Children's Hospital of Oklahoma

Introduction: Sotalol is a class III antiarrhythmic. In hemodynamically unstable patients, a continuous infusion may be preferred over intermittent intravenous sotalol to reduce the risk of hypotension and bradycardia. However, there is a paucity of literature regarding sotalol continuous infusions. The purpose of this study was to describe the use of sotalol continuous infusions in critically ill neonates and children. Methods: This was a retrospective case series of patients < 18 years of age from 1/1/2018 to 2/28/2025 who received a sotalol continuous infusion for >12 hours. Data collection included demographics, arrhythmia type, presence of congenital heart disease, sotalol dosing and duration, concomitant antiarrhythmics adverse events [bradycardia (defined as less than 100 beats/min in neonates and less than 50 beats/min in infants and children), prolonged QTc (defined as greater than 480 ms), and significant QTc prolongation (defined as greater than 550 ms)]. The primary objective was to identify the median dose and duration of sotalol continuous infusions. Secondary objectives included identifying drug interactions and adverse events with sotalol. Descriptive statistics were performed. Results: Fourteen patients were included. The age range for these patients was 0.33-192 months. Eight patients had supraventricular tachycardia, and six patients had atrial tachycardia. Six patients had congenital heart disease. Sotalol was initiated most commonly as a third-line antiarrhythmic, and eight patients received a loading dose of sotalol prior to the continuous infusion. The median initial dose was 52.5 mg/m2/day and ranged from 23-85 mg/m2/day. The median infusion duration was 293 hours and ranged from 25.3-2129.2 hours. Three patients required a dose reduction for an adverse event; one patient required the addition of vasopressors. All patients were on concomitant antiarrhythmics. Conclusions: Sotalol was initiated most commonly as a third-line anti-arrhythmic. There was variability between patients for the dosing and duration of sotalol. Four patients required dose adjustments or other interventions for an adverse event. Overall, larger studies evaluating continuous infusion sotalol in children and neonates is needed.

Inter-alpha Inhibitor Proteins (IAIP) are serine protease inhibitors and a reliable inflammatory biomarker. We have demonstrated that IAIP levels decrease during sepsis in humans and animal models. Currently, enzyme-linked immunosorbent assay (ELISA) is the standard procedure to measure IAIP levels. We developed a lateral flow immunoassay (LFIA) that allows rapid, point of care detection. We compared IAIP levels in infants with sepsis and/or necrotizing enterocolitis (NEC) by ELISA and LFIA in a multi-center, cross-sectional study. Blood samples were collected from 47 infants with sepsis, 31 sepsis case controls, 52 gestational age (GA)-matched controls and 10 infants with culture-negative sepsis (“clinical sepsis”). We also collected samples from 17 infants with NEC, 7 NEC case controls and 15 GA controls. IAIP levels at presentation of acute events and over the next 72 hours were significantly reduced in infants with sepsis, NEC and culture negative sepsis when compared to controls. IAIP levels did not differ in patients with sepsis or culture negative sepsis. IAIP levels measured by ELISA and LFIA were highly correlated (R2 = 0.9326) and both showed reliable detection of neonatal sepsis, NEC and culture negative sepsis. IAIP levels were 80.0% sensitive and 92.3% specific using LFIA for the detection of neonatal sepsis. For detection of NEC, IAIP levels were 84.6% sensitive and 86.7% specific.

Emanuel Syndrome Presenting with Respiratory Distress and Feeding Difficulties in an Infant: A case Report from NepalSurabhi Aryal1 , Krishna Kumar Maharjan1 , Sajjad Ahmed Khan2 , Dikshya Devkota3 , Aakash Khatiwada2, Prajita Baral2, Huma Kausar41Dep

Despite the growing use of unsedated transnasal endoscopy (uTNE) in pediatrics, no validated tool exists to assess competence in performing uTNE, hindering effective training and consistent, high-quality performance. Video-based assessment offers a scalable and reliable method for assessing and enhancing procedural skills. Using Delphi methodology, we aimed to identify key competencies and establish content validity evidence for the TransNasal Endoscopy Skills Assessment Tool (TNE-SAT), a video-based tool designed to assess clinician competence in performing uTNE. North American pediatric uTNE experts iteratively rated potential assessment items, on a 5-point scale, based on their importance as indicators of endoscopist competence in performing uTNE. After each voting round, items scoring ≤3/5 were eliminated, and the remaining items were re-sent to the panel for further rating until consensus was reached, defined as ≥80% of panelists rating all remaining items ≥4. Items meeting this threshold were included in the final TNE-SAT tool. Twenty-seven experts from 19 sites across North America participated. One hundred thirty items were generated through literature review, task deconstruction, and Delphi panelist input. Three rounds of surveys were completed before consensus was achieved, with response rates ranging from 85% to 9. Seven items reached consensus for inclusion in the final TNE-SAT. This North American Delphi study identified core competencies required for effective uTNE performance and informed the development of the TNE-SAT, a structured, video-based tool to assess clinician competence. The TNE-SAT offers a promising tool to guide training and support quality improvement in pediatric uTNE.

The Western diet (WD) has been associated with various pathologies, largely due to chronic inflammatory responses triggered by insulin spikes and excess cholesterol. However, the effects of maternal WD on offspring are currently understudied. We hypothesize that maternal WD consumption in baboons induces a hyperinflammatory state in offspring, leading to compromised intestinal barrier function. Intestinal tissue was harvested from olive baboon (Papio anubis) 0.9 gestation fetuses and juveniles (age 2-3 yr), whose mothers were fed either a high-fat/high-sugar WD or a control diet (CD) of standard monkey chow. RNA and protein were isolated and analyzed for markers of inflammation and apoptosis. Intestinal organoids (enteroids) were generated from these bowel samples and subsequently subjected to hypoxia and LPS to simulate necrotizing enterocolitis (NEC). RNA was extracted and similarly examined for inflammatory markers and markers of apoptosis. Enteroids were plated onto TransWellTM plates to evaluate barrier function. Immunohistochemistry and immunofluorescence were used to evaluate barrier proteins. The intestinal tissue of baboon fetuses and juveniles of mothers fed a Western diet exhibited evidence of a hyperinflammatory state. Although not all cytokines reached our significance set a priori at P < 0.05, interleukin-8 (IL-8) and Interferon γ (IFNγ) were significantly elevated. This trend was stable across generations. Offspring from the Western diet group exhibited decreased barrier function based on transepithelial resistance measurements. Maternal consumption of a Western diet during gestation in olive baboons leads to a generalized inflammatory state and weakened intestinal barrier function in offspring, with potential long-term health implications.NEW & NOTEWORTHY Our research examines a currently understudied area of the maternal/fetal relationship. This is especially pertinent, given the rampant access to high-fat/high-sugar foods in the Western diet. It is also noteworthy due to the findings of decreased barrier function among those in the Western diet group. This decreased function and hyperinflammatory state can prime neonates for various pathologies, such as necrotizing enterocolitis.

Food insecurity (FI) has documented negative health impacts on children, with a higher prevalence in children with kidney disease. The prevalence and consequences of FI in pediatric kidney transplant recipients are unknown. In this study, we screened and assessed pediatric kidney transplant recipients for FI using the Hunger Vital Sign and analyzed the impact of FI on pediatric kidney transplant outcomes. Of the 118 pediatric kidney transplant recipients screened, 23 (19.5%) were identified as FI. Food-secure and food-insecure recipients were not significantly different in age or gender, but there was significantly more FI in recipients of Hispanic ethnicity (56% vs. 30%) and with public insurance (83% vs. 52%). Markers of nutrient stores and transplant outcomes were not significantly different in recipients with FI. Our study highlights the feasibility and importance of screening pediatric kidney transplant recipients for FI with the Hunger Vital. The observed link of FI with demographic characteristics such as Hispanic ethnicity and having public insurance offers potential targets for intervention. Larger studies assessing FI and outcomes in pediatric transplant recipients are critical for focused interventions and policy development.

Abstract Background Apnea of prematurity is nearly universal among very low birth weight infants (VLBW). In VLBW infants, changes in clinical status usually occur due to sepsis or non-infectious causes and it is challenging to differentiate between the two. We as clinicians use irregularities in vital signs as an early warning sign of sepsis to facilitate early treatment and improve patient outcomes. Adults have used RDW as a marker of worsening respiratory status and mortality from acute respiratory distress syndrome (ARDS). In this study, we seek to investigate elevations in Red Cell Distribution Width (RDW) as markers for culture positive sepsis and need for escalation of respiratory support in VLBW neonates. Association between RDW values and positive cultures Methods We did a retrospective chart review using the Electronic Medical Records (EMR) of VLBW infants (&amp;lt; 1500g) admitted to the Neonatal Intensive Care Unit (NICU) of a community hospital over 3 years. We included all babies who had True apnea (apnea &amp;gt; 20 seconds) or apnea with bradycardia and desaturations, after day seven of life and had CBC tests sent and were being managed for presumed late onset sepsis secondary to this vital sign instability. Other demographic data was gathered and tabulated. The data was analyzed to check for association between increased red cell distribution width (RDW) and need for escalation of respiratory support. Escalation in respiratory support included an increased need of assisted ventilation to support breathing. We also looked at positive blood / urine cultures and RDW values. Association between RDW values and change in baseline respiratory support Results 50 babies matched our inclusion criteria. 31 babies had a positive blood /urine culture. 21 of the 31 had elevated RDW which was statistically significant at p&amp;lt; 0.05 (Table1), hence showing that positive culture late onset sepsis had elevated RDW. Also, we saw increased need for escalation in respiratory support amongst culture positive babies with an elevated RDW at p &amp;lt; 0.05 (Table 2). Conclusion We conclude from this, that elevations in RDW is a marker for VLBW babies needing escalation in respiratory support. Elevations were also seen in culture positive sepsis. More studies need to be done as most of the available data is in adults. We can look more associations in babies with RDS (respiratory distress syndrome) and predict respiratory distress and for early interventions and better outcomes. Disclosures All Authors: No reported disclosures