Spring 2011 - netdna
Transcription
Spring 2011 - netdna
CONCUSSION l NOONAN SYNDROME l NEW CWPW AFFILIATIONS l ADD l CWPW MEDICAL RESEARCH l CWPW ADVERTISING & PR CWPW Children’s &Women’s Munger Pavilion, Room 123 • Valhalla, New York 10595 Physicians of Westchester, LLP The la r ges t g r oup of pediatr ic spec ialists o f its kind in the region. COMPREHENSIVE CARE FOR INFANTS, CHILDREN AND YOUNG ADULTS SPRING 2011, VOL. 1, NO. 4 CONCUSSION SPECIALTIES Can Have Drastic Consequences ADOLESCENT MEDICINE T The lar ges t group of pediatric spe cia lists of its kind in the re g ion. Westchester County 19 Bradhurst Avenue, Suites 1400, 2400 &2550 Hawthorne, NY 10532 • Cardiology – (914) 594-4370 • Endocrinology – (914) 366-3400 • General Pediatrics – (914) 493-7235 • Hematology/Oncology – (914) 493-7997 • Infectious Disease – (914) 493-8333 • Medical Home – (914) 594-4602 • Nephrology – (914) 493-7583 • Neonatology Follow-Up Program – Referral Only • Pediatric Surgery – (914) 493-7620, (914) 761-5437 • Psychology – (914) 493-7697 • Pulmonology/Allergy – (914) 493-7585 • Rheumatology – (914) 594-4835 503 Grasslands Road, Suite 200 & 201 Valhalla, NY 10595 • Adolescent Medicine – (914) 304-5300 • Developmental – (914) 304-5250 • Gastroenterology – (914) 367-0000 • Medical Genetics/Metabolic – (914) 304-5300 Medical Service Building at Phelps Memorial Hospital 755 North Broadway, Suite 400 & 540 Sleepy Hollow, NY 10591 • Endocrinology – (914) 366-3400 • Neurology – (914) 358-0188/0190 Briarcliff Pediatric Associates 755 North Broadway, Suite 500 Sleepy Hollow, NY 10591 • General Pediatrics (914) 366-0015 Pediatrics Sleepy Hollow 241 North Broadway, Suite 201 Sleepy Hollow, NY 10591 • General Pediatrics (914) 332-4141 Sound Shore Medical Center 16 Guion Place New Rochelle, NY 10802 • Cardiology – (914) 594-4370 • Endocrinology – (914) 366-3400 • Hematology/Oncology – (914) 365-3065 1 2 3 4 5 6 CWPW • The Children’s Rehabilitation Center 317 North Street, White Plains, NY 10605 • Neonatology – (914) 597-4080/4115 Eastchester Pediatric Medical Group 266 White Plains Road Eastchester, NY 10709-4423 • General Pediatrics – (914) 337-3960 Croton Pediatrics 1130 Grand Street Croton on Hudson, NY • General Pediatrics (914) 271-4727 Rockland County North Rockland Pediatric Associates 171 Ramapo Road, Suite 4 Garnerville, NY (845) 947-1772 Suffern Medical Pavilion at Good Samaritan Hospital 255 Lafayette Avenue, Suite 370 & 390 Suffern, NY 10901 • Cardiology – (914) 594-4370 • Endocrinology – (914) 366-3400 • Gastroenterology – (914) 367-0000 • Medical Genetics/Metabolic – (914) 304-5300 • Neonatology Follow-Up Program – Referral Only • Neurology – (914) 358-0188/0190 • Pulmonology – (914) 493-7585 Pomona Pediatrics 4 Medical Park Drive Suite C Pomona, NY • General Pediatrics (845) 362-0202 Pediatrics and Adolescent Medicine of New City 337 North Main Street New City, NY • General Pediatrics (845) 634-7900 Orange County Orange Specialty Center 100 Crystal Run Road, Suite 108 Middletown, NY 10941 • Cardiology – (914) 594-4370 • Developmental – (914) 304-5250 7 8 9 10 11 12 13 14 • Endocrinology – (914) 366-3400 • Gastroenterology – (914) 367-0000 • Hematology/Oncology – (914) 493-7997 • Medical Genetics/Metabolic – (914) 304-5300 • Neonatology Follow-Up Program – Referral Only • Neurology – (914) 358-0188/0190 • Pulmonology – (914) 493-7585 Herbert Kania Pediatric Group 10 Ronald Reagan Blvd. Warwick, NY 10990 • General Pediatrics – (845) 986-2058 Medical Center of New Windsor 575 Hudson Valley Avenue, Suite 203 New Windsor, NY 12553 • Cardiology – (914) 594-4370 • Gastroenterology – (914) 367-0000 • Pulmonology – (914) 493-7585 Dutchess County Pediatric Sub-Specialty Center at Vassar Brothers Medical Center 45 Reade Place Poughkeepsie, NY 12601 • Cardiology – (914) 594-4370 • Gastroenterology – (914) 367-0000 • Hematology/Oncology – (914) 493-7997 • Medical Genetics/Metabolic – (914) 304-5300 • Pulmonology – (914) 493-7585 104 Fulton Ave, Poughkeepsie, NY 12601 • Neurology – (914) 358-0188/0190 Bronx County Woodlawn Medical Arts Building 4350 Van Cortlandt Park East Bronx, NY 10470 • Cardiology – (914) 594-4370 • Developmental – (914) 304-5250 • Endocrinology – (718) 231-6565 • Gastroenterology – (914) 367-0000 • General Pediatrics – (718) 231-6565 • Hematology/Oncology – (347) 226-6437 • Medical Genetics/Metabolic – (914) 304-5300 15 16 17 • Neurology – (914)358-0188/ (347) 226-6437 • Pulmonology – (914) 493-7585 Southern Connecticut Pediatric Gastroenterology 149 East Avenue, Suite 39, Norwalk, CT 06851 • Gastroenterology – (203) 853-7170 Children’s and Women’s Physicians of Westchester, LLP at Danbury 67 Sandpit Road Danbury, CT 06810 • Cardiology – (914) 594-4370 • Gastroenterology – (914) 367-0000 • Medical Genetics/Metabolic – (914) 304-5300 Watson Building at Greenwich Hospital 5 Perry Ridge Road, 2nd Floor Greenwich, CT 06830 • Endocrinology – (914) 366-3400 • Gastroenterology – (914) 367-0000 • Medical Genetics/Metabolic – (914) 304-5300 Children’s Specialty Center at Norwalk Hospital 30 Stevens Avenue Norwalk, CT 06856 • Cardiology – (914) 594-4370 • Gastroenterology – (914) 367-0000 • Pulmonology – (914) 493-7585 19 20 21 22 18 V i s i t O u r W e b S i t e f o r A d d i t i o n a l I n f o r m a t i o n : w w w. c w p w. o r g here are numerous advantages to headache and lack of concentration and students playing sports in school. judgment to loss of memory and poor Physical activity keeps them fit. Sports balance and coordination. bolsters self-esteem, and healthy “Since most victims do not suffer a loss competition builds character, promotes of consciousness with concussion, it can camaraderie, leads to lasting friendships, be overlooked as just a minor incident, or and allows children to set and reach goals. ignored altogether,” explains Carey S. There are caveats, however. Aside from Goltzman, MD, FAAP, Chief of Pediatric the risks of everyday sports injuries, Critical Care Medicine at CWPW. another looming threat to children on the “Symptoms of a concussion range playing field, basketball from subtle to court or playground is obvious and usually “All concussions are concussion. happen right after Concussion is serious, and all athletes the injury but may defined as any injury to with suspected concussions take hours to days the brain that disrupts to show up.” With should not return to play most concussions, normal brain function until they see a doctor,” the player is not on a temporary or permanent basis. knocked out or Dr. Goltzman advises. Typically resulting from unconscious. A a blow or jolt to the number of athletes head, concussion can actually alter the way who have had concussions may report the brain functions, and can have a number feeling normal before their brain has of deleterious effects. These can range from fully recovered. CARDIOLOGY CRITICAL CARE DEVELOPMENTAL PEDIATRICS ENDOCRINOLOGY “Concussions can happen in any sport but more often occur in collision sports, such as football, rugby, or ice hockey,” Dr. Goltzman says. They also are common in contact sports that don’t require helmets, such as soccer, basketball, wrestling, and lacrosse. However, a concussion can also occur from a collision with the ground, a wall, a goalpost, or a ball that has been thrown, hit, or kicked. Many concussions also occur outside organized sports. For example, a child riding a bike or skateboard can fall down and bump his head on the street or an obstacle. About 375,000 children and teens are treated in emergency rooms annually just for basketball injuries alone (basketball is the most popular competitive school sport). “All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor,” Dr. Goltzman advises. “A doctor can confirm the diagnosis of concussion based on clinical presentation and can determine the need for any specialized tests, such as a CT scan of the brain, MRI of the brain, or neuropsychological tests and then decide if it is OK for an athlete to return to play.” Prematurely returning to play after a concussion, he adds, “can lead to another concussion or potentially a GASTROENTEROLOGY GENERAL PEDIATRICS HEMATOLOGY/ ONCOLOGY INFECTIOUS DISEASE & IMMUNOLOGY MEDICAL GENETICS NEONATOLOGY NEPHROLOGY NEUROLOGY PEDIATRIC SURGERY PSYCHOLOGY PULMONOLOGY, ALLERGY & SLEEP MEDICINE RESEARCH RHEUMATOLOGY continued on page 3 CWPW • www.cwpw.org A MESSAGE FROM The President A t Children’s & Women’s Physicians of Westchester, our goal has always been to provide the highestquality medical care in a range of specialties for Leonard Newman, MD infants and children throughout the Hudson Valley and beyond. With some of the finest physicians in the country working with us, our strong affiliations with major health care institutions from Albany to New York and Connecticut, and our state of the art medical practice, we are able to meet and exceed our mission of delivering comprehensive medical care for infants, children and young adults every day. At Children’s & Women’s Physicians of Westchester, we always put the health and wellbeing of our patients first. We’re proud of the fact that we have some of the finest physicians anywhere, as well as superior subspecialty care that addresses virtually every conceivable childhood illness or condition. Medical care only gets more complex with time, and our doctors are at the forefront of advances in pediatric medicine to diagnose and treat every child. Over the winter we’ve taken some positive moves that are already going a long way toward making CWPW even better. We’ve added several new satellite offices to CWPW in order to broaden our service area and treat even more children in the lower Hudson Valley region. We’re pleased to report that Croton Pediatrics has joined the CWPW family of pediatric continued on page 3 CWPW Spring 2011 Vol. 1, No 4 CWPW Newsletter is published four times a year by Children’s & Women’s Physicians of Westchester, LLP. Munger Pavilion, Room 123, Valhalla, NY 10595 • Phone: 914-594-4280 Fax: 914-594-3693 • www.cwpw.org Leonard Newman, MD: President Michael H. Gewitz, MD: Vice President Gerard Villucci: Chief Executive Officer Publisher: Yaeger Public Relations Editor: Harold Clark Art Director: Denise Stieve 2 NEW CWPW AFFILIATIONS CROTON PEDIATRICS G lenn J. Belkin, DO, FAAP, has enjoyed a long and respected relationship with CWPW and its president, Leonard Newman, MD. In fact, Dr. Belkin has known Dr. Newman since 1982 and worked with CWPW for over eight years, providing subspecialty care in the area of Pediatric Developmental Behavioral Medicine. Now, Dr. Belkin and his medical practice, Croton Pediatrics in Croton on Hudson, New York, officially operates under the CWPW umbrella. “Everyone is happy with this arrangement,” Dr. Belkin explains. With Croton Pediatrics’ affiliation with CWPW, the practice can focus on general pediatric medicine while Dr. Belkin concentrates more on pediatric behavioral medicine. In addition to Dr. Belkin, his wife, Patricia Belkin, serves as a lactation consultant for new mothers. Pediatrician Haeyoung Ko Hwang, MD, FAAP, FAAAAI, also with the practice, has a subspecialty in pediatric allergy and immunology. Dr. Hwang is Assistant Professor of Pediatrics at New York Medical College. Formalizing the arrangement with CWPW means less administrative work for Dr. Belkin, and more time to treat children. “I like to take care of children, and this arrangement allows me to do that,” Dr. Belkin states. For 12 years he served as Community Pediatrics Chief with CWPW, “so this is a natural evolution,” he says. Dr. Hwang says “the arrangement allows for greater commitment to patients and their families. I am looking forward to contributing to the warm, welcoming atmosphere here while providing quality care for the children.” Croton Pediatrics is located at 130 Grand Street, Croton on Hudson, New York. (914) 271-4727. PEDIATRICS OF SLEEPY HOLLOW T his is proving to be an expansive year for CWPW. Pediatrics of Sleepy Hollow, a four-physician primary pediatric practice in Westchester County, recently joined the CWPW family of regional offices. Leonard Newman, MD, President of CWPW, made the announcement. The practice consists of Drs. Harry R. Lubell, Margaret Stillman, Caroline Cho and Emily Koelsch. Pediatrics of Sleepy Hollow, located at 245 North Broadway, Suite 201 in Sleepy Hollow, New York, (914) 332-4141, treats patients from infancy through age 21, with an emphasis on primary care. The arrangement with CWPW allows the practice to focus on quality pediatric medicine while operating under the auspices of a larger overseeing organization. Dr. Lubell, a partner in the Sleepy Hollow, office explains: “We were looking into partnering with larger umbrella groups, seeing the benefit for a small group to prosper in these changing and difficult economic times. This partnership also allows us to move forward with modern technology to better serve our patients.” Dr. Lubell adds: “Our practice already had a strong relationship with Maria Fareri Children’s Hospital and with a number of subspecialists from CWPW. We have known Dr. Newman and Dr. Gewitz for many years, so when they presented this partnership to us last year we could see that it was a natural and good fit. This arrangement allows us to keep our identity as a small practice, yet have the resources of a large pediatric organization like CWPW.” “The relationship with CWPW opens up more opportunities for us and increases our exposure to subspecialty care for our patients,” Dr. Ronan states. “It’s a win-win situation for everyone, particularly for our patients, who will continue to be well served.” POMONA PEDIATRICS T he CWPW family of regional offices continues to expand with the integration of Pomona Pediatrics into the group. Pomona joined with CWPW as of February 1; the announcement was made by Leonard Newman, MD, President of CWPW. The Rockland County-based practice has four full-time physicians and one part-time doctor on staff. Jesse Hackell, MD, FAAP, is joined by William Greenberg, MD, Gerald Vogel, MD, Evan Weissman, DO, and Lorna Sackler, MD. Practicing in Rockland County since 1981, and forming Pomona Pediatrics with Dr. Greenberg six years later, Dr. Hackell says the arrangement with CWPW “was a no-brainer” and that his familiarity with Dr. Newman and many of the physicians at CWPW made the decision an easy one. “Getting big is the only way to survive these days,” Dr. Hackell points out. “CWPW had a process that was very conducive to what we were looking for.” Within two months of their initial merger discussions, Dr. Hackell’s group signed on with CWPW. “They’ve been very supportive in terms of all organizational efforts. It has been an easy transition.” Dr. Hackell practices general pediatrics, and has a special interest in treating pediatric ADHD. The arrangement with CWPW “is absolutely the way to go,” he insists. “This positions us well in the county and in this region.” CWPW’s experience in practice management will prove advantageous to Pomona Pediatrics, Dr. Hackell insists. “They have access to things that we cannot get, and that’s very helpful. It’s a great concept, and a great group of people and it’s evident in the kind of medical care they provide. Our comfort level is very high.” Pomona Pediatrics is located at 4 Medical Park Drive, Suite C, in Pomona, New York, (845) 362-0202. PEDIATRIC AND ADOLESCENT MEDICINE OF NEW CITY C WPW continues to broaden the number of regional offices throughout the Lower Hudson Valley by the addition of Pediatric and Adolescent Medicine of New City, with Joshua E. Chesir, MD, FAAP & Sharon Ronan, MD, FAAP. Located at 337 North Main Street in New City, New York, (845) 634-7900. Dr. Chesir has been in practice in New City since 1987. Drs. Chesir and Ronan have a medical staff of eight, providing a full range of pediatric medicine to children and adolescents, with added expertise in childhood asthma and other lung disorders.“I’ve been looking at pediatric medical groups for some time, and finally decided that a relationship with CWPW would be mutually beneficial,” Dr. Chesir explains. “Our intention is to continue to provide state-of-the-art medical care to children and adolescents in this region, while at the same time being able to take full advantage of the range of subspecialties provided through CWPW.” Dr. Chesir adds that he has known CWPW President Leonard Newman, MD, for some time, and that “the arrangement just makes sense.” Dr. Chesir is an Attending Physician at Good Samaritan Hospital and Nyack Hospital, and is an Associate Clinical Professor of Pediatrics at New York Medical College. Prior to joining Dr. Chesir’s practice, Dr. Ronan worked for several years at Orangetown Pediatrics in Tappan, New York, as well as at Essex-Morris Pediatric Group in Livingston, New Jersey. She is a graduate of Sackler School of Medicine in Tel Aviv, Israel, and completed a pediatric residency at Morristown Memorial Hospital in Morristown, New Jersey. “The relationship with CWPW opens up more opportunities for us and increases our exposure to subspecialty care for our patients,” Dr. Ronan states. “It’s a win-win situation for everyone, particularly for our patients, who will continue to be well served.” CWPW Named Chief of Pediatric Hematology/Oncology M itchell S. Cairo, MD, a highly respected pediatric cancer specialist, educator and researcher, has been named Chief of Pediatric Hematology/Oncology and Stem Cell Transplantation, and Director of the Childhood and Adolescent Cancer and Blood Diseases Center at CWPW. Leonard Newman, MD, President of Mitchell S. Cairo, MD CWPW, announced the appointment. Dr. Cairo has special expertise in pediatric bone marrow transplantation, immunology, leukemia and lymphoma. He has also been cited for several years by Castle Connolly Medical Ltd. as among New York’s Top Doctors and America’s Top Doctors. “It’s a big move for me,” Dr. Cairo states, adding that he is bringing about a dozen medical professionals with him to CWPW. Prior to joining CWPW, Dr. Cairo was Professor of Pediatrics, Medicine, and Pathology and Cell Biology at Columbia University Medical Center. Dr. Cairo was also Director, Pediatric Blood and Marrow Transplantation, Children's Hospital of New YorkPresbyterian, Morgan Stanley Children’s Hospital. CWPW • www.cwpw.org “Any worsening of concussion symptoms or changes in behavior (e.g., agitation, significant brain grogginess, disorientation),” he adds, injury that could “should be immediately reported to lead to death. An your physician. “The best advice with any head injury,” athlete with a Dr. Goltzman says, “is that it should never history of a be ignored, no matter how major or minor singular or it may be considered to be.” multiple Mitigating harm to the head is key in concussion(s) Carey S. Golyzman, MD preventing concussion, Dr. Goltzman may be more susceptible to another injury than an athlete insists. “Not all concussions can be prevented, but some may be avoided,” without a history of concussion.” he says. Helmets should be worn for any The best treatment for a concussion is complete rest from all physical and mental riding activities (like horseback, all terrain activity, Dr. Goltzman says. “Children may need frequent monitoring but there is no need for wake-up checks during sleep.” Access to loud music, computer, and TV should be limited or stopped if they increase the symptoms. School attendance and work may need to be modified. Students need to be excused from physical education/gym class or recess activities. Concussion MITCHELL S. CAIRO, MD Dr. Cairo’s additional current appointments are with New York Medical College, where he is professor of Pediatrics, Medicine, Pathology, Micro-Biology, Immunology, and Cell Biology and Anatomy, and Maria Fareri Children’s Hospital at Westchester Medical Center. He brings a strong research background to CWPW, having been the principal or co-principal investigator of a dozen clinical research studies and a contributor to nearly 300 peer-reviewed publications. He has a particular interest in cellular therapies including bone marrow transplantation for childhood cancers and blood disorders, as well as childhood hematological malignancies such as acute leukemias and lymphomas. He will also lead a new research team at New York Medical College that will search for more effective cancer and blood disorder treatments. Dr. Cairo is widely published, sits on the editorial board of several distinguished publications, and is a member of numerous boards as well as national and international associations. CWPW continued from page 1 vehicle [ATV], motorbike, bike, skateboard, or snowboard) or contact sports (like football, hockey, or lacrosse). Helmets should fit appropriately and be in good condition. Athletes should be taught safe playing techniques and to follow the rules of the game. “Most importantly,” he states, “every athlete needs to know how crucial it is to let their coach, athletic trainer, or parent know if they have hit their head or have symptoms of a head injury — even if it means stopping play. Never ignore a head injury, no matter how minor.” CWPW A Message From The President continued from page 2 practices. In addition, Pomona Pediatrics and Pediatrics of Sleepy Hollow have become members of our pediatric group, as has Pediatric and Adolescent Medicine of New City. These fine practices will continue to provide outstanding medical care to children in Westchester and Rockland counties, with the added medical and administrative support and expertise of CWPW. Sports injuries have been in the news lately, and in this newsletter we offer insight into the all-too common but “Finally, as we continue to grow, we want to reach out in new and exciting ways to families in our region.” misunderstood condition of concussion — what it is, how to detect it, what to look for, and how to treat it. We also take a serious look at Noonan Syndrome, a genetic disorder that is not often talked about but that affects many children. There has been a lot of discussion lately about Attention Deficit Disorder, or ADD, and here we examine the condition and offer ways to help you determine whether your child might have ADD. We also highlight some of the physicians associated with CWPW and look at their research endeavors. Finally, as we continue to grow, we want to reach out in new and exciting ways to families in our region. As part of this effort we are launching a creative advertising and public relations to spread the word about CWPW. As part of this effort we recently ran full-page ads in Westchester Magazine promoting our services, and one to mark Heart Health Month. We’ve reproduced the ads here to show you what we’ve done. Look for more in the near future. As always, if you have a question, comment or a story you’d like to see in an upcoming issue, email us at [email protected]. Enjoy the season! CWPW www.cwpw.org • CWPW 3 ADD Paying Attention Is Key to Treatment ediatric ADD, or Attention Deficit Disorder, should not be ignored or overlooked. Children who appear absent-minded, unfocused, seem to be daydreaming or have a short attention span may actually have this serious but treatable syndrome. What we know today as ADD, which affects between five and seven percent of children, was first recognized in the 1960s, explains William Levinson, MD, Chief of Developmental Pediatrics at CWPW. Known initially by other clinical labels such as MBD, or Minimal Brain Dysfunction, ADD emerged as an all-encompassing term to describe children with symptoms ranging from short attention span and an inability to focus, to hyperactivity, forgetfulness, and difficulty following directions. “I prefer to take a functional approach to ADD,” Dr. Levinson says. “If a child’s behavior is getting in the way at school, at home, socially or with his or her peers, and the behavior meets the clinical criteria, then it’s important to have it investigated.” Determining who has ADD is the first step toward treatment. Dr. Levinson says a continuous performance test like the IVA test, which gauges visual and auditory responses, or an EEG, a study of brain waves, can help to determine whether a child has ADD. The syndrome is not new, he points out, but it has gained greater recognition and acceptance in recent years. It’s difficult to gauge which children will suffer from ADD, and who is most susceptible. Dr. Levinson notes, however, that studies indicate that premature babies are at slightly higher risk, and a family history of ADD might also contribute to a child having ADD. Lead poisoning can be a factor as well, as can certain thyroid conditions. The school setting is crucial in making the ADD diagnosis, Dr. Levinson says, enabling teachers to observe a child’s activities and behavior. “Most parents who come to us — usually when the child is in kindergarten or the first grade — tell us the teacher notices that the child is not focusing like the rest of the class,” he explains. “They may NOONAN SYNDROME affected by it. These children tend to be much shorter than their peers. Some children with NS can also exhibit marked feeding problems in infancy. “That’s what drives parents crazy,” she notes. “These children don’t gain weight, and it’s very frustrating for parents.” Because of the variability in the symptoms, the age of diagnosis is also variable. Some may be diagnosed right after birth (likely if there is a heart murmur or heart abnormality noted early on), but in some cases children are not diagnosed with NS until later in childhood, adolescence or even adulthood. For example, babies may present with significant swelling of the hands and feet and widening of the neck with or without congenital heart disease, while other individuals may present in adulthood only after their child is diagnosed with NS. P Features Distinct Characteristics Y ou may never have heard of Noonan Syndrome, or NS, but it is a fairly common congenital genetic condition, with an estimated incidence of one child in every 1,000 to one in every 2,500 live births. Alicia A. Romano, MD, a Alicia A. Romano, MD pediatric endocrinologist in CWPW, is considered an international expert in NS, having both research and clinical experience involving this condition. As a subspecialist at CWPW she is called upon to help diagnose, develop treatment plans, and work with other physicians involved in the care of children with NS.. Dr. Romano was the leading author of a succinct yet far-reaching article published recently in the prestigious medical journal Pediatrics. In the article, Dr. Romano and her expert colleagues describe the clinical features, diagnostic considerations and management guidelines based on the latest medical evidence. “The article is an important tool for primary care practitioners,” Dr. Romano says. “Not only are they often responsible for identifying the condition, but for coordinating all of the facets of care for these children and their families. Their care is truly multidisciplinary, often requiring multiple subspecialists as well as other services such as physical therapy, speech and feeding therapy, etc.” According to Dr. Romano, NS is characterized by distinctive facial features, short stature, and congenital heart disease. “It’s not always easy to diagnose because there’s a lot of clinical variability,” she explains. “Some children have no heart issues, and only some facial features that may blend in with other children,” Dr. Romano says. Some individuals with NS have normal stature, but short stature can be problematic for those 4 CWPW • www.cwpw.org “It’s not always easy to diagnose NS because there’s a lot of clinical variability,” Dr. Romano explains. NS is caused by a mutation or change in one of several genes, the most common of which is the PTPN 11 gene. Although great strides have been made in the molecular understanding of the condition, a mutation can be detected in about 70% of the cases. That is, 30% of those who seem to have NS will have no detectable change in their genes to explain their clinical features. “Even if all of the genetic tests come back negative, the child can still have NS,” Dr. Romano says. “So until the remaining gene mutations are identified, ultimately NS is a clinical diagnosis.” In about half of those affected, the gene change is the result of a spontaneous mutation. This means that neither parent has the gene change and the have to repeat directions or requests, and they might have trouble with multiple requests.” Treatment for ADD can involve a range of options. “We try to get a multi-faceted treatment plan in place for the child,” Dr. Levinson says. “Medication may be indicated, and we can build in a counseling component for the individual and the family.” The school can be involved as well, he adds, by “modifying the teaching environment,” which can include preferential seating for the ADD child. “The learning environment is probably the most stressful for attention span,” Dr. Levinson says, “so teachers’ input is most valuable” in diagnosing and helping the ADD child. Most schools have in-house services to help teachers to recognize ADD and to help the afflicted child. CWPW child’s mutation is due to “happenstance” so to speak. Once the diagnosis of NS is considered, the child is typically referred to a geneticist for confirmation. Acknowledgement of the condition dates to 1962, when pediatric cardiologist Jacqueline A. Noonan, MD, from the University of Kentucky Medical Center, identified a group of children with similar facial features, short stature, chest deformities, and congenital heart defects. The facial features often provide clues to the diagnosis in infancy, Dr. Romano states. These include a large forehead, narrow temples, small face with wide-spaced eyes, a short, broad nose, low-set ears that are oval in shape, distinctive lips, and a short neck with excessive skin. The eyes are frequently a strikingly beautiful blue color. These features can change with age and appear different toward adolescence, she adds. There is no single treatment for NS; individual conditions such as growth failure, cardiac or feeding issues are addressed by subspecialists. The Noonan Syndrome Support Group (TNSSG), based in Baltimore, is an organization that offers support for those affected by NS. Dr. Romano has lectured at international meetings of TNSSG, where groups of children, adolescents and adults convene with health experts to share insights into and experiences of living with NS. “Children with NS can get teased a lot,” Dr. Romano says, mostly because of their short stature. Facial differences may also set them apart, which can make living with NS challenging. “They’re delicious kids,” Dr. Romano says of the NS patients she’s treated. Making the NS diagnosis answers lots of questions for families of NS children, and opens doors to proper treatment. “Part of the importance in making the diagnosis is so parents know what to expect, and to make sure they get the treatment and the services they need,” Dr. Romano explains. “The management guidelines in Pediatrics were developed to facilitate the diagnosis and promote optimal care.” CWPW CWPW PHYSICIANS Conducting Important Medical Research Some of the finest pediatric subspecialty care physicians in the region are associated with CWPW. Many of these respected doctors have conducted or are undertaking important leadership roles in the advancement of child medicine through research efforts on the state or national level. Additionally, many CWPW physicians belong to or serve on committees and organizations dedicated to promoting child health and well-being. Praveen Ballabh, MD Sergio G. Golombek, MD Neonatology Neonatology Dr. Ballabh has been involved in a considerable amount of research, and has a number of ongoing research efforts. He is Primary Investigator in a $1.4 million NIH grant running through 2014 to study white matter injury after brain hemorrhage of premature rabbits and humans. A second NIH grant, in which Dr. Ballabh is Primary Investigator, runs through 2011 and studies elevated chondroitin levels in newborns. Also under way is an American Heart Grant in aid running through 2012. Dr. Ballabh has completed research efforts for Pfizer, the Maria Fareri Children’s Hospital Foundation, the NIH, Q Therapeutics, United Cerebral Palsy, as well as independent research. Dr. Golombek is Associate Professor of Pediatrics and Clinical Public Health at New York Medical College. He is an attending Neonatologist at the Regional Neonatal Center of the Maria Fareri Children’s Hospital at Westchester Medical Center. He is the past president of the New York Perinatal Society, member of the American Academy of Pediatrics, the Society for Pediatric Research, the American Public Health Association and the Ibero-American Society of Neonatology. Markus Erb, MD Cardiology Dr. Erb is a Pediatric Cardiologist with CWPW, as well as Director of the Cardiac Catheterization Lab and Director of Pediatric Interventional Cardiology at Maria Fareri Children’s Hospital at Westchester Medical Center. He is a member of the American Heart Association/ Cardiovascular Disease in the Young and is currently President of the Pediatric Cardiology Society of Greater New York. Dr. Erb is also Assistant Professor of Pediatrics at New York Medical College. Dr. Erb’s areas of research interest include Investigational Device Use: Amplatzer Occluder Devices for Congenital Heart Defects, having served as a Principal Investigator in RESPECT (Randomized Evaluation of Recurrent Stroke, Comparing PFO Closure to Established Current Standard of Care Treatment). Among his philanthropic pursuits is serving on the Board of Directors of the Make-A-Wish Foundation of the Hudson Valley. His research has included the use of inhaled nitric oxide in newborn babies (for pulmonary hypertension in term and late-term infants, and for prevention of chronic lung disease in preterm infants). In addition, Dr. Golombek participated as a Site-PI in the NIHsponsored trial “NO-CLD,” published in the New England Journal of Medicine in 2006 He served as a co-PI with Edmund La Gamma, MD in a National Institute of Neurological Disorders and Stroke (NINDS)sponsored trial regarding supplementation of thyroid hormone to extremely low birth weight infants with transient hypothyroxinemia of prematurity. A Phase 3 study in the same area is being planned. Lance A. Parton, MD, FAAP Neonatology Dr. Parton is a Neonatologist at CWPW and Professor of Pediatrics, Obstetrics and Gynecology and Anesthesiology at New York Medical College, and Associate Professor of the Regional Neonatal Intensive Care Unit at Maria Fareri Children’s Hospital at Westchester Medical Center. Dr. Parton is the Vice-President of New York Chapter 3 of the American Academy of Pediatrics and is past chairperson for the Committee on Fetus and Newborn for this Chapter. He is also active in the American Thoracic Society (Assembly on Pediatrics, Program Committee). His research investigates the genetic foundations of conditions that contribute to prematurity, as well as the complications of prematurity. Dr. Parton’s laboratory has investigated the role of single nucleotide polymorphisms (SNPs) in the development of preterm prolonged rupture of membranes (PPROM), intrauterine growth retardation (IUGR), and preeclampsia in collaboration with Obstetrics and Maternal Fetal Medicine. The complications of preterm infants such as bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) are also active areas of investigation. Susceptibility to respiratory syncytial virus (RSV) bronchiolitis, as well as variability of responsiveness to albuterol in infants with RSV bronchiolitis has been undertaken in collaboration with Pediatric Pulmonology, Allergy and Sleep Medicine. Clinical areas of investigation include comparative studies of surfactants, high frequency ventilation, and exhaled nitric oxide in ventilated preterm infants, as well as the effects of music therapy on preterm infants, the latter in collaboration with music therapist, Laurie Park. Julian Stewart, MD, Ph.D. Cardiology Dr. Stewart is a Pediatric Cardiologist at CWPW and Professor of Pediatrics and Physiology at New York Medical College. In addition to earning an MD, he also has a Ph.D. in biophysics. Dr. Stewart currently holds three NIH grants and is interviewing for the Clinical Integrative Cardiovascular study section of the NIH. He regularly presents to and will be a member of the faculty at the American Heart Association, American College of Cardiology, American Physiological Society, and the American Autonomic Society. Dr. Stewart has conducted significant research since 1984. One NIH-funded study, “Circulatory Dysfunction in Chronic Fatigue Function,” is ongoing and seeks to determine the causes of Chronic Fatigue Syndrome (CFS) in adolescents. He has also published hundreds of original articles and abstracts, made countless peer presentations, and written seven books on pediatric medicine. www.cwpw.org • CWPW 5 ADVERTISING AND PUBLIC RELATIONS CWPW Launches Media Campaign I n an effort to spread the word about the unparalleled level of subspecialty care offered to families in the Lower Hudson Valley and Connecticut, CWPW has begun a broad-based advertising and public relations campaign in regional media showcasing its quality physicians and medical services. The first of two full-page color ads appeared in WESTCHESTER Magazine’s ‘Best Doctors in the County” issue in November 2010 and focused on the full breadth of pediatric care available at CWPW. The second full-age ad appeared in the same publication in February 2011 to coincide with American Heart Month. The ad featured excellence in pediatric cardiology at CWPW. Additional advertising and public relations efforts — including this newsletter, which is distributed to physicians and parents in the region — are planned for 2011 and beyond. CWPW ADOLES CE MEDICIN NT E CARDIOL OGY & ADULT C O HEART D NGENITAL ISEASE CRITICA L CARE DEVELO PMENTA L PEDIATR ICS ENDOCR INOLOGY GASTRO ENTERO LOGY GENERA L PEDIAT RICS HEMATO LO ONCOLO GY/ GY INFECTIO U DISEASE S & IMMUNO LOGY MEDICA L GENET ICS NEONAT OLOGY NEPHRO LOGY NEUROL OGY PSYCHO LOGY PULMON OLOGY, ALLERG Y& MEDICIN SLEEP E RESEAR CH RHEUMA TOLOGY CWPW Your ch ild’s With 18 re CWPW gional offices, 20 area is the la s rgest gr oup of p of medical expe ediatric rtise an here’s n ians in othing m the enti d 145 skilled p out th ore im re regio hysician doctors e Hudson Vall portant than n. s, the hea at CW ey, W T estchest PW. Sk lth of yo medica illed er a ur lp their co roblems and re in a range of sp nd Connectic child. That’s w ut rely o mmunit hy famil sume ev e c ialties, o y — wit n sup ies th exceptio e ry u day life ho n with ex r physicians he erior care from roughyour fam al pediatric me ut having to tr ception lp child th avel to dical ca ily can c a re l pediatr n to ove e New re, ount on ic care rcome CWPW and all close to York City or beyond that’s right in . home: F .G rom infa ncy thro reat doctors, ugh ado lescence , Children's & Women's Physicians of Westchester’s (CWPW) Pediatric Neurologist Ronald Jacobson, MD (right), was recently interviewed by WABC-TV Eyewitness News reporter Jim Dolan on the subject of the MMR vaccine and autism. 6 CWPW • www.cwpw.org (914) 593-8 800 heart he alth Outpat ien (CT), N t locations in V orwalk (CT), N alhalla, Middle Affiliate ew Win t d with M dsor, an own, Poughke eps other le d a ri Woodla a F are ading m wn (Bro ie, Suffern, Da edical c ri Children’s H nbury nx). enters in ospital/W the Hud estchest Februar e son Vall ey and r Medical Cente Connec Put you y is Americ r and ticut. r child’s an He is our h ighest p riority. ar the pedia he tric card art health in t t Month. he iology ex perts at best care: CWPW . Munger P avilion, R oom 123 , Valhalla , NY 105 95 • (91 4) 594-4 370 • (8 45) MY-C HILD • (845) 692 -4453 • www.cw pw.org • www. cwpw .org Comple cardiov te care for ascular children infants, and for , teens, with conadults heart disgenital orders. Fetal Ca rdiology Electrop hysiolog y Echocard io g and Card raphy Imaging iac Interven Cardiolo tional gy Pediatric Vascular Heart & Surgery Preventi Cardiolo ve gy Exercise Laborato ry Pediatric Intensiv e Care www.cwpw.org • CWPW 7