Bearings - Spring 2010
Children’s National Partners with Holy Cross Hospital to Detect Congenital Heart Disease in Newborns
Congenital heart disease (CHD) is the most common birth defect and affects approximately 8 per every 1,000 babies born each year. More than 36,000 babies are born with CHD each year in the United States. Tremendous advances have taken place in the care of children with CHD and survival rates are now approaching 96 percent for all affected children. Yet despite these advances, CHD is still the leading cause of death for babies born with a birth defect.
In 2009, the American Heart Association reported that more than 30 percent of infants who die from a birth defect in the first year of life have some form of CHD. One element of this mortality is that a significant number of children are not detected as having heart disease in the newborn nursery and either die before care is provided or present in poor condition for their corrective procedure. This mortality could be eliminated with an effective newborn screening mechanism before they leave the nursery.
Pulse oximetry (pulse ox) has been shown to be an effective screening test to detect CHD before babies leave the newborn nursery. Pulse ox is a test for basic vital signs and is a quick, inexpensive, and painless test that takes less than four minutes to perform. Currently, there are a small handful of newborn nurseries in the United States that are screening for CHD, however screening has not been recommended as a universal standard of care because there are still questions surrounding implementation in community nurseries.
In order to address concerns over implementation, Children’s National worked with Holy Cross Hospital in Silver Spring to research best practices for implementing pulse ox screening in community nurseries. We began screening in January 2009 and to date have screened more than 5,000 newborns. We have identified one infant with serious disease and two infants with non-serious disease; we have had only two false positives. Screening has taken less than four minutes per infant. Additionally, no additional staff has been necessary to implement a screening program.
Because of the positive experience at Holy Cross Hospital, Children’s National Heart Institute partnered with the Child Health Advocacy Institute at Children’s National to implement the program in additional nurseries and to explore regulatory solutions for the enactment of universal screening in the State of Maryland. We created a toolkit with recommendations for best-practice implementation as well as educational materials for parents and staff. Children’s National extends its gratitude to Delegate Tom Hucker (District 20-Montgomery County) and Congressman Chris Van Hollen (MD-8) for endorsing the toolkit.
Currently, seven other hospitals in the national capital region are interested in implementing a screening program. We hope that the program dissemination initiated by Children’s National will position Maryland to assume national leadership in establishing CHD screening as the standard of care for all newborns.
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Children’s National Opens Last Two Floors of Patient Tower
Children’s National Medical Center recently opened the two remaining floors of its East Inpatient Tower. The 6th floor north unit opened on January 12 and the 7th floor opened on February 21.
The 6th floor north unit is home to a 12-bed inpatient unit used for Gastroenterology and patients who are treated through the Intestinal Rehabilitation Program. The south unit is home to the Neonatal Intensive Care Unit, which opened in May 2009.
The 7th floor is a 50-bed unit for pulmonary patients and medical care patients, which includes a variety of conditions, including autoimmune diseases.
In November 2007, the first of three floors opened in the state-of-the-art Inpatient Tower. Other units include surgical care, heart and kidney, neurology, and critical care, including the region’s only Cardiac Intensive Care Unit (ICU) dedicated to pediatrics. The Inpatient Tower helps Children’s National to meet its goals of providing world-class care in a family-centered environment to children and families in Maryland and the Greater Washington metropolitan region.
“The opening of the final floors of the Inpatient Tower is the culmination of years of careful planning and provides a wonderful healing environment for our patients and families,” said Edwin K. (Ned) Zechman Jr., president and CEO of Children’s National.
The Inpatient Tower contains state-of-the-art technology that will enhance a family’s clinical treatment and overall experience at the hospital. The Inpatient Tower will give Children’s clinicians access to wireless monitoring of vital functions. All rooms will also feature televisions and computers with Internet access that will provide information to patients and families. These entertainment/information systems will welcome the patient and families to the room, orient the patient to the room, play a welcoming message, and feature entertainment, as well as Internet access.
Complementing the clinical and technological features, the Inpatient Tower also provides comforts that enhance Children’s focus on family-centered care. The Inpatient Tower has private patient rooms that can accommodate overnight stays of parents, who are encouraged to participate with the clinical team.
Planning for the new patient tower began more than 10 years ago with the help of staff and families. Construction began in 2003.
The Washington Post produced a feature about the Inpatient Tower, which can be accessed here.
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Children's National Assists in Haiti
Several medical professionals from Children’s National Medical Center have been assisting with the relief efforts following the devastating earthquake in Haiti.
Rotating teams of pediatric orthopaedic surgery specialists made weekly trips to Haiti earlier this year. During the week of January 17, two orthopaedic surgeons, John Lovejoy, III, MD, and Edward Fink, MD, along with physician assistant Kim O’Brien, and nurse Stephanie Gano traveled to Haiti to assist pediatric patients. Also in January, orthopaedic surgeon Jeff Hanway, MD, and physician assistant Rebecca Radcliffe, traveled to Haiti to assist in the relief efforts.
While in Haiti, the team from Children's National operated at Hôpital Sacré Coeur (HSC), the largest private hospital in the north of Haiti. Located in the town of Milot, approximately 70 miles from Port-au-Prince, the hospital has 73 beds. The team from Children’s National is with the Massachusetts-based nonprofit CRUDEM (Center for the Rural Development of Milot), that runs the hospital.
During one day alone, the team treated more than 300 patients and performed 24 operations in two operating rooms. Helicopters from the Coast Guard have been transporting patients every 20 to 30 minutes, reports Dr. Lovejoy.
“Most patients have been triaged in the field or on the Coast Guard choppers,” reports Dr. Lovejoy. “Most of the surgeries have been open fractures, some head and spine injuries, and a lot of gangrene.”
In addition to the orthopaedic team, Shawn Safford, MD, a general and thoracic surgeon at Children’s National Medical Center, is aboard the USS Comfort that is part of the rescue mission in Haiti.
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Jeroy's Visit to the PICU
Five-year old Jeroy Acosta started feeling poorly in September, catching a bug from his younger brother, Jarel. Jarel quickly felt better, but Jeroy eventually had a fever of 104 degrees. To complicate matters, Jeroy has asthma, which increased his chances in becoming infected with the H1N1 (swine) flu.
That was enough to make his pediatrician and his parents, Ana and Wilmer, worry about the H1N1 epidemic. Sure enough, on a Sunday, Jeroy was transported from Silver Spring, MD, via ambulance to Children’s National Medical Center’s Pediatric Intensive Care Unit (PICU). Doctors and nurses examined Jeroy and determined that his lungs were bleeding as a result of the virus, and his breathing was very labored. His respiratory failure was so severe that the care team in the PICU was worried about Jeroy’s chances for survival.
“We were terrified and scared that our son would not make it,” said Ana.
Jeroy spent 18 days at Children’s National. Since his breathing problems were so severe, he was immediately placed on a ventilator (breathing machine). While the vast majority of H1N1 infections are not severe, a few are and those infections can be very damaging to the lungs. “He needed to go on a breathing machine so we could help make sure the oxygen got into his lungs,” said David Stockwell, MD, medical director of the PICU. “In a serious case like this, it is standard procedure to use a breathing tube and ventilator to provide respiratory support.”
Today, Jeroy has no memories of his time in the hospital and is back to his active self. “The people at Children’s National don’t work for a salary; they work for love,” said Wilmer.
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Enrollment Underway for April Session of Dr. Bear’s University
Elected officials and community and business leaders from across the region have a unique opportunity to participate in Dr. Bear’s University, a mini-internship program designed to provide participants with an in-depth, behind the scenes experience at Children’s National Medical Center.
Local leaders will spend the day at Children’s National in clinical rotations with physicians and nurses, observe the special care given to our young patients, and learn more about the nature of specialty pediatric care in the region.
Maryland alumni of Dr. Bear’s University include: Delegates Charles Barkley (District 39-Montgomery County), Barbara Frush (District 21-Prince George’s County), Anne Healey (District 22-Prince George’s County), Heather Mizeur (District 20-Montgomery County), Joseline Pena-Melnyk, (District 21-Prince George’s County), Craig Rice (District 15-Montgomery County), and Jeff Waldstreicher (District 18-Montgomery County).
The next session of Dr. Bear’s University will be held on Tuesday, April 27. If you are interested in learning more about Children’s National, how we serve Maryland’s children and families, and what makes us one of the top pediatric hospitals in the country, please contact Tim Jones, Manager of State Government Affairs, at firstname.lastname@example.org.
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