FEBRUARY 2015

 

In this issue of the Pediatric Update, read how existing therapies and new research may shape future outcomes for children with Autism Spectrum Disorders. We provide updates and announcements from local chapters of American Academy of Pediatrics. In the Division Spotlight, read how child rehab patients are benefiting from innovation and teamwork. In the Research Spotlight, Dr. Carrie Henderson shares improvements that will support patients and families facing complex medical problems and end-of-life decisions. In the Education Spotlight,  learn how our genetic counselors are engaging patients, families, students, faculty and others.  This issue wraps up with an introduction to specialists who are joining the department and a request for your help with future story ideas.

Sincerely,


EXISTING THERAPIES AND RESEARCH TOGETHER:  
SHAPING THE FUTURE FOR AUTISM SPECTRUM DISORDERS.

Researchers and physicians at the Medical Center agree that early intervention with existing therapies and research together may shape the long term outcomes of children with Autism Spectrum Disorders (ASD).   

Research teams at the Medical Center and University of California San Francisco published a report in the Proceedings of the National Academy of Sciences of the United States of America (PNAS) this month. News reports describe the research as novel, being the first to use an animal model to prove that the brain could be rewired after intensive auditory training. Learn more.

Dr. Rick Lin, professor of neurobiology and anatomical sciences at the Medical Center and co-author of the report says the study "focused" on hearing and interpreting sounds, which is often affected in children with ASD. "What is important and meaningful about these findings is that, probably because of the brain's extensive interconnections, intense treatment, focused on a single malfunctioning brain system can not only repair that system but many others in the brain as well," he added.     
  
Rick Lin, professor of neurobiology and anatomical sciences has a secondary research appointment in the Department of Pediatrics. 
    Access PDF version of published report. 
Long term outcomes for children with ASD may be shaped by this research.  Lin admits that there is a fair amount of work to be done before this is ready for use in humans.  Some of the questions that follow on research intends to answer include: "How much training is needed? When in development can the treatments be applied most successfully? When or if the interventions will stop working?," he said.

Nevertheless, Lin, who has a secondary appointment in the Department of Pediatrics, foresees this science translating into new medical interventions for children. He suggests that the timeline for human studies might begin within the next few years. "If it works as well in humans as it does in our rat model, it could open new avenues of treatment. For example video games could become a mode of intervention to assist parents and therapists with the child's training needs. This would not eliminate the need for specialized therapies, but it could well augment them and speed the process of improvement of symptoms," he adds.

Pediatricians in the Department of Pediatrics weigh in on the findings and offer suggestions to help parents who may wonder what these recent findings might mean.

Sara Weisenberger, M.D., associate professor in the division of ambulatory pediatrics, who sees patients at the Children's North Clinic, finds the research encouraging. "Finding a way to change the child's response to auditory stimuli would lessen their anxiety, thus helping them remain calmer and more likely to interact with others," she said. Weisenberger, like many pediatricians, has observed the behavior of autistic children and is aware of known interventions available for children with ASD. "Having an improvement in the way that they perceive sound and to have it organized for language development would go a long way to a more normal life," she adds. 

Omar Abdul-Rahman, M.D., professor and division chief of pediatric medical genetics, speaks to the importance of early intervention with existing therapies.  "These findings show that therapy does work and that it can actually improve the autistic brain.  New therapies may come out of these findings down the road," he said. "However, the essential message is not to give up on existing therapies," he adds.


Pediatricians at our primary care clinics ensure that children's needs are addressed in a comprehensive manner Children seen at one of our primary care clinic locations are referred to specialists and sub-specialists on a case-by-case basis. Call 855-984-5437, our dedicated referral line, to make appointments.

UPDATES & ANNOUNCEMENTS
American Academy of Pediatrics (AAP)
 
 

MSAAP LEGISLATIVE UPDATE

 

The Mississippi American Academy of Pediatrics (MSAAP) has had two major areas of focus this 2015 Legislative Session. Given that Mississippi still has the highest teen traffic death rate in the nation, MSAAP is pushing a ban on texting while driving. HB 389 would prohibit texting or other manual cell phone use while driving, and levy a $25 fine for the first year. The second year in law the fine would rise to $100. Over 70 young people age 15-20 died in traffic crashes in 2014; texting bans in other states help protect young lives. The bill passed the House and goes next to the Senate Transportation Committee chaired by Sen. Willie Simmons; his number at the Capitol is (601)359-3237.

 

The second major work of state pediatricians this session has been to stop HB 130,  designed to weaken state immunization requirements. Originally written to add a belief exemption to state law, the bill allows any US physician to write a medical exemption for a child, and remove Mississippi State Department of Health (MSDH) from the process. In early February the bill was amended before passage by the House Education Committee. The amended HB 130, went before the House, but House leadership let the bill die on February 12. If successful, It would have removed the belief exemption. The current nationwide measles outbreak helped slow momentum for passage of HB 130 by making clear the dangers of under-immunizing school children.

 

MSAAP is also supporting passage of HB 910 to widen accessibility to 17-P as part of the MSDH infant mortality reduction initiative. The lights for bikes bill, SB 2241 is being supported as well. 

 

Email Lynn Evans with questions. 

 

 

  

EVENTS

  

What? American Academy of Pediatrics Helping Babies Survive Course
 

When? February 23-26, 2015   

   

Where? University of Alabama-Birmingham 

 

Who should attend? Anyone interested in global health for newborns.   

  

Register now (space is still available)   
www.helpingbabiesbreathe.org 

 

Questions? Call 866-843-2271  

 

The Golden Minute Matters

Helping Babies Breathe (HBB) emphasizes skilled attendants at birth, assessment of every baby, temperature support, stimulation to breathe, and assisted ventilation as needed, all within "The Golden Minute" after birth.   

 

Renate Savich, M.D., newborn medicine division chief, is a member of the AAP Helping Babies Breath steering committee and master trainer. Savich will serve as the AAP liaison to Ethiopia where the programs will be implemented.  

   

The modules, according to Savich, are used around the world to train birth attendants in basic resuscitation and early care of the newborn. "These efforts are a key aspect of the global initiative to reduce neonatal mortality throughout the world," she said.  

 

  

  

Division Spotlight
Children's Rehabilitation Services

Children's Rehabilitation Services (CRS) team gathers in the gym for a group photo. 

The multidisciplinary Children's Rehabilitation Services (CRS) team assists patients with treatments to facilitate recovery from injuries, illnesses and diseases. The entire team agrees in the goal of restoring their patients to as normal a condition as possible.      

 

Dr. Amanda Witt and Dr. Catherine Zimmerman are assistant professors at The University of Mississippi Medical Center who care for children with congenital and or acquired conditions requiring inpatient and outpatient rehabilitative services. They are seated in the picture above flanked by team members who are holding weights to spell out the word "rehab." Zimmerman is holding the letter "e" and Witt is seated  beside her holding the letter "h".  

    

Witt and Zimmerman collaborated with neurosurgery and trauma surgery teams to develop a concussion pathway that now benefits children who are admitted to the hospital with mild to moderate brain injuries. They know that clinical pathways like this have been shown to improve the quality of care and to enhance the role for rehabilitation at an early stage. Patients undergo a therapy screening process with subsequent follow-up in clinic. Witt sees the patients who have ongoing cognitive or academic challenges and Zimmerman prepares the patients to return to sports and activities.

 

Inpatient rehab service provides intensive daily therapy to children who would benefit from physical therapy, occupational therapy and /or speech therapy to make their transition back to home as safe as possible. Therapies and treatments can be prescribed for brain trauma, spinal cord injuries, stroke, brain tumors and nerve or muscle disease. The outpatient rehab clinic follows children who have been discharged from the inpatient unit and also evaluates children for equipment, bracing, therapy, or spasticity needs.

 

Witt describes rehabilitation as a broad field that includes congenital conditions like cerebral palsy, congenital torticollis.  Acquired conditions such as sports injuries, traumatic brain injuries (TBI), and spinal cord injuries (SCI) are also included.  "There is not a focus on just one specialty or body system, but instead we focus on a patient's ability to function in play, at school and at home; even if this includes specialized adaptations or equipment," she says.  

 

Zimmerman describes Orthopedics as a facet of Children's rehab services that focuses on the musculoskeletal system. Zimmerman is a trained musculoskeletal specialist who recognizes and understands aspects of normal development. "Knowledge of normal development is a unique feature and an integral piece when caring for children with congenital abnormalities, gait concerns and skeletally-immature athletes who present with pain," she says.

 

According to Zimmerman, the patients she sees generally benefit from orthopedic interventions like casts, braces and formal therapy services. "We emphasize nutrition with all patients, particularly young female athletes, obese children and those with chronic medical conditions to ensure they maintain normal growth and bone health," she adds.

 

Witt, Zimmerman and the entire CRS team are passionate about the care they offer to children.  Call 855-984-5437 to schedule appointments or to make outpatient referrals.

 

Education Spotlight
Division of Pediatric Genetics
Holly Zimmerman, genetic counselor, lectures medical students in the S123 classroom.

University of Mississippi Medical Center now has four genetic counselors in the division of Pediatric Genetics. This fact is cause for celebration in a division where the clinical staff is growing. This month, the staff welcomes Dr. Julie Kaplan on board as well.   

 

Emily Boothe, Andrew Gunter, Laura Hendon and Holly Zimmerman refer to themselves as "the educators." "We provide educational counseling to individuals and families who have a genetic diagnosis or who may be at risk for one," says Zimmerman who serves as the division's education coordinator.  

 

In addition to having clinical duties, genetic counselors educate healthcare professionals and medical students. We increase the educational opportunities within the division by creating a bi-monthly education conference where clinicians and guest speakers present interesting cases, the latest technology, and diagnostic challenges.

 

Over the years, Zimmerman has increased the number of opportunities that students, residents and fellows have to interact with the Genetics staff. "Our staff will interface with students at several points during their educational journey," she says. First year medical students attend lectures about pedigrees, inheritance patterns, recurrence risks, and Hardy-Weinberg principles. Third-year students who are on pediatric rotation attend interactive lectures. In addition there is a genetics lecture for maternal fetal medicine fellows and there are genetics electives for third year medical students and pediatric residents.

 

"We are proud of our counselors and their involvement on the national level," says Division Director Omar Rahman, M.D. Some recent activities include presentations at national conferences, annual meetings and quarterly webinars.

 

During the National Society of Genetic Counselors (NSGC) Annual Education Conference this year, Gunter presented his thesis entitled "The Health Literacy and Pregnancy Care Preferences of Advanced Parental Age Couples."

 

Zimmerman was a guest speaker for a quarterly webinar sponsored by NSGC's Pediatric Special Interest Group.

 

Laura Hendon spoke at the American College of Osteopathic Obstetricians and Gynecologists Annual Meeting this year. She gave a talk entitled, "Non-invasive prenatal screening.

 

Email Holly Zimmerman for more information.

 

Research Spotlight                                        
Division of Pediatric Critical Care 
Carrie Henderson, M.D. uses a quote from Edgar Allan Poe's short story, "The Premature Burial,
to illustrate the ethical dilemmas inherent with end-of-life decisions.     

  

Dr. Carrie Henderson who cares for children in the Pediatric Intensive Care Unit (PICU) at Children's of Mississippi Hospital has set her sights on improving how we care for children and families during an acute illness, and especially at the end of life. She is the site lead in a multi-center study aimed at developing a tool to help pediatricians better predict time-to-death after the withdrawal of life sustaining therapies.

 

In conjunction with the Division of Palliative Medicine, she is part of a team formulating "triggers" to better incorporate palliative services for patients admitted in the Pediatric Intensive Care Unit. These services will add an additional layer of support for the family, especially those caring for children with complex medical problems.

 

Henderson has a faculty appointment with the Center for Bioethics and Medical Humanities at the University of Mississippi Medical Center. In that role, she is working to publish findings from her study regarding pediatricians' views and understanding of Palliative Sedation, a controversial topic that involves intentionally sedating a patient at the end-of-life.

 

"I am collaborating with other pediatric faculty to teach an ethics curriculum. Pediatric residents will benefit because it is designed especially for them by other pediatricians," she says. Henderson also serves as course director of a new fourth year medical student elective aimed at giving future physicians a broad introduction to ethical topics in clinical medicine. The class kicked off last month.

 

Email Carrie M. Henderson, M.D. for more information. 

 

The boundaries which divide Life from Death are at best shadowy and vague. Who shall say where the one ends, and where the other begins?" - Edgar Allan Poe, The Premature Burial, 1844

 

New Specialists                        
Request an appointment by phone or online.

Children's of Mississippi continues to add specialists to the staff to meet the growing needs of our patients. Call the dedicated referral line to make an appointment. New providers in divisions marked with an asterisk ,"*", staff our inpatient units and/or do not accept appointments. 
 
Provider 
Division 
Nicole Borges,Ph.D.
Julie Kaplan, M.D.
Office of the Vice Chancellor*
Pediatric Genetics
 
 
 
 
 

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