2016 Eastern SPR Annual Meeting
Abstract Number: 1617
Filename: 752828
Publication Number: 385
Presenting Author: Kirsten A. Bechtel, MD
Department/Institution/Address: Pediatrics and Emergency Medicine, Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT, 06511, United States
Phone: 203-737-7449
Fax: 203-737-7447
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: Characteristics That Distinguish Abusive from Nonabusive Causes of Sudden Unexpected Infant Deaths
Kirsten A. Bechtel1, Meagan Derbyshire2 and James Gill2. 1Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven and 2Frank Netter School of Medicine, Quinnipiac University, North Haven.
BACKGROUND: Sudden Unexpected Infant Death (SUID) is a leading cause of infant death. The majority are from non-abusive causes, such as unsafe sleeping environments. Fatal child abuse is the leading cause
of traumatic death in infancy. Recognizing abusive causes of SUID on presentation to the Emergency Department (ED) can be important for protection of surviving siblings.
OBJECTIVE: To determine if there are historical or clinical characteristics that may be useful to distinguish abusive from non-abusive causes of SUID in the ED setting.
DESIGN/METHODS: We retrospectively reviewed deaths of infants younger than twelve months of age who had a complete forensic autopsy by the Connecticut Chief Medical Examiner from 2009-2015. Cases were
included if they were infants who were found unresponsive at home, required cardiopulmonary resuscitation and transfer to an Emergency Department or were pronounced deceased in the field by Emergency Medical
Services. Outcomes included infant age; race; gender; maternal substance use; presence of male head of household or surviving siblings; return of spontaneous circulation (ROSC); transfer to an Intensive Care Unit
(ICU); and presence of sentinel injuries (head and neck bruising, scleral hemorrhage or labial or lingual frenulum injury). Student's t-test, chi-square analysis and likelihood ratios were used to determine significant
differences in outcomes between abusive and non-abusive causes of death.
RESULTS: We reviewed 173 cases; the mean age was 103 days; 66% were male; and 40% were Caucasian; 161 cases were from non-abusive causes-of these, 44 (27%) the sleeping conditions contributed to the
death. Twelve cases had abusive causes of death (6.9%); of these 10 (83%) were from abusive head trauma. ROSC occurred either in the field or in the ED in 14% of all cases, all of whom later died in the ICU. Age,
gender, race; maternal substance use; the presence of surviving siblings or male head of household were not significantly different between the two groups. The presence of sentinel injury (36% vs 7%; p=0.034; LR
6.77); ROSC (67% vs. 8%; p=0.000; LR 21.7); and ICU admission (58% vs. 10%; p= 0.000; LR 26.5) were associated with an increased likelihood of an abusive cause of death.
CONCLUSIONS: Non-abusive causes of SUID are far more common than abusive causes. The presence of sentinel injury, ROSC and ICU admission are associated with an increased likelihood of an abusive cause
of death in cases of SUID.
2016 Eastern SPR Annual Meeting
Abstract Number: 2908
Filename: 750417
Publication Number: 386
Presenting Author: Dianne Lee, D.O., M.B.A.
Department/Institution/Address: Pediatrics, Stony Brook Children's Hospital, 100 Nicolls Road, HSC T-11, Room 040, Stony Brook, NY, 11794, United States
Phone: 631-258-2533
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: Ethanol Intoxication in Infants: A Case Series and Systematic Review
Dianne Lee1 and Ilana Harwayne-Gidansky2. 1Dept of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY and 2Division of Pediatric Critical Care Medicine, Stony Brook Children's Hospital, Stony Brook, NY.
BACKGROUND: Pediatric ethanol exposure is relatively common with 11,026 exposures reported in children under five years old in 2013. However, ethanol exposure in infants 3 months and younger is uncommon
and potentially life-threatening. Infant ethanol exposures include household products, liquid medications, transcutaneous absorption from umbilical cord cleaning, and improper formula mixing with clear ethanol.
OBJECTIVE: To describe the clinical sequelae of ethanol intoxication in infants 3 months and younger to better understand how infants respond to ethanol.
DESIGN/METHODS: Case series and systematic review of the literature using PubMed and MESH database using keywords “ethanol” AND “poisoning” or “toxicity” selected for human subjects only, and ages birth
through 3 months which identified 121 articles. 19 articles were selected and manually reviewed. Reference lists of potentially relevant articles were also manually reviewed to identify any unidentified studies.
RESULTS: Peak serum ethanol levels in infants 3 months or younger ranged from 43mg/dL to 525mg/dL. The ethanol clearance rates ranged from 17.1 mg/dL/hr to 22.6 mg/dL/hr, and is similar to ethanol elimination
in non-ethanol using adults. Common presentations included altered sensorium (n=10,77%), metabolic acidosis (n=6, 46%), hypotonia (n=4, 31%) and hyperglycemia (n=4, 31%). Severe manifestations included
apnea (n=2, 13%), respiratory failure requiring intubation (n=2, 13%), seizure activity (n=2, 13%), circulatory failure (n=1, 8%) and coma (n=1, 8%). There were no reported cases of hypothermia or hypoglycemia and
no patients died.
CONCLUSIONS: Acute ethanol intoxication in young infants present with varied clinical manifestations. Most commonly noted was altered sensorium, metabolic acidosis, hypotonia and hyperglycemia. Given the
ubiquity of ethanol within the household, it is necessary for health professionals to maintain a high index of suspicion for intentional or unintentional ethanol intoxication when encountering an infant presenting with
nonspecific symptoms of acutely altered sensorium, metabolic acidosis and hypotonia.
2016 Eastern SPR Annual Meeting
Abstract Number: 2927
Filename: 750561
Publication Number: 387
Presenting Author: Lori D. Frasier, MD
Department/Institution/Address: Penn State Milton S. Hershey Children's Hospital, 500 University Drive, 156 BITTERSWEET DR, HERSHEY, PA, 17033-2607, United States
Phone: 8017186014
Fax: United States
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: Quality Improvement in Child Sexual Abuse Evaluation: Review of Photos and Documentation as a MOC Part 4 Project
Lori D. Frasier1. 1Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, PA.
BACKGROUND: Child sexual abuse evaluations are dependent upon skills and experience of the medical examiner. There has been a tremendous amount of literature discussing the challenges in accurate analysis
physical evidence such as photographs of genital findings. Photodocumentation of genital examinations in children is a key element of this evaluation. Peer review of examinations has been demonstrated to lead to
improved diagnostic accuracy, however this depends upon the quality of that photodocumentation.
OBJECTIVE: This project was developed as a Maintenance of Certification (MOC) part 4 to confirm with the American Board of Pediatrics re-certification requirements. The goal was to improve quality of image review
and photodocumentation.
DESIGN/METHODS: Participants were required to submit 3 cycles of 5 cases each over one year. The five cases were sequential examples of photodocumentation of genital examinations of children and adolescents
who were evaluated for concerns of sexual abuse. Written documentation, including age, gender, acuity of the examination, general physical examination, description of the genital examination, and interpretation of
findings was submitted. A secure HIPAA compliant web platform (TeleCAM by Xyfin) was used, and the examiners and reviewers were blinded to each other. PDSA (Plan, Do, Study, Act) quality improvement
principles were followed. The case cycles were reviewed by one of three experts in child abuse, trained in a uniform evaluation process. A numerical rating system was developed to assess photographic quality and
documentation of examination findings and to provide empiric data. Based upon the review the examiner could select from a variety of interventions that were customized to address the quality issues of each case
cycle. This was repeated twice and the final cycle included summary comments from the reviewer.
RESULTS: 27 Participants have completed the three submissions of five cases each. 19 examiners demonstrated improvement in the quality of photo and written documentation. Eight participants demonstrated a
decline in quality of review and 2 examiners remained equivalent.
CONCLUSIONS: Expert review with interventions customized to address quality issues in photodocumentation and written documentation in a PDSA cycle, result in overall improved quality of both types of
documentation. This hopefully results in better outcomes for children who are being evaluated for possible sexual abuse.
2016 Eastern SPR Annual Meeting
Abstract Number: 2979
Filename: 750968
Publication Number: 388
Presenting Author: Bridget Kiely
Department/Institution/Address: 80 Red Gate Lane, Amherst, MA, 01002, United States
Phone: (413) 687 0193
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: Psychiatric Correlates of Bullying Victimization in Children with Developmental Disabilities
Bridget Kiely1, Sujit Vettam2 and Andrew Adesman1. 1Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY and 2Johns Hopkins University, Baltimore, MD.
BACKGROUND: Studies of the general pediatric population have shown that victims of bullying are at an elevated risk of experiencing psychiatric problems related to depression and anxiety. However, few studies
have examined this association among children with developmental disabilities.
OBJECTIVE: To determine whether bullying victimization (BV) is associated with depression and anxiety among children with developmental disabilities.
DESIGN/METHODS: Data were analyzed from the CDC's Survey of Pathways to Diagnosis and Services, a nationally representative survey of the parents of 4032 children ages 6-17 years who were ever diagnosed
with an autism spectrum disorder (ASD), intellectual disability (ID), and/or developmental delay (DD). Children were identified as victims if parents indicated that it was “somewhat true” or “certainly true” that their child
was picked on or bullied by other children. Respondents were divided into two groups: 1) those with a current diagnosis of ASD, with or without ID/DD; 2) those with a current diagnosis of ID and/or DD, without ASD.
Within these groups, Rao-Scott chi-square analyses were used to examine the associations between BV and 4 types of psychiatric comorbidities: 1) current diagnosis of depression; 2) current diagnosis of anxiety; 3)
depression symptoms, with or without a formal diagnosis; 4) anxiety symptoms, with or without a formal diagnosis.
RESULTS: In the ASD group, BV occurred in nearly three-fourths of those who showed signs of depression (74.5%), compared to 55.0% of those without depression symptoms (p<.001). Likewise, compared to
children who did not have these issues, BV rates were higher in children with anxiety symptoms (68.6% vs. 53.2%; p=.008) and in those with a formal anxiety disorder diagnosis (73.8% vs. 57.2%; p=.004). Similar
trends were observed in the ID/DD-only group: BV rates were higher in children who had symptoms of depression (71.9% vs. 41.1%; p<.001); a formal diagnosis of depression (72.0% vs. 51.2%; p=.003); symptoms of
anxiety (67.4% vs. 34.2%; p<.001); and a formal diagnosis of anxiety (68.2% vs. 49.1%; p<.001).
CONCLUSIONS: BV is strongly associated with depression and anxiety in children with developmental disabilities. Further studies are needed to determine whether comorbid psychopathology is a cause or a
consequence of victimization among children with developmental disabilities.
2016 Eastern SPR Annual Meeting
Abstract Number: 4356
Filename: 750970
Publication Number: 389
Presenting Author: Bridget Kiely
Department/Institution/Address: 80 Red Gate Lane, Amherst, MA, 01002, United States
Phone: (413) 687 0193
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: Parental Beliefs about the Etiology of Developmental Disabilities
Bridget Kiely1, Sujit Vettam2 and Andrew Adesman1. 1Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY and 2Johns Hopkins University, Baltimore, MD.
BACKGROUND: Parental perceptions about the etiology of autism spectrum disorders (ASDs), intellectual disability (ID), and developmental delay (DD) may influence their decisions about a range of health-related
behaviors, including family planning, vaccination, and treatment choices.
OBJECTIVE: To assess parental beliefs about the causes of their children's developmental disabilities.
DESIGN/METHODS: Data were analyzed from the CDC's Survey of Pathways to Diagnosis and Services, a nationally representative survey of the parents/guardians of 4032 children ages 6-17 who were ever
diagnosed with ASD, ID, and/or DD. On a four-point Likert scale, parents were asked to indicate the extent to which they believed that prenatal exposures, postnatal exposures, and genetic factors caused their child's
condition. Chi-square analyses were used to examine the association between regression and parental beliefs, and to compare beliefs across three diagnostic categories: ASD without ID or DD (ASD-only), ASD with
ID/DD, and ID/DD without ASD (ID/DD-only). To avoid inclusion of children that likely received a prenatal genetic diagnosis, participants were excluded if they indicated that their child's problems began at or before
birth.
RESULTS: Beliefs about genetic etiology differed according to diagnosis (p=.001); 71.2% of the ASD-only group identified genetics as a cause, compared to 68.4% of the ID/DD-only group and 56.4% of the
ASD+ID/DD group. Although beliefs about prenatal exposures did not differ across groups (32.9% ASD+ID/DD, 31.6% ID/DD-only, 27.6% ASD-only; p=.549), the three groups differed according to the percent that
endorsed postnatal exposures as a cause (40.5% ASD+ID/DD, 33.7% ASD-only, 22.8% ID/DD-only; p<.001). Among parents of children with ASDs, those who reported that their child had experienced regression
were significantly more likely to identify postnatal exposures as a cause (p<.001), compared to those who reported no history of regression.
CONCLUSIONS: Parental beliefs about etiology were found to differ according to clinical characteristics, such as diagnosis (ASD and/or ID/DD) and history of regression. An understanding of parental perceptions of
etiology may aid clinicians in counseling the families of children with these disorders.
2016 Eastern SPR Annual Meeting
Abstract Number: 193
Filename: 750772
Publication Number: 390
Presenting Author: Maria Valicenti-McDermott, MD MS
Department/Institution/Address: Pediatrics/CERC, Montefiore Medical Center/Albert Einstein College of Medicine, 1225 Morris Park Avenue, Bronx, NY, United States
Phone: 7188397284
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: Age of Diagnosis of Autism Spectrum Disorder in an Ethnically Diverse Population Before and After the 2007 AAP Recommendation for Universal Screening
Maria Valicenti-McDermott1, Rosa Seijo1 and Lisa Shulman1. 1Pediatrics/CERC, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
BACKGROUND: Children with Autism Spectrum Disorder(ASD) benefit from early diagnosis and intervention services. In 2007 the American Academy of Pediatrics(AAP) recommended pediatricians perform
screening for ASD at the 18 and 24 month child visits. However, the U.S. Preventive Services Task Force recently concluded there is not enough evidence to recommend universal autism screening of young children
for whom no concerns of ASD have been raised by their parents or clinical provider. Children who are Latino or African American are already being diagnosed later and families may be less aware of ASD symptoms,
the impact of such recommendation on the age at diagnosis in an ethnically diverse population is important, but unknown.
OBJECTIVE: To compare the age at diagnosis of ASD in two groups, those children born before 2005, prior to universal screening recommendations, and those born in 2005 or later, who would have been of age to
undergo ASD screening by 24 months based on the 2007 AAP recommendation.
DESIGN/METHODS: Review of all children initially diagnosed with ASD from 2003 to 2012 in a University Affiliated Developmental Center. Data included demographic and clinical characteristics. Statistics included
chi-square, t-test, non parametrics, and logistic regression.
RESULTS: We identified 512 children,78% boys, 16%White, 47%Hispanic, 26%African-American, 38% bilinguals(English/Spanish). Of 512, 295(58%) were born before 2005 and 217(42%) were born during 2005 or
after. The mean age at diagnosis of children born before 2005 was 46±15months and those born during or after 2005 was 31±12 months(p<.001). The percentage of children diagnosed with ASD after age 3
decreased from 63% in the group born before 2005 to 26%(p<.001). This decline occurred across all ethnic groups (White 55% to 27%; Hispanic 76% to 23%; African-American 73% to 32%). The association between
diagnosis with ASD after age 3 and being born before 2005 remained significant after adjusting for demographics and clinical characteristics (OR=4.2;95th CI 1.7-10.3).
CONCLUSIONS: In this ethnically diverse population, children who were born before the AAP recommendation for universal screening were diagnosed with ASD significantly later that those born after the AAP
recommendation. It is unclear at this point if this was entirely the result of pediatrician universal screening but, since 2007, children are being diagnosed with ASD earlier.
2016 Eastern SPR Annual Meeting
Abstract Number: 3953
Filename: 755101
Publication Number: 391
Presenting Author: Daniela M. Ziskind, M.D.
Department/Institution/Address: Developmental & Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd floor, Philadelphia, PA, 19104, United States
Phone: 267-426-5200
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: Therapy and Medication Use in Young Children with Autism: A Secondary Data Analysis from the Autism Speaks-Autism Treatment Network
Daniela M. Ziskind1, Amanda E. Bennett1, Abbas F. Jawad2,3 and Nathan J. Blum1. 1Developmental & Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; 2Pediatrics, The Children's
Hospital of Philadelphia, Philadelphia, PA and 3University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
BACKGROUND: Guidelines suggest young children with Autism Spectrum Disorder (ASD) should receive intensive psychosocial interventions. Additionally, associated symptoms may be treated with psychotropic
medications. However, actual intervention use by young children with ASD has not been well characterized.
OBJECTIVE: To describe interventions received by young children with ASD ≥6 months after diagnosis. The association with socio-demographic factors was also explored.
DESIGN/METHODS: Data were used from the Autism Speaks- Autism Treatment Network (AS-ATN), a research registry of children with ASD within 17 sites in the U.S. and Canada. AS-ATN participants undergo a
standardized diagnostic evaluation and receive treatment recommendations from Autism specialists. At follow-up visits, parents report intervention use. Subjects aged 36-72 months were included for the time period
12/2007-12/2013.
RESULTS: Most young children (91%) received psychosocial interventions but only 36% received behavioral-based therapy. The median total hours per week (hrs/wk) of therapy was only 5.0 (range 0-65; interquartile
range 1.5-14) and of those receiving behavioral-based therapies, the median hrs/wk was only 4.6 (range 0.1-50, interquartile range: 2-12). 50% of subjects received <5 hrs/wk of therapy and only 18% received >20
hrs/wk. Demographic factors found to be associated with increased total therapy intensity included younger age, non-Hispanic/ Latino ethnicity, higher parental education level and geographic location in the Northeast
or Southern U.S. Additionally, 22.4% of subjects were on ≥1 psychotropic medication and the most commonly prescribed medications were α-agonists (off-label for children with ASD). Demographic factors associated
with increased psychotropic medication use included older age, Black/ African American race, lower parental education and living in Canada.
CONCLUSIONS: Relatively few young children with ASD diagnosed at high quality academic centers are receiving evidence-based behavioral therapies and few are receiving interventions at the recommended
intensity. There is significant regional and socio-demographic variability in intervention use. Additionally, the class of medications most commonly prescribed has not been well-studied in this population. Further
research is needed to support current prescribing practices and to improve access to evidence-based treatments for young children with ASD.
2016 Eastern SPR Annual Meeting
Abstract Number: 3632
Filename: 754093
Publication Number: 392
Presenting Author: Meghan Harrison, DO
Department/Institution/Address: General Pediatrics, Nemours AI duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19806, United States
Phone: 302-651-4000
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: Behavioral/Developmental Access to Reduce Time to Diagnosis of Autism Spectrum Disorder
Meghan Harrison1, Persephone Jones2, Iman Sharif1 and Matthew D. Di Guglielmo1. 1General Pediatrics, Nemours/AI DuPont Hospital for Children, Wilmington, DE and 2Developmental Medicine, Nemours/AI DuPont
Hospital for Children, Wilmignton, DE.
BACKGROUND: Early implementation of behavior based treatment programs for young children with autism spectrum disorder (ASD) improves language, adaptive, and cognitive skills; however, the majority of
children are not diagnosed until after age 4. Nationally, long wait times exist for appointments with Developmental-Behavioral Pediatricians (DBP). Prior data obtained from our institution showed this wait to be an
average of 46.7 weeks (July-Dec 2014). To address this barrier, we developed a Behavioral/Developmental Access Clinic (BDAC), staffed by a general pediatrician, psychologist, and social worker, with the goal of
improving access to developmental assessments for children 5 years of age and younger.
OBJECTIVE: To test the impact of BDAC on time to diagnosis and age at diagnosis of ASD.
DESIGN/METHODS: We conducted a retrospective chart review of patients seen in BDAC between Jan 1- June 30, 2015. For children diagnosed with ASD, we calculated the time from scheduling phone call to
diagnosis and the average age at diagnosis.
RESULTS: 151 new patients were seen by the general pediatrician in BDAC between Jan-June 2015. Overall, 30 children (20%) were diagnosed with ASD. Of these, 17 (57%) were diagnosed at the initial visit and
13(43%) were diagnosed after a second visit that included autism testing with a psychologist in our division of behavioral health. Average wait time from scheduling phone call to initial appointment in BDAC was 3.1
weeks. For those patients requiring additional autism testing with psychology, the average wait time from the BDAC appointment to follow-up testing was 7 weeks. In this cohort of patients the average time from initial
scheduling phone call to diagnosis of ASD was 6.7 weeks. The average age at ASD diagnosis was 36.6 months.
CONCLUSIONS: A behavioral-developmental access clinic can allow for earlier diagnosis of ASD.
2016 Eastern SPR Annual Meeting
Abstract Number: 4569
Filename: 755591
Publication Number: 393
Presenting Author: Meghan Harrison, DO
Department/Institution/Address: General Pediatrics, Nemours/AI duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19806, United States
Phone: 302-651-6400
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: General Pediatrician-Staffed Behavioral/Developmental Access Clinic Decreases Time to Evaluation of Early Childhood Developmental Disorders
Meghan Harrison1, Persephone Jones2, Iman Sharif1 and Matthew D. Di Guglielmo1. 1General Pediatrics, Nemours/AI DuPont Hospital for Children, Wilmington, DE and 2Developmental Medicine, Nemours/AI DuPont
Hospital for Children, Wilmington, DE.
BACKGROUND: Earlier diagnosis and treatment of children with developmental disorders is associated with improved outcomes. Children referred for developmental assessments often wait several months for
evaluation with fellowship-trained developmental pediatricians (DP). Recognizing that long wait times for appointments creates an inherent barrier to providing early assessmnets, Nemours created a
Behavioral/Developmental Access Clinic (BDAC), the goal of which was to improve access to developmental assessments for children 5 years of age and younger.
OBJECTIVE: To determine if creation of a BDAC decreased time to developmental evaluation of young children.
DESIGN/METHODS: In 2014, we opened the BDAC, staffed by a general pediatrician, psychologist, and social worker. Parents of children under 5 referred for developmental assessment (including those waiting for
their scheduled appointment with DP) were given the opportunity to schedule an appointment with a clinician in the BDAC. Retrospective data collection focused on wait time for initial evaluation, referrals made,
diagnoses given, and recommended follow up for patients seen by the general pediatrician in the BDAC. We used two-tailed t tests to compare the mean time to initial evaluation in BDAC vs. DP.
RESULTS: 63 children were seen in BDAC from July-December 2014. Referrals from BDAC included: physical/occupational/speech therapy (71%), psychology (35%), audiology (25%), genetics (14%), and neurology
(8%). Five patients (8%) were given a new diagnosis of autism spectrum disorder (ASD). Compared to time to DP appointment (327 days), mean time from initial referral to developmental assessment was shorter for
the 45 patients who accepted earlier appointments in BDAC (159 days) and for the 18 patients seen in BDAC as new referrals (10.7 days), p<0.001. Of the patients seen in BDAC who had future appointments with
DP, 12 (27%) canceled and 3 (7%) did not show. Follow up with DP was recommended for 9 (50%) of the new patient referrals evaluated in BDAC.
CONCLUSIONS: BDAC allows for earlier developmental assessment of young children, with potential for earlier diagnosis and treatment of developmental disorders, including ASD. Opportunity for initial evaluation in
BDAC could decrease the number of patients requiring evaluation by DP, improving access to this subspecialty.
2016 Eastern SPR Annual Meeting
Abstract Number: 460
Filename: 752162
Publication Number: 394
Presenting Author: Manuel Jimenez, MD
Department/Institution/Address: Pediatrics, Rutgers Robert Wood Johnson Medical School, 89 French St, New Brunswick, NJ, 08901, United States
Phone: 7322356188
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: Timing of Adverse Experiences and ADHD at Age 9
Manuel Jimenez1,2, Roy Wade3, Ofira Schwartz-Soicher4, Yong Lin5 and Nancy Reichman4,6. 1Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 2Children's Specialized Hospital, New
Brunswick, NJ; 3Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; 4Princeton University, Princeton, NJ and 5Rutgers School of Public Health, New Brunswick, NJ.
BACKGROUND: Cross-sectional studies have linked Adverse Childhood Experiences (ACE) to parent reported ADHD diagnosis. Little is known regarding the timing of ACEs relative to attention problems in
childhood. Understanding the timing of exposures in relation to outcomes can inform interventions and elucidate underlying pathways connecting ACEs to poor outcomes.
OBJECTIVE: To examine associations between ACEs occurring in early childhood and school age and parent reported ADHD at age 9.
DESIGN/METHODS: We conducted a secondary analysis of data from the Fragile Families urban birth cohort using data from the 5 and 9 year interviews. The sample was limited to children for whom mothers were
the primary caregiver and mother-reported information on 8 ACEs were available at age 5 and 9. The outcome variable was parent reported ADHD diagnosis at age 9. ACEs consisted of exposure to depression,
incarceration, domestic violence, and substance use, as well as physical, sexual, psychological abuse and neglect occurring before age 5 and between ages 5 and 9. We created an ACE score at each time point by
summing the number of types of child adversities. We examined associations between ACEs and outcomes using logistic regression controlling for potential confounders including gender, race, ethnicity, as well as
parental relationship status and income at age 9.
RESULTS: 1572 children were included in the analysis. 48% were African American, 51% were boys. 11% had parent reported ADHD at age 9. ACEs before age 5 were associated with report of ADHD at age 9
(Table). ACEs between age 5 and 9 were also associated with report of ADHD at age 9. When both ACEs that occurred before age 5 and ACEs occurring between age 5 and 9 were included in the model, the latter
were associated with ADHD diagnosis at age 9 and the former were not (Table).
ADHD at age 9: Adjusted Odds Ratio (95%CI)
Model 1
Model 2
Model 3
0
Referent
-
Referent
1
1.1(0.8-1.7)
-
1(0.6-1.5)
2
1.7(1-2.8)
-
1.3(0.8-2.2)
≥3
2.3(1.2-4.3)
-
1.5(0.8-3)
ACEs age 5
ACEs age 9
0
-
Referent
Referent
1
-
1.9(1.3-2.8)
1.8(1.2-2.8)
2
-
2.2(1.3-3.6)
2(1.2-3.3)
≥3
-
2.4(1.3-4.4)
2.1(1.1-4)
CONCLUSIONS: In this study of urban children, ACEs were associated with parent reported ADHD at age 9. When ACEs at two time points were included in models, ACEs occurring between 5 and 9 had stronger
associations with parent report ADHD highlighting the importance of intervention throughout childhood.
2016 Eastern SPR Annual Meeting
Abstract Number: 2321
Filename: 752194
Publication Number: 395
Presenting Author: Radley C. Sheldrick, PhD
Department/Institution/Address: Developmental-Behavioral Pediatrics, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, United States
Phone: 617-636-4830
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: Identifying Developmental-Behavioral Problems Among Young Children
Stacey L. Bevan1, Radley C. Sheldrick1 and Ellen C. Perrin1. 1Developmental-Behavioral Pediatrics, Tufts Medical Center, Boston.
BACKGROUND: The American Academy of Pediatrics recommends regular screening in the first 5 years of life to identify children with developmental-behavioral disorders. This screening is only cost-effective if it
reveals problems that were not already known.
OBJECTIVE: To describe the proportion of young children with developmental-behavioral problems who are identified using screening procedures but were not previously diagnosed and are not receiving services.
DESIGN/METHODS: In an ongoing NICHD-funded study, parents of 911 children (ages 9-66 months) were recruited through primary care pediatric practices. A two-stage screening and assessment process was
used to identify children with clinically significant developmental-behavioral problems. Children were considered to have previously identified conditions if their parents reported (1) a developmental-behavioral
diagnosis, or (2) current enrollment in developmental-behavioral interventions.
RESULTS: Through our two-stage assessment protocol, 203 children were identified as having developmental and/or behavioral problems for which additional services were recommended. For 50 of these children
(25%), parents reported previously identified conditions or ongoing participation in appropriate interventions. The remaining 153 children (75%) were identified as having developmental-behavioral problems that were
not reported by parents and thus were newly identified. Logistic regression revealed that, among children without previously identified conditions, significant predictors of developmental-behavioral problems included a
positive result on a comprehensive set of screening questionnaires (OR=6.7, p<.0005).
CONCLUSIONS: The importance of comprehensive screening in general pediatric contexts is confirmed by the findings that: (1) 75% of the children with developmental-behavioral problems had not previously
received a diagnosis or services appropriate to their condition, and (2) screening instruments are effective tools to detect previously unidentified developmental-behavioral problems in young children.
2016 Eastern SPR Annual Meeting
Abstract Number: 2915
Filename: 750471
Publication Number: 396
Presenting Author: Elizabeth T. Ninan, MBBS
Department/Institution/Address: Pediatrics, 1675 Selwyn Ave, Bronx, NY, 10457, United States
Phone: 1 646 912 0023
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: Analysis of Therapy and Psychostimulant Use in Children ≤5 Years Old with Symptoms of ADHD in a US Urban Setting
Elizabeth T. Ninan1, Ayotunde Adeyeye1, Ayoade O. Adeniyi1, Stefan Hagmann1, Richard Neugebauer1 and Jay Selman1. 1Pediatrics, Bronx Lebanon Hospital Center, Bronx, NY.
BACKGROUND: Children of low socioeconomic status (SES) are more likely to be affected by symptoms of attention deficit hyperactivity disorder (ADHD) and receive psychostimulants. Many are ≤5 years old, yet the
use of psychostimulants in these children has not been sufficiently studied.
OBJECTIVE: To assess behavioral therapy and psychostimulant use in children ≤5 years old with symptoms of ADHD in a US urban setting.
DESIGN/METHODS: Retrospective chart review of children evaluated for symptoms of ADHD at a large urban ambulatory network. Patients were identified by searching the electronic medical record with
ADHD-specific ICD-9 codes. Inclusion criteria were age ≤5 years old, and time for initial ADHD evaluation between 01/01/2012 and 12/31/2012.
RESULTS: A total of 102 patients (71% male, 65% English as primary language, median age of 4.9 [1.5-5.9] years) were identified. Almost all (97%) were evaluated for co-morbidites (oppositional defiant disorder
[29%] and asthma [28%] were the most frequently identified); only two thirds (67%) received a formal ADHD-specific evaluation. Overall, behavioral therapy and drug treatment were initiated in 41% and 40% of
patients, respectively. Of those receiving drug treatment, about two-thirds (66%) did not receive behavioral therapy and around a quarter received a prescription before formal evaluation had been completed (27%),
were lost to follow up (29%), or discontinued the medication (27%), respectively. The first medication (long acting methylphenidate [27%] and short acting methylphenidate [20%]), was taken for a median of 49 (9-191)
days. The most common reasons for discontinuation were side effects (64%) with sleep disturbances (17%) and mood changes (12%) being the two most commonly reported. Compliance with clinic visits was
incomplete with most patients (80%) missing at least one scheduled visit.
CONCLUSIONS: In this cohort of children ≤5 years presenting with symptoms of ADHD in a US urban clinic, many did not receive a formal ADHD-specific evaluation. Among those treated with medication, most did
not receive behavioral therapy. High rates of missed clinic visits and medication discontinuation complicated the management. Further exploration into the the practical availability of behavioral therapy in the
community as well as reasons for discontinuation of medication and poor compliance with follow up are needed.
2016 Eastern SPR Annual Meeting
Abstract Number: 1224
Filename: 754575
Publication Number: 397
Presenting Author: Susan H. Gray, MD
Department/Institution/Address: Department of Medicine; Division of Adolescent Medicine, Boston Children's Hospital, 333 Longwood Ave, 333 Longwood Ave, Boston, MA, 02115, United States
Phone: 6173558456
Fax: 6177300184
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: Reproductive Health Education Received By Young Women With Cerebral Palsy
Susan H. Gray1,2, Molly Wylie1 and Laurie Glader1,2. 1Medicine, Boston Children's Hospital, Boston, MA and 2Pediatrics, Harvard Medical School, Boston, MA.
BACKGROUND: Cerebral palsy (CP) occurs at a rate of 2.6/1,000 live births and is the most common motor disability in childhood. It is often associated with cognitive disabilities and comorbid medical conditions
Women with CP may be at risk for poor health outcomes due to physical and other barriers to receiving gynecologic care and reproductive health education.
OBJECTIVE: To define differences in reproductive health education received from parents by women with CP versus a representative sample in the 2006-2008 CDC National Survey of Family Growth, and to compare
education received from parents versus from health care providers.
DESIGN/METHODS: We surveyed young women with CP aged 18 and over who received care in CP clinics at four academic medical centers. For patients unable to complete the survey due to physical or intellectual
limitations, a parent or caretaker was asked to complete a proxy survey. All data analysis was conducted with STATA.
RESULTS: Eighty patients completed the survey; 13 (16%) were proxy responses. Ages of patients ranged from 18 to 66, with median 32. A full range of motor functioning levels were represented. The majority of
patients were white (76%) and 91% had completed high school. Compared to national data, fewer women with CP reported they had talked before the age of 18 years with a parent about sexually transmitted
infections (STI's)(35% vs. 55%, p<.001) or how to say no to sex (36% vs. 63%, p<.001). They had discussed methods of birth control, where to get birth control, how to prevent HIV/AIDS, and how to use a condom
with a parent at similar rates as the national sample. More patients in our study had discussed how to say no to sex with a parent than a health care provider (36%vs.15%, p<.001), and more had discussed methods
of birth control with a health care provider than a parent (64% vs. 45%, p=.005). They received education from health care providers and parents about where to get birth control (44% vs. 36%), STI's (38% vs 35%),
how to prevent HIV/AIDs (26% vs. 32%) and how to use a condom (13% vs. 21%) at similar low rates.
CONCLUSIONS: Young women with CP were less likely to receive education from their parents about abstinence or sexually transmitted infection than respondents in a national survey. This disparity places an
already vulnerable population at greater risk of unintended pregnancy and STI and represents an important opportunity for education by pediatricians and parents of young women with CP.
2016 Eastern SPR Annual Meeting
Abstract Number: 2982
Filename: 750973
Publication Number: 398
Presenting Author: Bridget Kiely
Department/Institution/Address: 80 Red Gate Lane, Amherst, MA, 01002, United States
Phone: (413) 687 0193
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: Clinical Correlates of Wandering in Children with Autism Spectrum Disorders
Bridget Kiely1, Talia Migdal1, Sujit Vettam2 and Andrew Adesman1. 1Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY and 2Johns Hopkins University, Baltimore, MD.
BACKGROUND: Elopement, or wandering, places children with autism spectrum disorders (ASDs) at risk of serious injury or even death. There is a need to identify clinical factors that are associated with elopement
risk in this population.
OBJECTIVE: To identify clinical correlates of elopement in children with ASDs.
DESIGN/METHODS: Data were obtained from the Survey of Pathways to Diagnosis and Services, a nationally representative, telephone-based survey of the parents and guardians of U.S. children ages 6-17 who
were ever diagnosed with developmental disorders. The present analysis was restricted to 1420 children who currently had an ASD. Rao-Scott chi-square tests were used to examine associations between elopement
and 1) parent-rated ASD severity and 2) the presence of comorbid intellectual disability and/or developmental delay (ID/DD). A subset of respondents also completed a written supplement that contained the Children's
Social Behavior Questionnaire (CSBQ), which is designed to assess a range of symptoms across the ASD spectrum. Mean scores from the 6 CSBQ subscales were compared between wanderers and non-wanderers
with ASDs.
RESULTS: Rates of elopement differed significantly (p=.004) among those with mild (27.3%), moderate (37.4%), and severe (49.8%) ASDs. Wanderers scored higher than non-wanderers (indicating higher levels of
ASD symptoms) on all 6 CSBQ subscales: “behavior/emotions not optimally tuned” (p<.001); “reduced contact and social interest” (p<.001); “orientation problems” (p<.001); “difficulties in understanding social
information” (p<.001); “stereotyped behavior” (p<.001); and “resistance to change” (p=.020). However, the proportion of children with comorbid ID/DD did not differ between wanderers and non-wanderers with ASDs
(p=.638).
CONCLUSIONS: In the first nationally representative survey of wandering behaviors in children with ASDs, ASD symptom severity – as measured by parental ratings and CSBQ subscale scores – was found to be
associated with elopement. However, no link was identified between comorbid ID/DD and wandering in this population. More work is needed to explore the causes of the apparent association between ASD symptoms
and elopement. A better understanding of the clinical correlates of wandering may help to guide the development of novel strategies for addressing this potentially fatal behavior.
2016 Eastern SPR Annual Meeting
Abstract Number: 2980
Filename: 750971
Publication Number: 399
Presenting Author: Bridget Kiely
Department/Institution/Address: 80 Red Gate Lane, Amherst, MA, 01002, United States
Phone: (413) 687 0193
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: Prevalence of Genetic Testing among U.S. Children with Developmental Disabilities
Bridget Kiely1, Sujit Vettam2 and Andrew Adesman1. 1Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY and 2Johns Hopkins University, Baltimore, MD.
BACKGROUND: Guidelines from the American Academy of Pediatrics and the American Academy of Neurology recommend that children with intellectual disability (ID), developmental delay (DD), and autism
spectrum disorders (ASDs) routinely receive genetic testing (GT) as part of a diagnostic workup. Identification of a genetic cause of a child's developmental issues may enable clinicians to counsel families about
recurrence risk and direct them to resources for treatment, research, and support. However, few studies have examined the extent to which recommended testing is actually performed in this population.
OBJECTIVE: To assess the national prevalence of genetic testing among children with developmental disabilities.
DESIGN/METHODS: Data were analyzed from the CDC's Survey of Pathways to Diagnosis and Services, a nationally representative survey of the parents of 4032 children who were ever diagnosed with ASD, ID,
and/or DD. The prevalence of GT was assessed based on parental response to a question about whether the child had ever received genetic screening "to confirm a diagnosis" or to "learn more about his/her
condition." In order to exclude those that likely received GT through prenatal or neonatal screening -- rather than in response to developmental concerns -- participants were not included in the analysis if they indicated
that their child's problems were present at or before birth. Chi-square analyses were used to examine associations between use of specialist care and receipt of GT, and to compare rates of GT across four diagnostic
categories: ASD without ID/DD, ASD with ID, ID/DD without ASD, and DD without ASD or ID.
RESULTS: The prevalence of GT differed according to diagnosis (p < .001); it was performed in 52.2% of the ASD+ID group, 45.9% of the ID/DD-only group, 28.3% of the DD-only group, and 17.1% of the ASD-only
group. Children who had ever seen a pediatric neurologist (PN) or a developmental pediatrician (DBP) were significantly more likely to have received GT than those who had not seen these specialists (p<.001 for
both). However, rates of GT did not differ between those who had seen a PN and those who had seen a DBP (p=.945).
CONCLUSIONS: In this nationally representative sample, the majority of children with developmental disabilities did not receive recommended genetic testing. More research is needed to determine to what extent this
reflects under-reporting by parents and/or true barriers to genetic testing in this population.
2016 Eastern SPR Annual Meeting
Abstract Number: 3364
Filename: 753016
Publication Number: 400
Presenting Author: Danielle Bosenbark, MS
Department/Institution/Address: Psychology, Drexel University, 3141 Chestnut Street, Stratton Hall, Suite 123, Philadelphia, PA, 19104, United States
Phone: 215-896-5854
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: Clinical Predictors of Neurocognitive Outcomes in Children Following Perinatal Arterial Ischemic Stroke
Danielle Bosenbark1, Lauren Krivitzky2, Rebecca N. Ichord2, Laura Jastrzab2 and Lori L. Billinghurst2. 1Psychology, Drexel University, Philadelphia, PA and 2Neurology, The Children's Hospital of Philadelphia,
Philadelphia, PA.
BACKGROUND: Children with perinatal arterial ischemic stroke (PAIS) are at risk for later neurocognitive and behavioral deficits, yet clinical factors contributing to these outcomes are largely unknown.
OBJECTIVE: To examine the influence of clinical variables on attention and executive functioning (EF) in children following PAIS.
DESIGN/METHODS: Forty children born at term (≥37 weeks gestation) with PAIS underwent a comprehensive neuropsychological battery at ages 3-16 years (median age 7.2 years; 58% male) to assess attention
and executive functioning (EF): WPPSI-IV or WASI-II, NEPSY-II, TEA-Ch, WMTB-C, TOL-Dx, and TMT-A&B. Parents completed questionnaires (ADHD-IV, BRIEF) regarding real-world functioning. Clinical variables
(age, sex, infarct characteristics, comorbid epilepsy) were collected. Composite scores were calculated for seven attention and EF domains (attention, working memory, verbal fluency, inhibitory control,
flexibility/shifting, planning/organization, processing speed) by averaging standardized z scores of all appropriate neuropsychological subtests and/or subscores assessing that domain. Composite scores were then
used in statistical comparisons (t-test, ANOVA, Pearson correlation, or Fisher's exact) and corrected for multiple comparisons.
RESULTS: With the exception of working memory, all measured domains of attention and executive functioning were significantly lower in children with PAIS than in the normative sample (p<0.001). Larger infarct
volume, older age at time of testing, and comorbid epilepsy negatively influenced performance on attention and EF measures (all p<0.01). These clinical factors were also significantly associated with greater
functional problems on parent report, including a higher incidence of clinically elevated ADHD symptoms and greater difficulties in EF (all p<0.05). Sex, infarct location and laterality were not associated with
performance measures or parental report of functioning.
CONCLUSIONS: Children with perinatal stroke--particularly those with large infarcts and co-morbid epilepsy--demonstrate attention and executive functioning deficits as they approach and reach school-age. These
children should be considered for early neuropsychological assessment to ensure timely implementation of therapeutic interventions and behavioural strategies.
2016 Eastern SPR Annual Meeting
Abstract Number: 4383
Filename: 751897
Publication Number: 401
Presenting Author: Sandhyaa S. Iyengar, MD
Department/Institution/Address: 122 Thornberry Lane, Rensselaer, NY, 12144, United States
Phone: 5169670807
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: Community-Based Parental Dialogic Reading Intervention to Improve Child's Emergent Literacy
Sandhyaa S. Iyengar1 and Stephen De Waal Malefyt1. 1Pediatrics, Albany Medical Center, Albany, NY.
BACKGROUND: Research demonstrates that a child's success in elementary school is directly correlated to early language exposure. Shared family reading impacts brain and language development and is valuable
for nurturing parent interactions. Dialogic Reading is an evidence-based structured reading interaction that involves prompting the child with questions and engaging them in discussion. Little research exists as to
whether this method can be applied using a brief interaction that builds on the success of the Reach Out and Read model.
OBJECTIVE: Compare parental reading behaviors and attitudes after brief educational session in both ambulatory and community settings.
DESIGN/METHODS: Qualitative IRB-approved study was performed at the following urban project sites: elementary school fair, parenting classes for low-income minority families, parenting classes for teenage
mothers, community farmers markets, daycare centers, and ambulatory pediatrics clinic. Consent to participate was obtained from parent with a child birth to 6 years old. During a 10-minute one-on-one session with
an ambassador, the parent learns and models age-appropriate techniques, receives a book, bookmark, reminder magnet, and handouts discussing library and media resources. Medical students completed a seminar
on early literacy to become ambassadors. Questionnaire was obtained prior to session and 1-3 months later by telephone.
RESULTS: A total of 64 parents participated in the program, of which 51 parents completed follow-up questionnaires at an average of 2.1 months later. The average age of child was 27 months. After the intervention,
there was increased parental report of reading at least once a week from 31% to 71%; 33% reported daily reading compared to 16% prior to the intervention. Reading for more than 20 minutes increased from 18% to
29%. Use of dialogic reading techniques (pointing to pictures and asking questions during reading) at least three times during a book increased from 29% to 70% and 27% to 59%, respectively. We also identified a
trend of increased child enjoyment of reading from 3.5 to 4.8 on a 5-point scale. On a 10-point scale, parents' perception of their importance in their child's reading increased from 6.5 to 8.6 after the intervention.
CONCLUSIONS: These findings demonstrate that a program targeting parent education about the importance of shared reading in both the ambulatory and community settings can successfully improve parents' skills
using dialogic reading strategies.
2016 Eastern SPR Annual Meeting
Abstract Number: 3039
Filename: 751273
Publication Number: 402
Presenting Author: Alexandra Hua, BA
Department/Institution/Address: 1983 Marcus Ave, Suite 130 - Develop Pediatrics, New Hyde Park, NY, 11042, United States
Phone: 516 802-6101
Fax:
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Other - Graduate student (MPH)
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: Increased Risk of Aggressive Behavior among Victims of Multiple Forms of Bullying
Alexandra Hua1, Tammy B. Pham2, Anne Shattuck3 and Andrew Adesman2. 1Public Health, Yale University, New Haven, CT; 2Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde
Park, NY and 3University of New Hampshire, Durham, NH.
BACKGROUND: With the widespread use of cell phones and the internet, many adolescents may now experience cyber-victimization (CV) in addition to face-to-face victimization (FV). Recent research has shown that
victims of peer aggression are themselves at greater risk for victimizing others. There has been limited research examining the many forms of victimization (alone and together) and their association with various types
of aggressive behavior.
OBJECTIVE: To assess the extent to which being a cyber-victim and/or face-to-face victim is associated with aggressive behavior among youth.
DESIGN/METHODS: Cross-sectional data from the 2014 National Survey of Children's Exposure to Violence III were analyzed for youth aged 10-17 (N=1959). CV was defined as being harassed via cell phone and/or
internet. FV was defined by Juvenile Victimization Questionnaire items regarding verbal/relational aggression, physical assault/intimidation, and property victimization. Aggressive behaviors comprised verbal
aggression, physical fighting (PF), damaging property (DP), and coercing peers (CP). Logistic regression adjusting for age, sex, and race compared victim groups against corresponding non-victims with respect to
aggressive behaviors. Analyses were conducted using procedures suited for survey data in Stata 13.
RESULTS: Overall, 43.0% of youth reported at least one form of FV; 6.7% reported at least one form of CV. Table 1 shows adjusted odds ratios (aOR) of aggressive behavior among victims of single and multiple
forms of peer aggression.
CONCLUSIONS: Our results showed a marked increase in likelihood of engaging in aggressive behaviors among victims of multiple forms of peer aggression. Victims of both cyber- and face-to-face aggression were
at highest risk for PF, DP, and CP--likely reflecting the negative effects of being victimized both in-person and on-line. Interventions should consider that targeting aggressive behavior in multiple contexts may lead to
significant decreases in victimization and its adverse consequences.
2016 Eastern SPR Annual Meeting
Abstract Number: 2480
Filename: 753388
Publication Number: 403
Presenting Author: Emir Tas, MD
Department/Institution/Address: Pediatric Endocrinology and Diabetes, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, 7070 Forward Avenue, Pittsburgh, PA, 15224, United States
Phone: 412-692-5916
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: Regulation of a Novel Acyl CoA Dehydrogenase: ACAD10
Emir Tas1, Zhenwei Gong1, Jerry Vockley2 and Radhika Muzumdar1. 1Pediatric Endocrinology and Diabetes, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA and 2Medical Genetics, Children's Hospital of
Pittsburgh of UPMC, Pittsburgh, PA.
BACKGROUND: Acylcoenzyme A dehydrogenase(ACAD)-10 is a recently discovered member of the ACAD family of enzymes. The gene product is a 1059 amino acid protein with several alternatively spliced
transcript variants. Variants of ACAD10 were shown to be associated with insulin resistance and type 2 diabetes in Pima Indians. In a mouse model of Acad10 deficiency we have shown that these mice have higher
body weight and abundant fat deposition, and have impaired glucose homeostasis due to insulin resistance.
OBJECTIVE: To study the transcriptional regulation of ACAD10 gene.
DESIGN/METHODS: Expression of ACAD10 and other genes mRNA level in 3T3-L1 (mouse) preadipocyte, mature adipocytes, HepG2 (human hepatoblastoma) cells, and mice adipose and hepatic tissues was
assessed via RT-PCR. Standard preadipocyte differentiation medium (insulin, dexamethasone, IBMX) was used between day 0 and 3 to induce the differentiation of preadipocytes into mature adipocytes. Hepatic
ACAD10 expression in wild type (WT) mice (n=5/group) following overnight fasting and refeeding, as well as in mice fed with regular chow (RC) or high-fat diet (HFD)(n=5/group) were studied to assess in vivo
regulation of ACAD10.
RESULTS: There was a drastic decrease in the expression of ACAD10 mRNA level through day 0 to 3 during preadipocyte differentiation (p<0.01), coinciding with the presence of insulin in the medium. By day 6,
ACAD10 mRNA level significantly increased and returned almost to baseline at Day 0 (p<0.01). Gene expression level of ACAD10 significantly decreased in mature adipocytes following 6 hours of treatment with
insulin at different concentrations (1, 10, 100 nM; p <0.01). Similarly, ACAD10 mRNA level in HepG2 cells also decreased following insulin treatment (100 nM; p < 0.01). In vivo studies showed that the hepatic
ACAD10 expression in mice increased with overnight fast and decreased with 6-hour refeed(p < 0.01). WT mice fed with HFD for 40 weeks had significantly increased hepatic ACAD10 expression compared to regular
chow fed mice (p=0.02).
CONCLUSIONS: We provide strong evidence supporting the transcriptional regulation of the ACAD10 enzyme by insulin in vivo and in vitro. This regulation appears to be insulin dose-independent in mature
adipocytes. Insulin resistant state induced by HFD mitigates the inhibitory effect of insulin on hepatic ACAD10 expression. FOXO3, an insulin dependent transcription factor that has binding sites in the promoter region
of ACAD10, is a potential mediator of this regulatory process.
2016 Eastern SPR Annual Meeting
Abstract Number: 2599
Filename: 754150
Publication Number: 404
Presenting Author: Laura J. Novello, MD
Department/Institution/Address: Pediatric Endocrinology, North Shore-LIJ Health System, 1991 Marcus Ave, Suite M100, Lake Success, NY, 11042, United States
Phone: +1-516-472-3750
Fax: +1-516-472-3751
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: Different Murine Tissues Express Different Glucocorticoid Receptor (GR) Isoforms
Laura J. Novello1, Mabel N. Abraham2, Daniela M. Jimenez2 and Clifford S. Deutschman2,3. 1Pediatric Endocrinology, Cohen Children's Medical Center, North Shore LIJ Health System, Lake Success, NY; 2General
Pediatrics Research, The Feinstein Institute for Medical Research, North Shore LIJ Health System, Manhasset, NY and 3Pediatrics, Cohen Children's Medical Center, North Shore LIJ Health System, New Hyde Park,
NY.
BACKGROUND: Glucocorticoids (GCs) are major endocrine effectors in mammals, modulating activity in virtually all tissues. Recent studies have identified multiple GR isoforms. GRα is the active form. GRβ is
inactive and acts as a GRα competitive inhibitor. They are transcribed from a single gene, but are formed via different RNA splice sites. Additional isoforms result when translation of GRα mRNA is initiated at different
start sites, resulting in GRα products of different molecular weights (MW), designated A (95 kiloDaltons (kD)), B (91kD), C1-3 (82-84kD), and D1-3 (53-56kD).
OBJECTIVE: To determine if specific GR isoforms are preferentially expressed in distinct tissues and thus might contribute to tissue-specific GC effects.
DESIGN/METHODS: We isolated protein from the kidney, heart, lung, liver, quadriceps, and hamstring of C57BL/6 mice. Proteins were separated by molecular weight using density-gradient polyacrylamide gel
electrophoresis. Immunoblot analysis was performed using primary antibodies (Abs) directed towards epitopes unique for GRα (D8H2) isoforms and GRβ, and secondary light-detecting Abs, so that relative
abundance was reflected in chemiluminescence intensity. GRα subtypes were identified by MW.
RESULTS: We identified organ-specific expression patterns for GRα isoforms. In kidney, the GRα-D isoform predominated. Hamstring and heart tissues expressed both GRα-A and -C, while in quadriceps, we found
bands consistent with A, C and D bands. Lung and liver strongly exhibited bands consistent with all 4 isoforms (A, B, C, D).
CONCLUSIONS: Different tissues express different GR isoforms. This variation may explain some of the tissue-specific effects of GCs. We speculate that diseases and syndromes may alter the relative abundance of
GR isoforms within tissues, mediating disorder-specific changes/abnormalities. Future experiments will examine 1) tissue and disease-specific changes in the abundance of GRβ; 2) mechanisms that may induce
differential, tissue-specific and disease-mediated differences in GRα subtypes (A-D); and 3) the link between isoform abundance and cellular/tissue-specific activity.
2016 Eastern SPR Annual Meeting
Abstract Number: 678
Filename: 751960
Publication Number: 405
Presenting Author: Allison Bauman, DO
Department/Institution/Address: Pediatric Endocrinology, Cohen Children's Medical Center, 1991 Marcus Avenue, Suite M100, Lake Success, NY, 11042, United States
Phone: 516-472-3750
Fax: 516-472-3751
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 Maternal Magnesium Deficiency on Fetal Pancreatic Development
Allison Bauman1, Xiangying Xue2, Marlena McGill2, Prodyot Chatterjee2, Gopal Kumar3, Patricia Vuguin4, Phyllis Speiser1 and Christine Metz5. 1Pediatric Endocrinology, Cohen Children's Medical Center, Lake
Success, NY; 2The Feinstein Institute for Medical Research, Manhasset, NY; 3Elmezzi Graduate School of Molecular Medicine, Manhasset, NY; 4Pediatric Endocrinology, Columbia University Medical Center, New
York, NY and 5Feinstein Institute for Medical Research and Hofstra-North Shore-LIJ School of Medicine, Manhasset, NY.
BACKGROUND: Observations concerning fetal origins of adult disease show that maternal nutrition affects growth and development of offspring into adulthood. Magnesium (Mg) deficiency has been linked to insulin
resistance and type 2 diabetes (T2D) in adults. To date, the effects of maternal Mg deficiency on fetal pancreatic development have not been studied.
OBJECTIVE: To determine if Mg deficiency in utero will: 1. Impair murine fetal pancreatic development by altering the expression of genes involved in beta cell differentiation. 2. Alter fetal phenotype and metabolic
markers related to glucose regulation.
DESIGN/METHODS: After weaning at 3 weeks of age, Swiss Webster female mice were placed on control (100 % Mg, 500 mg/kg Mg, n=11) or Mg deficient (MgD, 50 % Mg, 250 mg/kg Mg, n=10) diets prior to
breeding and during pregnancy. On embryonic day 17, dams were euthanized, while fetal pups were delivered and weighed. Fetal pancreata from the same dam were pooled and qRT-PCR was used to assess gene
expression (Pdx1, Bcl2v1, Casp3, Igf1v1, Igf2v1, Kcnj8, Ins2v1, VegfA and Kdr). Welch's t-test was used for analysis. Heparinized fetal blood will be analyzed for ionized magnesium, insulin and glucose levels. In
addition, gene expression from pups euthanized on postnatal day 3 will also be analyzed, as pancreatic development continues until about postnatal day 30.
RESULTS: Fetal pups from MgD dams weighed less (0.60±0.7g) than those from control dams (0.68±.24g), p<0.001. There was no change in litter size or fertility. Pancreatic Pdx1 expression was lower in the MgD
fetal pups vs. controls (p=0.021). There was no significant difference in mRNA expression between the control and MgD groups for the remainder of the genes. Quantitative analysis of gene expression from postnatal
day 3 samples and metabolic markers are pending.
CONCLUSIONS: Fetal pups exposed to MgD weighed less and had lower pancreatic expression of Pdx1 than control fetal pups. Because Pdx1 is critical in pancreatic development and beta cell maturation, we
hypothesize that Mg deficiency in utero may lead to glucose intolerance in the offspring. Inadequate Mg consumption is widespread, and thus the effect of MgD and Mg supplementation on fetal weight, pancreatic
development, and glucose tolerance should be further examined.
2016 Eastern SPR Annual Meeting
Abstract Number: 3190
Filename: 752183
Publication Number: 406
Presenting Author: Mahmuda M. Ahmed, M.D.
Department/Institution/Address: Pediatric Endocrinology, Baystate Medical Center, 759 Chestnut Street, S-3581, Springfield, MA, 01199, United States
Phone: 5164692123
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: Adrenal Suppression Occurs in Children Treated with Inhaled Steroids Taken Orally for Eosinophilic Esophagitis Treatment
Mahmuda M. Ahmed1, Anastasios Angelides2, Meghana Gudala1 and Holley Allen1. 1Pediatric Endocrinology, Baystate Medical Center, Springfield, MA and 2Pediatric Gastroenterology, Baystate Medical Center,
Springfield, MA.
BACKGROUND: Eosinophilic esophagitis (EoE), a chronic immune mediated esophageal disease has been described as “asthma of the esophagus”. Inflammatory changes in the esophageal mucosa and submucosa
are reduced through the use of inhaled corticosteroids (ICS) that are deliberately swallowed. Very little is known about the impact of this treatment modality on adrenal function and whether secondary adrenal
suppression occurs.
OBJECTIVE: To determine whether adrenal suppression occurs in patients treated with ICS which are swallowed for treatment of EoE. We hypothesized that adrenal suppression does occur in patients during and
immediately after chronically swallowed ICS treatment.
DESIGN/METHODS: A descriptive study was designed to include both prospective and retrospective data. Consent and assent were obtained from study subjects < 18 years and only consent was obtained from
those ≥ 18 years. All subjects had histologically confirmed EoE. Data, compiled via in-person questionnaire and patient charts were incorporated into a database. Morning ACTH, cortisol and DHEA-S levels were
collected. Individuals with a morning cortisol < 8 mcg/dL were referred for a 1 mcg ACTH stimulation test.
RESULTS: In our cohort of 46 patients, 23 subjects (17M) with mean age 13.6 years (range 6 to 19) were prescribed chronic ICS taken orally and had morning screening labs. The median cortisol level was 10.6
mcg/dL (range 4.4 to 24.7). Six subjects underwent ACTH stimulation tests following low morning cortisols. Two of these individuals were found to have biochemical adrenal suppression, both of whom were treated
with a moderate dose of 440 mcg of swallowed fluticasone. The first subject was a 12 year old male who underwent ACTH stimulation testing during the 10th week of treatment. He had also taken ICS intermittently for
asthma. The other was an 8 year old male who had completed a 10 week course of swallowed ICS one week prior to the ACTH stimulation test.
CONCLUSIONS: Adrenal suppression occured in 9% of our patients who are prescribed chronically swallowed ICS. Prospective studies with a larger sample size are needed to determine the relationship between
timing and dosage of steroids and incidence of adrenal suppression.
2016 Eastern SPR Annual Meeting
Abstract Number: 4414
Filename: 752619
Publication Number: 407
Presenting Author: M. Goldis, MD
Department/Institution/Address: Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, United States
Phone: 212-241-6936
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: Effect of One Year of Growth Hormone Therapy on A1C and BMI for GHD and ISS patients
M. Goldis1, L. Waldman1, K. Williams1, C. Romero1, E. Wallach1, E. Burtman1, V. Cabreza1, M. Regelmann1 and R. Rapaport1. 1Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New
York, NY.
BACKGROUND: Growth hormone treatment (GHT) has been suggested to impair glucose metabolism. Recent reports suggest that GH-deficient pediatric patients have increased fasting glucose, without changes in
glucose tolerance after 1 year of therapy. To our knowledge, there have been no reports of BMI change in GH treated vs. untreated patients.
OBJECTIVE: Compare ∆A1C and BMI in patients on GHT for GH-deficient vs. ISS pediatric patients.
DESIGN/METHODS: Retrospective chart review of patients who had a GH stimulation test with the same agents, Arginine/L-dopa (deficiency, GH peak of <10 ng/ml). Patients were excluded due to medical conditions
(Turner Syndrome, precocious puberty, inflammatory bowel disease, multiple pituitary hormone deficiencies, diabetes mellitus) or insufficient data. The Mann-Whitney U and T-test were used for statistical analysis.
GH deficient (n=44)
GHT (n=39)
Age (yrs), all
Age (yrs)
11.2±2.6
Mean A1C T=0 (%),all
14
6
5.28
5.34
5.26
5.26
-0.29
5.29
5.30
5.41
-0.29
5.24
-0.32
-0.32
-0.46
-0.32
-0.34
16.1±5.2
22
5.26
5.35
Mean BMI (kg/m2) T=12 SD,all
Mean BMI (kg/m2) T=12 SD
15±5.3
5.34
Mean BMI (kg/m2) at T=0 SD,all
9.52±3.3
15.7±5.2
6.7±2.7
5.26
Mean A1C T=12 (%),all
Mean BMI (kg/m2) at T=0 SD
13.0±1.0
33
Pubertal T=0
Mean A1C T=12 (%)
8.6±1.6
6.6±1.9
No GHT (n=19)
10.8±3.2
6.6±2
# Male
Mean A1C T=0 (%)
ISS (n=30)
GHT (n=11)
10.9±2.6
Peak GH (ng/ml), all
Peak GH (ng/ml)
No GHT (n=5)
-0.24
-0.28
-0.18
-0.21
-0.31 (n=18)
RESULTS: Of 211 patients reviewed, 74 were included in the study. 54 patients were pre-pubertal at GH stimulation (T=0) and 26 remained pre-pubertal at 12 months (T=12). The mean treatment dose at T=12 was
0.26 ± 0.2 mg/kg/day. Among the ISS patients there was no significant difference in the ∆A1C between treated and untreated groups (mean ∆A1C was -0.04% for untreated, 0.1% treated). In GHD patients, ∆A1C was
statistically significant (mean ∆A1C -0.1% for untreated, 0.1% treated), U=45 (critical value 52). There was a significant increase in the ∆BMI in ISS patients who were treated compared to those who were not treated
(0.25 SD vs -0.11 SD, p=0.04).
CONCLUSIONS: In treated GHD patients, ∆A1C was statistically significant, but not clinically relevant. ∆BMI for ISS treated vs. untreated patients reached statistical, but not clinical significance. Long term trends
need to be observed to determine the clinical relevance over the years.
2016 Eastern SPR Annual Meeting
Abstract Number: 3529
Filename: 753734
Publication Number: 408
Presenting Author: Jessica Kremen, MD
Department/Institution/Address: Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States
Phone: 617-355-7476
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: Oxcarbazepine Is an Underrecognized Cause of Symptomatic Hyponatremia in Pediatric Patients Without Thirst: Two Case Reports
Jessica Kremen1 and Joseph Majzoub1. 1Division of Endocrinology, Boston Children's Hospital, Boston, MA.
BACKGROUND: Hyponatremia is a well-known side effect of oxcarbazepine (OXC) anti-epileptic therapy in pediatric patients, with a reported incidence of up to 25%. The mechanism remains unknown, though it does
not seem mediated by inappropriate secretion of vasopressin/anti-diuretic hormone. Anecdotal evidence indicates that screening practices for hyponatremia in patients on OXC vary among pediatric neurologists.
Hyponatremia is most often asymptomatic in otherwise healthy patients, which may be due to a compensatory decrease in thirst and intake of fluids. As a result, patients on OXC without the ability to report thirst, in
whom free water is provided based on estimated fluids requirements, may be in particular danger of severe or symptomatic hyponatremia. The relative incidence of hyponatremia in patients treated with OXC who
cannot express thirst is not well documented.
OBJECTIVE: To describe 2 cases in which excess free water given to patients treated with OXC who are unable to express thirst contributed to the development of symptomatic hyponatremia.
DESIGN/METHODS: Medical chart reviews.
RESULTS: The first case is an 8-year-old boy with severe developmental delay due to neonatal stroke, on a stable OXC dose for 5 years, who presented with serum sodium of 122 mmol/L and lethargy in the setting
of free water administration above daily maintenance requirements during hot weather. He responded to fluid restriction with resolution of hyponatremia. The second is a 6-year-old girl with severe developmental
delay due to chromosomal deletion who presented with decreased mentation and a serum sodium of 120mmol/L after receiving free water in excess of maintenance needs and increased OXC dose for breakthrough
seizure. She had resolution of hyponatremia with weaning of OXC. Neither patient had prior hyponatremia. Other causes of hyponatremia including renal salt wasting, hypothyroidism and adrenal insufficiency were
considered unlikely in both cases based on laboratory evaluation performed during these and previous admissions.
CONCLUSIONS: In patients taking OXC who are unable to express thirst, administration of free water in excess of daily maintenance requirements may cause symptomatic hyponatremia. To our knowledge, this is the
first case series to describe this aspect of OXC-induced hyponatremia. We propose that this population should be monitored regularly for hyponatremia, particularly in the setting of changes in fluid administration or
OXC dose.
2016 Eastern SPR Annual Meeting
Abstract Number: 4365
Filename: 751293
Publication Number: 409
Presenting Author: Karla F. Leavens, M.D., Ph.D.
Department/Institution/Address: Pediatrics, Divison of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA, 19104, United States
Phone: 267-455-3727
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: Blood Glucose Levels During the First 24 Hours of At-Risk Infants: A Review of the Magee-Womens Hospital Infant Blood Glucose Policy
Karla F. Leavens1,2 and Abeer Azzuqa1. 1Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA and 2Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
BACKGROUND: One of the most dramatic physiologic changes that neonates undergo is the change in metabolic function that occurs once the maternal flow of nutrients ceases. Infants maintain and tolerate lower
blood glucose levels during the first hours of life, but it is unclear what safe glucose levels are during this period, even after decades of research and debate. Therefore, current consensus statements are based on
monitoring glucose levels in those infants identified as being at risk of developing hypoglycemia. One large group of these infants are those with immature metabolic systems, including those with intrauterine growth
restriction (IUGR), small-for-gestational age (SGA), low birth weight and born late-preterm.
OBJECTIVE: -To assess the implementation of the Infant Blood Glucose Policy in the newborn nursery at our hospital in at-risk infants. -To characterize the glucose patterns of this population in the first 24 hours of
life.
DESIGN/METHODS: Retrospective chart review of at-risk infants born at Magee-Womens Hospital in Pittsburgh from January 1 to June 30, 2012 based on ICD-9 codes for IUGR, SGA, late-preterm (35-37 weeks)
and low birth weight (<2500 grams).
RESULTS: A total of 685 charts were examined and data was collected from 387 of those after exclusion criteria were applied. Glucose monitoring was performed in 85% of at-risk infants. Of those 15% with no
glucose monitoring, 93% met criteria by SGA alone, accounting for 62% of SGA-alone infants. Of those monitored, 6.1-9.7% met criteria for hypoglycemia, and 4.8% were transferred to the NICU. 55% and 46% of
infants had appropriate start of feeds and glucose monitoring, respectively, and 91% had appropriate termination of glucose monitoring; however, there was significant heterogeneity in follow-up of borderline glucose
levels. Though mean glucose levels during hours 1-4 were significantly lower compared with hours 4-24 (55 versus 60 mg/dL), the mean and median times of the glucose nadir were 7.3 and 5.4 hours. The mean and
median glucose nadirs were 44 mg/dL, though infants with later nadir times tended to have higher nadir levels.
CONCLUSIONS: 6-10% of at-risk infants met criteria for hypoglycemia in our population. Improvements in adherence to the current policy could be made, especially as the majority of SGA-alone infants are not being
appropriately screened, possibly due to lack of identification of these infants during the first day of life.
2016 Eastern SPR Annual Meeting
Abstract Number: 4094
Filename: 755558
Publication Number: 410
Presenting Author: Swathi Sethuram, MD
Department/Institution/Address: Lincoln Medical and Mental Health Centre, 234 East, 149th Street, Bronx, NY, 10451, United States
Phone: +13479516246
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 Association of Elevated Alanine Transaminases With Cardiovascular and Metabolic Markers in Obese Children and Adolescents of the South Bronx
Swathi Sethuram1, Hoda Karbalivand1 and Swati Dave-Sharma2. 1Pediatrics, Lincoln Medical and Mental Health Centre, Bronx, NY and 2Pediatric Endocrinology, Lincoln Medical and Mental Health Centre, Bronx, NY.
BACKGROUND: In this study, we assess the co-relation between cardio-metabolic markers with elevated alanine transaminase(ALT) levels in obese children and adolescents in the South Bronx. We will identify
patients with metabolic syndrome and its association with altered liver enzymes.
OBJECTIVE: 1. Establish the association of elevated liver enzymes in obese patients of the South Bronx. 2. Identify the presence of high risk atherogenic index and elevated HOMA-IR, in children and adolescents
between 3-20yrs of age. 3.Identify the association of ALT with metabolic syndrome and thereafter, with other cardio-metabolic risk factors.
DESIGN/METHODS: Cross sectional study data from EMR record of outpatient visits between 2010-2015, ages 3 to 20yo. Inclusion criteria: documented age, sex, ethnicity, BMI, fasting glucose, insulin, lipid profile,
ALT and AST, HbA1C. Patients with prior steroid use, comorbid conditions: thyroid abnormalities or Cushing disease were excluded. HOMA-IR (Homeostatic model assessment-Insulin resistance) determined using
the cut-off points from established studies. Subjects over 10yo who fulfilled the NCEP ATPIII criteria were diagnosed with metabolic syndrome.Waist circumference (WC) was substituted with BMI (>/= 90th percentile).
RESULTS: Total patients(n) were 134,primarily Hispanic. 69% were overweight/obese, 28% were severely obese. Elevated ALT noted in 22 patients(p=0.009). 53% of population had elevated HBA1C levels. 16% of
this population (HBA1C>/=5.7) 5.9% of subjects with fasting glucose >100mg/dL and in 50% with glucose >126mg/dL (p = 0.03) had high ALT. Prevalence of metabolic syndrome was 34% in 115 patients. In these
patients, elevated ALT noted in 30%(p= 0.001), Elevated AI in 97%, IR in 35%, high insulin in 30% and 41% with elevated HBA1C. 54% of our total patient population with elevated ALT were diagnosed with metabolic
syndrome.
CONCLUSIONS: Liver enzymes are simple and effective tools. We identify a strong association between ALT and metabolic syndrome. We recommend the use of ALT to not only look for NAFLD but also to identify
the risk of cardio-metabolic disease and abnormalities of glucose metabolism in obese populations with or without metabolic syndrome. Further studies are mandated to establish the role of this enzyme in early
intervention and prevention strategies for obese children and adolescents, particularly in the high risk children of South Bronx.
2016 Eastern SPR Annual Meeting
Abstract Number: 3157
Filename: 751986
Publication Number: 411
Presenting Author: Shrinkhala Srivastava, MD
Department/Institution/Address: University of Connecticut, 505 Farmington Ave, 2nd floor, Farmington, CT, 06032, United States
Phone: 1-860-719-7536
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: Effects of Bariatric Surgery on Metabolic Risk Factors in Adolescents with Polycystic Ovarian Syndrome (PCOS)
Shrinkhala Srivastava1, Paola Palma Sisto1,2 and Trudy Lerer3. 1Department of Pediatrics, University of Connecticut, Farmington, CT; 2Division of Pediatric Endocrinology, Connecticut Children's Medical Center,
Hartford, CT and 3Research, Connecticut Children's Medical Center, Hartford, CT.
BACKGROUND: Adolescents with Polycystic Ovarian Syndrome (PCOS) and obesity are at risk for metabolic syndrome. Lifestyle modifications produce only modest weight loss with limited continuation rates. There
are limited studies showing the effects of bariatric surgery on the metabolic parameters of adolescent PCOS patients.
OBJECTIVE: Assess changes in BMI and metabolic parameters (including glucose metabolism, lipids, hypertension) in adolescent patients with PCOS one year after laparoscopic adjustable gastric banding (LAGB).
DESIGN/METHODS: Thirty pediatric patients underwent LAGB between 2008-2015. Patients who also carried the diagnosis of PCOS (n=7) with signed consent had their charts reviewed. BMI and metabolic profiles
were compared pre and 1 year post LAGB.
RESULTS: The seven patients had a mean age of 18.5±1.3 years at time of surgery. Mean BMI at first bariatric visit was 45.3±3.9 kg/m2. Average time in bariatric program prior to surgery was 9±3.4 months. All
patients decreased their BMI (mean change -4.2%, -1.9 ±1.1 kg/m2 (range -0.9 to -3.7)) through lifestyle interventions. Prior to surgery 57% (n=4) were also receiving Metformin therapy. Average percent change in
BMI 1 year after surgery was -5.5% (average BMI change -2.1±4.1 kg/m2, range -8.1 to +2.3). One year after surgery (average 11.5 ±1.4 months), 57% (n=4) of patients continued to decrease their weight. Two of the
patients (29%, n=2) had evidence of metabolic syndrome at program start, but only one met criteria one year post surgery.
CONCLUSIONS: All PCOS patients were able to lose weight prior to surgery with intensive lifestyle modifications. For some PCOS patients, bariatric surgery allowed for weight reduction, prevention, and reversal of
metabolic risk factors. Further studies are needed to assess the long term benefits of other bariatric surgical procedures in adolescent PCOS patients.
2016 Eastern SPR Annual Meeting
Abstract Number: 4662
Filename: 756017
Publication Number: 412
Presenting Author: Hoda Karbalivand, MD
Department/Institution/Address: Lincoln Medical and Mental Health Center, 234 East, 149th Street, Bronx, NY, 10451, United States
Phone: 2016201871
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: High Prevalence of Metabolic Syndrome, Increased AI (Atherogenic Index) and Increased IR (Insulin Resistance) in Obese Children and Adolescents of South Bronx
Hoda Karbalivand1, Swathi Sethuram1 and Swati Dave-Sharma2. 1Pediatrics, Lincoln Medical and Mental Health Center, Bronx, NY and 2Pediatric Endocrinology, Lincoln Medical and Mental Health Center, Bronx, NY.
BACKGROUND: Prevalence of obesity in Bronx reported to be about 22.5%. Along with rising prevalence of the childhood obesity, an increased prevalence of metabolic syndrome (MetS) and insulin resistance has
been observed. MetS is associated with risk factors that increase risk of atherosclerosis and type 2 diabetes mellitus. In this study we investigate the prevalence of MetS and its relationship with insulin resistance and
subclinical atherosclerosis among obese children and adolescents of south Bronx.
OBJECTIVE: 1. Identify prevalence of metabolic syndrome in obese children and adolescents of the South Bronx. 2. Identify association of cardio-metabolic parameters with metabolic syndrome.
DESIGN/METHODS: For this cross-sectional study, data was retrieved from chart review of obese patients from 3-20yo. Inclusion criteria: documented age, gender, BMI, triglyceride(TG), high density
lipoprotein(HDL), glycosylated hemoglobin(A1C), fasting plasma glucose(FPG) and fasting insulin level. Patients with steoid use, metabolic disorders excluded. We substituted waist circumference (WC) with BMI>90
percentile in the ATP III criteria for diagnosis of MetS. Insulin resistance (IR) was evaluated by homeostasis model assessment (HOMA)-IR and Atherogenic index (AI) calculated by log [TG(mg/dl)/HDL-C(mg/dl)]. Chi
square was elaborated to analyze the data. We attempted to analyze the relationship between MetS, AI and IR in our population.
RESULTS: 156 obese children, predominantly Hispanic, with an average age of 12.3±3.1 years (equal female to male ratio) were studied. Based on ATPIII criteria, prevalence of metabolic syndrome was 28%. No
significant relationship between MetS and A1C levels observed. Also, no correlation between current A1C cutoffs and the risk for having MetS identified. Our data showed significantly higher insulin resistance index
among patients with MetS (P Value: 0.006). More importantly, 95% of our obese children with MetS have subclinical atherosclerosis with high AI (P Value of 0.001).
CONCLUSIONS: We observed the prevalence of MetS among obese children of south Bronx is much higher than other studies. We report a strong correlation between metabolic syndrome, atherogenic index and
insulin resistance. Early detection can help with appropriate intervention. We suggest that BMI can be a good screening criteria for obese children and adolescents at risk for cardiovascular disease.
2016 Eastern SPR Annual Meeting
Abstract Number: 3162
Filename: 751997
Publication Number: 413
Presenting Author: Shrinkhala Srivastava, MD
Department/Institution/Address: Pediatric Endocrinology, University of Connecticut, 505 Farmington Ave, 2nd Floor, Farmington, CT, 06032, United States
Phone: 1-860-719-7536
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: Characterization at Diagnosis and Follow Up of Adolescent Patients with Polycystic Ovarian Syndrome (PCOS)
Shrinkhala Srivastava1, Paola Palma Sisto1,2, Christine Trapp1,2 and Trudy Lerer3. 1Department of Pediatrics, University of Connecticut, Farmington, CT; 2Division of Pediatric Endocrinology, Connecticut Children's
Medical Center, Hartford, CT and 3Research, Connecticut Children's Medical Center, Hartford, CT.
BACKGROUND: Studies on polycystic ovarian syndrome (PCOS) and its associated co-morbidities such as obesity and metabolic disease in adolescents are limited with small sample sizes.
OBJECTIVE: The aims of our study were to better characterize adolescent PCOS patients who were overweight/obese and examine how weight and metabolic parameters (including glucose metabolism, lipids, blood
pressure) change over time.
DESIGN/METHODS: Females (n=144) 12 to 19 years old diagnosed with PCOS between June 2012-June 2014 in a pediatric endocrine practice whose body mass index (BMI) was ≥ 85th percentile for age were
identified for chart review. Clinical and laboratory data were analyzed at diagnosis and at one year (range 10-15 months) to assess BMI and metabolic changes. Sixty-two patients had follow-up data.
RESULTS: Patients had a mean age of 15.5±1.4 years, 3.9±1.7 years post-menarchal, and average BMI 35±6.9 kg/m2. Patients receiving state health insurance (36.8%) had a higher BMI at diagnosis (p<0.01).
Hispanic patients were more likely to have fasting blood sugar above 100mg/dL (p=0.01). No patients had type 2 diabetes. Hirsutism (71.5%), acne (57.1%), hypertension (25%) and low high-density lipoprotein levels
(55.8%) were common. Family history of diabetes (68.6%) predicted a higher BMI at presentation (p<0.01). At diagnosis, lifestyle counseling (85%), Metformin (25%), and oral contraceptive therapy (51%) were
commonly prescribed. Average BMI change was +0.04±1.8 kg/m2 at one year. Weight loss was more likely in those with a lower BMI at diagnosis (p<0.01) or on Metformin (p<0.01). Metabolic parameters did not
change at one year, regardless of Metformin therapy.
CONCLUSIONS: This is one of the largest studies of adolescents with PCOS of its kind. These patients are frequently overweight/obese at diagnosis and can have signs of metabolic derangement even at this early
stage. Additional factors may impact degree of obesity (socioeconomic status) and degree of metabolic derangement (ethnicity). Lower BMI at diagnosis and Metformin therapy were significantly associated with
improved weight loss at 1 year.
2016 Eastern SPR Annual Meeting
Abstract Number: 1371
Filename: 751221
Publication Number: 414
Presenting Author: Daniel T. Yu, MB, BCh, BAO
Department/Institution/Address: 2001 Eastern Ave, Apt C, Baltimore, MD, 21231, United States
Phone: 9179712084
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: Foreign Medical Aid to Solomon Islands – Developing a Local Professional Education Curriculum Emphasizing Sustainability
Daniel T. Yu1, Karen A. Schneider1, Jennifer F. Anders1 and Martha W. Stevens1. 1Pediatric Emergency Department, Johns Hopkins Hospital, Baltimore, MD.
BACKGROUND: At the request of Solomon Islands' medical core, the Johns Hopkins Hospital Pediatric Emergency Department collaborated with their National Referral Hospital (NRH) to establish a month long
clinical education program in pediatric acute care for the country's inaugural class of national medical trainees, with an emphasis on sustainability with respect to available resources.
OBJECTIVE: To provide needs-based training in acute pediatric care and resuscitation, and to evaluate the initial impact of the curriculum, including knowledge, learner experience, satisfaction, and future needs.
DESIGN/METHODS: The curriculum was adapted based on clinical needs and surveys, and consisted of high yield didactics in the form of workshops, simulations, bedside teaching, and lectures at the NRH.
Evaluation of the curriculum employed a mixed methods design and included PALS type pre/post-event knowledge testing as well as post-event qualitative group discussion and individual surveys to assess learners'
experience and future needs.
RESULTS: The 12 pediatric topics requested by learners were drowning, seizure, sepsis, pediatric/neonatal resuscitation, airway management, dermatology, suturing, respiratory emergencies, diabetes, child abuse
and trauma; 6 were evaluated by post-event survey, and 3 with pre/post knowledge testing. A total of 78 pre/post-tests and 167 individual surveys were collected from a study population of 30 trainees. Completion
rates were 93% for surveys and 87% for pre/post-test pairs. Learners rated curriculum sustainability with respect to local resources at median 9/10 Likert. Knowledge increases were reflected by test score rise from
44% to 63% post-test. Learners reported a median 7.7/10 Likert for confidence in teaching the presented topics given access to curriculum material.
CONCLUSIONS: We modeled a sustainable teaching curriculum for the first class of Solomon Islands' medical graduates. We were invited by the NRH to return for additional curriculum development next year.
Knowledge growth and other positive impacts of our program were reflected in learner survey and test scores, both consistently highlighted topic areas of weakness and desire for further instruction – that will directly
guide future local educational endeavors. Establishing this initial process for teaching life-saving pediatric topics can in turn potentially play a major role in shaping the health of children in Solomon Islands.
2016 Eastern SPR Annual Meeting
Abstract Number: 2601
Filename: 754155
Publication Number: 415
Presenting Author: William Chan
Department/Institution/Address: Molecular and Cell Biology, University of Connecticut, 91 North Eagleville Road, Unit 3125, Storrs, CT, 06269, United States
Phone: 860-967-4692
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: Assessing Public Perceptions of Recent Epidemics in Children
William Chan1, Henry Guo1, Christine Mulvey2 and Sharon R. Smith2. 1Molecular and Cell Biology, University of Connecticut, Storrs, CT and 2Emergency Department, Connecticut Children's Medical Center, Hartford,
CT.
BACKGROUND: The Ebola and measles epidemics in 2014 significantly impacted children. Ebola lead to fear and impacted medical care throughout the world. Measles epidemic in US also caused fear and prompted
national discussions.
OBJECTIVE: To assess parents' and childrens' perceptions regarding the infectious epidemics from Ebola and measles, their knowledge, understanding of contagousness, risk, and venues where they seek medical
information.
DESIGN/METHODS: Items regarding parental and childrens perceptions about the recent Ebola and measles epidemics were developed by undergraduate students and administered to English speaking children
aged 7-17 and their parents in an urban Pediatric ED.
RESULTS: 200 parents and 200 children were approached and completed the questionnaire. Children were in grades 6-8 (32%), grades 9-12 (56%), and 84% parents had HS or college degrees. When asked if they
were more likely to get Ebola or measles: children reported measles 26%, Ebola 8%, either 11%, neither 54% and parents reported measles 21%, Ebola 6%, either 8%, neither 43%. 22% children were worried about
getting infected by these illnesses, and 49% would not feel safe at school if classmate got Ebola. Parents, when asked how many confirmed cases in our state would keep them home from work/children from school:
Ebola 1 case - 24% would stay home, 5 cases - 17%; and measles 1 case - 21% would stay home, and 5 cases 15%. 54% of parents reported talking to their children about infectious diseases such Ebola or measles.
Children reported getting medical information about Ebola from television (34.7%), school (20.6%) and social media (17.1%); and parents from TV (31.5%), doctors (28.5%) and social media (10.5%).
CONCLUSIONS: While both parents and children reported it was more likely to get measles than Ebola, about 10% reported they were most likely to get Ebola. Almost a quarter of parents reported they would stay
home from work and keep children home from school if 1 confirmed case of either Ebola or measles was reported in our state, suggesting high levels of fear and lack of knowledge. A third of children and parents
reported getting medical information about epidemics from television. Parents reported doctors and social media as next most common venues and children reported school and social media. Educational efforts in
future epidemics may consider using these venues.
2016 Eastern SPR Annual Meeting
Abstract Number: 3134
Filename: 751817
Publication Number: 416
Presenting Author: Leora Mogilner, MD
Department/Institution/Address: Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1202A, New York, NY, 10029, United States
Phone: 6464831632
Fax: 2129969685
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: Community Pediatrics and Advocacy Training in New York State: Where We Are and Where We Want to Be
Leora Mogilner1, Wee Chua2, Dodi Meyer3, Anne Armstrong-Coben3, Cappy Collins1 and Laurie Gordon4. 1Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; 2Pediatric Emergency Medicine,
University of Washington, Seattle, WA; 3Pediatrics, Columbia University Medical Center, New York, NY and 4Pediatrics, New York-Presbyterian/Queens, Flushing, NY.
BACKGROUND: ACGME guidelines mandate that pediatric residencies include 2 educational units of "ambulatory experiences to include elements of community pediatrics and child advocacy." New York State(NYS)
is home to 30 of the 200 pediatric training programs in the US, many in close proximity to one another. The NYS Pediatric Advocacy Coalition(NYSPAC) was created to enable residency programs to share community
pediatrics/advocacy curricular resources, offer a platform for joint training opportunities and create a unified voice to advocate for child health issues in NYS.
OBJECTIVE: To describe the current state of resident training in community pediatrics and advocacy in NYS and identify barriers to creating successful training programs.
DESIGN/METHODS: Faculty responsible for resident training in community pediatrics/advocacy at NYS pediatric residency programs were contacted. A phone survey was administered with structured questions
about training and resources and open-ended questions about programs' strengths and challenges. Qualitative analysis was performed by 2 readers to identify domains and ensure inter-rater reliability. IRB approval
was obtained from the authors' institutions.
RESULTS: 21(70%) of the 30 course directors were surveyed. 100% of programs offer community pediatrics/advocacy training. 9(43%) have a stand-alone rotation, 6(29%) have training integrated into other rotations
and 6(29%) have a mixture of both. Residents spend an average of 4 weeks on their community peds/advocacy training. 10(48%) of course directors have protected time to oversee their programs, ranging from
5-50% FTE. 15(71%) have no administrative support. 100% of respondents were interested in collaborating with other programs, participating in joint faculty development and sharing curricula. 90% were interested in
joint resident training. The greatest barriers identified were not enough protected faculty time and lack of administrative support.
CONCLUSIONS: Community pediatrics/advocacy training directors in NYS uniformly welcome collaboration between residency programs. They identify lack of faculty time and administrative support as the main
barriers to creating successful programs. Sharing resources and creating opportunities for joint faculty and resident training can mitigate these barriers. The goal of NYSPAC is to create a network of future pediatric
leaders who can advocate collectively on behalf of children in NYS.
2016 Eastern SPR Annual Meeting
Abstract Number: 4196
Filename: 755734
Publication Number: 417
Presenting Author: Aditi Khokhar, MBBS
Department/Institution/Address: 445 Lenox Road, Box 49, Brooklyn, NY, 11203, United States
Phone: 001-718-613-8605
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: Sex Maturity Rating- A National Survey of the Attitude, Knowledge and Practice of Pediatric Trainees
Aditi Khokhar1, Yagnaram Ravichandran2, Dimitre G. Stefanov3 and Sheila Perez-Colon1. 1Pediatric Endocrinology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY; 2Pediatrics,
SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY and 3Statistical Design & Analysis, Research Division, SUNY Downstate Medical Center, Brooklyn, NY.
BACKGROUND: Sex Maturity Rating (SMR) defines different levels of sexual maturity, based on development of secondary sexual characteristics. Periodic assessment of pubertal maturation by physicians is crucial
for timely identification of puberty related disorders.
OBJECTIVE: With this study, we aimed to assess the attitude, knowledge and practice of pubertal assessment by current pediatric trainees across the United States.
DESIGN/METHODS: An anonymous online survey questionnaire was sent to pediatric trainees at different levels of training across the US through AAP SOMSRFT section. The survey, comprising of 22 questions,
was sent to 11,300 trainees in total. Chi-square test was used to test for association between categorical variables. Knowledge scores were described using mean and standard deviation. Two-way ANOVA test was
used to estimate the independent contribution of training level and Endocrinology rotation. Stepdown Bonferroni procedure was used to adjust for multiple tests.
RESULTS: A total of 2231 complete responses were received, accounting for 20% response rate in 22 days survey period. Our study population demographics were similar to the current US Pediatric residents. Our
results showed that 96% of the trainees understand the importance of assessing SMR in pediatric population, 62% feel confident in assessing SMR and 55% feel comfortable assessing the need for an Endocrinology
referral based on abnormal SMR for age. However, only 33% of the trainees performed genital exams during all well visits in clinic while 27% never performed genital exams during any of the sick visits in clinic and
6% never assessed SMR during any of the well visits in clinic. Improvement in comfort level, practice and knowledge of trainees regarding pubertal assessment was associated with higher levels of training and having
completed an Endocrinology rotation.
CONCLUSIONS: To our knowledge, this is the first national survey of pediatric residents regarding SMR assessment. Current clinical practice of pediatric trainees with regards to genital examination and SMR
assessment need major improvements. Stronger reinforcement from continuity clinic preceptors and/or online and clinic based resources for SMR assessment for trainees might improve adherence to the
recommended guidelines. Endocrinology elective is a valuable option for trainees to improve their skills and knowledge regarding pubertal assessment.
2016 Eastern SPR Annual Meeting
Abstract Number: 4236
Filename: 755801
Publication Number: 418
Presenting Author: Sharyn Malcolm, MD, MPH
Department/Institution/Address: 7282 Mandan Road, Greenbelt, MD, 20770, United States
Phone: 617-699-6236
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: An Evaluation of Fellow Clinic Work Activities using Work Sampling Analysis in an Urban Academic Adolescent Medicine Outpatient Center
Sharyn Malcolm1, Jean Someshwar1, Robyn Miller2, Brooke Bokor1 and Joyce Campbell3. 1Division of Adolescent and Young Adult Medicine, Children's National Health System, Washington, DC; 2Adolescent
Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE and 3Medical Education, Children's National Health System, Washington, DC.
BACKGROUND: In an effort to identify and quantify activities perceived to be encroaching on time interacting with patients/families and educational activities, self-work sampling methodology was utilized to obtain
data on how fellows spend their time during the day and the perceived educational value of these activities within the Adolescent Medicine fellowship program of CNHS.
OBJECTIVE: To identify areas for program improvement through self-report of the time and perceived educational value of time spent on various work activities by fellows.
DESIGN/METHODS: A descriptive self-work sampling study using a programmed personal digital assistant (PDA) randomly queried fellows to document their real-time activity and rate the perceived educational
value. All three Adolescent Medicine fellows participated in this IRB exempt study. Data were collected between October 2013 and May 2014 for 2-3 weeks at a time with 1 week off for data download and evaluation
to ensure accuracy.
RESULTS: All three fellows participated in the study for 132 days and collected a total of 1,584 data queries. While data collected was insufficient in any one category to be statistically significant, the results show
potential trends. As a group, the fellows averaged 57% of time in clinic, 13% in formal education, and 9% in research. Within the clinic sub-activity, 40% of fellow's time was spent on medical record documentation
while 30% was spent with patients/families. Research time increased with level of trainee, as expected, but only 57% of the aggregated research time among all fellows was spent on research-related work while 25%
was spent on clinic-related activities. Interacting with patients/families and planned educational activities were rated excellent or good educational value in >90% of the queries.
CONCLUSIONS: The utilization of a PDA to document work activities allowed for identification of areas for education-work balance improvement, however, additional data points are needed to substantiate some of
the trends observed.
2016 Eastern SPR Annual Meeting
Abstract Number: 4210
Filename: 755754
Publication Number: 419
Presenting Author: Miriam T. Stewart, MD
Department/Institution/Address: Division of Neonatology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19143, United States
Phone: 267-283-7235
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: Developing a Peer Mentoring Program for Pediatric Residents
Miriam T. Stewart1 and Nicole Hames2. 1Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA and 2Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
BACKGROUND: Residents experience high rates of burnout. The support and shared wisdom of residents who are farther along in training could be protective. However, frequent changes in team composition during
residency make developing longitudinal relationships challenging. A structured peer mentoring program may facilitate supportive interactions between residents at different levels of training.
OBJECTIVE: To create a peer mentoring program for pediatric residents and to evaluate its effects on intern participants.
DESIGN/METHODS: Senior and junior residents were given the opportunity to volunteer to be mentors. Every incoming intern was assigned to a mentor “family,” comprised of 1-2 seniors, 1-2 juniors, and 2-3 interns.
Mentors were expected to make contact with their mentees monthly with the goal of in-person contact 3-4 times during the year. Reminder emails were sent to mentors quarterly. At the end of the year, an anonymous
20-item survey was sent via email to interns to assess the program's effectiveness.
RESULTS: 26/49 (53%) senior residents and 28/48 (58%) junior residents volunteered to be mentors. 28/49 (57%) interns responded to the survey. 18/28 (64%) of respondents reported contact with their senior
mentor at least 3 times during the year. Interns who had contact with their senior resident mentors ≥ 3 times during the year were more likely than those who had less contact to report that their mentor was helpful
(83% vs 40%), that their mentor had an important influence on their personal development (83% vs 0%), and that they would feel comfortable reaching out to their mentor during a difficult time (78% vs 0%). There
appeared to be a trend towards a dose-response relationship.
CONCLUSIONS: Resident peer mentoring is feasible and may be helpful to interns. More frequent contact appears to be associated with more successful mentoring relationships, though our small sample size limits
our ability to make definitive conclusions. Future research is needed to determine what factors contribute to more successful resident peer mentorship pairings.
2016 Eastern SPR Annual Meeting
Abstract Number: 1591
Filename: 752668
Publication Number: 420
Presenting Author: Keri Toner, MD
Department/Institution/Address: Pediatrics, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, United States
Phone: 4049381038
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: Resident Perspectives of Virtual Simulation in an Online Complex Care Curriculum
Keri Toner1, Dewesh Agrawal1, Priti Bhansali1 and Neha Shah1. 1Children's National Health System, Washington, DC.
BACKGROUND: There are a growing number of children with medical complexity (CMC). These children may be dependent on devices such as G tubes, VP shunts, or tracheostomies and have unique needs.
Resident physicians are involved in the care of these patients but may have less exposure to these devices. CMC serve as a special population for which virtual simulation (VS) may serve a beneficial role in pediatric
residency medical education. While simulation is a widely recognized training tool in graduate medical education, VS is relatively unique in this context.
OBJECTIVE: To ascertain resident perceptions toward the use of VS for learning to care for CMC with a medical device-related emergency.
DESIGN/METHODS: This was a cross-sectional survey of pediatric residents enrolled in a national randomized study evaluating an online curriculum on CMC. Pediatric residents were asked to complete the
curriculum and associated assessments, which included VS. Each participant was asked to complete one of three VS scenarios of an emergency related to medical device malfunction. In the VS scenario, participants
were provided with scenes where information was presented with audio and video inputs, prompting actions to address the acute problem. Survey outcomes included assessment of resident experience and
perceptions toward VS, and confidence in addressing medical device malfunction after participating in the VS.
RESULTS: 86 pediatric or medicine-pediatric residents from 20 pediatric residency programs across the nation completed the survey. Of the respondents, 77% have participated in live simulations in residency.
However, only 42% have participated in VS. 93% agree or strongly agree that simulation enhances learning methods in residency, and 94% agree or strongly agree that VS would be a useful supplement to live
simulations. Regarding CMC, 88% agree or strongly agree that VS would be helpful to learn about children with medical devices.
CONCLUSIONS: While live simulations are an integrated part of pediatric residency education, less than half of resident participants have utilized VS. VS provides a reality-based, safe learning environment, without
the resources and personnel required of live simulation. The majority of participants in this study believe that VS is particularly helpful in learning about the growing population of CMC with medical devices. VS is a
resource that from the learners' perspective would be a beneficial adjunct to current methods of residency education.
2016 Eastern SPR Annual Meeting
Abstract Number: 1148
Filename: 753716
Publication Number: 421
Presenting Author: Gina M. Geis, MD
Department/Institution/Address: Pediatrics/Division of Neonatology, Albany Medical Center, 43 New Scotland Ave, Mail Code 101, Albany, NY, 12208, United States
Phone: 5182625421
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: A Digitally Innovative Bioethics Curriculum for Neonatal-Perinatal Medicine Fellows: Results After Year 1 of a Pilot Study
Gina M. Geis1 and Christy Cummings2. 1Pediatrics/ Neonatology, Albany Medical Center, Albany, NY and 2Pediatrics, Boston Children's Hospital, Boston, MA.
BACKGROUND: Adequate training in ethics and professionalism is crucial so that neonatologists may effectively approach and resolve the ethical dilemmas that arise daily in the Neonatal Intensive Care Unit (NICU).
Although fellowship programs are required to establish trainee competency in this area, there are currently no standardized guidelines and only limited evaluation tools to teach and assess such knowledge and skills.
This project aims to address this critical educational gap.
OBJECTIVE: 1. To develop and locally pilot a digitally innovative case/simulation-based curriculum in ethics and professionalism and 2. To study the effects of the curriculum on individual learners' knowledge and
confidence after year 1 of the pilot.
DESIGN/METHODS: We developed 5 modules in ethics for neonatology fellows and piloted them at 2 institutions. Content was written by experts in neonatal ethics, peer-reviewed, and uploaded onto a digitally
innovative platform. Participants first reviewed content online and subsequently participated in live sessions already informed on the topic. This study was approved by the IRB at both institutions. Data were analyzed
using SAS 9.3 statistical software.
RESULTS: Baseline surveys including test of knowledge (TEK-Neo) and confidence in confronting ethical dilemmas were delivered prior to the start of the curriculum and repeated at the end of Year 1. In addition, preand post-tests were administered for each of the 5 modules. 100% of participants demonstrated improvement in knowledge scores on the post-test as compared to the pre-test. Three of the modules (Principles of
Bioethics, p<0.0001, Maternal-Fetal Conflict, p=0.0002, and Withdrawing/Withholding Support, p=0.02) as well as the composite TEK-Neo (p =0.04) had mean improvements reaching statistical significance. In
addition, the ethical domains covered in year 1 (End-of-Life Care, p =0.03 and Shared Decision-Making, p<0.05) demonstrated a mean improvement in confidence score reaching statistical significance, whereas the
domains not yet covered did not improve with significance, as expected.
CONCLUSIONS: Year 1 of this pilot demonstrated success by significant improvement in knowledge scores and confidence in confronting ethical challenges covered in this curriculum, and similarly, a lack of
improvement in domains not yet covered. Future steps include the development and implementation of the remaining modules and continued assessments of efficacy.
2016 Eastern SPR Annual Meeting
Abstract Number: 4411
Filename: 752538
Publication Number: 422
Presenting Author: Karishma Choksey, MD
Department/Institution/Address: 28 Richlee Court, Apt 4S, NY, 11501, United States
Phone: 516-817-2037
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: Efficacy of Pediatric Residents Training El Salvador Community Healthcare Workers in Basic Pediatric Life Support and Neonatal Resuscitation
Ngoc Nguyen1, Karishma Choksey1, Cecilia Monteilh1 and Paul Lee1. 1Pediatrics, Winthrop University Hospital, Mineola, NY.
BACKGROUND: Resident Initiated Global Medical Education (RIGME), a pediatric program at Winthrop-University Hospital, promotes health of children in El Salvador and provides medical education to local health
providers via resident driven educational workshops based on shared common interests. In El Salvador, community health workers (promotores) are critical in providing basic health care to neighborhoods, such as
first aid skills and post-natal care of newborns. However, with an average educational background of only four years of primary education and twelve-week accreditation training, the single biggest productivity boost for
promotores are infrequent refresher courses. RIGME collaborated with a non-profit medical organization, Glasswing International, to teach promotores basic pediatric life support (BLS) and essential neonatal
resuscitation through the Helping Babies Breathe (HBB) program.
OBJECTIVE: To assess change in promotores knowledge and comfort with HBB/BLS after pediatric resident teaching.
DESIGN/METHODS: A one day BLS and HBB workshop was given consisting of didactic lectures, hands on simulation, and case-based scenarios, and attended by 25 promotores from different communities near
San Salvador. A pretest was given prior to each teaching session to establish their knowledge baseline, and a posttest, to determine the effectiveness of the teaching sessions. A survey was given at the end of the
workshop to assess participant satisfaction with their training and its usefulness to them.
RESULTS: HBB pretest average was 86% from 23 promotores. BLS pretest average was 40% from 21 promotores. HBB posttest average after one day of training was 91%, and 59% for BLS. Post session surveys
had a 100% positive response, with the majority of promotores reporting their training enhanced their knowledge and was applicable to their practices.
CONCLUSIONS: While improvement was noted in the knowledge of both BLS and HBB for promotores, it was much greater for BLS, with promotores' baseline BLS knowledge well below average. This suggests
future teaching efforts in El Salvador should include BLS, where there is a greater knowledge gap and educational need. Resident education was not only effective, but also increased promotore comfort level, which is
vital for sustainable implementation of their acquired skills.
2016 Eastern SPR Annual Meeting
Abstract Number: 1470
Filename: 751857
Publication Number: 423
Presenting Author: Sathyaseelan Subramaniam, MD
Department/Institution/Address: Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Center, 451 Clarkson Avenue, C Building, Room CG-27a, Brookyln, NY, 11213, United States
Phone: 6176946210
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 Needs Assessment Study of Point-of-Care Ultrasound (POCUS) Education in Pediatric Residency: Demand Without Supply
Sathyaseelan Subramaniam1, Valeriy Chorny2, Michael Keenaghan2, Ramon Gist2, Ninfa Mehta3 and Jennifer Chao1. 1Pediatric Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital,
Brooklyn, NY; 2Pediatrics, SUNY Downstate Medical Center/Kings County Hospital, Brooklyn, NY and 3Emergency Ultrasound Divison, SUNY Downstate Medical Center/Kings County Hospital, Brooklyn, NY.
BACKGROUND: POCUS education is in the curriculum of several ACGME accredited residency and fellowship programs but is not required in pediatric residency.
OBJECTIVE: To explore pediatric resident and attending views on POCUS education and to generate a list of POCUS applications in order of perceived value by residents.
DESIGN/METHODS: Residents of all training years and attendings of all subspecialties were invited to complete an online survey. Questions required 'yes' or 'no' answers for interest, importance and specific barriers
to pediatric POCUS education. Respondents ranked 26 established POCUS applications as 'not valuable', 'occasionally valuable', 'valuable', 'mostly valuable' or 'essential' for learning. A list of POCUS applications
was generated based on highest to lowest percentage of 'essential' applications as ranked by residents.
RESULTS: 66 of 79 residents (84%) and 22 of 65 attendings (34%) completed the survey. 94% of residents and 91% of attendings are interested in POCUS, while 90% of residents and 95% of attendings find POCUS
education important in residency. Central line placement with POCUS was ranked as 'essential' to learn in residency by the highest number of residents and attendings.
Fracture and hydronephrosis diagnosis by POCUS were ranked as 'essential' to learn in residency by the lowest number of residents and attendings. Barriers to POCUS education in residency were similar for both
groups.
Barrier
Resident (n=66)
Attending (n=22)
No Formal Ultrasound Curriculum
86%
95%
Limited Hands On Ultrasound Teachers/Ultrasound Simulation
80%
95%
Limited Clinical Teaching on Rotation
77%
82%
Limited Didactics
73%
86%
Limited Time During Residency
61%
64%
No Accesible Ultrasound Machine
42%
77%
CONCLUSIONS: Despite barriers, the majority of residents and attendings find POCUS education important in pediatric residency. This list of applications may be helpful in the development and implementation of a
pediatric POCUS curriculum.
2016 Eastern SPR Annual Meeting
Abstract Number: 4601
Filename: 755829
Publication Number: 424
Presenting Author: J. Lauren Ruoss, MD
Department/Institution/Address: 300 Longwood Ave, Boston, MA, 02115, United States
Phone: 8502949492
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: Emergent Neonatal Pericardiocentesis Simulation
J. Lauren Ruoss1 and Elizabeth Doherty1. 1Pediatrics, Boston Children's Hospital, Boston, MA.
BACKGROUND: Pericardiocentesis is the definitive treatment for cardiac tamponade however formal procedural training in neonatology is lacking. Cardiac tamponade is a deadly complication of central lines with a
reported incidence of 0.1-2% in neonates.1,2 According to a survey of neonatologists 29% experienced perforated myocardium, 43% experience pericardial effusions, and 20% experienced death by cardiac
tamponade in association with central lines.3 Emergent pericardiocentesis (EP) can be a life saving procedure even in the extremes of prematurity.4 The SIMPeds Network Team at Boston Children's Hospital (BCH),
created an EP simulation program for neonatal practitioners; neonatologists, neonatology fellows, and neonatal nurse practitioners. Experiential, simulation based learning allows for application of skills, with correction
of errors and gaps before skills are applied in the real world setting. We found no published simulation programs for emergent pericardiocentesis in neonates.
OBJECTIVE: Does a simulation program educating neonatal practitioners on how to perform an EP make practitioners more comfortable with and more likely to perform this life saving procedure in an emergent
situation?
DESIGN/METHODS: All practitioners at BCH are invited to participate in the EP simulation program. Participants were tested before and after the simulation to assess skill level, readiness to perform, and ability to
recognize the need for the procedure. A checklist for the procedure of EP was modified by the Delphi Review to yield the final validated checklist. The checklist was also reviewed to include ease of use for both
participants and simulation facilitators. The evaluation forms gather information on knowledge, experience, and confidence in performing EP.
RESULTS: 2 simulation sessions have been completed thus far with a total of 14 practitioners participating (2 neonatology attendings, 8 neonatology fellows, and 4 neonatal nurse practitioners). 100% of participants
were able to proficiently perform the procedure after the simulation as assessed by a knowledge based survey and an observational checklist. All participants felt that this was a needed simulation and felt more
comfortable with the procedure after completing the simulation program.
CONCLUSIONS: All neonatal practitioners must know how to recognize cardiac tamponade and how to perform an emergent pericardiocentesis. Application of this type of program is vital to provide practitioners with
the necessary skills to perform this life saving procedure.
2016 Eastern SPR Annual Meeting
Abstract Number: 3826
Filename: 754735
Publication Number: 425
Presenting Author: Shipra Bansal, MBBS
Department/Institution/Address: Division of Pediatric Endocrinology, Downstate Medical Center, 460 Lenox Road, Box 49, Brooklyn, NY, 11203, United States
Phone: 718-613-8605
Fax: 718-270-1985
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: Survey Assessment of Knowledge, Attitudes and Practices of US Pediatric Residents Regarding Newborn Screening
Shipra Bansal1, Kannan Kasturi1 and Vivian L. Chin1. 1Dept of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Medical Center, Brooklyn, NY.
BACKGROUND: Pediatricians' knowledge about newborn screen (NBS) and response to positive results can impact their patient's care. It is reported that they are not well prepared to inform families about a positive
NBS, arrange confirmatory testing, and coordinate subspecialty referral. There are no known studies of pediatric residents' (RES) knowledge, attitudes and practice (KAP) regarding NBS.
OBJECTIVE: To identify the gaps in residents' KAP towards NBS in order to improve resident education.
DESIGN/METHODS: An IRB-approved anonymous electronic survey of categorical RES in the US was conducted through the Section on Medical Students, Residents and Fellowship trainees maintained by American
Academy of Pediatrics. Survey asked about knowledge (maximum score 21), attitude towards their role and comfort level and practice in terms of counseling and follow-up of results. Frequency tables and linear
regression analysis were performed.
RESULTS: A total of 655 responses (260 PGY1, 192 PGY2, 175 PGY3, and 28 PGY4), 96% and 94% completed nursery and NICU rotations. The mean knowledge score (KS) is 17.7 (SD 1.8), ranging 12-21.
Training level (p=0.001) and the completion of NICU rotation (p<0.001) are significantly associated with higher KS. The completion of NICU increases KS by 1.0 (95% CI 0.4-1.7). PGY2, 3 and 4 have 0.2, 0.7 and 0.6
higher KS than PGY1, adjusting for NICU rotation. Higher level RES are more likely to follow NBS results in clinic (p=0.0027) and know who to contact for results (p<0.001). RES are not more likely to discuss the
rationale for testing, discuss or follow results with parents in nursery and NICU even with more rotations, higher training level or having a US-born child. Greater than 90% feel that NBS is useful for screening and
agree about the pediatrician's role in counseling; only 62% feel comfortable doing so. 82% express the need for more NBS training during residency. 75% are not familiar with ACTion sheets, a clinical algorithm
developed by American College of Medical Genetics.
CONCLUSIONS: RES have excellent knowledge regarding NBS and know their role in counseling families, but feel less comfortable in practice. This may explain why a majority do not explain/counsel or follow-up
NBS results in NICU or nursery. Higher level RES are more likely to follow results in clinic and know whom to contact; this supports the need for earlier education with increased emphasis on tools available for NBS in
pediatric residency programs.
2016 Eastern SPR Annual Meeting
Abstract Number: 2545
Filename: 753825
Publication Number: 426
Presenting Author: Anson Elisabeth, MD
Department/Institution/Address: 2741 Woodley Place, Washington, DC, 20008, United States
Phone: 503-407-5134
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: Characterizing Medical Student Self-Identified Goals for the Pediatric Clerkship
Anson Elisabeth1, Robertson Kathryn1 and Kind Terry1. 1Pediatrics, Children's National Health Systems, Washington, DC.
BACKGROUND: Adult Learning Theory supports that adults learn best when individual interests and needs are met. Successful medical educators attempt to create an optimal learning environment by eliciting
students' learning goals at the start of a rotation and work to address these clinical settings. Identification and discussion of these goals allows educators to better tailor curricula to enhance clinical educational
experiences.
OBJECTIVE: We sought characterize third year medical students' self-identified goals for their pediatric clerkship. We also analyzed these goals in the context of timing within core clerkship year.
DESIGN/METHODS: Individual goals hand-written by all George Washington School of Medicine third year medical students at Children's National at the start of the pediatric clerkship were coded and categorized
thematically. After a preliminary review of 96 goals, all authors met to identify categories that emerged in the data. Two authors (EA and KR) categorized the goals from academic years 2009-2014 and assessed for
trends by time of year.
RESULTS: Investigators reviewed 1,579 goals obtained from 491 third year medical students. Four main categories emerged in the data: patient care, medical knowledge, career decision-making and personal
development. Patient care emerged as the most frequently identified theme, comprising 42% of total goals. Patient care was further categorized into history taking, physical exam, presentation skills, documentation
and unspecified patient care. Learning pediatric physical exam skills was the most frequently identified patient care related goal (18% of total goals). This was followed by nonspecific patient care (12%), history taking
(6%), presentation skills (3%), and documentation (<1%). Medical knowledge was the second most commonly identified main category (31%). Within personal development (20% of total goals), several subcategories
emerged. Multiple student goals identified the importance of having fun, learning to function as a team member and developing confidence. Notably, students goals did not appear to vary based upon timing within the
clerkship year.
CONCLUSIONS: The most commonly self-identified student goals in the pediatric clerkship were those pertaining to patient care and clinical skills. Students also frequently identified the importance of their own
personal development as trainees. These findings can be used to inform curriculum content and advising in support of the adult learner with self-identified goals.
2016 Eastern SPR Annual Meeting
Abstract Number: 2329
Filename: 752332
Publication Number: 427
Presenting Author: Cynthia Katz, MD
Department/Institution/Address: Pediatrics, The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY, 11201, United States
Phone: 718-250-6672
Fax: 718-250-7273
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: Does the ACGME Survey Tell Us What We Need to Know: Using a Graduate Survey to Find Out
Cynthia Katz1, Sarah Rawstron1, Sonia Desikan1 and Kenneth Bromberg1. 1Pediatrics, The Brooklyn Hospital Center, Brooklyn, NY.
BACKGROUND: In 1998 the ACGME proposed assessing educational outcomes in residency (the Outcome Project), and then in 2013 added a section to their annual survey targeting graduating residents to improve
outcomes assessment. The reliability of data, obtained from residents still in training, is unknown.
OBJECTIVE: To administer a survey to former residents to compare to ACGME surveys.
DESIGN/METHODS: Emails were sent to the last 3 classes of residents (2012-2014, 36 individuals) containing an anonymous survey link. Questions addressed weak areas reported in our 2013-2015 ACGME
surveys: satisfaction of residency preparation for procedures, patient management skills training, and continuity clinic experience. We also solicited information on current practice demographics and satisfaction with
educational topics (coding and billing, evidence based medicine, communication, conducting QI, life-long learning, and work-life balance). Likert scale rankings on surveys were collapsed into favorable and
unfavorable/neutral responses and then compared.
RESULTS: Survey responses: 31 ACGME, 29 graduate surveys. Of the 16 questions modeled after the ACGME survey, 3 showed discordant responses reflecting resident dissatisfaction: 1) management of
behavior/mental health problems (27% › in our survey); 2) clinic patient variety (21% › in our survey); and 3) patient ownership (16% ‹ in our survey). Feeling ownership of continuity patients increased from 67% to
90% from 2013 to 2014, during Patient Centered Medical Home certification. Responses for questions not in the ACGME survey concerned areas of dissatisfaction with training: billing/coding preparation: 59%;
transition to career: 45%; managing work-life balance: 17%. Reported sub-specialty training increased from 50% for 2012 and 2013 grads, to 78% for 2014 grads. All except one respondent would “highly” or
“definitely” recommend our program.
CONCLUSIONS: We did not expect the concordance between the ACGME survey and our survey administered after 1-3 years of post-residency perspective. Our data supports the accuracy of the ACGME survey to
assess most program outcomes. The additional questions in our graduate survey provided valuable information for program evaluation. Based on this feedback, we plan to incorporate more behavioral health, billing
and coding, transition to careers, and wellness curricula. Asking additional questions to residents while still in training might be a useful tool to assess program outcomes.
2016 Eastern SPR Annual Meeting
Abstract Number: 2006
Filename: 754959
Publication Number: 428
Presenting Author: Julia F. Aquino, MD
Department/Institution/Address: 77 Woodside Rd, Winchester, MA, 01890, United States
Phone: 14109082491
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 Novel Role Play Curriculum to Teach Patient and Family Centered Communication Skills to Medical Students
Julia F. Aquino1. 1Pediatrics, Tufts University School of Medicine, Boston, MA.
BACKGROUND: Patient and family centered rounds (PFCR) are the standard of care in pediatric inpatient medicine. Medical students are often not exposed to this style of rounding until the pediatric clerkship. PFCR
is known to cause anxiety to medical student learners. Role play has been shown to be an effective means of teaching medical communication skills as it allows participants to experience both patient and physician
roles.
OBJECTIVE: A role play based workshop to teach communication skills necessary for PFCR (the INCLUDES curriculum: I=Introduction, N=Non-verbal cues, C=Caring, L=Language understood, U=Understanding
checked, D=Decision making, E=Exchange of information, S=Summary) was created and evaluated to determine impact on medical student skill and comfort.
DESIGN/METHODS: Medical students on a pediatric clerkship were randomized to receive the INCLUDES curriculum (INCLUDES group) or instruction as usual (control group). All participants were directly observed
on PFCR by blinded trained pediatric hospitalists using a skills checklist. Participants completed a retrospective pre post survey regarding comfort on and perception of PFCR. Descriptive statistics and simple t-tests
were used to compare groups.
RESULTS: 37 students were enrolled in the study (22 INCLUDES group.) A total of 74 direct observations were completed (44 INCLUDES group.) Compared to control, the INCLUDES group showed showed
statistically significant improved skills of Introduction, Caring and Understanding checked with trends of positive improvement in Language understood and Summary. No significant differences were found for
perception of or comfort on PFCR between groups with both showing a trend towards improvement in self-assessment of skill and comfort.
CONCLUSIONS: Role play may be an effective and efficient way to teach communication skills necessary for PFCR to medical students. Specific skills such as practicing appropriate introductions, making statements
that show caring and respect for the patient and caregiver, and checking for patient and caregiver understanding of information given on rounds may be particularly amenable to role play based education. More
studies are needed to understand the optimal way for medical students to learn all skills necessary for successful communication on PFCR.
2016 Eastern SPR Annual Meeting
Abstract Number: 3830
Filename: 754746
Publication Number: 429
Presenting Author: Anna H. Abrams
Department/Institution/Address: General Pediatrics, Childrens National Medical Center, 111 Michigan Ave, 111 Michigan Ave, Washington, DC, 20010, United States
Phone: 216-650-8111
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: Why Does Infant Sleep Position Change Over Time and Who Influences Mothers' Decisions?
Anna H. Abrams1, Anita Mathews1, Rosalind P. Oden1, Brandi Joyner1 and Rachel Y. Moon1. 1Division of General Pediatrics and Community Health, Childrens National Medical Center, Washington, DC.
BACKGROUND: Sudden unexpected infant death, including SIDS, accidental suffocation, and ill-defined deaths, is responsible for ~3500 U.S. deaths annually. African-American infants are twice as likely to die as
Caucasians. Differing attitudes toward sleep position between African-American and Caucasian women may be associated with higher rates of prone sleeping in African-Americans.
OBJECTIVE: To document changes in sleep position in African-American infants and associated factors in the first 6 months of life.
DESIGN/METHODS: 1194 African-American mothers were recruited in the newborn nursery and interviewed about infant care practices when their infants were 2-3 weeks, 2-3 months, and 5-6 months of age.
Baseline characteristics were tabulated. The x2 test was used to compare expected and observed values of given variables. Correlations were studied using the two-tailed test of significance and Pearson correlation
coefficients.
RESULTS: At baseline, 91.7% of mothers intended to place their baby supine. The proportion of infants placed supine was 85.9% and 79% at 2-3 and 5-6 months, respectively. At baseline and at 1-2 weeks, nurses
(p=0.023) and the infant's father (p=0.04) had significant influence on sleep position. The influence of friends on sleep position decisions became increasingly significant (p=0.025 at 2-3 months and p<0.001 at 5-6
months).
CONCLUSIONS: In the first 6 months of life, there is a gradual decrease in the proportion of African-American infants placed supine. As the infant ages, friends may be more influential than health professionals in
maternal decision-making. Interventions targeted at family and friends may be important in improving sleep practices.
2016 Eastern SPR Annual Meeting
Abstract Number: 2793
Filename: 755311
Publication Number: 430
Presenting Author: Andrea Heras, MD
Department/Institution/Address: Department of Pediatrics, Flushing Hospital Medical Center, 4500 Parsons Blvd, Flushing, NY, 11355, United States
Phone: 718 670 5534
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: Early Complications Associated with Elective Circumcision in Healthy Newborns in Two Urban Community Teaching Hospitals
Andrea Heras1, Victoria Vallejo2, Marcela Pineda3, Sibat Khwaja4, Lourdes Cohen1 and Allan Jacobs5. 1Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY; 2Department of
Obstetrics/Gynecology, Flushing Hospital Medical Center, Flushing, NY; 3Department of Obstetrics/Gynecology, Jamaica Hospital Medical Center, Jamaica, NY; 4St. George's University School of Medicine, Grenada,
West Indies, Bahamas and 5Department of Obstetrics/Gynecology, Coney Island Hospital, Brooklyn, NY.
BACKGROUND: Neonatal circumcision is a minor surgical procedure with risk of major and minor complications. Policy statement by AAP (2012) stated that benefits outweigh risks of complications.
OBJECTIVE: To analyze early complication rates in neonatal circumcision performed by pediatricians and obstetricians.
DESIGN/METHODS: Retrospective chart review full term neonates circumcised during their birth hospitalization in two urban teaching community hospitals. Operator type (pediatrician vs obstetrician), instrument used
(Gomco vs Mogen) and presence of complication were identified. Complications as primary outcome were divided into two groups. Major complications (G1) included amputation, bleeding requiring transfusion or
suture, infection requiring IV antibiotics and revision. Minor complications (G2) included bleeding requiring pressure or local hemostatic agents and infection requiring topical antibiotic. Data were analyzed by
Chi-square test with EpiInfo software, and p<0.05 was significant.
RESULTS: From August 2011 to December 2014, 1064 charts were reviewed. The complication rate was 3.9% (41), 3 in G1 and 38 in G2 and all involved bleeding. All in G1 required sutures. In G2, pressure was
used in 24 (58.5%), silver nitrate or thrombin in 14 (34.2%). Gomco was the more common technique (55.84%) and more likely to result in bleeding 5.1% (30/594) compared to Mogen 2.3% (11/470), p<0.05, CI 95%.
Complication rates by pediatricians were 10.5% (16/151) compared to obstetricians 2.7% (25/913), p<0.05.
CONCLUSIONS: Neonatal circumcision is a fairly safe procedure with minimal rates of serious complications. In our study the most common minor complication was bleeding, was associated with most commonly
used method, Gomco and resulted from performances by pediatricians. These findings raise the concern for adequate training of pediatricians in performing circumcisions.
2016 Eastern SPR Annual Meeting
Abstract Number: 4145
Filename: 755663
Publication Number: 431
Presenting Author: Yisrael T. Lipener, MD
Department/Institution/Address: Department of Pediatrics, Flushing Hospital Medical Center, 4500 Parsons Blvd, Flushing, NY, 11355, United States
Phone: 7186705534
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: Weight Loss at Discharge of Neonates Born to Mothers with Gestational Diabetes Mellitus
Yisrael T. Lipener1, Sreevidya Sreekantha1, Ritesh Korumilli1, Lily Q. Lew1, Judith Eng1, Lourdes Cohen1 and Susana Rapaport1. 1Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY.
BACKGROUND: Newborns are known to lose weight within the first week of life. With increasing incidence of gestational diabetes mellitus (GDM), there is limited data on weight loss in infants of diabetic mothers
(IDM) depending on mode of treatment of GDM.
OBJECTIVE: To determine differences in weight loss at discharge of IDM depending on mode of treatment of GDM for both vaginal and caesarian delivery.
DESIGN/METHODS: This was a retrospective chart review of neonates born to mothers with GDM at Flushing Hospital Medical Center from Jan to Aug, 2015. Exclusion criteria were <36 weeks gestational age (GA),
multiple birth, congenital anomalies, sepsis and hyperbilirubinemia. Maternal age, parity, ethnicity, GA, gender, mode of treatment of GDM, birth weight and discharge weight at 48 hours for vaginal delivery and at 72
hours for cesarean section in accordance with length of hospital stay were collected. Neonates were subdivided into how GDM was treated, diet, insulin or glyburide. Data were analyzed using percentages, t test and
ANOVA, p<0.05 was significant.
RESULTS: Of 165 mothers identified to have GDM, 104 newborns (55 female) met inclusion criteria. Median maternal age was 32 years, 20% primigravida, 28% Hispanic, 20% Bengali and 19% Chinese. Subjects
were divided into mode of delivery. There were 51 (49%) neonates delivered vaginally. Of these subjects 33 (64%) were born to mothers controlled by diet alone, 8 (15.6%) were controlled with insulin and 10 (19.6%)
were on glyburide. There was no significant difference in weight loss between the three groups at discharge, p=0.341. Of 53 (51%) neonates delivered by cesarean section, 23 (43.3%) were born to mothers controlled
by diet, 22 (41%) by insulin and 8 (15%) by glyburide. There was no significant difference in weight loss between the three modes of treatment of GDM at discharge, p=0.36.
CONCLUSIONS: The mode of GDM treatment had no significant impact on the weight loss of neonates at the time of discharge whether delivered vaginally or by cesarean section.
2016 Eastern SPR Annual Meeting
Abstract Number: 3925
Filename: 755032
Publication Number: 432
Presenting Author: Elaine Lin, MD
Department/Institution/Address: Pediatrics, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1202A, New York, NY, 10029, United States
Phone: 2122414901
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: Evaluating Home and Office Based Multidisciplinary Programs for Children With Special Health Care Needs
Maureen Braun1, Elaine Lin1, Nicole Tennermann2, Kanasha Seales1, Sanite Theophile1, Alissa Pierre-Charles1 and Joseph Truglio1,3. 1Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; 2Social Work,
Division of Women and Children's Health, Icahn School of Medicine at Mount Sinai, New York, NY and 3Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
BACKGROUND: As Medicaid reimbursement models evolve there is increasing emphasis on value-based care, especially for high-utilizers of healthcare resources. The Pediatric Visiting Doctors Program at Mount
Sinai is a novel program that provides physician-led comprehensive, multidisciplinary care in the home for CSHCN. A clinic-based component was added to this program to serve CSHCN who live outside the home
visits catchment area but would benefit from enhanced medical, care coordination, and social work services. Home visitation and care coordination have been shown to improve health outcomes for children with
special health care needs (CSHCN). Data on physician home visits, health care utilization and cost for such programs are needed.
OBJECTIVE: To evaluate and compare healthcare utilization and cost of home-based and clinic-based comprehensive care programs for CSHCN.
DESIGN/METHODS: CSHCN who have been enrolled in the Pediatric Visiting Doctors Program for at least three months are being analyzed for emergency room visits, hospitalizations, length of stay, and direct cost.
Utilization and cost are being compared across equal time periods before and after enrollment. The impact and cost of home visits will be compared with those of clinic-based care in a similar population.
RESULTS: Since July 2013 one-hundred and twenty-seven patients have been enrolled in the home visits program. Since July 2015 eighteen patients have been enrolled in the clinic-based program. Enrollment is
ongoing. Within the home visits program ED visits have reduced by 56%, hospitalizations by 45% and length of stay by 5 days. Preliminary direct cost analyses reveal approximately $916 per-patient-per-year cost
savings based on direct room costs. The total operating cost for the program is approximately $500,000. The clinic-based intervention data analysis and comprehensive cost analysis of both programs are ongoing.
CONCLUSIONS: Multidisciplinary care and care coordination delivered at home and in a clinic setting decreases health care utilization and may produce cost savings.
2016 Eastern SPR Annual Meeting
Abstract Number: 3916
Filename: 755000
Publication Number: 433
Presenting Author: Boran Li, MD
Department/Institution/Address: 112 Nassau Dr., Lawrenceville, NJ, 08648, United States
Phone: 6096356003
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: Do Serum Bicarbonate Values Correlate with Length of Hospitalization in Pediatric Patients Admitted with Dehydration?
Boran Li1, Nancy Palumbo1 and Stephen Barone1. 1Pediatrics, Cohen Children's Medical Center, New Hyde Park.
BACKGROUND: Dehydration is a leading cause of hospitalization in children. The decision to admit and treat with IV fluids is based on multiple factors, including clinical signs, symptoms, and laboratory testing. Many
providers obtain serum bicarbonate levels to help assess severity of dehydration, however, there is no consensus regarding the use of serum bicarbonate to improve the decision-making process. We hypothesize that
the initial serum bicarbonate value does not correlate in a linear fashion with clinical outcome (length of stay) and therefore should not be used independently to make treatment decisions. Furthermore, an initial low
serum bicarbonate level may actually prolong length of stay (LOS), as physicians repeat the test until it is “normal”.
OBJECTIVE: To evaluate the correlation between the initial serum bicarbonate level obtained in children who are admitted for dehydration and LOS.
DESIGN/METHODS: A retrospective chart review of previously healthy children, ages 2 mos-18 yrs. admitted to CCMC from 1/14-7/14 with a discharge diagnosis of dehydration was performed. Patients were
excluded if they had pre-existing medical conditions such as inborn errors of metabolism, RTA, eating disorders etc. Data collected included initial serum bicarbonate; anion gap (AG), admitting service (hospitalist vs.
voluntary), and whether or not labs were repeated. LOS was measured in hours. The data was analyzed by the use of linear regression models and two-sample T tests.
RESULTS: 182 patient charts were reviewed. 46 were excluded based on pre-existing medical conditions leaving 136 patients for analysis. 131 (96%) patients had a discharge diagnosis of dehydration secondary to
gastroenteritis. The average LOS for all patients was 38 hours. When patients were analyzed via linear regression based on initial serum bicarbonate levels, there was no correlation with LOS, regardless of value. 48
patients had repeat lab work. Their LOS was longer, regardless of their initial bicarbonate level, than those who did not (50 vs. 31 hrs p=0.0005). There was no correlation between LOS and patient's initial AG, or
admitting service.
CONCLUSIONS: Initial serum bicarbonate levels did not correlate with LOS in those children admitted for dehydration. The group which had repeat serum bicarbonate levels performed had an increased LOS.
Physicians should not rely on serum bicarbonate values to make clinical decisions in regards to the treatment of dehydration.
2016 Eastern SPR Annual Meeting
Abstract Number: 2879
Filename: 750180
Publication Number: 434
Presenting Author: Shiori Nariai, M.D.
Department/Institution/Address: 77 Lime Kiln Rd Apt 2G, Tuckahoe, NY, 10707, United States
Phone: 2486728483
Fax: United States
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Other - Resident
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: Predictors of Pediatric Intensive Care Unit (PICU) Admission in Children with Acute Bronchiolitis
Shiori Nariai1, Paulo Pina1,3, Courtney Ann McNamara2,3, David H. Rubin1,3 and Alyssa H. Silver2,3. 1Pediatrics, St. Barnabas Hospital, Bronx, NY; 2The Children's Hospital at Montefiore, Bronx, NY and 3Albert Einstein
College of Medicine, Bronx, NY.
BACKGROUND: Acute bronchiolitis is a cause of significant morbidity in lower respiratory tract infection during the first year of life and the most common cause of admission. Prematurity and young age have been
shown to be independent risk factors for hospitalization. Risk factors for acute respiratory exacerbation in acute bronchiolitis requiring PICU admission are yet to be well established.
OBJECTIVE: To elucidate risk factors for PICU admission in children with acute bronchiolitis.
DESIGN/METHODS: This is an IRB approved retrospective study of 1136 patients admitted to an urban tertiary care children's hospital. All patients ≤ 24 months old admitted between October 1 to April 30 each
season from 2008 and 2012 with a diagnosis of acute bronchiolitis were included. Exclusion criteria were concurrent admission of asthma or chronic lung disease, patients enrolled in separate bronchiolitis clinical trial
and those with incomplete data. We compared the demographic and clinical characteristics of patients admitted to PICU versus general pediatric floor. We performed bivariate and logistic regression analysis of the
primary outcome of admission to PICU to assess independent risk factors.
RESULTS: We reviewed charts of 1136 eligible patients, 939 patients met inclusion criteria for analysis (positive respiratory syncytial virus (RSV) 68.4%, median age 4.0 months, male 56%). Mean age was slightly
younger in those admitted to the PICU (5.13 vs. 6.19 months, p=0.083). Bivariate analysis showed prematurity, congenital heart disease (CHD), oxygen requirement and racemic epinephrine use were associated with
PICU admission. Gender, age, albuterol use, steroid use, RSV seropositivity and insurance status were not associated with PICU admission. Children with history of prematurity (OR 2.41, CI 1.44-4.03, p=0.01), CHD
(OR 4.80, CI 2.07-11.13, p<0.01), racemic epinephrine use (OR 6.37, CI 2.90-14.04, p<0.01) were more likely to be admitted to PICU. Oxygen use was not associated with higher rate of PICU admission.
CONCLUSIONS: In infants admitted with bronchiolitis, prematurity, CHD, and racemic epinephrine use were independently associated with higher risk of PICU admission. Identifying these risk factors when evaluating
patients early in their presentation may be helpful to predict a more severe course which require PICU admission and benefit from closer monitoring.
2016 Eastern SPR Annual Meeting
Abstract Number: 590
Filename: 751066
Publication Number: 435
Presenting Author: Alexander S. Whitaker, MD
Department/Institution/Address: Pediatrics, University of Maryland Medical Center, 22 S Greene St, Pediatric Education Office, Baltimore, MD, 21230, United States
Phone: 14103286662
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: Morbidity in Children With Genetic Disorders Hospitalized With Viral Respiratory Illnesses
Alexander S. Whitaker1, Carol Greene1 and Alexander G. Agthe1. 1Pediatrics, University of Maryland Medical Center, Baltimore, MD.
BACKGROUND: Viral respiratory infections (VRIs) are common among children and lower tract VRIs are the leading cause of hospitalization among infants. Prematurity, heart failure and chronic lung disease are
well-established risk factors for increased morbidity but there is currently limited data on the role of genetic disease as an independent risk factor for hospital morbidity in VRIs.
OBJECTIVE: To determine if children with underlying genetic disorders have increased morbidity when hospitalized with VRIs compared to the general population.
DESIGN/METHODS: A random sample of children with positive respiratory viral panels at the University of Maryland Children's Hospital from January 2012 through December 2014 was selected. 30 children with
confirmed or highly suspected genetic disorders were compared to 61 non-genetic controls. Exclusion criteria were premature birth <35 weeks, status asthmaticus, chronic lung disease, presence of a tracheostomy,
recent cardiac surgery, congestive heart failure, immunodeficiencies predisposing to viral illnesses, and concurrent chemotherapy. Length of hospital (LOH) stay, length of ICU stay, and need for mechanical ventilation
were analyzed using Kaplan-Meier curves and log-rank test.
RESULTS: The median LOH stay in the genetic group was longer with 3.3 days (25%-75% = 1.9-4.7 days), compared to 2.4 days (25%-75% = 1.8-3.7 days) among the control group (log-rank 4.16; p<0.05). The
frequency of intensive care unit (ICU) admissions was 37% vs. 49% (p=0.26). The genetic group had a median ICU stay of 3 days (25%-75% = 2-6 days) compared to 2 days (25%-75% = 1-3 days) among the control
group (log-rank 3.23; p=0.07). There was a similar frequency of mechanical ventilation between groups (7% vs. 3%; p=0.6).
CONCLUSIONS: Children with underlying genetic disorders hospitalized for VRIs had longer hospital courses than children without genetic disorders. There was no statistical difference in frequency of ICU admission,
length of ICU admission, or need for mechanical ventilation.
2016 Eastern SPR Annual Meeting
Abstract Number: 911
Filename: 750783
Publication Number: 436
Presenting Author: Elizabeth Silberholz, MD
Department/Institution/Address: 160 E. Erie Ave., Philadelphia, PA, 19134, United States
Phone: 2405154562
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 Effects of a Pediatric Resident Educational Program on Long-Acting Reversible Contraceptive Knowledge and Counseling
Elizabeth Silberholz1, Courtney M. Dominic1, Danielle Erkoboni1, James Hall2, Ambika J. Lall1, Christine E. Nazarian1, Jennifer L. Robbins1, Elizabeth W. Tindal2, Courtney E. Wein1, Bruce A. Bernstein1, Lee M.
Pachter1 and Daniel R. Taylor1. 1St. Christopher's Hospital for Children, Philadelphia and 2Temple University, Philadelphia.
BACKGROUND: Ninety five percent of unplanned pregnancies are associated with contraception non-use or inconsistent use. These pregnancies may adversely affect mother and child, especially if they occur soon
after another pregnancy. Long-acting reversible contraceptives (LARCs) such as arm implants or intrauterine devices (IUDs) are now recommended as the first-line contraceptive option for most women. In a
preliminary study at our institution, however, few pediatric providers routinely counsel women with young children about LARCs; barriers to counseling include a lack of provider comfort and knowledge.
OBJECTIVE: To determine if brief, intensive resident education compared to standard of care (SOC) leads to increases in provider knowledge about LARCs, comfort discussing LARCs, and beliefs that such
discussions will impact maternal LARC uptake, in an inner city pediatric continuity clinic.
DESIGN/METHODS: This investigator blinded, controlled trial recruited pediatric residents at a single institution, and randomized them to watch a customized 45-minute instructional video and receive weekly emails
(intervention), or interact with caregivers using only pre-existing knowledge (SOC). All participants completed a 14-item pre- and post-intervention survey that included Likert scales to assess comfort and beliefs, and
multiple choice, true/false, and matching questions to assess knowledge. Paired t-tests were used to assess differences in pre-post changes comparing groups.
RESULTS: Sixty-one pediatric residents were enrolled. The educational intervention improved knowledge about LARCs, both by test (26% increase in scores, p=0.05) and self-report (25% increase in knowledge,
p=0.02). After the intervention, residents in the intervention group were 24% more confident that discussing LARCs will change maternal behavior (p=0.04), with no difference in the SOC group (p=0.51). Residents in
the intervention group reported more LARC discussions after the intervention (IUD p=0.02, implant p=0.08).
CONCLUSIONS: A low-resource educational intervention enhanced provider knowledge and confidence regarding recommendation of LARCs in a vulnerable population. We will next assess the impact of LARC
discussions on maternal uptake in the community.
2016 Eastern SPR Annual Meeting
Abstract Number: 737
Filename: 752705
Publication Number: 437
Presenting Author: Nicola Brodie, MD
Department/Institution/Address: Pediatric Residency Program, St. Christopher's Hospital for Children, 160 E Erie Avenue, Philadelphia, PA, 19134, United States
Phone: 1-240-441-0013
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: A Multi-Faceted, Interdisciplinary Approach Can Improve HPV Vaccination Rates in an Urban Pediatric Practice
Nicola Brodie1, Bruce Bernstein1, David Cooperberg1, Mario Cruz1 and Katie McPeak1. 1General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA.
BACKGROUND: Despite compelling evidence regarding its safety and efficacy, Human Papilloma Virus (HPV) vaccination rates remain low nationally with high rates of missed opportunities to vaccinate. Provider
recommendation is the most important factor in determining vaccine approval by families; yet, studies show that providers are hesitant to strongly recommend vaccination, especially at younger ages.
OBJECTIVE: We hypothesized that educational and quality improvement interventions targeting all members of our clinical team (providers, medical assistants, nursing and registration staff) would improve
vaccination rates among patients ages 9-10 years, and decrease rates of missed opportunities to vaccinate patients ages 11-13 years.
DESIGN/METHODS: This observational time series study took place at an urban, academic pediatric primary care center in north Philadelphia which serves as the medical home for 25,000 children. A
multi-disciplinary team performed a series of planned sequential interventions to improve HPV vaccination rates (see figure 1). We queried our electronic health records of children ages 9-13 who presented to our
center for sick or well care from September 2014 through March 2015 (n=2915). Statistical process control charts and established rules for detecting special cause variation were applied.
RESULTS: Rates of missed opportunities to vaccinate 11-13 year old patients decreased from 63% to 24% within 3 months of the intervention.
Rates of immunization of 9-10 year old patients remained stable without special cause variation throughout the study period.
CONCLUSIONS: This low-resource, multi-faceted, interdisciplinary quality improvement project resulted in a marked decrease in missed opportunities to vaccinate for HPV among children ages 11-13 years old, but
did not change HPV vaccination rates for children ages 9 and 10. Ongoing interventions are needed to further decrease our rates of missed opportunities and to encourage vaccination of our younger patients.
2016 Eastern SPR Annual Meeting
Abstract Number: 2214
Filename: 751431
Publication Number: 438
Presenting Author: Ashleigh J. Hall, DO
Department/Institution/Address: Pediatrics, Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, 3223 N Broad Street, Philadelphia, PA, 19140, United States
Phone: 2157075437
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: Identifying Asthma Patients Who Require a Controller Medicine: Comparison of the National Heart, Lung, and Blood Institue (NHBLI) Guidelines With the Healthcare Effectiveness Data and
Information Set (HEDIS) Criteria in One Urban Practice
Ashleigh J. Hall1, Amer Kechli1, Beth Moughan1, Carol Smolij2 and Stephen Aronoff1. 1Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA and 2Health Partners Inc, Philadelphia, PA.
BACKGROUND: Persistent asthma requires daily controller medications. The NHBLI asthma guidelines are used by clinicians to classify asthma and determine the need for a controller; insurers use HEDIS quality
measures obtained from billing codes to determine the need for a controller and to provide quality report cards to practices.
OBJECTIVE: To determine the degree of agreement between NHBLI and HEDIS criteria in classifying persistent asthma in one urban, publicly insured pediatric population.
DESIGN/METHODS: Asthma patients ages 5 years and older in a university practice who were continuously enrolled with one managed care organization (MCO) from 1/1/12-12/31/13 were identified by the MCO.
Those that also had at least one clinician's asthma classification (NHLBI) during the study period identified by the practice's electronic health record were included for analysis. The independence of NHLBI and HEDIS
criteria in identifying patients for a controller was analyzed using McNemar's test with p < .05. The degree of agreement between the two classification systems was determined by confusion matrix analysis and
Cohen's kappa statistic with continuity correction.
RESULTS: 329 patients met inclusion criteria. 247 patients (75%) and 299 patients (90.9%) met criteria for a controller medicine by NHLBI and HEDIS, respectively. NHLBI and HEDIS criteria had 81% correlation
(241 controller, 24 no controller; p <.00001). 53/324 (16%) required a controller by HEDIS but not by NHLBI guidelines while 6/324 (2%) required a controller by NHLBI but not by HEDIS criteria (K=.36; 95%
CI=.22-.51).
CONCLUSIONS: NHLBI and HEDIS criteria for persistent asthma are not statistically independent but only have a modest degree of agreement. HEDIS overcalled the need for a controller by 16% compared to
NHLBI. Practices using NHLBI guidelines to classify persistent asthma may underperform with insurers on this HEDIS quality measure.
2016 Eastern SPR Annual Meeting
Abstract Number: 3112
Filename: 751656
Publication Number: 439
Presenting Author: Whitney J. Washburn, BS
Department/Institution/Address: 4 Chapman Street, Apt G, Newington, CT, 06111, United States
Phone: (401) 525-1770
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: Improving Vision Screening Rates of 3-Year-Olds in a Primary Care Clinic
Whitney J. Washburn2, Patricia Garcia1,2 and Catherine Wiley1,2. 1Primary Care, Connectiut Children's Medical Center, Hartford, CT and 2School of Medicine, University of Connecticut, Farmington, CT.
BACKGROUND: Early detection of refractive amblyopia results in better long-term visual outcomes. Therefore, a goal of Healthy People 2020 is to increase vision screening rates in preschool aged children from 40%
to 50%.
OBJECTIVE: We aimed to improve our vision screening rates to >90% of 3-year-old children.
DESIGN/METHODS: We obtained baseline vision screening rates for 3-year-olds by a 1-month retrospective chart review. Using successive improvement cycles (plan-do-study-act) and run charts, we monitored
vision screening attempts, successful completion, and time to screen over the improvement period for all 3-year-olds presenting for well child appointments. We introduced an autorefractor to supplement testing with
visual acuity charts. Screening rates and mean time to screen were compared using chi square and t-tests.
RESULTS: Over the 12-month project period, 520 3-year-old children presented for well child visits (mean age 37.5 months, 51% male, 84% Medicaid, and 9% uninsured). Screening was attempted for 305 of these
children. Attempted vision screening rates increased from <2% in August 2014 to 83% in August 2015 (P < .001). Successful screens increased from <2% to 57% (P < .001, see figure). During the study period only
18% of patients were able to complete screening with visual acuity charts but 63% were successfully screened using the autorefractor (P < .001). Average time spent screening decreased during the intervention
period from 5.4 minutes in June 2015 to 2.6 minutes in July 2015 (P < .001).
CONCLUSIONS: Using quality improvement methodology, vision screening in our practice became more consistent, efficient and effective. Key interventions to successful implementation included optimizing use of
the autorefractor, one-on-one training, and at-the-elbow support for staff. Ongoing barriers include time-pressure and variable tester confidence. Future study will analyze referral outcomes made during this project.
2016 Eastern SPR Annual Meeting
Abstract Number: 3431
Filename: 753319
Publication Number: 440
Presenting Author: Kymberly M. Gonzalez, MD
Department/Institution/Address: Pediatrics, Division of General Pediatrics, University of Pennsylvania, Perelman School of Medicine, 1310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19130, United States
Phone: 2155733980
Fax: 2155732742
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: Promoting Healthy Active Living for the Children of Teen Parents
Kymberly M. Gonzalez1, Christina Bourland2, Mary F. Jarcy4 and Nancy R. Kelly3. 1Pediatrics, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA; 2Pediatrics, Pediatric Associates of
Dallas, Dallas, TX; 3Pediatrics, University of Texas Southwestern Medical Center, Children's Health Dallas, Dallas, TX and 4East View High School, Georgetown Independent School District, Georgetown, TX.
BACKGROUND: With funding from an American Academy of Pediatrics (AAP) Community Pediatrics Training Initiative Grant, we generated a multi-partner collaborative with the University of TX Southwestern
(UTSW) Pediatric Residency Program, Garland Independent School District's (GISD) New Horizon Program (a drop-out prevention program for pregnant and parenting students [mothers and fathers]), and Texas
Pediatric Society to implement a health promotion program centered on healthy active living for teen parents and their children.
OBJECTIVE: 1) to establish a multi-partner collaborative to facilitate resident engagement with teen parents in a community setting and 2) to determine if a resident-led health promotion program increased students'
knowledge about healthy living strategies for their children.
DESIGN/METHODS: During their Community Pediatrics Rotation, pediatric interns created and delivered presentations centered on modifiable behaviors as defined by the AAP Healthy Active Living for Families
principles. Presentations were interactive, varied in format (games, PowerPoint, and group discussion), and lasted for 45-60 minutes. During the 2014-15 academic year, interns created and presented eight sessions
to pregnant and parenting high school students. Brief (1-4 questions), anonymous pre- and post-tests were administered to the students before and immediately after each of the 8 sessions to assess changes in
knowledge. We calculated the percentage of correct answers on pre-tests and post-tests (from all 8 sessions combined) and used Chi-square analysis to evaluate for change. IRB approval was obtained from UTSW
and GISD.
RESULTS: 21 interns participated in the creation and presentation of the sessions. Student attendance ranged from 10-23 teens per session. Data from 130 pre- and 132 post-tests was analyzed. A positive trend
towards increased student knowledge was demonstrated (66.2% correct at pre-test, 85.2% at post-test; p=0.05). Positive trends for increased knowledge were seen for understanding BMI, breast-feeding
recommendations/benefits, timing of solid foods, importance of family mealtime, and hunger cues.
CONCLUSIONS: This initiative demonstrates the feasibility of a multi-partner collaborative to facilitate resident engagement with pregnant and parenting teens in a community setting. Trends towards increased
knowledge suggest this to be an effective means of educating teen parents about healthy living strategies for their children.
2016 Eastern SPR Annual Meeting
Abstract Number: 3501
Filename: 753600
Publication Number: 441
Presenting Author: Eli Sprecher, MD MPP
Department/Institution/Address: 27 Stearns Rd, Unit 2, Boston, MA, 02446, United States
Phone: 617-355-7701
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: Utilization of Patient Navigators in an Urban Academic Pediatric Primary Care Practice
Eli Sprecher1,2, Jenny Chan1, Kathleen Conroy1,2 and Joanne Cox1,2. 1Boston Children's Hospital, Boston, MA and 2Harvard Medical School, Boston, MA.
BACKGROUND: Navigating a complex healthcare system is challenging, especially for children with medical complexity (CMC) and low socioeconomic status. Patient navigators (PNs) have demonstrated
effectiveness for adult populations, but have not been studied in primary care pediatrics.
OBJECTIVE: To (1) describe demographic characteristics of patients referred to PNs, and (2) perform a preliminary analysis of PNs' effectiveness in resolving referral concerns.
DESIGN/METHODS: This prospective descriptive study of 2,111 referrals for 1,488 patients was conducted in an urban academic pediatric clinic with 17,000 predominately non-white (>90%) and publicly insured
(65%) patients, with many CMCs (5%). Providers could refer for any reason. PNs kept logs of referred patients from 10/1/12 through 9/1/15. For a subset of 1,109 referrals, time spent and detailed outcome data were
collected. Factors associated with referrals and referral outcomes were analyzed using bivariate and multivariate logistic regression adjusted for multiple comparisons (α=0.005).
RESULTS: The most common reasons for referral were assistance with transportation (33.4%), developmental concerns (32.6%), and adherence/care coordination concerns (14.0%). There were a number of
statistically significant demographic differences (p<0.05) between patients referred to PNs and those who were not referred. The most significant demographic predictors of referral were medical complexity (OR 7.42,
99.5%CI 5.72, 9.62), public insurance (OR 1.86, 99.5%CI 1.43, 2.42), male sex (OR 1.50 99.5%CI 1.24, 1.83), and no-show rate in the highest quartile (OR 1.54; 99.5%CI: 1.16, 2.05). PNs spent an average of 62
minutes per referral. 86% of referrals were resolved successfully. PNs spent significantly more time (65 vs. 50.1 minutes, 95% CI: 0.36, 29.4) on successful referrals. The type of referral and the no-show quartile were
the only significant predictors (p<0.05) of successful referral.
CONCLUSIONS: PCPs were most likely to request the help of a PN for the patients with the greatest needs navigating the healthcare system, especially children with medical complexity, on public insurance, and with
a history of a poor show rate. PNs successfully resolved the majority of referrals. Future directions include analysis of cost effectiveness of the PN program and analysis of parent and PCP experience. As PCPs
become accountable for patient outcomes, PN programs should demonstrate value by improving patient connectedness to care.
2016 Eastern SPR Annual Meeting
Abstract Number: 1291
Filename: 750643
Publication Number: 442
Presenting Author: Christine M. Arsnow, M.D.
Department/Institution/Address: 19 Crafts Ave, West Lebanon, NH, 03784, United States
Phone: 17818646525
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: Shared Care in Pediatrics: Optimizing Co-Management by Primary Care and Subspecialist Physicians
Christine M. Arsnow1 and Scott Shipman1. 1Pediatrics, Children's Hospital at Dartmouth, Lebanon, NH.
BACKGROUND: The use of specialty pediatricians is growing beyond the capacity of the workforce. A variety of barriers inhibit a patient's transition from ongoing specialty care back to the primary care physician
(PCP).
OBJECTIVE: To investigate how often primary care and specialty pediatricians agree that a patient is appropriate to return to the PCP for ongoing management, and to examine physician perspectives on barriers to
this process.
DESIGN/METHODS: We composed case vignettes based on patients followed in 11 specialty clinics at a New England children's hospital. We identified 5 patients per specialty that met the following criteria: common
diagnosis (per published lists of conditions commonly referred to each specialty), ongoing care (at least 12 months of follow-up with the specialist), and stable condition (no medication changes in 12 months). Each
vignette was sent to the subspecialist team and the specific primary care doctor who follow the patient on whom the vignette was based. Physicians answered multiple choice questions about whether the patient
described in the vignette could be managed exclusively by the PCP, and about what factors were preventing the patient's transition back to primary care. They were also encouraged to leave open-ended comments.
RESULTS: Both PCP and subspecialist completed 47 (85%) of surveys. In 45% of cases, either the PCP or specialist reported that the PCP could manage the patient. In 36% of cases, the PCP and specialist agreed
that the patient could be managed exclusively by the PCP. A Cohen's kappa of 0.65 showed substantial inter rater agreement overall. Leading reasons for ongoing specialist care included a perceived inability of the
PCP to manage the patient, patient preference, and specialty clinic preference for longitudinal follow up. A frequently endorsed theme in physician comments was that “Good communication among patients, PCP, and
specialists is essential to the co-management process.” Other themes reflected patient complexity or the impact of a primary care clinic's limited resources on the PCP's ability to manage a patient.
CONCLUSIONS: The need for high-value care obligates us to efficiently allocate specialists' services. In our sample, PCPs and specialists agreed that 1/3 of patients being actively managed by pediatric
subspecialists could return to primary management by their PCP. PCPs and specialists agree that improved communication between providers and with families is essential for effective co-management.
2016 Eastern SPR Annual Meeting
Abstract Number: 2105
Filename: 750190
Publication Number: 443
Presenting Author: Jarreau Spencer S. Chen, MD
Department/Institution/Address: Pediatrics, St. Barnabas Hospital, 4422 Third Ave., Bronx, NY, 10457, United States
Phone: 718-960-9000
Fax: 718-960-9418
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: Knowledge and Attitudes about Pediatric Obstructive Sleep Apnea among Caregivers
Jarreau Spencer S. Chen1, Daniel Erichsen1,2, David H. Rubin1,2 and Paulo R. Pina1,2. 1Pediatrics, St. Barnabas Hospital, Bronx, NY and 2Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
BACKGROUND: Obstructive sleep apnea (OSA) is a common condition affecting the pediatric population which can result in serious complications including failure to thrive, developmental delay, and systemic and
pulmonary hypertension. Knowledge-based questionnaires for physicians have been developed and used successfully in educational research about OSA in adults and children. These studies have shown significant
deficits in the knowledge of pediatricians and primary care physicians. There are, however, limited studies that examine knowledge and attitudes among the general population, specifically among parents and other
caregivers.
OBJECTIVE: To evaluate knowledge and attitudes about pediatric OSA among parents and other caregivers.
DESIGN/METHODS: Cross sectional study of caregivers seen at the general pediatric clinic at an urban university-affiliated community hospital from December 2014 to November 2015. The questionnaire was
adapted from a previously validated survey used for physicians. Questions included demographics, and knowledge and attitude questions about pediatric OSA. Knowledge items addressed awareness, signs and
symptoms, complications and treatment of OSA. Attitude items addressed health-seeking behaviors. Descriptive statistics were used to summarize survey responses. Chi-square was used to compare proportions
across age, gender, knowledge and attitude variables. Spearman's rho was used to correlate knowledge level and demographic factors.
RESULTS: 85 surveys were completed and analyzed. Mean caregiver age was 33.2 years (SD 9.3). 84.7% were female and 77.6% were mothers. Only 32.9% had heard of OSA. There was a significant positive
correlation between educational attainment and knowledge of OSA (r=0.401, p=0.034). There was no significant association with age or gender. 50.0% identified physicians as their source of information about OSA.
50.6% would schedule a doctor's appointment if their child was snoring. Interrupted breathing during sleep was the most commonly perceived symptom with OSA (71.4%), followed by snoring (46.4%). Heart problems
was the most commonly perceived complication of OSA (28.6%). 71.4% recognize OSA as a treatable condition.
CONCLUSIONS: There is an overall deficit in knowledge and awareness about pediatric OSA among parents and caregivers, although those with the highest educational attainment have the strongest knowledge of
OSA. Educational intervention is needed to address these deficits.
2016 Eastern SPR Annual Meeting
Abstract Number: 2878
Filename: 750162
Publication Number: 445
Presenting Author: Rachel Klausner
Department/Institution/Address: P.O Box 208064, 333 Cedar Street, New Haven, CT, 06611, United States
Phone: 2036887953
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: Implementation of a Screening program for Detection of Critical Congenital Heart Disease (CCHD) in Newborns in a Large Connecticut Health System
Rachel Klausner1, Eugene D. Shapiro1, Robert W. Elder2 and Jaspreet Loyal1. 1Pediatrics, Yale School of Medicine, New Haven, CT and 2Pediatric Cardiology, Yale School of Medicine, New Haven, CT.
BACKGROUND: In 2012, the AAP recommended that newborns undergo pulse oximetry screening (POxS) for CCHD. As of Jan 1, 2013, Connecticut requires hospitals to perform POxS in all newborns.
OBJECTIVE: To report the results of and to identify problems with implementation of a screening program to detect CCHD.
DESIGN/METHODS: We reviewed records of infants born between Jan 1 and Dec 31, 2014 delivered at 4 Yale-New Haven Health System hospitals. Infants eligible for CCHD screening by POxS were ≥24 hrs of age
who did not require supplemental oxygen. Screening performed >72 hrs of life was considered delayed. Charts of infants with negative CCHD screening results were reviewed at >6 months of age.
RESULTS: Screening Program: Of 10,589 infants eligible for POxS screening, 97.5% (N=10,316) were screened by POxS, 1.6% (N=175) had an echocardiogram (ECHO) and so did not need screening, and 0.9%
(n=98) were not screened. Of the 13 infants diagnosed with CCHD during the study period, 12 did not undergo post-natal POxS. Eleven (85%) were diagnosed prenatally and 1 (8%) with total anomalous pulmonary
venous return was diagnosed by ECHO at <24 hours of age, while 1 (8%) whose POxS result on day 10 was negative was diagnosed with coarctation of the aorta on day 13 after a murmur was heard on day 12. Four
infants with a positive POxS result had non-critical cardiac lesions by ECHO. Twenty-four infants with a negative result by POxS were subsequently found to have cardiac abnormalities not considered “critical” but
underwent surgery at <1 yr of age. Implementation: Of 10,316 infants screened by POxS, 5% (n=521) were screened at either <24 hrs (n=132) or >72 hrs (n=389) of age. Of 389 infants screened at >72 hrs, 94%
(n=367) were NICU patients. Of 10,316 infants screened by POxS, 6.5% (n=673) had incomplete documentation (e.g., oxygen saturation not recorded but screening result recorded), 0.8% (n=88) had duplicate
screens when not indicated and 0.08% (n=8) were incorrectly classified as normal when abnormal or vice versa.
CONCLUSIONS: The majority of newborns were screened as recommended by the AAP. Most CCHD lesions were detected prenatally. No CCHD lesions were detected by POxS alone. Our study highlights the
importance of internal quality review of implementation of CCHD screening and is a reminder of the limitations of screening to detect non-targeted CCHD (e.g. coarctation) and non-critical lesions.
2016 Eastern SPR Annual Meeting
Abstract Number: 2756
Filename: 755074
Publication Number: 446
Presenting Author: Chelsey Clark
Department/Institution/Address: Pediatrics, Cohen Children's Medical Center of New York, 1983 marcus avenue, suite 130, Lake Success, NY, 11042, United States
Phone: 516 802 6100
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: Physician Discussion of AAP Car Seat Safety Guidelines: Unexpected Racial Disparities
Chelsey Clark1, Tammy B. Pham1, Tasnim Ahmed1, Chuck Ng1 and Ruth L. Milanaik1. 1Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY.
BACKGROUND: Unintentional injury, including motor vehicle accidents (MVA), is the leading cause of death in children in the U.S. In 2011, the AAP revised its policy statements outlining proper car seat safety
practices for children. These policies are easily accessible for primary medical doctors (PMDs) so that they can provide proper anticipatory guidance to patients. However, it is unclear if car safety is being discussed
with parents by their PMDs.
OBJECTIVE: To assess car seat safety anticipatory guidance provided by PMDs.
DESIGN/METHODS: In the waiting areas of two pediatric specialty clinics, parents of children aged 1-5 were asked to complete anonymous surveys about child safety policies. The surveys asked about car seat
practices, advice given by PMDs about motor vehicle safety, and demographic information. A Chi-Squared Test was used to assess differences in PMD discussion of car seat safety across parental demographics.
RESULTS: Sixty parents were surveyed: 88% female; 46% White, 11% Asian/Pacific Islander, 18% Black, 18% Hispanic, 7% other. Although 100% of parents correctly used car seats, only 44% reported receiving car
seat guidance from their PMDs. Furthermore, an analysis of PMD anticipatory guidance across minority status (white vs. non-white) showed that 82% of white parents received guidance, compared to 32% of minority
parents, χ2 = 12.90, p < .001. When parents were asked how much car safety advice they wished to receive from their PMDs, 52% stated that they desired more advice; this differed significantly between minority
parents (75%) and white parents (25%), χ 2 = 13.02, p < .001. There were no significant differences across gender, income, or education level.
CONCLUSIONS: Given that MVAs are a leading cause of child death and injury, it is imperative that PMDs counsel all parents on AAP-supported car safety practices. Nearly half of parents in this study did not receive
advice from their PMDs on car seat safety. Furthermore, the results show a clear racial disparity in anticipatory guidance, leaving minority children at greater risk of death or injury from MVAs. The majority of parents,
especially minority parents, are eager for more PMD advice about car seat safety. PMDs should make better use of the AAP's readily available resources to counsel all patients on critical child safety practices.
2016 Eastern SPR Annual Meeting
Abstract Number: 2827
Filename: 755428
Publication Number: 447
Presenting Author: Sreevidya Sreekantha, MD
Department/Institution/Address: Department of Pediatrics, Flushing Hospital Medical Center, 4500 Parsons Blvd, Flushing, NY, 11355, United States
Phone: 7186705534
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: Factors Affecting Weight Loss in Healthy Term Newborns on Mixed Feeds
Sreevidya Sreekantha1, Jennifer Nguyen1, Alexandra Spilsbury1, Ritesh Korumilli1, Lily Q. Lew1, Dakshayani Guttal2, Susana Rapaport1 and Lourdes Cohen1. 1Department of Pediatrics, Flushing Hospital Medical
Center, Flushing, NY and 2Department of Pediatrics, Jamaica Hospital Medical Center, Jamaica, NY.
BACKGROUND: Weight loss in immediate postnatal period is a well known phenomenon. Recent reports demonstrated differences in weight loss depending on mode of delivery and whether exclusively breast fed or
formula fed.
OBJECTIVE: To explore factors that may affect weight loss during birth hospitalization in babies receiving mixed feeds (both breast and formula fed).
DESIGN/METHODS: Retrospective chart review of newborns born at Flushing Hospital Medical Center over 16 months between Jan 2013 to Dec 2014. Newborns <38 weeks gestation, multiple birth, exclusively
breast or formula fed, requiring intensive care or phototherapy, >10% weight loss or any weight gain during birth hospitalization were excluded. Data were collected on maternal age, parity, ethnicity, mode of delivery,
gestational age (GA), birth weight (BW), gender and feeding type. Cohort was stratified by mode of delivery (vaginal and Cesarean). Group 1 (G1) included newborns born between 38-39 6/7 weeks and Group 2 (G2)
> 40 weeks. The effect of parity, gender and GA on weight loss was analyzed independently using t-test, p<0.05 was significant.
RESULTS: Of 3317 charts reviewed, 1681 newborns met inclusion criteria; of those, 828 females (49.2%),1115 delivered vaginally (66%),the mean BW was 3304±402 gms. Median maternal age was 29 years, 677
were primigravida (40%), 54% Asian and 40% Hispanic.Parity and gender independently did not affect weight loss among newborns on mixed feeds (p>0.05). In newborns delivered vaginally, the mean weight loss
was 3.3% at 39hours in G2compared to 3.6% at 37hours in G1, p<0.05. In newborns delivered by cesarean section, the mean weight loss was 3.3% at 59hours in G2 compared to 3.9% at 57hours in G1, p<0.05. G1
lost more weight independently of mode of delivery.
CONCLUSIONS: Newborns with GA>40 weeks and receiving mixed feeds lost less weight during birth hospitalization compared to newborns born between 38-39 6/7 weeks, independently of their mode of delivery.
Parity and gender did not affect weight loss in our cohort.
2016 Eastern SPR Annual Meeting
Abstract Number: 947
Filename: 751225
Publication Number: 448
Presenting Author: Yogen Utturkar, PhD
Department/Institution/Address: One Research Circle, ES-210, Niskayuna, NY, 12309, United States
Phone: 1-518-387-6238
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: A Physics/Physiology-Based Model for Neonatal Core Thermoregulation in a Radiant Warmer
Yogen Utturkar1 and Wolfgang Stautner1. 1GE Global Research, Niskayuna, NY.
BACKGROUND: The lack of a thermal comfort model leads bedside caregivers to erroneous temperature setpoints on infant warmers potentially contributing to increased infection/mortality and length of hospital stay
in case of 66-93% of preterm newborns with extremely low birth weight [1]. While postnatal progress is strongly correlated to the sustenance of the core at ~37C, the current radiant warmers rely on human judgment
and single-point skin temperature measurement to allude towards that goal. 1. Thermoregulation and Heat Loss Prevention After Birth and During Neonatal Intensive-Care Unit Stabilization of Extremely
Low-Birthweight Infants, Knobel R. and Holditch-Davis D., J. of Obs., Gyn. & Neonatal Nursing, 2007 36(3):280-287.
OBJECTIVE: The current study develops a mathematical handle on the dynamics of a neonate's core temperature. Using the model, the difference between neonatal core and skin temperatures is provided for
selected scenarios to highlight its variance under conditions internal and external to the baby's body.
DESIGN/METHODS: A model for time-dependent prediction of neonatal core, skin and blood temperature is developed. While the core and skin directly are participative in a baby's heat gain and loss mechanisms,
blood flow is treated to act as a heat transport mechanism. The temperature rise or fall within these three body compartments depends on the net difference between the gain and loss terms. To stay lean on
empiricism, the model leverages the physics of body heat loss and psychrometry, mechanics of a radiant warmer, chemistry of brown adipose fat metabolism, and physiology of epidermal water loss, respiration and
blood flow.
RESULTS: Skin/core temperature predictions for a baby in a radiant warmer (mass 1.6 Kg, height 40 cm, 25 C room with 0.025 m/s air flow, gestational age 32 weeks, postnatal age 1 day, tidal volume 8.5 ml/Kg,
blood circulation period 60 s). The radiant warmer's power is adjusted to produce a constancy of 37 C core.
Breathing freq. [/min]
Blood volume [ml/Kg]
Core-to skin difference [C]
40
75
2.2
80
75
1.6
80
100
1.0
CONCLUSIONS: The core-to-skin temperature difference can have substantial variability based on the baby's physiological and other parameters. Thus, the current practice of regulating a warmer device using baby's
skin temperature measurement can be inadequate. A robust control over neonatal thermal zone that has a quantitative logic towards achieving a selected core temperature will be an indispensable asset in pediatric
health.
2016 Eastern SPR Annual Meeting
Abstract Number: 2332
Filename: 752362
Publication Number: 449
Presenting Author: Alexander Feldman, DO
Department/Institution/Address: Pediatrics, Rutgers University, New Jersey Medical School, 90 Bergen Street, Newark, NJ, 07205, United States
Phone: 9739729835
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 Single Nucleotide Polymorphisms of Hypoxia Inducible Factor 1α and Retinopathy of Prematurity
Alexander Feldman1,2, Umesh Paudel1, Asma Amin1 and Lance A. Parton1. 1Newborn Medicine, The Regional Perinatal Center Division of Newborn Medicine, New York Medical College, Maria Fareri Children's
Hospital at Westchester Medical Center, Valhalla, NY and 2Neonatology, Rutgers University, New Jersey Medical School, Newark, NJ.
BACKGROUND: Hypoxia inducible factor 1a (HIF1α) is a potent mediator of oxygen related vascular response that has been implicated in bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL) and
retinopathy of prematurity (ROP). Under conditions of hypoxia, HIF1a degradation is impaired, resulting in increased stimulation of angiogenic factors including vascular endothelial growth factor (VEGF) and several
angiopoietins. This stimulation promotes abnormal vascular growth that has been implicated in many neonatal morbidities.
OBJECTIVE: To investigate the association of HIF1α SNPs with BPD, PVL and ROP in ELBW infants.
DESIGN/METHODS: This is an ongoing cohort study of infants born <1 kg. DNA was isolated from buccal mucosal swabs and subjected to allelic discrimination using probes for SNPs of HIF1α (rs12434438,
rs2301113, rs11549465, rs11549467,) during RT-PCR. Χ2 test, t-test, z-test were performed to determine association between HIF1α and neonatal outcome. P<0.05 was considered significant.
RESULTS: 202 infants were included for analysis; 58% of infants had moderate or severe BPD; 9% of infants had PVL; 50% of infants had ROP. BPD, ROP and PVL were all more common in smaller and more
immature infants. Gender and racial distributions were similar between the groups. No differences in genotype distribution, minor allele frequency or minor allele distribution were seen. However, infants who contained
the homozygous minor allele at rs2301113 (cc) were more likely to have ROP than infants who contained the wild type allele (A) (63% v 45%; P<0.05).
CONCLUSIONS: Single nucleotide variations of HIF1α may be implicated in the development of ROP. We speculate that HIF1α polymorphism may result in excessive stimulation of VEGF and other angiogenic
factors leading to abnormal vascular development in the retina.
2016 Eastern SPR Annual Meeting
Abstract Number: 881
Filename: 750341
Publication Number: 450
Presenting Author: Stephanie M. Prescott, MSN, NNP,PhD student
Department/Institution/Address: 19615 Edgemont Square, 19615 Edgemont Square, Ashburn, VA, 20147, United States
Phone: 7032209820
Fax: United States
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Other - PhD 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: Exploring Near Infrared Spectroscopy Scores in Neonates by Birth Weight, Gestational Age, Day of Life, and Mean Blood Pressure
Stephanie M. Prescott1,2,3. 1Nursing Research, University of Virginia, Charlottesville, VA; 2Neonatology, Inova Children's Hospital, Falls Church, VA and 3Neonatology, Fairfax Neonatal Associates, Falls Church, VA.
BACKGROUND: Near infrared spectroscopy (NIRS) scores are considered to be a marker of perfusion status. Organ perfusion may change during early transition to the extra-uterine environment, or as the
gestational age (GA) or birth weight (BW) changes. NIRS is a new technology and has not been associated with well-defined normative values in the neonatal population.
OBJECTIVE: Understanding the relationships between NIRS and known values such as mean blood pressure (MBP), day of life (DOL), BW, and GA, may lead to greater understanding of the effects of prematurity
and low birth weight on organ perfusion, and thus the adverse outcomes commonly associated with prematurity.
DESIGN/METHODS: Secondary Data Analysis of 13 infants between the GA of 26-41 weeks, with BW of 880g-4.4kg, and between 2 and 32 DOL. Measurements of cerebral, and renal or mesenteric NIRS scores
were obtained and recorded hourly for 3-6 days. MBP was recorded when available. Data were analyzed using SPSS v.22. ANOVA was chosen to examine the pattern of cerebral and renal NIRS scores based on the
interaction between DOL and MBP categories. Regression analysis was used to test the predictive value of MBP, GA, and DOL for cerebral, renal, and mesenteric NIRS scores. Repeated measures ANCOVA was
used to determine differences in NIRS scores over time by MBP after controlling for GA.
RESULTS: All measured NIRS values were higher in the first 5 days of life (p< 0.001). Cerebral and renal NIRS were lower in infants born less than 31 weeks GA (p<0.001). Cerebral NIRS had conflicting results when
controlled for blood pressure across day of life categories, while renal NIRS scores where higher when the MBP was in the highest quartile across DOL categories (p<0.001). Cerebral scores did not change over three
random days when controlled for MBP or GA (p=0.791). Somatic scores were significantly lower in the lower blood pressure categories over the three days when controlled for GA (p=0.015). GA was a significant
predictor of NIRS scores in all locations (p<0.001-p=0.009); though, these represent a small portion of the variance in these scores.
CONCLUSIONS: Organ perfusion changes are detectable by NIRS during the newborn transitional period. Infants born prematurely and with low birth weights have lower NIRS scores than those born near term.
Blood pressure impacts cerebral and somatic organs differently, and is likely affected by transition, maturation, and physiologic compensation.
2016 Eastern SPR Annual Meeting
Abstract Number: 592
Filename: 751088
Publication Number: 451
Presenting Author: Samantha E. Dizon, BS
Department/Institution/Address: Pediatrics, University of Maryland Baltimore School of Medicine, 110 S. Paca St, 110 S. Paca St, Baltimore, MD, 21201, United States
Phone: 4103286003
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: Premature Small for Gestational Age (SGA) Infants: What Should Their Blood Pressure Be?
Samantha E. Dizon1 and Suma B. Hoffman1. 1Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore.
BACKGROUND: In the premature neonate, there is no consensus regarding normal blood pressure. The most common definition of hypotension is a mean arterial blood pressure (MAP) < gestation age (GA),
however, it is unknown whether this is valid for the SGA infant.
OBJECTIVE: To test the hypothesis that maturity is a more important factor than size in determining MAP in the SGA infant in the first 96 h of life.
DESIGN/METHODS: A single center 4 year retrospective review was conducted on infants 24-32 wks gestation. Demographic and clinical data were collected. MAPs were collected and averaged every 12 h for the
first 96 hrs of life. Patients were determined to be SGA if their birth weight (BW) was less than the <10% for GA. Demgraphic and clinical differences in SGA vs approriate for GA (AGA) subjects were evaluated with
t-test and chi square analysis. For each time point, the difference in MAP in SGA vs. AGA infants was evaluated with t-testing. Further, multiple linear regression with collinearity diagnostics was performed to evaluate
the outcome of MAP at each time point controlling for BW, GA, and SGA status.
RESULTS: 356 subjects were evaluated. 52 (15%) were SGA. Compared to AGA subjects, SGA infants were significantly smaller, discharged later, had higher retinopathy of prematurity rates, and higher mortality
rates(p < 0.05). In univariate analysis, MAP in the SGA group more closely matched the MAP of AGA babies of similar GA for the first 24 h of life. After 24 h, the SGA group had MAPs that more closely resembled
AGA babies of similar BW
. Regression revealed no significant collinearity between BW and GA. In the 2 time periods in the first 24 h, the model was significant (R2 .26 and .25 respectively, p < 0.0001) with GA as the only significant parameter
estimate ( p < 0.0001). Over time, the model stayed significant with p <0.0001 and GA being the most significant parameter p ≤ 0.05, however, R2 fell over time to .12.
CONCLUSIONS: In the SGA infant, their blood pressure should be considered based on their GA, especially in the first 24 hours of life.
2016 Eastern SPR Annual Meeting
Abstract Number: 3248
Filename: 752465
Publication Number: 452
Presenting Author: El Noh, DO, MPH
Department/Institution/Address: Neonatology, Children's Hospital of Richmond at VCU, PO Box 980276, Richmond, VA, 23298, United States
Phone: 7578696525
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: Increased Clotting Events in Infants with Congenital Diaphragmatic Hernia Treated with Extracorporeal Membrane Oxygenation
El Noh1, Betty Chui1, Henry Rozycki1 and Russell Moores1. 1Neonatology, Children's Hospital of Richmond at VCU, Richmond, VA.
BACKGROUND: Inflammatory cascade, triggered upon initiation of extracorporeal membrane oxygenation (ECMO), especially in neonates, can lead to significantly inadequate production and increased consumption
of anticoagulant factors. Clotting within the ECMO circuit poses great risks to the patients, which is worsened with pauses in the ECMO treatment for consequent and necessary circuit changes. Clinical observation of
recurrent clotting events with resultant increase in ECMO circuit changes in infants with congenital diaphragmatic hernia (CDH) prompted a comparative study of the clotting problems on ECMO between infant with
and without CDH.
OBJECTIVE: To compare number of clotting events and circuit changes between CDH and non-CDH infants on ECMO.
DESIGN/METHODS: Retrospective analysis was done for infants on ECMO in the CHoR NICU between 2009 and 2015. Anticoagulation was managed per our institutional guideline consistently over the study period.
Clotting events were defined as individual incidences when clotting was noted within the circuit. Event frequencies were analyzed by Mann-Whitney U test.
RESULTS: 45 infants were included in the study; 15 CDH and 30 non-CDH indications for ECMO. The median days on ECMO were 20 days and 13 days for CDH and non-CDH infants respectively with a p value of
0.11. Data for clotting events and circuit changes were normalized per day on ECMO to account for differing ECMO durations. Median number of clotting events and circuit changes per day on ECMO for CDH and
non-CDH infants are as listed on the table. The p values for the clotting events and circuit changes between the 2 groups were 0.0005 and 0.0012 respectively.
CDH
Non-CDH
n
15
30
Median Birth Weight (range) g
2700 (1930 – 3810)
3048 (2120 – 4770)
Median Days on ECMO (range)
20 (2 – 33)
13 (2 – 24)
Median # of Clotting Events per ECMO day (range)
0.11 (0 - 0.46)
0.08 (0 - 0.20)
Median # of Circuit Changes per ECMO day (range)
0.08 (0 - 3.6)
0.04 (0 - 0.13)
CONCLUSIONS: CDH infants had a significantly higher incidence of clotting problem while on ECMO. Follow up studies are required to evaluate the possible causes of the increased clotting events and develop
improved anticoagulation management for CDH infants.
2016 Eastern SPR Annual Meeting
Abstract Number: 4441
Filename: 753432
Publication Number: 453
Presenting Author: A. Maxwell, MD
Department/Institution/Address: 33 Eaton Street, West Haven, CT, 06516, United States
Phone: 203-507-9093
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: “Liquid Gold”, a Breastfeeding Bundle, Increases Lactation Success in Mothers of Extremely Low Birth Weight Infants
A. Maxwell1, D. Aboudi1,2, H. Brumberg1, K. Olivo1, T. Roeder1, R. Valdes-Greene1 and B. Parvez1. 1The Regional NICU, Maria Fareri Children's Hospital at WMC, NYMC, Valhalla, NY and 2School of Public Health,
CUNY, New York, NY.
BACKGROUND: Mothers of Extremely Low Birthweight(ELBW) infants face significant barriers to breastfeeding(BF). A bundled approach in a regional perinatal center(RPC) where these barriers are more prevalent
may help increase the lactation success of these high risk mothers.
OBJECTIVE: To investigate the effect of our BF bundle, “Liquid Gold”, on ELBW receipt of human milk(HM) at our RPC.
DESIGN/METHODS: This is a retrospective cohort study of ELBW infants with gestational age(GA)>23 wks who were admitted<96hrs of life and received their 1st feed at RPC. We excluded infants who died<96 hrs
of birth. HM rates (at 1st and discharge[D/C] feeds) were compared between 3 time epochs: Baseline(B;1/12-7/13), Transition(T;provision of HM derived fortifier;8/13-12/14), Liquid Gold(LG;full bundle;1/15-present).
LG included antenatal counseling, staff education, colostrum(C) collection<1hr of life, pumping<6 hrs for both inborns and outborns, C oral care, and exclusive HM diet with mother's own, and bridged by donor milk
when necessary. Lactation support was provided to all. Data included demographic, dietary, and morbidities. Χ2, Fisher's Exact, ANOVA, and logistic regression were performed.
RESULTS: 242 infants were included over the 3 epochs; B=102, T=84, and LG=56. BW(759±139, 751±161, 719±183) & GA(26±2, 26±2, 25±1) did not differ significantly by epoch (B,T, LG respectively). In the LG
epoch, 98% of ELBW infants received HM (donor or mom) during hospitalization which is significantly above the WHO 2020 Healthy People goals for full term babies (81.9%). HM as 1st feed was progressively higher
by epoch (39%B, 46%T, 91%LG, p<0.001). HM at D/C, however, did not differ by epoch (18%B, 13%T, 31%LG). When adjusting for multiples, BW, 5 min APGAR <3, inborn status & maternal age, ELBW had
improved odds of receiving HM at 1st feed in LG epoch(OR 19.8, 95% CI 6.5-60.1) and T epoch(OR15.9, 95% CI 5.1-49.3) compared with B epoch. IVH was reduced over time (19%B, 18%T, 2%LG, p=0.003). BPD,
NEC, ROP (stage>3), and sepsis did not differ by epoch.
CONCLUSIONS: A “Liquid Gold” bundle allowed a comprehensive approach in our RPC and led to significant increase in the provision of HM to the most vulnerable infants. We believe that our BF bundle may assist
other institutions in achieving lactation success in high risk mothers.
2016 Eastern SPR Annual Meeting
Abstract Number: 3154
Filename: 751957
Publication Number: 454
Presenting Author: Jessica A. Zina, MD, MA
Department/Institution/Address: Baystate Medical Center, 759 Chestnut st, Springfield, MA, United States
Phone: 4134272427
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: Increasing Human Breastmilk Feeding Rates at Discharge in Very Low Birth Weight Infants
Jessica A. Zina1,2, Lora Warren1, Jennie Fleming1, Jennifer Marion1 and Rachana Singh1,2. 1Baystate Medical Center, Springfield, MA and 2Tufts University School of Medicine, Boston, MA.
BACKGROUND: Human milk has better clinical outcomes as compared to formula for VLBW infants. Donor breast milk (DBM) is an alternative to formula when mother's own BM is not available. A DBM program was
initiated in 2014 with the expectation of having lower rates of NEC and increased maternal breastmilk feedings at discharge. The NICU spent $32,895 for 2014 without the expected improvements. This reiterated the
importance of strategies to improve mother's own milk productaion.
OBJECTIVE: To improve mother's own milk feedings at the time of discharge for VLBW infants by using QI processes in a Level III NICU.
DESIGN/METHODS: In 2015, the NICU joind a statewide initiative in Massachusetts to improve the breastfeeding rates in the NICU. For the first PDSA cycle of the QI project the objective was to decrease time to first
pumping and/or hand expression of BM in new mothers who delivered a VLBW infant. The interventions that were implemented included training the NICU staff to better educate parents, improve availability of pumps
on labor and delivery, providing Colostrum Information sheet and educational handouts for hand expressing to the parents in the room right after birth, as well as providing better access to lactation consultants.
RESULTS: As a baseline measure, time to first pumping was gleaned from the EMR and of the 47 mother-infant dyad between Jan 2015 to August 2015 only 32% were in the target range of 0-6hr. For the fisrt PDSA
cycle there were 13 mother-infant dyad between Sep 2015 to Oct 2015 with 69% in the target range. Comparative VON data for 4 years demonstrated that for year 2015 76.2% mother's were breastfeeding at
discharge, with 10% infants with discharge weight < 3rd %tile on Fenton's curve, with a 4.5% rate of NEC as compared to the previous year.
CONCLUSIONS: We show that QI processes focusing on early initiation of breast milk pumping and or hand expression can improve breastfeeding rates at discharge as well as improved growth trajectory for the
VLBW infants.
2016 Eastern SPR Annual Meeting
Abstract Number: 677
Filename: 751958
Publication Number: 455
Presenting Author: Shachee P. Pandya, MD
Department/Institution/Address: Neonatal-Perinatal Medicine, Cohen Children's Medical Center of New York, Neonatal Research Lab, Fe, 269-01 76th Ave, New Hyde Park, NY, 11040, United States
Phone: 718-470-3440
Fax: 718-347-3850
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: Bacterial Stability with Freezer Storage of Human Milk
Shachee P. Pandya1, Champa Codipilly1, Harshit Doshi1 and Richard J. Schanler1. 1Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Lilling Family Neonatal Research Lab, Feinstein Institute for Medical
Research, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
BACKGROUND: We reported previously that storage of human milk at -20°C for up to 9 months results in significant declines in total bacterial colony counts with minimal changes in nutrient composition. There are
three potential concerns with milk stored frozen for extended times: the paucity of infants' probiotic exposure, the possible regrowth of bacteria once milk is maintained at room temperature for feeding, and whether the
method of storage (manual vs automatic defrost freezer) affects bacterial growth.
OBJECTIVE: Our objectives were to test whether there are differences in selected bacteria stored for 2 and 12 weeks at -20°C in either manual or automatic defrost freezers and whether subsequent maintenance of
stored milk at room temperature promotes bacterial growth.
DESIGN/METHODS: Fresh expressed milk (40 mL) was obtained from mothers in the NICU (n=25), divided into aliquots, and maintained for 2 and 12 weeks at -20°C in either automatic or manual defrost freezers.
After the storage, samples were analyzed for colony counts of selected bacteria (lactobacillus, bifidobacteria, staphylococcus, streptococcus, and enterococcus). These bacteria were isolated from selective media
immediately and after 4 hours of maintenance at room temperature.
RESULTS: There were no differences in colony counts for any bacterial species between baseline and 2 weeks of freezer storage (p>0.05). There were significant declines in colony counts at 12 weeks storage
(p<0.05) for all bacterial species except streptococcus (p>0.05), which had a very low prevalence. There were no differences in any colony counts between the two freezer methods at either time point (p>0.05).
Subsequent maintenance at room temperature did not elicit any bacterial growth at either time point or with either method (p>0.05).
CONCLUSIONS: Human milk bacteria help to establish healthy intestinal microflora in newborn infants. Short-term freezer storage of human milk at -20°C for 2 weeks does not affect the quantity of selected milk
bacterial flora. However, storage to 12 weeks results in a decline in bacterial colony counts. The lack of bacterial growth once the milk is maintained at room temperature suggests that freezer storage adversely affects
the survival of bacteria. The type of freezer used for storage does not have an impact on bacterial survival. It is unclear how the infant benefits from exposure to the selected bacteria, and thus a trial of milk stored for
long vs short intervals is indicated.
2016 Eastern SPR Annual Meeting
Abstract Number: 4310
Filename: 755936
Publication Number: 456
Presenting Author: Shannon L. Eccles, DO
Department/Institution/Address: Pediatrics, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, United States
Phone: 001-732-804-4686
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 Role of the Type of Full Feeding on the Growth Pattern of Very Preterm Born Infants
Shannon L. Eccles1, Rajeev Mehta1 and Anna Petrova1. 1Pediatrics, Rutgers Robert Wood Johnson, New Brunswick, NJ.
BACKGROUND: Optimal feeding of surviving very or extremely premature born infants is one of the major factors that secure their growth and development. Although human milk is recognized as the optimal food for
all newborns, breast milk feeding of very preterm infants is still a subject of debate.
OBJECTIVE: To identify the role of the type of full feeding in the weight gain of preterm infants born at gestational age less than 32 weeks.
DESIGN/METHODS: We stratified data on infants born at gestational age < 32 weeks with respect to the type of full feeding (exclusive breast milk, partial breast milk, or formula) to compare the change (%) in infants'
weight from day 1 to day 7 (Point estimate 1) and day 1 to day 10 (Point estimate 2) of full feeding. Role of the primary predictor (type of feeding) in the infants' growth was assessed after adjusting for the important
covariance including birth weight, gestational age, duration of NPO, day of life feeding initiated and full feeding achieved.
RESULTS: Among the 84 infants on full feeds, 9.5% had received exclusive breast milk (Group 1), 79.8% received partial breast milk (Group 2) and 10.7% had received high calorie preterm formula (Group 3). Infants
in Group 1 were born at lower gestational age and birthweight than in Group 2 and 3 (P<0.03 and P<0.02). The mean duration of NPO and age at which feeding started were comparable between the studied groups.
Full feedings were achieved at a mean age of 31.9+/-14.2 days in Group 1, 18.1+/-12.4 days in Group 2, and 16.9+/-6.7 days in Group 3 (P< 0.011). In Group 1 and Group 2 the changes in weight at Point 1 was
10.8% (95%CI 5.9%-15.7%) and 8.8% (95%CI 7.6%-10.0%), respectively ( P>0.05),which was significantly higher than in Group 3 [3.3% (95%CI -3.1%-9.7%)]. At Point 2, the difference in the change of weight
between the groups did not reach statistical significance: Group 1 (14.4%, 95%CI 7.4%-21.3%), Group 2 (14.0%, 95%CI 12.8%-15.3%), and Group 3 (11.2% 95%CI 4.3%-18.0%), P=0.379. Adjustment to covariance
(see Methods) confirmed an association between increase in weight after 7 days of full feeding and inclusion of breast milk in the feeding. None of the covariance included in the model had an independent effect on
the infant's growth after both, day 7 and day 10 of full feeding (P>0.05).
CONCLUSIONS: The growth pattern of very preterm born infants who have been on full feeds for 7 days is improved by the use of human milk.
2016 Eastern SPR Annual Meeting
Abstract Number: 788
Filename: 753363
Publication Number: 457
Presenting Author: David Box, MD
Department/Institution/Address: Pediatrics, Saint Peters University Hospital, 254 easton avenue, New Brunswick, NJ, 08901, United States
Phone: 7327458523
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: Outcome of Premature Infants on Liquid Human Milk Fortifier
David Box1, Bethany Jung1 and Shakuntala Chandra1. 1Division of Neonataology, Department of Pediatrics, Saint Peters University Hospital, New Brunswick, NJ.
BACKGROUND: Fortification of breast milk is necessary to maintain adequate nutrition, growth and development in premature infants. Human milk fortifier is a liquid additive made from pooled human milk (breast
milk) donors, is pasteurized and has specified nutritional components with higher caloric content and electrolytes. Supplementation with complete human milk has shown reduced incidence of necrotizing enterocolitis.
The effects of this additive on nutrition, growth parameters have been limited due to reduced usage of this product secondary to cost.
OBJECTIVE: Preterm infants on human milk fortification had comparable growth to infants on cow's milk fortification.
DESIGN/METHODS: Retrospective chart reviewHuman milk fortifier usage in our NICU started since Jan 2014 in preterm infants.Two similar groups of preterm infants (≤ 1250 gms) before and after the usage of
Prolacta (HMF) were compared Group A: All preterm infants ≤ 1250gms who's mother's breast milk was fortified with cows milk fortifier (CMF group). Group B: All preterm infants ≤ 1250gms who's mother's breast milk
was fortified with human milk fortifier (HMF group).Primary outcome measurement was related to growth - Extra uterine growth restriction measured in 2 ways:Weight below the 10th percentile at discharge and Mean
of difference between birth weight percentile and discharge percentile with ± 1 SD. Secondary outcomes included necrotizing enterocolitis,electrolyte imbalance such as sodium levels, length of hospital stays, and
retinopathy of prematurity, bronchopulmonary dysplasia, intra ventricular hemorrhage & mortality.
RESULTS: Both groups (HMF n=20 and CMF n=64) were comparable by gestational age and birth weight. %age of growth restriction was higher in the HMF group (65%) in comparison to CMF group (57%). Mean of
difference between birth weight percentile and discharge percentile with ± 1 SD which delineates growth restriction was significantly higher in HMF group (29.25±28.93) in comparison to CMF group (16.87± 16.5) with
p=0.02. There was no statistical difference in electrolyte imbalance such as sodium levels, length of hospital stay, retinopathy of prematurity, bronchopulmonary dysplasia, intra ventricular hemorrhage and mortality
but incidence of NEC was higher at (p=0.01) 1.5% in CMF group compared to 15% in HMF group.
CONCLUSIONS: Neonates on human milk fortifier showed a significant increase in growth restriction higher association with increased incidence of NEC.
2016 Eastern SPR Annual Meeting
Abstract Number: 196
Filename: 751018
Publication Number: 458
Presenting Author: S. Lainwala, MD,PHD
Department/Institution/Address: Neonatology, Connecticut Children's Medical Center, 282 Washington street, Hartford, CT, 06106, United States
Phone: 8605458950
Fax: 8605458959
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: Clinical and Nutritional Outcomes of Two Liquid Human Milk Fortifiers Used in Preterm Infants
S. Lainwala1, N. Kosyakova1, A.M. Spizzoucco1, V. Herson1 and E. Brownell1. 1Neonatology, Connecticut Children's Medical Center, Hartford, CT.
BACKGROUND: It is standard practice to fortify human milk (HM) with fortifiers (HMF) to optimize nutrition and growth in preterm infants.
OBJECTIVE: To compare nutrition, growth and clinical outcomes in preterm infants receiving 2 different liquid HMFs (LHMF).
DESIGN/METHODS: A retrospective study was conducted including infants with BW<1.8k, born 10/1/2014-04/31/2015, admitted to a level IV NICU and receiving any HM and LHMF. Infants with congenital anomalies
were excluded. Demographics, and nutrition, growth and clinical outcomes were compared between infants born-10/1/2014-12/31/2014 and received acidified LHMF (LHMF1) and 1/1/2015-4/31/2015 and received
non-acidified LHMF (LHMF2). Metabolic acidosis (MA; base excess (BE) <-4 mmol/L), feeding intolerance (FI) leading to NPO>1 day and laboratory data after starting LHMF were collected. Univariate and multivariate
regression analyses were used.
RESULTS: Of 85 qualifying infants, 67 received HM and LHMF and were included in the study. Infants receiving LHMF1 had a significantly higher incidence of MA, lower bicarbonate (H2CO3) and BE levels and lesser
FI relative to infants receiving LHMF2 (all p<0.03). There were no significant differences by LHMF status in demographics, nutrition and clinical outcomes or growth at PMA 36wk (Table 1). In multivariate analyses,
infants receiving LHMF1 were more likely to have lower H2CO3 and BE levels and lesser FI. Delay in initiation of LHMF was associated with less FI (Table 2). In a subgroup analysis of infants with BW<1250g (n=35),
MA was significantly higher in LHMF1 group relative to LHMF2 (LHMF1:10,57%; LHMF2:1,6%; p=0.003).
CONCLUSIONS: In our study, nutrition, growth and clinical outcomes were similar between 2 LHMF groups. However, preterm infants receiving acidified HMF were more likely to develop MA with low H2CO3 and base
excess levels compared with LHMF2. MA should be closely monitored in infants receiving acidified HMF. Since this was a small single center study, RCTs are warranted to evaluate these findings.
2016 Eastern SPR Annual Meeting
Abstract Number: 3648
Filename: 754162
Publication Number: 459
Presenting Author: Alexandra Vinci, MD
Department/Institution/Address: Pediatrics, Winthrop University Hospital, 259 First St, Mineola, NY, 11501, United States
Phone: 011-516-663-2288
Fax: 011-516-663-8955
Presenting Author E-mail: [email protected]
Is Presenting Author a Trainee? Yes, Other - Chief Resident
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: Readmissions (readm) for Hyperbilirubinemia (↑BR) Following Phototherapy (PT) in the Nursery. Know Your ABOs
Alexandra Vinci1, Ceena Philipose1 and Warren Rosenfeld1. 1Department of Pediatrics, Children's Medical Center at Winthrop University Hospital, Mineola, NY.
BACKGROUND: Readm for ↑BR is common in pediatrics. Previously we reported increased readm to our Hospital associated with an increase in breast feeding. An increase in readm for PT was also noted in patients
who had received PT during their nursery stay.
OBJECTIVE: To determine the incidence of readm for ↑BR in patients who had previously undergone PT during their initial nursery stay (PT Readm) and what factors played a role in this subgroup.
DESIGN/METHODS: Births from 2009-2014 were reviewed. Only readm from the Winthrop Well Baby Nursery were included. All who had PT prior to readm were identified. Analysis included GA, maternal age,
delivery type, race and sex. Also analyzed were risk factors (eg. ABO), hr of PT start, hrs of PT, rebound bilirubin (BR), BR on readm, hrs of age at readm, and hrs of PT on readm. Feedings (B=exclusive breast milk,
B&F = breast and formula, F = formula only) were also analyzed.
RESULTS: Over 6 yrs 23,774 births were reviewed and 288 were readmitted for ↑BR. The # of PT Readm rose until 2014 when it fell. PT Readm were not associated with breast feeding & the rate of breast feeding
was similar in the PT Readm group (80%) and the Hospital in general (86%). ABO incompatibility occurred in 17/29(59%) of PT Readm prior to 2014. The rate fell to 16% in 2014 when a study involving ABO patients
requiring strict adherence to AAP PT guidelines was initiated. Early use of PT (<24 hrs) and lack of adherence to AAP PT Guidelines were also associated with PT Readm.
BIRTHS
#
YEAR
BR READM
3 (%)
PT READM
# (%)
ABO
# (%)
B/B&F/F
#
2009
3841
37 (0.96)
3 (8.1)
2 (67)
0/3/0
2010
3897
26 (0.67)
3 (11.5)
2 (67)
0/2/1
PT<24 hrs
# (%)
3(100)
PT
#(%)
1(33)
1(33)
2(67)
2011
3898
34 (0.87)
5 (14.7)
3 (60)
0/3/2
3((60)
3(60)
2012
3848
47 (1.22)*(p<0.001)
6 (12.7)
2 (33)
1/3/2
5(83)
3(50)
10(83)
2013
4209
79 (1.88)*(p<0.001)
12 (15.1)+(p<0.04)
8 (67)
3/8/1
6(50)
2014
4081
65 (1.59)*(p<0.001)
6 (9.2)
1 (16)
1/4/1
0(0)
Total
23774
288(1.2)
35(12)
18(51)
5/23/7
2(33)
18(51)
21(60)
CONCLUSIONS: PT Readm account for 12% of readm for ↑BR. PT Readm were not related to breast feeding. PT Readm were associated with ABO requiring PT in the nursery and early PT. Proper use of PT
including meeting threshhold, especially in patients with ABO, may help to reduce PT Readm.
2016 Eastern SPR Annual Meeting
Abstract Number: 4462
Filename: 753895
Publication Number: 460
Presenting Author: A. Bamanikar, MD
Department/Institution/Address: 416 Old country road, Elmsford, NY, 10523, United States
Phone: 6128608604
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: Medication Administration Practices in the NICU Affect Osmolality of Human Milk
A. Bamanikar1, P. Giri1, T. Roeder1, R. Valdes-Greene1, E. LaGamma1 and B. Parvez1. 1Newborn Medicine, The Regional Neonatal Center, Maria Fareri Children's Hospital at Westchester Medical Center, New York
Medical College, Valhalla, NY.
BACKGROUND: Studies have linked high osmolality of oral medications in the NICU and necrotizing enterocolitis. Sodium chloride (Na) supplementation is common in the NICU. There is limited data on resultant
osmolality of different volumes of unfortified and fortified milk with varying Na doses.
OBJECTIVE: To determine the changes in osmolality of unfortified and fortified breast milk with the addition of oral Na solution (2.5 mEq/ml, 5000 mOsm/L).
DESIGN/METHODS: We developed an in-vitro experiment which closely approximates real-time practices in our NICU in relation to administration of Na. 1 and 2 mEq/kg of Na was chosen as a common dose for a
growing preemie with weight of 1.5 Kg, who would be expected to have reached full feeds. Na was mixed in 10 and 30 ml of expired preterm and term mother's own and full term donor milk (unfortified). Milk was
fortified using cow-milk or human-milk derived fortifier. Osmolality was measured using the freezing-point thermodynamics (Advanced Micro-Osmomter Model 3320). Multiple samples were analyzed. Independent
t-Test was performed with p value < 0.05 being significant.
RESULTS: Unfortified milk was iso-osmolar (300 mOsm/kg/H2O ± 7, mean ± SD) and did not differ between type of milk.Fortification of milk to 22 and 24 Kcal/oz rendered the milk hyperosmolar (323 ± 2 and 372 ± 2),
respectively. The addition of 1.5 mEq Na to 10 ml of milk (fortified and unfortified) raised the osmolality by an average of 160 mOsm/kg/H2O ± 20. When the same dose of Na was added to 30 ml of milk, the resultant
osmolality increase was 50 mOsm/kg/H2O ± 30. When the dose of Na was doubled in 10 and 30 of milk, the osmolality reached above 800 ± 20 and 450 mOsm/kg/H2O ± 24 respectively.
CONCLUSIONS: Fortification of human milk with either cow or human milk derived fortifier causes hyperosmolality. Addition of sodium significantly increased osmolality of unfortified and fortified milk - regardless of
volume of dilution. Dilution of sodium in larger volume of milk somewhat ameliorated hyperosmolality. Our data suggests that caution should be applied when administering oral sodium to growing preemies.
2016 Eastern SPR Annual Meeting
Abstract Number: 4200
Filename: 755738
Publication Number: 461
Presenting Author: Swati Murthy, MD
Department/Institution/Address: 848 S Swanson Street, Philadelphia, PA, 19147, United States
Phone: 315-427-0499
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 Cardiorespiratory Events Trigger Gastroesophageal Reflux or Vice Versa?
Swati Murthy1 and Zubair H. Aghai1. 1Neonatology, Thomas Jefferson University Hospital/Nemours, Philadelphia, PA.
BACKGROUND: Gastroesophageal reflux (GER) is common in preterm and term infants. While GER is mostly considered benign, it is sometimes considered a cause of cardiorespiratory events (apnea, bradycardia,
desaturation). Many infants are started on thickened feeding regimens, acid suppression, or promotility agents. However, evidence for therapy is poor and has been associated with adverse events including sepsis
and NEC. Multi-channel intraluminal impedance studies have become the gold-standard for diagnosing GER.
OBJECTIVE: To determine the temporal relationship between GER and cardiorespiratory events.
DESIGN/METHODS: This is a retrospective analysis of term and preterm infants who underwent an impedance study at Thomas Jefferson University, October 2009-October 2015. Infants were referred for impedance
studies by the primary team based on clinical suspicion for pathologic GER. Impedance studies were reviewed and nursing report of cardiorespiratory events were correlated with GER. Events were considered related
to reflux if they occurred within 5 minutes of GER.
RESULTS: There were 119 infants who underwent impedance studies in the study period. Only 52 infants (BW 1603±950, GA 30±5.2) had nursing report of apnea, bradycardia, or desaturation during their impedance
study. There were 329 cardiorespiratory events reported (18 apneas, 171 bradycardias, 139 desaturations) and 68 (21%) were considered related to GER. There were 2054 episodes of GER recorded and 68 (3.3%)
were associated with cardiorespiratory events. Of the related cardiorespiratory events, 22 (32%) occurred prior to reflux indicating that GER could have been triggered by the cardiorespiratory event.
Cardiorespiratory Events
Apneas
Apneas related to reflux
Apneas before reflux
Apneas after reflux
Bradycardias
Bradycardias related to reflux
Bradycardias before reflux
Bradycardias after reflux
Desaturations
Desaturations related to reflux
Desaturations before reflux
Desaturations after reflux
18
3 (17%)
0
3 (2 acidic, 1 non-acidic)
171
32 (19%)
10 (3 acidic, 7 non-acidic) (31%)
22 (10 acidic, 12 non-acidic) (69%)
139
33 (24%)
12 (7 acidic, 5 non-acidic) (36%)
21 (10 acidic, 11 non-acidic) (64%)
CONCLUSIONS: Very few GER events are related to cardiorespiratory events and cardiorespiratory events may be the cause of some GER.
2016 Eastern SPR Annual Meeting
Abstract Number: 1684
Filename: 753215
Publication Number: 462
Presenting Author: Pinchi Srinivasan, MD
Department/Institution/Address: Pediatrics, New York Presbyterian Queens, 56-45, Main Street, Flushing, NY, 11355, United States
Phone: 7186701184
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: Transcutaneous Bilirubin (TCB) Nomogram for Newborns of East Asian (EA) Ethnicity
Pinchi Srinivasan1, Michael Brandler1, Eli Koenig1, Elise Lavery1, Piyush Jain2 and Joseph Abularrage1. 1Pediatrics, New York Presbyterian Queens, Flushing, NY and 2Translational Health Science and Technology
Institute, Faridabad, Haryana, India.
BACKGROUND: Limited data available on the natural history of TcB levels during the first days of life, and it is incorrect to plot TcB levels on Serum Bilirubin based nomograms. EA ethnicity has been shown to be a
major and independent risk factor for hyperbilirubinemia.
OBJECTIVE: To evaluate TcB levels for the first 96 hours after birth in healthy term and late PT neonates of EA ethnicity and develop a TcB nomogram based on hour-specific TcBs. No existing studies on the
immigrant population of EA ethnicity with nomograms for these newborns that carry an independent risk factor.
DESIGN/METHODS: Prospective study, from a diversified immigrant population in NYC. Inclusion: EA term and late PT (GA≥35 Wks) admitted to nursery, Exclusions: Perinatal asphyxia, Rh Incompatibility, G6PD
deficiency and those requiring phototherapy. TcB measurements using the Draeger JM-103TM obtained every 4 hours between 10 AM and 10 PM (10,2,6,and 10) on weekdays, for all eligible infants whose ages were
within 2 hours of one of the designated 4-hour time intervals (8,12,16,...96 Hrs). Clinical data including mode of delivery, GA, feeding type and BW collected
Demograpghics
* (Mean ± sd)
GA (wks)
38.9±1.1*
VD/C-section (%)
68/32
Gender M/F (%)
54/46
Birth Weight (gms)
3306±409*
TcB observations
5.6±2.7*
Weight loss at DC
172 gms (5.2%)
.
RESULTS: 8,944 TcB observations obtained on 1,599 neonates. A nomogram was constructed, identifying the 10th, 25th, 50th, 75th, 90thand 95th percentile curves. The 95th percentile values at 12, 24, 48, and 72
hours were 4.8, 7.4, 11.1, and 11.9 mg/dL, respectively. No statistically significant association between the difference in TcB levels from 8h to 36h and mode of delivery (Kruskal-Wallis test, p=0.88) or gender
(Mann-Whitney test, p=0.44).
CONCLUSIONS: In this cohort of EA neonates from immigrant population the mean TcB levels at epochs of 24, 48, and 72 hours are higher than the levels of similar epochs from published nomograms on Caucasian,
Hispanic and Thai neonates.
2016 Eastern SPR Annual Meeting
Abstract Number: 3883
Filename: 754900
Publication Number: 463
Presenting Author: Sourabh Verma, MD
Department/Institution/Address: Division of Neonatology, Department of Pediatrics, NYU School of medicine, 462 First avenue, New York, NY, 10016, United States
Phone: 19898544863
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: Inter and Intra Device Variability in Irradiance Among Phototherapy Devices
Sourabh Verma1, Pradeep V. Mally1, Sarah L. Zhang1, Katherine E. Carome1, Martha C. Caprio1 and Sean M. Bailey1. 1Division of Neonatology, NYU School of Medicine, New York, NY.
BACKGROUND: Neonatal hyperbilirubinemia is common in newborn infants and usually treatable by phototherapy alone. Different device types can be used for phototherapy such as Halide spotlights, LED lights, and
fiber-optic bili blankets. Current recommendations suggest a minimum irradiance of 8-10 µW/cm2/nm for standard phototherapy and an irradiance of 30 µW/cm2/nm or higher for intensive therapy.
OBJECTIVE: To determine inter and intra device variability in irradiance among different phototherapy devices being used in clinical practice such as Halide spotlights, LED lights and fiber-optic blanket.
DESIGN/METHODS: Data were collected prospectively in the NICU at NYU Langone Medical Center and Bellevue Hospital. Irradiance was measured with an Olympic Bili-meterTM Model 22 both while patients were
on phototherapy, and additional spot check irradiance measurements were made with same equipment when not in clinical use. For overhead lights, 5 body sites, and for Bili-blankets, 3 body sites were measured. All
measuring devices had up to date recalibrations. Data were analyzed using student t-tests to compare mean irradiance between the different devices. A p<0.05 was considered significant.
RESULTS: Total of 149 measurements were taken from 24 subjects undergoing phototherapy. Approximately 20% of live-time measurements fell below 9 uW/cm2/nm, although the mean irradiance of all devices
reached the minimum standard irradiance guidelines. Irradiance mean for LED lights was 9.9 +/-3.1 (n=65), for Halide spotlights was 28.9 +/-8.5(n=43), and for Bili blankets was 18.3 +/-10.9 (n=15). The irradiance
mean measurement for combined LED and Halide spotlight was 29.1 +/-6.5 (n=26). The p-value for inter-device variability of irradiance was found to be <0.001. Intra device irradiance mean range when devices were
not in use for Halide spotlight was 25.3 +/-7.6 (n=10), for LED lights was 13.2 +/-3.6 (n=7) and for Bili blankets was 37.8 +/-15.2 (n=5).
CONCLUSIONS: We found inter and intra device variability among different devices used for phototherapy in our NICU. LED delivered the least amount of irradiance. Halide spotlight consistently delivered the highest
irradiance. Addition of LED with Halide spotlight added minimal increased irradiance.
2016 Eastern SPR Annual Meeting
Abstract Number: 1160
Filename: 753908
Publication Number: 464
Presenting Author: David L. Schutzman, MD
Department/Institution/Address: Pediatrics, Einstein Medical Center Philadelphia, 5501 Old York Rd., Philadelphia, PA, 19141, United States
Phone: 215-456-6698
Fax: 215-456-6769
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: Identification of Hemolysis in the Well-Baby Nursery
David L. Schutzman1. 1Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, PA.
BACKGROUND: Risk of hemolysis, limited by reliance on DAT+ status, modifies management decisions regarding discharge screening for hyperbilirubinemia. End tidal breath carbon monoxide (CO) levels corrected
for inhaled CO (ETCOc) offers a more direct measure of bilirubin load due to hemolysis.
OBJECTIVE: To correlate ETCOc ranges adjusted for risk of hyperbilirubinemia in the well-baby nursery.
DESIGN/METHODS: 116 healthy infants, predominantly African American (59%), from the well-baby nursery were studied beginning at greater than 6 hrs. of age daily during their birth hospitalization. ETCOc was
measured with the CoSense, (Capnia, CA) device (precision ±0.1 ppm). Serum bilirubins (TB) were measured at the time of newborn metabolic screening. ETCOc values were stratified by postnatal age (PA) epochs.
Hyperbilirubinemia risk was determined by plotting TB on the Bhutani nomogram.
RESULTS: ETCOc stratification by PA epochs (0-24, 24-48, 48-72, >72 hrs.) were (2.0, 2.1, 1.5-2.4), (1.9, 1.9, 1-6-2.1), (1.8,1.7, 1.5-2.2) and (1.8, 1.9, 1.4-2.0 [mean, median, interquartile range]). Risk due to
hemolysis as detected by ETCOc was independent of risk due to hour specific bilirubin level (*chi2=11.5, p=0.25: re-run).
Risk on TB Nomogram
ETCOc <1.0
1.0≤ ETCOc ≤1.5
1.5< ETCOc <2.5
ETCOc ≥2.5
ETCOc (ppm; mean ± S.D.)
TB < 40th %tile (n=57, 49%)
1 (2%)
22 (38%)
29 (51%)
5 ( 9%)
0 (0%)
7 (20%)
22 (65%)
5 (15%)
0 (0%)
6 (29%)
11 (52%)
4 (19%)
0 (0%)
0 (0%)
2 (50%)
2 (50%)
(ETCOc: 1.7; 1.4-2.0)
TB=40-75th %tile(n=34,29%)
(ETCOc: 1.9; 1.6-2.3)
TB>75≤95th %tile (n=21,9%)
(ETCOc: 1.9; 1.5-2.3)
TB>95th %tile (n=4, 3%)
(ETCOc; 2.7; 2.3-3.0)
TB>75th %tile (n=25/116,22%)
6/25 (17%)
19/25 (76%)*
CONCLUSIONS: Although ETCOc stratification by PA epochs is similar to data presented by Srinivas, the risk due strictly to hemolysis is quite different from that presented by Bhutani et al (J Perinatol 2014). This
may have been due to a more rapid maturation of UGT or other bilirubin carrier proteins in our cohort. This may be caused by differences in enzyme activity among various ethnic groups, as African American infants
are known to be at lower risk for significant hyperbilirubinemia during the immediate period after birth. This research was supported in part by a grant from the Lucille Packard Foundation.
2016 Eastern SPR Annual Meeting
Abstract Number: 955
Filename: 751323
Publication Number: 465
Presenting Author: Neera Prakash, MD
Department/Institution/Address: 101 Nicolls Rd, Stony Brook, NY, 11794, United States
Phone: 631-444-7653
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: Reducing Painful Procedures in Late Preterm Infants By Using Umbilical Cord Blood as Alternative to Admission Complete Blood Count
Neera Prakash1 and Echezona Maduekwe1. 1Pediatrics, Stony Brook University, Stony Brook.
BACKGROUND: The long term consequences of early, repeated painful experiences in neonates caused by needle insertions and punctures have been established by physiologic studies. We hypothesize that the
number of painful procedures in late preterm infants with no perinatal exposure to chorioamnionitis (presumed sepsis) can be reduced by using umbilical cord blood as an alternative to admission complete blood count
(CBC).
OBJECTIVE: To evaluate if umbilical cord blood can be used as an alternative to CBC drawn at the time of NICU admission in late preterm infants with no presumed sepsis.
DESIGN/METHODS: We conducted an IRB approved, prospective study in which CBC was performed on 96 paired umbilical cord and admission blood samples from late preterm infants with no presumed sepsis.
Sampling occurred from September 2014 to November 2015. Umbilical cord blood was obtained in the delivery room within 10 minutes of delivering the placenta, and admission CBCs within one hour of age. The
primary outcome measure was how closely related were the umbilical cord white blood cell count (WBC), hematocrit (Hct) and platelet (Plt) to the admission CBC. Data analysis was done using paired t-test, one way
analysis of variance (ANOVA) and Pearson's correlation coefficient.
RESULTS: Of the 96 patients recruited in the study, 48% were female, 55% were delivered via cesarean section. Fifty percent were Caucasians, 36% Hispanic, 10% African-American, and 4% Asians. The mean
difference between the cord WBC and admission WBC was -2.65 (SD of 3.73); Hct was -2.42 (SD of 5.28); and Plt was 9.27 (SD of 67.5.) Umbilical cord and admission WBC, Hct, and Plt counts are all significantly
(P<0.001) correlated with paired neonatal samples (R=0.63, 0.68, 0.74.) No difference was noted if cord blood was from the umbilical vein or artery, and no difference was noted if admission CBC was from the
capillary or artery.
CONCLUSIONS: Umbilical cord blood can be used for admission CBC taken within the first hour of life in late preterm infants with no presumed sepsis. Eliminating the admission CBC will decrease the number of
painful procedures on these infants. Future studies will need to focus on babies with presumed sepsis.
2016 Eastern SPR Annual Meeting
Abstract Number: 3518
Filename: 753654
Publication Number: 466
Presenting Author: Eric M. Ly, MD
Department/Institution/Address: Neonatology, University of Maryland, 110 South Paca Street, 8th floor, Baltimore, MD, 21201, United States
Phone: 410-328-6003
Fax: 410-328-1076
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: Bilirubin Inhibition of L1 Cell Adhesion Molecule (L1) Activation of ERK1/2
Eric M. Ly1, Gail Cameron1, Ningfeng Tang1, Min He1 and Cynthia F. Bearer1. 1Neonatology, University of Maryland School of Medicine, Baltimore, MD.
BACKGROUND: Bilirubin in preterm babies frequently casues developmental disability. Free bilirubin (Bf) is thought to be the neurotoxicant. Although phototherapy decreases bilirubin concentrations, it may increase
mortality in infants < 750 g. Bf binds to phospholipids in cell membranes. These phospholipids exist in either liquid-ordered domains (lipid rafts), or liquid-disordered domains (non-lipid rafts). L1 cell adhesion molecule
(L1), a protein critical to development of the central nervous system, depends on signal transduction through extracellular signal-regulated kinase 1/2 (ERK1/2). Lipid raft disruption inhibits L1-mediated ERK1/2
phosphorylation. Our hypothesis is that Bf inhibits these L1-mediated functions by disrupting lipid rafts.
OBJECTIVE: To determine if a physiologic concentration of Bf inhibits L1 activation of ERK1/2 in cerebellar granule neurons (CGN).
DESIGN/METHODS: Solutions containing 0, 2, 10, 50 µM of bilirubin in 100 µM human serum albumin (HSA) were prepared in media. The Bf concentrations were determined by peroxidase assay. CGN were grown
on PLL overnight, then the media was replaced with bilirubin containing media. After 1 h, L1 was activated. CGN were harvested 10 min later. Phosphorylated ERK1/2 (pERK) was determined by immunoblot. Blots
were stripped and reblotted for total ERK1/2. Blots were quantified by photodensitometry. The ratio of pERK to total ERK was calculated and normalized to control. The mean + SEM were then calculated. Significance
was determined by a one-way ANOVA followed by post hoc pairwise comparison.
.
RESULTS: Bf was 38 and 122 nM at 10 and 50 µM total bilirubin. Total bilirubin at 50 µM significantly inhibited L1 mediated phosphorylation of ERK1/2.
CONCLUSIONS: Bf within the range found in preterm infants could potentially disrupt lipid rafts leading to long term cerebellar dysfunction.
2016 Eastern SPR Annual Meeting
Abstract Number: 2173
Filename: 750990
Publication Number: 467
Presenting Author: Richard A. Jack, MD
Department/Institution/Address: Division Of Newborn Medicine, Penn State Hershey Children's Hospital, 500 University Drive, H085, Hershey, PA, 17033, United States
Phone: 7175311588
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: Electrical Grounding Is Associated With Decreased Sympathetic Activity in Preterm Neonates
Richard A. Jack1, Kim K. Doheny1 and Charles Palmer1. 1Division of Newborn Medicine, Penn State Hershey Children's Hospital, Hershey, PA.
BACKGROUND: We have shown that electrical grounding (EG) increases vagal tone in the preterm infant. Adult studies have found that EG reduces sympathetic nervous system activity as measured by skin
conductance (SC), which is a non-invasive measure for sympathetic arousal. We wished to confirm if EG could reduce sympathetic activity in the preterm infant.
OBJECTIVE: To determine if EG lowers sympathetic nervous system activity using the skin conductance measure of electro-dermal responses per second (EDR/s).
DESIGN/METHODS: 15 clinically stable, non–ventilated preterm (34-36 weeks PMA) infants were enrolled in this study.Infants with cardiovascular defects, intracranial abnormalities, or those exposed to opiates in
utero were excluded. Continuous recording of SC was obtained by placing 3 surface electrodes on the infant's foot. The measurement electrode is placed on the plantar surface of the foot and the other two are placed
adjacent to the medial and lateral malleolus. SC is measured as µsiemens. In order to electrically ground the infant, an additional electrode was placed on the infant's chest. This electrode was then connected to a
ground outlet to provide EG when desired. Data was collected in three phases, each lasting 20 minutes. Phase 1(Ph1)= pre-grounded phase, Phase 2(Ph2)= grounded phase and Phase 3 (Ph3)=post grounded
phase. We standardized testing for time of day, environmental stimuli and post-prandial sleep state.
RESULTS: Recordings from the full duration of each phase were analyzed to determine the EDR/s for each phase. The phase results for the 15 patients are depicted as median (IQR) EDR/s. Ph1 0.01(0.002), Ph2
0.003 (0.006) and Ph3 0.001(0.01). The 10 fold decrease in EDR/s between Ph1 and Ph3 was significant p =0.023, Wilcoxon Signed Rank test. The difference between Ph1 and Ph2 showed a trend to lower values
p=0.07.
CONCLUSIONS: These preliminary results suggest that EG contributed to a significant (10 fold) decrease in sympathetic activity in Phase 3. We speculate that the effects of grounding maybe sustained after
grounding is discontinued. Additional subjects are needed to confirm the timing of the grounding effect.