Inside Pediatrics Spring 2025

PEDIATRICS

Spring 2025

The Next Wave Using Sound Waves to Test Lung Function in Preemies

ALSO INSIDE : Flow restrictors offer hope for high-risk newborns

A t Children’s of Alabama, innovation is at the center of what we do. We are always searching for—and creating—new ideas to help treat our patients more effectively. In this issue of Inside Pediatrics, you’ll read about some of these ideas and see the difference they’re already making. In many cases, innovation comes in the form of new technology. Our neonatology team, for example, developed a device that uses sound waves to measure lung function in premature babies. They hope it will one day become the standard of care in hospitals everywhere. Meanwhile, our heart team is using flow restrictor devices to treat newborns with hypoplastic left heart syndrome. They allow patients to postpone surgery until their bodies are ready for it. Sometimes, innovating simply means taking a new approach. We did that by adding a new mental health safe space to our emergency department two years ago, and it’s already paying off. We call it the Nature Hall, and it serves patients in the midst of a mental health crisis. Since the space opened, we’ve dramatically decreased the average length of stay for these patients. In hematology and oncology, one clinic is innovating—and thus improving care— through teamwork. Our Neurofibromatosis and Schwannomatosis Clinic is using a

Tom Shufflebarger, President and CEO

multidisciplinary approach to treat patients with this complex genetic disorder. Clinicians are working to streamline patient care, and they’re expanding their research to learn more about how to effectively treat patients with this condition. Big ideas are nothing new at Children’s of Alabama. In this issue of Inside Pediatrics, you’ll see some of our latest. They’re more examples of how We Are Here for patients in Alabama and beyond.

INSIDE THIS ISSUE

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

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Division Rounds Quick briefs and news from around the hospital

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Transforming Emergency Mental Health Care New safe area in emergency department leading to improvements

DESIGN Becca Hodges Scott LeBlanc Dana Stuckey PHOTOGRAPHY Eric Gray Chris Luker Andrea Mabry Denise McGill CONTRIBUTORS Katherine Gaither Debra L. Gordon, MS Sarah Handzel, BSN, RN Julia Levet

Flow Restrictors Offer Hope for High-Risk Newborns Tiny devices are showing promise for helping patients with hypoplastic left heart syndrome

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Rhonda Lee Lother Maureen Salamon

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The Next Wave How neonatologists are using sounds waves for lung testing

Heather Watts Unlock Health DIGITAL CONTENT Andre Green MEDICAL LEADERSHIP Yung Lau, M.D. Katharine Reynolds Ireland Chair of Pediatrics Chair, UAB Department of Pediatrics Physician-in-Chief, Children’s of Alabama Mike Chen, M.D., MBA Joseph M. Farley Chair in Pediatric Surgery University of Alabama at Birmingham Chief of Pediatric Surgery and Surgeon-in-Chief Children’s of Alabama Sonya Pritchard, M.D. Professor Chief of Service, Child & Adolescent Psychiatry Children’s of Alabama

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A New Chapter in Neurofibromatosis Care Children’s and UAB building on already successful program

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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

ENDOCRINOLOGY

Study aims to reveal type 2 diabetes conversion culprits

The issue is particularly relevant to Alabama, which is one of 15 states considered to be in the “Diabetes Belt” because the incidence of type 2 diabetes is about one-third higher than the national average. Children’s cares for more than 80% of the state’s pediatric type 2 diabetes patients, with nearly 650 such children referred for evaluation for new-onset cases between March 2017 and March 2021. Additionally, hospital admissions for new-onset pediatric type 2 diabetes cases in Alabama more than doubled over a two-year span that led up to the early stages of the pandemic.

Researchers at Children’s and UAB are joining others from 15 prominent institutions across the U.S. in a study designed to determine what factors lead to type 2 diabetes conversion among children who are overweight or obese.

Alabama is one of 15 states in the “Diabetes Belt” 1 / 15

80% of Alabama’s type 2 patients are cared for by COA 80 %

children will enroll in the study in the next two years 3,600

The DISCOVERY study aims to uncover these factors to help them more precisely predict which children are at the highest risk. “Even though we understand that high BMI predisposes someone to type 2 diabetes, what is really unclear is what prompts a child who has all these risk factors to convert,” said Ambika Ashraf, M.D. (top), DISCOVERY co-investigator and director of the Division of Pediatric Endocrinology at Children’s. “This study is designed to recruit at-risk children and see who actually converts to type 2 diabetes, looking at a broad suite of factors—everything from social risk factors to biological factors,” said study co-investigator Barbara Gower, Ph.D. (bottom), chair of the Department of Nutrition Sciences at UAB.

Over the next two years, DISCOVERY will enroll approximately 3,600 children and teens ages 9–14, all with a BMI at or above the 85th percentile and HbA1c levels of 5.5% or higher. Children will be tracked for between two-and-a-half and four years, completing comprehensive annual visits, including a three-hour oral glucose tolerance test and detailed physiological assessments. They will also undergo a brief visit every six months, along with telephone checks every three months to monitor for type 2 diabetes. “If we can determine the risk factors that predispose certain individuals to develop type 2 diabetes, that could have a huge impact,” Ashraf said. “It may have a global impact, too, because type 2 diabetes is going to cause a huge economic impact throughout the world.”

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UROLOGY

Improving pediatric renal injury care

A collaborative developed by urologists at Children’s and UAB is changing the way physicians manage renal injuries in children. The Trauma Renal Injury Collaborative in Kids (TRICK), developed by Carmen Tong, D.O. , and a team of experts, including David Kitchens, M.D. , consists of five Level-1 tertiary pediatric trauma centers across the United States. It’s aim is to standardize both evaluation and management protocols for pediatric patients with high-grade renal trauma. Tong, Kitchens and the other experts who developed TRICK did so because the prevailing guidelines for the evaluation and management of renal injury focused on adult patients. But because children are anatomically different from adults, they can’t be viewed as little adults. The collaboration has led to some groundbreaking findings. One pivotal discovery revealed that children with gross hematuria (visible blood in urine) following trauma benefit from more extensive radiologic evaluation, similar to adult patients. This novel discovery challenges the prevailing assumption that pediatric and adult renal trauma require vastly different diagnostic approaches. This finding also helps clinicians better recognize pediatric patients at increased risk for surgical intervention who would, by turn, benefit from a more thorough radiographic evaluation. By identifying these children early, healthcare providers can prioritize further radiographic testing. However, for stable, asymptomatic

patients, repeat imaging can often be avoided, reducing both patient risk resulting from radiation and overall health care costs. For parents and guardians, TRICK’s work highlights the importance of vigilance following blunt abdominal trauma. Visible blood in a child’s urine or significant trauma to the side of the body—common in sports injuries or falls—warrants a rapid medical evaluation to rule out renal injury. Educating families about these warning signs promotes early intervention and better outcomes. TRICK’s ongoing efforts aim to standardize imaging protocols, particularly for children with gross hematuria, as a predictor of surgical intervention. Tong predicts that future studies likely will explore additional predictors and refine management strategies, further enhancing pediatric trauma care. Through collaboration and innovation, TRICK continues to make strides in ensuring that children with renal trauma receive the best possible care, tailored to their unique needs.

NEPHROLOGY

Studying outcomes in continuous renal replacement therapy With most research that evaluates a vital form

Children’s serves as a hub for CRRT care for a high volume of pediatric kidney patients. In the decade-plus between 2013 and mid-2024, 602 patients were treated with CRRT at Children’s. Children’s has also long stood out among pediatric hospitals by

offering CRRT to the tiniest infants using modified Aquadex equipment. Aquadex had initially been developed for adult patients with heart failure to remove fluid from the heart, but Children’s nephrologist David Askenazi, M.D. , seized on the technology’s small filters to adapt it for use in neonates. Now, other centers offer neonatal dialysis with modified Aquadex as well. The WE ROCK effort has generated at least 10 published manuscripts so far by study collaborators, with the promise

of dialysis care in children called continuous renal replacement therapy (CRRT) lacking in size and scope—hampering efforts to glean practice-changing insights—an international effort in which Children’s of Alabama is integral is expected to fill the gap. Dubbed WE ROCK (Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease), the retrospective study involves a total of nearly 1,000 children treated at 32 centers in seven countries between 2018 and 2021. Representing the largest international

registry of children receiving CRRT for acute kidney injury or fluid overload—which can result from a variety of factors, including congenital anomalies, nephrotoxins and others—WE ROCK aims to evaluate the association of factors such as fluid balance and timing of CRRT initiation and duration with patient outcomes. “It’s so hard to get data of this type, so this study is very significant,” said Tennille Webb, M.D. , a pediatric nephrologist at Children’s of Alabama.

of many more to come, Webb says. By looking at outcomes such as major adverse kidney events 90 days after CRRT (including mortality, dialysis dependence and persistent kidney dysfunction) as well as functional outcomes, investigators should be able to derive data that could change pediatric nephrology practice. “Having that data from 32 centers, we can see what they’re doing, model it and make some improvements in these patients,” Webb said.

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DIVISION ROUNDS (cont.)

PULMONOLOGY

NEUROLOGY

New MEG at UAB to enhance neuroimaging possibilities

The complexity of the human brain has long been an enigma that neuroscientists have sought to untangle. Now, new technology at UAB is acting as a critical tool to help researchers and clinicians interpret the brain in unprecedented ways. UAB recently invested in a new MEG, which stands for magnetoencephalography. It is used on pediatric and adult patients, so it benefits patients at both UAB and Children’s of Alabama. The technology measures the magnetic fields that come from the brain’s nerve cells in an effort to analyze their function—and does so at millisecond intervals. These implications are significant not only for localizing abnormalities in the brain in patients with diseases such as epilepsy but also for studying how the brain performs normal functions like speaking, hearing and seeing. “It’s not invasive,” said Ismail Mohamed, M.D. , professor in the UAB Division of Pediatric Neurology, Department of Pediatrics. “You don’t have to put electrodes in the brain, and it has no risks. You can potentially measure brain activity across multiple sessions. You can potentially measure them across a lifetime span. You can use it to learn things about how our brain functions.” For the patient, the experience is similar to getting an MRI, Mohamed said, but the measurements are taken in a different way. “MRI looks at structure, but MEG primarily looks at the brain waves itself,” Mohamed explained.

Helping children with Down syndrome manage sleep apnea Obstructive sleep apnea (OSA) is significantly more common in children with Down syndrome (80%) than in the general pediatric population (5%). But for some of these patients, the indicated first-line and supplemental treatments (adenotonsillectomy and continuous positive airway pressure therapy) aren’t always effective. That’s why the Children’s of Alabama Sleep Disorders Center is using a new and innovative approach. In July 2024, sleep specialist Mohini Gunnett, M.D. , worked with pediatric otolaryngologist Philip Rosen, M.D. , to implant the first Children’s patient with an upper airway hypoglossal nerve stimulation (HGNS) device to assist with management of their obstructive sleep apnea. This device, which is currently approved for patients with Down syndrome, works by producing gentle pulses to the nerve that protrudes the tongue forward during inspiration in sleep to help open the airway. “We see firsthand how frustrated families become when their child with Down syndrome does not respond or tolerate conventional options to treat their sleep apnea,” Gunnett said. “Since the FDA approval in 2023 of this device for adolescents with Down syndrome over the age of 13 for management of OSA, we have had a growing interest in patients and families seeking this procedure,” Rosen said. “Families are coming with optimism and appropriate questions during our initial consultations, as we determine together whether their child would be an appropriate candidate that would benefit from this device.” “We have already seen significant improvement and control in OSA with the few initial patients implanted with the device at our center,” Gunnett said. “I am excited to see how this device may provide short- and long-term benefit to our children with Down syndrome who are impacted by the physical and neurocognitive effects of OSA during their pivotal developmental years.” Currently, Children’s of Alabama is the only accredited pediatric center consulting for HGNS implantation in patients with Down syndrome in Alabama and the Florida Panhandle.

One significant implementation of the MEG is for use in epilepsy surgery to determine where in the brain seizures originate. It can also be used for functional brain mapping—to localize areas important for language, sensory and motor function. “It also has a lot of potential research use for the prediction of disease outcomes—studying things like dementia or Alzheimer’s disease,” Mohamed said. UAB was among the first medical centers in the country to obtain a MEG, having done so originally in 2001; however, evolving technology has created a need for replacing the old technology with a new one. The new machine was installed in September 2024. UAB is one of fewer than 30 clinical centers in the nation that houses this technology.

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ORTHOPEDICS

Ortho and radiology collaborating to improve musculoskeletal infection treatment Each year, Children’s evaluates between 500 and 1,000 children for musculoskeletal infections, which are far trickier to characterize in children than in adults. This poses challenges to determine the best course of treatment. That’s why the Children’s orthopedics and radiology teams have joined forces in an innovative collaboration. Their goal is to determine which young patients might be best-suited for special MRI imaging techniques that can both be performed quickly— avoiding sedation—and represent the best hope for distinguishing crucial infection characteristics. Children’s orthopedic surgeon Kevin Williams, M.D. , is spearheading the initiative. He and his colleagues have been tracking improvements over the past decade in technology and MRI techniques that can counteract this problem. They discovered recent research that, he says, assessed “specific MRI sequences or sets of images that can be performed expediently to avoid sedating or putting a child to sleep for the MRI, and they’re also good enough quality for clinical decision-making.”

The group is working to determine which of the hospital’s MRI machines are capable of this technology. They’re also consulting with anesthesiologists to determine which young patients may be suitable for those types of MRIs. In the fall of 2024, they

were able to develop a “FAST protocol” for musculoskeletal imaging to assist with efficient clinical decision-making. It typically takes less than 15 minutes and does not

necessitate sedation or gadolinium contrast application. It has significantly improved treatment protocols for these infections, and the team anticipates it will reduce health care expenditures, time in the hospital, and will be beneficial to patient outcomes. “We are constantly striving to revolutionize the care we give to the children of Alabama with musculoskeletal infections,” Williams said. “Innovating our practice with the help of the most recent medical literature will keep us at the forefront of delivering the best patient care possible.”

GASTROENTEROLOGY

New technology improves diagnosis of esophageal conditions Diagnosing esophageal disorders in pediatric patients presents a number of challenges for both providers and patients. The diagnostic tools typically used in the past often caused discomfort for the patient and made diagnosis difficult. Thanks to the addition of a new technology, Children’s of Alabama is able to circumvent these issues to streamline the process for both sides.

In the fall of 2024, Children’s began using an endoluminal functional lumen imaging probe, also known as EndoFlip. It’s a device that evaluates esophageal distensibility under general anesthesia during endoscopy to provide important insights for patients with conditions like dysphagia, eosinophilic esophagitis (EoE) and post-surgical complications. Clinicians have been using this on adult patients since 2009, but it was FDA approved for children 5 and older in the last few years. In pediatric patients, who often struggle with conventional methods, the use of anesthesia significantly reduces stress and discomfort for both children and their families. With the use of this technology, Children’s “can now identify abnormalities that were previously undetectable, leading to timely and effective interventions,” Children’s pediatric gastroenterologist Diana Montoya Melo, M.D. , said. EndoFlip is particularly beneficial for patients with swallowing difficulties. By measuring esophageal distensibility, physicians can detect subtle functional issues that may not be evident with endoscopy or other imaging studies. It also helps physicians identify areas of reduced esophageal diameter, guiding therapeutic interventions such as esophageal dilation. The technology also helps evaluate post-surgical complications in patients with congenital esophageal anomalies, such as tracheoesophageal fistula. By pinpointing areas of reduced distensibility, EndoFlip helps ensure accurate diagnoses and effective management plans. EndoFlip adds just a few extra minutes to the procedure, Montoya Melo said, and it also leads to reduced hospital visits, fewer diagnostic tests and faster resolutions to symptoms.

Picture: Functional lumen imaging probe inflated. Source: White E, Mutalib M. Use of endolumenal functional lumen imaging probe in investigating paediatric gastrointestinal motility disorders . World Journal of Clinical Pediatrics. 2023;12(4):162-176. Available from: https://www.wjgnet.com/2219-2808/full/v12/i4/162.htm. Licensed under CC BY-NC 4.0 (https://creativecommons.org/licenses/by-nc/4.0/).

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Inside Pediatrics | Children’s of Alabama

BEHAVIORAL HEALTH

Transforming Emergency Mental Health Care NEW SAFE AREA IN EMERGENCY DEPARTMENT LEADING TO IMPROVEMENTS IN CARE

T wo years after opening a behavioral health safe area within its emergency department (ED), Children’s of Alabama is already seeing dramatic improvements to the way children in mental health crises are treated. It’s the fruition of a vision the hospital’s behavioral health team began to develop several years ago.

The Children’s of Alabama Nature Hall opened in March 2023 as an expansion of the ED designed to provide 24/7 services to children and adolescents who arrive in need of a mental health evaluation. With 16 beds, it quadrupled the hospital’s capacity to treat children with mental health needs in the ED. Children’s developed the space in response to a record surge in mental health patients that began around 2019.

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CHILDREN’S OF ALABAMA’S BEHAVIORAL HEALTH SERVICES

For some patients, the Nature Hall is the entry point to Behavioral Health Services at Children’s of Alabama. From there, they can be connected with other services that help meet their needs.

EMERGENCY DEPARTMENT NATURE HALL

PARTIAL HOSPITALIZATION PROGRAM

INPATIENT AND OUTPATIENT CARE

INTENSIVE OUTPATIENT PROGRAM (IOP)

PEDIATRIC ACCESS TO TELEMENTAL HEALTH SERVICES (PATHS)

PSYCHIATRIC INTAKE RESPONSE CENTER (PIRC)

A Marked Improvement

Moore attributes the Nature Hall’s success in part to

Already, the Nature Hall’s impact is clear. Since it opened, the average length of stay for patients discharged from the ED has decreased from 9.46 hours to 4.55 hours. The number of patients who left without being seen dropped all the way to zero in 2024, compared to 47 in 2022, the year before the Nature Hall opened.

the team’s decision to staff the unit with trained behavioral health professionals, including nurses, behavioral associates,

and psychiatric providers. “This ensures children receive care from experts who understand their unique needs, which has greatly enhanced patient outcomes,” she said. Some of the staff who serve the unit are part of the Psychiatric Intake Response Center (PIRC), which is a phone response center for adults seeking mental health resources for their children or adolescents. The PIRC team is made up of licensed mental health professionals who, in addition to answering calls, also provide behavioral health consultation services within the ED.

DURATION OF STAY * for patients discharged from the ED

9 HOURS 28 MINUTES 2023

2025 4 HOURS 33 MINUTES

“These are incredible outcomes that reflect the dedication of our staff and the importance of having the right resources in place,” said Bonnie Moore, director of Inpatient Behavioral Health Services at Children’s.

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Nature Hall Room Features

The Nature Hall’s rooms are modeled after inpatient behavioral health rooms at Children’s and offer the latest safety features designed to protect patients, caregivers and employees. “Many patients come to the Emergency Department in a health crisis,” Jones said. “But for those in a mental health crisis, the hospital wanted the environment of care to be as safe and secure as possible.”

For patients in a mental health crisis, the hospital wanted the environment of care to be as safe and secure as possible.

In the Nature Hall, PIRC therapists are part of the Psychiatric Consult Team, which provide evaluations, Alabama Department of Human Resources reporting, discharge planning and transfers to outside hospitals. With the PIRC’s robust database of more than 2,100 providers, team members are also able to offer mental health resources for patients and their families. “The PIRC program bridges a critical gap in mental health care by providing both in-person and phone-based resources,” PIRC director Cindy Jones, MA, LPC-S, NCC, said. The team’s ability to employ pro re nata (PRN), or as needed, psychiatric employees has also risen dramatically, from 11.9% to 94%, ensuring timely relief for distressed patients and their families. “Having experienced behavioral health staff who can effectively communicate and de-escalate situations has made a substantial difference,” Moore said.

To keep patients safe, each room features limited medical equipment. “Regular emergency department rooms have a lot of medical devices and equipment that pose a risk to a child with suicidal thoughts or aggressive behavior,” Jones said. “The Nature Hall mitigates any chance of harm to oneself or others.” The rooms also offer sensory lighting to accommodate patients who may need more or less light.

PRN PSYCHIATRIC STAFFING

% 12

% 94

2023

2025

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Inside Pediatrics | Children’s of Alabama

The Idea Behind the Nature Hall

Nature Hall Unit Features

The need for a behavioral health safe area like the Nature Hall became evident in 2019 when the hospital faced a record surge in emergency mental health cases. Behavioral health patients began occupying up to half of the ED’s beds, far exceeding the capacity of its original four-bed, behavioral-health-safe “pod.” This crisis prompted Children’s to repurpose an underutilized space within the ED, culminating in the creation of the Nature Hall. Now, children and providers both benefit from this state-of-the-art area dedicated to pediatric behavioral health patients. Both Moore and Jones attribute the rising demand for children’s mental health services to several factors, including social media influences, exposure to inappropriate content online, and increased societal

The Nature Hall is an inviting, colorful, safe psychiatric environment with hallway walls painted in bright colors and covered with paintings or photographs of flowers, animals, bikes, sailboats and beaches.

stressors. While these challenges existed prior to the pandemic, COVID-19 exacerbated the crisis. “People are now more willing to seek mental health care due

One of many art pieces in the Nature Hall, April the Giraffe is a favorite among staff and patients alike.

In the unit’s hallways, fluorescent lighting, which is often too bright and overstimulating, is dimmed to 50%. To help staff, the Nature Hall also has video monitors mounted on the walls of an enclave showing two camera angles for each room. This provides employees with additional monitoring for the patient and caregiver’s safety. Next to this enclave is a space designated for hospital security guards. This work area gives security a greater presence on the Nature Hall. caregiver’s senses, promote positive energy and distract from any intense emotions. The videos run 24 hours a day and are changed monthly to increase visual variations. “Feedback from Nature Hall employees showed that they gained the same benefit from these images as patients and caregivers,” Jones added. Throughout the unit, two computer monitors project images to engage the patient and

to reduced stigma, but this has created additional pressure on resources,” Jones explains. “However, part of the PIRC’s mission is to assist caregivers by helping them navigate what behavioral health services are available, match them with the appropriate services and resources in their communities, and educate them on what to expect while caring for their child.” Children’s of Alabama continues to refine its approach to managing pediatric mental health demands, demonstrating how targeted efforts address urgent public health issues. Moore says the improvements Children’s has seen since opening the Nature Hall highlight the impact of investing in specialized care for the most vulnerable patients. ●

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The Children’s of Alabama PedsCast is a pediatric subspecialist 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.

FEATURED EPISODE Behavioral Health Services: A Comprehensive Approach with Brandy Reeve, MSN, RN, CPN, CENP Associate Vice President, Behavioral Health Services

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

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Inside Pediatrics | Children’s of Alabama

CARDIOLOGY

A New Blueprint for High-Risk

Newborns

FLOW RESTRICTOR DEVICE SHOWS PROMISE FOR HELPING PATIENTS WITH HYPOPLASTIC LEFT HEART SYNDROME

B abies born with hypoplastic left heart syndrome, in which the left side of the heart doesn’t fully develop and thus can’t pump blood very well, typically require open-heart surgery soon after birth or a hybrid surgical approach combining stenting and open surgery to establish systemic blood flow and control pulmonary blood flow. Given the already fragile state of the infant, however, neither approach is optimal, and both have high mortality rates.

Doctors at Children’s of Alabama are helping these children by using an internal pulmonary flow restrictor created by modifying a microvascular plug. They form the device by cutting a tiny hole in the Gore-Tex covering of the microvascular plug originally designed to close blood vessels in children and adults. With this use of the device, they are able to postpone surgery for months until the infant is bigger and stronger while still controlling pulmonary blood flow in a completely non invasive manner. “The problem we’re addressing is over-circulation of blood to the lungs,” explained pediatric cardiologist Mark Law, M.D. “Traditionally, it requires open-heart surgery to place a band around the pulmonary artery to reduce blood flow. However, this surgery is invasive and can be very stressful for the baby.”

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When inserting the flow restrictor, Law and his team thread the plug through the femoral or internal jugular vein into the pulmonary artery.

The blood from the pulmonary artery hits the device’s covered side first and is forced through the hole creating a pressure head restricting the flow. The pressure beyond the device is lower than in front of the device.

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Law and his team have presented a series of five cases in which they used the technique on babies who were too medically fragile for surgery. All survived and all were later able to undergo the needed open surgery. “We’re confident some of these babies wouldn’t have made it otherwise,” he said. “But because they’re older, bigger, stronger and breathing on their own” the procedure was much less risky.

Now, Law and his team are able to treat the infant in the cath lab rather than an operating room. There, they thread the plug through the femoral or internal jugular vein into the pulmonary artery to partially restrict excessive blood flow to the lungs. “It’s a far less invasive procedure and the recovery is faster,” he said. It also allows the surgeons to operate without scar tissue from a previous surgical procedure.

This procedure enables babies who are too fragile for surgery to safely grow stronger before undergoing their first operation. In one study, 10 out of 13 infants treated with this technique survived to their next surgery, typically performed within two to six months of the catheter procedure. When compared to historical data from similar high-risk patients who underwent traditional procedures, the new technique was associated with significantly better six-month survival rates after adjusting for other risk factors. Importantly, the baby’s pulmonary arteries grow over that time, which is crucial for their long-term outcomes. In addition, the devices can be easily removed during subsequent surgical procedures. Law and his team have presented a series of five cases in which they used the technique on babies who were too medically fragile for surgery. All survived, and all were later able to undergo the needed open surgery. “We’re confident some of these babies wouldn’t have made it otherwise,” he said. “But because they’re older, bigger, stronger and breathing on their own” the procedure was much less risky. Still, challenges remain. The device must be customized for each patient, and its small size limits its use to very young infants. Nonetheless, pediatric cardiologists across the country are adopting the procedure, Law said. “We’re all learning from each other and sharing data to refine the technique.” “This technique represents a shift in how we think about treating congenital heart defects,” said Law. “The ability to delay surgery and avoid scar tissue is a game changer.” ●

With the use of this tiny device—inserted non- invasively—doctors are able to postpone a patient’s surgery until their body is ready for it.

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When Savanna came here, we found a heart of gold .

At Children’s of Alabama, we often see patients and families dealing with challenging situations, and what we discover about each child is truly amazing. For example, Savanna, who was born with a heart murmur and double outlet right ventricle.

Despite enduring several surgeries, obstacles and setbacks on her journey, she remained positive and optimistic. We didn’t just see a heart problem, we saw the kindness and joy of a young heart, and it’s our hope that the world can see it, too.

ChildrensAL.com/heart

A Sound Strategy A DEVICE DEVELOPED BY CHILDREN’S OF ALABAMA NEONATOLOGISTS USES SOUND WAVES TO MEASURE LUNG FUNCTION IN PREMATURE BABIES

NEONATOLOGY

Using a decades-old technology, Travers and his team developed a device that can measure a preemie’s lung function with sound waves.

O ne of the most important parameters of a premature baby’s health status is respiratory health. How well are their lungs working? What long-term respiratory complications might occur from the premature birth? Yet assessing lung function in these fragile newborns has long been a complex and invasive process.

Measuring lung function in children and adults is as simple as having them blow hard into a plastic tube. Pulmonary function testing in neonates, however, requires complicated equipment as well as sedation or anesthesia, limiting its use outside of research studies. So, Travers and his team have brought a decades old technology used in adults called forced oscillation technique (FOT) to the NICUs at the University of Alabama at Birmingham (UAB) and Children’s. They worked with the device manufacturer to develop a machine designed for small babies. It sends sound waves into the lungs while the infant is sleeping and breathing naturally. The sound waves then bounce off the lungs, providing information on stiffness and resistance in the airways. It can be performed in less than

“Historically, we diagnosed lung disease based on whether a baby needed oxygen or not,” Children’s of Alabama neonatologist Colm P. Travers, M.D., said. “But we didn’t know how severe their lung disease was and what type of lung disease they had.”

Colm P. Travers, M.D.

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Inside Pediatrics | Children’s of Alabama

30 seconds, non-invasively, without sedation and repeated over time. It typically takes just a few minutes to set up and can be used soon after birth. “It’s well suited to neonates because it doesn’t need any effort on behalf of the baby,” Travers said. “Oscillometry is also able to tell you the severity and the type of lung disease a baby has.” In addition, he said, it’s an ideal tool to use in research because of its simplicity and accuracy. The Children’s team has already used the device in more than 600 neonates. They published the first results of their work in 2020, which demonstrated the feasibility of using oscillometry in healthy newborns and those with respiratory disorders. Now, they’re in the midst of a larger study funded by the National Heart, Lung, and Blood Institute involving 550 babies with the goal of establishing

normative data for infant lung function and tracking outcomes, such as asthma and wheezing, in early childhood. “We’re also using it in our NICU to see whether babies respond to certain medications,” Travers said. This approach could help doctors quickly determine if a treatment is effective or if they need to pursue alternative options. The use of FOT at Children’s is still only in the research phase. Eventually, Travers hopes, it will become standard of care not only in his NICU, but in hospitals everywhere. ●

To learn more about Travers’ research, read his most recent published study on Pub Med .

A poster showing Travers’ findings that he presented at the Pediatric Academic Societies (PAS) 2024 meeting in Toronto, Canada

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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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HEMATOLOGY + ONCOLOGY

A New Chapter in Neurofibromatosis Care

CHILDREN’S AND UAB BUILDING ON ALREADY SUCCESSFUL PROGRAM

N eurofibromatosis (NF) is a complex genetic disorder of the nervous system, marked by the growth of tumors—malignant and benign—along nerve sheath cells. In addition to tumor growth, it impacts nearly every organ, including the skin, eyes, heart and bones, and causes neurological symptoms such as ADHD, speech disorders and learning disabilities. There is no cure, although new treatments are emerging. Thus, it requires intensive management with a multidisciplinary team, which is exactly what the Neurofibromatosis and Schwannomatosis Clinic at Children’s of Alabama and the University of Alabama at Birmingham (UAB) is designed to do. Neuro-oncologist Rebecca Brown, M.D., Ph.D., directs the adult portion of the clinic and pediatric neuro-oncologist Katie Metrock, M.D., directs the pediatric side. The two work closely together, with Brown seeing patients as young as 12 and both teaming up to create a transitional program for children moving into adult care.

Mt. Sinai Health System in New York City. “I tell people that I’m the most generalist sub-specialist that exists because NF experts are the only ones who really understand, pay attention to and address all these many aspects.” “Even though they all have the same diagnosis of NF, every patient is different, and every family is a little different,” Metrock said. “So, how do we approach care in a way that makes the most sense for each patient?”

Rebecca Brown, M.D.

Katie Metrock, M.D.

For Brown, that means shifting the adult clinic from one that’s been focused on diagnosis, genetics, and disease phenotype to one that can have a greater clinical impact on patients. “My focus

“The disease affects every aspect of these patients’ lives,” said Brown, who recently moved to UAB from

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is patient forward,” she said. “I’m interested in addressing the problems that patients experience, especially with regards to supportive care, including psychological care and pain management, and delivering the most recent recommendations for tumor surveillance and other health risk factors such as hypercholesterolemia, stroke and heart disease.” She also wants to bring more clinical trials to UAB to “try to push the envelope as far as developing novel therapies for their conditions.”

In addition, she offers a resection clinic to remove cutaneous tumors. After going through special training, she started it for two reasons. “The first is that patients have a difficult time finding a surgical specialist who has the interest and the bandwidth to remove these tumors,” she said. “And second is that the out-of-pocket costs can be prohibitive.” She can remove multiple tumors in a single 90-minute session, reducing both the financial burden and time commitment for patients.

Our Multidisciplinary Approach to Care

PEDIATRIC RADIOLOGY

THE HOPE & COPE PSYCHOSOCIAL AND EDUCATION PROGRAM

SCHOOL LIAISONS

SOCIAL WORKERS

GENETICS

PLASTIC SURGERY

NEUROSURGERY

CHILD LIFE SPECIALISTS

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Inside Pediatrics | Children’s of Alabama

On the pediatric side, non-medical specialists such as social workers, child life specialists and school liaisons provide the holistic level of support children and their families require. “There’s so much that needs to be to be managed outside of our clinic with these children,” Metrock said. “So the social worker and school liaison really help bridge the gaps between school and life.” The clinic also works closely with the Hope and Cope team to help address neurocognitive and mental health issues. “We’re very committed to providing care for these patients, not just for their tumors, but for how the disease affects their life outside of our clinic,” she said. “But I always felt we could grow. So I’m very excited that Dr. Brown is here and that we have a new push for what we can do for these families.” That includes building on the existing multidisciplinary foundation and working on streamlining care for families so they don’t have visit the hospital—often hours away from their homes— for multiple appointments.

To learn more about Metrock’s leadership at Children’s and UAB, check out this episode of our INSIDE PEDIATRICS podcast.

Neurofibromatosis Clinical Trials Consortium (NFCTC), which coordinates research across 24 sites internationally. Girish Dhall, M.D., who directs the Division of Pediatric Hematology, Oncology and the Blood and Marrow Transplantation Program at Children’s, leads the consortium. Since its inception in 2006, it has grown from nine to 24 sites with more than 72 investigators, according to Karen Cole Plourde, the NFCTC operations center program director. It has also launched 17 clinical trials involving more than 500 patients, with eight trials currently in development; published more than 19 peer-reviewed papers with five in progress; and landed more than $5 million in funding from pharmaceutical companies, foundations and government sources. In addition, UAB boasts one of the world’s most robust genetic labs for the disease, which has identified more than 3,000 NF type 1 mutations. The research team also played a crucial role in developing the first FDA-approved drug for NF, which blocks the action of an abnormal protein that signals tumors to grow. This can stop or slow tumor growth. While selumetinib has been a major step forward, more fast-acting targeted therapies are needed, Brown said. “These patients can develop new and enlarging tumors in a relatively short period of time,” she said. “There is very much a need and value in finding medications that can stabilize or shrink those tumors over the long term.” In the meantime, she and Metrock focus on proactive management. “We’re very proud of what we have here and are very aware of the responsibility we have to move forward for these patients,” Metrock said. ●

“They have other children, they have jobs, they have everything outside in life, and so, us asking them to ‘come back, come back,’ can be quite overwhelming,” Metrock said. ”So how can we streamline their care so that they’re getting the best care they can in a way that allows them to keep living their life away from clinic in the hospital?” That involves bringing more clinicians interested in the condition into the clinic as well as expanding an already robust clinical research program.

Indeed, research is embedded in the mission of the clinics. UAB is the headquarters for the

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The Neurofibromatosis Clinical Trials Consortium Improving the quality of life of persons with neurofibromatosis

PARTICIPATING HOSPITALS 24

CLINICAL TRIALS 17

PEER-REVIEWED PAPERS 19+

INVESTIGATORS 72+

IN FUNDING $ 5M+

The Neurofibromatosis Clinical Trials Consortium brings together clinical centers with special expertise in the management of neurofibromatosis and links them together with a central operations center. The operations center, based at the University of Alabama at Birmingham, helps to organize the trials and ensure that all of the necessary regulations regarding clinical trials are followed. Having multiple centers participating around the country makes it easier to recruit a sufficient number of participants to obtain reliable conclusions. Since the discovery of the genes responsible for the different forms of neurofibromatosis, much has been learned about how the various problems associated with neurofibromatosis come about. This opens the door toward development and testing of medications that may be helpful in preventing or treating complications of the disorders. The consortium was formed in 2006 with funding from the U.S. Army Medical Research and Materiel Command to carry out clinical trials of such medications.

FOR MORE INFORMATION, VISIT UAB.EDU/NFCONSORTIUM/

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Inside Pediatrics | Children’s of Alabama

NEWS, HONORS AND AWARDS

Huls honored as CTSP Hero Spotlight Kara Huls, M.D., assistant professor in the Division of Pediatric Emergency Medicine, was featured by the Child Trafficking Solutions Project (CTSP) in a hero spotlight.

Donahue accepted as PPN Research Scholar Andrew Donahue, M.D., fellow in the Division of Pediatric Emergency Medicine, was accepted into the Pediatric Pandemic Network (PPN) Disaster Science Research Training Program.

Three faculty elected to Society of Pediatric Research Viral Jain, M.D. , assistant professor in the Division of Neonatology, Melissa Mannion, M.D. , associate professor in the Division of Pediatric Rheumatology and Christine Stoops, D.O. , associate professor in the Division of Neonatology, were elected to the Society for Pediatric Research (SPR). The SPR aims to cultivate a diverse network of child health researchers through collaboration, community, mentorship and advocacy.

Stoll elected to American Pediatric Society Matthew Stoll, M.D. , professor in the Division of Pediatric Rheumatology, was elected to the American Pediatric Society (APS). The APS is dedicated to shaping the future of academic pediatrics through engagement of distinguished child health leaders to represent the full diversity within the field.

Children’s of Alabama/UAB Pediatric Transplant and Heart Failure receives Pediatric Heart Transplant Study Vanguard Award The Pediatric Heart Transplant Study (PHTS) has recognized the Children’s of Alabama/UAB Pediatric Transplant and Heart Failure Team with the prestigious PHTS Vanguard Center Award.

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Densmore chosen for competitive Educational Scholars Program Caroline Densmore, M.D., assistant professor in the Division of Academic General Pediatrics, was selected as a 2025 American Pediatric Association (APA) Educational Scholar.

Oduru receives National Pancreas Foundation travel grant Olawale Oduru, M.D., fellow in the Division of Gastroenterology, Hepatology and Nutrition has received a travel grant to attend the National Pancreas Foundations (NPF) Fellows Symposium.

Residents elected to Alpha Omega Alpha Alana Nichols, M.D., and Gillian Garver, M.D., fourth year Med-Peds residents, have been elected for membership into the Alpha Omega Alpha Medical Honor Society (A Ω A). Since its founding in 1902, the society has elected 200,000 members dedicated to honoring academic achievement, professionalism and exceptional teaching in the field of medicine. More than 4,000 students, residents/fellows, faculty and alumni are elected each year.

Two earn Southern Society for Pediatric Research awards Annalise Sorrentino, M.D., professor in the Division of Pediatric Emergency Medicine, and Sam McCartney, M.D., second-year pediatric resident, received awards from the Southern Society for Pediatric Research (SSPR).

Sorrentino received the SSPR Educator Award for her outstanding contributions to pediatric educational programs and her recognition as a role model within the education community.

McCartney received the SSPR Trainee Travel Award for his continued work in pediatric research. He presented his study, “Development of a Dexamethasone Response Estimator in Preterm Infants on Invasive Mechanical Ventilation ” at SSPR in New Orleans. These awards are meant to facilitate and encourage young trainees to attend and present their research at this meeting.

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When Children’s of Alabama was founded in 1911, an all-female group of volunteers did whatever was needed to operate the charity hospital, from scrubbing floors to sitting with sick children. One hundred fourteen years later, 86% of our dedicated staff and 62% of our leadership team are women. Today, we have been recognized as one of America’s Greatest Workplaces for Women 2025 by Newsweek and Plant-A Insights Group!