Pediatric Medical Center Research Articles

Unplanned Intensive Care Unit Admission Following Cleft Palate Repair by Head and Neck Surgeons.

To examine the incidence of pediatric intensive care unit (PICU) admission following primary repair of cleft palate by otolaryngologist-head and neck surgeons at 2 tertiary centers. To identify potential diagnoses associated with admission or unanticipated PICU transfer. Multi-institutional case series with chart review. Two tertiary pediatric medical centers. Children who underwent primary repair of cleft palate at 2 cleft centers over a 10-year period were identified. Charts were reviewed for demographics, comorbidities, and whether PICU admission was required. From 2009 to 2019, 464 patients underwent primary repair of a cleft palate by 1 of 6 otolaryngologist-head and neck surgeons with subspecialty training in cleft surgery; 459 patients had sufficient postoperative documentation and 443 children met inclusion criteria. The incidence of PICU admission was 9.3% (41/443), with 33 (7.4%) planned admissions and 8 (1.8%) unexpected PICU transfers. Syndromic conditions were associated with both planned and unanticipated PICU admissions. The incidence of unanticipated postoperative PICU admission following cleft palate repair by otolaryngologist-head and neck surgeons was low. Risk stratification by surgeons with expertise in airway management may inform decisions regarding postoperative disposition of patients with medical or airway complexity who are undergoing cleft palate repair.

Healthcare Use and Case Characteristics of Commercial Sexual Exploitation of Children: Teen Victims Versus High-Risk Teens.

The overall goal of this study was to provide further information about the characteristics of commercial sexual exploitation of children (CSEC) victims by comparing the characteristics of a known victim pool to high-risk patients identified. The specific objectives of this study were to describe patient demographic characteristics, pediatric healthcare use, familial psychosocial characteristics, and child sexual abuse case characteristics present in youth identified as high risk for CSEC victimization compared with a sample of known victims. A retrospective chart review was conducted on patients presenting to the emergency department or Child Advocacy Center for a concern of sexual abuse/assault at a midwestern U.S. academic pediatric medical center. Adolescents aged 12-21 years were included in the study. In the current study, multiple CSEC risk factors were noted to increase odds for CSEC victimization: homelessness or life on the streets, runaway behavior, living with mother only, placement in a juvenile detention center, placement in a residential treatment center or group home, and number of living arrangements (four or greater). Multiple elements of high-risk sexual behavior increased odds of CSEC victimization: legally age-inappropriate sex, gonorrhea diagnosis, trichomonas diagnosis, other sexually transmitted infection (STI) diagnoses, number of STIs, and chlamydia diagnosis. These findings suggest that age of sexual partners and number and types of STIs are associated with CSEC and should be validated in other groups. In addition, these data suggest that use of cocaine and opiates could serve as an important, yet underrecognized, risk factor.

Racial and ethnic disparities in pediatric magnetic resonance imaging missed care opportunities.

Imaging missed care opportunities (MCOs), previously referred to as "no shows," impact timely patient diagnosis and treatment and can exacerbate health care disparities. Understanding factors associated with imaging MCOs could help advance pediatric health equity. To assess racial/ethnic differences in pediatric MR imaging MCOs and whether health system and socioeconomic factors, represented by a geography-based Social Vulnerability Index (SVI), influence racial/ethnic differences. We conducted a retrospective analysis of MR imaging MCOs in patients younger than 21years at a pediatric academic medical center (2015-2019). MR imaging MCOs were defined as: scheduled but appointment not attended, canceled within 24h, and canceled but not rescheduled. Mixed effects multivariable logistic regression assessed the association between MCOs and race/ethnicity and community-level social factors, represented by the SVI. Of 68,809 scheduled MRIs, 6,159 (9.0%) were MCOs. A higher proportion of MCOs were among Black/African-American and Hispanic/Latino children. Multivariable analysis demonstrated increased odds of MCOs among Black/African-American (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.7-2.3) and Hispanic/Latino (aOR 1.5, 95% CI 1.3-1.7) children compared to White children. The addition of SVI >90th percentile to the adjusted model had no effect on adjusted OR for Black/African-American (aOR 1.9, 95% CI 1.7-2.2) or Hispanic/Latino (aOR 1.5, 95% CI 1.3-1.6) children. Living in a community with SVI >90th percentile was independently associated with MCOs. Black/African-American and Hispanic/Latino children were almost twice as likely to experience MCOs, even when controlling for factors associated with MCOs. Independent of race/ethnicity, higher SVI was significantly associated with MCOs. Our study supports that pediatric health care providers must continue to identify systemic barriers to health care access for Black/African-American and Hispanic/Latino children and those from socially vulnerable areas.

PheNominal: an EHR-integrated web application for structured deep phenotyping at the point of care

BackgroundClinical phenotype information greatly facilitates genetic diagnostic interpretations pipelines in disease. While post-hoc extraction using natural language processing on unstructured clinical notes continues to improve, there is a need to improve point-of-care collection of patient phenotypes. Therefore, we developed “PheNominal”, a point-of-care web application, embedded within Epic electronic health record (EHR) workflows, to permit capture of standardized phenotype data.MethodsUsing bi-directional web services available within commercial EHRs, we developed a lightweight web application that allows users to rapidly browse and identify relevant terms from the Human Phenotype Ontology (HPO). Selected terms are saved discretely within the patient’s EHR, permitting reuse both in clinical notes as well as in downstream diagnostic and research pipelines.ResultsIn the 16 months since implementation, PheNominal was used to capture discrete phenotype data for over 1500 individuals and 11,000 HPO terms during clinic and inpatient encounters for a genetic diagnostic consultation service within a quaternary-care pediatric academic medical center. An average of 7 HPO terms were captured per patient. Compared to a manual workflow, the average time to enter terms for a patient was reduced from 15 to 5 min per patient, and there were fewer annotation errors.ConclusionsModern EHRs support integration of external applications using application programming interfaces. We describe a practical application of these interfaces to facilitate deep phenotype capture in a discrete, structured format within a busy clinical workflow. Future versions will include a vendor-agnostic implementation using FHIR. We describe pilot efforts to integrate structured phenotyping through controlled dictionaries into diagnostic and research pipelines, reducing manual effort for phenotype documentation and reducing errors in data entry.

Sustained Within-season Vaccine Effectiveness Against Influenza-associated Hospitalization in Children: Evidence From the New Vaccine Surveillance Network, 2015-2016 Through 2019-2020.

Adult studies have demonstrated within-season declines in influenza vaccine effectiveness (VE); data in children are limited. We conducted a prospective, test-negative study of children 6 months through 17 years hospitalized with acute respiratory illness at 7 pediatric medical centers during the 2015-2016 through 2019-2020 influenza seasons. Case-patients were children with an influenza-positive molecular test matched by illness onset to influenza-negative control-patients. We estimated VE [100% × (1 - odds ratio)] by comparing the odds of receipt of ≥1 dose of influenza vaccine ≥14 days before illness onset among influenza-positive children to influenza-negative children. Changes in VE over time between vaccination date and illness onset date were estimated using multivariable logistic regression. Of 8430 children, 4653 (55%) received ≥1 dose of influenza vaccine. On average, 48% were vaccinated through October and 85% through December each season. Influenza vaccine receipt was lower in case-patients than control-patients (39% vs 57%, P < .001); overall VE against hospitalization was 53% (95% confidence interval [CI]: 46, 60%). Pooling data across 5 seasons, the odds of influenza-associated hospitalization increased 4.2% (-3.2%, 12.2%) per month since vaccination, with an average VE decrease of 1.9% per month (n = 4000, P = .275). Odds of hospitalization increased 2.9% (95% CI: -5.4%, 11.8%) and 9.6% (95% CI: -7.0%, 29.1%) per month in children ≤8 years (n = 3084) and 9-17 years (n = 916), respectively. These findings were not statistically significant. We observed minimal, not statistically significant within-season declines in VE. Vaccination following current Advisory Committee on Immunization Practices (ACIP) guidelines for timing of vaccine receipt remains the best strategy for preventing influenza-associated hospitalizations in children.

Food insecurity during COVID-19 in children with end-stage kidney disease: a pilot study

BackgroundFood insecurity, an important social determinant of health among children, has become more common during the COVID-19 pandemic. Children with chronic diseases including end-stage kidney disease (ESKD) are at higher risk of food insecurity due to their complex care needs, medication burden, and dietary restrictions. No data exists describing food insecurity prevalence in pediatric ESKD patients during the COVID-19 pandemic.MethodsFood insecurity was assessed among families of children (age 0–18 years) with ESKD on chronic dialysis at two pediatric academic medical centers. Families were screened in April 2020 using the Hunger Vital Sign, a validated 2-question screening tool. We assessed impact of COVID-19 on food insecurity. We compared serum phosphorus “pre-COVID” (January/February 2020) to “during COVID” (April/May 2020).ResultsA total of 29 families enrolled in this study. 62% (18/29) of children with ESKD lived in food insecure households, and of those, 72% (13/18) reported that COVID-19 had worsened their food insecurity status. During the COVID-19 pandemic, food insecure patients experienced greater rise in their serum phosphorus levels (1.1 mg/dL vs. 0 mg/dL, p = 0.03) and decreased likelihood of having adequate phosphorus control (50% vs. 11%, p = 0.03).ConclusionFood insecurity was common among children with ESKD on chronic dialysis during the COVID-19 pandemic. Children with food insecurity had a greater increase in their phosphorus levels during the pandemic than did food secure children. Further exploration into how food resources such as an onsite food pantry impacts food insecurity and phosphorus control in children with ESKD is essential.

Differences Between Pediatric and Adult Protocols and Medical Centers in the Treatment of Acute Myeloid Leukemia in the United States.

Differences Between Pediatric and Adult Protocols and Medical Centers in the Treatment of Acute Myeloid Leukemia in the United States.

Application of a Child Sex Trafficking Screening Tool in Patients with Abuse: A Retrospective Chart Review in the Pediatric Emergency Department.

Human trafficking (HT) is a global problem that may affect children's health. In the United States, victims and children are at risk in most communities. History of abuse is a risk factor for HT. This study explored associations between pediatric patients with positive universal abuse screens and indicators from the commercial sexual exploitation of children/child sex trafficking (CSEC/CST) screening tool. A retrospective chart review was conducted on random patients, aged 11-17 years, with positive universal abuse screens at emergency/urgent care departments in a large Midwest pediatric medical center in 2018. Documentation identifying at least two CSEC/CST screening tool indicators was abstracted from these records. Data analysis included descriptive statistics, univariate analyses, and correlations. Two or more indicators from the CSEC/CST screening tool were identified in 43% (n=121). Age and history of running away were significant predictors for a patient having two or more CSEC/CST positive indicators. Targeted screening and interventions are needed to identify and help these vulnerable youth.

Ifosfamide-Induced Neurotoxicity in Children with Solid Tumors: A Seven Year Retrospective Analysis of Incidence and Risk Factors.

Background: Patients with cancer treated with the pro-drug ifosfamide may experience drug-induced neurotoxicity. Ifosfamide-induced neurotoxicity (IIN) is well described in the adult literature, but there is limited knowledge about this toxicity in pediatrics, especially in children with solid tumors. Methods: In this retrospective descriptive study, the author reviewed 7 years of clinical data regarding patients with solid tumors who received ifosfamide at a large, urban pediatric medical center. The author used descriptive statistics and logistic regression to describe the incidence of IIN and identify demographic and clinical factors most likely to be associated with the toxicity. Results: In a sample of 169 pediatric patients who received ifosfamide between 2011 and 2018, 13% developed symptoms of IIN. The author identified ifosfamide doses >2,000 mg/m2 to be a risk factor for IIN in the study sample (OR 17.82; 95 CI [2.17, 146.18]; p = .0073) and cited other variables as possible risk factors, though each could be linked to participants' ifosfamide exposure. Discussion: This study is the largest to describe IIN specifically in the pediatric solid tumor population. The study findings suggest the pattern of toxicity observed in adult patients should not be assumed in children. The author identified one risk factor that may predispose children to develop IIN and recommends further attention be paid to this toxicity in the pediatric population.

The Impact of COVID-19 on Laboratory Test Utilization at a Pediatric Medical Center.

BackgroundThe epidemiology and clinical manifestation of coronavirus disease 2019 (COVID-19) in the pediatric population is different from the adult population. The purpose of this study is to identify effects of the COVID-19 pandemic on laboratory test utilization in a pediatric hospital.MethodsWe performed retrospective analysis on test utilization data from Ann & Robert H. Lurie Children’s Hospital of Chicago, an academic pediatric medical center. Data between two 100-day periods prior to (prepandemic) and during the pandemic (mid-pandemic) were analyzed to evaluate changes in test volume, lab utilization, and test positivity rate. We also evaluated these metrics based on in- vs outpatient testing and performed modeling to determine what variables significantly impact the test positivity rate.ResultsDuring the pandemic period, there was an expected surge in COVID-19 testing, while over 84% of lab tests studied decreased in ordering volume. The average number of tests ordered per patient was not significantly different during the pandemic for any of the laboratories (adjusted P value > 0.05). Thirty-three studied tests showed significant change in positivity rate during the pandemic. Linear modeling revealed test volume and inpatient status as the key variables associated with change in test positivity rate.ConclusionsExcluding severe acute respiratory syndrome coronavirus 2 tests, the COVID-19 pandemic has generally led to decreased test ordering volume and laboratory utilization. However, at this pediatric hospital, the average number of tests performed per patient and test positivity rates were comparable between pre- and mid-pandemic periods. These results suggest that, overall, clinical test utilization at this site remained consistent during the pandemic.

Consumer-centric approach to enhance access to pediatric specialty care.

Health systems must adapt to an increased consumer-centric environment to remain relevant in an ever-growing competitive health care landscape in which convenience is a key driver of patient satisfaction and loyalty. To adapt to this new environment, health systems must redesign processes to transform the delivery of ambulatory care and provide near real-time access to specialty care. A pediatric academic medical center in western Pennsylvania used a process-improvement approach to enhance timely access to specialty care and deliver a consumer-centric patient experience. Critical factors in this process included engagement of key stakeholders, implementation of scheduling best practices, development of a set of scheduling guidelines, increased use of advanced practice providers, and use of data analytics to measure and benchmark performance. The time to schedule a new patient appointment decreased from 42 to 4 days and the patient satisfaction access domain increased by 57 percentile points. These factors should scale to other institutions, thereby enabling generalizable results.

The contribution of the Neurobehavioral Screening Tool to identifying fetal alcohol spectrum disorders in children at high risk of prenatal alcohol exposure and neurobehavioral deficits

BackgroundFetal alcohol spectrum disorders (FASD) describe various conditions resulting from prenatal alcohol exposure. The diagnosis of FASD can be challenging and complex. The Neurobehavioral Screening Tool (NST), derived from Achenbach's Child Behavior Checklist, has been suggested as a tool for identifying FASD. AimsTo assess the external validity of the NST and to identify additional characteristics of FASD in a cohort of Israeli children and young adults referred to a neurology and child developmental clinic at a tertiary pediatric medical center in Israel. Study designAn observational study based on medical records. Subjects151 children and young adults, of whom 40 were diagnosed with FASD according to updated clinical guidelines. Outcome measuresNST results, as well as demographic and neurobehavioral variables, were compared between those who were and were not diagnosed with FASD. ResultsThe NST demonstrated 72 % to 73 % sensitivity, and 34 % to 36 % specificity, in identifying FASD. Items 4 and 5 (‘Lies or cheats’, ‘Lacks guilt after misbehaving’) were the most predictive items in the NST. Other variables that were characteristic of the FASD group included: emotional regulation difficulties (p value <0.01), being born and adopted in Israel (vs. other countries) (p value <0.01) and younger age at the first visit to the clinic (p value <0.01). ConclusionsOur findings regarding the screening capabilities of the NST were less promising than those of most previous studies. Further research is needed to establish a valid neurobehavioral tool with the possible focus on antisocial behaviors and emotional regulation problems.

Characterizing opioid prescribing to adolescents at time of discharge from a pediatric hospital over a five-year period

PurposeTo characterize opioid prescribing over a 5-year period to adolescents upon discharge from one urban pediatric medical center. Design and methodsA retrospective cross-sectional analysis of 4354 adolescents discharged with a pain medication after an admission of ≤5 days between January 2015 and December 2019 was performed. Two outcome groups, based on the analgesics prescribed at discharge, were compared: those discharged with a prescription for a non-opioid only and those discharged with an opioid prescription. The association between year of discharge and receipt of opioid, while adjusting for relevant demographic and clinical characteristics, was also explored. ResultsApproximately 64% of the sample was discharged with an opioid prescription. Of those, the median daily dosage was 45.0 morphine milligram equivalents (MME) [IQR: 32.4, 45.0]. Year of discharge was associated with decreased odds of receiving an opioid when adjusting for age, race, sex, insurance, pain scores, opioid exposure during hospitalization, length of stay, and undergoing surgery. The odds of being discharged with an opioid decreased each year by 29% (Adjusted Odds Ratio [AOR] = 0.71, CI:0.68–0.73). Concurrently, the proportion of patients discharged with nonopioid pain medication increased from 25% of adolescent patients in 2015 to 50% in 2019. ConclusionsOverall, opioid prescribing to adolescents at time of discharge decreased over time in our sample. Practice implicationsWhile prescribing has decreased opioid analgesics are dispensed to young patients. Risk of opioid use disorder and overdose is rare in this population, but adolescence is good opportunity for nursing to promote safe prescribing and analgesic use.

Comparison of pre-high school and high school football quarterback injuries

ABSTRACT Objective To compare the common injuries of pre-high school American football quarterbacks (Pre-HS QBs) and high school American football quarterbacks (HS QBs) within the last 15 years. Methods A retrospective chart review was performed at a sports medicine clinic at a tertiary-level pediatric medical center. Pediatric and adolescent American football quarterback patients who sustained sports-related injuries were extracted. Injury status (acute vs. overuse), injured anatomic locations, injury types, and surgical status were compared by Pre-HS QBs (<14 years old) and HS QBs (14–18 years old). Results A total of 121 injuries were found in 118 male Pre-HS QBs (mean age: 12.4 ± 1.6), while 302 injuries were observed in 256 male HS QBs (mean age: 15.8 ± 1.4). Overall, nearly two-third (2/3) of injuries were acute (64.3%) while a little over one-third (1/3) of injuries were overuse in nature (35.7%), and there were no differences between Pre-HS and HS QBs (58.7% vs. 66.7%, p = 0.114). The top 3 injured anatomic locations for Pre-HS QBs were elbow (20.7%), shoulder (18.2%), and head/neck (14.0%). For HS QBs, the top 3 injured anatomic locations were shoulder (24.5%), knee (17.5%), and head/neck (15.2%). There were significant differences in proportion of elbow (20.7% vs. 10.6%, p = 0.006), hip/trunk/upper leg (10.7% vs. 3.3%, p = 0.002), and knee injuries (9.1% vs. 17.5%, p = 0.028) between Pre-HS and HS QBs. Pre-HS QBs had significantly more bony/cartilaginous/labral injuries than their older counterparts (60.3% vs. 46.3%, p = 0.009) while HS QBs experienced significantly more ligamentous injuries than Pre-HS QBs (14.2% vs. 5.8%, p = 0.015). Conclusions QB-associated injuries were distinctively different between Pre-HS and HS QBs. Future studies are warranted to investigate relatively high proportions of elbow injuries as well as bony/cartilaginous/labral injuries found in Pre-HS QBs.

Predicting Outcomes 2 Months and 1 Year After Inpatient Rehabilitation for Youth With TBI Using Duration of Impaired Consciousness and Serial Cognitive Assessment.

To examine predictive utility of the Glasgow Coma Scale (GCS), time to follow commands (TFC), length of posttraumatic amnesia (PTA), duration of impaired consciousness (TFC+PTA), and the Cognitive and Linguistic Scale (CALS) scores in predicting outcomes on the Glasgow Outcome Scale-Extended, Pediatric Revision (GOS-E Peds) for children with traumatic brain injury (TBI) at 2 months and 1 year after discharge from rehabilitation. A large, urban pediatric medical center and inpatient rehabilitation program. Sixty youth with moderate-to-severe TBI (mean age at injury = 13.7 years; range = 5-20). A retrospective chart review. Lowest postresuscitation GCS, TFC, PTA, TFC+PTA, inpatient rehabilitation admission and discharge CALS scores, GOS-E Peds at 2-month and 1-year follow-ups. CALS scores were significantly correlated with the GOS-E Peds at both time points (weak-to-moderate correlation for admission scores and moderate correlation for discharge scores). TFC and TFC+PTA were correlated with GOS-E Peds scores at a 2-month follow-up and TFC remained a predictor at a 1-year follow-up. The GCS and PTA were not correlated with the GOS-E Peds. In the stepwise linear regression model, only the CALS at discharge was a significant predictor of the GOS-E Peds at the 2-month and 1-year follow-ups. In our correlational analysis, better performance on the CALS was associated with less long-term disability, and longer TFC was associated with more long-term disability, as measured by the GOS-E Peds. In this sample, the CALS at discharge was the only retained significant predictor of GOS-E Peds scores at 2-month and 1-year follow-ups, accounting for roughly 25% of the variance in GOS-E scores. As previous research suggests, variables related to rate of recovery may be better predictors of outcome than variables related to severity of injury at a single time point (eg, GCS). Future multisite studies are needed to increase sample size and standardize data collection methods for clinical and research purposes.

Comparison of Quantitative Liver US and MRI in Patients with Liver Disease.

Background Quantitative US techniques can be used to identify changes of liver disease, but data regarding their diagnostic performance and relationship to MRI measures are sparse. Purpose To define associations between quantitative US and MRI measures of the liver in children, adolescents, and young adults with liver disease and to define the predictive ability of quantitative US measures to detect abnormal liver stiffening and steatosis defined with MRI. Materials and Methods In this prospective study, consecutive patients aged 8-21 years and known to have or suspected of having liver disease and body mass index less than 35 kg/m2 underwent 1.5-T MRI and quantitative liver US during the same visit at a pediatric academic medical center between April 2018 and December 2020. Acquired US parameters included shear-wave speed (SWS) and attenuation coefficient, among others. US parameters were compared with liver MR elastography and liver MRI proton density fat fraction (PDFF). Pearson correlation, multiple logistic regression, and receiver operating characteristic curve analyses were performed to assess associations and determine the performance of US relative to that of MRI. Results A total of 44 study participants (mean age, 16 years ± 4 [SD]; age range, 8-21 years; 23 male participants) were evaluated. There was a positive correlation between US SWS and MR elastography stiffness (r = 0.73, P < .001). US attenuation was positively correlated with MRI PDFF (r = 0.45, P = .001). For the prediction of abnormal (>2.8 kPa) liver shear stiffness, SWS (1.56 m/sec [7.3 kPa] cutoff) had an area under the receiver operating characteristic curve (AUC) of 0.95 with 91% sensitivity (95% CI: 71, 99) (20 of 22 participants) and 95% specificity (95% CI: 76, 99) (20 of 21 participants). For the prediction of abnormal (>5%) liver PDFF, US attenuation (0.55 dB/cm/MHz cutoff) had an AUC of 0.75 with a sensitivity of 73% (95% CI: 39, 94) (eight of 11 participants) and a specificity of 73% (95% CI: 55, 86) (24 of 33 participants). Conclusion In children, adolescents, and young adults with known or suspected liver disease, there was moderate to high correlation between US shear-wave speed (SWS) and MR elastography-derived stiffness. US SWS predicted an abnormal liver shear stiffness with high performance. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Khanna and Alazraki in this issue.

Investigating a cluster of pediatric oncology invasive fungal infections–Lessons learned

Background: In spring 2021, the infection prevention and control department at a pediatric academic medical center identified 3 oncology patients with concern for invasive Rhizopus spp infections. An in-depth investigation was conducted, but a common source of the fungus was not identified. In August 2021, an additional oncology patient with concern for invasive Rhizopus spp was identified, resulting in an extended investigation for possible sources of fungus. Methods: A multidisciplinary work group was assembled. The CDC Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi was used as a framework for conducting the investigation. Stakeholders were engaged throughout the process, including the hematology–oncology service, hospital leadership, environmental services, patient safety and quality, and facilities and engineering. The investigation included hospital incident command system (HICS) activation; visual inspection of patient rooms and common spaces; heating, ventilation, and air conditioning (HVAC) review; environmental sampling (surfaces, linen, and air); chart review; and process mapping. Results: By early October 2021, 2 environmental samples grew isolates (each at 1 CFU/m3) of the same species of Rhizopus as one of the affected patients. One sample was from a patient room, and the other from an outdoor garden space. No source of indoor amplification of Rhizopus was identified. The investigation revealed several opportunities for improvement: annual room maintenance schedules, use of gardens and outdoor spaces by at-risk patients, linen storage, construction and/or infection control risk assessment (ICRA) processes, and appliances used by families (eg, washing machines and refrigerators). Work streams were established to address each of these areas. Conclusions: No definite source was identified for the 4 invasive Rhizopus spp infections. This extensive investigation highlighted multiple opportunities for improvement; the changes implemented may prevent future invasive fungal infections in high-risk pediatric patients.Funding: NoneDisclosures: None

Real World Experience With Dupilumab in Eosinophilic Esophagitis in Children and Young Adults at a Tertiary Care Pediatric Medical Center.

Dupilumab is one of a number of biologics currently under investigation for the treatment of eosinophilic esophagitis (EoE). We report on a group of 7 pediatric and young adult patients with EoE who were treated with dupilumab for a primary indication of asthma or atopic dermatitis, all of whom previously failed swallowed topical corticosteroid therapy dietary for management of their EoE. All 7 patients demonstrated histologic improvement in their EoE while on dupilumab, with a drop in median peak esophageal eosinophil count from 50 eosinophils per high-powered field (eos/hpf) (IQR 48-95 eos/hpf) to 2 eos/hpf (IQR 0-5 eos/hpf) off swallowed topical corticosteroid. Additionally, improvements in EoE symptoms and endoscopic findings were noted. This report highlights the effectiveness of dupilumab in a group of multiply atopic pediatric and young adult patients with difficult-to-treat EoE in real world practice.

Increasing Pediatric Infectious Diseases Consultation Rates for Staphylococcus aureus Bacteremia.

Introduction:Staphylococcus aureus bacteremia (SAB) in children is associated with significant mortality and morbidity, including recurrent bacteremia. Infectious disease consultation (IDC) improves SAB outcomes in adult patients. However, increasing IDC and impact for pediatric patients with SAB is not well described.Methods:This quality improvement project aimed to increase IDC for SAB events at a quaternary pediatric medical center. First, we evaluated the local practices regarding pediatric SAB and engaged stakeholders (July 2018–August 2020). We added an advisory comment supporting IDC for SAB to all blood culture results in September 2020. Using statistical process control charts, we monitored the number of SAB events with IDC before a SAB event without IDC. Finally, we evaluated SAB recurrences before and after initiating the advisory comment.Results:In the baseline period, 30 of 49 (61%) SAB events received an IDC with a mean of 1.4 SAB events with IDC before a SAB event without IDC. Postintervention, 22 of 23 (96%) SAB events received IDC with a mean of 14 events with IDC before 1 event without IDC. The SAB recurrence rate was 8%, with 6 events in 4 children; none of the index cases resulting in recurrence received an IDC (P = 0.0002), and all occurred before any intervention.Conclusions:An electronic advisory comment supporting IDC for SAB significantly increased the rate of pediatric IDC with no further SAB recurrence episodes following intervention. This low-resource intervention may be considered in other pediatric centers to optimize SAB management.

Implementation of a Post-Baccalaureate Program at a Pediatric Academic Medical Center: A Pathway to Graduate School.

Post-baccalaureate programs are increasingly common and have demonstrated success in preparing students for graduate programs. Most post-baccalaureate programs have a pre-medical focus, and the few existing clinical psychology-focused programs are centered on coursework, situated within a university, costly to students, and/or geared towards career change. The post-baccalaureate program at Nationwide Children's Hospital was created in 2017 and is uniquely positioned within a pediatric academic medical center. The program provides research skill training, mentorship, professional development, and graduate school preparation to employed clinical research coordinators. An early program assessment, based on self-reports, revealed the program attracts diverse participants that are primarily interested in pediatric or child psychology and rate themselves as "somewhat confident" in their current research skills. This manuscript summarizes the three phases of development and key components of the post-baccalaureate program, which can serve as a model to other medical centers interested in developing training programs for research staff, particularly underrepresented racial and ethnic minorities, and those from disadvantaged backgrounds.