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echocardiogram

AI may revolutionize rheumatic heart disease early diagnosis

echocardiogram

Researchers at Children’s National Hospital have created a new artificial intelligence (AI) algorithm that promises to be as successful at detecting early signs of rheumatic heart disease (RHD) in color Doppler echocardiography clips as expert clinicians.

Researchers at Children’s National Hospital have created a new artificial intelligence (AI) algorithm that promises to be as successful at detecting early signs of rheumatic heart disease (RHD) in color Doppler echocardiography clips as expert clinicians. Even better, this novel model diagnoses this deadly heart condition from echocardiography images of varying quality — including from low-resource settings — a huge challenge that has delayed efforts to automate RHD diagnosis for children in these areas.

Why it matters

Current estimates are that 40.5 million people worldwide live with rheumatic heart disease, and that it kills 306,000 people every year. Most of those affected are children, adolescents and young adults under age 25.

Though widely eradicated in nations such as the United States, rheumatic fever remains prevalent in developing countries, including those in sub-Saharan Africa. Recent studies have shown that, if detected soon enough, a regular dose of penicillin may slow the development and damage caused by RHD. But it has to be detected.

The hold-up in the field

Diagnosing RHD requires an ultrasound image of the heart, known as an echocardiogram. However, ultrasound in general is very variable as an imaging modality. It is full of texture and noise, making it one of the most challenging to interpret visually. Specialists undergo significant training to read them correctly. However, in areas where RHD is rampant, people who can successfully read these images are few and far between. Making matters worse, the devices used in these low resource settings have their own levels of varying quality, especially when compared to what is available in a well-resourced hospital elsewhere.

The research team hypothesized that a novel, automated deep learning-based method might detect successfully diagnose RHD, which would allow for more diagnoses in areas where specialists are limited. However, to date, machine learning has struggled the same way the human eye does with noisy ultrasound images.

Children’s National leads the way

Using approaches that led to successful objective digital biometric analysis software for non-invasive screening of genetic disease, researchers at the Sheikh Zayed Institute for Pediatric Surgical Innovation, including medical imaging scientist Pooneh Roshanitabrizi, Ph.D., and Marius Linguraru, D.Phil., M.A., M.Sc., principal investigator, partnered with clinicians from Children’s National Hospital, including Craig Sable, M.D., associate chief of Cardiology and director of Echocardiography, and cardiology fellow Kelsey Brown, M.D., who are heavily involved in efforts to research, improve treatments and ultimately eliminate the deadly impacts of RHD in children. The collaborators also included cardiac surgeons from the Uganda Heart Institute and cardiologists from Cincinnati Children’s Hospital Medical Center.

Dr. Linguraru’s team of AI and imaging scientists spent hours working with cardiologists, including Dr. Sable, to truly understand how they approach and assess RHD from echocardiograms. Building the tool based on that knowledge is why this tool stands apart from other efforts to use machine-learning for this purpose. Orienting the approach to the clinical steps of diagnosis is what led to the very first deep learning algorithm that diagnoses mild RHD with similar success to the specialists themselves. After the platform was built, 2,136 echocardiograms from 591 children treated at the Uganda Heart Institute fed the learning algorithm.

What’s next

The team will continue to collect data points based on clinical imaging data to refine and validate the tool. Ultimately, researchers will look for a way that the algorithm can work directly with ultrasound/echocardiogram machines. For example, the program might be run through an app that sits on top of an ultrasound device and works on the same platform to communicate directly with it, right in the clinic. By putting the two technologies together, care providers on the ground will be able to diagnose mild cases and prescribe prophylactic treatments like penicillin in one visit.

The first outcomes from the program were showcased in a presentation by Dr. Roshanitabrizi at one of the biggest and most prestigious medical imaging and AI computing meetings — the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI).

doctor measuring girl's height

Vosoritide shows promise for children with certain genetic growth disorders

doctor measuring girl's height

This is the first clinical trial in the world testing vosoritide in children with certain genetic causes of short stature, including hypochondroplasia, Noonan syndrome, NPR2 mutations and Aggrecan mutations.

Andrew Dauber, M.D., M.M.Sc., endocrinologist at Children’s National Hospital, presented preliminary results from a phase II clinical trial of a new drug, vosoritide, used to treat children with certain growth disorders, at the Pediatric Endocrine Society annual meeting held virtually on May 1.

Vosoritide is a C-type natriuretic peptide analog that binds its receptor on chondrocytes, leading to increased chondrocyte proliferation and differentiation via its inhibition of the ERK1/2-MAPK pathway.

This is the first clinical trial in the world testing vosoritide in children with certain genetic causes of short stature, including hypochondroplasia, Noonan syndrome, NPR2 mutations and Aggrecan mutations.

To date, 34 participants have enrolled in the trial with a median baseline height of -3.2 SD (interquartile range (IQR) -3.7, -2.6). 18 subjects have initiated on vosoritide and twelve have completed six months of therapy. The authors note that the mean increase in annualized growth velocity (AGV) was 1.8 cm/yr for subjects with hypochondroplasia and 6.1 cm/yr for subjects with Noonan syndrome or NPR2 mutations. The two subjects with NPR2 mutations had increased AGVs of 4.4 and 9.2 cm/yr, while the two subjects with Noonan syndrome had increased in AGVs of 7.5 and 3.3 cm/yr. One of the Noonan syndrome subjects was previously treated with growth hormone (GH) for 2 years and AGV was 6.7 cm/yr while on GH, 4.1 cm/yr during the trial 6-month observation period and 11.6 cm/year during the first six months of vosoritide treatment.

To the researchers, the safety profile is quite reassuring. So far, the preliminary results showed increased growth in all the genetic subgroups with the patients with hypochondroplasia demonstrating a response similar to that seen previously in patients with achondroplasia. While the results are very promising for patients with Noonan syndrome and NPR2 mutations, the clinical trial must be completed before drawing further conclusions. The experts also plan to submit the study to a peer-reviewed journal in the future to validate the findings.

The big picture

This is the first medication that directly targets the pathway in chondrocytes (cells in the growth plate that make the bones grow longer) affected by these specific mutations. This means that the novel approach may give patients additional therapeutic options outside of growth hormone.

Why we’re excited

“These are the first patients in the world to ever receive this medication for their conditions,” said Dr. Dauber. “The results are very promising and may change the way we practice medicine. Patients have come from all over the world to participate in the study.”

Children’s National leads the way

This clinical trial funded by BioMarin is the first of its kind to treat children with genetic short stature who do not have achondroplasia. Children’s National is the only site in the world offering this therapy for patients with these conditions.

Find out more about the trial here.

PAS Logo

Children’s National Hospital at the 2022 Pediatric Academic Societies Meeting

Are you attending the 2022 Pediatric Academic Societies meeting this week? There will be over 20 Children’s National Hospital-affiliated participants at this year’s meeting. We have compiled their sessions into a mini schedule below.

Name Department Role Topic Date Time
Kristen Sgambat, Ph.D., R.D. Center for Translational Research Speaker Fueling our patients for success: Optimizing nutritional support for kids with kidney disease 4/22/2022 2:30 PM
Priti Bhansali, M.D., M.Ed. Child Health Advocacy Institute Co-speaker APA Division Directors/Faculty Development Combined SIG 4/23/2022 8:00 AM
Karen Smith, M.D., M.Ed.
Neha Shah, M.D., M.P.H.
Workshop co-leaders Don’t Struggle In Solitude: Recovery and Peer Support after Unanticipated Outcomes, Errors, and Difficult Conversations 4/23/2022 8:00 AM
Ian Chua, M.D., M.H.P.E.
Gabrina Dixon, M.D., M.Ed.
Margarita Ramos, M.D., M.S.
Workshop co-leaders Finding the DEI in LGBTQIA: Incorporating LGBTQIA diversity in your environment 4/23/2022 8:00 AM
Kevin M. Cook, Ph.D. Co-presenter Early exposure to the extra-uterine environment in premature infants is associated with altered functional brain connectivity compared to in-utero age-matched fetuses 4/23/2022 8:15 AM
Gabrina Dixon, M.D., M.Ed.
Terry Kind, M.D., M.P.H.
Workshop co-leaders Changing the system: Best practices in supporting and advancing underrepresented in medicine (UIM) medical students 4/23/2022 10:00 AM
Yao Wu, Ph.D. Oral abstract presenter Impaired prenatal brain growth predicts adverse neurodevelopmental outcomes in infants with congenital heart disease 4/23/2022 10:00 AM
Lee S. Beers, M.D. General and Community Pediatrics Moderator Scholarship in the Domain of Child Health Advocacy: Making It Work in the Academic Medical Center 4/23/2022 10:00 AM
Chaya Merrill, Dr.P.H. Center for Translational Research Speaker Using data to advance advocacy in the academic medical center 4/23/2022 10:00 AM
Yuan-Chiao Lu, Ph.D. Oral abstract presenter Delayed Fetal Cortical Maturation Predicts 18-Month Neurodevelopment in Infants with Congenital Heart Disease 4/23/2022 10:15 AM
Olanrewaju O. Falusi, M.D., M.Ed. Child Health Advocacy Institute Speaker Generating currency for advancement and professional development in the domain of advocacy 4/23/2022 10:15 AM
Subechhya Pradhan, Ph.D. Oral abstract presenter Abnormal in-vivo brain biochemistry in fetuses with complex congenital heart disease 4/23/2022 10:30 AM
Lenore R. Jarvis, M.D., M.Ed. Emergency Medicine and Trauma Services Speaker Academic advocacy for the subspecialist 4/23/2022 10:30 AM
Jillian E. Nickerson, M.D., M.S. Emergency Medicine and Trauma Services Presenter Utilizing an Online Module Platform to Teach Newborn Delivery and Resuscitation Skills to Pediatric Emergency Medicine Providers 4/23/2022 10:30 AM
Lee S. Beers, M.D. General and Community Pediatrics Presenting Author Leadership in legislative advocacy at the national level 4/23/2022 11:00 AM
Kevin M. Cook, Ph.D. Oral abstract presenter Relative neighborhood disadvantage is associated with increased functional network segregation in fetal brains 4/23/2022 11:15 AM
Jung-Hoon Kim, Ph.D. Presenting Author Gestational age-related changes in the fetal functional connectome: in utero evidence for the global signal 4/23/2022 1:00 PM
Ioannis Koutroulis, M.D., Ph.D., M.B.A. Emergency Medicine and Trauma Services Oral abstract presenter Immunometabolism in septic encephalopathy: a novel therapeutic target 4/23/2022 1:00 PM
Terry Kind, M.D., M.P.H. General and Community Pediatrics Workshop co-leaders Making Meaning from the Data: Exploring Coding in Qualitative Research 4/23/2022 1:00 PM
Josepheen D. Cruz, M.D., Ph.D. Oral abstract presenter Cortical thickness changes in fetuses exposed to heightened maternal psychological distress 4/23/2022 1:30 PM
Monika Goyal, M.D., M.S.C.E. Emergency Medicine and Trauma Services Moderator Adolescent Medicine II 4/24/2022 8:00 AM
Binny Chokshi, M.D., M.Ed.
Yael Smiley, M.D.
Workshop co-leaders Applying The Collective Impact Model to Pediatric Health Interventions 4/24/2022 8:00 AM
Aisha Barber, M.D. M.Ed. Hospital Medicine Workshop co-leaders Demystifying DEI in Recruitment: Strategies for Creating a Diverse and Inclusive Residency and Fellow Training Environment 4/24/2022 8:00 AM
Panagiotis Kratimenos, M.D., Ph.D. Neonatology Oral abstract presenter Maternal Immune Activation and Hypoxia Induces Cerebellar Injury 4/24/2022 8:45 AM
Monika Goyal, M.D., M.S.C.E. Emergency Medicine and Trauma Services Co-moderator Emergency Medicine I 4/24/2022 10:00 AM
Priti Bhansali, M.D., M.Ed. Hospital Medicine Workshop co-leaders Making the Most of Peer Mentors within a Diverse Developmental Network: Supporting Scholarship and Academic Advancement 4/24/2022 10:00 AM
Ian Chua, M.D., M.H.P.E.
Gabrina Dixon, M.D., M.Ed.
Karen Smith, M.D., M.Ed.
Hospital Medicine

 

Workshop co-leaders The Art of Negotiation: Applying Negotiation Frameworks to Get More of What You Want in Your Academic Career 4/24/2022 10:00 AM
Matthew Magyar, M.D. Hospital Medicine Oral abstract presenter The association between social needs and unscheduled healthcare utilization among a nationally representative sample of children with asthma 4/24/2022 10:00 AM
Lena A. Saleh, M.D., M.P.H. Oral abstract presenter Machine Learning to Predict the Need for Intensive Care for Pediatric Asthma Exacerbation 4/24/2022 10:30 AM
Christina R. Rojas, M.D. Emergency Medicine and Trauma Services Oral abstract presenter Pediatric Emergency Department Undertriage for Patients with Limited English Proficiency 4/24/2022 10:30 AM
Ololade Okito, M.D. Neonatology Workshop co-leaders Best Practices in DEI Recruitment: Holistic Review and Addressing Systemic Bias 4/25/2022 8:00 AM
Jennifer H. Klein, M.D. Presenter Geography of pediatric health: Using geospatial analysis tools in pediatric care 4/25/2022 8:00 AM
Anand Gourishankar, M.B.B.S., M.R.C.P., M.A.S. Hospital Medicine Presenter Geospatial analysis in pediatric health: Principles, pitfalls, and practice 4/25/2022 8:00 AM
Sarah D. Schlatterer, M.D., Ph.D. Neurology Oral abstract presenter Autonomic Dysfunction and Hemodynamic Instability Precedes Cardiac Arrest in Infants with Congenital Heart Disease 4/25/2022 8:15 AM
Chaya Merrill, Dr.P.H. Presenter Mapping neighborhood-level inequities using the Childhood Opportunity Index 4/25/2022 8:20 AM
Jennifer H. Klein, M.D. Speaker Geospatial distribution of congenital heart disease 4/25/2022 8:40 AM
Ioannis Koutroulis, M.D., Ph.D., M.B.A. Emergency Medicine and Trauma Services Panelist APA Urgent Care SIG 4/25/2022 10:00 AM
Priti Bhansali, M.D., M.Ed. Hospital Medicine Workshop co-leaders From Mediocre to Masterly: Using Cognitive Interviewing to Improve the Validity of Your Survey 4/25/2022 10:00 AM
Beth A. Tarini, M.D., M.S. General and Community Pediatrics Speaker SPR Presidential Plenary: “Transforming the Culture of Pediatric Research: We Are the Problem and the Solution 4/25/2022 10:00 AM
Deena Berkowitz, M.D., M.P.H. Emergency Medicine and Trauma Services Speaker 2. UC fellowships and accreditation: the APA pipeline 4/25/2022 10:30 AM
John T. Kulesa, M.D. Hospital Medicine Oral abstract presenter A Descriptive Model for Prioritization and Resource Allocation in Academic Global Health Partnerships 4/25/2022 10:30 AM
Ariella Slovin, M.D. General and Community Pediatrics Speaker APA Well-being and Vitality SIG 4/25/2022 1:00 PM
Melissa Baiyewu, M.H.A., C.H.E.S.
Lin Chun-Seeley, M.A.
Desiree D. de la Torre, M.P.H., M.B.A.
Olanrewaju O. Falusi, M.D., M.Ed.
Chaya Merrill, Dr.P.H.
General and Community Pediatrics Workshop co-leaders Training Faculty Members to Model and Teach Health Equity: A New Faculty Development Curriculum 4/25/2022 1:00 PM
Ariella Slovin, M.D. General and Community Pediatrics Speaker Wellness and Vitality SIG: Overview of endeavors to date and status report on well-being of APA Members 4/25/2022 1:30 PM
Beth A. Tarini, M.D., M.S. General and Community Pediatrics Speaker Navigating Research Careers Through the Currents of Policy and Politics 4/25/2022 1:36 PM
Rebecca S. Lundberg, M.D. Oral abstract presenter Early parenteral nutrition support and preterm cerebellar metabolic maturation 4/25/2022 2:00 PM
Aisha Barber, M.D., M.Ed. Hospital Medicine Workshop co-leader Moving with the Tide: Taking Steps Toward Anti-Racism and Equity 4/233/22 1:00 PM

 

life sciences industry imagery

Grand Rounds analyzes the state of life sciences industry in Maryland

life sciences industry imagery

A recent Children’s National Grand Rounds panel analyzed the state of the life sciences industry in the region and the potential steps that can be taken to accelerate the manufacturing landscape.

The BioHealth Capital Region, consisting of Maryland, Virginia and Washington, D.C., has surged in recent years to become one of the nation’s strongest biopharma clusters. While the region does not lack opportunity to cultivate and grow innovation, manufacturing business related to scientific research and development in Maryland is lagging compared to other leading states.

That was the message from Martin Rosendale, CEO of the Maryland Tech Council, who was recently the featured speaker of the Children’s National Grand Rounds panel, which analyzed the state of the life sciences industry in the region and the potential steps that can be taken to accelerate the manufacturing landscape. The Maryland Tech Council is a not-for-profit collaborative community actively engaged in building strong life sciences and technology industries.

Moderated by Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer at Children’s National Hospital, the panel cited data recently compiled by the Milken Institute Center for Regional Economics that demonstrated the degree to which Maryland’s life sciences manufacturing industry needs to catch-up.

“On the manufacturing business front, we’ve actually been lagging compared to the rest of the country. Other metros have grown faster than we have over the last five years, but that presents an opportunity,” says Rosendale. “We have the opportunity to work more with academia and medical institutions like Children’s National to produce more companies, more intellectual property and more startups.”

According to the Milken data, when compared to other leading states including Massachusetts (2nd), California (3rd), New York (8th), Florida (9th) and Texas (12th), Maryland ranked as the 20th state for life sciences manufacturing growth over a five-year period. Of the growth that occurred over that time, the greatest came in the Washington-Arlington-Alexandria and Baltimore-Columbia-Towson metros, where industry wages tend to be higher.

Kolaleh-Eskandanian

Kolaleh Eskandanian, vice president and chief innovation officer at Children’s National Hospital, recently moderated the Children’s National Grand Rounds panel, which analyzed the state of the life sciences industry in the BioHealth Capital Region.

Highlighting the region’s status as a rich biopharma cluster, and the fact that the innovation sector is growing up in and around Washington, D.C., Rosendale identified the key to help bolster life sciences manufacturing in the region – sustaining life sciences business spending in Maryland. Evidence has demonstrated that incentives are a core component of supporting business research and development, and sustained spending has helped support high-tech business formation and high-wage job creation. It has also generated job creation in occupations that require fewer credentials, such as non-tech-intensive industries.

Growth in these areas can be bolstered by Maryland’s existing life sciences landscape, which ranks as one of the strongest and most robust in the nation. It contributes more than 54,000 high paying jobs in the state with over 2,700 life science firms and more than 500 biotech firms, according to a recent Milken Institute report.

“The District of Columbia has a robust pipeline of up-and-coming talent to further develop the life sciences industry in the region. The potential this expertise offers is a key focus of the new Children’s National Research & Innovation Campus, to drives discoveries that save and improve the lives of children,” says Eskandanian. “Children’s National has combined our strengths with those of public and private partners, including industry, universities, federal agencies, start-up companies and academic medical centers, to provide a rich environment to help bolster pediatric innovation and commercialization to further advance the life sciences industry.”

Data from Genetic Engineering & Biotechnology News (GEN) continues to show that Maryland and the greater BioHealth Capital Region remains one of the country’s premier hubs for innovation companies. The rankings are based on five criteria including NIH funding, VC funding, patents, lab space and jobs. In 2021, the BioHealth Capital Region held its top-four ranking and is expected to rise to a top-three cluster by 2023. The current top-three clusters ranked in the United States are Boston/Cambridge, MA (1st), the San Francisco Bay Area (2nd) and New York/New Jersey (3rd).

human heart

Heart anatomy determines outcomes of valve repair for single ventricle hearts after Fontan procedure

human heart

The data shows that the valve repair surgery itself doesn’t increase the likelihood of heart transplant or death. Instead, it is only those with right ventricle dominant heart function who are significantly more likely to have such a negative outcome.

A new study in the Journal of the American College of Cardiology finds the anatomy of the heart is a key predictor of how efforts to repair atrioventricular valve regurgitation — or a leaky heart valve — will impact children with single ventricle heart defects who have undergone a Fontan surgical procedure.

The study uses retrospective data from the largest database of patients who have had the Fontan procedure, the Australia and New Zealand Fontan Registry. The data shows that the valve repair surgery itself doesn’t increase the likelihood of heart transplant or death. Instead, it is only those with right ventricle dominant heart function who are significantly more likely to have such a negative outcome.

It was conducted by cardiac surgeons at Royal Children’s Hospital, including Yves d’Udekem, M.D., Ph.D., who is now chief of cardiac surgery at Children’s National Hospital. Dr. d’Udekem presented the findings at the recent American College of Cardiology Scientific Sessions in Washington, D.C.

What this means

Until now, it was unclear why patients who had undergone a Fontan heart procedure were more likely to need a heart transplant or die after they also underwent surgery to repair atrioventricular valve regurgitation. This type of leaking valve is common in patients who have undergone a Fontan procedure, and it can also be dangerous if left untreated. But because existing data showed poor outcomes following atrioventricular valve repair, it was considered high risk to perform this repair on children with Fontan circulation.

However, this study drilled down into the outcomes of atrioventricular valve repair for these patients and found that it isn’t the surgery that leads to a poor outcome. Instead, it’s a specific anatomic feature — having a dominant right ventricle — that is predictive of the outcome.

Up to now, it was unclear whether surgery should be offered to all patients with a Fontan circulation who had leaky atrioventricular valves. This study shows that things are different for patients with dominant left or dominant right ventricle. For patients with dominant right ventricle, leaving this regurgitation not repaired is much more likely to lead to death and transplantation, and these patients should be operated at the earlier stages of the deficiency of their valves.

The hold-up in the field

One of the biggest challenges to identifying evidence-based best practices for children born with single ventricle heart defects, which are critical congenital heart defects, is the small number of patients at any one institution each year. The Australia and New Zealand Fontan Registry, founded by Dr. d’Udekem and the team at Royal Children’s Hospital, forms one of the world’s longest standing databases of patient information, including outcomes, for this population.

The patient benefit

This data can help doctors and families make the best care decisions possible for children with single ventricle defects by understanding how each child’s unique anatomy may impact how their heart will respond to treatment.

What’s next

Dr. d’Udekem hopes results from this study will improve how doctors strategize and recommend (or not) surgical repair of atrioventricular valve regurgitation. Additionally, the study shows the value of centralized patient registries and data for informing the standard of care. Similar registries across the world may promise to provide even greater insight into the long-term outcomes for patients born with these congenital heart conditions.

Handrawn illustration of human Kidneys

Children’s National Nephrology team presents virtually at IPTA’s 11th Congress

Handrawn illustration of human KidneysThe International Pediatric Transplant Association (IPTA) is hosting their 11th Congress meeting March 26-29, 2022, and many Children’s National Hospital providers will be presenting throughout the conference. We hope you will join us!

Diversity, inequity and inclusivity in the practice of pediatric transplantation in the U.S.

Presenter: Marva Moxey-Mims, M.D., division chief, Nephrology

Dr. Moxey-Mims will review the trends in pediatric kidney transplantation over the past decade, focusing on differences by race and ethnicity, whether the gaps have narrowed over that time and steps that can be taken to increase equity.

Prevalence of mycophenolate mofetil discontinuation and subsequent outcomes in pediatric kidney transplant recipients: A PNRC study

Presenter: Asha Moudgil, M.D., medical director, Kidney Transplant

Mycophenolate mofetil (MMF) is a common maintenance immunosuppressant in children receiving kidney transplants but is often discontinued for various reasons. In this multi-center Pediatric Nephrology Research Consortium study, researchers sought to determine the prevalence and reasons for MMF discontinuation and its association with patient and allograft outcomes. They will be discussing their methodology and results from this study.

Additional Children’s National staff involved in the study include:

Changes in diastolic function and cardiac geometry after pediatric kidney transplantation: A longitudinal study

Presenter: Kristen Sgambat, Ph.D., clinical assistant professor

Children with end stage kidney disease are at high risk for cardiovascular morbidities. Indicators of systolic function, such as ejection fraction and fractional shortening, are often preserved and may not reveal cardiac dysfunction until it is severe. Longitudinal changes in diastolic function and cardiac geometry have not been well studied.

Additional Children’s National staff involved in the study include:

COVID19 in pediatric kidney transplant recipients: Incidence, outcomes, and response to vaccine

Presenter: Asha Moudgil, M.D., medical director, Kidney Transplant

At the start of the pandemic, no information was available on the outcomes of pediatric kidney transplant recipients with COVID-19. When the COVID-19 vaccine became available, response of immunosuppressed children to the vaccine was not known. While more information has become available in adult transplant recipients, information on pediatric transplant recipients remains limited.

The team will discuss their methodology of collecting information and their results and conclusions.

Additional Children’s National staff involved in the study include:

Poster presentation: Psychological functioning and adaptive behavior in pediatric patients awaiting renal transplantation.

Presenter: Kaushal Amatya, Ph.D., psychologist

Psychosocial functioning of children with chronic kidney disease (CKD) at pretransplant evaluation is associated with transplant readiness and post-transplant outcomes. Higher prevalence of emotional/behavioral issues is noted in children with CKD compared to healthy counterparts. Although issues with functional impairment is often reported, research on adaptive functioning using a validated measure is lacking. The study aimed to explore psychological and adaptive functioning in pediatric pre-transplant patients to identify areas in need of intervention.

Additional Children’s National staff involved in the study include:

  • Asha Moudgil, M.D., medical director, Kidney Transplant
  • Paige Johnson, Psychology resident

 

Charles Berul

Charles Berul, M.D., receives Meritorious Achievement Award

Charles Berul

Charles Berul, M.D., chief of Cardiology at Children’s National Hospital has earned a lifetime achievement award, the 2021 Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts) Meritorious Achievement Award.

The Meritorious Achievement Award recognizes a person whose achievements have made a significant impact in the field of congenital heart disease and heart health in the young and have helped to further the mission of the Young Hearts council. The council’s mission is to improve the health of children and adults with congenital heart disease and acquired heart disease during childhood through research, education, prevention and advocacy.

Dr. Berul received this award in recognition of his lifelong achievements in the field of pediatric electrophysiology. He is known for his development of innovative electrophysiologic studies for phenotypic evaluations of genetically manipulated pre-clinical models. Over the past two decades, his research focus and passion have been to develop novel minimally invasive approaches to the heart and improving methods for pediatric pacing and defibrillation.

He has also mentored dozens of trainees who have gone on to successful careers and particularly advocates for young investigators and clinician-scientists. He is known for his collaborative style and for supporting advancement of faculty physicians in academic medicine.

Dr. Berul has served on multiple society committees, task forces and writing groups, and is currently an associate editor for the Heart Rhythm Society’s journal. He is also actively involved in other key organizations such as Mended Little Hearts and the Pediatric and Congenital Electrophysiology Society (PACES). He has more than 300 publications and is an invited speaker nationally and internationally in the areas of pediatric cardiac electrophysiology and miniaturized device development.

Dr. Berul received the award on November 12 during a virtual presentation at the American Heart Association’s Scientific Sessions. He is the fourth Children’s National cardiologist to be recognized with this prestigious honor from the council in the last decade.

Kolaleh Eskandanian

Health IT Panel Focuses on Leveling the Playing Field for Women in Healthcare Leadership

Kolaleh-Eskandanian

Kolaleh Eskandanian, PhD, MBA, PMP, vice president and chief innovation officer at Children’s National Hospital, spoke on gender gaps in healthcare leadership during the 6th annual Health IT + Revenue Cycle Conference hosted by Becker’s Healthcare.

Although women account for nearly half of entry-level jobs in the healthcare industry, female clinician-scientist executives continue to be sparse among healthcare leadership ranks. Less than a third of C-suite roles – approximately 26 percent – are filled by women and tend to focus on human resources or marketing, according to a recent analysis by Becker’s Hospital Review.

Addressing and bridging this gender gap in healthcare leadership was the focus of the recent panel, “Leveling the Playing Field for Women in Healthcare at Macro and Micro Levels,” as part of the 6th annual Health IT + Revenue Cycle Conference hosted by Becker’s Healthcare. Moderated by Alya Ellison of Becker’s Hospital Review, the panel examined the different ways that leading healthcare institutions are working to improve mentorship and leadership opportunities for women to create a more equitable path to the C-suite.

Among those participating in the discussion was Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer at Children’s National Hospital, who noted that some organizations may require one or two cycles of leadership change for more female clinician-scientist executives to reach the C-Suite. Even so, Eskandanian emphasized that the desire and strategy to bridge this gap should be imprinted in the DNA of every major healthcare organization.

“Hopefully, many organizations started thinking about diversity and inclusion years ago. At Children’s National Hospital, this is deeply engrained within our culture and is something that we consciously focus on,” Eskandanian says. “In addition to focusing on inclusion at the leadership level, we also work diligently with medical school graduates in our residency program to ensure that both the micro and macro levels of balance are in place.”

Eskandanian adds that Children’s National Hospital also has developed and implemented a program for physicians and scientists known as W@TCH (Women @ Children’s Hospital) to help address the specific needs of women in academic medicine. Led by Naomi Luban, M.D., vice chair of Faculty Affairs and medical director for the Office for the Protection of Human Subjects, the program began as a series of informal lectures designed to address the challenges faced by women in medicine and academia and, with the help of junior faculty, has expanded to include a yearly “brown bag” seminar series with a formal W@TCH-related Grand Rounds that includes a half-day Career Development Workshop and a growing organizing committee of junior faculty.

Senior W@TCH members, many of whom are division chiefs at Children’s National Hospital, also oversee the selection of faculty members to attend different Association of American Medical Colleges (AAMC) programs including Women in Medicine and Science (GWIMS) Professional Development Seminars for early and mid-level faculty and minorities.

“This incredible program started organically at the hospital and has proven highly successful, so we hope that many organizations can follow the same organic process, which truly demonstrates the kind of leadership we need in order to be problem-solving organizations that lead to positive outcomes,” Eskandanian says.

Eskandanian and fellow panelists Tracy Donegan of MLK Community Health and Amy Schroeder of Lexington Regional Health agreed that, as there are still inequities in healthcare leadership roles, it is up to organizations to acknowledge disparities in order to start a dialogue that creates a more inclusive culture focused on manageable strategic goals that make awareness actionable.

screenshot of conversation between Dr. Beers and Simone Biles

Dr. Lee Beers speaks with Olympic gold medalist Simone Biles about mental health

Lee Savio Beers, M.D., F.A.A.P., medical director of Community Health and Advocacy at the Child Health Advocacy Institute (CHAI) at Children’s National Hospital and president of the American Academy of Pediatrics (AAP), delivered the President’s Address to AAP members around the world and held a keynote conversation with Olympic gold medalist Simone Biles about mental health during AAP’s National Conference and Exhibition.

After being introduced by her children, Charlotte and Jonah, Dr. Beers thanked AAP members around the world for their ability to adapt and provide quality care to patients throughout the COVID-19 pandemic. “The COVID-19 pandemic has changed our collective calculus of uncertainty, yet you continue to adapt and adjust to provide quality care in your clinics, emergency departments, ICU’s and exam rooms,” said Dr. Beers.

Dr. Beers continued by reflecting on accomplishments that AAP members and volunteers were able to achieve over the last year including the establishment of community immunization efforts, interim guidance provided on numerous pandemic-related issues and bi-weekly COVID-19 townhalls and educational sessions.

Shortly after her address, Dr. Beers sat down with Simone Biles to discuss the importance of advocating for mental health as an athlete.

During their conversation, Biles discussed the importance of making her mental health a priority by withdrawing from several events during the 2020 Tokyo Olympics. She reflected on the outpouring support she received and how it made her feel.

Biles also offered advice for youth dealing with mental health issues and stressed the importance of reaching out to parents or peers so they can get the help and support they need.

AAP’s National Conference and Exhibition, held from October 8 through October 11, serves as an opportunity to keep pediatric providers abreast of the latest best practices in pediatrics and strives to meet participants’ identified educational needs and support their life-long learning with a goal of improving care for children and families.

Speaker and presentation information can be found here.

screenshot of conversation between Dr. Beers and Simone Biles

Simone Biles discussed the importance of making mental health a priority with Dr. Lee Savio Beers.

Drs. Wernovsky and Martin

Cardiac care leaders recognized for mentorship and innovation at AAP

Two Children’s National Hospital cardiac care leaders received prestigious recognition awards from the American Academy of Pediatrics (AAP) during that organization’s virtual National Conference and Exhibition in October 2021.

  • Gil Wernovsky, M.D., cardiac critical care specialist at Children’s National Hospital, received the 2021 Maria Serratto Master Educator Award from AAP Section on Pediatric Cardiology and Cardiac Surgery, celebrating his 30-plus-years as a clinician, educator, mentor and leader in the field.
  • Gerard Martin, M.D., FAAP, FACC, FAHA, C. Richard Beyda Professor of Cardiology, Children’s National Hospital, received the AAP Section on Advances in Therapeutics and Technology (SOATT) Achievement Award, in recognition of his work to establish the use of pulse oximetry to screen newborn infants for critical congenital heart disease in the first 24 hours of life.

Dr. Wernovsky: 2021 Maria Serratto Master Educator Award, AAP Section on Pediatric Cardiology and Cardiac Surgery

Gil Wernovsky

Gil Wernovsky, M.D., received the 2021 Maria Serratto Master Educator Award from AAP Section on Pediatric Cardiology and Cardiac Surgery.

The Master Educator Award is presented each year to a pediatric cardiologist or cardiothoracic surgeon who exemplifies excellence as an educator, mentor and/or leader in the field.

A practicing cardiac critical care specialist with more than 30 years’ experience in pediatric cardiology, Dr. Wernovsky trained and mentored more than 300 fellows in pediatric cardiology, cardiac surgery, neonatology, critical care medicine and cardiac anesthesia, in addition to countless residents and fellows. He also organizes national and international symposia to share expertise around the world. During the COVID-19 public health emergency, for example, he co-founded the Congenital Heart Academy (CHA). The CHA provides content from an international faculty of cardiac care to more than 26,000 practitioners in 112 countries and includes a thriving YouTube channel.

Dr. Wernovsky is also a founding member of several international societies focused on bringing together clinicians, researchers and students across sub-specialties of pediatric cardiology and cardiac surgery for knowledge exchange and best practice sharing. These include: the Pediatric Cardiac Intensive Care Society, World Society for Pediatric and Congenital Heart Surgery, the International Society of Pediatric Mechanical Circulatory Support and the Cardiac Neurodevelopmental Outcome Collaborative.

Dr. Wernovsky received the award on October 10 at the virtual Scientific Sessions of the 2021 American Academy of Pediatrics National Conference and Exhibition.

Dr. Martin: AAP Section on Advances in Therapeutics and Technology (SOATT) Achievement Award

Gerard Martin

Gerard Martin, M.D., FAAP, FACC, FAHA, C. Richard Beyda Professor of Cardiology, Children’s National Hospital, received the AAP Section on Advances in Therapeutics and Technology (SOATT) Achievement Award.

The Section on Advances in Therapeutics and Technology (SOATT) educates physicians, stimulates research and development and consults on therapeutics and technology-related matters for the AAP. The Achievement Award recognizes someone who has shown leadership in applying innovative approaches to solve pressing problems.

Dr. Martin is the C. Richard Beyda Professor of Cardiology and has cared for children at Children’s National for more than 30 years. As an advocate for congenital heart disease efforts nationally and internationally, he played an integral role in the development of an innovative use of existing hospital technology—the pulse oximeter—to detect critical congenital heart disease in newborn babies.

Today, Dr. Martin and colleagues across the United States and around the world have worked to make this screening method a standard of care for newborns everywhere. It is a part of the Health Resources and Services Administration (HRSA) Recommended Uniform Screening Panel and has become law in every state. They continue to conduct research to refine the recommendations and hone-in on the most effective ways to harness these tools.

Dr. Martin was selected for this award in 2020. He accepted it and offered remarks during the 2021 virtual AAP National Conference and Exhibition on Monday, October 11, 2021.

Charles Berul receives award

Charles Berul, M.D., named Pioneer in Cardiac Pacing and Electrophysiology by Heart Rhythm Society

Charles Berul receives award

Dr. Berul receives the Pioneer in Cardiac Pacing and Electrophysiology from the Heart Rhythm Society at their 2021 meeting.

The Heart Rhythm Society has awarded its 2021 Pioneer in Cardiac Pacing and Electrophysiology Award to Charles Berul, M.D., chief of Cardiology and co-director of the Children’s National Heart Institute at Children’s National Hospital.

The award recognizes an individual who has been active in cardiac pacing and/or cardiac electrophysiology for many years and has made significant contributions to the field. It is typically given to electrophysiologists who treat adults. Dr. Berul is the second pediatric specialist to receive it. Dr. Berul accepted his award at Heart Rhythm 2021, the society’s annual meeting.

“It is wonderful news that Dr. Berul is receiving this award in recognition of his major contributions to this field and to improve the lives of children with heart rhythm challenges,” says David Wessel, M.D., executive vice president, chief medical officer and physician-in-chief at Children’s National Hospital. “We are proud of all he has achieved so far, and are so thankful that he shares his expertise, leadership, mentorship and friendship with us at Children’s National every day. Congratulations to him on this tremendous honor.”

The Heart Rhythm Society notes that Dr. Berul has mentored dozens of trainees who have gone on to successful careers and particularly advocates for young investigators and clinician-scientists. He is known for his collaborative style and promotion of faculty physicians in academic medicine. His scientific work began with cellular electrophysiology and clinical genetics of inherited arrhythmia disorders.

He is known for his development of innovative electrophysiologic studies for phenotypic evaluations of genetically manipulated pre-clinical models. Over the past two decades, his research focus and passion have been to develop novel minimally invasive approaches to the heart and improving methods for pediatric pacing and defibrillation.

Dr. Berul is an active member of the Heart Rhythm Society. He has served on multiple society committees, task forces, and writing groups, and is currently an associate editor for the society’s journal, Heart Rhythm. He is also actively involved in other key organizations such as Mended Little Hearts and the Pediatric and Congenital Electrophysiology Society (PACES).

He has more than 300 publications and is an invited speaker nationally and internationally in the areas of pediatric cardiac electrophysiology and miniaturized device development.

pediatric cardiac and vascular MRI coil

Overcoming real and perceived barriers to pediatric device innovation

pediatric cardiac and vascular MRI coil

A working group of innovators, engineers and clinicians from Children’s National Hospital and other institutions came together to address the real and perceived barriers to the creation of pediatric devices, such as this pediatric cardiac and vascular MRI coil developed by Inkspace Imaging.

A working group of innovators, engineers and clinicians from Children’s National Hospital, Children’s Hospital of Orange County and other institutions came together to address the real and perceived barriers to pediatric device innovation through opportunities that may change the return-on-investment in this market and improve health outcomes.

The new report, published in the Journal of Translational Engineering in Health and Medicine, mentions barriers that impede the advancement of pediatric devices, including excessive limitations for testing and validation, lack of incentives, inadequate research models and inconsistent pediatric-related knowledge among companies, regulatory experts, ethic review panels and government reviewers.

To remove the real and perceived barriers fostering excessive limitations, the researchers suggest reducing the perceived risk by establishing guidelines that standardize the review process and ethical research models, incentivizing small companies to participate in pediatric device innovation.

To increase incentives, the researchers call for the development of pediatric versions of adult devices with or without enforcement of regulations, develop incentives for small, medium and large-size companies, extend patent protection and more.

Since science corroborates the device’s effectiveness and safety, tailored pediatric research models are needed to help advance pediatric device innovation. While randomized trials in well-defined cohorts are commonly used in the scientific quest, they do not reflect the clinical practice in the pediatric devices field.

“Overcoming this barrier will require greater opportunity for creativity in the design of clinical trials, including delayed entry, intent-to-treat analysis, personalized outcome measures, and post-hoc subgroup analysis,” said Terence et al. “Effective research for pediatric device innovation will require greater ability to rely on ‘real-world’ data from post-market use of the proposed device or similar devices.”

On the education side, stakeholders, such as device sponsors and researchers, must receive an improved education on pediatric devices, according to the authors. Pediatricians should also be added to the regulatory review panels and advisory boards, so decision-makers can receive the pediatric perspective and fold it into their considerations.

“The consensus outcome of this meeting is that there are multiple opportunities, and a flexible combination of new programs and regulatory changes can be created to benefit the multiple stakeholders in pediatric device development,” said Terence et al. “An essential component will be building a cadre of experts with the development, regulatory, and clinical expertise to support all innovators.”

Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer at Children’s National Hospital adds that supporting and expanding pediatric innovation is a key focus of the new Children’s National Research & Innovation Campus, the first-of-its-kind focused on pediatric health care innovation, with the first phase currently open on the former Walter Reed Army Medical Center campus in Washington, D.C. With its proximity to federal research institutions and agencies, universities, academic research centers, the campus provides a rich ecosystem of public and private partners which will help bolster pediatric innovation and commercialization.

Authors from Children’s Hospital Orange County include Terence Sanger, M.D., Nadine Afari, M.S., Anthony Chang, M.D., William Feaster, M.D., Sharief Taraman, M.D., Debra Beauregard, Brent Dethlefs, Tiffani Ghere, R.D., C.S.P., Mustafa Kabeer, M.D., and George Tolomiczenko.

Screenshot of Drs. Northam, Newman and Batshaw

4th Annual Children’s National Hospital-NIAID Virtual Symposium

Screenshot of Drs. Northam, Newman and Batshaw

Keynote speaker Virginia Governor and pediatric neurologist, Ralph Northam, joined Dr. Kurt Newman, president and CEO of Children’s National Hospital, and Dr. Mark Batshaw, executive vice president, physician-in-chief and chief academic officer at Children’s National Hospital, during the 4th Annual Children’s National Hospital-NIAID Virtual Symposium.

Children’s National Hospital and the National Institute of Allergy and Infectious Diseases (NIAID) hosted their 4th annual symposium, attracting nationwide researchers, trainees and health care professionals to share updates on the COVID-19-related condition known as Multisystem Inflammatory Syndrome (MIS-C) in Children, allergy and immunology in the pediatric population.

“Children’s National relationship with the NIAID is a strategic and novel alliance that benefits children everywhere,” said Kurt Newman, M.D., President and CEO of Children’s National Hospital. “I’m so proud of our unique partnership and how it has enriched the high-quality research being conducted at Children’s National and enabled us to interact on pressing health issues. With the opening of our new Children’s National Research & Innovation Campus on the grounds of the former Walter Reed Army Medical Center, the sky is the limit to how we can work together with the NIAID to innovate for kids so that we help them grow up stronger.”

The discussions at the symposium centered around various topics, including clinical manifestations of SARS-CoV-2 in children, comparative disease biology manifestation in children and adults, therapies and vaccines in the pediatric setting, intersectionality of allergy, immunology and COVID-19, modulating biologic factors in immune regulation and treatments that invoke tolerance in allergy.

Keynote speaker Virginia Governor and pediatric neurologist, Ralph Northam, spoke about the COVID-19 pandemic and strategies to reintroduce children into schools and sports.

“Schools provide stability and structure. We know that children need to be in school for educational achievements and their mental health, but it has taken time to make school staff and families more comfortable with a greater time of in-person learning,” said Dr. Northam. “Our goal is to have all in-person learning this fall. That is where our children need to be because it is the safest place for children.”

During the keynote session, Dr. Northam also addressed the mental health issues related to the pandemic where pediatricians have seen an increase in depression and suicide rates.

“As we move forward to a back more normal life, we need to keep an eye on these children and make sure that they continue to get the support and treatment that they need,” said Dr. Northam.

Below are the speakers and the focus of their presentations.

  • Post-COVID cardiac manifestations in children: Anita Krishnan, M.D., Children’s National
  • Immunomodulation and Cytokine Profiling in MIS-C: Hemalatha Srinivasalu, M.D., Children’s National
  • The MUSIC study: Long-TerM OUtcomes After the Multisystem Inflammatory Syndrome in Children: Jane Newburger, M.D., Boston Children’s Hospital
  • MIS-C in Typical Cases and Down Syndrome: Dusan Bogunovic, M.D., Mount Sinai
  • Age-Related Virus-Specific T-Cell Responses to SARS-CoV-2: Susan Conway, M.D., Children’s National
  • Systems Immunology of COVID-19: Integrating Patient and Single Cell Variations: John Tsang, Ph.D., NIAID
  • Therapeutics for Children with COVID-19: Trying to be Data Driven in the Absence of Pediatric Trials: Andy Pavia, M.D., University of Utah
  • SARS-CoV-2 Vaccine Clinical Research: Alicia Widge, M.D., NIAID
  • Implementation and Public Health Aspects: Cara Biddle, M.D., M.P.H., Children’s National
  • COVID-19 and Pediatric Asthma: William Sheehan, M.D., Children’s National
  • The COVID-19 Pandemic and Immunodeficiency: The Burden and Emerging Evidence: Jessica Durkee-Shock, M.D., NIAID
  • SARS-CoV-2 Infection in Children with Cancer: The MSK Experience: Andy Kung, M.D., Memorial Sloan Kettering
  • Adaptive and Maladaptive Immunity to the Microbiota: Implication for Inflammatory Disorders: Yasmine Belkaid, M.D., NIAID
  • Deep Immune Profiling of Peanut Reactive CD4+ T-Cells Reveals Distinct Immunotypes Link to Clinical Outcome: Erik Wambre, M.D., Benaroya Research Institute
  • B Cells and Food Allergy: Not Just for Making IgE: Adora Lin, M.D., Ph.D., Children’s National
  • Emerging Biologic Therapies for Food Allergy: Hemant Sharma, M.D., Children’s National
  • The Promise and Limits of Allergen Immunotherapy: Carla Davis, M.D., Texas Children’s
  • Maternal Fetal Interactions in Food Tolerance: Michiko Oyoshi, M.D., Harvard Medical School

The Clinical and Translational Science Institute at Children’s National (CTSI-CN) and the NIAID organized the 4th annual symposium and wished to showcase some of the critical research being done on this worldwide infectious disease, particularly amongst the pediatric population and those affected with allergic and immunologic disease. By sharing this work, they hope it will help continue to drive the advancement of pediatric research in relation to this disease.

The research partnership between Children’s National and the National Institute of Allergy and Infectious Diseases (NIAID) is devoted to protecting and advancing the health of children with allergic, immunologic, autoinflammatory and infectious diseases through collaborative research and education. The partnership co-hosts an annual symposium to disseminate new information about science related to the partnership.

To view all the presentations from the symposium, click here.

For questions about the symposium or projects there, contact: CN-NIAIDPartnership@childrensnational.org.

NIAID Symposium banner

PAS Logo

Children’s National Hospital at the 2021 Pediatric Academic Societies Meeting

Attending the 2021 Pediatric Academic Societies meeting this week? There will be over 20 Children’s National Hospital-affiliated participants at this year’s meeting. We have compiled their sessions into a mini schedule:

Name Program/Department Session and role Date Time
Taeun Chang, M.D.  Neonatal Neurology and Neurocritical Care Program PAS Postgraduate Course: Neonatal Neurology: HIE-focused Project-Based (Chair) Friday, 30 April

 

9:00 AM –
4:00 PM
CT
Taeun Chang, M.D. Neonatal Neurology and Neurocritical Care Program PAS Postgraduate Course: Neonatal Neurology: HIE-focused Project-Based (Presenter) Friday, 30 April 9:30 AM – 10:00 AM
CT
Yuan-Chiao Lu, Ph.D. Developing Brain Research Laboratory Cardiology Poster: Care of the Fetus and Newborn with CHD (Presenter) Saturday, May 1 4:30 PM – 4:45 PM
CT
Chidiogo Anyigbo, M.D., M.P.H. General and Community Pediatrics Poster: Health Services Research I (Presenter)

 

Saturday, May 1 5:15 PM – 5:30 PM
CT
Panagiotis Kratimenos, M.D. Neonatology Platform (moderator) Saturday, May 1 4:30 PM – 6:00 PM
CT
Sudeepta Basu, MBBS, MS Neonatology Hot Topic Symposia: The Neurological Implications of Abnormal Glycemia in Neonatal Encephalopathy and Prematurity (Chair) Sunday, May 2 9:00 AM – 12:00 PM
CT
Sudeepta Basu, MBBS, MS Neonatology Hot Topic Symposia: The Neurological Implications of Abnormal Glycemia in Neonatal Encephalopathy and Prematurity (Presenter) Sunday, May 2 9:55 AM – 10:15 AM
CT
Ashraf Harahsheh, M.D., F.A.C.C., F.A.A.P.

 

Cardiology Cardiology: Heart Disease in the Older Child Sunday, May 2 10:00 AM – 12:00 PM
CT
Rana F. Hamdy, M.D., MPH, MSCE Infectious Diseases

 

Expanding Outpatient Antibiotic Stewardship: Practical Strategies, Novel Settings, and Sociobehavioral Influences (Presenter) Sunday, May 2 10:15 AM – 10:30 AM
CT
Rana F. Hamdy, M.D., MPH, MSCE Infectious Diseases

 

Hot Topic Debates: Antibiotic Use in Hospitalized Children (Chair) Sunday, May 2 1:00 PM – 3:00 PM
CT
John Idso, M.D. Critical Care Poster: Resuscitation and Potpourri (presenter) Sunday, May 2 2:20 PM – 2:30 PM
CT
Michael Shoykhet, M.D., Ph.D. Critical Care Medicine

 

Critical Care Poster: Resuscitation and Potpourri (presenter) Sunday, May 2 2:20 PM – 2:30 PM
CT
Panagiotis Kratimenos, M.D. Neonatology Neonatal Neurology: Basic & Translational I (moderator) Sunday, May 2

 

4:30 PM – 6:00 PM
CT
Monika Goyal, M.D. Emergency Medicine and Trauma Services Injury Prevention (moderator) Sunday, May 2 10:00 AM – 12:00 PM
CT
Ioannis Koutroulis, M.D., Ph.D., M.B.A. Genetic Medicine Research

 

Emergency Medicine III (moderator) Tuesday, May 4 2:00 PM – 4:00 PM
CT
Sudeepta Basu, MBBS, MS Neonatology Neonatal Neurology: Clinical: HIE and Other Insults (moderator) Tuesday, May 4 4:30 PM – 6:00 PM
CT
Josepheen De Asis-Cruz, M.D., Ph.D. Center for the Developing Brain Neonatal Neurology: Clinical: HIE and Other Insults (presenter) Tuesday, May 4 4:30 PM – 4:45 PM
CT
Asad Bandealy, M.D., MPH
Priti Bhansali, M.D. Monika Goyal, M.D.
Sabah Iqbal, M.D. Kavita Parikh, M.D. Shilpa Patel, M.D.
Workshop. ThisIsSTILLOurLane: Protect Kids, Not Guns Monday, May 10 9:00 AM – 11:00 AM
CT
Cara Lichtenstein, M.D. General and Community Pediatrics APA Injury Control/Advocacy Training Combined SIG (SIG Chair) Monday, May 10 1:00 PM – 3:00 PM
CT
Terry Kind, M.D., MPH General and Community Pediatrics

 

APA Women in Medicine / Qualitative Research Combined SIG (SIG Chair) Wednesday, May 12 9:00 AM – 11:00 AM
CT

Phase I: April-30-May 4 and Phase II: May 10-June 4

PAS 2021 Virtual Schedule

happy children running with kite

Spurring innovation to support pediatric preparedness

happy children running with kite

There are many lessons to be learned from the response to the COVID-19 pandemic, but one that is at the forefront is to be prepared for anything and to strengthen readiness even in the unlikeliest circumstances.

This was the focus of a recent panel discussion featuring Lee Beers, M.D., F.A.A.P, medical director of Community Health and Advocacy within the Goldberg Center for Community Pediatric Health and Child Health Advocacy Institute at Children’s National Hospital. Dr. Beers is also president of the American Academy of Pediatrics.

The webinar entitled, “Protecting Our Future: Spurring Innovation to Support Pediatric Preparedness,” was hosted by Johnson & Johnson Innovation – JLABS (JLABS) as a product of BLUE KNIGHT™, a collaboration between JLABS and the Biomedical Advanced Research and Development Authority (BARDA), a component of the Office of the Assistant Secretary for Preparedness and Response within the U.S. Department of Health and Human Services.

This event focused on what innovators can do to develop therapeutics, diagnostics, vaccines and other technologies that may protect our future, our children. Experts shared what has been done to develop groundbreaking medical countermeasures that aim to prepare and protect pediatric populations from the health threats of today and those of tomorrow. The main discussions were on ecosystems readiness, adaptations for the pediatric population and the way forward in 2021.

“One size does not fit all for pediatrics when it comes to treatments and personal protective equipment,” said Dr. Beers “We need to know the need and how to do the roll-out.” Fellow panelists agreed.

Dr. Beers went on to say that mental health is the pandemic within the pandemic for our nation’s youth. There are increased cases and severity now for children who struggle to cope with the lockdowns. “We cannot have our children bear the burdens of our challenges.”

After robust questions and answers from everything from the role of artificial intelligence in preparing for future pandemics to the inclusion of families in research and decisions, the panelists walked away with a good feeling about the future with the unprecedented speed of vaccines aimed to counter the effects of the 2020 virus crisis.

The consensus priorities of 2021 should be to develop specifics for children and not just adaptations from adults, with the aim to advance equity, diversity and inclusion in treatment goals, and to build on the success of telemedicine.

Nationally, funding for pediatric research continues to trail efforts targeted for adults. That’s why Children’s National is creating a one-of-a-kind pediatric research and innovation hub. The Children’s National Research & Innovation Campus is set to open in 2021, located on a nearly 12-acre portion of the former Walter Reed Army Medical Center campus. The campus will combine the strengths of Children’s National with those of public and private partners who share the vision of accelerating new discoveries that save and improve the lives of children. At the new campus, breakthrough innovations can more quickly be translated into new treatments and technologies benefitting kids.

Sally Allain, Head of Johnson & Johnson Innovation – JLABS @ Washington, D.C., highlighted the opening of a 32,000 square-foot facility on the Research & Innovation Campus with a residency capacity for up to 50 companies. This will be the first JLABS site anchored with a children’s hospital and research institute working to bring recognition to the need for more early-stage research and innovation in pediatrics for our smallest patients.

The new site will serve as an incubator for pharmaceutical, medical device, consumer and health technology companies, and serve as the hub for BLUE KNIGHT™. BLUE KNIGHT™ aims to stimulate innovation and incubation of technologies that improve health security and response through companies focused on public health threats and emerging infectious diseases. At JLABS @ Washington, DC, companies selected for BLUE KNIGHT™ will have access to the JLABS ecosystem and being a part of the Research & Innovation Campus, as well as fee assistance for certain costs associated with access, mentorship for BARDA, and dedicated equipment for BLUE KNIGHT™ companies.

global connectedness concept illustration

Research partnerships and capacity building in the time of COVID-19

global connectedness concept illustration

“COVID infection anywhere in the world is COVID infection everywhere in the world,” said John Nkengasong, M.Sc., Ph.D., director of the Africa Centers for Disease Control (Africa CDC), during his remarks on the importance of shared science, innovation and diplomacy. Leading experts in global health met virtually on November 13, 2020, to discuss updates in the COVID-19 crisis and lessons learned in Africa. Children’s National Hospital, along with the George Washington University (GW) Institute for Africa Studies and the CNRS-EpiDaPo Lab, sponsored the half-day conference that captured the interest of international attendees committed to examining how best to expand strong and enduring partnerships between U.S. and African scientists, health professionals and research institutes to meet global challenges.

Trust, transparency and communication were common themes of expert panelists that included Elizabeth Bukusi, Ph.D., M.P.H., Kenya Medical Research Institute; Maryam DeLoffre, Ph.D., GW Humanitarian Action Initiative; Peter Kilmarx, M.D., National Institutes of Health (NIH) Fogarty International Center; Enock Motavu, Ph.D., Makerere University in Uganda; Jennifer Troyer, Ph.D., Human Health and Heredity in Africa Program (H3Africa) at NIH; Désiré Tshala-Katumbay, M.D., Ph.D., National Institute of Biomedical Research in Kinshasa; Eric Vilain, M.D., Ph.D., Center for Genetic Medicine Research at Children’s National, with Institute for African Studies Director Jennifer Cooke, and Jonathan LoTempio Jr and D’Andre Spencer of Children’s National as moderators and co-conveners. Read more about the panelists.

The keynote speaker, Nkengasong, updated the group on the massive efforts in bending the COVID-19 disease curve on the African continent which at present has two million cases and 46,000 deaths. This is fewer than many other regions, and Nkengasong attributes this in part to health systems strengthening and capacity building that already occurred with past pandemics like Ebola. He stressed the importance of focusing on the “4 Ps” — population, pathogen, politics and policy — in fighting the pandemic, and the need to ensure that citizens trust their leaders and the public health measures they advance. New endeavors by the Africa CDC include the Pathogen Genomic Initiative, which will help inform research and responses to COVID-19 and other emergent disease threats, and the African COVID-19 Vaccine Development and Access Strategy, which aims to ensure widespread access, delivery and uptake of effective vaccines across Africa. Africa CDC is surging to hotspots as lockdowns ease or shift, and is empowering universities to invest in proactive and, which has helped with the active response success. “Rising tides raise all boats in the sea,” said Nkengasong. He went on to say that there is great power in coordination and cooperation, and science diplomacy and technology are critical to winning the novel coronavirus war.

In a panel on research partnerships, speakers Motavu, Tshala-Katumbay, and Vilain emphasized the global benefits of scientific collaborations in Africa. Africa contains more human genetic variation than any other region of the world, and capturing that diversity in global understanding of the human genome — which is still heavily skewed toward individuals of European ancestry — will be a major factor in global medical advances of the future. And research into relatively localized diseases can lead to breakthroughs in broader understanding on connections between climate variation, environment, nutrition and child health. “The simplistic, localized, nationalist, way of doing science is over,” said Tshala-Katumbay, “and there is no way to go back.” The discipline of science diplomacy will take time for people to grasp, he added, “but it will be crucial for the future generation of scientists to go back.”

A recurring conference theme was that collaboration between countries is crucial for development of better care. Kilmarx told the event participants that in 2019, the National Institutes of Health supported some 1,668 collaborations with African research institutions. Investments in capacity building have yielded impressive results, and today some of Africa’s foremost leaders in science research and public health have received NIH training and support, stating: “If you plant acorns over the decades, you have some mighty oaks.” Bukusi, once such NIH trainee, now is engaged in training a new generation of African researchers and U.S. researchers based in Africa and expanding research partnerships at the Kenya Medical Research Institute.

Troyer showed the successes of the Human Heredity and Health in Africa Initiative, a large consortium that supports a pan-continental network of laboratories that aims to determine disease susceptibility and drug responses. Finally, DeLoffre underscored the need for long-term investments and the value of building local capacities to respond to current crises and anticipate future challenges.

Overall, there was optimism that innovative coalitions are a long-term strength in fighting pandemics and promoting reciprocal learning that will last after the crisis. Science can be a neutral platform that, combined with diplomacy and technology, builds bridges between peoples.

a telehealth video visit with a patient family

Steady rates of patient satisfaction, reimbursement for cardiac telehealth during COVID-19

a telehealth video visit with a patient family

In the first two weeks of COVID-19’s major impact on the U.S., Children’s National Hospital moved most of its subspecialty in-person day-to-day clinics to virtual care. Children’s National Heart Institute was one of the first divisions to offer telehealth visits — in part because the team was an early adopter of telehealth in cardiology for both physician-to-physician consultations and direct-to-patient care, and stood poised to widely implement it.

A poster presentation at the American Heart Association Scientific Sessions 2020 quantified how the rapid transition to direct-to-consumer telehealth services impacted families with children who have congenital heart disease. The findings were presented by first author Kristine Mehrtens, M.S., B.S.N., R.N., C.P.N., clinical manager for the Heart Institute’s Ambulatory Services.

The team found that though in-person cardiology visits decreased during the COVID-19 pandemic, direct-to-patient telehealth visits were able to partially compensate for the sudden drop.

Additionally, payer reimbursement rates for these direct-to-consumer telehealth visits were similar to in-person clinic visits.

”This is exciting as prior to COVID-19  we have seen a lower reimbursement rates for these cardiology direct-to-consumer telehealth visits compared to in-person cardiology clinic visits,” said Ashraf S. Harahsheh, M.D., a pediatric cardiologist at Children’s National Hospital who has utilized direct-to-consumer telehealth visits since 2016 and is a senior author on the new study.

Patient satisfaction scores for care providers, including the likelihood of recommending a care provider from Children’s National Hospital, was the same for telehealth follow-up visits as it was for in-person clinic visits before the pandemic.

“As a multidisciplinary team, we agreed that diagnostic studies such as echocardiograms were important to include with follow-up visits,” says Mehrtens. “Together we developed a strategy to ensure we could meet the needs of the patients and also safely conduct in-person visits when necessary.”

Why is this important?

The pandemic and the resulting temporary halt to in-person, non-urgent/emergent visits earlier this year put the most vulnerable people with congenital heart disease at high risk for complications or worsening of their existing heart disease because they are unable to follow the recommended schedule for follow-ups.

The readiness of the Children’s Heart Institute team to quickly move to a telehealth platform successfully bridged the gap between in-person visits for some patients, allowing cardiology surveillance to continue safely.

“I am proud of our team of physicians and advanced care providers,” Harahsheh concludes. “We went from three providers (8%) pre-COVID 19 to 31 (79%) providers offering direct-to-consumer telehealth visits during the pandemic.”

What’s next?

Building on previous, smaller studies of telehealth before the pandemic began, the team will continue to conduct research to assess the safety and efficacy of these telehealth visits over time. The increase in patients who are continuing to see their providers for routine follow-ups via telehealth will allow a larger sample for effective study of this care model.

American Heart Association Scientific Sessions 2020
Impact of Telemedicine on Pediatric Cardiac Center’s Ambulatory Response to the 2019 Novel Coronavirus Disease (covid-19) Pandemic
P1692
9:00am – 10:00am
Fri, Nov 13  (CST)

Read additional news stories about cardiology telehealth:

newborn in ICU

Cardiac technology advances show promise for kids but only if right-sized

newborn in ICU

“Smaller patients, and those with congenital heart disease, can benefit from minimally-invasive methods of delivering pacemakers and defibrillators without the need for open-chest surgery,” says Charles Berul, M.D.

How to address the growing need for child-sized pacemakers and defibrillators, and finding better surgical techniques to place them, is the topic of an invited session called The Future is Now (or Coming Soon): Updates on New Technologies in Congenital Heart Care at the 2020 American Heart Association Scientific Sessions.

“Smaller patients, and those with congenital heart disease, can benefit from minimally-invasive methods of delivering pacemakers and defibrillators without the need for open-chest surgery,” says Charles Berul, M.D., co-director of the Children’s National Heart Institute and chief of Cardiology at Children’s National Hospital, who presented at the session.

“This unmet need can only be met by innovative pediatric research, geared towards miniaturization technologies for use in the smallest of children,” he says.

His presentation focused on the devices and approaches that have caught the attention of pediatric cardiology, such as pacemakers and subcutaneous defibrillators designed without lead wires, as well as less-invasive surgical approaches that may reduce recovery time for children with congenital heart disease who require these assist devices.

Using them in kids comes with added challenges, however. Often pediatric cardiologists have to be creative in how to make them work for smaller patients, Dr. Berul notes. This reiterates the important point that simply applying an adult technology to a child isn’t the right approach. The subcutaneous defibrillator, for example, is still pretty large for a child’s body. Some studies also show these devices may not be as accurate in children as in adults.

Investigators in the Sheikh Zayed Institute working together with the cardiologists at Children’s National Hospital are focused on product development and commercialization of tools and techniques to allow percutaneous minimally-invasive placement of devices, taking advantage of the newest devices and surgical techniques as they develop.

In his presentation, Dr. Berul stressed that as the technology for adults advances, it creates an opportunity for pediatric cardiology, but only if the devices, and the techniques to place them, are specifically redesigned for pediatric application.

American Heart Association Scientific Sessions 2020
The Future is Now (or Coming Soon): Updates on New Technologies in Congenital Heart Care – On Demand Session
CH.CVS.715
9:00am – 10:00am
Fri, Nov 13  (CST)

coronavirus

Single institution study finds high rates of cardiac complications in MIS-C

coronavirus

At this year’s AHA Scientific Sessions, cardiologists from Children’s National Hospital presented a poster about an interesting finding in children with MIS-C.

During the height of the pandemic, researchers at Children’s National Hospital discovered that as many as one half of children diagnosed with multisystem inflammatory disease in children (MIS-C) at the hospital developed cardiac complications including coronary artery abnormalities, even when diagnosed and treated promptly.

The data was shared as part of a poster presentation at the American Heart Association Scientific Sessions in November 2020. Though analysis was limited to the data from one institution’s confirmed MIS-C cases, the findings are significant enough to warrant further study.

Interestingly, the authors noted that the high rate of cardiac complications far exceeds the rate of similar issues in children with Kawasaki disease — another pediatric inflammatory syndrome that shares many common symptoms with MIS-C. The two are so similar that immunomodulation therapies successfully deployed in children with MIS-C were based on those developed to treat Kawasaki disease.

Knowledge of common cardiac complications in Kawasaki disease also flagged the need for routine echocardiograms in patients with MIS-C, which helped identify the higher rates of cardiac complications seen in the MIS-C patient population.

“This finding, however, is another data point that shows how MIS-C and Kawasaki disease have some specific differences needing further study,” says Ashraf Harahsheh, M.D., a pediatric cardiologist at Children’s National Hospital who studies Kawasaki disease and the first author on the new study.

“Previous clinical advancements made in Kawasaki disease set the stage for our response to MIS-C early on,” he said. ”Now we also need to understand MIS-C as its own syndrome so we can better address what we are seeing in this patient population,” he says.

While most of the cardiac findings resolved during follow up, long-term studies are needed to determine if the cardiac abnormalities are associated with major cardiac events later.

“This work will help inform the community of the importance of diagnosing children with MIS-C promptly and following clinical guidelines for necessary tests and treatments once MIS-C is diagnosed,” Harahsheh concludes.

Next, the research team plans to take a deep dive into patient demographics as well as findings from clinical, laboratory and electrocardiogram data for children who developed cardiac complications with MIS-C. The goal will be to refine treatment algorithms and potentially identify a subgroup of patients who may require different or more intense therapy to prevent cardiac complications.

American Heart Association Scientific Sessions 2020 Poster Session
Cardiac Complications of SARS CoV-2 Associated Multi-System Inflammatory Syndrome in Children (MIS-C)
P1306
9:00am – 10:00am
Fri, Nov 13 (CST)

Dr. Laura Tosi talks to a patient

Refining criteria for childhood skeletal fragility and osteoporosis

Dr. Laura Tosi talks to a patient

Orthopaedic surgeon Laura Tosi, M.D., presented information about bone fractures and skeletal fragility in children at this year’s POSNA Annual Meeting.

It’s true that broken bones are often a typical part of childhood, says international bone health expert Laura Tosi, M.D., an orthopaedic surgeon at Children’s National Hospital. But for some children, a single bone fracture under the right circumstances may be a signal that a child needs a closer look to rule out underlying skeletal fragility.

Dr. Tosi presented on this topic as part of the Pediatric Orthopaedic Society of North America’s (POSNA) 2020 Annual Meeting. The presentations were conducted virtually this year due to COVID-19.

“We know that between 27 and 40% of girls, and 42 to 51 percent of boys will have at least one fracture during childhood,” she says. “What we have also seen over time is that almost 40 percent of children who have one fracture will have more. How do we tell which children with a fracture may need our help to avoid future ones?”

During her session, Dr. Tosi discussed how adding more nuance to clinical evaluation criteria for childhood fractures can help identify which children should be evaluated for conditions affecting bone density.

To widen the scope and make sure an underlying bone density issue is detected and treated as early as possible, Dr. Tosi says there are some specific findings that should suggest the need for further exploration:

  • Does the child have an a priori risk for a fragility fracture due to a genetic bone disorder(such as osteogenesis imperfects (aka brittle bone disease) or immobility caused by a disorder such as spina bifida, cerebral palsy or muscular dystrophy?
  • Is there a mismatch between the fracture severity and level of trauma that led to the injury?
  • Does the child’s history include any of four factors known to be associated with increased fracture risk: early age at the time of the first fracture, intolerance to cow’s milk, low dietary calcium intake or high BMI values.
  • Does the child have a vertebral compression fracture?
  • Is there a family history of frequent fractures (which may indicate a previously unidentified genetic condition)

Dr. Tosi also laid out specific evaluation steps for a skeletal fragility condition when a child’s fracture meets criteria, including:

  • Family, nutrition and exercise histories
  • A detailed physical exam
  • Complete radiograph review, including previously existing films and bone densitometry
  • Rule out rickets and child abuse
  • A complete lab work up

“It can be extremely challenging to identify if a child’s first bone fracture is a result of typical childhood activity or something else,” says Dr. Tosi. “But the risks of waiting to evaluate a fracture that meets some of the criteria above may mean we are delaying a treatment that might improve bone density and prevent a future fracture altogether — which is always what we’d hope to do.”

In the past, bone health experts felt that the word “osteoporosis” should not be used in children and pushed for the term “low bone density for age.”  That perspective has begun to change thanks to important advances in our understanding of the genetic basis of bone fragility, the important role of chronic conditions and how the use of bone-active medications can significantly reduce fracture risk and improve function in certain conditions.

She then spoke about the benefits of early detection for conditions causing skeletal fragility by presenting compelling evidence of the resiliency of a child’s bones when they are managed appropriately.

She noted that she’s seen significant bone remodeling in patients with serious bone degeneration due to osteogenesis imperfecta and leukemia, for example, thanks to early detection and treatment.

“Our knowledge of bone density and bone health is improving, but is still imperfect,” she concluded. “But as we learn more, and are able to appropriately identify and treat kids with skeletal fragility or osteoporosis earlier, we can continue to refine how we evaluate and care for all of them.”