2023 Department of Pediatrics Academic Annual Report

2023 Academic Annual Report

2023

Academic Annual Report

Table of Contents

04 06 07 08 34 40

151 153 155

Welcome from the Chair

Pediatrics Faculty Achievement Awards

Department Leadership

Kaul Pediatric Research Institute (KPRI)

Endowed Chairs and Professorships

Dixon Pediatric Fellowship

156 Chu Family Educational Scholarship 157 Founder’s Fund Grants 159 Pediatric Research Office 161 Office of Faculty Development 163 Pediatric Office for Improvement Science (POISE) 164 Pediatric Surgery: Welcome from the Chair and Table of Contents

High-Impact Research

Diversity, Equity and Inclusion

Pediatric Divisions

124 Pediatric Education Programs 125 Pediatric Residency Programs 131 Pediatric Scholars Programs 138 Pediatric Fellowship Programs 148 Mini Medical School

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Welcome from the Chair

Dear Friends and Colleagues, In the UAB Department of Pediatrics, we have one mission: to improve the health of the children of Alabama, the region, and beyond. In order to do this, we focus on four pillars: 1) clinical care and service to the profession, 2) research and new knowledge discovery, 3) teaching and training the next generation of providers and leaders, and 4) advocacy. Furthermore, we reaffirm our strong commitment to justice, diversity, equity, and inclusion. The clinical advances and research breakthroughs we describe throughout this Annual Report have a direct impact on children’s lives. That impact will be our legacy. We present evidence of this impact as measured by major research accomplishments, grants, publications and awards. In 2023, the Department of Pediatrics faculty had 474 publications. In FY 2023, our research funding totaled $43.1 million, with funding from the National Institutes of Health (NIH) contributing $25.4 million of the total funds. This puts us in the top 16 departments of pediatrics in the country. Since FY 2013, we have had a 4.5-fold increase in NIH funding, and we have grown the number of NIH-funded investigators from 8 to 32 (a 4-fold increase). Many of these new investigators have been supported by the department’s investments in their research programs, by pilot and feasibility awards from the Children’s of Alabama Kaul Pediatric Research Institute, and by the combined investments from the department and Children’s of Alabama in research infrastructure. The department aims to build on these successes, expand the size and, importantly, the impact of our research in the coming years. We anticipate continued growth not only in our core areas of significant accomplishment—virology, therapeutic drug development, cancer, sickle cell disease, neonatology, acute kidney injury and outcomes research—but also in newer areas such as pediatric rehabilitation, critical care and neuromuscular diseases, where the recruitment of talented young researchers will ensure continued and expanded success.

In addition to our research accomplishments, our focus on safety and quality is always paramount. For the 14th consecutive year, U.S. News & World Report ranked Children’s of Alabama’s pediatric specialty services among the top 50 in the nation. Eight specialties were ranked: Cancer, Cardiology & Heart Surgery, Endocrinology and Diabetes, Gastroenterology & GI Surgery, Nephrology, Neurology & Neurosurgery, Pulmonology and Urology.

Our clinical mission is to deliver exceptional, safe and accessible care in order to improve the outcomes for children in Alabama and elsewhere. We are committed to reducing inequities that result in health outcome disparities. Several of our programs, including the Institute for Cancer Outcomes and Survivorship,

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UAB Pediatrics By The Numbers

are working to make this a reality. Our care and our academic achievements simply would not be possible without the physicians, nurses and staff who bring their talents and passion to the care of children every day from everywhere in the state, the region and the nation. This coming year, we will continue to grow our subspecialty expertise, our research strength and our advocacy efforts. We have also strengthened our resident scholar programs for those interested in pediatric education, rural health, global health and health equity. We have begun a third cohort of our a mini-medical school, a curriculum for middle school students to increase the pipeline for those traditionally underrepresented in medicine and STEM careers. And, in 2023, we launched several new efforts in global health, including the recruitment of Dr. Stephen Obaro, who leads the International Foundation Against Infectious Disease in Nigeria (IFAIN). I am very hopeful that 2024 will be the best year ever. Please know that one thing always remains in focus: our commitment to serving the patients and families who look to us for healing and hope. Thank you for being part of that most worthy endeavor.

284 Faculty

19 Divisions 20 Fellowship Programs

74 Fellows 97 Residents

$25.14 million in total NIH research funding in 2021 $43.1 million in total research funding in 2021 16th in Research Funding Among All Pediatrics Departments

Mitchell B. Cohen, M.D. Katharine Reynolds Ireland Chair of Pediatrics University of Alabama at Birmingham Physician in Chief, Children’s of Alabama

474 Publications

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Department Leadership

Mitchell Cohen, M.D. Chair, Department of Pediatrics

Smita Bhatia, M.D., MPH Vice Chair for Outcomes

Yung Lau, M.D. Co-Vice Chair for Clinical Affairs

Chrystal Rutledge, M.D. Vice Chair for Diversity, Equity and Inclusion

Tamera Coyne-Beasley, M.D., MPH Vice Chair for Community Engagement

Jeffrey Lebensburger, D.O. Vice Chair for Faculty Development

Erin Shaughnessy, M.D. Co-Vice Chair for Clinical Affairs

David Kimberlin, M.D. Vice Chair for Clinical and Translational Research

Lauren Nassetta, M.D. Chief Wellness Officer

Richard J. Whitley, M.D. Vice Chair for Research

Michele H. Nichols, M.D. Vice Chair for Education

Division Directors

Terry Wall, M.D....................................................................Academic General Pediatrics Tamera Coyne-Beasley, M.D., MPH...............................Adolescent Medicine Prescott Atkinson, M.D., Ph.D..........................................Allergy & Immunology Yung R. Lau, M.D................................................................Cardiology Michael Taylor, M.D...........................................................Child Abuse Pediatrics Nancy Tofil, M.D., M.Ed.....................................................Critical Care Laura McGuinn, M.D..........................................................Developmental & Behavioral Pediatrics Kathy Monroe, M.D............................................................Emergency Medicine Ambika Ashraf, M.D...........................................................Endocrinology and Diabetes Sandeep Gupta, M.D.........................................................Gastroenterology, Hepatology and Nutrition Girish Dhall, M.D.................................................................Hematology/Oncology Erin Shaughnessy, M.D......................................................Hospital Medicine Richard J. Whitley, M.D. David Kimberlin, M.D.........................................................Infectious Diseases Waldemar A. Carlo, M.D. Namasivayam Ambalavanan, M.D..................................Neonatology Daniel Feig, M.D., Ph.D......................................................Nephrology Leon S. Dure, M.D..............................................................Neurology Hector Gutierrez, M.D.......................................................Pulmonology and Sleep Medicine Drew Davis, M.D.................................................................Rehabilitation Medicine Randy Cron, M.D., Ph.D....................................................Rheumatology

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Endowed Chairs & Professorships

Children’s of Alabama Endowed Chairs Virginia Walker Jones Endowed Chair in Neonatology............................................................................Namasivayam Ambalavanan, M.D. Ralph Frohsin Endowed Chair in Pediatric Endocrinology...............................................................................................Ambika Ashraf, M.D. W. Charles Mayer Endowed Chair in Pediatric Nephrology...............................................................................David Askenazi, M.D., MSPH Donald M. James Endowed Chair in Pediatric Cardiac Intensive Care.......................................................Santiago Borasino, M.D., MPH Derroll Dawkins, M.D. Endowed Chair in Adolescent Medicine......................................................................Tamera Coyne-Beasley, M.D. Temple W. Tutwiler, III Endowed Chair in Pediatric Rehabilitation Medicine......................................................................Drew Davis, M.D. Benjamin Russell Endowed Chair in Pediatric Hematology/Oncology..............................................................................Girish Dhall, M.D. William Bew White, Jr. Chair in Pediatric Neurology................................................................................................................Leon Dure, M.D. Margaret M. Porter Endowed Chair in Pediatric Nephrology....................................................................................................Dan Feig, M.D. David E. Dixon Endowed Chair in Pediatric Gastroenterology......................................................................................Sandeep Gupta, M.D. Raymond K. Lyrene, M.D. Endowed Chair in Pediatric Pulmonary Medicine...........................................................Hector Gutierrez, M.D. Sergio B. Stagno, M.D. Endowed Chair in Pediatric Infectious Diseases.....................................................................David Kimberlin, M.D. Thomas N. Carruthers, Jr. Endowed Chair in Pediatric Cardiology.....................................................................................Yung R. Lau, M.D. Hugh Morgan Endowed Chair in Pediatric Hematology-Oncology....................................................................Jeffrey Lebensburger, DO Thomas H. Lowder Endowed Chair in Developmental and Behavioral Pediatrics....................................................Laura McGuinn, M.D. C. Phillip McWane Endowed Chair in Pediatric Emergency Medicine............................................................................Kathy Monroe, M.D. Frederick W. Renneker, III Endowed Chair for Pediatric Education.............................................................................Michele Nichols, M.D. Beth Gordy Dubina Endowed Chair in Pediatric Hospital Medicine........................................................................Erin Shaughnessy, M.D. Ann Dial McMillan Endowed Chair in Pediatric Critical Care.................................................................................................Nancy Tofil, M.D. John W. Benton, M.D. Endowed Chair in General Pediatrics....................................................................................................Terry Wall, M.D. Children’s of Alabama Endowed Professorships Hugh Dillon, M.D. Endowed Professorship in Pediatric Infectious Diseases.............................................................Suresh Boppana, M.D. Waldemar A. Carlo, M.D. Endowed Professorship in Clinical Neonatology.......................................................................Carl Coghill, M.D. Endowed Professorship.............................................................................................................................................................Michele Kong, M.D. Child Abuse Pediatrics Professorship....................................................................................................................................Michael Taylor, M.D. UAB Endowed Chairs Gay & Bew White Endowed Chair in Pediatric Oncology.....................................................................................................Smita Bhatia, M.D. Charles A. Alford, M.D. Endowed Chair in Pediatric Infectious Diseases...................................................................................Bill Britt, M.D. Edwin M. Dixon Chair in Neonatology........................................................................................................................................Wally Carlo, M.D. Katharine Reynolds Ireland Chair of Pediatrics......................................................................................................................Mitch Cohen, M.D. Arthritis Foundation Alabama Chapter Endowed Chair in Pediatric Rheumatology.......................................................Randy Cron, M.D. Helen and Robert Whitley Endowed Chair of Pediatrics.....................................................................................Stephen Obaro, M.D., Ph.D. Loeb Eminent Scholar Chair in Pediatrics..........................................................................................................................Richard Whitley, M.D. UAB Endowed Professorships Sarah Katherine Bateh Endowed Professorship for Rett Syndrome......................................................................................Alan Percy, M.D. Endowed Professorship in Pediatrics.......................................................................................................................................Liz Worthey, Ph.D.

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High Impact Research

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Hign Impact Research

Study Assesses the Poverty and Relapse Risk in Children with Acute Lymphoblastic Leukemia by Emily Franklin

The study, led by Aman Wadhwa, M.D., assistant professor in the Division of Pediatric Hematology and Oncology, assessed individual-level poverty using self-reported annual household income and US Census Bureau yearly poverty data. This study was a secondary

analysis of Children’s Oncology Group study AALL03N1, whose primary aim was to examine adherence to oral 6-mercaptopurine during maintenance in children with ALL. The study chair was Smita Bhatia, M.D., MPH, director of the Institute for Cancer Outcomes and Survivorship and professor in the Division of Pediatric Hematology and Oncology. Among the 592 patients in this analysis, researchers found that 12.3% of the patients were living in extreme poverty. The cumulative incidence of ALL recurrence at three years following study enrollment was significantly greater among those living in extreme poverty (14.3%) than among those not living in extreme poverty (7.6%) during a median follow-up of 7.9 years. Based on the study’s findings, researchers discovered that children with ALL who lived in extreme poverty had a nearly two-fold increased risk of experiencing a relapse. Additionally, the study showed that children with ALL living in extreme poverty were significantly less likely to achieve the critical level of adherence to 6-mercaptopurine required to reduce the risk of relapse. However, this lower level of adherence did not completely explain the higher risk of relapse in children living in extreme poverty.

Aman Wadhwa, M.D.

Smita Bhatia, M.D., MPH

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Among the 592 patients in this analysis, researchers found that 12.3% of the patients were living in extreme poverty Recurrence was significantly greater among those living in extreme poverty at 14.3% than among those not living in extreme poverty at 7.6%

“ “We hope to highlight the role played by social risk factors and social determinants of health in influencing health outcomes among children with cancer.”

“Using this study, we hope to highlight the role played by social risk factors and social determinants of health in influencing health outcomes among children with cancer,” said Aman Wadhwa M.D., MSPH, assistant professor in the Division of Pediatric Hematology and Oncology. “Pediatric oncology centers need to screen for these risk factors and support their patients with available resources.” ■

– Aman Wadhwa M.D., MSPH

The study, “Poverty and relapse risk in children with acute lymphoblastic leukemia: a Children’s Oncology Group study AALL03N1 report,” was published in the journal Blood. Wendy Landier, Ph.D., professor in the Division of Pediatric Hematology and Oncology, is a co-author with Drs. Bhatia and Wadhwa.

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Hign Impact Research

Single dose of azithromycin reduces maternal sepsis or death by Hannah Echols

Ten percent of maternal deaths are caused by infections that occur shortly before, during or after delivery. Maternal infections and sepsis, which is a serious complication of infections, are among the top five causes of maternal mortality worldwide. Maternal infection also increases the risk of neonatal sepsis, which accounts for 16 percent of newborn deaths. A new study published today in the New England Journal of Medicine provides evidence that a single oral dose of azithromycin, a common antibiotic, reduced the risk of maternal sepsis or death by 33 percent in women who delivered vaginally. The results from the Azithromycin Prevention in Labor Use Study, or A-PLUS, trial led by investigators at the University of Alabama at Birmingham enhances information from previous UAB-led trials, which showed azithromycin administered before cesarean delivery reduced maternal infections. The multi-country, randomized trial was conducted at eight sites in seven low- and middle-income countries in Africa, Asia and Latin America. The study was funded by the National Institutes of Health and the Bill & Melinda Gates Foundation and conducted by the NICHD Global Network for Women’s and Children’s Health Research. Published results were presented simultaneously at the Society for Maternal-Fetal Medicine’s annual meeting in San Francisco, California. “The World Health Organization and others have prioritized reducing maternal sepsis to reduce maternal deaths,” said Alan Tita, M.D., Ph.D., professor in the UAB Department of Obstetrics and Gynecology and director of the UAB Center for Women’s Reproductive Health and Mary Heersink Institute for Global Health, and associate dean for Global and Women’s

10% of maternal deaths are caused by infections that occur shortly before, during or after delivery. A single oral dose of azithromycin, a common antibiotic, reduced the risk of maternal sepsis or death by 33% in women who delivered vaginally.

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Health. “Studies confirming the effectiveness of azithromycin for vaginal delivery, which is the most common mode of delivery, were lacking. We wanted to find a low-cost intervention that could be used globally to address this problem.” From September 2020-August 2022, more than 29,000 women were randomized to either an active or placebo group. Those in the active group were given a single 2-gram

dose of azithromycin. Maternal sepsis or death, the study’s primary outcome, occurred in 1.6 percent of women in the active group versus 2.4 percent in the placebo group. Additionally, rates of several secondary outcomes including specific maternal infections such as endometritis, wound infections and urine infections were lower in the azithromycin group.

“In addition to the decrease in maternal infections, there were fewer maternal hospital readmissions and unscheduled visits for care in the first 42 days after delivery, which is consistent with findings from the large United States trial in women who underwent a cesarean birth,” said Waldemar A. Carlo, M.D., co-director of the Division of Neonatology at the UAB Marnix E. Heersink School of Medicine and Children’s of Alabama, co-lead of the A-PLUS trial and principal investigator of the UAB NICHD Global Network site. While findings showed azithromycin reduced the risk of maternal sepsis or death, the intervention did not reduce the risk of sepsis or death in newborns. However, there were no adverse newborn effects. ■ Funding for the trial was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development and a grant from the Foundation for the National Institutes of Health through the Maternal, Newborn & Child Health Discovery & Tools initiative of the Bill & Melinda Gates Foundation. A-PLUS partners include 14 organizations from within the United States and internationally that make up the NICHD Global Network for Women’s and Children’s Health Research. UAB leveraged a partnership with investigators from the University Teaching Hospitals in Zambia, ongoing for more than 20 years.

Alan Tita, M.D., Ph.D.

Waldemar A. Carlo, M.D.

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Hign Impact Research

Around 40 percent of preterm infants with BPD-PH die before the age of 2. UAB studies establish two significant risk factors of the condition.

by Hannah Echols

Around 50 percent of preterm infants develop some form of bronchopulmonary dysplasia, a breathing disorder that can cause long term breathing and health issues. Around 20 percent of preterm infants develop BPD with pulmonary hypertension, the most severe subtype of the condition.

± 50% of preterm infants develop some form of bronchopulmonary dysplasia. ± 20% of preterm infants develop BPD with pulmonary hypertension, the most severe subtype of the condition.

An estimated 40 percent of this group will die before the age of 2. However, little is known about what causes the development of BPD-PH.

“Current screening methods are limited in their ability to detect BPD, let alone the severity of the disease,” said Samuel Gentle, M.D., assistant professor in the University of Alabama at Birmingham Division of Neonatology. “Since both BPD and BPD-PH are common morbidities in preterm infants, we wanted to evaluate other potential methods for earlier diagnosis.” Gentle, along with other researchers from the UAB Marnix E. Heersink School of Medicine, conducted two studies to evaluate risks and predictors of preterm infants’ developing BPD-PH. Results from the studies, published in the American Journal of Respiratory and Critical Care Medicine, establish the duration of intermittent hypoxemia events and the time the patent ductus arteriosus vessel remained opened as potential predictors for BPD PH in preterm infants.

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“ “Since both BPD and BPD-PH are common morbidities in preterm infants, we wanted to evaluate other potential methods for earlier diagnosis.”

Intermittent Hypoxemia and BPD-PH Preterm infants struggle to accurately control their breathing, typically due to their lungs’ being underdeveloped. This can lead to intermittent hypoxemia or periodic drops in an infant’s oxygen saturation level below an acceptable range. Studies suggest that the cumulative effect of IH episodes may be detrimental to a neonate’s health. The first UAB study evaluated whether characteristics of IH episodes such as frequency and duration of IH events can predict which preterm infants will later develop BPD-PH. Results showed that infants with IH events lasting longer than one minute were twice as likely to develop BPD-PH. The frequency of the episodes did not differ between the two groups. “If the length of IH episodes is a predictor of developing of BPD-PH, it may enable physicians to identify infants with BPD-PH earlier on,” Gentle said. “We are hopeful that earlier detection translates to earlier intervention and improved outcomes in infants with this devastating disease.”

– Sam Gentle, M.D.

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Hign Impact Research

Patent Ductus Arteriosus and BPD-PH

While in utero, a fetus does not need blood pumped to its lungs as the mother provides the fetus with oxygen. Instead, the patent ductus arteriosus vessel is one mechanism by which blood from the heart bypasses the lungs and is directed toward the body. Once a baby is born, the PDA vessel typically disappears early on during the transitional circulation period. In preterm infants, the PDA vessel stays open longer, sometimes for months. Gentle’s second study evaluated how the length of time the PDA vessel remained open affected the development of BPD-PH. Results showed that preterm infants born between 22 and 28 weeks with BPD-PH more frequently had a PDA that remained opened beyond 28 days. Additionally, a persistent PDA duration was linked with BPD-PH-related death. This was more frequent than in infants with only BPD. Observational studies have shown that babies with a PDA that stays open longer are more likely to develop BPD. Additional studies have shown that intervention, such as prescribing acetaminophen or ibuprofen, can help close the PDA but does not necessarily prevent development of BPD.

“ “Our results provide evidence that taking a conservative approach to PDA intervention beyond four weeks after birth may increase infants’ risk of developing BPD-PH.”

– Sam Gentle, M.D.

evidence that taking a conservative approach to PDA intervention beyond four weeks after birth may increase infants’ risk of developing BPD-PH.”

Gentle also notes that the question remains whether a persistent PDA is what causes BPD-PH or developing BPD-PH leads to a PDA that remains open longer. He says longitudinal monitoring of PDA, including echocardiograms before 28 days postpartum, could help provide additional markers that could be used as determinants of development. ■

“There is considerable practice variation as to whether doctors should intervene and close persistent PDAs,” Gentle said. “Our results provide

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Treatment Effects of Hydrocortisone by Risk of Bronchopulmonary Dysplasia or Death Among Extremely Preterm

by Heather Watts

Extremely preterm infants who develop bronchopulmonary dysplasia (BPD) are at a higher risk for adverse pulmonary and neurodevelopmental outcomes. Hydrocortisone has been considered as a potential therapy to prevent development of BPD. However, in the recently conducted National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN) Hydrocortisone Trial, hydrocortisone exposure did not reduce rates of BPD or death compared to placebo. The trial enrolled infants between August 22, 2011, and February 4, 2018, born at a gestational age of less than 30 weeks who received mechanical ventilation for at least seven days. Researchers at UAB, led by Sam Gentle, M.D., assistant professor in the Division of Neonatology, conducted a secondary analysis to evaluate whether a subpopulation of infants benefitted from hydrocortisone treatment. The team analyzed data from the NICHD NRN trial for this study. The original study was a double-masked, placebo controlled, randomized clinical trial conducted in 19 US academic centers. Dr. Gentle used the NICHD

Neonatal BPD Outcome Estimator to estimate the infants’ baseline risk of grades 2 to 3 BPD or death and then reanalyzed subpopulations to assess potential benefit. The analysis of these data revealed that the infants’ baseline risk for BPD (e.g., whether it was high or low) did not modify the impact of hydrocortisone on the development of BPD. Since only hydrocortisone was assessed in the original study, the potential benefit of other steroids on BPD outcomes was not assessable. “Hydrocortisone, used either selectively or non-selectively, may not be the appropriate corticosteroid to reduce BPD or death in extremely preterm infants. Additional trials of alternative corticosteroid exposure strategies may still be warranted,” explained Gentle, principal investigator on the study. ■

This study was published in JAMA Network Open in May 2023. Namasivayam Ambalavanan, M.D., professor in the Division of Neonatology, and Waldemar A. Carlo, M.D., professor in the Division of Neonatology, are co-authors with Dr. Gentle.

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Hign Impact Research

Analyzing the Clinical Features and Risk Factors Associated with Multisystem Inflammatory Syndrome in Children With Cancer and COVID-19

by Heather Watts

Children infected with COVID-19 are susceptible of developing multisystem inflammatory syndrome in children (MIS-C). Studies have shown that being school-aged, male, Black, and Hispanic are risk factors for developing MIS-C, but underlying comorbidities (including cancer and/or immunosuppression) have not been specifically investigated with MIS-C. Researchers, led by Julie Wolfson, M.D., associate professor in the Division of Pediatric Hematology/Oncology, and Emily Johnston, M.D., assistant professor in the Division of Pediatric Hematology/Oncology, analyzed the evaluated development of MIS-C among children with cancer and COVID-19, as well as the symptoms and disease severity associated with MIS-C in this population. “We wanted to understand which children with cancer and COVID-19 were more likely to develop MIS-C,” explained Johnston. “We also wanted to understand the symptoms and disease severity of MIS-C in this population.” Using the Pediatric Oncology COVID-19 Case (POCC) Report (est. March 2020), the largest US registry of children with cancer who become infected with COVID-19, the study found that children with comorbidities were more likely to develop MIS-C than those without comorbidities.

Emily Johnston, M.D

Julie Wolfson, M.D

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“ “We wanted to understand which children with cancer and COVID-19 were more likely to develop MIS-C. We also wanted to understand the symptoms and disease severity of MIS-C in this population.”

– Emily Johnston, M.D.,

Of the 2,035 children with cancer and COVID-19, 1.2% developed MIS-C. Eighty-three percent of children with MIS-C had a hematologic malignancy, and 50% had at least one comorbidity besides cancer. The study found that the majority of children with MIS-C

“We are hopeful that these findings can inform conversations between oncology teams and families regarding the risks of COVID-19 and the benefits of prevention,” said Wolfson. “These preventions can range from vaccination, masking, as well as such treatment as antivirals and monoclonal antibodies.” ■

Of the 2,035 children with cancer and COVID-19, 1.2% developed MIS-C.

had their cancer directed therapy changed, and those with MIS-C face a more severe clinical course than others do.

These study results were published in JAMA Oncology in August. Smita Bhatia, M.D., MPH, professor in the Division of Pediatric Hematology/Oncology, is a co-author with Wolfson and Johnston.

These findings determine that MIS-C is a serious outcome for children with cancer and COVID-19. Preventing COVID-19 infection in this vulnerable population will have the additional benefit of preventing MIS-C and its associated complications.

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Impact on Health Disparities and Underserved Populations in Alabama

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Community Impact

Children’s of Alabama Community Healthcare Education Simulation (COACHES) Program by Emily Franklin

In 2017, the Children’s of Alabama Community Healthcare Education Simulation (COACHES) Program was launched with a mission of improving pediatric care in community hospitals throughout Alabama. Over the past seven years, this program has made substantial progress in disseminating knowledge to 50 hospitals in Alabama as well as eastern Mississippi and western Georgia.

“The aim of the COACHES Program is to better equip hospitals with the training and tools necessary to ensure quality care for children,” said Chrystal Rutledge, M.D., associate professor in the Division of Pediatric Critical Care and program director of the COACHES Program. The program engages with community healthcare providers who are crucial in delivering care to pediatric patients. Specifically, the emphasis is on those working in emergency departments and on inpatient pediatric floors, as well as facilities that are planning to expand their outpatient clinics.

Chrystal Rutledge, M.D.

The success of the COACHES Program is attributed to its key personnel’s dedication. The leadership team includes Dr. Chrystal Rutledge, serving as the Program Director, Dr. Sarah Bingham as the Assistant Program Director, Stacy Gaither, MSN, RN, and Carrie Norwood, MSHI, BSN, RN as Program Coordinators, and Dr. Lauren Robinson, who leads the Office and School-Based Education aspect. Drs. Bingham and Robinson joined the team in 2023.

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This impactful program owes much of its existence to the generous financial support of Dr. Joe and Mrs. Cornelia LaRussa. Their commitment has enabled the program to flourish and make a lasting impact on pediatric healthcare in the region. This year, the program has partnered with the Pediatric Pandemic Network hub at Children’s of Alabama and the UAB Department of Pediatrics to hire additional personnel that allows significant expansion of its services.

“ “The aim of the COACHES Program is to better equip

hospitals with the training and tools necessary to ensure quality care for children”

COACHES is a testament to the power of simulation in advancing pediatric healthcare. With a broad reach, a dedicated team and crucial financial support, this program continues to shape the landscape of pediatric clinical care, patient safety and education in Alabama and beyond. ■

– Chrystal Rutledge, M.D.

For those seeking more information, the program’s website childrensal.org/coaches serves as a comprehensive resource.

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Community Impact

Renal Care Center Food Assistance Program by Emily Franklin

In 2020, the Renal Care Center Food Assistance Program was launched in the dialysis unit at Children’s of Alabama. This project aims to address the often-overlooked problem of food insecurity and insufficient access to nutritious foods in dialysis patients. The Program has received generous support from Children’s of Alabama through the Children’s Table Initiative. This project was implemented by Sahar Fathallah-Shaykh, M.D., the previous director of the Pediatric Dialysis Unit, along with Janelle Hanick RDN, LD, Registered Dietitian at Children’s of Alabama. The program is currently led by Daniel Feig, M.D., Ph.D., M.S., professor in the Division of Pediatric Nephrology. Hanick said, “This program helps by addressing food insecurity in our dialysis population to ensure these children receive the appropriate prescribed diet, e.g., adequate protein, lower salt, and appropriate potassium and phosphorus containing foods, and can achieve adequate nutrition.” The cornerstone of the program is the understanding that, although modern medical procedures such as dialysis are vital for patients’ health, food insecurity affects health outcomes and increases the need for healthcare services. This project emerged from an incident that took place with a patient while she was in the hospital and revealed that, instead of health issues, her declining condition was caused by inadequate food resources. This incident stressed the significance of food insecurity in the care of patients needing dialysis. The program uses a comprehensive strategy, concentrating on screening and intervention to address hunger in the most susceptible individuals. Acknowledging the high expense of nutritious food, which is heightened by inflation, the initiative fills the financial gap for patients and their families.

Sahar Fathallah-Shaykh, M.D.

Janelle Hanick RDN, LD

Daniel Feig, M.D., Ph.D., M.S.

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A social worker performs a formal socioeconomic evaluation at the start of the procedure to gauge the degree of food insecurity. This evaluation explores the complexities of the patient’s financial status by looking at income, personal expenses, and any current support networks. The program started by providing

“ “This program helps by addressing food insecurity in our dialysis population to ensure these children receive the appropriate prescribed diet.”

non-perishable food items but now includes fresh unprocessed ingredients such as meat, fruits, and vegetables which is vital for dialysis patients. The families can pick up the prepared food box from their local supermarket. To provide patients with comprehensive dietary assistance that is specifically catered to their medical needs, this care goes beyond basic nourishment and includes therapeutic nutritional supplements that might not be covered by health insurance.

– Daniel Feig, M.D., Ph.D., M.S.

The impact of this program transcends mere provision of food; it serves as a lifeline for families navigating the complexities of chronic illness and financial strain. The success of this initiative underscores the importance of recognizing food as a fundamental component of healthcare, particularly in populations with chronic illnesses such as end-stage renal disease. It serves as a testament to the power of collaboration between healthcare providers, community organizations, and philanthropic entities in addressing multifaceted health challenges.. ■

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Community Impact

Increasing Food Insecurity Screening by Emily Franklin

In a dedicated effort to alleviate the struggles of families facing food insecurity, the Increasing Food Insecurity Screening project at the University of Alabama at Birmingham Department of Pediatrics and Children’s of Alabama is committed to providing resources both within and beyond the confines of the hospital. “While the global aim is to support families admitted to Children’s of Alabama, our current focus is on refining the screening process to accurately identify those experiencing food insecurity,” said Adolfo Molina, M.D., MSHQS,

Adolfo Molina, M.D., MSHQS

assistant professor in the Division of Pediatric Hospital Medicine. “Overcoming the challenges in this arena is crucial to delivering truly holistic care to our families, recognizing that medical advances are only meaningful when basic needs are met.”

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Approximately one in four children in Alabama struggle with food insecurity.

This project extends its reach to patients from all corners of Alabama. The goal for those who are admitted to Children’s of Alabama is to help find local support for ongoing needs in addition to providing urgent resources. Food-insecure patients are identified through the American Academy of Pediatrics Hunger Vital Signs criteria, emphasizing UAB and Children’s of Alabama’s commitment to a comprehensive screening process. “This initiative is truly a multidisciplinary effort, involving physicians across the training spectrum (residents, fellows and faculty), social workers, nutritionists, nursing staff and external organizations. Together, we are dedicated to making a meaningful impact on the lives of families facing food insecurity,” says Molina. “When social services are aware of food insecurity, we meet with the family to discuss how to access food while in the hospital,” said Cindy Deerman, medical social worker on the pediatric hospital medicine team. “We also ensure that they know how to apply for food stamps and/or the Women, Infants and Children (WIC) program, provide a list of county food banks, and give them a $20 gas card to get to the food bank. And hopefully, in the near future, we will also give a box of food to bridge them to their local food bank.” Approximately one in four children in Alabama struggle with food insecurity, emphasizing the urgency and significance of this project.

“ “Overcoming the challenges in this arena is crucial to delivering truly holistic care to our families, recognizing that medical advances are only meaningful when basic needs are met.”

– Adolfo Molina, M.D., MSHQS

As part of our commitment to ongoing support, Deerman has had the opportunity to call these families after their admission to see if the provided resources were helpful. “I often hear how thankful they are for the resources. It may be that we helped them apply for food stamps or WIC and they now have it, or we connected them to a local food bank, and they were able to get food after discharge,” explained Deerman. Through these comprehensive efforts, the project aims to address immediate needs and to create lasting solutions for families facing food insecurity, thereby fostering a healthier and more secure future for children in our care. ■

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Community Impact

Using community engagement to improve the public health issues for children living in the Black Belt of Alabama by Heather Watts

Access to care and social determinants of health (SDOH) play a significant role in health disparities and outcomes in our communities. The Black Belt region of Alabama has some of the highest SDOH burden in the state and is at a higher risk for poor access to care due to its rural location. The Black Belt region is largely rural and is predominately black and many of the residents live below the poverty line.

To work at combating these issues in the Black Belt, researchers at the University of Alabama at Birmingham have partnered with state and community partners to improve access to quality care and preventative services. Claudette Poole, M.D., assistant professor in the Division of Pediatric Infectious Diseases, is program lead on two separate programs targeting sanitation health and rural care coordination to improve asthma outcomes in children in the Black Belt.

Claudette Poole, M.D.

Dr. Poole began her work in the Black Belt with the Center for Disease Control and Prevention (CDC) funded Sanitation Health Project. Due to failing septic systems and insufficient sewage disposal in the Black Belt, residents, especially children and pregnant women, in the area are at a higher risk of contracting intestinal infections and parasites.

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UAB has partnered with the Rural Health Medical Program, Inc. (RHMP), the Alabama Department of Public Health (ADPH), and the Consortium for Rural Alabama Water and Wastewater Management (CFRAWAWM) and the CDC to improve the failing sanitation systems, educate the public on poor sanitation risks, and connect rural healthcare providers with patients to screen for home conditions.

with Whitfield Regional Hospital, Selma Pediatrics, and other regional health providers, together with the Alabama Department of Public Health (ADPH), the Alabama Medicaid Alabama Coordinated Health Network (ACHN), the Alabama Asthma Coalition, and the Community Action Agency, Drs. Poole, Magruder and Virella-Lowell will work to leverage existing resources and community partners to improve access to quality care and preventative services to improve asthma in children in the region.

Isabel Virella-Lowell, M.D.

“ “The Alabama Black Belt is a region of our state that is rural, has suffered decades of outmigration and economic decline and as a result is chronically under-resourced.”

– Claudette Poole, M.D.

Teri Magruder, M.D.

“This program began as a disease surveillance project, to determine the prevalence of intestinal parasitic disease in children in the Alabama Black Belt,” explained Poole. “Although, our investigations did not identify any cases of intestinal parasitic infection, we have identified children in certain communities that are rural and predominantly African American and that do not have access to safe water and effective sanitation.” The program has evolved into a coalition of academic, non-profit organizations, community based groups, community leaders, and local and state government agencies working towards sustainable solutions to ensure equitable access to safe water and effective sanitation to all communities. With funding from the Health Resources and Services Administration (HRSA), Dr. Poole is working with Teri Magruder, M.D., associate professor, and Isabel Virella-Lowell, M.D., professor in the Division of Pulmonology and Sleep Medicine, on the HRSA Rural Care Coordination project to improve outcomes for children with Asthma in the Black Belt. In collaboration

“The Alabama Black Belt is a region of our state that is rural, has suffered decades of outmigration and economic decline and as a result is chronically under resourced,” said Poole. “Despite these conditions, there are vibrant, close-knit communities that are finding innovative ways to support households, children and families to thrive. It has been immensely inspiring meeting and working alongside many remarkable individuals and community organizations teaching us how to do this work well.” “The metrics to document outcomes has highlighted stark disparities in many domains, however these measures often overlook the many assets that protect and nurture these incredibly resilient communities despite the challenges.” “We are humbled and privileged to be welcomed by these communities as we look to see how our UAB resources may amplify their work and strengthen ongoing partnerships” ■

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Global Health

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Global Health

A Global Partnership in Pediatric Oncology by Emily Franklin

A groundbreaking collaboration is flourishing between the University of Alabama at Birmingham Division of Pediatric Hematology, Oncology and Blood & Marrow Transplantation and the Children’s Cancer Hospital Egypt (CCHE) 57357, the largest pediatric cancer hospital globally. CCHE 57357, nestled in the bustling city of Cairo, has treated more than 23,000 pediatric cancer patients since its founding in 2007. With its impressive 298 beds, this amazing facility has been a representation of tenacity and commitment to the battle against pediatric cancer. Recognizing the imperative to expand expertise and knowledge in the field of pediatric oncology, the UAB Division Pediatric Hematology, Oncology and Blood & Marrow Transplantation (BMT), Children’s of Alabama and CCHE 57357 have forged a robust partnership aimed at fostering collaboration in clinical medicine, research and education. “The vision is to not only

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“ “The vision is to not only treat young patients but also to empower medical professionals with specialized training that transcends borders,”

– Girish Dhall, M.D.

The Children’s Cancer Hospital Egypt (CCHE) 57357 is the largest pediatric cancer hospital globally with 298 beds and treating over 23,000 patients since its founding in 2007.

treat young patients but also to empower medical professionals with specialized training that transcends borders,” explained Girish Dhall, M.D., division director and professor in the Division of Pediatric Hematology/Oncology. At the heart of this initiative are joint subspecialty fellowship training programs in pediatric neuro oncology and pediatric BMT. The pediatric neuro

clinical assignments, mentoring, research and live telemedicine lectures. The trainees will spend significant time at CCHE 57357 in Cairo, where they will receive hands-on experience and exposure to diverse cases. Additionally, they will undertake four-week clinical observerships at Children’s of Alabama/UAB and DFCI/Boston Children’s Hospital for a BMT fellowship and Children’s of Alabama/ UAB and St. Louis Children’s Hospital/Washington University for a neuro-oncology fellowship. “The goals of these training programs will be to admit deserving candidates from Egypt, the Middle East and Africa and provide them with exceptional subspecialty training so that they can return to their home country to establish programs in neuro oncology and BMT, providing much-needed expertise in their respective regions/countries,” says Dhall. As the first cohort of trainees embarks on this transformative journey, the collaborative effort between UAB, Children’s of Alabama and CCHE 57357 stands as a testament to the power of global partnerships in advancing pediatric oncology. ■

oncology fellowship is a tripartite effort involving CCHE 57357, Children’s of Alabama/UAB and St. Louis Children’s Hospital/

Washington University School of Medicine. Simultaneously, the pediatric BMT fellowship program is a collaboration between CCHE 57357, Children’s of Alabama/UAB and Dana Farber Cancer Institute (DFCI)/Boston Children’s Hospital.

Girish Dhall, M.D.

The training programs are designed to be immersive and comprehensive, incorporating

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Diversity, Equity & Inclusion

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Diversity, Equity & Inclusion

Collaboration, integrity, respect and excellence are shared values of our institution and are the core of what it means to be a part of the UAB community. A key foundation at UAB is diversity, equity, and inclusion. At UAB, everybody counts every day. UAB is committed to fostering a diverse, respectful, and inclusive environment that values all regardless of background and embraces individual differences. UAB values and cultivates equity, diversity, and inclusion in our research, learning, clinical and work environments. Our students, residents, fellows, faculty, and staff add diversity to our community through life experiences, perspectives and viewpoints that are enriching for the learning and work environment and are reflective of the students and communities we serve. Because UAB serves a diverse population, the UAB Office of Diversity, Equity and Inclusion, along with the Department of Pediatrics, aims to create an inclusive environment for all UAB faculty, staff, students, and patients through education, training, and awareness programs.

UAB Pediatrics Demographics

Total for FY22

Hired in FY22

Women –58% Men – 42%

Women –78% Men – 22%

White – 70% Asian – 9% Black/African American – 17% Two or More Races – 4%

White – 68% Asian – 15% Black/African American – 9% Hispanic/Latino – 7% Two or More Races – 1%

5 out of 9 Vice-Chairs are Women

7 out of 19 Division Directors are Women

2 out of 9 Vice- Chairs are URIM

4 out of 19 Division Directors are URIM

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