Pediatric Care

Coronavirus Science: Two Studies Raise New Concerns

Posted on May 5, 2020 in Carousel, Innovation, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Pediatric Care, People, Research, Scroll Images, Uncategorized

Every day brings new scientific insights into COVID-19 and the coronavirus that causes it. Studies authored by Sutter Health experts examine the virus’s impact on children and diabetic adults.

COVID-19 and Kawasaki Disease

Recently, doctors began warning of a potential consequence of COVID-19 infection in children; some youngsters appear to develop an abnormal immune response that results in symptoms commonly associated with Kawasaki disease or toxic shock syndrome – two rare, but well-characterized inflammatory conditions. The first known U.S. case of Kawasaki disease possibly connected to COVID-19 was reported by Veena Jones, M.D., (lead author) and Dominique Suarez, M.D., both pediatric hospitalists with the Palo Alto Medical Foundation, part of the Sutter Medical Network.

Veena Jones, M.D.

Their six-month-old patient was diagnosed with classic Kawasaki disease, admitted to the hospital for treatment, and subsequently received a positive test result for COVID-19. The main reason for treatment in children with Kawasaki disease is to prevent further complications of the disease on the heart. The patient received appropriate treatment and has since fully recovered and has maintained normal heart function. But the case caused the doctors to question: could the COVID-19 infection have led the patient to develop Kawasaki disease?

“Our patient met the classic criteria for Kawasaki disease, so there was little doubt about the diagnosis or treatment plan,” said Dr. Jones. “But we do wonder if the COVID-19 infection could have caused the Kawasaki disease, especially because Kawasaki disease is widely thought to be triggered by an infection or an abnormal immune response to an infection.”

Dominique Suarez, M.D.

A careful review of the existing medical literature found that COVID-19 co-occurring with Kawasaki disease had not previously been reported, so the doctors decided to write up the case and submit it to the Journal of Hospital Pediatrics for publication. “Researchers still know very little about exactly why Kawasaki disease develops in some patients, so our hope was to accurately describe the novel case that we encountered and share that with the medical community to encourage further investigation and dialogue,” said Jones. In the race to understand the burden of COVID-19 on the human body this kind of early observation by doctors on the frontline can help inform future decisions around diagnosis and treatment.

COVID-19 and Diabetes

Since the start of the coronavirus pandemic many have warned that people with existing chronic illness who contracted the infection would become sicker than those without. Now, research authored by Sutter Health clinician David Klonoff, M.D. suggests that diabetes, one of the most serious chronic illnesses in the world, is strongly correlated with death among hospitalized patients diagnosed with COVID-19.

David Klonoff, M.D.

Accepted by the Journal of Diabetes Science and Technology, Dr. Klonoff’s paper represents the largest study yet reported on outcomes of patients with COVID-19 and diabetes or uncontrolled hyperglycemia. The observational study of 1122 inpatients with COVID-19 at US hospitals between March 1 and April 6, 2020, found that those with diabetes or hyperglycemia throughout their hospital stay had a four-fold greater inpatient mortality than those without diabetes or hyperglycemia. In a further subset analysis, death rates were seven-fold greater among those who did not have evidence of diabetes prior to admission, but developed hyperglycemia during their hospitalization.

The study also demonstrated that during a hospitalization for COVID-19, the presence of diabetes or hyperglycemia was associated with a longer hospital stay and slightly worse kidney function.

“I am now analyzing the same database to determine whether COVID-19 patients with diabetes and uncontrolled hyperglycemia, who were better controlled in the hospital, had better outcomes,” said Klonoff. If an association between greater survival and achieving target glycemia (following initial hyperglycemia) is demonstrated, and acted on, lives could be saved.

“These data may have wide implications for how we care for COVID-19 positive patients who experience hyperglycemia during their hospital stay or who have already been diagnosed with diabetes.”

The Surprising Place Where COVID-19 Can Appear

Posted on Apr 3, 2020 in Carousel, Pediatric Care, Quality, Safety, Scroll Images, Sutter Medical Center, Sacramento, Uncategorized

SACRAMENTO, Calif. – If your child is in diapers or is being potty-trained, don’t poo-poo this advice. During this coronavirus pandemic, it may just save your life or that of a loved one.

Paul Walsh, M.D., medical director of the Pediatric Emergency Department at Sutter Medical Center, Sacramento, says that babies and small children may not show any signs at all of being sick with COVID-19. But the “presents” they’re leaving behind may be especially harmful as they could contain traces of the virus.

Dr. Walsh said hand-washing during this time is important for everyone, but it’s critical for those who are changing diapers or potty-training toddlers.

“One of the cases that came out of China was a child who was orphaned at 6 months old because he was shedding lots of the coronavirus, but had no symptoms whatsoever,” he said. “So remember to wash your hands thoroughly after every diaper change or potty time.”

Dr. Walsh admits that everyone is at risk for catching the virus, but children usually handle such sicknesses much better than adults do.

“Children have vigorous immune systems,” Dr. Walsh says. “It’s not just with this virus, but with most colds and other sicknesses. Their bodies aggressively fight off the sickness.”

With the first death of an infant who tested positive for COVID-19, Dr. Walsh said parents shouldn’t be too anxious.

“There’s no need to freak out,” he said, “but be vigilant with hand-washing and social distancing. Observe your children in their activities. And, especially, keep them away from seniors. They’re still the most at risk.”

Dr. Paul Walsh treats a child in the dedicated Pediatric Emergency Department at Sutter Medical Center, Sacramento.

After Saving Teen’s Life, School Nurse Pleads for Training

Posted on Feb 7, 2020 in Cardiac, Pediatric Care, Scroll Images, Sutter Medical Center, Sacramento, Uncategorized

SACRAMENTO, Calif. – Kathy Papa, a school nurse with the Live Oak Unified School District, spreads her duties among five schools. It was luck – some may say fate or providence – that she was at Live Oak High School just after lunch on Jan. 13 when she got a call to go to English teacher Dani Fernandez’s classroom.

Use of AED
Pediatric electrophysiologist Dr. Oleg Kovalenko of Sutter Children’s Center demostrates how to use an AED.

When she arrived, she found 14-year-old Annalese Contreras slumped in her desk in full cardiac arrest, not breathing and without a pulse. Having been a hospital registered nurse, Kathy knew immediately what was wrong and what needed to be done, but never did she think she’d come upon this situation outside the hospital without a skilled team to assist her.

Kathy immediately sprung into action, starting rescue breaths, directing the 911 call, having two classmates get Annalese out of the desk and onto the floor so compressions could be started, and sending Fernandez to get the school’s portable defibrillator, called an AED. The school had it for years, but it had never been used. After a few successions of CPR, the AED arrived and Kathy applied the pads. The second shock did the trick and Annalese’s heart was back beating. She was then stabilized by EMTs and airlifted to the Sutter Medical Center Children’s Center. 

Annalese suffered cardiac arrest due to ventricular fibrillation, an event that is often fatal. Thanks to Kathy’s heroics and the care she received at the Sutter Children’s Center, Annalese is alive and now recuperating at home. Sutter Children’s Center pediatric electrophysiologist Oleg Kovalenko, M.D., pinpointed her ventricular arrhythmia and Annalese had a defibrillator called an ICD implanted by Sutter electrophysiologist Jonathan Man, M.D., to shock her heart into the correct rhythm when it detects irregular heartbeats.

“Cardiac arrest is an electrical abnormality in the heart. It leads to sudden death in many, many cases and leads to 2,000 deaths a year in children,” said Dr. Kovalenko, Sutter Medical Center’s medical director of pediatric electrophysiology. “In cardiac arrest, there’s no blood flow to your brain and your organs, and the longer a patient stays in this condition, the less chance of survival,” he said, noting that usually that’s just three to five minutes. “The only way to fix it is to shock.”

Annalese Contreras, center, was saved by school nurse Kathy Papa, left, who received the Heartsaver Hero Award from Liam Connelly of the American Heart Association.

Thankfully, Annalese received those shocks within a few minutes. For her efforts, Papa received a Heartsaver Hero Award from the American Heart Association. The AHA and Sutter Medical Center physicians urged all schools to have an AED on-site and train staff on CPR and how to use the defibrillator. Papa started working at the school district in 2019 and already had classes set up to train staff on both, and this event has made it even more important in the staff’s eyes.

As Dan Falco, co-medical director of the Sutter Medical Center Children’s Center said, “That school nurse is the real hero here.” However, Papa was quick to point out that the quick action on the part of Fernandez and the two classmates got Annalese out of the desk are heroes, too.

Annalese’s parents are so grateful to the school and Sutter Children’s Center staff for saving their daughter’s life that they traveled from Live Oak to the hospital to thank them personally and shared their thanks publicly through the media.

“I’d just like to give thanks to everybody – the school, the nurse, the emergency room, the ambulance, the helicopter, the EMS and the hospital – because if it wasn’t for all of them, my daughter wouldn’t be here today,” said Annalese’s father, Felipe Contreras. “I consider all you guys heroes.”

As for Papa, she had a plea: “I want the public to be aware that anyone can save a life, and it just takes a day of training or even just a few hours so that you know what to do in case of an emergency. And,” she said, holding up a portable AED, “this awesome device saves lives. And we all can see that that has happened.”

Here is a video of this story from Fox 40 in Sacramento.

Colorful Baby Keepsake Doubles as Medical Diary

Posted on Jan 8, 2020 in California Pacific Medical Center, Pediatric Care, People, Quality, Scroll Images

“Tiny Victories of Life” beads track critically ill and premature infants’ medical journeys

SAN FRANCISCO, Calif. – At Sutter’s California Pacific Medical Center (CPMC) Van Ness Campus hospital, Child Life Specialists help parents mark their critically ill or premature newborns’ milestones using colorful beads and charms with the “Tiny Victories of Life” program.

Just ask new mom Amanda Bates about her son Asher’s Tiny Victories strand of beads.

“Each bead that has a figure represents an achievement of that day,” says Bates, while holding a string with nearly 40 beads.

Critically ill and premature babies at CPMC spend their first weeks or months fighting to achieve crucial health markers. Child Life Specialists use the aptly-named “Tiny Victories of Life” program as visual storytelling to document and celebrate each baby’s remarkable journey.

Amanda Bates’ son Asher, who arrived six weeks early, is steadily hitting important milestones that babies in the hospital’s Neonatal Intensive Care Unit (NICU) are required to reach before discharge.

The program was started in 2016 by hospital Child Life director, Lori Denault, who modeled it after “Beads of Courage,” a similar national initiative that tracks patient progress using beads. (Sutter Medical Center in Sacramento participates in Beads of Courage.)

Blue beads represent individual days, while special charms represent significant or personally meaningful achievements such as a duck charm for baby’s first bath or a music note each time baby receives music therapy. Asher’s Tiny Victories strand includes a red bead to mark meeting Santa Claus because he spent his first Christmas in the hospital.

The Tiny Victories of Life program encourages parents to forge a strong bond with their newborns—which can be a challenge when a baby is very ill and must remain in the hospital for a long period of time after birth. Beads are added to the strands each week during one-on-one family sessions or at a NICU parent group meeting.

Bates Family
Kyle and Amanda Bates pose with baby Asher at Sutter’s California Pacific Medical Center (CPMC) Van Ness Campus hospital.

CPMC Child Life Specialist Shannon Banahan says, “Tiny Victories is a way for parents to look forward to the progress their baby is making. Families can get overwhelmed in thinking about the long and seemingly never-ending days in the NICU. But once they look back on their beads and see how far their baby has come, it feels like there’s an end in sight and makes them hopeful and proud.”

On Asher’s discharge day, he received the final bead in his strand—the butterfly bead, which signifies he’s ready to spread his wings.

“Receiving the butterfly bead is always emotional for parents, both because they are leaving this community of nurses and new parent friends and also because they are finally being able to start this new chapter of life at home with baby,” says Banahan.

Fourteen Sutter Hospitals Honored for Reducing C-Sections

Posted on Dec 13, 2019 in Pediatric Care, Quality, Scroll Images, Uncategorized, Women's Services

Cal Hospital Compare award recognizes hospitals meeting national goal.

SACRAMENTO, Calif. — Sutter hospitals, which have among the lowest cesarean section (C-section) rates in California, were recognized today by the California Health and Human Services Agency (CHHS) for reducing cesarean births for first-time moms with low-risk pregnancies. Fourteen hospitals at the not-for-profit health care network were named to the state’s 2019 Maternity Care Honor Roll, nine of which have been recognized on this honor roll for four consecutive years. Dr. Mark Ghaly, Secretary of CHHS, announced the honor roll recognition on behalf of Cal Hospital Compare, a performance reporting initiative informed by representatives from hospitals, purchasers, health plans, and consumer groups. The following Sutter hospitals were named to the 2019 Maternity Care Honor Roll:

  • Alta Bates Summit Medical Center – Alta Bates Campus 
  • California Pacific Medical Center – Mission Bernal Campus 
  • Eden Medical Center 
  • Memorial Medical Center 
  • Memorial Hospital Los Banos
  • Mills-Peninsula Medical Center 
  • Sutter Davis Hospital 
  • Sutter Delta Medical Center 
  • Sutter Lakeside Hospital 
  • Sutter Maternity & Surgery Center of Santa Cruz 
  • Sutter Medical Center, Sacramento 
  • Sutter Roseville Medical Center 
  • Sutter Santa Rosa Regional Hospital 
  • Sutter Solano Medical Center

“Improving the quality of patient care in hospitals is critically important,” said CHHS Secretary Dr. Mark Ghaly. “These annual measurements through Cal Hospital Compare allow us to acknowledge hospitals doing excellent work.”

When complications arise during pregnancy, C-sections can save the lives of mothers and infants, but some women undergo the surgery for no medical reason, exposing both mother and baby to potentially avoidable risks. To respond to the rise in unnecessary C-sections, the U.S. Department of Health and Human Services adopted the Healthy People 2020 target of reducing nationwide C-section rates for low-risk, first-births to 23.9 percent. The Maternity Care Honor Roll acknowledges hospitals that have achieved—and in many cases gone beyond—that goal. The Sutter Health system NTSV C-section Rate for a rolling 12 months ending October 31, 2019 was 20.8 percent, well below the 23.9 national goal.

“Over the last decade, Sutter Health has developed and implemented many programs to improve the care and safety of mothers and babies through pregnancy, labor and delivery,” said Sutter Health Chief Medical Officer Stephen Lockhart, M.D., Ph.D.. “We’ve worked hard to enhance quality and safety at our hospitals to ensure we have among the lowest C-section rates in California, rates which are experienced equitably by mothers of all races and ethnicities—so it’s especially gratifying to receive recognition for leadership in this area.”

Sutter hospitals consistently outperform state and national averages for many measures of quality, and Sutter Health is committed to accurately and transparently sharing quality data with patients. The Sutter Hospital Quality Dashboard allows patients to learn more about the care provided throughout Sutter’s integrated network. In addition, patients are encouraged to talk with their doctors and nurses about any questions or specific outcomes related to their care.

Expectant Mom Suffers Massive Stroke: How a Health Network Saved Her and Her Baby

Posted on Oct 25, 2019 in Affiliates, Carousel, Expanding Access, Innovation, Neuroscience, Pediatric Care, People, Quality, Scroll Images, Sutter Davis Hospital, Sutter Medical Center of Santa Rosa, Sutter Roseville Medical Center, Women's Services

Just two days from delivering her third child, Vivian Dos Santos suffered an intracerebral hemorrhage – a life-threatening stroke. Watch her amazing story, with details on how an integrated health network saves and blesses lives, by viewing the following video. You may want some tissues handy just in case …

For more on her story, and to view an infographic on Sutter’s integrated system, go to www.sutterhealth.org/newsroom/can-expect-integrated-network.