stressed pregnant woman

Pandemic stress in pregnant mothers may affect anxiety regions of babies’ brains

stressed pregnant woman

The research from Children’s National Hospital provides mounting evidence that children of the pandemic, even those far too young to understand it, need ongoing assessments of developmental or mental health support later in life.

A critical part of the brain linked to risks for anxiety later in life – the left amygdala – was significantly smaller by volume in babies of mothers who reported stress during the COVID-19 pandemic, according to a new manuscript published in JAMA Network Open.

The right hippocampus, which governs spatial, visual and verbal memories, and the white matter were also reduced in children whose mothers reported stress.

The research from Children’s National Hospital provides mounting evidence that children of the pandemic, even those far too young to understand it, need ongoing assessments of developmental or mental health support later in life.

“Looking ahead, we want to use this information – and studies with similar findings – to empower pregnant mothers to request support to mitigate their stress, especially in the event of another global health crisis,” said Nickie Andescavage, M.D., a neonatologist and principal investigator at the Center for Prenatal, Neonatal & Maternal Health Research. “We also want to make sure babies born during COVID-19 get the services that they need in life if they develop anxiety or other mental health disorders.”

The fine print

Researchers at the center used magnetic resonance imaging (MRI) to compare the brains of 103 babies born between 2014 and 2019 prior to the pandemic to 59 born between 2020 and 2022. Mothers who had COVID-19 or other complications in their pregnancies were excluded. The babies underwent MRI imaging while in utero and again soon after delivery.

The mothers were evaluated for stress and anxiety, using the Spielberger State-Train Anxiety Inventory and other evidence-based scoring measures. Pre-pandemic, 21% of mothers reported elevated symptoms of anxiety; in the pandemic cohort, that number jumped to nearly 62%.

Their babies’ brains were also changed, as regions widely understood to control emotion and anxiety displayed smaller volumes on MRI imaging. Given the global impact of the pandemic and universal reports of mental distress worldwide, the potential impact of these findings may impact an entire generation of children born during the pandemic. The team is just beginning to unravel the medical significance.

What’s next

Catherine Limperopoulos, Ph.D., director of the Center for Prenatal, Neonatal & Maternal Health Research, said understanding the impact of stress is vital in supporting the healthy development of young children. Current studies are underway at her center to tease apart the role of stress in prenatal development and examine its long-term impact on development, including cognition, behavior and mental health.

“We all know that being pregnant can be quite stressful, and there are certain times of collective stress that can provide us windows to understand how the body and mind manage it,” Dr. Limperopoulos said. “At our center, we care deeply about the health of mothers and babies, and our researchers plan to continue investigating the role of stress in development to continue building data to show that mental health must be a greater priority.”

This study – “Prenatal maternal psychological distress during the COVID-19 pandemic and newborn brain development” – was supported by the National Institutes of Health, the Intellectual and Developmental Disabilities Research Center, and the A. James & Alice B. Clark Foundation. You can read the full study in JAMA Network Open.

Monika K. Goyal, M.D., M.S.C.E., and Beth A. Tarini, M.D., M.S., M.B.A.

Drs. Goyal and Tarini to lead Center for Translational Research

Monika K. Goyal, M.D., M.S.C.E., and Beth A. Tarini, M.D., M.S., M.B.A.

As CTR co-directors, Drs. Goyal and Tarini will lead the hospital’s mission to advance translational science, clinical research and community health.

Children’s National Hospital has appointed two nationally regarded leaders in pediatric research – Monika K. Goyal, M.D., M.S.C.E., and Beth A. Tarini, M.D., M.S., M.B.A. – to head its Center for Translational Research (CTR), a hub of high-impact scientific investigation that touches nearly every pediatric specialty.

As CTR co-directors, Drs. Goyal and Tarini will lead the hospital’s mission to advance translational science, clinical research and community health. They will begin their new roles on July 1.

Moving the field forward

“It is truly an honor to lead the CTR at such a pivotal moment in pediatric health,” said Dr. Goyal, an emergency medicine specialist and health services researcher. “I look forward to helping Children’s National lead the science on advancing health equity for the patients, families and communities we serve, both locally and nationally.”

As the largest of the six centers within the Children’s National Research Institute, CTR is pivotal in finding groundbreaking ways to improve health across pediatric medicine. Using a “bench to bedside” approach, the CTR faculty strives to seamlessly translate science from the laboratory bench to the patient’s bedside, moving pediatric medicine forward as expeditiously as possible to bring advances into the community.

“CTR is uniquely positioned to solve the biggest healthcare issues facing our pediatric patients,” said Dr. Tarini, a pediatrician and national leader in newborn screening research and policy. “I look forward to leading our diverse faculty of physicians and researchers as they leverage their front-line experience and innovative research to improve child health.”

Why we’re excited

Dr. Tarini joined Children’s National in 2018 and is currently the associate director for CTR. She was recently promoted to tenured professor of Pediatrics at George Washington University and has extensively studied policies to optimize the delivery of genetic services to families of newborns. In January, Dr. Tarini was appointed to a National Academies of Sciences, Engineering and Medicine Committee to examine the current landscape of newborn screening systems, processes and research in the United States. Dr. Tarini has obtained $10 million in federal and foundation funding, and she has served as president of the Society for Pediatric Research.

Dr. Goyal joined Children’s National in 2012. She is the inaugural endowed chair for Women in Science and Health and has served as the associate division chief for Academic Affairs and Research within the Emergency Department since 2018. She was recently promoted to tenured professor of Pediatrics and Emergency Medicine at George Washington University. Dr. Goyal is a nationally renowned equity science scholar and has published over 130 peer-reviewed manuscripts. She has secured more than $25 million in federal and foundation funding to address disparities in adolescent sexual health, pain management and firearm violence.

Children’s National leads the way

Catherine Bollard, M.D., M.B.Ch.B., interim chief academic officer, said she looks forward to seeing the advances in pediatric health guided by these two outstanding researchers. “By harnessing the immense talent within Children’s National for our search, we found two exceptional leaders in Drs. Goyal and Tarini,” Dr. Bollard said. “Their work promoting research that accelerates discovery across the continuum of bench, bedside and community has already made a significant impact.”

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

Children’s National announces two new professorships

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

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

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

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

About the award

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

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

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

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

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

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

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

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

About the donors

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

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

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

Kevin Cleary, Ph.D.

Kevin Cleary, Ph.D., named as Sheikh Zayed Professor of Bioengineering

Kevin Cleary, Ph.D.

Dr. Cleary joins a distinguished group of Children’s National physicians and scientists who hold an endowed chair.

Children’s National Hospital named Kevin Cleary, Ph.D., as the Sheikh Zayed Professor of Bioengineering through philanthropic support from the people of the United Arab Emirates (UAE).

Dr. Cleary serves as Technical Director of the Bioengineering Initiative within the hospital’s Sheikh Zayed Institute for Pediatric Surgical Innovation. He also is professor of Pediatrics and Radiology at The George Washington University School of Medicine and Health Sciences.

About the award

Dr. Cleary joins a distinguished group of Children’s National physicians and scientists who hold an endowed chair. Children’s National is grateful to generous donors who altogether have funded 48 professorships.

Professorships support groundbreaking work on behalf of children and their families. They foster new discoveries and innovations in pediatric medicine. These appointments reflect the recipient’s achievements and the donor’s commitment to advancing knowledge.

Under Dr. Cleary’s leadership, the Bioengineering Initiative fosters innovation via collaboration across the hospital. It fuels the development of minimally-invasive robotics that improve outcomes for children. For example, Dr. Cleary’s team is collaborating with the Division of Physical Medicine & Rehabilitation to develop PedBotHome. This video game-based robotic ankle device helps children with neurological impairments such as cerebral palsy do rehabilitation exercises at home.

“I am deeply honored by this endowed professorship,” says Dr. Cleary. “It will enable me to continue to fulfill our mission of providing more precise and less invasive solutions to improve children’s health. The Sheikh Zayed Institute will continue to be a hub for technology development and innovation.”

The people of the UAE created the professorship endowment through philanthropy. The UAE’s vision and generosity will ensure that Dr. Cleary and future holders of this professorship will have the opportunity to make strategic and timely investments. This will advance the field of bioengineering and improve children’s lives.

About the donors

Children’s National takes pride in four decades of medical collaboration with the UAE. This relationship inspired a philanthropic partnership yielding more than $215 million to advance children’s health worldwide. The UAE’s generosity reflects the longstanding commitment of His Highness Sheikh Mohamed bin Zayed Al Nahyan, president of the UAE and ruler of Abu Dhabi.

About the Sheikh Zayed Institute for Pediatric Surgical Innovation

In 2009, the UAE generously funded the creation of the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National. The government of Abu Dhabi made the gift in honor of His Highness Sheikh Zayed bin Sultan Al Nayhan. Sheikh Zayed founded the UAE and served as the country’s president from 1971 until his death in 2004.

The Institute seeks to make pediatric surgery more precise, less invasive and pain free. It drives progress for children by translating breakthrough discoveries into new treatments and medical inventions. These include support for a technology that seeks to objectively measure pain through a handheld device and the first  use of high-intensity focused ultrasound (HIFU) to treat childhood nerve tissue tumors.

The Sheikh Zayed Professorship in Bioengineering is a continuation of the UAE’s investment within the Sheikh Zayed Institute.

graphic explaining LIFU and CAR T

Mission critical: Pentagon awards grant to combine two novel brain tumor therapies

graphic explaining LIFU and CAR TA Children’s National Hospital researcher is embarking on a two-year project that could revolutionize the care of rare pediatric brain tumors, through a Department of Defense (DOD) award to study the efficacy of combining the powers of acoustic therapy and cellular immunotherapy to treat the deadliest forms of medulloblastoma.

Designed by DOD to advance novel innovations that could revolutionize medicine, the prestigious Idea Award supports independent investigators with high-risk, but potentially high-reward, concepts to fill gaps in cancer prevention and treatment. Dalia Haydar, Pharm.D., Ph.D., principal investigator at the Cell Enhancement and Technologies for Immunotherapy Program, believes her first-of-its-kind approach could do just that.

A one-two punch

Dr. Haydar is building on promising research into a novel type of immunotherapy – chimeric antigen receptor (CAR) T-cell therapy – which uses the body’s own immune system to target and destroy pediatric brain tumors. She hopes to combine the potential of this immunotherapy with the early success seen in an acoustic therapy, called low-intensity focused ultrasound (LIFU). Akin to the imaging technology used during pregnancy, the sound waves can be directed toward any organ of the body for therapeutic reasons. With LIFU, Dr. Haydar hopes to tune the right amount of energy toward a brain tumor to temporarily open the blood-brain barrier and improve the delivery of therapeutics.

“We’re using two treatments that are tested in the clinic. We know how they work individually, but we’re investigating methods to combine the best aspects of both,” Dr. Haydar said. “I hope to use it, not just to open the channels in the blood-brain barrier, but also to cause a certain kind of immune response in the brain, which will help the CAR T-cells fight cancer.”

This collaborative grant includes experts in the field, including Yanxin Pei, Ph.D., principal investigator at Children’s National and an expert in medulloblastoma modeling, and Natasha Sheybani, Ph.D., assistant professor at the University of Virginia and a leading figure in the application of focused ultrasound.

Why we’re excited

Dr. Haydar is initially focused on high-risk medulloblastoma, specifically sonic hedgehog and group 3 subtypes, both of which are often fatal with existing chemotherapy and radiation treatments. Even when successful, the standard treatments can lead to life-long developmental side effects. Dr. Haydar hopes to show that the combined treatment improves survivorship, and she anticipates expanding her work to other types of pediatric brain tumors.

The $600,000 award shows the importance of well-resourced research institutions uniquely focused on pediatrics. Dr. Haydar noted that Children’s National is one of few research hospitals in the country with the necessary laboratory and ultrasound equipment on-site to develop a customizable treatment protocol. “We’re not just proposing to test this as a science project,” she said. “We’re proposing something that we can very well translate into the clinic and into a new approach for pediatric cancer patients.”

What we hope to discover

Through congressional funding, the Defense Department – one of the largest providers of pediatric healthcare for U.S. children – looks for opportunities to support the needs of military personnel and their dependents. Much of Dr. Haydar’s work will focus on determining safety and optimizing the delivery of the two treatments.

“You have to find the ideal timeline,” Dr. Haydar said. “Which therapy do you do first? How much spacing is best between them, and when do you repeat the therapy? What is the best dosing? It’s a puzzle, and I am hoping to solve it to give children with these often-fatal diagnoses a longer life – and a better one than existing treatments provide.”

illustration of a neural network

Adjusting key protein could improve brain function in children with fetal alcohol syndrome

illustration of a neural network

Researchers at Children’s National are testing whether controlling the level of apolipoprotein E could serve as an effective treatment for the poor neurobehavioral outcomes tied to fetal alcohol spectrum disorders.

Reduced levels of a protein – called apolipoprotein E – are responsible for the lifelong cognitive and neurological symptoms in fetal alcohol spectrum disorders (FASD), according to a new study published in the journal Molecular Psychiatry. For the first time, researchers at Children’s National Hospital are testing whether controlling the level of this protein could serve as an effective treatment for the poor neurobehavioral outcomes tied to FASD, which is believed to affect roughly 5% of school-aged children.

Apolipoprotein E is controlled by a gene called APOE, a well-known risk gene for Alzheimer’s disease. It contains the instructions that guide how the connections between neurons in the brain strengthen or weaken over time. This process, known as synaptic plasticity, is crucial for learning and memory formation. In this study, plasma was collected from participants at two sites in Western Ukraine, along with information about drinking behavior reported by their mothers.

What this means 

“In addition to Alzheimer’s risk, we found this gene is also a crucial contributor to cognitive problems in children with FASD,” said Kazue Hashimoto-Torii, Ph.D., a principal investigator at the Center for Neuroscience Research at Children’s National. “The new data shows that we understand the mechanism by which prenatal alcohol exposure causes a decrease of the APOE level in the brain. We will continue this work to help improve our understanding of FASD, hoping to replenish this important protein and improve outcomes for children with these disorders.”

FASD is an umbrella diagnosis for the physical and developmental challenges that face children who are exposed to alcohol in utero, including intellectual disability, delay in motor and language development and other neurological diagnoses. While alcohol alone is problematic to many aspects of development, evidence also suggests that genetic factors play a role. Only 4.3% of children with heavy alcohol exposure develop FASD, and twin studies have revealed that fraternal twins have different FASD outcomes compared to identical twins.

What’s next 

The research team at Children’s National wanted to pinpoint places where genes could play a role and consider therapies. For the first time, researchers found that plasma levels of APOE were reduced in children with FASD, which strongly supports a potential target for therapy. In addition, their genomics study found a variant of APOE increases the risk of cognitive problems in subjects who were prenatally exposed to alcohol, especially those of African ancestry.

“We found that providing a drug that activates the APOE receptor rescued learning deficits and anxiety in pre-clinical models,” said Masaaki Torii, Ph.D., principal investigator at the Center for Neuroscience Research. “The implications offer an exciting glimpse into possible therapies for some of the neurological harms associated with prenatal alcohol exposure and FASD.”

Read the full manuscript – Reduction of APOE accounts for neurobehavioral deficits in fetal alcohol spectrum disorders – in Molecular Psychiatry.

Dr. Anitha John addresses symposium attendees

Addressing long-term brain effects of congenital heart disease

Dr. Anitha John addresses symposium attendees

Dr. Anitha John, medical director of the Washington Adult Congenital Heart Program at Children’s National Hospital, presenting on the lifelong effects of congenital heart disease on brain health at a recent symposium.

About 81% of the 40,000 babies born in the United States with congenital heart disease (CHD) are expected to survive to at least age 35, according to the Centers for Disease Control and Prevention. As survival rates have increased in recent decades, clinicians treating CHD patients are seeking to improve outcomes by understanding the long-term health effects and complications that arise for them.

Anitha John, M.D., Ph.D., medical director of the Washington Adult Congenital Heart Program at Children’s National Hospital, presented an overview of what researchers currently know about the lifelong effects of CHD on brain health at a symposium focused on the heart-brain continuum presented by Children’s National Innovation Ventures, CobiCure and JLABS @ Washington, D.C. She also discussed critically needed advancements in monitoring technology to help clinicians better understand and address how CHD affects the brain.

Why it matters

Based on data collected from adults and children with the condition, Dr. John shared that people with CHD face many potential lifelong challenges and risks, which vary based on disease severity:

  • About one-third report a mood disorder, either anxiety or depression
  • 25% higher risk of substandard academic outcomes
  • 50% more likely to require special education services
  • Higher incidence of motor skills impairment
  • Higher lifetime prevalence of ADHD
  • Generally lower educational attainment at adulthood
  • Higher risk of autism spectrum disorders
  • Higher rate of dementia before the age of 65

Why do some people with CHD experience profound, lifelong brain effects? Dr. John notes that clinicians and researchers are seeking those answers, recognizing that they likely involve various factors and accumulating issues that occur over the entire lifespan, from fetal life onward.

Because the heart supplies the brain with oxygen through circulated blood, the diagnostic tool clinicians most want for patients of all ages is a technology that enables noninvasive monitoring of central venous pressure, an indicator of the volume of blood returning to the heart and the pressure within the heart. Currently, the most reliable way to measure this pressure is by an invasive procedure in which a catheter is inserted into the patient’s subclavian or internal jugular vein or by placing a device into the patient’s pulmonary artery. These procedures have limitations and cannot be used for routine surveillance.

What’s next

Dr. John says noninvasive central venous pressure monitoring is important to understanding and addressing what is causing brain injury in CHD patients. She says the challenges in developing this monitoring solution include the need for an individualized approach, a design that accommodates multidisciplinary use, sizing for patients from infants to adulthood, usability for all age groups and avoiding stigma for wearers.

To address this need, the Alliance for Pediatric Device Development – a consortium funded by the Food and Drug Administration and led by Children’s National – is partnering with CobiCure to issue a request for proposals for direct device funding. The goal is to provide funding to innovators who offer solutions to the dire unmet need for pediatric devices that provide noninvasive monitoring of the circulatory system and heart performance. Details will be announced in June 2024.

 

Maureen Lyon, Ph.D.

Pilot program improves well-being of families during advanced care planning


Children with life-limiting rare diseases and their caregivers face tremendous stress and anxiety about the heart-breaking decisions before them. A new intervention – designed at Children’s National Hospital to support the palliative needs of these families – improved their spiritual and emotional well-being, according to new research published in the journal, Pediatrics.

Called FACE Rare (FAmily CEntered Pediatric Advance Care Planning Intervention for Rare Diseases), the counseling tools were found to be safe, effective and increased feelings of peace among families in this underserved population.

“Seventy-four percent of the families in that intervention group reported feelings of sadness, yet 100% reported our pilot intervention was a worthwhile experience,” said Maureen Lyon, Ph.D., a clinical psychologist and principal investigator at the Center for Translational Research at Children’s National. “If you’re talking about the possibility that the worst thing in the world would happen to you – that your child might die, and what you would want for them – the families found that our intervention helped. They had a place to process their feelings and consider what would be important to their child.”

The big picture

A rare disease is defined as any condition affecting fewer than 200,000 people in the United States. In pediatrics, these diseases often require constant caregiving and require families to face the cruel reality that the diagnosis may be life-limiting. In such cases, clinical teams often decide that conversations about advanced care planning (ACP) are needed.

The pilot-phase, randomized trial enrolled patients from Children’s National between 2021 and 2023. Research nurses underwent two days of training to be certified in the new intervention. Families assigned to the new approach received three, weekly 60-minute sessions and were evaluated using evidence-based assessment tools, including the Carer Support Needs Assessment Tool/Action Plan and the Next Steps: Respecting Choices Pediatric ACP Conversation. Measures of anxiety and spiritualization were tracked, and families returned after three months for follow-up.

Patients had a range of diagnoses that put tremendous strain on the caregivers, including complex digestive disorders, white-matter diseases and rare forms of epilepsy. Yet the caregivers expressed similar challenges: having time for themselves during the day, knowing what to expect in the future for their child’s care, and managing financial, legal and work issues.

What we found

Reinforcing the need to improve engagement and support for these families, the investigative team found that those who received the FACE Rare intervention reported higher levels of spiritual meaning and peace than those who received “treatment as usual.” All families living below the poverty line reported greater anxiety, and noteworthy to the team, black caregivers were less likely to report caregiver distress than non-black caregivers.

Dr. Lyon said future research needs to understand better how families respond to the challenges of rare diseases and unique social determinants of health that can change the approach to care.

“In some cultures, and families, having strong feelings is discouraged,” Dr. Lyon said. “We want to give families and caregivers space to have these emotions and think about what would be important for their child, if the worst were to happen. They appreciated that they participated in the program and had the space to consider these difficult questions.”

Read the full study, “Advance Care Planning for Children with Rare Diseases: A Pilot RCT,” in Pediatrics.

person circling items on mental health summit agenda

Unique alliance expands access to mental health support for kids

  • carefirst mental health summit photo
  • carefirst mental health summit photo
  • carefirst mental health summit photo
  • carefirst mental health summit photo
  • carefirst mental health summit photo
  • carefirst mental health summit photo
  • carefirst mental health summit photo
  • carefirst mental health summit photo
  • carefirst mental health summit photo
  • carefirst mental health summit photo
PreviousNext
12345678910

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

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

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

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

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

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

  • Value-based care
  • Community health initiatives
  • Member benefit enhancements

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

  • Behavioral and mental health
  • Diabetes
  • Infant mortality

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

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

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

Illustration showing phthalate exposure during cardiopulmonary bypass

Pediatric heart patients exposed to plastic chemicals during cardiopulmonary bypass

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

What is it?

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

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

Why does it matter?

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

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

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

Children’s National leads the way

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

What’s next

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

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

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

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

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

teenager receiving an intravenous infusion

Novel cell therapy treatments offer promise to immune-compromised children

teenager receiving an intravenous infusion

In a first-of-its-kind clinical trial, researchers found that intravenous therapies made from virus-specific T-cells (VST) can effectively treat immunocompromised pediatric patients, far surpassing the current standard of care, according to new research published in Nature Communications.

More than 60% of patients in the phase 2 clinical trial led by investigators from Children’s National Hospital and Huntsman Cancer Institute responded to the innovative VST therapy. This new treatment uses blood from healthy donors to manufacture a highly specialized immune therapy that, when given to immune-compromised patients, prompts their immune system to fight off potentially life-threatening viruses, including cytomegalovirus, Epstein-Barr and adenovirus. Without this therapy, estimates suggest that less than 30% of patients would recover, using standard protocols.

“A vast majority of our patients not only responded to the therapy, but they were able to come off their antivirals, which come with extensive side effects,” said Michael Keller, M.D., the paper’s first author and the Translational Research Laboratory director at the Children’s National Cell Enhancement and Technologies for Immunotherapy (CETI) program. “This promising data suggests hope for patients with rare immune-compromising diseases that leave them vulnerable to so much in the world.”

The study brings together experts from the Pediatric Transplantation and Cell Therapy Consortium (PTCTC) and the Primary Immune Deficiency Treatment Consortium (PIDTC) to create the first multi-center, pediatric-consortium trial of adoptive T-cell therapies for viruses. It also represents one of the first to include critically ill patients, who are often excluded from research.

Children’s National leads the way

Working alongside Catherine Bollard, M.D., M.B.Ch.B., director of the Center for Cancer and Immunology Research (CCIR), Dr. Keller and the CCIR team helped build an internationally recognized program, pioneering therapies to prevent complications from viral infections in immunocompromised patients. This includes patients with congenital immune deficiency and others who have undergone bone marrow transplantation for malignancies or non-malignant conditions, such as sickle cell disease.

While doctors can treat some immune-compromised patients for infections with standard antivirals, a small fraction don’t respond. Children’s National is one of a handful of hospitals in the country that has options. Over the last several decades, researchers have found ways to develop VST therapies made from banked T-cells, a more advanced application of how donated red blood cells are used to treat anemia.

In 2017, Drs. Keller and Bollard started collaborating with Michael Pulsipher, M.D.—now with Intermountain Primary Children’s Hospital and the Huntsman Cancer Institute at the University of Utah—to create a multi-institute clinical study. They combined the expertise at Children’s National in producing and banking cell therapy products with the community built around the PTCTC. Ultimately, they launched a clinical trial that was open to 35 centers in the U.S., enrolling 51 patients at 22 hospitals from 2018-2022.

“We wanted to prove that this potentially life-saving therapy could be given safely at regional pediatric centers that had never been able to use this approach before,” said Dr. Pulsipher, who served as the study’s co-principal investigator with Dr. Keller. “We united top experts in this area from the PTCTC and PIDTC and successfully treated some of the most challenging patients ever treated with this approach. Our findings helped define who can benefit the most from this therapy, paving the way for commercial development.”

The Good Manufacturing Practices (GMP) laboratory at Children’s National, led by Patrick Hanley, Ph.D., provided suitable VST therapies for 75 of 77 patients who requested to join the study. Clinical responses were achieved in 62% of patients who underwent stem cell transplants and in 73% of patients who were treated with VST and evaluated one month after their infusion. The paper laid out risks and clinical factors impacting outcomes when third-party donors are used to manufacture the VST therapies.

What’s ahead

Given that researchers are only beginning to develop cell therapies, work remains to understand the many ways they interact with the immune system. In a separate paper also recently published in Nature Communications, members of the multi-institute team documented a case of an infant with severe combined immune deficiency, who faced extremely rare side effects when the VST treatment interfered with her donor bone marrow graft. The case led the team to work with the Food and Drug Administration to identify criteria for VST donors enrolled in this study to mitigate complications.

In the decade ahead, Dr. Bollard sees promise in cell therapies for patients with cancer, immune deficiencies after transplant and dozens of other disorders, including genetic and autoimmune diseases. “Future studies will continue to look at ways to optimize the manufacturing, the administration and the long-term outcomes for these therapies—and to enhance the lifelong impact on our patients,” she said. “When we pair human ingenuity with the power of technology, I see tremendous potential.”

Acknowledgments: This study was funded with a nearly $5 million grant from the California Institute of Regenerative Medicine and was run through the operations center at the Children’s Hospital of Los Angeles, where Dr. Pulsipher was formerly on faculty.

Participants at the annual “Make Your Medical Device Pitch for Kids!”™ competition

Two pediatric medical device companies awarded at pitch competition

Participants at the annual “Make Your Medical Device Pitch for Kids!”™ competition

Winners and finalists competed at UCLA during annual L.A. MedTech Week 2024. Left to right are: Nada Hanafi, MedTech Color Board treasurer; Vernessa Pollard, MedTech Color Board secretary; Dr. Sanna Gaspard, CEO and founder of Rubitection, (winner -$35,000 first prize); Dr. Kolaleh Eskandanian, Children’s National vice president and chief innovation officer; Kwame Ulmer, MedTech Color founder and board chair. Photo credit: MedTech Color

Alliance for Pediatric Device Innovation (APDI), a federally funded consortium led by Children’s National Hospital, and member MedTech Color announced the winners of the recent edition of the Make Your Medical Device Pitch for Kids!™ competition, which focused on recognizing and supporting African American and Hispanic pediatric medical device innovators. The awardees received a combined $50,000 in grant funding from APDI, made possible by the U.S. Food and Drug Administration (FDA) to support the advancement of pediatric medical technologies to the market.

The winners were selected from a field of five finalists who gave pitch presentations on their innovation’s attributes, benefits to patients and pathway to commercialization before a panel of five expert judges. The event was held on March 15 at the University of California, Los Angeles, as part of the annual MedTech Color Pitch Competition during L.A. MedTech Week 2024, powered by BioscienceLA.

The award-winning pediatric devices and companies are:

  • Rubitection, Pittsburgh, Pa.– A low-cost skin assessment management tool for chronic wounds, Rubitection measures the properties of the skin. The system allows the user to monitor incremental changes in skin health to predict risk, monitor progression and customize care.
  • Kofimi Technology Inc., Danvers, Mass. – This patent-pending pulse oximeter device is designed specifically for pediatric populations to provide superior accuracy for all levels of skin pigmentation. A pulse oximeter measures oxygen levels in the blood.

Why we’re excited

“Funding innovators of African American and Hispanic backgrounds is crucial for advancing diversity, equity, and inclusion initiatives because it addresses systemic barriers and inequities that have historically hindered this group from accessing resources and opportunities in the life sciences sector,” said Kolaleh Eskandanian, Ph.D., M.B.A., P.M.P., vice president and chief innovation officer at Children’s National and APDI program director and principal investigator. “Supporting a diverse group of innovators enriches the research and development process by bringing a variety of perspectives and viewpoints representing all populations.”

Along with the grant award, all finalists receive access to a network of supportive resources and expertise as part of their connection to APDI and MedTech Color.

Along with the pitch presentations, the event program included a keynote talk from Tonya Kinlow, vice president of Community Engagement, Advocacy and Government Affairs at Children’s National, highlighting advocacy initiatives leading to an all-inclusive system of care for children.

Children’s National leads the way

Julia Finkel, M.D., pediatric anesthesiologist at Children’s National and principal investigator for APDI, participated in the panel discussion “Inequity within Inequity,” which highlighted how racial disparities in pediatric healthcare remain a critical challenge across the United States. APDI’s goal is to advance pediatric devices that meet patient needs while promoting a more inclusive approach to discovering and supporting talented innovators.

“We believe there is a community of companies focused on platforms that treat or diagnose pediatrics,” said Kwame Ulmer, founder of MedTech Color. “This partnership allows us to significantly increase the support we provide for entrepreneurs in this area. We are delighted to be a part of the Children’s National community to drive positive patient outcomes.”

The patient benefit

Founded in 2017, MedTech Color is a nonprofit organization built on the same ideal: diverse leadership in the medical technology ecosystem leads to greater innovation and better outcomes. The organization works to advance the representation of people of color in the medical device industry and to nurture the next generation of founders. For more information on MedTech Color, visit medtechcolor.org.

APDI is one of five nonprofit consortia in the FDA’s Pediatric Device Consortia program that receives funding to provide a platform of services, expertise and grants to support pediatric innovators in bringing medical devices to the market that address the needs of children. Along with Children’s National, APDI members include Johns Hopkins University, CIMIT at Mass General Brigham, Tufts Medical Center, Medstar Health Research Institute, OrthoPediatrics Corp. and MedTech Color.

Advancements in pediatric medical devices continue to lag significantly behind those of adults, which is why APDI is focused on helping more pediatric medical device innovations achieve commercialization. For more information on APDI, visit innovate4kids.org

Nathan Kuppermann, M.D., M.P.H.

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

Nathan Kuppermann, M.D., M.P.H.

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

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

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

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

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

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

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

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

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

Newborn baby in a crib

Pioneering research center aims to revolutionize prenatal and neonatal health

  • Katherine Wisner
  • Catherine Stoodley
  • Katherine Ottolini
PreviousNext
123

Catherine Limperopoulos, Ph.D., was drawn to understanding the developing brain, examining how early adverse environments for a mother can impact the baby at birth and extend throughout its entire lifetime. She has widened her lens – and expanded her team – to create the new Center for Prenatal, Neonatal & Maternal Health Research at Children’s National Hospital.

“Despite the obvious connection between mothers and babies, we know that conventional medicine often addresses the two beings separately. We want to change that,” said Dr. Limperopoulos, who also directs the Developing Brain Institute. “Given the current trajectory of medicine toward precision care and advanced imaging, we thought this was the right moment to channel our talent and resources into understanding this delicate and highly dynamic relationship.”

Moving the field forward

Since its establishment in July 2023, the new research center has gained recognition through high-impact scientific publications, featuring noteworthy studies exploring the early phases of human development.

Dr. Limperopoulos has been at the forefront of groundbreaking research, directing attention to the consequences of maternal stress on the unborn baby and the placenta. In addition, under the guidance of Kevin Cook, Ph.D., investigators published a pivotal study on the correlation between pain experienced by premature infants in the Neonatal Intensive Care Unit and the associated risks of autism and developmental delays.

Another area of research has focused on understanding the impact of congenital heart disease (CHD) on prenatal brain development, given the altered blood flow to the brain caused by these conditions during this period of rapid development. Led by Josepheen De Asis-Cruz, M.D., Ph.D., a research team uncovered variations in the functional connectivity of the brains of infants with CHD. In parallel, Nickie Andescavage, M.D., and her team employed advanced imaging techniques to identify potential biomarkers in infants with CHD, holding promise for guiding improved diagnostics and postnatal care. Separately, she is investigating the impact of COVID-19 on fetal brain development.

In the months ahead, the team plans to concentrate its efforts on these areas and several others, including the impact of infectious disease, social determinants of health and protecting developing brains from the negative impacts of maternal stress, pre-eclampsia and other conditions prevalent among expectant mothers.

Assembling a team

Given its robust research plan and opportunities for collaboration, the center pulled together expertise from across the hospital’s faculty and has attracted new talent from across the country, including several prominent faculty members:

  • Katherine L. Wisner, M.S., M.D., has accumulated extensive knowledge on the impact of maternal stress on babies throughout her career, and her deep background in psychiatry made her a natural addition to the center. While Dr. Wisner conducts research into the urgent need to prioritize maternal mental health, she will also be treating mothers as part of the DC Mother-Baby Wellness Initiative — a novel program based at Children’s National that allows mothers to more seamlessly get care for themselves and participate in mother-infant play groups timed to align with their clinical appointments.
  • Catherine J. Stoodley, B.S., M.S., D.Phil., brings extensive research into the role of the cerebellum in cognitive development. Dr. Stoodley uses clinical studies, neuroimaging, neuromodulation and behavioral testing to investigate the functional anatomy of the part of the brain responsible for cognition.
  • Katherine M. Ottolini, M.D., attending neonatologist, is developing NICU THRIVE – a research program studying the effects of tailored nutrition on the developing newborn brain, including the impact of fortifying human milk with protein, fat and carbohydrates. With a grant from the Gerber Foundation, Dr. Ottolini is working to understand how personalized fortification for high-risk babies could help them grow.

Early accolades

The new center brings together award-winning talent. This includes Yao Wu, Ph.D., who recently earned the American Heart Association’s Outstanding Research in Pediatric Cardiology award for her groundbreaking work in CHD, particularly for her research on the role of altered placental function and neurodevelopmental outcomes in toddlers with CHD. Dr. Wu became the third Children’s National faculty member to earn the distinction, joining an honor roll that includes Dr. Limperopoulos and David Wessel, M.D., executive vice president and chief medical officer.

Interim Chief Academic Officer Catherine Bollard, M.D., M.B.Ch.B., said the cross-disciplinary collaboration now underway at the new center has the potential to make a dramatic impact on the field of neonatology and early child development. “This group epitomizes the Team Science approach that we work tirelessly to foster at Children’s National,” Dr. Bollard said. “Given their energetic start, we know these scientists and physicians are poised to tackle some of the toughest questions in maternal-fetal medicine and beyond, which will improve outcomes for our most fragile patients.”

Before and after pictures of the patient's improved gait

Next-generation genomics testing holds key to undiagnosed rare disease

Before and after pictures of the patient's improved gaitSeth Berger, M.D., Ph.D., felt the pull to dig deeper when he started reading the chart. An 11-year-old boy had an abnormal gait and couldn’t even walk in a straight line down the sidewalk to go trick-or-treating. Yet workups with neurology, orthopedics and an exome analysis of the patient’s genetic code did not provide a diagnosis. He had been getting worse for roughly three years.

With one of the largest clinical genetics departments in the country, Children’s National Hospital receives more than 10,000 visits a year from patients like this middle schooler. Often, they are children and caregivers who are searching for answers and follow-up support for diagnoses of genetic disorders, which impact so few people that only highly trained geneticists and genetic counselors can get to the root of the disorder.

“In genetics, we are finding layers of understanding. A negative clinical test is not always the final answer because the significance of variants can often be missed or misunderstood,” said Dr. Berger, a medical geneticist and principal investigator in the Center for Genetics Medicine Research at Children’s National. “It can take extensive research and a deep knowledge of the limits of certain tests to reach a diagnosis.”

The fine print

On page 4 of the patient’s genetics report, Dr. Berger found a reference to a pair of variants with no known clinical impact. Dr. Berger recognized that the genes referenced could affect proteins that drive potentially treatable neurological outcomes.

Dr. Berger ordered further testing, including biochemical testing of the patient’s blood and a phenylalanine loading challenge, a test that measures how the body metabolizes certain amino acids. With the results, he confirmed a recessive GCH1 deficiency in the patient was causing a condition called DOPA-responsive dystonia, a disorder that causes involuntary muscle contractions, tremors and uncontrolled movements. Laura Schiffman Tochen, M.D., director of the Movement Disorders Program at Children’s National, started the patient on levodopa-carbidopa — a drug combination used to treat Parkinson’s disease and other neurological disorders — and within two hours the boy showed improvement. His gait was almost normal.

Why we’re excited

Dr. Berger presents at conferences on this case and several other medical mysteries that he’s recently solved in his clinical practice and his role at the Pediatric Mendelian Genomics Research Center, a Children’s National program immersed in a federally funded research study to better understand how differences in genetic material can affect human health. As part of his work, he’s joined the GREGoR project (Genomic Research to Elucidate the Genetics of Rare Disease), which hopes to increase the number of genetic disorders where a cause can be identified. The elite genetics consortium includes nationally recognized research centers – the University of California at Irvine, Broad Institute, University of Washington, Baylor University, Stanford University, Invitae and Children’s National – which are working together to harness cutting-edge genomics sequencing capabilities. They hope to enroll thousands in their research, funded by the National Institutes of Health.

“It’s truly stunning what genetic sequencing can find. The outcomes can be life-changing,” said Dr. Berger. “These cases with life-altering diagnoses don’t come along every day, but when they do, they make the hunt to find answers all the more worthwhile.”

pregnant woman talking to doctor

Prenatal COVID exposure associated with changes in newborn brain

pregnant woman talking to doctor

The team found differences in the brains of both infants whose mothers were infected with COVID while pregnant, as well as those born to mothers who did not test positive for the virus.

Babies born during the COVID-19 pandemic have differences in the size of certain structures in the brain, compared to infants born before the pandemic, according to a new study led by researchers at Children’s National Hospital.

The team found differences in the brains of both infants whose mothers were infected with COVID while pregnant, as well as those born to mothers who did not test positive for the virus, according to the study published in Cerebral Cortex.

The findings suggest that exposure to the coronavirus and being pregnant during the pandemic could play a role in shaping infant brain development, said Nickie Andescavage, M.D., the first author of the paper and associate chief for the Developing Brain Institute at Children’s National.

The fine print

The study’s authors looked at three groups of infants: 108 born before the pandemic; 47 exposed to COVID before birth; and 55 unexposed infants. In all cases, researchers performed magnetic resonance imaging (MRI) scans of the newborns’ brains during the first few weeks of life. The MRI scans, which are non-invasive and do not expose patients to radiation, provided 3D images of the brain, allowing doctors to calculate the volume of different areas.

Researchers found several differences in the brains of babies exposed to COVID. They had larger volumes of the gray matter that makes up the brain’s outermost layer, compared to the two other groups. In contrast, an inner area of the brain, known as deep gray matter, was smaller than in unexposed babies. These are areas that contain large numbers of neurons that generate and process signals throughout the brain. “Their brains formed differently if they were exposed to COVID,” said Dr. Andescavage, adding that “those exposed to COVID had unique signatures” in the brain.

Doctors also measured the depths of the folds in the babies’ brains – a way to determine how the brain is maturing during early development. Babies born to mothers who had COVID in pregnancy had deeper grooves in the frontal lobe, while babies born during the pandemic – even without being exposed to COVID – had increased folds and grooves throughout the brain, compared to babies born before the pandemic. “There was something about being born during the pandemic that changed how the brain developed,” Dr. Andescavage said.

What’s ahead

The study authors can’t fully explain what caused the differences in brain development in these babies, Dr. Andescavage said. But other studies have linked maternal stress and depression to changes in the newborn brain. In a future study, Dr. Andescavage and her colleagues will examine the relationship between infant brain development and how stress and anxiety during the pandemic may have played a role in early development.

Because the babies in the study were just a few weeks old, researchers don’t know if their altered brain development will affect how they learn or behave. Researchers plan to follow the children until age 6, allowing them to observe whether pandemic-era babies hit key developmental milestones on time, such as walking, talking, holding a crayon and learning the alphabet.

Researchers have been worried about the effect of COVID on the fetus since the beginning of the pandemic. Studies show that babies exposed to COVID in the womb may experience developmental impacts, and research is underway to better understand long-term outcomes.

Although the coronavirus rarely crosses the placenta to infect the fetus directly, there are other ways maternal infection can influence the developing baby. Dr. Andescavage said inflammation is one potential harm to a developing baby. In addition, if a pregnant woman becomes so sick that the levels of oxygen in her blood fall significantly, that can deprive the fetus of oxygen, she added.

In recent decades, studies of large populations have found that maternal infections with influenza and other viruses increased the risk of serious problems in children even years later, including autism, attention deficit hyperactivity disorder and schizophrenia, although the reasons behind the association are not well understood. Technology may allow doctors to answer a number of questions about COVID and the infant brain.

“With advanced imaging and MRI, we’re in a position now to be able to understand how the babies are developing in ways we never previously could,” Dr. Andescavage said. “That will better allow us to identify the exposures that may be harmful, and at what times babies may be especially vulnerable, to better position us to promote maternal wellness. This, in turn, helps infant wellness.”

mother kissing newborn baby

Evidence review: Maternal mental conditions drive climbing death rate in U.S.

mother kissing newborn baby

More than 80% of maternal deaths in the United States are preventable, particularly the nearly 1 in 4 maternal fatalities that are attributable to mental health disorders.

Painting a sobering picture, a research team led by Children’s National Hospital culled years of data demonstrating that maternal mental illness is an under-recognized contributor to the death of new mothers. They are calling for urgent action to address this public health crisis in the latest edition of JAMA Psychiatry.

Backed by dozens of peer-reviewed studies and health policy sources, the journal’s special communication comes as maternal mortality soars in the United States to as much as three times the rate of other high-income countries.

“The contribution of mental health conditions to the maternal morbidity and mortality crisis that we have in America is not widely recognized,” said Katherine L. Wisner, M.D., associate chief of Perinatal Mental Health and member of the Center for Prenatal, Neonatal & Maternal Health Research at Children’s National. “We need to bring this to the attention of the public and policymakers to demand action to address the mental health crisis that is contributing to the demise of mothers in America.”

The evidence review laid out the risks facing new mothers: More than 80% of maternal deaths in the United States are preventable, particularly the nearly 1 in 4 maternal fatalities that are attributable to mental health disorders. Overdose and other maternal mental health conditions are taking the lives of more than twice as many women as postpartum hemorrhage, the second leading cause of maternal death. For non-Hispanic Black mothers, the mortality rate is a striking 2.6 times higher than non-Hispanic White mothers.

Yet the research team found that recent national efforts to combat maternal mortality have failed to address maternal mental health as “the public health crisis that it represents.” Even methodologies to measure maternal health statistics are inconsistent, which challenges efforts to shape health policy.

In examining 30 recent studies and another 15 historical references, the team – which included Caitlin Murphy, MPA, PNP, research scientist at the Milken School of Public Health at George Washington University, and Megan Thomas, M.D., FACOG, obstetrician at the University of Kansas School of Medicine – found ample data to support the need to elevate maternal mental health as a priority. Some examples:

  • Multiple studies show that the perinatal period puts women at higher risk for new and recurrent psychiatric disorders, with 14.5% of pregnant mothers having a new episode of depression and another 14.5% developing an episode three months after birth.
  • Nationwide, more than 400 maternity healthcare centers closed between 2006 and 2020, creating “maternity care deserts” that left nearly 6 million women with limited or no access to maternity care.
  • Mental health conditions such as suicide or opioid overdose are to blame for nearly 23% of maternal deaths in America, according to reports from three dozen Maternal Morbidity and Mortality Review Committees, which are state-based organizations that review each maternal death within a year of pregnancy. That’s followed by hemorrhage (13.7%), cardiac conditions (12.8%) and infection (9.2%).

Even with these sobering statistics, Dr. Wisner says that only 20 percent of women are screened for depression postpartum. “Given that this is a time that many mothers have contact with healthcare professionals, it’s critically important that all mothers are screened and offered treatment,” she said. “Mental health is fundamental to health — of the mother, the child and the entire family.”

Dr. Wisner is board-certified in general and child psychiatry. Throughout her research career, she has conducted research on maternal-infant interactions and family health. She recently joined the new Center for Prenatal, Neonatal & Maternal Health Research because of its vision to improve outcomes for the entire family by understanding the relationship between mothers and their babies.

“Throughout my career, I have fought hard against these silos that try to lock psychiatry into certain age categories,” Dr. Wisner said. “At Children’s National, we have a huge interest in reunifying the family. We want to ensure that we’re caring for unborn babies, infants and toddlers, while focusing on maternal health and the family in its broader context.”

desktop computer showing the CNRI Annual Report

Driving pediatric breakthroughs through 2023

desktop computer showing the CNRI Annual ReportThe Children’s National Research Institute released its 2022-2023 Academic Annual Report. In the report, a summary of the past academic year highlights the accomplishments of each of the institute’s research centers, provides research funding figures and exalts some of the institute’s biggest milestones.

The stories in the report are a testament to the hard work and dedication of everyone at the Children’s National Research Institute.

We celebrated five decades of leadership and mentorship of Naomi Luban, M.D., and her incredible accomplishments in the W@TCH program, which have been instrumental in shaping the future of pediatric research.

We also celebrated innovation, highlighting our recent FDA award to lead a pediatric device consortium, which recognizes our commitment to developing innovative medical devices that improve the lives of children.

Breakthroughs at the Research & Innovation Campus continued as our researchers worked tirelessly to develop new treatments and therapies that will transform the lives of children and families around the world.

Taking a look at the breakthroughs happening in our now six research centers, we spotlighted the following stories:

  • Reflecting on decades of progress in the blood, marrow and cell therapy programs at Children’s National. Our researchers have made significant strides in this field, and we are proud to be at the forefront of these life-saving treatments.
  • In genetic medicine, we continue to be a beacon of hope for families facing rare and complex conditions. Our researchers are making incredible breakthroughs that are changing the landscape of pediatric medicine.
  • We are also proud to share the $90 million award received from an anonymous donor to support pediatric brain tumor research. The predominant focus of this award is to develop new treatments that will improve outcomes for children with this devastating disease.
  • This year, we opened a new Center that enhances our research capabilities in the field of Prenatal, Neonatal & Maternal Health Research. We are excited about the possibilities this new center will bring and look forward to the discoveries that will emerge from it.
  • In addition, we are driving future pandemic readiness with the NIH funded Pediatric Pandemic Network. Our researchers are using cutting-edge technology and innovative approaches to prepare for the next pandemic and protect children.
  • We are also exploring the potential of artificial intelligence (AI) in pediatric breakthroughs. Our researchers are using machine learning and other AI techniques to develop new treatments and therapies that will transform the lives of children.
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.”

Doctors performing bilateral high intensity focused ultrasound (HIFU) pallidotomy on a patient with dyskinetic cerebral palsy.

Children’s National performs first ever HIFU procedure on patient with cerebral palsy

Doctors performing bilateral high intensity focused ultrasound (HIFU) pallidotomy on a patient with dyskinetic cerebral palsy.

HIFU is a non-invasive therapy that utilizes focused ultrasound waves to thermally ablate a focal area of tissue.

In January, a team of multidisciplinary doctors performed the first case in the world of using bilateral high intensity focused ultrasound (HIFU) pallidotomy on Jesus, a 22-year-old patient with dyskinetic cerebral palsy.

The procedure is part of a clinical trial led by Chima Oluigbo, M.D., pediatric neurosurgeon at Children’s National Hospital.

“The primary objective of the study is to evaluate the safety of ExAblate Transcranial MRgFUS as a tool for creating bilateral or unilateral lesions in the globus pallidus (GPi) in patients with treatment-refractory secondary dystonia due to dyskinetic cerebral palsy,” Dr. Oluigbo explained. “The secondary purpose is to assess the impact of HIFU pallidotomy on dyskinetic cerebral palsy movement disorder in pediatric and young adult patients.”

In addition, the impact of bilateral pallidotomy on motor development, pain perception, speech, memory, attention and cognition in these patients will be assessed.

“We hope that the trial will help us find results that lead to treatments that can reduce the rigidity and stiffness which occurs in cerebral palsy so we can help these children who do not have any effective treatment,” Dr. Oluigbo added.

“This new, first of its kind, non-invasive therapeutic approach – without even a skin incision – will open the door to offering hope for a number of kids with movement disorders who have failed conventional therapy,” said Robert Keating, M.D., chief of neurosurgery at Children’s National. “We are at the beginning of a new era for treating functional disorders in the pediatric patient.”

How it works

HIFU is a non-invasive therapy that utilizes focused ultrasound waves to thermally ablate a focal area of tissue. In the past, Children’s National successfully used HIFU to treat low-grade type tumors located in difficult locations of the brain, such as hypothalamic hamartomas and pilocytic astrocytoma, as well as for epilepsy and other movement disorders.

This most recent procedure was another successful milestone for the hospital, discharging Jesus the following day without any complications.

The team comprised neurosurgeons, MRI techs, anesthesiologists and radiologists, to name a few.

Originally, Jesus came to Children’s National in 2006 when he started working with the Physical Medicine and Rehabilitation team to help him with his muscle hypertonia management as well as equipment, orthoses and therapy concerns.

“As he continued to grow, his muscle hypertonia became more pronounced and caused difficulty with his care, positioning and comfort,” said Olga Morozova, M.D., pediatric rehabilitation specialist at Children’s National. “We have tried multiple oral medications however he has had significant side effects from the majority of the medications.”

Dr. Morozova and Julie Will, M.S.N., F.N.P., the nurse practitioner that worked with Jesus, referred him to Dr. Oluigbo after they learned about HIFU being an option to treat Jesus using a non-invasive approach.

Moving the field forward

This clinical trial highlights the expanding indications for focused ultrasound.

“We are excited about the potential for these innovative treatment strategies in neurosurgery to transform the lives of pediatric patients who suffer from challenging diseases, such as brain tumors, epilepsy, and movement disorders,” said Hasan Syed, M.D., co-director of the Focused Ultrasound Program at Children’s National. “We are redefining what is possible in neurosurgery.”

From low-intensity focused ultrasound (LIFU) treatments for our young DIPG patients to now the groundbreaking research on HIFU for pediatric movement disorders, the dedication to cutting-edge techniques highlights the team’s commitment to patients and transforming pediatric neurosurgical care.