New Lexington Shriners facility

New Shriners facility enhances patient care, strengthens collaboration with UK

On Sunday, patients, medical center staff and doctors, donors, and UK HealthCare leaders came together to dedicate the new Shriners Hospitals for Children Medical Center Lexington facility, which opened earlier this spring on the UK HealthCare campus.

While healthcare providers at Shriners Medical Center and Kentucky Children’s Hospital have collaborated for decades, the opening of the new facility will better accommodate follow-up appointments for patients seeing multiple doctors for complex medical conditions.

“Shriners Medical Center moving to the UK HealthCare campus allows for seamless care to occur across institutional boundaries,” said Dr. Ryan Muchow, a pediatric orthopaedic surgeon at Shriners and UK HealthCare. “The patients are benefited tremendously when two excellent institutions combine mission and service to advance the pediatric orthopaedic care.”

Continuity of care

When the new facility opened earlier this year, patients like Zayleigh Hancock were the first to benefit.

Zayleigh, a longtime patient at Shriners, was born with a complex medical condition called hemiplegia cerebral palsy (CP), a brain impairment that impacts a person’s ability to control movement and posture. Traveling to Lexington from her hometown of Morristown, Tenn., the 10-year-old has received ongoing treatment and numerous surgical interventions at both Shriners and KCH to improve her mobility and quality of life.

Earlier this year, Zayleigh’s head started slumping to the side, a symptom caused by overlapping bones in her neck. The condition required an inpatient surgical procedure at KCH and follow-up care and assessment at Shriners.

This close connection between KCH and Shriners, which is now connected by a pedestrian bridge to UK Albert B. Chandler Hospital and KCH, enabled seamless inpatient treatment and post-surgical care for Zayleigh. In addition, Zayleigh benefited from continuity of care, seeing familiar orthopaedic surgeons who have monitored her condition for years while also having access to advanced pediatric specialists at KCH.

A history of collaboration

Shriners has operated in Lexington since 1926. Transitioning from its former location on Richmond Road, Shriners now occupies 60,000 square feet of space on the bottom three floors of the new building on South Limestone. UK HealthCare leases the top two floors for ophthalmology services. The new Shriners includes a motion analysis center, 20 patient exam rooms, two surgical suites, a rehabilitation gymnasium, a prosthetics and orthotics department, therapy rooms, and interactive artwork. The energy-efficient building has geothermal heating and cooling, LED lighting and occupancy sensors, and automated equipment and controls.

UK HealthCare and Shriners have forged a longstanding collaborative relationship through years of service to Kentucky’s children. Pediatric specialists in the fields of orthopaedics, anesthesiology and rehabilitation serve on the medical staff of both organizations.

Mark D. Birdwhistell, vice president for administration and external affairs at UK HealthCare, called the new facility a win for UK, Shriners and the Lexington community.

“The building we are dedicating today will allow us to collaborate in a whole new way,” Birdwhistell said during the dedication, “bringing together Shriners Medical Center’s pediatric orthopaedic expertise and the Kentucky Children’s Hospital’s specialty and subspecialty care for children with complex conditions.”

Watch the video below to hear Dr. Henry Iwinksi, the chief of staff at Shriners and pediatric surgeon at UK HealthCare, discuss the longstanding relationship between Shriners and UK and what the new facility will mean for kids and families in the Commonwealth.


Next steps:

  • Learn more about the pediatric orthopaedic care provided by the experts at KCH and Shriners.
  • When your child is sick or hurt, you want the best care possible. That’s exactly what you get at Kentucky Children’s Hospital. Learn more about KCH.
Two doctors at UK HealthCare decided to study aromatherapy's positive healing effects on at-risk infants in the NICU. Early results have been encouraging.

UK neonatal physicians use aromatherapy to soothe newborns

Pulling away the seal of a fresh aromatherapy patch, Dr. John Daniel took a deep inhalation as the fragrance of lavender and chamomile essential oils permeated his surroundings.

Daniel was ending an overnight shift in the neonatal intensive care unit (NICU), and one waft of lavender was enough to calm his senses and induce a state of relaxation. While popular with pediatric residents, fellows and nurses in the NICU, the aromatherapy patches are also being used to soothe and mitigate stress of the hospital’s smallest and most agitated patients – babies suffering from drug withdrawal.

Demonstrating how babies receive aromatherapy as part of their medical treatment, Daniel applied a thumbnail-size patch to the “palm” of a floppy green pillow called a Zaky arm. The Zaky arms, which mimic the feeling and shape of a caregiver’s arm, carry both the scent of the baby’s mother and calming aromatherapy oils. He then placed the lavender-scented pillow alongside a baby dozing off in a NICU bed.

Studying the effects of aromatherapy

Herbalists, chemists and massage therapists have long promoted the therapeutic and healing properties of essential oils. Lavender oil, which produces the mood-balancing serotonin chemical in the brain, triggers sedative states and relaxation while chamomile oil balances out emotions. Dr. Lori Shook, a neonatologist in the NICU, wondered if the oils could help mitigate disease-related stress and anxiety in NICU babies.

Shook was familiar with veterinarians’ use of lavender to calm skittish animals and, as a horse owner, had seen spooked horses respond to lavender. Knowing many of her infant patients were inundated with drugs in the early days of their lives, she wanted to integrate more non-pharmaceutical therapies to treat babies experiencing stress and medical complications related to withdrawal from drug exposure in the womb, or neonatal abstinence syndrome (NAS).

Few scientific studies have produced evidence showing an association between aromatherapy exposure and improved health outcomes. Shook and Daniel, a pediatric fellow, set out to examine the potential to use aromatherapy to reduce stress in agitated infants.

“There is a lot of complementary alternative medicine research out there that is not subjected to rigorous scientific methodology,” Daniel said. “When we started this project, that was our goal.”

Shook and Daniel recently completed a pilot study reporting positive results from administering aromatherapy as an adjunctive treatment for babies recovering from NAS. Since launching recruitment in fall 2015, Shook and Daniel have enrolled 40 infants admitted to the NICU with symptoms of NAS. Infants assigned to the experimental condition received an aromatherapy patch, in addition to other necessary medical interventions to facilitate recovery. The preliminary results show babies who received aromatherapy stayed in the NICU an average of 6.4 fewer days than babies who did not receive the aromatherapy treatment. The researchers found babies who received aromatherapy needed smaller doses of withdrawal maintenance medication than those who didn’t receive aromatherapy.

Shortening an NAS infant’s length of stay in the NICU helps families, but also reduces medical costs. One day of treatment in the NICU nursery costs about $5,000 for one baby. The study suggests that aromatherapy patches, at about $2 apiece, can be implemented cost-effect measure for reducing drawn-out hospital admission for NAS treatment.

“The cost of caring for these babies is astronomical,” Shook said. “Being able to shorten their stay is a financial and social windfall for everybody.”

Another tool in the medical “toolbox”

Shook considers aromatherapy another element in a comprehensive medical “toolbox” to facilitate recovery in babies experiencing stress from NAS or other medical complications at birth. Doses of methadone and morphine are the standard pharmaceuticals for babies experiencing withdrawal. But Shook and NICU providers avoid medications as a first-line treatment, trying multiple interventions and natural therapies before prescribing maintenance medication.

“It’s easy to throw drugs at these babies. The traditional approach is a dark, quiet room and swaddling, and if that doesn’t work then you use morphine,” Daniel said. “We would prefer to not use drugs. Once they get started, it’s a long haul sometimes.”

Shook has integrated multiple non-pharmaceutical therapies and practices, such as shushing, meditation, energy flow, music therapy, occupational therapy, skin-to-skin bonding and infant massage, to decrease stress and promote recovery in NAS babies at Kentucky Children’s Hospital. Parents and families receive instruction on how to perform stress-reducing practices to soothe babies at home. Shook references both scientific and anecdotal evidence from working with new mothers to support the effectiveness of adjunctive therapies for distressed babies. She only introduces medication after many non-pharmaceutical alternatives are ruled ineffective in reducing infant stress.

Exploring more possibilities for aromatherapy

Shook has proposed another study to explore whether aromatherapy alleviates stress and increases sleep hours in NICU nurses. She is also working to extend the study of aromatherapy in babies to multiple sites across Kentucky and rural satellite nurseries receiving NAS babies. Ideally, babies showing symptoms of untreated drug exposure will receive aromatherapy before the onset of withdrawal. Many babies admitted to the KCH NICU are transferred from smaller rural hospitals and already experiencing withdrawal.

Shook also thinks future research must identity the specific processes in the brain stimulated by aromatherapy, contributing to scientific evidence in favor of using aroma as a clinical therapy. Aromatherapy could be used in numerous pediatric settings to help calm children undergoing treatment. Shook would like to see the medical community embracing alternative therapies and natural remedies rather than relying only on medication to heal patients.

“There is so much opportunity here,” Shook said of researching alternative therapies. “There is a reason these things exist in folklore, and it’s because they work.”


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Gilson Capilouto, PhD, along with Tommy Cunningham, PhD, created a device that can measure and improve neonatal feeding, which some infants struggle with.

First-of-its-kind infant feeding device gets its start at UK

Since the early days of her career, Gilson Capilouto, PhD, has been interested in pediatric feeding, but it wasn’t until she joined the UK’s multidisciplinary team in the Neonatal Intensive Care Unit (NICU) that she became especially interested in feeding challenges for children who are born early or with illnesses. Around 15 million babies are born prematurely in the U.S. each year, and up to 70 percent of them, as well as about 10 percent of full-term babies, experience difficultly transitioning to oral feeding.

“My interest in neonatal feeding began in earnest when I came to UK 15 years ago. It seemed a natural extension of the work I was doing as part of the UK NICU multidisciplinary team, following high-risk infants after they’re discharged from the hospital,” Capilouto said.

Feeding is important for a baby’s nutrition, of course, but it also has implications for long-term development and eating. Neonatal sucking is considered the most complex behavior of a newborn. Research suggests that infant sucking may provide an early window into the overall integrity of the central nervous system, possibly predicting long-term neurodevelopmental outcomes. Studies have shown that early sucking correlates with overall development at six months, one year and two years. Infant feeding problems can also spill over into eating difficulties with solid food, especially in cases where feeding might have been an unpleasant experience during infancy, and can cause great distress for caregivers.

Skip ahead a few years, and Gilson and her business partner Tommy Cunningham, PhD, now run an award-winning company, NFANT Labs, LLC, based on a device they developed to measure the strength and coordination of an infant’s ability to suck. The device, called the nfant Feeding Solution, is essentially a “smart” baby bottle that uses low-energy Bluetooth technology and a mobile app to provide immediately actionable information about what’s going on with an infant’s feeding. It displays the impact of feeding interventions in real time, tracks and charts infant progress, and creates a continuity of care among caregivers. It’s also the first “internet of things” medical device cleared by the Food and Drug Administration for use in the NICU. (You can see the device here.)

UK’s multidisciplinary NICU initiates research

This journey began as a simple research question that came to Capilouto during a continuing education conference focused on feeding preterm and sick term infants in the NICU.

“This whole thing started when I was attending a conference and the speaker was talking about the fact that for adults who aren’t orally fed for a while, their tongue muscle atrophies in a short period of time,” Capilouto said. “But we didn’t know if this was true in pre-term babies, who could go many weeks before they’re ever allowed to feed orally, sometime around 32-34 weeks gestation. So if baby is born at 28 weeks, for example, it will be many weeks before they can start to use their tongue muscle.”

When she got back to UK, Capilouto assembled a multidisciplinary team that could undertake the task of trying to measure infant sucking. The group included an expert in muscle biomechanics (Dr. Tim Butterfield also in the UK CHS), a muscle biologist, a clinical radiologist, and Cunningham, who at that time was at UK as a PhD student in biomechanics. An inventor with a couple patents under his belt, he’d also started a small engineering firm to help clinicians develop the tools they needed to conduct their research. His particular focus was, and remains, using evidence-based medicine to inform product development.

“Gilson came to me and Dr. Butterfield and said, ‘I need a bottle that can measure the strength of a baby’s tongue.’ She specifically wanted to be able to measure tongue strength during actual bottle feeding. Dr. Butterfield and I were intrigued by the challenge and after a couple of months, we had a proof-of-concept device.”

With a grant from the Kentucky Science and Engineering Foundation in 2011, they developed and tested the device, hypothesizing that both tongue force and tongue size would be different between preterm infants beginning to orally feed and full term infants. Results of that first study provided support for their hypothesis, as pre-term infant tongue force was found to be significantly less than full-term infants relative to nutritive sucking; interestingly, simple pacifier sucking strength was not different between the two groups.

“When we got those results, we were pretty excited, we knew we wanted to continue this line of research, but we needed instrumentation that was more NICU-friendly. Ultimately we saw the clinical utility of what we were doing, so we wanted to build an instrument not just for research purposes, but also a tool that could be used in clinical practice at the bedside,” Capilouto said. “We knew we were on to something, but the methods were cumbersome – it required a bank of computers and four people to collect the data, and we knew for the long term that would not be feasible.”

Following release of the Intellectual Property from the University, Capilouto and Cunningham sought further funding from the Office of Research in the UK College of Health Sciences in 2012 to help them develop a second prototype that could be used bedside in the NICU.

“We leveraged a lot of technologies out there, like what’s in your cell phone, and built it on a scale to fit around a baby bottle so it could be easily incorporated to bedside work flow. We also wanted the final device to be easy to use and low cost. Millions of cell phones are made, so that drives down prices of the components,” Cunningham said.

Testing the second prototype provided the necessary confirmation for the new design and also provided important feedback about desirable features and characteristics from NICU bedside nurses. Armed with this information, Cunningham, who had moved to Atlanta after he finished his PhD at UK, left his job to devote himself full-time to development of the device. After rapid prototyping and validating the final device, Capilouto and Cunningham founded NFANT Labs, LLC, based in Atlanta, in 2013. The company has two patents and a third one pending.

In the fall of 2015, the nfant Feeding Solution device was cleared by the FDA and that following January, Capilouto took a one-year, university-approved entrepreneurial leave of absence and relocated to Atlanta to work with the company. During this time, they were able to introduce the product in NICUs around the country and establish partnerships for conducting clinical trials. The company also developed, tested and launched a second product — a line of high quality silicone bottle nipples.

UK offers its support

Currently, a novel methodology award from the UK Center for Clinical and Translational Science and the UK College of Health Sciences supports a research study to determine if the measures of sucking performance from the nfant Feeding Solution can be used to identify infants who are most likely to experience ongoing feeding problems after discharge. Dr. Peter Giannone, chief of the division of neonatology at UK, serves as co-investigator on the grant.

The study is following preterm infants at high risk for developmental concerns from hospital discharge through their first year. For those babies whose one-year developmental testing reveals cognitive or motor issues, the team will go back to data from their early feeding behaviors in the hospital in the hopes of identifying sucking performance variables that could possibly have predictive power.

“We want to identify babies who we are at risk for poor developmental outcomes as early as possible, so we can get them the help they need as soon as possible and take advantage of the mechanisms of neuroplasticity.” Capilouto said.

NFANT Labs has earned several accolades for its pioneering work. In March of this year, the Technology Association of Georgia, the state’s leading association dedicated to the promotion and economic advancement of Georgia’s technology industry, named nfant Feeding Solution as the Breakthrough Technology of the Year and NFANT Labs one of its Top 10 Innovative Technology Companies in the state. Last year, NFANT Labs was named a Silicon Labs “Internet of Things Hero” and also received Georgia Bio’s coveted Innovation Award. In 2015, the company received the E-Achiever Award from the Lexington Venture Group.

With this strong foundation, NFANT Labs is experiencing rapid growth. To date, they have raised $3.5 million of private capital and are gearing up to raise another $5 million to expand their sales force, create additional products and take the company to the next level. The device is being used in NICUs across the country to assist healthcare teams in clinical decision making regarding a fragile infant’s transition to oral feeding. UK is currently in the process of purchasing and integrating it into their standard of care. It is also being used in several of the top children’s hospitals in the country to study important research questions, including the relationship between early sucking performance and neonatal brain injury.

Capilouto and Cunningham both emphasize the necessity of a team that takes advantage of multiple fields of expertise.

“To get us to this point, we assembled a distinctive interdisciplinary research team consisting of basic, translational and clinical investigators with expertise in pediatric feeding and swallowing, muscle physiology, muscle biomechanics, biomedical engineering, diagnostic radiology and neonatology,” Capilouto said.

Cunningham added that “the idea is just one thing. You need clinical research, executive leadership, capital backing, sales and marketing, manufacturing, etc. It takes a vast amount of resources to go from an idea to a sustainable business focused on improving patient care.”

As their company grows, the team hopes to broaden the use of the nfant Feeding System to learn more about feeding behaviors and neurodevelopment of specific groups of infants, as well as extend their capacity to support caregivers.


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sports-related injuries

5 tips to prevent sports-related injuries in kids

Warmer weather is here and the spring sports season is just around the corner. Now’s the time to make sure your kids take the right precautions to avoid sports-related injuries.

In 2013, more than 1 million children ages 19 and under were seen in emergency departments for injuries related to 14 commonly played sports. Here are some tips to help you and your kids prevent injury:

1. Get a physical

Before playing organized sports, make sure your child receives a pre-participation physical exam, or PPE. This should be performed by a doctor or a nurse practitioner or qualified clinician under the supervision of a physician.

2. Stay hydrated

Bring a water bottle to practice and games. Encourage children to stay well-hydrated by drinking plenty of water before, during and after play.

3. Stretch

Stretching before practice and games can release muscle tension and help prevent sports-related injuries, such as muscle tears or sprains. Make sure there is time set aside before every practice and game for athletes to warm up properly.

4. Take time off

Encourage kids to take time off from one sport to prevent overuse injuries. It is an opportunity to get stronger and develop skills learned in another sport.

5. Coaches, know your stuff

It’s also a good idea for coaches to get certified in first aid and CPR, learn the signs and symptoms of a concussion, and help avoid overuse injury by resting players during practices and games.


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benefits of breastfeeding

Breastfeeding gives your baby the best possible start

The decision to breastfeed has a wide array of benefits for both mom and baby.

Breastfeeding provides warmth and closeness, and the physical contact helps create a special bond between you and your newborn. In addition, research shows that breastfeeding and breast milk can lead to better health for mothers and their children.

Benefits for babies

  • Breast milk is easier for your baby to digest.
  • It doesn’t need to be prepared.
  • It’s always available.
  • It has all the nutrients, calories and fluids your baby needs to be healthy.
  • It has growth factors that ensure the best development of your baby’s organs.
  • It has many substances that formulas don’t have that protect your baby from diseases and infections. In fact, breastfed babies are less likely to have:
    • Ear infections.
    • Diarrhea.
    • Pneumonia, wheezing and bronchiolitis.
    • Other bacterial and viral infections, such as meningitis.
  • Research also suggests that breastfeeding may help to protect against obesity, diabetes, sudden infant death syndrome (SIDS), asthma, eczema, colitis and some cancers.

Benefits for mothers

  • Breastfeeding releases hormones in your body that promote mothering behavior.
  • It returns your uterus to the size it was before pregnancy more quickly.
  • It burns more calories, which may help you lose the weight you gained during pregnancy.
  • It delays the return of your menstrual period to help keep iron in your body.
  • It provides contraception, but only if these three conditions are met:
    • You are exclusively breastfeeding and not giving your baby any other supplements.
    • It is within the first six months after birth.
    • Your period has not returned.
  • It reduces your risk of ovarian cancer and breast cancer.
  • It keeps your bones strong, which helps protect against bone fractures in older age.

UK HealthCare is Baby-Friendly

At UK HealthCare, we’re committed to ensuring a happy, healthy start for newborns and their mothers. In fact, we’re a Baby-Friendly USA® hospital, which is a prestigious acknowledgment of the top-notch care that we provide.

Baby-Friendly USA is a global initiative sponsored by the World Health Organization and the United Nations Children’s Fund (UNICEF). The initiative encourages hospitals to provide breastfeeding mothers with information, confidence, support and skills necessary to initiate and continue breastfeeding.

Find out more about the Baby-Friendly initiative.


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Prevent medication poisoning in your home with these simple steps

To children, medication around the house might look like candy waiting to be consumed. That’s part of the reason why medicine is the leading cause of child poisoning in the U.S.

Every year, nearly 60,000 children are seen in the emergency room for medicine poisoning. Here are a few simple steps you can take to prevent medicine-related poisoning in your home.

Top tips for medication safety

  1. Put all medicine up, away and out of sight. In 86 percent of emergency department visits for medicine poisoning, children took medicine belonging to a parent or grandparent.
  2. Consider unlikely places where medicine is kept. Children can get access to medication in many places, some of which you might not consider, such as purses and nightstands. Place purses and bags in high locations and avoid leaving medicine on a nightstand or dresser.
  3. Consider products you might not think about as medicine. Health products such as vitamins, diaper rash creams, eye drops and hand sanitizer can be harmful if kids ingest them. Store these items up, away and out of sight, just as you would traditional medicine.
  4. Only use the dosing device that comes with the medicine. Kitchen spoons aren’t all the same, and a teaspoon or tablespoon used for cooking won’t measure the same amount of medicine as a dosing device.
  5. Write clear instructions for caregivers. When other caregivers are giving your child medicine, they need to know what medicine to give, how much to give and when to give it. Be clear and detailed in your instructions for caregivers.
  6. Save the Poison Help line in your phone: 800-222-1222. Put the toll-free number for the Poison Control Center into your home and cellphone. You should also put the number on your refrigerator or another place in your home where babysitters and caregivers can see it. Call the help line with any questions or concerns about medication. The Poison Help line is open 24 hours a day, seven days a week.

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Empowering those in our community affected by Down syndrome

Written by Traci Brewer, executive director of the Down Syndrome Association of Central Kentucky (DSACK). UK HealthCare is proud to support DSACK and many other community organizations.

Today, March 21, is World Down Syndrome Day. Why? Because it’s 3/21, and people with Down syndrome have three copies of the 21st chromosome. That means they have 47 chromosomes instead of the typical 46, so we like to say they have a little something extra.

A lot has changed over the years for people with Down syndrome and for those who help care for them. As recently as the 1980s, individuals with Down syndrome had an average life expectancy of 25. Today, thanks to better medical treatments and screening, people with Down syndrome can live well into their 60s.

Education has also changed dramatically. As recently as the 1980s, families were told to institutionalize their loved ones with Down syndrome because they would never be able to read, write, talk, or contribute anything of value to their family or society. Today, right here in Kentucky, people with Down syndrome are attending college, working in meaningful jobs, driving, dating, volunteering in their communities and living productive, meaningful lives.

Organizations such as the Down Syndrome Association of Central Kentucky provide support for new families and empower self-advocates and their families by providing important information such as early math and literacy learning, financial planning, Individualized Education Plans consulting, career planning, and much more. One of our most exciting initiatives is We Work!, a multiphase program for students age 15 and older that teaches job skills, leadership skills, how to explore career opportunities and how to serve as peer mentors.

Recently someone said that DSACK has a great story to tell and many more chapters to be written. We still have more milestones to reach, more bridges to cross and many more chapters to write. You can learn more about us by visiting our website at www.dsack.org and by visiting our Facebook page, the Down Syndrome Association of Central Kentucky.


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6 tips to poison-proof your home

It’s not uncommon for kids to get their hands on potentially dangerous stuff around the house. From makeup and personal care products to pesticides and art supplies, many common household items represent a threat to children, especially if they’re ingested. In fact, nine out of 10 poisonings in children occur in the home.

This week is National Poison Prevention Week and the perfect time to learn how you can poison-proof your home and prevent accidental poisonings.

Poison-proof your home

  1. Store all household products and cleaning solutions out of children’s sight and reach. Young kids are often eye-level with items under the kitchen and bathroom sinks.
  2. Store poisonous items out of reach or use safety locks on cabinets within reach. These items also include liquid packets for the laundry and dishwasher.
  3. Read product labels to find out what can be hazardous to kids. Dangerous household items include health and beauty products, plants, cleaning and gardening supplies, lead, alcohol, and carbon monoxide.
  4. Make sure that all medications, including vitamins and adult medicines, are stored out of reach and out of sight for children.
  5. Put the toll-free number Poison Help Number (800-222-1222) in your home and cellphones. You should also post it near your home phone or on your refrigerator for the babysitter.
  6. Check for lead-based paint. Remove any peeling paint or chewable surfaces painted with lead-based paint.

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Pneumonia in Bangladeshi children is pandemic, and their current healthcare model makes it difficult to treat. But KCH's Dr. Fuchs may have a solution.

UK pediatrician uses his expertise to save children in Bangladesh

In developing countries, pneumonia is the leading cause of disease-related death in children ages 5 and younger, accounting for more than 1 million deaths a year. Most of the world’s pediatric pneumonia cases are condensed to Sub-Saharan Africa and South Asia, including Bangladesh, where the disease is pandemic.

Bangladeshi children diagnosed with pneumonia also often suffer from malnutrition, an undertreated condition that increases the likelihood of death from pneumonia. In developing countries, more than half of all pediatric deaths in children younger than 5 are associated with a moderate to severe malnutrition diagnosis. If both conditions are not treated, children are susceptible to recurrent pneumonia and further health complications that can lead to death.

Now, after years of researching this problem, Dr. George Fuchs, a pediatric gastroenterologist at Kentucky Children’s Hospital, is working to improve the care Bangladeshi children receive and to reduce the number of deaths related to pneumonia and malnutrition.

Through his research, Fuchs found barriers in the Bangladesh healthcare system that delayed care for children suffering from severe pneumonia and underlying nutritional deficiencies. A scarcity of hospital beds, limited pediatric resources and practical barriers  such as the burden of hospitalization on the family  prevent children from receiving sufficient treatment for both conditions. Fuchs and collaborators at the International Centre for Diarrhoeal Disease Research, Bangladesh, with funding from UNICEF and UBS Optimus Foundation, proposed a solution to address these health system barriers and decrease child mortality in Bangladesh.

The Day-Care Approach

Fuchs, who has studied nutritional deficiencies and interventions in developing countries since the late 1980s, is conducting a multisite trial to evaluate the effectiveness of a treatment method called the Day-Care Approach (DCA). This new pediatric care model responds to a lack of hospital beds and pediatric resources by diverting children with severe illness to outpatient, or day-care, clinics.

These day-care clinics provide safe and effective therapies for severe forms of pneumonia and malnutrition, as well as diarrhea and other common illnesses, during the daytime hours. Previous studies in controlled settings have shown the success of the DCA model in treating severe pneumonia and malnutrition. Compared with traditional hospital care, the DCA system model reduces healthcare costs by a third. Fuchs and his colleagues are now testing a scaled-up version of the DCA model in the Bangladesh healthcare system.

“I realized these children were not getting treatment, and these are really sick kids, so I said, ‘Let’s at least try something else with an outpatient approach,’” Fuchs said. “It has to be better than the alternative, which is no care.”

Since January 2015, Fuchs has collected and analyzed outcome data from patients treated in the DCA model and compared it to data from patients in the existing model of hospitalized care. In the existing healthcare system, community health workers identify children with pneumonia and refer them to local health clinics, where their symptoms are categorized as moderate or severe. Those children in the moderate category are sent home with 48-hour antibiotics.

However, children presenting to the local clinic with severe pneumonia and those who fail the 48 hours of antibiotics are sent to the hospital for supportive therapies, such as airway suction, fluids, nutrition, antibiotics and constant oversight.

In the DCA model, children receive the same initial treatment, with community health workers locating pneumonia cases and determining severity. What’s different is that children with severe pneumonia or those who fail antibiotics at home are sent directly to the day-care clinic, where they receive supportive therapies throughout the day. They then return to their homes in the evening and come back for care the following morning. Hospitalization occurs only if the treatment available through the day-care service fails.

According to Fuchs, an initial set of studies over 10 years indicates the DCA model is a viable and sustainable system with the potential to reduce the rates of pediatric mortality caused by pneumonia and malnutrition. The DCA model is also much less costly for both the health system and for families seeking treatment. While data collection is ongoing for the current trial, Fuchs is encouraged by the preliminary analysis.

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DCA model overcomes barriers to care

The DCA system also proved more feasible and desirable for Bangladeshi families. In the traditional Bangladeshi household, the mother cares for multiple children throughout the day while the father works outside the home. As the primary caregivers, mothers confront practical barriers to accessing treatment for one child. The DCA system delivers advanced care so a child doesn’t require a burdensome and costly hospital stay, which families avoid to the point of not seeking treatment.

“The underlying problem is there are not enough hospital beds,” Fuchs said. “Another obstacle is mothers are required to stay with children in the hospital, but they often leave against medical advice or won’t go in the first place because of other important family responsibilities at home.”

Fuchs said health workers in Bangladesh have embraced the DCA intervention as a beneficial treatment system for pediatric pneumonia. If it’s successful on a larger scale, the cost-effective DCA model holds the promise of reducing the occupancy of scarce pediatric beds in regional hospitals, which can be used for children with other illnesses. Fuchs and his collaborators are working with government officials and Bangladeshi health agencies to implement the system as a viable and sustainable replacement for the existing pediatric care system.


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UK Shriners

UK Pediatric Orthopaedics, UK Advanced Eye Care moving into new Shriners building

The new Shriners Hospitals for Children Medical Center ‒ Lexington building on the UK HealthCare campus, which broke ground in March 2015, will open this spring.

In addition to Shriners, the building will be home to UK Pediatric Orthopaedics and will provide leased space for UK Ophthalmology (now renamed UK Advanced Eye Care).

Current locations of UK Advanced Eye Care along with the UK HealthCare Optical (formerly known as University Optical) will close March 17. They will reopen in the Shriners Building on March 20.

Pediatric orthopaedics patients will be seen in the new Shriners facility beginning April 17, although there will be a period of transition during which patients may be seen at either the current clinic within the Kentucky Clinic building or in the new Shriners space. During this transition, which is expected to last four weeks, parents whose children have a pediatric orthopaedics appointment are encouraged to call 800-444-8314 (toll-free) in advance to confirm where they will be seen.

Inpatient care for pediatric orthopaedics patients will be provided at Kentucky Children’s Hospital.

Members of UK health plans, including the UK-HMO and PPO/EPO options, will see no change in their copay/out-of-pocket charge with this move.

The new Shriners, which will be an outpatient surgical and rehabilitation center, was built on land that Shriners leased from UK. It remains a separate entity that is not owned or managed by UK.

UK Orthopaedic Surgery & Sports Medicine providers serve as the pediatric orthopaedic specialists for Shriners, an arrangement that has been in place since the 1970s.

The proximity of Shriners to Kentucky Children’s Hospital will facilitate collaboration of Shriners’ pediatric orthopaedic expertise and UK HealthCare’s specialty and subspecialty care for children with complex conditions.

Patients and families with appointments in the new facility will park in the UK HealthCare Parking Garage located just across Conn Terrace from Shriners. The building can be accessed via a pedestrian bridge at Level C of the garage.


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