Pediatric Sinus Research Articles

Racial and socioeconomic disparities in status exceptions for pediatric heart transplant candidates under the current U.S. Pediatric Heart Allocation Policy

The 2016 revision of the US Pediatric Heart Allocation Policy developed stringent rules for priority status creating impetus for clinicians to seek status exceptions. We hypothesized there may be differential status exceptions based on race and socioeconomic status (SES) contributing to disparities in waitlist outcomes. The Scientific Registry for Transplant Recipients was queried for children listed for heart transplant from 2012 to 2020. Waitlist status & mortality with regards to race and neighborhood SES were stratified by listing before (Era 1) or after (Era 2) the policy change. The use of both 1A and 1B exceptions (E) increased in Era 2. In Era 1, there was no association between patient race or neighborhood SES on use of 1A(E) or 1B(E) when controlling for age and diagnosis. In Era 2, neither race nor neighborhood SES were associated with 1A(E), but both were associated with 1B(E): non-Hispanic (NH) Black children and those from low- and middle-SES neighborhoods were significantly less likely to be listed 1B(E). In Era 1, there were no significant differences in waitlist mortality based on race at any waitlist status; in Era 2, NH Black children had higher waitlist mortality when initially listed 1B or 2. Since the 2016 policy change, racial disparities in waitlist mortality have worsened among children initially listed with lower priority status. Unequal use of 1B exceptions, which lower waitlist mortality, may explain some of these disparities. Recently implemented standardized pediatric exception guidance has the potential to improve equity.

Examination of Prediabetes and Diabetes Testing Among US Pediatric Patients With Overweight or Obesity Using an Electronic Health Record.

Background: Youth with excess weight are at risk of developing type 2 diabetes (T2DM). Guidelines recommend screening for prediabetes and/or T2DM after 10 years of age or after puberty in youth with excess weight who have ≥1 risk factor(s) for T2DM. Electronic health records (EHRs) offer an opportunity to study the use of tests to detect diabetes in youth. Methods: We examined the frequency of (1) diabetes testing and (2) elevated test results among youth aged 10-19 years with at least one BMI measurement in an EHR from 2019 to 2021. We examined the presence of hemoglobin A1C (A1C), fasting plasma glucose (FPG), or oral glucose tolerance test (2-hour plasma glucose [2-hrPG]) results and, among those tested, the frequency of elevated values (A1C ≥6.5%, FPG ≥126 mg/dL, or 2-hrPG ≥200 mg/dL). Patients with pre-existing diabetes (n = 6793) were excluded. Results: Among 1,024,743 patients, 17% had overweight, 21% had obesity, including 8% with severe obesity. Among patients with excess weight, 10% had ≥1 glucose test result. Among those tested, elevated values were more common in patients with severe obesity (27%) and obesity (22%) than in those with healthy weight (8%), and among Black youth (30%) than White youth (13%). Among patients with excess weight, >80% of elevated values fell in the prediabetes range. Conclusions: In youth with excess weight, the use of laboratory tests for prediabetes and T2DM was infrequent. Among youth with test results, elevated FPG, 2hrPG, or A1C levels were most common in those with severe obesity and Black youth.

Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020

Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020

Mental Health Revisits at US Pediatric Emergency Departments

Pediatric emergency department (ED) visits for mental health crises are increasing. Patients who frequently use the ED are of particular concern, as pediatric mental health ED visits are commonly repeat visits. Better understanding of trends and factors associated with mental health ED revisits is needed for optimal resource allocation and targeting of prevention efforts. To describe trends in pediatric mental health ED visits and revisits and to determine factors associated with revisits. In this cohort study, data were obtained from 38 US children's hospital EDs in the Pediatric Health Information System between October 1, 2015, and February 29, 2020. The cohort included patients aged 3 to 17 years with a mental health ED visit. Characteristics of patients, encounters, hospitals, and communities. The primary outcome was a mental health ED revisit within 6 months of the index visit. Trends were assessed using cosinor analysis and factors associated with time to revisit using mixed-effects Cox proportional hazards regression. There were 308 264 mental health ED visits from 217 865 unique patients, and 13.2% of patients had a mental health revisit within 6 months. Mental health visits increased by 8.0% annually (95% CI, 4.5%-11.4%), whereas all other ED visits increased by 1.5% annually (95% CI, 0.1%-2.9%). Factors associated with mental health ED revisits included psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and presence of an inpatient psychiatric unit at the presenting hospital. Patients with psychotic disorders (hazard ratio [HR], 1.42; 95% CI, 1.29-1.57), disruptive or impulse control disorders (HR, 1.36; 95% CI, 1.30-1.42), and neurodevelopmental disorders (HR, 1.22; 95% CI, 1.14-1.30) were more likely to revisit. Patients with substance use disorders (HR, 0.60; 95% CI, 0.55-0.66) were less likely to revisit. Markers of disease severity and health care access were associated with mental health revisits. Directing hospital and community interventions toward identified high-risk patients is needed to help mitigate recurrent mental health ED use and improve mental health care delivery.

Worsening racial disparity in waitlist mortality for pediatric heart transplant candidates since the 2016 Pediatric Heart Allocation Policy revision.

The US Pediatric Heart Allocation Policy (PHAP) was revised in March 2016, with the goal of reducing waitlist mortality. We evaluated the hypothesis that these changes, which increased status exceptions, have worsened racial disparities in waitlist outcomes. Children in the Pediatric Heart Transplant Study database listed for first heart transplant from January 2012 - June 2020 were included and stratified by listing before (Era 1) or after (Era 2) the PHAP revision. A total of 4,089 children were listed during the study period. Compared with white children (n= 2648), non-white children (n= 1441) were more likely to have an underlying diagnosis of cardiomyopathy in both eras. Waitlist mortality was similar in white and non-white children in Era 1, but comparatively worse for non-white children in Era 2. In multivariable analysis controlling for diagnosis, age, and severity markers, non-white children had a significantly higher waitlist mortality only in Era 2 (Era 1: sHR 1.22 [95%CI 0.90-1.66] vs. Era 2: sHR 1.57 [95%CI 1.17-2.10]). Widening racial disparities in waitlist mortality may be an unintended consequence of the 2016 PHAP revision. Additional analyses may inform the degree to which this policy vs. unrelated changes in care differentially contribute to these disparities.

A Novel Approach to Assessment of US Pediatric Trauma System Development

Mature trauma systems are critical in building and maintaining national, state, and local resilience against all-hazard disasters. Currently, pediatric state trauma system plans are not standardized and thus are without concrete measures of potential effectiveness. To develop objective measures of pediatric trauma system capability at the state level, hypothesizing significant variation in capabilities between states, and to provide a contemporary report on the status of national pediatric trauma system planning and development. A national survey was deployed in 2018 to perform a gap analysis of state pediatric trauma system capabilities. Four officials from each state were asked to complete the survey regarding extensive pediatric-related or specific trauma system parameters. Using these parameters, a panel of 14 individuals representing national stakeholder sectors in pediatric trauma care convened to identify the essential components of the ideal pediatric trauma system using Delphi methodology. Data analysis was conducted from March 16, 2019, to February 23, 2020. Based on results from the national survey and consensus panel parameters, each state was given a composite score. The score was validated using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) fatal injury database. The national survey had less than 10% missing data. The consensus panel reached agreement on 6 major domains of pediatric trauma systems (disaster, legislation/funding, access to care, injury prevention/recognition, quality improvement, pediatric readiness) and was used to develop the Pediatric Trauma System Assessment Score (PTSAS) based on 100 points. There was substantial variation across states, with state scores ranging from 48.5 to 100. Based on US CDC WONDER data, for every 1-point increase in PTSAS, there was a 0.12 per 100 000 decrease in mortality (95% CI, -0.22 to -0.02; P = .03). Results of this cross-sectional study suggest that a more robust pediatric trauma system has a significant association with pediatric injury mortality. This study assessed the national landscape of capability and preparedness to provide pediatric trauma care at the state level. These parameters can tailor the maturation of children's interests within a state trauma system and assist with future state, regional, and national planning.

Enhanced hippocampal neurogenesis mediated by PGC-1α-activated OXPHOS after neonatal low-dose Propofol exposure.

BackgroundDeveloping brain is highly plastic and can be easily affected. Growing pediatric usage of anesthetics during painless procedures has raised concerns about the effect of low-dose anesthetics on neurodevelopment. It is urgent to ascertain the neuronal effect of low-dose Propofol, a widely used anesthetic in pediatrics, on developing brains.MethodsThe behavioral tests after neonatal exposure to low-dose/high-dose Propofol in mice were conducted to clarify the cognitive effect. The nascent cells undergoing proliferation and differentiation stage in the hippocampus and cultured neural stem cells (NSCs) were further identified. In addition, single-nuclei RNA sequencing (snRNA-seq), NSCs bulk RNA-seq, and metabolism trials were performed for pathway investigation. Furthermore, small interfering RNA and stereotactic adenovirus injection were, respectively, used in NSCs and hippocampal to confirm the underlying mechanism.ResultsBehavioral tests in mice showed enhanced spatial cognitive ability after being exposed to low-dose Propofol. Activated neurogenesis was observed both in hippocampal and cultured NSCs. Moreover, transcriptome analysis of snRNA-seq, bulk RNA-seq, and metabolism trials revealed a significantly enhanced oxidative phosphorylation (OXPHOS) level in NSCs. Furthermore, PGC-1α, a master regulator in mitochondria metabolism, was found upregulated after Propofol exposure both in vivo and in vitro. Importantly, downregulation of PGC-1α remarkably prevented the effects of low-dose Propofol in activating OXPHOS and neurogenesis.ConclusionsTaken together, this study demonstrates a novel alteration of mitochondrial function in hippocampal neurogenesis after low-dose Propofol exposure, suggesting the safety, even potentially beneficial effect, of low-dose Propofol in pediatric use.

Assessment of low-dose paranasal sinus CT imaging using a new deep learning image reconstruction technique in children compared to adaptive statistical iterative reconstruction V (ASiR-V)

PurposeTo compare the effects of deep learning image reconstruction (DLIR) and adaptive statistical iterative reconstruction V (ASiR-V) on image quality in low-dose computed tomography (CT) of paranasal sinuses in children.MethodsLow-dose CT scans of the paranasal sinuses in 25 pediatric patients were retrospectively evaluated. The raw data were reconstructed with three levels of DLIR (high, H; medium, M; and low, L), filtered back projection (FBP), and ASiR-V (30% and 50%). Image noise was measured in both soft tissue and bone windows, and the signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the images were calculated. Subjective image quality at the ethmoid sinus and nasal cavity levels of the six groups of reconstructed images was assessed by two doctors using a five-point Likert scale in a double-blind manner.ResultsThe patients’ mean dose-length product and effective dose were 36.65 ± 2.44 mGy·cm and 0.17 ± 0.03 mSv, respectively. (1) Objective evaluation: 1. Soft tissue window: The difference among groups in each parameter was significant (P < 0.05). Pairwise comparisons showed that the H group’ s parameters were significantly better (P < 0.05) than those of the 50% post-ASiR-V group. 2. Bone window: No significant between-group differences were found in the noise of the petrous portion of the temporal bone or its SNR or in the noise of the pterygoid processes of the sphenoids or their SNRs (P > 0.05). Significant differences were observed in the background noise and CNR (P < 0.05). As the DLIR intensity increased, image noise decreased and the CNR improved. The H group exhibited the best image quality. (2) Subjective evaluation: Scores for images of the ethmoid sinuses were not significantly different among groups (P > 0.05). Scores for images of the nasal cavity were significantly different among groups (P < 0.05) and were ranked in descending order as follows: H, M, L, 50% post-ASiR-V, 30% post-ASiR-V, and FBP.ConclusionDLIR was superior to FBP and post-ASiR-V in low-dose CT scans of pediatric paranasal sinuses. At high intensity (H), DLIR provided the best reconstruction effects.

Demographic and Clinical Differences Between Applied Definitions of Medical Complexity.

To identify the degree of concordance and characterize demographic and clinical differences between commonly used definitions of multisystem medical complexity in children hospitalized in children's hospitals. We conducted a retrospective, cross-sectional cohort study of children <21 years of age hospitalized at 47 US Pediatric Health Information System-participating children's hospitals between January 2017 to December 2019. We classified patients as having multisystem complexity when using 3 definitions of medical complexity (pediatric complex chronic conditions, pediatric medical complexity algorithm, and pediatric chronic critical illness) and assessed their overlap. We compared demographic, clinical, outcome, cost characteristics, and longitudinal healthcare utilization for each grouping. Nearly one-fourth (23.5%) of children hospitalized at Pediatric Health Information System-participating institutions were identified as meeting at least 1 definition of multisystem complexity. Children with multisystem complexity ranged from 1.0% to 22.1% of hospitalized children, depending on the definition, with 31.2% to 95.9% requiring an ICU stay during their index admission. Differences were seen in demographic, clinical, and resource utilization patterns across the definitions. Definitions of multisystem complexity demonstrated poor agreement (Fleiss' κ 0.21), with 3.5% of identified children meeting all 3. Three definitions of multisystem complexity identified varied populations of children with complex medical needs, with poor overall agreement. Careful consideration is required when applying definitions of medical complexity in health services research, and their lack of concordance should result in caution in the interpretation of research using differing definitions of medical complexity.

A longitudinal study assessing the impact of ongoing COVID-19 pandemic among hematology-oncology trainees.

11033 Background: Hematology-Oncology (HO) trainees faced significant challenges due to the COVID-19 pandemic highlighted by a previous survey (Durani, Urshila, et al. "Impact of COVID-19 on Hematology-Oncology Trainees: A Quantitative and Qualitative Assessment." JCO Oncology Practice (2021): OP-21). Despite the positive impact of effective vaccines, the pandemic is still ongoing; thus, the challenges remain. Our aim is to evaluate how well the trainees have adapted to changes in their clinical training environment after the early phase of the COVID-19 pandemic. Methods: A cross-sectional internet-based survey (Shih, Grace, et al. "The impact of the COVID‐19 pandemic on the education and wellness of US Pediatric Anesthesiology Fellows." Pediatric Anesthesia 31.3 (2021): 268-274) from December 10, 2021, to January 10, 2022, was obtained from the trainees enrolled in Accreditation Council for Graduate Medical Education (ACGME)-accredited HO fellowship programs in the United States in their fourth (PGY4), fifth (PGY5), and sixth (PGY6) postgraduate year. Results: The survey was completed by 102 trainees. Demographics of the participants are reported in Table. Interestingly, 51% reported an impact of COVD-19 on their employment plans, primarily due to the inability to interview in person (24%, n=23). Trainees experienced several stressors due to the pandemic, including fear of getting sick from a patient (71%) or a coworker (66%). Approximately 27% (n=26) experienced mental health issues requiring additional care. Less than one-third of the trainees were concerned about clinical expertise and procedural skills. Trainees also felt that the change of conference to virtual format impacted their learning activities compared to in-person education (66%, n=64). Most trainees (52%, n=53) reported limited involvement in COVID-related research and journal club education. Most had access to socialization (59%, n=60), virtual office hours (70%, n=72), and telehealth visits (83%, n=85). Female trainees (18%) were more likely to seek mental health care than the male trainees (7.8%) (P=.02). Female trainees (33%) also reported facing more challenges in their employment plans compared to males (16%) (P=.003). Conclusions: Our study highlights the challenges experienced by hematology-oncology trainees with the ongoing COVID-19 pandemic and reveals the gender gap related to employment plans and seeking mental health care. [Table: see text]

A rare case report of dominant paediatric sinus pericranii: food for thought!

BackgroundSinus pericranii (SP) is a rare venous anomaly abnormally connecting the intracranial dural sinuses with the epicranial venous channels. Various authors have attempted to classify this entity to decide management for this potentially life-threatening condition. With approximately 200 cases reported in world literature till date, no definitive guidelines for management have emerged.Case presentationA female child aged 7 years presented to us with complaints of occipital swelling since birth. This swelling was gradually increasing in size as reported by the parents. On examination, the swelling was located in the right parieto-occipital region, size 10 cm diameter in lying position, soft, non-tender, fluid-like diffuse swelling with underlying areas of palpable bony defects, partially reducible in sitting up position, and cough impulse was present. On evaluation, a case of dominant SP was established.ConclusionTraditionally, SP has been reported mostly in paediatric population and managed surgically or endovascularly for selected cases, while the remaining cases have been observed. Profuse haemorrhage has been a major deterrent to manage these lesions surgically. Long-term complications like trauma, haemorrhage, infection and thrombosis have been reported in conservatively managed cases. The neurosurgical community has thus been left searching for the optimal management of SP. The authors report this case attempting to classify this case according to the available classification systems and hence decide the best possible management.

Typhoid Fever in the US Pediatric Population, 1999-2015: Opportunities for Improvement

The Pediatric Infectious Disease Journal: May 2022 - Volume 41 - Issue 5 - p 426 doi: 10.1097/INF.0000000000003510

Status Exceptions and Racial Disparities in Pediatric Heart Transplant Waitlist Outcomes

<h3>Purpose</h3> The 2016 revision of the US Pediatric Heart Allocation Policy (USPHAP) created more stringent rules for priority status. We evaluated the hypothesis that resultant differential status exceptions based on race contribute to racial disparities in waitlist outcomes. <h3>Methods</h3> The Scientific Registry for Transplant Recipients database was queried for children listed for first heart-alone transplant from January 2012 to June 2020. Waitlist status & mortality with regards to race were evaluated, stratified by listing before (Era 1) or after (Era 2) the policy change. <h3>Results</h3> The use of both status 1A and 1B exceptions (E) increased in Era 2 (1A(E): 5% in Era 1 vs 12%, p<0.001; 1B(E): 6% vs 10%, p <0.001). In Era 1, there was no association between patient race/ethnicity and use of 1A(E) or 1B(E) when controlling for age and diagnosis. In Era 2, race/ethnicity was not associated with 1A(E) but was associated with 1B(E): non-Hispanic (NH) Black children were significantly less likely to be listed 1B(E) compared to NH White children (OR 0.46 [95% CI 0.31-0.68]) or Hispanic children (OR 0.52 [95% CI 0.33-0.84)) with similar ages and diagnoses. Among children initially listed status 1B or 2 in Era 2, those with status 1B(E) had lower waitlist mortality when controlling for age, diagnosis, and renal function (aHR 0.3 [95% CI 0.1-0.8]). In Era 1, there were no significant differences in waitlist mortality based on race/ethnicity at any waitlist status; in Era 2, however, NH Black children had higher waitlist mortality than NH White children when initially listed 1B or 2 (Figure 1). <h3>Conclusion</h3> Since the 2016 USPHAP change, racial disparities in waitlist mortality have worsened among children initially listed with lower priority status. While 1B(E) status is associated with lower mortality risk, a lack of exceptions being sought for Black children contributes to their higher mortality. Standardized exception guidance and pediatric specific review boards (both implemented after this study period) have the potential to improve equity.

The Clinical and Economic Impact of Measles-Mumps-Rubella Vaccinations to Prevent Measles Importations From US Pediatric Travelers Returning From Abroad.

BackgroundPediatric international travelers account for nearly half of measles importations in the United States. Over one third of pediatric international travelers depart the United States without the recommended measles-mumps-rubella (MMR) vaccinations: 2 doses for travelers ≥12 months and 1 dose for travelers 6 to <12 months.MethodsWe developed a model to compare 2 strategies among a simulated cohort of international travelers (6 months to <6 years): (1) No pretravel health encounter (PHE): travelers depart with baseline MMR vaccination status; (2) PHE: MMR-eligible travelers are offered vaccination. All pediatric travelers experience a destination-specific risk of measles exposure (mean, 30 exposures/million travelers). If exposed to measles, travelers’ age and MMR vaccination status determine the risk of infection (range, 3%-90%). We included costs of medical care, contact tracing, and lost wages from the societal perspective. We varied inputs in sensitivity analyses. Model outcomes included projected measles cases, costs, and incremental cost-effectiveness ratios ($/quality-adjusted life year [QALY], cost-effectiveness threshold ≤$100 000/QALY).ResultsCompared with no PHE, PHE would avert 57 measles cases at $9.2 million/QALY among infant travelers and 7 measles cases at $15.0 million/QALY among preschool-aged travelers. Clinical benefits of PHE would be greatest for infants but cost-effective only for travelers to destinations with higher risk for measles exposure (ie, ≥160 exposures/million travelers) or if more US-acquired cases resulted from an infected traveler, such as in communities with limited MMR coverage.ConclusionsPretravel MMR vaccination provides the greatest clinical benefit for infant travelers and can be cost-effective before travel to destinations with high risk for measles exposure or from communities with low MMR vaccination coverage.

Reporting of Participant Race and Ethnicity in Published US Pediatric Clinical Trials From 2011 to 2020

Equitable representation of participants who are members of racial and ethnic minority groups in clinical trials enhances inclusivity in the scientific process and generalizability of results. To assess participant race and ethnicity in pediatric clinical trials published from 2011 to 2020. This cross-sectional study examined articles reporting pediatric clinical trials conducted in the US published in 5 leading general pediatric and 5 leading general medical journals from January 1, 2011, to December 31, 2020. Reporting of participant race and ethnicity and comparison of enrolled participants vs US census populations of pediatric racial and ethnic groups in published clinical trials. The study included 612 articles reporting pediatric clinical trials during the study period, with 565 618 total participants (median per trial, 200 participants [IQR, 90-571 participants]). Of the 612 articles, 486 (79.4%) reported participant race and 338 (55.2%) reported participant ethnicity. From 2011 to 2020, relative rates of reporting of participant race increased by 7.9% per year (95% CI, 0.2%-16.3% per year) and reporting of ethnicity increased by 11.4% per year (95% CI, 4.8%-18.4% per year). Among articles reporting race and ethnicity, the method of assignment was not reported in 261 of 511 articles (51.1%) and 207 of 359 articles (57.7%), respectively. Black/African American children were enrolled proportionally more than the US population of Black/African American children (odds ratio [OR], 1.88; 95% CI, 1.87-1.89). Hispanic/Latino children were enrolled commensurately with the US population of Hispanic/Latino children (OR, 1.02; 95% CI, 1.01-1.03). American Indian/Alaska Native (OR, 0.82; 95% CI, 0.79-0.85), Asian (OR, 0.56; 95% CI, 0.55-0.57), and Native Hawaiian/Pacific Islander (OR, 0.66; 95% CI, 0.61-0.72) children were enrolled significantly less compared with the respective US populations of these groups. White children were enrolled less than expected (OR, 0.84; 95% CI, 0.84-0.85) but represented 188 156 (46.0%) of participants in trials reporting race or ethnicity. This cross-sectional study revealed that the proportion of published pediatric clinical trials that reported participant race and ethnicity increased from 2011 to 2020, but participant race and ethnicity were still underreported. Disparities existed in pediatric clinical trial enrollment of American Indian/Alaska Native, Asian, and Native Hawaiian/Pacific Islander children. The greater representation of Black/African American children compared with the US population suggests inclusive research practices that could be extended to other historically disenfranchised racial and ethnic groups.

Factors Associated With Penicillin Allergy Labels in Electronic Health Records of Children in 2 Large US Pediatric Primary Care Networks

Penicillin allergy labels influence clinical decision-making, yet most children who are labeled do not have type 1 hypersensitivity allergic reactions and instead have a history of predictable adverse reactions or unspecified illness symptoms while receiving penicillin for viral infections. Studies describing penicillin allergy labeling in the pediatric outpatient setting are lacking. To describe the epidemiology and factors associated with penicillin allergy labels across 2 large US pediatric primary care networks. This retrospective, longitudinal birth cohort study was conducted in 90 primary care pediatric practices serving a diverse population of children across Houston, Texas, Austin, Texas, Philadelphia, Pennsylvania, and parts of New Jersey. Participants were children born between January 2010 and June 2020 who had a health care visit in the first 14 days of life and at least 2 additional visits in the first year of life at one of 90 primary care pediatric practices. Censoring criteria were additionally applied to exclude data from children no longer seeking health care in the 90 clinics over time. Statistical analysis was performed from February to May 2021. Basic patient demographics, health care utilization, penicillin exposure, and primary clinic location. Addition of penicillin allergy label in the electronic medical record. Among 334 465 children in the birth cohort, 164 173 (49.1%) were female; 72 831 (21.8%) were Hispanic, 59 598 (17.8%) were non-Hispanic Black, and 148 534 (44.4%) were non-Hispanic White; the median (IQR) age at censoring was 3.8 (1.7-6.6) years; 18 015 (5.4%) were labeled as penicillin allergic, but the prevalence of penicillin allergy labeling ranged from 0.9% to 10.2% across practices. Children were labeled at a median (IQR) age of 1.3 (0.9-2.3) years. Non-Hispanic White children were more likely to be labeled compared with non-Hispanic Black children after controlling for potential confounders (adjusted odds ratio, 1.7 [95% CI, 1.6-1.8]). There were 6797 allergic children (37.7%) labeled after receiving 1 penicillin prescription and 1423 (7.9%) labeled after receiving 0 penicillin prescriptions. In this cohort study of more than 330 000 children, penicillin allergy labeling was common and varied widely across practices. Children were labeled early in life, and almost half were labeled after receiving 1 or 0 penicillin prescriptions. These findings raise questions regarding the validity of penicillin allergy labels. Future work exploring the fidelity of and outcomes associated with penicillin allergy-labeling in children is warranted.

Opportunities for Antibiotic Stewardship Interventions in a Pediatric Hospital

Abstract Objective This study's objective was to assess an antibiotic stewardship intervention, compare pediatric antibiotic usage in a non-university hospital (Children's Hospital Traunstein [TS]) with a university hospital (Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich [MUC]), and assess adherence to national guidelines. Methods Antibiotic usage pre- and post-antibiotic stewardship (ABS) intervention was compared, and antibiotic prescriptions over 4 months were prospectively recorded. ABS intervention consisted of weekly teaching sessions, antibiotic pocket cards, and rounds with pediatric infectious disease staff. Medical records were reviewed to describe antibiotic consumption, antibiotic dosages and length of use, and adherence to national guidelines. Pediatric antibiotic usage was compared between hospitals and patient groups. Results After the ABS intervention, the use of second-generation cephalosporins decreased, while penicillin with β-lactamase inhibitors (BLI) increased. Survey of antibiotic prescriptions over the 4 months study period in the non-university hospital showed a high administration rate of second-generation cephalosporins and extended-spectrum penicillins in the non-intensive care units (ICU) wards (48.53 and 38.93 days of therapy [DoT]/1,000 patient days [PD], respectively) and a high rate of third-generation cephalosporins in the ICU ward (110.33 DoT/1,000PD). A high prescriptions rate was seen in the neonatal intensive care unit (NICU) wards (DoT/ length of therapy [LoT] ratio of 2.185). Reserve group antibiotics were only given in the ICU. Adherence to national guidelines was highest in the NICU and pediatric ICU wards. Striking was the relatively high rate of incorrect usage of second-generation cephalosporins. Comparing the pediatric wards of the non-university hospital (TS) and the university hospital (MUC), the prescription ratio was 11.1% (TS) versus 30.6% (MUC), and DoT/1,000PD 198.9 (TS) versus 483.6 (MUC), p = 0.02. ABS intervention changed the choice of described antibiotics, but not the overall frequency. Conclusion Adherence to national guidelines was highest in fields with standardized therapy recommendations, like in the NICU. In MUC, antibiotics, in particular restricted ones, were prescribed more frequently, probably due to higher severity of illness.These data indicate that the usage of antibiotics and adherence to national guidelines show a wide variety, but ABS interventions were effective in changing prescription behavior.

A Scanning Electron Microscopic Study on Effect of Blood and Artificial Salivary Contamination on Marginal Adaptation of Mineral Trioxide Aggregate, When Used as a Retrograde Filling Material: An In Vitro Study.

ABSTRACTAim and objectiveThe present study was conducted to evaluate the marginal adaptability of mineral trioxide aggregate (MTA) as a root-end filling material when manipulated using two different IV fluids intended for pediatric usage; in the presence of blood and salivary contamination.Materials and methodsSixty single-rooted teeth were selected. Conventional endodontic root canal preparation was performed on all specimens followed by root-end resection and retrograde cavity preparation. The roots were randomly divided into two groups (n = 30). In the specimens of group I, fresh blood was used as a contaminant and in group II artificial saliva was used as a contaminant. In both groups, MTA (e-MTA, Kids-e-Dental®) manipulated using either Ringer's lactate IV fluid (n = 15) or Tetraspan IV fluid (n = 15) was used for root-end filling in blood or artificial saliva-coated retrocavities. Furthermore, these roots were placed in beakers pooled with fresh phlebotomized blood or artificial saliva. After incubating for 48 hours, the roots were divided longitudinally to expose the retrofilled cavities and were then sputter-coated with gold-platinum dust. To assess the marginal adaptation of MTA to radicular dentin “maximum gap width” and “gap perimeter” were measured in images obtained from scanning electron microscopy of root specimens. SPSS 21 was employed for statistical analysis at (p < 0.05). Mann–Whitney U test and ANOVA were used for analyzing the data obtained.ResultsThe gap width was more among samples exposed to blood (p < 0.05) than artificial saliva. No significant difference was reported in the gap perimeter when cavities were filled with MTA mixed with either IV fluids (p > 0.05).ConclusionExposure to blood during setting had a negative effect on gap width when retrocavities were filled with MTA using Tetraspan. No effect was seen on the arch perimeter in retrocavities filled with MTA mixed with Ringer's lactate or Tetraspan.Clinical significanceFor avoiding failure, it is critical to select a biocompatible root-end filling material with high sealing ability. Hence, by doing the same, the clinical situation can be simulated.How to cite this articleMody A, Arora R, Chauhan P, et al. A Scanning Electron Microscopic Study on Effect of Blood and Artificial Salivary Contamination on Marginal Adaptation of Mineral Trioxide Aggregate, When Used as a Retrograde Filling Material: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(5):674–680.

Abstract 10540: Worsening Racial Disparity in Waitlist Mortality for Pediatric Heart Transplant Candidates Since the 2016 Pediatric Heart Allocation Policy Revision

Introduction: The US Pediatric Heart Allocation Policy was recently revised with the goal of lowering waitlist mortality. Effective March 2016, these rules significantly changed the requirements for priority status. We evaluated the hypothesis that this change, which has led to an increase in status exceptions, has worsened known racial disparities in waitlist outcomes. Methods: Children in the Pediatric Heart Transplant Study database listed at a US center from January 2012 - June 2020 were included and stratified by listing before (Era 1) or after (Era 2) allocation policy change on March 22, 2016. Competing risk survival analysis was performed to evaluate endpoint of death or deterioration on the waitlist with transplant treated as a competing risk. Results: Compared with white children (n=2,648), non-white children (n=1,441) were more likely to have an underlying diagnosis of cardiomyopathy (49% vs. 39%, p&lt;0.001), be currently hospitalized (81% vs. 71%, p=0.007) and supported with a ventricular assist device (VAD) (12% vs 9%, p=0.005) at the time of listing. Waitlist mortality was similar in white and non-white children in Era 1, but worse for non-white children compared to white children in Era 2 (Figure). In multivariable analysis controlling for diagnosis, age and severity markers, non-white children had a significantly higher waitlist mortality only if listed after the policy change (Era 1: sHR 1.18 [95%CI 0.88 - 1.59] vs. Era 2: sHR 1.52 [95%CI 1.14 - 2.02]). Hispanic ethnicity was not associated with waitlist mortality in either period when controlling for other risk factors. Conclusions: Widening racial disparities in waitlist mortality may be an unintended consequence of the 2016 Pediatric Heart Allocation Policy revision. Additional analyses may help the transplant community understand the degree to which this policy (i.e. prioritized listing status and exceptions) vs. unrelated changes in care differentially contribute to these disparities.

Literature Review on Siddha Medicine for the Management of Neerkana Maantham with Utthamani Kudineer- A Drug Review

Siddha medicine is an ancient and traditional system of medicine.. When the three humors (Vatham, Pitham, Kabam) are in proper balance then the person experiences good health; any imbalance of three humors leads to disease. Acute Nasopharyngitis defines an inflammation of the mucous membrane of the naso pharynx. It is characterized by rhinorrhea, nasal obstruction, sneezing, malaise, fever, headache, &amp; myalgia. It may be correlated with Neerkana maantham, one of the 31 types of Maantham in children mentioned in Siddha literature Balavagadam. The symptoms of Neerkana mantham can be managed by Siddha herbal formulation Utthamani kudineer. The main ingredients of the Utthamani kudineer are Chukku, Milagu, Thippili, Omam, Sutta Vasambu, Utthamani leaf, Velai ver, Nochi thulir, Murungai eerku, Nuna eerku. The ingredients of this formulation possess anti-inflammatory, antiviral, anti microbial, antipyretic activities. All the ingredients of trial drug are purely herbals only. It is easily prepared, palatable, assimilates quickly and also safe for pediatric usage in the treatment of Neerkana maantham. Hence, this article gives an insight on the efficacy of Utthamani kudineer for Neerkana maantham (Acute Nasopharyngitis) based on review of various literatures and scientific studies. This review further focuses to improve the research on Siddha herbal medicines.