Inside Pediatrics Fall/Winter 2024

PEDIATRICS

Fall/Winter 2024

Saving Lives in Latin America How the Children’s cardiovascular team is making a difference abroad

PLUS: Developing treatments for the most severe cystic fibrosis cases

W ith another football season in full swing, many fans are hoping their favorite teams will go the distance and win a championship. Here at Children’s of Alabama, we go the distance every day to help our patients win battles against illness and injury. In some cases, that means traveling a literal distance—sometimes thousands of miles—to help children in need. Figuratively, it can mean striving for a cure or creating comprehensive programs that address the needs of every type of patient. In this issue of Inside Pediatrics, you’ll read about many of the ways Children’s is going the distance. Each year, a team from Children’s visits countries in Latin America through Heart Care International to provide care to heart patients. For cardiac pediatric intensivist Santiago Borasino, M.D., these trips are personal. A native of Peru, Borasino gets to return to his home country. He travels this long distance to give back. In pulmonology, most patients with cystic fibrosis have access to drugs that can improve their life expectancy. At Children’s, however, most isn’t enough. Our physicians want every patient to have these groundbreaking treatments. That’s why they’re working to develop genetic therapies to help the 5% of patients who don’t benefit from the current treatments. Girish Dhall, M.D., also aims to provide treatment for every patient. In six years as the director of the Division of Hematology, Oncology, and the Blood and Marrow Transplantation Program, he’s more than doubled the number of consortia in which Children’s is enrolled. This has provided our patients with access to many more clinical trials.

Tom Shufflebarger, President and CEO

Our behavioral health team also has built something special. In response to the mental health crisis, they began adding unique services to address young people’s growing needs. Now, the team offers a comprehensive array of programs that meet kids where they are on their mental health journey. Epilepsy patients in Alabama and beyond also now have access to another treatment option thanks to the work of our neurology and neurosurgery teams. In January 2024, Curtis Rozzelle, M.D., performed a deep brain stimulation procedure for epilepsy. It’s the first time Children’s had ever offered this treatment. At Children’s of Alabama, we’ll always go the distance to better the lives of children in Alabama, across the Southeast and around the world.

INSIDE THIS ISSUE

ADMINISTRATION Tom Shufflebarger, President and CEO Chandler Bibb, Chief Development Officer Garland Stansell, Chief Communication Officer EDITORIAL Conan Gasque, Editor Amy Dabbs

Division Rounds Quick briefs and news from around the hospital 2

DESIGN Becca Hodges Scott LeBlanc Dana Stuckey PHOTOGRAPHY MaryMargaret Chambliss Eric Gray Denise McGill CONTRIBUTORS Corinn Cross, M.D. Leslie Feldman Debra L. Gordon, MS Sarah Handzel, BSN, RN Savanah Kirchner

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New Options for Epilepsy Patients Neurosurgeon performs procedure for the first time at Children’s

Healing Hearts in His Home Country Children’s physicians perform heart surgeries in Peru every year. For one, it’s a personal assignment. Drive for the 5% Developing treatments for the most severe cystic fibrosis cases

Rhonda Lee Lother Maureen Salamon Bob Underwood, M.D.

Heather Watts Unlock Health DIGITAL CONTENT Andre Green MEDICAL LEADERSHIP Mitchell Cohen, M.D. Katharine Reynolds Ireland Chair of Pediatrics, University of Alabama at Birmingham Physician-in-Chief, Children’s of Alabama Mike Chen, M.D. Joseph M. Farley Chair in Pediatric Surgery, University of Alabama at Birmingham Chief of Pediatric Surgery and Surgeon-in-Chief, Children’s of Alabama James Cullinan, D.O. Associate Professor Director, Child & Adolescent Psychiatry Chief of Service, Child & Adolescent Psychiatry, Children’s of Alabama

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A Creative Approach to Behavioral Health Services How the team at Children’s is responding to the mental health crisis

Building a National Leader in Clinical Trials Girish Dhall’s vision is paying off

News, Honors and Awards

For questions or additional information or to share feedback, please contact us at insidepediatrics@childrensal.org. An online version of the magazine is available at childrensal.org/insidepediatrics.

DIVISION ROUNDS

For a closer look at these stories and more, visit InsidePeds.org

NEONATOLOGY

Studies identify risk factors for BPD-PH in preterm infants Two studies led by Children’s of Alabama neonatologists are shedding light on the risk factors for bronchopulmonary dysplasia–associated pulmonary hypertension (BPD-PH), a condition that can lead to long-term breathing and health problems. It’s a major threat: nearly half of preterm infants develop BPD. About 20% of these babies also develop PH, and an estimated 40% of them will die of BPD-PH before turning 2 years old.

neonatologist Samuel Gentle, M.D., wanted to fill the vacuum. That’s why he and colleagues at the University of Alabama at Birmingham (UAB) published two studies that assessed factors that may contribute to BPD-PH in preterm babies. Published in the American Journal of Respiratory and Critical Care Medicine , they found two important associations: The duration of intermittent hypoxia events and the presence and persistence of a patent ductus arteriosus (PDA) after birth are both novel risk factors for BPD-PH. But far more study is needed, Gentle pointed out. “While this research focused on a specific phenotype of BPD,” he said, “we need a comprehensive approach to identifying each infant’s specific type of lung disease from which we can decide on the best therapeutic course for every child.”

will also develop PH 20 %

die before the age of 2 40 %

NEARLY HALF

preterm infants develop BPD

Since research has been scant about what causes the development of BPD-PH—as well as how to screen, treat and prevent it—

NEPHROLOGY

Testing the first potential treatment for AMKD

A team of clinicians and researchers from Children’s and the University of Alabama Birmingham (UAB) has launched a potentially groundbreaking clinical trial testing the first potential treatment for APOL1-mediated kidney disease, or AMKD, a genetic condition linked to mutations in the APOL1 gene that can lead to rapid kidney function decline and, ultimately, kidney failure. This genetic factor is particularly common in African Americans, contributing significantly to the higher rates of kidney failure seen in this population. The trial, called AMPLITUDE, is testing the efficacy and safety of a first-in-its-class oral medication called VX-147, or inaxaplin. The drug is designed to inhibit the inflammatory pathway triggered by the APOL1 gene variant. The hope is that blocking this pathway will slow or even stop the progression of AMKD.

“It’s exciting because these patients have no other options for therapy,” said Children’s pediatric nephrologist Daniel Feig, M.D., Ph.D. The trial is enrolling about 500 adult and pediatric participants, including about 150 children ages 10 to 18. More than 200 centers in the U.S. and other countries are involved.

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ENDOCRINOLOGY

GASTROENTEROLOGY

A potential breakthrough in hypothalamic obesity treatment Acquired hypothalamic obesity has long presented a complex challenge in healthcare, leaving pediatric patients struggling to lose weight. To address the problem, Children’s of Alabama is involved in an innovative study involving a medication called setmelanotide, a drug that targets melanocortin receptors, which are crucial in regulating the body’s satiety signals. According to Children’s endocrinologist Hussein Abdul-Latif, M.D., the medication can have an impact on correcting the disrupted signals that lead to continuous hunger and reduced metabolism— two key factors contributing to this form of obesity. The ongoing phase 3 trial involves multiple sites, including Children’s of Alabama, enrolling patients up to 30 years old. The research offers hope to those struggling with acquired hypothalamic obesity, Abdul-Latif says. The condition, which previously was perceived as challenging to treat

New Polyposis Clinic aims to enhance gastrointestinal care

Successfully managing gastrointestinal issues in children can be extremely challenging, but a new clinic at Children’s of Alabama is providing a hub of specialized care.

The Children’s of Alabama Polyposis Clinic was conceived to fill a crucial gap in pediatric gastroenterology. Recognizing the need to provide focused expertise and coordinated care for patients with polyposis syndromes “was the major impetus for establishing a dedicated clinic,” said pediatric gastroenterologist Cary Cavender, M.D., who leads the clinic. The clinic, which opened in January 2024, operates on a quarterly basis. It offers advanced diagnostic and treatment procedures, including advanced endoscopy and colonoscopy techniques such as pill cam endoscopy as well as medication management. Because many patients have an increased risk for cancer, the clinic works with members of the oncology team specializing in cancer predisposition. Among their other duties, oncology team members coordinate genetic counseling for high-risk patients at the Oncology Cancer Predisposition Clinic, ensuring families receive comprehensive support. The clinic is one of the first of its kind in the Southeast. Cavender believes it will serve as a vital resource, offering top-tier care for children with polyposis syndromes.

effectively, now has a potential breakthrough. The medication provides promise for a segment of the population in need of more personalized solutions, hinting at a positive outlook for the future of treating this condition.

UROLOGY

ORTHOPEDICS

A new model for testicular torsion detection

Orthopedics team expands to meet patients’ needs In response to increased demand for services, the Children’s of Alabama orthopedics team has expanded, adding two orthopedic surgeons and two advanced practice providers since late 2022. The division now has six surgeons and four advanced practice providers.

10 - 20 %

Testicular torsion is a serious medical emergency that requires immediate surgical intervention. Yet the condition may present with vague symptoms such as abdominal pain and nausea. That’s why Children’s urologist Carmen Tong, D.O., teamed up with the hospital’s Pediatric Simulation Center team to create a new model to help with diagnosis. Prompt diagnosis is crucial. The so-called “golden window” to salvage testicular function after symptom onset is between four and eight hours. So to improve detection, Tong turned to Nick Rockwell, M.D., and advanced nurse educator Autumn Layton, MSN, RN, in the simulation center. Together, they created a testicular torsion model that provides experiential learning for residents. Rockwell, Layton and their team used Play-Doh–covered Styrofoam balls to simulate a torsed testicle, while a stress ball represents a normal testicle. These are enclosed in balloons to mimic scrotal skin and attached to a mannequin. Residents can then practice palpating the model to distinguish between normal and torsed testicles. The response to the training has been overwhelmingly positive, Tong said. “What’s super impressive about this model is that it’s easily replicable,” she added. “So once we publish this, other institutions can take what we did and create the same model. It doesn’t cost thousands of dollars.”

Increased demand each year since 2020

The staff additions are the department’s response to steady population growth in the Birmingham area and lengthening wait times for clinic appointments. According to orthopedic surgeon Kevin Williams, M.D., demand for the team’s services has continued at a clip of 10% to 20% year over year since 2020. “We’re constantly looking to provide better care for children of Alabama,” Williams said. “One way was to put more providers in place who can take care of these patients in clinic and think about how to best care for children with difficult pathologies.” With the new providers, the team can now see patients within an appropriate time frame instead of having to book appointments months out. Adding team members also adds flexibility to everyone’s roles. Advanced practice providers can see patients independently, freeing up surgeons for surgical cases. They can also assist in the operating room.

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Inside Pediatrics | Children’s of Alabama

New Options for Epilepsy Patients NEUROSURGEON PERFORMS DBS FOR EPILEPSY, IMPLANTING RNS DEVICE I n January 2024, a University of Alabama at Birmingham (UAB) pediatric neurosurgeon performed Children’s of Alabama’s first deep brain stimulation (DBS) procedure for epilepsy, offering a new treatment option for pediatric patients who experience drug-resistant seizures.

was designed to communicate with a computer to record brain activity, recognize seizure-related patterns and deliver stimulation to suppress seizures. The device, which is curved for better placement within the skull, monitors brainwaves constantly and can be customized on a patient by-patient basis. “Much like a cardiac pacemaker that senses and responds to abnormal heart rhythms, this combination of technologies detects brain activity that precedes seizures and then stimulate pathways deep in the brain to either prevent seizures from starting or stop seizure activity in its tracks,” said Rozzelle.

During the procedure, Curtis J. Rozzelle, M.D., a professor in the UAB Department of Neurosurgery, also implanted the first NeuroPace responsive neurostimulation (RNS) epilepsy treatment device at Children’s.

The NeuroPace RNS® System, which consists of a small generator attached by leads to electrodes,

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NEUROLOGY

When performing a DBS procedure, a neurosurgeon inserts electrodes connected to a neurostimulator into the brain to disrupt epileptic electrical activity before it can cause a seizure. Similar to the RNS System, the DBS neuromodulation device—after placement—can be programmed in an outpatient clinic by an epilepsy specialist, such as UAB Department of Pediatrics Division of Neurology professor Monisha Goyal, M.D. In this case, Rozzelle placed the RNS System electrodes in the thalamus, resulting in a twofold RNS and DBS procedure.

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Inside Pediatrics | Children’s of Alabama

Curtis Rozzelle, M.D., performing Children’s of Alabama’s first DBS procedure for epilepsy.

Neurostimulators have long been used to treat various neurological disorders when traditional treatment options fail. DBS was originally developed in 1997 to treat Parkinson’s disease and has since expanded as a treatment option for epilepsy, dystonia and more. RNS gained initial FDA approval in 2013 and has proved to be effective in many patients. Presently, RNS is FDA-approved only for adults but is successfully being used off-label in the pediatric population.

Though DBS and RNS are not viable options for all patients, they show tremendous potential in treating children with epilepsy who need more innovative treatment options.

“With this first RNS implantation [at Children’s of Alabama], we have expanded the armamentarium of therapies available to individuals with poorly controlled epilepsy,” Goyal said. “Unfortunately, neuromodulation with RNS is only [FDA-approved] for individuals who are at least 18 years old. The pediatric epilepsy team at Children’s of Alabama hopes that this therapy will be available to more children of Alabama soon.” ●

Another First for Rozzelle Less than a year before Rozzelle performed

cases stems from the specific needs of young patients and advancements in the field. “Until Dr. Gantz arrived at UAB, we didn’t have a movement disorder neurologist here who

Children’s first DBS procedure for epilepsy, he also achieved another milestone for the hospital. In 2023, working alongside neurologist Emily Gantz, M.D., he performed Children’s first DBS procedures for patients with progressive dystonia. “We’re excited that this innovative procedure is now transferring over to our pediatric patients,” Rozzelle said. Studies suggest that pediatric patients with progressive dystonia respond well to deep brain stimulation, especially after failing conventional medications. The decision to apply DBS in pediatric

Curtis Rozzelle, M.D.

also had training and experience with deep brain stimulation,” Rozzelle said. “When she arrived, Dr. Gantz opened the door for us to be able to perform the technical aspects of the surgical procedure.” The procedure was featured in the Spring/Summer 2024 issue of Inside Pediatrics. You can also learn more about it at InsidePeds.org.

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PEDSCAST Podcast

The Children’s of Alabama PedsCast is a pediatric sub-specialist peer-to-peer podcast focused on research, innovative programs and advances in pediatric health care at Children’s of Alabama. Featured speakers include physicians, surgeons, clinical specialists and other experts in the field of pediatrics.

Behavioral Health Services: A Comprehensive Approach Brandy Reeve, MSN, RN, CPN, CENP

Pediatric to Adult Care Transition in Endocrinology Sajal Patel, M.D.

Inside the Pediatric Clinical Trials Office at Children’s of Alabama Matthew Kutny, M.D.

Outcomes in Babies with Hypoxia Ischemic Encephalopathy Vivek Shukla, M.D.

To tune in, visit ChildrensAL.org/PedsCast or subscribe through your favorite podcast app.

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CARDIOLOGY

GIVING BACK TO WHERE HIS HEART IS FOR ONE CHILDREN’S PHYSICIAN, AN ANNUAL TRIP TO PERU WITH HEART CARE INTERNATIONAL IS EXTRA SPECIAL

F or Children’s of Alabama cardiac pediatric intensivist Santiago Borasino, M.D., traveling to Peru each year as part of a team providing cardiovascular surgeries to children offers him a special way to give back to his home country. The trips are sponsored by Heart Care International, a nonprofit organization committed to saving the lives of children born with congenital heart defects. Volunteer medical teams come from cardiac centers throughout the United States, including Children’s of Alabama, to provide care throughout Latin America.

Borasino’s first trips were to Chiapas, Mexico, but after learning about the organization’s work in Peru, he focused his efforts there. “I get to give back to my country,” he said. “There’s always a lot of guilt for leaving. And so I get to go there, help with surgeries and give back to the country some— a little bit. This teeny tiny bit probably doesn’t repay everything that the country has done for me, but it’s a little bit. It’s very special to me.”

Santiago Borasino, M.D.

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Inside Pediatrics | Children’s of Alabama

The team—which most recently included Children’s cardiothoracic surgeon Robert Sorabella, M.D.; pediatric cardiac anesthesiologists Jack Crawford, M.D., Ph.D. and Patrick Hussey, M.D.; and Stephanie McBride, RNFA—works with doctors at the Instituto Nacional de Salud del Niño (INSN) San Borja in Lima, where Borasino was raised and attended medical school. The local doctors coordinate with the visiting clinicians to choose the cases. “We can’t do cases that are too complex because we don’t have ECMO,” Borasino said. ECMO, or extracorporeal membrane oxygenation, is a life-support machine that can temporarily replace the heart and lungs. They also want the child to be able to recover before the team leaves, so they have to choose wisely, he added. The visiting team works closely with their Peruvian counterparts. The American and Peruvian surgeons, anesthesiologists and nurses team up for surgeries, while Borasino partners with his Peruvian counterpart to manage the post-operative care side in the ICU. They generally perform about 15 surgeries a day. Over his six trips to Peru, Borasino has witnessed significant growth in the skills and knowledge of the local medical professionals, most of whom were just starting to practice when he met them. “They’ve grown just like any doctor in the United States grows from being a young doctor who hasn’t done this too much to somebody who’s done it quite a lot.”

Borasino, seen on these pages with other physicians and a patient during his most recent trip to Peru.

“The ultimate goal is that they will be independent,” he said. “They’re never going to be like Americans because of the resources. But, in theory, they could get close, at least for the moderate or low cases, a little complex but not too complex.”

“ The families come back every year when they know we’re there just to say hi and tell us, ‘You saved our kid’s life.‘

Without these volunteer trips, the outlook for many of the young heart patients is grim. “Some of them will be lucky enough to get surgery within the system,” Borasino said. “And some of them will die. Not immediately, but eventually. Like in a few years without surgery, you end up dying. All these congenital heart diseases eventually kill you, either in weeks, months or years.”

However, the team’s work can be life-changing for the patients they’re able to help.

“The families are so thankful,” Borasino added. “Some come back every year when they know we’re there just to say hi, to bring their kids and tell us, ‘You saved our kid’s life.’”

“It’s an opportunity to see more than just cardiac medicine,” he added. “And just to help.” ●

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Through Heart Care International, physicians from Children’s of Alabama and other renowned hospitals have saved thousands of children’s lives in five Latin American countries since 1994.

Inside Pediatrics provides information, news and the latest updates from departments and divisions at Children’s of Alabama. Articles and features cover the current developments and discoveries related to pediatric medical research, clinical trials and treatments happening today. Inside Pediatrics helps keep you connected and up-to-date on the latest breakthroughs and medical advances at Children’s of Alabama.

CATEGORIES

BEHAVIORAL HEALTH

CARDIOLOGY

ENDOCRINOLOGY

GASTROENTEROLOGY

HEMATOLOGY & ONCOLOGY

NEONATOLOGY

NEPHROLOGY

NEUROLOGY & NEUROSURGERY

ORTHOPEDICS

PULMONOLOGY

UROLOGY

UPCOMING EVENTS

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Inside Pediatrics | Children’s of Alabama

PULMONOLOGY

DRIVE FOR THE 5% DEVELOPING TREATMENTS

FOR THE MOST SEVERE CYSTIC FIBROSIS CASES

T he evolution of cystic fibrosis (CF) life expectancy for patients skyrocketing from early teens in the 1970s to well over 50 years today. But Children’s of Alabama specialists continue dogged efforts to help the 5% of CF patients who don’t qualify for or respond to groundbreaking disease-modulating drugs— which Children’s faculty helped develop and test—that have transformed CF treatment over recent years. University of Alabama at Birmingham (UAB) Cystic Fibrosis Therapeutics Development Center—a joint pediatric and adult endeavor—boasts more than 25 years of prominence in CF research. Nationally recognized as one of the top centers of its kind, it’s one of only 13 national resource centers for the more than 90 clinical trial centers that comprise the CF Clinical Trials Network. treatment is considered one of the major success stories in medicine, with average Co-directed by Isabel Virella-Lowell, M.D., and George “Marty” Solomon, M.D., the

5% CLINICAL TRIALS AND RESEARCH COULD HELP THE

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Gene mutations in an epithelial membrane protein called CFTR trigger chloride transport defects that drive CF symptoms. Much-heralded disease-modulating

drugs to target those defects—including Trikafta, a triple combination therapy

Isabel Virella-Lowell, M.D.

approved in 2019 to treat patients with the most common CF mutation—have greatly improved both health and quality of life for the vast majority of these patients, Virella-Lowell said. But the research team wants all CF patients—about 30,000 in the United States and 70,000 worldwide—to have those same advantages. “About 5% of patients don’t have a life-changing medication,” Virella-Lowell explained. “The answer for them will be introducing a corrected gene or fixing the CFTR gene with gene editing techniques so the epithelia will produce its own normal chloride channels. If genetic therapies are successful, they could be extended to the entire CF population. Ultimately, the goal is to develop a genetic therapy that cures cystic fibrosis.”

Two of the team’s current clinical trials are focusing on these potential approaches. One is an mRNA-CFTR therapy, while the other is an adeno-associated virus (AAV)-based CFTR gene therapy. Both are phase 1 trials to determine safety and potential side effects. Other genetic therapy trials are in the pipeline as well. With this research, the UAB CF Therapeutics Development Center is again setting itself apart in the region. It’s one of only four centers in the Southeast conducting the mRNA genetic therapy trial and one of only three performing the AAV gene therapy trial. ●

OF CF PATIENTS WHO DO NOT QUALIFY FOR OR RESPOND TO DISEASE-MODULATING DRUGS

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Inside Pediatrics | Children’s of Alabama

BEHAVIORAL HEALTH

COMPASSION, COMMUNICATION AND CARE: three words that sum up what behavioral health professionals offer to their patients. Since the onset of the mental health crisis, they’ve had to add another “c” to their repertoire— creativity. It’s been a crucial characteristic these last few years, and for Children’s of Alabama, it’s the rudder that has steered the department’s growth and development. A CREATIVE APPROACH TO BEHAVIORAL HEALTH SERVICES As the crisis progressed, it plunged behavioral health professionals into uncharted waters. Scores of new patients were seeking services, and many providers felt overwhelmed. Faced with an inundation of children and adolescents in need, they were forced to answer a key question: What can we do to help all these struggling young people? The hospital’s Behavioral Health Ireland Center already offered traditional services, such as its inpatient, outpatient and partial hospitalization programs. And while those were great, they wouldn’t be enough in this emerging new era. Children’s would need to tailor its services to fit a more diverse set of needs.

“ It’s all about our ability to meet as many patient needs as possible.

“Our goal here is to try to be creative and look at the way that we’re offering services from a different lens to see if there’s an opportunity to increase access for patients,” said Brandy Reeve, associate vice president of Behavioral Health Services at Children’s. “At the end of the day, it’s all about our ability to meet as many patient needs as possible.”

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The mental health crisis served as that new lens; the team’s response provided the answer that helped to develop a comprehensive approach that benefits not only the hospital and its patients, but also other providers around Alabama. That answer was adding unique services. The team started by adding a service that, at the time, was offered in only two other places across the country. In 2018, they opened the Children’s of Alabama Psychiatric Intake Response Center (PIRC), a call center designed to help adults navigate the mental health care system for their children. In 2021, the team added another unique service, Pediatric Access to Telemental Health Services (PATHS). It uses a three-pronged approach to help primary care providers across the state address their patients’ mental health needs.

has finished their inpatient stay, they will often move to the PHP or IOP until they’re ready for outpatient services. “We find that those programs all intertwine quite nicely to create a sort of a framework

in which we’re able to meet needs across the spectrum of acuity,” Reeve said.

Brandy Reeve, MSN, RN, CPN, CENP

So, what happens if the mental health crisis deepens, and even more patients need the hospital’s help? Children’s is already preparing for that. In March 2023, the hospital opened the Nature Hall, a new 16-bed psychiatric area within the emergency department that provides care for children and adolescents who arrive

in need of mental health services. Construction is already underway on hospital renovations that will add 11 additional inpatient behavioral health beds by February 2025. And PATHS received a HRSA grant for the next three years that the team will use to expand the program by partnering with school systems and rural emergency departments throughout the state. Reeve says she could see all of the programs growing in the future. “The goal is to continue to improve access in whatever unique ways we can find,” Reeve said, “and just be that resource for those that need it that are willing to partner with us in providing care to the patients that we see throughout the state.”

Most recently, in August 2024, the team opened its Intensive Outpatient Program (IOP), a complement to the hospital’s Partial Hospitalization Program (PHP). These two programs work together to help patients with the process of readjusting to normal life after dealing with mental health challenges. The traditional and unique programs fit together seamlessly in a way that allows patients to move from one to another as needed. For example, once a patient

Hear more from Reeve on the Children’s of Alabama PEDSCAST

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Inside Pediatrics | Children’s of Alabama

When the mental health crisis began, Children’s of Alabama behavioral health professionals responded by adding services designed to meet patients where they are. As a result, the hospital now offers a comprehensive array of both traditional and unique services .

Inpatient and Outpatient Care For high-acuity patients, Children’s offers a 44-bed inpatient unit staffed by psychiatrists, mental health therapists, nurse practitioners and others. These professionals follow the patients during their admission, which often includes group therapy and medication management. Lower-acuity patients are cared for in one of Children’s two outpatient locations, where they may be seen by psychologists, mental health therapists or psychiatrists, depending on their needs. Many patients attend therapy sessions, which may start as frequently as once a week but can be spaced out over time. This is determined by the patient’s treating provider. “It really varies based on the patient’s needs, but typically for those two spaces—both inpatient and outpatient—it is dependent upon the acuity and individual needs of the patient,” Reeve said. Partial Hospitalization Program (PHP) Some patients need a level of care that falls somewhere between inpatient and outpatient. For them, Children’s offers the PHP—a day treatment program that helps patients who now require less intense treatment and are able to step down from an acute inpatient unit. This program can also be a great option for patients seen in the outpatient setting who need to step up in the intensity or frequency of therapy provided. The program is for patients 12 to 18 years old and resembles a typical school day, running from 8:30 a.m. to 2:30 p.m., Monday through Friday. It involves intense group therapy sessions with other patients in the same age group. “They learn coping mechanisms and how

to deal with the everyday stress that our adolescent population often faces,” Reeve said. Patients also have time to keep up with schoolwork, spending at least one hour on academics each day. For many patients, the PHP eases the transition from the rigors of inpatient care back to the less intense outpatient care. “Going from having structure 24 hours a day to only having one hour of therapy a week—that’s a big difference for a child,” Reeve said. “And so that is why I think the evidence shows that this is so successful and is such a needed robust program within our state.” Intensive Outpatient Program (IOP) Just as the PHP was created to fill the gap between inpatient and outpatient services, the brand-new IOP is meant to help these young patients make another crucial step—back to normal living. The program, which opened in August 2024, is an extension of the PHP and designed to help patients adapt to daily life. Like the PHP, it serves adolescents ages 12 to 18, but it runs three hours a day, three days a week—from 1:30 to 5:30 p.m., similar to an after-school program. The less frequent, less intensive schedule is its main distinction from the PHP. But both programs have the same staff support, including psychiatrists, therapists, nurses and other mental health clinicians. The IOP also coordinates a variety of community resources for patients and families that help adolescents build a comprehensive support network to enhance treatment outcomes. “The IOP is a natural progression to our efforts to reduce the time we’re removing a child from a home environment,” program manager Lauren Byrd, MS, LPC, said, “and helping them meet their goals in the least disruptive, least traumatic way possible.”

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Psychiatric Intake Response Center (PIRC) The PIRC is a phone response center for adults seeking mental health resources for their children or adolescents. Callers can have free, confidential conversations with licensed mental health clinicians who assess a child or teen’s mental, emotional and behavioral needs and recommend the best treatment options, including the contact information of multiple mental health professionals in their community. The PIRC is open seven days a week, year-round, from 8 a.m. to 11 p.m. “It’s a tremendous opportunity for Children’s of Alabama to offer an innovative and much-needed mental health service to those in the community statewide,” PIRC director Cindy Jones, MA, CPC-S, NCC, said. “Our mental health professionals support callers by listening and guiding them to the best next steps for their child.”

Funded by a federal HRSA grant, PATHS is dedicated to increasing primary care providers’ ability to diagnose, treat and manage mild to moderate behavioral health conditions in children and adolescents. It does this through a three-pronged approach that includes education for primary care providers throughout Alabama, along with telehealth consults for providers and telehealth appointments for patients.

“ Those programs all intertwine to create a sort of a framework in which we’re able to meet needs across the spectrum of acuity.

Primary care practices enroll with the program and receive access to the PATHS team, which includes child/ adolescent psychiatrists and psychologists, psychiatric nurse practitioners, licensed clinical social workers and licensed professional counselors. In return, they agree to start behavioral health screenings for well-child visits and report results to PATHS; participate in one hour, bi-weekly educational sessions on pediatric and adolescent mental health issues; and maintain ongoing responsibility for their patients’ behavioral health care and treatment. Providers call PATHS when they have a patient who needs additional assistance. After an initial consult with a social worker, they are directed to the most appropriate team member to help. If the child needs more intensive care, they can interact directly with one of the PATHS specialists from their primary care office via telehealth. “This allows a patient not to have to come to Birmingham to see us,” Yalamanchili said. “It’s a really nice bridge until a local psychiatrist can see them.” Initially founded to help rural practitioners, PATHS now works with providers throughout the state, even those just a few miles away from the hospital. “It’s something that’s a little bit more outside-of-the-box thinking but has proven to be quite successful,” Reeve said. ●

Pediatric Access to Telemental Health Services (PATHS)

Adding to the already challenging circumstances of the mental health crisis is a severe shortage of pediatric psychiatrists and other mental health providers, especially in rural areas. This can lead to long wait times and unaddressed problems. “It can take three to six months to see a therapist or psychiatrist,” child psychiatrist Vinita Yalamanchili, M.D., said. Waiting that long for treatment means kids in crisis are at risk of self-harm. To address these obstacles, Children’s created PATHS. With this program, a patient can get expert care from their primary care provider, often within 24 hours.

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Inside Pediatrics | Children’s of Alabama

We’re making an impact—not just locally, but nationally and globally. “

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HEMATOLOGY + ONCOLOGY

Building a National Leader in Clinical Trials BEHIND THE VISION OF GIRISH DHALL, M.D., CHILDREN’S HAS DEVELOPED A TOP CLINICAL TRIALS PROGRAM IN CANCER AND HEMATOLOGY

W hen Girish Dhall, M.D., arrived at Children’s of Alabama in 2019, he inherited a division with a plethora of strengths: great facilities, compassionate physicians and a robust clinical trials program. He knew he was somewhere special. Still, he knew it could be better—a national destination center for research and clinical trials. That became his vision. As he began his new role as director of the Division of Hematology, Oncology, and the Blood and Marrow Transplantation Program, he immediately started work on one of his first objectives—expanding the clinical trials program. Prior to Dhall’s arrival, the hospital offered many clinical trials through the Children’s Oncology Group—the largest consortium in the U.S.—for children who were newly diagnosed with cancer.

For patients who had relapsed or had experienced progression of their disease, however, the options were limited. Dhall knew the hospital would need to join more consortia—groups of hospitals that collaborate to offer large-scale clinical trials that might be impossible for a single institution. For Children’s, joining more consortia would give patients access to a wider array of clinical trials. Dhall and his team of experts began applying for membership in various consortia. Five years later, Children’s has more than doubled the number in which it is enrolled. “What that did,” Dhall said, “is give us access to a large number of clinical trials for this group of patients that we didn’t have great options for.”

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Inside Pediatrics | Children’s of Alabama

The Benefits for Alabama and Beyond For children in Alabama with cancer, the new clinical trials are game-changing. Previously, patients may have had to travel out of state or even to another part of the country to access the trials they needed. “And that was only accessible for some families who have the resources to do it,” Dhall said. “For a large number of our patients, that was not possible.”

even beyond Alabama. Dhall says patients come from Mississippi, Louisiana, North Florida and other parts of the Gulf Coast region for the trials. The hospital even gets referrals from other countries. “The impact of having access to these clinical trials is great for this region,” he said. “It’s a good challenge to have to accommodate all those patients and provide access. So I think it’s been great not just locally, but regionally as well.”

Now, those children have access to the same clinical trials without having to leave the state. That’s big

Jaxan’s Story For Jaxan Jernigan and his family, the new clinical trials are already paying off. When he was 6 years old, he began experiencing headaches and seizures. At the local hospital in Pensacola, Florida, doctors discovered a large brain tumor. After a 14-hour surgery, they determined it was a high-grade aggressive tumor called a CNS embryonal tumor. At Children’s, Dhall was leading the Head Start 4 Clinical Trial—one of the new trials added through his expansion efforts. Jaxan’s parents agreed to have him receive therapy on this trial, and he went through five rounds of intensive chemotherapy and three stem cell transplants followed by 30 days of brain and spinal irradiation. Nearly eight months later, Jaxan was considered to be in remission. Today, he’s back to an active life. “We owe so much of that to Dr. Dhall and the entire staff at Children’s,” Jaxan’s dad, Craig, said.

Head Start and Other Trials The Head Start trial (mentioned in Jaxan’s Story above) is just one example of the opportunities Dhall brought. It opened in 1990 and is currently in its fourth iteration, now involving more than 60 institutions across the U.S., Canada, Australia, New Zealand and Europe. Dhall is a national co-chair of the study. “The idea behind Head Start is to give high-dose or intensive chemotherapy up front so that we can either avoid whole-brain irradiation completely for these infants and young children and/or be able to give really reduced dose and volume of irradiation,” Dhall said, “and keeping in mind that we want to

maintain the survival that we see with irradiation, but with much less long-term side effects.”

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Other Trials

Matthew Kutny, M.D., was named director of the Children’s of Alabama Pediatric Clinical Trials Office in 2022.

Just in the last couple of years, researchers involved in Head Start have seen big results. At an international conference in Philadelphia in 2024, Dhall reported on a group of patients with a sub-type of Grade 4 brain tumors, i.e., SHH-activated medulloblastoma. Using the Head Start treatment strategy, doctors were able to cure more than 95% of the patients without using radiation therapy to the brain, Dhall said. “So that actually moves the field significantly forward,” he added.

“ We want to maintain the survival that we see with irradiation, but with much less long-term side effects.

the Children’s Pediatric Clinical Trials Office—a role Dhall held until he turned it over to Kutny in 2022. Since then, Kutny has continued to build the program and seen a lot of exciting developments, including the move toward targeted therapy and immunotherapy. These can allow patients, when possible, to avoid chemotherapy, which can damage healthy cells in the process of killing cancer cells. Targeted therapies zero in on the changes that occurred in the cells to make them cancerous. Kutny says these treatments have been successful against leukemia and solid tumors. Immunotherapy, on the other hand, engages a child’s immune system to fight off cancer as if it were an infection. “There are several exciting immunotherapy research projects that we’ve been able to participate in and lead here in Alabama,” Kutny said.

More than 95% of the patients in the study were able to be cured without using radiation to the brain.

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Treating brain tumors is just one of the program’s focal points. The hospital also has teams that specialize in blood disorders, leukemia and lymphoma, solid tumors such as kidney and liver cancer and more.

“So you can imagine the breadth of the trials that are involved,” said Matthew Kutny, M.D., director of

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Inside Pediatrics | Children’s of Alabama

Hear more from Kutny about the Pediatric Clinical Trials Office on the Children’s of Alabama PEDSCAST

Children’s also performs bone marrow and stem cell transplants, which have proven life-saving for many patients. The stem cell transplant team offers CAR T-cell therapy, in which a patient’s own immune cells are taken into a lab and programmed to fight their cancer. “We’ve been able to offer that to some of the children of Alabama here who otherwise would have had to go through those very intensive treatments with chemotherapy and stem cell transplant,” Kutny said. “And they’ve been able to respond to these new cellular therapies, and it’s really amazing to see how well they tolerate the treatments, and it’s been a great success in our era of oncology.” A Promising Future Because of the efforts of Dhall and Kutny, Children’s now has one of the nation’s largest clinical trial programs in pediatric oncology and hematology. “I’ve been really blessed to be a part of this team that has seen extreme growth over the last five years,” Kutny said.

is actively expanding the number of consortia and partnerships with other hospitals. With cellular therapy and immunotherapy, they’re already offering an array of complicated, leading-edge trials. “We can offer, across a wide spectrum, the best clinical trials that are out there right here for patients in Alabama regardless of the type of disease that the patient is facing in oncology or hematology,” he said. “And that’s been great for the families of these patients to know that they come to Children’s of Alabama, and they’re receiving the very best care that can be offered.”

“ We can offer the best clinical trials that are out there… right here for patients in Alabama.

In the process, they’re contributing to research that can help develop more advanced treatments. “We are making an impact, not just locally, but nationally and globally,” Dhall added.

More growth may be coming. Kutny says the team

Just the way he envisioned it when he first arrived. ●

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Breakthroughs will become cures here •

When people with extraordinary talent and passion are given the technology, the facilities and the support, they

achieve great things. The discoveries and innovations happening today will help shape the future of treatments

and lead to cures. And it benefits not only the patients and families who come to Children’s of Alabama, but people

across the country and around the world for years to come.

Learn more at ChildrensAL.org

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Inside Pediatrics | Children’s of Alabama

NEWS, HONORS AND AWARDS

Kimberlin appointed to National Sustainability Committee David Kimberlin, M.D., professor in the Division of Pediatric Infectious Diseases, was appointed to the United States National Sustainability Committee (NSC) for the Elimination of Measles, Rubella, and Congenital Rubella Syndrome (CRS). The committee’s primary objective is to certify whether the United States has fulfilled all requirements for the reverification of the elimination of measles, rubella and congenital rubella syndrome. Gentle receives SSPR Young Investigator Award Sam Gentle, M.D., assistant professor in the Division of Neonatology, received the Southern Society for Pediatric Research (SSPR) Young Investigator Award at the Annual Meeting in New Orleans in February. He was recognized for his research titled, “Reducing Adverse Delivery Outcomes Through Teleneonatology: A Randomized Simulation Trial.” Alishlash speaks at the First Qatar International Thoracic Conference Ammar Saadoon Alishlash, M.D., associate professor in the Division of Pediatric Pulmonary and Sleep Medicine, was invited as a speaker to the First Qatar International Thoracic Conference held in Doha in February. Alishlash talked about the challenges of pediatric pulmonary hypertension. During his stay in Qatar, Alishlash discussed the management of challenging pediatric pulmonary hypertension cases with the local specialists in Hamad Medical Corporation and Sidra Medicine. Bhatia honored for contribution to cancer prevention Smita Bhatia, M.D., director of the University of Alabama at Birmingham’s (UAB) Institute for Cancer Outcomes and Survivorship, received the 2024 American Society of Clinical Oncology (ASCO) American Cancer Society Cancer Prevention Award. The award recognizes those in the medical community who have made monumental contributions to cancer prevention, control research and practice.

Three neonatology faculty receive career development grants from the American Heart Association Sam Gentle, M.D., Viral Jain, M.D., and Kent Willis, M.D., all assistant professors in the Division of Neonatology, received career development grants from the American Heart Association. The grants are for three years with a total award amount of $231,000 each. The funding will support their research on various aspects of the premature baby disease bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH).

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Ladinsky appointed to AAP 2024 committee Morissa Ladinsky, M.D., professor in the Division of Academic General Pediatrics, was appointed to the American Academy of Pediatrics (AAP) Committee on State Government Affairs. She began a six-year term in July. The committee coordinates all state legislative and regulatory issues affecting youth and recommends to the AAP Board optimal prioritization of these. It also assists state AAP chapters in development and execution of their legislative agendas and reviews advocacy resources and relevant background materials. Ladinsky receives Lion Award from SOJOURN Morissa Ladinsky, M.D., professor in the Division of Academic General Pediatrics, received the Lion Award from SOJOURN (Southern Jewish Resource Network for Gender and Sexual Diversity). Blount receives award from AANS Jeff Blount, M.D., MPH, professor in the Department of Neurosurgery, received the Humanitarian Award from the American Association of Neurological Surgeons (AANS). The award recognizes AANS members who have given their time and talents to charitable or public activities and whose actions have brought honor to the neurosurgical specialty.

Stoll elected chair of Spondyloarthritis Research and Treatment Network Matthew Stoll, M.D., Ph.D., professor in the Division of Pediatric Rheumatology, has been elected as chair of the Spondyloarthritis Research and Treatment Network (SPARTAN). SPARTAN is a network of health care professionals in North America who are dedicated to research, awareness and treatment of spondyloarthritis.

UAB researchers receive award for advancements in tuberous sclerosis complex research Three UAB researchers were honored with the Progress in Research Award from the Tuberous Sclerosis Complex (TSC) Alliance, a nonprofit focused on advancing TSC research and supporting investigators. The three UAB researchers include Martina Bebin, M.D., the principal investigator of the trial and a founding member of the TSC Clinical Research Consortium; Sarah O’Kelley, Ph.D., associate professor in the UAB Department of Psychology and lead neurodevelopmental psychologist for the trial; and Gary Cutter, Ph.D., professor emeritus in the UAB Department of Biostatistics and the trial’s biostatistician. This recognition celebrates their achievement in their clinical research, the PREVeNT Trial.