Radio Rounds

At one time, newborns with diseased or absent kidneys had few options other than adult-sized dialysis machines. Today, aquapheresis therapy is a treatment option to provide renal support for neonates. In 2020, St. Louis Children's Hospital began using aquapheresis therapy to care for babies with congenital or acquired renal disorders, one of few centers in the country to offer this advanced treatment. Dr. Eileen Ciccia, Washington University pediatric nephrologist at St. Louis Children's Hospital, joins us to talk about renal disease in newborns, aquapheresis therapy, and its impact on NICU care.

About one baby in every 1,000 in the United States is born with clubfoot, a congenital foot deformity where the foot points downward with toes turned inward and the foot bottom twisted inward. Clubfoot is one of the most common congenital foot deformities. Almost half of babies diagnosed with clubfoot have bilateral clubfoot where both feet have the deformity. Treatment options have evolved through the years and, with early intervention, children with clubfoot have high rates of correction.Dr. Pooya Hosseinzadeh, Washington University pediatric orthopedic surgeon at St. Louis Children’s Hospital, joins the show to talk more about diagnosing clubfoot and when to consult with a specialist, treatments options including the Ponseti method, what families can expect, and the clubfoot program at St. Louis Children’s.

While the coronavirus pandemic spread across the world, information about the impact of COVID-19 and pregnant and breastfeeding women was continuously evolving. And now, with the development of a COVID-19 vaccine, there are many new questions and considerations for Ob/Gyns and healthcare providers to address as they continue to counsel their patients. Jeannie Kelly, MD, MS, Washington University maternal-fetal medicine specialist at the Women & Infants Center, a partnership among Barnes-Jewish Hospital, St. Louis Children’s Hospital and Washington University Physicians joins the show to talk more about how COVID-19 affects women during pregnancy and during breastfeeding, and the recommendations for this population as they become eligible to receive the COVID-19 vaccine.

Childhood obesity is a significant problem across our country, leading to serious long-term health issues for those at risk. According to the Centers for Disease Control, for children and adolescents aged 2 - 19 years, the prevalence of obesity was 18.5% and affected about 13.7 million children and adolescents. Programs designed to support and treat childhood obesity and Laurie Sax, dietitian in the Pediatric Gastroenterology Hepatology and Nutrition Department at St. Louis Children’s Hospital and certified specialist in obesity and weight management , joins the show to discuss the Healthy Start Clinic and the multi-disciplinary approach they’re taking to promote new beginnings and healthy changes for obese children.

Multisystem Inflammatory Syndrome (MIS-C) is a rare but serious complication associated with COVID-19. First recognized in April 2020, MIS-C has now been diagnosed in more than 1288 children across the country as of December 4, 2020 according to the CDC. The syndrome can affect multiple organs, including the heart. The MIS-C Clinic at St. Louis Children’s Hospital was established as a collaborative clinic between Cardiology and Rheumatology to specifically care for children experiencing this inflammatory syndrome and to monitor any heart-related issues as a result of the syndrome. Dr. William Orr, Pediatric Cardiologist at St. Louis Children’s Hospital and Associate Professor of Pediatrics at Washington University School of Medicine, joins us to talk more about MIS-C, what we’ve learned about the disease, and the new clinic caring for these patients at St. Louis Children’s.

From the accidental ingestion of grandma’s blood pressure medication to novel drug exposures in adolescents, the Washington University toxicology service cared for many patients at the bedside in 2020. Although many patients with an acute ingestion may require referral to a healthcare facility, there are many toxic exposures including exposure to lead which can be effectively managed in the outpatient setting in the majority of cases. To better treat kids with a toxic exposure, Washington University and St. Louis Children’s Hospital established the Pediatric Toxicology and Lead Clinic in September 2020.Dr. Jason Devgun joins the show to discuss some of the more common exposures children experience and the services offered by the pediatric toxicology clinic.

As mobile technology advances, many health care providers are relying on smartphone apps to help manage their busy schedules. Dr. Tosin Adeyanju joins the show to talk about the best apps for managing evidence-based medicine updates, finding and utilizing point-of-care resources, managing pediatric emergencies and apps that help families access medical information and manage their health.

Technological advancements in telemedicine have paved the way for safe, secure, face-to-face pediatric cardiology visits in the comfort and convenience of a patient’s home. The St. Louis Children’s and Washington University Heart Center offers telemedicine visits for pediatric heart patients, from infant to young adults. Washington University Physician Assistant, Lisa Roelle, joins us to discuss when and how to use this service, and what patients can expect.

St. Louis Children’s After Hours offers convenient medical care for children’s illnesses and injuries when their pediatrician’s office is closed. During the COVID-19 pandemic, After Hours has made changes to their processes and services to ensure the safety of patients, families and staff while still delivering kid-focused care.Learn more from Beth Schickler about the changes made and how they are working with pediatricians to care for their patients.

Asthma is one of the most common chronic diseases in children. According to the Asthma and Allergy Foundation, more than 6.2 million children under age 18 have asthma. For many, asthma is manageable through quick-relief and long-term controller medications. For some children, however, asthma is severe and requires additional care and treatment.Lila Kertz, Clinical Director of the Severe Asthma Clinic at St. Louis Children’s, joins the show to talk more about the prevalence of severe asthma, available treatment options, and the services offered at the specialized Severe Asthma Clinic.

Early reports of a multi-system inflammatory disorder in children with COVID-19 began in April 2020 in the United Kingdom. Since then, cases have appeared throughout the United States including our region. Known as “Multisystem Inflammatory Syndrome in Children (MIS-C)”, the illness is characterized by prolonged fever, inflammation in the body and involvement of one or more organ systems.In this episode, Dr. Alexis Elward, Chief Medical Officer at St. Louis Children’s Hospital and Washington University pediatric infectious diseases specialist, shares more about the frequency of this syndrome, symptoms and treatment options.

The COVID-19 pandemic has changed the way many of us are delivering care to our pediatric population. In an effort to keep patients, families and caregivers safe from possible exposure to the virus, St. Louis Children's Hospital is now offering virtual ED visits for pediatric patients who are experiencing respiratory symptoms.Dr. Lozovatsky joins the show to talk about this new service and how your patients can access the service.

Chronic kidney disease (CKD) refers to the kidney’s progressive inability to perform its functions such as removing waste and toxins, regulating vitamins and minerals, releasing hormones and vitamins that regulate the level of red blood cells, help control blood pressure and regulate the amount of certain nutrients. When this happens, a child becomes sick and the risk for kidney damage becomes higher.Dr. Eileen Ciccia joins the show to discuss chronic kidney disease and when to refer to a specialist.

While transgender people have experienced growing visibility and acceptance in recent years, there’s still considerable confusion about even the most basic facts about trans people, gender identity and gender expression. What does it mean to be transgender versus transsexual? Are kids too young to know the difference? Are kids just “confused” or are they just suffering from psychological issues? The implications of such myths can further deny equitable opportunities to children who identify as transgender—from discrimination from health care providers, a reluctance to seek preventive care, and future employment discrimination, resulting in disproportionate unemployment rates and a consequent lack of any health insurance coverage.Christopher Lewis, MD, pediatric endocrinologist and medical director of the Washington University and St. Louis Children’s Transgender Center, joins the show to debunk myths associated with transkids.

Tuberculosis is the top infectious disease worldwide, with an estimated 1.1 million new cases in children reported in 2018. While rates of tuberculosis remain low in the US, children are at high risk of developing disease if infected. Dr. Rachel Orscheln joins the show to discuss global trends in TB, and appropriate screening strategies that can detect TB in those who are infected, and reduce false positives in those at low risk.

While recent studies suggest prolonged social media use can lead to anxiety and depression among teens, other studies show these platforms can have a positive effect on personal creative expression, peer connection and digital literacy. The pros and cons of social media usage are significant, so what do we tell our teens? Dr. Mary Fournier joins the show to weigh the good and the bad when it comes to social media use among teens.

Past societal norms and formal education taught us that pronoun usage had rules based on a binary male/female and singular/plural framework. However, this framework often leads to misgendering people whose identity is nonbinary, including members of the transgender, genderqueer and gender nonconforming communities. Modern society now calls for updating the previously taught and accepted grammatical framework to be considerate of the intersections between gender, race, class and other complex layers of identity.Christopher Lewis, MD, pediatric endocrinologist and medical director of the Washington University and St. Louis Children’s Transgender Center, joins the show to discuss the origins of gender-neutral pronouns, what they mean and how to use them.

The urology specialists at St. Louis Children's Hospital perform some of the most technologically advanced procedures when treating children, and is one of only a few pediatric facilities in the country—and the only one in the St. Louis region—to offer robotic surgery for children needing urologic procedures. In most of these cases, the children experience less pain, heal faster and benefit from stronger restoration than with the standard open surgical techniques.Dr. Vricella joins the show to discuss advancements in pediatric urologic surgery, and when a pediatrician should refer a patient to a specialist.

Infantile Eczema (atopic dermatitis) can show up as dry, scaly patches on a baby's skin, often during their first few months. Babies can get the condition virtually anywhere on their bodies, but most often, it affects their cheeks, chin and joints of their arms and legs. While most babies outgrow atopic dermatitis, it is oftentimes itchy and painful. Dr. Elizabeth Nieman joins the show today to discuss how pediatricians can help parents keep this condition under control, and at what point a baby should be referred to a specialist.

For children with a history of penicillin allergy, new evidence suggests a vast majority of kids could be “de-labeled” after undergoing a risk assessment and oral challenge in the pediatric emergency room. George Hoganson, MD, a Washington University emergency medicine fellow at St. Louis Children’s Hospital, is collaborating on a two-year, multi-center study to test children described as penicillin allergic, but who very likely do not have a true penicillin allergy in the St. Louis Children's Hospital Emergency Department. Dr. Hoganson joins the show to discuss the study, which involves a penicillin oral challenge with observation in the Children’s emergency room.

Pediatric cardiologists at the St. Louis Children’s and Washington University Heart Center care for more children with heart disease than any other center in the region. With extensive experience treating children with common to complex heart issues, from cardiac surgeries and cardiac catheterizations to heart monitoring, our heart specialists are the region’s go-to heart program for second opinions and referrals for advanced pediatric heart care.Dr. Caroline Lee joins the show to discuss how the Heart Center’s continuum of care, and when to refer a patient to a specialist.

Devastating consequences of the opioid epidemic include increases in opioid misuse and related overdoses, as well as the rising incidence of newborns experiencing withdrawal syndrome due to opioid use and abuse during pregnancy. According to the Centers for Disease Control, more than 130 people in America-- or one person every 11 minutes-- dies everyday due to accidental misuse of these drugs. Dr. AuBuchon joins the show to discuss this serious national crisis, and what pediatricians and other heath care providers can do to help combat this deadly addiction.

The Centers for Disease Control recently linked a current lung disease outbreak to electronic cigarettes (e-cigarettes) and vape devices. These devices have rapidly become the most common tobacco products used by teens, driven in large part by marketing and advertising by e-cigarette companies that market the products’ convenience of use and flavor variety. Now, however, the use of these unregulated products is landing many kids in the emergency rooms of hospitals across the country with serious lung illnesses.Dr. Ferkol joins the show to discuss the current outbreak, when a child should be seen for treatment, as well as recommendations for pediatricians and pediatric health care providers to combat tobacco use in all forms.

The neurorehabilitation program at St. Louis Children’s Hospital is designed to address the needs of children and adolescents who have suffered severe injury or illness. In-patient rehabilitation is available for children age 6 months and older whose illness or injury has resulted in impaired physical, cognitive or communication skills.Michael Noetzel, MD, Washington University pediatric neurologist at St. Louis Children’s Hospital, joins the show to discuss how the neurorehabilitation program strives to maximize physical, psychological, cognitive, social and educational outcomes for children with a variety of neurologic conditions.

Earlier this month, St. Louis Children's Hospital welcomed Trish Lollo, former president of Barnes-Jewish West County Hospital, as its new president. Listen as Trish gives a glimpse into the journey that led her to St Louis, and her vision for St. Louis Children's Hospital.

Traditionally, cochlear implants are only provided to children with severe-to-profound hearing loss in both ears. At St. Louis Children’s Hospital, the cochlear implant program is one of the only in the area—and one of few in the nation—providing cochlear implants to children with single-sided deafness. Bernadette Rakszawski, pediatric audiologist at St. Louis Children’s Hospital, joins the show to discuss how her team is leading the way in assessing the impact of single-sided deafness, as well as understanding how various treatment options affect expected outcomes.

A normal spine, when viewed from behind appears straight. However, a spine affected by kyphosis shows evidence of a forward curvature of the vertebrae in the upper back area, giving the child an abnormally rounded or "humpback" appearance. Children whose curvature exceeds a limited range of variation - curving forward in a “C” shape- will require medical attention and may be diagnosed with kyphosis. Together with scoliosis, another type of curvature, this condition comprises a significant proportion of spinal deformity diagnoses seen by pediatric orthopedists.Dr. Munish Gupta joins the show to discuss the importance of early detection, treatments, and follow-up care for children diagnosed with kyphosis.

The St. Louis Children’s Hospital Department of Therapy Services provides occupational, physical and speech therapy within an individualized state-of-the-art model of care in conjunction with world class physicians and medical practices. As a highly trained pediatric team with an international reputation for excellence, the staff tailors therapy to each child's developmental stage and individual needs for the most effective results. Now, pediatricians, patients and families have the convenience of accessing these services at a new location near Progress West Hospital.Sarah Becker, speech language pathologist, joins the show to discuss services offered and when a pediatrician should refer a patient to a therapy specialist.

Good sleep is essential to a child's health and well-being, but not all kids get the recommended amount that their bodies need. For issues that require care from a specialist, the Sleep Center at St. Louis Children’s Hospital, accredited by the American Academy of Sleep Medicine, meets the highest possible standards for comprehensive sleep care for newborns to young adults. Dr. James Kemp explains how our newly-expanded sleep lab is designed just for kids and is fully equipped with the latest equipment and the staff is fully trained in a wide array of sleep disorders in children.

As kids continue to focus on one sport early on and playing it year-round, sometimes on multiple teams at once, overuse injuries have increased dramatically over the past decade.Tom McGowan discusses how The Washington University and St. Louis Children's Young Athlete Center has developed a series of interactive injury prevention and educational programs designed to improve the overall health of young athletes.

In the final segment of this 3-part series on Cannabinoid Use in Pediatrics, Dr. Jennifer Griffith discusses addressing parents’ concerns and other frequently asked questions about the use of cannabinoids for childhood conditions or illnesses.

In Part 2 of our 3 part series on Cannabinoid Use in Pediatrics, Dr. Jennifer Griffith, a Washington University Pediatric neurologist at St. Louis Children’s Hospital discusses the case study that started the national conversation over the use of cannabinoids to treat pediatric epilepsy patients, and the clinical trials that were conducted as a result.

Although marijuana and its derivatives are currently Schedule 1 substances per the federal Controlled Substances Act (CSA), many states have relaxed their legislation to allow use. In this 3 part series on Cannabinoid Use in Pediatrics, Jennifer Griffith, MD, PhD discusses how more recently, the use of cannabidiol (CBD) products in pediatrics has sparked additional debate, and pediatric providers have started encountering patients experimenting with these products in their daily practice, necessitating an understanding of the history and available medical literature on this topic.

Many young athletes are unprepared to fully participate in sports without risk of injury. Paul Jenkins PT, MSPT, OCS shares that whether an athlete has decreased strength following an injury, has had surgery, or just lacks optimal strength and coordination, the Washington University and St. Louis Children's Hospital Young Athlete Center Bridge Program is designed to "bridge" the gap between where a young athlete currently is, and where they want to be.

Fetal surgery for myelomeningocele, the most severe form of spina bifida, is an extremely delicate surgical procedure where fetal surgeons open the uterus and close the opening in the baby's back while they are still in the womb. Fetal spina bifida surgery is shown to offer significantly better results than traditional repair after birth. Because spinal cord damage is progressive during gestation, prenatal repair of myelomeningocele may prevent further damage.Mothers carrying a baby with myelomeningocele who choose fetal surgery for spina bifida require the most expert and carefully managed care. Dr. Bebbington, a leading fetal interventionist with 15 years of experience in open fetal surgery and fetoscopic-based interventions, joins the show to discuss comprehensive care for families that spans their needs while their babies are still inside the uterus, through labor and delivery, the NICU and then for years to come.

The pediatric orthopedic program at St. Louis Children’s is one of the largest in the Midwest, caring for nearly 30,000 pediatric patients each year. Staying at the forefront of this care means adapting to differing methods by which patients and families receive our services. Consequently, Washington University Physicians and St. Louis Children’s Hospital are continuously improving and creating new access points to meet the changing needs of our orthopedic patients. From therapy and surgical services, to sports medicine and emergency room coverage for orthopedic injuries, Dr. Goldfarb joins the show to discuss where your patients can access pediatric orthopedic services by expert orthopedic physicians.

Congenital scoliosis is a sideways curvature of the spine that is caused by a defect that was present at birth. It occurs in only 1 in 10,000 newborns and is much less common than the type of scoliosis that begins in adolescence. Even though congenital scoliosis is present at birth, it is sometimes impossible to see any spine problems until a child reaches adolescence.Dr. Gupta joins the show to explain more about congenital scoliosis and when to refer to a specialist.

Twin-twin transfusion syndrome (TTTS) is a rare, serious condition that can occur in pregnancies when identical twins share a placenta. Abnormal blood vessel connections form in the placenta and allow blood to flow unevenly between the babies. One twin − called the donor – becomes dehydrated; and the other − called the recipient − develops high blood pressure and produces too much urine and over fills the amniotic sac. Without treatment, this condition can be fatal for both twins. Dr. Bebbington, a leading fetal interventionist with 15 years of experience in open fetal surgery and fetoscopic-based interventions, joins the show to discuss twin-to-twin transfusion syndrome, and why fetal surgery is sometimes necessary to save one or both babies.

CARE (Clinic for Acceptance, Recovery, and Empowerment) in pregnancy is one of only two programs in St. Louis that offer prenatal care, substance abuse treatment and extended postpartum support for pregnant women facing the challenges of an opioid use disorder. Hayley Friedman, MD and Jeannie Kelly, MD, discuss how personalized treatment plans help support the well being of mother and child not just during pregnancy, but for at least one full year postpartum.

As St. Louis Children’s Hospital and Washington University pediatricians continue to expand pediatric services within our communities, patients and families are now provided with even more options to access the expertise of Washington University pediatric doctors. Mark Lowe, MD, PhD discusses the recent openings of two multispecialty center locations in Arnold, Mo, and Shiloh, Il.

Palliative care is often misunderstood. Oftentimes palliative care is associated with end-of-life (hospice) care or “giving up.” In reality, palliative care together with curative treatment is appropriate for any stage of illness. Joan Rosenbaum, MD , part of the Pediatric Advanced Care Team (PACT) at St. Louis Children’s Hospital, is here to share how PACT offers an additional layer of support by specialists to provide relief from the symptoms, pain and psycho-social, emotional and spiritual stress of serious illness for both the patient and the family.

Doing the right thing is often simple and clear. We find the medical problem and we do all we can to heal, to comfort, and make life better for our young patients and their families. But sometimes doing the right thing isn’t easy, simple or clear. In addition to medical questions, families and caregivers sometimes have moral or ethical issues. These come up when it is not clear what is "right" – the question is what should be done, not what can be done. Most of the time, even hard questions are answered through open and honest talking between children, parents and their health care professionals. When we don't all agree, it can be useful to ask for help. Jay Malone, MD, MS, PhD is here to let you know that in order to provide such help with some of these problems, the St. Louis Children's Hospital Medical Ethics Subcommittee can help.

Motion analysis technology and expertise in interpreting findings and making recommendations are vital components in helping kids in need achieve the greatest mobility possible. Pooya Hosseinzadeh, MD discusses the newly-opened Motion Analysis Center at St. Louis Children's Hospital which aims to do just that-- and it's the only one in the St. Louis area.

Although many adolescents today are overweight, there are some teens whose extreme obesity causes serious medical complications, including Type 2 diabetes, high blood pressure and metabolic syndrome, just to name a few. These teens often are unable to lose weight through diet and exercise. However, not losing weight — and continuing to gain — is a dangerous path for them. Shaina Eckhouse, MD discusses The Adolescent Bariatric Surgery Program at Children's and how studies show that obese adolescents remain so into adulthood, with the consequence of worsening medical conditions that limit their activities and shorten their lives.

As 3D technology transforms health care and becomes more commonly used, St. Louis Children’s Hospital now has “in-house” 3D printing capabilities. Munish Gupta, MD, Washington University orthopedic spine surgeon, discusses this technology and how it has been life-changing for patients with spinal deformities.

Sport-related concussion is a “hot topic” in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes.Mark Halstead, MD, SLCH’s leading expert on concussions, discusses the AAP’s updated concussion recommendations to support children and teens engaging in light physical activity and returning to school as they recover. The report, revised for the first time in eight years, also advises against complete removal of electronic devices. Dr. Halstead, an associate professor of pediatrics and of orthopedic surgery at Washington University School of Medicine, is the lead author of the AAP report.

An increasing number of boys and girls are playing recreational and organized sports. As a result, there is a rise in the number of overuse injuries seen among children and adolescents. The majority of sports and overuse injuries are due to minor trauma involving soft tissue injuries--injuries that affect the bone, muscles, ligaments, and/or tendons. One such injury is Spondylolysis, or a pars defect, which is marked by back pain. Brian Kelly, MD discusses the ways in which Spondylolysis is classified. He shares treatment and prevention advice and when it is important to refer to the specialists at St. Louis Children;s Hospital.

The 2019 Clinical Pediatric Update is designed to offer the primary care provider clinical approaches to problems common in pediatric and adolescent practice. Expect to explore current recommendations in adolescent medicine, urology, dermatology, endocrinology, allergy and pulmonary, psychiatry, orthopedics and genetics- all for CME credit.Joining the show is Dr. Brian Kelly. He's a Washington University pediatric orthopedic surgeon at St. Louis Children's Hospital, and is one of many conference presenters at the upcoming conference, which will take place on Friday, March 29, at Marriott West in St. Louis.Dr. Kelly will speak about the main topics on the agenda this year, and what attendees can expect.

Mary Fournier, MD, MPH, discusses the current state of STDs and birth control in the millennial generation. She shares what has changed, any  new methods available and how pediatricians can help frame this conversation for parents and patients.

For children diagnosed with congenital heart disease, physical activities may come with limitations. The St. Louis Children’s and Washington University Heart Center combines the benefits of exercise with the expertise of pediatric cardiologists specializing in exercise physiology to aid children with heart disease. Dr. Orr joins the show to discuss exercise physiology services at St. Louis Children’s Hospital and when to refer to a specialist.

According to the Centers for Disease Control and Prevention, influenza is the most frequent cause of death in the United States from a vaccine-preventable disease. The 2017-18 influenza season was an intense one, with 172 pediatric deaths recorded. David Hunstad, MD discusses what we know about the current state of this year's flu season, and what we can we expect before its peak.