News of Note: Pediatric Grand Rounds

Sep 16, 2016 at 02:56 pm by Staff

Two cute graduates of the Saint Thomas NICU. Photo provided by Saint Thomas Health.

Off to a Great Start

Whether it's a great start to the new school year or having the best chance to thrive at the start of life, Saint Thomas Health (STH) celebrated those important milestones with the community last month.

STH President and CEO Karen Springer, MNPS Superintendent Shawn Joseph, EdD, Titans Quarterback Marcus Mariota, and Mayor Megan Barry pitched in to help stuff and deliver backpacks to ensure financial constraints wouldn't keep students from the tools needed to succeed in the classroom.

At the end of August, the Saint Thomas Foundation hosted a celebration of the numerous babies who have 'graduated' from the Neonatal Intensive Care Unit at Saint Thomas Midtown. The children were encouraged to wear western attire, including cowboy boots and hats, for a fun afternoon hoedown filled with lots of hugs and laughter.

After-Hours Access

The Children's Hospital at TriStar Centennial recently began offering a free, after-hours pediatric care phone service, Call-A-Nurse. By dialing (615) 342-KIDS, parents connect with pediatric nurses who can provide quick answers to children's health questions from 5:00 pm - 8:00am Monday - Friday and 24 hours a day on Saturday and Sunday.

"Call-A-Nurse is a great, after-hours resource for parents who have questions about cuts, fevers and stomach aches and need help determining whether a visit to the emergency room is necessary," said Joann Ettien, COO and administrator of the children's hospital.

Monroe Carell Jr. Children's Hospital at Vanderbilt recently opened a new clinic location at 1155 Kennedy Drive in Murfreesboro, expanding their after-hours care from board certified pediatricians to Rutherford County. Open daily including holidays, clinic hours are Monday-Friday 6-9:30 pm and Saturday-Sunday 12:30-7:30 pm.

"Our after-hours clinic program is designed to support our patients and families closer to home, yet continue to partner with our community pediatricians in continuity of care," said Meg Rush, MD, MMHC, chief of staff and executive medical director of Children's Hospital. A report is sent to the child's regular pediatrician the day service is provided.

MHA Provides New Resources for Student Mental Health

In other back-to-school news, Mental Health America has launched new resources focused on student mental health with an emphasis on web-based tools that can be easily shared across social media platforms.

This year, MHA has developed tools and resources to inform and educate both students and parents about how self-esteem and body image issues can be critically important to a student's overall mental health.

"Issues of low self-esteem and distorted body image often develop during adolescent years, and some youth develop dangerous and destructive habits that should be addressed as soon as possible -- before Stage 4," said Paul Gionfriddo, president and CEO of MHA.

The toolkit includes key messages, drop-in articles, sample social media posts and graphics for use across numerous new media platforms, an infographic to guide parents through 'do's and don'ts,' self-image and self-esteem themed listicles, and fact sheets on self-injury, eating disorder, Body Dysmorphia Disorder, and repetitive behaviors like hair pulling or skin picking.

More information is available at

Raising $1 Million for Cancer Care

Last month, Teen Cancer America (TCA) and Monroe Carell Jr. Children's Hospital at Vanderbilt announced the launch of a collaborative effort to raise $1 million to expand the Adolescent and Young Adult Cancer program in Nashville.

U.S. Ambassadors and Grammy® Award-winning trio The Band Perry plan to work closely with both the foundation and the hospital in support of fundraising efforts over the coming year. The siblings kicked off the effort with a $25,000 donation to the nonprofit, which they won on a recent episode of Celebrity Family Feud.

"Over the course of our career we have been to many hospitals around the country, and in these facilities teens are stuck somewhere between the pediatric and adult units. It's important to us to come together with an organization like Teen Cancer America as they work to create and implement medical programs geared specifically towards teens," The Band Perry said in a statement.

NIH Discovers New Inflammatory Disease

In late August, the National Institutes of Health announced researchers have discovered a rare and sometimes lethal inflammatory disease - otulipenia - that primarily affects young children. They have also identified anti-inflammatory treatments that ease some of the patients' symptoms: fever, skin rashes, diarrhea, joint pain and overall failure to grow or thrive.

Otulipenia is caused by the malfunction of OTULIN, a single gene on chromosome 5. When functioning properly, OTULIN regulates the development of new blood vessels and mobilization of cells and proteins to fight infection.

"The results have been amazing and life changing for these children and their families," said Daniel Kastner, MD, PhD, National Human Genome Research Institute scientific director and head of NHGRI's Inflammatory Disease Section. "We have achieved the important goal of helping these young patients and made progress in understanding the biological pathways and proteins that are important for the regulation of the immune system's responses."

An international network of scientists studying inflammatory diseases identified four children from Pakistani and Turkish families with unexplained skin rashes and inflamed joints. NIH scientists then searched for disease-causing genes using next-generation DNA sequencing, technology that allows researchers to sequence DNA quickly and economically. Once they found that the OTULIN gene was abnormal in the sick children, they studied the immune pathway in order to understand the mechanisms of disease and to improve treatment of these patients. They discovered a problem in the processing of a small protein, ubiquitin, which is critical to the regulation of many other proteins in the body, including immune molecules.

The researchers determined the children with otulipenia might respond to drugs that turned off tumor necrosis factor. Inflammation subsided in the children who had been treated with anti-tumor necrosis factor drugs (TNF inhibitors), which are also used to treat chronic inflammatory diseases such as rheumatoid arthritis.

New Diagnostic, Treatment Options

ImPACT®, a computerized, concussion-specific tool with more than 14 years of evaluation, recently became the first medical device of its kind to receive U.S. Food and Drug Administration (FDA) de novo clearance. FDA clearance was granted under Computerized Cognitive Assessment Aid for Concussion, a new category for a device that uses an individual's scores on a battery of cognitive tasks to provide an indication of the current level of cognitive function in response to concussion. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) was approved for ages 12-59, and ImPACT Pediatric is approved for children ages 5-11.

Amid a public outcry over price, officials with EpiPen manufacturer Mylan NV have announced plans to release a generic option at $300 for a two-pack carton, which is half off the list price for the brand name drug. The company has also introduced new savings programs for the branded product to make the life-saving injection more affordable.

Silvergate Pharmaceuticals, Inc. recently announced he FDA has approved Qbrelis™, as the first lisinopril oral solution 1 mg/mL for pediatric patients ages 6 and older. Qbrelis, which is indicated for the treatment of hypertension, enables weight-based dosing for children who previously had to rely on an adjusted adult dose.

Timing, Teamwork Key for Young Vanderbilt Liver Transplant Patient

Antwane Cole Jr., known as "AJ" to friends and family, began his summer playing football and enjoying his favorite superhero, Spiderman. A seemingly healthy seven-year-old, the whites of his eyes suddenly turned bright yellow. No previous signs indicated that in a three-week span his health would be in such dire straits that his liver would fail, requiring a transplant at Monroe Carell Jr. Children's Hospital at Vanderbilt.

Because of his mother's intuition and persistence, coupled with the comprehensive team approach of Children's Hospital's pediatric liver transplant team, AJ is once again superhero tough. Diagnosed with autoimmune hepatitis, he is the sixth pediatric patient to receive a liver transplant at Children's Hospital since the program launched in June 2015. He received a new liver in fewer than three days after being listed for transplant.

AJ's journey began in June when his mother, Monjineh Singer, noticed his eyes were turning golden yellow, and appeared almost catlike. Worried about jaundice, she took him to the local emergency department in Mississippi. After two visits, three days apart, and no improvement in his eye color, the hospital told Singer he might have acute viral hepatitis. The infection, they said, would clear up on its own.

A follow-up with their family doctor and blood tests revealed that AJ had extremely abnormal liver function. He was referred to a pediatric gastrointestinal specialist in Jackson, Miss., Sara Rippel, MD, who trained at Vanderbilt. Concerned for his health, Rippel immediately called Lynette Gillis, MD, assistant professor of Pediatrics and medical director of Pediatric Hepatology and Liver Transplantation at Vanderbilt. Rippel then sent AJ to Baptist in Jackson, Miss., where LifeFlight quickly transported him to Children's Hospital. He arrived in Nashville on June 17, suffering from acute liver failure caused by the autoimmune hepatitis, which is characterized by the body's immune system attacking its own liver cells.

Close, continuous monitoring of AJ's neurological and liver function would lead to him being moved up on the transplant list. He would get a new liver June 20, following a six-hour surgery led by Douglas Hanto, MD, PhD, chief of the Pediatric Liver Transplant Program and director of the Vanderbilt Transplant Center, alongside a team of doctors, nurses, anesthesiologist and techs.

"He got the transplant that Monday and the liver was a perfect match almost," said Singer. "One family lost their child, and we were able to save our child. It was sad and amazing all at once."

AJ will continue to receive follow-up care in Nashville from Gillis and Hanto, as well as from Rippel in Jackson, Mississippi.

"Our superhero has won the battle, and is ready to start second grade," said Gillis. "And like all superheroes, his friends and teachers won't know his 'secret powers' as he looks and acts just like he did at the beginning of summer vacation. How great is that?"


Building Blocks for Infant Mental Health

TriStar Centennial

Monroe Carell Jr. Children's Hospital at Vanderbilt

Saint Thomas Health

Mental Health America Student Resources

Teen Cancer America


FDA Approvals

Vanderbilt Pediatric Liver Transplant Program

Sections: Clinical