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In Brief

A Key to Preventing Stenosis in Tissue-Engineered Vascular Grafts
 A Key to Preventing Stenosis in Tissue-Engineered Vascular Grafts 600 400 Kevin Mayhood
By: Kevin Mayhood
Tissue engineered vascular graft

Seeding a high number of bone marrow mononuclear cells on graft appears to prevent narrowing. Tissue-engineered vascular grafts hold promise for children with congenital heart disease because the grafts, which carry a patient’s own cells, have the potential to grow and regenerate just as the child’s blood vessels do. But over time, some grafts develop…

How Primary Care Providers Can Address Suicidal Youth and Self-Harming Behaviors
 How Primary Care Providers Can Address Suicidal Youth and Self-Harming Behaviors 150 150 John Hofmeister
By: John Hofmeister

Pediatricians are in an optimal position to see early warning signs and recommend treatment. Pediatricians are often in an optimal position to see early warning signs of suicidal and self-harming behavior in their patients, to diagnose and recommend treatment, and to provide referrals depending on individual presentation and symptom severity. To help providers who may…

Immune Cell Subtype Tied to Asthma in Mice Found in Humans With Viral Infections
 Immune Cell Subtype Tied to Asthma in Mice Found in Humans With Viral Infections 969 533 Kevin Mayhood
By: Kevin Mayhood
Illustration of NK Cells, T Cells, other immune cells floating across white background

If asthma development in people parallels mice, the cells’ mechanisms may provide a target for disease prevention. A subtype of neutrophil, labeled CD49d+ PMN, which is necessary to drive asthma and allergies in a mouse model, also accumulates in the nasal fluid of people with symptoms of an upper respiratory viral infection, researchers have discovered. Neutrophils are…

After Bariatric Surgery, Adolescents Show Decreased Risk for Cardiovascular Disease
 After Bariatric Surgery, Adolescents Show Decreased Risk for Cardiovascular Disease 150 150 Gina Bericchia
By: Gina Bericchia

Three years after surgery, only 5 percent of study participants had three or more risk factors for cardiovascular disease, a significant reduction from 33 percent before surgery. Adolescents with severe obesity who had bariatric surgery showed significant improvements in cardiovascular disease risk factors, according to the most recent “Teen Longitudinal Assessment of Bariatric Surgery” (Teen-LABS)…

Large-Scale Genomics Study Identifies Children With High-Risk Cancer
 Large-Scale Genomics Study Identifies Children With High-Risk Cancer 150 150 Mary Bates, PhD
By: Mary Bates, PhD

Some subtypes of leukemia have a poor prognosis. Genomic studies are helping to identify these subtypes, leading to targeted therapies. Acute lymphoblastic leukemia (ALL), a malignancy of the white blood cells, is a common childhood cancer. Understanding the genomic changes underlying ALL has led to the development of new, targeted therapies, especially for patients with…

Making Stem Cell Transplantation Work for Sickle Cell Disease
 Making Stem Cell Transplantation Work for Sickle Cell Disease 150 150 Mary Bates, PhD
By: Mary Bates, PhD

New regimen offers a promising approach for unrelated donor transplants. Sickle cell disease (SCD) is a blood disorder affecting 1 in every 500 African-American newborns. It is characterized by extreme pain and decreased longevity. Currently, the only cure for SCD lies in hematopoietic stem cell transplantation. A well-matched sibling donor is needed for the best…

Can Spinal Replace General Anesthesia in Pediatric Urology Patients?
 Can Spinal Replace General Anesthesia in Pediatric Urology Patients? 150 150 Jeb Phillips
By: Jeb Phillips

Spinal anesthesia offers a viable low-risk alternative to general anesthesia for a wide range of pediatric procedures, particularly for urology patients. As research continues to illuminate the possibility of neurotoxic effects from general anesthesia in pediatric patients, surgeons and anesthesiologists at Nationwide Children’s Hospital have already sought out an alternative among children 2 years of…

Cysteamine Appears to Help Clear Antibiotic-Resistant Bacteria from Cells of Patients With Cystic Fibrosis
 Cysteamine Appears to Help Clear Antibiotic-Resistant Bacteria from Cells of Patients With Cystic Fibrosis 150 150 Kevin Mayhood
By: Kevin Mayhood

The drug could help eradicate members of the B. cepacia complex and other bacteria in CF. Physicians and researchers from Nationwide Children’s Hospital have found that the drug cysteamine protects cells of patients with cystic fibrosis (CF) against a group of disease-causing and multi-drug resistant microorganisms — members of the Burkholderia cepacia bacterial complex — in several…

Building Heart Valves From Extracellular Matrix
 Building Heart Valves From Extracellular Matrix 150 150 Abbie Miller
By: Abbie Miller

Physicians at Nationwide Children’s Hospital describe the use of an extracellular matrix cylindar valve in the mitral position. At The Heart Center at Nationwide Children’s, Patrick McConnell, MD, a pediatric cardiothoracic surgeon, is using an alternative to the traditional cadaveric, mechanical or biological replacement valve. In a recent case report published in Echocardiography, Dr. McConnell and his colleagues describe the…

Care Bundles Can Reduce Hospital-Acquired Pressure Injuries
 Care Bundles Can Reduce Hospital-Acquired Pressure Injuries 150 150 Brianne Moore
By: Brianne Moore

Reliable implementation of care bundles reduces the number of serious hospital-acquired pressure injuries Hospital-acquired pressure injuries (PI) are a significant cause of preventable harm that can increase hospitalization costs and length of stay. Up to 27 percent of pediatric intensive care unit (PICU) patients and up to 23 percent of neonatal intensive care unit (NICU)…

Two Classes of GGAA-Microsatellites in a Ewing Sarcoma Context
 Two Classes of GGAA-Microsatellites in a Ewing Sarcoma Context 150 150 Abbie Miller
By: Abbie Miller

Characterization of GGAA-microsatellites provides insight in the role of noncoding DNA in cancer susceptibility and therapeutic development. In a study published in PLOS ONE, researchers describe two types of GGAA-microsatellites and their roles in EWS/FLI binding and gene regulation in Ewing sarcoma. Ewing sarcoma is the second most common pediatric bone malignancy. It is initiated by chromosomal…

How Genes and Environment Interact to Raise Risk of Congenital Heart Defects
 How Genes and Environment Interact to Raise Risk of Congenital Heart Defects 150 150 Mary Bates, PhD
By: Mary Bates, PhD

Genetic susceptibility plus maternal hyperglycemia interact to contribute to heart defects during fetal development. Infants of mothers with diabetes have a three- to five-fold increased risk of congenital heart defects. Such developmental defects are likely caused by a combination of genetic and environmental factors. However, the molecular mechanisms by which maternal diabetes disrupts normal heart…

Dopamine: A Rescue Therapy for Fontan Patients With Protein-Losing Enteropathy?
 Dopamine: A Rescue Therapy for Fontan Patients With Protein-Losing Enteropathy? 150 150 Jeb Phillips
By: Jeb Phillips

Patients with quickly worsening PLE saw serum albumin levels stabilize after dopamine treatment. Patients who have undergone the Fontan procedure for single ventricle congenital heart disease do not often develop protein-losing enteropathy (PLE) – but those who do are at substantial risk of mortality and morbidity. Only heart transplant has been shown to alleviate PLE…

Speedy Development of Support Programs for Second Victims Demands Collaboration
 Speedy Development of Support Programs for Second Victims Demands Collaboration 150 150 John Hofmeister
By: John Hofmeister

Openly sharing research and resources results in rapid development and growth of peer program for health care workers experiencing second victim phenomena. A career in health care brings many rewards — but it also puts its practitioners at risk for depression, anxiety, shame or career burnout whenever a medical error occurs or a patient experiences…

The Evolution of Precision Medicine for Children With Aggressive Brain Tumors
 The Evolution of Precision Medicine for Children With Aggressive Brain Tumors 150 150 Jonathan Finlay, MB, ChB, FRCP
By: Jonathan Finlay, MB, ChB, FRCP

The Head Start 4 clinical trial introduces risk stratification and builds on the success of bone marrow transplantation for young children with malignant embryonal tumors. Cancers in the brain and spinal cord (the central nervous system, CNS) are now the most common cause of deaths due to disease in children and adolescents. Among these tumors,…

A New Paradigm for Treating Transcription Factor-Driven Cancers
 A New Paradigm for Treating Transcription Factor-Driven Cancers 150 150 Abbie Miller
By: Abbie Miller

Researchers describe how the association of the EWS/FLI transcription factor with GGAA-microsatellites drives Ewing sarcoma. In the current issue of Proceedings of the National Academy of Sciences, researchers from Nationwide Children’s Hospital describe a new paradigm for treating transcription factor-driven cancers. The study focuses on Ewing sarcoma and how the EWS/FLI transcription factor drives the malignancy…

Family Focus Restructures Single Ventricle Care
 Family Focus Restructures Single Ventricle Care 150 150 Brianne Moore
By: Brianne Moore

Standardize, connected care in a multidisciplinary team environment aims to improve outcomes and quality of life for patients born with single ventricle heart anatomy. Children with single ventricle anatomy, one of the most harrowing of congenital heart defects, face unique challenges that require multiple procedures and hospital admissions to treat. In most institutions, each admittance…

Could Nutritional Supplements Impact Autism Symptoms in Toddlers Born Preterm?
 Could Nutritional Supplements Impact Autism Symptoms in Toddlers Born Preterm? 150 150 Rachael Hardison
By: Rachael Hardison

Supplementing with omega-3 and -6 fatty acids impacts language development in preterm toddlers at risk for developing autism. Delay in language development is often an early indicator in children at risk for developing autism spectrum disorder (ASD), yet clinicians are still trying to understand the best practices for how and when to implement early intervention…

“Impatient” Therapy: Physicians Too Aggressive in Treatment of ITP
 “Impatient” Therapy: Physicians Too Aggressive in Treatment of ITP 150 150 Brianne Moore
By: Brianne Moore

Despite guidelines that advocate watching and waiting, physicians are still treating most patients with immune thrombocytopenia. When a child presents with easy bruising or bleeding, red skin spots and fatigue – symptoms similar to those for leukemia – families seek evaluation immediately. However, more often these cases are pediatric immune thrombocytopenia (ITP), an acquired disorder…

How to Improve Apparent Cause Analyses and Reduce Error Recurrence
 How to Improve Apparent Cause Analyses and Reduce Error Recurrence 150 150 Brianne Moore
By: Brianne Moore

A quality improvement team embarks on a project focused on the accuracy of future quality improvement initiatives. An apparent cause analysis (ACA) is a process used to investigate the cause or causes of a medium or low-risk safety event. Designed as a quality improvement measure, ACAs are used to explain in detail why an issue…

Children With Autism and Abdominal Pain Have Distinctive Bacterial Profiles
 Children With Autism and Abdominal Pain Have Distinctive Bacterial Profiles 150 150 Kevin Mayhood
By: Kevin Mayhood

The microbiome may harbor causes of abdominal and behavioral issues and potential targets for relief. Children with autism spectrum disorder (ASD) and functional abdominal pain may have a distinct microbiome-neuroimmune profile compared to kids with gastrointestinal disorders (GI) and those with no GI illness. Building on others’ research showing that Clostridia bacteria in the gut are altered…

Combining Quality Measures to Improve Surgical Outcomes
 Combining Quality Measures to Improve Surgical Outcomes 150 150 Kevin Mayhood
By: Kevin Mayhood

Use a refined morbidity and mortality conference with a national database, a new study suggests. A pediatric surgery morbidity and mortality (M&M) conference that applies quality improvement practices borrowed from industry can be a significantly more effective tool for learning from mistakes and making corrections, researchers from Nationwide Children’s Hospital show in a new study.…

How to Reduce Unnecessary Antibiotic Use for UTI in Urgent Cares
 How to Reduce Unnecessary Antibiotic Use for UTI in Urgent Cares 150 150 Jeb Phillips
By: Jeb Phillips

A quality improvement project shows children with negative urine cultures take antibiotics they don’t need. Even before a urine culture confirms the diagnosis, urgent care physicians often prescribe antibiotics when children present with symptoms of urinary tract infection (UTI). Early treatment is important for relief of symptoms and prevention of complications. But what if the…

Emergency Departments Can Help Prevent Suicide
 Emergency Departments Can Help Prevent Suicide 150 150 Brianne Moore
By: Brianne Moore

Secondary screenings, safety plans and phone follow-ups are key to reducing death by suicide. Suicide is the tenth leading cause of death in the United States and has increased in incidence 27 percent from 1999 to 2015. Interestingly, up to 40 percent of individuals who die by suicide visit an emergency department (ED) in the…

Cannabidiol May Reduce Drug-Resistant Seizures by Half
 Cannabidiol May Reduce Drug-Resistant Seizures by Half 150 150 Brianne Moore
By: Brianne Moore

Two studies demonstrate clinically significant response to oral liquid cannabidiol over placebo. Two recent studies – one published in The New England Journal of Medicine and one presented at the 2017 American Academy of Neurology annual meeting – indicate that a new plant-based, cannabis-derived treatment may be able to decrease the incidence of seizures in two complex…

Specialists Collaborate to Improve Ovary Preservation
 Specialists Collaborate to Improve Ovary Preservation 150 150 Brianne Moore
By: Brianne Moore

A weekend case inspires an investigation into how pediatric surgeons and gynecologists treat the same patient differently. When lesions persist on a patient’s ovary, there are two options for treatment: oophorectomy, which removes the entire ovary, and ovarian sparing surgery (OSS). Depending on referral patterns and access to specialists, either a pediatric surgeon or a…

Mechanism for Expulsion of DNA from NTHI Described
 Mechanism for Expulsion of DNA from NTHI Described 150 150 Abbie Miller
By: Abbie Miller

Researchers at Nationwide Children’s publish breakthrough discovery revealing how DNA and DNABII proteins are released into the biofilm matrix. Nontypeable Haemophilus influenzae (NTHI) bacteria, a common culprit in otitis media, are known for their ability to create dense biofilms. As the subject of much biofilm and vaccine research, they are increasingly understood as complex and surprising organisms.…

Meaningful Improvement of Child Health Requires Core Quality and Outcomes Measures
 Meaningful Improvement of Child Health Requires Core Quality and Outcomes Measures 150 150 Brianne Moore
By: Brianne Moore

The seemingly infinite indicators large pediatric systems use to measure children’s health often fall short in determining patient outcomes and quality of care. In an editorial published in JAMA Pediatrics, Kelly Kelleher, MD, director of the Center for Innovation in Pediatric Practice at Nationwide Children’s Hospital, and co-author William Gardner from the Children’s Hospital of Eastern Ontario, call for…

Math Model Reveals Immune System Secrets
 Math Model Reveals Immune System Secrets 150 150 Brianne Moore
By: Brianne Moore

Natural killer (NK) cells are a key part of the innate immune system, activating to destroy virally infected cells or tumor cells detected in the body. While the mechanism of detection of infected cells by NK cells is well understood, some aspects of how NK cells communicate with other immune cells are not. Due to…

How to Advocate for Patients with Legislators
 How to Advocate for Patients with Legislators 150 150 Steve Allen, MD
By: Steve Allen, MD

Perhaps more this year than any other in recent memory, the health care community has come together against a proposed piece of federal legislation. While opposition to the American Health Care Act/Better Care Reconciliation Act has been particularly urgent, hospitals and medical associations regularly engage in government advocacy work. At Nationwide Children’s Hospital, for example,…

Different Patterns of Executive Function Deficits in Different Pediatric Brain Disorders
 Different Patterns of Executive Function Deficits in Different Pediatric Brain Disorders 150 150 Mary Bates, PhD
By: Mary Bates, PhD

Clinical implications include specialized testing for deficits in executive function as these may not be apparent at a routine exam. A large group of researchers, including many from Nationwide Children’s Hospital, recently looked at whether children with different brain disorders show diverse patterns of strengths and weaknesses in executive functions. Children with traumatic brain injuries…

Immune Profiling Leads to Implications for Immunotherapy for NF1-Associated Tumors
 Immune Profiling Leads to Implications for Immunotherapy for NF1-Associated Tumors 150 150 Abbie Miller
By: Abbie Miller

Profiling reveals histologic subtype distinctions and heterogeneity of neurofibromatosis type 1-associated tumors. Neurofibromatosis type 1 (NF1) — an autosomal dominant disorder affecting approximately one in every 3,500 people — results in dysfunctional neurofibromin, a protein expressed throughout the body and involved in the RAS signaling pathway. Virtually all patients with NF1 develop benign peripheral nerve…

Hepatitis E Persists and Self-Limits Due to Novel Mechanism, Study Finds
 Hepatitis E Persists and Self-Limits Due to Novel Mechanism, Study Finds 150 150 Brianne Moore
By: Brianne Moore

A team of researchers finds that Hepatitis E behaves uniquely compared other hepatitis viruses and hopes to pave the way for future investigation. Hepatitis E virus (HEV) is one of five known human hepatitis viruses and infects approximately 20 million people annually. HEV causes significant morbidity and mortality around the world, causing acute hepatitis in…

Combining Immunotherapies Effective Against Mouse Model of Cancer
 Combining Immunotherapies Effective Against Mouse Model of Cancer 150 150 Mary Bates, PhD
By: Mary Bates, PhD

Recent study results suggest that combining virotherapy and PD-1 blockades may be more effective than either approach alone. Rhabdomyosarcoma, a cancer made up of cells that normally develop into skeletal muscles, is the most common soft tissue cancer in children. If it is detected early and localized in certain areas, rhabdomyosarcoma is usually curable with…

Sweat Chloride Should Be the First-Line CF Test, but Often Isn’t
 Sweat Chloride Should Be the First-Line CF Test, but Often Isn’t 150 150 Jeb Phillips
By: Jeb Phillips

A study finds that CFTR mutation analysis is being ordered before (or without) sweat chloride in some cases, potentially leading to missed diagnoses, increased patient anxiety and unnecessary costs. The Cystic Fibrosis Foundation is clear in its diagnostic guidelines: sweat chloride needs to be the first test ordered after a positive newborn screening for cystic…

Needle-free Immunization Prevents Experimental Otitis Media
 Needle-free Immunization Prevents Experimental Otitis Media 1024 575 Tiasha Letostak, PhD
By: Tiasha Letostak, PhD
Close up, color image of someone extending a gloved hand with a small patch face up on their pointer finger that resembles a circular adhesive bandage that has a smaller, blue square patch on its center

The first data to demonstrate the efficacy of a simple, needle-free vaccine delivery system for middle ear infections. Otitis media (OM), or middle ear infection, accounts for approximately 30 million doctor visits a year in the U.S. The pathogen nontypeable Haemophilus influenzae (NTHI) causes the majority of cases of ear infection, including chronic OM, recurrent OM, and…

Assessing Romantic Lives of Adult Survivors of Childhood Cancer
 Assessing Romantic Lives of Adult Survivors of Childhood Cancer 150 150 Kevin Mayhood
By: Kevin Mayhood

In some ways, the group appears more resilient than survivors of adult-onset cancer or those with other childhood-onset diseases. Adult survivors of childhood cancer appear, on the whole, to have comparable romantic lives to others their age, new studies show. Surprisingly, the group doesn’t seem to carry the same burdens as men and women with…

When Talking About Birth Control, Don’t Leave Boys Out of the Conversation
 When Talking About Birth Control, Don’t Leave Boys Out of the Conversation 150 150 Sarah Saxbe, MS, MSW, LISW-S
By: Sarah Saxbe, MS, MSW, LISW-S

Sex education for boys should include information about all forms of birth control, even those for females. When a child arrives in his or her pediatrician’s office each year for their well visit, the nurse and provider often go over a long list of questions for the parents and child. Many are related to daily…

The First Study of Oncolytic HSV-1 in Children and Young Adults With Cancer Indicates Safety and Tolerability
 The First Study of Oncolytic HSV-1 in Children and Young Adults With Cancer Indicates Safety and Tolerability 1024 575 Abbie Miller
By: Abbie Miller

The phase 1 trial shows safety and tolerance of HSV1716 in the pediatric population; evidence of viral replication in the blood and acute inflammation on PET/CT scans suggest a phase 2 trial for dosage and efficacy is warranted. HSV1716 – an oncolytic herpes simplex virus-1 – has been studied in adults via injection into the…

Secondary Findings: What Should Be Reported?
 Secondary Findings: What Should Be Reported? 150 150 Brianne Moore
By: Brianne Moore

With the growing use of exome and genome sequencing in research and diagnosis, the ACMG has recently released a policy update on the reporting of secondary findings. Genomic sequencing is instrumental in identifying many diseases. It can also reveal disease causing variants in our genetic code unrelated to the reason the clinical exome or genome…

In Extremely Preterm Babies, SNAP-II Score Predicts Brain Impairments at Age 10
 In Extremely Preterm Babies, SNAP-II Score Predicts Brain Impairments at Age 10 150 150 Kevin Mayhood
By: Kevin Mayhood

Measures taken in first 12 hours of life are associated with a host of deficits. Children born extremely preterm are known to be at increased risk of neurodevelopmental impairments, but not all babies born the same early date and weight are equal. Researchers have found that for children born at less than 28 weeks, a…

The Maternal Microbiome: How Stress During Pregnancy Impacts Female Offspring in Adulthood
 The Maternal Microbiome: How Stress During Pregnancy Impacts Female Offspring in Adulthood 150 150 Tiasha Letostak, PhD
By: Tiasha Letostak, PhD

A recent study suggests a critical window of pregnancy where stress is able to influence the microbiome and intrauterine environment, with lasting behavioral consequences. Previous research has demonstrated that stress during pregnancy changes the composition of the intestinal microbiota and is related to the emergence of behavioral disorders such as anxiety and depression. A new…

Balancing Immune Activation and Suppression After Cardiopulmonary Bypass
 Balancing Immune Activation and Suppression After Cardiopulmonary Bypass 150 150 Mary Bates, PhD
By: Mary Bates, PhD

Understanding how the immune system responds to CPB could dramatically impact postsurgical outcomes. Cardiopulmonary bypass (CPB) is a relatively routine procedure, generally with favorable outcomes. However, among the risks posed to patients is the over- or under-activation of the immune system following the surgery. Mark Hall, MD, FCCM, division chief of Critical Care at Nationwide Children’s Hospital,…

Bracing for Buckle Fractures
 Bracing for Buckle Fractures 150 150 Jeb Phillips
By: Jeb Phillips

Shifting from casts to splints for distal radius buckle fractures has saved time and money for providers and families. The traditional treatment for distal radius buckle fractures involves immobilization in a short- or longarm cast. A 2015 multi-institutional study found that more than 70 percent of pediatric orthopedic specialists use this as their standard of…

Survey: Physical Barriers, Not Fear, Keep Homeless Youth From Receiving Care
 Survey: Physical Barriers, Not Fear, Keep Homeless Youth From Receiving Care 150 150 Brianne Moore
By: Brianne Moore

Research survey investigates barriers to care in unstably-housed youth. Every year, an estimated 1.6 to 1.7 million youth in the United States are living on the streets, in shelters or in other temporary living situations. Earlier studies have suggested that homeless youth do not seek medical services because of fear-based barriers – distrust of doctors,…

Best Practices in Severe BPD Treatment
 Best Practices in Severe BPD Treatment 150 150 Jeb Phillips
By: Jeb Phillips

To help standardize care, the Bronchopulmonary Dysplasia Collaborative has published a comprehensive review of evidence-based approaches for treatment of patients with severe forms of the disease. Infants with severe bronchopulmonary dysplasia (BPD) have high risks of late morbidities and mortality, but the best ways to manage these vulnerable patients are still debated. In fact, it’s…

Cognitive Behavioral Therapy Can Help Children With Persistent Post-Concussive Symptoms
 Cognitive Behavioral Therapy Can Help Children With Persistent Post-Concussive Symptoms 150 150 Mary Bates, PhD
By: Mary Bates, PhD

A psychological intervention improves kids’ function and quality of life even years after a concussion. For most children and adolescents that experience concussions, symptoms resolve after a week or two. However, a small subset of kids has persistent symptoms lasting for months or even years after the injury. These symptoms can be disruptive and stressful,…

How a QI Intervention Lowered Breast Milk Errors in a Busy NICU
 How a QI Intervention Lowered Breast Milk Errors in a Busy NICU 150 150 Kevin Mayhood
By: Kevin Mayhood

Bedside barcode scanners and dedicated milk preparation technicians helped drive the decline. A quality improvement (QI) initiative in the Neonatal Intensive Care Unit (NICU) at Nationwide Children’s Hospital has been associated with a substantial reduction in errors administering mother’s milk to these vulnerable infants. The total number of scanned errors declined from 97.1 per 1,000…