A Note from MIAAP

On January 20, the president issued a series of executive orders including a set of changes pertaining to the Immigration process in the United States. Among the many provisions, the order stipulates a process to expand the use of expedited removal of individuals not currently authorized to reside in the United States as well as enhanced vetting for visa applicants and current visa holders. These directives have the potential to impact patients and physicians in various ways.

Given the complexity and interconnectedness of health care regulations, the customary process for regulatory change is usually deliberate and slow. The changes in question did not provide the physician community with very much lead time to understand how these changes might affect the delivery of care to patients as well as how this might affect medical staffs that rely on physicians that do not possess U.S. Citizenship. Because this Executive Order does not have a great deal of historical precedent from a policy perspective and it was not accompanied with specific guidance from the federal government, there is a lot of uncertainty about what the ultimate impact of these policies might mean in practice.

Aspects of this Executive Order are already being challenged in court. Decisions from the courts could result in restraining orders that temporarily suspend certain aspects of the Executive Order as well as potentially rendering decisions that help clarify the contours and limits of these changes. Furthermore, we are hearing of some specific instances from our members where there have been interactions with immigration officials at health care settings that also help us to understand how this order may be enforced.

Unfortunately, this situation is complicated and very fluid which makes giving specific guidance very challenging and impractical. However, we are working with the AAP and other partner organizations to better understand the impact of this issue and communicate that information as it is gathered. To that end, we will be maintaining a page on our website with resources that may be valuable for pediatricians and your patients.

The link to our resource page is here.

If there are particular areas of concern, or if there is a resource that you have found to be of value to you or your practice and would like to share, please contact us at administrator@miaap.org

MIAAP Wants to Hear From You

We know our members carry a wealth of knowledge and often have practical tips they have learned on the job. MIAAP aims to create a space to share those tips with each other, and our resident and med student members. If you have a practical peds tip you'd like to have featured in our newsletters please submit one below!

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MIAAP EDUCATION OPPORTUNITIES

“Michigan State University College of Osteopathic Medicine is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. MSUCOM designates this program for a maximum of 8.0 AOA Category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s

participation in this activity.” “Michigan State University College of Osteopathic Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. MSUCOM designates this live activity for a maximum of 8.0 AMA PRA Category 1 Credit(s)TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.”

GRAND ROUNDS

February 28, 2025 - Hot Topics in Public Health- Julie Kehdi, DO - Register Now

April 11, 2025 - Follow up Care After Pediatric Critical Illness- Lauren Yagiela, MD - Register Now

May 16, 2025 - Irregular Bleeding and Dysmenorrhea in Adolescents - Lisa Lowery, MD - Register Now

November 21, 2025 - Follow up Care after NICU - Christy Lawrence- Register Now

MORE DATES TO BE ANNOUNCED SOON

Michigan News

Flu levels ‘very high’ and climbing in Michigan

Michigan’s flu-like illness levels are “very high” according to the U.S. Centers for Disease Control and Prevention (CDC).

The state ranked among the top 15 nationally as of Jan. 25, reaching the second-highest of 13 levels on the CDC’s influenza surveillance system. Only six states had higher levels of flu-like illness during the latest reporting period.

Health Department of Northwest Michigan names Shannon Klonowski as new health officer

The board of health for the Health Department of Northwest Michigan named a new Health Officer to lead the department on Tuesday.

After serving as the Chief Financial Officer of the health department for two and a half years, Shannon Klonowski will be stepping into the role of Health Officer. The board of health officially approved her hiring at their meeting on Feb. 4.

AAP News

Study Identifies Large Overlap Between Children With Autism and Those With Medical Complexity, Analyzes Costs of Services

A Pediatrics study finds extensive overlap in children with autism and children with medical complexity and observes that these groups are generally treated separately in services, research and policy. The study, “Autism and Medical Complexity among Children in the U.S,” published in the March 2025 Pediatrics (published online Feb. 3) analyzed information from databases provided by the National Survey of Children’s Health and Medical Expenditure Panel Survey, selecting children ages 0-17. Medical complexity was defined as having multiple or severe chronic health conditions, often affecting multiple organ systems and resulting in major functional limitations.

How to code for care during newborn’s hospital admission

Newborns may require varying levels of care during their hospital stay. Even a seemingly healthy newborn can become ill unexpectedly.

Accurate physician documentation and appropriate code selection are necessary to ensure that providers receive proper payment for their services.

Following is an overview of coding for various levels of newborn care and examples of how care levels may change during a newborn’s hospital admission.

Pediatricians in the News

1-year-old girl in desperate need of kidney, undergoing daily dialysis

Doctor Melissa Gregory, a pediatric nephrologist at Children's Hospital of Michigan, explained to me that kidney disease in children is incredibly rare. But for Luna, it is now a race against the clock because dialysis takes a much bigger toll on little bodies long term.

" Dialysis over the course of years takes its toll," Gregory said. "It's difficult for kids to have normal development while on dialysis... Luna's on a daily dialysis program."

Now, Luna's family is turning to the community desperately searching for a kidney donor match.

"I can't imagine a better thing that anybody can do for another person. And to be a living donor and to be able to give a kidney to somebody and know them, it's just so selfless," Winn said.

Melissa Gregory, MD

I’m a pediatrician. When parents attack me for suggesting vaccines, I fume at RFK Jr.

So many parents refusing vaccines for the children I see in my examination room have been encouraged to do so by Robert F. Kennedy Jr., the charlatan President Donald Trump has picked to take the reins of the Department of Health and Human Services. The Senate Finance Committee will vote on Kennedy's nomination Tuesday and, we should all hope, reject it.

I was raised by Depression-era blue-collar parents who knew firsthand the devastating diseases few of today’s parents would recognize. For them, each new vaccine increased the chance that theirs would be the first generation that didn’t expect to bury a child. I still remember how proud my mom was taking me to the pediatrician for vaccines. She was doing her job, keeping us safe. As a pediatrician, I see vaccines as a force field that we and parents use to protect young lives.

Patricia Wells, MD

Partner Programs

MC3 Opportunity: Part MOC-4

When a patient discloses suicidal ideation: Identifying, assessing and managing suicidal thoughts and behaviors

Unfortunately, the rates of youth suicidal ideation have increased, and patient disclosures of suicidal thoughts or behaviors is common in pediatric clinics and inpatient settings. The updated AAP Bright Futures recommendations now include universal suicide specific screening in addition to depression screening. Many pediatricians have relied upon the PHQ-9 to identify those youth at risk using question #9 “Thoughts that you would be better off dead or of hurting yourself in some way”. While the PHQ-9 is an excellent screening tool for depression, NIH research found that using only question #9 as a proxy for suicidal ideation misses many patients who have suicidal thoughts.

For busy pediatricians, changing practice workflows to include suicide-specific screening may seem daunting. Where do you even start? The MC3 MOC Part 4 Suicide Prevention project will guide you through the implementation of suicide-specific screening and risk assessment, provides 25 MOC 4 credits applicable to pediatrics. Board-certified family medicine and psychiatry prescribers can also receive MOC 4 credit, family medicine and psychiatry. (please reach out to Elizabeth Tengelitsch PhD for specific information)

This 6-month QI project will:

· Walk you through suicide-specific screening

· Assist with data collection

· Provide educational, asynchronous modules that demonstrate use of these tools

Past participants commented:

“This was very helpful to be aware of the resources available to me and having the next steps on what to do if I have patients with positive screens. I feel confident in assessing patients with suicidality, assessing acuity of their suicidality, and safety planning with them.”

“This was a helpful project to enhance my knowledge and communication skills surrounding suicide.”

“I found this helpful - the main change I implemented in my practice as a result was adding in the ASQ to the PHQ-9. I now give both of these screeners to all of my patients 12 and up at well visits (and at other visits when indicated).”

Pediatricians are on the front line and are often the professionals patients and their families seek for mental health concerns. Be the one who can help!

To get started complete the introductory SURVEY here. Please contact Elizabeth Tengelitsch PhD with any questions.

Updated Newborn Screening Cystic Fibrosis 139 Mutation Panel

The State of Michigan Newborn Screening (NBS) Program is working to establish infrastructure and framework to expand second-tier molecular analysis for cystic fibrosis (CF) screening. These efforts are supported by funding from the Cystic Fibrosis Foundation and the Health Resources Services and Administration (HRSA).

Screening for cystic fibrosis in Michigan utilizes a two-tiered approach. In the 1^st tier, immunoreactive trypsinogen (IRT) is measured in every infant’s NBS specimen. Elevated IRT levels are associated with CF. For infants identified with elevated IRT, a 2^nd tier mutation analysis of the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene is performed. This two-tiered approach is the consensus standard for NBS and has been in place since Michigan began CF NBS in 2007. Currently, 2^nd tier testing in Michigan is performed using the FDA-cleared Luminex xTAG CFTR 60 v2 kit, which tests for the presence of 60 CF-causing CFTR variants. Beginning early 2025, the Michigan NBS laboratory will switch to the next generation sequencing (NGS) based Illumina TruSight Cystic Fibrosis 139-Variant Assay, more than doubling the number of detectable CFTR variants.

The use of the 139-variant assay will greatly improve equity of cystic fibrosis screening, as most additional CF-causing variants are more prevalent in non-white populations. However, the 139-variant panel does not cover every possible CF-causing variant and the Michigan NBS laboratory’s transition to a 139-variant panel is the start of a long-term process to expand the variant panel to continuously improve CF screening quality and equity.

Updated educational materials, including the list of CFTR variants included on the 139-variant panel, can be found on the NBS website at: Hereditary Disorders (michigan.gov)

For direct email updates, sign up for the NBS list serv at the following link: https://forms.office.com/g/rFHkMvSc2a

For questions or comments on this change, please contact the Newborn Screening Program via email at newbornscreening@michigan.gov or via phone at 517-335-4181.

MI Chapter American Academy of Pediatrics

106 W. Allegan, Suite 310, Lansing, MI 48933

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