Update - Fall 2012

Best of Both Worlds: Center Integrates Pediatric and Adult Care of Congenital Heart Disease

Cleveland Clinic’s pediatric cardiologists are partnering with adult cardiologists who have additional training in congenital heart disease to see adults with congenital heart conditions in a shared location. Their aim is to provide a team approach to enhance the continuity of care that these complex patients often require in both early and later adulthood.

As of the beginning of September, the Center for Adult Congenital Heart Disease in the Heart & Vascular Institute has been regularly staffed by a dedicated team of four pediatric cardiologists who see adult patients in tandem with one of the center’s two adult cardiologists. While close collaboration between the pediatric and adult sides of this subspecialty is hardly new, the formal consolidation of the two teams in a single location on Cleveland Clinic’s main campus — with regular scheduling of appointments with members of each team — is a new development.

“Survival in children with congenital heart disease has increased to the point where a large number of the little kids we operated on are becoming young adults,” says Richard Sterba, MD, Interim Chair of Pediatric Cardiology, Cleveland Clinic Children’s Hospital. “Many pediatric cardiologists don’t feel comfortable caring for all of the noncardiac medical issues an adult patient may have.”

In turn, adult cardiologists are not fully comfortable with the anatomy of congenital heart defects, says Richard Krasuski, MD, Director of the Center for Adult Congenital Heart Disease. “So we’ve tried to incorporate the best of both worlds for adults with congenital heart disease: pediatric cardiologists who best understand the heart lesion and adult cardiologists who specialize in the complex adult medical care that’s necessary for managing these patients,” he explains.

Meeting the needs for special attention

Adults with congenital heart defects often develop other medical issues earlier in life than the general adult population does. “This is a patient population that really needs special attention,” Dr. Krasuski notes.

Cleveland Clinic’s newly enhanced integration of specialist care for these patients is aimed at providing that attention. With a focused core of pediatric and adult cardiologists regularly working side by side and seeing patients together, “we can interact like never before and define care paths for these patients,” says Dr. Sterba.

“The opportunity to get a second opinion from another colleague with different training is incredibly important” in patients with such complex clinical profiles, says Dr. Krasuski.

The enhanced integration also helps this tight core of cardiologists cultivate expertise among subspecialists in other disciplines, such as nephrology or hepatology, who have an interest in caring for problems secondary to congenital heart conditions such as cyanotic heart disease or longstanding heart failure. “Now we can more easily discuss which of our colleagues in other specialties have the interest and experience to become our go-to person for the complex secondary conditions these patients develop,” says Dr. Sterba. “This is necessary to obtain the best outcomes for this complex patient group.”

Transition of care without losing continuity

Another benefit for patients is that they receive both transition of care and continuity of care. “When patients reach a certain age, we need to make sure we’re approaching all the critical aspects of care required by an adult,” says Dr. Krasuski. “When a patient who had been followed by an outside pediatric cardiologist is referred to us, having a pediatric cardiology colleague involved makes that transition to the adult clinic much easier.”

“Our pediatric patients and families are wed to us after 18 years of care,” adds Dr. Sterba. “They can’t just be directed to the adult side without transition. This integrated, collaborative approach preserves the physician-patient relationship.”

Fairview Hospital’s NICU Outcomes Rank Among the Best Nationally

Outcomes in the NICU at Cleveland Clinic’s Fairview Hospital are among the best in the nation, according to data from the independent Vermont Oxford Network, which monitors NICU outcomes around the world.

“The network compared data from more than 16,000 U.S. infants in 2011 and, across all outcomes measures, Fairview Hospital scored in the highest quartile,” says Jalal Abu-Shaweesh, MD, Director of Neonatology at the hospital. “In fact, we were among the top 5 to 10 percent of NICUs in the nation in many measures.”

He cites the following examples:

  • Necrotizing enterocolitis. While the national average incidence of this complication in premature infants is 6 percent, Fairview had no cases among 98 patients qualifying for measurement in 2011 and has had a rate of just 0.4 percent over the past 20 years.
  • Infections. Whereas the national infection rate was 10 percent in 2011, Fairview’s rate was 2.2 percent.
  • Chronic lung disease. The 2011 national incidence of 29.1 percent was halved at Fairview (14.6 percent).
Teamwork and bedside presence

Dr. Abu-Shaweesh and Ricardo Rodriguez, MD, Chairman of Neonatology in Cleveland Clinic’s Pediatric Institute, both attribute the success of Fairview Hospital’s level III NICU to teamwork and a commitment to be at the bedside around the clock.

“Our doctors, nurse practitioners, nurses, pharmacists, respiratory therapists, occupational therapists, social workers – we all work together,” says Dr. Abu-Shaweesh. “We have multiple meetings to establish evidence-based medicine in our NICU and tackle any emerging problems together.”

He attributes the low infection rates to the team’s focus on hand washing and careful central-line management. Chronic lung disease is reduced by aggressive efforts to get babies off ventilators.

Dr. Rodriguez agrees that the committed team makes the difference, and adds that even nonclinical staff such as secretaries and suppliers are part of the effort. “There is no magic bullet,” he says. “We are constantly working together to re-evaluate everything we do.”

Round-the-clock board-certified staffing

He also emphasizes that the Fairview Hospital NICU has board-certified or board-eligible neonatologists in house at all times. “We are willing to be at the bedside when babies need it the most,” Dr. Rodriguez says. “Everyone accepts that these significantly better results are worth the effort. If those were our kids, we would want to do this for them.”

“We know there is exceptional access to neonatal care in Ohio, but our excellent outcomes differentiate us from other NICUs,” adds Dr. Abu-Shaweesh. “Our patients and their families are the beneficiaries of these outstanding results, and because of Fairview Hospital’s very accessible location, they receive this world-class care in their own community, closer to home.”

NICU Follow-up Clinic Expands to Fairview and Hillcrest Hospitals

The team that runs the successful NICU and High-Risk Infant Comprehensive Follow-up Clinic (NICU Clinic) at the Shaker Campus of Cleveland Clinic Children’s Hospital has added weekly clinics at Hillcrest and Fairview hospitals as well.

This multidisciplinary team, one of the few of its kind in the area, helps infants make a successful transition home from the NICU. The team is led by Jennifer Peterson, MD, and Carmela Lemcke, CNP, and includes a social worker, occupational and physical therapists, dieticians and others.

They coordinate infants’ medical management and help families understand and navigate their subspecialty appointments and treatment regimens. “We work closely with pediatricians and specialists to collaborate across the whole spectrum of care,” Dr. Peterson explains.

Available to any infant with assessment needs

Although many patients in the NICU Clinic have been discharged from a Cleveland Clinic Children’s Hospital NICU, any premature or medically fragile infant in need of developmental assessment will be evaluated.

Typically the team sees patients shortly after discharge and then at 4 months, 8 months and 2 years, corrected age, with visits occurring more frequently if needed.

The clinic, which has been offered at the Shaker Campus for six years, is being expanded to Hillcrest Hospital as part of its transition to level III NICU status. A similar clinic has been offered at Fairview Hospital but is being expanded by Dr. Peterson’s team.

Helping infants thrive, offering reassurance

Dr. Peterson describes the team’s primary goal as helping children meet their greatest potential in light of prematurity or medical illness at birth. “We want to help them thrive and achieve developmental success,” she says.

Many children are “catching up” nicely, she adds, and the team enjoys sharing that information as well. “The families of these children go through so much stress during the NICU hospitalization,” she says. “Reassuring them that their child is doing well after hospital discharge is an important part of what we do.”

For appointments in the NICU Clinic, families or physicians can call 216.444.KIDS (Fairview and Hillcrest hospital locations) or 216.448.6179 (Shaker Campus).

One-Stop Musculoskeletal Care Available in Community Settings

Cleveland Clinic is dedicated to making specialty care local, and pediatric rheumatology, orthopaedics, physiatry and sports medicine are no exception. Families can now see board-certified physicians in all of these specialties at single Cleveland Clinic family health center locations in two convenient community settings:

  • Richard E. Jacobs Health Center in Avon
  • Twinsburg Family Health and Surgery Center

Both family health centers also offer a pediatric infusion center and rehabilitation facilities. Other on-site services include outpatient surgery, full-scale imaging services and a retail pharmacy. The Richard E. Jacobs Health Center also features two state-of-the-art pools for aquatic therapy. The result at both locations is convenient “one-stop shopping” in pediatric bone, joint, sports and rehabilitation care.

Uniquely Local Service Offerings

“There’s nowhere else in Northeast Ohio where a patient can find all of these pediatric subspecialties in a single facility away from a hospital’s main campus,” says Steven Spalding, MD, Director of the Center for Pediatric Rheumatology. Offering all of these subspecialty services in the same community location allows physicians to maximize coordination of care. “Patients’ visits are more efficient — they don’t have to go to six different places to get their care,” Dr. Spalding explains.

“Not only do we provide comprehensive musculoskeletal care to pediatric patients,” says Ryan Goodwin, MD, a pediatric orthopaedic surgeon, “we also offer same-day appointments so our physicians are accessible to the community and patients can be seen and treated close to home.”

At the same time, patients are still receiving services that are nationally ranked. “There is no sacrifice in quality,” Dr. Spalding says, noting that many of the pediatric subspecialists at these family health centers practice at Cleveland Clinic Children’s Hospital on main campus as well.

“The broad pediatric subspecialty offerings at our family health centers in Avon and Twinsburg are a relatively rare proposition,” says Dr. Spalding. “We have a singular, well-integrated system to take care of the kids who need it.”

To refer a patient to a subspecialist in any of these fields at Cleveland Clinic’s Avon, Twinsburg or main campus locations, call 855.REFER.123 (855.733.3712).

Who’s New? Staff Spotlight

Behavioral Health

Ethan Benore, PhD, ABPP, BCBK
Specialty interests: Headache, chronic pain, biofeedback, sleep
Location: Shaker campus
Phone: 216.448.6253
Email: benoree@ccf.org


Laurie Minarich, MD
Specialty interests: Pediatric endocrinology

Nouhad Raissouni, MD
Specialty interests: Diabetes mellitus, thyroid disorders, obesity, insulin resistance, polycystic ovary syndrome, pubertal delay/precocity, short stature, adrenal disorders, Turner syndrome, amenorrhea, disorders of sex differentiation, bone disorders
Location: Main campus
Phone: 216.444.7987
Email: raisson@ccf.org


Jonathan Moses, MD
Specialty interests: Inflammatory bowel disease, celiac disease, eosinophilic esophagitis, cyclic vomiting syndrome
Location: Main campus
Phone: 216.444.4464
Email: mosesj@ccf.org


Wasim Khasawneh, MD
Specialty interests: Neonatal nutrition, management of mechanical ventilation, intensive care of preterm and ill neonates, postoperative care of neonates
Location: Main campus
Phone: 216.444.2568
Email: khasaww@ccf.org

Marina Perez-Fournier, MD
Location: Main campus
Phone: 216.444.2568
Email: perezfm@ccf.org

Natalie Yeaney, MD
Specialty interests: Neonatal nutrition, prenatal counseling
Location: Main campus
Phone: 216.444.2568
Email: yeaneyn@ccf.org


Raed Bou Matar, MD
Specialty interests: Nephrotic syndrome, nephritis, chronic kidney disease
Location: Main campus
Phone: 216.444.5437
Email: boumatr@ccf.org


Robert Rennebohm, MD
Specialty interests: Juvenile idiopathic arthritis, juvenile dermatomyositis, enthesopathy/spondyloarthropathy, general pediatric rheumatology, Susac syndrome
Location: Main campus
Phone: 216.445.6626
Email: rennebr@ccf.org


Audrey Rhee, MD
Locations: Main campus, Independence Family Health Center, Richard E. Jacobs Family Health Center (Avon)
Email: rheea@ccf.org

CME from the Pediatric Institute

Live CME

Oct. 17, 2012, 5:30 p.m. – 8:30 p.m.
Dino’s Restaurant & Banquet Center, Willoughby, Ohio
Maternal and Fetal Cardiac Disease: Perspectives from Perinatology and Pediatric Cardiology (complimentary CME dinner presentation)
RSVP by Oct. 12 at 216.448.6600 or zaibekj@ccf.org

Oct. 24, 2012, 5:30 p.m. – 8:30 p.m.
DeLuca’s Place in the Park, Lorain, Ohio
Maternal and Fetal Cardiac Disease: Perspectives from Perinatology and Pediatric Cardiology (complimentary CME dinner presentation)
RSVP by Oct. 19 at 216.448.6600 or zaibekj@ccf.org

Nov. 7, 2012, 5:30 p.m. – 8:30 p.m.
356th Fighter Group, North Canton, Ohio
Maternal and Fetal Cardiac Disease: Perspectives from Perinatology and Pediatric Cardiology (complimentary CME dinner presentation)
RSVP by Nov. 2 at 216.448.6600 or zaibekj@ccf.org

Nov. 9, 2012, 8 a.m. – Noon
Cleveland Clinic Main Campus (NA5-08 Amphitheatre), Cleveland, Ohio
Sleep Problems in Children with Special Needs
Covers disorders of breathing during sleep, with emphasis on children with special needs. For primary care providers, nurses and others.

Dec. 7, 2012, 8 a.m. – 11 a.m.
Fairview Hospital (Meeting Room A), Cleveland, Ohio
Pediatric Grand Rounds (complimentary; no preregistration)
8 a.m. – Vera Hupertz, MD, “Neonatal Jaundice”
9 a.m. – Audrey Rhee, MD, “Undescended Testicles”
10 a.m. – Nouhad Raissouni, MD, “Calcium and Vitamin D Deficiency”

Free Virtual CME

Check out a webcast on childhood autoinflammatory syndromes and online case-based lessons on well baby care and early signs of autism spectrum disorder.