Clinical Care

The Pediatric High Risk Asthma Program is a joint program of the Divisions of Pediatric Pulmonary Medicine and Allergy-Immunology. Each Wednesday afternoon clinic is staffed by asthma –specialist faculty and pulmonary and allergy-immunology fellows. Patients with high risk asthma are seen in a multidisciplinary clinic which includes nurse practitioners, nurses, respiratory care and social work. Specialized services such as allergy skin testing, immunotherapy, pulmonary function testing (including methacholine and exercise challenge testing) and referral to other specialists (ENT, GI) are readily available through this clinic.

Asthma is one of the most frequent causes of ED and hospital visits at Le Bonheur Children's Hospital and the Pediatric Pulmonary Medicine division is actively involved in hospital efforts to improve asthma care in the hospital, ED, and outpatient clinic. Division faculty and staff participate on multidisciplinary asthma improvement efforts, and work in the community and schools to improve asthma outcomes through education of patients and families, primary caregivers, and other staff. Faculty and fellows also have the opportunity to participate in clinical and epidemiologic research in asthma.

Memphis has one of the highest rates of prematurity in the nation and a significant number of infants with chronic lung disease are discharged from area nurseries. Many of these infants have significant oxygen requirements, and need careful follow-up as oxygen and chronic medications are weaned. The twice monthly CLD (B PD) Clinic provides a mechanism for the follow-up of premature infants with significant lung disease, apnea, or other complications during the crucial early months after nursery discharge. Infants are typically followed until weaned from oxygen. Improvement depends upon optimal growth and the role of the nutritionist in monitoring these infants is crucial. In addition the multidisciplinary clinic includes respiratory care and nursing.

The UT CF Care and Research Center at Le Bonheur Children's Hospital/Methodist University Hospital strives to provide outstanding care to adult and pediatric patients with CF from West Tennessee, eastern Arkansas, and northern Mississippi. Our major strength is our very experienced CF care team that has worked together for many years, along with the outstanding support of the administration of Le Bonheur Children's Hospital and of the Department of Pediatrics of the University of Tennessee. Our center is a CF Foundation Therapeutic Development Network (TDN) Center and we are actively involved in bringing new CF therapies to CF patients for clinical trials, with a dedicated CF research nurse coordinator. Our multidisciplinary CF team includes nursing, nutrition, respiratory therapy (RT), physical therapy (PT), social work, pharmacist, child life, and palliative care, all working together in a collaborative way.

In addition, the center team works closely with the CF Patient and Parent Advisory Council (PPAC). The PPAC and CF Center plan a yearly to twice yearly Family Education Day and a yearly CF team retreat focused on improving care. The Adult CF Care Program is centered at Methodist University Hospital (LINK) and includes monthly clinics and a dedicated adult CF care team including pulmonologists, RT, nursing, nutritionist, and social work.

The division oversees two fully equipped, modern pediatric pulmonary function laboratories staffed by specially trained technicians and respiratory therapists at Le Bonheur Children's Hospital and St. Jude Children’s Research Hospital. These laboratories provide state-of-the art testing for children from the Mid-South on both an inpatient and outpatient basis. Tests provided include spirometry (approximately 250 studies per month ), specialized bronchoprovocation testing, measurement of lung volumes by plethysmography, and measurement of carbon monoxide diffusing capacity. In addition, indirect calorimetry can be performed on selected children using our metabolic cart equipment. Our infant pulmonary function laboratory, one of only 39 such laboratories in the United States and the only one in the state of Tennessee, provides spirometry and plethysmographic lung volume measurements in infants with lung disorders. All pulmonary function tests are interpreted by pediatric pulmonology division faculty.

The division performs all flexible fiberoptic bronchoscopies at Le Bonheur Children's Hospital and at St. Jude Children’s Research Hospital (average 200 procedures per year) for airway evaluation of children. During these procedures, bronchoalveolar lavage and in selected patients, transbronchial amd and mucosal biopsies are performed for diagnosis as well as to relieve atelectasis. In collaboration with the pediatric critical care and anesthesia staff, we also perform intubation of the difficult airway. All bronchoscopies are performed in the operating room or in the pediatric critical care units at the respective hospitals under conscious or general anesthesia to maximize safety for the patients. Patients who may need rigid bronchoscopy or other surgical and endoscopic procedures for complex airway and aerodigestive disorders are done in consultation and collaboration with colleagues in pediatric surgery, pediatric otolaryngology, and pediatric gastroenterology.

The Le Bonheur Pediatric & Adolescent Sleep Disorders Center was established in 1994 to help newborns, children, and teens get the sleep they need. We provide clinical services to children to are referred to any one of the several specialists that are members of our multi-disciplinary team. All of the specialists and technicians who work with our center are committed to pediatric patients, and bring a kid-friendly and family-centered approach to evaluating and managing sleep problems. Robert A. Schoumacher, MD is a board-certified specialist in sleep medicine and serves as the medical director. He works with many of the Pediatric Neurologists, Pediatric Otolaryngologists and Pediatric Pulmonologists in Memphis to provide the appropriate level of evaluation and service to each patient. He also has his own clinic for children with sleep disorders every Tuesday.

Pediatric specialists in Neurology, Otolaryngology and Pulmonology that register as consultants with our sleep center get support and education on the latest information about sleep disorders in Children. They have access to all of the services of the center, including Polysomnography, Actigraphy, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing. The history and physical information they collect helps to inform Dr. Schoumacher’s interpretations of any studies performed at the center. Reports are made to those specialists to share with the patients and families, and copies are provided to the primary care physicians.

The center performs over 800 studies per year, and the Sleep Clinic follows a large number of patients with Obstructive Sleep Apnea, Snoring, Circadian Rhythm Disorders, Narcolepsy and Insomnia. The center has a large group of patients using CPAP and BiPAP to manage Obstructive Sleep Apnea, and assists the Pulmonologists who are managing various diseases with respiratory assistance by BiPAP or invasive mechanical ventilation.

A current goal of the center is to establish a Sleep Medicine Fellowship, coordinated with the Sleep Medicine Program for adults at the Veterans Administration Medical Center, to help train the next generation of Sleep specialists to serve our patients.

The Division of Pediatric Pulmonary Medicine cares for a number of children who are dependent on various degrees of advanced technology for their health. This includes a large number of children using oxygen supplementation for chronic lung disease, CPAP or BiPAP for Obstructive Sleep Apnea, or with chronic tracheostomy and/or gastrostomy placement. These children are typically seen as consultation cases whenever they are hospitalized at Le Bonheur, and followed on a regular basis as outpatients in the Pediatric Pulmonology Clinics.

The one special clinic is our Apnea Monitor Clinic, held at least monthly, to help manage the children who have been discharged from any area hospital with a home apnea monitor. With appropriate evaluation and care, most of these children can be successfully and safely weaned from these devices within a few visits.

The most complicated patients, with invasive mechanical ventilation, are followed in our regular Pediatric Pulmonology Clinics. We provide some extra services to these patients, including a review by a Respiratory Therapist at every clinic visit, measurement of resting oxygen saturation level and end-tidal capnometry, and special nursing and nutritional evaluation as needed. Ventilator settings or weaning protocols can be adjusted in the Clinic, with additional oxygen saturation and capnometry testing as required. Most of our ventilator-dependent patients are associated with a single Pulmonologist, and will have most or all of their Clinic appointments with that physician.

Le Bonheur Children's Hospital has a well-establish training program for Technology Dependent Children, which is strongly supported by our Critical Care Division and the Pulmonology Division. Nurse Practitioners are provided by Le Bonheur to help the resident physician staff and attending physician staff provide this complex care and make all of the necessary arrangements for eventual home placement. Experienced Respiratory Therapists assist the dedicated nursing staff in training the families in all the necessary skills, and documenting the mastery achieved by the family prior to discharge. The Pulmonology Division is closely involved in this long process, rounding on every patient in the Transitional Care Unit at least weekly , with a focus on their long-term care needs, their pathophysiology and their long-term management/weaning plans.