At New Jersey hospitals, among the most noteworthy technological advancements and cutting-edge techniques are targeted toward our state’s youngest residents. The state’s groundbreaking pediatric care treatments and technologies cover a broad range of healthcare issues that impact infants, toddlers and adolescents, whether it’s a chronic condition or traumatic injury.
Of course, when talking about pediatric care, the state’s neonatal care services are at the top of the list of advancements. Camden-based Cooper University Hospital’s state-of-the-art services for its youngest patients include high-frequency ventilation and therapeutic hypothermia, while its pediatric intensive care unit is equipped with the latest technologies to care for the sickest and most critically injured children with a team of both pediatric and adult trauma specialists. For complex medical or surgical needs, Children’s Regional Hospital at Cooper employs experts in 27 pediatric subspecialties.
“We do offer the most up-to-date treatments and technology, but I think one of the most cutting-edge aspects of Cooper is that we live and breathe compassionate-, patient- and family-centered care that may not be cutting-edge, but in many ways it actually is cutting-edge,” says Dr. Michael Goodman, chief and chair of pediatrics at Children’s Regional Hospital at Cooper University Hospital. “That kind of environment between providers, physicians, nurses and patients helps create a compassionate connection and leads to better outcomes and patient satisfaction scores … and we feel that the old-fashioned way of medicine – truly caring about your patient – is the new way of medicine, especially in pediatrics.”
At Saint Peter’s University Hospital in New Brunswick, two of the latest advancements in pediatric care include antisense oligonucleotide (AON) and gene therapies. AON therapies target specific RNA sequences and induce targeted protein reduction or restoration; AON therapies currently approved in the US include treatments for spinal muscle atrophy, duchenne muscular dystrophy, and acute hepatic porphyria. Viral-based gene therapy products have been registered for ADA-Severe Combined Immunodeficiency (SCID), beta-thalassemia, Leber’s congenital amaurosis, and spinal muscle atrophy type I.
“The goal of gene therapy is to introduce a therapeutic or working gene copy at a level sufficient to improve or cure disease symptoms with minimal adverse events,” explains Dr. Debra-Lynn Day-Salvatore, chair of the department of medical genetics and genomic medicine at Saint Peter’s University Hospital. She notes that there are hundreds of cell and gene therapy programs presently in clinical development. “DNA or gene editing techniques are currently in early experimental stages, but they will offer new opportunities for personalized gene therapy by modifying specific, unique nucleotide sequences. Earlier diagnosis and treatment of genetic conditions reduce morbidity and mortality and improve quality of life and longevity.”
Of course, treating children doesn’t come without its challenges, especially those with progressive genetic conditions. “The initial challenge is the ability to identify them early enough to prevent irreversible complications,” Day-Salvatore says. “Newborn screening has made a tremendous impact on infants with a certain subset of inborn errors of metabolism, and will undoubtedly expand in the future as viable therapies are approved.”
Infants and children also present several unique challenges when designing clinical trials, including the fact that the number of procedures that require sedation and radiation exposure must always be limited. “Neurodevelopmental assessments are also extremely important to evaluate effectiveness of treatment in infants and children who are unable to answer questions or complete surveys on quality of life,” Day-Salvatore adds.
But involvement in clinical trials isn’t the only challenge. Many of the state’s healthcare institutions are grappling with the same issues that they face with treating adult patients, and how to make changes within their pediatric departments to enhance both quality of care and outcomes as well as improve patient experience and satisfaction. “Children with medical complexity deserve and require a greater investment in direct care, time and care coordination,” asserts Dr. Matthew B. McDonald, III, president and CEO of Children’s Specialized Hospital (CSH) in New Brunswick. That’s why he notes that the hospital is striving to shift the care delivery model from traditional “fee for service” toward value and outcomes-driven payment. “Alternative models of payment will allow our healthcare systems to provide better care and a better experience to our patients,” he adds.
Children’s Specialized Hospital, an RWJBarnabas Health facility, provides rehabilitative and specialty care services to nearly 40,000 children and youth annually at 14 locations throughout New Jersey, and utilizes the latest and most advanced technologies available to its patients. “In our inpatient rehabilitative areas, we leverage innovative ventilator and respirator support technologies, advanced nutrition strategies, and create new, adaptive equipment to help our patients meet their full potential,” McDonald says. CSH also frequently participates in research focused on creating adaptive technology for children and trials related to new treatments for autism, ADHD and cerebral palsy.
At CSH, the advancements in the field of genetics have also made a significant impact for its patient population. For example, the early detection of genetic diseases is allowing physicians to tailor care to patients earlier in life. “There are a growing number of children with special healthcare needs and a marked increase in the demand for behavioral health services as the incidence of anxiety and depression increases,” he adds. “As the needs of our pediatric patients change, CSH will be there to meet their unmet needs so that each patient may reach their full potential.”
When it comes to pediatric care, perhaps one of the most important tools being used by providers is collaboration. A recent case – where a spinal fusion surgery was performed at K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center in Neptune on a baby who was only a few days old – demonstrated the value of connecting with experts to consistently devise new approaches to meet the needs of each individual patient.
“We had a baby born with a complicated fracture and dislocation of the cervical vertebrae, and when dealing with this type of injury, nobody has that much experience on how to handle it because it’s such a rare injury,” says Dr. Lawrence Daniels, a neurosurgeon with Hackensack University Medical Center. It was the youngest case to have been documented with this injury. In these types of pediatric cases, he explains, the first step is to assemble a team, from plastic surgeons, adult spinal surgeons, to neurosurgeons, to help determine the best way to care for the unique needs of each patient.
“We do a lot of spinal surgeries in the US, but they are typically performed on adults with degenerative diseases,” he adds. “We often run into situations where we have to get creative and use techniques that have been tested and shown to be efficacious in adult patients – using tools and devices and instruments and grafts that are also primarily for adults – and make it work in a way to do something very unique and sometimes in a one-off situation for pediatric patients.”
In pediatrics, having the latest technology at your fingertips isn’t always the solution, as it can often be when treating adults. That’s why pediatric care specialists at the state’s top hospitals and healthcare networks are constantly remaining on the cutting-edge of new approaches and techniques to treat the complex needs of children, whether it’s a micro-preemie born before 26 weeks of gestation, a traumatic injury from an accident or after-school sports, or a chronic condition or disease like cerebral palsy.
“We have all of these technologies in medicine, such as computers and monitoring tools to protect the spinal cord while operating, for example, but when your patient is only a week old, a lot of times those things aren’t always very useful,” Daniels concludes. “We have to be constantly innovating in how we work with a child’s anatomy and stimulate our youngest patients to grow in a way that won’t hinder them in the future, but still allow them to grow to become healthy, thriving adults.”
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