Pediatrics

 

 

The Department of Pediatrics provides highly specialized healthcare solutions to a wide range of children’s diseases. Its services include allergy/immunology, endocrinology/diabetes, gastroenterology, infectious diseases, nephrology, rheumatology, pulmonology, neonatology, and pediatric intensive care units. Our highly skilled medical professionals promote medical research and education programs, including undergraduate and postgraduate education training, and contribute to the prevention of diseases. The department has many achievements to its credit, including a growing number of referrals and launch of the Virtual Clinic.

The Department of Pediatrics is dedicated to provide state-of-the-art tertiary and quaternary care for a diverse population of chronically and acutely ill infant and children. We are committed to providing outstanding education experiences for the next generation of medical students, residents and clinical fellows in childhood disease prevention, management, research, and advocacy.

 

Scope of Services:

The Section of General Pediatrics collaborates with the other sections in the Department of Pediatrics to provide a multi-disciplinary, comprehensive, high-quality care to KFSH&RC pediatric patients. The services provided include:

Pediatrics - Clinical Excellence:

The general Pediatrics service provides care to all patients aged 14 years and below who present to our hospital with any of the following:

• Certain conditions originating in the perinatal period
• Certain infectious and parasitic disease
• Child abuse / suspected child abuse cases
• Congenital malformations, deformations and chromosomal abnormalities
• Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
• Diseases of the circulatory system
• Diseases of the digestive system
• Diseases of the ear and mastoid process
• Diseases of the eye and adnexa
• Diseases of the genitourinary system
• Diseases of the musculoskeletal system and connective tissue
• Diseases of the nervous system
• Diseases of the respiratory system
• Diseases of the skin and subcutaneous tissue
• Endocrine, nutritional and metabolic diseases
• External causes of morbidity and mortality
• Injury, poisoning, and certain other consequences of external causes

• Symptoms, signs, and abnormal and laboratory findings

 

Pediatrics - Achievements

• The number of referrals of patients with cystic fibrosis is increasing gradually with a range of 15-20 new cases/year. The service cares for a total of > 240 cases, 170 of which are actively followed-up at King Faisal Specialist Hospital & Research Centre
• Pre-Implantation Genetic Diagnosis (PGD) and Invitro-Fertilization (IVF) of Cystic Fibrosis (CF). Our IVF laboratory has adopted Genetic haplotyping to involve CF families with unknown mutations to go for IVF/PGD procedure to have normal children. 
• More than 100 patients underwent Family screening with sweat chloride test and Cystic Fibrosis Transmembrane Regulator Gene (CFTR) mutational analysis
• Implementation of Vermont Oxford Network which is a non-profit collaboration of health care professionals dedicated to improving the quality and safety of medical care for newborn infants and their families. Established in 1988 and is today comprised of over 700 Neonatal Intensive Care units around the world
• 65 patients are on Insulin pump therapy program- Treatment of diabetic children with intensive insulin therapy using insulin pump and several new generation insulin analogues
• The Virtual Clinic in Department of Pediatrics was officially launched on 29 March 2015 
• Establishment of the International Journal of Adolescent Health.

 

 The general Pediatrics service provides care to all patients aged 14 years and below who present to our hospital with any of the following:

• Certain conditions originating in the perinatal period
• Certain infectious and parasitic disease
• Child abuse / suspected child abuse cases
• Congenital malformations, deformations and chromosomal abnormalities
• Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
• Diseases of the circulatory system
• Diseases of the digestive system
• Diseases of the ear and mastoid process
• Diseases of the eye and adnexa
• Diseases of the genitourinary system
• Diseases of the musculoskeletal system and connective tissue
• Diseases of the nervous system
• Diseases of the respiratory system
• Diseases of the skin and subcutaneous tissue
• Endocrine, nutritional and metabolic diseases
• External causes of morbidity and mortality
• Injury, poisoning, and certain other consequences of external causes
• Symptoms, signs, and abnormal and laboratory findings

 

Strategies to Assess and Meet Patient Care Needs:

The section's effort is always to geared towards providing care for all pediatric patients regardless of where they present to our hospital, e.g., emergency room, outpatient clinics, and inpatient wards. The section strives to be always available to all our patients.

To meet the needs of our patients, we will continue to provide 24-hour on-call coverage and consultations for the inpatient wards as well as to the emergency room (in cooperation with the consultants of the Department of Pediatrics).

 

During the weekday, our Section continues to provide outpatient clinic visits like what we have been doing during the previous years, where we see over 4,000 visits per year.

The section also established the Adolescent Medicine service, where residents grant scholarship training abroad in this field to address the healthcare needs of the adolescent population. In addition, we will be initiating the set up for adolescent clinics and adolescent beds in the Children's Hospital for our patients until 18 years of age.

In relation to this, we have also established the Saudi Society for Adolescent Health (SSAH), which is now approved by the Saudi Commission for Health Subspecialties. The SSAH is a multidisciplinary organization committed to improving the physical and psychosocial health and well-being of all adolescents through advocacy, clinical care, health promotion, health service delivery, professional development, and research. Our vision is for the SSAH to be the leader in promoting optimal health and well-being for adolescents and young adults. The Society is committed to ensure the provision of the highest standard of care for our youth, to create greater awareness of the health issues affecting this special population among healthcare and other professionals, policymakers, and youth-serving organizations, and to help parents understand the health care needs of their adolescent children.

 

Quality of Provided Services:

• Provides highest standard of healthcare needs for all pediatric patients.

• Advocates optimal awareness on the health issues of pediatric patients.

• Provides intensive educational activities and reviews for health care providers.

 

 Pediatric Endocrinology / Diabetes

The Department of Pediatrics is dedicated to providing state-of-the-art tertiary and quaternary care for a diverse population of chronically and acute ill infant and children. We are committed to providing outstanding education experiences for the next generation of medical students, residents and clinical fellows in childhood disease prevention, management, research and advocacy.

The Section of Pediatric Endocrinology/ Diabetes provides specialized treatment for children age 0-14 years as in- patient, out-patient, Day Medical Unit, with a wide range of Endocrinological, metabolic and diabetes disorders in addition of being the pioneer section in the department in initiating and continue to have fellowship training program.

 

Pediatric Endocrinology / Diabetes - Clinical Excellence:

1- LDL - Apheresis for Familial HomozygoteHypercholesterolemia:

The only center treating Severe Homozygote Hypercholesterolemia using LDL apheresis in collaboration with Blood Bank. All these patients are referred to liver transplant department for possible liver transplant which is the only final solution for them on gene therapy under investigation.

2- Insulin Pump Therapy Program in conjunction with the Adult Endocrinology team. Now, almost 100 patients at least 90'X» are children onInsulin pump program

3- Vit.DDependentRicketsTypeII,CaInfusionTherapy - usingintravenoushi8hdoseelementalcalciuminfusionthroughacentralline—doneintheDay MedicalUnit

4- Treatment for Osteogenesislmperfecta with IV / Po Biphosphonate, in collaboration with Department of Orthopedics atKFSH&RC.

5- Largest population in the Kingdom in the treatment of Growth Hormone Insensitivity Syndrome using IGF1 “lncrelix“. KFSH&RC is still receiving the majority of patients in the kingdom.

6- TreatmentofFamilialPersistentHyperinsulinemiaHypoglycemiaofinfancy - the largest collection of patients in the Kingdom. Both Medical and Surgical treatment in collaboration with Pediatric Surgery at KFSH&RC.

7- National Programs Contribution in collaboration of Health Outreach for work up and management of patientswith:Short stature Ambiguous Genitalia

8- Providing care for big population of Congenital Adrenal Hyperplasia in collaboration with Urology Department.

9- Providing genetic study and counselling and Pre-gestational Implantation “PGD” for incurable Endocrine and Geneticdiseases.

 

Pediatric Nephrology

The Department of Pediatrics is dedicated to provide state-of-the-art tertiary and quaternary care for a diverse population of chronically and acute ill infant and children. We are committed to providing outstanding educat ion experiences for the next generation of medical students, residents and clinical fellows in childhood disease prevention, management, research and advocacy.

The Section of Pediatric Nephrology in the Department of Pediatrics, King Faisal Specialist Hospital and Research Centre (KFSH&RC)-Riyadh is the main tertiary referral center for children with congenital/hereditary and acquired kidney diseases. It provides comprehensive service in collaboration with Pediatric Urology, Pediatric Surgery, Dietitian and Social Worker and Renal Transplant Department. It provides its expertise in outpatients and in-patients unites. In addition, we have active Health Outreach program.

 

Scope and Complexity of Patient Care Needs:

1. Renal Biopsy
2. Acute & chronic Peritoneal Dialysis
3. Acute & chronic Hemodialysis
4. Continues Ambulatory Peritoneal Dialysis (CAPO)
5. Automated Peritoneal Dialysis (APT)
6. Continues Renal Replacement Therapy (CRRT)
7. Outpatient Clinics (7 clinics per week)
8. Consultations from various parts of the hospital- ER, PICU, NICU, Bone Marrow Transplant services, Hematology/Oncology, Cardiovascular, Urology, Neurology, General Pediatrics and any other services.
9. Outreach visits and virtual clinics provided to different parts of the Kingdom.

 

Pediatric Allergy / Immunology

The Pediatric Allergy/Immunology service has developed over the years to become one of the world’s leading centers for the treatment of patients with primary immunodeficiency (PID) and allergic diseases. This encompassed a comprehensive and extensive inpatient and outpatient care program, including allergic and immunological diagnostic testing, antibody replacement, and immunotherapy and haematopoietic stem cell transplantation.

The Department of Pediatrics is dedicated to provide state-of-the-art tertiary and quaternary care for a diverse population of chronically and acutely ill infant and children. We are committed to providing outstanding education experiences for the next generation of medical students, residents and clinical fellows in childhood disease prevention, management, research, and advocacy.

 

Scope of Services:

 

The Pediatric Allergy/Immunology service at King Faisal Specialist Hospital & Research Centre has developed over the years to become one of the world's leading centers for the treatment of patients with primary immunodeficiency (PID). This encompassed a comprehensive and extensive inpatient and outpatient care program, including immunological diagnostic testing, antibody replacement, and haematopoietic stem cell transplantation.

 

Our services include inpatient, outpatient, and day-case services. Our section works in close collaboration with the BMT Unit, providing the only BMT service for severe immunodeficiency in the Kingdom and the Gulf area. This is considered one of the largest centers for BMT for PID worldwide. The Section also provides care for complicated asthma and allergic disorders.

 

The Pediatric Allergy / Hematology subspecialty encompasses two main services:

 

1- Immunology: The high incidence of consanguinity in saudia Arabia predisposed this country to a high incidence of primary immunodeficiency disorders resulting in undue susceptibility to infections. Our unit considered one of the largest units in the world that manage these disorders. We are the only center at the kingdom that is capable to investigate and provide tertiary care for such disorders. In collaboration with the Hematology Service more than 35 bone marrow transplantation for immunodeficiency disorders done yearly.

 

2- Allergy: Allergic diseases are probably the most common chronic diseases and are highly prevalent in Saudi Arabia, it include bronchial asthma, Allergic rhinitis, drug allergies, food allergies, anaphylaxis and atopic dermatitis.

 

We provide tertiary care services to patients with allergic or immunodeficiency diseases that include:

1. Investigating and diagnosing primary immunodeficiency disorders.
2. Bone marrow transplantation for immunodeficiency disorders in collaboration with the Hematology Service.
3. IV immunoglobulin replacement.
4. Management of severe asthma, allergic rhinitis, anaphylaxis, severe atopic dermatitis, urticaria, insect and drug allergy .
5. Allergen skin testing.
6. Immunotherapy to aeroallergens and venoms.

 

 

We are the only center in the Kingdom and the Gulf Area that is capable of providing a comprehensive diagnostic and management of patients with primary immunodeficiency disorders.

Currently, we have more than 1000 cases of PIDs including BMT that are currently actively followed at the Immunodeficiency Clinics. This is considered one of the largest numbers of patients with such disorders who are treated and followed-up in a single institution worldwide.

In addition, more than 500 PIDs cases had been transplanted in collaboration with the Pediatric Stem Cell Transplantation Team. This considered one of the largest number of SCTs done in single centre worldwide. Moreover, the Section provides care for complicated asthma and allergic disorders.

 

Strategies to Assess and Meet Patient Care Needs:

1. Section's statistics
2. Bone Marrow Transplantation database
3. Establishment of the Primary Immunodeficiency Registry

 

Quality of Provided Services:

1. Follow the practice parameter for the diagnosis and management of primary immunodeficiency by the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI)
2. Use the EBMT guidelines for HSCT for primary immunodeficiency.
3. 100% compliance with the hospital wide infection control recommendations.

 

Pediatric Gastroenterology, Hepatology and Nutrition

The section of Pediatric Gastroenterology, Hepatology and Nutrition offers tertiary care for pediatric patients less than 14 years of age. The aim of the management is to achieve normalization of growth and development and control or abort pathology. Pediatric Gastroenterology is an invasive branch of Pediatrics where invasive diagnostic and therapeutic procedure such as upper and lower GI Endoscopies, ERCP and liver biopsies are utilized. We work in conjunction with other section of the department of Pediatrics and with the help of highly specific diagnostic procedures and experienced personnel at KFSH&RC to achieve our goals. The patient care activities include highly specialized tertiary care of patients with pediatric gastrointestinal and liver diseases. Clinical nutrition is an important aspect of management in pediatric patients with different diseases. We see a wide variety of consultations throughout the hospital from different services including post BMT, cancer chemotherapy or following major neuro and cardiac surgery. We are involved heavily in consultation with our colleagues in the medical genetics service dealing with a large number of patients with inborn error of metabolism and metabolic liver diseases including tyrosenemia, galactosemia, glycogen storage diseases and others. We are also involved in assessing patients requiring liver transplant as well as providing post liver transplant care in collaboration with our colleagues in liver transplant service. Formal association with other medical personnel including pediatric subspecialists, pediatric surgeons, radiologists, pathologists, nurse practitioners, nurses, nutritionists, psychologists and social workers is an important aspect of patient care. The Department of Pediatrics is dedicated to provide state-of-the-art tertiary and quaternary care for a diverse population of chronically and acutely ill infant and children. We are committed to providing outstanding education experiences for the next generation of medical students, residents and clinical fellows in childhood disease prevention, management, research and advocacy.   Endoscopy Unit The Endoscopy unit is equipped with modern video endoscopes of diagnostic and therapeutic type. We perform diagnostic endoscopies as well as therapeutic procedures including foreign body removal, esophageal variceal banding and sclerotherapy, esophageal dilation, injection of bleeders and polypectomy. PH and GI motility studies are done on a daily basis. ERCP is done with the assistant of our adult gastroenterologist. Recently, we have introduced capsule endoscopy to investigate patient with undiagnosed abdominal pain and GI bleeding. We are the first hospital in the kingdom that introduce pediatric capsule endoscopy service.   Day Surgical and Medical Units Day surgical unit is utilized to perform same day endoscopic procedures in the operating room every Monday / Thursday. Patients will be seen one (1) before in the pre-anesthesia clinic to assure their suitability to undergo general anesthesia. We utilize the day medical unit for medical treatment of our patients which includes intravenous infliximab (anti TNF) for children with inflammatory bowel diseases, IV anti-biotics and IV hydration.   Outpatient Clinics A total of eight (8) outpatient clinics per week including pediatric gastroenterology, pediatric hepatology. They provide patient care, as well as training for pediatric residents and pediatric gastroenterology fellows.

Scope of Services:

The patient care activities include highly specialized tertiary care of patients with pediatric gastrointestinalandliverdiseases.Clinicalnutritionisanimportantaspectofmanagementin pediatric patients with different diseases. We have an average of five (5) inpatients beds as well as admitting patients to both pediatric ICU and neonatal ICU. We see a wide variety of consultations throughout the hospital from different services including post BMT. Cancer chemotherapy or following major neuro and cardiac surgery. We are involved heavily in consultationwithourcolleaguesinthemedicalgeneticsservicedealingwithalargenumberof patients with inborn error of metabolism and metabolic liver diseases including tyrosenemia, galactosemia,glycogenstoragediseasesandothers.Wearealsoinvolvedinassessingpatients requiring liver transplant. Formal association with other medical personnel including pediatric subspecialists, pediatric surgeons, radiologists, pathologists, nurse practitioners, nurses, nutritionists,psychologistsandsocialworkersisanimportantaspectofpatientcare.

 

 

Quality of Provided Services:

HighQualityofPatientCareisensuredbyapplyingevidencebasedmedicinepracticeand clinical guidelines.PhysiciansareencouragedtoattendInternationalmeetingsandearnCME as per SCFHSguidelines.

 

Pediatric Infectious Diseases

The Section of Pediatric Infectious Diseases was established in 1989. There are 6 Consultants (4 full-time employees and 2 are part-timers), 1 Associate Consultant and 1 Assistant Consultant in the Section. All of the Consultants have certification in Pediatrics and subspecialty certification in Infectious Diseases from either the American Board, or the Canadian Royal College of Physicians and Surgeons. Additionally, individual consultants have special training and expertise in Virology, Mycology, Epidemiology, Design, Measurement and Evaluation of Clinical Research, health education, stewardship, and infection control.

The Section of Infectious Diseases is dedicated to the promotion of excellence in patient care, disease prevention and control, and education in the field of Pediatric Infectious Diseases.

 

Scope of Services:

The Section of Pediatric Infectious Diseases was established in 1989. The Section has grown considerably since then with the addition of new staff and the increasing number of patients/services requiring the input and expertise of Infectious Diseases Consultants, e.g. Cardiovascular Department, Pediatric Hematology/Oncology, King Fahad National Children Cancer Centre, Medical Outreach Program, and others. The Section members are involved in planning continuing medical education activities and development of multidisciplinary management guidelines in collaboration with other subspecialty services.

  

Pediatric Infectious Diseases - Clinical Excellence:

The section provides consultations to all Pediatric Subspecialties (medical and surgical) throughout KFSH&RC and the King Fahad National Children's Cancer Centre (KFNCCC) as well as Outreach consultations over the Kingdom. In order to provide efficient and high quality service, there are usually 3 consultants on-call during work hours, each covering one of the following area/services:

• Critical Care Units + Emergency Services + cardiovascular units
• In-patient wards, out-patient clinics, Family Medicine clinics, DMU, DSU, infectious diseases services (average number of consultations per year – 2000)
• King Fahad National Children Cancer Centre (KFNCCC)
• Phone consultation from outreach office

The Section also provides:

• Diagnostic and management of opportunistic infection in the immunocompromised host (transplant recipient, malignancy, congenital- acquired and novel immunodeficiency.
• Treatment of infection due to multi-drug resistance organism
• Post-operative complicated infections
• HIV infections
• Immunization including immunocompromised patients
• Wide variety of infectious Diseases condition

 

Outpatient Clinics (weekly):

• 6 Pediatric Infectious Diseases Clinics, 6^th Floor, North Tower Bldg., KFSHRC
• 2 HIV Clinics, 3^rd Floor, Outpatient clinics, KFSHRC
• 1 Immunocompromised Clinic, Outpatient, KFNCCC
• 2 Protocol clinics, Protocol Clinic, Main Hospital

 

A) Consultations

In-patient wards, out-patient clinics, and Family Medicine clinics

Critical Care Units Emergency Services

provide efficient and high quality service, there are usually 2 to 3 consultants on-call during work hours, each covering one of the following area/services:

The section provides consultations to all Pediatric Subspecialties (medical and surgical) throughout KFSH&RC and the King Fahad National Children's Cancer Centre KFNCCC as well as Outreach consultations over the Kingdom. In order to

King Fahad National Children Cancer Centre (KFNCCC)

 

B) Outpatient Clinics (weekly)

6 Pediatric Infectious Diseases Clinics

2 HIV Clinics

1 Clinic (KFNCCC)

2 Protocol Clinics

 

C) International Collaboration

• Professor Jean Laurent Casanova (Hopital Necker-EnfantsMalades, France)
• Duke University Medical Center, Durham, NC to carry-out important investigation to help children with invasive fungal
• Infections.
• Collaboration with international centers based on patients' needs.

 

Strategies to Assess and Meet Patient Care Needs:

• Guidelines I Clinical Pathways
• Clinical pathway for management of children with febrile neutropenia
• Guidelines for management of funneled central venous catheters in children
• Antimicrobials - Usage Guidelines
• Disease Management Guidelines
• Prevention and treatment of cytomegalovirus infection in children undergoing bone marrow transplantation
• Antimicrobial stewardship program.

 

Quality of Provided Services:

• State-of-the-art inpatient and outpatient care for pediatric patients with related infectious diseases provided by consultant-led medical team and multi-disciplinary team.

 

Pediatric Intensive Care Unit (PICU)

• The Section of Pediatric Intensive Care is dedicated to the provision of specialized high quality, safe, and efficient intensive care to children admitted to the Pediatric Intensive Care Unit (PICU). The Section also provides consultations to other subspecialties/services on patients outside of the PICU who are clinically unstable and could require transfer to the PICU.
• The Section Staff endeavor to accommodate as many referrals as possible within the restrictions imposed by the number of beds in the PICU through efficient utilization of patient beds and minimizing unnecessary stay in the unit.
• The Section promotes, plans, and supports educational activities in the discipline of Pediatric Intensive Care to Residents, fellows, and other healthcare providers in the Unit.
• The PICU at KFSHRC is an 18-bed unit, designed according to modern standards. It is equipped with up-to-date equipment required for provision of all intensive care therapeutic maneuvers including, but not limited to, dialysis, CVVH, HFO, nitric oxide, and all invasive monitoring.
• The Department of Pediatrics is dedicated to providing state-of-the-art tertiary and quaternary care for a diverse population of chronically and acutely ill infant and children. We are committed to providing outstanding education experiences for the next generation of medical students, residentsandclinicalfellowsinchildhooddiseaseprevention,management,research,andadvocacy.

 

Scope of Services:

• ThepracticeofPediatricCriticalCareMedicineisahospital-based,dedicatedto,anddefinedbythe needsofcriticallyillpatients.Thiscaremustbecontinuousandproactiveinnature,assuringthaithe patient is managed in a safe, humane, and effective manner, utilizing finite resources in a fashion designed to provide a high-quality of care and optimaloutcome.
• TheSectionofPediatricCriticalCareatKingFaisalSpecialistHospital&ResearchCentre—Riyadhis dedicated to the provision of specialized, high-quality, safe, and efficient intensive care to children admittedtothePediatricIntensiveCareUnit(PICU).TheSectionalsoprovidesconsultationstoother subspecialties/services to patients outside the PICU, who are clinically unstable and could require transfer to theunit.
• ThegoaloftheSection’sstaffistoaccommodateasmanyreferralsaspossiblewithintherestrictions imposedbythenumberofbedsinthePICUthroughefficientutilizationofpatientbedsandminimizing unnecessary stay in theunit.
• The Section promotes, plans, and supports educational activities in the discipline of Pediatric Critical Care to residents, fellows, and other healthcare providers in the Unit.
• ApartfromthePICUattheMainHospital,theSectionalsoprovides24-hourcoveragetotheKingFahadNational Children’s Cancer Centre (KFNCCC).

  

The Pediatric Intensive Care Unit:

• ThePICUatKFSHRCisan18-bedunit.Designedaccordingtomodemstandards.Itisequippedwith up-to-date equipment’s required for provision of all intensive care therapeutic maneuvers including. but not limited to, dialysis, CVVH, HFO, nitric oxide, and all invasivemonitoring.
• ThePICUattheKFNCCChasacapacityoften bedsandservespatientsatthatHospital.
• ThePICUismanagedbyaqualifiedteamofphysicians,nurses,respiratorytherapists,socialworkers, pharmacists,anddieticiansunderthesupervisionoftheConsultantPediatricIntensivists.
• Patients are admitted to the Unit from the wards, emergency department, and operating theater at KFSHRCandKFNCCCaswellasfromotherhospitalsintheKingdomandGulfcountries.Theunit provides care to patients with a wide spectrum of disease conditions requiring intensive care due to complications or their disease and / or therapy, including patients with cancer, kidney diseases, metabolic diseases, neurosurgical problems, and organtransplantation.

 

 A) CNS

1.  StatusEpilepticus
2. Neuromusculardisorders
3. Coma (of differentetiologies)
4. Pre-operativeandpostoperativemanagementofpatientundergoingneurosurgery
5. Hydrocephalus andshunts
6. Intracranial hypertension care andmanagement
7. Sever traumatic headinjuries

 

B) Respiratory

1.    Upper airwayobstruction
2. Lower airway disease: severe pneumonia, ARDS, pneumothorax, pleuraleffusions
3. Mechanical ventilation, oxygen, nitric oxide. and bronchodilatortherapy

 

C) Cardiovascular

1. Congenital Heart Disease(CHD):cyanotic and acyanotic CHD and thepathophysiology leadingtocyanosisespeciallycomplexCHDrequiringmechanicalandinotropesupport
2. Preandpost-operativecareofcongenitalandacquiredheartdisease
3. Heartfailure
4. Dysrhythmia
5. Post-cardiacarrest
6. Hypertensivecrisis

 

D) Gastrointestinal

1. Severegastroenteritisanddehydrationleadingtoshockandorgandysfunction
2. Acute hepaticfailure
3. Management of massive gastro intestinal bleed e.g. esophagealvarices
4. Management of intestinal obstruction, perforation and toxicmegacolon
5. Management of corrosiveingestion

 

E) Genitourinary

1. Acuterenalfailuremanagementandsupportincludingallrenalreplacementtherapies
2. Acute hypertension and hypertensiveencephalopathy

 

F) Metabolic/Endocrine

1. Manageanon-exhaustivelistofcausesthatincludediabetesmellitus,diabeticketo- acidosis,pheocromocytoma,thyroidcrisis,SyndromeofInappropriateAntiDiuretic Hormone(SIADH),diabetesinsipidus,andcerebralsaltwastingsyndrome.Managing inborn errors of metabolismcrisis.

 

G) Therapies of Drug Ingestions andPoisoning

1. Drug overdose

 

H) Trauma and Bums

1. The Unit takes care of patients with multiple trauma including severe head injury

 

L) Hematological Diseases

The Unit manages the following non-exhaustive list of hematological diseases:

1. reduction and over production of hematologicalcells
2. thrombosis and coagulation defect including Disseminated Intravascular Coagulation(DIC)
3. blood product transfusion and the need for specialprecautions
4. recognition and management to THE matological crisis such as sickle crisis, hemolysis
5. management of tumor lysis syndrome

 

J) Solid Tumors and Masses

1. The Unit manages the following non-exhaustive list of solid tumor-related problems such as upper airway obstruction with mediastinal tumor, increased intracranial pressure with brain tumors or space occupying lesion and respiratory compromise with abdominal distention related to tumor or masses, as well as managing induction therapy oflargemass lymphomas in case they develop tumor lysis syndrome.

 

K) Organ and Bone MarrowTransplantation

The Unit is caring for these patients during acute crisis and decompensation

 

L) Immunology and Infectious Diseases

The PICU manages patients who have severe infections leading to major organ dysfunctions

 

M) Pre and Post Operative Care

1. The PICU cares for pre and post operative patients whose surgeries are potential causes of major organ dysfunction.

 

Strategies to Assess and Meet Patient Care Needs:

With regard to the pediatric Critical Care as “an innovative approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, andprovidersthatrecognizestheimportanceofthefamilyinthepatient’slife.”'TheAAPpolicyis based on the concept of collaboration among patients, families, physicians, nurses, and other professionals. These collaborative relationships are guided by 6principles•

 

1. Listening to and respecting each child and their(amily)
2. Ensuring flexibility in organizational policies, procedures, and practices
3. Sharing complete, honest, and unbiased information with patients and families
4. Providing and ensuring formal and informal support for the child and family
5. Collaborating with patients and families at all levels of healthcare
6. Recognizing and building on the strengths of individual children and families

 

Quality of Provided Services:

The Section writ provide state of the art healthcare in areas of tertiary and quaternary care beret/or children with critical medical conditions.

• Ensure optimal flow of pediatric patients throughthe
• TocontinuetofunctionastheTertiaryReferralCenterforcriticallyillchildreninSaudiArabia
• Deliver high quality culturally sensitive care in a cost-effectivemanner
• Continue to develop quality improvement programs within the Unit
• Implement evidence based practice and caredelivery
• To establish a family centered healingenvironment
• Maintain and improve quality care indicatorsand benchmarks

 

Pediatric Pulmonology

The Department of Pediatrics is dedicated to providing state-of-the-art tertiary and quaternary care for a diverse population of chronically and acutely ill infant and children. We are committed to providing outstanding education experiences for the next generation of medical students, residents and clinical fellows in childhood disease prevention, management, research, and advocacy.

 

Pediatric Pulmonology - Clinical Excellence

• Specialized care to pediatric inpatients and outpatients with the following conditions:

 

1. Chronic lung disease (BPD) and patients with oxygen requirements
2. Obstructive lung disease, including asthma, bronchitis, emphysema, bronchiectasis, and cystic fibrosis.
3. Diffuse interstitial lung disease
4. Pulmonary vascular disease, including primary and secondary pulmonary hypertension, and pulmonary hemorrhage syndromes
5. Acute lung injury, including radiation and inhalation
6. Pulmonary manifestations of systemic diseases, including collagen vascular diseases and diseases which are primary in other organs
7. Disorders of the pleura and the mediastinum
8. Genetic and developmental disorders of the respiratory system
9. Respiratory sleep disorders
10. Lower respiratory tract infections
11. Cystic lung disease
12. Airway appliances and chronic ventilatory assistance
13. Aspiration syndromes
14. Chronic suppurative lung disease

• Interpretation of Pulmonary Function Tests. To assess respiratory mechanics, gas exchange, and respiratory drive, including spirometry, flow-volume studies, lung volumes, diffusing capacity, arterial blood gas analysis, and exercise studies.
• Family screening with sweat chloride test and Cystic Fibrosis Transmembrane Regulator Gene (CFTR) mutational analysis.

 

Scope of Services:

 

a. Clinical Activities

• Consultations

Diagnostic and medical treatment of highly specialized nature for inpatients and out-patients consultation.

• Outpatient Clinics (weekly)

1. 4 Pulmonary clinics
2. 2 Cystic Fibrosis clinics
3. 1 Respiratory Insufficiency Pediatric clinic
4. 1 Protocol clinic
5. 1 Oxygen Dependent clinic (every 1'1 and 3'd Sunday)

 

b. Interpretation of Pulmonary Function test (PIT)

To assess respiratory mechanics. gas exchange, Spirometry(flow-volume studies), lung volumes, diffusing capacity, blood gas analysis , and exercise studies

 

c. Cystic Fibrosis Standard Care

• Multidisciplinary tertiary standard care that provides up to date diagnostic and medical treatment that includes: Pediatric Pulmonologist, Clinical dietitian. Clinical pharmacist, Respiratory therapist, and health educator.
• Pre-Implantation genetic Diagnosis and Invitro-Fertilization (IVF) Of Cystic Fibrosis (CF): KFSHRC is the only center that provides the above service for families with an affected child or a relative if they are known to be a carrier.
• Performance Improvement Project: Cystic Fibrosis Clinical Pathway (CP): Formalize a plan of care for the management of cystic fibrosis during their admission for pulmonary exacerbation to reduce overall length of stay which applies a multidisciplinary approach.

 

d. Polysomnography (Sleep Study) -

Our hospital has a fully functioning sleep laboratory with active service for diagnosis and management of sleep disordered breathing in adults. However, the pediatric sleep-related breathing disorder is still underprivileged and lack of sleep medicine physician within pediatric pulmonology and lack allocated time for the pediatric patients.

 

e. Pediatric Bronchoscopy

The service was initiated recently to provide our children with the highest quality of tertiary medical care involved with airway endoscopy both as a diagnostic and therapeutic tools.

 

f. Pediatric Pulmonology fellowship

Started January 2011 under the umbrella of the Saudi Commission for Health Specialist (SCFHS), which provides specialized training in many aspects of pulmonary diseases. The pediatric pulmonology of KFSHRC is part of the national program for pediatric pulmonology fellowship training program.

 

g. Annual Bronchoscopy Course and Teaching

To promote the competency for pediatric pulmonologists and allied services and raise their standards for such procedure in Saudi Arabia.

h. Research

Pediatric Pulmonology Section is active in clinical research with the involvement of the junior staff.

 

 

Only patients who need tertiary care centre for diagnosis and management with all types as mentioned in types of patients served above. But once diagnosis is established, the treatment plan is outlined and treatment is identified to be available in a primary or secondary care hospital, the patient will be referred back to the referring hospital to continue to follow the same treatment strategies.

 

Strategies to Assess and Meet Patient Care Needs:

After the patient is screened, necessary investigations are identified and interpreted which include: blood tests, radiological investigations, PFT, exercise test, Echo and/or bronchoscopy.

Once diagnosis is made and treatment plan is identified, follow up is given every 3-6 months according to acuity of the problem. If treatment is available in a local hospital, the patient is given medical report delineating treatment plan in the local hospital.

 

Quality of Provided Services:

The Section provides state-of-the-art healthcare in areas of tertiary and quaternary care level for children with complex disorders of respiratory system.

 

Pediatric Research Unit

The Pediatric Department is committed to pediatrics patient care, teaching, and research. Its mandate includes research on the challenges of childhood diseases faced in Saudi Arabia and its objective is to increase scientific knowledge of pediatric diseases including the epidemiology, risk and risk factors, prevention, treatment. The KFSH&RC Pediatric Research Unit managed to publish 37 researches in prestigious and international scientific journals, in addition to 42 researches approved for publication.

 

Pediatric Rheumatology

King Faisal Specialist Hospital and Research Centre (KFSH&RC)-Riyadh is the main referral center for children with complex connective tissue and rheumatologic diseases in Saudi Arabia. The Section of Pediatric Rheumatology provides a comprehensive care to pediatric in-patients and outpatients with a wide spectrum of rheumatic diseases, including juvenile idiopathic arthritis, systemic lupus erythematosus, scleroderma, dermatomyositis, Henoch-Schonlein purpura, Kawasaki Disease, systemic vasculitis, familial arthropathy, and others. The Section also provides consultations to other subspecialties on children with difficult and complex inflammatory conditions. The Immunopathology Section in the Department of Pathology provides specialized tests for diagnosis and monitoring of these patients.

Children with rheumatologic diseases often require a coordinated multidisciplinary approach for optimal management of the complex musculoskeletal and extra-articular manifestations of their diseases, and complications of therapy. To that effect, the Section of Rheumatology collaborates closely with several services including physical therapy and rehabilitation, orthopedics, ophthalmology and various subspecialties in the management of these children.

The Department of Pediatrics is dedicated to providing state-of-the-art tertiary and quaternary care for a diverse population of chronically and acutely ill infant and children. We are committed to provide outstanding education experiences for the next generation of medical students, residents and clinical fellows in childhood disease prevention, management, research, and advocacy.

 

Scope of Services:

• Advanced treatment modalities and therapeutic approaches for children with rheumatic diseases.
• Systemic Lupus Erythematosus Clinic. This outpatient Clinic provides state of the art management for severely affected children with systemic lupus erythematosus.
• Outpatient intravenous infusion including therapies including: cyclophosphamide, infliximab and riutiximab, abatacept, pamidronate and intravenous immunoglobalin in the Day Medical Unit.

 

 

Strategies to Assess and Meet patient Care Needs:

• Advanced treatment modalities and therapeutic approaches for children with rheumatic diseases.
• Systemic Lupus Erythematosus Clinic. This outpatient Clinic provides state of the art management for severely affected children with systemic lupus erythematosus.
• Outpatient intravenous infusion including therapy of cyclophosphamide, infliximab, rituximab and ectemra in the Day Medical Unit.

 

Special Services provided in this Subspecialty:

The service provides an advance specialized therapy including wide spectrum of biologic agents, intra-articular injections, immunosuppressive protocols for children with advanced and refractory rheumatic diseases and recognition of familial arthropathy conditions that have not been described before.

 

Quality of Provided Services:

Provides state-of-the art- management for severely affected children with different rheumatic diseases.

 

Neonatal Critical Care

The Neonatal service at KFSH&RC is dedicated to offer high standard clinical care for the newborns. The Newborn Intensive Care Unit (NICU) at KFSH&RC is one of the tertiary care units in the Kingdom. We cater for critically ill newborns and infants, including consultation, and intensive care from all KFSH departments and eligible patient referred from all over the Kingdom and gulf state. NICU is staffed 24 hours a day by a specially trained team of doctors, nurses and respiratory therapists who provide the most advanced care available. Our neonatologists are all board-certified and actively involved in cutting-edge treatment and research.

Our facilities are equipped to provide care for the complete range of neonatal and infant critical illnesses, including all types of respiratory, surgical, cardiac, genetic, renal, neurological, hematological and metabolic diseases. It also has an excellent metabolic team which is able to diagnose prenatally many serious metabolic diseases which are common in Saudi Arabia. It is equipped with high standard technology where most advanced types of ventilators are used, i.e. high frequency oscillatory ventilators, nitric oxide and all types of non-invasive ventilation. Almost all types of neonatal service approved presently are available in our unit. KFSH&RC is one of the leaders in fetal surgery and intra-uterine exchange transfusion in the Kingdom.

Our care for newborns often begins even before the birth and continues long after the baby leaves the hospital. When potential problems are detected during pregnancy, our perinatologists and neonatologists work together to plan ahead for the baby's health. After the baby is born, we work with the other specialists to arrange for any special care the baby may need at home. In addition, we allow parents to practice caring for their babies before going home from the hospital including CPR training.

The Department of Pediatrics is dedicated to providing state-of-the-art tertiary and quaternary care for a diverse population of chronically and acutely ill infant and children. We are committed to providing outstanding education experiences for the next generation of medical students, residents and clinical fellows in childhood disease prevention, management, research, and advocacy.

 

Scope of Services:

The Section of Neonatology provides comprehensive care for critically ill newborns infants, including consultation, and intensive care. The Newborn Intensive Care Unit (NICU) at KFSH & RC is staffed 24 hours a day by a specially trained team of doctors, nurses and respiratory therapists who provide the most advanced care available. Our neonatologists are all board-certified and actively involved in cutting-edge treatment and research.

Our facilities are equipped to provide care for the complete range of neonatal and infant critical illnesses, including all types of respiratory, surgical, cardiac, genetic, renal, neurological, hematological and metabolic diseases.

Some of our areas of expertise include:

• Congenital heart disease
• Airway disorders
• Prematurity
• Persistent Pulmonary Hypertension of the Newborn
• Inborn errors of metabolism

• The use of high frequency ventilation and nitric oxide

• All neonatal surgery