Hasbro Children's Hospital Research Articles

1116-P: Increase in the Incidence of Type 2 Diabetes in Children <11 Years during the COVID-19 Pandemic

Objectives: To analyze the incidence and characteristics of new-onset type 2 diabetes (T2D) in youth < 11years prior to and during the COVID-19 pandemic, and to compare the metabolic parameters at presentation in younger (< 11 years) versus older youth (11-21 years). Study methods: We performed a retrospective chart review of newly diagnosed T2D among youth < 21 years at Hasbro Children's Hospital between 1/1/2017 and 12/31/2021. We analyzed the incidence of cases presenting at < 11 years pre (1/1/2017 to 2/29/20) and during (3/1/20-12/31/21) the COVID-19 pandemic. We compared metabolic parameters of those presenting < 11years to ≥ 11 years during the pandemic. Results:Eight youth < 11 years (8/145, (5.5 %)) presented with new-onset T2D during the study period (Table1), and all presented during the pandemic (8/89, 9%). Compared to older youth, those < 11years had higher BMI percentile (166% of the 95th%tile ± 38.4 vs. 139.4% ± 42.6, p=0.03), and were more likely to have diastolic hypertension (62.5% vs. 23.8%, p=0.03). Conclusions: We report an abrupt rise in the incidence of new-onset T2D in children < 11 years during the COVID-19 pandemic. Compared to older youth, younger children were more obese, and were more likely to have diastolic hypertension. Further study is needed to elucidate contributing factors to this concerning finding, and to further aid in pediatric T2D prevention. Disclosure S.Sasidharan pillai: None. P.Has: None. L.S.Topor: None. M.E.Fredette: None.

362. Association of Eosinophilia with Parasites in Rhode Island Refugees, 2015 - 2020

Abstract Background There are sparse data reporting the rates of potentially pathogenic parasites in asymptomatic, newly arrived refugees to the United States. Untreated parasitic infections can have significant health consequences including anemia, malnutrition, infertility, urinary tract malignancy, and death, among others. Eosinophilia may serve as a biomarker for certain parasites, but its reliability is debated. We hypothesized that detection of eosinophilia in refugees to Rhode Island would be useful for guiding management in this vulnerable population. Methods A retrospective chart review was performed on all adult and pediatric refugees who had their initial refugee intake clinic visit at Lifespan’s Center for Primary Care Refugee Clinic, Hasbro Children Hospital’s Refugee Clinic, or Medicine-Pediatrics Refugee Clinic, all in Rhode Island, from January 2015 to December 2020. Patients who had delayed intakes or were originally evaluated in other states were not eligible. Data were systematically collated in RedCap and descriptive statistics were performed. Results Charts of 955 refugees were reviewed retrospectively, of which 143 did not meet eligibility criteria and were excluded. Overall, 505 (62.2%) patients were from Africa, 242 (29.8%) from Asia, 32 (3.9%) from the Americas, 32 (3.9%) from Europe, and 1 (0.1%) from Australia. Among the 812 individuals included, 147 (18.1%) patients had eosinophil counts > 500/uL, of whom 113 (76.9%) had mild (450-1499/uL), 30 (20.4%) had moderate (1500-4999/uL), and 4 (2.7%) had severe eosinophilia (⪰ 5000/uL). The majority of patients with or without eosinophilia originated from Africa. Prevalence of symptoms (Table 1) ranged from 0% (bloody stools) to 17.6% (abdominal pain). Overall, > 50% of refugees tested positive for a parasite by various methods (Table 2). Serology did not distinguish between acute or past infection. One patient (0.7%) was diagnosed with Plasmodium falciparum malaria. Table 1.Symptoms at Initial Encounter Among Patients With Eosinophilia (n=68)Table 2.Lab Values Among Patients with Eosinophilia (n=147) Conclusion Eosinophilia was common in both adult and pediatric asymptomatic refugees in Rhode Island who had parasites detected by various tests. Therefore, we conclude that routine testing for eosinophilia may inform treatment of potentially dangerous parasites in the absence of symptoms. Disclosures All Authors: No reported disclosures.

Self-Perception of Transition Readiness Amongst Pediatric Patients with Childhood Heart Disease.

This study assesses self-report of transition readiness among adolescents and young adults (ages 12-25years) with childhood and congenital heart disease (CHD), receiving care at Hasbro Children's Hospital, whose CHD diagnosis warranted transfer to adult cardiology care. Patients were mailed the American Academy of Pediatrics/American College of Physicians Transition Readiness for Youth Assessment survey. Confidence scores ranged between 0 (not) and 10 (very). Mann-Whitney U test was used to assess differences in scores between younger (12-17years) and older (18-25years) groups. 396 patients met inclusion criteria; 88 surveys were returned. Half of respondents were in the older group. While most respondents felt empowered to take charge of their own health and equally confident about moving to adult care, this did not always translate to actual knowledge. Younger patients had statistically significant lower knowledge scores in these metrics. Aspects of care with low scores include medication refills, communication with primary care team, and the lifelong need for cardiology follow up and health insurance. This discrepancy between self-report and actual knowledge highlights the need for more varied and age appropriate interventions to help patients navigate a complex healthcare system. A concrete approach to acquire the knowledge necessary to ensure successful transfer to adult cardiology care should be a focus.

Righting the course of the ship: How professional shared governance can implement a behavior system

The Pediatric Inpatient Medical Psychiatric Program (Selya 6) at Hasbro Children's Hospital is a unique environment structured to simultaneously address the physical and emotional needs of adolescents. Located at the top floor of Rhode Island's only Level 1 trauma center for children, this unit manages typical medical conditions with psychiatric comorbidity, with access to specialty consultations from departments within the hospital. Early this year, Selya 6 found itself needing to recalibrate its integrated approach in the caring for patients; thus, the unit reformed the Professional Shared Governance Committee (PSGC). The PSGC was composed of representation from psychiatry, pediatrics, psychology, social work, nursing, and milieu staff. This article explores the implementation of a new behavior system to promote positive reinforcement for patients using the PSGC, and examines Erik Erikson's Identity versus Role Confusion as an overarching principle for growth during a critical development period.

Rethinking Greulich and Pyle: A Deep Learning Approach to Pediatric Bone Age Assessment Using Pediatric Trauma Hand Radiographs.

To develop a deep learning approach to bone age assessment based on a training set of developmentally normal pediatric hand radiographs and to compare this approach with automated and manual bone age assessment methods based on Greulich and Pyle (GP). In this retrospective study, a convolutional neural network (trauma hand radiograph-trained deep learning bone age assessment method [TDL-BAAM]) was trained on 15 129 frontal view pediatric trauma hand radiographs obtained between December 14, 2009, and May 31, 2017, from Children's Hospital of New York, to predict chronological age. A total of 214 trauma hand radiographs from Hasbro Children's Hospital were used as an independent test set. The test set was rated by the TDL-BAAM model as well as a GP-based deep learning model (GPDL-BAAM) and two pediatric radiologists (radiologists 1 and 2) using the GP method. All ratings were compared with chronological age using mean absolute error (MAE), and standard concordance analyses were performed. The MAE of the TDL-BAAM model was 11.1 months, compared with 12.9 months for GPDL-BAAM (P = .0005), 14.6 months for radiologist 1 (P < .0001), and 16.0 for radiologist 2 (P < .0001). For TDL-BAAM, 95.3% of predictions were within 24 months of chronological age compared with 91.6% for GPDL-BAAM (P = .096), 86.0% for radiologist 1 (P < .0001), and 84.6% for radiologist 2 (P < .0001). Concordance was high between all methods and chronological age (intraclass coefficient > 0.93). Deep learning models demonstrated a systematic bias with a tendency to overpredict age for younger children versus radiologists who showed a consistent mean bias. A deep learning model trained on pediatric trauma hand radiographs is on par with automated and manual GP-based methods for bone age assessment and provides a foundation for developing population-specific deep learning algorithms for bone age assessment in modern pediatric populations.Supplemental material is available for this article.© RSNA, 2020See also the commentary by Halabi in this issue.

NASPGHAN Distinguished Service Award 2019: Neal S. LeLeiko.

NASPGHAN Distinguished Service Award 2019: Neal S. LeLeiko.

Perspectives from abroad: Reflections from my time working in a Cambodian children's hospital

In April, I spent a month working at the Angkor Hospital for Children in Siem Reap, Cambodia, with one of my pediatric colleagues, Dr. Jennifer Mann. Hasbro Children's Hospital has had a long partnership with Angkor and has sent many pediatric attendings and residents over the years. I spent the majority of my first weeks there working in the general inpatient unit, where I saw cases that I had never encountered during my time in medical school and residency, as well as many that I had. Due to lower rates of vaccination among Cambodian children, I saw patients with diseases I had only read about in textbooks. I also saw numerous children suffering from severe malnutrition, including an infant where the family was using rice water for feeding after the mother was unable to produce breast milk. I also learned about diseases endemic to the area that I had either never heard of or had only encountered in passing, such as melioidosis and Dengue fever.

Home Hospice

Rebecca MacDonell-Yilmaz received her bachelor of arts and master of public health degrees from Dartmouth College in Hanover, NH. She earned her MD from Stony Brook University in Stony Brook, NY, and completed a pediatrics residency, chief residency, and hospice and palliative medicine fellowship at Hasbro Children's Hospital and Rhode Island Hospital in Providence. She is currently a fellow in pediatric hematology/oncology. In her spare time, she enjoys writing, reading, and spending time with her husband and two sons. “Home Hospice” © 2018 by Rebecca MacDonell-Yilmaz. Contact author: [email protected]. Art of Nursing is coordinated by Amy M. Collins, managing editor: [email protected].

'Emergency nursing is the best job you'll ever have'.

What is your job? I am a clinical development specialist at Hasbro Children's Hospital, the paediatric division of Rhode Island Hospital in Providence, US. I educate and mentor new graduate nurses from the paediatric emergency department (ED) and inpatient areas.

Domestic Minor Sex Trafficking Patients: A Retrospective Analysis of Medical Presentation

Study ObjectiveTo describe the clinical characteristics of patients referred for domestic minor sex trafficking (DMST) to improve identification and intervention. DesignRetrospective cohort study. SettingThe Lawrence A. Aubin, Sr Child Protection Center at Hasbro Children's Hospital where patients are evaluated by child abuse pediatricians in outpatient, emergency department, and inpatient settings. ParticipantsA total of 41 patients younger than the age of 18 years referred for the evaluation of DMST involvement between August 1, 2013 and March 30, 2015. Interventions and Main Outcome MeasuresWe collected demographic, social-environmental, medical, and psychiatric variables from the medical records of patients referred for evaluation who have self-disclosed, been reported with evidence, and/or have histories that place them at high risk for DMST involvement. ResultsChildren had frequent contact with medical providers, with 81% seen in the year before referral for DMST. Childhood maltreatment and family dysfunction were identified (sexual abuse, 21/37 or 57%; parental substance abuse, 22/37 or 60%) in the 41 patients. Children had medical problems (eg, sexually transmitted infection, 13/41 or 32%), psychiatric needs (eg, acute suicidality, 8/41 or 20%; at least 1 previous psychiatric admission, 19/41 or 46%), and substance use (36/41 or 88%). Although 26/41 (63%) had runaway and 17/41 (42%) lived in a group home placement, 28/41 (68%) currently lived at home and 29/41 (71%) presented with a parent/guardian or relative. ConclusionChildren referred for DMST present frequently to physicians and have complex medical and psychiatric needs. Medical providers' increased awareness of this health issue would inform victim identification and intervention.

Lessons of resilience provided by refugee children

As the number of families seeking refuge has skyrocketed, questions have been raised throughout the world community about what it means to grant refuge and resettlement and how this can affect the communities that become the new homes for resettled families. Arguably, something that is missing from the public discourse is a discussion about how refugee families may truly and deeply benefit Americans. As providers working in the Hasbro Children's Hospital Refugee Health Clinic in Providence, Rhode Island, we have had the privilege to experience firsthand the ways that refugee families can enrich and teach the larger communities where they are resettled. In this commentary, we want to share perspectives that we have found that our refugee families bring to their daily lives — perspectives we believe can be enriching to the communities where they are resettled.

61. The Adolescent Leadership Council (TALC) of Hasbro Children's Hospital

61. The Adolescent Leadership Council (TALC) of Hasbro Children's Hospital

Health and Well-Being of Immigrant Children and Youth

Department of Social, Cultural and Media Studies, University of the Fraser Valley, 33844 King Road, Abbotsford, BC, V2S 7M8, CanadaReceived 15 July 2012; Accepted 15 July 2012This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This special issue includes a wide spectrum of research papers: using qualitative, quantitative, and mixed methods; from a variety of countries (Australia, Canada, and the United States of America); examining a diverse array of immigrant children and their families. While some of the research follows a more traditional academic research approach, others are the product of program analyses. One thing, however, that all of the papers have in common is that they all focus on a marginalized immigrant group. This special issue is not only interesting, but it is encouraging to see scholars from around the world centre their attention on the health of marginalized children.It has been a delight to edit this special issue. I thank my coeditors Dr. A. George and Dr. U. Tran for their efforts. We would like to thank the many researchers that sent in manuscripts to be included in this issue. The health and well-being of immigrant children is an important issue that needs our attention and dedication. While funding for such research tends to be limited, especially in the current global economic climate, I would encourage readers from all countries to continue on in their efforts to showcase the health disparities and related inequalities that immigrant children and their families endure. By doing this we can highlight the existing inequalities to policy makers and governments and collectively make a difference in the well-being of future generations.Dr. U. Tran (MD) is a developmental paediatrician and researcher in Queensland, Australia. Her paper showcases the results of a pilot study that compared perceived parenting roles, child development, health service utilization, as well as child health, illness, and disability among Vietnamese immigrants in Australia versus Australian-born Caucasians. Her research makes a valuable contribution to what is known about Vietnamese immigrants' perceptions of health and health care practices, particularly in the Australian context since scant research can be found on the topic. Dr. U. Tran concludes that key differences between Vietnamese immigrant and Australian-born Caucasian parents were detected and that the immigrant parents were not only less familiar with health services that were available for their children, but they were also less satisfied with the mainstream services that they had utilized. These findings suggest that a better understanding of the health care needs of specific (i.e., immigrant) populations is warranted.Dr. T. Tuma (PhD) is a researcher at the Hasbro Children's Hospital Refuge Health Clinic in Rhode Island, USA. Together with her colleagues, Ms. L. Ratanaprasatporn, Dr. D. J. Watts (MD), and Dr. C. Lewis (MD), this team of researchers present their evaluation of the refugee home--the Hasbro Children's Hospital's Refugee Health Clinic that was established in 2007 to serve the health needs of refugee families in the Rhode Island area. Their evaluation illustrates truly amazing results; the medical home model has increased screening rates to 100% and increased completion of TB treatment to 100%. In addition, missed appointments dramatically declined (compared to the former nonfamily centred care). This refugee healthcare model is one that policy makers, health funders, and health authorities should take note of and consider implementing elsewhere. …

Early Detection of Biliary Atresia Raises Questions About Etiology and Screening

Biliary atresia (BA) is the most significant life-threatening hepatobiliary disorder in children and is the most common indication for liver transplantation in the pediatric population.1 It occurs in ∼1 in 10 000 infants.2 BA is the result of an obliteration of all or part of the biliary ductal system. If BA is left untreated, the prognosis is poor: it leads to either liver transplantation or death from complications of liver failure.3 The commonly accepted treatment for BA is the restitution of the bile flow via the hepatoportoenterostomy operation (Kasai procedure), which is achieved by the excision of the extrahepatic biliary remnants and anastomosis to a jejunal loop. A successful hepatoportoenterostomy can delay or decrease the need for a liver transplant. A number of research studies have found that the most favorable outcomes of the hepatoportoenterostomy are related to the appropriate timing of the procedure; better results are … Address correspondence to Ezequiel Neimark, MD, Hasbro Children's Hospital, 593 Eddy St, MPH-131, Providence, RI 02903. E-mail: eneimark{at}lifespan.org

Emergency Evaluation of Children When Sexual Assault Is Suspected

Three reports in this issue of Pediatrics address the challenge of evaluating acute sexual assault of children and adolescents. The first, by Floyed et al, discusses using a screening tool in the pediatric emergency department to determine whether a child can be referred to a different (less-busy or more-appropriate) practice setting for evaluation.1 This is a reasonable approach, because many children report abuse that occurred days, weeks, or years before presentation to the emergency department. Two caveats, however, should be noted. The first comes from the other 2 studies in this issue.2,3 Both of those studies report an occasional incident in which forensic testing revealed evidence in assault cases several days after the events occurred. Another consideration is that, although a child's disclosure of sexual abuse in the distant past might not be perceived as a medical emergency by health care providers, it often is perceived as a major emotional crisis … Address correspondence to Carole Jenny, MD, MBA, Hasbro Children's Hospital, Potter-005, 593 Eddy St, Providence, RI 02903. E-mail: cjenny{at}lifespan.org

Medical Management Versus Surgical Intervention of Pediatric Orbital Cellulitis: The Importance of Subperiosteal Abscess Volume as a New Criterion

To investigate age and frontal sinusitis as indications for the surgical management of pediatric orbital cellulitis with subperiosteal abscess (SPA) and to create an SPA volume criterion that would favor nonsurgical management. A retrospective chart review was performed to find all patients age 18 years and younger who presented to Hasbro Children's Hospital with orbital cellulitis secondary to sinusitis with an SPA from 2005 to 2009. SPA volume was measured using a CT ruler at the largest axial, coronal, and sagittal dimensions. Student t testing was used for statistical analysis. Twenty-nine patients were included: 8 (27.6%) were managed surgically and 21 (72.4%) were managed medically. The mean age of patients undergoing surgical management was 7.0 years old versus medical management 6.1 years old and was statistically similar (p < 0.001). The age range of patients undergoing surgical management was 17 months to 11 years versus 4 months to 13.4 years for medical management. The mean volume of abscesses needing surgery were larger (3,446.3 mm) than abscesses not needing surgery (420.5 mm) (p < 0.04). Volumes of <1,250 mm did not require surgical management (p < 0.001). The frontal sinuses were visualized on CT scan in 17 patients; frontal sinusitis was found in 11 of 17 (64.7%) patients; of these 11 patients, 4 (36.4%) underwent surgical drainage and only 2 (18.2%) showed positive culture results. The 2 (18.2%) patients who had positive culture results had an SPA volume that was ≥ 1,250 mm. The volume of SPA seemed to be the most important criterion in determining medical versus surgical management. The volumes of abscesses needing surgery were larger than the volumes of abscesses not needing surgery. Volumes of <1,250 mm did not require surgical management. Most cases of SPA with concurrent frontal sinusitis do not require surgical intervention. The cases of frontal sinusitis requiring surgical intervention always had concurrent SPA volumes of ≥ 1,250 mm. Patients both under 9 years old and ≥ 9 years old required surgical intervention with SPA volumes of <1,250 mm being a consistent determining factor.

Impact of Children With Medically Complex Conditions

The last half century has seen dramatic improvements in pediatric care with reduced mortality and prolonged survival of children with complex health conditions.1 Advances in neonatal care have improved survival rates of premature infants, infants with chronic lung disease, cardiac anomalies, birth defects, and genetic disorders.2,3 Medical treatments and surgical interventions have improved outcome and survival rates. More infants born with spina bifida and children with cystic fibrosis survive to adulthood.4,5 Medical equipment and technologic advances, gastrostomy tubes, and ventilator support have prolonged the lives of children and youth with neuromuscular disorders.6 Although these advances indicate success in neonatal, medical, and surgical care, an almost unavoidable consequence is that some infants who would not have survived now live with significant physical and neurologic disorders. These disorders can include lifelong disabilities, declining health, and increasing medical fragility and complexity. Children and youth with these conditions are increasing in number and are placing newer and greater demands on the health care system, which, in turn, … Address correspondence to Robert T. Burke, MD, MPH, FAAP, Special Needs Pediatrics, Nathstar Pediatrics, Hasbro Children's Hospital, 593 Eddy St, Providence, RI 02903. E-mail: robert_burke{at}brown.edu

Composite Playground Safety Measure to Correlate the Rate of Supracondylar Humerus Fractures With Safety: An Ecologic Study

More than 200,000 children are injured at playgrounds in the United States each year. Our goal was to introduce a composite measure of playground safety and use this instrument to correlate the incidence of supracondylar humerus fractures with playground safety in an ecologic study design. We used a novel "overall-safety rating," defined as a composite of 3 previously validated instruments (National Program for Playground Safety School score, surface depth compliance, and the use zone compliance) to measure the overall safety of all playgrounds within a region. The regions were rated from most to least safe based on average playground safety as measured by this new method. The incidence of supracondylar fractures was calculated using Hasbro Children's Hospital Emergency Department data and state of Rhode Island Census data from 1998 to 2006. The incidence was then correlated with playground safety as defined by our composite measure. Compared with the neighborhood deemed the safest, the least safe district had 4.7 times greater odds of supracondylar humerus fracture. Overall composite safety score of the district was linearly correlated with the injury rate observed in the population at risk (R=0.98; P=0.04). Using our novel composite playground safety score, we found that the incidence of supracondylar humerus fractures was increased in districts with playgrounds with lower scores, suggesting that improvements in playground infrastructure may potentially reduce the incidence of supracondylar humerus fractures, and other injuries, in children. Level IV.

Prospective Validation of a Clinical Prediction Model for Lyme Meningitis in Children

Lyme meningitis is difficult to differentiate from other causes of aseptic meningitis in Lyme disease-endemic regions. Parenteral antibiotics are indicated for Lyme meningitis but not viral causes of aseptic meningitis. A clinical prediction model was developed to distinguish Lyme meningitis from other causes of aseptic meningitis. Our objective was to prospectively validate this model. Children between 2 and 18 years of age presenting to Hasbro Children's Hospital from April through October of 2006 and 2007 were enrolled if a lumbar puncture for meningitis showed a cerebrospinal fluid white blood cell count of >8 cells per microL. Cerebrospinal fluid was sent for Lyme antibody testing. The probability of Lyme meningitis was calculated by using the percentage of cerebrospinal fluid mononuclear cells, duration of headache, and presence of cranial neuropathy by using the prediction model. Definite Lyme meningitis cases were defined as cerebrospinal fluid pleocytosis with (1) positive Lyme serology confirmed by immunoblot or (2) erythema migrans rash. Possible Lyme meningitis cases were defined as cerebrospinal fluid pleocytosis with positive cerebrospinal fluid Lyme antibody. Sensitivity, specificity, and likelihood ratios for definite and possible Lyme meningitis were determined by using 10% increments of calculated probability of Lyme meningitis. Fifty children were enrolled, including 14 children with definite Lyme meningitis, 6 with possible Lyme meningitis, and 30 with aseptic meningitis. A calculated probability of <10% for Lyme meningitis had a negative likelihood ratio of 0.006 for definite and possible Lyme meningitis cases. A calculated probability of >50% for Lyme meningitis had a positive likelihood ratio of 100 using these definitions. A clinical prediction model using the percentage of cerebrospinal fluid mononuclear cells, headache duration, and presence of cranial neuropathy can differentiate children with Lyme meningitis from children with aseptic meningitis. Our findings suggest categories of low (<10%), indeterminate (10%-50%), and high (>50%) probability of Lyme meningitis.

Questionnaire Helps Identify Children's Sleep Disorders

Questionnaire Helps Identify Children's Sleep Disorders