A quarterly publication of the Children’s Hospital of Georgia
THE 2013 CHILDREN’S MIRACLE NETWORK HOSPITALS CELEBRATION RAISED $913,000 FOR SERVICES AND PROGRAMS AT THE CHILDREN’S HOSPITAL OF GEORGIA.
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Welcome: Welcome to the summer 2013 edition of Georgia Kids First, a quarterly publication from the Department of Pediatrics at the Children’s Hospital of Georgia! There are so many good things going on at CHOG. To begin with, the 2013 Children’s Miracle Network Hospitals Celebration raised $913,000 to benefit CHOG services and programs. This is great news as we continue to provide specialized care to children statewide. We also broke ground on another gift to our community. On July 16, we joined the Ronald McDonald House Charities of Augusta for the groundbreaking of a new home away from home for family members of hospitalized CHOG patients. The facility, which originally served as the home of the Medical College of Georgia President, is mere steps away from the hospital. Additionally, we are honoring the outstanding CHOG physicians who have made the America’s Top Doctors® list and an inaugural Top Regional Doctors list. Our patients are in good hands as our physicians provide care to nearly all of Georgia. In more physician news, we are making a leap into the future by launching our first official mentoring relationship between a research scientist and clinical investigator. This collaboration links scientific breakthroughs in the lab to the neonatal clinic, expediting new treatments for sick infants. Physicians are not the only health care providers taking care of our community. This edition of the newsletter highlights several exemplary nurse practitioners who provide care to the thousands of children coming to this hospital for specialized care. And as summer winds down, check out this edition’s backpack tips to ensure your children stay light on their feet as they begin a new school year. Thank you for reading this edition of Georgia Kids First as you take a break from your summer adventures.
Dates to remember: Extra Life Nov. 2
The Children’s Miracle Network Hospitals invite you to play a 25-hour gaming marathon. Families and friends will pledge to play games such as board games, video games, golf, and others. Pledges are enouraged to benefit CHOG. For more info visit: extra-life.org.
Monster Bash Oct. 18 The second annual Monster Bash will be held at 8 p.m. at Enterprise Mill in downtown Augusta. Costumed guests will dance the night away to the music of 7 Once and enjoy heavy hors d’oeuvres catered by Fat Man’s Café. Costumes are encouraged, and prizes will be given for the best couple and individual costumes. Silent auction proceeds will be given to the hospital benefiting patients and families. All proceeds will benefit CHOG. For questions, call Catherine Stewart at 706-721-4004.
Cares for Kids Radiothon Dec. 5-7
Tune into the largest single fundraiser for the Children’s Bernard L. Maria, M.D., M.B.A. Pediatrician-in-Chief, Children’s Hospital of Georgia Ellington Charles Hawes Professor Chairman, Department of Pediatrics
Georgia Regents University
GEORGIA Kids First
Hospital of Georgia on 104.3 WBBQ-FM and KISS 96.3-FM as the stations hit the airwaves live from our lobby. Listen to patients and families tell their stories and become a Miracle Maker by pledging $15 a month. Last year’s Radiothon was a record-breaking year with over $239,000 raised for the patients and families of CHOG through the Children’s Miracle Network Hospitals program.
CHOG Physicians Make Top Doctors and Regional Top Doctor’s lists Several Children’s Hospital of Georgia physicians were named to the 2013 list of America’s Top Doctors® a national patient reference guide published by Castle Connolly Medical Ltd. that identifies the top 1 percent of physicians in the nation by specialty. In addition, Castle Connolly this year released its first list of Top Regional Doctors, or those recognized as the top 10 percent in their specialty by region. Check out who from the Children’s Hospital of Georgia made the list:
CHOG’s America’s Top Doctors Dr. Dennis R. Ownby Allergy-Immunology
Dr. Sandra G.B. Sexson
Child and Adolescent Psychiatry
Dr. Jack C. Yu
Pediatric Plastic Surgery
CHOG’s Regional Top Doctors Dr. David B. Flannery
Dr. Bernard Maria
Dr. Ian M. Heger
Dr. Clay N. Stallworth
Dr. Christopher P. Houk
Dr. Henry B. Wiles
Pediatric Neurological Surgery
Dr. William A. Lutin Pediatric Cardiology
CHOG Nurse Practitioners
Nicole Wimmer Years as Nurse Practitioner - Nine
Editor’s note: The following article profiles several of the outstanding Nurse Practitioners who serve as vital members of the health care team at CHOG.
Nicole Wimmer, a Pediatric Nurse Practitioner in the Division of Pediatric Pulmonology, treats children with pulmonary conditions including cystic fibrosis, chronic lung disease, and asthma. “I look at my role as caring for patients beyond the medications that make them better,” says Wimmer. “I am making sure the families are really educated about why we have made the choices we have made to help treat their child, along with identifying possible barriers that may inhibit their care.” Wimmer is making families breathe a little easier knowing that their child is in the hands of a dynamic multidisciplinary care team, including physicians, nurses, respiratory therapists, social workers, and dietitians. Nurse practitioners provide a true bridge of communication between physicians and patients, she says. Because family members aren’t always comfortable asking physicians questions, she provides educational support to ensure their bases are covered.
GEORGIA Kids First
Beth Fisher Years as Nurse Practitioner - 12
After falling in love with Pediatric Hematology Oncology, Beth Fisher, a Certified Pediatric Nurse Practitioner, has been working for 12 years in the same clinic specialty that prompted her career path. “I love the pediatric cancer and blood disorder clinic here at the Children’s Hospital of Georgia because it is a mixed bag,” says Fisher. “It’s not just one certain disease or one type of patient I see; it’s a hodgepodge which keeps you on your toes!” The clinic has plenty of support. All of the children’s hospitals across the country work together to fight childhood cancer. CHOG works with the Children’s Oncology Group, a liaison to treatment options nationwide. The pediatric cancer and blood disorder clinic features a tight-knit multidisciplinary team—physicians, nurses, and others work to put a treatment plan in action. The team also includes social workers and child life specialists to address the emotional impact of childhood cancer. “We work as a team and we get to know these children together,” says Fisher, who treats 15 to 30 children a day in the clinic. The clinic serves children statewide—some as close as 10 minutes away and others who travel up to five hours to access care. “We are not just seeing the patients here, we are collaborating with home health and hospice agencies, creating an outreach into the community as we treat these children,” says Fisher. “If I know more about the community the child lives in, then I can help them get better access to good care.”
CHOG Nurse Practitioners
M N Cynthia Mundy Years as Nurse Practitioner - Six
Most mothers have a hard time taking care of just one baby; imagine taking care of up to 42 babies! It’s all in a day’s work for Cynthia Mundy, a CHOG Certified Neonatal Nurse Practitioner. Mundy is part of a team of physicians, nurses, respiratory therapists, and many others who treat some of the sickest babies in the hospital. “The neonatal nurse practitioner’s role serves as a liaison and support for the medical staff,” says Mundy. “Being nurse practitioners, we are trained medically, but also have a nursing theory background in clinical practice; we bring those two elements together by supporting the nursing side as well as the medical side.” The unit is a regional referral center, offering specialized care to babies throughout Georgia and South Carolina. “We collaborate with the neonatology team, which is headed up by the neonatologist,” says Mundy. “We work together to come up with the care plan with the medical team and revise and adapt care plans throughout the day, depending on what is going on with the baby.” Each nurse practitioner takes care of eight to 12 patients, routinely assessing health indicators including vital signs and nutritional status. “I chose to go into neonatal specifically because of the resiliency of babies,” says Mundy. “It is amazing how sick they can be and how quickly they can recover, many times to a normal state.” Mundy is fascinated with the unprecedented rate of growth that characterizes the first year of life, typically including a tripled birth weight and milestones such as walking and talking.
Nicole Winstead Years as Nurse Practitioner - Five
Nicole Winstead, a busy Certified Pediatric Nurse Practitioner in the CHOG Newborn Nursery and Pediatric Rheumatology Clinic, still found time this summer to be a camp counselor for Camp Joint Venture. Camp Joint Venture, an annual CHOG-sponsored summer camp for children with rheumatic conditions, hosted 45 children this July in Rutledge, Ga. “It was awesome to see my patients be kids for a whole week,” says Winstead. “The kids did rock-climbing, ropeswinging, swimming, bike-riding, and had a whole lot of fun as they forgot about their joint pain and participated in what every kid should experience during the summer months.” In the Pediatric Rheumatology Clinic, Winstead works closely with physicians as they treat conditions such as arthritis, lupus, Raynaud’s disease, scleroderma, and other illnesses. Switching gears to the nursery, she performs physical exams, routine newborn screenings, education, and discharge preparation. “I do this for the kids, no matter what age they are,” says Winstead, who takes pride in making patients feel comfortable about their care, both in and out of the hospital. Whether sending a newborn home or discharging a child with a new diagnosis, she makes sure everyone involved knows what to expect.
Camp Joint Venture
Keep Backpack Loads Light
DR. DAVID CEARLEY, PEDIATRIC ORTHOPEDIC SURGEON TALKS ABOUT HOW SOME BACKPACKS ARE JUST TOO HEAVY FOR YOUNGSTERS
As a pediatric orthopedic surgeon and a father of three, I have ample opportunity to practice what I preach. For instance, I reassured my wife that our daughters would outgrow their pigeon toes. When my son split his forehead open, I talked her into letting me treat the wound at home with steri-strips. (I’m still paying for that one, by the way.)
But when my daughter started school, I was the one who needed reassurance when I picked up her backpack. It weighed at least 10 pounds. I couldn’t believe it! My first thought was, “How in the world can a 5-yearold be expected to carry something so heavy?” My second thought was, “No wonder I see so many kids with back pain in my clinic if this is what they’re toting around all day.” My wife reassured me that the load, which included school supplies, would be lightened by the second day. Nonetheless, I started to do a little research. It turns out that more than a few people who are smarter than I am have looked into the issue, applying scientific principles to determine whether backpacks cause back pain in students. Recommendations include using both shoulder straps and securing backpack contents so the weight doesn’t shift during use. A rolling pack is a good option if the child walks to school or doesn’t have a locker. What we know is that children who carry a heavy backpack for a long period of time are more likely to complain of pain than those who do not. The best way to prevent pain is to keep the pack as light as possible, wear it appropriately (even if it doesn’t look cool), and stay fit and active. If the most exercise students get is carrying a backpack every day, don’t be surprised if their backs hurt.
Read more, bit.ly/lightbackpacks GEORGIA Kids First
Dr. Brian Stansfield Medical School: MCG (‘04) Residency: Pediatrics, MCG (2004-07) Fellowships: Neonatology, Indiana University (2009-11); National Institutes of Health Research Fellowship (2011-13)
The Children’s Hospital of Georgia has set out to bridge the gap between laboratory findings and clinical care. Dr. Stephen Black, a Georgia Regents University cell and molecular biologist (see Carnitine supplement, page 7), has launched a mentor relationship with Dr. Brian Stansfield, a clinician investigator in the CHOG Neonatal Unit. “What we are hoping to do is to try and build bridges between clinician investigators and basic scientists,” said Black. Black, who has been working with pediatricians for almost 20 years, hopes his laboratory findings will help Stansfield make babies healthier. “The opinions of the pediatricians remain as a guiding voice on my shoulder,” said Black. Stansfield, who joined CHOG in July, is excited about the new beginnings. “Dr. Black and I are collaborating on a number of projects,” said Stansfield. “We initiated the collaboration earlier this year when I decided this was where I wanted to come for my first faculty appointment.” Several projects are already underway. “We are in the planning stages of our research and have initiated pilot experiments to determine feasibility,” said Stansfield.
Carnitine Supplement Linked to Heart Health
Dr. Stephen M. Black A common nutritional supplement may be part of the magic in improving the survival rates of babies born with heart defects, researchers report. Carnitine, a compound that helps transport fat inside the cell powerhouse where it can be used for energy production, is currently used for purposes ranging from weight loss to chest pain. New research shows it appears to normalize the blood vessel dysfunction that can accompany congenital heart defects and linger even after corrective surgery, said Dr. Stephen M. Black, cell and molecular physiologist at the Vascular Biology Center at the Medical College of Georgia at Georgia Regents University. “My hope is this is going to have a major, major impact on survival of babies,” Black said. About half the babies born with heart defects have excessive, continuous high pressure on their lungs from misdirected blood flow. Early surgery can prevent full-blown pulmonary vascular disease, but scientists are finding more subtle disruptions in the signaling inside blood vessel walls that can be problematic – even deadly – up to 72 hours after surgery. The good news is the changes are reversible and that carnitine speeds recovery and can even prevent the damage in a lamb model of these human heart defects, according to studies published in the journal Pediatric Research. Normally, most blood flow bypasses the lungs in utero when the placenta provides blood and oxygen for the baby. Baby’s first breaths naturally expand the lungs and blood vessels, activating a process inside the lining of vessels that enables them to accommodate the initial blood surge, then reduce pressure quickly, dramatically, and permanently. This natural transition doesn’t occur when heart defects misdirect blood flow. “It’s kind of like a chronic fetal-tonewborn transition,” said Black, the study’s corresponding author. Lungs get pounded with about three times the
normal flow and, even when surgeries are done as early as possible to repair the defect, correct blood flow, and protect the lungs, the 20 percent death rates from acute pulmonary hypertension have remained unchanged for a decade. “That’s 1 in 5 kids (with this condition),” Black said. Left unchecked, the barrage thickens blood vessels, making them unresponsive, much like those of an elderly individual who has lived for years with uncontrolled high blood pressure. The comparatively brief periods of pounding these babies experience impairs the ability of the endothelial cells, which line blood vessels, to produce nitric oxide, a major dilator of blood vessels. The shear force disrupts carnitine homeostasis, weakens the mitochondria (the cell powerhouse) and impairs nitric oxide production. To make bad matters worse, the precursor to nitric oxide instead makes more peroxynitrite, prompting endothelial cells to grow and thickening blood vessels. Black was also corresponding author of a recent study in the Journal of Biological Chemistry that showed peroxynitrite does this by turning on the cell survival protein kinase Akt1. The new study indicates that even without fixing the heart defect, high daily doses of carnitine in the first four weeks of life can prevent endothelial dysfunction. In fact, the laboratory lambs’ ability to make nitric oxide is preserved even without the benefit of heart surgery and the responses to the chemical activity that enables blood vessel dilation is normalized, Black said. Study co-author Dr. Jeffrey Fineman, a whole-animal physiologist and physician at the University of California, San Francisco, developed the model, a lamb whose fourchambered heart is very similar to humans. In utero surgery that misdirects too much blood to the lungs, means that, like children, the lambs are born with the defect. Black is now working with Fineman, who is pursuing additional funding to resolve questions such as the optimal dosage and timing for giving carnitine. “Do you want to give it for six weeks when you only have to give it for six hours?” Black said. The researchers also plan to examine carnitine homeostasis in the blood of children with heart defects to see if it’s disrupted. If it is, they plan to start clinical trials. About 1 in 125 babies are born with a heart defect each year in the United States, according to the March of Dimes. The research was funded by the National Institutes of Health, the Foundation Leducq, and the American Heart Association.
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Ronald McDonald House Groundbreaking THE COMMUNITY BROKE GROUND JULY 16 ON THE RONALD MCDONALD HOUSE THAT WILL SERVE CHOG PATIENTS AND THEIR FAMILIES.
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