Pediatrics Commons^™

Characterizing Children With Chronic Kidney Disease And Severe Proteinuria In The United States: A Retrospective Analysis Using Electronic Health Records., Bradley A. Warady, Simone Heeg, Alfredo E. Farjat, Rachel Knapp, Siir Su Saydam, Alexander Vowinkel, Alain Gay, James Potts, Andrea Scalise, Gordana Atanackovic, Sascha Van Boemmel-Wegmann

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: In recent years, real-world data have been increasingly used to enrich data from interventional studies on treatment effectiveness. To explore the viability of hybrid study designs in pediatric chronic kidney disease (CKD), we assessed the feasibility of identifying a real-world cohort of children with CKD and severely increased proteinuria who satisfied adapted eligibility criteria from the FIONA trial.

METHODS: We used data from the Optum® de-identified Electronic Health Record dataset (Optum® EHR) to identify and characterize children with CKD and severely increased proteinuria in records from January 2013 to December 2022. Patients were identified based on two sets of …

Medication Management And Caregiving Stress Or Benefit In Children With Medical Complexity., Casey O'Hare, Nicole Werner, Makenzie Morgen, Sophie Kooiman, James Feinstein, Michelle A. Chui, Gemma Warner, Anna Jolliff, Brittany Storhoff, Kristan Sondegren, Danielle Gerber, Jens Eickhoff, Ryan J. Coller

Manuscripts, Articles, Book Chapters and Other Papers

This study quantified medication management experiences for children with medical complexity and associations with caregiver stress or benefit. Using data from the MedS@HOME trial, involvement of professional caregivers was associated with increased caregiver benefit, and greater network collective efficacy was associated with increased caregiver benefit and decreased caregiver stress.

TRIAL REGISTRATION: ClinicalTrials.gov, ID NCT05816590.

Touch Contamination And Associated Peritonitis In Children Undergoing Maintenance Peritoneal Dialysis., Rebecca G. Same, Natalie K. Grills, Sreejata Dutta, Alicia M. Neu, Bradley A. Warady, Brandy Begin

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Infections are a leading cause of hospitalization and death in children receiving maintenance peritoneal dialysis (PD). Touch contamination is an established risk factor for development of peritonitis, but data regarding optimal management of touch contamination are limited.

METHODS: We conducted a retrospective cohort study using data submitted to the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative between 10/1/2011 and 7/31/2025 to evaluate touch contamination in children. Reported touch contamination events and their management, including administration of prophylactic antibiotics and transfer set changes, were evaluated. Univariate and multivariable generalized linear mixed modeling were used …

Ambulatory Arterial Stiffness Index Among Children And Adolescents With Chronic Kidney Disease: A Report From The Chronic Kidney Disease In Children Study., Susan M. Halbach, Jennifer Roem, Michael F. Schneider, Joshua Samuels, Susan L. Furth, Bradley A. Warady, Joseph T. Flynn, Ckid Study Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: To quantify the association between ambulatory arterial stiffness index (AASI) and hypertensive status, and to identify additional predictors of AASI, including body mass index (BMI), proteinuria, and mineral metabolism, in children and adolescents with chronic kidney disease (CKD).

METHODS: We analyzed data collected from 654 participants during 1283 study visits in the Chronic Kidney Disease in Children (CKiD) prospective cohort study. AASI was calculated from ambulatory blood pressure monitoring (ABPM) data as 1 minus the slope coefficient from a least squares linear regression of diastolic blood pressure (BP) on systolic BP. Hypertensive status was determined by clinic BP and …

Families' Neighborhood Resources Predict Treatment Response For Regulating Together, A Group Therapy For Emotion Dysregulation In Autistic Youth., Walker S. Mckinney Ph.D., Lauren M. Schmitt, Jennifer R. Ruberg, Marika Coffman, Debra Reisinger, Rebecca C. Shaffer

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Autistic youth often face difficulties with emotion dysregulation (ED) and associated challenging behaviors. The Regulating Together (RT) group therapy was developed to treat ED in autistic youth ages 8-18 years and has been shown to be feasible, acceptable, and efficacious at reducing ED. Results from other clinical trials suggest the efficacy of behavioral therapies may vary based on family- or neighborhood-level social determinants of health (SDOH: "the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks"; U.S. Department of Health …

Parent Anxiety And Response To A Telehealth Intervention For Hypoglycemia Fear: Secondary Analysis Of A Randomized Trial., Susana R. Patton, Alexandra Monzon, Nicole Kahhan, Jacob M. Redel, Kimberly Driscoll

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Parents of young children with type 1 diabetes (T1D) frequently report fear of hypoglycemia (FH), which can impact their diabetes management. REDCHiP (Reducing Emotional Distress for Childhood Hypoglycemia in Parents) is a telehealth-delivered cognitive behavioral intervention shown to reduce FH, but less is known about which parents benefit most.

OBJECTIVE: This secondary analysis examined whether pretreatment parent anxiety moderated REDCHiP's effects and explored responder patterns by intervention arm and pretreatment anxiety.

METHODS: This was a secondary analysis of a large, randomized clinical trial comparing REDCHiP to an attention control condition (ATTN). We assessed outcomes before treatment (time 1) and …

Evaluating A Peer Support Program: Impact On Peer Supporters In A Tertiary Care Children’S Hospital, Lauren R. Anderson, Heather Dekeyser, Sonja I. Ziniel, Michele Loi, Emily Muther, Kami Wolfe Schneider, Christine Waasdorp Hurtado, Jo Vogeli, Jennifer Reese

Journal of Wellness

Introduction: Healthcare workers experience emotional distress following poor patient outcomes, which can negatively impact wellbeing and retention. Peer support programs are an evidence-based approach to mitigating distress through provision of confidential counseling by a trained peer. However, data on impact of participation on peer supporters is limited. We aimed to evaluate and describe the peer supporters’ experience at our tertiary children’s hospital.

Methods: A web-based survey was developed with input from key partners. Content was reviewed via cognitive interviews. The survey was administered to 167 trained peer supporters during the spring of 2022. Demographic comparison data were gathered from an …

Use Of Extracorporeal Membrane Oxygenation In Neonates With Congenital Anomalies Of The Kidney And Urinary Tract: A Multicenter Survey Of Current Practices Across Chnc And Pedi-Ecmo Centers., Syed Ahmed, Burhan Mahmood, John M. Daniel Iv, Sandy Johng, Amy Strong, John Ibrahim, June Hu, Kara Short, Kelsey Montgomery, Keri Drake, Kushal Bhakta, Leslie Lusk, Mary Revenis, Pratibha Thakkar, Ruth Seabrook, Samir Pandya, Sarah Keene, Sharada Gowda, Suma Hoffman, Tahagod Mohamed, Tara Beck, Tasnim Najaf, Robert Digeronimo, Natalie Rintoul, Abhishek Makkar

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: This study aimed to characterize practices and decision-making for extracorporeal membrane oxygenation (ECMO) for congenital anomalies of the kidney and urinary tract (CAKUT).

METHODS: General practices (GP) section inquired about institutional practices and barriers, ECMO criteria, and dialysis. The hypothetical cases (HC) illustrated four clinical scenarios with varying degrees of renal severity for ECMO candidacy.

RESULTS: Then, 99 (42 centers) and 91 (38 centers) physicians completed the GP and HC components, respectively. The majority considered ECMO on a case-by-case basis (66%). Bilateral renal agenesis was the most common diagnosis for exclusion (52%). Prenatal markers used for ECMO exclusion included …

Eicosanoids As Biomarkers Of Hyperfiltration-Mediated Injury In Ckd., Tarak Srivastava, Ginger L. Milne, Jianping Zhou, Mohammad H. Rezaiekhaligh, Derek K. Ng, Jennifer L. Roem, Bradley A. Warady, Susan L. Furth, Ram Sharma, Mukut Sharma, Ckid Study Investigators

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Early biomarkers of hyperfiltration-induced injury are not known. We previously reported elevated urinary prostaglandin E2 (PGE₂) preceding albuminuria in children with solitary kidney, and upregulated cyclooxygenase-2 (COX2)-PGE₂-EP2 axis in unilaterally nephrectomized mice. To determine chronic kidney disease (CKD) stage-associated changes in urinary eicosanoids, baseline urine samples from the CKD in children (CKiD) biorepository (n = 318) and a comparator group of children with enuresis (n = 72) were analyzed.

METHODS: Liquid or gas chromatography-mass spectrometry was used to measure metabolites of arachidonic acid and linoleic acid (ng/mg creatinine, P ≤ 0.05).

RESULTS: The …

Life Participation In Parents Of Children With Ckd., Anastasia Hughes, Andrea Matus Gonzalez, Anita Van Zwieten, Chandana Guha, Simon Carter, Germaine Wong, Dale Coghlan, Amanda Dominello, Jonathan C. Craig, Martin Howell, Siah Kim, Karine Manera, Colm O'Reilly, Javier Recabarren Silva, Angela Rejuso, Benedicte Sautenet, Nicole Scholes-Robertson, Amanda Sluiter, Rebecca Wu, Mignon Mcculloch, Natalia Armijo, Ximena Atilano-Carsi, Patricia De La Cerda, Gabriel Alexis Gallardo Letelier, Carla Galvez, Nicole Gonzalez-Agüero, Maria Maldonado, Viola Pinto, Lilian Reyes, Lena Rodriguez, Angelica Rojo, Alejandro Sepúlveda, Luca G. Torrisi, Andrea K. Viecelli, Bashir Admani, Bethany J. Foster, Alexander J. Hamilton, Augustina Jankauskiene, Rebecca J. Johnson, Jasmijn Kerklaan, Isaac Liu, Stephen D. Marks, Cozumel S. Pruette, Franz Schaefer, Sebastian Wolfenden, Allison Jaure, Song-Kids Life Participation Workshop Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The caregiver burden among parents of children with chronic kidney disease (CKD) is high and can impair their life participation, which may in turn have negative consequences on their children's care and outcomes. We aim to describe effects on life participation in parents of children with CKD, from the perspectives of their children, health professionals, and the parents themselves.

METHODS: We thematically analyzed data from the Standardized Outcomes in Nephrology-Children and Adolescents Initiative (SONG-Kids) life participation workshops involving children with childhood CKD, parents or caregivers, and health professionals, for content related to perspectives on life participation among parents of …

Navigation-Assisted Minimally Invasive Direct Pars Repair For Lumbar Spondylolysis., Jack Mangan, Richard M. Schwend, John Anderson, Michael Benvenuti, K Aaron Shaw

Manuscripts, Articles, Book Chapters and Other Papers

Spondylolysis is a common cause of mechanical low back pain in adolescent athletes. While nonoperative management is frequently successful, a subset of patients fail conservative treatment and require surgical intervention. Direct repair of the pars defect offers a motion-preserving alternative to fusion in appropriately selected patients, but traditional open and fluoroscopy-guided minimally invasive techniques are limited by soft-tissue morbidity and variability in screw placement accuracy, and detailed technical descriptions of navigation-assisted approaches remain limited in the literature. We present a detailed, illustrated technique for navigation-assisted minimally invasive direct pars repair, in which a single midline incision accommodates bilateral fixation with …

High-Fidelity Simulation Model For The Posterior Sagittal Anorectoplasty In Anorectal Malformations With Rectovestibular And Rectourethral Fistula., Tobias Jhala, Lukas Bischoff, Ismael Elhalaby, Jonathan Aichner, Jörg Fuchs, Marc A. Levitt, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Surgical training for posterior sagittal anorectoplasty (PSARP) in anorectal malformations is limited by the rarity of the condition and restricted operative exposure. Existing low-cost simulators facilitate learning of procedural steps but lack realistic tissue characteristics and anatomical fidelity.

METHODS: A high-fidelity animal-tissue simulation model was developed using poultry slaughter by-products. The model combines the perineal anatomy of a chicken with a segment of turkey esophagus to recreate multilayer tissue structures and simulate rectovestibular and rectourethral fistulae. Model construction and surgical simulation were designed to reflect the standardized operative steps for PSARP defined by international consensus.

RESULTS: The model reproduces …

Establishment Of A Diabetes-Tailored Data Intelligence Platform Enhances Clinical Care, Enables Risk-Based Monitoring, And Facilitates Population-Health-Based Approaches At A Pediatric Diabetes Network., Brent Lockee, Craig Vandervelden, Daniel R. Tilden, Kelsey Panfil, Erin M. Tallon, Emily Dewit, Katie Noland, David D. Williams, Harpreet Gill, Susana R. Patton, Priya Prahalad, Juan Espinoza, Amey Waghmode, Mitchell Barnes, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Patient-generated health data (PGHD) represents an opportunity to customize care, particularly in type 1 diabetes (T1D) care where continuous glucose monitor (CGM) and insulin pump usage continues to rise. Previous solutions to integrating CGM data into the electronic health record (EHR) have been limited in their ability to integrate data from multiple sources, ensure data fidelity, integrate data from multiple data streams, and rapidly adapt to changes in data output from numerous vendors. We developed a novel data infrastructure contained outside of the EHR to provide an alternative approach to PGHD integration, enable diabetes centers to identify and predict …

Identifying Burnout In Pediatric Clinicians Using Wearable Biometric Data: Development And Feasibility Study., Thomas Ayres, George E. Quaye, Harpreet Gill, Addison M. Pritchett Ms, Catherine Koertje, J Steven Leeder, Brooke L. Fridley, Tiffany Addington

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Addressing the burnout epidemic among health care providers remains one of the foremost challenges of modern health care systems. Past researchers have turned to passively gathered biometric data from wearable devices to identify key variables that predict burnout. However, this has resulted in limited success.

OBJECTIVE: This pilot and feasibility study aimed to test the feasibility and accuracy of developing an Extreme Gradient Boosting machine learning model to classify health care providers as being at higher or lower risk of burnout based on their biometric data.

METHODS: We conducted a 3-month pilot and feasibility study where health care providers …

Incidence And Outcomes Of Human Adenovirus Infection And Disease In A Multicenter Cohort Of Pediatric Allogeneic Hematopoietic Cell Transplant Recipients., Brian T. Fisher, Jesse A. Blumenstock, Craig L K Boge, Sydney Shuster, Alix E. Seif, Michael Green, Marian G. Michaels, Jessie L. Alexander, Monica I. Ardura, Jeffery J. Auletta, Tamara P. Miller, Diego R. Hijano, William J. Muller, Jennifer E. Schuster, Abby M. Green, Daniel E. Dulek, Yun Li, Adriana E. Kajon, Michael Grimley, Lara Danziger-Isakov

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Human adenovirus (HAdV) among pediatric allogeneic hematopoietic cell transplant (allo-HCT) recipients can result in asymptomatic infection with risk for disease progression. There are limited data defining HAdV infection, disease, and case-fatality rates in a HAdV polymerase chain reaction (PCR) surveillance testing era. The current study aimed to define these outcomes using a priori definitions applied by a central review committee.

METHODS: Pediatric allo-HCT recipients were followed up for 180 days after HCT at 10 pediatric institutions. Blood and stool specimens were collected 0-7 days prior to allo-HCT for serum HAdV immunoglobulin G and stool HAdV PCR testing. Clinical data, …

Discover To Deliver Pediatric Futures: Viewpoints Of Future Medicine From A Pediatric Health Care System., Vanessa Watkins, Ken Chang, Laura Sarff, Jared Vavroch, Dawn Wolff, Lori A. Erickson

Manuscripts, Articles, Book Chapters and Other Papers

Pediatric health care systems face increasing uncertainty driven by rapid technological change, workforce shifts and shortages, environmental threats, and evolving family and community needs. Pediatrics requires future-focused considerations that go beyond adult systems, including family-centered care, developmental trajectories, and long-term societal impacts on child well-being. While the future cannot be predicted, futures medicine methods offer structured approaches to anticipate change and support proactive, values-driven planning. This Viewpoint describes the application of pediatric futures methods within an academic, independent nonprofit pediatric health system and proposes a practical framework that connects future readiness to strategic decision-making and daily care delivery. Futures medicine …

Murine Typhus In Georgia: Historical Context And A Probable Case Of Resurgence Where Previously-Thought Eradicated, Giovanni Mella-Velazquez, Christopher He, Bolanle Akinsola, Judson Miller

Journal of the Georgia Public Health Association

Background: Murine typhus, caused by Rickettsia typhi, is a flea-borne illness historically endemic to the southeastern United States, with initial cases reported in Atlanta, Georgia in 1913. Following vector control efforts, incidence declined significantly, and the disease was removed from the nationally notifiable disease list in 1987. While recent cases have been reported in select regions, murine typhus has not been documented in Georgia for decades. We present a pediatric case in Atlanta that may represent the first reported instance in nearly 40 years, suggesting possible reemergence in the Southeast.

Methods: We conducted a case report analysis of a pediatric …

Notch2 Vus Interpretation In Pediatric Cholestasis: A 365-Variant Landscape And Genotype-Phenotype Analysis Of 7 Cases, Brett J. Hoskins, Tiziano Pramparo, Shannon M. Vandriel, Chaowapong Jarasvaraparn, Michael J. Wilsey, Voytek Slowik, Lakshmi Kunam, Janis M. Stoll, Ruben E. Quiros-Tejeira, Simon Lam, Wikrom Karnsakul

Manuscripts, Articles, Book Chapters and Other Papers

Background/Objectives: Interpretation of NOTCH2 variants of uncertain significance (VUSs) remains challenging in pediatric cholestasis and suspected Alagille syndrome (ALGS) due to incomplete penetrance, phenotypic variability, and extensive genetic variation. Although disease-specific variant classification criteria have identified pathogenic hotspots within epidermal growth factor (EGF)-like repeats 8-12 and ankyrin repeat domains 3-6, characterizing these VUSs requires a robust framework. Methods: We reviewed aggregate deidentified data from 519 multigene cholestasis panel entries and evaluated genotype-phenotype data from a consortium cohort of 7 pediatric patients with heterozygous NOTCH2 VUSs using a clinical-genomic prioritization framework informed by disease-specific ACMG criteria and domain location. …

Peritoneal Dialysis Catheter Complications In Neonates With Kidney Failure., Shannon Reinert, Maanasa Yarlagadda, Alexander Bondoc, Donna Claes, Stefanie Riddle, Meredith P. Schuh

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Neonates with kidney failure require placement of a peritoneal dialysis catheter (PD-C) shortly after birth. PD-C malfunction and peritonitis, both common in this population, are associated with PD failure. The aim of this study was to describe our center's PD-C-related practices and outcomes in neonates with kidney failure.

METHODS: We performed a retrospective chart review of neonates who required kidney replacement therapy (KRT) within the first 30 days of life from 01/2018-12/2023. We evaluated for PD-C duration, PD-C replacement or revision, and peritonitis.

RESULTS: Twenty-four neonates had PD-C placed for chronic dialysis at a median of 9.7 days and …

Clinical Presentations, Treatments, And Outcomes Of Pediatric Lupus Nephritis: A Prospective Cohort Study From The Pediatric Nephrology Research Consortium., Melonie Phillips, Mahmoud Kallash, Chloe Tang, Steve Rust, Kia Jubert-Bacon, Scott Wenderfer, Smriti Mohan, Neal Blatt, Don Batisky, Alejandro Quiroga, Tetyana L. Vasylyeva, Nilka Dejesus, Jerome C. Lane

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: There are few prospective studies of mycophenolate mofetil (MMF) versus cyclophosphamide (CYC) for pediatric lupus nephritis (pLN) and none evaluating rituximab (RTX).

METHODS: The Prospective Pediatric Lupus Nephritis Registry (ProPeL-R) enrolled patients <  21 years within 4 weeks of an initial kidney biopsy diagnostic of pLN. Demographic, clinical, and laboratory data were collected prospectively at enrollment, 3 months, 6 months, and then every 6 months thereafter for up to 5 years of follow-up. For this study, we compared patients receiving initial therapy with corticosteroids (CS) and either MMF (n = 33) vs. CYC (n = 18), and those treated with CS, either MMF or CYC, with RTX (n = 20) vs. without RTX (n = 51).

RESULTS: Histology consisted of 18% class III; 35% class IV; 25% mixed class; and 22% pure class V. Eighty-two percent were female. No significant differences in response or infection rates were identified between those receiving MMF or CYC. There was a significant increase in combined complete (CR) and partial response (PR) at 24 months with RTX use. Overall CR rates at 6 and 24 months were 35% …