CHOC Children’s Grand Rounds Video: Insufficient Sleep is a Public Health Concern

The Centers for Disease Control and Prevention has recognized insufficient sleep as a public health concern, says CHOC Children’s pulmonologist Dr. John Saito.

In this grand rounds video, Dr. Saito addresses the problem, which is often rooted in childhood. Disorders and disruptions of sleep in a developing brain may have short- term neurocognitive effects, as well as long- term consequences, especially in children who are medically fragile.

Healthcare providers, educators and parents all need to update their level of understanding sleep and sleep disorders in children in order to identify, diagnose, and reduce the negative health consequences of sleep disruption to the child, to the family and to society.

View previous grand rounds videos.

November is Prematurity Awareness Month – CHOC Offers Innovative and Life-Saving Neonatal Care

In recognition of National Prematurity Awareness month, we’re highlighting the innovative life-saving treatment provided to some of the tiniest and most fragile babies through our neonatology services.

Premature birth is the leading cause of newborn death in the United States. While California has one of the lowest premature birth rates in the nation, almost 9 percent of infants born in 2013 in the state were premature, according to the March of Dimes. Pre-term newborns often need immediate specialized care not available at birthing centers, and CHOC Children’s is ready to help if the baby needs to be transferred.

CHOC uses the latest in life-saving technology and trained neonatal specialists to provide the best possible outcomes for both pre- and full-term newborns. While many hospitals offer neonatal intensive care units (NICUs), the CHOC NICU is rated by the American Academy of Pediatrics as a Level 4 NICU – the highest rating available – and is among the top 25 in the nation, according to U.S. News & World Report.

“Because of our innovation and advanced protocols, our survival of low-birth-weight babies, and the long term quality of health of such babies, admitted to the CHOC NICU are the best in California according to the California Perinatal Quality Care Collaborative,” said Dr. Vijay Dhar, medical director, CHOC NICU. “Coordinated care across multiple specialties ensures that these fragile newborns receive treatment from a full medical team.”

With access to a full range of CHOC pediatric subspecialists, the NICU offers a number of life-saving technologies and advanced respiratory support such as high-frequency ventilation and inhaled nitric oxide; advanced brain and body cooling; the only extracorporeal membrane oxygenation (ECMO) unit in Orange County; and innovative procedures including mandibular distraction and epidural anesthesia.

For babies born as young as 24 weeks, or who weigh less than 1,000 grams, the CHOC NICU has a Small Baby Unit (SBU) — the only one of its kind — to focus on caring for the unique needs of these newborns. We also have the only Surgical NICU on the West Coast, which cares for babies needing complex surgery; the only Cardiac NICU in Orange County that performs open heart surgery on newborns; and a Neurocritical NICU to treat babies with neurological issues such as seizures, asphyxiation and brain damage. All four areas provide the highly specialized care needed for fragile newborns.

CHOC has three NICUs, serving CHOC Children’s Hospital, St. Joseph Hospital and CHOC Children’s at Mission Hospital. In addition, our neonatologists have privileges at more than a dozen hospitals across Southern California. And, we are currently building 36 private, state-of-the-art rooms at CHOC Children’s Hospital, which will further advance the quality, safety and outcomes of our neonatology program.

Neonatal Intensive Care Unit (NICU) Referrals:

When a baby is born, the CHOC Children’s Transport Team is ready and waiting to transport newborns to CHOC from other hospitals in Southern California. Our neonatologists and surgeons are available for consultations with other hospitals around the clock and can collaborate with referring physicians via phone, telemedicine and secure text messaging.

For any questions, to request a consultation with an on-call neonatologist, or to schedule a transport, referring hospitals may call the CHOC Children’s NICU 24/7 at 714-509-8540.


CHOC Children’s Research Week 2015

Join us for CHOC Children’s Research Week, being held through Nov. 20 on CHOC Children’s main campus in Orange.

CHOC Research

Tuesday, Nov. 17

Research Resources at CHOC Children’s

8 a.m. – 9:30 a.m., Bill Holmes Tower, second floor, conference room A & B

Presenters: Amit Soni, MD, Megan Bailey, BA, Phuong Dao, JD


CHOC Research Institute Open House

Noon – 1:30 p.m., CHOC Research Building, third floor, conference room 2

Refreshments will be served.


Wednesday, Nov. 18

Research Grand Rounds

“A Closer Look at Genomics in the Diagnosis and Treatment of Pediatric Cancers”

8 a.m. – 9 a.m., CHOC West, Wade Education Center, second floor

Leonard S. Sender, MD, medical director, Hyundai Cancer Institute

Keri Zabokrtsky, MS, research programs supervisor, CHOC Children’s Hyundai Cancer Genomics Program

Troy A. McEachron, PhD, senior postdoctoral fellow, Integrated Cancer Genomics Division, Translational Genomics Research Institute (TGen)

CME credit available.


Scientific Poster Presentations

9 a.m. – 10 a.m., CHOC West, Wade Education Center, second floor

Moderated by Philip Schwartz, PhD, supervisor senior scientist, CHOC Children’s and managing director, National Human Neural Stem Cell Resource


Thursday, Nov. 19

2015 CHOC – UC Irvine Child Health Research Awardee Presentations

9:30 a.m. – 11:30 a.m., CHOC Research Building, third floor, conference room 2

Moderated by Michelle Fortier, PhD, co-director, Center on Stress & Health and assistant professor, UC Irvine School of Medicine

Presenters: Antonio Arrieta, MD, Tami John, MD, Calvin Li, PhD, Joanne Starr, MD, Sharief Taraman, MD, & Ruth McCarty, MS, LAc

Light refreshments will be served.


Emerging Research Programs

2:30 p.m. – 4 p.m., CHOC Research Building, third floor, conference room 1

Moderated by Brent A Dethlefs, executive director, CHOC Children’s Research Institute

Presenters: Antonio Arrieta, MD, Randy Berg, PhD, Mariella Simon, PhD Candidate, Raymond Wang, MD

Light refreshments will be served.


Friday, Nov. 20

Research Subjects’ Perspectives

11 a.m. – 1 p.m., Bill Holmes Tower, second floor, conference room C

Moderated by Kathleen Adlard, clinical nurse specialist, Hyundai Cancer Institute and industry track IRB co-chair

Lunch will be served.


Highlights in Nursing Research

1:30 p.m. – 2:30 p.m., Bill Holmes Tower, second floor, conference room B

“Coping with Cancer: The Adolescent and Young Adult Journey”

Nancy Kuntz, MN, RN, CPNP, CPON

“Nursing Evidence-Based Practice: Best Care Based on Well-Designed Studies”

Susan Elliott, PhD, RNC, APRN-BC

Light refreshments will be served.


For more information, please call 714-509-4341. Learn more about research services at CHOC.

CHOC Helps Parents with Prenatal Surgery Planning

CHOC surgical servicesSome babies are born with complex conditions requiring surgery during the first few hours following birth. From the moment prenatal testing reveals an abnormality, CHOC Children’s is ready to help with the prenatal care and birth planning necessary to ensure the best-possible outcome.

CHOC has a trained and experienced team that includes perinatologists, neonatologists, pediatric surgeons and NICU nurses to guide families through the months before delivery. And families are essential to the planning process.

“The well-being of the child is surprisingly dependent on the well-being of the family, both psychologically and emotionally,” said Dr. David Gibbs, division chief, pediatric surgery, CHOC Children’s Specialists. “Preparation helps the family cope better, and the family that is coping better is able to provide better care for their child.”

According to Dr. Gibbs, recent advances in the care and outlook for babies born with abnormalities have come from closer prenatal coordination with perinatologists and families, combined with highly specialized neonatal intensive care. The CHOC NICU is rated by the American Academy of Pediatrics as a Level 4 NICU, the highest designation available and given only to facilities that also provide onsite surgical repair of serious congenital or acquired malformations.

That immediate access to the full NICU medical team, resources and support is critical for babies born with gastroschisis, a condition that requires surgery within the first hour following birth, and omphalocele, which must be corrected within the first few days. For the smallest and sickest, CHOC’s Small Baby Unit offers additional support to help babies grow and recover more quickly with fewer infections and setbacks.

For babies born with congenital diaphragmatic hernia, the CHOC Surgical NICU provides the optimal environment in which to stabilize and gain strength before surgery. One room inside the CHOC NICU converts into a state-of-the-art operating room, allowing pediatric surgeons to perform delicate procedures within the unit.

And babies born with congenital cystic adenomatoid malformation (CCAM) may actually get to go home for continued evaluation months before surgery.

Dr. Gibbs added that an important element of prenatal planning is deciding in advance where your baby will be born. Moms who know their baby will need surgery may choose to deliver at a hospital that is near a pediatric facility like CHOC. When the baby is born, the CHOC Transport Team is ready 24 hours a day to transport the baby to CHOC from hospitals throughout the region. Specially trained and equipped, this team uses ground and air transportation to travel to and from hospitals throughout Orange, Los Angeles, Riverside, San Bernardino and San Diego counties — and even beyond.

“We expect most children will do well and have normal lives,” Dr. Gibbs said. “But the first step is meeting with the perinatologist, pediatric surgeon and NICU team. Starting that relationship as soon as possible will make the process of coping with what may seem to be an overwhelming process a lot easier.”

CHOC’s surgeons provide cardiothoracic surgery, gastrointestinal (GI) surgery, general surgery, neurosurgery, urological surgery, otolaryngological (ENT) surgery, plastic surgery, ophthalmologic surgery and orthopaedic surgery.

Learn more about surgical services at CHOC.

In the Spotlight: Neal Nakra, M.D.

Dr. Neal NakraAs medical director of the CHOC Children’s pediatric sleep program, Dr. Neal Nakra is examining sleep study data to further analyze the relationships between sleep and obesity, metabolic syndrome and other pediatric conditions.

Dr. Nakra’s initial interests in sleep medicine deepened during his pulmonary medicine fellowship at Yale-New Haven Hospital, in Connecticut. Already well aware of the respiratory issues associated with obesity, his research found that the presence of obstructive sleep apnea was associated with obesity and markers for metabolic syndrome.

He focused his interests in obesity, sleep apnea and metabolic syndrome, and became board certified in pulmonology, pediatrics and sleep medicine. A few years later, Dr. Nakra was co-director of the Cystic Fibrosis Center and associate director of the pediatric residency program at St. Joseph Children’s Hospital in New Jersey, when he heard about an opportunity at CHOC.

The CHOC Sleep Center had recently doubled in size, becoming one of the largest programs in the state. Dr. Nakra was drawn by the opportunity to grow the program further and to work with CHOC pediatric subspecialties.

“Sleep inherently deserves multidisciplinary treatment with other pediatric subspecialties,” said Dr. Nakra, who is working with CHOC otolaryngologists, plastic surgeons and endocrinologists. “One of the joys of practicing sleep medicine at CHOC is the ability to collaborate on a multidisciplinary platform, pick the brains of the best and brightest in the fields, and work together to help the kids of Orange County.”

Dr. Nakra has quickly become an integral part of that team. At a recent CHOC Grand Rounds presentation, he discussed screening guidelines for obesity, metabolic syndrome and obstructive sleep apnea. The American Academy of Pediatrics recommends during routine office visits for pediatricians to ask families about how the patient sleeps at night and for the presence of multiple nighttime awakenings, difficulty breathing, loud snoring and pauses in breathing. This is especially true for overweight and obese children.

“We’re trying to break the cycle of obstructive sleep apnea and obesity,” he said. “Often, the families do not volunteer this information, but when asked, will confirm symptoms of obstructive sleep apnea. In this case, further evaluation by a sleep physician or referral for an overnight sleep study would be warranted.”

Dr. Nakra advises physicians to ask about sleeping when evaluating other symptoms, such as hyperactivity and behavioral disorders in elementary or middle school-age kids. For teens, improved sleep has been shown to improve academic performance and reduce motor vehicle crashes.

When to Refer

An overnight sleep study is recommended for patients with concerns for:

  • Nighttime snoring
  • Persistent mouth breathing
  • Witnessed pauses in breathing while sleeping at night
  • Frequent nighttime awakenings

Further evaluation in the pediatric sleep clinic is warranted based on the results of the sleep study or prior to the study based on pediatrician or parental concerns.

Dr. Nakra sees patients at CHOC Children’s Hospital; CHOC Children’s Health Center, Mission Viejo; and CHOC Children’s Health Center, Huntington Beach. For more information or to schedule a consultation, call 714-509-8622.