COVID-19 in Children, Seizures, Smoking Cessation, CAG Funding

By limjr [at] email.chop.edu (Jillian Rose Lim)

In our latest roundup of news, researchers in Infectious Diseases, Neurology, and Pediatrics at Children’s Hospital of Philadelphia demonstrate their ingenuity, resourcefulness, and expertise when it comes to challenges in children’s health: Our chief of the Division of Infectious Diseases shares her thought on children’s role in COVID-19 transmission, a team of neurologists develop a novel approach to detecting infant seizures, and PolicyLab researchers refine their research into preventing secondhand smoke in children.

Susan Coffin, MD, PhD, Discusses Children’s Role in COVID-19 Transmission

Dr. Coffin, chief of the Division of Infectious Diseases, is working hard to better understand the natural history of COVID-19 in children. In a new “Leader’s Perspective” article for the Children’s Hospital Association, which has over 200 members worldwide, Dr. Coffin shared thoughts on how her work could help overall efforts to control and prevent the SARS Cov-2 virus, as well as why she believes COVID-19 differs from new viruses she has seen before.

“To date, a small proportion of the total cases from just about any jurisdiction are children,” said Dr. Coffin in the Q&A article. “This is really different than the vast majority of respiratory viruses, where children tend to have the most frequent and severe symptoms. Understanding why that is — and whether it is in some way linked to their role in transmission to adults — are key questions.”

Dr. Coffin noted the power and potential of community-based studies (which look at cohorts of children beyond those who present for medical care) when trying to study a virus transmittable when someone is asymptomatic. She also shared some preliminary findings from her research, which draws on samples of about 150 children diagnosed with COVID-19 and treated at CHOP.

“…we have very low rates of detection of the virus in otherwise healthy children present in such minute quantities that it is not likely to be a cause of transmission of infection,” Dr. Coffin said. “Much more study is needed to verify that, but I do think there is a differential of risk from a child passing coronavirus to an adult based on whether they do or don't have symptoms.”

Read the full Q&A.

Researchers Find Remote Monitoring Effectively Identifies Seizures in At-Risk Newborns

Neonatal seizures are common, occurring in four of every 1,000 births. Though more than 80 percent of these instances do not have identifiable symptoms, continuous electroencephalogram (CEEG) monitoring helps clinicians to detect seizures. Through CEEG, clinicians can review dynamic information about brain function. In many neonatal clinics, however, lack of equipment and lack of experienced personnel often prevent clinicians from implementing the technology.

In a new study published in the Journal of Clinical Neurophysiology, CHOP researchers addressed this challenge by expanding access to CEEG for at-risk infants via a framework that uses CEEG remotely. Remote monitoring allows clinicians to catch more instances than typical methods and improves the quality of care for infants in hospitals that lack the on-site resources for detecting these seizures.

As part of the study, the CHOP team set up their remote CEEG framework at two neonatal intensive care units of network hospitals. When those network hospitals identify a newborn who should undergo CEEG based on clinical concerns (i.e. unexplained encephalopathy), an EEG technologist places the EEG leads and gathers standardized clinical data, then notifies an EEG technologist at the main hospital (CHOP). In a review of the pilot program’s first 27 months, the CHOP team found much success.

“In the first two years of this pilot program, we demonstrated that neonatal seizures are common in at-risk neonates and that CEEG often impacted outcomes,” said Mark P. Fitzgerald, MD, PhD, lead author of the study and a pediatric neurologist in the Division of Neurology at CHOP. “By providing remote CEEG to network hospitals, we allow these neonates to remain in centers that could meet their overall medical needs and alleviate the safety risks associated with transferring critically ill newborns between hospitals.”

Read the full press release.

Identifying Parents’ Preferences for Smoking Cessation Messages

More than 40 percent of children in the U.S. are exposed to secondhand smoke, increasing their risk of respiratory infections, asthma flare-ups, and premature death. Since parents often accompany their child to doctor’s visits, pediatricians occupy a unique position to deliver family services that can motivate parents to protect their children from secondhand smoke. In a recently published Pediatrics article, a team of CHOP researchers identified the type and content of smoking cessation messages that parents most preferred to hear from their children’s doctors.

In the study led by Brian Jenssen, MD, MSHP, attending physician at CHOP, 180 parent smokers rated the relative importance of 26 messages designed to encourage treatment to stop smoking. Each message varied when it came to the subject (child, parent, or family), the outcome mentioned (general health, cancer, respiratory illnesses, child becoming a smoker, or financial impact), and whether the message was “gain” or “loss” framed.

Dr. Jenssen and his team found that parent smokers prioritized messages that emphasized the impact on their child and messages whose outcomes focused on respiratory health, cancer, or general health.

“The clinical impact of these messages should be tested in future research,” the authors wrote in the paper’s abstract.

Dr. Jenssen and colleagues have studied how clinicians can best help parents quit smoking for a number of years. This study is part of a larger research project, Parents Quit IT, that will develop a clinician decision support tool (CDS) system that effectively prompts clinicians to consistently deliver these framed messages for tobacco cessation treatment. In the long run, the larger study aims to develop smoking cessation interventions that target vulnerable populations and that health systems could scale for broad population impact.

Learn more in the Pediatrics paper.

Center for Applied Genomics Receives Funding to Study Disease Risk

Researchers in our Center of Applied Genomics (CAG) at CHOP are among the recipients of a multi-million dollar grant from the National Institutes of Health that seeks to use genomics to improve risk assessment for diverse populations, then integrate the findings into clinical care. The grant is part of the Electronic Medical Records and Genomics (eMERGE) Genomic Risk Assessment and Management Network, which has provided CAG funding for the past eight years. As the largest pediatric biorepository in the U.S., CAG has had a focus on minority and underserved populations. African Americans represent about 90 percent of the whole genome sequence data CAG has contributed to eMERGE to date.

With this round’s funding, CAG will home in on five specific areas of research: generating and validating polygenic risk scores for multiple common diseases; examining legal, ethical, and social implications of returning genomic risk assessments; recruiting and engaging new participants not previously enrolled with CAG (with at least 75 percent of participants being African American); returning risk assessments to those same recruited participants; and integrating polygenic risk scores with electronic health records.

“The Center for Applied Genomics and the National Institutes of Health have had an excellent partnership within the eMERGE Network, and we are thrilled to continue to build upon the valuable work that we have been able to achieve so far, with particular emphasis on resolving diseases in diverse patient populations and minority groups,” said Hakon Hakonarson, MD, PhD, Director of CAG and principal investigator of the program. “The primary goals of this program are to identify disease risks faced by patients and their families and to determine the most appropriate actions we can take to improve health outcomes. The program specifically focuses on African American children and their families, who will constitute 75% of participants.”

Learn more in the press release.

ICYMI

Catch up on our headlines from our June 19 In the News:

• Asthma Emergency Department Visits Decline Dramatically During COVID-19 Pandemic
• Universal Preoperative COVID-19 Screening Identifies Asymptomatic Patients, Improves Safety
• Telemedicine Proves Effective for Pediatric Neurology Network
• One-stop Resource for Genetics of Mitochondrial Disease
• PolicyLab Model Forecasts Show Memorial Day Travel has Minimal Impact on COVID-19 Cases
• Food Allergy Center Named Discovery Center of Distinction

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