Pediatric Research Podcast

Effective decision making in the Pediatric Intensive Care Unit relies on quickly ascertaining diagnostic information in order to deliver a tailored clinical response. The utility of rapid genetic testing of critically ill patients has been demonstrated several times, owing to their relatively high diagnostic yield. However the cost and slow turnaround of results have been major barriers in the past to the widespread uptake of this technology in the clinical setting. In this episode, we meet Professor Steve Kernie from Columbia University Irving Medical Center and Morgan Stanley Children's hospital, who conducted a pilot study to assess what impact the use of rapid exome sequencing would have on the length of stay of a subset of children admitted to the Pediatric Intensive Care Unit. Have a listen!  See acast.com/privacy for privacy and opt-out information.

Smoking in adults and adolescents is at an all-time low today, yet around 1 in 2 children who visit the Emergency Department have been exposed to tobacco smoke. We know that there numerous health consequences associated with tobacco smoke exposure (TSE), and that this also comes at a substantial monetary cost- in 2010, child tobacco smoke exposure resulted in more than 101,570 annual ED visits, costing nearly $63 million. In this episode, we meet Early Career Investigator, Ashley Merianos from the University of Cincinnati and Cincinnati Children's Hospital Medical Center, who performed a cross-sectional analysis of children visiting the ED in order to assess the contribution of child TSE on healthcare resource utilization patterns.  See acast.com/privacy for privacy and opt-out information.

Institutions and healthcare systems had started to introduce wellness initiatives following the growing realization of the widespread problem of physician distress and burnout. Whilst these programs might be effective, there is currently a lack of evidence about who uses them and whether they are best suited to their target audience. In this episode, we meet Dr. Andrea Weintraub from the Icahn School of Medicine at Mount Sinai, who conducted a cross-sectional national survey amongst different pediatric subspecialties to find out which initiatives were available, whether people knew about them or used them, and to better understand what initiatives pediatricians would like to see made available.  See acast.com/privacy for privacy and opt-out information.

40% of infants with hypoxic ischemic encephalopathy (HIE) go on to develop long-term disability, despite receiving therapeutic hypothermia. Mounting evidence suggests that children with HIE are at a higher risk of both hypoglycemia and hyperglycemia, which may explain the variable outcomes to therapeutic hypothermia. In this episode, we meet this month's featured Early Career Investigator Dr. Paolo Montaldo, from Imperial College London, UK and the University of Campania Luigi Vanvitelli, Italy who used continuous glucose monitoring to assess the association between neonatal glucose control and neurological outcomes at 18-24 months. Related Article.  See acast.com/privacy for privacy and opt-out information.

There is a growing body of evidence to suggest that insufficient sleep can have detrimental effects on school-age children's cognitive, emotional and behavioral regulation. But there remains a lack of objectively measured data on the stability and prevalence of insufficient sleep. In this episode, we meet Bror Ranum who is currently doing his PhD at the Norwegian University of Science and Technology. He was involved in a large prospective study of almost 800 children between the ages of 6-12 years to objectively measure the prevalence and stability of insufficient sleep using actigraphy. The results suggest the importance of measuring the number of nights of insufficient sleep as opposed to only taking an average measure over a week.   See acast.com/privacy for privacy and opt-out information.

Young children face unprecedented access to screens in the modern environment. It was recently estimated that children between the ages of 3-8 get almost 3 hours of screen use a day. The American Academy of Pediatrics (AAP) have recommendations for screen-based media use which focus on four variables: access to screens, frequency of use, content and grownup-child interaction, or “co-viewing". In this episode, we meet Early Career Investigator, Dr John Hutton, from Cincinnati Children's Hospital Medical Centre, who has created a composite measure of these variables, reflecting current modes of screen-based media use.   See acast.com/privacy for privacy and opt-out information.

There is a growing body of evidence to suggest that early life stress can have detrimental effects on a child's physical and mental health. Hair cortisol concentrations are increasingly accepted as a cumulative measure of stressful experiences but they are understudied in preschool children. In this episode, we meet Professor Sunny Anand from Stanford University School of Medicine who developed a sensitive assay for hair cortisol concentrations. He and his team took hair samples from children aged 1-4 years in order to uncover psychosocial and demographic factors associated with this measure of physiological stress.  See acast.com/privacy for privacy and opt-out information.

In this episode, we meet Early Career Investigator, Dr Anna Tottman who during her time at the University of Aukland, Liggins Institute performed a retrospective cohort study looking at the relationship between neonatal nutrition and neurodevelopmental outcomes. Her research suggests that nutrition for preterm infants may need to be sex-specific. Take a listen!  See acast.com/privacy for privacy and opt-out information.

Preterm infants regularly need Packed red blood cell transfusions. This life-saving therapy can help prevent anaemia of prematurity and in turn, safeguard normal organ function. However, there is a risk that donor blood contains the heavy metals mercury (Hg), lead (Pb) and Cadmium (Cd) which are known developmental neurotoxicants and may be present in neurotoxic doses. In this episode we meet Alison Falck, Assistant Professor of Pediatrics at the University of Maryland School of Medicine who has studied the relationship between the donor concentration, number of transfusions and exposure in preterm infants. Her results may have implications for prescreening of donor blood.  See acast.com/privacy for privacy and opt-out information.

Medical Simulation is a powerful model for pediatric education. This type of experiential training is used to teach various skills including stressful medical tasks like resuscitation, without putting patients at risk. In order to better understand the behavior of healthcare providers during these situations, researchers have started to use eye-tracking technology. In this episode, we meet Early Career Investigator, Michael Wagner from the Medical University of Vienna, who during a fellowship at the Yale University, carried out a simulation-based study using eye-tracking glasses to explore the gaze behavior and subjective experience of care-givers during a neonatal resuscitation to assess the usability of this technology for training.  See acast.com/privacy for privacy and opt-out information.

Clinical studies have shown that newborns can experience up to 14 painful procedures each day of admission at the neonatal intensive care unit. There is evidence that these early experiences can cause changes to the developing nervous system affecting, amongst other things, nociception in adulthood. Preterm infants are at particular risk from repeated noxious procedures owing to the extensive developmental and functional changes taking place in the CNS at that time. In this episode, we meet Dr Nynke van den Hoogen, who during her time at Maastricht University, used an animal model to assess whether the number of neonatal noxious events has an affect on acute and long-term mechanical sensitivity.  See acast.com/privacy for privacy and opt-out information.

Cumulative exposure to psychosocial adversity in the early years of life can have an adverse effect on early child development (ECD).  Focus on ECD is growing globally, yet to date, the bulk of research on adverse psychosocial experiences and child development has taken place in high-income, Western countries, despite a large burden in developing countries. This month, we meet Early Career Investigator Dr. Annie Berens, a pediatric resident at the University of California San Francisco. She created the Childhood Psychosocial Adversity Scale, a novel measure of cumulative risk which has had its first application in Bangladesh.   See acast.com/privacy for privacy and opt-out information.

A number of clinical variables are used to predict the likelihood of childhood epilepsy, however, additional predictors are needed to improve patient stratification for those at the highest risk of recurrent seizures. In this episode, we meet Adam Numis from the University of California San Francisco, who set out to assess the utility of circulating cytokines as a predictor of childhood epilepsy. He performed a longitudinal study of newborns at risk of neonatal encephalopathy, revealing an association between circulating levels of particular inflammatory cytokines and the later development of epilepsy.  See acast.com/privacy for privacy and opt-out information.

Neonatal encephalopathy (NE) is associated with substantial morbidity and mortality and affects around 1.5/1000 live term births. Predicting the severity and outcome of neonates with NE is therefore vital in order to provide the best care for neonates with NE, and a biochemical marker obtained at birth would therefore be useful to bolster the current scoring system. In this episode, Geoff Marsh speaks to Early Career Investigator Dr. Imran Nazir Mir, from the University of Texas, Southwestern Medical Center. He's just published a paper testing the utility of two potential candidate proteins for determining the presence and severity of hypoxic NE, and to understand where these molecules are synthesized and cleared.  See acast.com/privacy for privacy and opt-out information.

For term-born infants, low birth weight has been shown to correlate with a broad array of adverse cardiometabolic outcomes, and excess glucocorticoid exposure has been linked to these relationships. Also, intra-uterine growth restriction (IUGR) in term-born infants has been linked to subsequent increases in adrenal androgen activity. In this episode, we meet Kristi Watterberg, a professor of Pediatrics at the University of New Mexico who evaluated the relationship between preterm birth to salivary cortisol and dehydroepiandrosterone (DHEA) at age 6, and assessed the relationship of cortisol and DHEA with blood pressure and measures of adiposity. The results suggest interventions to improve the cardiometabolic outcomes of infants born extremely preterm.  See acast.com/privacy for privacy and opt-out information.

Over-the-counter (OTC) medications are used in an estimated 70% of pregnancies. Acetaminophen, also known as paracetamol is found in a large number of OTC and prescription drugs. Given its prevalence and its ability to freely cross the placenta, researchers are now focusing on the safety of maternal exposure to this drug and its effects on fetal health. There have been inconsistent results in both human and animal studies on the short and long-term effects of acetaminophen use during pregnancy. In this episode, we meet Early Career Investigator, Melissa Smarr, an assistant professor at the Emory University School of Public Health as she describes her study into the effects of prenatal acetaminophen use on fetal growth.  See acast.com/privacy for privacy and opt-out information.

Almost 10% of newborn infants develop significant hyperbilirubinemia, and many require phototherapy treatment. This is costly and can increase the likelihood of patients developing allergic diseases. However the costs of not treating neonatal jaundice can be more severe as it can cause lifelong disability. Precise patient monitoring and deliberate treatment assignment are therefore essential for at-risk neonates. In this episode, we meet Sven Wellman, then of the University of Basel's Children Hospital in Switzerland. He and his team developed an online tool that uses machine learning methods to accurately predict neonates at risk of developing clinically relevant hyperbilirubinemia.  See acast.com/privacy for privacy and opt-out information.

Placental dysfunction is a leading cause of morbidity and mortality in children. Yet, despite its central importance, there is a lack of tools to assess in vivo placental health. Ex vivo evaluation of placentas has shown there to be micro-architectural changes with fetal growth restriction (FGR), but currently there are no tools to assess this before birth. In this episode, we speak with this month's Early Career Investigator- Prof. Nickie Andescavage from George Washington University, who recently performed an advanced textural and morphometric of Magnetic Resonance images of the in vivo placenta in healthy and high-risk pregnancies.  See acast.com/privacy for privacy and opt-out information.

In 2015, Brazil experienced an unprecedented epidemic of zika virus infection. Concurrently, there was an increased incidence of children born with primary congenital microcephaly. Researchers quickly suspected a link between the zika virus infection in pregnant women and congenital microcephaly due to the so-called congenital Zika syndrome (CZS). With the impending threat of a second outbreak, Marcio Leyser from the University of Iowa proposes a multilevel-based research framework for CZS, based on the multifaceted aspects of the disease.  See acast.com/privacy for privacy and opt-out information.

Bronchopulmonary Dysplasia (BPD) is a form of Chronic lung disease and results from extreme pre-term birth. Systemic corticosteroid therapy is used postnatally to reduce the severity of BPD, however there is a large range in the phenotypic response to this treatment. In this episode, we speak to Tamorah Lewis, a neonatologist at Children's Mercy Hospital in Kansas City, who aimed to identify pharmacogenetic variants associated with the clinical response to systemic corticosteroid treatment.  See acast.com/privacy for privacy and opt-out information.