Protecting the young
As a pediatric critical care specialist at Texas Children’s Hospital, Dr. Jeanine Graf works to give newborns, children and adolescents a chance to cheat death and start life.
Graf is an associate professor of pediatrics at Baylor College of Medicine and earned her medical degree from Ohio State in 1988.
How have medical advances during the last two decades changed the tools that are available to you?
In the early ’70s, pediatric intensive care unit survival was about 60 to 70 percent. Now, that survival is on the margins of 96 percent. A lot of that is because of advances in what we have learned about taking care of children.
It is a combination of technological advances and all that we have learned in applied sciences about what works and what doesn’t work. We have also formed a national network to learn how to do things better, based on things like advancements in cancer care in children by studying groups of children. Not any one group or location has enough patients to figure it out. The great thing about pediatrics is our systems often work together on initiatives to advance care.
For example, children who have organ transplants now have extended lives. Last year at Texas Children’s, we had 98 pediatric organ transplants and we had a survival rate of over 97 percent. That is phenomenal, and it wouldn’t have been possible without the new drugs we have and new technology, tools and monitoring devices.
How does a large medical team work together to give kids in critical situations a fighting chance?
Like any large company, communication is an ongoing challenge. We really emphasize collaboration by doing multidisciplinary rounds every day, whether it be myself as the attending [physician], the critical care fellow, the resident, the bedside nurse or the pharmacist. We all have a say.
It’s my job as a team leader to make sure that everyone’s voice is heard. I encourage people to call each other by their first names and give input, because everybody has their sphere of expertise.
What are some of the most challenging medical cases you face?
Unfortunately, one of the most challenging recurring cases is child abuse. When a child suffers injuries at the hands of a caregiver, these injuries can be devastating and permanent. They often happen to otherwise healthy children who could have had completely normal health.
It’s a complex problem that starts way outside the ICU. It’s a combination of societal, economic and parenting factors and [lack of] education that all play into this bad outcome for a baby.
One thing I’m engaged in is, how can we prevent child abuse? Our hospital is exploring new preventive opportunities where families with a baby have an opportunity to learn about the stresses of having a brand-new infant.
Child abuse is the No. 1 thing I have difficulty dealing with because it’s preventable.
Are there specific challenges associated with transporting and treating kids?
Pediatric specialized transport is exciting. I look at it as an outreach of the ICU.
We have a trained pediatric critical care nurse and a respiratory therapist who go out to hospitals where doctors have called for assistance, and we raise the child to a higher level of care. The ICU doctor in the main hospital gives online medical advice. If all goes well, the team can begin ICU care as soon as the child arrives at that referring institution. It really does bring the pediatric ICU to the bedside of these remote locations.
The state of Texas has a large geographic area to cover. So we not only go by ground, but we also have a Citation jet that we take to places like El Paso or McAllen or east Louisiana to bring children to Texas Children’s and support them by offering services they might not have in their small towns.