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  Practice Variations in Sedated Echocardiography and Impact on Repeat Echocardiography in Non-Refractory Kawasaki Disease

  Nicholas Clark, Troy Richardson, Jennifer E. Schuster, Anitha Parthiban, and Henry T. Puls

  This study discovered significant variation among children's hospitals in the use of sedated echocardiiography for children <30 months of age with non-refractory Kawasaki disease prior to the American Heart Association 2017 Kawasake disease guideline update. Consideration should be given to performing sedated echocardiography as it may reduce the need for repeat echos without impacting length of stay or total>costs.

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  The Effect of Antihypertensive Dosing on Hypertension in Children with Chronic Kidney Disease

  Benjamin A. Matta, Uri S. Alon, Bradley Warady MD, Tarak Srivastava, and Darcy Weidemann

  Background

  Hypertension (HTN) is a highly prevalent and major risk factor for poor cardiovascular and renal outcomes in chronic kidney disease (CKD). Previous research suggests that HTN is underdiagnosed and undertreated in children with CKD. To our knowledge no studies have investigated the effect of antihypertensive (antiHTN) dose on blood pressure (BP) control in this population.

  Objective

  To determine the effect of antiHTN dose on HTN status in children with CKD.

  Methods

  Study population: 255 participants studied in the Chronic Kidney Disease in Children (CKiD) study at their 3rd visit, taking at least 1 antiHTN drug.

  Cumulative Drug Dose Index (cDDI): We developed a new quantitative tool, Drug Dose Index (DDI) which is expressed as a ratio between the current dose and the maximum potential dose, accounting for age, weight and renal dose adjustments. cDDI = sum DDI for all antiHTN agents for a subject.

  Primary outcome: HTN status - controlled HTN (cHTN) or uHTN (= masked HTN or ambulatory HTN).

  Secondary outcome: Left ventricular hypertrophy.

  Statistical analysis: Univariate analysis: Comparison of cDDI between the outcome groups. Multivariate Logistic Regression: 2 models with outcomes: uHTN and LVH.

  Results/Discussion

  This was the 1st quantitative analysis of antiHTN dose (cDDI), and its relationship with HTN status in children with CKD. No differences in cDDI between uHTN vs. cHTN, or LVH vs. no LVH, but higher cDDI was associated with AH on univariate analysis. RAASi and diuretic use were associated with lower odds of uHTN. Non-Caucasian race, absence of RAASi and diuretic agents, and higher number of agents were associated with uHTN. Female gender, higher BMI z-score, lower eGFR, higher number of agents and lower cDDI were associated with LVH. Further research is needed to validate the use of cDDI and the the roles of medication class and dose on BP control in children with CKD.

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  Improving bronchiolitis care across multiple care settings using a deimplementation bundle

  Amanda Nedved, Kathleen Berg, Troy Richardson, Amanda Montalbano, and Matthew B. Johnson

  Despite the availability of a bronchiolitis CPG; variation in care practices still existed at our institution. The aim of our quality improvement (QI) project was to increase overall adherence with our institutional CPG in patients 60 days to 24 months of age diagnosed with bronchiolitis in the urgent care centers (UCC), emergency departments (ED), and general inpatient units from a baseline of 40.9% to 60% by the end of two bronchiolitis seasons.

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  Total and Free Plasma Bilirubin and Clinical Outcomes in Severe Hyperbilirubinemia

  Sean M. Riordan, Jean-Baptiste LePichon, Steven Shapiro, Tina Slusher, Fatima Abdullahi, Hafsat M. Suleiman, Victor C. Pam, Mamu B. Samuel, Christopher S. Yilgwan, Christian Isichei, and Idris Y. Mohammed

  Acute bilirubin encephalopathy (ABE) and kernicterus spectrum disorder (KSD) have become relatively uncommon in high income countries but remain a major cause of morbidity and mortality in low- and middle-income countries. To better understand the relationship between free (Bf) and total (TB) bilirubin levels and the development of ABE and KSD we followed infants born in three large tertiary centers in northern and central Nigeria (Jos, Kano and Zaria).

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  Weighted Pathway Genetic Load Analysis of Hyperbilirubinemic Infants Indicates a Potential Genetic Component for Susceptibility to Bilirubin Neurotoxicity

  Sean M. Riordan, Jean-Baptiste LePichon, Steven Shapiro, John Cowden, Monica VillaGullen, Laurence Thielemans, Dina Villanueva Garcia, and Jesus Aguirre-Hernandez

  Severe kernicterus spectrum disorder (KSD) is described as motor and auditory deficits resulting from brain damage caused by hyperbilirubinemia. The severity of HB does not always predict the severity of injury. The lack of a strong monogenetic link to susceptibility suggests bilirubin-induced brain damage may be due to impaired bilirubin response pathways. This poster describes work to use a modified pathway genetic load (mPGL) score method to perform a targeted genetic analysis of whole exome data from patients with various degrees of neonatal HB, with an ultimate goal of developing a neonatal screen to susceptibiltiy to bilirubin neurotoxicity.

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  Developing Technologically Advanced Research in Low- and Middle-Income Countries

  Isa Abdulkadir, Tina Slusher, Fidelia Bode-Thomas, Sean Riordan, Jean-Baptiste LePichon, Laila Hassan, Shehu Abdullahi, Akinyemi Ofakunrin, Stephen Oguche, Steven Shapiro, and William Ogala

  This poster presents a collaboration between a group of scientists in Nigeria and the USA in developing a genomic research project and the solutions adopted in tackling the ethical implications and partnership equity and ownership of such a project.

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  Identifying Structural Factors Associated with Central Line-Associated Bloodstream Infections (CLABSI) Risk in a Single-Center Pediatric Academic Hospital

  Elizabeth Monsees, Paul N. Bauer, Yolanda Ballam, and Brian R. Lee

  Objective: compare unit structure and process-related factors against unit-specific CLABSI rate.

  Conclusion: CLABSI mitigation requires more than individual competence with task-related practices; the unique work ecology of each clinical area may broadly influence CLABSI as an outcome; extending analyses to consider organizational structure can inform resource allocation and recalibrate traditional prevention strategies.

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  Sepsis: Triage Triggers, Outcomes Quicker

  Rylee Ainge, Mackenzie Flaws, Natalie Heim, Emily Herndon, Hayley Norris, and Amy L. Scott

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  Analgesia and Sedation Medication Use in Infants with Congenital Diaphragmatic Hernia is Associated with Adverse Outcome

  Mark Weems, Theresa Grover, Robert DiGeronimo, Jason Gien, Ruth Seabrook, Sarah Keene, Natalie Rintoul, Beverly Brozanski, John Daniel, Rachel Chapman, Burhan Mahmood, Yvette Johnson, Yigit Guner, Holly Hedrick, Isabella Zaniletti, and Karna Murthy

  This study describes the use and variation of sedation and analgesic medications as well as short-term clinical outcomes in infants with congenital diaphragmatic hernia.

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  Association of Food Deserts and Pediatric Hospitalization Rates

  Laura Plencner, Matthew Hall, Molly Krager, Henry T. Puls, Jessica L. Markham, Ellen Kerns, and Jessica L. Bettenhausen

  Retrospective cross-sectional study describes differences in hospitalization rates for children based upon their residence within a food desert and describes any differences among reasons for hospitalization.

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  Burnout and Resilience Among Pediatric Residents in Stockholm, Sweden: Findings from a Mixed-Methods Study

  Lauren Poull, Sanaz Skyttner-Rahmani, Andrea P. Anderson, Weston T. Powell, Jiaqi Yin, Carolyn C. Foster, and Maneesh Batra

  Objective

   To measure the prevalence of burnout among pediatric residents at Karolinska University Hospital (KUH).
   To describe the local drivers of burnout and the protective factors that lead to resilience and workplace engagement.

  Conclusions

   Prevalence of burnout among Swedish pediatric residents in this study was 39%, which is lower than reported in the US (50-60%).
   Drivers of burnout were identified across all four domains. They included local features of the learning environment, and many are modifiable.
   Protective factors include perceived control over scheduling, better mental and physical health, lower perceived stress, and being a parent.
   Future work will evaluate interventions designed to modify the drivers of burnout and reinforce the drivers of resilience.

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  Chenla Children's Healthcare in Kratie, Cambodia

  Clayton Mowrer

  Describes a global health learning experience in Kratie, Cambodia.

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  Choosing Catheter Sheath Introducers in Infants-Information You Are Not Provided but Should Have!

  Christopher Mathis, Ryan Romans, and Abhay Divekar

  Background: The advertised catheter sheath introducer (CSI) size, the internal diameter (ID), defines the maximum size of medical devices that can pass through it. However, the outer diameter (OD) determines the risk of vascular injury, varies considerably between manufacturers, and is not advertised. The highest risk of vascular injury is in infants less than one year of age and 3 - 6Fr CSIs are typically used.

  Methods: The OD of 3, 3.3, 4, 5, and 6F CSIs (5 of each size) from different manufacturers were measured using a Mitutoyo Digital Micrometer. CSIs were measured with the dilator in place. Three authors measured the OD at the mid- and proximal portions (3 readings at each site) and were blinded to the other authors’ measurements. Continuous variables are reported as mean ± SD. Mid and proximal measurements were compared using an independent samples T test. Cronbach’s alpha and Intraclass Correlation Coefficient were used to measure the agreement for measurements between authors. Significance was set at P < .05.

  Results: Based on our study there are significant differences in the OD of CSIs among manufacturers, and these are not advertised. There was no difference in the diameter of the CSI at the mid-point or proximally (P < .05). The intra-rater and inter-rater reliability were excellent (Cronbach’s Alpha 1.0 and Intraclass correlation coefficient 1.0). CSIs developed for transradial catheterization had the smallest OD when compared to traditional CSI (1F, 0.33 mm smaller). The OD of CSIs by Terumo Interventional Systems were on average 0.5F (0.17 mm) smaller than those from other manufacturers. The OD of the 4F transradial CSI by Merit Medical (Prelude IDeal, 1.610 ± 0.006 mm) is essentially the same as the OD of the 3F Elite HV Braun Interventional Systems (1.644 ± 0.016 mm), 3.3Fr PediaVascular (1.635 ± 0.005 mm) CSIs.

  Conclusions: A smaller CSI does not guarantee a smaller OD. The OD of the 4F transradial CSI is the same as the OD of the 3Fr and 3.3Fr CSI. The “smaller” CSIs also require use of specially designed 3F catheters and 0.030-inch guidewire. On the other hand, the 4F CSI has the same OD but offers access to a wider assortment of well-established, commonly stocked, and cheaper 4F diagnostic and interventional tools. This is achieved without increasing the risk of vascular injury and may also help reduce catheterization laboratory inventory in the era of cost containment.

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  Creating Staff Engagement in Transition Planning Through the Use of Data

  Teresa Hickam and Michelle Bozarth

  In 2017 the Children's Mercy Kansas City Transition Program provided 14 Divisions and 28 programs with data to support their hard work. 2,160 of 3,768 patients (61%) completed readiness assessments and held transition-related discussions with their health care team.

  Data reports providing timely, routine feedback on staff success and missed opportunities helps keep staff engaged, their efforts visible and transition planning on a conscious level.

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  Determining the Instructional Effectiveness of an Online Resident Vaccine Curriculum

  S. Elizabeth Williams, Shannon Clark, Barbara A. Pahud, Sharon Humiston, Donald Middleton, and Kadriye O. Lewis

  We developed four online modules through the Collaboration for Vaccine Education and Research (CoVER) project. The objective of this qualitative study is to determine the instructional effectiveness of the CoVER curriculum from the perspectives of medical residents.

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  Examining Nurse Resiliency & a Mindfulness-Based Stress Reduction Intervention to Prevent Nurse Burnout

  Allegra Grannell

  Nurses continually give of themselves at work, as well as outside of work. This results in extensive stress, physiological distress, and ultimately burnout for individuals in the nursing profession. Nurses that work in high-stress environments, such as critical care, pediatrics, and oncology, are at a significantly increased risk of manifesting physical and psychological symptoms of burnout syndrome, compassion fatigue, and post-traumatic stress disorder (PTSD). Many of these factors are leading to nurses leaving the profession prematurely, resulting in significantly high turnover rates. High burnout and turnover rates of nurses result in the lack of adequate nursing staff in hospitals, which in turn results in the inadequate ability to provide safe and effective care to patients. Resilience is a topic that has gained much discussion in recent years surrounding the significant burdens nurses are experiencing. Nurses with resilience exhibit a heightened awareness, internal stability, and flexibility that allow them to navigate high-stress situations. The goal of resilience training and education is to enable nurses to respond to clinically challenging situations in ways that will protect them against detrimental consequences. Mindfulness based stress reduction (MBSR) has gained significant headway in recent years as a valuable, evidence based intervention to increase resiliency in nurses, improve job satisfaction, and reduce burnout. The purpose of this quality improvement project was to implement a MBSR course for nursing staff to improve nurse resiliency in a mid-western freestanding Children’s hospital. This project examined nurse resiliency pre-intervention, and post-intervention utilizing the Connor-Davidson Resilience Scale, as well as compassion fatigue, compassion satisfaction, burnout, and secondary traumatic stress pre-intervention, and post-intervention using the Professional Quality of Life scale. Results of the project indicate that resilience scores improved, at a statistically significant level, from pre-intervention to post-intervention.

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  Gastroenterology Elective in the Philippines

  Katie Black and Jennifer Watts

  Recounts learning experiences while working at the Philippines Children's Medical Center in Manila.

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  General Philippine Hospital, Manila, Philippines

  Cara Cecil

  Describes her experience working in the Philippine General Hospital/University of the Philippines providing care in the pediatric ICU, neonatal ICU, and emergency department.

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  Global Health Elective in Rural Guatemala

  Kendall Burns

  Describes pediatric resident's experience learning to translate evidence based medicine to resource-limited areas in rural Guatemala.

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  Global Health Elective in San Pedro La Laguna, Guatemala

  Page Pomo

  Future outpatient general pediatrician serving bilingual populations describes working in rural Guatemala and opportunities to practice Spanish language skills.

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  Global Health Elective, Philippine Children's Medical Center

  Keith J. Martin

  Describes a global health learning experience working in the Philippine Children's Medical Center in Quezon City, Metro Manila, Philippines.

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  Global Health Elective: Santo Domingo, Dominican Republic

  Joan Strong

  Describes the experiences of a pediatric anesthesiology fellow's time working Medical Aid for Children of Latin America (MACLA) in Santo Domingo, Dominican Republic.

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  Global Health Elective: Trujillo, Peru

  Naseem Nikaeen

  Describes pediatric resident's learning experiences to provide better medical care in low resource environments.

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  Global Health Experience in Botswana

  Sarah Bieser

  Describes experience providing care at the Botswana-Baylor Children's Center of Excellence in Gabarone, Botswana and the Princess Marina Hospital.

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  Global Health Experience in Botswana

  Jared Willard

  Describes a global health learning experience at the Botswana Baylor Center of Excellence with emphasis on treating pediatric HIV/AIDS patients.