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MNAAP Newsletter

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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Searching for The Holy Grail: A Perfect Screen for Social Determinants of Health

DianaCuttsDiana Cutts, MD, FAAP, Hennepin County Medical Center; and Rich Sheward, deputy director of innovative partnerships at Children’s HealthWatch

Why screen for social determinants of health?
In the United States, we spend increasingly more money per capita on medical services compared to other industrialized nations, while we spend increasingly less on social services. Thus, despite medical advances and increased health care spending, underinvestment in addressing patients’ socioeconomic needs inhibits progress in achieving improvements in our nation’s health.

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Statewide Project to Prepare for Pediatric Disasters

Paula Kocken, MD, FAAP, Pediatric Emergency Medicine, Children’s MinnesotaPaulaKocken

How would your local hospital respond to 15 pediatric victims of a disaster presenting to the emergency department (ED) in one hour?

A surge of pediatric patients can come from a mass casualty event like the Boston Marathon or from a chlorine spill at a pool.

The National PedsReady project from 2013 showed, on average, only 60 percent of Minnesota hospitals are sufficiently prepared for a pediatric surge of patients.

Through a grant from the AAP, I am working with a multidisciplinary group and the Minnesota Department of Health (MDH) to create and roll out an educational curriculum to improve the care of young patients during a large volume event.

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Sounding the Alarm on School Start Times: Later is Attainable

By Julie Dahl, APRN, CNP, President of the MN Sleep Society, Respiratory Consultants; Julie Baughn, MD, Mayo Center for Sleep Medicine, Children’s Center; Robin Lloyd, MD, Mayo Center for Sleep Medicine, Children’s Center

It is widely known that adequate sleep is required for optimal health and learning. Yet, adolescents nationwide are sleep deprived. Why? As children transition to adolescence, their biological sleep clocks shift, with a delay in melatonin release occurring around 10:45 pm (1). With early school start times, adolescents are unable to get the quality, well-timed sleep they need.  In Minnesota, 87 percent of high schools start before 8:30 a.m. and 60 percent of adolescents report inadequate sleep (2,3).  Parents will likely turn to their pediatricians for the facts.

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