Pediatrics Commons^™

Reduced Vns Settings Paradoxically Decreases Seizure Burden In A Patient Following Resolution Of Sleep Disordered Breathing, Austin Sponaugle, Rebecca Stainman, Christopher M. Carosella

Abington Jefferson Health Papers

Vagus nerve stimulation (VNS) can be a highly effective treatment option for patients with drug resistant epilepsy. Notably, VNS has demonstrated side effects including a unique form of sleep disordered breathing known as vagus nerve stimulator associated sleep disordered breathing (VaS). However, the ways in which VaS interacts with seizure frequency is unknown. We report a case of a 28-year-old woman who presented to our department with complaints of worsening sleep quality 3 years following VNS implantation. Upon polysomnographic (PSG) evaluation, it was discovered that she suffered from VaS. The patient’s VNS output current was then down titrated during a …

A Multi-Modal Intervention To Improve Identification, Management, And Prevention Of Early Childhood Caries In The Primary Care Setting, Rieley M. Hull

Evidence-Based Practice Project Reports

Early childhood caries (ECC) is the most prevalent chronic childhood disease and, if untreated, can lead to significant long-term health and social consequences, posing a substantial healthcare burden (AAPD, 2023; ADA, 2023; USPSTF, 2021; WHO, 2022). This evidence-based practice (EBP) project aimed to implement a multi-modal intervention to reduce ECC risk factors, prevent new dental caries, and halt the progression of existing dental caries. Conducted in a pediatric primary care setting in West Michigan, the project included patients five and under who received an oral examination and dental caries risk assessment following the AAP’s guidelines. Based on their oral health …

A Single Center Qualitative Study To Improve Coordination Of Follow-Up Care For Patients Diagnosed With Abusive Head Trauma, Ruairi Smith-Dewey, Elise Wright, Daniella Donofrio, Hannah Goebel, Sara Kilbride

Posters

Introduction: Children diagnosed with abusive head trauma (AHT) have subsequent long-term developmental, behavioral, and medical consequences resulting in increased medical system utilization. There were 16 overall potential needs identified, with a single patient having 12. In 2023 at Children’s Mercy Hospital (CMH), 47% (8/17) of patients with AHT had < 50% of follow-up needs addressed at time of discharge. None had 100% of follow-up needs addressed. Needs not being addressed included need not identified or written documentation for need of follow-up without subsequent referral placed/appointment scheduled. Project goal was all follow-up needs to be addressed for at least 50% of children with AHT by January 2025. Methods (include PDSA cycles): Children admitted to CMH from January 2024-December 2024 and diagnosed with AHT by the Safety, Care & Nurturing (SCAN) team were included. Interventions were designed and implemented by a multidisciplinary team to address barriers including variation in scheduling process per specialty, lack of knowledge, and changing caregivers. • PDSA 1 (1/1/24): SCAN added standardized list of potential follow-up needs to documentation. • PDSA 2 (2/1/24): Trauma NP placed ophthalmology outpatient referrals. • PDSA 3 (3/1/24) Social work placed and documented early intervention referrals. Transitioned to SCAN RN responsibility. • PDSA 4 (4/10/24): AHT caregiver handouts with description of all potential follow-up needs added to discharge instructions. • PDSA 5 (12/11/24): AHT Evidence Based Practice guideline created including follow-up needs. Appointments and referrals were tracked by the author. QI tools used included fault tree, fishbone, and PICK Chart. Results: In 2024, 27 children were diagnosed with AHT by SCAN team at CMH. Five children were excluded from the study as 3 died and 2 were transferred to another hospital. The number of patients with < 50% of follow-up needs addressed was reduced from 47% to 43%. All follow-up needs were addressed in 13% (3/23) of patients. Conclusions: While project aims weren’t met, there was progress. Next steps include educating all discharging teams at CMH as there is no single team discharging these patients. Overall, there are few of these patients so standardization of discharge practices is challenging. SCAN created a working group and point person for appointment tracking to ensure follow-up needs established at discharge.

Analysis Of Myositis Development In Adults And Children With Inflammatory Bowel Disease, Yu Rim Park, Jamal Kriem

Conference Presentation Abstracts

Background/Objective Inflammatory bowel disease (IBD) is an autoimmune disorder that can present with a wide range of clinical manifestations spanning multiple organ systems. Myositis in patients diagnosed with IBD is an uncommon presentation, and the pathophysiology in this population is not well studied. Given the lack of research surrounding the natural history of myositis in IBD patients, we decided to investigate the demographics and medication use that may potentially serve as predictors of symptom development. We hypothesized increased rates of myositis development in patients on TNF-alpha inhibitors given anecdotal evidence in clinical practice and literature review of several clinical vignettes …

A Multimodal Intervention To Improve Treatment And Clinical Outcomes In Children With Recurrent Otitis Media, Daniel Courtaney

Evidence-Based Practice Project Reports

Acute otitis media is the number one cause for primary health care visits and antibiotic prescriptions in the pediatric population (El Feghaly & Jackson, 2023). Upwards of 27% of children experience multiple episodes of otitis media (OM) that meet recurrent otitis media (ROM) diagnosis criteria (Pelton & Marchisio, 2023). Guided by the Iowa Model (Iowa Model Collaborative, 2017), the project’s purpose was to implement a multimodal intervention to decrease recurrent OM and repeat clinic visits. A comprehensive literature search of 5 databases yielded 16 sources ranging from levels I-IV (Melnyk & Fineout-Overholt, 2023). Using the AGREE II and JBI Critical …

Physical Activity Programming To Improve Qol In Pediatric Ibd Patients, George Russell, Anya K. Cutler, Anna Furr, Julia Fritz, Kevin Sztam, Birgitta Polson, Rebecca Edwards, Noah Hoffman

Costas T. Lambrew Research Retreat 2025

Discussion: This work contributes to limited literature supporting the positive impact of PA in a target population and provides novel guidelines to implement an accessible PA program proven to be effective and well-liked by patients & families. Findings support incorporation of PA into the holistic care of pediatric patients with IBD.

Mental Health Conditions Among Patients With A Disorder Of The Gut-Brain Interaction, Ambia Ahmed, Nicole Smith, Anya Cutler, Mariaelena Terzis, Laura J. Faherty, Julia Fritz

Costas T. Lambrew Research Retreat 2025

Two thirds of pediatric patients with disorders of the gut-brain interaction have mental health comorbidity.

Laying The Groundwork: Implementing The 2021 Aap Well Appearing Febrile Infant Clinical Practice Guideline Across A Rural Health System, E Freeman, L Mallory, Lm Seften, T Palnitkar, A Cutler, J Gregory, M Jackson

Costas T. Lambrew Research Retreat 2025

The American Academy of Pediatrics (AAP) published their first-ever Clinical Practice Guideline (CPG) on the management of well-appearing febrile infants aged 8-60 days in 2021. A system specific CPG and order set for the management of well-appearing febrile infants has been published across MaineHealth (MH) to align with the AAP.

Test-Retest Agreement And Reliability Of Psychosis And Mental Health Screens For Maine Adolescents And Young Adults In Primary Care, Erika Mayer, Eb Bernier, Merelise Ametti, Julia Plumb, Adriana Lovric, Yaerin Wallenberger, Kristen Woodberry

Costas T. Lambrew Research Retreat 2025

Psychotic spectrum disorders are among the most severe mental health conditions. Although early intervention can lead to significantly improved outcomes, minimizing delays in the identification of psychotic spectrum symptoms (PSS) remains challenging.

Implementation And Evaluation Of A Resident Pediatric Complex Care Education Series, Calivin Schaffer, Danielle Doctor, Amy Buczkowski, Bonnie Lynne Boomsma, Logan Murray

Costas T. Lambrew Research Retreat 2025

Children with medical complexity have significant chronic health problems that affect multiple organ systems and result in functional limitations, high health care need or utilization, and often dependence on medical technology. Addressing their needs requires optimizing care within the medical home and medical neighborhood.

A Quality Improvement Project To Reduce Variation In Pediatric Asthma Care Using The Hospital Asthma Severity Scoring (Hass) Tool, Sean Patterson, Leah-Marie Seften, Rachel Williams, Noah Diminick, Anne Coates, Laura Amar-Dolan

Costas T. Lambrew Research Retreat 2025

The aim of this project was to increase HASS score use to greater than 50%within one year and determine the impact of our interventions on the quality of asthma care and patient outcomes.

Pediatric Asthma Subspecialty Referral Practices In Rural Maine, Paras Patnaik, John Dipalazzo, James Bohnhoff

Costas T. Lambrew Research Retreat 2025

Over 7.2 million children in the United States have asthma.

• >300,000 asthma-related ED visits & hospitalizations yearly
• Both PCP’s and pediatric asthma subspecialists (allergist/immunologists and pediatric pulmonologists) provide long-term asthma care

Overcoming Specialty Care Connection Barriers: The Econsult Effect, Genevieve Whiting, Noah Hoffman, Anya K. Cutler, Leah M. Seften, Laura J. Faherty

Costas T. Lambrew Research Retreat 2025

Pediatric patients are 2.6x more likely to attend a new specialist visit after Specialist affirms referral need via eConsult.

Pilot Study Of Serial Telemedicine Assessments To Safely Exclude Neonates From Therapeutic Hypothermia Treatment, Alexa Craig, Anya K. Cutler

Costas T. Lambrew Research Retreat 2025

Two neonatal encephalopathy exams performed by telemedicine, with scores of less than 4, correctly excluded neonates from treatment with therapeutic hypothermia.

Physical Activity Programming To Improve Qol In Pediatric Ibd Patients, Anna Briley, George Russell, Anya K. Cutler, Anna Furr, Julia Fritz, Kevin Sztam, Birgitta Polson, Rebecca Edwards, Noah Hoffman

Costas T. Lambrew Research Retreat 2025

Discussion: This work contributes to limited literature supporting the positive impact of PA in a target population and provides novel guidelines to implement an accessible PA program proven to be effective and well-liked by patients & families. Findings support incorporation of PA into the holistic care of pediatric patients with IBD.

Crispr/Ncas9-Edited Cd34+ Cells Rescue Mucopolysaccharidosis Iva Fibroblasts Phenotype, Angélica María Herreno-Pachón, Andrés Felipe Leal, Shaukat Khan, Carlos Javier Alméciga-Díaz, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Mucopolysaccharidosis (MPS) IVA is a bone-affecting lysosomal storage disease (LSD) caused by impaired degradation of the glycosaminoglycans (GAGs) keratan sulfate (KS) and chondroitin 6-sulfate (C6S) due to deficient N-acetylgalactosamine-6-sulfatase (GALNS) enzyme activity. Previously, we successfully developed and validated a CRISPR/nCas9-based gene therapy (GT) to insert an expression cassette at the AAVS1 and ROSA26 loci in human MPS IVA fibroblasts and MPS IVA mice, respectively. In this study, we have extended our approach to evaluate the effectiveness of our CRISPR/nCas9-based GT in editing human CD34+ cells to mediate cross-correction of MPS IVA fibroblasts. CD34+ cells were electroporated with the CRISPR/nCas9 system, …

Smoking Cessation Education In Caregivers Of Pediatric Patients Hospitalized With Asthma Exacerbation, Maya Emptage, Kaitlynn Lineberry, Suzanne Kayali, Bobby Bellflower Dnsc, Nnp-Bc, Faanp, Michelle Rickard Dnp, Pnpac-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Pediatric asthma is rising globally, currently affecting over 300 million individuals and projected to reach 400 million by 2025. This scoping review aims to summarize existing evidence on the impact of providing smoking education to caregivers during hospitalization on reducing pediatric asthma exacerbations, with the goal of encouraging further research.

Methods

The search spanned from August 2022 to November 2024, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria focused on studies involving human participants and caregivers of children receiving smoking cessation education in relation to asthma exacerbation and hospital admission. Databases searched included …

In-Person And Virtual Adaptation Of An Interprofessional Palliative Care Communications Skills Training Course For Pediatric Oncology Clinicians, Karen Moody, Clark R. Andersen, Robert M. Arnold, Julie Bradley, Allie Carter, Lauren Draper, Timothy Garrington, Jonathan B. Gill, Douglas J. Harrison, Masanori Hayashi, Amy Heaton, Cynthia Holladay, Alex Lion, Alakh Rajan, Beatriz N. Rozo, Daniel V. Runco, Shermini Saini, Laura K. Salvador, Kathryn Sutton, Verna Ferguson

Advances in Cancer Education and Quality Improvement

Introduction

Empathic communication is crucial for clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Training was provided using an in-person format and then adapted to a virtual platform to accommodate remote learners.

Methods

Clinicians were trained in dyads (one physician and one nurse [RN] or advanced practice provider [APP]) over 3 days (in-person or virtually). Four pediatric oncology cases were …

Association Of Delayed Asthma Diagnosis With Asthma Exacerbations In Children, Chung-Il Wi, Euijung Ryu, Katherine S King, Jung Hyun Kwon, Joshua T Bublitz, Miguel Park, Sergio E Chiarella, Jason D Greenwood, Thanai Pongdee, Lynnea Myers, Björn Nordlund, Sunghwan Sohn, Elham Sagheb, Bhavani Singh Agnikula Kshatriya, Dave Watson, Hongfang Liu, Beverley J Sheares, Carla M Davis, Wade Schulz, Young J Juhn

Faculty, Staff and Student Publications

Background: There is a significant delay between symptom onset and diagnosis of childhood asthma, but the impact of this delay on asthma outcomes has not been well understood.

Objectives: We sought to study the association of delayed diagnosis of asthma with asthma exacerbations (AEs) in children.

Methods: Using the Mayo Clinic birth cohort, we identified children with a diagnosis of asthma from electronic health records. We defined onset date as the date when subjects first met predetermined asthma criteria ascertained by an electronic health records-based natural language processing algorithm. Delay in diagnosis (DD) was defined as first diagnosis >30 days …

Socio-Medical Factors Associated With Neurodevelopmental Disorders On The Kenyan Coast, Patricia Kipkemoi, Jeanne E. Savage, Joseph Gona, Kenneth Rimba, Martha Kombe, Paul Mwangi, Collins Kipkoech, Beatrice Mkubwa, Amina Abubakar, Charles Newton

Institute for Human Development, East Africa

Neurodevelopmental disorders (NDDs) are a group of conditions with their onset during the early developmental period and include conditions such as autism and intellectual disability. Occurrence of NDDs is thought to be determined by both genetic and environmental factors, but data on the role of environmental factors for NDD in Africa is limited. This study investigates environmental influences on NDDs in children from Kenya. This case-control study compared children with NDDs and typically developing children from two studies on the Kenyan coast. We included 172 study participants from the Kilifi Autism study and 151 from the NeuroDev study who had …