Section on Neurological Surgery of the American Academy of Pediatrics

Joseph Piatt, MD

SONS Update

As the Annual Report of the Section on Neurological Surgery, SONS, of the American Academy of Pediatrics, AAP, just appeared in the January issue of the Journal of Neurosurgery: Pediatrics, this column will be limited to a few highlights and updates.

Trauma: This past year the Board of Directors of the AAP has been inventorying the organization’s trauma-related activities and considering how to respond to the needs of children and its own membership for pediatric leadership in this area. The board has agreed on a strategy of cooperation -- rather than competition -- with the American College of Surgeons Committee on Trauma, and high-level discussions between the AAP and the ACS have led to the creation of a designated pediatric liaison to the Committee on Trauma, Steven Krug, MD, an emergency physician at Children’s Memorial Hospital in Chicago. The pediatric liaison augments the continuing presence on the committee of a number of Specialty Fellows of the AAP acting in their capacities as Fellows of the ACS. Dr. Krug hopes to use his position to develop opportunities for coordination on many levels between the two organizations.

Transition: The 2007 Annual Leadership Forum endorsed and subsequently gave “Top 10” priority to a resolution, written in the SONS and cosponsored by the Pennsylvania Chapter, calling for a task force on the problems of transition to adult care settings for patients with chronic, childhood-onset medical and surgical conditions. This resolution seemed to serve as a focal point for impatience with the status quo in almost every sector of pediatric practice. The Board of Directors has responded by surveying AAP leaders for their perspectives and directions, reaching out to potential partnering organizations, such as the American College of Physicians, which seem independently to have recognized a degree of ownership of this issue, and hiring a consultant to write a white paper. The particular concerns of pediatric neurosurgeons and other surgical subspecialists are not going to be the very top priority, but in a mid-March meeting with the Surgical Advisory Panel, the Board of Directors committed to remain in conversation with surgical subspecialists and to lend the support of the AAP to specific initiatives to mitigate obstacles to transition for surgical patients.

National Health Policy: The overwhelming preoccupation of the AAP Department of Federal Affairs last year was the expansion of the State Children’s Health Insurance Program, SCHIP. This effort was a failure, but there were some less prominent successes. Of interest to pediatric neurosurgeons was the passage of the Pediatric Medical Device Safety and Improvement Act, PMDSIA, of 2007 (for a concise summary see http://www.aap.org/advocacy/washing/Therapeutics/docs/deviceonepage.pdf). This bill creates incentives for the development and marketing of medical and surgical devices for children, and it gives the Food and Drug Administration authority to require long-term postmarket surveillance. The essentials of this bill were formulated in a series of workshops sponsored by the AAP, the National Association of Children’s Hospitals, the National Organization for Rare Diseases, the Elizabeth Glaser Pediatric AIDS Foundation, and the Advanced Medical Technology Association, an industry group, back in the fall of 2004. The AAP sent neurosurgical representatives -- Jeffrey Blount, MD, Joseph Piatt, MD, and John Ragheb, MD -- to each of these meetings. The PMDSIA is an outstanding example of the advocacy of the AAP on behalf of -- and in active cooperation with -- pediatric neurosurgery.