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Clinical Updates

What is “Dry Drowning,” and How Do I Talk to Parents About It?
 What is “Dry Drowning,” and How Do I Talk to Parents About It? 1024 683 Daniel Scherzer, MD and Bema Bonsu, MD
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The concern about so called “dry drowning” (which is not an actual medical phrase; neither is “secondary drowning”) is based on the fear that a child can unexpectedly succumb to respiratory problems some unpredictable time after swimming. This fear has been exacerbated by media reports dramatizing events without fully explaining them. The concept that dry…

Unraveling Intractable Functional Constipation: Manometries Are Still the Gold Standard
 Unraveling Intractable Functional Constipation: Manometries Are Still the Gold Standard 1024 680 Natalie Wilson
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Close up color photo of little boy holding hands on his belly

Cine-MRI recordings can’t replace colonic manometries when assessing motility among children with functional constipation, but they may offer additional information. And conducting both MRIs and manometries simultaneously is feasible. While functional constipation (FC) is common in childhood, and most children who experience it respond well to behavioral interventions or treatment with laxatives, some children continue…

Indicators of Blood Clot Potential Directly Relate to Nephrotic Syndrome Severity
 Indicators of Blood Clot Potential Directly Relate to Nephrotic Syndrome Severity 150 150 Katie Brind'Amour, PhD, MS, CHES
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Researchers in the NEPTUNE network and collaborators at Nationwide Children’s Hospital have confirmed their preclinical studies demonstrating a direct correlation between the severity of disease and prothrombotic biomarkers in patients with nephrotic syndrome. Nephrotic syndrome (NS) dramatically increases the risk of a life-threatening blood clot, but until recently, clinicians have had no reasonable biomarker to…

The First Opioid-Prescribing Guidelines for Children Who Require Surgery
 The First Opioid-Prescribing Guidelines for Children Who Require Surgery 1024 573 Lauren Dembeck
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Providers should recognize the risks of opioids, maximize nonopioid regimens, and educate families appropriately. The first opioid-prescribing guidelines to address the unique needs of children who require surgery have been published by an expert panel in JAMA Surgery. The new guidelines aim to help health care professionals caring for children and adolescents in the perioperative…

A New Kind of Rectal Diversion in Classic Bladder Exstrophy
 A New Kind of Rectal Diversion in Classic Bladder Exstrophy 1024 754 Jeb Phillips
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  This article appeared in the Spring/Summer 2021 print issue. Download the full issue.   Medical illustrations by Mandy Root-Thompson for Nationwide Children’s Hospital Source: V. Rama Jayanthi, chief of Urology at Nationwide Children’s Hospital To learn more about the procedure and it’s applications, read A Surprising Approach to Classic Bladder Exstrophy.

A Surprising Approach to Classic Bladder Exstrophy
 A Surprising Approach to Classic Bladder Exstrophy 1024 754 Jeb Phillips
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A procedure developed at Nationwide Children’s Hospital comes with possible risks but can have a huge impact on quality of life. It’s become clearer over the last two years that a “good outcome” for children born with classic bladder exstrophy is in the eye of the beholder. One of the best outcomes, nearly everyone would…

Pediatricians Offer Valuable Oral Health Services for the Very Young, Before and Throughout Pandemic
 Pediatricians Offer Valuable Oral Health Services for the Very Young, Before and Throughout Pandemic 1024 680 Katie Brind'Amour, PhD, MS, CHES
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toddler brushing teeth

Medical professionals see very young children much more frequently during the first several years of life than dentists, and many states’ Medicaid programs have seized the opportunity to reimburse pediatricians for preventive oral care, such as fluoride application and oral hygiene education. Despite reimbursement options and national guidelines recommending dental care begin by age 1,…

Even Severe Asthma Can Improve if Guidelines Are Followed
 Even Severe Asthma Can Improve if Guidelines Are Followed 1024 683 Mary Bates, PhD
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Patients treated with adequate medications and asthma family education can significantly improve irrespective of asthma severity. Severe asthma accounts for 5-8% of patients with asthma, but this group is more challenging to treat and is responsible for up to 40% of total asthma-care expenses. The majority of patients with severe asthma have difficult-to-treat asthma (in…

Global Study Highlights Antibiotic Overuse in the NICU
 Global Study Highlights Antibiotic Overuse in the NICU 1024 683 Abbie Miller
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Baby in NICU

Antimicrobial stewardship programs were associated with lower antibiotic use, regardless of the country’s income level. Excessive antibiotic use among infants born preterm in the newborn intensive care unit (NICU) is associated with poor patient outcomes, such as sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia and others, and contributes to the emergence of multi-drug resistant microbes. A new…

Long-Term Treatment of Pediatric Chronic Inflammatory Demyelinating Polyneuropathy with Pulse Oral Corticosteroid Therapy
 Long-Term Treatment of Pediatric Chronic Inflammatory Demyelinating Polyneuropathy with Pulse Oral Corticosteroid Therapy 150 150 JoAnna Pendergrass, DVM
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Pediatric patients with chronic inflammatory demyelinating polyneuropathy can benefit from the safety and effectiveness of long-term pulse oral corticosteroid therapy. Chronic inflammatory demyelinating polyneuropathy (CIDP) affects the peripheral nervous system in children, causing weakness, sensory loss and depressed tendon reflexes. Pediatric patients with this rare, immune-mediated disease often undergo years of immunomodulatory therapy, with the…

How Important is Fasting for Pediatric Routine Cholesterol Screening?
 How Important is Fasting for Pediatric Routine Cholesterol Screening? 1024 575 Andrew Tran, MD
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A nonfasting lipid panel is a great first-line screening tool to use. While it is ideal to have a fasting lipid panel, this can be difficult to obtain in practice. For the purposes of screening, I think that it is much more important to go ahead and get the nonfasting lipid panel while the patient…

No More Sitting in the Dark?
 No More Sitting in the Dark? 1024 728 Laura Dattner
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A new study from the Center for Injury Research and Policy, Sports Medicine and Emergency Medicine is the first to document objectively self-paced physical and cognitive activity post-concussion among youth. The results suggest they may be able to engage in physical and cognitive activity as soon as tolerated post-concussion. Clinical guidelines for managing concussion in…

Protecting an ‘Open Future:’ Improving Fertility Preservation Decision-Making for Young Males With Cancer
 Protecting an ‘Open Future:’ Improving Fertility Preservation Decision-Making for Young Males With Cancer 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Color photo of Black father holding infant on shoulder in front of nursery background with clouds on the wall

Evidence from a new study highlights the importance of family-centered decision processes and clinician facilitation in improving fertility preservation uptake prior to cancer treatment. Numerous cancer treatments can reduce fertility or render some patients entirely infertile, but fertility preservation (FP) services have historically had low rates of uptake. When a young person is diagnosed with…

A Quick and Reliable Method to Determine The Time to Full Weight Bearing in Patients Undergoing Intramedullary Limb Lengthening
 A Quick and Reliable Method to Determine The Time to Full Weight Bearing in Patients Undergoing Intramedullary Limb Lengthening 1024 575 Lauren Dembeck
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A new method to objectively measure bone healing may help the patient with an intramedullary lengthening nail make strides to full weight bearing status. Intramedullary limb lengthening is indicated for the treatment of limb length discrepancy and short stature. Traditionally, the procedure was done using external fixators, which must remain on the patient’s limb for…

No Evidence Supporting Prophylactic Indomethacin Treatment for Most Preterm Infants
 No Evidence Supporting Prophylactic Indomethacin Treatment for Most Preterm Infants 1024 575 Lauren Dembeck
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Nurse caring for infant in Neonatal Intensive Care Unit (NICU)

Inconsistency among studies prompted researchers to take a closer look at the drug’s effects. Despite limited evidence supporting its use, prophylactic indomethacin treatment is often administered to very preterm infants within the first 24-hours after birth to reduce the risks of intraventricular hemorrhage and longer-term neonatal morbidities, such as bronchopulmonary dysplasia (BPD). Data from a…

One Year Reflection: Behavioral Health Pavilion Adds to Industry-Leading Model of Care During Pandemic
 One Year Reflection: Behavioral Health Pavilion Adds to Industry-Leading Model of Care During Pandemic 1024 538 Kaitlin Hall
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The full impact of COVID-19 on children’s mental health likely won’t be known for some time. But even before the pandemic, pediatric mental health was in a national crisis, with one in five children living with a mental illness, and suicide the second leading cause of death for children 10 and older. That means the…

Batten Disease Experts Publish Common Key Practices For Enzyme Replacement Therapy
 Batten Disease Experts Publish Common Key Practices For Enzyme Replacement Therapy 1024 683 Lauren Dembeck
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Neuronal ceroid lipofuscinosis type 2 disease is a rare, rapidly-progressing, neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 deficiency. This form of Batten disease has an onset between two to four years of age. Children with CLN2 disease may experience intractable epilepsy, progressive cognitive and motor decline, and loss of vision. Historically, most children…

Early Intervention is Key to Avoid Hospitalization for Cyclic Vomiting Syndrome
 Early Intervention is Key to Avoid Hospitalization for Cyclic Vomiting Syndrome 1024 683 Mary Bates, PhD
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Health care provider talking to male teen patient

Study finds that waiting to go to the emergency department for treatment increases likelihood of hospitalization. Cyclic vomiting syndrome is a functional gastrointestinal disorder characterized by periodic episodes of intense nausea and vomiting lasting hours to days. During episodes, some children become very sick and require emergency department care and hospitalization to manage symptoms and…

How Has the COVID-19 Pandemic Affected Measles Vaccination Rates?
 How Has the COVID-19 Pandemic Affected Measles Vaccination Rates? 1024 575 Mary Bates, PhD
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Toddler playing with toys

Researchers are concerned about declining vaccination rates in the Nationwide Children’s Hospital pediatric primary care network. One consequence of the COVID-19 pandemic is that more families are putting off their children’s preventive care visits, causing pediatric providers to worry about missed vaccines. In a recent study published in Pediatrics, researchers at Nationwide Children’s evaluated changes in…

More to Telehealth Than Meets the Screen
 More to Telehealth Than Meets the Screen 1024 535 Abbie Miller
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Collage of health technology tools

Telehealth has become essential to American health care during the COVID-19 pandemic, but is it really the solution to our biggest access-to-care problems? When COVID-19 ignited stay-at-home orders, public and private insurers quickly relaxed the rules for covering telehealth visits. Health care systems responded in kind by rapidly expanding their telehealth capacity and training. Expanding…

Updated Guidance on Oral Food Challenges
 Updated Guidance on Oral Food Challenges 1024 575 Mary Bates, PhD
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New report offers guidelines and examples for safely performing oral food challenges in clinical practice. Oral food challenges are integral for allergists to diagnose food allergies. In 2009, the Adverse Reactions to Foods Committee within the American Academy of Allergy, Asthma & Immunology published a report providing guidance for safely conducting an oral food challenge.…

CMS Approves New Code for Adult Congenital Heart Disease Subspecialty
 CMS Approves New Code for Adult Congenital Heart Disease Subspecialty 1024 683 Katie Brind'Amour, PhD, MS, CHES
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The official billing code will enable growth of the subspecialty and is expected to result in improved patient care. In March, the Centers for Medicare and Medicaid Services (CMS) approved a unique code for subspecialists in adult congenital heart disease (ACHD). The code will allow board-certified ACHD specialists to bill as such, rather than as…

Improving Guidelines for Pediatric Hypertension Diagnosis
 Improving Guidelines for Pediatric Hypertension Diagnosis 1024 683 Natalie Wilson
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It is vital to accurately recognize and diagnose hypertension in children to avoid long term morbidity and allow for appropriate treatment. A recent pilot study highlights additional diagnostic criteria for clinicians to consider. Pediatric hypertension, or high blood pressure (BP), has become increasingly common and now affects over 3% of children and adolescents. Untreated, hypertension…

Redo Surgery After Anorectal Malformation Repair Can Improve Functional Outcomes
 Redo Surgery After Anorectal Malformation Repair Can Improve Functional Outcomes 1024 575 Mary Bates, PhD
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A reoperation can improve continence and quality of life in children still struggling with fecal incontinence following ARM repair. In a new study, researchers from Nationwide Children’s Hospital show that redo surgeries are   safe and may be an effective option for patients with fecal incontinence after an anorectal malformation repair. For many patients, a reoperation…

When Should Breastfed Babies Be Supplemented?
 When Should Breastfed Babies Be Supplemented? 1024 575 Vanessa Shanks
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This question has received increasing attention in the last several years, especially when considering supplementation for late preterm and early term babies. As more hospitals focus on promoting and supporting breastfeeding, supplementation rates have decreased for infants in the newborn nursery. However, there has been increasing awareness from primary care providers who may see these…

New Newborn Screening Approach Allows for Earlier Detection of Menkes Disease
 New Newborn Screening Approach Allows for Earlier Detection of Menkes Disease 1024 575 Natalie Wilson
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Targeted next generation DNA sequencing can enable improved clinical outcomes for any genetic disorder not detectable through other biochemical newborn screening methods. Menkes disease is a rare, X-linked recessive pediatric disease caused by gene mutations of the copper transporter gene, ATP7A, leading to low levels of copper in infants’ blood and brain, as well as abnormal…

How Do Parents and Surgeons Evaluate Treatment Options for Uncomplicated Appendicitis?
 How Do Parents and Surgeons Evaluate Treatment Options for Uncomplicated Appendicitis? 1024 575 Natalie Wilson
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Parent and provider at child's hospital bed

The most recent in a series of publications on management of uncomplicated appendicitis showed patients and families cited the same concerns when electing either surgery or nonoperative treatment. Antibiotics alone have been shown to successfully treat uncomplicated appendicitis in children. But patients, families and surgeons may differently evaluate risks and benefits of this treatment option.…

Novel Intervention Helps Infants With Cerebral Palsy Develop Arm and Hand Function
 Novel Intervention Helps Infants With Cerebral Palsy Develop Arm and Hand Function 1024 683 Abbie Miller
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A new NIH-funded randomized controlled trial shows that an intervention combining a patented soft restraint harness, therapist coaching and parent training increases reach smoothness, fine motor skills and tactile sensation in the more-affected upper extremity. For the first time in infants with CP under 2, a clinical trial of this type of intervention was shown…

Choking Education an Important Element of Care for Prader-Willi Syndrome Families
 Choking Education an Important Element of Care for Prader-Willi Syndrome Families 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Choking prevention and intervention education offer a simple way to address this common cause of death among PWS patients. Individuals with Prader-Willi Syndrome (PWS) suffer from poor oral muscle control, generalized low muscle tone that can make it hard to swallow properly, a poor gag reflex and an insatiable desire to eat. Together with a…

Novel Use of Vedolizumab Resolves Steroid-Refractory Acute Graft-Versus-Host Disease in a Pediatric Transplant Recipient
 Novel Use of Vedolizumab Resolves Steroid-Refractory Acute Graft-Versus-Host Disease in a Pediatric Transplant Recipient 1024 575 Lauren Dembeck
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Vedolizumab is a monoclonal antibody that targets α4β7 integrin present on gut homing T cells and is indicated for adult inflammatory bowel disease Physicians at Nationwide Children’s Hospital have successfully treated steroid-refractory gastrointestinal acute graft-versus-host disease (SR GI aGVHD) with adjuvant vedolizumab therapy in a pediatric allogeneic hematopoietic cell transplant (HCT) recipient. The case was…

How a Network of Hospitals Reduced Average Age at Cerebral Palsy Diagnosis to 9.5 Months
 How a Network of Hospitals Reduced Average Age at Cerebral Palsy Diagnosis to 9.5 Months 1024 683 Katie Brind'Amour, PhD, MS, CHES
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In just one year, hospital teams working as part of a network to implement international cerebral palsy diagnosis guidelines successfully reduced average age at diagnosis from 19.5 months to 9.5 months. More than 50% of all eventual cerebral palsy (CP) cases spend time in the Neonatal Intensive Care Unit, making early CP evaluation a crucial…

THRIVING After Severe Bronchopulmonary Dysplasia
 THRIVING After Severe Bronchopulmonary Dysplasia 1024 731 Abbie Miller
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Meet Willow. She was born via emergency C-section at just 22 weeks. Doctors at the delivering hospital told Willow’s mom Cortney that her baby’s chances of survival were low. But after a long journey through the newborn intensive care unit (NICU) at Nationwide Children’s Hospital, Willow is a vivacious 4-year-old looking forward to starting kindergarten…

From Clinician Ideas to Commercially-Available Clinical Devices
 From Clinician Ideas to Commercially-Available Clinical Devices 150 150 Kevin Mayhood
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Pressure wounds were a common complication following a tracheostomy, often resulting in advanced-stage wounds, national studies showed. Nationwide Children’s Hospital was no different but Kris Jatana, MD, and Charles Elmaraghy, MD, surgeons in the Department of Otolaryngology, knew they could improve these outcomes. Brendan Boyle, MD, and Alex Green, DO, were fellows in the Division…

Percutaneous Occlusion Linked to Respiratory Improvements in Low-Weight Infants with PDA
 Percutaneous Occlusion Linked to Respiratory Improvements in Low-Weight Infants with PDA 1024 575 Abbie Miller
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Nurse caring for infant in Neonatal Intensive Care Unit (NICU)

Percutaneous occlusion for patent ductus arteriosus (PDA) in infants weighing less than 6 kg is associated with potential longer term improvements in respiratory health, research by investigators at Nationwide Children’s Hospital shows. “A new device for PDA closure recently approved by the FDA has potential to reduce the incidence of device-related complications. This important work…

A Major Milestone in Cystic Fibrosis Treatment
 A Major Milestone in Cystic Fibrosis Treatment 1024 575 Mary Bates, PhD
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Illustration of lungs on blue silhouette of upper chest on black background

A triple medication combination could be life-changing for the majority of patients with cystic fibrosis. A Phase III clinical trial shows that elexacaftor added to ivacaftor and tezacaftor improves lung function and quality of life in cystic fibrosis patients with the most common genetic mutation, F508del. The triple therapy, known as Trikafta, could effectively treat 90%…

A New Therapeutic Era in Pediatric Functional and Motility Disorders
 A New Therapeutic Era in Pediatric Functional and Motility Disorders 150 150 Katie Brind'Amour, PhD, MS, CHES
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20 years ago, treatment options were limited for children with functional gastrointestinal (GI) and motility disorders. Now, a growing list of drugs, behavioral and dietary care plans, and an advanced, forward-looking technique – neuromodulation – are transforming pediatric GI care. Gastrointestinal (GI) disorders are notoriously difficult to diagnose. Virtually all functional and motility-related GI problems…

CMV Testing: Why You Don’t Need Legislation to Make It a Good Idea
 CMV Testing: Why You Don’t Need Legislation to Make It a Good Idea 1024 575 Samantha Morsink
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CMV is the leading non-genetic cause of sensorineural hearing loss in infancy and childhood. Identification of newborns with congenital CMV infection can improve their outcomes by early intervention programs and/or antiviral treatment. Cytomegalovirus, or CMV, infects almost everyone at some point in time, and it is one of the most common congenital infections worldwide. While…

What You Need to Know About Tick-Borne Diseases
 What You Need to Know About Tick-Borne Diseases 1024 575 Mike Patrick, MD
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Update: July 2021, this content has been reviewed for accuracy. The downloadable practice tool has been replaced with an updated version. Ranges of disease-carrying ticks are shifting in the United States. Combined with family travel, this means physicians and families should have a wider lens on what tick-borne diseases they might encounter. Ticks represent a…

Neonatal Abstinence Syndrome: Transforming Care for Newborns and Their Families
 Neonatal Abstinence Syndrome: Transforming Care for Newborns and Their Families 1024 575 Abbie Miller
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If there’s a success story to be told at this point in the history of the opioid crisis, it’s in the newborn intensive care unit. From changing attitudes to standardizing treatment, clinical care for infants with neonatal abstinence syndrome (NAS) and their families is markedly different than it was 10 years ago.   CHANGING ATTITUDES…

Primary Care Provider Guide to Neonatal Abstinence Syndrome Follow Up
 Primary Care Provider Guide to Neonatal Abstinence Syndrome Follow Up 150 150 Nationwide Children's
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Pediatricians have a unique challenge when it comes to caring for the broad spectrum of needs associated with opioid-exposed infants. Some babies who were treated with pharmacological methods in a hospital will be discharged home still on neuro-active medications. Other babies did not receive a neonatal abstinence syndrome (NAS) diagnosis or specific treatment after birth…

Opening the Door to Adult Medicine
 Opening the Door to Adult Medicine 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Care transition plans aren’t just for kids with congenital conditions anymore. Could your practice benefit from a proactive transition plan for all patients? In the shift from pediatric to adult care, young patients have the responsibility to adjust to a new life of self-management. But health care providers also play an important role in this…

Could Earlier Spirometry Get CF Inpatients Home Sooner?
 Could Earlier Spirometry Get CF Inpatients Home Sooner? 150 150 Katie Brind'Amour, PhD, MS, CHES
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A retrospective chart review suggests early spirometry is associated with shorter length of stay. As multicenter studies examine whether length of hospital stay and duration of treatment can be safely shortened for cystic fibrosis-related pulmonary exacerbations, physician-researchers at Nationwide Children’s Hospital have been exploring another unresolved angle related to these admissions: when to do pulmonary…

8 Ways You Can Support Families in Need of Behavioral Health Services
 8 Ways You Can Support Families in Need of Behavioral Health Services 150 150 Nancy Cunningham, PsyD
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Long wait times and difficulties accessing behavioral health services cause stress for many patients and families. As awareness grows about the prevalence of behavioral health challenges for children and adolescents, more patients and families are seeking specialized care. However, due to a shortage of behavioral health specialists, wait times can seem daunting. As the pediatrician,…

Managing Depression, Anxiety and Other Behavioral Health Issues in Primary Care
 Managing Depression, Anxiety and Other Behavioral Health Issues in Primary Care 1024 575 Rachael Hardison
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Teen girl with backpack

An estimated 20 percent of children struggle with mental health illness. As awareness grows, the call for primary care physicians to play a leading role in care grows louder. One in five children will struggle with a mental health illness by the age of 12, but a recent survey by the American Academy of Pediatrics…

Neurosurgery May Provide Lasting Relief From Spasticity
 Neurosurgery May Provide Lasting Relief From Spasticity 1024 575 Abbie Miller
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Selective dorsal rhizotomy can provide life-changing results, but patients work hard in physical and occupational therapy to get there. When Sushma Manjunatha watches her daughter sleep, she sees something new. Instead of being tightly curled up, with legs pulled in, her daughter’s legs are stretched out, finally relaxed. This change is the result of a…

Childhood Kidney Stones: Their Surprising Connection to Future Disease
 Childhood Kidney Stones: Their Surprising Connection to Future Disease 150 150 Jeb Phillips
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Once thought to be an adult condition, urinary stone disease is increasingly found in children – and may be related to the development of cardiovascular disease, chronic kidney disease and low bone density. By one well-regarded estimate, the risk of developing urinary stone disease in childhood doubled between 1997 and 2012. That’s worrying enough on…

Omega-3 Supplements Tied to Notable, Sustained Mental Health Improvements
 Omega-3 Supplements Tied to Notable, Sustained Mental Health Improvements 150 150 Kevin Mayhood
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Case study shows reduction in bipolar youth’s psychotic mania, depression and anxiety Medications unchanged, a severely bipolar girl’s depressive, manic and psychotic symptoms improved significantly during the two years her mother added omega-3 supplements to her daily diet. The case, reported by researchers at Nationwide Children’s Hospital and Ohio State University Wexner Medical Center, is…

InSight: Restoring Normal Habits
 InSight: Restoring Normal Habits 471 285 Tiasha Letostak, PhD
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SACRAL NERVE STIMULATION (SNS) is a new treatment that helps control urinary incontinence and fecal soiling. For some children, the nerves that control urination and bowel movements do not work correctly. The SNS unit consists of a small, safe battery and wire under the skin and sends signals to the sacral nerve. The signals help restore…

InSight: Working Up the Nerve
 InSight: Working Up the Nerve 150 150 Katie Brind'Amour, PhD, MS, CHES
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Using regional anesthesia to numb nerves reduces pain and speeds recovery in pediatric orthopedic surgery. Ultrasound-guided regional anesthesia has been used in adult patients for more than a decade but is now being used more regularly in pediatric patients, especially for orthopedic procedures. Femoral nerve block, in which the femoral nerve is numbed, is among…