Jacqueline M. Saito, M.D., M.S.C.I., M.B.A.

Jacqueline Saito, M.D., named chief quality and safety officer and VP for Medical Affairs

Jacqueline M. Saito, M.D., M.S.C.I., M.B.A.

Dr. Saito will lead Children’s National in its continuous efforts on quality, patient safety and employee safety, as well as medical staff affairs.

Children’s National Hospital is pleased to welcome Jacqueline M. Saito, M.D., M.S.C.I., M.B.A., as the new chief quality and safety officer and vice president for Medical Affairs, effective March 1, 2024.

Dr. Saito will lead Children’s National in its continuous efforts on quality, patient safety and employee safety, as well as medical staff affairs. In addition, she will serve on the medical faculty and as attending physician in the Division of General and Thoracic Surgery.

“I am honored to lead the patient safety and quality initiatives at Children’s National Hospital,” Dr. Saito said. “This role is pivotal in advancing our standards of excellence. Together as a team, we will intensify our focus on enhancing quality initiatives and striving to make a positive impact on the lives of our patients, their families and the community we serve.”

Dr. Saito is a recognized leader in quality improvement, evidence-based care, supply standardization and clinical integration/clinical engagement, and has a background and training in pediatric surgery. Dr. Saito has served as a leader for the American College of Surgeons, National Surgical Quality Improvement Program-Pediatric and has been an active participant in the Children’s Hospitals Solutions for Patient Safety (SPS). Additionally, she has served as the principal investigator for multicenter research projects related to pediatric surgical outcomes. She holds a Master of Science in Clinical Investigation.

She joins Children’s National after 15 years at Washington University, St. Louis, where she was associate professor of Surgery and associate medical director of Supply and Resource Stewardship at the BJC Healthcare Center for Clinical Excellence. Dr. Saito has served as site principal investigator for several multi-institutional clinical research projects related to pediatric surgical outcomes and antimicrobial stewardship.

“We are pleased to welcome Dr. Saito’s leadership and expertise as we continue to ensure the safest, highest-quality care for the children we care for,” said David Wessel, M.D., executive vice president, chief medical officer and physician-in-chief at Children’s National. “With her exceptional background in quality improvement and medical staff affairs she will elevate our efforts in safety, quality improvement and patient care outcomes.”

 

Meghan Delaney, D.O., M.P.H.

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

Meghan Delaney, D.O., M.P.H.

“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.

Monika Goyal, M.D., MSCE

Q&A with Dr. Goyal: Trailblazing equity work leads to election to ASCI

Monika Goyal, M.D., MSCE, associate division chief of Emergency Medicine and Trauma Services

Monika Goyal, M.D., MSCE, associate division chief of Emergency Medicine and Trauma Services, is joining The American Society for Clinical Investigation (ASCI), one of a small cadre of pediatric emergency medicine physicians elected to the premier medical honor society for physician-scientists. Dr. Goyal considers her new honor a pivotal opportunity to represent pediatric emergency medicine, which is often underrepresented in research.

Interim Chief Academic Officer Catherine Bollard, M.D., M.B.Ch.B., nominated Dr. Goyal to ASCI because of her nationally renowned work as an equity science scholar, having published more than 130 peer-reviewed manuscripts and securing more than $25 million in funding from the National Institutes of Health (NIH). “From the very beginning of her career, Dr. Goyal has been a trailblazer as it relates to her research interests,” said Dr. Bollard, also an ASCI member.

Dr. Goyal serves as the inaugural chair for Women in Science and Medicine and associate division chief for Academic Affairs and Research at Children’s National Hospital. Her academic work has focused on disparities in the emergency setting, where she has studied the impacts of gun violence, pain management, sexual health and more. In 2023, the journal Pediatrics named a Children’s National manuscript on gun violence one of the 12 most significant papers in its 75-year history. Dr. Goyal was the first author and remains tremendously proud of the impact science can make on society.

Q: How did you find yourself investigating the science of gun laws?

A: A half-dozen years ago, three other pediatric emergency medicine physicians and I had been caring for countless numbers of children who had been victims of gun violence and felt motivated to act. I started SAFER at Children’s National – Safer through Advocacy, Firearm, Education and Research – which is now an institution-wide initiative to address gun violence within our community and beyond. More than 50 individuals at Children’s National are now active in our organization.

We’ve been able to publish a lot of research in this area, including our national study looking at the association between the strictness of gun laws with firearm-related deaths in children. We found that children are more likely to die from gun violence in states with less strict gun laws. It’s not surprising, yet the recognition by the American Academy of Pediatrics demonstrates the importance of using science to understand this, and it shows how far we’ve come in the medical community. Until recently, this issue has been under-recognized and under-supported, despite it being a massive public health crisis for our children and our country.

Q: Given the pace of emergency medicine, how did you find your way to research?

A: Early in my career, much of my work focused on adolescent sexual health. I kept finding that there was racial bias in terms of who we considered to be at risk for sexually transmitted infections. This finding then motivated me to investigate and understand whether racial bias impacted other aspects of care delivery across various clinical conditions in the Emergency Department.

I started by looking at whether differences existed in pain management based on a patient’s race. In evaluating data on children nationwide who are diagnosed with appendicitis, we found that Black children are less likely to receive appropriate pain management compared to white children, even after we adjusted for pain score and illness severity. We have found similar themes with respect to pain management among children diagnosed with fractures.

Q: What can be done?

A: We are grateful to have been awarded additional NIH funding to develop and test interventions to mitigate inequities. Currently, we are studying the impact of audit and feedback through the provision of what we are calling ‘equity report cards’ and clinical decision support embedded in the electronic health record to improve racial, ethnic and language equity in pain management.

Hundreds of studies have demonstrated that this is an issue at hospitals across the country. I am proud of Children’s National for having the humility for this self-reflection and the courage to do something about it. Our work here is helping to inform efforts across the country, and I am proud of our institution’s leadership in advancing health equity through community-informed, evidence-based interventions.

Boy lying in a hospital bed, surrounded by medical equipment

Black, Hispanic children at greater risk for complications during hospitalization

Boy lying in a hospital bed, surrounded by medical equipment

The research team found that patients who are Black and Medicaid-insured patients experienced the greatest disparities in postoperative sepsis, a rare complication in which patients suffer from infection that can cause multi-organ failure.

Evaluating more than 5 million pediatric hospital stays nationwide, researchers found children who are Black, Hispanic or insured with Medicaid face a greater risk of health events after surgeries than white patients, according to a new study published in the journal Pediatrics.

“We looked at the data, and we calculated the risks,” said Kavita Parikh, M.D., MSHS, medical director of Quality & Safety Research, research director of the Division of Hospital Medicine and first author on the multi-institute study. “Despite decades of focus on eliminating medical errors, we know that children continue to suffer substantial harms in hospital settings, and our study highlights where children who are Black, Hispanic or insured with Medicaid are at the greatest risk.”

The big picture

The study analyzed data from more than 5.2 million hospitalizations collected by the 2019 Kids’ Inpatient Database, a national repository of data on hospital stays. It includes a 10% sample of newborns and an 80% sample of other pediatric discharges from 4,000 U.S. hospitals. More than 80% of patients were younger than 1 year of age.

The research team found that patients who are Black and Medicaid-insured patients experienced the greatest disparities in postoperative sepsis, a rare complication in which patients suffer from infection that can cause multi-organ failure. Patients who are Hispanic experienced the greatest disparity in postoperative respiratory failure, a complication that can limit breathing and ventilation.

Plausible factors cited include structural racism in the U.S. healthcare system, clinician bias, insufficient cultural responsiveness, communication barriers and limited access to high-quality healthcare.

What’s ahead

The study – “Disparities in Racial, Ethnic, and Payor Groups for Pediatric Safety Events in U.S. Hospitals” – is foundational in understanding what is happening among pediatric patients. Dr. Parikh said that researchers now must conduct further studies into these alarming disparities and qualitative work to understand drivers, with the action-oriented goal of developing interventions to improve patient safety in the hospital for all children.

“We brought together leaders in pediatric medicine, health policy and public health to analyze this data, and we are committed to taking the next steps to improve outcomes for pediatric patients,” Dr. Parikh said. “It will take more patient-centered work and research, resources and multifaceted strategies to resolve these worrying disparities for our pediatric patients nationwide.”

collage of news outlet logos

Children’s National in the News: 2023

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

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

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

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

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

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

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

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

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

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

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

6. Formerly conjoined twins reunite with doctors who separated them

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

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

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

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

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

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

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

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

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

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

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

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

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

healthcare workers putting on PPE

“Mask up!” Soon, AI may be prompting healthcare workers

Researchers at Children’s National Hospital are embarking on an effort to deploy computer vision and artificial intelligence (AI) to ensure medical professionals appropriately use personal protective equipment (PPE). This strikingly common problem touches almost every medical specialty and setting.

With nearly $2.2 million in grants from the National Institutes of Health, the team is combining their expertise with information scientists at Drexel University and engineers at Rutgers University to build a system that will alert doctors, nurses and other medical professionals of mistakes in how they are wearing their PPE. The goal is to better protect healthcare workers (HCWs) from dangerous viruses and bacteria that they may encounter — an issue laid bare with the COVID-19 pandemic and PPE shortages.

“If any kind of healthcare setting says they don’t have a problem with PPE non-adherence, it’s because they’re not monitoring it,” said Randall Burd, M.D., Ph.D., division chief of Trauma and Burn Surgery at Children’s National and the principal investigator on the project. “We need to solve this problem, so the medical community will be prepared for the next potential disaster that we might face.”

The big picture

The World Health Organization has estimated that between 80,000 and 180,000 HCWs died globally from COVID-19 between January 2020 and May 2021 — an irreplaceable loss of life that created significant gaps in the pandemic response. Research has shown that HCWs had an 11-fold greater infection risk than the workers in other professions, and those who were not wearing appropriate PPE had a 1/3 higher infection risk, compared to peers who followed best practices.

Burd said the Centers for Disease Control and Prevention has recommended that hospitals task observers to stand in the corner with a clipboard to watch clinicians work and confirm that they are being mindful of their PPE. However, “that’s just not scalable,” he said. “You can’t always have someone watching, especially when you may have 50 people in and out of an operating room on a challenging case. On top of that, the observers are generally trained clinicians who could be filling other roles.”

What’s ahead

Bringing together the engineering talents at Drexel and Rutgers with the clinical and machine-learning expertise at Children’s National, the researchers plan to build a computer-vision system that will watch whether HCWs are properly wearing PPE such as gloves, masks, eyewear, gowns and shoe covers.

The team is contemplating how the system will alert HCWs to any errors and is considering haptic watch alerts and other types of immediate feedback. The emerging power of AI brings tremendous advantages over the current, human-driven systems, said Marius George Linguraru, D.Phil., M.A., M.Sc., the Connor Family Professor in Research and Innovation at Children’s National and principal investigator in the Sheikh Zayed Institute for Pediatric Surgical Innovation.

“Human observers only have one pair of eyes and may fatigue or get distracted,” Linguraru said. “Yet artificial intelligence, and computers in general, work without getting tired. We are excited to figure out how a computer can do this work – without ever blinking.”

Children’s National Hospital leads the way

Linguraru says that Children’s National and its partners make up the ideal team to tackle this vexing challenge because of their ability to assemble a multidisciplinary team of scientists and engineers who can work together with clinicians. “This is a dialogue,” he said. “A computer scientist, like myself, needs to understand the intricacies of complicated clinical realities, while a clinician needs to understand how AI can impact the practice of medicine. The team we are bringing together is intentional and poised to fix this problem.”

U.S. News Badges

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

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

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

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

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

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

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

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

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

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

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

clinician measuring obese child's waist

Surgeon says treatment silos in childhood obesity need to end

clinician measuring obese child's waist

An editorial in one of the top-ranked pediatric journals — Lancet Child & Adolescent Health — asserts that researchers studying obesity in children and adolescents should stop comparing medication versus bariatric surgery to see which is more effective.

An editorial in one of the top-ranked pediatric journals — Lancet Child & Adolescent Health — asserts that researchers studying obesity in children and adolescents should stop comparing medication versus bariatric surgery to see which is more effective.

Evan Nadler, M.D., director of the Child and Adolescent Weight-loss Surgery Program at Children’s National Hospital, writes that patients don’t want or need the answer to that question. Instead, the two treatment approaches should work together. He cites the field of oncology, where medicine and surgery work hand-in-hand as a comprehensive treatment plan that is individualized for each person’s unique condition.

Why it matters

“The obesity field has long been evaluating isolated interventions. There is a battle between those who favor medical therapy and those who favor surgical therapy,” Nadler writes. “Would it not make more sense for patients if we consider all available options until the desired weight loss is achieved rather than be a staunch advocate of the therapy that we personally like the best?”

According to Nadler, the American Academy of Pediatrics’ 15-year-process to release their first guidelines for treatment of childhood obesity is a consequence of these same silos.

“If medical and surgical oncologists figured out how to work together decades ago, why is it taking so long for practitioners who treat obesity to join forces and use combination therapy for their patients?”

Read the editorial in the Lancet Child & Adolescent Health.

child in hospital bed

Children’s National team develops trigger program for improved safety

child in hospital bed

Children’s National Hospital developed a unique pediatric triggers program that offers customized, near real-time reports of potential safety events.

Errors and adverse events continue to be a source of patient harm despite many hospitals creating safety programs. However, there are opportunities to improve patient safety using novel tools. For example, trigger programs.

A new study, published in Pediatrics, shows how a team at Children’s National Hospital developed a unique pediatric triggers program that offers customized, near real-time reports of potential safety events.

The big picture

The team defined a measure to quantify clinical utility of triggers, termed “trigger signal,” as the percentage of cases that represent true adverse or near-miss events (numerator) per total triggers activated (denominator). A Key Driver Diagram focused on unifying the program structure, increasing data analytics, promoting organizational awareness and supporting multidisciplinary end user engagement.

What we did

Using the Model for Improvement, the team of experts aimed to double overall trigger signal from 8% to 16% and sustain for 12 months.

“The Triggers Program used data analytics with quality and process improvement tools to employ novel strategies to improve trigger signal,” said Parissa Safari, M.H.A., Triggers Program project lead at Children’s National Hospital and one of the study’s authors. “This included shifting to multiple trigger committees, integrating electronic health record data with end user feedback and promoting organizational awareness.”

What we learned

Relying on the model, the team found that:

  • Trigger signal increased from 8% to 41% and sustained during the COVID-19 pandemic.
  • A balancing measure of time to implement a new trigger decreased.
  • Key interventions to increase trigger signals were changing the program structure, increasing stakeholder engagement and development of self-service reports for end users.

The triggers program developed by the team at Children’s National highlights successful evolution of an iterative, customized approach to increase clinical utility which hospitals can implement to impact real-time patient care.

Authors on the study from Children’s National include: Richelle M. Reinhart, M.D.; Ranjodh Badh, B.S.; Solomon Abera, Pharm.D., M.Sc.; Anit Saha, M.S.H.A., M.B.A.; Jessica Herstek, M.D.; Rahul K. Shah, M.D., M.B.A.; Kavita Parikh, M.D., M.S.H.S.

Abstract Happy 2022 New Year greeting card with light bulb

The best of 2022 from Innovation District

Abstract Happy 2022 New Year greeting card with light bulbA clinical trial testing a new drug to increase growth in children with short stature. The first ever high-intensity focused ultrasound procedure on a pediatric patient with neurofibromatosis. A low dose gene therapy vector that restores the ability of injured muscle fibers to repair. These were among the most popular articles we published on Innovation District in 2022. Read on for our full top 10 list.

1. Vosoritide shows promise for children with certain genetic growth disorders

Preliminary results from a phase II clinical trial at Children’s National Hospital showed that a new drug, vosoritide, can increase growth in children with certain growth disorders. This was the first clinical trial in the world testing vosoritide in children with certain genetic causes of short stature.
(2 min. read)

2. Children’s National uses HIFU to perform first ever non-invasive brain tumor procedure

Children’s National Hospital successfully performed the first ever high-intensity focused ultrasound (HIFU) non-invasive procedure on a pediatric patient with neurofibromatosis. This was the youngest patient to undergo HIFU treatment in the world.
(3 min. read)

3. Gene therapy offers potential long-term treatment for limb-girdle muscular dystrophy 2B

Using a single injection of a low dose gene therapy vector, researchers at Children’s National restored the ability of injured muscle fibers to repair in a way that reduced muscle degeneration and enhanced the functioning of the diseased muscle.
(3 min. read)

4. Catherine Bollard, M.D., M.B.Ch.B., selected to lead global Cancer Grand Challenges team

A world-class team of researchers co-led by Catherine Bollard, M.D., M.B.Ch.B., director of the Center for Cancer and Immunology Research at Children’s National, was selected to receive a $25m Cancer Grand Challenges award to tackle solid tumors in children.
(4 min. read)

5. New telehealth command center redefines hospital care

Children’s National opened a new telehealth command center that uses cutting-edge technology to keep continuous watch over children with critical heart disease. The center offers improved collaborative communication to better help predict and prevent major events, like cardiac arrest.
(2 min. read)

6. Monika Goyal, M.D., recognized as the first endowed chair of Women in Science and Health

Children’s National named Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine, as the first endowed chair of Women in Science and Health (WISH) for her outstanding contributions in biomedical research.
(2 min. read)

7. Brain tumor team performs first ever LIFU procedure on pediatric DIPG patient

A team at Children’s National performed the first treatment with sonodynamic therapy utilizing low intensity focused ultrasound (LIFU) and 5-aminolevulinic acid (5-ALA) medication on a pediatric patient. The treatment was done noninvasively through an intact skull.
(3 min. read)

8. COVID-19’s impact on pregnant women and their babies

In an editorial, Roberta L. DeBiasi, M.D., M.S., provided a comprehensive review of what is known about the harmful effects of SARS-CoV-2 infection in pregnant women themselves, the effects on their newborns, the negative impact on the placenta and what still is unknown amid the rapidly evolving field.
(2 min. read)

9. Staged surgical hybrid strategy changes outcome for baby born with HLHS

Doctors at Children’s National used a staged, hybrid cardiac surgical strategy to care for a patient who was born with hypoplastic left heart syndrome (HLHS) at 28-weeks-old. Hybrid heart procedures blend traditional surgery and a minimally invasive interventional, or catheter-based, procedure.
(4 min. read)

10. 2022: Pediatric colorectal and pelvic reconstructive surgery today

In a review article in Seminars in Pediatric Surgery, Marc Levitt, M.D., chief of the Division of Colorectal and Pelvic Reconstruction at Children’s National, discussed the history of pediatric colorectal and pelvic reconstructive surgery and described the key advances that have improved patients’ lives.
(11 min. read)

girl getting a vaccine

Second dose of Pfizer COVID-19 vaccine safe for children with allergic reaction to first dose

girl getting a vaccineA new study published in The Journal of Allergy and Clinical Immunology: In Practice found that pediatric patients who experienced an adverse reaction to the first dose of the Pfizer-BioNTech COVID-19 vaccine or with suspected polyethylene glycol or polysorbate allergies can safely receive the second dose in a supervised setting. Until now, previous studies demonstrating second dose safety after a reaction to the first dose have only included adult patients.

“These results reaffirm similar studies performed in adults and provide additional assurance specific to the pediatric population,” says Joel Brooks, D.O., M.P.H., allergist and immunologist at Children’s National Hospital and corresponding author of the study. “We found that most of these initial reactions are not supportive of an IgE-mediated mechanism.”

The researchers evaluated 13 children referred to a specialized vaccine clinic for suspected immediate allergic reactions to the first dose of the Pfizer-BioNTech COVID-19 vaccine from May 2021 to February 2022. Nine of the 13 children were evaluated after experiencing an allergic reaction following the first dose. All nine successfully received the second dose with no or minimal symptoms.

The other four children were evaluated after clinical histories of PEG/polysorbate allergy. Three of the four received both Pfizer vaccine doses with no symptoms. The fourth patient elected to receive the Janssen COVID-19 vaccine.

“It is important that children 6 months and older receive two doses of the COVID-19 vaccine for full protection from severe illness and hospitalization due to COVID-19 infection,” adds Dr. Brooks. “Children with potential anaphylaxis should undergo careful evaluation to weigh the benefits and risks of the second dose.”

You can read the full study, “Safety outcomes of SARS-CoV-2 vaccination in pediatric patients with a first dose reaction history or allergy to polyethylene glycol or polysorbate,” here.

Drs. Sophie Pestieau and Andrew Waberski

Children’s National receives sustainability award for reducing anesthetic gases

Drs. Sophie Pestieau and Andrew Waberski

Drs. Sophie Pestieau and Andrew Waberski.

The District of Columbia Department of Energy & Environment (DOEE) has awarded Children’s National Hospital with a 2022 District Sustainability Award for its successful work around reducing anesthetic gases that contribute to ozone depletion and greenhouse warming.

The big picture

Current data suggests the U.S. healthcare sector contributes 10% of the nation’s greenhouse effect. Volatile inhaled anesthetic gases are often used in the operating room (OR) during procedures that require anesthesia. Most of the organic anesthetic gases remain in the atmosphere for a long time, where they have the potential to act as greenhouse gases.

  • “In perspective, one hour of anesthesia with the volatile anesthetic Desflurane is equivalent to the greenhouse gas emissions from driving 190 miles,” said Andrew Waberski, M.D., pediatric cardiac anesthesiologist, at Children’s National.

The Children’s National Sustainability Council recognized that gas flows can be safely reduced to levels that provide both economical and health benefits to patients as well helping hospitals “go green.” By doing so, hospitals can decrease the amount of inhaled anesthetics used, which decreases the Global Warming Potential (GWP), and also reduce costs.

Why we’re excited

After assessing the impact of anesthetic gases, the Children’s National anesthesia team proposed several interventions to deliver safe and sustainable anesthesia to children. After implementing low-flow anesthesia techniques and reducing Desflurane usage, Children’s National has reduced its GWP of volatile anesthetics by 80%.

What they’re saying

  • “Thank you to the DOEE for recognizing the sustainability efforts we made in the Anesthesia Division at Children’s National,” said Dr. Waberski. “We are now preventing the emission of approximately 725 tons of CO2 per year. We thank our staff members, faculty and providers for helping to implement these changes and contributing to our sustainability efforts.”
  • “I became passionate about sustainability in healthcare once I became a parent, wanting a healthy environment and healthy future not only for my children to grow in, but for all children,” said Sophie Pestieau, M.D., vice chair of Clinical Affairs, Division of Anesthesiology, Pain and Perioperative Medicine. “As a physician with a duty to ‘first do no harm,’ I see an opportunity to directly address the industry’s growing environmental footprint and assist in the transition to greener healthcare.”
  • “Our Sustainability Council is focused on the hospital’s mission of helping kids grow up stronger, and we pursue this by creating healthy environments. Our projects are successful at reducing waste, saving financial resources and generating quality improvement,” said Rusty Siedschlag, manager of Sustainability at Children’s National.

In September 2021, 200 medical journals named climate change the number one threat to global public health. Children’s National joined the Biden Administration for a White House event on June 30, 2022, with the U.S. Department of Health and Human Services, where our team and industry colleagues pledged meaningful action to decarbonize the healthcare sector and make healthcare facilities more resilient to the effects of climate change. Children’s National has committed to meet the Biden administration’s climate goal of reducing emissions by 50% by 2030 and achieving net zero emissions by 2050.

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Children’s National named to U.S. News & World Report’s Best Children’s Hospitals Honor Roll

US News BadgesChildren’s National Hospital in Washington, D.C., was ranked No. 5 nationally in the U.S. News & World Report 2022-23 Best Children’s Hospitals annual rankings. This marks the sixth straight year Children’s National has made the 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 sixth year in a row.

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

“In any year, it would take an incredible team to earn a number 5 in the nation ranking. This year, our team performed at the very highest levels, all while facing incredible challenges, including the ongoing pandemic, national workforce shortages and enormous stress,” said Kurt Newman, M.D., president and chief executive officer of Children’s National. “I could not be prouder of every member of our organization who maintained a commitment to our mission. Through their resilience, Children’s National continued to provide outstanding care families.”

“Choosing the right hospital for a sick child is a critical decision for many parents,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “The Best Children’s Hospitals rankings spotlight hospitals that excel in specialized care.”

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

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

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

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

Drs. Kane and Petrosyan

POEM procedure is safe and effective for children with esophageal achalasia

Drs. Kane and Petrosyan

Drs. Petrosyan and Kane combined perform more POEM procedures for children than any other pediatric surgeons in the United States.

Peroral endoscopic myotomy (POEM) is a safe and effective procedure to treat pediatric achalasia according to a single-center outcomes study in the Journal of Pediatric Surgery.

Authors Timothy Kane, M.D., chief of General and Thoracic Surgery at Children’s National Hospital, and Mikael Petrosyan, M.D., MBA, associate chief of that division, together perform more of these procedures than any other pediatric surgeons in the United States.

Their experience with POEM shows that it is as safe and effective as the current standard of care for pediatric achalasia, which is a procedure called the laparoscopic Heller myotomy (LHM). Even better, previous research in adults and now in pediatric patients, has shown that those who undergo POEM as an alternative to LHM report less pain and often require shorter hospital stays after surgery.

Why it matters

POEM has been an option for adults with achalasia for many years, but not for children because it requires technical skill and expertise not readily available everywhere. More studies of young patients with successful outcomes following POEM procedures can help make the case for training more pediatric surgeons to learn this approach, and help this alternative method become an additional surgical option for children with achalasia.

The hold-up in the field

Achalasia is a rare condition in adults (1/100,000) and even less common in children, occurring in only 0.1 per 100,000 patients with an estimated prevalence of 10 per 100,000. The rarity of achalasia in children compared with adults makes collecting enough statistically significant evidence about how best to treat them difficult, more so than for other more common pediatric surgical conditions.

Children’s National Hospital leads the way

Children’s National Hospital is one of the only children’s hospitals in the country to offer the option of POEM for treatment of these conditions in children — and Drs. Kane and Petrosyan combined perform more of these procedures than any other pediatric surgeons in the United States.

The surgeons at Children’s National offer POEM as a primary intervention for children with esophageal achalasia and are also applying the same approach for pediatric gastroparesis as well.

Children’s National Hospital is one of only 12 children’s hospitals in the country, and the only hospital in the Washington, D.C., region, to be verified as a Level 1 Children’s Surgery Center by the American College of Surgeons (ACS) Children’s Surgery Verification Quality Improvement Program. This distinction recognizes surgery centers whose quality improvement programs have measurably improved pediatric surgical quality, prevented complications, reduced costs and saved lives.

Bottom line

Given their reported outcomes so far, the authors believe that in the long term this approach may replace the current pediatric standard of care, the LHM. More research is needed to make this case, however, including long-term follow-up studies of the patients who have undergone the procedure so far.

You can read the full study, “Per Oral Endoscopic Myotomy (POEM) for Pediatric Achalasia: Institutional Experience and Outcomes,” in the Journal of Pediatric Surgery.

Meghan Delaney

Meghan Delaney, D.O., M.P.H., receives 2021 James Blundell Award

Meghan Delaney

The British Blood Transfusion Society (BBTS) recognized Meghan Delaney, D.O., M.P.H., division chief of Pathology and Lab Medicine and director of Transfusion Medicine at Children’s National Hospital, with the James Blundell Award.

The James Blundell Award is the most prestigious award given by the BBTS. Introduced in 1984, this award is given to recipients for original research resulting in an important and significant contribution to the body of medical and or scientific knowledge within the field of blood transfusion.

“I am honored to receive this award from the British Blood Transfusion Society,” says Dr. Delaney. “The field of transfusion medicine is dynamic and provides an important part of our healthcare infrastructure.  It’s wonderful to have this recognition and I am grateful to the society for the award.”

She is professor of Pathology and Pediatrics at the George Washington University with over 100 manuscripts, 25 book chapters and over 60 presented abstracts. Dr. Delaney serves as a member of the Board of Directors for the Association for the Advancement of Blood & Biotherapies (AABB), is a Scientific Member of the BEST Collaborative and is a member of the American Board of Pathology Test Development and Advisory Committee. She serves as the chair of the National Institutes of Health’s BLOODSAFE Program that aims to improve access to safe blood in Sub Saharan Africa.

Dr. Delaney received the award on September 14 at the 2021 BBTS Annual Conference, where she presented the lecture titled: “Access to safe blood transfusion in low- and middle-income nations: From ‘big data’ to mosquitos.”

Tomas Silber

Tomas Silber, M.D., awarded AAP’s highest honor in bioethics

Tomas Silber

Each year the American Academy of Pediatrics (AAP) Section on Bioethics presents the Academy’s highest honor in bioethics, the William G. Bartholome Award for Ethical Excellence. The award is named in honor of Dr. Bartholome, who made significant contributions to the field of pediatric ethics, and thus to the medical care of children. This year the Section proudly presented the award to Tomas Silber, M.D., M.A.S.S., adolescent medicine specialist and executive committee member of the Ethics Program at Children’s National Hospital and professor emeritus at George Washington University.

Dr. Silber has dedicated more than fifty years of work to reflecting, writing, teaching and devoting his energy to the divulgation of the field of pediatric ethics. He says it’s an honor to be recognized by his peers with this award.

“As a very young physician, I edited several issues of Pediatric Annals to Pediatric Ethics. One of the contributors I invited was actually Dr. Bartholome, whose seminal work on Pediatric Assent I had followed very closely and admiringly,” says Dr. Silber. “Forty years have passed since our work together, and it is a tremendous honor, now that I am emeritus, to receive the award named after him.”

As he reflects on the present day, Dr. Silber says one of the most important pediatric ethical issues is equity and social justice in the care of children and adolescents.

“Ethicists need to be proactive in dealing with systemic racism in medicine and provide consultations free of bias,” he says.

Dr. Silber is a graduate from the Facultad de Medicina de la Universidad de Buenos Aires. He did his first pediatric residency at El Hospital de Niños en Buenos Aires, his second pediatric residency at Thomas Jefferson University, as part of the community pediatrics track, his fellowship in adolescent medicine at Children’s National and his master’s in special studies (bioethics) at George Washington University. He is a fellow of the AAP, the Pediatric Society, the Academy for Eating Disorders and the Society for Adolescent Medicine and Health.

For several decades, Dr. Silber served as the director of the Pediatric Ethics Program at Children’s National.

“I am most proud of the thoughtful contributions of the multi-disciplinary team of the Ethics Committee at Children’s National, and above all how the torch has now passed to Dr. Vanessa Madrigal and her wise leadership,” says Dr. Silber.

Other standout career achievements include his leadership as chair of the Section on Bioethics of the AAP, and his contribution to the AAP Ethics Curriculum for Pediatric Residents and the chapter on adolescents in the Encyclopedia of Bioethics.

Dr. Silber extends his gratitude to the leadership of Children’s National, who he says made it possible for him to obtain his master’s degree, publish Pediatric Ethicscope and develop his skills as an ethics consultant and research subject advocate.

“Without the support I’ve been given at Children’s National, my work in the field of Pediatric Ethics would not have been possible,” he says.

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

US News badges

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:

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

doctor listening to girl's heart

Decision support tool for chest pain reduces unnecessary cardiology referrals

doctor listening to girl's heart

A new study in the journal Medical Decision Making reports how well a new decision-support tool assisted pediatricians to apply validated criteria and reduce referrals to cardiology for children with chest pain.

In 2017, cardiologists from Children’s National Hospital and other centers published criteria to reliably detect risk for cardiac disease in children presenting with chest pain. However, despite the validated criteria published more than three years ago, as many as half of the children with chest pain who are referred to cardiology from a primary care doctor continue not to meet these criteria.

In response, the cardiology and Children’s National Pediatricians & Associates (CNP&A) team developed a decision support tool based on the validated criteria that was then incorporated into the CNP&A electronic medical record. A study, Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative, in the journal Medical Decision Making reports how well the tool assisted pediatricians to apply the criteria and reduced referrals to cardiology for children who do not meet criteria for consultation by a pediatric cardiac specialist.

“As stated by the Institute for Healthcare Improvement, improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations and reducing per capita costs of health care. Known as the Triple Aim, such improvement includes reducing referrals to specialists for conditions that could be managed in primary care. Fewer unnecessary referrals can reduce costs by decreasing unnecessary testing and specialist time and also has the potential to improve the patient experience by providing care in the medical home,” the authors note.

The study highlights the results of a focused healthcare improvement initiative that engaged pediatricians, nurses, trainees and nurse practitioners at primary care practices to implement the new decision support tool. With the tool in place, the team saw a 71% reduction (from 17% referred to 5% referred) in cardiology referrals for children presenting to cardiology who did not meet the criteria for a referral. At almost one year of follow up, the reduction in referrals based on the criteria did not lead to any missed detections of potential life-threatening events, either.

“This study shows that patients presenting with chest pain who do not meet clinical criteria for referral can be safely and confidently managed at their medical home by their primary care provider,” says Ashraf Harahsheh, M.D., director of Quality Outcomes in Cardiology at Children’s National Heart Institute, who led the study with colleagues. “Avoiding unnecessary referrals to cardiology may help prevent missed work and school days for families and children and will also make sure that the children who truly need a cardiology evaluation can be evaluated quickly.”

This collaboration between our specialty colleagues and primary care clinicians improves care for our patients by bringing an evidence-based approach to managing a condition in a manner that reduces the burden of anxiety for families by addressing their concerns in their medical home,” adds Ellen Hamburger, M.D., study co-author and medical director of the Pediatric Health Network.

After the success of the project at Children’s National Hospital in partnership with the CNP&A, the team is now in talks with UPMC Children’s Hospital of Pittsburgh and Phoenix Children’s Care Network to expand the quality improvement initiative to their primary care networks as well.

Ashraf S Harahsheh, Ellen K Hamburger, Lena Saleh, Lexi M Crawford, Edward Sepe, Ariel Dubelman, Lena Baram, Kathleen M Kadow, Christina Driskill, Kathy Prestidge, James E Bost, Deena Berkowitz. Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative. Med Decis Making. 2021 Mar 3;272989X21991445. Online ahead of print. DOI: 10.1177/0272989X21991445

girl with asthma inhaler

Children’s National becomes part of CAUSE Network

girl with asthma inhaler

Seven clinical sites in six different cities will join forces to perform mechanistic and translational studies examining the basic immunology of pediatric asthma among urban, under-resourced and largely minority children and adolescents.

The National Institute of Allergy and Infectious Diseases (NIAID) allocated $10 million in funding to establish the Childhood Asthma in the Urban Setting (CAUSE) network. The NIAID plans to increase this number by $70 million over seven years to support the network. Children’s National Hospital will be part of the new research network, which is a 7-year consortium comprising of seven clinical sites in six different cities that will join forces to perform mechanistic and translational studies examining the basic immunology of pediatric asthma among urban, under-resourced and largely minority children and adolescents.

Children’s National is the home of Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC). The program focuses on research, care and advocacy to decrease asthma morbidity experienced by at-risk youth in the region while serving as a model program for the nation. NIAID gave an initial $3 million to IMPACT DC to conduct its own pilot study of anti-IgE therapy to prevent asthma exacerbations. Additional support for this and other studies will come from subcontracts from the CAUSE Coordinating Center at the University of Wisconsin in Madison.

“This new award allows IMPACT DC to remain part of one of the nation’s most prestigious pediatric asthma research consortia,” said Stephen Teach, M.D, M.P.H., chair for the Department of Pediatrics at George Washington University School of Medicine and Health Sciences. “It will allow us to both pursue an independent research agenda while collaborating with similar academic centers nationwide.”

Pediatric asthma is the most common chronic disease in children, and it is estimated that about 6.1 million children under 18 years suffer from this condition. It disproportionately affects urban, minority and under-resourced children and adolescents.

“It is essential to develop an understanding of the basic immunology of the disease and therapeutic options to ameliorating these disparities,” said Dr. Teach.

CAUSE researchers will explore the mechanisms of immune tolerance to allergens, the role of early environmental exposures in the pathogenesis of asthma, the pathogenesis and mechanisms of non-atopic asthma, the role of the respiratory epithelium in asthma and more.

The CAUSE network comprises of seven clinical research centers, including Children’s National led by principal investigator, Dr. Teach, and the following research centers:

  • Boston Children’s Hospital. Principal investigators: Wanda Phipatanakul, M.D., and Talal Chatila, M.D.
  • Cincinnati Children’s Hospital Medical Center. Principal investigator: Gurjit Khurana Hershey, M.D., Ph.D.
  • Columbia University Health Sciences, New York. Principal investigator: Meyer Kattan, M.D.
  • Icahn School of Medicine at Mount Sinai, New York. Principal investigators: Paula Busse, M.D., Supinda Bunyavanich, M.D., and Juan Wisnivesky, M.D.
  • Lurie Children’s Hospital of Chicago. Principal investigators: Rajesh Kumar, M.D., and Jacqueline Pongracic, M.D.
  • University of Colorado Denver. Principal investigator: Andrew Liu, M.D.
Children's National Hospital

Children’s National laboratory receives CAP accreditation

Children's National Hospital

Pathology and Laboratory Medicine at Children’s National Hospital has been awarded accreditation by the Accreditation Committee of the College of American Pathologists (CAP) based on results of a recent on-site inspection conducted by CAP inspectors.

Pathology and Laboratory Medicine at Children’s National Hospital has been awarded accreditation by the Accreditation Committee of the College of American Pathologists (CAP) based on results of a recent on-site inspection conducted by CAP inspectors. The inspection team included practicing pathology and laboratory medicine professionals.

The Children’s National laboratory is one of more than 8,000 CAP- accredited facilities worldwide that have been recognized for excellence in laboratory services.

“Receiving this gold standard laboratory accreditation again shows that our team is committed to providing lab services with the highest quality and accuracy,” said Meghan Delaney, D.O., M.P.H., chief of Pathology and Laboratory Medicine at Children’s National Hospital.

The U.S. government recognizes the CAP Laboratory Accreditation Program, started in the early 1960s, as being equal-to or more-stringent-than the government’s own inspection program.

During the CAP accreditation process, which is designed to ensure the highest standard of care for all laboratory patients, inspectors examine the laboratory’s records and the quality control of procedures for the preceding two years. The CAP inspectors also examine laboratory staff qualifications, equipment, facilities, safety program and record and overall management.

This significant accomplishment further demonstrates the commitment of the pathology and laboratory medicine team to ensuring high-quality patient care at Children’s National Hospital.