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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The Five Most Common Pitfalls in Diagnosis and Treatment of Group A Streptococcal Infection
Michael Smith and Angela Myers
While 80 percent of pharyngitis is viral in etiology, Group A streptococcus (GAS) remains an important cause of pharyngotonsillitis in the pediatric population.
Inappropriate testing for GAS pharyngitis inevitably leads to overuse of antibiotics, which can result in a pitfall of treatment with an inappropriate antimicrobial agent.
Join Dr. Myers, MD, MPH to learn more about an algorithm your office can use to optimize testing and treatment of GAS pharyngitis, avoiding the five most common pitfalls in diagnosis and treatment of GAS Infection. -
Study Examines Genetics Impact on Statin Disposition and Response
Michael Smith and Jonathan B. Wagner
Based on guidelines from the American Academy of Pediatrics (AAP), approximately 0.8 percent of adolescents 12 to 17 years old with dyslipidemia may qualify for pharmacological treatment.
That translates into approximately 200,000 adolescents who could be eligible for statin therapy.
With the increasing prevalence of overweight children, the incidence of clinically diagnosed coronary artery disease in young to middle-aged adults is expected to increase by 5 to 16 percent over the next two decades.
Jon Wagner, DO, is here to discuss how he is leading a research study looking at the liver specific protein transporter, OATP1B1, which is the major transporter of statins from the blood to the liver to better understand how children’s bodies distribute statins in the body. -
MAGEC® Rod System: Minimally Invasive Approach to Pediatric Spinal Care
Michael Smith and Nigel Price
Children’s Mercy Kansas City is one of only 20 children’s hospitals in the nation selected to participate in the early user group for the MAGEC® (MAGnetic Expansion Control) System.
In early 2015, a seven-year-old became the first patient in Kansas and Missouri to receive a new, ground-breaking treatment for scoliosis, aptly named MAGEC.
To brace the spine and minimize the progression of spinal curvature, the MAGEC system’s magnetic rods are implanted along each side of the spine during a one-time, surgical procedure.
Nigel Price, MD shares more about how MAGEC is transforming pediatric medicine during this segment of Transformational Pediatrics. -
New Emerging Food Allergies
Michael Smith and Chitra Dinakar
Food allergies have increased dramatically over the past 15 years with more and more children affected.
In addition to traditional food allergies such as peanuts, dairy products and shellfish, there has been a increase in children with reactions to foods not previously considered part of the top eight allergens.
Specialists are now seeing allergies to sesame, fruits, and other foods as we are importing more foods and consuming more foods from other cultures.
The increase has been seen in both percentage of people with reactions and in the severity of reactions, and is particularly a problem in developed countries and among the children of immigrants.
How big is the problem? What is the reason for the increase? How do you prevent or treat these allergies?
Chitra Dinakar, MD is here to discuss the future with food allergy treatment and prevention? -
Treatment of Elevated Blood Pressure in Children
Michael Smith and Douglas Blowey
In the NICU, the decision to initiate inotropic therapy, provide volume support, or initiate antihyperintensive therapy is often guided by blood pressure measurements.
However, research led by Doug Blowey at Children’s Mercy and reported in the Journal of the American Society of Hypertension, found that standard oscillometric measurement overestimates the blood pressure in very ill neonates.
Dr. Blowey is here to explain elevated blood pressure in children and is now part of an international committee that is writing guidelines to address the measurement, evaluation and treatment of hypertension in hospitalized children. -
Home Ventilator Program: Treating Infants and Children in the Comfort of Home
Michael Smith and Winston M. Manimtim
Children’s Mercy Kansas City’s Infant Tracheostomy and Home Ventilator Program provides infants and children who require long-term ventilation, individualized care in the home setting.
Children’s Mercy’s program is one of the largest in the U.S., with more than 25 new patients treated each year.
While at home, patients and their families are given the opportunity to have a sense of normalcy and thrive in an environment outside the hospital critical care units while still receiving complex medical care with access to on-call physician 24/7 and multidisciplinary care team and the support of local private duty nurse in the home.
The program has seen excellent results both in survival rate and short-term neurodevelopmental outcome since its creation in 2005.
Most infants are successfully weaned off the ventilator by the time they are 2 ½ to 3 years of age and the tracheostomy tube removed after several months.
Winston Manimtim, MD is here to discuss Children’s Mercy Kansas City’s Infant Tracheostomy and Home Ventilator Program. -
The Ketogenic Diet: An Effective Non-Medication Treatment for Intractable Epilepsy
Michael Smith and Ahmed Abdelmoity
Home to a Level IV designated Comprehensive Epilepsy Center, Children's Mercy offers one of the largest ketogenic diet programs in the U.S.
The diet is an effective non-medication treatment for intractable epilepsy.
While it is unclear exactly how the diet works, it has been shown to control seizures and minimize the need for antiepileptic drugs, which can have unpleasant side effects.
Children’s Mercy patients have fared better than national averages, with ketogenic diet patients seeing a 72 percent improvement after one year, and 90 % after two years.
Dr. Ahmed Abdelmoity, the Chief of the Section of Epilepsy and Neurophysiology at Children’s Mercy Kansas City, is here to discuss ketogenic diet programs. -
Image Gently: Why it Matters
Michael Smith and Nima Kasraie
Children’s Mercy Kansas City understands that children are not simply small adults.
From physical to cognitive process, pediatric medicine requires a holistic understanding of the child – including how they react to radiation.
With the guidance of staff physicist, Nima Kasraie, PhD, Children’s Mercy Kansas City radiology treatments provide the least amount of radiation possible to its patient – thought to be the least amount of radiation a child would receive from any hospital in the country.
Join Dr. Kasraie as we learn more about Image Gently and why it matters for our children. -
The Children’s Mercy Beacon Program For Children With The Most Complex Special Needs
Michael Smith and Amber Hoffman
The Children’s Mercy Beacon Program provides a patient-centered primary care medical home for children with the most complex special needs, as well as for their siblings.
The Beacon team communicates with health care providers in clinics, hospitals, schools and at home to coordinate care and assist with transition throughout the health care system.
The program streamlines the health care process for families with at least one child with medical complexity, from birth to 21 years, and their siblings.
Amber Hoffman,MD is here to discuss how care is coordinated across multiple specialties to simplify appointment scheduling and to reduce patent visits and inpatient admissions -
Respiratory Outpatient Clinic: A Proactive Approach to Reducing Bronchiolitis Admissions
Michael Smith and Patrice Johnson
Bronchiolitis is a common lung infection in children and the leading cause of hospitalization in children under 2.
The Children’s Mercy Respiratory Outpatient Clinic provides 24/7 outpatient treatment for young infants who have been referred by their primary care provider following assessment and diagnosis of bronchiolitis.
Pediatric registered respiratory therapists provide respiratory assessments and airway clearance as well as educational resources with the goal of reducing hospital admissions and readmissions.
Therapists follow the hospital’s Bronchiolitis Care Process Model to assess and provide treatment.
Patrice Johnson, MBA, the Director of Respiratory Care at Children’s Mercy Kansas City, is here to explain The Children’s Mercy Respiratory Outpatient Clinic. -
Cardiac High Acuity Monitoring Program (CHAMP): An App for Rapid Intervention
Michael Smith and Amy Lay
CHAMP (Cardiac High Acuity Monitoring Program) is a multi-disciplinary based team that has been designed to meet the needs of the most complex cardiac population with single ventricle heart disease.
The program closely monitors patients with single ventricle heart disease between the critical first and second stages (before stage II Glenn surgery).
The team at the Ward Family Heart Center at Children’s Mercy has also developed a tool that makes it easier for families to report their single ventricle child’s vital signs from home and provides the hospital team with frequent updates needed to keep these patients well between visits.
Amy Lay, MD, the Director of Inpatient Cardiology at Children’s Mercy Kansas City, is here to help you better understand CHAMP. -
Communication in Palliative Care: Words Matter
Michael Smith and Brian S. Carter
Clinicians involved in palliative care are inclined to be sensitive to the humanistic aspects clinical practice – foremost among them being good communication.
For both children and their families choosing the time, manner, environment and context into which communication about care that is oriented towards optimizing the quality of their days throughout a disease trajectory is extremely important.
Dr. Carter is here to discuss the verbal and non-verbal communication that clinicians should be aware, as well as strategies around active listening, reflection and an effort to engage in relational communication with an allowance for timely silence, acknowledgment of suffering and emotional validation.
Finally, the importance of key words – those that may be easily taken out of context, or heard differently than intended – will be addressed. -
Polycystic Ovary Syndrome: Current Treatment Concepts for A Complex Condition
Michael Smith and Tania S. Burgert
As many as 5 million women in the U.S. may be affected by polycystic ovary syndrome, a hormonal imbalance in which the ovaries make more androgen than normal.
PCOS can occur in girls as young as 11 years old and may lead to acne, excessive hair growth, weight gain, high blood pressure, pelvic pain, and problems with menstrual cycles and fertility.
The cause of PCOS is not known, but some have linked the condition to overproduction of insulin.
Tania Burgert, MD is here to discuss the Polycystic Ovary Syndrome Clinic at Children’s Mercy and how they're focused exclusively on identifying and treating PCOS in adolescent girls. -
Neuro NICU: Improving Long Term Outcomes for Neurodevelopmental Disorders
Michael Smith and Steven Olsen
Though survival rates are increasing, critically ill premature and term babies are often at risk for long-term developmental issues due to neurological damage from hypoxia, hemorrhages, brain malformations, genetic disorders, seizures and other injuries and disorders.
New treatment approaches, as well as technology, are helping providers prevent, diagnose and treat neurodevelopmental disorders in newborns and improve long term outcomes.
Steven Olsen, MD is here to discuss how the Neuro NICU program at Children’s Mercy brings neurology and neonatologists together in the Level IV NICU to offer the highest level of care to these newborns and improve neurological development. -
Multidisciplinary Feeding Clinic: Transforming the Approach to Complex Feeding Disorders
Michael Smith and Sarah T. Edwards
Feeding problems are quite common, affecting approximately 25 % of children.
With all these children, the number one treatment goal is to identify the underlying causes of the problem to better enable adequate growth.
Children’s Mercy Kansas City utilizes a multidisciplinary feeding clinic to bring all the specialists needed together to address the often complex needs of these patients.
Team members include physicians, psychologists, occupational therapists, speech pathologists and nutritionists.
The clinic focuses on assessing the need for tube feedings, weaning children off tube feedings, assessing for underlying causes, and providing education for parents all with an end goal focused on promoting oral intake while maintaining growth.
Listen today as Sarah Edwards, DO discusses Children’s Mercy's Multidisciplinary Feeding Clinic. -
Clots and Kids: An Increasing Problem
Michael Smith and Shannon L. Carpenter
Venous thromboembolism in children is becoming a more common problem, particularly in the hospitalized population.
A retrospective study of patients between 2001 and 2007 found VTE increase 70% during the period of study, from 34 to 58 cases per 100,000 admissions.
The complications of VTE are serious, with 16-20% resulting in pulmonary embolus and 1-4% leading to death.
Prevention where possible is always best, but current strategies are frequently inadequate or unevenly applied.
Children’s Mercy has implemented measures to identify patients at risk and institute measures to prevent hospital-acquired VTE.
Shannon Carpenter, MD is here to discuss Venous thromboembolism. -
Neonatal Simulation: Practice Makes Perfect
Michael Smith and Danielle Reed
Simulation-based training facilitates the use of higher order thinking skills.
The simulations Children’s Mercy Kansas City have developed in the NICU, Fetal Health Center and with ECMO challenge medical teams to develop cognitive, technical and behavioral skills through the use of mannequins, working medical equipment and colleagues.
During scenarios, trainees must make use of their knowledge base, analyze and synthesize factors contributing to the crises and evaluate the effects of their actions.
Danielle Reed, MD is here to discuss neonatal simulation and how practice makes perfect. -
Continuity of Care Through an Oncology Case Management Model
Michael Smith and Gerald Woods
The highly complex nature of hematology disorders and cancer care in children requires a well-coordinated, multidisciplinary team approach.
Children’s Mercy takes a holistic approach looking at the whole child to ensure that each child is meeting with every professional resource needed to manage the disease.
Every patient is assigned a case manager, usually an advanced practice nurse or physician’s assistant, teamed with a social worker and hematology/oncology specialist who oversees each child’s case from diagnosis through follow-up care.
The child has the same team throughout their entire treatment.
Gerald M. Woods, MD is here to discuss hematology disorders and cancer care in children. -
Dialysis in Infants: Survival Rates on the Rise
Michael Smith and Bradley A. Warady
Historically, infants with end-stage renal disease who received dialysis in the first year of life have been less likely to survive or receive a kidney transplant compared with those who started dialysis later in childhood.
In a study published in the September 2015 issue of Pediatrics, Dr. Bradley Warady and colleagues looked at recent NAPRTCs data and found that survival and transplant rates have improved in recent years.
While the provision of chronic peritoneal dialysis to neonates and infants is by no means free of potential complications, improvements in medical and surgical care have resulted in greater patient survival on dialysis and greater access to successful kidney transplantation, according to Dr. Warady.
Dr. Warady is here to discuss dialysis in infants and how survival rates are on the rise. -
Cardiac Neurodevelopmental Clinic: Redefining Outcomes for Congenital Heart Disease
Michael Smith and Elizabeth J. Willen
Though mortality is the traditionally recognized measure of quality in children undergoing surgery for complex congenital heart disease, the Cardiac Neurodevelopmental Program at Children’s Mercy is seeking to redefine outcomes measures for this pediatric population.
The program coordinated by the Ward Family Heart Center, is one of just a handful of innovative programs across the nation designed to help these children and their families deal with the sequelae of complex congenital heart disease.
Elizabeth Willen, PhD is here to discuss the Cardiac Neurodevelopmental Program at Children’s Mercy. -
Polyposis: Are Orphan Drugs the Answer?
Michael Smith and Seth Septer
Researchers at Children’s Mercy Kansas City are using a multi-pronged research approach to investigate the underlying causes of inherited conditions and possible new treatment options.
Dr. Seth Septer and partners are looking into the genotype and phenotype correlations within inherited gastrointestinal syndromes, such as familial adenomatous polyposis, to determine if patients may be at risk for certain type of cancer or a more aggressive form of cancer, depending on their gene mutations.
The team has already found success testing orphan drugs against patients tumor cells grown in a dish.
Dr. Seth Septer is here to discuss how he and his partners are making advances in hereditary polyposis and other inherited gastrointestinal conditions. -
Abdominal Pain: A Biopsychosocial Approach to Improving Outcomes
Michael Smith and Craig A. Friesen
Chronic abdominal pain is a common problem that affects up to 20 percent of all school-aged children and teens.
Despite how many youth struggle with abdominal pain, there is no clear agreement among medical professionals about how best to manage it.
What professionals do agree on is that abdominal pain is complex and can be difficult to treat effectively.
Craig Friesen, MD, is here to explain how the Gastroenterology Division at Children’s Mercy uses a biopsychosocial approach to chronic pain and has delivered resolution or near resolution of symptoms in 70-80 percent of patients within six weeks. -
Adverse Childhood Events and Toxic Stress
Michael Smith and M Denise Dowd
earning how to cope with adversity is an important part of growing up.
However, when adversities in childhood can exceed the child’s ability to manage them there can be negative consequences.
Stresses caused by exposure to poverty, neglect, abuse or community violence can alter the developing brain in ways which negatively impact physical and mental health well into adulthood.
Such experiences, when not buffered by caring, involved adult caregivers result in a type of neuro-developmental toxicity, changing neural pathways through epigenetic mechanisms.
Studies have shown that an alarming number of American children are exposed to or victims of violence involving a weapon.
According to one recent study published in the journal Pediatrics, nearly one-third of children in the United States are exposed to violence before the age of 18.
The study noted that about 1 in every 33 kids are assaulted with guns and knives during these incidents.
Denise Dowd, MD is here to discuss how the psychological and physical effects of these incidents are manifested in many ways and have long term implications on the child’s health. -
Preventing, Delaying and Reversing the Progression of Type I Diabetes
Michael Smith and Mark A. Clements
The Division of Pediatric Endocrinology and Diabetes is committed to providing patients the best medical care possible.
This commitment goes hand in hand with their dedication to discovering and pioneering the latest treatment methods through ongoing clinical research.
Their research areas include a vast range of topics associated with endocrinology, including diabetes, growth and growth hormone.
At Children’s Mercy Kansas City, approximately 200 children, adolescents and young adults are diagnosed with type I diabetes each year.
Patient volume, combined with a diverse patient population, the broad geographic area covered, and a full-service program, means Children’s Mercy is well positioned to conduct research on diabetes prevention, and serve as an Affiliate of the National Institutes of Health’s TrialNet.
The work TrialNet and Children’s Mercy do today may help prevent type I diabetes tomorrow or at least make it easier to control by preserving beta cell mass.
Mark Clements, MD is here to discuss how the goal is to identify individuals who have the genetic predisposition, but who haven’t develop the autoimmunity and have not experienced destruction of beta cells in order to preserve their beta cell mass and prevent the development of type I diabetes in these individuals. -
Understanding the Role of Genetic Variations in Hispanic Pediatric Cancer Patients
Michael Smith and Terrie Flatt
The incidence of acute lymphoblastic leukemia is approximately 15 percent higher in Hispanics than Caucasians and the overall survival rate is lower in this population.
But little is known about why.
Are genetic variations the cause of the differences in survival rates?
Are there variations even within the populations classified as Hispanic?
Dr. Terrie Flatt is here today to discuss leading research in conjunction with a partner hospital in Mexico to better understand the role of ethnicity in acute lymphoblastic leukemia (ALL) and how patients with certain cytogenetic arrangements in their cancer cells may respond to treatment.
