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Pediatric
Powerhouses
BJC’s St. Louis
Children’s Hospital and SSM’s Cardinal Glennon Children’s Hospital
are recognized leaders in pediatric care and research.
By Liese Hutchison
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St.
Louis is a remarkable place to raise children for many reasons,
especially in terms of health care—with two children’s hospitals,
complete with pediatric research centers, level one trauma facilities
and international recognition—area children receive extraordinary
care.
“For the size of our population, we’re unique in having two children’s
hospitals,” notes Dr. Bill Keenan, vice president of medical affairs,
neonatology, at Cardinal Glennon Children’s Hospital and a professor
of pediatrics at Saint Louis University School of Medicine. Keenan
states that Chicago and Philadelphia both have three children’s
hospitals. “Having the two medical centers here [Saint Louis University
and Washington University] allows us to have high quality health-care
workers and physicians trained to treat children.”
Through the research efforts of these two institutions, along
with other research conducted worldwide, Keenan claims, “There
aren’t as many diseases that kill children—infectious disease
as a cause for mortality in children has almost gone, heart diseases
are now diagnosed earlier, even inutero and cancer therapy has
changed dramatically with the survival of children with leukemia
increasing from 20 to 90 percent. Even traumas are down thanks
to better seat belts and protective devices.”
Dr. Alan Schwartz agrees. “Probably one of the most important
things that has happened over the last few years and will happen
over the next several years is the release of vaccines for the
most common diseases that affect children,” notes the pediatrician-in-chief
and the Harriet B. Spoehrer professor and chair of the department
of pediatrics. “We’ve seen a market acceleration in vaccines in
the last 20 years that protect children.”
The latest vaccine just approved by the Food and Drug Administration
treats pneomoccocal disease for children under two years of age.
“It is the most common cause of septis and pneumonia,” Keenan
states. “This vaccine is active against seven different species
of the bacteria and every pediatric practice is now using it.”
Keenan states that in addition to the development of vaccines,
molecular genetics is making a difference in treating children.
“Molecular genetics allows for early diagnosis of transplantable
diseases. If you can identify the problem early enough and do
replacement, you can ensure the child’s health,” he remarks. “Children
who receive transplants have a higher survival rate than adults.”
The hospitals are known for their firsts in the transplant arena—Cardinal
Glennon performed the first infant kidney transplant in Missouri
and St. Louis Children’s Hospital performed the area’s first split
liver transplant by dividing a single donor liver between two
patients. Organ transplantation is a point of pride for SLCH.
During 1998, the hospital performed more solid organ transplant
procedures than any other pediatric hospital in the world, with
transplant surgery now performed on hearts, livers, kidneys, lungs,
small intestines and bone marrow and it has the world’s largest
pediatric lung transplant program. SLCH has performed more than
100 transplants each for heart and lung.
“Saint Louis Children’s Hospital once again is one of the top
two pediatric organ transplant centers in the country. We continue
to be the world leading lung transplant center and one of the
leading heart transplant centers in the country. We are on the
cutting edge of both clinical care, clinical investigation and
basic investigation in heart and lung transplantation,” Schwartz
notes.
Another area where SLCH excels is in treating asthma. “The leading
cause for admission for children to hospitals is asthma. We at
St. Louis Children’s Hospital and Washington University School
of Medicine are part of the largest NIH [National Institutes of
Health] clinical trial program to evaluate asthma therapy in children
in the community. The results of those studies will come out in
the next six to 12 months. And my expectation is that these studies
will change the way we deliver asthma care to children in the
home and in the doctor’s office to minimize the time children
spend in the hospital,” Schwartz states. “Our asthma program has
been recognized as one of the five centers in the United States
for the evaluation and testing of new asthma medicine for children.”
Cardinal Glennon is recognized for its stem cell research and
the St. Louis Cord Blood Bank at the Pediatric Institute. Umbilical
cord blood is rich in hematopoletic stem cells, which are the
same cells found in bone marrow. Children with leukemia, bone
marrow failure or genetic disorders may require a stem cell transplant
as part of their treatment. Currently only 70 percent of children
and adults in need of a bone marrow transplants will be able to
find a matched, unrelated donor through bone marrow registries.
Cord blood offers an opportunity as an alternative transplant
source of young blood-making cells. “When there’s a needy child
who is compatible with one of the 10,000 samples we have, he or
she can have a transplant,” Keenan states.
Another blood-related program that’s a leader in the pediatric
field is St. Louis Children’s Hospital’s work with sickle cell
disease. “Sickle cell disease is a leading cause for morbidity
among black children in this country. Over the course of the last
two years, Dr. Michael DeBaun has established a very robust, comprehensive
sickle cell program that deals with diagnosis, education, counseling,
school treatment strategies, out-of-hospital treatment strategies
and in-hospital treatment strategies. He also established in St.
Louis one of the first programs in the nation with cooperation
of the Red Cross Blood Bank to provide the Red Cross with specially
matched blood to reduce the risk of receiving blood that is difficult
to match for children with sickle cell who usually need numerous
blood transfusions throughout their lives,” Schwartz states.
With the advancement in prevention and safety devices for children,
traumas are on the decline and as a result pediatric physicians
are being trained differently. “Pediatrician training is changing—a
lot less of their time is spent on acute care,” Kennan states.
And training focuses more on teaching physicians to communicate
with their patients and their families, learning about what’s
happening in school and in the home and understanding common problems
such as attention deficit, hyperactivity and learning disabilities.
“These topics have been added to the training in response to demand.
Now pediatricians can better understand these common problems
children face,” Keenan says.
Liese L. Hutchison is an assistant professor in the department
of communication at Saint Louis University and a free-lance writer.
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