Pediatrics Commons^™

Can We Predict Dominant Compensatory Curves In Congenital Scoliosis?, Myung-Jin Cha, William Elnemer, Paul D. Sponseller

Research Colloquium

Background: A complication in the natural evolution of congenital scoliosis is the development of a compensatory curve. Congenital curves are often focal and rigid, causing patients to develop a compensatory curve cranial and/or caudal to the congenital anomaly to achieve coronal balance. Therefore, surgeons are faced with the difficult choice of waiting for the patient to reach an appropriate age for surgery or correcting the congenital curve before a compensatory curve develops.

Methods: By searching the Pediatric Spine Study Group database, we identified 307 pediatric patients (age <18) with congenital scoliosis who had preoperative radiographs taken during at least 2 years of natural growth (without bracing or surgery). Of these patients, 17 (5.5%) had a dominant compensatory curve, and 290 had no compensatory curve or one that was smaller than the congenital curve. Of those 290 patients, we randomly selected 100 to serve as a control group, referred to as the nondominant curve cohort. We extracted data on the type of congenital anomaly and its vertebral level, as well as the Cobb angles of the congenital and compensatory curves at initial and latest follow-up. We compared vertebral level and type of congenital anomaly via chi-squared test between the dominant and nondominant curve group.

Results: The congenital anomaly was located at L4 or more caudal in 18% …

Evaluation Of The Garmin Vivofit 4 For Assessing Sleep In Youth Experiencing Sleep Disturbances., Paul R. Hibbing, Madison Pilla, Lauryn Birmingham, Aniya Byrd, Tumusifu Ndagijimana, Sara Sadeghi, Nedra Seigfreid, Danielle Farr, Baha Al-Shawwa Md, David G. Ingram Md, Jordan A. Carlson

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Wearable monitors are increasingly used to assess sleep. However, validity is unknown for certain monitors and populations. We tested the Garmin Vivofit 4 in a pediatric clinical sample.

METHODS: Participants (n = 25) wore the monitor on their nondominant wrist during an overnight polysomnogram. Garmin and polysomnography were compared using 95% equivalence testing, mean absolute error, and Bland-Altman analysis.

RESULTS: On average (mean ± SD), the Garmin predicted later sleep onset (by 0.84 ± 1.60 hours) and earlier sleep offset (by 0.34 ± 0.70 hours) than polysomnography. The resulting difference for total sleep time was -0.55 ± 1.21 hours. …

Use Of Web-Based Surveys To Collect Long-Term Pediatric Outcomes In Patients With Twin-Twin Transfusion Syndrome Treated With Fetoscopic Laser Photocoagulation: Observational Study, Eric Bergh, Kimberly Rennie, Jimmy Espinoza, Anthony Johnson, Ramesha Papanna

Faculty, Staff and Student Publications

Background: In the United States, patients with monochorionic diamniotic twins who undergo in utero fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS) may travel great distances for care. After delivery, many parents cannot return to study sites for formal pediatric evaluation due to geographic location and cost.

Objective: The aim of this study was to collect long-term pediatric outcomes in patients who underwent FLP for TTTS.

Methods: We assessed the feasibility of using a web-based survey designed in REDCap (Research Electronic Data Capture; Vanderbilt University) to collect parent-reported outcomes in children treated for TTTS at a single center during …

Cardiac Manifestations And Outcomes Of Covid-19 Vaccine-Associated Myocarditis In The Young In The Usa: Longitudinal Results From The Myocarditis After Covid Vaccination (Maciv) Multicenter Study, Supriya S. Jain, Steven A. Anderson, Jeremy M. Steele, Hunter C. Wilson, Juan Carlos Muniz, Jonathan H. Soslow, Rebecca S. Beroukhim, Victoria Maksymiuk, Xander Jacquemyn, Olivia H. Frosch, Brian Fonseca, Ashraf S. Harahsheh, Sujatha Buddhe, Ravi C. Ashwath, Deepika Thacker, Shiraz A. Maskatia, Nilanjana Misra, Jennifer A. Su, Saira Siddiqui, Danish Vaiyani, Aswathy K. Vaikom-House, M. Jay Campbell, Jared Klein, Sihong Huang, Christopher Mathis, Matthew D. Cornicelli, Madhu Sharma, Lakshmi Nagaraju, Marla Johnston, Et Al

School of Medicine Faculty Publications

Background: We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). Methods: In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤ 30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The …

Clinical Practice Guideline-Inconsistent Chemotherapy-Induced Vomiting Prophylaxis In Pediatric Cancer Patients In Community Settings: A Children's Oncology Group Study, Aaron J. Sugalski, Allison C. Grimes, Michelle M. Nuño, Subhash Ramakrishnan, Melissa P. Beauchemin, Paula D. Robinson, Nancy Santesso, Alexandra M. Walsh, Andrea R. Wrightson, Lolie C. Yu, Susan K. Parsons, Lillian Sung, L. Lee Dupuis

School of Medicine Faculty Publications

Background: This study aimed to determine the proportion of patients receiving clinical practice guideline (CPG)-inconsistent care related to chemotherapy-induced vomiting (CIV) prophylaxis, and to describe the association between CPG-inconsistent care and site size. The association between delivery of CPG-inconsistent care and patient outcomes (CIV control, admission prolongation, and unplanned healthcare visits) was also described. Methods: This was a retrospective study conducted at Children's Oncology Group (COG) National Cancer Institute Community Oncology Research Program (NCORP) sites. Eligible patients received highly (HEC) or moderately emetogenic chemotherapy (MEC) as inpatients from January 2014 through December 2015, and were previously enrolled in a COG …

Developing A Stand-Alone Children’S Hospital In Southern Nevada: Improving Pediatric Care And Diversifying The Regional Economy, The Lincy Institute

Lincy Institute Events

Southern Nevada is the largest metropolitan region in the country without a stand-alone children's hospital. The absence of such a facility results in poor health outcomes for children, fragmented and inadequate specialized care, and a shortage of pediatric medical professionals. Currently ranked last in clinical care nationwide, Nevada urgently needs a centralized, academic-based children's hospital to improve health services.

The Lincy Institute hosted a community forum to release the findings of a new report conducted by Tripp Umbach detailing why Southern Nevada needs a stand-alone children’s hospital. Tripp Umbach is a recognized industry leader, with 30 years of successful partnerships …

Developing A Stand-Alone Children’S Hospital In Southern Nevada: Needs, Opportunities, And Economic Development Considerations, Tripp Umbach

Policy Briefs and Reports

This independent study developed by Tripp Umbach demonstrates how an independent, research-intensive, stand-alone children’s teaching hospital can significantly enhance the health status of Southern Nevada’s children, reduce outmigration, attract children from neighboring states, and stimulate the healthcare economy. Tripp Umbach evaluated the need for a children’s hospital, the barriers to overcoming its absence, and the advantages of establishing a stand-alone children’s hospital in Southern Nevada for diverse audiences throughout Nevada and nationally.

World Allergy Organization (Wao) Diagnosis And Rationale For Action Against Cow's Milk Allergy (Dracma) Guideline Update – Xi – Milk Supplement/Replacement Formulas For Infants And Toddlers With Cma – Systematic Review, Antonio Bognanni, Ramon Firmino, Stefania Arasi, Derek Chu, Alexandro Chu, Siw Waffenschmidt, Arnav Agarwal, Piotr Dziechciarz, Andrea Horvath, Rose Kamenwa

Paediatrics and Child Health, East Africa

Background: Cow's milk allergy (CMA) is the most complex and common food allergy in infants. Elimination of cow's milk from the diet and replacement with a specialized formula for infants with cow's milk allergy who cannot be breastfed is an established approach to minimize the risk of severe allergic reactions while avoiding nutritional deficiencies. Given the availability of multiple options, such as extensively hydrolyzed cow's milk-based formula (eHF-CM), aminoacid formula (AAF), hydrolyzed rice formula (HRF), and soy formula (SF), there is some uncertainty regarding which formula might represent the most suitable choice with respect to health outcomes. The addition of …

The Impact Of Health Status On Health Care Utilization Of Children In Foster Care, Jill Mcleigh, Gunjan Singh, Rong Huang

Health Status, Outcomes, and Literacy and Healthcare Utilization

This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

Low-Acuity Pediatric Emergency Department Utilization, Lisa Ziemnik, Noah Parker, Kyra Bufi, Kristen Waters, Jacob Almeda, Adrienne Stolfi

Medical Education Faculty Publications

Objectives: Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions.

Methods: Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. …

Competency-Based Medical Education And The Education Continuum: Establishing A Framework For Lifelong Learning, Ann E. Burke, Daniel J. Sklansky, Hilary M. Haftel, Andrew Mitchell, Keith J. Mann

Pediatrics Faculty Publications

Competency Based Medical Education (CBME) is built on the concept that the competencies of learners, both graduates and practicing physicians, should ensure they are ready to meet the ever-changing healthcare needs of patients.1, 2, 3 Education outcomes in a CBME system are defined based on the needs of patients, and in healthy CBME systems, there is a paradigm shift from a focus on process and teachers to outcomes and learners.2,4 CBME should occur across the continuum of one's career, from undergraduate medical education through retirement. Furthermore, learners must be accustomed to driving their own educational processes.4,5 This learner-centered perspective requires …

Special Considerations For The Child With Obesity: An Obesity Medicine Association (Oma) Clinical Practice Statement (Cps) 2024., Suzanne Cuda, Marisa Censani, Valerie O'Hara, Jennifer Paisley, Roohi Kharofa, Rushika Conroy, Brooke Sweeney, Cristina Fernandez Md, Meredith Dreyer, Nancy T. Browne

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th andpercentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is …

Minimally Invasive Repair Of Pectus Excavatum Without Stabilizers Does Not Result In Increased Bar Displacement Or Other Post-Operative Complications, Meredith Elman, Seth Saylors, Ismael Elhalaby, Pablo Aguayo

Presentations

Introduction/Purpose Since the Nuss procedure was first performed in the 1990s, surgeons have adopted various modifications and techniques that vary by practice to optimize patient outcomes and minimize complications following pectus excavatum repair. Bar dislocation is a particularly dreaded complication, and as such, many Nuss bars are secured using unilateral or bilateral stabilizers. However, additional foreign body use can be associated with increased morbidity such as infection at stabilizer sites (~3% incidence), and pain attributed to stabilizer presence. Beginning in 2020, individuals in our practice did not place stabilizers in patients undergoing minimally invasive repair of pectus excavatum (MIRPE), and …

A Genomics Driven Human Induced Pluripotent Stem Cell Model Of Infant All – Updates On Hematopoietic Differentiation, Meagan Vacek, Jacqelyn Nemechek, Irina Pushel, Priyanka Kumar, Bradley Thornton, Molly Leyda, Midhat Farooqi, Erin Guest, Jay L. Vivian, John M. Perry

Posters

Acute lymphoblastic leukemia in infants (iALL) is a high-risk subtype of childhood leukemia, with poor survival outcomes despite intensive therapies. Rearrangement of KMT2A (KMT2A-r) occurs in 70% of cases and is associated with chemotherapy resistance, early relapse, and rapid leukemic progression, all of which contribute to poor survival outcomes. The most common KMT2A-r in iALL is KMT2A::AFF1 (MLL::AF4), derived from t(4;11)(q21;23). This KMT2A-r generates a driver fusion oncogene which leads to epigenetic dysregulation of target gene transcription. Infant ALL’s cell of origin is thought to be a very early hematopoietic precursor, with transcriptomic studies of iALL blasts showing similarities to …

"Ghosts In This Country": Pediatric Caregiver Perspectives On Immigration Status In The Healthcare Setting, Anik Patel, Ali Fowler, Juan Farias Torres, Ana Contreras, Claudia Zepeda, Estefania Bazan, John Cowden, Frances Turcotte Benedict, Jennifer Watts, Kimberly A Randell

Posters

Background: There are approximately 11.4 million undocumented immigrants (UI) in the United States. Immigration status (IS) is a unique social determinant of health that directly and indirectly impacts health and healthcare access. There are gaps in our understanding about how IS impacts health, particularly because it is not frequently discussed in the healthcare setting. This study expands our understanding of immigrant caregiver perceptions about discussing IS in the healthcare setting and provides insight into specific needs that we may not be currently addressing. Methods: Setting: ED or Spanish-speaking majority pediatric clinic at Children's Mercy Inclusion criteria: Caregivers who are 18+, …

Congenital Diaphragmatic Hernia, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Child Physical Abuse, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Work Where You Live Or Live Where You Work? Resident Work And Sleep Patterns While On "Home Call", David T Mitchell, Noa G Koppin, Michael T Talanker, Mohin A Bhadkamkar, Erik S Marques, Matthew R Greives, David C Hopkins

Faculty, Staff and Student Publications

Background: Unlike in-house call, the Accreditation Council for Graduate Medical Education (ACGME) does not require a postcall day for "home call" shifts. Despite this, we hypothesize that on-call residents are still in the hospital for the majority of their shift despite having the luxury of home call and, thus, are not protected by ACGME postcall duty hour regulations.

Methods: A prospective single center survey study was conducted by surveying junior and senior residents who completed overnight call shifts from January 2023 to April 2023 at one of the busiest level 1 trauma centers in the United States. Data include number …

Cardiac Manifestations And Outcomes Of Covid-19 Vaccine-Associated Myocarditis In The Young In The Usa: Longitudinal Results From The Myocarditis After Covid Vaccination (Maciv) Multicenter Study., Supriya S. Jain, Steven A. Anderson, Jeremy M. Steele, Hunter C. Wilson, Juan Carlos Muniz, Jonathan H. Soslow, Rebecca S. Beroukhim, Victoria Maksymiuk, Xander Jacquemyn, Olivia H. Frosch, Brian Fonseca, Ashraf S. Harahsheh, Sujatha Buddhe, Ravi C. Ashwath, Deepika Thacker, Shiraz A. Maskatia, Nilanjana Misra, Jennifer A. Su, Saira Siddiqui, Danish Vaiyani, Aswathy K. Vaikom-House, M Jay Campbell, Jared Klein, Sihong Huang, Christopher Mathis, Matthew D. Cornicelli, Madhu Sharma, Lakshmi Nagaraju, Jocelyn Y. Ang, Santosh C. Uppu, Preeti Ramachandran, Jyoti K. Patel, Frank Han, Jason G. Mandell, Jyothsna Akam-Venkata, Michael P. Dilorenzo, Michael Brumund, Puneet Bhatla, Parham Eshtehardi, Karina Mehta, Katherine Glover, Matthew L. Dove, Khalifah A. Aldawsari, Anupam Kumar, Spencer B. Barfuss, Adam L. Dorfman, Prashant K. Minocha, Alexandra B. Yonts, Jenna Schauer, Andrew L. Cheng, Joshua D. Robinson, Zachary Powell, Shubhika Srivastava, Anjali Chelliah, Yamuna Sanil, Lazaro E. Hernandez, Lasya Gaur, Michael Antonchak, Marla Johnston, Jonathan D. Reich, Narayan Nair, Elizabeth D. Drugge, Lars Grosse-Wortmann

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM).

METHODS: In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The primary …

Comparing The Diagnostic Yield Of Germline Exome Versus Panel Sequencing In The Diverse Population Of The Texas Kidscanseq Pediatric Cancer Study, Lauren R Desrosiers-Battu, Tao Wang, Jacquelyn Reuther, George Miles, Hongzheng Dai, Eunji Jo, Heidi Russell, Robin Raesz-Martinez, Alva Recinos, Stephanie Gutierrez, Amy Thomas, Emily Berenson, Jessica Corredor, Kimberly Nugent, Rachel Wyatt Castillo, Rebecca Althaus, Rebecca Littlejohn, Shawn Gessay, Gail Tomlinson, Jonathan Gill, Juan Carlos Bernini, Kelly Vallance, Timothy Griffin, Sarah Scollon, Frank Y Lin, Christine Eng, Shashikant Kulkarni, Susan G Hilsenbeck, Angshumoy Roy, Amy L Mcguire, D Williams Parsons, Sharon E Plon

Faculty, Staff and Student Publications

Purpose: To evaluate the relative diagnostic yield of clinical germline genomic tests in a diverse pediatric cancer population.

Patients and methods: The KidsCanSeq study enrolled pediatric cancer patients across six sites in Texas. Germline analysis included both exome sequencing and a therapy-focused pediatric cancer gene panel. The results were categorized by participants demographics, the presence of pathogenic or likely pathogenic (P/LP) variants, and variants of uncertain significance (VUS) in cancer predisposition genes (CPGs). Pediatric actionable CPGs were defined as those with cancer surveillance recommendations during childhood.

Results: Cancer P/LP variants were reported by at least one platform in 103 of …