Spring 2011 - netdna

Transcription

CONCUSSION l NOONAN SYNDROME l NEW CWPW AFFILIATIONS l ADD l CWPW MEDICAL RESEARCH l CWPW ADVERTISING & PR
CWPW
Children’s &Women’s
Munger Pavilion, Room 123 • Valhalla, New York 10595
Physicians of Westchester, LLP
The la r ges t g r oup of pediatr ic spec ialists o f its kind in the region.
COMPREHENSIVE CARE FOR INFANTS, CHILDREN AND YOUNG ADULTS
SPRING 2011, VOL. 1, NO. 4
CONCUSSION
SPECIALTIES
Can Have Drastic Consequences
ADOLESCENT
MEDICINE
T
The lar ges t group of pediatric spe cia lists of its kind in the re g ion.
Westchester County
19 Bradhurst Avenue,
Suites 1400, 2400 &2550
Hawthorne, NY 10532
• Cardiology – (914) 594-4370
• Endocrinology – (914) 366-3400
• General Pediatrics – (914) 493-7235
• Hematology/Oncology – (914) 493-7997
• Infectious Disease – (914) 493-8333
• Medical Home – (914) 594-4602
• Nephrology – (914) 493-7583
• Neonatology Follow-Up Program –
Referral Only
• Pediatric Surgery – (914) 493-7620,
(914) 761-5437
• Psychology – (914) 493-7697
• Pulmonology/Allergy – (914) 493-7585
• Rheumatology – (914) 594-4835
503 Grasslands Road, Suite 200 & 201
Valhalla, NY 10595
• Adolescent Medicine – (914) 304-5300
• Developmental – (914) 304-5250
• Gastroenterology – (914) 367-0000
• Medical Genetics/Metabolic –
(914) 304-5300
Medical Service Building at
Phelps Memorial Hospital
755 North Broadway, Suite 400 & 540
Sleepy Hollow, NY 10591
• Neurology – (914) 358-0188/0190
Briarcliff Pediatric Associates
755 North Broadway, Suite 500
• General Pediatrics (914) 366-0015
Pediatrics Sleepy Hollow
241 North Broadway,
Suite 201
Sound Shore Medical Center
16 Guion Place
New Rochelle, NY 10802
• Cardiology – (914) 594-4370
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CWPW •
The Children’s Rehabilitation Center
317 North Street, White Plains, NY 10605
• Neonatology – (914) 597-4080/4115
Eastchester Pediatric Medical Group
266 White Plains Road
Eastchester, NY 10709-4423
Croton Pediatrics
1130 Grand Street
Croton on Hudson, NY
Rockland County
North Rockland Pediatric Associates
171 Ramapo Road, Suite 4
Garnerville, NY
(845) 947-1772
Suffern Medical Pavilion at
Good Samaritan Hospital
255 Lafayette Avenue, Suite 370 & 390
Suffern, NY 10901
• Cardiology – (914) 594-4370
(914) 304-5300
Referral Only
• Neurology – (914) 358-0188/0190
• Pulmonology – (914) 493-7585
Pomona Pediatrics
4 Medical Park Drive Suite C
Pomona, NY
Pediatrics and Adolescent
Medicine of New City
337 North Main Street
New City, NY
• General Pediatrics
(845) 634-7900
Orange County
Orange Specialty Center
100 Crystal Run Road, Suite 108
Middletown, NY 10941
• Cardiology – (914) 594-4370
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(914) 304-5300
Referral Only
• Neurology – (914) 358-0188/0190
• Pulmonology – (914) 493-7585
Herbert Kania Pediatric Group
10 Ronald Reagan Blvd.
Warwick, NY 10990
Medical Center of New Windsor
575 Hudson Valley Avenue, Suite 203
New Windsor, NY 12553
• Cardiology – (914) 594-4370
• Pulmonology – (914) 493-7585
Dutchess County
Pediatric Sub-Specialty Center at
Vassar Brothers Medical Center
45 Reade Place
Poughkeepsie, NY 12601
• Cardiology – (914) 594-4370
(914) 304-5300
• Pulmonology – (914) 493-7585
104 Fulton Ave, Poughkeepsie, NY 12601
• Neurology – (914) 358-0188/0190
Bronx County
Woodlawn Medical Arts Building
4350 Van Cortlandt Park East
Bronx, NY 10470
• Cardiology – (914) 594-4370
(914) 304-5300
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• Neurology – (914)358-0188/
(347) 226-6437
• Pulmonology – (914) 493-7585
Southern Connecticut
Pediatric Gastroenterology
149 East Avenue, Suite 39,
Norwalk, CT 06851
Children’s and Women’s Physicians
of Westchester, LLP at Danbury
67 Sandpit Road
Danbury, CT 06810
• Cardiology –
(914) 594-4370
(914) 304-5300
Watson Building at Greenwich Hospital
5 Perry Ridge Road, 2nd Floor
Greenwich, CT 06830
(914) 304-5300
Children’s Specialty Center at
Norwalk Hospital
30 Stevens Avenue
Norwalk, CT 06856
• Cardiology – (914) 594-4370
• Pulmonology – (914) 493-7585
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V i s i t O u r W e b S i t e f o r A d d i t i o n a l I n f o r m a t i o n : w w w. c w p w. o r g
here are numerous advantages to
headache and lack of concentration and
students playing sports in school.
judgment to loss of memory and poor
Physical activity keeps them fit. Sports
balance and coordination.
bolsters self-esteem, and healthy
“Since most victims do not suffer a loss
competition builds character, promotes
of consciousness with concussion, it can
camaraderie, leads to lasting friendships,
be overlooked as just a minor incident, or
and allows children to set and reach goals.
ignored altogether,” explains Carey S.
There are caveats, however. Aside from
Goltzman, MD, FAAP, Chief of Pediatric
the risks of everyday sports injuries,
Critical Care Medicine at CWPW.
another looming threat to children on the
“Symptoms of a concussion range
playing field, basketball
from subtle to
court or playground is
obvious and usually
“All concussions are
concussion.
happen right after
Concussion is
serious, and all athletes the injury but may
defined as any injury to with suspected concussions take hours to days
the brain that disrupts
to show up.” With
should not return to play most concussions,
normal brain function
until they see a doctor,” the player is not
on a temporary or
permanent basis.
knocked out or
Dr. Goltzman advises.
Typically resulting from
unconscious. A
a blow or jolt to the
number of athletes
head, concussion can actually alter the way
who have had concussions may report
the brain functions, and can have a number
feeling normal before their brain has
of deleterious effects. These can range from
fully recovered.
CARDIOLOGY
CRITICAL CARE
DEVELOPMENTAL
PEDIATRICS
ENDOCRINOLOGY
“Concussions can happen in any sport
but more often occur in collision sports,
such as football, rugby, or ice hockey,”
Dr. Goltzman says. They also are common
in contact sports that don’t require helmets,
such as soccer, basketball, wrestling, and
lacrosse. However, a concussion can also
occur from a collision with the ground, a
wall, a goalpost, or a ball that has been
thrown, hit, or kicked.
Many concussions also occur outside
organized sports. For example, a child
riding a bike or skateboard can fall down
and bump his head on the street or an
obstacle. About 375,000 children and
teens are treated in emergency rooms
annually just for basketball injuries alone
(basketball is the most popular competitive
school sport).
“All concussions are serious, and all
athletes with suspected concussions
should not return to play until they see a
doctor,” Dr. Goltzman advises. “A doctor
can confirm the diagnosis of concussion
based on clinical presentation and can
determine the need for any specialized
tests, such as a CT scan of the brain, MRI
of the brain, or neuropsychological tests
and then decide if it is OK for an athlete to
return to play.” Prematurely returning to
play after a concussion, he adds, “can lead
to another concussion or potentially a
GASTROENTEROLOGY
GENERAL PEDIATRICS
HEMATOLOGY/
ONCOLOGY
INFECTIOUS
DISEASE &
IMMUNOLOGY
MEDICAL GENETICS
NEONATOLOGY
NEPHROLOGY
NEUROLOGY
PEDIATRIC SURGERY
PSYCHOLOGY
PULMONOLOGY,
ALLERGY & SLEEP
MEDICINE
RESEARCH
RHEUMATOLOGY
continued on page 3
CWPW • www.cwpw.org
A MESSAGE FROM
The President
A
t Children’s
& Women’s
Physicians of
Westchester, our
goal has always
been to provide
the highestquality medical
care in a range
of specialties for Leonard Newman, MD
infants and children throughout
the Hudson Valley and beyond.
With some of the finest
physicians in the country
working with us, our strong
affiliations with major health
care institutions from Albany to
New York and Connecticut, and
our state of the art medical
practice, we are able to meet and
exceed our mission of delivering
comprehensive medical care for
infants, children and young
adults every day.
At Children’s & Women’s
Physicians of Westchester, we
always put the health and wellbeing of our patients first. We’re
proud of the fact that we have
some of the finest physicians
anywhere, as well as superior
subspecialty care that addresses
virtually every conceivable
childhood illness or condition.
Medical care only gets more
complex with time, and our
doctors are at the forefront of
advances in pediatric medicine
to diagnose and treat every
child.
Over the winter we’ve taken
some positive moves that are
already going a long way toward
making CWPW even better.
We’ve added several new
satellite offices to CWPW in
order to broaden our service area
and treat even more children in
the lower Hudson Valley region.
We’re pleased to report that
Croton Pediatrics has joined the
CWPW family of pediatric
continued on page 3
CWPW
Spring 2011 Vol. 1, No 4
CWPW Newsletter is published four
times a year by Children’s & Women’s
Physicians of Westchester, LLP.
Munger Pavilion, Room 123, Valhalla,
NY 10595 • Phone: 914-594-4280
Fax: 914-594-3693 • www.cwpw.org
Leonard Newman, MD: President
Michael H. Gewitz, MD: Vice President
Gerard Villucci: Chief Executive Officer
Publisher: Yaeger Public Relations
Editor: Harold Clark
Art Director: Denise Stieve
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NEW CWPW AFFILIATIONS
CROTON PEDIATRICS
G
lenn J. Belkin, DO, FAAP, has enjoyed a long and respected
relationship with CWPW and its president, Leonard Newman,
MD. In fact, Dr. Belkin has known Dr. Newman since 1982 and
worked with CWPW for over eight years, providing subspecialty
care in the area of Pediatric Developmental
Behavioral Medicine. Now, Dr. Belkin and his
medical practice, Croton Pediatrics in Croton
on Hudson, New York, officially operates
under the CWPW umbrella.
“Everyone is happy with this
arrangement,” Dr. Belkin explains. With
Croton Pediatrics’ affiliation with CWPW,
the practice can focus on general
pediatric medicine while Dr. Belkin
concentrates more on pediatric
behavioral medicine. In addition to
Dr. Belkin, his wife, Patricia Belkin,
serves as a lactation consultant
for new mothers. Pediatrician
Haeyoung Ko Hwang, MD,
FAAP, FAAAAI, also with the
practice, has a subspecialty
in pediatric allergy and
immunology. Dr. Hwang is
Assistant Professor of
Pediatrics at New York
Medical College.
Formalizing the
arrangement with CWPW
means less administrative
work for Dr. Belkin, and
more time to treat
children. “I like to take
care of children, and this arrangement allows me to do that,” Dr.
Belkin states. For 12 years he served as Community Pediatrics
Chief with CWPW, “so this is a natural evolution,” he says.
Dr. Hwang says “the arrangement allows for greater
commitment to patients and their families. I am looking forward
to contributing to the warm, welcoming atmosphere here while
providing quality care for the children.”
Croton Pediatrics is located at 130 Grand Street, Croton on
Hudson, New York. (914) 271-4727.
PEDIATRICS OF SLEEPY HOLLOW
T
his is proving to be an expansive year for CWPW. Pediatrics
of Sleepy Hollow, a four-physician primary pediatric practice
in Westchester County, recently joined the CWPW family of
regional offices. Leonard Newman, MD, President of CWPW,
made the announcement. The practice consists of Drs. Harry R.
Lubell, Margaret Stillman, Caroline Cho and Emily Koelsch.
Pediatrics of Sleepy Hollow, located at 245 North Broadway,
Suite 201 in Sleepy Hollow, New York, (914) 332-4141, treats
patients from infancy through age 21, with an emphasis on
primary care. The arrangement with CWPW allows the practice
to focus on quality pediatric medicine while operating under the
auspices of a larger overseeing organization.
Dr. Lubell, a partner in the Sleepy Hollow, office explains:
“We were looking into partnering with larger umbrella groups,
seeing the benefit for a small group to prosper in these
changing and difficult economic times. This partnership also
allows us to move forward with modern technology to better
serve our patients.”
Dr. Lubell adds: “Our practice already had a strong
relationship with Maria Fareri Children’s Hospital and with a
number of subspecialists from CWPW. We have known Dr.
Newman and Dr. Gewitz for many years, so when they presented
this partnership to us last year we could see that it was a natural
and good fit. This arrangement allows us to keep our identity as
a small practice, yet have the resources of a large pediatric
organization like CWPW.”
“The relationship with CWPW opens up more opportunities for us and increases our exposure
to subspecialty care for our patients,” Dr. Ronan states. “It’s a win-win situation for everyone,
particularly for our patients, who will continue to be well served.”
POMONA PEDIATRICS
T
he CWPW family of regional offices continues to expand with
the integration of Pomona Pediatrics into the group. Pomona
joined with CWPW as of February 1; the announcement was made
by Leonard Newman, MD, President of CWPW.
The Rockland County-based practice has four full-time
physicians and one part-time doctor on staff. Jesse Hackell, MD,
FAAP, is joined by William Greenberg, MD, Gerald Vogel, MD,
Evan Weissman, DO, and Lorna Sackler, MD.
Practicing in Rockland County since 1981, and forming
Pomona Pediatrics with Dr. Greenberg six years later, Dr. Hackell
says the arrangement with CWPW “was a no-brainer” and that his
familiarity with Dr. Newman and many of the physicians at CWPW
made the decision an easy one.
“Getting big is the only way to survive these days,” Dr. Hackell
points out. “CWPW had a process that was very conducive to what
we were looking for.” Within two months of their initial merger
discussions, Dr. Hackell’s group signed on with CWPW. “They’ve
been very supportive in terms of all organizational efforts. It has
been an easy transition.”
Dr. Hackell practices general pediatrics, and has a special
interest in treating pediatric ADHD.
The arrangement with CWPW “is absolutely the way to go,” he
insists. “This positions us well in the county and in this region.”
CWPW’s experience in practice management will prove
advantageous to Pomona Pediatrics, Dr. Hackell insists. “They
have access to things that we cannot get, and that’s very helpful.
It’s a great concept, and a great group of people and it’s evident
in the kind of medical care they provide. Our comfort level is
very high.”
Pomona Pediatrics is located at 4 Medical Park Drive, Suite C,
in Pomona, New York, (845) 362-0202.
PEDIATRIC AND ADOLESCENT
MEDICINE OF NEW CITY
C
WPW continues to broaden the number of regional offices
throughout the Lower Hudson Valley by the addition of
Pediatric and Adolescent Medicine of New City, with Joshua E.
Chesir, MD, FAAP & Sharon Ronan, MD, FAAP. Located at 337 North
Main Street in New City, New York, (845) 634-7900. Dr. Chesir has
been in practice in New City since 1987.
Drs. Chesir and Ronan have a medical staff of eight, providing a
full range of pediatric medicine to children and adolescents, with
added expertise in childhood asthma and other lung
disorders.“I’ve been looking at pediatric medical groups for some
time, and finally decided that a relationship with CWPW would be
mutually beneficial,” Dr. Chesir explains. “Our intention is to
continue to provide state-of-the-art medical care to children and
adolescents in this region, while at the same time being able to
take full advantage of the range of subspecialties provided through
CWPW.” Dr. Chesir adds that he has known CWPW President
Leonard Newman, MD, for some time, and that “the arrangement
just makes sense.”
Dr. Chesir is an Attending Physician at Good Samaritan
Hospital and Nyack Hospital, and is an Associate Clinical
Professor of Pediatrics at New York Medical College.
Prior to joining Dr. Chesir’s practice, Dr. Ronan worked for
several years at Orangetown Pediatrics in Tappan, New York, as
well as at Essex-Morris Pediatric Group in Livingston, New Jersey.
She is a graduate of Sackler School of Medicine in Tel Aviv, Israel,
and completed a pediatric residency at Morristown Memorial
Hospital in Morristown, New Jersey.
“The relationship with CWPW opens up more opportunities for
us and increases our exposure to subspecialty care for our
patients,” Dr. Ronan states. “It’s a win-win situation for everyone,
particularly for our patients, who will continue to be well served.”
CWPW
Named Chief of Pediatric Hematology/Oncology
M
itchell S. Cairo, MD, a highly
respected pediatric cancer specialist,
educator and researcher, has been named
Chief of Pediatric Hematology/Oncology
and Stem Cell Transplantation, and Director
of the Childhood and Adolescent Cancer
and Blood Diseases Center at CWPW.
Leonard Newman, MD, President of
Mitchell S. Cairo, MD
CWPW, announced the appointment.
Dr. Cairo has special expertise in pediatric bone marrow
transplantation, immunology, leukemia and lymphoma. He has also
been cited for several years by Castle Connolly Medical Ltd. as
among New York’s Top Doctors and America’s Top Doctors.
“It’s a big move for me,” Dr. Cairo states, adding that he is
bringing about a dozen medical professionals with him to CWPW.
Prior to joining CWPW, Dr. Cairo was Professor of Pediatrics,
Medicine, and Pathology and Cell Biology at Columbia University
Medical Center. Dr. Cairo was also Director, Pediatric Blood and
Marrow Transplantation, Children's Hospital of New YorkPresbyterian, Morgan Stanley Children’s Hospital.
“Any worsening of concussion symptoms
or changes in behavior (e.g., agitation,
significant brain grogginess, disorientation),” he adds,
injury that could “should be immediately reported to
lead to death. An your physician.
“The best advice with any head injury,”
athlete with a
Dr.
Goltzman says, “is that it should never
history of a
be ignored, no matter how major or minor
singular or
it may be considered to be.”
multiple
Mitigating harm to the head is key in
concussion(s)
Carey S. Golyzman, MD
preventing
concussion, Dr. Goltzman
may be more
susceptible to another injury than an athlete insists. “Not all concussions can be
prevented, but some may be avoided,”
without a history of concussion.”
he says. Helmets should be worn for any
The best treatment for a concussion is
complete rest from all physical and mental riding activities (like horseback, all terrain
activity, Dr. Goltzman says. “Children may
need frequent monitoring but there is no
need for wake-up checks during sleep.”
Access to loud music, computer, and
TV should be limited or stopped if they
increase the symptoms. School attendance
and work may need to be modified.
Students need to be excused from physical
education/gym class or recess activities.
Concussion
MITCHELL S. CAIRO, MD
Dr. Cairo’s additional current appointments are with New York
Medical College, where he is professor of Pediatrics, Medicine,
Pathology, Micro-Biology, Immunology, and Cell Biology and
Anatomy, and Maria Fareri Children’s Hospital at Westchester
Medical Center. He brings a strong research background to
CWPW, having been the principal or co-principal investigator of
a dozen clinical research studies and a contributor to nearly 300
peer-reviewed publications. He has a particular interest in cellular
therapies including bone marrow transplantation for childhood
cancers and blood disorders, as well as childhood hematological
malignancies such as acute leukemias and lymphomas. He will
also lead a new research team at New York Medical College that
will search for more effective cancer and blood disorder
treatments.
Dr. Cairo is widely published, sits on the editorial board of
several distinguished publications, and is a member of
numerous boards as well as national and international
associations. CWPW
continued from page 1
vehicle [ATV], motorbike, bike,
skateboard, or snowboard) or contact
sports (like football, hockey, or lacrosse).
Helmets should fit appropriately and be
in good condition. Athletes should be
taught safe playing techniques and to
follow the rules of the game.
“Most importantly,” he states, “every
athlete needs to know how crucial it is to
let their coach, athletic trainer, or parent
know if they have hit their head or have
symptoms of a head injury — even if it
means stopping play. Never ignore a
head injury, no matter how minor.”
CWPW
A Message From
The President
continued from page 2
practices. In addition, Pomona
Pediatrics and Pediatrics of
Sleepy Hollow have become
members of our pediatric group,
as has Pediatric and Adolescent
Medicine of New City. These
fine practices will continue to
provide outstanding medical
care to children in Westchester
and Rockland counties, with
the added medical and
administrative support and
expertise of CWPW.
Sports injuries have been
in the news lately, and in this
newsletter we offer insight into
the all-too common but
“Finally, as we
continue to grow,
we want to reach out
in new and exciting
ways to families in
our region.”
misunderstood condition of
concussion — what it is, how to
detect it, what to look for, and
how to treat it. We also take a
serious look at Noonan
Syndrome, a genetic disorder
that is not often talked about
but that affects many children.
There has been a lot of
discussion lately about
Attention Deficit Disorder, or
ADD, and here we examine the
condition and offer ways to help
you determine whether your
child might have ADD.
We also highlight some of
the physicians associated with
CWPW and look at their
research endeavors.
Finally, as we continue to
grow, we want to reach out in
new and exciting ways to
families in our region. As part
of this effort we are launching a
creative advertising and public
relations to spread the word
about CWPW. As part of this
effort we recently ran full-page
ads in Westchester Magazine
promoting our services, and one
to mark Heart Health Month.
We’ve reproduced the ads here
to show you what we’ve done.
Look for more in the near
future.
As always, if you have a
question, comment or a story
you’d like to see in an upcoming
issue, email us at info@cwpw.org.
Enjoy the season! CWPW
www.cwpw.org • CWPW
3
ADD
Paying Attention Is
Key to Treatment
ediatric ADD, or Attention Deficit Disorder, should not
be ignored or overlooked. Children who appear
absent-minded, unfocused, seem to be daydreaming or
have a short attention span may actually have this serious
but treatable syndrome.
What we know today as ADD, which affects between five
and seven percent of children, was first recognized in the
1960s, explains William Levinson, MD, Chief of Developmental Pediatrics at CWPW. Known initially by other
clinical labels such as MBD, or Minimal Brain Dysfunction,
ADD emerged as an all-encompassing term to describe
children with symptoms ranging from short attention span
and an inability to focus, to hyperactivity, forgetfulness, and
difficulty following directions.
“I prefer to take a functional approach to ADD,” Dr.
Levinson says. “If a child’s behavior is getting in the way at
school, at home, socially or with his or her peers, and the
behavior meets the clinical criteria, then it’s important to
have it investigated.”
Determining who has ADD is the first step toward
treatment. Dr. Levinson says a continuous performance test
like the IVA test, which gauges visual and auditory
responses, or an EEG, a study of brain waves, can help to
determine whether a child has ADD. The syndrome is not
new, he points out, but it has gained greater recognition
and acceptance in recent years.
It’s difficult to gauge which children will suffer from
ADD, and who is most susceptible. Dr. Levinson notes,
however, that studies indicate that premature babies are at
slightly higher risk, and a family history of ADD might also
contribute to a child having ADD. Lead poisoning can be a
factor as well, as can certain thyroid conditions.
The school setting is crucial in making the ADD
diagnosis, Dr. Levinson says, enabling teachers to observe
a child’s activities and behavior. “Most parents who come to
us — usually when the child is in kindergarten or the first
grade — tell us the teacher notices that the child is not
focusing like the rest of the class,” he explains. “They may
NOONAN SYNDROME
affected by it. These children tend to be much shorter
than their peers.
Some children with NS can also exhibit marked
feeding problems in infancy. “That’s what drives parents
crazy,” she notes. “These children don’t gain weight, and
it’s very frustrating for parents.” Because of the variability
in the symptoms, the age of diagnosis is also variable.
Some may be diagnosed right after birth (likely if there is
a heart murmur or heart abnormality noted early on), but
in some cases children are not diagnosed with NS until
later in childhood, adolescence or even adulthood. For
example, babies may present with significant swelling of
the hands and feet and widening of the neck with or
without congenital heart disease, while other individuals
may present in adulthood only after their child is
diagnosed with NS.
P
Features Distinct Characteristics
Y
ou may never have heard of
Noonan Syndrome, or NS, but
it is a fairly common congenital
genetic condition, with an estimated
incidence of one child in every
1,000 to one in every 2,500 live
births. Alicia A. Romano, MD, a
Alicia A. Romano, MD
pediatric endocrinologist in CWPW,
is considered an international expert in NS, having both
research and clinical experience involving this condition.
As a subspecialist at CWPW she is called upon to help
diagnose, develop treatment plans, and work with other
physicians involved in the care of children with NS..
Dr. Romano was the leading author of a succinct yet
far-reaching article published recently in the prestigious
medical journal Pediatrics. In the article, Dr. Romano
and her expert colleagues describe the clinical features,
diagnostic considerations and management guidelines
based on the latest medical evidence. “The article is
an important tool for primary care practitioners,” Dr.
Romano says. “Not only are they often responsible for
identifying the condition, but for coordinating all of the
facets of care for these children and their families. Their
care is truly multidisciplinary, often requiring multiple
subspecialists as well as other services such as physical
therapy, speech and feeding therapy, etc.”
According to Dr. Romano, NS is characterized by
distinctive facial features, short stature, and congenital
heart disease. “It’s not always easy to diagnose because
there’s a lot of clinical variability,” she explains.
“Some children have no heart issues, and only some
facial features that may blend in with other children,” Dr.
Romano says. Some individuals with NS have normal
stature, but short stature can be problematic for those
4
“It’s not always easy to
diagnose NS because there’s
a lot of clinical variability,”
Dr. Romano explains.
NS is caused by a mutation or change in one of
several genes, the most common of which is the PTPN 11
gene. Although great strides have been made in the
molecular understanding of the condition, a mutation can
be detected in about 70% of the cases. That is, 30% of
those who seem to have NS will have no detectable
change in their genes to explain their clinical features.
“Even if all of the genetic tests come back negative, the
child can still have NS,” Dr. Romano says. “So until the
remaining gene mutations are identified, ultimately NS is
a clinical diagnosis.” In about half of those affected, the
gene change is the result of a spontaneous mutation. This
means that neither parent has the gene change and the
have to repeat directions or requests, and they might have
trouble with multiple requests.”
Treatment for ADD can involve a range of options. “We try
to get a multi-faceted treatment plan in place for the child,”
Dr. Levinson says. “Medication may be indicated, and we
can build in a counseling component for the individual and
the family.” The school can be involved as well, he adds, by
“modifying the teaching environment,” which can include
preferential seating for the ADD child.
“The learning environment is probably the most stressful
for attention span,” Dr. Levinson says, “so teachers’ input is
most valuable” in diagnosing and helping the ADD child.
Most schools have in-house services to help teachers to
recognize ADD and to help the afflicted child. CWPW
child’s mutation is due to “happenstance” so to speak.
Once the diagnosis of NS is considered, the child is
typically referred to a geneticist for confirmation.
Acknowledgement of the condition dates to 1962,
when pediatric cardiologist Jacqueline A. Noonan, MD,
from the University of Kentucky Medical Center, identified
a group of children with similar facial features, short
stature, chest deformities, and congenital heart defects.
The facial features often provide clues to the diagnosis in
infancy, Dr. Romano states. These include a large
forehead, narrow temples, small face with wide-spaced
eyes, a short, broad nose, low-set ears that are oval in
shape, distinctive lips, and a short neck with excessive
skin. The eyes are frequently a strikingly beautiful blue
color. These features can change with age and appear
different toward adolescence, she adds.
There is no single treatment for NS; individual
conditions such as growth failure, cardiac or feeding issues
are addressed by subspecialists.
The Noonan Syndrome Support Group (TNSSG), based
in Baltimore, is an organization that offers support for those
affected by NS. Dr. Romano has lectured at international
meetings of TNSSG, where groups of children, adolescents
and adults convene with health experts to share insights
into and experiences of living with NS. “Children with NS
can get teased a lot,” Dr. Romano says, mostly because of
their short stature. Facial differences may also set them
apart, which can make living with NS challenging.
“They’re delicious kids,” Dr. Romano says of the NS
patients she’s treated.
Making the NS diagnosis answers lots of questions
for families of NS children, and opens doors to proper
treatment. “Part of the importance in making the diagnosis
is so parents know what to expect, and to make sure
they get the treatment and the services they need,”
Dr. Romano explains. “The management guidelines in
Pediatrics were developed to facilitate the diagnosis and
promote optimal care.” CWPW
CWPW PHYSICIANS
Conducting Important Medical Research
Some of the finest pediatric subspecialty care physicians in the region are associated with CWPW. Many of
these respected doctors have conducted or are undertaking important leadership roles in the advancement of
child medicine through research efforts on the state or national level. Additionally, many CWPW physicians
belong to or serve on committees and organizations dedicated to promoting child health and well-being.
Praveen Ballabh, MD
Sergio G. Golombek, MD
Neonatology
Neonatology
Dr. Ballabh has been involved in
a considerable amount of research,
and has a number of ongoing
research efforts. He is Primary
Investigator in a $1.4 million NIH
grant running through 2014 to study white matter injury
after brain hemorrhage of premature rabbits and
humans. A second NIH grant, in which Dr. Ballabh is
Primary Investigator, runs through 2011 and studies
elevated chondroitin levels in newborns. Also under way
is an American Heart Grant in aid running through 2012.
Dr. Ballabh has completed research efforts for Pfizer, the
Maria Fareri Children’s Hospital Foundation, the NIH,
Q Therapeutics, United Cerebral Palsy, as well as
independent research.
Dr. Golombek is Associate
Professor of Pediatrics and Clinical
Public Health at New York Medical
College. He is an attending
Neonatologist at the Regional
Neonatal Center of the Maria Fareri Children’s Hospital at
Westchester Medical Center. He is the past president of
the New York Perinatal Society, member of the American
Academy of Pediatrics, the Society for Pediatric
Research, the American Public Health Association and
the Ibero-American Society of Neonatology.
Markus Erb, MD
Cardiology
Dr. Erb is a Pediatric Cardiologist
with CWPW, as well as Director of
the Cardiac Catheterization Lab and
Director of Pediatric Interventional
Cardiology at Maria Fareri
Children’s Hospital at Westchester Medical Center.
He is a member of the American Heart Association/
Cardiovascular Disease in the Young and is currently
President of the Pediatric Cardiology Society of Greater
New York. Dr. Erb is also Assistant Professor of
Pediatrics at New York Medical College. Dr. Erb’s areas
of research interest include Investigational Device Use:
Amplatzer Occluder Devices for Congenital Heart
Defects, having served as a Principal Investigator in
RESPECT (Randomized Evaluation of Recurrent Stroke,
Comparing PFO Closure to Established Current
Standard of Care Treatment). Among his philanthropic
pursuits is serving on the Board of Directors of the
Make-A-Wish Foundation of the Hudson Valley.
His research has included the use of inhaled nitric
oxide in newborn babies (for pulmonary hypertension
in term and late-term infants, and for prevention of
chronic lung disease in preterm infants). In addition,
Dr. Golombek participated as a Site-PI in the NIHsponsored trial “NO-CLD,” published in the New
England Journal of Medicine in 2006 He served as a
co-PI with Edmund La Gamma, MD in a National
Institute of Neurological Disorders and Stroke (NINDS)sponsored trial regarding supplementation of thyroid
hormone to extremely low birth weight infants with
transient hypothyroxinemia of prematurity. A Phase 3
study in the same area is being planned.
Lance A. Parton, MD, FAAP
Neonatology
Dr. Parton is a Neonatologist at
CWPW and Professor of Pediatrics,
Obstetrics and Gynecology and
Anesthesiology at New York Medical
College, and Associate Professor of
the Regional Neonatal Intensive Care Unit at Maria Fareri
Children’s Hospital at Westchester Medical Center. Dr.
Parton is the Vice-President of New York Chapter 3 of the
American Academy of Pediatrics and is past chairperson
for the Committee on Fetus and Newborn for this
Chapter. He is also active in the American Thoracic
Society (Assembly on Pediatrics, Program Committee).
His research investigates the genetic foundations of
conditions that contribute to prematurity, as well as the
complications of prematurity. Dr. Parton’s laboratory
has investigated the role of single nucleotide
polymorphisms (SNPs) in the development of
preterm prolonged rupture of membranes (PPROM),
intrauterine growth retardation (IUGR), and
preeclampsia in collaboration with Obstetrics and
Maternal Fetal Medicine.
The complications of preterm infants such as
bronchopulmonary dysplasia (BPD) and patent ductus
arteriosus (PDA) are also active areas of investigation.
Susceptibility to respiratory syncytial virus (RSV)
bronchiolitis, as well as variability of responsiveness
to albuterol in infants with RSV bronchiolitis has been
undertaken in collaboration with Pediatric Pulmonology,
Allergy and Sleep Medicine.
Clinical areas of investigation include comparative
studies of surfactants, high frequency ventilation, and
exhaled nitric oxide in ventilated preterm infants, as well
as the effects of music therapy on preterm infants, the
latter in collaboration with music therapist, Laurie Park.
Julian Stewart, MD, Ph.D.
Cardiology
Dr. Stewart is a Pediatric
Cardiologist at CWPW and
Professor of Pediatrics and
Physiology at New York Medical
College. In addition to earning an
MD, he also has a Ph.D. in biophysics. Dr. Stewart
currently holds three NIH grants and is interviewing
for the Clinical Integrative Cardiovascular study
section of the NIH. He regularly presents to and will
be a member of the faculty at the American Heart
Association, American College of Cardiology, American
Physiological Society, and the American Autonomic
Society. Dr. Stewart has conducted significant research
since 1984. One NIH-funded study, “Circulatory
Dysfunction in Chronic Fatigue Function,” is ongoing
and seeks to determine the causes of Chronic Fatigue
Syndrome (CFS) in adolescents. He has also published
hundreds of original articles and abstracts, made
countless peer presentations, and written seven books
on pediatric medicine.
5
ADVERTISING AND PUBLIC RELATIONS
CWPW Launches Media Campaign
I
n an effort to spread the word about the unparalleled level of subspecialty care offered to families in
the Lower Hudson Valley and Connecticut, CWPW has begun a broad-based advertising and
public relations campaign in regional media showcasing its
quality physicians and medical services.
The first of two full-page color ads appeared in
WESTCHESTER Magazine’s ‘Best Doctors in the
County” issue in November 2010 and focused on the full
breadth of pediatric care available at CWPW. The second
full-age ad appeared in the same publication in February
2011 to coincide with American Heart Month. The ad
featured excellence in pediatric cardiology at CWPW.
Additional advertising and public relations efforts —
including this newsletter, which is distributed to
physicians and parents in the region —
are planned for 2011 and beyond.
CWPW
ADOLES
CE
MEDICIN NT
E
CARDIOL
OGY &
ADULT C
O
HEART D NGENITAL
ISEASE
CRITICA
L CARE
DEVELO
PMENTA
L
PEDIATR
ICS
ENDOCR
INOLOGY
GASTRO
ENTERO
LOGY
GENERA
L PEDIAT
RICS
HEMATO
LO
ONCOLO GY/
GY
INFECTIO
U
DISEASE S
&
IMMUNO
LOGY
MEDICA
L GENET
ICS
NEONAT
OLOGY
NEPHRO
LOGY
NEUROL
OGY
PSYCHO
LOGY
PULMON
OLOGY,
ALLERG
Y&
MEDICIN SLEEP
E
RESEAR
CH
RHEUMA
TOLOGY
CWPW
Your ch
ild’s
With 18
re
CWPW gional offices,
20 area
is the la
s
rgest gr
oup of p of medical expe
ediatric
rtise an
here’s n
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the enti d 145 skilled p
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doctors e Hudson Vall portant than
n.
s,
the hea
at CW
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their co roblems and re in a range of sp nd Connectic child. That’s w
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CWPW and all close to York City or
beyond that’s right in
.
home: F
.G
rom infa
ncy thro reat doctors,
ugh ado
lescence
,
Children's & Women's Physicians of Westchester’s
(CWPW) Pediatric Neurologist Ronald Jacobson,
MD (right), was recently interviewed by WABC-TV
Eyewitness News reporter Jim Dolan on the subject
of the MMR vaccine and autism.
6
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Outpat
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CWPW
.
Munger P
avilion, R
oom 123
, Valhalla
, NY 105
95 • (91
4) 594-4
370 • (8
45) MY-C
HILD •
(845) 692
-4453 •
www.cw
pw.org
•
www.
cwpw
.org
Comple
cardiov te
care for ascular
children infants,
and for , teens,
with conadults
heart disgenital
orders.
Fetal Ca
rdiology
Electrop
hysiolog
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Echocard
io
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and Card raphy
Imaging iac
Interven
Cardiolo tional
gy
Pediatric
Vascular Heart &
Surgery
Preventi
Cardiolo ve
gy
Exercise
Laborato
ry
Pediatric
Intensiv
e Care
7

Spring 2011 - netdna

Transcription

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