January 6, 2015

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This year’s flu season is in full force with about half of the country, including Texas, experiencing high levels of influenza activity. According to the Centers for Disease Control and Prevention, the flu has claimed the lives of 21 children and hospitalized almost 4,000 people in the United States.

Dr. Carol Baker, a pediatric infectious disease specialist and executive director of the Center for Vaccine Awareness and Research at Texas Children’s Hospital, says it’s not too late to get vaccinated against the potentially deadly infection and penned a column that ran in the Dec. 29 edition of the Houston Chronicle urging people to do so.

Read her column below, and if you haven’t already, get your annual flu vaccine. Employee Health is administering free seasonal influenza vaccinations to all Texas Children’s employees, Baylor College of Medicine employees working in Texas Children’s facilities, Texas Children’s medical staff and volunteers. Call the Employee Health Clinic at Ext: 4-2150 today to make an appointment to get your flu vaccine.

Recently, the news has been dominated by the dangers and deaths from Ebola virus, with thousands of Americans being deployed to West Africa to fight Ebola. Yet we need to also be concerned about another epidemic, one that hits us every year: influenza virus or the flu, which killed more Americans last year than the current total deaths from Ebola in Liberia. While the severity of the flu epidemic is unpredictable, it always hospitalizes thousands of Americans and last year killed 107 children, almost half of whom were previously healthy; so far this year, five children have died. This month ushered in this year’s epidemic in Texas. We also learned from the U.S. Centers for Disease Control and Prevention that the most frequent strain of the four influenza viruses, H3N2, is dominant so far. H3N2 flu is linked to severe influenza seasons, with high rates of hospitalization and death. Also, a little more than half of the patients with H3N2 flu disease so far have virus that has mutated slightly, making this part of the vaccine less effective.

You may think this change in one of the four flu viruses is a reason not to get vaccinated. This is simply not the case. The influenza vaccine remains the best way to protect yourself and your family from the flu, and it is better than other important strategies, like hand and cough hygiene and staying away from people with flu symptoms. Even with the mutated H3N2 flu circulating, this year’s flu vaccine protects against other strains causing flu. While this year’s vaccine could be somewhat less effective, opting for no vaccination assures no protection.

Getting the flu vaccine is especially important to protect the most vulnerable: pregnant women, children under two years of age, the elderly and those people with diseases or receiving medications that impair the immune system (e.g., cancer). Last year, only 52 percent of pregnant women and 70 percent of children under two were vaccinated. Pregnant women are five times more likely to have a complication from influenza that results in hospitalization than nonpregnant women of the same age. Vaccination not only protects the woman, but the antibodies created by the mother in response to flu vaccine pass through the umbilical cord and breast milk to the baby, protecting the baby before age 6 months when the flu vaccine can be given. Also, flu-vaccinated pregnant women have fewer premature and low-birth weight babies, and millions of flu vaccine doses given in the past have proven how safe this vaccine is for mother and baby.

While you may think that flu is no worse than other respiratory viruses common this time of year, flu is distinct. It causes high fever, severe muscle aches, fatigue, sore throat and in children sometimes vomiting and diarrhea, symptoms that last a week or more. Getting the vaccine not only protects, but if you do get the flu, the symptoms are less severe and don’t last as long.

Every year, my colleagues and I care for far too many vulnerable infants and children who suffer needlessly from an infection that can be prevented. It’s not too late to be immunized: The flu epidemic typically peaks in February and continues into the spring. Vaccine is still available; if your physician has no more supply, go to a pharmacy or the health department. It takes 14 days to be protected after vaccination, so readers who haven’t already done so should take this opportunity to seek the flu vaccine as soon as possible.

We still anticipate seeing an increase in cases at our hospitals, so there is still time to protect yourself and your loved ones. Flu vaccine is truly the best personal protective equipment you can wear during flu season.

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Texas Children’s researchers have embarked on a five-year crossover dietary intervention study that could determine why certain children with Irritable Bowel Syndrome (IBS) develop symptoms when eating wheat.

IBS is a common gastrointestinal (GI) disorder that can develop in children at any age. Since IBS patients have extremely sensitive digestive tracts, they may experience frequent abdominal pain, bloating, flatulence and changes in bowel habits that include diarrhea and/or constipation.

A group of sugars called FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are known to exacerbate IBS symptoms. Since these sugars are poorly digested in the small intestine, trillions of bacteria in the colon ferment the sugars, which can produce excessive gas in IBS sufferers. One of these hard-to-digest sugars is fructans.

In collaboration with researchers at Baylor College of Medicine and funding from the National Institutes of Health (NIH), Texas Children’s Gastroenterologist Dr. Bruno Chumpitazi and his team are conducting a double-blind, randomized, placebo-controlled study to examine the effects of fructans – a natural sugar found in wheat – in 80 children with IBS.

“Certain IBS children experience unpleasant GI symptoms when challenged with fructans,” said Chumpitazi, director of Texas Children’s Neurogastroenterology and Motility program. “We hypothesize these symptoms are due to the composition of bacteria in their gut, or gut microbiome, and what these bacteria do with the fructans.”

All 80 children will receive the same low FODMAP diet with varying drinks prepared by the Children’s Nutrition Research Center at Baylor. Based on randomization, one drink will contain fructans while the other will contain maltodextrin, a starch that our bodies can easily absorb without the help of gut bacteria.

“The children will consume the assigned diet over a period of 72 hours,” said Chumpitazi. “They will return to their normal diet for at least seven days before starting the low FODMAP diet with a different drink combination.”

With the help of Texas Children’s Microbiome Center led by Dr. James Versalovic and the Texas Children’s Center for Pediatric Abdominal Pain Research led by Dr. Robert J. Shulman, researchers will track the children’s symptoms daily and collect stool samples before and after the dietary interventions to monitor changes in their gut microbiome’s bacterial composition and bacterial byproducts. The byproducts produced by the bacteria will also be measured through breath testing.

The objective of the NIH-funded study is to identify whether bacteria in the gut and/or other factors are responsible for IBS symptoms in patients when fructans are consumed.

“If we understand why IBS children in the trial respond differently to the fructan challenge, it could help scientists develop targeted therapies to enhance the quality of life for patients with this GI disorder,” said Chumpitazi.

Other Baylor College of Medicine scientists collaborating in this study include Dr. Joe Petrosino and Dr. Aleksander Milosavljevic.

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Historically, it has been difficult to schedule surgery from Texas Children’s Hospital locations outside Main Campus. A pilot project launched a few months ago in the Division of Otolaryngology has overcome this challenge and made scheduling surgery from remote locations easier.

Surgeons now can insert an order into Epic at the time of a patient visit. Previously, when otolaryngologists traveled to see patients, they faxed or transported paper forms to Main Campus or called to schedule surgery.

“Those methods of scheduling surgery from offsite locations were less efficient and rife with opportunities for missed communications,” said Dr. Carla Giannoni, the Texas Children’s otolaryngologist who spearheaded the project.

Now, surgeons can use Epic to immediately submit an order for surgery.

“When I am at a satellite office, I am able to request the exact procedure I want, including special details, without depending on a faxed piece of paper to get to my scheduler at Main Campus,” Giannoni said. “The need to communicate about an upcoming surgery is resolved instead of having to be logged, tracked, and communicated back at a later date and time.”

In addition, the project provides for more secure patient information and increases HIPAA compliance.

“The potential to lose patient information has been eliminated with this new process,” she said. “The program has worked very well for me.”

Plans to roll out this program to other Department of Surgery divisions are underway. Surgical Services Director Trent Johnson said it will likely start early this year in the Division of Ophthalmology.

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By Dr. Gail Demmler-Harrison

Congenital cytomegalovirus (CMV) is the most common virus that most people have never heard of. Most everyone will catch CMV at some time in their lives and never know they have it.

If a woman gets CMV for the first time while she is pregnant, she can be in a potentially dangerous situation. CMV infects almost 1 out of every 100 newborns in the United States and is the most common congenital infection.

The virus is passed to the unborn baby from the mother and can cause serious complications in the newborn, like platelet problems, liver disease and lung disease. It can also cause long-term effects on hearing, vision, growth and development by invading the brain, eyes and ears.

What makes CMV even more dangerous is that most people, including pregnant women, have never heard of CMV. Since CMV does not cause a rash like its cousin, chicken pox, you do not know who is infected and shedding the CMV.

The good news is CMV infection is potentially preventable.

If a pregnant woman is aware of CMV, she can take simple hygienic precautions to reduce her exposure to the virus. Toddlers are a “hot zone” for CMV, and by slightly modifying your behavior while pregnant, you can reduce your risk of catching this silent virus.

CMV is present in saliva and urine, so…

  1. Do not share food or drink with your toddler — no more “one for mommy one for baby” mealtime games while you’re pregnant.
  2. Do not kiss your toddler on the lips or cheek, rather hug them and give them a loving kiss on the top of the head while you’re pregnant.
  3. Wash your hands carefully after changing diapers and wiping your toddler’s nose and face.

An ounce of CMV awareness and three simple hygienic precautions while you’re pregnant are all it takes to save your unborn baby from a potentially devastating infection.

But, what if you contract CMV during pregnancy? I’ve put together a list of questions and answers with basic information that I hope you’ll find helpful. Click here to read my other blog.

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Amy Smith, a board certified music therapist at Texas Children’s, received the prestigious 2014 Arthur Flagler Fultz Research Grant from the American Music Therapy Association (AMTA).

The grant will support Smith’s study, “The Effects of Live Contingent Singing on Preterm Neonates with Bronchopulmonary Dysplasia,” which will examine the impact of a live music therapy intervention on the physiologic and behavioral responses of preterm infants with a chronic lung condition.

The study is slated to begin in early 2015 and run through mid-2016. The research team includes physicians, nurse practitioners and researchers from Texas Children’s Hospital. The results from the study will provide important information on the potential impact of music therapy on the overall well-being of infants with chronic and long term hospitalization needs.

The AMTA Arthur Flagler Fultz Research Award is the largest and most prestigious grant awarded to one individual each year from a highly competitive field of applications.

“I am honored to receive this research grant award,” said Smith. “This generous funding will help us advance music therapy research and identify innovative music therapy treatments for Texas Children’s patients.”

Since the hospital launched the program in 2013, Smith has provided music therapy to patients in the Neonatal Intensive Care Unit and the Inpatient Rehabilitation Unit.

The Music Therapy program is part of the Creative Arts Therapy program in the Child Life Department which provides developmental, educational and therapeutic interventions for children undergoing medical treatment.

“Music therapy is about providing families with the tools to interact and bond with their babies,” said Smith. “When a parent has a very small and very sick baby, they may be unable to hold or touch their newborn and music therapy can encourage bonding through songs and lullabies.”

Click here to watch a video about Texas Children’s Music Therapy program. For more information about music therapy, click here to visit our website.

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Texas Children’s Hospital Autism Center and Meyer Center for Developmental Pediatrics opened its doors December 19 for its inaugural Parents’ Night Out event. Fourteen children participated in the event, which was open to clinic patients as well as their siblings. The event was staffed by volunteers from the Autism Center and Meyer Center, including physicians, psychologists, social workers, medical assistants, and administrative staff.

The idea to host a Parents’ Night Out came from a team discussion about how to give back to the patients and their families during the holiday season. Offering such an event allowed the clinic to reach several families and to give parents a much-valued gift: time. For many parents, finding reliable and trustworthy child care is difficult. For parents of children with developmental disabilities such as autism or intellectual disability, finding such child care is nearly impossible. This event provided parents with the peace of mind that their child was in a safe environment and was being cared for by trained professionals in a familiar place, which allowed the parents to then truly relax and enjoy a few hours to themselves. Many parents shared that it was the first time in months that they were able to spend the evening relaxing, going out to dinner, shopping, and going to the movies.

The children were welcomed by enthusiastic volunteers, and there were various activities and games set up for their enjoyment. Kids decorated holiday cards and cookies, played Nintendo Wii, board games and musical instruments, and kept busy playing soccer and catch. The children interacted really well together, and it is safe to say that everybody made some new friends that evening. Many parents told staff the following week that their kids kept asking when they were going to see their “new friends” again, and when they get to go “back to their doctor’s office to play.”

All in all, it was a successful evening. The children had a great time, the parents were extremely appreciative of the time volunteered by the staff, and the volunteers enjoyed spending time with the kids outside of the clinic setting. It was a wonderful way for the Autism Center and Meyer Center to kick off the holiday season!