OUT 10 OF 10

Medical Specialties Annual Report 2019 Table of contents Leadership Team Welcome to Riley Children’s Health Ryan D. Nagy, MD Welcome to Riley Children’s Health ...... 1 Interim President As one of the nation’s leading pediatric health systems, Riley Children’s Health Elaine G. Cox, MD About Riley Children’s Health ...... 2 is committed to delivering evidence-based, patient-centered care to children and Chief Medical Officer Helping to build strong, healthy communities ...... 4 families. We are pleased to share this overview of Riley’s 25 medical specialties,* Paul Haut, MD Maternity Tower at Riley Hospital for Children at IU Health ...... 6 highlighting our expertise in pediatric healthcare from primary care to the most Chief Operating Officer Medical Specialties serious and complex medical conditions. Megan Isley, DNP, MBA, RN Chief Nursing Officer Adolescent ...... 8 Our care teams are honored to be part of a children’s hospital that is consistently Frank Runion and ...... 10 ranked among the best in the nation by U.S. News & World Report. This year, Riley Chief Financial Officer ...... 12 Hospital for Children at Indiana University Health—Indiana’s only nationally ranked D. Wade Clapp, MD Child Development and Developmental ...... 14 children’s hospital—is one of only 24 hospitals to be ranked in all 10 pediatric Chairman, Department of Pediatrics Child Protection Program ...... 16 specialties cited by U.S. News. Our and cardiology and heart Frederick J. Rescorla, MD Critical Care programs are ranked second and fifth, respectively, with three other programs Surgeon-in-Chief Nationally out Pediatric earning placement in the top 15. Cardiac Critical Care ...... 18 Ranked in 10 of 10 Specialties Pediatric Critical Care ...... 20 With quality and safety among our highest priorities, Riley is a partner in the Children’s Hospitals’ Solutions for Patient ...... 22 Safety Network, a group of hospitals that shares best practices for delivering preeminent care. As a leader in harms Diabetes and ...... 24 Cancer reduction and quality improvement, Riley has exceeded, as of November 2020, 483 days without a serious safety event. ...... 26 We’ve also received best-in-class recognition for our Level I Pediatric Trauma Center, congenital heart surgery program and Cardiology & 5th extracorporeal membrane oxygenation program, among others. , and Nutrition ...... 28 IN THE Heart Surgery NATION General Pediatrics and Primary Care ...... 30 While this is a 2019 report, we would be remiss if we didn’t address the COVID-19 crisis that has gripped our state, nation / ...... 32 Diabetes & and world. Months before the pandemic and in step with other IU Health system hospitals, Riley prepared for what we knew ...... 34 Endocrinology to be unprecedented circumstances. Making significant modifications to safely deliver care under challenging conditions, our Infectious Diseases ...... 36 response to COVID-19 has been swift, far-reaching and impactful. Medical and Molecular Genetics ...... 38 Gastroenterology & GI Surgery ...... 40 ■ Riley is the only Indiana children’s hospital—and one of the few regionally—to voluntarily contribute data to the ...... 42 TOP Virtual PICU System, a dashboard launched to track pediatric COVID-19 cases across North America and used to Neonatology 15 ...... 44 inform best practices for treatment. TOP ...... 46 Nephrology & Kidney Diseases 15 ■ For seriously ill children with heart and kidney conditions, we transitioned within 36 hours to virtual care to Physical Medicine and Rehabilitation ...... 48 ensure crucial monitoring and oversight continued without interruption. Neurology & and Psychology ...... 50 ■ Our specialists have initiated COVID-19 research studies and developed clinical guidelines to treat children with and ...... 52 Orthopedics multisystem inflammatory syndrome (MIS-C). ...... 54 TOP ■ Through virtual town halls, Riley are sharing the latest information and guidance with pediatric ...... 56 Pulmonology & Lung Surgery 15 providers across the state. Riley Medical Specialties Team Member Directory ...... 59 2nd Urology IN THE Refer a patient ...... 65 NATION These are just a few examples of our leadership in battling COVID-19. Through this pandemic and beyond, Riley is driven by our enduring commitment to deliver the unmatched clinical care and ambitious research that make healthier lives possible On the cover Inspiring patients, for children in Indiana and around the world. From the comfort of his Riley red wagon, Phoenix Spejewski, age world-class care: 3, likes playing with toy trucks and dinosaurs while recovering from open-heart surgery. An expert stories of Riley kids team of cardiologists and a Elaine G. Cox, MD Brian E. Wagers, MD unique integrated care model Physicians and care teams at Chief Medical Officer Director of help ensure heart patients like Riley Children’s Health treat Pediatric and Maternal Quality and Patient Safety Phoenix receive the highest thousands of children each year. level of pediatric care. The Riley Heart Center, Read some of their stories on consistently recognized for pages 3, 58, 63 and 64. exceptional patient outcomes, * The surgical specialties of Riley Children’s Health are highlighted in a is ranked fifth in the nation by separate annual report. Visit rileychildrens.org/surgeryannualreport or U.S. News & World Report. request print copies from [email protected]. This annual report is also available online at rileychildrens.org/medicalannualreport.

Riley Children’s Health Medical Specialties Annual Report 2019 | 1 About Riley Children’s Health

Riley Children’s Health, Indiana’s largest and most Riley Children’s Health Statewide Reach skilled pediatric system, provides care in more Story of Riley siblings: South Bend than 50 locations in communities across Indiana. Crown Point Samantha Brown, age 7 Miles Brown, age 3 Fort Wayne More than 300,000 Brother and sister West Lafayette PATIENTS TREATED ANNUALLY Lafayette beat cancer together.

Muncie

Fishers Carmel PRIMARY SPECIALTY Richmond Jeff and Melissa Brown are watching and laughing as their Indianapolis CARE CARE 7-year-old daughter flips her little body into cartwheels and 200 + 400 Avon headstands around their Westfield home. The laughter feels Greensburg good after nine months of unrelenting worry. It’s a long way physicians across 40 specialties Terre Haute Columbus from where they were last summer, when the couple were Bloomington knocked flat by the news that their first-born, Samantha, had kidney cancer. Two pediatric hospital Just about the time they approached the finish line of her locations in central Indiana: treatment at Riley at IU Health came another devastating blow almost too cruel to believe. Their 2-year-old son, Evansville/Newburgh Miles, was diagnosed with Burkitt’s leukemia, an ■ Riley Hospital for Children at IU Health – Indianapolis aggressive cancer. After learning that Miles had multiple tumors on his kidneys and his , Jeff immediately sent an email to Riley “I don’t know that we have processed it,” Melissa said ■ Riley Hospital for Children at IU Health oncologist Michael J. Ferguson, MD, who was overseeing during an interview earlier this year. “You don’t really have a North Hospital – Carmel Samantha’s care. The email was marked urgent, but this Riley Hospital for Children choice but just to keep moving forward.” time it was about Samantha’s little brother. at IU Health is a Magnet® It started in August 2019 when Samantha was diagnosed hospital, recognized for Dr. Ferguson got on the phone with the couple and the with Wilms’ tumor, a rare form of kidney cancer. She AFFILIATED WITH nursing excellence and high- Chicago urologist to discuss Miles’ care and create a game underwent surgery to remove the tumor, then began a five- quality clinical outcomes. plan for treatment. The family got in their car and drove month course of chemotherapy as an outpatient at Riley. back to Indianapolis the next day. In December, when Samantha was just a month away Once at Riley, a CT scan confirmed the diagnosis of Burkitt’s. from completing chemo and her scans were looking Miles was admitted to Riley and was hospitalized for 54 days. good, the family took a trip to Chicago, where they had ■ One of the largest medical schools in the U.S. Leader in research previously lived. While there, Miles, who was born in Riley oncology team members helped carry them through ■ One of the busiest locations for pediatric and innovation Chicago, had an appointment with a pediatric urologist who the worst of it, Melissa and Jeff said. There were nurses research funded by the National Institutes of had been watching a condition he was born with called who became an extension of their family because they Health and other sponsors ■ Indiana’s only pediatric hydronephrosis, a cared for their son like he was one of their own. And there research hospital was Dr. Ferguson, who told the couple to reach out anytime Riley Children’s Health and IU School of Medicine swelling of the kidney with questions. are committed to providing excellent healthcare due to a build-up of ■ Sixth-ranked children’s hospital urine. Now 3, Miles is regaining the strength he lost during for children through prominence in education, for National Institutes of Health funding training and research. Jeff will never forget treatment. ■ Home to the Herman B Wells Center what he saw during The Browns don’t know why both of their children were for Pediatric Research, Miles’ testing. afflicted with cancer, but they hope they are through the COMPREHENSIVE CHILDREN’S HOSPITAL AND HEALTH SYSTEM OF the Children’s Clinical “I was watching the worst of it. Research Center and ultrasound and I could “I will always be on edge with this,” Jeff said. “Whether the Center for Children’s see stuff lighting up in it’s a temperature or a bruise or whatever, anytime they’re Health Services Research there, and I’m asking, not feeling well, I’m probably going to communicate with ‘What is that?’” Dr. Ferguson.”

2 | Riley Children’s Health Medical Specialties Annual Report 2019 | 3 As Indiana’s largest and Sharing expertise with Virtual visits most comprehensive colleagues statewide To help ensure uninterrupted care during the pandemic, healthcare system for COVID-19 town halls Riley specialists increased ■ Virtual events for children, Riley Children’s and in some cases initiated community-based Health is committed to using medical providers the use of virtual visits and telehealth to meet the health our expertise and resources ■ Latest guidance and needs of pediatric patients in to serve our community. treatment of MIS-C Indiana. Several Riley surgical We offer advanced, nationally ■ Back-to-school series with specialties use virtual care ranked care in more than practical health tips for for initial assessments and a safe restart during the follow-up visits, and the Riley 15 communities across pandemic Emergency department is Indiana. Riley is also a leader ■ COVID-19 research by evaluating how telehealth in promoting preventive Riley specialists can be used to provide care and in sharing our emergent care. Project ECHO specialized expertise with (Extension for Community medical providers and Healthcare Outcomes) Supporting civic involvement and stakeholders to improve Riley physicians participate in Project ECHO, an initiative healthcare advocacy the health and well-being connecting local primary care Riley emergency medicine of children and families. providers with specialists physicians volunteered to improve treatment for to participate in VotER, a complex and chronic health nationwide nonpartisan concerns. In 2019, our initiative aimed at helping physicians shared knowledge people register to vote. and best practices for sepsis Founded by an emergency prevention. medicine resident at Harvard, Helping to build strong, VotER mobilizes healthcare organizations to provide healthy communities Promoting prevention information and resources and improving access to patients who express to care an interest in voting or Flu vaccinations using their voice to change and COVID-19 healthcare policy. Physicians In a year when flu at Riley and IU Health Meeting patients where they are: vaccinations are even more Methodist Hospital—wearing Riley Children’s Health at important to , “Ready to Vote?” lanyards— IU Health North Riley provided hundreds of helped 85 patients ■ Riley inpatient care at IU Health North free flu shots to children register to vote in Hospital with pediatric intensive care and families during two the weeks before unit and 24/7 coverage flu vaccination events at Indiana’s voter ■ Surgery and procedures in The Children’s Museum registration gastroenterology, urology, pulmonology, of Indianapolis. deadline. otolaryngology, orthopedics and , and

■ On-site pediatric emergency medicine physicians

■ Outpatient care in more than two dozen pediatric specialties

4 | Riley Children’s Health Medical Specialties Annual Report 2019 | 5 New maternity tower to feature unique, fully integrated care model

The Maternity Tower at Riley Hospital for Children at IU Health is scheduled to open in 2021. The facility centralizes all of Riley’s obstetric and neonatal care across the Riley Hospital for Children and IU Health Methodist Hospital campuses. The maternity tower features a new coordinated care model anchored by the long- standing reputation of Riley at IU Health for delivering expert care for complicated pregnancies and at-risk newborns. Riley, alongside our partners at IU Health, offers comprehensive, multidisciplinary services and exceptional medical support to patients experiencing low- to high-risk pregnancies. In March 2020, Riley Maternal Fetal Medicine relocated to the Riley Outpatient Center, expanding its footprint with additional private exam rooms and ultrasound suites. The Riley Fetal Center is housed in the same area and includes a “nesting room” for patients to relax between appointments and testing.

Riley Fetal Center Maternity Tower at Riley Hospital for Children Learn more about our approach to The Riley Fetal Center provides preeminent Expertise and services management of a broad range of complex maternity and newborn health ■ Most comprehensive and maternal fetal medicine and high-risk conditions, while supporting program in the state Collaboration between obstetrics and neonatology exists in most health families with coordinated care specific to the ■ High-risk pregnancy consultation and services for women with centers, but the Riley care model is integrated both operationally and needs of the patient. medical and obstetrical issues physically in our children’s hospital. This allows our specialists to deliver services in a seamless manner from initial consultation and maternal ■ Advanced fetal imaging, including ■ On-site Level III and Level IV NICUs and fetal assessment to delivery planning—and finally, to management echocardiography, extensive – Riley’s combined Level III and Level IV NICU is the largest NICU of labor and delivery. For babies needing immediate, high-level care, ultrasonography and the state’s only in Indiana and among the largest in the country fetal MRI our pediatric subspecialists are available on site, with no need for ■ Specialty maternal fetal medicine programs: transport, resulting in consistently better patient outcomes. ■ Personalized, multidisciplinary and family- – Mood Disorders Program (collaboration with IU Health Psychiatry) centered care consultations with families Comprehensive services for high-risk and support team members – Maternal Recovery Program (women recovering from substance abuse disorders) and low-risk pregnancies ■ Multidisciplinary fetal care conferences, Being equipped to manage the highest risk cases means Riley is bringing together more than 40 Riley – Centering Pregnancy Program (group prenatal care) more than prepared to take care of mothers experiencing normal specialists, to discuss best practices – Programs for pregnant women with medical conditions such pregnancies. Complications during labor and delivery are unpredictable and management plans for complex as diabetes and cardiac disease and occur even in pregnancies that are considered low risk. Our fetal diagnoses ■ General pregnancy care, including experienced obstetricians expertise in managing complex pregnancies makes Riley the safest and midwifery program place even for low-risk patients because of our ability to skillfully respond at the highest level to unexpected complications that Maternity tower These images are renderings only. The final product may differ slightly. can happen. In addition, the new midwifery program at Riley offers an alternative for women who want a more natural labor and delivery experience but also desire the security of a hospital setting. Our certified nurse midwives provide patient-centered care for women through pregnancy, birth, postpartum and beyond.

24/7 adult care for mothers While our maternity services are in a children’s hospital, our program The tower includes: is closely aligned with IU Health adult services to provide high-quality, ■ 45-bed Level III NICU ■ Labor/delivery birthing suites safe care for all mothers delivering at Riley. Our obstetrics intensive (private rooms) ■ 68 private postpartum rooms care unit will be covered 24/7 by an adult intensive care physician, and ■ Obstetrics intensive care unit for mother and baby both adult and pediatric experts from throughout the IU Health Adult With 105 total NICU beds (new Level III NICU plus existing 60-bed Academic Health Center will be on call day and night for consultations Level IV NICU), Riley at IU Health houses the largest NICU in the state. at Riley, if needed.

6 | Refer a patient: 317.944.7010 (Maternal Fetal Medicine | Riley Fetal Center) Riley Children’s Health Medical Specialties Annual Report 2019 | 7 Riley Gender Health Program for children Riley Adolescent Medicine is dedicated to the care and treatment and adolescents of young people up to age 21. Our fellowship-trained physicians, This interdisciplinary experienced in caring for the special needs of teenagers and young program offers adults, treat a wide range of adolescent health concerns, including comprehensive support eating disorders, reproductive health and gender health. The to children, teens and adolescent medicine team routinely works with other Riley specialties, young adults who are including cardiology, hematology/oncology, child development, experiencing gender psychiatry, endocrinology, and obstetrics and gynecology. dysphoria and seek supportive and affirmative care. We address the medical, psychological, nutritional, family, social, legal and school- Expertise and specialized programs to treat related issues associated with diverse gender identities. Our team DIVISION CHIEF a variety of adolescent health concerns offers a variety of care and services, including: Rachel A. Katzenellenbogen, MD Adolescent Medicine Consultation Program ■ Gender-affirming hormone Program leader since 2020 This program offers evaluation and treatment of any problem in an Associate Professor of Pediatrics, adolescent that persists or requires more specialized treatment than ■ Puberty-blocking medication IU School of Medicine For full team member list, see page 59. is usually available through primary care providers. The range of ■ Treatment for menstrual suppression services is broad and includes treatment for physical, emotional ■ Psychological counseling and support and behavioral concerns. Patients are seen in person at the Riley Program distinctions Pediatric Care Center or through a virtual visit. Common referrals ■ Surgery consultation and coordination include (but are not limited to): One of the largest divisions of its Charis Center for Eating Disorders kind in the nation with high- ■ Management of chronic illness The Charis Center offers the full array of medical, psychological volume clinical care, prolific ■ Evaluation for chronic symptoms without a diagnosis and family services for patients with eating disorders. The grant-funded research and a multidisciplinary program includes physicians, nurses, psychologists, robust training program ■ Mental health and behavioral issues, including anxiety, dietitians, art therapists, schoolteachers and psychiatrists who focus depression and disordered attention on the care of children, adolescents and adults with eating disorders. Home to the Charis Center, ■ Nutritional concerns, including eating disorders The Charis Center treats patients of all ages and provides three levels Indiana’s most comprehensive of care to match the needs of the patient and family. eating disorders treatment Adolescent gynecology and reproductive healthcare program Riley adolescent medicine specialists evaluate and treat a variety ■ Partial hospital program – Eleven-hour therapy, five days per week of gynecological conditions, including delayed puberty, dysfunctional ■ Intensive outpatient program – Three-hour therapy, three days The only comprehensive program uterine bleeding, polycystic ovary syndrome, chronic pelvic pain and per week; provides group therapy targeted for patients who need in the state targeted to meet the dysmenorrhea. Riley offers specialized gynecology and reproductive more focused treatment unique needs of gender-diverse healthcare, such as long-acting reversible contraceptive options. children and adolescents ■ Outpatient care -- More than 10,000 outpatient visits each year Our specialists have extensive experience consulting patients and families about fertility preservation for adolescents with complex illnesses, such as heart transplants and congenital heart conditions, sickle cell disease, , and childhood cancer.

Active in research Riley adolescent medicine specialists conduct research in a variety of areas, including human papillomavirus (HPV), HPV vaccines, sexually transmitted infections, healthcare access for youth, eating disorders, teen pregnancy prevention, gender health and the long-term effects of illness and recovery on youth. Our researchers are committed to translating research findings into improved patient care and healthcare policy.

8 | Refer a patient: 317.274.8812 Riley Children’s Health Medical Specialties Annual Report 2019 | 9 Allergy and Immunology With experience and Immunomodulator management and immunotherapy training in the unique Our specialists—all trained in the management of allergic rhinitis The board certified allergy and immunology specialists at Riley at IU Health and asthma—have improved the quality of life for hundreds of ways allergic reactions are extensively trained in the management and treatment of pediatric allergy, children with severe asthma by using immunomodulators (biologic asthma and immunology issues. Our skilled team, which includes two pediatric affect children, Riley medications that reduce inflammation). We also treat children with nurse practitioners, offers the latest diagnostic tools and treatments delivered allergy physicians immunotherapy—allergy injections that change the body’s immune in a safe and comfortable manner to children dealing with the challenges of response to pollens, molds, dust mites and animals. Children can offer the skills and allergic conditions. We collaborate with other medical disciplines at Riley to then reduce or even stop their medications for itchy eyes, runny nose, provide integrated, multidisciplinary care to children and families. expertise to manage the sneezing and similar chronic symptoms. We currently see patients most complex allergic in Indianapolis, Carmel and Bloomington, with plans to add more Comprehensive care for allergy and immunology conditions statewide locations. As clinicians, researchers and educators, our specialists are uniquely qualified to conditions in children. DIRECTOR diagnose and treat the full spectrum of pediatric allergic conditions: Girish V. Vitalpur, MD, FAAP, FAAAAI ■ Allergic rhinitis (hay fever) ■ Eosinophilic esophagitis ■ Immune deficiencies The allergy program is a vital part of the Riley Program leader since 2018 Associate Professor of Clinical Pediatrics, ■ Angioedema (swelling) ■ Food /anaphylaxis ■ Insect sting reactions High-Risk Asthma Program, which brings IU School of Medicine For full team member list, see page 59. ■ Asthma ■ Food protein-induced enterocolitis ■ Oral allergy syndrome together allergists, pulmonologists and clinical syndrome asthma educators to address all aspects of ■ Drug allergies ■ Recurrent infections ■ Urticaria (hives) asthma management. Program distinctions ■ Eczema (atopic dermatitis) ■ Sinusitis A center of clinical excellence Fields of clinical excellence and specialized programs in food allergy—a certification Serving Indiana’s Food allergies. Riley at IU Health is recognized by Food Allergy Research & Education selectively awarded by Food as a center of excellence. We perform more than 200 food challenges annually, and Allergy Research & Education children our team has years of experience in food introduction at all ages. The Children’s Riley immunologists are Clinical Research Center at Riley provides designated, child-friendly rooms for families Home to a leading and responsible for reviewing participating in research protocols and food challenges. innovative High-Risk all positive results for Drug allergy management. Our allergy physicians perform several outpatient drug Asthma Program Indiana’s newborn screening challenges each year. Antibiotic challenges are the most common. In addition, we program for severe combined have collaborated with colleagues in infectious diseases and to develop an Inpatient and outpatient immunodeficiency (SCID). algorithm based on history, testing and oral drug challenges that accurately labels or antibiotic allergy and Outcomes from SCID de-labels a child’s drug allergies. We have also advised pediatricians across Indiana on de-labeling programs treatment show that early how to implement these programs in their practices. identification and intervention Gastrointestinal Digestive Disease Program. Riley has the only multidisciplinary with hematopoietic stem program in Indiana dedicated to the treatment of children with eosinophilic digestive cell transplant provide the disorders. Riley allergists, gastroenterologists and dietitians consult with patients and best chance for survival. families at every visit to provide comprehensive care for eosinophilic esophagitis, Our specialists are leaders eosinophilic gastroenteritis and other complex immune-mediated digestive issues. in the state in treating Immunology SCID. Management for Dedicated to clinical and basic science research these children includes Our team provides inpatient and outpatient consultation for children with primary and prompt diagnosis, family secondary immune deficiencies. We guide the use of immunoglobulin replacement n Riley allergists participate in international clinical trials for peanut genetic counseling, inpatient and other immune modulators in working with children who have challenging allergy oral and patch immunotherapy. management and long-term cases. Our immunology program addresses the array of immune system disorders, n Our team collaborates with basic science researchers at the care after hospitalization. including DiGeorge syndrome, antibody deficiencies, chronic granulomatous disease Herman B Wells Center for Pediatric Research at Riley to study the and other complex conditions. In the past 20 years, we have performed stem cell initiation, pathogenesis and progression of allergic diseases to identify better transplants in more than 25 children with severe combined immunodeficiency (SCID) ways to treat or prevent allergic symptoms. and other immune deficiencies. Riley immunologists routinely participate in national ■ Other areas of research interest include: conferences to review complex cases with colleagues in hematology/oncology, rheumatology and infectious diseases. – Examining the regulation of genes important for the development of T cells involved in allergic inflammation Our allergy and immunology specialists collaborate with rheumatologists and other – Studying the biology of cytokines and other factors that promote specialists in the Riley Center for Immune Dysregulation. This multidisciplinary allergic disease program provides optimal care and research opportunities for patients with complex disorders of the immune system. The center is the first of its kind in Indiana and – Analyzing lung development and function and how changes contribute provides families with opportunities to participate in national trials. For more about to lung reactivity to allergens the center, refer to page 57.

10 | Refer a patient: 317.948.7208 Riley Children’s Health Medical Specialties Annual Report 2019 | 11 Total Catheterization Volume: 2016 – 2019 Cardiology We are the only pediatric heart program in Indiana to perform transcatheter closure of patent ductus arteriosus (PDA) in tiny premature . The Riley Heart Center is one of the most highly RANKED 5th IN THE NATION respected programs for diagnosis and treatment 600 of congenital and acquired heart conditions in 500 526 500 479 children. With the latest technologies and world-class 427 400 facilities, expert cardiologists at Riley provide the full continuum of care from fetuses and premature 300 infants to adults with congenital heart disease. 200 51 PDAs 47 PDAs 78 PDAs 52 PDAs 100 (2 premature (7 premature (21 premature (24 premature Care from a highly skilled team infants) infants) infants) infants) 0 Heart care is managed by an experienced and highly 2016 2017 2018 2019 DIVISION CHIEF skilled team, including cardiologists, cardiovascular Larry W. Markham, MD surgeons, cardiovascular critical care specialists, cardiovascular anesthesiologists, neonatologists, cardiovascular geneticists Care for the most complex Program leader since 2018 and adult cardiologists specializing in congenital heart disease. We also have inpatient and outpatient nursing and advanced Phillip Murray Professor of Pediatric Cardiology, Cardiac catheterization practice providers who are specifically dedicated to the care of cardiac patients. IU School of Medicine Riley Heart Center specialists use the latest advancements in cardiac For full team member list, see page 59. Care for the most fragile catheterization, making it possible to diagnose and treat cardiac birth Fetal Cardiology Program defects without conventional surgery. We routinely perform leading- Our Fetal Cardiology Program, part of the comprehensive Riley Fetal Center, offers in-depth diagnostic imaging and counseling edge procedures, including atrial septal defect closure, ventricular Program distinctions septal defect closure, balloon valvuloplasty and transcatheter valve during pregnancy to enable thorough evaluation and development of a treatment plan. With nearly 1,700 evaluations Ranked among the top five replacement. In the past five years, our team has implanted 57 performed in 2019, patient volume has more than doubled since 2000. Fetal echocardiograms are performed statewide in pediatric heart programs by transcatheter pulmonary valves. South Bend, Fort Wayne, Bloomington, Evansville and at U.S. News & World Report five locations in Indianapolis. Cardiomyopathy Program Notable Home Monitoring Program outcomes Our program is approved by the Children’s Cardiomyopathy Foundation One of only seven programs Home Monitoring Program ■ 0% inter-stage mortality from 2016 to 2019; Centers of Care, which recognizes medical centers with expertise in worldwide to earn the highest Originally designed for babies with single ventricle 3.8% since 2009 pediatric cardiomyopathy. A center of care provides high-quality cardiac rating (three star) from the physiology, this program now includes any baby with Society of Thoracic Surgeons (STS) ■ 89% survival from birth to first birthday care and specialized disease management, including genetic evaluation, complex physiology. Implemented upon discharge after to children with cardiomyopathy. Riley cardiologists evaluated 110 new ■ Greater than 75% without growth failure by Integrated care model promotes initial intervention, the Riley Home Monitoring Program patients in 2019. Since 2016, we’ve assessed more than 500 children Stage 2 intervention high-level subspecialty care uses a unique web-based iPad component to assist for this heart condition. parents in tracking wellness and enable cardiologists ■ Less than 1% readmission rate for major or serious coordination and novel approaches to cardiac intensive to evaluate data in real time. Parents with questions adverse events through Stage 2 intervention Heart failure, transplant and mechanical support In 2019, Riley Heart Center: care, inpatient navigation and can contact an on-call provider 24/7. Our program What parents say ■ Provided support with a Berlin Heart to three patients awaiting home monitoring allows patients and families to go home sooner and ■ 89%: Program helped them feel more comfortable transplant has contributed to a median length of stay following leaving the hospital ■ Performed nine heart transplants: six pediatric patients and three Only children’s hospital in Indiana the Norwood procedure that is lower than the national ■ 86%: Home monitoring increases confidence in adult congenital patients to offer a home monitoring average (47.5 days versus 49.8 days).* providing care at home ■ 100% survival to date in patients receiving heart transplants in 2019 program for babies born with * Source: Society of Thoracic Surgeons (STS) July 2015 – June 2019. single ventricle or complex Most recent data available as of Nov. 15, 2020. ■ 83%: They feel more connected to the Riley care team Adult Congenital Heart Disease Program physiology because of the program Jointly led by adult congenital cardiologists from Riley and the Krannert Institute of Cardiology at IU Health Methodist Hospital, our program has Only formalized comprehensive experienced tremendous growth in recent years, with outpatient visits adult congenital heart disease South Bend increasing from 275 just seven years ago to almost 2,000 evaluations program in the state Statewide access in 2019. to nationally Fort Wayne 17,938 0 ranked heart care

Lafayette Muncie A leader in research and quality improvement

12,000 11,439 Indianapolis Our patients participated in the pediatric heart failure clinical trial for Entresto®, Richmond which in 2019 resulted in FDA approval of this medication in children. 9,000 7,833 Greensburg Terre Haute Riley cardiologists contributed to an international multicenter study for hypertrophic cardiomyopathy 6,000 Columbus Bloomington in children that was published in Circulation, an American Heart Association journal. 46% 0 3,000 The Riley Heart Center is enrolled in the ACTION learning network, a multicenter collaborative aimed at

0 quality improvement in pediatric heart failure, mechanical support, cardiomyopathy and heart transplant. 2016 2019 Evansville

12 | Refer a patient: 317.944.8906 Riley Children’s Health Medical Specialties Annual Report 2019 | 13 Child Development and Skilled, multidisciplinary Inpatient care team serves children care team with complex medical needs Developmental Pediatrics Riley Developmental Pediatrics leads the complex care inpatient ■ 5 board certified specialists in service at Riley Hospital for Children, in addition to providing Riley at IU Health experts in child development and developmental neurodevelopmental disabilities outpatient services for children with neurodevelopmental conditions.

pediatrics have the experience and resources to care for infants and ■ 2 board certified developmental- Our inpatient team serves children who have complex medical children with neurodevelopmental disabilities, including those who behavioral pediatricians concerns or existing chronic conditions and require a hospital stay. may have co-occurring emotional or behavioral concerns. Annually, We deliver comprehensive and coordinated care, addressing both ■ 3 board certified child neurologists our programs serve more than 5,000 children living in Indiana and medical and social needs. The complex care inpatient approach surrounding states. We collaborate to provide specialized services to ■ 1 board certified sleep medicine allows healthcare providers to collaborate as they individualize and improve access and overall quality of care for our patients. specialist streamline each child’s care plan.

Helping families understand their child’s condition, our specially trained ■ 8 general pediatricians Connecting patients with community resources DIVISION CHIEF, CHILD DEVELOPMENT professionals develop personalized treatment plans to ensure each child ■ 1 medicine/pediatrics specialist We are committed to providing individualized care for each child and Angela M. Tomlin, PhD, HSPP receives the care he/she/they need. We provide comprehensive care, Program leader since 2012 family, with the goal of helping children develop to their full potential. working in teams comprised of board certified physicians, pediatric nurse ■ 10 licensed psychologists Professor of Clinical Pediatrics, Focused on the importance of community in the lives of children, our IU School of Medicine practitioners, psychologists, speech pathologists, social workers, dietitians, ■ 6 certified pediatric nurse practitioners team members are knowledgeable about resources and committed For full team member list, see page 59. a genetic counselor, nurses and others. ■ 2 speech language pathologists to helping families make connections in their local communities. Riley Child Development and Riley Developmental Pediatrics are ■ 1 genetic counselor located in the Pediatric Care Center, a newly renovated building on the Committed to training future clinicians Riley at IU Health downtown Indianapolis campus. The space houses ■ 5 social workers We understand the importance of educating individuals interested in working with this complex patient population. Our teams interdisciplinary teams that often collaborate to support children with ■ 2 dietitians developmental needs, offering more services and improved access. provide training to help increase the number of leaders in neurodevelopmental disabilities nationwide. Leadership Education in Neurodevelopmental 0 0 Riley Child Development and Developmental Disabilities (LEND) Pediatrics teams partner with other providers to 1,500 The Riley Child Development LEND Program is part of a system share expertise and knowledge. One example is of graduate-level interdisciplinary leadership training programs that are federally funded through the Health Resources & Services our Early Autism Evaluation (EAE) hub—a statewide 1,000 1,145 1,153 Administration’s Maternal and Child Health Bureau. In existence for tiered system for screening and diagnosing autism. more than 50 years, LEND produces leaders and innovators in the With practice locations across Indiana, the EAE field of autism and other neurodevelopmental and related disabilities. DIVISION CHIEF, DEVELOPMENTAL PEDIATRICS 500 These leaders are solidly grounded in their own disciplines and able Celanie K. Christensen, MD, MS enables large numbers of young children to be Program leader since 2020 to work collaboratively with colleagues in interdisciplinary settings. evaluated within their local primary care setting. Assistant Professor of Clinical Pediatrics 0 Graduate and Neurology, IU School of Medicine 2018 2019 For full team member list, see page 59. IU School of Medicine’s neurodevelopmental disabilities residency and developmental-behavioral pediatrics fellowship programs, based at Riley at IU Health, provide a variety of clinical experiences Program distinctions to help shape the knowledge of physicians working in the field of Active in research on telehealth neurodevelopmental disabilities. effectiveness and satisfaction among patients and providers Innovative partnership provides unique service Partner with the Riley Child Protection Program to support Riley Child Development specialists are partnering with the developmental and behavioral colleagues in Riley Neonatology to establish an needs of children in foster care mental health program for the Riley neonatal intensive care unit. Christine M. Raches, PsyD, HSPP, and Fully integrated in the cerebral Elesia N. Hines, PsyD, HSPP, provide support to families palsy and spina bifida programs and educate team members to promote infant social at Riley and emotional well-being in both the inpatient and Engaged in research and teaching outpatient care settings. related to safe transportation guidelines for children with special health needs

14 | Refer a patient: 317.944.4846 (Riley Pediatric Care Center) Riley Children’s Health Medical Specialties Annual Report 2019 | 15 Child Protection Program The Riley Child Protection Program revolves around these core strengths:

With expertise unmatched in Indiana, the Riley at IU Health Child Protection ■ Comprehensive medical evaluations in cases of suspected Program offers multidisciplinary clinical services and education to child abuse improve the evaluation and care of maltreated children. Our program’s ■ Crisis counseling for families five board certified physicians provide evidence-based consultation in cases of suspected child maltreatment. These consultations are objective ■ Community education and coordination of services assessments to help determine the extent of injury and whether medical In 2019, Riley Child Protection facilitated 48 community cause or accidental mechanism accounts for the injury pattern. Our team education programs. offers the following services:

■ Evaluation of suspected victims of child abuse and/or neglect Leadership in graduate medical education The three-year Riley at IU Health child abuse pediatrics fellowship DIVISION CHIEF ■ Professional consultation for healthcare providers, child protection is one of only 25 child protection fellowship programs accredited Roberta A. Hibbard, MD services, law enforcement and other professionals by the Accreditation Council for Graduate Medical Education Program leader since 1986 ■ Crisis counseling for families (ACGME). Physicians participating in this subspecialty program Professor Emeritus of Pediatrics, IU School of Medicine receive multidisciplinary training and experience to become ■ Expert testimony in legal settings when required For full team member list, see page 59. experts in child abuse pediatrics. ■ Professional education

Specialized child protection programs offered at Riley Program distinctions Pediatric Center of Hope. Serving approximately 500 children each year, the center provides comprehensive medical Only physicians practicing in evaluation for children alleged to have been sexually abused. Indiana who are board certified in child abuse pediatrics Foster Care Bridge Clinic. This multidisciplinary clinic acts as a bridge to provide comprehensive healthcare and acquisition of appropriate resources for children entering and making transitions within the foster care system until a permanent The Liaison Child Abuse Forum, founded at Child abuse physician experts medical home is identified. Riley at IU Health, brings together professionals available 24/7 to healthcare Crisis Counseling Services. These services bridge the gap from the time a child is identified as a possible child sexual from child protection services, law enforcement providers and family case abuse victim to when formal ongoing counseling may become available. Riley delivers these crisis counseling services to managers faced with making and public schools to solve problems in the about 1,500 children and family members annually. immediate care decisions identification and management of child abuse Child Abuse Consultation Service. This program facilitates comprehensive medical evaluations for children alleged to Home to one of the few have been physically abused or neglected. Annually, our team sees approximately 400 children referred to our program by cases in Marion County. The forum meets ACGME-accredited child medical providers or child protective services. monthly during the school year. protection fellowship programs Pediatric Evaluation and Diagnostic Services (PEDS) Program. Each year through PEDS, Riley consults with the Indiana in the nation Department of Child Services on about 6,000 cases of suspected child maltreatment.

0 00 1% 6,000 6% 5,552 5% 5,441 5,425 5,442 5,172 4,973 3% 5,000

4,000 3,485 19% 3,095 3,000 13% 2,044 47% 2,000

993 6% 864 1,000

0 2009–10 2010–11 2011–12 2012–13 2013–14 2014–15 2015–16 2016–17 2017–18 2018–19 2019–20 * July 2019 – June 2020 16 | Refer a patient: 317.274.2617 Riley Children’s Health Medical Specialties Annual Report 2019 | 17 Critical Care Cardiac Critical Care Only pediatric hospital in Indiana to offer emergency ECMO Providing expert care for critically ill newborns, infants, The Riley at IU Health Extracorporeal Membrane Oxygenation (ECMO) RANKED 5th IN THE NATION children and adolescents with congenital and acquired heart Program provides cardiopulmonary bypass support in the CVICU disease, the Riley pediatric cardiovascular intensive care setting for neonates and children who suffer from cardiac failure unit (CVICU) treats more than 540 inpatients and over 250 that is refractory to conventional . Riley has earned the cardiopulmonary bypass patients each year. In addition to Extracorporeal Life Support Organization’s highest designation—the 16 beds for CVICU patients, our unit also includes a six-bed Platinum Level Center of Excellence—and is one of just six pediatric specialized neonatal ICU. institutions worldwide with this designation. For more on ECMO at Riley, refer to pages 20 and 40. Riley specialists and professionals from various disciplines— , cardiology, cardiac critical care, As one of the first neonatology, nursing, respiratory therapy, nutrition and pediatric heart DIRECTOR pharmacy—are available for daily rounds to facilitate patient- programs in the Riad Lutfi, MD focused care coordination and to expedite care. Program leader since 2020 U.S. to give a child Associate Professor of Clinical Pediatrics, IU School of Medicine Focused on quality and safety: Riley Cardiac Critical Care is a leader with a Berlin Heart For full team member list, see page 59. a purposefully developed culture of safety resulting in a 14% decrease ventricular assist below benchmark data for adverse events of all causes reported by the device, Riley also Pediatric Cardiac Critical Care Consortium (PC4). offers mechanical Program distinctions ventricular support Ranked among the top five (including total pediatric heart programs by U.S. News & World Report Dedicated to artificial heart and HeartMate II™ and HeartMate 3™) to children quality and clinical 5.0 5.0 Only program in Indiana to offer 4.1% excellence 3.7% with heart failure refractory to medications. pediatric heart transplantation and mechanical circulatory The Riley Heart Center is Committed to educating future critical care specialists 2.5 2.5 support capability a high-reliability unit with 2.02% Riley is the only facility in Indiana that offers fellowship training experienced specialists 0.81% in pediatric cardiac critical care. Our fellowship trainees actively and team members participate in the collaborative care of all cardiology and Exceptional patient quality and 0.0 0.0 safety record that includes three working tirelessly to Riley All PC4* facilities Riley All PC4* facilities cardiovascular surgical patients admitted to the pediatric CVICU. years without a hospital-acquired ensure patient safety and We also share our knowledge internationally through lectures and infection, including CLABSI the highest quality care. * Pediatric Cardiac Critical Care Consortium (PC4) humanitarian work to further promote children’s heart health. Note: Risk adjustment is a methodological approach incorporating unique patient characteristics that impact patient For more about intensive care at Riley, refer to pages 20 – 21 and 40 – 41. outcomes and are unrelated to the quality of care delivered by the care team or hospital. Only pediatric hospital in the state with an emergency ECMO program, using ECMO in cases of pediatric cardiac arrest Additional 2019 outcome measures Advancing care at Riley and internationally One of only seven programs Riley Heart Center specialists are committed to improving worldwide to earn the highest Alternative complications Cases Out of Riley All PC4* facilities care for critically ill children with congenital and acquired rating (three star) from the heart disease at Riley, in the U.S. and around the world. Society of Thoracic Surgeons (STS) In addition to contributing to several multicenter research CLABSI per 1,000 line days 0 2,718 0 per 1,000 1.13 per 1,000 (central line-associated bloodstream infection) studies, our physicians founded and serve as the coordinating center for the Collaborative Research in Pediatric Cardiac Intensive CAUTI per 1,000 catheter days 0 1,077 0 per 1,000 1.22 per 1,000 Care (CoRe-PCIC) network. The network includes 20 U.S. sites (catheter-associated urinary tract infection) participating in several ongoing clinical research projects. Our specialists also are involved in the Pediatric Cardiac Critical Unplanned extubation per 100 days 7 1,640 0.43 per 100 0.35 per 100 Care Consortium (PC4), which uses registry data from 60 congenital heart programs to evaluate best practices and drive improvements in care. Riley cardiologists and cardiovascular surgeons also serve SSI per 100 surgical procedures 0 678 0 per 100 0.23 per 100 (surgical site infections) in international medical missions, providing heart care to critically ill

* Pediatric Cardiac Critical Care Consortium children in Uganda, Jordan and Lebanon.

18 | Refer a patient: 317.963.3330 (IU Health 24/7 Transfer Center) Riley Children’s Health Medical Specialties Annual Report 2019 | 19 Critical Care Pediatric Critical Care Dedicated to Experienced, high-quality critical care transport clinical excellence Our highly skilled transport team, led by pediatric critical care Treating more than 2,500 patients each year, the Riley pediatric intensive and patient safety physicians, brings Riley’s standard of care to 4,000 pediatric care unit (PICU) is one of the highest acuity centers in the U.S. according to transport patients each year. Trained to care for critically ill children As a member of the Children’s The Children’s Hospital Association. Our 42-bed PICU is capable of caring in extremely complex situations, our multidisciplinary team provides: Hospitals’ Solutions for Patient Safety for children with a variety of complex illnesses and provides advanced ■ Air and ground transport with mobile ICU capabilities Network, the Riley PICU actively supportive modalities, including extracorporeal membrane oxygenation participates in this national network ■ Multiple forms of respiratory support, including high-flow nasal (ECMO), inhaled nitric oxide, continuous renal replacement therapy and to enhance the delivery of safe cannula, intubation and mechanical ventilation, and inhaled high-frequency oscillatory ventilation. care to our patients. By reviewing nitric oxide

Experts in safe procedural sedation outcomes, our team implemented ■ IV/IO placement, needle decompression and chest tube The Riley at IU Health procedural sedation team is led by a pediatric multidisciplinary process improvements placement DIVISION CHIEF critical care physician and sedation nurse who manage the administration and accomplished the following quality ■ Invasive and noninvasive monitoring and point-of-care Mara E. Nitu, MD, MBA of that reduce awareness, anxiety, pain and discomfort during improvement measures in 2019: laboratory testing Program leader since 2011 medical care and procedures, such as: ■ Reduced central line-associated Professor of Clinical Pediatrics, ■ Isolette transport for patients under 5 kilograms IU School of Medicine ■ Liver biopsy, kidney biopsy bloodstream infections from IU Health LifeLine serves the entire state of Indiana, as well as For full team member list, see page 59. ■ Lumbar puncture, bone marrow aspiration 2.4 to 0.7 infections per 1,000 line days western Ohio and eastern Illinois. With five base locations throughout ■ Hearing tests, dental care Indiana, IU Health LifeLine provides 24/7/365 critical care transport ■ ■ Maintained a low rate of catheter- Program distinctions Imaging studies, including MRI, CT, ultrasound and interventional services for our sickest pediatric patients. radiology procedures associated urinary tract infection Only pediatric hospital in Indiana with an emergency ECMO ■ PICC placement with 0.7 infections per 1,000 program, using ECMO in cases of catheter days The Riley procedural sedation team cared for 1,302 children in 2019 pediatric cardiac arrest with less than 0.5% serious adverse events. According to the Pediatric ■ Achieved an unplanned extubation Sedation Research Consortium, our team has an excellent safety record rate of 0.46 events per 100 days One of just six pediatric institutions worldwide designated as a with outcomes better than or equivalent to most sedation centers. of mechanical ventilation—well Platinum Level Center of below the national benchmark Excellence by the Extracorporeal ECMO provides Based on high-quality of 0.95 Life Support Organization lifesaving support care and exceptional The Riley ECMO Program delivers patient outcomes, Pioneer in implementing ICU cardiopulmonary bypass support Riley’s ECMO program liberation through quality for neonates and children improvement programs: is designated as a optimized sedation and delirium who suffer from respiratory or management, sleep hygiene cardiac failure that is refractory Platinum Level Center promotion, early mobility, and early to conventional therapies. of Excellence by the liberation from mechanical ventilation

Comprised of intensivists, Extracorporeal Life All FAA Part 135 aviation services provided by Metro Aviation, Inc., which maintains exclusive operational For more about intensive care at Riley, refer to pages pediatric and cardiac surgeons, Support Organization. control over all aircraft. 18 – 19 and 40 – 41. and ECMO nursing specialists, our multidisciplinary ECMO team supports more than 40 patients annually, making it a high-volume pediatric ECMO center. For more Advancing care for critically ill children— on ECMO at Riley, refer to pages in Indiana and nationwide 19 and 40. Riley pediatric intensivists formed the Pediatric Community Outreach Mobile Education (PCOME) Caring for children with COVID-19 project to provide on-site simulation training and During the viral pandemic, the Riley PICU established procedures and education to community hospital healthcare providers for the protocols to safely and effectively care for children with respiratory failure initial stabilization and management of pediatric patients. resulting from COVID-19. Collaborating with our infectious diseases, PCOME is internationally recognized for its innovative approach cardiology and rheumatology colleagues, the pediatric critical care team in teaching pediatric care to statewide community hospitals. developed clinical guidelines for the diagnosis and treatment of children Riley’s pediatric critical care team continues to have a national critically ill with multisystem inflammatory syndrome (MIS-C). We continue presence in multicenter research collaboratives through such organizations as the Pediatric Acute Lung Injury and Sepsis to partner with PICUs across the U.S. to better understand the best Investigators network, the Extracorporeal Life Support Organization and the Pediatric Cardiac Critical Care Consortium. treatment modalities for children suffering from COVID-19.

20 | Refer a patient: 317.963.3330 (IU Health 24/7 Transfer Center) Riley Children’s Health Medical Specialties Annual Report 2019 | 21 Dermatology

Early recognition of problematic skin conditions and accurate diagnoses Riley dermatologists lead to improved outcomes for patients. Board certified pediatric offer leading-edge dermatologists at Riley at IU Health provide high-quality care and the treatments: latest treatments for common dermatological conditions, such as eczema and acne, and more complex disorders of the skin. Through expert ■ Beta blockers for diagnosis and interventions, our goal is to improve quality of life for hemangioma children with skin disease. ■ Allergy patch testing Treating children from birth to age 18, our dermatologists partner with other Riley specialists to provide comprehensive care, ensuring that each ■ Laser and excisional patient’s individual needs are met. surgery DIVISION CHIEF Anita N. Haggstrom, MD Expert care for a variety of conditions ■ Phototherapy Program leader since 2006 Dedicated to addressing skin health with advanced treatments, Riley Associate Professor of Dermatology, IU School of Medicine dermatologists diagnose and treat a wide range of skin conditions: For full team member list, see page 60. ■ Acne ■ Melanoma and mole screening

■ Alopecia areata ■ Nail disorders Program distinctions ■ Atopic dermatitis ■ Pigmented birthmarks Comprehensive treatment ■ Drug reactions (skin) ■ Psoriasis includes excisional and laser surgery in both outpatient and ■ Genetic skin disorders ■ Skin infections operating room settings ■ Hyperhidrosis ■ Vascular malformations

■ Infantile hemangiomas ■ Vitiligo Board certified pediatric dermatologists lead multidisciplinary programs for patients with vascular birthmarks

Pediatric dermatology fellowship program

Committed to pediatric dermatology research

Our dermatologists participate in research and clinical studies related to many skin, hair and nail conditions in children. Studies pertaining to vascular birthmarks are conducted in collaboration with the Pediatric Dermatology Research Alliance and the Hemangioma Investigator Group, an international consortium dedicated to advancing infantile hemangioma research. Studies led by Riley dermatologists have received support from the National Institutes of Health.

22 | Refer a patient: 317.944.7744 Riley Children’s Health Medical Specialties Annual Report 2019 | 23 Diabetes and Endocrinology Specialized programs for Riley Endocrine Patient Distribution by Diagnosis: 2019 children with diabetes and 127 48 Treating thousands of patients each year, Riley diabetes and other endocrine disorders 326 endocrinology specialists provide expert care for infants, children and 244 ■ Type 1 Diabetes Program Congenital adrenal hyperplasia adolescents with diabetes and other endocrine 327 Disorders of sex development ■ 82 disorders. Part of a nationally ranked program, Type 2 Diabetes Comprehensive Gender dysphoria Riley’s board certified endocrinologists have Care Program Metabolic bone disease received additional subspecialty training in ■ Pediatrics to Adult Program for 2,231 Hypopituitarism pediatric endocrinology and pediatric diabetology. Transitioning Adolescents Turner syndrome In addition, certified diabetes educators partner Growth ■ 1,780 with physicians to provide a wide range of Hip Hop Obesity Program Puberty educational resources. ■ Youth Diabetes Prevention Program Thyroid DIVISION CHIEF

With comprehensive services for children with ■ Endocrine Diseases Newborn Erica A. Eugster, MD 7,107 Program leader since 2004 dysfunction of the endocrine glands, Riley at IU Health treats numerous Screening Program 1,942 Professor of Pediatrics, disorders, including: ■ Gender Health Program IU School of Medicine ■ Type 1 and Type 2 diabetes For full team member list, see page 60. ■ Comprehensive Care Center for ■ Growth disorders Congenital Adrenal Hyperplasia ■ Delayed and precocious puberty Program distinctions ■ Prader-Willi Syndrome Program ■ Disorders of sex development Riley Diabetes Patient Volume: 2019 Ranked among the top pediatric ■ Hypopituitarism ■ Turner Syndrome Program diabetes and endocrinology ■ Congenital and acquired disorders of thyroid function ■ Growth Disorders Program 2,500 programs by U.S. News & ■ Metabolic bone disease World Report ■ Metabolic Bone Disease Program 2,036 ■ Turner syndrome 2,000 1,881 ■ Disorders of Sex Development ■ Disorders of calcium metabolism Multidisciplinary programs in metabolic Program 1,500 bone disease, congenital adrenal ■ Adrenal disorders (including congenital adrenal hyperplasia 1,189 hyperplasia, transgender health, and adrenal insufficiency) 1,000 disorders of sex development, ■ Dyslipidemia Prader-Willi syndrome, Duchenne 528 ■ Gender dysphoria 500 muscular dystrophy and childhood 155 cancer survival Riley endocrinologists provide outpatient care in Indianapolis, Carmel, South Bend, Fort Wayne, Bloomington and Evansville. In addition, 0 Youth Diabetes Prevention our experienced team offers extensive, multidisciplinary educational Program, providing individualized services for newly diagnosed patients and parents requiring specialized intervention for children and instruction. Family education, empowerment and psychosocial adolescents with prediabetes support are emphasized, and all patients have 24/7 access to a nurse practitioner or physician. Opportunities for participation Riley Endocrinology Current Research Studies in clinical trials of new 0 0 medications to treat diabetes 15,000 and endocrine conditions 12,696 12,100 2 12,000 11,080

9,000 3 6,000 5,464 5,265 4,568 4,538 11 4,039 4,078 2,569 5 3,000 2,173 2,211 300 347 324 0 2017 2018 2019 New endocrinology New diabetes Return endocrinology Return diabetes Total

24 | Refer a patient: 317.944.3889 Riley Children’s Health Medical Specialties Annual Report 2019 | 25 Emergency Medicine The leading pediatric The Indiana Network for Patient Care trauma center in Indiana As a member of this care coordination network, Riley at IU Health Riley Emergency Medicine pairs pediatric clinical expertise with kindness Riley at IU Health is one of a has access to medical records for most Indiana hospitals. If a and compassion to care for some of the youngest and most critically child has visited a participating hospital, Riley can retrieve critical select number of hospitals ill children in the state. Our skilled team of more than 30 emergency information about the child’s medical history, drug allergies and medicine physicians specializes in the care of infants and children up to in the nation—and the only specific needs. 18 years old. In addition, our nurses and other medical team members, one in Indiana—to be verified including child life specialists, are trained and experienced in working by the American College of with children and families during health-related emergencies. Surgeons (ACS) as a Level I Emergency medicine team members have access to the latest medical Pediatric Trauma Center. Riley Emergency Department: and information technology, including 24-hour access to pediatric Established by the ACS in radiology, all pediatric and other resources found in a By the numbers DIVISION CHIEF 1987, this verification program nationally ranked academic medical center. Our team works closely Elizabeth Weinstein, MD with other physician specialists and health professionals throughout promotes the development Program leader since 2017 Admission rate: Associate Professor of Clinical Emergency the hospital to ensure coordinated, effective care for every child and of trauma centers in which 16.1% Medicine, IU School of Medicine adolescent who comes to the Emergency department. verified centers provide not For full team member list, see page 60. Emergency Severity Index only the hospital resources (ESI) Level 1 or 2: 16.1% necessary for trauma care, Program distinctions but also the entire spectrum Average daily census: Indiana’s only Level I Pediatric With expertise extending beyond emergency of care to address the needs 140 Trauma Center medicine, our team includes physicians with of injured patients. This subspecialties in quality and safety, out-of- encompasses the prehospital One of the state’s first hospitals hospital care, , informatics to be recognized by the Indiana phase through rehabilitation, and pediatric ultrasound. Emergency Medical Services for as wellChildren’s as injury prevention. Surgery Median length of stay: Children Program as “pediatric 173minutes Riley has beenVerification a verified ready;” pediatric readiness is associated with reduced morbidity Level I Pediatric Trauma Center Median door-to-doctor time: and mortality in critically ill children since 1992. minutes23 Helped lead Indiana in pediatric Average door-to-doctor time: emergency medicine response minutes38 to COVID-19, working collaboratively with infectious disease experts to enhance safety in emergency departments across the state

More than 90% of physicians credentialed in pediatric point-of- care ultrasound—accelerates 0 0 diagnosis and management of illness and injury, and improves 51,077 accuracy and patient safety 50,000 47,632

40,000

30,000

20,000

10,000

0 2018 2019

26 | Refer a patient: 317.963.3330 (IU Health 24/7 Transfer Center) Riley Children’s Health Medical Specialties Annual Report 2019 | 27 Gastroenterology, Riley GI physicians and Riley gastroenterologists and hepatologists treat a variety of conditions, including: Hepatology and Nutrition hepatologists see patients in downtown Indianapolis, ■ Alagille syndrome ■ Gastroesophageal reflux Riley at IU Health provides nationally recognized care Fort Wayne, South Bend, ■ Alpha-1 antitrypsin deficiency ■ Gastrointestinal polyps to children with conditions of the digestive tract, liver ■ Anal fissure ■ GI foreign bodies and pancreas, as well as nutritional issues. Through Evansville, Bloomington ■ Autoimmune ■ Hepatitis (A, B and C) comprehensive evaluation, individualized treatment and Fishers. Our team ■ * ■ and extensive education, our board certified pediatric Hirschsprung’s disease also offers extensive ■ gastroenterologists and skilled team members work Celiac disease* ■ Inflammatory bowel disease with each child to improve health and ensure quality telemedicine options, ■ Cirrhosis and portal (IBD)* of life. Our team of 17 specialists leads nationally facilitating broader patient hypertension ■ Irritable bowel syndrome ■ DIVISION CHIEF in research and clinical care, performing more than Clostridium difficile ■ and family access to our Lactose intolerance Jean P. Molleston, MD 2,700 endoscopies and managing 16,000 outpatient visits each year. ■ Constipation expertise. Wait time for ■ Motility disorders* Program leader since 2005 ■ Professor of Clinical Pediatrics, Crohn’s disease* ■ Specialized programs address complex conditions new patient consultations Neonatal hepatitis IU School of Medicine ■ Through a variety of multidisciplinary programs, Riley gastroenterology (GI) Cyclic vomiting syndrome ■ is short, and we reserve Nonalcoholic steatohepatitis For full team member list, see page 60. specialists provide expert care for patients with inflammatory bowel disease ■ Cystic fibrosis liver disease* ■ time in our schedule for Obesity and metabolic (IBD), liver disease, obesity, allergic eosinophilic GI disorders, motility disorders, ■ Delayed gastric emptying syndrome* Program distinctions cystic fibrosis, short bowel syndrome, aerodigestive disorders, nutritional ■ urgent care needs. Encopresis ■ Pancreatitis* disorders and psychological conditions related to GI diseases. ■ Nationally ranked among Eosinophilic disorders* ■ Peptic ulcers, gastritis and the top 25 pediatric ■ Failure to thrive helicobacter pylori gastroenterology programs by ■ Feeding problems ■ Sclerosing cholangitis U.S. News & World Report

Successful pediatric liver transplant program ■ ■ Fulminant hepatic failure Short bowel syndrome* Riley at IU Health transplant surgeons perform between Prominent, well-established ■ Functional abdominal pain ■ Ulcerative colitis* 10 and 16 pediatric liver transplants each year with inflammatory bowel disease ■ Gallbladder disease ■ Wilson’s disease outstanding outcomes. program that is part of the * Specialized clinic or program is available. national ImproveCareNow 34 transplants since January 2018 network (for children and Improving patient care quality and safety adolescents with ulcerative colitis ■ transplants since program started in 1988 Study of vaccination rate in immunosuppressed children with and Crohn’s disease) 273 IBD led to improved understanding of family decision-making and 97% one-year survival rate obstacles to immunizing these vulnerable children; interventions Multidisciplinary pediatric weight resulting from study are now in place. management program ■ Riley hematology and liver transplant teams implemented a novel evaluation to identify clotting disorders pre-operatively to reduce Two full-time pediatric Combining leading-edge care with the latest technology clotting complications after transplant. psychologists specially trained We use the most advanced technologies for the diagnosis and treatment to treat psychological conditions ■ Pilot study of depression screening and management in GI of digestive and liver disease, including: related to GI disease program revealed the importance of early intervention and led ■ FibroScan specialized ultrasound technology to measure liver fibrosis to the expansion of our screening program. and fat

■ High-resolution motility testing to record GI tract motility

■ IB-STIM device to treat abdominal pain and nausea Strong GI and liver research program advances clinical care ■ High-resolution esophageal manometry testing to measure peer-reviewed publications since January 2018 pressures in the esophagus 82 Other technologies used in diagnosis and treatment: 70 approved research studies ■ Cholestatic liver disease ■ Inflammatory bowel disease ■ Gastric pacemaker ■ Constipation ■ Irritable bowel syndrome ■ Bravo wireless pH probe studies ■ Eosinophilic esophagitis ■ Motility disorders ■ Upper endoscopy and colonoscopy ■ Fatty liver ■ Nutrition and feeding

■ ■ ■ Capsule endoscopy Gastroesophageal reflux disease Pancreatitis ■ Hepatitis B and C ■ Short bowel syndrome

28 | Refer a patient: 317.944.3774 Riley Children’s Health Medical Specialties Annual Report 2019 | 29 IU School of Medicine General and Community Pediatrics General Pediatrics and Riley Pediatric Care Center Volume: 2017 – 2019 and Primary Care New patients 967 Riley Children’s Health is committed to providing exceptional and 1,000 comprehensive pediatric primary care. Serving newborns, children, 750 adolescents and young adults, our board certified pediatricians, internal 620 medicine/pediatricians and physicians see children in 478 500 offices across Indiana. Our program is anchored by a general and community pediatrics division of Indiana University School of Medicine. 250 IU School of Medicine General and Community Pediatrics 0 Primary care 2017 2018 2019 DIVISION CHIEF University faculty physicians provide preventive care and disease Dorota A. Szczepaniak, MD, FAAP management to children with a variety of neurodevelopmental and chronic Total patient visits Program leader since 2014 conditions. More than 75% of the patients visiting this on-site practice at 9,890 Associate Professor of Clinical Pediatrics, 10,000 9,480 Riley at IU Health are children with special healthcare needs. Evidence-based 8,914 IU School of Medicine medical management and a team-based approach promote high-quality For a list of General and Community Pediatrics 7,500 team members, see page 60. For a full list of care. The multidisciplinary care team includes skilled pediatricians, a nurse Social work Riley community-based primary care providers, inverventions: 5,038 practitioner, pharmacist, nursing and medical assisting professionals, and a visit rileychildrens.org/findprimarycare. 5,000 Mental health social worker. Integrated mental health services are also available. integrated into primary care (visits): 488 Diagnostic office 2,500 Pediatricians in this office work closely with Riley specialty programs to care Program distinctions for children with more complex health issues and improve access to specialty 0 care. Services include: 2017 2018 2019 Team-based primary care (including More than care coordination, social work, Autism Early Evaluation Program lactation support and pharmacy) Expert physicians evaluate children, ages 18 – 42 months, who are at risk focusing on access, quality 200 Community-Based Primary Care for autism spectrum disorder. Following a patient’s initial visit, the team primary care care and integrated mental coordinates care and helps families initiate essential therapies and navigate Riley Children’s Health primary care pediatricians, / health services healthcare financing. providers pediatricians and family medicine physicians focus on meeting the highest quality, safety, educational and care standards. Our practice Early Years Program throughout Evidence-based follow-up for This multidisciplinary program supports babies with complex medical Indiana teams provide effective, evidence-based care that is personalized to meet the needs of each child. premature infants born with needs in transitioning from the neonatal intensive care unit (NICU) to complex conditions outpatient care. Infants’ neurodevelopmental progress is then followed for ■ Get-to-know-you visits ■ Immunizations three to five years. All babies discharged from the Riley NICU are eligible ■ Well-child visits ■ Sports physicals for this program and receive necessary follow-up care. The Infant Growth Patient- and family-centered ■ Sick and acute care visits ■ Vision and hearing screenings and Development Program provides support each month to more than diagnostic support for toddlers 60 infants who are discharged from the NICU with feeding challenges. Sharing expertise with ■ Chronic disease management with developmental concerns The Healthy Lungs Program supports the developmental needs of children providers across Indiana related to autism spectrum disorder with bronchopulmonary dysplasia. Our primary care physicians, with General pediatrics specialty programs support from the IU School of Medicine General pediatricians collaborate with pediatric subspecialties to improve Department of Pediatrics, host the Unique care coordination system access related to pediatric weight management (through our weight annual Riley Pediatric Conference. The to support children with special management program) and pediatric gastrointestinal disorders. conference provides an opportunity healthcare needs and their for pediatric providers in Indiana and families Center for Youth and Adults with Conditions of Childhood (CYACC) surrounding states to stay current on Funded by the state, the CYACC at Riley helps youth age 11 to 22 with pediatric healthcare, network with Program to support teens and chronic health conditions transition from seeing pediatric physicians to colleagues and Riley specialists, and young adults with complex adult physicians. learn about various community-based medical conditions in Collaborative Improvement and Innovation Network (CoIIN) health organizations and wellness transitioning to adulthood Designed to improve the quality of life for children with medical complexity, resources. Our general and community CoIIN promotes the well-being of families and increases the cost- pediatrics division also organizes the effectiveness of care by testing and spreading promising care delivery quarterly Pediatric Pearls Conference, strategies through innovative care coordination. The project is funded by focusing on evidence-based clinical care the federal Health Resources & Services Administration. IU School of and the latest topics in pediatrics. Medicine is one of 10 CoIIN teams in the state.

30 | Refer a patient: 1.888.IUHEALTH Riley Children’s Health Medical Specialties Annual Report 2019 | 31 We are affiliated with the Expertise in the treatment of Hematology/Oncology Hematology pediatric Indiana University Health hematologic conditions patients treated 2,885 Riley Hematology/Oncology delivers patient- and Melvin and Bren Simon Hemostasis and Thrombosis Program – Riley provides multidisciplinary care to Hematology patients family-centered care for children and adolescents Cancer Center and the enrolled in clinical trial 5 with cancer and blood disorders. In addition to children and adolescents with bleeding Indiana University Simon treating patients from Indiana, Riley hematologists and clotting disorders, including heavy and oncologists also care for children in Michigan, Cancer Center, which menstrual bleeding and vascular anomalies. We also collaborate with Illinois, Ohio and Kentucky. Our physicians see more earned the National the Herzog Laboratory at IU School of Medicine, a leader in research than 300 new oncology patients and over 700 new Cancer Institute’s (NCI) for alternative forms of treatment for children with hemophilia. hematology patients each year. We manage more highest recognition— Hemoglobinopathy Program – Riley has the largest pediatric sickle than 13,000 outpatient visits annually, including a comprehensive telehealth Comprehensive Cancer cell program in the state and the only stem cell transplant center for program offering virtual visits to patients throughout the state. Center—in 2019. non-malignant transplants. Our program serves children with sickle DIVISION CHIEF cell disease and other hemoglobinopathies such as thalassemia. Jamie L. Renbarger, MD, MS Holistic care and clinical leadership Program leader since 2016 Providing comprehensive cancer treatment, Riley hematologists and Bone Marrow Failure Program – Treating children with bone Caroline Symmes Professor of Pediatric oncologists collaborate with specialists in other medical fields to help ensure marrow failure syndromes and cytopenias, our program includes an Cancer Research, IU School of Medicine the best possible outcomes for children and young adults with cancer. internationally known, NCI-funded research laboratory employing For full team member list, see pages 60 – 61. functional genomics and super-resolution imaging to understand the ■ 85% five-year ■ 70 open clinical ■ 9 open clinical trials survival rate trials in oncology in hematology mechanistic origins of genomic instability in Fanconi anemia and other bone marrow failure/cancer predisposition syndromes. Program distinctions Stem Cell Transplant and Cellular Therapy Program Ranked among the top 25 Employing both autologous and allogeneic transplants, as well Precision genomics pediatric cancer programs by as CAR-T cell therapy, Riley oncologists use cellular therapy to targets aggressive U.S. News & World Report cancer with customized fight a variety of pediatric cancers and other severe diseases. 2019 Hematopoietic Stem Cell Transplants Only facility in Indiana offering pediatric These include acute lymphoblastic leukemia, acute myeloid Autologous stem cell transplants 35 therapies stem cell transplant, CAR-T cell Our Precision Genomics leukemia, sickle cell disease, immunodeficiency, bone marrow Allogeneic matched donor transplants 7 therapy and immune effector failure and other non-malignant conditions. Program helps identify new cell therapy for pediatric patients Haploidentical transplants 14 treatment options that may Leukemia and Lymphoma Program Other cellular therapy infusions 3 be effective when other Affiliated with IU Simon Cancer Center -- Indiana’s only cancer center Riley is home to the largest leukemia and lymphoma program Allogeneic transplant 100-day survival rate treatments no longer work. 95% designated for clinical care by of its kind in Indiana. We offer the latest and most innovative ■ Our innovative approach uses genetic testing to identify DNA, the National Cancer Institute treatments, including CAR-T cell therapy, for newly diagnosed 2019 Patient Volume RNA and proteins in cancer cells that can be precisely targeted and relapsed childhood leukemia and lymphomas. Using Treats more than 80% of children LEUKEMIA/LYMPHOMA with different treatments. precision medicine and new immunotherapies, our highly and adolescents diagnosed with Leukemia patients treated 392 ■ trained physicians have diagnosed and treated more than After testing is interpreted, the team researches therapeutic cancer in the state 1,000 children in the past decade, with very high cure rates. Lymphoma patients treated 120 options and facilitates tumor board in collaboration with the Indiana’s only pediatric cancer treating physician. Leukemia/lymphoma patients enrolled in clinical trial 59 program to offer precision Solid Tumor Program Relapsed patients treated with targeted immunotherapy 5 ■ More than 290 pediatric patients have been evaluated through genomics—individualized Our oncologists have extensive experience in diagnosing and the program, and nearly a quarter of those patients are receiving treatment for children with treating all types of solid tumor malignancies. Riley patients SOLID TUMOR Neuroblastoma patients treated 18 recommended therapy. relapsed or aggressive cancer have access to the latest clinical trials, including the leading- edge antibody therapy for neuroblastoma known as Hu3F8. Riley Bone tumor patients treated 65 at IU Health is the only hospital in Indiana offering this novel Soft tissue sarcoma patients treated 55 treatment and has treated patients from around the world. Wilms’ tumor patients treated 67 Exclusive partnership offers greater access Neuro-Oncology Program Liver tumor patients treated 18 Focused on delivering comprehensive clinical care from Germ cell tumor patients treated 15 to immunotherapy trials diagnosis to long-term follow-up, this program provides holistic Retinoblastoma patients treated 20 CureWorks—a unique collaboration among five elite academic children’s social, emotional, spiritual and supportive care to maximize Total solid tumor patients enrolled in clinical trial 58 hospitals that includes Riley at IU Health—enables our oncologists to offer quality of life for children and their caregivers. Our approach is more clinical trial options in CAR-T cell therapy science to children with cancer. facilitated through collaborations with essential specialists to Member hospitals are supported in launching and participating in exclusive clinical ensure complete care for patients with brain and spinal cord 2019 Patient Volume trials. CureWorks streamlines immunotherapy production, clinical trial enrollment and NEURO-ONCOLOGY PROGRAM tumors. Our unique, multidisciplinary retinoblastoma program the trial coordination process. In addition to expanding access to the latest treatments, is one of the only comprehensive programs of its kind in Pediatric patients treated 222 the collaboration allows Riley patients to get this more advanced care closer to home. the Midwest. Brain tumor patients enrolled in clinical trial 15

32 | Refer a patient: 317.944.2143 Riley Children’s Health Medical Specialties Annual Report 2019 | 33 Hospital Medicine Riley hospitalists care for infants and children across central Indiana. Serving more than 6,000 patients in 2019, Riley Hospital Medicine Riley Hospital for Children at IU Health is committed to excellence in the care of hospitalized children. Our IU Health Academic Health Center, Indianapolis, Indiana team of more than 30 physicians continually strives to improve Care of hospitalized pediatric patients with attention to general care through quality improvement, collaboration with inpatient pediatric health issues, as well as co-management of pediatric specialists and primary care providers, community outreach, and neurologic, genetic, adolescent and rheumatologic issues the education and training of future healthcare providers. Dedicated to delivering exceptional inpatient care, Riley IU Health Methodist Hospital hospitalists have led family-centered rounds for nearly a decade. IU Health Academic Health Center, Indianapolis, Indiana This type of rounding—conducted with physicians, learners Care of normal newborns and nursing team members at the bedside with the patient DIRECTOR and family at the center of the discussion—allows for optimal IU Health Kimberly S. Schneider, MD, FAAP communication and understanding of treatment plans, expected North Hospital Program leader since 2020 Carmel, Indiana Assistant Professor of Clinical Pediatrics, outcomes and length of stay. IU School of Medicine Care of hospitalized For full team member list, see page 61. High-quality inpatient care children in pediatric Through implementation of best practices and taking part in leading-edge research, Riley Hospital Medicine sets the unit; overnight care standard for inpatient pediatric care and targets continuous quality improvement. of pediatric intensive Program distinctions care unit patients; Neonatal sepsis calculator. Specializing in the care of our youngest patients, Riley newborn hospitalists have implemented a emergency department One of the largest pediatric hospital medicine programs in neonatal sepsis calculator to limit unnecessary antibiotic use in newborns and reduce the time these babies are separated consultations; care of the nation from their mothers. normal newborns Infant mortality. Riley hospitalists work tirelessly to impact infant mortality in Indiana. Aware of the racial disparities associated with this tragedy, we collaborate with the Indiana chapter of the American Academy of Pediatrics infant mortality IU Health West Hospital Home to one of the country’s committee, the Indiana State Department of Health (ISDH) and the Indiana University School of Medicine Division of Avon, Indiana longest-running pediatric Children’s Health Services Research to identify and address the gaps contributing to these disparities. Riley hospitalists also Care of hospitalized children in the pediatric unit; emergency hospitalist programs serve the ISDH by partnering with the Indiana Hospital Association to create a statewide hospital certification program for department consultations; attendance during deliveries and resuscitation of infants; care of normal newborns, as well as infants newborn care. Leader in quality and safety (32 weeks estimated gestational age or older) in the hospital’s for hospital-based care Advancing inpatient care. Riley pediatric hospitalists conduct ongoing research on a variety of clinical issues, including the Level II neonatal intensive care unit care of children with brief resolved unexplained event (BRUE) and optimizing treatment for children and teens with self-harm behaviors. In addition, our hospital medicine team is spearheading a hospitalwide sepsis protocol to aid in early identification and treatment of patients with bacterial sepsis.

Fostering clinical partnerships and collaboration Viewing our role as the “hospital medical home,” Riley hospitalists Committed to training prioritize collaboration, communication and coordination of care future physicians with specialists and primary care providers. Providing instruction to more than 320 With expertise in the care of the hospitalized patient, Riley learners each year, Riley hospitalists Hospital Medicine serves as the primary admitting service for host pediatric residents, family practice many subspecialties at Riley, including neurology, rheumatology, residents, transitional-year residents and adolescent medicine, psychiatry and genetics. We provide medical students at multiple locations. general pediatric inpatient consults for patients admitted to other These students and residents, guided services and partner with surgical subspecialists to co-manage by Riley hospitalists, learn to care for otolaryngology and urology patients. hospitalized patients and communicate When patients are ready for discharge, Riley hospitalists ensure with families, specialists and support primary care providers are kept informed of the hospitalization, teams with a goal of improving clinical procedures, treatments and follow-up. Our team was instrumental care quality. in creating a same-day discharge summary process that allows primary care physicians to receive electronic communication of their patients’ hospital stay in real time, ensuring a smooth transition of care for every child.

34 | Refer a patient: 317.963.3330 (IU Health 24/7 Transfer Center) Riley Children’s Health Medical Specialties Annual Report 2019 | 35 Infectious Diseases Infection prevention and antimicrobial stewardship A leader in global pediatric infectious disease clinical care, research and Riley at IU Health is committed to education, the Ryan White Center for Pediatric Infectious Diseases and Global keeping the rates of hospital-acquired Health helps children and families affected by infectious diseases overcome infections low. Additionally, our or manage these conditions. In addition to prevention and diagnosis, Riley antimicrobial stewardship program specialists focus on treatment and ongoing care of children with infectious helps prevent unnecessary antibiotic diseases. The center offers services designed to provide complete care use that could lead to drug resistance for children with infectious diseases and to prevent infection and its or drug-related complications, and complications in children. encourages the use of the correct antibiotic when one is needed. A major part of our infection Comprehensive inpatient and outpatient care DIVISION CHIEF Riley at IU Health is home to one of the few dedicated inpatient pediatric prevention program is the promotion Chandy C. John, MD, MS infectious disease programs in the nation. Children can be transferred to of vaccines, which are the most Program leader since 2015 Riley at any time and receive direct primary care from the specialists most effective means of preventing Ryan White Professor of Pediatrics, familiar with infections and their complications. infection. IU School of Medicine For full team member list, see page 61. Our board certified pediatric infectious disease specialists also provide comprehensive outpatient care for children with infectious diseases. In most cases, patients can be seen within one week at Riley at IU Health in Program distinctions downtown Indianapolis or at the Riley Children’s Health outpatient office in Advancing research in infectious diseases Home to Indiana’s only inpatient Carmel, Indiana. Our team also strives to accommodate urgent visits that Our physician researchers are committed to preventing pediatric infectious disease service require even more rapid evaluation. infection, disease and complications in malaria, HIV and sickle cell disease—among the leading causes of death Pediatric infectious disease consultations and disability in children worldwide. We also conduct research Rigorous infection prevention and antimicrobial stewardship Riley infectious disease specialists are available 24 hours a day, seven studies in diseases more common in Indiana, including bone programs days a week, to answer questions about infectious disease concerns or to infections, Kawasaki disease and COVID-19. accept transfer of patients with complex infectious disease issues. Our team of expert physicians responds to thousands of inquiries from community Malaria Expertise in infections in ■ immunocompromised patients physicians each year. Parasite and host factors that lead to severe malaria in children

■ Complications of severe malaria, including neurodevelopmental Indiana’s largest center for program impairment and acute kidney injury pediatric HIV care Riley infectious disease specialists provide health services to children and families before and after international travel, ■ Effects of changing transmission on malaria immunity including preventive medicine, vaccinations and travel education. We also offer support for parents of internationally adopted children. These services are provided to young travelers of all ages and the adults accompanying them on their trip. HIV Recognized leaders in global pediatric infectious disease ■ Adherence to HIV medications In addition, Riley at IU Health laboratories are capable of diagnosing travel-related conditions, such as malaria and parasitic research and diarrheal infections. Our travel medicine team stays current on the latest alerts and advisories from the Centers for ■ Stigma in HIV Disease Control and Prevention and the World Health Organization. ■ Disclosure of HIV status to children

■ Evaluation and treatment of HIV in adolescents Primary care for patients with HIV ■ Neurodevelopmental impairment in infants exposed to HIV Riley infectious disease specialists Sickle cell disease evaluate and treat the majority The Ryan White Center for ■ Prevention of infection in sickle cell disease of Indiana children with human Pediatric Infectious Diseases and Bone infection immunodeficiency virus (HIV). Our Global Health is a major referral ■ Improved detection of bacterial causes of bone infection program is led by experts in all aspects of HIV and its complications, program and provides care during Kawasaki disease and includes professionals in nursing, more than 4,000 inpatient and ■ KIDCARE: Preventing recurrence of Kawasaki disease pharmacy and social work to provide outpatient visits each year. COVID-19 the best care for children with HIV. ■ TACTIC: Investigating asymptomatic SARS-CoV-2 transmission in children and families

■ DISCOVER: Evaluating the immune response to COVID-19

36 | Refer a patient: 317.944.7260 Riley Children’s Health Medical Specialties Annual Report 2019 | 37 Medical and Molecular Genetics Subspecialty focus areas Cancer genetics. Board certified clinical geneticists and genetic Offering evaluation and management of a wide variety of counselors offer clinical cancer genetic services to children and adults genetic conditions, Riley Medical and Molecular Genetics is who are diagnosed with, or have a family history of, cancer, polyposis, Indiana’s largest provider of genetics services. We provide genetic pancreatitis or other syndromes associated with increased cancer risk. assessment, testing, treatment and counseling for individuals or To meet growing demand, our cancer genetics program has increased families touched by inherited conditions, chromosomal disorders the number of monthly clinics. or other genetic disease. Cardiovascular genetics. We evaluate and treat patients with cardiomyopathy, heritable arrhythmias, aortopathy and connective The care we deliver is: tissue disorders, pulmonary hypertension, and lipid disorders. Comprehensive Metabolism. Our team provides comprehensive evaluation and team- ■ Diagnosis and management of genetic conditions in individuals DIRECTOR of all ages, from fetuses to the elderly based management of patients with inborn errors of metabolism, including lysosomal storage disorders and mitochondrial disorders. Stephanie M. Ware, MD, PhD ■ Expertise in all subspecialty areas of medical and molecular Program leader since 2017 genetics, including cancer, neurology, cardiology, Our patient population of more than 450 ranges from neonates Professor of Pediatrics and Medical and and others identified through newborn screening to adults. Molecular Genetics, IU School of Medicine For full team member list, see page 61. ■ Inpatient and outpatient services available Rare disorders and genomic medicine. Riley Medical and Molecular Genetics team members evaluate children with rare conditions using ■ Statewide management for patients with inborn errors of metabolism the latest genetic testing methodology. Program distinctions Leading-edge Genetic testing. Offering highly complex and unique medical tests in Only genetics team in Indiana ■ cytogenetics and cytogenomics, biochemical genetics, and molecular with subspecialty expertise in Recently formed a program at Riley for undiagnosed rare diseases Medical and Molecular Genetics Patient Visits: genetics, our labs process more than 14,000 genetic tests annually pediatric neurology, maternal ■ Manage a program for the delivery of Palynziq®, a new therapy 2017 – 2019 with turnaround time outperforming the national average in all areas. fetal medicine, cardiovascular for phenylketonuria (PKU) genetics and biochemical genetics 6,000 5,800 ■ Orphan disease therapies such as enzyme replacement and new 4,900 drug treatments for rare diseases 5,000 Leaders in the delivery of medical 4,000 Accessible 4,000 services that improve outcomes for patients with inborn errors ■ Genetics physician available 24/7 3,000 of metabolism ■ Improved access and shorter wait times for new patients; triage 2,000 system to ensure patients with certain genetic indications are 1,000 On-site genetic testing laboratories seen the next day are national clinical reference ■ 0 Telehealth and virtual visits available for genetic counseling or 2017 2018 2019 laboratories and worldwide geneticist evaluation leaders in innovative laboratory research and development ■ Educational videos incorporated into the cystic fibrosis program to enhance patient knowledge and improve satisfaction

■ Genetic and biochemical testing through our on-site laboratories; stat testing and rapid diagnostics for the most seriously ill infants and children with genetic disease Team-based ■ Geneticists, genetic counselors, nursing team members, dietitians and a social worker specially trained to provide expert care to patients with complex genetic disorders ■ Partner with many Riley specialties, including pediatric cancer, cardiology, otolaryngology and ophthalmology, to Research funding and clinical trials deliver multidisciplinary care ■ The IU School of Medicine Department of Designated providers for Indiana children with genetic and metabolic conditions Medical and Molecular Genetics is ranked For more than 30 years, the Riley genetics team has partnered with the Indiana State 10th in the nation in National Institutes of Department of Health to provide biochemical/molecular confirmation, counseling and medical/ Health funding for genetics research. Total genetics dietary management of newborns who screen positive for inborn errors of metabolism. Riley research funding at Riley exceeded $14 million in 2019. geneticists have outstanding metrics in days from diagnosis to implementation of medical care, ■ Our team is involved in more than 20 multicenter including dietary treatment with medical formula. research studies or clinical trials for disorders such For newborns identified with cystic fibrosis, the team partners with the state to offer genetic as PKU, achondroplasia, homocystinuria, urea cycle counseling services. With the initiation in 2019 of Indiana’s newborn screening for severe combined disorders, cardiomyopathy, arrhythmia and congenital immunodeficiency (SCID) disease and spinal muscular atrophy, our team also facilitates genetic heart defects. testing, provides genetic counseling and coordinates multidisciplinary care for these conditions in partnership with Riley immunologists and neurologists.

38 | Refer a patient: 317.944.3966 Riley Children’s Health Medical Specialties Annual Report 2019 | 39 Neonatology Riley Neonatology offers Committed to quality care and patient safety ■ Low central line-associated bloodstream infections numerous leading-edge Riley at IU Health—home to a 60-bed, Level IV (0.38 per 1,000 line days) neonatal intensive care unit (NICU)—offers the most therapies, including ■ Low unplanned extubation rate (0.48 per 100 ventilator days) advanced neonatology services in Indiana. Treating whole-body therapeutic ■ Zero breast milk administration errors over the past three years nearly 700 newborns each year and staffed by board due to on-site human milk lab

certified neonatologists, our expert team delivers hypothermia, continuous ■ Evidence-based guidelines to standardize care and improve the highest level of care to neonates in need of video EEG, ECMO, peritoneal outcomes specialized, lifesaving services. In many cases, our care Riley Neonatology: begins prenatally and continues throughout the NICU dialysis, inhaled nitric oxide, ■ Participates in the Vermont Oxford Network to benchmark stay. We collaborate with the full spectrum of medical, high-frequency ventilation, outcomes to NICUs nationwide and as a platform for quality surgical and interventional subspecialists at Riley and coordinate appropriate improvement with NICUs throughout Indiana DIVISION CHIEF neurodevelopmental follow-up upon discharge from the hospital. and advanced genetic and ■ Is a member of the Children’s Hospitals Neonatal Consortium Laura S. Haneline, MD metabolic testing. (of Level IV NICUs) to improve outcomes for infants with the most Program leader since 2015 Our team is multidisciplinary with dedicated advanced practice providers who Edwin L. Gresham Professor of Pediatrics, communicate with referring obstetricians, neonatologists, pediatricians and complex surgical and medical diagnoses IU School of Medicine primary care physicians about infants being treated in our NICU. For full team member list, see page 61. Dedicated to family-centered care The Riley NeuroNICU Program ■ NICU Nest program – As members of the neonatal team, parents NeuroNICU Program treats about 210 infants each develop education and support resources for families to use Program distinctions Focused on safeguarding infant brain health, Riley’s world-class neonatal year, accounting for 30% during and after their time in the NICU. neurocritical care program brings together neonatologists, neonatal of the total admissions Ranked among the top 15 ■ Psychological support – Neonatology team includes psychologists neurologists, pediatric neurosurgeons and neurodiagnostic specialists. to the Riley NICU. pediatric neonatology programs to serve NICU families’ mental health needs. This team provides the highest level of care to infants born with: in the nation by U.S. News & ■ NICView™ -- A camera system allows parents to observe their World Report ■ Neonatal encephalopathy ■ Stroke newborns using any internet-connected device. ■ Brain and spine malformations ■ Intracranial hemorrhage One of the first neonatal ■ Seizures ■ Genetic and metabolic disorders Riley Early Years Program neurocritical care programs A care collaboration between neonatology, psychology, developmental ■ Meningitis in the country pediatrics and general pediatrics, the Riley Early Years Program Riley Heart Center NICU provides follow-up care for NICU patients after discharge. The program Committed to the full spectrum of Riley Neonatology offers a dedicated program to support babies with serves as a single screening and referral point for patients as they grow care from prenatal consultation cardiovascular anomalies. The team provides care through a collaboration with Riley cardiology, cardiovascular surgery, through infancy and early childhood. and NICU treatment to cardiovascular intensive care and genetics. Annually, approximately 150 newborns with congenital heart disease are treated discharge with individualized in the Riley Heart Center NICU. Riley neonatologists provide care neurodevelopmental follow-up

throughout central Indiana IU Health North Hospital Extracorporeal Membrane Oxygenation (ECMO) Program Excellent outcomes attributed Level III NICU n 23 private beds Treating more than 1,000 infants and children since 1987, the Riley at to experience managing a IU Health Methodist Hospital Average annual admissions: 301 IU Health ECMO program is designated as a Platinum Level Center of consistently high volume of Level III NICU n 38 beds

Illinois Street 116th Street complex patients, and neonatal Excellence by the Extracorporeal Life Support Organization (ELSO). The Average annual admissions: 573 expertise within all subspecialties, designation recognizes centers 96th Street 5 including Riley’s top-ranked urology and demonstrating an exceptional Our survival rates for 86th Street 82nd Street cardiology programs commitment to evidence-based neonates requiring ECMO Riley Hospital for Children for respiratory or cardiac Community Hospital North processes and quality measures, at IU Health ville Road Level III 56thNICU Stree nt 43 private beds failure are consistently n 5 team member training, Level IV NICU 60 private beds Allison Average annual admissions: 558 continuing education, patient above the ELSO average. Average annual admissions: 660

ost Road 0 satisfaction and clinical care. In P INDIANAPOLIS 21st Street Neonatal critical care transport addition to nurses specially trained in ECMO, team members include W. 10th Street The Riley neonatal transport team manages care neonatologists, pediatric surgeons, pediatric intensivists and pediatric 5 0 for more than 900 neonatal helicopter and ground cardiovascular surgeons. For more on ECMO, refer to pages 19 and 20. Sidney & Lois Eskenazi Hospital 0 n transports annually. We have access to specialized Level III NICU 36 private0 beds 5 Average annual admissions: 503 5 therapies, including high-frequency ventilation, Bronchopulmonary dysplasia team 5 inhaled nitric oxide and whole-body hypothermia. For infants with severe lung disease acquired from premature birth, IU Health LifeLine team members communicate specialists from pediatric pulmonology, neonatology, respiratory therapy 5 directly with Riley neonatologists during transport. and advanced practice providers collaborate to provide individualized, Franciscan Health Indianapolis For more on pediatric transport, refer to page 21. consistent care to improve patient outcomes. Level III NICU n 27 private beds Average annual admissions: 362 40 | Refer a patient: 317.963.3330 (IU Health 24/7 Transfer Center) Riley Children’s Health Medical Specialties Annual Report 2019 | 41 Nephrology Enhancing quality of life for children with kidney disease Riley Nephrology is Indiana’s only Kidney Camp. Children with kidney disease enjoy a week provider of comprehensive evaluation at Kidney Camp each year. Riley supports the camp by and treatment for children with providing an on-site nephrologist, dialysis nurses and kidney disease or kidney failure. Our nurse practitioners who provide dialysis care and medical eight pediatric nephrologists are management. leaders in using novel technologies and research breakthroughs to Riley Nephrology Music Program. The first initiative of launch new clinical programs that its kind in the U.S., the Riley Nephrology Music Program lead to better treatments for children provides a diversion to help children cope with multiple impacted by kidney disease. hours of inpatient dialysis. Each week during their treatment, DIVISION CHIEF patients participate in 30-minute private piano lessons. David Hains, MD Specialized, team-based programs Program leader since 2017 target unique patient needs Byron P. & Francis D. Hollett Professor of Delivering personalized care that focuses on patient and Pediatrics, IU School of Medicine family needs, our nephrology programs provide leading-edge For full team member list, see page 61. patient care and treatment with a multidisciplinary, team- based approach. Program distinctions Stone Program Nationally ranked among the The Riley at IU Health Stone Program focuses on long-term kidney stone prevention and relief. The program educates top 15 pediatric nephrology patients on the importance of making meaningful diet and fluid intake changes to help prevent and control symptoms. programs by U.S. News & Developing customized care plans for each patient, Riley nephrologists work closely with colleagues in pediatric urology on World Report strategies to help reduce or eliminate the occurrence of kidney stones. Metabolic Bone Disease Program Largest pediatric end-stage kidney Riley nephrologists, in collaboration with pediatric endocrinologists, diagnose and treat children who are at risk for frequent disease program in Indiana fractures due to metabolic bone disease and low bone density. and provides dialysis and transplantation for children Outpatient Dialysis Program throughout the state On average there are 40 children on dialysis in the Riley Outpatient Dialysis Unit at any given time. The modality of dialysis is blended between hemodialysis and peritoneal dialysis. Our treatment goal is for all children to receive a renal transplant. Only outpatient chronic Kidney Transplant Program hemodialysis unit in Indiana The Riley at IU Health Pediatric Kidney Transplant Program is nationally ranked in the top quartile, based on the number of exclusively for pediatric patients patients receiving transplants and its leadership in positive patient outcomes. Our transplant center is part of the Improving Renal Outcomes Collaborative (IROC), a nationwide pediatric kidney transplant outcomes network that seeks to improve long-term health outcomes and quality of life for children with kidney transplants. Transition Program Pediatric and adult nephrologists collaboratively manage patients with the goal of preparing adolescent patients for independence and establishing continuity with nephrologists at IU Health. Riley at IU Health and IU School Leaders in research Innovative care models and expanded services of Medicine offer a three-year Blood pressure monitoring. Riley Nephrology directs a statewide Ambulatory Blood Pressure Monitor Program for initial and Riley at IU Health is among the leading recipients of National nephrology fellowship program ongoing assessment of children with abnormal blood pressure readings. We increased the number of studies from 50 in Institutes of Health funding for pediatric nephrology. In addition to certified by the American Board of 2017 to more than 600 in the past year. two R01-funded nephrologists, we have 20 ongoing Institutional Review Pediatrics. Board-approved clinical studies. Every physician member of our team is a Telemedicine. We offered telemedicine services for dialysis patients and ambulatory blood ■ Provides extensive training in all principal investigator on an active research study. pressure monitoring visits in 2019. We have significantly expanded these capabilities and 3,142 areas of clinical nephrology now see all patients via telemedicine when appropriate. Through the first five months of patient visits COVID-19 antibody study ■ Six months of inpatient service the COVID-19 pandemic, Riley Nephrology conducted more than 350 virtual visits. In 2019, Riley and six months of outpatient Riley Nephrology leads a COVID-19 antibody surveillance program in our Satellite program expansion. Sushil Gupta, MD, is leading our statewide expansion efforts nephrologists experience dialysis unit. This project has already resulted in a high-profile publication, by opening an in-person practice in Fort Wayne and continuing our presence in Evansville. conducted more ■ Two years of research to broaden Based on need, these programs are slated for further expansion. patient visits than “Asymptomatic Seroconversion of Immunoglobulins to SARS-CoV-2 in a understanding of renal disease ever before.* Pediatric Dialysis Unit,” in the Journal of the American Medical Association. Expansion of prenatal services. Our nephrologists, in collaboration with Riley Maternal Fetal Medicine physicians, offer prenatal consults five days a week. * Excluding dialysis and transplant

42 | Refer a patient: 317.274.2563 Riley Children’s Health Medical Specialties Annual Report 2019 | 43 By the numbers: 2019 Concussion. In addition to consulting on pediatric concussion cases, Neurology Riley neurologists treat concussions through our traumatic brain Epilepsy Surgery Program The largest child neurology group in Indiana, nationally ranked Riley injury program. The program, a collaboration with neurosurgery, 57 therapeutic procedures, Neurology includes 17 board certified pediatric neurologists. Our specialists pediatric rehabilitation, neuropsychology and , including: use the latest diagnostic tools and therapies to aims to accelerate recovery and maximize functional outcomes for ■ 9 temporal lobectomy diagnose and treat the most complex neurologic pediatric patients sustaining mild to severe traumatic brain injury. A disorders in children. Caring for patients and families ■ 2 hemispherectomy schoolteacher provides educational support to patients and families. from throughout the Midwest, our team, which includes ■ 6 laser ablation Pediatric headache center. Led by a pediatric neurologist and five advanced practice providers and a genetic a nurse practitioner skilled in headache medicine, Riley’s ■ 2 responsive neurostimulation counselor, has developed numerous specialized multidisciplinary pediatric headache center offers a comprehensive multidisciplinary services. These include programs 11 invasive monitoring procedures approach for patients with extreme refractory headache disorders. for muscular dystrophy and refractory epilepsy. Treatments include the latest therapeutic techniques, with rational DIRECTOR Electrophysiological monitoring use of medications, pain psychology, biofeedback, cranial nerve Christopher T. Jackman, MD Comprehensive, seamless care 2,191 routine EEG blocks, botulinum toxin therapy and trigger point injections. Program leader since 2018 Riley Neurology provides both inpatient and outpatient care. Our outpatient Assistant Professor of Clinical Neurology, prolonged video EEG services are centered at Riley at IU Health in downtown Indianapolis with 2,823 Neurogenetics. The Riley Neurogenetics Program is directed by a IU School of Medicine a satellite office in Carmel and outreach programs in Avon, Lafayette and pediatric neurogeneticist, neurodevelopmental pediatrician and For full team member list, see page 62. Patient volume Bloomington. Riley neurologists offer inpatient coverage and manage genetic counselor. We specialize in the diagnosis of neurological new outpatient consults epilepsy monitoring units at Riley at IU Health and Riley Hospital for Children 3,715 disorders through clinical evaluation and expanded genetic testing, Program distinctions at IU Health North Hospital in Carmel. 11,881 return patient visits particularly next generation and whole exome sequencing. Ranked among the top 25 Neonatal neurology. Through the first and only program of its kind Expertise in treating complex neurologic conditions pediatric neurology programs in Indiana, Riley’s neonatal neurologists collaborate with NICU Pediatric epilepsy. Riley Neurology offers the full range of surgical evaluations and treatments for epilepsy. Our team by U.S. News & World Report specialists to examine outcomes and develop best practices for includes a surgeon specializing in pediatric epilepsy and five pediatric epileptologists. In cooperation with Riley pediatric term and preterm neonates with neurologic injury, disease or neurosurgeons, our neurologists work diligently to improve identification and surgical treatment of epilepsy patients with Largest epilepsy program in Indiana seizures. For more, refer to the NeuroNICU Program on page 40. medically refractory epilepsy. and an accredited Level 4 center Movement disorders. Riley at IU Health offers the only pediatric by the National Association of movement disorders program in the state, which includes Epilepsy Centers; only state collaboration with a neurologist and neurosurgeon experienced program offering subdural grids, in deep brain stimulation. stereo EEG and laser ablation

The state’s largest program Employing leading-edge diagnostics, focused on neurocutaneous syndromes such as Riley Neurology: neurofibromatosis and ■ Performed the first two pediatric tuberous sclerosis responsive neurostimulation (RNS) implantations in the state Muscular Dystrophy Association Care Center, recognizing expert ■ Continues to expand the use of clinical care and research intracranial electroencephalogram (EEG) monitoring and stereo EEG Indiana’s only pediatric stroke program

Neuromuscular/MDA. Riley at IU Health offers a bimonthly multidisciplinary program with specialists from neurology, neurogenetics, physiatry, cardiology, pulmonology, genetic counseling, social work and physical therapy. Our neuromuscular specialists are active in clinical trials of several agents for Duchenne muscular dystrophy, and we lead the state in the treatment of spinal muscular atrophy (SMA). Our team administers both nusinersen, an intrathecal therapy that can help maintain or improve strength in SMA, as well as the new revolutionary gene therapy for this disease. Pediatric stroke. Riley treats patients with prenatal, perinatal and childhood stroke and cerebral sinovenous thrombosis. Our team, including a dedicated stroke neurologist and pediatric interventional radiologist, works in collaboration with hematology and neurosurgery to ensure children with stroke receive timely and appropriate evaluation and the most advanced interventions.

44 | Refer a patient: 317.948.7450 Riley Children’s Health Medical Specialties Annual Report 2019 | 45 Palliative Care Interdisciplinary team Partners in home-based delivers comprehensive pediatric hospice care The Riley at IU Health Palliative Care team provides comprehensive palliative palliative care Serving children and families The Riley Palliative care services for children with a variety of life-limiting or life-threatening across Indiana, our palliative ■ 2.5 full-time physicians medical conditions. Committed to helping patients experience the best care team members help Care team directs possible quality of life, we support families in medical decision-making, ■ 2 advanced practice nurses coordinate home-based home-based goals of care discussions, advance directives, and complicated pain and pediatric hospice services. ■ 1 palliative care social worker hospice care for symptom management. Our team also oversees end-of-life care for patients Patients and families have in pediatric hospice. ■ 1 administrative assistant 24/7 on-call access for 40 to 50 patients guidance and support. each year with an These hospices include: average hospice DIVISION CHIEF ■ Center for Hospice Care stay of 52.5 days. Adam B. Hill, MD ■ Patient visit volume Visiting Nurse Service Program leader since 2017 (VNS) Hospice Associate Professor of Clinical Pediatrics, Riley Palliative Care 2,497 IU School of Medicine ■ team members conduct patient visits in 2019 Deaconess Hospice For full team member list, see page 62. inpatient and outpatient ■ Family Life Care clinical visits and offer ■ Good Samaritan Hospice Program distinctions home-based care in 315 ■ partnership with new consultations in 2019 Guardian Angel Significant program growth since its launch six years ago: hospice services. ■ Hospice of the 760 patient visits in 2014; Wabash Valley nearly 2,500 in 2019 ■ IU Health Hospice (Bloomington, Lafayette Serves as the medical director for and Indianapolis) home-based pediatric hospice Committed to training in the U.S. and around the world services in Indiana; collaborates ■ Our Hospice Riley at IU Health contributes to palliative care education and training at all levels—from undergraduates and medical with 13 hospices statewide students to residents, fellows, and nursing and physician colleagues. Our team has built a national and international ■ Seasons Hospice reputation for our work with opportunities to teach in several different states, as well as international programs such as ■ Unity Offers training tracks for Bugando Medical Center in Tanzania, the International Society of Nurses in Cancer Care in Auckland, New Zealand, and clinical palliative care fellows hosting the first-ever pediatric End-of-Life Nursing Education Consortium (ELNEC) training course at Beijing Medical Center in China. Affiliated with Indiana University School of Medicine, Riley Palliative Care participates in ongoing education training in Vital Talk, an empathic communication training skills curriculum, as well as ELNEC and the Pediatric End-of-Life Education Curriculum for Pediatric Residents.

Our palliative care services are integrated across specialties, with our team 21% Riley Palliative Care develops end-of- receiving referrals for new consultations life education for hospices in Indiana from several clinical departments at Riley. to continually improve the home-based experience for pediatric patients. 18% We also work closely with and educate 15% IU Health colleagues to enhance the quality of our care, improve 18% communication, and promote 17% effective and timely care delivery.

11%

46 | Refer a patient: 317.944.3478 Riley Children’s Health Medical Specialties Annual Report 2019 | 47 Physical Medicine and Rehabilitation Outpatient rehabilitation offers continuity of care To prevent complications and continue improvement after A variety of medical conditions can impact a child’s ability to move, perform hospital discharge, outpatient rehabilitation is essential. daily living activities and interact with family, school and community. Riley In addition to therapy, the pediatric physical medicine and Physical Medicine and Rehabilitation, led by expert physiatrists, offers rehabilitation team provides adaptive tools, education on lifestyle medical management to optimize health, function and overall well-being. We changes and support to help each child function comfortably at provide structured therapy programs designed to maximize children’s function home and thrive as they grow. and mobility so they can return to regular activities. While in the hospital, Patients have access to several multidisciplinary programs, early treatment is essential to ensure patients retain any current mobility and including: to help prevent any future decline in function. ■ Traumatic Brain Injury Program Children and adolescents may be admitted to Riley’s inpatient rehabilitation ■ Neuro-Oncology Program center if they are: DIVISION CHIEF ■ Spina Bifida Program Francisco Angulo-Parker, MD ■ Medically stable Program leader since 2019 ■ Cerebral Palsy Program ■ In need of active and ongoing multidisciplinary intervention Assistant Professor of Clinical Pediatrics, IU School of Medicine ■ Muscular Dystrophy Program ■ Able to tolerate at least three hours of therapy a day For full team member list, see page 62.

Program distinctions Working with Riley specialists across multiple disciplines to understand each patient’s challenges, Indiana’s only inpatient pediatric rehabilitation center our team develops interdisciplinary, customized treatment plans to address specific functional goals. Acute inpatient rehabilitation facility for patients requiring more Riley Physical Medicine intensive or interdisciplinary and Rehabilitation therapy and support, such as Inpatient rehabilitation provides personalized, coordinated care specializes in treating occupational therapy, physical With a goal to facilitate seamless recovery, our physiatrists and the functional needs of therapy or speech language therapy multidisciplinary team members work with patients and families to help children and adolescents children return home, to school and to their community as soon as possible. A partner in several affected by a variety of Riley Physical Medicine and Rehabilitation team members provide multidisciplinary treatment individualized care for each patient that includes: diseases and conditions, programs at Riley that including: promote functional recovery ■ Daily visit from a physiatrist of children and adolescents ■ Brain injury ■ Documented plan of care within the first four days of admission with

weekly team meetings to evaluate progress and modify care plan, as ■ Trauma needed ■ Severe burns ■ Family meetings to coordinate care, provide updates and plan for care Inpatient volume following discharge ■ Amputation In 2019, the Riley at IU Health Inpatient Pediatric Rehabilitation Center ■ Emotional and social support from family support services ■ Spinal cord injury admitted 135 children and young adults ranging from 6 months to 18 years old. The top three admitting diagnoses were: ■ Recommendations for and provision of resources to ensure a safe ■ Cancer transition from hospital to home ■ Non-traumatic brain dysfunction ■ Neuromuscular ■ ■ A teacher who works with the child’s school to facilitate schoolwork Traumatic brain injury disorders during hospitalization and to provide assistance once the child returns to ■ Patients recovering from selective dorsal rhizotomy surgery school ■ Stroke Shorter length of stay On-site resources offer added support for inpatient care ■ Congenital diseases The WeeFIM II® System, provided by Uniform Data Systems (UDS), allows the To help facilitate recovery and functional improvement, the Riley at IU Health Riley team to compare pediatric rehabilitation outcomes to similar facilities pediatric rehabilitation gym includes equipment and toys for children of ■ Rhizotomy/baclofen pump placement across the U.S., including gains in independence and length of stay. In 2019, all stages and levels of function and mobility. Because families play an our inpatient pediatric rehabilitation center had a shorter length of stay important role on the rehabilitation and recovery care team, our center (21.5 days) and a greater WeeFIM II® System Rating Total Gain (27.5) provides sleeping arrangements in patient rooms if parents choose when compared to similar facilities nationwide that also use the UDS system. to stay with their children in the hospital.

48 | Refer a patient: 317.944.2353 Riley Children’s Health Medical Specialties Annual Report 2019 | 49 Psychiatry and Psychology Riley’s highly trained Mood Disorders Program Riley psychiatric specialists specialists diagnose and Riley at IU Health psychiatry and psychology specialists diagnose and treat manage evaluation and care treat a variety of psychiatric children of all ages. Our expert team of child and adolescent psychiatrists, for children with a variety of clinical child psychologists and psychiatric social workers partners with and psychological conditions, mood disturbances, including:

children and families to develop a treatment plan to address each child’s including: ■ Social isolation

mental health needs. Working in outpatient, hospital-based and emergency ■ Attention-deficit/hyperactivity ■ Depression department settings, our clinicians focus on advanced, evidence-based disorder (ADHD) evaluations and treatments to provide expert care for psychiatric diagnoses ■ Loss of interest or ■ Autism spectrum disorder and behavior problems. pleasure in normal ■ Anxiety disorders activities Diagnostic evaluation. Riley specialists conduct thorough interviews and use the latest assessment methods to identify problems and establish a diagnosis. ■ Bipolar disorder ■ Irritability DIRECTOR Leslie A. Hulvershorn, MD, MSc Psychological testing. In-depth psychological testing can be used to provide ■ ■ Suicidal ideation Depression Program leader since 2020 specific, quantifiable results explaining the nature and severity of psychological ■ Language and learning disorders Dual Diagnosis Program Associate Professor of Psychiatry, challenges. IU School of Medicine This concentrated outpatient program is designed for children and ■ Post-traumatic stress disorder For full team member list, see page 62. Individual psychotherapy. Working one-on-one with children, our specialists help teens with psychiatric disorders who also struggle with substance them learn coping strategies to build skills and address challenges in feelings, ■ Obsessive compulsive disorder abuse. The program helps patients and families deal with the

beliefs and behaviors with the goal of moving toward desired changes. ■ Substance abuse disorders challenges of each circumstance to promote recovery and improved Program distinctions Family therapy and behavior modification.Through consultation with children well-being. ■ Psychosis Largest youth mental health and family members, Riley psychiatry and psychology experts work to change For children ages 10 to 18, Riley’s program uses a treatment model specialty and general clinical ■ Tourette syndrome family interactions and structure to improve children’s behavior and mental called ENCOMPASS that incorporates cognitive behavioral therapy, service in Indiana well-being. motivational enhancements, parent management training and Pharmacotherapy. Based on thorough evaluation, our physicians may medication-assisted treatment. Evidence-based treatment for all major pediatric mental health recommend treating certain psychological conditions with medicines that help Pediatric Psychology Testing Program regulate brain-based psychological and behavioral problems. and substance use disorder We offer standardized psychological tests for many issues, including: categories ■ Intellectual ability strengths and weaknesses Home to the only fellowship Our comprehensive child psychiatry and psychology ■ Attention and learning problems services include specialized programs designed to training program for child ■ Severe/unexplained emotional, behavioral or personality meet unique needs: psychiatrists in the state problems Autism Treatment Center ■ Memory problems An expert resource dedicated to treating children with autism spectrum disorder, this center offers leading-edge care for children with autism who struggle with social interactions, communication and other developmental abnormalities. ADHD/Disruptive Behavior Disorders Program This comprehensive program offers evaluation and treatment for children Committed to improving clinical care through research with persistent, severe patterns of inattention, hyperactivity and impulsivity. Riley psychiatrists and psychologists are faculty members at IU School of Our team also provides diagnostic and treatment services for other issues Medicine who conduct leading-edge research to better understand how such as oppositionality, defiance, outbursts, rule breaking and anger behaviors, emotions, abilities and skills develop in children and adolescents. They control issues. also study how disorders surface at different ages and stages of development. Tic/Anxiety/Compulsive Disorders Program Our investigators lead research to uncover new insights for a variety of disorders: Riley specialists diagnose and treat children and adolescents with any of ■ ADHD ■ Disruptive behavior disorders the following symptoms: ■ Autism spectrum disorder ■ Language and learning disorders ■ Recurrent obsessions or compulsions that are severe enough to significantly impair daily living ■ Addictions ■ Traumatic stress

■ ■ Recurrent tics, vocal noises or outbursts Mood disorders

■ Anxiety/fearfulness/apprehension Research studies using the latest treatment protocols and technology are in progress to better identify, evaluate and treat these and other psychiatric disorders in children and ■ Trichotillomania adolescents. Findings help pave the way for new interventions to improve clinical care.

50 | Refer a patient: 317.329.7313 Riley Children’s Health Medical Specialties Annual Report 2019 | 51 Pulmonology and Sleep Medicine Riley pulmonology specialists are at Pulmonary Hypertension (PH) Program. The program focuses on the forefront of clinical care through evaluating and treating children with pulmonary vascular disease. Riley Pulmonology and Sleep Medicine is a nationally leadership and participation in: We provide guidelines-based assessments via echocardiography, cardiac catheterization evaluations, lung function and exercise ranked leader in clinical care, teaching, research ■ Cystic Fibrosis Foundation and advocacy in pediatric respiratory medicine. Our testing, radiological imaging, and individualized genetic testing and ■ American Thoracic Society expert team cares for children throughout the state counseling. Team members have extensive experience with multi-drug and nation, and aims to: ■ American Board of Pediatrics treatment regimens, including parenteral medications. Customized treatment regimens use all available therapeutic modalities for the ■ Provide advanced, child-focused and family- ■ American Academy of Pediatrics treatment of PH. Some children may be eligible for clinical research centered clinical care to children with respiratory, ■ Childhood Interstitial Lung Disease trials evaluating new PH medications. allergy and sleep disorders Network ■ Serve as a specialized medical home that works ■ Pulmonary Hypertension DIVISION CHIEF together with hospital and community-based providers in the care of Association New Initiations of IV/SubQ Treprostinil Therapy: 2013 – 2019 James F. Chmiel, MD, MPH children with chronic respiratory illnesses Program leader since 2019 ■ Primary Ciliary Dyskinesia Severe pulmonary arterial hypertension often requires ■ Conduct basic, clinical and translational research that directly brings aggressive, multidrug regimens to stabilize the disease. Professor of Pediatrics, Foundation IU School of Medicine new discoveries and therapies to the forefront of treatment Treprostinil, the most potent of these medications, is most For full team member list, see page 62. ■ NIH Asthma Clinical Trial Network ■ Train pediatric physician-scientists and clinician educators as future effective when given continuously through either a permanent IV ■ academic leaders Global Tracheostomy Collaborative or a small subcutaneous catheter. Our team has multiple years of experience in initiating and maintaining our most vulnerable Program distinctions patients on this complex, labor-intensive therapy. Ranked among the top 15 pediatric pulmonology programs 25 25 Specialized programs treat complex conditions in the nation by U.S. News & Aerodigestive Program. Dedicated professionals from pulmonology, World Report New starts gastroenterology, otolaryngology and speech therapy provide 20 advanced multidisciplinary care for infants and children with airway, Cumulative 17 Perform more than 10,000 feeding and gastrointestinal disorders. Our approach allows for pulmonary function tests efficient diagnosis and treatment for our patients through coordinated 15 each year appointments and procedures, with all care organized through a dedicated clinical nurse coordinator. 11 10 Recipients of more than 8 Bronchopulmonary Dysplasia Program. Pediatric pulmonologists, $30 million in research 7 6 general pediatricians, a nutritionist, a respiratory therapist, a funding 5 4 4 speech pathologist and a social worker deliver leading-edge care to 3 2 infants. With all care organized by a dedicated nurse coordinator, 1 Engaged in COVID-19 basic patients undergo comprehensive guideline-based evaluations and 0 science research and submitted 2013 2014 2015 2016 2017 2018 2019 management. We provide respiratory medication management and an investigative new drug oxygen weaning and titration, while assuring that children receive application to the FDA for a adequate nutrition for optimal somatic growth. In addition, close COVID-19 clinical trial neurodevelopmental follow-up reassures parents and educates them Pediatric Sleep Medicine Program on appropriate developmental milestone attainment, specific to the With 16 beds in two locations, our program includes four certified sleep child’s chronologic age and degree of prematurity. medicine physicians, two behavioral sleep psychologists, respiratory therapists and registered polysomnographic technologists. Specific Improving clinical outcomes High-Risk Asthma Program. The Riley High-Risk Asthma Program is aspects of our program: through research one of the longest-running clinics of its kind in the U.S. Patients are In 2019, Riley pediatric respiratory disease assessed by a multidisciplinary team, including an asthma educator, Behavioral sleep medicine. We offer assessment and brief focused treatments for behavioral and/or psychological factors that contribute researchers conducted 119 clinical trials pulmonologist, allergist, social worker, respiratory therapist and and published 53 manuscripts related to: psychologist. The program has resulted in a 70% decrease in hospitalizations and improved quality of life. to the development and persistence of sleep disorders in children. Our clinical psychologists treat children with sleep difficulties such as ■ Cystic fibrosis ■ Neuromuscular Program. Accredited by the Muscular Dystrophy Association, our neuromuscular clinic is the only one of insomnia, persistent nightmares and circadian rhythm sleep disorders. Primary ciliary dyskinesia ■ Asthma its kind in the state. It is exclusively dedicated to children with neuromuscular disorders and is staffed by an experienced Positive airway pressure (PAP) sleep medicine. A licensed psychologist ■ Sickle cell disease team of board certified pulmonologists, sleep physicians, neurologists, cardiologists, endocrinologists, palliative care and respiratory technician work with children who require PAP therapy ■ Food allergies physicians, physical medicine and rehabilitation physicians, physical therapists, dietitians, and social workers. We perform but struggle to wear it consistently. Children with developmental, ■ Sleep disorders comprehensive pulmonary function testing and sleep studies and provide specialized therapies like non-invasive ventilation sensory, psychological or behavioral difficulties are seen frequently ■ Preterm lung disease when indicated. to help desensitize them to wearing a mask when they sleep. ■ Pulmonary hypertension

52 | Refer a patient: 317.948.7208 Riley Children’s Health Medical Specialties Annual Report 2019 | 53 Radiology provides minimally invasive methods for effective diagnosis and treatment Performing thousands of imaging exams each year, the Riley at Riley’s specially trained interventional radiologists use minimally IU Health pediatric radiology team specializes in the diagnosis of invasive procedures to diagnose and treat many pediatric conditions. medical conditions in infants, children and adolescents. Our 20 By minimizing the physical trauma associated with open surgery, our fellowship-trained radiologists use advanced radiologic technologies program contributes to decreased infection rates, faster recoveries tailored to the needs of children: and shorter hospital stays. Pediatric patients benefit greatly from this approach to treatment, which often results in less pain than ■ Computed tomography (CT) scanners that allow organs to be standard procedures. viewed in different planes or as three-dimensional images

■ 3T and 1.5T magnetic resonance imaging (MRI) scanners offering Our interventional radiologists use X-ray, computed tomography or both advanced imaging sequences and fast-imaging techniques ultrasound to see inside the body and guide tools such as catheters, stents and needles to: that reduce the need for sedation in our youngest children CO-DIVISION CHIEF ■ ■ Fluoroscopy rooms that use advanced low-dose fluoroscopy Diagnose conditions Matthew L. Cooper, MD equipment and can reduce X-ray dosage by as much as 70% ■ Obtain biopsies Program leader since 2015 Assistant Professor of Clinical Radiology & ■ Digital radiology (DR) units that produce high-quality images ■ Treat: Imaging Sciences, IU School of Medicine quickly and shorten exam times – Tumors ■ Ultrasound units specifically designed for pediatric imaging – Joint pain

■ An on-site interventional radiology suite – Bile ducts that are blocked or damaged – Blocked or damaged arteries or veins Comprehensive radiologic and imaging services Highly trained pediatric radiologists – Blockages in the urinary tract ■ EOS Riley radiologists have specialized expertise ■ Stop intestinal bleeding in a variety of areas: ■ CT ■ Stop internal bleeding caused by organ trauma or ■ Cardiac imaging ■ MRI pelvis fractures ■ Pediatric musculoskeletal imaging ■ Fluoroscopy ■ Pediatric genitourinary imaging ■ Ultrasound ■ Fetal imaging ■ ■ Pediatric oncologic imaging ■ Anesthesia for ■ Interventional radiology diagnostic and CO-DIVISION CHIEF interventional ■ Neuroradiology Donald D. Corea, DO Program leader since 2014 ■ procedures Neurointerventional radiology Assistant Professor of Clinical Radiology & ■ Procedural sedation ■ Nuclear medicine Imaging Sciences, IU School of Medicine For full team member list, see page 62.

Radiology Exam Volume: 2018 – 2019 2018 2019 Program distinctions One of the first three programs Riley Radiology offers Computed tomography (CT) 7,630 8,769 advanced technology in the nation to implement 3.0 Tesla fetal MRI EOS X-ray technology: Provides the highest Fluoroscopy 6,278 4,319 quality images with the lowest possible dose of radiation. Interventional radiology 2,393 3,575 Advanced fetal imaging that includes quantitative MRI SPECT/CT: Allows a cross-sectional Magnetic resonance measurement of blood volume 8,863 11,204 rendering of nuclear medicine images. imaging (MRI) in the placenta and brain The CT image is fused to the nuclear medicine image for precise localization of Nuclear medicine 989 1,053 Home to the only pediatric areas on the SPECT image, allowing for a neurointerventional radiologist more accurate diagnosis. Radiographs 62,809 61,761 in Indiana MRI: Perfusion MRI allows for brain tumor and outcome prediction, and Ultrasound 13,596 15,264 One of the only facilities in functional MRI maps brain structure and the region to offer SPECT/CT technology function for safer surgery. TOTAL EXAMS 102,558 105,945

54 | Refer a patient: 317.962.3580 | Reading Room: 317.948.6315 Riley Children’s Health Medical Specialties Annual Report 2019 | 55 Rheumatology Active in research and clinical trials Riley Rheumatology is one of the nation’s largest programs specializing in autoimmune diseases such as juvenile arthritis and lupus, and less Riley Rheumatology leads diverse clinical research that common autoinflammatory diseases. Our team of eight board certified includes Phase 2 through 4 medication trials, large registry rheumatologists and five dedicated rheumatology nurses offers the latest studies and innovative investigator-initiated studies. and most promising treatments, some of which are only available through Childhood Arthritis and Rheumatology research trials. Our specialists are involved in clinical trials of novel Research Alliance (CARRA) medications and drug combinations that are defining how to treat these Riley at IU Health is a leading recruiting site for CARRA, the largest, chronic inflammatory diseases in children. most comprehensive North American registry of patients with pediatric rheumatic disease. Our program is currently conducting Comprehensive treatment for pediatric rheumatic illnesses more than 230 CARRA studies with increasing enrollment over the DIVISION CHIEF Riley at IU Health rheumatologists provide consultation with physicians past three years. Eric P. Hanson, MD throughout the region and manage or co-manage children with a wide Program leader since 2019 range of pediatric conditions—sometimes even for diseases yet to Associate Professor of Pediatrics, be named. Our skilled team diagnoses and treats a broad range of IU School of Medicine For full team member list, see page 62. inflammatory and autoimmune illnesses, including: 0 0 ■ Antiphospholipid syndrome 700 643% ■ Autoinflammatory diseases Program distinctions 600 Only group of board certified ■ Childhood nonbacterial osteomyelitis 500 pediatric rheumatologists ■ Childhood sclerodermas and morphea 418% in Indiana 400 ■ Childhood systemic lupus erythematosus

300 Advanced immunogenetics ■ Juvenile dermatomyositis and polymyositis translational research program 200 143% ■ Juvenile idiopathic arthritis aimed at understanding the

100 mechanisms of pediatric ■ Juvenile mixed connective tissue disease rheumatic disease 0 ■ Periodic fever syndromes, such as NOMID and PFAPA 2017 2018 2019 At the forefront of advancing new ■ Raynaud disease therapies, including the first ■ Reactive arthritis preventive trial for complications Riley Center for Immune Dysregulation of juvenile arthritis ■ Rheumatic fever The ImmunoGenetics Program at the Riley Center for Immune ■ Sarcoidosis Dysregulation was established in 2019 to study genetic causes ■ Sjögren’s syndrome and disease mechanisms of rare autoimmune, autoinflammatory and primary immune deficiency overlap syndromes. Patients are ■ Vasculitis (ANCA positive and negative) enrolled in one or more natural history protocols to be evaluated. In addition, we diagnose biomechanical issues that can produce some symptoms seen The center’s lab is in the Herman B Wells Center, adjacent to the in chronic inflammatory or autoimmune disease. For all rheumatology patients, our Children’s Clinical Research Center at Riley at IU Health. For more physicians gather a detailed medical history, perform a thorough physical examination about the center, refer to page 10. and address the current medical issues while considering all aspects of the child’s health. When treatment is required, Riley rheumatologists develop pediatric-focused treatment South Bend Leader in fellowship training plans that improve a child’s symptoms and healthy function. To help alleviate the national shortage of pediatric rheumatologists Fort Wayne in the U.S., Riley doubled the size of its rheumatology fellowship program in 2019. On track to becoming one of the top five pediatric rheumatology programs in the nation, our fellowship attracts diverse physicians from Indiana and beyond with Statewide outreach Indianapolis graduates achieving a 100% pass rate on the pediatric While most outpatient visits occur in Indianapolis, Riley Rheumatology serves subspecialty board examination. patients in other communities, with plans for continued expansion. In addition, our

rheumatologists use virtual visits and telehealth to increase statewide access. Bloomington

56 | Refer a patient: 317.274.2172 Riley Children’s Health Medical Specialties Annual Report 2019 | 57 Riley Medical Specialties Team Member Directory

Adolescent Medicine Child Development and Critical Care Story of Riley newborns: Rachel A. Katzenellenbogen, MD Developmental Pediatrics Cardiac Critical Care Division Chief Riad Lutfi, MD Child Development Lena and Delaney Drew J. Dennis Fortenberry, MD, MS Director Angela M. Tomlin, PhD, HSPP Eric Meininger, MD, MPH Gabriela I. Centers, MD Division Chief Twins overcome rare disorder Mary Ott, MD, MA Christopher W. Mastropietro, MD, FCCM Billy E. Beechler, MD Cynthia Robbins, MD, MS Lee D. Murphy, DO during NICU stay at Riley. Michelle J. Curtin, DO Mary Rouse, MD Tina M. Schade Willis, MD Brett Enneking, PsyD, HSPP Marcia Shew, MD, MPH Kevin M. Valentine, MD Elesia N. Hines, PsyD, HSPP Rebekah Williams, MD, MS Mouhammad Yabrodi, MD Steven M. Koch, PhD, HSPP Kelly Donahue, PhD, HSPP Monica S. Broo, NP Rebecca H. McNally Keehn, PhD, HSPP Beth Thielking, MSN, CPNP, CDE Melinda Christian, NP Christine M. Raches, PsyD, HSPP In June 2019, Lena and Delaney Drew were delivered in Indianapolis, while Eric stayed in Evansville with Delaney. Melissa Cleveland, NP Debra L. Reisinger, PhD, HSPP Evansville by emergency C-section at just 24 weeks and Amy DeHeer, NP For two weeks, they Allergy and Immunology Maura Rouse, PsyD, HSPP six days. The identical twins were identified as mono-mono Angela Finley, NP dealt with each Girish V. Vitalpur, MD, FAAP, FAAAAI Lynne A. Sturm, PhD, HSPP twins early in the pregnancy. It’s an anomaly that occurs in Director Melissa Johnson, NP twin’s medical crises Paula A. Sullivan, PhD, HSPP just 1% of pregnancies wherein both twins share the same Jay J. Jin, MD, PhD Jessica Riggins, NP separated by the 170- Caitlin Martin, MS, CCC-SLP Kirsten M. Kloepfer, MD, MS Kimberly Stull, NP amniotic sac with the same placenta. In early pregnancy Sarah Muir, MS, CCC-SLP plus miles between Nurcicek Padem, MD, MS and up to 24 weeks, monoamniotic or monochorionic twins Erica Vinson, NP them. After Delaney Cecilia M. Beehler, MSN, CPNP, FNP-C Developmental Pediatrics have a survival rate of 50%. suffered a pulmonary Olivia M. Swinger, MSN, RN, CPNP Celanie K. Christensen, MD, MS Critical Care “We knew it was really rare and it’s one of the riskiest hemorrhage, she Division Chief Marilyn J. Bull, MD Pediatric Critical Care pregnancies there is, so we were going to appointments joined her sister at Riley at the end of June. Cardiology Melanie W. Capobianco, MD Mara E. Nitu, MD, MBA every other week,” said Emma Drew. “We knew that there Larry W. Markham, MD Neonatologist David W. Boyle, MD, co-medical director, Lara E. Darling, MD Division Chief Division Chief was a high chance that one or both wouldn’t make it even Devonne A. Elkins, MD Kamal M. Abulebda, MD Riley Maternity & Newborn Health, and medical director, Ryan D. Alexy, MD before birth. And then after birth, with them coming so Deborah K. Hamby, MD Samer Abu-Sultaneh, MD Riley Fetal Center, worked with staff in Evansville to get Mark D. Ayers, MD early, it’s tough.” Jordan C. Huskins, MD Andrew L. Beardsley, MD Delaney moved to Indianapolis. Randall L. Caldwell, MD Stephanie J. Jackson, MD Zachary J. Berrens, MD, MPH Before the twins’ birth, Emma and her husband, Eric, also Thomas E. Capannari, MD “This is the place to be; they’re wonderful here,” Emma said. Abigail F. Klemsz, MD, PhD Gabriela I. Centers, MD learned the babies had twin to twin transfusion syndrome Timothy M. Cordes, MD Henry R. Knouse, DO Jason A. Espinoza, MD Robert K. Darragh, MD (TTTS), meaning one twin—in this case Lena—was in While at Riley, the girls were treated for patent ductus Matthew L. Friedman, MD Erin K. Davis, MD Carolyn L. Lytle, MD, MPH effect stealing blood and nutrients from her sister, putting arteriosus, a congenital heart defect common in premature Courtney Frye, MD Eric S. Ebenroth, MD Matthew Miller, MD Delaney at risk. Left untreated, the survival rate for TTTS babies in which a vessel connecting the pulmonary artery Michael J. Hobson, MD Huda Elshershari, MD Joseph O’Neil, MD, MPH to the descending aorta fails to close. What once required Brian D. Leland, MD twins is 10-15%. Anne G. Farrell, MD Sarah M. Puffer, MD Riad Lutfi, MD open-heart surgery now can be repaired using a device in Mark H. Hoyer, MD Susan M. Bollman, CPNP When the babies Chris G. Markham, MD the cardiac catheterization lab, a relatively new procedure Michael W. Johansen, DO Casaundra Buning, CPNP “Our colleagues in were born, Christopher W. Mastropietro, MD, FCCM being performed at the Riley Heart Center. Tiffanie R. Johnson, MD Charlene H. Davis, CPNP Delaney weighed Danielle K. Maue, MD Evansville were terrific. Adam C. Kean, MD, MPH Patricia A. Halloran, CPNP 1 pound, 8 ounces, After five months in the hospital, Lena “graduated” from Lee D. Murphy, DO It was so important that Benjamin J. Landis, MD Mary F. Hickel, CPNP and Lena weighed the Riley NICU and made her first trip home to Petersburg, Donna U. Watkins, CPNP Laura A. Pacholski, MD we got both babies to Jacqueline A. Maiers, MD 1 pound, 9 ounces. Indiana. Her twin sister, Delaney, was able to go home a John J. Parent, MD, MSCR Kerry M. White, MS, LCGC Colin M. Rogerson, MD Indianapolis so the family Despite her bigger month later—just in time for Christmas. Gabriel Paris, MD Courtney M. Rowan, MD Tina M. Schade Willis, MD could be together.” size, Lena was Jyoti K. Patel, MD Child Protection Program Ronald M. Payne, MD Nathan D. Swinger, MD David W. Boyle, MD in worse shape Roberta A. Hibbard, MD Poonam M. Puranik, MD Alvaro J. Tori, MD Co-medical director, Riley than her sister. Division Chief Andrew L. Rodenbarger, MD Cortney Demetris, MD Kevin M. Valentine, MD Maternity & Newborn Health, and Doctors prepared medical director, Riley Fetal Center Michael M. Ross, MD Tara L. Harris, MD Mouhammad Yabrodi, MD Emma and Eric for Marcus S. Schamberger, MD Ralph A. Hicks, MD Matthew L. Yuknis, MD the possibility of Ryan M. Serrano, MD Shannon L. Thompson, MD Monica S. Broo, NP losing her. Within Mouhammad Yabrodi, MD Anna Gordon, RN, PNP Casey L. Culley, NP a week, Lena had Lauren E. Sterrett, PA Barbie Mulvaney, RN, PNP Angela R. Finley, NP been flown to Rosemary Bland, NP Andrea Powers, RN, PNP Christina M. Geis, NP Riley for treatment Nichole M. Gralia, NP Jennifer C. Hamilton, NP Jennifer A. Grossi, NP Sandra K. Kennedy, NP of a perforated Dana M. Hartman, NP Ann E. McCallister Mills, NP bowel. Emma Anila N. Paul, NP followed her to Natalie E. Szczypiorski, NP

58 | Riley Children’s Health Medical Specialties Annual Report 2019 | 59 Riley Medical Specialties Team Member Directory

Dermatology Cory D. Showalter, MD Matthew R. Sall, MD Jayne VonBergen, RN, MSN, CPNP Medical and Molecular Genetics Scott C. Denne, MD Anita N. Haggstrom, MD Dan Slubowski, MD Emily K. Scott, MD Debra Wagner, RN, MSN, CPNP Stephanie M. Ware, MD, PhD Asuncion R. Dorotheo, MD Division Chief Jennifer Sullivan, MD Ryan J. Stegnik, MD Stayce Woodburn, RN, MSN, CPNP Director Matthew D. Durbin, MD Sarah A. Skillman, MD Sean M. Thompson, MD Sarah M. Stelzner, MD Erin Conboy, MD Mark L. Edwards, MD Jenna L. Streicher, MD Mary Verghese, MD Katie M. Swec, MD Hospital Medicine Clair Francomano, MD Osayame A. Ekhaguere, MD Donna C. Cummings, PA-C Brian E. Wagers, MD Patricia A. Treadwell, MD Gabrielle Geddes, MD Kimberly S. Schneider, MD, FAAP William A. Engle, MD Anne Whitehead, MD David E. Van Reken, MD Director Brett H. Graham, MD, PhD Levi Funches, Jr., MD Diabetes and Endocrinology Kyle B. Yoder, MD Laura M. Walls, MD Richelle Baker, MD Bryan Hainline, MD, PhD Veronica M. Guilfoy, MD Melissa Lah, MD Erica A. Eugster, MD For a full list of Riley community- Nick Bartel, MD David E. Hertz, MD Molly McPheron, MD Division Chief Gastroenterology, Hepatology based primary care providers, visit Amanda Benaderet, MD Abbey C. Hines, PsyD rileychildrens.org/findprimarycare. Wilfredo Torres-Martinez, MD Linda A. DiMeglio, MD and Nutrition Sara Bland, MD Sandra J. Hoesli, MD Jamie Felton, MD Gail Vance, MD Jean P. Molleston, MD Melissa Boling, DO Katie A. Huff, MD John S. Fuqua, MD Lawrence Walsh, MD Division Chief Allison Burke, MD Sara K. Kane, DO Anisha Gohil, DO Hematology/Oncology David Weaver, MD William E. Bennett, MD, MS Patrick Clements, MD Matthew A. Kardatzke, MD Nadine G. Haddad, MD Jamie L. Renbarger, MD, MS Jennifer Weida, MD Molly A. Bozic, MD Angela Dietrich, MD Poonam Khurana, MD Tamara S. Hannon, MD Division Chief Theodore Wilson, MD Joseph M. Croffie, MD, MPH Blake Froberg, MD Melissa D. Klitzman, MD Erik A. Imel, MD Sandeep Batra, MD Joseph F. Fitzgerald, MD Genetic Counselors K. Lim Kua, MD Heba Ismail, MD Melissa K. Bear, MD, MS Michael Goodman, MD Elaine Gilbert, PsyD, HSPP Sandy Prucka, LCGC, Director James A. Lemons, MD Nancy B. Johnson, MD Jennifer A. Belsky, DO, MS Amanda Gripe, MD Sandeep Gupta, MD Zeina M. Nabhan, MD Lindsay A. Blazin, MD Fatima Jafri, MD Adult and Pediatric Cardiology Matthew C. Lewis, MD Kathryn E. Harlow, MD, MS Todd D. Nebesio, MD Scott L. Coven, DO, MPH Eddie Kim, MD Sara Fitzgerald-Butt, LCGC Edward A. Liechty, MD Emily C. Hon, MD Juan C. Sanchez, MD James M. Croop, MD, PhD Ellen Klink, MD Ben Helm, LCGC Izlin Z. Lien, MD Brian A. McFerron, MD Emily K. Sims, MD Meghan D. Drayton Jackson, DO Hank Knouse, DO Kelly Schmit, LCGC Diane E. Lorant, MD Sara K. Naramore, MD Emily C. Walvoord, MD Michael J. Ferguson, MD, MS Manasa Mantravadi, MD Katie Spoonamore, LCGC Melinda H. Markham, MD Marian D. Pfefferkorn, MD Kelly Donahue, PhD William S. Goebel, MD, PhD Jodie Meara, MD JoAnn E. Matory, MD Erin J. Phipps, MD General Genetics/Pediatrics Heather Jolivette, NP Kerry M. Hege, MD, MS Jon Merrell, MD Brock H. Medsker, MD Ryan T. Pitman, MD, MS Katie Anderson, LCGC Jill Meier, NP Kyle W. Jackson, MD, MPH Rachel Peterson, MD Jason Z. Niehaus, MD Kanika Puri, MD Rebecca Baud, LCGC Mary Kaye Mitscher, NP Seethal A. Jacob, MD, MS, FAAP Emily Pittman, MD Charles C. Njinimbam, MD Girish S. Rao, MD Kate Burns, LCGC Staci Nekic, NP Jay J. Jin, MD, PhD Callyn Riggs, MD Charles S. Phillips, DO Katherine Schwartzkopf, PsyD, HSPP Kahlen Darr, MS Tina Pottorff, NP Alex Lion, DO, MPH Peter Ronco, MD Rebecca S. Rose, MD Brandon A. Sparks, MD Paula Delk, LCGC Karen Stancombe, NP Emily L. Mueller, MD, MS, FAAP Laura Ruhl, MD Zeynep N. Salih, MD Steven J. Steiner, MD, MS Trisha Neidlinger, LCGC Stephanie Woerner, NP Robert P. Nelson, MD Jonathan Salisbury, MD Emily K. Scott, MD Charles P.B. Vanderpool, MD Kayla Treat, LCGC Toshihiro Onishi, MD Michele Saysana, MD Riddhi Shukla, MD Shamaila Waseem, MD, MS Genetics/Developmental Pediatrics Emergency Medicine Kathleen Overholt, MD Andrew Shriner, MD Gregory M. Sokol, MD Jill M. Lindgren, CPNP Kerry White, LCGC Elizabeth Weinstein, MD Kristy Pilbeam, DO Nicole Steber, MD Beatrice Stefanescu, MD Division Chief Kent A. Robertson, MD, PhD, FAAP Emily Webber, MD Metabolic Genetics Kristen R. Suhrie, MD Sheryl E. Allen, MD General and Daniel V. Runco, MD Margaret Westwater, MD Sharon Luu, LCGC Anna E. Thomas, MD Tyler S. Arnold, MD Community Pediatrics Amanda J. Saraf, DO Laurie Wilkie, MD Katie Sapp, LCGC Michael S. Trautman, MD Rachael R. Schulte, MD Stephen J. Cico, MD, MEd Dorota A. Szczepaniak, MD, FAAP Adult and Pediatric Neurology Elizabeth A. Wetzel, MD Division Chief Jodi L. Skiles, MD, MS Gregory W. Faris, MD Victoria Klee, LCGC Paul D. Winchester, MD Beth A. Barron, MD Patricia A. Treadwell, MD Infectious Diseases Lindsey N. Haut, MD Katelyn Payne, LCGC Geoffrey P. Hays, MD James T. Blackwell, MD Terry A. Vik, MD Chandy C. John, MD, MS Division Chief Melanie S. Heniff, MD Marly P. Bradley, MD, JD Allison M. Yancey, MD, MS Oncology and Precision Medicine Nephrology Muayad Alali, MD Susan M. Hoffert, MD Mary R. Ciccarelli, MD Katlyn Antior, RN, MSN, FNP Tina Bouril, LCGC David Hains, MD Division Chief Darlene R. House, MD Susan M. Gaston, MD Amber Cassady, RN, MSN, FNP Samina Bhumbra, MD Cindy Hunter, LCGC Sushil Gupta, MD Christine Huang, MD Robert Gonzalez, MD Megan Dean, RN, MSN, CPNP James G. Carlucci, MD Jennifer Ivanovich, LCGC Jessica M. Kanis, MD Mitchell A. Harris, MD Victoria Dewitt, RN, MSN, FNP John C. Christenson, MD Alexis McEntire, LCGC Myda Khalid, MD Heather Kelker, MD Abbey A. Haste, MD Shelby Forney, RN, MSN Elaine G. Cox, MD Courtney Schroeder, LCGC Corina Nailescu, MD Jennifer L. Kersey, MD Jill V. Helphinstine, MD Ryanne Green, RN, MSN, FNP Leslie A. Enane, MD Leigh Anne Stout, LCGC Neha Pottanat, MD Kara Kowalczyk, MD Maria J. Herrera, MD, MS Ann Haddix, RN, MSN, CPNP Annette S. Foti, MD Andrew Schwaderer, MD Roxanna Lefort, MD, MPH Henry L. Jones, MD Jessica Harrison, RN, MSN, CPNP Shaina M. Hecht, MD Neonatology Michelle Starr, MD, MPH Kari A. Lemme, MD Thomas K. Klausmeier, MD Kelli Hession, RN, MSN, CPNP Alka Khaitan, MD Laura S. Haneline, MD Amy C. Wilson, MD Benjamin K. Nti, MD Parisa Mansoori, MD Jennifer Kaericher, RN, MSN, CPNP Lindsey A. Kirkpatrick, DO, PhD Division Chief Lindsay Berman, NP Kyra D. Reed, MD Meagan B. O’Neill, MD Kristine Kauffman, RN, MSN, CPNP Michelle L. Kussin, PharmD Jayme D. Allen, MD Allie Brock, NP Christina M. Ricks, MD Erin J. Phipps, MD Juliann Kiefer, RN, MSN, CPNP Megan S. McHenry, MD, MS Alana L. Barbato, MD Beth Johnston, NP Debra S. Rusk, MD Lori S. Price, MD Cheri Lee, RN, MSN, CPNP Jack G. Schneider, MD David W. Boyle, MD Kristin McGuire, NP Heather R. Saavedra, MD Deanna R. Reinoso, MD Kimberly McGinnis, RN, MSN, CPNP Bree A. Weaver, MD Bobbi J. Byrne, MD Sandra H. Schwab, MD Christina P. Ricks, MD Sharon Tormoehlen, RN, MSN, CPNP James B. Wood, MD, MS Paulomi M. Chaudhry, MD Haig V. Setrakian, MD Jerry L. Rushton, MD Paula Towell, RN, MSN, CPNP Kathryn L. Ehrhart, PA-C D. Wade Clapp, MD

60 | Riley Children’s Health Medical Specialties Annual Report 2019 | 61 Riley Medical Specialties Team Member Directory

Neurology Mallery Neff, MD Sleep Medicine Story of a Riley kid: Christopher T. Jackman, MD Martin Plawecki, MD, PhD Anuja Bandyopadhyay, MD Director Maurizio Pugliese, DO Stephanie J. Jackson, MD Kylei Parker, age 12 Marcia Felker, MD Kristen Schroeder, MD Hasnaa E. Jalou, MD Program Director Kelda Walsh, MD Harish S. R. Rao, MD Experienced PICU team Robert Blake, MD Rachel Yoder, MD Sarah M. Honaker, PhD, HSPP, CBSM Celanie Christensen, MD Alex Roberts, NP Kate Lyn Walsh, PsyD saves young girl’s life. Susan Conrad, MD Psychology Basic Science Research Sarah Delima, MD Zachary Adams, PhD Simon J. Conway, PhD Whitney Gervelis, DO Hillary Blake, PsyD Joan M. Cook-Mills, PhD Meredith Golomb, MD, MS Melissa Butler, PhD Michael D. Davis, PhD Aline Hamati, MD Kathleen Crum, PhD Benjamin M. Gaston, MD Bittu Majmudar-Sheth, MD Jill Fodstad, PhD Nadzeya V. Marozkina, PhD For Kylei Parker, a “Clearly she had an infection and septic shock,” Dr. Abulebda Matthew Miller, MD Elaine Gilbert, PsyD Robert S. Tepper, MD, PhD Florida vacation with said. “She had a lot of swelling and redness in her leg, so Lisa Smith, MD Stephanie Hullmann, PhD Matthew J. Turner, MD, PhD her family last year we were quite concerned that she had extensive infection Deborah Sokol, MD, PhD William Kronenberger, PhD Kai Yang, PhD Kristyn Tekulve, MD Ann Lagges, PhD turned terrifying there.” Baohua Zhou, PhD Laurence Walsh, MD Noha Minshawi-Patterson, PhD after a scrape on her Sarah Wing, MD Gabriela Rodriguez, PhD big toe morphed into Jennifer Zimmer, MD Amy Williams, PhD Radiology a life-threatening “Her blood pressure was very low, and Victoria Klee, MS, LCGC Social Work Pediatric Radiology infection. Necrotizing that’s consistent with the diagnosis Caitlyn Alvar, MSN, CPNP Sarah Harris, LCSW, MSSW Matthew L. Cooper, MD fasciitis—more of septic shock. We had to give her a Megan Railing, PA-C Kathy Hayes, LCSW, MSW Co-division Chief Patricia Grayson, MSN, CPNP Lindsey Noble, LCSW, MSW Donald D. Corea, DO commonly known as lot of antibiotics to cover any possible Kristin Hall, MSN, FNP-C Laura Redelman, LCSW, MSW Co-division Chief flesh-eating disease—can be deadly. It starts suddenly and organism that could cause this, and we Yvonne Hayden, MSN, FNP-C Valerie Scislowicz, LCSW, MSW Rusty Becker, MD progresses rapidly, eating deep into a person’s soft tissue. Brandon Brown, MD, MA, FAAP had to give a lot of fluids to try to bring Tamara Stanley, LCSW, MSW More than 25% of people who contract the disease die; Lisa Delaney, MD Palliative Care her blood pressure up.” Monica Forbes-Amrhein, MD, PhD many more lose limbs. Adam B. Hill, MD Pulmonology and -- Kamal M. Abulebda, MD Richard Gunderman, MD Division Chief After spending a day at the pool and beach, Kylei woke up Pediatric critical care intensivist Sleep Medicine Boaz Karmazyn, MD Kari Kendall, MD with pain in her calf. Her mom, Michelle Brown, thought it Pulmonology Sara Lay, MD Mona Raed, MD, FAAP James F. Chmiel, MD, MPH Megan Marine, MD was a muscle cramp, but by the following day the pain was Amy Haskamp, MSN, RN, PCNS-BC, Division Chief Matthew Wanner, MD worse and Kylei could walk only on her toes. To prevent ongoing sepsis that can lead to multi-organ CPON, CHPPN Anuja Bandyopadhyay, MD failure, the Riley critical care team treated Kylei’s infection Amy Hatton, MSN, RN, CPNP, CHPPN A. Ioana Cristea, MD, MS Interventional Radiology Michelle made an appointment with Kylei’s pediatrician as Caitlin Scanlon, MSW, LCSW Angela O. Delecaris, MD Francis Marshalleck, MD they began their drive home to Mooresville. By the time with antibiotics, while supporting her vital organs with fluids Sean Pfaff, MD Shannon Lytle Benjamin M. Gaston, MD they arrived at the doctor’s office the next day, Kylei’s pain and inotropic medications. Michelle S. Howenstine, MD Christopher Sinsabaugh, MD had intensified. Her pediatrician told Brown to take her Within a few hours of Physical Medicine Hasnaa E. Jalou, MD Pediatric Neurointerventional daughter to Riley immediately. being admitted to Riley, an and Rehabilitation Nadia L. Krupp, MD Radiology Francisco Angulo-Parker, MD Evans M. Machogu, MD, MS Mesha Martinez, MD Kylei arrived in the Riley Emergency department with orthopedic surgeon drained Jeffrey D. Macke, MD Division Chief Pediatric Neuroradiology a temperature of 99.9, but just 30 minutes later, it had and removed the deep tissue Gregory S. Montgomery, MD Laura Black, MD Chang Ho, MD infection in Kylei’s right leg. Heather N. Muston, MD jumped to 103. A rash had also developed on her body. Jessica Camilleri, DO Rupa Radhakrishnan, MD, MS Sandeep S. Puranik, MD She had two more Sara Cartwright, MD Drew A. Streicher, MD “Everything started going downhill quickly,” Michelle wrote Harish S. R. Rao, MD before she was released a Ben Schrock, PA-C Tanya Supakul, MD in a Facebook post after the ordeal. “She had contracted a Clement L. Ren, MD, MBA week later. Ann Coon, CPNP Isaac Wu, MD bacteria somehow that had already turned into infection. Jennifer Jack, CPNP Don B. Sanders, MD, MS John C. Stevens, MD It was an aggressive infection … her blood pressure was Necrotizing fasciitis is rare, and Robert S. Tepper, MD, PhD Rheumatology in critical numbers and her Dr. Abulebda said he can count Psychiatry and Psychology Michael S. Tsangaris, MD Eric P. Hanson, MD heart rate was very high.” on one hand the number of Division Chief Psychiatry Tiffany L. Turner, MD cases Riley sees each year. Leslie A. Hulvershorn, MD, MSc Andrea D. Weist, MD Susan Ballinger, MD Kylei was admitted to Riley’s Director Kate Lyn Walsh, PsyD Michael Blakley, MD pediatric intensive care unit, “Her medical staff, the Corissa Dionisio, MD Thomas Klausmeier, MD Grace A. Godfrey, RN, MSN, NP where she was treated by emergency room staff, everyone was absolutely amazing,” David W. Dunn, MD Julia D. Kemen, RN, MSN, NP Melissa Oliver, MD, MS Michelle said. “They worked very aggressively to save her Julianne Giust, MD Aries D. Lowden, RN, MSN, NP Martha Rodriguez, MD critical care intensivist Amber Hunt, DO Lauren Y. Utt, RN, MSN, NP Brandi Stevens, MD, MS Kamal M. Abulebda, MD. life, and I’m very, very fortunate.” Cassie Karlsson, MD Nancy J. Valentine, RN, MSN, NP Stacey Tarvin, MD, MS

62 | Riley Children’s Health Medical Specialties Annual Report 2019 | 63 Refer a patient

Riley Children’s Health cares for children in Indiana, across the nation Submit a referral online at Story of a Riley kid: and around the world. Same-day appointments are available for some rileychildrens.org/refer. providers. To schedule an appointment or to speak with a Griffin Smith, age 17 administrator, please call:

Specialists and therapists SPECIALTY PHONE NUMBER speed teen’s recovery from Adolescent Medicine 317.274.8812 rare spinal injury. Allergy and Immunology 317.948.7208

Cardiology 317.944.8906

Child Development and Developmental Pediatrics 317.944.4846 In July 2020, Griffin Smith was looking forward to starting “They both love (Riley Pediatric Care Center) his senior year at Noblesville High School, seeing his friends to push me. They Child Protection Program 317.274.2617 again and gearing up for lacrosse season. Those plans were know how to make put on hold when the 17-year-old suffered a serious back me work hard Critical Care injury that left him unable to walk. enough to keep Cardiac Critical Care 317.963.3330 me going for the It was in the Emergency department at an Anderson (IU Health 24/7 Transfer Center) day,” said Griffin. hospital that Griffin first realized the freak back injury he Pediatric Critical Care 317.963.3330 suffered while playing a game outdoors might be worse than Spinal strokes (IU Health 24/7 Transfer Center) he and his parents originally thought. Gradually, he began account for just Dermatology 317.944.7744 to lose feeling in his lower body. He turned to his mom and over 1% of hospital said, “I can’t move my legs.” admissions for Diabetes and Endocrinology 317.944.3889 stroke, and it’s Griffin’s parents, Greg and Heather, get emotional when Emergency Medicine 317.963.3330 even rarer in (IU Health 24/7 Transfer Center) they talk about the care their son received at Riley Hospital children. About for Children at IU Health, where Griffin was transported by 10-20% of patients Gastroenterology, Hepatology and Nutrition 317.944.3774 ambulance shortly after the injury. report some General Pediatrics and Primary Care 1.888.IUHEALTH “Riley has done an amazing, amazing job to get him where improvement in motor skills over time. Hematology/Oncology 317.944.2143 he’s at,” Greg Smith said. “Miracles do happen here.” Griffin is determined to be among that group. He made Griffin had suffered a rare spinal stroke, a disruption in tremendous progress during his three-week stay in Riley’s Hospital Medicine 317.963.3330 (IU Health 24/7 Transfer Center) the blood supply to the spinal cord. Under the care of inpatient rehab unit, where he embraced the multiple Riley neurologists, he progressed from no feeling to being therapy sessions required daily. Undergoing outpatient Infectious Diseases 317.944.7260 able to wiggle both of his big toes and move both knees. therapy, he’s motivated to recover and hopes to be back at Medical and Molecular Genetics 317.944.3966 Physical therapist Kristina Davey and occupational therapist school for his last semester. Kelly Salter worked the 6-foot-3-inch athlete hard—just the “I’m focused on getting better and graduating and walking Neonatology 317.963.3330 (IU Health 24/7 Transfer Center) way he wants it. again,” Griffin said. “I’ll figure out the rest once I start walking.” Nephrology 317.274.2563

Neurology 317.948.7450

Palliative Care 317.944.3478

Physical Medicine and Rehabilitation 317.944.2353

Psychiatry and Psychology 317.329.7313

Pulmonology and Sleep Medicine 317.948.7208

Radiology 317.962.3580 317.948.6315 (Reading Room)

Rheumatology 317.274.2172

64 | Riley Children’s Health Medical Specialties Annual Report 2019 | 65 Riley Children’s at Indiana University Health Riley Children’s Health is Indiana’s only full-service statewide pediatric health system. Riley Children’s Health offers complete, comprehensive pediatric care ranging from routine primary care checkups to the most complex acute care needs from highly skilled pediatric specialists. The system connects patients with 200 primary care and 400 specialty care physicians in communities across the state of Indiana. Riley physicians treat patients in their home communities, bringing top-notch care close to home. This statewide network is an extension of Riley Hospital for Children at Indiana University Health, one of the nation’s leading children’s hospitals. rileychildrens.org ©2020 IUHealth 12/20 IUH#34405