September 11, 2020
In This Issue

Research Spotlight:
COVID-19: Back to School Resources

Upcoming Events

Recent Publications
COVID-19: Back to School Resources
Back in May, we wrote a Research Spotlight about the various ways in which CPCE team members were addressing the COVID-19 pandemic. Now four months later, we’re putting the spotlight back on the pandemic, with a special emphasis on the start of the 2020-2021 school year, which looks very different for many students, families, and teachers.

In case you missed it, Susan Coffin, MD, MPH has discussed considerations for maximizing safety in schools, youth sports, and other activities with various news outlets, including but not limited to: The Philadelphia Tribune, CBS Philly, and The Philadelphia Inquirer.

Kevin Downes, MD led a team of pediatric infectious diseases (ID), transplant ID, public health, transplant psychology, and infection prevention and control specialists to address concerns about school reentry, specifically for pediatric solid organ transplant recipients. Dr. Downes and his co-authors recognized “that risk will vary substantially across communities and schools, and that decisions must ultimately be shared between patients, families, providers, and their schools.” Their guidance, published in the Journal of the Pediatric Infectious Diseases Society, is meant to provide a framework for such decision making.

Some colleges and universities that attempted to bring students back to campus have subsequently moved to online or hybrid learning models. Brian Fisher, DO, MSCE, who has contributed to PolicyLab’s COVID-19 mapping project, told Bloomberg, “We’re really watching these mini-experiments happen all across the country. It remains to be seen for some campuses whether they’re going to get their outbreaks under control.”

Outbreaks on college campuses have the potential to impact their surrounding communities, as David Rubin, MD, MSCE discussed with The Verge, making it especially difficult for K-12 schools in these areas to keep students and staff safe.

As our understanding of COVID-19 evolves, we’ll continue to provide periodic updates. In the meantime, see the resources below for further reading.

Upcoming Events

Novel Strategies to Prevent Gender-Based Violence Among Adolescents
Date: September 14, 2020
Time: 3:00 pm ET
In a major breakthrough, randomized trials have started demonstrating there are interventions that can be used to reduce the rate of gender-based violence (GBV). In this talk, participants will first learn about the “big picture” of GBV prevention, then move into case-based discussions of adolescent GBV prevention programs in three different settings. The speakers will then synthesize all of the learning into a larger discussion of best practices and directions for future practice and research. Sponsored by the Stanford Maternal & Child Health Research Institute. Learn more and register here.

2020 PCORI Virtual Annual Meeting: Accelerating Impact on Care and Patient-Centered Outcomes
Dates: September 16-17, 2020
This year's sessions will feature PCORI-funded COVID-19 research, telehealth, and health and healthcare disparities, among other hot topics. Learn more and register here.

CPCE/PolicyLab Virtual Seminar Series: Opportunities for Prevention Research
Date: September 18, 2020
Time: 12:00 noon - 1:00 pm
Presented by Alex R. Kemper, MD, MPH, MS, Division Chief of Primary Care Pediatrics at Nationwide Children’s Hospital and Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Kemper is a former member of the US Preventive Services Task Force. He serves as the Chair of the Condition Review Workgroup for the U.S. Secretary of Health and Human Services Advisory Committee on Heritable Disorders in Newborns and Children. Dr. Kemper is also the Deputy Editor of Pediatrics. Via BlueJeans.

Patients, Providers & Data: How the EMR and Data Science are Changing Clinical Care
Date: September 24, 2020
Time: 3:00 - 4:00 pm
Penn Engineering, Department of Bioengineering, hosts Kevin B. Johnson, M.D., M.S., Informatician-in-Chief, Cornelius Vanderbilt Professor and Chair of Biomedical Informatics, and Professor of Pediatrics at Vanderbilt University Medical Center. Dr. Johnson will showcase projects from his lab that demonstrate the multi-disciplinary nature of biomedical informatics/data science research and translation using the EHR, and our current understanding of its potential from my perspective as a pediatrician, a researcher in biomedical informatics, and Chief Information Officer, an educator, and an advisor to local and international policy. Via Zoom. Passcode 812421.

Cancer and COVID-19: Update from Penn's Abramson Cancer Center
Date: September 30, 2020
Time: 6:00 - 8:45 pm
This activity is designed to focus on the major areas in which the COVID-19 pandemic has impacted how cancer care is delivered and experienced by patients. Participate in this live webcast and join the discussion on this fast moving subject while gaining up-to-date, practical information with immediate clinical and operational application. Anthony S. Fauci, MD, Director NIAID and Founding Member of the White House Coronavirus Task Force, will deliver a keynote address. Learn more and register here.

International Workshop on Microbiome in HIV Pathogenesis, Prevention, and Treatment 2020
Dates: October 7-8, 2020
The virtual edition will provide an immersive experience to all participants through an interactive platform for real-time Q&A sessions and roundtables to fuel inspiring discussions that will move the microbiome and HIV interaction field forward. Learn more and register here.

CHOP Global Health Virtual Conference
Dates: October 9-10, 2020
The 2020 12th Annual CHOP Global Health Conference will explore how politics, governance, and leadership affect global child health. In low-, middle-, and high-income countries around the world, these key factors influence health systems in powerful ways, and affect healthcare delivery. This meeting will bring policy, political science and global child health experts together to share approaches for working with and within various political systems to positively impact child health. The meeting will also challenge and equip attendees to become advocates for child health within their own systems at the local, national, and international levels. Learn more and register here.

Diagnostic Error in Medicine 13th Annual International Conference (SIDM2020)
Dates: October 19-21, 2020
Join researchers, educators, clinicians and patients to learn about the latest work to drive diagnostic quality and safety. Virtual education events will include keynotes, breakout sessions, oral abstracts, and poster sessions. Learn more and register here.

IDWeek 2020
Dates: October 21-25, 2020
Given the evolving global pandemic, IDWeek organizers have made the unanimous decision to convert the meeting to a 100% virtual event. Receive the latest updates on COVID-19 and other infectious diseases through an exciting and content-rich virtual program. Learn more about the virtual program or register now. Anthony S. Fauci, MD, FIDSA will deliver the opening presentation during the Chasing the Sun event on Oct. 21 at 10 a.m. ET.
Recent Publications

There are no proven safe and effective therapies for children who develop life-threatening complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Convalescent plasma (CP) has demonstrated potential benefit in adults, but has theoretical risks. Kathleen Chiotos, MD, MSCE and colleagues present the first report of CP in children with life-threatening coronavirus disease 2019 (COVID-19), providing data on four pediatric patients with acute respiratory distress syndrome. They measured donor antibody levels and recipient antibody response prior to and following CP infusion. They found that CP was safe and possibly efficacious.

The US Centers of Disease Control and Prevention reports multiple-victim school homicide rates have increased significantly between 2009 and 2018, following 15 years of decline. Considering the overall burden of gun violence, mass shootings are responsible for a relatively small number of deaths and injuries. However, these events expose other residents, notably children, in nearby communities to violence. Researchers including Scott Lorch, MD, MSCE, Molly Passarella, and Sage Myers, MD, MSCE examine the location of mass shootings relative to schools and places frequented by children, highlighting the potential risk of exposure to violence in our communities.

Although living donor kidney transplants have declined among adults with end-stage renal disease (ESRD), with increases in racial-ethnic disparities over time, these secular trends have not been studied well in children. Sandra Amaral, MD, MHS and her research team used multivariate Cox modeling to examine changes in living donor kidney transplant rates over time and probability of receiving living donor kidney transplantation within 2 years of incident ESRD by race/ethnicity. They found ongoing declines in living donation for children with ESRD for uncertain reasons, and minority populations experience significantly reduced access to timely living donor transplant, even when accounting for changes in deceased donation and donor-recipient relationships.

A team including Fran Balamuth, MD, PhD aimed to evaluate the association of height of fever with invasive bacterial infection (IBI) among febrile infants <=60 days of age. In a secondary analysis of a multicenter case-control study of non-ill-appearing febrile infants, they compared the maximum temperature for infants with and without IBI. They then computed interval likelihood ratios for the diagnosis of IBI at each half-degree Celsius interval. They found that although IBI is more likely with higher temperatures, height of fever alone should not be used for risk stratification of febrile infants.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition of immune dysregulation. Children offer suffer from primary genetic forms of HLH, which can be triggered by infection, while other suffer from secondary HLH, as a complication of infection, malignancy, or rheumatologic disease. William Otto, MD, Brian Fisher, DO, MSCE, and their team describe the clinical and virologic characteristics of 5 children admitted with adenovirus infection during 2018-2019 who developed HLH or HLH-like illness. None of the patients were found to have a genetic predisposition to HLH, suggesting that adenovirus 7 infection alone can result in HLH.

Poor vitamin D status is a global health problem and common in patients with human immunodeficiency virus (HIV) in high-income countries. Andrew Steenhoff, MBBCh, DCH and colleagues ran a cross-sectional study to determine the vitamin D status in Batswana HIV-infected mothers and their children, differences among HIV-infected mothers and between HIV-exposed and –infected infants and children, and associations between vitamin D and disease-related outcomes, nutrition, and growth. Results showed a low prevalence of vitamin D insufficiency in Botswana. Growth was positively correlated with vitamin D status in HIV-exposed children, and HIV+ children had poorer linear growth than HIV-children.

Andrew C. Glatz, MD, MSCE and his colleagues conducted a retrospective study of 35 neonates with pulmonary lymphatic abnormalities who underwent lymphatic evaluation. Demographics, clinical characteristics, and outcomes were compared for patients with only pulmonary lymphatic perfusion syndrome, classified as neonatal chylothorax (NCTx), and those with multiple flow abnormalities, classified as central lymphatic flow disorder (CLFD). Establishing a diagnosis of NCTx or CLFD is paramount in selecting treatment options and providing prognostic information. Development of lymphatic interventions represents a paradigm shift in our understanding of neonatal lymphatic flow disorders and may be associated with improved survival.

Prior single site evaluations of PriCARE, a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes. Joanne Wood, MD, MSHP, Devon Kratchman, and their team measured the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study. PriCARE showed promise in improving parental perceptions of the severity of child behaviors and decreasing parenting stress but did not have an observed impact on parenting attitudes.

Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. Charlotte Woods-Hill, MD and her team ran a single-center cross sectional electronic survey of bedside nurses to explore factors impacting bundle performance in the pediatric intensive care unit (PICU). Results showed that PICU nurses are knowledgeable and motivated to prevent CLABSI, but face challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle.

The similar socioeconomic position of black and Hispanic women coupled with better birth outcomes among Hispanic women is termed the “Hispanic Paradox.” However, birth outcome disparities among Hispanic women exist by maternal nativity. Persistent unequal exposure over time to stressors contributes to these disparities. Diana Montoya-Williams, MD, FAAP, Heather Burris, MD, MPH and their colleagues hypothesized that variation in maternal resilience to stressors also exists by race, ethnicity, and nativity. They found that resilience did not differ significantly across race/ethnicity or by foreign-born status in the overall cohort or among immigrant women by continent of birth. Overall, foreign-born Hispanic women appear to possess a resilience advantage.

About CPCE

We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing and centralizing the performance of clinical effectiveness research -- research aimed at understanding the best ways to prevent, diagnose and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.

CPCE E-News is edited by Holly Burnside. Please feel free to contact us with questions or feedback.