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Background Decisions to discontinue antibiotics in infants undergoing evaluation for central nervous system (CNS) infection can be difficult. Previous reports have associated the use of the meningoencephalitis (ME) PCR panel with decreased hospital stay and antimicrobial use in pediatric and adult patients. However, limited focus has been on infants ≤60-days-old with temperature instability (TI) who undergo evaluation for serious bacterial infection based on age and risk-stratification. We hypothesize use of the ME panel will decrease the duration of antimicrobial use in infants with TI and negative bacterial cultures undergoing evaluation for CNS infection. Methods The electronic medical record was queried for patients that met inclusion criteria. Infants ≤60-days-old evaluated for CNS infection due to TI between 1/1/12 – 1/31/22 were included. Exclusion criteria were history of intracranial (IC) devices, previous IC surgery, IC structural or neurovascular abnormalities, or head trauma. A retrospective chart review was performed. We compared length of stay and antimicrobial duration for the groups of patients with the ME panel done versus not done. Results A total of 1808 patients with negative bacterial cultures were identified, 96 of whom had the ME panel performed. Patient age, sex, and race were similar between groups. The median hospital length of stay for the patients that had the ME panel done was 64.7 hours as compared to 47.8 hours for those that did not have the ME panel done. The duration of antibacterial therapy was similar when the ME panel was done versus not done. The median duration of therapy for acyclovir was 8.5 when the ME panel was done versus 14.8 hours when it was not done. Conclusion When including all patients ≤60-days-old evaluated for TI, use of the ME panel did not lead to a shorter length of hospital stay or duration of empiric antibiotics. However, use of the ME panel decreased duration of therapy in the subset of patients empirically started on acyclovir. Further data analysis will seek to identify patient populations that may most benefit from the use of the ME panel. Disclosures All Authors: No reported disclosures.

This study explores frontline educators' experience with learner burnout in the clinical learning environment (CLE) and how perceived burnout may impact assessment.A survey was sent to 105 Pediatric Hospital Medicine faculty and fellows at 7 sites across the United States representing diverse CLEs. They were invited to participate in an 11-question web-based survey that was developed, edited, and revised in step-wise fashion. It consisted of 5-point Likert scale, forced-choice, and dichotomous questions. Data from the web-based survey were compiled for descriptive purposes and analyzed for trends.The response rate was 53%. Most respondents (83%) perceive learner burnout at least once per year, but median comfort in identifying burnout was 3 (scale 1-5, 3 = neutral). Factors associated with comfort were education as primary niche (P = .01) and having wellness training (P = .045). In terms of the impact of perceived learner burnout impacts on assessment, 88% report impact on feedback sessions and 60% reported impact on summative assessment; most are more lenient. Stated belief in whether perceived burnout should or should not impact assessment had 60% sensitivity and 84% specificity in predicting whether it does.Frontline educators routinely perceive learner burnout in the CLE and it often impacts educators' assessment of a learner. The discrepancy between the expected and actual impact may suggest amplification of known barriers to accurate assessment in the CLE. Comfort associated with wellness training suggests that interventions targeting frontline educators in the CLE may improve their ability to simultaneously support and assess learners.

Background The full clinical spectrum of anti- N -methyl-D-aspartate receptor encephalitis is unknown in the pediatric population. Patient We describe a previously healthy 4-year-old girl presenting with opsoclonus-myoclonus together with ataxia who had NR1-specific, anti- N -methyl-D-aspartate receptor antibodies in the cerebral spinal fluid. Conclusion The presence of NR1-specific, anti- N -methyl-D-aspartate receptor antibodies in the setting of opsoclonus-myoclonus and ataxia syndrome may represent an expansion of the clinical presentations of anti- N -methyl-D-aspartate receptor encephalitis.