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  Can Mentoring Improve Professional Skills for Mentors and Mentees?

  Emilie Keeton, MSOD; Myles Chandler; Eric T. Rush; Susan B. Hathaway; and Jacqueline Hill

  Introduction/Background: We implemented a structured 10-month mentoring program at our pediatric academic hospital designed to assist faculty in actualizing professional and personal goals through developing trusted, mutually rewarding relationships. Goals/Hypothesis: To evaluate if faculty participants in the 2 inaugural mentoring program cohorts improve scores on 6 behavioral competencies related to maintaining effective communication, aligning expectations, assessing understanding, addressing diversity, fostering independence, and promoting professional development. Methods/Approach We used pre- and post-program Mentoring Competency Assessments to assess changes in 26 skills across 6 competencies and gather feedback on program elements from participants. Results/Outcomes: 19/35 (54%) mentees and 15/29 (52%) mentors completed both assessments. 20/26 rated skills across 6 competencies significantly increased for mentees (p < 0.05), while 4/26 rated skills across 6 competencies significantly improved for mentors. Overall, 89% of mentors and 87% of mentees agreed the program was worth their time to participate. Conclusion/Impact: Program was successful in helping mentees improve most skills across all 6 competencies, whereas mentors saw minimal improvement in skills. Both mentors and mentees reported the program helped them build professional relationships and was worth their time to participate. Future efforts will focus on obtaining assessments and enrolling more participants.

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  Clinical and Non-Clinical Factors Associated with Early Discharge in Pediatric Non-Trauma Patients Transported by Rotor Wing

  Jordon Mitzelfelt, Lisa Pruitt, Amy Papa, Ashley K. Sherman, David Juang, Sarah Brunner, Asdis Finnsdottir Wagner, and Jennifer Flint

  Objective: Helicopter emergency medical services (HEMS) are crucial for transporting critically ill children to definitive care, however, rising costs and relative risks of this type of transportation necessitate careful evaluation of potential over-utilization. Current literature primarily focuses on pediatric trauma patients, leaving a significant gap in data regarding non-trauma pediatric HEMS transports and the influence of non-clinical factors such as referral hospital distance, resources, and capabilities on transport decisions. This study aims to address these gaps by examining non-trauma pediatric HEMS patients and identifying associated clinical and non-clinical factors related to early hospital discharge (< 24 hours). Methods: This retrospective, single-center study includes pediatric patients with medical and non-trauma surgical diagnoses transported by HEMS between April 1, 2021 and March 31, 2024. Clinical data were extracted from transport team records and the hospital’s electronic health records. Analyses were performed to identify factors associated with discharge within 24 hours of admission. To identify predictors of early discharge, we analyzed clinical factors including chief complaint, pre-transport vascular access, transport crew interventions (medication administration and procedures), respiratory assistance, and Pediatric Age-Adjusted Shock Index (SIPA) scores. Additionally, we examined the impact of the initial admit unit, and medical support required within the first 24 hours of hospitalization. Non-clinical predictors included the referring hospital’s status (critical access and/or rural designation) and the time of transport. Results: A total of 568 patients were transported by HEMS, of whom 88 (15%) were discharged within 24 hours. Patients in the early discharge group were more likely to present with neurologic chief complaints (40%), whereas those remaining hospitalized beyond 24 hours more frequently presented with respiratory complaints (40%). Normal SIPA scores both prior to and at the conclusion of transport were significantly associated with early discharge (p=0.012 and p=0.011, respectively). Furthermore, patients requiring no medications or respiratory assistance during transport, or no respiratory support within the first 24 hours of admission, were significantly more likely to be discharged early (p< 0.001). Notably, all patients with central access prior to transport remained admitted for more than 24 hours (p=0.004). Regarding non-clinical factors, patients transported from designated rural hospitals were more likely to experience early discharge (p< 0.001). Conclusion: These results characterize the pediatric non-trauma HEMS population and identify key predictors of early hospital discharge. This data is essential for developing standardized dispatch criteria to mitigate over-utilization and ensure high-acuity transport is reserved for the most appropriate patients.

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  Does Variation in Systemic Steroid Use Impact Outcomes in Preschoolers Hospitalized with Viral Respiratory Tract Infection?

  Smit Shah, Kathryn Kyler, Matt Hall, and Jessica Markham

  Background: Systemic corticosteroids (SCS) are a cornerstone of treatment for acute asthma exacerbation. However, the role of SCS in preschool-aged children hospitalized with viral respiratory tract infection (vRTI), including viral induced wheezing, remains uncertain. Clinical trials have reported conflicting results about the benefits of SCS in this population. Objectives: To evaluate hospital-level variation in inpatient management of preschool-aged children admitted with vRTI and to compare clinical and utilization outcomes based on hospital-level SCS use. Methods: We conducted a retrospective cohort study of children aged 24-59 months admitted to US children’s hospitals with vRTI from July 2022-July 2024 using the Pediatric Health Information System. We excluded encounters with complex chronic conditions, intensive care unit stays, bacterial RTIs (e.g., pneumonia, pertussis) and vRTI treated with SCS (e.g., croup, COVID-19). We calculated hospital-level proportion of encounters receiving SCS (including methylprednisolone, prednisone, prednisolone, dexamethasone), albuterol on ≥1 day, and inhaled corticosteroids (ICS). We grouped hospitals into quartiles based on the proportion of encounters receiving SCS. Generalized estimating equations were used to compare length of stay (LOS), ED revisits, readmissions, and costs between low SCS (1st quartile) and high SCS (4th quartile) hospitals, adjusting for age, sex, payor, illness severity, and asthma diagnosis. Results: We identified 44,848 vRTI encounters across 46 hospitals; 42.4% had an asthma diagnosis. On average, 55% of encounters received SCS (range: 39%-60%), 32.2% received ≥1 day of albuterol (range: 7%-56%), and 19.3% received ICS (range: 3%-37%) (Fig. 1). A positive correlation existed between hospital-level proportion of encounters receiving ≥1 day albuterol and hospital-level SCS use (Pearson’s r =0.52, p< 0.001) (Fig. 2). In unadjusted analyses, only 7-day revisit rates differed between low SCS hospitals (revisit rate=2.0%) and high SCS hospitals (revisit rate 1.6; p=0.014). In adjusted analyses, hospitals with low and high SCS use had similar LOS, ED revisits, readmissions, and costs (Table 1). Conclusions: Substantial hospital-level variation exists in use of SCS and albuterol among preschool-aged children hospitalized for vRTI. Hospitals with higher SCS use had similar outcomes compared to those with lower use. Our findings suggest potential overuse of SCS and highlight the need for more evidence to guide appropriate SCS use in preschool aged vRTI.

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  Forecasting the Consequences of Collapse in Infection Prevention and Control: A Premortem Analysis Using the Socioecological Model

  Stephanie Stroever, Elizabeth Monsees, Lisa Hall, Monika Pogorzelska-Maziarz, Shelley E. Kon, and Heather Gilmartin

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  Health Disparities for Pneumonia and Sinusitis Antibiotic Treatment in the Emergency Department

  Joshua Saucedo, Leslie Hueschen, Amanda Nedved, and Rana El Feghaly MD

  Optimal antibiotic selection and duration are pillars of antimicrobial stewardship efforts. In our emergency department (ED), >80% of community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS) are treated with first-line (FL) guideline-concordant antibiotics. Differences in care based on socioeconomic factors (race, ethnicity, language, and insurance status) have not been characterized. We sought to compare differences in antibiotic choice and duration for different socioeconomic factors, and analyze changes after quality improvement (QI) efforts. Multidisciplinary QI team used multiple Plan- Do-Study-Act cycles and was successful in improving antibiotic duration for CAP and ABRS from a baseline of 13% to 61% (January 2024- July 2025). We evaluated antibiotic choice and duration for 2,943 encounters in relation to socioeconomic variables and compared the 17-month pre-intervention period (August 2022-December 2023) to the 19-month post-intervention period. Chi square test used to evaluate the differences using IBM SPSS software. Pre-intervention: Median of 45 visits per month, interquartile range (IQR): 39,63, Post-intervention: Median of 82 visits per month, IQR: 70,118. No statistically significant differences in the pre-intervention FL antibiotic choice between: Races: Black 85.6% vs White 79.5%, p = 0.063, Ethnicities: Hispanic 82.8% vs non-Hispanic 81.1%, p = 0.552, Insurances: Medicaid 83.1% vs Private 79.7%, p = 0.211, Languages: Spanish 82.3% vs English 81.5%, p=0.84.Disproportionate improvement in FL selection in the post-intervention period with widening of the gap for: Race: Black 89.5% vs White 79.2%, p < 0.001, Ethnicity: Hispanic 88.4% vs non- Hispanic 83.1%, p = 0.004, Insurance: Medicaid 85.3% vs Private 81.2%, p = 0.024. Substantial improvement in duration post- intervention. No statistically significant differences between the different sociodemographic categories with optimal duration in pre- or post-intervention periods. White, non-Hispanic, and privately insured patients had lower rates of FL therapy and saw less improvement after interventions compared to Black, Hispanic, and patients with Medicaid insurance. Our QI efforts, focused on improving duration, resulted in similar improvement across socioeconomic groups, with no substantial differences between groups. Further studies to understand and address the underlying factors creating inequities are essential. We recommend interrogating current, ongoing QI project data for inadvertent worsening of differences in patient care management

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  Impact of nurse-driven de-isolation process on isolation precautions duration at a Pediatric Hospital

  Christelle Ilboudo, Kathlyn Baharaeen, Jenny Heltzer, and Elizabeth Monsees

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  Initial Results of a Structured Coaching Program for Academic Promotion Preparation

  Jacqueline Hill, Christine Sullivan, Tyler Smith, Margaret Gibson, Valerica Mateescu, and Wendell K. Clarkston

  Introduction: Applying for academic promotion can be a confusing and arduous process, often with little guidance to assure a successful experience, especially for junior faculty located at affiliate hospitals. Goals: We present initial results of a structured university mentorship program to prepare faculty to apply for academic promotion. Methods: Program was designed as a small working group of 5 structured sessions over a 9-month period where participants were coached by senior faculty from 3 university affiliate hospitals. Program culminated in the completion of an academic promotion application. Results: Since launch in 2019, we have completed 4 program cohorts and paused 2 cohorts due to the pandemic. 23 of 29 (79%) enrolled faculty successfully completed the program. Majority (24, 83%) were applying for Associate Professor. Of faculty who completed the program, 13 (57%) have successfully achieved promotion, 6 (26%) have applications currently under review, and 4 (17%) have not yet applied. Conclusion: Program was successful in coaching faculty to prepare applications for academic promotion. Through mentor feedback, some participants determined they did not yet have all necessary activities to successfully apply for promotion and instead created a plan to first bolster scholarly accomplishments. Our results suggest that investing in structured coaching sessions is a valuable strategy to increase the likelihood of faculty successfully achieving promotion.

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  Navigating Academic Promotion: Identifying the Winning Combination for Volunteer Faculty

  Enam Haddad, Jacqueline Hill, Sarah Tsai, Ruba A. Abdelhadi, Sarah Braet, and Eric T. Rush

  Introduction/Background: Academic promotion is an arduous and time-consuming process. Implementation of support resources is essential for faculty success. Supporting faculty through the process, we developed multiple promotion resources, including a robust online resource catalogue, peer coaching sessions, and detailed weekly email reminders. Goals/Hypothesis: To examine which resources faculty find most helpful in preparing their academic promotion application. Methods/Approach: We surveyed promotion applicants from 6 cycles (2020-2025). Faculty rated the usefulness of promotion resources, how prepared they felt at different points in the promotion timeline, and provided feedback about the overall promotion preparation process. Results/Outcomes: 258/354 (73%) applicants responded to the survey. Respondents agreed or strongly agreed that the following resources were most helpful: promotion strategy meetings with faculty development director (93%), conversations with promotion committee reviewer (93%), conversations with faculty leaders (90%), and weekly promotion communications (90%). 94% of respondents reported feeling prepared for initial application submission for promotion committee review and 96% felt prepared for the final submission to university. Conclusion/Impact: Majority of faculty applicants value promotion conversations with multiple faculty and promotion process leaders and weekly outlined communications as they navigate the academic promotion process.

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  Neonatal Outcomes Associated with Maternal SSRI Use throughout the COVID Pandemic

  Carlie G. Gatlin, Megan Tucker, Angela Bolton, Mary Anne Kucera, Deanna McPherson, Kerry Kohrs, Staci S. Elliott, Hung-Wen Yeh, and Venkatesh Sampath

  Background: Maternal antenatal selective serotonin reuptake inhibitor (SSRI) use has been suggested as a risk factor for neonatal complications, though evidence remains inconclusive. Mental health conditions increased during the COVID-19 pandemic, raising questions about SSRI prescription trends. This study examines associations between maternal SSRI use and neonatal outcomes across three time periods: before, during, and after the pandemic. Objectives: Primary: Determine if SSRI use in pregnancy is associated with NICU admission, respiratory support, hospital stay length, hypoglycemia, formula feeding, and/or delivery room resuscitation. Secondary: Assess SSRI prescription prevalence across pandemic phases. Methods: Retrospective chart review of term maternal-infant dyads born in Jan/June during each of the years of 2019–2022 in a level III NICU. Data included maternal demographics, SSRI use, comorbidities, and neonatal outcomes. Exclusions: congenital anomalies, multiple gestations, and preterm birth < 37 weeks. N=1,246. Categorical variables were compared using Chi-squared or Fisher’s exact test; continuous variables via Wilcoxon or Kruskal-Wallis tests. Regression models adjusted for COVID phase and covariates. Missing data (>5%) were imputed using MICE and random forest, with pooled results via Rubin’s rule. Results: Maternal SSRI use rates did not differ significantly across the 3 time periods (pre-Covid 54/572 9.5% vs. during Covid 31/338 9.3% vs. post-Covid 36/336 11%) (Table 1). SSRI use was highest among those with pre-pregnancy use (p=< 0.001), and white mothers (White 108/890 12% vs. Non-white 13/354 3.7 %, p= < 0.001) (Table 2). Infants exposed to SSRIs were more likely to require delivery room resuscitation (OR 2.51, 95% CI 1.19-5.26, p= 0.015) (Table 3B). Mothers using SSRIs were more likely to formula or combo feed rather than exclusively breastfeed (OR 2.86, 95% 1.68-4.85, p=0.000) (OR 1.91, 95% 1.05-3.47, p= 0.034) (Table 3F). No significant associations were found between maternal SSRI use and neonatal hypoglycemia, NICU admission, respiratory support, or length of stay (Table 3A,C,D,E). Conclusion: In our study, we did not find an increase in maternal SSRI use during the COVID pandemic. Maternal SSRI use was associated with increased delivery room resuscitation and non-exclusive breastfeeding, but not other adverse neonatal outcomes. These findings highlight the continued concerns of maternal SSRI use on neonatal outcomes, and advocate for careful consideration and discussion of its benefits vs. risks in pregnant mothers as expressed by recent FDA and ACOG statements.

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  Reducing Waste and Cost by Utilizing Tap Water for Laceration Irrigation in the Emergency Department: A Quality Improvement Approach

  Alison L. Fowler; Rohan Akhouri; Josaih Galdean; Isabella Dunt; Christopher Kaberline; Viktoriya Stoycheva MHA, RN, CPN; Sarah Nienhaus; and Leslie Hueschen

  Purpose/Objective: Lacerations requiring closure make up 8 million emergency department (ED) visits annually. Irrigating prior to closure with potable tap water decreases cost and waste without increasing rates of infection compared to sterile fluids. Currently, only 3.5% of lacerations closed in our ED are irrigated with tap water. This project aims to increase the percent age of lacerations closed by ED providers irrigated with tap water from 3.5% to 60% by March 2026 in a freestanding pediatric emergency department across two sites (ED 1, ED 2). Design/Methods: A multidisciplinary team (physicians, nurses, QI consultant, parent advisors) formed in November 2024. Using driver diagram, fishbone, and PICK charts, interventions were identified and implemented in Plan-Do-Study-Act (PDSA) cycles (Table 1). The outcome measure was percentage of lacerations irrigated with tap water. Process measures were the number of sterile fluid bottles ordered for ED 2, order set usage, and rate of irrigation by nurses. The balancing measure was the rate of return visits for infection within 3 days. Fifty randomized charts were reviewed monthly. IRB deemed this study QI, not human subjects research. Results: Of 3,288 eligible encounters, 985 were randomized and included. Tap water irrigation increased from 3.5% to 64.6% (Fig 1). The average number of sterile bottles ordered monthly for ED 2 decreased from 102 to 16, representing a monthly savings of at least $430 and a reduction in plastic waste by at least 9 kg per month, reducing carbon emissions equivalent to 26 miles driven in a gas-powered car. There were no differences in irrigation by nurses or order set usage. There were no return visits for infection. Conclusion/Discussion: Altering the environment by removing sterile irrigation supplies from quick access locations was the most impactful intervention, allowing the team to meet their goal of increased tap water irrigation and decreased cost and waste. Future interventions include patient/family education and a new clinical pathway for lacerations. Limitations include inability to update order sets and limited monitoring of return visits. With the success of this project, the team plans to expand tap water irrigation to urgent care and subspecialist laceration repairs.

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  Structure and Leadership of Antibiotic Stewardship Programs in post-acute care: Findings from the APIC MegaSurvey 2025

  Lisa Hall, Sara Reese, Elizabeth Monsees, Ann L. Wirtz, and Monika Pogorzelska-Maziarz

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  Structure and Leadership of Inpatient Antibiotic Stewardship Programs: Findings from the APIC MegaSurvey 2025

  Elizabeth Monsees, Sara Reese, Lisa Hall, Ann L. Wirtz, and Monika Pogorzelska-Maziarz

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  Structure and Leadership of Outpatient Antibiotic Stewardship Programs: Findings from the APIC MegaSurvey 2025

  Elizabeth Monsees, Sara Reese, Lisa Hall, Ann L. Wirtz, and Monika Pogorzelska-Maziarz

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  Structure, Staffing, and Strain: Lessons from U.S. Infection Preventionists on Building Resilient Systems Post–COVID-19

  Anika Patel, Tara Schmidt, Elizabeth Monsees, Terri Rebmann, Patricia W. Stone, Pamela de Cordova, and Monika Pogorzelska-Maziarz

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  Variation in dexamethasone prescribing practices for pediatric asthma exacerbations in acute care settings

  Hannah Reilly, Natalie J. Kane, Sian Best, Mark A. Hoffman, and Kathryn Kyler

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  Clinical validation of targeted somatic structural variant detection in pediatric cancer via long-read sequencing

  Aravindh Nagarajan, Byunggil Yoo, Emily Farrow, John Herriges, Lei Zhang, Elena Repnikova, Tomi Pastinen, Carol J. Saunders, Midhat Farooqi, and Lisa Lansdon

  Introduction: Structural variants (SVs) leading to gene fusions are one of the most common classes of driver mutations in pediatric cancer. Clinical SV detection relies on a combination of techniques including karyotyping, FISH, microarray and RNA fusion testing, and, more recently, optical genome mapping. SV detection via long-read genome sequencing (lr-GS) offers the advantage of breakpoint and complex event resolution; however, its implementation has been limited by the lack of an optimized somatic SV caller, among other factors. Here we describe the clinical validation of lr-GS for targeted somatic SV detection in pediatric cancer using Severus, a newly available somatic SV caller for lr-GS. Methods: DNA was isolated from fresh or fresh frozen samples from 34 pediatric cancers (26 heme and 8 solid) previously tested clinically for SVs, 28 of which were positive for clinically relevant (i.e., oncogenic) SVs (crSVs) expected to result in a gene fusion. The estimated tumor content for these cases, per pathology review, was 25-98%. Briefly, libraries were prepared using PacBio’s SMRTbell Prep Kit 3.0, and Revio sequencing was performed to an average depth of 30x. Reads were aligned to GRCh38 and processed with Severus v1.6.0 in ‘tumor-only’ mode. Data filtering parameters included a pediatric crSV gene-focused panel , a minimum supporting read count of 4, and the location of the breakpoint relative to the nearest gene. All crSVs detected by Severus were inspected in IGV and compared with orthogonal clinical results for each patient. To establish the assay’s limit of detection, DNA from a neoplastic sample with a crSV was diluted at different ratios with DNA from the same patient’s germline sample. Assay precision was assessed by sequencing the same sample with a crSV across two different runs performed on different days. All resulting data was analyzed as above. Results: Severus detected 25 out of 25 crSV-positive cases that were above the limit of detection established for this assay (30% tumor); the results were concordant with prior laboratory testing, leading to an accuracy of 100%. In some cases, the breakpoint resolution offered by lr-GS identified additional rearrangement complexity that helped clarify orthogonal test results. Across the 34 samples (28 positive + 6 negative), no false positive SVs were identified, yielding an analytical specificity of 100%. In the dilution sample (84% tumor), the SV remained detectable down to an ∼13% observed VAF, leading to a conservative reporting cutoff at ~15% VAF (supportive of the 30% tumor minimum requirement). The assay demonstrated 100% precision, as a re-sequenced sample processed with different technologists, reagent lots, and SMRT cell detected the expected crSV consistently across both runs. Conclusion: Reliable detection of crSVs is crucial for supporting or refining diagnoses, predicting the prognosis, and determining effective treatment strategies for pediatric cancer. The validation performance characteristics presented here demonstrate that Severus can be successfully implemented in clinical settings for effective targeted crSV detection. This approach also enables precise breakpoint resolution for improved interpretation of complex or cryptic crSV events, with the potential to expand from a targeted assay to a genome-wide SV assessment tool. Furthermore, lr-GS offers the benefits of SNV and methylation information that, although not explored in the present study, hold great future potential for additional profiling of these samples from a single data source.

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  Lessons learned: Targeted RNA sequencing as a tool for resolving variants of uncertain significance

  Allison Kalinousky, Vitoria Paolillo, Florencia Del Viso, Elena Repnikova, Ana S A Cohen, Joseph Alaimo, Emily Farrow, Carol J. Saunders, and Isabelle Thiffault

  Our study demonstrated the utility of RNA studies in providing sufficient evidence to reinterpret VUS in a small cohort of clinically diverse pediatric patients who received ES/GS-based testing. Fifteen patients (68%) received an updated clinical report. Notably, in 59% the RNAseq data resulted in a molecular diagnosis. Moreover, ~47% of our positive variants were not located at splicing junctions, and therefore, would most likely not be flagged as a likely candidate in ES/GS analysis pipelines. While most variants with low TPM in blood failed, two positive variants had TPM less than 0.1, indicating that while TPM values can help narrow down which variants could be reflexed to targeted RNAseq, these values and in silico splicing predictions have significant limitations. As the cost of sequencing continues to decrease, findings of this diagnostic study demonstrate that the ability to perform targeted RNAseq concurrently with DNA sequencing represents an important advancement in genetic testing by improving classification of variants, therefore, improving the diagnostic yield.

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  Prospective Validation Of Selective Serotonin Reuptake Inhibitor Pharmacokinetic Models For Precision Dosing In Children And Adolescents

  Ethan A. Poweleit; Whitney Sparks MS; Catherine Koertje; Addison Pritchett MS; Gail Robertson; Lindsey Malloy-Walton; Stephani Stancil; Jeffrey R. Strawn; Alexa L. Pagano; Kathryn Kyler; Jonathan B. Wagner; Brandon Retke; Paul C. Toren; J Steven Leeder PharmD, PhD; and Laura B. Ramsey

  Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to children and adolescents with anxiety and depression. However, their clinical use is complicated by marked interindividual variability in exposure, which contributes to differences in treatment response and side effects. Further, SSRIs are commonly dosed using a trial-and-error approach. Model-informed precision dosing could improve treatment outcomes, yet existing SSRI population pharmacokinetic (PK) models have not been prospectively validated and may not generalize to pediatric patients. This study aims to evaluate how accurately these models predict exposure for three SSRIs—escitalopram (ESC), sertraline (SRT), and fluoxetine (FLX)—and refine them to develop tools for dose individualization. Methods: This is an open-label prospective study with dense PK sampling in participants (6-18 years old) prescribed ESC, SRT, or FLX at steady state. Following two weeks of adherence monitoring, participants complete a 24-hour PK study visit where ≤18 blood samples are collected across the dosing interval to measure SSRI plasma concentrations by liquid chromatography mass spectrometry. Published models are implemented into NONMEM to generate individual predicted concentrations from observed trough concentrations to mimic therapeutic drug monitoring. The models are considered validated if the mean ratios of predicted-to-observed Cmax, AUC24, and clearance were within 0.8-1.25. Results: A total of 8 ESC, 8 SRT, and 3 FLX/norfluoxetine (NFLX) models were included for validation. There were 4 ESC, 2 SRT, and 11 FLX/NFLX participants with measured concentrations from interim analysis. Model validation showed 5/8 (63%) of ESC, 0/8 of SRT, and 1/3 (33%) FLX/NFLX models (both parent and metabolite) met full acceptance criteria for all three endpoints, with some models meeting partial acceptance criteria (Figure). Conclusions: Prospective external validation shows several models met the a priori validation criteria for the ESC and FLX/NFLX cohorts. Additional participants in each drug cohort are needed to verify the models are fit for purpose. These findings provide a foundation for future model refinement and suggest that model-informed precision dosing could reduce trial-and-error prescribing and improve SSRI tolerability and efficacy in youth.

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  Asthma Phenotypes and Control in 22q11.2 Deletion Syndrome: A Single-Center Retrospective Study

  Cody Shopper, Katey Campbell, and Nikita S. Raje

  Background: Patients with 22q11.2 deletion syndrome have increased rates of atopy and immune dysregulation and may experience a higher burden of asthma; however, real-world data describing asthma control, severity, and treatment patterns in this population are limited. We hypothesized that asthma control and severity patterns in patients with 22q11.2 deletion syndrome differ from those observed in the general asthma population. Objectives/Goal: To characterize asthma control, severity, and treatment patterns among patients with 22q11.2 deletion syndrome and to compare observed patterns with those typically reported in the general asthma population. Methods/Design: We conducted a retrospective observational cohort study of patients with 22q11.2 deletion syndrome and a provider-diagnosed history of asthma at a single tertiary care center. Data was extracted from electronic medical records and included demographics, asthma severity classification, Asthma Control Test (ACT) scores, oral corticosteroid (OCS) use, inhaled controller therapies, comorbid pulmonary conditions, hospitalizations, biologic therapy use, and asthma-related mortality. The primary outcome was asthma control, defined as a mean ACT score < 20 and/or receipt of two or more OCS courses in the preceding 12 months. When available, the three most recent ACT scores were averaged from the most recent assessment. Results: Of our 512 patient cohort, 92 patients (18%) with 22q11.2 deletion syndrome were diagnosed with asthma. Overall, 20% met criteria for uncontrolled asthma at their most recent evaluation. Among the cohort, 23% had moderate or severe persistent asthma. Eight percent required two or more courses of oral corticosteroids in the prior 12 months. ACT scores were available for 50% of patients; among those with documented ACT data, 28.3% had a mean ACT score < 20. Patients were more frequently treated with medium-dose inhaled corticosteroids alone (n=24) compared with combination inhaled corticosteroid–long-acting beta agonist (ICS–LABA) therapy (n=12). No patients received biologic therapy, and there were no asthma-related deaths. Conclusions: In this single-center cohort of patients with 22q11.2 deletion syndrome, nearly one in five were diagnosed with asthma. Further, one in five individuals with asthma demonstrated uncontrolled disease, and nearly one-quarter had moderate to severe persistent asthma. Despite this, combination ICS–LABA therapy and biologic agents were infrequently utilized. These findings suggest a potential treatment gap and raise important questions regarding asthma phenotype, pulmonary comorbidities, and optimal controller strategies in this population. Future prospective studies incorporating pulmonary function testing, inflammatory biomarkers, and standardized asthma assessments are needed to better characterize disease mechanisms and improve asthma outcomes in patients with 22q11.2 deletion syndrome.

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  Improvements in EEG tracing following initiation of cannabidiol: a case report

  Katherine Horman, Ara Hall, and Kailash Pawar

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  Perioperative anaphylaxis in a healthy adolescent after first lifetime surgery

  Shayan Sazdar and Salman Aljubran

  Introduction: Perioperative anaphylaxis is a rare life-threatening event. Its evaluation poses complex considerations inherent to the use of multiple medications. Patient presentation: A healthy 11-year-old boy developed anaphylaxis shortly after discharge home from first lifetime surgery for orchiopexy. Perioperative medications included rocuronium, propofol, fentanyl, bupivacaine, sugammadex, ondansetron, dexamethasone, dexmedetomidine, and ketorolac. No antibiotics. After surgery, he consumed fast food dinner and ice cream. Within 2 hours after discharge home, he returned to our Emergency Department (ED) with facial and tongue angioedema, hives, and respiratory distress. He received multiple doses of intramuscular epinephrine and briefly required epinephrine drip in the ED. Tryptase was 3.9. He was admitted to the general pediatric service for 24-hour observation. Due to uncertain recall of general tree nut consumption, tree nut panel was obtained which was non-contributory. He had skin prick and intradermal (ID) testing to all suspected medications used intraoperatively except for ketorolac and dexmedetomidine. ID testing was positive for rocuronium, otherwise negative. Since his event, he tolerated ibuprofen, acetaminophen, methylprednisolone and ondansetron. Additionally, he passed in clinic challenge to oral ketorolac. Discussion: In perioperative anaphylaxis, the most common offending agents are antibiotics and neuromuscular blocking agents (NMBAs). With positive intradermal testing, rocuronium is the most suspected agent for this patient and will need to be avoided along with other NMBAs. Challenges to other medications with negative testing were recommended to be done in the operating room. Patient outcomes: This case highlights the importance of careful review of history and appropriate medication skin testing in evaluating perioperative anaphylaxis.

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  Quantitative Echocardiography Markers to Denote Severity of Tricuspid Regurgitation Compared to Cardiac MRI in Single Right Ventricle Variants

  Tony Zunica, Daniel Forsha, Janelle Noel-Macdonnell, and Anmol Goyal

  Background: Single right ventricle and Hypoplastic Left Heart Syndrome (HLHS) are congenital heart diseases that require multiple palliative surgeries to create a single right ventricular system. 25-30% of these patients develop significant tricuspid regurgitation (TR), which is associated with worse outcomes among all stages of palliation. Echocardiography remains the cornerstone imaging modality for serial evaluation in these patients. However, estimating tricuspid regurgitation is highly subjective in the pediatric population, necessitating need for reliable and reproducible quantitative echocardiography markers. Currently, cardiac magnetic resonance (CMR) is considered the gold standard for quantification of tricuspid regurgitation with good accuracy and reproducibility. Objectives/Goal: Our primary aim was to identify quantitative markers of determining TR severity using echocardiography that correlated with CMR between the final two palliative stages. Methods/Design: This was a single-center, retrospective study performed at Children’s Mercy Hospital. Inclusion criteria included patients with single systemic right ventricle with a systemic tricuspid valve who have undergone an echocardiogram within 6 months of their CMR. All other congenital heart diseases were excluded. Patient characteristics included age, sex, body surface area, diagnosis, heart rate with echocardiography and CMR and time between echocardiography and CMR. Multiple echocardiographic variables were recorded including but not limited to Nyquist limit, TR continuous wave doppler density, shape and volume time integral (VTI), vena contract width, jet number, proximal isovelocity surface (PISA) radius, leaflet morphology and right ventricular functional indices. Tricuspid valve regurgitation fraction (TRF) by CMR was recorded and categorized as mild (≤15%) or greater than mild (>15%). Each quantitative echocardiographic variable was correlated with the two groups as estimated by CMR. P value < 0.05 was considered statistically significant. Results: 27 patients met inclusion criteria. Mean age was 3.8 ± 0.7 years. Majority were male (20, 74%) with HLHS being the most common diagnosis (21, 78%). Average heart rate was 89 bpm. Average time between echocardiography and CMR was 31 days (0-112 days). Nyquist limit ranged between 42 to 123 cm/s, with mean of 82.4 cm/s. 20 patients (74%) were characterized as mild based on CMR TRF. Vena contracta width (0.61-0.76 for greater than mild vs 0.17-0.35 for mild, p< 0.001), TR continuous wave VTI (76.8-143.9 for greater than mild vs 15.7-69.3 for mild, p = 0.021) and PISA radius (0.51-0.89 for greater than mild vs 0.21-0.40 for mild, p = 0.006) were statistically significantly higher in the greater than mild category. Calculated indices such as effective regurgitation orifice area and regurgitation volume were statistically significantly higher in greater than mild category (p=0.016 and 0.007, respectively). Conclusions: Although sample size is small, our study highlights echocardiographic markers such as vena contracta width, PISA radius, and associated calculated indices that can potentially be used to better estimate severity of TR in HLHS variants. Future large-scale studies are needed to further evaluate this correlation, which may lead to more objective methods of estimating TR using echocardiography, leading to improved management decisions and outcomes.

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  Current practices of anticoagulant utilization in pediatric patients with acute myeloid leukemia (AML)

  Abbey Elsbernd, N Grills, J Antoon, Kathryn Kyler, L Orth, T Savage, M Hall, Jennifer Goldman, and Shannon Carpenter

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