Every week is full of discovery at The Children’s Hospital of Philadelphia. Among the highlights this week are a significant discovery and new treatment option in a heart surgery complication that affects young patients; a study of how to predict infants’ later obesity risk; and a CHOP cancer immunotherapy story hitting the world stage at an international conference.
Unclogging the Mystery of Plastic Bronchitis
A CHOP team has devised an innovative, safe, and minimally invasive procedure that helps relieve rare but potentially life-threatening airway blockages, called plastic bronchitis, occurring in children who had surgery for congenital heart defects.
They also discovered the primary cause of this complication: It is a lymphatic flow disorder, occurring due to abnormal lymphatic flow into lung tissue. Approximately 5 percent of children surviving heart surgeries used for single-ventricle disease experience plastic bronchitis because the surgery alters venous and lymphatic pressure. The abnormal circulation causes lymph to ooze backward into a child’s airways, drying into a caulk-like cast formation that takes the shape of the airways.
Over the past several years, Maxim Itkin, MD, an associate professor of Radiology in the Perelman School of Medicine at the University of Pennsylvania, and Yoav Dori, MD, a pediatric cardiologist in the Cardiac Center at CHOP, developed a customized form of magnetic resonance imaging, called dynamic contrast enhanced MR lymphangiogram, to visualize the anatomy and flow pattern of a patient’s lymphatic system. This technique allows clinicians to locate the site at which lymph leaks into the airways.
After identifying the leakage site in a lymphatic vessel, the lymphatic team intervenes, using a technique called lymphatic embolization. Through small catheters, the team blocks the abnormal flow with a variety of tools: coils, iodized oil, and covered stents, based on an individual patient’s needs.
“This is a new treatment option for children with plastic bronchitis and has the potential to offer long-term improvement of this condition,” Dr. Dori said in the CHOP press release. “This procedure may even provide cure and avoid the need for a heart transplant.”
The study reporting on outcomes for 18 children treated at CHOP was published in the journal Circulation.
Read more in the CHOP press release.
BMI Predicts Babies’ Obesity Risk
Body mass index (BMI) is a common measure used for adults and children over age 2 to identify those at risk for health complications of excess weight or future obesity.
However, there is no currently accepted definition for excess body weight before age 2. Although BMI charts are available, the American Academy of Pediatrics currently recommends using weight-for-length (WFL) as a standard measurement during infancy, and WFL is also predominantly used worldwide.
With a new study published online in the journal Pediatrics, researchers at CHOP suggest that BMI could be a more useful predictor than WFL of later obesity risk among infants.
The study team analyzed medical records of nearly 74,000 full-term infants seen during their first two years at well-child visits in the CHOP pediatric Care Network from 2006 to 2011.
The authors found that 31 percent of 2-month-old babies with BMI at or above the 85th percentile were obese at age two, compared to 23 percent of 2-month-olds at the 85th percentile by WFL. At the 97.7th percentile for BMI at age 2 months, 47 percent of babies were obese at age 2 compared to 29 percent by WFL.
"To our knowledge, this was the first study to compare BMI to WFL in predicting future obesity risk in a large, diverse cohort of full-term infants," said senior author Babette Zemel, PhD, the director of CHOP's Nutrition and Growth Laboratory. "We found that while BMI and WFL agreed after age 6 months, high BMI at age 2 months was a better predictor of obesity at 2 years of age than WFL. We recommend that clinicians consider measuring BMI in early infancy."
The study’s first author was Sani Roy, MD, a pediatric endocrinology fellow at CHOP.
Learn more in the CHOP press release.
Cancer Immunotherapy Stories Shared at the Vatican
Susan Rheingold, MD, medical director of the Oncology Outpatient Clinic and an attending physician with the Cancer Center at CHOP, was at the Vatican this week to share the cutting-edge work in immunotherapy to treat pediatric cancer patients. Joining Dr. Rheingold was CHOP Cancer Center patient, Nicholas Wilkins and his family. Nicholas was enrolled in a clinical trial at CHOP where he received experimental immunotherapy treatment.
Dr. Rheingold spoke, and Nicholas and his family shared their story, at Cellular Horizons: The Third International Conference on the Progress of Regenerative Medicine and Its Cultural Impact at the Vatican April 28. Created by the Stem for Life Foundation, STOQ, and the Vatican’s Pontifical Council for Culture, this exclusive international event gathered the world’s leading cell therapy scientists, physicians, patients, ethicists, and leaders of faith, government, and philanthropy to discuss the latest cellular therapy breakthroughs and hope for the future.
In case you missed it, this week on Cornerstone we brought you the announcement of the first-ever winner of CHOP’s Award for Excellence in Mentoring Research Trainees, Hakon Hakonarson, MD, PhD.
In addition, we celebrated Gregory Tasian, MD, MSc, MSCE, who recently received the 2016 Young Physician-Scientist Award at a joint meeting of the Association of American Physicians, the American Society for Clinical Investigation, and the American Physician Scientists Association held in Chicago. The award recognizes his work on preventing recurrence of kidney stones in pediatric patients.
Last week’s “In the News” summary showed how CHOP is addressing youth violence as a public health issue, discussed how injury prevention researchers are measuring how well teens comply with restrictions to their driver’s licenses, and shared a story of a sexual health risk researcher who stood up to defend the importance of her work to legislators.
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