WMC - Advances in Pediatrics 2011

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MARIA FARERI CHILDREN’S HOSPITAL AT WESTCHESTER MEDICAL CENTER

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BRAIN SURGERY

‘heart’ kids LIVING LONGER

2 W e lco m e 3 the hub of children’s healthcare

4 a h a p py p l ac e to heal

6 t r e at i n g

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8 b r a i n s u r g e ry,

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This special supplement to Westchester Health & Life magazine profiles the region’s centerpiece for children’s healthcare: Maria Fareri Children’s Hospital at Westchester Medical Center.

Maria Fareri Children’s Hospital is the advanced care pediatric facility for Westchester and the Hudson Valley. This means that its doctors, nurses and scores of other pediatric specialists care for the most critically ill and injured kids. The hospital has experts in every children’s healthcare specialty.

In this supplement, you will learn how Maria Fareri Children’s Hospital’s pediatric neurosurgeons are pioneering minimally invasive procedures that have children home just days after surgery; how the hospital’s pediatric cardiology program is helping kids with chronic conditions live longer and more productive lives; and how a new leader with a new vision is planning to turn Maria Fareri Children’s Hospital into an international destination for children’s cancer care.

But that’s only half the story. Maria Fareri Children’s Hospital was built with the goal of getting the whole family feeling better.

That’s why the hospital operates under a family-centered care philosophy. This healing environment and why it is so good for even the youngest patients is discussed in this supplement as well.

For more information about Maria Fareri Children’s Hospital at Westchester Medical Center, visit www.WorldClassMedicine.com/ MFCH and while you’re there, take a video tour of the hospital.

We’re confident you will be impressed.

any other

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crohn’s disease

Advances in Pediatrics is published by Wainscot Media, Montvale, NJ. © 2011.

All rights reserved.

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Michael D. Israel President & CEO Westchester Medical Center

Michael Gewitz, M.D. Physician-in-Chief Maria Fareri Children’s Hospital Westchester Medical Center

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Throughou t N ew Yo r k ’ s Hudson Valley region and Fairfield County, Connecticut, you’ll find several community

The hub of

hospitals equipped to treat local children who become ill or injured. But only Maria Fareri Children’s Hospital at Westchester Medical Center has the expertise and advanced technology to handle the most serious childhood illnesses and accidents.

Since opening in September 2004, Maria Fareri Children’s Hospital has treated more than 100,000 children.

As the “hub” of the region’s system of pediatric care, the hospital maintains the highest standards and accreditation.

“We are staffed with specialists in just about every pediatric subspecialty, so we can handle the most complex cases,” says Michael Gewitz, M.D., Physician-inChief. These specialties include pediatric trauma and minimally invasive surgery, cardiology, oncology, anesthesiology, transplantation and neuroscience. (There are only 200 fellowship-trained pediatric neurosurgeons in the United States, and two of them work at Maria Fareri Children’s Hospital.)

The hospital provides the only pediatric intensive care unit in the Hudson Valley, and its Regional Neonatal Intensive Care unit is designated a Level IV unit by New York State, meaning it can care for the region’s tiniest and sickest newborns, who are transferred from local community hospitals. These units, along with Maria Fareri Children’s Hospital’s pediatric emergency department, are staffed with physicians, nurses and other specialists trained specifically for children’s care.

The inspiration for the hospital is due in large part to one family, the Fareris of Greenwich, Connecticut.

When their 13-year-old daughter, Maria, died of rabies in 1995, John and Brenda Fareri vowed to honor Maria’s wish for “the health and well being of all the children in the world.”

Although Westchester Medical Center,

Maria Fareri Children’s Hospital’s goal is to get the whole family feeling better

which had a thriving pediatric tertiary care program since 1983, was already working toward building a world-class children’s hospital for the Hudson Valley, “it took the Fareris, and their devotion, to be the catalyst for making that a reality,” says Dr. Gewitz.

But Maria’s family envisioned more than just the highest level of medical care. “We wanted a new philosophy of health care, which treated the child and the entire family,” says John. The medical expertise was already in place, and the Fareris helped drive the physical and philosophical changes to create

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a more family-centered facility. These changes include child-friendly décor and family-focused support services.

“Ample evidence shows that when the whole family is involved in care and understands the problem, it increases the effectiveness of the child’s treatment,” says Dr. Gewitz.

The doctor adds that the response from patients and their families has “exceeded our expectations. Our objective over the next few years is to achieve continued growth to better accommodate the needs of children and their families from the region.”

www.World Class Medicine.com/ MFCH

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a happy place to heal If you want to know the mission of Maria Fareri Children’s Hospital at Westchester Medical Center, just take a walk around. From the colorful hallways and saltwater aquariums to the performing arts stage and History of New York Baseball Museum, the facility is designed to make kids and their families feel at home.

“Having a positive attitude in the face of challenging health issues is critical for healing,” says Michael Gewitz, M.D., Physician in Chief. “The child-friendly design helps put our patients at ease, which can make them better able to receive treatments—even

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those that are painful.”

The hospital, which opened in 2004, was designed with direct input from a committee of young patients and their families, who roamed the former pediatric floors within the general hospital with cameras and notepads noting how certain features could be improved. As a result, changes big and small were put in place—from creating “satellite” nursing stations for every two rooms to lowering desk levels so kids could see over them. “The hospital also has an open layout, which encourages interaction,” Dr. Gewitz says.

Since many sick children require

Maria Fareri Children’s Hospital was designed with youngsters— and their families— in mind

overnight stays—sometimes for weeks or months at a time—the inpatient floor is divided into themed neighborhoods. The lounge of the “Heroes” neighborhood, for instance, is painted to depict the inside of a fire station and contains a real fire truck cab that patients can play in.

Hospital rooms are all single occupancy with bathrooms, showers, sleeping areas for parents and other special features. “There are sconces by the parents’ bed so they can read while the child sleeps, and plenty of storage space,” says Tricia Hiller, Director of Child Life and Creative Arts Therapy. “If

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we can get parents to relax, it benefits the children.”

The hospital also has two playrooms, an art studio and a music studio with instruments and recording equipment. In addition to having access to a variety of toys and games, patients are allowed to play with medical equipment (some real, some toy-like) during special Monday morning clinics.

“By observing the children play, we can assess how well they understand what is happening to them,” says Hiller.

Hiller and her staff also use play to help prepare patients for upcoming tests and procedures. “We meet with the entire family and use pictures and age-appropriate terminology to explain things like surgery, imaging scans and blood work,” she says. Youngsters can even perform “surgery” on dolls, such as adding tubes and drains and changing bandages, to mimic their own experiences. “Research shows that the more hands-on kids can be in their medical treatment, the more compliant they’ll be,” Hiller adds. “If they can touch the equipment, it’s less scary.”

Older children can enjoy more mature activities such as poetry writing and music writing and recording. The Lion’s Den, funded by hockey star Pat LaFontaine’s Companions in Courage Foundation, offers multiple Xbox consoles, a video conference pod and computers with Internet access. Every Thursday evening, patients are invited to play the popular video game “Rock Band.”

Holidays and special events are also celebrated at the hospital. Patients can go trick or treating through the halls on Halloween, paint eggs for Easter, create Valentine’s Day cards on February 14 and make edible menorahs on Hanukkah.

And it isn’t uncommon to find performances by singers, dancers, musicians and celebrities in the lobby, which are broadcast on closed-circuit television for those patients who aren’t able to watch in person. “I made

pancakes one morning for the kids with the CEO of IHOP,” says Dr. Gewitz.

Pediatric patients and their family members and friends are welcome to visit the Family Resource Center, which offers comfortable seating, a large selection of books (in both English and Spanish) and a business center with five computers. “Parents can come here just for some respite, or to request whatever help they might need,” says Mary Delaney, Director of Family Support and the Family Resource Center. “Our mission is to lighten their load.” That can include talking with a social worker, child life specialist or therapist, joining a support group or asking a volunteer for help with laundry.

“We spent every day and night in the center—it was like our living room,” says Rockland County resident Aideen.

Her son, Kevin, spent 118 days in the Isaac and Naomi Kaplan Family Regional Neonatal Intensive Care Unit after being born at just 24 weeks gestation in December 2009. “Our extended family could

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drop off meals, and we could charge our cell phones and use the computers.

It was a quiet place to cry, collect our thoughts—or just eat a sandwich.”

Another exciting development at the hospital this year is the opening of the new 15,500-sq.-ft. Ronald McDonald House of the Greater Hudson Valley, located just steps away from the hospital’s front door. The facility provides affordable temporary housing for families of seriously ill and injured children being treated at the hospital who live far away.

“If children and their families have to come back to the hospital for additional treatments, we find they don’t necessarily dread returning, in part because of everything we offer,” adds Dr. Gewitz.

Maria Fareri Children’s Hospital at Westchester Medical Center boasts many kidfriendly features to help put children at ease, including large saltwater aquariums (left and below) and themed patient “neighborhoods” such as Heroes (opposite, top), with a real fire truck cab. An outdoor teddy bear statue (opposite) greets patients as they arrive at the hospital.

www.World Class Medicine.com/ MFCH

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A hospital leads the fight against cancer and similar disorders m a r i a Fa r e r i children’s h o s p i Ta l at Westchester Medical Center is already the premier children’s cancer and blood disorder center in the Hudson Valley region. Now, under the direction of a new department head, the hospital aspires to become one of the top care and research facilities in the country for life-threatening illnesses such as leukemia, lymphoma and sickle cell anemia.

Mitchell Cairo, M.D., Chief of Pediatric Hematology, Oncology and Stem Cell Transplantation, came to the hospital from Morgan Stanley Children’s Hospital in New York City, bringing with him 15 of his researchers and support staff and millions of dollars in research grants from national foundations.

His vision for Maria Fareri Children’s Hospital includes the development of a new Children and Adolescent Cancer and Blood Disease Center, and the opening of a new clinical laboratory this summer called the Stem and Cellular Therapy and Engineering Laboratory.

The lab’s research will

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focus on moving Dr. Cairo’s team’s ideas “from the bench to the bedside,” meaning the doctor can take what he discovers and create practical, bedside treatments for patients at the hospital.

“There will be no other lab like this in the area,” he says.

For now, the team is working from an existing lab at the hospital, and is already making strides in cell treatments that introduce reengineered cells to take the place of damaged or diseased ones. Particular progress has been made in the fight against sickle cell anemia, a lifelong, genetic disease that affects 70,000 to 100,000 people in the United States, mainly African Americans.

While normal red blood cells are disc-shaped and move easily through the blood vessels, patients suffering from sickle cell anemia have sickleshaped red blood cells. These sickle cells contain abnormal hemoglobin and are stiff and sticky and tend to block blood flow in the vessels of the limbs and organs.

Normal cells live about 120 days in the bloodstream and then die, while sickle cells usually die after only about 10 to 20 days. A sickle cell patient’s bone marrow can’t make new red blood cells fast enough to replace the dying ones, which causes the number of red blood cells to be low—the definition of anemia. These patients often face a shorter life expectancy and experience chronic pain, fatigue, organ damage, strokes and a life-threatening respiratory problem known as acute chest syndrome. The disease also destroys the spleen, which impairs the body’s immune system and makes youngsters extremely vulnerable to serious bacterial infections.

Standard treatment calls for ablating, or suppressing, the bone marrow, then transplanting healthy marrow from a sibling who is found

to be a donor match. “Ablating is the most risky and difficult part of the traditional procedure,” mitchell cairo, m.d.

Dr. Cairo says.

But a new procedure the doctor is pioneering, called reduced intensity conditioning, eliminates the need for ablation. It works by using immunotherapy (medications and antibodies to suppress the immune system) and chemotherapy to “condition” the existing bone marrow.

Dr. Cairo recently reported a 100 percent success rate in a small study of 10 sickle cell anemia patients who received treatment prior to a bone marrow transplant from a sibling. And the treatment greatly reduced the side effects of the transplant. “A standard treatment is a 10 on the ablation scale, but this reduced intensity conditioning approach is a 3 or 4,” Dr. Cairo says.

“These are very exciting results.”

While this has been wildly successful for patients with a sibling donor, only 15 percent of children with sickle cell anemia have a sibling tissue match. For the 85 percent who don’t, Dr. Cairo is currently testing two other treatment methods. One involves re-engineering the mother’s bone marrow cells by removing T cells, which are part of the immune system and can lead to transplant complications, before transplantation.

His researchers are also studying skin and bone marrow cells taken from the patients themselves, removing the abnormal sickle cell gene and recreating healthy bone marrow cells for transplantation.

Because of these promising results, Dr. Cairo looks forward to continuing translating stem and cellular therapy at the new laboratory.

“The opportunity here at Westchester Medical Center is fantastic,” he says.

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Sickle cell anemia: THE FACTS  it’s most prevalent in people

whose ancestors are from africa, south or central america (especially panama), the caribbean islands, mediterranean countries, india and saudi arabia.

 The disease affects

approximately 70,000 to 100,000 people in the united states.

 The disease occurs in about 1 out of every 500 african american births, and more than 1 out of every 36,000 hispanic american births.

 more than 2 million americans have the sickle cell trait, meaning they carry one but not both of the genes that cause sickle cell anemia.

SOURCE: NATIONAL HEART, LUNG AND BLOOD INSTITUTE

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surgery—

improved

Advanced pediatric neurosurgery techniques put two little girls on the road to recovery The prospect of brain surgery is daunting, but it’s especially frightening when the patient is a child. Fortunately, the pediatric neurosurgeons of Maria Fareri Children’s Hospital at Westchester Medical Center are equipped to successfully treat the youngest and smallest patients using the latest technology—including minimally invasive techniques that can help with surgery, and sometimes eliminate the need for open surgery.

Kathy and Joe Paolo of Milton, N.Y., credit the hospital’s neurosurgeons for saving their daughter Charlotte’s life.

Although Charlotte, born last August, had been a happy, healthy baby, she became lethargic and irritable at the end of December.

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“She was tugging at her ear, so we thought it was an ear infection,” recalls Kathy, a nurse staying home to raise her four children. Kathy and Joe, a chief compliance officer at a financial service firm, took the baby to the pediatrician to check out the problem. Measurements showed that Charlotte’s head had grown 2 inches in one month, and a sonogram found fluid on her brain and an unusual mass. “We packed the other kids off to friends and took Charlotte to Maria Fareri Children’s Hospital,” Kathy says.

“We were very scared.”

At the hospital they were told that Charlotte had a benign brain tumor that produces abnormal amounts of cerebrospinal fluid. “These are vascular

tumors so they can bleed a lot, which is dangerous in a child so young,” explains Michael E. Tobias, M.D., Co-Chief of Pediatric Neurosurgery.

“One thing we can do here that most children’s hospitals can’t is interventional procedures with cerebral angiography,” Dr. Tobias says.

Much like an angiogram of the heart, interventional neurosurgeons can thread a small catheter through the arteries in the groin to the brain. Through the catheter they can inject dye to take detailed images of the vessels in the brain so they can visualize the blood supply to the lesion and plan the safest surgery. In some cases, they can use special glues to embolize, or stop blood flow, to the lesion.

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Avinash Mohan, M.D.

Michael Stiefel, M.D.

Embolization procedures can be very helpful in decreasing the blood flow to the lesion, and thus minimize blood loss during surgery. “Blood loss is the most dangerous part of operating on pediatric patients,” says Dr. Tobias Michael Stiefel, M.D., Director of Cerebrovascular and Endovascular Neurosurgery, performed an angiogram to embolize Charlotte’s tumor. “This is one of the youngest patients to have an angiogram and embolization for a type of tumor called a choroid plexus papilloma,” Dr. Tobias says. After the angiogram and embolization, Dr. Tobias and Avinash Mohan, M.D., Co-Chief of Pediatric Neurosurgery, successfully removed the tumor. (Drs. Tobias and Mohan are two of only about 200 fellowshiptrained pediatric neurosurgeons in the country.) “She did great and lost very little blood,” Dr. Tobias says.

“Charlotte is back to her normal, happy self,” Kathy says. Though she needs physical therapy for weakness on her right side, she’s making appropriate babbling sounds and learning to sit up— right on schedule. “This will just be a crazy story to tell her kids someday.”

A similar thing happened to fiveyear-old Kaitlyn Wayne, who lives in Orange County. Her father, Jason, a major in the U.S. Army working at West Point, first noticed something was wrong while giving Kaitlyn a bath last November.

“I was washing her hair, and she said, ‘Daddy, my hand doesn’t work,’”

Michael E. Tobias, M.D.

says Jason. “I thought she was playing a game, but I asked her to do things and she couldn’t.”

Her right hand was limp from the wrist to the fingertips.

Jason and his wife Kerry, who also have 20-month-old twins, rushed Kaitlyn to Keller Army Community Hospital at West Point, where she had a seizure then passed out. Her entire right side—arm, leg, face—sagged. “It was incredibly scary,” says Jason.

After an MRI showed a blood clot in her brain, Kaitlyn was taken by ambulance to Maria Fareri Children’s Hospital, the only hospital in the region equipped to handle pediatric neurosurgery. Here the Waynes met with Dr. Tobias, and testing showed Kaitlyn suffered from an arteriovenous malformation (AVM), an abnormal connection between arteries and veins in the brain that is prone to rupturing.

Dr. Stiefel then performed an angiogram. His pictures defined the AVM, but also showed that its location and configuration made it unsafe to embolize. In the end, it was decided that open surgery would be the best treatment for Kaitlyn. “As a team, we went over the angiogram together and decided it was safest to take Kaitlyn to the operating room to surgically remove the AVM,” says Dr. Tobias, who completed the surgery with Dr. Mohan.

“It took several hours, which seemed like forever,” says Kerry. “But

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Now healthy and thriving, five-year-old Kaitlyn Wayne (above) underwent surgery last year for an arteriovenous malformation (AVM), a serious neurological condition. She was successfully treated by pediatric neurosurgeons at Maria Fareri Children’s Hospital.

Kaitlyn was walking and talking the next day.” She even enjoyed a visit from the Radio City Music Hall Rockettes, who stopped by her room during a goodwill tour of the hospital.

Kerry and Jason stayed in Kaitlyn’s room in the Arlene and Arnold Goldstein Pediatric Intensive Care Unit for two weeks as their daughter recovered.

Although Kaitlyn is still in physical and occupational therapy for some weakness in her right hand, “she’s doing great now,” says Kerry.

Kaitlyn and Charlotte’s results would not have been possible at most hospitals, says Dr. Tobias. “Only a large academic medical center with the most advanced equipment and all the subspecialties of pediatric surgical care can handle these cases.”

www.World Class Medicine.com/ MFCH

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When

young

hearts

grow up Patients with congenital defects need continued care as they reach adulthood

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o n ly a F e W d e cades ago, a child born with a heart defect either died in infancy or failed to live past their early childhood. Today, however, advances in treatment mean that most children can and do live long, active lives.

While that’s very good news, it has created a challenge for doctors: what to do once patients are too old to be treated exclusively by a pediatric heart specialist. While some patients need only occasional checkups throughout adulthood, those with complex heart defects need long-term, specialized care to maintain a good quality of life.

Maria Fareri Children’s Hospital at Westchester Medical Center is taking the lead in our region by creating programs to help transition these patients into adult care.

Under the direction of Michael Gewitz, M.D., Physician-in-Chief and Chief of Pediatric Cardiology and Dr. Markus Erb, Senior Pediatric Cardiologist, the programs are designed to train adult-care physicians about these patients’ special needs and to coordinate care with other specialists. “We need a system of care that enables these now-adults and near-adults to continue lifelong treatment with

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WHAT YOU SHOULD KNOW ABOUT

heart defects

doctors who have expertise in their problems,” says Dr. Gewitz.

“There are about 2 million adults in the United States who have survived childhood with congenital heart defects,” says Dr. Gewitz, who is also the national chairperson of the Council of Cardiovascular Disease in the Young, a scientific council of the American Heart Association.

Congenital heart defects are structural problems present at birth that affect 8 out of every 1,000 newborns. They can alter the normal flow of blood through the heart, and can involve the interior walls of the heart, the valves, or the arteries and veins that carry blood to the heart or out from the heart to the body.

Some defects are simple, producing no symptoms, while others are more serious and even life threatening.

For example, some defects leave babies with just one of the two ventricles, the main pumping chambers of the heart. “These patients need a series of operations in infancy and early childhood, but they can live successfully after having started with basically half a heart,” says Dr. Gewitz. However, doctors are learning that complex defects of this type can impair future development of other organs and systems. “For

example, some patients can develop problems with michael gewitz, m.d. their liver as they move into young adult life,” he says. “Some develop neurological problems, such as learning disabilities and seizures as they grow up. Heart defects, even after treatment, can sometimes affect their ability to exercise, and can affect a woman’s ability to have healthy children of her own. We are only now beginning to understand these connections.”

For this reason, the hospital educates trainees in its adult cardiology program. “It’s a matter of educating doctors in other adult disciplines, because they’ll need to know about the patients who will be coming their way,” says Dr. Gewitz. The program is hosting a symposium this fall to further educate doctors from the Hudson Valley about this growing health issue. Dr. Gewitz says that national criteria are being developed for this field, and within the next three years or so, specialized training will lead to certification in the specialty of Adult Congenital Heart Disease.

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if you—or your child—were born with a heart defect, the surgery used to correct the problem was not necessarily “a cure,” according to the national heart, lung and blood institute. you still need regular follow up as an adult to maintain good health. here are tips from the institute: LEARN YOUR MEDICAL HISTORY some adults might not fully understand what kind of heart defect they had (or still have) or how it was repaired. be sure to talk to your physician and discuss any medicines you are currently taking.

ASK WHETHER YOU NEED ANTIBIOTICS in a few situations, people who have congenital heart defects need antibiotics before medical or dental procedures that might allow bacteria into the bloodstream.

CHOOSE THE BEST BIRTH CONTROL many women who have heart defects can safely use most methods of birth control. however, some women should avoid birth control pills or intrauterine devices (iuds). ask your doctor.

DISCUSS PREGNANCY CONCERNS many women who have simple heart defects can have a normal pregnancy and delivery, however some women may be at higher risk of having babies who themselves can have congenital heart defects. Talk to your doctor about whether to have fetal echocardiography (echo), which uses sound waves to create images of the baby’s heart, and genetic counseling.

SOURCE: NATIONAL HEART, LUNG AND BLOOD INSTITUTE

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2 ICUs unlike

any other These units support patients— and their families

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l a s T a u g u s T, J u l i e s T o i l Fernandez received a dreaded phone call. Her 11-year-old daughter, Sasha, had fallen off a zip line in the backyard of a friend’s house.

Sasha was rushed to Maria Fareri Children’s Hospital at Westchester Medical Center, where she spent five days in the Arlene and Arnold Goldstein Pediatric Intensive Care Unit (PICU) recovering from a concussion, broken ribs and a collapsed lung. Maria Fareri Children’s Hospital’s pediatric intensive care

unit is the only one of its kind in the Hudson Valley.

Julie, who lives in Brooklyn, feels fortunate that the injury happened in Westchester County. “There is no place like Maria Fareri Children’s Hospital where I live,” she says. “As a mental health lawyer I work in a lot of hospitals, and this is far and away the best place around for kids.”

Part of what distinguishes Maria Fareri Children’s Hospital is its stateof-the-art technology: It is the only pediatric facility in the region—and

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one of only a few in New York State—that provides extracorporeal membrane oxygenation, or ECMO, an organ bypass machine that does the work of a child’s heart and lungs for a time so those organs can recover their function.

Along with the PICU, Maria Fareri Children’s Hospital is home to the Isaac and Naomi Kaplan Family Regional Neonatal Intensive Care Unit (RNICU), the only Level IV neonatal unit of its kind in the Hudson Valley.

This means it can care for the tiniest and sickest newborns.

“About 700 babies are admitted to our RNICU every year, each with a rare and unusual illness or disorder,” says Edmund F. La Gamma, M.D., Chief of Newborn Medicine.

Advanced technology used in this unit includes the Cool Cap,TM which helps reduce the risk of permanent neurological injury when the brain is deprived of oxygen by circulating cold water around a baby’s head to cool and slow down brain function.

The RNICU also has special ventilators to keep tiny preemies breathing without damaging their under-formed lungs, and sophisticated incubators that warm infants weighing less than 1 pound without causing water loss and dehydration.

The PICU and RNICU (part of the Medical Center’s NYS Department of Health-designated Regional Perinatal Center), which form the center of the region’s spoke-and-hub network of pediatric care, accept both local kids and transferred patients from upstate New York, Long Island and Connecticut.

Even with such a high acuity rate, “of all the patients we treat in the PICU, 98 percent of them survive,” says Carey S. Goltzman, M.D., Chief of Pediatric Critical Care Medicine.

The two units also strive to make families feel comfortable. Sasha’s mom, Julie, says she is grateful for the

support she received while her child was in the PICU. “I was overwhelmed by the magnificence of the facility and the attentiveness of the entire staff,” she says.

Julie remembers one crucial conversation she had with Sasha’s doctor, which helped her make a difficult decision. Because Sasha’s collapsed lung was of great concern, the doctor discussed re-inflating the lung artificially, but said the procedure would be extremely painful. “He told me, ‘I am a parent, and if this were my child, I would not try it right now because the lung often comes back on its own,’” Julie says. “I was so grateful for his honesty and took his advice.”

Sasha’s lung function did return, and she improved daily and is fully recovered. Julie never left her daughter’s side. “I was able to sleep with her in the PICU, and the staff took care of both of us,” she says. “I had no clothes with me, so they got me clean underwear. There was food on site. It was all so simple; I never

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Edmund F. La Gamma, M.D.

Carey S. Goltzman, M.D.

had to leave her.”

Dr. Goltzman says the familycentered nature of the hospital was the goal of its founding benefactors, Brenda and John Fareri. Their 13-yearold daughter, Maria, was cared for at Westchester Medical Center in 1995.

“I took care of Maria at the time and had to deliver difficult news to her parents in the middle of a hallway,” the doctor remembers. “There were no private rooms, no place for parents to stay. Through their efforts, the Fareris have helped make the hospital a home away from home for these families.”

Below, Sejal Parikh, R.N. Opposite page, Edmund F. La Gamma, M.D., Chief of Newborn Medicine, cares for an infant being treated at the RNICU.

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Reaching new heights Synthetic hormones promote growth in kids of short stature

BEING VERTICALLY CHALLENGED might not be the most serious health condition a kid could have, but that doesn’t mean it isn’t important—especially to the child who is last to be chosen for sports or is made fun of at school. Richard A. Noto, M.D., Chief of Pediatric Endocrinology at Maria Fareri Richard A. Noto, M.D. Children’s Hospital at Westchester Medical Center, knows firsthand. “I was the shortest kid in the class, and I am now only 5’4”. I played high school football but was always told I was too short to play,” he says.

Nearly 2 million children are considered short in our country, which is defined as being in the third percentile or lower for height, but only 20 percent are referred to a specialist. Because growth potential deals with hormones, endocrinologists—doctors who treat conditions related to hormones and internal system regulation— handle these cases. (Endocrinologists also help children manage

diabetes and other disorders.) Most endocrinologists will consider kids below the fifth percentile for height evaluations, Dr. Noto says.

How can a parent know if his or her child is growing properly?

“Between the ages of 3 and adolescence, a child should grow 2 inches a year,” Dr. Noto says. Those growth charts your pediatrician fills out at every visit tell the story most clearly.

Doctors can determine predicted adult height with an X-ray of the hand called the “bone age.” Blood tests for hormone levels and genetic evaluations of growth-related chromosomes are also employed to diagnose the problem.

“Twenty years ago, growth hormone was derived from the pituitary gland,” Dr. Noto says. “The supply was very limited, and it was only approved for the very smallest kids.” Now, synthetic growth hormone can be used on any abnormally small child.

In addition to children who are growth-hormone deficient, synthetic growth hormone is approved for kids who are small as a result of genetics or whose growth is stunted for medical reasons.

Smaller patients, smaller surgeries Minimally invasive procedures aren’t just for adults

Pediatric surgeon Whitney McBride, M.D., plays with his young patient, Xzavier Hodge, post surgery.

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T H E T H O U G H T O F A N I N FA N T N E E D I N G SURGERY IS enough to send parents into a panic. But Maria Fareri Children’s Hospital at Westchester Medical Center has been at the forefront of pediatric surgery for many years. “Since 1994, we have performed many of the first minimally invasive surgeries on children in the region,” says Gustavo Stringel, M.D., Chief of Pediatric Surgery and Surgeon in Chief.

Minimally invasive procedures in the abdomen (called laparoscopy) and chest cavity (thoracoscopy) involve smaller incisions than with traditional open surgery. “We can operate through holes between 2 millimeters and 10

advances in

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millimeters,” he says. Most are done at 5 millimeters— about a quarter of an inch—or Gustavo Stringel, M.D. smaller, the doctor adds.

And that can make a big difference, especially when Dr. Stringel is operating on a newborn or infant. “The benefits are not just cosmetic,” he says. “It also results in shorter recovery time, less time in the hospital, less pain, less blood loss and less risk of complications, such as infection.”

These procedures have been driven both by new technologies and improved surgical skills, says Dr. Stringel, who is the immediate past president of the Society of Laparoendoscopic Surgeons. “When we started doing this, we had to use adult-sized instruments,” he says.

“Now we have instruments designed for smaller bodies.” In addition, the cameras and monitors are much improved, with high definition and extreme magnification. “We can see these small structures much better— in fact, better than with the naked eye,” he says.

Almost any surgery can be done with this technique, including stomach surgery to correct acid reflux, chest surgery to repair heart and lung disorders and the removal of tumors in the abdomen and chest.

“Appendectomies are now almost 100 percent minimally invasive, even complicated perforated appendicitis,” the doctor adds.

Minimally invasive procedures can even be done on premature babies. “We are getting better and better at these types of surgeries, and there is more of a demand for them,” Dr. Stringel says. “How far can we go with this? The sky is the limit.”

Relief for

Crohn’s disease As this intestinal disorder affects more children, doctors are finding better ways to diagnose and treat it Some illnesses continue to baffle the medical community, and Crohn’s disease, a chronic disorder Stuart Berezin, M.D. that causes inflammation of the gastrointestinal (GI) tract, is one of them. The trouble is it’s difficult to diagnose and treat, and doctors still aren’t sure what causes it. Moreover, the disease seems to be affecting more children than in the past.

“We have seen a dramatic increase in the number of young patients with the disease,” says Stuart Berezin, M.D., Chief of Pediatric Gastroenterology at Maria Fareri Children’s Hospital at Westchester Medical Center. “And no one knows why.” While Crohn’s disease most commonly begins in teenagers, “we are seeing more children in the 3 to 5 age range,” he adds. “We even see kids not yet 1 year old. It’s just unbelievable.”

Dr. Berezin explains that the increased number of cases is partly due to advances in diagnosing the disease. (In the past, it was harder to diagnose due to its similarities to inflammatory bowel diseases.)

Endoscopy, which involves sending a scope into the GI tract, is much more sophisticated today, he says, allowing for better pictures of the digestive

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tissue and the ability to biopsy the site. The hospital’s gastroenterologists also use capsule endoscopy, in which the patient swallows a capsule that contains a camera, which has only recently been approved for pediatric use. “It takes pictures as it passes through the GI tract,” Dr. Berezin says.

“We can see the entire small intestine better than ever before.” Finally, magnetic resonance imaging (MRI) has taken the place of X-rays and CT scans to provide better imaging without radiation exposure.

Thankfully, improved treatments, including new medications and intravenous infusions designed to combat the biochemicals that cause inflammation, are now available. “The majority of our kids do very well on these treatments,” he reports.

Left untreated, Crohn’s disease can cause bleeding in the GI tract, which could cause anemia. And children with it might suffer delayed development and stunted growth.

Several theories exist about what causes Crohn’s disease: one is that the body’s immune system reacts abnormally in people with the disease, mistaking bacteria, foods and other substances as foreign “invaders” and attacking them with immunity cells. These cells accumulate in the lining of the intestines, producing chronic inflammation, which leads to ulcerations and bowel injury.

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We’ve created a children’s hospital that treats kids like their lives depend on it.

Because they do.

Edmund F. La Gamma, M.D., Chief of Newborn Medicine.

At Maria Fareri Children’s Hospital at Westchester Medical Center, we are committed to providing the very best in advanced care for your child. Our 300+ experts, equipped with the latest diagnostic and interventional technologies, provide the finest care in operating suites, high-level ICUs, and patient-care units designed specifically for children.

Our goal is to help the whole family feel better, which is why we provide family-centered care in a kid-friendly environment that joins moms, dads, brothers, and sisters in the healing process.

Maria Fareri Children’s Hospital at Westchester Medical Center: advancing children’s healthcare, so we’ll be ready when you and your child need us most.

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