Allergy & Pulmonary Medicine | Clinical Activities

• Pediatric Lung Transplantation
• Cystic Fibrosis Center
• Sleep Diagnostic Service
• Sleep Clinic
• Specialized Pulmonary Services
• Congenital Alveolar Proteinosis / Surfactant Protein B Deficiency

Sleep Diagnostic Service

The Pediatric Sleep Diagnostic Service at St. Louis Children's Hospital is available for children who have or are suspected of having sleep related difficulties. Full-scale polysomnography during an overnight study permits assessment of quality of sleep, sleep stage by EEG, oxygenation and CO₂ retention, presence of apnea and its cause (central or obstructive). Polysomnography utilizing the Healthdyne Alice 3 system is performed at night, and also during the day for naps in younger children. Experienced pediatric respiratory therapists with sleep training attend and score studies. Patients can be referred for clinical evaluation via the Allergy/Pulmonary Office at (314) 454-2694.

Sleep Clinic

A multidisciplinary sleep clinic spearheaded by the division in coordination with the Departments of Neurology and Psychology is also available to help Pediatricians address an array of sleep-related issues including sleep-disordered breathing problems such as obstructive and central apneas, hypoventilation, respiratory insufficiency as well as nocturnal ventilatory support problems. Patients can be referred for clinical evaluation via the Allergy/Pulmonary Office at (314) 454-4007 or for polysomnography alone through the sleep lab at (314) 454-4503.

Specialized Pulmonary Services

Flexible fiberoptic bronchoscopy is an active service of excellence offered by our skilled bronchoscopists. Equipment includes the Olympus line -- the 2.2 mm ultrathin, the 3.7 mm pediatric, and the 4.9 mm small adult bronchoscopes. We have the Olympus EVIS video system permitting still and video recording. Most procedures are performed in the convenient Ambulatory Procedure Center on the first floor of the hospital. Bronchoscopic procedures are performed on an out-patient basis under conscious sedation. Bronchoalveolar lavage and transbronchial biopsy are both frequently performed. Through the extensive experience of our lung transplantation program, methods of performing biopsies in infants have been developed and have established our center as the leader in the field. Referrals should be made through the Division office at (314) 454-2694.

Congenital Alveolar Proteinosis / Surfactant Protein B Deficiency

Respiratory distress syndrome in a full term infant without associated risk factors (e.g., infection, congenital heart disease, etc.) should suggest a diagnosis of "congenital alveolar proteinosis". A subset of these infants are deficient in surfactant protein B. This diagnosis can be established by analysis of bronchoalveolar lavage lung tissue or, in some cases (with the common gene defect), by DNA analysis of peripheral blood. In some kindred antenatal diagnosis is possible. Treatment is supportive until lung transplantation can be accomplished (three patients have been transplanted at approximately two months of age for this disease at this Institution).

For more information, contact Aaron Hamvas, M.D., in the Division of Neonatology.