On the Pulse

Kawasaki disease is a condition that can affect many parts of a child’s body, including the mucous membranes (lining of the mouth and breathing passages), skin, eyes, and lymph nodes, which are part of the immune system.  The disease is the leading cause of acquired heart disease in children in the U.S, and it can affect the coronary arteries, which supply blood to the heart.  This can lead, in rare cases, to heart attack and death. 

What causes Kawasaki disease?

There are lots of theories about what causes Kawasaki disease.  Researchers have thought that it might be linked to genetics or even the wind, of all things.  Patients tend to be diagnosed with the condition more frequently from winter through spring, which suggests a possible environmental trigger.  Some investigators have even theorized that carpet mites could be carrying a pathogen that causes the disease.  “People had their carpets cleaned and, soon after, their children were diagnosed with Kawasaki disease,” said Michael Portman, MD, of Seattle Children’s Research Institute. 

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Several studies conducted in Los Angeles and New York City have identified high concentrations of air pollution as harmful to a developing fetus, but there have been few studies of traffic-related air pollution and birth outcomes in areas that have low to moderate air pollution.  Now, a team led by Sheela Sathyanarayana, MD, MPH, of Seattle Children’s Research Institute, has found modest effects on fetal growth in the Puget Sound Air Basin, a region in Washington state with low overall air pollutant concentrations.

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Most children watch TV before age two, typically starting at about five to nine months. That’s despite the fact that recent guidelines from the American Academy of Pediatrics discourage television or video viewing by infants before the age of two. Encouraged by disputed claims that videos can benefit an infant or toddler’s educational development, the infant digital video disc (DVD) business has become a $500 million industry in the U.S.

First Study to Look at Brain Chemistry in Infants

However, a new study conducted by investigators at Seattle Children’s Research Institute suggests that video watching causes different brain reactions than simple interactive games, such as playing with building blocks. The purpose of the research was to test whether there are quantifiable differences in the levels of cortisol between a known beneficial and traditional type of play and one that is new and relatively understudied.

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The U.S. Preventive Services Task Force recommended in 2009 that primary care clinicians should screen adolescents for depression.  But a positive result or screen does not mean that every young person needs active treatment—including psychotherapy and medication—for depression, based on a new study led by Laura Richardson, MD, MPH, of Seattle Children’s Research Institute.  The study, “Predictors of Persistence Following a Positive Depression Screen among Adolescents,” was published November 19 in Pediatrics.

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We’re approaching flu season, a time when you hear a lot about the importance of getting a flu shot, and parents get nervous about children catching the flu.  Heck, even parents get nervous about being sick. 

Speedy testing for the flu can help ease anxiety for parents – it might be just a common cold, after all.  And if it’s not, a fast diagnosis means a child receives the right treatment promptly.

Fastest in the Nation

Seattle Children’s laboratory is the fastest in the nation for producing respiratory virus results.  It’s a fact that Mike Astion, MD, PhD, medical director of Lab Medicine, is pretty proud of.  He and his team have made a lot of progress to reach that goal in recent years.

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In October 2010, Heather Landis received a phone call no expectant mother ever wants to receive. At five months pregnant with their second child, the doctor told Heather and her husband Dale that the baby girl they were expecting would be born with a cleft lip and palate, birth defects that occur early in pregnancy. After the initial shock of the diagnosis, the Landis’s began preparing themselves for the difficult road that awaited them. Struggling with her emotions, Heather put what she was feeling into a candid and personal blog detailing the months before and after the birth of her daughter, Danielle.

Her blog detailed Danielle’s trips to Seattle Children’s Hospital, where Dr. Hitesh Kapadia initiated the repair process using a nasoalveolar molding (NAM) device – a non-surgical method of reshaping the gums, lips, and nostrils of children with large cleft lips and palates prior to surgery. Following months with the NAM, the craniofacial team lead by Dr. Raymond Tse performed multiple surgeries to correct Danielle’s cleft lip and palate. Danielle is currently doing very well and her cleft lip and palate were successfully repaired by Danielle’s care team. The team’s courageous efforts, collaborative spirit, and amazing success also inspired Dale to apply for a job at Seattle Children’s, where he works today.

The Landis’ story is told in a compelling photo slideshow narrated by Heather, using entries from her months of blog posts and photos taken by the family during their difficult – but ultimately successful – journey.

Heart transplant recipients (clockwise, from top left): Brooke Naab, Hannah Campbell, Batul Al-Salami and AJ Baird.

In one five-day span this September, four patients – one teenager and three critically ill infants – received life-saving heart transplants at Seattle Children’s.

For four families, the week meant the end of an agonizing wait and the start of a new life.

To perform four transplants in five days is very unusual, says Dr. Lester Permut, heart surgeon and interim chief of Cardiothoracic Surgery at Seattle Children’s. “But these are situations we train for.”

The first notification came at the end of a busy Friday: A donor heart was available for 6-month-old AJ Baird, who had spent half his short life waiting for a heart in Children’s Cardiac Intensive Care Unit (CICU).

A team from Children’s – two heart surgeons and a transplant nurse – set out immediately to get the donor heart while a team led by Dr. Permut and another heart surgeon, Dr. Michael McMullan, readied AJ at Children’s. The transplant surgery started early on Saturday, Sept. 22.

The team was finishing AJ’s surgery when the beeper went off again: a heart was available for 14-year-old Batul Al-Salami, who has been followed by the Heart Center since birth.

Then it happened again, and again, until Wednesday, Sept. 26. By then, the team had completed a total of four heart transplants – more than Children’s had ever done in a single week.

The cluster of transplants made for an exhilarating week.

“When a heart comes up for one of our patients, we’re excited about it and the energy from that sustains us,” says Dr. Permut, who traded the role of lead and assistant surgeon with Dr. McMullan for all four surgeries.

“It was a tour de force for a big group of people,” adds Dr. McMullan. “It took an incredible team and a very good system to pull this off.”

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10-year-old Jenna Gibson, a Maple Valley, Wash. resident, has been a patient at Seattle Children’s since she was initially diagnosed with acute myeloid leukemia earlier this year.

While staying at the hospital’s cancer care inpatient unit recently, she had the idea to create for her friends and family a video entitled: “Haunting: A Head” – all in the spirit of Halloween fun.

In the video, Jenna, hidden beneath a magical hospital robe that makes everything but her head invisible, can be seen on a spooky hijinks across the floor.

“I wanted to show some of the things that were frustrating but kind of funny about being in the hospital,” said Jenna. “And I wanted to use only my head because it seemed mysterious.”

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Imagine a prowler casing a neighborhood, looking for a way into a home. That’s essentially what HIV, the human immunodeficiency virus, does:  It moves through the bloodstream trying to gain entry to T-cells — the primary warrior of the immune system. A special receptor on the T-cell’s surface (called CCR5) is the open door it seeks. Once it gains entry, the virus hampers a T-cell’s ability to do its job, leaving people vulnerable to infection and disease — and enabling HIV to spread.

Now imagine you can lock that door forever. The virus can’t enter the T-cells and interfere with the immune system and the body can fight off the infection.

Drs. Dave Rawlings, Andy Scharenberg and a team at Seattle Children’s are getting close to making that vision a reality. Working with colleagues at University of Washington and Fred Hutchinson Cancer Research Center in the Northwest Genome Engineering Consortium, they have figured out how to modify genes and knock the CCR5 receptor off T-cells.

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