What time is the right time to give a transfusion? Doctors at Boston Children's are turning a fresh eye on transfusion guidelines for children. (@alviseni/Flickr)
Cancer. Trauma. Sickle cell disease. Surgery. There are many reasons why a child might need a blood transfusion, but they all share a common theme: the need to replace blood or blood products (e.g., red blood cells, platelets) that have been lost or consumed, or make up for defects that keep the body from producing them in adequate amounts.
And though transfusions can be life saving, they come with risks, such as iron overload, inflammation or disease (a very low risk, thanks to improved screening tests). And blood products are expensive and scarce—another reason to be prudent about transfusions.
“There’s little science behind physicians’ current practices when deciding when to transfuse a patient,” says Jenifer Lightdale, MD, MPH, of Boston Children’s Hospital’s Division of Gastroenterology and Nutrition. “Many doctors use criteria their mentors passed down to them, which their mentors passed down to them, and so on. But ideally, the decision should be based on evidence, not tradition.” Full story »
Early seizures may disrupt circuit formation in babies' brains, leading to autism. But new research suggests that an existing drug can reverse this.
This is the third post in a series about new approaches for seizures and epilepsy. Read the first and second posts.
We already know that there’s some kind of connection between epilepsy and autism: Children who have seizures as newborns not uncommonly develop autism, and studies indicate that about 40 percent of patients with autism also have epilepsy. New research at Boston Children’s Hospital finds a reason for the link, and suggests a way to break it — using an existing drug that’s already been given safely to children.
In the online journal PLoS ONE, Frances Jensen, MD, in the Department of Neurology and the F.M. Kirby Neurobiology Center at Boston Children’s, and lab members Delia Talos, PhD, Hongyu Sun, MD, PhD, and Xiangping Zhou, MD, PhD, showed in a rat model that early-life seizures not only lead to epilepsy later in life, but also produce autistic-like behaviors.
Drilling deeper, they showed that early seizures hyper-activate a group of signaling molecules collectively known as the mTOR pathway. Full story »
Excess brain electrical activity at night can disrupt development -- but if found, may be treatable.
This is the second post in a series about new approaches for seizures and epilepsy.Read the first post here.
When a 2- or 3-year-old child begins losing milestones like language, walking skills and fine motor abilities, or is slow to achieve them, it’s devastating for families. The good news, at least for some children, is that it might be treatable.
Tobias Loddenkemper, MD, a neurologist in the Epilepsy Center at Boston Children’s Hospital, suspected that some children with developmental delay have seizure-like activity in the brain at night. These spikes of electrical activity, referred to medically as sleep-potentiated epileptiform activity, can be readily and inexpensively detected by electroencephalography, or EEG, and readily treated with nighttime anti-seizure drugs.
But likely, no one’s thought of it. “Very few physicians have been looking to see what’s happening at night,” Loddenkemper says.
He and research fellow Iván Sánchez Fernández, MD, with other colleagues, decided to look themselves. Full story »
This comfy wristband can sound an alarm when a child is having a seizure, and can help doctors better time medication dosing.
This is the first post in a series about new approaches for seizures and epilepsy.
Seizures are often hard to track in children with epilepsy, making it difficult for doctors to optimize their treatment. For parents, the greatest worry is that their child will have a life-threatening seizure in the middle of the night or away from home, unable to get help. And what about when that child goes off to college?
“Every parent asks, ‘What can I do to prevent my child from harm?’” says Tobias Loddenkemper, MD, a neurologist in the Epilepsy Program at Boston Children’s Hospital.
Loddenkemper also wanted to better understand his patients’ seizure patterns so he could better time the dosing of their medications. He’s been testing a wristband sensor system, developed by Rosalind Picard, ScD, and colleagues at the MIT Media Lab (Epilepsia, March 20), and thinks it could be part of the solution. Full story »
Innovation is one of the most talked-about subjects in business and now health care. It is also one of the most misunderstood subjects. People confuse innovation with creativity, brainstorming and invention.
Simply put: Innovation is a process for testing and developing new ideas. Innovation in health care organizations does not happen by chance, and in fact follows a predictable course.
Several years ago I developed the idea of an innovation “lifecycle,” comprised of six predictable stages with a gap in the middle (more on that gap below). It’s a powerful paradigm for understanding and organizing innovation in a health care organization (or any organization, for that matter).
Stage 1: Initiate
An innovation’s lifecycle begins with the identification of a problem or opportunity. Full story »
Nestled in the pons (the red area above), the area that controls breathing, DIPG tumors have been impossible to biopsy and analyze for therapeutic insights. Until now. (MEXT Integrated Database Project/Wikimedia Commons)
Brain tumors can be very difficult to treat, but at least we know what to do about them. For years, a mix of surgery, radiation and chemotherapy has been used to treat brain tumors like medulloblastoma.
These treatments are fairly successful, but for a rare, almost always fatal tumor called diffuse intrinsic pontine glioma (DIPG), we haven’t had any success—in fact, we haven’t known where to start.
The problem has to do with where DIPGs are located: nestled among the nerves in a portion of the brain stem, the pons, that controls critical functions like our breathing, blood pressure and heart rate.
“For 40 years, we lacked the neurosurgical techniques to biopsy DIPGs safely,” say Mark Kieran, MD, PhD, director of the Brain Tumor Program at Dana-Farber/Children’s Hospital Cancer Center (DF/CHCC). “In fact, one of the first lessons every oncologist is taught still is, ‘Don’t biopsy brain stem gliomas.’ The dogma was that the risk of severe or fatal damage was too great.” And because we couldn’t biopsy them, we couldn’t study them to learn what makes them tick.”
A lot can change in four decades. Techniques for operating on the brain have advanced considerably, as have the tools for probing tumors at the molecular level. So, looking to turn the dogma about DIPGs on its head, Kieran has launched a clinical trial that aims to use advanced surgical and diagnostic tools to target and individualize DIPG treatment. Full story »
Some children with autism are "bloomers" and are able to move to the high-functioning category. They're also more likely to have mothers who are white and educated.
A child with autism is more likely to do well if his mother is white and educated.
This is the message of a study just released in the journal Pediatrics, and it’s something we need to pay attention to—now.
Researchers from Columbia University wanted to find out what happens to children with autism over time. So they looked at the records of more than 6,000 children with autism who were enrolled in California’s Department of Developmental Services (DDS). To get into DDS they had to be referred, and their diagnosis had to be confirmed by someone with expertise in autism.
What they found was that when it came to social and communication skills, for the most part the kids fell into groups ranging from low-functioning to high-functioning. The kids did make progress; the most rapid gains were before age six, and the high-functioning kids tended to make more progress than the low-functioning ones. Even as they made progress, they tended to stay in the group they started in—with one notable exception. That exception was a group the researchers called the “Bloomers.” Full story »
Brain MRIs from mice after stroke. Mice lacking Hv1 (right panels) had a much smaller volume of infarcted tissue than normal mice. Hv1 can also be blocked chemically.
Whether it’s in adults or in children with clotting disorders or other conditions such as sickle-cell disease, a stroke can be likened to an atomic bomb. Just as ongoing radiation can do more damage than the bomb itself, the secondary damage of a stroke can devastate the brain.
In an ischemic stroke, accounting for nearly 90 percent of all stroke cases, it happens like this: When vessels supplying blood and oxygen to the brain are blocked by a narrowing or a clot, immune cells in the brain sense the low-oxygen conditions, suspect an invading organism and try to kill it by producing molecules known as reactive oxygen species or ROS’s. These, unfortunately, have an inflammatory effect that actually damages the brain further, injuring and killing neurons.
“Stroke produces inflammation, and that’s one of the main things people have been after in trying to reduce stroke damage,” says David Clapham, MD, PhD, chief of the Basic Cardiovascular Research Laboratories at Boston Children’s Hospital.
Right now there’s nothing that can do this. Most existing stroke drugs are aimed at preventing the stroke or dissolving blood clots once the stroke is happening – but they can’t deal with the aftermath. Full story »
On June 6, 2011, the Boston Bruins were playing the Vancouver Canucks in game 3 of the Stanley Cup finals. Bruins forward Nathan Horton had passed the puck to his teammate Milan Lucic when he was blindsided by the Canucks’s Aaron Rome, who buried his left shoulder into Horton’s face. Horton’s head was spun backwards, down towards the ice. The back of his head was the first part of his body to make contact with the ice. He was knocked unconscious. His arms became rigid. His eyes rolled back in his head. He had a convulsion.
Nathan Horton was concussed.
Concussion is all too common in sports, particularly those, like ice hockey, that involve body-to-body collisions. Yet it’s still somewhat of a medical mystery. Until the last 10 to 15 years, few physicians or scientists considered concussion significant enough to warrant scientific investigation. Thus, we know very little about it. Full story »
Leveling the immune system might let the body rebuild one that's tolerant of a transplanted kidney. (Photo: Tom Ulrich)
As the science of transplantation has gotten better, the patients whose lives are saved by other people’s organs are living longer and longer. But they’re paying a price—a lifetime of immunosuppressive drugs. William Harmon, chief of Nephrology at Children’s Hospital Boston, is trying to change that. Full story »
