171 Ashley Ave.
Charleston, SC 29425
843-792-1414
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July 2005
This edition:
Letter from the Chair
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L. Lyndon Key, MD
Professor and Chairman
Department of Pediatrics |
Dear Faculty, Staff, and Friends:
I'm pleased that we are highlighting our critical care division in this issue of Kids Connection. Some of the most traumatic situations lead to
some of the most incredible miracles. The compassionate and caring critical care team at our children's hospital plays an important role in providing
extraordinary health care every day. We often refer to them as our "miracle workers."
Conditions that our critical care team treats are very serious and require an intense level of care. Thankfully, when my patients are admitted to our
pediatric intensive care unit (PICU) or receive care through our emergency department I know they are in good hands. I know their chances of doing well
are dramatically improved under the care of our critical care specialists.
When you enter our PICU, you feel the energy, the vigilance and the caring atmosphere. The room pulses with fear but a sense of hope and promise drive
each and every caregiver in the room.
I have talked to many families whose children have been near death and have received care from our critical care division. These parents remember every
member of their child's health care team. Through my conversations with these families it is remarkable the level of respect they have for this division.
They remember the caring nurses who became their best friends during their child's stay. They remember the child life specialist that helped eliminate
fears for their child. They remember the social worker that provided recommendations on where to eat and places to stay.
Our PICU is the region's largest and most sophisticated critical care unit for children and a critical part of our children's hospital. It's a training
ground for future physicians, a safety net for our patients and a place where miracles happen every day.
Sincerely,
L. Lyndon Key, MD
Chair, Department of Pediatrics
Feature Story: Critical Care
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David Habib, MD
Medical Director, PICU |
Since the creation of the Critical Care Division and the Pediatric Intensive Care Unit (PICU) at the MUSC Children's Hospital
in the late 1980s, the physicians and staff have cared for hundreds of children injured in accidents or suffering from devastating
illnesses. Under the direction of David Habib, MD, the multidisciplinary division dedicates itself to providing not only the best
medical care to the children of South Carolina but to also caring for their spirits and those of their families.
Four attending physicians provide 24-hour coverage for the 10-bed unit and along side residents, nurses and many allied health providers
provide care to critically-ill babies and children through age 18. The nurse-to-patient ratio of 1:1 or 1:2 ensures that each patient is
attended to with the best possible care and very close attention. Everyone on the unit works closely together and values the open-communication
philosophy. They understand the importance of working as a team.
The PICU is a medical/surgical unit and sees pre- and post-operative surgery patients admitted for plastics and ENT cases, scoliosis repair,
shunt implantation, removal of brain tumors and vascular malformations and a host of general surgery conditions. Medical cases include children
that have been recently diagnosed with diabetes or those suffering from a relapse, children involved in motor vehicle accidents and those suffering
from child abuse and neglect.
"In the winter, we see a large number of children suffering from respiratory infections such as bronchitis and pneumonia," says Dr. Habib. "In the
summer, we see a lot of children involved in motor vehicle accidents and children that suffering from head trauma due to not wearing a helmet while
ride their bike. We also see a fair amount of near-drowning. The summer also brings quite a bit of encephalitis from Mosquito-born illnesses. We also
treat a significant number of asthmatics in conjunction with our colleagues in pediatric pulmonology."
Collaboration with physicians in other specialties is a hallmark of this division. "Because we are a children's hospital, we have access to specialists
in a variety of areas who can quickly get involved in difficult cases," says Dr. Habib. "This is a huge benefit to our patients because we can bring in
many points-of-view to ensure we come up with the best treatment plan. We also know that with talented researchers working in the Darby Children's
Research Institute, we will be among the first to have the latest treatments available. For example, Dr. Singh's recent discovery highlighted in this
issue of Kids Connection is an excellent example of emerging compounds that can protect the brain from injury following trauma, near-drowning or other
diseases that cause cells in the brain to swell and die."
No two days are the same in the PICU, though each day does begin with patient rounds with the attending physician, the residents, a pediatric pharmacist,
respiratory therapist, nutritionist and the bedside nurse. Child life therapists, social workers and chaplains are within easy reach to help patients and
their families deal with the many social issues surrounding their illness or injury.
The critical care division and the Pediatric Intensive Care Unit are an ever present and ever ready presence for the children of South Carolina. They
provide top-level, excellent care to critically-ill children while continuously seeking opportunities to improve the service they provide through
networking with leading researchers at MUSC in the Darby Children's Research Institute.
Message from the Medical Director
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J. Philip Saul, MD
Medical Director
Director, Pediatric Cardiology |
This issue focuses on the clinical and research aspects of critical care in at MUSC Children's Hospital.
All of the intensive care areas - from trauma and pediatric cardiac to neonatal care - require
state-of-the-art facilities and personnel that remain on the forefront of critical care and emergency
services. At MUSC Children's Hospital our administrative team is working diligently to ensure we recruit
knowledgeable health care professionals, as well as maintain and develop the necessary infrastructure in
order to meet the health care needs of our children.
In step with trends nationwide, we have had an increasing need for critical care beds and staff, which
comes in part from the increasing complexity of cases being admitted to the hospital, and in part from
the increasing incidence of very low birth weight infants requiring neonatal care.
To address these expanding needs, the Children's Hospital has recently added a 12-bed unit for neonates
and will soon open a 12-bed dedicated pediatric cardiac intensive care unit. These units will allow for
expansion of current service and eliminate constraints currently placed on existing units that are often
at maximum capacity.
We are also in the early planning stages for building a new neonatal unit that will house all of the newborns
needing low or high complexity care. By planning ahead and building for the future, we will be ready to translate
the research breakthroughs being developed in the CRI into the clinical arena and ultimately ensure we are
providing the best possible care for our patients.
Children's Research Institute News Brief
Two months following an Epstein-Barr (EBV) infection, a 17 year-old white female came to
our children's hospital with seizures, intermittent visual changes, and altered mental status.
Magnetic resonance imaging (MRI) showed white matter changes of acute disseminated encephalomyelitis,
also referred to as ADEM (see photo inset).
The symptoms and signs improved following treatment with a high dose of corticosteroids, intravenous
immunoglobulin, and several antiepileptic drugs, though ongoing neurologic morbidity and seizures
underscore the need for more effective modes of therapy to augment the survival and differentiation
of oligodendrocyte progenitor cells that can replaced damaged white matter.
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Bernard L. Maria, MD, MBA
Executive Director
Darby Children's Research Institute |
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Inderjit Singh, PhD
Scientific Director
Darby Children's Research Institute |
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On the 5th floor of the Darby Children's Research Institute, Dr. Singh and his team have been working
on the development and testing of compounds to enhance protection of the brain. In a recent paper that
will soon be published in the FASEB Journal, Dr. Ajab Paintlia and her colleagues, under the direction
of Dr. Singh, will report that lovastatin, a drug commonly used to reduce the amount of cholesterol and
certain fatty substances in the blood, protects against the degeneration of oligodendrocyte progenitors
(OPs) and enhances their differentiation.
The importance of this finding is that it may change the paradigm of therapy from one that has focused on
preventing the death of damaged cells to that of ensuring that dead cells can be replaced by a vibrant reserve
of cells. The new reserve cells would be protected pharmacologically from damaging effects of brain inflammation.
It is precisely this type of basic research and discovery that should be translated into clinical applications
to help future children and teens admitted to the pediatric and neonatal intensive care units. Research of this
kind can provide miraculous care to those children suffering from trauma, infection, and near-drowning that all
cause inflammation and loss of vital brain cells.
Mental Health Resource News Brief
An estimated 10 to 20 percent of women struggle with major depression before, during and after delivery of a baby. Perinatal
depression has substantial personal consequences and interferes with the quality of child-rearing, adversely affecting
parent-child interactions, maternal responsiveness to infant vocalizations and gestures and other stimulation essential
for optimal child development. Early detection is uncommon even though it is known to improve maternal well-being and
child outcomes. The American Academy of Pediatrics recognizes the importance of pediatric practitioner involvement in
early detection of maternal perinatal depression. Providers are encouraged to screen at several points including
prenatal or postpartum visits, infant well-child or episodic visits.
Resources available:
- The Family Psychosocial Screen
(pdf) developed by Dr. Kathi Kemper includes a four-item screen for depression as well as screens
for substance abuse, domestic violence, and other risk factors (such as low socio-economic status, absence of social support, etc.).
- The Edinburgh Postnatal Depression Scale 1 (EPDS)
is a free screen provided in English and Spanish. Psychometric studies provide support for accuracy, validity, and
standardization of 10 multiple choice items that produce a "possible depression" score and a single question focusing
on potential suicidal ideation. These screens can provide a time efficient method to alert the clinician to do a thorough
interview for maternal depression.
Our monthly Promoting Happy and Healthy Youth group provides peer group supervision and discussion for topics
such as maternal depression. This format provides an ideal way to disseminate mental health and developmental
information customized to the needs/questions of participants. Moderators are Drs. Eve Spratt and Michelle Macias,
and co-moderators Drs. Angela LaRosa and Roxanne Scott. All interested pediatric health care providers are welcome to
attend. Breakfast and CME's are provided. For more information e-mail spratte@musc.edu or
macaism@musc.edu.
A special thanks to the following individuals for their efforts in putting together Kids Connection each month.
Managing Editor: Bernard L. Maria, MD, MBA
Publisher: Jessica Munday (Trio Solutions Inc.)
Web design: Jennifer Cherock (Trio Solutions Inc.) and Brian Dadin (Trio Solutions Inc.)
Contributing Writers: Lyndon Key, MD; Bernard Maria, MD; Inderjit Singh, PhD, Phillip Saul, MD,
Michelle Macias, MD, Eve Spratt, MD and Rebecca Ceraul (Trio Solutions, Inc.)
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