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Washington state is currently experiencing a large RSV wave that is impacting a broad age range of children, with a disproportionate impact on children under the age of 2. Influenza activity in Washington State is now very high and other viruses are circulating also. The strain on hospital capacity is creating a critical situation for pediatric care in our state.

The situation at Seattle Children’s

• Seattle Children’s has been experiencing record-setting census for inpatients, intensive care units (ICUs) and the Emergency Department (ED). Our capacity situation is critical.
• Our ED is operating at 100% capacity almost around the clock, and up to 300% capacity in the evenings. We expect ED volumes to increase over the next several months.
• We are rescheduling nonurgent admissions; surgical cases are being reviewed for need to admit, level of care and/or ability to safely remain in the postanesthesia care unit (PACU). Outpatient procedures and other-day surgery cases are not being screened at this time because they don’t impact inpatient capacity.

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Seattle Children’s Autism Center is now offering a fast-track program for children and teens already diagnosed with autism or other neurodevelopmental disorders and who are struggling with psychiatric or behavioral concerns.

The program offers short-term evaluation and consultation to identify appropriate treatment options. Patients are then returned to their community provider with written recommendations for their ongoing mental health management, which may include medication and/or therapy.  See “What to expect” below for more details on patient hand-off.

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Seattle Children’s recently created two new algorithms to support PCPs’ care of their patients:

• Microcytic anemia (including iron deficiency) (algorithm)
• Hypospadias (algorithm)

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Seattle Children’s Fetal Care and Treatment Center expanded in October 2021 to offer fetal intervention and surgery. Dr. Bettina Paek and Dr. Martin Walker co-direct the surgery program with Dr. Rebecca Stark and are specialists in using fetoscopic laser ablation for twin-to-twin transfusion syndrome (TTTS). They have some of the highest survival rates in the United States.

From Seattle Children’s On the Pulse:

Katie and Nic Harmston were distraught as they drove to Kaiser for an ultrasound in July 2021.

Katie was six and a half weeks pregnant but was experiencing symptoms of a miscarriage. They both feared the worst.The Harmstons held their breath as the ultrasound began.

After a moment, the sonographer smiled and said, “We have a heartbeat.” Katie and Nic were nearly overwhelmed with relief. Then the sonographer said something unexpected.

“Hold on — there are two heartbeats!”

“We were shocked to find out it was twins,” Katie says. “I just started crying and laughing.”

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Tips to help your patients get their labs in the most timely, convenient way:

Tip 1:  Use the correct fax number to submit lab orders. The vast majority of lab orders should go to our central lab fax, 206-985-3193, but there are a few exceptions. Knowing about them will help your order be processed without delay.

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Seattle Children’s began work last fall to replace Code Purple (a code meant to initiate a de-escalation response when all other interventions to manage behaviors that put people at risk for injury or harm have been unsuccessful).

Replacing Code Purple was critical because it has routinely been used inequitably on Black and African American patients and families.

The new system, called Adaptive Social Response, was created in partnership with families, community leaders and workforce members. Adaptive Social Response provides support tailored for the specific need of a patient, family member or care team member, including specialized support to address issues of equity or discrimination. There is also a pathway specific to addressing violence/threat of violence.

Adaptive Social Response will be launched at the hospital campus and Springbrook Professional Center in early January 2023. Code Purple will no longer be used from that point onward.

Providers looking for more information about the changes to Code Purple at Seattle Children’s may contact [email protected].

Medical Staff

Jennifer Bracamontes, MD, Endocrinology

Carlos Castillo Pinto, MD, Neurology

Melissa Hathaway, MD, Medicine

Kevin Keith, MD, Emergency-Urgent Care

Brenda Kitchen, MD, Hematology-Oncology

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• Seattle Children’s is experiencing record-setting census for inpatients, intensive care units (ICUs) and the Emergency Department (ED).
• We also continue to treat high numbers of patients experiencing mental and behavioral health crises.
• Regionally, hospitals across Washington state continue to report strained pediatric capacity.
• Seattle Children’s has implemented a variety of surge plans to help us meet the demand for our services while ensuring we deliver the best possible care. Many of those plans are having a positive impact, but the capacity situation is still critical.
• Leaders are huddling daily to monitor the situation and propose additional solutions.
• When sending families to the ED, please call our Communications Center first (206-987-8899) to help with staffing and space planning. Advise families to expect longer-than-typical wait times and that we are triaging to see the sickest patients first.

For More Information: Please refer to our Emergency or Urgent Care Referral Guide when sending patients to Seattle Children’s.

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.