TAG: "Pediatrics"

Treating babies for autism may stave off symptoms


Infant Start therapy treats disabling delays before most kids are diagnosed with autism.

Sally Rogers, UC Davis

Treatment at the earliest age when symptoms of autism spectrum disorder (ASD) appear – sometimes in infants as young as 6 months old – significantly reduces symptoms so that, by age 3, most who received the therapy had neither ASD nor developmental delay, a UC Davis MIND Institute research study has found.

The treatment, known as Infant Start, was administered over a six-month period to 6- to 15-month-old infants who exhibited marked autism symptoms, such as decreased eye contact, social interest or engagement, repetitive movement patterns and a lack of intentional communication. It was delivered by the people who were most in tune with and spent the most time with the babies: their parents.

“Autism treatment in the first year of life: A pilot study of Infant Start, a parent-implemented intervention for symptomatic infants,” is co-authored by UC Davis professors of Psychiatry and Behavioral Sciences Sally J. Rogers and Sally Ozonoff. It is published online today (Sept. 9) in the Journal of Autism and Developmental Disorders.

“Most of the children in the study, six out of seven, caught up in all of their learning skills and their language by the time they were 2 to 3,” said Rogers, the study’s lead author and the developer of the Infant Start therapy. “Most children with ASD are barely even getting diagnosed by then.”

“For the children who are achieving typical developmental rates, we are essentially ameliorating their developmental delays,” Rogers said. “We have speeded up their developmental rates and profiles, not for every child in our sample, but for six of the seven.”

Rogers credited the parents in the small, pilot study with making the difference.

“It was the parents – not therapists – who did that,” she said. “Parents are there every day with their babies. It’s the little moments of diapering, feeding, playing on the floor, going for a walk, being on a swing, that are the critical learning moments for babies. Those moments are what parents can capitalize on in a way that nobody else really can.”

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UC Davis pediatrician named Quality Improvement Project Leader


Ulfat Shaikh to lead project for the American Academy of Pediatrics.

Ulfat Shaikh, UC Davis

Ulfat Shaikh, director for healthcare quality at UC Davis School of Medicine and pediatrician at UC Davis Children’s Hospital, has been named the Quality Improvement Project Leader for the American Academy of Pediatrics’ (AAP) Council on Quality Improvement and Patient Safety (COQIPS).

She will be leading a project on behalf of the AAP to improve the care of children and adolescents by utilizing clear communication strategies in clinical settings. This project will be the first of its kind to incorporate Maintenance of Certification Part 4 credits into a council program at the AAP National Conference and Exhibition, the academy’s largest gathering of members.

Through its Maintenance of Certification (MOC) Part 4 program, the American Board of Medical Specialities requires physicians seeking board certification to participate in quality improvement programs in their practice where they regularly assess their patients’ outcomes, identify areas for improvement, implement evidence-based changes to their practice and track their results. Clinicians participating in this AAP pilot project will submit baseline data for their own patients using the AAP Quality Improvement Data Aggregator system, attend a learning session at the AAP National Conference & Exhibition, submit data during the action period, participate in webinars to learn about health literacy and quality improvement methods, review their performance improvement data using run charts and implement improvement cycles based on learnings from their performance data.

As project leader, Shaikh’s responsibilities will include providing leadership to the COQIPS project planning group in accomplishing its goals, establishing the framework of the project, overseeing and approving a system to track and monitor physician participation, facilitating meetings and webinars, conducting day-to-day oversight and management of the project and developing project materials.

“It is an honor to partner with the AAP, an organization highly respected for its advocacy of children and their families, to create a new model that involves front-line clinicians in quality improvement activities,” said Shaikh. ”Just like my other colleagues, I have been trying to select MOC opportunities that not only allow me to complete my board recertification requirements, but that also help me provide better care to my patients. Improving health literacy and provider-patient communication is a national health priority and is a great focus area for this project.”

This project will serve as a model and a replicable standard for how other AAP councils and sections can provide MOC Part 4 opportunities to their members.

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Innovation Profile: Ulfat Shaikh

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Autism early-detection program expands


Developed at UC San Diego, effort seeks to identify at-risk toddlers by first birthday.

Karen Pierce, UC San Diego

Autism spectrum disorder (ASD) is now estimated to impact 1 in every 68 children born in the United States. Yet despite its rising prevalence and the known benefits of early detection and treatment, toddlers in much of the United States are routinely not identified as possibly having ASD until well after their third birthday.

“By that time, much precious brain development has already occurred,” said Karen Pierce, Ph.D., associate professor of neurosciences at the UC San Diego School of Medicine and assistant director of the UC San Diego Autism Center of Excellence.

A new 5-year, $5.1 million grant from the National Institute of Mental Health (NIMH) seeks to remedy that by expanding a program developed by Pierce and colleagues to reduce the mean age of ASD diagnosis in multiple cities across the U.S.

The program, called Get SET Early, is based upon a one-year well-baby check that Pierce first described in a paper published in 2011. In those findings, Pierce and colleagues reported that San Diego toddlers who were systematically assessed for ASD around their first birthday typically began receiving treatment within a few months, years before children in many other cities.

With NIMH funding, the Get SET Early program expands upon Pierce’s original model, adding new features and technologies, such as an iPad-based automatic referral system.

The improved model consists of three stages: In the Screening stage, a network of pediatricians conduct repeat evaluations of toddlers at multiple ages – 12, 18 and 24 months – using standardized testing and scoring. “Since the symptoms of autism can come on slowly between 12 and 24 months, if we screen three times, we are almost guaranteed to detect the overwhelming majority of children with this disorder,” Pierce said.

In the second Evaluation stage, toddlers who may have ASD are immediately referred to local clinics that specialize in ASD for more detailed evaluation.

In the final stage, Treatment, toddlers showing clear signs of ASD are referred to an established network of health care specialists for rapid treatment. “There is evidence that early therapy can have a positive impact on the developing brain,” Pierce said. “The opportunity to diagnose and thus begin treatment for autism around a child’s first birthday has enormous potential to change outcomes for children affected with the disorder.”

The Get SET Early program will expand first to Phoenix, which has one of the oldest average ages of ASD detection in the country. A recent survey conducted by the U.S. Centers for Disease Control found that children with autism living in Phoenix were typically not identified until they were almost 5 years old.

In her 2011 study, published in the Journal of Pediatrics, Pierce and colleagues created a network of 137 pediatricians in the San Diego region and asked them to include a brief assessment at the toddlers’ traditional one-year health checkup. The assessment consisted of parents or caregivers answering a questionnaire called the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist that queried about a child’s use of eye contact, sounds, words, gestures, object recognition and other forms of age-appropriate communication. Any infant who failed the screening was referred to the UC San Diego Autism Center of Excellence for further testing and re-evaluation every six months until age three.

While the NIMH grant will initially test the feasibility of establishing the Get SET Early model in Phoenix, research and testing will also continue in San Diego to assess the efficacy of new improvements, such as repeat triple screenings and Internet-based tracking of referrals and treatment.

“By creating a simple screening, evaluation and treatment initiation and tracking model, we hope to establish national standards so that one day ASD detection and treatment between the first and second birthday will happen for all children,” said Pierce.

Funding for this work comes from the National Institutes of Health and NIMH (grant R01 MH104446-01).

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SF celebrates 3 new hospitals with stars, lights and action


UCSF Hard Hat Walk, Lights On Festival draw thousands to Mission Bay.

San Francisco’s Mission Bay district became a melting pot of celebrities, civic dignitaries, community members and assorted creatures of unknown species with dazzling outfits and daring dance moves, as the city marked the upcoming opening of the new UCSF Medical Center.

Thousands joined in Saturday’s revelry, starting with the 5K Hard Hat Walk along the waterfront and through the Mission Bay neighborhood and ending with the Lights On Festival in the public plaza outside the medical center complex. The event culminated in a multicolor light show illuminating the windows of the three hospitals opening on Feb. 1, 2015: UCSF Benioff Children’s Hospital San Francisco, UCSF Bakar Cancer Hospital and UCSF Betty Irene Moore Women’s Hospital.

Donors and attendees of the celebration raised more than $525,000 for the new hospitals, exceeding the fundraising goal of $500,000.

Kicking off the Hard Hat Walk, UCSF Medical Center CEO Mark Laret paid tribute to the construction crew, staff and fundraisers. He urged the crowds to remind themselves that with “every step you take, think about a child whose life is going to be saved in that hospital and a mom who’s going to have an easier birth because of innovations here.”

There was plenty of levity to offset the serious moments.

A number of teams assembled for the walk dressed in fun costumes. UCSF Chief Information Officer Joe Bengfort nixed the sweats in favor of Luke Skywalker duds to lead his team, the Jedi Masters, which raised close to $12,000. The UCSF Cancer Crusaders donned superhero masks and capes; the Children’s Emergency Department team all wore rainbow tutus; and Remembering Maggie McDonald – one of the top patient fundraising teams – sported yellow hard hats in tribute to 19-year-old Maggie, a longtime patient of UCSF Benioff Children’s Hospital San Francisco who passed away earlier this year.

At the festival, families enjoyed pastries, tacos and other tasty treats from top local restaurants, while children got their faces painted, participated in wall art, played bungee run and danced to Vocal Rush, a teen a cappella group from the Oakland School for the Arts. Other participants decompressed with chair messages or a snuggle with a friendly possum from the San Francisco Zoo’s Zoomobile.

Adding razzle-dazzle to the event were Jesse Tyler Ferguson, star of the ABC television show “Modern Family,” Olympic champion figure skater Kristi Yamaguchi and San Francisco Giants home run king Barry Bonds, a longtime friend and supporter of UCSF Benioff Children’s Hospital San Francisco (“my brother from another mother,” according to Ferguson).

The midafternoon sun had segued into an early evening chill by the time celebrated singer and Bay Area native Michael Franti took the stage. But the audience warmed up dancing to his hits, “I’m Alive” and “Say Hey.”

At his invitation, a group of patients joined him on stage. The new hospitals were very personal to him, Franti explained, because his 15-year-old son had been a long-term patient at UCSF Benioff Children’s Hospital San Francisco. The audience nodded in unison, knowing the hospitals will play a key role in their health and that of their loved ones for generations to come.

David Chiu, president of the San Francisco Board of Supervisors, said it best when he addressed the crowd: “This is a moment in time so special for San Francisco.”

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Diaper detective


Students develop inexpensive, versatile pad to detect medical problems in infants.

A team of UC Riverside Bourns College of Engineering students created an inexpensive pad that can be inserted into diapers to detect dehydration and bacterial infections in infants.

The product, which recently won an award that included a $10,000 prize at a national engineering design contest, operates much like a home pregnancy test or urine test strip. Chemical indicators change color when they come in contact with urine from an infant who is suffering from dehydration or a bacterial infection.

The pad, which is 2.5 inches by 5 inches and called “The Diaper Detective,” is attractive for numerous reasons. It costs 34 cents to make. It doesn’t require electricity, cold storage or an advanced education to interpret. It’s customizable so that other chemical indicators can be added to test for other medical conditions. And it could be adapted to be used in adult diapers.

“We created this to fulfill a need for a versatile, inexpensive, non-invasive method of urine collection in developing countries and elsewhere,” said Veronica Boulos, one of the team members. “The beauty of this is that it solves a huge problem with simplicity.”

Strike against infant mortality

The Diaper Detective addresses the worldwide problem of infant mortality in developing nations. Of the estimated 3.9 million annual neonatal deaths, 98 percent occur in developing countries and could be prevented with access to low cost, point-of-care diagnostics.

In developing countries, the students hope the Diaper Detective will be distributed via relief organizations. In the United States, the students believe the pad would qualify for reimbursement through medical insurance, making it an inexpensive option for low-income users.

The uniqueness of the diaper insert comes from the use of lateral flow channels that guide the user’s urine to the reactive regions where the color change takes place. The lateral flow channels were originally created using Crayola crayons and are now created by paraffin wax and a laser printer.

The students won a third place award at the National Institute of Biomedical Imaging and Engineering Design by Biomedical Undergraduate Teams Challenge. They have also submitted the product to the National Collegiate Inventors and Innovators Alliance BMEStart competition.

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Study IDs genetic factors involved in pediatric ulcerative colitis


Findings point to novel approaches for prevention, treatment.

Microscope images of a normal mouse colon (left) and one with colitis (right).

UCLA researchers were part of a team that has discovered the interplay of several genetic factors that may be involved in the development of early-onset ulcerative colitis, a severe type of inflammatory bowel disease.

The early research findings may offer new targets for prevention and treatment strategies to address the inflammation generated by early-onset ulcerative colitis.

The rare disease affects infants and young children and can lead to early development of colon cancer and an increased risk of liver damage.

Scientists from the David Geffen School of Medicine at UCLA and Pusan National University in South Korea also created a first-of-its-kind animal model that mimics early-onset ulcerative colitis and can be used to help test new drug candidates to treat the disease. Their findings are published in the current issue of the peer-reviewed journal Gastroenterology.

“We hope that identifying these key genetic factors and providing a unique research model will help lead to new approaches to treat early-onset ulcerative colitis, a devastating disease that currently has no cure,” said Dr. Sang Hoon Rhee, the study’s senior author and an associate adjunct professor of medicine in the Division of Digestive Diseases at the David Geffen School of Medicine at UCLA.

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Pediatric transplant recipients, families celebrate at UCSF picnic


19th annual picnic points to growing success of organ transplants.

About 300 transplant recipients, donors and family members attended the 19th Annual Chris Mudge UCSF Pediatric Transplant Picnic on Aug. 23.

On a bright summer Saturday, dozens of children and their family members gathered at McNears Beach Park in San Rafael, listening to music, kayaking, having their faces painted, smashing piñatas, even playing with costumed Smurfs. For this group, the outlook wasn’t always this sunny.

The children are part of a special group: they’re pediatric transplant recipients from UCSF Benioff Children’s Hospital San Francisco.

The 19th Annual Chris Mudge UCSF Pediatric Transplant Picnic on Aug. 23 gave children who received transplants from UCSF and their families an opportunity to come together for support, to share knowledge and to celebrate having another chance at life. The 300 attendees included those who had received pre- and post-liver, kidney and small bowel transplants, as well as physicians, transplant surgeons, nurses and others from the UCSF Transplant Service.

“Some of my patients now are married and come to the picnic,” said Phil Rosenthal, M.D., former medical director of the pediatric liver transplant program and current director of pediatric hepatology at UCSF. “A lot of our families look forward to coming back to this picnic each year to reconnect.”

One of those returning patients was Justin Erickson of Redwood City. In 1992, he needed a liver transplant due to biliary atresia, a life-threatening condition in which the bile ducts are blocked.

Twenty-two years later, the 31-year-old city of San Carlos employee is a husband and father of a 5-month-old daughter.

“The first five years after the transplant, it was a real rough battle,” said Erickson, who has attended every picnic. “I had a lot of ups and downs, but I’m doing pretty good now. It’s amazing all the things I’ve accomplished and the goals that I’ve met after the transplant.”

In sharing his personal experience, Erickson has advice for pediatric patients and their families awaiting a transplant at UCSF.

“If you are looking to have a transplant at UCSF, hold your hopes up,” he said. “You definitely are talking to the right caregivers. Benioff Children’s Hospital San Francisco is the place to be with the cutting-edge technology and the doctors that have the know-how.”

Erickson is living proof of the growing success of organ transplants. Before, a 50-percent success rate was considered satisfactory. Now, thanks to medical advances and improved immunosuppressive drugs to combat infection and rejection, more than 90 percent of transplant patients are surviving, including children.

Founded in the 1960s, the UCSF Transplant Service is a world leader in clinical transplantation and has developed innovative techniques while producing superior outcomes. UCSF began pediatric kidney transplants in 1964 and pediatric liver transplants in 1989, making it among the oldest children’s transplant services in the country.

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Researchers to develop virtual center for developmental disorders


UC Merced project will focus on at-risk children up to 5 years old.

Jeff Gilger, UC Merced

UC Merced researchers will develop a virtual center to support parents and caregivers, as well as health and other professionals in detecting and treating Merced County children with developmental disorders, work made possible by a grant from First 5 Merced County.

Psychology professor Jeff Gilger and Blum Center interim Executive Director Steve Roussos are leading the two-year project, which is an example of how UC Merced’s innovative work can serve the community. The research will focus on at-risk children ages 0 to 5 years old, ages when many disorders remain undetected.

“Thousands of children get lost in the system and aren’t diagnosed with learning or other developmental problems,” said Gilger, UC Merced’s Carlston Cunningham Chair in Cognitive Development. “Early detection and treatment can significantly help a child, preventing a cascade of problems later in life.”

Merced County’s youth are particularly at risk for these disorders, given the county’s demographics: high rates of poverty, poor prenatal care, lack of stimulating environments, inadequate access to services and a host of other factors, Gilger said.

“This is a chance to give our campus an opportunity to do what it does best — using research and measurement in a very tangible way to help people,” Roussos said.

Many people are familiar with developmental problems such as autism or Down syndrome, yet there is a wide spectrum of disorders, and professional help can be difficult to find, even for middle-to-upper class parents, he said. This is especially true for the more subtle developmental disorders like learning disabilities. Parents who are just getting by financially have an even more difficult time finding assistance.

The $383,788 grant was awarded last month by First 5 Merced County to Gilger and Roussos, and is being administered by the Health Sciences Research Institute. The UC Merced Blum Center is part of the research and outreach. Two graduate students and a couple dozen undergraduate students will help with the research and analysis, and a programmer will be hired to develop the center’s website.

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UC Davis researchers launch study examining autism in girls


Little is known about biological differences between boys and girls with autism.

Little is known about autism in girls.

Autism is far more common in boys than girls – affecting 1 in 54 boys and 1 in 252 girls — but little is known about biological differences between boys and girls with autism. A new study, called the ‘Girls with Autism — Imaging of Neurodevelopment’ or GAIN Study, led by researchers at the UC Davis MIND Institute will explore those differences in very young girls with autism.

“We know that the incidence of autism is much lower in girls than it is in boys. But we don’t know much about why that is, and what those differences are,” said Christine Wu Nordahl, assistant professor of psychiatry and behavioral sciences and principal investigator for the study. “Because autism so much more common in boys, girls are often understudied, and we haven’t had the chance to evaluate them in depth.”

To investigate the differences between autism in boys and autism in girls, MIND Institute researchers are seeking very young girls with autism — between the ages of 2 and 3.5 years old — who are recently diagnosed with autism. The researchers also are enrolling girls in the same age range who are developing typically.

Study participants will be followed for two years and will receive magnetic resonance imaging (MRI) scans and other tests, to help researchers identify differences in brain structure and connectivity between boys and girls with autism.

“A comprehensive understanding of the female phenotype of autism spectrum disorder is a pressing and timely topic, as indicated by national efforts to direct research towards this goal,” Wu Nordahl said.

For further information about the research or to inquire about enrolling a child in the study, please contact Michelle Huynh, study coordinator, at (916) 703-0410, or michelle.huynh@ucdmc.ucdavis.edu.

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Breastfeeding may delay onset of puberty in girls


Girls with early-onset puberty at risk for multitude of health challenges.

Julianna Deardorff, UC Berkeley

In a recent study, maternal and child health researchers at the UC Berkeley School of Public Health looked into the idea that breast feeding may serve as a protective mechanism to delay onset of puberty in girls. They found that, in some cohorts, girls who were predominantly breastfed (as opposed to predominantly formula fed) showed later onset of breast development.

Girls with early-onset puberty are at risk for a multitude of health challenges, including greater risks of obesity, hypertension and some cancers. Early maturation is also associated with lower self-esteem, higher rates of depression and norm-breaking behaviors, and lower academic achievement.

“These findings are unique in suggesting that exclusive breastfeeding may delay onset of girls’ pubertal timing,” says Julianna Deardorff, assistant professor of maternal and child health and co-author of the study. “Given the limited number of modifiable factors influencing puberty, this is a promising area of research for intervention.”

The study was led by Aarti Kale, M.P.H. ’11, who analyzed data from a population of 1,237 girls recruited across three geographic locations — New York City, Cincinnati and the San Francisco Bay Area. Breast feeding practices were assessed using self-administered questionnaires with the primary caregiver. The girls were seen on an annual basis to assess breast and pubic hair development. In addition to breastfeeding correlating with pubertal onset, duration of breastfeeding was also directly associated with age at onset of breast development. However, a stratified analysis showed the association only in the Cincinnati cohort.

“The results varied across the sites, suggesting that unique characteristics of these cohorts and their environments modify effects,” says Deardorff. “Further research into the contexts within which breastfeeding and girls’ development occur would potentially illuminate sources of variability.”

The study was published in the Journal of Maternal and Child Health.

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Napa quake survivor thankful to UC Davis Children’s Hospital


Injured 13-year-old in good condition.

Nicholas Dillon received a visit from Sacramento Republic FC soccer club Forward Max Alvarez, himself a native of Napa.

Nicholas Dillon, the brave 13-year-old who survived after a chimney collapsed on him in his home during the Napa Valley earthquake last Sunday, is in good condition in UC Davis Children’s Hospital. Dillon’s recovery has garnered national and international media attention. He was interviewed from his hospital room in the Pediatric Intensive Care Unit yesterday by NBC News, among other media outlets.

Dillon also received a visit from Sac Republic FC soccer club forward Max Alvarez, himself a native of Napa.

“I want to thank all of the people who helped me,” Dillon said. “I’m grateful to the paramedics who brought me to Queen of the Valley (Medical Center) and to UC Davis, all of the staff at UC Davis, my family and friends. I can’t describe how thankful I am. I was in tears last night a little bit looking at the news.”

Dillon is expected to make a full recovery.

“I’m going to be fine. It’s going to be a long recovery, but I’m going to be okay,” he said.

The determined young man had an inspiring message for everyone affected by the earthquake.

“I just want everyone to know that we all have setbacks, but we will get through this as a community.”

Dillon’s family has established a fund to accept donations to support his recovery at the Bank of America: Nicholas M. Dillon Savings Account: 1641-0344-2511.

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Colds may temporarily increase stroke risk in kids


Study shows colds, flu can create short-lived increased stroke risk in vulnerable children.

A new study suggests that colds and other minor infections may temporarily increase stroke risk in children. The study found that the risk of stroke was increased only within a three-day period between a child’s visit to the doctor for signs of infection and having the stroke.

The study was led by researchers at UCSF Benioff Children’s Hospital San Francisco in collaboration with the Kaiser Permanente Division of Research.

“These findings suggest that infection has a powerful but short-lived effect on stroke risk,” said senior author Heather Fullerton, M.D., a pediatric vascular neurologist and medical director of the Pediatric Brain Center at UCSF Benioff Children’s Hospital San Francisco.

“We’ve seen this increase in stroke risk from infection in adults, but until now, an association has not been studied in children.”

Strokes are extremely rare in children, affecting just 5 out of 100,000 kids per year. “The infections are acting as a trigger in children who are likely predisposed to stroke,” said Fullerton. “Infection prevention is key for kids who are at risk for stroke, and we should make sure those kids are getting vaccinated against whatever infections – such as flu – that they can.”

The study appears in today’s (Aug. 20) online issue of Neurology.

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