Pediatric e-Briefs from All Children's Hospital

With May designated as Stroke Awareness Month, it's an ideal time to showcase the Pediatric Stroke Program at All Children's Hospital Johns Hopkins Medicine (ACH JHM) in St. Petersburg. The program combines the expertise of All Children's Hospital and the Johns Hopkins Children's Center in Baltimore to help children who have developed a stroke.

The Pediatric Stroke Program is co-directed by Dr. Neil Goldenberg (Pediatric Hematologist) and Dr. Madeline Chadehumbe (Child Neurologist). Both have special expertise in pediatric stroke. Dr. Goldenberg, an international leader in pediatric stroke, was recruited by All Children's Hospital and Johns Hopkins University in 2012 from Children's Hospital Colorado, where he founded and co-directed one of the top pediatric stroke programs in the U.S. Dr. Chadehumbe was also recruited to ACH in 2012 from Michigan State University and Helen DeVos Children's Hospital in Grand Rapids, Michigan. She completed fellowships in child neurology and neuromuscular disorders at Cincinnati Children's Hospital Medical Center, where she also served as child neurology chief resident.

The ACH program provides a variety of services for pediatric stroke patients and their families in a comprehensive, multidisciplinary setting. It extends from the All Children's Hospital Emergency Center, where a Pediatric Stroke Alert system led by pediatric emergency medicine specialist Dr. Craig Kizewic, inpatient care in the Pediatric Intensive Care Unit (PICU) and or on the Pediatric Medicine unit, to outpatient care and consultation.

The outpatient Pediatric Stroke Clinic is a comprehensive, multidisciplinary clinic involving a team of care providers devoted to stroke in children, including a neurologist, hematologist, pharmacist, and nurse. Additional services, including physical therapy, occupational therapy and speech therapy, are coordinated via the clinic. In addition, if the patient has an underlying medical problem or condition, a physician from the All Children's pediatric cardiology or pediatric neurosurgery program may also join the clinic team to address the patient's specific needs.

Why choose the Pediatric Stroke Program at All Children's Hospital?

Our pediatric stroke doctors have devoted their careers to caring for children who experience a blood clot and strive to provide the best possible outcomes for their patients.

Because stroke in children is very rare—and very complex—few physicians have extensive experience in treating this problem and preventing the possible short-term and long-term complications. These may include: bleeding complications if the patient is given aspirin or blood thinners; the development of second strokes; neurological impairments (such as weakness, difficulty walking, impaired coordination, problems speaking); school difficulties; depression; and seizures as a result of damage to brain tissue from a stroke.

Dr. Chadehumbe and Dr. Goldenberg have a combined experience of managing over 200 pediatric stroke patients in the past 10 years. This experience, combined with their involvement in the latest national/international guidelines and clinical research studies, enables them to determine soon after the onset of stroke whether a child is at high versus low risk for many of the potential long-term complications described above. They develop an individualized treatment and follow-up plan designed to achieve the best outcomes for each infant, child, and teen.

Why is a multidisciplinary team of experts so important in the care of children with stroke?

Optimal care of children with stroke typically requires expertise not only from pediatric neurologists and hematologists who specializes in stroke, but from a variety of other pediatric specialists, including pediatric emergency department physicians, radiologists, anesthesiologists, intensive care physicians, pharmacists, clinical laboratory specialists, and stroke rehabilitation specialists. The Pediatric Stroke Program at All Children's Hospital Johns Hopkins Medicine provides family-centered, comprehensive and coordinated care for infants, children and teens who suffer a stroke. Thanks to the team's expertise and coordinated approach to care, children who suffer a stroke will receive treatment and follow-up care aimed at minimizing long-term complications and achieving the best possible outcomes.

On April 13, the Pediatric Emergency Center physicians at All Children's Hospital collaborated with the Pediatric Emergency medicine physicians at Johns Hopkins in Baltimore to stage the first one-day Pediatric Emergency Medicine Conference at All Children's Hospital. And it couldn't have gone better.

The conference, which provides the latest updates on common pediatric emergencies, drew more than 115 people – physicians, nurses and pre-hospital personnel.

"Feedback from attendees was excellent, with many expressing their enthusiasm to return for future conferences," said Dr Wassam Rahman, Medical Director of Pediatric Emergency Medicine. "The event featured lectures, audience questions and a display of common emergency techniques and hardware. Our hats off to members of the All Children's Hospital CME department – they were instrumental in organizing the whole event. We also thank Dr. Doug Baker, the Chairman of Pediatric Emergency Medicine Department in Baltimore, for his support in coordinating this event."

The conference was co-chaired by Dr. Thuy Ngo from Johns Hopkins and Dr. Rahman from the All Children's Hospital Emergency Center. Among the highlights:

•		Dr. Jennifer Anders (JHCC) discussed the controversial topic of pediatric fever and its management at different age groups;

•		Dr. Justin Jeffers (JHH) discussed and reviewed the controversies of common respiratory illnesses (asthma, croup and bronchiolitis as encountered by clinicians);

•		Dr. Rahman (ACH) discussed pediatric abdominal pain and the latest diagnostic techniques.

•		Dr. Rafael Santiago (ACH) discussed a hot topic currently in the media, about head injuries and concussions.

•		Dr. C. Jean Ogborn (JHCC) reviewed the current AAP recommendations for emergencies in the office setting.

•		Dr. Thuy Ngo (JHH) gave a challenging lecture on the visual diagnoses of the newborn by effectively using the audience response system.


•		Dr. Patrick Mularoni (ACH) gave comprehensive lecture on pediatric fractures, a topic the audience couldn't get enough of.

The conference ended with all the physician presenters participating in a show-and-tell session on wound care, splinting, common pediatric procedures and a review of common pediatric hardware clinicians may encounter in their practices.

The panel of speakers had a lively discussion on their respective topics and there was an overwhelming request by the attendees for more topics and in the future – and possibly a two-day conference in the future. Based on the success and attendance of this first conference on Pediatric Emergency Medicine at All Children's Hospital, the physicians from both campuses are already planning another conference for spring 2014.

It's not every day that veteran ESPN analyst and hoops Hall of Famer Dick Vitale, the irrepressible icon of college basketball, gets so excited to meet a soft-spoken young doctor that he can't wait to tell the Twittersphere about it.

But that's precisely what happened one evening in last fall when Vitale, renowned for his tireless pediatric cancer fundraising efforts, ran into an important new addition to All Children's Hospital at the Tampa Bay Business Journal's Health Care Heroes awards.

Vitale's enthusiastic tweet, read: I met Dr. Calvin Lee 1st Dick Vitale perpetual fellow to study Pediatric Cancer @ All Children's

There was even a snapshot attached of the two beaming men – Vitale, a long-time ambassador of college hoops, standing side by side with Dr. Lee, a new ambassador of pediatric cancer research.

The broadcaster affectionately known as Dickey V. was on hand to receive the Philanthropist of the Year award for the millions of dollars in pediatric cancer research he has raised through the annual Dick Vitale Gala in Sarasota to benefit the V Foundation for Cancer Research. The non-profit organization is dedicated to finding a cure for cancer, and it funds research and education programs at All Children's, including the Dick Vitale Pediatric Cancer Research Fellowship.

That is what brought Lee, the first recipient of the honor, to the event at the Renaissance Vinoy. But more important, the fellowship brought the gifted doctor to St. Petersburg and All Children's in the fall of 2012 after completing a three-year fellowship in Pediatric Hematology/Oncology at Johns Hopkins University and the National Cancer Institute.

Following discussions by All Children's president Dr. Jonathan Ellen and pediatric oncology leadership at Johns Hopkins, several doctors were invited to interview late last fall for the Vitale fellowship. And Dr. Lee, who earned his medical degree from Boston University in 2006, was a natural choice to help expand research resources at All Children's.

"I'm absolutely excited by the opportunity," he said. "Enhancing research into pediatric cancer is part of the vision of the hospital and I really hope to make a contribution."

Dr. Lee's emphasis to date has been laboratory based work, particularly with investigators at Moffitt Cancer Center in Tampa. All Children's is the sole pediatric affiliate of Moffitt and the two work collaboratively on bone marrow and stem cell transplant, sarcoma treatment and research, cancer survivorship and other areas. His focus is on the field of epigenetics, exploring the genetic basis of different types of cancer, and in taking different approaches to treating cancer. "We can apply this to various pediatric cancers as well," he explained.

Dr. Lee's focus is on the field of epigenetics, exploring the genetic basis of different types of cancer. "There's obviously a genetic basis for everything and I study mutations in various genes," he said. "Here's one way to look at it: Say you have a newspaper and if one of those pages is completely crinkled up, all the news is still there but you're not going to be able to read it. And that mechanism of crinkling up the page and then opening it back up so it can be read is epigenetics. I'm interested in how all this applies to pediatric cancer."

A graduate of Columbia University, Dr. Lee's interest in pediatric care stemmed from his desire to pursue a holistic approach to medicine at Boston University. "In pediatrics, you take care of patients and families," he said.

He'll have a chance to do that at All Children's soon, when he starts clinical work this
summer. "I'm looking forward to that," he said. "But there are other things I find very exciting, too. There's just such a large group to work with here in Florida, a large patient population that I think is under-served if we don't apply research into how we approach their disease. Without that, the future of treatment is more limited. I think All Children's is really trying to gear up in a way which serves the community – and science – as a whole."