Stories about: Pediatrics

Fertility preservation for children with cancer: What are the options?

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More than 75 percent of children diagnosed with cancer are surviving into adulthood, leaving more and more parents to wonder: Will my child be able to have children down the road?

They’re right to be concerned. The cancer treatments that are so effective at saving children’s lives can themselves cause a host of problems that don’t manifest until years later. These late effects include particularly harsh impacts on fertility.

On our sister blog Notes, urologist Richard Yu, MD, PhD, of Boston Children’s Hospital and fertility specialist Elizabeth Ginsberg, MD, of Brigham and Women’s Hospital outline where the science of fertility preservation is going.

“It may take 15 or 20 years to develop the techniques to help a child who is 8 years old now,” notes Yu. “But if you don’t preserve something now, you run the risk of not being able to do anything for them later, which is where we are now with a large number of adults who survived childhood cancer.”

Read more about fertility preservation and childhood cancer on Notes.

 

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Keeping up with marijuana use and its outcomes in kids

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For the first time since 1937, marijuana is legal for recreational use: adults now can legally possess it in Colorado, Washington, Oregon and Alaska, and there are similar ballot initiatives in many states. With laws at least partially legalizing marijuana in 23 states and the District of Columbia, it’s now a big business. A study comparing 2012-2013 with 2001-2002 found that marijuana use had doubled over the 10 year-period. And that was three years ago.

What are the public health consequences of freely available weed — both acute and long-term? Are we making a big mistake here?

Concerned about potential harms to adolescents, Sharon Levy, MD, MPH and Elissa Weitzman, ScD, Msc, of Boston Children’s Hospital’s division of Adolescent/Young Adult Medicine argue for a better, real-time marijuana surveillance system in this week’s JAMA Pediatrics.

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Q&A: Mosquitos, Zika virus and microcephaly in Brazil

mosquito-Thriving

As you may have heard, Brazil is facing a startling outbreak of microcephaly, a rare condition in which a child is born with a head and brain that are much smaller than normal. Microcephaly is almost always associated with neurologic impairment and can be life-threatening.

The epidemic has been linked to an influx of the mosquito-borne virus Zika, first detected in Brazil last April. This past Friday, January 16, the Centers for Disease Control and Prevention issued travel warnings advising pregnant women to avoid visiting El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela and Puerto Rico. And over the weekend, the first U.S. case of microcephaly linked to Zika reportedly surfaced in Hawaii.

Why this virus, why now? And how can a virus affect someone’s head size? In this Q&A on our sister blog, Thriving, Ganeshwaran Mochida, MD, of Boston Children’s Brain Development and Genetics (BrDG) Clinic, who specializes in microcephaly, and Asim Ahmed, MD, an infectious disease specialist at Boston Children’s, offer their insights.

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9 science and innovation predictions for 2016

Everett Collection/Shutterstock
Everett Collection/Shutterstock

What does 2016 have in store in the realm of science and clinical innovation? Vector asked clinical, digital and business leaders from around Boston Children’s Hospital to offer their forecasts.

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How can we make personalized therapy for childhood cancer a reality?

For some pediatric cancers, such as acute lymphoblastic leukemia, older forms of therapy — and older ways of defining who receives which therapy — have served well over the last few decades. But that approach is no longer sufficient. Revolutionary gains have been made in adult oncology using personalized genomic therapy — therapy based on matching treatments to the genetic makeup of a patient’s tumor. The time has come to take them to the pediatric space.

But how will pediatric oncology get there? A panel discussion at Boston Children’s Hospital’s Global Pediatric Innovation Summit about personalized cancer genomics — moderated by Bloomberg News’s John Lauerman and featuring Katherine Janeway, MD, clinical director of the Solid Tumor Center at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center — took on this question. Panelists raised four overarching concepts to consider: numbers, sharing, collaboration and incentives.

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In case you missed it: A look back at 2015

Dog looking back-cropped-Kim Britten-shutterstock_306257615It’s been another exciting year in science and innovation at Boston Children’s Hospital. Read on for a few Vector and audience favorites in science and technology.

 

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Genetic factors linked with neurodevelopmental delays in children with congenital heart disease

brain geneticsAs survival has improved dramatically for children with even the most serious forms of heart disease, neurodevelopmental disabilities have been increasingly recognized. These can affect not only school performance, but also future employment, quality of life and social relationships.

“We’ve known for a while that children with congenital heart disease (CHD) have a higher risk of developmental delays,” says Amy Roberts, MD, a genetic cardiologist at the Boston Children’s Hospital Heart Center. “There are multiple hypotheses as to why that might be, and they’re not mutually exclusive.”

The side effects of surgery, such as oxygen deprivation during bypass, are commonly thought to be to blame. Others suspect problems with the in utero environment. But these factors are not the whole story.

“Even in studies that have measured every known risk factor, only one third of neurodevelopmental disabilities in children with CHD can be explained by factors related to the child’s heart disease, medical history or family factors,” notes Jane Newburger, MD, MPH, director of the Cardiac Neurodevelopment Program at Boston Children’s.

Perhaps there is a genetic component?

In a recent study published in Science, a team of researchers from seven hospitals (Boston Children’s, Brigham and Women’s Hospital, Children’s Hospital of Philadelphia, Columbia, Mount Sinai, Yale and University of California Los Angeles), examined the whole genomes of 1,213 patients with complex CHD, looking for genetic indicators that a child will have developmental delays alongside his or her CHD.

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Accessible and affordable dialysis for children in developing countries


Children living outside industrialized nations have limited access to health care, and many children with severe kidney dysfunction do not have access to dialysis. Some developing countries have access to manual peritoneal dialysis, which requires the placement of a catheter into the abdominal cavity every one to two hours, 10 hours per day. But supplies are expensive, and many countries lack the infrastructure needed to get large quantities of dialysis fluid to children’s homes.

At the recent 2015 Boston Children’s Hospital Global Pediatric Innovation Summit + Awards, pediatric nephrologist Sara Jandeska, MD, of Rush Children’s Hospital in Chicago, pitched a portable, affordable solution: providing just the dialysis salts.

See more posts and videos from the Global Pediatric Innovation Summit.

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Mobile app lets doctors tell when a heart murmur is benign

More than half of all heart murmur referrals to pediatric cardiologists are for a Still’s murmur — a benign murmur that naturally occurs in 50 to 90 percent of children and goes away by adolescence.

Every year, pediatric cardiologists in the United States see 1.3 million children with Still’s murmurs. That adds up to over $400 million in consultation fees alone.

The cardiologist, in turn, may still be unsure whether the murmur is benign after listening to the child’s heart with a stethoscope. He or she might order a follow-up echocardiogram to be certain. If this happens just 10 percent of the time, that’s an additional $200 million in unnecessary costs incurred per year. On top of the financial burden on the healthcare system, the referrals and testing cause unnecessary anxiety for patients and families.

A mobile app in development by Raj Shekhar, MD, of Children’s National Health System and his team has the potential to significantly alleviate these burdens. The app, called StethAid, allows pediatricians to identify a Still’s murmur, thus establishing the child’s murmur as benign and eliminating the need for cardiac referral.

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The power of the pulse: Ventriflo re-imagines cardiopulmonary support

Is there anything more fundamental to human life than the heartbeat? That thud, thud, thud — that reliable rhythm — is synonymous with being alive.

When a person undergoes open-heart surgery, however, the heartbeat must be interrupted to give surgeons access to that essential organ. The organic pulse is temporarily replaced by a machine that provides continuous blood flow to the body.

Doug Vincent, President and CEO at Design Mentor, Inc., has been studying the ways in which current continuous flow devices fail to provide optimal cardio-pulmonary support. Vincent has designed his own support mechanism device that simulates the natural pulsating rhythm of the heart, called VentriFlo.

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