Credit: Robinder Khemani, MD, MsCI, Attending Physician in Pediatric Intensive Care at Children’s Hospital Los Angeles has received a $3.4 million grant from the National Institute of Health to examine to improve outcomes of children put on ventilators. « Using Machine Learning to Make Ventilator Support Safer for Children
Newswise — LOS ANGELES — Critically ill children on ventilator support can experience a mismatch between their breathing efforts and) the rhythm delivered by the ventilator. This mismatch, called patient-ventilator asynchrony (PVA), is difficult to detect and can worsen patient outcomes. PVA is commonly associated with longer stays on a ventilator for adults and can raise the risks of infection, lung injury and brain damage. However, little is known about PVA in children, where it could be just as, if not more, common. Robinder Khemani, MD, MsCI, Attending Physician in Pediatric Intensive Care at Children’s Hospital Los Angeles, is using machine learning to improve the outcomes of children put on ventilators.
A CHLA research team led by Dr. Khemani has received a $3.4 million grant from the National Institutes of Health to examine the frequency and risk factors for common types of PVA in critically ill children. Working with hospitals in Canada and the Netherlands, the researchers will investigate whether PVA is independently associated with poor clinical outcomes and determine the effects on the body when breathing doesn’t match the flow of air provided by the ventilator.
Children can need ventilator support for multiple reasons, including severe pneumonia or acute respiratory distress syndrome (ARDS), when infection or trauma causes swelling, inflammation and fluid buildup in the lungs. The body’s response to the initial injury can harm the lungs even more than the infection or trauma itself.
“Many of these very sick patients can develop unexpected complications from the very procedures that we use to help them,” says Dr. Khemani. Ventilator-induced lung injury can lead to heart and kidney damage, or can increase vulnerability to future lung disease, asthma or sleep-disordered breathing.
“Brain function can also be impaired by all the medications, anesthetics and sedation patients receive to help them to tolerate the ventilator,” says Dr. Khemani. “We weigh the risks and benefits to minimize potential harms and hopefully get them off the ventilator as soon as they are ready.”
Measuring patient-ventilator mismatch “There are many types of PVA, but we still don’t know which PVA subtypes are most harmful or are the most frequent,” says Dr. Khemani. “We need to develop a common set of definitions and measurements, especially for pediatric patients.”
Mismatches between patient breathing and the rhythm the ventilator provides can occur in different ways, as children’s breathing varies according to their weight, size and age. Respiration patterns can also change during the course of a child’s stay in the pediatric intensive care unit. But existing studies use different definitions for PVA subtypes and no study so far has been large enough to evaluate the relationship between different types of PVA and patient outcomes, or has yet focused on the highest-risk patients.
Automating ventilator-patient breathing “It takes a very highly trained human to recognize PVA,” says Dr. Khemani. “But computers can do this very well. Our colleagues at the Virtual Pediatric Intensive Care Unit (vPICU) here at CHLA have been working with us on this project for a few years and have developed machine-learning algorithms that can identify different types of breathing asynchronies in children on ventilators.”
The study team will collect measurements from 200 children and combine this data with the analysis of 350 children in other studies, including a clinical trial that is testing a novel ventilator strategy. “By the end of this project, we hope to have developed these algorithms and validate that they work in three different hospitals using data from many different children,” says Dr. Khemani. “Simultaneously we will build a tool to automatically detect PVA by analyzing ventilator data through machine-learning algorithms. We will test how well the tool helps providers to identify the minute-to-minute changes in patients and potentially alert the bedside team that an adjustment to the ventilator may be needed.”
To minimize the risks of ventilator support, medical teams want to keep patients participating in breathing for themselves as much as possible. “So that’s where this study really comes into play, by constantly tracking the interaction between the child and the ventilator to ask if the ventilator is supplying just the right amount of help, precisely when needed,” says Dr. Khemani.
About Children’s Hospital Los Angeles Founded in 1901, Children’s Hospital Los Angeles is the largest provider of hospital care for children in California. Renowned pediatric experts work together across disciplines to deliver inclusive and compassionate health care to one of the world’s most diverse populations, driving advances that set child health standards across the nation and around the globe. With a mission to create hope and build healthier futures for children, the hospital consistently ranks in the top 10 in the nation, No. 1 in California and No. 1 in the Pacific U.S. region on U.S. News & World Report’s Honor Roll of Best Children’s Hospitals. The Saban Research Institute of Children’s Hospital Los Angeles supports the full continuum of child health research and is among the top 10 pediatric academic medical centers for National Institutes of Health funding, meaning physicians and scientists translate discoveries into treatments and bring answers to families faster. Home to one of the largest pediatric training programs in the United States, Children’s Hospital Los Angeles graduates a new class of physicians each year who have learned world-class children’s health care at the forefront of medicine. And as an anchor institution, the hospital strengthens the economic health of surrounding communities by fighting food insecurity, enhancing health education and literacy, and introducing early careerists to health care. To learn more, follow us on Facebook, Instagram, LinkedIn, YouTube and Twitter, and visit our blog at CHLA.org/blog.
(Family Features) Hypertrophic cardiomyopathy, also called HCM, is the leading cause of sudden cardiac death in young athletes, sometimes with no warning signs. It is characterized by the thickening and stiffening of the heart walls, which can impede the heart’s ability to pump blood efficiently since the chambers cannot fill up.
In addition, HCM is the most common inherited heart disease, affecting 1 in 500 people in the U.S., according to the American Heart Association. Because HCM runs in families, first-degree relatives – including parents, siblings and children – should be screened if a family member has been diagnosed.
Consider this information to get a better understanding of this life-altering genetic condition’s symptoms and diagnosis, which can make a crucial difference in managing the disease effectively.
Recognizing the Signs and Symptoms
The symptoms and severity of HCM can vary widely among individuals. While some people may experience no symptoms at all, common symptoms include fatigue, fainting, shortness of breath, dizziness, chest pain and irregular heartbeats, especially during physical activity. Research shows Black male athletes in high-intensity sports like football and basketball may be at higher risk.
The Importance of Family History in Diagnosis
Because HCM is a genetic condition, family history is a critical component in its diagnosis. If someone in your family has been diagnosed with HCM, heart failure or cardiac arrest, children, siblings and parents should be screened for HCM. Genetic testing and echocardiograms are commonly used to catch HCM early. These tests assess the thickness of the heart muscle and observe blood flow, which can indicate the presence of the disease.
There are two main types of HCM – obstructive and nonobstructive – and treatment options vary depending on the type and severity of symptoms.
If HCM runs in your family, don’t wait. Talk to your doctor about screening options and encourage your loved ones to do the same. Early detection can be lifesaving. To learn more about HCM, visit heart.org/HCMStudentAthlete.
Photo courtesy of Shutterstock
SOURCE:American Heart Association
Currently, getting a yearly COVID-19 vaccine is recommended for everyone ages 6 months and older, regardless of their health risk.
In the video announcing the plan to remove the vaccine from the CDC’s recommended immunization schedule for healthy children and healthy pregnant women, Kennedy spoke alongside National Institutes of Health Director Jay Bhattacharya and FDA Commissioner Marty Makary. The trio cited a lack of evidence to support vaccinating healthy children. They did not explain the reason for the change to the vaccine schedule for pregnant people, who have previously been considered at high-risk for severe COVID-19.
Similarly, in the FDA announcement made a week prior, Makary and the agency’s head of vaccines, Vinay Prasad, said that public health trends now support limiting vaccines to people at high risk of serious illness instead of a universal COVID-19 vaccination strategy.
Was this a controversial decision or a clear consensus?
Many public health experts and professional health care associations have raised concerns about Kennedy’s latest announcement, saying it contradicts studies showing that COVID-19 vaccination benefits pregnant people and children. The American College of Obstetrics and Gynecology, considered the premier professional organization for that medical specialty, reinforced the importance of COVID-19 vaccination during pregnancy, especially to protect infants after birth. Likewise, the American Academy of Pediatrics pointed to the data on hospitalizations of children with COVID-19 during the 2024-to-2025 respiratory virus season as evidence for the importance of vaccination.
Kennedy’s announcement on children and pregnant women comes roughly a month ahead of a planned meeting of the Advisory Committee on Immunization Practices, a panel of vaccine experts that offers guidance to the CDC on vaccine policy. The meeting was set to review guidance for the 2025-to-2026 COVID-19 vaccines. It’s not typical for the CDC to alter its recommendations without input from the committee.
Robert F. Kennedy Jr. has removed COVID-19 vaccines from the vaccine schedule for healthy children and pregnant people.
FDA officials Makary and Prasad also strayed from past established vaccine regulatory processes in announcing the FDA’s new stance on recommendations for healthy people under age 65. Usually, the FDA broadly approves a vaccine based on whether it is safe and effective, and decisions on who should be eligible to receive it are left to the CDC, which bases its decision on the advisory committee’s research-based guidance.
The advisory committee was expected to recommend a risk-based approach for the COVID-19 vaccine, but it was also expected to recommend allowing low-risk people to get annual COVID-19 vaccines if they want to. The CDC’s and FDA’s new policies on the vaccine will likely make it difficult for healthy people to get the vaccine.
Will low-risk people be able to get a COVID-19 shot?
Not automatically. Kennedy’s announcement does not broadly address healthy adults, but under the new FDA framework, healthy adults who wish to receive the fall COVID-19 vaccine will likely face obstacles. Health care providers can administer vaccines “off-label”, but insurance coverage is widely based on FDA recommendations. The new, narrower FDA approval will likely reduce both access to COVID-19 vaccines for the general public and insurance coverage for COVID-19 vaccines.
Under the Affordable Care Act, Medicare, Medicaid and private insurance providers are required to fully cover the cost of any vaccine endorsed by the CDC. Kennedy’s announcement will likely limit insurance coverage for COVID-19 vaccination.
Overall, the move to focus on individual risks and benefits may overlook broader public health benefits. Communities with higher vaccination rates have fewer opportunities to spread the virus.
This is an updated version of an article originally published on May 22, 2025.Libby Richards, Professor of Nursing, Purdue University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
What parents should know about pediatric growth hormone deficiency
(Family Features) Pediatric growth hormone deficiency (GHD) is a relatively rare condition, affecting an estimated 1 in 4,000-10,000 children. Despite its rarity, GHD can significantly impact a child’s growth and development, which can potentially lead to short stature, delayed puberty, decreased muscle mass, delay in bone maturation and psychosocial implications.
With early diagnosis and appropriate treatment, children with GHD can achieve improved growth outcomes and lead healthy lives. Increasing understanding of GHD treatment options and closing knowledge gaps can make a difference in the patient and caregiver journey.
What is PGHD?Growth hormone plays a critical role in helping young bodies grow and develop, including improving muscle metabolism, growing bones and breaking down fats.
PGHD occurs when a child’s pituitary gland is unable to produce enough growth hormone which results in noticeable changes on the growth chart.
Children with PGHD may look younger than their peers of the same age and gender, and puberty may be delayed or absent. Muscle development, metabolism and bone strength may also be impacted by insufficient or inadequate levels of growth hormone.
While growth hormone stimulates height increase during development, its role in the body extends beyond childhood. Even after growth plates close, growth hormone plays a vital role for cardiovascular health and for maintaining normal body structure and metabolism. Research also indicates osteoporosis as a long-term implication of GHD, highlighting its importance in overall health and well-being.
What are the Symptoms?
PGHD may be apparent during infancy, or it may not be revealed until later in childhood. Children with PGHD tend to have typical body proportions but noticeably slow growth. Other symptoms may include an immature or significantly younger look than other children of the same age, chubby body build, slow hair and nail growth, teeth that come in late and episodes of low blood sugar.
Children who have experienced a brain injury, brain tumor or radiation treatment involving the head are at higher risk for PGHD. Genetic factors can also increase risk.
How are Children Diagnosed?
Generally, doctors attempt to rule out other causes of slow growth, which may include genetic short stature, poor nutrition – which may be the result of an underlying condition such as celiac disease – and other genetic conditions, such as a hypothyroidism or Turner syndrome.
X-rays to evaluate bone age and imaging to identify the location of the pituitary gland can support the diagnosis. Another common screening option is a growth hormone stimulation test, in which medications are administered to trigger the release of growth hormone and blood is drawn frequently to monitor the body’s response.
What Treatment Options are Available?
Once a diagnosis is confirmed, children with PGHD often work closely with an endocrinologist to develop a treatment plan that includes growth hormone replacement therapy and closely monitor future growth. Dosing is based on weight and requires ongoing monitoring for adjustments. Traditionally, treatment was through daily injections, but more recently, weekly injections became available.
Children with PGHD who begin treatment early in life are more likely to reach adult height consistent with their family’s stature.
Learn more about PGHD at GHDinKids.com.
From Playdate to PGHD
During a visit to a friend’s house, Erin Swieter noticed her 18-month-old daughter, Ingrid, was about a head shorter than her peer who was six weeks younger. Upon learning her friend’s daughter was only in the 10th percentile for height, Swieter realized Ingrid must be even smaller.
While she was hitting her developmental milestones, she was still wearing 9-to-12-month clothes and had a baby-like appearance. Swieter took her concerns to Ingrid’s pediatrician; her growth charts were monitored closely for the next several months.
Following a move to a new city, the Swieters found a new pediatric endocrinologist, who was instrumental in diagnosing Ingrid. The endocrinologist reviewed previous labs and monitored Ingrid’s growth carefully, eventually diagnosing her with PGHD after a failed growth hormone stimulation test.
“Receiving Ingrid’s diagnosis was a relief, as it confirmed our suspicions and gave us a clear path forward,” Swieter said.
After learning about daily injections, the Swieters were hesitant about proceeding. The Swieters discussed their worries with Ingrid’s pediatric endocrinologist, who recommended weekly injections as a viable option due to Ingrid’s age and the duration of treatment she would likely need.
“We had heard from other parents about the challenges of daily medications, which could pose a problem during travel, day trips or sleepovers at Grandma’s house,” Swieter said. “The weekly injection eliminates the need for a daily treatment routine.”
Navigating the insurance approval process proved challenging, but once Swieter provided evidence of two failed growth hormone stimulation tests, the weekly injections were approved.
“Insurance and pharmacy challenges can be frustrating, but patience and persistence are key,” Swieter said. “Educate yourself about your insurance, treatment options, and medical literature to be a strong advocate for your child.”
Ingrid has embraced opportunities to share her journey with her condition through a school project, proudly engaging her classmates in conversations about her experience. At the same time, she is making strides physically, continuing to grow and thrive.
Photos courtesy of Shutterstock (mom measuring daughter and mom and son talking to doctor)
Real patient and caregiver photo courtesy of Erin Swieter (mom and daughter hiking)
SOURCE:Skytrofa
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