From the category archives:

Pediatrics

Their bodies are broken. What about their brains? Traumatic brain injuries after the marathon bombing.

by Tom Ulrich on April 26, 2013

(Jerome Gerrior Racing/Flickr)

In the hours and days following the Boston Marathon bombings, the first concern for the victims was literally life and limb—stabilizing the survivors and treating wounds suffered in the blasts.

But as the survivors begin the road to recovery—a road that promises to be long and complicated—subtler effects of the blast may become apparent, including traumatic brain injuries (TBIs).

“The difference between traumatic brain injuries and the other injuries we’ve seen is that the extent of other injuries can be readily seen,” says Mark Proctor, MD, a neurosurgeon and director of Boston Children’s Brain Injury Center. “You can have a traumatic brain injury without any external signs.”

TBIs have been a major concern among soldiers serving in war zones like Iraq or Afghanistan who have experienced the concussive force of bomb or improvised explosive device (IED) explosions—not unlike the explosions on Marathon Monday. Full story »

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Shining light on jaundice in the developing world

by Tom Ulrich on April 16, 2013

Babies with newborn jaundice need phototherapy. In the developed world that's easy; in the developing world, not so much. (Bruce R. Wahl/Beth Israel Deaconess Medical Center)

Family lore has it that when I was born, I had to spend a couple of extra days in the hospital for jaundice, the distinctive yellow tint to the skin that shows that a baby’s liver isn’t fully up and running yet. For me—and most of the newborns that develop jaundice every year in the developed world—the treatment was simple: spending some time lying under bright blue lights (aka phototherapy).

Note that I said “developed world.” The story in the developing world is quite different. Sometimes the nearest hospital with phototherapy equipment is hours’ or days’ travel away. Even though it’s simple, phototherapy is power intensive; no power, no treatment.

And untreated jaundice can have devastating consequences. The yellow pigment, called bilirubin, can accumulate in the brain and cause permanent brain damage or death.

The best solution for regions with few resources would have to be small and portable, run on batteries or other off-grid power sources, cost little, but still be safe and deliver the right wavelength and intensity of light. This is where Donna Brezinski, MD, wants to make a difference. And the Bili-Hut is her answer. Full story »

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Of magnets and bacteria: Filtering the blood of patients with sepsis

by Tom Ulrich on April 12, 2013

(Ryan Somma/Flickr)

There’s no other way to say it: sepsis is a horrible disease. It typically starts with a runaway bacterial infection in the blood, followed by a runaway immune response that severely damages the body it’s trying to save. The results: shock, multiple organ failure and—in between 210,000 and 375,000 people in the United States alone every year—death.

Part of the problem is that the methods available for treating sepsis aren’t particularly good. Antibiotics can kill the bacteria, but that still leaves bacterial debris floating in the bloodstream, fueling the already over-excited inflammatory response.

Removing the bacteria altogether—as fast as possible—would be the better solution. At least that’s what Daniel Kohane, MD, PhD, thinks. His lab at Boston Children’s Hospital’s Division of Critical Care Medicine has developed a new approach that combines magnetic nanoparticles, a synthetic molecule (called bis-Zn-DPA) that binds to the bacteria, and magnetized microfluidic devices to pull bacteria from the blood quickly and efficiently. Full story »

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Sobering ADHD findings suggest: Stay in treatment

by Nancy Fliesler on March 19, 2013

(leesean-Flickr)

(leesean-Flickr)

There’s a widespread view that attention-deficit hyperactivity disorder (ADHD) is grossly over-treated in kids, especially boys, and will eventually be outgrown. But the results of the first large, long-term population-based study, published recently in Pediatrics, suggest that couldn’t be further from the truth.

While other studies have indicated dire outcomes when children with ADHD grow up, most of these have been small and have focused on the severe end of the spectrum—for instance, boys referred to psychiatric treatment facilities. This new study, started at the Mayo Clinic and led by William Barbaresi, MD, looked at the general population of kids with ADHD and found a greater likelihood of their having other psychiatric disorders as adults, doing jail time or committing suicide.

“Only 37.5 percent of the children we contacted as adults were free of these really worrisome outcomes,” says Barbaresi, now at Boston Children’s Hospital. “That’s a sobering statistic that speaks to the need to greatly improve the long-term treatment of children with ADHD and provide a mechanism for treating them as adults.” Full story »

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A vaccine that works in newborns?

by Nancy Fliesler on March 12, 2013

If we could immunize infants at birth, far more could be protected from infections.(DFID-UK Dept for International Development)

Right now, immunizations against most infections begin at 2 months of age. But that leaves newborns at risk for infections like rotavirus, whooping cough and pneumococcus during a highly vulnerable time.

In resource-poor countries, this is a serious problem: Many children see a health care provider only at birth, so may miss their chance to be protected. Worldwide, each year, more than 2 million infants under 6 months old die from infections, especially pneumonia. If we could immunize infants at birth, it would be a huge win for global health.

Unfortunately, though, newborns don’t respond to most vaccines. Their immune systems are too immature—which is why few vaccines for newborns exist. Full story »

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First reported cure of a baby infected with HIV

by Tom Ulrich on March 8, 2013

HIV (green dots) budding from a white blood cell. (CDC)

AIDS and HIV have been with us for more than 30 years. In that time, millions have died and millions more have been able to keep the virus at bay with a cocktail of medications called highly active antiretroviral therapy, or HAART.

But of those millions, only one person has reportedly been cured. As of this week, that number may now be two.

A team of researchers at Johns Hopkins University Medical School reported at last weekend’s Conference on Retroviruses and Opportunistic Infections the case of a child believed to be born HIV-positive and who, by all available tests, is no longer carrying active virus in the blood.

The key, according to their report, was aggressive and near immediate HAART treatment, starting before the child was 30 hours old and continuing until she was a year and a half old.

“This finding is hopeful but requires further study,” says Sandra Burchett, MD, MSc, clinical director of our Division of Infectious Diseases and director of the Children’s Hospital AIDS Program. “We all agree that treating babies infected with HIV as soon as possible maintains a healthy immune system; what we do not know is when, if ever, it is safe to stop HAART. Treating adults early after infection is not curative, but it may be that babies are somehow different.

“It is critically important, though,” she cautions, “for children, youth and young adults with HIV who are on HAART now to keep taking their medications, not stop on their own to see if they too are cured.”

Some question, though, whether the child was ever actually infected. Her doctors started therapy so early because her mother had uncontrolled HIV, putting the child at extremely high risk of developing the infection herself.

The only other patient reportedly ever cured of HIV is a man named Timothy Ray Brown. In 2006, Brown received a bone marrow transplant for leukemia, but with a twist: the marrow donor had been chosen for harboring a rare genetic mutation that conferred resistance to HIV. According to a paper published in the New England Journal of Medicine in 2009, Brown has been off HAART treatment since 2007 with little to no sign of infection.

Want to learn more? Click here to read an online Q&A with Burchett hosted by The Guardian on March 5.

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Mapping the wiring of the developing brain in 3D

by Tom Ulrich on March 4, 2013

Ed. note: Last week we wrote about Jurriaan Peters, MD’s brain network analysis in children with autism. In the second of our two part series on brain mapping, we talk about ways of mapping the brain’s physical wiring.

(AMagill/Flickr)

At the most basic level, the brain is a collection of wires, albeit a really complex one.

But how during development do nerve fibers thread their way through the growing brain and make the right connections?

The answer to that question could reveal more about the nature of conditions like autism spectrum disorders—which, as we reported about a year and a half ago, seem to have their roots in structurally altered brain pathways.

“We know very little about what’s happening in the developing brain in three dimensions,” says Emi Takahashi, PhD, a researcher in the Fetal-Neonatal Neuroimaging & Developmental Science Center (FNNDSC) at Boston Children’s Hospital. “With histology techniques, we can achieve a two-dimensional view over small areas, but it’s hard to know which fiber bundles are growing in which ways during different stages of development in the whole brain.”

But new MRI-based technologies are quickly closing that knowledge gap, giving us our first high-resolution peek into how the developing brain wires itself up.

Using something called high angular resolution diffusion imaging (HARDI) MRI, Takahashi and her colleagues (including neuroradiologist and FNNDSC director P. Ellen Grant, MD) can trace the three-dimensional pathways within the growing brain via stunning images like these:

Courtesy Cerebral Cortex (Takahashi et al., 2012)

Full story »

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Could “network” analysis of the brain explain autism’s features?

by Nancy Fliesler on March 1, 2013

Ed note: The Obama administration is expected to unveil plans for a decade-long Brain Activity Map project next month. This is Part One of a two-part series on brain mapping.

How is information routed in the brains of children with autism? (Image: Jpatokal/Wikimedia Commons)

It’s now pretty well accepted that autism is a disorder of brain connectivity—demonstrated visually with advanced MRI techniques that can track the paths of nerve fibers. Recent exciting work analyzing EEG recordings supports the idea of altered connectivity, while suggesting the possibility of a diagnostic test for autism.

But what’s happening on a functional level? A study published this week zooms out to take a 30,000-foot view, tracking how the brain routes information in children with autism—in much the way airlines and electrical grids are mapped—and assessing the function of the network as a whole.

“What we found may well change the way we look at the brains of autistic children,” says investigator Jurriaan Peters, MD, of the Department of Neurology at Boston Children’s Hospital. Full story »

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Redesigning behavioral health care: The time is now

by Richard Antonelli on February 8, 2013

(TheReapersApprentice/deviantART)

Richard Antonelli, MD, is a primary care pediatrician and medical director of Integrated Care and Physician Relations and Outreach at Boston Children’s Hospital.  He also co-chairs the Task Force on Care Coordination for Children with Behavioral Health Needs, a group within the Massachusetts Child Health Quality Coalition. Laura Chandhok, MPH, Physician Partnership Liaison at Boston Children’s Hospital, contributed to this post.

The recent shootings in Newtown, Conn., have revived the long-standing debate about gun control in the United States and rightly put a spotlight on media and video-game violence. Importantly, this tragic event has also raised questions about the adequacy of our nation’s behavioral health system and whether troubled children, adolescents and their families have access to needed diagnostic and management services.

These questions aren’t new. And as care delivery models evolve in response to the demands for better care at lower costs, we have an opportunity to improve our behavioral health services. Full story »

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Telemedicine brings expert blindness screenings to preemies

by Nancy Fliesler on February 7, 2013

ROP screening in the NICU

Gretchen Hamn (L) and Margie Young screen a premature infant for retinopathy of prematurity. (Photos: Katherine C. Cohen)

We’re in the Neonatal Intensive Care Unit at South Shore Hospital. Six tiny, swaddled preemies are ready to be examined, their eyes numbed and their pupils dilated with special drops.

Gretchen Hamn, NNP, and medical assistant Margie Young go from isolette to isolette. Young tends to the first baby and gently positions him for his exam. Hamn pulls over a cart and extends a kind of hose with a camera at the tip. This she places directly on each of the baby’s eyes, taking a digital video of his retinas. Full story »

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