Published on in CHOP News
More than 200 experts from Children’s Hospital of Philadelphia (CHOP) traveled to Baltimore for this year’s Pediatric Academic Societies Meeting. The gathering brought together thousands of pediatricians and other healthcare providers united by a common mission: to improve the health and well-being of children worldwide. Presentations covered issues of interest to generalists, as well as topics critical to many specialty and subspecialty areas.
CHOP also congratulates Dr. Barbara Schmidt, former Director of clinical research in the Division of Neonatology at CHOP, for receiving the Douglas K. Richardson Award. This award was established to honor Dr. Douglas K. Richardson’s contributions to child health services, perinatal and pediatric research, and the Society for Pediatric Research, and honors the lifetime achievement of an investigator who has made substantive contributions in child health.
Specific CHOP presentation highlights included:
Web Cameras May Help Reduce Stress for Parents with Babies in NICU
As telehealth technologies become increasingly common in healthcare, new findings show that bedside web camera interventions could potentially reduce stress in parents with a child hospitalized in the neonatal intensive care unit (NICU), according to a study led by Katherine Guttmann, MD, fellow in Neonatology at CHOP.
Though the potential of telehealth technologies is clear, little is known about the impact on parent stress levels, particularly in the NICU, where depression and anxiety levels are generally high. In this study, a total of 114 parents completed the Parental Stress Scale survey while their babies were hospitalized at seven to 10 days of admission. Of the 48 parents who reported whether or not they had used a bedside camera, 21 (44%) had used one, and those parents reported lower levels of stress related to the sights and sounds of the unit, the appearance of the baby, and their relationship with the infant and the parental role. These parents also reported significantly less stress related to being separated from their babies than those who did not use a camera.
While these findings warrant further study to assess their impact on other factors such as sleep disturbances and fatigue, the study team says that units may want to consider web cameras in order to increase family-centeredness of care.
Infants Exposed to Opiates In Utero More Likely to Use Health Care
Opiate use by pregnant mothers can result in neonatal abstinence syndrome (NAS), a group of conditions caused when a baby suffers withdrawal symptoms from certain drugs that she or he was exposed to in the womb. Scott A. Lorch, MD, attending neonatologist at CHOP, and colleagues, studied the association of exposure to long-term maternal opiates (LTOE) and NAS on hospital admissions, emergency department visits, and outpatient provider visits compared with infants without similar opiate exposure.
Using Medicaid data for 813,334 patients from 19 states, the study team found that 4.82% of the cohort was diagnosed with LTOE and 0.5% of infants had NAS. Opiate-exposed infants had higher rates of hospital admissions by 30 days after discharge, and LTOE infants had more emergency department visits. In a multivariable analysis, LTOE infants had higher 30-day readmission risk from any cause, and this remained elevated through the first year after being discharged, and both LTOE and NAS infants had more emergency departments and total visits during that first year after being discharged. Hospitalizations and emergency department visits for abuse and neglect were also elevated in both opiate exposed groups.
Lorch and colleagues suggest careful monitoring and transitioning the care of these high-risk infants is needed to minimize their use of healthcare in the first year of life.
Caregivers Hold Many Inaccurate Beliefs about Influenza Vaccination
More than 90% of caregivers believe their child would be protected with only one flu shot, even though many children between 6 months and 8 years of age need two doses, according to the findings of a collaborative study involving CHOP, Columbia University Irving Medical Center, and the Pediatric Research in Office Settings Network of the American Academy of Pediatrics.
The study assessed vaccine hesitancy and influenza disease and vaccine beliefs among 256 caregivers from across the country of children who received the first of the two required influenza vaccine doses.
Even after their child received the first of the two required influenza vaccine doses, 12% of caregivers reported moderate or high vaccine hesitancy and held the following inaccurate beliefs: “flu is just a bad cold” (40%); child will be protected with “only one flu shot” (94%); “flu shot causes the flu” (57%); and children cannot “die from the flu” (68%). “These findings emphasize the importance of promoting the second dose of influenza vaccination and educating caregivers about influenza disease and vaccination before and after they agree to the first dose,” said study lead author Ekaterina Nekrasova, MPH, research assistant at PolicyLab and the Center for Pediatric Clinical Effectiveness at CHOP.
Practitioners Describe Strategies, Barriers to Improve HPV Vaccination Coverage
Despite the availability of a safe and effective HPV vaccine since 2006, coverage rates are lower than coverage for other adolescent vaccinations, leaving adolescents susceptible to this cancer- causing virus. Alex Fiks, MD, MSCE, pediatrician and Associate Director of CHOP’s Center for Pediatric Clinical Effectiveness (CPCE) and Director of the American Academy of Pediatrics Pediatric Research in Office Settings (PROS) network, and colleagues examined the barriers to HPV vaccination and the strategies used to improve vaccination rates.
In a sample of 47 pediatric primary care practitioners (including both pediatricians and nurse practitioners) from 19 states, all reported at least one barrier to HPV vaccination. The most common barrier reported by practitioners was parent refusal or delay, cited by more than 80% of those surveyed. Other major barriers included insufficient time to discuss HPV vaccination with families, a lower proportion of adolescents coming in for well visits, lack of training in providing a strong practitioner recommendation, views of some practitioners that the HPV vaccination can wait, and challenges associated with administering the vaccine at acute or chronic care visits.
Approximately 89% of practitioners reported using prompts when HPV vaccination is needed, and 87% commonly use tools to improve communication about HPV vaccination with parents and adolescents. However, only 17% of practitioners used reminder-recall messages specific to the HPV vaccine. While a wide variety of strategies are being used, even more can be done to bolster HPV vaccination coverage.
Implementing an Adult-Like Sepsis Score for Pediatric Patients Appears Feasible
The Sequential Organ Failure Assessment (SOFA) score is used to define sepsis in adult patients, with a score of at least 2 indicating a sepsis infection. A pediatric version of this scoring system (pSOFA) is available. Fran Balamuth, MD, PhD, attending physician and Associate Director of research in the Emergency Department, and colleagues evaluated the use of the pSOFA score in the emergency department (ED) as a predictor of mortality in all patients and specifically in patients with a suspected sepsis infection.
In retrospective data from seven children’s hospitals in the United States collected between 2012 and 2018, pSOFA scores ranged from 0 to 14. Patients with a score of at least 2 were 31.8 times more likely to die from sepsis compared with patients with a lower score. These patients also had a longer length of stay in the ED. Of 490,388 patients with suspected infection, 6.2% had sepsis and 0.03% had septic shock.
Overall, a pSOFA score of at least 2 was uncommon but associated with increased mortality, and the scoring system fairly discriminated for hospital mortality among all ED visits.
Treatment with Intrapartum Antibiotics Linked to Higher Weight Gain in Children
Intrapartum antibiotics are given during labor to prevent or reduce the risks associated with Group B Streptococcus disease. However, because these antibiotics can impact the gut microbiota during the critical prenatal period, they have been associated with abnormal weight gain in preclinical models. Since human studies did not find a conclusive relationship, Sagori Mukhopadhyay, MD, MMSc, attending neonatologist at CHOP Newborn Care at Pennsylvania Hospital, and colleagues conducted a large, retrospective study to determine if an association existed.
The study team found that neonatal antibiotic exposure was significantly associated with increased weight gain and BMI. Specifically, intrapartum antibiotic prophylaxis was significantly associated with increased weight gain and BMI among both vaginal and cesarean births.
Mukhopadhyay and colleagues stressed that these findings must be balanced against the morbidity and mortality from GBS infection, and suggest a need to develop other approaches for preventing GBS that might not lead to weight gain.
Intervention Strategies Needed for Extremely Premature Infants with Late-Onset Sepsis
Despite prevention strategies that have been attempted, the incidence of late-onset Group B Streptococcus disease (LOGBS) has not changed. To develop better vaccine development for sepsis, researchers at CHOP led by Karen M. Puopolo, MD, PhD, attending neonatologist, studied the impact of LOGBS in extremely preterm infants.
In this retrospective study, the team observed that clinical complications were most frequent in infants with non-GBS late-onset sepsis, while infants with LOGBS were more likely to have suffered early-onset GBS disease. The first episode of late-onset sepsis occurred at a later age for infants with LOGBS than with non-GBS late-onset sepsis infants. Among infants who survived for more than 30 days, the risk of death was significantly increased for infants with LOGBS compared with infants who did not have late-onset sepsis.
Nearly half of the infants with LOGBS either died or survived, but with neurodevelopmental impairment, which is what has been observed to infants with late-onset sepsis from other causes. The study team suggests developing preventive strategies like maternal vaccination or targeted immune therapies to help this vulnerable group of infants.
Arterial Stiffness Found in Youth with Hypertension Can Impair Cardiac Function
An increase in arterial stiffness has been linked to elevated blood pressure and hard cardiovascular events, such as myocardial infarction or sudden cardiac death, in adults. A study team led by Kevin E. Meyers, MBBCh, Assistant Chief of the Division of Nephrology and Co-Director of the Lupus Integrated Nephritis Clinic at CHOP, evaluated if the blood pressure-related increased stiffness posed the same risk to youth with hypertension.
Among 347 adolescents, higher pulse wave velocity (PWV), a measure of arterial stiffness, increased among mid- and high-risk groups in the study, defined by higher blood pressure levels. Higher PWV correlated with higher blood pressure and lower systolic strain and diastolic function. The study team concluded that arterial stiffness can be found in youth and can impact cardiac function, meaning that strategies to control blood pressure are needed to reduce the risk of cardiac events.
Continuous Glucose Monitoring Systems Help Monitor Glycemic Control in Children with Congenital Hyperinsulinism
Using a continuous glucose monitoring system (CGMS) is an accurate and effective method for monitoring glycemic control in children with congenital hyperinsulinism (HI), according to a study led by Diva D. De León-Crutchlow, MD, MSCE, Chief of Endocrinology and Diabetes and Director of the Congenital Hyperinsulinism Center at CHOP.
Congenital HI is the most common cause of persistent hypoglycemia in infants and children. Currently, monitoring involves measuring plasma glucose four to six times daily using handheld glucose meters. However, this method does not provide a comprehensive assessment of glycemic control.
The team studied 14 patients between ages 15 and 67 months. The sensitivity and specificity of CGMS and its ability to detect hypoglycemia were 86% and 81.4%, respectively. The positive predictive values for hypoglycemia and severe hypoglycemia were low, while the negative predictive values were high. The study team concluded that CGMS can be useful in detecting hypoglycemia and can prevent unnecessary checks by glucose meter. However, a glucose meter is still needed to confirm CGMS-detected hypoglycemia because of the high number of false positives, suggesting that the main benefit of CGMS is in guiding the need to check plasma glucose by a glucose meter rather than accuracy.
Contact: Natalie Solimeo, The Children’s Hospital of Philadelphia, 267-426-6246 or email@example.com