CHOP Research In the News: Fetal Imaging, Hoverboards, and Violence

Jan 29 2016

CHOP Research In the News: Fetal Imaging, Hoverboards, and Violence

CHOP Research In the NewsViolence Against Children: An Urgent Public Health Priority

Violence against children has reached an epidemic level globally, according to a new study published in the journal Pediatrics and reported by CBS News.

A team from the U.S. Centers for Disease Control and Prevention (CDC) and Massachusetts General Hospital/Harvard Medical School analyzed 38 reports covering 96 countries and estimated that at least 50 percent of children in Asia, Africa, and North America experienced past-year violence, as did more than 30 percent of children in Latin America.

The study was well done and very strong, according to Joel Fein, MD, MPH, co-director of the Emergency Department Violence Intervention Project at The Children's Hospital of Philadelphia and The University of Pennsylvania Medical Center, and Stephen Leff, PhD, a psychologist in the department of Child and Adolescent Psychiatry and Behavioral Sciences and co-director of the Violence Prevention Initiative (VPI) at CHOP, who were quoted in the CBS News report.

The VPI launched a set of programs in 2014 designed to reduce the severity and impact of violence and aggression on children and families not only in Philadelphia communities but also across the country. The programs reach beyond the hospital and doctors’ offices into schools, homes, neighborhoods, and recreation centers by empowering and training kids and adults to interrupt the cycle of violence.

“This supports the reason why we do this work,” said Dr. Leff, who also is a professor of clinical psychology at Penn's Perelman School of Medicine. “The fact that this is being published in the journal Pediatrics really does speak to the point that the health care system has a strong role in addressing this issue.”

Serious Birth Defect Increasing and Raising Concern

Holly L. Hedrick, MD, a pediatric and fetal surgeon at CHOP, told The New York Times that a new report about the prevalence of gastroschisis is “staggering.” Infants with the defect are born with intestines poking out of a hole in the abdominal wall, typically on the right side of the belly button.

The CDC reported based on analysis of data from 14 states that the prevalence of gastroschisis has increased by about 30 percent, to 4.9 births out of 10,000 during the period from 2006 to 2012 compared to the preceding ten years.

The defect occurs more often in babies born to mothers younger than 20, although the rate has increased among mothers of all ages. The defect occurs very early in gestation and usually is diagnosed by routine ultrasound in the second trimester when free-floating intestine is seen. Repair of gastroschisis after birth involves returning the extra-abdominal contents back into the abdominal cavity, followed by abdominal wall closure. This surgery can either be performed immediately after birth or is more commonly done in a series of steps (staged repair) performed over an average of five to 10 days.

Once the abdominal wall is closed, “babies can lead normal lives and fare very well,” assuming the bowel is not injured, Dr. Hedrick said in her interview. “In general, it’s a fixable problem, but we’d rather it was a preventable problem.”

The CDC continues to study birth defects like gastroschisis in order to learn how to prevent them and understand why this condition is increasing.

New Alliance Expands CHOP’s International Expertise

President and CEO of CHOP Madeline Bell received a warm welcome in Dubai at a press conference announcing a knowledge-sharing partnership between CHOP and VPS Healthcare, one of the fastest growing integrated healthcare service providers in the Middle East, Europe and India, according to a Philadelphia Magazine article.

“This alliance marks many exciting firsts, as it is both my first visit to the UAE and CHOP's first alliance of its kind in the Middle East,” Bell stated in a CHOP press release. “VPS Healthcare’s innovative approach and growing presence in the region creates an ideal opportunity for us to share our expertise and capabilities in order to help build local capacity, while also providing a unique opportunity for CHOP to expand and increase our international expertise.”

Initially, they will conduct a gap analysis of the current state of pediatric care at VPS, in order to institute specific steps in enhancing local training, technology, and treatments to provide world-class patient care in the United Arab Emirates (UAE). CHOP doctors also will have opportunities to travel to Dubai and Abu Dhabi to consult on patient care and conduct continuing-education conferences in the UAE, and VPS doctors will have opportunities to travel to CHOP to observe patient care and incorporate best practices.

This is the first of several joint initiatives emanating from a memorandum of understanding signed last October in which both organizations committed to establishing standards of excellence for pediatric care at VPS hospitals and clinics. VPS plans to set up a state-of-the-art facility — scheduled to open in 2017 — that marks a significant step forward in offering the most advanced medical care to the children of the UAE and across the Middle East.

Avoiding Hoverboard Hazards

While many parents may be concerned about the fire hazards that hoverboards may pose, Flaura Koplin Winston, MD, PhD, scientific director of CHOP’s Center for Injury Research and Prevention, took a different spin in her Healthy Kids blog post featured on Philly.com.

The two-wheeled, self-balancing, battery-powered scooters can move more than 10 miles per hour, so Dr. Winston pointed out that it is not surprising that concussions, fractures, sprains, and lacerations are among the hoverboard-related injuries that have been tracked by The Consumer Product Safety Commission. While long-term data on hoverboards is not available, Dr. Winston cited a skateboarding safety study that she co-authored in 2002: Skateboarding injuries increased by 16,500 each year between 1998-2001, with approximately 100,000 people visiting the emergency department 2001.

The blog post shares tips on avoiding hoverboard injuries, including not buying them in the first place. The CPSC lists other safety recommendations here.

Improvements in Fetal MRI Imaging Help Better Depict Birth Defects

Ongoing research efforts are focused on improving upon magnetic resonance imaging (MRI) technology to enhance the prenatal evaluation and diagnosis of patients facing a birth defect. At CHOP, the Center for Fetal Diagnosis and Treatment is a leader in fetal imaging, including the use of ultrafast fetal MRI.

In a recent study conducted at CHOP, Teresa Victoria, MD, PhD, Ann Johnson, MD, and colleagues found that performing MRIs at 3 Tesla (T) versus 1.5T can produce higher-quality images. Using this higher magnet strength, their team was better able to depict fetal anatomic structures, such as the spine, bowel, liver and kidneys. Imaging at 3T has the potential to provide increased signal, faster scan times, and increased anatomic visualization.

“Improvements in imaging software and protocols allow optimal visualization and examination of fetal pathologic abnormalities,” Dr. Victoria wrote, “thus better identifying fetal and maternal needs both prenatally and postnatally.”

Dr. Victoria’s findings are published in the American Journal of Roentgenology.