Pediatrics Commons^™

But, It's Just A Uti, Gillian Long

Posters

IgA Vasculitis is a commonly seen presentation in the pediatric population. The constellation of symptoms typically includes purpuric rash, joint pain, abdominal pain and hematuria. This 12 year old female was seen by her pediatrician for rash on her legs, shortness of breath, cough and night sweats that all started around 2 months ago. Additionally, a 25 pound weight loss was noted over the past year. The rash appeared as nonblanching purpura on her lower extremities, lending suspicion to IgA Vasculitis. She was first treated for UTI with cefuroxime, and then treated with steroids. Urinalysis showed persistent hematuria and she …

Postnatal Growth Of Etiologically Characterized Preterm Newborns According To Gestational Age At Birth, Paola Roggero, Irina Ryumina, Robert Gunier, Adele Winsey, Stephen Rauch, Irma Alejandra Coronado Zarco, Shabina Ariff, Maria Albertina Rego, Constanza Soto Conti, R. Ochieng

Obstetrics and Gynaecology, East Africa

Objective: To examine the relationship between etiologically-based preterm birth sub-groups and early postnatal growth according to gestational age at birth.

Methods: Prospective, multinational, cohort study involving 15 hospitals that monitored preterm newborns to hospital discharge. Measures/exposures: maternal demographics; etiologically-based preterm birth sub-groups; very, moderate and late preterm categories, and feeding. Primary outcomes: serial anthropometric measures expressed as z-scores of the INTERGROWTH-21st preterm postnatal growth standards.

Results: We included 2320 singletons and 1180 twins: very=24.4% (n = 856, including 178 < 28 weeks’ gestation); moderate=16.9% (n = 592) and late preterm=58.6% (n = 2052). The median (interquartile range) postmenstrual age at the last measure was 37 (36–38) weeks. The ‘no main condition’ sub-group percentage increased from early to late preterm; the ‘perinatal sepsis’ sub-group percentage decreased. ‘Perinatal sepsis’, ‘suspected IUGR’ and ‘fetal distress’ very and late preterm infants had lower postnatal growth patterns than the ‘no main condition’ reference sub-group. This pattern persisted in late but not very preterm infants when postnatal growth was corrected for weight z-score at birth.

Conclusion: The proportional contribution of etiologically-based preterm sub-groups and their postnatal growth trajectories vary by preterm category. Postnatal growth is partially …

Analyzing Llama 3-Based Approach For Axiom Translation From Ontologies, Xubing Hao, Licong Cui, Cui Tao, Kirk Roberts, Muhammad Amith

Faculty, Staff and Student Publications

Ontology development involves a top-down approach where ontology engineers and domain experts collaboratively define and evaluate ontological elements and axioms. Translating ontology axioms into natural language can significantly aid in ontology evaluation by making the content more understandable to subject matter experts who may lack a background in knowledge engineering. In this preliminary study, we investigate the potential of large language models (LLMs) in axiom translation from ontologies to facilitate ontology evaluation. We utilize Llama 3 to translate 1,192 ontology axioms across 19 distinct axiom types from five published ontologies. Results show that 163 (13.67%) of the Llama 3 translation …

Malignant Transformation And Tumour Recurrence In Sacrococcygeal Teratoma: A Global, Retrospective Cohort Study., Lieke J. Van Heurn, Joep P M Derikx, Nigel Hall, Jennifer H. Aldrink, Maria M. Bailez, Lohfa B. Chirdan, Shigehisa Fumino, Afua Hesse, Tuktu Soyer, Shawn D. St Peter, Jos Twisk, Tianyou Yang, Ernst L W Van Heurn, Sct-Study Consortium

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Sacrococcygeal teratoma (SCT) is a rare congenital tumour. The risk of malignancy and recurrence are not well defined. Previous studies are small and report differing conclusions about the timing of surgery and the duration of follow-up. We studied the risk of malignant transformation and SCT recurrence after surgery to address these gaps.

METHODS: This was a global retrospective cohort study. Data of consecutive SCT patients was obtained from 145 institutes in 62 countries. Malignant transformation, defined as malignancy at initial resection, malignant recurrence or death due to malignancy, and its risk factors were analysed.

RESULTS: Of the 3612 included …

Addressing Weight Bias Among Pediatric Healthcare Clinical Staff., Kathyrn Kyler, Codi Cutburth, Gayla Goleman, Sarah Hampl, Amy R. Beck

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children with obesity may experience weight-based discrimination as a result of weight bias and stigma, which can have deleterious effects on their health and wellbeing, including increased risk of dysregulated, maladaptive, and disordered eating such as restriction, purging, and binging. Prior work has shown that weight bias occurs from healthcare workers caring for adults, but less is known about the prevalence of weight bias in the pediatric healthcare setting.

METHODS: We aimed to determine what proportion of pediatric healthcare professionals had attitudes of weight bias at our own institution by constructing a survey with questions from validated weight bias …

Social Determinants Of Health Curriculum For The Pediatric Clerkship, Caroline Roth, Amy Prudhomme, Kayla Griese, Robbie Beyl, Jessica Patrick-Esteve

School of Medicine Faculty Publications

Introduction: Education on social determinants of health (SDH) aligns with national standards for medical education. However, there are minimal existing resources targeted to medical students specific to the care of the pediatric population. We designed a case-based curriculum on SDH for third-year medical students on their pediatric clerkship to address this deficit. Methods: Third-year medical students on their pediatric clerkship received a case-based flipped classroom educational series on SDH in four 10-minute segments. Students completed voluntary and anonymous surveys delivered via an electronic survey tool before and after completion of the curriculum. Surveys were a self-assessment of knowledge and skills …

Hematopoietic Cell Transplant Compared With Standard Care In Adolescents And Young Adults With Sickle Cell Disease, Mark C. Walters, Mary Eapen, Yiwen Liu, Fuad El Rassi, Edmund K. Waller, John E. Levine, John J. Strouse, Joseph H. Antin, Suhag H. Parikh, Nitya Bakshi, Carlton D Dampier, Jennifer J. Jaroscak, Shayla Bergmann, Trish E. Wong, Vamsi K. Kota, Betty Sue Pace, Lazaros J. Lekakis, Premal D. Lulla, Robert Nickel, Kimberly A. Kasow, Uday R. Popat, Wally R. Smith, Lolie C. Yu, Nancy L. Difronzo, Nancy L. Geller, Naynesh Kamani, Elizabeth Sue Klings, Kathryn Hassell, Adam M. Mendizabal, Et Al

School of Medicine Faculty Publications

Disease-modifying therapies are standard of care (SOC) for sickle cell disease (SCD), but hematopoietic cell transplantation (HCT) has curative potential. We compared outcomes prospectively through 2-years after biologic assignment to a Donor or No Donor (SOC) Arm based on the availability of an HLA-matched sibling or unrelated donor (BMTCTN 1503; NCT02766465). A donor search was commenced after eligibility confirmation. The primary endpoint was the comparison of survival 2 years after biologic assignment between treatment arms. Power calculations required 60 participants on the Donor Arm and 140 on the No Donor Arm to determine if early transplant-related mortality might be balanced …

A Genome-Wide Association Study Identifies Genetic Determinants Of Hemoglobin Glycation Index With Implications Across Sex And Ethnicity, John S. House, Joseph H. Breeyear, Farida S. Akhtari, Violet Evans, John B. Buse, James Hempe, Alessandro Doria, Josyf C. Mychaleckyi, Vivian Fonseca, Mengyao Shi, Changwei Li, Shuqian Liu, Tanika N. Kelly, Daniel Rotroff, Alison A. Motsinger-Reif

School of Medicine Faculty Publications

Introduction: We investigated the genetic determinants of variation in the hemoglobin glycation index (HGI), an emerging biomarker for the risk of diabetes complications. Methods: We conducted a genome-wide association study (GWAS) for HGI in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (N = 7,913) using linear regression and additive genotype encoding on variants with minor allele frequency greater than 3%. We conducted replication analyses of top findings in the Atherosclerosis Risk in Communities (ARIC) study with inverse variance-weighted meta-analysis. We followed up with stratified GWAS analyses by sex and self-reported race. Results: In ACCORD, we identified single …

Decentralized Clinical Trials (Dcts): Facilitators & Barriers For A Pediatric Research Site, Abby Kietzman

Presentations

In 2020, the COVID-19 pandemic drastically altered the way clinical research is conducted through a widespread adoption of telemedicine practices. Using telehealth/telemedicine services allowed researchers to conduct “decentralized clinical trials”, or DCTs, for all or portions of study protocol procedures while maintaining safety measures implemented for pandemic control. However, current review of available literature details the explosion in use of decentralized clinical trials, resulting in gaps in evidence-based outcomes and lack of standardization across research entities. While sponsors and contract research organizations (CROs) tend to lead the charge around adoption of DCTs, research sites are hesitant to make the transition …

Multilevel Disparities Of Sex-Differentiated Human Papilloma Virus-Positive Oropharyngeal Cancers In The United States, Rhea Verma, David J. Fei-Zhang, Lily B. Fletcher, Sydney A. Fleishman, Daniel C. Chelius, Anthony M. Sheyn, Jeffrey C. Rastatter, Jill N. D’Souza

School of Medicine Faculty Publications

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality–urbanicity measures alongside individual-level race–ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males …

Sars-Cov-2 Infection Induces Human Milk Antibodies Capable Of Mediating Multiple Functional Activities, Jared Sheehan, Aline Andres, Laxmi Yeruva, Alistair J. Ramsay

School of Medicine Faculty Publications

Background and Aims: Passive transfer of antibodies through breastfeeding is a potential mode of protection for newborns and infants following maternal SARS-CoV-2 infection. The primary goal of this study was to evaluate and characterize SARS-CoV-2 Spike (S)-specific antibodies in human milk samples collected longitudinally from a cohort of convalescent mothers. Methods: SARS-CoV-2 infected participants enrolled in this study were lactating women aged 29–36 years with a confirmed COVID-19 diagnosis who donated milk samples at intervals over the six-month study period. Samples were evaluated for antibody subclass SARS-Cov-2 S glycoprotein binding activity by ELISA, and for the capacity of antibodies purified …

Key Data Elements For A Successful Pediatric Rheumatology Virtual Visit: A Survey Within The Pr-Coin Network., Y Ingrid Goh, Meghan E. Ryan, Shoghik Akoghlanian, Rajdeep Pooni, Julia G. Harris, Danielle R. Bullock, Sheetal S. Vora, Tzielan C. Lee, Shirley M L Tse, Fatima Barbar-Smiley

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease which is commonly monitored by a combination of history, physical examination, bloodwork, and imaging. The COVID-19 pandemic prompted a rapid shift to telemedicine to ensure that patients continued to receive healthcare. The shift to telemedicine changed the methodology and ability of healthcare providers to monitor their patients' progress, as they were unable to perform direct hands-on assessments. The following survey sought to understand the impact of switching pediatric rheumatology healthcare delivery from in-person to telemedicine modality. Specifically, it sought to examine the rate of collection of critical data …

Estrogen Plus Progestin And Colorectal Cancer: Long-Term Findings From The Women's Health Initiative Randomized Clinical Trial, Rowan T Chlebowski, Aaron K Aragaki, Kathy Pan, Juhua Luo, Thomas E Rohan, Karen C Johnson, Jean Wactawski-Wende, Su Yon Jung, Qian Xiao, Sayeh Lavasani, Joann E Manson, Michael S Simon

Faculty, Staff and Student Publications

We report long-term colorectal cancer findings from the Women’s Health Initiative trial where 16,608 postmenopausal women with a uterus were randomized to daily conjugated equine estrogen (CEE) 0.625 mg, plus medroxyprogesterone acetate (MPA) 2.5 mg, or placebo. When intervention ended after 5.6-years, while there were 44% fewer colorectal cancers in the intervention group (43 vs 72, P = 0.003), the cancers more commonly were lymph node positive (59.0% vs 29.4%, P = 0.003). Now after cumulative 24-year follow-up, with 431 breast cancers, CEE plus MPA no longer influenced colorectal cancer incidence (215 [0.15, annualized rate %] vs 216 [0.15], HR …

What Makes An Effective Chief Of Pediatric Cardiology: Insights From Chiefs Of North American Pediatric Programs, Michael E. Kim, Wayne Franklin, Anne M. Dubin, Jeffrey J. Kim, Shubhayan Sanatani, R. Krishna Kumar, Shubhika Srivastava, Thomas R. Kimball, Mark Lewin, Joseph Rossano, Colin J. Mcmahon

School of Medicine Faculty Publications

BACKGROUND: Although the position of a pediatric cardiology chief is often seen as the apex of one's academic career, its roles, responsibilities, and qualifications are not well defined in the literature. This study was done to gain further insight of the role and attributes of a pediatric cardiology chief by surveying those who are currently serving the position across North American centers. METHODS AND RESULTS: This was a mixed-methods study with a survey given to North American pediatric cardiology chiefs at programs with fellowship training programs. The survey was a semistructured questionnaire that was independently reviewed by 3 cardiologists. Smaller …

Neighborhood Effects On Acute Pediatric Asthma: Race, Greenspace, And Pm2.5, Elizabeth Wesley, Nathaniel A. Brunsell, David R. Rahn, Jarron M. Saint Onge, Natalie J. Kane, Kevin F. Kennedy

Manuscripts, Articles, Book Chapters and Other Papers

Urbanization produces spatially variable landscapes where climatic, environmental, and social systems interact in complex ways that affect public health. Environmental exposure along with the associated health risks are unevenly distributed and communities of color are often disproportionately affected by poor health outcomes. Acute pediatric asthma is the most common chronic condition of childhood in developed nations and is especially prevalent in minority and low-income children. In this study, we analyze the spatial variability of neighborhood-level acute pediatric asthma emergency department (ED) visits across the Kansas City Metro Area. Using Bayesian negative binomial regression, we describe the relationships and interactions between …

Pediatric Cardiac Xenotransplantation And Expanded Access: Ethical Considerations, Daniel J Hurst, Christopher Bobier, Anthony Merlocco, Luz A Padilla, Daniel Rodger, David Cleveland, John D Cleveland

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Due to the current organ shortage waitlist, alternatives to allotransplantation are necessary. Xenotransplantation is currently being pursued as one such alternative in adults in need of kidney or heart transplantation. Cardiac xenotransplantation of genetically modified pig hearts has been conducted twice in adults under the United States Food and Drug Administration (FDA) expanded access criteria. Because of the shortage of transplantable hearts for children as well as the lack of mechanical circulatory support in this population, pediatric researchers are exploring FDA expanded access in high-risk neonates and infants who lack alternative options for survival. The adult cardiac xenotransplantation experience with …

Clean Intermittent Catheterisation Determinants And Caregiver Adherence In Paediatric Patients With Spinal Dysraphism And Spinal Cord Injury In A Paediatric Spinal Differences Clinic: A Mixed Methods Study Protocol., Azadeh Wickham, Cynthia L. Russell, John Gatti

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Clean intermittent catheterisation (CIC) is the standard of care for treating neurogenic lower urinary tract dysfunction (NLUTD), the most common bladder dysfunction in children diagnosed with spinal dysraphism (SD) and spinal cord injury (SCI). Failure to follow the prescribed CIC regimen results in urinary tract infections, incontinence and renal insufficiency. Adherence to CIC is suboptimal, with reported non-adherence rates of 18%-66%. Despite the efficacy of CIC, the research on CIC adherence is not well defined in the literature and even less for caregivers of children on CIC protocols.

METHODS: This proposed study aims to identify caregiver CIC adherence and …

A Feasibility Study Of A Music Enrichment Program On Relative Reinforcing Value Of Food And Home Environmental Enrichment Among Families Of Low Socioeconomic Status., Kai Ling Kong, Amy R. Smith, Brenda Salley, Deanna Hanson-Abromeit, Hideko Engel, Catherine Serwatka

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Emerging evidence suggests that low socioeconomic status (SES) home environments may play a role by promoting excess energy intake through a lack of access to non-food reinforcers. Because of the deleterious effects of SES-related disparities on child health and development, feasible and culturally acceptable interventions are urgently needed. Community-based music enrichment programs may be an ideal intervention strategy.

METHODS: In collaboration with a local non-profit organization and music studio, we conducted a pilot randomized controlled trial to assess the effects of a music enrichment program versus a play date control in a group of 9-24-month-old healthy infants (N = …

Cardiovascular, Autonomic Symptoms And Quality Of Life In Children With Hypermobile Ehlers-Danlos Syndrome., Amanda K. Hertel, William R. Black, Ashley Lytch, Emily Cramer, Lindsey Malloy-Walton, Jordan T. Jones

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Hypermobile Ehlers-Danlos syndrome is a connective tissue disorder characterized by joint hypermobility and other systemic manifestations. Cardiovascular, autonomic symptoms and dysautonomia are frequently reported in adults with hypermobile Ehlers-Danlos syndrome and have been shown to have a negative impact on quality of life. However, there is scant literature on autonomic symptoms in pediatric patients with hypermobile Ehlers-Danlos syndrome. This study aims to characterize cardiovascular symptoms and diagnoses in pediatric patients with hypermobile Ehlers-Danlos syndrome and evaluate the impact of autonomic symptoms on quality of life.

METHODS: As part of a longitudinal study, a consecutive sample of 70 patients with …

Challenges In Paediatric Xenotransplantation: Ethical Components Requiring Distinct Attention In Children And Obligations To Patients And Society, Anthony Merlocco, Daniel J Hurst

Rowan-Virtua School of Osteopathic Medicine Departmental Research

The transplantation of non-human organs into humans, or xenotransplantation (XTx), has recently garnered new attention and is being developed to help address the problem of organ scarcity in transplantation. Ethical issues surrounding XTx have been studied since initial interest arose decades ago and have experienced renewed discussion in the literature. However, the distinct and relevant differences when applied to children has largely been overlooked with few groups attending to the concerns that XTx in children raises. In this paper, we explore ethical challenges to be expected in paediatric XTx, in particular exploring organ sizing concerns, infectious risks, psychological burdens, and …