Neonatology Archives

The best of 2023 from Innovation District

December 27, 2023

Advanced MRI visualization techniques to follow blood flow in the hearts of cardiac patients. Gene therapy for pediatric patients with Duchenne muscular dystrophy. 3D-printed casts for treating clubfoot. These were among the most popular articles we published on Innovation District in 2023. Read on for our full list.

1. Advanced MRI hopes to improve outcomes for Fontan cardiac patients

Cardiac imaging specialists and cardiac surgeons at Children’s National Hospital are applying advanced magnetic resonance imaging visualization techniques to understand the intricacies of blood flow within the heart chambers of children with single ventricle heart defects like hypoplastic left heart syndrome. The data allows surgeons to make critical corrections to the atrioventricular valve before a child undergoes the single ventricle procedure known as the Fontan.
(3 min. read)

2. Children’s National gives first commercial dose of new FDA-approved gene therapy for Duchenne muscular dystrophy

Children’s National Hospital became the first pediatric hospital to administer a commercial dose of Elevidys (delandistrogene moxeparvovec-rokl), the first gene therapy for the treatment of pediatric patients with Duchenne muscular dystrophy (DMD). Elevidys is a one-time intravenous gene therapy that aims to delay or halt the progression of DMD by delivering a modified, functional version of dystrophin to muscle cells.
(2 min. read)

3. New model to treat Becker Muscular Dystrophy

Researchers at Children’s National Hospital developed a pre-clinical model to test drugs and therapies for Becker Muscular Dystrophy (BMD), a debilitating neuromuscular disease that is growing in numbers and lacks treatment options. The work provides scientists with a much-needed method to identify, develop and de-risk drugs for patients with BMD.
(2 min. read)

4. First infants in the U.S. with specially modified pacemakers show excellent early outcomes

In 2022, five newborns with life-threatening congenital heart disease affecting their heart rhythms were the first in the United States to receive a novel modified pacemaker generator to stabilize their heart rhythms within days of birth. Two of the five cases were cared for at Children’s National Hospital. In a follow-up article, the team at Children’s National shared that “early post-operative performance of this device has been excellent.”
(2 min. read)

5. AI: The “single greatest tool” for improving access to pediatric healthcare

Experts from the Food and Drug Administration, Pfizer, Oracle Health, NVIDIA, AWS Health and elsewhere came together to discuss how pediatric specialties can use AI to provide medical care to kids more efficiently, more quickly and more effectively at the inaugural symposium on AI in Pediatric Health and Rare Diseases, hosted by Children’s National Hospital and the Fralin Biomedical Research Institute at Virginia Tech.
(3 min. read)

6. AAP names Children’s National gun violence study one of the most influential articles ever published

The American Academy of Pediatrics (AAP) named a 2019 study led by clinician-researchers at Children’s National Hospital one of the 12 most influential Pediatric Emergency Medicine articles ever published in the journal Pediatrics. The findings showed that states with stricter gun laws and laws requiring universal background checks for gun purchases had lower firearm-related pediatric mortality rates but that more investigation was needed to better understand the impact of firearm legislation on pediatric mortality.
(2 min. read)

7. Why a colorectal transition program matters

Children’s National Hospital recently welcomed pediatric and adult colorectal surgeon Erin Teeple, M.D., to the Division of Colorectal and Pelvic Reconstruction. Dr. Teeple is the only person in the United States who is board-certified as both a pediatric surgeon and adult colorectal surgeon, uniquely positioning her to care for people with both acquired and congenital colorectal disease and help them transition from pediatric care to adult caregivers.
(3 min. read)

8. First-of-its-kind holistic program for managing pain in sickle cell disease

The sickle cell team at Children’s National Hospital received a grant from the Founders Auxiliary Board to launch a first-of-its-kind, personalized holistic transformative program for the management of pain in sickle cell disease. The clinic uses an inter-disciplinary approach of hematology, psychology, psychiatry, anesthesiology/pain medicine, acupuncture, mindfulness, relaxation and aromatherapy services.
(3 min read)

9. Recommendations for management of positive monosomy X on cell-free DNA screening

Non-invasive prenatal testing using cell-free DNA (cfDNA) is currently offered to all pregnant women regardless of the fetal risk. In a study published in the American Journal of Obstetrics and Gynecology, researchers from Children’s National Hospital provided context and expert recommendations for maternal and fetal evaluation and management when cfDNA screening is positive for monosomy X or Turner Syndrome.
(2 min. read)

10. Innovation in clubfoot management using 3D anatomical mapping

While clubfoot is relatively common and the treatment is highly successful, the weekly visits required for Ponseti casting can be a significant burden on families. Researchers at Children’s National Hospital are looking for a way to relieve that burden with a new study that could eliminate the weekly visits with a series of 3D-printed casts that families can switch out at home.
(1 min. read)

11. Gender Self-Report seeks to capture the gender spectrum for broad research applications

A new validated self-report tool provides researchers with a way to characterize the gender of research participants beyond their binary designated sex at birth. The multi-dimensional Gender Self-Report, developed using a community-driven approach and then scientifically validated, was outlined in a peer-reviewed article in the American Psychologist, a journal of the American Psychological Association.
(2 min. read)

12. Cardiovascular and bone diseases in chronic kidney disease

In a study published by Advances in Chronic Kidney Disease, a team at Children’s National Hospital reviewed cardiovascular and bone diseases in chronic kidney disease and end-stage kidney disease patients with a focus on pediatric issues and concerns.
(1 min. read)

Drs. Catherine Limperopoulos, Yao Wu and David Wessel

AHA’s Outstanding Research Award: Three generations of pediatric cardiac excellence

December 13, 2023

Catherine Limperopoulos, Ph.D., Yao Wu, Ph.D., and David Wessel, M.D.

Children’s National Hospital is celebrating a remarkable milestone as three of its faculty members have been honored over 15 years with the American Heart Association’s Outstanding Research in Pediatric Cardiology Award. Yao Wu, Ph.D., became the latest researcher to earn the accolade for her groundbreaking work into congenital heart disease (CHD).

A research faculty member with the newly established Center for Prenatal, Neonatal & Maternal Health Research, Dr. Wu received the award specifically for her studies on the role of altered placental function, measured by advanced in utero imaging, and neurodevelopmental outcomes in toddlers with CHD.

Honored at the association’s annual meeting in Philadelphia, Dr. Wu returned to Children’s National to warm congratulations from her colleagues who had previously won the award: David Wessel, M.D., executive vice president and chief medical officer, and Catherine Limperopoulos, Ph.D., director of the new center.

“I am thrilled to pass the baton to one of our own,” Dr. Limperopoulos said. “Dr. Wu’s recognition speaks to the outstanding and innovative research happening at Children’s National among junior faculty who are focusing on advancing our understanding of congenital heart disease and its long-term neurodevelopmental outcomes.”

Why we’re excited

The prestigious award represents more than individual accomplishments; it symbolizes three generations of mentorship and collaboration at the hospital. In 2007, Dr. Wessel joined Children’s National to enhance the care of newborns across specialty services by expanding programs and research, with a focus on critically ill newborns with heart disease. He recruited and mentored Dr. Limperopoulos in 2010, who became one of his research partners and creator of the hospital’s Center for Prenatal, Neonatal & Maternal Health Research. Dr. Limperopoulos, in turn, recruited and mentored Dr. Wu, providing her with the tools to conduct advanced imaging on in-utero brains and placentas, as well as the development of children with CHD.

“Each one of us is in different phases of our careers, yet we are connected by our deep interest in advancing cardiac care for critically ill newborns,” Dr. Wessel said. “In this collaborative environment, we learn from each other to improve entire lifetimes for our patients.”

Dr. Wu said she believes in sharing scientific developments for the advancement of the entire medical community. “It was an honor to be chosen to join this esteemed club, which has a relentless focus on improving health outcomes,” she said.

Children’s National leads the way

The award winners shared five collaborations published in leading journals to contribute to the ongoing dialogue in the field and the innovative work happening at Children’s National:

Painful NICU procedures change neurological development in preterm babies

December 12, 2023

Premature infants exposed to pain while in the Neonatal Intensive Care Unit (NICU) are at greater risk for motor delays, language deficits and autism, even in the absence of structural brain injuries, according to findings from the new Center for Prenatal, Neonatal & Maternal Health Research at Children’s National Hospital.

The research sheds light on the potential outcomes of routine medical interventions – such as heel pricks, venipunctures and IV placements – and correlates these skin breaks to changes in neurological connectivity in the preterm infants’ brains. Published in BMC Medicine, the work provides valuable insights about the far-reaching impact of early medical care.

“We know that premature babies are often exposed to repeated medical interventions, light, sound and other stimuli that they would not experience in utero, and we wanted to better understand the long-term effect,” said Kevin Cook, Ph.D., research faculty at the new center and an expert in fetal and neonatal neurology. “Through this study, we can see that early and repeated exposure to pain appears to alter brain development and put children at risk for poor neurodevelopmental outcomes.”

The big picture

Globally, nearly 1 in 10 babies is born preterm, and the Children’s National team was particularly interested in the experience of those born “very” and “extremely” preterm, which is considered any delivery earlier than 32 and 28 weeks of gestation, respectively. While rates of prematurity have been relatively stable, survival rates of these babies have increased remarkably in recent decades, thanks to improved interventions and therapies for preterm infants. Yet neurodevelopmental challenges among these children persist, with noteworthy risks of autism and other neurological deficits.

At Children’s National, researchers are working to understand the mechanism behind those challenges. Given that the late second trimester and the third trimester are critical periods for brain development, the team wanted to study the effects of exposing babies to the world outside the womb early.

The fine print

Dr. Cook and his colleagues collected resting-state functional MRI (fMRI) scans from 148 infants born at least four weeks prematurely, along with 99 infants born full term. The fMRI scans, uniquely suited for studying the resting state of the brain in non-responsive infants, revealed significant hyperconnectivity within the cerebellum, which coordinates muscle activity, and the limbic and paralimbic regions, which govern emotions, motivation and cognitive functions.

Notably, the hyperconnectivity correlated with the number of skin break procedures, including heel pricks, venipunctures and IV placements. When the children returned for developmental evaluations at 18 months, the skin breaks were strongly associated with an increased risk of autism and lower motor and language scores. The toddlers identified at risk for autism had an average of 118 skin breaks, which is significantly more than the average of 65 skin breaks in those who were not at risk.

What’s ahead

Catherine Limperopoulos, Ph.D., director of the Center for Prenatal, Neonatal & Maternal Health Research, said the findings have important implications for understanding how painful NICU procedures can impact long-term outcomes and how physicians conceptualize the risks of care given to preterm babies. She and her team at the center recommend further research into managing pain in premature babies, especially given the limits of current options and the known risk of opioids.

“With this foundational study, we should consider ways to improve pain management for preterm infants and methods to better weigh the interventions used on these incredibly vulnerable patients,” Dr. Limperopoulos said. “Saving their lives is certainly the priority, and the quality of that life should also be forefront of our minds.”

Modified aquapheresis for the smallest patients in intensive care

December 5, 2023

To date, four patients have benefited from modified aquapheresis at Children’s National in both the PICU and the CICU.

The Division of Nephrology at Children’s National Hospital now offers modified aquapheresis for the smallest patients with acute kidney injury or chronic kidney disease in intensive care units. Aadil Kakajiwala, M.D., MSCI, director of Pediatric Acute Kidney Support Therapies, has been the leader in establishing modified aquapheresis at Children’s National. He joined the faculty at Children’s National in 2021 after completing his pediatric nephrology fellowship at the Children’s Hospital of Philadelphia and pediatric critical care medicine fellowship at Children’s National.

To date, four patients have benefited from modified aquapheresis at Children’s National in both the PICU and the CICU. Dialysis equipment designed for adults has filter set volumes as high as 165ml. Since implementing modified aquapheresis, the new equipment’s filter set volume is just 35ml, making it a great option for dialyzing small patients as low as 1.8kg. This limits blood exposure to the patient and overcomes the limitation of obtaining larger vascular access by using a PICC line.

Dr. Kakajiwala looks to continue training nephrologists, intensive care unit providers and staff across the hospital on modified aquapheresis. “This new offering allows us to offer dialysis to our smallest patients. By utilizing modified aquapheresis, we ensure simultaneous removal of waste products along with fluid removal during the therapy,” says Dr. Kakajiwala. He hopes to work on standardizing all forms of renal replacement therapy offered at Children’s National across all care providers.

Perinatal Mood and Anxiety Lab to launch at Children’s National

December 4, 2023

The hospital has been working for years on improving screenings and support for perinatal mood and anxiety disorders.

Physician researchers at Children’s National Hospital secured a $1.8 million grant from the Agency for Healthcare Research and Quality (AHRQ) that will fund a Perinatal Mood and Anxiety Patient Safety Lab. Neonatologists, pediatric emergency medicine physicians, psychologists, computer scientists and the Perinatal Mood and Anxiety Disorder team from Children’s National will partner with systems engineers at Virginia Tech and Human Factors experts at MedStar Patient Safety Institute to set up a learning lab. The lab will improve mental health screening, referral and treatment of parents and caregivers at the hospital.

The need

“After multi-month admission to our NICU, 45% of parents screen positive for depression. I can’t think of any other disorder or disease that screens positive at 45%. This can’t be ignored,” says Lamia Soghier, M.D. M.Ed., M.B.A., neonatologist and medical director of the Neonatal Intensive Care Unit (NICU) at Children’s National. “Our goal is to provide safe, comprehensive, point-of-care access to mental health services for caregivers of infants treated at our hospital. I can’t think of a better team on the cutting edge that’s qualified to tackle this issue.”

The big picture

The new grant will tackle three major aims:

Optimize screening, referral and treatment for postpartum depression in the NICU and the Pediatric Emergency Department (ED).
Design and develop a novel software dashboard for real-time tracking of the screening, referral and treatment stages for eligible mothers.
Implement new solutions and evaluate latent safety threats related to missed screening, referral or treatment in current and future systems.

Researchers from the Center for Prenatal, Neonatal & Maternal Health Research and population health experts from the Child Health Advocacy Institute at Children’s National will also support this work.

Leading the way

“Children’s National is truly an innovator in this space,” says Dr. Soghier. “There are very few pediatric hospitals working with families to screen for mental health in the NICU, and fewer tackling the problem in the ED. Our team is dedicated to paving this path.”

The hospital has been working for years on improving screenings and support for perinatal mood and anxiety disorders, which was originally made possible by an investment from the A. James & Alice B. Clark Foundation to Children’s National aimed at providing families with greater access to mental health care and community resources. This new AHRQ grant will support the trajectory and goals of this work.

Understanding mechanisms of injury due to prematurity in human cerebellum

November 17, 2023

“There is no better model to study preterm injury than the human brain. Our team, along with the expertise of the scientific advisory board of the Raynor Cerebellum Project, will approach this project in multiple ways to extract the most possible information from the extremely precious human tissues,” says Dr. Kratimenos.

Children’s National Hospital has received $1 million in funding as part of the Raynor Cerebellum Project, whose mission is to improve the lives of those with cerebellar disease in seven to ten years. Panagiotis Kratimenos, M.D., Ph.D., principal investigator and Co-Director of Research in the Division of Neonatology at Children’s National, says the goal of this work is to understand the mechanisms of injury due to prematurity in human cerebellum and identify opportunities for intervention.

Why the research is unique

This project is unique because it focuses on postmortem human cerebellum, addressing the effect of the immune dysregulation of the mother during preterm labor. “We have established a large cohort of human term and preterm subjects and we will leverage cutting edge techniques to understand how the immune system of the mother during preterm labor shapes the cerebellum in a way that becomes more vulnerable to subsequent insults,” says Dr. Kratimenos.

Why this research matters for critical newborns

“There is no better model to study preterm injury than the human brain. Our team, along with the expertise of the scientific advisory board of the Raynor Cerebellum Project, will approach this project in multiple ways to extract the most possible information from the extremely precious human tissues. This will give us insight into the real mechanisms of preterm birth induced injury due to maternal immune dysregulation,” says Dr. Kratimenos.

Children’s National selected as member of ARPA-H Investor Catalyst Hub spoke network

November 13, 2023

The hospital will advocate for the unique needs of children as part of nationwide network working to accelerate transformative health solutions.

Children’s National Hospital was selected as a spoke for the Investor Catalyst Hub, a regional hub of ARPANET-H, a nationwide health innovation network launched by the Advanced Research Projects Agency for Health (ARPA-H).

The Investor Catalyst Hub seeks to accelerate the commercialization of groundbreaking and accessible biomedical solutions. It uses an innovative hub-and-spoke model designed to reach a wide range of nonprofit organizations and Minority-Serving Institutions, with the aim of delivering scalable healthcare outcomes for all Americans.

“The needs of children often differ significantly from those of adults. This partnership reflects our commitment to advancing pediatric healthcare through innovation and making sure we’re addressing those needs effectively,” said Kolaleh Eskandanian, Ph.D., M.B.A., vice president and chief innovation officer at Children’s National. “Leveraging the strength of this hub-and-spoke model, we anticipate delivering transformative solutions to enhance the health and well-being of the patients and families we serve.”

Children’s National joins a dynamic nationwide network of organizations aligned to ARPA-H’s overarching mission to improve health outcomes through the following research focus areas: health science futures, proactive health, scalable solutions and resilient systems. Investor Catalyst Hub spokes represent a broad spectrum of expertise, geographic diversity and community perspectives.

“Our spoke network embodies a rich and representative range of perspectives and expertise,” said Mark Marino, vice president of Growth Strategy and Development for VentureWell and project director for the Investor Catalyst Hub. “Our spokes comprise a richly diverse network that will be instrumental in ensuring that equitable health solutions reach communities across every state and tribal nation.”

As an Investor Catalyst Hub spoke, Children’s National gains access to potential funding and flexible contracting for faster award execution compared to traditional government contracts. Spoke membership also offers opportunities to provide input on ARPA-H challenge areas and priorities, along with access to valuable networking opportunities and a robust resource library.

Children’s National awarded nearly $7.5 million by FDA to lead pediatric device innovation consortium

November 2, 2023

Children’s National Hospital was awarded nearly $7.5 million in a five-year grant to continue its leadership of an FDA-funded pediatric device consortium. Building upon a decade of previous consortium leadership, the new consortium is Alliance for Pediatric Device Innovation (APDI) and features a new and expanded roster of partners that reflects its added focus on providing pediatric innovators with expert support on evidence generation, including the use of real-world evidence (RWE), for pediatric device development.

Collaborating for success

With the goal of helping more pediatric medical devices complete the journey to commercialization, APDI is led by Children’s National, with Kolaleh Eskandanian, Ph.D., M.B.A., vice president and chief innovation officer, serving as program director and principal investigator, and Julia Finkel, M.D., pediatric anesthesiologist and director of Pain Medicine Research and Development in the Sheikh Zayed Institute for Pediatric Surgical Innovation, serving as principal investigator.

Consortium members include Johns Hopkins University, CIMIT at Mass General Brigham, Tufts Medical Center, Medstar Health Research Institute and MedTech Color. Publicly traded OrthoPediatrics Corp., which exclusively focuses on advancing pediatric orthopedics, is serving as APDI’s strategic advisor and role model for device innovators whose primary focus is children.

Why we’re excited

Consortium initiatives got underway quickly with the announcement of a special MedTech Color edition of the “Make Your Medical Device Pitch for Kids!”^™competition that focuses on African American and Hispanic innovators. Interested innovators can find details and apply at MedTech Color Pitch Competition. The competition was announced at the recent MedTech Color networking breakfast on Oct. 10,2023 at The MedTech Conference powered by AdvaMed.

“We all benefit from greater equity and inclusion among pediatric MedTech founders, decision-makers, investigators and developers in more effectively addressing the needs of the entire pediatric population,” said Eskandanian. “We need the expertise and insights of innovators from diverse backgrounds, and we want to provide these talented individuals with more opportunities to present their work and share their perspectives on pediatric device development.”

Additional details

APDI is one of five FDA-funded consortia created to provide a platform of services, expertise and funding to help pediatric innovators bring medical devices to the market that specifically address the needs of children.

Documentation of pain assessment after pain management interventions in the NICU

October 10, 2023

Timely assessment of pain in neonates continues to be difficult for staff due to high acuity, workload and staffing shortages.

Neonates may experience more than 300 painful procedures and surgeries throughout their hospitalization. A proactive assessment of pain allows the medical team to detect pain early and adequately manage it. At Children’s National, the Neonatal Intensive Care Unit (NICU) team wants to minimize the impact of pain, particularly in preterm nonverbal infants as it has short- and long-term adverse neurodevelopment effects. Smitha Israel, BSN, RN, clinical program coordinator in the Children’s National neonatology department, created a team to increase compliance in pain reassessments and documentation in the NICU using technology to speed up reporting. That compliance increased from 50% to 75% and has been sustained for over two years.

What’s been the hold-up in the field?

Timely assessment of pain in neonates continues to be difficult for staff due to high acuity, workload and staffing shortages. To combat this, Israel’s group partnered with experts from the triggers team to speed up the reporting of pain assessments and to standardize the assessments when administering a pharmacological intervention.

How will this work benefit patients?

This work improves patient care in the NICU by improving pain management and reducing those possible adverse effects in a neonate’s development that pain may contribute to.

How is this work unique?

This study at Children’s National is the first study of pain assessment in the NICU that has shown improvement beyond published rates and has been sustained for six months after implementation.

JAMA Pediatrics editorial: A better approach for newborn screening

August 7, 2023

The medical community has an opportunity to update its approach to newborn screening (NBS) to be prepared for emerging technological advancements that will help diagnose children with rare diseases from their first weeks of life, according to an editorial from a leading Children’s National Hospital researcher published in JAMA Pediatrics.

“In health care, we are seeing ways in which we can identify more children who have rare diseases even earlier, in the newborn period, rather than waiting for children to develop symptoms or experience irreversible changes,” said Beth Tarini, M.D., M.S., M.B.A., associate director of the Center for Translational Research. “We have continued innovations in screening technology – with more on the way – that can be added to the screening programs overseen by all 50 states. Updating how we approach newborn screening presents an incredible opportunity for doctors and their patient-families.”

Why it matters

Newborn screening happens before the baby leaves the hospital, generally with a prick of the heel to take a small sample of blood to look for several dozen rare, debilitating disorders such as sickle cell disease, congenital hypothyroidism and cystic fibrosis. The current screening system has grown successfully for roughly 60 years and creates a network of state programs. Along the way, researchers have had extensive debates about which disorders to include, based on whether there are treatments and options for patients.

Dr. Tarini, a pediatrician who has done extensive research on NBS and related policies, said that the existing screening programs across all 50 states should be modernized, with federal research support and funding, to create a unified “learning newborn screening system” that derives information from the 4 million babies born each year and provides feedback to the medical community about best practices for babies who are diagnosed with a rare disease or at risk for developing one.

“A new approach will require resources and infrastructure, but as the technology advances, we should change our system to leverage the experience of doctors, patients, and NBS programs across the country,” Dr. Tarini said. “We have the will, the experience and the ability to transform the care for children with rare disease.”

Read the full editorial in JAMA Pediatrics.

Lenore Jarvis, M.D. participates in congressional briefing on maternal mental health

July 26, 2023

Lenore Jarvis, M.D., M.Ed., recently participated in a congressional briefing about maternal mental health.

Lenore Jarvis, M.D., M.Ed., director of advocacy and health policy for the Division of Emergency Medicine and an affiliate faculty member of the Child Health Advocacy Institute at Children’s National Hospital, recently participated in a congressional briefing about maternal mental health. The goal of the briefing was to bring awareness to the devastating impact of untreated perinatal mood and anxiety disorders (PMADs) on moms, babies and families and to eliminate the pervasive stigma around seeking care, including in communities of color and military populations.

PMADs are one of the leading causes of maternal mortality and morbidity in the U.S., responsible for nearly one quarter of all maternal deaths. Evidence shows that 1 in 5 women experience a PMAD during pregnancy or the postpartum period. All maternal mental health conditions are treatable, yet over 75% go untreated.

Dr. Jarvis spoke about the importance of screening caregivers for PMADs not just in outpatient settings, but also in emergency departments and NICUs. She said that an emergency department can serve as a safety net for high-risk patient populations who may have limited access to primary or mental health care, or for those who use the emergency department at a time of increased stress, anxiety or depression. Similarly, the NICU population is comprised of caregivers coping with stressful scenarios like traumatic perinatal or birth experiences and life altering diagnoses.

“At Children’s National, our primary care clinics screen for PMADs, but we also provide universal screening by approaching caregivers with infants six months and younger in both the emergency department and the NICU. Our philosophy is that by offering this screening and education to families, we are providing a higher standard of care for the patients seen in these settings,” said Dr. Jarvis. If a caregiver screens positive, meaning they are exhibiting enough symptoms that they could be at risk for experiencing PMADs, a member of our social work team meets with that caregiver to complete an additional assessment and provide further support, including to understand if there are suicidal or infanticidal ideations and intent to act. Our social workers can then make referrals to connect them to more care and follow up with those caregivers to confirm they have connected with the appropriate resource.

Dr. Jarvis was asked how to make it easier to support caregivers and families regarding PMADs. “Caregivers need education regarding PMADs. We need them to know it’s common and it doesn’t make them bad parents. We also need to ensure that providers are screening and that they have increased time for visits that include addressing mental health concerns.” She also stressed that the healthcare system can be difficult to navigate. “We need to decrease barriers to care, like the long wait times to get into mental health care and insurance coverage issues.”

Children’s National Hospital ranked #5 in the nation on U.S. News & World Report’s Best Children’s Hospitals Honor Roll

June 21, 2023

Children’s National Hospital in Washington, D.C., was ranked #5 in the nation on the U.S. News & World Report 2023-24 Best Children’s Hospitals annual rankings. This marks the seventh straight year Children’s National has made the Honor Roll list. The Honor Roll is a distinction awarded to only 10 children’s hospitals nationwide.

For the thirteenth straight year, Children’s National also ranked in all 10 specialty services, with eight specialties ranked in the top 10 nationally. In addition, the hospital was ranked best in the Mid-Atlantic for neonatology, cancer, neurology and neurosurgery.

“Even from a team that is now a fixture on the list of the very best children’s hospitals in the nation, these results are phenomenal,” said Kurt Newman, M.D., president and chief executive officer of Children’s National. “It takes a ton of dedication and sacrifice to provide the best care anywhere and I could not be prouder of the team. Their commitment to excellence is in their DNA and will continue long after I retire as CEO later this month.”

“Congratulations to the entire Children’s National team on these truly incredible results. They leave me further humbled by the opportunity to lead this exceptional organization and contribute to its continued success,” said Michelle Riley-Brown, MHA, FACHE, who becomes the new president and CEO of Children’s National on July 1. “I am deeply committed to fostering a culture of collaboration, empowering our talented teams and charting a bold path forward to provide best in class pediatric care. Our focus will always remain on the kids.”

“I am incredibly proud of Kurt and the entire team. These rankings help families know that when they come to Children’s National, they’re receiving the best care available in the country,” said Horacio Rozanski, chair of the board of directors of Children’s National. “I’m confident that the organization’s next leader, Michelle Riley-Brown, will continue to ensure Children’s National is always a destination for excellent care.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals and recognizes the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News.

“For 17 years, U.S. News has provided information to help parents of sick children and their doctors find the best children’s hospital to treat their illness or condition,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “Children’s hospitals that are on the Honor Roll transcend in providing exceptional specialized care.”

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.

The eight Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

Neonatology (No. 2), led by Division Chief Billie Lou Short, M.D.
Neurology and Neurosurgery (No. 3), led by Division Chiefs William D. Gaillard, M.D., and Robert F. Keating, M.D.
Cancer (No. 4), led by Division Chief Jeffrey S. Dome, M.D., Ph.D.
Nephrology (No. 6), led by Division Chief Marva Moxey-Mims, M.D.
Orthopedics (No. 7), led by Division Chief Matthew Oetgen, M.D., M.B.A.
Diabetes and Endocrinology (No. 7), led by Division Chief Andrew Dauber, M.D., MMSc.
Gastroenterology and GI surgery (No. 8), led by Division Chief Ian Leibowitz, M.D.
Pulmonology and Lung Surgery (tied for No. 9), led by Division Chief Anastassios Koumbourlis, M.D., M.P.H.

The other two specialties ranked among the top 50 were cardiology and heart surgery, and urology.

Pandemic stress reshapes the placentas of expectant moms

May 10, 2023

Elevated maternal stress during the COVID-19 pandemic changed the structure, texture and other qualities of the placenta in pregnant mothers.

Elevated maternal stress during the COVID-19 pandemic changed the structure, texture and other qualities of the placenta in pregnant mothers – a critical connection between mothers and their unborn babies – according to new research from the Developing Brain Institute at Children’s National Hospital.

Published in Scientific Reports, the findings spotlight the underappreciated link between the mental health of pregnant mothers and the health of the placenta – a critical organ that develops during pregnancy to nourish and protect babies. The long-term neurodevelopmental impact on their children is under investigation.

“During the pandemic, mothers were exposed to a litany of negative stressors including social distancing, fear of dying, financial insecurity and more,” said Catherine Limperopoulos, Ph.D., chief and director of the Developing Brain Institute, which led the research. “We now know that this vital organ was changed for many mothers, and it’s essential that we continue to investigate the impact this may have had on children who were born during this global public health crisis.”

The big picture

Dr. Limperopoulos’s team compared magnetic resonance imaging (MRI) of 165 women who were pregnant before March 2020 to 63 women who became pregnant during the pandemic. Those pregnant during the pandemic were not knowingly exposed to COVID-19, and they collectively scored significantly higher on questionnaires measuring stress and depression. They were recruited at Children’s National as part of a clinical trial aimed at reducing pregnant women’s elevated stress levels during the pandemic.

The placenta is a temporary organ that grows during pregnancy to provide oxygen, nutrients and immunological protection to babies, and its health is vital to the well-being of the developing fetus. The data showed key changes in how the placenta grew and developed among women pregnant during the pandemic, especially when compared to placental growth and development among women who were pregnant before the pandemic. Changes in placental development also were associated with the infant’s birth weight at delivery. Importantly, these changes seem to be connected to maternal stress and depression symptoms.

Taken as a whole, the findings suggest that the disturbances measured on placental development in the womb may influence the placenta’s ability to support fetal health and wellness. “We are continuing to follow up on these mother-baby dyads to determine the long-term functional significance of these placental changes in utero,” Dr. Limperopoulos said.

Studies have shown that the placenta adapts to negative changes in the maternal environment and mental health status, and disruptions in placental function impact infant brain development and children’s neurobehavior and temperament.

The patient benefit

Dr. Limperopoulos’s research studying childbirth amid the pandemic builds on her extensive work investigating the impact of maternal stress on unborn children, including its adverse effect on brain structure and biochemistry. She’s also working on treatments and interventions to better support new families. Her program, DC Mother-Baby Wellness, brings together community partners to provide wrap-around care to expectant and new moms with elevated scores for stress, anxiety and depression.

“When identified early, maternal stress is a modifiable risk factor that can be treated with psychotherapy, social support and other personalized, evidence-based interventions,” Dr. Limperopoulos said. “We look forward to continued research in this area to better understand the mechanisms behind these biological changes and the needs of mothers and children who are born during pandemics, natural disasters and other significantly stressful events.”

DC Mother Baby Wellness marks 1,000-referral milestone

April 19, 2023

Launched 18 months ago, the city-wide DC MBW program brings together prenatal care providers, pediatricians, community-based organizations and birthing hospitals to provide essential services to mothers and babies at high risk for adverse health outcomes.

Launched 18 months ago, the city-wide DC MBW program brings together prenatal care providers, pediatricians, community-based organizations and birthing hospitals to provide essential services to mothers and babies at high risk for adverse health outcomes. Using evidence-based screening and evaluation tools, the program provides timely and targeted resources – including mental health care for mothers, developmental screening and treatment for newborns and other support – to ensure that families with the most acute social and medical needs have access to culturally relevant resources.

“Healthy moms are the foundation of healthy families and communities,” says Catherine Limperopoulos, Ph.D., the program’s director and director of the Developing Brain Institute at Children’s National. “Perinatal mood and anxiety disorders are among the most common complications of pregnancy. By offering thoughtful, individualized mental health resources – in English and Spanish – we are improving outcomes for local families facing some of the most complex and challenging health needs.”

Dr. Limperopoulos has done extensive research on the profound, negative effects of expectant mothers’ stress on their unborn children. Using advanced fetal MRI technology, her published research continues to show that stress, anxiety or depression in pregnant mothers alters babies’ brain development. These mental health challenges are associated with poor obstetric outcomes and social, emotional and behavioral problems in children.

The DC MBW 1,000-referral milestone comes as Dr. Limperopoulos expands her research role at Children’s National with the creation of a new Center for Prenatal, Neonatal & Maternal Health Research that she will lead. Opened in April, the center will be a research hub for maternal health and prevalent pediatric disorders that may be present in the earliest stages of life.

At DC MBW, Dr. Limperopoulos and her team serve mostly women of color with complex social needs that drive their anxiety, stress, depression and other mental health concerns. More than a third of the mothers referred to the wellness program are experiencing housing insecurity at intake – a number that climbs to more than 75% during their pregnancy and first year postpartum. About 30% of referred women are experiencing food insecurity. One in four are experiencing intimate partner violence, and 10% report contemplating suicide.

Dr. Limperopoulos says the team’s data indicate expectant mothers’ symptoms of depression drop dramatically within as few as six weeks of engagement with the wellness program’s services. These mothers are supported during pregnancy and beyond, as they check in with their providers during primary care visits at various Children’s National locations, participate in interactive, evidence-based play to boost child development and attend prenatal group classes that start this spring.

“It is not an overstatement to say that this program has saved lives,” says Siobhan Burke, M.D., director of Obstetrics and Gynecology at Unity Health Care. “There are so many initiatives and programs that focus on screening for depression in pregnancy, but DC MBW is actually doing the work and getting patients the treatments that they want and need. The team has designed a program that focuses on removing barriers. Whether that’s things like transportation, insurance status or language barriers, they find a way to help.”

The Centers for Disease Control and Prevention reports that the U.S maternal death rate continues to climb locally and nationally. The rates for Black mothers are significantly higher than for white and Latina mothers, making early intervention and wrap-around healthcare services even more vital to reverse this sobering trend.

The DC MBW program was underwritten by a $36 million investment from the A. James & Alice B. Clark Foundation and has hired more than a dozen full-time experts who provide care coordination, psychotherapy and patient referrals to a range of community resources. Most often, patients are referred by providers at Unity Health Care, the George Washington University Hospital, MedStar Washington Hospital Center and other leading prenatal care practices in the city.

“I credit our team’s tireless efforts for achieving this milestone so quickly. I have witnessed firsthand the dedication, time and boundless energy that they have devoted to each and every one of these people, walking side by side with them on their journey toward wellness,” Dr. Limperopoulos says. “Our research clearly supports the need for the care and resources we provide through the DC Mother-Baby Wellness initiative. Through our existing referral collaborative, we look forward to welcoming even more patients to this city-wide network as we welcome their babies into the world.”

New research center focuses on origins of prenatal and neonatal disease

March 21, 2023

Children’s National Hospital researchers will develop new diagnostic tools and precision medicine for unborn children, babies and young children at the hospital’s newly established Center for Prenatal, Neonatal & Maternal Health Research.

The investment comes as research continues to show the importance of high-quality, evidence-based care at this crucial stage of pediatric development, especially for underserved families. The center is the sixth organization to join the Children’s National Research Institute.

What we hope to discover

“We know that many chronic diseases that crop up during adulthood have their footprint in the womb,” said center Director Catherine Limperopoulos, Ph.D. “While this concept has been around for years, our new center will provide a unique opportunity to study such research questions as the role of prenatal stressors on long-term outcomes. And we’ll be able to provide interventions earlier, improving mothers’ outcomes sooner. This benefits the mom, the fetus, the child and has implications for the next generation.”

Limperopoulos’s research will continue the hospital’s longstanding investment in improving the understanding, prevention and treatment of childhood diseases. The center will foster collaborations throughout the hospital by teaming with experts in neuroscience, oncology, genetics and other disciplines that are vital for safeguarding the health of mothers and their babies, even before they’re born.

The big picture

“We know that many chronic diseases that crop up during adulthood have their footprint in the womb,” said center Director Catherine Limperopoulos, Ph.D. “While this concept has been around for years, our new center will provide a unique opportunity to study such research questions as the role of prenatal stressors on long-term outcomes.

Limperopoulos will also continue to serve as the director of the Children’s National Developing Brain Institute, which focuses on the brain in utero, after birth and throughout preschool. Her research is paving the way toward understanding how maternal stress impacts fetal brain development and helping to advance perinatal mental health while addressing racial disparities in access to care. The center will also partner with clinical leaders throughout Children’s National and community partners to expand existing efforts, such as the DC Mother-Baby Wellness Initiative, an innovative program that Limperopoulos leads.

“The care of mothers and their young children will change dramatically in the next decade, and the breadth of our research has the power to lead the way in harnessing medical advancements to nurture healthier families,” Limperopoulos said. “Imagine a day when we can identify in utero a biomarker for a disorder such as sickle cell disease and prevent the disease from taking hold with a novel therapy. This is the vision for the groundbreaking research that will happen at the new center.”

baby with with bronchopulmonary dysplasia

A team approach to complex bronchopulmonary dysplasia

March 14, 2023

“By the time a baby is diagnosed with bronchopulmonary dysplasia, families have already had a long journey with prematurity in the neonatal intensive care unit (NICU),” says Hallie Morris, M.D., neonatologist and lead of the Complex Bronchopulmonary Dysplasia (BPD) Program at Children’s National Hospital. “To be able to have a team that is focused on the holistic health of their child in the context of this diagnosis makes a world of difference to these families.”

The big picture

Some premature infants with BPD experience more severe respiratory disease with comorbidities associated with their underlying disease processes, but also factors related to their lengthened intensive care unit (ICU) stay. This includes delayed development with neurodevelopmental impairment, ICU delirium, pulmonary hypertension, airway disease, gastroesophageal reflux disease, feeding difficulties, retinopathy of prematurity and more.

The Complex BPD Program at Children’s National encompasses a group of specialists dedicated to improving the care of infants with BPD and other chronic lung disease of infancy. BPD places extreme demands on families. Education is a critical component for families and our team works to make sure they are well informed, have realistic expectations and understand their care plan.

What they’re saying

“Our program is unique in that it has the ability to follow the patient for several months in the NICU as well as after discharge,” says Maria Arroyo, M.D., pulmonologist and co-lead of the Complex BPD Program at Children’s National. “This includes a subacute facility where some of our NICU patients transfer to for continued respiratory weaning and rehabilitation with parent education and outpatient visits once families are home.”
“Since this program was created, we have improved patient care and outcomes with this interdisciplinary approach,” says John Berger, M., medical director for the Pulmonary Hypertension Program at Children’s National. “We expect that with our consistent and personalized care, patients will continue have better overall outcomes, less readmissions and improved neurodevelopmental outcomes.

Learn more about the Complex BPD Program.

Will SARS-CoV-2 during pregnancy impact child’s neurodevelopment?

March 14, 2023

Sarah Mulkey, M.D., prenatal-neonatal neurologist at Children’s National, will lead the neurodevelopmental evaluations of the infants born to mothers with SARS-CoV-2 infection during pregnancy to understand any long-term neurological effects in offspring.

Scientists led by the Lieber Institute for Brain Development are studying how a mother’s SARS-CoV-2 infection during pregnancy affects the biology of the placenta and the corresponding trajectory of the child’s brain development, including the risk for neurodevelopmental disorders such as schizophrenia and autism. The work is made possible by a $3 million, five-year grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, part of the National Institutes of Health.

The project stems from a collaboration between the Lieber Institute for Brain Development on the Johns Hopkins medical campus in Baltimore, Children’s National Hospital in Washington, D.C., and the Women’s Health Integrated Research Center at Inova Health System in Virginia.

The big picture

The group aims for a clearer picture of how a mother’s SARS-CoV-2 infection during pregnancy affects neurodevelopment in utero, the effects of which may manifest early in a child’s life. The researchers hope to understand how the infection interacts with other factors relevant to brain development, including genomic risk for neurodevelopmental disorders, maternal stress and social determinants of health.

The team will study whether the relationship between maternal SARS-CoV-2 infection and offspring brain development is mediated by changes in the biology of the placenta and the activation of the mother’s immune system. They will also gauge any differences in the effects of SARS-CoV-2 between female and male children and in the offspring of vaccinated and unvaccinated mothers.

Why it matters

Preliminary data show that pregnant people with symptomatic SARS-CoV-2 infections are more likely to have a preterm delivery, abnormalities in the placenta and prenatal and perinatal complications such as preeclampsia and fetal growth restriction. All these complications have been found to increase a child’s risk of neurodevelopmental disorders later in life.

What we hope to discover

Sarah Mulkey, M.D., prenatal-neonatal neurologist at Children’s National, will lead the neurodevelopmental evaluations of the infants born to mothers with SARS-CoV-2 infection during pregnancy to understand any long-term neurological effects in offspring. The researchers will evaluate the children’s neurodevelopment at both 24 and 36 months of age. This work builds upon Dr. Mulkey’s longitudinal neurodevelopmental evaluations in children exposed to Zika virus in utero.

“What we’ve learned is that even when babies don’t have Zika-virus-related birth defects, we still find differences in early child development compared to children who weren’t exposed to Zika virus,” said Dr. Mulkey. “With SARS-CoV-2, there is still so much we don’t know. But by better understanding the long-term impact of COVID exposure during pregnancy, we can ultimately find ways to prevent adverse outcomes.”

Recommendations for management of positive monosomy X on cell-free DNA screening

February 15, 2023

In a study published in the American Journal of Obstetrics and Gynecology, researchers provide context and expert recommendations for maternal and fetal evaluation and management when cfDNA screening is positive for monosomy X or Turner Syndrome (TS).

Non-invasive prenatal testing (NIPT) using cell-free DNA (cfDNA) is currently offered to all pregnant women regardless of the fetal risk. While this test has excellent value to screen for chromosomal abnormalities such as Down syndrome, the test has a much lower positive predictive value for sex-chromosome abnormalities such as Turner syndrome. In a study published in the American Journal of Obstetrics and Gynecology, researchers provide context and expert recommendations for maternal and fetal evaluation and management when cfDNA screening is positive for monosomy X or Turner Syndrome (TS).

The manuscript was put together by the Turner Syndrome Special Interest Group (TS SIG) of the Pediatric Endocrine Society, chaired by Roopa Kanakatti Shankar, M.D., endocrinologist at Children’s National Hospital, along with other specialists including a gynecologist, maternal fetal medicine expert, cardiologists and pediatric endocrinologists.

The big picture

The field of NIPT using cfDNA testing has advanced considerably making it routine in the care of pregnant women and more couples are opting for it. This will lead to an increased detection of monosomy X overall — some of which may be true positives, but others may be false positives, or even an indicator of maternal TS rather than an affected fetus. This article discusses the changing landscape and provides an expert opinion on how to manage these scenarios.

How does this work move the field forward?

“We hope that this will increase provider knowledge and recognition of the pitfalls of NIPT as a screening test for sex-chromosome disorders such as monosomy X,” says Dr. Kanakatti Shankar. “It will also provide a framework for the next diagnostic steps, management and referrals that a provider may take to optimize care for both mother and child.”

How is Children’s National leading in this space?

Current guidelines for the care of individuals with TS throughout the lifespan do not specifically address management of individuals with a cell-free DNA screen positive for monosomy X.

“As chair of the TS Special Interest Group, I was able to lead this unique collaborative effort which we hope will lead to better understanding of NIPT results in the context of TS and for multispecialty providers to improve prenatal detection and timely care,” says Dr. Kanakatti Shankar.

Neuroprotective effect of Src kinase in neonates affected by HIE

February 8, 2023

Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and mortality worldwide.

In a systematic review published by Frontiers in Neuroscience, and co-authored by Panagiotis Kratimenos, M.D., neonatologist at Children’s National Hospital, Ioannis Koutroulis, M.D., pediatric emergency medicine physician at Children’s National and Javid Ghaemmaghami, M.S., researcher with the Center for Neuroscience Research at Children’s National, it was concluded that Src kinase is an effective neuroprotective target in the setting of acute hypoxic injury.

The paper reviews hypoxic-ischemic encephalopathy (HIE), a major cause of neonatal morbidity and mortality worldwide (one in four perinatal deaths is attributed to hypoxic-ischemic). While therapeutic hypothermia has improved neurodevelopmental outcomes for some survivors of HIE, this treatment is only available to a subset of affected neonates. Src kinase, an enzyme central to the apoptotic cascade, is a potential pharmacologic target to preserve typical brain development after HIE. This paper, a product of collaboration for a Master’s Thesis with the Aristotle University School of Medicine, Thessaloniki, Greece, where Dr. Kratimenos holds the appointment of Visiting Professor, presents evidence of the neuroprotective effects of targeting Src kinase in preclinical models of HIE.

The systematic review shows that while heterogeneity and risk for bias were limiting factors, the overall results indicate that Src-i neuroprotective properties could be a promising therapeutic strategy for neonates after hypoxic events.

Inducing strokes in newborns to treat hemimegalencephaly

February 3, 2023

“The number one thing people are perplexed by is how well these babies recover and how they can only live with half a brain,” said Tayyba Anwar, M.D., neonatal neurologist and co-director of the Hemimegalencephaly Program at Children’s National Hospital. “People think if a child has half a brain that’s damaged or dysplastic, how are they functioning? But babies are so resilient. It still amazes me.”

The big picture

Children’s National experts have pioneered a novel approach of inducing strokes to stop seizures and improve neurodevelopmental outcomes in newborns under three months old with hemimegalencephaly (HME).

The procedure, called an endovascular embolic hemispherectomy, can be safely used to provide definitive treatment of HME-related epilepsy in neonates and young infants, according to a study in the Journal of NeuroInterventional Surgery.

Prior to this approach, the standard treatment was an anatomic hemispherectomy — surgical removal of the affected half of the brain. But infants had to be at least three months old to undergo such a complex surgery. Delaying surgery meant the persistent seizures compromised the development of the healthy half of the brain.

What they’re saying

In this video, Dr. Anwar and Panagiotis Kratimenos, M.D., Ph.D., neonatologist and co-director of Research in Neonatology at Children’s National, discuss the critically important neonatal care provided to babies who undergo endovascular embolic hemispherectomy and how protocols have evolved with each case to make this less invasive approach a feasible early alternative to surgical hemispherectomy.

Drs. Anwar and Kratimenos are part of the multidisciplinary team of neonatal neurologists, neurointerventional radiologists, neonatologists and neurosurgeons performing endovascular hemispherectomies.