OBJECTIVE: Cardiopulmonary exercise testing (CPET) is used prior to bariatric surgery in adolescents with obesity to assess surgical risk factors. Lack of normative equations for peak oxygen consumption (pVO2) for this population limits CPET interpretation. We aimed to use lean body weight (LBW) to predict pVO 2 and developed novel predictive equations for use in this population. METHODS: 446 participants with obesity ages 9-20 underwent CPET prior to bariatric surgery from January 1, 2006 to December 31, 2019. Bioelectrical impedance analysis helped calculate LBW. Achieving peak heart rate > 90% predicted and RER of >1.1 were considered satisfactory effort. RESULTS: 107 CPET studies (29%) were satisfactory. Mean weight was 127 ± 21 kg, and BF% 49.7 ± 6.8, and LBW 63 ± 10, kg. Mean pVO 2 was 22.2 ± 3.2 mL/kg/min. The mean pVO 2 using LBW was 44.8 ± 8.7 mL/kg/min. Total body weight (TBW) estimated pVO 2 to be 50.7 ± 7.0 % predicted[(1)](#ref-0001), while LBW estimated it at 102.3 ± 17.6 % predicted. Linear regression yielded reference equations pVO 2=1571.6+12.2*TBW (males) and pVO2=1301.8+10.6*TBW (females). CONCLUSION: When pVO 2 is corrected for LBW, adolescents with obesity demonstrate normal pVO 2. A novel set of equations were developed to predict absolute pVO 2 using TBW.

Background Adolescent and young adult (AYA) women with sickle cell disease (SCD) have increased pregnancy-related health risks and are prescribed potentially teratogenic medications, yet little is known about pediatric SCD provider contraceptive practices. We aimed to assess pediatric hematology providers’ beliefs, practices, motivators, and barriers for providing contraceptive care to female AYA with SCD. Methods Guided by the Health Belief Model (HBM), we developed a 25-question, web-based survey to assess providers’ practices. Survey links were distributed nation-wide to pediatric SCD and/or general hematology providers through their publicly available emails and by request to directors of U.S. accredited Pediatric Hematology-Oncology fellowship programs for distribution to their SCD providers. Data analysis included descriptive statistics, chi-square analysis, logistic regression. Results Of 177 respondents, 160 surveys meeting inclusion criteria were analyzed. Most providers reported counseling (77.5%) and referring female AYA patients for contraception (90.8%), but fewer reported prescribing contraception (41.8%). Counseling practices significantly differed in trainees versus established providers (54% vs. 85%, p<0.001) with a similar trend for prescribing (p=0.05). Prescription practices did not differ significantly by provider beliefs regarding potential teratogenicity of hydroxyurea. Key motivators included patient request and disclosure of sexual activity. Key barriers included inadequate provider training, limited visit time, and perceived patient/parent interest. Conclusion Provider contraceptive practices for female AYA with SCD varied, especially by provider status. Health beliefs regarding teratogenic potential of hydroxyurea did not correlate with contraceptive practices. Clinical guidelines, provider training, and patient/parent decision-making tools may be tested to assess whether provider contraceptive practices could be improved.

Background: Pediatric acute lymphoblastic leukemia (ALL) treatment regimens are lengthy, and there is limited data on the systemic and individual economic burden associated with treatment of ALL. Objective: This study aims to examine healthcare resource utilization (HCRU) and costs accrued during the first year of therapy among pediatric ALL patients, and to compare costs among those who are Commercially and Medicaid insured. Methods: Administrative claims data from 2011-16 were analyzed utilizing IBM MarketScan. Newly-diagnosed ALL patients with at least 12 months of enrollment were studied. Demographics and HCRU and costs were stratified by insurance type. The mean (standard deviation (SD) HCRU and reimbursed costs were measured during the first year post-diagnosis. Multivariable generalized linear models were run for total healthcare costs. Results: 730 (528 Commercial) patients with median age of 6 years were studied. During the 12 months following diagnosis, the mean(SD) inpatient admissions and ER visits for Commercial and Medicaid patients was 6.2(3.7) vs. 6.0(4.6), p=0.6310 and 2.8(6.4) vs. 2.1(2.6),p=0.0380, respectively. Commercial patients experienced more outpatient visits (77.2(28.1) versus 57.4(33.3), p<0.0001) and less pharmacy claims (54.1(22.9) and 61.0(41.8),p<0.0001) versus Medicaid patients. Total healthcare costs were $535,135.89($547,506.23) versus $198,694.94($181,856.27),p<0.0001 for Commercial and Medicaid patients, respectively. When adjusted for age and gender, total healthcare costs in the year post-diagnosis for Commercial patients were 1.60 times the costs in patients with Medicaid. Conclusion: Pediatric ALL patients have high HCRU and incur significant economic burden. The total cost of care for Commercially insured patients is more than double that of Medicaid insured patients.

Background: Childhood acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. The onset of obesity during childhood ALL has been well established and is associated with inferior survival rates and increased treatment-related toxicities. This pilot study sought to determine if a dietary intervention is feasible and minimizes weight gain during the initial phases of treatment for ALL. Methods: Participants were recruited from four institutions, fluent in English or Spanish, between 5-21 years old, and enrolled within three days of starting induction therapy. Participants were counseled for six months to follow a low glycemic diet. Dietary and anthropometric data were collected at baseline, end of induction, and end of month six (NCT03157323). Results: Twenty-three of 28 participants (82.1%) were evaluable and included in the analysis. Dietary intake of several nutrients targeted by the nutrition intervention declined (sugar, P = 0.003 and glycemic load, P = 0.053). We also observed a persistent increase in total vegetables across each timepoint (P = 0.015) and by the end of the intervention (P = 0.033). Importantly, we did not observe an increase in body mass index z-score during induction or over the six-month intervention period. Most families found the nutrition intervention easy to follow (60%) and affordable (95%) despite simultaneous initiation of treatment for ALL. Conclusions: A six-month nutrition intervention initiated during the initial phase of treatment for childhood ALL is feasible and may prevent weight gain. Our preliminary findings need to be confirmed in a larger clinical trial.