HEROES Clinic at Forefront of Childhood Obesity IssueChildhood obesity has taken center stage on the national scene, and has been adopted as an area of interest by first lady, Michelle Obama. The prevalence of high body mass index (BMI) among children and teens in the U.S. ranges from approximately 10 percent for infants and toddlers to approximately 18 percent for adolescents and teenagers ( JAMA, 2010). The HEROES Weight Management Clinic at Children’s Hospital & Medical Center serves this population of children who have a BMI of greater than the 95th percentile for age and height, or who have associated co-morbid conditions.

Patients referred to the HEROES Clinic receive nutrition counseling, exercise schedule and log book and medical management that includes referrals to Cardiology or Behavioral Health, as appropriate. A fitness class is also available.

Since the clinic opened in October of 2009, more than 50 patients have been evaluated. The clinic receives an average of five to eight referrals per week, according to Tami Dolphens, PA-C, Cardiology and HEROES mid-level provider, UNMC/CUMC Joint Division of Pediatric Cardiology. Patients range in age from 5 to 18. Although only a handful of the patients have dropped a significant amount of weight, they all have improved their fitness levels, as measured through their exercise testing, lipids, metabolic profile, Vitamin D levels, thyroid and insulin levels. To refer a patient or for more information, call 402.955.4080.

1.888.592.7955PHySICIanS’ PRIORIty LInE

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ERICKSOn CO-autHORS aHa StatEmEnt On CIEdsChristopher C. Erickson, MD, electrophysiologist at Children’s Hospital & Medical Center and UNMC Joint Division of Pediatric Cardiology, is co-author of a recent Scientific

Statement published by the American Heart Association (AHA). In the statement, scientists weigh in on prevention and management of cardiovascular implantable electronic device (CIED) infections. CIEDs include pacemakers, defibrillators and implantable loop recorders (small devices implanted under the skin that can record the heart rhythm during specific symptoms for up to three years). All of these CIED implant procedures are performed at Chil-dren’s, where every precaution is taken to avoid infection during implantation as well as during the life of the CIED. CIED infections are often a serious problem for the patient. Most often infections are found in the device pocket (usually the muscle) or with the wires that lead into the blood stream.

The AHA statement provides a precaution to physicians who have patients with CIEDs. If an infection is suspected, sometimes practitioners are tempted to perform a needle aspirate of the infection site for a culture. However, current AHA recommendations state that this procedure should not be performed since it is not helpful and may be harmful to the patient. There is concern by most implanting electrophysiologists that aspiration into a pacemaker pocket could introduce an infection if one was not already there. In addition, there is no advantage to pocket aspiration. Device infections often act differently than infections not involving a foreign body. If an infection

is suspected, the new recommendations suggest that it is reasonable for the patient be evaluated by an expert in device infections. It is recomended that two sets of blood cultures be drawn prior to starting antibiotics and that an echocardiogram (transesophageal in adult-sized patients or those with poor transthoracic imaging) be performed. Sometimes an ultrasound can be performed to the pocket to look for fluid.

Children’s Interventional Electrophysiology Program treats children and young adults as well as adults with congenital heart disease. Services offered include ablation procedures, implantation of CIEDs, full non-invasive arrhythmia evaluations (ECGs, Holters, stress testing, etc), and inpatient telemetry monitoring, which records the heart rhythm of inpatients. With ablation, physicians have the ability to create an electrical map of the arrhythmia source using 3-D electroanatomic mapping. This allows the abnormal area to be destroyed with a specialized heart catheter that creates a small lesion.

The program also has a Genetic Arrhythmia Clinic in conjunction with UNMC for families with inherited arrhythmias and cardiomyopathies. The physician and Genetic Arrhythmia Clinic nurse will meet with families to create a family history and pedigree in order to identify others in the family at risk. Molecular genetic variant analysis is also available.

Contact the Cardiology Clinic at 402.955.4350 for more information.

Christopher Erickson, MD

RESEaRCH FOCuSES On dIaPHRagmatIC HERnIaS

Dr. Kenneth Azarow is leading the DHREAMS (Diaphragmatic Hernia Research Exploration Advancing Molecular Science) research team at Children’s Hospital & Medical Center.

He is currently recruiting families to take part in a study focusing on concongenital diaphragmatic hernia (CDH), a birth defect that occurs when the diaphragm does not form properly. The resulting hole in the diaphragm can cause the contents of the abdomen to move into the fetal chest. Currently little is known about why this birth defect occurs, but researchers at Children’s are working to change that.

According to Dr. Azarow, Children’s was chosen to participate based upon the reputations of our pediatric surgeons and our willingness to comply with the study guidelines. “Participation in this study shows we are at the cutting edge for perinatology and neonatal surgical diseases,” said Dr. Azarow. “The goal is to be able to predict which families are at risk and ultimately set up the best prenatal and postnatal care available.”

CDH is relatively rare, generally 1 in 10,000 births. But for those families dealing with the challenges of this disease, it is vital that researchers try to find a way to prevent it.

Participating families will be asked to allow a small blood sample and a small sample of the child’s diaphragm to be taken for analysis. Children will be assessed again at age 2. The DHREAMS study team hopes the research will lead to significant advances in the diagnosis, prognosis, prevention and treatment of this disease.

For more information contact study coordinator, Sheila Horak, APRN-NP, at 402.955.7400.

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InCREaSE In PEdIatRIC tRanSPORtS REvEaL nEEd

Of the patients transported last year by the Children’s Transport Team, 24 percent were neonatal transports and 72 percent were pediatric transports. These numbers continue to grow since the pediatric component was added in September of 2009. The Transport team uses a new, child-friendly ambulance equipped specifically for critical care pediatric and neonatal transports. A study in Pediatrics (July 2009), while acknowledging the proven benefits of specialized transport for newborns, examined the benefits of specialized transport for older children. The study found that critically ill children fare much better with a specialized team than with a team lacking pediatric skills.

“We can certainly see the benefits for ourselves time and time again that specialized pediatric transport is an essential service for the children of Nebraska and throughout this region,” said Rob Chaplin, MD, FAAP, medical director of the transport team.

Children’s responds with the Newborn Critical Care Transport Team for children younger than 2 months old, and the Pediatric Critical Care Transport Team responds for children over the age of 2 months. “We are prepared for all critically ill patients, but are always able to transport any patient no matter how sick they are,” said Chaplin. “We feel our expertise also guides appropriate treatment and hospital placement, therefore reducing delays in therapy or unnecessary costs.”

Children’s Newborn and Pediatric Transport Teams are the only such teams in the region,

The 2010 Upper Midwest Regional Pediatric Conference is a unique pediatric conference providing two distinct tracks specific to each health care provider’s scope of practice. Plan to attend Sept. 23-24, 2010, at the Marina Inn, in South Sioux City, Neb. Go to www.umrpconference.com for conference information and updates.

SavE tHE datE: umRPC 2010

serving Nebraska, western Iowa, northern Missouri, northern Kansas, eastern Colorado and South Dakota. Children’s can arrange for transport via helicopter, fixed wing or ground service.

One call to the Physicians’ Priority Line, 888.592.7955, activates the appropriate transport team.

REgIStER FOR tRauma COnFEREnCEChildren’s Hospital & Medical Center’s Fourth Annual Trauma Conference, “Treatment & Rehabilitation of the Pediatric Trauma Patient,” takes place Friday, June 4, 2010 at the Omaha Marriott. Call 800.833.3100 or visit ChildrensOmaha.org/Trauma.

CHILdREn’S CmO dEPaRtSDavid Christensen, MD, senior vice president and chief medical officer, resigned from Children’s Hospital & Medical Center at the end of January 2010. He has accepted aposition as vice president and chief medical officer at Children’s Hospital of Central California in Madera, Calif. The search for a new senior vice president and chief medical officer is currently underway.

Kenneth Azarow, MD

(COn’t)