Download [9] Ifeolu Akinnola, IBP MD/PhD Student

31st Annual
Pediatric Research
Education and
Scholarship
Symposium
P
R
E
S
S
Friday, April 14, 2017
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ACKNOWLEGEMENTS:
ABSTRACT GRADERS
Melena Bellin, MD
Associate Professor of Pediatrics
Division of Endocrinology
Sarah Cusick, PhD
Assistant Professor of Pediatrics
Division of Global Pediatrics
Timothy Hallstrom, PhD
Assistant Professor of Pediatrics
Division of Blood and Marrow Transplantation
JUDGES
Sunny Chan, PhD
Assistant Professor of Pediatrics
Division of Blood and Marrow Transplantation
Colleen Correll, MD
Assistant Professor of Pediatrics
Division of Rheumatology
Terri Laguna, MD MSCS
Assistant Professor of Pediatrics
Division of Pediatric Pulmonary and Sleep Medicine
The PRESS 2017 Committee would like to thank everyone for their assistance with making
this event possible.
Gwenyth Fischer, MD
Aaron Kelly, PhD
Angela Panoskaltsis-Mortari, PhD
Caitlyn Bralick, Administrative Associate
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31st ANNUAL PEDIATRIC RESEARCH, EDUCATION AND
SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
2:00–6:00 p.m.
University of Minnesota Masonic Children’s Hospital
Wilf Family Center, 2nd Floor/Lobby Level of the Riverside East Building
_________________________________________________________________________
FORMAL ORAL PRESENTATIONS
Wilf Family Center
2:00-4:00 p.m.
See Full Abstracts 1-8 in Oral Presentation section
2:00pm
Amanda Barks, Neuroscience MD/PhD Student – Pediatric Neonatology
“ADULT HIPPOCAMPAL TRANSCRIPTOME IS PERMANENTLY ALTERED FOLLOWING
FETAL/NEONATAL IRON DEFICIENCY”
 Research Sponsor: Michael Georgieff
2:15pm
Diana Wallin, Graduate Student – Pediatric Neonatology
“SHORT AND LONG-TERM CEREBELLAR AND STRIATAL METABOLIC ALTERATIONS DUE TO
NEONATAL PHLEBOTOMY-INDUCED ANEMIA”
 Research Sponsor: Michael Georgieff
2:30pm
Nathan Schuldt, Postdoctoral Fellow – Pediatric Rheumatology
“DUAL TCRα EXPRESSION POSES AN AUTOIMMUNE HAZARD BY LIMITING T REG CELL
GENERATION”
 Research Sponsor: Bryce Binstadt
2:45pm
Isuruni Sonnadara, Postdoctoral Fellow – Pediatric Infectious Disease & Immunology
“A PROSPECTIVE BLINDED STUDY FINDS THAT SYMPTOMATIC BREAST MILK-ACQUIRED
CYTOMEGALOVIRUS INFECTIONS IN A HIGH-RISK NICU POPULATION OFTEN ESCAPE
REAL-TIME BEDSIDE DIAGNOSIS”
 Research Sponsor: Mark Schleiss
3:00pm
Rachel DeVries, Pediatric Resident – Pediatric GME
“LEVERAGING THE EHR TO INCREASE FOOD SECURITY SCREENING AND ACCESS TO
FOOD RESOURCES FOR FAMILIES”
 Research Sponsors: Diana Cutts (HCMC) and Mike Pitt
3
3:15pm
Vishal Naik, Pediatric Resident – Pediatric GME
“WEIGHT-FOR-AGE PERCENTILE AS A PREDICTOR OF EMERGENCY DEPARTMENT
OUTCOME IN A TERTIARY CARE PEDIATRIC CENTER”
 Research Sponsor: Mike Pitt (Local sponsor for work done in medical school)
3:30pm
Erin Plummer, Pediatric Fellow – Pediatric Neonatology
“PRETERM BODY COMPOSITION ACCRETION THROUGH PRESCHOOL AGE IS ASSOCIATED
WITH COGNITION”
 Research Sponsors: Johannah Scheurer and Sara Ramel
3:45pm
Katie Satrom, Pediatric Fellow – Pediatric Neonatology
“MILD HYPERBILIRUBINEMIA ALTERS THE NEUROCHEMICAL PROFILE, GENE EXPRESSION,
AND DENDRITIC ARBORIZATION IN THE HIPPOCAMPUS OF PRETERM GUNN RATS”
 Research Sponsor: Raghu Rao
4
POSTER SESSION
UMMCH 2nd Floor/Lobby Level
4:00-5:30 p.m.
See Full Abstracts in Poster Session Section
Abstract #
[9]
Ifeolu Akinnola, IBP MD/PhD Student – Pediatric Blood and Marrow Transplantation
“RECONSTITUTION OF PULMONARY VASCULATURE USING ENDOTHELIAL
PROGENITOR CELLS”
 Research Sponsor: Angela Panoskaltsis-Mortari
[10]
Ranyah Aldekhyyel, PhD Student – Pediatric Hospital Medicine
“AN EPIC SOLUTION FOR PAIN REASSESSMENT: A NOVEL PATIENT COMMUNICATION
APPROACH INTERACTING FOUR HOSPITAL TECHNOLOGIES”
 Research Sponsor: Mike Pitt
[11]
Zineb Alfath, Undergraduate Student – Pediatric Emergency Medicine
“DO ADOLESCENT MENTAL HEALTH PATIENTS RECEIVE A SEXUAL HISTORY OR
SCREENING FOR SEXUALLY TRANSMITTED INFECTION IN THE EMERGENCY
DEPARTMENT?”
 Research Sponsor: Kari Schneider
[12]
Erin Balay, Medical Student – Pediatric Emergency Medicine
“IDENTIFYING BARRIERS TO THE TIMELY DOSING OF INTRAVENOUS ANTIBIOTICS IN
CHILDREN PRESENTING TO A PEDIATRIC EMERGENCY DEPARTMENT: AN EPAC DRIVEN QI
PROJECT”
 Research Sponsor: Jeff Louie
[13]
Amanda Barks, Neuroscience MD/PhD Student – Pediatric Neonatology
“PROTEOMIC ANALYSIS OF CORD BLOOD EXOSOMAL PROTEINS ALTERED BY FETAL IRON
STATUS”
 Research Sponsor: Phu Tran
[14]
Mackenzie Diekmann and Megan Reinhard, Medical Student/Undergraduate – Pediatric
Infectious Disease
“EPIDEMIOLOGY AND CLINICAL FEATURES OF SEPTIC ARTHRITIS IN CHILDREN (1-18YO)”
 Research Sponsor: Bazak Sharon
[15]
Aya Eid, Undergraduate Student – Pediatric Cardiology
“MATERNAL DIABETES AND FETAL CARDIAC OUTPUT”
 Research Sponsor: Shanthi Sivanandam
[16]
Zach Galliger, BME Graduate Student – Pediatric Blood and Marrow Transplantation
“CARTILAGE-DERIVED EXTRACELLULAR MATRIX METHACRYLAMIDE FOR 3D BIOPRINTING
OF PEDIATRIC-SIZED TRACHEA”
 Research Sponsor: Angela Panoskaltsis-Mortari
[17]
Robert Gruhl, Medical Student – Pediatric Hospital Medicine
“NOT ALL THAT VESICLES IS HERPES”
 Research Sponsors: Andrew Olson and Micah Niermann
5
[18]
Kathryn Hiolski, Pre-doctoral LEAH Fellow/MPH Student – General Pediatrics and Adolescent
Health
“BEHAVIORAL INDICATORS OF PHYSICAL HEALTH AMONG YOUTH WITH INCARCERATED
PARENTS”
 Research Sponsor: Rebecca Shlafer
[19]
Tarissa Host, Undergraduate Student – Pediatric Emergency Medicine
“CAN A PEDIATRICIAN CHANGE CULTURE AT A GENERAL EMERGENCY DEPARTMENT?
REDUCIDNG CERVICAL SPINE CT USE FOR NECK TRAUMA – A PRELIMINARY REPORT”
 Research Sponsor: Jeff Louie
[20]
Neil Hultgren, Graduate Student – Pediatric Epidemiology and Clinical Research
“CENTRAL BLOOD PRESSURE REGULATION IN RELATION TO HYPERTENSION AND
ADIOPOSITY IN YOUTH”
 Research Sponsor: Justin Ryder
[21]
Bradley Janus, Undergraduate Student – Pediatric Infectious Diseases
“EVALUATING GUINE PIGS AS AN EXPERIMENTAL MODEL OF CONGENITAL ZIKA
SYNDROME”
 Research Sponsors: Craig Bierle and Mark Schleiss
[22]
Rebecca Kehm, Graduate Student – Pediatric Epidemiology and Clinical Research
“THE MEDIATING ROLE OF SOCIOECONOMIC STATUS IN RACIAL DISPARITIES IN
CHILDHOOD CANCER SURVIVAL”
 Research Sponsor: Logan Spector
[23]
Andrew-Kemal Kirchmeier, Undergraduate Student – Pediatric Infectious Diseases
“INTERACTIONS BETWEEN MALARIA AND SYSTEMATIC CYTOMEGALOVIRUS INFECTION: A
COMPARISON OF UL144 GENOTYPES IN MINNESOTA INFANTS WITH CONGENITAL CMV AND
AFRICAN CMV STRAINS IN CHILDREN WITH MALARIA”
 Research Sponsor: Mark Schleiss
[24]
Gabriela Lazalde, Graduate Student – General Pediatrics and Adolescent Health
“DENTISTS AS HPV VACCINATORS: WHAT DO PARENTS THINK?”
 Research Sponsor: Annie-Laurie McRee
[25]
Lee Meier, MD/PhD Student – Pediatric Rheumatology
“DISCRETE POPULATIONS OF MONONUCLEAR PHAGOCYTES ORCHESTRATE MITRAL
VALVE DISEASE THROUGH LOCAL AND SYSTEMIC INFLAMMATION”
 Research Sponsor: Bryce Binstadt
[26]
Rose Olson, Medical Student – Pediatric Neonatology
“GROWTH OUTCOMES DURING NICU STAY IN EXTREMELY LOW BIRTH WEIGHT INFANTS
TREATED WITH ERYTHROPROTEIN AND HIGH DOSE IRON SUPPLEMENTATION COMPARED
TO VON AVERAGES”
 Research Sponsors: Tara Zamora and Asha Siddappa
[27]
Christen Pentek, Predoctoral Fellow – General Pediatrics and Adolescent Health
“SCHOOL RESOURCE OFFICERS, STUDENT PERCEPTIONS OF SAFETY, AND EXPERIENCES
OF SCHOOL DISCIPLINE: DIFFERENCES ACROSS RACE”
 Research Sponsor: Marla Eisenberg
6
[28]
Megan Reinhard, Undergraduate Student – Pediatric Infectious Diseases
“EPIDEMIOLOGY AND CHARACTERISTIC FEATURES OF PEDIATRIC LYME ARTHRITIS IN AN
ENDEMIC REGION”
 Research Sponsor: Bazak Sharon
[29]
Monica Yue, Graduate Student – Pediatric Infectious Disease
“UNDERSTANDING THE EFFECTS OF ANTIVIRAL TREATMENT ON CCMV OUTCOMES IN A
UMN LIONS CLINIC COHORT”
 Research Sponsor: Mark Schleiss
[30]
Carly Alexander, Postdoctoral Fellow – Pediatric Neuropsychology
“USING THE VINELAND ADAPTIVE BEHAVIOR SCALE TO ASSESS ADAPTIVE
FUNCTIONING DIFFERENCES BETWEEN SUBTYPES OF MUCOPOLYSACCHARIDOSIS I”
 Research Sponsor: Kelly King
[31]
Mary Christoph, Postdoctoral Fellow – General Pediatrics and Adolescent Health
“NUTRITION FACTS USE BY YOUNG ADULTS: PREDICTORS, INFORMATION SOUGHT, AND
RELATION TO DIETARY INTAKE”
 Research Sponsor: Dianne Neumark-Sztainer
[32]
Laurel Davis, Postdoctoral Fellow – General Pediatrics and Adolescent Health
“HEALTH STATUS AND HEALTH CARE UTILIZATION OF JUSTICE-INVOLVED FAMILES”
 Research Sponsor: Rebecca Shlafer
[33]
Jennifer Doty, Postdoctoral Fellow – General Pediatrics and Adolescent Health
“SEXUAL HARRASSMENT INVOLEMENT: CONNECTIONS MATTER”
 Research Sponsor: Iris Borowsky
[34]
Katherine Klipfel, Postdoctoral Fellow – Pediatric Neuropsychology
“NEUROPSYCHOLOGICAL SEQUELAE OF AN INTERNATIONALLY ADOPTED CHILD:
PRELIMINARY CONCEPTUALIZATION AND FUTURE DIRECTIONS”
 Research Sponsor: Margaret Semrud-Clikeman
[35]
Christopher Mehus, Postdoctoral Fellow – General Pediatrics and Adolescent Health
“TESTING THE SOCIAL INTERACTION LEARNING MODEL WITH ADOLESCENT SUBSTANCE
USE OUTCOMES IN A PROSPECTIVE AUSTRALIAN SAMPLE”
 Research Sponsor: Barbara McMorris
[36]
Chimei Lee, Postdoctoral Fellow – Pediatric Neuropsychology
“SENSITIVITIES AND SPECIFICITIES OF SOCIAL COMMUNICATION QUESTIONNAIRE IN A
CLINIC-REFERRED SAMPLE”
 Research Sponsors: Amy Esler and Rebekah Hudock
[37]
April Wilhelm, Postdoctoral Fellow – General Pediatrics and Adolescent Health
“MENTAL HEALTH IN SOMALI YOUTH: THE ROLE OF PROTECTIVE FACTORS IN PREVENTING
DEPRESSIVE SYMPTOMS, SUICIDALITY, AND SELF-INJURY”
 Research Sponsor: Annie-Laurie McRee
7
[38]
Julie Anderson, Pediatric Resident – Pediatric Emergency Medicine
“A COMPARISON OF THE EFFICACY OF ENEMA SOLUTIONS IN PEDIATRIC
PATIENTS WITH CONSTIPATION”
 Research Sponsor: Marissa Hendrickson
[39]
Julie Ansbaugh, Pediatric Resident – Pediatric Hospital Medicine
“TRAINEE RESILIENCE DATA – UNIVERSITY OF MINNESOTA RESIDENTS COMPARED TO
NATIONAL DATA”
 Research Sponsors: Mike Pitt, Maren Olson, and Emily Borman-Shoap
[40]
Rachel Cafferty and Amanda Gillett, Pediatric Residents – Pediatric Hospital Medicine
“FOOD FOR THOUGHT – RESIDENTS’ PERSPECTIVES ON SCREENING FOR FOOD
INSECURITY”
 Research Sponsors: Mike Pitt and Diana Cutts (HCMC)
[41]
Jacquelyn Campbell and Ashley Phimister, Pediatric Residents – Pediatric Hospital Medicine
“STREPTOCOCCUS INTERMEDIUS: AN UNCOMMON PATHOGEN WITH A COMMON
PRESENTATION”
 Research Sponsor: Zachary Kaltenborn
[42]
Catherine Koozer, Pediatric Resident – Pediatric Neonatology
“IDENTIFICATION OF MISSSED CHD FROM CARDIAC INTERVENTION DATA AND DEATH
RECORDS DURING THE PULSE OXIMETRY PILOT STUDY IN MN”
 Research Sponsors: Melissa Engel and Jamie Lohr
[43]
Stephanie Lauden, Pediatric Resident – Global Pediatrics
“WHAT WE CAN LEARN FROM RESIDENTS’ DISEASE LOGS FROM GLOBAL HEALTH
ELECTIVES”
 Research Sponsor: Mike Pitt
[44]
Stephanie Lauden, Pediatric Resident – Global Pediatrics
“THE WELLNESS RX: USING A WRITTEN PLAN FOR PERSONAL WELLNESS ABROAD”
 Research Sponsor: Ben Trappey
[45]
Heidi Moline, Pediatric Resident – Pediatric Infectious Diseases
“ACUTE TRANSVERSE MYELITIS CAUSED BY ECHOVIRUS 11 IN A 12-YEAR-OLD BOY”
 Research Sponsor: Mark Schleiss
[46]
Heidi Moline, Pediatric Resident – Pediatric Infectious Diseases
“WHAT’S THE DIAGNOSIS: 3-WEEK-OLD PRESENTS WITH RAPIDLY SPREADING
ERYTHEMATOUS ANNULAR LESIONS”
 Research Sponsor: Stacene Maroushek
[47]
Nasreen Quadri, Pediatric Resident – Pediatric Infectious Diseases
“FROM LEPROSARIUM TO LIVING WITH LEPROSY: DIAGNOSIS OF HANSEN’S DISEASE IN AN
11-YEAR-OLD BHUTANESE BOY FROM NEPAL AND INVESTIGATION OF CURRENT M.
LEPRAE DISEASE TRENDS”
 Research Sponsor: Mark Schleiss
[48]
Emma Schempf, Pediatric Resident – Pediatric GME
“IMPROVING RESIDENT COMMUNICATION WITH VACCINE-HESITANT FAMILIES THROUGH
STIMULATION”
8
 Research Sponsor: Dawn Martin
[49]
Joe Woolley, Pediatric Resident – Pediatric GME
“ABNORMAL POSTURING IN AN SEVERELY INTOXICATED TEENAGER”
 Research Sponsor: Jeff Louie
[50]
Andrew Wu and Ashish Shah, Pediatric Residents – Pediatric Hospital Medicine
“CHOOSING THE PERFECT SHOT – THE LOADED NARRATIVE WITHIN IMAGERY IN ONLINE
NEWS COVERAGE OF VACCINES”
 Research Sponsor: Mike Pitt
[51]
Shannon Andrews, Pediatric Fellow – Pediatric Infectious Diseases
“PENICILLIN RESISTANCE IDENTIFIED IN A CASE OF THORACIC ACTINOMYCOSIS”
 Research Sponsor: Patricia Ferrieri
[52]
Danielle Bullock, Pediatric Fellow – Pediatric Rheumatology
“FAMILIARITY VITAL FOR TELEMEDICINE UPTAKE AMONG PARENTS OF PEDIATRIC
RHEUMATOLOGY PATIENTS”
 Research Sponsor: Colleen Correll
[53]
Nita Ray Chaudhuri, Pediatric Fellow – Pediatric Cardiology
“PRENATAL PREDICTORS OF URGENT BALLOON ATRIAL SEPTOSTOMY IN TRANSPOSITION
OF GREAT ARTERIES”
 Research Sponsor: Shanthi Sivanandam
[54]
Elissa Downs, Pediatric Fellow – Pediatric Gastroenterology
“INTUSSUSCEPTIONS ALONG GASTROJEJUNOSTOMY TUBES: KNOWN COMPLCIATION OR
NEW ISSUE?”
 Research Sponsor: Alan Baldridge
[55]
Jorge Galvez Silva, Pediatric Fellow – Pediatric Blood and Marrow Transplantation
“CHARACTERIZATION OF SEROTHERAPY-ASSOCIATED FEVER IN PEDIATRIC PATIENTS
UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANT”
 Research Sponsors: Angela Smith, Weston Miller, and John Wagner
[56]
Vasu Gooty, Pediatric Fellow – Pediatric Cardiology
“LEFT HEART AGENESIS WITH TOTAL ANOMALOUS PULMONARY VENOUS RETURN IN A
FETUS”
 Research Sponsor: Shanthi Sivanandam
[57]
Alyssa Halper, Pediatric Fellow – Pediatric Endocrinology
“BONE MINERAL DENSITY AND BODY COMPOSITION IN CHILDREN WITH CONGENITAL
ADRENAL HYPERPLASIA”
 Research Sponsor: Kyriakie Sarafoglou
[58]
Elwaseila Hamdoun, Pediatric Fellow – Pediatric Endocrinology
“TOTAL 25-HYDROXYVITAMIN D MEASUREMENT MAY NOT BE A SENSITIVE SCREENING
MEETHOD TO DETECT VITAMIN D DEFICIENCY IN SOME ETHNIC PEDIATRIC POPULATIONS”
 Research Sponsors: Muna Sunni and Antoinette Moran
[59]
Angela Hanson, Pediatric Fellow – Pediatric Neonatology
9
“IUGR ALTERS CORTICAL AND HIPPOCAMPAL TRANSCRIPTOMES IN DEVELOPING AND
ADULT RATS”
 Research Sponsor: Phu Tran
[60]
Ellen Ingolfsland, Pediatric Fellow – Pediatric Neonatology
“EARLY INFANCY BODY COMPOSITION OF VLBW PRETERM INFANTS IS NOT ASSOCIATED
WITH HIGHER BLOOD PRESSURE AT FOUR MONTHS CGA”
 Research Sponsor: Sara Ramel
[61]
Leslie Kummer, Pediatric Fellow – General Pediatrics and Adolescent Health
“INTERPERSONAL AND STRUCTURAL DETERMINANTS OF BREASTFEEDING IN THE UNITED
STATES”
 Research Sponsor: Iris Borowsky
[62]
Ketzela Marsh, Pediatric Fellow – Pediatric Infectious Diseases
“STRATEGIES TO ENGAGE WITH YOUTH REGARDING PREP: LESSONS LEARNED FROM
RECRUITMENT OF YOUTH FOR FOCUS GROUPS”
 Research Sponsor: Mark Schleiss
[63]
Karl Migally, Pediatric Fellow – Pediatric Cardiology
“DURATION OF HIGH-DOSE ASPIRIN THERAPY DOES NOT AFFECT CORONARY ARTERY
OUTCOMES IN KAWASAKI DISEASE”
 Research Sponsors: Bryce Binstadt and Elizabeth Braunlin
[64]
Lerraughn Morgan, Pediatric Fellow – Pediatric Cardiology
“NOT YOUR TYPICAL ENDOCARDITIS: A CASE RESPORT OF GRANULICATELLA ADIACENS
ENDOCARDITIS”
 Research Sponsor: Elizabeth Braunlin
[65]
Erin Plummer, Pediatric Fellow – Pediatric Neonatology
“CLINICAL PROCESS MODEL UTILIZING DEXTROSE GEL FOR NEONATAL HYPOGLYCEMIA
IMPROVES OUTCOMES”
 Research Sponsor: Erin Stepka
[66]
Annie Simones, Pediatric Fellow – Pediatric Neonatology
“PULMONARY ACCELERATION TIME IS AN INDICATOR OF SEVERE PULMONARY
HYPERTENSION IN NEWBORN INFANTS”
 Research Sponsors: Aura Sanchez and Kari Roberts
[67]
Cassandra Sung, Pediatric Fellow – Pediatric Cardiology
“THORACIC DUCT IMAGING”
 Research Sponsor: John Bass
[68]
Robin Williams, Pediatric Fellow – Pediatric Hematology/Oncology
“IMPACT OF RECEIPIENT T CELL EXHAUSTION ON SUCCESSFUL ADOPTIVE TRANSFER OF
HAPLOIDENTICAL NATURAL KILLER CELLS”
 Research Sponsors: Michael Verneris and Bruce Blazar
[69]
Elizabeth Zorn, Pediatric Fellow – Pediatric Neonatology
“SPEED OF PROCESSING AND MEMORY FUNCTION IN INFANTS WITH A HISTORY OF
HYPOXIC-ISCHEMIC ENCEPHALOPATHY TREATED WITH THERAPEUTIC HYPOTHERMIA”
 Research Sponsor: Katie Pfister
10
REFRESHMENTS AND HORS D’OEUVRES
WILL BE SERVED AT THE POSTER SESSION
UMMCH 2nd floor/Lobby level
4:00-5:30 p.m.
Gardens of Salonica Catering (butler passed and buffet)
APPETIZERS
Tyro dip with vegetables
Tarama (fish roe) with pita crisps
Spinach-feta boughatsa
Skordalia (garlic blend) stuffed crimini caps
SALADS/ENTREES
Greek salad (horiatiki) on a stick
Gyros (with lettuce, tomato, onion)
Chicken oregano style
Tzatziki sauce and Pita
DESSERT BUFFET
Handmade baklava, lemon cream boughatsa, gioconda truffles
Coffee, peppermint tea, Souroti sparkling water, home-made lemonade
(100% honey sweetened)
AWARDS
Wilf Family Center
5:30-6:00 p.m.
11
FORMAL
ORAL
PRESENTATIONS
(Abstracts 1-8)
12
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [1]
Name: Amanda Barks
Status: MD/PhD Student
Division: Pediatric Neonatology
Research Sponsor: Michael Georgieff
Adult hippocampal transcriptome is permanently altered following fetal/neonatal iron deficiency
Amanda Barks, Phu Tran, Michael Georgieff
Background
Early-life iron deficiency (ID) compromises the developing hippocampus, driving adult deficits despite iron
repletion. The gene expression changes and regulatory mechanisms that drive these lasting deficits are poorly
understood. In previous animal studies of ID, concurrent anemia has been a confounding factor.
Objectives
Isolate the effects of developmental ID, independent of anemia, on adult hippocampal gene expression, and
determine whether iron repletion reverses these effects.
Methods
Transgenic mice carrying a dominant negative transferrin receptor (DN-TfR1) and CamKIIa-tTA were used to
generate non-anemic hippocampal neuronal-specific ID starting at embryonic day 18. Wildtype (WT) littermates
served as controls. Half of mice began doxycycline (Dox) treatment at postnatal day (P)21 to silence DN-TfR1
expression and restore neuronal iron status, generating 4 groups: Iron deficient (DN-NoDox), Formerly iron
deficient (DN-P21Dox), and Iron sufficient controls (WT-NoDox and WT-P21Dox, respectively). RNA from P90
hippocampi (n=4/group) was isolated, sequenced, and analyzed for differential expression. Differentially
expressed genes were further analyzed in Ingenuity Pathway Analysis.
Results
346 genes were differentially expressed between iron deficient and control hippocampus. Of these, 29% are
known to be enriched for the epigenetic modification 5-hydroxymethylcytosine (5hmC), implicating dysfunction of
iron-dependent Ten-Eleven Translocation (TET) proteins, which generate 5hmC. Pathway analysis revealed that
ID dysregulates genes in several critical neurodevelopmental pathways. Iron repletion at P21 normalized
expression of 198 genes, but left genes involved in CREB and PKA signaling dysregulated in adulthood.
Conclusions
Permanent ID beginning in development alters adult hippocampal neuronal gene expression, independent of
anemia. Restoring iron status at P21 rescues expression of >100 genes; however several synaptic plasticity
genes and pathways remain dysregulated in adulthood. Iron-dependent TET proteins and 5hmC are a possible
epigenetic mechanism for these lasting gene expression changes, and could drive the adult neurocognitive
deficits that follow ID in human infants.
13
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [2]
Name: Diana Wallin
Status: Graduate Student
Division: Pediatric Neonatology
Research Sponsor: Michael Georgieff
Short and long-term cerebellar and striatal metabolic alterations due to neonatal phlebotomy-induced
anemia
Background: Anemia is extremely common, especially for children receiving multiple daily blood draws during
their NICU stay. Phlebotomy-induced anemia (PIA) during this period causes alterations to the developing
hippocampus. Two structures that may be particularly vulnerable due to their developmental timecourse are the
cerebellum and striatum, structures critical to learning skilled motor movements.
Objective: To assess the effects of early-life PIA in mouse cerebellum and striatum.
Design/Methods: Postnatal day (P)3 mice were bled daily to induce anemia (hematocrit < 25%) during the first
two postnatal weeks of life. Concentrations of 17 metabolites indexing neurotransmission, phospholipid, and
energy metabolism were obtained by in vivo magnetic resonance spectroscopy in P14 cerebellum and striatum.
Mice recovered from early-life anemia from P14 until early adulthood where metabolism was assessed again
(P120) in addition to behavioral testing via the accelerating rotarod task (P65).
Results: At P14, striatal lactate concentration was increased 74% in PIA mice (p=0.01). Additionally,
phosphocholine concentration within the PIA cerebellum was decreased 18% (p=0.01). After recovery, formerly
PIA adult mice had a lower concentration of glutamate and glutamine (-6%, p=0.05) within the striatum. In the
formerly anemic cerebellum, mice had lower creatine (-11%, p=0.04) and higher phosphocreatine concentration
(+17%, p=0.03). Both glucose (+83%, p=0.02) and myo-inositol (+15%, p=0.02) concentrations in the formerly
anemic cerebellum were significantly higher. Formerly anemic mice had more difficulty in performance during the
accelerating rotarod task than never-anemic mice (P65).
Conclusion(s): Early-life patterning of metabolic processes is essential for proper long-term metabolic and
behavioral function. Alterations in several key metabolites within these brain regions in early-life led to greater
alterations that lasted well beyond the period of anemia into adulthood. It is important to understand these
changes in order to properly manage neonatal anemia during the NICU stay so as to prevent long-term neural
and functional consequences.
14
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [3]
Name: Nathan Schuldt
Status: Postdoctoral Fellow
Division: Pediatric Rheumatology
Research Sponsor: Bryce Binstadt
Dual TCRα expression poses an autoimmune hazard by limiting Treg cell generation
Nathaniel J. Schuldt, Jennifer L. Auger, Justin A. Spanier, Tijana Martinov, Elise R. Breed, Brian T. Fife, Kris A. Hogquist,
and Bryce A. Binstadt
Despite accounting for 10-30% of the T cell population in mice and humans, the role of dual TCR-expressing T
cells in immunity remains poorly understood. It has been hypothesized that dual TCR T cells pose an
“autoimmune hazard” by allowing self-reactive TCRs to escape negative selection. We revisited this hypothesis
using the non-obese diabetic (NOD) mouse model of type 1 diabetes (T1D). We bred NOD mice hemizygous at
both TCRα and β (TCRα+/- β+/-) loci, rendering them incapable of producing dual TCR T cells. We found that NOD
mice lacking dual TCRα expression were resistant to diabetes. However, resistance did not appear to be the
result of more efficient negative selection, as there were equivalent numbers of insulin-specific T cells in single
TCR T cell and WT NOD mice. Rather, resistance was attributable to increased regulatory T (T reg) cell
commitment in the insulin-specific T cell population, resulting in a more tolerogenic Treg:Tconventional ratio. We
observed a similarly skewed ratio in the bulk single positive (SP) thymocyte population indicating increased T reg
commitment occurs early, during thymocyte development. Agonist selection is a process by which strongly selfreactive thymocytes commit to the Treg lineage rather than submitting to negative selection. Increasing evidence
suggests agonist selection is governed by Aire-expressing medullary thymic epithelial cells (mTECs). InsB is
known to be regulated by Aire and expressed by mTECs. Insulin-specific thymocytes exhibited higher CD5
expression and decreased deletion in the signaled SP thymocytes of single TCR T cell NOD mice relative to WT
controls. Taken together, these data support a novel hypothesis in which dual TCRα expression limits agonist
selection by decreasing overall thymocyte avidity to agonistly selected self-antigens.
15
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [4]
Name: Isuruni Sonnadara
Status: Postdoctoral Fellow
Division: Pediatric Infectious Diseases
Research Sponsor: Mark Schleiss
A Prospective Blinded Study Finds that Symptomatic Breast Milk-Acquired Cytomegalovirus Infections in
a High-Risk NICU Population Often Escape Real-Time Bedside Diagnosis
Isuruni Sonnadara, Erin A. Osterholm, Mary Pat Osborne, Nelmary Hernandez-Alvarado, Mark R. Schleiss
Background: Short and long-term risks associated with post-natal CMV acquisition, particularly in premature
infants, remain largely unknown. CMV can be transmitted via breast milk from mother to infant. In healthy
immunocompetent infants, the infection is clinically asymptomatic. Preterm very low birth weight infants are at risk
for the development of symptomatic disease.
Objective: To examine the prevalence of CMV virolactia, CMV transmission rates via breastmilk, and whether
symptomatic disease occurs in infants with CMV DNAemia.
Methods: A prospective analysis of 58 mother-infant dyads was completed at the UMN/Masonic Children’s
Hospital NICU. Infants were <1500 grams and without congenital CMV infection. Weekly serial samples of
breastmilk and serum were analyzed for CMV via qPCR.
Results: In our analysis, viral load from breast milk and blood identified shedding of CMV virus in breast milk in
15/58 mothers (25.8%). Median viral load in breast milk was 1.7x104 copies/ml. 4 infants from the 19 infants
exposed to CMV-positive milk developed CMV DNAemia with a mean of ~250 copies/mL of serum. On average,
viremia occurred by day 55 after delivery. The CMV transmission rate via breast milk was 26.6 %. Clinical
complications of CMV were evaluated retrospectively in infants with proven DNAemia. Complications included
chronic lung disease (BPD); gram negative pneumonia; and sepsis syndrome with unexplained thrombocytopenia
and neutropenia. In one infant CMV infection was diagnosed by the primary care team in real-time, but in 3/4
(75%) the diagnosis of CMV infection was not considered.
Conclusions: Over 1/4th of mothers in our sample demonstrated CMV virolactia. Breast milk-infected infants in
this prospective analysis had symptomatic CMV disease, although in most cases this was not identified in realtime by the primary care team. Prospective surveillance for CMV DNAemia should be considered as a
component of routine anticipatory surveillance in NICU patients receiving breast milk.
16
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [5]
Name: Rachel DeVries
Status: Pediatric Resident
Division: Pediatric GME
Research Sponsors: Mike Pitt & Diana Cutts
Leveraging the EHR to Increase Food Security Screening and Access to Food Resources for Families
BACKGROUND: The American Academy of Pediatrics (AAP) published guidelines regarding food security
screening in November 2015. Prior to these guidelines, Hennepin County Medical Center (HCMC) Pediatric
Clinic, which serves a largely underserved population in Minneapolis, was not routinely screening for food
security.
OBJECTIVE: Leverage the electronic health record (EHR) to increase access to food resources by pairing
standardized food security screening during well child checks (WCC) with the ability to auto-refer to a food bank.
METHODS: We embedded the AAP’s recommended standard two-question screen for food security to WCC
templates, rolling them out in step-wise fashion based on age of WCC from April 2016 to August 2016. Providers
were encouraged to screen at each WCC and refer families screening positive for food insecurity using an order
embedded in the EHR which automatically connects the family with trained outreach workers at the regional food
bank.
We obtained the number of food assistance outreach referrals per month from HCMC pediatric clinics and nonpediatric clinics for 3 months prior to the screening implementation, and 3 months after the final implementation
and compared pre and post means with an unpaired t-test. Relative changes to the average monthly referrals
rates before and after screening implementation were compared.
RESULTS: After implementation of the EHR-based screening and referral, the average referrals per month to the
regional food bank from the pediatric clinics increased 3.8 fold from an average of 16 referrals/month to 60
referrals/month (p<0.001). In the same time periods, the non-pediatric clinics increased there referrals 2.2 fold
from 46 referrals/month and 100 referrals/month (p=0.03).
CONCLUSIONS: After incorporating the new AAP recommendation of standard food security screening into the
WCC templates and streamlining the referral process with an EHR based order, there was a nearly fourfold
increase in referrals to food assistance outreach, a 73% greater increase than that seen in the clinics not
implementing the EHR based screening. Leveraging tools within the EHR may help providers implement food
security screening and best serve their patients and their families.
17
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [6]
Name: Vishal Naik
Status: Pediatric Resident
Division: Pediatric GME
Research Sponsor: Mike Pitt
Weight-for-age percentile as a predictor of emergency department outcome in a tertiary care pediatric
center
Vishal Naik, MD, Cheryl Lefaiver, Ph.D, Avni Dervishi, MS1, Vinod Havalad, MD
Background:
Obesity in adults is a major risk factor for admission from the emergency department (ED), but studies examining
pediatric weight-for-age as a predictor of admission for all diagnoses have not been performed
Objectives:
To test the association between weight-for-age percentile and pediatric admission from the ED
Methods:
A retrospective cohort study of 1410 pediatric ED visits from 2013-2015 was conducted at a tertiary children’s
hospital. Patients were separated into 4 categories by age and weight. Those greater than 18.0 years and those
who had repeat visits were excluded from the study. Variables examined in the study were ED disposition, ageadjusted weight category, reason for visit, and Emergency Severity Index (ESI). Associations between weight-forage and outcome category were analyzed using chi-square and logistic regression.
Results:
In our sample, 76 (5.3%) patients were underweight, 919 (65.1%) were normal, 215 (15.2%) were overweight,
and 222 (15.7%) were obese. Overall, patients in the underweight weight category were more likely to be
hospitalized than those in the normal weight group (OR 2.79, P < .001). Younger age (OR .935, P < .001) and
higher acuity (ESI OR 3.79, P < .001) were also significant predictors of admission. Analyses per age group
showed underweight patients less than 2.0 years (OR 1.99, P = .045), 2.01-6.0 years (OR 9.47, P = 0.007), and
6.01-13.0 (OR 5.22; P = 0.034) were more likely to be hospitalized than normal weight children. There was no
significant association found in the underweight category for patients 13.01 years and older (OR 3.34, P = .320).
There were no significant associations found between the overweight/obese weight categories and admission for
any of the age groups.
Conclusions:
Underweight children less than 13 years are more likely to be hospitalized from the ED as compared to the
normal weight, overweight and obese children. When compared to ESI, the current standard of severity
prediction, a lower weight-for-age percentile proved to be a comparable predictor of hospitalization. The results of
this study may prompt the addition of weight-for-age percentile as a metric for emergency triage scoring.
18
Image:
19
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [7]
Name: Erin Plummer
Status: Pediatric Fellow
Division: Pediatric Neonatology
Research Sponsors: Johannah Scheurer & Sara Ramel
PRETERM BODY COMPOSITION ACCRETION THROUGH PRESCHOOL AGE
IS ASSOCIATED WITH COGNITION
E. Plummer, J. Scheurer, L. Zhang, E. Demerath, N. Miller, S. Hultgren, S. Ramel
University of Minnesota, Minneapolis, MN, USA
BACKGROUND: Early growth is critical for optimal neurodevelopment among preterm infants. Preterm infants
have lower fat-free mass (FFM) and higher percentage of body fat (%BF) at term in comparison to their healthy
term counterparts. Higher FFM at 4 months corrected age (CA) has been associated with improved cognitive
scores and faster neural speed of processing.
OBJECTIVE: To determine if neonatal to preschool age body composition changes are associated with cognitive
function.
METHODS: A prospective, observational study examined growth, body composition, and cognition in appropriate
for gestational age (AGA) preterm infants (n = 20) as compared to their term, AGA counterparts (n = 51) from
infancy to preschool-age. Anthropometric measurements and body composition testing via air displacement
plethysmography were obtained at term (Visit 1, V1), 4 months CA (Visit 2, V2), and 4 years of age (Visit 3, V3).
Neurocognitive testing at 4 years of age included the Wechsler Preschool and Primary Scale of Intelligence-IV
(WPPSI-IV) test and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Linear regression
was used to test the association of body composition accretion (rate of FFM and %BF gain from V1 to V2 and V2
to V3) with cognitive function at 4 years.
RESULTS: Rates of FFM gain in preterm and term infants were similar from V1 to V2 and from V2 to V3. Rates
of fat mass (FM) gain were significantly less in preterm infants from V1 to V2 (59.8 g/wk vs 90.7 g/wk, p=0.0010)
and similar from V2 to V3. In preterm infants, gains in %BF from V1 to V2 were associated with poorer working
memory (lower working memory index score and more errors in CANTAB working memory tasks). Faster gains
in FFM from V2 to V3 were associated with improved full scale IQ and speed of processing tests. (Table 1)
CONCLUSIONS: Differences in infant and early childhood body composition are associated with neurocognition
in preschool-age, preterm-born children. In this small study of 20 preterm infants, growth in lean and adipose
tissue compartments and at different time points appear to influence distinct areas of the brain. If supported in
larger studies, this could point to critical windows during which closer attention to body composition trajectories
may be needed to optimize different domains of neurocognitive development.
20
Variable
IQ
Table 1. Cognitive factors in preterm infants as associated with rate of body composition change
V1-V2: FFM Rate
V2-V3: FFM Rate
V1-V2: %BF Rate
Estimate
pEstimate
p-value
Estimate
pTest
(SE)
value
(SE)
(SE)
value
0.85 (0.4)
0.0332
WPPSI-IV
0.03 (0.2)
0.8562
-5.63 (7.9)
0.4880
Full Scale IQ
V2-V3: %BF Rate
Estimate (SE)
pvalue
-61.97 (68.2)
0.3781
0.07 (0.2)
0.6916
0.95 (0.4)
0.0154
1.47 (8.2)
0.8594
-41.00 (70.3)
0.5682
-13.14 (29.7)
0.6658
-244.79
(43.6)
<0.0001
431.16
(1534.5)
0.7831
7107.14
(12707.2)
0.5855
-0.14 (0.2)
0.4668
0.28 (0.4)
0.5192
-20.92 (6.3)
0.0046
-18.62 (72.1)
0.7996
0.10 (0.1)
0.2151
0.02 (0.2)
0.9217
8.52 (3.2)
0.0218
41.68 (34.8)
0.2545
0.12 (0.1)
0.3559
0.32 (0.4)
0.3919
13.27 (4.8)
0.0178
-87.70 (53.6)
0.1300
21.61 (6.1)
0.0045
CANTAB
0.22 (0.2)
0.2092
0.45 (0.5)
0.3962
-58.76 (83.7)
SWM
Total error
*All variables are adjusted for sex, race, and mother’s education level
PSI = Processing Speed Index; DMS = Delayed Matching to Sample; WMI = Working Memory Index; SWM = Spatial Working Memory
0.4971
Processing
Speed
Working
Memory
WPPSI-IV
PSI
CANTAB
DMS Mean Correct
Latency
WPPSI-IV
WMI
CANTAB
SWM
4-box error
CANTAB
SWM
6-box error
21
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [8]
Name: Katie Satrom
Status: Pediatric Fellow
Division: Pediatric Neonatology
Research Sponsor: Raghu Rao
Mild Hyperbilirubinemia Alters the Neurochemical Profile, Gene Expression, and Dendritic Arborization in
the Hippocampus of Preterm Gunn Rats
K Satrom1, I Tkac2, K Czerniak1, R Rao.1 Department of Pediatrics1, CMRR2; University of Minnesota, Minneapolis, MN.
Background: Hyperbilirubinemia is common in preterm infants. High levels of unconjugated bilirubin (UCB) lead
to encephalopathy by targeting the basal ganglia. The effects of low UCB levels on the hippocampus are
unknown.
Objective: To determine the effects of low UCB levels on hippocampal neurochemistry, gene expression, and
dendritic arborization in a preterm Gunn rat model of hyperbilirubinemia.
Methods: Control (Jj, n=6) and jaundiced (jj, n=6) Gunn rats were studied. Homozygous (jj) pups develop
jaundice in the neonatal period due to a UDP glucuronyl-transferase mutation, while heterozygotes (Jj) remain
unaffected. The concentrations (conc) of 18 neurochemicals in the hippocampus were determined using in vivo
1
H NMR spectroscopy (MRS) at 9.4T on P5 and P12. mRNA expression of markers of oxidative stress (p53,
PARP-1) and anti-oxidant potential (GPX4, SOD2) were determined on P28 using qPCR. Effects on dendritic
arborization were determined using microtubule-associated protein 2 (MAP2) immunohistochemistry on P28.
Results: Mean ± SD (mg/dL) UCB levels were higher in the jj group on P5 (3.9 ± 0.7), P12 (8.8 ± 0.8), and P28
(3.1 ± 0.3) relative to the Jj group (0.0 mg/dL, p<0.01). Taurine (Tau; -6%, p=0.01) conc was lower on P5 and Nacetylaspartate (NAA; +4%, p=0.04) higher on P12 in the jj group. On P28, p53 (+23%; p<0.01), PARP-1 (+26%;
p=0.16), GPX4 (+25%; p<0.05) and SOD2 (+23%; p=0.13) mRNA expression was upregulated in the jj group.
MAP2 histochemistry demonstrated disorganized CA1 dendrites in the jj group.
Conclusions: Mildly increased UCB levels alter the neurochemistry, gene expression and structure of the
developing hippocampus. The MRS data suggest higher excitotoxicity potential on P5 and impaired myelination
on P12. Upregulation of markers of oxidative stress on P28 suggest risk for oxidant-mediated injury. Impaired
dendritic complexity on P28 suggests lasting structural changes. Mild hyperbilirubinemia may be responsible for
the hippocampus-mediated deficits in preterm infants.
22
POSTER
SESSION
23
UNDERGRADUATE /
GRADUATE /
MEDICAL
STUDENTS
Abstracts (9-29)
24
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [9]
Name: Ifeolu Akinnola
Status: IBP MD/PhD Student
Division: Pediatric BMT
Research Sponsor: Angela Panoskaltsis-Mortari
Reconstitution of Pulmonary Vasculature Using Endothelial Progenitor Cells
Ifeolu Akinnola, Carolyn Meyers, Angela Panoskaltsis-Mortari PhD
Within pulmonary medicine, there are many individuals that develop end stage lung diseases
from pulmonary diseases such as cystic fibrosis and emphysema. This disease state subsequently
leads to a decreased lifespan and lower quality of life. Treatment requires a transplant, which is
difficult due to limited usable donor lungs and post-transplant complications.
Whole organ decellularization and recellularization is a rapidly growing area in tissue engineering
research with the intent to bioengineer transplant organs for patients. By growing an organ using a
patient’s own reprogrammed cells there is hope that patients can obtain a new organ sooner and
decrease the rate of organ rejection. Decellularization has been optimized to maintain the extracellular
composition and ultrastructure of decellularized lung scaffolds (DLS). Maintaining lung ultrastructure
and ECM composition is critical as they provide cues to aid progenitor cells into differentiating towards
the proper cell types within the airway, vasculature and parenchyma. In terms of recellularization there
is still more work to be done on recreating the lung itself.
Our lab is interested in the potential of hemangioblasts, a known progenitor for
hematopoietic and endothelial cells, to reconstitute pulmonary vascular endothelium. The
objective of our project is to expand on the current knowledge of hemangioblasts differentiation
by characterizing their growth in DLSs and on gel composed from the ECM of DLSs. Our
hypothesis is that DLSs will be able to improve the efficiency of hemangioblasts to differentiate
into endothelial cells, thus bringing current research closer to creating highly functional and
implantable lungs.
Figure. Flow cytometry plots of iPSCs differentiated into hemangioblasts following a modified
protocol from Uenishi et al.1 Differentiation was carried out on Corning® Synthemax™ II (A)
and Tenascin C (B) coated plates. Plots compare percentages of stem cell and endothelial
cells markers expressed in each culture population as well at FITC/PE/APC controls.
25
B
A
1. Uenishi G, Theisen D, Lee JH, Kumar A, Raymond M, Vodyanik M, et al. Tenascin C
promotes hematoendothelial development and T lymphoid commitment from human
pluripotent stem cells in chemically defined conditions. Stem Cell Reports 2014; 3
(6):1073-1084.
26
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [10]
Name: Ranyah Aldekhyyel
Status: PhD Student
Division: Pediatric Hospital Medicine
Research Sponsor: Mike Pitt
An Epic Solution for Pain Reassessment: A Novel Patient
Communication Approach Interfacing Four Hospital Technologies
Ranyah Aldekhyyel a, Genevieve B. Meltona,b , Jason Albrechtc, Yan Wang a, Bruce
Lindgrend,Michael B. Pitte
a
Institute for Health Informatics, bDepartment of Surgery, c Masonic Children’s
Hospital,d Clinical and Translational Science Institute, eDepartment of Pediatrics;
University of Minnesota, MN
PURPOSE: Nursing documentation of pain reassessment is low. We created a novel
Pain Management Interface (PMI) connecting four independent technology systems.
At a pre-defined time after medication is administered, a pop-up reas- sessment
appears on the patient’s television with results communicated to the nurse’s phone
and automatically documented in the Electronic Health Record (EHR) (Figure 1). We
wished to study this tool’s effect on pain reassessment documenta- tion.
METHODS: We extracted pain reassessment documentation data from the EHR for a
period of 22 months (Jan.2014- Nov.2015) covering pre and post implementation
periods. Nursing pain reassessment documentation compliance rates were calculated
using the same standards followed by the hospital (e.g., 30 – 65 minutes
documentation post oral narcotic ad- ministration, 15- 35 minutes documentation post
intravenous narcotic administration). Statistical methods for analysis in- cluded Chisquare test and Wilcoxon rank sum test.
27
RESULTS: We identified 56,951 records of pain medication administration (29,707
during the 11 months pre implementa- tion; 27,244 post). Documentation improved
post-implementation (51.8% to 53.4%) with an increase in timely documenta- tion
(26.1% to 32.8%) and a decrease in median time of documentation (29.0m to 25.0m).
When patients/parents used the tool (1,767/27,244; 6.5%) nursing documentation
increased from 52.7% to 63.4% (all p-values < 0.001).
CONCLUSION: Our study proved that we could successfully integrate four
independent technology systems, which will likely have other uses beyond this pain
management pilot. While nursing pain reassessment documentation and usage of the
tool by patients/parents was low, implementation of the PMI led to significant
increases in overall nurse timely documenta- tion of reassessment (25.7% increase)
and a (13.8%) decrease in the median time to documentation.
28
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [11]
Name: Zineb Alfath
Status: Undergraduate
Division: Pediatric Emergency Medicine
Research Sponsor: Kari Schneider
Do Adolescent Mental Health Patients Receive a Sexual History or Screening for
Sexually Transmitted Infection in the Emergency Department?
Kari Schneider, MD; Zineb Alfath; Daniel Nerheim; Jeffrey Louie, MD.
Objective: To determine frequencies of physician-documented sexual history and STI
screening in adolescents presenting to a PED with mental health-related complaints.
Background: Sexually transmitted infection (STI) rates among adolescents in pediatric
emergency departments (PED) are as high as 10-20% and a large proportion are
asymptomatic. It is well established that adolescents with psychiatric conditions and
substance use more commonly engage in high-risk sexual behaviors. These adolescents
presenting to PEDs with these issues may be an especially important population in which to
target screening efforts.
Methods: A retrospective study of patients aged 14-18 presenting to a PED from February
2015 to September 2016. Electronic medical records were reviewed for demographics,
chief complaint, sexual history documentation, gonorrhea/chlamydia screening, resident
involvement in patient care, and disposition. Proportions were calculated, and chi square
analyses and Fisher exact tests evaluated factors associated with documentation and
screening.
Results: 285 patient encounters were identified, ranging from 15-18 years. The most
common chief complaint was “intentional ingestion/overdose” (169 encounters, 59.3%)
followed by “suicidal/attempted suicide” (59, 20.7%). 76 patients (26.6%) had sexual history
documented. Female patients were more likely to have sexual history documented (75% vs
52%, p=0.0005). 31 patients (40.8%) denied any sexual activity or stated they were
recently tested for STI. 45 (59.2%) patients were noted to be sexually active, and 17
(37.8%) of these were screened for STI. There was no relationship between screening and
race, gender, or involvement of a resident in patient care.
Conclusions: In a high risk population, physicians documented a sexual history only 26.6%
of the time. Female patients were more likely to be asked sexual history, and less than half
of patients with a sexual history indicating risk for STI were screened. Future work can be
directed at improving both sexual history taking in this population as well as increasing
screening.
29
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [12]
Name: Erin Balay
Status: Medical Student
Division: Pediatric Emergency Medicine
Research Sponsor: Jeff Louie
Identifying Barriers to the Timely Dosing of Intravenous Antibiotics in Children
Presenting to a Pediatric Emergency Department: An EPAC Driven QI Project
Erin Balay, Wenliang Geng, Leah Krause, Matthew Thompson, Shane Mcwhirter, Patricia
Hobday, Shannon Wagner, Theresa Cahill, Lucie Turcotte, Dan Nerheim, Jeff Louie
Background
A central line (CL) is a surgically inserted catheter into a central vein which is commonly
placed in children with blood or solid tumors undergoing chemotherapy. These children
often present to the ED with fevers and neutropenia. Timely antibiotics within an hour is
an Oncology and ED benchmark and has proven to reduce mortality in children in septic
shock. In our ED, we initiated a QI project to determine barriers to timely administration of
antibiotics.
Methods
In order to identify barriers, we first administered an electronic survey (Survey Monkey®)
to all ED and Float Pool nurses to determine current perspectives on common barriers to
accessing a patient's CL and administering antibiotics. We then developed a Key Driver
Diagram to outline our approach.
Results
A total of 17 of 22 (77%) nurses responded to the survey. Respondents felt a majority of
children do receive antibiotics within an hour (74%). Common barriers to administering
antibiotics included: only 31% of parents can recall the child’s port type, only 25% of
parents can recall the needle length, and less than half (45%) of children presenting to
the ED have topical anesthetic covering their port site. The respondents felt that the port
information can be found in the EMR (electronic medical records) within 10 to 30
minutes.
Conclusion
Our results found 4 potential barriers to timely administration of antibiotics: lack of parental
knowledge of port type and needle length, absence of topical anesthetic covering the port,
and delays finding port information in the EMR. Working with the Oncology team, port
information is now readily available in the EMR. We have also developed an infographic
brochure and wallet card to remind parents of their child's port information, what will
happen in the ED, and to place topical anesthetic prior to leaving home.
30
Figure 1: Key driver diagram; barriers to timely antibiotic administration and project
interventions
31
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [13]
Name: Amanda Barks
Status: MD/PhD Student
Division: Pediatric Neonatology
Research Sponsor: Phu Tran
Proteomic Analysis of Cord Blood Exosomal Proteins Altered by Fetal Iron Status
1Amanda
1Masonic
Barks, 2Sharon E Blohowiak SE, 2Pamela J Kling, and 1Phu V Tran
Children’s Hospital, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455
2Meriter Hospital, University of Wisconsin Madison, Madison, WI 53715
Background: Iron deficiency (ID) anemia during pregnancy is common worldwide, causing
long-term cognitive and socio-emotional abnormalities. Current serum-based diagnostic
markers for ID are neither sensitive nor specific, and can be confounded by variables
including maternal inflammation and body mass index (BMI), which have been correlated
with lower maternal/fetal iron status. Additionally, current markers do not index fetal brain
iron status, which is likely already iron deficient by the time of diagnosis.
Objective: Identify serum-based biomarkers with predictive value for fetal-neonatal brain
iron status across varying maternal BMI.
Methods: Cord blood plasma samples were obtained at routine C-sections. Maternal BMI
was classified into 2 categories around a threshold of 30 kg/m2. Cord blood iron status was
determined by serum ferritin level, and was classified as adequate (≥84 ng/mL), or low (<84
ng/mL). Exosomal proteins were isolated and quantified using isobaric tagged for relative
and absolute quantitation (iTRAQ). Quantified proteins were analyzed for differential
expression between iron status groups, and between BMI groups. ELISA was used to
validate target proteins.
Results: BMI and iron status were correlated (p=0.06, n=31). >140 exosomal proteins were
quantified in cord blood plasma samples (n=14). Clusterin was differentially expressed
between BMI groups, but still correlated significantly with iron status. We used ELISA to
confirm this finding, and found that Clusterin levels were highest in those with high BMI and
low iron status (p=0.07, n=16). Notably, clusterin is expressed highly in the brain, and has
been previously identified as a potential marker of both active and past developmental ID.
Conclusions: Proteins altered in the central nervous system in animal models of
developmental ID anemia are also identifiable in human cord blood exosomes. Additional
testing and validation is needed to establish clusterin as an early blood-based index of
brain iron status.
32
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [14]
Names: Mackenzie Diekmann and Megan Reinhard
Status: Medical Student/Undergraduate
Division: Pediatric Infectious Diseases
Research Sponsor: Bazak Sharon
Epidemiology and Clinical Features of Septic Arthritis in Children (1-18yo)
Mackenzie Diekmann, Megan Reinhard , Bazak Sharon
Objectives: Children with acute arthritis are commonly admitted to the hospital. Septic
arthritis (SA) and the concerns of its complication often direct management. Benign
conditions (e.g. Lyme arthritis) are common and may present similarly. Understanding the
epidemiology and clinical presentation of SA is crucial when managing patients with acute
joint arthritis.
Methods: Utilizing the EMR we retrieved the charts of all children (1-18yo) who presented
to hospitals and clinics of one large academic health organization between Jan 2011 – July
2016 with chief complaints of arthritis, joint swelling, joint pain and/or diagnoses of arthritis,
Lyme arthritis (LA), or SA. Septic arthritis was confirmed when synovial bacterial culture or
PCR were positive. SA was suspected in cases with negative synovial culture, with positive
blood culture, or in patients without an alternate diagnosis who completed 4 weeks of
antibiotics.
Results: 705 charts were reviewed. Non-infectious etiologies (609) and those with Lyme
arthritis (72) were excluded. Of the study cohort of 24 children with SA (figure 1), 6 patients
had joint infection complicating pre-existing serious illness. Seven patients had extensive
musculoskeletal (MSK) infection (myositis, osteomyelitis), evident on physical exam and
confirmed by imaging. Acute, isolated, monoarthritis (AIMA) was diagnosed in 11 patients.
Five had knee arthritis, 2 of which had a specific complicating factor (puncture trauma,
steroid course). Staphylococcus was the most common pathogen, though 5 had no positive
cultures.
Conclusion: Pediatric joint infection, is usually managed inpatient and has a wide spectrum
of clinical presentations and prognoses, though lab abnormalities overlap (table 1). When
SA complicates serious pre-existing illness it carries significant morbidity and should be
managed aggressively. In healthy children, SA may be a part of extensive MSK infection, or
isolated. Suspected MSK infections should prompt IV antibiotics and surgical interventions.
In patients with AIMA watchful waiting is a safe approach.
33
34
35
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [15]
Name: Aya Eid
Status: Undergraduate
Division: Pediatric Cardiology
Research Sponsor: Shanthi Sivanandam
Maternal Diabetes and Fetal Cardiac Output
Aya Eid, Ayesha Bhatia, Julia Steinberger, Shanthi Sivanandam
Background: The in-utero environment is a key determinant of long- term health
outcomes for the child and a poor maternal metabolic state (diabetic, placental
insufficiency) is strongly associated with long- term health risks. Myocardial hypertrophy
has been observed in fetuses of diabetic mothers, as early as 20 weeks, even with
reasonable metabolic control. Little is known about the difference in fetal cardiac output
hemodynamics of diabetic mothers (DM) vs non diabetic mothers (NDM). Our study aims
to investigate the left and right sided cardiac output in fetuses of DM vs NDM. Methods:
Retrospective data were collected with GE Voluson/Phillips in 519 fetuses of DM and 53
NDM at a mean gestational age of 23 weeks. Examination included 2D echo and pulse
wave Doppler using variable frequency transducer. Imaging included aortic (AV) and
pulmonary valve (PV) annulus diameter, aortic and pulmonary velocity time interval, and
heart rate. Fetal weight was calculated using the Hadlock formula. Cardiac output was
calculated using = [0.785* (d^2) * TVI * HR] / wt. Wilcoxon rank sum tests were used to
compare distributions of maternal and fetal continuous measures between DM and NDM.
The Chi- square test was used to test for association between diabetic status and
delivery method. Results: DM mothers had higher mean weight (94.3 +/- 23.4 kg) than
NDM (75.1 +/- 14.6 kg), p < 0.0001. Due to high fetal weight (table), 66% of DM fetuses
were delivered by C- section. All fetuses had normal cardiac anatomy. Fetuses of DM
mothers had significantly larger AV diameter, higher LV output, combined cardiac output,
and lower RV output compared to NDM (table). Conclusion: The greater combined and
left sided cardiac output in the fetuses of DM, compared to NDM, after adjustment for
fetal weight, may represent differences in cardiac adaptation to the diabetic environment.
Postnatal follow-up could provide further insight in the mechanisms of these changes.
36
Fetal Measures
Gestational age (wks)
Fetal weight (kg)
Heart rate (bpm)
Pulmonary valve
diameter (mm)
PV VTI
Ao valve diameter
(mm)
Ao VTI
RV output
LV output
RV % (RV/combined)
LV % (LV/combined)
RV/LV Ratio
Combined Cardiac
output / kg
(mL/min/kg)
Diabetes N=519
(type I-150, II-207,
Gestational-162)
Mean (SD)
23.29 (2.91)
0.77 (0.44)
145.44 (8.92)
4.71 (1.00)
Non diabetic N=53
Mean (SD)
23.66 (3.71)
0.72 (0.51)
145.91 (8.30)
4.08 (1.06)
0.091
0.013
0.958
<0.0001
7.11 (1.63)
4.12 (0.87)
7.22 (1.62)
3.37 (0.71)
0.626
<0.0001
7.41 (1.54)
193.37 (117.16)
150.77 (79.23)
55.17 (9.33)
44.83 (9.33)
1.34 (0.55)
474.86 (168.33)
7.14 (1.71)
152.83 (104.13)
100.57 (59.85)
58.86 (8.46)
41.14 (8.46)
1.61 (1.12)
392.06 (144.45)
0.256
0.0007
<0.0001
0.007
0.007
0.007
0.001
37
P-value for
Wilcoxon ranksum test
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [16]
Name: Zach Galliger
Status: BME Graduate Student
Division: Pediatric BMT
Research Sponsor: Angela Panoskaltsis-Mortari
Cartilage-Derived Extracellular Matrix Methacrylamide for 3D Bioprinting of PediatricSized Trachea
Zachary Galliger1, James Wollack PhD2, Angela Panoskaltsis-Mortari PhD1 University
of Minnesota, Minneapolis MN1, St. Catherine University, St. Paul MN2
Pediatric patients suffering from tracheal defects such as tracheal atresia or tracheomalacia have very
few treatment options. Most often these defects are corrected with surgical intervention, but when the
affected area reaches a critical length replacement tissues are required. These implants are currently
synthetic materials that will not adapt to the growing child. Therefore, they require multiple surgeries to
replace the implant over time. Alternatively, bio-engineered tracheal tissue capable of integrating and
growing with the host could be transplanted. This work seeks to create this bio- engineered tracheal
tissue using 3D bioprinting and decellularized tracheal extracellular matrix. Gelatin methacrylamide
(GelMA) and extracellular matrix methacrylamide (ECM-MA), have been used to create mechanically
stable and tunable photo-crosslinking hydrogels. [1,2] We have developed ECM- MA from decellularized
porcine tracheal cartilage by combining previously described techniques. [1,3] Currently our work is
focused on optimizing ECM-MA/GelMA blends for 3D bioprinting neocartilage by examining the effects
of the degree of chemical modification of the proteins and their combinations on the compressive
modulus. Initial results of this work are shown in figure 1, where we examined the compressive modulus
of GelMA with high and low degrees of chemical modification with methacrylic acid (MA) and the effect
of adding ECM-MA to these gels. Four different blends were tested: 1) entirely composed of high MA
GelMA (H-GelMA); 2) 70% H-GelMA and 30% ECM-MA; 3) only low MA GelMA (L-GelMA); 4) 70% LGelMA with 30% ECM-MA. There was a significant difference between the H-GelMA and L-GelMA
moduli, indicating the degree of modification significantly impacts the compressive modulus. The
addition of ECM-MA to the H-GelMA decreased its modulus, most likely because the ECM-MA had
fewer methacrylamide groups, decreasing the crosslinking potential of the gel. However, the addition of
ECM-MA did not significantly impact the modulus of the L-GelMA, suggesting the ECM-MA and LGelMA had a similar degree of modification. We are now examining how mesenchymal stromal cells
interact with these hydrogel scaffolds to produce bio-engineered trachea.
Compressive Moduli of GelMA
References
1. Benton JA.Tissue Eng
Part A. 2009;15(11):32213230
2. Visser J. Tissue Eng Part A.
2015;21(7- 8):1195-1206
3. Price AP. Tissue Eng
Part A. 2010;16(8):25812581-2591.
Modulus (kPa)
150
*
100
50
0
H
ECM+H
L
ECM+L
Figure 1: The compressive moduli of gels: (H) HGelMA; (ECM+H) H-GelMA with ECM-MA; (L)
L-GelMA; and (ECM+L) L-GelMA with ECM-MA. N
= 3. Mean, ± standard deviation shown. *P value of
0.05.
38
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [17]
Name: Robert Gruhl
Status: Medical Student
Division: Pediatric Hospital Medicine
Research Sponsors: Andrew Olson & Micah Niermann
Not All that Vesicles is Herpes
Eczema coxsackium (EC) typically presents with a widespread vesicular rash, fever, and pain,
much like the feared diagnosis eczema herpeticum (EH). In contrast to EH, which has severe
complications and involves treatment with acyclovir, EC is less common, self- limited, and usually
only requires supportive measures. Atopic dermatitis (AD), a risk factor for EC, can also complicate
management as it allows for more aggressive infection via intrinsic skin barrier defects. We
describe a case of EC in a patient with history of mild AD who was initially diagnosed with and
treated for EH. Prompt recognition of risk factors and targeted testing for coxsackievirus allowed for
limited exposure to acyclovir and a shorter hospital stay. Pediatricians should be aware of EC
when EH is suspected because early identification can lead to more appropriate use of medical
resources and decreased exposure to antivirals and antibiotics.
Figure 1: Eczema coxsackium of trunk and legs. Notably the rash involves the extremities much
more than the trunk.
39
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [18]
Name: Kathryn Hiolski
Status: MPH Student
Division: General Pediatrics and Adolescent Health
Research Sponsor: Rebecca Shlafer
BEHAVIORAL INDICATORS OF PHYSICAL HEALTH AMONG YOUTH WITH INCARCERATED
PARENTS
Kathryn Hiolski (Pre-doctoral LEAH Fellow, MPH Student)
Research Sponsor: Rebecca Shlafer, PhD, MPH
Background: Mass incarceration is becoming one of this country’s most detrimental public health
problems. Children are particularly affected by this phenomena, as it is estimated that more than 5
million children have had an incarcerated parent at some point in their lifetime. Parental incarceration
is associated with a host of adverse outcomes, including children’s engagement in health-risk
behaviors that may negatively influence their mental and physical health.
Methods: Using cross-sectional data from the 2016 Minnesota Student Survey (MSS), this secondary
data analysis examined behavioral indicators of physical health in 8th, 9th, and 11th grade students (N
= 117,563). Behavioral indicators of physical activity, fruit and vegetable consumption, fast food
consumption, sugar-sweetened beverage consumption, and sleep were assessed. We also included a
measure of perceived overall health. Logistic regression models controlling for demographic
characteristics (e.g., age, race/ethnicity, food insecurity) compared youth with currently and formerly
incarcerated parents to youth with no history of parental incarceration.
Results: As predicted, parental incarceration was significantly associated with lower levels of healthy
behaviors (i.e., physical activity, fruit and vegetable consumption, and sleep) and higher levels of
unhealthy behaviors (i.e., fast food consumption and sugar-sweetened beverage consumption).
Surprisingly, youth with currently incarcerated parents did not differ significantly from youth with
formerly incarcerated parents.
Conclusion: Parental incarceration was associated with youth engagement in negative health
behaviors, even if the parent was not currently incarcerated. This suggests parental incarceration is
associated with long-lasting effects on children’s behavior, and emphasizes the need for practitioners
and policy-makers to focus on interventions for this high-risk group of children and their families.
40
Table 1
Descriptive Statistics by Incarceration Status
117,563
117,563
117,563
Full Sample
Mean (SD) /
%
14.8 (1.32)
50.4
27.1
0 = None
Mean (SD) /
%
14.8 (1.32)
50.0
21.5
1 = Former
Mean (SD) /
%
14.8 (1.30)
52.8
54.3
2 = Current
Mean (SD) /
%
14.7 (1.28)
47.2
63.9
117,563
9.0
6.7
18.7
33.9
117,563
117,290
116,906
25.2
67.7
30.7
22.6
70.7
31.8
37.0
52.8
24.6
49.7
52.0
29.4
116,850
53.4
55.2
44.6
43.8
116,767
115,683
116,859
71.6
76.0
37.6
70.9
74.7
39.4
75.7
82.1
28.9
74.4
83.7
29.3
N
Age (years)
Gender (1 = Female)
Free/Reduced-price lunch (1 =
Yes)
Economic hardship (1 = At least 1
risk)
Race/ethnicity (1 = Not White)
Overall health (1 = Good health)
Physical activity (1 = At least 6
days)
Fruit/vegetable consumption (1 =
MR*)
Fast food consumption (1 = Any)
SSB consumption (1 = Any)
Sleep (1 = MR)
*MR = Meets Recommendation
41
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [19]
Name: Tarissa Host
Status: Undergraduate
Division: Pediatric Emergency Medicine
Research Sponsor: Jeff Louie
Can a Pediatrician Change Culture at a General Emergency Department? Reducing Cervical
Spine CT Use for Neck Trauma – A Preliminary Report
BACKGROUND: The prevalence of medical radiation exposure to children is increasing, likely from
overuse of Computed Tomography (CT) scanning by Emergency Medicine providers as 90% of
children are evaluated in adult emergency departments (EDs). In children, medical radiation is now
believed to cause brain tumors and leukemia at a rate of 1 in 10,000 after exposure from a CT scan.
The rate of cervical spine CT scanning is on the rise, yet the prevalence of cervical spinal cord injury
(CSI) is less than 1%. Our goal is to decrease C-spine CT rates among four adult EDs in the
surrounding area.
METHODS: ED sites were presented with 2 to 3 didactic learning sessions. Sites were also provided
Neck Injury Guidelines and relevant literature. We used Quality Improvement (QI) methods and
Control Charts to track historical control data and “prospective” data. A pre-intervention survey was
also distributed to all providers.
RESULTS: We created run charts for C-spine CT (CSCT) and C-spine radiographs (CSR) rates.
Baseline median rate of CSCT was 11 per month and decreased to a median of 10 per month after
interventions. CSR baseline rate was a median of 30 per month that decreased to 29 per month. No
child had a CSI. Survey results indicated a majority of providers order CT scans based on their
training (19%), followed by uneasiness interpreting c-spine films (23%) and 34% feel a CT scan is
superior to radiographs.
CONCLUSION: We showed a decrease in CSCT and CSR use after our interventions. Survey results
indicate that a mixture of barriers exist for reducing Neck CT scans. Our next PDSA cycle is to provide
ED Directors with providers who commonly order CT scans, develop a patient-centered care tool for
families, and assist ED providers in using the tool.
42
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [20]
Name: Neil Hultgren
Status: Graduate Student
Division: Pediatric Epidemiology and Clinical Research
Research Sponsor: Justin Ryder
Central Blood Pressure Regulation in Relation to Hypertension and Adiposity in Youth
Neil E. Hultgren4, Nicholas G. Evanoff4, Alexander M. Kaizer2, Kyle D. Rudser2, Donald
R. Dengel1, 4, Aaron S. Kelly1, 3, Justin R. Ryder1
1)
2)
3)
4)
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
School of Kinesiology, University of Minnesota, Minneapolis, MN
Introduction
The relationship between different central BP measurements with hypertension status in youth is not
well documented. We hypothesized that measures of central BP would be positively associated with
hypertension status in youth independent of adiposity.
Methods
We recruited 149 males and 160 females for this cross-sectional analysis (mean±SD: age
= 12.8±2.7; BMI percentile (%) = 78.5±27.8). Body fat % was measured by dual energy X-ray
absorptiometry (DXA) and brachial BP was measured using an automated cuff to calculate systolic BP
(SBP) and diastolic BP (DBP). Determined by systolic percentile, there were 238 normotensive
th
th
th
th
(<90 ), 29 pre- <95
) individuals enrolled. Central
BP was determined using the SphygmoCor MM3 system to calculate carotid-aorta SBP (caSBP)
carotid-aorta DBP (caDBP) radial-aorta SBP (raSBP) and radial-aorta DBP (raDBP).
Central BP measures were compared across hypertension status groups using ANCOVA, with post-hoc
Tukey HSD, adjusted for age, sex, and race. Pearson correlations (unadjusted) and multiple linear
regression models, examining the relationship between central BP measures with brachial BP adjusted
for age, sex, race, and height, were conducted with further adjustment for body fat % (shown as β±SE).
Results
raSBP, caSBP, raDBP, and caDBP were significantly different between the normotensive and
hypertensive groups (all p<0.001). No statistically significant differences were found between
normotensive and pre-hypertensive or between pre-hypertensive and hypertensive groups. raSBP and
caSBP were correlated to SBP (r=0.59, r=0.62, respectively, p<0.001). raDBP and caDBP were
correlated to DBP (r=0.58, r=0.6, respectively, p<0.001). In regression analysis, SBP was positively
associated with both raSBP and caSBP (β=0.3±0.06, p<0.001) and (β=0.28±0.08, p<0.001),
respectively. DBP was positively associated with raDBP and caDBP (β=0.31±0.06, p<0.001) and
(β=0.31
±0.06, p<0.001), respectively. All associations remained significant after adjustment for body fat %.
Conclusion
These data suggest that central BP, regardless of measurement site, is highly associated with
brachial BP and hypertension status in youth independent of adiposity.
43
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [21]
Name: Bradley Janus
Status: Undergraduate
Division: Pediatric Infectious Diseases
Research Sponsor: Craig Bierle
Evaluating guinea pigs as an experimental model of congenital Zika syndrome
Bradley Janus, Claudia Fernández-Alarcón, Nelmary Hernandez-Alvarado, Jason C. Zabeli, Mark R. Schleiss,
Craig J. Bierle
Zika virus (ZIKV) is an emerging flavivirus that causes severe birth defects, including microcephaly.
ZIKV infections during pregnancy can cause spontaneous abortion and the virus is teratogenic,
disrupting fetal neurodevelopment. Animal models that accurately recapitulate congenital Zika
syndrome are urgently needed for vaccine development and for the study of ZIKV pathogenesis.
Guinea pigs and humans have morphologically similar hemomonochorial placentas and the relatively
long (~65 day) guinea pig gestation can be divided into trimesters that are developmentally analogous
to those of humans. As guinea pigs have successfully been used to model transplacental infections by
cytomegalovirus, syphilis, and Listeria monocytogenes, we sought to test whether ZIKV could cause
infections with attendant fetal pathology during pregnancy.
We found that guinea pig cells supported ZIKV replication in vitro. Detectable viremia was observed
(by reverse-transcriptase PCR) following experimental challenge of non-pregnant guinea pigs with the
French Polynesian strain of ZIKV. No significant differences in maternal weight gain or pup size was
observed following ZIKV infection of pregnant guinea pigs infected early during the second trimester.
Although ZIKV was not detected by qRT-PCR after challenge during pregnancy, a robust antibody
response against a non-structural protein of ZIKV was detected in both the pups and dams,
suggesting some degree of viral replication occurred in vivo. These results suggest that guinea pigs
can model aspects of the immune response to ZIKV infection during pregnancy.
44
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [22]
Name: Rebecca Kehm
Status: Graduate Student
Division: Pediatric Epidemiology and Clinical Research
Research Sponsor: Logan Spector
The mediating role of socioeconomic status in racial disparities in childhood cancer survival
Despite improved cancer outcomes over the last four decades in the US pediatric population, nonHispanic blacks continue to experience lower survival rates compared to non-Hispanic whites. The
underlying causal mechanisms accounting for this disparity are not well understood, and likely vary by
cancer, with competing biologic and socioeconomic explanations emerging in the literature. In this
study, we tested the mediating role of socioeconomic status (SES) in black-white survival disparities
using causal mediation methods. We used population-based SEER data to obtain a sample of cases,
ages 0 to 19 years, diagnosed between 2000 and 2011. Our final analytic sample was 28,150 cases.
To measure SES, we used the census tract-level SES index available in the SEER restricted dataset,
thus improving upon prior SEER studies that used county-level measures of SES. We compared
black-white survival rates using Kaplan-Meier survival curves and multivariate Cox proportional
hazards regression. Models adjusted for age, year of diagnosis, sex, surgery, radiation, and stage.
We employed inverse odds weighting to test mediation by SES, estimating the percent change
between the total effect of race on survival and the direct effect of race on survival not operating
through SES. Whites had a significant survival advantage over blacks for acute lymphoid leukemia
(ALL; HR=0.68; 95% CI=0.55, 0.85), acute myeloid leukemia (AML; HR=0.58; 95% CI=0.47, 0.85),
Hodgkin lymphoma (HR=0.61; 95% CI=0.39, 0.95), non-Hodgkin lymphoma (NHL; HR=0.63; 95%
CI=0.46, 0.86), astrocytoma (HR=0.55; 95% CI=0.43, 0.69), neuroblastoma (HR=0.70; 95% CI=0.54,
0.90), and soft tissue sarcomas (HR=0.70; 95% CI=0.59, 0.84). A statistically significant indirect effect
of SES was identified for ALL (% change=45%; p<0.001), AML (30%; p=0.006), and neuroblastoma
(50%; p=0.015), and near significant for NHL (35%; p=0.066). These findings suggest that the blackwhite survival gap can be substantially attenuated for many childhood cancers through interventions
that address social and economic barriers to care.
45
Figure 1. Total and direct effects of race on survival, accounting for the mediating effect of
SES; SEER 18 Registries, N=18,150.
NOTES: Group 1 includes cancers for which survival was independently associated with both race
and SES. Group 2 includes cancers for which survival was independently associated with race, but
not SES. Total hazard ratios estimate the total effect of race predicting survival after adjusting for age,
year of diagnosis, sex, surgery, radiation, and stage. Direct hazard ratios estimate the direct effect of
race predicting survival after adjusting for covariates and accounting for the mediating effect of SES
through weighted regression.
46
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [23]
Name: Andrew-Kemal Kirchmeier
Status: Undergraduate
Division: Pediatric Infectious Diseases
Research Sponsor: Mark Schleiss
Interactions Between Malaria and Systemic Cytomegalovirus Infection: A Comparison of
UL144 Genotypes in Minnesota Infants with Congenital CMV and African CMV Strains in
Children with Malaria
Kemal Kirchmeier, Claudia Fernández-Alarcón, Nelmary Hernandez-Alvarado, Mark R. Schleiss (UMN Medical School),
Chandy C. John, Dibyadyuti Datta (Indiana University Medical School)
Research Questions: Is the genotypic variability of the UL144 gene of Human
Cytomegalovirus (HCMV) region specific? Are specific symptom clusters of varying severity
associated with strains with distinct mutations of the UL144 gene? Do our sequence results
corroborate reports of strain variability?
Human cytomegalovirus (HCMV) is the most common congenital viral infection in the U.S. Sequelae
include sensorineural hearing loss and mental disability. The UL144 open reading frame (ORF), a
highly variable region, encodes a tumor necrosis factor receptor homologue. Sequence variation is
useful in understanding the epidemiology of the infection. Therefore, we analyzed variations of the
UL144 gene in HCMV positive clinical isolates obtained from Uganda and Minnesota. 33 samples
from Uganda in children with active malaria were examined. There was interestingly a trend toward
improved survival in children with malaria who had concomitant CMV DNAemia: 7 of 20 surviving
children had CMV viremia (35%) while only 3/14 fatal cases (21%) had DNAemia. 3 samples were
successfully RT-PCR amplified. 25 qPCR verified HCMV positive samples were sequenced: 7 clinical
isolates (CIs) and 5 cell-culture adapted derivatives (CCAD) from USA, 3 CIs and 10 clone colonies
from Uganda. We were able to amplify a 737 base pair (bp) DNA product from the UL144 gene of
HCMV from these samples by conventional PCR using previously published primer pairs. Sanger
sequencing was performed on the resulting positive PCR amplification. Sequence variation was
analyzed using bioinformatics. Phylogenetic analyses indicated that the nucleotide and amino acid
(aa) sequences of the samples diverged into three major groups: subgroup 1A, 7/25; subgroup 1C,
4/25 and group 3, 14/25. Results suggest that strain variability is conserved between the two
countries. Further characterization and analysis of strain variation of UL144 with an increased sample
size could provide better understanding of the molecular epidemiology between strains of HCMV in
Minnesota, with the samples from Uganda providing insight about intercontinental variability. Trends
toward improved survival in the setting of CMV reactivation require further examination, but may
reflect salutary modulation of the anti-malaria cytokine response following CMV reactivation.
47
FIG 1. Phylogenetic analysis of 27 UL144 DNA sequences. Tree was generated using the program
Geneious (version 9.1.7). Distinct genotypic groups differing by nucleotide variation from the Toledo
clinical strain were previously described by Lurain et al., (1999). Numbers denote Uganda sample
strain identity. C1, Clone 1. Uganda sample 693 demonstrates mixed infection, or multiple UL144
genotypes.
48
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [24]
Name: Gabriela Lazalde
Status: Graduate Student
Division: General Pediatrics and Adolescent Health
Research Sponsor: Annie-Laurie McRee
Dentists As HPV Vaccinators: What Do Parents Think?
Gabriela Lazalde, BS, University of Minnesota School of Public Health, Minneapolis, MN, Melissa Gilkey, PhD,
Harvard Medical School, Boston, MA and Annie-Laurie McRee, DrPH, University of Minnesota Medical School,
Minneapolis, MN
Introduction: Human papillomavirus (HPV) vaccination can prevent types of HPV that cause
cervical, anal, and oral cancers, yet adolescent vaccination rates remain low. Offering the vaccine in
alternative settings beyond the traditional medical home holds promise for increasing vaccination
rates. Dentists have expertise in oral preventive care and are among the most frequently visited
health providers; their practices may be one such setting.
Objectives: To assess parents’ attitudes towards dentists administering HPV vaccinations to their
adolescent children.
Methods: In 2016, we conducted an online survey using a national sample (n=1,209) of U.S. parents
of adolescent children aged 11-17. Adolescents’ mean age was 14; 53% were male and 62% were
non-Hispanic White. We identified correlates of comfort with dentists as HPV vaccinators using
multivariable logistic regression.
Results: Overall, 23% of parents reported that they would feel comfortable with their adolescent child
receiving HPV vaccine from a dentist. In multivariable analyses, parents had greater odds of being
comfortable if they perceived ≥ 2 benefits about dentists providing HPV vaccinations (OR=6.82, 95%
CI 4.44-10.47); or had higher trust in their child’s provider (OR=1.46, 95% CI:1.06-1.83). Parents had
lower odds of being comfortable if their child was female (OR=0.68, 95% CI: 0.51-0.89) or if they had
≥2 concerns (OR=0.12, 95% CI: 0.07-0.19). Convenience (20%) and oral health expertise (20%) were
the most commonly cited benefits of dentists administering the vaccine while wanting their child’s
regular provider to administer (61%) and track vaccinations (58%), and lack of insurance coverage
(30%) were the most cited concerns.
Conclusions: Findings from this national sample suggest low parent comfort with dentists as HPV
vaccinators and highlight concerns that should be addressed if dental practices might offer HPV
vaccination in the future. Further research should assess dentists’ perspectives and explore
alternative roles for dentists in HPV prevention efforts.
49
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [25]
Name: Lee Meier
Status: MD/PhD Student
Division: Pediatric Rheumatology
Research Sponsor: Bryce Binstadt
Discrete populations of mononuclear phagocytes orchestrate mitral valve disease
through local and systemic inflammation
Lee Meier, Jennifer Auger, Brianna Engelson, Hannah Cowan, Elise Breed, Mayra Gonzalez-Torres,
Joshua Boyer, Bryce Binstadt
Background. Autoantibody (autoAb) production accompanies several experimental and human
cardiovascular diseases (CVD), but the specific mechanisms by which autoAbs engage the
immune system to drive cardiovascular pathology remain unclear. Here we explore how
autoAbs act through Fc receptors to activate pathogenic mononuclear phagocytes (MNP) that
drive CVD.
Methods. Using a mouse model of autoantibody-mediated mitral valve disease (MVD), we
employed monoclonal antibody (mAb) neutralization in conjunction with conditional gene
knockout approaches to define key inflammatory pathways. Gene deletion in the mononuclear
phagocyte (MNP) system was accomplished using Cx3cr1-Cre transgenic mice intercrossed
with mice carrying floxed target alleles including Itga4 (encoding α4 integrin/CD49d) or Syk.
Analysis primarily entailed multiparameter flow cytometry, immunofluorescence (IF), and
histological staining.
Results. MVD is orchestrated by MNP subsets at multiple levels. Remote from the mitral valve
(MV), circulating autoantibodies (autoAbs) in the secondary lymphoid organs (SLOs) engage
activating immunoglobulin G (IgG) receptors (FcγRs), primarily expressed on the resident and
recruited macrophage populations. AutoAb-FcγR interactions induce Syk-dependent cytokine
production (tumor necrosis factor/TNF and interleukin-6/IL6, in particular) and systemic
inflammation. Next, local to the MV, cytokine-mediated activation of the endothelium induces
vascular cell adhesion molecule-1 (VCAM1) expression, enabling recruitment of circulating
inflammatory and patrolling monocytes from the blood to the underlying interstitium in a VLA4dependent manner (very late antigen-4, CD49d/CD29, α4β1). These recruited monocytederived macrophages assume a tissue-reparative (M2) phenotype within the MV interstitium
and constitute the majority of inflammatory cells therein.
Conclusions. These studies define the immune molecules (Syk, TNF, IL6, VCAM1/VLA4) and
cells (chiefly MNPs) that act concertedly to orchestrate inflammatory CVD. Knowledge of this
pathway will help guide development of rational therapeutic approaches.
50
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [26]
Name: Rose Olson
Status: Medical Student
Division: Pediatric Neonatology
Research Sponsors: Tara Zamora and Asha Siddappa
GROWTH OUTCOMES IN VLBW INFANTS RECEIVING ERYTHROPOIETIN AND AGGRESSIVE
IRON SUPPLEMENTATION
R Olson, T Zamora, A Siddappa
Introduction: Very low birth weight (VLBW) infants are at risk for developing symptomatic anemia
and iron deficiency anemia. Erythropoietin (EPO) has been used to stimulate erythropoiesis in at risk
infants, and more recent literature suggests a possible neuroprotective effect. However, the impact of
EPO and more aggressive iron supplementation on overall growth has not been previously described.
Question: How does EPO and aggressive iron supplementation affect growth parameters in VLBW
infants?
Methods: This is a retrospective chart review of infants born <28 weeks gestational age and treated
with early EPO and aggressive iron supplementation according to a single institution protocol (n=118).
Total iron needs, red blood cell indices, and growth parameters were extracted over the course of
hospitalization and compared to national averages as reported in the Vermont Oxford Network (VON).
Results:
Average birth and discharge weight of EPO cohort was 789g and 3050g respectively, compared to
943g and 2440g in VON cohort. Average birth and discharge head circumference of EPO cohort was
22.6 cm and 33.3 cm respectively, compared to 24.6 cm and 31.5 cm in the VON cohort.
Conclusions: EPO and high dose iron may have a positive impact on growth at discharge when
compared to VON averages and warrants further study.
51
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [27]
Name: Christen Pentek
Status: Predoctoral Fellow
Division: General Pediatrics and Adolescent Health
Research Sponsor: Marla Eisenberg
School Resource Officers, Student Perceptions of Safety, and Experiences of
School Discipline: Differences Across Race
Christen Pentek, MSW(c), and Marla Eisenberg, ScD, MPH
Objective: Violence has been linked to disparate health and education outcomes, which has led
to School Resource Officers (SROs) in many public schools. Research has shown mixed effects
on student levels of offenses, and community perceptions of safety in schools with SROs. This
paper seeks to describe students’ perceptions regarding SROs (awareness, comfort, and
helpfulness) and test associations between these perceptions and disciplinary experiences,.
Methods: This study uses data from the 2016 Minnesota Student Survey (MSS), a triennial
survey administered to Minnesota 8, 9, and 11th grade students (n=126,868). We examined
students’ perceptions of their SROs in a twelve-point scale (tell if something illegal, help,
general good idea; Alpha=0.74), school disciplinary experiences, and student perceptions of
safety. Chi-square tests and multiple logistic regression were used to compare students across
race and other demographic characteristics.
Results: Seventy-one percent of students’ report having an SRO in their school. The presence of a
school resource officer correlates significantly with race (chisq=118.71, p<.0001), school discipline
(chisq=25.27, p<.0001), and feelings of safety (chisq=61.99, p<.0001). Among those with an SRO,
the average perception score was 7.16, where higher numbers indicate more positive perceptions
(SD=1.98, range=1-12). Perceptions of SROs significantly correlated with experiences of school
discipline (Chisq=3459.06, p<.0001) and feelings of safety (t=-4.43, p<.0001). For example, the
average Black students’ perception of SROs is 6.78, compared to 7.28 for Asian/Pacific Islander
students (F=137.78, p<.0001). Disparate disciplinary actions correlate with race and perceptions of
SROs, but not with officer presence.
Conclusions: This study suggests that school resource officers are present in less safe schools and
are part of school staff teams that utilize higher disciplinary actions than school staff teams without
SROs. Disparate experiences of school discipline, which is a form of institutional violence, can lead
to disparate health outcomes.
52
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [28]
Name: Megan Reinhard
Status: Undergraduate
Division: Pediatric Infectious Diseases
Research Sponsor: Bazak Sharon
Epidemiology and Characteristic Features of Pediatric Lyme Arthritis in an
Endemic Region
Megan Reinhard, Mackenzie Diekmann, Bazak Sharon, MD
Background: Arthritis is a common pediatric presentation. In endemic areas, Lyme arthritis
(LA) is the leading cause of acute arthritis in healthy children.
Objectives: Describe the epidemiology and common clinical presentation features of LA in
children.
Design/Methods: We performed a retrospective chart review of all children (1-18yo) diagnosed
with LA at one upper mid-west health organization between Jan 2011–July 2016. Presenting
symptom criteria included arthritis, joint swelling, joint pain, and/or diagnosis of LA with positive
borrelia burgdorferi PCR from synovial fluids. Thorough review confirmed diagnosis when all
following criteria were met: isolated joint effusion in an otherwise healthy child, positive Lyme
studies (PCR or western blot), and full recovery with standard Lyme treatment alone.
Results: Of 98 charts reviewed, the study cohort consisted of 74 confirmed LA diagnosed patients.
Ages ranged from 2-17 years (mean 9.4yo) with 50 boys and 24 girls. In all but 2 cases, the knee
was the affected joint. Thirty received arthrocentesis, consistently showing elevated WBC count
predominantly PMN (5-115K, mean 38K).
Cases presented throughout the year with higher rates in fall. Peripheral WBC count was
consistently within normal limits (5-14.2K, mean 8.9K); inflammatory markers were usually elevated,
with ESR (7-89, mean 33) typically higher than CRP (<2.9-104, mean 20). All but 4 children could
bear weight, of which 39 had pain or limping, 7 walked with significant difficulties, and 21 had no
difficulties walking. Only 40% recalled removing ticks or spending time in wooded areas; none
recalled erythema migrans.
Conclusions: LA, the most common etiology of isolated acute knee arthritis in endemic regions,
presents year-round. LA is usually a benign condition manageable in outpatient settings. Prompt
clinical recognition, supported by initial lab values and confirmed as needed by synovial fluid
analysis can prevent misdiagnosis and unnecessary interventions including IV antibiotics, surgical
procedures, and hospitalization.
53
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [29]
Name: Monica Yue
Status: Graduate Student
Division: Pediatric Infectious Diseases
Research Sponsor: Mark Schleiss
Understanding the Effects of Antiviral Treatment on cCMV Outcomes in a UMN Lions Clinic
Cohort
Monica Yue and Mark R. Schleiss (Sponsor)
Cytomegalovirus (CMV) is a common virus acquired by age forty, and about a quarter of children in
the US are infected by puberty. In most populations, CMV remains dormant and asymptomatic (Dahle
et al., 2000). If expectant mothers contract CMV, they can pass it to the unborn child, leading to
hearing loss and other developmental and physical effects.
Congenital CMV (cCMV) may be either symptomatic (10%) or asymptomatic (90%). Among
symptomatic infants, risk of hearing loss is as high as 65%. Degree, configuration, progression, and
fluctuation of hearing loss associated with cCMV are not well defined; additionally, symptomatic cCMV
may also manifest as delayed walking, balance issues, and eye abnormalities. The present study
examines these trends.
A retrospective chart review was performed using a database of pediatric patients (N = 286) seen at a
multidisciplinary hearing clinic at UMMC. Individuals in the database range from having normal
hearing with some risk factors for hearing loss, to having severe-to-profound hearing loss requiring
cochlear implants (CIs). Twenty-eight patients (9.8%) were positive for cCMV.
Of these twenty-eight patients, fourteen received antiviral therapy (ganciclovir or valganciclovir).
Thirteen did not receive any antiviral therapy, and one was missing information regarding antiviral
therapy. Treatment groups were analyzed regarding hearing loss progression and fluctuation, as well
as other cCMV-related developmental and physical effects. Both treated and untreated groups
showed a range of outcomes. In particular, unilateral progression of hearing loss was noted only in
the treated group, a trend suggesting antiviral therapy may limit progression of hearing loss to one ear
instead of both (Figure).
The results of this preliminary study suggest that further clinical investigation is necessary to
determine the effect of antiviral treatment on CMV outcomes, particularly on progression of hearing
loss. These findings may be useful in counseling parents of children identified with cCMV.
54
Figure. Laterality of progression of hearing loss in the patients with cCMV, separated by treatment
groups
55
PEDIATRIC
POSTDOCTORAL
FELLOWS
(Abstracts 30-37)
56
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [30]
Name: Carly Alexander
Status: Postdoctoral Fellow
Division: Pediatric Neuropsychology
Research Sponsor: Kelly King
Using the Vineland Adaptive Behavior Scale to Assess Adaptive Functioning Differences
Between Subtypes of Mucopolysaccharidosis I
Alexander, C. J., Romero, R., Shapiro, E., Hathaway, K., & McLeod, J.
Department of Pediatrics, University of Minnesota Medical School
Objective
Mucopolysaccharidosis (MPS) Type I is a rare recessive genetic disorder involving errors in
metabolism. The deficient enzyme activity characteristic of this disease results in numerous medical
complications involving almost every organ system, including the central nervous system. Due to the
various rates of disease progression and variation of symptoms between subtypes, treatment options
are limited and time sensitive. Age, diagnosis, Vineland Adaptive Behavior Scale-II (VABS-II) scores,
and physical symptoms score (PSS) were used as data. This study assessed adaptive functioning of
children, to provide data to inform the childrens’ treatment teams.
Participants and Methods
This current study utilized an archival dataset collected by the Lysosomal Disease Network (LDN) and
participating centers, including the University of Minnesota, Twin Cities Campus. The sample
consisted of 47 participants with MPS I.
Results
A one-way MANOVA was conducted to compare the VABS-II scale means for both groups of MPS
participants. The ANOVAs of the VABS-II composite and the two subdomains were not significant.
There was a negative correlation between the PSS and VABS-II composite and Daily Living Skills
subdomain (DLS).
Conclusions
A significant difference of adaptive functioning between MPS subgroups was found. A negative
relationship between PSS scores and overall adaptive functioning was found. As participants
experience more physical symptoms, their ability to complete their activities of daily living was
negatively impacted. An understanding of the impact of medical symptoms on adaptive functioning
can help to target specific interventions on measured deficits, increasing overall quality of life.
57
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [31]
Name: Mary Christoph
Status: Postdoctoral Fellow
Division: General Pediatrics and Adolescent Health
Research Sponsor: Dianne Neumark-Sztainer
Nutrition Facts Use by Young Adults: Predictors, Information Sought, and Relation to Dietary
Intake
Mary J. Christoph1, Nicole I. Larson2, Melissa N. Laska2, Dianne Neumark-Sztainer1,2
Department of Pediatrics and 2Division of Epidemiology and Community Health, University of Minnesota,
Minneapolis, MN 55414
1
Background
Nutrition labels are a low-cost intervention with the potential to encourage more informed eating habits.
Our objective was to investigate correlates of Nutrition Facts usage, describe label information observed by
label users, and investigate how Nutrition Facts usage related to dietary intake.
Methods
Young adults (N = 1475) were surveyed as a part of Project EAT-IV, the fourth wave of a 15-year
longitudinal cohort study wherein students were originally recruited in middle- or high-schools in the
Minneapolis-St. Paul metropolitan area of Minnesota. Surveys assessed Nutrition Facts usage, frequency
of looking at specific label information, sociodemographics, anthropometrics, behavioral characteristics,
and dietary intake using a semi-quantitative food frequency questionnaire. Logistic regression was used to
cross-sectionally examine how demographic and behavioral factors related to Nutrition Facts use. Adjusted
means accounting for demographics, activity, and weight status were used to investigate how label usage
related to dietary outcomes.
Results
Participants were on average 31.1 ± 1.6 years old, and 56.1% were female. Over a third (36.8%) reported
using Nutrition Facts labels “most of the time” or “always”. Nutrition Facts usage was related to being
female, younger age, high education and income, preparing food regularly at home, having overweight,
and being physically active (p<0.05). Label users reported observing total calories (73.3%), sugars
(72.6%), and serving size (69.8%) most often. Label users consumed more daily servings of fruit,
vegetables, and whole grains and fewer servings of dairy and sugar-sweetened beverages (all p<0.05).
Label users reported eating at sit-down restaurants more frequently than non-users (p=0.02), but less
frequently at fast-food restaurants (p<0.01).
Conclusions
While Nutrition Facts use was associated with markers of better dietary quality in a population-based
survey, only just over a third of young adults used labels frequently. Labels should be tailored to the
interests and needs of consumers to make informed dietary choices.
Funding source: This study was supported by Grant Number R01HL116892 from the National Heart,
Lung, and Blood Institute (PI: Dianne Neumark-Sztainer). The content is solely the responsibility of the
authors and does not necessarily represent the official views of the National Heart, Lung, and Blood
Institute or the National Institutes of Health. M.J. Christoph is supported by the Health Resources and
Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under
National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI:
Borowsky). This information or content and conclusions are those of the author and should not be
construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or
the U.S. Government.
58
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [32]
Name: Laurel Davis
Status: Postdoctoral Fellow
Division: General Pediatrics and Adolescent Health
Research Sponsor: Rebecca Shlafer
Health status and health care utilization of justice-involved families
Laurel Davis, PhD & Rebecca J. Shlafer, PhD, MPH
BACKGROUND: Parental incarceration is one of the most pervasive public health concerns in the
United States. More than 5 million U.S. children have had an incarcerated parent at some point during
their lives. Justice-involved populations have worse health and more unmet health care needs than
the general population. Health disparities likely exist for the children of incarcerated people, but have
not yet been documented. This aims of this study are to document health status and health care
utilization among children with incarcerated parents and describe an innovative approach to
addressing their healthcare needs.
METHODS: Data were collected at four jails in the Midwest. Caregivers of minor children (N = 86)
reported on the health status and health care utilization of one child (aged 3– 17 years) of the
incarcerated parent. A comparison sample was drawn from the 2012 National Survey of Children’s
Health. Statistics were computed with SPSS v. 23.
RESULTS: Children of jailed parents were less likely to have good or excellent oral health, less likely
to be insured, more likely to have a gap in insurance in the past year, and less likely to receive care
within a medical home than the comparison sample.
JAIL-COMMUNITY PARTNERSHIP: In fall 2016, the Washington County, MN Sherriff's Office
established quarterly jail resource fairs for individuals with loved ones in jail. Fairs are held on-site
during family visiting hours and include representatives from county departments such as public
health, prescription drug takeback, and family services. The fair represents a unique opportunity for
service providers to interface with a vulnerable and hard-to-reach population.
CONCLUSIONS: Health inequities, particularly in access to quality health care, might be one factor
that drives social exclusion for the children of justice-involved people. Future research should assess
the long-term impact of jail-based programming to promote health in justice-involved families.
59
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [33]
Name: Jennifer Doty
Status: Postdoctoral Fellow
Division: General Pediatrics and Adolescent Health
Research Sponsor: Iris Borowsky
Explaining Patterns of Bullying and Sexual Harassment Involvement:
Connections Matter
Purpose: Bullying and sexual harassment involvement are often studied separately, yet both are
associated with adolescent mental health problems such as depression and self-harm. Key questions
of this study were: 1) In what ways do bullying and sexual harassment victimization and perpetration
co-occur? 2) Does connectedness with family and community members protect against patterns of
bullying and sexual harassment?
Methods:
Data were from the 2013 Minnesota Student Survey of 8th, 9th, and 11th graders (n=121,131); 50%
were female; 73% White. The dependent variable, patterns of bullying and sexual harassment, was
derived from a latent profile analysis of involvement in the following behaviors in the last 30 days
(1=any, 0=none): victimization and perpetration via physical bullying, relational bullying, sexual
harassment, and cyberbullying. Independent variables measuring connectedness included single
items asking about communication with father and mother, how much parents, adult relatives, friends,
teachers, and other adults in the community care (1=not at all to 5=very much). Controls included age,
gender, free/reduced lunch status, family structure, and race/ethnicity. Multinomial logistic regressions
examined protective factors related to risk patterns.
Results: Youth were classified into five patterns: High-Risk of All Forms of Perpetration/Victimization
(7%), Relational Victimization (17%), Sexual Harassment Victimization and Perpetration (8%),
Physical Bullying Perpetration (6%), and Low-Risk(62%). Compared to the Low-Risk pattern, students
in other patterns were significantly less likely to report that they could talk to their parents (range:
OR=.88-.92) and that teachers cared (range: OR=0.74-.85; p<.001).
Conclusions: Results illustrate the importance of examining bullying and sexual harassment
together, especially given the separate treatment of these issues in research and prevention.
Compared to the lowest-risk class, students in risk patterns demonstrated lower levels of social
connections. Building stronger relationships, particularly with parents and teachers, may be important
intervention strategies for schools and health care providers to protect against bullying/sexual
harassment involvement.
60
Figure. Classes of bullying and sexual harassment victimization and perpetration
61
High-Risk
Est.
S.E
.
0.0
4
Relational
Bullying
Victimization
OR
Est.
1.93
1.32
*
0.39
*
0.62
*
0.01
0.02
Female
0.66*
Ninth
Gradea
-0.44*
0.0
4
0.64
Eleventh
Gradea
-0.91*
0.0
5
0.40
Free
Lunch
Two
Biological
Parents
Raceb
0.19*
0.0
4
0.0
4
1.22
-0.12
America
n Indian
Asian
Pacific
Islander
Black
3.41*
0.89
0.0
6
0.1
4
30.2
7
1.17
-0.95*
0.0
9
0.39
Hispanic
-0.37*
0.0
8
0.69
Multiracial
-0.19
0.0
6
0.83
0.16
Talk to Father
-0.14*
0.0
2
0.87
Talk to
Mother
-0.13*
0.0
2
0.88
Parents Care
-0.29*
0.0
2
0.75
Other Adult
Relatives
Care
Friends Care
-0.12*
0.0
2
0.89
-0.26*
0.0
2
0.77
Teachers
Care
-0.41*
0.0
2
0.66
Adults in
Community
Care
-0.04
0.0
2
0.97
S.E
.
0.0
3
Sexual Victimization &
Perpetration
OR
Est.
S.E.
OR
3.67
0.66
*
0.10
0.03
0.52
0.03
1.11
0.0
3
0.68
0.0
3
0.54
0.35
*
0.03
1.42
0.0
3
0.0
3
0.99
0.07
0.03
0.03
0.93
0.03
0.97
2.25
*
0.01
0.98
9.4
9
1.0
1
1.54
*
0.45
0.0
7
0.1
6
4.66
0.0
0.4
0.74 6
8
*
0.0
0.4
0.88 8
1
*
0.0
0.7
0.31 5
3
*
0.0
0.90
0.10 1
*
0.0
0.91
0.09 2
*
0.0
0.87
0.15 2
*
0.0
0.98
0.02 2
0.55
*
0.04
0.0
6
0.58
0.0
6
0.96
0.02
0.0
5
1.02
0.36
*
0.20
*
0.00
0.0
7
0.1
2
0.64
0.08
*
0.16
*
0.07
0.01
0.92
0.01
0.85
0.02
0.93
0.05
0.02
0.94
0.0
2
0.70
0.09
*
0.02
1.09
0.0
2
0.82
0.02
0.80
0.0
1
1.00
0.22
*
0.11
*
0.02
0.90
Physical
Bullying
Perpetration
Est
.
0.8
7*
0.3
5*
0.9
0*
0.4
3*
0.3
0*
S.
E.
0.
04
O
R
0.
41
0.
01
0.
70
0.
04
0.
41
0.
04
0.
04
1.
54
0.
74
0.7
1*
0.4
6*
0.
10
0.
12
2.
03
1.
58
0.4
5*
0.4
3*
0.
08
0.
64
0.
06
1.
54
0.3
4*
0.
05
1.
42
0.0
6*
0.1
8*
0.1
3*
0.0
3
0.0
2
0.2
4*
0.0
8*
0.
01
0.
94
0.
02
0.
84
0.
03
0.
88
0.
02
0.
97
0.
02
0.
98
0.
02
0.
79
0.
02
0.
92
Table 3. Multinomial Regression Modeling Protective Relationships with Adults on Classes of Bullying
and Sexual Harassment.
Note. Reference group is the Low-Risk class. a Reference group is 8th graders. b Reference group is
White. * p < .001
62
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [34]
Name: Katherine Klipfel
Status: Postdoctoral Fellow
Division: Pediatric Neuropsychology
Research Sponsor: Margaret Semrud-Clikeman
Neuropsychological Sequelae of an Internationally Adopted Child: Preliminary
Conceptualization and Future Directions
This case study focuses on the unusual neuropsychological profile of an internationally
adopted child with aim to disseminate information about this unusual case and to provide information
to practitioners who may also be working with children with this unusual presentation. The patient
was internationally adopted at 4 months-of-age. His medical history is significant for low birth weight,
dehydration, low respiratory rate, dysentery, pneumonia, Hepatitis A, tuberculosis exposure, and
sepsis. Repeated neuropsychological evaluations, educational records, and consultation from
neurology, psychiatry, occupational therapy, rheumatology, ophthalmology, and genetics are present.
Within the context of normal development early, he began to show motor, attention, and sensory
processing concerns at the age of 3 years. At age 5, patient showed a significant decline in fine motor
and reading skills and onset of hand tremor, mood dysregulation, and physical concerns (e.g., eye
asymmetry, staring spells, frontal headaches, hypersomnia). An MRI was notable for a single small
focus of T2 hyperintensity in the posterior left cerebellum. Additional medical work-up showed mild
astigmatism, rapid medication metabolization, and a genetic anomaly for the R779Q variant in the
SMARCA1 gene. The patient has shown intact intellect and language, alongside impaired attention
and executive functions, reading accuracy, verbal memory, visual-spatial skills, fine motor skills, and
emotional/behavioral functioning. Interventions have included occupational therapy, medications, IEP
services, and counseling, with some improvement. We will present the serial neuropsychological
findings for this child. The current case study demonstrates the complexities observed in an
internationally adopted child. Findings also provide evidence for the possible significance of
SMARCA1 anomaly, which requires broader investigation within the field.
63
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [35]
Name: Christopher Mehus
Status: Postdoctoral Fellow
Division: General Pediatrics and Adolescent Health
Research Sponsor: Barbara McMorris
Testing the Social Interaction Learning Model with adolescent substance use outcomes in a
prospective Australian sample
Introduction. Parents and peer contexts both impact the development of adolescent substance misuse. The
Social Interaction Learning (SIL) model provides a theoretical explanation of relationships between parenting,
peers, and youth outcomes. The model posits that parenting has a direct effect on youth behavioral outcomes
but also that this relationship is partially mediated through children’s antisocial behavior and antisocial peers. In
other words, poor parenting contributes to increased antisocial behavior, which contributes to antisocial peer
associations, which contribute to poor outcomes. The SIL model has been tested primarily with samples from
the United States with conduct-disorder outcomes. Here, we add to the field by testing the full SIL model with
substance-use outcomes in a prospective, longitudinal sample of Australian youth.
Methods. Three waves of data from students (n=907) in Victoria, Australia were used. We created latent
variables of parenting and anti-social behavior in 5th grade and anti-social peer associations in 6th grade.
Substance use outcomes used 10th grade reports. Using Structural Equation Modeling, we evaluated model fit,
the direct paths from parenting to substance use outcomes, and each mediational path.
Results. The fit statistics and path estimates (Figure 1) show that the model fit was good and that each of the
mediational paths were significant. From parenting, only the direct paths to binge drinking and marijuana use
were significant, but indirect effects were significant suggesting full mediation through the anti-social behavior
and peer pathways.
Conclusion. Findings support the usefulness of the SIL model in a cultural and policy context that differs from
the US with regard to substance use. Replication of this model in diverse societies suggests that preventive
interventions grounded in this model may be easily adaptable to a range of communities.
64
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [36]
Name: Chimei Lee
Status: Postdoctoral Fellow
Division: Pediatric Neuropsychology
Research Sponsors: Amy Esler and Rebekah Hudock
Sensitivities and Specificities of Social Communication Questionnaire in a Clinic-Referred
Sample
Chimei M. Lee1, Amy N. Esler2, Rebekah Hudock2
Pediatric Neuropsychology Clinic; 2Autism Spectrum and Neurodevelopmental Disorders Clinic
Department of Pediatrics, Division of Clinical Behavioral Neuroscience
University of Minnesota, Minneapolis, MN
1
The Social Communication Questionnaire (SCQ) is a widely used checklist for Autism Spectrum
Disorders (ASD) in both clinical and research settings. Previous studies suggested that the SCQ
demonstrated satisfactory psychometric property as a screening measure for a research-referred
sample. However, subsequent studies using the SCQ in clinic-referred samples revealed low
sensitivities and specificities in differentiating children with ASD from children with non-spectrum
disorders. Since the SCQ is commonly used as an inclusion/exclusion criterion for research and is
frequently utilized in clinical settings to inform diagnostic decisions, information is needed on the
characteristics of children who tend to be misclassified by the SCQ to guide decision-making in
research and clinical settings. One hundred and sixty-four participants, ages 4 to 18 years old, were
recruited from an ASD specialty clinic. All participants completed a detailed diagnostic interview,
administration of the Autism Diagnostic Observation Schedule (ADOS) by research-reliable clinicians,
and developmental evaluation, including cognitive functioning and social/emotional/adaptive
functioning. Receiver Operating Characteristic (ROC) curves were used to determine sensitivity and
specificity of the SCQ for children with best estimate diagnosis of ASD or non-spectrum disorders.
Results suggested that the SCQ had lower sensitivity and specificity than previously reported in
studies using samples comprised of clinic- and research-referred individuals. Children who were
identified as false negatives tended to display better functional communication, social skills, and
adaptive functioning, as well as less restricted and repetitive behaviors than true positives. The
findings revealed that the SCQ may be better used as a measure of the distribution of ASD symptoms
across populations with and without ASD, rather than as a clinical screener or confirmatory tool.
Future studies are needed to determine whether parent-endorsed symptoms on the SCQ are
supported in well-validated direct measures of ASD symptoms, such as the ADOS, even for children
who receive non-spectrum diagnoses.
65
Figure 1. The ROC Curve Comparisons using SCQ Total Scores
66
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [37]
Name: April Wilhelm
Status: Postdoctoral Fellow
Division: General Pediatrics and Adolescent Health
Research Sponsor: Annie-Laurie McRee
Mental health in Somali youth: the role of protective factors in preventing depressive
symptoms, suicidality, and self-injury
April K. Wilhelm, MD; Annie-Laurie McRee, DrPH, MPH; Marla Eisenberg, ScD, MPH
Purpose: Certain community, school, family, and individual factors are protective against mental
illness in general samples of youth. How these assets apply to Somali adolescents remains unclear in
the existing, primarily qualitative, literature. This study aims to quantify which protective factors are
associated with lower prevalence of depressive symptoms, suicidality, and self-injurious behaviors
among Somali youth compared with their white peers.
Methods: Data are from the 2016 Minnesota Student Survey, an anonymous school-administered
statewide survey. Subjects include 8th, 9th, and 11th graders who identified as Somali ethnicity (n =
2009) or as non-Hispanic white (n = 84,349). Categorical and continuous variables were compared
using chi-square and student t-tests. Multivariate logistic regression tested the odds of depressive
symptoms, suicidal ideation and attempts, and self-harm for youth with nine types of protective factors
(e.g., developmental assets, school engagement, and family, teacher, and community connectedness.
Grade, gender, family structure, and socioeconomic status were included as covariates. Interaction
terms for Somali/White and each protective factor were tested, and models were stratified
accordingly.
Results: Somali youth were more likely to receive free or reduced price lunch compared to white
students, but less likely to report living with two biological parents or previous mental illness. Somali
youth reported significantly higher levels of internal developmental assets, school engagement, and
empowerment, but lower levels of safety, family connectedness, and level and quality of after school
activities than their white peers (Table 1). Somali youth were less likely to screen positive for
depression (p=0.037), and to report previous suicidal ideation or attempts, and self-harm behaviors (p
< 0.001). Logistic regression results are forthcoming.
Conclusions: Protective factors varied significantly across groups. Further exploration of how
protective factor effects may differ between Somali and white youth will offer important insights into
potential pathways to promote mental wellbeing in these groups.
67
PEDIATRIC
RESIDENTS
(Abstracts 38-50)
68
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [38]
Name: Julie Anderson
Status: Pediatric Resident
Division: Pediatric Emergency Medicine
Research Sponsor: Marissa Hendrickson
A comparison of the efficacy of enema solutions in pediatric patients with constipation
Background
Abdominal pain due to constipation is a frequent presenting complaint in pediatric emergency
departments (EDs); enemas are commonly used for quick symptom relief in these patients. However,
literature to guide the selection of enema solution is limited. At our institution there is a locally
compounded enema product called the “pink lady,” composed of docusate, magnesium citrate,
mineral oil and sodium phosphate; however, this combination has not been reported in the literature.
Objective
To assess and compare the efficacy and side effect profile of enema solutions used in our pediatric
ED.
Methods
Children under 18 years of age who were who were administered any enema prior to being
discharged from the ED were identified from electronic records for inclusion in the study. Physician
investigators reviewed routine documentation from each patient’s ED visit record to confirm the type
and dosage of enema and to assess reported co-morbidities, indications, efficacy and side effects.
Subjective descriptions of results were classified as small, moderate, or large by reviewer consensus.
Results
661 records were identified and reviewed. Mean patient age was 6.2 years (SD 4.6); 359 were
female, 256 were Black, 50 were Hispanic. Solutions used included sodium phosphate, tap water,
soap suds, and pink lady. Frequencies and results are summarized in the table:
Conclusion
Of the multiple enema types regularly used in our institution, sodium phosphate, soaps suds, and pink
lady were the most likely to produces moderate or large stool output. Tap water was more likely to
require a second enema, although the number of uses was very small. Sodium phosphate and pink
lady enemas were least likely to require more than one enema, and despite its more complex formula
the pink lady was not superior to pre-mixed sodium phosphate.
69
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [39]
Name: Julie Ansbaugh
Status: Pediatric Resident
Division: Pediatric Hospital Medicine
Research Sponsors: Mike Pitt, Maren Olson & Emily Borman-Shoap
Trainee Resilience Data - University of Minnesota Residents Compared to National Data
Saki Ikeda, Stephanie M. Lauden, Julie Ansbaugh, Muna Sunni, Emily Borman-Shoap, Michael B.
Pitt, Maren Olson
Background
Residents often experience burnout and depressive symptoms during training. Emotional exhaustion
(EE), depersonalization (DP), and loss of personal accomplishment (PA) are key factors in burnout.
Understanding prevalence and risk factors associated with burnout is an important step in addressing
trainee wellness.
Objective
To compare the prevalence of burnout among University of Minnesota (UMN) Pediatric (PED) and
Medicine Pediatrics (MEDPED) residents with national data and characterize risk and protective
factors for burnout.
Method
The Pediatric Residency Burnout & Resilience Consortium (PRBRC) conducted an anonymous online
survey of 34 residency programs in 2016. The survey tool included demographics, debt, training year,
recent experiences, as well as 17 standardized measures of burnout, stress, mindfulness, selfcompassion, empathy, sleepiness, and resilience. Three measures were used to look at burnout
prevalence, with burnout defined as a resident who scored high on the EE and/or DP scale. The study
analyzed national and program-specific trends in burnout, wellness, and predictive factors and
reported data along each standardized metric.
Results
Sixty-eight percent of UMN residents responded (66% nationally). Data from the 17 measures was
reported. Burnout was identified in 36% of UMN residents compared to 55% nationally. Burnout
prevalence was higher in the MEDPED cohort (44% UMN, 62% nationally) compared to PED (33%
UMN, 54% nationally). UMN residents reported lower rates of PA compared to national data. See
Figure 1.
Conclusion
This study represents an important look at prevalence and protective factors surrounding resilience.
Fewer UMN PED and MEDPED residents were found to have burnout compared to the national
average. While these residents experienced lower rates of EE and DP, two factors related to burnout,
they had less of the PA protective factor. Longitudinal data can be used in the future to assess trends
and best timing for interventions to address and prevent burnout.
70
71
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [40]
Names: Rachel Cafferty and Amanda Gillett
Status: Pediatric Residents
Division: Pediatric Hospital Medicine
Research Sponsors: Mike Pitt & Diana Cutts (HCMC)
Food for Thought – Residents’ Perspectives on Screening for Food Insecurity
BACKGROUND: One in five families with children under age six in Minnesota are affected by food
insecurity, defined as unreliable access to quality foods. Food insecurity is a known social determinant
of health for children. As such, the American Academy of Pediatrics (AAP) recommends universal
screening and early referral to food resources.
OBJECTIVE: Evaluate current screening practices among pediatric residents and design a tool for
use in clinic to improve access to resources for food-insecure children and families.
DESIGN: We surveyed pediatric residents at the University of Minnesota to evaluate current
knowledge of the AAP policy, screening rates, resident comfort with screening, and interventions. We
reviewed local resources (food pantries, reduced cost food sites, and free meal services) and created
easy-to-read pamphlets for residents to provide to patients screening positive for food insecurity.
RESULTS: 54 residents responded to the survey (53%). Most (61%) were unaware of the AAP policy
on food insecurity. After excluding one clinic site that recently incorporated screening questions into
the EHR, we found that few residents (21%) actively screen. 48% of providers felt either somewhat
uncomfortable or very uncomfortable screening for food insecurity; only 3.7% felt very comfortable.
Most residents (72%) are unaware of resources to utilize after identifying a food-insecure home.
CONCLUSIONS: The majority of pediatric residents at the University of Minnesota are unaware of the
AAP policy and do not currently screen patients for food insecurity. Very few residents feel
comfortable with the screening process, and most are unaware of resources to refer families to if food
insecurity is identified. We hope that by creating patient-friendly brochures listing local food resources,
it will both improve resident knowledge and rates of screening as well as provide a valuable resource
for families in Minnesota.
72
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [41]
Names: Jacquelyn Campbell and Ashley Phimister
Status: Pediatric Residents
Division: Pediatric Hospital Medici ne
Research Sponsor: Zachary Kaltenborn
Streptococcus intermedius: An uncommon pathogen with a common presentation
A 13-year-old boy, otherwise healthy, presented with persistent chest pain, shortness of breath, and
new onset of fever. He had been experiencing chest pain for the past 3 weeks, but this acutely
worsened on the day of admission. His past medical history is significant for an uncomplicated
tonsillectomy and adenoidectomy one month prior to presentation. Three days prior to admission, he
was seen in an outside ED where he was found to have an unremarkable chest x-ray and diagnosed
with costochondritis. He developed worsening pain and shortness of breath, so he presented to the
ED again the day of admission. He was febrile and in mild respiratory distress requiring supplemental
oxygen. His exam was significant for diminished breath sounds over the right middle and lower lobes.
His labs were remarkable for an elevated CRP and leukocytosis with a left shift. A chest x-ray and
chest CT were performed and demonstrated a moderate to marked right sided pleural effusion. He
was given ceftriaxone and azithromycin, and admitted to the hospital for further treatment. On hospital
day 2, he underwent video-assisted thoracoscopic surgery (VATS) with washout, decortication, and
drainage. He had two chest tubes placed and pleural fluid was collected. The pleural fluid was found
to be exudative and grew Streptococcus intermedius and Eikenella corrodens. He was transitioned to
Augmentin to complete a total of 14 days of antibiotics. Our patient’s recent tonsillectomy and
adenoidectomy likely put him at risk for this particular infection because this type of bacteria is often
hematogenously spread and is a known oral anaerobe. This case highlights the importance of
considering the Streptococcus milleri group of bacteria as a rare, but significant cause of pulmonary
abscess and empyema in immunocompetent pediatric patients.
73
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [42]
Name: Catherine Koozer
Status: Pediatric Resident
Division: Pediatric Neonatology
Research Sponsors: Melissa Engel & Jamie Lohr
Identification of Missed CHD from Cardiac Intervention Data and Death Records During the
Pulse Oximetry Pilot Study in MN
CJ Koozer, Melissa Engel, Lazaros Kochilas, Amy Gaviglio, Jamie Lohr
Background: A pilot study performed between 8/7/2011 and 11/1/2012 tested the feasibility of pulse
oximetry screening for critical congenital heart disease (CCHD) in six nurseries affiliated with the
University of Minnesota Masonic Children’s Hospital (UMMCH). Most errors detected during data
analysis were misapplication or misinterpretation of the screening algorithm. One limitation not
addressed is failure of appropriate CCHD screening to identify all newborns that require early
intervention. The goal of this study was to identify infants from surgical, catheterization and death
records that passed the CCHD screen, yet were subsequently identified with CHD requiring
intervention in the first year of life.
Methods: Data from the pilot study cohort were matched by indirect identifiers to cardiac
catheterization and surgical records from UMMCH and the death records from the Minnesota
Department of Health (MDH) up to the first birthday of each participant. Retrospective chart review
was completed to obtain demographics and prenatal history in patients requiring cardiac interventions.
Results: Among the 7,543 subjects tested in the pilot study and passed, three infants (0.035%)
required transcatheter intervention and three died (0.035%) within the first year of life. All three
transcatheter interventions were performed for valvar pulmonary stenosis. The causes of death for
the three infants who passed their screen during the pilot study were not cardiac related. Two infant
deaths were recorded as Sudden Unexplained Death of Infancy and one as positional asphyxia.
There are two additional hospitals that perform cardiac catheterization and surgery in Minnesota. A
search of their catheterization and surgical records for infants diagnosed with CHD screened at our
pilot hospitals is currently underway.
Conclusions: Pulse oximetry is a good newborn screening tool for CCHD causing hypoxemia. The
infants in our study who passed the pulse oximetry screening during the pilot study and required an
intervention within the first year of life did not have any of the CHD target lesions. We will supplement
these results with statewide data with the implementation of electronic CCHD reporting through the
MDH and our established collaboration with the two other cardiac centers in Minnesota.
Kochilas LK, Lohr JL, Bruhn E, et al. Implementation of critical congenital heart disease screening in
Minnesota. Pediatrics 2013;132(3):e587-94.
74
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [43]
Name: Stephanie Lauden
Status: Pediatric Resident
Division: Global Pediatrics
Research Sponsor: Mike Pitt
What We Can Learn from Residents' Disease Logs from Global Health Electives
Stephanie Lauden, Sophia Gladding, Cynthia Howard, Tina Slusher, Michael B. Pitt
Background: Residents are increasingly participating in global health (GH) electives in resource- limited
settings. While anecdotally these experiences are deemed valuable by residents, little is known about the
breadth and impact of the clinical scenarios encountered.
Objective: Identify themes in residents’ perception of the most interesting/impactful clinical scenarios
which they encountered on GH electives as part of the University of Minnesota GH track.
Methods: Pediatric (8) and medicine-pediatric (5) residents participated in 4-8 week electives as part of a
global health curriculum from March to December of 2016. Each was asked to maintain an online disease log
where they described the ten most interesting/impactful clinical scenarios encountered. One author read the
de-identified comments multiple times identifying themes. A second author then independently coded all of
the written comments using the updated themes. The two authors met and compared their coding for each
question, agreed upon 28 unique codes, mapped to ACGME core competencies, and discussed areas of
disagreement until consensus was reached.
Results: We received disease logs from all 13 residents who participated in electives, yielding 129 unique
clinical scenarios from eight countries. During the first-order analysis, 8 themes were found in more than
10% of comments and are summarized in Table 1 along with the ACGME Core Competencies which they
address.
Conclusion: Residents reported a wide variety of reasons for why the clinical scenarios they encountered
on GH electives were impactful, with the most frequent themes mapping well to ACGME core competencies.
GH electives may provide an opportunity for residents to develop meaningful competencies in areas which
can be difficult to address in traditional residency training. These themes can inform best practice in predeparture training, highlight potential risk factors for resident moral distress, and demonstrate personal
development.
75
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [44]
Name: Stephanie Lauden
Status: Pediatric Resident
Division: Global Pediatrics
Research Sponsor: Ben Trappey
The Wellness Rx: Using a Written Plan for Personal Wellness Abroad
Stephanie M. Lauden, Ashish Shah, Brian Muthyala, Michael B. Pitt, Bernard Trappey
Background: Trainees participating in global health (GH) electives face significant emotional and ethical
challenges. The University of Minnesota GH Track holds a one-day GH preparatory course for trainees
participating in an elective. This session has not formally addressed wellness abroad in the past.
Objective: Incorporate wellness preparation into GH pre-departure training via a novel moderated activity we
called Wellness Rx.
Methods: This year’s pre-departure session began with a large group introduction to the concept of moral
distress – when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue
it – followed by a faculty panel sharing personal stories of challenging experiences abroad. Small groups then
rotated between three workshops: a simulation session involving a neonatal death after a futile resuscitation
(sugarprep.org); hands-on procedural skills; and the new Wellness Rx session. In this session, GH faculty
facilitated discussion about the importance of wellness abroad, including packing tips, mindfulness, and
narrative writing. The workshop concluded with trainees writing their own Wellness Rx – a personal action plan
for wellness while away. We surveyed residents after the sessions, including asking what, if any, emotions they
experienced in anticipation of their elective during the moral distress session and the wellness session.
Results: Response rate was 100% (8 residents, 3 medical students). 82% stated that the Wellness Rx would
change the way they prepared for their elective, either somewhat (5) or to a great extent (4). Table 1 shows the
range of emotions experienced in the two sessions.
Conclusion: The addition of a written Wellness Rx activity to GH preparation was well received by trainees, and
provided an opportunity to reflect on their emotions surrounding their elective – including many which were
negative – and consider and intentionally plan their strategies for wellness before their departure. We have
made the resources for this session available as open-source for other programs (http://bit.ly/WellnessRx).
76
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [45]
Name: Heidi Moline
Status: Pediatric Resident
Division: Pediatric Infectious Diseases
Research Sponsor: Mark Schleiss
Acute transverse myelitis caused by Echovirus 11 in a 12-year-old boy
Abstract: A 12-year- old boy presented with acute transverse myelitis involving the cervical cord (CT1) and acute flaccid myelitis involving the right upper extremity. Evaluation for an infectious etiology
demonstrated the presence of human echovirus 11. The patient recovered with some disability, but
return of function. Echovirus 11 is among the more common etiologies of acute flaccid myelitis and
should be considered in the differential diagnosis of this increasingly recognized pediatric infection.
Discussion includes a review of the literature and epidemiology of echovirus 11 central nervous
system infections.
77
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [46]
Name: Heidi Moline
Status: Pediatric Resident
Division: Pediatric Infectious Diseases
Research Sponsor: Stacene Maroushek
What's the Diagnosis: 3-week-old presents with rapidly spreading erythematous annular
lesions
Abstract: A 3-week-old male newborn presents with a one week history of rash. A skin scraping of the
lesions with KOH preparation was consistent with Trichophyton rubrum (D. Tinea corporis). Further
evaluation of the mother found extensive ring lesions across her arms and chest. The differential of
annular lesions in a neonate are explored, as well as the epidemiology and management of tinea
infections in children of this age.
78
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [47]
Name: Nasreen Quadri
Status: Pediatric Resident
Division: Pediatric Infectious Diseases
Research Sponsor: Mark Schleiss
From Leprosarium to Living with Leprosy: Diagnosis of Hansen's Disease in an 11-Year-Old
Bhutanese Boy from Nepal and Investigation of Current M. leprae Disease Trends
Nasreen Quadri, MD and Mark R. Schleiss, MD (Sponsor)
University of Minnesota, Combined Internal Medicine and Pediatrics Resident
An eleven-year old Bhutanese-Nepali boy, who immigrated to the U.S. two years prior, presented to his primary
physician with six months of an enlarging hypopigmented, hypoesthetic plaque of his left arm noted after
removal of cast for humeral fracture. When the rash failed to improve on several anti-fungal topical agents, he
underwent skin biopsy. Histopathology demonstrated sarcoidal and tuberculoid granulomatous dermatitis
diagnostic of the paucibacillary form of Hansen’s Disease (tuberculoid leprosy). In consultation with the National
Hansen’s Disease Program, he was started on two-drug therapy of Dapsone and Rifampin for one-year duration
to treat the disease and prevent permanent nerve damage. The disease affects cooler tissues including nerves,
skin, eyes and nasal mucosa by the slow growing acid-fast bacillus Mycobacterium leprae. While skin findings
are a hallmark of Hansen’s disease, the suspected mode of transmission is through respiratory droplets via
prolonged close contact with an affected person.
We investigated the current epidemiology of Hansen’s disease in the U.S. In 2015, cases from 31 states and
Puerto Rico were reported; 72% of cases (129/178) were in FL/CA/TX/LA/HI/NY, following prior trends. In
several southern states, zoonotic transmission from wild armadillos is the principle source of infection. In 2015,
57% of affected individuals were born outside the U.S. in 26 different countries, predominately in the South
Pacific region. Globally, the WHO reports a decline of 60% in annual new cases from 2001 to 2014, most
notable in countries within Southeast Asia. Among children, typical presentation is paucibacillary forms between
ages 10 and 14 years. In 2015, there were 178 new cases reported in the U.S. (ages 7-95) with a 2:1 male to
female predominance and 13,950 cases registered in the U.S. since 1894. Index of suspicion for Hansen’s
Disease should remain high for patients from endemic regions and the southern U.S.
Tuberculoid, paucibacillary Hansen’s
disease affecting extensor surface of left
arm in an 11-year-old boy. (A)
Hypopigmented central region of rash
with associated alteration of sensitivity.
(B) Solitary plaque with raised
erythematous edge.
References:
“A Summary of Hansen’s Disease in the United States-2015”. National Hansen’s Disease
Program. Released 2016.
https://www.hrsa.gov/hansensdisease/pdfs/hansens2015report.pdf.
Barretto de Oliveira, MB. Diniz, LM. “Leprosy among children under age 15: literature
review”. An Bras Dermatol. 2016 Mar-Apr; 91(2): 196–203. doi: 10.1590/abd18064841.20163661
79
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [48]
Name: Emma Schempf
Status: Pediatric Resident
Division: Pediatric GME
Research Sponsor: Dawn Martin
IMPROVING RESIDENT COMMUNICATION WITH VACCINE-HESITANT FAMILIES THROUGH
SIMULATION
Background: Childhood immunizations are the cornerstone of pediatric preventive care, yet vaccine
hesitancy remains a challenge. Provider communication is a significant factor in immunization
delivery and acceptance. Conversations about vaccine hesitancy are challenging, and simulation
provides a unique opportunity for resident education. We hypothesize that participating in
conversations with vaccine-hesitant families will improve communication skills and provide a
framework for these discussions.
Objective: To enrich resident learning through a standardized simulation curriculum on vaccine
hesitancy.
Methods: We designed 4 scenarios, including influenza vaccine refusal, MMR denial in a Somali
immigrant family, HPV concerns and an alternative vaccine schedule request. We conducted the
simulation sessions at Hennepin County Medical Center with trained simulated caregivers. All firstyear residents in the University of Minnesota Pediatric Residency Program participate as part of an
outpatient rotation. Each session begins with a short presentation on effective communication
strategies, including the C.A.S.E. method and presumptive vs participatory approach to vaccine
discussions. Pre- and post-simulation data were gathered about resident comfort with these difficult
conversations (Likert scale 1 – 5, with 1 being least comfortable, 5 being most comfortable).
Results: After simulation training, residents report higher levels of comfort regarding conversations
with vaccine-hesitant families (pre: 3.0 vs post: 4.2). Residents also felt they had more strategies for
talking to vaccine-hesitant families (2.8 vs 4.0) and were more confident utilizing reliable vaccine
resources (2.8 vs 4.4). 91% of residents reported they planned to change their approach to vaccinehesitant families following the training.
Conclusions: Pediatric residents who participated in these simulations acquired strategies and
gained confidence in effective communication with vaccine-hesitant families. By improving
communication skills, we anticipate residents will engage in more effective discussions with vaccinehesitant families.
80
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [49]
Name: Joe Woolley
Status: Pediatric Resident
Division: Pediatric GME
Research Sponsor: Jeff Louie
Abnormal Posturing in an Severely Intoxicated Teenager
We describe a 16-year-old male with a history of poorly controlled diabetes who presented to the
Emergency Department via ambulance after being found unconscious in the street for an unknown
period of time. The mother relayed her son’s past medical history consisting of diabetes and previous
alcohol abuse. Upon arrival, he was breathing spontaneously, although unresponsive to painful
stimuli. He was hypothermic to 34.8°C, otherwise hemodynamically stable. There were no external
signs of significant trauma, but was noted to be displaying unprovoked decerebrate and decorticate
posturing, raising concern for an intracranial process. Pupils were equal at 5mm and equally reactive
to light. He subsequently received a loading dose of fosphenytoin to address possible seizure
activity. Routine labs revealed significant hyperglycemia (524 mg/dl), blood gas consistent with a
mixed respiratory and lactic acidosis, and unremarkable biochemistry and hematology. His
diminished gag reflex and abnormal posturing prompted decision to intubate the trachea, which was
performed without complication. Subsequent CT imaging of the brain revealed no intracranial
pathology. Urine drug screen was positive for cannabinoids and ethanol, and blood alcohol level was
ultimately found to be significantly elevated at 0.32 g/dL. He was transferred to the PICU where he
was managed with an intravenous insulin drip and fluids. He was weaned from the ventilator to be
extubated within 24 hours with complete return to normal conscious level. Reflex posturing can occur
in disorders that cause significant increases in intracranial pressure such as masses, traumatic brain
injuries, hemorrhages, or encephalopathies. The adult literature supports a rare, alternative cause:
severe alcohol intoxications mimicking metabolic encephalopathies. Based on our patient’s rapid and
complete recovery, a normal head CT and absence of other possible metabolic etiologies, we believe
we have described the first pediatric case of abnormal posturing secondary to severe ethanol
intoxication.
81
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [50]
Names: Andrew Wu and Ashish Shah
Status: Pediatric Residents
Division: Pediatric Hospital Medicine
Research Sponsor: Mike Pitt
Choosing the Perfect Shot - The Loaded Narrative within Imagery in Online News Coverage
of Vaccines
Andrew Wu, MD, MPH, Ashish Shah, MD, Tara Haelle, Scot Lunos, MS, Michael Pitt, MD
Background: The images chosen to accompany online vaccine news coverage may play a role in
either undermining or reinforcing public health initiatives about vaccination. We hypothesize that the
proportion of images used in online vaccine news coverage that negatively portray vaccination is
substantial.
Methods:
In order to capture various news stories around vaccination, we searched the following terms in
Google News Archives: “autism and vaccine”, “flu and vaccine”, and “measles and Disneyland”. We
developed a coding tool that classified images as negative, positive, neutral, or irrelevant based on
features displayed in the image. All images included in news reports on the first ten search pages
were coded independently by two researchers, after which discrepancies were discussed by the two
raters until consensus was reached. Analyses of image classifications were performed with a chisquare test.
Results:
We identified 734 images for analysis with similar numbers of images identified per search term (31%
for “autism and vaccine”, 32% for “flu and vaccine”, and 37% for “measles and Disneyland”). While the
majority of images were coded as irrelevant (56%); of the remaining images, 28% had negative
features compared to 30% with positive features (p=0.41). Negative features appeared in 33% of
images depicting non-Caucasian individuals compared to 27% of images containing only Caucasian
individuals (p=0.38).
Conclusion:
Many images accompanying online news coverage of vaccines contain features which may promote
negative connotations about vaccination. As the messages within images have been associated with
decision making around health, editors seeking to support public health initiatives should give careful
consideration to their choice of photographs accompanying their vaccine news coverage.
82
PEDIATRIC
FELLOWS
(Abstracts 51-69)
83
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [51]
Name: Shannon Andrews
Status: Pediatric Fellow
Division: Pediatric Infectious Diseases
Research Sponsor: Patricia Ferrieri
Penicillin Resistance Identified in a Case of Thoracic Actinomycosis
Shannon Andrews, MD; Nadir Demirel, MD; Tamara Pozos, MD PhD; Shane McAllister, MD PhD; Patricia
Ferrieri, MD
Thoracic actinomycosis is a rare but emerging infection observed in children with chronic
granulomatous disease (CGD). Actinomyces species are described as universally susceptible to betalactam antibiotics.
A 2 year old male with X-linked CGD was treated with three months of amoxicillin for an infection with
Actinomyces meyeri with resolution of his symptoms . He underwent flexible bronchoscopy to identify
the etiology of a new opacities on a follow-up chest CT. Actinomyces odontolyticus was isolated from
tissue culture of an endobronchial mass. Minimum inhibitory concentrations (MIC) were obtained via E
test and susceptibilities were reported in accordance with CLSI standards. The Actinomyces
odontolyticus isolate was susceptible to amoxicillin/clavulanate, cefotaxime, and clindamycin (MIC 4
ug/mL, 2 ug/mL, and 0.25 ug/mL respectively). The isolate was resistant to penicillin (MIC 4 ug/mL)
and metronidazole (MIC 32 ug/mL).
We present a case of thoracic actinomycosis with an isolate that was resistant to penicillin, which has
not been reported previously in the literature. This microbe was identified in a patient that was
undergoing prolonged treatment with amoxicillin for a previous infection with Actinomyces meyeri.
Vigilance for antimicrobial resistance must remain high in patients treated with prolonged courses of
antimicrobials.
84
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [52]
Name: Danielle Bullock
Status: Pediatric Fellow
Division: Pediatric Rheumatology
Research Sponsor: Colleen Correll
Familiarity Vital for Telemedicine Uptake among Parents of Pediatric Rheumatology Patients
1
Danielle R. Bullock, MD1, Richard K. Vehe, MD1; Lei Zhang, ScM2; Colleen K. Correll, MD, MPH1
Division of Pediatric Rheumatology, Department of Pediatrics; University of Minnesota Masonic Children’s
Hospital; Minneapolis, MN, USA.
2 Clinical and Translational Sciences Institute, University of Minnesota; Minneapolis, MN, USA.
Background:
With a limited number and distribution of pediatric rheumatologists, telemedicine has been proposed
as one way to provide children with access to pediatric rheumatology (PR) care. Because low
familiarity with telemedicine is a known barrier to successful implementation, the purpose of this study
was to assess familiarity with telemedicine and how this influenced opinions about this modality
among parents of PR patients in the Upper Midwest.
Methods:
For six weeks in 2015, English-speaking parents of patients being evaluated at the University of
Minnesota PR Clinic were eligible to participate in a survey. Responses were analyzed using
descriptive statistics.
Results:
Of 221 eligible participants, 159 (72%) responded. The included table outlines patient characteristics.
Only 8% (13/158) of respondents reported that they or a family member or friend had ever used
telemedicine, and the majority (75%, 115/154) felt that they did not know enough about telemedicine
to determine if such visits are better, equal, or worse to in-person visits. Those familiar with
telemedicine were more likely to report a preference for a telemedicine option over in-person visits
(27% vs 3%; p=0.0087). They were also more likely to report telemedicine as equal to or better than
in-person visits (42% vs 8%; p=0.0033). Still, an overwhelming majority (95%, 144/152) reported a
preference for in-person visits, and this preference persisted even when travel to the clinic was
inconvenient (inconvenient 92%, convenient 97%; p=0.2881).
Conclusion:
Most respondents reported a preference for in-person visits over the option of telemedicine; however,
familiarity with telemedicine was low. Familiarity with telemedicine positively influenced both a
preference for a telemedicine option and the assessment of telemedicine quality. Sample bias existed
because only those who came to the PR clinic were surveyed. Efforts to increase familiarity with
telemedicine may foster increased acceptability and are therefore vital when implementing a
telemedicine program.
85
Characteristic
Table: Patient characteristics
Classification
N (%)*
Age
<6
15 (9.4)
6 - 12
65 (40.9)
≥ 13
76 (47.8)
Ethnicity
White
136 (85.5)
Non-white
21 (13.2)
Insurance
Private
113 (71.1)
Public
43 (27.0)
None
1 (0.6)
Primary diagnosis
Juvenile idiopathic arthritis
90 (56.6)
Not yet determined
26 (16.4)
Other
10 (6.3)
Juvenile dermatomyositis
7 (4.4)
Uveitis/iritis
6 (3.8)
Chronic recurrent multifocal osteomyelitis
4 (2.5)
Spondyloarthropathy
3 (1.9)
Systemic lupus erythematosus
3 (1.9)
Mixed connective tissue disease
3 (1.9)
Periodic fever
2 (1.3)
Psoriasis
1 (0.6)
Reactive arthritis
1 (0.6)
Behcet's disease
1 (0.6)
Amplified musculoskeletal pain
1 (0.6)
Sjogren's syndrome
0 (0)
Lyme disease
0 (0)
Travel time
0 - < 1 hour
76 (47.8)
1 - < 3 hours
37 (23.3)
3 - <6 hours
37 (23.3)
6 hours or more
8 (5.0)
* Percentages are out of 159 survey respondents. Some respondents did not answer all questions.
86
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [53]
Name: Nita Ray Chaudhuri
Status: Pediatric Fellow
Division: Pediatric Cardiology
Research Sponsor: Shanthi Sivanandam
Prenatal Predictors of Urgent Balloon Atrial Septostomy in Transposition of Great Arteries
Nita Ray Chaudhuri MD1, Prasad Ravi MD2, Lisa K. Hornberger MD3, Shanthi Sivanandam MD4
1,4 Division
2,3 Division
of Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota
of Fetal & Neonatal Cardiology, University of Alberta, Edmonton, Canada
Background: The preoperative mortality associated with transposition of great arteries (D-TGA) has
been reported to be as high as 6% which is largely due to severe cyanosis with inadequate atrial level
mixing. With prenatal detection of D-TGA on the rise, we have an opportunity to improve our ability to
predict the need for emergent balloon atrial septostomy (BAS).
Objective: To examine the sensitivity and specificity of current prenatal predictors of need for
emergent neonatal BAS.
Materials and Methods: Prenatal echocardiograms of 50 fetuses with D-TGA performed in the 3rd
trimester were reviewed retrospectively at the Universities of Minnesota (n=11) and Alberta (n=39)
from 2003 to 2016. Postnatal outcomes of these fetuses were reviewed. Variables evaluated from
prenatal echocardiograms included 1) Diameter of the foramen ovale (FO) flow orifice; 2) Ratio of FO
diameter to interatrial septal length (IAS); 3) Thickening of IAS and mobility of septum primum; 4)
Ductus arteriosus (DA) size and flow.
Results: Mean gestational age at diagnosis was 33.9 weeks. 13 fetuses required emergent BAS at
<2 hours after birth and 18 others underwent BAS 2-24 hours. 19 fetuses required no BAS. Best
predictors of need for urgent BAS at <2 hours included: 1) FO <6 mm (sensitivity 0.60, specificity
0.84, p=0.02); 2) FO/IAS length ≤0.3 (sensitivity 0.48, specificity 0.95); 3) DA <3.5 mm (sensitivity
0.48, specificity 0.75, p=0.19); 4) Restrictive FO <6 mm & DA size <3.5 mm (sensitivity 0.85,
specificity 0.63, p=0.003).
Conclusions: Our data suggests that a small FO, ratio of FO/IAS, ductal size of <3.5 mm and
especially a combination of small FO and ductal size of <3.5 mm most predict need for early BAS.
Majority of fetuses that required urgent BAS <2 hours had all above features, however 1 fetus that
required urgent BAS did not have any of these features.
87
Table 1: IAS and PDA features predicting BAS in Fetal D-TGA
Prenatal features
Urgent BAS at
<2 hours
BAS
2-24 hours
No BAS
26%
0
0
FO 6 to 7mm
0
36%
0
FO > 7mm
0
0
38%
Thick IAS & ↓ mobility
19%
71%
0
FO/IAS length <0.3
16%
26%
5%
FO flow restriction
15%
11%
0
DA < 3.5 mm
31%
44%
25%
Abnormal DA flow
27%
19%
16%
FO < 6mm
88
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [54]
Name: Elissa Downs
Status: Pediatric Fellow
Division: Pediatric Gastroenterology
Research Sponsor: Alan Baldridge
Intussusceptions along gastrojejunostomy tubes: Known complication or new issue?
Downs EM, Baldridge AD, and Dietz K
Background:
Gastrojejunostomy (GJ) tubes are a convenient way to provide nutrition to children with complex
medical issues such as global developmental delay, hypotonia, or dysphagia and aspiration. They are
generally safe, but not without risks. A known risk factor is development of intussusception with the
tube acting as an extrinsic lead point. Patient factors (small habitus, hypotonia, dysmotility, previous
intussusception, post-operative state, younger age, male sex), and tube factors (French size or pigtail
anchor) are reported as increasing risk for GJ-tube intussusception (GJI).
Aim:
Primary: Identify our cases of GJI and evaluate risk factors for development.
Secondary: Identify if a device safety issue is occurring given perceived increase in GJI.
Methods:
Patients with GJ-tubes placed/replaced at the University of Minnesota between 4/2014 and 5/2016
were identified via search of billing codes and radiology reports. Charts were reviewed for further
details of GJI.
Results:
During the study period, 123 patients had GJ-tubes placed, with 17 identified GJI. One patient also
had a prior GJI. Of those, 10 (58%) were female, with median age 3.3 years (range 0.4-15.1). GJtube was in place prior to GJI for median 60 days (range 10-1476), although last tube manipulation
prior to GJI was sooner (median 38 days, range 10-852). 10 patients had a 16 French tube. J-tube
length, where known, was evenly distributed between 22cm (n=5), 30cm (n=6), and 45cm (n=5).
Additional risk factors include post-operative status (n=9), transplant status (n=9), underlying cardiac
disease (n=8), and prematurity (n=6).
Conclusions:
Our population is at risk for GJI development GJI due to post-operative status, small size, and
dysmotility. Although we perceived an increase in GJI, our 14% rate is within reported rates of 1050%. GJI was seen across all French sizes, J-tube lengths, and brands of GJ-tube, thus a specific
device safety issue was not identified.
89
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [55]
Name: Jorge Galvez Silva
Status: Pediatric Fellow
Division: Pediatric BMT
Research Sponsors: Angela Smith, Weston Miller & John Wagner
Characterization of Serotherapy-Associated Fever in Pediatric Patients Undergoing
Hematopoietic Stem Cell Transplant
Jorge Galvez Silva, MD; Hesham Eissa, MD; Angela Smith, MD; Weston Miller, MD; John Wagner, MD
Introduction: Serotherapy is commonly used in patients undergoing hematopoietic stem cell transplant
(HSCT) to reduce the incidences of engraftment failure and graft versus host disease. However, one
well-known side effect is fever. As children undergoing HSCT have compromised immune defenses,
fever may also be an early indicator of bloodstream infection, which would warrant prompt use of
broad-spectrum antibiotics. In a subset of patients with serotherapy-associated fever, antibiotics,
which may induce antibiotic resistance and increase costs, may be unnecessary. We aimed to
determine the incidence and characteristics of serotherapy-related fever, as well as the likelihood of
concomitant bacteremia, in our institutional experience.
Methods: A 3-year retrospective chart review was conducted of pediatric patients who received
serotherapy as part of HSCT conditioning at the University of Minnesota.
Results: Ninety-one consecutive HSCT patients who received serotherapy - either ATG (N= 66) or
alentuzumab (N= 25) – were identified. The median age at HSCT was 6-years (range, 0.4-18 years).
A total of 61 patients (66%) developed fever while on serotherapy (ATG= 52, alentuzumab=9). Fiftysix patients presented fever during the first infusion, and the median onset of fever was 7 hours after
commencing infusion (range, 0.1-22 hours). Fever resolved at a median 8 hours (range, 1-48 hours).
Sixty patients (98%) underwent 101 total blood cultures. Fifty-three patients (87%) were started on
empiric antibiotics, while 21% (N=13) were on antibiotic treatment prior to serotherapy for previously
known or suspected infections. Four patients (7% of febrile patients, 4% of all patients) had positive
blood cultures (ATG= 3; Alentuzumab=1). No infection-associated deaths were observed.
Conclusions: While fever is common during serotherapy conditioning in children undergoing SCT,
episodes of concomitant bloodstream infection are rare. Ongoing analysis of this cohort aims to
identify potential risk factors for bacteremia and, conversely, subgroups of patients for whom close
monitoring alone may be safe.
90
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [56]
Name: Vasu Gooty
Status: Pediatric Fellow
Division: Pediatric Cardiology
Research Sponsor: Shanthi Sivanandam
Left Heart Agenesis with Total Anomalous Pulmonary Venous Return in a Fetus
Clinical Case Presentation:
24-year-old mother was referred at 20-week gestation for a fetal echo, which demonstrated agenesis
of left heart along with anomalous pulmonary veins forming a confluence draining into dilated
coronary sinus. At one week of life, the neonate underwent Norwood procedure with Sano shunt and
anastomosis of pulmonary venous drainage via primary sutureless repair to the right atrium.
Intraoperatively, visual inspection of the cardiac structures showed complete agenesis of left atrium
and left ventricle. No left atrial appendage was visualized and the confluence of pulmonary veins
drained into dilated coronary sinus. At 6 months of age, the infant underwent an off-pump bidirectional
Glenn procedure.
Imaging Findings:
Transthoracic echo showed absence of left atrial appendage, left atrium and left ventricle (agenesis).
The right ventricle was mildly dilated with normal contractility. Ascending aorta was diminutive.
Proximal and distal transverse arch appeared normal in size and perfused by retrograde flow from
ductus arteriosus into aortic arch and ascending aorta. The confluence of pulmonary veins was
unobstructed, draining into coronary sinus which eventually opened into right atrium. Cardiac CT scan
reconfirmed diagnosis.
Role of Imaging:
This case summarizes the role of multimodality imaging in the diagnosis and management of critical
complex congenital heart disease. We demonstrated prenatally agenesis of left atrium, ventricle and
total anomalous pulmonary venous return to dilated coronary sinus eventually draining into right
atrium. Postnatally, transthoracic echo and cardiac CT confirmed the diagnosis.
Summary/Discussion Points:
This is a rare case of agenesis of left heart structures along with anomalous pulmonary venous
drainage to dilated coronary sinus eventually draining into right atrium. Diligent pre-operative
assessment of cardiac anatomy and course of pulmonary venous drainage with the help of
multiimaging modality including fetal echo, transthoracic echo and CT scan are essential in planning
and counseling families for single ventricle palliation.
91
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [57]
Name: Alyssa Halper
Status: Pediatric Fellow
Division: Pediatric Endocrinology
Research Sponsor: Kyriakie Sarafoglou
Bone mineral density and body composition in children with congenital adrenal hyperplasia
Alyssa Halper, MD1, Belen Sanchez, MD1, James Hodges, PhD2, Aaron Kelly, PhD3, Donald Dengel,
PhD4, Brandon M. Nathan, MD1, Anna Petryk, MD1*, Kyriakie Sarafoglou, MD1
1
University of Minnesota Masonic Children's Hospital, Minneapolis, MN, US
University of Minnesota Division of Biostatistics, Minneapolis, MN, US
3
University of Minnesota Division of Epidemiology and Clinical Research, Minneapolis, MN, US
4
University of Minnesota Department of Kinesiology, Minneapolis, MN, US
*Current affiliation: Alexion Pharmaceuticals, Inc., New Haven, CT 06510, USA
2
Background: Children with congenital adrenal hyperplasia (CAH) require life-long hydrocortisone
replacement, leaving them at risk for transient periods of both hypo and hypercortisolemia and
hyperandrogenemia. The effect of these fluctuations on bone mineral density (BMD) and body
composition is not clearly established.
Objective: To compare BMD and visceral adipose tissue (VAT) in children with CAH to healthy
controls.
Methods: 42 CAH cases (mean age 12.3 years; 40% males) were matched to 101 healthy controls
(43% males) on age, sex, and BMI Z-scores. All participants underwent anthropometric
measurements and a dual energy X-ray absorptiometry (DXA) scan. Total body BMD (TBMD) was
adjusted for height-for-age Z-score (TBMDHAZ). Hydrocortisone (HC) doses (mg/m2/day) were
averaged over the past year, and bone age Z-scores were used as a surrogate marker of androgen
exposure.
Results: CAH cases had lower TBMD and TBMDHAZ Z-scores than controls (0.81 vs. 1.27, p=0.003
for TBMD; -0.51 vs. -0.01, p=0.001 for TBMDHAZ). TBMD and TBMDHAZ Z-scores in CAH cases were
not associated with HC dose; however, they were positively correlated with bone age Z-scores
(r=0.63, p<0.0001 for TBMD; r=0.51, p=0.001 for TBMDHAZ). Although the percentage of total tissue
fat was similar in CAH cases and controls (30.6% vs. 32.4%, p=0.052), VAT was lower in CAH cases
vs. controls (171 vs. 273 cm2, p=0.009). This difference remained after adjusting for sex, BMI Zscores, HC dose, and bone age Z-scores.
Conclusion: CAH cases had lower TBMD and TBMDHAZ Z-scores compared to controls. The lack of
correlation with HC dose may be due to inter-individual variability in glucocorticoid sensitivity and
cortisol pharmacokinetics. Lower VAT in CAH children may reflect the positive effect of androgen
exposure on VAT and a more complex interplay of androgens and cortisol fluctuations on bone and
fat metabolism in CAH.
92
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [58]
Name: Elwaseila Hamdoun
Status: Pediatric Fellow
Division: Pediatric Endocrinology
Research Sponsors: Muna Sunni & Antoinette Moran
Total 25-Hydroxyvitamin D measurement may not be a sensitive screening method to
detect vitamin D deficiency in some ethnic pediatric populations
Hamdoun E1, Piloya T2, Cusick S1, Nathan B1, Mahamed Z1, Moran A1, Petryk A1 , Sunni M1
1University
2University
of Minnesota, MN, USA
of Makerere, Uganda
BACKGROUND
Total 25-dihydroxyvitamin D (T25OHD) is frequently low in African-Americans without any clinical
or biochemical manifestations of deficiency, though it is universally accepted as a sensitive
screening tool. New evidence casts doubts on its usefulness in some African children.
METHODS
We measured T25OHD and other vitamin D metabolites by mass spectrometry, parathyroid
hormone [PTH] by immunoassay in 3 groups of well children age ≤7yrs: Caucasian Minnesotans
(n=14), Minnesotans of Somali descent (n=55), and Ugandans in Africa (n=94, equatorial latitude).
RESULTS
Vitamin D levels <30 ng/ml were found in 64% of Caucasians, 91% of Somalis and 49% of
Ugandans. Of those, 89% of Caucasians, 52% of Somalis and 12% of Ugandans were
hypocalcemic (corrected total serum Ca<9.1mg/dl for age≥11 months, and 8.5 for age<11
months). Across all groups, higher PTH was associated with hypocalcemia (r= -0.32, P = <0.0001)
but not with T25OHD status (D<30, r= -0.07, p=0.6). Assuming hypocalcemia represents true
vitamin D deficiency status, T25OHD<30 ng/ml had an overall sensitivity of 74%. We have found a
positive correlation between a promising new biomarker, the ratio of inactivated vitamin D
(24,25(OH)2D3) to T25OHD [24/25D ratio], and serum calcium (r=0.35, p=<0.0001).
CONCLUSIONS
Measurement of T25OHD may neither be sufficient to evaluate significance of underlying
metabolic derangements related to vitamin D status nor to inform clinical decisions about
therapy in African children. Future work will test vitamin D-binding protein levels and its
haplotypes, and calculate free and bioavailable 25OHD. This information will be used to better
explore the observed correlation between 24/25D ratio and calcium levels, and whether it can
serve as a better indicator of true vitamin D status in this cohort.
93
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [59]
Name: Angela Hanson
Status: Pediatric Fellow
Division: Pediatric Neonatology
Research Sponsor: Phu Tran
IUGR alters cortical and hippocampal transcriptomes in developing and adult rats
Angela Hanson, Amanda Barks, Kathleen Ennis, Raghavendra Rao, Anne Maliszewski-Hall, and Phu Tran
Background
Children born with intrauterine growth restriction (IUGR) are at increased risk of
neurodevelopmental consequences. The etiology is poorly understood; however, altered gene
networks critical for central nervous system development and function is a potential
mechanism. Next-generation sequencing (NGS) analysis of transcriptomes could further
elucidate why IUGR children are at risk for these neurological deficits.
Objectives
Determine the effects of IUGR on cortical and hippocampal gene expression in developing and
adult rats.
Methods
IUGR was induced using bilateral uterine artery ligation at gestational day 19 in pregnant Sprague
Dawley dams (term = 22.5 days). Normally grown (NG) control rats were generated without
manipulation of the uterine arteries. Postnatal day (P) 7 and 60 cortices and hippocampi were
collected from male rats and analyzed by NGS (n=4/group). Differentially expressed genes were
functionally annotated using the knowledge-based Ingenuity Pathway Analysis (IPA).
Results
More than 17,000 loci were sequenced. 208 genes were differentially expressed (1.2% of
transcriptome) between IUGR and NG at P7 in the cortex and hippocampus (P<0.05). No
significant difference was found at P60. In the P7 cortex, the down-regulated genes include
neurogranin, synapotophysin, neurochondrin, and CaMK2a; all are involved in synaptic plasticity,
learning and memory, and neuronal growth. Among the up-regulated genes, doublecortin, which
plays a key role in neuronal differentiation and migration, is most prominent.
Conclusions
IUGR alters neuronal gene expression in the developing rat implicated across a number of cortical
pathways that could underlie the neurodevelopmental deficits associated with IUGR. Increased
expression of doublecortin suggests accelerated neural differentiation as potential catch-up
growth of neural tissue in IUGR. Further analysis is ongoing.
94
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [60]
Name: Ellen Ingolfsland
Status: Fellow
Division: Pediatric Neonatology
Research Sponsor: Sara Ramel
Early infancy body composition of VLBW preterm infants is not associated with higher
blood pressure at four months CGA
Ellen C. Ingolfsland1, Lei Zhang3, Ellen Demerath2, Sara E. Ramel1
1. Pediatrics, University of Minnesota, Brooklyn Park, MN, United States.
2. Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN,
United
States.
3. Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States.
Background: Poor weight gain in preterm infants is associated with worse neurodevelopmental
outcomes, so there has been a movement towards aggressive early nutrition during
hospitalization. With improved catch-up growth, however, there is concern for increased adiposity
and its potential consequences of later metabolic syndrome and hypertension. Little is known
regarding how adiposity and body composition during early infancy affect blood pressure at followup.
Objective: To determine if body composition at term and 4 months corrected gestational age
(CGA), or change in these measurements over time, was associated with higher blood pressure at
4 months CGA.
Design/Methods: Prospective data was collected on 68 appropriate for gestational age (AGA)
infants born <32 weeks gestational age. Body composition (fat mass (FM), fat free mass (FFM),
and % FM) was measured with air displacement plethysmography at term and at 4 months CGA,
and change in these measurements calculated. Blood pressure was measured at 4 months CGA.
Linear regression analysis was performed, adjusting for sex, gestational age, and time between
the two measurements.
Results: Median gestational age at birth was 28 1/7 weeks and mean birth weight was 1075g (zscore -0.03). 51% were male. At term, mean %FM was 18%. At 4 months CGA, mean % FM was
22.3%. Adjusted regression models showed that neither DBP nor SBP at 4 months CGA was
significantly associated with FM, FFM, or FM% at discharge or at 4 months CGA, or with the
change in body composition between the two timepoints. (Table 1. p>0.1 for all).
Conclusion(s): Early changes in body composition are not associated with increased BP at 4
months CGA in this group of preterm infants. Long term data is needed to determine critical
periods for gains in various compartments and their associations with long-term metabolic risk.
95
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [61]
Name: Leslie Kummer
Status: Pediatric Fellow
Division: General Pediatrics and Adolescent Health
Research Sponsor: Iris Borowsky
Interpersonal and Structural Determinants of Breastfeeding in the United
States
Leslie Kummer, MD, Laurel Davis, PhD, Naomi Duke, MD, MPH, and
Iris Borowsky, MD, PhD
BACKGROUND: Human breast milk is optimal nutrition for most infants and confers numerous
health benefits to the mother--‐infant dyad. Yet, U.S. breastfeeding initiation and 6--‐month
exclusivity rates continue to fall below the 2020 Healthy People goals of 81.9% and 25.5%,
respectively. While the impacts of individual--‐level socioeconomic factors on breastfeeding
behavior are well documented, less is known about the influence of interpersonal, community,
and health system--‐level factors on breastfeeding at the population level. The objective of this
study is to determine whether the interpersonal and structural contexts within which mother--‐
infant dyads live are associated with breastfeeding behavior.
METHODS: We analyzed data from the 2012 National Survey of Children’s Health (NSCH), a
cross--‐sectional, nationally--‐representative survey. Analyses were limited to mothers of children
aged 6 months to 5 years, for whom breastfeeding data were available (N=27,511).
Associations between independent variables (see Table) and proportions of women who ever
breastfed and who breastfed exclusively for 6 months were explored using logistic regression.
RESULTS: Overall, 78% of children had ever been breastfed, and of these, 21% were
breastfed exclusively for 6 months. After adjusting for maternal age and education level,
race/ethnicity, household generational status and income, those living in neighborhoods with 2
to 4 amenities had between 1.254 and 1.574 times the odds of initiating breastfeeding
compared to those living in neighborhoods with fewer amenities (Table). Breastfeeding
exclusively to 6 months was significantly associated with living in a socially supportive
neighborhood and perceived neighborhood safety.
CONCLUSIONS: Positive neighborhood characteristics are associated with an increased
likelihood of breastfeeding, suggesting potential community--‐level approaches to increase U.S.
breastfeeding rates.
96
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [62]
Name: Ketzela Marsh
Status: Pediatric Fellow
Division: Pediatric Infectious Diseases
Research Sponsor: Mark Schleiss
Strategies to Engage with Youth Regarding PrEP:
Lessons Learned from Recruitment of Youth for Focus Groups
Ketzela J. Marsh, M.D., Keith J. Horvath, PhD, and Meghan Rothenberger, M.D.
Introduction: Youth aged 13-24, particularly young men who have sex with men (YMSM) of color,
are disproportionately burdened by HIV in the United States. Pre-exposure prophylaxis (PrEP) is
effective at reducing HIV infection when taken as prescribed, but substantial barriers exist along the
PrEP care cascade for this population.
Description: The University of Minnesota Youth and AIDS Projects provides outreach and education
for HIV+ and HIV- high-risk youth, mainly for YMSM of color. We are using focus groups to assess the
knowledge, attitudes, and barriers to PrEP among individuals aged 13-24 that are eligible for PrEP but
not currently utilizing this intervention. Data obtained from these groups will inform the development of
a comprehensive youth-centered PrEP program.
Lessons Learned: Recruitment of youth for PrEP focus groups is challenging. We found that many
participants were more comfortable in one-on-one interviews, since peer groups are potential sources
of embarrassment or disclosure. Recruiting this population by working directly with other community
partners who have existing relationships with high-risk youth was substantially more successful than
indirect methods such as fliers, e-mails, or posts on websites or social media. Holding groups on site
with our community partners or providing private transportation to and from groups also greatly
facilitated participation. Although recruitment was challenging, the lessons we learned about PrEP use
in youth are invaluable and will alter how we provide PrEP programming for this high-risk group.
Recommendations: Input from adolescents and young adults at high-risk for HIV infection is
essential to develop youth-centered comprehensive HIV prevention programs that include PrEP. We
found that high-risk youth, including YMSM of color, are more likely to participate in qualitative
research about PrEP if they are recruited directly by people they trust in the community. The option for
one-on-one interviews was more comfortable for many, especially for transgender individuals.
97
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [63]
Name: Karl Migally
Status: Pediatric Fellow
Division: Pediatric Cardiology
Research Sponsors: Bryce Binstadt & Elizabeth Braunlin
Duration of High-Dose Aspirin Therapy Does Not Affect Coronary Artery Outcomes in
Kawasaki Disease
Background: Kawasaki Disease (KD) is an acute vasculitis targeting coronary arteries. Treatment
with intravenous immunoglobulin (IVIg) reduces occurrence and potential progression of coronary
artery aneurysms (CAAs). The role of high-dose aspirin (HDA) therapy on CAA progression is
unclear, and its duration varies widely.
Methods: We studied retrospectively all patients with KD presenting to our hospital over a 10-year
period. Patients were categorized as having received one of three HDA durations: 0, 1-7, or >7 days.
The primary outcome was maximum coronary artery Z-score; secondary outcomes included Creactive protein (CRP) and platelet count at diagnosis, 4-8 weeks, and 9-15 months from
presentation.
Results: 103 patients with KD had HDA duration documented; 35 of those patients had CAAs at
diagnosis. There was no difference in age, sex, race, KD status (classic versus incomplete), or CRP
and platelet count at diagnosis between the three HDA groups. The 17 patients who received no HDA
had longer illness duration before diagnosis and were less likely to have received IVIg. There was no
difference in HDA duration between patients with and without CAAs at diagnosis. Among patients with
CAAs at diagnosis, linear regression analysis adjusted for age, sex, and IVIg resistance revealed that
HDA duration did not predict coronary dimensions at 9-15 months. Similarly-adjusted longitudinal
analysis demonstrated no difference in rate of decline of coronary Z-score, CRP, or platelet count
between HDA groups. Factors associated with higher coronary Z-scores at 9-15 months were higher
coronary Z-scores and older age at diagnosis.
Conclusion: In KD patients, longer illness duration before diagnosis and lack of administration of IVIg
were associated with not administering HDA. Among all patients, coronary Z-score and age at
diagnosis were the only predictors of coronary Z-score at 9-15 months. Duration of HDA
administration had no apparent effect on clinically-relevant outcome measures, particularly CAA
persistence.
98
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [64]
Name: Lerraughn Morgan
Status: Pediatric Fellow
Division: Pediatric Cardiology
Research Sponsor: Elizabeth Braunlin
Not Your Typical Endocarditis: A Case Report of Granulicatella adiacens Endocarditis
Lerraughn Morgan, Briana Bruce, Elizabeth Swanson, Elizabeth Braunlin
Infective endocarditis is a known complication of implanted bioprosthetic cardiac material following
congenital heart surgery and interventional procedures. Granulicatella adiacens is a rare cause of
bacterial endocarditis and can be especially difficult to identify and treat due to its fastidious
nature. We present a case of Granulicatella adiacens endocarditis in a pediatric patient with partial
bioprosthetic repair of her pulmonary arteries after routine dental cleaning despite appropriate
subacute bacterial endocarditis prophylaxis.
99
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [65]
Name: Erin Plummer
Status: Pediatric Fellow
Division: Pediatric Neonatology
Research Sponsor: Erin Stepka
CLINICAL PROCESS MODEL UTILIZING DEXTROSE GEL FOR
NEONATAL HYPOGLYCEMIA IMPROVES OUTCOMES
E. Plummer, N. Fahim, C. Henke, I. Ninkovic, A. Reese, R. Rao, C. Bendel, E. Stepka
North Memorial Medical Center, Maple Grove Hospital, and
University of Minnesota, Minneapolis, MN, USA
BACKGROUND: Dextrose gel is an inexpensive and safe option that should be considered for firstline treatment of asymptomatic hypoglycemia in late preterm and term infants. In January 2012, we
introduced a new clinical process model (CPM) for neonatal hypoglycemia management that featured
initiation of enteral feedings within one hour of life. In January 2014, our CPM was updated to include
use of dextrose gel. Our goals were to assess outcomes after institution of this CPM and to compare
results with historical controls.
METHODS: 5224 asymptomatic infants born  36 weeks gestational age (GA) between January 2010
and July 2016 were identified as “at risk” for neonatal hypoglycemia. Risk factors included infants of
diabetic mothers, large for GA, small for GA, <37 weeks GA, 5 minute APGAR score <7, perinatal
stress, possible sepsis, or intrauterine growth restriction. Infants were separated into three groups by
epoch: pre-CPM (2010-2011), CPM w/o gel (2012-2013), and CPM w/gel (2014-2016). Data were
recorded regarding blood glucose (BG) levels, feeding, IV dextrose use, and LOS. Outcomes between
groups were then compared.
RESULTS: Post-CPM outcomes in infants at risk for hypoglycemia showed significantly increased
enteral feeding within 1 hour of life, higher rates of hypoglycemia resolution, and reduction in IV
dextrose use. Overall, LOS was unchanged.
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Within the CPM w/gel group, infants with hypoglycemia (BG <45) who received appropriate treatment
with dextrose gel had significantly decreased LOS compared to those who did not receive gel (2.9 vs
3.5 days, p=0.020). Additionally, infants who received dextrose gel were less likely to require
treatment with IV dextrose (3.8% vs 6.4%, p=0.004), and LOS was significantly reduced if infants
received gel and IV dextrose compared to those who received IV dextrose alone (5.7 vs 11.7 days,
p=0.003).
CONCLUSIONS: Our CPMs for neonatal hypoglycemia significantly increased initiation of enteral
feedings within 1 hour of life, improved rates of hypoglycemia resolution, and decreased IV dextrose
use. Reduction in LOS was only significant when hypoglycemic infants were appropriately treated with
dextrose gel per the CPM.
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PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [66]
Name: Annie Simones
Status: Pediatric Fellow
Division: Pediatric Neonatology
Research Sponsors: Aura Sanchez & Kari Roberts
Pulmonary acceleration time is an indicator of severe pulmonary hypertension in newborn
infants
Ann Simones, MD, Kari Roberts, MD, Matthew Ambrose, MD, Aura Sanchez, MD
The ability to accurately estimate the severity of pulmonary hypertension (PH) has significant
implications in the management of neonates with persistent pulmonary hypertension of the newborn
(PPHN) and congenital diaphragmatic hernia (CDH). Pulmonary acceleration time (PAAT) < 90 ms
predicts pulmonary vascular resistance (PVR) index > 3 WUxm2 in children and is routinely
obtainable. The goal of this study is to assess the utility of PAAT in infants with severe PH.
This study is a retrospective review of 60 term neonates with PPHN, CDH, and controls. Clinical data
and echocardiograms performed at < 5 days of life were reviewed. PAAT was measured by Doppler
interrogation across the pulmonary valve. Routine parameters used to classify severity of PH included
ductus arteriosus flow direction and velocity, tricuspid regurgitation jet velocity, and ventricular septum
position in systole.
PAAT was significantly shorter in the CDH and PPHN groups compared to controls. This correlated
with increased severity of PH by routine parameters. A total of 10 infants required ECMO support, 6
with CDH and 4 with PPHN. Neonates with CDH and PPHN that required ECMO had significantly
shorter PAAT than those that did not require ECMO. At 2-3 weeks of life, PAAT increased in the CDH
and PPHN groups, but remained predominantly < 90 ms.
PAAT can be used as an indicator of PH severity in neonates. Infants that require ECMO support
have significantly shortened PAAT values than those that do not require ECMO, reflecting worsen
pulmonary vascular compliance. Further research with larger number of patients is needed to
establish cut-off values of PAAT to predict ECMO support in this population.
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PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [67]
Name: Cassandra Sung
Status: Pediatric Fellow
Division: Pediatric Cardiology
Research Sponsor: John Bass
Thoracic Duct Imaging
Cassandra Sung, M.D., John L. Bass, M.D., James M. Berry, R.D.M.S., Charles W. Shepard, M.D., Bruce
Lindgren, M.S., and Lazaros K. Kochilas, M.D.
Background: Ultrasound imaging of adults with congestive heart failure (HF) and increased central venous
pressure (CVP) has shown significant thoracic duct (TD) dilation from impedance in lymphatic
drainage. Elevated CVP and abnormal lymphatic drainage are implicated in severe Fontan circulation
complications, such as protein losing enteropathy (PLE) and plastic bronchitis (PB). Systematic studies of TD
and lymphatic circulation in children are limited and their cervical TD normative values have not been
established.
Methods: This retrospective study included TD images from routine echocardiograms performed 7/2014 to
9/2016 in children 5-21 years old with normal cardiac anatomy and Fontan palliation. An S12-4 MHz transducer
was used to assess where the TD joined the central venous system (lympho-venous junction). Initially, only TD
ostia were measured, but ostium shape variability at the lympho-venous junction led to inclusion of the TD arch
5-10 mm proximal to the ostium starting 11/2014.
Results: 79 patients (58 controls, 21 Fontan subjects) were evaluated. The controls’ mean age was 13 ± 3.8
years old. 13 Fontan patients without HF (EF > 50%) had a mean age of 11.5 ± 4.5 years old, and 3 had PLE
and 2 had PB. 8 Fontan subjects had HF (EF ≤ 50%) and mean age of 13.4 ± 7.1 years old, and 2 had PLE.
Indexed TD ostial diameters in combined Fontan subjects were significantly larger (p = 0.04) than in controls,
but other TD size differences were not statistically significant between these groups (Table 1).
Conclusion: This study provides the first normative data of TD imaging in children. Fontan patients had larger
TD diameters than controls, suggesting that Fontan circulation with higher CVP causes lymphatic circulation
congestion. Larger studies may reveal a stronger correlation and demonstrate that Fontan circulation
complications, such as PLE and PB, may be related to further TD dilation.
Table 1: Thoracic Duct Comparisons and Imaging Success Rate
Control
TD Ostium*
Fontan no HF
3.2 ± 1.3 mm
Fontan with HF
All Fontan
3 ± 1.1 mm
4.2 ± 1.4 mm
3.5 ± 1.3 mm
[p = 0.83]
[p = 0.07]
[p = 0.37]
(76% seen)
(77% seen)
(88% seen)
TD Ostium indexed 2.2 ± 0.8 mm/m2 2.8 ± 1.2 mm/m2 3.7 ± 2.5 mm/m2 3.2 ± 1.8 mm/m2
[p = 0.16]
[p = 0.08]
[p = 0.04]
TD Arch**
2.5 ± 0.7 mm
2.5 ± 0.6 mm
3.5 ± 2 mm
2.8 ± 1.2 mm
[p = 0.98]
[p = 0.40]
[p = 0.63]
(83% seen)
(60% seen)
(50% seen)
TD Arch indexed
1.7 ± 0.6 mm/m2 2.4 ± 1 mm/m2
3 ± 2.3 mm/m2 2.6 ± 1.4 mm/m2
[p = 0.14]
[p = 0.27]
[p = 0.08]
All p-values are comparisons to control patients.
Values in parentheses are the imaging success rate.
* Ostium values reflect the sum of all ostia in those with multiple ostia
**TD arch imaging success rate based on echocardiograms done after November 2014
Abbreviations: TD=thoracic duct, HF = heart failure (EF ≤ 50%
103
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [68]
Name: Robin Williams
Status: Pediatric Fellow
Division: Pediatric Hematology/Oncology
Research Sponsors: Michael Verneris & Bruce Blazar
Impact of Recipient T Cell Exhaustion on Successful Adoptive Transfer of Haploidentical
Natural Killer Cells
Natural killer (NK) cells are cytotoxic innate lymphoid cells, which play a role in tumor surveillance.
Adoptive transfer of NK cells from haploidentical donors (haplo-NK) after lymphodepleting
chemotherapy can induce remission in some patients with refractory acute myeloid leukemia (AML).
We have previously shown that remission induction correlates with successful in vivo haplo-NK cell
expansion beyond day+7 after infusion. However, the factors that modulate haplo-NK cell
expansion are unknown and understanding the regulators could impact future adoptive haplo-NK
cell therapeutics. We hypothesized that recipient T cells dampen proliferation of adoptively
transferred MHC-mismatched haplo-NK cells and that T cell dysfunction could permit persistence. T
cell exhaustion is an established state of dysfunction occurring after chronic and continuous antigen
stimulation and is well-documented in human cancer. It is characterized by progressive loss of
effector functions and co-expression of multiple inhibitory receptors, such as PD-1 and Tim-3 and
the altered use of key transcription factors, including gain of Eomes and T-bet. We studied adult
patients with relapsed/refractory AML who received haplo-NK cellular therapy along with NCI rhIL15. Patients who successfully expanded haplo-NK cells had lower percentages of T cells in the
peripheral blood prior to lymphodepleting therapy and had more exhausted CD8+ T cells (PD-1high
or dual PD-1+Tim-3+) at day+14. Thus, low percentages of activatable CD3+ cells prior to haplo-NK
cell infusion and recipient T cell exhaustion at day+14 are associated with haplo-NK cell expansion
and AML remission. These studies support further efforts to selectively deplete recipient T cells or
modulate their function to enhance the success of therapeutic NK cell adoptive transfer.
104
PEDIATRIC RESEARCH, EDUCATION AND SCHOLARSHIP SYMPOSIUM (PRESS)
April 14, 2017
ABSTRACT [69]
Name: Elizabeth Zorn
Status: Pediatric Fellow
Division: Pediatric Neonatology
Research Sponsor: Katie Pfister
Speed of Processing and Memory Function In Infants with a History of Hypoxic-Ischemic
Encephalopathy Treated with Therapeutic Hypothermia
Background: Therapeutic hypothermia (TH) improves survival and neurodevelopment in children with
hypoxic-ischemic encephalopathy (HIE), however these children are still at risk for impairments. A
previous study by our group using event-related potentials (ERPs) showed that newborns with HIE
who had undergone TH had preserved memory function yet a difference in the region of the brain
activated by memory processing compared to controls. We hypothesized that the altered activation
pattern may be a compensatory change after injury and a beneficial result of TH, and that the
preserved memory function would persist at 12 months. Elicited imitation (EI) is a validated test of
memory in pre-verbal infants.
Design/Methods: Using the cohort previously studied, SOP was assessed at 8 months using visual
evoked potentials (VEPs) in 17 infants with HIE and 19 healthy controls. Latency to P100 was used to
assess SOP at midline, left, and right occipital lobe. Memory function at 12 months was assessed
using EI.
Results: At 8 months, infants with HIE had similar SOP to controls in all regions studied. Speed of the
attentional response to auditory stimuli at 2 weeks was not predictive of SOP at 8 months. Both
groups had similar EI scores at 12 months of age. Cognitive and motor, but not language, Bayley
subscores at 12 months were positively correlated with EI scores.
Conclusions: Our findings suggest that the preserved memory function observed in newborns with
HIE treated with TH persists at 12 months. At 8 months, the infants with HIE also have overall SOP
similar to controls, which may be a benefit of TH via decreased white matter damage. Memory and
SOP affect daily functioning and these results may give us early insight into longer-term outcomes.
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