Inside Pediatrics Spring 2025

ORTHOPEDICS

Ortho and radiology collaborating to improve musculoskeletal infection treatment Each year, Children’s evaluates between 500 and 1,000 children for musculoskeletal infections, which are far trickier to characterize in children than in adults. This poses challenges to determine the best course of treatment. That’s why the Children’s orthopedics and radiology teams have joined forces in an innovative collaboration. Their goal is to determine which young patients might be best-suited for special MRI imaging techniques that can both be performed quickly— avoiding sedation—and represent the best hope for distinguishing crucial infection characteristics. Children’s orthopedic surgeon Kevin Williams, M.D. , is spearheading the initiative. He and his colleagues have been tracking improvements over the past decade in technology and MRI techniques that can counteract this problem. They discovered recent research that, he says, assessed “specific MRI sequences or sets of images that can be performed expediently to avoid sedating or putting a child to sleep for the MRI, and they’re also good enough quality for clinical decision-making.”

The group is working to determine which of the hospital’s MRI machines are capable of this technology. They’re also consulting with anesthesiologists to determine which young patients may be suitable for those types of MRIs. In the fall of 2024, they

were able to develop a “FAST protocol” for musculoskeletal imaging to assist with efficient clinical decision-making. It typically takes less than 15 minutes and does not

necessitate sedation or gadolinium contrast application. It has significantly improved treatment protocols for these infections, and the team anticipates it will reduce health care expenditures, time in the hospital, and will be beneficial to patient outcomes. “We are constantly striving to revolutionize the care we give to the children of Alabama with musculoskeletal infections,” Williams said. “Innovating our practice with the help of the most recent medical literature will keep us at the forefront of delivering the best patient care possible.”

GASTROENTEROLOGY

New technology improves diagnosis of esophageal conditions Diagnosing esophageal disorders in pediatric patients presents a number of challenges for both providers and patients. The diagnostic tools typically used in the past often caused discomfort for the patient and made diagnosis difficult. Thanks to the addition of a new technology, Children’s of Alabama is able to circumvent these issues to streamline the process for both sides.

In the fall of 2024, Children’s began using an endoluminal functional lumen imaging probe, also known as EndoFlip. It’s a device that evaluates esophageal distensibility under general anesthesia during endoscopy to provide important insights for patients with conditions like dysphagia, eosinophilic esophagitis (EoE) and post-surgical complications. Clinicians have been using this on adult patients since 2009, but it was FDA approved for children 5 and older in the last few years. In pediatric patients, who often struggle with conventional methods, the use of anesthesia significantly reduces stress and discomfort for both children and their families. With the use of this technology, Children’s “can now identify abnormalities that were previously undetectable, leading to timely and effective interventions,” Children’s pediatric gastroenterologist Diana Montoya Melo, M.D. , said. EndoFlip is particularly beneficial for patients with swallowing difficulties. By measuring esophageal distensibility, physicians can detect subtle functional issues that may not be evident with endoscopy or other imaging studies. It also helps physicians identify areas of reduced esophageal diameter, guiding therapeutic interventions such as esophageal dilation. The technology also helps evaluate post-surgical complications in patients with congenital esophageal anomalies, such as tracheoesophageal fistula. By pinpointing areas of reduced distensibility, EndoFlip helps ensure accurate diagnoses and effective management plans. EndoFlip adds just a few extra minutes to the procedure, Montoya Melo said, and it also leads to reduced hospital visits, fewer diagnostic tests and faster resolutions to symptoms.

Picture: Functional lumen imaging probe inflated. Source: White E, Mutalib M. Use of endolumenal functional lumen imaging probe in investigating paediatric gastrointestinal motility disorders . World Journal of Clinical Pediatrics. 2023;12(4):162-176. Available from: https://www.wjgnet.com/2219-2808/full/v12/i4/162.htm. Licensed under CC BY-NC 4.0 (https://creativecommons.org/licenses/by-nc/4.0/).

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Inside Pediatrics | Children’s of Alabama