Pediatric Laboratory Research Articles

Using Quality Improvement to Optimize Blood Product Utilization in a Pediatric Cardiac Catheterization Laboratory.

Packed red blood cells (PRBC) are frequently ordered for cardiac catheterization procedures, which increases resource utilization and patient charges. We applied the Plan-Do-Study-Act (PDSA) principle in order to optimize the ordering of PRBC for pediatric cardiac procedures and reducing charges. Our primary aim was to increase adherence to ordering guidelines to greater than 97%, with a global aim to reduce resource utilization. The existing PRBC ordering guidelines were revised and procedure reports were updated to include administration of PRBC. The rate of pre-procedure PRBC orders, adherence to the new protocol guidelines, presence of documentation and rate of blood transfusion within 24h post-procedure, frequency of emergency release blood during a procedure were monitored. During our study period, there was an increased adherence from 86 to 100% adherence following implementation of the updated guidelines. With improved adherence, we decreased PRBC ordering and hospital charges to the patient in low-risk cardiac catheterization procedures, without an increase in blood transfusions.

B-171 Iohexol Mass Spectrometry Method Validation and Comparison in Clinical Pediatric Laboratory

Abstract Background Accurate assessment of kidney function is important yet challenging in pediatric patients due to changing muscle mass affecting serum creatinine. There are several key methods to assess kidney function in this population, including estimated glomerular filtration rate (eGFR) from serum creatinine, urine creatinine clearance, and eGFR from serum iohexol clearance, which often provides a more reliable estimate. Iohexol is a non-ionic iodinated contrast agent filtered freely through the glomeruli without tubular secretion, making it an ideal GFR marker.In this study, we validated the LC-MS/MS method to quantitatively measure iohexol in clinical pediatric plasma and serum samples. The clinical performance was compared with the novel Verispray method. Methods A series of iohexol standards (Caymen Chemical) were prepared at 10, 100, 500, 1000 µg/mL in serum (UTAK). The liquid chromatography-tandem mass spectrometry (LC-MS/MS) method and Verispray method were developed to quantitatively measure iohexol concentrations in spiked pediatric specimens. The internal standard (IS) solution was prepared with Iohexol-D5 (Cayman Chemical) at 9 µg/mL in UPLC grade methanol. Specimen or calibration/QC (50 µL) were mixed with IS solution (450 µL), and then centrifuged at 14,000xg for 3 minutes. The supernatants were analyzed. For LC-MS/MS, 3 µL supernatants were chromatographed on a AccucoreTM Vanquish C18 50 x 2.1mm (Thermo Scientific) using a gradient of water with 0.1% formic acid (FA) against methanol with 0.1% FA. Iohexol and IS were measured by multiple reaction monitoring using a TSQ Quantis Plus Mass Spectrometer (ThermoFisher). For Verispray, 10 µL supernatants were loaded on the Verispray sample plate (ThermoFisher) without LC portion. The samples were extracted from the plate paper using 95% acetonitrile with 5% water and 0.1% FA before directly injected into the mass spectrometer. The LC-MS/MS method was evaluated for linearity, patient comparison, carryover, matrix effect, and stability. 40 patients were analyzed between methods. Results Linearity was assessed over 5 days at 4 calibrator levels, the coefficient of variation (CV) ranged from 3.46 - 5.99%. The patient comparison of 40, 20 serum and plasma respectively, was conducted with Mayo Clinics, and good concordance was observed. Matrix effects were evaluated with spiked samples prepared with 50% mobile phase A and B, the ion enhancement was at 10.7%, within the allowable limits. No significant carryover was seen. The samples were stable at room temperature for 48 hours and 4oC for 7 days. Freezing is not recommended. The comparison between Verispray and LC-MS/MS showed significant bias between and within the performing personnel, the deviation can be up to 40% comparing to LC-MS/MS method. Conclusions The LC-MS/MS method demonstrated stable and consistent analytical performance for iohexol measurement. However, the Verispray method showed significant inter- and intra-user variabilities. As the Verispray sample spot can only be used once, respotting is required for any additional measurement, reducing reproductivity. It is highly recommended to duplicate all samples when using Verispray, to limit preparation to one user per patient run. Overall, our validation indicates the LC-MS/MS method provides reliable performance as a useful alternative to other complex gold standard pediatric tests of kidney function.

Parental Perspectives From the Survey of Sleep Quality in the PICU Validation Study on Environmental Factors Causing Sleep Disruption in Critically Ill Children.

Sleep promotion bundles being tested in PICUs use elements adapted from adult bundles. As children may react differently than adults in ICU environments, this study investigated what parents report disrupted the sleep of their child in a PICU. Secondary analysis of a multicenter validation study of the Survey of Sleep quality in the PICU. Four Northeastern U.S. PICUs, one hospital-based pediatric sleep laboratory. Parents sleeping at the bedside of a child in the PICU or hospital-based sleep laboratory. Anonymous one-time survey eliciting parts of hospital or ICU environments that have been described as disruptive to sleep in validated adult ICU and pediatric inpatient questionnaires. Level of sleep disruption was scored by Likert scale, with higher scores indicating more disruption. Age, demographics, baseline sleep, and PICU exposures were used to describe causes of sleep disruption in a PICU. Of 152 PICU parents, 71% of their children's sleep was disrupted significantly by at least one aspect of being in the PICU. The most prevalent were "being in pain or uncomfortable because they are sick" (38%), "not sleeping at home" (30%), "alarms on machines" (28%), and "not sleeping on their home schedule" (26%). Only 5% were disrupted by excessive nocturnal light exposure. Overall sleep disruption was not different across four PICUs or in those receiving sedation. The validation study control group, healthy children undergoing polysomnography, had less sleep disruption than those in a PICU despite sleeping in a hospital-based sleep laboratory. There are multiple aspects of critical care environments that affect the sleep of children, which are different from that of adults, such as disruption to home schedules. Future interventional sleep promotion bundles should include sedated children and could be applicable in multicenter settings.

How We Would Treat Our Own Congenital Cardiac Catheterization Laboratory Patient

The field of congenital cardiac catheterization (CCC) has changed dramatically since it began eight decades ago. New techniques and devices have expanded the indications for interventional catheterization. Heart teams who care for patients in the pediatric and congenital cardiac catheterization laboratory are confronted with a growing number of patients presenting for a wide range of increasingly technically-challenging cases. Multiple societies have published expert guidelines for CCC management to provide recommendations for best practice. We reviewed risk stratification strategies for CCC and describe our institution's comprehensive, multidisciplinary approach to the periprocedural management of patients with congenital heart disease undergoing cardiac catheterization, using the index case of a 6-year-old patient with multiple heart defects. We concluded that risk stratification and a comprehensive, multidisciplinary team approach that begins when a procedure is booked is essential to inform management and optimize outcomes. Clinical decision-making should be informed by expert guidelines and evolving risk stratification research.

Clinical features of anti-neurofascin-155 antibody positive autoimmune nodopathy in 6 children

Objective: To analyze the clinical features of anti-neurofascin-155 (NF155) antibody positive autoimmune nodopathy in children. Methods: This was a case series study. A total of 6 children who were diagnosed accurately as anti-NF155 antibody positive autoimmune nodopathy by cell immunofluorescence assay at the Children's Hospital of Fudan University from January 2020 to December 2023 were collected. This study retrospectively analyzed 6 pediatric children's clinical manifestations, laboratory and electrophysiological examination results, and treatment outcomes. Results: Among 6 children with anti-NF155 antibody positive autoimmune nodopathy, there were 4 boys and 2 girls. The onset age of 6 children ranged from 3 years and 8 months to 12 years. All 6 children had extremity weakness (more severe in the distal and the lower extremities than in the upper extremities), 5 children had sensory deficits such as numbness or pain in the extremities, 4 children had tremors and ataxia, 3 children had cranial nerve involvement. Among the 6 children, 4 children had protein-cell separation in cerebrospinal fluid examinations. Among the 6 children, 1 child had central nervous system demyelination, the brain magnetic resonance imaging showed multiple abnormal signals in the bilateral cerebral hemispheres. Four children showed motor and sensory nerve damage in electrophysiological examination, and 2 children only showed motor nerve damage. Three children showed myelin and axonal damage, and 3 children only showed axonal damage. Among the 6 children, 5 children were treated with intravenous immunoglobulin and steroids. Among them, 2 children underwent plasma exchange due to poor efficacy, and subsequently, rituximab was added. There was 1 child changed the treatment with olfatomumab since the symptoms did not significantly improve after using rituximab. After treatment for 4-15 months, 2 children had no clinical symptoms, 1 child had improvement in clinical symptoms, 2 children had no significant improvement in clinical symptoms, and 1 child who did not receive the immunotherapy had no significant change in clinical symptoms. Conclusions: Anti-NF155 antibody positive autoimmune nodopathy in children presents with varying degrees of clinical manifestations. It is mainly characterized by extremity weakness, numbness and pain, often accompanied bytremorsand ataxia. Some pediatric patients may also have central nervous system demyelination. Cerebrospinal fluid and electrophysiological examination are important auxiliary examination methods. If steroid therapy is not effective, plasma exchange and rituximab treatment should be used as soon as possible.

Considerations for applying emerging technologies in paediatric laboratory medicine.

Emerging technology in laboratory medicine can be defined as an analytical method (including biomarkers) or device (software, applications, and algorithms) that by its stage of development, translation into broad routine clinical practice, or geographical adoption and implementation has the potential to add value to clinical diagnostics. Paediatric laboratory medicine itself may be considered an emerging area of specialisation that is established relatively recently following increased appreciation and understanding of the unique physiology and healthcare needs of the children. Through four clinical (neonatal hypoglycaemia, neonatal hyperbilirubinaemia, sickle cell disorder, congenital adrenal hyperplasia) and six technological (microassays, noninvasive testing, alternative matrices, next generation sequencing, exosome analysis, machine learning) illustrations, key takeaways of application of emerging technology for each area are summarised. Additionally, nine key considerations when applying emerging technology in paediatric laboratory medicine setting are discussed.

Experience in treating multifocal alopecia areata in a child with Jak kinase inhibitors

Alopecia Areata is an autoimmune disease characterized by hair loss mediated by CD8 + T cells. There are no proven effective treatments for alopecia. Recent research on the immunology of hair follicles and recent developments in the field of immunopatogenesis, as well as common ways of developing the disease with other autoimmune disorders have led to research on new treatments, targeted at specific immunological pathways. The so-called JAK-STAT pathway is responsible for transmitting signal from different cytokines to the nucleus of the cell, suggesting that blocking this pathway may be effective in the treatment of alopecia.Study purpose. Presentation of Clinical Case of Multi-focal Alopecia Treatment in Child Oral Tofacitinib.Materials and methods. The study was conducted on the basis of the dermatology department with the laser surgery group of the Center for Pediatric Dermatology and Laboratory of Skin Pathology in children FGAU «National Medical Research Center for Children’s Health» of the Ministry of Health of Russia from April 2021 to November 2022. Severity Alopecia Tool (SALT) was used to determine the severity of the disease in participants. The SALT scale takes into account the percentage of affected hair and divides it into 6 subclasses (S 0 %, S1 <25 %, S2 25–49 %, S3 50–74 %, S4 75–99 % and C5100 %).Results. When oral tofacitinib was administered for 6 months in a 9-year-old patient, full recovery of hair growth on the scalp was observed. No significant abnormalities based on clinical and biochemical blood results were found for the period of treatment and for a year after withdrawal. There was no recurrence of hair loss after the withdrawal of the drug for 12 months.Conclusion. JAK inhibitors can be effective new treatments for alopecia in children. Additional data from randomized controlled trials are required for safe use of JAK inhibitors.

Small patients, big challenges: navigating the complex world of pediatric reference intervals

Abstract With about 60%-70% of medical decisions based on laboratory investigations, modern medicine is increasingly more reliant on laboratory medicine. Pediatric healthcare particularly depends on laboratory testing, with reference intervals (RIs) serving as critical tools for accurate result interpretation. However, establishing pediatric RIs poses distinctive challenges due to developmental, growth, nutritional, and disease-related variations across age groups, along with technical, ethical, and logistical challenges. Despite these limitations, there are several ongoing initiatives for developing pediatric RIs globally, underscoring the importance of developing accurate pediatric RIs. This review outlines the particularities of pediatric laboratory medicine and the specific challenges in establishing pediatric RIs, highlighting the recent initiatives in this area. It also addresses biological and analytical variability issues and explores future perspectives aimed at enhancing diagnostic accuracy and elevating patient care standards.

Radiation Reduction in Paediatric Cardiac Catheterization: We Can Go Even Lower

BackgroundRadiation reduction is an integral component in the management of a paediatric cardiac catheterization laboratory. Simple and easily implementable protocol changes and technical upgrades have been shown to significantly reduce radiation exposure. MethodsRadiation exposures (2020-2022) at Safra Children’s Hospital, Sheba Medical Center, Israel (unit A: n = 672) were retrospectively reviewed, including dose area product (DAP) (μGy m2), DAP/kg, Air Kerma (mGy), and fluoroscopy time (minutes) for 16 procedural types. Median doses were compared with those measured (2011-2014) at the Hospital for Sick Children, Toronto, Canada (unit B: n = 2033). Radiation reduction techniques included fluoroscopy acquisition at 7.5 frames/s, removal of antiscatter grids for children <30 kg, limiting field of view, use of Philips ClarityIQ technology, and an institutional culture of radiation mindedness. ResultsExposure was significantly lower in unit A in 14 of 16 procedure types. Total median doses were lower in unit A (DAP: 91.4 [44.7-205.4] vs 387 [138.2-1339] μGy m2 [P < 0.001], DAP/kg: 9.33 [4.3-16.4] vs 29.22 [12.8-65.9] μGy m2/kg [P < 0.001], and Air Kerma: 14.9 [7.8-29] vs 61 [23-176.4] mGy [P < 0.001]) despite higher fluoroscopy time (14.1 [4.2-24.6] vs 12.3 [6.8-23.3] minutes [P = 0.03]). DAP was lower for specific procedures including pulmonary valvuloplasty (46.3 [14.3-219.3] vs 127 [60-323] μGy m2 [P < 0.001]) and patent ductus arteriosus closure (51.9 [18.8-111.8] vs 178 [96-410] μGy m2 [P < 0.001]). ConclusionsEnhanced radiation reduction techniques can lead to lower than previously published exposure levels across a wide range of procedure types when employing dose-limiting protocols and radiation reduction technology.

Novel Uses of the SwiftNinja Steerable Microcatheter for Pediatric Cardiovascular Interventions.

In the present era, the intricacy of procedures undertaken by a pediatric interventional cardiologist has increased, primarily attributed to dealing with smaller, younger patients with more complex anatomies. To adapt to these smaller and more complex patients, we must adapt our interventions and our equipment to perform these procedures. This article outlines various innovative applications of the SwiftNinja steerable microcatheter within the pediatric cardiac catheterization laboratory.

Reverse-engineered exclusive enteral nutrition in pediatric Crohn's disease: A pilot trial.

In pediatric Crohn's disease (CD), commercial formulas used as exclusive enteral nutrition (EEN) are effective at inducing remission. This study aims to assess the impact of a whole-food blended smoothie as EEN on CD activity and the intestinal microbiome. A 4-week prospective trial assessed the impact of EEN with a whole-food smoothie on newly diagnosed mild-to-moderate active pediatric CD. The smoothie with a multivitamin were developed to meet age-appropriate nutritional requirements. Assessment over 4 weeks included Pediatric Crohn's Disease Activity Index (PCDAI), serum laboratories, fecal calprotectin (FCP), and stool collection for metagenomic shotgun sequencing and microbiota composition analysis. Clinical remission was defined as PCDAI ≤ 10 at week 4. Ten participants were enrolled with median age 14.5 years, and 8 completed the trial. Baseline mean PCDAI was 26.3 ± 9.1 and mean FCP 1149 ± 718 µg/g. At week 4, 80% of participants achieved clinical remission. FCP decreased by over half in 60% of participants, with FCP below 250 µg/g in 60% and below 100 µg/g in 40%. Microbiome analysis showed a significant increase in species richness over 4 weeks (p = 0.01). Compared to baseline, the relative abundance at week 2 and at week 4 was significantly increased for Bifidobacterium and Streptococcus and decreased for Blautia (p < 0.05 for all). A whole-food blended smoothie was effective for inducing clinical remission and decreasing FCP in pediatric CD similar to commercial EEN formulas. Further research may give insight into data-driven whole-food dietary approaches for CD management. gov NCT03508193.

Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group - CORRIGENDUM.

Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group - CORRIGENDUM.

Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities, and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group.

There is limited data on the organisation of paediatric echocardiography laboratories in Europe. A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs. Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1-12), and echocardiography machines was four (range 1-12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20-60) minutes, and for repeat examination was 20 (5-30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%). Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.

Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM).

The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by experts in both adult and pediatric laboratory and clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems, including Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections; or into etiologic agent groups, including arboviral Infections, Viral Syndromes, and Blood and Tissue Parasite Infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. In addition, the pediatric needs of specimen management are also addressed. There is redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients.

First record of pediatric cardiovascular interventional procedures performed in a state pediatric catheterization laboratory in El Salvador

First record of pediatric cardiovascular interventional procedures performed in a state pediatric catheterization laboratory in El Salvador

Europeanpediatric Acute Leukemia (EuPAL) Registry

The Leukemia Lymphoma Society (LLS) Pediatric Acute Leukemia (PedAL) Initiative is a collaborative international effort that aims to improve the cure of children with relapsed/refractory (R/R) and other high-risk leukemias. Its comprehensive approach included preclinical and clinical research, standardization and improvement of diagnostics, quality management, and global data integration and analysis. The European Pediatric Acute Leukemia (EuPAL) Foundation was established as the PedAL Initiative partner to support European stakeholders in these efforts. A major focus of the EuPAL Registry and PedAL Initiative is to increase access to and test new drugs targeting leukemia-specific biologic and genetic characteristics in pediatric patients with R/R acute myeloid leukemia (AML). However, identification and recruitment of patients remains a challenge. For this purpose, the APAL2020SC screening trial (NCT04726241) in North America, Australia, and New Zealand and the EuPAL registry in Europe have been launched. In collaboration with national and international study groups, pediatric leukemia reference laboratories, and participating clinical trial sites, each child with R/R AML should be registered. In Europe, the EuPAL registry office identifies the best available trial for the patient based upon leukemia-associated genetic and immunophenotypic data and closest trial site(s) and coordinates contact between the treating physician/site and the trial site as needed. Results The EuPAL registry has been approved by the leading ethic committee in Germany with extension to several other European countries ongoing. To date, 35 children and adolescents with R/R AML have been enrolled since June 2022. The median age at initial diagnosis was 7.3 (range 0.2 to 17.7) years with median duration of remission 1.3 (0.3 to 5.3) years. Most patients were registered at first relapse (n=29) with 3 patients in second relapse and 1 patient in third relapse. Two children were diagnosed with a molecular relapse (n=2). Fourteen patients have been transplanted in 1 st CR (n=9) /2 nd CR (n=5) prior to registration Regarding the initial risk groups at diagnosis, most relapses occurred in the intermediate risk group (IR) n=19) and the high-rik group (HR; n=12). The others were standard risk, one isolated CNS relapse in APL and two in children with trisomy 21. Patients were treated at relapse on the AML-BFM 2017 registry (treatment recommendation: Idarubicin, fludarabine, cytarabine (IDA-FLA), FLA and HSCT), the AIEOP-BFM-AML 2020 trial (FLA- gemtuzumab ozogamicin (GO) or IDA-FLA t(8;21)), the AMORE 2017 trial (azacytidine and HSCT; n=2) or received off-label therapies (cytarabine/GO, venetoclax/cytarabine, or azacytidine). Conclusion The EuPAL registry has been successfully established and is beginning to generate relevant knowledge regarding the frequency and timing of pediatric AML relapse, leukemia-associated genetics, and immunophenotypic characteristics. In collaboration with the LLS PedAL Initiative, the EuPAL registry will continue to facilitate recruitment of children with R/R AML and other leukemias to clinical trials testing innovative therapies, as well as improve understanding of potential bias in clinical trial referrals. Current challenges include integration of more European countries into the EuPAL Registry and increasing the number of open early-phase PedAL/EuPAL clinical trials.

Application of bi-directional long-short-term memory network in cognitive age prediction based on EEG signals

Electroencephalography (EEG) measures changes in neuronal activity and can reveal significant changes from infancy to adulthood concomitant with brain maturation, making it a potential physiological marker of brain maturation and cognition. To investigate a promising deep learning tool for EEG classification, we applied the bidirectional long short-term memory (BLSTM) algorithm to analyze EEG data from the pediatric EEG laboratory of Taipei Tzu Chi Hospital. The trained BLSTM model was 86% accurate when identifying EEGs from young children (8 months–6 years) and adolescents (12–20 years). However, there was only a modest classification accuracy (69.3%) when categorizing EEG samples into three age groups (8 months–6 years, 6–12 years, and 12–20 years). For EEG samples from patients with intellectual disability, the prediction accuracy of the trained BLSTM model was 46.4%, which was significantly lower than its accuracy for EEGs from neurotypical patients, indicating that the individual’s intelligence plays a major role in the age prediction. This study confirmed that scalp EEG can reflect brain maturation and the BLSTM algorithm is a feasible deep learning tool for the identification of cognitive age. The trained model can potentially be applied to clinical services as a supportive measurement of neurodevelopmental status.

Comparison of risk factors for Methicillin Resistant Staphylococcus aureus (MRSA) colonization in healthy newborns, born to mothers with and without MRSA colonization.

To compare the risk factors for MRSA colonization in healthy newborns, born of mothers with and without MRSA colonization. This case control study was conducted in post-natal unit of Lady Willingdon Hospital, affiliated with King Edward Medical University/Mayo Hospital, Lahore from January to June 2017. The vaginal and anterior nares swabs for MRSA culture were collected from mothers within six hours before planned delivery and the neonatal anterior nares swabs for MRSA culture were taken within one hour of birth. All the samples were cultured in Paediatric Microbiology laboratory in Mayo Hospital. Data were analyzed through SPSS 20.0 and logistic regression was applied for risk factors analysis. Out of total 80 mothers and their newborns, 15 (18.75%) mothers and 16 neonates (20%) were MRSA colonized. The frequency of MRSA colonization in mothers' anterior nares and vaginal swab was 17.5% and 1.25% respectively. The significant risk factors were prolonged rupture of membranes for >18 hours (p-value 0.02, odds ratio 11.85, 95% CI 1.41-99.3), birth weight <2500 grams (p-value 0.01, odds ratio 5.39, 95% CI 1.35-21.4), history of presence of meconium (p-value 0.006, odds ratio 7.30, 95% CI 1.78-29.8). The non-significant factors were age of mother (p-value 0.682, odds ratio 0.765, 95% CI 1.0.212-2.76), parity (p-value 0.185, odds ratio 3.82, 95% CI 0.46-31.66) , gestation (p-value 0.615, odds ratio 0.797, 95% CI 0.714-0.89) , mode of delivery (p-value 0.576, odds ratio 0.543, 95% CI 0.062-4.76), sex of baby (p-value 0.546, odds ratio 0.683, 95% CI 0.196-2.37) and presentation of baby at birth (p-value 0.47, odds ratio 0.795, 95% CI 0.71-0.89). The presence of meconium, prolonged rupture of membranes and low birth weight were the significant risk factors for MRSA colonization in healthy new-borns, born to mothers with and without MRSA colonization.

P044 Assessing Sp02 Data Reliability in a Paediatric Laboratory: A Comparative Study of Pulse Oximetry and Transcutaneous Oxygen Monitoring

Abstract Introduction Pulse oximetry is the primary method for measuring Sp02 in polysomnography studies to determine the presence of sleep apnoea. In paediatric studies where there is significant artefact in pulse oximetry, we investigate if transcutaneous oxygen monitoring (TcOM) can be used as a reliable alternative to measure blood oxygen concentration (Sp02). Methods A comparison of pulse oximetry (Nonin) and TcOM (Sentec) data was performed by a retrospective analysis of 16 diagnostic studies (Male=50%; Median age= 8±4.69SD). 6 studies were excluded due to: AHI &amp;gt;5/hr, missing data and artefact. A comparison was made between the two sampling methods for: Oxygen desaturation index (ODI) per hour, nadir and baseline. Statistical analysis run was a paired t-test. Results Poor test-retest reliability was observed for all parameters- mean(SD): ODI Nonin=1.13(1.24), ODI Sentec=50.74(29.13)*; Nadir Nonin=91.10(3.78), Nadir Sentec=69.10(10.62)*; Baseline Nonin=98.(0.57), baseline Sentec=99.50(0.71)*. These results strongly indicate a significant statistical difference between data groups. *indicates P=&amp;lt;0.05 Discussion Our analysis demonstrated inconsistent data between the two methods, and unstable Tc0M readings, which if used could lead to misdiagnosis of sleep-disordered breathing. Further comparative analysis using different Tc0M skin sites could yield more reliable data. Two reliable sources of SpO2 data would provide an in-clinic verification tool in instances of significant artefact or troubleshooting, to improve quality of studies conducted.

Renal Involvement in Multisystem Inflammatory Syndrome in Children: Not Only Acute Kidney Injury.

Kidney involvement has been poorly investigated in SARS-CoV-2 Multisystem Inflammatory Syndrome in Children (MIS-C). To analyze the spectrum of renal involvement in MIS-C, we performed a single-center retrospective observational study including all MIS-C patients diagnosed at our Pediatric Department between April 2020 and May 2022. Demographic, clinical, pediatric intensive care unit (PICU) admission's need and laboratory data were collected at onset and after 6 months. Among 55 MIS-C patients enrolled in the study, kidney involvement was present in 20 (36.4%): 13 with acute kidney injury (AKI) and 7 with isolated tubular dysfunction (TD). In eight patients, concomitant AKI and TD was present (AKI-TD). AKI patients needed higher levels of intensive care (PICU: 61.5%, p < 0.001; inotropes: 46.2%, p = 0.002; second-line immuno-therapy: 53.8%, p < 0.001) and showed lower levels of HCO3- (p = 0.012), higher inflammatory markers [neutrophils (p = 0.092), PCT (p = 0.04), IL-6 (p = 0.007)] as compared to no-AKI. TD markers showed that isolated TD presented higher levels of HCO3- and lower inflammatory markers than AKI-TD. Our results indicate a combination of both pre-renal and inflammatory damage in the pathogenesis of kidney injury in MIS-C syndrome. We highlight, for the first time, the presence of tubular involvement in MIS-C, providing new insights in the evaluation of kidney involvement and its management in this condition.