Clinical Activities/For Parents
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 2008 survey and the 2009 US & World Report Best Hospitals ranking. Nine (9) faculty members from the Division were listed as Best Doctors in America® this year. The Division supports an active clinical practice, and our faculty and nurse practitioners saw over 8500 outpatient visits at all sites last year, including nearly 2,500 new patient referrals and outpatient consultations. Inpatient clinical volumes and consultations have also grown following the creation of the 7 East Respiratory Unit at St. Louis Children’s Hospital.
Pediatric Asthma and Allergy Center
Asthma care and research are prominent activities of the Division. More than 3000 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 most receive care by Division physicians and/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 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 are leading 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, 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, Asthma and Nocturnal Hypoxemia in Sickle Cell Anemia.
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 now see more than 230 children and adolescents regularly. 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 Cystic Fibrosis Center is a member of the Cystic Fibrosis Foundation Therapeutics Development Network and 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, focusing on variant forms of cystic fibrosis. 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. National Institutes of Health-funded investigators are working together on projects that deal with host-pathogen interactions, pulmonary inflammation, diabetes, and hepatic disease. Center investigators continue their relationships with the Washington University Genome Sequencing Center and the Mallinckrodt Institute of Radiology that will advance our understanding of the basic defects in cystic fibrosis and translated to patient care.
The Center produces newsletters for patients and families, and supports Cystic Fibrosis Parents Night Out and monthly Cystic Fibrosis Parent Networking Group for families of cystic fibrosis children. As part of our quality improvement efforts, we created an active Parent Advisory Committee five years ago that has been a valuable resource, providing ideas for improvement of inpatient and outpatient cystic fibrosis care.
The Pediatric Lung Transplantation Center
St. Louis Children's Hospital continues to be one of the most active pediatric solid organ transplant centers in the United States. The Washington University School of Medicine and St. Louis Children's Hospital pediatric lung transplant program was the first free-standing pediatric lung transplant program, 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 National Institutes of Health recognized the leadership role of our pediatric lung transplantation program in 2007, when after a highly competitive grant review process, it selected this Division to participate in the Clinical Trials in Organ Transplantation in Children (CTOT-C) consortium and lead the first ever international network of academic children’s hospitals focused on understanding the mechanisms that lead to rejection in these patients, Viral Triggers of Alloimmunity and Autoimmunity in Pediatric Lung Transplantation. In 2013 the Division was successful in obtaining competitive CTOT-C renewal to carry out a second project, entitled B-Cell Targeted Induction to Improve Outcomes in Pediatric Lung Transplantation.
Pediatric Sleep Clinic and Laboratory
The Pediatric Sleep 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, excessive daytime sleepiness, nighttime seizures, and many other problems brought on or made worse by sleep. Our sleep program is independently accredited as a Sleep Center by the American Academy of Sleep Medicine.
Outpatient clinic evaluations and full-scale, overnight polysomnography permit assessment of sleep quality, presence of apnea and its cause (central or obstructive), and explanations for sleep disruption. The core staff of the Sleep Center includes Sleep Board-certified pediatricians from the pulmonology and neurology divisions, a Sleep nurse clinician, and 6 sleep laboratory technicians. The larger Sleep Center team includes pediatric otolaryngologists, 2 psychologists with a particular interest in insomnia among small children and adolescents, and a pulmonologist and a nurse practitioner who manage children with tracheostomies receiving mechanical ventilation. Polysomnography utilizing the Somnistar System is performed at night, and is also available during the day for naps in younger children. Experienced pediatric respiratory therapists with sleep training attend and score studies.
As a certified Sleep Center, treatment services are provided for all children with problems diagnosed through our center. Early referrals for otolaryngology evaluation are available. Extensive expertise in managing non-invasive ventilation (CPAP, BiPAP) in children is available with the participation of the sleep laboratory staff, the Sleep nurse clinician, and nurses and respiratory therapists from a dedicated respiratory unit at St. Louis Children’s Hospital. Children and adolescents with narcolepsy have access to our core staff pediatric neurologists, and will be cared for by them once the diagnosis of narcolepsy is established.
Funded research projects participated in by the Sleep Center core staff include characterizing sleep and breathing in children with cerebral palsy, development of streamlined algorithms to diagnose and treat sleep-disordered breathing in children with Trisomy 21, and evaluation of ventilatory control among premature infants in the NIH-funded Prematurity and Respiratory Outcomes project (PROP).
Practitioners can refer patients directly to the sleep laboratory for overnight studies, if they are comfortable doing so. (314-454-4503). Referrals to a Sleep Disorders Clinic can be made by calling 314-454-2694, or 314-454- 4007. Direct referral to a pediatric neurologist with special expertise in sleep disorders can be made by calling 314-454-6120. Direct referrals by practitioners to pediatric psychology are often appropriate (314-454-6069).
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 alveolar proteinosis, pulmonary hemosiderosis, bronchopulmonary dysplasia, bronchiolitis obliterans, interstitial pneumonitis, primary ciliary dyskinesia, tracheobronchomalacia, vocal cord dysfunction, aspiration disorders, hypersensitivity pneumonitis, and a variety of lung diseases associated with neuromuscular disorders. Patients can be referred for clinical evaluation by calling our office at (314) 454-2694.
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 cardiopulmonary studies, resting metabolics, 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 routinely performs over 7000 tests annually.
Pediatric pulmonologists attend our bronchoscopy center, where more than two hundred procedures are performed annually. Flexible fiberoptic bronchoscopy is an active service of excellence offered by our skilled bronchoscopists. Most procedures are performed in the convenient Ambulatory Procedure Center, and are usually performed on an out-patient basis. Depending on the indication, bronchoalveolar lavage and transbronchial biopsy can be obtained during the procedures. Indeed, because of our extensive experience with lung transplantation, methods of performing biopsies in infants have been developed and have established our center as the leader in the field. Referrals should be made through the Division office at (314) 454-2694.