Children's Connection | Issue 2, 2010

RETCAM3

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WE knoW ChildREn

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ChildREn’s AdvoCACy TEAM

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spECiAlTy pEdiATRiC CEnTER

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spECiAlizEd EMERgEnCy MEdiCinE

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A jouRnAl foR physiCiAnsissuE 2, 2010

proudly serving children since 1948, Children’s hospital & Medical Center is the only full-service, pediatric health care center in nebraska. located in omaha, it provides expertise in more than 30 pediatric specialty services to children and families across a five-state region and beyond. The 145-bed, nonprofit hospital houses the only dedicated pediatric emergency department in the region and offers 24-hour, in-house services by pediatric critical care specialists. Children’s hospital & Medical Center has achieved the Magnet designation for nursing excellence and is an infoWorld 100 award winner for innovation in information technology. A pediatric affiliation established between Children’s hospital & Medical Center and the university of nebraska Medical Center College of Medicine supports enhancements in pediatric education, research and clinical care. Children’s is also the primary teaching site for the family practice and joint pediatrics residency programs at Creighton university and unMC. for more information on Children’s hospital & Medical Center go to Childrensomaha.org.

RETCAM3

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specialists in Children’s niCu are using the RetCam3, which provides full-color images of the retina, to help detect and treat potentially serious eye conditions in newborns.

WE knoW ChildREn

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The “We know Children” campaign invites community leaders and lawmakers to see first-hand why the best place for children to be treated is a facility that specializes in children.


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for a child, a trip to the Emergency department can be frightening. But at Children’s hospital & Medical Center, emergency staff are specially trained not only to treat traumatic injuries of children and teens, but to ease the pain and anxiety that can come with pediatric emergencies.


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suzanne haney, M.d., directs a team of experts who serve as advocates for children who have experienced non-accidental injuries. The CAT team assists physicians with the decision to report, and how to report suspected child abuse.


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The specialty pediatric Center adds new and previously off-site clinics in one convenient location for families seeking pediatric specialty services, and enhances opportunities for collaboration among specialists.

ConTEnTs

TRAnspoRT MilEsTonE

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ouTREACh CliniCs

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Also:

ChildREn’s ConnECTion AdvisoRy CounCil

shAhAB f. ABdEssAlAM, M.d.john d. kuglER, M.d.josEph T. (jAy) snoW, M.d.jAyEsh C. ThAkkER, M.d.don W. CoulTER, M.d.pEggy hogAn, R.n., physiCiAn liAison

nEW RETCAM3 is lATEsTdiAgnosTiC Tool foR niCu

RETCAM3

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Try holding steady a struggling, tiny newborn, spreading open their eyelids and shining a bright light into their eyes long enough to visually inspect the retina – all while making certain you get a good enough look that you can accurately draw what you see in order to properly diagnose potentially serious eye conditions.

“Just imagine how tricky that is,” says Lynne Willett, M.D., neonatologist, Children’s Specialty Physicians, and Clinical Service Chief of the Newborn Intensive Care Unit (NICU) at Children’s Hospital & Medical Center.

That procedure and others involving close examinations of the eye are becoming dramatically less laborious thanks to a new piece of equipment at Children’s, the RetCam3 wide field imaging system.

A product of Clarity Medical Systems, Inc., the RetCam3 is an intuitive digital photographic system that eliminates the need for awkward, prolonged examinations and sketching of the eye. The NICU at Children’s is one of very few medical facilities in the region that has the RetCam3.

Retinopathy of prematurity (ROP), or the abnormal development of blood vessels in the retina, can result in scarring, retinal detachment or childhood blindness if not properly treated. According to the National

Eye Institute, ROP primarily affects premature infants weighing about 2¾ pounds (1,250 grams) or less who are born prior to 31 weeks of gestation. The smaller a baby is at birth, the more likely that baby is to develop ROP.

Previously, ROP has commonly been detected at the patient’s bedside by an ophthalmologist who examines the eyes and sketches what he or she sees to be shared with the medical team and kept in the patient’s records. While the details observed by the ophthalmologist can be accurately interpreted, drawings capture these details far less accurately than a photograph – especially from an examination involving a moving infant.

The RetCam3 combines a mobile computerized workstation with a hand-held camera that produces brilliant, full-color images viewed immediately on the monitor screen for detailed assessment of the retina and anterior chamber.

“You simply touch the hand-held camera to the eye after numbing it and instantly take a photo of the entire retina and view the entire disk out to the periphery,” Dr. Willett says.

The RetCam3 is an easy-to-learn, extremely user-friendly device that can be wheeled to any bedside.

“We can train a select group of our nursing staff to use the RetCam3,” she says. “If an

ophthalmologist isn’t readily available, rather than wait for one to arrive, these trained nurses can capture and transmit the images directly to them for review – any time of the day or night.”

The RetCam3 can be used by other specialists outside the NICU.

“Certainly any physician could use it in a number of situations, such as diabetic retinopathy or the evaluation of non-accidental trauma, and it can aid in the diagnosis of genetic conditions and congenital infection,” she says. “The photos produced by the RetCam3 are permanent and are far less subject to interpretation than drawings on paper.”

In cases of suspected child abuse, the RetCam3 can be an invaluable tool when it comes to courtroom testimony. “With drawings, there is always the possibility of misinterpretation by non-medical people,” Dr. Willett says. “Photographic evidence of non-accidental trauma is pretty conclusive.”

The RetCam3 also allows for the recording of videos. Still photos can be captured individually, during the recording of a video, or taken from a video after the exam. The user also can enter notes onto the still photos, as well as draw lines and circle particular areas for emphasis. The digital files can be transferred from the portable unit to Children’s electronic medical records (EMR) system.

“THE RETCAM3 IMAgES HELP TO fURTHER COLLAbORATION bETWEEN SPECIALTIES. WE’RE ALL SEEINg, EvALUATINg , AND MAkINg RECOMMENDATIONS fOR THE SAME THINg RATHER THAN TRYINg TO INTERPRET WHAT SOMEONE ELSE SAW.”

lynnE WillETT, M.d.nEonATologisT, ChildREn’s spECiAlTy physiCiAnsCliniCAl sERviCE ChiEf, nEWBoRn inTEnsivE CARE uniTpRofEssoR, nEWBoRn MEdiCinE, univERsiTy of nEBRAskA MEdiCAl CEnTER CollEgE of MEdiCinE

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physiCiAns’ pRioRiTy linE 1.888.592.7955

EffICIENCY & CLARITYThE nEW RETCAM3 AT ChildREn’s hospiTAl & MEdiCAl CEnTER:

➜ Delivers objective, interpretive detail of the retina and anterior chamber in even tiny newborns;

➜ Captures structural elements allowing for physician review, consultation and follow-up;

➜ Can be used as an illustrative tool to educate parents and medical staff regarding specific conditions;

➜ Provides reliable, defensible documentation for cases involving legal proceedings.

because ROP develops close to term gestational age, guidelines call for the initial examination of a newborn’s retina when they are four weeks old, Dr. Willett says.

by using the RetCam3, she says, any issues that are diagnosed can be photographed and used to explain the condition and recommended treatment to the child’s parents. “Rather than try to explain it or draw it, you can better show them exactly what you’re talking about.”

During the necessary follow-up examinations, the RetCam3 allows photos to be compared side-by-side to better gauge progress and outcomes, Dr. Willett says. The images it produces can be transferred to a network to allow viewing and analysis anywhere the network can be accessed, and by any number of specialists.

“We have so many babies and children who require multidisciplinary care,” she says. “The RetCam3 images help to further collaboration between specialties. We’re all seeing, evaluating, and making recommendations for the same thing rather than trying to interpret what someone else saw.”

She says it also provides a better means to communicate with referring physicians. “We can send them photographic images that they can examine and save in their own patient records system, whether it’s paper or electronic.”

The RetCam3 is a fast, efficient and less traumatic tool with many applications. “We can take it to the emergency department for trauma cases or anywhere else in the hospital that it’s needed and take photos all in the time it takes to dilate the eyes,” Dr. Willett says.

Once a diagnosis is made, she says, “Determining a course of action and the potential need for laser surgery is crucial. With this tool, you can follow changes in the eye daily if necessary so surgery can be optimized and scheduled immediately, if needed.”

When it comes to preserving a child’s sight, Dr. Willett says, the RetCam3 “is a valuable tool that provides more accurate, documentable, concrete information right when we need it.”

In the blink of an eye.

1.888.592.7955 PHYSICIANS’ PRIORITY LINE

Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.

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Senators, members of Congress and a variety of state and local legislators and community leaders have been visiting Children’s in recent months. It’s part of an effort to communicate our “We know Children” message. Through this campaign, these visitors are invited to see our facilities and learn first-hand the need for pediatric specialists and sub-specialists. Some of the legislators who have visited Children’s include U.S. Senator Mike Johanns, U.S. Representatives Lee Terry and Adrian Smith, Nebraska State Senators Jeremy Nordquist, Heath Mello, John Nelson, Norman Wallman and Mike gloor.

The We know Children campaign is meant to raise awareness that Children’s Hospital & Medical Center is a leader in child advocacy and public health policy for children.

Also part of the campaign was a series of postcards highlighting eight core reasons children should be treated at a facility that specializes in children.

Children’s introduced Spira, a magazine designed to educate lawmakers and influential individuals about the unique value of Children’s. A companion website, WeknowChildren.org, also helps to convey the story.



A diffEREnT kindof hospiTAl visiT

The We Know Children campaign, directed to community leaders and lawmakers, encompasses eight core messages summarized in these statements.

Children Are Different As unique and distinctive as snowflakes, children require individualized care, experienced and well-trained caregivers, and specialized medications and treatments.

Children’s Hospital & Medical Center is Different Drawing patients from throughout Omaha, the region and the nation, we treat everything from earaches and broken bones to the most critical and chronic cases.

Innovation Gifted medical professionals can only accomplish what their tools allow. That is why Children’s takes every opportunity to encourage the use of new treatments and techniques, and support them with the latest in equipment and technology.

Education Learning to be the best requires learning from the best. Children’s is a research and education partner with the University of Nebraska Medical Center (UNMC) and Creighton University School of Medicine, supporting pediatric residency and fellowship programs, as well as students from the region’s nursing and other health profession schools.

Advocacy From injury-prevention programs to child abuse education and awareness, children’s hospitals act as a voice for those who need to be heard.

Recognition Recognition and compliments are measures of success. Judging by patient satisfaction and the awards we receive, Children’s measures up quite nicely. Children’s Hospital & Medical Center ranks among the top two percent of children’s hospitals in the nation in patient satisfaction.

The Best Care for Children Since our doors opened in 1948, Children’s Hospital & Medical Center has never lost sight of its mission – that all children may have a better chance to live. Children’s is a name that families and physicians can rely upon and trust.

Strength & Hope Time and again, parents say that Children’s caregivers become like a part of their family. That’s because we care for every child as if he or she were our own.

nEBRAskA sTATE sEnAToR, MikE glooR, RECEnTly visiTEd ChildREn’s hospiTAl & MEdiCAl CEnTER To hEAR ThE “WE knoW ChildREn” MEssAgE. hE Also sToppEd To visiT WiTh jAnET And john slAMA in ThE niCu. glooR, REpREsEnTing nEBRAskA disTRiCT 35, is ThE foRMER pREsidEnT And CEo of sAinT fRAnCis MEdiCAl CEnTER in gRAnd islAnd. hE CuRREnTly sERvEs on sEvERAl lEgislATivE CoMMiTTEEs, inCluding hEAlTh & huMAn sERviCEs, BAnking, CoMMERCE & insuRAnCE, And plAnning CoMMiTTEEs.

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WE knoW ChildREn

Discovering that a child brought in for treatment may be the victim of physical abuse can be difficult for any physician. In these cases, treating a broken bone or an internal injury isn’t enough. The physician must also take action to be certain the child is safe.

Suzanne Haney, M.D., is medical director for Project Harmony, an Omaha-based nonprofit agency whose mission is to offer a coordinated response to the abuse of children in Nebraska and western Iowa. The only board-certified child abuse pediatrician in Nebraska, Dr. Haney also serves as medical director for the Children’s Advocacy Team at Children’s Hospital & Medical Center.

“Physicians must realize that if they are going to be true advocates for the child, they need to be

sure the child is safe,” she says. “A vast majority of the time, the family is the child’s greatest advocate, but there also are times that the family may be causing harm and the child may have to be separated from the family in order to be protected. I understand that this can be very hard for physicians who have been working with the child and family for many years.”

In some cases, the child may not be the only person in the home who is a victim.

“Sometimes it’s linked to domestic violence,” Dr. Haney says. “Sometimes the whole family needs to get help. by contacting us and getting social services involved, everyone in the family can get the help they need.”

It is important to note, Dr. Haney says, that physicians who suspect an injury is non-

accidental do not need to prove it.

“As long as the physician has a ‘reasonable concern’ that the child is a victim of abuse, he or she is required to report it to the proper authorities,” she says. “Then it’s up to Child Protective Services and local law enforcement to conduct the investigation. We at Project Harmony and the Children’s Advocacy Team are here to assist with the decision to report, and with how to report.”

“Proper examination, including radiology exams, is necessary to ensure the integrity of the investigation,” says John Wendel, M.D., radiologist, Children’s Specialty Physicians & clinical service chief for Radiology at Children’s. Dr. Wendel has conducted research in non-accidental injuries in his residency and fellowship

physiCiAns REly upon AdvoCACy TEAM ExpERTs in CAsEs of suspECTEdnon-ACCidEnTAl injuRiEs


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training at the University of Texas Medical branch in galveston. When abuse is suspected, Dr. Wendel and his fellow pediatric radiologists at Children’s work closely with Dr. Haney.

“We bring a high level of diagnostic expertise to her aid,” he says. “We’re fortunate to have her as a resource, because it is up to her to present this information to law enforcement and the courts, if necessary.”

The radiologist is part of the skilled team of caregivers.

“My role on this team is to ensure that appropriate imaging studies are obtained, and then to interpret these studies rigorously,” Dr. Wendel says, “communicating clearly whether the findings are suspicious and whether they merely raise the question of abuse, strongly suggest abuse, or are diagnostic of abuse.”

He suggests referring physicians consider two things when abuse is suspected and imaging is required.

“first, before you obtain a skeletal survey at your local hospital, ask yourself whether you are likely to transfer the patient to Children’s at some point of the work-up. If the answer is yes, obtain only the imaging studies that may change management prior to or during the transfer and let the radiologists at Children’s supervise

the remainder of the imaging work-up. We are constantly refining and updating our imaging protocols for children and use only the most current equipment to maximize diagnostic yield while minimizing radiation exposure.”

“Second, faster is often not better when imaging patients for non-accidental trauma,” he says. “by all means, image an extremity if it appears fractured or dislocated, but in many cases, a harried skeletal survey obtained at night is not as good as a meticulous skeletal survey obtained the next day, not only because the quality of the study itself is better, but because the quality of the interpretation improves.”

Dr. Haney says she relies upon Dr. Wendel and his staff to explain the intricacies of radiology studies.

“They educate me as to their findings so that I can go before a judge and speak intelligently about what is depicted in an X-ray or other study.”

New medical tools, such as the new RetCam3 wide field imaging system at Children’s, are valuable when detailing in court the extent of a child’s injury, Dr. Haney says.

“Rather than try to translate what used to be presented in a drawing made by an ophthalmologist, we now can admit as

evidence a photograph showing precisely the injury I am describing,” she says. “I can say, ‘See all these red blobs? Those are blood and they aren’t supposed to be there.’ Judges and juries immediately understand that.”

Dr. Haney spent nine years on active duty in the Navy. following her residency at the Naval Medical Center in Portsmouth, va., she completed fellowships at the Eastern virginia Medical School and at Children’s Hospital of The king’s Daughters in Norfolk, va.

She came to Omaha to accept the position at Project Harmony nearly three years ago. As a mother of two young boys, she says it can be difficult to witness some of the most serious abuse cases.

“Abuse can be heart-wrenching, but for the most part, I take satisfaction in knowing the kids I work with are probably not going to get hurt again,” she says. “I can make a difference.”



“AbUSE CAN bE HEART-WRENCHINg, bUT fOR THE MOST PART, I TAkE SATISfACTION IN kNOWINg THE kIDS I WORk WITH ARE PRObAbLY NOT gOINg TO gET HURT AgAIN.”

suzAnnE B. hAnEy, M.d.MEdiCAl diRECToR, ChildREn’s AdvoCACy TEAMChildREn’s hospiTAl & MEdiCAl CEnTERMEdiCAl diRECToR, pRojECT hARMony

“WE ARE CONSTANTLY REfININg AND UPDATINg OUR IMAgINg PROTOCOLS fOR CHILDREN AND USE ONLY THE MOST CURRENT EqUIPMENT TO MAXIMIzE DIAgNOSTIC YIELD WHILE MINIMIzINg RADIATION EXPOSURE.”

john WEndEl, M.d.RAdiologisT, ChildREn’s spECiAlTy physiCiAnsCliniCAl sERviCE ChiEf, RAdiologyAssisTAnT pRofEssoR of RAdiology, univERsiTy of nEBRAskA MEdiCAl CEnTER CollEgE of MEdiCinE

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Prior to the move into the new Specialty Pediatric Center at Children’s Hospital & Medical Center, families seeking orthopaedic care for their children often had to be examined at one place, then travel to another location for an MRI, ultrasound or other lab procedure.

Not any more.

“There’s no need to schedule an MRI five miles away,” says Children’s Specialty Physicians orthopaedic surgeon Paul W. Esposito, M.D. “Today, it’s a matter of walking across the hall rather than driving across town.”

Like other clinics and services new to the Specialty Pediatric Center, the three fellowship-trained pediatric orthopaedic surgeons – Drs. Esposito, brian P. Hasley and Susan A. Scherl – and their support staff are raising the bar when it comes to efficient, convenient pediatric specialty care.

“Our goal is to see more kids and give more kids access to the care they need in a highly effective manner,” Dr. Esposito says. “We understand that children and their families are anxious about visiting us. The new Specialty Pediatric Center helps us to provide a personal, caring touch in a reassuring environment, with more space and quieter private rooms for examinations and consultations.”

The Orthopaedic Surgery Clinic at Children’s is the largest and most comprehensive group in the region specializing in the diagnosis and treatment of orthopaedic conditions in children. The clinic treats a wide range of conditions, including cerebral palsy, dwarfism and bone dysplasias, bone infections, Legg-Calve-Perthes disease, osteogenesis imperfecta, scoliosis, spina bifida, foot problems and many others including pediatric sports problems.

The pediatric training and experience are critical to a child’s health and healing. The orthopaedic specialists at Children’s develop customized treatments for issues from simple fractures to complex, uncommon congenital and acquired conditions to help ensure continued growth and recovery. Additionally, the physicians’ affiliation with the University of Nebraska Medical Center College of Medicine (see sidebar) enables them to combine clinical care with

ExTEnsivE oRThopAEdiC sERviCEs noW MoRE ConvEniEnT



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cutting-edge research. Dr. Hasley, for example, has worked extensively and also conducted research into the use of spinal growing rods for scoliosis and the vertical Expandable Prosthetic Titanium Rib (vEPTR), a surgically implanted device used to treat Thoracic Insufficiency Syndrome (TIS) in pediatric patients.

TIS is a congenital condition where severe deformities of the chest,

spine, and ribs prevent normal breathing and lung growth and development. The vEPTR device, which can be adjusted as the child grows, helps straighten the spine and separate ribs so that the lungs can grow and fill with enough air to breathe.

Dr. Esposito says being situated in the new Specialty Pediatric Center will better enable the orthopaedic surgery clinic to address children with extremely complex conditions like TIS. “The total integration of the specialty services system here is a real plus for us and our patients,” he says. “We can collaborate with other doctors, take an X-ray in our office, and if necessary transition seamlessly to a hospital setting 100 feet away.”

It also means increased accessibility for referring physicians, Dr. Esposito says. “because we’re all in one place we have access to referrals every day,” he says. “If a referring physician has an urgent case, we can see the child today.”

The electronic medical records (EMR) system at Children’s promotes prompt communication between the orthopaedic surgeons and referring physicians. “We recognize how important it is to communicate with a patient’s own physician,” Dr. Esposito says. “With EMR, there are times we get a note out to the referring physician before the family has even left the clinic.”

That quality of care and concern will remain high, even as the number of children seen increases, he says. “We plan to recruit an adequate number of physicians to ensure that continues,” Dr. Esposito says. “We’re very proud of the standard we’ve set.”



UNPARALLELED EXPERIENCEThe three pediatric orthopaedic surgeons at Children’s possess a wide range of training and experience.

Dr. Esposito is a pediatric orthopaedic surgeon with Children’s Specialty Physicians and professor of Orthopaedic Surgery and Pediatrics, University of Nebraska Medical Center College of Medicine. He is board certified and is a member of the Pediatric Orthopaedic Society of North America, a member of the American Orthopaedic Association, and a fellow of both the American Academy of Orthopaedic Surgeons and the American Academy of Pediatrics, where he has served on the Executive Committee since 2004.

At Children’s he specializes in extremity deformities, osteogenesis imperfecta, congenital and developmental disorders and cerebral palsy, treating children from across the nation and overseas.

Dr. Scherl is a pediatric orthopaedic surgeon, Children’s Specialty Physicians and professor of Orthopaedic Surgery at the University of Nebraska Medical Center College of Medicine and is an expert in orthopaedic trauma. board-certified in orthopaedic surgery, she is a member of the American Academy of Orthopaedic Surgeons Trauma Call Task force and has served as chair of the Pediatric Orthopaedic Society of North America Trauma and Prevention Committee.

A pediatric orthopaedic surgeon, Children’s Specialty Physicians and assistant professor of Orthopaedic Surgery at the University of Nebraska Medical Center College of Medicine, Dr. Hasley is board-certified by the American board of Orthopaedic Surgery and is a candidate member of the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America.

“Together,” Dr. Esposito says, “we’ve been able to have a profound impact on children’s lives.”

vEpTR dEviCE

“THE TOTAL INTEgRATION Of THE SPECIALTY SERvICES SYSTEM HERE IS A REAL PLUS fOR US AND OUR PATIENTS. WE CAN COLLAbORATE WITH OTHER DOCTORS, TAkE AN X-RAY IN OUR OffICE, AND If NECESSARY TRANSITION SEAMLESSLY TO A HOSPITAL SETTINg 100 fEET AWAY.”pAul W. EsposiTo, M.d.pEdiATRiC oRThopAEdiC suRgEon, ChildREn’s spECiAlTy physiCiAnspRofEssoR, oRThopAEdiC suRgERy And pEdiATRiCs, univERsiTy of nEBRAskA MEdiCAl CEnTER CollEgE of MEdiCinE

pAul EsposiTo, M.d.

BRiAn hAslEy, M.d.

susAn sChERl, M.d.

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Whether it’s a simple case of tonsillitis or a complex airway disorder, children are benefitting from the presence of a clinic at the new Specialty Pediatric Center dedicated to Ear, Nose and Throat (ENT) issues – and staffed by two of the only three board-certified, fellowship-trained pediatric otolaryngologists in the state.

Prior to the opening of the new center, ENT cases were seen either as part of the multi-specialty Aerodigestive Clinic at Children’s Hospital & Medical Center, or at the ENT Specialists P.C. offices in Regency.

Now, Drs. Debora goebel and Ryan Sewell see pediatric patients in clinic at Children’s. That will make it convenient for children whose conditions require being seen by more than one specialist. It will also make it easier for the specialists involved in these cases to consult and collaborate with each other.

“There are complex cases such as osteogenesis imperfecta that involve orthopaedic specialists and also issues that require ENT services,” Dr. Sewell says. “Rather than have the child seen here at Children’s by an orthopaedic specialist then driven to see me, they simply have to come across the hall.”

The new Specialty Pediatric Center provides workrooms and conference rooms where specialists can discuss treatment options for complex cases.

“being in a clinic space integrated with other specialties, and able to share ideas and plan with other physicians sitting next to me in the workroom, makes communication so much easier,” says Dr. goebel.

Dr. Sewell, a graduate of the University of Iowa College of Medicine, as well as the University of Iowa College of Law, completed his internship in general surgery at the University of Nebraska Medical Center College of Medicine.

In 2009 he received a fellowship match at Children’s Hospital boston – the primary pediatric teaching hospital of Harvard Medical School.

Dr. goebel, a graduate of the Jefferson Medical College of Thomas Jefferson University in Philadelphia, completed her fellowship training at Cincinnati Children’s Hospital Medical Center. She is a recipient of a UNMC College of Medicine volunteer faculty Award recognizing her for her work with residents in pediatric otolaryngology and for “upgrading the level of pediatric care in otolaryngology in our community.”

“Together, we can offer expertise for complex pediatric otolaryngologic cases that previously may have been referred to other institutions distant from Omaha,” Dr. goebel says. Those disorders include some that require complicated airway reconstructions, and those that may be addressed by the latest in minimally-invasive (endoscopic) procedures.

Subglottic stenosis, for example, is a potentially severe narrowing of the subglottic airway that can be congenital or acquired, often from prolonged intubation, says Dr. goebel. Management options for subglottic stenoses include endoscopic surgery, possibly involving balloon dilation of the scar tissue to widen the airway, endoscopic surgery, tracheotomy, or open reconstruction, where the airway is split at the level of the scar and costal cartilage from the rib region or cartilage from the voice box itself is inserted.

Clinical and endoscopic examinations along with X-rays are essential to proper diagnosis, Dr. goebel says.

“I can perform awake endoscopy exams here in the clinic and the family can share in the images and understand what we need to do,” she says. “If the operating room is required for a laryngoscopy exam, there are cases that I

can diagnose and treat all in the same visit.” She says there has been a decrease nationwide in the incidence of subglottic scarring in premature infants.

“Airway management here in the Newborn Intensive Care Unit at Children’s has been fantastic,” she says, “with the physicians and nursing staff using age- and size-appropriate endotracheal tubes, and avoiding excess movement that could cause scarring in intubated patients.”

Whether it’s a new patient, a referring physician or a fellow specialist, Drs. Sewell and goebel are eager to make their expertise available – no matter how unusual the case may be.

“There was a pulmonologist doing an exam in their clinic here who contacted me and said they thought they had a child with a bug in their ear,” Dr. Sewell says. “I thought they might be pulling my leg, but I did an exam and I could see there really was an insect in there.”

because the bug could not be removed in the clinic setting, a trip to the operating room was scheduled. “It was tiny,” he says, “but it wasn’t coming out on its own.”

The odd case illustrates the extreme range of issues that can be addressed at the ENT clinic.

“I’m certain,” Dr. Sewell says, “that I haven’t seen everything yet.”



nEW EnT CliniC diAgnosEs,TREATs full RAngE of issuEs

“WE CAN OffER EXPERTISE fOR COMPLEX PEDIATRIC OTOLARYNgOLOgIC CASES THAT PREvIOUSLY MAY HAvE bEEN REfERRED TO OTHER INSTITUTIONS DISTANT fROM OMAHA.”dEBoRA goEBEl, M.d.pEdiATRiC oTolARyngologisTAdjunCT AssisTAnT pRofEssoR of oTolARyngology, univERsiTy of nEBRAskA MEdiCAl CEnTER CollEgE of MEdiCinE

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livER disEAsEs ARE foCus of nEW CliniC

Except for those children awaiting or undergoing transplantation, medical issues concerning the liver are now being diagnosed and treated at the new Liver Clinic at the Specialty Pediatric Center at Children’s Hospital & Medical Center.

“We are seeing patients with a wide array of liver issues including Hepatitis b and C, jaundice and other conditions at our new clinic,” says gastroenterologist, Children’s Specialty Physicians, and Pediatric gastroenterology & Hepatology clinical service chief Ruben E. quiros, M.D. “Even if they may require a transplant in the future but are not yet listed, anyone with liver disease may come here to be seen.”

Children whose liver disease requires a multidisciplinary approach will receive comprehensive care at Children’s. for example, Dr. quiros says the liver treatment team plans to work closely with the HEROES Weight Management Clinic at Children’s in an effort to treat and study pediatric non-alcoholic fatty liver disease (NAfLD), a condition that appears to be linked in some way to obesity in children.

NAfLD ranges from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis, an irreversible, advanced scarring of the liver. With NAfLD, as fat is deposited in the liver, it can trigger an inflammation remarkably similar to that which results from excessive alcohol consumption, Dr. quiros says.

“This condition can progress to cirrhosis of the liver, very similar to the result of alcohol

abuse,” he says. “We aren’t certain why, but it is much more common in overweight children. The biopsy taken from these children in fact looks exactly like that taken from someone who suffers from alcoholism, yet these children do not drink alcohol.”

The relationship between pediatric NAfLD and childhood obesity is a research interest for Dr. quiros. “I hope to establish several projects with other specialists here to do translation of data.”

The multidisciplinary nature of the new Specialty Pediatric Clinic has the potential to yield groundbreaking research, he says.

“We need to study not just why some children become overweight but also what obesity does to the body,” Dr. quiros says. “It is a growing public issue yet I believe we are just seeing the tip of the iceberg. And from what we’ve witnessed with the onset of liver disease and other serious complications, obesity is like a ticking time bomb for some of these children.”

With liver disease and hypertension, for example, “by the time we see the signs and symptoms, the conditions are already far advanced,” he says.

being situated in the new center means Drs. quiros and pediatric gastroenterologist Ryan fischer, Children’s Specialty Physicians, will be able to collaborate more conveniently and efficiently with other specialists.

“Ryan and I are looking forward to taking full advantage of the presence of other specialists,” Dr. quiros says. “As for our patients, it’s now convenient to see more than one specialist.”

He and Dr. fischer are also members of the pediatric liver transplant team at the University of Nebraska Medical Center, which helps ease the transition to the liver transplant program for patients at Children’s, should the need arise.

Dr. quiros expects the new clinic to initially see approximately 250 pediatric liver patients annually, a number that is anticipated to rise as clinic hours are added. If obesity in children continues to increase, so will the need to treat accompanying liver conditions.

“Obesity-related liver disease can be fatal,” he says. “Time and again we’ve seen it lead to cirrhosis and ultimately require a transplant.”

He says pediatricians who identify an obesity problem in a child should conduct lipid profile and liver enzyme tests that can reveal liver damage or disease.

“Any doctor whose patient presents liver function tests that are not normal, or who discovers liver masses, tumors or lesions should take no chances,” he says. “We have the experts in liver disease here that these children need. We are able to perform more sophisticated interventions, as well as conduct research into causes that can lead to new treatments and techniques.”



“WE HAvE THE EXPERTS IN LIvER DISEASE HERE THAT THESE CHILDREN NEED. WE ARE AbLE TO PERfORM MORE SOPHISTICATED INTERvENTIONS, AS WELL AS CONDUCT RESEARCH INTO CAUSES THAT CAN LEAD TO NEW TREATMENTS AND TECHNIqUES.”RuBEn E. QuiRos, M.d.gAsTRoEnTERologisT, ChildREn’s spECiAlTy physiCiAnsCliniCAl sERviCE ChiEf, pEdiATRiC gAsTRoEnTERology And hEpATologypRofEssoR of pEdiATRiC gAsTRoEnTERology, univERsiTy of nEBRAskA MEdiCAl CEnTER CollEgE of MEdiCinE

p. 13


ExpAndEd CysTiC fiBRosis CliniC hoME To Top 10 pRogRAM

When Dee Acquazzino joined the pediatric cystic fibrosis program at the University of Nebraska Medical Center more than three decades ago, the average life expectancy of a child with Cf was 12 years old.

Today, it’s just over 37 years. With continued research and discovery, it is hoped the average life expectancy will continue to rise, says Acquazzino, clinical and research coordinator for the UNMC program and the newly expanded Cystic fibrosis Clinic at Children’s Hospital & Medical Center.

“Research has improved, there are many more antibiotics available, and we have a better knowledge of nutrition,” Acquazzino says. “good nutrition means good lungs.

“Managing Cf aggressively very early in children’s lives with nutritional support, antibiotics, inhaled medicines and psychological support is making a huge difference in both the quality of life and the length of life.”

Cystic fibrosis is an inherited chronic disease that affects the lungs and digestive system of about 30,000 children and adults in the United States and 70,000 people worldwide. A defective gene and its protein product cause the body to produce unusually thick, sticky mucus that clogs the lungs and leads to life-threatening lung infections, obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food.

John Colombo, M.D., serves as pulmonologist, Children’s Specialty Physicians and clinical service chief of Pediatric Pulmonology at Children’s.

Dr. Colombo says that since 2006, when mandatory newborn screening for Cf started in Nebraska, children are being identified much earlier and being treated more effectively.

“Most Cf patients are now diagnosed within the first month of life,” he says. “Instead of first seeing kids when they are malnourished or have recurring pneumonia, we are now able to see kids before they get sick. This is allowing us to produce better outcomes for our patients.”

No screening, however, is perfect, Dr. Colombo says. “That’s why pediatricians need to keep their eyes open to recognize the signs of Cf.”

Children age 16 and under will be seen at the expanded Cf Clinic at Children’s, housed within the new Specialty Pediatric Center. Children older than 16 and adults will continue to be seen at UNMC, where Peter James Murphy, M.D., heads the adult Cf program. The pediatric clinic follows about 210 patients, while the adult clinic sees about 140, Acquazzino says.

Together, the clinics form the Nebraska Regional Cystic fibrosis Center, the only Cystic fibrosis foundation accredited center in the region and one of the oldest Cf centers in the nation.

To be accredited, a Cf center must meet a high standard of care combined with medical education and research. The Nebraska center’s pediatric program is consistently ranked in the top 10 percent for pulmonary function outcomes, and among the top 15 percent in nutritional outcomes, according to data collected by the foundation.

Dr. Colombo estimates there are at least 20 new drug therapies currently being studied in the fight against cystic fibrosis. The pediatric and adult clinic patients are participants in many of those trials, he says.

He says the additional space at the new Specialty Pediatric Center and the close proximity to ear, nose and throat (ENT) and other subspecialists will help to further Cf research and collaboration. “We have the area we need to work and the most experienced Cf staff in the region all under one roof,” he says.

Acquazzino says parents are often confused and disturbed when they are told their newborn has Cf.

“It is a frightening thing for them to hear,” she says, “but their vision of the child being an

invalid and only living a very short time are misconceptions. Many of our patients live very full, satisfying and fairly healthy lives.”

Cf is passed on to a baby when both parents are carriers of the defective gene. Acquazzino says that since 2001, the American College of Obstetricians and gynecologists has recommended that all women be offered Cf testing. If the woman tests positive, her husband can be tested to better predetermine if their child will have Cf.

Regionally, between 10 and 15 new Cf cases are diagnosed annually. Not all are newborns, she says.

“Some are young children born prior to mandatory screening,” she says. “We also diagnose a few adults each year who were either misdiagnosed earlier in their lives or have a very mild level of Cf.”

While she has seen many impressive advances since joining the Cf program in 1978, Acquazzino says more are on the horizon.

“Our center is involved in five to 10 clinical trials at any given time, including trials looking at altering the defect in Cf,” she says. “At some point in time, we believe therapies will become available that will control the lung portion of the disease. That’s very significant because 95 percent of Cf patients die from lung disease.”



“INSTEAD Of fIRST SEEINg kIDS WHEN THEY ARE MALNOURISHED OR HAvE RECURRINg PNEUMONIA, WE ARE NOW AbLE TO SEE kIDS bEfORE THEY gET SICk. THIS IS ALLOWINg US TO PRODUCE bETTER OUTCOMES fOR OUR PATIENTS.”john ColoMBo, M.d.pulMonologisT, ChildREn’s spECiAlTy physiCiAnsCliniCAl sERviCE ChiEf, pEdiATRiC pulMonologypRofEssoR of pEdiATRiC pulMonology, univERsiTy of nEBRAskA MEdiCAl CEnTER CollEgE of MEdiCinEMEdiCAl diRECToR, nEBRAskA REgionAl CysTiC fiBRosis CEnTER

p. 14

ChildREn’s And unMC CollEgE of dEnTisTRy CollABoRATE To EnhAnCE pEdiATRiC dEnTAl sERviCEs

Expanding its pediatric dentistry program to a clinic within the new Children’s Specialty Pediatric Center helps to realize and improve upon a longtime goal of the University of Nebraska Medical Center College of Dentistry, according to Dean John Reinhardt, D.D.S.

“One of the first ‘dreams’ we discussed when I arrived here in 2000 was to have a new pediatric dental clinic,” says Dr. Reinhardt. “We wanted a place that would be convenient, accessible and functional. by incorporating the clinic into Children’s new Specialty Pediatric Center, we’re getting what we dreamed we’d have – made even better.”

The College of Dentistry offers a fully accredited advanced education program in pediatric dentistry that leads to a Certificate of Specialization in Pediatric Dentistry and satisfies the requirements mandated by the American board of Pediatric Dentistry for Examination and board Certification.

Situated on the East Campus of the University of Nebraska-Lincoln, the College of Dentistry is affiliated with the University of Nebraska Medical Center (UNMC) in Omaha. In 2007, Children’s and UNMC signed an institutional affiliation agreement to further collaboration between the two entities.

In the wake of that agreement, “the leadership at Children’s approached the College of Dentistry about leasing space within the new Specialty Pediatric Center for our pediatric dental program,” says Dr. Reinhardt. “I do sense after speaking with other pediatric dentists that the strongest programs are those associated with children’s hospitals. While they wanted us, we also wanted to be associated with them.

Expanding our pediatric program to Children’s opens a whole new world of educational experiences for our students.”

Currently, dental students obtain pediatric clinical experience at the Munroe Meyer Institute in Omaha three days a week and at the Children’s Specialty Pediatric Center two days a week.

“Many of our pediatric patients at the Munroe Meyer Institute have severe disabilities and are

unique in their needs, and I want to emphasize that we are by no means abandoning them,” Dr. Reinhardt says. “At Children’s we expect to face more acute types of issues, as well as open our doors to regular pediatric dental patients. I believe there will be plenty of work to be done at both facilities.”

There are six dental chairs at the institute and 10 in the new space at Children’s. Pediatric dentistry specialization is a two-year program with a total of eight residents per year.

Dr. Reinhardt says having a presence at Children’s will allow a number of educational opportunities, and create new options for referring physicians whose patients require dental treatment as part of their overall care.

“The multidisciplinary nature of so many of the patients at Children’s will allow us to participate in joint treatment,” he says. “The effects of chemotherapy, for example, create a need for specialized dental care. Our dental students will benefit from this wide range of experiences.”

He says residents and faculty “were in awe” of the environment at the new Specialty Pediatric Center.

“It’s truly amazing, from the beauty and functionality of the clinic space to being surrounded by so many experts all in one place,” Dr. Reinhardt says. “Having our faculty and residents there will provide a wonderfully rich environment for learning.”

He says there is a significant need for pediatric dentists, “not only in Omaha and Lincoln but in rural areas as well.”

Making high-quality dental care accessible to children across the region is a primary goal for the College of Dentistry. Among the most visible programs UNMC has developed to date are the annual Lincoln and Panhandle Children’s Dental Days, whose two-pronged focus is

treatment and the education of new mothers and young children to the need for regular dental care.

“Studies are indicating that age 1 should be the time for the first dental visit, because we’re finding kids at age 3 with advanced dental disease,” he says. “And we are finding that about 20 percent of the pediatric population has about 80 percent of the dental disease. That’s very unfortunate because it’s a preventable disease.”

He says the new clinic at Children’s will help further the college’s dental health objectives.

“by joining forces with the region’s premier pediatric health care facility, we have the chance to educate not only our students but also families and the public,” he says. “I anticipate great things happening.”



“bY INCORPORATINg THE CLINIC INTO CHILDREN’S NEW SPECIALTY PEDIATRIC CENTER, WE’RE gETTINg WHAT WE DREAMED WE’D HAvE – MADE EvEN bETTER.”john REinhARdT, d.d.s.dEAn, univERsiTy of nEBRAskA MEdiCAl CEnTER CollEgE of dEnTisTRy

pEdiATRiC dEnTAl CliniC AT ChildREn’s spECiAlTy pEdiATRiC CEnTER

p. 15


REConsTRuCTivE plAsTiC suRgERy ChAngEs ChildREn’s livEs

Parents know how self-conscious children can be about their looks. A crooked tooth, an odd birthmark, a mole or an ill-timed outbreak of acne can set their world on edge, making them fearful of what other kids might think, or worse, what they might say.

but there is a greater concern. In the case of a child with a giant congenital nevus, or birthmark, there is a risk that the nevus may develop into skin cancer such as malignant melanoma.

Children with congenital nevi are among those who will benefit from the new Plastic Surgery Clinic at the Children’s Hospital & Medical Center Specialty Pediatric Center.

Pediatric craniofacial and plastic surgeon Jason Miller, M.D., D.M.D., f.A.C.S., heads the clinic. After earning his medical degree from the University of Nebraska Medical Center, he remained at UNMC to participate in a select surgery internship program and complete an oral and maxillofacial surgery residency. He then completed his plastic and reconstructive surgery residency prior to completing a fellowship through the Stanford University Medical Center.

“We see everything from small moles, which can be removed in the office, to severe

disfiguring deformities that require multiple operations to address,” Dr. Miller says.

Cases that require reconstructive surgery can be complicated and require extended management. Treatment for a giant congenital nevus, for example, may include staged or serial excision.

“In some cases, we employ a technique known as tissue expansion,” Dr. Miller says. “We place devices similar to tiny balloons called tissue expanders beneath the surface of the skin. Then every week or two, we inflate the devices with saline solution. This stretches the good skin so that when we operate, we can use the new skin to replace that which we remove.”

Surgical removal is important beyond physical appearance. According to the National Institutes of Health, skin cancer may develop in up to 15 percent of people with larger or giant nevi, often in childhood. The risk is higher for larger or giant congenital nevi located on the back or abdomen.

Dr. Miller also treats conditions well below the surface of the skin. While they do not affect appearance, issues such as hemangiomas and vascular malformations can pose serious problems internally.

“At Children’s we have imaging technologies that are very valuable in diagnosing abnormalities that can’t always be seen,” he says. “The fact that we can employ these technologies and techniques in a kid-friendly environment means we can do some pretty amazing things.”



“WE SEE EvERYTHINg fROM SMALL MOLES, WHICH CAN bE REMOvED IN THE OffICE, TO SEvERE DISfIgURINg DEfORMITIES THAT REqUIRE MULTIPLE OPERATIONS TO ADDRESS.”jAson MillER, M.d., d.M.d.CRAniofACiAl plAsTiC suRgEonAssisTAnT pRofEssoR, plAsTiC And REConsTRuCTivE suRgERy, univERsiTy of nEBRAskA MEdiCAl CEnTER CollEgE of MEdiCinE

TWo pATiEnTs WiTh hEMAngioMA BEfoRE And AfTER suRgiCAl REMovAl And AdvAnCEMEnT flAp REConsTRuCTionp. 16

for a child, a visit to a hospital emergency department can be a frightening experience. Adult hospitals are primarily designed to treat adult patients. At Children’s Hospital & Medical Center, every aspect of the Emergency Department experience is focused on making the child feel more comfortable. Children’s is the only ED in Nebraska with Pediatric Emergency Medicine specialty boarded physicians. Nurses are specially trained in pediatric emergency medicine and care of the trauma patient. Not only are the doctors and nurses clinical experts, they have additional expertise in easing the pain and anxiety that can come with pediatric emergencies.

One area in which this pediatric expertise is evident is in the Iv success rates. At 99.8 percent, the ED has one of the highest success rates in the hospital in starting peripheral

Ivs. The ED had nearly 4,000 Iv starts in a three-month period. This success can be attributed to the expertise of the ED nurses and their proficient skills.

Children’s emergency staff are used to the conditions and ailments typical of children and teenagers. This specialization and attention to young patients in stressful situations can be measured in patient satisfaction surveys conducted by HealthStream®. Children’s consistently receives higher scores than the national average, scoring in the 89th percentile for “Likely to Recommend.” (See Chart A)

Low Scores When it Counts

Children’s ED is a participant in a Child Health Corporation of America (CHCA) forum that monitors and tracks quality indicators for pediatric emergency rooms around the country. One of the most important ED core measures is Length of Stay. This is measured in minutes from entering the ED through dismissal. Children’s ED is a leader in this measurement, scoring much shorter wait times than the national average. (See Chart b)

Another measure is the percentage of patients who leave the ED before being seen by a provider. This is usually a reflection of wait times. Children’s consistently remains below the CHCA average, with the exception of the H1N1 surge in October of 2009. As a direct response to our data, Children’s ED adopted a temporary H1N1 satellite clinic. (See Chart C)

Children’s Experience & Expertise Inspires Trust

Children’s ED treats more than 25,000 patients each year and emergency staff have access to pediatric radiology and pathology experts on site, and pediatric sub-specialists who are available for consultation. With excellent patient satisfaction scores and specially trained pediatric emergency medicine staff, families and physicians can be confident in trusting their young patients to Children’s ED, the state’s only emergency department designed especially for kids.

WhEn iT CoMEs To EMERgEnCiEs... onE sizE doEs noT fiT All

Left Without Being Seen

6.0%5.0%4.0%3.0%2.0%1.0%0.0%

July

1

Sept

1

Nov

1

Jan

1

Mar

1

May

1

July

1

Sept

1

Nov

1

Jan

1

Mar

1

May

1

20092008 2010

Children’s CHCA Avg

Patient Satisfaction% Likely to Recommend Children’s ED

100908070605040302010

0

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q2

20092008 2010

Children’s National Avg

Length of Stay

180160140120100

80604020

0

Oct

2009 2010

Nov Dec Jan

Feb

Mar

Apr

May

Children’s CHCA Avg

Chart A

Chart B

Chart C

p. 17


pEdiATRiC REsouRCE diRECToRy

Children’s Hospital & Medical Center’s pediatric resource directory is in the mail and is also downloadable at ChildrensOmaha.org/PediatricResourceDirectory.

If you would like an additional printed copy, please call 402.955.6957.

The directory highlights various specialty services available to health care providers across the region. It is a quick reference tool, but is not intended to serve as a complete medical staff directory. A more comprehensive listing is available online 24/7 at ChildrensOmaha.org.

TRAnspoRT MilEsTonE

It has been a busy year for the Newborn and Pediatric Critical Care Transport Team at Children’s Hospital & Medical Center. On Tuesday, Nov. 2, the team reached a milestone, making its 500th patient transport trip of 2010.

“In all of 2009, we went on 216 transport calls. To more than double that number over a shorter time frame shows significant need for this service. Providing access to specialized care even before a patient reaches our door can dramatically improve a child’s outcome,” said pediatric intensivist, Children’s Specialty Physicians, Robert Chaplin, M.D., medical director of the Children’s Transport Team and assistant professor of Pediatric Critical Care, University of Nebraska Medical Center College of Medicine.

Children’s began offering specialized transport services in 2006 with the creation of the hospital’s neonatal transport team for newborns and infants up to two months of age. In September 2009, Children’s expanded its program to include pediatric transport service for all other ages.

Last fall, Children’s partnered with American Medical Response (AMR) to provide ground transportation in its own dedicated child-friendly ambulance. In July 2010, the Children’s Transport Team partnered with LifeNet, in association with AirMethods Corporation, to provide helicopter service for the sickest children.

The team has been present for the delivery of newborns with anticipated complications, and in 2010 has transported these babies (just minutes old), as well as children through age 18, from hospitals and medical care centers in Nebraska, Iowa, kansas and Missouri. The shortest trip by ambulance this year has been just shy of two miles to The Ambassador Omaha. The longest ambulance journey took the team 182 miles north to O’Neill, Neb. The team has covered roughly the same distance by air. The longest helicopter flight so far was to kearney, Neb.

October 2010 was a record-setting month for Children’s with 67 transports. That number could reach 600 by the end of the year.

ChildREn’s TRAnspoRT TEAM MARks MilEsTonE – 500 TRips in 2010

p. 18

Physicians’ Priority Line (physician-to-physician consult and referral line)1.888.592.7955

Transport (Physicians’ Priority Line) 1.888.592.7955

Hospitalist Service 402.955.5400 or 1.888.592.7955

PICU 402.955.4200

NICU 402.955.6230

ChildREn’s hospiTAl & MEdiCAl CEnTER ouTREACh CliniCs

ouTREACh CliniC sChEdulE

Clinic Location Rotation Frequency Phone

CARDIOLOGY

David Danford, MD Grand Island, Neb Semi-annually 308.382.1100

Hastings, Neb Semi-annually 402.463.6828

Lincoln, Neb Monthly 402.486.1500

Rapid City, SD Monthly 605.341.7337

Jeffrey Delaney, MD Lincoln, Neb Monthly 402.486.1500


Christopher Erickson, MD Lincoln, Neb Monthly 402.486.1500


Sioux Falls, SD Semi-annually 605.322.3666

Scott Fletcher, MD Columbus, Neb Quarterly 402.955.4350

Holdrege, Neb Quarterly 308.955.4431

Norfolk, Neb Monthly 402.844.8000


Carl Gumbiner, MD Kearney, Neb Quarterly 308.865.2141

John Kugler, MD Lincoln, Neb Monthly 402.486.1500

North Platte, Neb Quarterly 308.534.9230


ENDOCRINOLOGY

Monina Cabrera Sioux City, IA Monthly 402.955.3871

Kevin Corley, MD Lincoln, Neb Weekly 402.486.1500

Hastings, Neb Semi-Monthly 402.463.6858

North Platte, Neb Quarterly 308.534.9230

Norfolk, Neb Quarterly 402.644.7132

Jean-Claude DesMangles, MD Lincoln, Neb Monthly 402.486.1500

Peg Struebing, PA-C Sioux City, IA Monthly 402.955.3871

HEMATOLOGY/ONCOLOGY

David Gnarra, MD Lincoln, Neb Weekly 402.486.1500

Clinic Location Rotation Frequency Phone

METABOLIC

Rose Kreickmeier, APRN Lincoln, Neb Monthly 402.486.1500

NEUROLOGY

Young Oliver, MD Sioux City, Iowa Monthly 402.955.5372

Ivan Pavkovic, MD Lincoln, Neb Weekly 402.486.1500

NEUROSURGERY

Mark Puccioni, MD Lincoln, Neb Monthly 402.486.1500

ORTHOPEDICS

Paul Esposito, MD Lincoln, Neb Weekly 402.486.1500

Brian P. Hasley, MD Lincoln, Neb Weekly 402.486.1500

PULMONARY MEDICINE

Mark Wilson, MD Sioux City, Iowa Monthly 402.955.5570

Lincoln, Neb Weekly 402.486.1500

John Colombo, MD Lincoln, Neb Weekly 402.486.1500

Paul Sammut, MD Lincoln, Neb Weekly 402.486.1500

RHEUMATOLOGY

Adam Reinhardt, MD Lincoln, Neb Monthly 402.486.1500

SURGERY

Sahab Abdessalam, MD Lincoln, Neb Monthly 402.486.1500

Kenneth Azarow, MD Lincoln, Neb Monthly 402.486.1500

Robert Cusick, MD Lincoln, Neb Monthly 402.486.1500

Steve Raynor, MD Lincoln, Neb Monthly 402.486.1500

p. 19

ChildrensOmaha.org

1.888.592.7955physiCiAns’ pRioRiTy linE

Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and neonatal transport service.

“I’ve been using the Physicians’ Priority Line for admissions to the NICU and appreciate the streamlined service I’ve received. Having one number to call for all the arrangements is efficient and effective.”

bobbi Hawks, M.D., neonatologist, Saint Elizabeth Regional Medical Center, Lincoln, Neb.

Children's Connection | Issue 2, 2010

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Transcript of Children's Connection | Issue 2, 2010