TAG: "Pediatrics"

Benioffs donate another $100M to UCSF children’s hospitals

Donation to strengthen children’s health care across San Francisco Bay Area.

UC San Francisco announced today a second gift of $100 million from Lynne and Marc Benioff to UCSF Benioff Children’s Hospital and also its affiliate, Children’s Hospital & Research Center Oakland.

The gift will be used to strengthen the existing talent and programs in basic and clinical research and patient care at the two premier institutions, as well as attract new expertise, in order to accelerate the development of innovative solutions for children’s health on both sides of the San Francisco Bay, as well as nationally and globally.

“We are thrilled to advance our vision of improving health of the children in Oakland and San Francisco, and to fuel positive changes in the care of our youngest patients today and for future generations,” said Sam Hawgood, M.B.B.S., interim chancellor of UCSF, dean of the UCSF School of Medicine and a neonatologist. “This gift significantly strengthens the abilities of both institutions to attract and retain top talent in pediatric health, as well as to support the next evolution of research and clinical programs.”

In recognition of the two hospitals’ affiliation on Jan. 1, 2014, Children’s Hospital Oakland will be named UCSF Benioff Children’s Hospital Oakland, and UCSF Benioff Children’s Hospital will be named UCSF Benioff Children’s Hospital San Francisco. Together, the hospitals will be named UCSF Benioff Children’s Hospitals.

UCSF Benioff Children’s Hospitals are two leading Bay Area children’s hospitals with longstanding commitments to public service. Both institutions, as well as UCSF Medical Center, care for all children who seek help, regardless of their family’s ability to pay, and provide millions of dollars of uncompensated care and community services for low-income, homeless and underinsured patients. From free children’s health screenings to staffing clinics, the hospitals help meet the needs of Northern California’s most vulnerable populations.

“The generosity and commitment of Marc and Lynne Benioff will strengthen Oakland’s thriving medical research community and ensure doctors on both sides of the bay have world-class facilities to care for children, regardless of income,” said California Gov. Edmund G. Brown Jr.

UCSF Benioff Children’s Hospital San Francisco will be part of a 289-bed integrated hospital complex for children, women and cancer patients that will open Feb. 1, 2015, at UCSF Mission Bay.

Construction of the new children’s hospital is on schedule and below budget. The 183-bed hospital increases the capacity of the current UCSF Benioff Children’s Hospital San Francisco – located on the UCSF Parnassus campus – by 20 beds, and will feature a rooftop helipad to bring critically ill newborns, children and pregnant women to UCSF from community hospitals; a dedicated pediatric emergency room designed just for children; as well as private and semi-private rooms in the new intensive care nursery.

“We are building a world-class pediatric facility that puts the needs of our patients and their families at the forefront,” said Mark Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. “This donation ensures we can continue to advance the most innovative clinical care within the new hospital, as well as outside its walls by partnering with colleagues at our research campus and with Children’s Oakland physicians and staff.”

“This extraordinary gift will have a significant impact on the care we provide children as it will be used to strengthen facilities at Children’s Oakland as well as our education, research and community benefit missions,” said Bert Lubin, M.D., CEO of UCSF Benioff Children’s Hospital Oakland and a pediatrician.

The two hospitals have worked together for decades and are highly regarded nationally as well as internationally, each having made significant advancements in developing new treatments and achieving better health outcomes for children.

“Private support is essential for UC to deliver the highest quality care, training and research innovations needed to advance children’s health,” said Janet Napolitano, president of the University of California. “I thank the Benioffs for their generous support of UCSF and their commitment to our shared mission of building healthy communities.”

UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco are involved in more than 400 research protocols led by more than 500 investigators researching cures for hundreds of pediatric and adult diseases. The children’s hospital is one of the leading children’s hospitals in the nation, according to U.S. News & World Report.

“We have been deeply inspired by the incredible kids, doctors, researchers, and administrators at both UCSF and Children’s Hospital Oakland,” said Lynne and Marc Benioff. “We feel extremely fortunate to have this opportunity to support the best children’s hospitals in the world.”

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SSRI use during pregnancy associated with risk of autism in boys

Highest association found during first-trimester exposure for autism.

Irva Hertz-Picciotto, UC Davis

Prenatal exposure to selective serotonin reuptake inhibitors (SSRIs), medications frequently prescribed to treat depression, anxiety and other mental health disorders, is associated with a higher incidence of autism spectrum disorder (ASD) and developmental delays (DD) in male children, a study of nearly 1,000 mother-child pairs has found.

Published online today (April 14) in the journal Pediatrics, the study involved 966 mother-child pairs from the Childhood Autism Risks from Genetics and the Environment (CHARGE) study, a population-based, case-control study at the UC Davis MIND Institute led by professor Irva Hertz-Picciotto, chief of the Division of Environmental and Occupational Health in the UC Davis Department of Public Health Sciences.

“This study provides further evidence that in some children, prenatal exposure to SSRIs may influence their risk for developing an autism spectrum disorder,” Hertz-Picciotto said. “It also highlights the challenge for women and their physicians, to balance the risks vs. benefits from taking these medications, given that a mother’s underlying mental health conditions may also pose a risk to both herself and her child.”

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New program offers parents medical guidance for international adoptions

UCLA pediatric infectious disease specialists seek to help adoptive parents, children.

The Wilson family

With thousands of internationally adopted children arriving in the United States each year, there is a growing demand for a specialized health care support system that helps adoptive parents and children navigate through the international adoption process.

Now, Dr. Yvonne Bryson and Dr. Nava Yeganeh, pediatric infectious disease specialists at Mattel Children’s Hospital UCLA, have created a new program to meet this need.

The goal of the hospital’s new International Adoption and Travel Clinic is to provide parents with a medical-based support system as they embark on their adoption journey.

“Children adopted internationally, many from developing countries, may have spent months to years in orphanages and other state-run institutions; their medical histories may be incomplete, and many need specific infectious disease–related attention,” said Bryson, professor and chief of pediatric infectious diseases at Mattel. We also help families prepare for international travel, with guidance on recommended vaccines and other medical preparations.”

The Wilsons of Bakersfield have experienced firsthand some of the challenges of trying to piece together medical expertise on their own. The family includes three biological children, two brothers adopted from Ethiopia in 2011 and two boys adopted from China last year. The Wilsons were referred to the new UCLA clinic when their sons from China needed an infectious disease specialist because of possible tuberculosis exposure. The clinic is now completing other missing tests so that the boys have a complete medical workup.

“Having medical experts from a dedicated international adoption clinic can really help streamline things, whether it’s getting a timely review of the potential child’s health records or having a more comprehensive check list of necessary vaccines and specific tests that need to be performed once the child is home with us,” said the Wilson boys’ mother, Brooke. ”We are starting another adoption in China, and this time, we plan on working with the clinic from the beginning of the process. Having a medical group available to help families before and after their journeys with their children is an incredible asset.”

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Atypical development in siblings of kids with autism can be seen at 12 months

Close to half of younger siblings of children with autism develop atypically, study finds.

UC Davis MIND Institute researcher Sally Ozonoff (right) working with a family

Atypical development can be detected as early as 12 months of age among the siblings of children with autism spectrum disorder, a study published by researchers with the UC Davis MIND Institute and UCLA has found.

Published online in the Journal of the American Academy of Child and Adolescent Psychiatry, the study found that close to half of the younger siblings of children with autism spectrum disorder (ASD) develop in an atypical fashion, with 17 percent developing ASD and another 28 percent showing delays in other areas of development or behavior.

Among the 28 percent of children with older siblings with ASD who showed delays in other areas of development, differences were identified in their social, communication, cognitive or motor development by 12 months. The most common deficits were in the social-communication domain, such as extreme shyness with unfamiliar people, lower levels of eye contact and delayed pointing.

The research suggests that parents and clinicians should be vigilant for such symptoms early on among the siblings of children with autism, in order to take full advantage of opportunities for targeted early intervention to improve those children’s outcomes.

“Having a child in the family with autism spectrum disorder means that subsequent infants born into that family should be regularly screened for developmental and behavioral problems by their pediatricians,” said Sally Ozonoff, study lead author and professor of psychiatry and behavioral sciences at the UC Davis MIND Institute.

“This research should give parents and clinicians hope that clinical symptoms of atypical development can be picked up earlier, so that we can, perhaps, reduce some of the difficulties that these families often face by intervening earlier.”

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Grant supports research on the cause of childhood leukemia

UC Santa Cruz research could help enable the design of targeted cancer drugs.

Camilla Forsberg, UC Santa Cruz

Biomedical research at UC Santa Cruz has the potential to change how the most common type of childhood cancer is treated. A new grant from the nonprofit Alex’s Lemonade Stand Foundation will help UCSC researcher Camilla Forsberg advance her work to identify the root cause of acute lymphocytic leukemia (ALL) in infants and children.

Approximately 2,900 children and teens are diagnosed with ALL each year in the United States. Most are ages 2 to 3 years when diagnosed.

Forsberg, associate professor of biomolecular engineering in the Jack Baskin School of Engineering, and co-director for the UCSC Institute for the Biology of Stem Cells, is one of 16 researchers nationwide who have been awarded the foundation’s Innovations Awards. The two-year, $250,000 awards provide critical and significant seed funding for experienced investigators with novel and promising approaches to finding causes and cures for childhood cancers.

“Understanding the cause of this disease will enable the design of drugs that specifically eliminate cancer cells,” said Forsberg, “without causing damage to the body’s healthy cells while curing children with cancer.”

Avoiding treatment side effects is particularly important in children, as their growing bodies are much less able to tolerate standard chemotherapy. The idea of specific drug targeting is based on the success with the drug Gleevec in treating patients with chronic myelogenous leukemia.

Leukemia is a cancer that starts in early blood-forming cells. In a healthy child, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. Cancer researchers like Forsberg are seeking a better understanding of what causes blood-forming stem cells to start behaving abnormally.

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Acetaminophen use during pregnancy linked to ADHD in children

UCLA study raises concerns about use of acetaminophen during pregnancy.

Beate Ritz, UCLA

Acetaminophen, found in over-the-counter products such as Excedrin and Tylenol, provides many people with relief from headaches and sore muscles. When used appropriately, it is considered mostly harmless. Over recent decades, the drug, which has been marketed since the 1950s, has become the medication most commonly used by pregnant women for fevers and pain.

Now, a long-term study by UCLA, in collaboration with the University of Aarhus in Denmark, has raised concerns about the use of acetaminophen during pregnancy.

In a report in the current online edition of JAMA Pediatrics, researchers from the UCLA Fielding School of Public Health show that taking acetaminophen during pregnancy is associated with a higher risk in children of attention-deficit/hyperactivity disorder and hyperkinetic disorder. The data raises the question of whether the drug should be considered safe for use by pregnant women.

ADHD, one of the most common neurobehavioral disorders worldwide, is characterized by inattention, hyperactivity, increased impulsivity, and motivational and emotional dysregulation. Hyperkinetic disorder is a particularly severe form of ADHD.

“The causes of ADHD and hyperkinetic disorder are not well understood, but both environmental and genetic factors clearly contribute,” said Dr. Beate Ritz, professor and chair of the department of epidemiology at the Fielding School and one of the senior authors of the paper. “We know there has been a rapid increase in childhood neurodevelopmental disorders, including ADHD, over the past decades, and it’s likely that the rise is not solely attributable to better diagnoses or parental awareness. It’s likely there are environmental components as well.”

“That gave us the motivation to search for environmental causes that are avoidable,” said the University of Aarhus’ Dr. Jørn Olsen, another senior author and former chair of the UCLA Fielding School’s epidemiology department. “Part of the neuropathology may already be present at birth, making exposures during pregnancy and/or infancy of particular interest. Because acetaminophen is the most commonly used medication for pain and fever during pregnancy, it was something we thought we should look at.”

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Child obesity: cues and don’ts

Study suggests training kids to pay less attention to food might help them eat less.

Kerri Boutelle, UC San Diego

Among the multiple factors that can cause obesity is an abnormal neurocognitive or behavioral response to food cues. The brain becomes wired to seek – and expect – greater rewards from food, which leads to unhealthful overeating.

Attention modification programs, which train a person to ignore or disregard specific, problematic cues or triggers, have been used effectively to treat cases of anxiety and substance abuse. In a novel study published this week in the journal Appetite, Kerri Boutelle, Ph.D., professor of pediatrics and psychiatry at the UC San Diego School of Medicine, and colleagues report using a single session of attention modification to decrease overeating in obese children.

“Attentional bias is a long-studied psychological phenomenon,” said Boutelle. “Attentional bias to food means that food grabs a person’s attention. If two people were in a room with potato chips on the table, the person with attentional bias would be paying attention to, maybe looking at, the chips and the person without the bias would not really notice or pay attention to them.

“We believe that there is a group of people who are inherently sensitive to food cues and, over time, eating in response to paying attention to food makes them pay even more attention.  It’s based on Pavlovian conditioning.”

Obesity in the United States is a well-documented problem, with more than a third of American adults considered to be obese. Child obesity is equally alarming, with an estimated one-third of American children overweight or obese. These children are at greater risk for cardiovascular disease, cancer, orthopedic and endocrine conditions and more likely to die earlier.

Boutelle and colleagues investigated whether attention modification training might be another way to treat problematic eating and obesity in children. In a novel pilot study, they recruited 24 overweight and obese children between the ages of 8 and 12 and split them into two groups.

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Using formula in hospitals deters breastfeeding

Mothers who planned to breastfeed did so far less when their babies received formula.

Caroline Chantry, UC Davis

When mothers feed their newborns formula in the hospital, they are less likely to fully breastfeed their babies in the second month of life and more likely to quit breastfeeding early, even if they had hoped to breastfeed longer, UC Davis researchers have found.

“We are a step closer to showing that giving formula in the hospital can cause problems by reducing how much women breastfeed later,” says Caroline Chantry, lead author and professor of clinical pediatrics at UC Davis Medical Center. “Despite being highly motivated to breastfeed their babies, in-hospital formula use limits this important practice. Given the benefits of breastfeeding for both mother and baby, this is a public health issue.”

“In-Hospital Formula Use Shortens Breastfeeding Duration” was published online in The Journal of Pediatrics today (Feb. 14). The study only included women who intended to exclusively breastfeed their babies for at least a week, meaning they did not plan to use formula in the hospital.

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Marijuana-derived epilepsy drug in clinical trial for kids with uncontrolled seizures

Study is first to gather data on safety, tolerability of non-psychotropic component of cannabis for children.

Maria Roberta Cilio, UC San Francisco

Maria Roberta Cilio, UC San Francisco

A new international, multicenter study led by researchers from UCSF Benioff Children’s Hospital is the first to evaluate whether purified cannabinoid is effective in treating severe forms of childhood epilepsy that do not respond to standard antiepileptic drugs.

“Better treatment for children with uncontrolled seizures is desperately needed,” said Maria Roberta Cilio, M.D., Ph.D., principal investigator for the multicenter study and director of research at the UCSF Pediatric Epilepsy Center.  “It’s important to get seizure control at any age, but in children, uncontrolled seizures may impact brain and neurocognitive development, which can have an extraordinary effect on quality of life and contribute to progressive cognitive impairment.”

The drug, called Epidiolex, is a purified cannabinoid that comes in a liquid form containing no tetrahydrocannabinol (THC), the psychotropic component in cannabis. Produced by the biopharmaceutical company GW Pharmaceuticals, Epidiolex is considered a schedule 1 substance by the U.S. Food and Drug Administration (FDA) and is closely monitored and restricted by both the FDA and U.S. Drug Enforcement Administration.

The trial will enroll a total of 150 patients across six centers. The study began earlier this month at UCSF Benioff Children’s Hospital and is also under way at NYU Langone Medical Center. Pending FDA approval, it will launch at four additional institutions this year.

“Studies have been conducted in healthy adults who have shown CBD to be well tolerated and safe,” said Joseph Sullivan, M.D., co-investigator for the UCSF trial and director of the UCSF Pediatric Epilepsy Center. “While we don’t know the full side effect profile in children, this study will allow us to follow the children closely and determine if the side effect profile differs from that in adults.”

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New insights into controlling pediatric obesity

Electronic health records can be a useful tool to help clinicians educate kids and families.

Ulfat Shaikh, UC Davis

Ulfat Shaikh, UC Davis

Childhood obesity is a growing epidemic. Almost one-third of children in this country are overweight or obese, but how can we stem the tide? One idea is to use electronic health records (EHRs) to help clinicians intervene more aggressively. Programmed alerts could spur caregivers to order key tests and educate patients and families. But how does this approach work in the real world?

n a study published earlier this month in the American Journal of Medical Quality, researchers at UC Davis found mixed results. While EHR alerts definitely changed physician behavior when treating overweight and obese children, they are no magic bullet. The authors believe EHRs must be incorporated into a more comprehensive strategy to help patients overcome their weight issues.

“The alerts led to significant but not dramatic improvements,” said Ulfat Shaikh, lead researcher, pediatrician and director of Healthcare Quality at the UC Davis School of Medicine. “We believe any electronic record intervention must be combined with other approaches.”

To measure whether EHRs enhance practice, the researchers added obesity-related alerts to health records at the UC Davis Health System’s outpatient clinic, which cares for about 12,000 children each year. The alert — highlighted in bright yellow on the screen — warned physicians when a patient’s weight hit the 85th percentile, which is considered “overweight.”

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Related link:
Innovation Profile: Ulfat Shaikh

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Pediatrics chair contributes to World Symposium on Pulmonary Hypertension

New focus on pediatric population establishes guidelines.

Robin Steinhorn, UC Davis

Robin Steinhorn, UC Davis

New standards, approaches and recommendations for diagnosing, treating and conducting research on pulmonary hypertension in infants and children were recently published in the Journal of the American College of Cardiology. The journal devoted an entire issue to findings of the 5th World Symposium on Pulmonary Hypertension (WSPH), held in Nice, France, in 2013. Robin Steinhorn, professor and chair of the UC Davis Department of Pediatrics, was one of only two neonatologists worldwide invited to participate.

“For the first time, the World Symposium on Pulmonary Hypertension included a task force focused on pediatrics,” said Steinhorn, who co-authored an article titled “Pediatric Pulmonary Hypertension.” ”The addition of a pediatric task force not only underscores the fundamental differences between adult and pediatric pulmonary hypertension, but it provides practitioners with guidance to better cope with this challenging and increasingly recognized condition.”

Pulmonary hypertension can occur at any age but is often seen in newborns who are born with heart or circulation defects, certain genetic diseases, drug exposures or infections. It involves high blood pressure in the arteries of the lungs (the pulmonary arteries), which reduces blood flow to the lungs. Affected newborns may have a bluish color and low oxygen levels.

The first WSPH was organized by the World Health Organization and took place in Geneva, Switzerland, in 1973. The symposium now takes place every five years at various sites throughout the world. Twelve task forces set standards in the field of pulmonary hypertension by refining the classification of the disease based on the latest scientific evidence, and making recommendations on diagnostic and treatment algorithms and research priorities. According to Steinhorn, such standardization is critical to ensuring uniformity so that comparisons can be made worldwide.

“Being involved in the Nice symposium was a fantastic highlight of my career,” said Steinhorn. “It was an honor to help develop the guidelines that will set the standard in pediatric pulmonary hypertension for the next five years.”

Steinhorn, who is the medical director of UC Davis Children’s Hospital, is an internationally recognized expert and thought leader in pediatric pulmonary hypertension. Her research has contributed to a better understanding of the basic mechanisms regulating a newborn’s circulatory system and factors that contribute to pulmonary hypertension before or soon after birth. Steinhorn is currently conducting basic research into the condition as well as a number of clinical trials that will help determine the efficacy of various novel treatments for the treatment of pediatric pulmonary hypertension.

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Immune system drives pregnancy complications after fetal surgery in mice

Possible clue to high rate of preterm labor after human fetal surgery.

Tippi Mackenzie, UC San Francisco

Tippi Mackenzie, UC San Francisco

As a fetal surgeon at UC San Francisco, Tippi MacKenzie, M.D., has long known that conducting surgery on a fetus to correct a problems such as spina bifida often results in preterm labor and premature birth.

Now, MacKenzie and her UCSF colleagues have shown that, in mice at least, pregnancy complications after fetal surgery are triggered by activation of the mother’s T cells – the same T cells that cause the body to reject a donor organ after transplant surgery

“Here at UCSF, the birthplace of fetal surgery, preterm labor has been described as the ‘Achilles’ heel’ of the field because it diminishes the benefit of the surgery itself,” said MacKenzie, an associate professor of surgery and director of research at the UCSF Fetal Treatment Center. “However, specific treatments have not been developed because until now, the biological triggers responsible for preterm birth have been unknown.”

If the same fetal rejection mechanism is occurring in humans, she said, “we have the ability to design specific medical treatments to prevent it – for example, by using medications that target some of the pathways involved in T cell-mediated rejection.”

The study was published online on Jan. 15 in the Journal of Immunology and will be printed in the Feb. 15 issue.

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