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2014 Eastern SPR Annual Meeting
Abstract Number: 1693
Filename: 751971
Publication Number: 337
Presenting Author: Noeet Elitsur, MD
Department/Institution/Address: Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, 800 Washington St., Box 44, Boston, MA, 02111, United States
Phone: 617-636-5322
Fax: 617-636-1456
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Lactation and Breast Feeding Knowledge Gap Identified in Incoming Pediatric Interns and Second Year Residents
Noeet Elitsur1, Roger Edwards2, Maria Blanco3 and MaryAnn Volpe1,3. 1Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA; 2Bouve College of Health Sciences,
Northeastern University, Boston, MA and 3Tufts University School of Medicine, Boston, MA.
BACKGROUND: Despite improving attitudes towards breastfeeding, significant gaps remain in health care providers' knowledge of breastfeeding practices. This has inhibited optimal healthcare delivery to
breastfeeding mothers and achievement of Healthy People 2020's breastfeeding-related goals. Further, the AAP recently recommended a curriculum in lactation during residency.
OBJECTIVE: Determine lactation and breastfeeding knowledge base in early pediatric training to identify potential gaps in knowledge that require improved educational interventions. We hypothesize that current
pediatric training does not provide adequate education in breastfeeding and lactation.
DESIGN/METHODS: To examine residents current lactation knowledge, a multiple choice Needs-Assessment Questionnaire (NAQ) was developed; content areas including breast milk/feeding basic knowledge,
composition and techniques, lactation physiology and pharmacology. This NAQ was distributed to entering Tufts Medical Center interns and second-year pediatric residents (N=22). Data was analyzed by calculating
and comparing percentages of total scores within and between groups.
RESULTS: Interns (N=11) and second year pediatric residents (N=11) from the northeast (65%), southeast (19%), midwest/northwest (12%) and international (4%) medical schools (25-35 yrs of age, 73% female)
completed the NAQ during orientation to the new academic year. Results showed that interns were deficient (≥ 75% incorrect) in content areas including breast milk/feeding basic knowledge, composition, techniques
and pharmacology but proficient in lactation physiology (0% incorrect). Second-year residents showed deficiencies in similar content areas (≥ 50% incorrect) but were more deficient in breast milk pharmacology (100%
incorrect).
CONCLUSIONS: This group of pediatric residents have significant knowledge gaps in breastfeeding and lactation, despite having varied training backgrounds. We are developing a novel computer animated
educational program that includes knowledge base and practical tutorials that will provide medical trainees simulated learning and knowledge reinforcement. Development of such an innovative educational resource
has the potential to improve providers' breastfeeding knowledge and skills, which would eventually increase national breast feeding rates, positively impacting infant nutrition, immunity and developmental outcomes.
2014 Eastern SPR Annual Meeting
Abstract Number: 3894
Filename: 753751
Publication Number: 338
Presenting Author: Andrew Adesman, MD
Department/Institution/Address: Developmental & Behavioral Pediatrics, Cohen Children's Medical Center of NY, 1983 Marcus Avenue, Suite 130, Lake Success, NY, 11042, United States
Phone: 5168026100
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Breastfeeding Toddlers & Preschoolers: Is It More Common With Boys or Does the Mass Media Sensationalize Nursing?
Alexis Tchaconas1 and Andrew Adesman2. 1Columbia University, New York, NY and 2Developmental & Behavioral Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY.
BACKGROUND: Time magazine recently chose a provocative cover photo of a woman breastfeeding a 4-year old boy. In the movie, Grown-Ups 2, a young school-age boy tells his mother he is thirsty, and she
proceeds to open her blouse. The fact that media depictions of extended nursing often involve boys, not girls, raises the question of whether women nurse boys for a longer time, or if the media is sensationalizing this
phenomenon.
OBJECTIVE: To determine if there are gender differences in how long women chose to breastfeed toddlers and preschoolers.
DESIGN/METHODS: Two national sets data were analyzed. In the National Survey of Children's Health (NSCH), a large, nationally representative survey, mothers of children 0-5 were asked at what age they stopped
breastfeeding. Since the CDC didn't publicly release data beyond age 3, an on-line questionnaire (OLQ) focused on extended nursing was promoted to nursing mothers via e-mail, chat rooms, list-serves, etc.
RESULTS: In the NSCH, the mean and median duration for breastfeeding were 225/180 days for boys (n=9,715) and 232/180 days for girls (n=8,880). Figure 1a and 1b depict the ages when women reported stopping
nursing their children. At the 36 month end-point, the % of boys still nursing is not greater than girls.
Figure 2 results from the OLQ (n=27,003).
No gender differences were noted for toddlers >15 months or for preschoolers.
CONCLUSIONS: Although magazines and television typically nursing preschoolers with boys, not girls, nursing, analysis of two very large data sets fails to find any suggestion that women breastfeed boys longer than
girls.
2014 Eastern SPR Annual Meeting
Abstract Number: 3908
Filename: 753839
Publication Number: 339
Presenting Author: Trishna Sisodraker, MD
Department/Institution/Address: 98-25 64th Road Apt 6J, Rego Park, NY, 11374, United States
Phone: 630-240-3629
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Are We Ready for Healthy People 2020? Breastfeeding Continuation Rates and Barriers in an Underserved Community
Trishna Sisodraker1, Puneet Arora1, Anudeepa Sharma1, M. Roger Kim1, Mariana Szuchmacher1, Divya Panneerselvam1 and Sindhu Mohandas1. 1Pediatrics, Brookdale University Hospital and Medical Center,
Brooklyn, NY.
BACKGROUND: Breastfeeding(BF) is known to have unparalleled benefits to infants and their mothers. There are cumulative benefits which are proportional to the duration of exclusive BF. The rates of initiation and
continuation of BF should be higher, especially in underserved communities. As per the Healthy People 2020(HP) targets for BF: unless contraindicated, infants should be exclusively BF until 6 months of age.
OBJECTIVE: To investigate exclusive BF continuation rates until 6mo of age and barriers to success in an underserved community.
DESIGN/METHODS: The lactation registry from a hospital in New York state was reviewed from April 2012 to April 2013 for demographic data and type of feeding at discharge. Of the 344 mothers who were
exclusively BF at the time of discharge, 63 were contacted via telephone to analyze continuation rates of BF and possible barriers.
RESULTS: Demographic Data with continuation rates of a subset of exclusive BF mothers.
Total Deliveries Available Data Lactation class attendance Breast upon delivery Exclusive BF at discharge BF 1mo
1433
1091
86%(919/1091)
58%(632/1091)
31%(344/1091)
BF 3mo
BF 6mo
53%(33/63) 33%(21/63) 14%(9/63)
Continuation rates of exclusive BF in relation to maternal age.
14-20yr 21-30yr 31-44yr
n=63
7
35
21
EBF 1mo 3
20
9
EBF 3mo 2
13
6
EBF 6mo 0
5
4
Barriers to the continuation of exclusive BF: resuming work(40%), decreased milk production(32%), difficulty in BF(15%). Medical and social reasons together accounted for 13% of discontinuation.
CONCLUSIONS: The initiation and continuation of BF in our community is much lower than national and NY state rates. Barriers to initiation of exclusive BF include: large population of young mothers, social myths
and substance abuse prevalence. In our population, cannabis abuse alone was 2.5% where BF is contraindicated. With these initiation barriers the continuation of exclusive BF also suffers. The HP proposed target for
exclusive BF at 3mo(46.2%) and 6mo(25.5%) with our rates being only 33% and 14% respectively. There must be increased effort and support to encourage and empower mothers to continue to BF exclusively.
Hospital practices along with education and promotion during prenatal through postnatal periods are crucial, as once the decision to stop exclusive BF is made the choice is irreversible.
2014 Eastern SPR Annual Meeting
Abstract Number: 3896
Filename: 753753
Publication Number: 340
Presenting Author: Alexis Tchaconas
Department/Institution/Address: 1 Woodsorrell Lane, East Northport, NY, 11731, United States
Phone: 631-413-4725
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Undergraduate Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Maternal Ratings of Factors That Influenced Their Decision To Breastfeed Beyond 1 Year of Age
Alexis Tchaconas1 and Andrew Adesman2. 1Columbia University, New York, NY and 2Developmental & Behavioral Pediatrics, Cohen Children's Medical Center of New York, Lake Success, NY.
BACKGROUND: According to the CDC (2013), 76.5% mothers in the U.S. initiate breastfeeding (BF) but less than 50% BF at 6 months, and just 27% BF at 12 months. Although investigators have extensively
investigated nursing discontinuation in the first year of life, little attention has focused specifically on mothers' decision to do extended nursing (EN) -- BF beyond 12 months.
OBJECTIVE: To delineate, in a large national sample, what factors are important in a mother's decision to continue nursing beyond a child's first birthday.
DESIGN/METHODS: An on-line questionnaire (OLQ) focused on extended nursing was developed and disseminated to nursing mothers via e-mail, on-line support groups and chat rooms, list-serves, etc. In addition
to questions about demographics and BF history, mothers were asked to rate to what extent 15 different factors influenced their decision to nursing history, mothers were asked how comfortable they felt discussing
their EN decision and how supported they felt.
RESULTS: A total of 31,281 questionnaires were completed by women living in the U.S. between ages 18-50 years. Women who taught breastfeeding were excluded from the analysis (n=4,278), leaving a final
sample of N=27,003.
Ratings for the 15 factors are summarized in Table 2 in descending order of influence.
CONCLUSIONS: In deciding to continue BF beyond 1 year of age, women were most influenced by nutritional and health benefits and by pro-social reasons. Nursing support organizations were also important.
Women who do EN were least influenced by the recommendations of HCPs, family and friends.
2014 Eastern SPR Annual Meeting
Abstract Number: 3895
Filename: 753752
Publication Number: 341
Presenting Author: Alexis Tchaconas
Department/Institution/Address: 1 Woodsorrell Lane, East Northport, NY, 11731, United States
Phone: 6314134725
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Undergraduate Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Support for Mothers' Decision To Breastfeed Beyond One Year of Age: Healthcare Providers, Family, and Friends
Alexis Tchaconas1 and Andrew Adesman2. 1Columbia University, New York, NY and 2Developmental & Behavioral Pediatrics, Cohen Children's Medical Center of New York, Lake Success, NY.
BACKGROUND: The American Academy of Pediatrics (AAP) recommends that mothers exclusively breastfeed (BF) for about 6 months, and continue BF with solid foods up to or beyond 12 months of age, for
however long it is mutually desired by mother and child. Although the AAP clearly supports BF beyond 1 year of age, women who do extended nursing (EN) -- BF beyond age 12 months -- are in a minority and
sometimes feel unsupported in their decision.
OBJECTIVE: 1) To assess to what extent mothers feel comfortable discussing their decision about EN with healthcare providers (HCP), family, and close friends and whether mothers feel each were supportive of EN.
2) For HCPs, to assess if there are gender differences regarding comfort or perceived support.
DESIGN/METHODS: An on-line questionnaire (OLQ) focused on extended nursing was developed and disseminated to nursing mothers via e-mail, on-line support groups & chat rooms, list-serves, etc. In addition to
questions about demographics and nursing history, mothers were asked how comfortable they felt discussing their EN decision and how supported they felt.
RESULTS: A total of 31,281 questionnaires were completed by women living in the U.S. between ages 18-50 years who BF beyond 1 year of age. Women who taught BF were excluded (n=4,278), leaving a final
sample of N=27,003.
Women felt generally comfortable discussing EN and supported in their decision. Gender differences were noted. See Table 2.
CONCLUSIONS: Although women who chose to BF beyond infancy reported feeling comfortable discussing with -- and supported by -- their HCP, gender differences were noted.
2014 Eastern SPR Annual Meeting
Abstract Number: 366
Filename: 751077
Publication Number: 342
Presenting Author: Vidhu Thaker, MD
Department/Institution/Address: Division of Endocrinology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, United States
Phone: 857-218-3674
Fax: 617-730-0194
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Severe Hypercalcemia Associated With Subcutaneous Fat Necrosis
Vidhu Thaker1, Daniel Shumer1, George Taylor2 and Ari Wassner1. 1Division of Endocrinology, Boston Children's Hospital, Boston, MA and 2Department of Radiology, Boston Children's Hospital, Boston, MA.
BACKGROUND: Subcutaneous fat necrosis (SCFN) is a rare form of panniculitis in young infants, and hypercalcemia occurs in a subset of patients. There are limited data on the management and outcomes of infants
with severe hypercalcemia due to SCFN.
OBJECTIVE: To delineate the clinical course of infants with severe hypercalcemia due to SCFN with special attention to presentation, management, and complications of fever and nephrocalcinosis.
DESIGN/METHODS: We reviewed the medical records of all infants with fat necrosis and serum calcium > 12 mg/dL presenting to Boston Children's Hospital between 2000-2013. SCFN was defined as presence of
classic skin lesions and absence of another identifiable cause of hypercalcemia. Details of patients' clinical course, treatment and outcomes were extracted. A radiologist blinded to clinical course reviewed renal
ultrasounds and graded nephrocalcinosis on a standardized scale.
RESULTS: Seven infants had severe hypercalcemia due to SCFN during the study period, with median peak serum calcium of 16.5 mg/dl (range 13.2- 20.3). Median age at diagnosis was 28 days (range 16-38).
Symptoms of lethargy, poor feeding or failure to thrive were present in 4/7 patients. All infants were treated with intravenous hydration and furosemide. Six patients received glucocorticoids, 5 received low-calcium
formula, and 1 patient each received calcitonin or pamidronate. Hypercalcemia resolved after a median of 5 days (range 2-42) of treatment. Three of the seven infants (43%) developed fever during initial treatment.
One patient had bacteremia related to a central venous catheter, one had a UTI and RSV infection, and one had no source identified after thorough evaluation. Hypercalciuria was present in all infants and persisted
for a median of 19 days (range 11-32). Nephrocalcinosis was identified in 5/6 (83%) in whom ultrasound was performed. Follow-up ultrasounds at a median age of 20 months (range 3-48) showed persistent
nephrocalcinosis in all 5 patients, but renal growth and function were normal in all cases.
CONCLUSIONS: Severe hypercalcemia due to SCFN usually presents within the first 6 weeks of life. Fever is common in these infants and may be due to serious bacterial infection. We hypothesize that in rare cases
fever may be caused directly by SCFN. Nephrocalcinosis is nearly universal and persists over time. No adverse renal outcomes are apparent after several years of follow up, but long-term follow up is needed.
2014 Eastern SPR Annual Meeting
Abstract Number: 1295
Filename: 751076
Publication Number: 343
Presenting Author: Teena Sebastian, MD
Department/Institution/Address: Division of Gastroenterology, Hepatology and Nutrition, Childrens National Medical Center, 111 Michigan Ave NW, Washington D.C, 20010, United States
Phone: 215-880-8613
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: A Series of Detergent Pod Ingestions in Toddlers
Teena Sebastian1, Kelley C. Shirron1 and Laurie S. Conklin1. 1Division of Gastroenterology, Hepatology and Nutrition, Childrens National Medical Center, Washington, DC.
BACKGROUND: Laundry detergent pods are brightly colored capsules comprised of a liquid detergent within a water-soluble membrane. It is composed of sulfated and ethoxylated alcohols, with a pH of 6.8-7.4.
OBJECTIVE: Most reported cases have been among children less than 5 years of age. A significant number of cases have been associated with vomiting, respiratory side effects and mental status changes.
DESIGN/METHODS: In this case series, we describe six single-center cases of detergent pod ingestion in children under 4 years of age, who presented and were admitted to our institution over a 12 month period.
Vomiting occurred in each of the 6 cases and 4 also presented with respiratory symptoms. Two required mechanical ventilation. 2 of the 6 cases underwent upper endoscopy of which 1 showed grade 1 esophageal
injury.
RESULTS: Case Descriptions:
1. A 3 year- old who presented with emesis after ingestion. She had normal exam findings. Diet was advanced and EGD was not done.
2. A 21-month old presented with stridor and drooling. EGD was normal.
3. A 14 month-old who presented with lethargy and respiratory distress requiring mechanical ventilation. Chest Xray was concerning for aspiration pneumonia. Upper endoscopy revealed grade 1 esophageal injury.
4. An 11 month-old boy who presented with moderate respiratory distress, requiring oxygen via nasal cannula. Chest X-ray was normal. The patient improved within 24 hours and EGD was not done.
5. A 13 month-old presented with emesis after ingestion. Had a normal physical exam and chest Xray. He was discharged within 24 hours without endoscopic evaluation.
6. A 3-year-old girl presented with emesis, coughing and respiratory distress following ingestion. She was intubated for airway protection for 24 hours. Serial X-rays were normal. Endoscopy was not performed.
CONCLUSIONS: Our case series highlights potentially serious respiratory sequelae, though esophageal and gastric mucosal injuries were not significant. Complications reported in literature include eye injuries,
respiratory failure, vomiting, dysphagia and mental status changes. Vomiting is common and associated mental status changes may lead to a higher aspiration risk. Injury to the GI tract has not been highlighted as a
complication. Since pH is neutral, endoscopy may not be necessary in all children with detergent pod ingestion, particularly in those with no dysphagia or respiratory symptoms. Physicians and parents should be
aware of the potential multisystem effects of detergent pod ingestion in young children.
2014 Eastern SPR Annual Meeting
Abstract Number: 3769
Filename: 752774
Publication Number: 344
Presenting Author: Diana M. Pimentel, BS
Department/Institution/Address: 2536 Christian Street, Philadelphia, PA, 19146, United States
Phone: 404-538-4387
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Plasma Levels of GLP-1 During Fasting and in Response To Nutrients in Children With Hypoglycemia
Diana M. Pimentel1,2, Samir Sayed1, Stephanie Givler1, Andrea Kelly1,2 and Diva D. De Leon1,2. 1Department of Pediatrics, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia,
PA and 2Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
BACKGROUND: GLP-1 is an enteroendocrine hormone secreted by intestinal L-cells in response to ingested nutrients. In addition to its potent insulinotropic actions, GLP-1 has multiple glucose-lowering effects
including: inhibition of glucagon secretion, hepatic glucose production, gastric emptying, and appetite. Studies with the GLP-1 receptor antagonist exendin-(9-39) suggest that GLP-1 and its receptor may play a role in
the pathophysiology of hyperinsulinism (HI), but it is not clear if increased GLP-1 secretion contributes to the hypoglycemia in this or other hypoglycemic disorders.
OBJECTIVE: To examine GLP-1 secretion during fasting and in response to ingested nutrients in children with hypoglycemia.
DESIGN/METHODS: This is a cross-sectional study of incretin secretion during fasting and in response to nutrients in children with hypoglycemia. Intact GLP-1 (iGLP-1) was measured at the end of a diagnostic fast in
children with suspected hypoglycemia. To determine the response to ingested nutrients, oral glucose (1.75 g/kg) and protein (1.5 g/kg) tolerance tests (OGTT and OPTT) were performed 3-4 hrs after a meal in
children with hypoglycemia due to HI or other causes. Means and standard deviations are reported for all variables, Student t-test was used to compare data from 2 groups, ANOVA was used to compare 3 or more
groups.
RESULTS: At the end of a diagnostic fast, iGLP-1 was 12.6 ± 8.4 pM in children with HI (n=4), 7.0 ± 0.5 pM in children with ketotic hypoglycemia (n=9), and 6.9 ± 0.5 pM in children with normal fasting adaptation
(n=4) (p=0.07).
During OGTT, baseline iGLP-1 was 5.6 ± 4.9 pM in children with HI (n=6) and 2.3 ± 1.5 pM in children with hypoglycemia not due to HI (n=3) (p=0.18). Peak iGLP-1 was 17.4 ± 11.6 pM in children with HI and 4.2 ±
1.7 pM in the hypoglycemia group (p=0.3).
During OPTT, baseline iGLP-1 was 8.2 ± 7.8 pM in children with HI (n=23), 7.5 ± 8 pM in children with hypoglycemia not due to HI (n=4), and 6.4 ± 3.8 pM in normal controls (n=4) (p=0.9). Peak iGLP-1 was 14.6 ±
15.3 pM in children with HI, 9.4 ± 8 pM in the hypoglycemia group, and 12.2 ± 7.7 pM in normal controls (p=0.8).
CONCLUSIONS: While the iGLP-1 response to nutrients was not different among the groups, iGLP-1 levels during fasting were higher in children with HI. However in this small sample size this difference was not
statistically significant. Further studies to examine iGLP-1 secretion during fasting in HI are needed.
2014 Eastern SPR Annual Meeting
Abstract Number: 965
Filename: 751427
Publication Number: 345
Presenting Author: Leora Branfield Day, BSc (Hons)
Department/Institution/Address: 37 Grosvenor St. Unit 2201, Toronto, ON, M4Y3G5, Canada
Phone: (416)-624-1674
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Liver Disease in Bardet-Biedl Syndrome
Leora Branfield Day1, Claudia Quammie2, Elise Heon1,2 and Binita M. Kamath1,2. 1University of Toronto, Toronto, Canada and 2Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto,
Canada.
BACKGROUND: Bardet-Biedl Syndrome (BBS) is a rare, autosomal recessive ciliopathy, which is genetically heterogeneous and has considerable phenotypic variation. It is characterized primarily by photoreceptor
degeneration, learning difficulties, digit anomalies, obesity, male hypogonadism and renal anomalies. Liver involvement in the form of congenital hepatic fibrosis has been widely described in several ciliopathies due to
a presumed developmental anomaly. Hepatic fibrosis and elevated liver enzymes have been reported in BBS in isolated case reports, yet liver involvement remains one of the least well-characterized findings in BBS.
OBJECTIVE: To characterize the nature of liver involvement in BBS utilizing clinical, biochemical and radiologic parameters from one of the largest cohorts of genotypically and clinically well-characterized BBS
patients.
DESIGN/METHODS: Patients were ascertained from a cohort of BBS patients at the Hospital for Sick Children. Inclusion criteria included meeting genotypic and/or clinical criteria for BBS, and having a liver
ultrasound and serum liver enzyme levels assessed since Jan. 2012, with no more than 6 months between the measurements.
RESULTS: 21 patients were identified; 10 children (14.1-17.6 years) and 11 adults (18.5-24.4 years). All subjects in whom body mass index (BMI) data were available (8/10 children and 3/11 adults) were obese.
Pediatric patients had a mean BMI percentile of 96.1 (SD = 3.3) and adult patients had a mean BMI of 37.5 (SD = 4.9). Elevated ALT levels (>40 U/L) were found in 40% of pediatric (n = 10) and 45% of adult patients
(n = 11). Abnormal ultrasounds were reported in 44% of pediatric (n = 9) and 33% of adult BBS patients (n = 9), all of which revealed increased echogenicity consistent with steatosis. Hepatic cysts were also noted in
2 patients who had steatosis.
CONCLUSIONS: In a cohort of well-characterized BBS patients, 62% had evidence of liver involvement, specifically steatosis on ultrasound and/or elevated ALT. Almost 20% of patients had both findings, consistent
with non-alcoholic fatty liver disease (NAFLD). These novel findings highlight the prevalence of NAFLD in BBS, which differs from the fibrotic liver manifestations seen in other ciliopathies. We hypothesize that there is
an underlying developmental hepatic anomaly in BBS and the obesity results in steatosis and a "second hit" to the liver. Further studies are needed to confirm these hypotheses histologically and to determine the
long-term hepatic course in BBS.
2014 Eastern SPR Annual Meeting
Abstract Number: 324
Filename: 751979
Publication Number: 346
Presenting Author: Robert J. Karp, MD
Department/Institution/Address: Pediatrics, SUNY-Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, NY, 11203, United States
Phone: 718-270-7337
Fax: 718-270-2412
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Filling, Affordable and Nutritious (FAN): An Individualized Program To Assist Poorer Families in Obtaining Sufficient, Nutritious Food at a Reasonable Cost
Robert J. Karp1, Isabelle Bollendorf1, Christian Ngo1 and Spiros Mancoridis2. 1Pediatrics, SUNY-Downstate Medical Center, Brooklyn, NY and 2Computer Science, Drexel University, Philadelphia, PA.
BACKGROUND: It is difficult to construct filling, affordable and nutritious menu plans using the USDA-Low Cost Food Plan (LCFP) given the cost of nutrient dense fruits and vegetables; moreover, “food insecurity”
(FI), a fear that desired food choices are not affordable, is common among the poor. A computer program, Filling, Affordable and Nutritious/ Low-Cost Menu Selector (FAN/LCMS) plans a 7 day, 3 meals and 2 snack
menu with 2,000 kcal/day, costing < $4.40, with 400 µgm of folate and 2 servings each of fruit, vegetable and dairy products.
OBJECTIVE: Using the FAN/LCMS we sought to document 1) changes in food frequency selections of families enrolled in the intervention and 2) changes in prevalence of FI from baseline to follow-up.
DESIGN/METHODS: A convenience sample of 90 families was enrolled in urban ambulatory care clinics. At baseline, food frequencies from NHANES for the 10 domains of the LCFP plus food choices likely to
diminish the quality of the diet were provided by the adult giving the history. Menus were prepared from foods selected by the adult. Telephone follow-up was 5 to 7 weeks after baseline. We analyzed differences
between baseline and follow-up food frequencies using Wilcoxon Signed-Rank Test for Matched Pairs. Changes in FI were assessed with a two-tail Fisher's Exact Test for non-parametric data.
RESULTS: Of the 90 baseline participants 42 (47%) responded to the follow-up interview. Food frequencies showed an increase in consumption of fresh vegetables (p<0.0001) and fruits (p=0.0006) and decrease for
foods of low nutritional value (p=0.02), juice (p=0.02), bottled water (p<0.0001) and “fast food”(p=0.007). There were no significant changes for other food domains. At baseline 44% were FI and 56% were Food
Secure (FS). At follow-up, 29% were FI and 71% were FS. (P = 0.0157).
CONCLUSIONS: This small study's data show significant changes in food choices. However, a 53% non-response rate after 5-7 weeks emphasizes the multiple obstacles to good nutrition among the poor in the
United States. On a positive note: Post-intervention families reported an increase in high nutrient content vegetable and fruit intake with decreases in food choices diminishing diet quality. Frequencies for staples were
not reduced suggesting a sensitivity to food cost and value. This pilot study shows encouraging evidence of the benefit of the FAN/LCMS.
2014 Eastern SPR Annual Meeting
Abstract Number: 1807
Filename: 752828
Publication Number: 347
Presenting Author: Rahul A. Darwar
Department/Institution/Address: University Of Connecticut, North Eagleville Road, Storrs, CT, United States
Phone: 860-545-9200
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Undergraduate Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Simple Nutrition Screeners in the Pediatric Emergency Department (PED) Focus Nutrition Education for Obesity Prevention
Rahul A. Darwar1, Renee M. Silvis3, Shashank Vodapally1, Natalie Smith2, Mastaneh Sharafi2, Valerie B. Duffy2 and Sharon R. Smith3. 1Molecular & Cell Biology, University of Connecticut, Storrs, CT; 2Allied Health
Sciences, University of Connecticut, Storrs, CT and 3Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT.
BACKGROUND: PEDs can reinforce diet and physical activity messages for obesity prevention if tailored to the child's behaviors and risk. Assessing dietary likes/dislikes during acute PED visits is feasible, correlates
with intake biomarkers, and has strong test-retest reliability from PED to post-discharge.
OBJECTIVE: To utilize screeners to identify child-specific obesity prevention messages in a PED.
DESIGN/METHODS: A convenience sample of children was enrolled at an urban PED. They reported likes/dislikes for 36 foods and 11 activities on a line scale, and self-rated their body size on a 7-point figure rating
scale. Survey responses were grouped into food or activity categories and a healthy behavior index. Age and sex-specific percentiles were determined from measured height and weight (BMI calculation) and waist
circumference (WC).
RESULTS: Participating were 254 children (49% male), with average age of 11y (range 5–17y), who were diverse (46% Caucasian, 17% Hispanic, 15% African-American) and 54% publically-insured. BMI and WC
percentiles showed strong correlation (r=0.62). By WC, 7% were below normal (<10th percentile), 56% normal (10–80th), and 37% overweight/obese (>80th). All reported vegetables as least liked. Overweight/obese
children reported greater liking for sweetened beverages and less liking for physical and non-physical activities. Higher adiposity (measured or self-rated) was associated with a lower healthy behavior index,
particularly for girls. Self-rated body size showed strong correlation with WC or BMI percentile (r=0.46-0.48). Up to half of girls or boys were concordant in measured and perceived adiposity–these children had more
healthy behavior indices than children who were discordant, particularly those who perceived their adiposity less than measured.
CONCLUSIONS: The liking survey was child friendly, allowed screening of behaviors to support simple messages–consume more vegetables and fewer sweetened beverages, and keep physically active. WC and
self-rated body size were feasible and accurate adiposity screeners for the PED. Combining self-rated with measured adiposity identified children with highest nutrition education needs.
USDA Hatch Project CONS00928.
2014 Eastern SPR Annual Meeting
Abstract Number: 1250
Filename: 754604
Publication Number: 348
Presenting Author: Ros Dalope, MD
Department/Institution/Address: 5860 Mountain Laurel Drive, Coopersburg, PA, 18036, United States
Phone: 610-807-4247
Fax: 610-807-4248
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Serum Vitamin D Levels Among Adolescents Admitted To an Pediatric Acute Rehabilitation Facility
Ros Dalope1. 1Pediatrics, Good Shepherd Rehabilitation Hospital, Bethlehem, PA.
BACKGROUND: Period of rapid skeletal growth coupled with increasing desire for autonomy and independence in making nutritional and lifestyle choices render adolescents at risk for poor bone health. The need for
healthy bones cannot be overemphasized in an acute rehabilitation setting where many patients are admitted with bone fractures, orthopedic procedures, and various medical conditions that predispose to poor bone
health. Measurement of serum levels of 25-hydroxy vitamin D, 25(OH)D, which reflects the body's vitamin D stores, is generally used as a laboratory assessment of bone health.
OBJECTIVE: To determine serum levels of 25(OH)D among adolescents admitted to a pediatric acute rehab facility (PARF).
DESIGN/METHODS: Levels of serum 25(OH)D were obtained as part of nutritional evaluation from a convenient sample of consecutive adolescent patients who were admitted to PARF between January 2012 through
October 2013.
RESULTS: Twenty-five patients, ages 13-19, were evaluated. Of these patients, 19 (76%) were admitted for traumatic injuries, 16 of which were associated with motor vehicular accidents. All of the 19 trauma patients
presented with bone fractures. None of the trauma patients have significant medical conditions. The rest of the diagnoses include 1 osteosacoma (4%), 1 glioma (4%); and 4cerebral palsy (16%). Mean serum
25(OH)D levels was 24 ng/mL with a range of 11 ng/mL to 46 ng/mL. Nine of the 25 patients (36%) had levels less than 20 ng/mL and 8 (32%) had levels between 21 ng/mL to 29 ng/mL. Thirteen trauma patients,
both osteo and glioma patients, and 2 of the 4 CP patients--a total of 17 patients (68%)--had levels below 30 ng/mL. Patients with levels below 30 ng/mL were treated with vitamin D according to published guidelines
and were provided calcium supplements if their diets did not indicate sufficient calcium intake.
CONCLUSIONS: About 2/3 of adolescent patients admitted to a PARF had serum 25(OH)D levels below 30 ng/mL and required treatment.
2014 Eastern SPR Annual Meeting
Abstract Number: 3168
Filename: 753830
Publication Number: 349
Presenting Author: Susan M. Braid, DrPH, NNP-BC
Department/Institution/Address: Department of Family and Community Health, University of Maryland Baltimore, 655 West Lombard Street, Room W217, Baltimore, MD, 21201, United States
Phone: 858-531-7486
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Early Complimentary Feeding in Preterm Infants
Susan M. Braid1, Jenny Bernstein2 and Nana Matoba3. 1University of Maryland Baltimore, Baltimore, MD; 2Mercy Medical Center, Baltimore, MD and 3Northwestern University Feinberg School of Medicine, Chicago, IL.
BACKGROUND: Guidelines regarding the optimal age to introduce complementary foods to preterm infants are lacking. A limited number of observational studies suggest that the majority of preterm infants are
introduced earlier than term infants. Factors associated with early complementary feeding in term infants are well-described, while little research exists concerning what factors influence timing in preterm infants.
OBJECTIVE: The study objective was to determine if preterm infants are fed complimentary foods earlier than term infants and to examine whether the factors associated with early complementary feeding were
consistent in term and preterm infants.
DESIGN/METHODS: This secondary data analysis utilized the Early Childhood Longitudinal Study, Birth Cohort a nationally representative sample of infants born in 2001. The sample included singleton infants aged
22 to 42 weeks without any major congenital anomalies. Data for term and preterm infants were analyzed both together and separately. Multiple logistic regression was conducted to determine the effect being preterm
had on the timing of complementary food introduction. In stratified analysis multiple logistic regression was used to identify factors associated with early feeding in both populations.
RESULTS: Being preterm (<37 weeks) was independently associated with the early introduction of complementary food. Preterm infants aged 22 to 32 weeks had the highest odds of being fed complimentary food
before 4 months when compared with term infants (OR 9.9, 95% CI: 5.45-18.0). Predictors of early feeding among term infants were consistent with previous studies. Among preterm infants, lower gestational age,
maternal age, and current maternal smoking were associated with early feeding. Breastfeeding was not protective against early complementary feeding in the preterm infants.
CONCLUSIONS: Preterm infants were fed complementary food before 4 months (age adjusted) more frequently than term infants. Neonatologists and pediatricians should be aware of this difference in feeding
practices as well as the potential risks of this practice in preterm infants. The factors that predict early introduction of complementary foods were surprisingly different in preterm and term infants highlighting the need
for the development of evidence-based guidelines specifically for preterm infants.
2014 Eastern SPR Annual Meeting
Abstract Number: 4778
Filename: 756243
Publication Number: 350
Presenting Author: Kawsari Abdullah, MBBS
Department/Institution/Address: 1277 Wilson Avenue, Apt 221, North York, ON, M3M1K1, Canada
Phone: 647-340-4190
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Ph.D. Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Prevalence, Practice Patterns and Hematological Outcomes of Young Children Identified With Non-Anemic Iron Deficiency (NAID): Implications of Screening in Primary Care Settings
Kawsari Abdullah1,2, Jonathon L. Maguire1,2,3,5,8, Catherine S. Birken1,2,6,8, Kevin E. Thorpe3,4, Anthony J. Hanley4,9,10, Darcy Fehlings2,7,8 and Patricia C. Parkin1,2,6,8. 1Division of Pediatric Medicine, Department of
Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada; 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; 3Li Ka Shing Knowledge Institute, St. Michael's
Hospital, Toronto, ON, Canada; 4Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; 5Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada; 6Child Health Evaluative
Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada; 7Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, and Bloorview Research Institute, Toronto, ON,
Canada; 8Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 9Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada and 10Division of Endocrinology,
Department of Medicine, University of Toronto, Toronto, ON, Canada.
BACKGROUND: There is emerging evidence that non-anemic iron deficiency (NAID) in early childhood may be association with poor health and developmental outcomes. Some guidelines recommend screening for
iron deficiency anemia; however, the role of screening for NAID is unknown.
OBJECTIVE: To determine the prevalence and risk factors associated with NAID in pre-school children; describe the practice patterns associated with the management of NAID in primary care settings; and describe
the hematological outcomes of NAID with or without treatment.
DESIGN/METHODS: A cohort study of healthy children, aged 1-5 years, seen for primary health care between July 2008 and June 2012 was conducted through the TARGet Kids! practice based research network.
Descriptive statistics were used to describe the prevalence, risk factors, practice patterns and the hematological outcomes of children identified with NAID (defined as serum ferritin ≤12 µg/L and hemoglobin of ≥110
g/L). The association between NAID and potential risk factors were examined using a multivariate logistic regression analysis.
RESULTS: Of 2276 children undergoing screening, 155 had NAID, for a prevalence of 7% (95% CI, 5.95%-8.05%). Risk factors significantly associated with NAID included younger age, higher zBMI and having a
mother of European ethnicity. An assessment of practice patterns revealed that for 57/155 children (37%) an intervention for NAID was recommended (diet, oral iron or both); and for 14/155 children (9%) a follow-up
blood test was completed to re-evaluate their iron status. An assessment of the hematological outcomes of NAID with treatment (n=57) revealed that of the 14 children with a follow-up blood test, 11 children resolved
their NAID and in 3 cases NAID did not resolve. An assessment of the hematological outcomes of NAID without treatment (n=98), revealed that of the 26 children with a follow-up blood test, NAID resolved in 17 , did
not resolve in 8 , and in 1 child progressed to iron deficiency anemia.
CONCLUSIONS: This study shows that NAID is a prevalent condition; that there is substantial practice variation in management of NAID following screening. Further research is necessary to understand the benefits
of screening for NAID and evidence-based practice guidelines are needed to manage NAID in early childhood.
2014 Eastern SPR Annual Meeting
Abstract Number: 101
Filename: 750886
Publication Number: 351
Presenting Author: Deepthi Alapati, MD
Department/Institution/Address: Pediatrics, Nemours Alfred I duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, United States
Phone: 302 494 0552
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Electronic Health Record Monitoring Combined With a Collaborative Multidisciplinary Approach Decreases Duration of Hyperoxia in Neonates
Arlene Zamora1, Beth Euston1, Elaine Guilday1 and Deepthi Alapati1,2. 1Pediatrics, Nemours Alfred I DuPont Hospital for Children, Wilmington, DE and 2Pediatrics, Jefferson Medical College/Thomas Jefferson
University, Philadelphia, PA.
BACKGROUND: Infants in the NICU experience oxygen saturations (O2 sat) outside policy-specified targets, that increases the risk for oxidative injury. An effective system-based mechanism is essential to improve
adherence to target O2 sat.
OBJECTIVE: Examine the performance of a quality improvement (QI) model combining the use of electronic health record (EHR) and a collaborative multidisciplinary approach to achieve target O2 sat in neonates.
DESIGN/METHODS: A multidisciplinary team was established and unit based clinical practice guidelines for initiation, weaning and discontinuation of supplemental O2 designed for non-physician health care providers
was developed. Goal O2 sat targets were 89%-94% for neonates < 36 wks GA, 90%-96% for neonates ≥ 36 wks GA and 92%-96% for neonates with diagnosis of pulmonary hypertension. Minute by minute patient O2
sat was captured in EHR. Time spent outside target O2 sat ranges was measured by respiratory therapist who provided feedback to the clinical team. Compliance to adhere to ordered alarm limits and percentage of
time spent outside target O2 sat was measured before, 2 months and 6 months after implementation of the QI initiative.
RESULTS: Baseline characteristics of the population were similar among the three groups. Compliance to adhere to alarm limits improved from 40% during the pre intervention period to 100% two months post
intervention and was sustained at 100% six months post intervention. Percentage of time an infant spent with O2 sat greater than the goal O2 sat decreased from 28% during the pre-intervention period to 17% in the
post intervention period and remained low 6 months post intervention. No significant difference was observed in duration of time with O2 sat less than target range. Overall, among infants receiving supplemental O2,
percentage of time spent outside target O2 sat was reduced significantly from 40% during the pre-intervention period to 27% after QI implementation.
CONCLUSIONS: QI model combining the use of EHR and a collaborative multidisciplinary approach driven by non-physician health care providers decreases duration of hyperoxia among infants receiving
supplemental O2 in the NICU. Based on our experience, other institutions can customize clinical practice guidelines for O2 use in neonates to their local practice. Effect of such a QI model on long term outcomes such
as BPD and neurodevelopment needs to be evaluated.
2014 Eastern SPR Annual Meeting
Abstract Number: 4685
Filename: 755635
Publication Number: 352
Presenting Author: Smita Prakash, BS
Department/Institution/Address: NYIT College of Osteopathic Medicine, Northern Blvd, Old Westbury, NY, 11568, United States
Phone: 9144938859
Fax: 9144931488
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Are Genetic Variants of the Platelet Activating Factor Pathway Associated With Necrotizing Enterocolitis?
Narendra Dereddy3, Smita Prakash4, Lynnette H. Kim1, Nayan Patel1, Johanna Calo2, Umesh Paudel1 and Lance A. Parton1. 1Newborn Medicine, Dept Pediatrics, MFCH at WMC, NYMC, Valhalla, NY; 2Newborn
Medicine, Dept Pediatrics, St. Joseph's Regional Med Center, Patterson, NJ; 3Newborn Medicine, Dept Pediatrics, Univ of Tenn, Memphis, TN and 4NYIT College of Osteopathic Medicine, Old Westbury, NY.
BACKGROUND: Inflammatory vasoactive mediators including platelet activating factor (PAF) play a central role in the final inflammatory pathway leading to necrotizing enterocolitis (NEC). PAF is an endogenous
phopsholipid with powerful pro-inflammatory actions expressed in response to endotoxin and hypoxia. PAF-acetyl hydrolase (PAFAH) catalyzes the hydrolysis of PAF, resulting in inactivation. PAFAH is present in
human breast milk, and has been implicated in decreased NEC of breast-fed preterm infants. The functional genetic variants of PAFAH-I198T and A379V-lower PAFAH activity, resulting in prolonged PAF expression.
The functional variant A224D of PAF Receptor (R) disrupts PAF signaling. Inhibition of PAFR binding has been associated with decreased NEC in a murine model.
OBJECTIVE: We tested the hypothesis that functional genetic variants in the PAF pathway are associated with NEC.
DESIGN/METHODS: Preterm infants, without congenital or chromosomal anomalies, are monitored for the development of Bell's state II or greater NEC. DNA is isolated from buccal mucosal swabs and subjected to
allelic discrimination using Taqman probes during RTPCR. ANOVA, chi square, and T-tests are used with statistical significance when P<0.05.
RESULTS: We had previously shown that the PAFAH I198T (rs1805018) SNP approached statistical significance with a smaller sample size, but our increased cohorts of both NEC and Non-NEC reveal no
association, with either PAFAH I198T or A379V variant and NEC. PAFR demographic and SNP A224D data is shown:
NEC
Birthwt (Mean±SD)
No NEC P Value
776±188 762±158 0.7
Gestational Age (Mean±SD) 26±2
25±2
0.7
Gender (Male%)
65
47
0.3
4
29
Race
Caucasian
0.9
Black
7
29
Hispanic
6
34
Other
0
3
CC
6
15
any a
11
80
PAFR A224D
0.09
CONCLUSIONS: While an association with increased PAF levels has been demonstrated for preterm infants who progress to NEC, the two functional genetic variants for PAFAH gene that we tested-which would
perpetuate a higher level of PAF-cannot account for increased susceptibility to NEC. Disrupted signaling through a functional PAFR variant-as demonstrated in a murine model of NEC-approached significance. We
speculate that preterm infants who ingest breast milk may have sufficient PAFAH in their breast milk to inhibit PAF, thus minimizing the effects of PAFAH variants. However, genetic variants of PAFR may alter PAF
signaling, increasing susceptibility to NEC.
2014 Eastern SPR Annual Meeting
Abstract Number: 3886
Filename: 753715
Publication Number: 353
Presenting Author: Dalal Taha, DO
Department/Institution/Address: Pediatrics/Neonatology, Thomas Jefferson University/Nemours, 833 Chestnut Street, Suite 1210, Philadelphia, PA, 19107, United States
Phone: 2012187865
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Occult Blood in Stool Does Not Predict Occurrence of Necrotizing Enterocolitis in Preterm Infants
Dalal Taha1, Ursula Nawab1, Kristin McKenna1 and Zubair H. Aghai1. 1Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA.
BACKGROUND: Necrotizing enterocolitis (NEC) can cause significant morbidity and mortality in low birth weight neonates. Presence of occult blood in stool may reflect intestinal mucosal injury and help in identifying
infants earlier in the course of the disease. Early detection of NEC may help reduce morbidity and mortality in preterm infants. There are no studies to support the utility of heme occult testing of stools in early
diagnosis of NEC.
OBJECTIVE: To determine the utility of occult blood testing in stool in early detection of NEC in preterm infants.
DESIGN/METHODS: This is a case-control study of all preterm neonates (GA < 35 weeks) admitted to the NICU between 2006 and 2012 with a diagnosis of NEC. Heme occult stool results were collected for 7 days
prior to the diagnosis of NEC. These results were compared to heme occult stool results for 7 days of age-matched controls.
RESULTS: 29 infants met the inclusion criteria and were compared to 64 age-matched controls. There was no difference in BW, GA, or 5 minute Apgar score between the two groups. Median age of diagnosis of NEC
was 34 days (range, 7-100 days). 431 stool samples were collected and tested for occult blood in the 7 days prior to developing NEC in the NEC group. 791 stool samples were collected and tested for occult blood for
7 days in the age-matched control group. There was no significant difference in the number of heme occult positive stools in the NEC group (26 out of 431, 6.0 %) compared to the control group (44 out of 791, 5.5%,
p=0.8). The number of infants with heme positive stools, both 7 days and 3 days preceding the diagnosis, was similar between the two groups (Table 1). There was no significant difference in the number of infants
with heme positive stools each day of the preceding 7 days in the two groups.
NEC
Control
p
(29)
(64)
BW (g)
868±265
941±380
0.4
GA (w)
26.8±2.66
26.6±2.7
0.7
Sex Male (%)
17 (58.6)
36 (56.3)
Apgar 5 minutes (med, range)
7 (1-9)
7 (1-9)
Total stools in preceding 7 days (mean/infant)
431 (14.9)
791(12.4)
0.8
Heme positive stools in preceding 7 days (%)
26 (6.0)
44 (5.5)
0.8
Heme positive stools in preceding 3 days (%)
13 (3.0)
23 (2.9)
0.9
Number of infants with heme positive stools in
preceding 7 days (%)
10 (34.5)
17 (26.5)
0.6
Number of infants with heme positive stools in
preceding 3 days (%)
7 (24.1)
14 (21.8)
0.9
CONCLUSIONS: Routine testing of stools for occult blood is not associated with early detection of NEC in preterm infants.
2014 Eastern SPR Annual Meeting
Abstract Number: 3885
Filename: 753714
Publication Number: 354
Presenting Author: Amy J. Sloane, MD
Department/Institution/Address: Pediatrics Residency, 1600 Rockland Rd., Wilmington, DE, 19803, United States
Phone: 302-932-2594
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Utility of Measuring Direct Bilirubin at 24-72 Hours of Age in Neonates Admitted To the Neonatal Intensive Care Unit
Amy J. Sloane1, Ursula S. Nawab1, Kristin McKenna1 and Zubair H. Aghai1. 1Neonatology, Thomas Jefferson University Hospital/Nemours, Philadelphia, PA.
BACKGROUND: The American Academy of Pediatrics recommends the measurement of direct bilirubin (DB) in late preterm term and full term infants receiving phototherapy for jaundice, jaundice presenting at or
beyond 3 weeks of age, and ill appearing infants. Routine practice at our institution is to measure the DB levels at 24-72 hours of age for all infants admitted to the Neonatal Intensive Care Unit (NICU).
OBJECTIVE: To assess the utility of measuring DB at 24-72 hours of life in infants admitted to the NICU.
DESIGN/METHODS: Infants born between 5/06-6/13 and admitted to the NICU were included. Relevant demographic, laboratory and clinical data were collected. Abnormal DB was defined as: 1) DB level ≥ 1mg/dl
with a corresponding TB of ≤5 mg/dl or 2) DB of >20% of the corresponding TB that is > 5 mg/dl.
RESULTS: A total of 4,449 infants were admitted to the NICU during the study period. The DB levels were measured in 3,715 (84 %) infants at 24-72 hours of life. The median gestational age was 38 weeks (w)
(range, 22-42 w) and the median birth weight was 2960 grams (g) (range 323-6115 g). First DB was measured in 2,548 infants (69%) on day 1, 973 infants (26%) on day 2 and 194 infants (5%) on days 3. (The
median (5-95th %tile) DB on days 1, 2 and 3 was 0.4 (0.0-0.6), 0.4 (0.0-0.8) and 0.4 (0.0-0.9), respectively. 63 infants (1.7%) had abnormal DB during the first 3 days of life, additionally 31 infants had abnormal DB
between days 4-7. Hypoxic ischemic encephalopathy (HIE) was the most common cause of high DB. In 25 infants (40%) cause for high DB was unknown. In a number of infants with potential treatable diseases
(biliary atresia, choledochal cyst, hypothyroidism) the only abnormal finding was mildly elevated DB (1-2mg/dl) during the first 3 days of life.
HIE
23
On ECMO
4
Biliary Atresia
3
Possible Metabolic Disease
2
Hypothyroidism
1
Choledochal Cyst
1
Congenital Syphillis
1
Neonatal Hepatitis
1
Severe Hemolysis (HbH, ABO) 1
Unknown
25
CONCLUSIONS: 1.7% of infants admitted to the NICU had abnormal DB during the first 3 days of life. Routine measurement of DB in neonates admitted to NICU may be helpful in identifying potential treatable
causes of cholestasis. Further studies are needed to assess the utility of routine screening for DB in all neonates.
2014 Eastern SPR Annual Meeting
Abstract Number: 2723
Filename: 752667
Publication Number: 355
Presenting Author: Paulomi Mehta, MD
Department/Institution/Address: Yale Child Health Research Center, Room 219, PO Box 208081, 464 Congress Avenue, New Haven, CT, 06520, United States
Phone: 501-908-9792
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Factors Affecting Nasal Intermittent Positive Pressure Ventilation (NIPPV) Failure and Impact on Bronchopulmonary Dysplasia (BPD) in Neonates
Paulomi Mehta1, Jessica Berger1, Emily Bucholz1 and Vineet Bhandari1. 1Pediatrics, Yale University School of Medicine, New Haven, CT.
BACKGROUND: NIPPV is becoming more important as a primary or secondary mode of respiratory support in the neonatal intensive care unit (NICU). To the best of our knowledge, there have been no detailed
studies characterizing those neonates who fail NIPPV, and the reasons for failure.
OBJECTIVE: To determine differences between neonates who are successfully extubated to NIPPV and those who require reintubation from NIPPV, and the impact of timing of NIPPV failure on BPD rates.
DESIGN/METHODS: This was a retrospective cohort study (January 1, 2006 - December 31, 2012) in which we included infants with gestational age ≤28wks, birth weight ≤1000g, and intubation on day of life 1.
Chi-square, ANOVA, and logistic regression models were used for statistical analyses.
RESULTS: Two hundred and forty infants were studied, of which 60 (25%) were successfully extubated on the first attempt. One hundred and eighty (75%) failed NIPPV during their stay in the NICU and of these, 33
(18.3%), 39 (21.7%), and 108 (60%) failed NIPPV within 0-6hrs, 6-24hrs, and >24hrs, respectively. Female gender, African-American race, and higher weight were protective against NIPPV failure (adjusted OR (95%
CI): 0.386 (0.182-0.818), 0.314 (0.151-0.652), 0.006 (0.001-0.049)). Increased gestational age at extubation and female gender were both predictors of increased time to failure (p=0.0083, <0.001, respectively).
Apnea had an increasing impact for failure >24hrs (p=0.0149) while increased work of breathing/FiO2 requirements were more significant causes when NIPPV failure occurred earlier (p=0.0013). Neonates who failed
NIPPV within 24hrs were more likely to develop BPD (OR 2.989, 95% CI 1.054-8.478) and increased severity of BPD than those who failed >24hrs (OR 1.493, 95% CI 0.852-2.681).
CONCLUSIONS: Significant differences in neonatal characteristics may help identify which neonates are more likely to fail NIPPV, and the timing of failure. Neonates who fail NIPPV within the first 24hrs are at
increased odds of developing BPD and the earlier they fail, the greater the odds they will develop a higher level of severity of the disease.
2014 Eastern SPR Annual Meeting
Abstract Number: 1109
Filename: 753267
Publication Number: 356
Presenting Author: Kathryn R. Robertson, MD
Department/Institution/Address: Pediatrics, National Children's Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, United States
Phone: 1 202 476 5000
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Cost-Effectiveness of Resuscitation at 23 Weeks' Gestation: Quantifying the Maternal-Fetal Conflict
Kathryn R. Robertson1, J. Colin Partridge1, Elizabeth E. Rogers1, Geri O. Landman2, Allison J. Allen3 and Aaron B. Caughey3. 1Pediatrics, University of California San Francisco, San Francisco, CA; 2Center for Clinical
and Policy Perinatal Research, University of California San Francisco, San Francisco, CA; 3Pediatrics, Boston Children's Hospital, Boston, MA and 4Obstetrics and Gynecology, Oregon Health and Science University,
Portland, OR.
BACKGROUND: Resuscitation of extremely premature infants remains controversial and clinical thresholds for resuscitation and NICU care vary. We have previously reported that NICU care is not cost-effective from
a maternal perspective.
OBJECTIVE: We sought to investigate the cost effectiveness of resuscitation and intensive care for infants born 23 0/7-23 6/7 weeks' gestation from a combined maternal-neonatal perspective.
DESIGN/METHODS: Decision-analytic modeling comparing universal and selective resuscitation to non-resuscitation for 5176 live births at 23 weeks in a theoretic U.S. cohort. Estimates of death (77%) and disability
(64-86%) were taken from the literature. Maternal and combined maternal-neonatal utilities were applied to discounted life expectancy to generate maternal and neonatal QALYs (mQALYS and nQALYs,
respectively). Incremental cost-effectiveness ratios were calculated, discounting costs and QALYs. Main outcomes included number of survivors, their outcome status, and incremental cost-effectiveness ratios for the
3 strategies. A cost-effectiveness threshold of $100,000/QALY was utilized.
RESULTS: For mothers, non-resuscitation is less expensive ($19.9 million) and more effective (120298 mQALYs) than universal resuscitation ($1.2 billion; 119181 mQALYs) or selective resuscitation ($845 million;
119542 mQALYs). For neonates, both strategies were cost-effective when the probability of neonatal death was < 0.95, resulting in 22256 and 15134 nQALYS, respectively, vs 247 nQALYs for non-resuscitation.
Universal resuscitation would save 1,059 infants: 138 severely disabled, 413 moderately impaired, 508 without significant sequelae. Selective resuscitation would save 717 infants: 93 severely disabled, 279
moderately impaired, 343 without significant sequelae. In sensitivity analyses, universal resuscitation was cost-effective from a maternal perspective only at utilities for neonatal death < 0.42. From a
maternal-neonatal perspective, universal resuscitation was cost-effective when the probability of neonatal death was < 0.95.
CONCLUSIONS: Over wide ranges of probabilities for survival and disability, resuscitation strategies were not cost-effective from a maternal perspective, however both strategies were cost-effective from a combined
maternal-neonatal perspective. These results support a more permissive response to parental requests for aggressive intervention at 23 weeks' gestation.
2014 Eastern SPR Annual Meeting
Abstract Number: 4582
Filename: 754231
Publication Number: 357
Presenting Author: Suna Seo, MD
Department/Institution/Address: Division of Neonatal and Perinatal Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, United States
Phone: 202-444-8783
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Patterns and Perceived Utility of Neurodevelopmental Screening With Magnetic Resonance Imaging in Preterm Infants
Suna Seo1 and Melissa Scala1. 1Division of Neonatal and Perinatal Medicine, MedStar Georgetown University Hospital, Washington, DC.
BACKGROUND: Research has shown correlation between magnetic resonance imaging (MRI) brain metrics at term equivalence (TE) and neurodevelopmental outcomes. Practical use of this imaging modality in
Neonatal Intensive Care Units (NICU) is unknown.
OBJECTIVE: To characterize the current use of brain MRI in preterm infants in United States (US).
DESIGN/METHODS: This descriptive study surveyed neonatologists(MD) in the US from August to October 2013, using an online questionnaire, developed and anonymized via Survey Monkey, and distributed via
the American Academy of Pediatrics section of perinatal medicine listserv.
RESULTS: Total of 445 MDs from 48 states (except Maine & Wyoming) participated. Comparison between academic (level 4) vs community (level 2-3) NICUs is shown.
Academic
Community
n=287
n=156
P
MRI Criteria
GA 24-26 wk
65 (23)
7(5)
<0.0001
GA 27-29 wk
40 (14)
4(3)
<0.0001
BW <1000g
54(19)
28(18)
0.9
BW 1001-1500g
15(5)
9(6)
0.8
Modalities Available
Brain Metrics
138(48)
56(36)
0.02
Spectroscopy
125(44)
37(24)
<0.001
Prognosis
204(71)
104(66)
0.5
Counseling
21(74)
119(76)
0.3
Obtaining Services
85(30)
54(34)
0.2
"Feel MRI Useful"
156(54)
86(55)
0.92
Use of MRI Results
Although many use MRI results for prognostication, only about 55% report subjective utility. MRI has not completely replaced head ultrasound (HUS) at discharge with 26%of those who find MRI's useful still ordering
predischarge HUS. Given a clinical scenario of a healthy 27wks GA infant, 88% would not order predischarge brain MRI at TE.
CONCLUSIONS: Survey results indicate the use of predischarge MRI at TE occurs at a minority of centers. Many academic centers, and even more community centers, lack the technology available to maximize
brain MRI results. Even among MDs who find MRIs useful, a minority ordered routine MRIs based on BW or GA alone. More research is needed to better marry current evidence of the emergent technology to its
practical application.
2014 Eastern SPR Annual Meeting
Abstract Number: 4751
Filename: 756098
Publication Number: 358
Presenting Author: Wendy L. Timpson, MD
Department/Institution/Address: Neonatology, University of Massachusetts Memorial Healthcare, 119 Belmont Street, Worcester, MA- MASSACHUSETTS, 01605, United States
Phone: 5083346206
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Using an Early CRP To Rule Out Neonatal Sepsis
Wendy L. Timpson1 and Joel H. Weiner1. 1Neonatology, University of Massachusetts Medical School, Worcester, MA.
BACKGROUND: Neonatal sepsis is a rare, but potentially fatal disease. It is standard practice to evaluate risk factors and initiate antibiotics if present, thereby exposing hundreds of thousands of non-infected infants
to antibiotics. Diagnosis of infection is clouded by pre-treated cultures, lack of specificity of complete blood counts (CBCs) and symptoms that mimic infection. There are no universally accepted guidelines on timing of
antibiotic discontinuation.
Based on previously published research, our NICU has limited antibiotic duration to 24 hours in infants with two normal CBCs and negative cultures. However many non-infected infants remain on antibiotics because
of abnormal CBCs. C-reactive protein (CRP) has been extensively studied in neonatal sepsis and has a high negative predictive value (NPV). However, no study published to date has looked at using CRP to limit
antibiotic duration.
OBJECTIVE: To measure the sensitivity and NPV of CRP to determine its utility in reducing antibiotics in infants being ruled-out for sepsis.
DESIGN/METHODS: All neonates admitted to UMMHC who undergo sepsis rule out from April 2013 to April 2014 are eligible. A standardized clinical pathway determines sepsis rule outs. Subjects undergo standard
care. A blinded CRP is collected at 10-12 hours. The clinical team determines presence of infection. Course and demographics are collected prospectively.
RESULTS: Preliminary data has been analyzed for 129 infants. 122 (95%) were not infected while 6 infants (5%) had either presumed or culture positive sepsis. The non-infected group was a younger gestational age
(mean 34.1 vs. 37.5 wks) and of a lower birth weight (2200 vs. 3400 g). There were no differences for other common demographic data.
Of the non-infected infants, 81 (66%) underwent a 24 hour rule out, while 41 (34%), required antibiotics for 48 hours or greater. All 6 infected infants had abnormal CBCs and/or positive culture and were treated for
7-10 days. The mean CRP was 5.6 ±10.4 in the non-infected group and 20.8 ±24.7 in the infected group. All 6 infected infants had either a CRP ≥10 or a positive culture. Of the 41 non-infected infants who did not
qualify for a 24 hour rule out, 25 (61%) had a CRP ≤10.
CONCLUSIONS: In our study to date, a normal early CRP and a negative culture has 100% sensitivity and 100% NPV for early-onset sepsis. If current enrollment rates persist, we expect to amass a population of
300 infants by April of 2014. If our hypothesis holds, this will prevent millions of doses of uneccessary antibiotics each year.
2014 Eastern SPR Annual Meeting
Abstract Number: 2060
Filename: 754366
Publication Number: 359
Presenting Author: Katherine Rittner, MD
Department/Institution/Address: 759 Chestnut St, Springfield, MA, United States
Phone: 413-794-3998
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Sustaining Improvement: Experience With Reducing Pharmacotherapy for Gastroesophageal Reflux in Preterm Infants
Katherine Rittner1,2, Paul Visintainer1, Stanley Konieczny1 and Rachana Singh1,2. 1Baystate Children's Hospital, Springfield, MA and 2Tufts University School of Medicine, Boston, MA.
BACKGROUND: Preterm infants may have respiratory events attributed to gastroesophageal reflux events (GER). Studies show no association between GER and these events while documenting adverse effects
with medications used to treat GER.
OBJECTIVE: To assess impact of practice changes on decreasing anti-reflux pharmacotherapy (ARx) for suspected GER in preterm infants.
DESIGN/METHODS: Pre- and post intervention cohort study of infants ≤35 weeks gestational age (GA) with suspected GER. Data collected for 1 year pre and 2 years post limitation of ARx . Data collected included
GA, birth weight (BW), feeding history (type, additives, feeding time), ARx medication history (type, dose & duration), non–pharmacological interventions and any oxygen in NICU & at discharge.
RESULTS: Table 1 shows results of comparison for the 177 eligible infants. The ARx decreased significantly from 58.5% pre- to 34.1% (year 1) and 21.1% (year 2) post-intervention (p <0.001).
Characteristics
Pre-Intervention Post- Intervention Post- Intervention
p-value
(Year 0: 2010)
(Year 1 : 2011)
(Year 2: 2012)
Mean (SD)
Mean (SD)
Mean (SD)
GA (wks)
30.3 (± 3.6)
29.2 (± 3.4)
29.7(± 3.5)
0.28
BW (gms)
1542.2 (± 683.0) 1338.2 (± 609.6)
1431.9(± 605.8)
0.26
% (n)
% (n)
% (n)
Male
63.1 (41)
56.1(23)
53.5(38)
0.52
Any O2 in NICU
89.2 (58)
95.1(39)
91.5 (65)
0.65
Any O2 at discharge
36.9 (24)
53.7 (22)
40.9 (29)
0.22
Anti-reflux Therapy
58.5 (38)
34.1 (14)
21.1 (15)
<0.001
Breast Milk
24.6 (16)
43.9 (18)
33.8 (24)
Formula
23.1 (15)
22.0 (9)
18.3 (13)
Thickening of feeds
7.8 (5)
24.4 (10)
18.3 (13)
0.04
Positioning
16.9 (11)
19.5 ( 8)
12.7 (9)
0.5
61.0 ( 25)
52.1 (37)
0.14
Feeding Type
0.27
Expanded feeding time 41.5 (27)
Length of stay (LOS), rate of Necrotizing Enterocolitis (NEC) and any late infection for three time periods showed no difference.
CONCLUSIONS: Limiting ARx is possible without any increase in adverse effects, may help save costs while minimizing exposure to potentially harmful therapies in a vulnerable population.
2014 Eastern SPR Annual Meeting
Abstract Number: 3841
Filename: 753367
Publication Number: 360
Presenting Author: Hyung C. Woo, MD
Department/Institution/Address: Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, Department of Neonatology, 8th Floor, Baltimore, Maryland, 21201, United States
Phone: 917-968-2506
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Non-Invasive Neonatal Glucose Monitoring: Proof of Concept
Hyung C. Woo1, Leah Tolosa2, Sunsanee Kanjananimmanont2, Xudong Ge2 and Rose M. Viscardi1. 1Pediatrics, University of Maryland School of Medicine, Baltimore, MD and 2Chemical, Biochemical, and
Environmental Engineering, University of Maryland, Baltimore County, Baltimore, MD.
BACKGROUND: Current point-of-care (POC) glucometers to detect neonatal hypoglycemia are inaccurate and confirmatory testing with gold standard laboratory analyzers requires blood draws and delays diagnosis.
The fluorescently tagged glucose binding protein (GBP) is magnitudes more sensitive to glucose than any available POC and is highly specific for glucose even in a complex mixture.
OBJECTIVE: To determine if transdermal sampling of glucose levels (GLs) is feasible by a novel approach with a fluorescent based sensor on the GBP.
DESIGN/METHODS: Adult vs. Infant: After washing and air drying the skin, transdermal GLs were extracted by inverting an Eppendorf tube filled with 125uL of phosphate-buffered-saline (PBS) onto a neonate's palm
or adult finger for several minutes. The collected fluid was analyzed with the GBP analyzer. Fluorescence intensities were measured on a Varian Cary Eclipse Fluorescence Spectrophotometer (Varian Instruments,
Walnut Creek, CA).
Prandial Measurements: An infant's skin was cleaned with 70% isopropyl alcohol, then with 125uL PBS, and air-dried. 125uL PBS was placed in a silicone sampler to extract the glucose for 1 min. The extracted
glucose was then analyzed with the GBP analyzer.
RESULTS: The glucose rate from an adult transdermal sample was 0.382ng/cm2min and from a premature infant was 16.9ng/cm2min (more than 40 times the adult rate). Transdermal GLs were obtained from an
infant before and after feeds which revealed prandial variations with lower levels before feeds and higher levels after feeds as expected. However, further testing resulted in failure of the sampler adhesive, resulting in
leakage of the PBS and low GLs were observed. Correlation between adult skin and blood GLs was observed.
CONCLUSIONS: There is no current method to painlessly and non-invasively evaluate GLs accurately in neonates. This study shows that the GBP biosensor can detect very low transdermal GLs and is proof of
principle that non-invasive glucose monitoring is possible in the near future. Supported by: 1R41HD069207.
2014 Eastern SPR Annual Meeting
Abstract Number: 978
Filename: 751561
Publication Number: 361
Presenting Author: Robert Locke, DO, MPH
Department/Institution/Address: Neonatology, Christiana Care Health System, 4745 Ogletown Stanton Rd Ste 217, MAP-1, Suite 217, Newark, DE, 19713, United States
Phone: 3027332410
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: How Good Are Simulation Model Lungs?
Sue Coffey Zern1, Stephen Pearlman1,2, Thomas Blackson1, Joseph Ciarlo1 and Robert Locke1,2. 1Christiana Care Health System, Newark, DE and 2Jefferson Medical College, Philadelphia, PA.
BACKGROUND: Use of simulation models training is a primary teaching method for resusitation in developed and developing countries. New or experienced providers may acquire or maintain skills to provide
positive pressure using newborn simulation mannequins. It has not been previously established if the neonatal simulation models' lung components have similar lung mechanics to a newborn's lung.
OBJECTIVE: To determine the respiratory compliance of 2 neonatal simulation models.
DESIGN/METHODS: Respiratory compliance was compared in SimNewB (used in Neonatal Resuscitation Program in developed countries) with NeoNatalie (used in Helping Babies Breathe in developing countries)
by use of in-line pneumotach to measure tidal volume and pressure alterations (COSMO).
RESULTS: SimNewbie and NeoNatalie had significant differences in mean compliance and Vt x PIP over the typical range of applied Vt and pressures (p<0.01). Both models showed a linear relationship (p<0.01)
over the Vt and pressures used.
CONCLUSIONS: SimNewB and NeoNatlie demonstrate respiratory mechanics that are not representative of newborn lungs, which typically show a "S-like" curve with diminishing compliance at the extremes of Vt.
The VT per PIP is also not representative of a typical newborn. This raises concern that providers may acquire improper skills through training on these models. Simulated newborn resuscitation training, especially
modeling the delivery of positive pressure ventilation, could be improved if the respiratory mechanics of the simulation mannequin were more reflective of newborn lungs.
2014 Eastern SPR Annual Meeting
Abstract Number: 4455
Filename: 751637
Publication Number: 362
Presenting Author: Sandeep Sadashiv, MD
Department/Institution/Address: 275 South Bryn Mawr Avenue, Apartment E 34, Bryn Mawr, PA, 19010, United States
Phone: 215-460-8233
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy in Infants Less Than 36 Weeks Gestation
Sandeep Sadashiv1, Zubair Aghai1, Andrew Ellefson1, Rochelle Haas1 and Ursula Nawab1. 1Neonatology, Thomas Jefferson University Hospital, Nemours, Philadelphia, PA.
BACKGROUND: Therapeutic hypothermia (TH) has been established as a standard of care for managing term infants with hypoxic ischemic encephalopathy(HIE). Recently Cochrane Review determined that TH was
beneficial in term and late-preterm infants, defined as ≥ 35 weeks. Since most of the large RCTs used 36 weeks as the lower age limit for inclusion, there are very limited data to extend use of TH for late preterm
infants < 36 weeks with HIE.
OBJECTIVE: The primary objective was to compare survival, short-term and long-term outcomes among late-preterm infants to term infants receiving TH.
DESIGN/METHODS: Retrospective observational study of 13 late-preterm infants (LPT), defined as infants < 36 weeks treated with TH for HIE. Data were matched to 26 term (T) infants, defined as ≥ 36 weeks
treated with TH for HIE and compared for clinical outcomes.
RESULTS: The LPT group (mean GA 35.1 ± 0.45) had a higher percentage of males, Hispanics and average for gestational age infants. There was no difference in mode of delivery (including emergency cesarean
section) and APGAR scores at 1, 5 and 10 minutes. LPT infants received primarily total body cooling (92% v 42%, p<0.001). Mortality was significantly higher in LPT infants compared to T infants (23% v 0%, p=0.03).
There were no statistically significant differences in length of stay, neurological exam at discharge, seizures during hospitalization, abnormal EEG, cardiac compromise or coagulopathy. The LPT infants had a longer
duration of oxygen (13.8 v 6.4, p<0.025) and were more likely to need treatment for hypocalcemia. Neurodevelopment follow up at 18 months was available for 100% of eligible LPT infants and 63% of T infants.
Developmental Assessment ≥ 18 months
Normal Any Abnormality Global Delay Motor Delay Speech & Language Delay (SLD)
SLD - Mild/ Non Specific
Seizures
LPT Group, n=7 (Eligible 7)
3
4
0
0
4
3(2/1)
0
T Group, n=12 (Eligible 19)
1
11
6
9
10
4(3/1)
5
CONCLUSIONS: Infants with HIE who are < 36 weeks of gestation are increasingly being referred for cooling evaluation or treatment with TH. In our study, LPT infants had a higher mortality rate prior to discharge;
however, those who survived were more likely to have a normal or mild neurodevelopment abnormality by 18 months. The risk versus benefit of TH in late-preterm infants with HIE warrants further evaluation in larger
studies before it is established as a standard of care.
2014 Eastern SPR Annual Meeting
Abstract Number: 2327
Filename: 750913
Publication Number: 363
Presenting Author: Eilann C. Santo, BA
Department/Institution/Address: 1007 S Dorrance Street, Philadelphia, PA, 19146, United States
Phone: 781 254 9474
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Efficacy of Bronchodilator Use in the Newborn Intensive Care Unit
Eilann C. Santo1, Bridget K. Hughes2 and Lawrence M. Rhein3. 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; 2University of Rochester School of Medicine and Dentistry,
Rochester, NY and 3Newborn Medicine and Pediatric Pulmonology, Boston Children's Hospital, Boston, MA.
BACKGROUND: Bronchodilators (BD) have been used for over 30 years in preterm infants with bronchopulmonary dysplasia (BPD). While some data is available on its role in short-term pulmonary compliance, little
data exists regarding efficacy of BD for clinical respiratory outcomes.
OBJECTIVE: To assess efficacy of BD in improving pulmonary status of preterm infants within 48 hours of use, and to determine correlation with Newborn Intensive Care Unit (NICU) length of stay.
DESIGN/METHODS: We identified infants born between 2002 and 2013, who received BD treatment at any point during the initial hospitalization at a Level 3 NICU. We selected controls matched for birth gestational
age week, birth year, race, and gender. Exclusion criteria included lack of control patient with matching criteria (n=6) or lack of information to allow calculation of the pulmonary score for either index or control patient
(n=16). Pulmonary scores were calculated from clinical data (Madan et al, Pediatrics 2005) on the day prior to first BD exposure, and at 24 and 48 hours post treatment. Higher scores reflect worse lung disease.
Pulmonary scores for controls were calculated on the same day of life corresponding to the day of first BD exposure for the matched patient. Demographic and clinical variables were extracted from medical records.
RESULTS: Infants who received BD had lower pulmonary scores at baseline pre-1st BD dose (2.23 v 0.18, p<0.0001), 24 hrs (1.09 v 0.10, p<0.0001) and 48 hrs (1.16 v 0.10, p<0.0001) compared to matched
controls. Infants treated with BD showed greater improvement from baseline at both 24 (p<0.0001) and 48 hours (p<0.0001) than those who did not receive BD. NICU length of stay was increased in infants who
received BDs compared to controls (p<0.0001).
CONCLUSIONS: Infants treated with BD showed greater improvement in respiratory function both 24 and 48 hours post BD administration compared to infants who did not receive BD. Infants who received BD had
more severe lung disease at similar ages compared to matched controls, and despite short-term improvement in pulmonary score, had longer NICU length of stay. Prospective studies are needed to evaluate the role
of BD in improving clinical respiratory outcomes.
2014 Eastern SPR Annual Meeting
Abstract Number: 1111
Filename: 753286
Publication Number: 364
Presenting Author: Neetu Singh, MD
Department/Institution/Address: Pediatrics, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, United States
Phone: 6036504753
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Inconsistent Use and Unanticipated Adverse Effects With Premedication for Neonatal Intubations: An Unrecognized Area for Improvement
Neetu Singh1 and Gautham K. Suresh1. 1Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH.
BACKGROUND: Despite strong evidence and recommendations for premedication use in non-urgent neonatal intubations, it is not a standard practice in most neonatal units.
OBJECTIVE: To identify inconsistencies in premedication use for non-urgent neonatal intubation; and its effects on intubation performance and outcomes.
DESIGN/METHODS: We conducted a single-center retrospective study in a Level 3 NICU to obtain baseline data for quality improvement. We reviewed charts of all non-urgent intubations and premedication use
from April 2011 through December 2012 and collected information on infant demographics, indication for intubation, premedication use, person attempting intubation, number of attempts at intubation and any adverse
effects (with or without premedication). The primary outcome was percent of non-urgent neonatal intubations receiving one or more of the following medications: atropine, fentanyl and rocuronium. Secondary
outcomes were number of intubation attempts, and any associated adverse events. We compared intubation performance and outcomes with and without premedication.
RESULTS: Premedication was administered in only 51% of 103 non-urgent intubation episodes reviewed. Atropine was the medication used most frequently (92%), followed by fentanyl (83%) and rocuronium (61%).
Premedication was used most frequently by residents (76%), and less often by nurse practitioners (46%) and neonatologists (20%). The incidence of successful intubation on the first attempt was not significantly
different with premedication (46%) and without premedication(44%). The median number of attempts for successful intubation was also identical in the two groups. Intubation complications and duration of attempts
were poorly documented. The incidence of severe hypercapnia (arterial or arterialized capillary PCO2>80mmHg) post-intubation was significantly higher in those whose premedication included rocuronium (45%),
compared to premedication without rocuronium (28%) and no premedication (12%); p<0.02 for premedication including rocuronium versus no premedication.
CONCLUSIONS: The use of premedication during non-urgent neonatal intubations remains inconsistent, in spite of strong evidence favoring its use and expert recommendations. Increase in post-intubation PCO2
with premedication including muscle relaxant is a significant finding. This may represent inadequate maintenance of functional residual capacity after paralysis, particularly with long acting muscle relaxants.
2014 Eastern SPR Annual Meeting
Abstract Number: 691
Filename: 753535
Publication Number: 365
Presenting Author: Lindsay R. Tellefsen, MD
Department/Institution/Address: Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, 3601 A Street, Philadelphia, PA, 19134, United States
Phone: 215-427-5202
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Using a Quality Improvement Project To Optimize Placement of Umbilical Catheters
Dimitrios Angelis1,2, Lindsay R. Tellefsen1,2 and Endla K. Anday1,2. 1Pediatrics, Drexel University College of Medicine, Philadelphia, PA and 2Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children,
Philadelphia, PA.
BACKGROUND: Umbilical catheters [UCs] are often required to provide fluids, nutrition, and medications to critically ill neonates but are frequently malpositioned. Formulas developed for catheter insertion are often
inaccurate for the initial placement of UCs, with a tendency toward overinsertion, or “high” placement, especially in ELBW infants, necessitating the readjustment of the UC after the initial placement. A commonly
used formula devised by Shukla (1986) uses birth weight to determine optimal catheter placement as follows: UAC= 3 x birth weight in kg +9, UVC=UAC / 2 + 1 cm.
OBJECTIVE: In a quality improvement initiative, we aimed to optimize both the initial and final positions of UCs within 12 hours after placement by using a written guideline and the Shukla formula.
DESIGN/METHODS: Pre-Intervention [Pre-I] data were collected during a 10-month period (January 2012-October 2012). During this period, various methods, including morphometric measurements using anatomic
landmarks or regression formulas using weight, were used to estimate the insertion length of the UCs. Post-Intervention [Post-I] data were collected during a 5-month period (January 2013-May 2013). In Post-1 all
physicians and NNPs used the Shukla formula when inserting UCs, with the goal of placing them at the levels of the following vertebral bodies: UAC tip between T6-T10 and UVC tip between T8-T10. After catheter
tip location was confirmed by chest radiograph, the final catheter insertion length was recorded. A written protocol using a step-by-step approach was followed by all health care providers, focusing on the immediate
readjustments of the UCs with radiographic confirmation, targeting at the above levels.
RESULTS: Pre-I: 40 infants with UVC and 28 infants with UAC were included. 24/40 (60%) of the UVC and 17/28 (40%) of the UAC were misplaced. Of them, 14/24 (59%) (UVC) and 5/17 (45%) (UAC) remained
misplaced for >12 hours after initial placement. Post-I: 19 infants with UVC and 10 infants with UAC were included. 4/19 (21%) of the UVC (P< 0.05 vs Pre-I) and 2/10 (20%) of the UAC were misplaced. Of those,
none of the catheters remained misplaced after 12 hours of insertion.
CONCLUSIONS: A standardized written protocol for the insertion of UCs is an effective means of optimizing their initial location. Furthermore, caregivers are prompted to follow through and recognize inappropriate
placement with rapid correction of any malpositioning that does occur.
2014 Eastern SPR Annual Meeting
Abstract Number: 1561
Filename: 751073
Publication Number: 366
Presenting Author: Lyndsey R. Garbi, MD
Department/Institution/Address: The Regional Neonatal Center Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center/NYMC, 100 Woods Road, Valhalla, New York,
10595, United States
Phone: 0015164454442
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Neurodevelopmental Outcomes of Neonatal Extracorporeal Membrane Oxygenation (ECMO) Therapy
Lyndsey R. Garbi2, Ruth Milanaik3, Maria Mendoza3, Anna Krevskaya3 and Susana Castro-Alcaraz1. 1Neonatal Perinatal Medicine, Cohen Children's Medical Center of NY, North Shore – LIJ School of Medicine, New
Hyde Park, NY; 2The Regional Neonatal Center Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center/NYMC, Valhalla, NY and 3Behavior & Development, Cohen Children's
Medical Center of NY, North Shore – LIJ School of Medicine, New Hyde Park, NY.
BACKGROUND: ECMO is a technique used to treat severe acute cardiorespiratory failure in newborns when the mortality risk is higher than 80%. Two modalities of ECMO are used: venovenous (VV) & venoarterial
(VA). Long-term neurodevelopmental (ND) outcome studies comparing VV to VA ECMO are needed.
OBJECTIVE: To evaluate ND outcomes using Cognitive Adaptive Test/Clinical Linguistic & Auditory Milestone Scale (CAT/CLAMS) in newborns treated with VV vs VA ECMO.
DESIGN/METHODS: We conducted a retrospective & prospective chart review comparing CAT/CLAMS developmental quotients (DQ) at ages 18 to 36 months corrected age in newborns treated with VV vs VA
ECMO. CAT/CLAMs is a ND tool for the cognitive assessment of infants & toddlers. This test correlates well with the Bayley Scales of Infant Development & is useful for detecting & quantifying mild & severe
cognitive impairment. CAT/CLAMS were considered abnormal if DQ < 1 standard deviation below mean.
RESULTS: We enrolled 14 newborns (5 received VV & 9 received VA ECMO). There were no significant differences observed between VV vs VA pre-ECMO mode of ventilation, ventilator settings, diagnoses,
inotropic support, blood gas measurements, oxygenation index and use of neuromuscular blockers or sedation. In both VV & VA groups, an abnormal CLAMS DQ was associated with a lower gestational age 37.5 ±
1.67 wks compared to the normal group 41 ± 1.13 wks (p<0.005). An increased median time to extubation 395 hours (range: 319 to 744) was associated with abnormal CLAMS DQ compared to newborns with
normal CLAMS DQ 187.5 (range: 143 to 363) (p < 0.004). Of the newborns who received inotropic support, 37.5% had at least one abnormal CAT/CLAMS during their follow-up period; of the 6 babies who did not
receive inotropic support, 100% were abnormal at least once (p<0.03). Of the 8 newborns with meconium aspiration syndrome (MAS), 37.5% had at least one abnormal CAT/CLAMS during their follow-up period; of
the 6 babies with other diagnoses, 100% were abnormal at least once (p<0.03).
CONCLUSIONS: VA & VV ECMO treated newborns have comparable ND outcomes measured by CAT/CLAMS up to 36 months of age. The more immature newborns had greater risk of receptive & expressive
language abnormalities. Greater ND abnormalites were seen in newborns requiring prolonged intubation times. Newborns treated with inotropic agents or with diagnoses of MAS had a reduced risk of ND
abnormalities.
2014 Eastern SPR Annual Meeting
Abstract Number: 2648
Filename: 751715
Publication Number: 367
Presenting Author: S. Shah, MD
Department/Institution/Address: Dept. of Pediatrics, Neonatology, Golisano Children's Hospital, University of Rochester Medical Center (URMC), 601 Elmwood Avenue, Rochester, NY, 14642, United States
Phone: 6462900471
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Chorioamnionitis Increases Preterm Cord Blood CD4+ T Lymphocyte IL-6 and TNF-α Response Which Predicts the Development of Bronchopulmonary Dysplasia (BPD)
S. Shah1, R. Misra1, D. Fowell1, H. Wang1, K. Scheible1, T. Stevens1, S. Misra1, H. Huyck1, T. Mariani1 and G. Pryhuber1. 1Department of Pediatrics, Neonatology Division, Golisano Children's Hospital, University of
Rochester Medical Center (URMC), Rochester, NY.
BACKGROUND: Inflammation of the chorio-amnion (chorioamnionitis, CA) is associated with premature delivery and bronchopulmonary dysplasia (BPD). We speculate that CA leads to dysregulated CD4+ T cell
homeostasis. We hypothesize that preterm infants exposed to CA have reduced suppressive regulatory T cells (Treg) and increased non-Treg pro-inflammatory cytokine production increasing their risk for BPD.
OBJECTIVE: To evaluate the relationship of CA to preterm cord blood CD4+ T cell anti-inflammatory regulatory T cell phenotype and pro-inflammatory cytokine production, and the potential effect on
bronchopulmonary dysplasia.
DESIGN/METHODS: Using flow cytometry, 40 consented cord blood samples (20 with and 20 without histological CA (hCA) from infants with GA < 32 weeks were analyzed. The prevalence of obstetrician-defined
clinical CA (cCA) was 30% in the cohort. Clinical information was collected by retrospective chart review. Absolute numbers of putative Treg (CD4+FoxP3+CD25+CD127Dim) and CD4+ non-Tregs, and CD4+ T cell
intracellular cytokine content, were compared with CA status and oxygen requirement at 36 weeks postmenstrual age (BPD36). Frozen cord blood mononuclear cells (CBMC) were thawed, rested overnight and
cultured in media (RPMI+10%FBS+Penicilin/Streptomycin) ± stimulation (4.5 hours) with PMA (50 ng/ml)/Ionomycin (1mmol/L)/monensin (1 mmol/L). Cells were stained, assessed by 18 channel BD LSRII flow
cytometer and analyzed with FlowJo® and Prism® software. T-test, chi-square test and Fisher's exact test were applied where appropriate.
RESULTS: Absolute Treg numbers were not different in CA and non-CA exposed samples. Greater IL-6 and TNF-α responses to in vitro stimulation occurred in the hCA and cCA cells (p = 0.03 and 0.04 respectively)
compared to non-CA cells. Absolute Treg numbers were lower (p = 0.0124) and basal IL-6 and TNF-α positive cells were more frequent (p= 0.041 and p = 0.051) in CBMC of infants who developed BPD36 than in
those who did not.
CONCLUSIONS: We report a pro-inflammatory CD4+ T cell status, based on TNF-α and IL-6 production and fewer Tregs, in preterm infants exposed to CA, as well as in those who developed BPD. It is proposed
that in utero activated lymphocytes contribute to the pathophysiology of chronic lung disease of prematurity.
NIHT32HD057821, NHLBIU01HL101813 and URMC Dept of Pediatrics.
2014 Eastern SPR Annual Meeting
Abstract Number: 480
Filename: 752228
Publication Number: 368
Presenting Author: Shetal I. Shah, MD
Department/Institution/Address: 27 Donna Lane, Syosset, NY, 11791, United States
Phone: 917-940-2262
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Early Initiation of Nitric Oxide Improves Lung Morphology in a Lamb Model of Persistent Pulmonary Hypertension
Shetal I. Shah1, Sushma Krishna2, Sylvia Gugino3 and Satyan Lakshminrusimha3. 1Pediatrics/Neonatology, Maria Fareri Children's Hospital/New York Medical College, Valhalla, NY; 2Pediatrics/Neonatology, Cornell
University Medical Colleg/New York Hospital, New York, NY and 3Pediatrics/Neonatology, State University of New York at Buffalo, Buffalo, NY.
BACKGROUND: Persistent pulmonary hypertension of the newborn causes morbidity & mortality. Inhaled nitric oxide (iNO) reduces extracorporeal membrane oxygenation use but does not improve survival.The
optimal timing of iNO is not fully elucidated. In lamb models, early use of iNO decreased oxygenation index & reduced pulmonary artery contractility but did not alter total oxygen exposure or peroxynitrite formation.
The effect of early vs. late iNO therapy on lung histology is not known.
OBJECTIVE: To determine the timing of iNO therapy on lung histology.
DESIGN/METHODS: Time-dated pregnant ewes underwent surgical ligation of the ductus arteriosus at 128 days gestation & recovered in utero prior to cesarean delivery day of life (DOL) 134 & 135 (term ∼ 145
days) & were randomized to:
Early iNO (N=7): Lambs were ventilated with oxygen to maintain PaO2 levels between 60-80mmHg for 3 hours followed by iNO at 20 parts per million (ppm). If oxygen was weaned to <60% and PaO2 remained >60
mmHg, then iNO was weaned by 5ppm every 4 hours until 5ppm,with 1ppm wean thereafter. Lambs were sacrificed at 24 hours of age.
Late iNO (N=6): Same protocol, only with iNO begun at 6 hours post ventilation.
A linear 133-point-counting grid was superimposed onto each digitized image. Morphometric assessments & polymorphonuclear (PMN) cell counts were manually performed on 7mm, fixed-inflated lung cross
sections stained with hematoxylin-eosin by blinded observers.Three slides from each animal were randomly chosen and 3-5 images were analyzed per slide.The percentage of air space, parenchyma and vascularity
were counted. Airspace/Parenchyma (A/P) ratios were also calculated. Student's T-test was used for analysis. P<0.05 was considered significant.
RESULTS: A total of 25,137 points were manually counted from 189 digitized images. There was no difference in the number of PMNs/High Power Field (hpf) between the two groups (Early iNO 46.5+12.5 vs. Late
iNO 40.9+16.4, p<0.25). Percentage airspace approached statistical significance (Early iNO 52.8+8.6 vs. Late iNO 45.2+8.5, p<0.06). Lambs in the Late iNO group had more lung parenchyma (Early iNO 34.5+8.5 vs.
Late iNO 46.9+10.0, p<0.03) and less vascularity (Early iNO 12.5+4.5 vs. Late iNO 7.8+3.7, p<0.03). The A/P ratio was higher in the Early iNO group (Early iNO 1.6+0.6 vs. Late iNO 1.04+0.4, p<0.03).
CONCLUSIONS: Early use of iNO improved lung histology but did not alter the number of PMNs.
2014 Eastern SPR Annual Meeting
Abstract Number: 2758
Filename: 753272
Publication Number: 369
Presenting Author: Jenda Arawiran, MD
Department/Institution/Address: Neonatal-Perinatal Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, United States
Phone: 914-493-8558
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Hyperoxia Downregulates Bone Morphogenetic Protein Receptor II (BMPRII) Expression in Human Pulmonary Arterial Endothelial Cells (HPAECs)
Jenda Arawiran1, Susan Olson2, Johanna Calo3 and Lance Parton1. 1Neonatalogy, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY; 2Biochemistry, New York Medical College, Valhalla,
NY and 3Neonatalogy, St. Joseph's Children's Hospital, Paterson, NJ.
BACKGROUND: Bone morphogenetic proteins (BMPs) are members of the transforming growth factor-β (TGF-β) family. They are multifunctional cytokines with significant roles in development. They regulate cell
proliferation, differentiation, and apoptosis in different tissues. Dysregulated BMP signaling may influence pathological processes such as bronchopulmonary dysplasia (BPD). BPD remains to be a common morbidity
in the NICU despite advances in neonatal medicine.
OBJECTIVE: The aim of this study was to assess the temporal expression of BMP and BMPRII in HPAECs exposed to hyperoxia.
DESIGN/METHODS: HPAECs were cultured in endothelial cell culture medium & maintained in a sterile humidified cell culture incubator at 37oC with 5% CO2. Cells were passaged at 70-80% confluence with trypsin.
Primary cultures of passage 5 were used in the experiments. HPAECs were plated in 30mm well plates & exposed to hyperoxic gas with 95% O2 & 5% CO2 for up to 72 h & and for control group, cells were placed on
room air in an incubator. Cell lysates were collected at 0, 24, 48 and 72h. Viable cells were counted by trypan blue exclusion using the Neubauer hemocytometer & antibodies to BMP4 and BMPRII were used in
Western blot assays to determine protein expression.
RESULTS:
Results showed that BMPRII expression was decreased following 72h of hyperoxia exposure of HPAECs, though this did not reach statistical significance. Expression of BMP4 was not affected.
Cells exposed to hyperoxia showed a decrease in number as the duration of hyperoxia increased compared to the control wherein the cells proliferated.
CONCLUSIONS: This experiment showed that BMPRII expression was decreased in HPAECs exposed to hyperoxia. We speculate that the downregulation of BMPRII following hyperoxia may increase the
susceptibility of HPAECs to apoptosis, leading to microvascular obliteration, and resulting in hypoalveolarization, such as seen in BPD, because of the alveolar-capillary interdependence during lung development.
2014 Eastern SPR Annual Meeting
Abstract Number: 2363
Filename: 752032
Publication Number: 370
Presenting Author: Jessica Dodge, BA
Department/Institution/Address: Pediatrics, Connecticut Children's Medical Center, 263 Farmington Avenue, Farmington, CT, 06030, United States
Phone: 8606794331
Fax: 8606791403
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Perinatal Characteristics Associated With Transfusion Related Necrotizing Enterocolitis
Jessica Dodge2 and Naveed Hussain1. 1Pediatrics, Connecticut Children's Medical Center, Farmington, CT and 2University of Connecticut School of Medicine, Farmington, CT.
BACKGROUND: Among infants who develop NEC there is a subgroup in which it is diagnosed soon after a packed red blood cell transfusion (pRBC) and is thought to be related to transfusion related gut injury. The
risk factors associated with this transfusion related NEC (TR-NEC) are not well understood.
OBJECTIVE: To compare differences in perinatal risk factors between infants who develop TR-NEC and NEC not associated with pRBC transfusions (nonTR-NEC).
DESIGN/METHODS: A retrospective study was done with all infants admitted to a single tertiary care NICU between Jan. 1994 and Dec. 2008. Diagnosis of NEC was based on Bell's criteria. TR-NEC was defined as
stage 2-3 NEC diagnosed within 48 hours of a pRBC transfusion; and the rest of cases were classified as nonTR-NEC. Univariate comparisons of 20 putative perinatal risk factors were made between the two groups.
These included, maternal complications of pregnancy, maternal medications including steroids and indomethacin, factors associated with birth, resuscitation and neonatal morbidities.
RESULTS: Of the 7,080 infants admitted during the 15 years of study, complete data was available for 6,793. There were 20 cases of TR-NEC and 103 cases of nonTR-NEC. Among various perinatal risk factors
analyzed by univariate comparisons, TR-NEC was associated with lower gestational age (GA) at birth, birth weight, and corrected GA (CGA) at diagnosis. TR-NEC was also associated with higher pre and postnatal
indomethacin use, RDS, BPD, and PDA ligation. However, on multiple logistic regression analyses only lower GA at birth and lower CGA at diagnosis remained statistically significant. All cases of TR-NEC occurred
in infants born at < 32 wk GA and ≤ 34 wk CGA.
CONCLUSIONS: TR-NEC was seen only in the most premature infants (av.25.8 wk GA) in the NICU but no other perinatal risk factors were identified. Additionally, over the 15 years of study, there were no cases
TR-NEC that occurred in infants who received a pRBC transfusion beyond 34 wk CGA. These findings need to be corroborated using a multi-center based data-set.
2014 Eastern SPR Annual Meeting
Abstract Number: 3143
Filename: 753315
Publication Number: 371
Presenting Author: Sussan Mbi Ndakor, MD
Department/Institution/Address: Pediatrics, University of Maryland Medical Center, 22 South Greene Street, Baltimore, Maryland, 21201, United States
Phone: 571-218-9444
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Antibiotics Exposure: Risk Factor for Necrotizing Enterocolitis in Very Low Birth Weight Infants
Sussan Mbi Ndakor1, Alexander G. Agthe1, Rose M. Viscardi1 and Hyung C. Woo1. 1Pediatrics, University of Maryland School of Medicine, Baltimore, MD.
BACKGROUND: Antibiotics exposure in very low birth weight (VLBW) infants reduces gut flora diversity and may increase the risk for necrotizing enterocolitis (NEC). We hypothesized that cumulative antibiotics
exposure will increase the risk for NEC.
OBJECTIVE: To analyze a possible association between cumulative antibiotics exposure and the development of NEC in VLBW infants.
DESIGN/METHODS: A retrospective case-control study was conducted of all VLBW infants (BW <1500 grams) admitted between 2008 and 2012 to a single tertiary NICU. Cases (N=45) had radiological confirmed
NEC Bell stage 2 or higher. Controls without NEC were matched 2:1 with NEC cases for gestational age (GA) ±1 week, birth weight ±100 grams, and gender. Antibiotics exposure time for the 2 controls in each
cluster was the number of days prior to NEC diagnosis in the matched case. Odds ratios (OR) of NEC were calculated for obstetric and neonatal factors as well as the day of life of first antibiotics exposure,
cumulative antibiotic days, type of antibiotics, type of sepsis, day of life of NEC, type of enteral feeds, and percentage of enteral feeds at time of NEC. Factors with p values <0.1 were entered into a multiple
conditional regression model. The primary outcome variables were total antibiotic days and NEC.
RESULTS: The median GA was 27.7 weeks for the cohort (IQR 25.6–29.1 weeks). The median age of NEC onset was 28 days (IQR 20–42 days, range 8–84 days). The average cumulative antibiotics exposure
(ABXex) was 9.7±8.1 days in NEC patients vs. 8.2±6.9 days in controls (p=0.3). In a simple conditional logistic regression analysis, there was not a significant association between NEC and maternal ABXex or
ABXex in the first 48 hours of life. There was a trend towards decreased NEC risk with prenatal steroids exposure (OR 0.66; 95% CI 0.41–1.07). In a multiple conditional regression model, the risk for NEC was
increased for: (1) each additional week of cumulative antibiotics exposure (OR 1.71; 95% CI 1.01–2.91) and (2) medical treatment of PDA (OR 3.1; 95% CI 1.07–9.1). There was a protective effect from any
expressed breast milk feedings (OR 0.26, 95% CI 0.01–0.71).
CONCLUSIONS: Cumulative days of antibiotics exposure are associated with the increased risk for NEC. Further studies are needed to determine if this association is causal.
2014 Eastern SPR Annual Meeting
Abstract Number: 2656
Filename: 751881
Publication Number: 372
Presenting Author: Lynn E. Zeits, M.D.
Department/Institution/Address: Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 245 N. 15th Street, New College Building, MS 1029, Philadelphia, PA,
19102, United States
Phone: (215) 762-7515
Fax: (215) 762-7960
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Effect of Epidermal Growth Factor Receptor (EGFR) Kinase Inhibition on Long Term Src Kinase Activity Following Hypoxia in the Cerebral Cortex of Newborn Piglets
Lynn E. Zeits1, Andy Wang1, Tania Fontanez-Nieves1, Shadi Malaeb1 and Maria Delivoria-Papadopoulos1. 1Dept. of Pediatrics, Drexel University and St. Christopher's Hospital for Children, Philadelphia, PA.
BACKGROUND: Protein tyrosine kinases (PTKs) mediate signal transduction and control processes such as differentiation, intercellular communication and programmed cell death. Previous studies have shown
cerebral hypoxia results in increased tyrosine phosphorylation of neuronal proteins including the antiapoptotic proteins. We have also shown hypoxia results in increased activity of EGFR kinase, a membrane PTK,
and increased activity of Src kinase, a non-membrane PTK, in the cerebral cortex (CC) of newborn piglets.
OBJECTIVE: The present study tests the hypothesis that pre-hypoxic administration of PD168393, an EGFR kinase inhibitor, results in long term inhibition of hypoxia-induced Src kinase activation in the CC of
newborn piglets.
DESIGN/METHODS: Thirteen piglets were randomly assigned to 7 groups: normoxia (Nx, n=3), normoxia pretreated with EGFR kinase inhibitor PD168393, 1mg/kg i.v., 30 min prior (Nx+EGFRi, n=1), acute hypoxia
(Hx, n=2), hypoxia followed by FiO2 0.21 for 1 day (Hx-1D, n=3) and 14 days (Hx-14D, n=2), hypoxia-pretreated with EGFR kinase inhibitor PD 168393, 1mg/kg i.v., 30 min prior to hypoxia followed by FiO2 0.21 for 1
day (Hx+EGFRi-1D, n=1) and 14 days (Hx+EGFRi-14D, n=1). Membrane fractions of CC were prepared and Src kinase was isolated using a Src kinase specific antibody. Activity was determined radioactively by
measuring 33P incorporation into a tyrosine specific substrate and immunopurified Src kinase protein.
RESULTS: Src kinase activity (pmoles/mg protein/hr) was 123.9±38.7 in Nx and 142.7±65.4 in Hx. After return to FiO2 0.21, Src kinase activity was 151.8 in Hx-1D and 300.8 in Hx-14D. In piglets administered
PD168393 the Src kinase activity was 19.8 in Nx+EGFRi, 54.9 in Hx+EGFRi-1D, and 29.1 in Hx+EGFRi-14D. The data show that Src kinase activity increases on days 1 and 14. Administration of EGFR inhibitor prior
to hypoxia reduces Src kinase activity by 64% on day 1 and by 90% on day 14 following hypoxia.
CONCLUSIONS: Src kinase activity increases following hypoxia and persists for 14 days. We propose that the mechanism of Src kinase activation following hypoxia is EGFR kinase mediated. We suggest that
administration of EGFR inhibitor soon after cerebral injury occurs will prevent the tyrosine phosphorylation of apoptotic pathway mediators that triggers programmed cell death in the hypoxic newborn
brain.(NIH-HD20337)
2014 Eastern SPR Annual Meeting
Abstract Number: 3788
Filename: 752955
Publication Number: 373
Presenting Author: James Haiyang Xu, BSc, MD Candidate
Department/Institution/Address: 251 Barrie St. #1, Kingston, ON, K7L3K8, Canada
Phone: 6138769086
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Impact of a Novel Predictive Model for Early-Onset Neonatal Sepsis Evaluation
James Haiyang Xu1 and Kimberly Dow1. 1Department of Pediatrics, Queen's University, Kingston, ON, Canada.
BACKGROUND: The multivariate risk model proposed by Puopolo et al (Pediatrics 2011;128(5):e11655-1163) has been shown to identify 35% fewer asymptomatic infants born at ≥ 36 weeks in a single maternity
center as high risk for early onset neonatal sepsis (EOS) when compared with standard algorithms. (Mukhopadhyay et al E-PAS2013:3355.6).
OBJECTIVE: To retrospectively examine the number of infants assessed and treated for EOS using local guidelines in a Canadian neonatal unit in comparison with that would have been assessed by using the
quantitative multivariate risk model of Puopolo et al.
DESIGN/METHODS: Retrospective cohort study of infants born at ≥34 weeks gestational age (GA) admitted to a Canadian NICU, between July 2012 and June 2013. The cohort was stratified into high- and low-risk
groups according the model of Puopolo et al., which uses gestational age, highest maternal intrapartum temperature, duration of rupture of membranes, maternal group B Strep status and timing/type of intrapartum
antibiotics to calculate a risk. Value of ≥ 0.5 per 1000 live births was higher than baseline population risk and therefore the threshold for investigation. The numbers investigated (CBC, blood culture, or CSF culture)
and/or treated for EOS within each group were then identified.
RESULTS: 89.5% (239/267) of infants were calculated as low risk while 10.5% (28/267) as high risk, with the mean risk scores being 0.12 +/-0.01 (95% C.I., 0.0-0.47) and 1.68 +/-0.91(95% C.I., 0.52-13.19),
respectively. Within the low risk group, 130/239 (54%) were investigated for EOS with 31/239 (13%) also received antibiotics. The high risk group had 18/28(64%) investigated with only 2/28(7%) also treated. In both
high- and low-risk groups, there were no difference in the mean risk scores between those investigated and those who were not, neither were there difference between those treated with antibiotics and those who
were not. In total, 148/267(55.4%) of infants were investigated for EOS in this cohort based on clinical judgement. No cases of EOS as defined by a positive blood or CSF culture were identified.
CONCLUSIONS: Use of the Puopolo et al. neonatal sepsis predictive model would have resulted in 81% fewer infants investigated. Costs savings generated by this model, associated with the investigations,
treatment and NICU stay, are currently being evaluated. Prospective study is needed to further evaluate the practical impact of this predictive instrument on EOS identification and associated cost savings in Canadian
NICUs.
2014 Eastern SPR Annual Meeting
Abstract Number: 2609
Filename: 751110
Publication Number: 374
Presenting Author: Sam Ajayi, M.D.
Department/Institution/Address: Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 245 N. 15th Street, New College Building, MS 1029, Philadelphia, PA,
19102, United States
Phone: (215) 762-7515
Fax: (215) 762-7960
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Long Term Effect of Src Kinase Inhibition on Apoptotic Protease Activating Factor-1 (Apaf-1) Expression in the Cerebral Cortex of Newborn Piglets
Sam Ajayi2, Dimitrios Angelis1, Lynn E. Zeits1, Aaron Pinninti1 and Maria Delivoria-Papadopoulos1. 1Dept. of Pediatrics, Drexel University and St. Christopher's Hospital for Children, Philadelphia, PA and 2Dept. of
Pediatrics, Albert Einstein Medical Center, Philadelphia, PA.
BACKGROUND: Apoptotic protein activating factor-1 (Apaf-1) is a cytosolic protein that plays a major role in the apoptotic cascade. Apaf-1 binds with cytochrome-c to form the apoptosome that cleaves and activates
procaspase-9 to active caspase-9, an initiator of programmed cell death. We have previously shown that acute hypoxia-induced increased expression of Apaf-1 proteins is Src kinase mediated.
OBJECTIVE: The present study aims to investigate the long term effect of acute Src kinase inhibition on the expression of Apoptotic Protease Activating Factor-1 (Apaf-1) following hypoxia in the cerebral cortex of
newborn piglets.
DESIGN/METHODS: Twenty one piglets were divided into 7 groups: normoxia (Nx, n=3), acute hypoxia (Hx, n=3), hypoxia followed by 1 day (Hx-1D, n=3) and 14 days (Hx-14D, n=4) in FiO2 0.21,
normoxia-pretreated with selective Src kinase inhibitor PP2 (4-amino-5-(4-chlorophenyl)-7-(dimethylethyl)pyrazolo[3,4-d] pyrimidine, 1 mg/kg, i.v., 30 min prior to hypoxia) followed by 1 day (Nx+PP@-1D, n=3) in FiO2
0.21, hypoxia-pretreated with PP2 followed by 1 day (Hx+PP2-1D, n=3) and 14 days (Hx+PP2-14D, n=3) in FiO2 0.21. Cytosol was isolated and expression of Apaf-1 was measured by Western blot using a Apaf-1
antibody. Protein bands were detected by enhanced chemiluminescence analyzed by densitometry and expressed as absorbance (OD/mm2).
RESULTS: Density of Apaf-1 was 245.47±8.9 in normoxia and 351.34±2.68 in hypoxia (p<0.05). During recovery, density of Apaf-1 was 225.77±0.32 in Nx+PP2-1D (p <0.05 vs Hx groups), 326.49±29.36 in Hx-1D,
313.23±43.28 in Hx-14D, 240.94±20.32 in Hx+PP2-1D (p <0.05 vs Hx groups) and 257.04±41.32 in Hx+PP2-14D (p <0.05 vs Hx groups). The data show that following 1 day and 14 day after hypoxia, expression of
Apaf-1 is attenuated by the administration of Src kinase inhibitor.
CONCLUSIONS: We conclude that Src kinase mediated-hypoxia-induced increased expression of Apaf-1 persists for 1 day and 14 days following hypoxia, however, this increase in Apaf-1 expression was prevented
on both day 1 to day 14 following hypoxia in the hypoxia-pretreated with the Src kinase inhibitor group. The decreased expression of Apaf-1 will decrease the Apaf-1 procaspase interaction and decreased caspase-9
activation, a critical step in cascade of caspase-mediated hypoxic cell death. (NIH-HD 20337)
2014 Eastern SPR Annual Meeting
Abstract Number: 2554
Filename: 750238
Publication Number: 375
Presenting Author: Dimitrios Angelis, M.D.
Department/Institution/Address: Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 245 N. 15th Street, New College Building, MS 1029, Philadelphia, PA,
19102, United States
Phone: (215) 762-7515
Fax: (215) 762-7960
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Effect of Hypoxia on Interleukin 1 beta (IL-1ß) Production in the Cerebral Cortex of Newborn Piglets
Dimitrios Angelis1, Tania Fontanez-Nieves1, Shadi Malaeb1, Qazi Ashraf1 and Maria Delivoria-Papadopoulos1. 1Dept. of Pediatrics, Drexel University and St. Christopher's Hospital for Children, Philadelphia, PA.
BACKGROUND: IL-1β is known to be a proinflammatory cytokine. The synthesis of IL-1β precursor is induced by stimulation of innate immune cells by receptors. To gain the ability to bind to IL-1 receptor, IL-1β
precursor has to be cleaved by cysteine protease caspase-1. Caspase-1 is needed to activate a formation of inflammasome mediated by cytoplasmic pattern recognition receptors signaling. Caspase-1 activation
regulates the production of IL-1ß, IL-18 and TNFa. IL-1ß plays a key role in the regulation of immune response activating T and B lymphocytes and leads to programmed inflammatory cell death (pyroptosis).
Previously we showed that caspase-1 activity is increased following hypoxia and persist for 14 days.
OBJECTIVE: The present study tests the hypothesis that hypoxia increases the production of IL-1ß in the newborn piglet brain.
DESIGN/METHODS: Twenty piglets were divided into: Normoxia (Nx, n=5), Hypoxia (Hx, n=5), Hypoxia-1 day (Hx-1D, n=5), Hypoxia-14 days (Hx-14D, n=5). Hypoxia was induced by FiO2 0.07 for 1 hour. Hypoxia
was documented by determining the levels of ATP and phosphocreatine (PCr). IL-1ß levels in the cytosolic fraction of the cerebral cortex were determined by solid phase ELISA, using a specific antibody for IL-1ß.
Results were expressed as pg/ml.
RESULTS: ATP levels (µmol/g brain) were 4.6±0.3 in Nx and 1.6±0.4 in Hx (p<0.05 vs Nx). PCr values (µmol/g brain) were 3.4±0.3 in Nx and 1.2±0.4 in Hx (p<0.05 vs Nx).IL-1ß (pg/mL, M±SD) levels were 89±34 in
Nx, 77±7 in Hx (NS vs Nx), 139±45 in Hx-1D (p<0.05 vs Nx, Hx), 90±33 in Hx-14D (p<0.05 vs Hx-1D, NS vs Hx, Nx). The data show that IL-1ß production was increased 1 day after hypoxia. The levels of IL-1ß
returned to baseline at 14 days following the acute hypoxic event.
CONCLUSIONS: Hypoxia increases IL-1ß production in the piglet brain. Pro-inflammatory cytokines can activate microglia and recruit inflammatory cells into the brain parenchyma. Cell-mediated inflammatory
response may persist well after the acute phase of hypoxia-induced neuroinflammatory response mediated by IL-1ß. Neuroinflammation triggered by perinatal infection or induced by cerebral hypoxic injury
exacerbates brain damage following HI. We suggest that hypoxia-induced caspase-1 mediates IL-1ß production that plays a role in the initiation of the neuroinflammatory response which leads to delayed cell death
following hypoxia in the newborn piglet brain.(NIH-HD 201337)
2014 Eastern SPR Annual Meeting
Abstract Number: 3962
Filename: 754294
Publication Number: 376
Presenting Author: Jayasree Nair, MD
Department/Institution/Address: Pediatrics/Neonatology, State University of New York at Buffalo, 219 Bryant Street, Buffalo, NY, 14222, United States
Phone: 7168787673
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Ontogeny of Nitric Oxide Pathway in Ovine Fetal Mesenteric Arteries: Correlation With Age at Onset of NEC
Jayasree Nair1, Cheryl Allen1, Lori Nielsen1, Sylvia Gugino1 and Satyan Lakshminrusimha1. 1Department of Pediatrics, State University of New York at Buffalo, Buffalo, NY.
BACKGROUND: An altered vasoconstrictor-vasodilator balance in the mesenteric circulation is thought to contribute to Necrotizing Enterocolitis (NEC). Nitric oxide (NO) may play a key role as an intestinal
vasodilator and reduce the risk of NEC (Upperman et al,Sem Ped Surg 2005). Several studies have shown that NEC peaks at 31-35wk postmenstrual age. The exact etiology for this common age at onset of NEC is
not known. We have previously shown that mesenteric vascular constriction response peaked at late preterm and near term gestation while the relaxation response of ovine MAs increased with gestation and peaked
postnatally (Nair et al PAS 2010). 135d (term 147d) in sheep corresponds to 34wk gestation in humans in maturation.
OBJECTIVE: To determine the effect of gestational age on protein expression of enzymes of the NO pathway in preterm ovine fetal mesenteric arteries (MA).
DESIGN/METHODS: Preterm lambs at different gestational ages 116 d (previable), 128d (Extreme Prematurity), 135d (Late preterm) and 140d (near term) were sacrificed at birth. Postnatal lambs at 3-7d age were
udder fed at the farm and then sacrificed. Mesenteric arteries were dissected and Western blots for protein were performed for endothelial nitric oxide synthase (eNOS), soluble guanylate cyclase (sGC) and
phosphodiesterase 5 (PDE5).
RESULTS: Expression of eNOS, sGC and PDE5 increased with gestational age with high levels at near term gestation. During the postnatal period, mesenteric arterial eNOS protein remained unchanged, sGC
decreased and PDE5 increased compared to fetal levels.
CONCLUSIONS: There is a distinct developmental ontogeny noted in protein expression of enzymes of the NO pathway with peak levels just before birth. These changes optimize the mesenteric circulation for
maximal vasodilation in response to postnatal feeds. Decreased eNOS and sGC protein expression at late preterm gestation may limit the potential for mesenteric vasodilation and increase the risk of NEC at 31-35
wk postmenstrual age.
2014 Eastern SPR Annual Meeting
Abstract Number: 4815
Filename: 756452
Publication Number: 377
Presenting Author: Nidhi Agarwal, MD
Department/Institution/Address: Neonatology, Montefiore Medical Center, Albert Einstein College of Medicine, 1825 Eastchester Road, Weiler Hospital Division, Bronx, New York, 10461, United States
Phone: 718 904 4105
Fax: 718 904 2659
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Spontaneous Intestinal Perforation: Maternal and Neonatal Factors
Nidhi Agarwal1, Jaime R. Braverman3, Mimi Kim2 and Alecia Thompson1. 1Department of Neonatology, Montefiore Medical Center, Bronx, NY; 2Department of Epidemiology & Population Health, Albert Einstein
College of Medicine, Bronx, NY and 3Department of Pediatrics, Montefiore Medical Center, Bronx, NY.
BACKGROUND: Spontaneous Intestinal Perforation (SIP) occurs mostly in extremely low birth weight infants and may lead to delayed enteral feeding, prolonged hospitalization and risk of cerebral lesions. The
incidence of SIP is 5-6%. Maternal medications such as Magnesium Sulfate (MGS) given as fetal neuroprotection, tocolysis and/or treatment of preeclampsia, indocin (INDO) and antenatal steroid (ANS) may affect
the gastrointestinal smooth muscle wall and motility in the fetus.
OBJECTIVE: We hypothesized that co-administration of MGS, INDO and ANS increases the risk of SIP postnatally.
DESIGN/METHODS: We conducted a single center retrospective case control study of inborn SIP cases admitted to the NICU between Jan'07 and Mar'13. For each case, 2-3 controls with gestational age (GA) [+/- 1
week] and date of birth [+/- 2 months] matched were selected. Exclusion criteria were gastrointestinal anomalies, genetic syndromes or being born outside of the Montefiore Health System. We collected demographic
variables, prenatal factors like maternal medications ANS, INDO and MGS, prolonged rupture of membranes and placental pathology. Postnatal factors (all prior to onset of SIP) included platelet count (Plt Ct),
highest white count (WBC) within 48 and 24 hours prior to onset respectively, maximum feeds reached, presence of patent ductus arteriosus (PDA), respiratory support and change in oxygen requirement 24 hours
before SIP occurrence. The primary outcome was whether co-administration of ANS, INDO, and MGS increase the risk of SIP. The data were analyzed using Chi Square and Fisher's exact tests and p value was
calculated.
RESULTS: There were 23 cases, however only 17 met the inclusion criteria; 47 controls were matched. For the cases, mean GA at presentation was 26.75 + 1.76 weeks, mean weight was 780 + 200 grams and
mean postnatal age was 4.7 + 2.3 days. We did not find significant difference in highest WBC, resuscitation at delivery and placental infection. Incidence of Plt Ct <100 X 103 was more common in SIP cases (p=
0.051). Though maternal medications ANS, Indo or total dose of MGS received in isolation was not significant, co-administration of these medications in the same timeframe was significantly associated with increase
risk of SIP (p= 0.002).
CONCLUSIONS: Co-administration of maternal magnesium, Indocin and antenatal steroids was significantly associated with increased occurrence of SIP cases.
2014 Eastern SPR Annual Meeting
Abstract Number: 3667
Filename: 751704
Publication Number: 378
Presenting Author: Seema P. Anandalwar, BS
Department/Institution/Address: 39 Cummings Road, Monmouth Junction, NJ, 08852, United States
Phone: 7322336688
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Growth Velocity Correlates With Pulmonary Hypertension Course in Neonates With Pulmonary Hypertension and Bronchopulmonary Dysplasia
Seema P. Anandalwar1, Mary P. Mullen2, Ronald V. Lacro2 and Lawrence M. Rhein1. 1Neonatology and Pediatric Pulmonary, Boston Children's Hospital, Boston, MA and 2Cardiology, Boston Children's Hospital,
Boston, MA.
BACKGROUND: Pulmonary hypertension (PH) is a common and concerning consequence of bronchopulmonary dysplasia (BPD). Although there is limited data on the natural course of PH, recent studies suggests
that a majority will experience resolution. Nutrition has been found to be an important factor in lung maturation and growth. Adequate nutrition and growth has been implicated in not only the prevention of BPD but
also as an important factor in its management.
OBJECTIVE: To assess the relationship between changes in growth parameters and outcome in BPD-associated PH.
DESIGN/METHODS: We identified 102 infants with birth gestational age ≤ 32 weeks gestation, birth between 1998 and 2012, BPD diagnosis, and PH diagnosed by echocardiogram at ≥ 2 months of age.
Echocardiograms were followed until documented PH resolution. Demographics and details of the respiratory and PH management were collected for all patients. Weights taken at the time of diagnostic and
resolution echocardiograms were documented and z-scores were determined based on corrected gestational age using World Health Organization curves. Significant change in z-score was defined as a change in
z-score of ≥0.5.
RESULTS: Of the 102 patients with PH reported on echo after 2 months of age, 45 had documented evidence of PH resolution and corresponding weight measurements. Two-thirds (n=26) of these patients had
growth failure, (defined as a weight <10th percentile on World Health Organization growth curves) at the time of PH diagnosis. Mean change in weight z-score from diagnostic to resolution echocardiogram was 0.46.
Over 84.4% (n=38) patients had similar or improved z-scores at the time of PH resolution, while 7 (15.5%) had worsening z-scores despite resolution of PH.
CONCLUSIONS: Growth failure is a common finding in preterm infants at time of PH diagnosis. Improvement or maintenance of weight z-score seems to correlate with PH resolution.
2014 Eastern SPR Annual Meeting
Abstract Number: 1940
Filename: 753672
Publication Number: 379
Presenting Author: Cydney Weiner
Department/Institution/Address: 759, Chestnut Street, Springfield, MA, United States
Phone: 413-794-2400
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Undergraduate Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Role of Chronic Diuretic Therapy in the Era of New Chronic Lung Disease: Clinical Value and Cost Effectiveness
Cydney Weiner1, Paul Visintainer1,2, Jennie Fleming1, Robert Rothstein1,2 and Rachana Singh1,2. 1Baystate Children's Hospital, Springfield, MA and 2Tufts University School of Medicine, Boston, MA.
BACKGROUND: Antenatal steroids & surfactant therapy have altered histopathology of Chronic Lung Disease (CLD), with more alveolar growth inhibition rather than inflammation. This raises concerns about the
efficacy and utility of diuretic therapy, with known complications.
OBJECTIVE: To assess practices response rate, associated complications and costs associated with diuretic therapy in preterm infants.
DESIGN/METHODS: Observational prospective cohort of preterm infants ≤ 30 weeks gestational age (GA) in a 3 year study period. No study related interventions were made in infant care. Data collected - maternal
& infant characteristics, details of respiratory support, diuretic medications (type, dose, duration), clinical response (change in oxygen requirement after 1 week of treatment), electrolyte imbalance and cost of
medications (diuretics & electrolyte supplements).
RESULTS: Of the 139 infants, 64.7% received any diuretics for CLD,of which 65.5% were non-responders. Treated infants had lower GA and more co-morbidites, but diuretics did not decrease discharge home on
oxygen. Significant electrolyte imbalances were seen with average additional medication cost of $1,864.00 [range $ 5.00 to $ 5,301.00]. Comparing diuretic responders to non-repsonders, of all the characteristics, the
only significant variables were - meeting CLD definition [p=0.02] and Vit A use [p=0.006].
No Diuretic Therapy Diuretic Therapy
Characteristic
% (n)
% (n)
P-value
Mean GA [weeks]
28.5 ±1.76
26.7 ± 1.04
<0.001
Male
57.1 (28)
63.3 (57)
0.59
C-section
42.9 (21)
61.1 (55)
0.05
PPROM
34.7 (17)
13.3 (12)
0.004
PIH
12.2 (6)
18.9 (17)
0.35
Chorioamnionitis
53.1 (26)
44.4 (40)
0.38
Antenatal Steroids
89.8 (44)
86.7 (78)
0.79
Intubation at birth
22.4 (11)
67.8 (61)
<0.001
Positive Blood Culture
2.0 (1)
4.4 (4)
0.66
Positive ETT Culture
30.6 (15)
37.8 (34)
0.46
PDA
6.1 (3)
31.1 (28)
0.001
PDA ligation
0.0 (0)
15.6 (14)
0.002
Steroids for CLD
0.0 (0)
20.0 (18)
<0.001
Inhalars for CLD
6.1 (3)
38.2 (34)
<0.001
Hyponatremia
18.4 (9)
77.8 (70)
<0.001
Hypokalemia
12.2 (6)
38.9 (35)
0.001
Abnormal Alkaline Phosphatase 24.5 (12)
37.8 (34)
0.13
Oxygen at discharge
77.5 (69)
<0.001
12.2 (6)
CONCLUSIONS: Diuretic therapy for CLD though often used does not decrease discharge home on oxygen, causes significant electrolyte imbalances and increases costs. A subset of infants may benefit from
diuretics and identifying them may help target clinical care.
2014 Eastern SPR Annual Meeting
Abstract Number:
Filename: 755833
Publication Number: 380
Presenting Author:
Department/Institution/Address:
Phone:
Fax:
Presenting Author E-mail:
Is Presenting Author a Trainee? Not Yet Indicated
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title:
2014 Eastern SPR Annual Meeting
Abstract Number: 3719
Filename: 752305
Publication Number: 381
Presenting Author: Ahmad I. El Samra, MD
Department/Institution/Address: 5 Lilac Drive, Apt #4, Rochester, NY, 14620, United States
Phone: 315-395-8213
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Urinary Biomarkers To Evaluate for AKI in Premature Neonates Exposed To Prenatal Indomethacin
Ahmad I. El Samra1, Ayesa Mian2, Marc Lande2 and Ronnie Guillet1. 1Pediatrics/Neonatology, University of Rochester, Rochester, NY and 2Pediatric Nephrology, University of Rochester, Rochester, NY.
BACKGROUND: A 2-day short course of indomethacin (INDO) is commonly used to inhibit labor. Prolonged administration of INDO can cause irreversible chronic kidney damage but the impact of a 2-day course of
prenatal INDO on preterm infant kidney function is not known. Serum creatinine (SCr) lacks sensitivity in detection of acute kidney injury (AKI). Recently, measurement of urinary biomarkers (UBio) has emerged as a
potentially more sensitive method for the detection of AKI.
OBJECTIVE: To determine the effects of a 2-day prenatal course of INDO on premature infants' kidney function as reflected by Scr, urine output, and novel UBio.
DESIGN/METHODS: Ongoing longitudinal study of premature infants (≤ 32 wk) without major kidney structural abnormalities, congenital heart disease,or confirmed sepsis. Using cotton in diapers, urine was collected
for the first 14d and samples were analyzed for Cystatin C, NGAL, Osteopontin, beta 2 microglobulin, epidermal growth factor (EGF), uromodulin and microalbumin (O'Brien AKI Center). Bivariate analysis compared
levels of SCr and UBio of the exposed (INDO) to that of the unexposed (CONT) subjects. Both mean and peak values of UBio were evaluated. Relevant maternal and infant demographic information was extracted
from medical records.
RESULTS: To date, UBio in 200 urine samples from 28 patients (13 INDO, 15 CONT) have been analyzed of a planned 400 samples from 60 patients. The cohorts were similar in gestational age, birthweight, race,
gender, maternal preeclampsia, maternal nephrotoxic meds, Apgar scores,and postnatal INDO exposure. Two INDO subjects had AKI based on AKIN SCr criteria vs. none in the CONT group. UBio over the first 8
days showed AKI in the INDO group, as evidenced by lower EGF levels.
CONT n=15 INDO n=13 p
CONT n=15 INDO n=13 p
UBio
Mean±SD
Mean±SD
Peak±SD
Albumin
6.0±0.3
6.1±0.2
0.37 6.1±0.4
6.2±0.3
0.29
B2M
5.0±0.3
5.0±0.2
0.41 5.2±0.2
5.1±0.2
0.42
CystC
4.2±0.8
4.0±0.6
0.57 4.5±0.8
4.3±0.7
0.59
EGF
1.8±0.1
1.6±0.1
0.002 1.9±0.2
1.7±0.2
0.04
NGAL
4.2±0.6
4.2±0.5
0.97 4.4±0.6
4.5±0.5
0.63
Osteopontin 4.3±0.3
4.3±0.3
0.78 4.5±0.3
4.5±0.2
0.91
UMOD
5.0±0.2
0.64 5.2±0.2
5.2±0.3
0.73
5.0±0.2
Peak±SD
Both subjects with increased SCr also had lower EGF levels. Other Ubio were not significantly different .
CONCLUSIONS: Preliminary analysis of our ongoing study suggests that a 2-day course of INDO used to inhibit preterm labor may be associated with AKI in preterm neonates.
2014 Eastern SPR Annual Meeting
Abstract Number: 3190
Filename: 754124
Publication Number: 382
Presenting Author: Charu Gupta, MD, MPH
Department/Institution/Address: Pediatric Nephrology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, United States
Phone: 302-249-4796
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: A Novel Definition of Acute Kidney Injury in Term Newborns With Hypoxic Ischemic Encephalopathy
Charu Gupta1,3, An Massaro2,3 and Patricio Ray1,3,4. 1Nephrology, Children's National Medical Center, Washington, DC; 2Neonatology, Children's National Medical Center, Washington, DC; 3Pediatrics, The George
Washington University School of Medicine, Washington, DC and 4Center for Genetic Medicine Research, Children's National Medical Center, Washington, DC.
BACKGROUND: Newborns with hypoxic-ischemic encephalopathy (HIE) requiring therapeutic hypothermia (HT) are at risk of developing acute kidney injury (AKI). Absolute serum creatinine (SCr) levels and urine
output are not very sensitive parameters to diagnose AKI during the first week of life.
OBJECTIVE: Based on the normal GFR and SCr values estimated for term babies during the first days of life, we hypothesized that the rate of decline of SCr from birth through the end of the first week of life will be
useful to identify newborns with AKI.
DESIGN/METHODS: This retrospective cohort study included 77 term newborns (>36 weeks GA) with HIE treated with HT. Medical records were reviewed to collect data including serial SCr, urine output, fluid
balance, and gentamicin levels during the first week of life. Clinical factors suggestive of renal compromise were compared between infants with and without AKI. ROC analysis was performed to identify a cut-point
for SCr decline that predicted AKI. Statistical analysis was done using SPSSS 18.0 software.
RESULTS: Newborns with AKI as per the new definition had lower GA (38±2 vs. 39±1.7 wks, p<0.02). Other baseline characteristics including BW, presenting pH, Apgar scores, and gender, were similar between
newborns with and without AKI. Mean±2 SEM SCr over the first week of life are shown in figure 1.
ROC analysis revealed that SCr decline by <30% on day 3 was predictive of AKI (AUC 0.87, specificity 71 %, sensitivity 80 %). A rate of decline less than 40% of SCr from baseline after birth to day 5, identified all
patients with AKI according to the AKIN/RIFLE criteria (13/77), and detected 23 additional patients. The AKI group showed more significant hypotension, fluid overload, higher gentamicin levels and longer length of
stay (P < 0.05).
CONCLUSIONS: A less than 40% decline of SCr from baseline at birth to day of life 5 provides a new sensitive definition of AKI during the first week of life. Early identification of AKI can facilitate early renal protective
therapy in at-risk newborns.
2014 Eastern SPR Annual Meeting
Abstract Number: 3999
Filename: 754583
Publication Number: 383
Presenting Author: Hala Al Moaigel, MD
Department/Institution/Address: Pediatric Nephrology, Children's Hospital of Estern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
Phone: 1-613-737-7600 Ext 2441
Fax: 1-613-738-3254
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Reticulocyte Hemoglobin Levels in Pediatric CKD Patients
Hala Al Moaigel1, Nick Barrowman2, Elaine Leung3, Janusz Feber1 and Anne Tsampalieros1. 1Pediatric Nephrology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; 2CHEO Research institute, Children's
Hospital of Eastern Ontario, Ottawa, ON, Canada and 3Hematology & Transfusion Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
BACKGROUND: The reticulocyte hemoglobin equivalent (RET-He) is a parameter that can be easily assessed on routine CBC sample and measures the iron content of the reticulocytes, RET-He reflects the recent
functional availability of iron and has been used in the assessment of iron deficient status. It has been well characterized in the adult chronic kidney disease (CKD) population, however it has not been studied in
pediatric CKD patients to date.
OBJECTIVE: To describe RET-He levels in pediatric CKD patients and assess their correlation with other measures of iron deficiency.
DESIGN/METHODS: Retrospective cross-sectional single-center study. The study included pediatric patients who visited our CKD clinic and had at least one measurement of their RET-He and soluble transferrin
receptor (sTfR) at the same visit. Serum markers were collected from the patients' records over an 18 months interval. Iron deficiency (ID) was defined as either a serum ferritin < 100 ng/ml or transferrin saturation
<20%. Data were analyzed using STATA.
RESULTS: There were 63 participants with a mean (SD) age of 11.0 (4.7) years. Twenty nine (46%) participants were receiving iron supplementation and 24 (38%) were receiving erythropoietin. The median
Schwartz eGFR was 44 (5 to 124) ml/min/1.73 m2 ; n=10 were CKD stage 1, n=35 CKD stages 2-3 and n=18 CKD stages 4-5. Mean (SD) RET-He level was 31.2 (2.4) pg for all participants and did not differ
significantly between CKD stages. RET-He levels were significantly associated with sTfR (β=-1.26 (95% CI -2.10,-0.42) p=0.004), and iron levels (β=0.13 ( 95% CI 0.03,0.23)p=0.02), however they were not
associated with age, gender or ferritin. Forty (63%) participants were iron deficient. RET-He did not differ significantly between ID and non-ID groups. The area under the curve (AUC) of RET-He for predicting ID was
not significantly different from the AUC of sTfR (p= 0.32).
CONCLUSIONS: RET-He is a newer marker of ID, but did not prove to be significantly better than sTfR for the diagnosis of ID. Future studies are needed to establish pediatric RET-He cut-offs to diagnose true ID
status.
2014 Eastern SPR Annual Meeting
Abstract Number: 1021
Filename: 752066
Publication Number: 384
Presenting Author: Saritha Ranabothu, MD
Department/Institution/Address: 25 Washington Lane, Apt # 611, Wyncote, PA, 19095, United States
Phone: 8482483151
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Renal Transplantation in Children With Cognitive Delay (CD)
Saritha Ranabothu2, Sonya Lopez1, Natalia Zelikovsky1, Jorge Baluarte1 and Kevin Meyers1. 1Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA and 2Pediatrics, Einstein Medical Center, Philadelphia,
PA.
BACKGROUND: There is scant data addressing long term outcomes of kidney transplantation (txp) in children with CD. This single-center study was performed to evaluate renal allograft survival in CD versus age
matched cognitively normal (CN) children. We hypothesized that CD and CN children have similar txp outcomes with regards longevity, compliance and Quality Of Life (QOL).
OBJECTIVE: To report the post kidney txp outcomes in children with CD compared with their CN peers.
DESIGN/METHODS: Cross sectional study, with retrospective chart review. We identified 10 CD patients (IQ 50-90), and a control group of 12 age matched CN (IQ>90) patients who received a renal transplant from
1993 to 2009. We determined IQ, mean calculated eGFR, number of rejections, post txp infections, graft survival, QOL, drug and clinic adherence.
RESULTS: Age at txp CD 9.95 yrs (2-18) vs. CN 9.375 yrs (1.5-18). Txp survival was CD 5.55 yrs ± 2.2 (3- 11yrs) vs. CN 8.70 yrs ± 4.1 (4-17yrs). Functioning grafts CD vs. CN 100% at 3 yrs, 9/10 and 12/12 at 5 yrs
(ns). Two CD and 2 CN transferred to adult care with good graft function 3-4 yrs after txp. Calculated eGFR was equal to better in CD vs. CN groups.
]Mean end GFR 67 in CD vs. 55 in CN groups. Rejections no. 2 in 1 CD pt at 3 yrs post txp; 4 in 2 CN pts 5 yrs post txp.1/12 in CN group received second txp 9 years post txp. PTLD 1 in CD vs. 0 in CN (P=ns). BK
virus, EBV, UTI infections were 3, 1, 3 in CD vs. 3, 3, 5 in CN group (P=0.7). Drug non adherence 1 in CD vs. 1 in CN groups (P=ns). Clinic adherence no difference and QOL improvement equal in both groups.
CONCLUSIONS: Our study shows that there is no significant difference between CD and CN patients related to txp longevity, compliance and QOL at 5 yrs post txp. We conclude that CD cannot be used as a sole
justification for delaying access to kidney txp.
2014 Eastern SPR Annual Meeting
Abstract Number: 3276
Filename: 755476
Publication Number: 385
Presenting Author: Hilary M. Whelan, BS
Department/Institution/Address: Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, United States
Phone: 717-531-5337
Fax: 717-531-0809
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: The Impact of BUZZY® on Outpatient Venipuncture in Children
Hilary M. Whelan1, Allen R. Kunselman4, Neal J. Thomas2, Jeffrey Moore3 and Robert F. Tamburro2. 1Pennsylvania State University College of Medicine, Hershey, PA; 2Pediatrics and Public Health Sciences, Penn
State Hershey Children's Hospital/Pennsylvania State University College of Medicine, Hershey, PA; 3Pathology, Hershey Medical Center, Hershey, PA and 4Public Health Sciences, Pennsylvania State University
College of Medicine, Hershey, PA.
BACKGROUND: Venipuncture is a commonly needed procedure in children that may be the source of significant pain. Various techniques have been offered to minimize venipuncture pain, but all have limitations.
Many appear to complicate or delay successful completion of the procedure. Recently, the use of Buzzy®has been offered as a solution to the management of venipuncture pain in children. The Buzzy®device utilizes
continuous mechanoreceptor stimulation to minimize the pain that accompanies a needle stick. At present, its use has not been assessed for pediatric outpatient venipunctures.
OBJECTIVE: To assess 1) the impact of Buzzy® on the pain associated with venipuncture; and 2) the phlebotomists' perception of its effect on the procedure.
DESIGN/METHODS: Survey data was collected prospectively as part of a quality improvement project. The sample consisted of 64 children ages 4 to 18 years undergoing outpatient phlebotomy. Initial data was
collected on 29 children prior to the implementation of Buzzy®. Subsequently, 35 children were surveyed after Buzzy® use had been implemented. Procedural pain was reported using a 0-5 age appropriate pain
scale. Additional data collected from the patient included their age, their number of previous venipunctures, their desire for a pain reduction intervention (pre-Buzzy® cohort) and the impact of Buzzy® (post-Buzzy®
cohort). Phlebotomists (n = 7) were asked if Buzzy® complicated the procedure, made the procedure easier, or had no effect.
RESULTS: In the pre-Buzzy® era, 17 of the 29 (59%) children indicated that they wished something had been done to decrease venipuncture pain. Twenty-three of 29 (79%) children that did not use Buzzy® reported
a 0 or 1 pain score. Similarly, 25 of the 35 (71%) children that used Buzzy® reported a 0 or 1 pain score (p = 0.92). Of the children that used Buzzy®, 82% reported that Buzzy® helped to alleviate pain; 80% indicated
that they would like the use of Buzzy® for future venipunctures. Moreover, the phlebotomists reported that Buzzy® made the procedure easier in 81% of the cases, had no effect in 19%, and did not complicate any of
the venipunctures.
CONCLUSIONS: These results suggest that Buzzy® may be a useful device to decrease the perception of pain in children undergoing venipuncture and to facilitate completion of the procedure.
2014 Eastern SPR Annual Meeting
Abstract Number: 3974
Filename: 754395
Publication Number: 386
Presenting Author: Sarah B. Wren, NP
Department/Institution/Address: Pediatric Emergency Medicine, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY, 10467, United States
Phone: 718-920-5312
Fax: 718-798-6485
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Pattern of Presentations Among Female Adolescent Patients With Gonorrhea and Chlamydia Infection in the Pediatric Emergency Department
Sarah B. Wren1, Nicole C. Agcanas1, David L. Goldman2 and Hnin Khine1. 1Pediatric Emergency Medicine, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY and 2Pediatric Infectious
Diseases, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY.
BACKGROUND: Sexually transmitted infections due to gonorrhea (GC) and chlamydia (Chl) are very common among females aged 15-24 years. Both biological and behavioral factors have been cited for their high
infection rate.
OBJECTIVE: To describe the presentations of female patients with GC and Chl infections to the pediatric emergency department (PED) and to characterize their management.
DESIGN/METHODS: A retrospective study of female patients aged <21 yrs, who were seen in an urban PED and had GC and Chl infections during a 15 mos period. Demographics, chief complaint, time to diagnosis,
time to treatment and the appropriateness of treatment, according to CDC recommendations were noted.
RESULTS: 365 GC or Chl infections were identified during the study period. To date, 199 cases were reviewed. 35 specimens from male patients and 22 repeat specimens were excluded.10 (8%) patients had
simultaneous GC & Chl infections, leaving 132 unique patients for analysis. The mean age of patients was 17.6 yrs. 30% were black, 64% were mixed racial group and 2% were white. Isolated GC and Chl infections
were found in 11(8%) and 111 (84%) of patients, respectively. Table 1 shows the presenting complaints of patients. 33/70 (47%) reported having prior GC and/or Chl infection. 17 (13%) were pregnant at the time of
diagnosis. The mean time to laboratory diagnosis was 2.5 d (SD±1.2). 6(5%) were unreachable after diagnosis. 46(35%) were treated at the time of first visit. Of 80 recalled patients, the mean time to definitive
treatment was 6.8 d (SD ± 7.2). 96/118 (81%) patients treated in the ED received therapy consistent with CDC recommendations. Of the 19 patients with upper quadrant pain, 5 were diagnosed with Fitz-Hugh-Curtis
and 14 were treated with doxycycline for presumed upper tract infection.
Table 1: Presenting chief compliants of patients with GC & Chl infections
n (%)
Type
Abdominal pain
79(60%)
Upper quadrant
19
Lower quadrant
42
Generalized
31
Vaginal discharge (VD) 26
Other GU related complaints
No STI symptoms
29(22%)
VD
21
other
8
24 (18%)
CONCLUSIONS: Female patients with GC & Chl infections present with varying chief complaints and 18% were asymptomatic at the time of diagnosis. Routine screening may be warranted considering the high
incidence of asymptomatic infections and atypical presentations among this cohort. There are significant delays to definitive therapy among those recalled for treatment.
2014 Eastern SPR Annual Meeting
Abstract Number: 3120
Filename: 752805
Publication Number: 387
Presenting Author: James M. Dodington, MD
Department/Institution/Address: 100 York Street, Suite 1F, New Haven, CT, 06511, United States
Phone: 203-737-7445
Fax: 203-737-7447
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: The Use of Capnography During Critical Events in Children
James M. Dodington1, Adam Bullock3, Aaron J. Donoghue2 and Melissa L. Langhan1. 1Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT; 2Pediatrics, Division of
Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA and 3Pediatric Emergency Medicine, Boston Medical Center, Boston Univeristy School of Medicine, Boston, MA.
BACKGROUND: Capnography is an effective tool for monitoring during resuscitation and confirming correct endotracheal tube (ETT) placement. During cardiopulmonary resuscitation (CPR) it can be used to guide
effective compressions, and to detect return of spontaneous circulation (ROSC). The 2010 American Heart Association (AHA) guidelines recommend the routine use of capnography during these critical events. It is
unclear whether these updates are being adhered to in pediatric emergency departments (EDs).
OBJECTIVE: The primary objective of this study was to assess the use of capnography for CPR and ETT placement in the pediatric emergency setting.
DESIGN/METHODS: A retrospective chart review was performed on children age birth to 21 years who were intubated or received CPR in two academic children's hospital EDs between January 2009 and December
2012. Potential patients were identified through hospital databases. Investigators extracted data and resolved discrepancies by consensus. Age, gender, time of arrival, medical or traumatic cause, length of CPR,
ROSC, documented use of capnography and colorimetry (e.g. EasyCap), capnography values, and adverse events were recorded.
RESULTS: 292 patients were identified and analyzed. Median age was 1.8 years, 61% male; 77% of events were medical and 23% were traumatic in origin. Intubation occurred in 95% of cases and colorimetry was
documented in 69% (191/292) of cases. ED CPR occurred in 90 cases (31%) with mean length of resuscitation being 18 minutes and ROSC in 21 subjects (23%). Capnography was used in 36% (105/292) of
intubations and 12% (11/90) of patients requiring CPR. There was a significant difference in capnography use between the two sites for intubation (15% vs. 54%, p<.05), but not for CPR (8.8% vs. 15.5%, p=0.5). An
association was observed between the use of capnography during resuscitation and ROSC (ROSC/+Capnography 64% vs. ROSC/-Capnography 18%, p<.05). There was no significant difference in capnography use
by medical vs. traumatic cause or by age, and no significant increase in capnography use comparing before and after 2010 AHA recommendations.
CONCLUSIONS: Despite the 2010 AHA recommendations, a minority of critically ill children are being monitored with capnography with significant institutional variation. Further education and promotion of
capnography should take place to improve implementation of these guidelines with the goal of improving resuscitation outcomes in pediatric EDs.
2014 Eastern SPR Annual Meeting
Abstract Number: 3576
Filename: 750367
Publication Number: 388
Presenting Author: Clare Stephens, DO
Department/Institution/Address: Jefferson Medical College/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, United States
Phone: 856-834-4173
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Non-Anogenital Injury after Sexual Assault in Pediatric Patients
Clare Stephens1, Dustin Flannery1 and Amy Thompson2. 1Pediatric Residency Program, Jefferson Medical College/Alfred I. duPont Hospital for Children, Wilmington, DE and 2Division of Emergency Medicine,
Department of Pediatrics, Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, DE.
BACKGROUND: Emergency management following sexual assault includes documentation and care of sustained injuries. In adults, there is a reported high rate (40-82%) of non-anogenital injuries associated with
sexual assault. There has been little data reported to date on these injuries in the pediatric population.
OBJECTIVE: To examine the rate and characteristics of non-anogenital injuries in patients presenting to a pediatric emergency department for evaluation of sexual abuse.
DESIGN/METHODS: We conducted a retrospective cohort study of children evaluated at a tertiary care pediatric ED between 2004 and 2013 who presented for evaluation of sexual abuse. Patients were identified
using ICD-9 codes. Medical records were reviewed and abstracted data was entered into a standardized electronic database. We defined prepubertal patients as patients younger than 10 years of age.
RESULTS: We identified 880 children of which 191 (22%) were male and 689 (78%) were female. The median age was 54 months [interquartile range (IQR) 40 -83 months] and the median time from abuse to ED
presentation was 24 hours [IQR 12 – 72 hours]. A total of nineteen patients (2%) reported non-anogenital trauma associated with the sexual assault and 15 of these patients (79%) had abrasions or bruising on
physical exam. No patient required trauma consultation, operative care or hospitalization for a non-anogenital injury. Of the 758 prepubertal patients, 11 (1.5%) had non-anogenital trauma while 8 of the 122 pubertal
patients (6.6%) had non-anogenital injuries. In the pubertal population, non-anogenital trauma was associated with anogenital injury (OR=5.1, 95% CI, 1.1-24.1) and anal assault (OR=9.2, 95% CI, 1.8-46.5). In the
prepubertal population, non-anogenital trauma was also associated with anogenital injury (OR=7.2, 95% CI, 2.1-25.3).
CONCLUSIONS: The overall rate of non-anogenital injury in both prepubertal and pubertal patients presenting to a pediatric emergency department for evaluation of sexual abuse is low. Risk for non-anogenital
trauma in both populations includes anogenital injury.
2014 Eastern SPR Annual Meeting
Abstract Number: 2892
Filename: 754928
Publication Number: 389
Presenting Author: Gal Altberg, MD
Department/Institution/Address: Pediatric Emergency Medicine, Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, NY, 10467, United States
Phone: 9179918357
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Validation of a Risk Stratification Strategy To Identify Serious Bacterial Illness in Febrile Patients With Sickle Cell Disease Who Present To the ED in the Post PCV7 Era
Gal Altberg1,2, Kathryn A. Koons1, Ellen Silver2, Hnin Khine1,2 and Jeffrey R. Avner1,2. 1Pediatric Emergency Medicine, Children's Hospital at Montefiore, Bronx, NY and 2Pediatrics, Albert Einstein College of Medicine,
Bronx, NY.
BACKGROUND: Most EDs use Risk Stratification Criteria (RSC) to determine which patients with Sickle Cell Disease (SCD) and fever are at high risk of having a serious bacterial illness (SBI) and therefore require
hospitalization and empiric antibiotic treatment. Since the widespread use of PCV7, the incidence of invasive pneumococcal disease has declined dramatically.
OBJECTIVE: To determine the current incidence of bacteremia and SBI in patients with SCD and fever and to validate common RSC used in the ED to identify SBI.
DESIGN/METHODS: A retrospective chart review of children with SCD ages 0-21years who presented with fever to large urban pediatric ED from 1/2010-12/2012. Clinical, radiological and laboratory data were
recorded as well as the diagnosis of SBI (bacteremia, Acute Chest Syndrome (ACS), pyelonephritis and osteomyelitis). Patients were classified as having a high risk for SBI if they had any of the following criteria: Ill
appearing, age less than 2 yrs., T >1040F, infiltrate on a chest X-RAY, WBC <5k or >30K, platelets <100K or hemoglobin <1.5 below baseline.
RESULTS: 606 charts were reviewed, representing 323 unique patients (78% with SS, 20% with SC, 2% S-beta thal). The mean age was 6.3 years. The overall incidence of bacteremia was 9/606 (1.5%;
95%CI:0.8-2.8) including S. Pneumonia n=3, Salmonella group D n=3, H. Influeneza type F n=2, E.Coli n=1. The incidence of SBI was 144/606 (23.7%; 95%CI:21-27.3). Based on the above criteria 338 (55.8%) were
high risk. High risk patients were significantly more likely to have SBI (41% vs. 2.2%, p< 0.0001; OR=30, 95%CI: 13-70). The RSC identified 138 of the 144 patients with SBI for a sensitivity of 95.8%
(95%CI:91.2-98.4) and specificity of 56.7% (95%CI:52.2-61.2). However 1 of the 9 patients with bacteremia met the low risk criteria.
CONCLUSIONS: In the post PCV7 era the rate of bacteremia in patients with SCD and fever remains significant. Using the current RSC alone failed to identify 4.2% of patients with SBI including one case of
bacteremia. These data support the use of empiric antibiotic treatment for patients in the low risk category regardless of disposition.
2014 Eastern SPR Annual Meeting
Abstract Number: 4710
Filename: 755787
Publication Number: 390
Presenting Author: Kaynan Doctor, MD
Department/Institution/Address: Emergency Medicine, Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, D.C., 20010, United States
Phone: 202-476-4177
Fax: 202-476-3573
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Variation in Testing Tendencies among Pediatric Urgent Care Providers
Kaynan Doctor1, Kristen Breslin1, Melissa M. Tavarez2 and Deena Berkowitz1. 1Emergency Medicine, Children's National Medical Center, Washington, DC and 2Emergency Medicine, Children's Hospital of Pittsburgh,
Pittsburgh, PA.
BACKGROUND: Rising costs in healthcare have led to focused attention on interventions to optimize patient care while decreasing unnecessary testing. Patients are triaged to urgent care [UC] areas within the
pediatric emergency department [ED] when their management is not expected to require extensive resources. Among UC providers, there is variation in the frequency of ordering invasive and cumulatively harmful
investigations such as laboratory tests and radiographs.
OBJECTIVE: Determine the frequency of tests ordered by UC practitioners by provider type, specialty training, and years since board certification.
DESIGN/METHODS: This is a retrospective chart review of all patients triaged to UC in an urban, academic pediatric ED in 2012. Frequency of orders for total complete blood counts (CBCs), aerobic blood cultures
(BCx), urine cultures (UCx) and chest radiographs (CXRs) were calculated per number of patients seen for each UC provider. We performed a Chi-squared analysis to compare ordering tendencies between nurse
practitioners [NPs] and physicians, subspecialty pediatricians and general pediatricians, and physicians with 5 or more years since board certification and physicians with less than 5 years since board certification.
RESULTS: Among the 17254 patient visits meeting inclusion criteria, there were 943 total orders for the tests of interest. There was a trend for physicians to order more UCx per patient seen than NPs (OR 1.5,
95%CI 1.0-2.2). General pediatricians were more likely to order UCx and CXRs compared to subspecialists (OR 1.3, 95%CI 1.1-1.5 and OR 1.8, 95%CI 1.4-2.3 respectively). However, subspecialists were more likely
to obtain CBCs (OR 1.6, 95%CI 1.1-2.4). Finally, UC physicians with 5 or more years since board certification ordered more CXRs compared to their less experienced peers (OR 1.5, 95%CI 1.1-1.9) while there was a
reverse trend with UCx (OR 0.8, 95%CI 0.6-0.9).
CONCLUSIONS: Our study identifies a difference in the ordering practices of UC practitioner groups, especially with the frequency of ordering urine cultures. Further research should examine interventions to
standardize practice across disciplines.
2014 Eastern SPR Annual Meeting
Abstract Number: 3473
Filename: 755075
Publication Number: 391
Presenting Author: Briana Fieramosca, DO
Department/Institution/Address: Pediatrics, Cohen's Children's hospital, 1 Robert Wood Johnson Place, Long Island, New York, 08903, United States
Phone: 732 235 7893
Fax: 732 235 9340
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Comparison of Clinical Management of Young Children With Simple Febrile Seizures in Association With Physicians' Training
Ernest G. Leva1, Briana Fieramosca2, Srividya Naganathan3, Brittany Carey3 and Anna Petrova1. 1Pediatrics, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ; 2Pediatrics, Cohen's Children's
Hospital, Long Island, NY and 3Pediatrics, K. Kovnanian Children's Hospital at Jersey Shore Medical Center, Neptune, NJ.
BACKGROUND: Simple febrile seizures (SFS) are the most common seizure disorder in young children presenting to the emergency department (ED). Although practicing evidence-based medicine would be
beneficial for clinical outcomes, as well as have positive economic implications, compliance with AAP recommendations by ED physicians in the management of SFS is still subject for intense investigation.
OBJECTIVE: Study was designed to determine the association between ED physician's training and their clinical management of children with a diagnosis of SFS.
DESIGN/METHODS: Medical records of young children diagnosed with SFS at 2 ED settings were analyzed retrospectively. Cases were included if they met the following criteria: age 6 months-6 years, seizures
were generalized tonic/clonic, fever > 100.4 F, < 15 minutes duration, not recurring within 24 hours, and absence of central nervous system symptoms. The management of patients with SFS was analyzed with
respect to the training of ED physicians which included general pediatricians (PED), emergency medicine pediatricians (PEM), and adult physicians (GEM) using ANOVA and Chi-square tests statistics.
RESULTS: A total number of 211 cases with SFS were included. Among those 50.7%, 39.3%, and 10.0% were managed by the physicians in (Group 1) PEDS, (Group 2) PEM, (Group 3) AEM respectively. Overall,
the majority (88.2%) of participants was more than 12 month of age, and no differences in age were recorded between the study groups.
Comparison of clinical management of young children with SFS in association with physicians' training.
(Group1) PEDS (Group2) PEM (Group3) AEM
P values
Diagnostic evaluation and treatment
(N=107)
(N=83)
(N=21)
Brain Imaging
20.6%
6.0%
14.3%
<0.02
Lumbar Puncture
3.7%
3.8%
4.8%
NS
EEG
3.9%
4.8%
38.1%
<0.00001
Blood Culture
15.9%
13.3%
71.4%
<0.00001
Chemistry and CBC
34.6%
18.1%
81.0%
<0.00001
Antipyretics
66.4%
66.3%
100.0%
<0.01
Anticonvulsant
0.9%
0
4.7%
<0.05
Hospitalization
17.0%
8.4%
76.2%
<0.001
CONCLUSIONS: There is a significant correlation between adherence to guidelines set forth by the AAP for the clinical management of young children with SFS and physician training. Pediatricians trained in
emergency medicine are more likely to follow evidence based guidelines in the management of SFS. Adherence to these guidelines not only improves quality of care but has significant economic ramifications.
2014 Eastern SPR Annual Meeting
Abstract Number: 2388
Filename: 752632
Publication Number: 392
Presenting Author: Matthew D. Thornton, MD
Department/Institution/Address: 100 York Street, Suite 1F, New Haven, CT, 06405, United States
Phone: 315-382-7236
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: The Effect of Legislation on the Availability of Automated External Defibrillators Among Connecticut High Schools
Matthew D. Thornton1, Lei Chen1, Megan E. McCabe1 and Mark X. Cicero1. 1Pediatrics, Yale University School of Medicine, New Haven, CT.
BACKGROUND: Automated external defibrillators (AEDs) have been shown to improve survival in out-of-hospital cardiac arrest when placed in high-risk public places. The prevalence of these devices in schools and
sporting venues has increased in recent years. In 2009, Connecticut passed a law requiring all high schools to have an AED, unless financial barriers prevented schools from obtaining this lifesaving technology. The
impact of this legislation is unknown.
OBJECTIVE: To determine if this legislation was associated with a significant increase in the prevalence of AEDs in Connecticut high schools. We also sought to ascertain if there was any difference in AED
prevalence between public and private schools before and after the legislation.
DESIGN/METHODS: A single researcher called all 54 public and 13 private high schools in New Haven County, Connecticut, and conducted a scripted telephone interview between March and June of 2013.
Respondents were primarily school nurses, but also included principals, building managers, and athletic trainers. The demographic information for most schools was obtained from the Connecticut State Department
of Education website. The principals of the remaining schools were contacted via email and provided the information.
RESULTS: All 54 public and 13 private high schools in New Haven County were contacted, and a response rate of 100% was achieved. Among all schools, 51.6% had an AED prior to the legislation, compared with
87.5% at the time of the survey, a statistically significant increase (p<0.0001). Prior to legislation, private schools were more likely than public schools to have an AED (75% vs. 46.2%; p=0.036). Post-legislation, there
is no longer a significant difference in the prevalence of AEDs between private and public schools (91.7% vs. 86.5%; p=0.63).
CONCLUSIONS: The passage of Connecticut state legislation requiring schools to have an AED, if financially feasible, was associated with a significant increase in the number of New Haven County high schools
with an AED on-site. The disparity in availability of AEDs between public and private high schools has vanished. This change suggests that legislation may result in a significant increase in resource availability. It may
also imply that the absence of this lifesaving technology was due more to a lack of awareness than an insurmountable financial burden. Legislation may be helpful in similar future public health matters.
2014 Eastern SPR Annual Meeting
Abstract Number: 2311
Filename: 750457
Publication Number: 393
Presenting Author: Matthew D. Thornton, MD
Department/Institution/Address: 100 York Street, Suite 1F, New Haven, CT, 06511, United States
Phone: 315-382-7236
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Disparities in the Availability of Automated External Defibrillators Among Connecticut Public High Schools
Matthew D. Thornton1, Lei Chen1, Megan E. McCabe1 and Mark X. Cicero1. 1Pediatrics, Yale University School of Medicine, New Haven, CT.
BACKGROUND: Automated external defibrillators (AEDs) have been shown to improve survival in out-of-hospital cardiac arrest when placed in high-risk public places. The presence of these devices in schools and
sporting venues has increased in recent years. In 2009, Connecticut passed a law requiring all high schools to have an AED, unless financial barriers prevented schools from obtaining this lifesaving technology. The
impact of this legislation is unknown.
OBJECTIVE: To determine the prevalence of AEDs in Connecticut high schools after the passage of this legislation, and to see if this is related to the number of students in attendance. We also aimed to identify any
demographic differences between the students of those schools with and without AEDs.
DESIGN/METHODS: A single researcher conducted telephone interviews using a predetermined script from March to June 2013. All public high schools in New Haven County, Connecticut were included.
Respondents were primarily school nurses, but also included principals, building managers, and athletic trainers. The demographic information for most schools was obtained from the Connecticut State Department
of Education website. The principals of the remaining schools were contacted via email and provided the information.
RESULTS: All 54 public high schools in New Haven County were included in the study, with a response rate of 100%. Eighty-seven percent of the schools (47/54) had at least one AED on-site. Small schools (<400
students) were significantly less likely to have an AED than medium (400-800 students), large (801-1200 students), or very large schools (>1200 students) (39.9% vs. 100%; p<0.0001). Schools with a higher
percentage of students with disabilities were also significantly less likely to have an AED than those with lower percentages of disabled students (p=0.005). This remained true when controlling for school size
(p=0.032). Racial and socioeconomic differences among students were not associated with significant differences in the presence of AEDs.
CONCLUSIONS: In New Haven County, Connecticut, high schools with fewer than 400 students and those with a higher percentage of students with disabilities were less likely to have an AED on-site in the event of
a sudden cardiac arrest than larger schools and those with a lower percentage of disabled students. Further research is needed to determine if these results are only locally representative, or if they exemplify a
nationwide trend.
2014 Eastern SPR Annual Meeting
Abstract Number: 3462
Filename: 754827
Publication Number: 394
Presenting Author: Michael J. Alfonzo, MD, MS
Department/Institution/Address: 42 Warren Street, Apartment 2, New Haven, CT, 06511, United States
Phone: 908-331-0484
Fax: 203-737-7447
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Provider Barriers To Identification and Management of Pediatric Sepsis in Rwanda
Michael J. Alfonzo1, Angelique Karambizi2, Gunjan K. Tiyyagura1, Melissa L. Langhan1 and Lei Chen1. 1Pediatrics, Yale University School of Medicine, New Haven, CT and 2Pediatrics, Centre Hospitalier Universitaire
de Kigali, Kigali, Rwanda.
BACKGROUND: Globally, sepsis is a leading cause of death. The World Health Organization reports that approximately 60% of deaths in resource-limited countries are due to communicable diseases, with 50% due
to severe sepsis within 24 hours of admission. Ninety percent of deaths from infections occur in resource-limited countries.
OBJECTIVE: We aim to understand experiences with pediatric sepsis and identify barriers to the identification and management of pediatric sepsis in a resource-limited setting.
DESIGN/METHODS: We performed a qualitative explorative study using one-on-one interviews with pediatricians working at Centre Hospitalier Universitaire de Kigali (CHUK) in Kigali, Rwanda. A semi-structured
interview guide was used to explore barriers to the identification and treatment of pediatric sepsis. All interviews were audio recorded and professionally transcribed. Four researchers independently read and coded
transcripts. Grounded theory, iterative analysis, and the constant comparative method were used to analyze the data.
RESULTS: We interviewed 15 native East African pediatricians with between 3-7 years of clinical experience. From our preliminary analysis, major barriers to sepsis recognition and management include the impact
of cost (“If he does not have much money…it will be a very huge barrier to the patient to get the medication”), lack of a sepsis protocol (“Always better to have a written protocol, especially when it is a critically ill
patient”), delay in transfer for advanced care (“We don't have a very good transfer system”), unavailable diagnostics (“Most of the time we really don't have any organism. So we just treat and cross our fingers”),
and futility of current management (“When septic shock is started, the chance of survival is too low”).
CONCLUSIONS: Local pediatricians identified many barriers, which can be targeted to improve the recognition and management of pediatric sepsis in this resource-limited setting. A key modifiable strategy would be
to design an evidence-based pediatric sepsis guideline to provide efficient use of available resources and to inform future interventional studies.
2014 Eastern SPR Annual Meeting
Abstract Number: 4376
Filename: 756429
Publication Number: 395
Presenting Author: Ravali Bandaru, MD
Department/Institution/Address: Pediatrics, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY, 11201, United States
Phone: 7182506227
Fax: 7182508735
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Caregiver Understanding of Discharge Instructions after Pediatric Emergency Visit in an Inner City Community Hospital.
Ravali Bandaru1, Mavellin Lim1, Sushma Ravirala1 and Noah P. Kondamudi1. 1Pediatrics, The Brooklyn Hospital Center, Brooklyn, NY.
BACKGROUND: Understanding of discharge instructions is a vital part of providing optimal emergency care. Previous reports have shown that deficits in understanding of instructions can lead to increased risk for
complications and overall poor outcomes. This lack of understanding can be worse in patients among inner city communities and those with limited language proficiency.
OBJECTIVE: The objective of this study is to assess the caregivers' comprehension of the discharge instructions and identify areas of gaps in understanding.
DESIGN/METHODS: A convenience sample of caregivers of children <18 years being discharged from the pediatric emergency department (PED) were consented for a follow up telephone interview within 1-2
weeks. The study was conducted at an inner city community hospital between July and October 2013. Discharge instructions were given by the ED team along with standard printed instruction sheet (Exitcare©).
Understanding occurred if responses regarding diagnosis, recommended medications, and follow-up were consistent with documentation on chart review . Caregivers were asked to rate their understanding on a five
point scale. Data was analyzed using SPSS for Windows software.
RESULTS: Of 258 caregivers approached, 236 consented to participate in the study. Telephone contact could not be made with 51, leaving a study subject total of 185 caregivers. Majority of care givers were African
American (62%, n=115) and Hispanic (31%, n=57). Most (96%) acknowledged receiving printed instructions and 87% (n=160) reported reading them. Understanding of diagnosis was rated good or excellent in 82%,
and not satisfactory in 18%. Understanding of discharge plan was rated as excellent or good in 85% and not satisfactory in 15%. A quarter of caregivers could not recall the discharge diagnosis (24%, n=44) and
recommended medications (27%, n=49). There was significant association of not satisfactory rating with lower education (p=0.08), Hispanic race (0.01), higher caregiver age (p=0.02) and non-English language
(p=0.001).
CONCLUSIONS: Rating of understanding of discharge instructions was high in this population of care givers, yet a quarter of them could not recall the diagnosis and recommended medications. Less education,
Hispanic race and those with limited English language proficiency should be paid special attention at discharge, and be provided with easily understandable instructions in their preferred language.
2014 Eastern SPR Annual Meeting
Abstract Number: 4694
Filename: 755678
Publication Number: 396
Presenting Author: Oluwakemi Badaki-Makun, MD CM
Department/Institution/Address: Pediatric Emergency Department, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, Maryland, 21287, United States
Phone: 410-955-6146
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Albuterol and Azithromycin Use for Acute Chest Syndrome in Children With Sickle Cell Disease Is Associated With Prolonged Hospital Length of Stay
Oluwakemi Badaki-Makun1, William Pastor2, Deepika S. Darbari3 and James M. Chamberlain2. 1Pediatric Emergency Department, Johns Hopkins Children's Center, Baltimore, MD; 2Emergency Medicine & Trauma
Center, Children's National Health System, Washington, DC and 3Hematology, Children's National Medical System, Washington, DC.
BACKGROUND: Acute Chest Syndrome (ACS) is a leading cause of death in patients with Sickle Cell Disease (SCD). Early treatment may improve outcomes. Inhaled bronchodilators (e.g. albuterol sulfate) and
macrolides (e.g. azithromycin) are frequently used as adjuncts in ACS treatment. Few data are available on the effectiveness of these therapies in the treatment of ACS.
OBJECTIVE: To identify targets for early treatment of ACS we determined the association between albuterol and azithromycin use and patient outcomes, specifically hospital length of stay (LOS), days on oxygen,
intensive care unit (PICU) LOS, days on ventilator support and mortality.
DESIGN/METHODS: A comparative effectiveness study was performed using the Pediatric Health Information System (PHIS), an administrative database containing inpatient data from 44 United States not-for-profit,
tertiary care pediatric hospitals. Multiple linear regression, chi square and non-parametric analyses were used to test the association between inhaled albuterol and azithromycin use and hospital LOS, days on
oxygen, PICU LOS and days on ventilator support.
RESULTS: 8361 visits for ACS between 2008 and 2012 in patients age 0 to 21 years were analyzed. Inhaled albuterol was used in 60.3% of visits. Both albuterol and azithromycin use were independently associated
with increased LOS (p<0.001). When patients with a concurrent diagnosis of asthma (n=2382, 28.5%) were excluded, azithromycin was no longer associated with increased LOS. These effects were independent of
PICU admission on day 1, a measure of severity of illness.
LOS
O2 days PICU LOS Vent days Mortality n
No Albuterol 5
4.22
3
0.14
7
3317
Albuterol
5.37
6.04
4
0.42
11
5044
p values
p<0.001 p<0.001 p=0.37
p=0.15
CONCLUSIONS: Albuterol use is associated with prolonged LOS and days on oxygen but not with increased PICU LOS or days on supplemental oxygen in this population of patients. In patients without a concurrent
diagnosis of asthma, Azithromycin is not associated with increased LOS. These findings are simply associations. Further study is needed to clarify which SCD patients with ACS would most benefit from these
therapies.
2014 Eastern SPR Annual Meeting
Abstract Number: 2127
Filename: 754713
Publication Number: 397
Presenting Author: Ioannis Koutroulis
Department/Institution/Address: Dept. of Emergency Medicine, St Christopher's Hospital for Children and Drexel University College o, 3601 A Street, Philadelphia, PA, 19134, United States
Phone: 2154275000
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Foreign Body Ingestion in Children; Are the Second Children Doomed?
Ioannis Koutroulis1, David Eng1, Panagiotis Kratimenos2 and Neha Jariwala3. 1Dept.of Emergency Medicine, St Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, PA; 2Dept.of
Pediatrics, St. Christopher's Hospital for Children & Drexel University College of Medicine, Philadelphia, PA and 3Drexel University College of Medicine, Philadelphia, PA.
BACKGROUND: Foreign body ingestions (FBI) is a common reason for visits in the pediatric emergency department. Although most ingested foreign bodies pass spontaneously, certain cases may require emergent
medical intervention to prevent significant morbidity and mortality. There is lack of effective measures to decrease the incidence of FBI. Physicians should be aware of the common risk factors for FBI in order to
provide appropriate counseling to the families.
OBJECTIVE: The present study tests the hypothesis that FBI are associated with the number of children in the household, birth order, age, gender, socio-economic status of the family, parental education and the
area of living.
DESIGN/METHODS: Patients were identified and families were contacted by telephone for information regarding income, parental educational levels, number of children in the household, birth order and past medical
history. Patients between the ages of 2 to 10 seen over the last 3 years were included, while those with developmental delays were excluded. Statistical analysis using frequencies was performed.
RESULTS: Urban area as the primary residence was reported by 100% (n=64) of the patients' families. In 84% (n=53) of the cases there were more than 2 children in the household at the time of ingestion. It is
significant that 16% (n=10) of the households included one child only, 36% (n=24) included two children and 48% (n=30) three or more. In 53% (n=33) of the cases, the second child of the family ingested the foreign
body. Only 9% of the parents reported having a college degree, 63% a high school diploma and 28% did not complete or even attend high school. Regarding the annual income, 41% of families were below the
poverty line of $11,490 as defined by the Census Bureau.
CONCLUSIONS: The current data show that there is a possible association between the presence of more than one child in the household and the accidental ingestion of foreign bodies that need evaluation in the
Emergency Department. Low socioeconomic status might be related to an increased risk of foreign body ingestion. Larger studies that include multiple areas with variable educational and income levels are needed.
2014 Eastern SPR Annual Meeting
Abstract Number: 4092
Filename: 755272
Publication Number: 398
Presenting Author: Ioannis Koutroulis
Department/Institution/Address: Emergency Medicine, St. Christopher's Hospital for Children & Drexel University College of, 3601 A street, Philadelphia, Pennsylvania, 19134, United States
Phone: 7182882032
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Association of Playground Equipment on Childhood Injury
Ioannis Koutroulis1, Dante Marconi3, Panagiotis Kratimenos2, Krystle Hernandez3, Elliot Dubowitch3, Andrew Mcinnes3 and Richard DeGroote3. 1Dept.of Emergency Medicine, St. Christopher's Hospital for Children &
Drexel University College of Medicine, Philadelphia, PA; 2Dept.of Pediatrics, St. Christopher's Hospital for Children & Drexel University College of Medicine, Philadelphia, PA and 3Dept. of Pediatrics, The Unterberg
Children's Hospital at Monmouth Medical Center, Long Branch, NJ.
BACKGROUND: The frequency of playground injuries is due not only to suboptimal parental guidance, but also to the dynamics of the playground equipment and the curiosity and risk-taking behavior of the typical
school/teen-aged child. Injuries related to monkey bars, jungle gyms, and gravity-defying trampolines have significantly increased in the last decade. Home insurance companies have raised the rates of their policies
if trampolines are present in the backyards.
OBJECTIVE: The present study tests the hypothesis that the use of playground equipment such as monkey bars, jungle gyms and trampolines is associated with significant injuries in children that are preventable.
DESIGN/METHODS: Retrospective chart review was performed from 2008 to 2013. Children between the ages of 4 and 18 years who were seen in the emergency department for injuries to the arm, elbow, leg, knee,
and ankle weer included in the analysis. The mechanism of injury, occurrence of fracture and admission to the hospital were reviewed.
RESULTS: Data of 468 patients were analyzed [(58% boys (n=271) and 32% girls (n=197)] and from those a total of 84 (18%) had sustained injuries from trampolines (n=46), monkey bars (n=24), or jungle gyms
(n=14). Of these 84 patients, 46% (n=39) sustained fractures. Median age was 7 years (range 3-17). 32% of the patients who sustained playground related injuries reported previous visits in the emergency
department for similar injuries. Proximal tibial and supracondylar fractures were the most prevalent types of fractures (47%, n=18). The most common cause of admission to the hospital is the occurrence of a fracture.
In 66% (n=308) of the total number of patients, there is at least another child in the household.
CONCLUSIONS: The data suggest a significant percentage of childhood injuries are associated with the use of playground equipment and thus are preventable. Prevention strategies to reduce the number of injuries
should be directed at trampolines, monkey bars and jungle gym. Primary care physicians should provide more intense counseling about those preventable injuries.
2014 Eastern SPR Annual Meeting
Abstract Number: 2589
Filename: 750802
Publication Number: 399
Presenting Author: Steven C. Rogers, MD
Department/Institution/Address: Pediatric Emergency Department, Connecticut Childrens Medical Center, 282 Washington Street, Hartford, CT, 06106, United States
Phone: 8605603640
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Evaluation of a Pediatric Emergency Department Screening Tool for Prediction of Violence Exposure and Behaviors
Steven C. Rogers1, Shadaab A. Kazi1, Renee Silvis1 and Sharon R. Smith1. 1Connecticut Children's Medical Center/University of Connecticut School of Medicine, Hartford, CT.
BACKGROUND: Youth violence is one of the leading causes of death for children. Emergency departments (ED) evaluate millions of children each year and may be good locations to screen children for future
violence. If high-risk children can be identified, effective interventions may be developed. However, there are no validated screening tools for use in the ED.
OBJECTIVE: The objective of this study is to further evaluate the effectiveness of an ED-based screening tool: VPET.
DESIGN/METHODS: The 7 VPET items were developed/published in two prior studies. A prospective study was conducted in an urban Pediatric ED. English and Spanish-speaking families, with children aged 8- 17
years and currently in school, were enrolled. VPET was administered to children without caregivers present. Follow-up telephone surveys were conducted at 3 and 6 months.
RESULTS: 245 children consented to participate. 55% were reached for follow-up at 3 months. The children had a mean age of 12.5 years and were 51% female, 29% Black and 62% Hispanic/Latino.
At 3 months, violence exposure/behavior was identified by follow-up survey questions which appear to have a significant association with positive responses to VPET items 2, 3 and 6. Other VPET items were less
predictive.
CONCLUSIONS: Three VPET items may provide a brief screening tool to predict future violence exposure for ED patients and may allow for provision of limited preventive resources to the most high-risk patients.
Further enrollment/analysis to determine long-term effects is in-progress and expected to be complete for presentation.
2014 Eastern SPR Annual Meeting
Abstract Number: 3593
Filename: 750665
Publication Number: 400
Presenting Author: Kruti Parikh, BS
Department/Institution/Address: 33 Hadrian Drive, Livingston, NJ, 07039, United States
Phone: 9738099175
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Review and Evaluation of Dermatopathology Assessments To Categorize Themes (REDACT) Study
Kruti Parikh1 and Albert C. Yan2. 1Robert Wood Johnson Medical School, Piscataway, NJ and 2Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA.
BACKGROUND: Pediatric dermatopathology is an emerging subspecialty field that bridges the fields of pediatrics, dermatology, and pathology. Since most specimens obtained from children are traditionally read by
general surgical/pediatric pathologists or general dermatopathologists, there is no available data in the literature dedicated to the evaluation of dermatopathology specimens by a dedicated pediatric dermatopathology
service. To our knowledge, there are only two dedicated pediatric dermatopathology services in the U.S., one at this institution (The Children's Hospital of Philadelphia (CHOP)), and one at the University of Colorado.
While the majority of dermatopathology specimens from adults include cutaneous malignancies as well as actinic and seborrheic keratosis, the dermatopathology specimens from children have not been evaluated for
trends.
OBJECTIVE: The purpose of this retrospective study was to identify and quantify the types of lesions evaluated by the Section of Pediatric Dermatology (SPD) at CHOP and to identify the most common associated
diagnoses. A priori we suspected that the most common pediatric diagnosis would be melanocytic nevi. Thus, the main study outcome measures included rate of melanocytic nevi among biopsied lesions, rate of
dysplasia among melanocytic nevi, and rate of other types of lesions.
DESIGN/METHODS: Dermatopathology specimens that were obtained by clinicians in the SPD at CHOP between 07/2009–12/2010 were reviewed and categorized in this study.
RESULTS: The results showed that the most common pediatric diagnoses include: melanocytic nevi (46.1%), inflammatory lesions (20.3%), benign growths (8.9%), vascular lesions (8.5%), and infections (4.2%). Of
the 596 dermatopathology reports that were reviewed, 47.68% of all lesions were pigmented lesions, 96.4% of which were melanocytic nevi. We also learned that 71% of the melanocytic nevi showed no signs of
dysplasia, while 18.8% showed mild dysplasia, 7.3% showed moderate dysplasia, 2.9% showed severe dysplasia, and none were identified as melanoma.
CONCLUSIONS: We were able to confirm our hypothesis that the most common diagnoses made in pediatric dermatopathology are indeed different from those in adult dermatopathology practices. Because
clinicians in pediatrics aim to limit the number of biopsies taken from children due to the accompanying pain, risk of infection, and anesthesia associated risks, it is important to have insight on the most common
diagnoses in the field of pediatric dermatopathology.
2014 Eastern SPR Annual Meeting
Abstract Number: 4449
Filename: 751502
Publication Number: 401
Presenting Author: Harini Racherla, MD
Department/Institution/Address: Pediatrics, Bronx-Lebanon Hospital, 1650 selwyn ave, 6th floor, Bronx, New York, 10457, United States
Phone: 917-704-7844
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Prevalence of Exergaming among Adolescents in an U.S. Inner-City Urban Region
Harini Racherla1, Sudheer R. Gorla1, Martha Casamalhuapa1, Savita Manwani1, Peter Sherman1, Richard Neugebauer1, Ayoade Adeniyi1, Stefan Hagmann1 and Priyadarshini Bhate1. 1Pediatrics, Bronx Lebanon
Hospital Center, Bronx, NY.
BACKGROUND: A large majority (75%) of U.S. adolescents do not participate in physical activity, and hence are at an increased risk for obesity. In addition, the utilization of traditional videogames by youth have also
been associated with an augmented obesity risk potential. In contrast, exergaming, a new generation of videogames, requiring physical activity has been found beneficial with obesity avoidance.
OBJECTIVE: To study the prevalence and perceived benefits of exergaming among adolescents residing in an inner-city urban region.
DESIGN/METHODS: An anonymous self-administered questionnaire was conducted in a convenience sample of adolescents (12-18 years of age) who presented for medical care between October 1, 2013 and
November 5, 2013 at one of the Bronx Lebanon Hospital Center pediatric outpatient clinics. The survey questionnaire contained 16 items, assessing demographic characteristics, videogaming and exergaming
behavior and exergaming-specific attitudes.
RESULTS: A total of 81 adolescents, 36 (44%) girls, with a median age [range] of 16 years [11-24]) responded to the survey. The respondents' most recent median final grade average (range) was 85% (60-99%), 26
(32%) practiced sports at least once per week, and 17 (21%) perceived themselves as overweight. Overall 55/81 (67%) were videogamers, of those 40/55 (73%) have played exergames while 15/55 (27%) have
never played exergames. Among videogamers 28/55 (51%), 14/55 (26%), and 13/55 (23%) played videogames 1-2 days/week, 3-5 days/week, and 7 days/week, respectively. Almost half (24/55, 44%) played for <2
hours/day, and most (48/55, 87%) snacked while playing videogames.
Weight losing benefits of exergaming was appreciated overall by 30/81 (37%), and by 25/55 (46%) of videogamers and 5/26 (19%) of non-videogamers (P<.046). Among other potential benefits 17/55 (31%) of
videogamers and 2/26 (8%) of non-videogamers indicated that exergaming may contribute to feeling good about oneself (P<.038).
CONCLUSIONS: Most inner-city adolescents who use videogames in this study were familiar with and had played exergames before. Benefits regarding weight-losing and improved self-esteem has been primarily
appreciated by videogamers. Further promotion of exergaming to inner-city youth may offer another avenue to fight the obesity epidemic.
2014 Eastern SPR Annual Meeting
Abstract Number: 2584
Filename: 750719
Publication Number: 402
Presenting Author: Arunjot Singh, MD, MPH
Department/Institution/Address: Pediatrics, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY, 10467, United States
Phone: 717-314-6004
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: iHealthNYC: Assessment of Smartphones and Apps To Mobilize the Medical Home
Arunjot Singh1, Sarah Wilkinson1 and Sandra Braganza1. 1Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
BACKGROUND: The patient-centered medical home emphasizes accessibility of services and clear communication of medical information. This is especially important with vulnerable underserved populations where
unstable housing and inadequate understanding of resources result in poor health outcomes. Given the increasing use of smartphones, these multifunctional devices may hold the potential to streamline
patient-provider communication, mobilizing the medical home.
OBJECTIVE: To assess: 1) demographics of smartphone (SP) ownership 2) primary uses of mobile devices 3) interest levels in using health apps.
DESIGN/METHODS: Randomized surveys were conducted in inner-city pediatric practices in Bronx, NY. Target populations included teens (13-19yo) and caregivers. Surveys collected demographic data, rates of
SP/app ownership, and Likert scales to assess interest in using medical apps. Surveys were verbally administered in waiting rooms and responses recorded into SAS database for bivariate analysis and chi-square
testing. A demo of health and nutrition apps was then conducted to increase awareness of sources available for download.
RESULTS: 148 surveys were completed in July-August 2013. Overall, 84% of subjects are SP users, with 57% using them as their primary internet source. There was no statistical difference in SP ownership in
demographic variables such as age, gender, ethnicity, income, and education. SP users had various apps (mean=14.5), with the top three categories being games, social networking and music. As predicted, teens
accessed apps more than caregivers (64.3 vs. 55.8%), although mean apps owned were less. Most users had significant interest in medical apps, but current use remains low, particularly in teens.
Teens (n=71)
CAREGIVERS (n=77)
Mean age=15.9yrs
Mean age=30.1yrs
Current Smartphone Users
80.3%
88.3%
Average # of Apps Owned
13.4 (s.d.=11.1)
15.4 (s.d.=14.2)
App Use Frequency >3x/day
64.3%
55.8%
Medical Info via SP
84.3%
59.7%
Interest in Medical Apps
Some Interest:50.7% Very Interested:7.0% Some Interest:36.4% Very Interested:40.3%
Current Medical App Owners 17.1%
35.1%
CONCLUSIONS: Prevalence of SP and app users in inner-city clinics was remarkably high. With increased interest in mobile health, smartphones offer a modality for patient education, disease management and
healthcare coordination apps in diverse settings. Further research is needed so pediatricians can promote evidence-based, patient-friendly apps to enable patients to take ownership of their health.
2014 Eastern SPR Annual Meeting
Abstract Number: 786
Filename: 751955
Publication Number: 403
Presenting Author: Kanani E. Titchen, MD
Department/Institution/Address: 1027 Arch Street #205, Philadelphia, PA, 19107, United States
Phone: 302.932.2366
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Domestic Child Sex Trafficking: the Need for Physician Education
Kanani E. Titchen1, Eliza Chin2 and Iman Sharif1. 1Pediatrics, Jefferson/AI duPont Hospital for Children, Philadelphia, PA and 2Medicine, University of California San Francisco, San Francisco, CA.
BACKGROUND: Data are scant regarding the beliefs, knowledge, and training of physicians regarding children trafficked for sex, and education for physicians regarding child sex trafficking is scarce and underutilized.
OBJECTIVE: We examined physician awareness of human sex trafficking and whether physicians feel that knowledge of trafficking is important to their practice. These results will be used to increase physician
training about human trafficking.
DESIGN/METHODS: We conducted an anonymous cross-sectional national survey of physicians, residents, and medical students. Participation was voluntary. An electronic 20-item survey was distributed by AMWA,
the APPD, and colleagues of the AAP from June through October 2013. The survey expanded upon a 2011 survey by Grace and Collins of Stanford University. Demographic information, and knowledge of trafficked
patients and national trafficking statistics, were assessed. Data were analyzed using univariate, multivariate, and chi-square analyses.
RESULTS: Of 1584 respondents, 374 were practicing physicians, 674 residents (461 pediatric), and 410 medical students.
Medical students were more likely than practicing physicians and residents to agree/strongly agree that “it is important for me to know about human trafficking” (86% vs. 83% vs. 81%, p<0.01). Practicing physicians
were more likely than medical students and residents to correctly estimate the number of trafficked youth in the U.S. each year (15.5% vs. 11.2% vs. 8.5%, p<0.01). Practicing physicians were more likely than
residents or students to agree that they knew who to call if they encountered a victim of trafficking (40.4% vs. 19.9% vs. 8.8%, p<0.01).
While 84% of pediatric residents agreed/strongly agreed that it was important to know about human trafficking, pediatric residents were less likely than non-pediatric residents to correctly estimate the number of youth
trafficked in the U.S. each year (7.6% vs. 12.3% , p<0.01). Conversely, pediatric residents were more likely than non-pediatric residents to accurately estimate the number of U.S. children on streets (41.2% vs. 37.9%,
p<0.01) and in shelters (16.1% vs. 11.4%, p<0.01) who exchanged sex for money.
CONCLUSIONS: While a majority of physicians in all stages of training value knowing about human trafficking, they lack knowledge about trafficking and are not familiar with existing resources. There remains a need
for physician-specific human sex trafficking education in U.S. medical schools, residency programs, and hospital-based practices.
2014 Eastern SPR Annual Meeting
Abstract Number: 3854
Filename: 753487
Publication Number: 404
Presenting Author: Stephen M. Sandelich, MD
Department/Institution/Address: General Pediatrics, St. Christopher's Hospital for Children, 3601 A Street, Philadelphia, Pennsylvania, 19134, United States
Phone: 2154275000
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: The Family Safe Zone: A Unique and Effective Multi-Level Positive Parenting Intervention in the Pediatric Setting
Stephen M. Sandelich1, Maria McColgan1 and Bruce Bernstein1. 1St. Christopher's Hospital for Children, Philadelphia, PA.
BACKGROUND: Positive parenting strategies have been associated with reduced risk of child abuse, aggressive behaviors, and mental health problems and can mitigate the negative effects of toxic stress including
poor health and early death. One way to promote positive parenting is by establishing guidelines and procedures to support parents and caregivers and by modeling a healthy pediatric environment.
OBJECTIVE: To assess the efficacy of The Family Safe Zone in reducing corporal punishment by parents in an urban primary care clinic.
DESIGN/METHODS: The multi-level program consisted of an on-site parenting specialist for parents at risk for using corporal punishment, training for hospital staff on methods to intervene with stressed, distracted, or
angry parents, and additional training for healthcare providers in positive parenting strategies. Providers and participants were surveyed before and six months post intervention. An independent evaluator observed
family interactions and staff interventions in the clinic waiting area.
RESULTS: 85% of staff (npre= 193; npost=107) reported observing harsh parenting in the hospital. Before the program, 2% of parent-child interactions in clinic waiting areas were negative. After the program, negative
interactions decreased to 0.4% (p<.005). There was only one positive interaction before and seven after. Staff comfort with intervention improved for the stressed parent (59% to 67%, p<.05), the distracted parent,
(73% to 86%, n.s.) and the abusive (37% to 59% , p<.001). After training, more residents and physicians (npre= 61; npost=27) reported counseling parents on toxic stress (36% to 54%, n.s.), hazards of spanking (80%
to 96%, n.s.) and referral to domestic violence resources (78% to 88%, n.s.). Families referred to the parenting specialist showed significant reductions in self-reported stress and utilization of corporal punishment.
CONCLUSIONS: As a result of the family safe zone, hospital staff were more likely to intervene and counsel families about corporal punishment and its negative impact on children's health.
2014 Eastern SPR Annual Meeting
Abstract Number: 3158
Filename: 753555
Publication Number: 405
Presenting Author: Joanne N. Wood, MD, MSHP
Department/Institution/Address: Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, 3535 Market Street, room 1517, Philadelphia, PA, 19104, United States
Phone: 2674269833
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Trends in Abusive Head Trauma Rates and Economic Stress Indicators
Joanne N. Wood1,2,3, Oludolapo Fakeye1, Benjamin French3, Kenneth Feldman4, Anthony Fabio5, Kathi L. Makoroff6, Phillip Scribano1,2 and Rachel Berger7. 1Division of General Pediatrics, The Children's Hospital of
Philadelphia, Philadelphia, PA; 2Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; 3Department of Biostatistics and Epidemiology, Perelman School of
Medicine at the University of Pennsylvania, Philadelphia, PA; 4Department of Pediatrics, Seattle Children's Hospital/Harborview Medical Center, Seattle, WA; 5Department of Neurosurgery, University of Pittsburgh,
Pittsburgh, PA; 6Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH and 7Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
BACKGROUND: Abusive head trauma (AHT) is the leading cause of mortality from child abuse. Prior research demonstrated that the rate of AHT in 3 regions of the country increased during the Great Recession of
2007-2009. Associations between child abuse rates and macroeconomic indicators including employment and mortgage delinquency have been suggested, but a link between the observed increase in AHT and
changes in economic indicator during the recession has not been established. It is unclear if the rate of AHT incidence subsequently returned to pre-recession levels.
OBJECTIVE: 1) To compare AHT rates in sampled counties from 3 regions of the US before, during, and after the Great Recession of 2007-2009. 2) To assess the relationship between the AHT rates and county-level
measures of mortgage delinquency and employment growth.
DESIGN/METHODS: Cases of AHT in children <5 years of age living in 74 counties from 3 geographic regions between 2004 and 2012 were identified through medical record review. The study period was divided into
pre-recession (2004 Q1-2007 Q3), recession (2007 Q4 – 2009 Q2), and post-recession (2009 Q3 – 2012 Q4) quarters based on NBER data. Zero-inflated Poisson regression models estimated differences in AHT
rates during the economic time periods and associations with mortgage delinquency and employment growth.
RESULTS: During the 9-year period, 712 children were diagnosed with AHT. Across counties, mean annual AHT rate increased 43% from 10.0 (95% CI: 9.8-10.2) pre-recession to 14.3 (CI: 14.0-14.7) diagnoses per
100,000 children during the recession (P=0.030). The rate decreased to 13.2 per 100,000 children (CI: 13.0-13.5) post-recession but remained elevated above the pre-recession rate (P=0.027). Overall, there was not
a consistent association between the AHT rate and the county-level delinquency or employment growth rates.
CONCLUSIONS: In the post-recession period, AHT rate was lower than during the recession yet significantly higher than the pre-recession level, suggesting a lingering effect of the economic stress of the recession
on families. These results support an association between the economic stress of the recession and increased rates of AHT.
2014 Eastern SPR Annual Meeting
Abstract Number: 3073
Filename: 751580
Publication Number: 406
Presenting Author: Joanne N. Wood, MD, MSHP
Department/Institution/Address: Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, 3535 Market Street, Room 1517, Philadelphia, PA, 19104, United States
Phone: 267-426-3107
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Development of Recommendations for Skeletal Survey in Young Children Presenting With Fractures
Joanne N. Wood1,2, Oludolapo Fakeye1, Chris Feudtner1,2, Valerie Mondestin1, Russell Localio3 and David M. Rubin1,2. 1Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia,
Philadelphia, PA; 2Department of Pediatrics and Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA and 3Department of Biostatistics and
Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
BACKGROUND: Skeletal survey (SS) performance rates for young children presenting with fractures vary across providers, with disparities associated with patients' characteristics. Lack of consensus regarding
indications for skeletal survey contributes to this variation.
OBJECTIVE: To develop consensus recommendations across pediatric specialties for performing SS in children <24 months old with fractures.
DESIGN/METHODS: Using the RAND/UCLA Appropriateness Method and evidence from a literature review combined with their own expertise, a multi-specialty panel of 13 experts rated the appropriateness of
performing a SS for 525 clinical scenarios. After initial ratings discussion and scenario revisions, the expert panelists again rated SS appropriateness for 240 scenarios. In a third round of ratings, the necessity of
performing SS for 191 clinical scenarios deemed appropriate in the previous round was assessed.
RESULTS: Panelists agreed that SS is “appropriate” for 191 (80%) and “necessary” for 175 (73%) of the 240 scenarios. SS is indicated if a fracture is attributed to abuse, domestic violence, or being hit by a toy. With
few exceptions SS is recommended in children without a history of trauma. In children <12 months old, SS is necessary regardless of the fracture type or reported history, with rare execptions. In children 12-23
months old, the necessity of obtaining SS is dependent on fracture type.
Skeletal survey is necessary in children 0-11 months with:
-Rib fractures
-Long bone fractures, except for distal radial/ulna buckle fracture or toddler fracture in cruising child >9 mo old w/ history of fall
-Skull fractures, except for a linear, unilateral skull fracture in child > 6 mo attributed to a high fall
-Clavicle fractures except in infant <30 days old with possible birth trauma
-Classic metaphyseal lesions
Skeletal survey is necessary in children 12-23 months with:
-Rib fractures
-Classic metaphyseal lesions
-Complex or ping-pong skull fractures
-Humeral fractures w/ epiphyseal separation attributed to short (<</span>3ft) fall
-Femur diaphyseal fracture attributed to a fall from any height
CONCLUSIONS: A multi-specialty panel reached agreement on multiple clinical scenarios for which skeletal survey is indicated in young children with fractures. These results could inform clinical guideline
development, with potential to decrease disparities in care and increase abuse detection in this population.
2014 Eastern SPR Annual Meeting
Abstract Number: 1714
Filename: 752104
Publication Number: 407
Presenting Author: Hiu-fai Fong, MD
Department/Institution/Address: 1600 Walnut St. Apt. 507, Philadelphia, PA, 19103, United States
Phone: 267-648-2532
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Do Mental Health Services Improve Behavioral Outcomes for Maltreated Children Who Remain at Home?
Hiu-fai Fong1,2,3, Benjamin French3,4, David Rubin1,2,3 and Joanne Wood2,3. 1Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA; 2Division of General Pediatrics,
The Children's Hospital of Philadelphia, Philadelphia, PA; 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA and 4Department of Biostatistics and Epidemiology, University of
Pennsylvania, Philadelphia, PA.
BACKGROUND: Over 3 million children are investigated annually for maltreatment in the US. The majority remains at home after investigation with high rates of behavioral problems. It is unknown whether current
mental health(MH) services improve these behavioral problems.
OBJECTIVE: To determine whether child and caregiver(CG) MH services reduce behavioral problems in children remaining at home after maltreatment investigation.
DESIGN/METHODS: Retrospective analysis of 2nd National Survey of Child and Adolescent Well-being data
Sample:1,256 children ages 2-17 remaining at home after maltreatment investigation
Outcome:Child Behavioral Checklist(CBCL) change scores from baseline to 18-mo
Predictors:Child and CG receipt of MH services
Analysis:Compared mean CBCL change scores between children who did and did not receive MH services using survey-weighted linear regression models, adjusting for potential confounders.
RESULTS: Children receiving MH services(23% weighted sample) had higher(worse) unadjusted 18-mo CBCL scores(all p<0.001) (Fig 1-2) and worsening unadjusted/adjusted behavior trends than children who did
not receive services(all p<0.001). CG receipt of MH services predicted improved total CBCL change scores(+2.6[0.3,4.8],p=0.024), while CG 18-mo depression predicted worsening scores(-4.0[-5.8,-2.2],p<0.001).
CONCLUSIONS: While current child MH services are not adequately addressing the needs of maltreated children remaining at home, CG MH services may positively impact child behavior. The content of these
services and the factors that influence their effectiveness must be further studied.
2014 Eastern SPR Annual Meeting
Abstract Number: 3519
Filename: 755959
Publication Number: 408
Presenting Author: Cynthia DeLago, MD, MPH
Department/Institution/Address: Pediatrics, Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA, 19141, United States
Phone: 1-215-456-2042
Fax: 1-215-456-3436
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Child-on-Child Sexual Abuse: A 10 Year Retrospective Review
Cynthia DeLago1,2, Emily Dudek1, Regina Yu1, Beth Anne Cooper1, Esther Deblinger1 and Martin Finkel1. 1CARES Institute, Rowan University, Stratford, NJ and 2Pediatrics, Einstein Medical Center, Philadelphia, PA.
BACKGROUND: According to the National Incident-Based Reporting System, 36% of all child sexual abuse offenses were perpetrated by juveniles in 2004. Child-on-child (COC) sexual abuse and its association with
pornography have not been well described in the literature.
OBJECTIVE: To describe COC sexual abuse victim / perpetrator characteristics, types of sexual acts described and association with pornography exposure.
DESIGN/METHODS: Retrospective, descriptive study. Patients referred to a regional child abuse diagnostic and treatment center for possible COC sexual abuse from 2002 to 2011 were identified, stratified by year
and assigned numbers. 300 medical charts / yr were chosen using computer-generated random numbers. Data were abstracted from the first 100 charts meeting study criteria (≥ 3 to <18 yrs, diagnosed with COC
sexual abuse). Data were abstracted from their perpetrators' charts, if they were also examined.
RESULTS: The mean age of 980 COC victims was 8 yrs. (median 7.3, range 3-17 yrs); 57% were female, 43% white, 34% black and 17% unknown race. The mean age of 202 perpetrators was 10.6 yrs, (median 11,
range 5-17 yrs); 80% were male. All but 1% were known to victims; 56% were siblings. Types of sexual acts included: 45% digital-genital; 38% oral-genital, 24% genital-genital and 24% genital-anal contact; 0.7%
described date-rape and 1.5% gang-rape. Almost 7% of victims were shown pornography by the perpetrator: 3% via TV/DVD; 2% via computer; 1% print media; 0.5% cell phones / video games. Twenty percent
(40/202) of perpetrators admitted viewing pornography: 9% via TV/DVD; 7% via computer, 2% cell phone, 1% video games and 1% print media. Perpetrators that viewed pornography were more likely to engage in
genital-genital contact compared to those that did not view pornography (13/40 vs. 19/152, Fisher's Exact test p=0.007).
CONCLUSIONS: Victims of COC sexual abuse more often were female; perpetrators were more often male. Almost all perpetrators were known to victims; most were siblings. One fifth of perpetrators reported
viewing pornography, most via TV and computers. More pornography-viewing perpetrators engaged in genital-genital contact than those that did not view pornography. This study raises questions about pornography
and COC sexual abuse. It also supports the AAP's recommendation to limit screen time, use parental controls and keep televisions out of children's bedrooms.
2014 Eastern SPR Annual Meeting
Abstract Number: 4033
Filename: 754956
Publication Number: 409
Presenting Author: Joanne N. Wood, MD, MSHP
Department/Institution/Address: General Pediatrics, Children's Hospital of Philadelphia, 3535 Market Street, Rm 1517, Philadelphia, PA, 19104, United States
Phone: 267-426-3107
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Occult Fracture Screening in Young Injured Children at Pediatric and Non-Pediatric Hospitals
Joanne N. Wood1,2,5, Benjamin French4,5, Keshia Maughn1, Oludolapo Fakeye1, Lihai Song1,3 and Chris Feudtner1,2,5. 1Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA;
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; 3Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA; 4Department of
Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA and 5The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
BACKGROUND: Radiologic imaging to screen for occult fractures is a key part of the evaluation of suspected physical abuse in young children. The American Academy of Pediatrics recommends occult fracture
screening for all children < 2 y.o. with suspected physical abuse. Little is known about the use of occult fracture screening at non-pediatric hospitals, where the majority of children receive care.
OBJECTIVE: 1) To describe variation by hospital type (pediatric vs. non-pediatric) in screening for occult fractures in children <2 y.o. diagnosed with physical abuse and in infants <1 y.o. with injuries associated with a
high likelihood of abuse. 2) To describe variation by hospital type in rates of diagnosis of abuse in infants <1 y.o. with injuries associated with a high likelihood of abuse.
DESIGN/METHODS: We performed a retrospective study of children <2 y.o. with diagnosis of physical abuse and infants <1 y.o. with non-motor vehicle crash-related traumatic brain injuries (TBI) or femur fractures
admitted in 2009-2012 to 438 hospitals in the Premier database. Patients transferred to or from another hospital were excluded. Mixed-effects logistic regression adjusting for patient demographics (age, race, gender,
insurance type) and hospital size and location was used to examine the association of hospital type with the principal outcomes of 1) occult fracture screening defined as receipt of skeletal survey and/or bone scan
and 2) diagnosis of abuse.
RESULTS: Adjusted occult fracture screening rates were higher at pediatric compared to non-pediatric hospitals in children <2 y.o. with a diagnosis of abuse (75% vs. 34%, P=0.001, n=2956), infants with TBI (73%
vs. 26%, P=0.002, n=1930) and infants with femur fractures (82% vs. 30%, P=0.001, n=1170). Adjusted rates of diagnosis of abuse were also higher at pediatric hospitals for infants with TBI (31% vs. 12%, P=0.001)
and femur fractures (25% vs. 8%, P=0.022).
CONCLUSIONS: The low rate of adherence to guidelines for occult fracture screening in victims of physical abuse <2 y.o. at non-pediatric hospitals raises quality of care concerns. The lower rates of occult injury
screening and diagnosis of abuse among infants with high risk injuries at non-pediatric hospitals suggests there may be missed opportunities to detect abuse in populations served by these hospitals.
2
2014 Eastern SPR Annual Meeting
Abstract Number: 678
Filename: 753351
Publication Number: 410
Presenting Author: Gunjan Tiyyagura, MD
Department/Institution/Address: 30 Rising Trail Drive, Cheshire, CT, 06410, United States
Phone: 203-464-6343
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Barriers To Recognizing and Reporting Child Abuse and Neglect (CAN) in the Emergency Department (ED)
Gunjan Tiyyagura1, Marcie Gawel1, Andrea Asnes1, Jeanette R. Koziel1 and Kirsten Bechtel1. 1Pediatrics, Yale University School of Medicine, New Haven, CT.
BACKGROUND: Victims of CAN frequently present to EDs for care. The majority of children in the U.S. who seek emergent care are seen in general EDs without specialized pediatric services. Identifying and
understanding barriers to recognizing and reporting CAN to Child Protective Services (CPS) in general EDs are important in developing comprehensive ED-based CAN detection programs.
OBJECTIVE: To gain insight into barriers and facilitators to recognizing and reporting CAN to CPS by medical providers in general EDs.
DESIGN/METHODS: We used a qualitative research design with one-on-one interviews to understand general ED providers' experiences with CAN. We conducted 21 semi-structured interviews of nurses and
physicians at three general EDs in Southeastern CT. In line with grounded theory, 4 researchers independently coded transcripts and then collectively refined codes and created themes. Qualitative software was used
for data management and analysis. Data collection and analysis continued until thematic saturation was achieved.
RESULTS: Barriers to recognizing CAN included: the providers' emotional responses to CAN, such as the desire to believe a caregiver's history; and failure to recognize that a child's clinical presentation could be due
to CAN. Barriers to reporting CAN included: factors associated with the reporting process (time-intensiveness, redundancy, difficulty contacting CPS) and poor follow-up of reported cases; misunderstanding the
mandated reporting law; challenges innate to working in an ED (missing the full story, lack of continuity of care and work-flow constraints); and perceived negative consequences of making a report. Facilitators to
reporting CAN included the availability of peers/supervisors to allow for real-time case discussion and the belief that it was better to make a CPS report if there was any suspicion of CAN. Providers requested more
case-based education and endorsed a desire to receive feedback regarding disposition of reported cases, use of a standardized reporting process to CPS, and real-time consultation for unclear cases of CAN.
CONCLUSIONS: Addressing the emotional response to CAN, standardizing the reporting process, providing education through case review, improving communication with CPS, and increasing real-time help with
case decisions are approaches to improving the reporting of CAN to CPS by ED medical providers.
2014 Eastern SPR Annual Meeting
Abstract Number: 4422
Filename: 756572
Publication Number: 411
Presenting Author: Chhanda Biswas, PhD
Department/Institution/Address: Pediatrics, Children's Hospital of Philadelphia, 415 ARC, 3615 Civic Center Blvd, Philadelphia, Pennsylvania, 19104, United States
Phone: 267-426-5693
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Other - Sr. Research Investigator
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Unique Role of Nuclear HO-1 in the Nuclear Transport of Nrf2: Implications for Oxidative Cytoprotection
Chhanda Biswas1,2, Guang Yang2, Mansa Muthu2, Nidhi Shah2, Ping La2 and Phyllis A. Dennery1,2. 1Pediatrics, University of Pennsylvania, Philadelphia, PA and 2Neonatology, The Children's Hospital of Philadelphia,
Philadelphia, PA.
BACKGROUND: The nuclear factor E2-related factor 2 (Nrf2) is a 'master regulator'' of the antioxidant response. Oxidative stress promotes Nrf2 stabilization and nuclear translocation. Although Nrf2 activation
enhances antioxidant defenses, it also regulates genes such as glucose-6-phosphate dehydrogenase (G6PD), which is essential for reprogramming energy metabolism, allowing for improved survival in adverse
environments. Activation of Nrf2 also induces heme oxygenase-1 (HO-1), an important cytoprotective molecule. HO-1 can be truncated at the C-terminus, facilitating its nuclear translocation. We hypothesized that
HO-1 cooperates with Nrf2 to promote downstream events, which facilitate cell survival in oxidative stress.
OBJECTIVE: Our objective is to demonstrate in cell-based assays that oxidative stress-mediated induction, truncation and nuclear migration of HO-1 provides cytoprotection by regulating Nrf2 activation.
DESIGN/METHODS: To this effect, WT and HO-1 null MEF cells stably transfected with either a FLAG tagged nuclear (TR), cytoplasmic (FL) HO-1 cDNA or empty vector, as well as HO-1 KO and WT cells transiently
transfected with an ARE/Luc reporter construct, were exposed to 95%O2, 5%CO2 (hyperoxia) for 18 hours. Controls were exposed to 95%Air/5%CO2 (air). In some experiments, shRNA was used to silence HO-1
expression.
RESULTS: Hyperoxia resulted in induction and nuclear translocation of HO-1 as well as enrichement of Nrf2 in the nucleus of WT MEF cells. Additionally, HO-1 KO MEF cells rescued with HO-1 TR showed
enrichment of Nrf2 in the nucleus compared to HO-1 (FL) and vector infected cells. Immunoprecipitation with FLAG retrieved Nrf2 and immunoprecipitation with Nrf2 antibodies retrieved HO-1 TR, suggesting a
physical interaction of HO-1 and Nrf2 in the nucleus. Photon emission was significantly higher in hyperoxia exposed HO-1 WT vs KO cells after ARE/Luc transfection. After hyperoxic exposure, the viability of TR cells
was significantly higher than controls or HO-1 FL. Lastly, silencing HO-1 reduced the expression of G6PDH and also reduced G6PDH enzymatic activity.
CONCLUSIONS: We conclude that nuclear HO-1 promotes nuclear transport of Nrf2 and induction of specific Nrf2 target genes involved in metabolic reprogramming. This may provide a survival advantage.
2014 Eastern SPR Annual Meeting
Abstract Number: 802
Filename: 752422
Publication Number: 412
Presenting Author: Gillian Dolansky, MD
Department/Institution/Address: Division of Emergency Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
Phone: 613-737-7600
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Corticosteroids and Antihistamines in the Treatment of Anaphylaxis: A Systematic Review and Meta-Analysis
Gillian Dolansky1, Samantha Calder-Sprackman1, Amy C. Plint1 and Roger Zemek1. 1Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
BACKGROUND: The wide variability in prescribing patterns and adherence to guidelines for the acute management of anaphylaxis may be partially justified by the paucity of randomized controlled trials examining the
efficacy of pharmacological treatment. Several systematic reviews have attempted to examine pharmacologic treatments in this domain but, due to strict inclusion criteria and the heterogeneity of published data, have
failed to find suitable studies to include.
OBJECTIVE: The objective of this study was determine if the use of epinephrine, corticosteroids or antihistamines affect rates of biphasic reactions in patients presenting to the emergency department (ED) with
anaphylaxis.
DESIGN/METHODS: We searched Medline (1946-September 2013) and EMBASE (1974-September 2013) using a peer-reviewed search string to identify original, English-language studies describing
pharmacological intervention for patients of all ages presenting to the ED with anaphylaxis. Exclusion criteria included single case reports, review articles, or treatment not reported. The primary outcome was the
association of pharmacological treatment with biphasic reaction. Secondary outcome was the adherence to recommended guidelines for the use of pharmacotherapy in anaphylaxis.
RESULTS: Of 1424 citiations, 1153 remained after removal of duplicates. After dual review, 35 observational studies remained. Twenty-seven studies were inlcuded in qualitative analysis, and seven studies were
included in meta-analysis (pooled n=1471).
Qualitative analysis revealed that current anaphylaxis guidelines are not being followed, regardless of population age or location. Corticosteroids and antihistamines are consistently prescribed more often than
epinephrine. Meta-analysis using calculated odds ratios revealed no significant association between of any of the medications studied and biphasic reaction.
CONCLUSIONS: Minimal evidence supports the use of adjunctive therapy to prevent biphasic reaction for anaphylaxis. There is poor application of existing guideline for the use of epinephrine in anaphylaxis,
highlighting a role for further knowledge translation. Prospective, controlled clinical trials are needed to determine the role for adjunctive medications (corticosteroids, antihistamines) in anaphylaxis.
2014 Eastern SPR Annual Meeting
Abstract Number: 1819
Filename: 752880
Publication Number: 413
Presenting Author: Heather J. Becker, MD
Department/Institution/Address: 14 Greenway Street, Hamden, CT, 06517, United States
Phone: 347-216-1961
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Maintaining Normal Ventilation in Children Needing Bag-Valve Mask Ventilation: Should Capnography Be Standard of Care?
Heather J. Becker1 and Melissa Langhan1. 1Section of Pediatric Emergency Medicine, Yale New Haven Hospital, New Haven, CT.
BACKGROUND: Bag-valve mask (BVM) ventilation requires both manual skill and clinical assessment of minute ventilation, subjective factors that can make supplying appropriate ventilation difficult in pediatric
patients. Capnography, an objective measure of ventilation, is not routinely employed when ventilating non-intubated patients.
OBJECTIVE: To determine if providers who are relatively inexperienced with BVM ventilation in children are able to maintain normal ventilation in pediatric patients when capnography is unavailable.
DESIGN/METHODS: Trainees (students, residents and fellows) provided 2 minutes of BVM respiratory support to healthy children during induction of anesthesia for an elective surgical procedure. These patients were
monitored by continuous waveform capnography, but this data was blocked from the view of the trainee. Capnography readings were video recorded; values between 30 and 50 mmHg were considered indicative of
normal ventilation of the patient. Any deviation from this normal range for a sustained period of at least 10 seconds was considered an episode of inappropriate ventilation.
RESULTS: Fourteen trainees have been enrolled to date, of which 11 were anesthesia residents. Eleven trainees (78.6%) were post-graduate year 3 or greater. The mean age of patients receiving BVM ventilation
was 6.4 years (range 1.9 to 12.8 years). Ten of the fourteen trainees (76.9%) provided inappropriate ventilation to their patient during the 2 minutes of BVM ventilation. The median number of episodes of inappropriate
ventilation was two per trainee. The trainees who provided inappropriate ventilation did so 41.7% of the 2-minute observation period (range 10-81.7%), which translates to a mean of 50 seconds per trainee (range 20
to 98 seconds).
CONCLUSIONS: Inappropriate ventilation is very common among trainees providing BVM ventilation to pediatric patients. Capnography may be useful to guide BVM ventilation by inexperienced operators.
2014 Eastern SPR Annual Meeting
Abstract Number: 1521
Filename: 750628
Publication Number: 414
Presenting Author: Kirsten Bechtel, MD
Department/Institution/Address: Pediatrics, Yale University School of Medicine, Section of Pediatric Emergency Medicine, 100 York Street Suite 1F, New Haven, CT, 06517, United States
Phone: 203-737-7449
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Use of the Pediatric Trauma Score To Triage Severity of Childhood Injury
Jennifer Fieber1, Michael Caty1 and Kirsten Bechtel1. 1Surgery, Yale University School of Medicine, New Haven, CT; 2Surgery, Yale University School of Medicine, New Haven, CT and 3Pediatrics, Yale University
School of Medicine, New Haven, CT.
BACKGROUND: Trauma is a leading cause of pediatric morbidity and mortality in the US. There is no widely accepted trauma scoring criteria for the rapid triage of acute injuries in children. The Pediatric Trauma
Score (PTS) was developed to reflect a child's vulnerability to injury and has been used to predict mortality.
OBJECTIVE: To evaluate the association of PTS with Emergency Department (ED) disposition, serious occult injury and subspecialist operative management in children with acute injuries.
DESIGN/METHODS: We performed a retrospective review of medical records of all patients less than 16 years old evaluated for acute injuries in the ED of Yale-New Haven Children's Hospital from 1/2005-12/2011.
Patient transfers were excluded. Demographics and PTS criteria (patient weight, airway integrity, systolic blood pressure, CNS status and presence of open wounds and skeletal trauma) were abstracted. PTS scores
were assigned, ranging from -6 to 12. Receiver Operating Curve characteristics were performed to determine the predictive ability (AUC-Area under the Curve) of the PTS at detecting outcomes including: presence of
CNS or solid organ injury; disposition from the ED; need for operative management; and mortality.
RESULTS: 3,817 patients' medical records were reviewed; average age was 7.25 years, 66.1% were male and 98.4% sustained blunt trauma. Mean PTS score was 10.0. PTS had outstanding association with
mortality (AUC: 0.996; SE: 0.001); acceptable association with CNS injury (AUC: 0.750; SE: 0.029); and with operative management including neurosurgery (AUC: 0.788; SE: 0.041), reconstructive surgery (AUC:
0.750; SE: 0.051), and pediatric surgery (AUC: 0.746; SE: 0.027). PTS had poor association with ED disposition including admission to surgical ward (AUC: 0.530, SE: 0.011), pediatric intensive care unit (AUC: 0.689,
SE: 0.017) and discharge to home (AUC: 0.641, SE: 0.009); operative management by orthopedic surgery (AUC: 0.565, SE: 0.014); and solid organ injury (AUC 0.572, SE: 0.038). The Negative Predictive Value of a
PTS score of 10 or greater was 100% for mortality; 98.7% for CNS injury; 99.5% for operative management by neurosurgery; 99.8% for operative management by pediatric surgery; and 99.3% for operative
management by reconstructive surgery.
CONCLUSIONS: PTS may be useful to triage acute injury in children and to predict likelihood of mortality, need for subspecialist surgical management and presence of CNS injury. Further prospective evaluation is
needed.
2014 Eastern SPR Annual Meeting
Abstract Number: 2776
Filename: 753554
Publication Number: 415
Presenting Author: Ronald F. Marchese, MD
Department/Institution/Address: Emergency Medicine, Children's Hospital of Philadelphia, 3501 Civic Center Blvd, CTRB 9th Floor, Philadelphia, PA, 19104, United States
Phone: 609-790-1383
Fax: 215-590-4454
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Use of Bedside Ocular Ultrasound To Identify Optic Disc Swelling in Children
Ronald F. Marchese1, Rakesh D. Mistry2, Gil Binenbaum3, Richard J. Scarfone1, Grant T. Liu4, Ashley L. Woodford1 and Aaron E. Chen1. 1Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA;
2
Emergency Medicine, Children's Hospital Colorado, Aurora, CO; 3Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA and 4Neuro-ophthalmology, Children's Hospital of Philadelphia, Philadelphia,
PA.
BACKGROUND: Measurement of optic nerve sheath diameter (ONSD) via bedside ocular ultrasound (BUS) has been postulated as a method for detection of optic disc swelling (DS) in children. Accurate
determination of DS is potentially useful in the diagnosis of increased intracranial pressure (ICP); however, the sensitivity of BUS for detection of DS in children has not been formally evaluated.
OBJECTIVE: To determine the test characteristics of BUS for detection of DS.
DESIGN/METHODS: This was a prospective cohort study of children aged 1-17 years evaluated by an ophthalmologist for DS in the emergency department (ED), inpatient ward, or neuro-ophthalmology clinic.
Children with glaucoma, retinal abnormality, ocular injury or medical instability were excluded. The gold-standard of DS was diagnosis by an ophthalmologist via fundus examination. Sonographers were pediatric ED
physicians masked to the clinical history and findings on fundus examination. Using standard through-the-lid technique, BUS was performed in multiple scanning positions. Subjects were considered to have a BUS
positive for DS if there was 1) presence of optic nerve head elevation or crescent sign and 2) ONSD greater than or equal to 5mm on at least 2 of 4 measurements. Sensitivity, specificity, and predictive values of BUS
for detection of DS were calculated.
RESULTS: 41 children were included; mean age 12.1 years (range 1-17). 26 (63%) were enrolled in the ED, 4 (10%) as inpatients, 11 (27%) in neuro-ophthalmology clinic. Common presenting symptoms were
headache (66%), visual disturbances (49%) and vomiting (17%). BUS was successfully completed in 40/41 (97.6%). Gold-standard determination of DS was present in 7 (17%, 95% CI 5.5-28.5) subjects, all of whom
had DS detected on BUS (sensitivity 100%, 95% CI 56.1-100). Two subjects had a false-positive DS by BUS (specificity 94.1%, 95% CI 78.9-99.0). Negative and positive predictive values were 100% (95% CI
86.7-100) and 77.8% (95% CI 40.2-96.1), respectively.
CONCLUSIONS: BUS demonstrates potentially high sensitivity for detection of DS in children when test criteria include optic nerve head elevation and crescent sign along with ONSD measurement. Larger studies are
needed to identify the most robust testing criteria and better define the accuracy of BUS prior to widespread clinical application.
2014 Eastern SPR Annual Meeting
Abstract Number: 2405
Filename: 753105
Publication Number: 416
Presenting Author: Elizabeth W. Pingree, MD
Department/Institution/Address: 72 West Cedar Street, Boston, MA, 02114, United States
Phone: 6106088301
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: The Impact of Traumatic Lumbar Puncture on Hospitalization Rate for Febrile Infants 28 To 60 Days of Age
Elizabeth W. Pingree1, Amir A. Kimia2 and Lise E. Nigrovic2. 1Medicine, Boston Children's Hospital, Boston, MA and 2Emergency Medicine, Boston Children's Hospital, Boston, MA.
BACKGROUND: Infants aged 28 to 60 days with a traumatic or unsuccessful lumbar puncture (LP) may be hospitalized because meningitis cannot be reliably excluded.
OBJECTIVE: To compare the rate of hospitalization and of serious bacterial infection (SBI) between low-risk infants and infants with a traumatic or unsuccessful LP.
DESIGN/METHODS: We performed a retrospective cohort study of infants 28 to 60 days of age presenting with fever to a single children's hospital emergency department between January 2007 and May 2013. We
identified infants who had a blood culture sent as well as a peripheral white blood cell (WBC) count < 20,000 cells/mm3 and a urine WBC < 10 cells per high power field. Of these, we classified infants with a
cerebrospinal WBC < 10 as “low-risk.” Of the remaining infants, those with either a CSF red blood cell (RBC) count > 10,000 cells/mm3 or no CSF cell counts obtained were classified as a “traumatic LP.” All other
infants were considered “ not low-risk.” We defined a SBI as growth of a bacterial pathogen from a blood, urine or cerebrospinal fluid (CSF) culture. We compared the hospitalization and SBI rates between low-risk
infants and infants with a traumatic LP.
RESULTS: Of the 571 study infants, 109 (19%) had a traumatic LP, 451 (79%) were low-risk, and 11 (2%) were not low-risk. Infants with a traumatic LP had a higher hospitalization rate [82/109 (75%) traumatic LP vs.
115/451 (25%) low-risk; p < 0.001] but a similar SBI rate [8/109 (7%) traumatic LP vs. 44/451 (10%) low-risk; p=0.61]. No infants with a traumatic LP had meningitis or bacteremia (0% risk, 95% confidence interval
0–3%). For hospitalized infants, the duration of hospitalization was similar (44.5 hours traumatic LP vs. 45.3 hours low-risk; p = 0.22).
CONCLUSIONS: Infants with a traumatic LP had a higher hospitalization rate with a similar SBI rate compared to low-risk infants. Just-in-time training should be focused on trainees prior to performing an infant LP.
2014 Eastern SPR Annual Meeting
Abstract Number: 1264
Filename: 750143
Publication Number: 417
Presenting Author: Talia M. Brooks, MD
Department/Institution/Address: Pediatric Emergency, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, United States
Phone: 516-659-0255
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Are Labs and Imaging Indicated in Pediatric Patients Who Present To the Emergency Department With Back Pain?
Talia M. Brooks1, Lana M. Friedman1, Renee M. Silvis1 and Matthew D. Milewski2. 1Pediatric Emergency, Connecticut Children's Medical Center, Hartford, CT and 2Elite Sports Medicine, Connecticut Children's Medical
Center, Farmington, CT.
BACKGROUND: Although back pain in pediatric patients is an uncommon presenting complaint in the emergency department (ED), there are serious underlying conditions which require prompt diagnosis and
treatment. While the etiology is often benign, clinical practice is variable.
OBJECTIVE: To determine whether pediatric patients presenting to the emergency department with back pain warrant laboratory and radiographic studies.
DESIGN/METHODS: A retrospective chart review was conducted of children age birth to 18 years who presented to a pediatric ED from January to December 2012 with a chief complaint of back pain. Primary data
outcome was discharge diagnosis, defined as nonpathologic (back pain, muscle or back strain, contusion) or pathologic (spinal tumor, epidural abscess, compression fracture, transverse myelitis, discitis,
osteomyelitis, spondylosis/spondylolisthesis, Scheuermann disease, scoliosis, ankylosing spondylitis). Descriptive statistics were used for data analysis.
RESULTS: Two-hundred thirty-two medical records were reviewed, with 181 included in data analysis based on eligibility criteria. A nonpathologic diagnosis of back pain was found in 82.3% of visits, with back pain
(64.1 %) and back or muscle strain (11.1%) as the most common diagnoses. Non-emergent and emergent pathologic diagnoses represented 1.7% and 0.6% of visits, respectively. A disposition of discharge home was
assigned to 97.2% of visits. Radiologic imaging was performed in 39.2% with positive X-ray, CT, and MRI findings in 5.5%, 1.1%, and 0.6%, respectively. Laboratory studies were conducted in 34.3%, with abnormal
values in 13.8%. The only statistically significant correlation was between abnormal X-ray findings and a pathologic diagnosis of back pain (p = 0.003). No statistically significant correlations were identified between
pathologic diagnoses and presenting complaints, physical examination findings, laboratory studies, CT scans, or MRIs.
CONCLUSIONS: The majority of pediatric patients presenting to the ED with back pain were found to have a nonpathologic etiology and were discharged home. Among those with a pathologic diagnosis, abnormal
X-ray findings were the only statistically significant correlation whereas laboratory studies, CT scans, and MRIs were less indicative. Larger scale investigations are needed to determine whether patients may be safely
discharged from the ED in lieu of these studies.
2014 Eastern SPR Annual Meeting
Abstract Number: 823
Filename: 752920
Publication Number: 418
Presenting Author: Thuy L. Ngo, DO, MEd
Department/Institution/Address: Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite G1509, Baltimore, MD, 21287, United States
Phone: 7037313982
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: EMS for Children Program Manager Survey on Education of Prehospital Providers
Thuy L. Ngo1, Karen Belli3 and Manish I. Shah2. 1Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; 2Pediatrics, Baylor College of Medicine, Houston, TX and 3EMSC National Resource Center,
Silver Spring, MD.
BACKGROUND: Although pediatric-specific objectives for the initial education of prehospital providers have been established, uniform implementation of these objectives and guidelines for hours of required pediatric
continuing education (CE) for prehospital providers have not been established.
OBJECTIVE: To nationally survey the content and number of hours of pediatric-specific education that prehospital providers receive during initial certification and recertification. Secondly, to identify barriers to
implementing specific requirements for pediatric education of prehospital providers.
DESIGN/METHODS: Electronic surveys were sent to 55 EMS for Children (EMSC) State Partnership grantee program managers inquiring about the certification and recertification processes of prehospital providers
and barriers to receiving pediatric training in each jurisdiction.
RESULTS: We had a 91% response rate. Pediatric education hours were specified in only 41% of states and territories for initial certification, increasing to 63-67% for recertification. Limitations in funding, time,
instructors, and accessibility are barriers to enhancing pediatric education.
CONCLUSIONS: Modifying statewide policies on prehospital education and increasing hands-on training may be needed to overcome identified barriers.
2014 Eastern SPR Annual Meeting
Abstract Number: 3420
Filename: 753134
Publication Number: 419
Presenting Author: Sani M. Roy
Department/Institution/Address: 633 West Rittenhouse Street, Apartment A1115, Philadelphia, Pennsylvania, 19144, United States
Phone: 214-868-2752
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Peak Body Mass Index (BMI) in Infancy and Childhood Growth in a Multi-Ethnic Cohort
Sani M. Roy1, Rui Xiao1, Frank Mentch1, Rosetta Chiavacci1, Hakon Hakonarson1, Babette Zemel1, Struan F.A. Grant1 and Shana E. McCormack1. 1The Children's Hospital of Philadelphia, Philadelphia, PA.
BACKGROUND: Risk of cardiometabolic disease in adulthood may be affected by childhood growth and development. Adiposity in infancy is often estimated using weight-for-length percentiles, which do not vary with
age. Magnitude and timing of the peak BMI has been proposed as an important alternative measure.
OBJECTIVE: To estimate timing and magnitude of peak infancy BMI in a large, multi-ethnic cohort and to determine their relationship to BMI and height at age 4y.
DESIGN/METHODS: 2,969 infants participating in the “Genetic Causes for Complex Pediatric Disorders” study at the Children's Hospital of Philadelphia having at least 6 clinical length and weight measurements in
the first 408 days of life were included. For each, a polynomial regression model with quadratic terms was fit to describe BMI trajectory over time. Inflection point corresponding to peak BMI was identified using the first
derivative of the model equation. Independent effects of self-reported clinical factors on magnitude and timing of peak BMI were assessed using multivariate linear regression analysis. Correlation of these with height
and BMI at 4y was assessed where available (n=1366).
RESULTS: The cohort was 54% male and 62% African-American (30% white). 16% were pre-term (<37 weeks), and 13% had birth weight <2500 g. Parameters were estimable for 2,786 subjects, with mean r2 =
0.83±0.15. Peak BMI was 18.3±1.7 kg/m2 and occurred around 8.6±1.3 months. In multivariate analysis (n=2310 with complete data), boys had a higher (0.44 kg/m2, p<0.001) and earlier (7 days, p<0.001) peak BMI
than girls. In African-Americans, the peak was higher (0.54 kg/m2, p<0.001) and occurred earlier (12 days, p<0.001). Babies born heavier had a higher (p<0.001) and earlier (p=0.002) BMI peak. Higher infancy BMI
peak was associated with higher BMI Z-score at age 4 (r=0.50, p<0.001) and height Z-score at age 4 (r=0.13, p<0.001). Later infancy BMI peak was also associated with higher BMI Z-score at age 4 (r=0.11, p=0.001).
These effects were similar in African-Americans and whites.
CONCLUSIONS: We demonstrate sex-specific effects on infant BMI patterns consistent with prior studies. We also report greater and earlier infancy BMI peak among African-American infants. Infancy peak BMI is
related to BMI and height in early childhood. These findings demonstrate the potential utility of these measures for future physiologic and epidemiologic studies.
2014 Eastern SPR Annual Meeting
Abstract Number: 1459
Filename: 750032
Publication Number: 420
Presenting Author: Rajeswari Arun, MBBS
Department/Institution/Address: Pediatrics, St.Barnabas Hospital, 4422 3rd avenue, 4th floor- Mills Building, Bronx, New York, 10457, United States
Phone: 9894001498
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Association Between Sleep Stages and Hunger Scores in Children Referred for Polysomnography
Rajeswari Arun1, Daniel Erichsen1,2 and David H. Rubin1,2. 1Pediatrics, St. Barnabas Hospital, Bronx, NY and 2Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
BACKGROUND: Childhood obesity is a growing health challenge; its relationship to sleep remains incompletely understood. Recent studies show that children with late bedtime and late awakening are more obese
independent of total sleep time. The relationship between sleep stages, hunger and obesity has not been studied in children.
OBJECTIVE: To investigate the association of sleep stages, hunger and obesity in a pediatric population.
DESIGN/METHODS: Retrospective chart review of children 5-18 years referred to the Pediatric Sleep Clinic at a university affiliated urban community health facility. Children referred for a a full night polysomnogram
between August 1, 2011-July 30, 2012 were included. Hunger Scores were obtained using a visual analog scale 5-10 minutes after lights on; 0 represented no hunger and 10 maximum hunger. Demographic variables
and BMI percentiles were also recorded.
RESULTS: 36 patients were enrolled in the study.
Table 1: Demographics and Sleep data (n=36)
Age (years, mean ± SD)
9.6 ± 3.5
Ethnicity (% Hispanic)
97.2%
Sleep time (min, mean ± SD)
363 ± 5
REM Sleep (% , mean ± SD)
13.8 ± 8.35
SWS (% mean ± SD)
36.3 ± 14.7
BMI percentiles (mean, range)
80.25, 5-99
Mean hunger scores were 2.07±2.78. There was a significant correlation between hunger scores and percentage of total REM sleep (r=0.438, p<0.01). Hunger scores were also positively correlated with REM sleep
duration in minutes (r=0.471, p<0.05). Percent slow wave sleep (SWS) was negatively correlated with hunger score (r=-0.360, p<0.05). Mean hunger scores and mean satiety scores were inversely correlated. There
were no significant correlations between age, sex, BMI percentiles, apnea-hypopnea index, total sleep time, sleep efficiency, sleep onset latency, stage 2 sleep duration and hunger scores.
CONCLUSIONS: REM sleep was positively correlated and slow wave sleep inversely correlated with hunger scores. No correlation was found between sleep stages and BMI percentiles. These findings suggest that
delayed bedtime, which increases the proportion of REM sleep and decreases the proportion of slow wave sleep results in higher hunger levels. Further studies are needed to establish the relationship between sleep
architecture and obesity.
2014 Eastern SPR Annual Meeting
Abstract Number: 30
Filename: 750227
Publication Number: 421
Presenting Author: Jaime L. Pula, PhD, RD
Department/Institution/Address: Pediatrics, St. Joseph's Children's Hospital, 703 Main Street, Paterson, NJ, 07503, United States
Phone: 973.754.3117
Fax: 973.754.2546
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: School-Based, Wellness Programs May Improve Students' Anthropometric Outcomes and Prevent or Reverse Childhood Obesity: A Pilot Study
Jaime L. Pula1 and Michael Lamacchia1. 1Pediatrics, St. Joseph's Children's Hospital, Paterson, NJ.
BACKGROUND: According to the Pediatric Nutrition Surveillance System, 1 out of 3 children are overweight or obese before their fifth birthday. The childhood obesity epidemic may be fueled by only about half of
school-aged children engaging in the evidence-based guideline of 60 minutes of physical activity per day. This is the first pilot study of its kind to incorporate Choose My Plate and Let's Move!
OBJECTIVE: The purpose of this pilot study was to examine physical outcomes [such as body mass index percentiles (BMI%) for-age based on gender, waist circumference, and body fat percentage (%)]
before-and-after a 12-week, school-based, wellness program.
DESIGN/METHODS: This pilot study was conducted over a 12-week period within a school-based, wellness program setting. Anthropometric data are presented for the subset of the cohort who successfully
completed the wellness program including 21 females [(13 case, 7 obese, 6 non-obese); and (8 control, 4 obese, 4 non-obese)] and 29 males [(16 case, 9 obese, 7 non-obese); and (13 control, 6 obese, 7
non-obese)]. The criterion for being overweight or obese was ≥85% for BMI%-for-age based on gender. The parents were administered a questionnaire eliciting basic demographic information. The protocol was
approved by the IRB of St. Joseph's Healthcare System.
RESULTS: Over 75% (22 of 29) of school-aged children had improved anthropometric outcomes following a 12-week school-based, wellness program. Of these students, 13 of 16 obese children had a BMI%-for-age
of ≥95% at the beginning of the wellness program; 3 of those obese children were able to decrease their BMI%-for-age to between the 85th and 90th percentiles. In addition, 2 obese children (who had a BMI%-for-age
of 90%) were no longer categorized as obese – or even overweight – after the wellness program intervention because at the 12-week end they fell into the 75th percentile for BMI%-for-age based on gender. There
were no observed increases in BMI%-for-age within the intervention group. Other favorable outcomes included a decrease in waist circumference (5 females; 11 males) and body fat % (6 females; 12 males).
CONCLUSIONS: More data is needed, however, school-aged children may benefit from a weight management intervention such as a 12-week school-based, wellness program by improvement in BMI%-for-age
based on gender, and, in general, a better body composition.
2014 Eastern SPR Annual Meeting
Abstract Number: 1803
Filename: 752785
Publication Number: 422
Presenting Author: William R. Grier
Department/Institution/Address: 1400 Spring Garden Street, Apartment 1207, Philadelphia, Pennsylvania, 19130, United States
Phone: 4848886871
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Obesity as a Risk Factor for Urinary Tract Infection in Children
William R. Grier1, Panagiotis Kratimenos2, John P. Gaughan3 and Ioannis Koutroulis1. 1Dept. of Emergency Medicine, St Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia,
PA; 2Dept. of Pediatrics, St Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, PA and 3Dept. of Epidemiology and Biostatistics, Temple University, Philadelphia, PA.
BACKGROUND: Childhood obesity is a nationwide epidemic, with an estimated 16-18% of children and adolescents listed as obese and another 21-24% considered overweight. The number of overweight
adolescents has increased by 50-60% in the last decades and obesity rates have doubled. Obesity has been linked to multiple co-morbities, including an increased risk of developing serious infections.
OBJECTIVE: The present study tests the hypothesis that obese children have an increased risk for urinary tract infections (UTIs), when compared to children with normal BMI.
DESIGN/METHODS: HCUP-KID 2009, a national pediatric database was queried to analyze national trends in patient encounters, specifically those listing patients as CM obese, and then identified those with UTI as
primary or secondary diagnosis, based on ICD-9 coding. Statistical analysis consisting of propensity matching was performed to calculate odds ratios for UTI incidence in the obese versus non-obese population.
RESULTS: A total of 86,638 hospital admissions were entered in the study of which 41,819 included the diagnosis of obesity. A UTI was diagnosed in 2,445 of the cases (1,425 in the obesity group vs. 1,020 in the
non-obesity group). In a propensity-matched sample (1 to 1), matched for age, sex, race and Diabetes mellitus, the risk of UTI was increased by 41% in obese vs non-obese children; OR = 1.41 (CI 95%
1.3006-1.5310) p-value <0.00001. UTI as a primary diagnosis represented 12% of the total UTI diagnoses in the propensity-matched sample.
CONCLUSIONS: The data suggest a possible association between UTIs and obesity in the pediatric population. As the prevalence of childhood obesity increases, it is important for health care providers to be
cognizant of this association and possibly include UTI in their differential diagnosis in order to achieve early recognition of the condition. Further studies are needed to determine this association and eventually
develop screening tools to prevent serious complications of the UTIs.
2014 Eastern SPR Annual Meeting
Abstract Number: 1146
Filename: 753764
Publication Number: 423
Presenting Author: Marsha B. Novick, MD
Department/Institution/Address: General Pediatrics, Penn State Hershey Medical Center, 500 University Drive, Mail Code H085, Hershey, PA, 17033, United States
Phone: 7175311595
Fax: 7175316139
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: A Pilot Evaluation of the Boy Scouts of America Weight-Loss Camp for Obese Adolescents
Marsha B. Novick1, Erik Lehman1 and Ronald J. Williams1. 1Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA.
BACKGROUND: Summer is an unstructured time for many obese children, and obesity tends to worsen during this time where few evidence-based programs are available. Residential weight-loss camps offer an
opportunity for overweight and obese adolescents to lose weight in a medically safe and supportive environment.
OBJECTIVE: To evaluate an innovative weight-loss camp for obese adolescents developed in partnership with the Boy Scouts of America.
DESIGN/METHODS: Obese adolescents between ages 13 and 18 were eligible for enrollment. Inclusion criteria included adolescent males who were obese (BMI ≥ 95%). Exclusion criteria included any uncontrolled
mental health diagnosis. BMI (kg/m²) was measured at the start and at the end of the 4 week camp. Additional anthropometric and metabolic measurements were also obtained.
RESULTS: Thirteen participants enrolled in camp. Eleven participants with the mean age of 16.1 years finished camp. Among these eleven participants, the mean pre-camp BMI was 40.2 +/- 13.0 kg/m² compared
with the mean post-camp BMI of 36.5 +/- 12.0 kg/m², a 9.1% reduction (p<0.001). Waist circumference decreased by 7.4% (48.4 +/- 9.6 cm vs. 44.9 +/- 9.4 cm; p<0.001), and fasting glucose levels decreased by
23.1% (84 mg/dL vs. 62 mg/dL; p=0.001).
CONCLUSIONS: Partnering with the Boy Scouts of America is an innovative approach to creating a weight management camp. Weight-loss camp for adolescents is effective in the short-term for reducing BMI and
improving metabolic parameters related to obesity. Additional study is needed about the long-term effects of such camps on weight loss, metabolic parameters and health outcomes.
2014 Eastern SPR Annual Meeting
Abstract Number: 1294
Filename: 751010
Publication Number: 424
Presenting Author: Jennifer Gauntt, MD
Department/Institution/Address: Department of Medicine and Pediatrics, Christana Care Health System, 4755 Ogletown-Stanton Road, Suite 2E70, Newark, DE, 19718, United States
Phone: 302-293-9468
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Extremes of Body Mass Do Not Affect Outcomes in Critically Injured Children
Glenn Stryjewski1, Jennifer Gauntt2, Heather Kulp1, Zhongcui Gao3, Diane Hochstuhl1, Sean Elwell1, Robin Brennan3 and Stephen Murphy1. 1Department of Anesthesia and Critical Care, Nemours/A.I. duPontHospital
for Children, Wilmington, DE; 2Department of Medicine and Pediatrics, Christiana Care Health System, Newark, DE and 3Nemours Health and Prevention Services, Nemours, Newark, DE.
BACKGROUND: Pediatric trauma continues to be a significant public health threat. More children under 14 die of traumatic injury-related causes than all other causes combined.Obesity in children is significant and is
associated with adverse health outcomes. Literature suggests that obese adult trauma patients with severe injury have worse outcomes than their normal-weight counterparts. A recent study has also shown that
those who are extremely underweight have even poorer outcomes than both normal-weight and obese patients. The effect of extremes of body mass in children with severe traumatic injury has not been investigated.
OBJECTIVE: To determine the effect of both extremes of body mass (overweight/obese and underweight) as compared to normal weight on clinically significant outcomes in children with severe traumatic injury.
DESIGN/METHODS: A retrospective cohort study of children ages 2 to 18 admitted to the Pediatric Intensive Care Unit (PICU) at the A.I. DuPont Hospital for Children between June 2008 and June 2013 with an
Injury Severity Score (ISS) > 8. Using CDC growth charts children were categorized as underweight with a Body Mass Index (BMI) of < 5% for age or overweight/obese with a BMI > 85% for age. These groups were
compared with their normal weight-for-age counterparts. Groups were compared regarding demographics, trauma score (PTS), ISS, and the outcomes of hospital length of stay (LOS), PICU LOS, need for and
number of ventilator days, number of hospital complications, and mortality.
RESULTS: There were 158 patients with 11 classified as underweight and 46 as overweight/obese. All groups were similar regarding PTS and ISS. The underweight group was significantly younger than their
counterparts (p=0.0008) and had a relatively higher rate of intubation on arrival (45% vs 28% p = 0.16). There were no significant differences found between the groups for mortality, hospital or ICU LOS, ventilator
days, or complications. There was a trend in the underweight group of an increased number of ventilator days (101 vs. 77.9 p= 0.056).
CONCLUSIONS: Despite adult literature demonstrating that severely traumatized individuals at the extreme of body masses tend to have poorer outcomes, similar findings were not seen in this pediatric cohort.
There is some evidence that severely underweight children remain mechanically ventilated for longer periods of time which warrants further investigation.
2014 Eastern SPR Annual Meeting
Abstract Number: 1456
Filename: 750026
Publication Number: 425
Presenting Author: Risa C. Eilbaum, B.A.
Department/Institution/Address: Pediatrics, Children's Hospital at Montefiore, 111 East 210 St, Rosenthal 4, Bronx, NY, 10467, United States
Phone: 718-741-2167
Fax: 718-654-6692
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: The Impact of Active Video Gaming on Weight in Youth: A Meta-Analysis
Risa C. Eilbaum1, Karen M. Sorensen1 and Peter F. Belamarich1,2. 1Albert Einstein College of Medicine, Bronx, NY and 2Pediatrics Department, Children's Hospital at Montefiore, Bronx, NY.
BACKGROUND: Exergames, unlike traditional sedentary video games, require physical activity to play (e.g. Dance Dance Revolution®). Although exergaming has been shown to increase heart rate, oxygen
consumption and energy expenditure at rates similar to light-to-moderate physical activity, available studies on exergaming as a weight management intervention in youth have yielded inconsistent results.
OBJECTIVE: A meta-analysis to determine the impact of exergaming compared to no-intervention on weight in youth.
DESIGN/METHODS: We found and reviewed articles from the medical, nursing, psychology and sociology literature spanning 1990s-2013. Key search terms included active video game, weight, body composition
and youth. We included only randomized controlled trials (RCTs) of participants < 19 years old comparing exergaming to no-intervention with pre-post weight change (in kg) as the outcome measure. We calculated a
standardized mean difference (SMD) and 95% confidence interval (CI) for each study and a combined overall effect. We assessed study biases.
RESULTS: Included in our meta-analysis were seven RCTs encompassing 588 participants, 7 to 19 years old (mean age 11.5 years, 37% female). We found no significant difference in pre-post weight change
between the exergaming and no-intervention group (SMD -0.08, 95% CI -0.25 to 0.08, p=0.31, See Figure 1). Among the included studies we identified selection bias, attrition bias, lack of blinding and low compliance
to the exergaming interventions.
CONCLUSIONS: In this meta-analysis, we found no difference in pre-post weight change between the exergaming and no-intervention group. However, the available evidence is limited by the brief intervention
periods and biases present in the included studies, and the use of raw weight (in kg) as the outcome measure, which was necessary to combine study results. To address this, future studies should be longer in
duration, use more sensitive outcome measures, recruit patients more systematically and attempt to mitigate the above stated biases.
2014 Eastern SPR Annual Meeting
Abstract Number: 858
Filename: 753976
Publication Number: 426
Presenting Author: Elizabeth Knuff
Department/Institution/Address: 1 College St, Worcester, MA, 01610, United States
Phone: 203-859-2211
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Undergraduate Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Associations Between Neighborhood Physical Activity Resource Characteristics and Where Urban Minority Children Play
Kathleen McGovern1, Maida P. Galvez1, Elizabeth Knuff2, Kevin Chatham-Stephens1, Jessica Feldman3, Alyson Beha3, Susan Teitelbaum1, Mary S. Wolff1 and Barbara Brenner1. 1Preventive Medicine, Icahn School of
Medicine at Mount Sinai, New York, NY; 2College of the Holy Cross, Worcester, MA and 3New Yorkers For Parks, New York, NY.
BACKGROUND: Inner city, low income minority children are at disproportionate risk for obesity. Evidence has shown that children, especially from low-SES families, have increased sedentary time and time indoors.
Availability and use of neighborhood physical activity resources, such as parks or playgrounds, are considered potential mitigators of the obesity epidemic. Yet, little is known how neighborhood physical activity
resource characteristics are associated with where urban minority children play.
OBJECTIVE: To describe associations between resource characteristics and use by children.
DESIGN/METHODS: A comprehensive field study conducted by NY4P (New Yorkers for Parks) physically counted and measured all publicly accessible physical activity resources in East Harlem, New York.
Measures of open space features included active (at least one feature such as a play area), passive (no features) and total acreage, permeable surface acreage, and types of recreational features. Children's use of
neighborhood resources, collected as part of the prospective cohort study Growing Up Healthy in East Harlem (n=234), was then examined using descriptive statistics to determine which open space characteristics
were associated with use by these children. Negative binomial models predicting count of children reporting use were built to determine which of the open space characteristics were most predictive of use.
RESULTS: Associations between physical activity resource characteristics and child use were dependent on the size of the resource and the number of features. Large parks and pocket parks were used most, with
87% and 24% of kids reporting use, followed by neighborhood parks at 16%. Overall type of resource plays an important role with 67% of 'active' resources used by at least 1 child compared to only 25% of 'passive'
resources; which are mainly community gardens. Count of features in a resource was predictive of more children reporting use, after adjusting for resource size.
CONCLUSIONS: Physical activity resource characteristics, including size and number of features, are associated with use of resources in this urban minority cohort of early school aged children. Understanding
associations between physical activity resource characteristics and use by inner city minority children can inform targeted community level interventions.
2014 Eastern SPR Annual Meeting
Abstract Number: 1757
Filename: 752421
Publication Number: 427
Presenting Author: Satkiran S. Grewal, MD, M.Sc
Department/Institution/Address: 376 Birnie Avenue, Springfield, MA, 01107, United States
Phone: 4137945316
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Incidence and Risk Factors for Hospital-Acquired Venous Thromboembolism in Pediatric Patients
Amy B.W. LaMothe1, Kathleen B. Kopcza1, Evan R. Horton2, Alexander Knee1 and Satkiran S. Grewal1. 1Baystate Medical Center, Springfield, MA and 2Pharmacy, MCPHS University, Worcester, MA.
BACKGROUND: Hospital-acquired (HA) Venous Thromboembolism (VTE) is an important cause of prolonged hospital stay and mortality in adult patients. Valid Risk Assessment Models are used to screen adults at
high-risk for HA-VTE. However, data on incidence and risk factors for HA-VTE in children are limited, leading to variability in pediatric VTE prophylaxis.
OBJECTIVE: To evaluate incidence and identify risk factors for HA-VTE at a tertiary Children's Hospital without a cardiac surgery program.
DESIGN/METHODS: 8-year retrospective chart review was performed of 0-21 year olds admitted to the pediatric service. Inclusion: ICD-9 diagnosis consistent with VTE; Exclusion: VTE at admission or prior to
hospital day 2. Cases were analyzed for presence of known VTE risk factors.
RESULTS: Of 57,232 admissions, 34 (6/10,000) children were diagnosed with HA-VTE, of which 5 (0.87/10,000) had pulmonary embolism (PE); one patient with multiple comorbidities (including pancreatitis)
developed PE and died. Six of 34 (18%) cases were on thromboprophylaxis prior to HA-VTE diagnosis. There was bimodal age distribution, with highest HA-VTE incidence in 0-12 months [38% (13/34 cases)] of
which 6 occurred in neonates; the second peak was among those >13 years [41% (14/34 cases)]. 47% of all cases occurred in the pediatric ICU. The 3 most frequent HA-VTE risk associations were central venous
catheter [CVL] (70% of cases), systemic infection (47%), and mechanical ventilation (35%). Of 28 HA-VTE cases with either mechanical ventilation or systemic infection, 24 (86%) had a CVL; 23/24 of these CVL were
temporary (femoral>PICC). Other associations were: recent surgery (n=6), BMI>30 (n=4), prior VTE (n=2), lupus (n=2), malignancy and known thrombophilia (1 each). Excluding age or immobility, 2 or more VTE risk
factors were present in 85% and 3 or more in 68% of HA-VTE cases respectively.
CONCLUSIONS: HA-VTE is uncommon in children. However, for select high-risk patients, thromboprophylaxis may be underused. A validated Risk Assessment Model, similar to that used in adults, is needed to
identify and manage children at high-risk for HA-VTE. In our dataset, major risk factors for HA-VTE were age (infancy/adolescence), ICU admission, temporary CVL, systemic infection, mechanical ventilation, recent
surgery and obesity. Presence of >1 risk factor may represent the highest risk group.
2014 Eastern SPR Annual Meeting
Abstract Number: 1440
Filename: 754762
Publication Number: 428
Presenting Author: Pradeep Bangalore Prakash, MD
Department/Institution/Address: Department of Pediatrics, Flushing Hospital Medical Center, 4500 Parsons Blvd, Flushing, NY, 11355, United States
Phone: 17186705000
Fax: 718-670-3031
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Association of Common Childhood Infections and Anemia in Children Between One and Two Years of Age
Pradeep Bangalore Prakash1, Fazlul Yusuf1, Salimah Walani1, Susana Rapaport1 and Partha Chatterjee2. 1Department of Pediatrics, Flushing Hospital and Medical Center, Flushing, NY and 2Department of Pediatrics,
Jamaica Hospital Medical Center, Jamaica, NY.
BACKGROUND: Iron deficiency anemia is a common nutrient deficiency worldwide. In-vitro studies show that iron deficiency causes impaired cell-mediated immunity by affecting T-cell, neutrophil and natural killer cell
functions. No observational studies have been done to associate anemia with specific childhood infections.
OBJECTIVE: To study the association of common childhood infections with anemia in children between 1 and 2 yrs of age.
DESIGN/METHODS: This was a retrospective chart review of children born between Jan 2009 and Sept 2011 and followed at Jamaica Hospital Medical Center. Children with normal hemoglobin at 1 yr (>11) and
anemia at 2 yrs (<11.0) of age (G1) were compared with children with normal hemoglobin at 1 yr and 2 yrs of age (G2). Children with chronic medical conditions, hemoglobinopathies and elevated lead level were
excluded. Demographic data and number of infections resulting in hospital visits were collected between 1 and 2 yrs of age. The two groups were compared using independent samples t-test and chi-square test. Data
were analyzed using SPSS version 20. A p<0.05 was significant.
RESULTS: Of 30 children in G1, the mean rate of infection was 5.1 compared to 30 children in G2 of 2.9 (p<0.05). By crosstable analysis, otitis media in G1 was 66.7% and in G2 33.3% (p=0.010), gastroenteritis in
G1 was 63.3% and in G2 36.7% (p=0.039). Emergency department visits were higher in G1 (60.5%) compared to G2 (39.5%) (p=0.032). There was no significant association between the rates of bronchiolitis and
acute febrile illness without focus between the two groups (p=0.176, 0.754). The total number of pneumonias and urinary tract infections in both groups was insufficient to study the association. There was no
significant difference between mean rate of infection in males compared to females (p=0.988).
CONCLUSIONS: Children with anemia appeared to have an increased incidence of otitis media and acute gastroenteritis and no significant increase in bronchiolitis and acute febrile illness between 1 and 2 yrs of age.
Children with anemia had increased emergency department visits for infections.
2014 Eastern SPR Annual Meeting
Abstract Number: 1984
Filename: 753880
Publication Number: 429
Presenting Author: Masaki Mori, M.D.,Ph.D.
Department/Institution/Address: 400 Brookline Ave 10-F, Boston, MA, 02215, United States
Phone: 1-617-756-8513
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Hippo Growth-Control Pathway Regulates MicroRNA Biogenesis and Links Global MicroRNA Suppression To Cancer
Masaki Mori1,2,3,4, Fernando D. Camargo1,2,4 and Richard I. Gregory1,3,4. 1Stem Cell Program, Boston Children's Hospital, Boston, MA; 2Department of Stem Cell and Regenerative Biology, Harvard University,
Cambridge, MA; 3Department of Biological Chemistry and Molecular Pharmacology, and Department of Pediatrics, Harvard Medical School, Boston, MA and 4Harvard Stem Cell Institute, Boston, MA.
BACKGROUND: Hippo pathway regulates growth and organ size in different organisms. The alteration of this pathway is implicated in numerous human malignancies including pediatric brain tumors, sarcomas and
acute lymphoblastic leukemia. A commonly observed feature of human tumors is global downregulation of microRNAs (miRNAs) that can have a causative role in tumorigenesis, but the underlying mechanisms remain
poorly understood.
OBJECTIVE: To elucidate new therapeutics for childhood tumors through identifying the molecular mechanisms underlying the global misregulation of miRNA in human cancer.
DESIGN/METHODS: Using mouse models of tumorigenesis that was induced by constitutive activation of Hippo pathway executioner YAP, the influences of Hippo signaling on miRNA was analyzed in an unbiased
manner. The underlying molecular machinery was investigated with in-vitro miRNA processing assay, mass spectrometry of YAP-bound proteins, siRNA-mediated knockdown and overexpression of Hippo pathway
components. Therapeutic potential of identified YAP-target protein was investigated with soft agar colony formation assay.
RESULTS: In mice, constitutive activation of YAP lead to the reduction of 52.5% and 61.0% of miRNAs in skin and liver tumors, respectively, recapitulating the findings in human cancer. Mass spectrometric analyses
identified p72 (DDX17) RNA helicase, a regulatory component of Microprocessor complex that mediates miRNA biogenesis, as a binding target of YAP protein. In tumor and proliferating cells, YAP sequesters p72
from Microprocessor complex thereby decreasing miRNA production that is mediated by p72. YAP/p72-mediated miRNA suppression leads to c-MYC induction that is a common target of the YAP/p72-subset of
miRNAs. Restoration of p72 counteracts the cell proliferation and anchorage-independent growth enhanced by YAP forced expression.
CONCLUSIONS: Hippo pathway utilizes miRNA machinery to induce c-MYC expression and tumorigenesis, and may be responsible for the widespread miRNA repression observed in human cancer. Our findings
suggest a potential of targeting and restoring the miRNA machineries for cancer therapy.
2014 Eastern SPR Annual Meeting
Abstract Number: 2105
Filename: 754598
Publication Number: 430
Presenting Author: Ashlin Yahr, BA
Department/Institution/Address: Pediatrics, New York Medical College, 50 Plaza West, Room 101, Valhalla, New York, 10595, United States
Phone: 9145943728
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Undergraduate Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Anti-CD20 Chimeric Antigen Receptor (CAR) Modified Expanded Natural Killer (NK) Cells Significantly Mediate Rituximab (Rx) Sensitive and Resistant Burkitt Lymphoma (BL) Regression and
Improve Survival in Human BL Xenografted NSG Mice
Ashlin Yahr1, Yaya Chu1, Janet Ayello1, Carmella van de Ven1, Matthew Barth2, Myron Czuczman3 and Mitchell S. Cairo1. 1Pediatrics, New York Medical College, Valhalla, NY; 2Pediatrics, State University of New York
at Buffalo, Buffalo, NY and 3Medicine, Roswell Park Cancer Institute, Buffalo, NY.
BACKGROUND: The outcome for children and adolescents with BL has improved significantly but for those who relapse, the prognosis is dismal (Cairo, et al, J Clin Oncol, 2012). We previously reported that
expanded Peripheral Blood Natural Killer (exPBNK) Cells electroporated with anti-CD20 CAR mRNA have significant cytotoxicity against CD20+ Rx sensitive and resistant BL in vitro (Chu/Cairo, et al, ASH, 2012).
OBJECTIVE: To examine the anti-tumor effect of anti-CD20 CAR+ modified exPBNK against CD20+ Rx sensitive and resistant BL in xenografted NSG mice.
DESIGN/METHODS: Anti-CD20 CAR mRNA was nucleofected into CD56+CD3- exPBNK and CAR expression was detected by flow cytometry (Chu/Cairo, et al, ASH, 2012). Raji or Raji-2R expressing luciferase was
i.p. or s.c. injected into NSG mice. Engraftment and progression were evaluated using the Xenogen IVIS-200 system. CAR+ exPBNK, CAR- exPBNK or medium only was i.p. injected once a week for 3 weeks.
Luciferase signals and tumor size were measured weekly.
RESULTS: In Raji xenografted mice after the third injection, luciferase signals in the CAR+ exPBNK group were significantly reduced than that in the control (P=0.0087) and CAR- exPBNK group (P=0.0128). The
CAR+ exPBNK mice had significantly longer survival time (40 days) compared to untreated (29 days, P<0.001) and CAR- exPBNK treated (30 days, P<0.001). Similarly, in Raji-2R xenografted mice after the third
injection, luciferase signals were reduced in the CAR+ exPBNK group compared to CAR- exPBNK treated mice (P<0.01). The tumor size in the CAR+ exPBNK group was significantly smaller than that in the control
(P=0.0175) and the CAR- exPBNK group (P=0.0122). The CAR+ exPBNK mice had significantly longer survival time (24 days) compared to untreated (18 days, P<0.001) and CAR- exPBNK treated (22 days, P<0.05).
CONCLUSIONS: Multiple injections of anti-CD20 CAR mRNA electroporated exPBNK cells can significantly mediate Rx sensitive and resistant BL tumor regression and extend survival of BL xenografted mice,
indicating the therapeutic potential for relapsed/resistant BL in patients.
2014 Eastern SPR Annual Meeting
Abstract Number: 1332
Filename: 752008
Publication Number: 431
Presenting Author: Satkiran Grewal, MD, MSc
Department/Institution/Address: Pediatrics, Baystate Medical Center, 376 Birnie Avenue, Springfield, MA, 01107, United States
Phone: 413-794-5316
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Improving Time To First Dose of Parenteral Antibiotic in Febrile Immunocompromised Children: A Single Institution Collaborative Project
Joeli Hettler1, Teresa Kanev1, Elizabeth Gale1 and Satkiran Grewal1. 1Pediatrics, Baystate Medical Center, Springfield, MA.
BACKGROUND: Febrile immunocompromised children are at high-risk for fulminant bacterial infections. Prompt initiation of IV antibiotics in these patients (pts) may improve outcomes.
OBJECTIVE: To evaluate current state and improve compliance with standard 60 min time from hospital presentation to first dose of IV antibiotics (Time to Abx) in febrile immunocompromised children presenting to
our emergency department (ED) or pediatric inpatient unit (INPT).
DESIGN/METHODS: Eligible children were evaluated for variables associated with delays in Time to Abx. Inclusion criteria were fever with: cancer therapy, known neutropenia, or sickle cell disease.
Based on gap analysis, interventions included: 1) calling an "expect" to INPT/ED 2) per new protocol/careset: entering Abx orders STAT upon pt arrival, 1st Abx dose prepared by unit nurse (bypassing pharmacy) &
Abx administration prior to resulting of blood count, and 3) robust staff education.
RESULTS: Pre-intervention data (51 consecutive pts) showed 2 major gaps: MD ordering of Abx and delay in Abx arriving from pharmacy.
Post-intervention (41pts), mean Time to ABx improved by 126 min (ED) and 82 min (INPT).
% of pts with Time to Abx: < 60 min improved from 2% to 49% and >180 min decreased from 58% to 2%.
Compliance with protocol was associated with attaining 60 min Time to Abx.
CONCLUSIONS: Baseline data showed practically no eligible child met the standard Time to Abx. QI interventions directed at identified process delays significantly improved the care of these high-risk children.
2014 Eastern SPR Annual Meeting
Abstract Number: 2443
Filename: 753991
Publication Number: 432
Presenting Author: Timmy O'Connell, MS
Department/Institution/Address: Department of Pediatrics, Department of Microbiology and Immunology, New York Medical College, 7 Dana Road, Valhalla, New York, 10595, United States
Phone: 1 (347) 633-3595
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Ph.D. Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: DLEU1 Knockout by Transcription Activator-Like Effector Nucleases (TALENs) Inhibits Apoptosis in Pediatric Burkitt Lymphoma (PBL): DLEU1 May Serve as a Tumor Suppressor Gene in PBL
Timmy O'Connell1,2, Changhong Yin1, Janet Ayello1, Carmella van de Ven1, Sanghoon Lee1,3 and Mitchell Cairo1,2,3,4,5. 1Department of Pediatrics, New York Medical College, Valhalla, NY; 2Department of Microbiology
and Immunology, New York Medical College, Valhalla, NY; 3Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY; 4Department of Medicine, New York Medical College, Valhalla, NY and
5
Department of Pathology, New York Medical College, Valhalla, NY.
BACKGROUND: PBL is the most common histological subtype of childhood and adolescent Non-Hodgkin Lymphoma (NHL) (Cairo et al, Blood, 2007; Miles/Cairo, BJHaem, 2012). We previously identified, in a subset
analysis, that children with PBL and a 13q14.3 deletion, had a significantly poorer clinical outcome (Poirel/Cairo et al, Leukemia, 2009; Nelson/Cairo/Sanger et al, BJHaem, 2009). Deleted in Lymphocytic Leukemia 1
(DLEU1) is a PBL classifier gene located on chr.13q14.3 (Dave et al, NEJM, 2006). Sequence-specific TALENs technologies were developed for precision targeted in vitro genome editing and were used to knockout
DLEU1.
OBJECTIVE: We hypothesize that 1) TALEN technology is suitable for the modification of DLEU1 locus and 2) DLEU1 may act as a tumor suppressor.
DESIGN/METHODS: TALENs were constructed based on modified REAL (restriction enzyme and ligation) assembly methods for DLEU1 gene modification (Lee/Cairo et al, ASH, 2012). Immunoblotting and qRT-PCR
was performed by CFX96 Real-time system (Bio-rad) using SsoFast Supermix (Bio-rad). Caspase 3/7 and MTS assays were performed for apoptosis and cell proliferation, respectively.
RESULTS: DLEU1 knockout (hemizygous) in Raji exhibited significantly reduced expression compared to mock control cells in each of several single clones. The comparison of mRNA expression of DLEU1 network
genes in DLEU1 knockout Raji resulted in significantly reduced expression of c-myc and TUBB2C mRNA compared to mock control cells. DLEU1 knockout Raji showed significantly reduced Caspase 3/7 activities,
significantly increased cell proliferation, and a significant increase in ikBa and Akt phosphorylation.
CONCLUSIONS: We demonstrate that 1) TALENs are useful tools for the modification of endogenous DLEU1 gene locus, 2) TALENs-mediated DLEU1 gene knockout resulted in down regulation of DLEU1 mRNA
and consequently, inhibition of BL apoptosis and increase in cell proliferation, and 3) we hypothesize that deletion of DLEU1 in PBL may result in chemotherapy resistance secondarily to a loss of a tumor suppressor
gene.
2014 Eastern SPR Annual Meeting
Abstract Number: 4249
Filename: 756106
Publication Number: 433
Presenting Author: D. Matthew Gianferante, MD
Department/Institution/Address: Pediatrics, 121 Green St, Unit 204, Jamaica Plain, MA, 02130, United States
Phone: 781-883-5781
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Cranial Irradiation Therapy for Pediatric T-Lineage Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis
Michael Kelly1, Thomas Trikalinos2, D. Matthew Gianferante1, Issa Dahabreh2 and Susan Parsons1. 1Pediatrics, Tufts Medical Center, Boston, MA and 2Brown University, Providence, RI.
BACKGROUND: Survival for T-lineage acute lymphoblastic leukemia (T-ALL) have improved over the last few decades. These outcomes have been documented in single arm cooperative group studies that have
evaluated systemic and intrathecal chemotherapy in combination with various cranial irradiation therapy (CRT) strategies: CRT for all patients, selective use (based on risk factors), or complete omission of CRT.
OBJECTIVE: We sought to explore the evidentiary basis supporting the administration of CRT for pediatric T-ALL by means of a methodologically rigorous synthesis of the totality of the available evidence.
DESIGN/METHODS: We performed random effects meta-analysis, subgroup meta-analysis, and meta-regression to explore the association of radiation strategies and other treatment strategies with survival.
RESULTS: The search returned 2383 abstracts. The final dataset included 59 eligible articles (5731 patients with T-ALL enrolled between 1973 and 2005) describing 75 treatment groups. Our review did not return any
randomized controlled trials specifically reporting survival outcomes for pediatric T-ALL patients stratified by CRT strategies. There was heterogeneity among the treatment studies (I2=82.4, PQ<0.001). Slightly more
than half of the studies administered CRT to all T-ALL patients (n=42, 56%). Nineteen studies (25%) used a risk-directed approach and seven (9 %) administered CRT to CNS positive patients only. Seven studies
(9%) omitted CRT completely. Over time, average event-free survival (EFS) was higher by 6% per 5 years (p<0.001). Adjusting for year, EFS differed by radiation strategy. The adjusted EFS for studies that
administered CRT to all patients was 65% (95% confidence interval, CI: 61% to 68%). Compared to the reference group (CRT for all) the adjusted EFS was significantly worse (risk difference (RD) = -10%, 95% CI:
-16% to -3%) among studies that used a risk-directed approach to CRT (p=0.002). The adjusted EFS for the other CRT strategies were similar when compared to the reference group: CRT for CNS positive patients
only (RD = -4%, 95% CI: -15% to 7%, p=0.47); CRT omitted for all patients (RD = 5%, 95% CI: -5% to 15%, p=0.29).
CONCLUSIONS: CRT may not be necessary with current chemotherapy for T-ALL. However, these associations are susceptible to bias and represent a weak evidentiary basis for drawing conclusions on the
comparative effectiveness of alternative CRT strategies.
2014 Eastern SPR Annual Meeting
Abstract Number: 4270
Filename: 756182
Publication Number: 434
Presenting Author: Mansi Sachdev
Department/Institution/Address: Pediatric Hematology/Oncology, Penn State Hershey Medical Center, 500 University Drive, PO Box HO850, Hershey, PA, 17033, United States
Phone: 001-717-531-4781
Fax: 001-717-531-4789
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Respiratory Syncytial Virus (RSV) Infection in Pediatric Cancer and Hematopoietic Stem Cell Transplant (HSCT) Patients
Mansi Sachdev1, Melanie Comito1, George McSherry1, Kevin Mulieri1, Lindsay Trout1, Brooke Soulier1, Wallace Greene1, Jane Black1 and Tammy Angeletti1. 1Penn State Children's Hospital, Hershey, PA.
BACKGROUND: RSV may be a major source of morbidity and mortality among pediatric cancer and HSCT patients. Therapies exist for the prevention and treatment of severe RSV infections, but they are expensive,
labor intensive, and not without risks. Currently, there are no established guidelines for their use in this high risk population.
OBJECTIVE: To assess recent guidelines established by a multidisciplinary working group for the treatment of RSV infections in pediatric cancer and HSCT patients.
DESIGN/METHODS: All cases of RSV in pediatric cancer and HSCT patients from 05/2006-04/2013 were reviewed. Data collected included demographics, oncologic diagnosis, HSCT status, chest x-ray findings and
the use of RSV specific treatment. Criteria developed by the working group were used to categorize patients as high or low risk and as upper or lower respiratory tract disease. Treatment guidelines were outlined for
each of four patient groups: high risk/upper tract, high risk/lower tract, low risk/upper tract, low risk/lower tract. RSV specific treatment consisted of ribavirin (oral or aerosolized) and palivizumab. Cases diagnosed
before 09/2012 were assessed retrospectively, while cases diagnosed after that were assessed prospectively. Outcome variables included treatment consistent with guidelines, the need for PICU admission and
survival. Odds ratios were determined to assess the association between adherence to the guidelines and survival.
RESULTS: 27 pediatric cancer and/or HSCT patients with RSV infection were identified; the mean age was 85.4 +/- 13.5months. Treatment consistent with guidelines occurred in 20 patients (74%). Ten (37%)patients
were classified as high risk and 14 (52%)had lower respiratory tract disease. Four patients (15%)required transfer to the PICU. There were 2 deaths; both classified as high risk/lower tract disease. In neither case was
treatment in accordance with suggested guidelines. Mortality among the high risk/lower tract disease group was 29%. The odds ratio for survival if guidelines were followed was 18.6 (95% CI:0.8, 447.6, p = 0.06).
CONCLUSIONS: Results of this small, single center study suggest that RSV treatment consistent with proposed guidelines may improve outcomes in pediatric cancer and HSCT patients. These results should serve
as pilot data to stimulate further, multicenter study.
2014 Eastern SPR Annual Meeting
Abstract Number: 2581
Filename: 750591
Publication Number: 435
Presenting Author: J. Riehl, MD
Department/Institution/Address: Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Division of Neonatology 2nd Floor, Philadelphia, PA, 19104, United States
Phone: 215-275-3526
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Variation in Withdrawal Discussions in Infants<28 Weeks Gestation Across US Centers
J. Riehl1, D. Munson1, J. Langer3, S. DeMauro1, E. Bell4, B. Poindexter5, C. Fortney6, R. Seabrook6, J. Tyson7, A. Dworetz8, G. Natarajan9, S. Shankaran9, B. Vohr10, R. Higgins2, A. Das3, B. Stoll8 and H. Kirpalani2.
1
Children's Hospital of Philadelphia, Philadelphia, PA; 2NICHD Neonatal Research Network, Bethesda, MD; 3RTI International, Washington, DC; 4University of Iowa Children's Hospital, Iowa City, IA; 5Indiana University
Riley Hospital for Children, Indianapolis, IN; 6Nationwide Children's Hospital, Columbus, OH; 7University of Texas, Houston, TX; 8Emory University, Atlanta, GA; 9Wayne State University, Detroit, MI and 10Brown
University, Providence, RI.
BACKGROUND: Infants born ≤28 weeks have high mortality rates. Many deaths in these infants occur after Withholding-Withdrawal of Life Sustaining Therapy (WWLST). We examined differences in discussions of
WWLST in 18 US NICUs and outcomes of infants following such counseling.
OBJECTIVE: Describe: (i) frequency of documented discussions on WWLST in NICHD Neonatal Research Network (NRN); (ii) in-hospital outcomes of infants who survived despite such a discussion.
DESIGN/METHODS: Prospectively collected cohort data of infants ≤28 weeks GA (April 2011-March 2013) compared rates of discussion recommending WWLST versus actual WWLST by NRN center; and maternal
and infant demographics and morbidities from birth to 120 days in these groups. Factors associated with actual WWLST post-discussion were estimated by logistic regression model adjusted for center, BW, GA, race,
sex and other covariates.
RESULTS: WWLST discussions occurred in 343 (14.2%) of 2416 infants in this cohort. Discussions were inversely related to GA: 22-24 wks (193), 25-26 wks (114), 27-28 wks (36). Most (78.4%) discussions led to
WWLST. Centers had variable rates of discussions (6-29%) and rates of ensuing WWLST (5% to 20%) (Figure). Site differences were greatest in infants 22-24 weeks GA. For infants who had a discussion,
characteristics significantly associated with WWLST at p<0.001 were: Center, GA ≤24 weeks, maternal age ≥26, BW, SGA, proven NEC, and high frequency ventilation. Seventy-four infants (3.5%) prompted a
discussion of WWLST but did not undergo WWLST; of those, 42 (57%) survived, with 11 discharged home, 5 on home-oxygen, and 31 remaining in long-term NICU care.
CONCLUSIONS: Wide site variation exists, both in the frequency of discussions of WWLST, and rate of subsequent WWLST. For the relatively few infants who survived after such discussions, only a minority were
discharged home before 120 days.
2014 Eastern SPR Annual Meeting
Abstract Number: 1802
Filename: 752784
Publication Number: 436
Presenting Author: Ursula Guillen, MD
Department/Institution/Address: 4745 Ogletown-Stanton Rd, MAP 1, Suite 217, Newark, DE, 19713, United States
Phone: 302-733-2410
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: International Comparison of Guidelines for the Management of Extremely Premature Deliveries: A Systematic Review
Ursula Guillen1, David Munson2, Constance Williams3, Ann Jefferies4, Thor Hansen5, Shigeharu Hosono6, Susan Albersheim7, Elaine Boyle8, Kei Lui9, Brian Darlow10 and Haresh Kirpalani2. 1Christiana Care Health
System, Newark, DE; 2Children's Hospital of Philadelphia, Philadelphia, PA; 3McMaster University, Hamilton, Canada; 4Mount Sinai Hospital, Toronto, Canada; 5Oslo University Hospital, Oslo, Norway; 6Nihon
University School of Medicine, Tokyo, Japan; 7University of British Columbia, Vancouver, Canada; 8University of Leicester, Leicester, United Kingdom; 9University of New South Wales, Sydney, Australia and
10
University of Otago, Christchurch, New Zealand.
BACKGROUND: Available data on survival rates and outcomes of extremely low birth weight (ELBW) and extremely low gestational age (ELGA) infants display a wide variation by country. Recent statements by
professional bodies by country may reflect or influence differences in the treatment of these infants.
OBJECTIVE: To perform a systematic review of management guidelines from the scientific societies and professional organizations in industrialized countries for the care of ELBW and ELGA infants in the delivery
room.
DESIGN/METHODS: Embase, PubMed, and Google scholar databases were searched using a combination of terms such as: “practice guidelines”, “infant, extremely premature”, “viability”, “treatment decisions”,
“perinatal care”. Local guidelines were excluded. Gestational age (GA) was defined as the postmenstrual age in weeks and days.
RESULTS: We found the recommendations from 15 professional organizations for 12 countries: North America (2), Europe (8), Asia (1), and Oceania (1) from the years 2004-2012. There was a wide range of
recommendations for initiating neonatal resuscitation: while Japan advocates resuscitation at any gestation, two states in Australia may offer comfort care up to and including 25 weeks GA. Resuscitation was deemed
as always indicated at ≥26 weeks GA. At <22 weeks GA, most national bodies suggest that because prospects of survival are very low, resuscitation should not be routinely offered. There was wide variability in the
recommendations at 22-25 weeks GA (figure).
CONCLUSIONS: Despite a wide variation in recommendations across 12 industrialized countries, the grey zone of viability remains 23-24 weeks gestation. In a few countries this grey zone extends to include 22 and
25 weeks gestation and may affect survival outcomes by country.
2014 Eastern SPR Annual Meeting
Abstract Number: 3716
Filename: 752269
Publication Number: 437
Presenting Author: Alison J. Falck, M.D.
Department/Institution/Address: Pediatrics, University of Maryland, 110 S. Paca St., 8th Floor, Baltimore, MD, 21201, United States
Phone: 4103286003
Fax: 4103281076
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Mercury, Lead and Cadmium Exposure from Transfusions in the VLBW Infant
Alison J. Falck1, Justine Cummins-Oman1, Dina El Metwally1 and Cynthia F. Bearer1. 1Pediatrics, University of Maryland, Baltimore, MD.
BACKGROUND: Mercury (Hg), lead (Pb), and cadmium (Cd) are developmental neurotoxicants. According to the CDC, these metals are present in adult blood. VLBW infants develop iatrogenic anemia which may
require multiple transfusions (Tx). Tx are a potential source of exposure to metals during critical periods of brain development.
OBJECTIVE: Our objective is to describe the Hg, Pb, and Cd exposure from donor blood and Tx practices in the NICU, and to determine if birthweight or number of Tx from a single donor is a risk factor for higher
exposure.
DESIGN/METHODS: Informed consent was obtained from eligible VLBW infants admitted to our NICU. Donor blood was collected from blood units following each Tx and analyzed for Hg, Pb, and Cd. Metal doses
(µg/kg/day) were calculated for all Tx, and compared to published intravenous reference doses (iRfD). Tx patterns, mean metal concentrations, metal doses, and cumulative exposures were calculated.
RESULTS: 37 eligible infants had complete collection of donor blood. Mean birthweight and gestational age were 996 ± 282 grams and 27.5 ± 2.5 wks. 30 infants received a median of 7 [range 1-28]) Tx, and were
exposed to a median of 3 [range 1-6] donors from a total of 251 Tx and 73 donors. Characteristics of these units are in Table 1.
Table 1. Tx demographics
Hg
Number of units with detectable metal
44 (60%) 33 (45)%
Pb
Cd
Metal concentrations, µg/L, mean+SD
4.2+/-2.8 20.8+/-14.3 0.64+/-0.5
Number Tx greater than iRFD
24 (9%)
69 (27%)
0 (0%)
Number Tx greater than twice the iRFD
5 (2%)
25 (10%)
0 (0%)
31 (42%)
38% of donor units contained all three metals. 5 infants received 11 Tx from 5 donors such that their dose of both Hg and Pb was greater than iRfD. Of these, 1 baby received 5 Tx from the same donor. In infants
<1000 grams (n=20), there was a significant increase in mean number of donors (2.7 vs. 1.1, p 0.01) and cumulative Hg exposure (0.43 µg/kg vs. 0.12 µg/kg, p=0.02). Increased cumulative Pb exposure approached
statistical significance (1.23 µg/kg vs. 0.51 µg/kg, p=0.06). For babies that received 3 or more transfusions from the same donor, there was a significant increase in Hg exposure (p=0.03).
CONCLUSIONS: Tx represent a source of neurotoxic heavy metal administration to VLBW infants. In our study, multiple Tx resulted in quantities of metal exceeding the iRfD for both Hg and Pb. Pre-screening of
donor blood may limit recurrent exposure. The neurodeveolpmental impact of these doses warrants investigation.
2014 Eastern SPR Annual Meeting
Abstract Number: 1890
Filename: 753322
Publication Number: 438
Presenting Author: Kyoung Eun Joung, MD
Department/Institution/Address: Newborn Medicine, Boston Children's Hospital, 300 Longwood Avenue, Enders 961, Boston, MA, 02115, United States
Phone: 617 9192341
Fax: 617 7300260
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Small for Gestational Age Newborn Infants Have Lower Cord Blood Irisin Levels Compared To Appropriate and Large for Gestational Age Infants
Kyoung Eun Joung1,2,3,4, Helen Christou1,2,4, Kyung-Hee Park3, Andreas Filippaios3, Fadime Dincer3 and Christos S. Mantzoros3,4. 1Newborn Medicine, Boston Children's Hospital, Boston, MA; 2Pediatrics Newborn
Medicine, Brigham and Women's Hospital, Boston, MA; 3Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, Boston, MA and 4Harvard Medical School, Boston, MA.
BACKGROUND: Irisin is a novel peroxisome proliferator-activated receptor gamma (PPARγ) coactivator 1-alpha (PGC-1α) - dependent myokine, secreted from skeletal muscle after exercise. Irisin regulates
exercise-related energy expenditure and glucose metabolism, and turns white adipose tissue (WAT) into brown adipose tissue (BAT). Thus, irisin is considered as a potential treatment for obesity and metabolic
syndrome. Neonates have higher contents of BAT than adults for thermogenesis. However, infants born small for gestational age (SGA) have lower content of fat compared to infants born appropriate for gestational
age (AGA) and have increased risk for metabolic syndrome as adults. Whether irisin is detectable in cord blood and its physiologic role in neonates remain to be studied.
OBJECTIVE: To evaluate the association of umbilical cord blood irisin levels with gestational age and birth weight in neonates.
DESIGN/METHODS: We performed a cross-sectional study of 262 newborns, from 26 to 41 weeks' gestation, and 14 healthy adults for comparison. We collected umbilical cord blood from newborns and venous blood
from adults and analyzed plasma for irisin by ELISA.
RESULTS: Plasma irisin levels were significantly lower in neonates (65.81±19.87ng/mL) compared to adults (99.46±15.91ng/mL, p<0.001).There were significant positive correlations between plasma irisin levels and
gestational age (r=0.24, p<0.001), birth weight Z-score (r=0.23, p<0.001), and body surface area (BSA, r=0.24, p<0.001). SGA infants had significantly lower levels of irisin (57.71±17.09ng/mL) compared to AGA
infants (67.84±20.51ng/mL p<0.01) and large for gestational age (LGA) infants (68.97 ±6.30ng/mL, p<0.01). The association between SGA and lower irisin levels remained significant in multivariate regression
analysis that included gestational age, maternal age and maternal BMI (β=-0.12, p=0.006).
CONCLUSIONS: Our results support that irisin may have a physiologic role in fetal growth. We speculate that suppression of irisin in SGA infants may be related to low content of BAT, and may contribute to the
development of metabolic syndrome.
2014 Eastern SPR Annual Meeting
Abstract Number: 3753
Filename: 752604
Publication Number: 439
Presenting Author: Elisabeth Bloch-Salisbury, PhD
Department/Institution/Address: Neurology and Pediatrics, University of Massachussets Medical School, 55 Lake Avenue North S5-718, Worcester, MA, 01655, United States
Phone: 508-856-6232
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Vibro-Tactile Stimulation: A Potential Therapeutic Intervention for Neonatal Abstinence Syndrome
Elisabeth Bloch-Salisbury1, Ian Zuzarte1, David Paydarfar1 and Francis Bednarek1. 1University of Massachusetts Medical School, Worcester, MA.
BACKGROUND: Infants exposed to opiates in utero commonly suffer withdrawal due to abrupt discontinuation of drug/s to which they have become physically dependent. Neonatal Abstinence Syndrome (NAS) refers
to behavioral and physiological symptoms of infant drug withdrawal, which include irritability and respiratory instabilities. Morphine is currently the primary treatment for opiate withdrawal. We propose a
non-pharmacological treatment complementary to standard care that could lessen need for medication, improve autonomic stability and have significant implications for neurodevelopment and improved outcomes in
this population.
OBJECTIVE: This study investigated whether low-level stochastic, vibro-tactile stimulation (SVTS): 1) reduces irritability, indexed by reduction in excessive body movements; 2) enhances respiratory
rhythm-generating circuits to promote eupneic breathing.
DESIGN/METHODS: Eleven methadone/buprenorphine exposed neonates (mean GA 39.3 wks; mean DOL 22.6; 7 male) were studied at UMass Memorial NICU. Quality of the pulse-oximetry plethysmographic signal
and video identified movement period. Respiratory inductance plethysmography of rib and abdominal muscles measured breathing. Counterbalanced 30 min intervals of SVTS (30-60Hz, RMS amplitude 0.1mm;
specially designed mattress) were compared to 30 min periods of no SVTS.
RESULTS: There was a 20.1% decrease in excessive movement (>5sec) and a 19.2% reduction in variance of the interbreath-interval with SVTS. Figure 1A illustrates this reduced movement with SVTS (Mattress) in
one infant, indexed by a decrease in signal artifact (Plethys and EKG). Figure 1B shows improved stability of eupneic breathing (Abd/Rib) with SVTS in the same infant.
CONCLUSIONS: These preliminary findings suggest SVTS may provide a complementary therapeutic intervention for facilitating drug withdrawal by reducing pathophysiological instabilities in NAS infants.
Grant Support: NIHR21DA035355; American Heart Association; Wyss Foundation, Harvard University.
2014 Eastern SPR Annual Meeting
Abstract Number: 1355
Filename: 752447
Publication Number: 440
Presenting Author: Craig Guerin, DO
Department/Institution/Address: Division of Neonatology, NYU Langone Medical Center, 560 1st Ave, New York, NY, 10016, United States
Phone: 212-263-7286
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Effectiveness of Routine TORCH Screening for IUGR Infants
Craig Guerin1, Micheal M. Espiritu1, Elena Wachtel1, Sean M. Bailey1 and Pradeep V. Mally1. 1Division of Neonatology, New York University Langone Medical Center, New York, NY.
BACKGROUND: Due to the extremely low incidence of TORCH, screening all Intrauterine Growth Restricted (IUGR) infants regardless of etiology may incur added and often unnecessary cost.
OBJECTIVE: To determine frequency of testing and rate of confirmed TORCH infection in infants with Birth Weight < 10%. To evaluate variation in testing among IUGR infants with different etiologies.
DESIGN/METHODS: 386 infants with BW < 10% admitted to NYULMC from 2007 to 2012 were identified. Retrospective chart review included maternal and neonatal demographics, as well as clinical manifestations
of TORCH infections. TORCH screening data, including serum total IgM, CMV PCR, and head ultrasound, were reviewed and analyzed.
RESULTS: 13% of infants had a BW less than 10th percentile. Of these, 53% were SGA, 29 % were symmetric IUGR and 29% asymmetric. A total of 32% of infants were screened for TORCH infection with no positive
results. A significantly higher percentage of symmetric IUGR infants were screened for TORCH compared to asymmetric IUGR and non-IUGR infants, (64% vs. 47% vs. 19%) p=<0.01. 63% of Infants with a known
cause for IUGR (e.g. maternal preeclampsia, HTN) were still screened for TORCH. 16% of all TORCH screenings were performed on the proper target group.
We calculated unnecessary cost of $64,065 was incurred by TORCH screening. There was no significant difference in the percent of symmetric (24%) vs asymmetric (21%) IUGR infants with history of
hypertension/preeclampsia.
CONCLUSIONS: Majority of infants screened for TORCH infections had one or more other known etiologies for IUGR. Because overall yield of TORCH screening is extremely low, testing should be limited to
symmetric IUGR infants without other known etiologies or those with clinical signs of TORCH infection. Unnecessary testing of patients can be avoided with improved guidelines for TORCH screening thus reducing
hospital cost and patient stress. Though maternal hypertension/preeclampsia is traditionally associated with asymmetric IUGR it is equally present in symmetric IUGR.
2014 Eastern SPR Annual Meeting
Abstract Number: 4151
Filename: 755623
Publication Number: 441
Presenting Author: Annette Scheid, MD
Department/Institution/Address: Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital, Enders Building Room 730, 300 Longwood Avenue, Boston, MA, 02115, United States
Phone: 1-617-875-3251
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Modeling Human Preterm Immunity To Inform Immunization
Annette Scheid1,2, David Dowling2, Ilana Bergelson2, Guzman Sanchez-Schmitz2, Helen Christou3, Tobias Kollmann4 and Ofer Levy2. 1Division of Newborn Medicine, Tufts Medical Center, Boston, MA; 2Department of
Medicine, Division of Infectious Diseases, Boston Children's Hospital & Harvard Medical School, Boston, MA; 3Department of Newborn Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston,
MA and 4Department of Pediatrics, Division of Infectious and Immunological Diseases, University of British Columbia, Vancouver, Canada.
BACKGROUND: Over 10% of all global births are preterm, generating newborns with a particularly heightened risk of infection. Immunization is a key approach to protecting infants from infection, but immunity of
preterm infants is impaired, reducing responses to sub-unit vaccines such as that for hepatitis B virus (HBV). Adjuvantation by using live attenuated vaccines that are self-adjuvanted such as Bacille Calmette-Guérin
(BCG) or by the addition of Toll-like receptor (TLR) agonists to boost Th-polarizing cytokine responses may enhance vaccine responses in special populations. Whereas Th1- and Th2-polarizing cytokines boost
cell-mediated and antibody production, respectively, responses of preterm leukocytes to multiple TLR agonists are impaired (Lavoie, P et al J Infect Dis 2010), and little is known regarding human preterm immune
responses to licensed adjuvanted vaccines. There is thus an unmet need to characterize preterm Th-polarizing cytokine responses to adjuvanted vaccines, which would play a significant role in informing preterm
immunization.
OBJECTIVE: To assess whether a preterm whole blood assay may allow modeling immune polarizing cytokine production in response to candidate adjuvants and licensed vaccines.
DESIGN/METHODS: Late preterm (34 weeks gestation) and term (>37 week GA) cord blood as well as healthy adult peripheral blood was collected and promptly (within a 4 hour window) diluted and added to a 96
well plate prior to stimulation for 6 hours with a panel of TLR agonists including Poly I:C (a TLR3), lipopolysaccharide (LPS, TLR4), R848 (TLR7/8), in addition to adjuvanted vaccines HBV (Engerix-B,
GlaxoSmithKline), BCG (Statens Serum Institut) (N =1-3 per group). Cytokine responses from whole blood supernatants were analyzed using ELISA and multiplex assays.
RESULTS: Stimulation of preterm whole blood with TLR agonists induced TNF-α and IL-1ß that was especially marked with the TLR7/8 agonist R-848. HBV induced modest production of IL-1, IL-6 and CXCL-8, while
BCG induced greater amounts of these cytokines as well as the Th1-polarizing TNF-α.
CONCLUSIONS: A high throughput preterm whole blood assay system is feasible and allows modeling of adjuvant- and adjuvanted vaccine-induced cytokine production from human preterm blood leukocytes. This
assay system can be used to model Th-polarizing cytokine induction in response to licensed and novel candidate vaccines to inform preterm vaccine development.
2014 Eastern SPR Annual Meeting
Abstract Number: 3608
Filename: 750854
Publication Number: 442
Presenting Author: Alexa S. Calero, MD
Department/Institution/Address: Stony Brook Long Island Hospital, Department of Pediatrics HSC 11 - 060, Stony Brook, NY, 11794-8111, United States
Phone: 973-9806011
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Does Hypoxia Evoke Enkephalin Synthesis and Release from Chromaffin Cells? Investigating a Novel Stress Response To Acute Hypoxia
Alexa S. Calero1 and Marian J. Evinger1. 1Pediatrics, Stony Brook Long Island Children's Hospital, Stony Brook, NY.
BACKGROUND: Oxygen deprivation is a significant cause of neonatal morbidity and mortality. Accordingly, hypoxia evokes substantial catecholamine release from this tissue. Prior to maturation of the sympathetic
nervous system, the adrenal medulla is largely responsible for sensing hypoxia. However, although the adrenal medulla synthesizes considerable quantities of opioid peptides, notably enkephalin, we do not know
whether acute hypoxia likewise induces opioid peptide release and accelerates chromaffin cell-based enkephalin production as it does in the central nervous system.
OBJECTIVE: We seek to determine whether an acute reduction in oxygen concentration [O2] stimulates the synthesis and release of enkephalin in chromaffin cells.
DESIGN/METHODS: Mouse pheochromocytoma cells (MPC10/9/96 line) were used to investigate hypoxia-evoked enkephalin synthesis and release. MPC cells were subjected to reduced oxygen ([O2] =10 %) by
incubation in a Billups-Rothenberg chamber. Following preparation of cell extracts, synthesis of pre-pro-enkephalin (pENK) messenger RNA (mRNA) was determined using reverse-transcriptase polymerase chain
reaction (RT-PCR) on complementary DNA templates synthesized from MPC total RNA; cyclophilin mRNA was utilized as an internal control. A mouse met-enkephalin peptide (ENK) ELISA was employed to measure
enkephalin cellular content and release.
RESULTS: Reduced oxygen concentrations stimulate enkephalin gene expression in MPC cells. When MPCs are incubated in 10% O2 for intervals (0, 15, 30, 45 and 60 min), RT-PCR reveals 40 – 140 % increase in
enkephalin mRNA by 60 min. Reduced [O2] also stimulates enkephalin peptide (ENK) production. Cellular content of ENK increases by an average 20 % after 60 minutes of hypoxia. Hypoxia also markedly enhances
ENK secretion: we detect an average 55 % increase in metENK secreted into the media following 60 minutes of hypoxia.
CONCLUSIONS: Acute hypoxia stimulates the release of met-enkephalin from chromaffin cell-derived MPC cells. Hypoxia-evoked ENK release is accompanied by stimulation of pre-pro-enkephalin gene expression
(as reflected by increased mRNA synthesis) and enhanced production of ENK peptide. Clinically, the ability of acute hypoxia to evoke significant release of enkephalin opioid peptides from chromaffin cells in neonates
may influence reflex regulation of blood pressure and heart contractility during asphyxia.
2014 Eastern SPR Annual Meeting
Abstract Number: 3814
Filename: 753160
Publication Number: 443
Presenting Author: Munmun Rawat, MBBS
Department/Institution/Address: Division of Neonatology, 219 Bryant Street, Buffalo, NY, 14222, United States
Phone: 001-703-462-0540
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Significance of Apnea at Birth Following Cesarean Section under General Anesthesia
Munmun Rawat1, Sylvia F. Gugino1, Daniel D. Swartz1, Carmon Koenigsknecht1, Bobby Mathew1, Jayasree Nair1, Praveen K. Chandrasekharan1 and Satyan Lakshminrusimha1. 1Division of Neonatology, The Women
and Children's Hospital, Buffalo, NY.
BACKGROUND: Many fetuses with in utero compromise are delivered by cesarean section under inhaled anesthetic that can depress fetal respiration. It is unknown if a newborn delivered by c-section with maternal
general anesthesia presenting with apnea is compromised similar to a gasping neonate.
OBJECTIVE: To compare hemodynamic and gas exchange parameters in asphyxiated lambs with and without apnea following maternal general anesthesia with inhaled isoflurane.
DESIGN/METHODS: Term pregnant ewes underwent c-section under isoflurane anesthesia. Fetal lambs were partially exteriorized and instrumented. 20% Meconium (5ml/kg in amniotic fluid) was instilled to the
endotracheal tube. The umbilical cord was occluded twice for 5min separated by a 5min recovery to induce asphyxia. After asphyxia, 23 lambs continued to gasp and 8 had terminal/secondary apnea. Baseline
characteristics, hemodynamic parameters and blood gases were compared at baseline, 1st cord occlusion, recovery, 2nd cord occlusion, delivery and in the first 30min of life.
RESULTS: Gestational age, birth weight and baseline blood gases were similar between the 2 groups. At delivery the HR, BP, carotid flow and pH were lower and PaCO2 was higher in terminal apnea group
compared to the continuous gasping lambs. After resuscitation with PPV, hemodynamic and gas exchange improved similarly in both groups.
Parameters just before resuscitation Terminal apnea
Continuous gasping
HR/min
83±11*
125±11
BP mmHg
24±14*
54±24
Carotid Flow ml/kg/min
9±3*
37±6
pH
6.98±0.2*
7.09±0.1
PaCO2
115±11*
93±5
PaO2
14±3
15±3
BE
-11±3
-11±2
* p<0.05 cf continuous gasping
CONCLUSIONS: In the presence of fetal compromise, apnea at birth is associated with hemodynamic decompensation and impaired gas exchange and should not be assumed to be transient respiratory depression
due to maternal anesthesia. This study supports NRP recommendation of prompt PPV for an infant presenting with apnea or gasping at birth.
2014 Eastern SPR Annual Meeting
Abstract Number: 1981
Filename: 753868
Publication Number: 444
Presenting Author: Umesh Paudel, MBBS
Department/Institution/Address: Department of Pediatrics, Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, 100 Woods Rd, Valhalla, NY, 10547, United States
Phone: 9144938558
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Are Single Nucleotide Polymorphisms of Matrix Metalloproteinase Proteinase-9 Gene Associated With BPD in ELBW Infants?
Umesh Paudel1, Narendra Dereddy1, Nayan Patel2, Joseph Tilliard2, Johanna Calo1, Divya Chhabra3 and Lance Parton1. 1Dept of Pediatrics, Div of Newborn Medicine, Maria Fareri Children's Hospital at Westchester
Medical Center, Valhalla, NY; 2Dept of Pediatrics, New York Medical College, Valhalla, NY and 3Channing Div of Network Medicine, Brigham and Women's Hospital, Boston, MA.
BACKGROUND: BPD appears to result from arrested lung development and is characterized by abnormal alveolar septation and microvascular maturation. Alveolarization requires extracellular matrix remodeling, a
process which involves matrix metalloproteinases (MMPs). MMP-9 is a proteolytic enzyme and polymorphisms of its gene are associated with COPD and asthma. We therefore considered rs3918242 and rs17576 as
the candidate genes.
OBJECTIVE: We tested the hypothesis that rs3918242 and rs17576 are associated with BPD in ELBW infants.
DESIGN/METHODS: This is an ongoing cohort study that enrolls infants with BW <1 kg, without congenital or chromosomal anomalies. BPD is defined as need for O2 at 36 weeks post-menstrual age. DNA was
isolated from buccal mucosal swabs (N=110) and subjected to allelic discrimination using Taqman probes during real-time PCR. Tracheal aspirates were collected (N=21) and MMP 9 levels measured by ELISA.
ANOVA, Chi square analyses and t-test were performed with P<0.05 denoting statistical significance.
RESULTS:
Gestational age (mean± SD)
Birth weight (mean± SD)
No BPD (n=42)
BPD (n=68)
26.2 ±1.6
25.3 ±1.6
0.003
840.1 ±144
712 ±141
<0.001
0.38
Male Gender
Race
16
33
Caucasian
16
23
Black
10
23
Hispanic
15
18
Other
1
4
Genotype
rs3918242
rs17576
No BPD
BPD
CC
16
12
Ct
22
42
tt
4
14
QQ
29
32
Qr
10
29
rr
3
7
Any r
13
36
P value
0.86
P value
0.04
0.07
0.04
Birth weights and gestational ages were smaller in the BPD group. Association analysis carried out using PLINK showed that SNPs were associated with BPD after adjusting for GA(p=0.006) and BW(p=0.007).
MMP-9 expression in tracheal aspirate was significantly higher among tt and rr genotypes.
CONCLUSIONS: In this pilot study, ELBW infants who progressed to BPD were more likely to contain the minor allele for the MMP-9 rs3918242 and rs17475. We speculate that higher MMP-9 proteolytic enzyme
expression in lung parenchyma increases the risk of BPD in preterm neonates.
2014 Eastern SPR Annual Meeting
Abstract Number: 3718
Filename: 752297
Publication Number: 445
Presenting Author: Joanna D. Costa, MD
Department/Institution/Address: 6 York Road, Wilmington, DE, 19803, United States
Phone: 609 315 1735
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Impact of Hyperoxia and Barotrauma on Pulmonary Artery Smooth Muscle Cells (PASMC): Physiologic and Molecular Correlates
Joanna D. Costa1,2,3, Yan Zhu2, Deepthi Alapati1,2,3, Victoria Maduskuie5, Paul Fawcett5, Jay S. Greenspan1,2,3 and Thomas H. Shaffer1,2,3,4. 1Pediatrics, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE;
Nemours Lung Research Center, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE; 3Pediatrics, Jefferson Medical College/Thomas Jefferson University, Phildelphia, PA; 4Temple University School of
Medicine, Philadelphia, PA and 5Center for Clinical Diagnostics, Alfred I. DuPont Hospital for Children, Wilmington, DE.
BACKGROUND: Abnormal pulmonary vascular remodeling (PVR) induced by hyperoxia and barotrauma is the pathological hallmark of pulmonary hypertension (PH) in preterm infants with bronchopulmonary
dysplasia (BPD). Pulmonary artery smooth muscle cells (PASMC) are the most numerous cell types in the vessel wall and play a critical role in PVR. However, the direct effects of hyperoxia and barotrauma on
PASMC are unknown.
OBJECTIVE: To develop an in vitro model of lung injury and compare the direct effects of hyperoxia and barotrauma on the production of inflammatory mediators in PASMC. We hypothesized that the individual as
well as combined effects of hyperoxia and pressure barotrauma will result in alterations in PASMC.
DESIGN/METHODS: Primary human PASMC were cultured in temperature and pressure controlled air-tight chambers and exposed to three experimental conditions: 95% FiO2, positive pressure ventilation at a rate of
60 cycles per minute with pressures of 24/8 cm H2O, or both for 24 hours. The pressure within the chamber was continuously monitored using a manometer. Control cells were cultured in room air under atmospheric
pressure. After a 24 hour exposure, cell medium was collected and IL-6 and IL-8 levels were measured by ELISA and Human Cytokine 25-Plex Panel using a Luminex 200 analyzer. Cells were also collected for
histology.
RESULTS: Secretion of IL-6 was higher in the hyperoxia group (p <0.05) and positive pressure group (p <0.05). Secretion of IL-8 was also higher in the hyperoxia group (p<0.05) and positive pressure group (p <0.05).
Secretion of both IL-6 and IL-8 was comparable to control in the combined hyperoxia and positive pressure group. Data obtained using the Luminex multi-plex array demonstrated similar trends. Histological analysis is
ongoing. DAPI staining of PASMC showed a decrease in cell nuclei (p<0.01) in the combined hyperoxia and positive pressure group when compared to control.
CONCLUSIONS: Both hyperoxia and barotrauma directly induce over-expression of inflammatory mediators by PASMC. Thus, abnormal PVR induced by hyperoxia and barotrauma may be mediated in part by the
direct inflammatory response of PASMC to both stressors. In this model, the combined stress of hyperoxia and positive pressure seems to affect cell viability, as evidenced by decreased inflammatory markers and
surviving cells under this condition.
2
2014 Eastern SPR Annual Meeting
Abstract Number: 999
Filename: 751801
Publication Number: 446
Presenting Author: Jessica Berger, BA
Department/Institution/Address: Pediatrics, Yale University School of Medicine, Yale Child Health Research Center, 464 Congress Avenue, Room 225, New Haven, CT, 06519, United States
Phone: 203.737.6814
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Impact of Early Extubation and Reintubation on the Incidence of Bronchopulmonary Dysplasia in Neonates
Jessica Berger1, Paulomi Mehta1 and Vineet Bhandari1. 1Pediatrics, Yale University School of Medicine, New Haven, CT.
BACKGROUND: Bronchopulmonary dysplasia (BPD) is a common respiratory comorbidity of prematurity. BPD is associated with multiple antenatal and postnatal factors including genetic susceptibility, intrauterine
infection, and postnatal supplemental oxygen use and invasive mechanical ventilation. Though many have examined the effect of prolonged invasive ventilation on the development of BPD, few have explored the
effect of early extubation in the first week of life. Fewer have studied whether reintubation affects the hazard of developing BPD in the setting of early versus delayed first extubation.
OBJECTIVE: To assess rates of BPD and BPD/death in infants first extubated between day of life (DOL)1-3 versus DOL 4-7 and DOL 8+. Additionally, to assess the impact of extubation failure versus success in
infants first extubated during different periods of postnatal life.
DESIGN/METHODS: We included infants with gestational age ≤28 weeks, birth weight ≤1000g, and intubation on DOL1. Proportional hazards regression modeled time to BPD and BPD/death, adjusting for potential
confounders.
RESULTS: Of 262 infants, 101 (38.55%), 41 (15.65%) and 120 (45.80%) were extubated between DOL1-3, 4-7, and 8+, respectively. Extubation between DOL4-7 versus DOL1-3 was associated with an increased
hazard of developing BPD [Hazard ratio (HR) 1.77; 95% Confidence interval (CI) 1.03-3.04]. Extubation on DOL 8+ was associated with a significantly increased hazard compared to extubation between DOL1-3 (HR
14.51; 95% CI 8.90-23.65) or DOL4-7 (HR 8.19; 95% CI 5.01-13.39). Similar results were noted with BPD/death. Re-intubation did not affect BPD and BPD/death. Rates of reintubation did not significantly differ across
study groups.
CONCLUSIONS: Delaying extubation beyond the first 3 and 7 days was associated with an increased risk of BPD and BPD/death. Re-intubation rates did not differ significantly with prolonged time to first extubation.
Re-intubation was not associated with increased incidence of BPD and BPD/death.
2014 Eastern SPR Annual Meeting
Abstract Number: 3915
Filename: 753938
Publication Number: 447
Presenting Author: Dalal Taha, DO
Department/Institution/Address: Pediatrics/Neonatology, Thomas Jefferson University/Nemours, 833 Chestnut Street, Suite 1210, Philadelphia, PA, 19107, United States
Phone: 2012187865
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Use of High Flow Nasal Cannula in Preterm Infants: Superiority To CPAP?
Dalal Taha1, Michael Kornhauser2, Jay S. Greenspan1 and Zubair H. Aghai1. 1Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA and 2Alere, Watham, MA.
BACKGROUND: High-flow nasal cannula (HFNC) is increasingly being used as a mode of noninvasive respiratory support for preterm infants. Unregulated distending pressure generated by HFNC may be injurious to
the lungs.
OBJECTIVE: To compare neonatal outcomes with the use of HFNC versus continuous positive airway pressure (CPAP) in preterm infants.
DESIGN/METHODS: This study is a retrospective data analysis from the Alere Neonatal Database for infants born between 01/10 and 07/13, weighing ≤ 1500 grams, and received HFNC or CPAP. The baseline
demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC or HFNC+CPAP. Multivariate regression analysis was performed to control for the
variables that differ in bivariate analysis.
RESULTS: A total of 3,126 infants met the inclusion criteria. 1,349 infants were in the CPAP group (BW 1130±263 g, GA 29.1±2.4 w), 480 infants in the HFNC group (BW 1055±287g, GA 28.5±2.5 w), and 1,297 in
the CPAP+HFNC group (BW 987±272g, GA 27.6±2.3 w). The groups differed in BW, GA, %ventilated, ventilator days and surfactant use. When corrected for these variables; the days to room air, the days to PO feed
and length of stay (LOS) was significantly higher with the use of HFNC compared to CPAP (all p<0.001). Similar differences were found when infants in the CPAP group were compared with infants in the
HFNC+CPAP group. Additionally, the odds ratio for developing chronic lung disease (CLD) was significantly increased in the HFNC+CPAP group compared to the CPAP group (OR 1.46, 95% CI 1.201-1.775,
p<0.001).
CPAP
HFNC
CPAP+HFNC
(1,349)
(480)
(1,297)
CPAP and/or HFNC (mean±SD)
10.4±12.8
12.3±14.4
**24.9±19.5
Days to RA
27.9±30.6
*42.3±44.0
**49.0±40.5
CLD (%)
360 (26.7)
147 (30.6)
^627
Days to PO
33.2±21.0
*42.1±26.8
**48.7±27.2
Days to fullPO
50.0±25.7
55.2±31.9
62.9±33.9
LOS (days)
61.9±29.5
*73.8±44.2
**87.1±43.1
(48.3)
CONCLUSIONS: Use of HFNC in preterm infants is associated with increased respiratory morbidities, delayed PO feeding and prolonged hospitalization. A large clinical trial is needed to evaluate safety and efficacy
of HFNC in preterm infants.
2014 Eastern SPR Annual Meeting
Abstract Number: 3598
Filename: 750735
Publication Number: 448
Presenting Author: Vinay Sharma, MD
Department/Institution/Address: Women and Children's Hospital of Buffalo, 219 BRYANT STREET, BUFFALO, NEW YORK, 14222, United States
Phone: 304 6885826
Fax: 716 8787945
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Fellow in Training
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Resuscitator's Perceptions and Time for Corrective Ventilation Steps during Simulated Neonatal Resuscitation
Vinay Sharma1, Bobby Mathew1, Satyan Lakshminrusimha1 and Vivien Carrion1. 1Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, NY.
BACKGROUND: NRP guidelines 2010 recommends performing corrective ventilation steps (MRSOPA) if the Heart Rate (HR) is below 100 after 30 seconds of positive pressure ventilation (PPV). Dannevig et al have
shown that delay in initiation of circulatory support for 90 sec may be harmful. The time taken to perform MRSOPA is not known. Performing MRSOPA can cause delay in initiation of chest compressions (CC).
OBJECTIVE: To determine the time taken to perform MRSOPA and provider's preference in performing MRSOPA at different levels of bradycardias during simulated resuscitation scenarios.
DESIGN/METHODS: All simulations were performed on SimNewB® and videotaped. Participants were given two resuscitaion study scenarios of term neonates: One with HR of 0 and another with HR 40, presented
in random order. Following initial assessment participants began PPV, which were reported to be ineffective. To improve ventilation,options were either to intubate or to perform MRSOPA. Study participants who
failed to initiate or performed incomplete MRSOPA steps received demonstration of corrective maneuvers. They were then asked to repeat the scenario. Time taken to reach CC after performing MRSOPA was
recorded. The end point of all simulations was initiation of CC. All videos were interpreted by primary investigator. The time taken to perform MRSOPA was the difference between the time taken to initiate CC with
and without MRSOPA.
RESULTS: 35 participants completed the study. 2/35 participants performed MRSOPA with initial HR =0 while 26/35 did so with an initial HR =40(p<0.01). The average time to initiate CC was 131 sec with MRSOPA
and 82 sec without MRSOPA (P<0.01). The time taken to perform MRSOPA was 48.9 sec.
CONCLUSIONS: In this simulated resuscitation study, average time taken to perform MRSOPA was 49 sec. Providers were more likely to omit MRSOPA steps in the scenario of asystolic cardiac arrest. Time taken
to perform MRSOPA was independent of years of experience and level of training.
2014 Eastern SPR Annual Meeting
Abstract Number: 1106
Filename: 753260
Publication Number: 449
Presenting Author: Satyan Lakshminrusimha
Department/Institution/Address: 219 Bryant St, Buffalo, NEW YORK, 14222, United States
Phone: 7168787673
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Hemodynamic and Respiratory Variables With Resuscitation Adhering To Oxygen Saturation Guidelines from Neonatal Resuscitation Program (NRP)
Satyan Lakshminrusimha1, Bobby Mathew1, Jayasree Nair1, Sylvia F. Gugino1, Carmon Koenigsknecht1, Munmun Rawat1, Praveen K. Chandrasekharan1 and Daniel D. Swartz1. 1University at Buffalo/Women and
Children's Hospital of Buffalo, Buffalo, NY.
BACKGROUND: NRP recommends upper and lower limits of preductal SpO2 based on normal values in preterm and term infants without any need for resuscitation (Dawson et al, Pediatrics 2010). These limits have
not been validated in a model of asphyxia and respiratory disease.
OBJECTIVE: To evaluate oxygenation and pulmonary/systemic hemodynamics following resuscitation with strict adherence to SpO2 guidelines in a term lambs with asphyxia & meconium aspiration.
DESIGN/METHODS: Pulmonary and carotid blood flow were measured in 24 lambs. Meconium (5ml/kg of 20% solution of human meconium in amniotic fluid) was instilled in the tracheal tube. Umbilical cord was
occluded intermittently for two periods of 5 min each to induce asphyxia and gasping resulting in meconium aspiration. Preductal SpO2 and blood gases were checked at baseline, cord occlusion, delivery and at
1,2,5,10,15,20,25 and 30 min of life. Ventilator settings were adjusted to maintain ETCO2 of 35-45mmHg and SpO2 as per NRP guidelines (shaded area in fig A).
RESULTS: Two lambs went into cardiac arrest requiring epinephrine and were excluded. For 22 lambs, the arterial pH was 6.96±0.04 and paCO2 was 103±8mmHg prior to resuscitation. Maintaining SpO2 in the
targeted range required frequent adjustment of inspired O2 (21-57%O2). PaO2 steadily increased with a 9-fold increase in pulmonary blood flow. Carotid flow returned to pre-asphyxia values within 1 min of
resuscitation. The increase in PaO2 and pulmonary blood flow were similar to that observed in lambs without asphyxia ventilated with 21%O2 (data not shown).
CONCLUSIONS: Maintaining SpO2 within limits recommended by NRP by actively adjusting inspired O2 leads to effective oxygenation and hemodynamic improvement in asphyxiated lambs with lung disease. These
findings support the current NRP SpO2 guidelines for O2 supplementation during resuscitation of an asphyxiated neonate.
2014 Eastern SPR Annual Meeting
Abstract Number: 4588
Filename: 754331
Publication Number: 450
Presenting Author: Bobby Mathew
Department/Institution/Address: Department of Pediatrics, 219 Bryant St., Buffalo, NY, 14222, United States
Phone: 1-716-878-1893
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Hemodynamics and Gas Exchange at Varying Depth of Chest Compressions During Cardiopulmonary Resuscitation in Newborn Piglets
Bobby Mathew1, Melissa F. Carmen3, Jayasree Nair1, Daniel D. Swartz2, Sylvia F. Gugino2, Carmon Koenigsknecht1, Vinay Sharma1 and Satyan Lakshminrusimha1. 1Department of Pediatrics, University of Buffalo,
Buffalo, NY; 2Department of Physiology, University of Buffalo, Buffalo, NY and 3Department of Pediatrics, University of Rochester, Rochester, NY.
BACKGROUND: The neonatal resuscitation program (NRP) recommends depth of chest compression during cardiopulmonary resuscitation to be one third of the anterior posterior diameter (APD) of the chest. There
is limited evidence to support this recommendation.
OBJECTIVE: To compare the hemodynamics and gas exchange with chest compressions to 1/3 and 1/4 AP diameter of the chest in newborn piglets.
DESIGN/METHODS: Newborn piglets 1-3-d old were intubated and anesthetized with isoflurane. Right carotid arterial, jugular venous and femoral arterial lines and a left carotid artery flow probe were placed. Piglets
were asphyxiated by endotracheal tube occlusion to asystole. Animals were randomized to receive chest compressions to 1/3 or 1/4 APD of the chest. CPR was performed as per NRP guidelines with 100%O2. To
ensure precise depth of compression the compressions were performed by placing the animal in a custom designed box with an adjustable base by the same operator. Arterial blood gases were obtained at cardiac
arrest, after 30 seconds of PPV, 1 min, 4 min and every 4 min till return of spontaneous circulation (ROSC) or 20 min. Systemic BP and carotid blood flow (CBF) were recorded continuously.
RESULTS: 8 piglets were randomized to 1/4 APD and 6 to 1/3 APD arms. 3 animals had achieved ROSC (2 in the 1/4 and 1 in the 1/3 APD groups). There were no significant differences in the systolic, diastolic or
mean BP between the groups. Similarly there were no differences in the pH, PaCO2 or PaO2 at at any of the time points studied. There was no difference in the CBF between the groups (not shown).
CONCLUSIONS: In this model of asphyxia induced cardiac arrest and resuscitation, gas exchange and hemodynamics were similar at 1/3 or 1/4 depth of chest compressions. Further studies with larger number are
needed to evaluate survival at different depths of CC.
(Supported by AAP NRP Young investigator award grant - MFC).
2014 Eastern SPR Annual Meeting
Abstract Number: 1240
Filename: 754545
Publication Number: 451
Presenting Author: Hilda Kabali, MD
Department/Institution/Address: Pediatric, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, United States
Phone: +1 215 456 7612
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Children's Home Sleep Environment and Sleep Problems in an Inner City Practice
Hilda Kabali1, Michelle King1, Stefan F. Mandakovic1, Casandra Arevalo1 and Matilde Irigoyen1. 1Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, PA.
BACKGROUND: Sleep disorders are common in childhood. The role of home environmental factors in sleep disorders is not well understood.
OBJECTIVE: To assess the association of health status and home environmental factors on sleep problems among children in an inner city practice.
DESIGN/METHODS: We conducted a prospective cross sectional study of all children ages 2-12 years who made a well-child visit to a hospital-based pediatric continuity clinic 09/2012 - 03/2013. The clinic serves a
predominantly low income, African American community. Parents were asked to complete a brief sleep questionnaire adapted from BEARS (Bedtime issues, Excessive daytime sleepiness, night Awakenings,
Regularity/duration of sleep, Snoring). The screener included additional questions about child's health status, bed/wake time hours, and exposure to home environmental factors related to sleep hygiene, including
room sharing, bed sharing, TV in bedroom, pets, and smoking. Medical records were reviewed for co-morbidities.
RESULTS: 400 out of 549 medical records of children with well child visits had completed screeners: mean age 5.4+3.0(SD) years, females 54%, Medicaid 95%, obesity 17%, asthma 29%. Home environmental
exposures included: room sharing 63%, bed sharing 23%, TV in bedroom 75%, pets 33%, smokers 36%. Most children had regular bedtime hours and went to bed by 9 pm (96%); bed/wake time hours shifted 2-3
hours later on weekends. Most parents felt their children had “enough” sleep (89%). Overall prevalence of sleep problems was 22%, most common were night awakening and excessive daytime sleepiness. Children
perceived in poor/fair health were significantly more likely to have sleep problems (34%) compared to children in good (29%) or excellent health (13%, p=0.001). Children with asthma were more likely to experience
snoring and children with eczema were more likely to have night awakenings, but this was not statistically significant. Room sharing, bed sharing, TV in bedroom, pets and smoking were not associated with sleep
problems.
CONCLUSIONS: Among children in an inner city practice, nearly one quarter had a sleep problem. Most children had regular bedtime hours but bedtime hours flexibility was seen on weekends. Parental ratings of
child health status were associated with sleep problems. However, home environmental exposures were not. Although not associated with sleep problems, the most striking finding was most children had a TV in their
bedroom.
2014 Eastern SPR Annual Meeting
Abstract Number: 2005
Filename: 754007
Publication Number: 452
Presenting Author: Nisha Narayanan, BA
Department/Institution/Address: George Washington University School of Medicine, 1111 25th Street NW, Apt 501, Washington, DC, DC, 20037, United States
Phone: 5103162885
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Medical Student
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: A Pilot Academic-Community Partnership To Advance the DC Healthy Schools Act
Nisha Narayanan1, Jonathan Tatum2, Margarita Ramos1, Jessica Kim1, Nisha Punatar1 and Michele Mietus-Snyder2. 1George Washington University School of Medicine, Washington, DC and 2Children's National
Health System, Washington, DC.
BACKGROUND: The goals of the DC Healthy Schools Act 2010 (HSA) align with pediatric evidence-based health promotion. However, progress has been slowed by a lack of engagement by students, faculty, and
parents, especially in communities at greatest risk for health disparity.
OBJECTIVE: To pilot a mentor-based health behavioral change model that positions medical students in DC Public Schools (DCPS) to help reach HSA goals.
DESIGN/METHODS: Team Kid POWER (KiPOW) consists of medical students who commit three hours/month to visit elementary school classrooms midday over one 4-month semester to teach short nutrition and
activity lessons, then to play at recess and eat school lunch together. Parental involvement is encouraged with weekly newsletters, a mid-semester dinner and end-of-semester picnic. Pre-post measures were taken
for weight, height, blood pressure (BP) and Fitnessgram Pacer scores per standard school site protocol and compared by paired t-test. Scores from standardized DCPS health literacy testing at the end of the
semester from 2012 (before KiPOW) were compared with 2013 scores by upaired t-test.
RESULTS: 57 fifth grade students in two elementary school classes participated (51% female; 100% Black). Mean BMI was at the 98th percentile and did not change. Baseline BP was normal; systolic BP did not
change but there was a drop in diastolic BP (mean reduction 4.4 + 10 mm Hg, p = 0.0005). There was a parallel increase in Pacer scores (mean change 10 + 14 laps, p = 0.0006). Health literacy test scores improved
in the nutrition category in both schools, by 2.9 & and 4.8%. Physical Education knowledge improved in one school by 2.8%, and was unchanged at the other. Medical student enthusiasm for the opportunity to
work/play/eat with school children was universal. Elementary students welcomed Team KiPOW and all school stakeholders endorsed the program. A limitation of this pilot is the lack of objective measures of change in
school lunch and recess behavior; lunch choices and recess activity will be quantified in the KiPOW 2014 program.
CONCLUSIONS: An academic-community partnership promoting face-time with trusted medical student health mentors who model good nutrition and active play improves fitness outcomes, bolsters health literacy in
elementary school children and may be a feasible adjunct to reinforce school wellness policy in other inner city school districts in proximity to health professional schools.
2014 Eastern SPR Annual Meeting
Abstract Number: 2004
Filename: 753988
Publication Number: 453
Presenting Author: David I. Rappaport, MD
Department/Institution/Address: General Pediatrics, Nemours/AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, United States
Phone: 302 651 6463
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Family-Centered Rounds Among Spanish-Speaking Families
David I. Rappaport1, Johan Tijerino1, Ashley Anttila2, Nusrat Zaman2 and Iman Sharif1. 1General Pediatrics, Nemours/AI duPont Hospital for Children, Wilmington, DE and 2Residency Program, Jefferson Medical
College/AI duPont Hospital for Children, Wilmington, DE.
BACKGROUND: Family-Centered Rounds (FCR) offer families the ability to partner with providers for medical decision making. FCR have become the preferred rounding format at pediatric institutions due to several
advantages for physicians, trainees, and families. Previous studies have revealed high satisfaction with FCR among staff and English-speaking families, but few studies have investigated FCR with Spanish-speaking
families.
OBJECTIVE: To identify which factors are most strongly associated with FCR satisfaction among Spanish-speaking families.
DESIGN/METHODS: Spanish-speaking General pediatrics patients at our children's hospital from July through November 2013 were identified on admission. A bilingual research assistant (RA) observed FCR and
completed a rounds observation tool, which included whether an interpreter was used and the interpretation type (live hospital interpreter, Spanish-speaking clinician, family member, language line, live video
interpreter via Ipad), which was at the medical team's discretion. After rounds, the RA interviewed families to collect parent demographics, English reading/writing ability, previous FCR experience, and satisfaction with
the helpfulness of the interpreter. We used logistic regression to test variables associated with increased odds of satisfaction with interpretation.
RESULTS: We collected data on 45 families over 4 months. Most respondents were patients' mothers (42, 93.3%), from Mexico (37, 82.2%), had a grade school education (30, 70%), and spoke English "not at all"
(17, 37.8%) or "poorly" (27, 60.0%). Previous experience with FCR was varied (35.6% had none, 22.2% had 1-2 prior exposures, and 42.2% had more than 2 exposures). Overall, families were either completely
satisfied (29, 64.4%) or somewhat satisfied (16, 35.6%) with the helpfulness of the interpreter on FCR. Parent and patient demographics were not significantly associated with FCR satisfaction. However, interpreter
type was associated with a statistically significant difference; as compared to language line or Spanish-speaking clinician, a live hospital interpreter or live Ipad interpreter was associated with an increased odds of
complete satisfaction with the interpreter (OR 11.8, p < 0.026).
CONCLUSIONS: Spanish-speaking families report higher levels of satisfaction with in-person interpreters on FCR, including hospital interpreters and using Ipads, compared to telephone interpreters. Live
interpretation via Ipad on FCR may be a promising new approach.
2014 Eastern SPR Annual Meeting
Abstract Number: 2204
Filename: 755127
Publication Number: 454
Presenting Author: Simone Bennett, MD, MS
Department/Institution/Address: Pediatrics, 7 Florence St #5, Cambridge, MA, 02139, United States
Phone: 206-303-9361
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Primary Language Is Associated With Parent-Teacher Disagreement about Child Attention and Hyperactivity Problems among Latino Children
Simone Bennett1, Caroline Kistin2 and Jenny Radesky2. 1Pediatrics, Boston Combined Residency Program, Boston, MA and 2Pediatrics, Boston Medical Center, Boston, MA.
BACKGROUND: Latino children are diagnosed with attention and hyperactivity disorders less frequently than white children. Both parental and teacher concern for symptoms are required for diagnosis.
OBJECTIVE: Latino children are diagnosed with attention and hyperactivity disorders less frequently than white children. Both parental and teacher concern for symptoms are required for diagnosis.
DESIGN/METHODS: We performed a cross-sectional analysis of data from the 8th grade wave of the national ECLS-K database to analyze discordance between parent and teacher concerns regarding child attention
and hyperactivity in Spanish-speaking and English-speaking Latino families compared to English-speaking white families. Race, ethnicity, and primary language were determined by parental report. Parent-teacher
disagreement was defined by no parental concern (no concern about child behavior or report that child was less attentive or more active than children of the same age) for a child for whom the teacher was concerned
(talked to a counselor about child's behavior or reported child was rarely or never attentive in class or disruptive most or all of the time). Parent-teacher disagreement was evaluated using chi-square tests for bivariate
and logistic regression for multivariate analyses.
RESULTS: The weighted sample included 344,985 Spanish-speaking Latino children, 296,382 English-speaking Latino children, and 2,160,705 English-speaking white children. Children in the three groups did not
differ with regard to age or gender. Spanish-speaking children were more likely to live below the federal poverty threshold (46% vs. 17% of Latino English-speaking and 10% of white English-speaking children, p
<0.001). Fewer Spanish-speaking parents reported concerns about child symptoms than other parents (38% vs. 49% and 60%, p <0.0001). In the multivariate logistic regression analysis, compared to white children,
the odds of parent-teacher disagreement were 1.77 (95% CI 1.73-1.81) for Spanish-speaking and 1.28 (95% CI 1.25-1.31) for English-speaking Latino children.
CONCLUSIONS: For Latino families, primary Spanish language at home is associated with teacher, but not parent, concern for attention and activity symptoms. This may represent a difference in cultural norms
regarding child behavior.
2014 Eastern SPR Annual Meeting
Abstract Number: 2086
Filename: 754511
Publication Number: 455
Presenting Author: Fredrick Dapaah-Siakwan, MD
Department/Institution/Address: Pediatrics and Adolescent Medicine, Albert Einstein Medical Center, 5501 Old York Road, Levy 2, Philadelphia, PA, 19141, United States
Phone: +12674747213
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Health Status of Newly Resettled Refugee Children in Philadelphia, PA
Fredrick Dapaah-Siakwan1, Sonia Mehra1 and Morgan Leafe1. 1Department of Pediatrics and Adolescent Medicine, Albert Einstein Medical Center, Philadelphia, PA.
BACKGROUND: Refugees in the United States bring with them various health conditions unique to their regions of origin or by virtue of exposures encountered during their migration. The demographics of refugees
entering the United States keep changing and thus the need to keep track of the results of the health screening of refugees upon entry into the US remains vital.
OBJECTIVE: To assess the health status of newly arrived pediatric refugees resettled in Philadelphia, PA.
DESIGN/METHODS: The study was conducted as a retrospective chart review of all newly resettled refugee children evaluated at Einstein Medical Center in Philadelphia, PA from September 2012 through August
2013. We collected data regarding physical examination findings and results of selected screening tests for TB, stool parasites, vitamin D, and vaccine-preventable diseases performed as part of the health screening.
Data was analyzed using IBM SPSS 21.0. Association between categorical variables was tested with Pearson's chi-square or Fisher's exact test. A p-value of 0.05 was considered significant.
RESULTS: A total of 66 pediatric refugees were examined. Median age was 9 years (range 1-19 years) with 58% being male. Middle East, Africa and East and Central Asia made up 58%, 26% and 12% of the
refugee cohort respectively. Iraqis constituted 52% of the study population. Among children aged ≥2 years, 6% were underweight and 12% were overweight or obese. Vitamin D deficiency/insufficiency (<30 ng/ml)
was found in 70% of those tested. Refugees of Middle Eastern origin were more likely than those from other geographic regions to be vitamin D deficient/insufficient (p<0.001; OR=58; 95% CI = 6.49 -518). Ten
percent had eosinophilia and 24% had pathogenic and/or potentially pathogenic ova and/or parasites in the stool. Three children tested positive for Schistosoma antibody. Latent tuberculosis infection (LTBI) was
diagnosed in 25% of the subjects and no refugee had active tuberculosis. None tested positive for HBsAg, HIV, RPR or hepatitis C. Venous blood lead levels ≥5ug/dl was found in 12% of the refugees.
CONCLUSIONS: Vitamin D deficiency, parasitic infections and LTBI were common among pediatric refugees relocating to Philadelphia. This reinforces the importance of the domestic health screening exam for all
refugees, as well as the importance of establishment of a medical home and support system for close follow-up.
2014 Eastern SPR Annual Meeting
Abstract Number: 4041
Filename: 755029
Publication Number: 456
Presenting Author: Hans B. Kersten, MD
Department/Institution/Address: Department of Pediatrics, St. Christopher's Hospital for Children, 3601 A Street, Philadelphia, PA, 19134, United States
Phone: 215-427-8150
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Creating a Hunger-Free Hospital Model To Reduce Hunger and Promote Healthy Eating
Hans B. Kersten1, Kirsten Johnson-Moore1 and Elizabeth Oquendo1. 1Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA; 2Department of
Emergency Medicine, St. Christopher's Hospital for Children, Philadelphia, PA and 3Medical Legal Partnership, St. Christopher's Hospital for Children, Philadelphia, PA.
BACKGROUND: St Christopher's Hospital for Children (SCHC) is situated in the poorest major city in the US. This community has a high prevalence of food insecurity (49.1%) [FI] and was designated a “food desert”
since families experience obstacles to accessing healthy foods. Hospitals are uniquely situated to treat hunger, improve food access and to promote healthy eating by addressing both the psychosocial and medical
needs of patients.
OBJECTIVE: To develop hospital-wide initiatives to address FI and food access at an urban tertiary care hospital.
DESIGN/METHODS: Initiatives were developed and promoted by faculty, residents and staff to address the high prevalence of FI and limited food access and to promote healthy eating by using a multi-pronged
approach originally described by Project Bread.
RESULTS: Initiatives include: 1) Expanded FI screening with a validated 2-item questionnaire and a Food Resource Guide to provide information about WIC/SNAP benefits and local food programs for positive
screens. In outpatient clinic: 3691 families screened, 19% had FI, 11% high FI and 4% required legal help over 2 years. FI screening in the ED had 83% to 95% compliance improvement over 6 months. 2) A program
to provide weekly discounted fresh produce (Farm to Families; F2F) was expanded with a prescription program (FreshRX) for providers to directly link families to food. In 2 years: 605 clients were registered and 2601
boxes distributed. Providers wrote 1451 prescriptions and 334 (23%) were redeemed for food boxes. 3) A WIC Mobile Unit was recently brought to the hospital to improve access for families; 55 families changed their
WIC provider to this site. 4) A cart sold fresh produce in the hospital with over 3000 sales and 20% completed with SNAP debit cards, but could not be sustained. 5) Hospital vending machines were changed to
include healthier choices; no difference in sales 1 year before and after change (p = 0.07). 6) 1307 needy families were given Thanksgiving meals through hospital collections and the Nursing Magnet committee
organized bi-annual food drives the last 4 years.7) An educational module was created on FI for ED staff with 56% compliance rate.
CONCLUSIONS: We have successfully implemented a multi-pronged approach to directly impact hunger and nutrition throughout the hospital. Collaboration throughout the hospital and with community organizations
was instrumental for this success. Future research will examine the impact on FI and food access.
2014 Eastern SPR Annual Meeting
Abstract Number: 2340
Filename: 751350
Publication Number: 457
Presenting Author: Akhila Vasthare, MD
Department/Institution/Address: General Pediatrics, Nemours AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, United States
Phone: 302-932-1865
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, House Officer
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Weight Trajectory in Refugee Children After Immigration To the United States
Akhila Vasthare1, Thao-Ly Phan1, Jobayer Hossain1, Sandra Hassink1, Christopher Raab1 and George Datto1. 1Pediatrics, Nemours AI duPont Hospital for Children, Wilmington, DE.
BACKGROUND: Obesity is increasingly recognized as a health concern in the refugee population. Weight on arrival to the United States varies by country of origin but there is limited evidence on the weight trajectory
of refugee children after resettlement in the US.
OBJECTIVE: This study aims to describe the weight status and trajectory of refugee children from three distinct countries of origin after settling in the US.
DESIGN/METHODS: A retrospective cohort study of refugee children from Bhutan, Burma and Iraq, seen between 2010 and 2013, in a refugee clinic in Philadelphia was conducted. Children were excluded from
analysis if they were less than 2 years of age, not seen within one month of arrival to the US, and did not have more than one recorded weight. Children were followed for up to one year in the clinic (mean time of
follow up 8.8 months). BMI, BMI percentile, and BMIz scores were calculated and demographic variables were collected at each clinic visit. Paired samples t-tests were used to compare mean BMIz scores over the
study period. Chi-square analyses were used to compare the proportion of children by weight category over the study period. Mixed-effects model analysis was used to evaluate the change in BMIz score by time,
country of origin, and demographic variables.
RESULTS: 129 children were included in the study (mean age 10 years, 54% female). 55% of the children were from Bhutan, 28% from Burma and 17% from Iraq. Mean BMIz significantly increased from -0.52 (0.11)
on arrival to the US to -0.11 (0.12) at the end of the study period, p<0.001. The proportion of patients classified with BMI >85% increased from 11% to 19% over the study period (p = 0.08) while the proportion of
children classified as underweight remained the same (13% at baseline to 14% at the end of the study period). The yearly rate of change in BMIz score for this population of children significantly increased over the
study period with an average gain of 0.38 (0.13) BMIz units a year (p < 0.01).
CONCLUSIONS: Mean BMIz score in a cohort of refugee children resettling in the US increased over the study period with the proportion of overweight or obese children nearly doubling.
2014 Eastern SPR Annual Meeting
Abstract Number: 3785
Filename: 752914
Publication Number: 458
Presenting Author: Karen L. Warman, MD, MSc
Department/Institution/Address: Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 1621 Eastchester Road, Bronx, NY, 10461, United States
Phone: 718-405-8090
Fax: 718-405-8091
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? No, Not a Trainee
Presenter Copyright Declaration:
I certify that any material I will use, display, distribute, reproduce or have reproduced or distributed in connection with my above noted presentation for which I do not have permission to use, is my original work and/or
is public information or another type of material which does not require securing permission from another party to use, display, distribute, reproduce or have reproduced or distributed.
Title: Are We Following Guideline Recommendations for Allergy Testing of Inner-City Children With Asthma?
Karen L. Warman1, P. Karina Tulipano2 and Ellen J. Silver1. 1Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY and 2Emerging Health, Montefiore Information Technology,
Montefiore Medical Center, Bronx, NY.
BACKGROUND: Inner-city children with asthma have high rates of sensitization and exposure to aero-allergens and high asthma morbidity, yet many children with persistent asthma may not receive sub-specialty
care and allergy testing as recommended by National Asthma Guidelines.
OBJECTIVE: To determine whether inner-city children with asthma are receiving sub-specialty care (allergy and pulmonary) in keeping with guideline recommendations and which factors influence receipt of this care.
DESIGN/METHODS: A retrospective cohort study of children ages 7- 17 with asthma who received primary care in an urban medical center in 2012. Computerized medical records were used to extract data for 3
racial/ethnic groups: Hispanic, Black, Non-Hispanic (NH) and White, NH, on asthma-related health care use from 1997 until 2013 and on age, gender, SES (z scores compared with mean poverty level estimated from
census tract), and insurance type. We compared asthma-related outpatient sub-specialty care (allergy or pulmonary (PULM)), primary care, and acute care utilization (emergency department (ED) visits and
hospitalizations (HOSP)) and other factors by group using Chi-square and ANOVA. We defined High ED utilizers as 2+ ED visits for asthma and High Admits as 2+ admissions.
RESULTS: The cohort consisted of 2925 Hispanic, 1815 Black, NH and 221 White, NH children; 57% male, mean age = 11 yrs. The groups did not differ by gender or age. SES z scores were higher for the White
group (-.95 vs.-3.83 Black and -4.19 Hispanic, p<.001), and more Whites had private insurance (53% vs. 44% Black and 33% Hispanic, p <.001). Primary care visits for asthma did not differ by group (mean = 7.84).
More Hispanic and Black than White children were ever seen in the ED (44% vs. 27%, p< .001) or hospitalized (23% vs. 14%, p< .004) for asthma. Few children had ever had an allergy (7.2%) or PULM (16.2%) visit;
these did not vary by group. More High vs. Low ED users had allergy (14% vs. 4.6%, p< .001) or PULM (33% vs. 10%, p<.001) visits. High vs. Low Admits were more likely to have seen allergy (21.6% vs. 5.5%, p<
.01) or PULM (55.8% vs. 11.6 %, p < .001), but most children with High Admits had never seen an allergist (78.4%) and only 2.3% had >10 allergy visits, suggesting few receive immunotherapy.
CONCLUSIONS: In this sample of inner-city children with asthma, few children were seen by an allergist. Efforts are needed to increase recommended allergy testing of inner-city children with persistent asthma.