Hospital Of Buffalo Research Articles

Postpartum contraception usage in immigrants compared with non-immigrants in Buffalo, NY

ObjectivesThe purpose of this study was to compare rates of postpartum contraception use in immigrant populations in Buffalo, NY compared with non-immigrant populations. The study also explores rates of specific birth control selection amongst those who did choose to employ postpartum contraception. Study designA retrospective chart review was conducted comparing the rate of postpartum contraceptive use in 132 immigrant individuals with that of 134 non-immigrant individuals, as measured by the documented intent or refusal to initiate any contraceptive method within the first three months postpartum. Patients were from clinics affiliated with the Women and Children’s Hospital of Buffalo (WCHOB) who delivered during the years 2015–2016. The immigrant patients were chosen from the top ten immigrant countries of origin who delivered at WCHOB at the time. ResultsAfter controlling for factors of maternal age, gestational age at time of delivery, and gravidity and parity, the immigrant group was more likely to decline postpartum contraception in the first three months postpartum compared with the non-immigrant group (25.8% vs 6.7%, p < 0.001). Immigrants were more likely to select a barrier method (p = 0.036) and decided to employ contraception more remotely from delivery when compared with non-immigrant individuals (p < 0.001). Amongst the immigrant cohort, there was no statistically significant difference in methods chosen based on broad geographic areas of origin. ConclusionsImmigrant obstetric populations in Buffalo are less likely to employ postpartum contraception compared with non-immigrant populations. The factors influencing this are multifactorial; however, this information can inform care for both immigrant and non-immigrant patients.

How Pediatric Sleep Disordered Breathing Impacts Parental Fatigue.

Previous research has indicated that sleep disordered breathing (SDB) can lead to a decreased quality of life in children and their families as compared to children who do not have SDB. The purpose of this study was to examine fatigue levels in parents who had young children who were impacted by sleep symptoms as determined by the OSA-18 scale. Survey. Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. Fatigue levels for parents of children with OSA-18 ≥ 60 were assessed using the Fatigue Severity Scale and the Chalder Fatigue Scale. Consecutive parents with at least one child between the ages of 1 and 10 were recruited. Parents scored their youngest child on the OSA-18 scale. Of the 261 respondents included, 37 parents had a child with an OSA-18 score ≥60. The majority, 211 (82.1%), of participants reported 2 caregivers in the household while 30 (11.7%) had 1 caregiver in the household. Parents of children with OSA-18 ≥60 had a significantly higher mean fatigue score, 16.5 ± 5.8, compared to their counterparts, 11.9 ± 5.2, on the Chalder Fatigue Scale (P < .001). Similar results were reported for the total score on the Fatigue Severity Scale, 34.7 ± 10.8 compared to 28.9 ± 12.0 (P = .004). Parents of children with OSA-18 score ≥60 are significantly more fatigued than parents of children with lower scores. Recognition of this is important for the health care community as it impacts not just the child with OSA but also their family.

The Clinical Exercise Physiologists Interview Series: Barry A. Franklin, PhD, ACSM-CEP, ACSM-PD, FACSM, FAHA, MAACVPR, FASPC, FPCNA (Hon)

The Clinical Exercise Physiologists Interview Series: Barry A. Franklin, PhD, ACSM-CEP, ACSM-PD, FACSM, FAHA, MAACVPR, FASPC, FPCNA (Hon)

Parents' Opinions About Pediatric Otolaryngology on Social Media.

Social media is a novel tool that many parents turn to when looking for a new healthcare provider. The purpose of this study is to assess how parents of children attending a pediatric otolaryngology practice engage with social media. Survey. Two pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. Parents of children aged <18 years were surveyed. The survey consisted of 25 questions divided into 5 categories: demographics, social media accounts, social media use, use of social media to interact with pediatric otolaryngologists, and perception of pediatric otolaryngologists' social media accounts. Frequencies were calculated. Three hundred five parent participants were included. 247 (81.0) were female and 57 (18.97) were male. 258 (84.6%) of the participants reported use of Facebook, which was the most popular social media platform. 238 (78.0%) of participants indicated that they would want to see medical posts and 98 (32.1%) participants indicated that they would want to see personal posts on the pediatric otolaryngologist's social media page. Younger parents were statistically more likely to check social media more often (P = .001) and seek a pediatric otolaryngologist's social media before seeing them (P = .018). Use of social media by pediatric otolaryngologists may positively impact the way a small percentage of their patients' parents perceive them. Social media accounts do not appear to be a vital part of pediatric otolaryngology practice in 2022.

The Importance of Differentiating Oligoarticular Juvenile Idiopathic Arthritis From Lyme Arthritis in Pediatric Patients.

Objective This study aims to compare clinical and laboratory features between Lyme arthritis (LA) and oligoarticular juvenile idiopathic arthritis (oligoarticular JIA) by examining several potential predictors in pediatric patients. This study also aims to improve and increase awareness of ways to detectLA and oligoarticular JIA in pediatric patients who present with clinical features of joint pain. Methods A medical chart review was conducted among pediatric patients diagnosed with LA or oligoarticular JIA at John R. Oishei Children's Hospital of Buffalo between January 2014 and September 2018. Patients' diagnoses were identified using the International Classification of Disease10th Revision code for LA (ICD 10 code A69.23) and oligoarticular JIA (ICD 10 code M08.40). Patients with LA were only included in this study if they (1) exhibited arthritis, (2) tested positive for Lyme antibodies, (3) indicated a positive western blot (WB) of five or more out of 10 Borrelia burgdorferi proteins by IgG antibodies or at least two of three B. burgdorferi proteins by IgM antibodies, and (4) at the age of 16 or below at the time of diagnosis. Patients with oligoarticular JIA were included in this study if they (1) exhibited arthritis affecting one to four joints for at least six weeks in the first six months of diagnosis and (2) are at the age of 16 or below at the time of diagnosis after ruling out LA and reactive arthritis. In this study, clinical presentations, physical exam findings during initial healthcare visits, and demographics including age, sex, and race of patients were obtained. In addition, laboratory results including white blood cells (WBCs), hemoglobin (Hgb), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, Lyme antibodies through enzyme-linked immunosorbent assay (ELISA) and WB, synovial fluid analysis for red blood cells (RBCs), nucleated cells, and polymerase chain reaction (PCR) for B. burgdorferi DNA were also collected and analyzed. Results In our data, ESR and CRP were significantly higher in LA compared to oligoarticular JIA (P=0.0053 and 0.0005, respectively). The mean WBC in the synovial joint fluid was significantly higher in LA compared to oligoarticular JIA (P=0.002). Conclusion LA shares features with oligoarticular JIA. This overlap prevents the creation of a clinically useful predictive model for LA. Therefore, Lyme testing should be performed on all patients presenting with monoarticular and oligoarticular arthritis. In addition, ESR, CRP, and WBC in the synovial joint fluid were significantly higher in LA compared to oligoarticular JIA in our findings. While this difference is not definitive by any means, it may help distinguish between the two in cases where the diagnosis is not clear-cut, and the values of ESR, CRP, and WBC in the joint aspirate may help guide clinical judgment in cases that lack a definitive diagnosis.

The Effect of Pharmacy-Led Medication Reconciliation on Odds of Psychiatric Relapse at a Community Hospital

Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient’s medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital’s outpatient CPEP within 30-days (P = .012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P = .024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings.

Parental Knowledge of Obstructive Sleep Apnea Symptoms and Tonsillectomy in Children.

Obstructive sleep apnea (OSA) is present in approximately 2% to 5% of children; however, only 15% of parents are reported to be knowledgeable about OSA in children. Sleep apnea in children can lead to cardiopulmonary disease, abnormal weight gain, failure to thrive, or learning difficulties. The purpose of our study is to assess parental knowledge of pediatric OSA to identify any knowledge gaps. Survey. Three pediatric otolaryngology clinics associated with a tertiary care children's hospital in Buffalo, NY. In June of 2021, parents of pediatric (0-18 years) otolaryngology patients completed a survey on their knowledge of OSA. Parents were asked to rank their concern about OSA and identify symptoms of OSA. Parental demographic data collected included gender, age, race, and educational level. Respondents were asked if their child had undergone a sleep study or tonsillectomy. Of the 246 parents included, 77 (31.4%) parents had a child who had a tonsillectomy, 40 (16.3%) had a child who had a sleep study done, and 25 (10.2%) had a child with both done. For recognizing the symptoms of pediatric OSA the mean was 6.3 (95% CI 5.8-6.8) out of 13 total. Symptoms least likely recognized were nocturnal enuresis and hyperactivity, 65 (27%) and 91 (37%) of parents correctly identifying these symptoms, respectively. Greater concern about OSA correlated with greater cumulative knowledge score (P < .001). Parents whose child had undergone a tonsillectomy were more likely to be concerned about OSA in children compared to non-tonsillectomy parents (P = .003), and sleep study parents were also more likely to be concerned about OSA than non-sleep study parents (P = .045). Parents who attended a pediatric otolaryngology clinic have knowledge gaps about pediatric sleep.

Reduction in Opiate Use, Pain, Nausea, and Length of Stay After Implementation of a Bariatric Enhanced Recovery After Surgery Protocol.

Evaluate adherence to bariatric surgery enhanced recovery after surgery (ERAS) protocols in pre-operative, operative, and post-operative phases, and to compare opiate use, nausea control, and length of stay (LOS) versus historical controls. A retrospective, observational cohort study was conducted to evaluate adherence to ERAS protocols and compare opiate and antiemetic use, pain intensity, and LOS versus those of traditional care (TC) patients preceding protocol implementation at Erie County Medical Center, a community-based hospital in Buffalo, NY, USA. One hundred ERAS and TC patients were compared. Patients were similar in age (42.5 years), gender (female, ~ 80%), race (~ 80 white), and BMI (47 kg/m2). The primary procedure performed was sleeve gastrectomy (89% ERAS, 86% TC). Protocol adherence was high for ERAS phases: prior to admission (85-98%), pre-operative (96-100%), operative (93-99%), post-anesthesia care unit (PACU) (55-61%), and floor (86-98%). Opiate morphine milligram equivalent (MME) was reduced in ERAS vs. TC in hospital by 73% (43.5 ± 42.4 vs. 160 ± 116; p < 0.001), discharge prescribing by 53% (34.8 ± 38.2 vs. 74 ± 125 MME; p = 0.003), and in total by 69% (78.3 ± 67.5 vs. 252 ± 160; p < 0.001). Despite lower opiate use, ERAS had lower pain intensity entering PACU (1.1 ± 1.8 vs. 1.9 ± 2.6; p < 0.011), leaving PACU (1.7 ± 1.5 vs. 2.9 ± 1.5; p < 0.001), and floor day 0 (5.0 ± 2.1 vs. 5.9 ± 1.8; p < 0.001). Fewer ERAS required antiemetic day 0 (63% vs. 94%; p < 0.001). ERAS were discharged in fewer hours than TC (41.1 ± 15.5 vs. 52.1 ± 18.9 h; p < 0.001). Bariatric surgery ERAS protocols were implemented with a high rate of adherence and yielded profound reduction in operative and post-operative opiate use while improving pain control and nausea management in hospital and decreasing LOS.

The Impact of under-Staffing of Nurses on Sedative/Analgesic Agents Administration in Pediatric Intensive Care Unit [PICU

<i>Institution</i>: Department of Pediatrics, pediatric critical care, University of Buffalo Oishei Children’s’ hospital. <i>Objective</i>: To evaluate the impact of understaffing on administration of sedatives and analgesics to patients in pediatric intensive care unit [PICU]. <i>Design</i>: Retrospective cohort. <i>Setting</i>: PICU in a university-affiliated children’s hospital. <i>Patients</i>: Fifteen intubated children 0-21 years of age admitted to the PICU in September and October 2017 at the Women’s and Children’s Hospital of Buffalo. Twenty-one intubated children admitted in January and February 2018 at Oishei Children’s Hospital. All intubated patients in our study received sedation and analgesic drips and/or boluses. <i>Intervention</i>: None. <i>Results</i>: We used NEMS [Nine Equivalent of nursing use Manpower score] as a way of evaluating the <i>‘appropriateness’</i> of nurse-patient ratio. <i>Appropriate shifts</i> were defined as shifts with Nurse/Patients [N/P] ratio similar to that determined per NEMS. <i>Under-staffed Shifts</i> were shifts with N/P ratio less than determined per NEMS. <i>Sedation burden</i> was defined as extradoses of sedation given or rate change of drip per shift. There were no differences in age, sex, race, weight and PRISM score between patients admitted in both hospitals. There was no significant difference in <i>sedation burden</i> between <i>appropriate shifts</i> 207/429 [48.2%] vs <i>under-staffed shifts</i> 26/44 [59.1%], <i>p</i>-value=0.17. Linear regression was used to account for severity of disease using PRISM score, there was no significant difference between the two groups. There was significant <i>sedation burden</i> in shifts with higher N/P ratio [1:1 or 2:1] vs lower N/P ratio [1:2] [112/191 58.6% vs 121/281 43%, <i>p</i>-value=0.0009]. <i>Conclusion</i>: We could not prove that understaffing would be associated with increase sedation. In our study group, there was increase sedation administration to patients when they had more nurses at their bedside. We think having an established sedation score and collecting these scores with the amount of sedation given during <i>appropriate</i> and <i>under-staffed shifts</i> might help controlling for some of the variables and give a more objective method to judge the patients’ depth of sedation. More studies need to be conducted on the effect of nurse staffing and the amount of sedation.

Fluorescent Cholangiography in Laparoscopic Cholecystectomy and the Use in Pediatric Patients.

Background: Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy and carries an incidence of 0.3%-0.7%. Recently indocyanine green (ICG) fluorescent cholangiography (FC) has been used as an adjunct to identify the biliary tract during adult laparoscopic cholecystectomy, allowing intraoperative identification of biliary anatomy. The objective of this article is to show its successful use in pediatric laparoscopic cholecystectomies. Method: From July 1, 2017, to November 30, 2018, surgeons at John R. Oishei Children's Hospital and Women and Children's Hospital of Buffalo have been utilizing ICG-FC as an adjunct in patients undergoing laparoscopic cholecystectomy. Thirty-one patients undergoing laparoscopic cholecystectomy had 1 mL of dilute ICG (2.5 mg) injected intravenously in the operating room (OR) before trocar placement. Demographics, intraoperative details, and subjective surgeon data were recorded for elective laparoscopic cholecystectomy cases involving ICG. We hypothesize that use of ICG-FC in the pediatric and adolescent patient population is a safe, reliable, and reproducible adjunct for identification of the biliary tree. Secondary outcomes were to identify rate of biliary anatomy identification, utilization ease, and operative times while using ICG technology in pediatric patients. Results: ICG-FC was used in 31 pediatric laparoscopic cholecystectomies performed by 5 surgeons at our institution. Ages ranged from 6 to 18 years. In all cases, the cystic duct-CBD junction was visualized while performing dissection of the triangle of Calot. No intraoperative complications occurred. Conclusions: ICG-FC provides a noninvasive real-time visualization of the extrahepatic biliary tree in children and adolescents. We demonstrate that ICG-FC can successfully be used as an adjunct in pediatric patients and has the potential to facilitate with the dissection and minimize risk of bile duct injuries during pediatric laparoscopic cholecystectomies.

Assembling, Flaming, Ringing: Listening to Julius Eastman's Gay Guerrilla

Assembling, Flaming, Ringing:Listening to Julius Eastman's Gay Guerrilla Ethan Philbrick (bio) julius eastman was a Black gay composer, pianist, vocalist, conductor, and dancer. Born in Harlem in 1940 , eastman trained classically in piano and composition at the Curtis Institute of Music in Philadelphia. After graduating in 1966, he joined Creative Associates at suny Buffalo in 1968, one of the hotbeds for the new music scene in the United States under the direction of lukas foss, and began to frequently perform and compose theatrical, electroacoustic, and improvisation-heavy chamber music works with the S.E.M. Ensemble. In 1973, eastman rose to national prominence as a performer for his virtuosic vocal performance on a Grammy-nominated recording of peter maxwell davies 's Eight Songs for a Mad King, and in that same year he premiered a minimalist chamber composition with S.E.M. Ensemble entitled Stay On It, which prefigured many of the encounters between minimalism and popular music that took hold later in the decade. In 1976, he relocated to New York City, where he traversed the downtown, uptown, disco, and new music scenes—performing with composer-choreographer meredith monk, collaborating with cellist and disco producer-songwriter arthur russell, appearing frequently at the performance and new music venue [End Page 351] The Kitchen, and playing in jazz combos with his guitarist brother gerry eastman. Eastman also became deeply enmeshed in the Manhattan queer scene during this time, with reports that he sometimes went by the nickname "Mr. Mineshaft" (after the notorious gay leather bar and sex club on Little West 12th Street). 1 Throughout his career, Eastman theorized his own compositional practice as operating under an "organic principle," meaning that his pieces took on a structural logic of accumulation. 2 In many of Eastman's compositions, musical phrases never simply replace other musical phrases as the piece unfurled in time; instead phrases and motifs persist dissonantly even as new material is introduced on top of and around them. The past of Eastman's pieces piles up even as new sounds are introduced. No musical material ever disappears; it is only buried. By calling his compositional technique "organic," Eastman evokes life cycles, chemical transformations, and the ecological returns of rotting matter; and yet Eastman's compositions also sound like history to me: slow and heavy, repetitive and yet morphing as they accumulate. Melody and harmony become texture in Eastman's gradually mutating blocks of sound. The formal structures that undergird Eastman's compositions are audible—an additive structure slowly being built and breaking down simultaneously under its own weight, older material sonically covered over by the accretion of new material. Eastman created musically violent structures that resonated critically with the structural violence he navigated throughout his life. By 1979, Eastman was touring his formally insurgent works across the United States and Europe, often challenging the division of labor between the composer and the performer by performing his own works and putting his body on the line in an overwhelmingly white "By calling his compositional technique "organic," Eastman evokes life cycles, chemical transformations, and the ecological returns of rotting matter; and yet Eastman's compositions also sound like history to me: slow and heavy, repetitive and yet morphing as they accumulate." [End Page 352] and straight new music scene. But by the early 1980s, his trajectory of increasing institutional success despite the institutions' whiteness and heteronormativity seemed to spin out of control. In 1983, he was evicted from his apartment, many of his scores were destroyed in the process, and a hoped-for faculty position at Cornell failed to materialize. This is where things get blurry in the written accounts of Eastman's life. Reportedly, Eastman all but disappeared from the downtown music scene for the next seven years; he developed an intimate relationship with harder drugs, bounced between residing in Tompkins Square Park and shelters in Buffalo, and eventually died in a hospital in Buffalo in 1990 of uncertain causes—perhaps due to complications related to AIDS, perhaps not. What is known by musicologists and music historians is that it took eight months for news of his death to reach colleagues in the Manhattan music world through an obituary...

1130. Vancomycin Use in Pediatric Severe Sepsis at a Freestanding Children’s Hospital

BackgroundSurviving Sepsis Campaign guidelines recommend antibiotics be administered within 1 hour of severe sepsis (SS) onset, but do not suggest which agents to give. Vancomycin (VAN) is often chosen as empiric therapy for severe sepsis (SS) in children without evidence of the prevalence or risk factors for infections requiring VAN. As VAN is associated with significant nephrotoxicity, this study was performed to measure the risk-benefit ratio of empiric VAN use in pediatric sepsis.MethodsThis was a retrospective study of children with SS between 1/1/2015 to 6/30/2018 at the Women and Children’s Hospital of Buffalo, as captured by billing data and sent to state Department of Health for mandated reporting. SS cases were assessed for risk factors for Gram-positive infections, including presence of a central venous line (CVL) or other invasive device; history of MRSA infection or nasal colonization within the last 2 years; skilled nursing facility (SNF) residence; and prolonged hospitalization of >1 month. Invasive infections for which vancomycin is an optimal agent, specifically culture-proven methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative Staphylococcus (CoNS), and ampicillin-resistant Enterococcus infections, were defined as vancomycin requiring (VAN-req). Acute kidney injury (AKI) was defined as having a serum Creatinine of twice normal per age-related reference values.ResultsOf 304 identified SS cases, 8.9% had VAN-req infections. VAN was empirically given to 58.2% of cases (177); 86.4% ultimately did not have VAN-req infections. 9.2% of all SS cases had AKI at SS onset; this included 15.8% of patients (28) receiving VAN, of which only 1 (3.6%) had a VAN-req infection. History of a past MRSA infection, prolonged hospitalization, SNF residence, and CVL presence were found to be independent risk factors for a VAN-req infection (Table 1). VAN-req infections in patients lacking these four risk factors was 3.1% (4/130).ConclusionVAN was given empirically in the majority of pediatric SS cases, but culture-proven infections requiring the drug were infrequent, especially in patients without specific risk factors. The use of empiric VAN for SS should be guided by well-defined criteria, as the drug’s potential risks are likely to outweigh any benefit in most patients. Disclosures All authors: No reported disclosures.

Implications of Clozapine Complications in Geriatric Patients with Type II Diabetes Mellitus

Second-generation antipsychotics, have known metabolic side effects; specifically, clozapine is implicated in worsening or causing hyperglycemia, hypercholesterolemia and weight gain. Recently, there has been an increased interest in the safe use of clozapine in patients with diabetes. In March 2018, a 65-year-old female with a diagnosis of schizophrenia was admitted for inpatient hospitalization to a psychiatric hospital in Buffalo, NY for further stabilization after receiving two months of treatment at a comprehensive psychiatric emergency program (CPEP). Her medical diagnoses included type 2 diabetes mellitus (T2DM), vitamin D deficiency, hyperlipidemia, glaucoma, and constipation. Upon admission, the patient was continued on clozapine, and fluphenazine for treatment of schizophrenia. Her medical medications upon admission included acetaminophen, cholecalciferol, multivitamin, and timolol maleate eye drops. Low blood glucose results at the beginning of her hospitalization led to discontinuation of fingerstick blood glucose readings as the patient was prescribed a controlled diet, and her most recent hemoglobin A1c (HgbA1c) level was 6.8% on March 23, 2018. Clozapine was initiated and titrated over the next four months of inpatient treatment. The patient became psychiatrically stable and was prepared for discharge. During her final medical and psychiatric evaluation laboratory findings included a HgbA1c of 14.4% - a total increase of 7.6% over the course of 31 weeks. Clozapine is implicated in causing health-related complications that include agranulocytosis, seizures, constipation, and hypersalivation, as well as, metabolic side effects such as weight gain and hyperglycemia. Clozapine can also exacerbate pre-existing diabetes or lead to a new diagnosis of T2DM. If not controlled, these metabolic effects can lead to serious long-term consequences. Clozapine was prescribed prior to hospital admission and further titrated during the patient’s hospitalization at a long-term psychiatric facility. The patient had a diagnosis of T2DM but did not receive pharmacotherapy due to well controlled blood glucose and a HgbA1c level within goal. Pending discharge, a final psychiatric and medical examination determined that the patient’s HgbA1c had more than doubled. The significant increase in HgbA1c in a geriatric patient with diet-controlled T2DM confirms that psychiatric medication changes can cause dysregulation of T2DM. Further research is needed to explore any potential increased likelihood, or magnitude of effect, of these drug induced metabolic consequences in older adults.

Antibiotic Treatments and Patient Outcomes in Necrotizing Enterocolitis.

This study aimed to examine the impact of different antibiotic treatments on necrotizing enterocolitis (NEC) outcomes. Patient outcomes, including total parenteral nutrition and hospitalization durations, abdominal surgeries, intestinal strictures, and mortality data, were analyzed and compared by various antibiotic groups and treatment durations for 160 NEC patients managed at the Women and Children's Hospital of Buffalo between 2008 and 2016. Fourteen different antibiotics were used for NEC, most commonly ampicillin, gentamicin, and metronidazole (AGM). Medical (vs. surgical) NEC patients more likely received AGM (37 vs. 6%, p < 0.001). Surgical (vs. medical) NEC patients more likely received vancomycin (80 vs. 30%, p < 0.001) and antipseudomonal agents (69 vs. 15%, p < 0.001). For medical NEC there were no outcome differences between patients receiving only AGM versus those receiving other treatments; in patients receiving AGM, there were no outcome differences in durations of ≤10 days versus longer courses. Antibiotic use for NEC varies substantially without definite outcome differences. Particularly with medical NEC, AGM for ≤10 days had comparable outcomes to other treatments. In light of growing concern for short and longer term adverse effects with early-life antibiotic exposure, narrow-spectrum and shorter course NEC treatment may be preferred.

Clinical Context-Specific Staphylococcus aureus Susceptibilities May Differ Substantially and Be Obscured by Aggregate Antibiograms

AbstractAggregate data in institutional antibiograms may not accurately represent major pathogens' antibiotic susceptibility patterns in important clinical scenarios. In this analysis of Staphylococcus aureus isolates between 2013 and 2016 at the Women and Children's Hospital of Buffalo, methicillin and clindamycin susceptibility rates of S. aureus differed significantly from aggregate data when stratified by wound specimen and osteoarticular infection (OAI) isolates. Clindamycin susceptibility of methicillin-resistant S. aureus (MRSA) in wound specimens was higher than published antibiograms, whereas the proportion of MRSA and total clindamycin susceptibility in OAI was relatively lower, which impacts empiric antibiotic decision-making. With S. aureus antibiotic susceptibility patterns shifting and differences by infection type, as well as geographic location, pediatric facilities are encouraged to perform local reviews and emphasize specimen and clinical-context rather than aggregate antibiograms.

Lyme Arthritis in Children on the Uptick in Western New York Area.

Objective:This study explores a suspected increasing incidence of Lyme arthritis in the Western New York pediatric population. In addition, we aim to describe a clinical picture of Lyme arthritis and the clinical features that distinguish it from other forms of arthritis.Methods:Patients diagnosed with Lyme arthritis between January 2014 and September 2018 were identified using International Classification of Diseases—10th Revision (ICD 10) codes for Lyme disease and Lyme arthritis. Patients were included in the study if they (1) exhibited arthritis, (2) tested positive for Lyme antibodies, and (3) exhibited a positive Western blot.Results:A total of 22 patients were included in the study. There was a general trend toward an increasing number of cases of Lyme arthritis over the 45-month observation period. We identified 1 case in each 2014 and 2015, 4 cases in 2016, 7 in 2017, and 9 in the first 9 months of 2018. In total, 17 patients had arthritis as their only symptom at the time of diagnosis and 10 patients had a rash or a history that prompted suspicion of Lyme disease. The knee was the most frequent joint (86.4% of patients), and patients typically had 2 or fewer joints affected (86.4% of patients).Conclusions:A significant increase (P = .02) in Lyme arthritis cases was observed at Oishei Children’s Hospital of Buffalo. Lyme arthritis may clinically present similarly to other forms of arthritis, such as oligoarticular juvenile idiopathic arthritis, so health care providers should be aware of distinguishing clinical features, which include rapid onset of swelling and patient age. Because the geographic area of endemic Lyme disease is expanding, all health care providers need to be aware of Lyme arthritis as a possible diagnosis.

283. Antibiotic Utilization for Pneumonia and Other Respiratory Infections in Pediatricians’ Offices, Urgent Care Centers, and a Pediatric Emergency Department

BackgroundPneumonia (PNA) and other respiratory infections are common diagnoses in outpatient pediatrics and often result in antibiotic utilization. Professional society guidelines recommend narrow-spectrum agents, namely amoxicillin/ampicillin, as empiric therapy for the majority of pediatric community-acquired pneumonia. In most respiratory infections other than PNA, antibiotics are not indicated. Adherence to PNA guidelines, and antibiotic use for other respiratory infections, in the varied outpatient settings in which children are seen, has not been well characterized.MethodsIn a large outpatient sepsis point prevalence study, various data were collected from all patients 0 to 18 years of age seen on September 5, 2016, December 5, 2016, March 6, 2017, and June 5, 2017, in the Emergency Department (ED) of the Women and Children’s Hospital of Buffalo, 11 primary pediatric (PMD) offices, and 2 private urgent care centers (UCC) in Buffalo, New York. For this secondary analysis, all children with a provider diagnosis of PNA, bronchitis, bronchiolitis, and upper respiratory infection (URI), were identified. Antibiotic utilization and adherence to Pediatric Infectious Diseases Society PNA (2011) guidelines were analyzed and compared relative to clinical care setting.ResultsA larger proportion of children seen in the ED (27.9%) and UCC (25.2%), then PMD (sick) visits (6.1%), were diagnosed with respiratory infections (P <0.001). PNA specifically was diagnosed in 8% (71/945) of all ED visits. When parenteral agents were given in the ED for PNA, ceftriaxone was most frequent: 58% (10/17) vs. 35% for ampicillin. In PMD and UCC, azithromycin was given in 50% of treated cases (6/12), amoxicillin in 25%, and amoxicillin/clavulanate in 17%. Across the 3 settings, 25% (73/291) of URI received antibiotics; 27% (20/73) did not have a documented co-infection (e.g., otitis media).ConclusionDespite general awareness of existing PNA guidelines, non-first-line antibiotics are still frequently used across outpatient settings in our area. Also, antibiotics are often given in cases where URI is the primary diagnosis, when a bacterial etiology is unlikely. Pediatric stewardship efforts should further promote available PNA guidelines and avoiding antibiotics for URI, and create educational activities tailored to their local providers.Disclosures All authors: No reported disclosures.

Presentation and Clinical Characteristics of Patients with Maturity Onset Diabetes of the Young (MODY) at Women and Children’s Hospital of Buffalo

Background: Maturity onset diabetes of the young (MODY) is a monogenic form of diabetes. It is rare, representing the final diagnosis in 1-2% of individuals with diabetes. In the pediatric cohort, it can be confused with type 1 diabetes. Clinical diagnosis is suspected in the case of hyperglycemia, lack of autoantibodies, and autosomal dominant transmission. This retrospective chart review evaluated the clinical presentation and characteristics of patients diagnosed with MODY by our practice with a goal of identifying patients that can be candidates for genetic testing. Methods: Using ICD10 codes for MODY, we performed a retrospective chart review of patients carrying MODY diagnosis confirmed by genetic testing, who received their care at the Diabetes Center at Women and Children’s Hospital of Buffalo. Results: We identified 10 subjects with confirmed genetic testing for MODY. Median age of presentation with hyperglycemia was 13.1 years (range of 3.6-17.3 years). Median HbA1c at presentation was 6.3% (range 6%-14%). While the initial referring diagnosis was elevated fasting BS (FBS) in 50% of subjects, FBS (mean 120±21 mg/dL) was abnormal for all but 1 subject at their first contact visit. All subjects had negative pancreatic autoantibodies. In our cohort, confirmatory testing was as follows: MODY2 (n = 6), MODY3 (n = 2), MODY 4 (n=1), and MODY5 (n=1). Three subjects were assigned a MODY diagnosis prior to genetic testing. Two were siblings with family history of maternal MODY2. The third subject had a history of polycystic kidney disease, septate uterus, and HbA1C in the prediabetes range. This subject was assigned a presumptive diagnosis of MODY 5 prior to genetic test. Conclusion: In our practice, all subjects with confirmed MODY diagnosis had negative pancreatic autoantibodies with most meeting criteria for prediabetes diagnosis. Clinicians should have a high index of suspicion for MODY in subjects who do not fit criteria for T1DM or T2DM. Disclosure L. Saadeh: None. L.D. Mastrandrea: Research Support; Self; Novo Nordisk Inc., AstraZeneca, Sanofi-Aventis. Advisory Panel; Self; Pediatric Diabetes Consortium. Other Relationship; Self; American Academy of Pediatrics. Advisory Panel; Self; JAEB Center For Health Research.

Dr Elliot F. Ellis: Initiating personalized asthma management in children

Abstract Elliot F. Ellis is indeed a giant in the field of allergy and immunology. From his leadership role in developing a pediatric allergy and immunology fellowship at National Jewish Health and his seminal work in theophylline pharmacokinetics, he trained many excellent clinicians and researchers. He assumed the role of Chair of Pediatrics at the Children's Hospital of Buffalo in 1974 and transformed that training program in pediatrics to a top-rated program in the country along with his own training program in allergy and immunology. He co-edited the first edition of Allergy Principles and Practice with Elliott Middleton, Jr., MD and Charles E. Reed, MD. His clinical research provided the building blocks for personalized medicine in asthma, especially as it pertains to children.

Impact of Long-Acting Reversible Contraceptive Counseling on Postpartum Contraceptive Choice [17G

INTRODUCTION: Approximately half of pregnancies occurring in the United States annually are unintended. Long-acting reversible contraceptives (LARCs) could help reduce unintended pregnancy, yet they are used by less than 3% of women in the United States. The objective of this study is to determine if prenatal contraceptive counseling for high-risk pregnant women will impact LARC choice postpartum. METHODS: A prospective cohort study was performed at the Perinatal Center of Women and Children’s Hospital of Buffalo. Patients who presented between ages 18 and 45 and within 34 weeks of gestation were recruited to participate in the study. Our intervention included two prenatal contraceptive counseling sessions. The patient’s choice of a LARC postpartum was compared to both their pre-counseling choice as well as to the choice of a control group who received standard prenatal counseling in the year prior to our intervention. Descriptive data and bivariate analysis were performed using SPSS. P-values less than or equal to .05 were considered significant. RESULTS: A total of 55 pregnant women were recruited. All women had co-morbid conditions, including chronic hypertension, diabetes, and venous thrombo-embolism. Counseling increased the intent for LARC from 27% pre-counseling to 42% post-counseling (P=.011). The intervention group also had higher postpartum LARC intent (42%) compared to control group who received standard counseling (20%) with P=.003. CONCLUSION: Our study suggests that instituting a prenatal contraceptive education program can improve LARC rates in high-risk pregnant women.