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Pediatric healthcare — some first steps are bigger than others
November 21, 2015, 4:23 pm
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Gerard Martin, MD, Cardiologist and Medical Director of Global Services, has been practicing at Children’s National Health System in Washington DC since 1986. In a recent interview to The Times Kuwait, Dr. Martin spoke from his extensive experience in the field of pediatric healthcare and specifically about child health in Kuwait.

In addition to his practice at Children’s National, Dr. Martin is Professor of Pediatrics at the George Washington University School of Medicine & Health Sciences. Children’s National has been serving the medical needs of children for over 140 years and is a leader in providing innovative new treatments for childhood illness and injury.

In response to the question about his work with patients in the Gulf and in particular in Kuwait, Dr. Martin said: “I have been visiting the Gulf for nearly 15 years.  In Kuwait, I have lectured at local hospitals and participated in Symposia on Congenital Heart Disease.  I have provided medical advice to colleagues in Kuwait on complex patient problems and met with families who were considering traveling abroad for care for heart disease.  I have worked with Ministry of Health (MOH) hospitals on training program to improve the detection of critical congenital heart disease by implementing Pulse Oximetry screening as a routine screening tool before babies were discharged after birth. 

Speaking about plans for partnerships with hospitals and medical centers in Kuwait, Dr. Martin revealed: “Children’s National has had longstanding relations with leading doctors, MOH hospitals and Ahmadi Hospital providing educational programs and patient evaluations in Kuwait.  We worked closely with Ahmadi and Adan Hospitals when they began their Screening Program in Newborns for Critical Congenital Heart Disease.  We have recently visited Bayt Abdullah Children’s Hospice and participated in two days of knowledge sharing on palliative care.

With regard to some of the most common problems associated with patients coming from Kuwait, Dr. Martin pointed out that children from Kuwait typically come to Children’s National for specialized treatment from experts in Heart Disease, Cancer, Orthopedics, Gastroenterology, Neurology, Neurosurgery, Pulmonary Medicine, and Genetics.

“One of the most common forms of heart disease in children that we have noticed is Congenital Heart Disease (CHD), which is the most common birth defect in children, impacting nearly 1 out of every 100 live births. Though CHD survival at many centers now approaches 98 percent, it still remains one of the most common causes of death in the first year of life.

“CHD is a heart disease that you are born with.  Of the congenital heart diseases, the most common forms are septal defects, openings between the chambers of the heart which cause increased blood flow to the lungs of young children.  Obstructive conditions, blockages of heart valves or blood vessels, are the second most common types of problems in children.  There are also more complex forms of heart disease in which the children may be missing valves or missing chambers resulting in cyanosis (blue baby disease). Additionally, there are acquired forms of heart disease in children — less common than CHD, but important in the Gulf region. The most common acquired heart disease is Rheumatic Heart Disease, a condition that follows streptococcal infections and leads to damaged heart valves in children.”

Elaborating on the innovative Pulse Oximetry Screening and the importance of testing children with this method, Dr. Martin said: “Pulse Oximetry Screening is a simple test that is performed using a pulse oximeter that measures the baby’s oxygen hemoglobin level in the arterial blood.  A pulse oximetry sensor is placed on the baby’s right hand and either foot.  If the baby’s reading is normal — 95 percent or higher in the right hand or foot and a difference of ≤3 between the two limbs — the baby passes the screen.  If the reading falls in the re-test range of 90-95 percent with a difference of 4 or more between the hand and foot, the test can be repeated up to three times, one hour apart.  A baby fails the screening test and requires further assessment by a pediatric cardiologist and an echocardiogram to rule out CCHD if the reading is 89 percent or less.  

“Pulse Oximetry has been found to be an effective screening mechanism for CCHD in the newborn nursery. It is a quick, painless, inexpensive test and usually takes less than four minutes to perform. The cost of pulse oximetry screening using a reusable probe is approximately one dollar, comparable to that of a diaper change.  When paired with fetal ultrasound and clinical assessment, detection of CCHD prior to discharge from a baby’s birth hospital improves from 50-70 percent to over 99 percent.” He added that the clinical outcomes for babies born with CCHD are excellent if they are identified early.

With regard to the number of children who need to get Pulse Oximetry screening and the number that actually does the screening in the Gulf region, especially in Kuwait, Dr. Martin said: “The best numbers are in Abu Dhabi where all 23 birthing hospitals are mandated to screen by law since 2011.  Kuwait is screening at the MOH hospitals but there is no data available.  I do not know about the private hospitals.

Stressing that childhood obesity is a growing problem around the world, Dr. Martin went on to add,Obesity often leads to hypertension, as well as Type II diabetes, both of which are harmful to the heart and places the child at risk for coronary artery disease in adulthood. There are other consequences of obesity, including on the muscular skeletal system that limit the child’s ability to exercise and compound the problem of obesity in the adult years.

In the nearly three decades that he has been with Children’s National, Dr. Martin has made a name for himself in pediatric healthcare. Following his education, at Syracuse University and the State University of New York, Upstate School of Medicine and residency at Brown University and the Rhode Island Hospital, Dr. Martin received training in pediatric cardiology at the Cardiovascular Research Institute at the University of California, San Francisco. He was named the C. Richard Beyda Professor of Cardiology in 2007. This allowed his team and him to focus on improving the diagnosis of children impacted by the most severe forms of heart disease.

He has published over 125 peer reviewed manuscripts, book chapters and invited publications, and has presented abstracts at over 100 meetings. He is respected international lecturer who has traveled to over 100 hospitals and universities within the US as well as around the world.

Gerard Martin, MD, Cardiologist and Medical Director of Global Services

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