Transformational Pediatrics features interviews with physicians and researchers at Children’s Mercy Kansas City who are transforming pediatric care through genomic medicine, personalized therapeutics, health services and outcomes research, and innovations in health care delivery.
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Sickle Cell Disease Treatment Demonstration Program
Michael Smith and Gerald Woods
Gerald Woods, MD, Division Director of Hematology/Oncology/BMT, has more than 30 years experience in sickle cell treatment. Dr. Woods is currently a PI for a study of GBT-440, a new drug to treat sickle cell.
Children’s Mercy is one of only two U.S. hospitals initially invited to participate in this research. Dr. Woods is leading the hospital’s participation in a Health Resources and Services Administration grant for the Sickle Cell Disease Treatment Demonstration Program Regional Collaborative.
Join us as Dr. Woods discusses the latest advancements in sickle cell disease and efforts to increase treatment options. -
The Image of Interventional Radiology
Michael Smith and Brenton Reading
Minimally invasive interventional radiology services, including angiography, vascular malformations, and tumor ablations, boast lower costs, fewer complications and faster recovery times compared to open surgery.
However, 65 percent of patients are entirely familiar with interventional radiology (IR) with 54 percent of medical students “unclear” of IR duties.
Join Brenton D. Reading, MD, with the Division of Radiology at Children’s Mercy Kansas City, as he introduces us to IR, IR services and outcomes from his dedicated interventional radiologist team at one of the largest pediatric radiology divisions in the nation. -
Translating Genome Sequences into Patient Prescriptions
Michael Smith and Neil Miller
Researchers at Children’s Mercy have developed Astrolabe, software for predicting a patient’s response to medications using whole genome sequencing. When used with a newly developed, low cost sequencing method, the software can identify the pharmacogenetics profile of each patient, enabling physicians to tailor medication selection to the patient’s DNA.
Join Neil Miller, Director of Informatics and Software Development in the Children’s Mercy Genome Center, as he introduces us to the Astrolabe software and the benefits it will offer to physicians and our pediatric patients. -
Cardio-Oncology: Addressing Cardiotoxicity in Pediatric Cancer Survivors
Michael Smith, Aliessa P. Barnes, and Joy M. Fulbright
Research shows that the most common cancer treatments can result in damage to the heart or vascular system. Children’s Mercy is now one of only a few pediatric hospitals in the world offering a Cardio-Oncology Program to address cancer treatment-related cardiotoxicity. In one appointment, patients will receive evaluation and expert advice from an oncologist and a cardiologist.
The program provides early detection of patients at risk for cardiotoxicity, early application of cardioprotective agents and ongoing monitoring to minimize damage secondary to cancer treatment.
Aliessa Barnes, MD, Medical Director of Pediatric Cardiac Transplant and Joy Fulbright, Director of Survive and Thrive, discuss how they are helping make sure today’s cancer survivors are not tomorrow’s heart failure patients. -
Rapid Exchange of Continuous Renal Replacement Therapy for Acute Kidney Injury
Michael Smith and Vimal Chadha
Children’s Mercy is one of only a handful of programs across the nation using a unique bridging technique called Rapid Exchange of Continuous Renal Replacement Therapy (RECRRT) for children diagnosed with acute kidney injury. By consistently using RECRRT, Children’s Mercy has become proficient in the bridging technique, resulting in significantly less blood exposure and therapy downtime for these critically ill children.
The technique’s primary goal is to reduce exposure to blood products for these patients.
Vimal Chadha, MD, Pediatric Nephrologist explains how this technique helps lower the risk for iron overload, transfusion reactions, exposure to infectious agents and sensitization to different antigens that could jeopardize a future kidney transplant. -
Treating Newly Diagnosed Diabetes Patients in the Ambulatory Setting
Michael Smith and Ryan McDonough
The Children's Mercy Diabetes Center is making a change to the way it cares for the 250 to 300 type 1 and 2 diabetes patients newly diagnosed each year, transitioning them from inpatient to outpatient treatment.
Patients over 5 years old and their families will receive the education and training needed to maintain healthy blood glucose levels in three outpatient visits over the course of 1 month. Children under 5 or those who present with diabetic ketoacidosis will continue to be admitted to the hospital. This change is being made to enhance the patient experience in receiving and retaining education related to their new diabetes diagnosis.
Hear from Ryan McDonough, DO, as he discuss this new clinic model and the benefits it will offer to patients newly diagnosed with diabetes. -
“Getting Used To it”: How Children and Teens (and their parents) Cope with Cancer
Michael Smith and Kristin Stegenga
Children and adolescents diagnosed with cancer face months to years of chemotherapy, sometimes including radiation and surgery. These life-altering disruptions place demands on children, teens and their parents.
The diagnosis is usually stunning and unwelcome, followed rapidly by tests, treatments and lots of information. Yet helping children, teens and families cope with this unexpected and unwelcome intruder is vital to physical and psychosocial health.
Listen in as Kristin Stegenga, PhD explores typical patterns of coping among children and adolescents while touching on the role of parent and family coping in these patterns. Ideas for supporting children and teens will also be discussed. -
Healthy Eating: Easily Misunderstood by Kids and Teens
Michael Smith and Sara R. Gould
Eating disorders can be physically, emotionally and socially devastating for patients and are difficult for families of those affected. This disorder is the third most chronic condition in adolescents, after obesity and asthma.
Recently the AAP published a clinical report addressing the interaction between obesity prevention and eating disorders. Adolescents can misinterpret what ‘healthy eating’ looks like and thus can lead to an eating disorder.
Hear from Sara Gould, PhD, on how to best manage conversations with teens and providing the right tools on how to live a healthier lifestyles and how the Children’s Mercy Kansas City Eating Disorder Center focuses on the complex medical, psychological, and nutritional issues that contribute to an eating disorder. -
Knee Injuries: When to Choose Operative Management
Michael Smith and Kevin Latz
The adolescent sports population is especially prone to knee ligament injuries with the increased specialized sport participation, overuse and suspected sedentary elementary years preceding highly active adolescent sports participation. The Center for Sports Medicine at Children’s Mercy is one of the nation’s leading sports medicine programs offering a comprehensive model of care from sideline trainers, to operative and non-operative treatment and return-to-play protocols.
Join Kevin H. Latz, MD, Chief, Section of Sports Medicine within the Division of Orthopaedic Surgery at Children’s Mercy Kansas City as he gives an introduction to knee ligament injuries, including prevention, epidemiology and choosing operative or non-operative treatment. -
Chiari Malformations – What to Know and When to Worry
Michael Smith and Paul A. Grabb
Chiari malformations, cerebellar tissue through the foramen magnum into the cervical canal, may clinically present in categories of pain-occipital/cervical (worsened with valsalva, cough, sneeze, or exertion), complications of syringomyelia (scoliosis, myelopathy), direct brainstem compression (e.g. nystagmus, strabismus, emesis, imbalance, auditory, swallowing/aspiration, and central apnea), as well as incidental.
Join Dr. Grabb and Transformational Pediatrics, as we discuss the relevant anatomy, discuss the pathophysiology of syrinx development, examine the different types of Chiari malformations and describe the classic clinical presentations for symptomatic Chiari 1 and 2 malformations. -
Bench to Bedside: Research Focused on Improving BPD Outcomes
Michael Smith and Venkatesh Sampath
Each year 13,000 to 15,000 extremely premature infants develop severe bronchopulmonary dysplasia (BPD). Despite major advances in neonatal intensive care and improved survival of infants born very prematurely BPD rates have not decreased over the last decade. While there are several reasons for this, a lack of understanding of the various paths to this disease, and the absence of personalized therapies have contributed to this problem.
Researchers at the Donald Thibeault Lung and Immunology laboratories are focusing their efforts on understanding how bacterial blood stream infections injures the developing lung and cause BPD in premature infants. Recently, Venkatesh Sampath, MBBS, MRCPCh, a physician-scientist with Neonatology at Children’s Mercy hospital was awarded a five-year grant by the National Heart Lung Blood Institute (NHLBI) to study the role of inflammatory angiogenesis in the developing lung. The major goal of this project is to understand how pulmonary endothelial immune activation during sepsis promotes lung inflammation and alters the formation of lung blood vessels predisposing to BPD. In collaboration with other researchers in the laboratory, center for infant pulmonary disorders, and clinicians in the NICU we hope to develop strategies and new therapies to decrease the burden of BPD.
Hear from Venkatesh Sampath, MBBS, MRCPCh on what their ongoing research tells us about how babies develop BPD and the other studies that are underway to investigate and treat BPD at CMH and Neonatology. -
Evaluation of Pediatric Syncope for the Primary Care Practitioner
Michael Smith and Brian Birnbaum
It is important to understand the difference between cardiac and non-cardiac causes of syncope. The cause of syncope can be identified in about 50 percent of patients by history and physical alone. Both past medical history and the history of the event are vital.
Cardiogenic Syncope can be life threatening. It generally requires specialized evaluation (echocardiogram, exercise stress test) and treatment and often requires activity restriction.
Listen in as Brian Birnbaum, MD explains that Vasovagal/Orthostatic Syncope is usually not life threatening and can often be diagnosed with history and a physical exam. -
Engaging Parents in the Care of Patients with IBD
Michael Smith and Julie A. Bass
As one of the larger inflammatory bowel disease (IBD) programs in the nation, the Children’s Mercy Kansas City Division of Pediatric Gastroenterology cares for 550 to 600 patients and their families on an ongoing basis. A unique component to the program is the parent engagement.
The IBD program has been recognized as a leader in parent engagement through ImproveCareNow and other national organizations, including the Institute for Healthcare Improvement.
Hear from Julie Bass, DO, on the impacts and benefits of creating a strong partnership with parents in the care for patients with IBD. -
BMT for Treatment of Rare Diseases: New Treatments and Donor Options
Michael Smith and Rakesh K. Goyal
A marrow or cord blood transplant could be the best treatment option, and for some patients, offer the only potential cure, when facing life-threatening diseases.
A FACT accredited (Foundation of the Accreditation of Cellular Therapy) program and a National Marrow Donor Program (NMDP) unrelated and cord blood donor center, Children’s Mercy Kansas City is a leader in research and the treatment of rare and complex diseases using bone marrow, peripheral blood stem cells and cord blood transplants. The program offers autologous, related allogeneic, unrelated allogeneic, and haplo-identical transplants.
Listen as Rakesh Goyal, MD, shares how the Children’s Mercy BMT program is expanding the use of transplants to successfully treat immunodeficiency, metabolic, sickle cell disease and other rare diseases. -
Pediatric Home Care: Sending Kids Home Safely and Reducing Readmissions
Michael Smith and Andrea Toomay
When a child is sent home from the hospital after a serious injury or illness, the ongoing medical care for that child can be overwhelming for parents. Home Care services provide a smooth transition to home and assists parents in accessing the required ongoing care ordered by a physician.
Andrea Toomay, Children’s Mercy Home Care, joins us to discuss the pediatric home care services and the value they provide to families. -
Congenital Heart Disease and Blood Clots
Michael Smith and Michael Silvey
Children with heart conditions are at increased risk for life-threatening blood clots according to a statement from the American Heart Association. Pediatric hematologists and cardiologists at Children’s Mercy are leading a multidisciplinary effort to reduce risk of clots in this fragile population of patients.
Michael Silvey, DO is here to explain that the goal of treatment is to reduce clotting risk, without thinning blood too much and promoting bleeding. -
Cancer Genomics: Researching New Treatment Strategies to Cure Infant Acute Lymphoblastic Leukemia (ALL)
Michael Smith and Erin M. Guest
Only about 100 infants are diagnosed with acute lymphoblastic leukemia (ALL) in the U.S. each year. Most of these babies respond to chemotherapy treatment at first, but go on to relapse and die of the disease.
Dr. Erin Guest and colleagues at Children’s Mercy are performing genomics research to uncover the reasons why leukemia in infants becomes resistant to treatment. Dr. Guest is also leading a national clinical trial for infants with ALL, through the Children’s Oncology Group.
Listen in as Erin Guest, MD discusses how she is working with researchers from around the globe to design new treatment strategies that will cure more infants with leukemia. -
SuPAR and Chronic Kidney Disease: Identifying Biomarkers for Disease Progression
Michael Smith and Darcy Weidemann
SuPAR (soluble urokinase-type plasminogen activator receptor) has been shown to be a promising biomarker in its ability to predict the development of chronic kidney disease in adults years earlier than traditional risk factors.
Darcy Weidemann, MD, pediatric nephrologist at Children’s Mercy is leading the largest North American study ever conducted to look at whether suPAR may be helpful to predict kidney function decline in children.
Listen in to Darcy Weidemann, MD as she explains the potential role that monitoring suPAR levels may play in improving the care of children with chronic kidney disease. -
The Comfort Ability: Addressing Pain Management Strategies in Pediatric Patients
Michael Smith and Dustin Wallace
Managing chronic pain in the pediatric patient can be a challenge, not only for the patient, but for their caregivers. The introduction to biobehavioral and congestive behavioral pain management strategies can help patients cope with the everyday pain.
Dustin Wallace, PhD, started the Comfort Ability workshop, led by staff psychologists from Children’s Mercy. This one day interactive workshop has been designed to teach new strategies to manage pain and improve day-to-day function.
Listen in to Dustin Wallace, PhD as he explains how the program emphasizes mind-body strategies for managing pain and pain-related stress, as well as individualized coping plans for improved pain management. Caregivers also gain an understanding of how to better support their child through their pain. -
"What a Pain" - Appreciating Pediatric, Adolescent Lumbar Disc Herniation Pain
Michael Smith and John Anderson
Although a commonly recognized condition in adults, herniated nucleus pulposus (HNP) is often an unrecognized cause of back and leg pain in the pediatric/adolescent population. This often leads to a delay in diagnosis and/or inappropriate treatment. HNP is distinct from a "bulged disc", an MRI finding often cited as a cause of pediatric /adolescent back pain. With HNP, patients generally have some element of back pain, but it is the leg pain (radiculopathy) or sciatica that often leads to their presentation to a health care provider.
It is not uncommon for children to present with "sciatic scoliosis", a spinal deformity that is a response to the patient's nerve root irritation. This condition can have a sudden presentation from a traumatic event of occur spontaneously with no known cause.
Join Dr. Anderson and Transformational Pediatrics as we discuss HNP, associated conditions, presentation, and treatment. -
Pulse Ox Screening for Newborns: Is It Making A Difference?
Michael Smith and Stephen Kaine
It's been almost five years since pulse oximetry screening was recommended to be added to the uniform screening panel for newborns. While Missouri and Kansas each took different approaches, pulse oximetry screening for CCHD in the newborn nursery is now almost universal in the United States.
Prior to oximetry screening, about 20% of newborns with CCHD left the hospital with undiagnosed heart defects. Now that number is much, much smaller.
Listen in as Dr. Stephen Kaine, Children’s Mercy cardiologist, discusses the implementation process for the screening, reporting, and outcomes. -
Amblyopia: Recognition, Screening, and Treatment in the Well-Child Care Setting
Michael Smith and Scott Atkinson
Amblyopia is by far the most common cause of unilateral vision loss in children, affecting 2 to 4 percent of the population. Screening for amblyopia is an important component of well-child pediatric care.
Join Children’s Mercy pediatric ophthalmologist Dr. Atkinson and Transformational Pediatrics, as we discuss the three generally-recognized types of amblyopia, available screening techniques, and treatments of the disease. -
Recognizing the Depressed Athlete: Are Student Athletes Less Likely to Ask for Help?
Michael Smith and Shayla Sullivant
A recent study found that student-athletes experience mental health issues at about the same rate as the general student body—30 percent. However, while 30 percent of those struggling students will get help, only 10 percent of their athlete counterparts will. Several organizations are taking steps to eliminate the stigma including the NCAA, NATA and universities through programs like Athletes Connected.
Listen to Dr. Sullivant (Children’s Mercy) discuss the study and the steps the Sports Medicine Department and other departments are taking at Children’s Mercy to combat the issue. -
Signs of Potential Child Abuse
Michael Smith and Emily Killough
Each year in the United States more than 3 million referrals are made to child protective services (CPS) involving more than 6 million children. Of those referrals which are investigated, between 15 to 20 percent involve allegations of physical abuse. Deaths from abuse and neglect occur most commonly in children less than 4 years of age, which highlights the importance of recognition of abuse by pediatricians in this age group.
Join us as Emily Killough, MD, discusses the diagnosis and evaluation of child abuse and a new mobile app to aid medical providers in the recognition of abuse. -
The State of Children’s Health in Kansas City
Michael Smith and Margo Quiriconi
Approximately 411,000 children live in a four county Kansas City metro area, accounting for 25.6 % of the population. A community health assessment by Children’s Mercy with assistance from Professional Research Consultants, examined current health status of children in the metro area, identified unmet needs and current health priorities, explored community strengths and gaps in resources, and provided insights to health advocates and providers.
The report identified numerous issues including poverty, employment, violence, parent support, access to care, mental/behavioral health, housing, obesity, food insecurity, early education and infant mortality.
Listen in as Margo Quiriconi, Director of Community Health Initiatives at Children’s Mercy, explains the key findings of the study and plans to address them.
