Two Tiny Miralces, Born Seven Months Apart

Two years ago, newlyweds Valentina and Anthony Holguin were excited when they learned that Valentina was expecting a little girl. In just a few short months, it seemed like everything they had ever wished for was coming true.

But after a smooth and uneventful pregnancy, Valentina began experiencing extreme pain at the beginning of her third trimester.

“All of a sudden, I had these awful symptoms,” Valentina recalled. “My ribs felt like they were going to break and I had difficulty breathing. I was in so much pain.”

Valentina brought her concerns to her OB-GYN, but she was told that what she was experiencing was normal, especially toward the end of a pregnancy. Valentina decided to push through the pain and do her best to enjoy the time she had left before her daughter was born. At 32 weeks pregnant, she and her husband planned a trip over Memorial Day Weekend to attend her little sister’s high school graduation.

“We drove five and a half hours to get there and we had to stop every hour because I was in such excruciating pain,” Valentina said. “I didn’t know it at the time, but I was experiencing labor pains.”

The morning after they arrived, Valentina proudly watched as her little sister walked across the stage to accept her diploma. She bent down to take a picture to commemorate the moment, and just then, her water broke.

“I didn’t know what happened at first because it wasn’t a huge gush, but I could tell something was off,” Valentina said. “I went into the bathroom and saw that I had some bleeding, so I called my OB-GYN and they told me to go straight to the ER.”

There, the doctors confirmed that Valentina was in labor. Because she was only 32 weeks along, however, they did everything they could to stop her from delivering that day.

“They wanted me to hold out as long as possible to give my baby more time to grow,” Valentina said. “They admitted me to the hospital and I spent the weekend there on bedrest.”

That following Tuesday, a Maternal-Fetal Medicine specialist took Valentina for an ultrasound to check on the baby’s progress.

“I remember that the specialist was concerned because I was so swollen,” Valentina said. “I had so much amniotic fluid in my womb that the specialist said it must have felt like I was carrying twins.”

After the ultrasound, the specialist sat down with Valentina and told her some devastating news. Her baby girl had a condition called hydrops fetalis, also known as hydrops, which is characterized by a large amount of fluid build-up in the tissues and organs. The condition causes swelling and has a poor prognosis, with less than 50 percent of unborn babies surviving birth. In Valentina’s case, her baby’s lungs were filled with fluid.

“She was very straightforward with us and prepared us for the worst, saying that there was a very real chance that our baby may not make it,” Valentina said. “I tried to remain as positive as possible and my husband and I just hoped and prayed she would make it. I knew that my daughter needed me to be strong, and so I was only going to emit positive energy to her.”

The specialist told Valentina that she would need to be transferred to a hospital with a Level IV NICU before delivery, since her daughter would need specialized surgery immediately after birth. With the clock ticking, Valentina was airlifted to The Children’s Hospital of San Antonio (CHofSA).

The day after she arrived, Valentina went into active labor, and she was placed under the care of OB-GYN Dr. Jacqueline Battistelli, MD.

“Dr. Battistelli was an angel sent from heaven above,” Valentina said. “She really helped guide me through the process of labor.”

Before the delivery, Valentina was also paid a visit by neonatologist Dr. Sowmya Mohan, MD.

“Dr. Mohan gave me such reassurance. She told me her name, introduced me to her team, and told me that they were going to take care of me and my baby,” Valentina said. “She also explained how, after the delivery, they were going to try to let me see her for a moment, if possible, but that they would then have to take her into surgery immediately and put a shunt in her lungs to release the fluid. She gave me such clarity as to what was going to happen, which I really appreciated.”

Neonatologist Dr. Sowmya Mohan helped Valentina understand exactly what to expect when her baby was delivered at The Children’s Hospital of San Antonio.

Shortly thereafter, Dr. Battistelli delivered a baby girl, whom Valentina and her husband named Elena Diana.

“It was a beautiful delivery,” Valentina said. “We played worship music and after just an hour of pushing, my beautiful daughter was born.”

Valentina was able to see Elena for just a few seconds before she was rushed into surgery. About an hour after the delivery, Dr. Mohan walked into the room and told Valentina that her little girl was OK.

“They were able to put the shunt in and drain the fluid, and she told us that Elena was in the NICU and ready for us to see her,” Valentina said.

Valentina and Anthony were relieved beyond belief. Elena stayed in the NICU for 47 days until she went home with her parents. During that time, Valentina and her husband stayed in the hospital at the Ronald McDonald House, located just one floor above the NICU.

“I hardly left her bedside,” Valentina said. “I couldn’t hold her for the first 12 days of her life because of all the tubing and how fragile she was, but I made sure to give her all the love she needed.”

Baby Elena was finally in her mother Valentina’s arms. The baby girl needed surgery immediately following her birth to have a shunt placed in her lungs.

Although the experience was difficult and at times exhausting, Valentina said she was so grateful for everyone at The Children’s Hospital who supported her and took care of her daughter.

“Every single morning our resident, Dr. Shawnee Wallace, would come by Elena’s room and answer all of my questions,” Valentina said. “I am so grateful for doctors like her that listened to all of my concerns and allowed me to advocate for my daughter. We had such an amazing experience with everyone, and I felt like I was just surrounded by such good people.”

During Elena’s NICU stay, Valentina was especially impressed with first year resident Dr. Shawnee Wallace who eased her concerns by thoroughly answering all her questions.

Valentina and Anthony were thrilled to finally bring their daughter home. But then, something unexpected happened.

“A month later, I found out I was pregnant again,” Valentina said. “We were shocked but also so excited. And we thought everything was going to be so different this time. What happened with Elena was so rare.”

For a while, Valentina’s pregnancy progressed as expected. She was monitored closely by a Maternal-Fetal Medicine specialist because of her previous experience, and so far, there were no signs of any complications. But then, at just 25 weeks, Valentina went into labor.

“I started work that morning at 8:00 a.m., and then by 9:08 a.m., I was on the floor with insane contractions—I thought it was Braxton Hicks,” Valentina said. “I was working from home so I got into the bathtub and filled it with some warm water just trying to soothe myself, but I was in miserable pain. Then I went to the bathroom and that’s when I could feel my amniotic sac.”

Valentina was fully dilated.

“I called my husband to come home and he rushed me to the nearest hospital, we didn’t have time to go anywhere else,” Valentina said.

Because her baby was breech, doctors performed an emergency C-section within an hour of her arrival at the hospital, and her second baby girl, due April 27, was born on January 13, 2022.

“She was so tiny, a micro-preemie, weighing just 1 pound, 13 ounces,” Valentina said.

Her daughter, Lucia Valentina, would need the highest level of NICU care, so Valentina asked for her to be transferred to The Children’s Hospital of San Antonio.

“It was so scary because of how tiny she was,” Valentina said. “At that point, I had already lived a NICU experience and I had made friends with other parents who had shared their experiences with me, both the good and also the really tragic and sad. So, this time it just felt more real.”

At CHofSA, Valentina learned that her daughter had a grade three bilateral brain bleed, as well as a patent ductus arteriosus (PDA) which is an opening between the two major blood vessels leading from the heart. Lucia was monitored closely by her primary doctor, Dr. Maria Pierce, a board-certified Perinatal-Neonatal Medicine physician at CHofSA. Both conditions, common among babies born as early as Lucia, were monitored closely and, thankfully, resolved with time.

Valentina wanted to make sure her daughter Lucia had the same level of care that Elena had. Again, she turned to The Children’s Hospital of San Antonio. This time Dr. Maria Pierce, Medical Director of the NICU, provided outstanding care to Lucia for more than 100 days.

“The doctors were so communicative with me and always let me know what was going on with her every single day,” Valentina said. “Dr. Mohan, who we had grown close to on our first NICU stay, never failed to come by and ask how we were doing, as well as answer any questions we had. She had a special way of explaining everything to us.”

The Holguins found themselves back in the NICU at The Children’s Hospital of San Antonio with their second daughter Lucia who was born prematurely. They returned only a few months after Elena was discharged from the NICU. The baby girls were born just seven months apart.

Lucia stayed in the NICU for 101 days. “This time was harder because I couldn’t live with her in the hospital since we had another baby at home,” Valentina said. “But it was comforting to know that she was in good hands with her nurses. It was a whole process learning to let go and trust others to look after her, but I know the staff there loved her so much. She had a couple of nurses that I got to know well during our NICU stay, and when Lucia was in their care, I could sleep peacefully at night. Amy Parker, Jesse Battleson, Dayzee Treiber, Coral Nolan and Kristin Joyner are some of those amazing nurses that I was confident would look after her with such genuine love and care.”

Despite two high-risk pregnancies, the Holguins welcomed two baby girls into their family during a short span of seven months. Here the couple is shown with daughters Lucia and Elena.

Today, both girls are home, surrounded by their loving parents and doting extended family. Although Lucia still has some hurdles in her growth and development—she is being treated for retinopathy of prematurity, an eye abnormality common in premature infants—she is making strides with a bright future ahead.

“We are just so in love with these amazing little babies,” Valentina said. “I still can’t believe I have two little miracles, and I am eternally grateful to The Children’s Hospital of San Antonio and its outstanding staff for taking care of my girls so well.”

To learn more about the Level IV NICU at The Children’s Hospital of San Antonio, visit https://www.christushealth.org/get-care/services-specialties/womens-services/neonatal-intensive-care.

FAQ About Infant Vaccines

Your little bundle of joy has arrived and you have taken every measure to make their health and safety a priority.  An important part of this includes protecting them from the unseen dangers of communicable diseases through immunization. Vaccines stimulate the immune system to develop antibodies that can provide a defense against various diseases.

How do I know when my baby needs vaccines?

Your health care provider can guide you to the vaccine schedule.

• The first vaccine (Hepatitis B) is given at birth.
• Your child should get vaccines at 2, 4, 6, 12 and 15 months of age. These vaccines are given at the same time as the health supervision exam.

Which diseases do vaccines prevent?

• In the last few decades, scientists have made strides in developing safe vaccines to fight against 16 diseases that used to have serious consequences.
• Immunizing your baby with vaccines protects against serious diseases like measles, mumps, rubella, whooping cough, polio, meningococcal disease, tetanus, rotavirus, hepatitis A, hepatitis B, chickenpox, influenza, and more.
• Vaccines won’t protect children from minor illnesses like colds, but they can keep children safe from many serious diseases.

What if my baby has a reaction to the vaccines?

• One can expect some fussiness, fever, local redness and pain in the area for a few days but these are easily treated.
• If the reaction is more severe like excessive crying for hours or very high fever, communicate with your health care provider immediately.
• Having a reaction does not mean that your child will not be immunized anymore; it just means that more precautions will be taken with the second set of vaccines. It is very unlikely that the child will have another serious reaction.

Why are there outbreaks of diseases like measles?

• An outbreak for a disease will occur mostly in people who are not vaccinated. 

• Measles is a disease that is common in many parts of the world including some countries in Asia, Europe, and Africa.
• Travelers with measles bring it to the U.S and when they reach groups of individuals in the communities who are not vaccinated, it spreads quickly.

Do vaccines cause autism?

• Childhood Vaccines do not cause autism.
• Numerous studies have repeatedly shown that there is no correlation between vaccines and autism.

Can I delay vaccines?

 No. Delaying the vaccines is like driving with your child in the back seat without a car seat or a seat belt.  You may be a very safe driver but you just don’t know when another driver may take a misstep and come crashing into your car.  It is just not worth taking that risk. Similarly, you may be very conscientious about good personal hygiene in your house but you cannot control all the virus and bacteria lingering in the environment outside.

Studies show that delaying vaccines does not offer any added benefit and does not decrease the risk of illnesses.

Your child’s health care provider is equipped to address any concerns you may have regarding vaccines.   If you need to identify a pediatrician for your child, please visit http://www.chofsa.org/findadoc

http://www.chofsa.org/findadoc.

March is National Trisomy Awareness Month

Rebecca Okashah Littlejohn, MS, CGC
Certified Genetic Counselor
The Children’s Hospital of San Antonio

According to the March of Dimes, about one in 150 babies is born with a chromosome condition.¹ Chromosomes are structures in each of our cells made of tightly coiled DNA. Portions of DNA are called genes. Genes provide the specific instructions that tell our bodies how to grow and develop. Most people have 23 pairs of chromosomes in most of all of their cells for a total 46 chromosomes.

Some individuals have three copies of an entire extra chromosome (i.e. full trisomy) or part of an extra chromosome (i.e. partial trisomy or duplication). The “tri” in trisomy means three and “somy” in trisomy means chromosome. An extra chromosome or part of an extra chromosome can occur in some cells or all cells.

Having a partial or extra chromosome can cause variable health problems. A trisomy can occur with any chromosome, but the three most well-known trisomy conditions are Trisomy 21 (Down syndrome), Trisomy 18 (Edwards Syndrome), and Trisomy 13 (Patau syndrome).  We often find that individuals with the same or similar extra copy of chromosome may have similar health or developmental problems. For example, individuals with Trisomy 21 or Down syndrome usually have mild-to-moderate intellectual disability and developmental delay, heart abnormalities, hearing and vision problems, thyroid problems and a number of other problems. Individuals with Trisomy 21 may have some or all of these health problems.

There are also other conditions where individuals have a partial extra chromosome like partial trisomy of chromosome 16p11.2 (i.e. duplication of chromosome 16p11.2). Individuals with this condition often have a low weight, a small head size (microcephaly), and developmental delays, especially in speech and language. Affected individuals also have an increased risk of behavioral problems.⁶ Individuals with duplication of chromosome 16p11.2 may have some or all of these health problems.

It is important for parents and physicians to know which chromosome or piece of chromosome is extra. Knowing the correct result will help with providing information on occurrence or recurrence, education about inheritance,  and information on medical management and research opportunities. Families are also encouraged to find a support group. Support groups whether at the local, state, or national levels can offer resources on challenges that individuals with these conditions may face.

Please join The Children’s Hospital of San Antonio in supporting National Trisomy Awareness Month and celebrating all those individuals with trisomy.

The Genetics Clinic at The Children’s Hospital of San Antonio provides evaluation, diagnosis, genetic counseling, treatment, and management of pediatric and adult patients. Talk to your doctor about a referral to the Genetics Clinic.

References:

1. https://www.marchofdimes.org/baby/chromosomal-conditions.aspx
2. https://chromodisorder.org/
3. https://www.nichd.nih.gov/newsroom/resources/spotlight/031513-trisomy
4. https://trisomy.org/
5. https://www.rarechromo.org/
6. https://ghr.nlm.nih.gov/condition/16p112-duplication

 

 

Kids and bleeding disorders

Patricia A. Clarke, MSN, APRN, CPNP, CPHON
Pediatric Nurse Practitioner, Hematology Oncology
The Children’s Hospital of San Antonio

March is National Bleeding Disorders Month

Our bodies are designed to stop the bleeding when we are cut or injured. The job of the blood is to carry oxygen to our brain and other tissues, so our blood needs to stay inside our bodies. Our blood has many substances to be able to form clots and stop the bleeding. When a person is missing some of these substances or the substances do not work correctly, bleeding can continue for too long. This is called a bleeding disorder.

How do I know if my child has a bleeding disorder?
Some families know their children have a bleeding disorder because it is inherited. Inherited means the disorder is present in other family members (perhaps parents, grandparents, sisters or brothers). Other families may not know their child has a bleeding disorder until the child bleeds for too long after a cut, an injury, surgery or even dental work. Children often fall and get bruises when they play outside, this is normal. Some children bruise a lot and bruises appear in unusual places, or the child can’t remember hurting themselves. Unusual, unexplained bruising might be a reason to suspect a bleeding disorder. Sometimes medications that a child may be taking can cause abnormal bleeding. Illness may cause easy bleeding, but this should go away after the child gets well.

Who can care for my child with a bleeding disorder?
Always report unusual bruising or bleeding (like nosebleeds that do not stop easily) to your child’s pediatrician. The pediatrician may order tests in their office to find reasons for the bleeding or bruising. The pediatrician might refer the child to a specially trained doctor called a pediatric hematologist. A pediatric hematologist knows how to take care of people with bleeding disorders. Sometimes medications can be given for bleeding disorders, and other times medications are not necessary.

What do I need to know to keep my child safe if he or she is diagnosed with a bleeding disorder?

• Avoid giving your child certain medications (such as aspirin or ibuprofen) which can make bleeding more likely.
• Certain activities such as rough contact sports may be restricted.
• Enforce wearing of helmets when riding a bike and wearing seat belts while riding in the car.
• Keep all follow-up appointments with the pediatrician and pediatric hematologist; take all medications as prescribed.
• Inform the school nurse and teachers about your child’s condition and what to do in case of emergency, including administration of prescribed medications.
• Let friends and playmates know what to do in case the child gets cut or injured.
• All new doctors and dentists must be informed your child has a bleeding disorder, especially if the child needs surgery or major dental work.
• Have your child wear a medical alert bracelet/necklace. These are inexpensive and available for purchase online. Medical alert bracelets/necklaces identify a child with a bleeding disorder to people who may not know the child.

If you need help finding a pediatrician or a physician who specializes in pediatric hematology, visit www.chofsa.org/findadoc.

Is your child getting enough sleep?

Samiya Ahmad, MD
Pediatric Neurologist and Sleep Medicine Physician
The Children’s Hospital of San Antonio
Diplomate of the American Boards of Sleep Medicine, Neurology and Psychiatry with Special Qualification in Child Neurology

March 15 is World Sleep Day 

Spring is upon us and so is World Sleep Day on March 15 this year. World Sleep Day was established to promote the understanding that sleep is a privilege that is compromised all too often by the rigors of modern life demands.

Profound, huh? Not so mind boggling if you know exactly why sleep is so important for you and your family.

Why is sleep important?
We spend a third of our lives sleeping. Children under 2 years spend over half of their lives sleeping. It is the principle activity of the developing brain. Sleep is a basic human need, like eating and drinking.

Insufficient or inadequate sleep can negatively affect well-being by impairing memory, attention span, and learning capabilities. Chronic sleep deficits can lead to obesity, weakened immune system, high blood pressure, heart disease, and diabetes.

Do you know these sleep facts?

• Sleep-related accidents account for 71,000 injuries each year in the U.S.
• 1,550 people die of sleep-related accidents
• Sleep problems are reaching epidemic proportions and affect the quality of life for up to 45 percent of the world population
• Sleep disorders are almost always preventable and treatable, however only one-third of affected people seek medical help

How can I ensure good sleep?

• Maintain a consistent, age appropriate bedtime and wake-up time
• Bedtimes before 9 p.m. for children are associated with better quality sleep
• Establish dim light conditions one hour prior to bedtime; this is the most potent stimulant for the natural secretion of melatonin
• Avoid use of electronic entertainment 30 minutes prior to bedtime
• Establish and nurture a relaxing bedtime routine
• Schedule age appropriate naps (naps phase out after age 5)
• Exercise regularly, but not too close to bedtime
• Enjoy sunshine during the day
• Avoid caffeine after 4 p.m. and 6 hours prior to bedtime
• Create a comfortable sleep environment with appropriate bedding and ambient temperature, in a quiet, dark, and well-ventilated room
• Use bed only for sleeping and avoid eating, reading, and doing homework in it

 How much sleep does my child need?

• 0-2 month: 12-18 hours
• 3-11 months: 14-15 hours
• 1-3 years: 12-14 hours
• 3-5 years: 11-13 hours
• 5-10 years: 10-11 hours
• 10-17 years: 8.5-9.25 hours
• Adults: 7-9 hours

If you child is experiencing sleep problems, talk to your pediatrician and ask for a referral to a pediatric sleep doctor at The Children’s Hospital of San Antonio.

If you need help finding a pediatrician, visit http://www.chofsa.org/pediatricians.

 

What’s for breakfast?

Ruchi Kaushik, MD, MPH, FAAP
Assistant Professor, Pediatrics
Baylor College of Medicine
Medical Director, ComP-CaN (Comprehensive Peds for Complex Needs)
Medical Director, Children’s Hospital of San Antonio Blog
The Children’s Hospital of San Antonio

National School Breakfast Week is March 4-8

Do your school-aged children get a healthy start to every morning?  Is your teen sleeping past the alarm and dashing out the door with an empty belly?  You have likely heard that breakfast is the most important meal of the day, but why?  Children who chow down on the first meal of the day have been found to have:

• Better memory
• Better test scores
• Better attention span
• Decreased irritability
• Healthier body weights
• Improved overall nutrition

But, oh my word, rushed mornings are tough!  So how can you set them up for caloric success and make sure they slide into their seats before the bell?

• Stick to a Routine Plan your morning minutes to include enough time to sit and eat as a family so children do not feel rushed. This may mean setting the alarm 10-15 minutes earlier.
• Dine and Dash Although ideally pediatricians recommend that families share meal time together, we also realize this is not always possible.  If time is limited, plan quick or grab-n-go meals such as cold cereal with fat-free or low-fat milk, bagels with reduced fat cream cheese, homemade muffins, fruit and yogurt, or hard-boiled eggs.  Cereal bars and granola bars are also good options, but be sure to read labels and avoid excessive sugars and corn syrup.  If you have time the night before, consider making your own granola.  Teens should not use coffee or energy drinks to replace meals.
• Sleep Older children and teens often do not stick to a scheduled bedtime and will wake up cranky or too nauseous to eat.  Stick to a routine and be sure to encourage sufficient sleep time in your home.  For more information, keep your eye out for our sleep blog on World Sleep Day, March 15.
• School Breakfast! March 4-8 is National School Breakfast Week and schools make it a point to craft healthy, nutrient-dense menus for your child.  Plan for your child to have breakfast at school and they will always be on time!

 

If you need some quick and easy recipe ideas for breakfast, check out the CHEF program website. Find healthy recipes online by visiting www.chefsa.org/recipes-for-life.

The Realities of Teen Dating Violence

By Ginny Dalton, LMSW
Social Worker, Outpatient/Ambulatory Clinics
Goldsbury Center for Children and Families
The Children’s Hospital of San Antonio

This year one in 13 teenage males, and one in nine females will experience physical intimate partner violence (IPV) (Centers for Disease Control and Prevention, 2017).  Though research is limited for teens within the LGBTQ community, they are at-risk for IPV at the same rates, if not higher than their heterosexual peers. Overall, dating violence is experienced at a higher rate when compared to other types of youth violence, particularly among teenage girls, and is likely to be more severe when experienced at a younger age. However, it is important to remember that anyone can experience IPV.

What is Dating/IPV?
IPV generally occurs between two people in a close relationship, and may present itself in some of the following ways:

1. Sexual Violence Unwanted/forced sexual activity, to include touching and threats.
2. Emotional and Psychological Abuse Calling names, keeping someone from seeing friends and family, possessive, controlling, intimidation, and blaming.
3. Physical Abuse Unwanted physical contact like biting, pulling hair, punching, kicking, and grabbing someone to keep them somewhere or to get their attention.
4. Stalking Repeated watching, following, harassment that makes someone feel unsafe. This may include repeated calls, voicemails, text messages, showing up at one’s workplace, home, or school.
5. Digital Abuse In-person, or over social media (cyberbullying) Controlling friendships by texts, sending unwanted messages and pictures and/or posting them publicly online, checking partner’s phone frequently, limited privacy online, tracking whereabouts by phone, GPS, etc.

Why is this important, and what does it mean for the future?
Dating violence among teens has long-term effects on mental, physical, and emotional health. Teenagers who have experienced this are at-risk for drug and alcohol abuse, eating disorders, thinking about or attempting suicide, and engaging in risky sexual behaviors that may lead to pregnancy and/or sexually transmitted infections (STIs).

What can we do?
Spread awareness. Talk about it. Create a safe and comfortable environment for conversation. Listen without judgement and be supportive. Most teens in an abusive relationship never report, due to fear, lack of money and resources, or distrust of authority figures. More than half of parents are not aware of teen dating violence or do not think there is an issue. IPV among teens is a national concern that is frequently overlooked. In recent years, Bexar County has ranked second in Texas for adult domestic violence cases, creating opportunities for the cycle of abuse to continue among teens and their dating partners.

Available Support
National Teen Dating Abuse Helpline: 1-866-331-9474 (8453 TTY), text loveis to 22522 http://www.loveisrespect.org -online chat available 4 p.m. to 2 a.m.

RAINN Hotline: 1-800-656-4673, http://www.rainn.org AND/OR San Antonio Rape Crisis Center: 210-349-7273, rapecrisis.com

National Suicide Hotline: 1-800-273-8255 or 1-800-784-2433

Break the Cycle: http://www.breakthecycle.org

National Center for victims of Crime-Dating Violence Resource Center: http://www.ncvc.org

Centers for Disease Control (CDC) Dating Matters: Strategies to Promote Healthy Teen Relationships: http://www.cdc.gov/violenceprevention/datingmatters

The Children’s Hospital of San Antonio Emergency Department/Forensic Nursing (SANE): https://www.chofsa.org/emergency  333 North Santa Rosa St., San Antonio, Texas 78207, 210-704-2190

If you are experiencing abuse, you may request a referral from your medical provider to speak with a social worker or psychologist at The Children’s Hospital of San Antonio or The Goldsbury Center for Children and Families. When appropriate, a referral can be made to The Center for Miracles at The Children’s Hospital of San Antonio, located at 315 N. San Saba, San Antonio, Texas 78207.

Heart screening for little Texans can save lives

By Dr. Lakshmi Nagaraju
Assistant Professor of Pediatrics, Baylor College of Medicine
Pediatric Cardiologist, The Children’s Hospital of San Antonio

February is American Heart Month

Congenital heart disease (CHD) affects the structure and function of a baby’s heart.  It is the most common type of birth defect and babies born with these conditions are living a longer and healthier life, thanks to advancements in cardiac care.

CHD affects about 1 percent of newborn babies per year in the United States. Approximately one out of every four babies requires some type of procedure in the first year of life; this is known as critical CHD.  Many newborns with critical CHD have symptoms and are diagnosed soon after birth; however, a significant number of newborns are discharged from the hospital without being diagnosed with CHD until they become very ill.  Symptoms of critical CHD can be different from what adults experience with heart disease and are often symptoms children have with other illnesses as well such as breathing fast, working harder to breathe, not eating well, getting tired easily, looking pale, and acting lethargic.

A delay in diagnosis can increase their risk of serious illness and death.  This is why newborn screening for critical congenital heart disease using a monitor that checks oxygen saturations was developed and is currently a state-mandated guideline in Texas.

The American Academy of Pediatrics’ (AAP) guidelines are the most commonly used recommendations for critical CHD screening:

• Screening is performed after 24 hours of life or as late as possible if early discharge is planned.
• Be aware that screening within the first 24 hours of life can be less accurate.
• One probe is placed on the right hand and one is placed on either foot, at the same time or one right after the other.

A positive screen includes:

• Oxygen saturation less than 90 percent in either extremity; or
• Oxygen saturation between 90 – 94 percent in both upper and lower extremities on three measurements, each separated by an hour; or
• Oxygen saturation difference greater than 3 percent between the upper and lower extremities on 3 measurements, each separated by an hour.

 

A newborn with a positive screen should not be discharged from the hospital and should undergo further testing (e.g. an echocardiogram or ultrasound of the heart, an X-ray, lab tests) or consultation (by a pediatric cardiologist) to understand the cause of the low saturation.

If your child has any symptoms of CHD listed above, talk to your pediatrician. If you need to identify a pediatrician for your child, visit www.chofsa.org/findadoc.

Tips for a heart-healthy diet

By Amy Bellanger, RD, CSP, LD
Clinical Dietitian
The Children’s Hospital of San Antonio

Happy American Heart Month! Here are a few simple but powerful changes you can start making today for a healthier heart.

Increase intake of fruits and vegetables
Most adults need two servings of fruits and three servings of vegetables daily. Work on making half your plate fruits and vegetables. There are always opportunities to add more vegetables to your favorite dishes. Consider adding sauteed bell peppers, mushrooms, onions to your eggs, or tomatoes and thinly sliced squash to your pasta dishes.

Limit saturated fat
Choose lean meats like loin and rounds, and avoid processed meats such as salami, bacon, chorizo, and pepperoni. Select plant-based proteins like tofu, beans, or legumes instead of animal protein. Choose low-fat cooking methods like grilling, broiling, baking, searing. Avoid deep-fried and processed foods such as chips, french fries, and funnel cakes.

Choose healthier fats
Eat fish two times per week. Select foods high in omega-3 fatty acids like salmon, albacore tuna, walnuts, and chia seeds. Other good sources of healthy fats are nuts, olive oil, canola oil, avocado, and ground flax seed.

Reduce sodium (salt) intake
Salt is salt, avoid added salt, and processed foods. Limit eating out and cook at home more often. Use onions, garlic, fresh lemon, pepper, jalapeño, herbs, and spices to add flavor to foods without using salt. Be aware of hidden salt by reading food labels. Most foods you eat should have less than 200 milligrams of sodium per serving.

Increase fiber intake
It is recommended that adults eat 25-30 grams of fiber daily, however the average American eats around 15 grams per day. A simple change would be to exchange processed or refined grains such as white bread for whole grains such as wheat bread or quinoa, and eat more fruits and vegetables.

Obtain a healthy weight
If you are overweight or obese work toward reducing your weight slowly and steadily. Healthy diet changes and reasonable physical activity can result in your ability to maintain your ideal weight in the long term. It’s a lifestyle change not a diet; these are long-term changes.

If you or your child need help finding a doctor to help with a weight loss program, visit www.chofsa.org/findadoc.

What parents should know about HPV and cervical cancer

Ruchi Kaushik, MD, MPH, FAAP
Assistant Professor, Pediatrics, Baylor College of Medicine
Medical Director, ComP-CaN (Comprehensive Peds for Complex Needs)
Medical Director, The Children’s Hospital of San Antonio Blog

January is Cervical Health Awareness Month

All right ladies (and parents of young ladies), this month is dedicated to the health of your cervix.  But you hardly know each other, so before diving into an intimate discussion, how about we start with some introductions?  Meet your cervix, the lower, narrow part of your uterus.  The cervix forms a canal that opens into the vagina and the vagina leads to the outside of the body.

HPV and Cancer
Now with the introductions out of the way, let’s get “down” to your “business.” Cervical Health Awareness Month is an opportunity to share information about HPV and cervical cancer.  HPV is the name for a group of over 150 viruses, some that cause warts and some that cause cancer.  HPV is transmitted either by skin-to-skin or sexual contact.

According to the CDC, HPV is one of the most common sexually transmitted infections–almost 80 million Americans currently have it, 14 million more become infected each year, and many people do not even know they are infected.

Most of the time, the infection goes away by itself, but sometimes it can lead to:

• cancer of the cervix, vagina, or vulva in women;
• cancer of the penis in men; and
• cancer of the anus and back of the throat in both genders.

Cervical Cancer Screening (Pap tests)
Over the past 40 years, the rate of cervical cancer and cervical cancer deaths have decreased because of women getting regular Pap test screenings.  Pap tests are recommended every three years for women 21-29 years of age and every three to five years for women 30-65 years of age. Check with your primary care physicians or gynecologist if you have questions.

HPV Vaccine
The HPV vaccine protects against nine types of HPV that most commonly cause cancer.  It is approved for both boys and girls over the age of nine and is typically given as a two-dose series starting at the 11-year-old physical (because there are often other vaccines given at this visit).  Below are some myths about the vaccine debunked:

MYTH: “It’s hasn’t been studied long enough to check out side effects.”
FACT: The vaccine does cause side effects such as pain, redness, swelling at the vaccine site, fever, headache, nausea, and muscle pain, just as most other vaccines do.  The only difference is that your preteen is able to tell you he is feeling this way and couldn’t tell you when he was two months old. Additionally, because your preteen is free to get up and walk away after a medical procedure (in comparison to when he was two months old and lying flat), he will also be asked to stay in the clinic for 15 minutes to make sure he doesn’t get “woozy.” The first HPV vaccine was licensed in 2006 and since then all three available HPV vaccines have been studied in almost 75,000 men and women.  The vaccine is safe.

MYTH: “Why should my son have to get a vaccine to prevent cancer in a girl?”
FACT: HPV can cause anal, penis, and throat cancer and genital warts in males.  It is just as important for your son to receive the vaccine as your daughter.  And it isn’t any different from any other vaccine.  Your son also received the whooping cough vaccine not only to protect himself from the whooping cough, but to also keep a community whooping cough-free.

MYTH: “It’s going to make my kid want to have sex.”
FACT: A recent study of almost 300,000 girls ages 12-18 years in British Columbia, Canada, revealed that receiving the vaccine did not increase engagement in sexual intercourse or risky sexual behaviors. While researchers could not conclude that the vaccine was a direct correlation, they did find that girls surveyed in 2013 after starting the school-based vaccination program were less likely to engage in sexual intercourse, less likely to have sex before 14, and less likely to become pregnant, compared to the girls surveyed in 2003 before the program started.

For more information about the HPV vaccine, talk to your child’s pediatrician. If you need to identify a physician for your child, please visit www.chofsa.org/findadoc.