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newborn in ICU

Cardiac technology advances show promise for kids but only if right-sized

newborn in ICU

“Smaller patients, and those with congenital heart disease, can benefit from minimally-invasive methods of delivering pacemakers and defibrillators without the need for open-chest surgery,” says Charles Berul, M.D.

How to address the growing need for child-sized pacemakers and defibrillators, and finding better surgical techniques to place them, is the topic of an invited session called The Future is Now (or Coming Soon): Updates on New Technologies in Congenital Heart Care at the 2020 American Heart Association Scientific Sessions.

“Smaller patients, and those with congenital heart disease, can benefit from minimally-invasive methods of delivering pacemakers and defibrillators without the need for open-chest surgery,” says Charles Berul, M.D., co-director of the Children’s National Heart Institute and chief of Cardiology at Children’s National Hospital, who presented at the session.

“This unmet need can only be met by innovative pediatric research, geared towards miniaturization technologies for use in the smallest of children,” he says.

His presentation focused on the devices and approaches that have caught the attention of pediatric cardiology, such as pacemakers and subcutaneous defibrillators designed without lead wires, as well as less-invasive surgical approaches that may reduce recovery time for children with congenital heart disease who require these assist devices.

Using them in kids comes with added challenges, however. Often pediatric cardiologists have to be creative in how to make them work for smaller patients, Dr. Berul notes. This reiterates the important point that simply applying an adult technology to a child isn’t the right approach. The subcutaneous defibrillator, for example, is still pretty large for a child’s body. Some studies also show these devices may not be as accurate in children as in adults.

Investigators in the Sheikh Zayed Institute working together with the cardiologists at Children’s National Hospital are focused on product development and commercialization of tools and techniques to allow percutaneous minimally-invasive placement of devices, taking advantage of the newest devices and surgical techniques as they develop.

In his presentation, Dr. Berul stressed that as the technology for adults advances, it creates an opportunity for pediatric cardiology, but only if the devices, and the techniques to place them, are specifically redesigned for pediatric application.

American Heart Association Scientific Sessions 2020
The Future is Now (or Coming Soon): Updates on New Technologies in Congenital Heart Care – On Demand Session
CH.CVS.715
9:00am – 10:00am
Fri, Nov 13  (CST)

Matt Oetgen talks about an x-ray

Nicotine-like anti-inflammatories may protect limbs, testicles from inflammatory damage after injury

Daniel Casella

Daniel Casella, M.D., is teaming up with Matthew Oetgen, M.D., MBA, for a POSNA-funded pre-clinical study of the anti-inflammatories varenicline and cytisine.

A new pre-clinical study will explore the use of anti-inflammatory medications to prevent the body’s inflammatory response from further damaging limbs after an injury restricts blood flow. Varenicline and cytisine, anti-inflammatories with similarities to nicotine, have shown early promise in similar pre-clinical laboratory studies of the testicles and will now be tested in arms and legs.

Matthew Oetgen, M.D., MBA, chief of Orthopaedic Surgery and Sports Medicine at Children’s National and Children’s pediatric urologist Daniel Casella, M.D., will jointly lead the new study entitled, “Modulation of the Injury Associated with Acute Compartment Syndrome,” which builds on Dr. Casella’s previous work with the two anti-inflammatory agents. Drs. Oetgen and Casella recently were awarded the Angela S.M. Kuo Memorial Award Research Grant to fund this research during the Pediatric Orthopaedic Society of North America’s (POSNA) Annual Meeting.

“We are honored that this important research was selected by POSNA for support,” says Dr. Oetgen. “An arm or leg injury can trigger the body’s natural inflammatory response, causing severe swelling that restricts blood flow. Even after blood flow is restored, the inflammatory response can lead to permanent muscle or nerve damage or even loss of limb. This grant will give us the opportunity to truly explore the application of anti-inflammatories after injury and see if this approach can modulate the immune response to protect the limbs.”

If successful in the laboratory, the team hopes to expand this work to human clinical trials.

Matt Oetgen talks about an x-ray

“We are honored that this important research was selected by POSNA for support,” says Dr. Oetgen. “This grant will give us the opportunity to truly explore the application of anti-inflammatories after injury and see if this approach can modulate the immune response to protect the limbs.”

The Angela S.M. Kuo Memorial Award Research Grant is given each year to an outstanding investigator aged 45 or younger based on criteria including the study’s potential significance, impact, originality/innovation, the investigator’s track record and study feasibility. The award totals $30,000.

While at POSNA’s 2019 Annual Meeting, Dr. Oetgen and Children’s pediatric orthopaedic surgery colleagues also participated in podium presentations and poster sessions, including:

  • “Achieving Consensus on the Treatment of Pediatric Femoral Shaft Fractures,” Matthew Oetgen, M.D., MBA
  • “A Prospective, Multi-centered Comparative Study of Non-operative and Operative Containment Treatments in Children Presenting with Late-stage Legg-Calve-Perthes Disease,” Benjamin Martin, M.D.

The Pediatric Orthopaedic Society of North America is an organization of 1,400 surgeons, physicians, and allied health members dedicated to advancing musculoskeletal care for children and adolescents. The annual meeting presents the latest research and expert clinical opinion in pediatric orthopaedics through presentations, posters, and symposia. It was held May 15-18, 2019, in Charlotte, North Carolina.