Pediatrics Commons^™

Metabolic Acidosis And Cardiovascular Disease Risk In Children With Ckd., Denver D. Brown, Jennifer Roem, Kimberly Reidy, Susan Furth, Bradley A. Warady, Michal Melamed, Tammy Brady, Ckid Study Investigators

Manuscripts, Articles, Book Chapters and Other Papers

KEY POINTS: Metabolic acidosis may be associated with adverse cardiovascular disease risk. Prospective studies of the benefit of alkali therapy on cardiovascular disease risk are needed.

BACKGROUND: The link between metabolic acidosis (MA) and cardiovascular disease (CVD) outcomes has been studied in adults but not in children with CKD where MA is a common and early finding. Using longitudinal BP and cardiac measurement data, we evaluated whether low serum bicarbonate (a surrogate for MA) is associated with adverse CVD risk.

METHODS: This study used data from children age 1 year and older with eGFRs between 30 and 90 ml/min per …

Changes In Antiviral Prescribing For Children With Influenza In Us Emergency Departments., Tess Stopczynski, Olla Hamdan, Justin Z. Amarin, James W. Antoon, Laura S. Stewart, Haya Hayek, James Chappell, Andrew J. Spieker, Eileen J. Klein, Janet A. Englund, Geoffrey A. Weinberg, Peter G. Szilagyi, John V. Williams, Marian G. Michaels, Julie A. Boom, Leila C. Sahni, Mary Allen Staat, Elizabeth P. Schlaudecker, Jennifer E. Schuster, Rangaraj Selvarangan, Ayzsa Tannis, Heidi L. Moline, Samantha M. Olson, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Despite national recommendations, antiviral prescribing in emergency departments (EDs) for children at higher risk of severe influenza, such as those younger than 5 years and those with specific underlying conditions, remains low.

OBJECTIVE: To assess whether there were changes in antiviral prescribing for children at higher risk of severe influenza in academic pediatric EDs before the COVID-19 pandemic (2016-2020) vs the late pandemic period (2021-2023).

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, cross-sectional study included influenza-positive children younger than 18 years presenting to the ED at 1 of 7 US pediatric academic hospitals participating in the Centers for Disease Control …

The Home Visiting Referral Quality Improvement Initiative (Thrive) Change Package, Elizabeth Yakes Jimenez, Theresa Cruz, Rebecca Craig, Ivan De La Rosa

Population Health Research and Scholarship

Early childhood home visiting programs improve maternal and child health outcomes but remain underutilized. Healthcare providers are well-positioned to connect families to home visiting services; however, structural barriers in clinical settings limit consistent and effective referral practices. The Home Visiting Referral Quality Improvement Initiative (THRIVE) change package was developed to provide a starting point for addressing these challenges. The THRIVE change package outlines actionable improvement strategies to test, such as standardizing referral workflows, training clinical teams, and establishing relationships and feedback loops with home visiting programs. It offers a scalable approach to strengthening clinical–community linkages and improving family engagement with …

Buprenorphine/Naloxone Therapy For Opioid Withdrawal, Medication-Assisted Treatment, And Pain Management In An Adolescent Patient, Sindhu H. Manjunath, Michael Spickler, Annas Aljassem

Conference Presentation Abstracts

Introduction: Opioid addiction is a chronic disorder centered around craving and compulsive use of prescription or non-medical opioids. The last three decades have seen a dramatic increase in opioid use order (OUD) in the United States, with about 87,000 adolescents in the 12–17 age group estimated to have OUD in 2019. Less than 10% receive medication-assisted treatment (MAT). We present a case of a 17-year-old male who received treatment with buprenorphine-naloxone (Suboxone) for withdrawal management, MAT and acute pain.

Case Description: A 17-year-old-male with a history of anxiety, depression, and attention deficit/hyperactivity disorder (ADHD) presented to the emergency department (ED) …

When To Tap: Complex Febrile Seizure With Atypical Course As Early Presentation Of Hsv-1 Meningoencephalitis, Isabella Comsa, Sindhu H. Manjunath, Elise Gross, Rawad Obeid, Graham Krasan

Conference Presentation Abstracts

Introduction: Febrile seizures have a prevalence of 2-5% among children ages 6-60 months. Less than 1% of complex febrile seizures without meningeal signs are associated with bacterial or viral meningitis. Current literature supports limiting routine lumbar puncture in this population. We present a case of Herpes Simplex Virus (HSV) encephalitis presenting with complex febrile seizure, who progressed to cerebritis requiring decompressive craniectomy, and discuss indications for further diagnostic evaluation.

Case Description: 2-year-old male with a history of simple febrile seizure presenting with a 10 minute tonic-clonic seizure with right-sided gaze deviation. He had tactile fever and low energy at home …

Evolving Management In Pediatric Appendicitis: A 14-Year Review Of Ketorolac, Opioid Use, And Imaging Trends, Sahithi Pemmasani, Ryan T. Davis, Margaret Menoch, Nathan M. Novotny

Conference Presentation Abstracts

Background: Acute appendicitis is a common pediatric emergency requiring timely diagnosis and effective pain management. This study evaluates trends in ketorolac use, opioid prescribing, and imaging modalities in pediatric appendicitis cases, addressing concerns about ketorolac’s role in diagnostic accuracy and opioid reduction.

Methods: A retrospective analysis of 2,294 pediatric emergency department (ED) visits for suspected appendicitis from 2010 to 2023 was conducted. Data included administration of ketorolac, opioids, and non-opioid analgesics, as well as imaging use (ultrasound [US] vs. computed tomography [CT]). Statistical analyses included Pearson correlation and chi-square tests.

Results: Ketorolac use increased significantly from 1.5% in 2010 to …

Toward A Clinically Actionable, Electronic Health Record-Based Machine Learning Model To Forecast 90-Day Change In Hemoglobin A1c In Youth With Type 1 Diabetes: Feasibility And Model Development Study, Erin M. Tallon, David D. Williams, Cintya Schweisberger, Colin Mullaney, Brent Lockee, Diana Ferro, Craig Vandervelden, Mitchell S. Barnes, Angelica Cristello Sarteau, Anna R. Kahkoska, Susana R. Patton, Sanjeev Mehta, Ryan Mcdonough, Marcus Lind, Leonard D'Avolio, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Clinicians currently lack an effective means for identifying youth with type 1 diabetes (T1D) who are at risk for experiencing glycemic deterioration between diabetes clinic visits. As a result, their ability to identify youth who may optimally benefit from targeted interventions designed to address rising glycemic levels is limited. Although electronic health records (EHR)-based risk predictions have been used to forecast health outcomes in T1D, no study has investigated the potential for using EHR data to identify youth with T1D who will experience a clinically significant rise in glycated hemoglobin (HbA1c) ≥0.3% (approximately 3 mmol/mol) between diabetes clinic visits. …

Associations Between Adhering To 24-Hour Movement Guidelines And Anxiety Among Adolescents Across Intersectional Identities: Kyrbs 2020-2022., Suryeon Ryu, Eun Young Lee, Zan Gao

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Identifying preventive measures for adolescent mental health is a global public health priority, as poor mental health heightens the risk of early death from related issues, including suicide. This study examined the associations between adherence to the 24-Hour Movement Guidelines and anxiety among a nationally representative sample of South Korean adolescents, using an intersectional identity framework.

METHODS: Data from the 2020-2022 Korea Youth Risk Behavior Surveys were analyzed. Adolescents aged 12-17 years were grouped based on adherence to guidelines: none, physical activity (PA), sedentary behavior (SB), sleep, two guideline combinations, and all three. Anxiety was the mental health outcome. …

Fetal Congenital Complete Heart Block: 2 Success Stories Through Multidisciplinary Care., Mohamed Aashiq Abdul Ghayum, Jenna Schermerhorn, Hayley S. Hancock, Lindsey Malloy-Walton, Steven Olsen, Laura Vricella, Kelsey Brattrud, Melanie Kathol, Rita France, Maria Kiaffas

Manuscripts, Articles, Book Chapters and Other Papers

Congenital complete heart block (CCHB) is a rare condition associated with significant fetal and neonatal mortality. It may present as an isolated conduction abnormality in association with autoimmune disease, or in conjunction with congenital heart defects including heterotaxy-polysplenia syndrome. Early prenatal diagnosis and coordinated perinatal care are critical for improving outcomes. We present 2 cases of prenatally diagnosed CCHB. The first occurred in a fetus with heterotaxy-polysplenia syndrome, and the second in the setting of maternal anti-SSA antibody exposure. Both fetuses developed progressive bradycardia, with heart rates declining to < 50 beats/min, necessitating close fetal surveillance and individualized perinatal management. Preterm delivery and prompt placement of temporary pacing wires allowed initial stabilization before eventual definitive management, resulting in survival. The successful outcomes in these neonates highlight the critical role of multidisciplinary prenatal care, timely delivery planning, and early postnatal intervention in improving survival in fetuses diagnosed with CCHB.

Pediatric Sickle Cell Disease Overview And Treatment, Michael Smith, Shabnam Arsiwala

Pediatrics in Practice: A CME Podcast

In this episode, we sit down with Dr. Shabnam Arsiwala, a leading pediatric specialist in sickle cell disease, to explore the essentials of caring for children living with this complex condition. Dr. Arsiwala shares insights on early diagnosis, routine management and the role of hydroxyurea in treatment. We also discuss common complications, psychosocial support for families, and exciting innovations on the horizon. Whether you're a general pediatrician or a specialist, this conversation offers practical guidance and fresh perspectives to enhance your clinical care.

Click here to stream the podcast episode.

Improving Outcomes In Pediatric Congenital Heart Disease: The Integration Of Wearable Technology And Ai-Driven Analysis, Sophia Moon, Melissa Cruz, Pad Renga

Research Colloquium

Background: Wearable devices such as biosensors and smartwatches have demonstrated clinical utility in arrhythmia detection in adult populations, but their integration into pediatric congenital heart disease (CHD) care remains limited. Despite advances in CHD management, challenges persist in the timely identification of arrhythmias in children. The use of wearables in pediatrics is constrained by research gaps, adherence issues, and complex data interpretation. Traditional tools like Holter monitors and event recorders face limitations in detecting intermittent arrhythmias and ensuring compliance. These devices cannot leverage artificial intelligence (AI) and machine learning (ML) to enhance ECG interpretation. This study analysis evaluates the potential …

Giving More Than Vision: The Evolution And Impact Of Give Kids Sight Day, Leah Prischak, Bs

inSIGHT

Current literature strongly suggests that quality of life is diminished in children with visual impairments.¹ In many situations, visual impairment (VI) can be a serious barrier in obtaining the typical experiences and accomplishments of childhood. Evidence suggests an association between visual acuity, refractive error, and child academic performance.² VI is also associated with the prevalence of more intangible, psychological obstacles in areas such as independence and autonomy, concerns about the future, social relationships, participation, and acceptance.³

Educational Services And Language Congruency In Low-Income Children Who Are Deaf Of Hard-Of-Hearing, Courtney J. Austin, Dylan Chan, Jihyun Stephans

Research Colloquium

Background: Children who are deaf or hard-of-hearing (DHH) are required by United States law to have access to educational services through the Individuals with Disabilities in Education Act (IDEA). However, access to language-congruent providers, as well as supplemental services, varies considerably. Household income is associated with poorer hearing care access and outcomes in DHH children. We predict that access to supplemental, language-congruent DHH services is poorer in DHH children from lower-income homes.

Methods: This is a secondary, ad hoc exploratory study of DHH children aged 0-27 months enrolled in a randomized clinical trial (CT.gov: NCT04928209). Children were enrolled across all …

Salvage Therapies For First Relapse Of Shh Medulloblastoma In Early Childhood., Craig Erker, Martin Mynarek, Marie Simbozel, Brandon T. Craig, Virginia L. Harrod, Andrea M. Cappellano, Kenneth J. Cohen, Vicente Santa-Maria Lopez, Andres Morales La Madrid, Chantel Cacciotti, Lorena Baroni, Ralph Salloum, Ashley S. Margol, George Michaiel, Dolly Aguilera, Claire M. Mazewski, Cassie N. Kline, Jonathan L. Finlay, Mohamed S. Abdelbaki, Jeffrey C. Murray, Kathleen Dorris, Bruce Crooks, Kevin Ginn, Nisreen Amayiri, Stephan Tippelt, Gudrun Fleischhack, Svenja Tonn, Nicolas U. Gerber, Alvaro Lassaletta, Jordan R. Hansford, Sara Khan, Stephen W. Gilheeney, Lindsey M. Hoffman, Michal Zapotocky, Valérie Larouche, Shafqat Shah, Vijay Ramaswamy, Amar Gajjar, Sébastien Perreault, Sabine Mueller, Juliette Hukin, Sylvia Cheng, Zhihong J. Wang, Kara Matheson, Simon Bailey, Eric Bouffet, Steven C. Clifford, Giles Robinson, Christelle Dufour, Stefan Rutkowski, Lucie Lafay-Cousin

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Sonic hedgehog (SHH) medulloblastoma is the most common molecular group of infant and early childhood medulloblastoma (iMB) and has no standard of care at relapse. This work aimed to evaluate the post-relapse survival (PRS) and explore prognostic factors of patients with nodular desmoplastic (ND) and/or SHH iMB.

METHODS: This international retrospective study included 147 subjects diagnosed with relapsed ND/SHH iMB between 1995 and 2017, < 6 years old at original diagnosis, and treated without initial craniospinal irradiation (CSI). Univariable and multivariable Cox models with propensity score analyses were used to assess PRS for those in the curative intent cohort.

RESULTS: The 3-year PRS was 61.6% (95% confidence interval [CI], 52.2-69.6). The median age at relapse was 3.4 years (interquartile range [IQR], 2.6-4.1). Those with local relapse (40.8%) more often received salvage treatment with surgery …

Antiviral Use Among Children Hospitalized With Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study., James W. Antoon, Justin Z. Amarin, Olla Hamdan, Tess Stopczynski, Laura S. Stewart, Marian G. Michaels, John V. Williams, Eileen J. Klein, Janet A. Englund, Geoffrey A. Weinberg, Peter G. Szilagyi, Jennifer E. Schuster, Rangaraj Selvarangan, Christopher J. Harrison, Julie A. Boom, Leila C. Sahni, Flor M. Muñoz, Mary Allen Staat, Elizabeth P. Schlaudecker, James D. Chappell, Benjamin R. Clopper, Heidi L. Moline, Angela P. Campbell, Andrew J. Spieker, Samantha M. Olson, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children.

METHODS: We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31 March 2020 at 7 pediatric medical centers in the New Vaccine Surveillance Network. The cohort consisted of children hospitalized with influenza A or B confirmed by clinical or research testing. The primary outcome was frequency of antiviral receipt during hospitalization. We used logistic regression to obtain adjusted …

Clinical Testing For Covid-19, Influenza, And Rsv In Hospitalized Youths, 2016-2024., Ariana P. Toepfer, Rachel E. Rutkowski, Leila C. Sahni, Geoffrey A. Weinberg, Marian G. Michaels, Rangaraj Selvarangan, Mary Allen Staat, Natasha Halasa, Janet A. Englund, Julie A. Boom, Peter G. Szilagyi, Jennifer E. Schuster, Elizabeth P P. Schlaudecker, Laura S. Stewart, Eileen J. Klein, Samantha M. Olson, Sascha Ellington, Meredith L. Mcmorrow, Heidi L. Moline, Fatimah S. Dawood, New Vaccine Surveillance Network Collaborators

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Studies of COVID-19, influenza, and respiratory syncytial virus (RSV) disease clinical epidemiology, disease burden, and vaccine effectiveness often rely on clinical testing to identify cases, particularly with increasing use of electronic health record data. However, few data are available describing clinical testing practices to inform interpretation of these studies.

OBJECTIVE: To characterize clinical testing frequency for SARS-CoV-2, influenza, and RSV among children and adolescents hospitalized with acute respiratory illness during the 2016 to 2024 respiratory illness seasons by age, intensive care unit admission, and time period (2016-2020 and each season in 2020-2024); estimate the case fraction missed by clinical …

High-Frequency And Conventional Ventilation In Very Low Birth Weight Neonates During Interfacility Transport, Trevor Cabrera, Janelle R. Noel-Macdonnell, Emily Mcnellis

Posters

Background: Very low birth weight (VLBW) neonates (≤1500 grams) transported across neonatal facilities often require advanced respiratory support, including high-frequency ventilation (HFV). While HFV use in this setting has increased, data evaluating its safety and efficacy in the VLBW population remain limited. We hypothesized that HFV will provide a safe modality to transport sick VLBW infants. Objectives: To present a comparative experience of safety and efficacy of HFV and CV in VLBW neonates during interfacility transport. Methods: We retrospectively reviewed neonates ≤1500g who received invasive ventilation during interfacility transport by our transport team between January 2019 and December 2022. HFV …

Discontinuous Or Attenuated Background, Absent Sleep Architecture, Absent Reactivity, And Presence Of Subclinical Seizures On Continuous Electroencephalography Are Associated With Unfavorable Short-Term Outcome Following Pediatric Severe Traumatic Brain Injury​, Xuexin Lu, Ara Hall, Yong Y. Han, Madeline Burdick, Avner Moeded, Isabella Boedefeld, Christian Kaufman, Jessica S. Wallisch

Presentations

BACKGROUND/PURPOSE: Accurate prognostication following pediatric severe traumatic brain injury (sTBI) remains challenging. Adult neuroprognostication guidelines recommend the use of prediction models that have not yet been validated in pediatric patients. We hypothesized certain continuous electroencephalography (cEEG) characteristics would be associated with unfavorable short-term outcome. METHODS: This was an IRB-approved, 7-year retrospective cohort study of children aged 1.5-18 years admitted to our PICU from 01/2018-12/2024 with sTBI and receiving cEEG monitoring per institutional standard management protocol. cEEG patterns (background, sleep architecture, reactivity, and electrographic seizure) during the first 12-hours of monitoring were analyzed for association with unfavorable short-term outcome at PICU …

Severe Thiopurine-Induced Myelosuppression In A Pediatric All Patient With The Nudt15 *1/*6 Genotype, Jillian Fry, Keith August, Terrie Flatt Do, Laura B. Ramsey

Posters

Introduction: Genetic variants in TPMT and NUDT15 that affect the metabolism of mercaptopurine (6MP) are routinely tested for to guide 6MP dosing. Nudix hydroxylase 15 (NUDT15) deficiency can cause myelosuppression when affected patients are treated with 6MP. The NUDT15 *6 allele is classified as having uncertain function by the Clinical Pharmacogenetics Implementation Consortium Guidelines given insufficient data to determine its phenotype. Here, we present the case of a pediatric patient with the NUDT15 *1/*6 genotype experiencing significant mercaptopurine-induced myelosuppression. Case Description: We present a 4-year-old female with standard risk-average precursor B-cell acute lymphoblastic leukemia treated per AALL1731. Exome sequencing reported …

A Novel “Stairstep” Approach To The Management Of Extreme Hypernatremia Using Continuous Kidney Replacement Therapy And Hypertonic Saline, Bahar Barani, Xuexin Lu, Darcy Weidemann, Judith Vansickle, Vimal Chadha, Nathan Beins

Posters

Hypernatremia is defined as a serum sodium greater than 145 mEq/L and is due to either a deficit of free water or excess sodium intake. Extreme hypernatremia (sodium level > 190 mEq/L) is immediately life–threatening with mortality rates > 60%. It is especially challenging to avoid complications, such as permanent neurological injury, respiratory failure, and profound electrolyte derangement, when children are in kidney failure. Established guidelines are lacking for correcting such extreme levels due to a paucity of information in the literature, although general recommendations are to decrease levels by no more than 10-12 mEq/L per day to prevent neurological complications. We …