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MNAAP Newsletter

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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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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Word from the President: Lori DeFrance


lori-defranceWith humility and gratitude, I have transitioned into the role of MNAAP president. Dr. Kiragu, our past president, has been an outstanding role model for leadership as he has guided us through the past two years with unwavering dedication and focus. Thank you, Dr Kiragu!

I will take this opportunity to introduce myself. I have practiced general pediatrics for 29 years in Duluth. How lucky am I to see the expansive and stunning vista of Lake Superior every day as I drive down the hill to The Duluth Clinic. My husband is a pharmacist at a Federal Prison Camp. I have a daughter who is starting her second year of medical school and a son who is an electrical engineering student. We became empty nesters two years ago. Much to her delight, our French Bulldog, Rosie, has become the center of attention in our household.

In June, I attended the AAP District VI meeting in Itasca, Illinois. This is an opportunity to interact with the chapter leaders of other states and Canadian provinces in our District, and to hear an update on the American Academy of Pediatrics’ priorities, challenges and strategies for action and ongoing advocacy. Dr Kyle Yasuda, president-elect of the AAP, opened the session discussing these key areas of concern: detention of immigrant children, physician health and wellness, diversity and inclusion initiatives, NAS and the opioid crisis, and e-cigarettes.

I gathered some interesting take away information from the many sessions – I will highlight toxic stress and implicit bias here.

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Early Hearing Detection and Intervention

Lisa Schimmenti


By Lisa A. Schimmenti, MD, Mayo Clinic School of Medicine, and Abby Meyer, MD, Children’s Minnesota

 The 2018 Early Hearing Detection and Intervention (EHDI) National Meeting was held March 18-20, 2018 in Denver, Colorado. As Minnesota’s AAP EHDI Chapter Champions, we attended the meeting and met with other Chapter Champions from across the country to review the most recent data and to strategize for the upcoming year.

On a national level, data from the 2015 CDC EHDI Hearing Screening & Follow-up Survey (HSFS) showed that 98 percent of infants had their hearing screened, 96 percent by the benchmark timeframe of before 1 month of age. Nearly 72 percent had confirmed diagnosis by 3 months of age with a 28 percent loss to follow up/loss to documentation rate. About 88 percent of infants identified as deaf or hard of hearing (DHH) were referred to Early Intervention (CI) and 65 percent of DHH infants were enrolled by 6 months of age. For further details, go to:

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