CHOC Included Among Nation’s Best Children’s Hospitals in U.S. News Survey

CHOC Children’s has been named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2017-18 Best Children’s Hospitals rankings.

CHOC ranked in seven specialties: cancer, diabetes/endocrinology, neonatology, neurology/neurosurgery, orthopedics, pulmonology and urology, which earned a top 20 spot on the coveted list.

According to U.S. News, the Best Children’s Hospitals rankings were introduced in 2007 to help families of children with rare or life-threatening illnesses find the best medical care available.

The 11th annual rankings recognize the top 50 pediatric facilities across the United States in 10 pediatric specialties.

The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology considers clinical outcomes, such as mortality and infection rates, efficiency and coordination of care delivery and compliance with “best practices.”

“At CHOC Children’s, we are steadfastly committed to delivering high-quality, safe and reliable health care to our patients,” said Dr. James Cappon, CHOC’s chief quality officer. “Recognition from U.S. News of our excellence in these seven subspecialties validates our efforts, but also provides our patients and families with even more assurance of our commitment to excelling in all areas of care.”

“The pediatric centers we rank in Best Children’s Hospitals deliver exceptionally high-quality care and deserve to be recognized for their commitment,” U.S. News Health Rankings Editor Avery Comarow said. “Children with life-threatening illnesses or rare conditions need the state-of-the-art services and expertise these hospitals provide every day.”

Learn more about survival rates, adequacy of nurse staffing, procedure and patient volume, availability of programs for particular illnesses and conditions and more. 

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CHOC’s Surgical NICU Offers Pioneering Coordinated Treatment

ICHOC Children's Surgical NICU nfants needing surgery require special attention, and a unique feature of CHOC’s Neonatal Intensive Care Unit (NICU) provides just that.

CHOC’s Surgical NICU, a dedicated space within the NICU, uses a comprehensive approach to care for these tiny patients. A coordinated treatment protocol – used in many adult intensive care units nationwide – has shown to result in fewer patient complications, better outcomes and faster discharges. And, CHOC’s Surgical NICU physicians and staff continue to research new ways to make the care even better.

“CHOC has one of the only two Surgical NICUs like it at any children’s hospital in the country,” says Dr. Mustafa H. Kabeer, who with Dr. Irfan Ahmad, a neonatologist, co-directs the Surgical NICU at CHOC.

“We have a room dedicated with eight beds and a second room with two beds that allow for surgeries to be done right there in the NICU. It’s a unique setting in which we have multi-disciplinary, coordinated care.”

“Babies in the NICU are very critical to start with and things can change minute by minute. When you add in the risks of surgery, it becomes more complex. We coordinate care through better communication with physicians and the nurses and the family. We involve all of these groups so everybody is on the same page. We have joint rounds with residents and fellows, and have initiatives on research and teaching, with monthly lectures on select topics. We are collecting data on outcomes and how the babies do,” says Dr. Kabeer.

Dr. Ahmad adds, “The experience has been so positive. We are all really happy with the care our patients are receiving. The surgeries and anesthesia have become safer.”

In a new effort, CHOC’s Surgical NICU team has begun a new research project to examine better pain control for babies following surgery. “This is going to be really big and is being planned by Dr. Kabeer from surgery, myself from neonatology, and Dr. Rebecca Sangster from anesthesia,” says Dr. Ahmad.

Other projects include investigating ways to decrease the occurrence of hypothermia, or low body temperatures, for babies having surgery. In addition, the Surgical NICU staff is maintaining a patient database that will help the staff design future quality improvement projects and clinical studies.

The Surgical NICU is special in other ways. Patient rounds there often include a dozen or more specialists who join the physician and nurses. “These rounds are very different than what goes on anywhere else. We try to educate the families about what this means and how unique this is,” says Dr.  Kabeer.

Babies in CHOC’s Surgical NICU receive consistent and coordinated care from a multidisciplinary healthcare team that includes neonatologists, nurses, surgeons, respiratory therapists, nutritionists and other specialists who may be needed. Parents and family members round out the team. The family joins the clinicians to discuss care plans, share information and make care decisions. Each patient receives a well-coordinated and consistent treatment plan.

Pediatric surgeons perform many types of surgeries in the Surgical NICU, including lung and thoracic surgeries, robotics surgeries, head and neck surgeries, repairs of umbilical and inguinal hernias, among a variety of different operations.

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  • CHOC Included Among Nation’s Best Children’s Hospitals in U.S. News Survey
    CHOC Children’s has been named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2017-18 Best Children’s Hospitals rankings.
  • Birth Defects
    Common birth defects include heart defects, cleft lip and cleft palate, Down syndrome and spina bifida. Congenital heart defects are the most common type of birth defect in the United ...
  • Testing for Birth Defects
    Advances in medicine have allowed doctors to diagnose birth defects and genetic conditions before a baby is born. Pregnant women older than 35, those with a history of miscarriages or health ...

Birth Defects

girl_braidCOMING TO TERMS WITH UNEXPECTED BIRTH DEFECTS
Common birth defects include heart defects, cleft lip and cleft palate, Down syndrome and spina bifida. Congenital heart defects are the most common type of birth defect in the United States, affecting nearly 1 percent of, or about 40,000, births per year, according to the Centers for Disease Control and Prevention. Birth defects can be minor to severe. “Some of these can be corrected by surgery and some can be treated by involving many different physicians with different specialties,” says Dr. Ahmad.

COPING LONG-TERM
“The most important thing for the parents is they still have to love their baby because all babies are precious,” says Dr. Ahmad. “As these babies grow up, we have the ability to provide these babies developmental help to cope.” Parents can reach out to the Regional Center of Orange County for help and therapy, public school districts offer assistance to disabled children, and pediatricians are a great source of information and resources as well. “Try to learn as much about the condition as possible. This will help parents cope and make sure that their baby gets the best possible care,” says Dr. Ahmad.

PREVENTING BIRTH DEFECTS
One of the best things a pregnant woman can do for her baby is to take good care of her health. Not all birth defects can be prevented but there are some things a woman can do before and during pregnancy to increase the chance of having a healthy baby, says Dr. Ahmad. They include:

  • Taking folic acid before becoming pregnant and during pregnancy to help prevent neural tube defects (defects of the brain and spine).
  • If the woman is diabetic, making sure her diabetes is under control. Uncontrolled diabetes can lead to different malformations and problems for the baby.
  • Avoiding alcohol use while pregnant. Drinking alcohol while pregnant can cause fetal alcohol syndrome.

FAST FACTS

  • Number of babies born with a birth defect in the U.S. each year: About 1 in every 33
  • Babies born annually with Down Syndrome in the U.S. each year: 1 in 691
  • Approximate percent of infant deaths caused by birth defects: Over 20%

View the full feature on Kids and Birth Defects

Dr. Ahmad
Dr. Irfan Ahmad
CHOC Children’s Neonatologist

PHYSICIAN FOCUS: DR. IRFAN AHMAD

Dr. Ahmad served as chief fellow and completed his neonatal-perinatal fellowship at the University of California Irvine Medical Center. He completed his pediatric internship and residency at the University of Oklahoma in Oklahoma City. Dr. Ahmad is an associate professor of Pediatrics at UCI and also the director of the Surgical Neonatal Intensive Care Unit at CHOC. His current focus is on babies born with congenital anomalies that can be treated through surgery.

Dr. Ahmad’s philosophy of care: “My philosophy is to provide evidence based care which can benefit both the child and the family.”

EDUCATION:
Aga Khan University Medical College, Karachi, Pakistan

BOARD CERTIFICATIONS:
Neonatal-Perinatal Medicine Pediatrics

More about Dr. Irfan Ahmad

This article was featured in the Orange County Register on June 16, 2014, and was written by Amy Bentley.

Testing for Birth Defects

Advances in medicine have allowed doctors to diagnose birth defects and genetic conditions before a baby is born.Testing_Birth_Defects

Pregnant women older than 35, those with a history of miscarriages or health problems, and women with a family history of certain disorders or birth defects are often tested for birth defects, says Dr. Irfan Ahmad, a CHOC Children’s neonatologist.

During pregnancy, mothers-to-be can undergo genetic counseling and genetic testing. Specially trained professionals can help prospective or expectant parents learn about genetic conditions they may face and their chances of having a child with a genetic condition. Genetic counseling and testing can also screen for diseases more common in certain ethnic groups. This helps people make informed decisions about family planning, testing and treatment.

Pregnant women can also have an ultrasound, an amniocentesis, or a blood test called a Quad Screen. Dr. Ahmad says these tests can help to diagnose birth defects including Down syndrome, heart conditions, neural tube defects such as spina bifida, and intestinal obstructions.

When diagnosed during pregnancy, some of these problems can be fixed or treated with surgery. Knowing ahead of time about a possible birth defect or other medical problem with the fetus allows the parent and their physicians to better prepare for the birth and treatments or surgery that may be needed, says Dr. Ahmad.

“You can also speak to a specialist, including a neonatologist and a surgeon, before the baby is born to offer counseling,” Dr. Ahmad says. “We can have a plan in place for when the baby is born and what we will do, so parents and physicians are prepared.”

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Neonatology: Then and Now

sbu_thenandnowCHOC Children’s has always done a great job of treating premature babies, and infants with heart problems, infections or birth defects. Over the last 50 years, I’ve seen technology and medicine change a lot in neonatology.

An extra special place at CHOC is its Small Baby Unit, a program within its neonatal intensive care unit (NICU). Reserved for the smallest and sickest babies, this unit gives hope to babies who wouldn’t have had a chance in 1964.

There, every newborn receives care from dedicated staff members. The space also has shrouded incubators to keep light away from the baby’s sensitive eyes and everyone (even family members) speaks gently to help create a calm, comforting and healing environment.

Kangaroo Care is another technique in neonatology that has grown in popularity since 1964. As babies spend time lying on their parents’ chests, they become more alert, cry less often and even a find feeding rhythm. Premature babies benefit from this practice by facing fewer complications, gaining weight and growing closer to their parents.

I know the doctors and nurses at CHOC care about the precious lives in the NICU. They provide exceptional service, but they’re not just focused on treating symptoms or reading monitors. They are also committed to giving newborns and families a strong chance of living healthy lives.

Tell me how CHOC helped your newborn baby and family by using the hashtag #thxCHOC on social media.

____________________________________________________________________________________________________________________________

CHOC Children’s 67-bed NICU includes four multi-patient rooms, six single care rooms, four private rooms for “rooming in,” and two four-bed suites. The unit also features a two-bed Extracorporeal Membrane Oxygenation (ECMO) unit. The life-saving ECMO unit is the only one of its kind in Orange County and CHOC also offers Orange County’s only ECMO transport unit.

Parents and Preemies

premature_babyHELPING PREEMIES GROW
A premature or preterm baby is born before 37 weeks of gestation. Preemies often require hospitalization but mom can help her preemie from day one, says Dr. Bixby, a CHOC Neonatologist. “Early on, the best way for a preemie to grow is with the mother’s milk. Moms can start pumping in the hospital and should start pumping as soon as possible after delivery. We also have found that having the parents place the infant on their chests, skin to skin (called “kangaroo care”) helps the baby grow, breathe better and develop better.” Parents should ask their neonatologist and pediatrician about medical issues to watch for as their preemie grows. Keeping up with standard vaccinations and special vaccinations for preemies is also important, says Dr. Bixby.  Parents should also keep up with their vaccinations, particularly influenza and pertussis vaccines, which will protect the baby until the babies immune system has matured and the standard vaccines are completed.

DEVELOPMENTAL MILESTONES
“Premature infants are at risk for developmental delays so parents should be watchful of the developmental milestones, taking into account the appropriate delay from an early birth,” says Dr. Bixby. Preemies visit CHOC’s Early Developmental Assessment Clinic at 6 months of age for a full assessment of the baby’s development and nutritional needs and a referral to the appropriate specialist if necessary, she said, adding, “Parents and families should create a loving and engaging home environment so the baby is encouraged to move around and reach for things and interact with the world and learn.”

PREVENTING PRETERM DELIVERY
Pregnant women are encouraged to seek prenatal care as soon as possible to help prevent a premature delivery and to identify any potential problems that could lead to a preterm birth, says Dr. Bixby. “Pregnant women should see their family practice doctor or obstetrician regularly and get a referral to a specialist if there are concerns about the pregnancy. Good dental care helps too. Research shows that dental disease or poor dentition is associated with preterm delivery. Mom should take care of herself, get some exercise in consultation with your obstetrician and eat well.”

FAST FACTS

    • Annual cost to society for premature births: $26 Billion+
    • Percent increase over the last 25 years in premature births in the U.S.: 36
    • Number of premature babies born each year in the U.S. (1 IN 9 BABIES): 500,000

View the full feature on Parents and Preemies

Dr. Christine Bixby
Dr. Christine Bixby
CHOC Neonatologist

PHYSICIAN FOCUS: Dr. Christine Bixby

Dr. Bixby completed her fellowship in neonatology at Harbor UCLA Medical Center and also completed her residency and internship training in pediatrics at Harbor UCLA Medical Center. She completed a fellowship in neonatology in a joint program between CHOC and Harbor UCLA Medical Center. Dr. Bixby specializes in caring for premature infants and is involved in research studies focusing on issues related to breast milk, establishing a milk supply and using breast milk for premature babies.

Dr. Bixby’s philosophy of care: “My philosophy of care is to bring in the parents and family as part of the health care team and making sure they are educated and comfortable with the care we are giving their children.”

EDUCATION:
University of California, Davis, School of Medicine

BOARD CERTIFICATIONS:
Pediatrics Neonatal-Perinatal Medicine

More about Dr. Christine Bixby

This article was featured in the Orange County Register on April 28, 2104, and was written by Amy Bentley.

Tips for Mitigating the Risk of Preterm Labor

Prematurity is the number one killer of babies worldwide, says Dr. Tony Soliman, a CHOC Children’s neonatologist. Even if a woman does everything right, her baby can still be born prematurely. In this CHOC Radio segment, Dr. Soliman addresses this serious health concern and offers tips for mitigating the risk of preterm labor.

Dr. Soliman encourages women to partner with health care providers even before getting pregnant. Prenatal care and eliminating high risk behaviors, such as smoking, are crucial. In addition, stress can have a huge impact on the health and well being of mom and baby.

Learn more by listening to Dr. Soliman and CHOC Radio host Bryan Mundia.

Extremely Low Birth Weight Program Provides Significant Outcomes for Tiny Patients

Medical advances are improving the survival of babies born at lower gestational ages, but survival – alone – isn’t the best measure of success, says Dr. Tony Soliman, a CHOC Children’s neonatologist.

In this CHOC Radio segment, Dr. Soliman shares his and his team’s commitment to ensuring not only the survival of this very fragile patient population but to ensuring bright, healthy futures for these babies.

According to Dr. Soliman, there’s no program on the West Coast like CHOC’s extremely low birth weight program, which is designed to address the unique needs of infants born at less than 28 weeks gestation and weighing less than 1,000 grams. He says having a specialized team, specific care guidelines and a separate unit – versus the main Neonatal Intensive Care Unit – have resulted in significant outcomes for his patients.

Tune in to hear more about the success of this very special program.

 

Caring For The Smallest Patients

annual-report-2013-caring-for-the-smallest-patients

When she would check in at the front desk to visit her prematurely born twin girls in the new CHOC Children’s neonatal intensive care unit (NICU) at St. Joseph Hospital, Mary Aguilar typically would be greeted with expressions of concern from hospital employees.

Aguilar would respond, “Actually, it’s cool up there.  I never feel like I’m going to a sad place.”

“Up there” is the 13-bed, CHOC Children’s-staffed-and-licensed Level IIB neonatal intensive care unit that, since opening Feb. 11, 2013, has been making life a lot easier for mothers, families and their newborns at CHOC’s adult hospital neighbor—and their newborns who need specialized care.

Aguilar’s girls, Lily and Ella, born just shy of 32 weeks, were among the first patients and the first set of twins to be cared for in the CHOC NICU at St. Joseph Hospital, whose opening coincided with a new mother-baby unit at St. Joseph.

Never far from mom

The NICU, staffed by a team of CHOC neonatal experts, is designed for newborns with low to moderate medical needs—typically, premature babies suffering from respiratory and circulatory problems. Newborns needing a higher level of critical care are sent to CHOC’s 54-bed NICU, located in the CHOC North patient care tower.

Lacy Pester, BSN, RNC-NIC and clinical manager of the CHOC NICU at St. Joseph Hospital said that prior to the opening of the new NICU, it sometimes was inconvenient for mothers to have to make the trip to CHOC’s NICU.  At nights, if there were no volunteers available to accompany them, mothers were not allowed to make the trek, Pester said. No longer.

Now new mothers like Aguilar are only steps away and can visit their babies easily.

The NICU provides accommodations for parents after a mother’s discharge as well.

For 27 days, Lily and Ella—who both weighed around 3½ pounds at birth—were cared for by a team of newborn intensive care nurses, respiratory therapists and physicians who relied on sophisticated monitoring equipment to closely follow their vital functions around the clock, including heartbeat, respiratory status, temperature and blood pressure.The girls got the Twin Room—the only two-bed room among the 12 rooms that make up the new NICU.

Choosing to have her babies at St. Joseph Hospital was easy for Aguilar. Her mother worked there as a security guard in the 1980s and her grandmother was a housekeeper in the emergency department. When her twins arrived early, Aguilar was grateful to hear that her babies would be receiving care in the new NICU.

annual-report-2013-caring-for-the-smallest-patients-2“I was excited, thinking we would have more privacy and our own nurse,” Aguilar says. “It was fantastic. We were in the corner of the unit and everything happened in one room. I loved it.”

Lanky Lily, kind of silly and prone to making pterodactyl noises, and chunky Ella, a happy baby with a sweet disposition, now are healthy babies closing in on 20 pounds. Aguilar, who lives with her husband, Ramon, and their twins in Corona, credits the expert team of neonatal specialists at the CHOC NICU at St. Joseph Hospital, including Christine E. Bixby, M.D., with her babies’ health.

“They always had the girls’ best interests in mind,” Aguilar said. “They are all very loving people. I feel like all the care they received helped set up my girls for success.”

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Event Raises Awareness of Kangaroo Care

Snuggling a newborn is one of life’s greatest pleasures, but did you know the practice also has lasting health and emotional benefits for parents and infants?Kangaroo

Giving a sick or preterm baby skin-to-skin contact – usually against a parent’s chest – is called “kangaroo care,” a cute name for a vitally important practice.

To raise awareness of the method, CHOC Children’s at Mission Hospital recently held a week-long “Kangaroo-a-thon,” during which parents were encouraged to snuggle their babies as much as possible. The event was held in collaboration with Mission Hospital and March of Dimes, and recognized November as Prematurity Awareness Month.

Studies have shown that kangaroo care can help maintain an infant’s body temperature, contribute to higher blood oxygen levels, and improve sleep, breast-feeding and weight gain, says Liz Drake, a clinical nurse specialist at CHOC at Mission.

Further, parents develop stronger bonds with their new babies and gain parenting confidence, and mothers often show improved milk production, she added.

During the Kangaroo-a-thon, parents in both hospitals spent 4,550 minutes — about 76 hours — cuddling with their infants, Liz says.

The method has been adopted worldwide, and, of course, at all three CHOC Children’s neonatal intensive care units. CHOC experts promote skin-to-skin contact with even the most fragile little patients, including babies with extremely low birth weights and those on ventilators.

Technology and medicine have brought many advances in neonatology, but the touch of a parent remains a key tool in the care of sick and preterm babies. Kangaroo care is one more technique contributing to a supportive environment that helps premature babies mature and develop as they would in their mother’s womb.

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