CHAIRMAN’S NEWSLETTER
GRAND ROUNDS: Thursday, November 18, 2010
Conference Center
Buffet Dinner – 5:15 PM
Speaker – 6 PM
Topic: “Transitions in Feeding and Swallowing in the First Year”
Speaker: Patti Bailey, M.S., CCC-SLP
Speech Pathology Coordinator
Milton J. Dance Jr. Head and Neck Center
Greater Baltimore Medical Center
Objectives: Describe feeding readiness cues in premature/newborn infants; discuss normal vs. abnormal swallow; describe clinical and instrumental assessment of feeding and swallowing difficulties; discuss treatment of feeding and swallowing difficulties.
Look Into My Eyes
One of the ironic joys of medicine is in making a terrific diagnosis. It is embarrassing in some ways, since we certainly wish that all children were physically and emotionally perfect. We do not wish anything bad to happen to our patients, yet the discovery of an illness or problem that we can prevent is truly a treat.
As pediatricians, we perform a number of low yield exam maneuvers, yet a positive finding may be life-altering for our patients. We take extra care since the stakes of a missed physical finding may be high. During newborn exams, we compulsively abduct and adduct baby hips to avoid missing dysplastic hips, listen attentively for murmurs so as to not miss congenital heart disease, and make sure all orifices are open and working.
And how many times have we elicited red reflexes in newborns, by cajoling or caressing them, at times grumble under our breath at their utter lack of cooperation? There are nearly 5000 babies born at GBMC and the rate of congenital cataracts is about 1 in 5000 to 1 in 10,000. That’s a lot of eyes, yet most of us will never see an absent red reflex in a newborn. So it was indeed a good moment when our neonatal physician assistant, Steve Lebowitz, recently noted absent red reflexes in a newborn. An absent red reflex can be caused by corneal opacity, cataract, glaucoma, retinoblastoma, retinal detachment or systemic or metabolic disease. In this instance, the baby had bilateral congenital cataracts: most unilateral ones are idiopathic, as opposed to bilateral cataracts, where 60% are caused by metabolic and systemic diseases.
Pediatric ophthalmology saw the baby immediately, and they will soon intervene to prevent what would have been inevitable and irreversible blindness (? or loss of sight) had this rare finding been missed. So kudos to our astute clinician, Steve Lebowitz, and for the rest of us, keep on gazing into those eyes.
(Contributors to this piece included Dr. Mary Louise Collins and Dr. Allison Jensen, Pediatric Ophthalmologists at GBMC.)
Timothy F. Doran, M.D.
Chairman, Department of Pediatrics
