New research reinforces that inborn vulnerabilities can tip infants toward SIDS.
Epidemiologic studies have shown that infants who die suddenly, unexpectedly and without explanation—what’s referred to as sudden infant death syndrome, or SIDS—are often found sleeping face down with their face in the pillow, or sleeping next to an adult. These are environments that have the potential to cause smothering and asphyxiation. By advising parents to have infants sleep on their backs, in a separate crib or bed, the government’s Safe to Sleep
campaign (formerly known as Back to Sleep) has greatly reduced deaths from SIDS.
Hannah Kinney, MD, a neuropathologist at Boston Children’s Hospital, is clear that this campaign must go forward—it’s saved thousands of lives. But still, she receives calls from parents and grandparents haunted by their infants’ death, feeling at fault and wanting a second opinion.
And in many cases, she has been able to document abnormalities in brainstem circuits that help control breathing, heart rate, blood pressure and temperature control during sleep.
What’s lacking is early detection and treatment. Full story »
This child-sized device assists children with thumb movements while giving them sensory and visual feedback. (Image: Wyss Institute, Harvard University)
Our ability to use the thumb as an opposable digit is a critical part of what sets us apart as a species. “That’s how you’re holding a pen,” Leia Stirling, PhD, a senior staff engineer at the Wyss Institute for Biologically Inspired Engineering told me recently as we talked about the Wyss’ latest collaboration with Boston Children’s Hospital. “That’s how you hold your phone; that’s how you open a door; that’s what makes us unique.”
It’s also an ability that children who have suffered a stroke or have cerebral palsy or hemiplegia (paralysis on one side of the body) can lose or fail to develop in the first place.
Stirling, along with Hani Sallum, MS, and Annette Correia, OT, in Boston Children’s departments of Physical and Occupational Therapy, are the architects of a robotic device that may improve functional hand use. The device assists children with muscle movements, using small motors called “actuators” placed over the hand joints, while giving them sensory and visual feedback. It’s called the Isolated Orthosis for Thumb Actuation, or IOTA. Full story »
Because unplanned hospital readmissions put patients at risk, burden families and add to the cost of health care, many medical professionals are taking steps to reduce them. To push the effort, new Centers for Medicare & Medicaid Services (CMS) rules impose escalating penalties that decrease a hospital’s Medicare payments if patients are readmitted within 30 days of discharge.
Last week on Vector, we reported research suggesting that some readmissions may be incorrectly classified as preventable (and thereby penalized), particularly at pediatric hospitals. But what steps can be taken to reduce the number of truly preventable readmissions?
One step, highlighted here last week, is making post-discharge communications much simpler with texts and emails. But how can hospitals make sure their patients are ready to go home? A new study published in the International Journal for Quality in Health Care finds that in pediatric settings, the answers may be found in parents’ perceptions, which turn out to be good predictors of an unplanned readmission. Full story »
Is universal cardiovascular screening supported by the data, and are clinicians ready?
In 2011, the National Heart, Lung, and Blood Institute (NHLBI) guidelines for cardiovascular risk reduction in pediatrics reinforced the recommendation that primary care pediatricians (PCPs) should screen children and adolescents for cholesterol and blood pressure elevations. However, as PCPs try to incorporate it into their well childcare routine, questions are being raised about the practical implications of implementing that recommendation.
Last month, the U.S. Preventive Services Task Force (USPSTF) published its finding that there is not enough evidence to recommend for or against routine screening for primary hypertension in asymptomatic children and teens, repeating its suggestions from 2003. It has issued similar statements about lipid screening.
At this week’s 2013 American Academy of Pediatrics (AAP) conference, Sarah de Ferranti, MD, MPH, director of the Preventive Cardiology Clinic at Boston Children’s Hospital, gave a presentation titled “Universal Lipid Screening: Are Pediatricians Doing It and How Is It Working?” She spoke with Vector about screening both for cholesterol and blood pressure in children. Full story »
The demand for hematopoietic stem cell transplants is rising. But how can we get more cells? (Text from Bryder D, Rossi DJ and Weissman IL. Am J Pathol 2006; 169(2): 338–346.)
You need a lot of hematopoietic stem cells to carry out a hematopoietic stem cell transplant
, or HSCT. But getting enough blood stem cells can be quite a challenge.
There are many HSCs in the bone marrow, but getting them out in sufficient numbers is laborious—and for the donor, can be a painful process. Small numbers of HSCs circulate within the blood stream, but not nearly enough. And while umbilical cord blood from newborn babies may present a relatively rare but promising source for HSCs, a single cord generally contains fewer cells than are necessary.
And here’s the rub: The demand for HSCs is only going to increase. Once a last resort treatment for aggressive blood cancers, HSCTs are being used for a growing list of conditions, including some solid tumor cancers, non-malignant blood disorders and even a number of metabolic disorders.
So how do we get more blood stem cells? Several laboratories at Boston Children’s Hospital and Dana-Farber/Boston Children’s Cancer and Blood Disorders Center are approaching that question from different directions. But all are converging on the same end result: making more HSCs available for patients needing HSCTs. Full story »
Hackathons are quickly growing beyond Red Bull- and Dorito-fueled code-fests into fertile grounds for new technologies and products that potentially could improve medicine and health care.
But beyond individual events, could hackathons signal the beginnings of a new ecosystem for medical innovation?
That’s what groups like MIT’s H@cking Medicine, Brigham and Women’s Hospital (BWH)’s new iHub and the New Media Medicine group at the MIT Media Lab are betting on. By tapping the same creative entrepreneurial energy that hackathon culture has brought to the technology industry, they believe they can fundamentally reimagine health care, one device, app and system at a time.
“The Boston area is the most fertile ground for medical innovation you could ever imagine,” says Michael Docktor, MD, a gastroenterologist at Boston Children’s and one of the organizers, with the H@cking Medicine team, of this weekend’s Hacking Pediatrics hackathon. “We need to make the case with the local medical and technology community that hackathons are a viable way of innovating in this day and age, that this is the way we ought to be innovating.” Full story »
With the latest technologies and techniques, MRI (bottom) is in many cases just as good as, if not better than, CT (top) when taking images of a child's chest. (Courtesy Edward Y. Lee, MD, MPH)
Magnetic resonance imaging, or MRI, can produce stunningly detailed images of the body’s tissues and structures. Historically, however, the chest—and in particular, the lungs and airway—has proven challenging for radiologists to clearly visualize through MR images.
Why is that? Unlike most other solid organs, the lung and trachea aren’t really solid. The air spaces within them do not absorb the magnetic fields or produce the radio signals needed to generate high-quality diagnostic images. Also, they are in constant motion—we have to breathe, after all.
For these reasons, radiologists have long relied on x-rays and computed tomography (CT) scans to take pictures of the lungs. Both can produce very good, highly detailed diagnostic images, but both also come with risks related to their reliance on ionizing radiation.
The lung MRI’s time may now have come. In a review paper in Radiologic Clinics of North America (RCNA), an international team of radiologists led by Simon Warfield, PhD, and Edward Y. Lee, MD, MPH, of Boston Children’s Department of Radiology outlines several recent advances that have made MRI a more viable—radiation-free—alternative for diagnostic imaging of children’s lungs and airway. Full story »
The discovery of penicillin in 1928 marked the beginning of the antibiotic era and dramatic improvements in health and medicine. With mass production of the new ‘wonder drug’ in the 1940s, threats from previously lethal diseases like bacterial infections and pneumonia waned. However, less than 100 years later, the Centers for Disease Control and Prevention (CDC) is sounding alarms about the increasing threat of antibiotic resistance.
The United States is edging closer to the cliff of a post-antibiotic era in which medications lose their effectiveness, the CDC cautioned in a September report, detailing the burden and threat posed by antibiotic-resistant bacteria.
Every year, more than 2 million people in the U.S. contract antibiotic-resistant infections, and at least 23,000 people die as a result. Estimates vary, but data suggest that the direct health care costs of antibiotic resistance may top $20 billion annually.
The path from remedy to resistance is rapid. “Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” says Steve Solomon, MD, director of CDC’s Office of Antimicrobial Resistance. Full story »
Boston Children’s Hospital convened the National Pediatric Innovation Summit + Awards 2013 with an ambitious goal: to bring together thought leaders to address the toughest challenges in pediatric health care. During the two-day summit, a series of panels and town hall discussions sparked dynamic dialogue.
While the summit was designed as a forum for ongoing discussion and relationship building, five key takeaways have emerged. Full story »
The Human Genome Project’s push to completely sequence the human genome ran a tab of roughly $2.7 billion and required the efforts of 20 research centers around the world using rooms full of equipment.
But that was using technology from the 1990s to early-2000s. As by a panel of genomics experts from industry and academia pointed out at last week’s National Pediatric Innovation Summit + Awards, a scientist in a single laboratory today can sequence a genome for as little as $1,000, making sequencing almost a medical commodity.
Now what? How do we go about making clinical genomics an everyday thing? The discussion left the answer to that question—and the other questions it raises—unclear. While the panelists expressed excitement about what’s possible, they cited great uncertainty among doctors, scientists, patients, payers, companies and regulators about how to make clinical genomics work. Full story »