Department of Pediatrics, University of Michigan Medicine

2021 PEDIATRIC RESEARCH SYMPOSIUM - May 11

University of Michigan/Michigan Medicine Department of Pediatrics

Welcome to the MM Department of Pediatrics 'Research Day' highlighting research in pediatric/children's health medicine at the University of Michigan.

Symposium (virtual) Activities:

8-9:00 AM

ANNUAL V. OPIPARI LECTURE (Grand Rounds)

Linda M. McAllister-Lucas, MD/PhD -

Chasing the MALT1 proto-oncoprotein: perspectives on a career in pediatric research.

Join Zoom Meeting: https://umich-health.zoom.us/j/93081397249?pwd=NGs3VTV6dE9qMURHdEhCbmZFQW9hdz09 (Meeting ID: 930 8139 7249 |Passcode: 662976)

12-1:00 PM

VIRTUAL POSTER SESSION: (you are here)

This virtual poster session, which begins at 12:00 Noon, features work by students, residents, fellows, staff, and faculty. The posters/abstracts are numbered and categorized in tracks (basic science, clinical investigation, health services research, and quality improvement, medical education). To attend a virtual poster discussion, click on the 'chat' button during the poster session (12-1pm, May 11). A few posters feature a pre-recorded video presentation. List by author / List by #

1-3:00 PM

PLATFORM/ORAL PRESENTATIONS: (click here for agenda)

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Meeting ID: 932 6295 4069

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More info: https://medicine.umich.edu/dept/pediatrics/research/annual-research-symposium

Filter displayed posters (89 keywords)

AWARD (10) DEI (8) PlatformPresentation(1-3pm) (8) GRpresentation (4) COVID-19 (2) DIPG (2) Health Disparities (2) show more... Adherence (1) Adolescent (1) Adverse Childhood Experiences (1) Adversity (1) Ang-1 (1) Ang-2 (1) Anorexia (1) Asthma (1) Bronchopulmonary Dysplasia (1) CANNABIDIOL (1) CFRT modulators (1) CHD (1) CMV (1) Child Behavior (1) Critical Care (1) Cystic Fibrosis (1) DMG (1) Dendritic cells (1) Developmental Outcomes (1) Differences/Disorders of sex development (1) Eating Disorder (1) Guideline (1) H3K27M (1) Health Economics (1) Hyperoxia (1) ICU (1) ID1 (1) Infectious Diseases (1) Integrated Behavioral Health (1) Kindergarten (1) LCI/MRI (1) Medical Education (1) Microbiome (1) Neonatal Seizures (1) Neonate (1) Nephrotic Syndrome (1) Otitis Media (1) Pediatric oncology (1) Precision medicine (1) Primary Care (1) Racial/Ethnic Disparities (1) Retinopathy of prematurity (1) Rheumatology (1) Sepsis (1) Spirometry (1) Trauma (1) VEGF (1) Vaccine (1) Young adults (1) assay (1) biliblanket (1) bioinformatics (1) biomarker (1) cancer genomics (1) critical care (1) development (1) diagnostics (1) epidemiology (1) glomerulonephropathy (1) hypothalamus (1) immunology (1) informed consent (1) jaundice (1) kidney (1) microbiome (1) minimal change disease (1) mortality (1) nephrology (1) newborn (1) obesity (1) outcomes (1) pediatric oncology (1) placenta (1) proxy decision-making (1) readmission (1) sequencing (1) severe sepsis (1) somatic (1) surgery (1) survey (1) transcriptomics (1) variant (1)

Show Posters: with Video Chat with Recorded Presentation

Tracks

Basic Science (11)

Clinical Investigation (38)

Health Services Research (9)

QI/Medical Education (2)

Quality Improvement (10)

▼ Basic Science Back to top

01: DEVELOPMENT OF A MOUSE MODEL OF HUMAN CORONAVIRUS NL63 (HCOV-NL63) INFECTION

J.K. Bentley, M. Han, C. Stroupe, H. Breckenridge, A. Mello, S. Jazaeris, A. Goldsmith, S.C. Baker, C.N. Lumeng, and M.B. Hershenson

Abstract

INTRODUCTION: The SARS CoV2 pandemic has produced morbidity and mortality worldwide depending on age, body mass index, cardiovascular disease and other factors. Of the human CoVs, SARSCoV2 and HCoV-NL63 bind ACE2. HCoV-NL63 causes upper respiratory tract infections in children, pneumonia in the elderly, and even Kawasaki disease in children. Hypothesis: HCoV-NL63 produces lung inflammation in mice expressing the human ACE2 protein. METHODS: HCoV-NL63 (ATCC) was propagated in Caco-2 cells. Virus cytopathic effect in Vero cells at 48 h infection was determined by TCID50. B6.Cg-Tg(K18-ACE2)2Prlmn mice (JAX Labs) express the human ACE2 protein in epithelial cells using the keratin 18 promoter. Eight-10 week-old K18-hACE2 or C57BL6/J mice were infected with 50 μL (100,000 TCID50) HCoV-NL63 or sham intranasally and euthanized at 2, 4, and 7 days post-treatment. Mouse lungs were assessed for histology, IFN and cytokine mRNAs, ACE2, viral RNA and HCoV-NL63 proteins (nucleoprotein, Nsp3 and Nsp4). Primers from the HCoVNL63 sequence (NC_005831.2) were used to measure vRNA by qPCR. Polyclonal antibodies to Nsp3 and 4 were (Chen et al, J Virol 2007) used with antibodies to human ACE2 (InVitrogen), HCoV-NL63 nucleoprotein (clone 2D5, Eurofins) for immunohistochemistry. RESULTS: HCoV-NL63 cytopathic effects in Vero cells colocalized with viral nucleoprotein. Virus propagated in K18-hACE2 but not C57BL6/J mice. vRNA levels plateaued 4 days after infection and were detectable 7 days after infection. Lung mRNA expression of IFN-α, IFN-β, IFN-λ, CXCL1 and IL-6 were significantly increased 48 h after infection in HCoV-NL63-treated K18-hACE2 but not C57BL6/J mice (N=3, p<0.05, Kruskal-Wallis test). Mouse lung had bronchovascular and peribronchial inflammation evident 7 days after infection. Nucleoprotein was found on the apical surface of airway epithelial cells of HCoV-NL63- but not sham-infected K18-hACE2 mice, and Nsp3 and Nsp4 were found in the basal cytoplasm of airway epithelial cells. CONCLUSION: Human coronavirus NL63 infects K18-ACE2 mice with an airway inflammatory response. Viral replication is evident. This model may be used to study HCoV-NL63-induced exacerbation of allergic airways disease; the effect of allergy, obesity and aging on human coronavirus infection, and possible cross-immunity between HCoVNL63 and other respiratory viruses.

Presented by

John Kelley Bentley

Institution

Dept. of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Dept. of Microbiology and Immunology; Loyola University, Chicago

Keywords

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Available May 11, 2021 12-1:00 PM

Watch Presentation

Chia-Jui Ku,1 Hao Hao Pontius,1 Dante Disharoon,2 David Marr,2 Keith Neeves,2 and Jordan Shavit1

Abstract

Background: Ischemic stroke occurs in 700,000 people yearly in the U.S. Infusion of tissue plasminogen activator (tPA) effects thrombus dissolution and recanalization of occluded vessels, is the only FDA approved treatment, but carries significant risk of hemorrhage. Additional options are needed to reduce the associated risks, especially in small vessel thrombi which account for ~20% of ischemic strokes and are not accessible to catheter-based thrombectomy. We have shown that colloidal microparticles assembled into microwheels (µwheels) using magnetic fields, and functionalized with tPA, enable rapid lysis of fibrin gels in microfluidic models of thrombosis. The zebrafish is a vertebrate with external and transparent development, essentially a living microfluidic model. The conserved coagulation system enables in vivo studies of thrombosis in the context of intact vasculature, coagulation factors, and blood cells. Objectives: Introduce tPA functionalized µwheels into zebrafish to determine whether they can perform targeted recanalization in vivo. Methods: We used laser-mediated endothelial injury in the posterior cardinal vein (PCV) of 3 day old larvae to produce thrombosis, followed by observation for recanalization. Infusion of tPA-coated particles was performed without and with a magnetic field (“tPA-particles” and “tPA-µwheels,” respectively). Results: After induced PCV thrombosis formation, spontaneous recanalization did not occur within 4 hours of observation, nor with infusion of saline or uncoated particles. Infusion of tPA alone resulted in lysis within 189.5 ± 70.6 minutes (n=40) and was 232.2 ± 31.3 minutes (n=16) for tPA-particles without application of the magnetic field. When a magnetic field was applied to particles or tPA-particles, only tPA-µwheels were able to recanalize, in 11.8 ± 5.4 minutes (n=15). tPA has been shown to have other roles in addition to plasminogen activation. To confirm the underlying mechanism, we evaluated tPA-µwheels in plasminogen (plg) knockout fish. We found that using tPA-µwheels, 90% of plg-/- mutants (n=20) were unable to be recanalized, but conversely 94% and 86% of wild-type (n=18) and heterozygous (n=43) siblings, respectively, recanalized within 30 minutes. Conclusions: Our data show that magnetically powered µwheels as a targeted tPA delivery system are dramatically more efficient at effecting plasmin-mediated thrombolysis than systemic delivery. Further development of this system with fish and mammalian models could enable a less invasive strategy for alleviating stroke that is safer than directed thrombectomy or systemic infusion of tPA.

Presented by

Hao Hao Pontius

Institution

1Department of Pediatrics, University of Michigan, Ann Arbor, MI 2Colorado School of Mines, Golden, CO

Keywords

AWARD, PlatformPresentation(1-3pm)

Jack Wadden1,2, Brandon Newell1, Josh Bugbee1, Robert Dickson3, Carl Koschmann4, David Blaauw2, Satish Narayanasamy1, Reetuparna Das1

Abstract

Background: Pediatric diffuse intrinsic pontine gliomas (DIPGs) and high-grade gliomas (HGG) with the H3K27M histone mutation portend an especially poor prognosis. Identification of these mutations typically takes days to weeks and is rarely available before it can inform initial treatment. Detection of these mutations immediately during biopsy or resection (<1hr) could help inform surgical decision-making, and also enable immediate and proper enrollment into promising targeted clinical trials. No prior work has demonstrated a sequencing-based molecular diagnostic within 1hr. Objectives: Develop strategies for design of ultra-rapid sequencing-based diagnostics and demonstrate H3K27M hotspot mutation confirmation from tumor tissue within 1hr. Methods: PCR and Loop-mediated Isothermal Amplification (LAMP) assays targeting HIST1H3B and H3F3A K27M were designed and used to amplify target regions of DNA extracted from patient tumor. PCR and LAMP product was then sequenced using Oxford Nanopore Technologies (ONT) MinION sequencer, and a rapid library preparation approach. Rapid library preparation and rapid DNA extraction kit parameters were optimized for time with acceptable efficiency loss. An analytical model of ONT sequencer performance was developed to estimate time-to-diagnostic-result based on assay amplification time and efficiency. Amplification efficiency was experimentally evaluated and coupled with the model to predict time-optimal assay parameters. A custom LAMP-specific bioinformatics tool was developed to analyze complex LAMP concatemer product, and call somatic variants. The tool was augmented to also leverage redundant information in LAMP concatemer segments to correct sequencing errors via plurality vote. Results: Time-optimal PCR- and LAMP-based assay parameters were identified and a timed assays were performed on aliquots of DIPG tumor tissue. H3K27M mutations from two different patients were able to be confirmed within 52 minutes (PCR) and 29 minutes (LAMP). Conclusions: Our results demonstrate that using our protocol optimization methodology, sequencing-based molecular diagnostics can be designed and performed within the intra-operative time-frame and should be considered for clinical use.

Presented by

Jack Wadden

Institution

1Department of Computer Science and Engineering, 2Department of Electrical Engineering and Computer Science, Michigan Engineering, Ann Arbor, MI 48109 3Department of Pulmonology, 4Department of Pediatrics, Michigan Medicine, Ann Arbor, MI 48109

Keywords

DIPG, DMG, H3K27M, diagnostics, sequencing, bioinformatics, assay, somatic, variant

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Available MAY 11, 2021 12-1:00 PM

▼ Clinical Investigation Back to top

11: RETHINKING THE RETINOPATHY OF PREMATURITY EXAMINATION: QUANTITATIVE ANALYSIS OF VEGF IN INFANT TEARS AS A BIOMARKER

J. Magnani1; O. Moinuddin2; M. Pawar2; S. Sathrasala3; C. Besirli2; R. Vartanian1

Abstract

Background: Retinopathy of prematurity (ROP) is a developmental vasoproliferative disorder in premature infants due to hypoxic-anoxic injury and incomplete vascularization of the retina. Infants born <30 weeks gestation or with a birth weight <1500 grams (g) are routinely screened for ROP by an ophthalmologist. Infants requiring treatment receive either retinal ablative therapy or intravitreal injection with Anti-Vascular Endothelial Growth Factor (Anti-VEGF) agents. VEGF is a key signaling protein in the vasoproliferative phase of ROP. Higher levels of VEGF were found in the vitreous and subretinal fluids of infants with congenital cataracts and retinal detachment from causes other than ROP. Tear VEGF has not previously been analyzed in neonates with ROP. Methods: Tear and saliva samples were collected from 20 infants born <28 weeks gestation or with a birth weight <900 g. Tear samples were collected using Schirmer strips placed in both eyes for 5 minutes. Saliva samples, which act as a surrogate for systemic VEGF, were collected using Sarstedt Salivette cotton swabs placed in the infant’s mouth for 3 minutes. Samples were diluted and analyzed with the Simple PlexTM EllaTM microfluidic platform using detection antibodies directed against VEGF. Results: There was a female predominance (n=12, 60%) and the study population was Caucasian (n=13, 65%), African American (n=5, 25%), and Asian (n=2, 10%). Infants with ROP requiring treatment (n=4, 25 6/7 weeks, 659 g), ROP not requiring treatment (n=5, 25 3/7 weeks, 786 g), and infants without ROP (n=9, 26 2/7 weeks, 909 g) did not differ significantly with respect to gestational age or birth weight. Two infants died prior to developing ROP. An increase in tear to saliva VEGF (>1.8) between 31-33 weeks and 37-39 weeks gestation was found in infants without ROP and with ROP not requiring treatment but was persistently low (<1.8) in infants with ROP requiring treatment. Overall mean tear/saliva VEGF ratio in infants with ROP not requiring treatment (2.04) was significantly higher than in infants with ROP requiring treatment (0.85, p=0.01). Conclusions: Adequate tear and saliva samples can be safely obtained from premature infants for analysis of VEGF. Infants with ROP requiring treatment have no increase in tear to saliva VEGF levels except following laser treatment. VEGF analysis may be an effective adjunct to ophthalmologic examination or may serve as a surrogate for ophthalmologic examination in resource-poor areas.

Presented by

Jessie Magnani

Institution

1 Neonatology, University of Michigan, Ann Arbor, MI. 2 Ophthalmology, University of Michigan, Ann Arbor, MI. 3 University of Michigan, Ann Arbor, MI.

Keywords

Retinopathy of prematurity, VEGF, Ang-1, Ang-2, Neonate

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Available May 11, 2021 12-1:00 PM

12: ASTHMA IS ASSOCIATED WITH AN INCREASED RISK OF POOR OUTCOMES IN HOSPITALIZED PATIENTS WITH COVID-19

Amy Ludwig MD1,2, Caryn Brehm MD3, Christopher Fung MD4, Shijing Jia MD3, Jonathan P. Troost PhD5, Laura Leuenberger MD1, Rayan Kaakati MD1, Catherine Tarantine MD1, Ella Christoph MD1, Michael W. Sjoding MD3, Njira Lugogo MD3

Abstract

Introduction Several chronic conditions have been associated with higher risk of severe coronavirus disease 2019 (COVID-19), including asthma. However, there are conflicting conclusions regarding risk of severe disease in this population. We seek to understand the association between asthma severity and phenotypes with outcomes of COVID-19. Methods We identified hospitalized COVID-19 patients with (n=183) and without asthma (n=1319) using ICD-10 codes with confirmatory PCR testing between March 1 – December 30, 2020. We determined asthma maintenance medications, pulmonary function tests (PFTs), highest historical absolute eosinophil count and IgE. Primary outcomes included an ordinal outcome of discharged alive, ongoing care, mechanical ventilation and/or ICU care, or death at 28 days. Secondary outcomes included level of oxygen support, intensive care unit (ICU) admission, ICU and hospital length of stay (LOS). Results Asthma patients were at higher risk of having a worse status at 28 days (aOR 1.70, 95% CI 1.13 – 2.55, p<0.001), more likely to require mechanical ventilation (aOR 1.54 95% CI 1.01 – 2.37, p=0.04) and ICU admission (aOR 1.61 95% 1.12-2.32, p=0.01), have longer hospital and ICU LOS, and had higher mortality (HR 1.51, 95% CI 1.00 – 2.30, p=0.05) compared to the non-asthma cohort. Asthma severity, ICS use, and eosinophilic phenotype did not significantly affect outcomes. Patients admitted later in the pandemic (June 15 – December 30) had significantly better outcomes compared to those admitted earlier across all outcomes examined. Conclusions Asthma was associated with severe COVID-19 after controlling for comorbidities, smoking status, and timing of illness in the pandemic.

Presented by

Amy Ludwig

Institution

1. Department of Internal Medicine, University of Michigan, Ann Arbor MI, USA 2. Department of Pediatrics, University of Michigan, Ann Arbor MI, USA 3. Division of Pulmonary and Critical Care Medicine. Department of Medicine, University of Michigan, Ann Arbor MI, USA 4. Department of Emergency Medicine, University of Michigan, Ann Arbor MI, USA 5. Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor MI, USA

Keywords

AWARD, GRpresentation

13: INCREASED INTERLEUKIN-8 LEVELS AND INTERLEUKIN-1 RECEPTOR ANTAGONIST ARE ASSOCIATED WITH ORGAN SYSTEM FAILURES IN CRITICALLY ILL CHILDREN

Silvia Ardila1, Mary K. Dahmer1, Heidi M. Weeks1, Michael W. Quasney1, Anil Sapru2, Martha A.Q. Curley3, Heidi Flori1

Abstract

Background: Interleukin-8 (IL-8) is a key neutrophil chemokine and IL-1 receptor antagonist (IL-1ra) blocks the pro-inflammatory cytokine interleukin-1β. Both biomarkers have been associated with poor clinical outcomes in adults and children with acute respiratory distress syndrome (ARDS). IL-8 has been associated with increased risk of multiple organ failures in adults.

Methods: We tested the association between the number of extrapulmonary organ system failures (OSFs) and levels of IL-8 and IL-1ra in children enrolled in the Genetic Variation and Biomarkers in Acute Lung Injury (BALI, R01HL095410) study, an ancillary study to the RESTORE clinical trial (U01HL086622). We hypothesized that there would be an association between elevated levels of both biomarkers and increased number of OSFs. Children with IL-8 or IL-1ra values on days 0-5 (day 0 is the day of intubation) were included in the analyses. Plasma IL-8 and IL-1ra were assayed by ELISA. Biomarker data was log transformed. Association of biomarker levels with OSFs was analyzed on days 1-4 with organ failure stratified into 0, 1, 2 and 3 or more OSFs. Univariate analysis significance was determined using the Kruskal-Wallis test. Multivariable logistic regression was adjusted for age, sepsis, race/ethnicity and severity of oxygenation defect (as measured by oxygenation index and/or oxygenation saturation index levels).

Results: 432 patients were included in the analysis. Univariate analysis indicated that increasing levels of IL-8 were associated with increasing number of OSFs on days 0-4 (p<0.05). Increasing levels of plasma IL-1ra were associated with increasing number of OSFs (1, 2 and 3 or more) on days 1-4 (p<0.05). Multivariable analyses also showed that increasing IL-8 was independently associated with increasing numbers of OSFs on days 1-4 (p<0.05) as compared to no OSFs. Multivariable analyses showed that increasing IL-1ra levels were independently associated with increased odds of 1 OSF on days 1 and 2 (p<0.05), 2 OSFs on day 2 (p=0.01), and 2 or more OSFs on days 1-4 (p<0.01) as compared to no OSFs.

Conclusions: Plasma IL-8 and IL-1ra levels are increased in pediatric patients with increasing number of OSFs on days 1-4 after acute respiratory failure. These biomarkers may be useful, if measured early and serially in the course of acute respiratory failure, in evaluating the severity of multiple organ dysfunction syndrome in critically ill children. These data also indicate the potential for targeted anti-inflammatory treatment in these patients.

Presented by

Silvia Ardila

Institution

1University of Michigan, Ann Arbor, MI; 2University of California, Los Angeles, CA; 3University of Pennsylvania, Philadelphia, PA.

Keywords

14: CLINICAL CHARACTERISTICS, TREATMENT PATTERNS AND OUTCOMES OF CHILDREN AND ADULTS WITH BIOPSY PROVEN MINIMAL CHANGE DISEASE FROM THE CURE GLOMERULONEPHROPATHY NETWORK STUDY (CureGN)

J.Balk, V.Kurtz, D.Gipson

Abstract

Background: Minimal change disease (MCD) is a common cause of primary nephrotic syndrome. The objective of this study was to evaluate differences in treatment outcomes and therapy between children, adolescents and adults with MCD. Methods: CureGN observational cohort study data from 551 participants with MCD were analyzed. Results: Adolescents and adults have time from onset to biopsy, eGFR at biopsy, and minimal pre-biopsy immunosuppression which are distinct from children (P<0.001, Table 1). Children were more likely to have frequently relapsing/steroid dependent disease than adolescents or adults (57% vs. 18% and 29%, p-value <0.0001). In longitudinal analysis, kidney function was stable in children and adolescents, but declined in adults (eGFR in ml/min/1.73m2: approximate values of 110 to 109 in children, 96 in adolescents, 85 to 78 in adults). Conclusions: We observed that the clinical practice patterns were similar in adolescents and adults with prompt biopsy following onset, delay of immunosuppression pending biopsy results, and kidney function at presentation. Over time, the stability of kidney function observed in children was also present in adolescents. (Table 2: Clinical characteristics and therapy at disease onset.)

Presented by

Julie Balk

Institution

Pediatric Nephrology, University of Michigan - On Behalf of the CureGN Consortium

Keywords

minimal change disease, glomerulonephropathy

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Available May 11, 2021 12-1:00 PM

15: A SURVEY OF CAMP LEADERSHIP TO ASSESS IMMUNIZATION REQUIREMENTS, POLICIES AND PRACTICES IN A NATIONAL COHORT OF SUMMER CAMPS

C Bunke, N Schellpfeffer, B Garst, S Bradin, M, Tracey Gaslin, A Dubin, M Ambrose, AN Hashikawa

Abstract

Background: 14 million children attend summer camps yearly. While the American Academy of Pediatrics (AAP) recommends all campers and staff receive vaccinations, camp leaderships’ immunization practices and perspectives have not been well characterized. Our study objective was to assess the current state of summer camps’ immunization requirements, policies, and practices by surveying a national cohort of camp leadership. Methods: We partnered with CampDoc.com, an online camp electronic health record system and the Association of Camp Nursing to conduct a 20-question online survey of camp leadership regarding current immunization requirements, policies and beliefs. One response was chosen from each camp by predetermined criteria. Results were analyzed using descriptive statistics, with multivariate logistic regression models applied to examine associations between camps having a written immunization policy and camp leadership responses and variables. Results: A total of 710 of 881 respondents, representing a total of 378 individual summer camps, reported being qualified to answer the survey, of which 343 individual camps had answered the survey in its entirety. Survey respondents were directors (44%, n=164), nurses (26%, n=98), office staff (16%,n=60), physicians (3%, n=13), owners (2%, n=8), emergency medical technicians (1%, n=3) and other (8%, n=32). Table 1 illustrates the percentage of camps that required various immunizations. The majority of leadership (92% n=316) agreed that vaccines reduce risk of disease; 80% (n=276) responded that campers should be fully immunized prior to attending camp. Despite this belief, only 50% (n=174) of camps had an immunization policy requiring camper immunizations and 39% (n=133) for staff; 54% (n=181) allowed unvaccinated children with non-medical exemptions to attend camp; 3% (n=10) of camps had experienced an outbreak of a vaccine-preventable illness and 14% (n=47) were warned of a potential exposure within the county in the past two years; 20% (n=68) responded that camps might lose a significant number of campers by requiring immunizations. Stepwise logistic regression analysis (Table 2) indicated camps were more likely to report having a policy requiring immunization for campers if leadership believed all campers should be immunized (adjusted odds ratio [aOR]= 3.1 95% confidence interval [CI]: 1.5-6.2) or if camps were located in states requiring immunization documentation (aOR=4.86; 95% CI: 2.9-8.0), but were less likely to have a policy when accepting non-medical immunization waivers (aOR = 0.27; 95% CI: 0.1-0.4). Conclusions: Despite AAP recommendations, a substantial proportion of leadership reported not having summer camp immunization policies that required camper immunizations. Policy-makers and camp health stakeholders should advocate for state policies that require camps to have documentation of campers’ immunizations status. Pediatricians should partner with camp leadership to develop camps’ immunization policies that are fully aligned with AAP guidelines to ensure the optimal well-being of all children in summer camps.

Presented by

Carissa Bunke

Institution

University of Michigan

Keywords

16: SERIAL PLASMA AND CSF CELL-FREE TUMOR DNA (CF-TDNA) TRACKING IN DIFFUSE MIDLINE GLIOMA PATIENTS UNDERGOING TREATMENT WITH ONC201

E Cantor1, K Wierzbicki1, RS Tarapore2, K Ravi1, C Thomas1, R Cartaxo1, VN Yadav1, R Ravindran1, AK Bruzek1, J Wadden1, CM Babila1, AR Kawakibi1, S Ji1, J Ramos1, A Paul1, I Wolfe1, M Leonard1, P Robertson1, A Franson1, R Mody1, H Garton1, Y Odia3, C Kline4, NA Vitanza5, S Khatua7, S Mueller6, JE Allen2, S Gardner8, C Koschmann1

Abstract

Background: Diffuse midline glioma (DMG) with the H3K27M mutation is a lethal childhood brain cancer, with patients rarely surviving 2 years from diagnosis. Methods: We conducted a multi-site Phase 1 trial of the imipridone ONC201 for children with H3K27M-mutant glioma (NCT03416530). Patients enrolled on Arm D of the trial (n=24) underwent serial lumbar puncture (baseline, 2 and 6 months) for cell-free tumor DNA (cf-tDNA) analysis at time of MRI. We also collected a total of 96 plasma samples and 53 CSF samples from 29 patients, including those with H3F3A (H3.3) (n=13), HIST13HB (H3.1) (n= 4), and unknown H3 status/not biopsied (n=12) [range of 0-8 CSF samples and 0-10 plasma samples]. We performed digital droplet polymerase chain reaction (ddPCR) analysis and/or amplicon-based electronic sequencing (Oxford Nanopore) of cf-tDNA samples and compared variant allele fraction (VAF) to radiographic change (maximal 2D tumor area on MRI). Results: Preliminary analysis of samples (n=58) demonstrates a correlation between changes in tumor size and H3K27M cf-tDNA VAF, when removing samples with concurrent bevacizumab. Analysis of remaining CSF and plasma samples is ongoing, including analysis of novel biomarkers of response. In multiple cases, early reduction in CSF cf-tDNA predicts long-term clinical response (>1 year) to ONC201 and does not increase in cases of later-defined pseudo-progression (radiation necrosis). For example, a patient with thalamic H3K27M-mutant DMG treated with ONC201 after radiation developed an increase in tumor size at 4 months (124% baseline) of unclear etiology at the time. Meanwhile, her ddPCR declined from baseline 6.76% VAF to <1%, which has persisted, with now near complete response (85% tumor reduction) at 30 months on treatment from diagnosis. Conclusion: We present the feasibility and utility of serial CSF/plasma monitoring of a promising experimental therapy for DMG.

Presented by

Evan Cantor

Institution

1Michigan Medicine, Ann Arbor, MI 2Chimerix, Durham, NC 3Miami Cancer Institute, Baptist Health South Florida, Miami, FL 4Children’s Hospital of Philadelphia, Philadelphia, PA 5Seattle Children’s Hospital, Seattle, WA 6University of California San Francisco, San Francisco, CA 7University of Texas MD Anderson Cancer Center, Houston, TX 8NYU Langone Health, New York, NY

Keywords

17: ASSOCIATION BETWEEN NUMBER OF ADVERSE CHILDHOOD EXPERIENCES, ACADEMIC ACHIEVEMENT, AND EMOTION REGULATION AT KINDERGARTEN IN A NATIONALLY REPRESENTATIVE SAMPLE

K. Chan-Zlatopolsky1, H. Weeks2, N. Kaciroti3, P. Shah1,4

Abstract

Background: A history of Adverse Childhood Experiences (ACEs) has been associated with numerous negative educational, medical, behavioral and psychosocial outcomes in school age-children, adolescents and adults, but the effects of ACEs on early childhood outcomes are relatively understudied. In children in poverty or involvement in the child welfare system, there is a relationship between higher ACEs in early childhood associated with poorer academic skills and increased problematic behaviors at kindergarten age. However, this association has not been examined in a nationally representative sample. Objectives: (1) To examine the association between early childhood ACEs and reading and math academic achievement in kindergarten. (2) To examine the association between early childhood ACES and emotion regulation (effortful control and externalizing behavior) at kindergarten. Methods: Data were obtained from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B). Seven ACE domains were ascertained from the ECLS-B and a cumulative ACE score was generated and dichotomized (ACE= 0-1, ≥2). At kindergarten, standardized assessments of academic achievement were obtained, and a parent behavior questionnaire was used to derive measures of effortful control and externalizing behavior. Multivariate linear regression examined the association between the number of ACEs and measures of kindergarten academic achievement and emotion regulation, adjusting for potential confounders. Results: In a sample of 5900 children, 3650 (61%) had 0 reported ACEs, 1550 (26%) had 1 reported ACE, and 700 (12%) had 2 or more ACEs. In adjusted analyses, compared with children who experienced 0-1 ACEs, a history of ≥2 ACEs was associated with lower effortful control (p< .001) β = -0.183; and higher externalizing behavior (p <.001) β = 0.394. (Figure 1) Conclusion: ACEs are associated with lower effortful control and higher externalizing behaviors in children experiencing ≥2 ACEs.

Presented by

Krystal Chan-Zlatopolsky

Institution

1. Division of Developmental Behavioral Pediatrics, Department of Pediatrics, University of Michigan 2. Department of Nutritional Sciences, School of Public Health, University of Michigan 3. Department of Biostatistics, School of Public of Health, University of Michigan 4. Department of Psychiatry, Medical School, University of Michigan

Keywords

Adversity, Trauma, Child Behavior, Adverse Childhood Experiences, Kindergarten

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Available May 11, 2021 12-1:00 PM

18: PSYCHOLOGICAL FUNCTIONING IN PEDIATRIC PATIENTS WITH SINGLE VENTRICLE CONGENITAL HEART DISEASE: A META-ANALYSIS AND SYSTEMATIC REVIEW

Christine Charpie1, Megan Wilde2, Kate Saylor3, Melissa Cousino2, and Amanda McCormick2

Abstract

Background: Single ventricle (SV) congenital heart disease (CHD) is associated with an increased risk for psychological comorbidities compared to healthy subjects or those with other CHD diagnoses. Psychological functioning is critical to cardiac health. This is the first known meta-analysis and systematic review of the pediatric SV psychological literature. Methods: A literature review was conducted using MEDLINE PubMed/ovid PsycInfo CINAHL Embase Scopus/WOS for full-length, peer-reviewed articles that included patients ages 0 – 25 years with SV CHD, and quantitative measures of patient self- or parent-reported psychological outcomes. Main findings and study quality/risk of bias were summarized in tabular form. Meta-analysis was conducted. Results: The initial search resulted in 1259 manuscripts for consideration. After further review, 30 manuscripts met criteria for inclusion in the study. Overall, most studies were deemed good to fair in study quality; 30% of studies were published in the past 5 years. Study sample sizes ranged from 12-1164 participants. Participant age ranges were vast, ranging from 1 year to young adulthood. In pediatric patients with SV CHD, 28 studies demonstrated risk for internalizing disorders, such as anxiety/depression; 24 studies demonstrated risk for externalizing disorders, such as attention or behavioral problems. Meta-analysis results will be available by conference date. Conclusion: Patients with SV CHD experience high levels of internalizing and externalizing disorders. The current review demonstrates the need for further studies to better understand psychological functioning in patients with SV CHD. This summary of the literature underscore the need for regular psychological screening, earlier intervention, and integrated mental health therapies in pediatric SV CHD.

Presented by

Christine Charpie

Institution

1College of Literature, Science and the Arts, University of Michigan, Ann Arbor, Michigan; 2Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan; 3Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan

Keywords

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Available May 11, 2021 12-1:00 PM

19: MEASLES MUMPS RUBELLA (MMR) VACCINE UPTAKE DURING 2019 MEASLES OUTBREAK IN MICHIGAN

J. Fisher1*; A. Wu1*; E. Yoon1

Abstract

Background: Immunizations have significantly decreased communicable diseases. In recent years, there has been a rise in anti-vaccination sentiments, leading to outbreaks of diseases such as measles. At our institution, the standard recommendation is to administer the first MMR vaccine at 1 year and the second at 4 years. Children can receive doses earlier. A measles outbreak occurred in Michigan from March 13-May 31, 2019; 40 of 46 cases were in Oakland County. MMR vaccine uptake during the 2019 measles outbreak in Michigan has not yet been characterized. Objectives: The purpose of this study is to characterize MMR vaccine uptake during the 2019 outbreak by patients seen at one of our pediatric clinics located near Oakland County and compare this to 2018. Methods: We performed a retrospective electronic medical record review of well, urgent, or vaccine only visits for patients ages 6 months to 5 years, during which the MMR vaccine was ordered. We used the Pearson chi-square to test bivariate comparisons between our outcome variables and categorical independent variables. Results: Table 1 shows comparisons between 2018 and 2019 during the same 2.5 month time-frames, for patients who received MMR vaccines. No patient received the vaccine early in 2018, whereas 17% did in 2019. Similarly, 6% received a catch up dose in 2018 compared to 12% in 2019 (p <0.001). Although not statistically significant, 10% of patients were under vaccinated or unvaccinated (not up to date) in 2018 compared with 16% in 2019. Patient demographics were similar between 2018 and 2019. Conclusions: During the measles outbreak, more patients received early and catch up doses of MMR vaccines compared to the same time frame one year before. There was a positive trend in MMR vaccine uptake during the outbreak among patients who were under vaccinated or unvaccinated, though not statistically significant. This suggests that disease outbreaks may impact vaccine uptake. Additional efforts to promote vaccination and address vaccine hesitancy in patients who are not up to date are needed.

Presented by

Jacqueline Fisher

Institution

1University of Michigan Pediatrics, Ann Arbor, MI *Authors contributed equally

Keywords

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Available May 11, 2021 12-1:00 PM

20: EPIDEMIOLOGY OF HOSPITALIZATIONS FOR ASTHMA IN CHILDREN IN THE UNITED STATES 2006 - 2016

Emily Fretz, MD, Acham Gebremariam, MS, Fola Odetola, MB CHB, MPH

Abstract

Background: Asthma affects 1 in 12 children under the age of 17 years, making it the most common chronic respiratory disease in childhood. Despite recent reports of decreasing prevalence, it is still, however, a leading cause for emergency department visits and child hospitalizations. Objective: To evaluate the trend of overall hospitalizations, associated medical technology use, and outcomes between 2006 and 2016 among children with asthma. Design/Methods: Retrospective study of children 0-20 years old hospitalized for treatment of asthma between 2006 and 2016 using the Kids' Inpatient Database. Descriptive analysis was performed to determine national estimates of the overall count of hospitalizations, patient and hospital characteristics, medical technology use, duration of hospitalization, hospital charges and in-hospital mortality. Results: There were 395,058, 434,924, 397,525, and 330,525 hospitalizations nationally for asthma in 2006, 2009, 2012, and 2016, respectively. Across the years, more males were hospitalized with a bi-modal peak in age distribution at 1-5 years and 16-20 years. The proportion of children with comorbidities and extreme illness severity increased over the years of study, with the majority of hospitalizations occurring at urban teaching hospitals in the South census region, most often among children residing in zip codes with the lowest median household income. Insurance coverage was predominantly via public insurance. Associated with the increase in illness severity over time was a concomitant increase in the deployment of medical technology including central venous catheterization, tracheostomy, invasive and non- invasive mechanical ventilation, continuous renal replacement therapy and extracorporeal membrane oxygenation. Duration of hospitalization was similar across the years of study and mortality remained low at <0.2%. Conclusion: The prevalence of hospitalizations for childhood asthma decreased over the 11-year period of the study; however, there was increase in hospitalizations of children with extreme illness severity and comorbid illness, with concomitant increase in the use of medical technology. This study provides new insight into the characteristics of children hospitalized with asthma over time and the associated patterns of resource use and outcomes.

Presented by

Emily Fretz

Institution

Department of Pediatrics, University of Michigan, Ann Arbor, MI.

Keywords

Asthma, epidemiology, outcomes

21: LACK OF ASSOCIATION BETWEEN DELIRIUM AND UNPLANNED EXTUBATIONS: A CASE-CONTROL STUDY

M. Gabrial1,H. McCaffery2,R. Eikstadt3,M.K. Dahmer1,N. Malas4

Abstract

Background: Unplanned extubations (UE) are associated with significant morbidity and mortality among critically ill patients. Providers may perceive agitation in 30-40% of UE, but no study has explored the potential relationship between delirium and UE in children. The primary aim of this study was to determine whether patients with UE were more likely to screen positive for risk of delirium as compared to other intubated patients. Methods: This was a retrospective, matched, case-control study of patients aged 0-21 years, intubated in the Pediatric Intensive Care Unit (PICU) at C.S. Mott Children’s Hospital between March 1, 2015 and June 30, 2019. Cases were patients with UE, whereas intubated patients without UE were controls. The patients were matched on age, illness severity using the Pediatric Risk of Mortality version III (PRISM III) score, and duration of mechanical ventilation. Risk of delirium, defined by the validated Cornell Assessment for Pediatric Delirium (CAP-D) score ≥ 9, was determined for cases and controls. Other patient factors studied include primary diagnosis and relevant clinical co-morbidities. The association of CAP-D≥9 with unplanned extubations was assessed using a multivariable logistic regression, including the co-variates shown in Table 1. Results: There were no statistically significant differences in frequency of demographic characteristics of cases (n=57) and controls (n=139). In univariate analysis, more controls were intubated for neurological reasons (18%) than seen in cases (3.5%; p=0.015), while more cases had a difficult airway diagnosis (24.6%) than controls (11.5%; p=0.037). In the multivariable model, screening positive for risk of delirium (CAP-D score≥9) was not associated with UE (Table 1). Conclusions: There was no association between screening positive for delirium (CAP-D≥9) and having an unplanned extubation.

Presented by

Mariam Gabrial

Institution

1Division of Critical Care, 2Biostatistics and Data Management Unit, 3Division of Nephrology, Department of Pediatrics, University of Michigan, 4Department of Psychiatry, University of Michigan.

Keywords

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Available May 11, 2021 12:30-1:00 PM

22: PRECISION MEDICINE PROOF OF CONCEPT FOR TNF INHIBITION IN FSGS AND TREATMENT RESISTANT MINIMAL CHANGE DISEASE

D. Gipson1, L. Mariani2, W. Ju2, S. Eddy2, H. Desmond1, V. Kurtz1, R. Eikstadt1, C. Klida1, M. Kretzler2, H. Trachtman3

Abstract

Background: Advances in systems biology have demonstrated that idiopathic focal segmental glomerulosclerosis (FSGS) is a heterogeneous disease caused by disturbances in a variety of injury pathways that lead to podocyte loss and glomerulosclerosis. In previous work, the NEPTUNE study group has demonstrated that nearly 20% of children and adults with FSGS have evidence of a gene expression profile that is best explained by TNF as the upstream regulator. Genes encoding TIMP-1 (TIMP1) and MCP-1 (CCL2) are part this gene group. These patients have poor outcomes, namely, lower eGFR at onset, decreased likelihood to achieve remission of proteinuria, and more rapid kidney function loss. Increased urinary excretion of TIMP-1 and MCP-1 provides a non-invasive biomarker of patients with the TNF activation signature. Objective: To determine whether short-term treatment with adalimumab, a monoclonal antibody to TNF, can reverse the abnormal biomarker profile indicative of TNF activation in patients with FSGS or treatment resistant-minimal change disease (TR-MCD). Design/Methods: This is an open label clinical trial with biomarker enrichment strategy—NCT04009668. Patients with primary FSGS or TR-MCD are pre-screened for evidence of the TNF activation profile, namely increased urinary excretion of TIMP-1 and MCP-1. Patients meeting pre-specified biomarker profile thresholds are consented to the interventional protocol in which they receive five doses of adalimumab, 20 mg if weight less than 30 kg, 40 mg if weight 30 kg or more, administered subcutaneously q 14 days. The primary endpoint is change in urinary biomarker profile at week 10, 2 weeks after the final dose of adalimumab. Secondary outcomes are safety and changes in eGFR and proteinuria. Results: As of abstract submission, 13 patients have been prescreened and 8 (62%) have demonstrated the abnormal biomarker indicative of TNF activation and one participant has commenced study therapy. Conclusions: This pilot study is the first to test the feasibility of multicenter precision-based trials for the treatment of FSGS and MCD. Using a non-invasive biomarker panel of intra-renal TNF activation, the trial has identified a greater proportion of biomarker-eligible participants than predicted, to date. This ongoing trial uses a clinical trial platform that may be used for additional precision medicine trials relevant for FSGS, MCD and other proteinuric kidney diseases.

Presented by

Debbie Gipson; Hailey Desmond

Institution

1Department of Pediatrics-Nephrology, University of Michigan 2Department of Internal Medicine-Nephrology, University of Michigan 3Department of Pediatrics-Nephrology, New York University-Langone

Keywords

Precision medicine, kidney, nephrology, biomarker

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Available May 11, 2021 12-1:00 PM

23: PARENTAL DECISION-MAKING IN PEDIATRICS: HEALTHCARE PROVIDERS’ PERSPECTIVES & ROLES

L. Gruppen1; M. Carley2; M.D. Gardner1; D. Stacey2; K.I. Suorsa-Johnson1; D.E. Sandberg1

Abstract

Background. Shared decision-making (SDM) is a standard of care in many clinical management discussions. SDM focuses on knowledge and values, but ignores the social context of decision-making and the influence this has on decisions. This gap is problematic in pediatrics, where patients’ interests are represented by proxies. Objective. Examine clinicians’ understanding and observations of issues facing proxy decision-makers in pediatric differences of sex development (DSD). Design/Method. A survey assessed clinicians’ perceptions of decisional needs for parents of infants and young children with DSD. Domains included: Common DSD decisions, Manifestations of parents’ decisional needs, and Resources and approaches to support parental decision-making. The survey was sent to an expert and diverse group of 31 individuals active in this field; 28 (90%) responded. Results and Conclusions. All participants reported parents experience decisional conflict, eg, feeling unsure, worrying about what could go wrong, and fearing choosing “wrong” irreversible choices. Most (>80%) reported parents experience strong emotions that interfere with decision-making. The majority identified decision-making barriers, eg, inadequate parental knowledge (>60%) and information overload (>90%). Participants rated three factors as “very” important: parents having information on benefits, harms, and other features of options (93%), having information about all the available options (89%), and having access to clinicians to discuss the decision (86%). Although having a clear understanding about what features of options are important (ie, parental values) is an essential element of SDM, it was not rated as highly (very, 54%; somewhat, 46%). Having access to patient decision aids was not rated highly (very, 39%; somewhat, 54%; a little, 7%). The majority (59-100%) endorsed using a variety of approaches to support parents making decisions, with >94% endorsement of 11 of the 14 approaches listed (eg, gauging receptivity, 100%; verifying understanding, 100%; inquiring about values, 100%; clarifying the decision, 95%; describing benefits and harms, 94%). Less endorsed items included screening for potential difficulties with implementing the chosen option (88%), providing written information (75%), and making recommendations (59%). Responses reflect clinician perspectives of parental decision concerns and therefore identify attitudes among clinicians that need to be considered in efforts to promote better SDM. Next steps include evaluating parent perspectives of clinical management decision-making.

Presented by

Larry Gruppen

Institution

1University of Michigan; 2University of Ottawa.

Keywords

24: RESPIRATORY FAILURE AND SHOCK IN A 7-MONTH-OLD BOY

Atchison C1,2, Holleran E1, Garcia A1, Chang YK1, Rappaport, L1

Abstract

PRESENTATION: A 7-month-old, unimmunized male infant with hypotonia and suspected motor delay presents to the emergency department with one-day history of nasal congestion and increased fussiness. Physical exam reveals a lethargic infant in severe respiratory distress, hepatomegaly, and poor perfusion. Venous blood gas collected on presentation reveals a pH of 6.89, pCO2 of 25, and a lactate of 14, with a bicarbonate of <10. He is intubated and epinephrine infusion is initiated due to persistent hypotension despite fluid resuscitation. Echocardiogram reveals dilated right ventricle with severely depressed right ventricular function and abdominal x-ray incidentally shows demineralization of the femoral heads, suggesting calcipenic rickets. The remainder of his workup is unrevealing.

DISCUSSION: The differential diagnosis at presentation includes sepsis, meningoencephalitis, toxic ingestion, non-accidental trauma, inborn error of metabolism, idiopathic pulmonary hypertension, heart failure of any etiology, and pulmonary veno-occlusive disease. Additional history is notable for the patient being exclusively breastfed, with mother consuming 0.5 to 3 pounds of corn starch daily and little additional caloric intake. The patient has rapid improvement after initiation of enteral feeds with standard infant formula and with normalization of cardiac function and improved neurologic status during a 26 day admission. Thiamine level on day 12 of admission was below normal range and the diagnosis of infantile beriberi was made.

THE CONDITION: Infantile beriberi is caused by an inadequate dietary intake of thiamine. Thiamine serves important functions in oxidative energy metabolism, as well as in the production of neurotransmitters, myelin, and nucleic acids. Intracellular thiamine is an important component of the enzyme complexes of pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase, which are responsible for production of the citric acid cycle precursor acetyl-CoA and citric acid cycle component succinyl-CoA, respectively. Without these thiamine-dependent enzymes, cellular energy production shifts towards anaerobic metabolism with resulting increase in cellular pyruvate and lactate.

TREATMENT: Current literature suggests a low threshold for attempting a therapeutic thiamine challenge as a diagnostic tool in the setting of acutely ill infants with clinical concerns for deficiency, with some sources suggesting that intramuscular or slow-push intravenous thiamine infusion be part of routine resuscitation.

Presented by

Evan Holleran

Institution

1University of Michigan, Department of Pediatrics, Ann Arbor, MI 48109, USA. 2Seattle Children’s Hospital, Department of Pediatric Critical Care, Seattle, WA 98105, USA.

Keywords

25: PEDIATRIC VACCINATION HABITS AMONG ARAB AMERICANS IN SOUTHEAST MICHIGAN

M. A. Ismail1,2,3, M. Kabalan2,4, H. Redah2,4, Z. Bazzi2,4, H. Shamroukh2,4, R. A. Blackwood2,3,5 MD PhD

Abstract

Background: To advance the wellbeing of Arab American children, the parental beliefs that dictate vaccination acceptance must be examined. There is, however, minimal literature on the health-seeking behaviors of the Arab American pediatric population. Objectives: The current study evaluates the implications of educational, social, and cultural influences on vaccination attitudes and habits among an Arab American pediatric population in Southeastern, Michigan. Methods: Data was collected anonymously via a 35-question digital survey through Qualtrics and was analyzed using SPSS. Our non-profit organization, Arab American Health Initiative (AAHI), has significantly contributed to the administration of the survey alongside the University of Michigan Dearborn, Arab Community Center for Economic and Social Services (ACCESS), Michigan Medicine, and various Arab American social media pages. To be eligible in this study, participants needed to be parents of children between the ages of 2 months and 18 years. Results: Data was collected in May 2019 through January 2020; 371 participants took part in the study. About 78.35% (257/328) of participants identified as Arab American and 82.59% (261/316) were female. A majority of participants 88.81% (246/277) are Wayne county residents and 31.92% (91/285) are foreign born. About 57.2% (135/326) of parents report an income greater than $49,000 and 51.56% (149/289) of parents have completed at least a Bachelor’s degree. The majority of parents, 88.70% (306/345), reported vaccinating their children. Additionally, 73.71% (185/251) of parents agree that vaccines are safe and 82.09% (220/268) reported vaccinating their child(ren) for the chicken pox. However, only 27.51% (74/269) of parents vaccinate their child annually for influenza. Conclusion: Our study is an important first step in better understanding an understudied and underreported population. By conducting this research, educational information will be available to not only the Arab American community but medical health professionals to better communicate the importance and efficacy of childhood vaccinations.

Presented by

Malak Ismail

Institution

1University of Michigan, Ann Arbor 2 Arab American Health Initiative 3Office for Health Equity and Inclusion 4University of Michigan Dearborn 5University of Michigan, Department of Pediatric Infectious Diseases

Keywords

DEI, Health Disparities, Vaccine, Racial/Ethnic Disparities

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Available May 11, 2021 12-1:00 PM

26: EFFECTS OF THE COVID-19 PANDEMIC ON INPATIENT ADMISSIONS AMONG ADOLESCENTS WITH RESTRICTIVE EATING DISORDERS

Jary, J. M.1; Sturza, J.; Miller, C.A1; Prohaska, N.; Van Huysse, J.3; Bravender, T.2; Otto, A.K.1

Abstract

Background: The COVID-19 pandemic has been associated with both negative psychological effects and delayed medical care for non-COVID conditions. These effects may worsen outcomes among individuals with eating disorders (ED) and those at risk for these disorders. Emerging data suggest the pandemic has been associated with worsening symptoms of ED among adults. There is a paucity of data on the effects of the pandemic on adolescent ED. Methods: We performed a retrospective chart review of patients ages 10-23 admitted medically to a tertiary-care children’s hospital for restrictive ED from 2017 to 2020. Data from 2017-2019 (pre-COVID) were pooled and compared to 2020 (during COVID). We used χ2, Fisher's Exact, two-sample t-tests, and Kruskal-Wallis tests to determine if patient and disease-course variables differed between groups. Results: The total number of admissions related to restrictive ED was 61% higher in 2020 (n = 51) than the mean for 2017-2019 (mean = 31.67). Patient demographics and markers of disease severity were similar pre- and during COVID, with the exception that patients admitted in 2020 were significantly more likely than those admitted pre-COVID to have severe (vs mild, moderate, or no) malnutrition (p < 0.001). Twenty-two patients admitted in 2020 (43%) reported their eating disorder symptoms began (n = 9) or worsened (n = 13) as a result of the pandemic. Conclusion: Medical admissions related to restrictive ED increased among adolescents during the COVID-19 pandemic.

Presented by

Jessica Jary

Institution

1. Pediatrics, University of Michigan 2. Pediatrics, Psychiatry, University of Michigan 3. Psychiatry, University of Michigan

Keywords

Adolescent, Anorexia, Eating Disorder, COVID-19

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Available May 11, 2021 12-1:00 PM

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27: PREVALENCE OF CONGENITAL HEART DISEASE IN INFANTS WITH CONGENITAL CYTOMEGALOVIRUS INFECTION AT A TERTIARY PEDIATRIC HOSPITAL

N. Kline1; A. McCormick;1 M. Pesch1

Abstract

Background: Congenital cytomegalovirus (cCMV) is the most common congenital infection in the United States, and is widely known to disrupt fetal brain development. Although many comorbidities of cCMV infection are well documented, few studies have examined the impact of cCMV on congenital cardiac development. Objectives: To examine the prevalence of congenital heart disease in individuals with known cCMV, and to identify characteristics of CHD in patients with co-occurring cCMV. Methods: A retrospective query of the electronic health records at a Midwestern tertiary care children’s hospital and congenital heart center was conducted using DataDirect to examine the prevalence of CHD in patients with and without cCMV. Medical records were individually reviewed and cases described in detail. Results: Between 2000-2020 604,898 children (<18 years old) were cared for at the University of Michigan, of those 17,642 had CHD, 134 had diagnosed cCMV, and 11 had both CHD and cCMV. Children with cCMV had 2.8 greater odds of having CHD than those without cCMV (OR 2.81, 95% 1.52-5.21) in the sample. The prevalence of CHD in children with cCMV was 8-fold greater than what would be expected in the general US population. Conclusions: Our study found nearly three-fold greater odds of CHD in children with cCMV. Future studies should investigate whether in-utero CMV exposure disrupts fetal heart development.

Presented by

Noah Kline, MD

Institution

1Universtiy of Michigan, Department of Pediatrics, Ann Arbor, MI

Keywords

CMV, CHD

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Available May 11, 2021 12-12:45PM

28: CHARACTERISTICS OF PEDIATRIC PATIENTS WITH CANDIDEMIA AND RISK FACTORS FOR DISSEMINATED CANDIDIASIS

KE Leopold, EC Lloyd, and JB Weinberg

Abstract

Background: Candida species are the most common cause of fungal infection in hospitalized patients. Patients with candidemia are at risk of developing disseminated infection. Studies in adults have described risk factors for disseminated candidiasis in patients with candidemia, but there are fewer such studies in pediatric populations. Objective: To examine the prevalence of disseminated candidiasis in pediatric patients with candidemia and to compare patients with disseminated candidiasis to those with candidemia alone. Methods: All patients with blood cultures positive for a Candida species from 2007-2018 were identified from the UM Clinical Microbiology Laboratory. Retrospective chart review was conducted to gather demographic, clinical, and microbiologic data. Disseminated candidiasis was defined as ocular infection; endocarditis; renal, hepatic, or splenic involvement; peritonitis; or CNS infection. Patients with disseminated candidiasis were compared to those with candidemia alone using chi-squared tests. Results: There were 81 episodes of candidemia during the study period, representing 61 unique patients. The most common comorbidity was intestinal failure (43%), followed by malignancy (15%). The presence of a central line (99%), recent antibiotic use (81%), and use of TPN (73%) were all highly prevalent. 16% of patients were pharmacologically immunosuppressed. The most frequently identified Candida species was C. albicans, followed by C. parapsilosis. There were 14 patients (17%) with disseminated candidiasis. The most common site for dissemination was the abdomen (36%); the least common was ocular dissemination (7%). Pharmacologically immunosuppressed patients were significantly more likely to have disseminated candidiasis (p=.002), while those with intestinal failure were significantly less likely to develop disseminated candidiasis (p=.003). Patients with disseminated candidiasis were significantly more likely to require ICU admission (p=.02) and were significantly more likely to die within three months of infection (p=.0004) than those with candidemia alone. Conclusions: Children who are receiving pharmacologic immunosuppression are more likely to develop disseminated candidiasis, and children with disseminated candidiasis are more likely to be admitted to the ICU and to die. The abdomen was the most common site for dissemination and ocular dissemination was the least common. These findings could be taken into account when developing guidelines for management of candidemia (e.g. additional imaging for patients at increased risk for disseminated candidiasis).

Presented by

Kay Leopold

Institution

Department of Pediatrics, University of Michigan, Ann Arbor, MI

Keywords

Infectious Diseases

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Available May 11, 2021 12-1:00 PM

29: INITIAL IMPACT OF COVID-19 PANDEMIC ON PEDIATRIC ONCOLOGY CARE AND OVERALL EXPERIENCES

S Ngo,1 L Sedig,2 Y Wang,3 M Murillo,3 E Stuchell,3 A Edmonds,2 I Wolfe,3 S Choi,2 R Mody,2 R Jasty-Rao2

Abstract

Background The COVID-19 pandemic led to unprecedented change in healthcare delivery. In pediatric oncology, patients and providers adapted to balance adherence to well-established oncology treatment and monitoring with minimizing exposures in an immunosuppressed population. This study evaluates the impact of the first 4 months of the COVID-19 pandemic on the timing of oncologic care and the overall experiences of pediatric oncology patients and caregivers. Methods Caregivers of patients aged under 18 or patients over 18 seen for active treatment or monitoring in the oncology clinic between January 1, 2019 and June 30, 2020 were eligible to complete an anonymous, encrypted electronic survey. Results There were 78 partial or complete responses to the survey. Of these, 24 were on active therapy with 8.4% reporting delay in therapy. About 17.9% respondents reported a delay in getting surveillance scans. About 24.2% reported a delay in scheduled appointments. No patients surveyed chose to delay treatments against provider’s recommendations. About 15.9% used our electronic medical record platform to send messages, and 59.4% had video visits with positive feedback overall. The majority of participants reported using a government website as their source for information about COVID-19, but participants relied more on their healthcare providers for cancer-specific information. Nearly a quarter (22.4%) of participants endorsed fear about going to the emergency department for care. About 89.7% responders felt the institution’s visitor policy helped keep them safe. About 17.6% families reported exposure to COVID-19, and 10.3% indicated a household member had symptoms or diagnosis of COVID-19. Of college students, 36.4% planned to defer classes. Over a third of households had someone stop working due to the risk of exposure. There was statistically significantly increased distress in patients on therapy, those who reached out to healthcare providers, those with household members with symptoms or diagnosis of COVID, and those who were not able to work outside the home. Conclusions Adherence to therapy and access to the oncology team was largely maintained, which is consistent as severity of COVID-19 infections in pediatric oncology patients is similar to their peers. Given frequent interruptions to education and/or work causing increased distress, screening for social stressors and identifying interventions is warranted.

Presented by

Sandra Ngo

Institution

1Department of Pediatrics, University of Michigan 2Department of Pediatric Hematology/Oncology, University of Michigan 3University of Michigan

Keywords

pediatric oncology, COVID-19, survey

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Available May 11, 2021 12-1:00 PM

30: BILATERAL PELVIC OSTEITIS AND PREMATURE EPIPHYSEAL CLOSURE IN RELATION TO SYSTEMIC ISOTRETINOIN USE IN A TEENAGE MULTI-SPORT ATHLETE

Mara Nydes, MD; Michael Anacker, MD

Abstract

Objective: Discuss Isotretinoin as a cause of joint pain in adolescent athletes. Design: Case report. Setting: Outpatient sports medicine clinic. Patients (or Participants): Adolescent male athlete with bilateral hip and knee pain. Interventions (or Assessment of Risk Factors or Independent Variables): Assessment included medication review, physical exam, xrays, and MRI. Intervention was discontinuation of isotretinoin in the absence of other risk factors for boney edema. Main Outcome Measures: Subjective improvement in pain and function. Results: Patient had improvement of pain and athletic function after discontinuation of isotretinoin. Conclusions: Isotretinoin can cause boney edema, and should be considered as a source of pain and athletic limitations in athletes using this medication.

Presented by

Mara Nydes

Institution

Pediatrics House Officer; Pediatrics Adolescent Medicine

Keywords

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Available May 11, 2021 12-1:00 PM

31: BILIBLANKET UTILIZATION FOR OUTPATIENT TREATMENT OF NEWBORN JAUNDICE

K Orringer1, S Kileny1, K Salada 2,4, E Sahloul2, A Gebremariam3, M Skoczylas5, E Yoon1.

Abstract

Objective: To characterize the use and clinical utility of at-home biliblankets for treatment of newborn jaundice. Methods: Retrospective medical record review of newborns (n=1164) with hyperbilirubinemia evaluated in pediatric clinics at Michigan Medicine. Main outcomes were whether a biliblanket was ordered for serum bilirubin within 3 mg/dL of phototherapy threshold and whether usage impacted readmission rates. Data analysis included descriptive statistics, simple and multivariate logistic regression. Results: Home biliblankets were used for 17% of newborns. 12% of newborns were admitted for hyperbilirubinemia. For newborns whose serum bilirubin was ever within 3 mg/dL of phototherapy threshold, 2% that were treated with biliblankets were hospitalized compared to 9% of newborns that were not treated with biliblankets (p=.003). Newborns treated with biliblankets had 0.34 lower odds of being hospitalized for treatment of hyperbilirubinemia compared to those not treated with biliblankets (95% CI, 0.18-0.65). A small group of newborns who were at or above inpatient phototherapy threshold and treated with at-home biliblankets successfully avoided readmission for treatment of hyperbilirubinemia. Conclusions: Biliblanket use was associated with lower odds of readmission for newborn jaundice. Home phototherapy may be an effective option to reduce newborn readmission for newborns within 3 mg/dL of phototherapy threshold and possibly for those at or above threshold. Further randomized prospective studies should examine 1) biliblanket use under higher thresholds aligned with NCNC guidelines and 2) the potential expanded use of biliblankets and impacts on readmission for newborns at or above inpatient phototherapy threshold.

Presented by

Kelly Orringer

Institution

Division of General Pediatrics1; Pediatric Residency Program2; CHEAR3; Lurie Children’s Hospitalist Division4, Division of Hospitalist Medicine5

Keywords

newborn, jaundice, biliblanket, readmission

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Available May 11, 2021 12-1:00 PM

32: ASSESSMENT OF A PROCEDURAL CURRICULUM USING 3D PRINTED AIRWAYS TO TEACH PEDIATRIC FLEXIBLE BRONCHOSCOPY

N. Painter, MD1, T. Saba, MD2

Abstract

Background: Pediatric flexible bronchoscopy (FB) is a relatively high-risk procedure performed by trained proceduralists to assess for congenital airway malformations and collect diagnostic bronchoalveolar fluid samples. Compared to adult FB, pediatric FB skills require a detailed anatomic assessment through relatively smaller airways. The use of 3D printed airways has been shown to be an effective way to teach adult, but not pediatric FB skills. We propose a novel curriculum to teach pediatric flexible bronchoscopy skills using a combination of tools including novel neonatal and pediatric 3D printed airways. We hypothesize that 3D printed airways are a feasible and effective way to teach pediatric flexible bronchoscopy skills. Methods: Pediatric pulmonology, critical care and surgery fellows will participate in a half-day curriculum at the beginning of fellowship. The curriculum will include a didactic training video, and the use of hands-on training using 3D printed airways and a virtual reality (VR) simulation tool. The 3D printed airways will be designed to teach technical bronchoscopy skills, airway anatomy assessment to the third generation and bronchoalveolar lavage. A normal pediatric airway and a neonatal airway with a congenital fixed obstruction will be modeled after de-identified patient CT scans. Using 5-point Likert scales, participants will complete assessments of the educational value of the curriculum. Qualitative and quantitative assessments of the 3D printed airways and the traditional VR model will be compared. Instructors will assess procedural competency of participants using a modified version of the Bronchoscopy Skills and Task Assessment Tool and provide formative feedback. Results: Results of the study will be available at the completion of the curriculum in August 2021. Conclusions: We expect that 3D printed neonatal and pediatric airway models will be a valuable tool for safely learning pediatric flexible bronchoscopy. This course will provide preliminary feasibility information upon which a larger study with different simulation models and pathologic variants can be developed.

Presented by

Natalia Painter

Institution

1Internal Medicine and Pediatrics Residency Program, University of Michigan; 2Department of Pediatrics, University of Michigan *Partially funded by Department of Pediatrics Resident and Fellow Research Grant Program

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Available May 11, 2021 12-1:00 PM

33: PROSPECTIVE STUDY OF CYSTIC FIBROSIS PATIENTS BY LUNG MRI TECHNOLOGY AND CLINICAL MEASURES OF PULMONARY FUNCTION

K. Qussous1, S.Nasr1, L.Caverly1

Abstract

Introduction: CF Transmembrane Conductance Regulator (CFTR) modulators can partially restore function of the mutated CFTR protein. They have been improving patients’ lung condition, nutritional status and overall health. Trikafta is the latest modulator to be approved for CF patients 12 y/o & older. Trikafta will soon be approved for patients 6-11 y/o. This study will evaluate the real life effect of Trikafta on this patient population objectively. Objective: Evaluation of 6-11 y/o patients starting Trikafta using: 1- CF airway microbiome & markers evaluation throughout the study. 2- Correlation between CF airway microbiome & markers and the early CF lung disease markers (Lung Clearance Index (LCI)/ Multiple breath washout (MBW) & magnetic resonance imaging (MRI)). 3- Correlation between HRCT, MRI & clinical lung function assessments (LCI /MBW & spirometry). Rationale: Changes in CF airway bacterial community structures, such as bacterial community diversity, are associated with lung function decline over time. It’s unknown if these changes in bacterial community structures precede lung function decline, & track with evidence of early CF lung disease. Hypothesis: Differences in CF airway microbiome will be associated with changes in lung disease as measured by LCI & MRI. Methods: This is a prospective study is to evaluate the correlation of bacterial community diversity with MRI & MBW/LCI & spirometry in CF patients before, 3 & 6 months after starting Trikafta. Patients will include naive & those who have been on Symdeko or Orkambi. The following will be utilized: MBW/LCI & Spirometry & MRI that will be done on research MRI scanner. All assessments will occur at all 3 visits. HRCT will be done at baseline & will be compared to MRI. Collection of OP swabs/sputum cultures at all study visits from the 3 centers, will be done. Samples will be shipped frozen to Dr. Caverly lab, where DNA extraction and bacterial DNA sequencing will be performed. Measures of bacterial communities will be correlated with LCI and MRI.

Presented by

Khaleel Qussous

Institution

1Pediatric Pulmonology, University of Michigan, Ann Arbor, MI Pediatric Pulmonology, Case Western University

Keywords

Cystic Fibrosis, Microbiome, CFRT modulators, LCI/MRI, Spirometry

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Available May 11, 2021 12-1:00 PM

34: VACCINE ATTITUDES AND HOSPITALIZATION IN PEDIATRICS

J. Sparks1; R. Rannefors2; K. Schwenk3; Y. Feygin4; G. Marshall5

Abstract

Background Childhood vaccination is an important public health intervention and is impacted by caregiver attitudes towards vaccines and trust of the healthcare system. Pediatric hospitalizations are significant experiences for families. Objectives The purpose of this study was to determine whether hospitalization of a child alters caregiver attitudes about childhood vaccination and, if so, to delineate factors that are associated with that change. Design/methods In this cross-sectional survey study, we asked primary caregivers of hospitalized children about their attitudes toward vaccinating their children within 24 hours of admission and again within one to two weeks of discharge, using Gilkey’s Vaccine Confidence Scale (VCS) in the 4-item short form. Prospective chart review was used to assess for demographic and other inpatient factors associated with changes in caregiver’s vaccination attitudes. Admission and post-discharge survey results were compared by calculating median scores and interquartile ranges for each of the four questions from the VCS scale for subjects at admission and after discharge. We used deductive coding for analysis of the free-response question on the post-discharge survey to identify potential variables associated with change in attitudes. Results A total of 83 primary caregivers of children admitted to a pediatric tertiary care hospital were surveyed, 16 were lost to follow up. Caregivers reported high ratings of vaccine confidence with median scores of 10 out of 10 on admission. There was no statistically significant change in median VCS scores in admission and post-discharge surveys. Overall, 4.5% of caregivers reported a change in attitudes toward vaccination, all of which more in favor of vaccinating their children following hospital admission, although there was not a significant change in VCS scores pre and post admission, in those reported being more in favor. Conclusions Hospitalization itself did not significantly influence attitudes toward vaccination. Caregivers generally reported high vaccine confidence. The COVID-19 pandemic did appear to increase vaccine confidence, although the effect of this is unclear given that these subjects were already in favor of vaccination. Less than half of subjects reported discussion of vaccines during admission, indicating there is opportunity for increased education.

Presented by

Rachel Rannefors

Institution

1Department of Pediatrics, University of Louisville, Louisville, KY; 2Department of Pediatrics, University of Michigan, Ann Arbor, MI; 3Division of Pediatric Hospital Medicine, University of Louisville, Louisville, KY; 4Biostatistics, University of Louisville, Louisville, KY ;5Division of Pediatric Infectious Disease, University of Louisville, Louisville, KY

Keywords

Abstract

Background. Patients with sickle cell disease are at higher risk of infection, especially from encapsulated bacterial organisms such as Streptococcus pneumonia and Neisseria Meningitidis mostly due to functional asplenia. These patients require additional immunizations compared to the standard recommended immunization schedule. There is evidence that patients with sickle cell disease have a suboptimal response to immunizations, though the reasons for this inadequate response are not well described. A possible mechanism was described by Watanabe-Matsui et al. who demonstrated that heme has a role in B-cell differentiation by reducing antibody class-switching and somatic hypermutation thereby decreasing the level of high-affinity antigen-specific IgG-secreting plasma cells. Intravascular hemolysis, and thus release of intracellular heme occurs to varying degrees in patients with sickle cell disease. Objective. This study was designed to determine if the level of hemolysis affects the response to Tetanus, Pneumococcus, and Meningococcus immunizations. We anticipated that patients with higher levels of hemolysis would have inferior response to immunizations. To test this hypothesis, we collected blood samples from sickle cell patients to determine the association between a previously described hemolytic index and total antibody and vaccine-specific antibody levels. Methods. Patients were eligible for inclusion in the study if they were 1-22 years old, had a confirmed diagnosis of sickle cell disease (genotype HbSC or HbSS) and a known vaccination history. Average baseline laboratory data from the previous 5 encounters for enrolled patients were analyzed using principal component analysis to calculate a hemolysis index using as variables: reticulocyte count, lactate dehydrogenase (LDH), total bilirubin, and aspartate aminotransferase (AST). Our calculated hemolysis index had a mean of 0 (SD = 1.51) and predicted 56.8% of the variation among all four variables (Eigenvalue = 2.27). It had correlations of r=0.91 (p < 0.0001) with reticulocyte count; 0.77 (p < 0.001) with LDH, 0.72 (p < 0.01) with AST, and 0.58 (p < 0.05) with total bilirubin. Patients were stratified by hemolysis index tercile for comparison. Continuous variables were compared with one-way ANOVA and the Kruskal Wallis non-parametric test, and categorical variables were compared with Chi-square tests. Quantitative IgG, IgA and IgM were measured via nephelometry for enrolled patients. Appropriate vaccine response was defined as titers >0.01 IU/mL for tetanus toxoid IgG, seroprotective titers for at least 12 of the 23 serotypes for S. pneumoniae, and seroprotective titers for at least 2 of the 4 serotypes for N. meningitidis. Results/Conclusions. The hemolysis index for 17 enrolled patients was calculated and, so far, immunoglobulin levels were obtained from 6 of those patients (low hemolysis n=1, intermediate hemolysis n=3, high hemolysis n=2). The data for these 6 patients shows a trend towards inferior response to pneumococcal immunization for patients with a higher hemolytic index; however, due to inadequate sample size these data are not sufficient to make conclusions regarding the association between the level of hemolysis and a response to immunizations. More data will be collected to power this study before making definitive conclusions. Our next step is to collect immunoglobulin levels for the remaining patients that are enrolled in this study.

Presented by

Shayan Sengupta

Institution

MM H.O. Pediatrics Core; Pediatrics Hematology/Oncology;

Keywords

Background: Congenital cytomegalovirus (cCMV) is the leading non-genetic cause of sensorineural hearing loss and neurodevelopmental delays in children. This prevalent viral infection can present in infants with or without symptoms. Little is known about the medical decision-making and practices healthcare providers use to screen an infant for cCMV. Early diagnosis leads to appropriate management and therapies that can minimize the risk of long-term sequela from this congenital infection. Objective: To analyze healthcare provider practices used to screen infants for cCMV in a U.S. quaternary care pediatric hospital. Methods: A retrospective review of the electronic medical record was completed to identify all infants who underwent CMV testing over a six -year period (2014-2019). Infant demographics, clinical variables, screening indication by provider, test modality and result were analyzed. Results: During the six-year period, 25,609 infants were cared for at the study site. A total of 274 infants were tested and 65% (n=179) met criteria for cCMV screening by day of life 21. Thirteen infants (range: 1-5 per year) were diagnosed with cCMV resulting in an overall detection rate of 0.0005%. The Neonatal Intensive Care Unit ordered the majority (72%) of screens compared to four other pediatric units. Screened infants frequently presented with jaundice (n=95), small-for-gestational age (SGA) (n=85), microcephaly (n=82), and thrombocytopenia (n=82). Twenty-five different screening indications in total (range: 10-18 per year) were documented by providers across units. Symmetric SGA was the most documented indication prompting screening across units. However, the dominant indication by unit varied. Only 15% of positive cCMV diagnoses were associated with symmetric SGA. The most common indication associated with positive cCMV diagnosis was positive maternal CMV testing, and these screens were ordered by the Newborn Nursery and General Pediatrics. Conclusions: Healthcare providers are infrequently testing for cCMV in infants. Medical decision-making prompting testing is inconsistent, and practices are varied among providers and units. The majority of cCMV cases were not identified in the neonatal period. Relying on healthcare provider suspicion alone leads to missed diagnoses. Systematic screening guidelines, such as a targeted or universal screening approach, for cCMV may improve diagnosis, management, and treatment.

Presented by

Kate Wilson

Institution

1Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, MI; 2Developmental and Behavioral Pediatrics, University of Michigan, Ann Arbor, MI.

Keywords

PlatformPresentation(1-3pm)

45: OUTCOMES AFTER MYECTOMY AND MITRAL VALVE REPAIR IN HYPERTROPHIC CARDIOMYOPATHY

Steven Wilson, MD; Francis Pagani, MD; Sara Saberi, MD

Abstract

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common monogenetic cardiac disease, affecting approximately 1 in 500 adults in the general population. Commonly, the disease manifests as left ventricular septal wall thickening leading to symptomatic left ventricular outflow tract obstruction (LVOTO). Often, there are concomitant abnormalities of the mitral valve, in part due to the abnormal configuration of the left ventricle, which also contribute to the LVOTO and mitral regurgitation and further exacerbate the symptom burden. Persistent symptomatic LVOTO despite medication optimization is often treated surgically with septal myectomy and complex mitral valve or subvalvular interventions. The 2020 American Heart Association/American College of Cardiology guidelines recommend such surgeries be performed at “comprehensive HCM centers” with sufficient volumes to meet specific targets for operative (ie, 30-day) outcomes. What volume of experience is commensurate with these targeted outcomes in unknown. The aim of this study is to assess operative outcomes of the University of Michigan surgical experience in the management of patients with symptomatic LVOT obstruction as compared with published data from other high-volume centers in the US. METHODS: This is a retrospective review of 322 consecutive operations for LVOTO performed by a single surgeon from 2007 to 2020. Demographic, genetic and clinical profiles, echocardiogram-derived HCM characteristics and hemodynamics, gas exchange variables, operative data, operative outcomes were analyzed. RESULTS: Of the 322 operations, XXX were isolated septal myectomies, XXX were myectomies with mitral valve or subvalvular apparatus intervention, and XXX were myectomies with another concomitant procedure. Mitral valve interventions included anterior leaflet shortening (XX%), chordae tendinae resection (XX%), papillary muscle resection (XXX%) and papillary muscle reorientation (XXX%). XXX patients underwent mitral valve replacement. XXX% required in-hospital pacemaker placement. There were XXX postoperative ventricular septal defects (XXX%). Operative mortality (within 30 days of surgery) was XXX%. These rates are similar to published data from other high-volume centers. CONCLUSION: Septal myectomy can be performed with excellent outcomes by a highly specialized surgeon with intermediate volumes in a comprehensive HCM center. When performed by an experienced surgeon, complex mitral valve and subvalvular interventions can be useful in relieving LVOTO without adding significant risk.

Presented by

Steven Wilson

Institution

House Officer, Medicine and Pediatrics Program, University of Michigan Hospitals; Michigan Medicine Int Med-Cardiology

Keywords

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Available May 11, 2021 12-1:00 PM

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46: VARIATIONS IN OBJECTIVE KNOWLEDGE AMONG DECISION SUPPORT PERSONS OF PATIENTS WITH EARLY STAGE BREAST CANCER

Victoria A. Wytiaz, MD, MA; Christine M. Veenstra, MD, MSHP; Sarah T. Hawley, PhD, MPH

Abstract

Background: Patients with breast cancer face complex decisions regarding treatment options, and frequently involve family, friends, and other decision supporters in decision-making. A high-quality decision is one that is both informed and values-concordant. While much has been done to evaluate the quality of decision-making among patients, very little is known about how decision supporters fit within that framework. Thus, we sought to understand variations in objective knowledge among decision supporters.

Methods: Patients with stage 0-II breast cancer reported to Georgia and LA SEER registries in 2014-15 and their key decision support person (DSP) were surveyed separately. DSPs were asked 4 objective knowledge questions regarding breast cancer treatment with responses dichotomized into high/low knowledge. Bivariate analyses and multivariable regression models were used to assess associations between DSP knowledge and important DSP characteristics (type of DSP, age, race, education), level of DSP engagement in 3 domains of patients’ decision-making (feeling informed about decisions, extent of and satisfaction with their involvement in decisions, and being aware of patients’ values/preferences), and patient clinical factors (stage, chemotherapy receipt, radiation receipt, type of surgery).

Results: 2502 patients (68% RR) and 1203 eligible DSPs (70% RR) responded. Most DSPs were husbands or daughters. 21% were Latino, 17% were black, 20% had
Conclusions: Objective knowledge about breast cancer treatment was varied among DSPs of patients with breast cancer. Highly engaged DSPs (aware and satisfied) were more likely to have high knowledge, suggesting that involving DSPs may be an untapped mechanism for improving patients’ understanding of treatment options. These finding suggest that DSPs can play a role in improving decision quality in patients, and that interventions focused on decision-making may benefit from modules directed to DSPs as well as patients.

Presented by

Victoria Wytiaz

Institution

Victoria A. Wytiaz, MD1; Christine M. Veenstra2; Sarah T. Hawley3 1Department of Internal Medicine, University of Michigan, Ann Arbor; 2Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor; 3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor

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Available May 11, 2021 12-1:00 PM

47: MUSLIM PEDIATRIC FASTING PRACTICES AMONG DIABETIC CHILDREN: A MIXED METHOD APPROACH

E. Dabaja1, H. Shihan1, M. Dabaja2, A. Chehimi2, Z. Berry2, M. Elhassan2

Abstract

Background/Purpose: Fasting during the holy month of Ramadan is one of the primary pillars of Islam. Muslims abstain from all water, food, and medications from dawn to dusk. Exemptions are made children before the age of puberty and those with chronic medical conditions. To date, there is no study that assesses fasting practices among diabetic children in the US. This abstract is part of a longitudinal multi-phase study assessing Muslim pediatric fasting practices and the current clinical practice of their physicians in Michigan. The purpose of this phase of the study is to assess the clinical outcomes of pediatric patients with diabetes who fast during Ramadan. Methods: Following IRB approval, a mixed method study was conducted that included a retrospective chart review and digital survey. A retrospective chart review was conducted for pediatric patients with diabetes who were routinely followed at the Children’s Hospital of Michigan Endocrinology Clinic. In addition, parents of Muslim pediatric patients with diabetes were surveyed using a 5-part questionnaire at the Endocrinology Clinic during routine follow-up appointments. Results: From 9/2019 to 2/2020, a total of 52 participants were surveyed. All participants identified as Muslim, 85% (44/52) identified as Arab/Arab American, 47% (22/47) identified as immigrants to the US, and 48% (21/44) had less than a high school diploma. A majority of participants, 92% (48/52) reported that their child had Type 1 Diabetes. Most parents, 76% (37/49), reported that their child was diagnosed with Diabetes before the age of 7 years old. About 27% (14/52) of patients fasted during Ramadan 2019, a majority of them 79% (11/14) fasting 15 or more days during the month. Of those children who fasted during Ramadan, the average age of the child who fasted was 11 years old. In addition, parents checked their child’s blood sugar 3.5 times per day on average when fasting. Overall, about 45% (18/40) of parents encouraged their child with diabetes to fast during Ramadan. Parents reported that diabetic control, age, and diabetes medication regiment were the primary factors that they considered when encouraging their child to fast. Conclusion: Our study is unique in its multi-phase approach and mixed methodology. It is the first study of its kind that assesses fasting practices among Muslim pediatric patients with diabetes that fast during Ramadan in the US. Subsequent analyses will focus on assessing diabetic control of patients who fast and the impact of glucose sensors and insulin pumps on the clinical outcomes.

Presented by

Zane Berry

Institution

1Children’s Hospital of Michigan, Department of Pediatrics, Detroit, MI; 2University of Michigan – Dearborn, Dearborn, MI.

Keywords

DEI

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Available May 11, 2021 12-1:00 PM

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S Ng1, KP Chua1, K Dombkowski1, S Creary2, S Reeves1

Abstract

Background: Children with sickle cell anemia (SCA) receive annual transcranial Doppler (TCD) screening to identify those at highest risk of stroke, and daily antibiotic prophylaxis and hydroxyurea to protect against infection and reduce pain crises. Yet, adherence has been limited. We evaluated associations between receipt of primary care, specialty care, and preventive services among privately insured children with SCA. Methods: Using validated case definitions, we identified children with SCA continuously enrolled for ≥1 year with a single form of health insurance from 2009-2018 in the nationwide Optum database. Annual outcomes were: (1) receipt of TCD screening (ages 2-15 years), (2) days of filled antibiotic prescriptions (ages 1-4 years), and (3) days of filled hydroxyurea prescriptions (ages 1-17 years). Annual patterns of outpatient care assessed were (1) presence of ≥1 visit and (2) number of total visits for both primary care providers and hematologists. Logit regressions with Generalized Estimating Equations modeled the relation between each outcome and patterns of care, adjusting for age, year, and plan type. Results: Among 3,488 person-years of enrollment (1,153 children with SCA), 77% had ≥1 primary care visit and 61% had ≥1 hematology visit. Annual mean number of visits to primary care providers and hematologists were 2.5 and 2.1. Adjusted analyses found ≥1 hematology visit was associated with an increase of 29% points for TCD screening, +105 days of antibiotic prophylaxis, and +96 days of hydroxyurea (Figure). Increased visits were associated with receipt of each preventive service among children received hematology care. Increased visits were associated with increased antibiotic prophylaxis among those received primary care. Conclusion: Privately insured children with SCA with outpatient hematologist visits were more likely to receive recommended preventive services. Primary care visits were frequent; pediatricians may have opportunities to emphasize SCA preventive care in coordination with hematologists.

Presented by

Sophia Ng

Institution

1Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI; 2Nationwide Children's Hospital, Columbus, OH.

Keywords

51: PROVIDERS OF AMBULATORY HEALTHCARE IN CHILDREN AND ADOLESCENTS WITH SICKLE CELL ANEMIA

P. Patel1, K. Dombkowski1, S. Reeves1

Abstract

Background: Sickle cell anemia (SCA) is a rare, chronic condition associated with significant morbidity and mortality. National guidelines recommend children with SCA should be seen regularly by both primary care providers as well as hematologists in order to receive comprehensive, multidisciplinary care. However, there is currently a gap in understanding which providers are caring for children with SCA in ambulatory care settings. Objectives: To characterize the annual and longitudinal patterns of primary and hematology care for children with SCA enrolled in Michigan Medicaid. Design/Methods: We used validated case definitions with administrative claims to identify children ages 1-17 years with SCA continuously enrolled in Michigan Medicaid for at least one year from 2010-2018. All outpatient visits for each child were identified. For each outpatient visit, the provider and associated specialty was identified using the National Provider Index (NPI). We characterized providers into the following four categories: 1) Primary Care Provider (PCP) which included Pediatrics, Family Medicine, Nurse Practitioners, and Physician Assistants; 2) Hematologist; 3) non-Hematologist Specialist; and 4) acute care hospital visits. We calculated the number of visits with a PCP or hematologist per person-year, as well as the proportion of children with at least one visit to a PCP, hematologist, or both a PCP and hematologist visit. We then ran two negative binomial regression models - one for each provider type - to calculate annual rates of visits. Results: A total of 877 children, 2,899 person-years, and 24,030 outpatient visits were included in the analysis. Each child contributed an average of 3.3 person-years (SD=2.5). The mean age was 9.6 years (SD=4.7). Of the total outpatient visits, 2,971 visits (12%) were with non-hematologist specialists or acute care hospital visits and were excluded from further analysis. There was a median of three PCP visits and two hematologist visits per person-year. Between 7-12% of children did not have a PCP visit in a given year. A more notable proportion of children (15-37%) did not have a hematologist visit in a given year. Approximately 67% of total person-years had at least one visit with a PCP and hematologist within a year, with the proportion ranging from 75% to 55% by year. The annual rate ranged from 3.86 - 4.48 for PCP visits and 2.28 - 2.50 for hematologist visits. Conclusions: While the majority of children with SCA obtain annual care from a PCP, substantial gaps exist in the receipt of annual hematology care. Increased coordination between primary and specialty care may be one strategy to improve comprehensive care and health outcomes for this population.

Presented by

Pooja Patel

Institution

1Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI

Keywords

AWARD, PlatformPresentation(1-3pm)

52: USING STATE PUBLIC HEALTH DATA TO IDENTIFY PERSONS POTENTIALLY ELIGIBLE FOR THE FLINT REGISTRY

Hannah K. Peng1; Marina Goulas2; Kevin J. Dombkowski1

Abstract

Background: From April 25, 2014 to October 16, 2015, residents of Flint, Michigan were potentially exposed to elevated lead levels through the municipal water system. The Flint Registry was developed to support persons who were impacted by this drinking water crisis, as well as refer them to services to reduce the impact of lead exposure on their health. In this analysis, we describe how we identified children potentially eligible for the Flint Registry using Michigan public health and administrative records. Methods: We used public health databases maintained by the Michigan Department of Health and Human Services (MDHHS): The Michigan Medicaid program, the Michigan Care Improvement Registry (MCIR), and the Michigan Childhood Lead Poisoning Surveillance System (MiCLPS). Each data source was queried for persons having an address with a Flint ZIP code during the exposure period. These databases were re-queried for the most recently known address and phone number for the potentially exposed persons; demographic information and blood lead test results were also obtained. Datasets were de-duplicated and linked by person using LinkageWiz software. The most recent exposure address and current contact information from all sources was maintained for each person; exposure addresses were geocoded using ArcGIS. Results: A total of 204,155 people were identified in at least one of the three sources as having a Flint ZIP code during the exposure period. Of those, 122,565 (60%) had an address within the Flint Water System boundary, and 14,159 (12%) of those were age 6 or younger when the exposure period began. These 14,159 children were the first priority of public health-identified cases for the Flint Registry staff recruitment team. While children could have been identified by multiple sources, the percentage of children identified as potentially eligible in each data source was 88.9% from Medicaid, 81.7% from MCIR, and 24.1% from MiCLPS. The data source for most recent address was most commonly Medicaid (88.8%), followed by MCIR (10.5%), and MiCLPS (0.7%). Blood lead tests results were available for 24% of children, and elevated for 2% of children. Conclusion: It is feasible to use existing public health registry and administrative data to identify children potentially eligible for the Flint Registry due to geographic proximity and demographic characteristics. This information will be instrumental in outreach to persons potentially impacted and evaluating health outcomes over time.

Presented by

Hannah Peng

Institution

1Child Health Evaluation and Research Center, University of Michigan; 2Altarum Institute

Keywords

AWARD, DEI

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Abstract

Background: Sudden infant death syndrome (SIDS) is largely preventable. In 1994, the AAP recommended “Back to Sleep”, then transitioned to “Safe to Sleep” whereby infants should sleep on their backs on a firm mattress in own sleep space without other objects or coverings. The uptake of this advice 27 years later is not universal. Methods: A QI clinic intervention involved parent survey of infant sleep habits to gauge sleep practices and parental knowledge about safe sleep. The intervention also offered safe sleep resources to families. Surveys were administered at newborn, 2 months, 4 months and 6 months of age. Chart review was performed for infants screening positive for unsafe sleep to assess if sleep counseling was documented. Results: Overall, 22/76 (29%) infants were sleeping unsafely or potentially unsafely at the newborn survey. 11/76 (14.5%) were sleeping unsafely. Another 11/76 (14.5%) were potentially sleeping unsafely. Unsafe sleep included sleeping in a bed with someone, in a swing, car seat, soft cushion, with stuffed animals, or sleeping on their side. Potentially unsafe sleep included sleeping with a blanket, in parent’s arms, if the parent was “unsure” how other adults put baby down to sleep, or other practice that needed more information to determine its safety. All babies were usually placed on their back to sleep. 1/76 (1.3%) were additionally sleeping on their side at the newborn survey, and 2/48 (4%) were also sleeping on their side at 2 months. Only 2 charts indicated unsafe sleep practices when physician and home nursing notes were reviewed. 72/76 (95%) parents had heard of SIDS at the newborn survey. At the 2-month survey, 15/48 (31%) infants were sleeping unsafely or potentially unsafely. Discussion: Unsafe infant sleep practices remain a risk for SIDS. Survey findings identified more at-risk sleep locations than did physician or visiting nurse visits. Although 100% of infants at both the newborn and 2-month follow up surveys were placed “back to sleep”, not all other “Safe to Sleep” recommendations were followed. Some parents who were educated about safe sleep and received safe sleep resources still place their infants in unsafe sleeping situations. These findings suggest that safe sleep counseling at each visit (initial newborn and early infant well visits), is important but not sufficient to reduce the risk of SIDS.

Presented by

Kelly Orringer

Institution

1. University of Michigan School of Public Health; 2. Michigan Medicine CHEAR Center; 3. Michigan Medicine General Pediatrics

Keywords

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Available May 11, 2021 12-1:00 PM

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56: PEDIATRIC CROSS-COVER EMERGENCIES CURRICULUM

T. Broome1; E. Muallem2; K. Levy3

Abstract

BACKGROUND: Pediatric residents frequently provide care for patients in the afternoon and overnight for whom they are not the primary provider. This role or action is commonly called cross-cover. Pediatric residents receive variable training on cross-cover prior to residency. The University of Michigan Pediatric residents were polled on their comfort with cross-cover halfway through the 2018-2019 year. Out of 11 interns polled, 63.6% reported feeling somewhat or not at all prepared to cross-cover patients prior to residency. There exists a gap in training and education on cross-cover. METHODS: The act of cross-covering patients is an expansive topic, thus the residents were also polled on what they would find useful to have additional training/education on. The majority of residents responded that calling a code, calling a RRT, and respiratory distress would be most useful topics for this curriculum. In 2018-2019 I created an introductory lecture that included cases from the mentioned topics. Based on positive feedback, in 2020 I expanded this to a four-part lecture series which include an introductory lecture, respiratory distress, sepsis, and seizures. All of these have the same basic structure: a short didactic followed by interactive cases that are based on simulated pages the interns respond to using a “sign-out” of the patients they are covering. I created pre and post-test surveys that contain both medical knowledge-based questions of the topics we cover, as well as assessing the interns comfort with cross-cover itself. Data was analyzed using independent t-test. RESULTS: The 2020 data showed that the post-lecture group (M = 3.46) was more confident in their ability to recognize emergencies overnight compared to the pre-test group (M =2.57) with p-value = 0. 013, which is statistically significant. The average for the knowledge-based questions on the pre-lecture survey was 69% and on the post-lecture survey was 78%, however, this did not reach statistical significance (p = 0.24). Of the interns that attended at least one lectures in the four-part series, 13 of 13 rated the lectures as very or extremely useful. CONCLUSION: Interns found the Pediatric Cross-Cover curriculum useful and their confidence improved after participating. It is unknown whether this change in confidence was due to the curriculum or the increase in overall experience managing patients from Sept. 2020 to Jan. 2021.

Presented by

Taylor Broome

Institution

1Internal Medicine-Pediatrics Residency, University of Michigan. 2Pediatrics Residency, University of Michigan. 3Internal Medicine-Pediatrics Hospitalist, University of Michigan.

Keywords

60: USE OF RESIDENT-PREPARED CHALK TALKS TO ENHANCE MEDICAL STUDENT EDUCATION

A. Kendall1; B. Pritz1; E. Jacobson1

Zoe Raglow, Meredith Sharp, Alison Tribble

Abstract

Background/Significance: Bloodstream infections (BSI) are a major cause of morbidity and mortality in hospitalized pediatric patients, and blood cultures remain the gold standard for the diagnosis of BSI. Studies have consistently shown that increasing blood culture volume increases pathogen recovery, which has led to standardized recommendations for blood culture volume in adults. Inherent problems with pediatric phlebotomy, most importantly small blood volumes, make standardization in pediatrics difficult; this has led to variations in practice. Though many pediatric hospitals have institutional guidelines for the collection of pediatric blood cultures, practices at the University of Michigan vary, and an institutional guideline does not exist. Methods: Data were obtained from the University of Michigan microbiology lab detailing average aerobic blood culture volume collected by pediatric unit to evaluate current practices. Blood cultures were incubated in the BD BACTEC™ FX blood cultures system. The average blood volume per aerobic culture bottle for each unit was obtained from the instrument from October 2018 –December 2020. Student’s t-test was used to compare blood volumes over the study period. Stakeholders including phlebotomy, nursing, and physician staff were interviewed to assess current practices. A literature search was performed and key studies were reviewed to assess the status of current research regarding pediatric blood culture collection. Finally, institutional guidelines from other pediatric institutions were reviewed. These studies and guidelines, along with interviews with stakeholders and institutional blood culture volume data, were used to develop institutional guidelines for the collection of pediatric blood cultures. Results/Outcome: Pediatric blood culture volume varied across units; in the fourth quarter of 2020, unit 12E had the highest average blood culture volume (3.4 mL/culture bottle; n=88) and CES had the lowest (1.1 mL/culture bottle; n=326). Over the study period, blood volume collected remained relatively stable (mean value across all surveyed units in 2019 was 2.07 mL/culture bottle; n=6905; mean value in 2020 was 2.16 mL/culture bottle, n=6392; p=0.72; Figure 1). Interviews with stakeholders as listed above revealed varying practices across pediatric units as evidenced by inconsistent volumes noted in microbiology data. To create institutional guidelines, estimated total blood volume by weight was referenced from Harriet Lane Handbook. This was used to approximate a maximum of 1% blood volume per blood culture draw and create weight-based recommendations for blood culture volume. Based on the newly developed guideline and the expected average patient size per unit, the majority of units were collecting volumes substantially smaller than recommended. Discussion/Conclusions: A review of the current practices at our institution revealed significant variation in institutional blood culture collection, including suboptimal blood volume collection in some units, which may lead to decreased pathogen recovery and difficulty distinguishing contaminants from true pathogens. Utilizing current literature and guidelines from other pediatric institutions, guidelines were created to recommended blood culture volume by patient weight. These guidelines are currently under institutional review.

Presented by

Zoe Raglow and Meredith Sharp

Institution

Residency Program Pediatrics, Michigan Medicine

Keywords

62: IMPROVING PATIENT SAFETY FOR PATIENTS WITH TYPE 1 DIABETES ON DILUTED INSULIN: SUPPORTING NURSE AND RESIDENT EDUCATION

L. Reynolds1, A. Garrity1, N Said1, I. Thomas1, J. Lee1

Abstract

Background: Treatment of type 1 diabetes in infants and toddlers is challenging due to the small amounts of insulin needed, which necessitates the use of diluted insulin. Diluted insulin allows for more precise dosing, but if used incorrectly can lead to hypoglycemia and other serious safety events. A number of incident reports were recently filed for inpatients on diluted insulin. Methods: We developed a key driver diagram (KDD) and identified a number of drivers that contribute to reducing these safety events. One primary driver for improving patient safety with the use of diluted insulin is to improve nurse and resident confidence and knowledge. To address this, we designed an electronic survey for nurses and residents who are involved in taking care of inpatients with type 1 diabetes to assess baseline confidence and knowledge of how to dose diluted insulin. Results: The survey was completed by 50 pediatric nurses/residents. When asked if they felt confident teaching families how to calculate a diluted insulin dose 73% of respondents disagreed or strongly disagreed. Only 56% of respondents were able to calculate the correct diluted insulin dose when that dose involved both carbohydrate coverage and a correction. Conclusions: We have found that nurses and residents are not confident in using diluted insulin and there are gaps in their knowledge regarding use of diluted insulin, both of which can contribute to patient safety events. Thus, we plan to create education materials to improve nurse and resident knowledge and confidence with diluted insulin. We will then assess improvement in these areas with a post education survey.

Presented by

Lyndsey Reynolds

Institution

1 Pediatric Endocrinology, University of Michigan, Ann Arbor, MI

Keywords

AWARD, PlatformPresentation(1-3pm)

63: SCREENING FOR CELIAC DISEASE IN PATIENTS NEWLY DIAGNOSED WITH TYPE 1 DIABETES – AN INSTITUTIONAL REVIEW

A. Rompca1; G. Lee2

Abstract

Background: A higher incidence of celiac disease (CD) exists in patients with type 1 diabetes mellitus (T1DM) compared to the general population. Because of this, routine screening for CD is recommended starting at diagnosis and at regular intervals thereafter. The goal of this study is to review the rate of screening for CD in patients newly diagnosed with T1DM at this institution and compare to national screening guidelines. Methods: Investigators performed a retrospective chart review of all patients diagnosed with type 1 diabetes in a five-year span at this institution (10/2015 through 09/2020). This review included laboratory studies obtained within 3 months of diagnosis, including tissue transglutaminase-IgA (tTG-IgA), tTG-IgG, and endomysial antibody (EMA) IgA. Repeat testing of tTG at any point in these five years was analyzed. Results: In this five-year timespan, 628 patients were diagnosed with T1DM. Of these patients, 449 patients (71.5%) were screened with either tTG or EMA. Both tTG and EMA were obtained in 51.8% of patients. Of the screened patients (449), 9.1% of patients had a positive result of either tTG or EMA, and 0.67% were indeterminate. Repeat tTG was obtained in 27.9% of patients; 48% of these patients tested negative at diagnosis, 13.1% were positive at diagnosis, 0.6% indeterminate at diagnosis, and 38.3% were not screened or did not have data in the system at diagnosis. Conclusion: These results indicate that, while the majority of newly diagnosed patients were screened, there is room for improvement in the consistency of screening at diagnosis and follow-up. Limitations of this study include the limited time-span for indicating follow-up based on when patients were diagnosed in the study span. In addition, some patients were included in data set that were diagnosed at an outside institution, transitioned to this institution, and may not have had access to laboratory results at diagnosis.

Presented by

Annemarie Rompca

Institution

1Michigan Medicine, Department of Pediatrics, University of Michigan; 2Department of Pediatric Gastroenterology, University of Michigan

Keywords

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Available May 11, 2021 12-1:00 PM

64: PHYSICIAN SURVEY REGARDING PEDIATRIC MUSLIM FASTING IN MICHIGAN

E. Dabaja1; E. Sahloul2; S. Haider1

Abstract

Background: Fasting during the holy month of Ramadan is one of the primary pillars of Islam. Muslims abstain from all water, food, and medications from dawn to dusk for the duration of the month. Fasting is considered obligatory for observant Muslims, including adolescents starting at puberty. Our study is focused on assessing physician knowledge and clinical practice in Michigan. To date, the existing medical literature focuses on health outcomes among adults who fast, with little attention paid to pediatric fasting practices. Methods: An anonymous, digital survey was conducted using Qualtrics software. Participants were recruited online at various hospitals in Michigan. To be eligible for the study, participants must identify as residents, fellows or attendings in Pediatrics, Medicine-Pediatrics, or Family Medicine. Results: From March to April 2019, 269 participants responded to the physician survey with 90% (243/269) identifying as Pediatrics trained. Of those pediatricians, 47% (114/243) were residents, 8% (19/243) were fellows and 45% (109/243) were attendings across multiple general practices and sub-specialties. To further stratify participants, 39% (94/243) identified as working at the Children’s Hospital of Michigan, 18% (45/243) at Helen Devos Children’s Hospital, and 22% (53/243) at the University of Michigan C.S. Mott Children’s Hospital. About 53% (138/259) of physicians had at least a moderate amount of exposure to Muslim pediatric patients in their clinical practice. Most physicians, 66% (167/253), reported they never asked their pediatric patients or their families about fasting. About 61% (159/259) of participants rated their understanding of fasting as minimal to none. Another 54% (140/259) of participants reported feeling somewhat or extremely uncomfortable discussing fasting recommendations with their pediatrics patients and their families. Interestingly, about 25% (65/252) said they did not believe there were any health benefits associated with fasting, with 95% (229/242) of physicians citing dehydration as an important health concern for their pediatric patients. Conclusion: Our study is the first of its kind in assessing current knowledge and clinical practice regarding Muslim pediatric fasting among physicians in Michigan. This study is especially relevant as there is a diverse and growing Muslim community in Michigan. In addition, it highlighted a gap in physician’s understanding and comfort level regarding providing necessary anticipatory guidance for pediatric patients and their families.

Presented by

Eman Sahloul

Institution

1Children’s Hospital of Michigan, Detroit Medical Center, Detroit, MI 2 C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI

Keywords

DEI

Background: The utilization of placental blood for neonatal blood cultures on admission has the potential to decrease iatrogenic anemia in the infant and minimize the need for red blood cell transfusion. Literature demonstrates feasibility of obtaining cord blood for neonatal admission labs, including blood cultures, with false-positive rates ranging from 0-12.5%1. However, hesitation persists regarding the utilization of cord blood for blood cultures and risk of contamination.

Objective: This study aimed to determine the accuracy of obtaining cord blood cultures on healthy, asymptomatic term infants on admission to this institution by assessing the false-positive rate, or contamination rate.

Methods: Cord blood cultures were obtained from 119 asymptomatic, term/near term infants from October 2018 to March 2020. All infants had no risk factors for sepsis and remained clinically stable throughout their admission. Cord blood cultures were obtained by two neonatal nurse practitioners. A standardized guideline for obtaining cultures was developed and used.

Results: Cord blood cultures from placental blood were obtained in 118 infants. There were 3 positive cord blood cultures that grew coagulase-negative Staphylococcus, Staphylococcus epidermidis, and Corynebacterium species. All three of these samples were attributed to contamination, due to the nature of the bacteria species that grew and clinical stability of infants from which they were obtained. These findings demonstrated a false-positive rate of 2.5% with 95% CI [0.005, 0.072], which is comparable to the most recent false-positive rate of peripheral blood cultures at this institution (1.5% in 2020, 1.3% in 2019, 1.39% in 2018).

Conclusion: These findings support the accuracy of obtaining blood cultures from cord blood as opposed to drawing blood from newborns on admission. This also allows for a larger blood sample to be obtained, which decreases the false-negative rate as well. These cord blood cultures obtained on healthy, term infants can be used to establish a control rate, with further studies on obtaining cord blood cultures from premature and unstable infants. Use of cord blood for admission labs in these infants has the potential to reduce the amount of blood loss and minimize blood transfusions, which have been associated with decreased risk of intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis and death2.

1Medeiros PB, Stark M, Long M, Allen E, Grace E, Andersen C. Feasibility and accuracy of cord blood sampling for admission laboratory investigations: A pilot trial. J Paediatr Child Health. 2020 Nov 10. 2Galel S, Fontaine MJ. Hazards of neonatal blood transfusion. Neoreviews. 2006;7(2):e69-e75.

Presented by

Sheri VanOmen

Institution

1Department of Pediatrics, University of Michigan, Ann Arbor, MI 2Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, MI

Keywords

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Available May 11, 2021 12-1:00 PM