Public Health Archives

Commercialization of novel facial analysis technology can improve diagnosis of rare disorders in pediatric patients

July 14, 2021

Children’s National Hospital has entered into a licensing agreement with MGeneRx Inc. for its patented pediatric medical device technology using objective digital biometric analysis software for the early and non-invasive screening of dysmorphic genetic diseases such as Noonan syndrome.

Children’s National Hospital has entered into a licensing agreement with life sciences technology company MGeneRx Inc. for its patented pediatric medical device technology using objective digital biometric analysis software for the early and non-invasive screening of dysmorphic genetic diseases. The technology, developed by a multidisciplinary Children’s National team led by Marius George Linguraru, D.Phil, M.A., M.Sc., of the Sheikh Zayed Institute for Pediatric Surgical Innovation and Marshall Summar, M.D., director of the Children’s National Rare Disease Institute (CNRDI), can provide a more advanced diagnostic tool for regions of the world with limited access to geneticists or genetic testing.

The application utilizes artificial intelligence (AI) and machine learning to analyze biometric data and identify facial markers that are indicative of genetic disorders. Physicians can capture biometric data points of a child’s face in real time within the platform, where it scans facial biometric features to determine the potential presence of a genetic disease, which can often be life-threatening without early intervention. Research studies conducted in conjunction with the National Human Genome Research Institute at the National Institutes of Health further enhanced the development of the application in recent years, showing the potential to detect, with a 90 percent accuracy, early diagnosis of 128 genetic diseases across pediatric subjects in 28 countries. These diseases include DiGeorge syndrome (22q11.2 deletion syndrome), Down syndrome, Noonan syndrome and Williams-Beuren syndrome.

“We are delighted to enter into this licensing agreement through Innovation Ventures, the commercialization arm of Children’s National Hospital, which seeks to move inventions and discoveries from Children’s National to the marketplace to benefit the health and well-being of children. Our mission is to add the ‘D’ in development to the ‘R’ in research to accelerate the commercialization of our intellectual property,” says Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer at Children’s National and managing director of Innovation Ventures. “It is through partnerships with startups and the industry that we can achieve this goal and thus we highly value this new partnership with MGeneRx Inc. The acceleration and commercialization of this objective digital biometric analysis technology will not only help diagnose rare genetic disorders – it will also allow for earlier interventions that improve the quality of life for the children living with these conditions.”

Eskandanian adds that the social impact of this technology is especially profound in lower income nations around the world, where there is a high prevalence of rare genetic conditions but a severe lack in the specialty care required to diagnose and treat them. Additional data collected through the expanded use of the technology will help to further develop the application and expand its capabilities to identify and diagnose additional rare genetic conditions.

The licensing agreement was arranged by the Children’s National Office of Innovation Ventures, which is focused on the commercialization of impactful new pediatric medical device technologies and therapies to advance children’s health care. Created to catalyze the ongoing translational research of the Children’s National Research Institute (CNRI) as well as inventions by hospital’s clinicians, Innovation Ventures focuses on four core pillars to advance pediatric medical technologies including a Biodesign program, partnerships and alliances to augment internal capacity, seed funding to de-risk technologies and validate market and clinical relevance, and back-office operations to manage intellectual property and licensing activities. Since 2017, Children’s National intellectual property has served as the basis for over 15 licensing or option agreements with commercial partners.

Providing access to an array of experts and resources for pediatric innovators is one of the aims of the Children’s National Research & Innovation Campus, a first-of-its-kind focused on pediatric health care innovation, with the first phase currently open on the former Walter Reed Army Medical Center campus in Washington, D.C. With its proximity to federal research institutions and agencies, universities, academic research centers, as well as on-site incubator Johnson and Johnson Innovation – JLABS, the campus provides a rich ecosystem of public and private partners, which will help bolster pediatric innovation and commercialization.

Autistic youth self-reporting critical to understanding of executive function challenges

July 9, 2021

Young people with autism are distinctly aware of their own challenges in areas such as flexibility, working memory and inhibition—abilities known collectively as “executive function,” according to the first study to measure and compare self-reports in these areas to more traditional reporting from parents.

Young people with autism are distinctly aware of their own challenges in areas such as flexibility, working memory and inhibition — abilities known collectively as “executive function,” according to the first study to measure and compare self-reports in these areas to more traditional reporting from parents. The study appears in the Journal Autism.

While autism research has started to focus on incorporating the experiences of autistic people themselves through self-reporting and greater inclusion in the design and execution of related research, this is the first time that a study has definitively captured self-reports of executive functions directly from young people with autism.

The study, which included 197 autistic youth, found that while both youth and their parents are in basic agreement about which areas of executive functioning that individual youth struggle with most, parents tended to report higher levels of impairment than the youth reported themselves. Executive function is related to a person’s ability to complete tasks such as adjusting to change, making a plan, getting organized and following through, as well as basic daily tasks like getting up and getting dressed or making small talk.

“While parents are reporting on outwardly observed behaviors in the context of home/community, for example, youth are reporting on their inner experiences across many contexts,” said Lauren Kenworthy, Ph.D., first author on the study and director of the Center for Autism Spectrum Disorders at Children’s National Hospital. “Our findings support the idea that autistic youth may be drawing their conclusions from different environmental data and cognitive frameworks than their parents, which adds a new dimension to our understanding of executive function in people with autism.”

The data are especially compelling because youth and parent reports of executive function were gathered on parallel measures with consistent items and factor structure, allowing for a true one-to-one comparison between youth and parent reporting.

“These kids are very aware of the areas where they struggle,” Dr. Kenworthy said. “And the findings from this study further elevate the importance of making sure that assessments of executive function take into account the perspective of the youth themselves, which can provide powerful insights into the interventions that they may benefit from the most.”

The study also compared reports from autistic youth to reports from both neurotypical youth and those with attention deficit hyperactivity disorder (ADHD), another condition where executive functioning skills can be challenged. There were distinct differences between all three groups—and the challenges profiled by youth with autism and those with ADHD were distinct from each other. For example, autistic youth reported greater challenges with flexibility, emotional control and self-monitoring than those with ADHD, who reported greater struggles with working memory.

The authors noted that future studies should include more performance-based measures, as well as larger numbers of females and people with intellectual disabilities to better understand how self-reporting can play a role in understanding and helping these specific groups. Additionally, developing new measures that capture the inner experience of autism by engaging autistic people in their creation could provide deeper insight into how young people with autism experience the world and how interventions designed to assist them are working (or not).

“These data provide clear evidence of the executive functioning challenges actually experienced by autistic youth as well as the primary role inflexibility plays in the lives of these young people,” the authors concluded. “This additional perspective and context for the experiences of these executive functioning challenges are of high clinical value and complement more frequently gathered assessments in ways never captured before.”

Calling greater attention to sub-Saharan Africa’s pressing challenges in pediatric cardiac care

June 30, 2021

Sub-Saharan Africa has only 0.19 pediatric cardiac surgeons per million children — nowhere near enough surgeons to care for all the pediatric congenital heart disease and acquired heart disease present in the people who live there.

A literature review in the journal Current Opinion in Cardiology draws further attention to the pressing needs for better pediatric cardiac care in regions of the world where the population continues to grow, but the development of specialty care for children continues to lag. The article focuses specifically on sub-Saharan Africa.

“If 40% of live births occur in Africa by 2050 as the projections suggest, congenital heart disease may well become the most important contributor to infant mortality rate in sub-Saharan Africa in the next three decades,” stated the authors, including Annette Ansong, M.D., who recently joined Children’s National Hospital as medical director of outpatient cardiology.

As highlighted previously by other authors within the Global Health Initiative at Children’s National and through the work of the American Heart Association, the region’s needs are already significant in tackling the impacts of existing congenital heart disease and rheumatic heart disease. Rheumatic heart disease is a devastating long-term outcome of rheumatic fever caused by untreated streptococcus infections.

“If 40% of live births occur in Africa by 2050 as the projections suggest, congenital heart disease may well become the most important contributor to infant mortality rate in sub-Saharan Africa in the next three decades,” stated the authors, including Annette Ansong, M.D., who recently joined Children’s National Hospital as medical director of outpatient cardiology.

Dr. Ansong and colleagues reiterate the point that today, “whereas one cardiac center caters to approximately 120,000 people in North America, 33 million people in sub-Saharan Africa must depend on one center for care.” They also note that this region of Africa has only 0.19 pediatric cardiac surgeons per million children compared with more than 58 times as many in North America.

Changing the trajectory of pediatric cardiac care in sub-Saharan Africa will take motivation on several fronts, the authors write. Dedication to early detection and intervention (medical or surgical), an emphasis on building an in-country pipeline of human resources and skills’ sets are needed to tackle the increasing numbers of children requiring this specialty care. Political will and better financial resources can also support the training and development of centers that specialize in these capabilities.

Demographic, clinical and biomarker features of MIS-C

June 25, 2021

In a new observational study, researchers provide insight into key features distinguishing MIS-C patients to provide a more realistic picture of the burden of disease in the pediatric population and aid with the early detection of disease and treatment for optimal outcomes.

Multisystem Inflammatory Syndrome in Children (MIS-C) significantly affected more Black and Latino children than white children, with Black children at the highest risk, according to a new observational study of 124 pediatric patients treated at Children’s National Hospital in Washington, D.C. Researchers also found cardiac complications, including systolic myocardial dysfunction and valvular regurgitation, were more common in MIS-C patients who were critically ill. Of the 124 patients, 63 were ultimately diagnosed with MIS-C and were compared with 61 patients deemed controls who presented with similar symptoms but ultimately had an alternative diagnosis.

In the study, published in The Journal of Pediatrics, researchers provide insight into key features distinguishing MIS-C patients to provide a more realistic picture of the burden of disease in the pediatric population and aid with the early detection of disease and treatment for optimal outcomes. The COVID-linked syndrome has affected nearly 4,000 children in the United States in the past year. Early reports showed severe illness, substantial variation in treatment and mortality associated with MIS-C. However, this study demonstrated that with early recognition and standardized treatment, short-term mortality can be nearly eliminated.

“Data like this will be critical for the development of clinical trials around the long-term implications of MIS-C,” says Dr. Roberta DeBiasi, M.D., lead author and chief of the Division of Pediatric Infectious Diseases at Children’s National. “Our study sheds light on the demographic, clinical and biomarker features of this disease, as well as viral load and viral sequencing.”

Of the 63 children with MIS-C, 52% were critically ill, and additional subtypes of MIS-C were identified including those with and without still detectable virus, those with and without features meeting criteria for Kawasaki Disease, and those with and without detectable cardiac abnormalities. While median age (7.25 years) and sex were similar between the MIS-C cohort and control group, Black (46%) and Latino (35%) children were overrepresented in the MIS-C group, especially those who required critical care. Heart complications were also more frequent in children who became critically ill with MIS-C (55% vs. 28%). Findings also showed MIS-C patients demonstrated a distinct cytokine signature, with significantly higher levels of certain cytokines than those of controls. This may help in the understanding of what drives the disease and which potential treatments may be most effective.

In reviewing viral load and antibody biomarkers, researchers found MIS-C cases with detectable virus had a lower viral load than in primary SARS-CoV-2 infection cases, but similar to MIS-C controls who had alternative diagnoses, but who also had detectable virus. A larger proportion of patients with MIS-C had detectable SARS-CoV-2 antibodies than controls. This is consistent with current thinking that MIS-C occurs a few weeks after a primary COVID-19 infection as part of an overzealous immune response.

Viral sequencing was also performed in the MIS-C cohort and compared to cases of primary COVID-19 infection in the Children’s National geographic population. 88% of the samples analyzed fell into the GH clade consistent with the high frequency of the GH clade circulating earlier in the pandemic in the U.S. and Canada, and first observed in France.

“The fact that there were no notable sequencing differences between our MIS-C and primary COVID cohorts suggests that variations in host genetics and/or immune response are more likely primary determinants of how MIS-C presents itself, rather than virus-specific factors,” says Dr. DeBiasi. “As we’ve seen new variants continue to emerge, it will be important to study their effect on the frequency and severity of MIS-C.”

Researchers are still looking for consensus on the most efficacious treatments for MIS-C. In a recent editorial in the New England Journal of Medicine, Dr. DeBiasi calls for well-characterized large prospective cohort studies at single centers, and systematic and long-term follow-up for cardiac and non-cardiac outcomes in children with MIS-C. Data from these studies will be a crucial determinant of the best set of treatment guidelines for immunotherapies to treat MIS-C.

Children’s National provides clinical validation, IP for health challenge designed to advance pediatric innovation

June 24, 2021

Reinforcing its commitment to expanding innovation in pediatric care, Children’s National Hospital has joined a strategic partnership with the Center for Advancing Innovation (CAI) , along with collaborators Resonance Philanthropies and Digital Infuzion, to launch the 2021-2022 Innovate Children’s Health Challenge. This year’s event, Innovate Children’s Health II, focuses on technologies that address pandemic resiliency and prevention in the pediatric population and seeks to advance diagnostics, therapeutics and digital health tools that address pediatric mental health.

The initiative matches entrepreneurial talent with breakthrough inventions to launch startups and connect them with capital. For this challenge, more than 15 startups will compete for the opportunity to commercialize promising mental health solutions from a variety of research partners, including Children’s National. Nationally recognized for its expertise and commitment to innovation in pediatric care, Children’s National will contribute to the clinical validation of selected technologies.

“In addition to our role in providing clinical validation, this initiative provides the opportunity for intellectual property (IP) developed by leading clinicians at Children’s National Hospital, as well as other great pediatric institutions, to be considered for partnership with entrepreneurs who can help bring these technologies to market,” says Kolaleh Eskandanian, PhD, MBA, PMP, vice president and chief innovation officer at Children’s National Hospital. “Our mission is to improve children’s healthcare and Innovate Children’s Health II is a great way to harness this trifecta model — innovation, talent and capital — in order to develop breakthrough solutions that address the unique needs of pediatric patients.”

“In addition to our role in providing clinical validation, this initiative provides the opportunity for intellectual property (IP) developed by leading clinicians at Children’s National Hospital, as well as other great pediatric institutions, to be considered for partnership with entrepreneurs who can help bring these technologies to market,” says Kolaleh Eskandanian, PhD, MBA, PMP, vice president and chief innovation officer at Children’s National Hospital.

There are three ways to participate in Innovate Children’s Health II:

Entrepreneurial-minded people, alone or as members of multidisciplinary teams, may compete to commercialize vetted inventions;
Existing startups may enter the challenge with other public health-related inventions, including their own and/or others to which they have access;
Participants may submit ideas that they believe will improve emergency preparedness and pandemic response.

Inventors and technology licensing officers may submit inventions to be evaluated and made available for licensing to challenge winners. Innovate Children’s Health II will accept invention submissions until September 1, 2021. Anyone with an entrepreneurial spirit and interest in stopping current and future pandemics is invited to sign up to learn more about the challenge. Teams may also enroll in the challenge to choose a featured invention, bring in a third-party invention or get matched with an invention based on area of interest.

“The COVID-19 pandemic has made our children anxious, depressed and pessimistic about their futures. Through Innovate Children’s Health II, CAI and our strategic partner Children’s National will strive to give our children hope,” says Rosemarie Truman, founder and CEO of CAI. “We are grateful to Digital Infuzion and Resonance Philanthropies for their support, which makes this challenge possible.”

Eskandanian adds that supporting and expanding pediatric innovation is a key focus of the new Children’s National Research & Innovation Campus, the first-of-its-kind focused on pediatric health care innovation, with the first phase currently open on the former Walter Reed Army Medical Center campus in Washington, D.C. With its proximity to federal research institutions and agencies, universities, academic research centers, as well as on-site incubator Johnson and Johnson Innovation – JLABS, the campus provides a rich ecosystem of public and private partners which will help bolster pediatric innovation and commercialization.

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

June 15, 2021

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

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

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

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

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

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

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

Neonatology (No. 1), led by Division Chief Billie Lou Short, M.D.
Neurology and Neurosurgery (No. 3 (No. 3 nationally, the best in the Mid-Atlantic region), led by Division Chiefs William D. Gaillard, M.D., and Robert F. Keating, M.D.
Cancer (No. 5), led by Division Chief Jeffrey S. Dome, M.D., Ph.D.
Nephrology (No. 6), led by Division Chief Marva Moxey-Mims, M.D.
Orthopedics (No. 6), led by Division Chief Matthew Oetgen, M.D., M.B.A.
Pulmonology and Lung Surgery (No. 8), led by Division Chief Anastassios Koumbourlis, M.D., M.P.H.
Diabetes and Endocrinology (No. 10), led by Division Chief Andrew Dauber, M.D., MMSc.

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

Children have more COVID-19 antibodies than previously thought, study finds

June 10, 2021

Seroprevalence of antibodies to SARS-CoV-2 in healthy children and children with chronic diseases is higher than researchers previously believed, according to a new study published in The Pediatric Infectious Diseases Journal. The study, which included 385 children in the Washington metropolitan area, found a 9.46% SARS-CoV-2 seroprevalence among this group. Researchers from Children’s National Hospital also identified predictive factors such as specific symptoms, race and ethnicity, that are associated with the antibodies’ presence in the blood, also known as seropositivity.

The 9.46% seroprevalence in healthy children and children with chronic diseases is higher than previously reported. However, this rate remains below the theoretical herd immunity threshold, estimated between 50% and 67% for the general population in the absence of any interventions — like vaccination — and assuming possible lasting immunity.

“We believe our estimate is a close approximation of seroprevalence for the diverse pediatric population in our region,” said the study authors, including Burak Bahar, M.D., lead author and director of Laboratory Informatics at Children’s National.

Since most symptomatic individuals are adults and they have been the main focus for seroprevalence studies, there is still a lack of information about SARS-CoV-2 seroprevalence for pediatric patients and healthy kids. With this study, researchers wanted to shed light on the knowledge gap in COVID-19 pediatric research.

“Parents are key allies who can help scientists better understand the virus’ behavior in children,” said Dr. Bahar.

Until now, it was also unknown if children with chronic diseases had less evidence of antibodies due to underlying conditions, particularly illnesses that cause weakened immune systems. The study showed no notable difference in the association with seropositivity among chronic illness groups, including immunocompromised children.

“Our findings offer important information as all children, with chronic illness or not, could be considered for ‘back to school’ transitions, because they have the same levels of protection. This means they all can have access to social, emotional and behavioral development,” said the authors.

The researchers explored co-existing conditions, symptomatology and demographics as predictors of antibody presence. The analysis showed that children with chronic conditions like asthma, diabetes and cancer were not predictors. This means that these sick kids, when introduced to the virus, make antibodies at the same levels as kids without these diseases.

While most participants were asymptomatic, in those who tested positive for anti-SARS-CoV-2 antibodies, fever, headache and cough were the most common symptoms.

Among the demographics, Hispanic children had a higher seropositive rate than white children. However, median household income based on reported zip code and state of residency were not found to be associated with having antibodies or not.

To determine the impact of continued infections in the community, future studies are needed to identify possible changes in the seroprevalence over a more extended period and to assess seropositivity with vaccination implementation, as that may influence the current rate.

The study is a snapshot in time from July to October 2020. The sample size of 385 patients included both healthy children and those with chronic diseases (69.7%) ranging from 2 months to 22 years old. From the sample pool, 38 individuals were found to have antibodies against SARS-CoV-2. To assess demographic characteristics, symptoms and co-existing conditions associated with seropositivity the researchers used a survey.

A related SARS-CoV-2 antibody production study published on Sept. 3, 2020 in the Journal of Pediatrics, also led by Bahar et al., found that antibodies are detected 18 days after a positive COVID-19 test in children. The authors further noted that the virus and antibodies can co-exist in young patients, so even if seropositivity is detected, they may still transmit the virus.

Incoming residency class at Children’s National three times more diverse than national average

June 10, 2021

The new class of residents arriving at Children’s National Hospital on June 9, will be the hospital’s most diverse class ever. 51% of the incoming intern class identify with races and ethnicities underrepresented in medicine (UIM) including Black, Latino and Southeast Asian, a percentage that is more than three times the national average for diversity within residency programs.

“We have worked hard to make our residency class more diverse because we know that diversity among academic pediatricians helps dismantle systemic health care inequities faced by children,” said Aisha Barber, M.D., M.Ed., director of the Pediatric Residency Program at Children’s National. “Studies show that when patients see someone they identify with, it enhances patient trust and satisfaction. Diversity within medical ranks has also been associated with improved health care outcomes for patients from underrepresented backgrounds.”

Children’s National created outreach and pipeline programs designed to reach a larger more diverse group of medical students and to increase diverse students’ interest in academic pediatrics at Children’s National. Program leaders reach out through various student medical association meetings, nationally and regionally.

In 2015, the hospital developed Advancing Diversity in Academic Pediatrics, a scholarship program for senior medical students from backgrounds UIM to experience what a career in academic pediatrics might look like for them. Since the start of the scholarship program, the diversity of incoming resident classes has grown from 12% to the current 51%.

“This scholarship program changed my career trajectory as it introduced me to the field of pediatric academic medicine,” said Jessica Hippolyte, M.D., M.P.H., pediatric chief resident at Children’s National and graduate of the scholarship program. “I was paired with minority resident and faculty mentors, networked with senior program leadership, received guidance on the application process and gained tremendous insight on all the opportunities available to Children’s National residents.”

Under the scholarship program, fourth year medical students are invited for a month-long clinical rotation and given a stipend funded by the CEO’s office at Children’s National. The program’s curriculum not only focuses on the clinical experience, but through relationships with mentors, focuses on the development of interview skills and the creation of a competitive curriculum vitae, or CV.

Since the program began, there have been over 70 participants and a 25% match rate to the pediatric residency program at Children’s National. Four members of the 2021 class are graduates of the scholarship program.

Every March, medical students learn which residency programs they will train with on what is known as ‘Match Day’. Children’s National receives over 2,000 applications per year for 41 residency positions. That’s more than half of medical student applications in the U.S. for pediatrics. Applicants were recruited from some of the top medical schools in the U.S. including the University of Pennsylvania, Columbia University, University of California, San Francisco and University of California, Los Angeles.

In addition to the increases in the racial and ethnic diversity of the incoming residents, at least 10% of the incoming class identify as LGBTQ, which mirrors the percentage of adults in D.C. who identify as LGBTQ.

“There are many factors that indicate to us that someone will make a great resident and a great doctor,” said Dr. Barber. “At Children’s National, we strive to be sure our residents understand that they’re appreciated not for how they add to diversity statistics, but for who they are as a whole person and all they have to contribute to our community.”

Screenshot of Drs. Northam, Newman and Batshaw

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

June 4, 2021

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

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

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

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

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

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

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

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

Below are the speakers and the focus of their presentations.

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

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

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

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

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

Linda Talley, M.S., R.N., inducted into Honorary Commander Program

May 21, 2021

Credit: USAF SrA Kevin Tanenbaum

Linda Talley, M.S., R.N., NE-BC, FAAN, vice president of nursing and chief nursing officer at Children’s National Hospital, was inducted as one of the Honorary Commanders for Joint Base Anacostia-Bolling during a ceremony at the base on May 14, 2021.

The Honorary Commander Program at Joint Base Anacostia-Bolling gives key community leaders the opportunity to understand the mission of the Air Force and the role of Joint Base Anacostia-Bolling in the Department of Defense’s overall mission. The program also allows military commanders and their units to connect with their community. Honorary commanders serve as a civilian representative between Joint Base Anacostia-Bolling and the external community, ensuring an increase in direct communication and partnership.

“I am pleased to accept this honor from Joint Base Anacostia-Bolling,” says Linda Talley. “I look forward to representing both the civilian and healthcare community and building a meaningful relationship with military leaders.”

The relationship will benefit both the civilian and military communities. Members of each community will be invited to participate in respective events to gain a better understanding of each other’s mission.

Talley will serve a two-year term and has been matched with the 316^th Medical Squadron.

Other newly inducted Honorary Commanders include D.C. Mayor Muriel Bowser and Chief Robert Contee of the Metropolitan Police Department.

Read more about the program and inductees here.

Credit: USAF SrA Kevin Tanenbaum

D.C. leaders unveil city’s largest solar canopy at Children’s National Research & Innovation Campus

April 27, 2021

The clean energy generated by this solar array, which is on the RIC parking garage, will be distributed through the Solar for All program, Mayor Bowser’s initiative to provide 100,000 low-to-moderate income families with the benefits of locally generated clean energy.

Washington, D.C.’s largest solar canopy was recently unveiled on the grounds of the Children’s National Research & Innovation Campus (RIC), located on the former Walter Reed Army Medical Center campus. The installation is part of the District’s Solar for All program and will provide more than 325 income-qualified households with clean, renewable energy and electricity bill savings over the next 15 years.

“When we began to plan the Children’s National Research & Innovation Campus, we wanted to do more than discover new and better ways to care for children. We also wanted to support the local community,” said Children’s National Hospital President and CEO Kurt Newman, M.D. “I’m proud that we could incorporate the solar design into our campus thereby returning clean energy to the residents of D.C.’s Ward 4 and doing our part to support the environment.”

The District of Columbia Department of Energy & Environment (DOEE) awarded Children’s National and partner New Columbia Solar (NCS) with the 2021 District Sustainability Award for the execution of this project.

“I am pleased to celebrate this innovative, award-winning project, accomplished with our partners for the benefit of our residents and community,” said DOEE Director Tommy Wells. “The completion of this project by New Columbia Solar is a tremendous achievement that will not only help to meet Mayor Muriel Bowser’s climate and clean energy goals for the District, but will also help to reduce energy costs for low-income households. The District is proud to be a national leader in sustainability, and this project further demonstrates our commitment to deploying solar and developing scalable solutions in a way that prioritizes equitable access for all.”

L-R: Children’s National Hospital Vice President of Community Engagement, Advocacy & Government Affairs Tonya Kinlow; New Columbia Solar CEO Mike Healy; Councilmember Mary Cheh; DOEE Director Tommy Wells; PSC Commissioner Emile Thompson; Children’s National Hospital Chief Operating Officer Kathy Gorman; and DCSEU Director Ted Trabue.

The clean energy generated by this solar array, which is on the RIC parking garage, will be distributed through the Solar for All program, Mayor Bowser’s initiative to provide 100,000 low-to-moderate income families with the benefits of locally generated clean energy. This installation will serve more than 325 income-qualified D.C. families, saving each household up to $500 annually and saving these families up to $2.4 million over 15 years.

“This project is the perfect example of why operating a solar company in the District is so rewarding,” said NCS CEO Mike Healy. “I look at this project and see major decision-makers in D.C. coming together, in the middle of a global pandemic, to prioritize powering our city through clean energy and to offset utility expenses for the families in our community who are most in need.”

The installation began when Children’s National acquired a large five-story above-grade parking garage, which provided the perfect location for a cutting-edge solar array. The original goal for the parking garage was always to incorporate a solar array. However, the installation of the 1,148 kW system was an engineering feat, representing one of the District’s most complex solar systems.

Over the past two years operating DOEE’s Solar for All program, the D.C. Solar Energy Utility (DCSEU) has worked with local solar developers to install 130 community solar facilities across the District. These installations are expected to serve more than 4,000 income-qualified D.C. families, with more community solar projects slated to be developed in 2021 to serve an additional 2,000 households.

“It’s an honor to deliver the Solar for All program in partnership with the District government and the D.C. business community,” said DCSEU Director Ted Trabue. “These projects bring opportunities to District businesses, jobs to D.C. residents and critical electricity bill savings to families who need it, all while helping work toward a carbon-free D.C.”

As part of the larger commitment of Children’s National to positively impact the environment and the community, the organization has formed a Sustainability Council with the overall purpose to build a long-term commitment to sustainable practices; integrate sustainability in the areas of education, research, operations and community service; and incorporate sustainable designs in future construction plans.

Limit antibiotic use before dental procedures to high-risk heart patients, says AHA

April 26, 2021

A new scientific statement from the American Heart Association (AHA) says that good oral hygiene and regular dental care are the most important ways to reduce the risk of a heart infection called infective endocarditis (IE) caused by bacteria in the mouth.

A new scientific statement from the American Heart Association (AHA) says that good oral hygiene and regular dental care are the most important ways to reduce the risk of a heart infection called infective endocarditis (IE) caused by bacteria in the mouth. The statement was published in Circulation, the AHA’s flagship journal.

This statement addresses the impact of the major changes made in the 2007 AHA infective endocarditis (IE) guidelines that limited antibiotic prophylaxis (AP) prior to dental procedures to cardiac conditions at highest risk of complications from endocarditis by focusing on the following:

What was the acceptance of and compliance with the 2007 recommendations?
Was there an increased incidence of viridians group streptococci (VGS) infective endocarditis (IE)?
Were the recommendations from the guideline valid and should they be revised?

While the statement speaks to all types of heart disease, one area of particular interest in congenital heart disease was highlighted by statement co-author Craig Sable, M.D., F.A.H.A., associate division chief of Cardiology at Children’s National Hospital.

He noted that the statement specifies that children and adult congenital heart patients undergoing pulmonary valve replacement can be at higher risk for IE. The most significant risk factor for IE is the material the valve is made from, regardless of whether it is placed by surgery or catheterization.

Watch AHA’s video explaining the statement, which features Dr. Sable.

Celebrating Research, Education and Innovation Week at Children’s National Hospital

April 21, 2021

Children’s National Hospital held its 11^th Annual Research, Education and Innovation Week, which showcased the scholarly achievements of faculty, staff and trainees across all disciplines and the roles they play in advancing medical science and providing the highest quality care to children.

The week-long event included poster presentations, guest lectures, educational workshops and panel discussions. Eight acclaimed speakers were invited to deliver keynote lectures, including, Wayne A. I. Frederick, M.D., M.B.A., FACS, president of Howard University, James W. Collins, Jr., M.D., M.P.H., associate director for the pediatric residency program at Lurie Children’s Hospital of Chicago, Francis S. Collins, M.D., Ph.D., director of the National Institutes of Health (NIH) and Sally Allain, MSc, M.B.A., head of JLABS @ Washington D.C. The themes for both Dr. Frederick’s and Dr. James Collins’s presentations were centered on diversity, equity and inclusion.

The keynote lecture “The State of Diversity in the Medical Profession” delivered by Dr. Frederick gave a voice to three often sidelined matters. First, the ongoing need to ensure greater equity and accessibility of health care for communities of color. Second, the unconscious biases that continue to permeate the medical profession, making it difficult for minorities to receive the health care they need. Third, how Historically Black Colleges and Universities in general, and Howard University in particular, shoulder an immense burden in developing African American doctors who enter the medical profession in this country.

To Dr. Frederick, progress begins with awareness and education. “I want people to understand why diversity is important, what challenges prevent it and what can be done to promote it. I also want each individual to understand the role he or she may play in fostering greater diversity,” said Dr. Fredrick. “These are institutional problems, but individual people have the power to change their environment. We will need to advocate for and work to bring about greater diversity. The more people giving momentum to this initiative, the further progress we will make.”

Dr. Frederick further explained that there are many obstacles to diversity. “Becoming a doctor requires time, money and resources. Aspiring Black doctors often forgo a medical career because they don’t have the resources to afford the education nor the luxury to defer earning a livable salary,” said Dr. Frederick. “To achieve diversity in all fields, but especially in the medical profession, we need to support students and the institutions that train them so they can make professional decisions based on their future goals rather than their immediate needs.”

The “The Racial Disparity in Adverse Birth Outcome: Zip Code Eclipses Genetic Code,” keynote lecture from Dr. James Collins shed light on African American women’s ongoing exposure to early-life impoverishment, racial discrimination and parental low socioeconomic status associated with adverse birth outcome.

“Racial disparities in certain U.S. zip codes persists even though it is known to negatively affect birth outcomes because it fails to eliminate the early-life—and generational—consequences of neighborhoods experiencing poverty and lifetime exposure to racial discrimination,” said Dr. James Collins. “We must eliminate the social and economic inequities that are the root cause of the racial disparity in adverse birth outcome.”

Children’s National faculty were also recognized for their high-quality research during the event. Awards for the best poster presentations were distributed according to the following categories:

Basic and Translational Research
Clinical Research
Community-Based Research
Education, Training and Program Development
Quality and Performance Improvement

The category winners conducted research on a variety of topics, including creating and applying telehealth innovation, developing educational intervention strategies, evaluating the impact of COVID-19 in the Washington Metropolitan area, using T-cell expansion for therapeutic use.

Sociodemographic factors linked to intentional youth firearm injuries

April 6, 2021

A new study led by researchers at Children’s National Hospital, finds that sociodemographic factors related to intent of injury by firearm may be useful in guiding policy and informing tailored interventions for the prevention of firearm injuries in at-risk youth.

Firearm injuries are a leading and preventable cause of injury and death among youth – responsible for an estimated 5,000 deaths and 22,000 non-fatal injury hospital visits each year in American kids. And while hospital systems are poised to tackle this issue using a public health approach, prevention efforts and policies may be differentially effective. A new study led by researchers at Children’s National Hospital, finds that sociodemographic factors related to intent of injury by firearm may be useful in guiding policy and informing tailored interventions for the prevention of firearm injuries in at-risk youth.

“We sought to explore differences by injury intent in a nationally representative sample of youth presenting to the emergency department with firearm injury,” said Shilpa Patel, M.D., M.P.H., emergency medicine physician at Children’s National Hospital. “We are hopeful that hospitals will support programs that are targeted, patient-centered and relevant to their communities to prevent firearm injury among youth.”

In one of the first comparative studies of factors and outcomes associated with intentionality of youth firearm injury in a large nationally representative sample, researchers identified more than 178,200 weighted hospital visits for firearm injuries with data collected from the Nationwide Emergency Department Sample (NEDS) from 2009 through 2016. Dr. Patel and her colleagues identified distinct risk profiles for individuals aged 21 and younger, who arrived at emergency departments with firearm injuries over an 8-year period.

Using NEDS data, researchers found that approximately one third of the injuries were categorized as unintentional, another third as assault and a small proportion as self-harm. The majority of visits were among youth age 18 to 21 years with almost 90% male, and more than 40% publicly insured. Nearly a third were admitted to the hospital and 6% died as a result of their firearm injuries. In addition, the study showed that the likelihood of unintentional injury was higher among children age 12 and younger.

Unintentional firearm injuries were also associated with rural hospital location, southern region, emergency department discharge and extremity injury. Self-harm firearm injuries were associated with older age, higher socioeconomic status, rural hospital location, transfer or death, and brain, back and spinal cord injury.

“These findings provide insight into the overlap between risk factors, outcomes and intentionality of youth firearm injury,” says Dr. Shilpa. “For hospitals looking to implement programs to reduce youth firearm injury, distinct risk profiles identified in our study align with prior evidence to support the following: screen for firearm access and provide counseling on safe storage targeting families with younger children; screen suicidal patients for access to lethal means, especially those hospitals in rural areas; and screen for firearm access especially among children exposed to violence or at risk for assault presenting to urban hospitals.”

Other researchers who contributed to this study include members of S.A.F.E.R. (Safer through Advocacy, Firearm Education and Research) — a firearm safety advocacy group at Children’s National: Gia M. Badolato, M.P.H., Kavita Parikh, M.D., M.S.H.S., and Monika K. Goyal, M.D., M.S.C.E, all of Children’s National, and Sabah F. Iqbal, M.D., of PM Pediatrics.

Children’s National awarded $4.2 million to lead maternal mental health research programs

April 5, 2021

Mothers and their babies often experience stress, depression and anxiety, which impacts the infant’s brain development.

Children’s National Hospital announces a $4.2 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to support maternal mental health research. The Developing Brain Institute at Children’s National will lead a new program that seeks to advance perinatal mental health and well-being while addressing racial disparities in access to resources that could boost positive health outcomes for women with few opportunities.

Mothers and their babies often experience stress, depression and anxiety, which impacts the infant’s brain development. Maternal psychological distress is more pronounced among low-income mothers — a health disparity that was exacerbated during the COVID-19 pandemic.

“The new fund will support many scientific research portfolios, including our project that will ensure pregnant women in D.C. get the care they need and deserve,” said Catherine Limperopoulos, Ph.D., director of The Developing Brain Institute at Children’s National and co-principal investigator of the project.

“I’m honored to be working alongside Dr. Limperopoulos and our partners. Collectively, our team aims to meet the needs of African American pregnant and postpartum women and their families during this important transition in their lives by providing services to address social determinants of health and prevent and treat maternal distress,” said Huynh-Nhu Le, Ph.D., the co-principal investigator of the project and professor in the Clinical Psychology program, part of the department of Psychological and Brain Sciences at George Washington University.

Cognitive-behavioral intervention, patient navigation and peer support, such tailored strategies developed in the program will provide effective mental health screening and care for 1,000 mothers living in Washington D.C. that is responsive to their cultural, social, environmental, behavioral and medical needs. The participants will access the resources either online or in-person, depending on the type of assistance that fits their lifestyle.

“I am overjoyed that PCORI has provided this essential funding, giving life to our project. The research done here will have a grand effect! Our goals are ambitious: To dissect all aspects of maternal health, beyond just mental health, literally creating a detailed timeline of events a mother can anticipate experiencing from pregnancy, at delivery and postpartum,” said Shanae Bond, one of the women whose firsthand experience giving birth in D.C. informed the study design. “With the maternal health crisis we are currently facing, it’s imperative to gain this type of insight to not only support mothers but to learn how they wish to be supported and how to best improve the care they receive – based on how it impacts, improves (or impairs) their lives,” said Bond.

The multidisciplinary group includes doctors, midwives, psychologists, advisors, community leaders and four prenatal care centers, MedStar Washington Hospital Center, Howard University, The George Washington University and Unity Health Care.

“Our initiative brings together obstetrics, pediatrics, and mental health care in an integrated care model. This collaboration brings early identification and immediate care coordination to its rightful place at the center of care,” said Loral Patchen, Ph.D., CNM, vice chair, Innovation and Community Programs at MedStar Washington Hospital Center. “The prenatal period offers an opportunity for us to support emotional healing, build coping strategies, and offer a safe space for people to prepare for the complex transitions that accompany childbearing. Offering services prior to delivery optimizes opportunity for strong parent-infant attachment and mitigates potential disruptions.”

Kristin L. Atkins, M.D., FACOG, assistant professor in the Obstetrics and Gynecology Department at Howard University College of Medicine, mentioned that Howard University is honored to partner with Children’s National Hospital. “The new program will help discover more about prenatal care interventions related to maternal mental health and how they may impact fetal and pediatric brain development,” said Dr. Atkins. “We are just discovering the impact of long-standing stress on health and well-being, and this starts in utero.”

To Jennifer Keller, M.D., MPH, FACOG, associate professor at The George Washington University School of Medicine & Health Sciences, this project is essential. “The events of the last year have had a profound impact on families in this city,” said Dr. Keller. “This project begins at a time of critical mental health needs for pregnant people in D.C.”

Siobhan Burke, M.D., director of OB/GYN at Unity Health Care, is also thrilled to be part of this partnership. “We all know underlying stressors such as financial difficulties, housing instability and systemic racism can impact health, but it’s important to find out what these things do to the developing fetus and to explore strategies to make lives better,” said Dr. Burke.

In 2020, Children’s National established The Clark Parent & Child Network funded by a $36 million investment from the A. James & Alice B. Clark Foundation. The Clark Network aims to provide families with greater access to mental health care and community resources. New projects like the D.C. mother-infant behavioral wellness program underwritten by PCORI funding will become natural extensions of this essential work.

“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options,” said PCORI Executive Director Nakela L. Cook, M.D., M.P.H.. “We look forward to following the study’s progress and working with Children’s National Hospital to share the results.”

This $4.2 million PCORI funding has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

Multidisciplinary team develops innovative PPE that fits clinical needs during COVID-19

March 29, 2021

Children’s National engineers and clinicians developed plexiglass shields for testing sites, comfortable face shields for clinical providers, affordable oversized breath shields for ophthalmology and 3D printed flip-up attachments to the safety goggles for nurses.

The Children’s National Hospital innovation working group shares a retrospective on their local experience in mobilizing resources to offer relief following the personal protective equipment (PPE) shortages at the beginning of COVID-19. Engineers and clinicians developed plexiglass shields for testing sites, comfortable face shields for clinical providers, affordable oversized breath shields for ophthalmology and 3D printed flip-up attachments to the safety goggles for nurses.

The study, published in the Surgical Innovation Journal, narrates a series of events that occurred at the beginning of the pandemic, where the increased demand for personal protective equipment (PPE) usage in healthcare personnel skyrocketed and led to a severe national shortage. Still, the multidisciplinary approach at Children’s National facilitated the response and preparedness to the emerging situation back in March of 2020, serving as a framework for the current and future challenges.

To meet the needs of one of the busiest pediatric emergency departments in the country, the researchers aimed to develop a plexiglass shield that was reliable, reusable and practical while staying pediatric-friendly. The prototype had advantages and disadvantages while administering a COVID-19 swab test in a tent.

The 2020 FDA Emergency Authorization Use (EUA) issued in April provided manufacturing guidelines to produce face shields. Given the federal support, innovators at Children’s National, in partnership with GCMI, designed a rigid and foam prototype. Both prototypes were measured by comfort, visibility, breathability, ability to perform the job, durability, stability, fit and easy assembly. The rigid prototype performed the highest in all metrics and it had few adjustments after various tests.

“While the FDA has become nimbler as evidenced by rapid issuance of EUA of the vaccines, regulatory concerns are still paramount,” Operfmann et al. write. “Having staff experienced with regulatory processes is important to introduce new regulated devices.”

In May 2020, there was also a production lag on the available oversized breath shields for ophthalmology slits, which cost between $35 and $40. To lift the burden, the researchers designed and produced in-house a cost-effective oversized breath shield for less than $9. They used a 40 W laser machine to cut through the thick clear cast acrylic while following the compatible measurements of commercial lamps. The team also distributed the breath shields to other Children’s National regional clinics.

Within the nursing staff, the main factor associated with abiding to PPE compliance is the usage of safety goggles before entering a room. But in time-sensitive situations like patients with severe COVID-19 symptoms, the equipment can be easily forgotten. To support busy shifts, researchers designed a 3D printable attachment valued at $5 for safety goggles, which are more comfortable to keep on, even during downtime. The efficacy of the flip-up attachment is yet to be determined in an upcoming trial.

“Hospitals have already begun augmenting their disaster preparation plans and ensuring they have adequate stockpiles of equipment for future events,” Opfermann et al. write.

Children’s National authors on the study include: Justin Opfermann, M.S., Anuradha Dayal, M.D., Alyssa Abo, M.D., M.B.A., Tyler Salvador, B.S., Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., Raven McLeese, R.N., and Kevin R. Cleary, Ph.D.

Children’s National Hospital joins unprecedented coalition to address pediatric drug shortages

March 18, 2021

Shortages of essential medicines for children are a persistent problem plaguing hospitals across the United States.

Children’s National Hospital joins in announcing the launch of a groundbreaking Children’s Hospital Coalition: Powered by Phlow^TM (CHC). This first-in-kind coalition brings together some of the top children’s hospitals across the nation, in collaboration with Phlow, to provide certainty in availability and access for key medicines necessary to sustain life and conquer disease and to address the nation’s broken essential medicines supply chain.

Shortages of essential medicines for children are a persistent problem plaguing hospitals across the United States. A 2019 survey of 330 U.S. hospitals, including 29 children’s hospitals, demonstrated that medicine shortages disproportionately and uniquely impact children’s hospitals.(Vizient, 2020) The COVID-19 pandemic has exposed further vulnerabilities in the overall U.S. hospital supply chain, particularly regarding essential injectable medications. To address this issue, the CHC is charged with a mission to deliver on the promise of ensuring a reliable supply of high-quality, affordable essential medicines to treat children.

“Far too often, the health care needs of children are not a priority. The coalition will draw attention to this important issue of shortages of essential medicines and more importantly, start to fix the problem,” says Kurt Newman, M.D., president and chief executive officer of Children’s National. “I know we can do better for children who require these life-saving treatments and cures, and I’m proud to join this great group of organizations in developing an innovative solution.”

The coalition is working together to further escalate this issue on the national agenda, to encourage children’s hospitals to join in this cause, and educate other hospitals on how this coalition will aid in ending shortages of essential medicines. Ultimately, the goal of the CHC is to increase the resiliency and reliability of the pediatric pharmaceutical supply chain.

“The pharmacists on my team are on the front lines of this struggle every day, so we know the need for this effort all too well,” says Eric Balmir, M.S., PharmaD, C.I.M., vice president and chief pharmacy officer at Children’s National. “We’re proud to be part of the solution, working to ensure that every child has access to the essential medicines they need.”

The CHC will identify and prioritize the most needed essential medicines, including sterile injectable medicines and medications used to treat pediatric cancers and rare diseases. Phlow will work quickly to ensure a high-quality, reliable supply of these essential medicines and will provide transparent, cost-plus pricing for all coalition members under uniform long-term purchasing agreements. Through this collaboration, the CHC will work toward improving the delivery of pediatric care.

Currently, the 11 founding hospital members of the CHC are: Arkansas Children’s, Boston Children’s Hospital, Children’s Hospital Los Angeles, Children’s Hospital of Richmond at VCU, Children’s National Hospital, Children’s Wisconsin, Cincinnati Children’s, Cook Children’s, Intermountain Primary Children’s Hospital, Ann & Robert H. Lurie Children’s Hospital of Chicago and Nationwide Children’s Hospital. Please visit www.childrenshospitalcoalition.org for more information on how to join the CHC.

An analysis of articles on pediatric COVID-19 cases

March 2, 2021

In a recent editorial, Dr. Briony Varda commented on a systematic review and meta-analysis of articles reporting on pediatric cases of COVID-19.

In a recent editorial, Children’s National Hospital Pediatric Urologist Briony Varda, M.D., M.P.H., and Emilie K. Johnson, M.D., M.P.H., from Ann & Robert H. Lurie Children’s Hospital of Chicago, comment on a systematic review and meta-analysis of articles reporting on pediatric cases of coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.

Their take home messages were that although COVID-19 is typically milder in children than in adults, children (particularly infants) do appear to have cardiac damage from COVID-19 which may be a consideration for preoperative evaluation among surgeons. They also note the MIS-C is another emerging concern for children following an infection with COVID-19.

Read the full editorial in the Journal of Pediatric Urology.

Pediatric asthma exacerbations during the COVID-19 pandemic

March 1, 2021

The authors found that in 2020, the District of Columbia did not experience the typical “September asthma epidemic” of exacerbations seen in past years.

In the United States, pediatric asthma exacerbations typically peak in the fall due to seasonal factors such as increased spread of common respiratory viruses, increased exposure to indoor aeroallergens, changing outdoor aeroallergen exposures and colder weather. In early 2020, measures enacted to reduce spread of the coronavirus (COVID-19) — such as social distancing, quarantines and school closures — also reduced pediatric respiratory illnesses and asthma morbidity. Children’s National Hospital immunologist and allergist William J. Sheehan, M.D., and colleagues sought to determine if these measures also affected the 2020 fall seasonal asthma exacerbation peak in Washington, D.C.

The authors found that in 2020, the District of Columbia did not experience the typical “September asthma epidemic” of exacerbations seen in past years. Emergency department visits, hospitalizations and intensive care unit admissions for asthma during the 2020 fall season were significantly reduced compared to previous years.

The authors conclude that, “this is likely due to social distancing, quarantines and school closures enacted during the pandemic. This is a small silver lining in a very difficult year. As 2021 brings optimism for gradual improvements of the pandemic, careful monitoring is necessary to recognize and prepare for childhood asthma morbidity to return to pre-pandemic levels.”

Additional study authors include: Shilpa J. Patel, M.D., M.P.H., Rachel H.F. Margolis, Ph.D., Eduardo R. Fox, M.D., Deborah Q. Shelef, M.P.H., Nikita Kachroo, B.S., Dinesh Pillai, M.D. and Stephen J. Teach, M.D., M.P.H.

Read the full study in the Journal of Allergy and Clinical Immunology: In Practice.

Asthma-Related Healthcare Utilization by Month (2016-2020). Asthma-related emergency department (ED) visits, hospitalizations and pediatric intensive care unit (PICU) admissions over time by month between 2016 and 2020. The p-values are for comparisons of mean monthly numbers for fall seasons of 2016-2019 to fall season of 2020. Image courtesy of the Journal of Allergy and Clinical Immunology: In Practice.

Novel SARS-CoV-2 spike variant found in a newborn in Washington, D.C.

February 24, 2021

Researchers at Children’s National Hospital found a new SARS-CoV-2 spike variant in a neonatal patient, according to a study that genetically sequenced the virus in 27 pediatric patients. The newborn presented with a viral load of 50,000 times more particles than the average patient, which led to identifying the N679S spike protein variant — the earliest known sample of this coronavirus lineage in the U.S. mid-Atlantic region.

While the paper is posted to the preprint server medRxiv and has not been peer-reviewed, it represents an early step towards establishing better surveillance of the COVID-19 pandemic. The new variant helps understand the process of viral adaptation, potentially informing treatment development and vaccine design for any viral variants in the future.

All genomes change and evolve. Additional viral variants are expected to emerge as more patients are infected. The data analysis recognized eight other cases in Washington, D.C., with the N679S variant, pointing toward a European origin due to the genetic similarity between of SARS-CoV-2 strains in the U.S. and United Kingdom.

“We need to sequence more cases to identify variants and stay ahead of the virus,” said Drew Michael, Ph.D., molecular geneticist at Children’s National and senior author of the study. “The United States sequences a tiny fraction of all cases, and because we are not sequencing enough, we are not aware of the variants in SARS-CoV-2 that may be spreading in our community.”

“Novel SARS-CoV-2 spike variant identified through viral genome sequencing of the pediatric Washington D.C. COVID-19 outbreak,” was published on the preprint server medRxiv. Additional authors include Jonathan LoTempio, Erik Billings, Kyah Draper, Christal Ralph, Mahdi Moshgriz, Nhat Duong, Jennifer Dien Bard, Xiaowu Gai, David Wessel, M.D., Roberta L. DeBiasi, M.D., M.S., Joseph M. Campos, Ph.D., Eric Vilain, M.D., Ph.D. and Meghan Delaney, D.O., M.P.H.

You can read the full preprint on medRxiv.