Emergency Medicine

Abstract Happy 2022 New Year greeting card with light bulb

The best of 2022 from Innovation District

Abstract Happy 2022 New Year greeting card with light bulbA clinical trial testing a new drug to increase growth in children with short stature. The first ever high-intensity focused ultrasound procedure on a pediatric patient with neurofibromatosis. A low dose gene therapy vector that restores the ability of injured muscle fibers to repair. These were among the most popular articles we published on Innovation District in 2022. Read on for our full top 10 list.

1. Vosoritide shows promise for children with certain genetic growth disorders

Preliminary results from a phase II clinical trial at Children’s National Hospital showed that a new drug, vosoritide, can increase growth in children with certain growth disorders. This was the first clinical trial in the world testing vosoritide in children with certain genetic causes of short stature.
(2 min. read)

2. Children’s National uses HIFU to perform first ever non-invasive brain tumor procedure

Children’s National Hospital successfully performed the first ever high-intensity focused ultrasound (HIFU) non-invasive procedure on a pediatric patient with neurofibromatosis. This was the youngest patient to undergo HIFU treatment in the world.
(3 min. read)

3. Gene therapy offers potential long-term treatment for limb-girdle muscular dystrophy 2B

Using a single injection of a low dose gene therapy vector, researchers at Children’s National restored the ability of injured muscle fibers to repair in a way that reduced muscle degeneration and enhanced the functioning of the diseased muscle.
(3 min. read)

4. Catherine Bollard, M.D., M.B.Ch.B., selected to lead global Cancer Grand Challenges team

A world-class team of researchers co-led by Catherine Bollard, M.D., M.B.Ch.B., director of the Center for Cancer and Immunology Research at Children’s National, was selected to receive a $25m Cancer Grand Challenges award to tackle solid tumors in children.
(4 min. read)

5. New telehealth command center redefines hospital care

Children’s National opened a new telehealth command center that uses cutting-edge technology to keep continuous watch over children with critical heart disease. The center offers improved collaborative communication to better help predict and prevent major events, like cardiac arrest.
(2 min. read)

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

Children’s National 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.
(2 min. read)

7. Brain tumor team performs first ever LIFU procedure on pediatric DIPG patient

A team at Children’s National performed the first treatment with sonodynamic therapy utilizing low intensity focused ultrasound (LIFU) and 5-aminolevulinic acid (5-ALA) medication on a pediatric patient. The treatment was done noninvasively through an intact skull.
(3 min. read)

8. COVID-19’s impact on pregnant women and their babies

In an editorial, Roberta L. DeBiasi, M.D., M.S., provided a comprehensive review of what is known about the harmful effects of SARS-CoV-2 infection in pregnant women themselves, the effects on their newborns, the negative impact on the placenta and what still is unknown amid the rapidly evolving field.
(2 min. read)

9. Staged surgical hybrid strategy changes outcome for baby born with HLHS

Doctors at Children’s National used a staged, hybrid cardiac surgical strategy to care for a patient who was born with hypoplastic left heart syndrome (HLHS) at 28-weeks-old. Hybrid heart procedures blend traditional surgery and a minimally invasive interventional, or catheter-based, procedure.
(4 min. read)

10. 2022: Pediatric colorectal and pelvic reconstructive surgery today

In a review article in Seminars in Pediatric Surgery, Marc Levitt, M.D., chief of the Division of Colorectal and Pelvic Reconstruction at Children’s National, discussed the history of pediatric colorectal and pelvic reconstructive surgery and described the key advances that have improved patients’ lives.
(11 min. read)

Depressed mom sitting on couch with infant

Improving post-partum depression screening in the NICU and ED

Depressed mom sitting on couch with infant

A universal screening program is a critical first step for hospitals caring for postpartum caregivers, both inpatient and outpatient.

Perinatal Mood and Anxiety Disorders (PMADs) — particularly postpartum depression — are more prevalent among parents who have newborns admitted to a Neonatal Intensive Care Unit (NICU). Children’s National Hospital sought to increase the number of parents screened for PMADs in the NICU and Emergency Department (ED), where there was a high incidence of people seeking care. The team found that a universal screening program is a critical first step for hospitals caring for postpartum caregivers, both inpatient and outpatient.

The big picture

Without treatment, PMADs affect the caregiver and disturb their interaction with their infant, impacting the child’s cognitive and emotional development.

“What surprised us was how many people we saw that screen positive for postpartum depression and anxiety disorders. The percentage of our population is higher than what is reported in the literature,” said Sofia Perazzo, M.D., program lead at Children’s National.

What we did

The team initiated a multifaceted approach, using an electronic version of the Edinburgh Postpartum Depression Screening tool.

  • A part-time family services support staff was hired to screen caregivers. Funding later expanded the team to cover more days and hours.
  • Real-time social work interventions and linkage to resources were provided to all caregivers.
  • A part-time psychologist was hired to provide telemedicine therapy to NICU parents.
  • Remote screening was implemented for those who could not be screened in-person.

In the NICU, 1,596 parents were approached from August 2018-April 2022. Of those approached, 90% completed the screen, 26% screened positive, 4% indicated having suicidal thoughts and about 13% of caregivers were fathers.

What we learned

  • Action plans need to be in place for positive screens at start.
  • Electronic tools can aid significantly in expanding screening.
  • Trained personnel and multidisciplinary approaches are key.
  • Screening in two different settings can be challenging as they present different systems.
  • Being flexible and adapting tools and the system are key to success.
  • Good team communication with the nurse is vital.

“We’re working on improving our screening system to make it more efficient. We also realized that we need to make more resources available to these families,” said Dr. Perazzo. “Our team is constantly looking for community resources that can help them along the way. There is also a big need to educate our families on mental health issues, so we use this encounter as an opportunity to do that as well.”

This work was made possible by an investment from A. James & Alice B. Clark Foundation to Children’s National that aims to provide families with greater access to mental health care and community resources. Read more about the work of the Perinatal Mental Health Task Force at Children’s National.

Boy on e-scooter with Mom

E-scooter bone injuries on the rise

Over the past decade, electric scooters (e-scooters) have been increasing in popularity across the country. But with their popularity, visits to the hospital have also been on the rise. According to a new abstract, e-scooter injuries are becoming much more common and increasingly severe.

Authors of the abstract, “National Trends in Pediatric e-Scooter Injury,” found hundreds of e-scooter injuries between 2011-2020.

Boy on e-scooter with Mom

Over the years, e-scooter injuries are becoming much more common and increasingly severe.

The findings show that the rate of hospital admittance for patients increased from fewer than 1 out of every 20 e-scooter injuries in 2011 to 1 out of every 8 requiring admittance into a hospital for care in 2020.

“The number of annual e-scooter injuries has increased from 2011 to 2020, likely due in some part to the rise in popularity of rideshare e-scooter apps,” said lead author Harrison Hayward, M.D., Emergency Medicine fellow at Children’s National Hospital. “Our study has characterized the spectrum of injuries that occur in children, which helps emergency room doctors prepare for taking care of them and helps parents and families to practice better safety.”

The most common injuries were arm fractures (27%), followed by minor abrasions (22%) and lacerations needing stitches (17%). The average age was 11.1 years and 59% of patients were male.

With the alarming rise in injuries, Dr. Hayward and other experts are saying the use of helmets are a must since over 10% of the reported cases were head injuries.

“Research has broadly demonstrated that helmets save lives for bicycle riders, and we should think similarly about e-scooters,” he said.

You can read more about the findings on the American Academy of Pediatrics website.

Monika Goyal

Researchers to address pain management inequities with over $4M NIH award

Monika Goyal

Over the years, research led by Dr. Goyal documented racial and ethnic inequities in the ED.

The National Institutes of Health (NIH) awarded Children’s National Hospital with over $4.2 million to address inequities in pain management for children that come into the emergency department (ED).

Why this matters

The ED is a strategic venue for addressing health inequities, where children account for more than 30 million visits annually.

“There are widespread inequities in the quality-of-care delivery for children. Because the factors contributing to these disparities arise on both individual and systemic levels, it is imperative that we develop interventions to achieve health equity,” said Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine at Children’s National Hospital and recipient of the award.

Over the years, research led by Dr. Goyal documented racial and ethnic inequities in the ED management of pain among children with long bone fractures and appendicitis and disparities in the management of pain reduction for minoritized children.

“These findings indicate there are differences in health care quality even in settings with universal access,” she added.

The research goal

Dr. Goyal and her team aim to mitigate, and ultimately eradicate, health care inequities through evidence-based interventions. With the research support from the NIH, the team will advance this goal by:

  • Measuring how clinician (physician and nursing) implicit bias is associated with quality of care for pain management in children presenting to the ED with appendicitis or long bone fractures.
  • Using a stakeholder-engaged approach to develop patient- and caregiver-informed quality metrics related to pain management.
  • Develop and measure the impact of ‘Equity Report Cards’ and electronic health record (EHR)-embedded clinical decision support (CDS) tools to mitigate inequities in care delivery.

The bottom line

Most research to date has focused on documenting disparities. This research has the potential to move the needle in equity research by developing and testing interventions that seek to eradicate inequities in care delivery.

a quote from Joelle Simpson

Five leading children’s hospitals secure funding to enhance future pandemic readiness

a quote from Joelle Simpson A group of children’s hospitals from across the country will coordinate on the response to future pandemics and other disasters through a new $29 million grant from the Health Resources and Services Administration (HRSA). The group, known as the Pediatric Pandemic Network (PPN), will focus on the unique needs and challenges to children during pandemics and disasters, ensuring that health equity is at the forefront of emergency planning.

The five hospitals are:

  • Children’s National Hospital in Washington, D.C. (lead institution)
  • Ann & Robert H. Lurie Children’s Hospital of Chicago
  • University of Alabama at Birmingham Department of Pediatrics at Children’s of Alabama
  • Children’s Mercy Kansas City
  • Seattle Children’s

“As the current pandemic has proven to the world, pandemics and public health crises magnify pre-existing environmental, health, social and economic inequities,” said Joelle Simpson, M.D., M.P.H., principal investigator of this grant and division chief of Emergency Medicine and medical director of Emergency Preparedness at Children’s National. “Communities of color not only feel the impact of pandemics and disasters far more severely than others, but also have more difficulty obtaining aid and assistance. If the needs of vulnerable populations are not addressed in emergency planning, the national disaster preparedness strategy could fail for all.”

The hospitals recognize that while the COVID-19 pandemic has been devastating for the entire world, the pediatric population in particular has been challenged by a lack of established coordination among pediatric care providers. In addition to addressing health equity, the funding facilitates the following:

  • Establishing pathways to gather and disseminate research-informed insights into how to care for children in a future pandemic to both medical providers and community organizations.
  • Developing a telehealth infrastructure to support the care of acutely ill children and expand mental health access.
  • Expanding pediatric-focused emergency preparedness and planning with a focus on behavioral health, social support, and educational services, all of which are typically provided by community organizations.

The hub for this grant will be located at the newly opened Children’s National Research & Innovation Campus – the site of the former Walter Reed Army Medical Center in Washington, D.C. Work will take place in the renovated Armed Forces Institute of Pathology, where past investigators made seminal discoveries in infectious diseases and pandemics. The former campus was named after Walter Reed because of his work around discovering the cause and prevention of outbreaks of yellow fever. This modern-day team of physician researchers intends to make equally important contributions to future pandemics and other disasters to help preserve the health of our nation’s children.

In September 2021, HRSA launched the Regional PPN by funding five pediatric hospitals to support the planning and preparation of children’s hospitals to respond to a global health threat. This new grant doubles the size and reach of the network in order to benefit all children in the nation.

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.

emergency signs

Social risk interventions significantly reduce asthma-related ED visits

emergency signs

In a systematic review and meta-analysis published in JAMA Pediatrics, researchers at Children’s National Hospital found that interventions focused on health, environment and community were associated with the greatest reduction in asthma-related emergency department visits and hospitalizations among children.

In a systematic review and meta-analysis published in JAMA Pediatrics, researchers at Children’s National Hospital found that interventions focused on health, environment and community were associated with the greatest reduction in asthma-related emergency department visits and hospitalizations among children. The findings suggest that addressing social risks may be a crucial component of pediatric asthma care to improve health outcomes.

“There are persistent and striking disparities in asthma outcomes among children,” said Jordan Tyris, M.D., hospitalist fellow at Children’s National and lead author. “Understanding how to address these is of utmost importance.”

“Literature on the spectrum of social factors, including social needs, social risks and social determinants, has increased recently across many aspects of health care,” adds Dr. Tyris. “But much of this literature has focused on adults with chronic conditions, for example diabetes or high blood pressure.”

The study authors searched PubMed, Scopus, PsychINFO, SocINDEX and CINAHL from January 2008 to June 2021 for U.S.-based studies evaluating the associations of interventions addressing one or more social risks with asthma-related emergency department visits and hospitalizations among children. The systematic review included 38 of the original 641 identified articles (6%), and the meta-analysis included 19 articles (3%). Overall, participation in social risk–based interventions, particularly those that addressed health literacy, home environmental conditions and peer support were associated with significantly reduced risks for asthma-related emergency department visits and hospitalizations among children.

You can read the full study, “Social Risk Interventions and Health Care Utilization for Pediatric Asthma: A Systematic Review and Meta-analysis” in JAMA Pediatrics.

stressed mom holding baby

An integrated approach to address perinatal mental health treatment

stressed mom holding baby

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth, with suicide as a leading cause of postpartum deaths.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth, with suicide as a leading cause of postpartum deaths. PMADs are associated with poor maternal, infant and family outcomes. A new advocacy case study in Pediatrics led by a collaborative team of physicians at Children’s National Hospital describes the creation of the Task Force to formalize collaboration between hospital divisions, promote systems-level change and advocate for health care policy solutions.

Spearheaded by the Division of Emergency Medicine, the Goldberg Center for Community Pediatric Health and the Division of Neonatology at Children’s National, the #1 rated neonatology program in the country, the physicians who led this case study hope it can serve as a model for advocates looking to integrate PMAD screening within their own institutions. Children’s National is currently one of only a few children’s hospitals in the country that have implemented universal PMADs screening.

Lenore Jarvis, M.D., director of advocacy and health policy for the Division of Emergency Medicine at Children’s National, and Lamia Soghier, M.D., medical director of the Neonatal Intensive Care Unit (NICU) and the NICU Quality and Safety Officer at Children’s National, discussed this important work:

Q: What were you looking at with this case study?

A: Dr. Jarvis: This case study describes the implementation and outcomes of a multidisciplinary Perinatal Mental Health Task Force created at Children’s National in Washington, D.C. It was created to promote systems change and health care policy solutions for improved identification and treatment of PMADs.

Using the social-ecological model as a framework, the Task Force addressed care at the individual, interpersonal, organizational, community and policy levels. It then applied lessons learned from division-specific screening initiatives to create best practices and make hospital-wide recommendations.

This foundational work enabled us to build community bridges and break down internal barriers to shift our hospital toward prioritizing perinatal mental health. As a result, screening expanded to multiple hospital locations and the Perinatal Mental Health Screening Tool Kit was created and disseminated within the community. Task Force members also testified in governmental hearings and joined national organizations to inform policy, and Task Force and community collaborations resulted in significant grant funding.

Q: How is this work benefitting patients?

A: Dr. Soghier: Identification and early intervention for PMADs are imperative for improving health outcomes – not only for mothers but for their children and families too. Given the prevalence and negative consequences of untreated PMADs, we continue to innovate to improve the care we provide for infants and their families. We hope that this case study inspires others who value family mental health and are looking to integrate PMAD screening within their institutions.

Q: What are some of the barriers to getting this work implemented more widely?

A: Dr. Jarvis: One important thing to note is that families and medical providers alike may be unaware of how common PMADs truly are. On top of that, they’re unaware of the downstream negative impact it can have on the infant and family.

As a society, we must realize that PMADs can affect paternal caregivers. We need to have resources that also address fathers in addition to culturally and racially competent systems and resources for referral and linkage to care.

A: Dr. Soghier: Within medical systems, fragmented and siloed care delivery systems continue to be a barrier. Medical staff may also feel untrained and uncomfortable with addressing positive PMADs screens. Within the pediatric practice, differential access to services and reimbursement continue to be a concern, especially in a system where the parent is technically “not our patient.”

Identifying PMADs in our families and providing real-time resources and linkage to care has been invaluable to us. Ultimately, we seek to improve the care we provide to our infants and families and improve patient-family outcomes.

Read the full case study in the journal Pediatrics.

Timeline of major Task Force events

Timeline of major Task Force events. CES-D, Center for Epidemiologic Studies Depression Scale; DC, District of Columbia; PCORI, Patient-Centered Outcomes Research Institute.

Meghan Delaney

Meghan Delaney, D.O., M.P.H., receives 2021 James Blundell Award

Meghan Delaney

The British Blood Transfusion Society (BBTS) recognized Meghan Delaney, D.O., M.P.H., division chief of Pathology and Lab Medicine and director of Transfusion Medicine at Children’s National Hospital, with the James Blundell Award.

The James Blundell Award is the most prestigious award given by the BBTS. Introduced in 1984, this award is given to recipients for original research resulting in an important and significant contribution to the body of medical and or scientific knowledge within the field of blood transfusion.

“I am honored to receive this award from the British Blood Transfusion Society,” says Dr. Delaney. “The field of transfusion medicine is dynamic and provides an important part of our healthcare infrastructure.  It’s wonderful to have this recognition and I am grateful to the society for the award.”

She is professor of Pathology and Pediatrics at the George Washington University with over 100 manuscripts, 25 book chapters and over 60 presented abstracts. Dr. Delaney serves as a member of the Board of Directors for the Association for the Advancement of Blood & Biotherapies (AABB), is a Scientific Member of the BEST Collaborative and is a member of the American Board of Pathology Test Development and Advisory Committee. She serves as the chair of the National Institutes of Health’s BLOODSAFE Program that aims to improve access to safe blood in Sub Saharan Africa.

Dr. Delaney received the award on September 14 at the 2021 BBTS Annual Conference, where she presented the lecture titled: “Access to safe blood transfusion in low- and middle-income nations: From ‘big data’ to mosquitos.”

Drs. Katie Donnelly, Panagiotis Kratimenos, Rana Hamdy, Shayna Coburn and Brynn Marks

Five Children’s National Hospital faculty named to Society for Pediatric Research

Drs. Katie Donnelly, Panagiotis Kratimenos, Rana Hamdy, Shayna Coburn and Brynn Marks

The Society for Pediatric Research (SPR) announced five new members from Children’s National Hospital: Drs. Rana Hamdy, Panagiotis Kratimenos, Brynn Marks, Shayna Coburn and Katie Donnelly.

The Society for Pediatric Research (SPR) announced five new members from Children’s National Hospital. Established in 1929, SPR’s mission is to create a multi-disciplinary network of diverse researchers to improve child health.

Membership in SPR is a recognized honor in academic pediatrics. It requires nomination by academic peers and leaders as well as recognition of one’s role as an independent, productive child health researcher.

“I am so proud of our faculty and all that they have accomplished. I am thrilled that they have been recognized for their achievements,” said Beth A. Tarini, M.D., M.S., SPR president and associate director for the Center for Translational Research at Children’s National Hospital.

SPR 2021 active new members from Children’s National are:

    • Katie Donnelly, M.D., M.P.H., attending physician in the Emergency Department at Children’s National Hospital. She is the medical director for Safe Kids DC, an organization dedicated to preventing accidental injuries in children in Washington DC. Her personal research interest is in preventing firearm injuries in children and she is a member of Safer through Advocacy, Firearm Education and Research (SAFER), a multidisciplinary team dedicated to firearm injury prevention at Children’s National. She is also the medical director of the newly founded hospital-based violence intervention program at Children’s National and an associate professor of pediatrics and emergency medicine at The George Washington University.“To be recognized by my peers as a researcher with a significant contribution to our field is very validating. It also opens a world of potential collaborations with excellent scientists, which is very exciting!” said Dr. Donnelly. “I am grateful for the immense support offered to me by the Division of Emergency Medicine to complete the research I am passionate about, especially my mentor Monika Goyal.”
    • Panagiotis Kratimenos, M.D., Ph.D., newborn intensivist and neuroscientist at Children’s National. He studies mechanisms of brain injury in the neonate, intending to prevent its sequelae later in life. Dr. Kratimenos’ interest lies in identifying therapies to prevent or improve neurodevelopmental disabilities of sick newborns caused by prematurity and perinatal insults.“Being a member of SPR is a deep honor for me. SPR has always been a ‘mentorship home’ for me since I was a trainee and a member of the SPR junior section,” said Dr. Kratimenos. “A membership in the SPR allows us to access a very diverse, outstanding team of pediatric academicians and researchers who support the development of physician-scientists, honors excellence through prestigious grants and awards, and advocates for children at any level either locally, nationally, or internationally.”
    • Rana Hamdy, M.D., M.P.H., M.S.C.E., pediatric infectious diseases physician at Children’s National and Director of the Antimicrobial Stewardship Program. She is an assistant professor of pediatrics at George Washington University School of Medicine and Health Sciences. Her area of expertise focuses on the prevention and treatment of antimicrobial resistant infections and the promotion of good antimicrobial stewardship in inpatient and outpatient settings.“It’s an honor to be joining the Society for Pediatric Research and becoming part of this distinguished multidisciplinary network of pediatric researchers,” said Dr. Hamdy. “I look forward to the opportunity to meet and work with SPR members, make connections for future collaborations, as well as encourage trainees to pursue pediatric research through the opportunities that SPR offers.”
    • Shayna Coburn, Ph.D., director of Psychosocial Services in the Celiac Disease Program at Children’s National. She is a licensed psychologist specializing in coping and interpersonal relationships in chronic illness treatment, particularly for conditions involving specialized diets. She holds an appointment as assistant professor of psychiatry and behavioral sciences at The George Washington University School of Medicine and Health Sciences. Her work has focused on promoting effective doctor-patient communication, reducing healthcare disparities and supporting successful adherence across the developmental span of childhood and adolescence. She currently has a Career Development Award from National Institute of Diabetes and Digestive and Kidney Diseases to refine and test a group intervention designed to improve self-management and quality of life in teens with celiac disease.
      “I hope that my background as a psychologist researcher will help diversify SPR. As an SPR member, I hope to encourage more opportunities for training, awards, and other programs that would be inclusive of clinician researchers who may not hold a traditional medical degree,” said Dr. Coburn.
    • Brynn Marks, M.D., M.S.-H.P.Ed., endocrinologist at Children’s National. As a clinical and translational scientist her goal is to use unique personal experiences and training to optimize both patient and provider knowledge of and behaviors surrounding diabetes technologies thereby realizing the potential of diabetes technologies improve the lives and clinical outcomes of all people living with diabetes. Her experiences as a person living with Type 1 diabetes have undoubtedly shaped her clinical and research interests in diabetes management and medical education.
      “It is an honor to be accepted for membership in the Society for Pediatric Research,” said Dr. Marks.  “Being nominated and recognized by peers in this interprofessional pediatric research community will allow me networking and growth opportunities as I continue to advance my research career.”
illustration of lungs with coronavirus inside

Study compares outcomes of SARS-CoV-2 versus other respiratory viruses

illustration of lungs with coronavirus inside

Until now, little was known about the incidence and virus-specific patient outcome of SARS-CoV-2 compared to common seasonal respiratory viruses in children — including respiratory syncytial virus (RSV), human parainfluenza (hPIV), human metapneumovirus (hMPV), respiratory adenovirus and human rhinovirus (hHRV) and respiratory enterovirus (rENT).

Common respiratory viral infections were associated with a higher proportion of inpatient admissions but were similar in intensive care unit (ICU) admissions and death rates in hospitalized pediatric patients when compared to SARS-CoV-2, according to Children’s National Hospital researchers that led a study published in Infection Control & Hospital Epidemiology.

Until now, little was known about the incidence and virus-specific patient outcome of SARS-CoV-2 compared to common seasonal respiratory viruses in children — including respiratory syncytial virus (RSV), human parainfluenza (hPIV), human metapneumovirus (hMPV), respiratory adenovirus and human rhinovirus (hHRV) and respiratory enterovirus (rENT).

The researchers also noted that there was an overall substantial decrease in seasonal respiratory viral infections, especially the severe forms that require hospitalization. They believe that this correlation might be associated with the adoption of COVID-19 public health mitigation efforts, which played a major role in the reduction of these viruses that often circulate in fall and winter. The retrospective cross-sectional cohort study analyzed over 55,000 patient admissions between Match 15 and December 31, 2020. The findings shed light on the incidences of eight common seasonal respiratory viral infections before and during the COVID-19 pandemic. It also compared patient outcomes associated with COVID-19 and these other viral infections among pediatric patients at Children’s National.

Xiaoyan Song, Ph.D., M.Sc., chief infection control officer at Children’s National, spoke to us about the study.

Q: Why is this important work?

A: This is the first study to date that has described and compared hospitalization rates, ICU admission rates and death associated with COVID-19, RSV, seasonal influenza, rhinovirus, enterovirus and other common respiratory viral infections in children in one study. Previously, studies have compared one or two viruses at a time. This study compared 8 viruses, including the most detected ones – COVID-19, RSV, seasonal flu, rhinovirus and enterovirus.

Q: How will this work benefit patients?

A: This study will inform patients, families and the public that preventative measures like masking, hand hygiene, avoiding crowds and avoiding people who are ill are good practices that work to protect children from getting COVID-19 but also from getting infected with RSV, influenza and other viruses. Any of these respiratory viruses could harm a patient to a point where the child may have to be hospitalized or receive ICU care.

You can read the full study published in Infection Control & Hospital Epidemiology.

pill bottles and pills

Racial and ethnic disparities in ED opioid prescriptions have decreased

pill bottles and pills

Whereas in 2012, there were clear racial and ethnic differences in opioid prescription rates. By 2019, those differences were no longer statistically significant overall or within sites.

As the provision of opioid prescriptions declined over time, previously marked racial and ethnic disparities in opioid prescription rates at the time of Emergency Department (ED) discharge also attenuated, according to new findings led by Monika Goyal, M.D., M.S.C.E., associate division chief of Emergency Medicine and Trauma Services at Children’s National Hospital, and others.

The research, published in Pediatrics, investigated whether racial and ethnic differences in the delivery of outpatient opioid prescriptions for children discharged from the ED with long-bone fractures diminished over time.

“In 2012 compared to 2019, although rates of opioid prescribing were higher across all racial/ethnic groups, they were highest for NH-white youth,” said Dr. Goyal. “It’s reassuring to see that as rates of opioid prescribing declined over time, such racial and ethnic differences have attenuated.”

Whereas in 2012, there were clear racial and ethnic differences in opioid prescription rates. By 2019, those differences were no longer statistically significant overall or within sites.

However, as clinicians prescribed fewer opioids, sites continued to have moderate racial and ethnic variability in opioid prescribing rates for non-Hispanic white, non-Hispanic Black and Hispanic children.

The authors caution that the reduction of opioid prescription is possibly attributed to the response against the opioid epidemic.  There is also a need for more studies that seek to identify optimal outpatient pain management for children with fractures and ensure suitable post-discharge pain control for all children, regardless of race and/or ethnicity.

The retrospective cross-sectional study sampled children 4-18 years with long bone fractures using the Pediatric Emergency Care Applied Research Network (PECARN) Registry, an electronic health record registry of four geographically diverse pediatric EDs, from January 1, 2012, to December 31, 2019.

Patient race and ethnicity were categorized as non-Hispanic (NH) white, NH-Black, Hispanic or other. The investigators performed bivariable and multivariable logistic regression to measure the association between patient race and ethnicity and outpatient prescription. Out of the 42,803 ED eligible visits to analyze, 6,441 received an opioid prescription at ED discharge. This data showed that disparities when prescribing an opioid decreased over a 7-year period.

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.

US News badges

For fifth year in a row, Children’s National Hospital nationally ranked a top 10 children’s hospital

US News badges

Children’s National Hospital in Washington, D.C., was ranked in the top 10 nationally in the U.S. News & World Report 2021-22 Best Children’s Hospitals annual rankings. This marks the fifth straight year Children’s National has made the Honor Roll list, which ranks the top 10 children’s hospitals nationwide. In addition, its neonatology program, which provides newborn intensive care, ranked No.1 among all children’s hospitals for the fifth year in a row.

For the eleventh straight year, Children’s National also ranked in all 10 specialty services, with seven specialties ranked in the top 10.

“It is always spectacular to be named one of the nation’s best children’s hospitals, but this year more than ever,” says Kurt Newman, M.D., president and CEO of Children’s National. “Every member of our organization helped us achieve this level of excellence, and they did it while sacrificing so much in order to help our country respond to and recover from the COVID-19 pandemic.”

“When choosing a hospital for a sick child, many parents want specialized expertise, convenience and caring medical professionals,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “The Best Children’s Hospitals rankings have always highlighted hospitals that excel in specialized care. As the pandemic continues to affect travel, finding high-quality care close to home has never been more important.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals. The rankings recognize the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News. The top 10 scorers are awarded a distinction called the Honor Roll.

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

Below are links to the seven Children’s National specialty services that U.S. News ranked in the top 10 nationally:

The other three specialties ranked among the top 50 were cardiology and heart surgery, gastroenterology and gastro-intestinal surgery, and urology.

PAS Logo

Children’s National participants share their expertise at PAS meeting

PAS Logo

The 2021 Pediatric Academic Societies (PAS) Virtual meeting hosted live-streamed events, on-demand sessions with live Q+A, a virtual exhibit hall, poster presentations and networking events that attracted pediatricians and healthcare providers worldwide. Among the physician-scientists, there were over 20 Children’s National Hospital-affiliated participants at this year’s meeting, adding to the conversation of pediatric research in specialty and sub-specialty areas.

Children’s National experts covered a range of topics, including heart disease, neurology, abnormal glycemia in newborns and antibiotic use in hospitalized children.

The “Neurological Implications of Abnormal Glycemia in Neonatal Encephalopathy and Prematurity” was a hot topic symposium presented by a panel of experts, including Sudeepta Basu, M.B.B.S., M.S., neonatologist at Children’s National.

The experts addressed the importance of recognizing early blood glucose disturbances in newborns with encephalopathy following birth asphyxia and its likely impact on brain injury and long-term outcomes. Although whole body cooling for newborns with encephalopathy after birth asphyxia is now standard of care in most advanced centers like Children’s National, many newborns still die or have neurological impairments. Dr. Basu emphasized on the need of continued advances in newer therapies and optimizing intensive care support for these vulnerable newborns immediately after birth. Dr. Basu’s presentation focused on the association of not only low blood glucose (hypoglycemia) but also high blood glucose (hyperglycemia) with abnormal motor, visual and intellectual outcomes in surviving newborns.

“Recognizing the problem is the first step for further advancement,” Dr. Basu said. “The scientific community needs to recognize the importance of early glucose status as an early marker for disease severity and risk of brain injury.” To sum up, Dr. Basu drew attention to recent newborn resuscitation guidelines from the International Liaison Committee on Resuscitation (ILCOR), which recommends close monitoring of blood glucose levels and optimizing supportive care to maintain it within normal range. Dedicated clinical trials are the need of the hour to guide what are “normal” glucose levels in newborns with encephalopathy and what treatment options are most beneficial.

Rana F. Hamdy, M.D., M.P.H., M.S.C.E., director of the Children’s National Antimicrobial Stewardship Program, delved into the increased number of children receiving care for acute conditions – like acute respiratory tract infections – from urgent care centers and direct-to-consumer (DTC) telemedicine companies during her session “Implementing Antibiotic Stewardship in Telemedicine and Urgent Care Settings.”

Telemedicine, in this case, refers to DTC telemedicine companies—not to be confused with the telemedicine established with primary care providers, like the services provided by Children’s National.

There has been little research focused on promoting good antibiotic stewardship in urgent care settings that tend to overprescribe antibiotics compared to a primary care setting. In addition to her work focusing on improving antimicrobial use within Children’s National, Dr. Hamdy has led collaborative quality improvement work nationally in both the pediatric urgent care and DTC telemedicine settings.

“What we’ve learned from our work with the DTC telemedicine setting is that leadership commitment coming from the company is a necessary core element,” Dr. Hamdy said. “There may be unique opportunities in the telemedicine setting to employ the home-grown computer systems for antimicrobial stewardship interventions, for example, incorporating clinical decision support or feedback reports into the electronic health record systems or displaying a commitment letter in the virtual waiting room.”

In the urgent care setting, Dr. Hamdy’s team recruited approximately 150 pediatric urgent care providers to participate in the national quality improvement initiative. Communication training modules for pediatric urgent care providers with scripted language for target infectious conditions — acute otitis media, pharyngitis and otitis media with effusion — were among the successful intervention approaches that led to improved appropriate antibiotic prescribing practices, according to her team’s findings.

“Understanding the prescribing practices in the urgent care setting is important to knowing where and how to focus on target conditions and to be able to support with education and resources,” Dr. Hamdy said. “And understanding the perceived barriers to judicious antibiotic prescribing can help to identify the highest yield interventions.”

This also reflects the approach taken by the outpatient antibiotic stewardship team at the Children’s National Goldberg Center, led by Ariella Slovin, M.D., primary care pediatrics provider at Children’s National Hospital. Dr. Slovin’s oral abstract entitled “Antibiotic Prescribing Via Telemedicine in the Time of COVID-19,” examined the effect that a shift to telemedicine due to the COVID-19 pandemic had on antibiotic use for acute respiratory tract infections. Overall, her team found a decrease in the proportion of acute respiratory tract infections prescribed antibiotics and concluded that the shift to telemedicine did not adversely affect judicious antibiotic prescribing for acute respiratory tract infections.

Other participants from Children’s National included: Taeun Chang, M.D.; Yuan-Chiao Lu, Ph.D.; Chidiogo Anyigbo, M.D., M.P.H.; Panagiotis Kratimenos, M.D.; Sudeepta Basu, M.B.B.S., M.S.; Ashraf Harahsheh, M.D., F.A.C.C., F.A.A.P.; Rana F. Hamdy, M.D., M.P.H., M.S.C.E.; John Idso, M.D.; Michael Shoykhet, M.D., Ph.D.; Monika Goyal, M.D.; Ioannis Koutroulis, M.D., Ph.D., M.B.A.; Josepheen De Asis-Cruz, M.D., Ph.D.; Asad Bandealy, M.D., M.P.H.; Priti Bhansali, M.D.; Sabah Iqbal, M.D.; Kavita Parikh, M.D.; Shilpa Patel, M.D.; Cara Lichtenstein, M.D.

To view the PAS phase I mini session list and the various areas of expertise at Children’s National, visit: https://innovationdistrict.childrensnational.org/childrens-national-hospital-at-the-2021-pediatric-academic-societies-meeting/

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.

Joelle Simpson

Joelle Simpson, M.D., receives ‘Washington Woman of Excellence’ 2021 Award

Joelle Simpson

“I’m honored to have been recognized as one of the many women in our city who have worked tirelessly and made a difference during a year that was challenging for so many beyond measure,” Dr. Simpson said.  

Joelle Simpson, M.D., medical director of Emergency Preparedness at Children’s National Hospital, received the ‘Washington Woman of Excellence’ 2021 Award from the Mayor Bowser’s Office on Women’s Policy and Initiatives (MOWPI).

Every year, in partnership with the District of Columbia Commission for Women, MOWPI bestow these awards to honor District women who have shown dedication, impact and excellence in the areas of health and wellness, civic engagement and women’s empowerment.

“I’m honored to have been recognized as one of the many women in our city who have worked tirelessly and made a difference during a year that was challenging for so many beyond measure,” Dr. Simpson said.

Dr. Simpson was selected for the Sheroes of Health category.

The distinction of this award is shared with a broad cohort of women who work across all eight wards in Washington D.C. Dr. Simpson was recognized for various of her roles, including her leadership and significant accomplishments as medical director for Emergency Preparedness at Children’s National; her work as an Emergency Department physician leading the D.C. Pediatric Medical Reserves Corps; and for her expertise and leadership in impacting the outcomes for children and the community during COVID-19 health emergency.

The Mayor and members of the DC Commission for Women celebrated the annual Washington Women of Excellence Awards virtually.

patient meets with ED robot

New robot helps care for kids in the emergency room at Children’s National Hospital

patient meets with ED robot

The robot, which is part of the FCC-funded COVID-19 Telehealth Program at Children’s National, is the latest innovation of the program that has rapidly evolved due to the ongoing pandemic.

Children and families who come into the emergency room at Children’s National Hospital may be surprised when their doctor comes in – in the form of a robot. Children’s National introduced a new robot to its Emergency Department (ED) for patients under evaluation for a COVID infection or being treated for other conditions. The robot, which is part of the FCC-funded COVID-19 Telehealth Program at Children’s National, is the latest innovation of the program that has rapidly evolved due to the ongoing pandemic.

“The robot can move in and out of spaces that otherwise we couldn’t get a significant number of providers in, especially with COVID-19 restrictions in place,” said  Shireen Atabaki, M.D., M.P.H., associate medical director of Telemedicine, emergency medicine physician and program director for the COVID-19 Telehealth Program at Children’s National. “This is a really exciting program and it implements innovation that we might not have been able to do without the insights we’ve gained from the pandemic.”

The robot is Wi-Fi-enabled and can be remotely controlled by the physician providing the teleconsultation to monitor patient vitals — such as heart rate, body temperature or respiration rate. This allows doctors to work virtually with their team while also having the flexibility to attend to patients faster.

“The pandemic has made us aware of the need to protect patients, families and staff from infectious diseases,” said  Alejandro Jose Lopez-Magallon, M.D., medical director of Telemedicine at Children’s National. The robot, he noted, spares clinicians from having to change their PPE, which saves time and gives them the ability to move on to the next patient while nurses and staff continue to provide bedside care.

“We have also seen that whenever a remote clinician is completely alone in the command center and can get on-screen without a mask, in a paradoxical way our patients may be more accepting of seeing a face on a screen that’s not covered with a mask and shield than a stranger using a mask in the same room,” Dr. Lopez-Magallon added.

Soon, the robot will also be used to coordinate subspecialty care — such as cardiac care — in the ED. This will provide more streamlined and expedited care for patients. Instead of leaving with a referral to set up a follow-up appointment with a specialist, patients would be able to receive the consult they need during the same appointment.

The robot is also presenting promising solutions for concerns around the number of restricted visitors. The team at Children’s National recently piloted using an iPad and other technology purchased with the FCC funds to remotely connect family members with patients.

“We downloaded the Zoom app to iPads in our ED to be able to coordinate calls between family members who can’t come in and see patients,” said Dr. Atabaki. “We are looking to implement this as a permanent solution keeping in mind how burdensome and emotionally stressful it has been for many not having the ability to be by the loved one’s side during such a challenging time.”

The FCC funds also covered the telehealth carts, tablets and other connected devices, the telehealth platform, telehealth equipment and innovative AI (augmented intelligence) to treat seriously ill COVID-19 pediatric patients.

The emergency department robot brings the robot-fleet at Children’s National up to three. The first robot was debuted in 2019 to serve children and families in the Cardiac Intensive Care Unit.

Pediatrician talking with young girl

The current state of academic pediatric urgent care fellowships

Pediatrician talking with young girl

Formal training in academic pediatric urgent care is a relatively new concept, but it is one that is rapidly gaining popularity due to consumer demand for low-cost convenient care.

As of 2017, there were 7,639 urgent care centers in the United States, with 21% dedicated to the treatment of pediatric patients. This rapid growth of urgent care centers has resulted in an increased need for urgent care providers, and has led to the development of fellowships focused on efficient evidence-based urgent care management.

In an article published in the Journal of Pediatrics, Deena D. Berkowitz, M.D., M.P.H., medical director of Fast Track Services and co-director of the Children’s National Hospital Urgent Care Fellowship, and Haroon Shaukat, M.D., assistant program director of the Children’s National Hospital Urgent Care Fellowship, and their colleagues summarized the current state and future direction formal training in academic pediatric urgent care. The authors conclude that “systematic training in acute ambulatory pediatric care will advance high quality clinical care and research on patient care, scope, and outcomes in pediatric urgent care.”