Mandatory Pulse Oximetry Screening for Newborns Takes Effect in Maryland

By Carissa M. Baker-Smith, MD, MPH

Assistant Professor, University of Maryland School of Medicine

Pediatric Cardiologist, University of Maryland Children’s Heart Program

A quick, painless and non-invasive test to determine the amount of oxygen in a newborn baby’s blood is a first step in screening infants for congenital heart defects. Beginning September 1, 2012, hospitals in Maryland must administer the test to all newborns.

Congenital heart disease (CHD) occurs in approximately 8 of every 1,000 children.  Infants born with congenital heart disease have structural defects of the heart. Approximately 25% of all CHD cases are critical and require intervention during the infant’s first month of life. Interventions can include the administration of special medications or even surgery. Pulse oximetry may be helpful in improving the detection of critical CHD (CCHD).

On September 1, 2012, hospitals across Maryland begin mandatory pulse oximetry screening for all newborns. The screening must be done by a health professional before the infant is discharged and within 24 to 48 hours after birth. All hospitals in Maryland will be responsible for creating and implementing pulse oximetry screening protocols.

Children who “fail” pulse oximetry screening will undergo further evaluation, and their primary care providers will work closely with pediatric cardiologists to make the correct diagnosis. Failing the pulse oximetry test means oxygen saturation is lower than normal without another explanation, such as infection or lung disease.

What is pulse oximetry?

Pulse oximetry relies on the use of a non-invasive, painless method for detecting the amount of oxygen in the blood.  Probes are applied to the palm of the hand and the sole of the foot. The protocol selected by the State of Maryland for screening  is published in the Journal of Pediatrics (Pediatrics 2011; 128; e1259). Children with oxygen saturation less than 90% automatically test positive and fail screening.  Children with oxygen saturation greater than 95% test negative and pass screening. Children with oxygen saturation between 90% and 95% will undergo repeat testing and evaluation.

What is the potential impact of pulse oximetry screening?

We anticipate that pulse oximetry screening will enhance detection of CCHD. Data indicate that for every 1,000 children born in Maryland, 2.3 have CCHD.  Currently, between 60% and 70% of these infants are diagnosed through prenatal screening, leaving approximately 30% who are not yet diagnosed by the time they are born. Combined with physical examination, pulse oximetry is reported to improve sensitivity for detecting CHD by 20%.

What is the role of the Children’s Heart Program?

The University of Maryland Children’s Heart Program offers a comprehensive panel of services designed to accurately diagnose and effectively manage and treat children with CHD and CCHD.  Pediatric cardiologists are available 24 hours a day, 7 days a week, to assist with the diagnosis of CHD.  Through consultation and telemedicine services, the Children’s Heart Program is ready to assist surrounding providers and families with the evaluation of infants with suspected CCHD.

For more information on pulse oximetry, please contact the Children’s Heart Program at 410-328-4FIT (4348).

Dr. Baker-Smith is a member of the Maryland State Advisory Council’s Committee for CCHD and the Newborn Screening for Critical Congenital Heart Disease multi-institutional group.

A Mission to Ecuador for Pediatric Heart Surgeon

By Meghan Scalea

UMMC Communications Account Leader

Sunjay Kaushal, M.D., Ph.D., associate professor at UM School of Medicine and director of pediatric cardiac surgery at UMMC, recently returned from a medical mission to Ecuador, where he performed life-saving heart surgeries on nearly 20 children who would have died without surgery.

 

Dr. Kaushal, a father of two, is a huge advocate for kids. This medical mission to Guayaquil, Ecuador, was his fifth trip with the International Children’s Heart Foundation (ICHF), a group dedicated to providing supplies, training and surgical resources to care for underprivileged children with heart disease in dozens of countries around the world.

According to the ICHF, 1% of the world’s population is born with heart disease, only about one-third is diagnosed, and even fewer receive life-saving heart surgery. Congenital heart disease is the most common birth defect in the world.

“There is a huge surplus of kids with congenital heart disease,” says Kaushal. “Traveling with this group allows me to provide free health care for children who wouldn’t otherwise be treated.”

Joining him in Ecuadorwas UMMC certified surgical technologist, Nicolette Dupuis, who supports Dr. Kaushal in his pediatric heart surgeries in the OR in Baltimore. This marked Dr. Kaushal and Ms. Dupuis’s third medical mission trip together. During their week inEcuador, they worked with cardiologists and intensivists from hospitals around theU.S. in the sparse operating rooms.

 “Part of our job while we were inEcuadorwas to teach the local medical professionals to do congenital heart surgeries like we do, but on a smaller level,” says Dr. Kaushal. “Our day began at 7:30 am, and we’d operate until 9:00 pm. We staffed the ICU 24/7 during the time we were there to make sure those children had the post-operative care they needed.”

Dr. Kaushal is the only board-certified congenital heart surgeon inMaryland, giving him a unique expertise in performing surgical procedures on babies just a few days old who were born with heart disease, children with congenital and acquired heart disease, and adults living with heart conditions they developed as babies, known as adult congenital heart disease.

Dr. Kaushal performs the most complex pediatric heart surgeries available today, including surgeries for babies with hypoplastic left heart syndrome, Tetralogy of Fallot and ventricular septal defect, and those in need of pulmonary valve replacement. He is also preparing to open a clinical trial that will use a baby’s own stem cells to regenerate the underdeveloped portion of their heart caused by hypoplastic left heart syndrome.

We invite you to learn more about what Dr. Kaushal and the Children’s Heart Program at UMMC are doing for children within the Mid-Atlantic region.

How to Raise a Veggie-Eating Kid

By Faith Hicks, MS, RD, LD/N, CSP

Senior Clinical Dietitian

Editor’s Note: A version of this article appeared in The Baltimore Sun 03/07/12, in the Taste section and online.

How is it that some kids will eat whatever is put in front of them, while others live on hot dogs and chicken nuggets and have a phobia for vegetables, especially anything green?  As adults, we know that we ourselves probably should be eating more fruits and vegetables, and we would like to raise our kids to have healthier eating habits and a varied diet right from the start.  There are a number of ways parents and other adults can promote good eating habits from early childhood and throughout the teen years.

Make a regular “date night” – a family dinner date night, that is!

One of the best ways of promoting good eating habits in children is to make eating meals together a priority. This is something that often gets lost in the shuffle of soccer practice and scout meetings, but try to identify at least one or two nights a week to have dinner as a family.  Children who are raised having regular family meals generally consume more servings of fruits and vegetables and develop a liking for a wider variety.  They also tend to have a diet lower in fat and are less likely to become overweight than children from families who eat on the run.  From the start, toddlers mimic their parents’ eating habits.  So a parent who includes fruits and vegetables at mealtimes sets the example that these foods are tasty and that consuming them is the norm and is expected.

There are other important benefits of having meals as a family. Children whose families dine together regularly develop better language skills.  During dinner conversation, they are exposed to a larger vocabulary. They become adept at participating in a higher level conversation.  Another benefit of family meals extends into the teen years, teens that regularly have dinner with the family get better grades and are less likely to try drugs, tobacco, and alcohol.  It seems that mealtimes help foster a sense of connectedness within the family and when parents are tuned into their teens, teens are less tempted to dabble in risky behavior. 

Lighten up and don’t turn mealtime into a “pressure cooker”

Another way of fostering a varied diet is to offer new foods several times and without undue pressure.  It may take more than several times trying a new food for a toddler or preschooler to accept it, so don’t give up after the first try! Place a small portion of each food that you are having on your child’s plate.  When they see that you eat it, the expectation is set that they will like it, too.  Beware of trying too hard to persuade a child to eat because this might backfire! It can send the message that the food item is not very appealing.  For example, if a child is rewarded for eating green beans by getting a cookie, the parent sends a message that green beans are yucky.  The child may think “that must not taste very good if I have to be bribed with treat.”  Rather, make a light-hearted request for the child to just to try “just a bite.”

Involve kids in food shopping and preparation.

Children and teens are more interested in foods they have selected, prepared, or even grown at home.  Wander the produce section of the grocery store with your child and let him choose a new vegetable or fruit to try each week.  Buy a colorful, child-oriented cookbook to provide ideas for foods you can prepare together.  Cooking together provides an opportunity to learn other skills, such as fractions.  Even small children can be safely involved in cooking activities such as washing produce or putting toppings on a veggie pizza. Consider planting even a small garden and check out seed displays with your child. Seed companies sell kid-friendly vegetables in packets bearing very appealing pictures. Children who are drawn to miniature things may be fascinated by picking cherry tomatoes or pulling from the ground the baby carrots planted earlier in the spring. Brussels sprouts might be a little more fun to eat once you have seen how they seem to march in lines as they grow from the plant’s stem! 

In summary, the key to raising a “good eater” is having fun with food together, right from the start.

Snowpile: Santa Sets Up a Satellite Workshop at the UM Children’s Hospital

By Shannon Joslin, MS, CCLS

Child Life Manager
University of Maryland Children’s Hospital

Being in the hospital at any time is a challenge, but especially so for young patients during the holidays.  Children miss their family, friends and their traditional holiday activities.

Here at the University of Maryland Children’s Hospital (UMCH), it’s a little easier thanks to some generous people in the community — grateful families of current and former patients, companies, local businesses and other individuals who open their hearts and checkbooks to allow the Child Life Program to host the second annual Snowpile event for children and families in the hospital over the holidays.

The Child Life team sets up a toy workshop from Dec. 21 to Dec. 23 each year and invites parents of children who are in the hospital over the holiday to come shopping (for free) for their child.

In addition to the toys, every parent is able to “stuff a stocking” full of goodies for their child in the hospital as well as stockings for any siblings at home so they don’t feel left out while their brother or sister is hospitalized.

We have volunteer gift wrappers to help with wrapping the gifts and we have coffee, cookies and snacks for parents so they can take a moment for themselves in the midst of their child’s hospitalization.  Last year, we had Girl Scout cookies donated through a troop whose leader works at UMMC. This year, we got donated food and drinks from the Au Bon Pain restaurant in the hospital lobby and The Penn Restaurant nearby onPratt Street.

Parents either take their gifts with them if there’s a chance their child is being discharged before the 25th, or they leave them with our Child Life team for delivery on the 25th.  Parents who have participated have commented on how this was such a help, for two reasons — finances are usually tight and their time to go shopping is limited because they want to stay at the hospital with their child.

If you would like more information about the Child Life Program at UMCH or how to help support children and families in the hospital, please visit our Child Life Web site.

10 Healthy Lunch Tips: Add Punch to Your Kid’s Lunch!

Childhood obesity is a growing public health crisis among children and adolescents that has continued to rise every year.  To address this epidemic, the University of  Maryland, in partnership with the Maryland Department of Health and Mental Hygiene, sponsored  The Summit on Childhood Obesity  November 15-16, 2011, at the Hilton Baltimore Hotel.  

The purpose of the University of Maryland’s Summit on Childhood Obesity is to exchange information, educate and engage prominent figures at the local and federal levels in discussions about how to confront the problem and develop an action plan to promote a healthier lifestyle for children and families.  Below, UMMC Nutritionist Shanti Lewis offers 10 healthy lunch tips to help pack a fun, healthy lunch for your kids.

 

by Shanti Lewis, RD, LDN, CSP, CNSD

Since 1 out of 3 children in the U.S.  is overweight or obese, parents play a vital role in teaching children healthy eating habits and helping them maintain a healthy weight.  One of the ways that parents can help children learn about nutrition is by getting them involved in preparing meals.  Getting kids involved in preparing their school lunch helps them learn about portion control and allows them to select healthy foods that they enjoy.

  • Choose the good stuff! Plenty of fruits, veggies, beans, lean meats, low-fat dairy and whole grains.
  • Make fun shapes! Use cookie cutters for flower, heart, star, or snowflake sandwich bites. Form a funny face, mermaid body, or spooky spider shape.
  • Get your kids involved! Have them pick pasta shapes, their favorite fresh fruits, nuts, seeds and veggies.
  • Utilize leftovers from last night’s dinner or today’s breakfast: think pizza bites, egg roll-ups, or mini bagels with low-fat cream cheese.
  • Remember food safety: Keep the hot foods HOT and the cold foods COLD. Use insulated lunchboxes with ice packs and a thermos for soup.
  • Choose water or low-fat milk in place of juice or sugary drinks.
  • Watch the salt! Select lower sodium lunchmeats and cheeses.
  • Find the fiber: Choose whole grain crackers, breads, wraps, and muffins. Try popcorn or whole wheat pretzels as a substitute for chips.
  • Be creative! Offer a variety of different textures, shapes, and colors from local and seasonal fruits and vegetables.
  • Decorate plastic bags with fun stickers, jot a note on the banana or orange skin, and tuck a handwritten love note inside the lunchbox.

Additional Resources

Shanti Lewis is a neonatal nutritionist at the University of Maryland Medical Center.  She is an author and frequent contributor to blogs and articles on fitness and nutrition. Lewis received her bachelor’s in nutrition and food science from Drexel University and completed her dietetic internship at the National Institutes of Health.

The Child Life Department Hosts a Back to School Carnival

By Megan Kikola, M.S., CCLS
Child Life Assistant

If you happened to take the rotunda elevators to the Children’s Hospital on Friday, August 12, you would have been greeted by a wonderland of music, characters, and bright colors. A world where the pediatric patients were not focused on pokes, IV pumps and tears; but on games, prizes and laughter.  This event was the “Back to School Carnival” hosted by the Child Life Department at the University of Maryland Children’s Hospital.

A primary goal of child life professionals is to normalize the hospital environment, while providing psychosocial support to patients and families. Most importantly, child life professionals promote self expression and play. Creating a world where kids can be kids is always a priority, which is how the carnival idea came to be.

The creative vision was that of Sandra Dean, one of the child life assistants. “It’s all for the kids,” Dean said of the event, “…anything to make their stay memorable.” Her imagination, coupled with the support of wonderful donors brought the carnival to life. Once the plan was in place, the child life team got to work creatively, rallied volunteers, and gained the support of the medical teams.

Some highlights of the event included a bounce house, water balloon pop, a DJ, snow cones, games and prizes. Book bags filled with school supplies were donated and distributed to patients. The happiness and excitement of the patients made all of the hard work worthwhile. When told the event was underway, a young patient stated “Yay! I’m so happy!” as she ran toward the festivities. A parent shared, “It was so fun, my kids could have stayed in the bounce house all day.”

The child life team is very grateful for the continued support of the hospital community and volunteers and looks forward to hosting more of these events.

UMMC Employee’s Girl Scout Troop Reaches Out to Help Those Less Fortunate on Thanksgiving

By Tanya Berry
Training Coordinator, Learning and Organizational Development

This school year I became a Girl Scout (GS) Troop Leader in Harford County, MD to five amazing 11-year-old girls. When we first met, I asked them what it was they wanted to focus on this year. Without batting an eye, they all responded that they wanted to help other people — less fortunate people.

Our first chance to work on achieving this goal came during our first cookie sale drive. The girls chose to collect donated boxes of cookies for the University of Maryland Hospital for Children, because they wanted the children who were hospitalized there to know that there were people thinking about them and their families and wishing for their speedy recovery. They collected 50 boxes of cookies, which they called “Gifts of Caring,” and were delighted when they received a photograph and note from the kids who were benefiting from their yummy gift of cookies.

With the Thanksgiving holiday approaching, the girls again wanted to reach out to those people less fortunate than themselves. I asked them how they thought they could achieve this, and they replied that they wanted to prove that the power of five was mighty! Five girls feeding 50 people!

Although the girls’ wanted to give back to the community, they knew they needed help. Each girl’s goal was to feed 10 homeless citizens here in Baltimore. They reached out to businesses in the neighborhood to ask for donations in order to realize this goal. Together, they were able to have Weis Supermarkets from Bel Air, MD donate 10 pounds of turkey and ham, six loaves of bread and seven cans of cranberry sauce. Kirbies Cafe in Baltimore was also kind enough to donate condiments, serving cups and 20 pounds of potato salad. The girls bought napkins, forks and sandwich bags with their own money. In the end, the troop was able make enough brown bag lunches to feed 80 people. They had a fantastic time making the lunches on Thanksgiving Eve.

We woke up early Thanksgiving morning to find homeless men and women throughout the area to feed. The girls searched under underpasses, street corners and park benches. They climbed the steps of Baltimore’s City Hall and fed the homeless at the Helping Up Mission on Baltimore Street. We were greeted with smiles and “Thank You’s” from all of the people we served that day, and the girls walked away with an amazing feeling and understanding of true community service.

The girls have now pledged to double the amount of food we serve next year and have already started planning their next service project. These kids genuinely want to give back and make a difference in the world they live in. I have never been more proud of any group of young girls as I am of my Troop 2825. I love them, and I know that they are each going do great things!

Tricks to Avoid Calorie-Heavy Treats on Halloween

By Amanda Tauber
UMMC Nutritionist

Editor’s Note: Amanda Tauber wrote this post on October 19, 2010 for Exercists, the Baltimore Sun’s health and fitness blog. This post, which has been edited, is reprinted with the permission of the Baltimore Sun.

Halloween is one of those holidays where eating too many sweets is common. From the 200 Tootsie Pops to the 50 Snickers bars you and your children will collect, it’s easy to see how the extra pounds and cavities can develop. Below are some tips to set you up for a healthier (but just as fun) Halloween season.

Eat ahead of time. Having a dinner or snack rich in complex carbohydrates, lean proteins and unsaturated fats can cut down on post holiday candy consumption. Some great options include peanut butter and jelly sandwiches with a glass of milk, whole grain pasta with vegetables and grilled/baked chicken, or tuna salad in whole wheat wraps.

Think small. Buy a little bucket for trick-or-treating. Lugging around a giant tub is not only impractical, but holds more candy that will likely get eaten. A smaller tub will save you the backache of having to carry it around and means less candy. Buy mini or “fun size” candy if possible. Buying smaller pieces can lead to eating less candy overall, plus most prepackaged bags of candy contain miniature or fun sizes.

Give it away. After a few days, bring in extra candy to work, parties, or other social gatherings. If this isn’t an option, consider throwing some of the candy out. Many places also accept donations of unwrapped candy.

Hide the candy. By placing sweet treats in a high cabinet, kids can’t reach it and you might be less likely to eat it, too. If you can’t hide it, divide and conquer: portion the candy out. Keep a sandwich-size plastic bag as a designated “candy bag.” Each day, put a few pieces of candy in the bag and have that be a daily sweet treat.

Buy healthier Halloween treats. Boxes of raisins, bags of pretzels, nuts, seeds, and popcorn are all healthier alternatives. If you must buy candy, some good choices are mini Tootsie Rolls (12 pieces/serving = 130 calories), 3 Musketeers fun size candy bars (1 piece = 63 calories), Tootsie Pop (1 pop = 60 calories); and if possible, choose dark over milk chocolate. Dove dark chocolate miniatures have 210 calories in 5 pieces and dark chocolate is a source of antioxidants. Also, look for 100 percent fruit snacks and 100 calorie packaged snacks.

Avoid it. Don’t buy any candy at all. While not the most popular choices, baseball cards, gum, mini pumpkins, pencils, fun bracelets, etc. can be a fun break from the usual giveaway. Watch out for too many sugar-free candies. Eating a lot of these options can upset stomachs. Also, limit the sweet drinks. Since you know that you and your kids will most likely be eating candy, stick to water and milk and skip the juices and sodas that provide even more sugar.

Walk a lot. If you live in a small neighborhood, venture to another nearby locale. It’s not only a great way to get some exercise, but you’ll be able to meet more neighbors.

Learn more. Search the web for some healthy themed recipes. Web sites like Kraft.com and Disney Family Fun have festive recipes that are sure to please everyone (try the Mummy-Face pizzas from Kraft).

It’s important to know that Halloween can not only be a fun time, but a healthy time as well. With a little preparation and creativity, it’s an easy goal to achieve.

Kami’s Jammies Brightens the Day for Thousands of Critically Ill Children

By Debi Katzenberger
Casey Cares Foundation

I am often approached with the question “How did Kami’s Jammies come about?” Attempting to answer this question, I have found that there is no one, simple answer. The idea manifested itself in small pieces over time, while working my way through the grieving process of losing a grandchild to cancer.

On the night of Kamryn’s passing, I made two promises, both of which remain at the forefront of my thoughts every day. My first promise was to Kamryn, that I would honor her memory every day of my life. My second promise was to Kamryn’s father, Chris, that Kamryn would never be forgotten. And that is where the answer to the question “How did Kami’s Jammies come about?” begins.

I started Kami’s Jammies to create a legacy for my granddaughter — a fantastic and brave little girl named Kamryn Lambert — who would never be able to create one for herself. Kamryn was diagnosed with acute lymphoblastic leukemia in September 2004. Although she fought a heroic battle and was in remission, she passed away from complications caused by a depleted immune system on September 3, 2007. Her flair for fashion and unflappable resolve to be a trendsetter in spite of her painful treatments and frequent hospital stays is the foundation on which this legacy is based.

Kami’s Jammies was formed with the mission to provide pajamas to children on extended inpatient stays at the hospital in an effort to brighten their day and make their stay a little more like home. I officially began this journey in February 2008, after surviving the first holiday season without Kamryn. It took its toll on the holiday traditions that had been so important to my family. Kamryn particularly loved the family tradition of wearing holiday pajamas, and as I fought to carry on the tradition without her, I purchased a pair for her as I normally would, simply because it was too painful not to purchase them. Left with the decision of what to do with “Kami’s Jammies,” I decided to give them to another little girl who was battling a brain tumor at the same clinic as Kamryn, the University of Maryland Pediatric Hematology/Oncology Clinic.

This little girl’s excitement at receiving this small gift made me remember how much Kamryn had always looked forward to receiving a new pair of pajamas while she was in the hospital for treatment. Here was something so simple, and yet so uniquely Kamryn, that I decided at that moment to pass this little symbol of joy and normalcy on to others who are battling critical illnesses.

My goal is to ensure that new pajamas are always on hand for patients beginning another round of inpatient treatment, or those who have been inpatients for a long period of time. Kami’s Jammies was introduced to the University of Maryland Hospital for Children in March 2008, exactly six months from the night that I made those two very important promises, and to the very hospital that had taken such wonderful care of Kamryn throughout her illness. Along with the pajamas, we also hold monthly themed pajama parties at the hospital.

In May 2008, Kami’s Jammies became a program under the Casey Cares Foundation, which provides uplifting programs to critically ill children and their families. Kamryn was a recipient of many of the services offered by the foundation, so it was a perfect fit. Together, we have collected over 4,000 pairs of pajamas and have expanded services to other area hospitals, including Mt. Washington Pediatric Hospital, an affiliate of the University of Maryland Medical System.

For information about how you can contribute to Kamryn’s legacy, please contact me at debi@caseycaresfoundation.org or visit our website at www.caseycaresfoundation.org.

UM Pediatrics at the Harbor

In this interview, Dr. Laura Finkelstein, a general pediatrician for the University of Maryland Hospital for Children and the new Pediatrics at the Harbor (PATH) clinic, provides an overview of the clinic’s history and the services offered to patients. She also explains the clinic’s mission, and talks about the features that make this new clinic unique in the Baltimore region.