Prior to COVID-19, our institution initiated a quality improvement (QI) program to improve comfort measure (CM) uptake, beginning with specific clinical areas with intent to scale up over time. When the COVID-19 vaccine was approved, mass vaccination clinics provided an opportunity to rapidly improve CM uptake across the institution. Methods: Mass vaccination clinics were staffed by nurses from across the hospital. Clinics occurred in 3 waves, based on federal approval for age groups (1: 12y+, 2: 5-11y, …

Injured Proximal Tubules Stain Positivity For Arginase-1 To Indicate Acute Tubular Injury (Ati), Jessica Anderson, Neal Blatt, Olabisi Afolayan-Oloye, Hassan Kanaan, Wei Li, Larysa Wickman, Ping Zhang

Conference Presentation Abstracts

Background: A recent study indicates that arginase-1 participates in M2 macrophage-mediated renal tubular regeneration in a rodent model (Shin et al. JASN 2022). As injured proximal tubule cells have a phagocytotic capacity (stain positively for CD68 and kidney injury moleucule-1 in previous studies), we hypothesized that the injured proximal tubules may stain positively for arginase1. Design: We analyzed PAS-stained renal biopsy sections for evidence of ATI using a semiquantitative scale: 0 (no injury) to 1-2+ (mild to moderate ATI) to 3+ (severe ATI). First group (N=7) consisted of renal biopsies that had no evidence of ATI or were obtained from …

Risk Factors For Seizure Recurrence After Initial Withdrawal Of Anti-Seizure Medications In Children With Epilepsy At Aga Khan University Hospital, Nairobi, Kenya, Nicholas Odero, Katherine Oyieke, Sanson Gwer, Pauline Samia

Paediatrics and Child Health, East Africa

Objectives: We sought to determine risk factors associated with seizure recurrence following initial withdrawal of anti-seizure medications (ASM) among children with epilepsy.

Methods: This was a retrospective observational study of children aged between 2 and 18 years with a diagnosis of epilepsy who underwent withdrawal of anti-seizure medication following remission of seizures. All eligible medical records between January 2011 and December 2019 were included. Demographic, clinical, imaging and electroencephalography data of all eligible patients were analyzed against seizure remission within 24 months after withdrawal of ASM, using appropriate parametric and non-parametric tests.

Results: A total of 49 …

Objective And Self-Report Outcomes Of Intensive Interdisciplinary Pain Treatment For Youth With Chronic Pain With And Without Functional Neurological Disorder, Kelsey Zaugg, Dustin Wallace, Kayla Friesen, Cara M. Hoffart

Posters

Introduction: Intensive interdisciplinary pain treatment (IIPT) is effective for youth with chronic pain (CP). Many from this population also experience functional neurological disorder (FND). Treatment outcomes for patients with CP and FND during and after IIPT have not been thoroughly examined, and studies utilizing objective physical and occupational therapy measures are particularly lacking. Methods: 301 adolescents (M age=15.34 years, 84.4% girls, CP only: 187, CP and FND: 114) participated in individualized physical, occupational, psychological, and other therapies. Self-report (COPM, functioning) and objective (BOT-2, 6-minute-walk) measures were administered pre-IIPT, post-IIPT, 6-months-post, and one-year-post. Results: Overall, there were strong and statistically significant …

A Case Of Hexasomy 15q Due To A Tricentric Supernumerary Chromosome 15, Emily Farrow, Laura A. Cross, Bonnie Sullivan, Keely M. Fitzgerald, Joseph Alaimo, Elena Repnikova, John Herriges, Lei Zhang

Posters

Background: A 7-month-old male with a history of developmental delay, plagiocephaly, hypotonia, chronic cough/congestion was admitted for abnormal movements. Prolonged EEG revealed focal epilepsy and epileptic spasms. Genetic testing revealed a complex structurally rearranged chromosome 15 which contains two inverted duplicated chromosome 15s joined together at one end, resulting in partial hexasomy for 15q. Case presentation: The proband was born to a G2P2 33-year-old mother following an uncomplicated pregnancy at 40 weeks 2 days gestation. At birth he was 6lbs 8oz, 20in long, and APGARs were 3/5/9 at 1/5/10 minutes. At delivery he was limp, pale and had poor tone …

Validation Of The Entrainment Signal Regularity Index And Associations With Children’S Changes In Bmi, Jennette P Moreno, Kevin M Hannay, Amy R Goetz, Olivia Walch, Philip Cheng

Children’s Nutrition Research Center Staff Publications

Objective: This study examined the validity of a novel metric of circadian health, the Entrainment Signal Regularity Index (ESRI), and its relationship to changes in BMI during the school year and summer.

Methods: In a longitudinal observational data set, this study examined the relationship between ESRI score and children's (n = 119, 5- to 8-year-olds) sleep and physical activity levels during the school year and summer, differences in ESRI score during the school year and summer, and the association of ESRI score during the school year and summer with changes in BMI across those time periods.

Results: The ESRI score …

Psychosocial Needs Of Pediatric Patients With Cancer Predisposition Syndromes: Standardized Screening Needed, Meredith Ehrhardt, Mirae Fornander, Rachel Moore

Posters

Introduction Cancer predisposition syndromes (CPS; e.g., Li-Fraumeni syndrome, Von Hippel-Lindau syndrome) require routine, standardized medical monitoring with accompanying unique, complex psychosocial needs (e.g., family medical needs). Despite limited research within pediatric populations, emerging literature has begun to support the benefit of routine psychosocial screening in this population. Very few pediatric CPS clinics with dedicated psychosocial care (i.e., psychology) exist in the U.S. and there is currently no standard of care for psychosocial support of CPS patients. This study aims to better understand the psychosocial needs of pediatric CPS patients and support the need for a standardized psychosocial screening protocol among …

Prevalence Of Iron Deficiency In Patients With Inherited Bleeding Disorders, Thomas Cochran, Brian Lee, Shannon Carpenter

Posters

Background: Synthesis of hemoglobin is one of several important roles iron plays in the human body. Approximately 50% of all anemia cases may be caused by iron deficiency which is frequently caused by chronic blood loss. Patients with bleeding disorders have greater propensity for blood loss and therefore may have a higher prevalence of iron deficiency when compared to the general population. However, few studies have assessed the prevalence of iron deficiency in children with inherited bleeding disorders. Objectives: This study aims to identify the prevalence of iron deficiency in children with an inherited bleeding disorder. Methods: A retrospective analysis …

Hypertension-Inpatient, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Anaphylaxis, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Clinical Practice Guidelines)

No abstract provided.

Bronchiolitis: Oral Feeding For Hospitalized Patients, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.