Newborn screenings: what to expect in hospital right after birth

For those of you who are expecting new babies, congratulations! In addition to getting to know your newborn and learning to care for her, there are many things that happen in the hospital after a baby is born that you should be aware of.

It may seem like a lot of poking and prodding around your perfect new baby, but each test is done for a very specific and important reason. All are designed to make sure your baby is healthy and has the best start in life.

You can talk to your baby’s future health care provider about these topics to learn more.

Vitamin K

All babies are born with a low vitamin K level, which is an important factor in helping a baby’s blood clot. That’s why we give all newborns a vitamin K injection shortly after delivery. The vitamin K shot helps prevent a type of bleeding called vitamin-K deficient bleeding (hemorrhagic disease of the newborn). This rare but serious condition can range from bruising of the skin to bleeding inside the baby’s brain. Unfortunately, there’s no way to tell who will be affected and vitamin K is not found in breastmilk or infant formula (Pediatrics).

Bilirubin

It’s normal for almost all babies to look a little yellow, or jaundiced, after birth. A blood or skin test  measures the baby’s amount of jaundice (bilirubin) after birth. Infants with very high levels of bilirubin are at risk for neurologic problems. This test can detect severe jaundice early, so that it can be treated right away, often with simple light therapy (Healthline).

Erythromycin

Newborn’s eyes are treated with erythromycin ointment, an antibiotic to prevent the development of bacterial conjunctivitis (eye infection). This preventive treatment is safe, easy and effective in preventing sight-threatening eye infections (Healthfamilies.org, American Academy of Pediatrics).

Hepatitis B

Vaccination of all newborns with hepatitis B vaccine, regardless of mom’s hepatitis B status, is recommended. The earlier a baby receives the first hepatitis B vaccine, the better protected she is in cases of unknown maternal infection or accidental exposure (Aboutaids.org, U.S. Dept. of Health and Human Services).

Newborn screen

Here in Oregon, babies receive the first newborn screen in the first day of life and the second one around two weeks of age. A few drops of blood from a heel prick are sent to the state public health lab. You and your baby’s provider will be contacted if anything abnormal is found (Oregon.gov, Oregon Health Authority).

Hearing screen

Hearing loss is the most common congenital condition in the United States. We screen all newborns in the hospital soon after birth to identify infants with hearing loss as early as possible. Early identification has been shown to improve outcomes (Healthchildren.org, American Academy of Pediatrics).

Heart disease screen

A pulse oximetry probe, which looks like a piece of tape, is placed on an infant’s hand or foot to measure the amount of oxygen in the blood. This test is not painful and can detect certain types of congenital heart disease in infants. Without screening, some newborns with heart defects might be missed because the symptoms may not be evident before they go home (Centers for Disease Control and Prevention).

Lauren Harris, M.D.
Second-Year Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

Carrie Phillipi, M.D., Ph.D.
Associate Professor of Pediatrics
OHSU Doernbecher Children’s Hospital
Director, Mother-Baby Unit
OHSU Hospital

 

Leadership matters

Jodi Coombs, M.B.A., B.S.N., R.N.

We are always bringing new talent to OHSU Doernbecher Children’s Hospital. Usually that means we are looking for a surgeon who can bring new expertise or pediatric specialists who have innovative research programs or who bring new programs to our children’s hospital. I’m particularly excited about two talented people that we’ve brought to the Doernbecher leadership team.

Last winter, Jodi Coombs, M.B.A., B.S.N., R.N., came to Doernbecher from Boston Children’s Hospital to be the Vice President for Women & Children’s Services. Jodi has been a leader in some of the best academic children’s hospitals in the United States.

In addition to Boston, she has worked at Vanderbilt and Stanford (Lucille Packard Children’s). Jodi’s nursing background informs her practice as an administrator, and she has been a great partner in advancing care at Doernbecher this past year.

Ken Azarow, M.D., F.A.C.S., F.A.A.P.

A few weeks ago, Ken Azarow, M.D., F.A.C.S., F.A.A.P., joined the Doernbecher leadership team as our Surgeon-in-Chief. Ken comes to OHSU Doernbecher from the University of Nebraska, where he was a Professor of Surgery, and he had a long career as a pediatric surgeon in the United States Army before moving to Nebraska. In addition to being a superb surgeon, his extensive leadership training and experience will serve us well. We are indeed fortunate to have recruited Ken.

Among our other tasks, Jodi, Ken and I will be working hard to ensure that our Doernbecher surgical services are second to none. Ken will also be working on a daily basis with our anesthesia and nursing leadership in the Doernbecher operating rooms to monitor and enhance the quality of our services.

We have a lot of work to do. Just a few of our tasks include:

  • Building new operating rooms, one of which will include an intraoperative magnetic resonance imaging (iMRI). The iMRI will ensure that our children with brain tumors and epilepsy are getting the very best cutting-edge care.
  • Planning for how to bring new technologies to other surgical programs, including upgraded operating rooms for our cardiac surgery program and minimally invasive surgical programs to many of our surgical subspecialties.
  • Helping advance our ability to provide outpatient surgical services – children are best off when home with their families. How do we best support families in providing more of the care at home.
  • Recruiting the next generation of Doernbecher surgeons.

Doernbecher is a great place. With these great partners in leadership, I’m very bullish on the future of Doernbecher. Everything we do is on behalf of the kids and families that we serve.

H. Stacy Nicholson, M.D., M.P.H.
Professor and Credit Unions for Kids Chair
OHSU Department of Pediatrics
Physician-in-Chief
OHSU Doernbecher Children’s Hospital

A walk through Doernbecher forever changed a teen boy’s life

David Mack and family are collecting donations for OHSU Doernbecher at 5701 Texas Drive Vancouver, WA 98661

Five years ago I was part of the Kids Making Miracles program at Hudson’s Bay High School. Eleven other guys and I raised thousands of dollars for OHSU Doernbecher Children’s Hospital, the experience was unforgettable. At 18 years old I felt like I was making a difference.

At that age most kids are just trying to figure out who they are and what they want to do with their lives. Being selected as one of the 12 guys to represent my high school and raise money for Doernbecher was, at first, more of an accomplishment than a privilege.

My thinking behind this was that in order to be one of the 12 participants you had to be selected by other students as well as staff, so being selected meant reaching a point where you were known and respected by others, or in other words popular; which, at that time seemed to be most important.

In December of 2007 my perspective of what was important to me changed. That December, 11 other guys and I visited Doernbecher Children’s Hospital — it was my first time. We toured the facility. We were shown the meditation room, the outdoor play area and walked past the patients’ rooms. It was at that point that I realized how much of a difference I could make, a difference that we all could make.

Looking into the patient’s rooms and seeing all of the young faces battling something bigger than I have ever realized.The only thing important to them was finding the will to survive, how foolish I felt at that moment. At first, becoming a representative to raise money was an accomplishment, something that I was proud of, but I had no idea the impact it would have in my life.

Those brief seconds of walking by the rooms I became humbled by the opportunity in front of me, a sense of responsibility grew within me.

The next five months were passionately spent fundraising. In the end over $85,000 was raised, hearing that total announced in front of the school filled me with pride. Knowing that the money was to go straight to Doernbecher to help all of those kids that we saw at the hospital and knowing that I was a part of it was such a satisfying feeling. What I did not realize in that moment of satisfaction was that the desire to help would remain.

I continue to support Doernbecher. Although it is not on such a grand scale, it is something that I am proud to support. Every Christmas my family and I decorate our house with thousands of lights and on most nights, although not all, we give out hot chocolate and candy canes. Throughout the whole month of December, we collect donations from people who pass by. At the end of the holidays we take all of the collections that we received and we bring them to Doernbecher.

We have all heard the saying, “Christmas is a time of giving.” For my family, this resonates in the back of our minds for the three days following Thanksgiving when we are setting up our Christmas lights. We think of all of the joy and cheer that the lights bring. If we can make just one person happy and smile, we feel that it was worth our time.

The lights are up and we are hoping to have many visitors.The video below is from five years ago, and the display has changed considerably. The most notable change is that we have more lights! Also we don’t have the big Doernbecher sign on the roof; we donated the letters to Hudson’s Bay and they continue to use them in the “Mr. Hudson’s Bay Pageant” for Kids Making Miracles.

So please stop by, have a cup of hot chocolate and listen to some holiday music as you enjoy the lights. Santa will be stopping by 5701 Texas Drive Vancouver, WA 98661 on Saturday, Dec. 14, 2013.

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David Mack
Hudson’s Bay High School graduate
Accountant at Geffen Mesher and Co.

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The Mr. Hudson’s Bay High School Kids Making Miracles fundraiser has supported OHSU Doernbecher Children’s Hospital since 1992, raising more than $800,000 to support the area of greatest need. These critical fund help:

  • Develop new clinical services.
  • Fund innovative research programs
  • Test new treatments for serious childhood diseases.
  • Address immediate children’s health care needs and take advantage of unanticipated opportunities.

For more information about KMM or to start a fundraiser at your school, please contact the Doernbecher Foundation office or e-mail dchfinfo@ohsu.edu.

‘Because some kids need help’: 9-year-old novelist raises $500 for Doernbecher

On one warm Thursday I woke up and was so excited. “It is the big day,” exclaimed Zoe. I know you must be wondering. I will tell you all about it.

Well one hot summer day, me (Zoe) and my friend Tess decided to raise money for the Doernbecher Children’s Hospital. So we started right away.

On a Tuesday my Aunt Mary came over and taught us how to make packs of greeting cards. When we made the cards, we used stamps. Some were of bunnies, cats, dogs and more. There were five cards in each pack. There were also five envelopes in each pack. We made birthday cards, thank you and blank cards. I love making cards and so does Tess.

Another way we raised money was by washing cars. We asked people to pay fifteen dollars for the inside and fifteen dollars for the outside. We washed my Uncle Rick’s car, my Aunt Carol’s car and a bunch more. I never knew cleaning cars was so hard.

At the end of the summer, we thought to ourselves, why did we do this project and then we remember we did this project because some kids need help.

Altogether we raised $500. I had so much fun and I think Tess did too. Ella, my little sister, also enjoyed helping us. Well today I am going to meet Sara who works at Doernbecher Children’s Hospital. I met her and handed her $500 cash. She said, “THANK YOU!” I felt amazing at that moment.

The hospital is a wonderful place for children and adults. “Everyone at DCH is always safe, happy and loved!” exclaimed Zoe.

Zoe Taaffe, 9
Fourth-grader, Byrom Elementary School
(In her spare time, Zoe likes to write books.)

Special Olympics: Time out of pediatric residency

There is a reason they call us residents. We do spend the majority of our time “residing” in the hospital. So it is always nice to be able to escape our residency and experience medicine in a community outside the hospital.

A few weekends ago, a group of five residents, including myself, and three supervising physicians made our way to the Nike campus to help out at the Special Olympics MedFest. My first impression was that Nike never does anything on a small scale.

Rain or shine (mostly rain), hundreds of children were set to try their hands, or feet as it may be, at their sport of choice. This included old pros as well as new members to the Special Olympics family. Volunteers were there in spades as well, filling in all the tiny gaps left between the swarming groups of children.

We somehow made it through to the temporary medical clinic, all nicely organized with exam tables, curtains dividing the “rooms,” a triage area supplied with scale and vision charts, and even a small waiting room.

Nursing students from OHSU volunteered their time to obtain vitals as well as perform vision and hearing screens. With our Special Olympics staff shirts proudly worn, we set about to make ourselves comfortable in the clinic.

Soon the athletes began to arrive. We were coached prior to arrival that every child we would see should first be thought of as an athlete and then as a patient. It is a different approach than that which we typically take in clinic, where all patients are primarily just patients.

In many ways, this was a challenging alteration of thought because my brain has been trained to first find the problem before addressing the solution. But there were endless number of interesting solutions, interests and new resolutions. It was fun to see how all the different athletes participated and each to varying capacities. It was fun to see their lives on their turf, not mine.

At the end of our rounds of sports physicals, gentle persuading and medical discussions, we were all happy we had come. If nothing else, it was inspiring to see these athletes succeed and be a part of a very welcoming family.

I would always be happy to help make that happen for anyone, even outside of the hospital.

Ashley Treece, M.D.
Third-Year Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

Survey finds 1 in 4 parents admits to driving with their child unbuckled

We never think it will happen to us. We watch the news, we surf the web and we see that bad things can happen to good people. Natural disasters, random acts of violence, accidents … our 24-hour media cycle means we have a front row seat to the suffering of others, and yet we seem to believe that we are immune.

I see it every day on Portland roads and highways — parents driving with children unrestrained, believing that a crash will never happen to them. Unfortunately, as a pediatrician, I also see the tragic consequences that result from this behavior all too often.

We are not magically protected, and therefore cannot ignore car safety seats and seat belts. Every day in the United States about four children younger than 16 die as passengers in motor vehicle crashes. Yesterday, today, tomorrow … four kids every single day.

Are we willing to pay that price? No. It is not OK that four kids will lose their lives by day’s end because they were unrestrained; lives filled with love, passion, humor and endless potential. Just as it would not be OK if it were an epidemic that claimed those lives every day. We should do everything in our power to ensure our kids are protected.

Results of a recent survey from General Motors and Safe Kids Worldwide shows that many Americans put their children in harm’s way, whether they realize or not. The survey of more than 1,000 parents showed that more than 1 in 4 parents thinks it is OK to drive with their children completely unrestrained in the car, even if it is just a short trip.

If you think that is bad, consider the fact that about 60 percent of all crashes involving children occur within 10 minutes of a family’s home — just the kind of “short trip” in which kids are not restrained.

How many such trips are taken every day? How many kids are unrestrained? And how many lives are shattered by injury and death? The sad fact is that almost all of them could be either prevented or decreased in severity through proper use of car safety seats and seat belts.

What can you do to best protect those most dear to you?

  1. Use the correct car safety seat for your child. Each seat has weight and height limits it. Do you have the right seat for your child?
  2. Follow the directions of the manufacturer and make sure the harness straps are used correctly, and the seat is correctly installed in the car using either LATCH anchors or the vehicle seat belt.
  3. Keep your child rear-facing as long as your car safety seat will allow. Children aged 1 and 2 are 500 percent less likely to be injured if they are facing toward the rear. Pay attention to the weight and height limits as determined by the seat manufacturer.
  4. Once you turn the child forward-facing, use a car safety seat with an internal harness until your child outgrows the weight and height limits
  5. Once your child outgrows the forward-facing seat, use a booster seat until the vehicle seat belt fits correctly (usually around ages 9 to 12 years …  yes, most kids do not fit in vehicle seat belts until they reach 4’ 9”, which is ages 9 to 12 for most kids).
  6. Keep kids in the back seat until they are at least 13. Kids 12 and younger have at least a 40 percent increased risk of injury in a crash.
  7. Be sure that every passenger in the vehicle is restrained — driver, passengers and each child on each and every ride. Highway, neighborhood side streets … every single ride.

I challenge parents and caregivers to ask themselves the following questions:

  • Do I let my kids ride unrestrained if I’m just going down the street to the grocery store?
  • Is my child in the right seat for his/her age, weight? Is he/she in the front?
  • Do I need help answering these questions?

The Tom Sargent Children’s Safety Center at OHSU Doernbecher Children’s Hospital has five National Highway Traffic Safety Administration-certified car seat technicians to help ensure you are doing the best you possibly can.

Ben Hoffman, M.D.
Medical Director, Tom Sargent Children’s Safety Center
Professor of Pediatrics
OHSU Doernbecher Children’s Hospital

 

Parents try alternative medicine to ease their child’s headache pain

More than 1 in 10 young people in the United States experiences recurrent headaches, and parents are eager to find ways to ease their pain and help their children get back to normal life and school.

To that end, nearly 1 in 3 youth aged 10 to 17 who regularly experience headaches are turning to some type of complementary or alternative medicine (CAM), in addition to conventional medical care.

CAM includes things like herbal therapies, acupuncture and mind-body approaches such as meditation or deep breathing. Across the country, youth with recurrent headaches are more than twice as likely to use CAM compared with youth who do not experience recurring headaches.

With that in mind, it is important for parents and children’s health care providers to both discuss the presence of headaches as well as the use of CAM to ensure CAM use is considered when making other medical recommendations and to track CAM’s impact and effectiveness. This is especially important because nearly 9 out of 10 youth with headaches also experience other chronic conditions, and those who use CAM are also among the highest users of conventional medical care.

In fact, a study we recently published in the journal Pediatrics showed that among youth experiencing recurrent headaches, those who used CAM also:

  • Had higher total expenditures for conventional care.
  • Were twice as likely to have seen a specialist.
  • Were more likely to take prescription medications.
  • Had six or more conventional care visits in the past year.

With improved communication between health care providers, parents and youth, everyone can learn more about the potential benefits from using the many self-care approaches included among CAM, as well as the possibility of reducing often costly medical interventions.

In addition, these discussions may also reveal the importance of medications and other treatments to help youth with headaches who often experience headaches on a weekly basis and who miss a large number of school days and repeatedly use the emergency room.

Care coordination and integration of care should also include complementary and alternative therapies. Coordination begins with communication between parents, youth and providers about the use of CAM.

Christina Bethell, Ph.D., M.B.A., M.P.H.
Professor, Department of Pediatrics
Director, Child and Adolescent Health Measurement Initiative
OHSU Doernbecher Children’s Hospital

 

 

Bedwetting: You are not alone

No shame or blame for accidents — nobody “wants” to wet the bed.

Wetting the bed is a common problem for children. In fact, 15 percent of 5-year-olds wet the bed. Unfortunately, it is also an issue that we tend not to talk about outside our immediate families – if it is talked about at all.

It is important for kids and their families to realize this is a common issue, usually there is not a medical reason, and it usually will stop on its own.

First:

  • No shame or blame for accidents — nobody “wants” to wet the bed.
  • Kids who wet the bed are NOT “lazy.”
  • If a kid could stop wetting the bed, he/she would.
  • Kids CAN be responsible for keeping themselves and their bed clean and dry (age-appropriate), i.e., help strip the bed, help with the laundry – NOT as a punishment

Your child may be ready to work on becoming dry at night if he/she:

  • Is asking about being out of diapers or pull-ups and wants to wear underwear.
  • Is feeling like he/she is missing out on social activities.
  • Seems excited to try something new to become dry.

Most kids are not ready to work on bedwetting until around age 7. Understandably, parents often want to work on bedwetting before the child is ready. Usually your child will be more successful once they are on board versus trying to make them want to work on it.

Tips:

  • Go pee right before bed (seems obvious but a lot of kids do not).
  • Limit fluids in the evening, especially known bladder irritants (carbonation, caffeine, citric juices, red/purple dyes, chocolate).
  • Have a flashlight/nightlight to help guide your chlid to the bathroom during the night.
  • Have your child practice getting up from his/her bed and going to the bathroom

Treatments:

  • Bed alarms: alarms that go off when your child starts to pee. Parents will most likely need to wake up the child – this may be the most effective treatment, but can take several months to work
  • Acupuncture.
  • Medications – they do not work for everyone and are not a cure, but may be helpful for your child
  • Combination therapy.

When to seek help:

  • Any time you have a question or concern; contact OHSU Doernbecher Pediatric Urology.
  • This is a new symptom (previously had six months of complete dryness).
  • Daytime peeing issues.

Erin Anderson, B.S.N., M.S.N, C.N.P.
Division of Pediatric Urology
OHSU Doernbecher Children’s Hospital

Introducing Nike Doernbecher Freestyle designers for 2013 — Jake Dering

Jake Dering, 8 (photo by Daniel Root)

Here’s the thing about 8-year-old Jake Dering: the kid’s got swagger. After enduring 19 surgeries to treat an extremely rare genetic condition called otopalatodigital syndrome type II, he’s earned the right to strut a little. Jake’s charm is not lost on the ladies.

He’s been known to liberally dose himself with Calvin Klein cologne (he calls it smelly sauce) when the occasion calls for it. He’s also a smooth operator on the dance floor, making him a high sought after partner at weddings. “I’m good at the tango and romance dancing,” he said.

His swagtastic creation, the Nike Free Jake 5.0, is ideal for fresh dance moves. Lenticular materials throughout the shoe give the appearance of constantly being in motion – just like Jake. He offers some words of advice on the sockliners: one side reads Be Brave, while the other reads Never Give Up. And around the ankle collar, Jake’s can-do attitude is summed up with the simple phrase I wasn’t made to fit in, I was made to stand out.

Even the name of the shoe is significant to Jake. “I just really want to be free of all this stuff,” he explained. “No halo, no cast, no crutches. That’s why it’s called the Free Jake.”

Jake Dering’s Nike Free Jake 5.0 (photo by Paul Wegman)

Next May, another surgery is planned to add 3 ½ inches to his right leg. Until then, he’ll continue rocking his Free Jakes with a special lift built right in. Besides making it a lot easier to run and play, his custom Nike kicks come with an extra special benefit.

“A lot of times people want to know what the deal is with my shoes – I get kind of tired of it,” he said. “But now, when people ask me, ‘where did you get that cool shoe?’ I can say, ‘I designed it!’”  Talk about bragging rights – or in Jake’s case, swagger rights.

A Free Jake tag on the tongue of Jake’s shoe (photo by Paul Wegman)

“Jake has undergone numerous surgeries throughout his life. He has been in and out of full body casts and halo neck traction. He is resilient, dedicated to improving his mobility, and tough. He is also a super charismatic and genuine person. He has overcome the odds – he is a fighter.” – Nathan Selden, M.D., Ph.D., F.A.C.S., F.A.A.P., head, Division of Pediatric Neurosurgery, OHSU Doernbecher Children’s Hospital.

The 2013 limited-edition Doernbecher Freestyle Collection includes apparel and footwear and will be sold at www.nike.com and at Nike retail locations across the country. All proceeds benefit OHSU Doernbecher Children’s Hospital.

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See more photos of Jake’s shoe and apparel.

Ashley Schmidt
Associate Director of Development
OHSU Doernbecher Children’s Hospital Foundation

 

 

Join us in celebrating Pacific Northwest Diabetes Health and Wellness Week

Taking care of diabetes can be a challenge, but you are not alone. Join OHSU and the rest of the diabetes community in celebrating Pacific Northwest Diabetes Health & Wellness Week.

Founded by the Chris Dudley Foundation and Novo Nordisk, this weeklong event, Nov. 10 – 16, is designed to unite our community in a collaborative effort to bring diabetes to light and change the way diabetes is viewed and treated.

The week’s activities include the 6th annual Pacific Northwest Diabetes Summit, Saturday, Nov. 9, at the Crowne Plaza Hotel in Portland, Ore.

Presented by the OHSU Harold Schnitzer Diabetes Center and Novo Nordisk, this year’s summit will have morning sessions devoted to type 1 diabetes and afternoon sessions focused on type 2 diabetes. All of the sessions are designed to provide practical information for individuals and families affected by diabetes. Topics range from new technologies in the care of diabetes to practical advice for coping with diabetes and diabetes management.

The summit is free and all are invited to attend.

In addition to the summit, kids with diabetes can take part in Circle on the Court, the week’s kick-off event, Friday, Nov. 8. Prior to attending a Portland Trailblazer game, participants will have the opportunity to meet former professional athletes, including Chris Dudley and Dominique Wilkins, and learn more about living an active life with diabetes.

Bruce Boston, M.D.
Professor of Pediatrics, Division of Pediatric Endocrinology
Harold Schnitzer Diabetes Health Center
OHSU Doernbecher Children’s Hospital

 

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