Pediatrics & Women's Health

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    Unassigned Albuterol Legislation
    (2023) Murthy, Bharati; Chaudhari, Sampada; George, Kevin
    Introduction: Asthma is a reversible chronic obstructive lung disease that affects over 6 million children ages 0-17 in the United States. An asthma attack is sudden and can be triggered by allergens such as mold, dust, cold weather, or tobacco. An asthma attack leads to airway narrowing through smooth muscle constriction, excess mucous production, and inflammation. Symptoms include chest tightness, wheezing, and anxiety. Acute asthma symptoms are commonly managed through short-acting beta agonists (SABA) like albuterol and best practice guidelines recommend these medications always be available to those with the condition. However, data suggests that only 20% of students with a diagnosis of asthma have access to albuterol in schools. To increase access to SABA among students experiencing respiratory distress, schools may "stock” albuterol and adopt standing delegation orders issued by a consulting physician. This is referred to as "unassigned albuterol.” According to the Asthma and Allergy Foundation of America (AAFA), there are 14 states with legislation in place regarding the use and administration of unassigned albuterol in K-12 schools. In 2021, national professional organizations endorsed guidelines that identified 4 essential components and 4 recommended components for state legislation regarding unassigned albuterol. The purpose of this study is to investigate alignment of existing state legislation with the 2021 national guidelines. Methods: The stock albuterol legislation was obtained from each state’s online repository of legislation and systematically reviewed by two independent researchers to assess whether or not it was aligned with each of the essential and suggested components of the national guidelines. Where there was lack of consensus on alignment, the component was reviewed by the full research team. A matrix was created presenting these findings. Results: From our comparative analysis of the fourteen states that currently have legislation for unassigned albuterol administration, we observed a widespread lack of alignment with national guidelines. All states had at least one essential or recommended component that was not aligned with guidelines. States ranged from a low of one misaligned component, to a high of six misaligned components. Among essential components of the guidelines, the recommendation for training was particularly problematic as it was only fully addressed by three states, was partially addressed by 8 states, and unaddressed by three states. Conclusion: This study highlights the lack of alignment between existing state legislation and national guidelines. It also highlights the importance of national guidelines to inform policy that supports implementation of best practice. For those 36 states that have not yet established legislation for unassigned albuterol, these results may help identify potential models for policy that aligns with national guidelines and supports best practice to meet the needs of children with asthma at school. Additionally, results suggest that training requirements for school health staff may benefit from greater attention from state and national stakeholders responsible for school asthma services, and by those involved in policy.
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    Control Case Study: E-Health Text Messaging Based Intervention on Developing Lifestyle Changes Related to the Improvement of Childhood Obesity
    (2023) Patel, Kavita; Robinson, Christina
    Background: The prevalence of chronic diseases in the United States including heart disease and cancer is majorly attributable to adverse lifestyle factors such as smoking, physical inactivity, poor diet, stress, negative emotion, etc. (CDC, 2012). Recent studies have shown that mothers with unhealthy lifestyles serve as an impetus for childhood obesity (Dhana et al, 2018). Community health promotion efforts and lifestyle interventions are successful in introducing healthy behaviors and promoting its adherence (Dickinson et al., 2006; Kent et al., 2015; Pekmezi, Marquez, & Marcus-Blank, 2010; Tucker et al., 2014; Tucker et al., 2016). Our study evaluates the utilization of an E-health text message system as an effective intervention for caregivers of obese pediatric patients to improve lifestyle behaviors that influence childhood obesity. Case Presentation: A 30 year old African American female presented to the Pediatric Mobile Clinic with her 3 year old child who had a BMI in the 82nd percentile. The caregiver and child met the inclusion and exclusion criteria including adequate biometric markers before they were randomized to one of 2 intervention arms: control health group or e-health group. This subject was randomized into the control intervention arm. Participants of the control arm received weekly text messages for 6 months inquiring subjects on any SMART goal and duration of their choosing as well as assessing their motivation and confidence related to that goal (scored on a scale of 10). They also received follow-up messages asking introspective questions regarding habit formation and messages with self-scripted inspirational statements. The intervention arm differed in that the SMART goal chosen by subjects had to focus on one of six lifestyle medicine factors emphasized for that week's duration. The SMART goals input by this subject centered on improving the outlook, organization, and control of her finances and career. The subject's motivation scores were similar to her confidence scores for each specific goal even though they varied overall. More importantly, both scores trended upwards within self chosen goal periods lasting ≥ 3 weeks. Additionally, a common theme emphasized in the subject’s responses to introspective questions regarding her goals focused on maintaining "positivity”. The patient indicated a 7/10 on her 6-month exit survey, highlighting that the program "somewhat” supported the patient on a road to wellness by helping her "break things down into achievable goals each week”. Conclusions: This case illustrates the role an E-health intervention program had in helping the patient construct and keep track of achievable goals. The program was still beneficial to the control-intervention arm subject as indicated by her exit survey. Observed increases in confidence and motivation scores within prolonged goal periods highlights the impact this program had in establishing the self-accountability necessary for conceiving new goals and maintaining consistency. In effect, this case emphasizes how the intervention aids in promoting a subject’s intrinsic motivation in relation to the development of their goals and eventual habits. Overall, this case suggests that having any intervention in place, even to the degree involved within case controls, is significant compared to no intervention.
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    Investigating Geographic Information System integration of health service, community resource, and medical education data for collaboration to improve rural pediatric asthma outcomes
    (2023) De Arrigunaga, Juan; Allsopp, Leslie C.; Tadesse, Meron
    Purpose: Rural children are at a disadvantage when it comes to health, health care accessibility, education, environmental exposures, and socioeconomic status (SES). These factors contribute to rural-urban disparities in pediatric chronic health conditions such as obesity and asthma. With respect to asthma, emergency department (ED) visits are adverse outcomes that indicate poor control and inadequate preventive care. Community asthma programs are effective at enhancing services to improve asthma outcomes, but evidence suggests there is a lack of such programs in rural areas. Geographic Information Systems (GIS) are recognized as potentially powerful tools to guide the development of community health interventions, but there has been limited application of this method to address pediatric asthma disparities, especially in rural areas. The purpose of this study is to investigate the application of GIS to integrate pediatric asthma ED visit rates, community health resources, and Rural Osteopathic Medicine Clinical Training Sites (ROME) to identify potential sites for collaborative initiatives to improve rural pediatric asthma outcomes. Methods: This study utilized ESRI ArcGIS software for mapping and preliminary spatial analysis. Through the Texas Department of State Health Services and internal resources, we obtained 2020, age-adjusted child and adolescent asthma emergency department visit rates (per 10,000), Rural Osteopathic Medical Education (ROME) Clinical Training and Preceptor Sites, current Community Health Worker (CHW) Training Sites, and location of Texas Critical Access Hospitals (CAHs). Using GIS spatial analysis tools, statistically significant areas with high pediatric asthma ED rates were identified. ROME and CHW within these areas were then located for potential collaboration. Results: Through mapping visualization, the counties of Johnson, Coryell, Bell, McLennan, Lubbock, and Hale were identified as potential sites for collaboration to improve pediatric asthma. Conclusion: Application of GIS can be utilized to identify spatial health inequalities and form coalitions for improvement. This study has identified potential ROME Clinical Training Sites and Community Health Worker Training Sites that are in areas with elevated rates of inadequate pediatric asthma management and adverse outcomes. Visualization of elevated pediatric asthma ED rates (suggesting a prevalence of uncontrolled pediatric asthma) helps to prioritize collaboration to improve rural pediatric asthma outcomes.
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    Polyglandular Autoimmunity: Two Cases of Type 1 diabetes (T1D) accompanied by Addison’s disease (AD)
    (2023) Borrego, Natali; Bommakanti, Maalini; Radack, Jill; Hamilton, Luke; Wilson, Don
    Background: Type 1 diabetes (T1D), present in ~1:500 children, is often accompanied by other autoimmune conditions, notably chronic lymphocytic thyroiditis. Involvement of other endocrine organs, however, is rare. Autoimmune impairment of more than one endocrine system is referred to as an autoimmune polyglandular syndrome (APS), categorized as type 1 (APS-1) or type 2 (APS-2). In addition to T1D, APS-1 is characterized by 1 or more of the following: candidiasis, hypoparathyroidism, and/or AD; while APS-2 involves AD and/or chronic thyroiditis2. The lifetime risk of developing a 2nd endocrine autoimmune condition in individuals with T1D is ~1:5, and usually occurs during adulthood. While children may be affected, such reports are unusual and generally limited to case studies. APS-2 is rare in childhood, with a prevalence of ~ 1:100,0004. We present two children with APS-2. Case Information: Case 1: A 6-year-old Caucasian male, who was diagnosed with T1D at 3 years-of-age, presented with persistent vomiting which required hospitalization. Although his diabetes was reasonably well controlled prior to his hospitalization, the child was noted to be overly sensitive to insulin during this admission, during which he experienced several episodes of hypoglycemia. Laboratory testing revealed metabolic acidosis, hyponatremia, and hypocortisolemia. Appropriate testing confirmed primary adrenal insufficiency; the latter, along with his T1D, being consistent with APS-2. Case 2: A 15-year-old Caucasian male experienced an unexplained 20 lb. weight loss. After developing fever, routine laboratory tests were reported to be characteristic of diabetic ketoacidosis (DKA) - hyponatremia, metabolic acidosis and hyperglycemia. With treatment, his DKA resolved, and he began conventional insulin therapy. However, follow-up laboratory tests demonstrated persistent hyponatremia. Additional studies confirmed the presence of AD, consistent with APS-2. Conclusion: These previously healthy children developed T1D accompanied by AD, characteristic of APS-2. The presence of both conditions significantly increases the risk of potential life-threatening complications in affected children5. Individuals with both T1D and AD have a 2.5-fold increased risk of adrenal crises, compared to those with isolated AD6. Timely diagnosis of polyglandular autoimmunity is critical to help inform clinical decision-making, and to avoid adverse outcomes. The diagnosis of APS is often hampered by common symptoms such as: fatigue and weakness, unexplained weight loss, increased thirst, frequent urination, irritability, nausea and abdominal pain, and changes in appetite2. Management is complicated by the effects of glucocorticoid levels on insulin sensitivity. For example, these patients have a risk of increased insulin sensitivity and hypoglycemia in the early morning hours prior to the next glucocorticoid dose1. Patient education is key for understanding the interactions between the two conditions as well as the effects of diet, physical activity, and emotional stress2. While the onset of APS is variable, most patients tend to develop autoimmunity sequentially over a period of many years2. APS-2 has been linked primarily to genes coding for major histocompatibility complex, particularly DR3-DQ2 and DR4-DQ8 variants6. Physicians should be vigilant in assessing children with autoimmune-related conditions, such as T1D, and although rare, aware of the potential for additional autoimmune-mediated organ failure in some.
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    An Unusual Presentation of Subcutaneous Inguinal Hematoma Mimicking Ovarian Torsion: A Case Report and Review of Literature
    (2023) Panzanaro, Victoria; Stallworth, Chrystal; Kremer, Timothy
    Background: Ovarian torsion is a condition in which an ovary rotates around one of the supporting ligaments that provides stabilization and perfusion in the pelvis, and can present as a medical emergency due to the rotation hindering blood flow. This is most often the infundibulopelvic (IP) ligament which connects the ovary to the lateral pelvic wall, but can also occur with other ligaments as well. Inguinal hematomas tend to present as a post-operative finding due to procedures such as inguinal hernia repairs. However, there are little to no reported occurrences of ovarian torsion presenting with inguinal hematoma. Case Presentation: A 36 year-old female presented to the emergency department with a chief complaint of left lower pelvic pain presenting with a large inguinal hematoma which had occurred two days earlier after intercourse. The patient stated she has a history of inguinal hematomas occurring after intercourse, however she stated that the bruising from this incidence was larger, more painful, and longer lasting than previous occurrences. Patient history includes a hysterectomy with bilateral salpingectomy and a left ovarian cyst that still remained. All laboratory values were unremarkable and vital signs were within normal limits. Using transvaginal ultrasound arterial blood flow to the left ovary was difficult to visualize, however venous blood flow was accounted for. The patient was suspected to have a left ovarian torsion and underwent a diagnostic laparoscopy. The decision was also made with the patient to perform a left oophorectomy due to her left ovarian cyst which can increase the occurrence of ovarian torsion, and was most likely contributing to her recurrence of this type of injury. At the time of surgery, the laparoscopy revealed that the left ovary was not extensively torsed and was adequately perfused. However, during the procedure an aberrant vessel was identified branching off of the IP ligament and terminating along the pelvic wall at the same location in which the inguinal hematoma was presenting externally. This aberrant vessel was ligated via electrocautery, and the patient tolerated the rest of the surgery without complications. The patient recovered and was discharged home with two week and two month follow-up appointments scheduled. These follow-up appointments revealed that her inguinal hematoma and pelvic pain resolved completely and that there was no negative impact to ligating the vessel. Conclusion: This case investigates a cause of pelvic pain due to aberrant vessels which can present similarly to a case of ovarian torsion. This case serves to provide a possible etiology of pelvic pain presenting with inguinal hematoma, in which there are not many situations similar to this case in the current literature.
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    E-Health Text Messaging based Intervention on Healthy Lifestyle Changes and Obesity in the Socioeconomically Disadvantaged Population
    (2023) Hussain, Rumaila; Robinson, Christina
    The obesity epidemic, known to be a multifactorial medical condition, in the United States has been declared a public health crisis. Parental obesity more than doubles the risk of adult obesity among both obese and nonobese children under 10 years of age. (Whitaker, Wright et al. 1997) Naturally, parents are often the strongest role models of their young children, who tend to imitate their eating behaviors as well as other lifestyle behaviors. (Lubna, Paloma et al. 2021) Therefore, it is of paramount importance to have upstream intervention programs to make positive changes in the obesity-promoting lifestyle behaviors of parents that often contribute to. The e-health text messaging platform integrated six major contributing factors of obesity, which included caloric content and quality of diet, physical activity, sleep, social connection, tobacco, and stress management. We hypothesized that if we could change the attitudes, knowledge, and beliefs of the caregivers, then this would cause a ripple effect leading to their children adopting the same healthy lifestyles, thereby decreasing the prevalence of the obesity epidemic. Subject 4 is a Black or African American female who was part of the intervention arm which received text messages every week for 6 months which included health education on 6 different topics. The participant was surveyed biweekly about her knowledge, attitudes, and behaviors regarding health education topics via text messages. Throughout the study, subject 4 showed high motivation to make positive changes in her life. Her goals consisted of sleeping 8 hours a night, staying hydrated, exercising 30 minutes daily, meditating, praying, and decreasing her sugar intake. Subject 4 mentioned that "consistency” and "accountability” are what motivated her. The platform was able to give her a sense of accountability by ensuring that she was staying consistent by monitoring her progress toward her goals. She mentioned that having goals for her habits impacted her health and wellness by keeping her "consistent.” She indicated that the program greatly supported her on her road to wellness at the end of the study and "it had helped her to stay positive and to leave bad habits.” At the 9 and 12-month follow-ups, she indicated on a scale of 1 to 10 (10 being the most consistent), 10 and 8 respectively, that she was continuing her goals/habits that she had formed to support herself on her road to wellness. This case illustrates that an e-health intervention program may benefit individuals by providing a platform where they can create personal goals, have a form of accountability that encourages them to make small changes by providing health literate education briefs, and provides a connection to local community resources to support participants to reach their goals. Additionally, this intervention program showed a beneficial impact on the subject’s wellness as indicated by the post-survey responses. This highlights that having an intervention program may be a step in the right direction to making small positive lifestyle changes and eradicating the obesity epidemic one family at a time.
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    Pediatric Weight Gain Rates in Fort Worth, TX Due to the COVID-19 Pandemic
    (2023) Elashyi, Tamer; Fernando, Shane; Matches, Sarah
    Background: Childhood obesity is already a problem in the United States, with one out of three children being overweight or obese and one out of six being obese. The consequences from the COVID-19 lockdown seemed to have progressed into something bigger. During the pandemic, added stress amongst the pediatric population dramatically increased causing this population to snack more and exercise less. This change in eating habits and behaviors can have long term implications on their health currently and in the future. Methods: Data from the outpatient Pediatric and Health Clinic at UNTHSC in Fort Worth, TX from January 2018 to May 2022 was used to assess this effect. Average weight gain year to year was computed and compiled for several zip codes in the North Texas area. The average weight gain was calculated based on the children’s age, sex, zip code and their ethnicity and race. Results : Within each variable the average weight gain had increased year to year. The average weight gain amongst the pediatric population in this study increased to 16.13% compared to 13.92% pre-pandemic. The increased weight gains are cumulative with each year, as with each year they are adding more weight on top of the weight they had gained the previous year. When we calculate the percent weight gain in specific age groups and genders, we see a higher increase in weight gain, with male children gaining more weight on average compared to females. When looking at different zip codes, we see greater increases in weight gain related to lower household incomes. Boyd had an average of 34.87% increase in weight post pandemic compared to 13.91% pre-pandemic. Conclusion: The increased weight gain leads to an increase in obesity rates among the pediatric population and the future adult population. This will burden our healthcare system now and more so in the future. Further research needs to be conducted on the health disparities between different ethnicities and races and average household incomes.
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    Symptomatic Rathke’s Cleft Cyst in a Pediatric Patient: A Case Report
    (2023) Fajkus, Austin; Jain, Kunal; Hafeez, Raheela
    Background: A Rathke’s cleft cyst (RCC) is an epithelium-lined intrasellar benign growth believed to originate from remnants of the Rathke’s pouch. It is commonly believed that the cleft regresses during embryologic development, and the persistence and enlargement of the cleft lead to the formation of RCC. However, other theories have been proposed to explain their exact origins, such as derivation from the neuroepithelium or endoderm, or metaplastic anterior pituitary cells.1 Based on autopsies, asymptomatic RCC is relatively common, being detected in 2-26% of individuals. Symptomatic cysts, on the other hand, are rare, with approximately 150 cases reported.1 Symptoms of RCC arise from cyst enlargement and compression of the optic chiasm, the pituitary gland/stalk, and/or the hypothalamus. According to the Eguchi study, visual symptoms were present in 47% of patients.2 Transsphenoidal surgery is the most common approach to treat RCC, in which the cyst is partially excised and drained. This method preserves the pituitary function and has been effective in reducing symptoms.1 This case report details a child with symptomatic RCC exacerbated by traumatic brain injury (TBI) and discusses the radiographic findings. Case Information: A 14-year-old female with a past medical history of one prior concussion several years ago and lifelong occasional headaches, presented two weeks following a head injury during a basketball game. The patient fell while playing basketball and hit her head. She denied any loss of consciousness. The patient has had headaches in the past, but since the injury, the headaches have increased in frequency. They now occur multiple times a day with each episode lasting about 15 minutes, and the pain is localized to the retroorbital and bilateral temporal regions. The patient has lifelong vision issues which have also worsened since the injury. She also reports photophobia, fatigue, anxiety, trouble breathing, and difficulty focusing during school. The photophobia is so intense that she must wear sunglasses all the time, even during class. A pertinent physical exam revealed flattening of the right nasolabial fold and protruding tongue deviation to the right, suggesting possible facial (CN VII) and hypoglossal (CN XII) cranial nerve involvement. Magnetic Resonance Imaging (MRI) revealed an RCC and brain capillary telangiectasia versus hemosiderin deposition in the setting of traumatic brain injury. The patient was urgently referred to neurology and neurosurgery following imaging results, as well as optometry and ophthalmology. Despite brain and physical rest for a week, and a new prescription for glasses, her headaches and visual symptoms continued to worsen. Due to severe photophobia, persistent daily headaches, and inability to complete classwork, the patient was removed from in-person school and all sports. Neurology is currently monitoring the patient for further progression of symptoms, and she is awaiting neurosurgery and ophthalmology evaluations. Conclusion: Given the common occurrence of RCC, symptomatic RCC should always be considered when assessing patients with persistent headaches and visual field defects. Furthermore, it is important to promptly order a brain MRI and refer patients to neurology and neurosurgery to assess the need for transsphenoidal surgery.
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    Changes in cardiac oxidative stress, nitric oxide bioavailability, mitochondrial function, and blood pressure in postpartum preeclamptic rats
    (2023) Owen, Malissa; Smith, Jonna; Smith, Savanna; Jones, Kylie; Castillo, Angie; Wiemann, Natalia; McCafferty, Adair; Srivastava, Prakriti; Cunningham, Mark
    Background: Preeclampsia (PE) is characterized by new onset hypertension (HTN) during pregnancy that usually occurs in the third trimester and is associated with decreased nitric oxide (NO) bioavailability, increased oxidative stress (OS), and mitochondrial dysfunction. Postpartum (PP) PE women have an increased risk of developing HTN and cardiovascular diseases (CVD) later in life. The timing and mechanisms of this rise in blood pressure (BP) and cardiovascular dysfunction in PP PE women are unknown. Previous studies in our lab indicate that PP PE rats have HTN, increased OS, and cardiac mitochondrial dysfunction at 10 weeks (PP10) (PMID: 34727994). Our current study examines the relationship between BP and cardiac NO bioavailability, OS, and mitochondrial dysfunction at 6 weeks (PP6), an earlier time point from our previous study. We hypothesize that PP6 PE rats will have HTN, increased cardiac OS, decreased cardiac NO bioavailability, and mitochondrial dysfunction. Methods: Pregnant Sprague Dawley rats were divided into 2 groups: normal pregnant rats (NP) and PE rats, derived from the surgically induced reduced uterine perfusion pressure model of PE (RUPP). All rats gave birth, and their offspring were weaned for 3 weeks. At PP6, BP was measured via carotid catheterization and heart tissues were collected to measure heat shock protein (HSP-1) (a measure of OS), copper zinc superoxide dismutase (CuZnSOD) (an antioxidant), manganese SOD (MnSOD) (a mitochondrial specific antioxidant), endothelial NOS (eNOS) (a measure of NO producing enzyme), and electron transport chain (ETC) proteins (a measure of mitochondrial function). These quantities were obtained through Western blots. Results: BP was significantly elevated in PP RUPP vs PP NP rats (128±6 vs 106±4mmHg, p < 0.05). HSP-1 was significantly decreased in PP RUPP vs PP NP rats (88±1.51 vs 100±4.05IU/Protein/CON%, p < 0.05). CuZnSOD showed no change between the two groups while MnSOD was drastically increased in PP RUPP vs PP NP (123±2.91 vs 100±5.30IU/Protein/CON%, p < 0.05). eNOS and ETC proteins were unchanged between PP RUPP and PP NP rats. Conclusion: Contrary to our hypothesis, PP6 PE rats have HTN with no increase in cardiac OS (due to decreased HSP-1 and increased in MnSOD amount) or decrease in cardiac NO bioavailability and mitochondrial dysfunction. These observations are different from our 10-week PP PE rats and may suggest that the heart is protected at 6 weeks PP despite the increase in blood pressure. Future studies will focus on the time frame in which cardiac dysfunction occurs in PP PE rats. Additionally, studies will explore the antioxidant, NO, and mitochondrial pathways along with other cellular mechanisms that may prevent the heart from damage and/or dysfunction after a PE pregnancy. This study is clinically relevant because it will inform clinicians on the mechanisms of HTN and cardiac dysfunction in women following a PE pregnancy as well as provide insights on therapies that could be used to prevent the development of CVDs later in life for PP PE women.
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    Use of the General Movement Assessment as an Early Marker of CP
    (2023) Mistry, Nisha; Rustom, Grace
    Use of the General Movement Assessment as an Early Marker of CP Authors: Yvette R. Johnson, MD, MPH; Treka L. Rogers, CPNP-AC; Chelsea L. Sapit, CPNP-PC; Kimberly Barber, PT; Robin Grady, OT; Betsy O’Hara, OTR; Heather Hilliard, DPT; Grace Rustom; Nisha Mistry, MS; Michelle Lee, MS; Tyler Hamby, PhD Purpose: Cerebral palsy (CP) is the most common physical disability in children affecting 1 in 500 live births. The average national standard of detecting CP occurs after 2 years of age by analysis of neurological signs. Since December 2014, the NICU Early Support and care Transition (N.E.S.T.) Clinic at Cook Children’s Medical Center has provided multidisciplinary comprehensive follow-up to high-risk NICU survivors. Cook Children’s Medical Center implemented an Early CP detection program in 2019 using the General Movement Assessment (GMA) in the NICU and NEST Clinic. There has been emerging evidence that evaluation of general movements in early infancy (writhing and fidgety periods) is predictive of a future CP diagnosis in an infant. This early diagnosis is key for better neurodevelopmental outcomes. Methods: Infants who met inclusion criteria had GMA videos captured shortly after birth during the NICU stay. Infants with abnormal GMA videos had further evaluation at 3-4 months corrected gestational age, during their NEST clinic visit. The data from the NEST clinic were then compiled to include high-risk variables. Retrospective review and analysis of data previously collected for the Early CP detection program was performed under the direction of Dr. Yvette Johnson and her Early Detection Team. Univariate Cox regression analyses were performed to determine which variables were predictive of CP diagnosis. Results: There were 471 patients who met inclusion criteria, including 292 (62%) very low birth weight (VLBW), 131 (28%) hypoxic-ischemic encephalopathy (HIE), 15 (3%) congenital diaphragmatic hernia (CDH), 8 (2%) extracorporeal membrane oxygenation (ECMO), and 25 (5%) congenital heart disease (CHD) infants. Four hundred ten (87%) had GMA’s in the writhing phase and 205 (44%) had GMA’s in the fidgety phase. The median (range) age of CP diagnosis was 1.07 (0.34-1.93) years, and 91% had been diagnosed by 1.50 years. The infants with HIE had a statistically significant increased risk of CP diagnosis compared to those in the VLBW category (10% vs. 6%, HR=2.50, p=0.014). The infants with an absent or abnormal fidgety GMA interpretation during the fidgety period had a statistically significant increased risk of CP diagnosis compared to those with other interpretations (46% vs. 3%, HR=15.69, p<0.0001). Conclusion: The results showed that having an abnormal or absent fidgety general movements during the fidgety phase was a significantly strong predictor of CP outcomes. These data can be extrapolated in clinical settings to provide early and evidence-based interventions that can improve long-term functional motor outcomes.
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    Challenges in Recruitment of Young Adults Engaging in Sexual Behaviors and Alcohol Use
    (2023) Cao, Julia
    Abstract Background Young adults are at increased risk of negative outcomes, such as sexually transmitted infections and unintended pregnancies, due to alcohol use during sex, condomless sex, and inconsistent contraceptive use. We seek to adapt a brief intervention to address these health behaviors, which requires formative research with young adults engaging in alcohol use during sexual activity. Recruitment of young adults in research studies can be challenging. We examined the recruitment approaches used in this formative study to gain a deeper understanding of the challenges encountered in the recruitment of young adults for a sexual health and alcohol study to improve strategies and overcome obstacles. Methods The goal of recruitment for the formative study was to identify eligible participants through a screening survey and invite them to participate in a focus group. Inclusion criteria for the formative study were young adults aged 18-25, not in a monogamous relationship, had inconsistent contraception use or condomless sex, alcohol use during sex in the past month, and had Texas residency. The research team used several recruitment strategies: flyers, emailing community stakeholders to share materials, social media, and monetary incentives. We used the Plan Do Study Act (PDSA) cycle to examine our recruitment approaches in three cycles and reflect on the effectiveness of our recruitment methods. The effectiveness of each cycle was measured by the number of surveys that were completed, the number of eligible participants identified, and the number of resulting focus group participants. The research team reflected on challenges in each cycle. Results There were three recruitment cycles identified. Cycle 1 (January-February 2022) primarily focused on distributing flyers and contacting partner organizations to share materials with their clients; challenges included logistics, locations, and the ability to track this strategy. This cycle resulted in 253 surveys completed, 23 eligible potential participants, and 10 focus group participants. Cycle 2 (February-June 2022) incorporated social media advertising (e.g., Twitter, Craigslist, TikTok, and Reddit) to reach large audiences, but introduced issues such as social media platform policies, inauthentic survey results, and increased recruitment costs. This cycle resulted in 475 completed surveys, 10 eligible potential participants, and 1 focus group participant. Cycle 3, where inclusion criteria were broadened to increase the eligible population is preparing to launch to address these challenges. Conclusions Many challenges were identified in recruiting young adults engaging in condomless sex, ineffective contraceptive use, and alcohol use during sex to participate in this research study. Each recruitment strategy came with unique issues but a large discrepancy between audiences reached, and successful participants was constant in all strategies. Direct recruitment through partner organizations was effective but required considerable effort to ensure that the study was adequately advertised to potential participants. Social media marketing was effective in reaching large audiences but was complicated by platform advertising policies, false and repeated survey responses, and did not yield a cost-effective number of successful participants. These results suggest that broadening the inclusion criteria may increase the number of eligible participants.
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    OMT Efficacy for Chronic Pelvic Pain Secondary to a Delayed Diagnosis of Endometriosis
    (2023) Settlemyre, Destinie; Nelsen, Meaghan
    Background: Endometriosis is a gynecological disease characterized by ectopic growth of endometrial tissue. Common symptoms include dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Additionally, current research is showing an increased incidence of systemic inflammatory illnesses in those with endometriosis. Due the variability in the presentation of symptoms and location of endometrial lesions, patients are often told their symptoms are consistent with normal menstruation and their true diagnosis is significantly delayed. Recent research suggests most patient experience a 7–9-year delay in diagnosis. Furthermore, after years of these troubling symptoms, treatment is not always effective at achieving pain relief. It has been found that up to 59% of patients continue to have pain after treatment. OMT has been poorly researched in this area, but currently available research has shown success in achieving pain relief for these patients. Case Presentation: A 39-year-old female presented to the UNTHSC OMM clinic for evaluation of pelvic pain secondary to endometriosis. Though she experienced symptoms of severe dysmenorrhea and pelvic pain since menarche and dyspareunia, infertility, and other systemic inflammatory illnesses since early in her reproductive years, she was not given the diagnosis of endometriosis until she was 27, after a disproportionately painful pelvic exam prompted an ultrasound. This ultrasound revealed two endometriomas, measuring 5.7x3.6cm and 4.5x3.4cm. Six months later, after a failed trial of progesterone and continued growth of the lesions, she underwent laparoscopic removal of the cysts which confirmed the composition of these endometriomas. She was then placed on oral contraceptive pills for management of her disease. Initially these were taken to allow for monthly menstruation, and she found enough relief to make her symptoms bearable for the next six years. However, at age 34, she was advanced to continuous use due to catamenial migraines. This regimen allowed her to return to roughly 50% of her normal daily activities, though she was still limited due to chronic pelvic pain and stress-induced flare-ups. Finally in 2020, at age 39, she found the UNTHSC OMM clinic and began bi-monthly treatments for her pelvic pain. She reported that after being treated here she experienced immediate relief of her pain. This relief initially would last for roughly 1 week and then her pain would slowly return. After several months of regular visits, she was able to gradually space out her visits to as far as six months apart without breakthrough pain. Conclusion: Endometriosis is a complex disease that leads to significant pain and diminished quality of life. Not only do these patients struggle with various gynecologic symptoms and systemic inflammatory flares, but they are also left to suffer for years without a diagnosis due to their pain being attributed to normal menstruation. After finally getting their diagnosis, many patients still do not get pain relief due to the reliance on medicinal treatments. This case is a clear example of the need for more intensive education for medical professionals in both the diagnosis of endometriosis and the addition of OMT to the treatment regimen.
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    Assessment of the Pediatric Mental Health Calls Program during the COVID-19 Pandemic and Stress Findings Among Teens and Adolescents.
    (2023) Song, Joice; Bui, Priya; Garcia, Joanna
    Purpose: The Pediatric Mental Health Calls Program was created in March 2020 as a response to the dramatically reduced in-person medical visits and increased virtual visits at the UNTHSC Pediatrics Clinic in Fort Worth following the COVID-19 pandemic. The program was initially used as a tool to support pediatric patients and caregivers while following up on their mental health status. However, considering the potential for the PMHC program in monitoring the long-term and enduring effects of the pandemic on the mental health of teens and adolescents, the program was assessed for data summary and project growth. Methods: The Pediatric Mental Health Calls were previously performed by trained medical and PA student volunteers who used call scripts to standardize the conversation with patients and their caretakers. In a retrospective review, data collected by REDCap electronic data capture tools was then stratified into three main groups: Infant, Toddler and Teens from 2020-2022. Data was then screened and summarized based on yes or no questions as answered by the patient’s caregivers regarding stress levels and mental health. Interview questions were also assessed for areas of improvement. A Chi-squared test of independence analysis was used, and significance was set at p < 0.05. Results: When surveying parents of teens and adolescents age 10-19, there was a higher percentage that reported yes to increased stress due to COVID-19 in 2021 (53%) compared to 2020 (39%), with a statistical significance of p < 0.015. Of the teens and adolescents who had online schooling for six months to one year or greater at the time of surveying in 2021, the percentage of increased stress was even higher at 61%. In addition, problems with discipline, motivation and/or socialization in teens and adolescents were higher in students who reported increased stress due to the pandemic in 2021 than in students who reported no stress. Conclusions: Due to the relatively inexpensive and flexible nature of home calling by volunteers, the PMHC program is a viable way to monitor stress and its effect on mental health amongst the pediatric population alongside changes in the COVID-19 pandemic, especially with the lift of quarantine mandates and return to in-person schooling. Future health calls may be improved by incorporating more of the teen/adolescent answers alongside parents to gauge correspondence between answers as well as providing scaled answer choices for further quantitative analysis.
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    The Correlation Between Menopause and Quiet Standing Variable Changes
    (2023) Hurt, Paige; Zhang, Fan; Meza, Sebastian; Campbell, Blake; Kennedy, Shawn; Buxton, Natasha; Patterson, Rita
    Purpose: During menopause, individuals experience hormonal changes that can affect body systems contributing to balance. It has been established that balance declines with increasing age, but cohort studies have shown that there is a significant increase in falls during the perimenopausal phase of an individual’s life. A previous study has also been able to relate kyphosis and osteoporosis, postmenopausal changes often associated with estrogen deficiency, to altered standing balance specifically an increase in velocity of the center of pressure (COP) displacement compared to premenopausal females, though this study had a relatively small sample size. The purpose of our study is to measure sway to determine if there are meaningful balance changes that occur during the menopausal transition. This could indicate intervention strategies and decrease risk for falls in postmenopausal females. Methods: Data was obtained from ongoing quiet standing project at the University of North Texas Health Science Center (UNTHSC). Patients visiting the osteopathic manipulative medicine (OMM) and geriatric clinic were asked to quietly stand on a Bertec force plate (Bertec, Columbus, Ohio) for 30 seconds with their eyes open and eyes closed. A total of 475 females were stratified into two groups those less than 48 years old were considered premenopausal (total = 188) and those 48 and older were considered perimenopausal or postmenopausal (total = 287). Results: When comparing the menopausal group to the pre-menopausal group with eyes open, 13 out of 20 sway variables showed a statistically significant difference, similarly with eyes closed, 17 out of 20 variables showed statistical significance. The most significant changes in variables in participants with their eyes open were found for the range of the COP in the anterior posterior direction (AP) and velocity. For the premenopausal group, the average range of COP AP direction was 13.09 mm, while the average range of COP AP in the postmenopausal group was 16.45 mm. The velocity showed a similar change in that the premenopausal group showed an average velocity of 7.84 mm/s2, while the menopausal group had an average velocity of 10.76 mm/s2. Conclusion: The increase in the average range of COP AP and average velocity between the two groups leads us to hypothesize that the menopausal group may have a decline in postural control due to hormonal changes. With the significant difference in the majority of the SWAY variables, it appears the menopausal group has increased movement during quiet standing at an increased velocity. Suggesting that this group is having increased difficulty in modulating the position of their body, which could lead to increased likelihood of fall. We also hypothesize that the menopausal group likely relies on vision more for stability because of age related changes in proprioception and strength. Further studies would be required to determine if these changes are related to age or menopause. In the future, identifying balance changes associated with menopause should be studied. This will lead to better monitoring and early preventative measures to prevent falls.
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    Changes in Blood Pressure and Abundance of Kidney Sodium Channels in Postpartum Preeclamptic Rats
    (2023) McCafferty, Adair; Smith, Jonna; Smith, Savanna; Jones, Kylie; Castillo, Angie; Wiemann, Natalia; Owen, Malissa; Srivastava, Riti; Cunningham, Mark
    Purpose: Postpartum (PP) preeclamptic (PE) women have an increased risk of developing hypertension (HTN) and chronic kidney disease. However, the mechanisms of these diseases in PP PE women are not fully understood. Results from our previous studies show 10-week PP PE rats have HTN (PMID: 34727994). One factor that could cause elevated blood pressure is an increase in sodium transport in the kidneys of PP PE rats. Our current study will examine the BP as well as the amount of Sodium Potassium Chloride Cotransporters (NKCC), Sodium Hydrogen Exchanger-1 (NHE1) and a-subunit of the Epithelial Sodium Channel (ENaC) within the kidney of PE rats 6 weeks postpartum (PP6). We hypothesize that PP6 PE rats will have an increase in BP as well as increased amounts of NKCC, NHE1 and a-ENaC proteins. Methods: Pregnant Sprague Dawley rats were divided into 2 group: control (CON) normal pregnant rats and PE rats (derived from the surgically induced placental ischemic model of PE). All rats gave birth and were weaned for 3 weeks. At PP6, BP was measured via carotid catheterization. Kidney cortex (KC) and medulla (KM) tissue were collected to measure for NKCC, NHE1 and a-ENaC amounts via Western Blots. Results: BP was significantly elevated in PP6 vs CON rats (128 ± 6 vs 106 ± 4mmHg, p<0.05). The amount of NKCC channels within the KC was significantly increased in PP6 vs CON rats (107.82 ± 5.64 vs 100 ± 1.48 IU/Protein/CON%, p<0.05). The amount of a-ENaC proteins within the KC was also increased in PP6 vs CON rats (123.4 ± 4.67 vs 116.5 ± 33.03 IU/Protein/CON%, p=0.06). NHE1 channels within the KC were slightly decreased in PP6 vs CON rats (77.31 ± 15.28 vs 100 ± 16.61 IU/Protein/CON%, N.s). No changes were observed in a-ENaC proteins within the KM in PP6 vs CON rats. Conclusion: PP6 PE rats have HTN as well as increased NKCC and a-ENaC sodium transport proteins in the kidney cortex. These results confirm our hypothesis that increased sodium transporters in the kidney, which could elevate sodium and water reabsorption, correlates with an increase in blood pressure. This study is clinically relevant because it informs clinicians on the pathophysiology of HTN and renal disease/dysfunction in PP PE women. It also highlights novel approaches to providing potential therapies to manage blood pressure in PP PE women. Future studies will investigate the cause-and-effect relationship between blood pressure and sodium handling in the kidney of PP PE rats.
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    Sexually Transmitted Infections: Does knowledge impact perceived susceptibility?
    (2023) Kinard, Ashlyn; Johnson, Kaeli; Lemuz, Tiffany; Terrillion, Ryan; Diener, Anelise; Griner, Stacey
    Introduction: Young adults (18-24) have high rates of sexually transmitted infections (STIs), including bacterial infections such as chlamydia and gonorrhea. STI research commonly focuses on disease prevention through reducing the associated risk behaviors, such as condomless sexual activity, but limited research exists on risk perceptions related to STIs. Perceived susceptibility, a Health Belief Model construct, describes perceived risk of acquiring a disease. This study assessed perceived susceptibility to chlamydia and gonorrhea and the relationship with STI knowledge. Methods: An online survey panel was used to recruit sexually active young adults aged 18-24 (n=375). STI knowledge was assessed using the Sexually Transmitted Disease Knowledge Questionnaire, a 27-item validated scale. The participants responded to each statement with either true, false, or don’t know. Correct responses were given one point and the scores were averaged to calculate a knowledge score, with a perfect score being 27. Perceived susceptibility to chlamydia and gonorrhea infection was measured using three categories (strongly disagree/disagree, neutral, agree/strongly agree). Demographics including gender, race, sexual orientation, and education status were collected. Participants also reported on prior gonorrhea and/or chlamydia diagnoses as well as current sex practices and risk behaviors. Descriptive and bivariate analyses were conducted in SPSS. This study was approved by the university’s Institutional Review Board. Results: The average knowledge score among participants was 8.3 (standard deviation=5.4, range 0-22). Most respondents perceived that they were not at risk (strongly disagreed/disagreed) for acquiring chlamydia (54%) or gonorrhea (50%). The average knowledge score did not significantly differ by participants perceived susceptibility to chlamydia (p=.087). However, those who agreed/strongly agreed that they were at risk of contracting gonorrhea had a significantly higher knowledge score (mean of 9.9) than those who were neutral (mean knowledge score of 7.7; p=.016) or strongly disagreed/disagreed (mean knowledge score of 8.0; p=.021). Conclusion: The results from this study indicate a significant relationship between STI knowledge and perceived susceptibility to contracting gonorrhea, leading to the conclusion that individuals with more knowledge about STIs can more accurately assess their potential risk of infection. However, this relationship was not noted with perceived susceptibility of contracting chlamydia. Further exploring the difference in overall STI knowledge scores based on susceptibility of disease may provide insight into specific areas of STI knowledge to improve. Future aims should be broadly directed towards STI education among sexually active young adults to increase perceived susceptibility to these infections and improve preventative behaviors, such as increasing condom use.
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    The Effects of Low Dose Naltrexone in Children with Chronic Pain
    (2023) Olsen, Dana; Darvesh, Kamran; Segovia, Alicia; Hamby, Tyler; Campbell, Throy; Gandhi, Artee; Brooks, Meredith
    Background: Naltrexone is an FDA-approved opioid antagonist. At one-tenth the usual dosage, it is thought to have antinociceptive effects mediated through microglial cell inactivation, which can be helpful for chronic pain states, such as fibromyalgia, in adults.[1,2] The percentage of youth that are affected from chronic pain conditions is estimated to be at 15-35%.[3] The present study is the first to examine the efficacy of low-dose naltrexone (LDN) in treating chronic pain in pediatric patients. Methods: A retrospective chart review was conducted on pediatric patients who were prescribed LDN between 2019 and 2022 for a chronic pain condition. At the start of LDN treatment and for each pain-clinic visit in the subsequent year, pain scores and functional disability inventory (FDI) scores were collected. Multilevel cumulative logit models and multilevel linear models were used to determine the effect of time of LDN on pain and FDI scores, respectively. Results: There were 168 patients who met inclusion criteria. As compared to visits without LDN, there was no statistically significant difference in pain scores for visits in which the patient had been on LDN for 0-2 months (p=0.88) or for ≥2 months (p=0.25). As compared to visits without LDN, FDI scores significantly decreased after taking LDN for ≥2 months (p< 0.001) but not for 0-2 months (p=0.12). Conclusion: Children who took LDN had a significant improvement in daily function as compared to before taking LDN. Citations: 1. Parkitny, L., & Younger, J. (2017). Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia. Biomedicines, 5(2), 16. YOUNGER, J., NOOR, N., MCCUE, R., MACKEY, S. (2013). LOW-DOSE NALTREXONE FOR THE TREATMENT OF FIBROMYALGIA. ARTHRITIS AND RHEUMATISM. HTTPS://DOI.ORG/10.1002/ART.37734 3. KING, S., CHAMBERS, C. T., HUGUET, A., MACNEVIN, R. C., MCGRATH, P. J., PARKER, L., & MACDONALD, A. J. (2011). THE EPIDEMIOLOGY OF CHRONIC PAIN IN CHILDREN AND ADOLESCENTS REVISITED: A SYSTEMATIC REVIEW. PAIN, 152(12), 2729–2738.
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    A new rodent model of preeclampsia: Pregnant daughters from hypertensive placental ischemic moms have hypertension
    (2023) Smith, Jonna; Powell, Madison; Cromartie, Whitney; Smith, Savanna; Jones, Kylie; Castillo, Angie; Wiemann, Natalia; McCafferty, Adair; Owen, Malissa; Srivastava, Prakriti; Cunningham, Mark
    Purpose: Studies show that daughters from hypertensive pregnancies are twice as likely to have preeclampsia (PE), pregnancy-induced hypertension (HTN) in comparison to women born from a normal pregnancy. PE affects ~5-10% of all births in the USA and is the leading cause of intrauterine growth restriction (IUGR). PE is associated with oxidative stress (OS) and cerebral damage. The causes of PE are unknown but is influenced by genetic and environmental conditions. Studies show that pregnancies involving placental insufficiency and HTN create an adverse environment that can affect the IUGR baby’s developmental programming and pregnancy outcomes. This study aims to characterize the pregnancy of IUGR rat offspring from hypertensive placental ischemic moms. We hypothesize female rats born from pregnant hypertensive placental ischemic moms will have elevated blood pressure (BP) and OS. Methods: Pregnant Sprague Dawley moms are divided into 2 groups: normal pregnant (NP) and the reduced uterine perfusion pressure (RUPP) hypertensive placental ischemic rats. On day 14 of pregnancy, the RUPP surgery is performed to generate PE. All dams (NP and RUPP) give birth naturally and weaned for 3 weeks. Offspring were then separated by sex and mother’s pregnancy status. ~10 weeks later, offspring were mated according to 4 groups: ♀NP x ♂NP (CON Preg, n=3), ♀NP x ♂RUPP (n=2), ♀RUPP x ♂NP (IUGR Preg, n=5), ♀RUPP x ♂RUPP (n=4). On day 19 of offspring pregnancy, BP was measured via carotid catheterization and the blood and brains were collected for analyses. Results: IUGR Preg rats have elevated BP (116 ± 4.17 vs 100.6 ± 2.54 mmHg, p<0.02) and 8-isoprostanes (439.2 ± 13.61 vs 381.3 ± 26.10 g, ns), decreased circulating antioxidant capacity (AC) (0.33 ± 0.01 vs. 0.37 ± 0.01 mM Trolox/mg protein, p<0.01), and reduced body weight (330.1 ± 5.24 vs 350.3 ± 10.82 g, ns) compared to CON Preg rats. IUGR Preg rats have larger brains, suggesting brain swelling (5.38 ± 0.10 vs 4.95 ± 0.19 g/1000g BW, p<0.04). HSP-1 (186.1 ± 28.14 vs 100.0 ± 6.36 %HSP-1/protein/CON, p<0.04) and H2O2 (25.76 ± 2.95 vs 15.81 ± 4.56 μM/mg protein, ns), markers of ROS, are increased in the brains of IUGR Preg vs. CON Preg rats. Cerebral AC was slightly reduced (260.0 ± 33.14 vs 292.3 ± 13.91 uM Trolox/mg protein) and MnSOD (antioxidant) amounts were decreased (87.96 ± 3.43 vs 100.0 ± 2.84 %MnSOD/protein/CON, p<0.63). Conclusion: IUGR Preg rats have increased systemic and cerebral OS, as well as larger brain sizes which may lead to cerebral damage. In summary, pregnant daughters from hypertensive placental ischemic moms show symptoms of a preeclamptic-like phenotype, thus creating a new model of PE. Future studies will determine the role of maternal PE status and OS in the development of HTN in pregnant IUGR offspring.
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    Correlative Findings of Maternal and Placental Health with Congenital Heart Disease and Post-Operative Acute Kidney Injury
    (2023) George, Ann; Hamby, Tyler; Lanier, Lane
    Purpose: Acute kidney injury (AKI) is a common complication in pediatric patients with congenital heart disease (CHD) who undergo cardiopulmonary bypass (CPB). Besides established risk factors such as time on CPB, factors affecting fetal development may contribute to the prevalence of AKI within this population. Adverse intrauterine microenvironments associated with certain maternal conditions have been shown to impact nephrogenesis. These factors also increase the risk of preterm delivery, shortening the timeframe for nephrogenesis. Thus, infants that develop in these microenvironments may be predisposed to develop AKI when subjected to secondary insults such as CPB. This study aims to examine the incidence of AKI in this patient population and determine whether maternal or fetal variables predict the development of AKI. Methods: Retrospective review of electronic medical records of pediatric patients at Cook Children’s Medical Center (CCMC) between 3/1/2022 and 4/14/2022. Inclusion criteria were as follows: patients aged 0-12 months who underwent surgical repair or palliation of CHD with care in the cardiac intensive care unit (CICU). Data collected included maternal variables such as pre-eclampsia, gestational diabetes, obesity, and smoking status; individual variables such as gestational age and other congenital factors; and surgical variables such as CPB time and average PAO2 during CPB. AKI was determined using creatinine levels from established Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: Twenty patients met inclusion criteria. No statistical significance was noted between maternal and surgical variables. Twenty percent of patients developed at least Stage 1 AKI. Conclusions: Identification of maternal risk factors for AKI in the pediatric population may allow further insight into the mechanisms of the development of AKI. Our results were impacted by the low power of our study. Inclusion of more patients into our study will positively impact our power.
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    Pediatric Rhabdomyolysis and Plasmapheresis - A Review of Two Cases
    (2023) Abdali, Kulsum; Tran, Jessica; Hamby, Tyler; Gillespie, Robert
    Background: Rhabdomyolysis is the breakdown of skeletal muscles causing leakage of cellular components like creatine kinase (CK) into the bloodstream. Clear guidelines for managing pediatric rhabdomyolysis currently do not exist. Traditional treatment involves prompt administration of intravenous (IV) fluids to counteract dehydration and prevent acute kidney injury (AKI). However, there have been limited case studies involving plasma exchange to treat severe cases of rhabdomyolysis in pediatrics. Case Information: Case 1: A 14-year-old female presented with muscle pain, headache, decreased urine output, and tea-colored urine. Her history included lifting weights and dehydration. Her presenting CK was 281,483 U/L and creatinine was 2.88 mg/dL. She was diagnosed with rhabdomyolysis, AKI, and transaminitis. CK levels rose to 410,000 U/L. On the second day, plasmapheresis was performed, and CK levels decreased after two more treatments. However, creatinine levels continued to increase. Renal biopsy showed acute tubular injury secondary to rhabdomyolysis. Hemodialysis was performed. Upon discharge, creatinine was 2.43 mg/dL, and she no longer required dialysis. Case 2: An 11-year-old female presented with a respiratory illness for two days. Her CK was 41,671 U/L. She was diagnosed with AKI and rhabdomyolysis induced by COVID-19. Standardized treatments were initiated with no improvement. CK levels reached over 410,000 U/L. Plasmapheresis was then initiated for three days, which lowered the CK levels significantly. Upon completion of plasmapheresis, her CK level dropped down to 40,000 U/L. Her CK levels normalized and her AKI became stable. Conclusions: Given the risks associated with high CK levels resistant to traditional IV hydration, it is crucial that the levels are brought down quickly to prevent long-term complications such as AKI. Therefore, plasmapheresis may be considered in severe, life-threatening rhabdomyolysis in pediatrics.