Nonalcoholic fatty liver disease (NAFLD) in Pediatrics with Shikha Sundaram, MD (Rebroadcast S5:E9)

Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood respiratory illness, resulting in annual outbreaks among all age groups. In the United States, an estimated 60,000 to 80,000 children, the majority of whom are under 6 months of age, are hospitalized each year. Approximately 100 to 300 kids die from this infection each year. RSV is the single most common cause of death from respiratory illness, after the newborn period, in developing countries. This year, the medical community has made history with the first RSV vaccine approvals for pregnant individuals, infants and the elderly. In this episode, we are taking a deep dive into RSVpref, which is the first RSV vaccine for use in pregnant individuals to protect newborns and infants from severe RSV in the first six months. We are also discussing nirsevimab, a monoclonal antibody, which protects infants and some children against RSV. That includes children 8 –19 at increased risk for severe disease. This is a significant milestone for the scientific community and for public health. “I think now, in another two or three years, we will decrease ER visits, we will decrease hospital visits and I hope we decrease ICU visits. And the next phase of course, hopefully in my lifetime, we get it into developing countries and see impacts on mortality,” Eric Simoes, MD, says. Dr. Simoes has been a part of the creation of these vaccines since the beginning and is our guest for this highly requested topic. He is a clinical professor of pediatrics and infectious disease at the University of Colorado School of Medicine, as well as a professor of epidemiology at the Colorado School of Public Health. He is currently an active clinical infectious disease physician at Children’s Hospital Colorado. Of important note, Dr. Simoes served as the global primary investigator for the RSVpreF and lead investigator for the development of nirsevimab. Some highlights from this episode include:  How these vaccines received approval and became available on market  Indications to delivering this vaccine to a pregnant person  Benefits of receiving these vaccines The future of this vaccine and its impact on people of different ages    For more information on Children’s Colorado, visit: childrenscolorado.org

21 Nov 202340min

The preteen and teenage years are taxing and have become increasingly difficult for a multitude of reasons. This is a part of the patient population that pediatricians really worry about. Part of the angst of this time of life has always been the changes that occur to kids’ bodies as they grow – particularly for young girls. This experience is different as they experience menarche, the onset of menstruation, which can be both psychologically and physically challenging. Menstrual irregularities are very common, occurring in an estimated 14% to 25% of all women of childbearing age. Many gynecologic conditions diagnosed during childhood require treatment that extends into adulthood and it’s hard to stay abreast of all the new therapies and hormonal management strategies of menstruation. “When you can really connect with a teen who is so vulnerable so has just been struggling that recognizes that this is normal, that they are not alone, and that we can help, that’s pretty great,” Tricia Huguelet, MD, says. Today we are joined Dr. Huguelet, a pediatric and adolescent gynecologist at Children’s Hospital Colorado. While she didn’t always plan for this career route, she developed a love for pediatrics from an early age. She fondly reflects on her memories going on rounds with her father who was a pediatrician focusing on pediatric infectious disease. Combining her love for children with her passion for surgery, she has become the section chief of pediatric and adolescent gynecology at Children’s Colorado, as well as a faculty member in the OBGYN department at the University of Colorado School of Medicine. “When I discovered that not only could I do reproductive care for women but then specifically focus in kids and teens it was a no brainer that that was where I was going to focus my time,” Dr. Huguelet says. Dr. Huguelet explains how menstrual abnormalities are not just physically demanding, but can create a strain on mental health. “I mean I’ve had patients with bleeding disorders who we send letters to school and they still aren’t excused. So just the embarrassment over that and day to day life when you don’t want to talk about it, you certainly don’t want to show it, has a tremendously negative impact,” Dr. Huguelet says. Some highlights from this episode include:   Most common menstrual abnormalities in children How to normalize these conversations between kids and parents Management and treatment of these abnormalities Mental health impacts from menstruation abnormalities   For more information on Children’s Colorado, visit: childrenscolorado.org

14 Nov 202327min

We live in a country where medical experts are breaking barriers and changing outcomes on a daily basis, so it’s always exciting when we get to celebrate one of our own. Recorded at the 2023 American Academy of Pediatrics (AAP) National Conference and Exhibition in Washington, D.C., this episode honors David Keller, MD, who was recently named the recipient of the 2023 AAP Job Lewis Smith Award. “I want to be a part of the solution to problems,” Dr. Keller says.   The award recognizes lifelong outstanding career achievement in community pediatrics and is the highest award bestowed by the council. Dr. Keller has dedicated more than 40 years to advancing child health and he currently serves as the Department of Pediatrics Vice Chair of Clinical Strategy and Transformation at Children’s Hospital Colorado. “We as pediatricians need to remember that children always live in context. There is no such thing as an isolated child. They live in the context of their families, but they also live in the context of their communities. If we don’t understand the communities that our kids live in, then it’s really challenging to understand how illness interacts with that community and how you can intervene,” Dr. Keller says.  Some highlights from this episode include:   Dr. Keller’s early career influences How he earned this prestigious award  How we learn more about the context of our patients  Advice for young doctors and medical professionals trying to make their own imprint  For more information on Children’s Colorado, visit: childrenscolorado.org

7 Nov 202333min

In the United States, 77% of vector-borne diseases are transmitted by ticks and numbers have increased dramatically in recent decades. While Lyme disease may be the most common in the country, with an estimated 475,000 new cases each year, there are many other vector-borne diseases affecting people every day. Information is constantly shifting related to current and predicted changes in the epidemiology of tick-borne diseases, age -specific clinical and laboratory manifestations, as well as treatment. In addition, there are many public misconceptions regarding vector-borne infections and approaches to infection. What is the risk of labeling someone as having Lyme disease and possibly missing the true diagnosis? We answer that question and many more on today’s episode. “When we think about tick-borne infections, I always like to focus on the tick, the organism that it transmits to and then on the disease process,” Lourdes Eguiguren, MD says.  This episode was recoded at the 2023 American Academy of Pediatrics National Conference and Exhibition in Washington, D.C., which provided us an opportunity to speak with experts in- person from across the country. As an infectious disease expert with a focus on tick-borne infection at Children’s Nebraska, Dr. Eguiguren is here to share her knowledge. She is an assistant professor in the division of infectious diseases at the University of Nebraska Medical Center. She has a passion for teaching trainees and connecting with her patients on a personal level. “Many times, we actually come up with a differential diagnosis or even the final diagnosis by talking to parents”, Dr. Eguiguren says.   Some highlights from this episode include:  Key details about Lyme disease  How disease is transmitted from tick to organism  The impact of climate change on the prevalence of ticks  Breaking down misconceptions about vector-borne infections  What treatment options look like    For more information on Children’s Colorado, visit: childrenscolorado.org

31 Okt 202337min

For parents expecting a newborn, their top priority is bringing a healthy baby into this world. But it’s not just their responsibility while their baby is in the womb. As newborns, important screenings are changing health outcomes. Over 98% of U.S. newborns are screened for hearing loss and about 6,000 U.S. infants born are identified early with a permanent hearing loss. In all 50 states and Washington D.C., there are newborn screening laws to make sure these tests happen. Experts say they are crucial to keep at the forefront of newborn care. It’s doctors like Owen Darr, MD, whose passion is helping these kids live the best life possible. “Working with families, helping them through a difficult time, finding interventions –– sometimes small, sometimes big –– that can really make a positive impact on a child’s life,” Dr. Darr says. In today’s episode, we are joined by Dr. Darr and Kristin Uhler, PhD. Dr. Darr specializes in otolaryngology at Children’s Hospital Colorado. He is also an assistant professor of otolaryngology, head and neck surgery. Dr. Uhler is an audiologist at Children’s Colorado, as well as an associate professor of physical medicine and rehabilitation. Dr. Uhler explains that 1998 was the year experts provided the efficacy for newborn screening. “Where they realized if you screen a baby by 1 month of age, you then rescreen them at and diagnose them with either hearing loss or normal hearing by 3 months of age, and then enroll them in early intervention by 6 months of age, that they have language on par with their typical hearing peers by preschool,” Dr. Uhler Says. Some highlights from this episode include:  Why we screen newborns and what we are screening for Sensitivity and specificity of the hearing test  Intervention options to help children with hearing loss  When physicians should refer kids for a hearing test  Today’s episode is underwritten by the Daniels Fund, in recognition of their longstanding commitment to the Bill Daniels Center for Children's Hearing at Children's Hospital Colorado. Cable television pioneer Bill Daniels suffered hearing loss traced to his service as a decorated fighter pilot in World War II. His experience formed a strong catalyst for the Daniels Fund's gifts to support Children's Colorado, since 2005. Thank you to the Daniels Fund for continued investment in Children’s Colorado to help children who are deaf or hard-of-hearing receive the care that they need to grow into healthy and dynamic citizens. For more information on Children’s Colorado, visit: childrenscolorado.org

24 Okt 202335min

We have listeners all over the world, many of whom are Spanish-speaking. Did you know we have a sister podcast, Pediatras en Línea? It stands out as one of the only podcasts in Spanish that focuses on medical education. About two and a half years ago, Pediatras en Línea launched and became a critical resource for pediatricians all throughout the U.S. and Latin America. Fast forward to today, they are growing 277% per month and have audience members in 90 countries. In 20 of those countries, Spanish is the official language.   In this episode, we are joined by the host of Pediatras en Línea, Carla Torres-Zegarra, MD. Dr. Torres-Zegarra is a pediatric dermatologist at Children’s Hospital Colorado and assistant professor of dermatology and pediatrics at the University of Colorado School of Medicine. Born and raised in Lima, Peru, Dr. Torres-Zegarra moved to the U.S. in 2009 to pursue medical school and has been practicing at Children’s Colorado since 2013. She says being able to work here at Children’s Colorado is a dream. “Now I feel the need to give back to the people that have allowed me to have this opportunity by being a resource and even an inspiration for those who are listening outside of the states,” Dr. Torres-Zegarra says. About 42.5 million people in the U.S. speak Spanish, and that number increases to more than 457 million worldwide. However, when we specifically look at the medical profession, only 6% of physicians identify as Hispanic and just 2% of non-Hispanic physicians are Spanish-speaking. Of that 6%, Dr. Torres-Zegarra highlights that only 2.4% are female. Through her podcast, she hopes to inspire other Spanish-speaking women to become physicians. “I am just one of them, and I am very happy to be one of them,” Dr. Torres Zegarra says. Some highlights from today’s episode include:  An overview of Pediatras en Línea The power of social media Challenges faced by overseas-trained doctors when relocating to the U.S. How these podcast episodes allow pediatricians to always learn something new For more information on Children's Colorado, visit: childrenscolorado.org

17 Okt 202332min

Miracles happen every day and it’s an honor when we can celebrate them. This year marks the 60th anniversary of the start of newborn screening in the United States. The program identifies infants with specific genetic conditions that are asymptomatic at birth and ensures they can receive prompt, lifesaving medical interventions. Over its lifespan, the program has saved countless lives. New research and technological advancements have allowed for innovation and enhanced abilities to screen for certain disorders. Today, newborn screening has evolved into one of the most effective public health programs in the country and its impact won’t stop anytime soon. On this 60th anniversary, experts are celebrating successes while still trying to improve current processes. “False positives are the Achilles’ heel of newborn screening. I know we always think about not missing a case, but the harms are almost all associated with telling a parent their child is positive when they aren’t. Some of these treatments are time critical,” says Ned Calonge, MD, one of our guests on today’s episode and the Chief Medical Officer for the Colorado Department of Public Health and Environment.   Dr. Calonge is joined by Stacey Martiniano, MD, a physician here at Children’s Hospital Colorado and Gregory Bonn, the Colorado newborn screening program manager. They are three experts behind some of the early intervention that ensures every child can live the healthiest life possible. “My favorite part is helping them stay as healthy as possible, live full lives and keeping that relationship with them throughout their childhood and young adulthood,” Dr. Martiniano says.  Some highlights from today’s episode include:   Variations of newborn screening programs in different states and countries How technology has advanced what's possible to identify and treat The history of how the program was created What's on the horizon for newborn screening For more information on Children’s Hospital Colorado, visit: childrenscolorado.org

10 Okt 202332min

During the 2022-2023 admission cycle, about 22,700 students enrolled in medical school in the United States. In this country alone, we have 154 medical schools offering an MD program. Many of these schools are actively working to incorporate modern learning principles into their structure. It’s all a part of a larger goal to align the forces affecting the delivery of care with educational priorities. Over time, comprehensive care has become a widely accepted standard for modern medicine; it puts positive patient outcomes at the forefront. That’s why creating those environmental opportunities are crucial to medical students as they prepare for a long career at the bedside. A Longitudinal Integrated Clerkship, or LIC, is a clinical curriculum in which students participate in the comprehensive care of patients over time. “LIC students have been found to experience lasting improvements in their patient centeredness, in their empathy, and also student satisfaction is higher,” says Amy Grover, MD, an assistant professor of pediatrics and pediatric hospital medicine.   Patient-student relationships are at the heart of LICs. We see these across the scope of medical education worldwide, but there is something unique about the LIC model here at Children’s Hospital Colorado. Dr. Grover is a guest on today’s episode, along with Meghan Treitz, MD, an associate professor of pediatrics and general pediatrics, and Margie Rodgers, an LIC coordinator. “One of the advantages of this model is students get exposure to the clinical world earlier and also at the end of their second year have had exposure to all of the core disciplines so planning for residency and career is actually made a little bit easier,” Dr. Treitz says.   Some highlights from this episode include: What an LIC is and how it works The advantages of an LIC curriculum compared to other medical education practices How students learn every discipline through an LIC in a pediatric hospital setting Stories about unique patient care experiences from students  Articles referenced in the podcast:  Hirsh DA, Ogur B, Thibault GE, Cox M. "Continuity" as an organizing principle for clinical education reform. N Engl J Med. 2007 Feb 22;356(8):858-66  Hirsh et al.  Better learning, better doctors, better delivery system: possibilities from a case study of longitudinal integrated clerkships.  Med Teach 2012;34(7):548-54.  Walters, et al. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. Med Educ 2012; 46: 1028-1041   Poncelet, et al.  Development of a longitudinal integrated clerkship at an academic medical center. Med Educ Online 2011; 16: 5939.   Hirsh D, Gauberg E, Ogur B, et al. Educational outcomes of the Harvard Medical School—Cambridge integrated clerkship: a way forward for medical education. Acad Med. 2012;87:643-50  Teherani, et al. Outcomes of Different Clerkship Models: Longitudinal Integrated, Hybrid and Block.  Acad Med 2013; 88: 1-9   Gaufberg E, Hirsh D, Krupat E, et al. Into the future: patient-centeredness endures in longitudinal integrated clerkship graduates. Med Educ. 2014;48:572-82.  Flick RJ, Adams JE. Alliance, trust, and loss: experiences of patients cared for by students in a longitudinal integrated clerkship. Acad Med. 2019  Beard AS, Candy AE, Anderson TJ, Derrico NP, Ishani  KA, Gravely AA, Englander R, Ercan-Fang NG. Patient satisfaction with medical student participation in a longitudinal integrated clerkship: a controlled trial. Acad Med. 2020. 95(3):417-424.  McKenna et al. The missing link: connection is the key to resilience in medical education. Acad Med 2016  Wald, Hedy S. PhD Professional Identity (Trans)Formation in Medical Education, Academic Medicine, 2015  For more information on Children’s Colorado, visit: childrenscolorado.org

3 Okt 202325min