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MNAAP Newsletter

Donor Milk in Minnesota…a MN Milk Bank is Coming!

By Teresa Kovarik, MD, FAAP, FABM, Medical Director of HealthPartners’ Lactation Services and Pediatrician at HealthPartners Como Clinic; Pamela Heggie, MD, IBCLC, FAAP, FABM, Director of Breastfeeding Medicine and Pediatrician at Central Pediatrics; and Nancy Fahim MD, FAAP, University of Minnesota, Neonatology at Maple Grove and North Memorial Hospitals

The AAP strongly supports breastfeeding for all infants given the substantial evidence showing improvement in health outcomes for babies fed human milk. In the 2012 policy statement about human milk, the AAP states that breastfeeding is a public health issue, not just a lifestyle choice. While mother’s own milk is preferred, some women have a low milk supply and, despite their best efforts, cannot meet their baby’s milk requirements. In some studies, only 30 percent of women who deliver premature infants can produce a full milk supply for their NICU babies. As we all know, mothers with full term infants can have similar difficulty. When supplementation is needed because of maternal low milk supply, pasteurized donor human milk is increasingly being used to bridge the gap.

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Addressing Adolescent Sexual Health Amid Rising STI Rates

karischneiderKari Schneider, MD, FAAP, University of Minnesota Medical School

The 2018 Minnesota Adolescent Sexual Health Report, released in June by the Healthy Youth Development Prevention Research Center (HYD•PRC) at the University of MN, provides a great look at the sexual health of Minnesota’s youth. Most notably, adolescent pregnancy and birth rates are at “historic lows” with a 65 percent decline in the adolescent birth rate between 1990 and 2016. Unfortunately, however, sexually transmitted infections (STIs) continue to increase in the young people of our state. The rates of chlamydia and gonorrhea in MN reached all-time highs in 2017. Chlamydia at 440/100,000 (an increase of 4 percent from 2016) and gonorrhea at 123/100,000 (an increase of 28 percent) illustrate the disproportionate effect that these infections have on Minnesota’s adolescents and young adults.

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Open Up! Addressing Oral Health at Well Visits

eileen crespoBy Eileen Crespo, MD, FAAP, Vice President of Medical Services, Delta Dental Minnesota; pediatrician at Hennepin Healthcare

Have you been to an adult dentist lately? If you have, you may have had your blood pressure measured. You might have thought that odd, but many dental practices are screening adults for high blood pressure. The goal is to screen and refer patients who may have regular dental care but may not be having regular medical care. The intention is to have dental and medical providers join efforts in collaborative patient care, working as a team.

In pediatrics, we are familiar with the concept of the medical home, a coordinated approach to providing comprehensive primary care for children, youth and adults. For many patients, the medical home might be comprised of primary care, medical specialties, social workers, community health workers and dieticians, but no oral health provider. The dental home is somehow separate, though poor oral health doesn’t follow arbitrary divisions.

We all have taken care of children with rampant dental decay that affects their overall health. From a sleepless night for a child with tooth pain or preoperative clearance for a child with special health care needs who needs surgical restorations for widespread dental caries, patients need an integrated approach that includes oral health as a basic primary care need.

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Promoting Knowledge and Awareness of Congenital CMV

MarkSchleissBy Mark R. Schleiss, MD, FAAP, University of Minnesota Medical School

Congenital infection with cytomegalovirus (cCMV) is common, and usually not recognized in the newborn nursery. All pediatricians are familiar with the presentation of severely affected infants – hepatosplenomegaly, petechiae, microcephaly, hearing loss – but, in fact, most infants with cCMV are either asymptomatic or minimally symptomatic. When cCMV is diagnosed and I see an affected infant in my clinical practice, virtually every family tells me that they never heard of this infection – before it happened to them!

More and more in recent years, I have wondered how it can be true that this infection – the single most common infectious diseases responsible for developmental disability, in particular hearing loss, in the United States – is so poorly known. Indeed, there is much better awareness of diagnoses associated with neonatal disabilities, such as Down syndrome, fetal alcohol syndrome, and Zika virus infection, than for cCMV. This lack of knowledge is particularly troubling in light of the fact that many cases of cCMV could be prevented by implementation of simple steps that prevent acquisition of infection during pregnancy (https://www.cdc.gov/features/prenatalinfections/index.html). Fortunately, in the past year extensive progress has been made in advancing awareness of cCMV infection.

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Beyond Automatic Repeal: The New AAP Recommendations of Do Not Attempt Resuscitation Orders for Children

By Naomi Goloff, MD, FAAP, University of Minnesota Masonic Children’s Hospital and Fairview Home Care and Hospice

naomiThe American Academy of Pediatrics (AAP) recently released new guidelines about intraoperative resuscitation for a patient with a serious illness and a pre-existing Do Not Attempt Resuscitation (DNAR) order.

Until recently, it had been standard practice to routinely “rescind” the DNAR in the perioperative period. Instead, the new AAP report describes a “required reconsideration” of the DNAR, a process of re-evaluation of DNAR orders that are incorporated into the process of informed consent prior to surgery and anesthesia.

It recommends an integrated approach involving attending anesthesiologists, surgeons, primary physicians or subspecialists and/or the palliative care team in these conversations. Essential components are clear documentation of the conversation and decisions, as well as clear communication with the entire team, especially the anesthesiologist and surgeon performing the case (many times the clinician getting consent, often with regards to anesthesia, will not be the one involved in the actual case). These recommendations also allow for a physician to withdraw from the case if he or she is unwilling or unable to implement the decision of the patient and/or family.

The report outlines 3 options or approaches for “required reconsideration.”

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