Devices In Pediatric Patients Research Articles

Cutaneous Adverse Effects From Diabetes Devices in Pediatric Patients With Type 1 Diabetes Mellitus: Systematic Review

Abstract Background Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance. Objective This systematic review aims to explore the current literature surrounding dermatologic complications of CGM and CSII as well as the impact on patient outcomes. Methods A systematic review of the literature was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines using 5 online databases. Included articles were those containing primary data relevant to human participants and adverse reactions to CGM and CSII devices in pediatric populations, of which greater than 50% of the sample size were aged 0‐21 years. Qualitative analysis was chosen due to the heterogeneity of outcomes. Results Following the application of exclusion criteria, 25 studies were analyzed and discussed. An additional 5 studies were identified after the initial search and inclusion. The most common complication covered is contact dermatitis, with 13 identified studies. Further, 7 studies concerned lipodystrophies, 5 covered nonspecific cutaneous changes, 3 covered unique cutaneous findings such as granulomatous reactions and panniculitis, and 2 discussed user acceptability. Conclusions The dermatologic complications of CGM and CSII pose a potential risk to long-term glycemic control in T1D, especially in young patients where skin lesions can lead to discontinuation. Increased manufacturer transparency is critical and further studies are needed to expand upon the current preventative measures such as device site rotation and steroid creams, which lack consistent effectiveness.

Outcomes of Intracorporeal Continuous and Paracorporeal Pulsatile Ventricular Assist Devices in Pediatric Patients 10-30 kg: Erratum.

Outcomes of Intracorporeal Continuous and Paracorporeal Pulsatile Ventricular Assist Devices in Pediatric Patients 10-30 kg: Erratum.

Capture of Group A Streptococcus by Open-Microfluidic CandyCollect Device in Pediatric Patients.

Obtaining high-quality samples to diagnose streptococcal pharyngitis in pediatric patients is challenging due to discomfort associated with traditional pharyngeal swabs. This may cause reluctance to go to the clinic, inaccurate diagnosis, or inappropriate treatment for children with sore throat. Here, we determined the efficacy of CandyCollect, a lollipop-inspired open-microfluidic pathogen collection device, to capture Group A Streptococcus (GAS) and compare user preference for CandyCollect, conventional pharyngeal swabs, or mouth swabs in children with pharyngitis and their caregivers. All child participants (30/30) were positive for GAS by qPCR on both the mouth swab and CandyCollect. Caregivers ranked CandyCollect as a good sampling method overall (27/30), and all caregivers (30/30) would recommend CandyCollect for children 5 years and older. Twenty-three of 30 children "really like" the taste and 24/30 would prefer to use CandyCollect if a future test were needed. All caregivers (30/30) and most children (28/30) would be willing to use CandyCollect at home. All participants tested positive for GAS on all three collection methods (pharyngeal swab, mouth swab, and CandyCollect). While both caregivers and children like CandyCollect, some caregivers would prefer a shorter collection time. Future work includes additional studies with larger cohorts presenting with pharyngitis of unknown etiology and shortening collection time while maintaining the attractive form of the device. Obtaining oral samples for the diagnosis of streptococcal pharyngitis is of great importance for children. To address the challenges associated with traditional pharyngeal swab sampling, we developed the CandyCollect device, a lollipop-inspired open mesofluidic saliva sampling system. In this study, saliva samples were collected from children, aged 5-14 years, with CandyCollect and mouth swabs and analyzed via qPCR. The results show CandyCollect is the child preferred collection tool and had 100% concordance with the results from traditional diagnosis methods as part of their clinical care.

P.493: Utilization of mechanical assist devices in pediatric patients with end-stage heart failure.

P.493: Utilization of mechanical assist devices in pediatric patients with end-stage heart failure.

Blood Gas Measurements Using Point-of-Care Testing Devices in Pediatric Patients

Blood Gas Measurements Using Point-of-Care Testing Devices in Pediatric Patients

Anorectal Manometry in Pediatric Colorectal Surgical Care.

Pediatric colorectal specialists care for patients with a variety of defecation disorders. Anorectal (AR) manometry testing is a valuable tool in the diagnosis and management of these children. This paper provides a summary of AR manometry techniques and applications as well as a review of AR manometry findings in pediatric patients with severe defecation disorders referred to a pediatric colorectal center. This is the first study describing multi-year experience using a portable AR manometry device in pediatric patients. An electronic medical record review was performed (1/2018 to 12/2023) of pediatric patients with defecation disorders who had AR manometry testing. Demographics, diagnostic findings, and outcomes are described. A total of 297 unique patients (56.9% male, n = 169) had AR manometry testing. Of these, 72% (n = 188) had dyssynergic defecation patterns, of which 67.6% (n = 127) had fecal soiling prior to treatment. Pelvic rehabilitation (PR) was administered to 35.4% (n = 105) of all patients. A total of 79.5% (n = 58) of the 73 patients that had fecal soiling at initial presentation and completed PR with physical therapy and a bowel management program were continent after therapy. AR manometry was well tolerated, with no major complications. AR manometry is a simple test that can help guide the management of pediatric colorectal surgical patients with defecation disorders. As a secondary finding, PR is a useful treatment for patients with dyssynergic stooling.

(130) - Clinical Features to Predict Weaning from Ventricular Assist Device in Pediatric Patients with Myocarditis

(130) - Clinical Features to Predict Weaning from Ventricular Assist Device in Pediatric Patients with Myocarditis

Continuous timely monitoring of core temperature with two wearable devices in pediatric patients undergoing chemotherapy for cancer – a comparison study

PurposePediatric patients with cancer often develop chemotherapy-induced fever in neutropenia (FN), requiring emergency broad-spectrum antibiotics. Continuous temperature monitoring can lead to earlier FN detection and therapy with improved outcomes. We aimed to compare the feasibility of continuous core temperature monitoring with timely data availability between two wearable devices (WDs) in pediatric oncology patients undergoing chemotherapy.MethodsIn this prospective observational two-center study, 20 patients (median age: 8 years) undergoing chemotherapy simultaneously wore two WDs (CORE®, Everion®) for 14 days. The predefined goal was core temperature recorded in sufficient quality and available within ≤ 30 min during ≥ 18/24 h for ≥ 7/14 days in more than 15 patients.ResultsMore patients reached the goal with CORE® (n = 13) versus Everion® (n = 3) (difference, 50% p < 0.001). After correcting for the transmission bottleneck caused by two WDs transmitting via one gateway, these numbers increased (n = 15 versus n = 14; difference, 5%; p = 0.69). CORE® measurements corresponded better to ear temperatures (n = 528; mean bias, − 0.07 °C; mean absolute difference, 0.35 °C) than Everion® measurements (n = 532; − 1.06 °C; 1.10 °C). Acceptance rates for the WDs were 95% for CORE® and 89% for Everion®.ConclusionThe CORE® fulfilled the predefined feasibility criterion (15 of 20 patients) after correction for transmission bottleneck, and the Everion® nearly fulfilled it. Continuous core temperature recording of good quality and with timely data availability was feasible from preschool to adolescent patients undergoing chemotherapy for cancer. These results encourage the design of randomized controlled trials on continuously monitored core temperature in pediatric patients.Trial registration.ClinicalTrials.gov (NCT04914702) on June 7, 2021.

Outcomes of Intracorporeal Continuous and Paracorporeal Pulsatile Ventricular Assist Devices in Pediatric Patients 10-30 kg.

Ventricular assist devices (VADs) have been increasingly implanted in pediatric patients. Paracorporeal VADs are generally chosen when intracorporeal continuous (IC) devices are too large. Superiority between IC and paracorporeal pulsatile (PP) devices remains unclear in smaller pediatric patients. Our study analyzes outcomes of IC and PP VADs in pediatric patients who could be considered for either of these options. Using the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) database, we identified children between 10 and 30 kg who received a VAD between June 2018 and September 2021. Survival and stroke outcomes were analyzed based on VAD type. There were 41 patients in the IC group and 54 patients in the PP group. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile at the time of implant was higher in the PP cohort ( p < 0.02). The PP cohort was younger ( p < 0.001) and smaller ( p < 0.001) than the IC cohort. The diagnosis was similar between cohorts. Overall survival was similar between groups. Stroke was more common in the PP cohort, but did not reach statistical significance ( p = 0.07). Discharge was possible only in the IC group, but the discharge rate was low (9.5%). Direct comparisons remain challenging given differences in INTERMACS profiles, age, and size.

A prospective randomised study to compare the efficacy of Medicam pediatric video Laryngoscope and Macintosh Laryngoscope as an intubating device in pediatric patients: Videolaryngoscopy in pediatric airway

Introduction: Airway management in paediatric patients is always a challenging task due to limited functional reserve. Recently, many airway devices have been utilized with varied success rates. The Medicam Paediatric Video Laryngoscope (MPVL) is a recent addition that may significantly impact paediatric airway outcomes. Hence, the present study was designed to assess the efficacy of MPVL and the Macintosh direct laryngoscope in terms of intubation characteristics. Methods: Following ethical approval and informed consent, this prospective, randomized study included sixty ASA I and II patients of either sex aged between 2 and 10 years of age. Patients were randomly allocated into two groups: Medicam Paediatric Video Laryngocope and Direct Laringocopy (n = 30 each), to be intubated with the Medicam Paediatric video laryngoscope and Macintosh direct laryngoscope, respectively. The primary outcome was intubation time, while the secondary outcome was first attempt success rate, Cormack Lehane grade, and ease of intubation. Results: The mean time to intubation in group MPVL was 16.0 ± 2.88 seconds, and in group DL was 12.33 ± 2.72 seconds (p-value &lt; 0.05). Cormack-Lehane grade 1 was significantly higher in Group MPVL than Group DL (p = 0.04). The two devices were comparable in terms of first-attempt success rate and ease of intubation. No complications were observed except in one patient in the DL group. Conclusion: MPVL provides better glottis visualization and a trend towards a higher first attempt success rate at the expense of prolonged intubation time. However, the time difference regarding intubation was not clinically significant.

Percutaneous treatment of symptomatic deep vein thrombosis in adolescents using large-bore thrombectomy systems.

While large-bore mechanical thrombectomy provides effective venous thrombus removal, often with avoidance of thrombolytics, literature surrounding the application of these devices in pediatric patients is sparse. To report technical success and outcomes following large-bore thrombectomy systems in adolescent patients with deep venous thrombosis. A retrospective review identified all patients less than 18years of age undergoing mechanical venous thrombectomy at a single institution between 2018 and 2022. No patients were excluded. Technical success was defined as extraction of thrombus sufficient to restore unimpeded flow in affected segments. Clinical success was defined as resolution of presenting symptoms. Nine consecutive patients (6 females, 3 males; age range 15-17years) underwent 10 thrombectomy procedures using ClotTriever (n=6; 60%), FlowTriever (n=2; 20%), or both (n=2; 20%). Chronicity of thrombus was categorized as acute (<2weeks) in 6 (60%), subacute (2-6weeks) in 1 (10%), and chronic (>6weeks) in 3 (30%). Distribution of thrombus was lower extremity and/or inferior vena cava (IVC) in 9 (90%) and unilateral axillo-subclavian in 1 (10%). Technical success was achieved in 9 interventions (90%). Clinical success was achieved in 8 patients (88.9%). No patients received thrombolytics. There were no intraprocedural adverse events (AE). Minor complications (Society of Interventional Radiology mild adverse events) were observed in a delayed fashion following 2 interventions (20%). This preliminary experience demonstrated high rates of technical and clinical success with large-bore deep venous thrombectomy in adolescent patients across a range of thrombus chronicity and locations.

Clinical Use of Continuous Glucose Monitoring in Critically Ill Pediatric Patients with Diabetic Ketoacidosis.

Background: The use of continuous glucose monitoring (CGM) in pediatric patients with diabetic ketoacidosis (DKA) remains investigational, and data on its accuracy in pediatric intensive care units (PICU) are limited. This study evaluated the accuracy of three CGM devices in pediatric patients with DKA in the PICU. Methods: We compared 399 matched pairs of CGM and point-of-care capillary glucose (POC) values and grouped patients based on whether they changed their CGM sensor during their PICU stay. Results: Eighteen patients with a mean age of 10.98 ± 4.20 years were included, with three patients in the sensor change group. The overall mean absolute relative difference (MARD) was 13.02%. The Medtronic Guardian Sensor 3 (n = 331), Dexcom G6 (n = 41), and Abbott FreeStyle Libre 1 (n = 27) showed MARD values of 13.40%, 11.12%, and 11.33%, respectively. The surveillance error grid (SEG), Bland-Altman plot, and Pearson's correlation coefficient demonstrated satisfactory clinical accuracy of the CGM devices (SEG zones A and B, 98.5%; mean difference, 15.5 mg/dL; Pearson's correlation coefficient [r2], 0.76, P < 0.0001). MARD was significantly lower in subjects who did not experience a sensor change (11.74% vs. 17.31%, P = 0.048). Also, a statistically significant negative correlation was found between serum bicarbonate levels and POC-CGM values (r = -0.34, P < 0.001). Conclusions: The severity of DKA has a major effect on reducing the accuracy of the CGM, especially during the first several days in the intensive care unit. The reduced accuracy appears to be related to acidosis, as reflected in the serum bicarbonate levels.

PEDS10: Characterizing the Fit of Transvalvular Left Ventricular Micro-Axial Flow Pumps in Pediatric Patients

Background: There are few FDA approved mechanical circulatory support (MCS) devices for pediatric patients. Physicians in the US and Europe have increasingly elected to use the Impella platform to support pediatric patients including use in axillary arteries with diameters as small as 4.8 mm for the Impella 5.5 with SmartAssist (21 F) without complication. Given the increasing use of these devices in pediatric patients, there is a need to quantify and characterize the device fit in this population. Methods: 3D anatomical reconstructions were built from pediatric cardiac CT scans (n=23, age 0.8-9.3 years, BSA 0.45-1.09 m2). The length of the left ventricle & ascending aorta and the diameters of the brachiocephalic & lower left subclavian arteries were measured via clinical CT practices and modeled as a scalar relationship to BSA using simple linear regression & bounded by critical Impella dimensions to evaluate transvalvular fit. Estimated distal artery diameters were calculated via published vessel models to evaluate intravascular device delivery potential. The models were tested on pediatric Impella patient data as reported in published case studies (n=27, age 4-19 years, BSA 0.91-2.38 m2). Results: CT scan reconstructions suggest sufficient LV length in 0.6 m2 and 1.2 m2 BSA patients for Impella 5.5 and Impella CP, respectively. For direct aortic implant, BSA >1.1 m2 may be required due to ascending aortic length. The ostial segments of the brachiocephalic and left subclavian arteries were of adequate size for Impella 5.5 in patients with BSA as small as 0.53 m2. Published models correlating vessel diameter with BSA suggest BSA >0.86 m2 and >1.15 m2 patients could fit Impella CP and Impella 5.5, respectively, via midclavicular axillary access. Modeled vessel diameters predict that all pediatric Impella patients evaluated (27/27) would fit an Impella CP, and 74% (20/27) would fit an Impella 5.5 compared with the minimum vessel size reported in the literature. Conclusions: These analyses outline critical parameters for current Impella devices to fit pediatric patients. Further characterization of pediatric vessel sizes based on readily available clinical metrics such as BSA may aid physician decisions for MCS use in patients in critical need.

141 Polyvinylpyrrolidone-Coated Catheters Show Fewer Astrocytes and Choroid Plexus Epithelium Adhesion and Better Flow/Pressure Performance Than Other Commercial Catheters in a New Catheter Assay System

INTRODUCTION: The major cause of failure of cerebral spinal fluid (CSF) shunting devices in pediatric patients is proximal catheter occlusion. There are a number of shunt catheters commercially available, but their occlusion properties are unclear. METHODS: There were four catheters tested: 1) antibiotic-impregnated, 2) polyvinylpyrrolidone, 3) barium stripe, and 4) barium impregnated. Catheters were inoculated with cultured astrocytes or choroid cells and incubated in growth media for 7 days prior to testing. Sample catheters were placed into a 3D-printed ventricular replicating system to test occlusion properties. Artificial CSF was pumped through the system to mimic physiologic flow and pressure resistance sensors measured obstruction. Afterward testing, catheters were stained with anti-GFAP or anti-transthyretin to visualize cellular adhesion using a fluorescence microscope. RESULTS: Five catheters of each type were used. Polyvinylpyrrolidone catheters had the highest flow (e.g., least obstruction) in the ventricular replication system (0.12 mL/min) compared to the antibiotic coated (0.10 mL/min), barium stripe (0.02 mL/min) or barium impregnated (0.08 mL/min; p &lt; 0.01). Polyvinylpyrrolidone catheters showed the lowest median cell attachment after cell marker staining (&lt;1 cells per 0.07 mm2) compared to antibiotic coated (4.0 cells per 0.07 mm2), barium stripe (3.5 per 0.07 mm2) or barium impregnated (2.0 per 0.07 mm2). CONCLUSIONS: Polyvinylpyrrolidone catheters were least likely to be occluded by astrocytes or choroid cells during testing in a novel ventricular replicating system due to lower cellular adhesion. Our findings may have clinical significance when choosing proximal ventricular catheters that are least likely to occlude and prevent proximal shunt failure.

Comparison of oropharyngeal leak pressure of I-gelTM and BlockbusterTM laryngeal mask airway in anaesthetized pediatric patients.

Supraglottic airways (SGA) are increasingly used in pediatric anesthesia.Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This studywas conducted to compare the clinical performance of I-gelTM and BlockbusterTM LMA in pediatric patients. A total of 140 children aged 1-5 years, who were undergoing elective surgery,were randomized into two groups either I-gelTM (Group I) or BlockbusterTM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under generalanesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), andsecondary objectives were number of attempts of device insertion, success rate, ease ofLMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities. The mean OPLP was significantly higher for I-gelTM compared to BlockbusterTM LMA(27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on thefirst attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time,ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups. The I-gelTM was more efficacious device in term of OPLP than BlockbusterTMLMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia.

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Executive Summary

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Executive Summary

Assessment of Safety and Efficacy of Anesthesia using Sevoflurane with Supraglottic Airway Device In Pediatric Patients Undergoing Magnetic Resonance Imaging

Objectives: To determine the safety and efficacy of Sevoflurane anaesthesia with a supraglottic airway device for MRI.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Anaesthesiology, of Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul to Dec 2019.&#x0D; Methodology: A sample size of 152 patients were calculated, including both genders from birth to 12 years. After applying inclusion and exclusion criteria, patients were chosen to undergo inhalational anaesthesia with Sevoflurane, including supraglottic airway device (SAD) insertion. After MRI, SAD was removed upon awakening and patients were shifted to the post-anaesthesia care unit (PACU) for further monitoring.&#x0D; Results: The mean age of patients was 4.07±2.312 years. Out of 152 patients, ninety (60%) were males, and sixty patients (40%) were females. Hypoxemia was seen in 1.3% cases, laryngospasm in 1.3%, and apnoea in 8% and coughing in 5% patients. There were no any other complications.&#x0D; Conclusion: The study concluded that Sevoflurane anaesthesia with SAD is a safe and reliable technique for artefact-free MRI of paediatric patients.

Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis

This research aimed to produce a coherent ranking of the effectiveness of intubation devices in pediatric patients using network meta-analysis (NMA). We searched the electric databases for prospective randomized studies that compared different tracheal intubation devices in pediatric patients. The primary outcome was intubation failure at the first attempt. Secondary outcomes were glottic visualization and intubation time. The statistical analysis performed used DerSimonian and Laird random-effects models. Frequentist network meta-analysis was conducted, and network plots and network league tables were produced. Subgroup analysis was performed after excluding rigid-fiberscope-type indirect laryngoscopes. Thirty-four trials comparing 13 devices were included. Most laryngoscopes had the same intubation failure rate as the Macintosh reference device. Only the Truview PCD™ had a significantly higher intubation failure rate than the Macintosh (odds ratio 4.78, 95% confidence interval 1.11–20.6) The highest-ranking laryngoscope was the Airtaq™ (P score, 0.90), and the AirwayScope™, McGrath™, and Truview EVO2™ ranked higher than the Macintosh. The Bullard™ had the lowest ranking (P score, 0.08). All laryngoscopes had the same level of glottic visualization as the Macintosh and only the C-MAC™ had a significantly shorter intubation time. Intubation time was significantly longer when using the GlideScope™, Storz DCI™, Truview PCD™, or Bullard™ compared with the Macintosh. P score and ranking of devices in the subgroup analyses were similar to those in the main analysis. We applied NMA to create a consistent ranking of the effectiveness of intubation devices in pediatric patients. The findings of NMA suggest that there is presently no laryngoscope superior to the Macintosh laryngoscope in terms of tracheal intubation failure rate and glottic visualization in pediatric patients.

Asistencia de larga duración en pacientes pediátricos: 15 años de experiencia

Background and aimThe aim is to analyse clinical and survival results after the implant of a long-term mechanical assist device in pediatric patients in the end stages of heart failure. MethodsBetween January 2006 and November 2021 34 Berlin Heart EXCOR® devices were implanted in pediatric patients. We analysed preoperative and intraoperative characteristics, together with complications after implant. Outcomes were also evaluated (transplant vs. death). Statistical analysis with STATAIC15. ResultsThe mean age was 51±53 months (1-180), mean weight 17±16kg (2.2-65). Underlying heart disease was myocardiopathy in 68% and congenital heart disease in 32%. The Berlin Heart EXCOR® device was univentricular in 64% of the patients. Surgical indication was bridge to transplant in 97%. Mean duration of mechanical support was 92±105 days (1-511). Postoperative complications were common: 62% infectious and 44% neurological (29% ischaemic and 15% haemorrhagic). Mortality of haemorrhagic strokes 80%, ischaemic 20%. Since 2019, when heparin was changed to bivalirudin, no mortal strokes were observed. 71% of the patients has been transplanted, 29% has died. ConclusionsAs a response to the increasing number of paediatric patients in end stages of congestive heart failure, the use of the Berlin Heart EXCOR® device has spread, especially if the intention is to use it as bridge to transplant. Neurological events, mostly haemorrhagic, are the most feared because of high mortality. Nevertheless, it is an encouraging alternative as a long-term mechanical assist device in children, allowing them to reach the transplant in 71% of the cases.

The Position and Orientation of the Pulse Generator Affects MRI RF Heating of Epicardial Leads in Children.

Infants and children with congenital heart defects often receive a cardiac implantable electronic device (CIED). Because transvenous access to the heart is difficult in patients with small veins, the majority of young children receive epicardial CIEDs. Unfortunately, however, once an epicardial CIED is placed, patients are no longer eligible to receive magnetic resonance imaging (MRI) exams due to the unknown risk of MRI-induced radiofrequency (RF) heating of the device. Although many studies have assessed the role of device configuration in RF heating of endocardial CIEDs in adults, such case for epicardial devices in pediatric patients is relatively unexplored. In this study, we evaluated the variation in RF heating of an epicardial lead due to changes in the lateral position and orientation of the implantable pulse generator (IPG). We found that changing the orientation and position of the IPG resulted in a five-fold variation in the RF heating at the lead's tip. Maximum heating was observed when the IPG was moved to a left lateral abdominal position of patient, and minimum heating was observed when the IPG was positioned directly under the heart. Clinical Relevance- This study examines the role of device configuration on MRI-induced RF heating of an epicardial CIED in a pediatric phantom. Results could help pediatric cardiac surgeons to modify device implantation to reduce future risks of MRI in patients.