Orthopedics

Matthew Evan Oetgen, M.D., and Timothy Dennis Kane, M.D.

Children’s National announces two new professorships

Matthew Evan Oetgen, M.D., and Timothy Dennis Kane, M.D.

Drs. Oetgen and Kane join a distinguished group of Children’s National physicians and scientists who hold an endowed chair.

Children’s National Hospital named Matthew Evan Oetgen, M.D., as the Joseph E. Robert, Jr. Professor of Orthopaedic Surgery and Sports Medicine. Dr. Oetgen serves as chief of Orthopaedic Surgery and Sports Medicine.

Children’s National Hospital named Timothy Dennis Kane, M.D., as the Joseph E. Robert, Jr. Professor of General and Thoracic Surgery. Dr. Kane serves as chief of General and Thoracic Surgery.

About the award

Drs. Oetgen and Kane join a distinguished group of Children’s National physicians and scientists who hold an endowed chair. Children’s National is grateful for its generous donors, who have funded 48 professorships to-date.

Professorships support groundbreaking work on behalf of children and their families. They foster new discoveries in pediatric medicine. These appointments carry prestige and honor that reflect the recipient’s achievements and donor’s forethought to advance and sustain knowledge.

Dr. Oetgen is a longstanding leader in orthopaedic surgery and sports medicine. Under his leadership, Children’s National opened the Fight For Children Sports Medicine Center in 2021. It provides a wide range of orthopaedic services to help young athletes function at their peak performance. Additionally, his team launched the nation’s first pediatric Spinal Fusion Surgical Home. This program led to significant decreases in average length of stay and patient pain scores for children with idiopathic scoliosis.

“We provide state-of-the-art care to young athletes across the region,” says Dr. Oetgen. “This professorship will help us continue the development of innovative clinical and research programs that streamline care for children with complex orthopaedic needs.”

Dr. Oetgen has authored more than 60 book chapters and publications. He has presented at many major national and international conferences in his field. Dr. Oetgen is also a key member of the multidisciplinary clinical trial team that was the first to apply magnetic resonance guided high-intensity focused ultrasound to non-invasively relieve osteoid osteoma tumors in children.

Dr. Kane works to develop the Joseph E. Robert, Jr. Center for Surgical Care’s minimally invasive surgery program through clinical practice, instruction and research, while improving minimally invasive surgical techniques and speed into standard clinical care for pediatrics. He serves as principal investigator in the Minimally Invasive Therapy Program in the Bioengineering Initiative of the Sheikh Zayed Institute for Pediatric Surgical Innovation. He has specific interest and expertise in minimally invasive thoracic, gastrointestinal and neonatal surgery. Under his direction, the Division of General & Thoracic Surgery developed peroral endoscopic myotomy (POEM), a newer technique to treat esophageal achalasia in children.

“Children’s National performs more POEM procedures than any other children’s hospital in the country,” says Dr. Kane. “I’m grateful for this professorship and look forward to making even more surgical advances in pediatric care.”

The Joseph E. Robert Jr. Trust, through their vision and generosity, are ensuring that Drs. Oetgen, Kane and future holders of these professorships will launch bold, new initiatives. These innovations will help rapidly elevate our leadership in the field of pediatric orthopaedic and general surgery and improve lifetimes for children.

About the donors

The Joseph E. Robert, Jr. Charitable Trust is a long-time champion of Children’s National. It honors the memory of the late Joseph “Joe” E. Robert, Jr. A native of Washington D.C., Joe was an entrepreneur and visionary who believed in the importance of investing in children through education and healthcare. His first gift to Children’s National created and endowed our Joseph E. Robert, Jr. Center for Surgical Care. He was also instrumental in shaping the vision and building support for the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National, created in 2009 with a $150 million gift from the Government of Abu Dhabi.

These professorships embody Joe’s legacy of inspiring others to think bigger and differently to advance pediatric healthcare for children of the Washington, D.C. community and beyond.

“Joe’s legacy is represented through the incredible work being done at Children’s National,” says David Fensterheim, board chair of Fight For Children. “Drs. Oetgen and Kane are trailblazers in pediatric healthcare. We are proud to honor them and their cutting-edge work with this prestigious professorship.”

Dr. Sean Tabaie talks to a patient with a cast

CME: Bracing and casting in the pediatric orthopaedic surgery clinic

Dr. Sean Tabaie talks to a patient with a castJoin Children’s National Hospital for a pre-recorded Continuing Medical Education (CME) presentation on Bracing and Casting in the Pediatric Orthopaedic Surgery Clinic: Improving Patient Care through Understanding and Troubleshooting. This 90-minute presentation will focus on bracing and casting in pediatric spinal deformity, trauma, cerebral palsy and sports medicine. The session offers one (1) CME credit and features Matthew Oetgen, M.D., M.B.A., Jeffrey Peck, M.D., Sean Tabaie, M.D., M.S., M.B.A., and Keyur Desai, M.D.

Learning Objectives:

  • Learn the common types of braces and casts used to treat patients in pediatric orthopedic out-patient clinics.
  • Understand indications for use, appropriate fitting, and patient questions to assess commonly used braces and casts.
  • Recognize complications associated with braces and casts in children and learn how to trouble-shoot these issues to improve patient care and safety.

Click here to view the presentation.

To claim credit for this presentation, please follow these steps:

  1. Log into your INOVA CME account, or create an account: cme.inova.org
  2. Credit for this session can be claimed in one of two ways:
    1. Text session code “QUXSEV” to 703-260-9391
    2. Enter the session code “QUXSEV” at cme.inova.org/code​​​​​

You have 30 days from March 1, 2024, to claim credit.

Gabi cheerleading

Transformative surgery: A catalyst for a girl’s future career aspirations

Gabi cheerleading

“I knew something was wrong because Gabi couldn’t walk in a straight line or ride a bike,” said Gabi’s mom, Petrice Young. “Since the surgery, she’s a different person. Dr. Oetgen literally changed her life.”

When Gabi, 17, went for her 12-year checkup, her pediatrician noticed a deformity in her spine. He quickly recommended Gabi make an appointment at Children’s National Hospital with Matthew Oetgen, M.D., chief of Orthopaedic Surgery and Sports Medicine. The X-rays indicated Gabi had a very large, 73 degree thoracic and 77 degree lumbar, double-S curvature in her spine and it was likely that as she continued to grow, the curve would get bigger.

Surgery was the best next step. The news came as a surprise to Gabi and her family, especially since she wasn’t experiencing any pain at the time.

“I knew something was wrong because Gabi couldn’t walk in a straight line or ride a bike,” said Gabi’s mom, Petrice Young. “Since the surgery, she’s a different person. Dr. Oetgen literally changed her life.”

Gabi was discharged just four days after her spinal surgery.

As a junior in her high school’s biomedical magnet program, Gabi actively participates as a cheerleader and is currently in her third year as a member of the softball team – something she’d never done before. She maintains a 4.0 GPA and participates in community service regularly.

Her dream career? Becoming an orthopaedic surgeon one day, expressing that her personal experience with the surgery will contribute to fostering a unique and meaningful patient-doctor relationship. She is extremely grateful to Dr. Oetgen for performing the surgery and influencing her career goals.

A program developed to treat the wide range of pediatric spine patients

Since 2015, patients undergoing spinal fusion at Children’s National have been part of the first-of-its-kind pediatric Spinal Fusion Surgical Home care model. This model was developed by a multidisciplinary team with the goal to streamline care for adolescent idiopathic scoliosis (AIS) patients with an emphasis on increasing quality outcomes.

The team’s coordinated approach means they can deliver care more efficiently, resulting in shorter hospital stays and allowing children to come home as soon as it is medically safe. As a leader in this care concept, Children’s National has standardized the infection-control process, pain-management pathway and physical-therapy program for AIS patients who require spinal fusion.

What is AIS?

Gabi playing softball

Gabi actively participates as a cheerleader and is currently in her third year as a member of the softball team – something she’d never done before.

AIS is a condition of the spine, which typically affects children between the ages of 10 and 14 years old, marked by an abnormal side-to-side shaped curve that measures 10 degrees or greater. There are two types of curves associated with idiopathic scoliosis – C-shaped (one curve) and S-shaped (two curves). Along with the curve, the spine also rotates or twists, pulling the ribs along with it. Children with idiopathic scoliosis may experience uneven hips and shoulders and the head may not be centered with the rest of the body.

The period of rapid growth poses the greatest risk for the progression of a child’s spinal curve. Even after reaching skeletal maturity, a child with a curve exceeding 50 degrees may continue to progress at a rate of one to two degrees per year throughout their lifetime.

Treatment of early onset scoliosis

Early onset scoliosis (EOS) is a curve in the spine present before the age of 10. Diagnosing and addressing spinal deformities in children before the age of 10 can significantly impact the long-term outcomes. Close monitoring allows healthcare professionals to intervene promptly if necessary, preventing the progression of the spinal curve.

Minimally invasive techniques are particularly advantageous in pediatric cases, as they often result in shorter recovery times, reduced pain and minimized disruption to a child’s normal activities. This approach aligns with the goal of returning the child to a normal, active life as quickly and seamlessly as possible. Some minimally invasive techniques for EOS include:

  • Casting – young children may be placed in what is called Mehta casting. In this advanced casting technique, the child’s chest and abdomen are casted. Every two to four months the cast is replaced as the child grows.
  • MAGEC™ (MAGnetic Expansion Control) spinal growing rods – these rods are surgically attached to the spine and doctors use an external remote control outside of the body to lengthen the magnetically controlled rod as the child grows. Traditional growing rods require multiple surgeries.

As part of the Growing Spine Study Group, Children’s National collaborates with other hospitals around the world to enhance care for EOS and related deformities.

The right facility

Children’s National is equipped to treat the most severe and high-risk cases of scoliosis. In rare cases, severe spinal curves can require month-long inpatient spinal halo-gravity traction prior to surgery. This can impede a child’s quality of life just as severely as the condition itself, often making eating, breathing and moving difficult.

Spinal halo-gravity traction can reduce the degree of surgical intervention necessary by accomplishing some gradual straightening of the spine prior to spinal fusion procedures. For severe spinal deformities, this has been shown to improve the safety and effectiveness of the final surgical procedure.

Recognizing the challenges posed by both the condition and its treatment, the surgery team at Children’s National endeavors to coordinate cases, providing patients with mutual support throughout the traction process.

Read more about our advances in Orthopaedic Surgery and Sports Medicine.

ICEOS logo

Global summit to address complex pediatric scoliosis

ICEOS logoThe 2023 International Congress on Early Onset Scoliosis and the Growing Spine (ICEOS) was a three-day conference for surgeons and health professionals from around the world. The sessions focused on solutions for pediatric spine deformities. Matthew Oetgen, M.D., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital, was a member of the faculty.

Session highlights included:

  • Pre-Course: Pediatric Spine Study Group (PSSG) Mini-Research Symposium – Considerations for your biosketch, regulatory and IRB
  • How Do You Propel Your Research Team

“Overall this was a great meeting with valuable content,” says Dr. Oetgen. “Learning and teaching alongside fellow orthopaedic leaders is a fantastic opportunity for everyone involved.”

Dr. Oetgen participated in the following sessions:

  • Timing of Hemivertebra Excision
  • Let’s Debate! nView Workshop – 3D imaging and guidance, available technologies for pediatric spine and when to use them
  • Case-Based Learning – Congenital Scoliosis

The 2024 ICEOS Meeting will be November 13-15 in Phoenix, AZ.

IPOS logo

Global gathering of orthopaedic leaders at IPOS

IPOS logoThe 2023 International Pediatric Orthopaedic Symposium (IPOS) was a comprehensive four-day conference that addressed a wide range of pediatric and adolescent orthopaedic conditions. The meeting focused on hands-on teaching and state-of-the-art surgical approaches to pediatric orthopaedic surgery.

“IPOS is unique in that, unlike many scientific meetings, there is less emphasis on original scientific content,” says Matthew Oetgen, M.D., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital and one of the faculty members of the symposium. “Instead, the focus is on providing instruction, hands-on learning and the introduction of new technology.”

Some session highlights include:

  • Essentials of Pediatric Orthopaedics – lectures on upper extremity and lower extremity trauma.
  • The Course for Mid-Career Surgeons – a talk full of valuable insights on mentorship and paying it forward.
  • The Author’s Preferred Techniques – surgical technique lectures on cavus foot reconstruction and repairing pediatric thumb fractures.

“Each of these sessions offer unique takeaways for a variety of learning levels from residents and fellows to course faculty members like myself,” says Dr. Oetgen. “Overall, this year’s IPOS was very educational and I was proud to have had a number of Children’s National faculty attend and experience the course.”

Dr. Oetgen participated in several sessions:

  • Essentials of Pediatric Orthopaedics II and III – Session Moderator
  • Essentials of Pediatric Orthopaedics: Back Pain, Kyphosis and Disc Disease – Lecture
  • Top Gun Surgical Simulation Competition – Faculty Leader
  • Hands-On Workshop – Pinning an Elbow – Faculty
  • Reconsidering How You Should Code for Fractures
  • EMR Hacks to Improve Wellness and Patient Experience – Lecture
  • Industry Spotlight Session nView Medical – Next Generation Pediatric 3D Imaging and Navigation – Simplifying Your Current Surgical Workflow – Lecture
    • Children’s National is was the first pediatric hospital in the country to use the 3D imaging technology by nView Medical in the operating room. Researchers studied its impact in the area of pediatric spine surgery, navigation and imaging. The team continues to be a major investigator and knowledge leader with this technology. Moving forward, researchers plan to study the technology’s impact in pediatric orthopaedic surgery.

 

collage of news outlet logos

Children’s National in the News: 2023

collage of news outlet logos
Explore some of the notable medical advancements and stories of bravery that defined 2023, showcasing the steadfast commitment of healthcare professionals at Children’s National Hospital and the resilient spirit of the children they support. Delve into our 2023 news highlights for more.

1. COVID during pregnancy dramatically increases the risk of complications and maternal death, large new study finds

According to a study published in British Medical Journal Global Health, women who get COVID during pregnancy are nearly eight times more likely to die and face a significantly elevated risk of ICU admission and pneumonia. Sarah Mulkey, M.D., prenatal-neonatologist neurologist, discussed findings based on her work with pregnant women and their babies.
(Fortune)

2. Rest isn’t necessarily best for concussion recovery in children, study says

A study led by Christopher Vaughan, Psy.D., pediatric neuropsychologist, suggests that — despite what many people may presume — getting kids back to school quickly is the best way to boost their chance for a rapid recovery after a concussion.
(CNN)

3. Pediatric hospital beds are in high demand for ailing children. Here’s why

David Wessel, M.D., executive vice president, chief medical officer and physician-in-chief, explained that one reason parents were still having trouble getting their children beds in a pediatric hospital or a pediatric unit after the fall 2022 respiratory surge is that pediatric hospitals are paid less by insurance.
(CNN)

4. Anisha Abraham details impact of social media use on children: ‘True mental health crisis’

Anisha Abraham, M.D., M.P.H., chief of the Division of Adolescent and Young Adult Medicine, joined America’s Newsroom to discuss the impact social media access has had on children’s mental health.
(FOX News)

5. Saving Antonio: Can a renowned hospital keep a boy from being shot again?

After 13-year-old Antonio was nearly killed outside his mom’s apartment, Children’s National Hospital went beyond treating his bullet wounds. Read how our Youth Violence Intervention Program team supported him and his family during his recovery.
(The Washington Post)

6. Formerly conjoined twins reunite with doctors who separated them

Erin and Jade Buckles underwent a successful separation at Children’s National Hospital. Nearly 20 years later they returned to meet with some of the medical staff who helped make it happen.
(Good Morning America)

7. Asthma mortality rates differ by location, race/ethnicity, age

Shilpa Patel, M.D., M.P.H., medical director of the Children’s National IMPACT DC Asthma Clinic, weighed in on a letter published in Annals of Allergy, Asthma & Immunology, asserting that the disparities in mortality due to asthma in the United States vary based on whether they occurred in a hospital, ethnicity or race and age of the patient.
(Healio)

8. How one Afghan family made the perilous journey across the U.S.-Mexico border

After one family embarked on a perilous journey from Afghanistan through Mexico to the U.S.-Mexico border, they eventually secured entry to the U.S. where Karen Smith, M.D., medical director of Global Services, aided the family’s transition and provided their daughter with necessary immediate medical treatment.
(NPR)

9. When a child is shot, doctors must heal more than just bullet holes

With the number of young people shot by guns on the rise in the U.S., providers and staff at Children’s National Hospital are trying to break the cycle of violence. But it’s not just the physical wounds though that need treating: young victims may also need help getting back on the right track — whether that means enrolling in school, finding a new group of friends or getting a job.
(BBC News)

10. This 6-year-old is a pioneer in the quest to treat a deadly brain tumor

Callie, a 6-year-old diagnosed with diffuse intrinsic pontine glioma, was treated with low-intensity focused ultrasound (LIFU) at Children’s National Hospital and is the second child in the world to receive this treatment for a brain tumor. LIFU is an emerging technology that experts like Hasan Syed, M.D., and Adrianna Fonseca, M.D., are trialing to treat this fatal childhood brain tumor.
(The Washington Post)

11. F.D.A. approves sickle cell treatments, including one that uses CRISPR

The FDA approved a new genetic therapy, giving people with sickle cell disease new opportunities to eliminate their symptoms. David Jacobsohn, M.B.A., M.D., confirmed that Children’s National Hospital is one of the authorized treatment centers and talked about giving priority to the sickest patients if they are on Vertex’s list.
(The New York Times)

12. 6-year-old fulfils wish to dance in the Nutcracker

After the potential need for open-heart surgery threatened Caroline’s Nutcracker performance, Manan Desai, M.D., a cardiac surgeon, figured out a less invasive procedure to help reduce her recovery time so she could perform in time for the holidays.
(Good Morning America)

x-ray showing a hip

Hip preservation: Moving the needle in patient care

x-ray showing a hip

Hip preservation treats a wide variety of conditions such as hip dysplasia, hip impingement, hip torsion/rotation abnormalities, hip synovitis, snapping hip and hip labrum tears.

The Hip Preservation Program at Children’s National Hospital offers advanced care to children and adults with hip pain, providing a continuum of care that extends well into adulthood. Jeffrey Peck, M.D., an orthopaedic surgeon with subspecialty interests in pediatric and young adult hip preservation, discusses the program and what Children’s National is doing to move the needle forward in patient care.

Q: What is hip preservation and what are common conditions it addresses?

A: The field of hip preservation is dedicated to diagnosing and treating hip conditions that result in hip pain and can potentially result in hip degeneration.

There are several potential conditions that can lead to hip pain and eventual hip joint degeneration.  These include atypical anatomy in and around the hip joint, which can be congenital, developmental or traumatic in origin. Strains and sprains of the muscles and ligaments around the hip may also cause hip joint pain. Hip preservation treats a wide variety of conditions such as hip dysplasia, hip impingement, hip torsion/rotation abnormalities, hip synovitis, snapping hip and hip labrum tears.

Q: Who is affected and when should a patient seek out an orthopaedic expert?

A: The people most often affected by conditions treated through hip preservation are adolescents and young adults up to age 45 years old who develop hip pain. When hip pain does not subside, it can be due to a condition that has resulted in hip joint inflammation that may eventually begin to cause hip joint degeneration leading to arthritis if the condition is not treated. If a patient has hip pain that lasts for multiple months without improving, it is prudent to seek evaluation with a hip preservation orthopaedic surgeon specialist.

Q: What is Children’s National doing to move the needle for hip preservation patients?

A: Children’s National cares for patients with hip pain using an integrated care team, featuring a Hip Preservation fellowship trained surgeon, physiatry experts, sports psychologists, radiologists and physical therapists with a focus on adolescents and young adults. We work in a collaborative environment with the shared goal of helping patients with hip pain return to living life without the pain that has held them back.

The Children’s National team also collects patient reported outcome scores to better understand the severity of patient symptoms and, later, how surgery has improved those symptoms. Additionally, Children’s National is engaged in research endeavors evaluating hip conditions and how patients have responded to treatment. By pursuing these efforts, we not only assist the patients we see today, but also contribute to advancing care to better help future patients.

Q: What excites you about the future for the field of hip preservation?

A: The field of Hip Preservation is a young specialty within orthopaedic surgery that has demonstrated consistently positive outcomes for patients who previously had very limited treatment options for their hip pain. With this comparative newness comes continual innovation and advancement as we learn more about how hip pain can occur and what we can do to best treat that pain. Procedures that we perform at Children’s National such as the Ganz Periacetabular Osteotomy (PAO) and the use of hip arthroscopy to treat hip impingement are relatively new innovations in the field of orthopaedics that can provide immense relief to patients having hip pain.

2023 with a lightbulb

The best of 2023 from Innovation District

2023 with a lightbulbAdvanced 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)

Matthew Oetgen

Advancing care: Innovations and learning in Spinal Fusion Surgical Home

Matthew Oetgen

“We are committed to discovering methods that eliminate variability in the care process and enhance the quality of care for pediatric orthopaedic patients,” says Matthew Oetgen, M.D., M.B.A., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital.

“We are committed to discovering methods that eliminate variability in the care process and enhance the quality of care for pediatric orthopaedic patients,” says Matthew Oetgen, M.D., M.B.A., chief of Orthopaedic Surgery and Sports Medicine at Children’s National Hospital. “The Spinal Fusion Surgical Home model is specifically designed for young patients with adolescent idiopathic scoliosis (AIS), laying the foundation for numerous other children undergoing various surgical procedures.”

The first-of-its-kind for pediatric patients, the Children’s National Spinal Fusion Surgical Home continues to streamline care with an emphasis on increasing quality outcomes for patients. At its inception, the program implemented a newly developed model of care to optimize the spinal fusion process for AIS patients. As a leader in this care concept, Children’s National has standardized the infection-control process, pain-management pathway and physical-therapy program for patients undergoing spinal fusion.

The patient benefit

A patient with a right thoracic deformity of approximately 33 degrees and a left thoracolumbar deformity of 54 degrees was treated with an instrumented posterior spinal fusion from T4-L3 and was admitted for 5 days post-operatively.

Children’s National has implemented standardized protocols and ongoing enhancements, including the establishment of a specialized surgical team and the integration of a Lean process analysis. This has led to a notable decrease in the average length of stay for spinal fusion patients from about five days to three days. The surgical home has also reduced the transfusion rate from 30% to 12% and patient pain scores have decreased. Additionally, the number of patients who have returned to the emergency department due to complications has also decreased.

In a case prior to the surgical home model being established, a patient with a right thoracic deformity of approximately 33 degrees and a left thoracolumbar deformity of 54 degrees was treated with an instrumented posterior spinal fusion from T4-L3 and was admitted for 5 days post-operatively. Per standard protocol at the time, this patient stayed in the intensive care unit (ICU) immediately after surgery for a day and a half.

In another case, a patient with a right thoracic deformity of 58 degrees and left thoracolumbar deformity of 67 degrees was treated with a similar instrumented posterior spinal fusion from T4-L3 and admitted for 2.5 days post-operatively. With the new model in place, this patient did not need any time in the ICU, required less length of stay and had less loss of blood.

“By working together with all our care givers, we have been able to standardize our care and decrease care variability. This has proven effective at improving outcomes allowing our patients to recover faster and avoid complications. These cases are an example of our system being primed to treat children with ever increasing complexity with better and better outcomes,” says Dr. Oetgen.

x-ray of a patient with a right thoracic deformity

A patient with a right thoracic deformity of 58 degrees and left thoracolumbar deformity of 67 degrees was treated with a similar instrumented posterior spinal fusion from T4-L3 and admitted for 2.5 days post-operatively.

Children’s National leads the way

Over the years, the Spinal Fusion Surgical Home has continuously fine-tuned its approach, resulting in greater success outcomes and better patient care. Children’s National orthopaedic experts have published many articles highlighting this evolution:

  • Lean process mapping: Implementation of a standardized care pathway developed with the use of the Lean process mapping technique to create an evidence-based protocol for preoperative, operative, postoperative and post-discharge care. Since 2015 our program has demonstrated effective and sustained improvements to the care of patients and decreased postoperative length of stay.
  • Significant decrease in perioperative blood transfusions: A study published in Pediatric Anesthesia details team findings that implementation of blood-conservation strategies as part of a perioperative surgical home for patients with AIS undergoing posterior spine fusion resulted in significant decrease in perioperative blood transfusions.
  • Reduced patient length of stay: An in-depth Lean process mapping technique improved outcomes and decreased length of stay of patients, as outlined in an article in Spine Deformity, through use of a standardized care pathway. Work to improve surgical efficiency, intraoperative fluid and blood management, and postoperative pain management continues to further improve effectiveness.
  • Standardization of intraoperative pain control: A study published in the Journal of Anesthesia on the implementation of the medical home model for AIS-improved pain control and decreased opioid consumption and hospital stay. Through pathway standardization, consistent multi-modal analgesia and early mobilization, the medical home model improved outcomes and is our standard of care.
  • Reduction in perioperative outcome disparities: Acknowledging the well-documented racial and ethnic disparities in treatment and perioperative outcomes for patients across healthcare, the team documented and published findings that this model was able to reduce racial and ethnic disparities in length of stay and pain scores.
  • Dedicated surgical team: Having dedicated spine personnel in the operating room decreases surgical time and improves clinical outcomes, as detailed in a study on Spine Deformity.

Read more about our advances in Orthopaedic Surgery and Sports Medicine.

ARPA-H logo

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

ARPA-H logoThe 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.

post-op x-ray of internal brace augmentation surgery

Innovative internal brace augmentation improves long-term foot stability

The use of internal brace (IB) augmentation leads to significantly improved long-term foot stability in flatfoot reconstructive surgery for children with cerebral palsy (CP) and pes planovalgus (flat foot) deformities, according to data presented by researchers at the American Academy for Cerebral Palsy and Developmental Medicine annual meeting.

Moving the field forward

The study looked at 58 patients − 31 without IB augmentation and 27 with IB augmentation. Both cohorts maintained improved radiographic indices at the final 24-month timepoint. However, weightbearing radiographs for the IB augmentation group had less midfoot collapse, maintaining a statistically significant difference in all radiographic parameters two years following the index procedure.

“Internal brace augmentation is an innovative surgical technique that provides additional stability to the medial column soft tissues following lateral collateral ligament (LCL) surgery,” says lead author Sean Tabaie, M.S., M.D., F.A.A.O.S., pediatric orthopaedic surgeon at Children’s National Hospital and  developer of this surgical technique.

The patient benefit

“Pes planovalgus deformities are common in children with CP and with painful progression, surgery is often indicated,” says Dr. Tabaie. “This procedure will help prevent mid-foot collapse and better maintain long-term foot shape when weightbearing.”

This novel surgical technique helps to maintain proper biomechanical orientation of the foot following LCL for correction of a pes planovagus foot deformity in the ambulatory pediatric CP population. Patients who received IB augmentation demonstrated consistently better radiographic parameters, including talar-first metatarsal angles and talonavicular coverage angles compared to those who underwent surgery without IB augmentation.

Children’s National Hospital leads the way

Children’s National demonstrates leadership in this area through its involvement in innovative clinical research including the surgical approach outlined in this study. This work is unique for two reasons:

  • Patient population: The study focuses on a specific and complex patient population—children with CP and pes planovalgus foot deformities. This highlights Children’s National Hospital’s commitment to addressing the individual healthcare needs of pediatric patients with special conditions.
  • Surgical innovation: The use of IB augmentation as a surgical technique is innovative. Children’s National is at the forefront of exploring new approaches to improve outcomes and quality of life for children with CP.

Alliance for Pediatric Device Innovation consortium members

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

Alliance for Pediatric Device Innovation consortium membersChildren’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.

 

Patient and doctor demoing Rare-CAP technology

M.D. in your pocket: New platform allows rare disease patients to carry medical advice everywhere

When someone has a rare disease, a trip to the emergency room can be a daunting experience: Patients and their caregivers must share the particulars of their illness or injury, with the added burden of downloading a non-specialist on the details of a rare diagnosis that may change treatment decisions.

Innovators at Children’s National Hospital and Vanderbilt University Medical Center, supported by Takeda, are trying to simplify that experience using a new web-based platform called the Rare Disease Clinical Activity Protocols, or Rare-CAP. This revolutionary collection of medical information allows patients to carry the latest research-based guidance about their rare disorders in their phones, providing a simple QR code that can open a trove of considerations for any medical provider to evaluate as they work through treatment options for someone with an underlying rare disease.

“No one should worry about what happens when they need medical help, especially patients with rare diseases,” said Debra Regier, M.D., division chief of Genetics and Metabolism at Children’s National and Rare-CAP’s lead medical advisor. “We built this new tool because I have watched as my patient-families have wound up in an emergency room — after all, kids get sprains or fractures — but they don’t have the expertise of a rare disease specialist with them. My hope is that they’re going to pull out their phones and access Rare-CAP, which will explain their rare disease to a new provider who can provide more thoughtful and meaningful care.”

The big picture

A rare disease is defined as any disorder that affects less than 200,000 people in the United States. Some 30 million Americans are believed to be living with one of the 7,000 known rare disorders tracked by the National Organization of Rare Diseases (NORD). Led by Dr. Regier, the Rare Disease Institute at Children’s National is one of 40 NORD centers for excellence in the country that provide care, guidance and leadership for the wide array of disorders that make up the rare disease community.

While a key goal of Rare-CAP is to bolster patient self-advocacy, the platform will also allow medical providers to proactively search for protocols on rare diseases when they know they need specialized advice from experts at Children’s National, a network of tertiary care centers and patient organizations.

As a leading values-based, R&D-driven biopharmaceutical company, Takeda has committed $3.85 million to the project to help activate meaningful change and empower a brighter future for rare disease communities, providing a unique understanding of the struggle that patients and caregivers face when they need care.

“Our team, alongside the medical and rare disease community, saw the need for a single portal to collect standardized care protocols, and we are thrilled to see this innovative tool come to life,” said Tom Koutsavlis, M.D., head of U.S. Medical Affairs at Takeda. “People with rare diseases and their caregivers need faster access to authoritative medical information that providers anywhere can act on, this will lead to improving the standard of care, accelerating time to diagnosis and breaking down barriers to increase equitable access.”

The patient benefit

The creators of Rare-CAP imagined its use in a wide range of settings, including emergency rooms, surgical suites, dental offices, urgent care offices and school clinics. The platform will eventually profile thousands of rare diseases and lay out the implications for care, while also creating a dynamic conversation among users who can offer updates based on real-world experience and changes in medical guidance.

“Our patients are unique, and so is this tool,” Dr. Regier said. “As we roll out Rare-CAP, we believe it is just the beginning of the conversation to expand the platform and see its power for the patient and provider grow, with each entry and each new rare disease that’s added to the conversation.”

AAP conference logo

Children’s National Hospital at the 2023 American Academy of Pediatrics meeting

There will be over 20 Children’s National Hospital-affiliated participants at this year’s American Academy of Pediatrics National Conference and Exhibition. The meeting will take place in Washington, D.C., from October 20 – October 24. We have compiled their sessions into a mini schedule below.

 

Date Time Presenter Title Division
10/20/2023 8:30 AM Vanessa Madrigal, M.D., M.S.C.E. Section on Cardiology & Cardiac Surgery Program: Day 1 Critical Care
10/20/2023 2:30 PM Kibileri Williams, M.B.B.S Appy Hour: a Current Update on Pediatric Appendicitis Surgery
10/20/2023 3:30 PM Roopa Kanakatti Shankar, M.D., M.S. Precocious Puberty: Puberty Suppression or Not? Endocrinology
10/21/2023 7:30 AM Allison Markowsky, M.D. What is Trending in the Newborn Nursery: Controversies and Evidence Hospital Medicine
10/21/2023 8:00 AM Jessica Herstek, M.D. Joint Program: Council on Clinical Information Technology and Council on Quality Improvement and Patient Safety Medical Informatics
10/21/2023 8:00 AM Nazrat Mirza, M.D., Sc.D. Section on Obesity Program IDEAL Clinic (Obesity Program)
10/21/2023 8:00 AM Hans Pohl, M.D. Section on Urology Program: Day 2 Urology
10/21/2023 9:00 AM Anil Darbari, M.D., M.B.B.S., M.B.A. Constipation: Getting it to Work Out in the End Gastroenterology, Hepatology and Nutrition
10/21/2023 9:00 AM Kibileri Williams, M.B.B.S Appy Hour: a Current Update on Pediatric Appendicitis Surgery
10/21/2023 1:30 PM Olanrewaju (Lanre) Falusi, M.D. Educational Program and Annual Assembly for Medical Students, Residents, and Fellowship Trainees Pediatrician
10/21/2023 2:00 PM Brian Reilly, M.D. Noise 201 – More than Headphones! Otolaryngology
10/21/2023 2:00 PM Erin Teeple, M.D. Hernias, Hydroceles, and Undescended Testicles: When to Wait and When to Operate Surgeon
10/21/2023 3:30 PM Amanda Stewart, M.D. Section on Emergency Medicine Program: Day 2 Emergency Medicine
10/21/2023 3:30 PM Shideh Majidi, M.D., M.S.C.S. Healthcare Disparities in Management of Type 1 Diabetes and Diabetes Technology Endocrinology
10/21/2023 3:30 PM Natasha Shur, M.D. Genetic Testing Boot Camp Geneticist (RDI)
10/21/2023 5:00 PM Danielle Dooley, M.D., M.Phil Connecting School Systems and Health Systems: Successes and Opportunities Pediatrician
10/22/2023 8:00 AM Jaytoya Manget, DNP, FNP Pediatricians and School Attendance: Innovative Approaches to Prevent Chronic Absenteeism
10/22/2023 8:00 AM Simone Lawson, M.D. Section on Emergency Medicine Program: Day 3 Emergency Medicine
10/22/2023 8:00 AM Hans Pohl, M.D. Section on Urology Program: Day 3 Urology
10/22/2023 1:00 PM Lenore Jarvis, M.D., M.Ed. Section on Early Career Physicians Program
10/22/2023 5:00 PM Brian Reilly, M.D. Pediatric Hearing Loss: What’s New in Diagnostics, Prevention and Treatments Otolaryngology
10/23/2023 8:00 AM Rosemary Thomas-Mohtat, M.D. Point-of-Care Ultrasound Fundamentals Course Emergency Medicine
10/23/2023 9:00 AM Matthew Oetgen, M.D., M.B.A. Section on Radiology Program: Imaging Diagnosis and Management of Osteoarticular Infections Orthopaedic Surgery and Sports Medicine
10/23/2023 9:00 AM Christina Feng, M.D. Masses for the Masses: Abdominal Masses in Children Surgeon
10/23/2023 9:00 AM Narendra Shet, M.D. Section on Radiology Program: Imaging Diagnosis and Management of Osteoarticular Infections Radiology
10/23/2023 9:00 AM Shireen Atabaki, M.D., M.P.H. Section on Advances in Therapeutics and Technology Program Telemedicine
10/23/2023 1:00 PM Brian Reilly, M.D. Pediatric Otolaryngology: Back to Basics Otolaryngology
10/23/2023 1:00 PM Sonali Basu, M.D. Point-of-Care Ultrasound Critical Competency Course CCM
10/23/2023 1:00 PM Vanessa Madrigal, M.D. Joint Program: Section on Bioethics, Section on LGBT Health and Wellness and Section on Minority Health, Equity, and Inclusion Critical Care
10/23/2023 2:00 PM Rebecca Persky, M.D. Menstrual Disorders: Primary or Secondary Amenorrhea Endocrinology
10/23/2023 5:00 PM Christina Feng, M.D. Masses for the Masses: Abdominal Masses in Children Surgeon
10/24/2023 9:00 AM Vanessa Madrigal, M.D. Section Showcase: Applying Ethics Principles and Tools To Advocate for Vulnerable Populations Critical Care

 

U.S. News Badges

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

U.S. News BadgesChildren’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:

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

girl hugging boy in wheelchair

Comparison of immobilization techniques following hip reconstruction surgery in children with cerebral palsy

girl hugging boy in wheelchair

Currently, there is no standardized protocol or consensus regarding post-operative immobilization following hip reconstruction in children with cerebral palsy or with other neuromuscular conditions.

A new study, led by Sean Tabaie, M.D., and published in Cureus, evaluated the effects of several methods of postoperative immobilization to determine which technique has the fewest complications.

Why it matters

Currently, there is no standardized protocol or consensus regarding post-operative immobilization following hip reconstruction in children with cerebral palsy or with other neuromuscular conditions.

What we learned

Findings provide evidence that there are no significant clinical ramifications of using less restrictive immobilization types such as abduction pillows in patients undergoing hip reconstruction surgery. There was no significant difference in length of stay, pain control duration or complication rates among the three methods of immobilization tested in the study.

What’s next

Further analysis is warranted to gather sufficient data of patients immobilized with an abduction pillow after skeletal osteotomies in conjunction with an anterior hip open reduction to definitively recommend its use versus a more restrictive option in the setting of an open reduction.

You can read the full study “Evaluating Postoperative Immobilization Following Hip Reconstruction in Children with Cerebral Palsy” in Cureus.

3d illustration of a lumbar spine injection

Epidural analgesia best option for kids after neuromuscular hip reconstruction?

3d illustration of a lumbar spine injection

A study showed that post-operative use of epidural analgesia in patients with neuromuscular conditions provided similar outcomes to traditional pain management regimens.

Sean Tabaie, M.D., pediatric orthopaedic surgeon and medical director of the motion capture lab at Children’s National Hospital, led a retrospective study to determine whether post-operative use of epidural analgesia in patients with neuromuscular conditions, such as cerebral palsy, provided similar outcomes with regard to pain scores, length of stay, duration of foley placement, duration of pain control and complications as compared to traditional pain management regimens.

The study showed that the use of epidural analgesia was associated with comparable pain scores, despite the increased length of stay and duration of Foley placement.

Why it matters

Neuromuscular conditions, such as cerebral palsy, are the most common motor disabilities in the pediatric population. Children with these conditions frequently have accompanying hip deformities that require pelvic and femur osteotomy to correct the spastic hip dislocations.

Studies suggest that children with cerebral palsy already experience twice as many complications and have high reoperation rates following hip surgery compared to their non-cerebral palsy counterparts. Therefore, to optimize outcomes in an already at-risk patient population – likely to undergo multiple procedures to correct musculoskeletal abnormalities – it is crucial to minimize opioid usage given its addictive nature and side effects such as constipation, sedation and tolerance.

Sean Tabaie

Dr. Sean Tabaie

What’s next

“We believe the present study can serve as a foundation for future prospective and multi-center studies, which should aim to investigate dose and timing of epidural analgesia in children with neuromuscular conditions with a particular focus on surgical approach, side effects and time to return to activity,” says Dr. Tabaie.

Given the scarcity of data surrounding the use of epidural anesthesia in children with neuromuscular conditions, future research should seek to further investigate the efficacy of epidural analgesia for post-operative pain management in children with neuromuscular conditions.

You can read the full study “Use of Epidural Analgesia in Children With Neuromuscular Conditions Following Hip Reconstruction” in Cureus.

Authors on the study from Children’s National include Sean Tabaie, M.D.

Osteopath examining boy's spine

Early-onset scoliosis etiology has greatest impact on long-term patient-reported outcomes

Osteopath examining boy's spine

A new study found underlying etiology of early-onset scoliosis has a significant impact on long-term patient reported outcomes.

Health-related quality of life is an important parameter to assess in the treatment of early-onset scoliosis (EOS). Understanding the impact of surgical intervention on a patient’s quality of life will help set patient expectations and can be useful in shared decision making around treatment options. A study published in Spine Deformity found underlying etiology of EOS has a significant impact on long-term patient reported outcomes.

What’s been the hold-up in the field?

“There is limited understanding of how our surgical interventions affect patient reported quality of life because a validated patient outcome tool has been lacking,” says Matthew Oetgen, M.D., M.B.A., chief of Orthopaedics at Children’s National Hospital and one of the study’s authors. “The recent development and use of the Early Onset Scoliosis Questionnaire (EOSQ) allows us to assess patient reported outcomes.”

How does this work move the field forward?

Underlying etiology has a significant impact in the long-term patient reported outcome. This information will allow surgeons and families to understand the impact of surgical intervention, set expectations, give a baseline for expected patient benefit from treatments and indicate when other assessments should be undertaken to improve patient outcomes.

How will this work benefit patients?

Many patients report good outcomes with surgical intervention for EOS. This will allow us to reassure patients and families we can make a positive impact in their lives when treating EOS, which is a very stressful diagnosis.

You can read the full study, Impact of surgical treatment on parent-reported health related quality of life measures in early-onset scoliosis: stable but no improvement at 2 years, in Spine Deformity.

images of baby's legs and casts

Innovation in clubfoot management using 3D anatomical mapping

Idiopathic clubfoot is one the most common congenital deformities of the lower extremity. Its incidence is reported to be 1-2 cases per 1000 live births.

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. The study, presented at the SPIE Medical Imaging Conference 2022, uses a novel photogrammetry method to gather 3D surface images of infant clubfoot anatomy and assess the foot position and correction.

Even better, this approach captures the images without additional radiation exposure.

“We’re not changing the gold standard of Ponseti casting, we’re adding to it,” says Sean Tabaie, M.D., orthopaedic surgeon at Children’s National and one of the study’s authors. “The more families we have in this study the greater the potential to move this field forward.”

Read more about the study, Development of a novel photogrammetry method for acquiring 3D surface models of infant clubfoot anatomy.

red and grey kidney illustration

Cardiovascular and bone diseases in chronic kidney disease

red and grey kidney illustration

A new study reviews cardiovascular and bone diseases in chronic kidney disease and end-stage kidney disease patients with a focus on pediatric issues and concerns.

In a study published by Advances in Chronic Kidney Disease and co-authored by Aadil Kakajiwala, M.D., MSCI, critical care specialist and nephrologist at Children’s National Hospital, a team reviewed cardiovascular and bone diseases in chronic kidney disease and end-stage kidney disease patients with a focus on pediatric issues and concerns.

Chronic kidney disease is common and causes significant morbidity including shortened lifespans and decrease in quality of life for patients. The major cause of mortality in chronic kidney disease is cardiovascular disease. Cardiovascular disease within the chronic kidney disease population is closely tied to disordered calcium and phosphorus metabolism. The metabolic bone disease of chronic kidney disease encompasses vascular calcification and the development of long-term cardiovascular disease.

Recent data suggest that aggressive management of metabolic bone disease can augment and improve cardiovascular disease status. Pediatric nephrologists need to manage the metabolic bone disease while keeping the ongoing linear growth and skeletal maturation in mind, which may be delayed in chronic kidney disease.

Read the full study in Advances in Chronic Kidney Disease.