Category Archives: Pediatrics

Pediatrics

HCPs can play an important role in addressing the US infant formula shortage – Contemporary Pediatrics

HCPs can play a role in addressing the US infant formula shortage | Image Credit: 279photo - 279photo - stock.adobe.com.

In results from a 2020 survey conducted by the CDC, 45.3% of infants in the United States were exclusively breastfed at the age of 3 months, with this percentage dropping to 25.4% by the age of 6 months.1 The World Health Organization and the US Dietary Guidelines for Americans recommend that all infants should exclusively receive breast milk until the age of at least 6 months.2,3 Caregivers can begin incorporating other solid and liquid foods at this 6-month mark; however, children should continue breastfeeding until the age of 2 years. The CDC reports that 20.8% of breastfed infants receive additional formula supplementation within the first 2 days of life, which can be attributed to a multitude of factors, including lactation issues, scheduling conflicts, and stigma.1 When breastfeeding is not an option, caregivers will turn to infant formulas to meet their childs nutritional needs.

Infant formulas contain important macronutrients such as carbohydrates and proteins, which are crucial to growth and development.4 In addition to the macronutrients, the infant formula contains micronutrients such as vitamin D, iron, and zinc. Vitamin D is a fat-soluble vitamin essential for the development of bones and the prevention of conditions such as rickets by regulating calcium and phosphorus levels in the body.4-6 Iron is required for hemoglobin production and tissue oxygenation, with low levels of iron causing anemia and failure to thrive.4,7 Zinc is a mineral that contributes to growth and immune function, with deficiencies leading to growth failure and skin rashes.4,6 Due to potential complications, it is important for all pediatric patients to meet their nutritional requirements. Unfortunately, when infant formula shortages occur, access is limited, leading to varying conservation efforts or work-arounds that put the infant at risk for the deficiencies and complications noted previously.

Infant formula shortages can be a direct result of supply chain issues, natural disasters, and/or recalls.8,9 One such example is the infant formula shortage in the United States in April 2022. Several brands of powdered infant formulas were found to be contaminated with Cronobacter sakazakii, prompting a nationwide recall due to the risk of sepsis and meningitis after ingestion.10 Another more recent example is the infant formula recall in the United States in December 2023, also due to Cronobacter sakazakii contamination.11 Health care providers (HCPs) play an important role in shortages, as they can provide education and resources to caregivers in need. The resources that HCPs can provide include but are not limited to comparative formulations, imports, proper feeding practices, and milk banks.

The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) has infant formula comparison guides that clinicians can use to make safe interchange recommendations.12,13 For example, NASPGHAN states that Similac Alimentum powder (Abbott) is interchangeable with Extensive HA (Gerber) for infants who require extensively hydrolyzed or hypoallergenic formula.13 HCPs can also recommend alternative formulations such as liquid concentrate or ready-to-feed formulations and provide appropriate mixing instructions, as this varies based on the product formulation.14 For example, powder and liquid concentrate formulations require mixing with water in varied ratios whereas ready-to-feed formulations require no mixing. HCPs should also counsel the family on a use-by date after mixing or opening the formulation, as these vary between the different formulations.15 However, it is imperative to note that cost fluctuates between the different formulations, and financial barriers should be considered.

Furthermore, families can seek imported formulas that are authorized by the FDA and available in US stores as an alternative.12 Initially, the FDA temporarily approved imported formulas that met the nutritional requirements but may not have met the labeling requirements of products in the United States.16 Manufacturers who received temporary approval during the initial shortage have since been provided guidance on labeling requirements in order to continue to market their product in the United States. Imported infant formulas are approved by the FDA with a close examination of the nutrients provided by the individual formula and compared with those required by US standards. Clinicians are encouraged to access the FDAs website, which provides recommendations for appropriate substitutions when switching to an imported infant formula.13,17 Third-party imported formula websites may sell products that are not FDA authorized and do not undergo the scrutiny necessary to mirror the nutritional values of US standards. Accessing and/or ordering from these websites should be avoided.4,18 The FDA provides advice to avoid counterfeit infant formulas by confirming the lot number and use-by dates on the package, checking for damage or label tampering, or calling the manufacturers toll-free line.19 If caregivers have used a specific product in the past, they should look out for discoloration and changes in smell or taste.

If an FDA-authorized imported infant formula is chosen, there are unique considerations. There may be unfamiliar language in the patient-facing directions, such as using the word teats for the nipple of the baby bottle.15 Additionally, the definition of a special infant formulation may vary based on the country of origin when compared with that of the United States. Furthermore, labeling may contain different languages that may not be readily translated. Imported products may use the metric system, requiring unit conversions and subsequent relay of this information to the caregiver. This is a key counseling point, as mixing the formula incorrectly may lead to electrolyte imbalance, seizures, and poor weight gain.15,16

Human milk banks are an option for caregivers if alternative formulas cannot be obtained. HCPs can provide caregivers a contact number for a local certified human breast milk donation center through the Human Milk Banking Association of North America.18 Human milk donors are thoroughly screened prior to donation.Purchasing human milk from the internet or social media sites should be avoided, as the milk is not adequately screened or regulated and could unintentionally expose the infant to infectious diseases, illicit drugs, and chemical contaminants.12

Cows milk is normally not recommended for children until they are 12 months or older due to nutritional differences, such as low levels of bioavailable iron and higher amounts of protein.20 If both human milk and infant formulas are unavailable, the American Academy of Pediatrics (AAP) recommends that infants older than 6 months consume cows milk for no more than 1 week.21 Iron supplementation can be given to infants under the supervision of a physician in the form of pediatric drops if they are younger than 6 months.8 Infants can be introduced to solid food at approximately 6 months of age, so it is important to introduce iron-rich foods or cereals to avoid iron deficiency.7,20 There are 2 sources of iron: heme and nonheme iron.7 Heme iron is available in red meat, seafood, and poultry. It is more easily absorbed by the body than nonheme iron. Nonheme iron is available in iron-fortified infant cereals, tofu, and beans. Moreover, goats milk is not approved for infants in the United States and plant-based milk is not recommended in children younger than 12 months.21 Soy milk, which is fortified with calcium and protein, may be used for less than 1 week if other avenues are exhausted. Lastly, toddler formula is not interchangeable with infant formula due to its differing nutritional value.3,6 Toddler formula is intended to be supplemented with an oral diet for toddlers. These formulas should only be used for children 12 months or older for a few days if there is no other choice.6,12,21

HCPs should be prepared to discourage conservation practices that could lead to unintentional infant harm. For example, in an effort to make infant formulas last longer, caregivers may dilute the product with more water. Infant formula should never be overdiluted, as it will offset the nutritional concentration and cause electrolyte disturbances.6,12,21 These complications can be fatal. In addition, homemade formulas should be discouraged, as they do not meet the nutritional or safety standards that commercial products have.21 Online recipes for homemade formulas may contain inadequate or excess amounts of vitamins and minerals and have been linked to severe, life-threatening complications.12 A case series published by the AAP described 2 patients who were fed with organic homemade infant formulas after transitioning from exclusive breastfeeding by the age of 1 month.22 The most notable laboratory abnormalities were related to inadequate vitamin D supplementation. Low levels of vitamin D resulted in inadequate calcium and phosphorus absorption and subsequent breakdown of bone. Further complications experienced by the patients included bone demineralization, cardiac arrest, hepatotoxicity, and ischemia of multiple organs. A summary of the dos and donts for HCP recommendations during an infant formula shortage can be found in the Table.4,9,12,16,17,21

Click table to enlarge.

Many homemade infant formula recipes can be found online and often contain ingredients that are harmful to infant growth and development. A 2020 study analyzed 149 homemade infant formula recipes distributed over 59 online blogs.23 A total of 24.3% of the recipes used whole unpasteurized cows milk, 23.6% used raw goats milk, and 14.5% used liver as the protein base for the homemade infant formula. Pasteurization is the process where raw milk is heated at a controlled temperature to reduce pathogens.24 Unpasteurized or raw milk is associated with outbreaks of foodborne illnesses such as Salmonella and Listeria infection. Liver contains high levels of vitamin A, which can lead to vomiting and bulging of the infants fontanelle.25 Additionally, only 84% of recipes included instructions for proper formula storage and 18.8% included shelf-life recommendations.23 Improper storage leads to an increased risk of bacteria proliferation and subsequent infection. Approximately 75% of the blogs did not encourage pediatrician consultations prior to the usage of a homemade formula.

Conclusion

HCPs are a vital source of information during the infant formula shortage and can provide reliable and safe resources to caregivers in need. It is imperative that HCPs discourage practices that can lead to unintentional infant harm. Education should be provided to all caregivers regarding proper feeding of infants and handling of infant formula.

Click here for more from the May issue of Contemporary Pediatrics.

References:

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HCPs can play an important role in addressing the US infant formula shortage - Contemporary Pediatrics

Pediatrics

East Wenatchee Doctor Awarded For Boosting Child Vaccinations – KPQ

A Confluence Health East Wenatchee pediatrician is being credited with boosting the vaccination rate of children in the area.

Dr. Doug Eisert is being cited for improving the vaccination rates of children significantly at Confluence Health in Wenatchee and East Wenatchee.

According to the Washington Chapter of the American Academy of Pediatrics (WCAAP), Dr. Eisert has stood out for his leadership in raising vaccinations for children and adolescents by 24% at Confluence Health in Wenatchee and 15% at Confluence Health in East Wenatchee, impacting 6,215 patients.

The group says Dr. Eiserts leadership and work with teams at the two Wenatchee area clinics made a significant impact on the health of Hispanic children, improving their vaccination rates by 27.5%.

In his work on increasing HPV vaccination for 9 and 10 year olds, Dr. Eisert helped the clinics improve vaccination coverage by 31%, impacting 1,252 patients at both clinics. .

"Dr. Eisert is a true champion for Wenatchee Valley children and youth, improving public health and health for future generations, said Washington Chapter of the American Academy of Pediatrics executive director Sarah Rafton.

Dr. Eisert said his success is based on a group effort. We worked with several vaccine interest groups and tracked our successes and opportunities in making progress with increasing the vaccination rates of our patients," said Dr. Eisert.

The Leah Layne Memorial Health Leadership Award is named after the late Leah Layne, a long-time campaigner and activist for rural health.

Dr. Eisert stands out to me as exemplar of WCAAP and our members working every day to inspire and support his teammates in clinic to improve child and teen health, and public health, said Washington Chapter of the American Academy of Pediatrics executive director Sarah Rafton.

Gallery Credit: Parker Kane

Link:

East Wenatchee Doctor Awarded For Boosting Child Vaccinations - KPQ

Pediatrics

HPV vaccination coverage of US-children aged 9-17 years in 2022 – Contemporary Pediatrics

HPV vaccination coverage of US-children aged 9-17 years in 2022 | Image Credit: Tobias Arhelger- Tobias Arhelger - stock.adobe.com.

Vaccination prevents and controls Human papillomavirus (HPV), the most common sexually transmitted infection (STI) in men and women in the United States. According to data from a National Health Interview Survey and the Centers for Disease Control and Prevention (CDC), in 2022, 38.6% of children aged 9 to 17 years received 1 or more HPV vaccine doses.1

HPV vaccination has been recommended in the United States for girls since 2006 and for boys since 2011, with multiple doses required for boys. Vaccination can begin at age 9, and is targeted for children aged 11 to 12 years to prevent and control associated outcomes of HPV including: genital warts, precancerous lesions, and certain cancers, such as cervical, vaginal, vulvar, anal, penile, and oropharyngeal.1

Parent-reported data from the 2022 National Health Interview Survey is used in the CDC report to describe the percent change of children aged 9 to 17 years who received at least 1 dose of the HPV vaccine by "selected sociodemographic and health characteristics," the report stated.1

That National Health Interview Survey is a nationally representative household survey of the United States civilian noninstitutionalized population, and is conducted continuously throughout the year by the National Center for Health Statistics.1

Overall, for 2022, 38.6% of children received 1 or more HPV vaccine doses. That percentage increased with age, as 7.3% of children aged 9 to 10 years received 1 or more dose, 30.9% of children aged 11 to 12 years, 48.8% among children aged 13 to 14 years, and 56.9% among children aged 15 to 17 years.1

According to the report authors, girls were more likely to received 1 or more HPV vaccine doses compared to boys (42.9% vs 34.6%).1

The percentage of children who received 1 or more vaccine dose also varied by race and Hispanic origin, as Hispanic children were less likely to receive 1 or more doses compared to White non-Hispanic children (34.4% vs 39.9%). Observed differences between Asian non-Hispanic, Black non-Hispanic, White, and Hispanic children were not considered significant.1

Health insurance was also a factor in the percentage of children who received 1 or more vaccine doses, as was parental education and family income.1

Children with private health insurance (41.5%) were more likely to receive 1 or more HPV vaccinations compared to children with Medicaid (37%), other government sponsored coverages (30.2%), and those without insurance (20.7%). Children with Medicaid were more likely to receive vaccine doses compared to those without insurance.1

Increasing parental education was associated with higher vaccination percentages in children, as 31.1% of children who lived in households with parents whose highest education was high school or less. For those with parents who had an associate's degree or some college experience, 40.6% of children received 1 or more vaccine doses. For children with parents whose highest education was a bachelor's degree or higher, 42.1% received at least 1 HPV vaccine dose.1

For family income, 29.9% of children with a family income of less than 100% of the federal poverty level received 1 or more vaccine doses, compared to 45.7% among children with a family income of 400% or more of the federal poverty level.1

According to the US Department of Health and Human Services, $27,750 per year was the 100% federal poverty level in 2022 for a family or household size of 4 in the 48 contiguous states (not Alaska and Hawaii). The 400% poverty level for the same household was $111,000 per year.2

Additionally, children with disability were more likely to receive HPV vaccination compared to those without disability (44.1% vs 37.7%). The same was true for children living in "large metropolitan areas (39.4%), large fringe metropolitan areas (41.1%), and medium and small metropolitan areas (39.4%) compared with those living in nonmetropolitan areas (30.0%)," stated the authors.1

According to the report, the CDC recommends a 2-dose series with 2 doses given 6 to 12 months apart for children aged 11 to 12 years, though vaccination series can start when children are at age 9 years. For those with a weakened immune system and those starting at age 15 years or older, a 3-dose series is recommended.1

References:

1. Villarroel MA, Galinsky AM, Lu PJ, Pingail C. Human Papillomavirus vaccination coverage in children ages 9-17 years; United States, 2022. National Center for Health Statistics. February 2024. Accessed May 10, 2024. https://www.cdc.gov/nchs/products/databriefs/db495.htm#Data%20sources%20and%20methods

2. 2022 poverty guidelines: 48 contiguous states (all states except Alaska and Hawaii). US Department of Health and Human Services. PDF. Accessed May 10, 2024. https://aspe.hhs.gov/sites/default/files/documents/4b515876c4674466423975826ac57583/Guidelines-2022.pdf

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HPV vaccination coverage of US-children aged 9-17 years in 2022 - Contemporary Pediatrics

Pediatrics

Weekly review: Profound genetic deafness gene therapy, measles increases, and more – Contemporary Pediatrics

Thank you for visiting the Contemporary Pediatrics website. Take a look at some of our top stories from last week (Monday, May 6, to Friday, May 10, 2024), and click on each link to read and watch anything you may have missed.

1.) DB-OTO improved hearing to normal in child with profound genetic deafness

Positive, phase 1/2 preliminary data for Regeneron Pharmaceuticals' DB-OTO, an investigational gene therapy for profound genetic deafness, was presented at the 2024 American Society of Gene and Cell Therapy (ASGCT) annual conference.

Click here for full commentary and data, in this discussion with Lawrence R. Lustig, MD, chair, Department of Otolaryngology-Head & Neck Surgery, Columbia University, and clinical trial investigator.

2.) Measles increase: Discussing vaccination with vaccine-hesitant parents

In a time when vaccine hesitancy is contributing to a rise in measles cases, an understanding of why parents are hesitant is key to help change their narrative.

Click here for the full article, part of the May issue of Contemporary Pediatrics.

3.) Child welfare: Now that we know better, lets do better

Improvement in access to mental health resources for children would decrease vicarious trauma of foster parents and social workers via improved living and working conditions.

Click here for the full article.

4.) Emergency department serves as equitable location for influenza vaccine delivery

Click here to watch the full interview with Courtney Nelson, MD, attending physician, director of Quality Division of Emergency Medicine, Nemours Children's Hospital Delaware; assistant professor of Pediatrics, Sidney Kimmel Medical College.

5.) The pediatrician's role in a multidisciplinary pediatric cardiology team

Carissa M. Baker-Smith, MD, MPH, explains how a multidisciplinary team works together to diagnose and treat hypertension, as well as obesity in children.

"We're not going to find the solutions to these problems by working in isolation within our respective fields or offices, we need to get out, include the patients, the community and the decision making, and very importantly, the general pediatricians."

Click here for the full interview.

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Weekly review: Profound genetic deafness gene therapy, measles increases, and more - Contemporary Pediatrics

Pediatrics

Pediatric Telehealth Platform Market is expected to Expand at a Massive CAGR of 26.6% through 2030 – openPR

Pediatric Telehealth Platform Market

The global Pediatric Telehealth Platform market research is predicted to record a Massive CAGR of +26.6 % during the review period 2024-2031.

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Market Overview: A Pediatric Telehealth Platform provides remote medical care for children, leveraging digital technologies. It offers real-time consultations with pediatricians through video calls or messaging. The platform facilitates timely diagnosis, treatment, and monitoring of various pediatric conditions. It enhances accessibility to healthcare, especially for families in remote or underserved areas. Additionally, it supports parental education and engagement in managing children's health. By promoting convenience and efficiency, it aims to improve pediatric healthcare outcomes while ensuring patient confidentiality and security.

Top Key Players in Global Pediatric Telehealth Platform Market, TytoCare, Alpha Medical, Blueberry Pediatrics, Anytime Pediatrics, NightLight Connect, Maven, Vsee, Anytime Telehealth, Amwell, Sesame, CallOnDoc, PM Pediatrics, Teladoc Health, K Health, Vivify Health, Southdale Pediatrics, KID-DOC Pediatrics, InSync Healthcare Solutions, CareXM,

The main goal for the dissemination of this information is to give a descriptive analysis of how the trends could potentially affect the upcoming future of Pediatric Telehealth Platform market during the forecast period. This markets competitive manufactures and the upcoming manufactures are studied with their detailed research. Revenue, production, price, market share of these players is mentioned with precise information.

In the geographic segmentation, the regions such as North America, Middle East & Africa, Asia Pacific, Europe and Latin America are given major importance. The top key driving forces of the Pediatric Telehealth Platform market in every particular market is mentioned with restraints and opportunities. The restraints are also given a counter act which prove to be an opportunity for this market during the forecast period of 2024 to 2030 respectively.

The Pediatric Telehealth Platform market is also explained to the clients as a holistic snapshot of a competitive landscape within the given competitive forecast period. A comparative analysis of regional players and segmentations, which helps readers get a better understanding of the areas and resources with better understanding.

Global Pediatric Telehealth Platform Market Segmentation:

Market Segmentation: By Type Cloud-based On-premises

Market Segmentation: By Application Respiratory Cold, Flu & Fever Gastroenterology Behavioural Health Dermatology Other

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An assessment of the market attractiveness with regard to the competition that new players and products are likely to present to older ones has been provided in the publication. The research report also mentions the innovations, new developments, marketing strategies, branding techniques, and products of the key participants present in the global Pediatric Telehealth Platform market. To present a clear vision of the market the competitive landscape has been thoroughly analysed utilizing the value chain analysis. The opportunities and threats present in the future for the key market players have also been emphasized in the publication.

Key questions answered in the report include: What are the main factors likely to encourage the growth of the global Pediatric Telehealth Platform Market? Which factors are expected to limit the development of the global Pediatric Telehealth Platform Market? Which application and product segments are anticipated to top in the forecast period? Which geographical segment is expected to lead and hold the main share of the global Pediatric Telehealth Platform Market in the next few years? What are the projected values and growth rate of the global Pediatric Telehealth Platform Market? Which are the key players operating in the global Pediatric Telehealth Platform Market?

Table of Contents Global Pediatric Telehealth Platform Market Research Report 2024 - 2030 Chapter 1 Pediatric Telehealth Platform Market Overview Chapter 2 Global Economic Impact on Industry Chapter 3 Global Market Competition by Manufacturers Chapter 4 Global Production, Revenue (Value) by Region Chapter 5 Global Supply (Production), Consumption, Export, Import by Regions Chapter 6 Global Production, Revenue (Value), Price Trend by Type Chapter 7 Global Market Analysis by Application Chapter 8 Manufacturing Cost Analysis Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers Chapter 10 Marketing Strategy Analysis, Distributors/Traders Chapter 11 Market Effect Factors Analysis Chapter 12 Global Pediatric Telehealth Platform Market Forecast

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Pediatric Telehealth Platform Market is expected to Expand at a Massive CAGR of 26.6% through 2030 - openPR

Pediatrics

DB-OTO improved hearing to normal in child with profound genetic deafness – Contemporary Pediatrics

Positive, phase 1/2 preliminary data for Regeneron Pharmaceuticals' DB-OTO, an investigational gene therapy for profound genetic deafness, was presented at the 2024 American Society of Gene and Cell Therapy (ASGCT) annual conference.

The gene therapy improved hearing to normal levels in a child born with profound genetic deafness, who was dosed at 11 months of age, within 24 weeks. Additionally, initial hearing improvements were observed in another child, who was dosed at 4 years of age, at a 6-week assessment.

"Both [of the children] received their treatment in the United Kingdom," Lawrence R. Lustig, MD, chair, Department of Otolaryngology-Head & Neck Surgery, Columbia University, and clinical trial investigator, told Contemporary Pediatrics in the video interview above.

"What we saw early on [in the child dosed at 11 months], was a gradual improvement of their hearing thresholds, their auditory thresholds. The most recent data that we captured at about 24 weeks shows that the hearing in the ear that was dosed with the gene therapy, particularly in the speech frequencies, is at a normal to mild hearing loss range, which honestly is jaw-dropping," added Lustig. "I think these results surpassed even our wildest imaginations in this 1 particular child."

Watch the video at the top of this article for Lustig's full interview with Contemporary Pediatrics.

Data stems from the ongoing phase 1/2 CHORD trial, a first-in-human, multicenter, open-label trial to evaluate the safety, tolerability, and preliminary efficacy of DB-OTO in infants, children, and adolescents with otoferlin variants.

Each child received a single intracochlear injection of DB-OTO in 1 ear, with a surgical procedure that leverages the same approach used for cochlear implants. Pure tone audiometry (PTA) and auditory brainstem response (ABR) assessed the hearing improvements. According to Regeneron, PTA is considered to be the "gold standard" measurement of hearing, measured through behavioral confirmation of sound, such as turning the head toward a sound. ABR, as an objective confirmation of hearing function, corroborates behavioral responses by measuring electrical brainstem responses to sound emitted at different decibels.

Both participants had behavioral (PTA) or electrophysiological (ABR) responses at maximum sound levels of 100 decibels or greater at baseline. After treatment with DB-OTO, both children showed auditory responses at the first efficacy assessment of 4 weeks.

The first participant was 16 months of age at the 24-week assessment. Data presented at ASGCT showed the child had improvement of hearing to normal levels among key speech frequencies. The child had an average of 84 dB improvement from baseline, and 1 frequency measure reaching 10 dB in hearing level per PTA. Among all tested frequencies, an average 80 dB improvement from baseline was observed.

The second trial participant was 4 years of age at the 6-week assessment and experienced consistent results to the first participant at the same timepoint, stated Regeneron in a press release.

The second participant demonstrated initial improvement of hearing with responses to loud sounds observed across key speech frequencies, with an average of 19 dB improvement from baseline. One frequency measure reached 80 dB in hearing level per PTA. In this child, an average 16 dB improvement from baseline was observed.

"What we have right now, is the ability to measure hearing on a hearing test to determine what level they can detect sounds," said Lustig. "We don't really know what they're hearing. It's not going to be until the children are older that we see how their speech and language and speech comprehension come along and to listen to how they hear sounds. That's when we are really going to know, but that's not going to be for several years down the road."

Congenital deafness impacts approximately 1.7 out of every 1000 children born in the United States according to Regeneron, and approximately half of these cases have genetic causes. Otoferlin-related hearing loss is "ultra-rare," as the condition is "caused by variants in the otoferlin gene, which impairs the production of the OTOF protein that is critical for the communication between the sensory cells of the inner ear and the auditory nerve," stated Regeneron in the press release.

"I think this has profound impact on the treatment of children in general with hearing loss and how we approach them," said Lustig. "All children born with hearing loss really need to be genetically tested, because this particular form of deafness is relatively rare. Understanding which gene is involved in the deafness in children, if it can be identified, is going to be important."

Watch the video at the top of this article for Lustig's full interview with Contemporary Pediatrics.

Reference:

Latest DB-OTO results show dramatically improved hearing to normal levels in a child with profound genetic deafness within 24 weeks and initial hearing improvements in a second child at 6 weeks. Regeneron Pharmaceuticals. Press release. May 8, 2024. Accessed May 8, 2024. https://investor.regeneron.com/news-releases/news-release-details/latest-db-oto-results-show-dramatically-improved-hearing-normal

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DB-OTO improved hearing to normal in child with profound genetic deafness - Contemporary Pediatrics

Pediatrics

The IT strategy behind a groundbreaking new $2B pediatric hospital – Healthcare IT News

Children's Healthcare of Atlanta Arthur M. Blank Hospital is scheduled to open this September. It was built from the ground up with the very latest healthcare information technology.

It is one of the largest and most advanced pediatric hospitals in the world. It cost more than $2 billion. It is 19 stories tall, with nearly two million square feet. It has 90 robots who have their own six elevators.

It features deep device integration, artificial intelligence, location awareness, video and patient engagement technology all focused on helping clinicians save steps and make better decisions while providing an excellent patient experience.

Jeremy T. Meller is chief information officer at Children's Healthcare of Atlanta Arthur M. Blank Hospital. We spoke with him to get the inside story of the creation of this facility's health IT strategy and the implementation of the very latest technologies.

Q. What was the overarching health IT strategy that went into creating the hospital from the ground up?

A. We are so proud of all the planning and work that has gone into Children's Healthcare of Atlanta Arthur M. Blank Hospital opening in September. The overall hospital visioning process began more than seven years ago. Children's worked with our Patient and Parent Advisory Council to understand what our families thought was most important for a new hospital.

We received so many valuable and creative responses that led to recommendations such as a second television in the room and washers and dryers on each floor. Our councils worked to understand the themes for what would make the most healing environment, with the best care possible for the kids we treat.

We also worked cross-functionally to learn about the leading practices in hospital design, understand pain points our staff were experiencing, and where we thought technology and innovation were headed in the future. But things move quickly. When we started the process in 2017, we assumed self-driving cars would need to be accommodated.

Meanwhile, we had no idea a global pandemic was on the horizon and we would be dealing with workforce issues. People were still confusing algorithmic bots with AI and nobody was talking about generative AI at all. We adapted our plans over the last few years to accommodate the new realities and needs we learned.

Our technology strategies started to form when we held massive-scale workflow simulations as part of our facility design process. Children's created "Cardboard City" by transforming a 100,000-square-foot warehouse into one of the largest, full-scale hospital mock-ups in the country. Using more than 12 miles of tape and 10,000 square feet of cardboard, our hospital planning and simulation teams built the mock-up to test drive the 3-D design plans and determine how the layouts might affect employee workflow, patient care and family experience.

Jeremy T. Meller, Children's Healthcare of Atlanta Arthur M. Blank Hospital

Through this process, we identified space requirements needed to be reworked in some areas, plug locations might be wrong, or we needed technology to help address an issue.

An example of this is the physical side of Arthur M. Blank Hospital. At nearly two million square feet, it rivals or exceeds many professional football stadiums in scale. This is in part because every patient room is spacious, with separate areas for parents. Parents will have a desk, a sofa bed, and their own television.

These amenities are sure to improve the quality of experience, but they also bring technology implications, such as increased network load. The physical size itself means moving around will simply take more time.

An extra 10,000 steps could impact the length of time it takes for a nurse to reach a patient room, so we were challenged to find ways that technology could help with communication, reduce steps (both physical and process steps), and improve the quality of care we were going to be providing.

Q. Were there special IT considerations because it is a pediatrics hospital?

A. Pediatric healthcare brings with it additional complexities in almost every way. Equipment must be sized for stages of anatomical childhood development. Care protocols are different and more complex.

Children respond differently to medical interventions, and most systems are not designed from the ground up to be oriented toward pediatric medicine. The electronic health record has more complexity, and providing access to patient records is more involved because a legal guardian relationship must be determined.

There are real-world reasons why pediatric hospitalizations are resource-intensive, but this doesn't mean finding experienced clinical staff and physicians is any easier. Our needs are more intensive, and we must do everything we possibly can to support our clinicians in providing the best care possible.

To help save physical steps and reduce time burden, we've integrated screens outside of each patient room with halo lights that change color depending on who is in the room. This is dependent on RTLS badges staff will wear once the hospital opens, and provides a visual clue that can reduce steps.

Locations are updated on status boards, and clinicians can review who is or was with the patient. This will help improve staff coordination, and in turn, patient care.

Q. You have 90 robots. Please talk about the place robotics holds in the hospital and what kinds of things they will be doing.

A. We are really excited about opening Arthur M. Blank Hospital with the world's largest fleet of robots. We will have two types of robots, autonomous mobile robots and Robos. About a third will be patient facing, helping to deliver meals or medications and pick up labs or other items that cannot go through the tube system.

Our back-hall "tugs" are designed with a platform to slide under specially designed carts that will haul heavy linen and trash. Arthur M. Blank Hospital has six elevators designed specifically for the robots. The system will include advanced algorithms and camera technology to determine location and bin utilization.

Logistical planning for the new hospital has been key for our teams as well. Our intelligent supply chain management system uses RFID technology to better automate stock and billing processes. Our pneumatic tube system has traffic-control monitoring, and our pressurized trash-chute system even has radiation monitoring.

Everything is connected. We have nearly 60 facility- and supply chain-related systems most of them are systems we have in other facilities, but at our new hospital they are networked, automated and monitored.

Q. You told me the hospital will feature deep device integration and artificial intelligence. Please elaborate.

A. Like many organizations, we have a long-term investment in predictive analytics but are more recently looking at how generative AI can be used in meaningful and safe ways. Everyone talks about how AI will change the world, change healthcare. But for AI to be useful, it needs to have content, it needs data. For predictive deterioration algorithms to be most effective, timely bio-physio data is needed.

Many hospitals have IT systems and medical equipment, but they aren't deeply integrated. A nurse will be standing at a computer, looking at a patient monitor (another computer) and keying in hourly vitals. This is an outmoded paradigm that needs to shift to real time.

We are integrating virtually every type of device that can provide this data, pulling it into our analytics systems, and currently are developing 11 predictive models to assist our clinical teams, helping them decide where to focus or make better, safer decisions.

Waveforms will be available to clinicians in real time on their mobile clinical smartphones, allowing them to better triage alarm response, such as seeing when a lead is disconnected. The nurse call system is integrated into our RTLS so alarms will auto-silence when a nurse enters the room.

Q. What kinds of patient engagement technologies do you have and what are the expected outcomes?

A. We know patients would probably rather be home than in the hospital, and that is why we've designed rooms that are all large and designed for the greatest comfort and connection for the whole family.

We will have multiple screens in each room. We will have the traditional patient education and entertainment screen, as well as a second TV for parents and a vertically mounted virtual whiteboard. The RTLS system will be integrated into the room, and when a clinician enters, a pop-up will appear on the television and whiteboard showing who just entered.

The whiteboard will provide information useful to the patient and family, including a daily schedule and a list of care team members. When the physician or nurse enters the room, the display will change, allowing the caregiver to pull up relevant information and radiology images to communicate with the patient.

A high-quality pan-tilt-zoom camera also is installed in every room and will allow caregivers, interpreters or even family members to dial into the room. It will turn away for privacy when not in use and all calls will be accepted or declined from the pillow-speaker.

Q. In the end, what are your goals as the CIO of this new high-tech hospital?

A. The new Arthur M. Blank Hospital will be one of the most advanced facilities in the world when it opens in September. My goal is we use technology to help clinicians provide the best care possible through more intelligent systems, save steps through improved communication and technology-supported visual processes, and improve care and experience through improved patient engagement.

Of course, we can't do anything in IT without an eye on cybersecurity, so that has been an integral part of everything we have done in advance of opening the hospital. All the new systems and capabilities have been carefully evaluated and implemented to provide the greatest safety and security possible.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email him:bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication.

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The IT strategy behind a groundbreaking new $2B pediatric hospital - Healthcare IT News

Pediatrics

Modest Changes in Kids’ Developmental Scores Seen From Pandemic – Medpage Today

Young children who lived through the COVID-19 pandemic demonstrated modest changes in developmental screening scores, according to a cohort study of more than 50,000 U.S. children.

Among kids age 5 and under, there were significant mean score decreases from the pre-pandemic to intra-pandemic periods in communication (0.029, 95% CI 0.041 to 0.017), problem-solving (0.018, 95% CI 0.030 to 0.006), and personal-social (0.016, 95% CI 0.028 to 0.004) domains as measured by the Ages and Stages Questionnaire (ASQ), according to Sara Johnson, PhD, MPH, of Johns Hopkins School of Medicine in Baltimore, and colleagues.

At the same time, there were no changes in fine or gross motor scores between the pre-pandemic and intra-pandemic periods, they reported in JAMA Pediatrics.

"Communication scores decreased approximately 3% and personal-social and problem-solving scores decreased approximately 2%," the researchers wrote. "Applied at the population level, a change of this magnitude would translate to 1,541 more recommended referrals per month across the U.S. over baseline."

Johnson said in an email to MedPage Today that there has been "a lot of uncertainty about what being isolated from friends and extended family, closures of schools and childcare, job loss, and other family stresses might mean for children's development. Until now, though, there hasn't been a large study of children across the U.S. to help answer this question."

As to potential mechanisms, she noted that the affected domains were "areas of development that children practice through interacting with others -- so these outcomes might be influenced by caregiver stress during lockdowns, childcare closures, and social distancing. On the other hand, we didn't see any differences in gross or fine motor development, which don't rely so much on interactions."

Overall, the study used an interrupted time series analysis comparing time periods classified as pre-pandemic (March 1, 2018 to Feb. 29, 2020), interruption (March 1, 2020 to May 31, 2020), and intra-pandemic (June 1, 2020 to May 30, 2022).

Ultimately, 50,205 children were included from a randomly sampled population of 502,052 children ages 0 to 5 years whose parents or caregivers completed developmental screening during pediatric visits at primary care practices participating in a web-based clinical process support system. Most respondents were mothers. However, the proportion of non-parent respondents increased over time from 9.1% during the pre-pandemic period to 20% during the intra-pandemic period.

The children had a mean age of 18.6 months, and the mean age for infants was 5.1 months.

Among infants specifically, there were similar effect sizes for communication (0.027, 95% CI 0.044 to 0.011) and problem-solving (0.018, 95% CI 0.035 to 0.001). However, there were no significant changes in personal-social, fine motor, or gross motor scores from the pre-pandemic to intra-pandemic periods.

Additionally, during the study period, 51% of caregivers completed two questions on worries and concerns about their children. "Overall, we saw limited evidence that caregivers' worries and concerns about their children changed over the study period," Johnson and colleagues wrote.

Rates of behavioral concerns were less prevalent (range 5.1% to 6.2%) than worries about the child (range 15.3% to 17.4%). After controlling for ASQ scores and changes, there was a small increase in caregiver worries in the intra-pandemic period compared with the pre-pandemic period (rate ratio 1.088, 95% CI 1.036-1.143).

Limitations of the study included that some covariates like prenatal substance use, prenatal or postnatal SARS-CoV-2 infection, and comorbidities were unavailable, Johnson and colleagues noted. Additionally, the ASQ was caregiver reported, and infants born preterm were excluded from the study.

Furthermore, primary care clinics in communities hard hit by COVID-19 might not have offered health supervision for portions of the follow-up period, they added. And there was no contemporaneous pandemic-unexposed comparison group possible.

"It will be important for future studies to continue to follow these large samples of children from across the U.S. to help us understand the long-term implications of our findings," Johnson said. "It's possible that after the pandemic, these changes in development will disappear for most children as families get back to more normal routines and experiences. It's also possible that new challenges will emerge as children age, for example when they enter kindergarten, or these deficits will get larger over time if changes in routines that were prompted by the pandemic, like greater reliance on screen time or school absenteeism, persist."

"Future studies should also look at variation in the pandemic's developmental impact among subgroups," Johnson added, "for example in preterm infants (who weren't included in our study) or in families living in poverty, who may have had the fewest resources to rely on during this time."

Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.

Disclosures

The study was supported by the Johns Hopkins Population Center and a grant from the National Institute of Child Health and Human Development.

Authors reported relationships with CHADIS, the NIH, the Center for Promotion of Child Development Through Primary Care.

Primary Source

JAMA Pediatrics

Source Reference: Johnson SB, et al "Developmental milestone attainment in US children before and during the COVID-19 pandemic" JAMA Pediatr 2024; DOI: 10.1001/jamapediatrics.2024.0683.

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Modest Changes in Kids' Developmental Scores Seen From Pandemic - Medpage Today

Pediatrics

This pediatrics subspecialty has the best work-life balance – MD Linx

Studies show that 1 in 4 kids or teens has a behavioral, developmental, emotional, or learning problem.[]

MDLinx spoke with Emily Wassmer, MD, IBCLC, a fellow at Childrens Hospital of Philadelphia, for an insider's perspective on the critical need for more developmental and behavioral pediatric (DBP) specialists.

According to Dr. Wassmer, DBP is a highly rewarding specialty with a great work-life balance. Despite this, she feels its often overlooked in medical school. Heres what else she had to say.

Dr. Wassmer says the dearth of DBP specialists primarily stems from a lack of exposure during training. While pediatrics is a required rotation, its subspecialties arent. If you do your core rotations at an institution without DBP, you wont experience the subspecialty clinically, she explains. You may hear about it in passing while seeing primary care patients, but that will also be attending-dependent.

She notes that many students aim for child and adolescent psychiatry or neurodevelopmental disabilities specialties, until they realize DBP is a better fit.

Typical career path

DBPs start with a 3-year residency in pediatrics, followed by 3 years of fellowship training.

Dr. Wassmer described the path to DBP: You get into any pediatric fellowship through the ERAS fellowship match, similar to the process you go through for residency. For pediatric subspecialties, applications are due in the summer, interviews are in the fall, and Match is in late November or early December. This process is done in the academic year before you plan on starting fellowship (summer/fall 2024 cycle if you want to start fellowship in summer 2025).

She also shared that since this pediatric subspecialty match was recently combined with the subspeciality match for Internal Medicine, partners trying to couples-match may want to consider this option.

A disheartening but common reason why people dont go into pediatric subspecialties is the salary, says Dr. Wassmer. Doing subspecialty training in pediatrics almost always guarantees youll lose lifetime earnings by doing extra training. Unlike adult specialists, pediatric specialists do not see a big jump in salary (or jump at all) after completing subspecialty training. Her opinion aligns with salary data for pediatric subspecialists.[]

Dr. Wassmer said that most DBPs make just under $200,000 as attendings. Ive heard of starting salaries as low as $150,000 to $160,000, but have also seen places that will start over $200,000. Pediatric subspecialties, in general, often end up with salaries in the $180,000 to $240,000 range, which is the same as or lower than that for general pediatricians, she explained.

Dr. Wassmer understands that mental health fields can be challenging, and many clinicians experience burnout, particularly when treating young patients. Nonetheless, she finds the field rewarding. We love having long-term continuity with our patients. We also love diving deep into issues and trying to get to the bottom of them, she shared.

Its a common misconception that DBPs only treat autism. On the contrary, Dr. Wassmer says they manage a broad scope of conditions.

You can be more of a general DBP who diagnoses and manages things like autism, ADHD, and developmental delays, she explains. Or, you can pick a more specific niche within the field, such as focusing on genetic disorders like Down syndrome or Fragile X. I personally have a clinical interest in hearing loss, so Im interested in working in a pediatric hearing loss clinic doing autism evaluations, as autism often presents very differently in kids with hearing loss.

Theres a long list of reasons to refer to a DBP, note researchers writing in Pediatrics, such as aggression, adoption and foster care, cerebral palsy, fetal alcohol spectrum disorders, gender identity and sexuality issues, OCD, Tourettes syndrome, and traumatic life events.

Such a varied field means Dr. Wassmer enjoys its multidisciplinary nature that allows her to collaborate with speech therapists, occupational therapists, audiologists, and genetic counselors.

"DBPs generally have a nice work-life balance, working 3 to 5 days per week and rarely working on weekends."

Emily Wassmer, MD, IBCLC

Dr. Wassmer said her schedule changes weekly in fellowship. She sees her own patients one half-day per week, but in her 2nd and 3rd years, itll increase to a full day. She spends another half-day per week participating in a LEND fellowship, a 1-year government-funded multidisciplinary program for trainees working with children with neurodevelopmental disabilities.

The other 3 days vary depending on my rotation, which could be neurology, genetics, rehab, resident teaching, community experiences, child psychiatry, or DBP, she explains. She said fellows occasionally have consults with patients in the hospital (about two or three times a month), but the consults arent urgent. She also covers her own patient messages throughout the day.

In my program, the fellows cover patient calls on weeknights, and the attendings cover patient calls on weekends. After-hours patient calls are infrequent, hardly ever more than one per night, she says.

What this means for you

The DBP subspecialty is a growing field with immeasurable rewards. Specializing in DBP means you can steer your career toward your interests while enjoying a manageable schedule. For residents considering pediatric-related fields, DBP is worth a closer look.

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This pediatrics subspecialty has the best work-life balance - MD Linx

Pediatrics

PM Pediatrics Cobble Hill closing Pediatric urgent care options in Brooklyn and lower Manhattan – Brooklyn Bridge Parents

PM Pediatric Urgent Care in Cobble Hill has announced that they will be closing on Sunday, May 19 after over 10 years at 240 Atlantic Avenue. Check out our overview of alternative urgent care options for kids in our neighborhoods, including dedicated pediatric emergency rooms, inpatient pediatric units, and services for all types of urgent care needs, from X-rays to stitches to treatments for colds and other common illnesses.

If your child needs emergency care, keep in mind that the co-pay at an urgent care clinic will typically be much less than a visit to the emergency room depending on your insurance. Our guide lists urgent care options first, followed by emergency room options.

CityMD has many locations in our neighborhoods, and while no appointment is needed, you can book a visit at your closest clinic. You can also check estimated wait times on their website. CityMDoffers quick, reliable, emergency care service 365 days a year. Board-certified doctors are availability to treat all of urgent care needs, from suturing and X-rays, to coughs, colds, and other common illnesses. All locations offer pediatric care.

+MEDRITE offers pediatric services for newborns up to age 18. No appointments are needed, and children are seen within minutes of arriving. Theyprovide onsite lab and X-ray facilities, as well as pediatric orthopedic care. Physicians treat urgent care needs from broken bones to strep throat to abrasions, cuts & stitches.

The NYU Langone medical center opened last spring on Atlantic Avenue with a 24-hour emergency department. Children and patients of all ages are being taken care of 24/7 with two emergency specialists on site all times and a pediatric ER specialist on site from 2 to 10 pm daily. Their services are more comprehensive than those offered by urgent care centers, which usually do not have advanced imaging services, cast set-up for fractures or emergency-trained nurses. If a person needs to be admitted to the hospital, their in-house team transports patients for free to the assigned hospital within their network. The center also offers valet parking. Emergency care wait times are posted on the website and updated every 5 minutes here.Learn more about the facility and its pediatrics team here!Pediatric patients who require advanced care or hospitalization will be transferred to NYU Langones Hassenfeld Childrens Hospital at 430 E 34th Street, right off the FDR in Manhattan.

506 6th Street

Located within NewYork-Presbyterian Brooklyn Methodist Hospitals main emergency room, the pediatric emergency service is a self-contained area staffed by physicians certified in both emergency medicine and pediatrics, and by registered nurses with specialized training.Everything in the pediatric emergency service is geared toward treating children and their families: all equipment is child-sized, the patient gowns feature cartoon characters, and the staff is sensitive to the needs of parents, as well as children.The separate pediatric waiting room is open 24 hours per day, seven days per week. Learn more here.

170 William Street

NewYork-Presbyterians location in Lower Manhattan also has a dedicated pediatric emergency room, and is located right over the Brooklyn Bridge. Physicians in the pediatric emergency service treat life-threatening illnesses, traumatic injuries, and less serious conditions.Pediatric patients who require advanced care or hospitalization will be transferred to the pediatric inpatient unit at Komansky Childrens Hospital at NewYork-Presbyterian/Weill Cornell Medical Center at 525 East 68th Streeton the Upper East Side.

121 DeKalb Avenue

The Brooklyn Hospital Center finished a major Emergency Department renovation in the summer of 2022. This renovation significantly improves the hospitals response to traumatic injury and illness, and has resulted in a state-of-the-art facility with a separate pediatric emergency room. The pediatric ED provides emergency services to infants, children and adolescents from birth to age 21 and is open 24 hours a day, 365 days a year. Highly trained board certified pediatric emergency physicians, residents, nurses and staff offer the crucial care needed in all types of pediatric emergencies.The facility is focused on all conditions affecting children, from minor to major illness, as well as injuries. In addition, TBHC offers a full range of pediatric services, including an inpatient pediatric unit, a six-bed pediatric intensive care unit and a neonatal intensive care unit, as well as many pediatric specialists on hand to provide their expertise if necessary.

4802 10th Avenue

The Maimonides Childrens Hospital has provided Brooklyns families with dedicated pediatric emergency care for over 30 years, treating infants, children, and adolescents 24 hours a day, 7 days a week. Healthcare providers in the fully-accredited Pediatric Emergency Room treat a range of conditions from allergic reactions to injuries and acute illnesses. Maimonides team is comprised of board-certified pediatric emergency medicine physicians, fellows, and nurses, as well as other specialists who can consult and provide additional services as needed. Translation services are also available at all times. Maimonides is also prepared for emergency conditions that may be uncommon in the United States. Maimonides also has Brooklyns only pediatric trauma center to treat life-threatening injuries that result from serious incidents like falls and car accidents.

For broken bones and other orthopedic emergences, its worthwhile to head to NYU Langones Samuels Orthopedic Immediate Care Center in Manhattan, one of New York Citys only walk-in orthopedic immediate care facilities. They offer medical care specifically for people with orthopedic injuries, unlike emergency rooms that treat people who have a broad range of urgent health problems. The result is that you receive specialized orthopedic care with less waiting time. The vast majority of patients are treated and discharged within two and a half hours. Their teamcomprised of an emergency medicine doctor and an orthopedic surgery resident doctor or physician assistantevaluate and treat children for sprains, dislocations and joint injuries, hand and foot injuries, hip, arm, or leg fractures, and joint and bone infections. They are open seven days a week: Sunday through Thursday, 8am to 9pm, and Fridays & Saturdays, 8am to 10:30pm.

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PM Pediatrics Cobble Hill closing Pediatric urgent care options in Brooklyn and lower Manhattan - Brooklyn Bridge Parents