PHILADELPHIA, April 29, 2019 /PRNewswire/ -- More than 200
experts from Children's Hospital of Philadelphia (CHOP) traveled to Baltimore for this year's Pediatric Academic
Societies Meeting. The gathering brought together thousands of
pediatricians and other health care providers united by a common
mission: to improve the health and well-being of children
worldwide. Presentations covered issues of interest to generalists,
as well as topics critical to many specialty and subspecialty
areas.
CHOP also congratulates Dr. Barbara
Schmidt, former director of clinical research in the
Division of Neonatology at CHOP, for receiving the Douglas K. Richardson Award. This award was
established to honor Dr. Douglas K.
Richardson's contributions to child health services,
perinatal and pediatric research, and the Society for Pediatric
Research, and honors the lifetime achievement of an investigator
who has made substantive contributions in child health.
Specific CHOP presentation highlights included:
Web cameras may help reduce stress for parents with babies in
NICU
As telehealth technologies become increasingly common in
healthcare, new findings show that bedside web camera interventions
could potentially reduce stress in parents with a child
hospitalized in the neonatal intensive care unit (NICU), according
to a study led by Katherine
Guttmann, MD, fellow in Neonatology at CHOP.
Though the potential of telehealth technologies is clear, little
is known about the impact on parent stress levels, particularly in
the NICU, where depression and anxiety levels are generally high.
In this study, a total of 114 parents completed the Parental Stress
Scale survey while their babies were hospitalized at 7 to 10 days
of admission. Of the 48 parents who reported whether or not they
had used a bedside camera, 21 (44%) had used one, and those parents
reported lower levels of stress related to the sights and sounds of
the unit, the appearance of the baby, and their relationship with
the infant and the parental role. These parents also reported
significantly less stress related to being separated from their
babies than those who did not use a camera.
While these findings warrant further study to assess their
impact on other factors such as sleep disturbances and fatigue, the
study team says that units may want to consider web cameras in
order to increase family-centeredness of care.
Infants Exposed to Opiates In Utero More Likely to Use
Health Care
Opiate use by pregnant mothers can result in neonatal abstinence
syndrome (NAS), a group of conditions caused when a baby suffers
withdrawal symptoms from certain drugs that she or he was exposed
to in the womb. Scott A. Lorch, MD,
attending neonatologist at CHOP, and colleagues, studied the
association of exposure to long-term maternal opiates (LTOE) and
NAS on hospital admissions, emergency department visits, and
outpatient provider visits compared with infants without similar
opiate exposure.
Using Medicaid data for 813,334 patients from 19 states, the
study team found that 4.82% of the cohort was diagnosed with LTOE
and 0.5% of infants had NAS. Opiate-exposed infants had higher
rates of hospital admissions by 30 days after discharge, and LTOE
infants had more emergency department visits. In a multivariable
analysis, LTOE infants had higher 30-day readmission risk from any
cause, and this remained elevated through the first year after
being discharged, and both LTOE and NAS infants had more emergency
departments and total visits during that first year after being
discharged. Hospitalizations and emergency department visits for
abuse and neglect were also elevated in both opiate exposed
groups.
Lorch and colleagues suggest careful monitoring and
transitioning the care of these high-risk infants is needed to
minimize their use of health care in the first year of life.
Caregivers Hold Many Inaccurate Beliefs about Influenza
Vaccination
More than 90% of caregivers believe their child would be
protected with only one flu shot, even though many children between
six months and eight years of age need two doses, according to the
findings of a collaborative study involving CHOP, Columbia University Irving Medical Center and the
Pediatric Research in Office Settings Network of the American
Academy of Pediatrics.
The study assessed vaccine hesitancy and influenza disease and
vaccine beliefs among 256 caregivers from across the country of
children who received the first of the two required influenza
vaccine doses.
Even after their child received the first of the two required
influenza vaccine doses, 12% of caregivers reported moderate or
high vaccine hesitancy and held the following inaccurate beliefs:
"flu is just a bad cold" (40%); child will be protected with "only
one flu shot" (94%); "flu shot causes the flu" (57%); and children
cannot "die from the flu" (68%). "These findings emphasize the
importance of promoting the second dose of influenza vaccination
and educating caregivers about influenza disease and vaccination
before and after they agree to the first dose," said study lead
author Ekaterina Nekrasova, MPH,
research assistant at PolicyLab and the Center for Pediatric
Clinical Effectiveness at CHOP.
Practitioners Describe Strategies, Barriers to Improve HPV
Vaccination Coverage
Despite the availability of a safe and effective HPV vaccine
since 2006, coverage rates are lower than coverage for other
adolescent vaccinations, leaving adolescents susceptible to this
cancer- causing virus. Alex Fiks,
MD, MSCE, pediatrician and associate director of CHOP's Center for
Pediatric Clinical Effectiveness (CPCE) and Director of the
American Academy of Pediatrics Pediatric Research in Office
Settings (PROS) network, and colleagues examined the barriers to
HPV vaccination and the strategies used to improve vaccination
rates.
In a sample of 47 pediatric primary care practitioners
(including both pediatricians and nurse practitioners) from 19
states, all reported at least one barrier to HPV vaccination. The
most common barrier reported by practitioners was
parent refusal or delay, cited by more than 80% of those surveyed.
Other major barriers included insufficient time to discuss HPV
vaccination with families, a lower proportion of adolescents coming
in for well visits, lack of training in providing a strong
practitioner recommendation, views of some practitioners that the
HPV vaccination can wait, and challenges associated with
administering the vaccine at acute or chronic care visits.
Approximately 89% of practitioners reported using prompts when
HPV vaccination is needed, and 87% commonly use tools to improve
communication about HPV vaccination with parents and adolescents.
However, only 17% of practitioners used reminder-recall messages
specific to the HPV vaccine. While a wide variety of strategies are
being used, even more can be done to bolster HPV vaccination
coverage.
Implementing an Adult-Like Sepsis Score for Pediatric
Patients Appears Feasible
The Sequential Organ Failure Assessment (SOFA) score is used to
define sepsis in adult patients, with a score of at least 2
indicating a sepsis infection. A pediatric version of this scoring
system (pSOFA) is available. Fran
Balamuth, MD, PhD, attending physician and associate
director of research in the Emergency Department, and colleagues
evaluated the use of the pSOFA score in the emergency department
(ED) as a predictor of mortality in all patients and specifically
in patients with a suspected sepsis infection.
In retrospective data from seven children's hospitals in
the United States collected
between 2012 and 2018, pSOFA scores ranged from 0 to 14. Patients
with a score of at least 2 were 31.8 times more likely to die from
sepsis compared with patients with a lower score. These patients
also had a longer length of stay in the ED. Of 490,388 patients
with suspected infection, 6.2% had sepsis and 0.03% had septic
shock.
Overall, a pSOFA score of at least 2 was uncommon but associated
with increased mortality, and the scoring system fairly
discriminated for hospital mortality among all ED visits.
Treatment with Intrapartum Antibiotics Linked to Higher Weight Gain in Children
Intrapartum antibiotics are given during labor to prevent or
reduce the risks associated with Group B Streptococcus
disease. However, because these antibiotics can impact the gut
microbiota during the critical prenatal period, they have been
associated with abnormal weight gain in preclinical models. Since
human studies did not find a conclusive relationship, Sagori
Mukhopadhyay, MD, MMSc, attending neonatologist at CHOP Newborn
Care at Pennsylvania Hospital and colleagues conducted a large,
retrospective study to determine if an association existed.
The study team found that neonatal antibiotic exposure was
significantly associated with increased weight gain and BMI.
Specifically, intrapartum antibiotic prophylaxis was significantly
associated with increased weight gain and BMI among both vaginal
and Cesarean births.
Mukhopadhyay and colleagues stressed that these findings must be
balanced against the morbidity and mortality from GBS infection,
and suggest a need to develop other approaches for preventing GBS
that might not lead to weight gain.
Intervention Strategies Needed for Extremely Premature
Infants with Late-Onset Sepsis
Despite prevention strategies that have been attempted, the
incidence of late-onset Group
B Streptococcus disease (LOGBS) has not changed.
To develop better vaccine development for sepsis, researchers at
CHOP led by Karen M. Puopolo, MD,
PhD, attending neonatologist, studied the impact of LOGBS in
extremely preterm infants.
In this retrospective study, the team observed that clinical
complications were most frequent in infants with non-GBS late-onset
sepsis, while infants with LOGBS were more likely to have suffered
early-onset GBS disease. The first episode of late-onset sepsis
occurred at a later age for infants with LOGBS than with non-GBS
late-onset sepsis infants. Among infants who survived for more than
30 days, the risk of death was significantly increased for infants
with LOGBS compared with infants who did not have late-onset
sepsis.
Nearly half of the infants with LOGBS either died or survived,
but with neurodevelopmental impairment, which is what has been
observed to infants with late-onset sepsis from other causes. The
study team suggests developing preventive strategies like maternal
vaccination or targeted immune therapies to help this vulnerable
group of infants.
Arterial Stiffness Found in Youth with Hypertension Can
Impair Cardiac Function
An increase in arterial stiffness has been linked to elevated
blood pressure and hard cardiovascular events, such as myocardial
infarction or sudden cardiac death, in adults. A study team led by
Kevin E. Meyers, MBBCh, assistant
chief of the Division of Nephrology and co-director of the Lupus
Integrated Nephritis Clinic at CHOP, evaluated if the blood
pressure-related increased stiffness posed the same risk to youth
with hypertension.
Among 347 adolescents, higher pulse wave velocity (PWV), a
measure of arterial stiffness, increased among mid- and high-risk
groups in the study, defined by higher blood pressure levels.
Higher PWV correlated with higher blood pressure and lower systolic
strain and diastolic function. The study team concluded that
arterial stiffness can be found in youth and can impact cardiac
function, meaning that strategies to control blood pressure are
needed to reduce the risk of cardiac events.
Continuous Glucose Monitoring Systems Help Monitor Glycemic
Control in Children with Congenital Hyperinsulinism
Using a continuous glucose monitoring system (CGMS) is an
accurate and effective method for monitoring glycemic control in
children with congenital hyperinsulinism (HI), according to a study
led by Diva D. De León-Crutchlow, MD, MSCE, chief of Endocrinology
and Diabetes and director of the Congenital Hyperinsulinism Center
at CHOP.
Congenital HI is the most common cause of persistent
hypoglycemia in infants and children. Currently, monitoring
involves measuring plasma glucose 4 to 6 times daily using handheld
glucose meters. However, this method does not provide a
comprehensive assessment of glycemic control.
The team studied 14 patients between ages 15 and 67 months. The
sensitivity and specificity of CGMS and its ability to detect
hypoglycemia were 86% and 81.4%, respectively. The positive
predictive values for hypoglycemia and severe hypoglycemia were
low, while the negative predictive values were high. The study team
concluded that CGMS can be useful in detecting hypoglycemia and can
prevent unnecessary checks by glucose meter. However, a glucose
meter is still needed to confirm CGMS-detected hypoglycemia because
of the high number of false positives, suggesting that the main
benefit of CGMS is in guiding the need to check plasma glucose by a
glucose meter rather than accuracy.
About Children's Hospital of Philadelphia: Children's Hospital of
Philadelphia was founded in 1855
as the nation's first pediatric hospital. Through its long-standing
commitment to providing exceptional patient care, training new
generations of pediatric healthcare professionals, and pioneering
major research initiatives, Children's Hospital has fostered many
discoveries that have benefited children worldwide. Its
pediatric research program is among the largest in the
country. In addition, its unique family-centered care and
public service programs have brought the 564-bed hospital
recognition as a leading advocate for children and adolescents. For
more information, visit http://www.chop.edu.
Contact: Natalie Solimeo
Children's Hospital of Philadelphia
(267) 426-6246
solimeon@email.chop.edu
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SOURCE Children's Hospital of Philadelphia