Clinical Activities/For Parents

Introduction

The multidisciplinary Washington University Division of Pediatric Allergy, Immunology, and Pulmonary Medicine at St. Louis Children’s Hospital is a premier academic program, and its commitment to excellence in patient care, teaching, and research was recognized by our inclusion as one of America’s best pulmonary services, according to Parent magazine’s survey and the US & World Report Best Hospitals ranking.

The Division supports an active clinical practice, and our faculty and nurse practitioners saw over 10,000 outpatient visits at all sites last year, including nearly 2,800 new patient referrals and outpatient consultations. Inpatient clinical volumes and consultations at St. Louis Children’s Hospital have also grown to nearly 7,000 patient-days last year.

Our faculty have been prominent nationally, and publishing manuscripts in high impact journals including the New England Journal of Medicine, Lancet Respiratory Medicine, Journal of the American Medical Association, American Journal of Respiratory and Critical Care Medicine, and the Journal of Allergy and Clinical Immunology.  The Division has a core of productive translational scientists and clinical investigators.  National Institutes of Health and other extramural funding has steadily increased ($4.9M direct costs), supporting investigator-initiated proposals and multicenter research networks that study childhood lung diseases.


Pediatric Asthma and Allergy Center

Asthma care and research are prominent activities of the Division. More than 3,000 children and adolescents with asthma are routinely followed in Pediatric Asthma Clinic, which is fully staffed by physicians, nurse practitioners, and skilled pediatric nurses. Over 1,200 children are admitted to St. Louis Children's Hospital each year for care of status asthmaticus, and many receive care by Division physicians or advanced practice nurses who are involved in the state-of-the-art evidence-based Asthma Intervention Model (AIM).

Management of children with all forms of allergic disease is an important part of the Division’s clinical activities. Faculty physicians provide expert consultation for children and adolescents with food and drug allergy, rhinitis, sinusitis, eczema, urticarial/angioedema, and other atopic and immunologic disorders. In addition, the Division offers diagnostic testing for penicillin allergy and oral challenges for the assessment of food allergy.  A state-of-the-art Pulmonary Function Laboratory supports patient care by providing comprehensive lung function testing. Patients can be referred for clinical evaluation by calling our office at (314) 454-2694.

Faculty in the Pediatric Asthma and Allergy Center at St. Louis Children’s Hospital have led multiple National Institutes of Health-supported pediatric asthma initiatives, including AsthmaNet, the Childhood Asthma Management Program (CAMP), the Severe Asthma Research Program, and the Inner City Asthma Consortium, research networks that are helping us understand the origins of asthma as well as the best approaches to asthma management. Division faculty have also pioneered the use of asthma coaching is provided to overcome barriers that interfere with asthma care delivery in urban communities, and have developed a multidisciplinary program focused on reducing asthma-associated morbidities and mortality among children with sickle cell disease.


Cystic Fibrosis Center

Caring for patients with cystic fibrosis for almost five decades, the comprehensive, fully accredited Cystic Fibrosis Center at Washington University Medical Center continues to thrive. The comprehensive, fully accredited Cystic Fibrosis Center at St. Louis Children’s Hospital supports premier clinical and research programs in cystic fibrosis.  Located at the St. Louis Children’s Hospital, the Pediatric Cystic Fibrosis Clinical Center has steadily increased in size, and we regularly see more than 230 children and adolescents.  In addition, we are involved in the care of cystic fibrosis patients from across the United States who have been referred for or benefited from lung or liver transplantation.  Referrals should be made through the Division office at (314) 454-2694.

The Center is a member of the Cystic Fibrosis Foundation Therapeutics Development Network, and Division investigators and clinicians led or participated in twenty-three (23) clinical trials this past year.  In addition, the Center is one of six primary sites of the National Institutes of Health-supported Genetic Disorders of Mucociliary Clearance Consortium, a clinical research network to study rare diseases of the airways.  National Institutes of Health-funded investigators have collaborated on cystic fibrosis-related projects examining the early origins of lung disease, host-pathogen interactions, and hepatic involvement.  The Center has close collaborative relationships with Washington University investigators in clinical and basic science departments, which has allowed us to consider questions fundamental to our understanding of the disease. 


The Pediatric Lung Transplantation Center

The Washington University School of Medicine and St. Louis Children's Hospital pediatric lung transplant program was the first pediatric lung transplant program in United States, and over 400 lung and heart-lung transplants have been performed here. The program remains the preeminent pediatric lung transplant program in the world, with referrals from across North America and worldwide. The transplant pulmonologists work closely with cardiothoracic surgeons, pediatric intensivists, and clinical staff to provide the best pre- and post-operative care of children with advanced lung diseases.  The pediatric lung transplantation program leads an international network of academic children’s hospitals focused on understanding the mechanisms of lung graft dysfunction, a project in the Clinical Trials in Organ Transplantation in Children (CTOT-C) consortium.


Pediatric Sleep Clinic and Laboratory

The Pediatric Sleep Diagnostic Center and Laboratory at St. Louis Children's Hospital serves children who have or are suspected of having sleep-related breathing disorders, narcolepsy, restless leg syndrome, periodic limb movements, insomnia, nighttime seizures, and many other problems brought on or made worse by sleep.  Accredited by the American Academy of Sleep Medicine, Center volumes have grown rapidly, with over 900 tests interpreted annually.

The core staff of the Sleep Center includes American Board of Sleep Medicine-certified pediatricians from the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine and Division of Pediatric Neurology, nurse clinicians, and sleep laboratory technicians.  The larger Sleep Center team includes pediatric otolaryngologists, psychologists, and psychiatrists.  Experienced pediatric respiratory therapists with sleep training attend and score studies.  

As an American Academy of Sleep Medicine-certified Pediatric Sleep Center, treatment is provided for all children with sleep disorders diagnosed through our center.  Extensive expertise in managing non-invasive ventilation in children is available, and early referrals for otolaryngology evaluation can be provided.  Children and adolescents with narcolepsy and neurosleep disorders have access to our staff pediatric neurologists.  Referrals can be made to the Pediatric Sleep Disorders Clinic by calling (314) 454-2694 or (314) 454-4007.  Alternatively, practitioners can refer patients directly to the sleep laboratory for overnight studies, (314) 454-4503. 

Washington University pediatric sleep physicians lead funded research projects characterizing sleep and breathing in children, including the National Institutes of Health-supported grant, titled Physiologic biomarkers predicting ventilatory instability and hypoxemia in premature infants that is examining central control of breathing in premature infants. 


Pediatric Pulmonary Clinics

In addition to the conditions described above, the Division faculty and nurses treat a variety of less common pediatric lung disorders, including bronchopulmonary dysplasia, bronchiolitis obliterans, interstitial lung diseases, primary ciliary dyskinesia, tracheobronchomalacia, vocal cord dysfunction, aspiration disorders, hypersensitivity pneumonitis, and a variety of pulmonary complications associated with neuromuscular disorders. Patients can be referred for clinical evaluation by calling our office at (314) 454-2694.

Division physicians and nurses also provide subspecialty care in our growing multidisciplinary pediatric technology-dependent clinic, which coordinates hospital-based and home care of ventilator-dependent children and provides consultative services at Rankin-Jordan Hospital for Children. Members of the Division contributed to the official American Thoracic Society Clinical Practice Guideline that outline standards for pediatric chronic home invasive ventilation, published in the American Journal of Respiratory and Critical Care Medicine last year.


Pediatric Pulmonary Function Laboratory

The Pediatric Pulmonary Function Laboratory at St. Louis Children's Hospital specializes in pediatric testing from infancy through adolescence. The laboratory offers a full range of lung function tests for clinical and research patients, from infancy into early adulthood. In addition to standard tests of lung mechanics and function (including spirometry, plethysmography, maximal respiratory pressures, and diffusion capacity measures), the laboratory conducts specialized tests including stress cardiopulmonary testing, multiple breath washout studies, and bronchoprovocation tests. The lab also performs state-of-the-art infant pulmonary function testing, including plethysmographic measurements of lung volume and raised-volume forced flows. The laboratory performed nearly 9,000 tests last year.


Pediatric Airway Center

Pediatric pulmonologists support our multidisciplinary Airway Center, where more than 300 procedures are performed annually. Most procedures are performed in the St. Louis Children’s Hospital Ambulatory Procedure Suite, and are usually performed on an outpatient basis. Depending on the indication, bronchial washings, bronchoalveolar lavage, endobronchial biopsies, and transbronchial biopsy can be collected during the procedures. Because of our extensive experience with lung transplantation, our center is identified as the leader in the field.  Indeed, Division physicians led the effort to revise the American Thoracic Society guidelines for performing flexible airway endoscopy in children, published in the American Journal of Respiratory and Critical Care Medicine.  Referrals should be made through the Division office at (314) 454-2694.

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