April 7, 2015

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4815pharmacyinside640Texas Children’s draws roughly 100 therapeutic drug levels per day to examine the presence and the amount of specific drugs in the bloodstream of children. These levels determine how well a patient’s body breaks down the drug and how it interacts with other medications.

“With most medications, you need a certain level of drug in your bloodstream to obtain the desired effect,” said Brady Moffett, a clinical pharmacy specialist at Texas Children’s. “Some medications are harmful if the level rises too high and some do not work if the levels are too low.”

To promote quality improvement and to continue to ensure the safety of our patients, Texas Children’s Department of Pharmacy and Clinical Chemistry Service in the Department of Pathology have produced an online, comprehensive guide to help clinicians monitor the therapeutic drug levels in a patient’s bloodstream to ensure they are within a safe and effective range.

Drug level testing is especially important in children taking certain medications to treat health problems like abnormal heart rhythms, diabetes, epileptic seizures and bacterial infections, as well as organ transplant patients who must take immunosuppressant drugs during their lifetime.

Produced specifically for pediatrics, Texas Children’s 92-page therapeutic drug monitoring guide is the first of its kind produced at a children’s hospital and represents a multidisciplinary collaboration among our physicians, pharmacists and laboratory personnel.

“We worked extensively with specialists across multiple service lines to gather their input and expertise to bring this project to fruition,” Moffett said.

Moffett co-edited the therapeutic drug monitoring manual with Dr. Sridevi Devaraj, director of Clinical Chemistry and Point of Care Testing at Texas Children’s.

“The online version of this manual will be updated in real time as new drugs and technologies emerge,” Devaraj said. “It will provide us with better guidance on how to safely adjust the proper dosage of medications to meet our patients’ individual medical needs.”

Click here to access Texas Children’s Guide to Therapeutic Drug Monitoring.

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Transplant teams with Texas Children’s Hospital performed 95 solid organ transplants in 2014, continuing to serve as one of the largest, most active, and successful pediatric transplant programs in the nation.

The heart and the lung transplant programs were the largest in the country last year. Overall, Texas Children’s was the second largest transplant program in the country. Lucile Packard Children’s Hospital was the largest with a total of 102 transplants.

“Texas Children’s Transplant Services continues to earn its reputation as one of the best pediatric transplant programs in the country,” said Dr. John Goss, medical director of Transplant Services.

“In 2014 – the 30th anniversary of the Heart Transplant program – the service performed the most transplants in its history. In addition, all of our transplant services continue to produce great outcomes for our patients.”

Goss said Transplant Services sponsored its first Transplant Symposium in 2014 and added a dedicated immunologist who is researching the interactions between allographic responses.

“I believe our success is a testimony to the skill and commitment of our multidisciplinary team,” he said.

By Shelly Lopez-Gray

First, let me say that there is no such thing as “eating for two.” I know this is a huge disappointment, as many people out there would love to use their pregnancy as an opportunity to eat every single thing that they ever thought tasted good (I know, I’ve been there). But let me fast forward through your pregnancy a bit – it’s unhealthy for you, it’s unhealthy for your baby, and the pregnancy weight is not going to magically fall off.

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As you begin your pregnancy, I wanted to share some key things to remember:

  • You need about 300 extra calories a day during pregnancy to support your baby’s growth and development.
  • Most doctors suggest women gain a total of 1 to 4 pounds total during the first three months of their pregnancy.
  • Women who gain too much are more likely to have a large baby or a premature baby.

A premature baby is born before 37 weeks of pregnancy. These mothers may also have health conditions like diabetes and high blood pressure that can cause problems during pregnancy.

The total amount of weight gain during your pregnancy depends on your weight when you become pregnant. Talk to your physician or midwife for more information.

Tips to help you create better eating habits:

Watch how much juice you drink. Even all-natural and 100 percent juice is full of sugar and empty calories. If you find it impossible to cut out these sweet drinks, treat yourself to a small glass once a day. If you are gestational diabetic, you should cut these out from your diet.

  • Anything canned or frozen is full of salt. Even if it’s a “healthy meal,” it’s still full of salt.
  • Try snacking on something healthy every two hours or so.
  • If you can pick the food up in a drive-through, it’s probably unhealthy.

Here’s a list of fruits, vegetables, dairy, grains and protein foods that are great for women to eat throughout their pregnancy.

Vegetable Group

  • Carrots
  • Sweet potatoes
  • Pumpkin
  • Spinach
  • Cooked greens (such as kale, collards, turnip greens, and beet greens)
  • Winter squash
  • Tomatoes and tomato sauces
  • Red sweet peppers

These vegetables all have both vitamin A and potassium. When choosing canned vegetables, look for “low-sodium” or “no-salt-added” on the label. Vitamin A helps with postpartum tissue repair and helps to fight infection. Potassium helps to maintain fluid and electrolyte balance in your body’s cells.

Fruit Group

  • Cantaloupe
  • Honeydew melon
  • Mangoes
  • Prunes
  • Bananas
  • Apricots
  • Oranges
  • Red or pink grapefruit
  • 100 percent prune juice or orange juice

These fruits all provide potassium, and many also provide vitamin A. When choosing canned fruit, look for those canned in 100 percent fruit juice or water instead of syrup.

Dairy Group

  • Fat-free or low-fat yogurt
  • Fat-free milk (skim milk)
  • Low-fat milk (1 percent milk)
  • Calcium-fortified soymilk (soy beverage)

These all provide the calcium and potassium you need. Make sure that your choices are fortified with vitamins A and D. A vitamin D deficiency during pregnancy can cause growth retardation and skeletal deformities. It also may have an impact on birth weight. Some researchers believe that a vitamin D deficiency during pregnancy can affect your baby’s bone development and immune function throughout your baby’s life.

Grain Group

  • Fortified ready-to-eat cereals
  • Fortified cooked cereals

When buying ready-to-eat and cooked cereals, choose those made from whole grains most often. Look for cereals that are fortified with iron and folic acid. Iron is essential for making hemoglobin, a protein in red blood cells. During pregnancy, the amount of blood in your body increases almost 50 percent, so you need more iron to make more hemoglobin.

Protein Foods Group

  • Beans and peas (such as pinto beans, soybeans, white beans, lentils, kidney beans, chickpeas)
  • Nuts and seeds (such as sunflower seeds, almonds, hazelnuts, pine nuts, peanuts, and peanut butter)
  • Lean beef, lamb and pork
  • Oysters, mussels, crab
  • Salmon, trout, herring, sardines, and Pollock

Some types of seafood can contain high levels of mercury. Too much mercury can damage your baby’s developing brain and nervous system. Shark, swordfish, king mackerel and tilefish can contain high levels of mercury.

The Food and Drug Administration and the Environmental Protection Agency say pregnant women can safely eat up to 12 ounces (340 grams) of seafood a week. Similarly, the 2010 Dietary Guidelines for Americans recommend 8 to 12 ounces of seafood a week for pregnant women – or about two average meals.

Talk to your provider if you have any questions about safe foods during pregnancy.

4815crcaward175The Clinical Research Center will present the Clinical Research Award for First Quarter 2015 to Dr. Poyyapakkam Srivaths, Department of Pediatrics-Renal, Baylor College of Medicine.

The award was established by the Clinical Research Center in collaboration with the Research Resources Office to recognize and honor individual contributions to protecting the best interest of the research subjects and compliance with applicable rules and regulations.

Dr. Srivaths’ research activities in the CRC focus on investigating cardiovascular morbidity associated with end stage renal disease (ESRD) in children.

Congratulations to Dr. Srivaths.

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Texas Children’s Hospital is excited to announce the addition of Dr. Sundeep Keswani. Keswani, whose appointment was effective March 2, is a pediatric and fetal surgeon at Texas Children’s and an associate professor at Baylor College of Medicine. He is also the principal investigator of a National Institutes of Health (NIH) funded laboratory.

“I am thrilled to welcome Dr. Keswani to our team,” said Dr. Jed Nuchtern, chief of the division of pediatric surgery at Texas Children’s Hospital and professor of surgery and pediatrics at Baylor. “Dr. Keswani provides expertise in several important areas that our division is expanding or creating. These include fetal diagnosis and therapy, pediatric wound care and general pediatric surgery. He also brings a significant NIH-funded research effort that will be a substantial addition to our current research portfolio.”

Keswani completed his surgical residency at Louisiana State University in his hometown of New Orleans and a fellowship in fetal surgery and surgical research at The Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania. He subsequently trained in pediatric surgery at the Saint Louis Children’s Hospital and the Washington University School of Medicine.

Keswani’s research interests closely pair with his clinical interests and include fetal regenerative wound healing, gene therapy applications, bone marrow contribution to tissue repair and fetal diagnosis and treatment. Currently, he is the principle investigator of a R01 and K08 grant from the National Institute for General Medical Sciences at the NIH. The goal of his research is to understand the underlying mechanisms of how the fetus heals without scarring to achieve postnatal regenerative tissue repair in various organ systems.

Texas Children’s division of pediatric surgery is one of the most robust pediatric surgery programs in the country with 16 full-time pediatric surgeons on staff. The range of surgical procedures performed by the division include fetal surgery, abdominal and thoracic surgery, pediatric surgical oncology, minimally invasive surgery including laparoscopic and thorascoscopic diagnosis and treatment, endocrine and biliary surgery, and adolescent bariatric surgery. In 2014, the division of pediatric surgery completed 5,792 surgeries and 11,809 clinic visits.

Texas Children’s Fetal Center works hand-in-hand with the division of pediatric surgery and is committed to providing the best possible care and outcome for each mother, baby and family. The core staff of Texas Children’s Fetal Center includes fetal and pediatric surgeons, maternal fetal medicine specialists and specialized coordinators. The Fetal Center’s physicians are recognized leaders in fetal medicine and fetal and neonatal surgery. As one of only a few centers in the United States to provide the full spectrum of fetal therapies, Texas Children’s attracts parents from around the world seeking the ultimate in care for their unborn child.