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.