Baylor of Pediatrics College of Medicine Department

Baylor College of Medicine Department of Pediatrics 2016 Annual Report 2016 Annual Report

bcm.edu texaschildrens.org © 2017 Baylor College of Medicine Department of Pediatrics and Texas Children’s Hospital. All rights reserved. TABLE OF CONTENTS

Welcome

Patient Care

Changing the milieu of childhood adversity: Section blends approaches to prevent, intervene and heal ...... 6 Teamwork at its finest: Program focuses on rare lung diseases ...... 10 They can survive: Global initiative changes outcomes of cancer and blood disorders in Africa ...... 14 Wherever they are: Emergency Medicine leads programs for improving children’s outcomes ...... 18 Navigating complex systems: Palliative Care team helps families and children with serious illness ...... 24

Education

Diversity enriches experience: Residents bring varied backgrounds to patient care ...... 30 Voices of Diversity: Meet the residents ...... 32

Research

Quicker diagnosis for liver disease: Researchers uncover hope for biliary atresia patients ...... 38 The language of life: Neuroscientists chart paths toward viable therapies ...... 42

News of Note

Baylor, Texas Children’s lead site for largest autism study ever ...... 47 Texas Children’s The Woodlands opens ...... 47 Collaborators develop immunotherapy for cancer treatment ...... 48 Vaccine unit studies people with Zika virus ...... 48 Teaching kitchen offers classes in Children’s Hospital of San Antonio ...... 48 Video game promotes eating fruit and vegetables ...... 49 Cancer patients make their mark ...... 49

Spotlight on the Department of Pediatrics

By the Numbers 2016 ...... 51 Department of Pediatrics Leadership ...... 52 Welcome Welcome

Dear Colleagues,

The world today is as complex as it is massive . In medicine, the days of the “all-knowing” independent clinician, researcher or educator have passed . Many of the challenges we face as physicians, scientists and medical leaders are so large and so complex that they require the contributions of entire multidisciplinary teams .We need absolutely everyone .

In the pursuit of excellence, diversity is a necessity .

Today, our Department of Pediatrics is more inclusive and more diverse than ever before, closely resembling the wonderfully diverse city in which we live and work . We embrace and celebrate diversity in its broadest sense . In fact, it is our view that diversity will be one of the key drivers of our march to preeminence in pediatric medicine . No program or hospital can attract the greatest talent if its culture is exclusive or unwelcoming of segments of our community .

In a very real sense, our Department of Pediatrics is itself a community .We all share a passion for improving the health and lives of children and families, but we bring to that passion diverse and complementary backgrounds, experiences and areas of focus . Each of us brings to each discussion our own unique perspectives, and the conversations are very rich . The children, families and broader community we serve all benefit.

I’m thrilled that our department is not filled with people from identical backgrounds. Such a program could not possibly match the capabilities and potential of the amazingly diverse faculty and trainees you will see profiled in the pages of this annual report. I hope you find our story informative and inspiring.

Sincerely,

Mark W. Kline, MD Physician-in-Chief Texas Children’s Hospital J .S . Abercrombie Professor and Chairman Ralph D . Feigin Chair Department of Pediatrics Baylor College of Medicine

The Department of Pediatrics is more diverse than ever before, closely resembling the diverse city in which we live and work.

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Section blends approaches to careers.Two factors influenced Department Chair Mark W . Kline, MD, Changing prevent, intervene and heal Giardino to become a board-certified thought that increasingly, the lines child abuse pediatrician . One was between the disciplines of pediatrics the Milieu of Imagine you are standing by a river, inspiration from the commitment and public health have blurred . Childhood seeing children float by. You pluck them of his residency’s leaders to abused out of the river to rescue them, but children. The other influence was “Medicine has focused on the individual Adversity you need to go upstream to find out more personal . patient, and public health focuses on how, why and where they’re falling into populations,” Kline said. “You’re only the water . doing half the job if you focus on the A report of child abuse is made every 10 seconds in the United patient to the exclusion of community Going upstream to find and correct States, and four children die as a and population health . Likewise, you’re the causes of problems is the model of result of abuse every day. only half of a public health practitioner public health . – U.S. Centers for Disease if you focus on populations and you Control and Prevention never consider the impact you’re “We have been spending all of our making on the individuals . time scooping kids out of the river, “At the end of my internship, I and now we’re developing a program, evaluated a healthy child at risk “It really came together when I was a strategy, to start going upstream,” for child abuse, and I made a recruiting Dr . Greeley to be chief of said Christopher Greeley, MD, MS, recommendation that he needed to our Child Abuse Pediatrics program . chief of the Section of Public Health be removed from his family to be kept His principal strength is understanding Pediatrics at Texas Children’s Hospital safe,” Giardino said .“The next year, I the milieu in which children are injured, and professor of pediatrics at Baylor learned that this beautiful little boy had the family dynamic that culminates in College of Medicine .“What are the been killed . I asked what had happened . violence, injury and abuse of children, reasons these kids are ending up at our Because of a paperwork glitch, he and understanding strategies to door? We will always take care of these was not removed from his family .This prevent that abuse from occurring . kids, but part of what our team does is incident seared in my mind that these to focus on things that place kids and systems to protect children have to be “As I was thinking about how broadly I families at risk ”. held accountable ”. wanted to define child abuse pediatrics in recruiting a chief, I thought this is The first public health section in a A report of child abuse is made every the perfect place to launch this public department of pediatrics in the United 10 seconds in the United States, and health pediatrics program,” Kline said . States grew out of the department’s four children die as a result of abuse And Greeley agreed . Child Abuse Pediatrics program, which or neglect every day, according to the was established in 1978 . Greeley, who U .S . Centers for Disease Control and Launched in October 2015, the Public is one of five board-certified child Prevention (CDC) . Health Pediatrics section has two abuse pediatricians in the section, is major domains . One is child abuse president-elect of the Ray E . Helfer More time on prevention pediatrics, and the other is the Center Society, the international society of As child abuse physicians, Giardino and for the Study of Childhood Adversity child abuse physicians . He served for Greeley kept seeing children after they and Resilience (CARE), which focuses four years as board chair of Prevent were harmed . It would be a great day on research to help prevent adverse Child Abuse America, with Texas if no one were hurt . And the only way childhood experiences such as Children’s Senior Vice President for that to happen would be for the poverty, violence, inequality and lack of Angelo P . Giardino, MD, PhD, serving health care team to spend more time adequate resources and care . as vice chair . on prevention, they agreed . Child abuse pediatrics Greeley and Giardino met while Meanwhile, at Texas Children’s The child abuse pediatrics program has Reading to young children is a good way to build close relationships while increasing the quantity and quality of language. The Section of Public Health Pediatrics uses this strategy to relieve parental stress and improve children’s outcomes. both were early in their pediatric and Baylor, Physician-In-Chief and four main components:

Department of Pediatrics 2016 Annual Report 7 Patient Care Patient Care The Child Abuse Pediatrics program interdisciplinary team members provide training and awareness sessions for civic groups, church groups and YMCAs. • Postpartum depression: If mothers Children’s and The University of University of Kansas . Early education has are depressed or unable to care Texas System conducts research into been shown to have a long-term impact for their babies,that can affect the strategies that can be deployed in on the child’s success in life . babies’ lifelong trajectory .Workgroup pediatric offices to identify stressors, members develop collaborations with link parents with resources, and give “One of the biggest obstacles for us is pediatricians, primary care physicians families some evidence-based skills to our time horizon,” said Greeley .“We and others in the community who are help them cope with the stress . can’t show definitive results next year screening for postpartum depression or next legislative session .We’re not and linking families to services . Grants from the State of Texas and the trying to fix a specific problem. We’re LENA Research Foundation support trying to make the circumstances better . • Intimate partner violence: Historically work on one promising strategy to It took decades for these circumstances called domestic violence or violence relieve parental stress and improve to occur; it’s going to take decades for in the household, this problem may children’s outcomes . Called upWORDS, them to get better ”. manifest in a mother being unable the strategy involves teaching parents to provide care for her children, how to improve the quantity and quality Improving the circumstances that cause or the children themselves may be of language spoken with their child . By adverse childhood experiences is a long- victims of violence .True to the public the time they’re 4 years old, children term, complex undertaking that must health model, the goal is to develop who grow up in poor households have be adapted to fit each community. But partnerships and strategies to reach been exposed to 30 million fewer the section of Public Health Pediatrics all families who need it, even those words than children in more affluent is ready to do whatever it takes to who never come to Texas Children’s households, according to research at the improve the lives of children . for care .

• Excellence in clinical care: Identifying in training in an accredited fellowship for abused and neglected children and • Food insecurity in Houston: Food and caring for abused and neglected in child abuse pediatrics, one of the are available to provide training and insecurity has a significant impact children and adolescents, testifying largest such programs in the country . awareness sessions for civic groups, on a child’s life and ability to go to in court and working with Child In addition to education for medical church groups and YMCAs. school and pay attention . Food and Protective Services . Approximately students and the greater Houston nutrition are such basic functions 2,500 suspected victims of abuse medical community, a training CARE that if food insecurity is a problem, it and neglect are evaluated annually at program is being developed for post- The primary focus of CARE is often clusters with other problems Texas Children’s and the Children’s doctoral public health practitioners . community-level research to identify, families may have, such as violence, Assessment Center in Houston . Care An outreach program trains members promote and implement strategies transportation issues, lack of is provided at Texas Children’s Main of the community on signs and to prevent adverse childhood utilities, poverty and safety in the Campus and planned for the new Texas symptoms and what to do if they experiences (ACE), such as poverty, neighborhood . Texas Children’s Children’s Hospital The Woodlands recognize child abuse . violence, inequality, homelessness, partners with city and county campus . Consultative services are and a lack of health care and mental governments, nonprofits, businesses available for Texas Children’s Hospital • Scholarship and new knowledge: health resources, education and and school systems to determine West Campus .The program provides Clinical research varies from early nutrition . A CDC study in the 1990s how they can collaborate and how medical support to the Children’s recognition of abuse to improving demonstrated a clear correlation they can help . Assessment Centers in both Houston mental health services for children in between ACE and increased sickness and Brazoria County . Because children foster care . and early death in adults . • Parenting stress: Having a young child in the foster care system are at risk is difficult, and often young babies of abuse, Texas Children’s also is • Community presence: The program’s CARE runs the following four ACE are at greater risk of harm due to developing a foster care clinic . interdisciplinary team of physicians, Workgroups, in coordination with parental fatigue or frustration . Funded nurses, social workers and public partners from the Texas Medical by a grant from the Department Christopher Greeley, MD, MS, chief of the Section of Public Health Pediatrics, • Training and education: Baylor and health practitioners help primary care Center, the greater Houston nonprofit of Family and Protective Services, a takes a long-range view of solving community health problems. Texas Children’s have three physicians physicians and nonprofits who care community, and city and county agencies: collaboration between Baylor/Texas

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Program focuses on three doctors outside their room, but immunology, rheumatology, genetics, rare lung diseases we’d have 20, some even from different transplant medicine, diagnostic hospitals, who were there to help imaging and pathology,” said Teamwork Never heard of BOOP, NEHI or PIG, Ethan,” said his father, Steven Smith .“It Silva-Carmona, assistant professor of at Its Finest much less how to treat them? Not felt like the cavalry had come ”. pediatric pulmonology and critical to worry . Manuel Silva-Carmona, MD, care medicine at Baylor College of director of the Rare and Interstitial In fact, for children like Ethan, it takes a Medicine .“The ability to provide Lung Disease program at Texas cavalry of medical professionals to find some of the best diagnosis and care Children’s Hospital, can help . a diagnosis and successful treatment . across multiple disciplines is what Initially, his parents wrote down the makes Texas Children’s rare ”. The simplicity of acronyms such name of everybody who helped them, as BOOP, NEHI and PIG belies the but after three-and-a-half months the In search of answers complexity of interstitial lung diseases, list had “literally hundreds” of names, It’s not unusual for these patients to be a general diagnostic term for a group Steven said . referred to Texas Children’s because of rare respiratory disorders, some their local doctor can’t figure out caused by genetics, others from what is wrong . Like Ethan, what starts “Part of our commitment is to acquired lung injury . work in collaboration with other as a common infection like RSV leads pediatric specialists to better to a severe pneumonia . Or, it may In addition to their obscurity, these understand, diagnose and treat be an infant or teen with recurrent conditions usually impact multiple the rare lung diseases and improve bleeding in the lungs, lung collapse, or outcomes for these patients.” uncontrolled pulmonary hypertension organs, making diagnosis and treatment – Manuel Silva-Carmona, MD more complex . Rare lung diseases combined with arthritis . require multidisciplinary medical teamwork at its finest. Ethan ultimately spent three “Not enough is known about some of months in the PICU, with 20 days on these diseases,” Silva-Carmona said . Case in point: Ethan Smith of Winnie, ECMO (extracorporeal membrane “While we are more aware of these Texas, was born at 38 weeks, what oxygenation), as Silva-Carmona and conditions compared to a few years doctors call early term but not a team of other physicians tried to ago, and we have become better at premature . Just two weeks later, his decipher exactly what was wrong . making timely diagnoses, there’s much parents noticed symptoms of RSV, ECMO uses a pump to circulate blood more work to be done ”. respiratory syncytial virus, an infection through an artificial lung back into the that can lead to life-threatening bloodstream, allowing the lungs to Silva was recruited in 2016 to lead the respiratory problems . rest and heal . Texas Children’s Rare and Interstitial Lung Disease program due to his Within two days, Ethan had been With time, doctors diagnosed experience in both lung disease and transported by Texas Children’s Ethan with a pulmonary growth intensive care . He inherits a program Kangaroo Crew from his pediatrician’s abnormality .This disease results in that was one of the first in the country, office in Galveston to the Pediatric lung underdevelopment and is more founded by Leland Fan, MD, in 1995 Intensive Care Unit (PICU) at Texas common in premature patients or and nurtured by Tim Vece, MD, prior to Children’s Hospital . Ethan was critically patients with heart disease, making Silva-Carmona’s arrival . ill, and his respiratory system had failed . Ethan’s case unusual . He had to be intubated, which exposed Being trained and board certified in him to two more infections . “For these lung disease patients, it’s both pulmonary and intensivist care great that our Pulmonology Medicine makes Silva-Carmona uniquely qualified Cavalry arrived Service is rated number one by to help these young patients . So many of “Every morning they’d do rounds, and U.S. News & World Report . But these them end up in hospital ICUs and have a Peter W. Hiatt, MD, chief of the Pulmonary Medicine Service, examines a young patient with a rare lung disease. other families would have maybe two or children also need our expertise in disease that affects multiple organs .

Department of Pediatrics 2016 Annual Report 11 Patient Care Types of rare lung disease

Typical symptoms in children referred to • Aspiration associated lung diseases • Hypereosinophilic disorders His dual training also gives him into better patient care, in the form closely with the Vascular Anomalies the program include diffuse lung disease experience working with multiple of quicker diagnosis and changes in and Bone Marrow Transplant programs . visible in imaging, decreased oxygen levels • Autoimmune or rheumatologic related • Immune-mediated lung disease specialists to find the right treatment treatment to reduce the incidence of Such cross-pollination of research and abnormal respiratory patterns such lung disease • Immunocompromised host associated for very sick children . lung injury . into what works for these patients as fast or labored breathing . ultimately will help the team reach • Bone marrow transplant associated lung disease lung disease “Part of our commitment is to work “Especially for the interstitial lung diagnoses more quickly and Acquired lung disease may be caused by • Primary immunodeficiency associated in collaboration with other pediatric disease patient, a large referral improve treatments . rheumatologic and immunologic disorders . • Cryptogenic organizing pneumonia lung disease specialists to better understand, program like ours helps generate In some cases, chemotherapy or radiation formerly known as bronchiolitis obliterans diagnose and treat the rare lung the critical mass needed to conduct A happy ending needed to treat cancer or prepare the organizing pneumonia (BOOP) • Lymphocytic interstitial pneumonia diseases and improve outcomes for the research that leads to quicker At 3 months old, Ethan was released body for transplant can contribute to the • DNA repair disorders • Lysosomal storage disorders these patients,” Silva-Carmona said . diagnosis and better treatments,” from Texas Children’s . He weighed 8 development of lung disease . Silva-Carmona said . pounds, was on oxygen 24 hours a day, • Drug induced lung disease • Neuroendocrine hyperplasia of infancy To that end, Silva-Carmona is leading and needed a feeding tube . He had little Rare lung disease diagnoses include: (NEHI) an effort to formalize the team’s Earlier diagnosis, muscle tone after having spent so long • Eosinophilic pneumonia • Acute interstitial pneumonia/pneumonitis • Nonspecific interstitial pneumonia multidisciplinary collaboration better treatments attached to various pieces of medical • Follicular bronchiolitis with other subspecialties such as Much has been learned about many equipment and being unable to move • Alveolar capillary dysplasia • Pulmonary interstitial glycogenosis (PIG) Immunology, Rheumatology and Bone pediatric conditions, but some, like around like other babies . • Pulmonary growth abnormalities • Alveolar hemorrhage syndromes Marrow Transplant, with the ultimate rare lung diseases, remain tantalizingly • Pulmonary histiocytosis • Hypersensitivity pneumonitis goal of improving patient care . obscure .Texas Children’s plans to “It was a big learning curve, dealing • Pulmonary lymphangiectasia change that . with all the equipment, giving him In addition to expert physician shots twice a day, and reinserting his specialists, the team includes nurses, While only in place for six months, Silva- nasogastric tube when he pulled it out,” social workers, dietitians, pharmacists Carmona has already begun the process said Ethan’s mother, Kellie Comeaux . and physical and occupational of formalizing the collaboration that therapists dedicated to the care of takes place for every Texas Children’s Today, Ethan has gained weight and is children with these complex and often patient with such conditions . off oxygen, and he’s busy getting into severe diseases . mischief with his siblings like other He’s identified a core group of healthy, rambunctious 2-year-olds . He is Refuge and resource physicians in different pediatric followed closely by Silva-Carmona and “It’s not unusual for a pediatric subspecialties who are also interested his team, as they continue to search for pulmonologist in a smaller city or less in these complex patients .This early a definitive diagnosis for Ethan and populous state to see only one or two groundwork has resulted in more his parents . of these cases in a lifetime,” said Peter patients being referred to his program . W . Hiatt, MD, chief of the Pulmonary Once Ethan is 6 years old, he will be Medicine Service at Texas Children’s “Through this collaboration we able to take a pulmonary function test and associate professor of pediatrics streamline the very complex clinical to determine the long-term damage at Baylor .“There aren’t many papers care that these patients receive,” to his lungs .They still keep oxygen about these conditions, and there Silva-Carmona said .“Thanks to and a pulse oximeter handy for the are virtually no randomized trials for our multidisciplinary approach, this occasional respiratory infection . these kids ”. collaboration also helps us improve our chances of recognizing diseases that “It’s truly amazing because he was That’s why the volume of patients seen might otherwise fly under the radar.” so sick but now there’s nothing he in Texas Children’s Rare and Interstitial can’t do . He’s a very driven kid,” Lung Disease program is an asset .The In addition to partnering with Steven said .“To have a child get 100+ children followed by this program Immunology, Rheumatology, Genetics, that sick, to literally kiss death, and provide the volume needed to amass Transplant Medicine, Diagnostic Imaging come out the other side . It’s an Manuel Silva-Carmona, MD, director of the Rare and Interstitial Lung Disease program, research data points that translate and Pathology, Silva’s team also works amazing experience ”. is formalizing the team’s multidisciplinary collaboration with other subspecialties.

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Global initiative changes and treat pediatric blood disorders pediatric oncologist in the country, outcomes of cancer and and cancer in Botswana, Malawi and he recognized the need there and blood disorders in Africa Uganda .The initiative also will create stayed for three and a half years . In They Can significant clinical, educational and that time, he increased the overall Survive In the United States, 80 percent research capabilities . Doctors, nurses number of cancer diagnoses threefold, of children with cancer survive . and ancillary professionals will be and increased cancer survival two and In sub-Saharan Africa, the overwhelming recruited from around the world to a half-fold in Princess Marina Hospital, majority of pediatric patients do not provide training to local health care the nation’s leading teaching hospital, survive .The mortality rate is estimated professionals and to continue treating where he practiced . to be as high as 90 percent, meaning children with blood disorders that thousands of children die from and cancer . Since then, Texas Children’s has had cancer across Africa each year . a pediatric oncologist continuously located at that site . Mehta now is The high mortality rate is in large “We believe in these countries associate director of Global Oncology there are more than 11,000 new and the Malawi Program at Texas part due to an inadequate health care cases annually of pediatric cancer infrastructure and a significant lack and 40,000 new cases of serious, Children’s and assistant professor of of expert physicians and other health life-threatening blood disorders pediatrics at Baylor College care workers trained to treat children such as sickle cell disease and of Medicine . with cancer . hemophilia, many of which are currently going undiagnosed.” – David G. Poplack, MD Through Global HOPE, the Bristol- Now there’s hope in the form Myers Squibb Foundation is of a comprehensive initiative called committing $50 million over five years Global HOPE – Heal the Children Solid foundation to fund the training of local health (Hematology-Oncology Pediatric “This project is building on a solid care providers as well as clinical Excellence), which will build long-term foundation for pediatric cancer infrastructure and operations . BIPAI/ capacity to treat and dramatically treatment in Botswana that began Texas Children’s will raise an additional improve the prognosis of thousands over a decade ago with pediatric $50 million for the initiative . of children with cancer and blood oncologists from Texas Children’s disorders in southern and Cancer and Hematology Centers,” “We are eager to get started on this eastern Africa . said His Excellency the President critical initiative to help children with Lieutenant General Dr . Seretse Khama blood disorders and cancer .Working In February 2017, the Bristol-Myers Ian Khama of the Republic of Botswana . with our partners and drawing on our Squibb Foundation, Texas Children’s “The Global HOPE program will bring expertise of building sustainable health Cancer and Hematology Centers to Botswana the latest biomedical systems in underserved countries, we and Baylor International Pediatric technologies and the potential to will help make a significant difference AIDS Initiative at Texas Children’s work with local institutions such as in the outcomes for children while Hospital (BIPAI), through public-private the Botswana Innovation Hub and creating a blueprint for other countries partnerships with the governments University of Botswana to quickly to follow,” said Giovanni Caforio, MD, of Botswana, Uganda and Malawi, increase the survival of children with chairman of the board of the Bristol- announced a $100 million initiative cancer and life-threatening blood Myers Squibb Foundation and chief to create an innovative pediatric disorders in Botswana and the region ”. executive officer, Bristol-Myers Squibb hematology-oncology treatment Company .“This initiative builds on 18 network in southern and eastern Africa . Texas Children’s Cancer Center’s years of success of the Foundation’s presence in Africa began in 2006, SECURE THE FUTURE program Global HOPE will partner with local when Parth Mehta, MD, MPH, went and will offer new hope to families governments and ministries of health to Botswana as a member of BIPAI’s impacted by pediatric blood disorders Oaitse Wally, MD, a resident in the University of Botswana Pediatrics Residency Program, Pediatric AIDS Corps. As the first and cancer ”. gives chemotherapy to a patient at Princess Marina Hospital, Botswana’s main teaching hospital. to build medical capacity to diagnose

Department of Pediatrics 2016 Annual Report 15 Patient Care Building on the success of the BIPAI model

As public-private partnerships, the of pediatric cancer and 40,000 new in sub-Saharan Africa (outside of The Global HOPE initiative will be modeled Since 2003, the Bristol-Myers Squibb “The success we’ve had in radically on the work of the Bristol-Myers Squibb Foundation and BIPAI have trained 52,000 changing the course of pediatric HIV/AIDS various governments each will play cases of serious, life-threatening blood South Africa) . A similar program will Foundation, BIPAI and the governments health care professionals and currently in sub-Saharan Africa is due in large part to an important role in developing disorders such as sickle cell disease be established in Botswana to train of Botswana, Uganda and Malawi, which provide care for nearly 300,000 children the tremendous support provided by the the pediatric hematology-oncology and hemophilia, many of which are additional pediatric hematologists- created the largest pediatric HIV treatment with HIV and their families in sub-Saharan country governments, health care providers network, assisting with the training, currently going undiagnosed,” Poplack oncologists for southern Africa . network in the world, leveraging existing Africa, lowering the mortality rate for these on the ground and donors who have made technology, logistics and resources to said .“Because of these staggering experience, infrastructure and public/ children from nearly 100 percent to our work possible,” said Mark W . Kline, MD, support Global HOPE . numbers, more health care providers Global HOPE also is providing private partnerships . 1 .2 percent . president and founder of BIPAI, physician- with special expertise are urgently comprehensive multidisciplinary training in-chief of Texas Children’s and chair of the Not enough experts needed . Global HOPE will help build programs for all levels of health care Department of Pediatrics at Baylor . “With only five pediatric oncologists capacity in the region to diagnose and workers needed to provide excellent currently in the countries of Botswana, care for children with blood disorders pediatric hematology-oncology care . Malawi and Uganda combined, there and cancer, offering the potential for are simply not enough expert doctors transformational change in survivorship “They say that pediatric oncology is to treat all the children diagnosed for these children ”. the rising tide that floats all boats. To with blood disorders and cancer,” said take excellent care of children with intensivists, infectious disease experts, and oncology at each of the seven The five-year Global HOPE initiative David G . Poplack, MD, director of Texas The new East Africa Pediatric cancer, you have to partner with many pharmacists, specialized nurses and current BIPAI sites .The initiative is is envisioned as the first phase of a Children’s Cancer and Hematology Hematology and Oncology Fellowship different disciplines,” Poplack said . social workers .This effort will improve developing a template for effective long-term project . Although it will Centers and professor of pediatric Program in Uganda already has the care not just for children with expansion as needed, using innovative take many years to accomplish, the oncology at Baylor . enrolled four Ugandan pediatricians as Excellent pediatric cancer care cancer and hematology, but for all solutions for temporary facilities eventual goal is to bring the cancer the first trainees. They will graduate requires pediatric specialists including pediatric patients in major cities where while long-term facilities are under and blood disease care in these “We believe in these countries there in two years as the first pediatric oncologists, cancer surgeons, these programs are located . construction . Standardized facilities countries to the point that excellent are more than 11,000 new cases annually hematologists-oncologists fully trained radiotherapists, pathologists, that are sturdy, easy to maintain and outcomes, equivalent to those in the The Global HOPE initiative will transportable can be used for several U .S ., will be achieved at all of the train an estimated 4,800 health care years as doctors’ offices, pharmacies sub-Saharan sites . professionals from Botswana, Uganda, and laboratories and then shipped to Malawi and other African countries . the next location . The program estimates that more than 5,000 children will receive care in the In addition to growing the first five years. physical presence of the Centers of Excellence and the medical “We look forward to helping patients knowledge, Global HOPE will reach and their families by embarking on out to communities to grow the this uncharted area of cancer care cultural knowledge base . in Africa,” said Mark W . Kline, MD, president and founder of BIPAI, “Churches, communities and families physician-in-chief of Texas Children’s need to begin thinking of pediatric and chair of the Department of cancer as something that they can Pediatrics at Baylor .“Working with beat, and that it’s an important our partners, we aim to build a self- investment,” said Kristi Wilson-Lewis, sustaining infrastructure that changes MSSW, director, Administration Parth Mehta, MD, MPH, visits with the tide of these childhood diseases in and Planning for Texas Children’s Botswana President Ian Khama, center, participates in the groundbreaking for the Botswana Children’s Cancer and Hematology Center a cancer patient during a follow-up of Excellence, in February 2017 in Gaborone, Botswana. Pictured, from left, are Phillip Makgalemele, assistant minister of health and sub-Saharan Africa .” Cancer and Hematology Centers . visit at Princess Marina Hospital in wellness; John Damonti, president of the Bristol-Myers Squibb Foundation; Emmanuel Blin, chief strategy officer and senior vice-president “Engaging the local community Gaborone, Botswana. Mehta was the at Bristol-Myers Squibb; Dorcas Makgato, minister of health and wellness; Khama; Cris Daskevich, senior vice president, Texas Children’s Future holds new promise is important in building cancer first pediatric oncologist to practice in Botswana as a member of the Hospital; David Poplack, MD, medical director of Texas Children’s Cancer Center; Michael Mizwa, COO of BIPAI and director of Texas Global HOPE is expected eventually awareness and the recognition that we Children’s Global Health. Pediatric AIDS Corps. to expand and create a Center of can save lives and give these children Excellence for pediatric hematology back their lives ”.

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Emergency Medicine leads knowledge and training gaps the child began to choke . Then programs for improving among first responders in pediatric he stopped breathing . And then his Wherever children’s outcomes emergency care . heart stopped . They Are Geography – perhaps even more than Texas Children’s Hospital and Baylor His frantic parents called 911 . A the severity of illness or injury – makes College of Medicine have taken the Houston Fire Department team of a big difference in your survival from an lead in developing programs that are prehospital providers arrived at the emergency . Depending on where you improving emergency care for children boy’s home to find him in cardiac are at the time and where you go for across the U .S . and the world .They arrest – the first time the team had treatment, your outcome could be very are using: dealt with a child in that condition . different, according to multiple reports It was not, however, the first time by the Institute of Medicine (IOM) over • Simulation to train prehospital that they had rehearsed for just such the past two decades . emergency providers . an event .

Children face even more challenges • Quality improvement to develop Like airline pilots who train over and to survival in an emergency due protocols for optimum pediatric over again to prepare for unusual to a lack of specialty training and treatment . events, this crew had trained as well . equipment for pediatric care . More They had recently participated in than 27 million children in the U .S . • Partnerships to share improvements Pediatric Simulation Training for visit emergency centers each year, and innovations so that children can Emergency Prehospital Providers with almost 2 million of those receive the best emergency care, (PediSTEPPs), initially funded by the arriving to the hospital by Emergency wherever they are . Cullen Trust for Health Care and Medical Services (EMS), also developed by a multidisciplinary team known as prehospital care . Not all Training providers of paramedics, EMS medical directors, hospitals have the special equipment, It started with an everyday activity, pediatric emergency medicine facilities and personnel needed for a 3-year-old boy having a snack of physicians, and simulation specialists optimal care of children, and a 2007 starfruit at home . Somehow a piece of from Texas Children’s, Baylor and the IOM report identified significant fruit became stuck in his throat, and Houston Fire Department .

With the cooperation of a nearby high school, Pediatric Emergency Medicine conducts a mass disaster training for members of the Houston police and fire departments. Members of the Houston Fire Department’s Emergency Medical Services take part in a Texas Children’s Hospital Pediatric Simulation Center training to be better prepared for treating children.

Department of Pediatrics 2016 Annual Report 19 Patient Care Patient Care

Within seconds of arriving at the Emergency Medicine at Texas Children’s Written protocols improve upon check- Improving hospital quality worldwide and one of the highest cost Collaboration goes national little boy’s home, the team removed and associate professor of pediatrics at off lists because they are based on Many of the protocols that start in an illnesses for a hospital . “We were one of the first hospitals the starfruit and performed Baylor . In addition, he serves as pediatric evidence from research . ambulance eventually progress through to have this protocol for pediatric cardiopulmonary resuscitation (CPR), medical director for the City of the entire hospital system, from Texas “Guidelines had been in place for years, septic shock care,” Patel said . As following an established protocol . Houston Fire Department EMS, on call “I tell my medics as I educate, ‘You Children’s Emergency Center (EC) but when you really looked at Texas the American Academy of Pediatrics By the time the child reached the for tough cases that call for experienced guys are 18, 20, 25 years old, and you to critical, inpatient and outpatient Children’s process, we weren’t actually was launching a quality improvement Texas Children’s Emergency Center, judgment beyond the protocols . are actually treating patients in some care . In addition, guidelines for a doing those things,” Patel said .“It’s not collaborative for sepsis under the he was awake, breathing on his own of the same ways we treat them in particular department often have an that it was bad people; it was a bad leadership of faculty at Baylor, three and responding to spoken words .The As the fourth largest city in the our ER,’” Sirbaugh said .“It’s not just EC component . system that was causing delays and papers about the local sepsis work emergency responders credited their country, Houston has one of the trying to make them feel good; it’s preventing the best care possible ”. were published by the Texas Children’s PediSTEPPs training for helping them busiest EMS systems . true .They’re actually very well trained For example, Texas Children’s Cancer improvement team . save the child’s life . folks that are constantly educated and Hematology Centers have specific To develop an effective protocol, “We looked at the guidelines and and tested ”. guidelines for children who come into Emergency Medicine partnered Eventually, 44 hospitals across the Nationally, only about 10 percent training for prehospital providers, the EC with fever . Because the children with Critical Care, Infectious nation joined the collaborative to of calls to EMS involve children, and we looked at the most recent Jennifer Arnold, MD, MSc, former are at high risk of developing infections, Disease and high-risk subspecialties learn and use shared information . according to the IOM report evidence — what are the best medical director of Texas Children’s faculty created guidelines that call for like Hematology-Oncology and The resulting improvements are Emergency Care for Children: Growing pediatric practices for everything from Pediatric Simulation Center; quick evaluation, lab tests, antibiotics Transplant . The multidisciplinary being analyzed .That collaborative Pains . Many emergency care providers cardiac arrest to seizure to drowning,” Manish Shah, MD, MS, prehospital and collaboration with the Cancer approach also included nurses, has transitioned into an even larger rarely encounter pediatric patients, Sirbaugh said .“Then all the amazing domain lead for the National Center to help provide the best care respiratory therapists, pharmacists and more broadly scoped initiative, making it difficult for them to experts in this institution worked with EMS for Children Innovation and for patients . and information systems (IS) . IPSO (Improving Pediatric Sepsis maintain pediatric skills . us to develop written protocols ”. Improvement Center, director Outcomes) through the Children’s of the EMS for Children State “We are more than 95 percent Hospital Association of America . “Finding a way to train 5,000 providers Making a list and checking it twice Partnership in Texas and associate effective at meeting our goal of “Finding a way to train 5,000 EMT Co-chaired by Baylor associate to give consistently good care to Research in the last decade has proven professor of pediatrics at Baylor; and antibiotics within one hour, which providers to give consistently good professor of pediatrics Charles Macias, pediatric patients is not an easy task,” that check-off lists improve care and Cara Doughty, MD, MEd, associate means we’re doing a very good job care to pediatric patients is not MD, MPH, IPSO looks at sepsis care an easy task.” said Paul Sirbaugh, DO, MBA, chief of safety, even with expert medical staffs . professor of pediatrics at Baylor, of making sure we take care of some not just in the EC, but through an – Paul Sirbaugh, DO, MBA were the Texas Children’s physicians of our sickest patients,” said Binita entire hospital system . who collaborated with the Houston Patel, MD, chief of Quality and Safety Fire Department to create the nine- for Emergency Medicine at Texas “Sepsis is a great example of addressing hour PediSTEPPs curriculum . Children’s and associate professor of “We had support from the bottom a problem through teamwork and pediatrics at Baylor . up, including executive leadership,” collaboration, rather than finger Beginning in 2012, simulation-trained Patel said .“It had to be something that pointing and blame,” Patel said .“It was Pediatric Emergency Medicine faculty The Emergency Medicine Quality the hospital valued . Leadership was one of the key elements that helped and educators from Texas Children’s Improvement team is heavily involved vested in it, and said that we want to bridge a gap between nurses and Simulation Center and Houston Fire in evidence-based guideline creation make this happen .Through months physicians, where we started working Department conducted two courses per for Texas Children’s, working with of planning and stakeholder meetings, together on projects ”. month to train teams of 12 to 14 Basic other Texas Children’s providers and figuring out what wasn’t working and Life Support (BLS) and Advanced Life Baylor faculty content experts through what we should be doing, we were Shared leadership in quality Support (ALS) providers .When tested, the Evidence-Based Outcomes Center able to create a protocol to treat improvement both BLS and ALS providers showed at Texas Children’s . these kids faster ”. As so often is true in a hospital, the an immediate, significant increase in frontline nurses are key to improving knowledge and self-confidence. Sepsis was the topic of one of the When implementation of the sepsis processes and implementing protocols higher impact protocols created quality improvement project began and guidelines . EC nurses not only By 2017, the training has reached 1,600 for the whole hospital . Sepsis, an at Texas Children’s in 2009, mortality participate in quality improvement Written treatment protocols in the Pediatric Emergency providers from Houston, and has been overwhelming infection that can affect from septic shock was 8 to 12 projects but also are empowered Center are based on evidence from research. adapted to reach other providers in all the organ systems of the body, is percent . Now the 30-day mortality is to suggest and lead improvement the U .S . and Botswana . one of the leading causes of death consistently 2 to 4 percent . opportunities .

20 Department of Pediatrics 2016 Annual Report Department of Pediatrics 2016 Annual Report 21 Patient Care Patient Care

In 2016, EMSC created the EMSC to connect the dots and empower the The EIIC is getting ready to launch for others to learn, adopt and Innovation and Improvement Center best of the best to be able to drive a reassessment for the National improve their outcomes ”. Emergency Medical Services train to give better care to children through simulations of trauma and disasters. (EIIC) to increase comprehensive, rapid some of these strategies,” Macias said . Pediatric Readiness Project (NPRP) uptake of quality improvement strategies “A lot of the things that began as in 2018 .The NPRP was built by The EIIC partners with other that reduce mortality and morbidity innovations here at Baylor and Texas consensus with multiple stakeholder organizations to drive data analytics among children in urgent and emergency Children’s we’ve been able to expand organizations to identify the to create greater transparency in care settings, no matter where they live and disseminate throughout the rest of characteristics of pediatric readiness . outcomes of performance measurement or travel in the United States . the country ”. across 58 states and territories “In two national surveys of more through the network of EMSC State “We realized that what was going to One of the partners in broad sharing than 4,000 hospitals, we’ve seen Partnerships . Using quality improvement drive innovation and improvement was of innovations has been the Center some improvement in pediatric strategies to bridge gaps in high quality going to be a stakeholder group that for Collaborative and Interactive readiness scores across the care delivery, the EIIC is working had quality improvement skills and also Technologies, led by C . Michael Fordis country,” Macias said .“But the with its national partners and federal content expert knowledge,” said Macias, Jr ., MD, senior associate dean for scores also have demonstrated collaborators to drive improvements who is executive director of the EIIC . continuing medical education at Baylor . huge gaps for many hospitals in in disaster preparedness, trauma, The center uses enhanced technology becoming pediatric ready ”. prehospital care and research across the The EIIC focuses on the critical to communicate research findings country, and is expanding some of those domains in emergency medicine: and the best science in a variety of The NPRP is designed not only to partnerships across the globe . materials and technology platforms make repeated assessments but also • disaster planning that can be used by physicians, to provide tools to help institutions “The bottom line is we’re doing a • trauma patients and policymakers . understand how to identify and lot to improve the outcomes of the At Texas Children’s, Daniel Christopher, interview families and see what they • prehospital care bridge their gaps . children that we treat,” Macias said . RN, became a quality improvement thought of it,” said Christopher, who Getting ready for kids “We never lose sight of that .That is specialist in the EC to help increase received one of the hospital’s highly • hospital-based care “One of the challenges that we “The intensity of our work has what we’re here for ”. patient safety and improve the overall valued Catalyst Leadership Awards • research have recognized is that fewer than grown tremendously,” Macias said . experience for both patients and their for 2017. “The very first person we roughly 85 percent of children with “The more we learn about what’s Improving children’s outcomes is the families .Through collaborative work, he interviewed turned out to be a nurse Matrixed into that activity are core emergency conditions are treated in successful, the more we can provide ultimate goal . has helped define flow processes within domains in quality improvement: who worked at an adult hospital pediatric facilities,” Macias said .“How the EC and through the continuum of somewhere else . She said, ‘I wish we do we reach out to the rest of the care into inpatient units . • advocacy Texas Children’s Main Campus Patient Satisfaction Rates did this where I work ’”. community to make other medical • education institutions more capable of handling 2 FY17 YTD: 84.7 The EC has defined a more efficient, Efforts have led to improvement in • collaboratives 0 pediatric emergencies?” Goal: 84.6 • measurement timely and patient-centered model of the EC “Left without being seen” rates flow through the department. Projects and in patient satisfaction over the last • evidence-based practice The EIIC collaborates with 14 6 85.3 have involved the creation of an onsite 84.4 84.4 three years . • patient safety states on a quality improvement Urgent Care unit to help with low acuity collaborative to recognize facilities patients, using physicians in triage, and 2 Spreading the word Teams at Texas Children’s and Baylor that are ready to manage children . In rapid placement of patients into rooms . 0 through partnerships collaborate with partners at the Texas, the EIIC has worked with the Decreasing mortality and morbidity American Academy of Pediatrics, Governor’s EMS Trauma Advisory The EC has also partnered with for children in emergencies by American College of Emergency Committee to endorse a facility 6 inpatient units to improve flow. One ensuring they receive the highest Physicians, Emergency Nurses recognition program, so that both example of this is the EC-to-inpatient quality care is a goal of the Emergency Association and National Association individuals and EMS providers will ct 16 o 16 Dec 16 an 1 e 1 ar 1 Apr 1 a 1 un 1 ul 1 Au 1 ep 1 patient transport process allowing Medical Services for Children of State EMS Officials, and work know where to go for the best 1 1 16 1 nurses a face-to-face report in the (EMSC) program, funded by the cooperatively with their federal care for specific types of illness or inpatient unit . Health Resources and Services partners at HRSA . injuries in children . It also will help all Administration (HRSA) of the U .S . Multiple quality improvement efforts in the Texas Children’s Emergency Center over the past institutions become more prepared to three years have improved processes so that patients can be seen more quickly and efficiently. “When we rolled out the patient Department of Health and “There’s a lot of great work going on in manage children . As a result, patient satisfaction rates have gone up. transport process, I went upstairs to Human Services . silos all across the nation, so we want

22 Department of Pediatrics 2016 Annual Report Department of Pediatrics 2016 Annual Report 23 Patient Care

Palliative Care team helps from the prestigious Children’s and emotional support for patients, families and children with Hospital of Philadelphia, where she their families and their siblings . And Navigating serious illness started a palliative care team and it’s just helping families navigate this managed it for the past 15 years . very complicated health care system ”. Complex When a patient’s mother needed it She launched the program at Texas Systems most, she found an incredible resource Children’s in October 2016 . To provide that support takes an and sense of relief in the form of interdisciplinary team of physicians, Texas Children’s Palliative Care team . Clearing up misunderstanding nurses, social workers, child life Her teenage son with developmental “Many people have the idea that specialists, chaplains and other delays had just been hospitalized for palliative care is hospice care or support specialists . the fifth time that year with pulmonary end-of-life care,” Kang said .“We problems, and the Palliative Care team certainly partner with hospice “Many of the kids have issues with came by for a visit . agencies in the community to provide multiple organ systems, where they have those kinds of services, if that’s what 20 or 30 medical problems that you’d “I’ve never had the chance before to the patient is facing and that’s the expect from someone in their 70s or sit and talk to a team of people – from family’s choice . But the vast majority 80s,” said Daniel Mahoney, MD, palliative the physician to the social worker to of children served by pediatric care physician at Texas Children’s and the chaplain – about what my concerns palliative care providers are not in assistant professor at Baylor . are for his future, what it’s like to hospice care and are not terminal . manage a special needs child in a home Instead, these are children with Sometimes the course of treatment, by yourself as a single parent, how to complex, serious illness who require such as chemotherapy or bone marrow manage two other children, or how additional support and services for transplants, may cause problems in the to manage expectations of extended managing distressing symptoms . It’s heart or kidneys . A problem in the family members and what they think for helping families understand the genetic code can affect every organ you should be doing with a child with medical processes and interventions, system in the body – the brain, heart, special needs,” the mother said . for providing psychosocial, spiritual lungs, kidneys and liver .

Helping parents verbalize their challenges and focus on what they want to accomplish with their seriously ill child are among the goals of the new system-wide Palliative Care program at Texas Children’s Hospital .

“What we have tried to promote is the understanding that palliative care is about maximizing quality of life, and improving care and support for children and families with serious illness, regardless of prognosis,” said Tammy Kang, MD, section chief of Palliative Care at Texas Children’s and associate professor of pediatrics at Baylor College of Medicine . Tammy Kang, MD, leads the Palliative Care section at Texas Children’s Hospital to help children with serious illness and their families. Kang, who also holds a clinical Jill Ann Jarrell, MD, MPH, who has dual appointments in palliative care and complex care, directs the new Pediatric Palliative Care Fellowship program, one of only 11 accredited programs in the U.S. epidemiology degree, was recruited

Department of Pediatrics 2016 Annual Report 25 Patient Care Patient Care

“Often kids have multiple specialists who Susan Blaney, MD, deputy director then communicates with both sides to and to provide the best care and the Besides emotionally supporting the palliative care field forward through try to coordinate care,” Mahoney said . of the Texas Children’s Cancer and help with the decision-making process . best support both in the hospital staff, the team provides education actively engaging in educational and Hematology Centers and executive and in the community,” Kang said . about palliative care to staff at Main research opportunities . A number Long-term attitude vice chair of the Department of “I think a lot of families have ideas “I perceive our outcomes as being Campus, The Woodlands and West of researchers across this institution Although the formal, system-wide Pediatrics, and Perry Ann Reed, about what they think, but they haven’t successful if we are doing our very best Campus . Beginning next year, team right now have research interests Palliative Care program is new at Texas director of Ethics and Palliative Care articulated them .They haven’t made for every patient and every family that members will be working with and relevant to palliative care, where I Children’s, individual palliative care at Texas Children’s, the organizational any plans or contingencies . Just offering walks through the door ”. helping to educate a fellow, who will think important questions could be programs existed in several service umbrella opened in 2016 with support them a space in which to communicate become a board-certified palliative answered here relatively quickly ”. lines . And, of course, working as a team from the Department of Pediatrics and and to clarify is very helpful . It’s not high Significant support for staff care physician .They anticipate to provide the best care for very sick Texas Children’s Hospital . tech, but high touch is really important ”. In addition to caring for patients and broadening their reach to areas of Putting its large, diverse patient children is not a new concept at families, the team helps support staff . the hospital that haven’t yet started population to good use for research, Texas Children’s . “One of the things that already Available 24 hours a day referring patients and to community Texas Children’s is a member of the existed here is this commitment It may not be clear in the first visit how “We didn’t really anticipate support physicians, educating them on the Pediatric Palliative Care Research A landmark report published in from the leadership on down to the the team can be helpful, but it becomes for staff as being so significant,” benefits of palliative care. Network, a research group of children’s 2000 by the Institute of Medicine, clinical providers to really provide the clear as they get to know the family Hesselgrave said .“To take care of and hospitals in the U .S . and Canada . When Children Die: Improving Palliative best possible care for every patient, and build a long-term relationship .The be the witness and the caregiver for “We are committed to developing a and End of Life Care for Children and for every family, regardless of where team provides a cell phone number to children who are very sick or dying research and outcomes platform as In the complex world of medicine, the Their Families, stimulated work across they came from, what their diagnosis parents, staff and referring physicians is very emotionally, physically and well,” Kang said .“We are well poised Palliative Care team leads families and the country to improve palliative care was, or their prognosis,” Kang said . for a phone that is answered 24 hours mentally exhausting . It’s very helpful at Texas Children’s, because it is the staff through the thicket today and programs for children . “What also exists here is this great a day, seven days a week by a physician to have members of our team there largest academic pediatric program uses research to clear the way collaborative energy between the from the team . walking the journey with them ”. in the country, to help move the for tomorrow . In the years since then, medical teams, the department, Texas Children’s has: the hospital and the hospital One of the team’s goals is a home administration that’s needed for our visit program, in which psychosocial • taught twice a year the End-of-Life integrated way of caring for children ”. providers can go to the homes to Nursing Curriculum, developed from check on patients, as well as provide a national Robert Wood Johnson “It’s not high tech, but high touch is support for caregivers and siblings . Foundation project really important.” – Joy Hesselgrave, RN “We know that siblings of children with • started a perinatal palliative care serious illness are at risk for increased service for pregnant women facing The Palliative Care team sees patients health issues, increased learning difficult fetal diagnoses across the hospital and its many clinics . issues, and increased behavioral and In the first 60 days, the team exceeded psychological issues,” Kang said .“These • supported clinicians to attend their estimated patient volume by children are often going through a lot the Palliative Care and Practice about 200 percent . of difficulties because their parents Educational course at Harvard and a are at the hospital, and there is a lot retreat presented by the Initiative for “We’ve heard from families that they of emotional and financial stress in the Pediatric Palliative Care really appreciate this consultant team household . Being able to provide some helping them identify the goals of care,” support for these children in the home • started a palliative care service said Joy Hesselgrave, a longtime nursing is a future goal ”. for Texas Children’s Cancer and staff member in Hematology-Oncology, Hematology Center patients who is now assistant clinical director While physician visits are billed as of Palliative Care .“The team listens medical visits, families are not billed for Under the leadership of Mark W . to what the family thinks they want any of the other services . Kline, MD, physician-in-chief of Texas for their child, listens to the clinical Daniel Mahoney, MD, palliative care physician, meets with interdisiciplinary team to consider the needs of patients. With him are, from left, Joy Hesselgrave, RN, assistant clinical director of palliative care, and Jessica Casas, MD, MPH, palliative care and oncology. Children’s and chair of the Department medical team who manages the medical “We really rely upon philanthropy to of Pediatrics, and with the efforts of care and who says what’s possible, and allow us to think about how to grow

26 Department of Pediatrics 2016 Annual Report Department of Pediatrics 2016 Annual Report 27 Education Education

Residents bring varied Second Look begins Diversity Council supports backgrounds to patient care Efforts to ramp up recruitment of In addition, a Diversity Council was Diversity under-represented minority applicants recently established to support On a given day at Texas Children’s started in 2013 with the Second Look the residents through recruitment, Enriches Hospital, pediatric residents care for program, an opportunity to bring mentorship and outreach . Experience lots of little Texans, who represent the talented under-represented minority ethnic diversity of Houston, one of the applicants back after the interview In 2015, Gillespie sent an email to see most diverse cities in the United States . season is over . who was interested in a group focused on diversity .Within one hour, she had Houston has no ethnic majority and a “It’s not intended to be a second 75 people signed up, and today there breakdown of 37% Hispanic, 37% Anglo, interview, it’s a second chance for them are 120 members . 17% Black, and 8% Asian, according to to look at us and all that we have to the U .S . Bureau of the Census 2015 offer,” Gillespie said . The council is developing a American Community Survey . mentorship program that will help establish a support system for “Houston’s diversity affords us both residents without adding another the opportunity and the mandate formal activity to their already busy to reflect that diversity among our schedules . Members participate in house staff,” said Mark W . Kline, MD, Baylor activities such as Doctors Day physician-in-chief of Texas Children’s Out (visiting local schools to inspire and chair of the Baylor College of minority students to become doctors) Medicine Department of Pediatrics . and Saturday Morning Science (high “I tell candidates for the residency school students visit the medical program that they will interface with school for lectures and activities) . children and families from every imaginable background . Living in “Dr . Kline has really been a champion Houston, they have an opportunity of our efforts to create a culture to include in their circle of contacts Susan Gillespie, MD, PhD of inclusion and diversity,” Gillespie people from all over the globe ”. said .“This is a big commitment, a big The visit includes a welcome dinner, investment of our resources, and it Thanks to efforts of the Department a special grand rounds presentation, takes this kind of top-down support to of Pediatrics, the pediatric residents are meetings with Kline and Mark A . make it work ”. more and more likely to come from Ward, MD, director of the Pediatric equally diverse backgrounds . Residency Program and associate As evidence of its effectiveness, the professor of pediatrics, time to Residency Training program is twice as “We really want our patients to be able interact with fellows and faculty in diverse today as it was five years ago. to interact with health care professionals their area of interest, and a no-holds who look like them and who may share barred lunch with current residents . “Diversity in every sense – ethnicity, some of their experiences because of socioeconomic background, geography, a common background,” said Susan The program has been very successful . gender, age and sexual orientation – is Gillespie, MD, PhD, associate program Three applicants participated the essential to everything that we hope to director for the Pediatric Residency first year, and all three matched to accomplish as a department and as a Program and associate professor of Baylor .This year, of 13 Second Look hospital,” Kline said. “You can’t exclude pediatrics at Baylor .“Patients are more participants, six matched to the part of your talent pool or make them satisfied and tend to do better when categorical pediatrics program, and feel unwelcome in some way . If you their health care professionals are able two matched to the new Primary Care want to be the best, you have to pull Janaki Paskaradevan and Henry Shiau, both third-year pediatric residents, typify the diverse backgrounds at Texas Children’s Hospital. Paskaradevan, LEAD and ACQUIRE program . a native of Sri Lanka, plans to specialize in pulmonary medicine, and Shiau, whose parents are from Taiwan, plans to specialize in gastroenterology. to relate more fully to them ”. from the deepest pool ”.

Department of Pediatrics 2016 Annual Report 31 Education Education

Voices of Diversity Voices of Diversity Voices of Diversity

New track trains future leaders Alex Alali, second-year, plans on Vathsala Ariyaratna, third-year, Peace Dike, second-year, plans on specializing in cardiology joining a pediatric practice specializing in gastroenterology after graduation A new pediatric residency track at Baylor Hometown: Victoria, TX Hometown: Katy, TX Kingwood, TX College of Medicine and Texas Children’s College: Houston Community Hometown: College: UT-Austin Hospital is training primary care physician College, University of Houston and University of Houston College: Medical School: UT Medical Branch leaders committed to serving underserved and Baylor University vulnerable populations . Medical School: Baylor College at Galveston Medical School: The University of of Medicine Texas (UT) Medical Branch at Galveston My parents are from Nigeria .They came to Texas Called LEAD and ACQUIRE (LEADership in Background: My family is originally from Sri Lanka . My through a lottery in 1982 and have been here ever since .They Advocacy/Community collaborations/QUality Background: My dad is Iraqi, and my mom is Colombian, parents left to seek a better life and greater educational left because there was a general lack of opportunity for them in Improvement in primary care Residency Background: and they met in college in England .They were chemical opportunities. They first moved to South Africa, which is Nigeria . Even though they had degrees, there was no guarantee Education), the track has obtained a grant from the State of Texas to train four residents engineers, and that caused them to travel a lot .They had my where my brother was born .They then moved to the United they’d get a job . And if they did get a job, there was no guarantee beginning July 1, 2017. For the first year, sister in England, my brother in New York and me in Sydney, States right before I was born so my father could complete they’d get paid for it . It was that lack of stability that they wanted 147 graduates of U .S . medical schools applied Australia .When I was 10, my parents divorced, and my his master’s at Texas Tech . My father is a professor of to escape, to have a better life for their children . to this track, of which 54 (or 37 percent) were mother and brother and I moved to Houston, and mathematics, and my mother is a family physician . under-represented minorities . then Victoria . Experiences that shaped me: Coming from a family of Experiences that shaped me: After visiting Sri Lanka immigrants, seeing my parents struggle and work so hard and “This program attracts individuals who want Experiences that shaped me: I got kicked out of high in high school, I truly understood the hardships my parents take jobs that they wouldn’t have taken if they’d had better to give back to their communities, people school right after I turned 18, and I wound up leaving home, faced growing up and how fortunate I am to live in the opportunities really instilled in me a strong work ethic and has who have the heart of service,” said Teri L . working in fast food, and sleeping in different places every United States . I realized how much I take for granted – such been my driving force to succeed . I got here (to being a doctor) Turner, MD, MPH, MEd, associate professor and night . I needed stability, so I decided to join the Army . I had as electricity 24 hours a day – and became more grateful for about as quickly as I could – no wandering off that path! vice chair of educational affairs in the Baylor to get my GED first, and then I was in the Airborne Infantry the life that my parents have worked so hard to give me . Department of Pediatrics .“We need to develop for almost four years . I wanted to become a doctor: Partly because of my father . skills for someone who would lead a clinic in an What I like about the program: The people I get to He always wanted to be a doctor, but when he came here he underserved area, who can figure out how to I knew I wanted to be a doctor when: I was in high work with every day are some of the most amazing, smart, had to start from scratch . He had mouths to feed, so he became provide the best and highest quality of care with school biology class and we learned about the heart . Even funny and compassionate people I’ve met in my entire life . a psychologist because it was quicker than medical school and a limited amount of resources ”. though I wasn’t the most motivated student at the time, Our residency class is so diverse, and being Sri Lankan hasn’t residency. My mother is also in a health field; she’s a substance I knew I wanted to become a heart doctor .The whole made me feel isolated, only unique . I’ve met people from so abuse counselor . The residents will learn to collaborate with time I was in the Army, my goal was to go to college and many unique cultures and backgrounds, and understanding their communities and partner with other become a doctor . While I was an undergrad, I supported and learning about them has made me a more well-rounded Why gastroenterology: I like it because there are so many organizations to solve problems and to advocate, myself as an EMT, because I wanted to be gaining some person . For example, one of my closest friends is from different pathways you can take with it . I’m really interested in not just for individual patients, but for changes useful experience in the medical field. I’ve been narrowly Eritrea, a country in Africa I didn’t even know existed until the way the body processes food – how important it is, how it on a broader scale . focused on this goal for a very long time now, and I’m finally I met her! I attended her wedding, which incorporated works in our bodies, how it can be harmful or healing . I want to applying for my pediatric cardiology fellowship . It’s exciting . traditional Eritrean customs, and I enjoyed learning so much be a clinician because I love interacting with patients and helping about her beautiful culture . Leading the residency track are Teresa Kay them feel better . Duryea, MD, and Lanessa Bass, MD, MEd, co- You might overhear me say: “I want to be able to look program directors and associate professors of back on my life and see that it had meaning ”. I haven’t You might overhear me say: “Speak up!” As a woman I Why Baylor/Texas Children’s: This was one of my last pediatrics; Julieana Nichols, MD, MPH, associate worked this hard to do something meaningless with my life . think sometimes we forget to be assertive because we were interviews, and probably because I’m from Houston and I director and assistant professor of pediatrics; There’s nothing more rewarding than taking care of the raised to be demure and polite . My intern year I received wanted more excitement, it wasn’t really high on my list .Then and Jill Roth, MD, assistant director and assistant sickest children . feedback from a female attending that because I spoke so I came here and met the program director, and my whole list professor of pediatrics . softly to other physicians, they were zoning out during my was immediately turned upside down . It’s hard to describe the presentations .Throughout my training I’ve worked with so feeling; there’s a certain energy that is created because of all the many strong women that have taught me to be confident in For more information, please contact different types of residents they pick . It makes this place feel who I am and what I can do . Now as a supervisor, I always Holly .Hummel@bcm .edu . like home. And not just the residents, the faculty. You’re rubbing advise my female interns to let their voice be heard! elbows with some of the smartest people you’ll ever meet, but there’s a humbleness and a lack of pretention that is really hard to find elsewhere.

32 Department of Pediatrics 2016 Annual Report Department of Pediatrics 2016 Annual Report 33 Education Education

Voices of Diversity Voices of Diversity Voices of Diversity Voices of Diversity

Josh Hilliard, second-year, plans on Flora Nuñez Gallegos, second-year, Janaki Paskaradevan, third-year, Dani Roberts, first-year at specializing in sports medicine and plans on specializing in cardiology and plans on specializing in Children’s Hospital of San Antonio primary care public health pulmonary medicine Hometown: Katy, TX Hometown: Houston Hometown: Los Angeles, CA Newport, Minnesota Hometown: College: Trinity University College: Johns Hopkins University College: UCLA University of Minnesota College: Medical School: Texas A&M Medical School: UT Southwestern Medical School: Stanford University Medical School: Johns Hopkins University in Temple at Dallas Background: I was born in a small village in El Salvador and Background: My parents are from northern Sri Lanka . My Background: My dad is this huge, redheaded English man, Background: I was raised by a single mom who was a social raised primarily by my grandmother after my mom went two older siblings and I were born in Sri Lanka . But, when a an executive at AIG, and my mother is a tiny 4’11” Chilean worker . I grew up in Greenspoint, considered one of the to the U .S . during the civil war .When I was around 5, my civil war in Sri Lanka escalated in 1988, my parents decided woman, who is a pre-kindergarten teacher . roughest neighborhoods in Houston . I also have an older 60-year-old grandma decided it was safer for us to leave as to leave the country . My older siblings tell me that while sister who is 13 years older than me who was like a second well . After a long journey, we crossed the border into the my mom was pregnant with me, they had to take shelter in Experiences that shaped me: I was born in England mom .We moved out to the suburbs right before I went to U .S . and reunited with my mother . My mother quickly instilled temples during night raids and bombings .This clearly wasn’t and lived there for my first seven years. Then we moved to high school . in me the notion of making the best of each opportunity . the environment my parents wanted for their children . Shortly Buenos Aires for seven years, and I had to learn Spanish . And Particularly when it came to my education . after I was born, my dad was able to get a visa to Canada and then we moved to Katy .That was really hard . Fourteen is a Experiences that shaped me: When I was in the fifth our family moved to Calgary, Alberta .We lived there for about difficult age anyway, and being new and different, and going grade, my mom gave me a children’s version of pediatric Experiences that shaped me: I vividly remember going 10 years before my dad took a job in Minnesota . My parents from a tiny private school to an enormous Texas high school, neurosurgeon Dr . Ben Carson’s autobiography . His story to immigration offices, standing in line all day for an update still happily live in Minnesota . that was a big adjustment .Thankfully, it got easier, and I really influenced me. I found similarities in our lives, and I on our case, meeting so many other families going through made friends. Now, as a doctor in San Antonio, I find my past thought, “Oh, I could do that too ”. There aren’t many people the same thing . My mother worked as a nanny and made Experiences that shaped me: Seeing and hearing about experiences to be really helpful .There are a lot of children from my neighborhood – or even in my family – who get a sure that I had whatever I needed for my education . My the risk my parents took to move my family from Sri Lanka to here who speak only Spanish and live in communities that full-ride scholarship to a place like Johns Hopkins . My mom mother would tell me that “When that day comes, you Canada has shaped me a lot . My dad is a mechanical engineer feel like Latin America, but of course they live in the U .S ., valuing education, seeing my potential and giving me that have to be ready ”. That gave me a strong sense of self and by training and gave up a successful career in Sri Lanka to take and they’re Americans . It creates a bit of a culture clash or book – that really set me off on this path . a desire to make something out of my life and give back to a chance in a new country . My parents struggled for many years, identity crisis . Because I know what it’s like to feel like an my community . with my dad initially working at fast food restaurants to make outsider and like people don’t understand me (literally and Why pediatrics: I love working with children . Medicine is a Fortunately, my green card was approved when I was a ends meet before he was able to go back to school for a degree figuratively), I can better connect to that struggle. really tough job . It’s nice to have a cute face to look at while junior in high school . I got a scholarship to UCLA . And then in information technology. Seeing how much they sacrificed for you’re doing it . Also, children are very resilient . I went to Stanford Medical School, where I concentrated the success of their children has always influenced me, showing Why Baylor/Children’s Hospital of San Antonio: on community health . I also went to Harvard to get a me the importance of hard work and resilience . This is only the second year of our residency program .That Why Baylor/Texas Children’s: My girlfriend and I co- master’s in public health so I could become an advocate presents some challenges, yes, but it’s also a huge opportunity . matched here. At first we thought we wanted to go outside of for underserved communities . I’ve always pushed myself Why Houston: I wanted to be in a big, diverse city that had For many of us, this was our first choice because we wanted Texas, but then she interviewed here and said, “It’s amazing . If because I am acutely aware of the opportunity I have in this a variety of things to offer (sports, theater, museums) . I also to be a leader and we wanted to have a real impact .The we get in, we have to go ”. And of course she was right . Also, I’m country and the sacrifice it took from my family so that I wanted to work in a city where I could care for populations things we do now, the programs we shape or create, those interested in pursuing medicine in underserved communities, might be in this position . that are typically more underserved . Houston seemed a things really matter. They’ll help define this hospital from here and we put a huge focus on that, whether it’s here or abroad . city that was both ethnically and socioeconomically diverse, on out . It’s a responsibility we all take seriously . When I meet with my patients today, I tell them my story, One of our health centers is in Greenspoint . I like the idea of without success being directly correlated to ethnicity . and how, through education, everything is possible . I start going back and helping out in the community I came from . What I like about the program: Because there are conversations with “Where are you going to college?” not Why Texas Children’s: When I came to visit, I was so only 10 residents in our year, we get to know each other “Are you” or “If you ”. Because education is one of the most impressed by the size and scope of Texas Children’s . Before really well, and our personalities and diversity come out What I like about the program: They give us a lot of powerful ways to break the cycle many immigrants find starting residency I didn’t know if I wanted to be a general that much more .We have residents from other states and freedom to pursue our own interests . I’m on a diversity themselves in . council to help the school attract even more diverse faculty pediatrician or a specialist and wanted to be somewhere other countries, like Puerto Rico and Syria, and we really and residents . I also like the people in my program and the that I could be exposed to most aspects of pediatrics .TCH value diversity and promote it . In a new program like this, it’s Why Baylor/Texas Children’s: My decision to come here dumb little things we do together, like go to bouncy houses was perfect for this . I also appreciated the diversity of faculty important to have a good attitude and be prepared to roll up was an easy one . I am surrounded by brilliant physicians, once a month . All 50 of us are really different, but as a whole members and seeing women in leadership roles . It’s always nice your sleeves and get stuff done . If you can do that, you’re in . there is a center for advocacy and policy, and I have the we get along great . I don’t know how they picked us, but it to see a diverse residency program, but having a diverse faculty That’s what I love about it . possibility to impact one of the most diverse communities in just works really well . gives you a wider group from which to find mentors and also the country . shows you the opportunities for advancement .

34 Department of Pediatrics 2016 Annual Report Department of Pediatrics 2016 Annual Report 35 Research Research

Researchers uncover hope transplant,” said Texas Children’s journal Pediatrics, Harpavat and his for biliary atresia patients pediatric surgeon and Baylor colleagues including Texas Children’s Quicker professor of surgery Mary Brandt, Department of Pathology Chairman Sanjiv Harpavat, MD, a pediatric MD, who is a national leader in Emeritus Milton Finegold, MD, Diagnosis For gastroenterologist at Texas Children’s performing this procedure .“Waiting examined lab records of 61 children Liver Disease Hospital and Baylor College of until there is significant scarring in with biliary atresia referred from their Medicine, is dedicated to improving the liver increases the chance of birth hospitals to Texas Children’s outcomes for children with needing a liver transplant ”. Hospital for care .They discovered that gastrointestinal disorders . But one all newborns with biliary atresia had particularly devastating liver disease One major challenge in achieving early persistently high direct or conjugated has become the centerpiece of his treatments is that infants with biliary bilirubin measurements in their research activities . atresia may appear normal in the first blood, indicating a problem with liver few weeks of life . Because of this, function that could be detected in the Affecting approximately one they are difficult to identify and are newborn period . in 10,000- 18,000 births in the United diagnosed and treated after 60 days of States, biliary atresia is a rare but life on average . Currently, many pediatricians deadly liver disease and the No . 1 already draw bilirubin levels on reason for pediatric liver transplants newborns .They are looking for high worldwide .As a result of a blocked “The best way to improve outcomes unconjugated bilirubin levels to bile duct that connects the liver to is by detecting and treating the assess severity of jaundice prior to the small intestine, the buildup of bile disease before symptoms appear.” administering phototherapy . Often – Sanjiv Harpavat, MD in the liver scars tissue so rapidly that during this testing, the direct or most newborns need a liver transplant conjugated bilirubin levels also are to survive . measured . Currently, pediatricians Acknowledging these delays, the have no guidelines to follow on how “Infants with biliary atresia develop a American Academy of Pediatrics to manage patients with abnormal tremendous amount of liver scarring in published a position paper levels of direct or conjugated the first few months of life, comparable recommending studies that explore bilirubin . Now, however, they are to that seen in adults with chronic liver screening strategies for biliary atresia . starting to pay more attention diseases such as hepatitis C,” Harpavat Currently no standard screen exists to the values . said .“The best way to improve their in the United States, and pediatricians outcomes is by detecting and treating the generally do not suspect the disease “We’re realizing that any abnormality disease early before symptoms appear ”. until considerable liver damage has in conjugated bilirubin is potentially already occurred . an important value that may need The only proven treatment strategy to be examined if we are to detect for biliary atresia is the Kasai Just like a hearing screen is standard for biliary atresia at its earliest, most portoenterostomy, a procedure all newborns in the United States, the treatable stage,” Harpavat said . in which the surgeon replaces the Texas Children’s Hospital team hopes damaged bile ducts with a piece of to someday implement a newborn Texas Children’s neonatologist Joseph the infant’s intestine .The procedure screening program nationwide for Garcia-Prats, MD, helped implement has variable success in preventing or biliary atresia .To do this, the group has a biliary atresia screening initiative at delaying the need for transplantation . initiated a clinical research program Ben Taub General Hospital and later with provocative early results . at Texas Children’s Newborn Center “Preliminary data suggest infants who following Harpavat’s retrospective undergo Kasai before 30 days of life Closer look at numbers findings. Garcia-Prats said biliary have a better outcome and may have In a retrospective study published atresia screening should be a Researchers recommend a heel-prick screening for the liver disease standard of care for all newborns . biliary atresia as a standard of care for all newborns. a lesser chance of needing a liver in the December 2011 issue of the

Department of Pediatrics 2016 Annual Report 39 Research Book chronicles triumphant outcomes

On Dec . 16, 2008, Tara Fields and her Abigail’s triumphant story is one of eight connected with other parents who had gone “Unlike a stool color card test, for biliary atresia in newborns, and screening test on a national level,” husband, Troy, welcomed 6-pound inspiring patient outcomes featured in a through a similar diagnosis .Through this which detects biliary atresia after shows that the test is very accurate,” said Guillory, who is an associate fraternal twins Abigail and Memphis into book edited by then Baylor College of initial conversation Lee and Camacho began symptoms appear, Dr . Harpavat is Shneider said. “If confirmed in larger professor of pediatrics at Baylor . their family . Medicine medical student Beverly Lee . conceptualizing the book . Camacho’s story testing a newborn screening tool that studies, this screening method might Since the publication of Biliary Atresia about her daughter is featured in the book . has demonstrated great potential in be used to screen every infant born Harpavat has presented his research While both twins appeared healthy at Patient Stories in 2015, Lee has maintained diagnosing biliary atresia earlier,” said in the United States for biliary to the Texas Medical Association, the birth, it wasn’t until the twins’ two-week a strong bond with many of the families, in Prior to editing the publication, Lee Garcia-Prats, who also is a professor atresia, similar to the way newborns Texas Pediatric Society’s Fetus and checkup that their pediatrician noticed some cases helping those undergoing liver collected stories written by patient of pediatrics at Baylor . are routinely screened for Newborn Committee, the March Abigail hadn’t grown as much as her transplantation write appreciation letters to families recounting their unique journeys other diseases ”. of Dimes and the State Newborn brother .The difference in size between donor families . with this disease . Each inspiring story Novel tool put to the test Screening Advisory Committee . the two babies became increasingly contains the contact information for the To determine whether such a screening While data is still being collected, one He also is discussing his research obvious . At 6 weeks old, Abigail produced featured patient family . program could work at diverse hospitals unique aspect of Harpavat’s ongoing findings at pediatric conferences white stool, and subsequently her complexion changed and the corners of “I was privileged to collaborate with these such as those found throughout the research study is that newborn across the country . her eyes began to turn yellow . biliary atresia families as they entrusted country, Harpavat and his colleagues, patients are receiving immediate me with their most personal thoughts and including Benjamin Shneider, MD, benefits from the blood screen test. Harpavat’s ultimate goal is to screen When lab results revealed that Abigail’s stories,” said Lee, MD, now a pediatrics professor of pediatrics and George 100,000 to 150,000 newborns in this conjugated bilirubin levels were abnormal, resident at Baylor and Texas Children’s . Peterkin Endowed Chair at Baylor “Hospitals outside our study have multicenter study before presenting her pediatrician immediately referred her “The book has already helped families Beverly Lee, MD and chief of the Gastroenterology, used our preliminary data and his findings to national health to Texas Children’s Hospital, where she connect with each other and demonstrates Hepatology and Nutrition Service at are paying closer attention to the screening panels, like the National underwent a battery of tests . The book is part of the packet of the partnership that’s possible between Texas Children’s, designed a study to conjugated bilirubin measurements,” Screening Advisory Committee, information that families receive from their physicians and patient families ”. test a simple way to screen infants for Harpavat said .“They’re calling us and eventually reaching out to “Our emotions were raw,” Tara recalled . liver team at Texas Children’s when their biliary atresia in the first two to three about their results, so we’re picking policymakers for their support . “By the end of the week, our daughter child has been diagnosed with The publication also contains a foreword weeks of life .Their research appeared up biliary atresia cases in a non- was diagnosed with biliary atresia . She biliary atresia . from Texas Children’s pediatric audiologist underwent the Kasai procedure on Ross Tonini, AuD, who underwent one of in the August 2016 issue of the studied way as well ”. “Our mission is to improve outcomes Feb . 23, 2009, and today she is a healthy, The idea for creating this book was the country’s earliest Kasai procedures to New England Journal of Medicine . in biliary atresia,” Harpavat said . vivacious 8-year-old who loves to dance conceived by a patient’s mother, Ana treat biliary atresia almost 60 years ago The average age of infants undergoing “We are evaluating an affordable, and perform gymnastics ”. Camacho . She expressed a desire to be when he was just 6 weeks old . The population-screening study Kasai portoenterostomy has dropped widely available, easily interpretable included all infants born in four at Texas Children’s since these studies test that has the potential to hasten hospitals around Houston during a began. A significant proportion of the diagnosis for infants with this 15-month period .The research now change is the result of the educational serious disease ”. has been expanded to 10 hospitals activities that have occurred in the in Houston and South Texas .The context of Harpavat’s studies . Shneider said Harpavat’s exciting screening they developed is based findings on biliary atresia screening on newborn direct or conjugated Push for universal screening already have changed the landscape bilirubin measurements . To mobilize statewide support for of the early phase of this disease and this lifesaving initiative, Harpavat has other forms of neonatal cholestasis All of the infants in the study were collaborated with longtime newborn in Houston . screened, and those identified as screening advocate and Texas having direct or conjugated bilirubin Children’s neonatologist Charleta “This work is a marvelous example concentration exceeding the 95th Guillory, MD, to begin introducing the of the positive impact of clinical percentile were rescreened at or research to leaders in the newborn research on the well-being of before their first well-child visit. screening field. children and exemplifies the rationale A total of 11 infants retested positive for clinical research being a major at the median age of 14 days . “The more compelling statistics we focus for programmatic development present in the state of Texas, the in pediatric gastroenterology, “This new study presents preliminary more credibility we’ll have in pushing hepatology and nutrition at Texas (From left to right) Sanjiv Harpavat, MD, Charleta Guillory, MD, and Joseph Garcia-Prats, MD, data on a novel method for screening forth this newborn biliary atresia Children’s Hospital,” Shneider said . discuss implementing a new screening tool for the liver disease biliary atresia.

40 Department of Pediatrics 2016 Annual Report Research

Neuroscientists chart paths year medical student at the American work, including most recently the toward viable therapies University of Beirut when civil war prestigious Breakthrough Prize in Life broke out and forced her to immigrate Sciences . Established by such Silicon Valley The Language In 1983, during her pediatric residency to the United States. After finishing luminaries as Facebook co-founder Mark of Life at Texas Children’s Hospital, Huda medical school, Zoghbi came to Zuckerberg, the Breakthrough Prize Zoghbi, MD, saw her first patient with Houston for further training . recognizes paradigm-shifting research, Rett syndrome, a nonverbal 5-year-old celebrating scientists and generating girl who couldn’t stop wringing her “Dr . Ralph Feigin recruited me to the excitement about science as a career . hands . Mysteriously, the patient had pediatric residency program at Baylor Zoghbi was honored for her discoveries been healthy until the age of 18 College of Medicine and taught me of the genetic causes and biochemical months, when she became withdrawn, clinical scholarship,” she said .“Dr . mechanisms of Rett syndrome, as well avoided eye contact and eventually Marvin Fishman, an exemplary clinician, as spinocerebellar ataxia, which usually stopped talking .The encounter then inspired me to become a pediatric appears in adulthood, destroying brain profoundly changed the young neurologist, and I met the patients who cells that control balance and breathing, pediatrician and set her on course for changed the course of my career . killing patients within 10-20 years of the a career uncovering the genetic causes first symptoms. of pediatric neurological conditions . “I turned to research for answers, and today, together with numerous Zoghbi has donated most of the The remarkable discoveries emerging collaborators and trainees, we are $3 million prize to advance genetic from the Jan and Dan Duncan charting new paths toward and neuroscience research and Neurological Research Institute (NRI) viable therapies.’” to inspire and support the next – Huda Zoghbi, MD at Texas Children’s Hospital and Baylor generation of investigators . College of Medicine offer hope for children and families facing rare and “As a young physician, I found it Since the nationally televised devastating neurological disorders like heartbreaking to watch my patients, Breakthrough Prize awards Rett syndrome . young and old, lose their lives to presentation in December 2016, neurological diseases,” Zoghbi said . hosted by actor Morgan Freeman and Under Zoghbi’s transformational “When I realized I needed to pursue featuring musical guest Alicia Keyes, leadership, the NRI is unlocking the basic research to truly help these Zoghbi has been flooded with an genetic and molecular mysteries patients, Dr . Arthur Beaudet, one of the overwhelming response from a wide- behind developmental and finest geneticists in the country, took ranging community extending far neurodegenerative brain disorders in me into his lab and taught me how to beyond her colleagues, family both children and adults . Dedicated be a scientist . and friends . to improving the lives of patients facing these devastating neurological “I turned to research for answers, “The messages I have received disorders, the NRI is a basic research and today, together with numerous showed me how the Breakthrough institute committed to understanding collaborators and trainees, we are Prize presentation ceremony the biological mechanisms that lead charting new paths toward viable humanized the process of science to neurological diseases in order to therapies .There is still a long way to for so many young people, especially develop effective treatments . go, but it is thrilling to see that we are young girls,” Zoghbi said .“Some said beginning to understand the language they are now excited about a career A Howard Hughes Medical Institute of life and translate it to help mankind ”. in science . Some messages were investigator, Zoghbi is founding from parents who said the televised director of the NRI and holds the International recognition ceremony gave them the opportunity Ralph D . Feigin, MD, Endowed Chair Now an internationally recognized to sit down with their children and in Pediatrics . Born and raised in neurogeneticist, Zoghbi has received talk about a career in medicine Huda Zoghbi, MD, leads a team of scientists in discovering or science ”. the genetic causes of pediatric neurological disorders. Beirut, Lebanon, Zoghbi was a first- numerous honors for her pioneering

Department of Pediatrics 2016 Annual Report 43 Research Research

disorders and are developing new it was much easier to pursue bold “The transition to independence is With subsequent donations from therapeutic targets to treat them . research ideas . the most difficult period in a young additional prizes and awards, including Graduate student Antonia De Maio and postdoctoral associate Alessandro Gennarino, PhD, discuss the intricacies of RNA biology in the brain. So far, most genetic disorders can’t scientist’s career,” Zoghbi said .“This the Shaw Prize and the Breakthrough be cured, but once the causes are “It wasn’t as hard to get funding, and kind of funding gives them a measure Prize, she has grown the fund discovered, treatments sometimes we didn’t feel the same pressures of freedom and signals our faith in substantially . Zoghbi hopes that can prevent or manage the disorders young scientists face today . I had no their abilities to carve out their support from this fund, combined with caused by abnormal genes . research experience when I decided own niche ”. hard work and protected space for to study genetics, but Dr . Beaudet intellectual freedom, will ensure Many of the NRI investigators took me into his lab anyway .That The NRI Mentorship Fund will the success of many young are physicians or physician- would be very hard to do today ”. provide one year of support to scientists poised to embark on scientists, whose patients inspire postdoctoral fellows who want to their independent careers . the time-consuming basic research Zoghbi has therefore established a test bold hypotheses that would not necessary to move forward toward special fund at the NRI to support be supported through conventional She hopes that, together, the young more effective therapies . And the next generation of scientists by grants . Zoghbi started the fund when researchers and more experienced discoveries in the pediatric arena giving them room to pursue creative she received the Gruber Prize in investigators will be able to provide now have led to breakthroughs ideas as they are beginning to launch Neuroscience, shortly after the NRI answers and help for those with in adult neurodegenerative and their independent research careers . first opened in 2010. neurological disorders . neuropsychiatric disorders, including Alzheimer, Parkinson, bipolar disorder and ALS .

The NRI brings together faculty with unique and complementary expertise representing a wide range of disciplines, all focused on solving previously intractable problems in neurological disorders and disease . And it wasn’t just the messages of the DNA of chromosomes that Mathematicians, high-level statisticians involving young people that influences gene control as the basis and computer scientists work closely touched Zoghbi . of Rett syndrome . with geneticists, neuroscientists, neurologists, pathologists, “I have so many emails from The Shaw Prize was established by Sir neurophysiologists and neurosurgeons . immigrants who said how proud Run Run Shaw, the media tycoon who The environment is open and they were and how they related to helped bring Chinese martial arts generous, encouraging innovative my journey, not just in science, but films to an international audience. collaborations between formerly in being a successful, valued part of The prize honors individuals who isolated fields. this country . Since I am an immigrant have recently achieved significant myself, these really touched me ”. breakthroughs in academic and Through robust, multidisciplinary scientific research and whose collaborations, the NRI is bridging the Earlier in the year, Zoghbi was work has resulted in a positive and gap between initial gene discovery and honored in Hong Kong with the profound impact on mankind . clinical applications, with the ultimate international Shaw Prize in Life goal of developing effective treatments Science and Medicine, along with Building for the future for a broad range of disorders . her Edinburgh colleague, Sir Adrian The investigators at the NRI are Bird, for their discovery of the continuing to gain insight into the Cultivating the next generation Postdoctoral associate Carlyn Adamski, PhD, purifies the ataxin1 genes and encoded proteins that underlying causes of numerous When Zoghbi started her career protein to study its interactions with its protein partners. recognize one chemical modification neurological and neuropsychiatric more than 30 years ago, she says

44 Department of Pediatrics 2016 Annual Report Department of Pediatrics 2016 Annual Report 45 News of Note

Baylor, Texas Children’s lead site To learn more about SPARK or to Just inside the main entrance is a for largest autism study ever participate, visit sparkforautism. grand staircase that simulates a tree Baylor College of Medicine and Texas org/texaschildrens or call house, giving the area a safe, central News of Children’s Hospital coordinate the 832-824-3624 . location for children and families Note Houston research site for an online visiting Texas Children’s Hospital The autism research initiative, one of Texas Children’s Hospital Woodlands . As you travel throughout the largest studies on autism to be The Woodlands opens the campus, there are images of undertaken in the United States . Texas Children’s Hospital The leaves on the ceiling, rivers on the Woodlands is now open and ready floor, and trees and 1,700 pieces The Simons Foundation Powering to serve children and families in of art created by children in The Autism Research for Knowledge, or The Woodlands, Kingwood, Conroe, Woodlands community on the walls . SPARK, study will collect information Spring, Magnolia, Humble, Huntsville and DNA for genetic analysis from and beyond . “A lot of planning and thought went 50,000 individuals with autism into the design of this facility,” said and their families to advance the The 550,000-square-foot state-of- Trent Johnson, director of business understanding of the causes of the-art inpatient facility opened operations and support services this condition and to promote the its doors on April 11, 2017, serving in The Woodlands . “It’s focused discovery of treatment and support . more than 150 children on its completely on our patients ”. first day . The Houston site is one of 21 Nearly 600 guests gathered on the across the country collaborating in Located off of I-45 in The Woodlands grounds of the new hospital for this effort . Robin Goin-Kochel, PhD, near CHI St . Luke’s and Methodist the Grand Opening Gala April 28 . associate professor of pediatrics in hospitals, Texas Children’s Hospital President of Texas Children’s Hospital the section of psychology at Baylor The Woodlands offers services in The Woodlands Michelle Riley-Brown and associate director for research more than 20 areas of specialty care welcomed everyone to the fête . at the Autism Center at Texas and is building on a decade’s worth Children’s, leads the study locally . of relationships Texas Children’s Co-chaired by Tracey and Approximately 200 individuals with has built in the community through Sean O’Neal and Johnna and Ryan autism and their family members primary and subspecialty care at Edone, the gala raised nearly will be recruited annually over the Texas Children’s Pediatrics locations $900,000 for the new hospital . next three years to participate in the and the Texas Children’s Health Guests bid on items during a live effort at Baylor/Texas Children’s . Center The Woodlands . auction before a performance by singer-songwriter Jewel . “The SPARK study will empower “Texas Children’s Hospital The researchers to make new discoveries Woodlands is really a comprehensive, The following day Hankins showed that may ultimately lead to the stand-alone children’s hospital that’s Jewel around the new facility. The first development of new supports and part of a larger system that provides stop on the tour was the audiology treatments to improve the lives care across the spectrum,” said suite in the Outpatient Building to of people with autism,” said Goin- Charles Hankins, MD, chief medical see the audiology booth, which was Kochel . “It is one of the most officer at the new hospital. generously donated by Jewel . insightful research endeavors to date on this disease ”. Designed with a “spirit of the woods” The Grand Opening celebration theme to incorporate the lush, continued with an Inaugural Family About 50 genes have been identified woodsy landscape that surrounds Fun Run April 29 . that are believed to play a role in it, the hospital offers an open and autism, and scientists estimate that an inviting setting for patients, families The hospital’s outpatient facility Nurses care for Emma Grace Vadala, the first inpatient in the Neonatal Intensive Care Unit on opening day at the new Texas Children’s Hospital The Woodlands. additional 300 or more are involved . and staff alike . opened in October 2016 .

Department of Pediatrics 2016 Annual Report 47 News of Note News of Note

Collaborators develop Therapy at Baylor and Texas Children’s Houston and Harris County are Funded by a grant from the Goldsbury first author of the paper in the Journal of Development . Debbe I .Thompson, immunotherapy for Hospital . Support from the Cancer vulnerable to an outbreak of Zika Foundation and created in partnership Nutrition Education and Behavior . “These PhD, RD, a USDA scientist and cancer treatment Prevention and Research Institute of virus because the two types of with the Culinary Institute of America, foods are part of a healthy diet, and associate professor of pediatrics- Baylor College of Medicine announced Texas (CPRIT) was instrumental in mosquitoes that transmit the virus CHEF drives healthy eating as a key may reduce the risk of some chronic nutrition, was principal investigator in September 2016 the launch of a conducting the underlying research and are prevalent . Other risk factors are ingredient for life-long health and diseases including cardiovascular disease and senior author of the paper . sponsored research collaboration in attracting Cell Medica to establish its areas of standing water that help the wellness . Maria Palma, CHEF program and certain cancers . So interventions to representing a significant milestone in U .S . headquarters in Houston . mosquitoes thrive and large numbers director and Culinary Institute of help children choose and eat more fruit Cancer patients make their mark its efforts to develop a new class of of people traveling back and forth America alumna, and Celina Parás, and vegetables are important ”. Colorful paintings on the walls at lifesaving cancer therapy . Vaccine unit studies people to Latin American countries that are the CHEF registered dietitian, have Houston airports welcome thousands with Zika virus reporting outbreaks . developed evidence-based classes The 10-episode video game, Squire’s of travelers to the city .The paintings are Baylor has provided biotech company The National Institutes of Health that bridge the art of cooking and Quest II: Saving the Kingdom of Fivealot, part of a larger exhibition of art and Cell Medica an exclusive license to selected the Vaccine Treatment and The Centers for Disease Control and the science of nutrition . Participants was designed to both entertain and creative writing called “Making A Mark,” its proprietary Natural Killer T Cell Evaluation Unit at Baylor College of Prevention has concluded that Zika learn nutrition information and promote behavior change . presented by The Periwinkle Foundation . immunotherapy platform, five product Medicine as one of three sites in the infection causes severe birth defects, practical cooking skills that will help Most of the artwork is from patients candidates and an option to license nation to study people infected with including the abnormally small heads them address prevalent health issues, Parents received a weekly newsletter and their siblings at Texas Children’s future product candidates . Zika virus to better understand the of microcephaly .The agency continues including obesity and type II diabetes . and a link to a website with Cancer and Hematology Centers . infection and the immune responses to recommend that pregnant women information on their child’s weekly Baylor and Cell Medica also entered following infection .The study will help not travel to areas where Zika In 2014 shortly after Children’s Hospital goals, suggestions for supporting “Making A Mark” is a traveling exhibit into a co-development collaboration inform diagnostic and infection control infection has been reported . of San Antonio opened, the CHEF achievement of goals and ways to on display in Houston and around combining Baylor’s expertise in the measures, as well as development of a program launched and construction overcome common barriers . Texas .Viewers are encouraged to share creation of modified immune cell Zika vaccine . Teaching kitchen offers classes in began on the teaching kitchen . feedback in the form of postcards . technologies with Cell Medica’s Children’s Hospital of San Antonio Researchers found that children in the A drop-box is provided at most expertise in manufacturing and The new Culinary Health Education Video game promotes eating action and coping plan groups reported exhibition sites, and to date, more than commercialization of cell therapy for Families (CHEF) teaching kitchen fruit and vegetables higher vegetable intake at dinner, and all 25,000 postcards have been sent back products .Together, the collaborators will at the Children’s Hospital of San Getting children interested in eating groups had significant increases in fruit to Texas Children’s artists . develop a pipeline of next-generation Antonio opened in January 2017, healthy foods is a challenge almost every intake at breakfast, lunch and snack time . cellular immunotherapy products for offering cooking demonstrations, parent can relate to . Recent research The work will be on display this the treatment of cancer . instruction and hands-on classes at the U .S . Department of Agriculture/ Funding for this study came from summer at the William P . Hobby Pediatrics Chair Mark W. Kline, MD, reads for patients, families, associates and Agricultural Research Service (USDA/ the USDA/ARS and the National Airport and the George Bush The collaboration will accelerate the about preventing Zika virus at a community physicians of the hospital . ARS) Children’s Nutrition Research Institute of Child Health and Human Intercontinental Airport in Houston . education event. pioneering work of Leonid Metelitsa, Center (CNRC) at Baylor College of MD, PhD, professor of pediatrics – Kristy Murray, DVM, PhD, associate The CHEF team cosponsors events Medicine and Texas Children’s Hospital oncology at Baylor .While recent clinical professor of pediatrics-tropical with organizations like the YMCA, has uncovered an unlikely ally in this age successes in the use of chimeric antigen medicine, leads the Baylor portion San Antonio Botanical Gardens and old battle – video games . receptor (CAR) modified T cells to of the study that involves Zika virus the Boys and Girls Club of America treat blood-related malignancies have detection in human subjects . Shital to help teach children and families in When children created action or generated considerable promise, results Patel, MD, Baylor assistant professor of the San Antonio community about the coping plans designed to help them in solid tumors have been limited .The medicine-infectious disease, is principal benefits of preparing healthy, home- meet goals while playing a video game primary goal of this collaboration is investigator of the entire study . Hana cooked meals . promoting fruit and vegetable intake, to extend the use of CAR technology El Sahli, MD, associate professor the researchers found that the children to natural killer T cells, which have of virology and microbiology, is “Culinary medicine is all about increased their meal-specific fruit and biological properties that may allow responsible for enrollment and follow- delicious and satisfying food that vegetable intake . effective targeting of solid tumors . up of study participants . happens to be good for you,” said Julie La Barba, MD, medical director “Few children eat enough servings Metelitsa’s research team is part of The other two sites are St . Louis of CHEF and assistant professor of of fruit and vegetables each day,” said Artwork by patients and siblings at Texas Children’s Cancer and Texas Children’s Cancer Center University and Emory University pediatrics at Baylor College Karen Cullen, DrPH, RD, professor of Hematology Centers is on display at Houston airports this summer. and the Center for Cell and Gene schools of medicine . of Medicine . pediatrics at Baylor and the CNRC and

48 Department of Pediatrics 2016 Annual Report Department of Pediatrics 2016 Annual Report 49 Spotlight on the Department of Pediatrics

By the Numbers 2016 Spotlight on the Baylor College of Medicine* Department of Pediatrics Department of Pediatrics One of the largest, most diverse departments of pediatrics in the United States #7 rank of pediatrics educational program for 2016 by U.S. News & World Report, up from #9 the previous year 100% of faculty reported high satisfaction with Department of Pediatrics in a survey by the Association of American Medical Colleges 1,499 full-time, part-time, secondary and voluntary faculty 178 residents 190 clinical postdoctoral fellows 93 research postdoctoral fellows 1,444 applicants for 46 slots in pediatric categorical residency program 3 books written or edited 435 chapters written or edited 1,224 journal articles $66.6 million in federal research funding $15.9 million in gifts and contributions from individuals and foundations ($14,002,602 from TCH and $1,922,420 at BCM)

Texas Children’s Hospital**

#4 rank on U.S. News & World Report Best Children’s Hospitals list 34,096 total patient admissions 226,950 census days 119,878 Emergency Center visits 3,569,163 patient encounters Patients from nearly 60 countries 50 states in U .S . are home to patients

*Baylor College of Medicine = July 1, 2015 – June 30, 2016 **Texas Children’s Hospital = October 1, 2015 – September 30, 2016, including Main Campus, West Campus and Pavilion for Women Texas Children’s Hospital and Baylor College of Medicine attract highly trained physician-scientists from around the world to care for patients from all over.

Department of Pediatrics 2016 Annual Report 51 Spotlight on the Department

Department of Pediatrics Leadership

Chairman / Physician-in-Chief Mark W . Kline, MD, mkline@bcm .edu

Executive Vice Chairs Susan Blaney, MD, sblaney@bcm .edu Sheldon Kaplan, MD, slkaplan@texaschildrens .org Gordon Schutze, MD, schutze@bcm .edu

Vice Chairs Mark Gilger, MD, mark .gilger@christushealth .org Chris Greeley, MD, PhD, Christopher .Greeley@bcm .edu Jordan Orange, MD, PhD, jsorange@texaschildrens .org Lara Shekerdemian, MD, lssheker@texaschildrens .org Teri Turner, MD, MPH, MEd, tlturner@texaschildrens .org

Associate Vice Chairs Lisa Bomgaars, MD, lbomgaars@txch .org Judith R . Campbell, MD, judithc@bcm .edu Tammy Kang, MD, tammy .kang@bcm .edu Kristy Murray, DVM, PhD, kmurray@bcm .edu Jean Raphael, MD, raphael@bcm .edu Heidi Schwarzwald, MD, hlschwar@texachildrens .org Geeta Singhal Das, MD, grsingha@texaschildrens .org

Section Heads Academic General Pediatrics: Angelo Giardino, MD, PhD, MPH, apgiardi@texaschildrens .org Adolescent & Sports Medicine: Albert Hergenroeder, MD, achergen@texaschildrens .org Cardiology: Daniel Penny, MD, PhD, djpenny@texaschildrens .org Community Pediatrics: Heidi Schwarzwald, MD, hlschwar@texaschildrens .org Critical Care: Lara Shekerdemian, MD, lssheker@texaschildrens .org Dermatology: Raegan Hunt, MD, Raegan .Hunt@bcm .edu Developmental Pediatrics: Robert Voigt, MD, rgvoigt@texaschidrens .org Diabetes/Endocrinology/Metabolism: Jake Kushner, MD, kushner@bcm .edu Emergency Medicine: Paul Sirbaugh, DO, pesirbau@texaschildrens .org Gastroenterology/Hepatology/Nutrition: Benjamin Shneider, MD, Benjamin .Shneider@bcm .edu Global Biologic Preparedness: Amy Arrington, MD, PhD, aa691762@bcm .edu Global Immigrant Health: Anna Mandalakas, MD, Anna .Mandalakas@bcm .edu Hematology/Oncology: David Poplack, MD, dpoplack@txch .org Hospital Medicine: Ricardo Quinonez, MD, quinonez@bcm .edu House Staff Education: Mark Ward, MD, maward@texaschildrens .org Immunology/Allergy/Rheumatology: Jordan Orange, MD, PhD, jsorange@texaschildrens .org Infectious Diseases: Sheldon Kaplan, MD, slkaplan@texaschildrens .org Neurology: Gary Clark, MD, gdclark@texaschildrens .org Newborn: Gautham Suresh, MD, gksuresh@texaschildrens .org Nutrition CNRC: Dennis Bier, MD, dbier@bcm .edu Palliative Care: Tammy Kang, MD, tammy .kang@bcm .edu Psychiatry: Laurel Williams, DO, laurelw@bcm .edu Psychology: M . Douglas Ris, PhD, dmris@texaschildrens .org Public Health Pediatrics: Chris Greeley, MD, Christopher .Greeley@bcm .edu Pulmonary: Peter Hiatt, MD, pwhiatt@texaschildrens .org Renal: Michael Braun, MD, mcbraun@texaschildrens .org Retrovirology/Travel Medicine: Mary Paul, MD, mepaul@texaschildrens .org Tropical Medicine: Peter Hotez, MD, PhD, hotez@bcm .edu

For a patient referral form, see texaschildrens.org/refer

52 Department of Pediatrics 2016 Annual Report