Public Health Archives

Call for action on healthcare sustainability

June 18, 2024

New research reveals the U.S. healthcare system’s contribution to greenhouse gas (GHG) emissions and climate change is disproportionately high and harms the public.

A recent review reveals the U.S. healthcare system’s contribution to greenhouse gas (GHG) emissions and climate change is disproportionately high and harms the public. The findings are part of a series of articles being co-published by Open Forum Infectious Diseases and the Journal of the Pediatric Infectious Diseases Society, which highlight the effect of climate change and air pollution on global health and infectious diseases.

“Our current policies and practices on healthcare waste and emissions do not do justice to the health of the children we want to improve,” said Shreya Doshi, pediatric fellow at Children’s National. “The U.S. contributes to 27% of the global healthcare industry GHG emissions (greater than any other country). Infectious diseases professionals can use their background in antimicrobial stewardship and infection prevention and control to lead projects in healthcare sustainability and make a difference.”

Q: How will this work benefit patients?

A: Ultimately, when different specialties and organizations in healthcare make changes to their practices, we will have fewer GHG emissions and a healthier planet for our patients. There is also strong evidence that climate change affects vulnerable communities and countries disproportionately and we hope to change that. We want to provide safe healthcare to children from the current generation without taking away resources from the future generation.

Q: What’s been the hold up in the field?

A: Lack of awareness and time needed for change in practices and policies. For any organization leadership buy-in is needed when it comes to healthcare sustainability. Children’s National actually received a sustainability award two years ago for reducing anesthetic gases.

Q: What did you find that excites you? What are you hoping to discover?

A: There is so much yet to be explored at the intersection of infectious diseases and healthcare sustainability and that’s exciting! No matter what you do within the healthcare field — there is room for improvement and room for reduction in waste and GHG emissions. It is time to reassess and, rethink and innovate our practices. Having collaborators in other specialties who are passionate about the sustainability can help us move the needle faster. Lastly, it is important to know that work in healthcare sustainability has huge cost savings, so it’s a win for the financial health of the institution and for the planet!

You can read the full study, Healthcare Sustainability to Address Climate Change: Call for Action to the Infectious Diseases Community, in the Open Forum Infectious Diseases and the Journal of the Pediatric Infectious Diseases Society.

Jennifer Cully, D.M.D, M.Ed., appointed division chief of Oral Health

June 18, 2024

“I am honored to continue my service to Children’s National by stepping into this leadership role,” said Dr. Cully.

Children’s National Hospital has appointed Jennifer Cully, D.M.D, M.Ed., as division chief of Oral Health.

Dr. Cully is currently a pediatric dentist and director of research for the Division of Oral Health at Children’s National, where she manages the division’s research initiatives. She’s also an associate professor of pediatrics at George Washington University.

“I am honored to continue my service to Children’s National by stepping into this leadership role,” said Dr. Cully.

Dr. Cully earned her bachelor’s degree in biology from the College of William & Mary, her Doctor of Medicine in Dentistry degree from the University of Medicine and Dentistry of New Jersey and received a certificate in pediatric dentistry from Children’s National. She received her master’s on Education from the University of Cincinnati. Dr. Cully is a fellow of the American Academy of Pediatric Dentistry and the American College of Dentists and will be inducted as a fellow in the International College of Dentists this fall.

“As a leader in the field of pediatric dentistry, Dr. Cully will play an integral role in helping to advance our comprehensive oral health program,” said Dr. Nathaniel Beers, executive vice president of Community and Population Health.

person circling items on mental health summit agenda

Unique alliance expands access to mental health support for kids

May 2, 2024

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CareFirst BlueCross BlueShield (CareFirst), one of the largest not-for-profit healthcare organizations in the nation, and Children’s National Hospital, a top-ranked children’s hospital located in Washington, D.C., announced a new alliance that’s taking a unique approach to help address the youth mental health crisis and improve health outcomes.

As part of this alliance, CareFirst has increased the reimbursement for preventive and mental health care for primary care providers who go through specialized mental health training focused on depression, suicide prevention, anxiety, ADHD and eating disorders. The training is offered through the Pediatric Health Network, the clinically integrated network of healthcare providers for Children’s National, to its more than 1,500 members including more than 700 primary care physicians.

In 2021, U.S. Surgeon General Dr. Vivek Murthy issued an advisory detailing an urgent youth mental health crisis. Unfortunately, access to pediatric mental health care is a national challenge, and for children and families, timely and effective support can be elusive. Empowering primary care providers with specialized training will help break down barriers and reshape care delivery.

“Providers face challenges due to limited resources and insufficient support in addressing pediatric mental health needs. CareFirst’s commitment to increasing reimbursement for mental health care underscores the integral role of primary care providers in this space,” says Nathaniel Beers, M.D., executive vice president for Community and Population Health for Children’s National Hospital. “With these trainings, our providers gain the knowledge, tools and confidence to handle sensitive conversations, offer vital support and make informed referrals when needed.”

The alliance executes a value-based care payment model for the Children’s National network of community physicians, enhancing benefits to offer more value to physicians and patients while aiming to drive improved outcomes, patient experience and coordination in care. By embedding mental health care within the familiar confines of primary care settings, this initiative ensures children receive timely interventions in an environment they trust.

This work to improve access to mental health services is just one part of the broader unique payer-provider alliance between CareFirst and Children’s National to address healthcare disparities and social determinants of health. Targeted pediatric interventions are set upon three pillars:

Value-based care
Community health initiatives
Member benefit enhancements

Each pillar is delivered and informed by experts from both organizations with distinct tactics and funding designed for three key priority health conditions:

Behavioral and mental health
Diabetes
Infant mortality

“As the lines continue to blur between payers and providers, with vertical integration and the reimbursement shift from volume to value, insurers and hospitals need to continue to evolve their relationships with each other,” said Brian Wheeler, executive vice president of Health Services for CareFirst. “This model aims to address the need for affordable healthcare, employing a patient-centric approach that encourages seamless treatment for the patient and provider.”

The next major program in development is focused on improving diabetes care through early diagnosis to lessen vulnerability and severity and improve long-term positive health outcomes.

Community health initiatives will continue to be developed through the Children’s National Child Health Advocacy Institute and Community Health programs with the support of CareFirst’s philanthropic efforts.

Children’s National Hospital at the 2024 Pediatric Academic Societies meeting

April 26, 2024

Children’s National Hospital-affiliated participants will present at this year’s Pediatric Academic Societies meeting. The meeting will take place in Toronto, from May 2-6, 2024. For information on the presentations, please refer to the chart below.

Day	Time	Presenter(s)	Title
5/3/2024	9:00 AM	Stacey Stokes, M.D., M.P.H.	APA QI: Informatics for Improvers: Leveraging Clinical Decision Support to Propel Data-Driven and Reliable Continuous Improvement
5/3/2024	12:00 PM	Rana F. Hamdy, M.D., M.P.H., MSCE	A Career in Antimicrobial Stewardship… so Much More to Explore
5/3/2024	12:00 PM	Ashima Gulati, M.D., Ph.D., FASN	Case Studies in Pediatric Kidney Diseases: Who, When and How to Order Genetic Testing?
5/3/2024	3:45 PM	Priti Bhansali, M.D., ME.d.	iSPOT an Improvement: Taking Peer Observation and Feedback to the Next Level
5/3/2024	3:45 PM	Josepheen De Asis-Cruz, M.D., Ph.D.	Maternal psychopathology and SSRI use during pregnancy are associated with altered fetal hippocampal connectivity in utero
5/4/2024	8:00 AM	Andrea J. Boudreaux, Psy.D., M.P.H., M.H.A., F.A.C.H.E.	A Doctor in the School Nurse’s Office? Bringing a Virtual School Based Program into Practice
5/4/2024	8:00 AM	Jessica Hippolyte, M.D., M.P.H.	A Practical Approach to a Thorny Issue: Evaluating the Role of Race, Ethnicity, and Ancestry in Clinical Decision-Making
5/4/2024	8:00 AM	Ashraf S. Harahsheh, M.D., F.A.A.P., F.A.C.C.	Cardiology 1
5/4/2024	8:00 AM	Dewesh Agrawal, M.D.	Emergency Medicine 1: Quality and Safety
5/4/2024	8:00 AM	Lenore Jarvis, M.D., ME.d. Amanda Stewart, M.D., M.P.H.	From Bedside to State House: Daily Advocacy
5/4/2024	8:00 AM	Aisha Barber, M.D., ME.d.	Unionization in Pediatrics: A Pro-Con Debate
5/4/2024	8:45 AM	Jillian E. Nickerson, M.D., M.S.	Implementation of tele-psychiatry in an urban pediatric satellite emergency department
5/4/2024	9:00 AM	Jessica Weisz, M.D.	“TEACH”ing: Evaluation of a 3-Year Multimodal Child Poverty Curriculum
5/4/2024	9:00 AM	Tameka T. Watson, M.D.	Timing of Growth Failure in Very Premature Infants and Implications for Brain Development
5/4/2024	10:00 AM	Neha H. Shah, M.D., M.P.H.	Subspecialty Networking Breakout: Pediatric Hospital Medicine
5/4/2024	11:00 AM	Lee S. Beers, M.D.	AAP Presidential Plenary: Emerging Research on the Intersections of Mental Health, Impact of the Pandemic, and Equity, Diversity, and Inclusion
5/4/2024	11:00 AM	Denver Brown, M.D.	Implications of SDOH on glomerular disease, hypertension and CKD
5/4/2024	11:15 AM	Josepheen De Asis-Cruz, M.D., Ph.D.	Associations Between Antenatal Opioid Exposure and Newborn Functional Brain Connectivity
5/4/2024	2:00 PM	Ian Chua, M.D., M.H.P.E.	Addressing Misinformation & Building Competency for Gender Diverse Patient Care
5/5/2024	8:00 AM	Tamara Gayle, M.D., ME.d., M.P.H.	APA SIG: Pediatric Hospital Medicine – Creating an Inclusive and Sustainable Workplace
5/5/2024	8:00 AM	Suma B. Hoffman, M.D., M.S. Simranjeet S. Sran, M.E., ME.d., C.H.S.E., F.A.A.P.	Hands on Workshop: Complex Resuscitations in Neonates and Infants – Managing High Acuity, Low Occurrence (HALO) Events
5/5/2024	8:15 AM	Jaytoya Manget, D.N.P., M.S.P.H., F.N.P.	Connecting the Dots to Improve Health and Education Equity: Results of A Pilot Program Integrating School Attendance Data into a Pediatric Primary Care
5/5/2024	8:55 AM	Aisha Barber, M.D., ME.d.	APA Pediatric Hospital Medicine SIG – Creating an Inclusive and Sustainable Workplace
5/5/2024	11:00 AM	Nicola Brodie, M.D. Julie Heier, Ph.D. Courtney Horton, M.D. Darcel Jackson, C.P.X.P., L.S.S.G.B. Emma Whitmyre, Ph.D.	Challenge Accepted: Integrating Behavioral Health in Primary Care for Children with Medical Complexity and Their Families
5/5/2024	11:00 AM	Ian Chua, M.D., M.H.P.E. Margarita Ramos, M.D., M.S. Neha H. Shah, M.D., M.P.H.	Embracing Failure: The Key To Success In Academic Medicine
5/5/2024	11:00 AM	Caleb E. Ward, M.B., B.Chir., M.P.H.	Emergency Medicine 4
5/5/2024	11:00 AM	Dewesh Agrawal, M.D. Terry Kind, M.D., M.P.H.	Launching and Landing a Career in Medical Education: From Passion to Profession
5/5/2024	11:00 AM	Nathaniel S. Beers, M.D., M.P.A. Andrea J. Boudreaux, Psy.D., M.P.H., M.H.A., F.A.C.H.E. Bianca Johnson, M.S.W. Jaytoya Manget, D.N.P., M.S.P.H., F.N.P. Jessica Weisz, M.D.	School Attendance as a Vital Sign: Integrating school attendance into practice to advance health and educational equity
5/5/2024	11:05 AM	Sudeepta Basu, M.D.	SPR 2023 Bridging to Success Award: GABA-editing spectroscopy for understanding the developing brain in preterm infants.
5/5/2024	2:00 PM	Allison M. Jackson, M.D., M.P.H.	Child Protective Services Referrals in the Context of Intimate Partner Violence: Clinical Practice, Research, & Advocacy
5/5/2024	2:00 PM	Josepheen De Asis-Cruz, M.D., Ph.D.	In utero SSRI exposure alters fetal cerebral cortical development and structural brain connectivity
5/5/2024	2:00 PM	Jeremy Kern, M.D. Lydia Lissanu, M.D. Elana Neshkes, M.D. Laura A. Nicholson, M.S.N., R.N., C.P.N., C.H.S.E. Grace Quinn, M.D. Ariella M. Weinstock, M.D., M.S. Ed	STRIVE for a restorative de-escalation: Strategies for a TRauma-Informed approach using Verbal and Environmental Skills
5/5/2024	2:45 PM	Kristen Sgambat, Ph.D., RD	Arterial stiffness, body composition, and perception of racism in pediatric kidney transplant recipients
5/5/2024	2:45 PM	Sudeepta Basu, M.D.	Cerebellar GABA and Glutamate Concentrations at Term-equivalent age Predicts 18-month Cognitive Deficits in Preterm Infants
5/6/2024	8:00 AM	Ian Chua, M.D., M.H.P.E. Gabrina Dixon, M.D., ME.d. Tamara Gayle, M.D., ME.d., M.P.H. Margarita Ramos, M.D., M.S.	Amplify Your Voice: Media Strategies Beyond Conventional Academic Dissemination
5/6/2024	8:00 AM	Stacey Stokes, M.D., M.P.H. Padma Swamy, M.D., M.P.H.	APA SIG: Health Informatics and Serving the Underserved Combined – Moving the Needle on Social Needs: From Screening to Data Management and Response
5/6/2024	8:00 AM	Deena Berkowitz, M.D., M.P.H.	APA Urgent Care SIG: You’re Not Too Busy To Think About Promotion: Leveraging Your Current Scholarly Activities For Academic Advancement
5/6/2024	8:30 AM	Padma Swamy, M.D., M.P.H.	Screening, data sharing, and resource allocation considerations when developing social needs interventions
5/6/2024	1:00 PM	Christina Lindgren, M.D.	APA Simulation-based Medical Education (SBME) SIG
5/6/2024	1:00 PM	Gabrina Dixon, M.D., ME.d.	Creating and Optimizing a Visiting Elective at your Institution for Underrepresented in Medicine (URiM) Students
5/6/2024	1:00 PM	Junghoon Kim, Ph.D.	Improved prediction of fetal neurobiological features by censoring high-motion frames in fetal functional MRI
5/6/2024	1:05 PM	Christina Lindgren, M.D.	Introduction to Conceptual Frameworks for Simulation Based Medical Education
5/6/2024	1:10 PM	Suma B. Hoffman, M.D., M.S.	Small Group Activity: Name That Conceptual Framework
5/6/2024	2:15 PM	Margaret Rush, M.D., M.S.H.S.	Racial disparities in hospital length of stay for bacterial tracheostomy associated infections

Illustration showing phthalate exposure during cardiopulmonary bypass

Pediatric heart patients exposed to plastic chemicals during cardiopulmonary bypass

April 23, 2024

Image credit: Transfusion, April 2024

Children undergoing cardiac surgery using cardiopulmonary bypass are exposed to high levels of plastic chemical additives called phthalates, including DEHP, according to the largest single center study to date to measure this exposure. The findings were authored by a multi-disciplinary group from Children’s National Hospital and appear in the journal Transfusion.

What is it?

Di(2-ethylhexyl) phthalate (DEHP) is one of the most commonly used plasticizers in polyvinyl chloride (PVC) plastics, making up 40% to 80% of the finished weight of medical-grade tubing and blood storage bags. The study’s primary goal was to quantify three aspects of pediatric cardiac surgery: the phthalate exposure with and without cardiopulmonary bypass (the heart and lung machine), the time it takes for phthalates to clear after surgery and any correlations between higher phthalate exposures and postoperative complications.

The authors suggested that, like infants in the NICU exposed to various medical equipment, children on cardiopulmonary bypass are likely exposed to significant DEHP levels from blood products, bypass circuit components, and endotracheal tubes, potentially impacting postoperative outcomes.

Why does it matter?

Despite daily phthalate exposure in the general population, studies link high phthalate levels to developmental delays in language and motor skills. Phthalates accumulate in the hearts of infants undergoing umbilical catheterizations or blood transfusions. This is worrisome as even low-dose environmental exposure correlates with higher risks of overall and cardiovascular-related mortality.

Knowing these risks exist, it is important to understand these exposures, what causes them and implement measures to mitigate them, safeguarding medically fragile children. Regulatory actions in NICUs have reduced DEHP-containing plastics, yet no such efforts have been made for children on cardiopulmonary bypass.

The study also found some associations between postoperative complications and higher levels of phthalates, especially in younger children. They write, “it is plausible that a combination for risk factors (young age, longer CPB duration, increased phthalate exposure) collectively contribute to these complications.” More research is needed to understand the association and the impact of phthalates on how children recover from surgery.

Children’s National leads the way

The study involved 110 pediatric patients undergoing 122 cardiac surgeries at Children’s National, marking the largest single-center investigation into phthalate exposures in cardiac surgery. Led by a multidisciplinary team, including divisions of Transfusion Medicine and Cardiac Surgery, along with researchers from the Sheikh Zayed Institute for Pediatric Surgical Innovation, the study’s findings are some of the first to quantify that pediatric cardiac surgery patients are exposed to greater levels of these phthalate chemicals from plastic medical products, with increasing exposure the longer they require cardiopulmonary bypass. This is especially true when the bypass uses a prime based on red blood cells.

What’s next

The teams are exploring strategies to minimize chemical exposures, such as:

Using freshly donated blood products (made possible at Children’s National by the unique on-site Blood Donor Center).
Storing blood in DEHP-free storage bags prior to use when possible.
Increasing use of cell-saver equipment, which washes red blood cell products and removes extracellular contaminants.
At Children’s National, cardiac surgeons prioritize the use of recently collected, washed red blood cells in cardiopulmonary bypass cases, especially for younger and/or smaller patients.

“These exposures will affect patients undergoing pediatric cardiac surgery at any institution,” says first author Devon Guerrelli, M.S. “But we hope understanding what’s causing the exposures will help operating rooms around the United States take immediate small steps, like using washed red blood cells, to begin mitigating these exposures as soon as possible.”

Senior author Nikki Posnack, Ph.D., adds that the implications of phthalates on health are tremendous. “Studies have shown that heightened phthalate exposure increases your risk of all-cause and cardiovascular mortality,” she said. “Now is the time to support research efforts to understand how plastic chemicals damage the heart and to investigate strategies to reduce their overall impact.”

Read the study:
Prevalence and clinical implications of heightened plastic chemical exposure in pediatric patients undergoing cardiopulmonary bypass

Nathan Kuppermann, M.D., M.P.H., named chief academic officer and chair of Pediatrics

March 13, 2024

Dr. Kuppermann will oversee research, education and innovation for the Children’s National Research Institute as well as academic and administrative leadership in the Department of Pediatrics at George Washington University School of Medicine & Health Services.

Children’s National Hospital has appointed Nathan Kuppermann, M.D., M.P.H., as its new executive vice president (EVP), chief academic officer (CAO) and chair of Pediatrics. In this role, Dr. Kuppermann will oversee research, education and innovation for the Children’s National Research Institute as well as academic and administrative leadership in the Department of Pediatrics at George Washington University School of Medicine & Health Services. He comes to Children’s National from UC Davis Health and UC Davis School of Medicine in Sacramento, CA, and will start in September.

After a national search, Dr. Kuppermann stood out for his exceptional contributions to clinical and academic research, focusing on pediatric emergency care, and his dedication to mentorship. For the past 18 years he has served as the Bo Tomas Brofeldt endowed chair of the Department of Emergency Medicine and is currently a distinguished professor of Emergency Medicine and Pediatrics, and the associate dean for Global Health at UC Davis Health.

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

Dr. Kuppermann is a pediatric emergency medicine physician and clinical epidemiologist, and a leader in emergency medical services for children, particularly in multicenter research. With more than 300 peer-reviewed research publications to his credit, Dr. Kuppermann has contributed extensively to high-impact journals including the New England Journal of Medicine, JAMA, BMJ and the Lancet.

“The Children’s National Research Institute is a key part of our health system’s ecosystem – it’s where we nurture innovation and pursue the most promising research,” says Michelle Riley-Brown, MHA, FACHE, president and CEO of Children’s National. “Dr. Kuppermann’s unwavering commitment to excellence in pediatric healthcare, research and innovation set him apart in a competitive field. I am confident he will advance our efforts in making breakthrough discoveries for kids everywhere.”

Dr. Kuppermann received his undergraduate degree from Stanford University, his medical degree from UC San Francisco School of Medicine and his Master of Public Health degree from the Harvard School of Public Health. He completed a pediatrics residency and chief residency at Harbor-UCLA Medical Center and a fellowship in Pediatric Emergency Medicine at Boston Children’s Hospital.

He has been recognized nationally and internationally for his research and mentorship. He was a Fulbright Distinguished Scholar in the U.K. and in 2010 was elected to the National Academy of Medicine. In 2022, he received the Maureen Andrew Mentor Award from the Society for Pediatric Research.

“Dr. Kuppermann’s leadership will undoubtedly propel the hospital’s efforts in advancing pediatric healthcare innovation, reinforcing Children’s National as a top-ranking institution,” says Horacio Rozanski, chair of the Children’s National Board of Directors. “We look forward to the positive impact he will make to the hospital’s overall mission, as well as its research and academic endeavors.”

Experts form Blood D.E.S.E.R.T Coalition to address global blood crisis

March 12, 2024

“The world does not have enough blood and the lack of blood is not distributed equally,” said Dr. Delaney. “Poor and rural communities are disproportionately affected with having low access to life-saving blood transfusion.”

Meghan Delaney, D.O., M.P.H., chief of Pathology and Lab Medicine and director of Transfusion Medicine at Children’s National Hospital, is among 17 global experts participating in a new collaborative initiative aimed at tackling the critical challenge of severe blood scarcity in rural areas. The coalition, known as the Blood D.E.S.E.R.T. Coalition, published a paper in Lancet Global Health outlining its recommendations for addressing the immediate need for blood through short-term strategies.

“The world does not have enough blood and the lack of blood is not distributed equally,” said Dr. Delaney. “Poor and rural communities are disproportionately affected with having low access to life-saving blood transfusion. This causes individuals to forego essential medical treatments, facing the consequences of morbidity or mortality, or to travel great distances to reach a facility that can give a blood transfusion. Addressing these disparities in basic healthcare access should be a global concern.”

Read the press release here.

Improving health outcomes by addressing chronic absenteeism

March 12, 2024

Through CARE program, parents and caregivers have the opportunity to consent to share their child’s attendance information with their child’s healthcare team. The team then provides outreach and medical attention to children who might be missing school.

School absenteeism is a national crisis. Chronic absenteeism, defined as missing 10% or more of the school year for excused and/or unexcused absence, is soaring. With rates of chronic absenteeism at 43% in Washington, D.C., and data showing clear connections between academic attainment, graduation rates, long-term health and life expectancy, school absenteeism is a critical health and educational equity issue for children in the nation’s capital.

The big picture

To combat this issue, Children’s National Hospital has partnered with District of Columbia Public Schools (DCPS) and other local partners to develop the Collaborative for Attendance Resources in Education and Health (CARE-H). Funded by the United Health Foundation, CARE-H is a cross-sector, multidisciplinary data-sharing program. Parents and caregivers have the opportunity to consent to share their child’s attendance information with their child’s healthcare team. The team then provides outreach and medical attention to children that might be missing school.

Children’s National Hospital leads the way

Each month, team members from primary care at Children’s National conduct outreach to patients and families who are experiencing barriers to school attendance, and assist families with referrals to primary care, subspecialty, mental health, oral health appointments and other social resources. “We know it is important to help families with the many medical and social barriers that may prevent them from attending school, and as their medical home, we are fortunate to have the ability to connect them with these important resources,” stated Jaytoya Manget, NP, DNP, FNP, Quality Improvement Lead for the CARE-H program at Children’s National.

During the 2022-2023 school year, the team conducted nearly 2,700 minutes of outreach and generated over 70 referrals for medical appointments and social resources. “A more supportive framework and holistic approach around attendance by the schools has helped promote acceptance of the hospital’s outreach, as has the trust its healthcare providers have established with their patients,” said Danielle Dooley, M.D., M.Phil., a pediatrician and medical director of Community Affairs and Population Health at Children’s National.

Children’s National also established a regional learning collaborative, with partners from Trenton, NJ and Delaware who have developed similar attendance data-sharing programs based on the work done by Children’s National. “I hope that through our collaboration, this model can be used to address chronic absenteeism across the nation,” said Dr. Dooley.

School entry neurodevelopmental outcomes of Zika-exposed Colombian children

February 26, 2024

The Children’s National Hospital Zika Research Team and collaborators from Biomelab, in Barranquilla, Colombia take a picture after a study visit in Sabanalarga, Colombia following the neurodevelopmental outcomes of children who had in utero exposure to Zika virus. Pictured from Children’s National Hospital: Dr. Sarah Mulkey, Regan Andringa-Seed, Margarita Arroyave-Wessel, and Dr. Madison Berl.

The long-term neurodevelopmental effects of antenatal Zika virus (ZIKV) exposure in children without congenital Zika syndrome (CZS) remain unclear, as few children have been followed to the age of starting primary school.

In a new study published in Pathogens, researchers found children with in utero ZIKV exposure appear to have an overall positive developmental trajectory at 4 to 5 years of age but may experience risks to neurodevelopment in areas of emotional regulation and adaptive mobility.

The hold up in the field

Children who were born during the ZIKV epidemic and who had in utero exposure to ZIKV are only now at the age to start school. Child neurodevelopmental outcome data has not been reported at the age of school entry for children with antenatal ZIKV exposure who do not have the severe birth defects of CZS.

“As these children approach the early school-age years, we aim to examine whether there are neurodevelopmental differences in executive function, motor ability, language development or scholastic skills as compared to a group of unexposed control participants from the same communities in Colombia,” says Sarah Mulkey, M.D., Ph.D., prenatal-neonatal neurologist in The Zickler Family Prenatal Pediatrics Institute at Children’s National Hospital and lead author of the study.

Moving the field forward

Building on previous findings, this study presents the longitudinal outcomes of a well-characterized Colombian cohort of ZIKV-exposed children without CZS at ages 4 to 5 years. These children have been seen for neurodevelopmental follow-up as infants and toddlers at approximately 6 months, 18 months and 3 years of age as part of an international collaboration between researchers in Barranquilla, Colombia and at Children’s National beginning in 2016. The objective of this study was to assess the multi-domain neurodevelopmental outcomes in 4 to 5-year-old children with antenatal ZIKV exposure without CZS compared to unexposed controls in Colombia.

Why we’re excited

Many of the children who had antenatal ZIKV exposure are making good progress in multiple areas of their neurodevelopment. However, the researchers found that children with antenatal ZIKV exposure have differences in areas of emotional regulation, executive function, mood and behavior which may relate to virus exposure during their early brain development.

“These areas of brain function are important for future academic achievement, employment, mental health and social relationships,” says Dr. Mulkey. “So, it will be important to continue to follow these children at older ages when they start school.”

Children’s National leads the way

Children’s National is a leader in conducting outcome studies of children born following antenatal ZIKV exposure. This study follows children in Colombia who are now 5 years old who were first studied while they were in the womb. These children have contributed unique longitudinal understanding to early child neurodevelopment following in utero exposure to ZIKV.

Dr. Mulkey is committed to studying the long-term neurodevelopmental impacts that viruses like Zika and SARS-CoV-2 have on infants born to mothers who were infected during pregnancy through research with the Congenital Infection Program at Children’s National and in collaboration with colleagues in Colombia.

Additional Children’s National authors include Meagan Williams M.S.P.H., C.C.R.C., senior research coordinator; Regan Andringa-Seed, clinical research coordinator, Margarita Arroyave-Wessel, clinical research coordinator; L. Gilbert Vezina, M.D., director, Neuroradiology Program; Dorothy Bulas, M.D., chief, Diagnostic Imaging and Radiology; Robert Podolsky, biostatistician.

Researchers showing paintings of zika virus

Dr. Sarah Mulkey and Children’s National clinical research coordinators in the Prenatal Pediatrics Institute and the Division of Pediatric Infectious Diseases display their paintings of the Zika virus. Pictured from left to right: Manuela Iglesias, Elizabeth Corn, Dr. Sarah Mulkey, Emily Ansusinha and Meagan Williams.

Optimizing pediatric diabetes management: Integrating a vital food pharmacy approach

February 13, 2024

Weighing approximately 50 pounds, the food packages are rich in protein, fiber and healthy fats, and include fruits and vegetables.

Social Determinants of Health are an essential focus in providing equitable diabetes care. Food and nutrition are integral parts of Type 1 diabetes (T1D) and Type 2 diabetes (T2D) management. Food insecurity increases the risk for T2D and is associated with higher A1C levels and hospitalization in those with diabetes.

The big picture

A study published in the American Diabetes Association Journal Diabetes assessed food insecurity among families with diabetes during their clinical visits. As of June 2023, 62% of the participants screened positive for food insecurity. In response, Children’s National Hospital partnered with the Capital Area Food Bank to create a food pharmacy within the diabetes clinic that supplies an average of 117 families per month with additional groceries to support those affected by diabetes.

What does this mean?

These packages are designed to sustain a family of four for three days. Weighing approximately 50 pounds, pantry essentials are rich in protein, fiber and healthy fats, and include fruits and vegetables. Additionally, the packages come with recipe cards that offer helpful suggestions for replacing or supplementing items, enabling individuals to obtain nutritious food beyond their diabetes appointments.

“We hope that these findings and future research will help bring to light the importance of food security, in addition to medication, in managing chronic illness,” said Alexis Richardson, M.S., R.D., L.D.N., C.D.C.E.S., food pharmacy founder and diabetes educator at Children’s National. “This research also opens up the possibilities for other studies on the effect food insecurity and Type 2 diabetes.”

What’s been the hold-up in the field?

Providing 50 pounds per set to over 100 families each month requires a substantial area for a food pharmacy. The storage facility must adhere to food safety standards and comply with Department of Health regulations. Additionally, all staff members are required to be ServSafe certified. Shortages in staffing and funding pose significant challenges. Clear procedures are needed for tasks such as placing orders, receiving food deliveries, managing loading docks and handling the refrigeration and shelving of bags.

Over the years, Children’s National has engaged with numerous programs, sharing their experiences and challenges to offer guidance and assist other institutions in establishing their own food pharmacies.

Children’s National in the News: 2023

January 18, 2024

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)

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)

screenshot from Congenital Heart Initiative (CHI) Registry Participant Timeline

Congenital Heart Initiative beat recruitment goals, kicked off patient-engaged studies in year three

December 6, 2023

The Congenital Heart Initiative (CHI) is celebrating its third year as the first global patient-powered registry for adults with congenital heart disease (CHD). In 2023, the registry surpassed recruitment targets and launched a data intake process to allow researchers from around the world to submit proposals for patient-centered research and programs around the critical questions for adults with CHD who had their hearts repaired in childhood.

What it means

By recruiting over 4,600 participants in all 50 states and 37 countries, the CHI is now the largest patient-powered registry for adults with congenital heart disease. This is the first time researchers and clinicians have been able to access this type of robust data set to help them better understand and address the needs of people with CHD as they continue to age. Even better, the registry’s mechanisms allow for routine feedback and input about priorities directly from the growing patient population.

“Patient-centered research organizations, not providers or universities, have the greatest ability to lead this charge and lay the foundation for future breakthroughs. The inspiring efforts of all participants to date gives me hope that the next generation of advances is within reach,” says Matthew Lewis, M.D., an adult congenital heart specialist and CHI-RON site PI from Columbia University Medical Center.

An ongoing sub-study of CHI uses PCORnet®, the National Patient-Centered Clinical Research Network, to better understand how gaps in care impact the adult patient experience with CHD. The CHI-RON study (PCORI RD-2020C2-20347) fills in these gaps by exploring three distinct data types: patient-reported outcomes, health insurance claims and electronic health records. The effort is led by Children’s National Hospital and Louisiana Public Health Institute.

This year, CHI also launched some of its first studies, focused on pregnancy, health disparities and long-term health care follow-ups. The first academic manuscripts about these studies are expected to publish in the next year.

Why it matters

Although nearly 2 million adults in the United States are living with a congenital heart defect — more adults than children in fact — it’s been historically difficult to gather data on these conditions and to identify patient needs.

As children born with CHD become adults, they have a lot of worry and uncertainty about their limitations and abilities to achieve what might be considered common adult milestones. The research made possible by this registry and the mechanisms to communicate findings to both the participants and the larger clinical community will make a big difference in quality of life and hope to provide more answers to these important questions.

The CHI related meetings have allowed a space where patients and researchers can come together to discuss research priorities.

“Once you go and look at things from the patient’s point of view, there is no going back. It is going to be something that will redefine you as a researcher and a provider,” says Rohan D’Souza, M.D., a maternal-fetal medicine specialist who is an active participant in a PCORI-funded maternal health consortium focused on reducing maternal morbidity and mortality in CHD patients (PCORI EACB-23293).

The patient benefit

Additionally, because people with CHD live all over the United States and the world, it can be hard for them to connect with each other to share common questions and experiences with clinicians and each other. The patient-driven registry engages participants and hopes to help make greater connections between people who live with CHD. A key registry partner, the Adult Congenital Heart Association (ACHA), helps create opportunities, such as virtual Coffee Hours, for people in the registry to weigh in on research priorities and share feedback about CHI’s work.

“The ACHA Cafe was born out of a need for connection,” says Aliza Marlin, who founded and organized the café project on behalf of the ACHA. “A virtual social hour, coffee optional, gave the ACHD community a safe space to come together. Using it as a conduit to the Congenital Heart Initiative gave us an empowered voice in our own futures. It’s the perfect example of social connection leading to transformative possibilities.”

What’s next

Anitha John, M.D., medical director of the Washington Adult Congenital Heart Program and an adult congenital cardiologist at Children’s National Hospital who leads CHI, says that the future looks bright for the registry and the vital information it can provide.

The new data intake process launched this year, she adds, gives anyone with an interest the ability to submit ideas for new grants, projects and studies. The team will also continue to engage with registry participants, researchers and the centers who provide care for people with CHD, all with the goal of finding more answers to the key questions about how to accomplish specific goals, such as improving mental health, the health care transition and overall quality of life for adults with CHD. For more information on how to get involved, please email ACHDresearch@childrensnational.org.

Local context, health system integrations key to sustainable interventions after RHD diagnosis

November 2, 2023

Although entirely preventable, RHD, a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low- and middle-income countries, as well as rural, remote, marginalized and disenfranchised populations within high-income countries.

A rheumatic heart disease (RHD) work group convened by the National Heart, Lung, and Blood Institute (NHLBI) concludes that any priority intervention strategies to slow or stop late complications of RHD need to consider local contexts and should be integrated into health systems to meet the affected community’s needs in a sustainable way.

The group outlined priorities based on current available evidence to support the development and implementation of accessible, affordable and sustainable interventions in low-resource settings to manage RHD and its related complications.

Craig Sable, M.D., associate chief of Cardiology at Children’s National Hospital, served as a senior author on the recommendations, based on the work group findings.

Why it matters

Although entirely preventable, RHD, a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low- and middle-income countries, as well as rural, remote, marginalized and disenfranchised populations within high-income countries.

The NHLBI workshop sought to support RHD eradication efforts worldwide by:

Analyzing the current state of science
Identifying basic science and clinical research priorities

Each work group was assigned to review existing guidelines and research for different stages of the disease’s progression, which is now being published together as a set of five companion articles to raise the prioritization of RHD research and funding.

Moving the field forward

Due to the high prevalence of RHD in low- and middle-income countries, Dr. Sable’s work group focused on gaining a better understanding of the needs in the field from the five perspectives: people living with RHD, the community, healthcare providers, health systems and policymakers.

They identified several priorities and strategies, and they stressed that any interventional strategy, now or in the future, must be culturally safe and community-driven to ensure the creation of a locally and culturally relevant, sustainable continuum of care for people from historically marginalized populations.

What’s next

The authors emphasize that that over 300,000 deaths per year are the result of inadequate, underfunded and poorly integrated care. “Global vision and leadership to enact and implement available policies are needed to close large research gaps in all aspects at patient, health system and policy levels. Robust research and development are urgently needed to improve comprehensive tertiary care and ensure implementation of evidence-based interventions, while developing new innovations, technologies and interventions.”

You can read all the working group manuscripts, including this one: Tertiary Prevention and Treatment of Rheumatic Heart Disease: A National Heart, Lung, and Blood Institute Working Group Summary, in BMJ Global Health.

Learn more about the challenges of rheumatic heart disease in sub-Saharan Africa and other developing parts of the world through the Rheumatic Heart Disease microdocumentary series:

Earlier detection of cardiometabolic risk factors for kids may be possible through next generation biomarkers

October 31, 2023

The next generation of cardiometabolic biomarkers should pave the way for earlier detection of risk factors for conditions such as obesity, diabetes and heart disease in children.

American Heart Association statement finds potential future measures, reiterates importance of heart-healthy lifestyle from birth through adulthood.

The next generation of cardiometabolic biomarkers should pave the way for earlier detection of risk factors for conditions such as obesity, diabetes and heart disease in children, according to a new scientific statement from the American Heart Association published in the journal Circulation.

“The rising number of children with major risk factors for cardiometabolic conditions represents a potential tsunami of preventable disease for our healthcare system,” says the statement’s lead author Michele Mietus-Snyder, M.D., a preventive cardiologist and clinical research scientist at Children’s National Hospital. “But by the time a child is identified based on today’s clinical biomarkers, it’s often too late to reverse the disease trajectory.”

The big picture

The scientific statement included biomarkers that met three criteria:

Early and precise clinical detection of metabolic abnormalities before a child begins to show the current clinical signs such as high body mass index (BMI), blood pressure or cholesterol.
Mechanistic intervention targets providing immediate risk measures and giving clinicians new targets to personalize and optimize interventions.
Modifiable biomarkers that are capable of tracking progression toward or away from cardiometabolic health.

The statement’s identified biomarkers included measures of:

Epigenetic, or environmental, factors
Gut microbiome health
Small particle metabolites in the body
Different types of lipids and their impacts on cell membranes
Inflammation and inflammatory mediators

The authors proposed these biomarkers with the goal of “expanding awareness to include a whole new realm of biomarkers that precede the traditional risk factors we currently rely upon, such as BMI, blood pressure, cholesterol and blood sugar,” says Mietus-Snyder. “Ideally, these new biomarkers will be added to the array of measures used in clinical research to better assess their value for earlier identification and prevention of global patterns of cardiometabolic health and risk.”

Why it matters

The next generation cardiometabolic biomarkers outlined by the authors are all currently used in research studies and would need to be validated for clinical use. However, Mietus-Snyder notes that the data already collected from these biomarkers in research can make a difference in clinical practice by enhancing our understanding of the deep metabolic roots for children at risk.

Evidence reviewed in the statement shows the risk factors children are exposed to, even before birth, can set the stage for cardiovascular and metabolic health across the lifespan.

Interestingly, all the different factors reviewed have been found to alter the functioning of the mitochondria — the complex organelles responsible for producing the energy for the body that every cell and organ system in turn needs to function. Every class of biomarkers reviewed is also favorably influenced by heart-healthy nutrition, a simple but powerful tool known to improve mitochondrial function.

What’s next

Even as the new so-called ‘omic’ biomarkers reviewed in this statement are developed for clinical applications, there are things clinicians can do to optimize them and improve mitochondrial function, according to Mietus-Snyder.

Most important is to strengthen the collective dedication of care providers to removing the barriers that prevent people, especially expecting mothers and children, from living heart-healthy lifestyles.

We have long known lifestyle factors influence health. Even as complicated metabolic reasons for this are worked out, families can reset their metabolism by decreasing sedentary time and increasing activity, getting better and screen-free sleep, and eating more real foods, especially vegetables, fruits and whole grains, rich in fiber and nutrients, with fewer added sugars, chemicals, preservatives and trans fats. Clinicians can work with their patients to set goals in these areas.

“We know diet and lifestyle are effective to some degree for everyone but terribly underutilized. As clinicians, we have compelling reasons to re-dedicate ourselves to advocating for healthy lifestyle interventions with the families we serve and finding ways to help them implement them as early as possible. The evidence shows the sooner we can intervene for cardiometabolic health, the better.”

Using a multisystem approach to improve access to autism care in Washington, D.C.

October 5, 2023

Children with autism face significant barriers to accessing evaluations and intervention services.

An article in the journal Pediatrics reviews the outcomes from a collective, targeted advocacy approach to improving access to autism supports and resources for children and their families in Washington, D.C. The effort was led by Children’s National Hospital and engaged a multidisciplinary team from within the hospital and across a wide range of community sectors.

What this means

Children’s National and DC Autism Parents worked collaboratively with a coalition of organizations from the broader District of Columbia community to address some of the biggest challenges and barriers that prevent autistic children and their families from receiving the resources and support they need in the nation’s capital.

Why it matters

Children with autism face significant barriers to accessing evaluations and intervention services often because of confusing referral processes, lack of centralized coordination across organizations serving children with autism, insurance coverage gaps, multiyear waitlists for diagnostic services and limited provider knowledge about autism. Racism and systemic inequities also persist in autism care across the United States.

Long and growing wait times in autism diagnostic clinics and lack of centralized care coordination for autistic children are prevalent across the District of Columbia, and as a result, many children and families in the region continue to lack access to the support they need.

What’s unique

The study describes multiyear efforts (2017–2022) to improve autism care throughout the District of Columbia using a collective impact framework to unite organizations from different sectors. This approach features the creation of a common agenda (including defining goals and priorities), shared measurement, mutually reinforcing activities, continuous communication and infrastructure support.

Together, the group members sought to address barriers and overcome challenges at multiple levels of the healthcare system at the same time by focusing advocacy in three specific areas:

Infrastructure-building initiatives/system-level approaches.
Population- and community-level services to build capacity and connect providers and families to needed resources.
Direct services that provide innovative, gap-filling supports to children and families as a stopgap until the necessary supports can be more sustainably provided across the board.

Bottom line

While more work is needed to continue expanding the availability of needed services, the findings from this initial effort can inform the next steps in Washington, D.C., and serve as a model for a collective framework approach for autism services in other parts of the United States.

You can read the full study “A Multisystem Approach to Improving Autism Care” in the journal Pediatrics.

More information and resources about these autism initiatives can be found at:

New School-Friendly Health Systems Framework supports children’s health and learning

September 6, 2023

With school back in session and students, educators and health care workers still recovering from the COVID-19 pandemic, it is critical for the health and education sectors to align efforts and drive innovative programs and policy change efforts to address the needs of children.

With input from expert stakeholders, including pediatricians, educators, school administrators, school nurses, parents and community health experts, Children’s National led the development of a School-Friendly Health System (SFHS) framework that is based on lessons learned from nationally recognized baby-friendly hospitals and age-friendly health systems initiatives. Becoming school-friendly means that hospitals and health systems have made a commitment to actively help children achieve optimal health and reach their full academic potential.

The big picture

Given the fundamental interrelation of health and education, hospitals and health care organizations need a holistic framework to guide their school partnerships and other efforts to make a positive impact on patient and family engagement, health care costs, health outcomes and, ideally, patients’ learning experience. For hospitals and health systems, partnering with schools in their local service area will not only improve service delivery to the students receiving care from the health system but will help strengthen health outcomes and overall student performance.

Children’s National Hospital leads the way

Eight health care organizations and partners, led by Desiree de la Torre, M.P.H., M.B.A., Julia DeAngelo, M.P.H., and Danielle Dooley, M.D., M.Phil., of the Child Health Advocacy Institute (CHAI) through executive support of Tonya Kinlow, M.P.A., and Nathaniel Beers, M.D., M.P.A., at Children’s National and with support from RESOLVE (a Washington, D.C., -based nonprofit based specializing in collaborative process design), have formed to update the SFHS framework that was first released in 2021. The Collaborative includes interdisciplinary health care professionals who have been leading and coordinating early childhood and K-12 school health initiatives across the nation.

The SFHS framework includes five principles that reflect a broad range of competencies, practices, and policy positions that health care and school health experts and stakeholders view as emblematic of a SFHS – some already practiced, some aspirational:

A few significant updates to the framework include embedding the “All Touchpoints Approach” principle across the framework and adding an “Alignment” principle. Other changes included modifying the wording of the Accessibility and Accountability principles and adding a few new practices.

What’s next

The Collaborative is now focusing on developing tools to support implementation. Through securing additional funding, the Collaborative will evaluate how the adoption of the SFHS framework across diverse settings has strengthened the healthcare sector’s relationships with schools, students and families and ability to improve health and academic outcomes.

Read the full study at childrensnational.org/school-friendly For more information on the SFHS Learning Collaborative, contact School Partnerships@childrensnational.org.

Children’s National joins team to use AI to expand health knowledge in Kenya

August 16, 2023

Children’s National Hospital is joining a team of global health researchers to use large language models (LLMs) like ChatGPT to help Kenyan youth learn about their health and adopt lifestyles that may prevent cancer, diabetes and other non-communicable diseases.

The work, which is one of nearly 50 Grand Challenges Catalyzing Equitable Artificial Intelligence (AI) Use grants announced by the Bill & Melinda Gates Foundation, will harness the emerging power of AI to empower young people with information that they can carry through adulthood to reduce rates of unhealthy behaviors including physical inactivity, unhealthy diet and use of tobacco and alcohol.

“We are thrilled to be part of this effort to bring our AI expertise closer to young patients who would benefit dramatically from technology and health information,” said Marius George Linguraru, D.Phil., M.A., M.Sc., a co-principal investigator for the project, the Connor Family Professor in Research and Innovation at Children’s National and principal investigator in the Sheikh Zayed Institute for Pediatric Surgical Innovation. “Using generative AI, we will build an application to enhance the knowledge, attitudes and healthy habits of Kenyan youth and use this as a foundation to improve health inequities around the globe.”

Why it matters

A lower middle-income country located on the east coast of Sub-Saharan Africa, Kenya is home to 50 million people and one of the continent’s fastest-growing economies. English is one of Kenya’s official languages, and the country has been recognized as a technology leader in Africa, with 82% of Kenyans having phone connectivity. Taken together, these factors make the country an ideal location to deploy an LLM-based platform designed to improve health information and attitudes.

The Gates Foundation selected this project from more than 1,300 grant applications. The nearly 50 funded projects are aimed at supporting low- and middle-income countries to harness the power of AI for good and help countries participate in the AI development process. The project’s findings will contribute to building an evidence base for testing LLMs that can fill wide gaps in access and equitable use of these tools. Each of the grants provides an opportunity to mitigate challenges experienced by communities, researchers and governments.

What’s next

The project development will be led by the National Cancer Institute of Kenya, with Linguraru and other global experts advising the effort from Kenyan institutions and Stanford University. Researchers plan to enroll youth from universities, shopping malls, markets, sporting events and other high-traffic locations. The study will look at participants’ risk factors and how their attitudes toward healthier lifestyles changed after engaging with the new LLM platform.

“The team is thrilled to be selected as one of the nearly 50 most promising AI proposals in the Gates Foundation Grand Challenge competition, and we look forward to seeing how our work can benefit the health of Kenyan youth,” said Dr. Martin Mwangi, principal investigator for the project and head of the Cancer Prevention and Control Directorate at the National Cancer Institute of Kenya. “If successful, we hope to share this model and the expertise we gain to expand health equity and knowledge to other regions.”

Pediatric hospitals underutilize systems to get at social challenges impacting health

July 31, 2023

Physicians treating hospitalized children rarely use a coding system established in 2015 for flagging social challenges and stressors that may be impacting patient health, according to new research from Children’s National Hospital.

Physicians treating hospitalized children rarely use a coding system established in 2015 for flagging social challenges and stressors that may be impacting patient health, according to new research from Children’s National Hospital published in Pediatrics. Known as social determinants of health (SDOH), these factors include food insecurity, homelessness and adverse childhood events like substance abuse at home, and they can greatly affect a child’s well-being.

“We only get so many touchpoints with our patients,” said Kaitlyn McQuistion, M.D., pediatric hospital medicine fellow at Children’s National and co-lead author of the paper. “Our research shows the screening itself provides valuable insight into our patients, making identification an important part of inpatient and post-discharge care. With this information, doctors can help families tap into social workers, community supports and other resources aimed at providing a more holistic approach to child health.”

The big picture

The American Academy of Pediatrics advises screening for unmet social needs and using the codes laid out in the International Classification of Disease, 10^th Revision (ICD-10), to flag risk factors for some of a hospital’s most vulnerable patients. In 2018, the American Hospital Association (AHA) clarified that the coding can be added by any healthcare professional accessing the chart, including nurses, social workers, case managers and physicians. The study looked at data from 4,000 hospitals in 48 states and the District of Columbia and found that use of the codes has remained low, even with the AHA’s clarification.

In practice, physicians know that screening and documentation are the essential first steps to help families find resources. Yet less than 2% of pediatric inpatients were coded as needing support. Most commonly, “problems related to upbringing” – a broad category indicating social needs and adverse childhood events – was used.

What’s ahead

Some providers are using these SDOH codes, or Z Codes, more often to address and improve health disparities. “Our mental health colleagues and those working with the Native American population, in particular, are using these tools more often to capture and disseminate critical information related to their patients’ social needs,” said Stacey Stokes, M.D., a hospitalist at Children’s National and co-lead author on the paper. “Their innovative approaches to address and improve health disparities may provide learning opportunities for institutions.”

The researchers said that more work needs to be done to take these successes to other populations, find ways to incentivize this work in billing and ensure that providers have community resources to address the needs that they uncover.

“The ultimate goal of this work is to identify patients with social needs affecting their health and connect them with resources,” said Kavita Parikh, M.D., director for the Research Division of Hospital Medicine. “There are many avenues to explore to find ways to better utilize this tool, including language learning models, improved training and stronger community resources.”

Survey: Teen parents with support report greater well-being

July 28, 2023

Teen parents in Washington, D.C., reported better physical and mental health when they had more social support, a community and people who understood their problems.

Teen parents in Washington, D.C., reported better physical and mental health when they had more social support, a community and people who understood their problems, according to a survey conducted as part of a novel city-wide program to bring together resources for young families.

“This should come as no surprise. Young parents say they do better – and their children do better – when they have the material and social supports they need,” said Yael Smiley, M.D., a pediatrician at Children’s National Hospital and lead author of research in BMC Public Health. “This work is the start of a roadmap to help young parents thrive.”

The big picture

Each year in D.C., 300 babies are born to teens, and the rate of births among teens ages 15 to 17 is higher than the national average. Dr. Smiley is a leader in a federally funded coalition run by D.C. Primary Care Association (DCPCA) to help support young parents called the D.C. Network for Expectant and Parenting Teens (DC NEXT!). This city-wide network brings together community partners to support teen mothers, fathers and their children.

A key feature of the program is its context team, a group of teen parents who provide insights into their experiences as young parents. They advise about research and support for their peers, and they also build a community and develop a platform to speak up about their issues. The context team recruited other parents to complete a well-being survey in 2022, which will guide programming and resources for families. An added benefit for the parents who participate in the context team: The survey data showed that a key facet of well-being for the young parents was feeling “like you were part of a group of friends or community” and having “someone who understood your problems.”

“The context team provides the type of community that the research shows is essential to the well-being of teen parents,” said Dr. Smiley. “Not only are the context team members helping us understand what teen parents need, but they are also helping each other thrive as young parents.”

The fine print

Among the findings of the survey of 107 teen parents in D.C.:

The most used resources were supplemental food programs – with 35% receiving Supplemental Nutrition Assistance Program (SNAP) benefits, 24% receiving support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and 18% accessing food pantries.
Also popular were Temporary Assistance for Needy Families (TANF), housing assistance and childcare.
Surprisingly, the largest group of respondents, 37%, reported receiving no resources.

Having higher social support was correlated with higher ratings for physical health, mental health and well-being. “With this research, we have even more evidence underscoring the need to connect young parents with programs and resources that will improve their well-being,” Smiley said. “I can’t wait to see what the leaders on the context team and in the DC NEXT! program do in the next phases of our work.”