Category Archives: Pediatrics

Pediatrics

Exposure to neighborhood violence linked to unmet health needs and increased care utilization in children – News-Medical.Net

A new collaborative study between Boston Medical Center, Brigham and Women's Hospital, Boston Children's Hospital, Hennepin Healthcare Research Institute, University of Pennsylvania, and Children's Hospital of Philadelphia finds exposure to neighborhood violence among children was associated with unmet health needs and increased acute care utilization. Published in the American Journal of Preventive Medicine and based on nationally representative data on violence exposure and gold standard access to care measures from the National Health Interview Survey, this study shows that evidence-based interventions to improve access to care in communities impacted by violence are needed to mitigate long-term physical and mental health consequences for children.

Millions of children in the U.S. are exposed to violence in their homes or communities. Research has shown that children exposed to violence have worse school performance in childhood, increased rates of substance use disorder in adolescence, increased rates of anxiety, depression, and post-traumatic stress disorder in adulthood, and increased risk of developing chronic medical conditions throughout their lives. Exposure to violence also deepens child health inequities, particularly in marginalized communities disproportionately exposed to violence due to systemic racism across generations.

This study helps examine violence exposure at the population level as both a direct driver of health inequities and as a consequence of fundamental causes like racism, poverty, and other structural risk conditions. The researchers found that, even after controlling for the effects of other important factors like family income and insurance status, children exposed to neighborhood violence face unmet physical and mental health care needs, cost-related barriers, decreased access to prescription drugs, increased urgent care and emergency department utilization, and decreased access to preventive care, mental health care, and medications.

The study also identified an association between exposure to neighborhood violence and mental health symptoms, including increased rates of depression and anxiety, which was consistent with multiple previous studies. Researchers also found that children exposed to violence have higher rates of delayed and forgone mental health care despite experiencing more mental health symptoms. Prior research shows how early access to care can mitigate the mental health consequences of violence exposure; improving access to high-quality, affordable mental health care services remains critical in communities impacted by neighborhood violence.

Researchers call attention to built-in environment reforms like neighborhood greening and cleanup, poverty alleviation interventions like the expanded Child Tax Credit, insurance coverage protections like continuous Medicaid enrollment, and hospital-based violence prevention programs as opportunities to take action.

Our findings highlight the profound impacts of limited access to care in communities affected by violence. We also identify specific opportunities for evidence-based clinician, health system, and policy actions that can reduce the incidence of neighborhood violence and mitigate its health consequences."

Rohan Khazanchi, MD, MPH, lead author,resident in the Harvard Internal Medicine-Pediatrics Residency Program at Brigham & Women's Hospital, Boston Children's Hospital, and Boston Medical Center

"To improve health outcomes for the millions of children in the United States affected by neighborhood violence, we have to invest in their families and communities," said senior author Aditi Vasan, MD, MSHP, a pediatrician at Children's Hospital of Philadelphia and Assistant Professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine. "Our findings underscore the need for both upstream policy interventions, like the expanded Child Tax Credit, which would provide essential economic support for families in low-income communities impacted by violence, and downstream health system interventions focused on improving access to high-quality, trauma-informed care for these children and their families."

Source:

Journal reference:

Khazanchi, R.,et al.(2024) Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence.American Journalof Preventive Medicine.doi.org/10.1016/j.amepre.2024.01.009.

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Exposure to neighborhood violence linked to unmet health needs and increased care utilization in children - News-Medical.Net

Pediatrics

OUtMATCH: Omalizumab Proves Utility in Multiple Food Allergies for Pediatric, Adult Patients – MD Magazine

R. Sharon Chinthrajah, MD Credit: Stanford Medicine

The management of food allergies has undergone a revolution in recent years, with the field propelled into the future by the development of clinical programs and pipeline items, including oral immunotherapy and epicutaneous immunotherapies.

Now, in early 2024, the field welcomed what could be the most significant breakthrough in its history, with the February 16, 2024 US FDA approval of omalizumab (Xolair) for the treatment of multiple food allergies.1

The basis of this approval, the OUtMATCH trial, was presented in full at the2024 American Academy of Allergy, Asthma and Immunology (AAAAI) Annual Meeting.2,3

Im excited that we have a promising new treatment for multifood allergic patients. This new approach showed really great responses for many of the foods that trigger their allergies, said senior investigatorSharon Chinthrajah, MD, associate professor of medicine and of pediatrics, and the acting director of theSean N. Parker Center for Allergy and Asthma Researchat Stanford Medicine.3

Named the Omalizumab as Monotherapy and as Adjunct Therapy to Multi-Allergen Oral Immunotherapy (OIT) in Food Allergic Children and Adults (OUtMATCH) trial, the study was designed as a double-blind, randomized, placebo-controlled trial with the intent of comparing omalizumab, a monoclonal anti-IgE antibody, against placebo therapy in management of multiple foods allergies. Conducted at 10 sites across the US, the trial screened 462 people aged 1 to 55 years with a history of allergy to peanut and at least 2 other foods from a protocol-specified list, including cashew, milk, egg, walnut, wheat, and hazelnut.2

Of the 462 who underwent screening, 180 were randomized in a 2:1 ratio to receive either omalizumab or placebo administered subcutaneously, with the dose based on weight and IgE levels, every 2 to 4 weeks for 16 to 20 weeks. For inclusion in the trial, participants were required to have a reaction to a food challenge of 100 mg or less of peanut protein and 300 mg or less of 2 of the other aforementioned foods. At the conclusion of the treatment period, the challenges were repeated.2

The primary outcome of interest for the trial was consumption of at least a single dose of at least 600 mg of peanut protein without dose-limiting symptoms at the completion of the first stage of the trial. The trial also included 3 key secondary outcomes of interest: the consumption of cashew, of milk, and of egg in single doses of at least 1000 mg each without dose-limiting symptoms.2

The overall study cohort had a median age of 7.0 years and 56% of the participants were boys. Investigators highlighted the trial population is representative of patients with multiple food allergies except for a lower percentage of Hispanic participants than in the general population. Investigators noted the analysis population included 177 individuals aged 1 to 17 years.2

Upon analysis, the primary outcome was achieved among 67% (79 of 118) of patients receiving omalizumab. In contrast, this occurred among just 7% (4 of 59) patients receiving placebo therapy (P < .001). Analysis off secondary outcomes of interest revealed a similar trend, with a greater rate of patients in the omalizumab group able to consume at least 1000 mg of cashew (41% v 3%), milk (66% vs 10%), and egg (68% vs 0) than their counterparts receiving placebo (P for all < .001).2

Analysis of safety outcomes in the trial revealed the incidence and severity of adverse events were similar between the study arms, except for injection site-related events, which were more common among the omalizumab group. Of note, a single serious adverse event occurred in a 1-year-old participant within the omalizumab group. In this child, liver enzyme levels became elevated during the first stage of the trial, but, after discontinuing treatment and a complete evaluation, investigators concluded that omalizumab was unlikely to be the cause.2

Chinthrajah noted, although this breakthrough adds a much-needed tool to the armamentarium of clinicians, the results of the trial provoke additional questions surrounding optimal management as well as the pathophysiology of food allergies.3

We have a lot of unanswered questions: How long do patients need to take this drug? Have we permanently changed the immune system? What factors predict which people will have the strongest response? Chinthrajah added.3We dont know yet.

References:

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OUtMATCH: Omalizumab Proves Utility in Multiple Food Allergies for Pediatric, Adult Patients - MD Magazine

Pediatrics

Neffy pharmacokinetic profiles compared to epinephrine injections – Contemporary Pediatrics

Sarina Tanimoto, MD, MBA, chief medical officer, ARS Pharma | Image Credit: ARS Pharma

Neffy (epinephrine nasal spray; ARS Pharma) is a potential needle-free option to treat type 1 allergic reactions, including anaphylaxis in adults and children weighing more than 66 lbs.1

ARS Pharmaceuticals recently announced topline data for repeat doses of neffy, compared to repeat doses of epinephrine intramuscular (IM) injections with and without nasal allergen challenge (NAC) conditions in response to the FDA's request of a pharmacokinetic (PK) and pharmacodynamic (PD) study issued in a September 2023 Complete Response Letter (CRL).1

Sarina Tanimoto, MD, MBA, chief medical officer, ARS Pharma, explains data from the study "Pediatric doses of neffy (intranasal nasal spray) demonstrate pharmacokinetic profiles that are equivalent to epinephrine injections products," in the Q+A interview below.

Data will be presented at the 2024 American Academy of Allergy, Asthma, & Immunology Annual Meeting (AAAAI) in Washington DC from February 23 to February 26, 2024.

Contemporary Pediatrics:

Can you explain how this study was organized, and what methods were used to compare pharmacokinetic profiles between neffy and epinephrine injection products?

Sarina Tanimoto, MD, MBA:

This study wasorganized asa single-arm, open-label [Pharmacokinetic-Pharmacodynamic] (PK/PD) study dosingneffy0.65 mg,1 mg or 2 mg (depending on subject weight) with PK/PD modeling to bridge to the data collected with injection in adults.A total of 80 total [individuals] were enrolled during the pediatric development of neffy. The 42 [individuals] presented in this AAAAI 2024 poster represents the data for the 2 doses (1 mg and 2 mg) dosed in the intended population for approval 1 mg for 15-30 kg [individuals], and 2 mg for 30 kg + [individuals].

[The] age of [participants] ranged from 4 years to 17 years old. Blood samples were collected over 120 minutes to determine how much epinephrine was absorbed after administration ofneffyand PD measures included blood pressure and heart rate which are directly impacted by epinephrine exposure.

The reason for the single-arm, open-label design was that FDA agreed it was not practical to conduct a randomized, crossover PK/PD study in children thatincluded injection as a comparator due to a variety of factors including the intense study conduct with respect to blood draws and duration, and general difficulty enrolling children wiling to be injected with epinephrine.FDA requested 10 [individuals] per dose group, but Europe requested 20 [individuals] per dose group, which is why this study has 21 [individuals] per dose group (for each 1 mg and 2 mg).

Separately from this EPI-10 study, to compare these data to injection, integrated PK analyses, including pharmacological base absorption model (PBAM) and a population pharmacokinetics assessments (POP PK) model werealsoused to extrapolate results from 0.3 mg IM injection and 0.3 mg EpiPen in our adult studies to pediatric subjects. These analyses demonstrated thatneffyachieved exposures in pediatrics that are comparable to or slightly greater than that observed withinjection inadults.

Contemporary Pediatrics:

Can you explain the make-up of the study?

Tanimoto:

EPI 10 included a total of 80 doses of neffy. Twelve [individuals] with body weight 15-30 kg received 0.65 mgneffyand 21 [individuals] with body weight 15-30 kg received 1 mgneffy. In the higher weight group of 30 kg or greater, 26 subjects received a 1 mg dose ofneffyand 21 subjects received a 2 mg dose ofneffy.

Thedata presented in this poster from the study included a total of 42 pediatric [individuals] that received the commercial doses ofneffywhich will be 1 mg for children 15 to <30 kg and 2 mg for children 30 kg or greater.

Half the [individuals] (n = 21) were 15-30 kg in weight, while the other half (n = 21) were 30kg+ in weight. Age range of subjects in the study is 4 to 17 years.

Contemporary Pediatrics:

Can you highlight the benefits of neffy compared to epinephrine injections, of course acknowledging there is no needle. What other benefits are there for neffy regarding the pediatric indication?

Tanimoto:

The literature indicates that parents are fearful and anxious to inject their own children with an epinephrine autoinjector, which causes them to hesitate and potentially allow an allergic reaction to progress to a more serious and potentially life-threatening event.

Parents also worry whether caretakers, guardians or teachers will be willing or know how to use the autoinjector device when the parent is not present given their complexity and risk of injury due to the needle. There are more than 3,500 accidental self-injections in the [United States] annually with epinephrine autoinjectors according to National Poison Center data.

Furthermore, pediatric patients are particularly fearful of being injected or self-injecting. There are very routinereports of pediatric patients resisting injection, and twisting and jerking, which led to lacerations and injuries due to the needle.

Neffy, as an alternative to injection, addresses all these concerns in pediatric patients by removing the fear and anxiety associated with the needle as neither children nor untrained adults can harm the child or themselves withneffy.

Autoinjectors are also large and bulky, which makes it less likely for children to carry the device; there is some social stigma that has been reported with carrying the device around, especially among adolescents. Literature indicates that only 45% of pediatric subjects carry one epinephrine autoinjector with them, and only 22% of pediatric subjects carry 2 devices, as recommended by treatment guidelines.2

Neffyis easy for children to carry as it is much smaller than autoinjectors, fitting in a pocket in a convenient carrying case that can fit 2 devices as guidelines recommend (since a second dose is required in ~10% of events) just like a wireless earbuds case.

Many pediatric patients and their caregivers do not correctly use their EpiPen and other autoinjector devices. In one published study, only 32% of pediatric subjects correctly demonstrated use of the epinephrine autoinjector.3 In another randomized controlled study, only 43% of mothers were able to use an epinephrine autoinjector after training.4

Neffyis also easier to use than an autoinjector as 100% of children were able to useneffy in formal human factors studies after training, and even 100% of adult lay people (e.g. third-party caregivers) who have no knowledge of anaphylaxis were able to useneffywithout any training. Therefore, both children and their caregivers may more easily be able to useneffyconfidently at the first sign of an allergic reaction without anxiety of fear, or risk of injury from the needle.

References:

1. Fitch, J. Neffy epinephrine nasal spray demonstrates positive data in repeat dosing study. Contemporary Pediatrics. February 21, 2024. Accessed February 23, 2024. https://www.contemporarypediatrics.com/view/neffy-epinephrine-nasal-spray-demonstrates-positive-data-repeat-dosing-study

2. Warren CM, Zaslavsky JM, Kan K, Spergel JM, Gupta RS. Epinephrine auto-injector carriage and use practices among US children, adolescents, and adults.Ann Allergy Asthma Immunol. 2018;121(4):479-489.e2. doi:10.1016/j.anai.2018.06.010

3. Sicherer SH, Forman JA, Noone SA. Use assessment of self-administered epinephrine among food-allergic children and pediatricians.Pediatrics. 2000;105(2):359-362. doi:10.1542/peds.105.2.359

4.UmasuntharT,ProcktorA,HodesM,SmithJG,GoreC,CoxHE,MarrsT, HannaH,PhillipsK,PintoC,TurnerPJ,WarnerJO,BoyleRJ.Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial.Allergy2015;70:855863.

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Neffy pharmacokinetic profiles compared to epinephrine injections - Contemporary Pediatrics

Pediatrics

Clinician quiz: AAP clinical practice guideline for treatment of children with obesity – Contemporary Pediatrics

Clinician quiz: AAP clinical practice guideline for treatment of children with obesity | Image Credit: Daqota - Daqota - stock.adobe.com.

Welcome to this Contemporary Pediatrics quiz. In this edition, we're asking you 5 questions from the American Academy of Pediatrics' (AAP) "Executive Summary: Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity."

The clinical practice guideline (CPG) was published January 9, 2023.

Authors noted the CPG aimed to inform pediatricians about standard of care for evaluating and treating children with overweight and obesity, along with related comorbidities.

According to the authors, the CPG is based on a "comprehensive evidence review of controlled and comparative effectiveness trials and high-quality longitudinal and epidemiologic studies."

The guideline acknowledges that childhood obesity can result from a multifactorial set of environmental, socioecological, and genetic influences that impact children and families.

At the time of guideline posting, the AAP stated 14.4 million children and adolescents were affected by obesity, both in current and long-term health aspects.

Click through each question below, make your selection and submit the answer.

What is the recommended age for pediatricians and other primary healthcare providers to evaluate children for abnormal glucose metabolism and abnormal liver function in the presence of obesity or overweight?

Interested in another quiz? Try this one:

Quiz: Recommendations for influenza control in children from the American Academy of Pediatrics

Reference:

Hample SE, Hassink SG, Skinner AC, et al. Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. The American Academy of Pediatrics. https://publications.aap.org/pediatrics/article/151/2/e2022060641/190440/Executive-Summary-Clinical-Practice-Guideline-for?searchresult=1?autologincheck=redirected

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Clinician quiz: AAP clinical practice guideline for treatment of children with obesity - Contemporary Pediatrics

Pediatrics

Contributed: Shortcomings and opportunities for health equity in pediatrics – Mobihealth News

Children and young people throughout the United States continue toface some of the biggest hurdles to receiving timely and appropriate healthcare. As incidence rates of mental health and complex medical conditionsrise, the majority of treatment-seeking children face strained health systems, limited affordable treatment options and care that is not personalized to their unique social, cultural and developmental needs.

Whiledigital health solutions have begun to offer some hope, there remains a disconnect between innovators and the health systems that they are solving for, resulting in products that do not fit clinical workflows, fail to meet the diverse needs of pediatric patients and ultimately struggle commercially.

Meeting user needs

A 15-year-old tells her doctor that she feels anxious. The doctor completes a brief assessment and diagnoses the patient with panic disorder. The doctor offers to write a prescription for an anti-anxiety medication and refers the patient to behavioral health services. The patient doesnt want to start taking medication, so she elects to be matched with a behavioral health service provider and is placed on a wait list.

Digital health technologies offer new forms of hope to young people and their families. Digital health interventions and telehealth areincreasing access to mental health and primary care services, making it easier for patients to find support when and where they need it.

To ensure that the right patients have access to the right technologies, hospitals are employing tools like AI to streamline patient referrals, provide more accurate diagnoses and gain insights into patient health trajectories that help them better predict and intervene appropriately. Since more still needs to be done to improve outcomes, reduce costs and improvethe shortcomings of digital health solutions in pediatric care, healthcare leaders from across the country are calling for greater attention to this space.

After struggling to find a therapist for a few months, the patient returns to her doctor. The doctor decides that the patient is a candidate for a new digital therapeutic. After getting set up with the app, the patient goes home and begins her treatment journey, only to find that the app doesnt seem relatable and worse isnt translated into her preferred language, making it difficult to comprehend. After a few days of trying it, she stops using the app.

Incidence rates of mental health conditions, such asdepression and anxiety, continue to rise throughout the United States, alongside the complexity of optimally treating patients with diverse needs. As the racial and ethnic makeup of the United Statescontinues to diversify, many families find it difficult to receive culturally competent care, raising the risk of negative healthoutcomes.

At a time when patients and families are increasinglyamenable to integrating digital solutions into their care experiences, their specific needs and requirements are often not being met. While digital health can address some of the most pressing issues of patient care, cohesive best practices for developing inclusive, culturally competent and ultimately equitablesolutions are largely absent.

To ensure continuity of care, the doctor would like to check their patients progress in the app and monitor any change in symptoms over time. While a dashboard exists to view this information, it is not integrated into the existing electronic health record system. Since this product is not interoperable with existing infrastructure, the provider is unable to use the dashboard and must wait to check in with their patient at her next six-month checkup. Rather than streamlining the providers process, the digital solution becomes yet another cog in their system.

Digital solutions have the potential to improve patient outcomes and supplement care. However, real challenges exist to their integration into clinical workflows and patients daily lives. Rather than delivering on the promise of streamlined care, digital solutions often cause fragmentation and interference in clinicians work, because their input and perspectives are unaccounted for.Without taking the unique needs of patients and clinicians into account, digital health solutions will see low uptake, activation ratesand ultimately struggle to succeed at scale.

Systematic barriers

The patient returns to the doctor after giving up on the app, saying that it was too complicated and difficult to understand. Fortunately, the doctor remembers learning about another app, one that is specifically designed for younger patients and delivers its content in various languages. However, this app isnt covered by the patients insurance and its out-of-pocket expense is too much for the family to afford. Left without a timely and appropriate treatment option, the patient risks worsening symptoms and long-term implications if her struggle to find care persists.

Even if solutions intended for children are built accordingly, they oftenhave a difficult time succeeding on the market. Struggles like this suggest that commercial incentives for pediatric digital health solutions are misaligned. Payers are hesitant to reimburse products with limited real-world evidence, while clinicians and health systems are inundated with a plethora of solutions but feel underprepared to adopt them. Ultimately, children and their families are left with a murky picture of which digital health solutions are available to them and how to pay for them.

Solving these challenges

Digital solutions promise to solve some of the most challenging aspects of care delivery, increase access and improve quality of life. However, when encountered in real settings, these tools often fail to meet diverse patient needs, do not integrate easily into clinical workflows and struggle to define real-world benefits. Ultimately, this perpetuates a cycle of inequitable and fragmented solutions that have no clear path to commercial success.

Delivering on the promise of digitization of pediatric care requires collaborative efforts between stakeholders, including clinicians, researchers, technology companies, investors, payers, policymakers and regulatory bodies.

Ian is a program lead at the Digital Medicine Society, where he leads a multi-stakeholder effort to create The Playbook: Pediatric Digital Medicine, an open access, action-oriented resource intended to catalyze innovation in pediatric healthcare. He has a background in research, operations and strategy related to medical devices and mental health, and is passionate about improving the lives of young people.

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Contributed: Shortcomings and opportunities for health equity in pediatrics - Mobihealth News

Pediatrics

Committed to physician education to enhance children’s health – UChicago Medicine

In 2023, the Department of Pediatrics made an unprecedented number of changes to its residency program to individualize and support residents learning experience.

Pediatric residents here have a personalized learning curriculum, multiple mentors specifically chosen to match residents research and clinical interests, individualized support, and ongoing feedback, allowing trainees to reach their highest potential, said pediatric hospitalist Nicola Orlov, MD, MPH, Residency Program Director and Associate Chair for Education.

The residents and fellows are an essential part of multidisciplinary teams that treat Chicagos most vulnerable kids. With each patient encounter, residents learn how to overcome social determinants of health and support children in getting the best care possible, said Orlov.

Many pediatric residency programs face major barriers in establishing robust mentorship programs, according to recent published research conducted by Orlov and colleagues. In the first-ever survey of U.S. pediatric residency mentorship programs, directors reported that a lack of funding and an inability to protect faculty time hampered their mentorship efforts.

Despite this nationwide trend in mentorship, UChicagos Department of Pediatrics training program recently doubled its leadership team by adding an additional five associate directors. These leaders have dedicated time to mentor their assigned residents in addition to their responsibility of ensuring continued innovation within the residency program.

Residents are paired with a second faculty mentor who serves as an advocate and supports them throughout their training in both their personal and professional lives.

From our research, we have identified and implemented new approaches to mentorship to ensure that our residents achieve their goals over the course of their training, said Orlov. We believe a more individualized approach that encourages trainees to share their personal and professional goals allows for better mentorship overall.

To support residents on their learning path, faculty members recognize that trainees have unique backgrounds and career goals. We are committed to fostering an inclusive environment, valuing the unique contributions of each trainee as we work together to address the health inequities of our patients, said Orlov. One aim of our program is to create psychological safety. Our residents know that we have their backs, that we are all learning, and that we are their advocates as they progress through residency.

In the coming academic year, residents will complete a new, one-month mental health outpatient rotation.

There is currently a huge burden of mental health illness among kids and adolescents, and its critical that pediatricians be able to manage disorders such as anxiety, depression and ADHD in their patients, said Orlov.

Clinical hours have been redistributed so residents spend more time learning in outpatient clinics in anticipation of 2025 requirements by the Accreditation Council for Graduate Medical Education. We have also analyzed previous residents board scores, their in-training exam scores, and the expectations of the American Board of Pediatrics to ensure that residents are well-prepared to take the boards and practice independently, she said.

Residents are being trained as patient safety experts as part of a robust safety curriculum that will include all clinical staff. Residents are expected to report any concerns about the safety of patient care, which will trigger an investigation and lead to strategies to prevent potential patient harm.

Residents will also receive feedback from families, nurses, attendings and clinical staff to help them assess their progress in residency and growth toward their goals.

Sometimes that feedback can be hard to hear, but it is important for residents to understand how they are perceived so they can improve their communication and professionalism skills with patients and better meet the needs of children and their families, said Orlov.

In 2023, 53 pediatric fellows participated in 13 subspecialty programs at Comer Childrens. The childrens hospital just added two more fellowships, Allergy and Immunology and Pediatric Hospital Medicine, for a total of 15 subspecialty fellowships.

Our institution has a wide range of fellowship programs, which enables us to provide immediate, state-of-the-art specialty care to every Comer patient, said neonatologist Bree Andrews, MD, MPH, who oversees the pediatric fellowship programs. Thats a very dynamic way to practice medicine.

Pediatric fellows at Comer are expected to devote 50% of their time to research to develop the expertise to treat clinically intricate problems in their subspecialty. Because the University of Chicago is renowned for the depth and breadth of its research, fellows receive unparalleled experience and exposure.

At UChicago Medicine, we have extensive expertise in bench science, translational science, quality improvement and population health, which is what our fellows want in a research experience, said Andrews.

The strong research component prepares physicians to conduct their own research after fellowship and to understand emerging research and the basic science behind treatments. Our fellows develop the tools and expertise to really make an impact in their fields, added Andrews.

At the other end of the medical-education continuum, Andrews teaches a premed course on the art of practicing medicine.

The Bucksbaum Institute launched the competitive, three-year Clinical Excellence Scholar Track (CEST) in 2013 to introduce undergraduates to the importance of the doctor-patient relationship, humanism and compassion in medical care.

Andrews is a CEST cohort leader as well as Senior Faculty Scholar at the Bucksbaum Institute. CEST requires that students provide 100 hours of volunteer service at UChicago Medicine and shadow physicians for at least 36 hours.

The early-career development program helps undergraduates decide what areas of medicine best suit their talents. Through their volunteer work, research experiences, and clinical shadowing, the undergraduates develop rich experiences, making them amazing candidates for medical school and shaping their interests in specialties such as pediatrics, she said.

Added Orlov: Regardless of where medical trainees are on their path to becoming leaders in pediatric care, our goal is to support their dreams and ambitions, foster their talents, and help them achieve their highest calling as pediatricians.

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Committed to physician education to enhance children's health - UChicago Medicine

Pediatrics

Washington University School of Medicine joins collaboration to improve pediatric heart disease care – News-Medical.Net

Washington University School of Medicine in St. Louis has joined the Pediatric Heart Network, a multicenter collaboration of leading hospitals and research institutions that works to improve care for pediatric heart disease patients.

Washington University School of Medicine in St. Louis has been named one of nine core sites in the Pediatric Heart Network, a national network of leading hospitals and research institutions that works toward improving outcomes and quality of life for children with heart disease.

The Pediatric Heart Network (PHN) is funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH), which will support Washington University named a core site together with Children's Hospital Colorado with $2.4 million over seven years.

The network targets pediatric heart diseases, particularly congenital heart disease in children and, more recently, in adults, unifying a somewhat fragmented research community. Over the past 22 years, the multicenter collaborative effort has supported 25 large studies, including 10 clinical trials, adding treatments and improving care for pediatric heart disease patients.

In the past, Washington University has been an auxiliary site for the network and was invited to participate when specific studies needed more patients. Now, as a core site, Washington University will participate in all PHN-led clinical studies and will have a seat at the table on the executive committee and all other PHN committees, helping to make decisions and shape the future of the network and its work.

Leading the new core site are Washington University's Andrew C. Glatz, MD, the Louis Larrick Ward Professor of Pediatrics and director of the pediatric departments cardiology division; and Jennifer N. Silva, MD, a professor of pediatrics in the cardiology division. From Children's Hospital Colorado, the core site leaders are Shelley Miyamoto, MD, chief of pediatric cardiology; and Emily Bucholz, MD, PhD, an assistant professor of pediatrics. The two centers will work together as the Gateway to the West Consortium, with regular virtual and in-person meetings as well as a shared plan to enhance diversity in research participants, and a shared mentorship model to train the next generation of pediatric cardiology clinical investigators.

For the last two decades, the Pediatric Heart Network has produced extremely influential research in the field of pediatric cardiology and congenital heart disease. Being part of this effort is indicative of the university's clinical and research excellence. We have the infrastructure and the expertise to be a valuable participant in this network, together with our site partner."

Andrew C. Glatz, MD, the Louis Larrick Ward Professor of Pediatrics, Washington University

Congenital heart disease is a birth defect that affects the structure of the heart and sometimes requires medical, surgical or transcatheter intervention to address blood flow and heart performance issues. One in 100 babies is born with this condition, and it is one of the most common causes of birth-defect-related infant death in the United States.

Washington University represents the Midwest, a region that historically has lacked representation in the network, according to Glatz.

Other Washington University investigators involved in the new core site are: Charles E. Canter, MD, a professor of pediatrics in the cardiology division, and the Lois B. Tuttle and Jeanne B. Hauck Chair in Pediatrics; Kory J. Lavine, MD, PhD, an associate professor of medicine, of developmental biology, and of pathology & immunology; Philip R.O. Payne, PhD, director of the Institute for Informatics, Data Science and Biostatistics, the Janet and Bernard Becker Professor, associate dean for health information and data science, and chief data scientist at the School of Medicine; and Adam Wilcox, PhD, a professor of medicine and director of the Center for Applied Clinical Informatics.

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Washington University School of Medicine joins collaboration to improve pediatric heart disease care - News-Medical.Net

Pediatrics

How to Treat Coughs in Kids – Health Matters

What is a cough? A cough is usually a reflex response to an irritant from a virus, to pollen, to cigarette smoke. Coughs are a way for the body to protect itself. They prevent irritants from getting deep into the lungs and help open our airways to exchange oxygen and carbon dioxide. For example, if you swallow water the wrong way, youre going to cough it up.

How do you diagnose whats causing the cough? First, we ask some basic questions. How long has the cough been happening and how often? What triggers it? Does the cough last just a couple of seconds or does it take minutes to recover? What makes it better? All of the information gives us hints to determine the cause of the cough.

With technology available, I also encourage parents to record the cough. Bringing a recording to your physician or the emergency department is very helpful, so we can observe any concerning signs of respiratory distress based on what were seeing on the video or hear on an audio recording.

Then we do a physical exam with a stethoscope to listen for sounds in the chest wall, neck, or the nose. This helps differentiate the cough between an upper respiratory cause versus a lower respiratory condition.

Some causes of cough can be detected with specific tests. Certain conditions like COVID, the flu, RSV, or strep can be checked in the office or emergency room if there is a high likelihood of these illnesses. Other conditions, like asthma, may require special exams like a pulmonary function tests.

How long do coughs usually last? It depends on whats causing of the cough. Most colds take three to five days to peak, but the symptoms can last up to two weeks so coughing for 10 to 14 days for a common cold is not unusual, especially in pediatrics.

With other conditions, like pneumonia, the cough may last a month after the main part of the illness is over. If the cough is lasting beyond the expected time, your provider may ask the child to come in more often to be monitored.

How long is a child contagious? It depends on the virus. In most cases, the first five to seven days of a cold is when your child is contagious. Fever can be an indicator of the contagious period. The likelihood of spreading the virus decreases after a week. Your doctor can give specific advice based on the virus.

When should children see a doctor about a cough? We always think about whether the cough interferes with daily activity. So for children, daily activity means going to school, sleeping, playing, or eating. If it interferes with any of those, that is a reason to see a physician. If the child has a cough and a fever that lasts more than five days, then those are signs to see a doctor too.

Another concern is respiratory distress. If the cough causes your child to breath faster than normal, or parents are noticing the breathing is visible underneath the rib cage or in the neck bone, or the nostrils are flaring to breathe those are signs that the body is working too hard. Many children can breathe 30 breaths per minute. For an adult, that would be way too fast. The older you are, the slower your normal breathing rate is. So if a child is breathing faster than normal, that would be reason to seek medical attention.

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How to Treat Coughs in Kids - Health Matters

Pediatrics

COVID-19 vaccination during pregnancy and offspring neurodevelopment – Contemporary Pediatrics

COVID-19 vaccination during pregnancy and offspring neurodevelopment | Image Credit: adipurnatama - adipurnatama - stock.adobe.com.

The increase in COVID-19 vaccination in pregnant people has brought on safety concerns for the unborn child and questions of neurodevelopment. Results of a prospective cohort study published in JAMA Pediatrics suggest that in utero vaccination was safe for the infant regarding neurodevelopment up to 18 months of age.

Pregnant individuals were excluded from early, large-scale clinical trials of COVID-19 vaccines, leaving questions about the impact from vaccine exposure that the offspring could face.

Ranging genetic and environmental factors could underline neurodevelopmental disorders, with fetal exposure to maternal inflammation presenting a potential source for risk.

For example, the authors wrote. In utero exposures to other infections including influenza and rubella have been linked to subsequent increases in lifelong neurodevelopmental and psychiatric impairments including autism spectrum disorder, intellectual disability, schizophrenia, anxiety, and depression."

To determine if in utero exposure to maternal COVID-19 vaccination was associated with risk for neurodevelopmental impairment in 12- and 18-month-old infants, investigators designed the prospective cohort Assessing the Safety of Pregnancy During the Coronavirus Pandemic (ASPIRE) study.

From May 2020 to August 2021, the study enrolled pregnant people aged 18 years and older at 10 weeks gestation or less. Completing study activities remotely, participants were followed up through pregnancy and for up to 2 years postpartum.

Completion of the baseline demographics questionnaire, the Ages and Stages Questionnaire (3rd edition [ASQ-3]) at 12 and 18 months postpartum, and of the vaccine history questionnaire (monthly) were inclusion criteria.

An abnormal screen on the ASQ-3, which would indicate risk for developmental delay, was the primary outcome of the study. The investigators established that, An abnormal screen was defined as falling below the established threshold score (<2 SDs below the normative data average) on any of 5 subdomains: communication, gross motor, fine motor, problem solving, and social skills.

The ASQ-3 featured 30 questions to indicate the frequency in which their child performed expected milestones, as scores ranged from 0 to 60 (worst to best, respectively). According to authors, the screener is valid, reliable, and ubiquitous in clinical and research settings, with sensitivity of 86%, specificity 85%,and positive and negative predictive values of 54% and 78%, respectively.

Vaccination for COVID-19 during pregnancy was the primary exposure, which was indicated by self-report and confirmed by investigators using dates of vaccinations compared to estimated dates of conception and delivery. Any dose of a vaccine series qualified as exposure, with the majority being messenger RNA vaccines.

In all, 2487 pregnant individuals were enrolled at less than 10 weeks gestation. With completed research activities, a total of 2261 aged 12 months and 1940 aged 18 months with neurodevelopmental assessments were included.

At 12 months, the prevalence of abnormal screens for developmental delay (ASQ-3 scores below established cutoff on at least 1 domain) was 30.6% among exposed. The prevalence of abnormal screens for unexposed at 12 months was 23.2% (2= 2.35;P=.13).

No differences were observed in risk of abnormal screen on the ASQ-3 after in utero exposure to vaccination at 12 or 18 months after adjusting for baseline race, ethnicity, maternal age, education, household income, depression, and anxiety (12 months: aRR, 1.14; 95% CI, 0.97-1.33; 18 months: aRR, 0.88; 95% CI, 0.72-1.07).

Without regard to exposure status, investigators observed more abnormal screens for developmental delay among male infants at 12 and 18 months of age compared to female infants, respectively (12 months: 325 of 980 [33.2%] vs 278 of 984 [28.3%]; 2= 5.57;P=.02; 18 months: 210 of 872 [24.1%] vs 161 of 836 [19.3%]; 2= 5.84;P=.02).

For female infants, a divergent pattern was demonstrated, as at 12 months, there was no difference in risk of abnormal ASQ-3 screen among exposed vs unexposed (aRR, 1.02; 95% CI, 0.81-1.30), though a reduction of risk was observed for exposed female infants at age 18 months (aRR, 0.69; 95% CI, 0.51-0.93).

Findings from the cohort study suggest that, maternal vaccination against COVID-19 during pregnancy was safe from the perspective of offspring neurodevelopment through 18 months of age, the study authors concluded.

Reference:

Jaswa EG,Cedars MI,Lindquist KJ, et al. In utero exposure to maternal COVID-19 vaccination and offspring neurodevelopment at 12 and 18 months.JAMA Pediatr.Published online January 22, 2024. doi:10.1001/jamapediatrics.2023.5743

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COVID-19 vaccination during pregnancy and offspring neurodevelopment - Contemporary Pediatrics