Pediatric Tertiary Care Center Research Articles

91 The impact of non-pharmaceutical public health interventions on hospital admissions and mortality from common causes of pediatric respiratory distress: a single center perspective

Abstract Background In response to the COVID-19 pandemic, jurisdictions around the world implemented policies to reduce COVID-19 transmission through public masking, travel restrictions, and closure of non-essential businesses. Collectively known as non-pharmaceutical interventions (NPI), these strategies reliably reduce the spread of COVID-19. International data suggests NPI also reduce hospitalizations for pediatric respiratory infections and their consequences, particularly asthma exacerbation. However, few Canadian studies have examined the impact of NPI on hospitalizations for common causes of pediatric respiratory distress. Objectives This study describes the impact of NPI on admissions for bronchiolitis, pneumonia, and asthma at a Canadian pediatric tertiary care centre. Design/Methods A retrospective chart review was conducted including all pediatric patients <18 years admitted to the general pediatric and pediatric intensive care units with bronchiolitis, pneumonia, or asthma. Data regarding diagnosis, length of hospitalization, and mortality were collected before (September 2016-March 2020) and in the 6 months after provincial NPI implementation (March 2020-September 2020). NPI were present throughout this period, however, specific measures varied due to evolving public health orders. Chi-squared testing was conducted to describe the impact of NPI on number of admissions, length of hospitalization, and mortality. Results Participants (n=1631) included 111 (6.8%) patients <1 month, 878 (53.8%) patients 1-23 months, 331 (20.3%) patients 24 months-4 years, and 311 (19.1%) patients ≥5 years. A mean of 205 patients were admitted every 6 months with respiratory distress (bronchiolitis, pneumonia, and/or asthma) prior to NPI implementation. During this timeframe, the 6-month mean admissions due to asthma, pneumonia, and bronchiolitis were 48, 56, and 101, respectively. In the 6 months following NPI implementation, there were 56 admissions for respiratory distress, including 15 for asthma, 19 for pneumonia, and 22 for bronchiolitis. Mean length of stay increased following the implementation of NPI from 8.49 to 11.68 days, whereas 6-month mean mortality decreased from two to zero deaths. Results did not attain statistical significance (p>0.05). Conclusion Results suggest NPI reduce hospitalizations and mortality from bronchiolitis, pneumonia, and asthma. Given the similar seasonality of these conditions, periodic use of NPI beyond the COVID-19 pandemic may reduce pediatric morbidity and mortality from common causes of respiratory distress. However, additional research is needed to describe the relationship between NPI and length of hospitalization. Future studies should also examine the impact of NPI on other pediatric infectious diseases to better characterize their utility.

Risk factors for mechanical complications of peripherally inserted central catheters in children.

To determine risk factors for mechanical (noninfectious) complications in peripherally inserted central catheters (PICCs) in children. Retrospective cohort study. Pediatric tertiary-care center in Nova Scotia, Canada. Pediatric patients with a first PICC insertion. All PICCs inserted between January 2001 until 2016 were included. Age-stratified (neonates vs non-neonates) Fine-Grey competing risk proportional hazard models were used to model the association between each putative risk factor and the time to mechanical complication or removal of the PICC for reasons not related to a mechanical complication. Models were adjusted for confounding variables identified through directed acyclic graphs. Of 3,205 patients with PICCs, 706 had mechanical complications (22% or 14 events/1000 device days). For both neonates and older children, disease group, lumen count, and prior leak were all associated with mechanical complications in the adjusted proportional hazards model. Access vein and prior infection were also associated with mechanical complications for neonates, and age group was associated with mechanical complications among non-neonates. We have identified several risk factors for mechanical complications in patients with PICCs that will help improve best practices for PICC insertion and care.

Chronic tracheostomy care of ventilator-dependent and -independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system.

To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation. A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up. The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona™ (17/17) and Shiley™ (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements. Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.

Strategies to recover blood donors during the COVID-19 pandemic: a tertiary level hospital experience.

The SARS-CoV-2 pandemic has challenged blood banks. In Mexico, donors decreased 22% between April and May 2020 compared to the same months in 2019. This study analyzed the effect of the strategies to recover donors (altruistic and family) in a tertiary pediatric care center during the pandemic. The Blood Bank of the Hospital Infantil de México Federico Gómez implemented strategies to obtain blood components to ensure self-sufficiency. The effect of these strategies on donor recovery was analyzed. There were 7,315 eligible donors in 2019 and 5,070 in 2020. Blood component requirements decreased from 10,037 units in 2019 to 8,619 in 2020. The strategies aimed at attracting altruistic donors managed to increase the percentage of this type of donor when comparing the months in which these strategies were applied with the same months in 2019. In addition, it was observed that the greater the number of methods used simultaneously, the higher the percentage of altruistic donors (rho = 0.846, p = 0.002). In contrast, strategies aimed at attracting family donors did not increase the number of this type of donor. Actions to recruit altruistic donors increased the number of this type of donor to meet the hospital's needs.

Trends in the treatment of undescended testes: a pediatric tertiary care center experience from Croatia

ObjectiveUndescended testes (UDT) is the most common anomaly of the male genitourinary tract. The guidelines suggest that orchidopexy in congenitally UDT should be performed between 6 months and 18 months...

SHORT TERM STUDY ON CLINICAL RELEVANCE AND OUTCOMES OF FOETAL HYDRONEPHROSIS

Background. Hydronephrosis is the most common urinary tract pathology detected on antenatal screening by Ultrasound. The detection of fetal hydronephrosis by ultrasound pres­ents a treatment dilemma to the treating surgeon and parental anxiety. Objective. This study aims to examine the role of serial ultrasounds in antenatally detected fetal hydronephrosis to know the disease progression, and to assess indications and timing of surgery in these patients to preserve renal function. Methods. This is an observational study of 30 cases of foetal hydronephrosis conducted at a tertiary care paediatric surgery centre. A foetal renal pelvic Antero-posterior diameter (APD) >7 mm at 32 weeks of gestation is considered to indicate Foetal hydronephrosis. These patients are followed up for a period of two years from 2018 to 2020. Progression of disease and need for surgical intervention is noted. Results. The study comprised 30 cases of antenatal foetal hydronephrosis (42 renal units). Of 26 renal units with mild hydronephrosis, all are resolved in the post-natal period. Of 10 renal units with moderate hydronephrosis, 3 (30%) resolved and 7 (70%) worsened and required surgical intervention. Of 6 renal units with severe hydronephrosis, all required surgical intervention and underwent surgery between 12 to 18 months of age. Conclusions. These results suggest a grading system with antero-posterior diameter of renal pelvis distinguishes those cases with moderate and severe degrees of hydronephrosis that are at higher risk of surgery.

Rare diseases, common barriers: disparities in pediatric clinical genetics outcomes.

Identifying a precise genetic diagnosis can improve outcomes for individuals with rare disease, though the resources required to do so may impede access and exacerbate healthcare disparities leading to inequitable care. Our objective was therefore to determine the effect of multiple sociodemographic factors on the yield of the diagnostic evaluation for genetics outpatients. This is a retrospective cohort study from 2017 to 2019 of outpatient genetics referrals at a pediatric academic tertiary care center. Exposures included: primary language, insurance type, and neighborhood resources (via the Childhood Opportunity Index, COI). The primary outcome was identification of a genetic diagnosis within 2 years of the initial clinic visit. COI quintile was not significantly associated with the odds of diagnosis but was significantly associated with clinic attendance, with lower neighborhood resources leading to incomplete referrals. Limited English proficiency was associated with a higher odds of diagnosis, though at an older age. Public insurance was associated with increased access to genetic testing. Lower neighborhood resources are negatively associated with clinic attendance. Our findings further suggest delays in care and a referral bias for more severe phenotypes among families with limited English proficiency. Improved access to clinical genetics is needed to improve diagnostic equity. The resources required to identify a genetic diagnosis may impede access and exacerbate healthcare disparities leading to inequitable care. In an analysis of pediatric outpatient genetics referrals, we observed a significant association between neighborhood resources and clinic attendance but not diagnostic yield for those attending, and a higher diagnostic yield for families with limited English proficiency, suggesting referral bias for more severe phenotypes. Thus, the primary barrier to finding a genetic diagnosis was initiation of care, not the ensuing diagnostic odyssey. Further research efforts should be directed at increasing access to clinical genetics evaluations for children with rare disease.

Impact of an outpatient parenteral antimicrobial treatment (OPAT) as part of a paediatric-specific PROA program

IntroductionOutpatient parenteral antimicrobial treatment (OPAT) is an alternative to in-patient care in carefully selected patients. This study presents a self-administration OPAT program integrated within the pediatric antibiotic stewardship program (ASP) in a pediatric tertiary care center. Material and methodsDescriptive, retrospective and unicentric study. Data from all patients under 20 years of age who were prescribed treatment by a pediatric unit during 2019 and 2020 were included. Data regarding number of saved beds and estimating the opportunity cost of the OPAT program for the hospital were analyzed. ResultsFifty-seven patients received 106 episodes of treatment. Favorable clinical outcome occurred in 74.5% of the episodes. The main cause of premature interruption was unfavorable clinical outcome of the infection (37.1%). A total of 2.62 beds/day were saved, resulting in an economic benefit of 1,069,963 €. ConclusionA self-administration OPAT program integrated within the pediatric ASP has proven to be safe and effective and provides economic benefits.

Large Vertex Encephaloceles: Management and Outcomes.

Complex vertex and posterior encephaloceles containing brain tissue have uncertain prognosis and high operative risk. Patients may not be offered operative intervention depending on local and regional specialist expertise. The authors present their experience treating 5 such pediatric patients. This is a retrospective review of the surgical assessment, planning, and technique of cranial repairs, as well as surgical outcomes and developmental follow-up regarding adaptive functioning for patients presenting for second opinion for encephalocele of the cranial vertex after having been deemed too high risk at another institution. Five consecutive patients presented between January 2014 and June 2016. One patient was not offered repair. Of 4 patients who underwent reconstruction, average age at time of repair was 2.7 months (range, 0.9-6.7). One presented with ruptured encephalocele, whereas the remaining 3 underwent drainage of the encephalocele (average volume of 1200mL) at time of surgical resection. Operative time averaged 3.7 hours (range, 2.2-5.3). There were no deaths. One patient had a single seizure postoperatively. Two patients required placement of permanent shunt for hydrocephalus. Two patients completed developmental evaluations, both of whom exhibited delays in adaptive functioning relative to same-aged peers. Patients with large, complex encephalocele warrant evaluation by an experienced high-volume tertiary care pediatric craniofacial center. The decision to proceed with surgical management should include an interdisciplinary team of surgeons, anesthesiologists, neurologists, and social work. Further study of developmental outcomes in both operated and unoperated patients is necessary to better understand risks and benefits of reconstruction.

Sickle cell bone disease and response to intravenous bisphosphonates in children

SummaryChildren with sickle cell disease (SCD) have the potential for extensive and early-onset bone morbidity. This study reports on the diversity of bone morbidity seen in children with SCD followed at three tertiary centers. IV bisphosphonates were effective for bone pain analgesia and did not trigger sickle cell complications.IntroductionTo evaluate bone morbidity and the response to intravenous (IV) bisphosphonate therapy in children with SCD.MethodsWe conducted a retrospective review of patient records from 2003 to 2019 at three Canadian pediatric tertiary care centers. Radiographs, magnetic resonance images, and computed tomography scans were reviewed for the presence of avascular necrosis (AVN), bone infarcts, and myositis. IV bisphosphonates were offered for bone pain management. Bone mineral density was assessed by dual-energy X-ray absorptiometry (DXA).ResultsForty-six children (20 girls, 43%) had bone morbidity at a mean age of 11.8 years (SD 3.9) including AVN of the femoral (17/46, 37%) and humeral (8/46, 17%) heads, H-shaped vertebral body deformities due to endplate infarcts (35/46, 76%), and non-vertebral body skeletal infarcts (15/46, 32%). Five children (5/26, 19%) had myositis overlying areas of AVN or bone infarcts visualized on magnetic resonance imaging. Twenty-three children (8/23 girls) received IV bisphosphonate therapy. They all reported significant or complete resolution of bone pain. There were no reports of sickle cell hemolytic crises, pain crises, or stroke attributed to IV bisphosphonate therapy.ConclusionChildren with SCD have the potential for extensive and early-onset bone morbidity. In this series, IV bisphosphonates were effective for bone pain analgesia and did not trigger sickle cell complications.

Urgent air transfers for acute respiratory infections among children from Northern Canada, 2005-2014.

BackgroundThe incidence of hospitalizations for acute respiratory infections (ARI) among young Indigenous children from Northern Canada is consistently high. ARIs requiring urgent air transfer can be life-threatening and costly. We aimed to describe their epidemiology, estimate age-specific incidences, and explore factors associated with level of care required.MethodsWe undertook a retrospective cohort study of children <5 years old from Northern Canada transferred by urgent air transport for ARI from 2005 through 2014 to 5 pediatric tertiary care centers in Vancouver, Edmonton, Winnipeg, Ottawa and Montreal. Admissions were identified via ARI-related ICD-9/10 coding and forward sortation area. Descriptive statistics and univariable analyses were performed.ResultsAmong 650 urgent air transfers, the majority were from Nunavut (n = 349, 53.7%) or Nunavik (n = 166, 25.5%), <6 months old (n = 372, 57.2%), and without underlying comorbidity (n = 458; 70.5%). Estimated annual tertiary care ARI admission rates in infants <1 year old from Nunavut (40.7/1000) and Nunavik (44.5/1000) were tenfold higher than in children aged 1 to 4 years. Bronchiolitis (n = 333, 51.2%) and pneumonia (n = 208, 32.0%) were the most common primary discharge diagnoses. Nearly half required critical care (n = 316, 48.6%); mechanical ventilation rates ranged from 7.2% to 55.9% across centres. The most common primary pathogen was respiratory syncytial virus (n = 196, 30.1%). Influenza A or B was identified in 35 cases (5.4%) and vaccine-preventable bacterial infections in 27 (4.1%) cases.InterpretationUrgent air transfers for ARI from Northern Canada are associated with high acuity. Variations in levels of care were seen across referral centers, age groups and pathogens.

Children With Short Stature Display Reduced ACE2 Expression in Peripheral Blood Mononuclear Cells.

BackgroundThe cause of short stature remains often unknown. The renin-angiotensin system contributes to growth regulation. Several groups reported that angiotensin-converting enzyme 2 (ACE2)-knockout mice weighed less than controls. Our case-control study aimed to investigate if children with short stature had reduced ACE2 expression as compared to controls, and its significance.Materials and Methodschildren aged between 2 and 14 years were consecutively recruited in a University Hospital pediatric tertiary care center. Cases were children with short stature defined as height SD ≤ −2 diagnosed with growth hormone deficiency (GHD) or idiopathic short stature (ISS), before any treatment. Exclusion criteria were: acute diseases, kidney disease, endocrine or autoimmune disorders, precocious puberty, genetic syndromes, SGA history. ACE and ACE2 expression were measured in peripheral blood mononuclear cells, angiotensins were measured by ELISA.ResultsChildren with short stature displayed significantly lower ACE2 expression, being 0.40 fold induction (0.01-2.27) as compared to controls, and higher ACE/ACE2, with no differences between GHD and ISS. ACE2 expression was significantly and inversely associated with the risk of short stature, OR 0.26 (0.07-0.82), and it had a moderate accuracy to predict it, with an AUC of 0.73 (0.61-0.84). The cutoff of 0.45 fold induction of ACE2 expression was the value best predicting short stature, identifying correctly 70% of the children.ConclusionsOur study confirms the association between the reduction of ACE2 expression and growth retardation. Further studies are needed to determine its diagnostic implications.

Analgesic Effects of a Novel Combination of Regional Anesthesia After Pediatric Cardiac Surgery: A Retrospective Cohort Study

The objective of this study was to determine whether the use of regional anesthesia in children undergoing congenital heart surgery was associated with differences in outcomes when compared to surgeon-delivered local anesthetic wound infiltration. A retrospective cohort study. At a single pediatric tertiary care center. Pediatric patients who underwent primary repair of septal defects between January 1, 2018, and March 31, 2022. The patients were grouped by whether they received surgeon-delivered local anesthetic wound infiltration or bilateral pectointercostal fascial blocks (PIFBs) and a unilateral rectus sheath block (RSB) on the side ipsilateral to the chest tube. Using overlap propensity score-weighted models, the authors examined postoperative opioid requirements (morphine milliequivalents per kilogram), pain scores, length of stay, and time under general anesthesia (GA). Eighty-nine patients were eligible for inclusion and underwent analysis. In the first 12 hours postoperatively, the block group used fewer morphine equivalents per kilogram versus the infiltration group, 0.27 ± 0.2 v 0.64 ± 0.42, with a weighted estimated decrease of 0.39 morphine equivalents per kilogram (95% CI -0.52 to -0.25; p < 0.001), and had lower pain scores, 3.2 v 1.6, with a weighted estimated decrease of 1.7 (95% CI -2.3 to -1.1; p < 0.001). The length of stay and time under GA also were shorter in the block group with weighted estimated decreases of 22 hours (95% CI -33 to -11; p=0.001) and 18 minutes (95% CI -34 to -2; p=0.03), respectively. Bilateral PIFBs and a unilateral RSB on the side ipsilateral to the chest tube is a novel analgesic technique for sternotomy in pediatric patients. In this retrospective study, these interventions were associated with decreases in postoperative opioid use, pain scores, and hospital length of stay without prolonging time under GA.

Paper 61: Surgical Management of Distal Clavicle Fractures in Skeletally Immature Athletes

Objectives:The objective of this study was to characterize distal clavicle fractures in a cohort of pediatric and adolescent athletes who underwent operative treatment at a single, tertiary-care pediatric center, including surgical techniques used and resultant clinical outcomes.Methods:A retrospective review was performed of all clavicle fractures extending to the level of the corococlavicular ligaments or more lateral, which were treated operatively at a single tertiary-care pediatric hospital between the years of 2005-2020. Patients >19 years-old or those with pathological fractures were excluded. Radiographic fracture characteristics, surgical techniques, time to radiographic healing, return to sports, and complications were analyzed.Results:Fifty-two patients were identified, with mean age 13.8 ± 2.2 years. The majority of fractures were classified as Nenopoulus type IIB (transverse, displaced; 42.3%) or type IIIB (oblique, displaced; 26.9%), though type IIA (transverse, minor displacement; 3.8%), IV (comminuted; 11.6%) , and V (AC dislocation; 15.4%) patterns were also observed. Primary direction of displacement was posterior in 90% of cases and superior in 10%. Plate fixation was performed in 53.8% of surgeries, with locking plate (26.9%) and hook plate (17.3%) most frequent. Suture-based fixation was performed in 32.7% of cases (Figure 1). Rate of implant removal was 66% after plate fixation, the majority of which (72.2%) were planned at the time of primary fixation. Total complication rate, including unplanned removal of implant, was higher in the plate fixation group (25%) than in the suture-based fixation group (11.2%). Time to radiographic healing was not significantly different between plate and suture-based constructs (2.9 vs. 2.9 months, p = 0.96) though patients with suture-based constructs returned to sport faster (2.5 vs. 3.6 months, p = 0.014).Conclusions:Posteriorly displaced fractures comprised the vast majority of surgically-treated distal clavicle fractures in pediatric and adolescent athletes. When chosen in the appropriate patient, based on age and fracture pattern, suture-only constructs can lead to similar time to radiographic healing and faster return to sports compared to plate-based constructs, with significantly reduced need for removal of hardware. These data provide a foundation for future comparative research to further elucidate precise surgical indications and optimal treatment approaches in this population.Table 1.Fixation Methods for Distal Clavicle Fractures

Clinical profile and outcome in neonates born to COVID-19 positive mothers and COVID positive children aged between 1 month to 12 years admitted in a tertiary COVID care centre: a cross sectional study

Background: COVID-19 pandemic has caused worldwide havoc since the first case was discovered in China in December 2019. The infection has caused less severe infections and fewer deaths in children compared to adults. During the first two waves of COVID-19, the mortality rate in children has been &lt;3% in India though more severe infections and hospitalizations were seen during the second wave. This study was undertaken at a tertiary Pediatric COVID care center during the third wave to understand the clinical, morbidity profile and outcomes in neonates born to COVID positive mothers and children who are COVID positive. Methods: Neonates born to COVID positive mothers and children between the age group 1 month to 12 years admitted in Government general hospital, Kakinada, Andhra Pradesh from 1January 2022 to 31March 2022 were included in the study. Their demographic, clinical, morbidity profile, treatment details were noted and outcomes observed.Results: All neonates were found to be RTPCR negative. 28% of neonates were born prematurely and 16% had birth asphyxia. Respiratory distress was the most presenting symptom. Death was seen in 4 newborns due to perinatal complications. More children less than 10 years required admission.15% of children were asymptomatic. Fever, cough, and running nose were the most presenting complaints. 2 children who had co-morbidities at the time of admission died.Conclusions: The third wave of COVID-19 did not cause any significant change in morbidity and mortality in children compared to the previous two waves.

Comparison of Two Laparoscopic Techniques in Management of Pediatric Inguinal Hernias.

Introduction: Many studies focus on comparing outcomes of the open method for inguinal hernia repair (IHR) and the laparoscopic method. However, few studies compare different laparoscopic techniques. With over a dozen different techniques described in the literature for laparoscopic IHR, significant opportunities exist to study the efficacy of each technique. We investigated outcomes of a subcutaneous endoscopically assisted transfixion ligation (SEATL) technique and a percutaneous internal ring suturing (PIRS). Materials and Methods: After receiving institutional review board approval, we completed a retrospective chart review of IHR performed at our pediatric tertiary care center between September 2015 and May 2020. We included all patients under the age of 18 years. We separated laparoscopic repairs from total repairs. Laparoscopic repairs were further divided into their respective techniques. Factors involving patient demographics, operative details, and postoperative complications were statistically analyzed using SPSS. Results: There was a total of 131 IHRs performed with SEATL and 124 IHRs performed with PIRS. Median operative time (minutes) differed significantly (P = .001) with SEATL at 49 (28-66) and PIRS at 55 (37-76)] minutes. Significantly more incarcerated hernias were repaired with PIRS (n = 13) than with SEATL (n = 3, P = .006). SEATL had a higher number of postoperative complications; the most significant were granulomas (n = 3, P = .09) and recurrent hernias (n = 12, P < .001). Conclusion: SEATL had a significantly higher number of postoperative complications. This may be a result of multiple factors including but not limited to the absence of electrocautery, a shorter median operative time, and utilization of absorbable suture. Modifications have been made to this technique to reduce risk of postoperative complications.

Continuous noninvasive blood gas estimation in critically ill pediatric patients with respiratory failure

Patients supported by mechanical ventilation require frequent invasive blood gas samples to monitor and adjust the level of support. We developed a transparent and novel blood gas estimation model to provide continuous monitoring of blood pH and arterial CO2 in between gaps of blood draws, using only readily available noninvasive data sources in ventilated patients. The model was trained on a derivation dataset (1,883 patients, 12,344 samples) from a tertiary pediatric intensive care center, and tested on a validation dataset (286 patients, 4030 samples) from the same center obtained at a later time. The model uses pairwise non-linear interactions between predictors and provides point-estimates of blood gas pH and arterial CO2 along with a range of prediction uncertainty. The model predicted within Clinical Laboratory Improvement Amendments of 1988 (CLIA) acceptable blood gas machine equivalent in 74% of pH samples and 80% of PCO2 samples. Prediction uncertainty from the model improved estimation accuracy by 15% by identifying and abstaining on a minority of high-uncertainty samples. The proposed model estimates blood gas pH and CO2 accurately in a large percentage of samples. The model’s abstention recommendation coupled with ranked display of top predictors for each estimation lends itself to real-time monitoring of gaps between blood draws, and the model may help users determine when a new blood draw is required and delay blood draws when not needed.

A Cross-Sectional Study of Unlocking Childhood Cancer Services during COVID-19 Pandemic: A Pediatric Oncology Tertiary Care Center's Experience from a Developing Country

Abstract Introduction The global coronavirus disease 2019 (COVID-19) pandemic has made the provision of cancer care services a challenging task all over the world, even in developed countries. Multiple studies have already reported increased rate of diagnostic delays, interruptions in radiotherapy and chemotherapy administration, and shortage of health care personnel to deliver these services. Objective The aim of this study was to analyze the impact of strategies used to deliver uninterrupted childhood cancer services at our center during the COVID-19 pandemic. Materials and Methods This is a cross-sectional study of the children less than 18 years of age admitted at our center between March 2020 and September 2021 to assess the effect of strategies adopted to provide uninterrupted cancer services during the COVID-19 pandemic. All the children with cancer who were managed during the study period were included in the study. The children who had treatment interruptions/lost to follow-up prior to onset of COVID-19 were excluded from the study. The primary outcome was to measure the effect of COVID-19 on delivery of cancer care services. The secondary outcome was to assess whether the strategies followed at our center helped to reduce diagnostic delays or loss to follow-up during the COVID-19 pandemic. Results Out of total 1,490 admissions, 199 children were managed during the study period. Among the 199 children managed, 124 of them were newly diagnosed, 75 had ongoing treatment, 16 children relapsed, 13 children received palliative care, and 6 families were lost to follow-up. Out of 1,471 tests done, only 16 children and 6 caregivers tested COVID-19 positive during routine screening. Thirty-five underwent surgery and 23 received radiotherapy during this period. Among 199 children, 143 (71.8%) received financial support for hospital expenses, 23 (11.5%) received travel support, 20 (10%) were provided free accommodation, and 15 (7.5%) received home delivery of oral chemotherapy and pain medications. A total of $86,989.05 was supported for diagnostic investigations, COVID-19 testing, chemotherapy, and supportive care; $1,144.90 for travel support; and $17,010.94 was waived off by hospital administration to support the poor families. Conclusion The shared care model, support from nongovernmental organizations and hospital administration, and utilization of local resources productively and effectively helped to avoid diagnostic delays and treatment interruptions, and provide uninterrupted pediatric cancer care services at our center.

Interventional endoscopy for abdominal transplant patients

Interventional endoscopy can play a significant role in the care and management of children pre-and post- abdominal solid organ transplantation. Such procedures primarily include endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), and balloon-assisted enteroscopy (BAE), though additional interventions are available using standard endoscopes (gastroscopes, colonoscopes) for therapeutics purposes such as endoscopic hemostasis.The availability of pediatric practitioners with the advanced training to effectively and safely perform these procedures are most often limited to large tertiary care pediatric centers. These centers possess the necessary resources and ancillary staff to provide the comprehensive multi-disciplinary care needed for these complex patients.In this review, we discuss the importance of interventional endoscopy in caring for transplant patients, during their clinical course preceding the potential need for solid organ transplantation and inclusion of a discussion related to endoscopic post-surgical complication management. Given the highly important role of interventional endoscopy in patients with recurrent and chronic pancreatitis, we also include a discussion related to this complex disease process leading up to those patients that may need pancreas surgery including total pancreatectomy with islet autotransplantation (TPIAT).

AB1144 COGNITIVE AND PSYCHOSOCIAL OUTCOME IN CHILDREN WITH MULTISYSTEM INFLAMMATORY SYNDROME FOLLOWING SARS-CoV-2 INFECTION

BackgroundDespite the low rate of neurological deficits following the SARS-COV-2 infection in the pediatric population, children and adolescents who develop multisystem inflammatory syndrome (MIS-C) after being infected with SARS-COV-2 are at a higher risk for neurological abnormalities and brain injury, increasing the risk of adverse cognitive and psychiatric outcome.ObjectivesGiven the increased risk of central nervous system impairment we chose to conduct a prospective study looking at the cognitive and psychosocial outcome of patients with MIS-C.MethodsOur study included 27 of the 29 patients between 2 to 18 years of age (M = 11.1, SD = 4.4) who were treated for MIS-C from the onset of the SARS-COV-2 pandemic until the beginning of May 2021 at the only tertiary care pediatric immunology center in Slovenia. We assessed these patients 6 months after diagnosis using the age-appropriate Wechsler intelligence scales and a battery of neuropsychological test measuring attention, executive function, memory and fine motor skills. We also asked parents to report on patients’ psychosocial outcome using the Achenbach Child Behavior Checklist.ResultsBy using Bayesian statistics to take into account parental education and any potential pre-morbid learning difficulties we found no evidence of impairment on measures of intelligence. However, the posterior distribution of scores on neuropsychological measures indicated that a significant proportion of patients scored 1SD bellow expected levels on measures of attention (31%), executive function (28%) and visual memory (35%). Increased symptoms of depression, anxiety and attention difficulties were also reported by parents, although their extent did not rise to a clinically significant level.ConclusionThe findings from our cohort suggest that the cognitive and psychosocial outcome of patients with MIS-C is generally favorable, although up to 35% may experience specific neuropsychological deficits more than 6 months after diagnosis. The most commonly impaired cognitive domains seem to be attention, executive function and visual memory.AcknowledgementsFunding for this work was provided by the Slovenian Research Agency grant J3-3061 and University Medical Centre grant 20210069. Support was also provided by Dušica Boben and the publisher Center za psihodiagnostična sredstva by providing the local adaptations of psychological assessment tools.Disclosure of InterestsDavid Gosar Speakers bureau: Biogen, Novartis, Mojca Zajc Avramovič: None declared, Nina Emersic: None declared, Mateja Šušterič: None declared, Maja Maša Šömen: None declared, Damjan Osredkar: None declared, Tadej Avcin: None declared