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Catherine Otten, MD, and Stephen Chee-Yung Wong, MD, lead the Inflammatory Brain Disorders Clinic at Seattle Children’s. With increasing evidence that children with severe problems related to thinking, learning and mental health have inflammatory brain disorders, Seattle Children’s created the clinic in 2021 to bring the latest advances in this fast-growing field to children in our region. The most common condition Drs. Otten and Wong see in patients is autoimmune encephalitis (AIE).

Q: Can you give us a quick reminder of what AIE is?

Autoimmune encephalitis is an inflammatory brain disease associated with antibodies that bind to cells in the brain. It is a type of noninfectious encephalitis. Patients can experience a wide range of neurologic and psychiatric symptoms, including seizures, abnormal movements, behavior changes, psychosis, autonomic dysfunction, cognitive symptoms, or altered level of consciousness. Different types of AIE can affect children and adults at different rates and with different symptoms. Often, patients may present with acutely to subacutely altered mental status, behavioral changes and seizures. Clinicians may be considering different types of encephalitis, including infectious and autoimmune encephalitis, in their differential diagnosis. Symptoms can progress, and a good portion will need critical care, and nearly all will be hospitalized acutely for treatment and management. Long-term, children typically continue to need treatment to manage relapses, refractory disease or sequelae from their AIE.

Q: How common is autoimmune encephalitis?

It is likely more common than we recognize! For instance, the California Encephalitis Project tracked the causes of encephalitis, and autoimmune causes of encephalitis were more common than any infectious agent. The most common type is anti-N-methyl-D-aspartate receptor encephalitis, or NMDARE, which affects women and children in higher proportion. AIE is not expected in very young infants under 6 months of age, but affects all ages otherwise. Read full post »

Seattle Children’s began palivizumab (Synagis) administration in mid-October due to increasing respiratory syncytial virus (RSV) rates.  Our providers will identify and refer their eligible patients. We ask that community providers with patients who need Synagis provide it directly rather than referring patients to Seattle Children’s due to capacity constraints at the hospital.

The American Academy of Pediatrics (AAP) continues to recommend five monthly doses for eligible patients while recognizing the need for monitoring and flexibility in what might be an atypical season. See the AAP recommendations.

Seattle Children’s is providing influenza vaccinations to inpatients and outpatients. Patients will be screened for eligibility. Seattle Children’s is also offering influenza vaccination to Emergency Department and Urgent Care patients. All vaccinations given to patients are documented in the Child Profile Immunization Registry.

We are providing flu shot vouchers to patients’ family members and household contacts age 3 and older during patient visits and stays.

• • Families in Washington or Idaho: The vouchers can be used at Rite Aid or Bartell Drugs (owned by Rite Aid) with no out-of-pocket cost. Rite Aid or Bartell Drugs will bill family members’ insurance, if available, and charge any remaining balance to Seattle Children’s. Families can also download the voucher from seattlechildrens.org.
  • Families in Alaska or Montana: The vouchers can be used at CVS in Alaska and Montana only with no out-of-pocket cost. CVS will bill family members’ insurance, if available, and charge any remaining balance to Seattle Children’s. Families can also download the voucher from seattlechildrens.org.

Family members and household contacts ages 6 months to 35 months will need to get their flu vaccine at their primary care provider’s office.

Seattle Children’s efforts to vaccinate patients are in accordance with recommendations from the Centers for Disease Control and Prevention to increase access to the vaccine in healthcare settings.

For questions about flu vaccinations at Seattle Children’s, email infectious diseases specialist Dr. Matthew Kronman at Matthew.kronman@seattlechildrens.org.

Seattle Children’s is now offering the Pfizer-BioNTech mRNA COVID-19 bivalent vaccine to individuals 5 years and older. We have the Moderna mRNA COVID-19 bivalent vaccine for individuals 12 years and older. Appointments are required and can be scheduled on our COVID-19 vaccine page.

Individuals are eligible to receive a bivalent booster if it has been at least two months since they have completed their primary vaccination series or have received the most recent booster dose with any authorized or approved monovalent COVID-19 vaccine.

The current monovalent vaccines are no longer authorized for use as boosters in individuals 5 years and older. Children ages 6 months to 4 years remain eligible for the primary, monovalent COVID-19 vaccine series from both Pfizer-BioNTech and Moderna and are not currently authorized for any COVID-19 booster doses.

For more information, please visit our website or email COVIDVaccine@seattlechildrens.org.

Seattle Children’s specialists have worked with PCPs to create over 60 algorithms and other resources for PCPs to support your care of your patients. You can find them on our website listed A to Z here. They are an important part of Seattle Children’s commitment to helping children remain in the primary care setting when appropriate and improving timely access to specialty care.

Please consider bookmarking the algorithms page and/or posting at your workplace the Algorithms and Other Clinical Resources flyer that includes a QR code to help health care providers easily access the site.

We welcome your questions or suggestions that will help improve our PCP resources. You can contact us at Physician.relations@seattlechildrens.org.

Seattle Children’s brings care closer to home with appointments at our multi-disciplinary outpatient clinics throughout Washington. Details of the specialty services we offer, along with the names of providers and their schedules at each clinic, are found in the site-specific flyers below. Many referring providers have told us they find it helpful to print and post these at work for easy staff reference.

• Services and Specialties: Bellevue Clinic (PDF)
• Services and Specialties: North Clinic in Everett (PDF)
• Services and Specialties: Olympia Clinic (PDF)
• Services and Specialties: South Clinic in Federal Way (PDF)
• Services and Specialties: Tri-Cities Clinic (PDF)
• Services and Specialties: Wenatchee Clinic (PDF)

As a reminder, Urgent Care is available on-site at our clinics in Everett, Federal Way and Bellevue seven days a week including holidays.

Jonathan Perkins, DO, is clinic chief of Vascular Anomalies at Seattle Children’s.

Q: What is PROS?

PROS is PIK3CA-related overgrowth spectrum disorders. It is a group of rare overgrowth disorders caused by mutations in the PIK3CA gene that can lead to the overgrowth of various tissues throughout the body, as well as abnormal lymph vessels or blood vessels. CLOVES and Klippel-Trénaunay syndrome are two of the more common PROS conditions.

Q: The FDA has approved alpelisib (Vijoice) for PROS disorders. Why is this significant?

Alpelisib provides the first-ever nonsurgical option for PROS patients. In the past, many children with PROS have required multiple high-risk surgeries. Some children have lesions and symptoms that cannot be treated with surgery.

Q: Isn’t alpelisib already in use?

It’s a common breast cancer drug for adults but was not approved for pediatric use for PIK3CA-related conditions by the FDA until April of this year.
Read full post »

Effective September 1, 2022, Seattle Children’s Urgent Care clinics can refer to Seattle Children’s specialists directly. Referrals may be placed without consulting with the specialist team. Urgent Care providers may still send patients back to a PCP for a referral at their discretion. PCPs will be notified when their patient is referred to a specialist through our standard after-visit summary.

We made this change to help improve patient access, decrease work for PCPs, prevent unnecessary emergency department visits and eliminate delayed care.

If you have questions, please contact Alicha.brown@seattlechildrens.org or Tia.rooney@seattlechildrens.org.

Seattle Children’s has opened eight new operating rooms (ORs) and two cath labs on two floors in our new building, Forest B. The addition of these new ORs marks a major expansion of our surgical capacity to meet the needs of our growing community.

Dedicated purposes

Two new ORs have adjacent cath labs and are dedicated to cardiovascular surgeries. Two more ORs are dedicated to neurosurgery cases, one OR is for complex general surgery, one is for orthopedic/spine cases and the remaining two ORs will handle other types of surgeries and urgent cases. One OR has an adjacent simulation room for training purposes.

Safety and air quality

To ensure a safe environment, the air supply for the ORs and cath labs is filtered through HEPA (99.97%) filters twice, once at the air handling unit prior to the air entering the duct system and a second time in the ceiling of each room just before the air enters the space.  Washington state code calls for one level of MERV 14 (90 to 95%) filtration in operating room environments either at the air handling unit or at the room. Read full post »

Please refer your patient to the Gender Clinic only if they are interested in gender-affirming medical care (puberty blockers, testosterone or estradiol). We see patients ages 9 through 16. The wait time for new patients is currently about six months.

• If your patient is not interested in medical care or is outside these ages, please direct them instead to the community resources on our website. If they still have questions, they are welcome to contact our care navigators at 206-987-5768.
• For patients who are interested in gender-affirming surgery only, please refer them directly to the Surgical Gender Affirmation Program for a consultation.
• For patients with Kaiser insurance, we encourage them to seek care through Kaiser’s Transgender Service Program which offers services similar to ours.

Additional resources:

• Gender Clinic referral algorithm
• E-consult: A free service for nonurgent questions about your transgender or gender-diverse patient (response within three business days)
• Gender Clinic Refer a Patient page