Georgia Kids First, Spring 2016

A Biannual Publication of the Children’s Hospital of Georgia

GEORGIA KIDS FIRST

SUMMER 2016

Next, Dr. Catherine Davis, professor of pediatrics, physiology and graduate studies, along with Dr. Martha Tingen, professor and endowed chair in pediatrics, have been working hard to objectively measure the connection between second-hand smoke and obesity in children. Their research has unveiled some surprising findings pertaining to the correlation between exposing children to secondhand smoke and the onset of diabetes and the correlation between second-hand smoke and cognitive performance.

CHOG continues to be the area’s only hospital dedicated exclusively to children and the designated tertiary hospital for neonatal patients in East Georgia. From staff training to specialized faculty to the emergency room, we are all about the children we serve. We are proud to offer our youngest patients the advantages that only an academic research hospital has to offer. Dr. Natalie Lane explains how CHOG’s faculty members are educated in the latest procedures and breakthroughs.

GEORGIA KIDS FIRST

SUMMER 2016

CHAIRMENÔS NOTE

DEAR READERS, Summer is officially here, and while that means vacation and relaxation for some, we are busier than ever here at the Children’s Hospital of Georgia. From trauma to basic emergency to complex heart conditions, we are bringing the latest research; the best physicians and the widest range of pediatric services to Georgia. We want the children and families we serve to have the best that medicine has to offer. This season is a time of beauty and growth. There is no better time to look at CHOG’s most recent changes and see how much the hospital has grown.

At CHOG, we work wholeheartedly to offer our patients the most advanced approaches. That is why we are one of the leading centers in the nation when it comes to using hybrid techniques. Dr. Anastasios Polimenakos, director of pediatric and congenital cardiothoracic surgery, explains how pediatric heart interventionists are working side by side with pediatric cardiac surgeons to bridge heart defects when surgery is high-risk. Dr. Zahid Amin, section chief of pediatric cardiology, explains how the ability of CHOG to streamline care makes us the only hospital in Georgia that can offer a mother and her infant born with a heart defect a shared room.

First is the creation of the Children’s Advisory Council. This council will act as a bridge to the communities we serve. It is vital that residents know what services are available to them and that we know CHOG is meeting their needs. Committee members assist with outreach activities and act as ambassadors on CHOG’s behalf. This is an exciting step towards building strong connections with the members of the community and the patients and families we serve.

As CHOG continues to grow, so does our faculty. We welcome Dr. Tony Bonitatibus who specializes in Allergy/ Immunology, Dr. Christopher Watson, Pediatric Critical Care and Dr. Paul Mann in Neonatology.The newest members of our family are committed to meeting the health needs of the children in Georgia, South Carolina; and the region. Welcome to the team!

At CHOG, we have the ambition to grow into one of the top-tier children’s hospitals in the country. That is a journey that requires changes and innovation along the way. We look forward to making changes in the future that make Augusta even prouder that CHOG is their hometown children’s hospital.

Best,

Dr. Charles Howell Dr. Charles Linder

Drs. Charles Linder (left) and Charles Howell (right) with CHOG mascot, Roary

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IN THIS ISSUE SPRING 2016

SECOND-HAND SMOKE INCREASES FATNESS, HINDERS COGNITION_____________________ 4

Georgia Kids First is published biannually by Children’s Hospital of Georgia and the Division of Communications and Marketing.

Please direct comments or questions to Editor Emily Renzi at erenzi@ augusta.edu or 706-721-3213.

SPECIALIZED EMERGENCY CARE___________ 6 CHOG ADVISORY COUNCIL________________ 7 CHILDREN’S HOSPITAL OF GEORGIA HIGH ECMO SURVIVAL RATES____________________ 8 WHOLE HEARTED_________________________ 9 NEW FACULTY____________________________ 10

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SUMMER 2016 GEORGIA KIDS FIRST

GEORGIA KIDS FIRST

SUMMER 2016

SECOND-HAND SMOKE INCREASES FATNESS, HINDERS COGNITION IN CHILDREN Exposure to second-hand smoke is associated with a larger waist and poorer cognition in children, researchers say.

“The take-home message is that for these children, smoke exposure was connected to two major adverse health outcomes, one above the neck and one below the neck,” said Dr. Catherine Davis, clinical health psychologist at the Georgia Prevention Institute at the Medical College of Georgia at Augusta University.

Researchers looked at passive smoke exposure in 220

overweight or obese 7-11-yearold boys and girls. They found smoke exposure associated with nearly all measures of adiposity in the children, including bigger bellies and overall fat. “And every single one of our cognitive measures was poorer in the smoke-exposed children,” said Davis, corresponding author of the study in the journal Childhood Obesity.

Percentages of body fat in smoke-exposed children were substantially higher than in their also heavy peers, further amplifying their risk of cardiovascular disease, diabetes

and more, Davis said. While studies, including Davis’ at MCG, have shown a relationship between overweight and reduced cognitive function, this study found passive smoke had an impact on cognition that was independent of fat or socioeconomic status.

“All the bad things fat does to us, passive smoking makes worse,” said study co-author Dr. Martha S. Tingen, Charles W. Linder, MD Endowed Chair in Pediatrics at MCG and director of the Tobacco Control Program at the Georgia Cancer Center at Augusta University.

“And children who were exposed to second-hand smoke scored poorer on all cognitive tests,” shortfalls that can translate to a poorer attention span and lower grades in the classroom and on standardized tests, Tingen said. “We are talking about a recipe for an unhealthy child who becomes an unhealthy adult who cannot reach their full potential.”

Tailored interventions covering nutrition, physical activity and tobacco use in children and their families affected by these adverse health scenarios are needed to prevent adverse outcomes, the researchers said.

“Doesn’t everyone want their children to be as smart and healthy as they can possibly be?” asked Davis.

Tingen notes that children typically don’t have options about smoke exposure

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and parents who smoke are demonstrating a poor health behavior choice that is putting themselves and their children at physical and mental disadvantage lifelong.

To help ensure accurate data, researchers collected both parental reports of their children’s smoke exposure as well as blood levels of cotinine, the major metabolite of nicotine, which is often used as a definitive test of smoking or passive smoke exposure. MCG researchers also assessed levels of physical activity, which can impact fatness, sleep and diabetes risk.

They found surprisingly that passive smoke exposure did not appear to worsen breathing problems, such as snoring and short periods of not breathing while the children slept. It also appeared unrelated – at least at this early age – to prediabetes, insulin resistance and fat around internal organs in the abdomen.

Fat around the organs is considered a particularly highrisk factor for vascular disease and diabetes and ultimately heart disease and stroke. However, the larger waist size found in the children exposed to smoke also is considered a risk factor for these obesity-related health problems.

Their findings suggest, that at this age, passive smoke may have more effect on the amount of

body fat rather than the metabolic dysfunction, such as diabetes, that fat may eventually cause, Davis said.

Davis noted that 28 percent of the children in the study were already prediabetic, but that the incidence was actually slightly higher in the children who were not exposed to second-hand smoke.

Previous studies, which often relied solely on parent reports of smoke exposure, have produced inconclusive findings about the relationship between passive smoke and obesity. Davis noted about a 25 percent discrepancy in their study between what parents reported and what their blood analysis showed. The largest discrepancy was in parents reporting there was not a smoker in the home while the children’s blood showed smoke exposure.

But, there were also 18 children whose parents reported a smoker but the child’s blood held no evidence of exposure.

“If you are breathing in secondhand smoke, it’s almost as bad as if you were smoking the cigarette yourself,” Tingen said. Immediate effects include a lowering of the protective cholesterol, highdensity lipoprotein, or HDL, and an increase in the disease-producing low-density lipoprotein, or LDL. Researchers are not certain, when or if, the negative effects will be reversed.

About 480,000 premature deaths occur in the United States annually related to tobacco use, with nearly 42,000 of those in nonsmokers due to passive smoke exposure, according to the U.S. Department of Health and Human Services.

The research was funded by the National Institutes of Health and the East Georgia Cancer Coalition.

Adult studies have shown a link between passive smoke exposure and type 2 diabetes.

Studies that measured cotinine levels have found associations between passive smoke exposure and worse cognition and sleep.

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SUMMER 2016 GEORGIA KIDS FIRST

SUMMER 2016 GEORGIA KIDS FIRST

The Neonatal Intensive Care Unit (NICU) at CHOG is the designated tertiary hospital in East Central Georgia for neonatal patients who require intensive or immediate care.

“The Pediatric Intensive Care Unit is the only intensive care facility for children in the region and is an invaluable resource to have within our hospital,” Lane said.

SPECIALIZED EMERGENCY CARE FOR KIDS

“We are also the only hospital in the area that has pediatric-trained orthopedic surgeons and a pediatric radiologist.“

Children’s Hospital of Georgia is the area’s only hospital dedicated exclusively to children. We have an emergency room especially designed to provide 24/7 rapid emergency care to children of all ages and are equipped to meet the needs of children requiring specialized subspecialty care.

The staff in CHOG’s Emergency Department has the ability to work in close coordination with the in-house Pediatric Intensive Care Unit and inpatient intensivist physicians, and hospitalists giving them the advantage of easy access to pediatric subspecialists.

“All of our pediatric emergency physicians have completed fellowships specializing in emergency medicine specially designed for children,” said Dr. Natalie Lane, medical director of the Children’s Medical Center Emergency Department. “As an academic hospital, our faculty are exposed and committed to continuous learning and educating our current fellow and residents in the process.”

“When needed, we can call on specialist teams for any kind of pediatric disease or injury,” Lane said.

CHOG offers a dedicated support staff of certified and experienced emergency medicine nurses and committed child life specialists.

“Many of our nurses are instructors of basic life support and pediatric advanced life support and emergency nurse pediatric course instructors.“ Lane said. “Our child life specialists help children cope with injury and sickness and help ease the minds of family members.”

That is not all that makes CHOG unique and puts them on the cutting edge.

CHOG’s child-friendly Emergency Department is open 24/7. In addition to specialized emergency care, we provide access to the area’s only children’s hospital specializing in pediatric services.

Available Subspecialty Care: • Pediatric Intensive Care

• Pediatric Urology

• Pediatric Pulmonology

• Pediatric Ophthalmology

• Pediatric Allergy

• Pediatric Neurosurgery

• Pediatric Nephrology

• Pediatric Transplant

• Pediatric Cardiology

• Pediatric Plastic Surgery

• Pediatric Psychiatry

• Pediatric Endocrinology

• Pediatric Gastroenterology

• Pediatric Neurology

• Pediatric ENT

• Pediatric Hematology and Neonatology

• Pediatric Orthopedics • Pediatric Cardiothoracic Surgery • Pediatric Surgery

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• Pediatric Infectious Disease

CHOG ADVISORY COUNCIL The Children’s Hospital Advisory Council will consist of a diverse group of leaders from the region who have a wide background of expertise and who have a passion to have a top-tier Children’s Hospital of Georgia in their community.

It will also include parents of children who have firsthand experiences with CHOG.

The council will serve as a bridge between the hospital and community and provide advice and direction for the hospital with particular emphasis on the quality of service and communication.

The council will consist of 15 members with a chair selected by the members. The initial meeting will provide an orientation and in-depth education about the facilities, services and staff. Future meetings will focus on strategies to promote awareness. Potential high-profile special events will be considered as well as potential partnerships with other community organizations and businesses.

The mission will be to raise awareness and support of CHOG as well as to promote a sense of community ownership of “their” hospital. In addition to philanthropic support, this sense of ownership is a common theme seen at all great children’s hospitals.

Dairy Queen is holding their Miracle Treat Day on Thursday, July 28. Purchase a Blizzard at any participating location, and the proceeds will go toward the local Children’s Miracle Network Hospitals. In 2014, over $18,000 was raised for the Children’s Hospital of Georgia. This is always a great opportunity to treat oneself while giving back to the local community.

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SUMMER 2016 GEORGIA KIDS FIRST

SUMMER 2016 GEORGIA KIDS FIRST

CHILDREN’S HOSPITAL OF GEORGIA BOASTS HIGH ECMO SURVIVAL RATES Number of babies saved through artificial heart-lung bypass technology exceeds national benchmarks Babies placed on an ECMO machine at Children’s Hospital of Georgia have a greater chance of survival at the state’s second largest children’s hospital than they would at many other facilities nationwide, according to the latest data.

Transport. “Even in the more complex problems our babies and children may experience, we either exceed the benchmark or have made significant improvements in our care. This is great news for the families of the hundreds of babies we take care of with ECMO at Children’s Hospital of Georgia.”

“ECMO, or extracorporeal membrane oxygenation, takes the pressure off a baby’s heart and lungs while their tiny bodies recover from a variety of serious illnesses at birth,” said Dr. Jatinder Bhatia, CHOG’s chief of neonatology. “ECMO is used only when all the standard treatments of care have been exhausted.”

CHOG is a pioneer in ECMO technology, having established the Southeast’s first ECMO program in 1985.

Since then, more than 530 patients have been treated with this life-saving technology.

“Our neonatal ECMO team has helped deliver some outstanding results for our patients and families through rigorous protocols and a commitment to excellence,” Bhatia said.

An ECMO run could be a couple of days or up to several weeks, depending on how much time an infant or child needs in order to maximize recovery efforts.

Newborns with meconium aspiration who are placed on ECMO at CHOG have the highest survival rates – 97 percent – according to data published by the Extracorporeal Life Support Organization, the international non-profit health care consortium that sets the standards for ECMO and other therapies that support failing organ systems.

CHOG operates one of just two neonatal ECMO programs in Georgia and about 250 worldwide. It has been designated an ELSO Center of Excellence since 2008.

“We are proud of our past and look to the future,” Bhatia said. “Success is a journey and not a destination.”

Meconium aspiration syndrome occurs when a newborn inhales, or aspirates, a mixture of meconium and amniotic fluid before, during or after delivery. The inhaled meconium can partially or completely block a baby’s airways, making it very difficult to breathe. The survival rate is 93 percent nationwide in ECMO Centers with comparable volumes.

Babies with the highest odds to overcome are those born with diaphragmatic hernia, or a defect in the diaphragm during gestation caused when one or more of a baby’s abdominal organs displaces the lungs. This hinders development and respiratory function and must be surgically corrected promptly after birth. However, even these infants have higher than average survival rates at CHOG, according to the ELSO data.

“When you look at the numbers, particularly our survival rates as compared to other hospitals and the national benchmarks, we are saving more babies’ lives,” said Linda Wise, coordinator of Neonatal ECMO and

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SPECIALTY CLINIC SPOTLIGHT

WHOLEHEARTED The Pediatric Heart Program at the Children’s Hospital of Georgia provides unique services available nowhere else in the region.

The baby was born at 9:44 a.m. on a Tuesday.

But three months earlier, he’d been diagnosed in utero with a congenital heart condition.

So the Children’s Hospital of Georgia’s Pediatric Heart Program was ready. So were the mother’s OB-GYN, the CHOG Neonatal Intensive Care Unit and the family.

“That’s the benefit of the Pediatric Heart Program at CHOG,” said Dr. Zahid Amin, section chief of pediatric cardiology.

“Once a baby is

diagnosed, we streamline care with pediatric cardiology, pediatric surgery, obstetrics and gynecology, and the NICU. Nowhere else in Georgia can parents having a baby with a congenital heart condition deliver their child and have both mom and baby remain under the same roof, even on the same floor. It’s a huge plus.”

It’s a unique — and familyfriendly — aspect of the heart program at CHOG that not even large centers in Atlanta offer.

as hypoplastic left heart syndrome, closure of holes in the heart in premature babies and some stent placements. “These are cases where surgery alone is contraindicated or highrisk and where a single intervention might not suffice,” said Dr. Anatasios Polimenakos, director of pediatric and congenital cardiothoracic surgery.

“Here, a strategy toward definitive correction of the defect can be bridged through a hybrid approach, where a cardiac surgeon performs part of the operation and the interventional cardiologist does the other part.”

Care at the Pediatric Heart Program at CHOG can also include a multidisciplinary approach that’s become a buzzword in major pediatric heart centers across the country: Known as a hybrid approach, it involves pediatric heart interventionalists working side by side with pediatric cardiac surgeons. CHOG is one of the leading centers in the nation when it comes to using hybrid techniques to place pulmonary valves in babies too tiny for an open surgical procedure, as well as for complex cases such

In fact, labor and delivery at the Augusta University Medical Center is only steps down the hall from the neonatal intensive care unit at CHOG, so parents can stay in close contact with their child during the immediate care that’s necessary when a baby is born with a heart defect.

The heart program also provides advanced care available nowhere else in the region, including: • Congenital heart surgery such as cardiac valve, single ventricle and hypoplastic left heart syndrome • A dedicated pediatric cardiac catheterization suite • Adult congenital heart care • Family amenities, ranging from an on-site Ronald McDonald House, child life specialists, a support group and a summer camp for children with heart defects

To learn more about the Pediatric Heart Program at, call 706-664-0585 or visit augusthealth.org/chog.

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SUMMER 2016 GEORGIA KIDS FIRST

GEORGIA KIDS FIRST

SUMMER 2016

NEW FACULTY

Tony Bonitatibus, MD

Paul Mann, MD

Christopher Watson, MD

Medical Degree: Medical College of Georgia

Medical Degree: Southern Illinois University School of Medicine

Internship: 1998-99 Medical College of Georgia / Pediatrics

Internship: Vanderbilt University/ Vanderbilt Children’s Hospital

Medical Degree: MD (Georgetown University), MPH (Johns Hopkins University)

Residency: 1999-2001 PediatricsMedical College of Georgia

Residency: Vanderbilt University/ Vanderbilt Children’s Hospital

Fellowship:2001-2003 Allergy / Immunology - Medical College of Georgia

Fellowship: University of Iowa/ University of Iowa Children’s Hospital

Clinical Interests: Asthma, allergic rhinitis, eczema /atopic dermatitis, food allergies, stinging insect / fire ant allergy

Clinical Interests: Neonatal and pediatric bioethics, clinical and developmental outcomes for extreme prematurely born neonates, improving communication between doctors and parents

Want to learn the latest CHOG news in a snap?

Check out our blog at blog.gachildrens.org for tips and information about nutrition, safety, parenting, and many other topics related to children’s health. It’s a fast, fun way to stay abreast of cuttingedge findings, age-old wisdom, and everything in between related to nurturing the little ones who count on us to keep them healthy and safe.

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Internship/Residency: National Capital Consortium Pediatric Residency, Bethesda, Maryland Fellowship: Johns Hopkins Hospital Clinical Interests: Patient safety, quality improvement, medical education and pediatric trauma

CHOG PEDIATRIC CONSULTATION Allergy/Immunology 706-721-3531 Tony Bonitatibus, MD William Dolen, MD Betty Wray, MD Child Abuse/Neglect 706-721-2456 Maureen Claiborne, MD General Pediatrics and Adolescent Medicine 706-721-2456 Reda Bassali, MD Lynnette Bauza, MD Alice Little Caldwell, MD Maureen Claiborne, MD Jacob A. Eichenberger, MD Davidson Freeman, MD Lisa Leggio, MD Charles Linder, MD Kathleen Mahoney, MD Kathryn McLeod, MD Donna Moore, MD Lauren Newhall, MD Robert Pendergrast, MD Nirupma Sharma, MD Leila Stallworth, MD Christopher White, MD Pediatric Cardiology 706-721-2336 Zahid Amin, MD William Lutin, MD, PhD Kenneth A. Murdison, MD Henry Wiles, MD Pediatric Endocrinology 706-721-4158 Chris Houk, MD Linnea M. Larson-Williams, MD Traci Scott, RN, CDE Pediatric Gastroenterology 706-721-4724 Joyce Dorman, PNP Vita Goei, MD Katy Slagle, PNP Jamie Wolf, DO Pediatric Genetics 706-721-2809 Carolyn Lovell, MAT, MS, CGC

Introducing a new physician referral tool making it simple for you and your patients

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Pediatric Hematology/Oncology/ Sickle Cell 706-721-3626 Afshin Ameri, MD Leila Clay, MD Theodore Johnson, MD Colleen McDonough, MD David Munn, MD Betty Pace, MD Pediatric Infectious Diseases 706-721-4725 Chitra S. Mani, MD Christopher White, MD Pediatric Neonatal Follow-up Clinic 706-721-2331 Chantrapa Bunyapen, MD Pediatric Nephrology 706-721-0177 Luis Ortiz, MD Pediatric Neurology 706-721-3371 Mary Gregory, MD Yong Park, MD Elizabeth Sekul, MD Suzanne Strickland, MD Pediatric Pulmonology 706-721-2635 Maxine S. Eikani, MD Valera Hudson, MD Kathleen T. McKie, MD Nicole Wimmer, RN, MSN, CPNP Pediatric Rheumatology 706-721-8950 Rita S. Jerath, MBChB Lauren Newhall, DO Pediatric Cardiothoracic Surgery 706-721-7608 Anatasios Polimenakos, MD Beth Bryant, WHNP Whitney Perry, NP-C Pediatric Neurosurgery 706-721-9386 Ian Heger, MD Cole Giller, MD (Pediatric Epilepsy) Miranda Wood, NP Pediatric Ophthalmology 706-721-1150

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Stephanie Goei, MD Andrea Prosser, MD Pediatric Orthopedic Surgery 706-721-2849 Styles Bertrand, MD David Cearley, MD Gregory Kalv, MD Luke A. Shiver, MD Courtney Nuckols, RN Pediatric Otolaryngology 706-721-6387 Jack Borders Jr., MD J. Drew Prosser, MD Brian Shirley, NP Pediatric Plastic Surgery 706-721-2198 Jack Yu, MD Pediatric Surgery 706-721-3941 Diane Bairas, PA Robyn Hatley, MD Charles Howell, MD Walter Pipkin, MD Christian Walters, MD Pediatric Urology 706-721-0982 Ronald Lewis, MD Durwood Neal, MD Pastelle Walston, NP Other Pediatric Services Neonatology 706-721-2331 Jatinder J.S. Bhatia, MD Chantrapa Bunyapen, MD James Holcomb, MD Paul Mann, MD Azif Safarulla, MD Brian Stansfield, MD Pediatric Critical Care 706-721-4402 William Cagle, MD Lyle Fisher Jr., MD Renuka Mehta, MBBS Mary Lynn Sheram, MD Christopher Watson, MD Pediatric Radiology Office: 706-721-5201 Reading Room: 706-721-5209 Kristopher Lewis, MD

SUMMER 2016 GEORGIA KIDS FIRST

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CHILDREN’S HOSPITAL OF GEORGIA IN THE COMMUNITY The Children’s Hospital of Georgia has launched its new ad campaign as being not only #1 in quality and safety in the nation, but also the #1 choice for pediatric care in the region. This campaign highlights the importance of being the top choice in reliability for children’s health care. CHOG kids are featured in the ads, including billboards, print ads and digital social media ads.