Pediatric Research Podcast

Acute kidney injury (AKI) causes significant morbidity and mortality in children, including prolonged hospital stays, increased risk of in-hospital death and future risk of hypertension and progression to chronic kidney disease. Whilst it is quite common, it often goes unrecognized, especially outside of the critical care setting. In this episode, Geoff Marsh speaks to Dr. Shina Menon, a pediatric nephrologist at Seattle Children's Hospital, who performed a pilot study which evaluated the utility of an e-alert system to alert care providers that a patient had AKI, in conjunction with a care bundle which offered simple guidelines to help with their management. 

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The latter half of gestation and early neonatal life are critical periods for the maturation of the autonomic nervous system. Premature infants are born with underdeveloped autonomic maturation and must undergo their developmental changes in a vastly different setting to the natural, in utero environment. A number of studies have shown autonomic dysmaturation in premature infants, although these have mainly looked at cohorts of children from high-morbidity NICUs. In this episode, Geoff Marsh talks to Dr. Sarah Mulkey, a fetal neonatal neurologist at Children's National Hospital in Washington DC, who tracked the sympathetic and parasympathetic maturation of a cohort of preterm infants with low medical morbidity in a large community NICU, to assess how birth gestational age affected their autonomic maturation. 

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Pediatric chronic kidney disease (pCKD) results in a life-long burden that requires routine care. Neurocognitive dysfunction, specifically impairment on tasks of executive function, is a well-established comorbidity but there is a paucity of data exploring the neurobiology of these cognitive deficits. In this episode, we meet early career investigator, Dr Lyndsay Harshman, a pediatric nephrologist at the University of Iowa's Stead Family Children's hospital, who compared the brain morphometry between early stage pCKD children and their typically developing peers, and linked this brain morphometry with disease status and performance on neurocognitive assessments. 

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Therapeutic Hypothermia has long been the standard of care for infants with moderate to severe neonatal encephalopathy. However, the future of treatment for neonatal encephalopathy (NE) will focus on hypothermia adjuvant therapies. There needs to be a rethink in how future NE clinical trials are designed and analyzed, according to a multi-disciplinary expert panel who met at the 'Hypoxic-Ischemic Encephalopathy Symposium: Developing the Future'. In this episode we meet Dr. Kristen Benninger, a neonatologist at Nationwide Children's Hospital in Columbus Ohio who wrote up the panel's summary. 

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Pediatric Pulmonary hypertension (PAH) is a heterogeneous disease, characterized by sustained elevation of pulmonary arterial pressures and death from right ventricular failure. Given the extremely high burden of morbidity and mortality associated with this disease, and the risk of the invasive procedures required for diagnostics, novel biomarkers for this disease would be beneficial. In this episode, we meet Early Career Investigator, Dr. Megan Griffiths from Johns Hopkins University, School of Medicine, who examined two candidate IGF axis proteins as potential predictors of PAH severity. 

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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!

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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.

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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.

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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.

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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. 

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