A Biannual Publication of the Children’s Hospital of Georgia
GEORGIA KIDS FIRST
FALL 2014
FALL 2014 georgia kids first
CHAIRMAN’S NOTE
DEAR READERS,
When I was asked to step out of retirement to succeed Dr. Bernard Maria as Chairman of the Medical College of Georgia Department of Pediatrics, I accepted on one condition: Don’t call me ‘interim.’ Don’t get me wrong; I’m too anxious to resume my golf game to covet the Chairman position for long, and I fully support MCG’s dynamic nationwide search for a full-time successor. So, yes, the “interim” title technically fits – but I have no intention of serving merely as a place holder during my tenure. Pediatrics is much too close to my heart for that. Nobody does children’s health care better than the Children’s Hospital of Georgia, and I intend to do everything in my power to perpetuate that proud legacy. I spent most of my career in pediatrics at GRU’s Medical College of Georgia, where I also earned my medical degree. I developed a keen appreciation for
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the patient care, research, and education that unfold daily on our campus. We offer not only second-tonone pediatricians, but subspecialists in every aspect of children’s care – people who offer cutting-edge treatments, develop new treatments through research, then teach their skills to future generations of physicians. No grass is growing under my feet as I advance this mission. I’m busy recruiting new faculty, inspiring new students, overseeing new services, cultivating new sources of support, and otherwise doing everything possible to optimize every day of my tenure. I plan to bequeath my successor a stronger department than the one I now oversee. And that’s saying a lot. I hope you get a feel for that by perusing this edition of Georgia Kids First. You’ll notice that we’ve tweaked the publication to appeal more directly to our referring physicians. You’ll find articles of substance in these pages, information that can enhance your own patient care and bolster your confidence when referring a patient to us. One article in particular is very close to my heart: One of our homegrown faculty, Dr. Ted Johnson, is overseeing an immunotherapy trial to treat glioblastoma, a deadly form of brain cancer. The current trial targets adult patients, but he plans to tailor it soon for children. Having lost my beautiful wife, Marion, at age 60 to this cruel disease, I can’t begin to express my excitement regarding this study’s potential. I hope you enjoy this edition, and I welcome your suggestions for improvement as we move forward. Best, Dr. Charles Linder Interim Chairman, Department of Pediatrics Medical College of Georgia
IN THIS ISSUE FALL 2014
FACULTY SPOTLIGHT______________ 4
ECMO AWARD____________________ 6
Georgia Kids First is published biannually by the Medical College of Georgia Department of Pediatrics and the
Georgia Regents University Office of Communications
NEW SIGNS______________________ 7
and Marketing. Please direct comments or questions to
Editor Christine Hurley Deriso at cderiso@gru.edu or 706-721-2124.
RESEARCH_______________________ 8 CHILDREN’S MIRACLE NETWORK____ 10 PEDS SURGERY PHYSICIANS________ 11
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FALL 2014
GEORGIA KIDS FIRST
FALL 2014 georgia kids first
FACULTY SPOTLIGHT
PEDIATRIC HEART SURGEON EXTOLS ENTHUSIASM, EXPERTISE
Few health conditions have seen a larger pendulum swing in the past generation than congenital heart defects. “The outcome was very poor for children in the past,” said Dr. Anastasios Polimenakos, a pediatric heart surgeon who joined Georgia Regents Heart & Cardiovascular Services in July. “Most did not survive past age 1.” Today, not only do most of these children survive, they thrive – thanks to advances such as those that unfold daily at GRU’s Children’s Hospital of Georgia. “The vast majority of the corrective procedures available today enable patients to go on to lead normal lives,” said Polimenakos, who came to GRU from Geisinger Health Center in Pennsylvania. “It makes me so appreciative for their good health.” Good prenatal care, he stressed, is vital. “Most heart defects are diagnosed in utero,” he said. Upon diagnosis, a highrisk obstetrics team pairs with cardiologists to determine next steps. If the mother is already a GRHealth patient, the process is seamless. But many CHOG patients are referrals, and the team does everything possible to ensure the process goes just as smoothly for them.
Dr. Anastasios Polimenakos
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The most common heart defects, such as hypoplastic left heart syndrome, generally require a single surgery for a veritable clean bill of health. Others, such as transposition of great arteries or extensive vessel abnormalities, can require more complex and potentially long-term treatment. But regardless of the complexity or severity, CHOG patients, their parents, and their referring physicians can rest assured that they are getting the best care possible. “Our specialized team of cardiologists, cardiac surgeons, and the primary care provider follows the child throughout childhood,” Polimenakos said, noting that the CHOG team is as committed as any he has ever worked with. “People here are very motivated and have significant expertise. There’s a lot of enthusiasm about the work we do.” The continuity of care creates bonds that often far outlive the patient’s medical condition. “I often receive cards and updates from former patients and their families,” said Polimenakos, who has two young children himself. “The feedback is incredibly meaningful.”
FACULTY SPOTLIGHT
Homegrown Talent
A shining example of homegrown talent at the Children’s Hospital of Georgia is unleashing initiatives that ideally will prove a game changer in the fight against children’s cancers. Dr. Theodore Johnson conducted research as an MD/PhD student at Georgia Regents University that is adding new dimensions to findings that are revolutionizing cancer treatment. As a student, he worked in the lab of Dr. Andrew Mellor, Director of the GRU Cancer Research Center. Mellor and Dr. David Munn, Professor of Pediatrics, in 1998, published their finding that an enzyme called indoleamine 2,3-dioxygenase, or IDO, signals the immune system to leave a fetus undisturbed, despite the fact that it is a foreign body. The finding led to several clinical trials unfolding on campus capitalizing on their new understanding of how the immune system is turned on or off. They discovered that cancer hijacks IDO to trick the immune system into giving it a pass. Partnering with NewLink Genetics, they have developed small-molecule drugs that inhibit IDO, prompting the immune system to unleash its fury on tumors that inadvertently slipped through its surveillance system. “Our mission is to get these discoveries to patients in Georgia and beyond so they can do some good,” says Munn.
Alumnus Returns to Campus to Battle Children’s Brain Cancer
Dr. Theodore Johnson
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Johnson is overseeing a clinical trial combining the IDO-inhibiting drug, indoximod, with standard chemotherapy to treat glioblastoma, which often can’t be fully removed surgically and almost always returns aggressively. The drug being used in the trial seeks not only to provoke an immune response with few side effects, but to battle the resistance tumors build up against chemotherapy agents. The clinical trial, which began accepting patients in March, is being used on adult glioblastoma patients, but the next step is tailoring the trial for children with the disease. “We’re very hopeful that we can open the trial for children within one to two years,” says Johnson. “This will fulfill my goal of bringing immunotherapy treatment into clinical use for children with cancer.” No place could have better prepared him for this challenge than GRU, he says. “My education and clinical experience here prepared me greatly for the challenges of a subspecialty fellowship,” Johnson says. “When I went to Cincinnati, I felt very well-prepared for that arduous training experience. And from a research perspective, I’d had the opportunity to work on a groundbreaking project – helping develop the IDO science that is ultimately leading to immunotherapy for cancer patients. We’re very excited that this may offer relapsed brain tumor patients the hope for a cure.”
FALL 2014
GEORGIA KIDS FIRST
FALL 2014 georgia kids first
ECMO Receives Nationwide Award
To Elizabeth Peed, the members of the Children’s Hospital of Georgia ECMO team are heroes. “Gates would not be alive if it weren’t for them. The team is not only brilliant, but also completely family-centered,” the Macon, Ga., mother said as she recalled the pediatric specialists who worked to keep her newborn son alive while his tiny body fought off a deadly infection. “I was never shooed away from his bedside. They gave me as much information as possible. They felt like my family, and we were all a part of Team Gates, fighting for his life.” A few hours after his birth, Gates was diagnosed with pneumonia, probably caused by group B strep or listeria. His best chance at survival was to be transferred to Atlanta or Augusta for extracorporeal membrane oxygenation, which routes blood into a roller pump, then pushes the blood through an oxygenator and returns it to the body. The process, temporarily taking over the functions of the heart and lungs, gives the organs a chance to heal. “We chose Augusta,” said Peed. “When we arrived, there were about 25 people there in the NICU working on him. It was his last shot.” Throughout Gates’ run on ECMO, a highly coordinated health care team provided
“Gates would not be alive if it weren’t for them. The team is not only brilliant, but also completely family-centered.” –Elizabeth Peed
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round-the-clock care. They were amazed at how quickly he improved. “Originally, they said it might be a 21-day ECMO run,” said Peed. “But Gates only had a six-day run. He just started getting better. He’s a miracle baby.” Gates is one of many CHOG patients whose lives have been saved by ECMO. In July, the program received its fifth consecutive Award for Excellence in Life Support from the Extracorporeal Life Support Organization. The award is recognized by U.S. News and World Report and Parents as a criterion for top pediatric hospitals. “I am so proud to work alongside such an amazing group of nurses, respiratory therapists, and physicians that make up our ECMO team. This award clearly demonstrates a dedication to excellence and a commitment to patients and their families that each member brings to the table,” said Linda J. Wise, Coordinator of ECMO and Neonatal Transport at CHOG. “Together, we have saved many young lives.” CHOG has treated 499 patients with ECMO since introducing it in the Southeast in 1985. Gates, who turned 1 in April, was patient number 465.
YOUNG PATIENTS “SIGN OFF” ON NEW MONIKERS
The Children’s Hospital of Georgia recently received a little help with some big signs as patients got a first look at new monikers going up at the area’s only children’s hospital. The kids gave the colorful logo and artwork a thumbs-up, and parents also were excited to see the name and brand posted. The pieces installed on the building facade include the traditional childlike “banana man” symbol, a large street
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number, and the hospital name/logo. Oversized graphics and illumination will make wayfinding easier for patients and guests. Opened in 1998, the 154bed Children’s Hospital of Georgia is the state’s second largest children’s hospital. Features include a 24-hour emergency room and the highest-level neonatal and pediatric intensive care units.
FALL 2014
GEORGIA KIDS FIRST
FALL 2014 georgia kids first
RESEARCH
Study Links Sodium Consumption with Obesity, Inflammation
The typical daily sodium consumption of U.S. adolescents – in some cases more than twice the recommended daily allowance – correlates with obesity and inflammation, regardless of calorie intake, researchers report. In a study of 766 healthy teens, 97 percent self-reported exceeding the American Heart Association’s recommendation of consuming less than 1,500 milligrams of sodium daily, according to a study in the journal Pediatrics. “The majority of studies show the more food you eat, the more salt you consume, the fatter you are,” said Dr. Haidong Zhu, a molecular geneticist at the Medical College of Georgia. “Our study adjusted for what these young people ate and drank, and there was still a correlation between salt intake and obesity.” These high-sodium consumers also had high levels of tumor necrosis factor alpha, which is secreted by immune cells and contributes to chronic inflammation as well as autoimmune diseases such as lupus and arthritis. Additionally, the adolescents had high levels of leptin, a hormone produced by fat cells that normally suppresses appetite and burns fat, but at chronically high levels can have the opposite effects. “Losing weight is difficult, but hopefully more people can be successful at reducing their
Dr. Haidong Zhu
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sodium intake,” said Zhu, the study’s corresponding author. “We hope these findings will reinforce for parents and pediatricians alike that daily decisions about how much salt children consume can set the stage for fatness, chronic inflammation, and a host of associated diseases like hypertension and diabetes,” said study co-author Dr. Gregory Harshfield, Director of GRU’s Georgia Prevention Institute. High sodium intake has been linked to higher weight, possibly because of increased water retention. While the new study does not prove a causal effect, it contributes to mounting evidence that high sodium could be a direct cause of obesity and inflammation, Zhu and her colleagues report. Longitudinal or randomized clinical trials are needed to clarify the relationships, the researchers said. “Obesity has a lot of contributing factors, including physical inactivity,” Zhu said. “We think that high sodium intake could be one of those factors.” Evidence suggests one direct cause may be increasing the size of fat cells. The study was supported by the National Heart, Lung and Blood Institute.
RESEARCH
Researchers Tackle Sickle Cell Double Whammy
Low levels of oxygen and nitric oxide appear to have an unfortunate synergy in sickle cell disease, Georgia Regents University researchers report. Their studies indicate that both factors dramatically increase red blood cells’ adhesion to the lining of blood vessel walls (the defining characteristic of the disease) and the debilitating pain crises that can result. The good news is that restoring normal levels of nitric oxide can substantially reduce red blood cell adhesion, said Dr. Tohru Ikuta, a molecular hematologist at GRU’s Medical College of Georgia. Ikuta and Dr. C. Alvin Head, former Chairman of MCG’s Department of Anesthesiology and Perioperative Medicine, were co-corresponding authors of the study in the journal Blood.
The study also points to a potentially new therapeutic target, the self-adhesion molecule P-selectin, which the researchers found plays a central role in increased red blood cell adhesion. Low levels of oxygen and nitric oxide both increase expression of P-selectin. Nitric oxide therapy likely would benefit only patients with intermittent or chronically low levels, Ikuta said. “The answer is that some patients may not need this. And, our studies indicate that there is no therapeutic benefit to increasing levels beyond physiologic levels.” The studies were funded in part by the National Institutes of Health.
Dr. Tohru Ikuta
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FALL 2014
GEORGIA KIDS FIRST
FALL 2014 georgia kids first
CMN Celebration Raises $906,000 for CHOG The 2014 Children’s Miracle Network Hospitals Celebration raised approximately $906,000 for the Children’s Hospital of Georgia. The celebration, which aired locally on WRDW-TV News 12 June 1, is a culmination of yearlong fundraisers and campaigns for CMN Hospitals, including CHOG. As a not-for-profit hospital, CHOG relies on community support to enhance services for patients and families. CHOG has been a CMN Hospitals beneficiary since 1986. In other CMN news, the local Clear Channel radio stations WBBQ 104.3 and KISS 96.3 FM have been named co-recipients of its 2013 Radio Station of the Year Award. The stations have raised more than $2.8 million since 2001 for CHOG through the annual Cares for Kids Radiothon, a CMN Hospital fundraiser. “We are honored to be recognized with the award,” said Ivy Elam, Market President for Clear Channel Media and Entertainment Augusta. “This award is a testament to the generosity of Augusta
The 14th Annual Cares for Kids Radiothon will be broadcast live from the Children’s Hospital of Georgia lobby Dec. 4-6. To make a pledge, call 706-922-KIDS (5437) or 1-866-412-KIDS (5437), visit caresforkidsradiothon.com.
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residents. Our listeners don’t sit on the sidelines; they take action to support the critical mission of the Children’s Hospital of Georgia and many other charitable initiatives. We are proud to connect our giving audience to the incredibly talented and dedicated individuals providing critical care to local children.” Jodi Carson (Koontz) of the syndicated show “Murphy, Sam and Jodi In the Morning,” was named Radio Personality of the Year. She and her co-hosts travel to Augusta each December to host the radiothon. “The Children’s Miracle Network has changed my life through radiothon,” said Carson. “It has taught me what’s truly important in our work, and, mainly, what’s not. In my opinion, CMN is the most important children’s charity in our country. Because I hold this group in such high regard, I am truly honored to have been recognized by them. I hope to continue for many years telling these stories of how we can all make things better for children.”
CHOG PEDIATRIC SURGERY PHYSICIAN CONSULTATION
Pediatric Cardiothoracic Surgery
Pediatric Plastic and Craniofacial Surgery
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Anastasios C. Polimenakos, MD
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Pediatric General and Thoracic Surgery
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S. Dion Macomson, MD
Charles G. Howell, MD Robyn M. Hatley, MD
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Walter Pipkin, MD
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K. Christian Walters, MD
Todd Merchen, MD
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David Cearley, MD
Durwood E. Neal, Jr., MD
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Introducing a new physician referral tool making it simple for you and your patients–
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Pediatric Otolaryngology 706-721-6387 George F. Harris IV, MD Charles A. Hughes, MD
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FALL 2014
GEORGIA KIDS FIRST
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