Innovate: Issue 17, Spring 2013

Spring 2013

/ COVER STORY /

Uncovering the Genetic Roots of Disease / F E AT U R E /

Practicing Kangaroo Care:

Skin-to-Skin Nurturing for Premature Infants

Genetic study of breast cancer / Concussion: assessment and treatment / Collaborative care for patients with stroke / Third Siteman location opens I N T H I S ISS UE

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In this issue

3 8

2

BY THE NUMBERS

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NEWS >

Genetic study of breast cancer suggests new treatments

>

Access to free birth control reduces abortion rates

>

Collaborative care benefits stroke patients

>

Clinic provides thorough concussion treatment

COVER STORY Uncovering the genetic roots of disease

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BREAKTHROUGHS >

Genomic profiling

>

Innovative intensive care unit

>

Mini ventricular assist device

SIDE BY SIDE Living life and logging miles: a patient’s story

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FEATURE STORY Practicing kangaroo care: skin-to-skin nurturing for premature infants

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AT A GLANCE Pedal the Cause : raising awareness and money for cancer research

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FYI >

Integrated operating room streams live surgery worldwide

>

Third Siteman location opens

A LETTER FROM RICHARD LIEKWEG B A R N E S - J E W I S H H O S P I TA L ,

a nonprofit academic institution, is the largest hospital in Missouri and is consistently ranked among the Honor Roll of America’s best hospitals

by U.S. News & World Report. The adult teaching hospital of Washington University School of Medicine, Barnes-Jewish was the first adult hospital in Missouri to be certified as a Magnet hospital for its nursing excellence.

Barnes-Jewish Hospital is a member of BJC HealthCare, one of the largest nonprofit health care organizations in the United States.

The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is the only cancer center in Missouri to hold the Comprehensive Cancer Center designation from the National Cancer Institute and membership in the National Comprehensive Cancer Network.

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE’S

2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish Hospital and St. Louis Children’s Hospital. The School of Medicine is among the country’s leading medical research, teaching and patient care institutions, currently ranked sixth in the nation by U.S. News & World Report.

For more information or to make an appointment, call 314-TOP-DOCS (314-867-3627) or 866-867-3627 (toll free).

You’ll discover as you read through this edition of Innovate that we earn our reputation as national leaders in medicine in many ways. Our scientist and physician partners at Washington University conduct research that changes the practice of medicine. For instance, on Page 8 you can discover how The Genome Institute at Washington University is currently participating in an international study that aims to discover the roots of human disease. The results of this study will affect how scientists and physicians from around the world look at disease prevention and treatment. And turn to Page 3 to learn how another study has the potential to fine-tune the treatments received by patients with breast cancer.

As important as research is, it is only part of the health care story at Barnes-Jewish Hospital. We pave the way for others in patient care as well. Thanks to the passion and compassion of our physician partners, nursing professionals, technicians and support staff, we change lives every day. I hope you’ll take the time to read about our advances in stroke and concussion care, and the ways a kidney transplant has transformed a patient’s life.

Sincerely,

Innovate is published quarterly

by Barnes-Jewish Hospital.

Editor Anne Makeever Contributing editors Mary Lee, Juli Leistner, Jackie Stack Contributing writers Caroline Arbanas, Anne Bassett, Carolyn Chaperlo, Mary Lee, Pam McGrath, Michael Purdy, Diane Duke Wiliams

Richard Liekweg President, Barnes-Jewish Hospital and Barnes-Jewish West County Hospital

Want to send a message to Richard Liekweg?

Have questions or comments? Email innovate@bjc.org.

Address Changes: Innovate Circulation Mailstop 90-75-585 | 4901 Forest Park Ave. | Suite 1221 | St. Louis, MO 63108 Visit BarnesJewish.org/e-news to manage your Innovate subscription, sign up for e-newsletters and request additional information.

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BY THE NUMBERS

101 VADs

2012 64 VADs

2011

30,243 FREE FLU SHOTS

55 VADs

2010

2009

52 VADs

SMOKER

30by VADs given to the St. Louis community and 2008funded The Foundation for Barnes-Jewish Hospital

VENTRICULAR ASSIST DEVICE

15th Anniversary at Barnes-Jewish Hospital NONSMOKER

101 VADs

2012 64 VADs

2011

55 VADs

2010

52 VADs

2009

30 VADs

2008

414

VADs implanted to support heart function in patients with weakened hearts or awaiting transplant since the first one in 1997

10 TIMES MORE

GENETIC MUTATIONS IN LUNG CANCER TUMORS OF SMOKERS

THAN NONSMOKERS, ACCORDING TO A NEW STUDY PUBLISHED BY WASHINGTON UNIVERSITY SCIENTISTS

According to a recent survey* of Missouri tanning facilities:

65% WOULD ACCEPT PRETEENS 80% SAY TANNING PREVENTS SUNBURN 43% CLAIM THERE ARE NO RISKS * Part of a Washington University study that examined the practices of unregulated tanning facilities in Missouri

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MORE THAN

200

transplant recipients, their guests, physicians and staff attended the Rams game on Sunday, Dec. 2, 2012, for Transplant Awareness

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News Image courtesy of Matthew Ellis, MD, PhD

Genetic study of breast cancer suggests new treatments University School of Medicine. “Now, we can investigate which drugs work best for patients based on the genetic profiles of their tumors.”

The most comprehensive analysis yet of breast cancer shows that one of the most deadly subtypes of this disease is genetically more similar to ovarian tumors than to other breast cancers.

The findings of this study suggest that most basal-like breast tumors and ovarian tumors have similar genetic origins and potentially could be treated with the same drugs.

“With this study, we’re one giant step closer to understanding the genetic origins of the four major subtypes of breast cancer,” says medical oncologist Matthew Ellis, MD, PhD, who treats

Access to free birth control reduces abortion rates Unplanned pregnancies are a significant problem in the United States. According to a 2012 Brookings Institution report, more than 90 percent of abortions occur due to an unintended pregnancy.

Each year, about 50 percent of all pregnancies that occur in the United States are not planned, a number far higher than is reported in other developed countries. About half of these pregnancies result from women not using contraception and the other half from incorrect or irregular use.

A study by investigators at Washington University reports that providing birth control to women at no cost substantially reduces unplanned pregnancies and cuts abortion rates by 62 to 78 percent compared to the national rate.

Human breast cancer cells, stained pink, that have been grafted onto mouse tissue

patients with breast cancer at the Siteman Cancer Center at BarnesJewish Hospital and Washington

The Contraceptive Choice Project enrolled 9,256 women and adolescents in the St. Louis area between 2007 and 2011. Participants were at risk for unintended pregnancy and willing to start a new contraceptive method.

The lower abortion rate among study participants is considerably less than those in St. Louis city and county, which ranged from 13.4 to 17 per 1,000 women for the same years. Among girls ages 15 to 19 who had access to free birth control, the annual birth rate was 6.3 per 1,000, far below the U.S. rate of 34.3 per 1,000 for girls the same age.

“Unintended pregnancy remains a major health problem in the United States, with higher proportions among teenagers and women with less education and lower economic status,” says lead author Jeffrey Peipert, MD, a Washington University

The recently completed analysis of breast cancer is part of The Cancer Genome Atlas project, which brings together leading genetic sequencing centers­—including The Genome Institute at Washington University— for the purpose of identifying and cataloging mutations involved in many common cancers. The effort is funded by the National Institutes of Health.

– C. ARBANAS

Abortion Rates: National Average vs. Study Participants

19.6 ABORTIONS

National rate per 1,000 women without access to free birth control

4.4 - 7.5 ABORTIONS

per 1,000 study participants with access to free birth control

2008*

2008 - 2010

*the latest year for which figures are available

obstetrician and gynecologist at Barnes-Jewish Hospital. “The results of this study demonstrate that we can reduce the rate of unintended pregnancy, and this is key to reducing abortions in this country.”

– D. DUKE WILLIAMS To view a video about this story, visit medicine.wustl.edu and search for birthcontrol1012.

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News service at Barnes-Jewish Hospital—are starting their evaluation of treatment effectiveness at the very beginning.

They are assessing the long-term recovery of patients given tPA, a clotbusting drug that can only be taken within the first few hours after a stroke. These results will be compared to those of stroke patients who could have been treated with tPA but did not arrive at the hospital quickly enough.

Brain Recovery Core benefits stroke patients The road to recovery after stroke is a long one. It often includes not only initial assessment and treatment in hospitals but also significant time in inpatient and outpatient rehabilitation services. Throughout this process, patients see a wide range of specialists, including acute care physicians, radiologists, neurologists, neurosurgeons, and physical and occupational therapists.

says Maurizio Corbetta, MD, the Norman J. Stupp Professor of Neurology at Washington University School of Medicine and clinical director of the stroke and brain tumor program at The Rehabilitation Institute of St. Louis. “We’re doing this to help us predict how challenging recovery will be for the patients and also to assess the effectiveness of our treatments in facilitating recovery.”

To improve care and advance the development of new treatments, Washington University, Barnes-Jewish Hospital and The Rehabilitation Institute of St. Louis have established the Brain Recovery Core (BRC). This collaborative group ensures that each specialist who treats stroke patients at these three institutions communicates and shares data effectively.

The Brain Recovery Core standardizes, collects and shares data throughout the entire course of stroke treatment.” — Maurizio Corbetta, MD

“The BRC’s goal is to standardize, collect and share data throughout the entire course of stroke treatment,”

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With a grant from The Foundation for Barnes-Jewish Hospital, Corbetta and his colleagues—including Washington University physical therapist Catherine Lang, PhD, and neurologist Jin-Moo Lee, MD, PhD, attending physician with the acute stroke

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In the area of prognosis, Maggie Bland, DPT, coordinator for the BRC, and her colleagues published a study in 2012 that showed testing a patient’s balance and ability to walk soon after a stroke gave a good indication of how well the patient would be able to walk a few weeks later at home.

“When we used to have patients in inpatient rehabilitation for months at a time, it was easy for the doctors to help families identify and implement the changes that the patient’s house might need—like railing on the stairs or changes to the doorways,” says Lang.

“Now, patients stay in the hospital two or three weeks at most, so everything needs to happen very quickly. These sorts of indicators help us better prepare the patient and the family for discharge right from the beginning.”

Patients who received acute care for a stroke at another hospital may come to the Brain Recovery Core for rehabilitation, Corbetta notes. Doctors may call 314-362-4503 to refer a patient to the neuro-rehabilitation clinic at Barnes-Jewish Hospital, where the patient will be entered into the BRC. – M. PURDY

Concussion: assessment and treatment Most people who sustain a firsttime concussion may experience symptoms—dizziness, nausea, headaches, anxiety and forgetfulness, among others—for about a week following the injury. When symptoms continue for a longer period of time, a thorough neurological assessment is needed.

“Little is known about how the brain is injured following a concussion, so we focus on treating symptoms,” says David Brody, MD, PhD, a Washington University neurologist at Barnes-Jewish Hospital. “For some patients, we may recommend they abstain from work, school or athletic activities for a period of time. We also may recommend restricting computer use and other activities that require intense concentration.

For other David Brody, MD, PhD patients, we may prescribe medications that help relieve or prevent headaches, promote sleep or ease depression. Symptoms for every concussion are different, so our treatment plans need to be highly individualized.”

Brody and his colleague Maurizio Corbetta, MD, also a Washington University neurologist and the head of neurorehabilitation at BarnesJewish, treat patients with concussion

at the hospital’s Concussion Clinic.

The clinic’s multidisciplinary team works together to help each patient make a complete and quick recovery by providing a rapid assessment and treatment approach similar to that used by the United States military.

“Prior to establishing our clinic, I traveled to Afghanistan to see how the military helped soldiers recover from concussions sustained in combat situations,” says Brody.

“From that research and our own years of experience with these injuries, we developed a protocol that offers the most up-to-date, Maurizio Corbetta, MD comprehensive

approach for assessing and treating concussion symptoms.”

“Our team includes neurologists, rehabilitation physicians, physical therapists and neuropsychologists who work to identify a patient’s symptoms and develop an individualized approach to treatment,” says Corbetta. Patients referred to the clinic are seen by a physician for a thorough examination and medical history. If appropriate, they then undergo a series of tests that assess cognitive function, balance and exercise tolerance. Once the evaluations are complete, the physician shares the findings with patients and recommends a treatment plan.

Adds Corbetta, “Often, part of the treatment is simply reassuring a patient that symptoms will improve over time as the brain heals.” – P. McGRATH

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atest The L ical d in Me s and urce Reso nology Tech

BREAKTHROUGHS at Barnes-Jewish Hospital and Washington University School of Medicine

GENOMIC PROFILING

INNOVATIVE ICU

MINI VAD

CANCER

PAT I E N T C A R E

C A R D I O LO G Y

Physicians can now take advantage of a

The design of the new 36-bed 4400 intensive

On Sept. 12, 2012, Washington University

new genetic test. One of the earliest of

care unit (ICU) was influenced by staff

physicians at Barnes-Jewish Hospital were

its kind to be offered in the United States,

input and techniques gleaned from the

the first in the United States to implant a

the analysis can help determine the best

automobile industry. The result: hallways

new mini ventricular-assist device (VAD), the

treatment for cancer patients. Genomics and

2 feet wider than standard and rooms that

Impella CP, into a patient with heart failure.

Pathology Services at Washington University

are longer. Beds rotate to face windows,

This small VAD was inserted via a catheter

(GPS@WUSTL) offers physicians a test

reducing the risk of ICU delirium that causes

rather than an open procedure. About the

that examines 40 genes for mutations that

patients to lose track of day/night cycles.

size of a coffee stirrer, the new device is the

reveal abnormalities in a tumor’s cellular

Ceiling-mounted booms hold equipment and

world’s smallest heart VAD, yet it can pump

machinery. This information can be used by

reduce room clutter. And a “sterile square”

up to 4 liters of blood per minute, helping

oncologists treating a variety of tumors and

positioned inside the room’s doorway

blood flow in patients with severe heart

blood cancers. GPS testing also supports the

reminds staff and visitors just how far they

failure or cardiogenic shock.

discovery of new genetic markers through

can enter the room without wearing gloves

clinical research in oncology and other areas.

and a gown. This innovation, one of the

Visit gps.wustl.edu or call 314-747-7337.

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first of its kind in the United States, reduces costs and protects patients.

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To learn more about VADs and their use in treating heart disease, visit BarnesJewish.org/vad.

SIDE BY SIDE

LIVING LIFE AND LOGGING MILES Patrick Tretter was diagnosed with type 1 diabetes in his early 20s but says he never let it stop him from doing the things he loved. Then in 2006, the Carbondale, Ill., resident suffered a severe ankle injury and later developed an ulcer on his other foot.

Just when he thought the worst was over, fluid began building up in his legs, and his health rapidly deteriorated. That’s when he was told his kidneys were failing and that he was a good candidate for a kidneypancreas transplant. Christina Klein, MD, Washington University transplant nephrologist at Barnes-Jewish Hospital, helped make that determination.

On Nov. 20, 2010, after eight months on dialysis, Tretter received transplant organs from a deceased donor and underwent surgery performed by Jason Wellen, MD, director of kidney-pancreas transplantation at Washington University and Barnes-Jewish Hospital. Tretter was back to work two weeks after surgery and within a month had returned to the gym.

Two years later, he’s in his best shape ever.

He works out four times a week and is an avid cyclist—now training for a 60-mile ride and, maybe one day, a 100-mile “century” ride.

Patrick Tretter Kidney-pancreas transplant recipient ON HIS CONDITION WHEN HE FIRST CAME TO BARNES-JEWISH

It came on slowly, so I didn’t realize how sick I was. And when Dr. Klein suggested I might be a candidate for a transplant, I wasn’t thrilled about having to undergo dialysis first. But I started it anyway, with the understanding that I needed to do what it would take to get a transplant.

Patrick could live longer and have a much better quality of life.

ON PATRICK’S CONDITION AFTER TRANSPLANT

His pancreas and kidney graft function have been excellent, and he’s become an avid exerciser. He’s also quite involved in being an advocate for himself and other patients, which I think is amazing.

Jason Wellen, MD Washington University transplant surgeon at Barnes-Jewish ON PATRICK’S CONDITION BEFORE TRANSPLANT Patrick Tretter

ON LIFE AFTER TRANSPLANT

I feel great. I started cycling alongside my longtime girlfriend, Evy, who was training for a half-marathon. We love going to the gym, and I also eat a wellbalanced diet. After my transplant, I knew I didn’t want to waste the gift of life that came from my donor, the donor family and my transplant team at Barnes-Jewish.

Christina Klein, MD Washington University transplant nephrologist at Barnes-Jewish ON FIRST MEETING PATRICK

During his evaluation, I thought Patrick could be a good candidate for a kidneypancreas transplant if he was able to lose a large amount of water weight in his legs, which required him to start dialysis first. He understood the need to get into the best condition possible to undergo surgery safely. With a successful combined transplant,

He’d been diabetic for about 20 years, and his kidneys had deteriorated.

His eyes were affected, his stomach wasn’t working well, and he developed nerve deterioration in his hands and feet. When a patient experiences deterioration in kidney function, my advice is to seek evaluation for a combined kidneypancreas transplant.

ON THE ADVANTAGES OF A KIDNEYPANCREAS TRANSPLANT

A patient with type 1 diabetes needs a new kidney to end dialysis. But when all indicators are positive, a kidneypancreas transplant can be an amazing opportunity. Patrick’s transplant put an end to renal failure and eliminated his need for insulin. As it has with Patrick, a kidney-pancreas transplant can reverse some of the effects of diabetes. – A. BASSETT To view a video of a kidney-pancreas transplant, visit BarnesJewish.org/kidneypancreas-transplant.

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UNCOVERING THE GENETIC ROOTS OF DISEASE

WRITTEN BY CAROLINE ARBANAS

By decoding the complete genetic code, or genome, of more than 1,000 people whose homelands stretch from Africa and Asia to Europe and the Americas, scientists have compiled the largest and most detailed catalog yet of human genetic variation. This massive resource will help medical researchers find the genetic roots of rare and common diseases in populations worldwide.

“With this resource, researchers have a roadmap to search for the genetic origins of diseases in populations around the globe,” says Elaine Mardis, PhD, one of the study’s coprincipal investigators and the codirector of The Genome Institute at Washington University. “We estimate that each person carries up to several hundred rare DNA variants that could potentially contribute to disease.

Now, scientists can investigate how detrimental particular rare variants are in different ethnic groups.”

At the genetic level, any two people are more than 99 percent alike. But rare variants—those that occur with a frequency of 1 percent or less in a population—are thought to contribute to rare diseases as well as common conditions like cancer, heart disease and diabetes. Rare variants may also explain why some medications are not effective in certain people or cause adverse side effects.

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Results of the new study are based on DNA sequencing of the following populations: Yorubas in Nigeria Han Chinese in Beijing Japanese in Tokyo Utah residents with ancestry from northern and western Europe ● Luhyas in Kenya ● People of African ancestry in the southwestern United States ● Toscanis in Italy

● ● ● ●

Identifying rare variants across different populations is a major goal of the project. During the pilot phase of the effort, researchers found that

BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS

● People of Mexican ancestry ● ● ● ● ● ●

in Los Angeles Southern Han Chinese in China Iberians in Spain British in England and Scotland Finnish in Finland Colombians in Colombia Puerto Ricans in Puerto Rico

most of the rare variants differed from one population to another.

These variants developed recently in human evolutionary history, after >

populations in Europe, Africa, Asia and the Americas diverged from a single group. The current study supports this initial work.

“This information is crucial and will improve our interpretation of individual genomes,” says another of the study’s co-principal investigators, Richard Wilson, PhD, director of The Genome Institute and a pioneer in cancer genome sequencing. “Now, if we want to study cancer in Mexican Americans or Japanese Americans, for example, we can do so in the context of their diverse geographic or ancestrybased genetic backgrounds.”

All study participants submitted anonymous DNA samples and agreed to have their genetic data included in an online database. To catalog the variants, the researchers first sequenced the entire genome—all the DNA—of each individual in the study multiple times. The process yields the precise order of DNA’s molecular building blocks, called nucleotides.

Surveying the genome in this way finds common DNA changes but misses many rare variants.

Then, to find rare variants, researchers repeatedly sequenced the small portion of the genome that contains genes—about 80 times for each participant to ensure accuracy. They looked closely for changes in the DNA sequence involving a single nucleotide, called SNPs (for singlenucleotide polymorphisms).

Using tools developed to analyze and integrate the data, researchers discovered a total of 38 million SNPs. They also found more than one million structural variations—sections of extra or missing DNA. SNPs and structural variants can help explain an individual’s susceptibility to disease, response to drugs or reaction to environmental factors such as air pollution or stress. Other studies have found an association between

structural variants and diseases such as autism and schizophrenia.

The 1000 Genomes Project has generated massive amounts of genomic data. Simply recording the raw information took up some 180 terabytes of hard-drive space, enough to fill more than 40,000 DVDs. All of the information is freely available on the Internet through public databases.

“This tremendous resource builds on the knowledge of the Human Genome Project,” says co-author George Weinstock, PhD, associate director of The Genome Institute.

“Scientists and, ultimately, patients worldwide will benefit from the extensive effort to understand the shared features and geographic diversity of the human genome.”

The 1000 Genomes Project involved some 200 scientists at Washington

University and other institutions.

Results detailing the DNA variations of individuals from 14 ethnic groups were published Oct. 31, 2012, in the journal Nature. Eventually, the initiative will involve 2,500 individuals from 26 populations.

In addition to The Genome Institute at Washington University, the project included these research centers: the Human Genome Sequencing Center at the Baylor College of Medicine, Houston; The Broad Institute of Massachusetts Institute of Technology and Harvard University in Cambridge, Mass.; the Wellcome Trust Sanger Institute in England; BGI Shenzhen in China; the Max Planck Institute for Molecular Genetics in Berlin; and Illumina Inc. in San Diego. n To listen to a recording of this story, visit medicine.wustl.edu and search for 1000Genomes1012.

Q & A : The ABCs of DNA What is DNA?

Deoxyribonucleic acid, or DNA, is the genetic blueprint for life.

DNA carries the instructions for an organism—be it a flower, a dog or a person—to develop, survive and reproduce. DNA is passed down from parents to their offspring, and it is what makes each of us unique.

Most DNA is located in the nucleus (or brain) of the cell, where it is packed tightly into 23 pairs of chromosomes. If unwound and tied together, the DNA in just one cell would stretch 6 feet.

What are genes?

Genes are the stretches of DNA that code for proteins, the workhorses of cells. Humans have about 20,000 genes, and together they make up only 1 to 2 percent of a person’s DNA. The rest of the DNA is thought to influence the activity of the genes.

What is a genome, and why is it studied?

A genome is the complete DNA sequence of an organism. In humans, that sequence is made up of 3 billion chemical units represented by the letters A, T, G and C. Spelling out the entire DNA sequence of a person would fill an estimated 200 New York City phone books.

At the genetic level, any two people are more than 99 percent alike. By studying the genome, scientists can identify variations in the DNA sequence that may contribute to good health or increase the risk of disease.

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WRITTEN BY CAROLYN CHAPERLO, MSN, RN

Practicing Kangaroo Care: Skin-to-skin nurturing for premature infants hen an infant is born prematurely or at low birth weight, or is struggling to transition to life outside the womb, he or she is most often placed in an isolette, a special bed that protects against unnecessary and often stressful stimulation. An isolette controls the newborn’s environment by offering a steady temperature and the absence of drafts and other external disturbances that can take their toll on a fragile new life. Along with the use of an isolette comes a process of care called “cluster care” that groups all interruptions and interventions together—things like feedings, diaper changing and medical treatment—so that the newborn experiences fewer disturbances during the early days of life.

The use of isolettes and the practice of cluster care have become a standard in hospital nurseries in the United States.

And some newborns do require a rigidly controlled isolette environment early in their stay in a hospital. But even these infants, as they grow and improve, can be connected to a more organic and long-term beneficial source of heat and positive stimulation—their mothers and fathers. This kind of care is now known as kangaroo care.

Kangaroo care began in the late 1970s as a solution to an overcrowded neonatal intensive care unit (NICU)

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in Bogota, Colombia. The NICU didn’t have enough isolettes available for the number of low-birth-weight infants in its care. In order to provide these newborns with a regulated and warm environment, their mothers were enlisted to be their baby’s source of heat. Each mother reclined comfortably in a chair with her gown or shirt opened to the front. And each infant, wearing only a diaper, was placed in an upright, prone position on his or her mother’s chest for one to three hours at a time. A blanket was draped over mother and baby to help provide temperature stability and privacy.

healthy infants. And now, kangaroo care includes fathers, grandparents and siblings as providers of warmth and stability.

Though it began as a temporary solution, kangaroo care now holds a respected place in current practice due to the benefits it provides to infants and their families—and even to health care providers. In fact, kangaroo care is part of the standard of care at Barnes-Jewish Hospital and St. Louis Children’s Hospital.

The most significant challenge in caring for infants born prematurely is providing an environment that is most

…the infants being held by their mothers

in this manner—skin to skin—were gaining weight more quickly and maintaining their body temperature sooner…

It soon became clear that the infants being held by their mothers in this manner—skin to skin—were gaining weight more quickly and maintaining their body temperature sooner than the infants who remained in their isolettes.

What’s more, the kind of growth these babies experienced meant their time in the NICU was shorter. Given these results, the practice of kangaroo care expanded, soon growing to include

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similar to life before birth. Kangaroo care meets many of these challenges by offering not only a heat source but also the stability and comfort of a human heartbeat and voice—things the infant was accustomed to before birth.

Skin-to-skin contact provides a kind of direct heat that infants in an isolette don’t experience. And infants receiving kangaroo care learn to >

during feedings and breast-pumping sessions. During kangaroo care, infants can easily access their mothers’ breasts for feeding. As a result, there are fewer barriers between the moment the infant indicates hunger and the satisfaction of that hunger.

This reinforces a strong feeding pattern and builds confidence in breast-feeding for both mother and her infant.

The use of an isolette, which represents a physical barrier to families, also can affect the bonding between baby and parents that typically begins at birth.

Kangaroo care removes that barrier, and the time spent in skin-to-skin contact allows family members to have close and intimate time with their newborn. They can be involved in the care of an infant who is not yet able to be taken home. As a result, parents report feeling satisfaction in being needed by nurses and playing an important role in helping their newborn transition from life in the NICU to life at home.

Kangaroo care offers a host of benefits to infants who are born prematurely, have a low birth weight or are struggling to transition to life outside the womb.

maintain a more consistent body temperature earlier in life by taking cues from the heart and respiratory rates of their holders. In fact, a study published in 2004 found that infants who received kangaroo care maintained heart rates and respiratory rates within normal limits while they rested against a parent or family member.

10 minutes before an injection maintained a relaxed breathing pattern and stayed calm or even asleep for the procedure, and their expressions showed little response to pain. Keeping infants calm during their hospital stay prevents a loss of calories due to unnecessary stress and preserves energy needed for growth and development.

Infants who receive kangaroo care show an increased ability to sooth themselves and to relax; this is especially true when they experience pain. Another study, published in 2008, found that infants who received kangaroo care

Kangaroo care also makes breastfeeding more organic. The time a mother and her baby spend in direct contact provides the stimulation needed to produce larger, more consistent volumes of breast milk

Kangaroo care also can be helpful for nursing staff and can improve the overall level of care in the NICU. When a mother is holding her infant, she can be a part of the team that observes and reports on the status of her baby; she may be able to observe what a nurse caring for multiple infants may not.

The bonding time kangaroo care offers means that parents and family more quickly gain the confidence they need to care for the new family member. They are often more able to manage their baby’s care on their own and move more quickly toward their goal—taking their baby home. n

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FYI Integrated operating room streams live surgery worldwide A new operating room at BarnesJewish Hospital offers a wealth of resources to the physicians who use it, their patients and physicians located around the world.

The first of its kind in St. Louis, the room is equipped with centralizedcontrol surgical equipment, including surgical devices, video monitors and other systems, historic patient archives, endoscopic video, video on demand and two-way Web-based communication.

Typically, the room serves patients requiring minimally invasive and weight-loss (bariatric) surgery.

“With this new integrated technology and enhanced visual definition, we may provide improved surgical outcomes,” says Esteban Varela, MD, Washington University bariatric surgeon at Barnes-Jewish Hospital.

Surgeons using this operating room can not only record procedures from multiple camera angles for training purposes, but they also can stream live surgeries in real time to physicians anywhere via the Internet.

“This technology allows us to obtain pictures not only from the room but through the endoscope,” says Varela. “Advances like these allow us to develop our clinical and teaching missions both locally and abroad.”

For example, Varela and his colleagues will use the technology to stream an upcoming graduate medical course about hernia repair to surgeons in South America and China.

One operating room at the hospital has this unique technology installed, but more are a possibility in the future, according to Colleen Becker, RN, executive director of perioperative services at BarnesJewish. “This technology fully supports our commitment to delivering the highest levels of patient care,” says Becker. – A. BASSETT

Siteman opens south county location Plaza, near the intersection of Interstate 55 and Butler Hill Road.

In addition to its main campus in St. Louis, Siteman also operates satellite cancer centers at BarnesJewish West County Hospital in Creve Coeur, Mo., and Barnes-Jewish St. Peters Hospital in St. Peters, Mo. The Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine has added a new satellite location to provide cancer care to residents in south St. Louis County and surrounding areas in Missouri and Illinois.

Siteman Cancer Center-South County opened Jan. 7 at 5225 Midamerica

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“As the largest provider of cancer care in the region, Siteman often attracts patients who travel long distances to be treated,” says director Timothy Eberlein, MD. “Our new south county location allows patients to see Washington University physicians and receive world-class cancer care closer to their homes and families.”

The 37,000-square-foot outpatient center offers physician consultations,

BARNES-JEWISH HOSPITAL AND WASHINGTON UNIVERSITY PHYSICIANS

chemotherapy and radiation therapy.

Multidisciplinary care is provided by medical oncologists, radiation oncologists and surgeons. Patients may see as many as three physicians in one trip and have their treatment plan determined in one visit.

The center also provides patient access to clinical trials as well as onsite laboratory and retail pharmacy services. The 16-acre site includes free parking close to the building and plenty of green space for patients and their families to enjoy. Future plans call for the construction of a healing garden. – M. LEE For more information, visit sitemansouth.wustl.edu.

AT A G L A N C E

$2 MILLION RAISED FOR CANCER RESEARCH The numbers are in. More than 1,800 riders raised $2,057,200 during the 2012 Pedal the Cause event, held Oct. 6-7, 2012, in downtown St. Louis, Mo. Founded in 2009 by two-time lymphoma survivor Bill Koman, Pedal the Cause raises money for the Alvin J. Siteman Cancer Center and St. Louis Children’s Hospital to fund cancer research

by Washington University. All money raised during the annual cycling event stays in the community, where it is used to fund innovative research projects.

For information about Pedal the Cause and to register for this year’s ride, visit pedalthecause.org.

P H OTO S B Y J I M G O O D W I N

One Barnes-Jewish Hospital Plaza Mailstop 90-75-585 St. Louis, MO 63108

Bringing the News to You To receive e-newsletters from Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center about the latest in medical news and breakthroughs, visit our website at BarnesJewish.org/e-news. You can also join in the conversation by visiting BarnesJewish.org/socialhub. barnesjewish.org/e-news

This publication in no way seeks to serve as a substitute for professional medical care. Consult your physician before undertaking any form of medical treatment or adopting any exercise program or dietary guidelines. Washington University School of Medicine and Barnes-Jewish Hospital are nonprofit organizations and do not endorse commercial products or services.