SHORT ANSWER
Advances and Answers in Pediatric Health
Transition Team
NEONATOLOGY
Age 2 to 4 months is a critical juncture for premature infants who have been on mechanical ventilation their entire lives .
“ Their lungs have developed after being born premature , but they ’ re still sick because of the prematurity ,” says Kirtley Ceballos , MSN , RNC-NIC . “ So the pathophysiology of their lungs is different , and their ventilation requirements are different and need to be managed very specifically .”
As director of patient care services over both Children ’ s Hospital Colorado ’ s Neonatal Intensive Care Unit and Colorado Fetal Care Center , Ceballos coordinates a large team : some 250 nurses and 28 attending physicians caring for infants from neonates to 10 months , with a huge array of complex conditions .
To better care for those diverse needs , Ceballos and her team have helped develop small , specialized teams of nurses : one focused on delivery , one focused on ECMO , one focused on pre-term babies . The transitional ventilation team is a deeper degree of specialization within the pre-term baby team designed to support babies who require prolonged ventilation .
The effort is being led by neonatologist Erica Mandell , DO , who is assembling a team of 9 neonatologists to care for 2- to 4-monthold premature babies who have been ventilated since birth . The goal is to increase consistency and collaboration among attendings and nurses , improve communication and decisionmaking with families and , eventually , develop best practices for this vulnerable population .
“ This age is a transition period , where often these patients end up needing a tracheostomy and get put on ventilation for the long term ,” says Ceballos . “ We ’ re hoping this model will allow more babies to come off ventilation more quickly .” •
ERICA MANDELL , DO
Neonatologist , Children ’ s Hospital Colorado Assistant professor , Pediatrics-Neonatology , University of Colorado School of Medicine
KIRTLEY CEBALLOS , MSN , RNC-NIC
Director of Patient Care Services , Maternal Fetal and Neonatal Services , Children ’ s Hospital Colorado - Anschutz Medical Campus
March Against
GASTROENTEROLOGY
The relationship between allergic disorders of the skin , lung and gut , collectively referred to as the “ allergic march ,” suggests communication among mucosal organs . But researchers know less about the mechanisms that link local allergic reactions to remote organs . New research from the Digestive Health Institute at Children ’ s Hospital Colorado shows that it may be due to the infiltration of eosinophils — a type of disease-fighting white blood cell — at all points .
Researchers posited that the frequency of the tissue eosinophils likely increases in response to allergic reactions . In turn , this cellular response may prime mucosal organs for future allergic reactions . Researchers created three animal models to simulate the allergic march and test their hypothesis .
Allergen-sensitive models were directly exposed to allergens of the skin , respiratory system and gut . Researchers then studied the type of eosinophils present and concentrations within non-exposed organs along that same axis .
Four days after the final exposure to allergens , biopsied tissue from all three disease models revealed local eosinophilic infiltration ( 1 ). Notably , further examination of a sample from the small intestine revealed a near doubling of eosinophils following allergen exposure to the skin or lung . These results indicate a two-way relationship between local gut , skin and respiratory allergic reactions and eosinophil concentrations in remote organs , and provides new insights into the progression of allergic disease . •
1 . Olbrich , Courtney L ., et . al . “ Remote Allergen Exposure Elicits Eosinophil Infiltration into Allergen Nonexposed Mucosal Organs and Primes for Allergic Inflammation .” Mucosal Immunol 13 , 777 – 787 ( 2020 ). 09 June 2020 .
LISA SPENCER , PHD
Associate professor , Pediatrics-Gastroenterology , Hepatology and Nutrition , University of Colorado School of Medicine
COURTNEY L . OLBRICH , BS
Predoctoral research assistant , University of Colorado School of Medicine
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