ANNUAL REPORT 2014-15 CONSTANTLY EVOLVING TO MEET CHANGING TIMES Department of Paediatrics TABLE OF CONTENTS Our Mission 3 Executive Summary 4 Changing Times 7 Division of Adolescent Medicine 11 Division of Cardiology 16 Division of Clinical Metabolic Genetics 36 Division of Clinical Pharmacology 52 Division of Developmental Paediatrics 57 Division of Emergency Medicine 67 Division of Endocrinology 82 Division of Gastroenterology/Hepatology/Nutrition 92 Division of Haematology/Oncology 112 Division of Immunology & Allergy 134 Division of Infectious Diseases 140 Division of Neonatology 151 Division of Nephrology 158 Division of Neurology 165 Division of Paediatric Medicine 184 Division of Respiratory Medicine 208 Division of Rheumatology 224 Grand Rounds 236 Medical Education Summary 241 Spotlight on PACT 269 2 The Hospital for Sick Children OUR MISSION Dedicated to improving children’s lives through advances in clinical care, research and innovation and the education of future caregivers. Department of Paediatrcis Annual Report 2014-2015 3 EXECUTIVE SUMMARY From Left to Right: Dr. Jeremy Friedman, Ben Vozzolo, Dr. Denis Daneman, Dr. Rayfel Schneider, Dr. Meredith Irwin, Marilyn Monk This year’s Annual Report represents the tenth along the way, but progress has been made in all and final one of my term as Chair of Paediatrics areas of the academic and clinical enterprise. at the University of Toronto and Paediatrician- in-Chief at The Hospital for Sick Children. It • Faculty size: we have recruited close to has been a distinct honor and privilege to 100 new faculty members in all job profiles, serve in these capacities, not only because of Clinician Scientist, Clinician Investigators, the prestigious nature of these two illustrious Clinician Educators and Academic Clinicians. institutions, but even more so because of the Most divisions have grown larger and more opportunity it has afforded me to work alongside productive. This is evidenced by promotion an incredibly talented faculty that has gone from of 137 members of the faculty to Associate strength to strength during these ten years. This or Full Professor during this time. is not to say we haven’t had significant challenges 4 The Hospital for Sick Children • Clinical care: examples of improvement Our vision these past 10 years has been in clinical care abound: an Emergency “to continuously evolve as one of the world’s Department that functions amongst Ontario’s leading paediatric departments.” There can best; shortened average lengths of stay; be no doubting that we have succeeded in this. new programs in childhood obesity, brain Nonetheless, dwindling health care budgets, at inflammation, palliative care and many the university, hospital and individual department more; a focused departmental scorecard; level have already put pressure on us to perform a menu of items for the Choosing Wisely more efficiently and in a less costly manner. campaign to reduce unnecessary healthcare Some cuts help us prioritize, when they get spending. Jeremy Friedman and the Clinical too deep they threaten our raison d’etre. Excellence Committee warrant our heartiest congratulations on these efforts. During the course of my almost 40 year career in Paediatrics, we have practiced what I would term • Research: we have reinforced our fundamental “sweat of our brow medicine,” and it has paid off research with key recruits in, for example, in buckets. Impressive gains have been made very early onset inflammatory bowel disease; in virtually every field in Paediatrics, but there is muscular dystrophies and hypotonia; kidney more to come, much more. I am envious of the disease; bolstered clinical and translational next generation of paediatricians who will, no investigation across the full spectrum of doubt, have new and better therapies, precision paediatric disorders, including common therapeutics, to offer their patients. We will paediatric conditions (TargetKids!), asthma continue to sweat about two issues, first, those (C.H.I.L.D.), obesity (STOMP), and diabetes who do not respond to these treatments, and, (TrialNet, TRIGR, AdDIT). We continue to second, those children who live at a disadvantage explore new areas of interest in health due to poverty, exclusion, discrimination. Our services research, health policy and Social Paediatrics program has put the spotlight economics. Research funding has almost on the second, and the light should focus tripled in the last 10 years and we rank second intensely until these problems have been licked. among all North American Departments of Paediatrics in numbers of publications. SickKids and UofT are great institutions because Meredith Irwin leads these efforts together of the people who work here. This is certainly with the Research Advisory Committee. true in Paediatrics. I cannot stress enough the joy it has been to have had the privilege • Education: Our educational activities have of leadership from 2006-2016. Don’t let up. become increasingly diversified with many more sites around the Greater Toronto Area. All of Thank you and all the best. our Postgraduate Training Programs are fully accredited with the Royal College and highly sought after by trainees around the world. Rayfel Schneider leads the education enterprise Denis Daneman, MBBCh, FRCPC, DSc(Med) with a hugely effective group of educators. Department of Paediatrcis Annual Report 2014-2015 5 FACULTY PROMOTED IN 2015 Full Professor Associate Professor Jill Hamilton Sarah Alexander Hartmut Grasemann Yaron Avitzur Patrick McNamara Sarah Bowdin Vicky Ng Migel Cortez Mark Palmert Doug Campbell Chris Parshuram James Dowling Elena Pope Mahendranath Moharir Lillian Sung Farid Mahmud Shelly Weiss Tal Schecter-Finkelstein Rachel Wald RECOGNIZING OUR STAFF I would like to take this opportunity to recognize our Department of Paediatrics office staff members for their ongoing commitment and operational excellence over the past calendar year. Paediatrics Office Staff Josefina Bento, Administrative Assistant Susan Jenkins, Business Supervisor, Postgraduate Anna Capizzano, Executive Assistant Sandra Layno, Program Coordinator, Postgraduate Amoye Henry, Project Coordinator Clare Schlesinger, Education Coordinator Maureen Lum, Financial Analyst Michelle Wan, Conference Administrator Angela McGerrigle, Executive Assistant Diva Mendes, Administrative Assistant, Paediatric Consultants Billing Office Office Secretary John Vetta, Manager of Finance, Controller Shelley Todd, Supervisor Shannon Baksh Medical Education Staff Ella Frias Kyle Martin Mary Antonopoulos, Shara Ramsaywack Clerkship Program Administrator Indra Samaroo Joanna Barnes, Program Coordinator, Jenette Singh Pre-clerkship, Electives, TTR Meena Singh 6 The Hospital for Sick Children CHANGING TIMES As we continue to evolve as one of the world’s leading academic institutions in Paediatrics, our commitment to quality through our clinical, research and education programs remains a constant. Through distinct clinical excellence and cutting edge research innovation, our future generation of medical professionals are destined to affect global change. Although the times are surely changing, one thing prevails: the dedication to Paediatric care in our department. We profile our six new faculty who share some of their thoughts on care for the generation to come. Department of Paediatrcis Annual Report 2014-2015 7 Krishna Anchala, Academic Clinician, Paediatric Thomas Eiwegger, Emergency Medicine Immunology Allergy Emergency Care, Always Changing Developing and facilitating new concepts in the treatment of food allergy Dr. Krishnapriya Anchala is an associate professor in the division of emergency medicine. Thomas Eiwegger earned his doctoral degree She joins SickKids from McMaster Children’s at the Medical University of Vienna, Austria, Hospital where she was an associate professor in where he also completed his paediatric training. the Department of Pediatrics. During her eleven He did his post Doc in the Swiss Institute of years at McMaster, she was instrumental in Asthma and Allergy in the group of Cezmi Akdis establishing a new pediatric emergency program from 2008-2010. Before moving to Sickkids to service the southeastern region of Ontario. Dr. Eiwegger was principal investigator and associate Professor at the Department of Her interests include novel curriculum Paediatrics and Adolescent medicine, development and emergency department team Medical University of Vienna, Austria. training. Dr. Anchala has led hospital wide patient safety initiatives, assisted with provincial As a clinician and scientist Dr. Eiwegger trauma planning for pediatrics and managed the will focus on food allergy. pediatric emergency medicine clinical teaching unit at McMaster. Being allergic to food is special since hidden food components may result in life-threatening “Prior to joining SickKids, I was fortunate to reactions. This generates fear that severely have been involved with the transformation impacts daily life of the affected child, the of pediatric emergency medicine care for the family and the environment. Until now allergen Hamilton region. As our healthcare system avoidance is the only available treatment. evolves, we will be challenged to find new and innovate ways to deliver emergency care to the Dr. Eiwegger will focus on better understanding GTA and surrounding region. I look forward to of the mechanisms of tolerance development to working with SickKids as we navigate these allergens. Dr. Eiwegger will define new treatment exciting and changing times” approaches