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Pediatric and Congenital Heart Center of Alabama

DabalEvery year surgeons at the Pediatric and Congenital Heart Center of Alabama at Children’s of Alabama perform hundreds of cardiopulmonary surgeries. If a child in Alabama needs one of these life-saving procedures, they will likely get it at Children’s.

Our expertise in treating congenital heart disease (CHD) in children can be traced back to Dr. John W. Kirklin, a legendary heart surgery pioneer, clinician and scientist who came to UAB from the Mayo Clinic in 1966 and died in 2004. In recent years, we have moved into state-of-the-art facilities at Children’s where we perform most of our procedures.

These days, we take a team approach to treating patients. In the past, doctors would work more or less independently, for instance, with patients moving from cardiologists, to surgeons, to ICU. Now, everybody is involved in every aspect of care. When patients enter the hospital, a team of doctors and nurses provide a continuum of care from admission to discharge and beyond. For example, a child coming in for open heart surgery will have a minimum of three doctors taking care of him or her at all times.

We spend much time and effort sharing data with a nationwide collaborative, run by the Society of Thoracic Surgeons, of congenital heart surgery programs. Every time we perform an operation, we enter all the information in a database that allows us to compare time in hospital, time in ICU, time on ventilators and other variables. We are proud of our outcomes. Last year, our surgical mortality rate was 2.6 percent, which is lower than the national average of 3.2 percent. That’s great for us and great for the children here.

A third of our patients are under 30 days old, and those tend to need the most complicated operations. Therefore, they spend the most time in the hospital. Another third of our children are between about 30 days old and 2 years old. And the final third of patients are toddlers through adults. Our program also has a component for adults who have congenital heart disease, and most of those operations are performed at UAB by Dr. James K. Kirklin.   Because of the outstanding success of the current surgeries, we expect that portion of our program to expand as generations of pediatric patients grow older and require follow up care.

A significant percentage of surgical patients need to be followed for a lifetime. Recently, Dr. Kirklin saw a 39-year-old patient who had surgery as a baby. The patient had been followed by a pediatric cardiologist until she was 13 and then released from care. It turns out that her pulmonary valve had been removed, and needed to be replaced. It shows that many if not most patients need lifelong follow up. The more complicated an operation is early in life, the more likely that follow up is needed late in life.

We also work cooperatively with interventional cardiology on hybrid procedures. Our new facility at Children’s includes a large cardiac catheterization lab that can double as an operating room, a hybrid room.. It has equipment for both specialties. While the cost of building and equipping this one room in the hospital was extremely high, it allows complicated operations to be performed in a more stream-lined fashion. Recently, I opened a child’s chest, performed a surgical repair and then put a catheter into an artery so a cardiologist could put a stent in a blood vessel. Then I removed the IV. The hybrid room made it easier on me, easier on the cardiologist and easier on the staff. But most importantly, the hybrid room made the operation easier on the patient.

As the field has evolved, results have improved, and now, there’s more emphasis on outcomes other than mortality. In the next decade we will be looking more closely to what happens to patients after the immediate post-op period. We want to see problems that arise in 6 months, 12 months or 5 years. That will help ensure that we are doing everything possible to protect the brain and other critical organs. Our goal is to provide patients a lifetime of good health, with hopes to restore a normal life expectancy.

Dr. Robert J. Dabal is the chief of pediatric cardiac surgery and an associate professor of surgery in the Division of Cardiothoracic Surgery at the University of Alabama at Birmingham (UAB). His areas of expertise include neonatal and pediatric cardiac surgery. Dr. Dabal graduated from Duke University School of Medicine and completed his cardiac training at the University of Washington Medical Center. He completed fellowships in congenital heart surgery at Denver Children’s Hospital and Children’s Hospital Boston.

Keeping Baby Safe in the Crib

If you’re the parent of a newborn or even a soon-to-be-parent, there’s no doubt you’ve been given plenty of advice about your baby’s sleep. For instance, you’ve probably already heard that you should place your baby on his or her back to sleep. But do you know how to ensure the crib itself is safe?

“Here’s a simple message to remember: bare is best,” said Ginger Parsons, patient health and safety information educator at Children’s of Alabama. The “bare is best” message was developed by the U.S. Consumer Product Safety Commission (CPSC) to bring attention to the suffocation potential. “A tight-fitting crib sheet is all that’s recommended.  Soft bedding items like blankets, stuffed toys and even crib bumpers could be hazardous. It is best to keep the crib bare when you lay your baby down to sleep.”

You may be tempted to buy crib bumpers to complete your nursery’s look, but they really aren’t necessary and could be harmful to your baby. A baby is unable to roll over with such force, therefore crib bumpers really don’t offer any protection in that regard. Concerned about your baby getting cold while sleeping? Wearable blankets are a safer alternative than a loose blanket placed in the crib.

A study released in November 2015 by “The Journal of Pediatrics” shows the number of deaths blamed on crib bumpers continues to increase. The Consumer Product Safety Commission reports that 23 babies died between 2006-2012 from suffocation attributed to a crib bumper. That’s triple the average number of such deaths in three previous seven-year periods. In all, there were 48 deaths blamed on crib bumpers from 1985-2012. An additional 146 infants sustained injuries – choking on the ties, nearly suffocating – from crib bumpers.

“Anything other than a tight-fitting crib sheet on a firm mattress is just not worth the suffocation risk,” Parsons said.

The CPSC’s “bare” advice also applies to any item you may attach to or place near baby’s crib, such as baby monitors, noise machines, mobiles and humidifiers. Cords from these items, including the cords from window treatments or other wall-mounted accessories, could pose a strangulation hazard.

And if baby falls asleep in a swing, car seat or even the parent’s bed, it may be tempting to leave him or her sleep there. “The crib is the safest place for baby to sleep, and always remember to place baby on his or her back to reduce the risk of Sudden Infant Death Syndrome (SIDS),” Parsons said.

To ensure your crib is safe:

  • Check that it meets the safety standards of the U.S. Consumer Product Safety Commission (CPSC) and the Juvenile Products Manufacturers Association (JPMA). You can also check with Recalls.gov for any safety recalls if you are using a secondhand crib.
  • Any replacement parts for your crib should come only from the original manufacturer.
  • The space between crib slats should be no wider than 2 3/8 inches. If a soda can fits easily through the slats, the spaces between the slats are too wide. Corner posts should not stick up any higher than 1/16-th of an inch.
  • When your baby can push up, it’s time to lower the crib mattress.

Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) can resemble a common cold in adults. For children, though, Dr. MeKeisha Pickensespecially those younger than 2 years old, it can be more serious.

RSV is an infection of the lungs and airways. In the Northern Hemisphere, including the United States, RSV occurs most frequently between November and April. “RSV is a winter virus, and we’re at the peak of its season right now in January and February,” said Dr. MeKeisha Pickens, staff pediatrician at Children’s of Alabama Pediatrics West primary care practice.

RSV is the most common cause of bronchiolitis, which is an infection of the bronchioles, the smallest airways of the lungs. “RSV has a greater impact on infants and young children because their noses and small airways can become more easily blocked,” Pickens said.

Preventing RSV
RSV is highly contagious and can spread quickly through daycare centers and schools. It is transmitted through droplets when someone infected with the virus coughs or sneezes. The virus can also live on hard surfaces such as countertops and doorknobs. One of the best lines of defense against RSV, Pickens said, is washing your hands and by making sure children follow your lead. However, it might not be possible to avoid it completely.

“By the time your child turns 2, it is highly likely that he or she has been exposed to RSV,” Pickens said.

While there isn’t a vaccine to prevent RSV for the general population, some at-risk children may get injections that help guard against an infection. “Children who were born prematurely or have chronic lung problems or heart disease are considered to be at-risk for an RSV infection,” Pickens said.

Symptoms of RSV
Early symptoms of an RSV infection are a mild cough with wheezing, runny nose, congestion and fever (greater than 100.4°F). There may also be a decreased appetite. The virus typically lasts up to five days, worsening on the third and fourth day. There could be some residual symptoms, including a lingering cough, for up to two weeks.

Parents should be aware of more serious symptoms associated with RSV. These signs could be rapid breathing, sinking of the skin between the ribs and above the neck as well as nose flaring.  “When the child is taking more than 60 breaths per minute, it’s time to call your doctor,” Pickens said.  Very young babies can also turn blue, or stop breathing completely.  This is an emergency, and parents should see a doctor immediately.

Severe cases of RSV may lead to other illnesses and even require hospitalization.

Treating RSV
One of the primary symptoms of an RSV infection is nasal congestion. If your child is unable to blow his or her own nose, you may need to assist with a bulb syringe or nasal aspirator.

“It’s so important to keep the child’s nose clear. Squirt a saline nasal spray or drops in each nostril. Wait about 30 seconds, and then clear the nose with an aspirator or bulb syringe. Most kids don’t like the aspirator, but it really does work,” Pickens said. She recommends repeating that process several times throughout the day, especially before eating or drinking and at naptime or bedtime.

Pickens also suggests acetaminophen or ibuprofen to reduce fever and liquids to stay hydrated. “You may have to have your child drink small amounts throughout the day. You want them urinating at least three times a day to ensure they aren’t dehydrated,” Pickens said.

A cool-mist humidifier may help alleviate congestion. Just remember to clean the humidifier regularly to prevent mold growth. “A dirty humidifier can cause even more respiratory issues,” she said.

One other treatment is even sweeter than the others: honey. “If your child is over a year old, you can treat with 5 mL (1 teaspoon) of honey three to four times a day,” Pickens said.

Treating mild cases of RSV is all about managing the symptoms. Sometimes all your child may need is time to rest and recover as the virus runs its course.

The Pediatric and Congenital Heart Center of Alabama

February is National Heart Month.  Oftentimes the focus may be on adults and heart disease, but children can have heart issues as well.  In fact almost one in every 100 newborns in the United States is born with a congenital heart defect.

Children’s of Alabama is home to the Pediatric and Congenital Heart Center of Alabama, where more than 250 professionals are solely dedicated to children with heart disease. Dr. Yung Lau is a Pediatric Cardiologist at Children’s. He says heart issues in children are different from adults. “Usually in adults, heart disease is an acquired disease, something that has developed over a lifetime,” Lau says.  “In pediatric cases, it’s more likely to be children born with hearts that aren’t properly formed from birth.”

Often parents are concerned their seemingly healthy child may have a heart complication during strenuous activity. Dr. Lau stresses the importance of a healthy diet and exercise to prevent heart disease from forming. He also says it’s very important for parents to fill out the Pre-Participation Physical before their child engages in sports. “The physical that is done and questionnaire is very important to identify children at risk for having sudden death on the playing field,” he says.

The Pre-Participation form will reveal many potential concerns including:

  • serious illnesses among family members
  • illnesses that kids had when they were younger or may have now, such as asthma, diabetes, or epilepsy
  • previous hospitalizations or surgeries
  • allergies (to insect bites, for example)
  • past injuries (including concussions, sprains, or bone fractures)
  •        whether the child has ever passed out, felt dizzy, had chest pain, or had trouble   breathing during exercise
  • any medications taken (including over-the-counter medications, herbal supplements, and prescription medications)

It can be tempting for parents to be overly protective, especially when it comes to concerns about their child’s heart. But preventing children from living a normal life can often do more harm than good.

Thankfully advancements in diagnostic technologies can identify and provide detailed information about heart abnormalities. Advancements in medical knowledge, treatments, surgery and catheterization can help the majority of pediatric heart patients have a good quality of life.