BACKGROUND: Researchers recently created a new scoring system for characterizing organ dysfunction in critically ill pediatric patients, named the pSFOA (pediatric sequential organ failure assessment). Support for applying this scoring system in pediatric patients who suffer from cyanotic and acyanotic congenital heart diseases has not been evaluated. OBJECTIVES: To compare the pSOFA scores between pediatric patients with acyanotic and cyanotic congenital heart disease (CHD). Exampine the pSOFA results of CHD patients with pediatric patients who underwent hematopoietic stem cell transplantations. METHODS: A retrospective case-study of pediatric patients with congenital heart disease admitted to the CICU at Boston Children’s Hospital in 2018. Patients were included if between 1 and 5 years of age, neonates of less than a month old were excluded. A total of 101 patients were reviewed, 50 with cyanotic CHD and 51 with acyanotic CHD. Patient vital signs were assessed using the pSOFA scoring system, with scores assigned based on indices of respiratory, coagulation, hepatic, cardiovascular, neurologic, and renal system function. Scores were analyzed using two-tailed nonparametric Mann-Whitney tests with an alpha of 0.05. The pSOFA scores of CHD patients were then compared to patients who were admitted to the ICU at Boston Children’s Hospital after they received a hematopoietic stem cell transplantation (HSCT). Dunn’s multiple comparisons tests were performed for the two CHD groups and the HSCT patients. An alpha value of 0.05 was also used for these tests. RESULTS: Parameters determined to be statistically significant between the cyanotic and acyanotic CHD patients were, Total High Direct score, Total Average Direct score, Total Low Indirect Score, Total High Indirect score, Neurologic High score, Average Neurologic score, Renal High score, Average Renal score, and Hepatic Low Indirect score. The parameters that were statistically different between the CHD groups and the HSCT group were Age, Maximum Coagulation, Maximum Renal, Maximum Hepatic, and Maximum Total pSOFA scores. Parameters that were significantly different only between cyanotic CHD and HSCT were Maximum Cardiovascular and Maximum Respiratory. Scores that were significantly different between acyanotic CHD and HSCT were Maximum Neurologic. CONCLUSIONS: There were significant differences in pSOFA scores between children with cyanotic CHD and acyanotic CHD, specifically regarding total direct, total indirect, neurologic, and renal scores. Additional research is required to explain these scores differences and validation of these scores in predicting morbidity and mortality outcomes in these patient populations. / 2022-06-02T00:00:00Z

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) was declared to be a pandemic and a public health emergency by the World Health Organization in March of 2020. Researchers and medical professionals worldwide have been working nonstop to better understand the disease process of COVID-19 in order to refine treatment protocols and create effective immunizations. Within the pandemic, children make up a unique patient population as they have shown to have similar but less severe clinical features when compared with infected adults. Most pediatric cases of COVID-19 have been reported as asymptomatic or mild with only 8 per 100,000 in the US requiring hospitalization between March 1-July 25, 2020, approximately 576 patients. The case presented is of a 4-year-old Caucasian female with an atypical presentation of a COVID-19-associated pneumonia, with a review of her presentation to the hospital, treatment plan, and discharge. The current frequency of pediatric cases of COVID-19 with severe disease is low, and thus, not fully understood. This case provides an example of successful diagnosis and in-patient treatment, and broadens the scope of severe disease potential from COVID-19 in the pediatric population.

Antibiograms are aggregates of susceptibility testing data of pathogens over a period of time. Bacteria are cultured from infected patients. Once identified, a pathogen undergoes testing against common antibiotics, indicating the effectiveness of specific antibiotics to the pathogen identified. This data gives clinicians an understanding of which antibiotics face increasing resistance in their communities. This project involved the development of a pediatric outpatient antibiogram which was compared against a regional inpatient pediatric antibiogram. The goal was to identify a significant difference in susceptibility between inpatient and outpatient pediatric infections. All urine cultures ordered within the ETSU Health pediatrics department over the course of 1 year between September 2018 and September 2019 were examined. There were 251 such cultures, of these 52 were abnormal, and required antibiotic treatment. All abnormal urine cultures were examined for pathogen identity, and susceptibility data. Pathogens were stratified by species and their susceptibility to commonly utilized antibiotics was aggregated and expressed as a percentage. This analysis did not distinguish between intermediate and resistant strains of bacteria, both results were marked resistant. There were 3 patients that presented with repeat cultures. Two of these patients presented with a single species of bacteria on follow-up cultures, and subsequent samples were excluded. One patient presented with two different urine cultures at different points in the year, and both samples were included. When stratified based on species, only E. Coli, with 30 unique samples, presented enough statistical power for analysis. We compared community and hospital pediatric antibiograms and found no statistical difference in susceptibility in E. Coli. However, analysis showed significant difference between both pediatric antibiograms and the inpatient adult antibiogram. We found significant difference in susceptibility between samples for ampicillin 11%, ampicillin-sulbactam 34%, tetracycline 21%, levofloxacin 21%, and Trimethoprim-sulfamethoxazole 12%. The adult antibiogram demonstrated lower susceptibility against all of these antibiotics. Additional research is necessary in this area. Based on this analysis, we cannot recommend pediatric community antibiogram creation. However, the differences observed between adult and pediatric antibiograms indicate a utility for continued stratification of antibiograms by age.

No description available.

Background: This systematic review aimed to identify factors related to psychological distress in family members of pediatric cancer patients on active treatment. Methods: Search strategies were entered into six academic databases. Randomized, nonrandomized, quantitative descriptive and mixed method studies, examining factors related to psychological distress in the population of study were included. Identified factors were coded as per the 4P’s of case formulation. Results: 59 studies were included. Parental factors identified: 24 predisposing factors; 12 precipitating factors; 35 perpetuating factors; and six protective factors. Sibling factors identified: five predisposing factors; one precipitating factor; 14 perpetuating factors; and two protective factors. A text-based, narrative synthesis and tabular summaries are presented. Discussion: Findings can support the: (1) recognition of distress exhibited in family members; and (2) the timing of interventions specific to the chronological manifestations of distress. Assessment of risk of bias was not done. Other: International Prospective Register for Systematic Reviews (PROSPERO) registration number CRD42018109802. No sources of funding to declare.

No description available.

Objective: The aim of this study was to assess the relation between family functioning and children's response to treatment for overweight in a primary care setting. Methods: Sixty predominantly African American (72%) parents of children who are overweight were recruited from a pediatric outpatient clinic to provide information about family functioning. Children's success in treatment was tracked through medical chart review. Results: Parents' baseline self-report of family adaptability was associated with child body mass index z-scores (zBMI) at 3-month follow-up, although this association was no longer significant once baseline child zBMI was taken into account. Conclusions: Families with greater ability to adopt/implement changes may have children who do better in weight loss treatment. This preliminary study provides a model for integrating family systems ideas into pediatric overweight research and offers heuristic value as well as directions for future research in primary care settings.

Indiana University-Purdue University Indianapolis (IUPUI) / Dietary recommendations concerning chocolate milk remain controversial since the effect of chocolate milk on the dental caries process is not clear. Cocoa with antibacterial and enamel-solubility-reducing properties may inhibit the formation of dental caries. Since chocolate milk contains a significant amount of sucrose (about 5 percent) and some cocoa (1 percent), laboratory testing of the cariogenicity of chocolate milk seems valuable. The present study investigated whether or not under mouth simulation conditions chocolate milk influenced the formation of dental caries compared to white milk. A control solution, four milk solutions and a milk solution with toothbrushing were tested over a 20-week experimental period. A mouth-like environment was established by constructing a mouth simulating device. One-hundred- and-sixty-two-teeth were mounted in the mouth simulator in six groups of 27 teeth each. Two independent evaluators had certified the teeth to be caries-free and a computer program was used to ensure complete randomization of the teeth in groups. After initial sterilization by ethylene oxide, the teeth were inoculated with a mixture of a culture of Streptococcus mutans and saliva. Each group was exposed to one of the milk formulations for a 15 minute period twice daily. After each period, a sterile bacterial medium was dripped (8 to 12 mls/hr) over the teeth in the mouth-like environment. After 20 weeks the teeth were separated, coded, and re-evaluated for pit and fissure caries by the same two evaluators. A statistical analysis by Repeated t Tests indicated the presence of three levels of relative cariogenicity: the chocolate milk group had the highest caries rate, the control group and the white milk group were intermediate and the chocolate milk with brushing group showed a marked reduction in dental caries. The results of two other groups were invalidated. In summary, for pit and fissure dental caries under the conditions tested in the mouth simulating device, chocolate milk exhibited a significant cariogenic potential relative to white milk, especially in the early incipient caries stage. It may be concluded from this study that in an individual with high dental caries susceptibility, it would seem unwise to recommend frequent ingestion of chocolate milk, unless proper and immediate oral hygiene follows the ingestion.

Sleep disorders are highly prevalent in children and adolescents, affecting approximately 25-40% of this population. Questions about sleep are among the most frequent concerns that parents raise to their child’s pediatric medical provider. Behavioral treatments are the empirically supported treatments for addressing behavioral disordered sleep, and pediatric medical providers often endorse using such strategies. However, given the time constraints of primary care visits, such strategies are delivered in a very brief format. Whether or not these recommendations result in a change in the child’s disordered sleep symptoms has not been explored. Further, it is likely that this brief recommendation format is effective for some patients but not others. For example, children with comorbid neurodevelopmental conditions, severe sleep problems, and anxiety are less likely to respond to brief sleep interventions, and, therefore, may require a more comprehensive, time-intensive behavioral intervention. The current study aimed to explore factors related to the efficacy of a brief behavioral intervention provided via telehealth. Thirteen parents completed all portions of the study. Three were parents of children between the ages of 8 to 15 years and 10 were parents of children between the ages of 4 to 7 years (M = 6.8; SD = 2.7). All parents identified as White mothers. All children were also identified as White with 38.5% being female. Due to small sample size, quantitative analyses were not appropriate, so a qualitative examination of the data was conducted to explore relationships among participant demographics, sleep hygiene behaviors, sleep knowledge, sleep symptom severity, anxiety symptoms, and effects of the intervention. Results indicated that 37.50% of parents accurately assessed whether their child had problematic sleep. Minor variations in sleep knowledge were observed between parents who accurately identified their child’s sleep problems and those who did not (7.67 and 6.40 out of 10, respectively). Overall, participants had an average initial sleep knowledge score of 6.68, an average follow up sleep knowledge score of 7.31, and an average change in knowledge score of 0.62. Regarding effects of the intervention on sleep symptom severity, the average initial sleep symptom severity score was 50.25, the average follow up sleep severity score was 48.77, and the average change in sleep severity score was -2.00. An examination of sleep hygiene characteristics highlighted that while 81.25% of participants endorsed having a bedtime routine, almost 70% reported that the routine included an electronic device. Differences in initial sleep symptom severity and sleep knowledge scores were noted between participants who did and did not include electronic devices in their bedtime routines. The clinical implications of these findings are discussed further. Differences in intervention efficacy between participants with and without ADHD was also examined, but differences were not apparent. Intervention acceptability and feasibility were also examined. The current study demonstrated that the intervention was feasible to deliver for most participants within 10 minutes and, therefore, would be conducive to a primary care setting. Additionally, parents reported high levels of satisfaction with the content, understandability, and comprehensiveness of the treatment, which is encouraging for parents’ willingness to utilize the intervention if it was available to them. This study acted as an important initial step to determining the feasibility and acceptability of a brief behavioral sleep intervention. Clinical implications and future directions are discussed.

Siblings of children with cancer are exposed to significant stress and experience challenges in many aspects of their lives throughout the pediatric cancer trajectory. As a result, siblings are at risk for acute and long-term psychosocial consequences and must be provided with appropriate supportive services during and after cancer treatment. At this time, there are no evidence-based standards to guide the supportive care of siblings of children with cancer. The purpose of this study was to explore and develop an understanding of the different ways in which siblings of children with cancer perceive their psychosocial needs are addressed from formal and informal sources. A qualitative interpretive descriptive methodology was used in the study design. Data were collected from a sample of ten siblings in Ontario whose siblings were diagnosed and treated for pediatric cancer within the past ten years. The data collection methods included semi-structured individual interviews, socio-demographic questionnaires, field notes, and the researcher’s reflexivity journal. A reflexive thematic and inductive approach was used for the analysis of the collected data. The study findings highlight that there are significant gaps in the psychosocial support provided to siblings of children with cancer. Four overarching issues were identified, including: (1) siblings’ isolation from the pediatric cancer experience, (2) limited parental awareness of siblings’ psychosocial needs, (3) needs for consistent academic and school support, and (4) needs for standardized psychosocial support from healthcare professionals and hospital systems. The study findings provide several implications for clinical practice, policy, education, and research for nurses and other healthcare professionals working in pediatric oncology settings. Recommendations include: (1) integration of psychosocial care for siblings into clinical practice, (2) development of evidence-based standards and guidelines for the psychosocial support of siblings, (3) ongoing education and training for healthcare professionals related to siblings’ psychosocial healthcare needs, and (4) additional research on standardized screening tools and interventions for siblings. / Thesis / Master of Science in Nursing (MSN)