Pediatrics 2019 Projects

Project Title: Retrospective review of receipt of recommended vaccines in pregnancy

Faculty Mentor’s Name: Lindsay Thompson

Student’s Name: Taylor Merritt

Project Description:

Current recommendations specify that all pregnant women should receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination and the annual inactivated influenza vaccination during pregnancy.1-3 Tdap is to be given at 27-36 weeks of gestation in every pregnancy.3 The inactivated influenza vaccination can be given at any point during the pregnancy, but current recommendations specify that pregnant women should be given the seasonal influenza vaccination as soon as it is annually available.2 Maternal vaccination with Tdap during pregnancy not only protects pregnant women, but effectively protects young infants from contracting pertussis through transfer of protective antibodies to their infants.4 These maternal antibodies prevent pertussis-related deaths during infancy, which is especially important for newborns who are exposed to pertussis before they have built enough immunity on their own through completion of the DTaP series . Similarly, the influenza vaccine cannot be administered to infants until they are at least 6 months of age. During this critical period, infants are reliant on their mother’s health and maternal antibodies for protection from influenza, and vaccination with the influenza vaccine during pregnancy is associated with lower rates of influenza infection in infants.5

Maternal Tdap and influenza vaccination uptake during pregnancy remains low despite current recommendations. Several studies have shown lower Tdap and influenza vaccination rates in women insured by Medicaid compared to other insurance types.6,7,8 Although Medicaid covers pregnancy-related services without cost-sharing, each state Medicaid program is able to decide whether other services, including vaccinations, are provided to pregnant mothers with or without cost sharing for the patient.9 In Florida, influenza and Tdap vaccinations are not currently included in the pregnancy-related services covered by Medicaid. Instead, vaccinations are subject to cost sharing premiums set by the Florida Medicaid program.

In addition to a patient’s type of health insurance, other factors have been shown to affect the uptake of the recommended vaccinations during pregnancy. In Massachusetts, non-Hispanic black women, women younger than 25 years old, and women who earned below the federal poverty level were less likely to receive the influenza vaccination during pregnancy.8 In contrast, when women were offered the Tdap vaccination on site during one of their prenatal visits, they were more likely to be vaccinated compared to women referred to off-site facilities.7 These discrepancies based on health insurance type, race, age, socioeconomic status, and on-site availability of the vaccine may represent several of the barriers patients face when attempting to obtain the recommended vaccinations during pregnancy.

Project Title: Socio-Economic Benefits of a Pediatric Neurosurgery Telemedicine Clinic

Faculty Mentor’s Name: Dr. Philipp Aldana
Phone: (904) 633-0991

Student’s Name: Alex Simko

Project Description:

The growth and evolution of telehealth are opening new avenues for efficient, effective, and affordable pediatric healthcare services in the United States and around the world. This study aims to address the socio-economic benefits to the patients of the Pediatric Neurosurgery Telemedicine Clinic(PNTMC) as well as the economic benefits to the healthcare facility. The PNTMC is a telehealth service located in Waycross, Georgia where patients receive their telemedicine care. The University of Florida College of Medicine Jacksonville is where the neurosurgeons provide the telehealth service and is based at Wolfson Children’s Hospital in Jacksonville, Florida.

This retrospective study is designed to compare telemedicine services with clinic consultations, under the assumption the patient would have traveled to our clinic base if telemedicine was not used. The study will measure outcomes of potential savings to the patients and the healthcare facility. Medical students would have the opportunity to collect and analyze data and potentially assist with manuscript development.

Project Title: The effects of implementing the Neonatal Kaiser Permanente Sepsis Calculator Length of stay in the UF Newborn Nursery

Faculty Mentor’s Name: Dr. Kendall Steadmon
Phone: 386-405-6366

Students’ Names: Nathan Burke and Mallory LeBlanc

Project Description:

Using an early onset sepsis calculator created by Kaiser Permanente, the newborn nursery has now decreased antibiotic use dramatically for infants born to group B strep unknown mother, mothers with chorioamnionitis, prolonged rupture of membranes, or fever.

The changes have been implemented but the impact has not been studied. The role of the medical student would be to chart review the patients that were treated based on the calculator guidelines and then study the impact, both long term and financial.

There will be no funding available or necessary travel.

Project Title: Understanding Families, Children’s Health, Influenza, and Development

Faculty Mentor’s Name: Dr. Melissa Bright
Phone: 352-273-4243

Student’s Name: Melanie Parrott

Project Description:

The first study seeks to determine whether children with a history of abuse or neglect have a blunted response to the influenza vaccine. Children with a history or abuse and neglect and high levels of toxic stress may need to start vaccinations earlier, receive additional vaccine boosters, or get vaccinations more often. In addition, there may be parent-child interaction interventions that can buffer the negative impact of the abuse and neglect and improve success of the vaccination.

The second project will investigate whether there is a difference in effectiveness of implementing the SEEK model early or later in pediatric clinics to identify and address risk for child maltreatment.

Project Title: Value of Routine Blood Cultures in Children on ECMO

Faculty Mentor’s Name: Dr. Saleem Islam
Phone: 352-273-8825

Student’s Name: Jourdan McKinnis

Project Description:

Extracorporeal membrane oxygenation (ECMO) is a life-sustaining device for infants with respiratory or heart problems. The most common conditions requiring ECMO usage include, but are not limited to, congenital diaphragmatic hernia, congenital heart defects, severe pneumonia, and meconium aspiration syndrome (Makdisi & Wang, 2015). ECMO is carried out by attaching a cannula into either the infant’s venous or arterial circulation. The machine then draws blood from the patient and sends it to an oxygenator, where the required gas exchange can occur, and from there, pumps it back into the patient (White & Fan, 2016). Due to the invasive nature of this device, many serious complications can occur. Major complications include bleeding, kidney failure, infection, and stroke (White & Fan, 2016). Infections while on ECMO can result from a variety of different sources including bacteria introduced through invasive lines or devices, previous conditions, immunosuppression, or other nosocomial factors (Biffi et al., 2017). Regarding the different types of infections, bloodstream infections are a major concern and often closely associated with increased morbidity and mortality. As a result, there are various precautions in place for prevention and early detection of these infections, such as prophylactic antibiotic therapy and routine screening blood cultures (Kaczala et al., 2009).

Routine screening blood cultures allow for the early detection of bloodstream infections to ensure prompt treatment and no further exacerbation of infection. However, collecting frequent blood cultures can be quite costly, as well as resource intense to the hospital laboratories. Furthermore, sometimes the results may even be contaminated which can lead to unnecessary follow up tests, procedures, and treatment. Current literature and protocols show that routine screening cultures may decrease mortality from BSI (Steiner, Steward, Sheldon, Hornung, & McKay, 2001). However, when using them in a prophylactic fashion, the best schedule for these cultures remains unknown. Per protocol, we are currently ordering blood cultures every three days on ECMO. We would like to understand the efficiency of this current schedule, and determine if any other factors could possibly effect this.