Tag Archive for: emergency medicine

MRI image of a brain on a black background

Mental health care gaps in pediatric emergency rooms

MRI image of a brain on a black background

Over the past 20 years and beyond, evidence shows inequities in pediatric mental health care in emergency departments.

Mental health disorders affect nearly 20% of adolescents across the United States. There has been accumulating research over the past 20 years and beyond which has documented inequities in pediatric mental health care in emergency departments (EDs). In a recent study published in Pediatrics, researchers at Children’s National Hospital summarized the full breadth of this research to understand the extent of inequities and facilitate further work that addresses these differences in mental health care.

The big picture

Eden Efrem, clinical research coordinator at Center for Translational Research, Monika Goyal, MD, MSCE, pediatric emergency medicine specialist and co-director of the Center for Translational Research, and other researchers examined and summarized research published from 2002 to 2024 to better understand inequities in pediatric mental health care provided in the ED. The team reviewed over 2,100 articles and of those, 50 articles met inclusion criteria for this review.

“Mental health care gaps were reported in ED mental health-related visits, ED disposition – including admission, discharge, transfer, and readmission –  outpatient and follow-up care, diagnosis of mental health conditions, ED referral and pre-hospitalization, length of stay and boarding, anxiety care, suicidal ideation/self-harm care and restraint use in EDs,” Efrem said.

Why this matters

These findings aim to guide future research, development and implementation of evidence-based interventions and policies that address the underlying contributing mechanisms of these inequities. This includes looking at clinician implicit bias and barriers to mental health care access.

“By identifying gaps in mental health care access, treatment and outcomes, these findings can guide the development of interventions and policies aimed at reducing these,” Goyal added. “These improvements can help improve the provision of fair mental health care thereby enhancing patient trust, improving communication and ensuring access to quality mental health care. Ultimately, this can lead to improved mental health outcomes for children and youth.”

Moving the field forward

The researchers found that differences exist in many facets of mental health care, from ED utilization to mental health care provision, such as physical restraint use.

“Addressing gaps in care is important because every individual deserves equal access to high-quality, evidence-based healthcare,” Efrem said. “Addressing these can not only enhance patients’ mental health outcomes, but also positively impact other areas of their lives, such as educational performance, social well-being and overall quality of life.

The ADAPT Lab, led by Dr. Goyal at Children’s National, is at the forefront of identifying and addressing gaps in pediatric health care, specifically in EDs. The lab is working to improve quality of health care provision and outcomes in mental health care, asthma care, sexual health and pain management by developing and implementing evidence-based interventions in the ED.

The study was funded by the Jesse Ball DuPont Fund.

Boy in bed with oxygen mask

New tool helps doctors know when kids with pneumonia need hospital care

Boy in bed with oxygen mask

A new international study led by Children’s National Hospital and Lurie Children’s Hospital of Chicago introduces a validated tool to predict pneumonia severity in children, helping emergency clinicians make faster, evidence-based decisions about hospitalization and intensive care.

Pneumonia is one of the most common infections in children. In the U.S., it’s a leading reason why kids are admitted to the hospital. But for emergency doctors, it’s not always easy to know which cases are serious — and which children will get better at home.

Now, a new study led by doctors at Children’s National Hospital and Lurie Children’s Hospital of Chicago has created a tool to help. It’s based on research from over 2,200 children treated at emergency departments in 14 countries.

The tool is simple: it uses symptoms that doctors already look for — like how fast a child is breathing, whether they’re getting enough oxygen, and if they’re drinking fluids — to score how serious their pneumonia might be. The score helps doctors decide whether a child needs to stay in the hospital, go to intensive care or can safely recover at home.

What the study found

The research team looked at children ages 3 months to 13 years who came to emergency departments with community-acquired pneumonia — a kind of pneumonia picked up outside of a hospital. Most had mild cases. But about 1 in 20 developed severe symptoms, like needing breathing support or admission to intensive care.

The team found that certain symptoms (like fast breathing or heart rate, chest retractions (a sign of struggling to breathe), low oxygen levels, refusing to drink and already being on antibiotics before coming to the hospital) were linked to a higher risk of serious illness. On the other hand, children who had a runny nose or congestion were more likely to have mild illness.

Using this data, the team created a point-based score. For example, if a child had low oxygen levels, they’d get 3 to 6 points depending on how low it was. Chest retractions added 3 points. Having a runny nose subtracted a point. The higher the total score, the greater the risk of moderate or severe pneumonia.

How it helps

The model was tested and found to be highly accurate. It performed better than doctors’ judgment alone in earlier studies — especially in spotting the children most at risk. The scorecard gives emergency doctors a fast, evidence-based way to support the decisions they make under pressure.

“Emergency departments around the world see thousands of children with pneumonia every day, but until now, we haven’t had a reliable way to predict who’s truly at risk of getting sicker,” said co-PI and senior author Nathan Kuppermann, MD, MPH, executive vice president, chief academic officer and director of the Children’s National Research Institute. “This model gives clinicians a practical tool, rooted in data, to guide that decision and ultimately improve care and outcomes.”

What’s next

While the tool is ready to be used in hospitals now, the team plans to test it in more locations and study how it affects real-world decisions. They also hope to add biomarkers — lab tests that could improve the score’s accuracy even more.

For now, the study offers something simple and powerful: a better way to know when a child’s pneumonia might become serious — and when it won’t.

The study was published in The Lancet Child & Adolescent Health and is part of a larger effort by the Pediatric Emergency Research Network (PERN), which connects emergency departments in dozens of countries.

Nathan Kuppermann

Honor bestowed on Nathan Kuppermann, MD, MPH

Nathan Kuppermann

Children’s National Hospital named Nathan Kuppermann, MD, MPH, the Fight For Children Distinguished Chair of Academic Medicine at Children’s National.

Children’s National Hospital named Nathan Kuppermann, MD, MPH, the Fight For Children Distinguished Chair of Academic Medicine at Children’s National.

Dr. Kuppermann serves as executive vice president and chief academic officer at Children’s National. He is the director of the Children’s National Research Institute and the chair of the Department of Pediatrics and associate dean of Pediatric Academic Affairs at the George Washington University School of Medicine and Health Sciences.

The big picture

Dr. Kuppermann joins a distinguished group of Children’s National physicians and scientists who hold endowed chairs. Children’s National is grateful to generous donors who have funded 49 professorships.

Professorships support groundbreaking research and innovation on behalf of children and their families and foster new discoveries and therapies in pediatric medicine. These appointments carry prestige and honor that reflect the recipient’s achievements and donor’s commitment to advancing and sustaining knowledge.

Why it matters

Dr. Kuppermann is a pediatric emergency medicine physician, clinical epidemiologist and leader in emergency medical services for children. He specializes in clinical trials and clinical prediction rules using large cohorts of acutely ill and injured children. He is world-renowned for his research and mentorship.

“I was drawn to Children’s National by its nationally recognized work and dedication to innovation and team science,” says Dr. Kuppermann. “I’m eager to contribute to the remarkable work being done in both the research and education space to continue to improve the understanding, prevention and treatment of childhood diseases.”

Fight For Children’s support ensures that Dr. Kuppermann and future holders of this professorship will launch bold, new initiatives to rapidly advance pediatric medical research, elevate our leadership and improve the lives of children in our community and around the world.

Moving the field forward

Fight For Children was founded in 1990 by the late Joseph (Joe) E. Robert, Jr., with the mission of improving the lives of underserved children in the nation’s capital. The organization has impacted the lives of more than 400,000 young people throughout the D.C. metropolitan area.

Fight For Children endowed the Fight For Children Chair in Academic Medicine in 1997 to support the clinical research initiatives of the Chief Academic Officer. Most recently, in 2019, they made a $5M gift to create the Fight For Children Sports Medicine Center at Children’s National. It is the region’s first site dedicated to the orthopedic surgery, sports medicine and comprehensive concussion needs of young athletes.

Joe Robert was an entrepreneur and visionary who believed in the importance of investing in children through education and healthcare. His largest gift to Children’s National created and endowed our Joseph E. Robert, Jr., Center for Surgical Care. He was also instrumental in developing the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National, created in 2009 with a $150 million gift from the government of Abu Dhabi.

“Joe’s legacy continues to be represented through the incredible work being done at Children’s National,” says David Fensterheim, chairman and interim CEO of Fight For Children. “Dr. Kuppermann is a pioneer in pediatric healthcare. We are proud to honor his cutting-edge vision as the latest holder of this prestigious professorship.”

This professorship embodies Joe’s legacy and Fight For Children’s commitment to inspire others to think bigger and differently to advance pediatric healthcare for children in the community and beyond.

illustration of bacterial outbreak

$2.2m grant to support AI-driven sepsis program for pediatric care

illustration of bacterial outbreak

Sepsis is a rapidly progressing, life-threatening condition characterized by organ dysfunction (OD) resulting from an immune response to infection.

Researchers at Children’s National Hospital are investigating pediatric sepsis, a leading cause of in-hospital death, particularly in underserved and minoritized populations.

A new Maximizing Investigators’ Research Award (MIRA) (R35) is granting over $2.2 million to Children’s National to establish a comprehensive sepsis program that will include a diagnostic artificial intelligence (AI) based, biomarker-enhanced platform for early recognition of pediatric sepsis and cutting-edge, extracellular vesicle-based therapeutics that can significantly decrease mortality and long-term disease sequelae.

MIRA provides support for research in an investigator’s laboratory that falls within the mission of The National Institute of General Medical Sciences.

Why it matters

Sepsis, defined as a rapidly progressive, is a life-threatening organ dysfunction (OD) due to an immune dysregulation as a response to infection. In the U.S., it results in over 75,000 pediatric admissions on an annual basis with an associated mortality rate of 5 to 20%.

“Sepsis has been linked to 20% of deaths worldwide and despite some recent advances in diagnostic tools, the lack of accurate definitions and heterogeneity of this clinical syndrome have led to delays in recognition and treatment with deleterious effects on the health of millions of children, especially those from minority groups,” says Ioannis Koutroulis, M.D., Ph.D., M.B.A., research director of Emergency Medicine at Children’s National. “Additionally, current sepsis therapeutic regimens are mostly supportive, lack the necessary personalization and fail to address the underlying physiological processes leading to sepsis-induced life threating organ failure.”

How does it move the field forward

High mortality rates and no significant new treatments in recent years due to sepsis presents a critical opportunity to make a global impact. Advancements in early recognition and intervention could save millions of lives. By utilizing AI and biomarkers for the early detection of sepsis in children, medical professionals could have the potential to greatly improve outcomes by enabling timely treatment.

“There is an urgent need to focus more attention on this condition and develop effective solutions to combat its devastating effects,” Dr. Koutroulis adds.

How we’re leading the way

The high-volume pediatric emergency room will serve as a crucial site for recruiting patients. With access to state-of-the-art laboratories, the research will be conducted in facilities equipped with cutting-edge technology, ensuring accurate and efficient analysis. This combination of a high patient volume and advanced research infrastructure will enable the program to deliver reliable results and make significant strides in the fight against pediatric sepsis.

“This grant will allow for early recognition of pediatric sepsis and treatment with an innovative approach using extracellular vesicle-based therapies that can directly affect immune and metabolic processes,” Dr. Koutroulis said.

Emergency department nurse with patient

Investment in pediatric emergency care could save over 2,100 lives annually

Emergency department nurse with patient

By becoming highly “pediatric ready,” emergency departments could prevent the deaths of 2,143 children each year with an annual cost between $0 and $12 per child resident, depending on the state.

In emergencies, children have distinct needs. Yet 83% of emergency departments (EDs) nationwide are not fully prepared to meet them. A new study has found that bridging that gap, known as becoming highly “pediatric ready,” could prevent the deaths of 2,143 children each year with an annual cost between $0 and $12 per child resident, depending on the state.

“Our country can afford it, and we owe it to our children to do it,” says the study’s senior author Nathan Kuppermann, M.D., chair of Pediatrics and chief academic officer at Children’s National Hospital.

The research team – led by Oregon Health & Science University and Children’s National – analyzed data from 4,840 EDs, focusing on 669,019 children at risk for death upon seeking care. Using predictive models, they assessed how every ED achieving high pediatric readiness – defined as scoring at least 88 out of 100 on the National Pediatric Readiness Project assessment – could impact mortality rates.

“The National Pediatric Readiness Project outlines essential pediatric capabilities for EDs, such as the availability of essential pediatric equipment and pediatric-specific training,” says Dr. Kuppermann, an emergency medicine physician. “While a perfect score of 100 is ideal, past research shows a score of 88 or higher can reduce mortality risk by up to 76% for ill children and 60% for injured children.”

Why it matters

In Maryland, an additional cost of $1.10 per child could save 17 pediatric lives annually, adjusted for population size. In Virginia, $2.42 per child could save 29 lives annually, and $1.59 per child in the District of Columbia could save 16 lives annually. The research team said strategies for implementing the findings would require regulation, incentives and policy-based initiatives.

“This study builds on a growing body of research demonstrating that every hospital can and must be ready for children’s emergencies,” says lead author Craig Newgard, M.D., M.P.H., an emergency physician at Oregon Health & Science University. “For the first time, we have comprehensive national and state-by-state data that emphasizes both the urgency and feasibility of this work.”

The patient benefit

Nathan Kuppermann

“Our country can afford it, and we owe it to our children to do it,” says the study’s senior author Nathan Kuppermann, M.D., chair of Pediatrics and chief academic officer at Children’s National Hospital.

By applying the potential reduction in mortality associated with high readiness to the number of children at risk of death, the researchers identified the number of lives that could be saved each year. State-specific estimates, adjusted for population size, ranged from 0 preventable deaths in Delaware to 69 in South Dakota.

“Achieving high readiness levels can be challenging for small emergency departments with fewer resources, typically in more rural areas. The result is significant inequity and large healthcare deserts in pediatric emergency care across the United States,” Dr. Kuppermann says. “Yet we found the cost of elevating care to the highest quartile of pediatric readiness is not very high.”

What’s next

The study authors estimate achieving universal high pediatric readiness across the United States would cost approximately $207 million annually. Per-child costs by state to raise ED readiness from current levels ranged from $0 to $12 per year.

“This research emphasizes the urgent need for widespread investment in pediatric readiness,” says Kate Remick, M.D., co-author and emergency physician with the Dell School of Medicine at the University of Texas at Austin. “The National Pediatric Readiness Project has provided a roadmap for improvement. But we need the full engagement of clinicians, healthcare administrators, policymakers and families to make universal pediatric readiness a reality.”

The study outlines several strategies to improve pediatric emergency care, such as integrating high pediatric readiness into hospital accreditation requirements and incentivizing readiness through performance-based reimbursement models.

This study was funded by a Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Emergency Medical Services for Children Targeted Issue grant (H34MC33243-01-01) and an HHS National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grant (R24 HD085927). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HHS, HRSA, NIH, or the U.S. Government.

Monika Goyal, M.D., MSCE

National Academy of Medicine elects gun violence, health equity expert

“It is an absolute honor and privilege to be elected to the National Academy of Medicine,” Dr. Goyal said. “I am committed to NAM’s mission of using science to inform policy for the achievement of health equity.”

The National Academy of Medicine (NAM) has elected Monika Goyal, M.D., M.S.C.E., to its international body of 2,400 leaders in medical sciences, healthcare and public health. One of the highest honors for physicians, the achievement is reserved for individuals who have demonstrated outstanding professional commitment and service.

Dr. Goyal, emergency medicine physician and co-director of the Center for Translational Research at Children’s National Hospital, was recognized for her national leadership in research focused on pediatric firearm injury prevention. She has spotlighted the burden of firearm violence on child health and advanced pediatric equity science. Her research has led to the development of interventions to address healthcare inequities.

“It is an absolute honor and privilege to be elected to the National Academy of Medicine,” Dr. Goyal said. “I am committed to NAM’s mission of using science to inform policy for the achievement of health equity.”

The big picture

The National Academy of Sciences established NAM in 1970 as the Institute of Medicine. The diverse organization requires that at least one-quarter of its membership be selected from fields outside the health professions, including law, engineering, social sciences and the humanities. NAM elected 90 regular and 10 international members during its recent annual meeting.

NAM works with the National Academy of Sciences and National Academy of Engineering. Upon election, NAM members commit to volunteering their services for National Academies activities.

Why we’re excited

“I am thrilled that Dr. Goyal is joining me in this incredible body that works to provide independent, objective analysis on complex scientific problems and public policy decisions,” said NAM member Nathan Kuppermann, M.D., M.P.H., chief academic officer and chair of Pediatrics at Children’s National. “Dr. Goyal’s contributions to pediatric health will be an incredible asset to the organization.”

healthcare professional putting on PPE

Prioritizing equity in pediatric care strategies following the pandemic

healthcare professional putting on PPE

Societal inequities can affect differential health outcomes among various populations.

The emergence of the COVID-19 pandemic prompted an examination and acknowledgment of the societal inequities affecting differential health outcomes among various populations. There’s been a heightened focus on identifying and confronting the longstanding factors contributing to health disparities, particularly among historically marginalized and minoritized groups, which expose them to greater vulnerabilities during emergencies like a pandemic.

The hold-up in the field

In a recent study published in Pediatric Clinics of North America, the authors introduce a focus on health equity and the social determinants of health as applied to an overarching framework of pandemic preparedness.

“There is little shared about the role of pediatricians in planning for disasters — like in the aftermath of the pandemic — with a focus on health equity,” says Joelle Simpson, M.D., M.P.H., chief of Emergency Medicine at Children’s National Hospital and co-author of the paper.

Moving the field forward

The authors discuss recommendations for pediatricians in planning for disasters with a focus on health equity and social determinants of health. In their observations, they consider:

  • The COVID-19 pandemic amplified health inequities and placed tremendous strain on society, economy, education systems and healthcare infrastructure.
  • Building on pediatric readiness frameworks is a recommended approach to creating a pediatric pandemic plan.
  • Health equity considerations need to be built into all policies, processes and systems at the outset.
  • The evolving national discourse on racism and inequities across communities including social injustices faced by minoritized groups is important framing for pandemic planning across all phases of disaster including preparedness, response and recovery.

The patient benefit

“Community engagement and serving as a trusted messenger and committed partner in health is critical in the process of recovery,” the authors write.

They emphasize the importance of integrating health equity viewpoints into communication planning and formulating strategies for community involvement. Fortunately, there has been a rise in opportunities to collaborate and gain insights from established networks dedicated to children’s pandemic or disaster readiness. These networks include the Emergency Medical Services for Children state programs, Pediatric Disaster Centers of Excellence and the Regional Pediatric Pandemic Network.

Children’s National Hospital leads the way

Children’s National, a lead hub for the Pediatric Pandemic Network (PPN), elevates the importance of planning for disasters as it pertains to children. Through the PPN, children’s hospitals in the country coordinate, prepare and enable high-quality, equitable, research-based pediatric care in emergencies, disasters and pandemics. The network prioritizes addressing the distinctive requirements and obstacles faced by children amid pandemics and disasters, emphasizing the importance of integrating health equity into emergency planning efforts.

HIV virus

NIH awards to address detection and treatment of HIV in adolescents

HIV virus

The funding will improve prevention, detection and treatment of HIV in adolescents.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health, awarded over $8 million to improve prevention, detection and treatment of HIV in adolescents through leveraging digital health for population-based screening in the emergency department (ED). The grants were awarded to multiple children’s hospitals, including Children’s National Hospital.

The big picture

The studies will play an important role in looking at how to curtail the HIV epidemic.

“This is an opportunity to make an impact on adolescent health and mitigate disparities,” said Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine and one of the main principal investigators of the awarded team.

Adolescents and young adults (AYA) are disproportionately affected by HIV in the United States. Despite adolescents accounting for over 20% of new infections, this age group is the least likely to be tested for HIV, linked to care and achieve viral suppression when compared to their adult counterparts. Further, AYA also have low rates of HIV awareness and initiation of HIV Pre-Exposure Prophylaxis.

“There is an urgent need to expand HIV screening and prevention strategies to nontraditional healthcare settings, such as emergency departments, to reach those adolescents who would otherwise not receive preventive healthcare,” Dr. Goyal added.

Why does this work matter?

Although adolescents frequently use the ED for access to healthcare, the ED has been underutilized as a venue for HIV screening, detection and prevention.

“We hope to curtail the HIV epidemic in youth by expanding HIV prevention and linkage to care services through the emergency department,” Dr. Goyal says.

Footnote: The grants issued by the NICHD are NICHD R01 HD110321 and UM2 HD111102-ATN.

 

Doctor holding notepad

In the News: Undertriage in emergency departments

Doctor holding notepad
“What prompted us to look into [undertriage] was a lot of our experiences. My colleagues and I have shared our stories and this is part of a larger project that we are doing to study the triage process as a quality improved tool in the emergency department (ED). We started to think about the triage process and how this really sets up the stage for the entire ED visit.”

Deena Berkowitz, M.D., M.P.H., associate division chief of Emergency Medicine, joined the American Academy of Pediatrics (AAP) to talk about rates of undertriage in the ED for children with non-English-speaking caregivers. Learn more about her thoughts and the study’s findings in this recent AAP podcast.

 

Monika Goyal

Monika Goyal, M.D., recognized as the first endowed chair of Women in Science and Health

Monika Goyal

Dr. Goyal’s tireless efforts continue to push boundaries.

Children’s National Hospital named Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine, as the first endowed chair of Women in Science and Health (WISH) for her outstanding contributions in biomedical research.

About the award

Women have long been underrecognized in science. The WISH endowed chair, provided by the Children’s National Research Institute, hopes to change this, explained Vittorio Gallo, Ph.D., interim chief academic officer at Children’s National.

“Recent research shows that women academics in medicine are less likely to hold an endowed chair position than their male peers,” he said. “Therefore, it is crucial our institutions fully commit to exceptional women researchers by providing strong support and recognizing their accomplishments and contributions.”

Several influential women in health and science from across Children’s National strongly supported Dr. Goyal’s nomination, including Joelle Simpson, M.D., Naomi Luban, M.D., Catherine Bollard, M.D., M.B.Ch.B., Randy Streisand, Ph.D., Lisa Guay-Woodford, M.D., and Denice Cora-Bramble, M.D., M.B.A.

The big picture

With a track record of research focused on health equity – including studies on racial inequities in managing pain in the emergency department, racial and socioeconomic disparities in COVID rates among children, and development of interventions to mitigate disparities in sexual health outcomes for youth –  Dr. Goyal’s tireless efforts continue to push boundaries. Her research shines a spotlight on the toll of racism, bias and discrimination on the health of children.

“I am inspired by how far we’ve come yet humbled by how far we have yet to go,” Dr. Goyal said. “I hope to continue to be part of the movement that works to achieve equity both in health care outcomes as well as in our workforce.”

What they’re saying

After being named the first endowed chair of WISH, Dr. Goyal said she felt hopeful that times are changing and women are increasingly being recognized for their accomplishments.

“I am grateful for all the mentors and sponsors who have helped clear the path for me and excited to continue on this journey, helping pave new roads and build new bridges for all those who are on their way,” she said.

Dr. Goyal has been a trailblazer and has shone a spotlight on the power of pediatric emergency medicine, said Dr. Simpson, division chief of Emergency Medicine at Children’s National.

“She not only touches the lives of her patients though her research, but she’s a mentor to her colleagues and trainees,” she added. “Part of being recognized as a leader woman in science and health is symbolic of what others can achieve in this career when you’re passionate about what you do.”

Dr. Cora-Bramble, chief diversity officer at Children’s National and one of Dr. Goyal’s mentors, said she has proudly watched her mentee blossom. According to Dr. Cora-Bramble, Dr. Goyal blends unique skills as a brilliant child health equity researcher and a passionate advocate for those impacted by her work.

“Monika has earned this honor,” she said. “She is unrelenting in her quest to answer vexing questions and can communicate, at times troubling, findings from her research fluently and transparently.”

bacterium Neisseria gonorrhoeae

Tackling sexually transmitted infections with ED based intervention

bacterium Neisseria gonorrhoeae

The study proposes to leverage digital health technology in the ED to support the adolescent population.

Children’s National Hospital will develop an emergency department (ED) based intervention to tackle the sexually transmitted infections (STI) epidemic through implementation of broad screening into the clinical workflow. The work is being led by Monika Goyal, M.D., M.S.C.E, associate chief of Emergency Medicine at Children’s National, through a $4.1M award from the NIH’s National Institute of Allergy and Infectious Diseases.

Why it matters

STI’s disproportionately affect adolescents, and adolescents often rely on ED’s for care.

“Adolescent sexual health, and in particular, diagnosis and management of sexually transmitted infections, is of substantial public health importance yet understudied and underfunded,” says Dr. Goyal.

The details

The study proposes to leverage digital health technology in the ED by:

  • Integrating patient reported outcomes into the electronic health record to drive patient-engaged clinical decision support for improved STI detection.
  • Using mobile health through two-way text messaging to impact STI treatment adherence for improved adolescent sexual health outcomes and mitigation of disparities in the STI epidemic.

Dr. Goyal’s team cares for a diverse patient population with high rates of STIs. This grant, she says, is timely and needed, as it may confer significant public health impact and is consistent with the mission of Healthy People 2030, a U.S. Department of Health and Human Services initiative.

What’s unique

“I have had a longstanding commitment to improving the sexual health of adolescents,” Dr. Goyal adds. “It is exciting to have an opportunity to leverage digital health by harnessing the strengths of electronic health and text messaging platforms to improve care for youth.”

Research reported in this publication was supported by the National Institute Of Allergy And Infectious Diseases of the National Institutes of Health under Award Number R01AI163232. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

girl looking out window

Commentary looks at childhood firearm exposure and adult outcomes

girl looking out window

In the commentary, the authors noted that the study by Copeland et al. found that having access to a gun in the home was associated with adult firearm ownership and carriage, gun violence exposure and suicidality.

In response to a study by Copeland et al. testing the associations of childhood domestic gun access with subsequent adult criminality and suicidality, Asad Bandealy, M.D., M.P.H., pediatrician, and other experts at Children’s National Hospital, argued that what happens in childhood in terms of firearm exposure matters in adulthood.

In the commentary, the authors noted that the study by Copeland et al. found that having access to a gun in the home was associated with adult firearm ownership and carriage, gun violence exposure and suicidality. Having a firearm in the home without access as a child was associated with adult ownership and carriage, but not criminality or suicidality. These findings provide further support for harm reduction approaches that focus on culturally competent counseling and clear conversations on safe storage to reduce child access.

In addition, the commentary called for supporting families in restricting child access to firearms, which may save lives into adulthood.

“There is a paucity of research related to firearms in general and particularly interventions to reduce firearm morbidity and mortality,” the authors wrote.

The authors commented on the need for more funding and training opportunities after decades of ‘stifling’ firearm research. Lastly, they emphasized that resources should be prioritized to enhance practice and policy interventions that will reduce firearm deaths in children and adolescents.

Little boy going to school with protective mask

Firearm injuries involving young children in the United States during the COVID-19 pandemic

Little boy going to school with protective mask

After seeing the surge of firearm injuries in young children and inflicted by young children during the first six months of the COVID-19 pandemic, the study’s experts are saying there is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.

A recent study pre-published in Pediatrics found that the COVID-19 pandemic is associated with a surge in fatal and nonfatal firearm injuries both in young children and inflicted by young children, correlating with a rise in firearm acquisitions.

The findings, led by Children’s National Hospital experts, show the risk was higher during the first six months of the COVID-19 pandemic as compared to the pre-COVID period.

“According to the Centers for Disease Control and Prevention, firearms are a leading cause of injury and death among youth,” said Monika K. Goyal, M.D., M.S.C.E., senior author of this study and associate  chief of Emergency Medicine and Trauma Services at Children’s National. “The pandemic has led to an increase in these preventable tragedies and it is incumbent upon us as a society to put appropriate measures in place to keep children safe.”

“Increased firearm purchases are one reason we have seen an increase in firearm injuries during the pandemic,” said Joanna S. Cohen, M.D., associate professor of Pediatrics and Emergency Medicine. “Increased purchases are likely related to the political unrest we recently witnessed and increased firearm injuries may be related to children being at home more. Whereas children were in school before, they might be home unsupervised while parents and caretakers are working.”

In addition, there has been an increase in domestic violence over the course of the pandemic which, according to Dr. Cohen, could be a reflection of the stress emerging from financial insecurity, joblessness, illness and other stressors deriving from the pandemic.

After seeing the surge of firearm injuries in young children and inflicted by young children during the first six months of the COVID-19 pandemic, the study’s experts are saying there is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.

“There is an urgent need for strategies to prevent further injuries,” Dr. Goyal said. “This includes counseling families on firearm safety at home, having more sensible gun laws and educating the public accordingly.”

In the past, if you were a new gun owner, you would have access to training on how to handle a gun and find safe storage. With all the sheltering in place due to the pandemic, those educational opportunities have fallen by the wayside. “Now you have more people who have become new gun owners but haven’t had the opportunity to get education on safe gun ownership, coinciding with more children staying at home because of the pandemic,” Dr. Goyal said.

The increase in domestic violence could also be a contributing factor. Children are often witnesses to violence at home, Dr. Cohen explained. In many cases, she said, if children see a parent being threatened with a gun, they might model that behavior without fully understanding the implications of holding a gun and the injury it can cause.

communication network concept image

Children’s National joins international AI COVID-19 initiative

communication network concept image

Children’s National Hospital is the first pediatric partner to join an international initiative led by leading technology firm NVIDIA and Massachusetts General Brigham Hospital, focused on creating solutions through machine and deep learning to benefit COVID-19 healthcare outcomes.

Children’s National Hospital is the first pediatric partner to join an international initiative led by leading technology firm NVIDIA and Massachusetts General Brigham Hospital, focused on creating solutions through machine and deep learning to benefit COVID-19 healthcare outcomes. The initiative, known as EXAM (EMR CXR AI Model) is the largest and most diverse federated learning enterprise, comprised of 20 leading hospitals from around the globe.

Marius George Linguraru, D.Phil., M.A., M.Sc., principal investigator at the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Hospital, noted that one of the core goals of the initiative is to create a platform which brings resources together, from a variety of leading institutions, to advance the care of COVID-19 patients across the board, including children.

“Children’s National Hospital is proud to be the first pediatric partner joining the world’s leading healthcare institutions in this collaboration to advance global health,” says Linguraru. “We are currently living in a time where rapid access to this kind of global data has never been more important — we need solutions that work fast and are effective. That is not possible without this degree of collaboration and we look forward to continuing this important work with our partners to address one of the most significant healthcare challenges in our lifetime.”

A recent systematic review and meta-analysis from Children’s National Hospital became another core contribution to understanding how children are impacted by COVID-19. Led by Linguraru and accepted to be published in Pediatric Pulmonology, it offers the first comprehensive summary of the findings of various studies published thus far that describe COVID-19 lung imaging data across the pediatric population.

The review examined articles based on chest CT imaging in 1,026 pediatric patients diagnosed with COVID-19, and concluded that chest CT manifestations in those patients could potentially be used to prompt intervention across the pediatric population.

Marius George Linguraru

“Children’s National Hospital is proud to be the first pediatric partner joining the world’s leading healthcare institutions in this collaboration to advance global health,” says Marius George Linguraru, D.Phil., M.A., M.Sc.

“Until this point, pediatric COVID-19 studies have largely been restricted to case reports and small case series, which have prevented the identification of any specific pediatric lung disease patterns in COVID-19 patients,” says Linguraru. “Not only did this review help identify the common patterns in the lungs of pediatric patients presenting COVID-19 symptoms, which are distinct from the signs of other viral respiratory infections in children, it also provided insight into the differences between children and adults with COVID-19.”

Earlier this month, NVIDIA announced the EXAM initiative had – in just 20 days – developed an artificial intelligence (AI) model to determine whether a patient demonstrating COVID-19 symptoms in an emergency room would require supplemental oxygen hours – even days – after the initial exam. This data ultimately aids physicians in determining the proper level of care for patients, including potential ICU placement.

The EXAM initiative achieved a machine learning model offering precise prediction for the level of oxygen incoming patients would require.

In addition to Children’s National Hospital, other participants included Mass Gen Brigham and its affiliated hospitals in Boston; NIHR Cambridge Biomedical Research Centre; The Self-Defense Forces Central Hospital in Tokyo; National Taiwan University MeDA Lab and MAHC and Taiwan National Health Insurance Administration; Tri-Service General Hospital in Taiwan; Kyungpook National University Hospital in South Korea; Faculty of Medicine, Chulalongkorn University in Thailand; Diagnosticos da America SA in Brazil; University of California, San Francisco; VA San Diego; University of Toronto; National Institutes of Health in Bethesda, Maryland; University of Wisconsin-Madison School of Medicine and Public Health; Memorial Sloan Kettering Cancer Center in New York; and Mount Sinai Health System in New York.

pill bottles and pills

Fewer than 60% of young women diagnosed with STIs in emergency departments fill scripts

Fewer than 60% of young women diagnosed with sexually transmitted infections (STIs) in the emergency department fill prescriptions for antimicrobial therapy to treat these conditions, according to a research letter published online May 28, 2019, by JAMA Pediatrics.

Adolescents make up nearly half of the people diagnosed with sexually transmitted infections each year. According to the Centers for Disease Control and Prevention, untreated sexually transmitted diseases in women can cause pelvic inflammatory disease (PID), an infection of the reproductive organs that can complicate getting pregnant in the future.

“We were astonished to find that teenagers’ rates of filling STI prescriptions were so low,” says Monika K. Goyal, M.D., MSCE, assistant chief of Children’s Division of Emergency Medicine and Trauma Services and the study’s senior author. “Our findings demonstrate the imperative need to identify innovative methods to improve treatment adherence for this high-risk population.”

The retrospective cohort study, conducted at two emergency departments affiliated with a large, urban, tertiary care children’s hospital, enrolled adolescents aged 13 to 19 who were prescribed antimicrobial treatment from Jan. 1, 2016, to Dec. 31, 2017, after being diagnosed with PID or testing positive for chlamydia.

Of 696 emergency department visits for diagnosed STIs, 208 teenagers received outpatient prescriptions for antimicrobial treatments. Only 54.1% of those prescriptions were filled.

“Teenagers may face a number of hurdles when it comes to STI treatment, including out-of-pocket cost, access to transportation and confidentiality concerns,” Dr. Goyal adds.

Future studies will attempt to identify barriers to filling prescriptions in order to inform development of targeted interventions based in the emergency department that promote adherence to STI treatment.

In addition to Dr. Goyal, study co-authors include Lead Author, Alexandra Lieberman, BA, The George Washington University School of Medicine & Health Sciences; and co-authors Gia M. Badolato, MPH, and Jennifer Tran, PA-C, MPH, both of Children’s National.

Billie Lou Short and Kurt Newman at Research and Education Week

Research and Education Week honors innovative science

Billie Lou Short and Kurt Newman at Research and Education Week

Billie Lou Short, M.D., received the Ninth Annual Mentorship Award in Clinical Science.

People joke that Billie Lou Short, M.D., chief of Children’s Division of Neonatology, invented extracorporeal membrane oxygenation, known as ECMO for short. While Dr. Short did not invent ECMO, under her leadership Children’s National was the first pediatric hospital to use it. And over decades Children’s staff have perfected its use to save the lives of tiny, vulnerable newborns by temporarily taking over for their struggling hearts and lungs. For two consecutive years, Children’s neonatal intensive care unit has been named the nation’s No. 1 for newborns by U.S. News & World Report. “Despite all of these accomplishments, Dr. Short’s best legacy is what she has done as a mentor to countless trainees, nurses and faculty she’s touched during their careers. She touches every type of clinical staff member who has come through our neonatal intensive care unit,” says An Massaro, M.D., director of residency research.

For these achievements, Dr. Short received the Ninth Annual Mentorship Award in Clinical Science.

Anna Penn, M.D., Ph.D., has provided new insights into the central role that the placental hormone allopregnanolone plays in orderly fetal brain development, and her research team has created novel experimental models that mimic some of the brain injuries often seen in very preterm babies – an essential step that informs future neuroprotective strategies. Dr. Penn, a clinical neonatologist and developmental neuroscientist, “has been a primary adviser for 40 mentees throughout their careers and embodies Children’s core values of Compassion, Commitment and Connection,” says Claire-Marie Vacher, Ph.D.

For these achievements, Dr. Penn was selected to receive the Ninth Annual Mentorship Award in Basic and Translational Science.

The mentorship awards for Drs. Short and Penn were among dozens of honors given in conjunction with “Frontiers in Innovation,” the Ninth Annual Research and Education Week (REW) at Children’s National. In addition to seven keynote lectures, more than 350 posters were submitted from researchers – from high-school students to full-time faculty – about basic and translational science, clinical research, community-based research, education, training and quality improvement; five poster presenters were showcased via Facebook Live events hosted by Children’s Hospital Foundation.

Two faculty members won twice: Vicki Freedenberg, Ph.D., APRN, for research about mindfulness-based stress reduction and Adeline (Wei Li) Koay, MBBS, MSc, for research related to HIV. So many women at every stage of their research careers took to the stage to accept honors that Naomi L.C. Luban, M.D., Vice Chair of Academic Affairs, quipped that “this day is power to women.”

Here are the 2019 REW award winners:

2019 Elda Y. Arce Teaching Scholars Award
Barbara Jantausch, M.D.
Lowell Frank, M.D.

Suzanne Feetham, Ph.D., FAA, Nursing Research Support Award
Vicki Freedenberg, Ph.D., APRN, for “Psychosocial and biological effects of mindfulness-based stress reduction intervention in adolescents with CHD/CIEDs: a randomized control trial”
Renee’ Roberts Turner for “Peak and nadir experiences of mid-level nurse leaders”

2019-2020 Global Health Initiative Exploration in Global Health Awards
Nathalie Quion, M.D., for “Latino youth and families need assessment,” conducted in Washington
Sonia Voleti for “Handheld ultrasound machine task shifting,” conducted in Micronesia
Tania Ahluwalia, M.D., for “Simulation curriculum for emergency medicine,” conducted in India
Yvonne Yui for “Designated resuscitation teams in NICUs,” conducted in Ghana
Xiaoyan Song, Ph.D., MBBS, MSc, “Prevention of hospital-onset infections in PICUs,” conducted in China

Ninth Annual Research and Education Week Poster Session Awards

Basic and Translational Science
Faculty: Adeline (Wei Li) Koay, MBBS, MSc, for “Differences in the gut microbiome of HIV-infected versus HIV-exposed, uninfected infants”
Faculty: Hayk Barseghyan, Ph.D., for “Composite de novo Armenian human genome assembly and haplotyping via optical mapping and ultra-long read sequencing”
Staff: Damon K. McCullough, BS, for “Brain slicer: 3D-printed tissue processing tool for pediatric neuroscience research”
Staff: Antonio R. Porras, Ph.D., for “Integrated deep-learning method for genetic syndrome screening using facial photographs”
Post docs/fellows/residents: Lung Lau, M.D., for “A novel, sprayable and bio-absorbable sealant for wound dressings”
Post docs/fellows/residents: Kelsey F. Sugrue, Ph.D., for “HECTD1 is required for growth of the myocardium secondary to placental insufficiency”
Graduate students: Erin R. Bonner, BA, for “Comprehensive mutation profiling of pediatric diffuse midline gliomas using liquid biopsy”
High school/undergraduate students: Ali Sarhan for “Parental somato-gonadal mosaic genetic variants are a source of recurrent risk for de novo disorders and parental health concerns: a systematic review of the literature and meta-analysis”

Clinical Research
Faculty: Amy Hont, M.D., for “Ex vivo expanded multi-tumor antigen specific T-cells for the treatment of solid tumors”
Faculty: Lauren McLaughlin, M.D., for “EBV/LMP-specific T-cells maintain remissions of T- and B-cell EBV lymphomas after allogeneic bone marrow transplantation”

Staff: Iman A. Abdikarim, BA, for “Timing of allergenic food introduction among African American and Caucasian children with food allergy in the FORWARD study”
Staff: Gelina M. Sani, BS, for “Quantifying hematopoietic stem cells towards in utero gene therapy for treatment of sickle cell disease in fetal cord blood”
Post docs/fellows/residents: Amy H. Jones, M.D., for “To trach or not trach: exploration of parental conflict, regret and impacts on quality of life in tracheostomy decision-making”
Graduate students: Alyssa Dewyer, BS, for “Telemedicine support of cardiac care in Northern Uganda: leveraging hand-held echocardiography and task-shifting”
Graduate students: Natalie Pudalov, BA, “Cortical thickness asymmetries in MRI-abnormal pediatric epilepsy patients: a potential metric for surgery outcome”
High school/undergraduate students: Kia Yoshinaga for “Time to rhythm detection during pediatric cardiac arrest in a pediatric emergency department”

Community-Based Research
Faculty: Adeline (Wei Li) Koay, MBBS, MSc, for “Recent trends in the prevention of mother-to-child transmission (PMTCT) of HIV in the Washington, D.C., metropolitan area”
Staff: Gia M. Badolato, MPH, for “STI screening in an urban ED based on chief complaint”
Post docs/fellows/residents: Christina P. Ho, M.D., for “Pediatric urinary tract infection resistance patterns in the Washington, D.C., metropolitan area”
Graduate students: Noushine Sadeghi, BS, “Racial/ethnic disparities in receipt of sexual health services among adolescent females”

Education, Training and Program Development
Faculty: Cara Lichtenstein, M.D., MPH, for “Using a community bus trip to increase knowledge of health disparities”
Staff: Iana Y. Clarence, MPH, for “TEACHing residents to address child poverty: an innovative multimodal curriculum”
Post docs/fellows/residents: Johanna Kaufman, M.D., for “Inpatient consultation in pediatrics: a learning tool to improve communication”
High school/undergraduate students: Brett E. Pearson for “Analysis of unanticipated problems in CNMC human subjects research studies and implications for process improvement”

Quality and Performance Improvement
Faculty: Vicki Freedenberg, Ph.D., APRN, for “Implementing a mindfulness-based stress reduction curriculum in a congenital heart disease program”
Staff: Caleb Griffith, MPH, for “Assessing the sustainability of point-of-care HIV screening of adolescents in pediatric emergency departments”
Post docs/fellows/residents: Rebecca S. Zee, M.D., Ph.D., for “Implementation of the Accelerated Care of Torsion (ACT) pathway: a quality improvement initiative for testicular torsion”
Graduate students: Alysia Wiener, BS, for “Latency period in image-guided needle bone biopsy in children: a single center experience”

View images from the REW2019 award ceremony.

Dr. Bear Bot

Advances in telemedicine start with new cardiac critical care robot

Dr. Bear Bot

Dr. Bear Bot’s “robot-only” parking space in the Cardiac ICU. Alejandro Lopez-Magallon, M.D., is featured on the robot display screen, where he drives the robot from his location in the command center, in order to visit patient rooms and capture additional medical information and connect with patients, parents, and attending nurses and physicians.

The telemedicine robot at Children’s National arrived in late August 2018 and recently completed a 90-day test period in the tele-cardiac intensive care unit (cardiac ICU) at Children’s National. The bot travels between rooms as a virtual liaison connecting patients and attending nurses and physicians with Ricardo Munoz, M.D., executive director of the telemedicine program and the division chief of critical cardiac care, and Alejandro Lopez-Magallon, M.D., a cardiologist and medical director of the telemedicine program.

Drs. Munoz and Lopez-Magallon use a nine-screen virtual command center to remotely monitor patient vitals, especially for infants and children who are recovering from congenital heart surgery, flown in for an emergency diagnostic procedure, such as a catheterization, or who are in the process of receiving a heart or kidney transplant. Instead of traveling to individual rooms to check in on the status of one patient, the doctors can now monitor multiple patients simultaneously, enhancing their ability to diagnose, care for and intervene during critical events.

If Drs. Munoz or Lopez-Magallon need to take an X-ray or further examine a patient, they drive the robot from its ‘robot-only’ parking space adjacent to the nurse’s station, and connect with attending doctors and nurses in the teaming area. The onsite clinicians accompany one of the telemedicine doctors, both of whom remain in the command center but appear virtually on the robot’s display screen, to the patient’s room to capture additional medical information and to connect with patients and families.

Over time, the telemedicine team will measure models of efficiency in the tele-cardiac ICU, such as through-put, care coordination, and standards of safety, quality and care, measured by quality of life and short- and long-term patient health outcomes. This test run will serve as a model for future command centers offering remote critical care.

Ricardo Munoz and Alejandro Lopez-Magallon

(R) Ricardo Munoz, M.D., executive director of the telemedicine program and the division chief of critical cardiac care, and Alejandro Lopez-Magallon, M.D., a cardiologist and the associate medical director of the telemedicine program in the tele-cardiac ICU command center.

“As technology and medicine advance, so do our models of telemedicine, which we call virtual care,” says Shireen Atabaki, M.D., M.P.H., an emergency medicine physician at Children’s National, who manages an ambulatory virtual health program, which enables patients to use virtual health platforms to connect with doctors, but from the comfort of their home. “We find the patient-centered platforms and this new technology saves families’ time and we’re looking forward to studying internal models to see how this can help our doctors, enabling us to do even more.”

The ongoing virtual connection program that Dr. Atabaki references launched in spring 2016 and has enabled 900 children to connect to a doctor from a computer, tablet or smart phone, which has saved families 1,600 driving hours and more than 41,000 miles over a two-year period. Through this program, virtual care is provided to children in our region by 20 subspecialists, including cardiologists, dermatologists, neurologists, urgent care doctors, geneticists, gastroenterologists and endocrinologists.

To extend the benefits of virtual communication, while saving mileage and time, Dr. Atabaki and the telemedicine team at Children’s National will partner with K-12 school systems, local hospitals and health centers and global health systems.

The Children’s National robot was named Dr. Bear Bot after a 21-day voting period with patients and staff, beating 14 other child-selected names, including SMARTy (Special Medical Access to Remote Technology), Dr. Bot and Rosie. Dr. Bear Bot celebrated with an official reveal party on Valentine’s Day, which was streamed to over 220 patients through the hospital’s closed-circuit television and radio station.

little boy looking at gun

A ‘compelling call’ for pediatricians to discuss firearm safety

little boy looking at gun

The Children’s commentators point to the “extremely dangerous” combination of “the small curious hands of a young child” and “the easily accessible and operable, loaded handgun” and suggest that pediatricians who counsel families about safely storing weapons tailor messaging to the weapon type and the family’s reason for owning a firearm.

Paradoxically, as overall firearm ownership decreased in U.S. households with young children from 1976 to 2016, the proportion of these families who owned handguns increased. This shift in firearm preferences over decades from mostly rifles to mostly handguns coincided with increasing firearm-mortality rates in young children, researchers report Jan. 28, 2019, in Pediatrics.

“Almost 5 million children live in homes where at least one firearm is stored loaded and unlocked,” Kavita Parikh, M.D., a pediatric hospitalist at Children’s National Health System, and co-authors write in an invited commentary. “This study is a loud and compelling call to action for all pediatricians to start open discussions around firearm ownership with all families and share data on the significant risks associated with unsafe storage. It is an even louder call to firearm manufacturers to step up and innovate, test and design smart handguns, inoperable by young children, to prevent unintentional injury,” Dr. Parikh and colleagues continue.

The Children’s commentators point to the “extremely dangerous” combination of “the small curious hands of a young child” and “the easily accessible and operable, loaded handgun” and suggest that pediatricians who counsel families about safely storing weapons tailor messaging to the weapon type and the family’s reason for owning a firearm.

They also advocate for childproofing firearms stored in the home – through free or discounted locks, storing weapons separately from ammunition, and using personalized technology that limits the firearm’s potential to be used by children accidentally. According to a retrospective, cross-sectional study led by Children’s researchers, younger children are more likely to be shot by accident.

“The development of effective safety controls on firearms is not only attainable but could be the next big step towards reducing mortality, especially among our youngest. We as a society should be advocating for continued research to ‘childproof’ firearms so that if families choose to have firearms in the home, the safety of their children is not compromised,” Dr. Parikh and co-authors write.

In addition to Dr. Parikh, the senior author, the Pediatrics commentary co-authors include Lead Author Shilpa J. Patel M.D., MPH, emergency medicine specialist; and co-author Monika K. Goyal M.D., MSCE, assistant division chief and director of research in Children’s Division of Emergency Medicine.

new mom with baby

Fighting perinatal mood and anxiety disorders on multiple levels

new mom with baby

Over the past several decades, it’s become increasingly recognized that perinatal mood and anxiety disorders (PMADs), including postpartum depression, are more than just “baby blues.” They’re the most common complication of childbirth in the U.S., affecting about 14 percent of women in their lifetimes and up to 50 percent in some specific populations. PMADs can lead to a variety of adverse outcomes for both mothers and their babies, including poor breastfeeding rates, poor maternal-infant bonding, lower infant immunization rates and maternal suicides that account for up to 20 percent of postpartum deaths.

But while it’s obvious that PMADs are a significant problem, finding a way to solve this issue is far from clear. In a policy statement published December 2018 in the journal Pediatrics, the American Academy of Pediatrics recommends that pediatric medical homes coordinate more effectively with prenatal providers to ensure PMAD screening occurs for new mothers at well-child checkups throughout the first several weeks and months of infancy and use community resources and referrals to ensure women suffering with these disorders receive follow-up treatment.

To help solve the huge issue of PMADs requires a more comprehensive approach, suggests Lenore Jarvis, M.D., MEd, an emergency medicine specialist at Children’s National Health System. A poster that Dr. Jarvis and colleagues from Children’s Perinatal Mental Health Taskforce recently presented at the American Academy of Pediatrics 2018 National Convention and Exhibit in Orlando, Florida, details the integrated care to help women with PMADs that originated at Children’s National and is being offered at several levels, including individual, interpersonal, organizational, community and policy. The poster was ranked best in its section for the Council on Early Childhood.

At the base level of care for mothers with possible PMADs, Dr. Jarvis says, are the one-on-one screenings that take place in primary care clinics. Currently, all five of Children’s primary care clinics screen for mental health concerns at annual visits. At the 2-week, 1-, 2-, 4- and 6-month visits, mothers are screened for PMADs using the Edinburgh Postnatal Depression Scale, a validated tool that’s long been used to gauge the risk of postpartum depression. In addition, recent studies at Children’s neonatal intensive care unit (NICU) and emergency department (ED) suggest that performing PMAD screenings in these settings as well could help catch even more women with these disorders: About 45 percent of parents had a positive screen for depression at NICU discharge, and about 27 percent of recent mothers had positive screens for PMADs in the ED.

To further these efforts, Children’s National recently started a Perinatal Mental Health Taskforce to promote multidisciplinary collaboration and open communication with providers among multiple hospital divisions. This taskforce is working together to apply lessons learned from screening in primary care, the NICU and the ED to discuss best practices and develop hospital-wide recommendations. They’re also sharing their experiences with hospitals across the country to help them develop best practices for helping women with PMADs at their own institutions.

Furthering its commitment to PMAD screening, Children’s National leadership set a goal of increasing screening in primary care by 15 percent for fiscal year 2018 – then exceeded it. Children’s National is also helping women with PMADs far outside the hospital’s walls by developing a PMAD screening toolkit for other providers in Washington and across the country and by connecting with community partners through the DC Collaborative for Mental Health in Pediatric Primary Care. In April 2019, the hospital will host a regional perinatal mental health conference that not only will include its own staff but also staff from other local hospitals and other providers who care for new mothers, including midwives, social workers, psychologists, community health workers and doulas.

Finally, on a federal level, Dr. Jarvis and colleagues are part of efforts to obtain additional resources for PMAD screening, referral and treatment. They successfully advocated for Congress to fully fund the Screening and Treatment for Maternal Depression program, part of the 21st Century Cures Act. And locally, they provided testimony to help establish a task force to address PMADs in Washington.

Together, Dr. Jarvis says, these efforts are making a difference for women with PMADs and their families.

“All this work demonstrates that you can take a problem that is very personal, this individual experience with PMADS, and work together with a multidisciplinary team in collaboration to really have an impact and promote change across the board,” she adds.

In addition to Dr. Jarvis, the lead author, Children’s co-authors include Penelope Theodorou, MPH; Sarah Barclay Hoffman, MPP, Program Manager, Child Health Advocacy Institute; Melissa Long, M.D.; Lamia Soghier M.D., MEd, NICU Medical Unit Director; Karen Fratantoni M.D., MPH; and Senior Author Lee Beers, M.D., Medical Director, Municipal and Regional Affairs, Child Health Advocacy Institute.

Lenore Jarvis at #thisisourlane meeting

#thisisourlane: Pediatricians call for safer firearm storage, enhanced research funding

Lenore Jarvis at #thisisourlane meeting

The 2-year-old scampered unexpectedly into a room, startling a family member. Thinking the toddler was an intruder, the family member fired, hitting the child in the chest.

In the emergency department at Children’s National Health System, Lenore Jarvis, M.D. MEd, FAAP, emergency medicine specialist, and colleagues tried to save the boy’s life, inserting tubes, transfusing blood and attempting to restart his dying heart via CPR. The Children’s team was unsuccessful and emerged covered in the blood of a boy whose death was heartbreaking and preventable.

“Firearm violence is a leading cause of childhood traumatic death and injury,” Dr. Jarvis told attendees of a recent congressional news conference intended to prod the incoming Congress to take more concrete action to prevent firearm violence. She provided snapshots of some of the countless lives of local youths cut short by firearms, including an 8-year-old girl killed on a playground in a drive-by shooting, a 13-year-old young man murdered during a fight, a 15-year-old young woman who committed suicide and an entire family who died from firearm injuries.

“I wish it were not so. But these stories are endless. In our emergency department, the effects of gun violence are frequent, life-altering and personal,” Dr. Jarvis said.

The #ThisISOurLane press conference, convened by U.S. Rep. Robin Kelly, (D-Illinois), included haunting stories by clinicians from across the nation about the devastating impact of firearm injuries on children and youth. According to a retrospective, cross-sectional study led by Children’s researchers, younger children are more likely to be shot by accident, and odds are higher that older youths are victims of an assault involving a firearm.

“Gun violence is a public health crisis and should be addressed as such. We need to reduce the numbers of suicides, homicides and accidental gun deaths in children,” added Dr. Jarvis, who also is president-elect of the District of Columbia Chapter of the American Academy of Pediatrics.

During the news conference, U.S. Rep. Frank Pallone Jr., (D-New Jersey), vowed that the House Energy and Commerce Committee he chairs this session will move forward languishing bills, including funding the Centers for Disease Control Prevention to conduct firearms violence research.