The Crucial Role of Colorectal Programs

  Earlier this year, new guidelines were released to improve the diagnosis of pediatric sepsis and septic shock. For the first time, the novel Phoenix Sepsis Criteria provides an objective and data-driven approach to aid in the identification of these life-threatening conditions, including prediction of mortality in children with suspected or confirmed infection. Sepsis is one of the leading causes of death among children worldwide, and these guidelines could be a major step in changing outcomes. To help us understand these guidelines and apply them to your practice, we are joined by two experts who have been at the forefront of this new research. Tell Bennett, MD, specializes in pediatric critical care at Children’s Hospital Colorado. He is the Vice Chair of Clinical Informatics, as well as a professor of biomedical informatics and pediatrics at the University of Colorado School of Medicine. Halden Scott, MD, is the Director of Research for the section of emergency medicine at Children’s Colorado. She is also an associate professor of pediatrics at the University of Colorado School of Medicine. Some highlights from this episode include:    How to diagnosis sepsis under the new guidelines   How these criteria can be applied to primary care practices  What treatment options are and why time is of the essence    For more information on Children’s Colorado, visit: childrenscolorado.org.    

Newborn screening has expanded dramatically over the last decade as our detection methods improved and new treatments became available for rare diseases. One of those rare diseases is adrenoleukodystrophy, otherwise known as ALD. ALD is an example of a rare disease where, thanks to expansions in newborn screenings, we are now able to make a precise genetic diagnosis very early in life and offer therapies far in advance of the onset of symptoms. Early detection and treatment of this can potentially spare a family a lifetime of devastating health impacts. In December 2013, New York became the first state to require newborn screening for ALD. Currently, 43 states and Washington, D.C. are testing babies for ALD. To help us understand the role of newborn screening, we are joined by Kevin Ess, MD. He is the Ponzio Family Chair of pediatric neurology and is the section head of neurology at Children’s Hospital Colorado. He is also a professor of pediatrics at the University of Colorado School of Medicine. Some highlights from this episode include:    The pathophysiology of ALD.  The clinical manifestations of ALD that make it the perfect model for newborn screening.  The specifics of diagnosing and treating ALD.  The long-term impact newborn screening can have for the lifetime of children with ALD.    For more information on Children’s Colorado, visit: childrenscolorado.org.    

Artificial intelligence (AI) has the potential to transform healthcare and disrupt the field of medicine in significant ways. We have already seen remarkable progress in areas such as diagnostics and data analysis, but what could broader use in patient care looks like? A little over a year ago, the arrival of ChatGPT got everyone talking about AI — how realistic it is, how well it understands certain concepts and, specifically in medicine, how it can benefit our care systems. In this episode, we explore the overarching needs for AI in pediatrics and medical education, as well as where we stand in implementing it. We are joined by two guests from Children’s Hospital Colorado who are leading the way in understanding how AI could be incorporated into pediatric care. Jim Barry, MD, specializes in neonatal/perinatal medicine at Children’s Colorado and is an associate professor of pediatric neonatology at the University of Colorado School of Medicine. He is also the Medical Director of the UC Health NICU. He co-founded NeoMIND-AI, a learning collaborative for neonatologists and data scientists interested in AI within neonatal and pediatric critical medicine. Sarah Milla, MD, specializes in pediatric radiology and is the John D. Strain Endowed Chair for Radiology, Chief of Pediatric Radiology and Vice Chair of Radiology at Children’s Colorado and the University of Colorado School of Medicine. She is also a visiting professor. Some highlights from this episode include:    Examples of how AI is currently being used in medicine  Ways providers can get started with AI  Ideas on how we can advance care in the future with this tool  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Over the last decade, we’ve watched childhood obesity emerge as a major health concern, taking over news stories and social media posts worldwide. The evaluation and treatment of children with obesity has evolved, and how we handle these diagnoses today is different than in years past. What’s important to emphasize is that obesity is a chronic disease, and the medical community needs to treat it as such. To learn more about this important topic and highlight an impressive woman in medicine, we are joined by Ihuoma Eneli, MD. She is the Section Head of Nutrition at Children’s Hospital Colorado and a visiting professor of pediatrics at the University of Colorado School of Medicine. She is an internationally recognized expert on pediatric obesity and serves in leadership and advisory roles for many organizations. Some highlights from this episode include: A discussion of the new AAP obesity guidelines  Genetics and how clinicians can reframe their understanding of obesity  Suggestions for motivational interviewing with patients and families  Treatment options that are available to patient-families  The stigma around fault versus genetics  New drugs and their future impact  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Hirschsprung disease. Anorectal and colorectal malformations. These are some of the most challenging surgical problems encountered in young children. The precision of surgical technique required to achieve optimal outcomes takes many years, if not decades, to develop. Colorectal surgery has become a subspecialty in pediatric surgery, requiring close collaboration with other specialists. At Children’s Hospital Colorado, we offer this care through our International Center for Colorectal and Urogenital Care, and our surgical team has some of the most experience in the world.  In this episode, we are joined by Andrea Bischoff, MD, and Luis De la Torre-Mondragon, MD. They both specialize in pediatric surgery at Children’s Colorado and are associate professors of surgery and pediatrics with a specialty in colorectal surgery at the University of Colorado School of Medicine. Dr. Bischoff is also the Medical Director of the International Center for Colorectal and Urogenital Care here at Children’s Colorado.  Some highlights from this episode include:    The importance of pediatric colorectal programs.  A discussion of when surgical intervention is necessary.  A look at what procedures are offered at Children’s Colorado and how they work.  The role primary care providers can play as it pertains to identification, referral and care of patients who might need colorectal surgery.  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Sleep problems can occur at any age, but when toddlers, children or young adults are the ones experiencing them, they can have a big impact on the entire family. Specifically, one to five percent of children, from newborns to teenagers, experience obstructive sleep apnea. While the effects may be significant, many children are not diagnosed or treated due to insufficient access to testing. A team at Children’s Hospital Colorado has been preparing a recommendation on how and when to use home sleep apnea testing in kids. To explore this topic, we are joined by Antoinette Burns, DO, who specializes in pediatrics and sleep medicine at Children’s Colorado. She is also an associate professor of clinical practice, Department of Pediatrics-Pulmonary Medicine, at the University of Colorado School of Medicine. Some highlights from this episode include:    An explanation of obstructive sleep apnea.  New modalities for sleep apnea testing.  Barriers for accessing testing and how to combat them.  Suggestions on what primary care providers should do when they think their patient might have obstructive sleep apnea.  For more information on Children’s Colorado, visit: childrenscolorado.org.    

Knowing something is wrong with your child is terrifying for any parent, but the mystery becomes more frightening when the symptoms even puzzle the experts. In 2018, at a peak in cases of acute flaccid myelitis, also known as AFM, otherwise healthy kids experienced debilitating paralysis. Researchers of this perplexing illness braced for a surge in 2022 that never came, and now there is talk about a possible increase of AFM this year. To break down the past and prepare for the future, we are joined by two experts. Kevin Messacar, MD, and Hai Nguyen-Tran, MD, both specialize in pediatric infectious disease at Children’s Hospital Colorado. Dr. Messacar is an associate professor and Dr. Nguyen-Tran is an assistant professor at the University of Colorado School of Medicine. Some highlights from this episode include:    What the history of AFM tells the medical community  Why it’s so tricky to diagnose and identify  How primary care providers can properly prepare   For more information on Children’s Colorado, visit: childrenscolorado.org.    

In just the United States, more than 15,000 children are diagnosed with cancer each year. Globally, that number is greater than 300,000. As difficult as those numbers may be, there is good news: Our cancer therapies continue to improve. In the 1960s, only about 5% of children survived leukemia. Today, that number is 90% or better. Many more pediatric oncology patients are now transitioning into survivors of childhood cancer and have the opportunity to achieve their hopes and dreams as adults. This means primary care providers are caring for these patients in increasing numbers. What’s important to know about this group of kids? In this episode, we discuss how to best integrate survivorship care with pediatric care. The Children’s Hospital Colorado HOPE Cancer Survivorship Program is one of the longest running survivorship programs in the nation. Leading that charge is Jenna Demedis, MD, who specializes in pediatric hematology and oncology. Dr. Demedis completed her training at Children’s Colorado and is currently an assistant professor at the University of Colorado School of Medicine. When a patient can transition into survivorship  How to keep patient families engaged in these programs  How primary care providers can partner with survivorship programs    For more information on Children’s Colorado, visit: childrenscolorado.org.    

  The mouth is a fundamental part of the human body. It allows us to eat, drink, breathe, speak, smile and express ourselves. Naturally, that means oral health is connected to our broader physical health, but in the United States, medical and dental care are structurally separate. Despite their connections, the two have entirely different systems of professional training schools, insurance coverage and care networks. This is referred to as the dental divide, and it results in varied levels of access and health outcomes. The repercussions of these barriers are significant, especially for children in our most vulnerable communities. To discuss this important topic, we are joined by Patricia Braun, MD. Dr. Braun is a primary care pediatrician at Denver Health, as well as a professor of pediatrics at the University of Colorado School of Medicine. She is the immediate past chair of the Section on Oral Health for the American Academy of Pediatrics, and her research focuses on oral health outcomes and program evaluation. She also currently directs the Rocky Mountain Network for Oral Health Integration. Some highlights from this episode include:    How to understand the dental divide  Ways this divide leads to poor oral health for children  Options for the medical community to combat these barriers  What primary care providers can look for in their visits with patients  For more information on Children’s Colorado, visit: childrenscolorado.org.    

When you work in neonatology, you are surrounded by babies. You’re regularly meeting new parents in the Neonatal Intensive Care Unit, some who are living the best days of their lives, and others who are experiencing the very worst. But as a doctor, you never expect to become the patient. We go beyond the white coat in this episode with a story of tragedy and personal discovery from Laurie Sherlock, MD, that changed how she interacts with her patients and practices medicine. “I’ve been gifted through the accident and my son’s death. I’ve been gifted so much compassion for what our families are going through. I think my bandwidth is so much higher because it’s so easy for me to put myself in their shoes,” says Dr. Sherlock. Dr. Sherlock specializes in neonatal and perinatal pediatric medicine at Children’s Hospital Colorado and is an assistant professor of pediatrics and neonatology at the University of Colorado School of Medicine. Mostly importantly, she is a survivor who is using her own narrative to help others. Some highlights from this episode include:    Dr. Sherlock’s personal story and the impact it’s had on her career  Using personal experience to be a better doctor  Tapping into compassion at the bedside  Advice for patients and families experiencing tragedy  For more information on Children’s Colorado, visit: childrenscolorado.org.