Local Children's Hospital Research Articles

Helicobacter pylori Infection Does Not Protect Against Allergic Diseases: Evidence From a Pediatric Cohort From Northern Sardinia, Italy

ABSTRACTBackgroundThe “hygiene hypothesis” states that reduced exposure to microbial antigens due to an excessively hygienic environment can increase the risk of developing autoimmune diseases, including atopic disorders and asthma. In recent decades, there has been a progressive decline in the prevalence of numerous microorganisms following improved hygienic‐sanitary conditions. More specifically, several studies reported an inverse association between the reduction in Helicobacter pylori infection and the rise of asthma and allergic disorders.AimTo evaluate the prevalence of atopic disorders in a pediatric population in relation to seropositivity against H. pylori.MethodsChildren from Northern Sardinia, Italy, referred to the local Children's Hospital for any reason, were investigated to identify risk factors, especially H. pylori infection, associated with atopic disorders. A validated questionnaire, including demographics, house size, history of breastfeeding, residence, school or daycare center attendance, exposure to animals, and a defined diagnosis of atopy—including asthma—was filled out by a trained pediatrician according to parents' answers and child records. A blood sample was collected from each participant and immunoglobulin G against H. pylori was assessed by a locally validated ELISA test.ResultsThe seroprevalence of H. pylori infection was 11.7% among 492 children (240 females). Thirty‐two children had a confirmed diagnosis of asthma and 12 of allergy. No one child showed both conditions. Statistically significant differences in H. pylori seropositivity were not detected between children with or without atopy (8.4% vs. 12.6; p = 0.233). Although atopic disorders were more frequent in children exposed to traditional atopic risk factors, none of them showed to be significant after adjusting for all covariates.ConclusionsSerologically assessed H. pylori infection was not significantly associated with a reduced risk of atopic diseases in children.

The Chaplain in the Pediatric ER: A Nurse and Mom's Perspective.

The day after a holiday, our medically complex son, who was acutely ill, needed care at the local children's hospital. Once in the emergency room (ER), he was triaged to a trauma room. Without our knowledge or consent, a chaplain entered the crowded and chaotic room. Although pleasant, the chaplain was not a person who comforted us. Her presence (1) increased our anxiety to panic level, (2) took our attention away from our acutely ill son to worst-case scenarios, (3) made us extremely uncomfortable, and (4) was counterproductive. We strongly feel that the patient/family should be asked if they want a chaplain or other spiritual/support person to enter the room.

The PLAY bundle for head deformities: A NICU quality improvement project

BackgroundPremature infants in the Neonatal Intensive Care Unit (NICU) have a greater risk of head deformities and related complications. Numerous evidence-based interventions demonstrate successful prevention and treatment for head deformities with maximized success when combined. Local problemThere was no standardized policy to aid in the prevention, evaluation, and management of head deformities at a local children's hospital. Additionally, the Electronic Health Record (EHR) did not optimize head measurement documentation and documented asymmetrical head measurements did not prompt follow-up. MethodsAuthors developed a nurse-driven order set, or bundle, comprised of Positioning and PT/OT involvement, Learning, Assistive Devices, and You (PLAY) as part of a quality improvement project to reduce the progression of head deformities through education, prevention strategies, and earlier identification and treatment. Data collected for the first 13 weeks was under the current standard of care and data collected under the second 13 weeks was under the PLAY bundle. Results33 infants participated with 19 after PLAY Bundle implementation. Under the current standard of care, 34% of patients (n = 27) had plagiocephaly documentation while just 7% (n = 6) received a PT (Physical Therapist) consultation. Of the participants diagnosed with head deformities since PLAY Bundle implementation, biweekly head measurements improved in 58%, worsened in 20%, worsened then improved in 8%, and stayed the same in 20%. ConclusionsThe PLAY Bundle was successful in the earlier identification and intervention of head deformities. In addition, the PLAY Bundle highlighted the importance of repositioning intervention for head deformities.

Storytelling: An Authentic Approach to Patient Safety Nursing Education.

An annual patient safety lecture is offered through a partnership with the local children's hospital. Presentations focus on the personal impact of medical errors, as told by families, patients, and care providers. The human stories of involvement with a medical error expose situations and actions that can lead to adverse clinical events. Nursing education strategies heighten students' awareness of patient safety policies and guidelines but may not assist students to understand the human impact of medical errors and their role in preventing them. Storytelling links course content to actual accounts of lived experiences involving medical errors. It promotes reflective learning by prompting students to examine beliefs, challenge assumptions, transform their understanding of concepts, and connect theory to practice. The annual culture of safety presentation promotes a deeper understanding of the role and responsibility that nurses have in promoting safe clinical practice.

A Measles Outbreak in a Local Children's Hospital in Korea, 2019.

A measles outbreak with 20 confirmed cases occurred at a local children's hospital in Daejeon from March 28 to April 21, 2019. The index patient was a 7-month-old girl with a recent history of travel to Vietnam. Contact tracing, active surveillance, and post-exposure prophylaxis were conducted by health authorities. Among the 20 patients, 11 (55%) were infants (0-11 months of age), three (15%) were aged 1-3 years, one (5%) was aged 4 years, and five (25%) were adults. Fifteen (75%) patients did not have a history of measles vaccination, and five (25%) had received only one vaccine dose. This study described the importance of prompt application of infection control measures in susceptible environments, including hospitals. Age-appropriate vaccination and providing information on infectious diseases to international travelers and multicultural families in Korea is vital.

The Pediatric Pharmacy Association and Members Threaded Through a Career and the Impact on Pediatric Drug Development.

The Pediatric Pharmacy Association and Members Threaded Through a Career and the Impact on Pediatric Drug Development.

Crossing unlikely paths in science.

Crossing unlikely paths in science.

Homeward.

Homeward.

Disability Daily Drawn: A Comics Collaboration

Disability Daily DrawnA Comics Collaboration Joann Purcell (bio) and Simone Purcell Randmaa (bio) My daughter Simone was the first person I met with Down syndrome. I was forty-two years old. This is an astonishing statement for many reasons, but primarily because I had worked as a nurse in downtown Toronto, Canada for fifteen years. When Simone was born, the delivery room went silent. The presumed tragedy of disability, medically avoidable, had permeated the room. Simone was not a child—she was a child with a disability. The chasm was wide. I remember being as devastated by her diagnosis as the rest of our family and friends, but we got on with our lives, largely because of our four-year-old twins. We loved Simone; we didn't love Down syndrome. She needed a lot of extra help to coordinate her muscles to crawl, walk, and eventually tie her shoelaces. She endured weekly visits from the physiotherapist, the early interventionist, and appointments with a myriad of specialists at the local children's hospital. It is undeniable that Simone is different, but I am also struck by how her way of being does not align with the stereotype I held previously. She is emotionally astute, a joyful child whose different way of knowing the world is creative, generative, and meaningful. There is a disconnect between our lived reality and the socially prevalent conceptions of Down syndrome. I began this comics project with the intention to amplify Simone's voice, to share her intellectual, affective, and communicative differences, and significantly, to share without speaking for her. Feminist scholar Linda Alcoff outlines the issues around speaking for others, in particular speaking for those who are or have been historically silent (6). The privilege of the speaking voice over another results in silences and erasure. Normative forms of communication dominate the sociocultural landscape, and thus the voice of a person with Down syndrome, who might be less vocally articulate, speak more slowly or with a focus that does not follow a logical conversation, may be dismissed. Artist, curator, and disability scholar Amanda Cachia writes, Developmentally disabled people are able to engage in modes of dialogical or socially engaged art practices in ways that express their way of knowing and understanding the world. These practices are particularly effective insofar as they emphasize the always-already inter-subjective and inter-corporeal nature of all embodiment. (122–23) [End Page 97] Click for larger view View full resolution [End Page 98] Click for larger view View full resolution [End Page 99] Click for larger view View full resolution [End Page 100] Click for larger view View full resolution [End Page 101] Click for larger view View full resolution [End Page 102] In choosing a platform, I landed on a comics practice for its dialogical structure and unique ability to showcase subjugated knowledge and to serve as visual witness to a life lived outside normative lines. I drew a four-panel comic every day beginning when Simone was ten years old, to the accumulation of 1095 pages. I distilled our exchanges and documented the mundanity of our life together. Over time, this daily practice became part of the fabric of our family's life. The element of time was integral to the project. The commitment to a daily entry over three years worked on many different levels. I found shorthand ways to draw, and my rusty drawing skills improved. Drawing, a skill I had let go of with the busyness of life, was now given the time, space, and purpose to develop again. Notably, this meant I regularly paid attention to the small details of our routine and repetitive life together. The need for content in the nightly transcription forced me to observe Simone more closely. I could see her, hear her, sense her in a new way. Our relationship grew. My perception of her vulnerability gave way to observations of her profound agency. The method for creating these comics was to employ sensory ethnography and mimesis. Sarah Pink writes about "doing ethnography that takes as its starting point the multi-sensoriality of experience, perception, knowing and practice" (1). This is a skill that requires time and...

ALL-098: COVID-19 in Children with Cancer: What We Learned from the First Wave

Context:COVID-19 is associated with morbidity and mortality in children with cancer, who are treated mainly in outpatient settings, where hospital visits are unavoidable for appropriate delivery of therapy, increasing their exposure risk to SARS-CoV-2.Objective:To measure the frequency of SARS-CoV-2 infection among hospitalized children with cancer and to detect the associated clinical manifestations and outcomes.Design:A prospective, nonintervention study recruited all hospitalized children with cancer with confirmed SARS-CoV-2 between mid-April and mid-June 2020 (NCT04404244).Setting:The study was carried out at a tertiary Pediatric Hematology Oncology Department at Ain Shams University in Egypt.Methodology:On admission and upon suspicion of COVID-19, patient clinical report forms, including demographic data, clinical assessments, epidemiological data (history of contact with a COVID-19 case), underlying oncologic disorders, and cause of admission, were completed. Baseline laboratory investigations, including complete blood count, C-reactive protein, serum ferritin, lactate dehydrogenase, and D-dimer, were performed. COVID-19 was confirmed by SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test by nasopharyngeal swab. Chest radiograph and/or high-resolution computed tomography (HRCT) chest scan was performed.Results:Over the study course, 61 children with cancer were admitted: 42 (68.9%) had acute lymphoblastic leukemia (ALL), 4 (6.5%) had lymphoma, and 15 patients had other malignancy. Fifteen were diagnosed with SARS-CoV-2. Most had hematological malignancies: 10 (76.9%) had ALL, 1 (6.7%) had acute myeloid leukemia, and 2 (13.4%) had lymphoma. Their mean age was 8.3 ± 3.5 years. Initially, 10 (66.7%) were asymptomatic, and 5 (33.3%) were symptomatic with fever and/or cough. Baseline laboratory tests other than SARS-CoV-2 RT-PCR were not diagnostic; the mean absolute lymphocyte count was 8.7 ± 2.4 × 109/L. C-reactive protein was mildly elevated in most of the patients. Imaging was performed in 10 (66.7%) patients, with significant radiologic findings detected in 4 (40%) patients. Treatment was mainly supportive with antibiotics, as per the febrile neutropenia protocol and local Children’s Hospital guidance for management of COVID-19 in children.Conclusions:Pediatric cancer patients with COVID-19 were mainly asymptomatic or with mild symptoms. A high index of suspicion and regular screening with nasopharyngeal swabs in asymptomatic hospitalized cancer patients is recommended.

Evaluating the efficacy of calcium chloride versus calcium gluconate in ECMO initiation for neonates

BackgroundNeonates who require Extracorporeal Membrane Oxygenation (ECMO) are at risk for calcium derangements and associated adverse outcomes. Local problemA large children's hospital in the Southwest changed their practice from using calcium gluconate in priming their neonatal ECMO circuits to using calcium chloride. The impact of this change was not investigated. MethodsA retrospective chart review of 56 neonates who required ECMO support one year prior to and one year following the practice change was conducted. Descriptive data was collected along with the first ionized calcium measured following ECMO initiation. ResultsUpon review of the data, the post-ECMO ionized calcium levels were not significant between the calcium gluconate and calcium chloride groups using a Mann Whitney U test (U = 315.5, z = −1.25, p = .213). However, Fisher's exact test revealed an odds ratio of 3.43 for the first ionized calcium being outside normal range in the calcium gluconate group. DiscussionWhile comparison of the first measured ionized calcium post-ECMO between the two groups was not statistically significant, there was a significant correlation with abnormal post-ECMO ionized calcium in the calcium gluconate group. ConclusionsThis project suggests that both calcium gluconate and calcium chloride are appropriate for use in priming the neonatal ECMO circuit, however calcium chloride may provide tighter control of calcium during ECMO initiation in neonates.

The caregiver's dilemma: in search of sustainable medical empathy

In 2015, our daughter Alma was delivered by emergency caesarean section at a local children's hospital. I listened for her cries, but she was silent. The medical team, too, was eerily quiet, gripped with concern. Alma struggled to live. We learned later that during her birth she had suffered a stroke. In those first moments as a parent, I realised two things. First, I wanted to protect my daughter more than anything I'd ever wanted. Second, I had already failed.

Who Deserves Access to Care in Children's Hospitals?

An eighteen-year-old with sickle cell disease was admitted to the pediatric hematology service at his local children's hospital for management of an acute pain crisis, one of many such admissions. He had a good relationship with his primary hematologist and primary nurse, but with other health care providers, there was evident friction. Sometimes, he was simply rude, rolling over and pretending to sleep in response to questions about his symptoms. When frustrated or convinced that his pain was not being addressed appropriately, he was prone to yelling and cursing at his nurses. After members of the health care team complained, their supervisor decided to transfer the patient to an adult general medicine service. Reasons cited for the transition included the stressful work environment created by the patient's actions, his refusal to follow directives from staff (although he was generally adherent to treatment), and the hypothetical harm to other young patients who might witness his behavior. Was this a just outcome? Is it ever permissible to deny access to pediatric care to a patient whose best interests would be served by it? Can access be withheld for "bad" behavior, and can transfer of care be wielded as a punishment?

Evaluation of the Healthy Lifestyles Initiative for Improving Community Capacity for Childhood Obesity Prevention.

Purpose and ObjectivesPolicy, systems, and environmental approaches are recommended for preventing childhood obesity. The objective of our study was to evaluate the Healthy Lifestyles Initiative, which aimed to strengthen community capacity for policy, systems, and environmental approaches to healthy eating and active living among children and families.Intervention ApproachThe Healthy Lifestyles Initiative was developed through a collaborative process and facilitated by community organizers at a local children’s hospital. The initiative supported 218 partners from 170 community organizations through training, action planning, coalition support, one-on-one support, and the dissemination of materials and sharing of resources.Evaluation MethodsEighty initiative partners completed a brief online survey on implementation strategies engaged in, materials used, and policy, systems, and environmental activities implemented. In accordance with frameworks for implementation science, we assessed associations among the constructs by using linear regression to identify whether and which of the implementation strategies were associated with materials used and implementation of policy, systems, and environmental activities targeted by the initiative.ResultsEach implementation strategy was engaged in by 30% to 35% of the 80 survey respondents. The most frequently used materials were educational handouts (76.3%) and posters (66.3%). The most frequently implemented activities were developing or continuing partnerships (57.5%) and reviewing organizational wellness policies (46.3%). Completing an action plan and the number of implementation strategies engaged in were positively associated with implementation of targeted activities (action plan, effect size = 0.82; number of strategies, effect size = 0.51) and materials use (action plan, effect size = 0.59; number of strategies, effect size = 0.52). Materials use was positively associated with implementation of targeted activities (effect size = 0.35).Implications for Public HealthCommunity-capacity–building efforts can be effective in supporting community organizations to engage in policy, systems, and environmental activities for healthy eating and active living. Multiple implementation strategies are likely needed, particularly strategies that involve a high level of engagement, such as training community organizations and working with them on structured action plans.

Predictors of long-term neurological outcomes in non-accidental head injury.

BackgroundNon-accidental head injury (NAI) is an inflicted injury usually on a child, often resulting in long-term neurological impairment and occasionally death. This study aimed to investigate the predictive values of acute findings, especially ocular, for long-term neurological outcomes.MethodsMedical records including retinal images of all children who attended the local Children's hospital with a diagnosis of NAI from over a period of 5 years were reviewed and data collected via the electronic patient record system. Patient demographics, injuries sustained, wide-field digital retinal images, visual acuity and sequalae, neurological function, and global function was noted. IBM SPSS software program was used for statistical analysis.ResultsOf the 38 patients (24 males, 14 females), 12 children died acutely from the head injury with the remaining 26 children available for long-term follow-up. A younger age of injury (P=0.004) was the only statistically significant predictor of good neurological outcome as compared with absence of macular retinoschisis, unilateral retinal haemorrhage, and unilateral subdural haemorrhage. Of the 38 children, 17 children had retinoschisis; 9 children with macular retinoschisis died acutely while 4 suffered a degree of developmental delay and only 4 were developmentally normal at the last follow-up. Long-term visual acuity data was available for 18 of the 26 survivors (range: NPL to Snellen 6/5). A statistical significance was noted between retinoschisis and worsened visual acuity (P<0.05).ConclusionsBilateral macular retinoschisis on acute presentation of NAI is associated with a seven-fold and unilateral with a four-fold increase in the development of a poor neurological outcome and eventual death. Conflicting to other studies, younger children presented better neurological outcomes.

Tablet-Based Intervention for Reducing Children's Preoperative Anxiety: A Pilot Study.

To examine the feasibility, acceptability, and effects of a novel tablet-based application, Story-Telling Medicine (STM), in reducing children's preoperative anxiety. Children (N = 100) aged 7 to 13 years who were undergoing outpatient surgery were recruited from a local children's hospital. This study comprised 3 waves: Waves 1 (n = 30) and 2 (n = 30) examined feasibility, and Wave 3 (n = 40) examined the acceptability of STM and compared its effect on preoperative anxiety to Usual Care (UC). In Wave 3, children were randomly allocated to receive STM+UC or UC. A change in preoperative anxiety was measured using the Children's Perioperative Multidimensional Anxiety Scale (CPMAS) 7 to 14 days before surgery (T1), on the day of surgery (T2), and 1 month postoperatively (T3). Wave 1 demonstrated the feasibility of participant recruitment and data collection procedures but identified challenges with attrition at T2 and T3. Wave 2 piloted a modified protocol that addressed attrition and increased the feasibility of follow-up. In Wave 3, children in the STM+UC demonstrated greater reductions in CPMAS compared with the UC group (ΔM = 119.90, SE = 46.36, t(27) = 2.59, p = .015; 95% confidence interval = 24.78-215.02). This pilot study provides preliminary evidence that STM is a feasible and acceptable intervention for reducing children's preoperative anxiety in a busy pediatric operative setting and supports the investigation of a full-scale randomized controlled trial.

Creation of a Pediatric Burn Clinic

Pediatric burns are a major source of morbidity and healthcare expenditure in the United States. Options and availability for outpatient pediatric burn treatment can be limited, potentially leading to high medical costs and delay in proper treatment. In our local community, there was no adequate, cost-effective outpatient treatment for patients with pediatric burn. In 2007, clinicians who specialize in pediatric burn care developed an outpatient pediatric burn clinic. The treatment team consisted of a pediatric nurse practitioner and four pediatric surgeons from the local children's hospital. Since opening, over 1,200 patients have been treated on a strictly outpatient basis. Kurt Lewin's three-stage model of change provided a conceptual model. The constructs include unfreeze the model pattern of burn referrals, change the pattern, and then work through a refreezing process. The burn clinic filled a need in the community by providing cost-effective outpatient specialty treatment for patients with pediatric burns. The future includes continuing ongoing marketing to the referring pediatric groups and outlying emergency department providers, expansion of staff to meet the growing needs of the community, and burn prevention community outreach.

Caregiver Soothing Behaviors After Immunization and Infant Attachment: A Longitudinal Analysis.

There were 2 primary objectives to the current study: (1) to relate caregiver behavior trajectories across immunization appointments over the first year of life to subsequent infant attachment and (2) to relate caregiver behavior trajectories within each immunization appointment over the first year of life to subsequent infant attachment. A subsample of 130 caregivers and their infants were recruited from a sample of 760 caregivers who were part of an ongoing longitudinal cohort that videotaped infants' 2-, 4-, 6-, and 12-month immunization appointments. This subsample of caregivers and their infants (n = 130) were invited to participate in an assessment of attachment when infants were between 12 and 18 months of age at the local children's hospital. Caregiver proximal soothing behaviors were the only caregiver behaviors postimmunization that were related to subsequent infant attachment. Higher frequencies of caregiver proximal soothing at 12 months were related to infants' organized attachment, whereas steeper decreases in proximal soothing across the first year were associated with disorganized infant attachment. In addition, when caregivers engaged in proximal soothing for longer after their 12 month olds' immunizations, these infants were more likely to be secure or organized in their attachment. These results provide empirical support for the ecological validity of studying infant attachment in a pediatric pain context. The pediatric "well-baby" visit may provide a potential opportunity to feasibly integrate brief infant mental health screening and intervention.

Promoting Health and Preventing Childhood Obesity through Policy Change: How Parks and Recreation Partnered with a Local Children's Hospital to Implement a Wellness Policy

Parks and Recreation represent an untapped opportunity for health promotion and childhood obesity prevention. Parks and Recreation have the capacity to implement strategies that increase opportunities for physical activity, encourage healthy eating, and much more. Focusing on policy change within the Parks and Recreation system is sustainable and has the potential to reach a large number of families. Although Parks and Recreation best practices encourage health and wellness promotion, most departments do not have a comprehensive wellness policy. Community partnerships can support policy change within Parks and Recreation. Gwinnett County Parks and Recreation partnered with Children’s Healthcare of Atlanta to develop a wellness policy. The wellness policy outlines strategies for providing safe opportunities for physical activity, offering healthy foods and beverages, ensuring access to smoke-free play areas, and providing a healthy summer camp and work environment. The wellness policy has potential to affect thousands of families. Annually, the department reaches over 418,000 visitors at county pools; 76,000 participants in recreation classes; 45,000 children in youth sports; and 4,000 children in camp. Through this innovative partnership, dietitians at Children’s Healthcare of Atlanta have supported the wellness policy through:

Medical student self-efficacy, knowledge and communication in adolescent medicine.

ObjectivesTo evaluate student self-efficacy, knowledge and communication with teen issues and learning activities.MethodsData were collected during the 8-week pediatric rotation for third–year medical students at a local children’s hospital. Students completed a self-efficacy instrument at the beginning and end of the rotation; knowledge and communication skills were evaluated during standardized patient cases as part of the objective structured clinical examination. Self-efficacy, knowledge and communication frequencies were described with descriptive statistics; differences between groups were also evaluated utilizing two-sample t-tests.ResultsSelf-efficacy levels of both groups increased by the end of the pediatric rotation, but students in the two-lecture group displayed significantly higher self-efficacy in confidentiality with adolescents (t(35)=-2.543, p=0.02); interviewing adolescents, assessing risk, sexually transmitted infection risk and prevention counseling, contraception counseling were higher with marginal significance. No significant differences were found between groups for communication; assessing sexually transmitted infection risk was marginally significant for knowledge application during the clinical exam.ConclusionsMedical student self-efficacy appears to change over time with effects from different learning methods; this higher self-efficacy may increase future comfort and willingness to work with this high-risk, high-needs group throughout a medical career.