Pediatrics Commons^™

Increasing Palliative Care Team Involvement In Pediatric Hematopoietic Stem Cell Transplant Patients, Meagan Vacek, Lisa Tarbell, Melissa List, Erin Hall, Jennifer Linebarger, Kelstan Ellis, Gina Jones, Joel Thompson

Posters

Background: Palliative care facilitates communication, helps with physical and psychological symptom management, and assists in goals of care and advance care planning discussions.1 Multiple organizations, including the American Academy of Pediatrics and American Society of Clinical Oncology encourage palliative care engagement and their involvement with hematopoietic stem cell transplant (HSCT) patients has been shown to be beneficial as HSCT is associated with a high degree of morbidity and possible mortality.2-3 Objective: To increase the number of PaCT consults for patients receiving HSCT for our targeted diagnoses from 48% to 75% by December 2023. Methods: Chart review was conducted for patients …

Testing For Bleeding Disorders In Child Abuse: Adherence To Aap Recommendations And Results Of Testing, Lyndsey Hultman, Angela Doswell, Henry T. Puls, Shannon L. Carpenter, Angela Bachim, Kristine Campbell, Daniel Lindberg, Joanne Wood, James Anderst

Presentations

Background: The American Academy of Pediatrics (AAP) recommends evaluations for bleeding disorders in children who have bruising and/or intracranial hemorrhage (ICH) concerning for abuse. Adherence to these recommendations is not known nor are the frequencies of identification of bleeding disorders or laboratory findings suggestive of a bleeding disorder. Objective: Using a multicenter research network (CAPNET), the objectives of this study were to characterize (1) the adherence to AAP recommendations for bleeding disorder testing in total and across CAPNET sites and (2) the frequency of identification of specific bleeding disorders and laboratory values concerning for bleeding disorders. Methods: We performed a …

How To Talk To Your Kids About Tragic Events, Maggie Mckay, Rachel Lapidus

Parent-ish Podcast

It never gets easier to talk to your kids about tragedies or senseless violence. But, you have the ability to create a safe space for your children to process what has happened.

Click here to stream the podcast episode.

A Physiological Approach To Renal Clearance: From Premature Neonates To Adults, Nick Holford, Conor J. O'Hanlon, Karel Allegaert, Brian Anderson, Amilcar Falcão, Nicolas Simon, Yoke Lin Lo, Alison H. Thomson, Catherine M.T. Sherwin, Evelyne Jacqz-Aigrain, Carolina Llanos-Paez, Stefanie Hennig, Linas Mockus, Carl Kirkpatrick

Pediatrics Faculty Publications

Aims: We propose using glomerular filtration rate (GFR) as the physiological basis for distinguishing components of renal clearance. Methods: Gentamicin, amikacin and vancomycin are thought to be predominantly excreted by the kidneys. A mixed-effects joint model of the pharmacokinetics of these drugs was developed, with a wide dispersion of weight, age and serum creatinine. A dataset created from 18 sources resulted in 27,338 drug concentrations from 9,901 patients. Body size and composition, maturation and renal function were used to describe differences in drug clearance and volume of distribution. Results: This study demonstrates that GFR is a predictor of two distinct …

A Qualitative Study On Mother's Occupational Engagement After A Nicu Experience, Rachel Garcia, Mary Ann Smith, Julie Heftie Ms, Otr/L

Spring 2024 Virtual OTD Capstone Symposium

Mothers who are “at-risk” for complications during pregnancy have an increased probability for mental health conditions following delivery, adversely affecting their engagement in motherhood occupations. This qualitative study identifies how best to address the needs of “at-risk” pregnant women. Through the process of conducting semi-structured interviews with women who have experienced NICU with their babies, and interviews with healthcare practitioners working in the NICU, their narrative addresses what approaches would support women while they are going through their “at-risk” pregnancies to assist them with the transition to their occupational roles as mothers and promote bonding with their baby.

Speeding Up Time: An Old Back In A Young Athlete, Carey Wagoner, Greg Canty

Posters

Case of a 16 year old female competitive dancer with chronic back pain. Previous diagnosis of mechanical low back pain being treated by PT without improvement. Further workup demonstrated bilateral spinal synovial cysts at L4/L5 facet joints. Patient underwent IR guided aspiration and steroid injection with resolution of her symptoms and ultimately returned to dance.

Time To Full Enteral Feeds In Hospitalised Preterm And Very Low Birth Weight Infants In Nigeria And Kenya, Zainab Imam, Helen Nabwera, Olukemi Tongo, Pauline Andang’O, Isa Abdulkadir, Chinyere Ezeaka, Beatrice Ezenwa, Iretiola Fajolu, Martha Mwangome, Dominic Umoru

Paediatrics and Child Health, East Africa

Background: Preterm (born < 37 weeks’ gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnera- ble infants in sub-Saharan Africa.

Aim: To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/ kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan Afri- can countries.

Methods: Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds.

Results: Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before …

Kawasaki Disease In Kenya And Review Of The African Literature, Angela Migowa, Catherine Njeri, Edwin Were, Thomas Ngwiri, L Colmegna

Paediatrics and Child Health, East Africa

Background: Kawasaki disease has been described across the globe, although publications from Africa are limited. To our knowledge, there are no publications on Kawasaki disease from Kenya, which triggered this report.

Methods: A retrospective cross-sectional study was undertaken to identify in-patients with a discharge diagnosis of Kawasaki disease, over 2 different 5-year periods, at two pediatric hospitals in Nairobi, Kenya. We reviewed the medical records of all patients and report their clinical findings, diagnostic workup and treatment. In addition, we undertook a detailed review of the literature.

Results: Twenty-three patients with Kawasaki disease were identified, of those 12 (52.2%) had …

Delayed Onset Of Neonatal Compartment Syndrome Associated With Compound Fetal Presentation, Nicholas Manini, Hayato Unno

Department of Medicine Faculty Papers

Neonatal compartment syndrome, although rare, has a classic presentation with sentinel skin findings and development of swelling, erythema, and tenderness of the affected extremity. Neonatal compartment syndrome requires prompt surgical intervention to preserve the affected limb and ensure its normal growth and development. Our patient was born at term via vaginal delivery complicated by a compound presentation involving the left upper extremity. No physical exam abnormalities were noted at birth, but she developed signs of neonatal compartment syndrome by 15 h of life. She was surgically treated at 22 h of life and recovered well. At one year of age, …

Wcn24-2067 Regional Differences In Acute Kidney Injury In Ugandan Children Hospitalized For Hypoxemia, Anthony Batte, Rodney Ogwang, Robert Opoka, Sophie Namasopo, Michael Hawkes, Andrea Conroy

Paediatrics and Child Health, East Africa

Introduction: Acute kidney injury (AKI) is associated with increased mortality in hospitalized patients and incidence is highest in resource limited settings. The objective of this study was to assess sub-National regional differences in the incidence of AKI in children <5 years of age hospitalized with an acute febrile illness and hypoxemia.

Methods: This was a secondary analysis of a stepped wedge cluster randomized controlled trial, which enrolled children <5 years of age hospitalized with hypoxemia between 2019 and 2021. At least one measure of kidney function was available in 1452 children. A single creatinine was measured at enrolment in a sub-set of 495 children with serum stored and AKI defined using KDIGO criteria where baseline creatinine was estimated using the age-based Pottel equation assuming a normal glomerular filtration rate of 120mL/min per 1.73m2. Markers were divided into structural (uNGAL positive, proteinuria, hematuria) or functional (AKI, saliva urea nitrogen (SUN)) measures of kidney injury.

Results: 1452 children were included in this AKI sub-study (Figure 1). The mean age of participants was 1.49 years (standard deviation (SD), 1.21) and 55.7% were male (809/1452). Overall 2.6% of children died (38/1452). The majority of participants enrolled were from the West (31.3%) …

Accuracy Of Influenza Icd-10 Diagnosis Codes In Identifying Influenza Illness In Children., James W. Antoon, Tess Stopczynski, Justin Z. Amarin, Laura S. Stewart, Julie A. Boom, Leila C. Sahni, Marian G. Michaels, John V. Williams, Janet A. Englund, Eileen J. Klein, Mary A. Staat, Elizabeth P. Schlaudecker, Rangaraj Selvarangan, Jennifer E. Schuster, Geoffrey A. Weinberg, Peter G. Szilagyi, Ariana Perez, Heidi L. Moline, Andrew J. Spieker, Carlos G. Grijalva, Samantha M. Olson, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Studies of influenza in children commonly rely on coded diagnoses, yet the ability of International Classification of Diseases, Ninth Revision codes to identify influenza in the emergency department (ED) and hospital is highly variable. The accuracy of newer International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify influenza in children is unknown.

OBJECTIVE: To determine the accuracy of ICD-10 influenza discharge diagnosis codes in the pediatric ED and inpatient settings.

DESIGN, SETTING, AND PARTICIPANTS: Children younger than 18 years presenting to the ED or inpatient settings with fever and/or respiratory symptoms at 7 …

Something's Gnawing At Me, Catharine Kral, Brian Harvey

Posters

17-year-old female presented to Sports Medicine clinic with a chief complaint of bilateral hip pain and difficulty walking who was found to have bilateral ovarian teratoma.

Hearing Loss In Children With 22q11.2 Deletion Syndrome, Lori Yaktine, Amanda Moore, Jamie Hamm, Blaine Crowley, Meghan Tracy, Janelle R. Noel-Macdonnell Phd, Kim Graiser, Bernice Marrow, Hansoo Song, Srivats Narayanan, Nikita Raje, Donna Mcdonald-Mcginn, Jill M. Arganbright

Posters

22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome, with most recent published prevalence of 1:2,140 live births. Hearing loss is common in children with 22q11.2DS and has been reported to occur in 32-60% of people. Hearing loss is typically conductive in nature secondary to chronic eustachian tube dysfunction and chronic otitis media with effusion (COME). Close monitoring of hearing and the middle ears is recommended to detect COME and the need for ear tubes. Additionally, there is a high prevalence of speech delay in children with 22q11.2DS, stressing the importance of close audiometric evaluation and medical intervention as …

Anterior Hip Pain In Adolescent Female Wrestler, Melanie Kennedy

Posters

No abstract provided.

Learning Circles: Promoting Inclusive Care Starting In The Classroom, April Graham, Kindsey Gattman, Tobias Johnson

Articles, Abstracts, and Reports

No abstract provided.

Self-Regulation And Sensory Processing Education Program For Educators, Julianne Mendivil, Tina G. Bhakta, Angela Blackwell

Spring 2024 Virtual OTD Capstone Symposium

Children with low self-regulation skills may face many challenges in the classroom environment that can impact their performance in school-based activities. As teachers play a vital role in the development of young children, this educational program aims to improve teacher competence (knowledge, skills, and attitudes) in applying sensory processing and self-regulating concepts to the school environment.

The Ci-Asd Program: Implementation Of Contextual Interventions For Autism Spectrum Disorder (Ci-Asd) With Latino Families (Preliminary Report), Gabriel Gonzalez, Erik Pérez, Angela Blackwell

Spring 2024 Virtual OTD Capstone Symposium

Children diagnosed with Autism Spectrum Disorder (ASD) experience sensory processing differences that affect their participation in daily activities and routines. Autism affects an estimated 1 in 36 children in the U.S. However, Latino children are diagnosed two years later than white children. Latino families still have the greatest disparities in accessing ASD resources throughout the U.S. compared to white families. The lack of ASD services and resources led to decreased parental self-efficacy, quality of life, and increased child behavioral problems.

Contextual Interventions Adapted for Autism Spectrum Disorder (CI-ASD) are an emerging intervention for occupational therapy (OT) practitioners. Recent literature shows …

The Association Between Mental Health Disorders And Glycemic Control In Adolescents With Type 1 Diabetes, Marcella Pietrzyk

Independent Study Project (ISP) Collection

Adolescence is a very challenging period in a person's life as it is often filled with hormonal changes, emotional turmoil, and time for development socially, emotionally, and mentally. The addition of a chronic illness on top of the transition from child to adult creates a large burden on quality of life. The most common chronic illness diagnosed in adolescence is type 1 diabetes. This is an illness with a significant medical burden as it requires close monitoring of blood glucose levels, constant insulin injections, and diet control. The combination of adolescence and a chronic illness leads to higher rates of …

Ovarian Torsion, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Improving Frequency Of Peer Review Of Abnormal Genital Exam Findings In Patients Undergoing Sexual Abuse Evaluation, Lyndsey Hultman, Terra N. Frazier, Jennifer Hansen

Presentations

Background/Objectives: 2023 Child Advocacy Center (CAC) accreditation standards require that “all medical professionals providing services to CAC clients must demonstrate that 100% of all findings deemed abnormal or “diagnostic” of trauma from sexual abuse have undergone expert review by an advanced medical consultant”. Prior to program implementation, scheduled Case Review occurred among the authors’ institution child abuse pediatricians (CAPs), but typical practice was to review cases upon CAP request. The authors’ institution faced practice standard implementation barriers of high case volumes and collaboration with multiple different CACs. Our primary aim was to increase peer review of abnormal exams from a …