Mary G Gaspers

Interests

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Courses

Scholarly Contributions

Books

• Gaspers, M. (2021). A Pediatrician's Path: What to Expect After a Pediatrics Residency. Science Books.
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  My chapter is about Pediatric Critical Care Fellowship

Chapters

• Pacheco, G. S., Vukovic, A., Davis, K., Gaspers, M., & Nathalang, D. (2016). Environmental Exposures and Intoxications. In Comprehensive Critical Care: Pediatric 2nd Edition(pp 3135 - 3192). Society of Critical Care Medicine.

Journals/Publications

• Bembea, M. M., Loftis, L. L., Thiagarajan, R. R., Young, C. C., McCadden, T. P., Newhams, M. M., Kucukak, S., Mack, E. H., Fitzgerald, J. C., Rowan, C. M., Maddux, A. B., Kolmar, A. R., Irby, K., Heidemann, S., Schwartz, S. P., Kong, M., Crandall, H., Havlin, K. M., Singh, A. R., , Schuster, J. E., et al. (2023). Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 24(5), 356-371.
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  Extracorporeal membrane oxygenation (ECMO) has been used successfully to support adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiac or respiratory failure refractory to conventional therapies. Comprehensive reports of children and adolescents with SARS-CoV-2-related ECMO support for conditions, including multisystem inflammatory syndrome in children (MIS-C) and acute COVID-19, are needed.
• Benamar, M., Chen, Q., Chou, J., Julé, A. M., Boudra, R., Contini, P., Crestani, E., Lai, P. S., Wang, M., Fong, J., Rockwitz, S., Lee, P., Chan, T. M., Altun, E. Z., Kepenekli, E., Karakoc-Aydiner, E., Ozen, A., Boran, P., Aygun, F., , Onal, P., et al. (2023). The Notch1/CD22 signaling axis disrupts Treg function in SARS-CoV-2-associated multisystem inflammatory syndrome in children. The Journal of clinical investigation, 133(1).
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  Multisystem inflammatory syndrome in children (MIS-C) evolves in some pediatric patients following acute infection with SARS-CoV-2 by hitherto unknown mechanisms. Whereas acute-COVID-19 severity and outcomes were previously correlated with Notch4 expression on Tregs, here, we show that Tregs in MIS-C were destabilized through a Notch1-dependent mechanism. Genetic analysis revealed that patients with MIS-C had enrichment of rare deleterious variants affecting inflammation and autoimmunity pathways, including dominant-negative mutations in the Notch1 regulators NUMB and NUMBL leading to Notch1 upregulation. Notch1 signaling in Tregs induced CD22, leading to their destabilization in a mTORC1-dependent manner and to the promotion of systemic inflammation. These results identify a Notch1/CD22 signaling axis that disrupts Treg function in MIS-C and point to distinct immune checkpoints controlled by individual Treg Notch receptors that shape the inflammatory outcome in SARS-CoV-2 infection.
• Halasa, N. B., Spieker, A. J., Young, C. C., Olson, S. M., Newhams, M. M., Amarin, J. Z., Moffitt, K. L., Nakamura, M. M., Levy, E. R., Soma, V. L., Talj, R., Weiss, S. L., Fitzgerald, J. C., Mack, E. H., Maddux, A. B., Schuster, J. E., Coates, B. M., Hall, M. W., Schwartz, S. P., , Schwarz, A. J., et al. (2023). Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 76(3), e280-e290.
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  Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients.
• Halasa, N., Zambrano, L. D., Amarin, J. Z., Stewart, L. S., Newhams, M. M., Levy, E. R., Shein, S. L., Carroll, C. L., Fitzgerald, J. C., Michaels, M. G., Bline, K., Cullimore, M. L., Loftis, L., Montgomery, V. L., Jeyapalan, A. S., Pannaraj, P. S., Schwarz, A. J., Cvijanovich, N. Z., Zinter, M. S., , Maddux, A. B., et al. (2023). Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak. JAMA network open, 6(8), e2328950.
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  Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.
• Maddux, A. B., Young, C. C., Kucukak, S., Zambrano, L. D., Newhams, M. M., Rollins, C. K., Halasa, N. B., Gertz, S. J., Mack, E. H., Schwartz, S., Kong, M., Loftis, L. L., Irby, K., Rowan, C. M., Tarquinio, K. M., Zinter, M. S., Crandall, H., Cvijanovich, N. Z., Schuster, J. E., , Fitzgerald, J. C., et al. (2023). Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C. Frontiers in pediatrics, 11, 1260372.
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  To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.
• Zambrano, L. D., Newhams, M. M., Olson, S. M., Halasa, N. B., Price, A. M., Orzel, A. O., Young, C. C., Boom, J. A., Sahni, L. C., Maddux, A. B., Bline, K. E., Kamidani, S., Tarquinio, K. M., Chiotos, K., Schuster, J. E., Cullimore, M. L., Heidemann, S. M., Hobbs, C. V., Nofziger, R. A., , Pannaraj, P. S., et al. (2023). BNT162b2 mRNA Vaccination Against Coronavirus Disease 2019 is Associated With a Decreased Likelihood of Multisystem Inflammatory Syndrome in Children Aged 5-18 Years-United States, July 2021 - April 2022. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 76(3), e90-e100.
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  Multisystem inflammatory syndrome in children (MIS-C), linked to antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with considerable morbidity. Prevention of SARS-CoV-2 infection or coronavirus disease 2019 (COVID-19) by vaccination might also decrease MIS-C likelihood.
• Halasa, N. B., Olson, S. M., Staat, M. A., Newhams, M. M., Price, A. M., Boom, J. A., Sahni, L. C., Cameron, M. A., Pannaraj, P. S., Bline, K. E., Bhumbra, S. S., Bradford, T. T., Chiotos, K., Coates, B. M., Cullimore, M. L., Cvijanovich, N. Z., Flori, H. R., Gertz, S. J., Heidemann, S. M., , Hobbs, C. V., et al. (2022). Effectiveness of Maternal Vaccination with mRNA COVID-19 Vaccine During Pregnancy Against COVID-19-Associated Hospitalization in Infants Aged <6 Months - 17 States, July 2021-January 2022. MMWR. Morbidity and mortality weekly report, 71(7), 264-270.
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  COVID-19 vaccination is recommended for persons who are pregnant, breastfeeding, trying to get pregnant now, or who might become pregnant in the future, to protect them from COVID-19. Infants are at risk for life-threatening complications from COVID-19, including acute respiratory failure (1). Evidence from other vaccine-preventable diseases suggests that maternal immunization can provide protection to infants, especially during the high-risk first 6 months of life, through passive transplacental antibody transfer (2). Recent studies of COVID-19 vaccination during pregnancy suggest the possibility of transplacental transfer of SARS-CoV-2-specific antibodies that might provide protection to infants (3-5); however, no epidemiologic evidence currently exists for the protective benefits of maternal immunization during pregnancy against COVID-19 in infants. The Overcoming COVID-19 network conducted a test-negative, case-control study at 20 pediatric hospitals in 17 states during July 1, 2021-January 17, 2022, to assess effectiveness of maternal completion of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy against COVID-19 hospitalization in infants. Among 379 hospitalized infants aged
• LaRovere, K. L., Poussaint, T. Y., Young, C. C., Newhams, M. M., Kucukak, S., Irby, K., Kong, M., Schwartz, S. P., Walker, T. C., Bembea, M. M., Wellnitz, K., Havlin, K. M., Cvijanovich, N. Z., Hall, M. W., Fitzgerald, J. C., Schuster, J. E., Hobbs, C. V., Halasa, N. B., Singh, A. R., , Mack, E. H., et al. (2022). Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020. JAMA neurology.
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  In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complications.
• Maddux, A. B., Berbert, L., Young, C. C., Feldstein, L. R., Zambrano, L. D., Kucukak, S., Newhams, M. M., Miller, K., FitzGerald, M. M., He, J., Halasa, N. B., Cvijanovich, N. Z., Loftis, L. L., Walker, T. C., Schwartz, S. P., Gertz, S. J., Tarquinio, K. M., Fitzgerald, J. C., Kong, M., , Schuster, J. E., et al. (2022). Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C. Pediatrics, 150(3).
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  To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C).
• Sahni, L. C., Price, A. M., Olson, S. M., Newhams, M. M., Pannaraj, P. S., Maddux, A. B., Halasa, N. B., Bline, K. E., Cameron, M. A., Schwartz, S. P., Walker, T. C., Irby, K., Chiotos, K., Nofziger, R. A., Mack, E. H., Smallcomb, L., Bradford, T. T., Kamidani, S., Tarquinio, K. M., , Cvijanovich, N. Z., et al. (2022). Factors associated with COVID-19 non-vaccination in adolescents hospitalized without COVID-19. Journal of the Pediatric Infectious Diseases Society.
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  Pfizer-BioNTech COVID-19 vaccine received emergency use authorization for persons ≥16 years in December 2020 and for adolescents 12-15 years in May 2021. Despite the clear benefits and favorable safety profile, vaccine uptake in adolescents has been suboptimal. We sought to assess factors associated with COVID-19 non-vaccination in adolescents 12-18 years of age.
• Zambrano, L. D., Newhams, M. M., Olson, S. M., Halasa, N. B., Price, A. M., Boom, J. A., Sahni, L. C., Kamidani, S., Tarquinio, K. M., Maddux, A. B., Heidemann, S. M., Bhumbra, S. S., Bline, K. E., Nofziger, R. A., Hobbs, C. V., Bradford, T. T., Cvijanovich, N. Z., Irby, K., Mack, E. H., , Cullimore, M. L., et al. (2022). Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children Among Persons Aged 12-18 Years - United States, July-December 2021. MMWR. Morbidity and mortality weekly report, 71(2), 52-58.
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  Multisystem inflammatory syndrome in children (MIS-C) is a severe postinfectious hyperinflammatory condition, which generally occurs 2-6 weeks after a typically mild or asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19 (1-3). In the United States, the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine is currently authorized for use in children and adolescents aged 5-15 years under an Emergency Use Authorization and is fully licensed by the Food and Drug Administration for persons aged ≥16 years (4). Prelicensure randomized trials in persons aged ≥5 years documented high vaccine efficacy and immunogenicity (5), and real-world studies in persons aged 12-18 years demonstrated high vaccine effectiveness (VE) against severe COVID-19 (6). Recent evidence suggests that COVID-19 vaccination is associated with lower MIS-C incidence among adolescents (7); however, VE of the 2-dose Pfizer-BioNTech regimen against MIS-C has not been evaluated. The effectiveness of 2 doses of Pfizer-BioNTech vaccine received ≥28 days before hospital admission in preventing MIS-C was assessed using a test-negative case-control design among hospitalized patients aged 12-18 years at 24 pediatric hospitals in 20 states** during July 1-December 9, 2021, the period when most MIS-C patients could be temporally linked to SARS-CoV-2 B.1.617.2 (Delta) variant predominance. Patients with MIS-C (case-patients) and two groups of hospitalized controls matched to case-patients were evaluated: test-negative controls had at least one COVID-19-like symptom and negative SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) or antigen-based assay results, and syndrome-negative controls were hospitalized patients without COVID-19-like illness. Among 102 MIS-C case-patients and 181 hospitalized controls, estimated effectiveness of 2 doses of Pfizer-BioNTech vaccine against MIS-C was 91% (95% CI = 78%-97%). All 38 MIS-C patients requiring life support were unvaccinated. Receipt of 2 doses of the Pfizer-BioNTech vaccine is associated with a high level of protection against MIS-C in persons aged 12-18 years, highlighting the importance of vaccination among all eligible children.
• Zinter, M. S., Zambrano, L. D., Walker, T. C., Staat, M. A., Schwartz, S. P., Schuster, J. E., Sahni, L. C., Randolph, A. G., Price, A. M., Patel, M. M., Pannaraj, P. S., Olson, S. M., Nofziger, R. A., Newhams, M. M., Michelson, K. N., Maddux, A. B., Mack, E. H., Maamari, M., Levy, E. R., , Kong, M., et al. (2022). Effectiveness of BNT162b2 Vaccine against Critical Covid-19 in Adolescents.. The New England journal of medicine, 386(8), 713-723. doi:10.1056/nejmoa2117995
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  The increasing incidence of pediatric hospitalizations associated with coronavirus disease 2019 (Covid-19) caused by the B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States has offered an opportunity to assess the real-world effectiveness of the BNT162b2 messenger RNA vaccine in adolescents between 12 and 18 years of age..We used a case-control, test-negative design to assess vaccine effectiveness against Covid-19 resulting in hospitalization, admission to an intensive care unit (ICU), the use of life-supporting interventions (mechanical ventilation, vasopressors, and extracorporeal membrane oxygenation), or death. Between July 1 and October 25, 2021, we screened admission logs for eligible case patients with laboratory-confirmed Covid-19 at 31 hospitals in 23 states. We estimated vaccine effectiveness by comparing the odds of antecedent full vaccination (two doses of BNT162b2) in case patients as compared with two hospital-based control groups: patients who had Covid-19-like symptoms but negative results on testing for SARS-CoV-2 (test-negative) and patients who did not have Covid-19-like symptoms (syndrome-negative)..A total of 445 case patients and 777 controls were enrolled. Overall, 17 case patients (4%) and 282 controls (36%) had been fully vaccinated. Of the case patients, 180 (40%) were admitted to the ICU, and 127 (29%) required life support; only 2 patients in the ICU had been fully vaccinated. The overall effectiveness of the BNT162b2 vaccine against hospitalization for Covid-19 was 94% (95% confidence interval [CI], 90 to 96); the effectiveness was 95% (95% CI, 91 to 97) among test-negative controls and 94% (95% CI, 89 to 96) among syndrome-negative controls. The effectiveness was 98% against ICU admission and 98% against Covid-19 resulting in the receipt of life support. All 7 deaths occurred in patients who were unvaccinated..Among hospitalized adolescent patients, two doses of the BNT162b2 vaccine were highly effective against Covid-19-related hospitalization and ICU admission or the receipt of life support. (Funded by the Centers for Disease Control and Prevention.).
• Feldstein, L. R., Self, W. H., Ferdinands, J. M., Randolph, A. G., Aboodi, M., Baughman, A. H., Brown, S. M., Exline, M. C., Files, D. C., Gibbs, K., Ginde, A. A., Gong, M. N., Grijalva, C. G., Halasa, N., Khan, A., Lindsell, C. J., Newhams, M., Peltan, I. D., Prekker, M. E., , Rice, T. W., et al. (2021). Incorporating Real-time Influenza Detection Into the Test-negative Design for Estimating Influenza Vaccine Effectiveness: The Real-time Test-negative Design (rtTND). Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 72(9), 1669-1675.
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  With rapid and accurate molecular influenza testing now widely available in clinical settings, influenza vaccine effectiveness (VE) studies can prospectively select participants for enrollment based on real-time results rather than enrolling all eligible patients regardless of influenza status, as in the traditional test-negative design (TND). Thus, we explore advantages and disadvantages of modifying the TND for estimating VE by using real-time, clinically available viral testing results paired with acute respiratory infection eligibility criteria for identifying influenza cases and test-negative controls prior to enrollment. This modification, which we have called the real-time test-negative design (rtTND), has the potential to improve influenza VE studies by optimizing the case-to-test-negative control ratio, more accurately classifying influenza status, improving study efficiency, reducing study cost, and increasing study power to adequately estimate VE. Important considerations for limiting biases in the rtTND include the need for comprehensive clinical influenza testing at study sites and accurate influenza tests.
• LaRovere, K. L., Riggs, B. J., Poussaint, T. Y., Young, C. C., Newhams, M. M., Maamari, M., Walker, T. C., Singh, A. R., Dapul, H., Hobbs, C. V., McLaughlin, G. E., Son, M. B., Maddux, A. B., Clouser, K. N., Rowan, C. M., McGuire, J. K., Fitzgerald, J. C., Gertz, S. J., Shein, S. L., , Munoz, A. C., et al. (2021). Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome. JAMA neurology, 78(5), 536-547.
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  Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear.
• Son, M. B., Murray, N., Friedman, K., Young, C. C., Newhams, M. M., Feldstein, L. R., Loftis, L. L., Tarquinio, K. M., Singh, A. R., Heidemann, S. M., Soma, V. L., Riggs, B. J., Fitzgerald, J. C., Kong, M., Doymaz, S., Giuliano, J. S., Keenaghan, M. A., Hume, J. R., Hobbs, C. V., , Schuster, J. E., et al. (2021). Multisystem Inflammatory Syndrome in Children - Initial Therapy and Outcomes. The New England journal of medicine, 385(1), 23-34.
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  The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy.
• Mendelson, J., Gaspers, M., & Pacheco, G. S. (2018). Pediatric Ventilator Management in the Emergency Department. Emergency Medicine Clinics of North America.
• Pacheco, G. S., Mendelson, J., & Gaspers, M. (2018). Pediatric Ventilator Management in the Emergency Department. Emergency medicine clinics of North America, 36(2), 401-413.
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  Pediatric mechanical ventilation is first initiated by emergency physicians when performing active airway management in a critically ill or injured child. When initiating and adjusting mechanical ventilation, the child has unique anatomy and physiology to consider. The EP is the first to respond to ventilator alarm triggers, and the initial medical provider to resuscitate the ventilated pediatric patient who is deteriorating while in the emergency department. This article uses cases to provide a framework to initiate and troubleshoot mechanical ventilation of pediatric patients in the emergency department.
• Ghavam, A., & Gaspers, M. (2015). Index of suspicion. Case 3: Emesis and Unsteady Gait in 35-month-old Boy. Pediatrics in review, 36(7), 316-8.
• Pacheco, G. S., Gaspers, M., Mendelson, J., & Woolridge, D. P. (2017). Pediatric Ventilator Management in the Emergency Department. Emergency Medicine Clinics of North America.
• Arcinegas-Rodriguez, S., Gaspers, M. G., & Lowe, M. C. (2011). Metabolic acidosis, hypoglycemia, and severe myalgias: an attempt to mask urine drug screen results. Pediatric emergency care, 27(4), 315-7.
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  Adolescent use of illicit substances remains a significant problem. In attempts to hide their use of these substances, some are using Internet-recommended methods of masking these drugs on drug screens, potentially exposing the adolescent to severe and possibly dangerous adverse effects. We report a 16-year-old patient who ingested approximately 13 g (twenty-six 500-mg tablets) of niacin during a 48-hour period in an attempt to mask his use of tetrahydrocannabinol on an upcoming drug screen. He subsequently developed severe chest and abdominal pain as well as extreme diffuse myalgias (previously unreported in association with niacin use). In addition, he developed severe hypoglycemia, acidosis, transaminitis, and coagulopathy. He required significant fluid resuscitation and bicarbonate infusion. Over approximately 5 days his symptoms resolved and he ultimately did well. Given increasingly available home drug screens and the abundance of false information readily available to adolescents via the Internet regarding "masking" of drug use, it is likely that cases such as ours will become more prevalent. Pediatric emergency physicians and pediatricians should maintain a high suspicion for use of niacin or other substances to obscure detection of illicit substances when patients present with symptoms similar to those of our patient.

Presentations

• Gaspers, M., Meyer, R., Typpo, K. V., King, C., & Berg, M. D. (2016, October). EN Guidelines Reduce PN Utilization. SCCM/ASPEN Nutrition Research Workshop: From Bench to Bedside.