2023 Annual Academic Report

CONNECTICUT CHILDREN’S DEPARTMENTS OF PEDIATRICS & PEDIATRIC SURGICAL SUBSPECIALTIES

ANNUAL ACADEMIC REPORT 2023

CHAIRS’ SUMMARIES

Dear Colleagues and Friends,

It is with great pleasure that we present the 14th annual report from the Department of Pediatric Surgical Subspecialties of Connecticut Children’s and the tenth combined report with the Department of Pediatrics. This report continues to highlight the solid alignment between Surgery and Pediatrics and the continued multidisciplinary growth of combined surgical and pediatric programs at Connecticut Children’s.

REFLECTION ON THE GROWTH OF SURGERY

We have welcomed five new physicians: Daniel Herz, MD, Division Head of Urology; Monika Gupta, MD, Medical Director of the Cardiovascular Intensive Care Unit, Herbert Becker, MD, Pediatric Ophthalmology, Jacob Campbell, MD, Pediatric Surgery and Irfan Warsy, MD, Pediatric Cardiology. In addition, we welcomed an entirely new Division of Pediatric Anesthesiology led by Ted Cortland, MD, and Amy Bouchard, MD.

We have performed over 7,720 cases in our main OR and 4,141 cases at our Farmington Ambulatory Surgery Center (ASC). Our new fourth operating room opened this past July at the ASC thanks to the generosity of our dental providers. This was a much-needed addition due to increasing case volumes across all surgical subspecialties.

Our Cardiovascular Institute, under the leadership of Shailendra Upadhyay, MD, and Dennis Mello, MD, continues to provide innovative excellent care. Dr. Mello has performed 116 cases, caring for our most fragile neonate’s hearts. Cesar I. Mesia, MD, and Caitlin Heyden, DO, are continuing to pioneer minimally invasive therapies to repair and replace valves, including being the first in the state to perform the trans-catheter pulmonary valve replacement with the Altera-Sapien valve system. Dr. Upadhyay continues to build the adult congenital heart program and received accreditation by the Adult Congenital Heart Association in 2018, being the first in Connecticut. We have recruited Dr. Warsy to expand

cardiac arrhythmia services. Our electrophysiology program continues to perform state of the art minimal fluoroscopy catheter ablation of arrhythmias.

OUR MISSION

Our strategic mission is to transform care for children. In line with this mission, our Fetal Care Center has expertly performed over 11 cases on fetuses, truly changing the life of an unborn child and their family. World-renowned surgeon, Timothy Crombleholme, MD, leads the Center and since the Center’s inception, has cared for expectant moms from all over the country.

CLOSE TO HOME

Our close to home strategy has grown significantly this year as we continue to strive to provide the right care at the right time as close to our patients’ homes as possible. In Fairfield County, our Westport, Danbury, and Shelton Specialty Care Centers have specialists providing surgical care in areas including pediatric cardiology, pediatric plastic surgery, pediatric surgery, pediatric neurosurgery, pediatric orthopedics and pediatric urology. We have begun performing ambulatory procedures at the Specialty Surgery Center in Stamford. Additionally, to reach the children of northern Connecticut and Western Massachusetts, we provide surgical services in our South Hadley Specialty Care Center including pediatric cardiology, pediatric neurosurgery, pediatric otolaryngology and pediatric ophthalmology. Through this continued expansion, we are making Connecticut Children’s expertise more accessible to our patients and our families.

SOME SPECIFIC HIGHLIGHTS Research

Our investigators in the Department of Surgery published 69 peer-reviewed publications in the last fiscal year. These included large, multi-institutional endeavors that generated new guidelines for pediatric care. Brendan Campbell, MD, Jonathan Martin, MD, and J. Leslie Knod,

MD, have been directing research initiatives at three of our national health professional societies—ACS, AANS/CNS, and AAP. Their research has advanced our understanding of the impact firearm injury has among pediatric patients, as well as surgeons’ knowledge of and biases regarding firearms. In the field of surgically treated infections. David Hersh, MD, has lead a national effort to investigate the rise in sinogenic/otogenic intracranial infections in North America since the end of the COVID-19 pandemic. It has also been an honor to see Kristan Pierz, MD, become site director for an NINDS-funded project modeling CharcotMarie-Tooth phenotypes. Along with Sylvia Ounpuu, PhD, Gyula Acsadi, MD, and collaborators from across the country, her work is helping to define the gait pathologies afflicting children diagnosed with Charcot-Marie-Tooth disease.

Education

A central mission of the Department of Surgery is the education of our future generation of pediatric surgical subspecialties and we reach almost all of the surgical learners in the state! We have faculty-teaching appointments at both the University of Connecticut and the Quinnipiac Netter School of Medicine. Surgical residents from Saint Mary’s Hospital, Danbury Hospital, Waterbury Hospital, Stamford Hospital and the University of Connecticut rotate at Connecticut Children’s and learn from our group of skilled surgeons and teachers. Our surgeons participate in interviewing prospective residents, teaching medical students and residents, and serving as the pediatric site for rotating residents in all specialties. In addition, all of our surgeons continue to provide ATLS and disaster management preparations for all local institutions.

Christine Rader, MD, from the Division of Pediatric Surgery continues as the Assistant Dean of the hospital and acts as the liaison between the University of Connecticut Medical School, Graduate Medical Education and Connecticut Children’s. She is involved in all aspects of education at the hospital and received the first “reach and teach” award this year from the pediatric residents. This

award is given to acknowledge teamwork and dedication to outstanding medical education.

Katerina Dukleska, MD, serves on the Council for Curriculum oversight at the Quinnipiac Netter School of Medicine and oversees the Quinnipiac medical student outpatient clinic rotations at Connecticut Children’s. In addition, Katherine Kavanagh, MD, from Pediatric

Otolaryngology was the first surgeon to participate in our new Zalneraitis Teaching Academy and will be mentoring others in the program. She and Michael Archambault, MD, from our new Division of Pediatric Anesthesiology continue to run the Basic Airway Course and the Crisis Resource Management course for the UConn residents.

Finally, Anne Dudley, MD, from the Division of Pediatric Urology serves as the Connecticut Children’s site director for the UConn Urology residency and teaches surgical skills regionally at the New England American Urological Association.

As you can see, this has been a busy and productive year. We will continue to forge new frontiers in our mission to provide the best care for our children. I look forward to the next five years as we continue to grow.

Warmly,

Christine Finck, MD, FACS

Professor of Surgery and Pediatrics

Vice Chair of Surgery

University of Connecticut School of Medicine

Peter Deckers Endowed Chair of Pediatric Surgery

Surgeon-in-Chief, Executive Vice President

Connecticut Children’s

Dear Colleagues and Friends,

It is with tremendous pride and joy that we present the combined 2023 Annual Academic Report for the Departments of Pediatrics and Pediatric Surgical Subspecialties and share with you the numerous achievements of our faculty and team members.

We began 2023 amidst a tri-demic surge where we saw incredibly high volumes in the hospital from children suffering from COVID, RSV and the flu. I want to sincerely thank all of our physicians, nursing teams, techs, and support staff for their tireless work during this challenging time, especially our residents who made it possible to care for boarder patients awaiting inpatient beds. I could not be more proud of the manner in which staff handled this unprecedented surge with grace, kindness, and personal sacrifice. This truly was a remarkable One Team response that was inspiring to witness.

On April 28, 2023, I had the privilege of participating in the historic groundbreaking ceremony for Connecticut Children’s new tower. Along with our team members, patient families and leaders we celebrated the largest expansion in our 27-year history — construction of an eight-story, state of the art, $326 million clinical tower scheduled for completion in late 2025. The clinical tower will include two floors with 50 private neonatal intensive care rooms, a Fetal Care Center with six labor, delivery, recovery and postpartum rooms, as well as two dedicated operating rooms, and an advanced cellular gene therapy unit where bone marrow transplants and liquid radiation treatments can be performed. This historic expansion is a testament to the remarkable care provided by our clinicians and staff over the years and their unwavering commitment to improving children’s health and wellbeing. In addition to the new tower, we also saw a great deal of growth and recruitment of clinicians in Fairfield County and across the border into New York State.

Connecticut Children’s physicians, faculty, and researchers have earned significant national recognitions in 2023. We were named to the 2023 Becker’s Hospital Review list of 100 hospitals and health systems with top-notch oncology programs. For the second time Connecticut Children’s has been named “Hospital of the Month” for October 2023 by Solutions for Patient Safety (SPS), for our outstanding commitment to pediatric care and continuous efforts to enhance the well-being of children and families. We significantly increased our presence at the 2023 Pediatric Academic Societies (PAS) meeting in Washington, DC, with a newly revamped exhibition booth along with the acceptance of 29 poster presentations, six oral abstracts and one platform presentation. Gyula Acsadi, MD, Division Head of Pediatric Neurology and Director of the Muscular Dystrophy Association (MDA) Care Center and Neuromuscular Program at Connecticut Children’s made national news after performing the first procedure in Connecticut using gene therapy to treat Duchenne Muscular Dystrophy. Jeffrey Hyams, MD, Division Head of Gastroenterology and expert in Crohn’s Disease, was awarded a $14 million grant by the National Institutes of Health (NIH) to investigate the triggers behind the chronic intestinal inflammation seen in Crohn’s Disease. Additionally, our infectious disease research team and I were awarded one of eight NIH research grants to refine new technologies for early diagnosis of severe illnesses resulting from COVID-19 infection in children.

2023 was another productive year in Academic Affairs. We successfully on-boarded 53 new faculty to the Departments of Pediatrics and Surgery. We also celebrated seven academic promotions and seven new faculty appointments. Connecticut Children’s was pleased to announce the founding of a new Teaching Academy in partnership with the Mayo Clinic, to be named in honor of Dr. Edwin Zalneraitis, which will carry on his legacy of educational excellence for years to come.

In 2023, we welcomed three new Division Heads. Our new Division Head for Child and Adolescent Psychiatry, Cristin McDermott, MD, started in January 2023. Prior to joining Connecticut Children’s, Dr. McDermott was on faculty as an Assistant Professor of Pediatrics & Psychiatry at the University of Pittsburgh Medical Center. Dr. McDermott along with Catherine Sullivan, MD, will serve as Co-Medical Directors for the new Inpatient Medical/Psychiatry Integrated Care Unit, scheduled to open in early 2024. This new 12 bed, multi-disciplinary unit is being designed for children who have difficulty accessing inpatient psychiatric services due to concurrent physical medical diagnoses. Daniel Herz, MD, joined the Division of Urology, in May 2023 as Division Head, on a full time basis. Dr. Herz comes to us from the Valley Children’s Hospital, Madera, CA where he was medical director of Urology. Finally, we recruited Jeffrey Shenberger, MD, to serve as Division Head of Neonatology, who started in June 2023. Dr. Shenberger comes to Connecticut Children’s from the Wake Forest School of Medicine and Atrium Health Wake Forest Baptist Brenner’s Children’s Hospital in Winston-Salem, North Carolina where he served as Professor of Pediatrics, Section Head of Neonatology and Vice Chair of Research.

It always gives me great pleasure to see our faculty grow and develop as leaders. While the many achievements of our faculty in 2023 are too numerous to list here, I would like to briefly note two: William Zempsky, MD, Division Head of Pain & Palliative Medicine was appointed Vice Chair for Academic Affairs and Research for the Department of Pediatrics and Annmarie Golioto, MD, was appointed Associate Chair for Clinical Affairs for the Department of Pediatrics.

Once again, it has been a great honor and privilege to serve alongside leaders of the highest caliber. As I look back at the tremendous growth and accomplishments of 2023, I am reminded that it is truly a team effort. I am

grateful for the exemplary leadership and unwavering support of our dean, Bruce T. Liang, MD, Jim Shmerling, CEO, our Connecticut Children’s Executive Management Team and our Board of Directors. I know they share the same pride and joy in celebrating the exceptional achievements of 2023.

Very Sincerely,

Juan C. Salazar, MD, MPH, FAAP

Professor and Chair, Department of Pediatrics

University of Connecticut School of Medicine

Executive Vice President of Academic Affairs

Physician-in-Chief

Connecticut Children’s

2023 HIGHLIGHTS

We are grateful to share some of the amazing accomplishments of our colleagues for the 2023 academic year. We experienced increased growth in many areas, including research grants, publications and presentations, faculty recruitment, and expansion of our training programs. Our faculty were the recipients of numerous teaching awards, grant funding, and academic promotions. We maintained our success in the recruiting of the highest quality of pediatric residents and fellows. Overall, the academic year was one of great accomplishments and fulfillment. We are excited, as we look to the future and all that is possible across our mission of clinical care, education, and research. Please join us in congratulating our faculty, trainees, and staff on another successful year!

Sincerely yours,

Juan

C. Salazar, MD, MPH, FAAP

Professor and Chair, Department of Pediatrics

University of Connecticut School of Medicine

Executive Vice President of Academic Affairs

Physician-in-Chief

Connecticut Children’s

Christine

Finck, MD, FACS

Professor of Pediatrics and Surgery

Associate Vice Chair of Surgery

University of Connecticut School of Medicine

Peter Deckers Endowed Chair of Pediatric Surgery

Surgeon-in-Chief, Executive Vice President

Connecticut Children’s

Engage ment Well-be ing

CONNECTICUT CHILDREN'S WOMEN IN SURGERY (WIS)

The mission of Connecticut Children's Women in Surgery is to enable women surgeons of Connecticut Children’s of all disciplines to develop as professionals through education, advocacy, sponsorship, and engagement. This year was highlighted by the creation of five pillars of focus: mentorship, education, networking, community service, and academic productivity. A leadership council was created with Christine Finck, MD, as the chair, Sonia Chaudhry, MD, as the vice chair, Allison Crepeau, MD, as the member at large, and Katherine Kavanagh, MD, as secretary. We were fortunate to have the opportunity to host a guest speaker, Suzanne McColl, LPC, in an engaging discussion about Imposter Syndrome. Several WIS members participated in the 5K Superhero fun run and our group held a suture workshop for the UConn women in surgery interest group. To wrap up our year, WIS opted to support the Women’s League for the holiday season; our donations went to purchasing gift cards for parents to assist with a holiday meal. We look forward to another year supporting our women in surgery to be the best and brightest leaders.

PEDIATRIC WOMEN RELATE (POWER)

The purpose of PoWER is to foster a community of women physicians, psychologists and leaders at Connecticut Children’s by providing leadership, professional and personal development, and support. PoWER was founded by Barbara Edelheit, MD, in 2020 and the group has grown significantly over the past three years. In 2023 PoWER held 16 events that were focused in three areas: career development, personal development, and networking.

The PoWER steering committee is composed of faculty from the primary care and subspecialty divisions and includes those earlier in career as well as those more established. Significant support is provided by Lisa Marella, Connecticut Children’s Senior Director of Organizational Effectiveness, and Lisa Parris assists with administrative support. Our steering committee includes Alicia Wang, MD (cardiology),

PoWER’s key achievements include: arranging multiple events which provide CME credit, working with UConn to create more equitable criteria for promotion, improvements in pay equity at Connecticut Children’s, and creation of the Women in Medicine Impact Award. In the coming years PoWER hopes to increase attendance (from both women and men), hold more events with CME credit, encourage faculty to attend national meetings for women in medicine, increase website presence, secure external funding, continue to improve pay equity and address academic issues identified by our membership by creating lasting change.

Connecticut Children’s recognized for Commitment to Creating a Mentally Healthy Workplace

In 2023 Connecticut Children's was one of the first recipients of the Mental Health America Bell Seal for Workplace Mental Health. Mental Health America (MHA) is the leading community-based nonprofit dedicated to addressing the needs of those living with mental illness and promoting the overall mental health of all. The Bell Seal for Workplace Mental Health is a national certification program that recognizes employers committed to creating mentally healthy workplaces. Employers that receive MHA's Bell Seal are nationally recognized as meeting or exceeding workplace practices and standards that promote positive worker mental health and well-being.

Hayley Wolfgruber, MD (PHM), Sonia Chaudhry, MD (Well Baby Nursery), Joanne Crowley, MD (PHM), Ada Booth, MD (SCAN), Emily Wakefield, (psychology), Bella Zeisler, MD (GI) and Barbara Edelheit, MD (Rheumatology) who leads the group.

Achievements Clinical

Connecticut Children’s recently became the first health system in Connecticut to use the BEAR® Implant to treat a torn pediatric anterior cruciate ligament (ACL), one of the most common sports injuries in the U.S. The surgery, performed by Allison Crepeau, MD, represents a huge shift from the standard treatment for ACL tears. Prior to this advancement, a patient’s best option usually involved major surgery and borrowing healthy tissue from another spot in their knee. The BEAR implant acts as a bridge to help the torn ends of the ACL heal together, speeding healing and improving long-term outcomes.

Connecticut Children’s Fetal Care Center

The Connecticut Children’s Fetal Care Center launched on April 3, 2023 and is led by Timothy M. Crombleholme, MD, who is one of the world’s most experienced fetal surgeons.

The fetal care team treats mothers who are high risk for delivering a baby with a serious birth defect or health condition that needs advanced care in utero and soon after delivery. As part of our Growth and Expansion strategic priority, the Fetal Care Center is part of our larger Care Alliance with Hartford HealthCare. Together we will care for both the mothers and the babies. The Fetal Care Center will eventually be housed on the third floor of Connecticut Children’s new Tower.

Other treatments performed by Dr. Crombleholme and his team include twin-twin transfusion syndrome procedures with the nation’s best survival rates and lowest complication rates, robotic fetoscopic myelomeningocele repair for the prenatal treatment of spina bifida and the FETO procedure, which stands for fetoscopic endoluminal tracheal occlusion. Ours will be one of only a handful of fetal centers offering the FETO procedure for the treatment of severe congenital diaphragmatic hernia.

Connecticut Children’s Breaks Ground on New Eight-Story Clinical Tower on 10th Annual Superhero Day

On April 28, 2023, Connecticut Children’s team members, patient families and leaders joined together for a superhero themed groundbreaking ceremony to celebrate the launch of the next phase of the health system’s growth and expansion plan, construction of a 190,000 square-foot, $326 million clinical tower on the front lawn and connected to the existing medical center in Hartford. Completion is scheduled for late 2025. The clinical tower will include two floors with 50 private neonatal intensive care rooms, a Fetal Care Center with six labor, delivery, recovery and postpartum rooms, as well as two dedicated operating rooms, and an advanced cellular gene therapy unit where bone marrow transplants and liquid radiation treatments can be performed. Additionally, we are constructing a 14-bed acuity adaptable unit that can flex to accommodate any level of patient acuity. The new tower will feature open-air terraces on inpatient floors where families and team members can find respite.

Christopher Hughes, MD, Performs Life-Saving Skin Transplant

Meier Samuels has spent most of his young life in the hands of doctors at Connecticut Children’s. Meier has a rare disease called familial dysautonomia, which only 290 people in the world have. He has been in and out of the ICU, faced two heart attacks and most recently, he had an infection that forced doctors to cut out a large section of his skin. To help prevent a possible life-threatening infection, Dr. Hughes had the novel idea to reach out to a company that uses a special technology to grow skin. “His skin is taken from him and then grown in a lab on sheets, and then after three weeks we’re able to graft it on,” said Dr. Hughes. It was a first for Connecticut Children’s and an innovative way to use this technology as it is typically only used for burn victims.

Connecticut Children’s New Neonatal Intensive Care Unit Named for Mandell-Braunstein Family

Connecticut Children’s has received a $2.5 million commitment from the MandellBraunstein family to support neonatology intensive care facilities and services in our new tower expansion. In recognition of this far-reaching gift, the seventh floor NICU of the health system’s new clinical tower in Hartford will be named the MandellBraunstein Family Neonatal Intensive Care Unit. Connecticut Children’s staffs 14 NICUs across Connecticut and New York, with the most critically ill babies receiving care at its Level 4 NICU in Hartford. The new Mandell-Braunstein Family Neonatal Intensive Care Unit will feature 25 private NICU patient/family rooms, family waiting rooms, procedure rooms, and team member areas. There will be another NICU floor with similar features, bringing the total of private NICU rooms to 50.

Connecticut Children’s Makes Medical History

Connecticut Children’s recently became the first health system in the state to administer specific gene therapy for Duchenne Muscular Dystrophy (DMD). Duchenne Muscular Dystrophy is a rare genetic disorder that affects approximately 1 in 3,500 male births. It leads to progressive muscle degeneration and weakness, loss of movement and heart failure, significantly impacting the quality of life for those diagnosed. Connecticut Children’s commitment to advancing medical care and embracing innovative treatments marks a significant step forward in the fight against this devastating disease.

The groundbreaking procedure, conducted by Gyula Acsadi, MD, Division Head of Pediatric Neurology and director of the Muscular Dystrophy Association (MDA) Care Center and Neuromuscular Program at Connecticut Children’s, was life-changing for patient Joseph Young and his family, giving them newfound hope for improved mobility and quality of life.

Connecticut Children’s Receives Accreditation for Bariatric Surgery Program

Connecticut Children’s has received accreditation from the American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Connecticut Children’s is one of only four free standing children’s hospitals in the nation to receive this accreditation, which formally acknowledges our commitment to providing and supporting quality improvement and patient safety efforts for metabolic and bariatric surgery patients.

Connecticut Children’s Named Hospital of the Month by National Patient Safety Organization

For the second time Connecticut Children’s has been named “Hospital of the Month” for October 2023 by Solutions for Patient Safety (SPS), for our outstanding commitment to pediatric care and continuous efforts to enhance the well-being of children and families. SPS is a network of more than 140 children’s hospitals dedicated to making progress on a journey to zero harm. Out of all the network hospitals, Connecticut Children’s was chosen for its commitment to quality and safety including exemplary data sharing, team member education practices, and consistent prevention of hospital acquired conditions.

Connecticut Children’s Named to Becker’s Review “Oncology Program” List

Connecticut Children’s has been named to the 2023 Becker’s Hospital Review list of 100 hospitals and health systems with great oncology programs. This list encompasses hospitals and health systems, including Connecticut Children’s, that have earned national recognition for their work in cancer care and have programs that offer leading-edge clinical trials and pioneering research discoveries that expand access to care and enhance patient outcomes.

Connecticut Children’s Named to Becker’s Review “Orthopedic Programs” List

The hospitals and health systems featured on this list of 100, including Connecticut Children’s, are the nation’s leading providers of orthopedic care. The list celebrates orthopedic programs that offer minimally invasive treatments, forward-thinking research and breakthrough clinical trials that drastically improve patient outcomes.

WELCOME TO Connecticut Children’s

CRISTIN MCDERMOTT, MD

joined Connecticut Children’s and the University of Connecticut School of Medicine as Division Head of Child & Adolescent Psychiatry and Assistant Professor of Pediatrics and Psychiatry in January 2023. Dr. McDermott completed her medical degree at the University of Connecticut School of Medicine in 2012, where she received the James Foster Teaching Award for Excellence in Medical Student Education, the New England Pediatric Society Award, and the Gold Humanism Honor Society Award. She completed Triple Board Residency (Pediatrics, General Psychiatry, Child and Adolescent Psychiatry) at the University of Pittsburgh Medical Center Western Psychiatric Hospital and Children’s Hospital of Pittsburgh in 2017. She is board-certified in Pediatrics, General Psychiatry, Child & Adolescent Psychiatry, and Pediatric Hospital Medicine.

Prior to returning to Connecticut, Dr. McDermott was on faculty as an Assistant Professor of Pediatrics & Psychiatry at the University of Pittsburgh Medical Center. She served as a pediatric hospital medicine attending and child & adolescent consultation & liaison psychiatrist at the UPMC Children’s Hospital of Pittsburgh. She was also the Associate Training Director for the UPMC Triple Board Residency Program. Dr. McDermott’s interests include the care of children with medical complexity, integrated care, women in medicine and wellbeing in medicine. She has presented regionally and nationally on physician well-being and the use of appreciative inquiry.

DANIEL HERZ, MD joined the Division of Urology, department of Surgery based at Connecticut Children’s on May 15, 2023 as a Division Head, on a full time basis. Dr. Herz comes to Connecticut Children’s from the Valley Children’s Hospital, Madera, CA where he was medical director of Urology. He received his medical degree from SUNY Health Science Center at Brooklyn (Downstate Medical Center) in 1991, and completed urological residency at University of Pittsburgh Medical Center in 1999. He completed a two-year clinical and research fellowship in pediatric urology at the Hospital for Sick Children, University of Toronto in 2001. He is Board certified by the American Board of Urology in both urology and pediatric urology, Dr. Herz has published extensively in the field of pediatric urology. His expertise and focus is in robotic assisted laparoscopic minimally invasive urological surgery. His primary research interests are in robotic surgery simulation and outcomes/ evidence-based urological.

JEFFREY SHENBERGER, MD joined Connecticut Children’s and the Department of Pediatrics, University of Connecticut School of Medicine, on June 1, 2023 as the Division Head of Neonatology. Dr. Shenberger comes to Connecticut Children’s from the Wake Forest School of Medicine and Atrium Health Wake Forest Baptist Brenner’s Children’s Hospital in Winston-Salem, North Carolina where he served as Professor of Pediatrics, Section Head of Neonatology and Vice Chair of Research. Dr. Shenberger served as a Major in the United States Air Force from 1995-1999 where he received numerous medals for his service and worked as Director of Neonatal Research at the Wilford Hall USAF Medical Center. Dr. Shenberger specializes in neonatal respiratory failure and lung development and is an expert in neonatal opioid withdrawal syndrome, nutrition, retinopathy of prematurity, bronchopulmonary dysplasia, and extracorporeal membrane oxygenation of the newborn.

Honors Awards

On December 14, 2023, Jeffrey S. Hyams, MD, Division Head of Digestive Diseases, was presented the Healthcare Hero Award from the Hartford Business Journal at a special ceremony at the Aqua Turf Club in Plantsville. He was placed in the winner category for Advancement in Health Care – Innovation. He was recognized for his ongoing research and teaching, as well as his work with the FDA to develop endpoints for pediatric research clinical trials.

Effective September 1, 2023, Eileen Mercurio, MD, has been appointed as the Clinical Site Director at the Burgdorf/Bank of America Health Center in Hartford, CT. Dr. Mercurio joined the Department of Pediatrics in August, 2021. Since that time, she has worked tirelessly to provide the best care for the children and families that the Burgdorf serves in the North End of Hartford. She has proven to be a valued educator for our medical residents and an exceptional team member.

Kerry Moss, MD, Pediatric Oncologist and Medical Director for the Sunflower Kids Palliative Care Program at Connecticut Children’s has received the 2023 Community Service Award from the Hartford County Medical Association. Dr. Moss is an expert in the care of survivors of childhood cancer. Following her subspecialty training in Pediatric Hematology and Oncology at The Children’s Hospital of Colorado she returned to Connecticut Children’s as an attending physician. In 2010, when no pediatric palliative care programs existed in the state of Connecticut Dr. Moss initiated the Sunflower Kids Palliative Care Program.

Lori Pelletier, PhD, MBA, was installed as the Popik Family Endowed Chair for Quality and Patient Safety in an investiture ceremony on October 11 at the Hartford Golf Club. Dr. Pelletier is nationally recognized as an expert in organizational excellence pedagogy and improving health care delivery through continuous improvement, engineering modeling, qualitative research, and systems engineering approaches. She has researched, designed and implemented methodologies for physician profiling, physician burnout, Patient-Centered Medical Home, electronic health records (EHR) and suicide risk screening, assessment and care. She is a co-Primary Investigator on the Zero Suicide grant for Connecticut Children’s, awarded by Cardinal Health Foundation, and lectures nationally on her current research in suicide prevention and organizational excellence.

Honors Achievements

Richelle deMayo, MD, was elected to the national Epic Cosmos Governing Council and joined the University of Connecticut’s Center for Population Health.

Anudeep Dodeja, MD, was an invited speaker for the 8th World Congress of Pediatric Cardiology and Cardiac Surgery and presented on “Managing Obesity in ACHD: The Unintended Consequence (of Pediatric Cardiology)” as well as on “Best Techniques Using Today’s Tools To Assess Systolic Function of The Subaortic RV For Clinical Decision Making” in Washington DC in August 2023.

Paul Dworkin, MD, received the 2023 Visionary Award on June 7, 2023. He was selected by Leadership Greater Hartford to receive its 2023 Visionary Award. The award honors an individual or institution that exemplifies Leadership Greater Hartford’s three pillars of community, leadership and connections. The organization states that Dr. Dworkin is being honored for his “exceptional medical career and contributions to building access to quality healthcare for underserved populations.” The award specifically recognizes his work leading the North Hartford Ascend, which is a collaboration of more than 20 partners that seeks to enhance academic, health and life outcomes for children living in the North Hartford Promise Zone. Ascend is funded by a $30 million grant from the U.S. Department of Education’s Promise Neighborhoods Program.

Annmarie Golioto, MD, IBLC, FAAP, was appointed to the role of associate Chair for Clinical Affairs for the Department of Pediatrics effective September 1, 2023. Dr. Golioto was chosen amongst a very talented group of physicians who responded to the internal search announcement. Dr. Golioto’s passion for clinical operations come from her experiences as Medical Director of the Connecticut Children’s NICU in Hartford, Regional Clinical Director of the Hartford HealthCare Nurseries and Chief of Pediatrics for Hartford Hospital. Her clinical interests include care of the late preterm infant, lactation and breastfeeding medicine, extracorporeal membrane oxygenation, and neonatal respiratory failure.

Christopher Grindle, MD, was appointed to lead the Pediatric Record Optimization for Sufficiency, Productivity, Efficiency and Revenue (PROSPER) initiative.

Andrea Guardenier, MD, was selected as one of the inaugural fellows of the Popik Family Quality and Patient Safety Fellowship Program.

James Healy, MD, was elected as Vice President of the CT Chapter of the American Society for Metabolic and Bariatric Surgery.

Andrew Heggland, MD, assumed directorship of the Connecticut Children’s Intelligent Decision-making and Effective Analytics (IDEA) Core.

Katherine Kavanagh, MD was the recipient of the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) 2023 Honor Award.

Jane Im, MD, was appointed to serve on the State Medical Association’s health information exchange Advisory Committee.

Carolyn M. Macica, MS, PhD, assumed the role of Director of Research Operations and Development.

Cristin McDermott, MD, and Catherine Wiley, MD, were appointed to the State of Connecticut’s Behavioral Health Partnership Oversight Council.

Beth Natt, MD, was appointed by Dr. Anand Sekaran, System Chair of Pediatrics for Nuvance, as the System Medical Director for Pediatric Hospital Medicine for Nuvance Health in recognition of her exceptional work to improve inpatient care for children throughout the Nuvance network. Dr. Natt focused on optimizing care within our inpatient and well newborn services at these hospitals and helped bring top quality pediatric and neonatal care to children and families close to home. Dr. Natt previously served as Regional Clinical Director for Pediatric Hospital Medicine, overseeing inpatient pediatric care for both Danbury and Norwalk Hospitals. She also played an instrumental role in establishing the new and successful pediatric service line at Vassar Brothers Medical Center in New York.

Robert Parker, DO, was accepted to the Harvard Macy Program for Educators in Health Professions.

Steven Rogers, MD, has been chosen by the American Association of Suicidology, as the 2023 Roger J. Tierney Award winner. This award is given annually to recognize an individual’s time and efforts to advance the association’s principles, growth and development, and/or for applied contributions to the fields of suicidology and crisis intervention.

Sara Sanders, MD, was appointed as the Core Faculty Leader (CFL) for the Residency Program.

Leonela Villegas, MD, was selected as one of two 2023 John E. Lewy Fund (JELF) Advocacy Scholars by the American Society of Pediatric Nephrology (ASPN). She will be immersed in leadership development and gain advocacy skills with government and regulatory expertise.

Jessica Winters, MD, was appointed as the PICU Patient Safety Officer and one of the initial fellows in the Quality and Safety Fellowship.

Melissa Santos, PhD, Division Head, Pediatric Psychology, has being selected as a 2023-2024 Mayday Fellow. Dr. Santos will join a cohort of 11 other fellows from across the United States and Canada to take part in a program focused on communication and advocacy for improved pain care. This honor follows on Dr. Santos’s continued success in research. She has recently secured funding from the TOW Foundation, Substance Abuse and Mental Health Services Administration (SAMHSA), and the American Diabetes Association.

Nancy Trout, MD, MPH, primary care physician and Co-Director of the Start Childhood Off Right (SCOR), received the Eastern Society for Pediatric Research Advocacy Award for her project “Evaluation of Food Insecurity and Implementation of a Produce Voucher Program in a Pediatric Emergency Department: A Feasibility Study.”

Jessica Williams, MD, was named an inaugural William Popik Quality and Safety Fellow.

The 2023 Resident Teaching Awards were presented as follows:

• Excellence in Teaching in an affiliated Pediatric Field Award presented to Nicole Murray, MD

• Excellence in Teaching in Acute Care Award presented to Sara Sanders, MD

• Excellence in Teaching in a Subspecialty Award presented to Alex Golden, MD

• Faculty Excellence in Teaching Award went to Melanie Rudnick, MD

• Fellow Teacher of the Year Award presented to Hala Saneh, MD

• Outstanding Contributions to Education and Career Development Award presented to Christine Skurkis, MD

• Outstanding Role Model Award presented to Caleb Wasser, DO

• The Leon Chameides Lifetime Achievement Award was presented to Eileen Gillan, MD, in recognition to her 30 years of teaching and mentoring.

Juan C. Salazar, MD, Physician-In-Chief presented the 2023 Chair’s Awards to:

• Chair’s Award for Well-being: Stewart Mackie, MD

• Chair’s Award for Innovation: Richelle deMayo, MD, CM, FAAP, FAMIA

• Chair’s Award for Teaching: Catherine Wiley, MD

• Chair’s Award for Teaching: Andrea Orsey, MD

• Chair’s Award for Citizenship: Haviva Veler, MD

• Chair’s Impact Award for Women in Medicine: Ilana Waynik, MD

The 2023 Reach and Teach Award Recipients are:

• Faculty Award: Christine Rader, MD

• Fellow Award: Erin Pastor, DO

• Resident Award: Marissa Rodenstein, MD

• Advanced Practitioner: Basia Adams, RN, APRN, DNP

Research

On November 8, 2023, the Connecticut Children’s Research Institute (CCRI) held its third annual Research Symposium, “Discovery Beyond Imagination” at the Trinity Innovation Hub in Hartford, CT. The symposium featured keynote speaker Dennis Durbin, MD, MSCE, President of the Abigail Wexner Research Institute at Nationwide Children’s Hospital. Dr. Durbin’s engaging talk, “Evidence-Based Advocacy: Past Lessons Applied to Future Challenges,” described the benefits and intersections of research and advocacy in order to impact communities and overall child health. Additional speakers included Dr. Rebecca Riba-Wolman, Dr. Jeffrey Hines, Chief Diversity Officer, UConn Health, Melissa Santos, PhD, and the 2022 Connecticut Connections Seed Grant Winners, Dr. Kelly Hawley and Dr. David Hersh.

The afternoon held breakout sessions by Drs. Timothy Crombleholme, Barbara Kream, PhD, Associate Dean of the Graduate School, UConn Health, Joanna Gell, Melissa Santos, Carolyn Macica, Richelle DeMayo and Danny Mendoza.

CCRI welcomed over 106 attendees in-person and an additional 78 virtual attendees from numerous institutions from Connecticut including The University of Connecticut School of Nursing, The University of Connecticut Health Center, Hartford Hospital, The Jackson Laboratory and Cigna. There were 52-poster presentations in-person, and 57 abstract submissions – almost 4 times the amount in 2022. The posters highlighted the diversity of research across the institute, spanning from basic science, translational, clinical and population studies.

Grants

Connecticut Children’s Connection is a community of members committed to supporting Connecticut Children’s mission and providing the care children and families deserve. Members have chosen to pool financial resources, volunteer their time and connect with professionals from across industries to raise awareness and support for Connecticut Children’s research initiatives.

Eight promising research scientists were invited to submit a request for proposal (RFP) for one of two $65,000 awards. The RFPs were reviewed by a committee of Connecticut Children’s Connection Visionary Members and four visionary finalists were invited to present their research proposals at Connecticut Children’s Connection Funding Selection Event Tuesday March 28, 2023 at Cigna’s Learning Center:

• Brooke T. Davey, MD – Study to Determine the Optimal Care Pathway for Children Suffering from Obesity with Cardiometabolic Disease and Inform National Standards

• Kelly L. Hawley, PhD – Developing a Syphilis Vaccine with Global Efficacy

• David Hersh, MD – Establishing the Feasibility of Robot-Assisted Fetal Surgery

• Olga H Toro-Salazar, MD – Cardio-Oncology Research & Development of the Center for Cardio-Oncology Health and Innovation for Cancer Survivors

Kelly L. Hawley, PhD and David Hersh, MD were each selected to receive a $65,000 award from Connecticut Children’s Connection to support the following research projects:

• Kelly L. Hawley, PhD – Developing a Syphilis Vaccine with Global Efficacy Syphilis poses an ongoing global threat to human health for at-risk populations in resource-poor nations and is resurging in developed nations like the United

States. Congenital syphilis is responsible for over half million perinatal deaths worldwide. The syphilis spirochete (Treponema pallidum) disseminates quickly from the infection site and can easily invade multiple organs and cross the placental barrier to infect the unborn fetus. Treponema pallidum has an extremely fragile cell envelope with a paucity of outer membrane proteins (OMPs). Antibodies generated by experimentally infected rabbits, as well as naturally infected humans, are generally believed to bind surface exposed OMP epitopes and mediated clearance by innate immune cells. Using bioinformatics and structural modeling, we defined to the repertoire of the bacterium’s OMPs (the “OMPeome”). While OMPeome members are highly promising as components of a future syphilis vaccine, little is known about their expression during infection. To address this critical knowledge gap in the quest for the first of its kind syphilis vaccine, Dr. Hawley proposed using T. pallidum-specific capture-based nextgeneration sequencing (NGS) to enrich for potential vaccine targets in RNA extracted from skin tissues from experimentally-infected rabbits. The funds would support purchase of capture probes, RNA extraction and quality control, NGS library construction, Illumina RNAseq flow cells, animal purchases and per diems and general laboratory reagents and consumables. Results from this investigation will greatly advance development of a syphilis vaccine.

• David Hersh, MD – Establishing the Feasibility of Robot-Assisted

Fetal Surgery

Spinal dysraphism is a congenital malformation of the spinal column. In the most common form of open spinal dysraphism – myelomeningocele – the abnormal spine becomes further damaged by exposure to the amniotic fluid and by direct physical trauma from the uterine wall. Dr. Hersh’s project seeks to improve the surgical technique associated with fetoscopic surgery for spinal dysraphism and study the feasibility of robot-assisted repair. The hypothesis states that the robot-assisted single access surgery will reduce the port-related maternal complications. The funding will be used during the first phase of the project, which is evaluating the technique on an animal model. Results from this research will be used to seek FDA approval to study the use of fetoscopic surgery in humans.

$14 Million Research Grant awarded Dr. Jeffrey Hyams

The National Institutes of Health (NIH) awarded Jeffrey Hyams, MD, Division Head of Gastroenterology and expert in Crohn’s Disease, a 5-year, $14 million grant to investigate the triggers behind the chronic intestinal inflammation seen in Crohn’s Disease and why some children respond quickly to current therapies and others do not. This is the largest research grant ever awarded to Connecticut Children’s by the

NIH. Dr. Hyams and his colleagues from children’s hospitals across the country hope to one day match specific therapies to the biology of each newly diagnosed pediatric patient.

“This study is the culmination of over twenty years of cooperative work by the leading experts in pediatric Crohn’s disease in the United States and Canada. We have a dream team of clinicians, research coordinators, and scientists who will be studying results in over 500 newly diagnosed children who are treated in a standard fashion,” said Dr. Hyams. “By examining how inflammation is regulated and the interaction of the body’s immune system with the intestinal microbiome we hope to better understand why some children rapidly get better and others do not respond to therapy. This is the goal of precision or personalized medicine.”

Juan C. Salazar, MD, Received COVID-19 Research Grant from NIH

The National Institutes of Health (NIH) has awarded Juan C. Salazar, MD, Physicianin-Chief, one of eight research grants to refine new technologies for early diagnosis of severe illnesses resulting from COVID-19 infection in children. This grant will allow Dr. Salazar and his team of research colleagues to continue their efforts to develop a tool that can easily diagnose MIS-C. This includes a point-of-care test with cuttingedge chip technology developed by Ciencia, Inc. (East Harford, CT) that can test for multiple proteins simultaneously.

“If it goes well, this kind of diagnostic capability could be used for many other conditions,” Salazar said.

“This chip could be quite innovative, and it’s being built right here in East Hartford.”

Robert Keder, MD, Developmental Pediatrician at Connecticut Children’s, recently discussed after school routines with Fox 61. In the interview, he shares that although there is great value in structured after school routines, unstructured time is also important and can help children tap into creativity and to better understand themselves.

To watch the full news segment, click here.

Cristin McDermott, MD, Division Head of child and adolescent psychiatry, recently spoke to Yahoo News! about the decline in youth suicide rates and how more needs to be done on a broader level to support good mental health in kids. Suicide is one of the leading causes of death for Americans, and it can have devastating consequences for those left behind. While any cases of suicide are devastating, new data from the Centers for Disease Control and Prevention shows that suicide deaths have dropped for young people.

To read the article, click here.

Ian Michelow, MD, Division Head, Infectious Diseases and Immunology, spoke to Yahoo Life about the newly released COVID-19 Vaccine booster, which is recommended as more of a priority for children who are immunocompromised or have medical complications. The Food and Drug Administration just approved the long-anticipated updated COVID-19 vaccine and booster for Americans. So what does this mean for children and who should receive one?

To read the full article, click here.

Media

In response to the recent FDA approval of Beyfortus, a drug aimed at protecting infants and toddlers from respiratory syncytial virus, or RSV, Dr. Michelow spoke to What To Expect about RSV infection and how the new medication will work to save lives. He was also featured in MSN about the recent outbreak of malaria in the U.S. In this article, he shares the symptoms of Malaria and what parents should look out for. Together, both articles have been read more than 180 million times!

Juan C. Salazar, MD, Executive Vice President and Physician-in-Chief at Connecticut Children’s recently joined Nemours Children’s Health “Well Beyond Medicine” podcast. During the podcast episode titled, “Collaboration Across Pediatrics” Dr. Salazar discusses research, the power and promise of collaboration across pediatric care and efforts to reduce health disparities. He also shares what it was like to be an infectious disease specialist leading a pediatric health care system through a pandemic.

To listen to the episode, click here.

Ching Lau, PhD, MD, Scientific Director of the Center for Cancer and Blood Disorders and division head of Pediatric Hematology-Oncology at Connecticut Children’s, recently spoke with JAX Labs about his research to further develop and improve personalized pediatric treatments. Dr. Lau and his team work to determine which cells the cancers originate from, the genetic aberrations driving the disease and the treatments that will give patients the best chance to not only survive, but to thrive.

You can learn more about their efforts in this article or by watching the video: https://www.youtube.com/watch?v=OCTwrhYNYNs&feature=youtu.be

Other

On March 27, 2023, Quinnipiac hosted its QTHON, an 8-hour dance marathon raising funds and awareness for Connecticut Children’s. Hundreds of Quinnipiac currents students, alumni and faculty and staff alike, came together to raise a total of $103,956.17 to benefit patients at Connecticut Children’s.

On March 4, 2023, nearly 30 children and teens, ranging in age from 3 to 16, received a VIP welcome as they joined more than 3,900 University of Connecticut students—the highest number for any university in the U.S. this year—who danced from 6 a.m. through midnight raising funds to benefit patient care at Connecticut Children’s. The 24th annual 18-hour dance marathon, held in the Hugh S. Greer Field House on the Storrs campus, topped off an annual year-long fundraising campaign known as HuskyTHON, which raised $1,480,255.77 to benefit the only health system in Connecticut dedicated exclusively to the care of children.

Appointments Promotions

PROMOTION TO PROFESSOR

• James I. Hagadorn, MD, Professor of pediatrics

Division of Neonatal-Perinatal Medicine

• Melissa Held, MD, Professor of pediatrics

Division of Infectious Diseases

• Nicole Murray, MD, Professor of surgery

Department of Surgery

APPOINTMENT TO PROFESSOR

• Ian Michelow, MD, Professor of pediatrics

Division of Infectious Diseases

• Timothy Crombleholme, MD, Professor of surgery

Fetal Medicine, Department of Surgery

PROMOTION TO ASSOCIATE PROFESSOR

• Alyssa R. Bennett, MD, Associate Professor of pediatrics

Division of Adolescent Medicine

• Mariann Kelly, MD, Associate Professor of pediatrics

Division of Emergency Medicine

• Dennis Mello, MD, Associate Professor of surgery

Pediatric and Adult Congenital Cardiac Surgery, Department of Surgery

• Catherine Sullivan, MD, Associate Professor of pediatrics

Division of Hospital Medicine

APPOINTMENT TO ASSOCIATE PROFESSOR

• Allison Cowl, MD, Associate Professor of pediatrics

Division of Pediatric Critical Care

• Adam Czynski, DO, Associate Professor of pediatrics

Neonatology at Nuvance Health

• Stewart A. Mackie, MD, Associate Professor of pediatrics

Division of Cardiology

• Shikha Sarkar, MD, Associate Professor of pediatrics

Division of Neonatal-Perinatal Medicine

• Haviva Veler, MD, Associate Professor of pediatrics

Division of Pulmonary Medicine

New Faculty

We continued to support the growth of our programs through faculty recruitment. During 2023, we were very fortunate to welcome 53 new faculty members to the Departments of Pediatrics and Surgery in the following divisions: Anesthesia (15); Cardiology (1); Developmental and Behavioral Pediatrics (1); Digestive Diseases, Hepatology and Nutrition (2); Emergency Medicine (2); Hospital Medicine (5); Neonatal-Perinatal Medicine (6); Nephrology (1); Neurology (1); Pain and Palliative Medicine (2); Pediatric Critical Care

(5); Plastic Surgery (1); Psychiatry (5); Psychology (2); Pulmonary Medicine (2); Urology (1); Weight Management (1).

PEDIATRIC SUBSPECIALTIES

ADOLESCENT MEDICINE

The Division of Adolescent Medicine welcomed postdoctoral psychology fellow, Jessica Simmons, PhD, to our team in the fall of 2023. Dr. Simmons specializes in youth with eating disorders and also treats anxiety, depression, and OCD.

CLINICAL

• Eating Disorders: Our medical providers evaluate the medical and nutritional status of patients, recommend levels of care, and collaborate with pediatricians, community therapists, and dieticians to provide longitudinal care over time. We also prescribe psychotropic medications for the treatment of anxiety and depression, which are common co-morbid diagnoses in patients with eating disorders.

• Contraception: We offer all forms of hormonal contraception, including same-day insertions of IUDs and implants, for both the management of menstrual concerns and for contraception. We also provide gynecologic care including Pap smears and sexually transmitted infection (STI) testing and treatment.

• Menstrual disorders: We treat a variety of menstrual disorders including abnormal uterine bleeding (AUB), dysmenorrhea, irregular menses, primary/secondary amenorrhea, and polycystic ovary syndrome (PCOS).

EDUCATION

Educating future pediatricians and pediatric subspecialists is an essential part of our mission. University of Connecticut pediatric residents complete a four-week adolescent medicine rotation during their second year of training. The residents work with Connecticut Children’s providers as well as our clinical partners in the community during their rotation. The Division of Adolescent Medicine greatly appreciates the time commitment and teaching contributions of the following clinical preceptors and their colleagues:

• Connecticut Children’s Sports Medicine, Farmington, CT: Imran Hafeez, MD, and Allison Crepeau, MD

• Westminster School, Simsbury, CT: Davis Smith, MD, Medical Director (through May 2023)

• Institute of Living, Child and Adolescent Programs, Hartford, CT: Victoria Urrutia, MD; Jennifer Downs, MD; and Salma Malik, MD, MS

• Women’s Ambulatory Health Services, Family Planning Clinic, Hartford, CT: Sarah Lindsay, MD, and Sheila Flaum, DO

We also offer an adolescent medicine elective for fourth year medical students from the UConn School of Medicine and the Frank H. Netter MD School of Medicine at Quinnipiac University. Jessica MacCormac, DO, MS continues in her role as the clerkship director of Ambulatory Pediatrics at the UConn School of Medicine.

RESEARCH & GRANTS

Alyssa Bennett, MD, continues her work with colleagues in the Division of Infectious Diseases on the Department of Public Health Integrated HIV Testing and PrEP Navigation Project.

STAFF

Alyssa Bennett, MD, Division Head

Jessica MacCormac, DO, MS

Esther Oziel, MD – primary care pediatrician (through September 2023)

Barbara Snyder, MD – per Diem

Mandi Boisvert, APRN

Jessica Simmons, PhD

BIOMEDICAL INFORMATICS

The Division of Pediatric Biomedical Informatics marked its seventh anniversary with an expansion of its workforce and a more explicit focus on innovation and advanced analytics to support patient safety, healthcare professional well-being, and clinical discovery.

The Division is extraordinarily proud to have led Connecticut Children’s recognition as an Epic “Honor Roll” awardee, reflecting uptake of medical record functionality to help save lives and increase satisfaction for patient families and their care teams. Nine members strong, but embracing a culture of collaboration extending beyond the Division proper, Biomedical Informatics faculty continue to strive to amplify the use of information technology to improve healthcare processes and outcomes for physicians, advanced practitioners and the young people they serve.

Designing and developing tools to assist healthcare professionals in making appropriate clinical decisions has been a long-standing area of focus for division members. Among notable accomplishments this year, Jessica Williams, MD, led an interdisciplinary team that also included Connecticut Children’s colleagues Heather Tory, MD, MPH, and Phuong Sander, PharmD, to engineer indication-specific medication guidance. Their achievements regarding contextaware benzodiazepine ordering spurred creation of a national workgroup of healthcare professionals and industry representatives to explore further opportunities for safer prescribing of pharmaceuticals used for a variety of purposes. Andrew Heggland, MD, partnered with Mary Saccoccio, RN to implement and evaluate predictive models for improved pediatric sepsis detection, and with Grace Hong, APRN to design and compare alternative EHR-integrated interventions to promote HIV diagnosis in youth. Throughout the year, Jill Herring, APRN, continued important work updating and adding electronic evidence-based pediatric clinical pathways. Significantly, the Division successfully established new cooperative Connecticut Children’s Clinical Decision Support processes with Nursing

Shared Governance and Clinical Applications teams to oversee implementation and optimization of alerts and order sets to enhance decision-making.

The Division continued to prioritize digital patientand family-oriented technologies, acknowledging the crucial role of patient engagement for care quality and safety. As co-chairs of the “MyChart” steering committee, Christopher Grindle, MD, and Dr. Williams led the a renewed focus on pediatric patient portal activation. More than 75% of clinic patient families now have active accounts granting them ready access to their health information as well as the opportunity to communicate securely with their care teams. Advancing the interests of family-centric socially-integrated care, Richelle deMayo, MD, CM, worked with Karen Rubin, MD, Katie Raboin, RN, and Allison Matthews-Wilson, LCSW, to design and develop novel EHR-embedded tools to address pediatric social drivers of health. Their resulting “Beyond Medical Factors” program, presented

to the Connecticut Public Health Association, has been implemented in several ambulatory clinics and will be expanded to inpatient settings this coming year. Dr. deMayo remains actively involved in the American Medical Informatics Association’s DEI subcommittee and the American Telemedicine Association’s Health Disparities Advisory, the latter of which published its third white paper this year on virtual health strategies to improve health equity.

In an era of abundant, but often insufficiently actionable, data, Jane Im, MD, continued her advocacy work as a member of the clinical advisory board to the state Health Information Exchange. Her championing of interoperability and data mapping included implementation of CONNIE’s “InContext” integrated point-of-care application to improve meaningful availability of a pediatric patient’s external data.

The Division also made progress leveraging its expertise in health information technology systems to support their fellow health care professionals. Sustaining its well-established individual peer-to-peer thrive program, division members also embarked upon several new initiatives to minimize clinician technostress and maximize satisfaction. All members of the division worked on revisions to documentation templates, order placement preference lists, and messaging configurations to improve efficiency for the largest pediatric clinical specialties. Additionally, Dr. Im directed a “Top 20 enhancements” effort for resident physicians and led further improvements in provider to provider handoffs. More recently, Dr. Grindle and Ms. Gigi Simko launched a historic transitioning of the Department of Pediatrics’ use of ambient clinical documentation from current state to a generative-AI-enabled real-time model.

Multiple members of the Division have been and continue to be involved in strategic planning for expanded pediatrics use of large datasets and advanced analytics methodologies such as large language models, AI/ML and custom cognitive computing. This year, Drs. deMayo and Heggland succeeding in creating initial data pipelines to support natural language processing of non-discrete data. They look forward to elaborating and expanding these efforts next year.

The division is delighted to celebrate the leadership accomplishments of several members in 2023. Dr. deMayo was elected to the national Epic Cosmos Governing Council and joined the University of Connecticut’s Center for Population Health. Dr. Williams was named an inaugural William Popik Quality and Safety Fellow. Dr. Im was appointed to serve on the state medical association’s Health Information Exchange Advisory Committee. Dr. Grindle was tapped to lead the PROSPER (Pediatric Record Optimization for Sufficiency, Productivity, Efficiency and Revenue) initiative. Dr. Heggland assumed directorship of the Connecticut Children’s Intelligent Decision-making and Effective Analytics (IDEA) Core. The Division’s newest members, Kimberly Roche, APRN, and Matt Light, PA, accepted the charge to grow pediatric wellness

informatics through the Well-being and Efficiency Learning Laboratory (WELL) and the Provider Configuration Collaboratory, increasing harmonization of Biomedical Informatics and faculty development office efforts to improve clinician experience.

STAFF

Richelle deMayo, MD, CM, Division Head

Robert Aseltine, PhD

Christopher Grindle, MD

Andrew Heggland, MD

Jill Herring, APRN

Jane Im, MD

Matt Light, PA

Jessica Williams, MD

Kimberly Roche, APRN

CARDIOLOGY

The Division of Pediatric Cardiology is dedicated to enhancing the cardiovascular well-being of newborns, children, and adolescents, with a commitment to guiding them seamlessly into healthy adulthoods. Our mission is characterized by an unwavering dedication to discovery, collaboration, integrity, and the pursuit of excellence in every facet of our work.

EXPANSION

The Cardiology Division delivers high-quality care within the community, catering to families across the region. Our expansion efforts this year have focused on satellite clinics, with three cardiologists offering their services off the main campus. We’ve also dedicated resources to critical care management for cardiac patients, established a trans-catheter heart valve program, and expanded electrophysiology services. Notably, we’ve developed a center for autonomic dysfunction in the young.

As we approach the end of the calendar year, we are thrilled to announce the recruitment of two well trained cardiac intensivists, Monika Gupta, MD, and Shalin Parekh, MD, along with the addition of Irfan Warsy, MD, CEPS, a highly experienced electrophysiologist specializing in autonomic dysfunction. Dr. Warsy now serves as the Director of the Electrophysiology Laboratory and Arrhythmia Service.

In Connecticut, at our Danbury and Westport locations, we have significantly expanded both outpatient cardiology services and fetal cardiology services. These enhancements reflect our commitment to providing comprehensive and accessible cardiovascular care.

INTERVENTIONAL CARDIOLOGY AND ELECTROPHYSIOLOGY: PROCEDURAL INNOVATIONS

Cesar Igor Mesia, MD, a seasoned veteran with over two decades of experience in interventional techniques for both acquired and congenital heart diseases, currently serves as the Director of Interventional Cardiology. Alongside esteemed interventional cardiologists, Caitlin

Heyden, MD, and Dr. Mesia, a comprehensive array of interventional procedures are conducted within the newly upgraded Hybrid Catheterization/EP Operating Room at Connecticut Children’s. Their commitment extends to providing round-the-clock coverage for emergency interventional cardiology procedures.

The Hybrid Catheterization/EP Operating Room, inaugurated on October 26, 2022, represents a significant milestone. Equipped with advanced capabilities such as low-dose radiation, rotational angiography, and 3D reconstruction, it has facilitated groundbreaking procedures previously performed in only a handful of institutions globally. These include transcatheter pulmonary valve implantation in native right ventricular outflow tracts using the Alterra Adaptive Prestent (Edwards Lifesciences), transcatheter closure of a sinus venosus interatrial communication, and transcatheter closure of perimembranous ventricular septal defects.

In 2023, our division has experienced substantial growth, nearly doubling the number of procedures compared to the previous five years. Our commitment to excellence is evident in the successful establishment of two pioneering programs: the “Premature Transcatheter PDA Closure Program,” which achieved successful procedures in ten very low birth weight infants, and the “Edwards Lifesciences Sapien Valve Transcatheter Pulmonary Valve Program,” with successful procedures in eight complex adult patients.

Dr. Warsy joined our division in March 2023 as the lead electrophysiologist, bringing almost a decade of experience in pediatric and congenital electrophysiology. Both Dr. Warsy and Shailendra Upadhyay, MD, CEPS, are certified in clinical electrophysiology by the International Board of Heart Rhythm Examiners. Our electrophysiology laboratory is at the forefront of non-fluoroscopic catheter ablation for supraventricular tachycardia in children, making Connecticut Children’s the sole facility in the state routinely performing this procedure without X-ray use. Notably, our fluoroscopy time for catheter ablation of arrhythmias is significantly lower than the national average.

The electrophysiology service has seen substantial growth in case volumes and complexity (~50% increase). Expert care is provided for the management of arrhythmia in patients with congenital heart disease, transcending age barriers. Connecticut Children’s boasts a dedicated pediatric pacemaker clinic run by a certified pediatric electrophysiologist and a pacemaker nurse. With the hybrid lab, we seamlessly integrate mixed electrophysiology and interventional cardiology procedures for patients with complex congenital heart diseases.

Our catheterization and electrophysiology laboratory proudly participates as a voluntary member of the American College of Cardiology’s Improving Pediatric and Adult Congenital Treatment (IMPACT) Registry™. Consistently achieving the “green” mark for betterthan-average outcomes in 2023, we also actively contribute to the Reducing Radiation Quality Care Initiative™, resulting in immediate drastic reductions in radiation exposure. Dr. Warsy has spearheaded a multi-disciplinary program catering to patients with Postural Orthostatic Tachycardia Syndrome (POTS) and dysautonomia, further solidifying our commitment to comprehensive and innovative patient care.

ADULT CONGENITAL HEART DISEASE PROGRAM

Connecticut Children’s is unwaveringly committed to delivering sophisticated and comprehensive care to adults grappling with congenital heart disease (ACHD). In a milestone achievement, our CT Adult Congenital Heart Disease Program (CTACH) earned the distinction of becoming the inaugural ACHD program in Connecticut to receive accreditation from the esteemed Adult Congenital Heart Association. This exclusive status places us among a select group, with only 51 accredited programs nationwide.

Guided by the adept leadership of Dr. Upadhyay, Chief of the Division of Cardiology, Felice Heller, MD, Director, and Anudeep Dodeja, MD, Co-Director, the CTACH program has consistently expanded its horizons, showcasing remarkable productivity. Our distinguished ACHD team also features Whitney Fairchild, APRN,

along with two dedicated nurses, Felicia Tam, RN, and Jamie Bopp, RN. Significantly, all three of our ACHD physicians boast board certification from the American Board of Internal Medicine in Adult Congenital Heart Disease, reflecting their unparalleled expertise in the field.

Over the preceding year, our outpatient specialty care center has extended its care to approximately 1,100 adults grappling with congenital heart disease. Concurrently, we have actively overseen the management of approximately 100 inpatients at both Hartford Hospital and Connecticut Children’s, providing round-the-clock call coverage for these individuals. Our specialized proficiency encompasses the intricate management of conditions as complex as heart failure, arrhythmias, and postoperative care. Noteworthy is the fact that adult congenital patients constituted a substantial 42% of the total cardiac catheterization volume, encompassing avant-garde procedures like the new-generation transcatheter pulmonary valve replacement. Additionally, ACHD patients accounted for 14% of electrophysiology procedures and 13% of all cardiac surgeries performed at Connecticut Children’s in the past year. This unwavering commitment to diagnostic excellence is further evident in the administration of 115 stress tests in ACHD patients, constituting 25% of the total stress tests conducted, along with a significant number of cardiac MRI procedures.

Our collaborative ethos extends to a profound partnership with colleagues from Maternal Fetal Medicine at Hartford Hospital. This strategic collaboration ensures the provision of comprehensive care for pregnant ACHD patients, a uniquely challenging subset that our dedicated team is wellequipped to address. Recognizing the significance of holistic care, we extend behavioral health services to our ACHD population. Michael Reiss, PsyD, serves as a dedicated ACHD psychologist, contributing significantly to the holistic well-being of our patients.

NON-INVASIVE IMAGING: PEDIATRIC & ADULT

The Echocardiography Laboratory at Connecticut Children’s has continued its trajectory of expansion and enhancement in services, quality, and education throughout 2023. In the fiscal year, a total of 7,927 transthoracic, transesophageal, and fetal echocardiograms were conducted, averaging an impressive 669 studies per month. Notably, the echo lab extended its services by introducing contrast echocardiography for pediatric and adult congenital patients. This newly introduced procedure involves the administration of microspheres through an IV, filling the heart for 3-5 minutes, thus optimizing image quality. This exceptional tool proves invaluable in cases with challenging acoustic windows, furnishing cardiologists with more accurate qualitative and quantitative assessments of cardiac function to inform critical decisions in patient care.

The additions of Dr. Warsy and Dr. Parekh to our echo lab physician team mark significant milestones in 2023. Our sonographer team, unparalleled in its energy and enthusiasm, continues to undertake the challenging yet rewarding work of imaging patients with suspected or confirmed congenital and acquired heart disease. Under the capable leadership of Ms. Hadley Santos, promoted to the position of Echocardiography Lab Manager, our group of sonographers consistently delivers excellence. Mr. Chris Savas, instrumental in creating the monthly Connecticut Children’s Newsletter, brings attention to intriguing cases and facilitates ongoing learning. The team has also expanded with the addition of Ms. Jordyn McStay. Ms. Leeza Swierzewski, now at the Fetal Care Center, maintains her support for the fetal cardiology team. Noteworthy is the training and certification of Olivia Boucher in fetal echocardiography, contributing to the support of the Fetal Cardiology program.

Remaining at the forefront of technological advances, our lab expanded its echo machine inventory with the acquisition of GE E95 and Philips Epiq machines. Subsequent upgrades have significantly enhanced image quality and acquisition. The reporting system, Intellispace, underwent a transformation, leading to more efficient reporting of study results.

The Connecticut Children’s imaging team, deeply dedicated to our mission and values, consistently employs innovative ideas to elevate the lab and enhance patient care. Certified by the Intersocietal Accreditation Commission, our echocardiography team maintains an unwavering commitment to delivering the highest quality echocardiograms. Through efficient and accurate interpretation, we continue to serve infants, children, and adults afflicted with congenital heart disease and acquired cardiac illnesses within our community.

NON-INVASIVE IMAGING: FETAL

Under the directorship of Alicia Wang, MD, our Fetal Cardiology Program has undergone sustained growth, extending its reach to serve our youngest cardiology patients throughout Connecticut and beyond, with an impressive volume exceeding 500 visits annually. Demonstrating a commitment to diagnostic precision, we proudly maintain an accuracy rate of 98% for fetal cardiac diagnoses, complemented by a 99% appropriateness in developing delivery plans based on postnatal outcomes. Our unwavering mission is to uphold the highest outcomes for our cardiac families.

This year, our focus on quality improvement centers around augmenting social supports for families, aiming to alleviate parental stress during pregnancy and mitigate the adverse effects of newborn hospitalization. At the core of our efforts is a stellar team of fetal cardiologists, including Dr. Wang, Brooke Davey, MD, James Enos, MD, and Raymond Lorenzoni, MD. This accomplished group is complemented by a cadre of certified fetal sonographers: Ms. Kristen Pruner, Ms. Olivia Boucher, Ms. Danielle DeMatteo, Ms. Melanie Bova, and Ms. Bella Levovitz. Our dedicated fetal nurse, Ms. Lora Rizy, RN, and administrative coordinator, Ms. Micaela Webster, complete our robust support team.

In fostering collaborative care, we maintain close partnerships with regional maternal-fetal medicine and obstetrics practices, collaborating seamlessly with neonatologists, the palliative care team, and cardiothoracic surgeons. Our support extends to the Fetal Care Center, where we actively contribute to the management of various high-risk non-cardiac

fetal conditions. We offer our services across multiple locations, including our main campus in Hartford, along with facilities in Farmington, Danbury, and Westport. As part of our commitment to education, we host monthly conferences for regional maternal-fetal medicine specialists, solidifying our role as a primary site for teaching fetal echocardiography for the maternal-fetal medicine fellowship at the University of Connecticut. Our dedication to excellence resonates through every facet of our program, ensuring unparalleled care and support for families navigating the complexities of fetal cardiac conditions.

NON-INVASIVE IMAGING: CARDIAC MRI

Presently, our Cardiovascular Magnetic Resonance (CMR) program employs a 3.0 Tesla Magnet situated at Connecticut Children’s and a 1.5 Tesla Magnet located at Hartford Hospital. Within the division, we are fortunate to have three seasoned cardiac MRI experts: Olga Salazar, MD, and Drs. Lorenzoni and Dodeja. Functioning as a referral program, we cater to pediatric and adult cases of congenital and non-ischemic cardiomyopathies, drawing referrals from across the state. Our specialized cardiac MRI team delivers highquality, noninvasive imaging for infants and children grappling with congenital and acquired heart disease, as well as pediatric and adult patients dealing with non-ischemic cardiomyopathy, genetic aortopathy, and transfusion-dependent disorders such as thalassemia and sickle cell disease.

Integral to our adult congenital heart disease center, our MRI program aligns seamlessly with AHA/ACC recommendations, necessitating CMR studies for these patients once every three years. In the past two consecutive years, we have seen over 1,100 patients over the age of 18 years at Connecticut Children’s. Moreover, the MRI program plays a pivotal role in supporting our Cardio-oncology program, facilitating imaging for an average of 50-60 patients annually. In the preceding fiscal year alone, we successfully completed 317 CMR studies.

Complementing our clinical endeavors, we have developed an encompassing training curriculum in CMR

imaging tailored for MR technologists. This intensive six-month program covers cardiovascular physiology, pathophysiology of congenital and non-congenital heart disease, MR physics applied to cardiovascular CMR applications, and post-processing. Annually, 1-2 MR technologists undergo this specialized training.

Dr. Lorenzoni has been actively engaged with “Cardioscape.” In 2021, after crafting and deploying a cardiology curriculum utilizing virtual reality, Dr. Lorenzoni collaborated with industry partners to customize software for 3D/4D visualization of congenital heart disease. This collaborative effort resulted in Cardioscape (www.cardio-scape.com), a multimedia solution at the intersection of industry and academia. This platform utilizes existing 3D crosssectional imaging, echocardiography, and pathology specimens to enhance comprehension of complex cardiac anatomy, pre-surgical planning, and medical education. The progress of this innovative initiative has been presented at both national and international meetings.

THE CENTER FOR CARDIO-ONCOLOGY HEALTH AND INNOVATION FOR CANCER SURVIVORS

The inception of the Cardio-Oncology program at Connecticut Children’s marked the beginning of a transformative journey, evolving into the distinguished Center for Cardio-Oncology Health and Innovation for Cancer Survivors. This center stands as a testament to our commitment to advancing health outcomes for every child grappling with the complexities of cardiotoxicity. It represents a dynamic and cohesive multidisciplinary collaboration, bringing together a cadre of dedicated clinicians and researchers united in the pursuit of enhancing the well-being of cancer survivors.

The Center for Cardio-Oncology Health and Innovation lead by Dr. Toro-Salazar, embodies a vision of excellence, serving as a hub where the fusion of expertise from various disciplines converges. It is not merely a program but a testament to our unwavering commitment to the holistic care of children diagnosed with cardiotoxicity. Within this innovative center, clinicians, cardiac imaging experts and researchers

work seamlessly together, creating an environment where collective knowledge and skills contribute synergistically to the advancement of health outcomes.

CARDIOMYOPATHY & HEART FAILURE PROGRAM

Under the directorship of Dr. Tsirka, we initiated the Cardiomyopathy and Heart Failure Program to provide comprehensive expert care to patients with all forms of cardiomyopathy, with an emphasis on genetic cardiomyopathies. The program incorporates multidisciplinary collaboration with state-of-the-art cardiac imaging, risk assessment, genetic counseling, and treatment. Our aim is to expand and become a center of excellence and regional referral center.

INPATIENT CARDIOLOGY

Under the directorship of Alex Golden, MD, MMM, the Inpatient Cardiology Program, supported by Katie Kellerman, PA-C, Jill Sullivan, PA-C, and Amanda Walker Allegra, APRN, offers comprehensive care for both pediatric and adult patients grappling with congenital and acquired heart diseases during their hospital admissions. This dedicated team extends its services to regular nursing floors and ICUs, collaborating seamlessly with cardiothoracic surgeons, critical care physicians, neonatologists, and other specialists. In addition to managing patients on the Cardiology and Cardiothoracic Surgery services, it provides consultation services to various departments, including medicalsurgical floor teams, subspecialty services, NICU, PICU, ED, and the Hartford Hospital Well Baby Nursery.

Over the past year, the inpatient service has witnessed a substantial increase in its annual census and the number of consultations provided, underscoring the growing demand for its expertise. A notable enhancement has been the implementation of a 24-hour telemetry service, featuring continuous coverage by a dedicated team of telemetry technicians. This specialized service focuses on monitoring patients with high arrhythmia risks on the Med-Surg floor, thereby enhancing the safety of vulnerable patients and optimizing ICU bed utilization for those with more critical care needs.

The inpatient team operates with meticulous attention to standardization of care, ensuring smooth transitions from the ICU to regular nursing floor settings and from inpatient to outpatient settings. Collaboratively, the team has developed standardized pathways for postoperative care in cardio thoracic surgery, as well as for the diagnosis and treatment of common conditions such as Kawasaki disease and the Covid-related multisystem inflammatory syndrome in children (MIS-C).

In addition to its clinical duties, the inpatient team actively contributes to the educational mission, providing support and teaching for the Cardiology Fellowship Program, the Connecticut Children’s residency house staff, and medical students from the University of Connecticut. This holistic approach reflects the team’s commitment to not only delivering excellent patient care but also fostering the growth and development of future medical professionals.

CARDIO-PULMONARY STRESS TESTING

We have witnessed remarkable growth in our cardiac and cardio-pulmonary stress test program, conducting over 300 annual stress tests—a significant increase from the previous range of 200-250 in preceding years. This program plays a pivotal role in supporting not only the Adult Congenital Heart Disease (ACHD) and cardio-oncology programs but also the broader domain of general cardiology.

To address the escalating demand for our services, we strategically welcomed Ms. Bree Ostrowsky, an accomplished exercise physiologist, to our team. This expansion reflects our commitment to meeting the evolving needs of our patients and ensuring the continued excellence of our cardiac care programs.

NON-INVASIVE RHYTHM MONITORING

We conduct comprehensive heart rhythm monitoring utilizing both non-invasive modalities such as Holter, Mobile Telemetry, and Event monitors, as well as invasive devices like Implantable Loop Recorders (ILR). Notably, we oversee one of the most extensive cohorts of pediatric patients with ILR in the New England

region. These sophisticated tools empower us with the capability to remotely monitor and effectively manage heart rhythm disorders, exemplifying our commitment to cutting-edge and patient-centric cardiac care.

OUTREACH UPDATES

The Division of Cardiology remains at the forefront of advancing Connecticut Children’s mission to deliver exceptional care within the proximity of families throughout the region. This achievement is underpinned by a multifaceted outreach program encompassing regional clinical program development, medical education, quality improvement, and innovative community engagement. Spearheaded by Dr. Enos and supported by the entire division, our regional expansion efforts have yielded notable outcomes.

Noteworthy is the increased referral volume from secondary service areas, including New Haven, Middlesex, and New London counties. The opening of the Westport Specialty Care Center has also contributed to heightened referrals from southern Fairfield County. Furthermore, our services extend beyond state borders, serving patients from eastern New York and Massachusetts through South Hadley, MA.

In the realm of innovative outreach, our endeavors encompass Continuing Medical Education (CME) courses and presentations across the state, alongside digital initiatives involving the creation of short videos for social media. Collaborative partnerships with influential community groups, such as Westport Moms, have been forged to disseminate timely health information pertinent to families in the region.

This year’s recruitment efforts to support regional expansion welcomed Dr. Warsy, whose significant regional responsibilities are centered in Westport. Dr. Warsy brings expertise in dysautonomia syndromes and has swiftly made strides in establishing a multidisciplinary dysautonomia clinic in our Westport Specialty Care Center.

Quality initiatives have been focused on enhancing access to care and streamlining Holter monitoring

processes, reflecting our commitment to delivering efficient and patient-centric services. Through these concerted efforts, the Cardiology Division has solidified its position as a go-to resource for referring physicians and families alike, thereby augmenting access to our healthcare system and driving clinical volumes across the division.

EDUCATION

Our division is fervently committed to the education and training of future medical professionals. Under the visionary leadership of Dr. Upadhyay, who recently transitioned the directorship to Dr. Golden, our pediatric cardiology fellowship program, newly accredited by ACGME, is flourishing. James Wiley, DO, our inaugural fellow, is currently in his second year.

The Adult Congenital Heart Disease (ACHD) team plays a crucial role in training adult cardiology fellows from Hartford Hospital, John Dempsey Hospital, and Danbury Hospital. Dr. Heller enhances this education through her esteemed monthly fellow’s lecture series on congenital heart disease and her contributions to the first-year medical student’s core curriculum. Whitney Fairchild, APRN, extends our educational reach by instructing Quinnipiac University meedical students in their cardiology anatomy lab using preserved congenital heart specimens.

Dr. Dodeja showcased her expertise as an invited speaker at the 8th World Congress of Pediatric Cardiology and Cardiac Surgery, presenting on “Managing Obesity in ACHD” and “Best Techniques for Assessing Systolic Function of The Subaortic RV.”

Dr. Dodeja gave two excellent grand rounds presentations at Hartford Hospital on Congenital Heart Disease for the General Cardiologist and at West Virginia University, Morgantown, WV on Adult Congenital Heart Disease for the Pediatric Cardiologist. Dr. Upadhyay presented a national webinar on Ebstein Anomaly for the Adult Congenital Heart Association.

Under the leadership of Dr. Dodeja, our division hosted an international virtual conference on congenital

coronary anomalies which was attended by physicians from 25 countries.

Dr. Wang provides specialized training in fetal cardiology for maternal-fetal medicine fellows at the University of Connecticut, and we offer subspecialty training in pediatric cardiology for pediatric residents.

The School of Pediatric Cardiac Ultrasound, housed within the Hoffman Heart and Vascular Institute of Connecticut, is now in its ninth year. Recognized by the Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT) and the Commission of Accreditation of Allied Health Education Programs (CAAHEP), it remains a distinguished training ground. Connecticut Children’s Echocardiography Laboratory serves as the training site for didactic and handson instruction in pediatric ultrasound, hosting one to two sonographers annually. Our Echocardiography Laboratory and Fetal Cardiology programs actively contribute to the training of sonographers and pediatric cardiology fellows in congenital and fetal echocardiography, further solidifying our commitment to advancing medical education.

PROFESSIONAL RECOGNITION

Dr. Dodeja has been appointed to several distinguished National Committees, including the American College of Cardiology (ACC), The Alliance for Adult Research in Congenital Cardiology (AARCC), Society of Cardiovascular Computed Tomography (SCCT), and the American Heart Association (AHA). Notably, Dr. Dodeja serves as the abstract reviewer for the American College of Cardiology Scientific Sessions and achieved Level 3 SCMR certification from the Society of Cardiac MRI this year.

Dr. Heller has an international reputation as an expert in LMNA cardiomyopathy, attracting patients from beyond the borders of Connecticut seeking her specialized care.

Seth Lapuk, MD, FAAP, continues his active involvement in the Connecticut chapter of the American Heart Association and the American College of Cardiology board of directors. His significant contributions were

recently acknowledged with the prestigious “Leadership Legacy Award” in Connecticut by the AHA.

Dr. Upadhyay serves as a valued member of the medical advisory board for Adult Congenital Heart Association.

Dr. Lorenzoni, representing Connecticut at the American Medical Association, also holds the position of Membership Chair for the Connecticut State Medical Society (CSMS). His substantial contributions to the Society for Pediatric Echocardiography and impactful work on young physician retention were recognized by the CT legislature’s Healthcare Workforce Task Force, earning him the inaugural Young Physician Advocacy award from CSMS.

RESEARCH

This year, research scientists in the Division of Cardiology successfully submitted and published several papers in internationally recognized, peerreviewed journals. Our research group continues to have a multitude of active projects that include the following areas of exploration:

Health Disparities in Congenital Heart Disease

Dr. Davey leads the New England Congenital Cardiology Association (NECCA) Health Disparities Working Group, comprising Connecticut Children’s team members Dr. Toro-Salazar and Dr. Wang. With champions in ten pediatric cardiology programs across six states, the group investigates congenital heart disease (CHD) care disparities in New England, striving to identify targeted strategies for intervention and equitable care improvement. Recognized with a New England Congenital Cardiology Research Foundation Award for the ‘Congenital Cardiology Outpatient Demographics in the New England Region’ project, Dr. Davey presented it at the 8th World Congress of Pediatric Cardiology and Cardiac Surgery in Washington, D.C., and later at the Connecticut Children’s Research Institute Symposium in Hartford, CT. Dr. Davey showcased the “NECCA Health Disparities Working Group Update” and the “NECCRF Update” at the 2023 NECCA Annual Fall Meeting in Rockport, ME, emphasizing the team’s collaborative efforts. The group is anticipating future projects,

including exploring cardiac neurodevelopmental follow-up in New England, creating a regional registry, and fostering collaboration on research and quality improvement, aligning with Connecticut Children’s commitment to diversity, equity, and inclusion.

Fontan Working Group

The Connecticut Children’s team actively engages in the NECCA Fontan Working Group. Drs. Davey and ToroSalazar previously published findings on surveillance and screening practices for Fontan patients in Congenital Heart Disease. Their prospective, multicenter study, “Clinical Characteristics and Associations of the ‘Good Fontan’ Patient,” was completed and published in JACC this year. The study aimed to identify clinical characteristics of Fontan patients with low risk for mortality or significant morbidity over a 12-month follow-up. The results indicate that predicting major adverse events in Fontan individuals remains challenging, with only marginal success. Notably, factors like diuretic/blocker use and systolic dysfunction/AV valve regurgitation overlap between predicting the “atrisk” group and actual major adverse events, warranting close attention in follow-up and further study.

Obesity and Preventative Cardiology

Dr. Davey collaborates with Christine Finck, MD, and the Pediatric Obesity Center for Treatment, Research, and Education at Connecticut Children’s. A finalist for the Connecticut Children’s Connection Grant Award, she is working on the future project “Impact of Bariatric Surgery in Adolescents with Obesity on Cardiac and Inflammatory-Induced Health Risks.” Additionally, she is collaborating with medical student Stephanie Akosa on a literature review titled “Cardiac Dysregulation and Dysfunction in Children and Adolescents with Obesity: A Systematic Review”.

Determinants of Umbilical Line Failure in Neonates with Congenital Heart Disease

Dr. Davey and Dr. Golden, along with resident Matthew Cummins, MD, and medical student Jake Defrancesco, collaborated on a project evaluating the failure rate of bedside umbilical vessel cannulation in neonates with congenital heart disease. The project aims to

characterize risk factors, associations with procedural failure, and compare failure rates and complications between neonates with heart disease and those without. Data collection and entry are complete, and the team is currently in the analysis phase.

Electrophysiology and Arrhythmia Research

Our electrophysiology laboratory performs predominant catheter ablation in pediatric and adult patients with congenital heart disease. Completed research projects include, “Zero Fluoroscopy” Radiofrequency Catheter Ablation of AV Node Re-entry Tachycardia in Children and patients with CHD’. The projects were presented in a poster format at the 8th World Congress of Cardiology and Cardiac Surgery this year.

Adult Congenital Heart Disease (ACHD) Research

Our Adult Congenital Heart Disease (ACHD) program has consistently contributed to cutting-edge research and made impactful presentations at national conferences. Dr. Dodeja’s research on Novel Temporal Strain Parameters in Congenital Heart Disease Patients earned an oral presentation slot at the Society of Cardiovascular MRI in January 2023. Furthermore, Dr. Dodeja and Dr. Upadhyay jointly presented an abstract at the American College of Cardiology annual meeting in March 2023, delving into “Raghib Syndrome, An Unsuspecting Culprit of Recurrent Strokes.” The ACHD team, comprising Dr. Dodeja, Dr. Upadhyay, and Whitney Fairchild, APRN, showcased their expertise with 10 abstracts at The World Congress of Pediatric and Cardiology and Cardiac Surgery, covering topics ranging from cardiac MRI to occupational trajectories in ACHD patients.

Engaged in a research project on Occupational and Educational Trajectories in ACHD, our team secured funding through the med-peds seed grant, collaborating with Dr. William Shaw of UConn occupational health. Achieving nearly 50% enrollment of anticipated patients, this project explores crucial aspects of ACHD patient life journeys.

Additionally, we are actively contributing to the Fontan Outcomes Registry Using CMR Examination (FORCE)

Multicenter Registry, with Dr. Dodeja serving as the site PI. This registry, supported by Additional Ventures and Evan’s Heart Fund, aims to enhance patient outcomes by identifying predictive clinical and advanced imaging markers for poor outcomes in Fontan patients.

Spearheaded by Dr. Dodeja, our ACHD team is undertaking a series of projects to evaluate metabolic risk factors in ACHD patients. High prevalence of hypertension, obesity, and dyslipidemia in Fontan patients underscores the critical need for screening and intervention in this high-risk population. In collaboration with Nephrology, we are also evaluating the utility of ambulatory blood pressure monitoring in the ACHD population. Both projects are ongoing, with the goal of collecting preliminary data for potential multicenter studies in the future.

PUBLICATIONS

Fusco F, Krasuki R, Upadhyay S, Broberg CS, Sarubbi B, et.al. COVID-19–Related Thrombotic andBleeding Events in Adults WithCongenital Heart Disease. Journal of American College of Cardiology Advances, 20203 Dec, 2 (10) 1000701.

Dodeja AK, Schreier M, Granger M, Mitchell D, Chumita R, Sisk T, Daniels CJ, Rajpal S. Patient Experience with Telemedicine in Adults with Congenital Heart Disease. Telemed J E Health. 2023 Jan 18. doi: 10.1089/ tmj.2022.0279. Epub ahead of print. PMID: 36656168. Dodeja AK, Daniels Z, Mah ML, Shay V, Bai S, Hor K, Kertesz N, Daniels C, Kamp A. Ventricular Arrhythmic Events After Transcatheter Pulmonary Valve Replacement in Adults with Repaired Tetralogy of Fallot. Pediatr Cardiol. 2023 Feb 10. doi: 10.1007/s00246-02303120-1. Epub ahead of print. PMID: 36763139.

Ratnayaka K, Wei ZA, Ryan JR, Heyden CM, Narayan HK, Slesnick TC, Lederman RJ, Moore JW, Yoganathan AP, El-Said HG. Transcatheter Hepatic Conduit-Azygous Vein Connection Reduces Pulmonary Arteriovenous Malformations in a Cyanotic Fontan Patient. .JACC Case Rep. 2023 Mar 15;10:101760. doi: 10.1016/j. jaccas.2023.101760. eCollection 2023 Mar 15.PMID: 36974056

Elder RW, Valente AM, Davey B, Wu F, Drucker N, Lombardi K, Lee S, McCollum S, Shabanova V, St. Clair N, Azcue N, Toro-Salazar OH, and Rathod RH. How good are cardiologists at predicting major adverse events in Fontan patients? JACC: Adv. 2024 Jan; 3:100736

STAFF

Shailendra Upadhyay, MD, CEPS, FHRS, Division Head, Co-Director, Connecticut Children’s

Leon Chameides, MD, Emeritus

Amanda Allegra, APRN

Brooke Davey, MD

Anudeep Dodeja, MD

James Enos, MD

Alex Golden, MD, MMM, FACC

Monika Gupta, MD

Whitney Fairchild, APRN

Felice Heller, MD

Caitlin Heyden, DO

Seth Lapuk, MD, FAAP, FACC

Raymond Lorenzoni, MD

Stewart Mackie, MD

Cesar Igor Mesia, MD

Shalin Parekh, MD

Olga Toro-Salazar, MD

Anna Tsirka, MD

Alicia Wang, MD

Irfan Warsy, MD, CEPS

Fellow

James Wiley, DO, PGY-5

CHILD & ADOLESCENT PSYCHIATRY

The Division of Child & Adolescent Psychiatry continues to be a highly active, vibrant, interdisciplinary and collaborative resource within the Department of Pediatrics at Connecticut Children’s. The year 2023, marks the first year that the Division of Child & Adolescent Psychiatry is being staffed primarily by psychiatrists and psychiatric nurse practitioners employed by Connecticut Children’s. Our work has focused on many areas including meeting the ongoing clinical demand for mental health crisis, assessment and treatment services; collaboration with other divisions within Connecticut Children’s; expansion and strengthening of community relationships; and the development of the first pediatric medical-psychiatric unit in Connecticut.

Over the past year, we have continued to see steady clinical volumes for all services in which we play a role. The Emergency Department (Zone C) sees an average daily census in the low-to-mid-20s, and provides behavioral health assessments, stabilization, disposition planning and care coordination for youth in crisis. Our Behavioral Health Transitions Clinic (BHTC) offers immediate access to mental health services for patients in need of bridging care from our emergency department, medical-surgical floors and our partnering inpatient psychiatric units to allow for flow of patients through all levels of mental health care.

The Child & Adolescent Psychiatry division’s services include the Consultation & Liaison (C&L) service, Emergency Psychiatric Services within the Emergency Department, and the Ambulatory Psychiatry Service (APS), the latter of which, opened in December 2023. The Consultation & Liaison service provides inpatient evaluations and support for any patient admitted to Connecticut Children’s with psychiatric concerns or comorbid psychiatric concerns related to their presenting physical medical diagnosis. This is also the primary teaching site for psychiatry trainees at

Connecticut Children’s. We train child & adolescent psychiatry fellows and general psychiatry residents from the University of Connecticut School of Medicine (UCONN) and from the Institute of Living (IOL); as well as residents in the University of Connecticut Pediatric Residency Program. Additionally, we teach medical students from the University of Connecticut School of Medicine and the Frank H. Netter MD School of Medicine at Quinnipiac University. The C&L service also serves as a training site for psychology interns and fellows. Additionally, the Emergency Department/ Zone C provides training in emergency psychiatry/crisis management for child & adolescent psychiatry fellows from the IOL and from UConn School of Medicine.

Our emergency psychiatry service is a multidisciplinary team providing mental health assessments, triage and disposition services within the Connecticut Children’s Emergency Department. This service is in partnership with the Division of Emergency Medicine and Center for Care Coordination and Social Work. The Ambulatory Psychiatry Service shares space with the BHTC, and primarily supports medication management for patients seen through the BHTC, through the Medical Coping Clinic (MCC) or through the Medical and Mental Wellness Program (MMWP). In the coming year, we anticipate expansion of the Ambulatory Psychiatry Service (APS) to support other CCSG divisions, as additional staffing and workflows evolve.

Our team has continued to collaborate with the Division of Pediatric Hospital Medicine to maintain and develop clinical pathways for our most complicated patients while providing effective collaborative care models based on extensive research of evidencebased treatments. This year we added a fourth mental/ behavioral-health related pathway for management of agitation. This partnership will continue to grow as we move to open a medical-psychiatric unit, - the Integrated Care Unit (IC5) - in 2024. Co-Medical Directors, Catherine Sullivan, MD, (PHM) and Cristin McDermott, MD, FAAP, (Psychiatry) will lead the multidisciplinary unit.

The IC5 will combine aspects of whole-child care, and include nursing, behavioral health milieu technicians, psychiatrists, pediatricians, psychiatric nurse practitioners, licensed clinical social workers, psychologists, child life specialists, recreational therapy, nutritionists, physical/occupational therapists, and a teacher. Designed for those children who have difficulty accessing traditional inpatient psychiatric treatment due to concurrent physical medical diagnoses, IC5 will offer intensive combined inpatient services.

Another highlight this year has been the replacement of Crisis Prevention Institute (CPI) training with the Marcus Crisis Prevention Program (MCPP); bringing with it a trauma-informed de-escalation approach to ensuring patient safety in times of crisis. MCPP is a nationally benchmarked training program providing high quality training to all team members. This crisis management program focuses on prevention, behavioral interventions, averting crises, de-escalating crises and when needed, physical management. It is designed to offer safety and flexibility in the least invasive way possible. The MCPP program is rolling out over the course of 2023-2024.

On the national level, Dr. McDermott collaborated with pediatric hospital medicine colleagues from Cincinnati Children’s Hospital to present an educational session on “High Yield Psychiatric Pearls in Hospitalized Children” at the Pediatric Hospital Medicine 2023 Annual Conference. This session was updated and submitted for presentation at the 2024 American Academy of Pediatrics Conference. In December 2023, Dr. McDermott was appointed to the state of Connecticut’s Behavioral Health Partnership Oversight Council along with Catherine Wiley, MD, the Division Head of Primary Care at Connecticut Children’s. It is important to highlight too, that our partners in Pediatric Hospital Medicine, Emergency Medicine, Nursing, Psychology and Social Work & Care Coordination have also presented locally and nationally on topics in pediatric mental health ranging from an internally developed behavioral health assessment tool – the eBHAT, to management of somatic symptoms and related disorders on inpatient medical floors. Collaboration

with local, regional and national partners to deliver educational content and to share innovative clinical and quality work will continue, and remains an important aspect in the growth of our division.

The Connecticut Children’s Division of Child & Adolescent Psychiatry continues to work closely with the University of Connecticut School of Medicine’s Department of Psychiatry, and with the Institute of Living. These joint efforts are borne out in training, education, academic, and clinical pursuits. We strive to uphold our position as collaborators, innovators and champions of pediatric mental health, with the goal of providing excellent care to Connecticut’s children.

Building a Division of Child & Adolescent Psychiatry requires recruitment of a dedicated workforce aligned with the goal of excellent patient/family-centered care. Our division currently has two staff psychiatrists and one psychiatric mental health nurse practitioner (PMHNP). To ensure our ability to provide care across the continuum of services, we are also supported by three locum tenens PMHNP. For 2024, we have hired a child & adolescent psychiatrist, Jessica Stephens, MD, to help build ambulatory psychiatry services and collaborate with the Pediatric Residency to meet the new American Board of Pediatrics requirement for mental health education. We have also hired two locum tenens child & adolescent psychiatrists and an additional locum tenens PMHNP to support the opening of the IC5. We are hopeful that recruitment efforts will continue to bring talent with a strong drive for clinical care, education and leadership to Connecticut Children’s.

MAJOR PUBLICATIONS

Sullivan C., McDermott C., et al. Connecticut Children’s Clinical Pathway: Agitation Management Pathway. August 2023.

STAFF

Cristin McDermott, MD, FAAP, FAACAP

- Division Head of Child & Adolescent Psychiatry

- Co-Medical Director of the Integrated Care unit (IC5)

- Site Director for UCONN Psychiatry/Child & Adolescent Psychiatry trainees & IOL Psychiatry/ Child & Adolescent Psychiatry trainees

Robert Stine, MD

Joseph (Kwaku) Gyasi, PMHNP

Locums Staffing:

Ogechi Ebere, PMHNP

Ayodeji Olawale, PMHNP Omalola Aragbada, PMHNP

Upcoming Staffing Highlights:

Jessica Stephens, MD (starting full-time in August 2024)

Locums Staffing: Silvia Fernandez, MD (starting February 2024)

Makeda Jones, MD (starting February 2024)

Ashley Sweeney, PMHNP (starting January 2024)

CHILD ABUSE PEDIATRICS

The Division of Child Abuse Pediatrics provides clinical evaluation services through the Suspected Child Abuse and Neglect (SCAN) program at Connecticut Children’s. Consults are provided on an inpatient and outpatient basis at the Hartford campus of Connecticut Children’s, and they include comprehensive expert medical evaluation and psychosocial assessment for children who may have experienced maltreatment. SCAN staff also provide medical services in three satellite locations at Children’s Advocacy Centers in Waterbury, Torrington, and Hartford. Program staff offer support to caregivers throughout the evaluation process. We collaborate with multidisciplinary partners in the service of the child and family, and strive to improve community response to child maltreatment through education, research, prevention, and advocacy.

Beyond clinical work, 2023 activities of division staff included the following:

• Teaching medical students, residents and fellows with didactics and block rotations.

• Teaching statewide multidisciplinary partners.

• Participation in nine regional community multidisciplinary teams: Hartford MDT, MDT 14, Central Connecticut New Britain MDT, Central Connecticut Bristol MDT, East Central MDT, North Central MDT, Tolland MDT, Torrington MDT, Waterbury MDT.

• Provision of regular expert testimony in Connecticut courts.

• Participation in statewide initiatives focused on child abuse prevention, human trafficking and domestic violence.

• Participation in quality improvement initiatives, including two active clinical pathways for suspected physical abuse and suspected sexual abuse.

• Provision of national medical peer review to other medical providers.

• Hosting a statewide ECHO telementoring program for sexual abuse medical examiners.

• Implementation of an Intimate Partner Violence Integrated Care Clinic in our Hartford location.

PUBLICATIONS

Thackeray J, Livingston N, Ragavan MI, Schaechter J, Sigel E. APP Council on Child Abuse and Neglect, Council on Injury, Violence, and Poison Prevention. Intimate Partner Violence: Role of the Pediatrician. Pediatrics. 2023;152(1):e2023062509. Doi:https://doi. org/10.1542/peds.2023-062509

Doswell A, Killough E, Zinku TP, Sheman A, Anderst J. Examining diagnostic variability among pediatric subspecialists using case examples of infant head injury. Child Abuse Negl. 2023 Oct;144: 106371. https://doi. org/10.1016/j.chiabu.2023.106371.

Doswell A, Anderst J, Tieder JS, Herman E, Hall Matt, Wilkins Victoria; Knochel ML, Kaplan R, Cohen A, DeLaroche AM, Harper B, Mittal MK, Sastri n, Prusakowski M, Puls HT. Diagnostic testing for and detection of physical abuse in infants with brief resolved unexplained events. Child Abuse Negl. 2023 Jan; 135:105952. https://doi.org/10.1016/j. chiabu.2022.105952.

STAFF

Nina Livingston, MD, Division Head

Ada Booth, MD

Angela Doswell, MD

Laura Caneira, APRN

Audrey Courtney, APRN

Heidi Schwab, APRN

Enjoli Berrios, MA

Crystal Vasquez, MA

Sara Goldstein, LCSW

Caliyah Meggett, LCSW

Wanda Vasquez, CCSG Manager

Lisa Parris, Administrative Assistant

COMMUNITY PEDIATRICS

Community Pediatrics is the largest division in the Department of Pediatrics, consisting of more than 200 providers in practices throughout Connecticut and Western Massachusetts. The academic activities of the division are centered on pediatric primary care education. Practices serve as teaching sites for the core clinical experience of medical students in ambulatory pediatrics. Many physicians also precept medical students, advanced practitioner students, and residents in continuity experiences.s

The Division of Community of Pediatrics serves a vital role in fostering the health and well-being of children and their families by focusing on wellness, safety, and behavior and development. 2023 was marked by an unusually high number of strep throat cases as we continue to navigate post pandemic medicine. In addition, Nirsevimab, a monoclonal antibody for prevention of RSV in babies 0-8 months became available to give infants to prevent RSV. This practice changing event was unfortunately stymied by a supply shortage. An RSV Vaccine also became available for pregnant mothers.

Many members of the Division of Community Pediatrics are also part of the Connecticut Children’s Care Network, a clinically integrated network that includes primary care providers and Connecticut Children’s subspecialists. This year, work continued on Value Based Contracts and 2024 will start with some upside/ downside risk contracts. The Care Network also sponsors bimonthly 2-hour “learning communities” that are highly valuable, rich in content, dynamic, interactive and well attended. Topics included asthma, obesity, eating disorders, and autism. Furthermore, the network is working on building integrated mental health into pediatric practices.

Biannual division meetings are held virtually via zoom and include introductions of new faculty, a clinical update on topics specific to primary care, a review of communication between the subspecialists and primary care providers and an opportunity to ask questions

and share challenges. A robust physician relations team works closely with practices throughout the region to help facilitate timely referrals and excellent communication between the specialists and referring providers. They also help educate practices about new providers, locations, and updates at Connecticut Children’s.

Our division emphasizes the ongoing education of its members. Our private practice pediatricians are encouraged to stay up-to-date on a broad variety of topics in pediatric medicine by attending grand rounds (or listening to the podcasts), participating in the ongoing webinar series Ask the Experts, using the CLASP guidelines on the Connecticut Children’s website and participating in “Lunch and Learns” all sponsored by Connecticut Children’s Continuing Medical Education office.

In 2024, we look forward to engaging our community members in student and resident education in a more robust way and have started a biweekly outpatient morning report with cases presented by community pediatricians to residents. In addition, we continue to place medical students and residents in community pediatric offices. 2024 will focus on Care Coordination and Integrated Behavioral Health as two key ways to both improve quality and decrease cost.

STAFF

Jennifer L. Schwab, MD, Division Head

Matthew G. Abel, MD

Robin Abramowicz, MD

Nicole T. Abramowitz, MD

Robert S. Adamenko, MD

Susan Adeife-Lee, MD

Amy D. Agoglia, MD

Eliyahu Akerman, MD

Roman Alder, MD

Anton M. Alerte, MD

Lauren F. Allison, MD

Jamie L. Alon, MD

Lisa C. Alonso, MD

Dina Amato, MD

Caroline Amin, MD

Marina Arena, MD

Rena L. Aroesty, MD

Richard J. Auerbach, MD

Maryam Azizi, MD

Leon A. Baczeski, MD

Lauren Bader, MD

Tina R. Bafumi, MD

Claire M. Bailey, MD

Kathryn A. Baker, DO

Sherry T. Banack, MD

Meredith W. Barrows, MD

Amy L. Baumer, MD

Shannon Beausoleil, MD

Kristi F. Beck, MD

Lucia Benzoni, DO

Sarah Bertram-Elbaum, MD

Thomas B. Binder, MD

Shawn Binns, MD

Elizabeth M. Bird, MD

Tamika T. Brierley, MD

Alicia A. Briggs, MD

David L. Brown, MD

Nancy B. Brown, MD

Steven J. Brown, MD

Ronald L. Buckman, MD

Olga A. Bulygina, MD

Arvin S. Bundhoo, MD

Karen P. Camera, MD

Keith P. Casey, MD

Christine M. Chaput, DO

Lauren K. Chase, MD

Christine M. Chew, PhD

Elizabeth Cipolla, MD

Carolyn A. Clark, MD

Greer A. Clarke, MD

Alberto Cohen-Abbo, MD

Bruce W. Cohen, MD

Elin R. Cohen, MD

Della M. Corcoran, MD

Cathy L. Corrow, MD

Alison S. Cowl, MD

Steven L. Craig, MD

Michael J. Curi, MD

Nancy K. Cusmano, MD

Lynn M. Czekai, MD

Jason M. Davis, MD

Christopher M. DeSanto, MD

Karen S. Dettmer, MD

Sachin Dhingra, MD

Leo J. DiStefano, MD

Andrea G. Dixon, MD

Alicia M. Dodson, MD

Robert W. Dudley, MD

Allyson N. Duffy, MD

Kari Edelson, DO

Craig R. Elliott, MD

Umit Emre, MD

Jeffrey M. Factor, MD

Frank Fanella, Jr., MD

Mina Farkhondeh, MD

William T. Flynn, MD

Bruce G. Freeman, MD

Traci A. Friedman, MD

Thomas N. Fromson, MD

Carolyn R. Ganeles, MD

Amy Garaffa, MD

Richard W. Geller, MD

Gregory S. Germain, MD

Sarah L. Germani, DO

Mark N. Gilroy, DO

Susan K. Glasser, MD

Karen Goldberg, MD

Carol N. Gorman, MD

Sophia Z. Grant, MD

Stephen S. Grevious, MD

Timothy M. Grogean, MD

David B. Gropper, MD

Jennifer B. Gruen, MD

Eva L. Grunberg, MD

Kimberly Gygi, DO

Evan R. Hack, MD

Hillary S. Hernandez-Trujillo, MD

Rachel A. Herold, MD

Caitlin Heyden, DO

Dena A. Hoberman, MD

Shannon M. Hogan, DO

Bryan R. Holland, MD

Joy E. Hong, MD

Judy C. Huang-Bulger, MD

Maria Ieni, MD

Shiji A. Isaac, MD

Saima N. Jafri, DO

Peter J. Jannuzzi, MD

Melissa L. Jones, DO

Patricia M. Joyce, MD

Brad A. Jubelirer, MD

Vasanth S. Kainkaryam, MD

Scott M. Kallor, DO

Norine T. Kanter, MD

Edward C. Kavle, MD

Jay D. Kenkare, MD

Anjum Khera, MD

Abraham J. Khorasani, MD

Kimberly J. Kim, MD

Rosemary Klenk, MD

Natalie S. Komaiszko, MD

Lauren B. Kopyt, MD

Kasia Koziol-Dube, MD

Gubbanna V. Kumar, MD

Kishore Kumar, MD

Sarojini C. Kurra, MD

Jaye T. Ladinsky, MD

Jerome E. Lahman, MD

Brian Lamoureux, MD

Christine T. Lamoureux, MD

Julius Landwirth, MD

Seth L. Lapuk, MD

John H. Lavalette, MD

Christopher C. Lawrence, MD

Susan E. Lelko, MD

Noelle M. Leong, MD

Harris B. Leopold, MD

Rebecca L. LePage, MD

Deepa P. Limaye, MD

Foong-Yi Lin, MD

Kathryn E. Litwin, MD

Jennifer R. Lombardi, APRN

Ruth A. Loomis, MD

Janice M. Lopez, MD

Matteo J. Lopreiato, MD

Jennifer Lovin, MD

Douglas MacGilpin, MD

Ana Paula Machado, MD

Christine E. Macken, MD

Aparna Madisetty, MD

Lourdes Maisonet, MD

Sajda Malik, MD

Pushpa Mani, MD

Kathleen A. Marinelli, MD

Laura M. Marks, MD

Elizabeth A. Martin, MD

Linda Mathew, MD

Yesu Kumar Matta, MD

Christopher J. McDermott, MD

Kristin D. McGregor, MD

Swathanthra K. Melekote, MD

Lauren E. Melman, MD

Lisa T. Menillo, MD

Melanie G. Mier, MD

Arpana Mohnani, MD

Alan H. Morelli, MD

David C. Muccino, MD

Jody E. Navitsky, MD

Alyssa Newman, MD

Elizabeth J. Northrop, MD

Glenda Nouman, DO

Laura S. Nowacki, MD

Cliff M. O’Callahan, MD

Frederick V. O’Connor, MD

James O’Connor, MD

Margaret M. O’Neill, MD

Bhawani S. Ojha, MD

Maureen N. Onyirimba, MD

Manuel A. Orta Cobo, MD

Susan Owen Perks, MD

Jeffrey A. Owens, MD

Todd R. Palker, MD

Hemant K. Panchal, MD

James F. Parker, MD

Robert E. Parnes, MD

Christine L. Patterson MD

Robyn E. Pemberton, MD

Jason Perkel, MD

Kenneth Perks, MD

Susan O. Perks, MD

Jenny L. Petrauskas, MD

Laura J. Pickett, MD

Tricia R. Pinto, MD

John G. Pitegoff, MD

Ross W. Porter, MD

Leah G. Post, MD

Priya Phulwani, MD

Ishra Quadri, MD

Aruna Ramanan, MD

Marc P. Ramirez, MD

Terry L. Ramos, MD

Meredith M. Renda, MD

Michael Reiss, PsyD

Lawrence S. Rifkin, MD

Tina M. Roman, MD

Rachel R. Rothschild, MD

Keith R. Ruppel, MD

Vandana Sacheti, MD

Bhavna Sacheti-Singh, MD

Kweku G. Sam, MD

Shikha Sarkar, MD

Krishanthi Satchi, MD

Rajadevi A. Satchi, MD

Julie E. Schiff, MD

Ashley E. Scholhamer, MD

J. Christopher Schuck, MD

Lester R. Schwartz, MD

Gavin Schwarz, MD

Richard A. Segool, MD

Meltem Seli, MD

John H. Senechal, MD

Rachel E. Sheiman, MD

Sarah Siegel, MD

Mary A. Simon, MD

Aaron Slaiby, DO

Marilyn P. Smith, MD

Candra Smith-Slatas, MD

Jonathan E. Sollinger, MD

Courtney L. Souza, MD

Kenneth Spiegelman, MD

Alison B. Sturm, MD

Cindy L. St. Onge, MD

Neil D. Stein, MD

Leah Sterry, DO

Kurt R. Stewart, MD

Lori M. Storch Smith, MD

Carrie S. Streim, MD

Kirin N. Suri, MD

Jessica Takores, MD

Judith E. Tapper, MD

Richard T. Tenczar, MD

Jody L. Terranova, DO

Charles Thompson, MD

Stephanie T. Tiso, MD

Robert R. Toscano, MD

John Tsalapatanis, MD

Nicholas Tzakas, MD

Richard R. Uluski, MD

Kerline A. Vassell-Klaus, MD

Juan C. Vasquez, MD

Anne Marie F. Villa, MD

Mark Vincent, MD

John H. Walker, MD

Rachna Walia, MD

Ramindra Walia, MD

Matthew S. Warren, MD

Allison H. Whitaker, MD

Felicia M. Wilion, MD

Anne Willenborg, MD

Jessica L. Williams, MD

Jennifer S. Wilner, MD

Daniel L. Winters, MD

Beth Wittenberg, MD

Janet C. Woodward, MD

Michael E. Yencho, MD

Nancy M. Yip, DO

Richard K. Young, MD

Joseph E. Yunis, MD

Robert W. Zavoski, MD

Sophia Zervas Grant, MD

Barbara Ziogas, MD

Susan M. Amster, PA-C

Jose F. Arraiano, PA-C

Jessica L. Bathel, PA-C

Sara E. Benjamin, APRN

Sherry S. Blair, APRN

Lisa L. Boule, APRN

Lori A. Bryon, PA-C

Heather Buccigross, PA-C

Jennifer B. Burns, APRN

Anna Camacho, APRN

Gretchen E. Carlin, APRN

Susan DeMelis-Turotsy, PA-C

Megan E. Drummey, APRN

Tamar Edelkind, APRN

Mark G. Elsesser, PA-C

Marnie B. Frey, APRN

Tristin E. Geist, APRN

Alison M. Gilbert, PA-C

Nikisha B. Hamal, APRN

Emma G. Hanrahan, PA-C

Michelle M. Henry, APRN

Kimberly A. Joerg, APRN

Alpha B. Journal, PA-C

Emilie Koepke Gibbs, PA-C

Nichole L. Kycia, PA-C

Joseph C. LaBell, PA-C

Laura Mandell, APRN

Ashlee T. Mattutini, APRN

Anne S. Mauk, PA-C

Meredith A. McKenna, APRN

Betsy Meyer, PA-C

Mary C. Mieczkowski, APRN

Rachel C. Mitchell, APRN

Dayna F. Nethercott, PA-C

Lynn E. Nochisaki, APRN

CRITICAL CARE

The Division of Pediatric Critical Care is dedicated to the delivery of state-of-the-art child and family centered care for critically ill and injured children.

The division’s mission is accomplished by a collaborative group of providers that champions a multidisciplinary approach to care, the incorporation of best available evidence into clinical practice, and acquisition of new knowledge through clinical research. Attention to patient safety, continuous performance improvement, and education of physicians, nurses, and other care team members is paramount.

Pediatric Intensive Care Unit (PICU) staff members have remained resilient in light of new challenges. The pediatric healthcare field faced a resurgence of common viruses leading to respiratory failure while still facing the uncertainty of COVID-19. They staffed additional beds as needed, with the goal that children in need of critical care services would have that provided at Connecticut Children’s. Despite these challenges, they successfully implemented a twoservice model of critical care and cardiac critical care, elevating the care of all children with whom we are entrusted. Throughout all this, the PICU faculty has been successful academically and professionally. Major awards and academic accomplishments among the division members include important contributions to several national societies and both internal and external collaborations.

Kenneth Banasiak, MD, serves as the assistant director of extracorporeal membrane oxygenation (ECMO) and is a key facilitator in the quality review conferences for both ECMO and cardiac critical care. He is skilled in evidence-based review and a skilled educator. Dr. Banasiak is a Pediatric Advanced Life Support instructor and oversees a continuing education curriculum on “Applied Critical Care Physiology,” which focuses primarily on the education of residents who intend to go on to careers in acute care subspecialties.

Leonard Comeau, MD, focuses on the comfort and quality of care for our patients, both in the PICU and hospital-wide. He participates in care delivered by the Sedation Service, and serves as the leader of the quality and safety oversight activities of the Sedation and Analgesia Committee. He is chair of the hospital Clinical Ethics Committee, which addresses issues related to the appropriateness and decision-making regarding health care for some of our most complicated patients. In addition, in collaboration with colleagues, he has facilitated a quarterly ethics forum to review common topics facing providers who provide critical care. Finally, along with pharmacy, has created a sedation and analgesia weaning algorithm to standardize the process and limit symptoms of abstinence. Dr. Comeau is recognized by his colleagues for his excellent debriefing skills and creating an environment of sharing and inclusiveness.

Allison Cowl, MD, is the medical director of the PICU and the medical director of the extracorporeal medicine oxygenation and continuous renal replacement programs. In these roles, she has excelled in bringing new technologies, therapeutics, and collaborations to improve and elevate the quality of care to meet national benchmarks. She continues to collaborates with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) international network, focusing on various aspects of the care of critically ill patients and is the key site director for these multi-institutional research collaboratives. Dr. Cowl serves as the site PI in a large international trial that is evaluating ventilation strategies, as well as the use of prone positioning in the treatment of patients with severe acute respiratory failure. In addition, Dr. Cowl has implemented a new care paradigm for all patients within the PICU, with an eye on ensuring the best possible functional outcomes for our patients and minimizing post-intensive care syndrome. As leader of our comprehensive care multidisciplinary program, she works with the care team to develop the expertise to recognize, minimize, and manage delirium, promote early mobilization of patients, and liberate them as early as possible from mechanical ventilation support.

Andrea Guardenier, MD, was hired in Sept 2023. She comes to us with extensive experience in Cardiac Critical Care in addition to critical care and has worked to improve cardiac and neuro critical care pathways. She was selected as one of the inaugural fellows of the Popik Family Quality and Patient Safety Fellowship Program.

Elliot Melendez, MD, is the Head for the Division of Critical Care. He has over a decade of experience in critical care quality improvement, specifically in the field of sepsis. He leads the Connecticut Children’s sepsis quality improvement program and is engaging all disciplines in improving sepsis care, including mentorship of residents. He is involved in the hospital’s overall quality improvement work and participates in event review, with the goal of improving the lives of each and every patient and family. His vision for the department is one that fosters and maintains a model of continuous improvement, which puts our patients and families in the center of all conversations in a collaborative and supportive environment. In addition, he aims to improve the well-being of his team by valuing both the clinical and nonclinical efforts that they bring to their everyday work.

Marie Nader, MD, was hired in Oct 2023 and joined us after completing her critical care fellowship at Yale–New Haven Pediatric Critical Care unit. She has an interest in Global Health and improving the delivery of care and education in resource limited settings. She has created a distance pediatric critical care nursing education and simulation curriculum for pediatric critical care nurses in Ghana and presented her work in national and international conferences over the past year. She is working on a multidisciplinary pediatric neurocritical care simulation based training curriculum in Africa. It was described in the October issue of CURRENTS, a journal for the Neurocritical Care Society. Robert Parker, DO, continues to spearhead novel medical education methods for multidisciplinary providers, paving new ground in immersive simulationbased learning. He serves as an instructor of our Advanced Resuscitation Team training sessions, rotation lead for Emergency Department Residents rotating in

the PICU, PICU lead in the Clinical Pathways Program, a Visual Abstracts Editor for the CHEST organization publishing a dozen visual abstracts this year, and a content creator for numerous international and local medical groups. He presented internationally on three separate occasions detailing his education curricula and simulation content for pediatric learners winning a section grant for his novel sepsis escape room at SCCM. After piloting a nursing education project, his Rolling Refreshers curriculum was awarded a CRISP grant for further expansion. Capping this year, Dr. Parker was selected as a scholar in the Harvard Macy Institute’s prestigious Program for Educators in Health Professions.

Rosanne Salonia, MD, specializes in the quality of care and safety for children with acute deterioration and in reducing the incidence of hospital acquired conditions. Specifically, she works as a member of the Emergency Response Committee, which oversees the use of the Pediatric Early Warning Score system (PEWS/MET) in focusing attention on patients at risk for clinical deterioration. She manages the associated database, coordinates the ongoing evaluation of the MET data, and continues her work to enhance this system. She is also co-leader of the Code Blue Committee, reviewing activations across the institution with a multidisciplinary team to improve patient outcomes and system-related issues.

Sara Sanders, MD, has an academic interest in medical education and is the core faculty leader for the pediatric residents rotating through the PICU. She has been elevating the resident educational experience by revamping the curriculum. She is co-founder of the Acute Care Interest Group for residents, a mentor to several residents and actively involved in resident wellness. Her efforts have not gone unnoticed; in her first year as faculty, she received the acute care teaching award from the graduating residency class. Due to her excellence in teaching, she was selected for the Advancing Pediatric Educator eXcellence (APEX) program from the Pediatric Academic Society.

Adam Silverman, MD, directs the Center for Global Health (CGH), leverages the skills and talents of our institution and its members to improve the health of children living in resource-limited settings. He leads efforts and increases an appreciation for diversity, equity, and inclusion amongst learners, staff and faculty at Connecticut Children’s. Dr. Silverman’s programs leverage technology to promote high-quality remote and in-person education and skill acquisition for nurses and doctors and facilitates collaboration between pediatric providers who care for severely ill and injured children in low- and middle- income countries. He cofounded the Pediatric Critical Care in Resource-Limited Settings program and is in the process of developing the Pediatric Emergency Medicine in Resource-Limited Settings program as well. He continues to organize the university-wide Global Health Symposium with students and colleagues from UConn, the UConn School of Medicine, and UConn Health. Locally, he leads the Global Health Pathway for pediatric residents, organizes a Global Health Boot Camp, and is a mentor to other faculty in their global health activities. Dr. Silverman is also a member of the Antimicrobial Stewardship Program and is an attending physician in the emergency department.

Jessica Winters, MD, is the Physician Quality and Safety Officer for the Division of Critical Care and leads initiatives in improving patient safety and reducing patient harm in the unit and throughout the hospital. She is part of the core hospital-wide group of physicians working on several projects to reduce medication error and improve medication safety. Dr. Winters started and leads a multidisciplinary group focused on reducing central line associated blood stream infections and collaborates with NICU and other divisions to align practices with national gold standard. Furthermore, she is focusing on communication within the PICU through a proactive safety huddle and improved multidisciplinary, multifaceted ways of engaging all staff. She was selected as one of the inaugural fellows of the Popik Family Quality and Patient Safety Fellowship Program. Dr. Winters is also the Assistant Director for continuous renal replacement therapy program and has an academic interest in prevention of acute kidney injury.

PUBLICATIONS

Walker SB, Winters JM, Schauer JM, Murphy P, Fawcet A, Sanchez-Pinto LN. Performance of Tools and Measures to Predict Fluid Responsiveness in Pediatric Shock and Critical Illness: A Systematic Review and Meta-Analysis. Pediatric Critical Care Medicine 2023. DOI: 10.1097/PCC.0000000000003320. PMID: 37462437.

Winters JM, Brocks R, Chapin CA, Lemoine CP, Superina R, Brandt KA, Sanchez-Pinto LN, Barhight MF. Fluid Balance in Pediatric Postoperative Liver Transplant Recipients. Pediatric Transplantation 2023; 27(4):e14499. DOI: 10.1111/petr.14499. PMID: 36951112.

Munoz Pareja J., O’Brien N., Fink E., Nader M., AbuSawwa R., Simon D., Lang H., Canarie M., Appiah J., Wilmshurst J. (2023). Development of a Multidisciplinary Pediatric Neurocritical Care Simulation-Based Training Curriculum in Africa. Currents.

Nader, M., Bonde, P., Massaro, S., Giuliano, J. S., Jr, & Shah, N. (2023). The Use of Extracorporeal Membrane Oxygenation as a Bridge to Bone Marrow Transplantation in a Patient With High-risk Acute Myeloid Leukemia. Journal of pediatric hematology/ oncology, 45(1), 18–20.

Parker, RM. Visual Abstract. Comparative effectiveness of first-line and alternative antibiotic regimens in hospitalized patients with nonsevere communityacquired pneumonia. Bai, A. Chest. August 2023.

Parker, RM. Visual Abstract. Indicators of neighborhood-level socioeconomic position and pediatric critical illness. Myers, C. Chest. July 2023.

Parker, RM. Visual Abstract. Conservative and surgical modalities in the management of pediatric parapneumonic effusion and empyema. Elviro, CF. Chest. June 2023.

Parker, RM. The relationship between norepinephrine equivalent dose of vasopressors within 24 hours from the onset of septic shock and in-hospital mortality rate. Sato, R. Chest. January 2023.

Parker, RM. Visual Abstract. Impact of a Multidisciplinary Post-COVID-19 Clinic on Hospital Admissions and ED Visits. Levan S. Chest. January 2023.

Parker, RM. Visual Abstract. Health Expectations and Quality of Life After Acute Respiratory Failure. Turnbull, A. Chest. January 2023.

Parker, RM. Visual Abstract. Contamination of Blood Cultures From Arterial Catheters and Peripheral Venipuncture in Critically Ill Patients. Nakayama, I. Chest. January 2023.

Parker, RM. Visual Abstract. Epinephrine in Out-ofHospital Cardiac Arrest. Fernando, S. Chest. January 2023.

Parker, RM. Visual Abstract. Nebulized vs IV Tranexamic Acid for Hemoptysis. Golpinath, B. Chest. May 2023.

Perry-Eaddy MA, Braccialarghe K, Cowl A, Melendez E. Can an unplanned extubation checklist solely identify children at-risk for adverse events? A response to the pediatric unplanned extubation risk score. Heart & Lung: The Journal of Cardiopulmonary and Acute Care. 2023 Jul 20.

Ardila, Silvia M., et al (Cowl A). “A Targeted Analysis of Serial Cytokine Measures and Nonpulmonary Organ System Failure in Children With Acute Respiratory Failure: Individual Measures and Trajectories Over Time.” Pediatric Critical Care Medicine 24.9 (2023): 727-737.

STAFF

Elliot Melendez, MD, Division Head

Leonard Comeau, MD

Allison Cowl, MD

Andrea Guardenier, MD

Marie Nader, MD

Robert Parker, DO

Rosanne Salonia, MD

Sara Sanders, MD

Adam Silverman, MD

Jessica Winters, MD

DEVELOPMENTAL & BEHAVIORAL PEDIATRICS

The Division of Developmental-Behavioral Pediatrics is composed of a diverse faculty of seven developmental behavioral pediatricians and two advanced practice registered nurses (APRNs). Our clinical services occur in a number of settings – outpatient in Farmington and Shelton and in the community (e.g., schools, Connecticut Birth-to-Three system, and other agencies). We provide direct consultation, optimal clinical care, and consultative services to schools and agencies across the state. The division’s mission is to provide comprehensive and compassionate diagnosis and management for children with neurodevelopmental and behavioral problems that range from normative deviations to rare disorders; to educate health care professionals and trainees about these problems; to add to existing knowledge by researching relevant questions in the field; and to offer advocacy and influence public policy.

CLINICAL STAFF ROLES

Sarah Schlegel, MD, serves as Division Head. Ana Garnecho, MD, is the site Director at the new Shelton location (relocated from Norwalk when the division separated from Nuvance Health). Robert Keder, MD, is the division’s Education Director. He is the division’s Core Faculty Liaison for the Residency Program and manages formal division education opportunities at all training/learning levels (undergraduate, graduate, and continuing medical education). He is also very engaged in legislative advocacy.

In October 2023, Mary Ann de Banate, MD, joined the team at the Farmington site.

ONGOING CLINICAL PROGRAMS

Dr. Keder continued as an embedded developmental behavioral pediatrician for Connecticut Children’s primary care settings, serving the goal of enhancing collaboration and co-management with primary care providers as well as improving access to care for our highest risk patients and families.

The Transition to Adulthood with Developmental Services Clinic, directed by Sarah Schlegel, MD, and serving patients 15 to 26 years of age and their families, celebrated five years of operation. The clinic is unique in the State of Connecticut and is one of only a few other similar programs in the United States. Two specialized physician-advanced practice provider collaboration pathways are offered to patients in the Developmental-Behavioral Pediatrics clinic: one for toddler evaluations (Ann Milanese, MD, and Dana Eisenberg, MA, MSN), the other for attention-deficit/ hyperactivity disorder evaluation and management (Dr. Schlegel and Keith Ellis, APRN, MPH).

CLINICAL HIGHLIGHTS/ACCOMPLISHMENTS

In addition to in-person appointments, the division continues to maintain a robust telemedicine presence (approximately half of all appointments), offering comprehensive virtual access to care to ensure the safety of patients, their families, and faculty and staff.

ONGOING COMMUNITY-BASED CONSULTATION PROGRAMS

For 30 years, Dr. Milanese has been medical advisor for school districts across Connecticut, including the Connecticut Technical High School system. Dr. Milanese has been the medical advisor for Connecticut’s Early Intervention program, Birth-to-Three, for 35 years and continued her appointment by Connecticut Governor Ned Lamont to the Connecticut Interagency Birthto-Three Coordination Council. Additionally, she has been providing daily general pediatrics consultation to the Institute of Living inpatient child psychiatric unit since 1997. Dr. Schlegel continues to direct the School Consultation Service (informally created in 2009), conducting individual evaluations of medically and developmentally complex students within their school districts, and now Dr. Keder has joined the endeavor. Dr. Schlegel has been serving as the medical director for Cheshire Fitness Zone for the past few years. She is also an elected member of the Autism Spectrum Disorder Advisory Council for Connecticut’s Commissioner of Social Services.

EDUCATION HIGHLIGHTS/ACCOMPLISHMENTS

• Division advanced practice providers (APPs) spearheaded a robust developmental-behavioral pediatrics preceptorship for training APPs.

• For the Society for Developmental and Behavioral Pediatrics (SDBP) Virtual Winter Workshops –One-Day Conference in February 2023, Dr. Keder led the presentation “Elephants in the Nursery: Unpacking the Intersection of Parenting to Provide Equitable Parenting Practices in Clinical Settings.”

• Later that month, he presented “Acronym Salad from Farm to Exam Table: Navigating School Services with Families” for Connecticut Children’s Grand Rounds. This presentation was modified and presented at Connecticut Children’s Sixth Annual Statewide Care Coordination Forum, Nurturing Connections: Transforming Care” in June 2023.

• In April 2023, Dr. Keder was an invited panelist for “Where Does School-Based Health Fit Within the Medical Home?” (the first of a three-part virtual discussion panel series) offered by the American Academy of Pediatrics and National Resource Center for Patient/Family-Centered Medical Home.

• Ms. Eisenberg co-presented “A Challenging Case Study: Caregiver Fabricated Illness Presenting as Autism” at Connecticut Children’s APP Summit in May 2023.

• “Facilitating Attuned Interactions: Communication Skills for Fostering Resilience in Primary Care” was co-presented by Dr. Keder for Connecticut Children’s Ask the Experts series in June 2023.

• At the SDBP Annual Meeting (SDBP AM) in September 2023, Dr. Keder presented in two topical symposia entitled “Redlining Begat Adverse Childhood Experiences: How Public Policy Impacts Child Health, Development, and Behavior” and “Media Matters: Effective Communication Skills for Engagement with Media” and was the lead presenter for a teaching workshop entitled “’Parenting Imposter Syndrome’ in Pediatric Trainees: Harnessing the Power of DBPs to Promote Relational Health through Implementation of Parenting Curricula for Pediatric Primary Care.”

• Also at the 2023 SDBP AM, Dr. Schlegel co-hosted the inaugural meeting of the Society’s Transition Special Interest Group (SIG) for which she is co-chair and Dr. Keder co-hosted the inaugural meeting of the Society’s School-Age Special Interest Group (SIG) for which he is co-chair.

• In November 2023, Drs. Keder, Garnecho, and Schlegel and Elizabeth Janofsky, MD, presented about autism spectrum disorder to the Connecticut Children’s Care Network Learning Community.

ONGOING RESEARCH

• Supported by research assistant Rosalie Lyons, BS, and research assistant Natalia Suarez, MA, from the Connecticut Children’s Research Institute, Thyde Dumont-Mathieu, MD, MPH, continues work on seven active research projects, three of which are currently externally grant-funded:

» Bridging the Gap: Providing Equitable Early Treatment of ASD [Autism Spectrum Disorder] by Finding Children, Wherever They Are

» Bridging the Gap: Equitable Start to Nutritional and Developmental Health

» Parent Training for Latinx Autistic Toddlers: Development and Preliminary Testing

» Strategies to Promote Culturally Effective Screening, Referral and Service Provision in Primary Care Practices and Birth-to-Three Programs

» Decision-Making Process and Experiences with Genetic Testing in Autism Spectrum Disorder: Pilot Study with a Clinically Derived, Diverse Sample of Participants (Co-I: Louisa Kalsner, MD, Division of Neurology)

» Connecting the Dots: An RCT [Randomized Control Trial] Relating Standardized ASD Screening, Intervention Access, and Long-Term Outcomes (PI: Deborah Fein, PhD, University of Connecticut)

» Early Detection of Autism/Pervasion Developmental Disorders (PI: Deborah Fein, PhD, University of Connecticut).

PUBLICATIONS

Williams LN, Wieckowski AT, Dieckhaus MFS, Dai YG, Zhang F, Dumont-Mathieu T, Barton M, Fein D, Robins DL. Primary Care Clinician and Child Characteristics Impacting Autism Surveillance. Brain Sci. 2022 Dec 22;13(1):18. PMID: 36672000; PMCID: PMC9855901.

Dai YG, Thomas RP, Brennan L, Luu ML, HughesLika J, Reilly M, Moreno P, Obe B, Ahmed KB, Berry LN, Goin-Kochel RP, Helt MS, Barton ML, DumontMathieu T, Robins DL, Fein DA. An initial trial of OPTIn-Early: An online training program for caregivers of autistic children. Autism. 2023 Aug;27(6):1601-1615. PMID: 36519775; PMCID: PMC10267291.

STAFF

Sarah Schlegel, MD, FAAP, Division Head

Mary Ann de Banate, MD, FAAP

Thyde Dumont-Mathieu, MD, MPH, FAAP

Ana Garnecho, MD, FAAP

Elizabeth Janofsky, MD, FAAP

Robert D. Keder, MD, FAAP

Ann Milanese, MD, FAAP

Dana Eisenberg, MA, MSN, PPCNP-BC

Keith Ellis, MPH, MSN, PPNP-BC

DIGESTIVE DISEASES, HEPATOLOGY & NUTRITION

The Division of Digestive Diseases, Hepatology, and Nutrition is committed to cutting edge and innovative clinical care of infants, children and adolescents; pioneering clinical, translational, and basic research; and the education of the next generation of physicians.

Growth has been the key word for our Division over the past year. From opening operations in Westport to expansion in South Hadley and record numbers of patients seen in all seven of our locations. We have now recruited a full time gastroenterologist to practice only in Westport starting February 2024 and who will perform endoscopic procedures in the Ambulatory Surgical Center in Stamford.

Our Center for Pediatric Inflammatory Bowel Disease (IBD), the largest program in the region between Boston and New York, continues to provide care to almost 900 children with Crohn’s disease and ulcerative colitis. The numbers of new patients with these disorders remains high and is around 100 per year. Pioneering research at Connecticut Children’s and its collaborating institutions funded by the National Institutes of Health (NIH) took a huge step forward with the awarding of a $14M U01 grant in April 2023 for the CAMEO study (Clinical, imaging, and endoscopic outcomes of children newly diagnosed with Crohn’s disease). This study is structured to unravel some of the mysteries underlying the pathogenesis of bowel inflammation and provide tools to utilize precision medicine in its treatment. Jeffrey Hyams, MD, head of the Division of Digestive Diseases, Hepatology and Nutrition, and holder of the Mandell Braunstein Family Endowed Chair in Pediatric Inflammatory Bowel Disease, is a co-principal investigator of this study in which Connecticut Children’s is the clinical directing center.

Our Center for Pediatric Liver Disease, directed by Karan Emerick, MD, continues its excellent work in providing care to children with hepatic disorders ranging from chronic hepatitis B and C, metabolic liver disease, autoimmune disease, and acute and chronic liver failure. It provides pre- and post-transplant care to over 40 children. Samantha Lee, APRN, under the guidance of Dr.

Emerick, coordinates the program, caring for children with non-alcoholic fatty liver disease (NAFLD), and she works closely with other divisions in the hospital. Fibroscan® technology, started over 2 years ago, allows the noninvasive evaluation of liver fibrosis in children with chronic liver disorders. This program not only welcomes patients at the hospital but also in our Shelton office.

Our Multidisciplinary Intestinal Rehabilitation Team (MIRT) is the only one of its kind in the state. Now co-directed by Bella Zeisler, MD, Karan Emerick, MD, and Christine Rader, MD, from Pediatric Surgery, this group focuses on the care of children with intestinal failure of all causes. Nicole Lewie, RN, and Kate Samela, RD, are integral parts of this team, which also facilitates the transition of patients from hospital to home. We have recruited additional faculty to start in August 2024 to provide additional growth to this program.

Corey Baker, MD, has continued to develop our Center for Neurogastroenterology and Motility Disorders and has established anorectal manometry and esophageal motility capability. Our program has pioneered the use of IB-stim, a therapy that was approved in 2019 by the Food and Drug Administration for treating adolescents with chronic abdominal pain. IB-stim is a non-surgical device that sends barely perceptible electrical impulses into cranial nerve bundles located in the ear that then stimulate regions of the brain that are involved in pain processing. We are still one of the few centers in the country currently offering this treatment modality, and we successfully used it for multiple patients with previously refractory abdominal pain.

Dr. Baker, along with Victoria Grossi, DO, Dr. Zeisler, and Pete Townsend, MD, serve as the gastroenterologists in the Division of Aerodigestive Medicine. This multidisciplinary team of otolaryngologists, pulmonologists, gastroenterologists, and speech therapists cares for children with complex airway, pulmonary and gastrointestinal disorders.

We have welcomed two new faculty, Panam Kaur, MD, and Sunpreet Kaur, MD, to our program. Despite having the same last name, they are not related! Dr. Panam Kaur is practicing general pediatric GI and helps staff our Danbury

satellite. Dr. Sunpreet Kaur has established a dedicated Eosinophilic Gastrointestinal Disorder program.

The medical education team within our department is involved in teaching the GI fellows, pediatric and other residents, and medical students. Dr. Zeisler is the fellowship director and Katherine Baldwin, MD, the associate director. In 2022 we expanded our fellowship from three fellows to four over a three-year training period. Resident education is led by Drs. Townsend and Grossi. Medical student teaching is directed by Drs. Grossi, Baldwin and Townsend. All GI faculty remain engaged in teaching different learners as they rotate through the various GI clinical opportunities. The great depth in our pediatric surgical and radiology programs as well as the great variety of clinical disorders and the intimate involvement of our faculty make our educational programs particularly attractive.

Logan Jerger, MD, is the division’s quality improvement officer. Current important projects include standardization of follow-up care for patients with celiac disease as well as standardization of data recording for patients with eosinophilic esophagitis. Dr. Townsend is our medical director of endoscopy and continues to direct our fecal transplant service.

Under the direction of Sarita Singhal, MD, our South Hadley campus has continued to thrive and attract patients regionally. Dr. Singhal assumed the regional liaison role.

Brad Jerson, PhD, our division’s pediatric psychologist, provides fully embedded psychological evaluation and intervention services. He has partnered with other institutional departments and regional community mental health agencies for development of psychosocial programming to address GI symptoms from an evidencebased perspective. He is deeply involved in the Center for Neurogastroenterology and we look forward to the successful recruitment of an additional psychologist in 2024. In December 2023 we were thrilled to welcome Ellen Sejkora, PhD, who joins our GI team as a pediatric psychologist. Dr. Sejkora has been at Dartmouth for the past several years.

PUBLICATIONS

Raygoza Garay JA, Turpin W, Lee SH, Smith MI, Goethel A, Griffiths AM, Moayyedi P, Espin-Garcia O, Abreu M, Aumais GL, Bernstein CN, Biron IA, Cino M, Deslandres C, Dotan I, El-Matary W, Feagan B, Guttman DS, Huynh H, Dieleman LA, Hyams JS, Jacobson K, Mack D, Marshall JK, Otley A, Panaccione R, Ropeleski M, Silverberg MS, Steinhart AH, Turner D, Yerushalmi B, Paterson AD, Xu W; CCC GEM Project Research Consortium; Croitoru K. Gut Microbiome Composition Is Associated With Future Onset of Crohn’s Disease in Healthy First-Degree Relatives. Gastroenterology. 2023 Sep;165(3):670-681.

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Atia O, Shavit-Brunschwig Z, Mould DR, Stein R, Matar M, Aloi M, Ledder O, Focht G, Urlep D, Hyams J, Broide E, Weiss B, Levine J, Russell RK, Turner D. Outcomes, dosing, and predictors of vedolizumab treatment in children with inflammatory bowel disease (VEDOKIDS): a prospective, multicentre cohort study Lancet Gastroenterol Hepatol. 2023 Jan;8(1):31-42.

Whaley KG, Xiong Y, Karns R, Hyams JS, Kugathasan S, Boyle BM, Walters TD, Kelsen J, LeLeiko N, Shapiro J, Waddell A, Fox S, Bezold R, Bruns S, Widing R, Haberman Y, Collins MH, Mizuno T, Minar P, D’Haens GR, Denson LA, Vinks AA, Rosen MJ Multicenter Cohort Study of Infliximab Pharmacokinetics and Therapy Response in Pediatric Acute Severe Ulcerative Colitis. .Clin Gastroenterol Hepatol. 2023 May;21(5):1338-1347.

Baldwin K, Grossi V, Hyams JS. Managing pediatric Crohn’s disease: recent insights. Expert Rev Gastroenterol Hepatol. 2023 Jul-Dec;17(10):949-958.

Feagan BG, Schreiber S, Afzali A, Rieder F, Hyams J, Kollengode K, Pearlman J, Son V, Marta C, Wolf DC, D’Haens GG. Ozanimod as a novel oral small molecule therapy for the treatment of Crohn’s disease: The YELLOWSTONE clinical trial program. Contemp Clin Trials. 2022 Nov;122:106958.

Sosnovski KE, Braun T, Amir A, Moshel D, BenShoshan M, VanDussen KL, Levhar N, Abbas-Egbariya H,

Beider K, Ben-Yishay R, Asad Ali S, Moore SR, Kugathasan S, Abramovich I, Glick Saar E, Weiss B, Barshack I, Gottlieb E, Geiger T, Ben-Horin S, Ulitsky I, Hyams JS, Denson LA, Haberman Y GATA6-AS1 Regulates Intestinal Epithelial Mitochondrial Functions, and its Reduced Expression is Linked to Intestinal Inflammation and Less Favourable Disease Course in Ulcerative Colitis. J Crohns Colitis. 2023 Jun 16;17(6):960-971.

Hyams JS, Russell RK. The State of Clinical Trials in Pediatric Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2023 Sep;52(3):589-597.

Marcovitch L, Focht G, Carmon N, Tersigni C, Ledder O, Lev-Tzion R, Church PC, Hyams JS, Baldassano RN, Bousvaros A, Mack DR, Hussey S, Otley A, Croft NM, Kappelman MD, Griffiths AM, Turner D. Development and Validation of the TUMMY-UC: A Patient-Reported Outcome for Pediatric Ulcerative Colitis. Gastroenterology. 2023 Apr;164(4):610-618.

Braun T, Sosnovski KE, Amir A, BenShoshan M, VanDussen KL, Karns R, Levhar N, Abbas-Egbariya H, Hadar R, Efroni G, Castel D, Avivi C, Rosen MJ, Grifiths AM, Walters TD, Mack DR, Boyle BM, Ali SA, Moore SR, Schirmer M, Xavier RJ, Kugathasan S, Jegga AG, Weiss B, Mayer C, Barshack I, Ben-Horin S, Ulitsky I, Beucher A, Ferrer J, Hyams JS, Denson LA, Haberman Y. Mucosal transcriptomics highlight lncRNAs implicated in ulcerative colitis, Crohn’s disease, and celiac disease. JCI Insight. 2023 Jul 24;8(14):e170181.

Croft NM, de Ridder L, Griffiths AM, Hyams JS, Ruemmele FM, Turner D, Cheng K, Lutsar I, Greco M, Gołębiewska Z, Laumond F, Cavaller-Bellaubi M, Elgreey A, Altepeter TA, Pallidis C, Norga K, Nelson R, Crandall W, Vassal G. Paediatric Inflammatory Bowel Disease: A Multi-Stakeholder Perspective to Improve Development of Drugs for Children and Adolescents. J Crohns Colitis. 2023 Mar 18;17(2):249-258.

Geem D, Hercules D, Pelia RS, Venkateswaran S, Griffiths A, Noe JD, Dotson JL, Snapper S, Rabizadeh S, Rosh JR, Baldassano RN, Markowitz JF, Walters TD,

Ananthakrishnan A, Sharma G, Denson LA, Hyams JS, Kugathasan S. Progression of Pediatric Crohn’s Disease is Associated with Anti-TNF Timing and BMI Z-Score Normalization. Clin Gastroenterol Hepatol. 2023 Oct 4:S1542-3565.

Crowley E, Ma C, Guizzetti L, Zou G, Lewindon PJ, Gee MS, Hyams JS, Rosen MJ, von Allmen D, de Buck van Overstraeten A, Shackelton LM, Remillard J, Schleicher L, Dillman JR, Rimola J, Taylor SA, Fletcher JG, Church PC, Feagan BG, Griffiths AM, Jairath V, Greer MC. Recommendations for Standardizing MRI-based Evaluation of Perianal Fistulizing Disease Activity in Pediatric Crohn’s Disease Clinical Trials. Inflamm Bowel Dis. 2023 Jul 31.

Colman RJ, Mizuno T, Fukushima K, Haslam DB, Hyams JS, Boyle B, Noe JD, D’Haens GR, Van Limbergen J, Chun K, Yang J, Denson LA, Ollberding NJ, Vinks AA, Minar P. Real world population pharmacokinetic study in children and young adults with inflammatory bowel disease discovers novel blood and stool microbial predictors of vedolizumab clearance Aliment Pharmacol Ther. 2023 Mar;57(5):524-539.

Venkateswaran S, Somineni HK, Matthews JD, Kilaru V, Hyams JS, Denson LA, Kellamayer R, Gibson G, Cutler DJ, Conneely KN, Smith AK, Kugathasan S. Longitudinal DNA methylation profiling of the rectal mucosa identifies cell-specific signatures of disease status, severity and clinical outcomes in ulcerative colitis cell-specific DNA methylation signatures of UC. Clin Epigenetics. 2023 Mar 24;15(1):50.

Kaur P, Chevalier R, Friesen C, Ryan J, Sherman A, Page S. Diagnostic role of fractional exhaled nitric oxide in pediatric eosinophilic esophagitis, relationship with gastric and duodenal eosinophils. World J Gastrointest Endosc. 2023 May 16;15(5):407-419.

Brandt K, Dukleska K, McKeown M, Brancato J, Grossi V, Schoem S, Sacco T, D’Amato J, Bourque MD, Campbell BT. Utilizing a critical airway response team expedites esophageal button battery removal. J Pediatr Surg. 2023 May;58(5):810-813.

STAFF

Jeffrey Hyams, MD, Division Head

Bella Zeisler, MD, Clinical Diirector

Corey Baker, MD

Katherine Baldwin, MD

Karan Emerick, MD

Victoria Grossi, DO

Logan Jerger, MD

Brad Jerson, PhD

Panam Kaur, MD

Sunpreet Kaur, MD

Ellen Sejkora, PhD

Sarita Singhal, MD

Peter Townsend, MD

Fellows

Jing Marrero, MD

Sydney Kuzoian, DO

Viven Solomon, DO

Pyae Naing, MD

EMERGENCY MEDICINE

The mission of the Division of Emergency Medicine is to provide the highest quality care for acutely ill or injured children. We strive to fulfill this through excellence in clinical care, teaching, and research.s

The Emergency Department (ED) at Connecticut Children’s completed its recovery from the COVID pandemic era and 2022’s post-pandemic RSV surge. Although overall patient acuity and trauma volume continue to be higher, essential work on patient satisfaction and LWBS (Left Without Being Seen) patients was rewarded with much improved scores. Our team leads efforts throughout the institution on patient flow, pathway development, the use of bedside ultrasound, and simulation.

The Connecticut Children’s Urgent Care in Farmington, whose providers are members of the Division of Emergency Medicine, saw record numbers of patients seeking care for minor illnesses and injuries.

OUR DIVISION

The Division of Emergency Medicine is composed of 19 Pediatric Emergency Medicine (PEM) board-certified/ eligible fellowship-trained faculty, one pediatrician, six PEM fellows, and 17 advanced practice providers (APPs). Division Head John Brancato, MD, and Associate Division Head Eric Hoppa, MD, work together to direct clinical operations, educational initiatives, research, patient safety, and quality improvement. Both have multiple other responsibilities throughout the institution. In addition, Dr. Hoppa completed Organizational Excellence 4.0 and took over as Medical Director of the Urgent Care in 2023.

Members of the Division of Emergency Medicine play an integral role in many areas of the hospital and region. Education and research are core parts of our mission. Faculty members teach and mentor 63 pediatric residents and 54 emergency medicine residents as well as family practice residents, medical students, dental students, and advanced practitioner students.

The fellowship in Pediatric Emergency Medicine (a subspecialty of both Emergency Medicine and Pediatrics) is now in its 24th year, led by Program Director Matt Laurich, MD. Dr. Laurich also leads the ED Sepsis Working Group and is a member of a nationwide sepsis learning collaborative. The Undergraduate Research Assistant Program, which was developed by Sharon Smith, MD, and is taught by our faculty, supports the research productivity of our division. Dr. Smith teaches two honors-level undergraduate courses at the University of Connecticut. She also serves as the division’s director of research and is the medical director of Pediatric Advanced Life Support (PALS) for the institution. Noah Jablow, MD, and Ruchika Jones, MD, share responsibility for orienting, scheduling and evaluating the large number of medical learners who work in our department. Dr. Jones also became Associate Program Director of the PEM fellowship and leads our division’s wellness and community involvement initiatives. Dr. Jablow brings his expertise in wilderness medicine, shared through didactic and other sessions at the resident and fellow level. Michael Soltis, MD, is the Medical Director of the Pediatric Critical Care Transport team and is the ED Coordinator for Clinical Forensics and Child Abuse Services.

The Division of Emergency Medicine is a leader in the implementation of simulation across the institution and with our affiliates. Mariann Kelley, MD, is Director of Simulation Education at the UConn School of Medicine. Carla Pruden, MD, is Director of Simulation at Connecticut Children’s. Together, they lead bimonthly simulation sessions for the Pediatric Emergency Medicine attendings and fellows; monthly sessions for the trauma team, residents and fellows; and ad hoc sessions for the Urgent Care staff, medical school and hospital using high fidelity manikins. Dr. Pruden has developed an inter-institutional (with Hartford Hospital) CME program using simulation to improve the care of pediatric trauma patients. She also helped to coordinate and provided content expertise for an Emergency Medicine Procedural Refresher Course held in 2023 at St. Francis Hospital. Both Dr. Pruden and Dr. Kelley also completed the Organizational Excellence 4.0 program this year.

Henry Chicaiza, MD, is the division director of pointof-care ultrasound (POCUS). He has developed an educational curriculum for our fellows, a formal ultrasound credentialing and quality program for the attending staff, and the hospital-wide ultrasound-guided IV program. He is strongly supported by Rahul Shah, MD, who returned to Connecticut Children’s last year after completing a fellowship in the use of emergency point-of-care ultrasound. Dr. Chicaiza is also a leader in the Pediatric Emergency Point-of-Care Educational Collaborative (PEPEC), an international group of leaders in pediatric bedside ultrasound, working together to promote education, research and best practices in the field.

Steven Rogers, MD, the division’s Director of Emergency Mental Health Services, has worked closely with the Division of Child and Adolescent Psychiatry and partners in the community to streamline the assessment and disposition process for patients with acute mental/ behavioral health concerns. His expertise in the area of pediatric suicide prevention has received national attention and recognition.

Ashley Notartomaso, MD, helped lead the division’s Diversity, Equity and Inclusion initiatives and is working on a behavioral health curriculum for resident trainees.

Candice Jersey, DO, is actively engaged in quality improvement research, looking to both decrease the time to performance of pelvic ultrasound studies and to leverage the Emergency Department to assess and address food insecurity, an important social determinant of health. Along with PEM fellow, Meghan Wilson Frost, MD, she is also working to improve the support for breastfeeding mothers while they are in the department.

Jonah Mandell, MD, and Carol Erickson, APRN, were joined this year by Ashley Pedneault, APRN, as core providers at the Urgent Care. Dr. Mandell continues to act as an Associate Program Director of the Pediatric Residency Program.

Two members of our team hold dual clinical appointments. They bring clinical expertise to our group

with natural bridges to other divisions. Jesse Sturm, MD, is the Division Head of the hospital’s Sedation Service, and Adam Silverman, MD, is primarily based in both Critical Care and Global Health.

The division is productive with many poster presentations at national conferences, publications in peer-reviewed journals, and book chapters.

PUBLICATIONS

Dukleska K, Brandt K, McKeown M, Brancato JC, Grossi V, Schoem S, Sacco, T, D’Amato J, Bourque MD, Campbell BT. Utilizing a Critical Airway Response Team Expedites Esophageal Button Battery Removal. J Pediatr Surg. 2023 May;58(5):810-813.

Schissler K, Gonzalez K, Chicaiza H. Identification of Papilledema in Pediatric Patients With Meningitis

STAFF

ATTENDINGS

John Brancato, MD Division Head

Eric Hoppa, MD, Associate Head

Henry Chicaiza, MD

Noah Jablow, MD

Candice Jersey, DO

Ruchika Jones, MD

Owen Kahn, MD

Mariann Kelley, MD

V. Matt Laurich, MD

Jonah Mandell, MD

Ashley Notartomaso, MD

John Peng, MD

Carla Pruden, MD

Steven Rogers, MD

Rahul Shah, MD

Using Ocular Point-of-Care Ultrasound. Pediatr Emerg Care. 2023 May 1;39(5):357-359. doi: 10.1097/ PEC.0000000000002920. Epub 2023 Feb 23. PMID: 36811554.

Schissler K, Stewart S, Phamduy T, Brimacombe M, Waynik I, Hoppa E. High-Risk Markers and Infection Rates in Febrile Infants Aged 29 to 60 Days Presenting to an Emergency Department During the COVID-19 Pandemic. Pediatr Emerg Care. 2023;39(11):895-899. doi:10.1097/PEC.0000000000002968.

Carter EJ, Zavez KB, Rogers SC, deMayo R, Harel O, Gerber JS, Aseltine RH, Documented Penicillin Allergies on Antibiotic Selection at Pediatric Emergency Department Visits. Pediatric Emergency Care 2023 Aug. DOI: 10.1097/PEC.0000000000003023.

Shah RD, Leviter J, Riera A. Acute and Critical Pathology Diagnosed by Timely Point-of-Care Ultrasound Review at a Tertiary Children’s Hospital. Pediatr Emerg Care. 2023 Aug 1;39(8):636-640. doi: 10.1097/PEC.0000000000002974. Epub 2023 May 20. PMID: 37256276.

Smith SR, Nguyen A, Chenard D, Burnham K, Albert A. Impacts of a University Research Assistant Program: The First Decade. Med Sci Educ. 2023 Sep 9;33(5):1139-1146.

Schenck C, Wilson M, Tiyyagura G, Bechtel K. Parental attitudes, beliefs, and practices related to firearm storage: a qualitative study. Inj Epidemiol. 2022 Dec 21;9(Suppl 1):35. doi: 10.1186/s40621-022-00400-x. PMID: 36544237; PMCID: PMC9768769.

Adam Silverman, MD (EM/Critical Care/Global Health)

Sharon Smith, MD

Michael Soltis, MD

Jesse Sturm, MD (EM/Sedation)

Kristin Welch, MD

APRN’S & PA’s

Sarah Orlando, PA-C, Lead APP

Mandi Boisvert, APRN

Mandi Boisvert, APRN (EM/Adolescent Medicine)

Carol Erickson, APRN

Amanda Good, APRN

Ann Gorjanc, PA-C

Victoria Greco, PA-C

Jessica Haggett, APRN

Tiffany Henry, APRN

Rachel Jankovsky, PA-C

Micaela Lavoie, PA-C

Jennifer Martin, APRN

Kezia Meyer, APRN

Ashley Pedneault, APRN

Jillian Scott, APRN

Joseph Stancavage, PA-C

Lisa Tryon, PA-C

Alexis Veith, PA-C

Lauren Wellner, APRN

FELLOWS

Emily Jonker, DO, PGY-4

Sarah McHugh, MD, PGY-4

Kathleen Felisca, MD, PGY-5

Meghan Wilson Frost, MD PGY-5

Susana Collazo, MD, PGY-6

Edgar Flores, MD, PGY-6

ENDOCRINOLOGY & DIABETES

MISSION STATEMENT:

The Division of Pediatric Endocrinology and Diabetes grew in its clinical programs, geographic reach, and research endeavors with the overriding mission to improve the health and quality of life of patients through prioritization of top-notch clinical care, excellence in teaching, and innovation in research aimed toward the development of new treatments through innovative clinical and laboratory investigations as well as groundbreaking clinical trials.

Our division focuses on providing the highest quality of patient care while at the same time providing world-class education to medical students, residents, and fellows. Our faculty members are involved in meaningful and innovative research, whether it be clinical, translational, and/or bench research, and they have given local, national, and international presentations. Our outpatient Specialty Care Centers in Farmington, Glastonbury, Hartford, Shelton, and Danbury remain very productive, and clinical care has now been fully established in our Westport site that opened in late 2022, with clinical care provided by Misha Sodhi, MBBS, who joined our division last year. Our multiple subspecialty clinics within the division have continued to grow and further develop.

This year we welcomed Ana Menendez, MD, to our division as another full-time faculty member. Dr. Menendez successfully graduated from our fellowship program this past summer. Her clinical endeavors are in our Farmington and Danbury sites, and her research focus is on adipocyte pathophysiology under the mentorship of Christine Finck, MD, FACS, (Connecticut Children’s Surgeon-inChief, Director of the Weight Management Program, and Professor of Surgery and Pediatrics at UConn Health). Dr. Menendez also has a focus on expanding diversity, equity, and inclusion (DEI) initiatives within the institution, regionally, and nationally. We were also very fortunate to add Alexandra Dube, APRN, FNP, to our team this year. She provides care in both our rapidly growing diabetes clinic and gender program and joins our other advanced

practice providers including Carey Driscoll, APRN, CPNP, Maureen Fearon, APRN, FNP-BC, and Elena Schneider, PA-C.

Our fellowship training program has been very successful year after year. Currently led by Sunitha Sura, MD, as Program Director and Christine Trapp, MD, as Associate Program Director, the Pediatric Endocrinology Fellowship is now in its 26th year and thriving. The fellowship program is extremely indebted to the prior leadership of Rebecca Riba-Wolman, MD, and has been successful in recruiting excellent fellows who are trained not only clinically but also in research. This has led to publications and numerous presentations at esteemed local, regional, and national meetings. Caroline Figgie, MD, was a second-year fellow this past year who joined us in July 2022. She completed her pediatrics residency at Case Western Reserve School of Medicine/Rainbow Babies in Cleveland. Kelly Smith, MD, joined us in July 2023 after completing her residency at Connecticut Children’s. Mofesola Modupe, DO, will be joining us as a first-year fellow in July 2024 after completing her pediatrics residency at University of Illinois College of Medicine, Peoria, IL. (For details, please see the “Fellowship” section of the report).

Since 2021, the division has been made up of three main clinical sections including Endocrinology, Diabetes, and the Glycogen Storage Disease (GSD) & Disorders of Hypoglycemia Program, and overall it consists of approximately 60 members. The division is led by Emily Germain-Lee, MD, professor of Pediatrics at the University of Connecticut School of Medicine. In addition to her clinical and administrative roles, she is an NIH-funded physician-scientist. Her research endeavors include her involvement with the Connecticut Children’s Research Institute (CCRI) as part of the Senior Advisory Committee and director of the Scientific Center for Rare Disease. She also serves as Chair of Research Council, Chair of Dean’s Council, and Co-Director of the MD/PhD program at the UConn School of Medicine. Our diabetes program is directed by Cem Demirci, MD, the Chase Family Chair of Juvenile Diabetes and the Clinical Director of the division. Dr. Demirci has been Director of our robust and very active diabetes program for over a decade,

and he has spearheaded numerous advancements in treatments as well as maintained the highest standards in providing top-notch clinical care, always focused on advocacy for patients and their families. The incorporation in 2021 of the Glycogen Storage Disease & Disorders of Hypoglycemia Program within our division has widened our breadth, with Dr. Riba-Wolman serving as Director. Dr. Riba-Wolman has not only established and grown an outpatient program for patients with GSD but has also taken this program to new heights with sustained international acclaim in both the clinical and research arenas.

SUMMARY OF SUBSPECIALTIES WITHIN THE DIVISION OF PEDIATRIC ENDOCRINOLOGY & DIABETES

The Division of Pediatric Endocrinology and Diabetes has a unique array of subspecialty clinics focused on specific conditions and directed by our 14 faculty members:

Diabetes Program: A large focus in the division is our Diabetes Program, which continues to grow each year. Directed by Dr. Demirci, it provides top-notch care and support for approximately 1,900 children and adolescents. The program encompasses clinical management for diabetes of all types, including type 1 and type 2 DM, monogenic diabetes, maturity onset diabetes of the young (MODY), permanent neonatal diabetes, cystic fibrosisrelated diabetes, and steroid-induced diabetes. The clinic’s staff is composed of a large and extremely dedicated multidisciplinary team, including advanced practice providers, registered nurses, registered dietitians, certified pediatric diabetes educators, a diabetes administrative coordinator, and pediatric social workers. Dr. Demirci has also spearheaded and established a unique specialty clinic within the diabetes program that is focused on patients who are at highest risk and who are often without adequate support systems in the home setting. He and his team work diligently and passionately to improve these patients’ diabetes control. Dr. Demirci is extensively involved in education sessions for diabetes throughout the region for providers, patients, families, and schools, and he is the organizer/medical director of the Annual Connecticut Children’s Diabetes Education Day for school nurses and primary care providers. He has led this

CME event yearly since 2011. Additionally, Dr. Demirci maintains the highest standards for point-of-care testing for this clinic (and many other clinics at Connecticut Children’s) as the director of the CCSG point-of-care testing program. Through his hard work and dedication, he helped lead the initiative to start a summer camp for children with diabetes, and it has been a huge success. The diabetes program has consistently been accredited by the American Association of Diabetes Educators (AADE). Virtually all of the pediatric endocrinologists in the division are involved in providing care within this clinic. Nordie Bilbao, MD, has started a diabetes program in her outpatient clinic sites in Danbury and Shelton, and she is spearheading the efforts in growing diabetes care in Fairfield County.

Gender Program: This program continues to grow tremendously under the direction of Priya Phulwani, MD, who provides unique care to children and adolescents with gender incongruence and also offers support to families from throughout the region and beyond. The care team greatly expanded this year with the additions to this program of Dr. Menendez and Alexandra Dube, APRN. Dr. Phulwani has a long-term history of continually advancing the program with state-of-the-art care, not only through clinical management but also through statewide advocacy and presentations given locally, regionally, and nationally. She has forged several important collaborations to improve the health and quality of life for patients, including the Center for Advanced Reproductive Services, which offers fertility options to patients with gender incongruence, as well as multiple initiatives in other departments at Connecticut Children’s. She gives many educational talks to improve awareness of gender diversity for the Connecticut Department of Children & Families, various health institutions/facilities, and schools. Dr. Phulwani has worked steadily and with great dedication to help Connecticut Children’s achieve the status of “high performer” this year in the Health Equality Index, which is a true hallmark of her work. This is the national LGBTQ+ benchmarking tool that evaluates the policies and practices of healthcare facilities related to the equity and inclusion of their LGBTQ+ patients, employees, and visitors.

Clinic for Variations of Sexual Development:

This clinic, co-directed by Dr. Phulwani, has evolved into a truly interdisciplinary model with visits involving joint meetings of the parent(s) with their child for evaluations by a pediatric urologist, a family support provider, and Dr. Phulwani. The providers build upon each other’s experiences to achieve a common shared goal of providing comprehensive compassionate care to infants, children, adolescents, and their families. The joint patient visits enable better coordination of care and allow for open, clear, and consistent communication. By providing ongoing age-appropriate education, the patients are empowered to be involved in the decision-making process. Dr. Phulwani actively participates with members of Medical Genetics, Urology, Plastic Surgery, Adolescent Gynecology, and Psychology. She also advocates extensively for these patients at the local, regional, and national levels.

Glycogen Storage Disease (GSD) & Disorders

of Hypoglycemia Program: The mission of this internationally known program, headed by Dr. RibaWolman, is to provide dedicated care and diagnostic evaluation for patients with disorders of hypoglycemia and also provide the best evidence-based care for patients with glycogen storage diseases. Dr. RibaWolman is involved in international collaborations and gives national/international presentations in this realm. She has established the GSD outpatient program at Connecticut Children’s and has expanded this clinic to include all conditions involving hypoglycemia. A dedicated medical support team for this program includes Karen Loechner, MD, PhD, Julieta Bonvin Sallago, MD, Amber Barry, RN, as well as Malaya Mount, RD, a metabolic nutritionist with a very extensive background in GSD and GSD-related research. This program provides comprehensive care to patients with multiple etiologies of hypoglycemia, with special attention to patients with glycogen storage diseases and ketotic hypoglycemia. Internationally recognized gene therapy trials in GSD are underway as described in the “Research” section of this annual report.

Center for Rare Bone Disorders: This international center for all types of rare bone disorders was established

at Connecticut Children’s by Dr. Germain-Lee in 2016 and has built upon her long-standing clinical care and translational laboratory research in this area. Dr. Germain-Lee was appointed by the State Legislature to serve on the Rare Disease Advisory Council, and she also serves on the Scientific Advisory Panel of the Rare Bone Disease Alliance, the Scientific Advisory Board of the Osteogenesis Imperfecta (OI) Foundation, and the International Expert Consensus Panel on Pseudohypoparathyroidism and Related Disorders. Through her work as vice president of the Human Growth Foundation, she focuses on expanding education, advocacy, and research for those with rare bone and growth disorders. She is a long-time advocate for patients with rare bone and rare endocrine disorders at the local, regional, national, and international levels and is also involved in advancing research in the state as an elected member of the Connecticut Academy of Science & Engineering. This center includes Nancy Dunbar, MD, MPH, Neetu Krishnan, DO, Laleh Ardeshirpour, MD, and Karen Loechner, MD, PhD, all of whom have expertise in bone disorders and who have specific areas of focus within rare bone disease (to be described). The center combines clinical care, clinical research, clinical trials, and basic science research, while at the same time working to improve the health and quality of life of patients and discover potential new therapies. The Center’s faculty give talks and webinars locally, regionally, nationally, and internationally on rare bone disorders.

Under the umbrella of the Center for Rare Bone Disorders are two subcenters:

• Albright Center: This is the first and only center dedicated to Albright hereditary osteodystrophy (AHO) worldwide, and it focuses on the two subtypes of the condition referred to as pseudohypoparathyroidism type 1A and pseudopseudohypoparathyroidism. Dr. GermainLee moved this center to Connecticut Children’s from Johns Hopkins and Kennedy Krieger Institute seven years ago and has evaluated the largest population of patients with AHO worldwide. Patients travel to Connecticut from throughout the United States and from other countries. Dr.

Germain-Lee is an NIH-funded investigator and has developed a bedside-to-bench research program focused on these patients as well as her knockout mouse model for AHO. Dr. Krishnan’s fellowship research with Dr. Germain-Lee involved this bedside-to-bench approach, and Dr. Krishnan was a joint first author on a 2023 publication from this work. Dr. Krishnan is now a part of this center and is active providing care to AHO patients as well as currently conducting clinical research with Dr. Germain-Lee. (Please see “Research” section.)

• Center for Osteogenesis Imperfecta (OI): This center was established in 2016 with Dr. Germain-Lee’s move to Connecticut, and it is codirected by Dr. Germain-Lee and Dr. Dunbar. The Connecticut Children’s OI Center is recognized officially by the OI Foundation and is a premier site in New England and the mid-Atlantic for patients with OI to be evaluated and treated. This center provides clinical care including state-ofthe-art DXA scan and infusion therapy capabilities as well as education and support sessions to patients and their families. A virtual group was initiated in 2022 by Drs. Dunbar and Menendez for Spanish-speaking patients. Dr. Loechner, who has extensive experience in OI, became a part of this center in 2022 upon her arrival at Connecticut Children’s. As will be discussed further within the “Research Section,” Drs. Loechner and Dunbar are currently investigators for a clinical trial in OI through Ultragenyx involving an exciting potential new therapy. As of 2022, Dr. Loechner is an offsite principal investigator on a philanthropic grant studying OI, funded as part of the Marcus Pediatric Cellular Therapies Award through Children’s Healthcare of Atlanta and Emory University. Dr. Germain-Lee has an established translational research program that includes both clinical research studies as well as basic science laboratory investigations utilizing mouse models of OI, and she is working toward developing novel treatments for this condition.

Metabolic Bone Clinic: Dr. Dunbar directs this clinic at Connecticut Children’s and Shriners Hospitals for

Children® in Springfield, MA. The clinic focuses on all forms of bone disorders as well as disorders of mineral metabolism. Additionally, Dr. Dunbar has developed a focus on bone loss in children with various physical impairments. She is a certified clinical densitometrist through the International Society for Clinical Densitometry, permitting her to provide official interpretations of DXA scans (for evaluation of bone mineral density) using the state-of-the-art DXA machine at Connecticut Children’s. She also provides these services to all other divisions. She has national recognition through her role on the Editorial Board of the Journal of the Endocrine Society. Drs. Loechner, Ardeshirpour, Dunbar, Germain-Lee, and Krishnan are also involved with patients with various metabolic bone disorders, participate in the Pediatric Endocrine Society Bone and Mineral Working Group, and have been actively involved in working groups within the American Society of Bone and Mineral Research.

Global Health: Dr. Dunbar was crucial in developing a type 1 diabetes clinic in Haiti, and she, along with Comalita Elliott, RN, CDE, have been working with local pediatric staff at Hôpital Sacré Coeur in Milot. Her continued efforts have helped to support the needs of the program and make it long-standing. Dr. Dunbar has made a significant impact on the improvement of diabetes care within this program based on quantitative measures, and even in the midst of the worst of the pandemic, she maintained communication with the staff at Hôpital Sacré Coeur.

Lipid Disorders Clinic: Dr. Sura heads up this unique and important clinic, which has been fully running over the past five years. This clinic also provides care from a specialized pediatric nutritionist, and it continues to expand its breadth each year. It is one of the few lipid clinics in the country that is within a pediatric endocrinology division and focused solely on the management of childhood lipid disorders. Dr. Sura is a member of the National Lipid Association and has given grand rounds and other talks educating practitioners on the management of lipid disorders. She received her American Board of Clinical Lipidology certification from the National Lipid Association, and she is part of the Pediatric Endocrine Society’s Lipid Special Interest Group. Dr. Sura is active

in educating the community as well as the institution in appropriate guidelines for managing lipid abnormalities.

Endocrine Tumors and Cancer Survivorship: Dr. Riba-Wolman is an active member of the New England Childhood Cancer Consortium and is well known for her expertise within New England and beyond. As the Director of Endocrine Oncology at Connecticut Children’s, she receives referrals from throughout the region with an ever-expanding clinic. She is also the endocrinologist for the REACH for the STARS Cancer Survivorship Program, a multidisciplinary clinic in the HematologyOncology division for long-term survivors of childhood cancer. In addition, Dr. Riba-Wolman is a crucial member of the Neuro-Oncology Program, a multidisciplinary clinic involving Oncology, Neurosurgery, and Endocrinology at Connecticut Children’s. She has embarked on clinical research in areas involving endocrine disorders observed in children with cancer.

Pediatric Thyroid Center: This multidisciplinary approach for treating thyroid nodules and thyroid cancer, involving Endocrinology, Pediatric Surgery, Pathology, Radiology, and Nuclear Medicine, is headed up by Dr. Bilbao and is in close collaboration with Dr. Riba-Wolman, who is the Director of Endocrine Oncology, and Dr. Finck. Dr. Bilbao has increased the footprint of this thyroid clinic with continued regional expansion. She has been very active in maintaining updated treatment standards and revised the Connecticut Children’s CLASP guidelines for thyroid nodules this year. Dr. Bilbao is active in the American Thyroid Association and has started to make headway in active research in this area.

Turner Syndrome Clinic: Dr. Loechner serves as director of the Turner Syndrome Clinic, initially established by Karen Rubin, MD, an international expert in this condition (and division head prior to Dr. Germain-Lee). This clinic involves a highly specialized interdisciplinary team, including a nutritionist, psychologist, and nurse, all of whom have expertise specifically in this disorder. Dr. Loechner has developed recognition in the field in leading the bone health section for the “Adult Comorbidity” group with her attendance at the June 2023 meeting in Denmark. With this work, she is actively involved in

outlining international guidelines for bone health in Turner Syndrome and is also a member of the Pediatric Endocrine Society Turner Special Interest Group.

Obesity: Drs. Trapp, Menendez, and Phulwani have clinical and research interests in obesity. Dr. Trapp’s national recognition in the field is exemplified by her involvement in the Pediatric Endocrine Society’s Special Interest Group, having been Co-Chair of the group from 2019-2022. Her specific interests include the obesity associated with type 2 diabetes mellitus, co-morbidities secondary to obesity, and conditions involving early onset obesity, specifically Prader-Willi and BardetBiedl syndromes. She is a member of the IMCIVREE (Setmelanotide) Early Experience Council (sponsored by Rhythm Pharmaceuticals). Dr. Menendez is involved in translational research on adipocyte pathophysiology with the mentorship of Dr. Finck, and she has a focus on DEIdirected clinical work and research in obesity. Dr. Phulwani is involved clinically in the area of obesity and serves as the endocrinologist in the multidisciplinary Bariatric & Weight Management Clinic housed in the department of Surgery and directed by Dr. Finck. Finally, Dr. Raul Arguello and Dr. Nordie Bilbao, who practice at our Danbury and Shelton specialty care centers sites, evaluate a significant number of patients referred for obesity in Fairfield County.

Adrenal Disorders: Dr. Loechner has a specific interest in adrenal disorders, stemming from her past research in the area. She is on the Medical Advisory Board for the CARES Foundation to help patients with congenital adrenal hyperplasia (CAH) through education and research, and she has been a part of the adrenal workgroup for the Ultragenyx GSD trial (described under “Research”). All providers within endocrinology are active in seeing patients with adrenal disorders.

Connecticut Newborn Screening Program: Through the tremendous efforts of Dr. Karen Rubin, past division head for Endocrinology & Diabetes, Connecticut Children’s is the site of the state’s Newborn Screening Network. This program provides important clinical needs as well as important research investigations, and Dr. RibaWolman in our division has been key to the success of the endocrinology division’s role within the state’s newborn

screening program along with our team of dedicated nurses.

Diversity, Equity, and Inclusion (DEI) Initiatives: Many efforts have been made in this area within the division. In addition to recognized efforts as mentioned in the sections above, this is also described within the following section on Research.

BASIC SCIENCE & TRANSLATIONAL RESEARCH (INCLUDING CLINICAL TRIALS)

The research performed in the division is integrally involved with the Connecticut Children’s Research Institute (CCRI), specifically within the realms of rare diseases and bone biology, given the national and international programs in glycogen storage disease, rare bone disorders, and other rare diseases that are seen within the division. The Scientific Center for Rare Disease for CCRI is headed by Dr. GermainLee, whose entire career has been focused on rare diseases. She is working alongside co-director, Carolyn Macica, MS, PhD (Director of Research Operations & Development at Connecticut Children’s), who also has had a long-term commitment to research and advocacy in rare diseases with specific expertise in rare bone disorders. In addition, there are extensive collaborations with the University of Connecticut School of Medicine and School of Dental Medicine, which is where all laboratory-based research is conducted, and where there are extensive resources for translational and basic science research. Collaborations with the Jackson Laboratory in both Farmington and Bar Harbor are also ongoing along with recent clinical research collaborations with the Institute for Collaboration on Health, Intervention, and Policy (InCHIP) at UConn.

Glycogen Storage Disease (GSD)

• Clinical Trials: The largest multinational site for gene therapy in GSD is headed by Dr. Riba-Wolman as principal investigator (PI) with Dr. Loechner as sub-PI. The first trial of gene therapy for Glycogen Storage Disease (GSD) Type Ia began in July 2018 with David Weinstein, MD, MMSc, as PI and with Connecticut Children’s/ University of

Connecticut as the lead site. Since Dr. Weinstein’s departure and the transition to Dr. Riba-Wolman as the PI in 2020, our site remains the largest in a multinational trial sponsored by Ultragenyx involving the safety and efficacy of adenoassociated virus (AAV) serotype 8-mediated gene transfer of glucose-6-phosphatase in adults with GSD Type Ia. Dr. Loechner joined these efforts as sub-PI in November 2021 with her recruitment to Connecticut Children’s. Utilizing new mRNA-based technology and with the sponsorship of Moderna, Dr. Loechner also leads Moderna’s novel Phase I clinical trial for GSD Ia as PI in order to determine if mRNA infusions are both safely tolerated and efficacious. A repository and other studies for GSD are under the direction of Drs. Riba-Wolman and Germain-Lee. Of note is that Dr. Riba-Wolman is very active in clinical research involving GSD and other hypoglycemic disorders along with her colleagues, Drs. Loechner and Bonvin Sallago, and Malaya Mount, RD.

• Laboratory Research: Under the direction of Youngmok Lee, PhD, basic science director for GSD, the laboratory focuses on two types of preclinical research for GSD-Ia, GSD-Ib, GSDVI, and GSD-IX using disease model animals, including, 1) the elucidation of pathological mechanisms underlying the complications of GSDs, such as liver cancer, steatosis, and fibrosis as well as immune cell dysfunction; and 2) the development of new gene therapy technology and evaluation of its efficacy and safety. The goal of the research is to understand the pathogenesis in GSDs and to develop new therapeutic strategies for treatment. His investigations are being conducted in the laboratory facilities at the University of Connecticut Cell and Genome Sciences building.

Rare Bone Disorders including Bone Biology

Dr. Germain-Lee’s bedside-to-bench research program is focused on the molecular, cellular, and physiological mechanisms underlying the pathogenesis of diseases affecting the endocrine system with a particular focus on rare bone disorders. Dr. Germain-Lee’s

overarching goal in her laboratory within the Center for Regenerative Medicine and Skeletal development at UConn Health is to develop new therapies and improve the health and quality of life for children and adults with these disorders. In addition, she has ongoing clinical research at Connecticut Children’s involving these same disorders. Through this translational research, she has built an extensive clinical and basic science research program that has also provided insights into general bone biology, given that the focus on rare bone disorders has shed light on fundamental pathways and processes.

During this past year, Dr. Germain-Lee has furthered her work in several areas. Her group has continued investigations of the pathophysiology of Albright hereditary osteodystrophy (AHO), a rare bone condition caused by heterozygous inactivating mutations in GNAS, a gene that encodes a key signaling component utilized by many G protein-coupled hormones. A major focus of her laboratory’s research during the past year has been to continue their investigations of the role of GNAS in regulating overall bone homeostasis, including the mechanisms underlying the development of heterotopic subcutaneous ossifications caused by loss-of-function mutations in GNAS as well as the aberrant bone regulation that contributes to craniofacial abnormalities occurring in Albright hereditary osteodystrophy. With Dr. Krishnan, Dr. Germain-Lee is conducting clinical studies involving investigations of bone mineral density as well as craniofacial/dental abnormalities in AHO.

In addition, Dr. Germain-Lee is collaborating with Se-Jin Lee, MD, PhD, (who holds a joint position at the University of Connecticut School of Medicine and the Jackson Laboratory) examining the role of the myostatin/activin A signaling pathway in regulating both muscle and bone. In recent studies, they have shown that targeting key receptors for myostatin and activin A can lead to dramatic increases in both muscle and bone mass. They are pursuing strategies to target this signaling pathway for applications in bone, muscle, and metabolic disorders. Dr. Germain-Lee is currently a PI with Dr. Lee on an NIH R01 grant to

continue work examining this pathway in bone. Finally, Dr. Germain-Lee and Dr. Lee are PIs on an NIH R21 grant investigating extragonadal functions of follicle stimulating hormone (FSH), specifically in regulating bone density and adiposity. Given that FSH secretion is regulated by activin A and that FSH utilizes G proteincoupled signaling, this project directly relates to many of the other projects that Dr. Germain-Lee is conducting regarding the signaling pathways in Albright hereditary osteodystrophy. The goal of this project is to develop the best strategies to target FSH signaling to treat osteoporosis and/or metabolic dysfunction, including diabetes and obesity

Development of Novel Therapeutics: Bone Loss and Muscle Wasting

Research efforts have extended even beyond Earth with Dr. Germain-Lee and her collaborator, Dr. Se-Jin Lee. In 2020, they sent mice to the International Space Station and continue to examine the role of a novel experimental agent that was created by Dr. Lee that can increase both bone and muscle mass. Microgravity causes both bone and muscle loss, as is evident in astronauts during space travel. This mimics the same phenomenon observed in patients who have bone disease, muscle wasting, and chronic illnesses, as well as in those who are elderly. By giving this experimental drug to mice exposed to systemic microgravity, they collaborated with NASA and were able to demonstrate that severe bone and muscle loss were prevented. They were also able to show this previously in 2015 in a mouse model of osteogenesis imperfecta (OI). This experimental molecule has the potential for therapeutic use not only in astronauts in space but also in many patients here on Earth who suffer from either musclewasting disorders, bone fragility disorders (including OI), or both.

Clinical Trials in Rare Bone Disorders

Drs. Loechner and Dunbar are involved in a phase 3 clinical trial on OI (sponsored by Ultragenyx), specifically involving a new drug to treat the bone fragility that is well known to be a major problem in patients with this disorder. In addition, Dr. Loechner is

the off-site PI on a foundation grant from Children’s Healthcare of Atlanta/Emory University (Marcus Pediatric Cellular Therapies Award) and is studying the role of mesenchymal stem cells on linear growth and bone health parameters in children with OI. Drs. Dunbar and Germain-Lee are involved in natural history studies involving hypophosphatasia (located at both Connecticut Children’s and Johns Hopkins respectively), another disorder involving poor bone mineralization. Dr. Dunbar has initiated work on a clinical trial involving a novel treatment modality for this condition, and she has given national talks on this condition. In addition, Drs. Dunbar and Ardeshirpour have specific interests in X-linked hypophosphatemia and have both been active in presentations and publications on this condition.

Sturge-Weber Syndrome

In addition to Dr. Germain-Lee’s research on AHO and OI, she has also been investigating the clinical/ hormonal phenotype in patients with Sturge-Weber Syndrome (SWS) over more than two decades. Working with Anne Comi, MD (Johns Hopkins University School of Medicine and Kennedy Krieger Institute), they were the first to demonstrate that these patients have a multitude of hormonal abnormalities. These findings are particularly significant in that SWS has been shown to result from somatic activating mutations in the gene encoding a specific G protein, GNAQ, raising the possibility that the hormonal abnormalities identified may be a subset of a wider spectrum of endocrine dysfunction. Additionally, Dr. Germain-Lee has collaborated with Dr. Comi on preliminary studies on a mouse model of SWS.

Diabetes and Metabolism

Drs. Demirci and Trapp are mentoring Dr. Figgie (2nd year fellow) in collaboration with Rebecca Puhl, PhD, from the Institute for Collaboration on Health, Innovation, and Policy (InCHIP) at UConn on a project investigating the prevalence of weight bias internalization and disordered eating behaviors in children and adolescents with type 1 diabetes mellitus. Dr. Demirci also has an ongoing collaboration with

Derya Unutmaz, MD, a researcher at the Jackson Laboratory, to investigate the intestinal microbiome and the link between food, microbes, and diabetes with the ultimate goal of finding which genes are turned on and off as a result of the interaction between the microbiome and the immune system. Dr. Demirci has recently started a collaboration as the clinical lead with Michael Stitzel, PhD, a basic scientist at the Jackson Laboratory who is conducting genomics-related research in type 1 DM.

Dr. Germain-Lee is conducting basic science research in diabetes and metabolism in her laboratory at UConn Health. In collaboration with Dr. Se-Jin Lee, she has been carrying out two projects aimed at discovering new strategies to reduce adiposity and improve glucose control. In one project, which is funded by Versanis, they are investigating the mechanisms by which members of the TGF-ß family of signaling molecules regulate body fat. In the second project, which is partly supported by a grant from the NIH, they are investigating the roles of these proteins in regulating the ability of the pancreas to produce insulin as well as to improve the responsiveness of peripheral tissues to insulin. The overall goal of this research is to find novel therapeutic approaches to treat metabolic diseases, including diabetes and obesity.

Obesity

In addition to research in metabolism as discussed in prior sections, important research investigating the role of inflammatory cytokine expression and adipose tissue dysfunction in obesity is underway by Dr. Menendez in the laboratory of Dr. Finck at UConn Health. Dr. Menendez is also evaluating the association of certain health risks with obesity, specifically in adolescents, which has been markedly understudied overall. She is combining these investigations with her research in DEI, as research is greatly impacted overall by the breadth of participant recruitment.

Adrenal

Dr. Loechner is the site principal investigator with Dr. Bilbao as co-investigator for an industry-sponsored Phase III trial (CAHtalyst Pediatric Study, Neurocrine

Biosciences) that is testing a new pharmacologic agent for its ability to treat children with congenital adrenal hyperplasia.

Diversity, Equity, and Inclusion

Diversity, equity, and inclusion (DEI) has been a focus of Dr. Menendez’s research. In fact, this ties in with her current translational research in obesity in which she is investigating a diverse group of patients in order to tie DEI into studies being performed in the laboratory, which is necessary for pediatric translational research to be carried out appropriately and without

bias. Dr. Menendez is part of DEI advocacy initiatives with Connecticut Children’s, UConn, and the Pediatric Endocrine Society. She is currently following a leadership track in DEI that was initiated by UConn Health in order to become a leader in the field and gain expertise in promoting clinical and translational research in minorities who usually do not feel comfortable being recruited for research projects. Of note is that Dr. Menendez was awarded the Pediatric Endocrine Society Spring Fellow Award and received the honor of being invited to participate in the Excellence in Clinical Endocrinology Leadership program (ExCEL) as an ExCel fellow this past year.

FEDERAL GRANTS

NIH

NIH R01 AR081659 – Principal Investigators: Emily L. Germain-Lee, MD and Se-Jin Lee, MD/PHD. Extracellular regulation of bone mass by transforming growth factor- -related ligands and their binding proteins. 7/21/22 – 06/30/27.

NIH R21 AG077792 – Principal Investigators: Emily L. Germain-Lee, MD and Se-Jin Lee, MD/PhD. Elucidating extragonadal functions of follicle stimulating hormone using genetic approaches in mice. 9/1/22 –6/30/24.

OTHER GRANTS

Industry Grants

Versanis – Principal Investigator: Se-Jin Lee, MD/PhD; Co-investigator: Emily L. Germain-Lee, MD. Tissue targets in the regulation of adiposity by myostatin and related ligands. 11/2/2023 –11/1/2025.

University of Connecticut

University of Connecticut CRISP Award – Principal Investigator: Olga Salazar, MD; Co-investigator: Emily L. Germain-Lee, MD. Role of transforming growth factor-ß-signaling pathway on cardiotoxicity from chemotherapeutic agents. 5/1/23 – 8/31/24.

Philanthropic Foundation Grants

Marcus Pediatric Cellular Therapies Award – Off-site Principal Investigator: Karen Loechner, MD/PhD. (Main site: Children’s Healthcare of Atlanta/Emory University). Role of mesenchymal stem cells on linear growth and bone health parameters in children with osteogenesis imperfecta (OI). 10/1/22 – 09/30/26.

PUBLICATIONS

Krishnan N, McMullan P, Yang Q, Buscarello A, GermainLee EL. (2023) Prevalence of Chiari malformation type 1 is increased in pseudohypoparathyroidism type 1A and associated with aberrant bone development. PLOS ONE 18(1):e0280463. doi: 10.1371/journal. pone.0280463. PMID: 36662765.

Malina SN, Flanagan J, Loechner KL, Wu M. (2023) Access to care among patients with osteogenesis imperfecta during the COVID 19 pandemic. Archives of Osteoporosis. 18:143 https://doi.org/10.1007/ s11657-023-01355-2.

Islam N, Hathaway KL, Anderson BS, Sharp WG, Loechner KJ. (2023) Brief report: Decreased bone health in children with autism spectrum disorder and avoidant restrictive food intake disorder. J Autism Dev Disord. PMID: 37179523.

Parmar K, Mosha M, Weinstein DA, Riba-Wolman R. (2023) Fasting ketone levels vary by age: implications for differentiating physiologic from pathologic ketotic hypoglycemia, J Pediatr Endocrinol Metab. 10.1515/ jpem-2022-0589. PMID 37160789.

Trapp CM, Censani M. (2023) Setmelanotide: a promising advancement for pediatric patients with rare forms of genetic obesity. Curr Opin Endocrinol Diabetes Obes. 2023 Feb 2. Epub ahead of print. PMID: 36722447.

Schigt H, Bald M, van der Eerden BCJ, Gal L, Ilenwabor BP, Konrad M, et al (Trapp C, 7/15). (2023) Expanding the phenotypic spectrum of KennyCaffey syndrome. J Clin Endocrinol Metab. 2023 Aug 18;108(9):e754-e768. doi: 10.1210/clinem/dgad147. PMID: 36916904.

STAFF

Emily L. Germain-Lee, MD, Division Head

Cem Demirci, MD, Clinical Director & Director, Diabetes Program

Rebecca Riba-Wolman, MD, Director, Glycogen Storage Disease & Disorders of Hypoglycemia Program; Fellowship Program Director (until 9/30/23)

Sunitha Sura, MD, Fellowship Program Director (10/1/23- present)

Christine Trapp, MD, Fellowship Associate Program Director

Youngmok Lee, PhD, Basic Science Director, Glycogen Storage Disease Program

Laleh Ardeshirpour, MD

Raul Arguello, MD

Nordie Bilbao, MD

Nancy Dunbar, MD, MPH

Neetu Krishnan, DO

Karen Loechner, MD, PhD

Ana Menendez, MD (as of Oct, 2023)

Priya Phulwani, MD

Misha Sodhi, MBBS

Carey Driscoll, APRN, CPNP

Maureen Fearon, APRN, FNP-BC, MSN

Elena Schneider, PA-C

Alexandra Dube, APRN, FNP, MSN

Fellows

Ana Menendez, MD (graduated Aug, 2023)

Caroline Figgie, MD

Kelly Smith, MD

EXCELLENCE IN PATIENT SAFETY & CLINICAL QUALITY

The Division of Excellence in Patient Safety and Clinical Quality strives to support Connecticut Children’s partnerships with patients, families, and communities using evidence-based models marching towards zero-harm, highest quality, world-class outcomes in a culture based on equity, continual improvement, and compassionate care through the integration of patient safety and quality across the institution. Their goal is to act as one team accelerating the transformation of people and systems to become nationally recognized for patient safety and quality, thereby enabling the vision of Connecticut Children’s in transforming children’s health and well-being as one team. We work to drive our culture of safety to the standard of zero-harm, to teach methods of improvement, and to use research to inform our programmatic efforts and innovations..s

In 2023, the division faculty continued to lead safety and improvement efforts across the organization, playing a role in each aspect of the organization’s Health Compass 2027 goals and objectives, and continuing to receive local, regional and national recognition for their work impacting the quality and safety of care for children. In recognition of this, Division Head Lori Pelletier, PhD, MBA, received the inaugural investiture of the Popik Family Endowed Chair for Quality and Patient Safety. Under her leadership and with the support of this endowment, the Popik Family Quality and Patient Safety Fellowship was created, with the goal of enabling the development of physicians and advance practice providers as quality and safety leaders in the organization through the augmentation of improvement science fundamentals and organizational excellence training with additional quality and patient safety operational and leadership knowledge and experience. The inaugural class of 14 Popik Family Quality and Patient Safety fellows enrolled in October, 2023 for a 2 year program with Heather Tory, MD, MPH, as the Program Manager. All of the division faculty members continued to support the promotion and expansion of Organizational Excellence mindset

and methodology in the institution through completion of the 3.0 and 4.0 training programs and acting as coaches and facilitators for the Popik Family QPS Fellows and Organizational Excellence 3.0 participants.

In promoting advancements in delivering the highest quality of patient care and striving for zero preventable harm for children, many of the division faculty members engaged with Solutions for Patient Safety (SPS) in reducing harm associated with various hospital acquired conditions, including: Natalie Bezler, MD, Sherene Mason, MD, MBA, Jessica Williams, MD, and Dr. Tory (medication safety and adverse drug events); David Sink, MD and Jessica Winters, MD, (unplanned extubations and catheter-associated urinary tract infections); and the newly formed SPS pilot initiative in addressing ambulatory patient safety (Logan Jerger, MD).

The Simulation Program at Connecticut Children’s, under the leadership of Carla Pruden, MD, MPH, continues to provide far-reaching impact across our network, enhancing the preparedness of clinical teams in all care locations for emergency resuscitation needs, in addition to advanced planning for new locations and service lines. Mariann Kelley, MD, assists with the Simulation Program activities, and additionally has continued work leading emergency preparedness and responses across the institution, promoting zero-harm through reductions in out of ICU codes, enhancements to our early detection of clinical deterioration and rapid response programs, and improvements in the quality of resuscitation efforts.

Brendan Campbell, MD, MPH, continued his leadership of the expansive surgical quality improvement programs, including overseeing the National Surgical Quality Improvement Program at Connecticut Children’s, our organization’s Children’s Surgery Verification through the American College of Surgery, and our accreditation as a level 1 Pediatric Trauma Center.

To promote and facilitate the use of best practice evidence-based guidelines to deliver the highest quality of care to patients across our network and region, the Clinical Pathways Program, under the leadership of

Ilana Waynik, MD, and the team of Grace Hong, APRN, Jill Herring, APRN, and Eric Hoppa, MD, continued to provide robust and highly sought pathways for the care of more than 50 pediatric conditions, spanning phases of care. The team has also worked to continue advancing the processes for automation of quality metric design, collection, and utilization for ongoing improvements and enhancements. The ambulatory comanagement program Connecticut Children’s Leaders in Advanced Solutions in Pediatrics (CLASP) has also continued to have success and expansion of impact via new processes of continual improvement focusing on direct input and engagement with pediatricians across the state. Dr. Hoppa was also recognized for his impact on quality improvement by engagement with the Clinical Pathways Program and local improvement work in the Emergency Department as the recipient of the 2023 Physician Quality Cup Award by the Medical Staff.

At the national level, Dr. Waynik continues to be a leader and founding steering committee member of the first national evidence based program group Pathways 4 Kids, aiming to optimize clinical outcomes for all pediatric patients via collaborative sharing of best practices for clinical pathway development, implementation and measurement strategies. A key component of the Clinical Pathways Program is the ongoing alignment and collaboration with the Antimicrobial Stewardship Program, which continues to provide ongoing support, guidance and innovative methods for incorporating best practices into antibiotic treatment decisions, under the leadership of Jennifer Girotto, PharmD.

Members of the division also participated in a wide array of other quality improvement-related activities and research, as represented in the publications and presentations below, including Tze Chiam, PhD, in utilizing novel approaches for quality measurement and use of predictive analytics to facilitate quality improvement and adaptation of care models, for which he was invited for multiple national presentations this year, and Dr. Golden in facilitation of the organizational excellence programs and continual improvement aspects of the division.

The work of the faculty of the Division of Excellence in Patient Safety and Clinical Quality, with multidisciplinary partnership, has been instrumental in organizational efforts to continue providing highest quality and safest care to our patients, and we look forward to ongoing efforts to promote the quality of care for patients throughout the region and nation in the coming year.

PUBLICATIONS

Bahalkeh E, Chiam TC, Yih Y. (2023). An interpretable clustering classification approach for assessing and adjusting hospital service lines. Healthcare Analytics. 4(6): 100255.

Boudreaux, E.D., Larkin, C., Vallejo Sefair, A., Ma Y., Ibrahim, A., Zeger, W., Brown, G., Pelletier, L., Miller, I. EDSAFE 2: Process Improvement for Suicide Prevention in the Emergency Department, JAMA Psychiatry (May 2023). doi:10.1001/jamapsychiatry.2023.1304.

Boudreaux, E.D., Larkin, C., Vallejo Sefair, A., Mick, E., Clements, K., Pelletier, L., Yang, C., & Kiefe, C. Studying the implementation of Zero Suicide in a large health system: Challenges, adaptations, and lessons learned, Contemporary Clinical Trials and Communications (2022), 10.1016/j.conctc.2022.100999.

Freeman RE, Qi YS, Geller RJ, Cohen AR, Iyer SS, Waynik IY, Sullivan AF, Camargo CA Jr. Parental Mental Health and Childhood Respiratory Outcomes in a Severe Bronchiolitis Cohort. Clin Pediatr (Phila). 2023 Oct;62(9):1067-1079. doi: 10.1177/00099228221150608. Epub 2023 Jan 30. PMID: 36715245.

Manchester, Gertrude W.; Donahue, Deirdre C.; Kiefe, Catarina I.; Pelletier, Lori; Sosa, Marie A.; and Keitz, Sheri A. (2023) “Measuring Blood Pressure in Primary Care for Accurate Diagnosis and Decision Making: Implementing Evidence-based Protocols Across a Health System,” The Lahey Journal: Vol. 1: Iss. 1, Article 4. Available at: https://journal.lahey.org/tlj/vol1/iss1/4

Schissler K, Stewart S, Phamduy T, Brimacombe M, Waynik I, Hoppa E. High-Risk Markers and Infection

Rates in Febrile Infants Aged 29 to 60 Days Presenting to an Emergency Department During the COVID-19 Pandemic. Pediatr Emerg Care. 2023;39(11):895-899. doi:10.1097/PEC.0000000000002968.

ORAL PRESENTATIONS

Chiam TC. From Stopwatch to Strategy – How Industrial Engineering adds Value to Healthcare Delivery. September 2023. Purdue University. West Lafayette, IN. (Invited)

Chiam TC. From Stopwatch to Strategy – How Industrial and Systems Engineering adds Value to Healthcare Delivery. Temple University. September 2023. Philadelphia, PA. (Invited)

Chiam TC. Prioritizing People and Culture to Empower Future Leaders. Chief Data Officer Network conference. September 2023. Newark, NJ. (Invited)

Chiam TC, Pelletier L. Multi-method approach to predicting and creating capacities for winter surge volumes at a Children’s Hospital. Informs Healthcare. July 2023. Toronto, Canada.

Lewis EC, Waynik I, Turcotte L Get to the Point! Preventing Pain in Venous Access Procedures. Pediatric Hospital Medicine Annual Conference. August 2023. Philadelphia, PA.

Pelletier L. Mindset in Healthcare Transformation. An Invitation to Think Differently. Lahey’s President’s Series on Learning Health Systems. Lahey Hospital and Medical Center. Burlington, MA. May 2023.

Pelletier L. “Sustainability in Healthcare: Is it a System, a Tool, a Mindset or Impossible?”, 35th Annual Shingo Conference, Provo, Utah. May 2023.

Waynik I, Hong, G. The Lung and Short of Current Community Acquired Pneumonia Management. Pediatric Podcast Pearls Educational Series. Connecticut Children’s Virtual content.

Waynik I. Utilization of Quality Improvement Strategies to Increase Topical Anesthetic Use for Venous Access

Procedures. ChildKind International Webinar. June, 2023. Virtual.

Waynik I. Utilization of Quality Improvement Strategies to Increase Topical Anesthetic Use for Venous Access Procedures. Pain Week Presentation. Connecticut Children’s. September, 2023.

Waynik I. Improving Topical Anesthetic Use for Venous Access Procedures. Illuminations Patient Safety and Quality Conference at Connecticut Children’s Medical Center. June 2023. Hartford, CT.

Williams J, Sander P, Tory H. Indication-Based Dosing Decision Support for the 6th Right of Medication Safety? Epic User Group Meeting. August, 2023. Verona, WI.

STAFF

Lori Pelletier, PhD, MBA, Division Head

Natalie Bezler, MD

Brendan Campbell, MD, MPH

Tze Chiam, PhD

Jennifer Girotto, PharmD

Alex Golden, MD, MMM

Jill Herring, APRN

Grace Hong, APRN

Eric Hoppa, MD

Logan Jerger, MD

Mariann Kelley, MD

Sherene Mason, MD, MBA

Carla Pruden, MD, MPH

David Sink, MD

Heather Tory, MD, MPH

Ilana Waynik, MD

Jessica Williams, MD

Jessica Winters, MD

GENERAL PEDIATRICS

The Division of General Pediatrics is committed to fostering optimal health and well-being of children, families and communities, and the education of the next generation of pediatricians.

To realize this mission, we provide exceptional clinical care in partnership with families, teach evidencebased clinical pediatrics to future pediatric healthcare providers, and pursue original research and vigorous advocacy around issues important to children, families and the public. Our activities place special emphasis on caring for children with special healthcare needs, including disadvantaged children, children growing up in low-income families, and children with complex and chronic health conditions.

In 2023, the Division of General Pediatrics celebrated the first full year of operation of our newest primary care office in Hartford (Primary Care South). Together with Primary Care East (East Hartford), West (Farmington), and the Burgdorf/Bank of America Health Center, the Division continues to provide pediatric care for most of Hartford’s children. Members of the Division provide ambulatory care to infants, children, adolescents, and young adults, as well as inpatient care in the newborn nurseries at Hartford Hospital in Hartford, CT, and John Dempsey Hospital/University of Connecticut Health Center in Farmington, CT, and inpatient consultation at Connecticut Children’s for children with lead poisoning. Our ambulatory services include health supervision, behavioral health care, chronic disease management, and same-day illness care using an NCQA-certified patient centered medical home model. The division houses innovative, community-wide clinical programs such as the Connecticut Children’s Lead Treatment Program and the Reach Out and Read early literacy program. Division faculty have gained regional and national prominence for clinical research, education, and program development in the fields of lead poisoning and prevention, integrated behavioral health, early obesity prevention and emergent literacy promotion. Supported by the Office for Community Child Health and funding from the Help Me Grow National Center, the division

completed a learning community pilot to enhance goal concordant care and is continuing in the next phase in 2023-2024.

This year marks the retirement of Jaye Ladinsky, MD, who has provided primary care for countless children in the region for over 32 years and the departures of Amira Mohamed-Ahmed, MD, and Esther Oziel, MD, to explore new opportunities. We congratulate Jody Terranova, DO, MPA, on her appointment as Deputy Commissioner in the Department of Public Health in January 2023; she now oversees Community, Family Health, and Prevention, Health Statistics and Surveillance, Infectious Diseases and the Public Health Laboratory, and Dr Anton Alerte’s transition to Associate Dean for Primary Care in the School of Medicine.

Faculty members in the division play a central role in education in the University of Connecticut system by providing the majority of pediatric primary care and newborn nursery educational experiences for medical students and pediatric residents in the region. Rotating learners from UConn and other institutions include family practice, dental, and psychiatry residents, and students from nurse practitioner, physician assistant and medical assistant programs. Division members serve on a wide variety of hospital, university and state committees. Membership on national committees includes the Reach Out and Read National Medical Advisory Committee (division head Catherine Wiley, MD), and the Society for Pediatric Dermatology Education Committee and the American Academy of Pediatrics Section on Dermatology Education Committee (Keri Wallace, MD). Dr. Wallace continues her work as core faculty lead to develop and restructure the pediatric dermatology rotation and curriculum. Research interests in the division include emergent literacy, cultural competence, immunization, food insecurity and obesity prevention, and screening in primary care. Division members collaborate in a wide variety of projects, including the Asthma Center’s Easy Breathing© program (Caleb Wasser, DO) and various co-management protocols with Connecticut Children’s pediatric subspecialists.

In response to the COVID pandemic, primary care continues to provide care via telehealth across all sites. Faculty members incorporate residents and medical students into this clinical experience. Andrew Carlson, MD, Medical Director continues his work as a core faculty lead in developing a formal primary care telehealth curriculum, including training via simulation. Division members also supported the Connecticut Children’s response to the respiratory illness surge by providing care in the Connecticut Children’s Emergency Department and in Urgent Care.

Monica Joyce-Montaudy, APRN, serves as Medical Liaison to Eagle House, providing primary care to children in residential psychiatric care as an extension of our partnership with The Village for Families and Children. Jennifer Haile, MD, continues to serve as Medical Director of the Connecticut Children’s Lead Poisoning Prevention and Treatment Center supported by a grant from the Department of Public Health (DPH). Dr. Haile also continues her appointment to the DPH Lead Poisoning Prevention and Treatment Legislative Workgroup and was named a leader for the newly formed Connecticut Children’s Faculty Teaching Academy. Douglas MacGilpin, MD, continues to serve as Medical Director of the Hartford Public Schools. Grael O’Brien, MD, MPH, continues as site director for the Continuity Clinic Research Network (CORNET) of the Academic Pediatric Association and has been active on the UConn School of Medicine Curriculum Reform Committee. Dr. Wiley continues her advocacy work in emergent literacy promotion and is the Medical Director of Reach Out and Read Connecticut. She was appointed to the State of CT Behavioral Health Partnership Oversight Council. Nancy Trout, MD, MPH, serves on the Childhood Obesity Advisor for Continuing Health (COACH) network of the American Academy of Pediatrics Section on Obesity and received the Eastern Society for Pediatric Research Advocacy Award for her project “Evaluation of Food Insecurity and Implementation of a Produce Voucher Program in a Pediatric Emergency Department: A Feasibility Study.” Additionally, Dr. Trout received a subaward from DPH for “Effects of COVID-19 Pandemic on Obesity-related Factors in Young Children.” She also continues her work on grants from Cigna (Healthier

Kids for our Future grant for the “Obesity prevention and Food is Medicine” initiative in the North Hartford Ascend neighborhoods) and Rite Aid (food insecurity screening and voucher program in the Emergency Department). Larry Scherzer, MD, continues his work as Chief of Pediatrics and Medical Director of the Newborn Nursery at John Dempsey Hospital/UConn Health. Amy Signore, PhD, continues her role of Associate Chair of Integrated Primary Care SIG for the Division of Health Psychology of the American Psychological Association. Dr. Signore received a grant from Antioch University to support training in autism evaluation (including the Autism Diagnostic Observation Schedule-Second Edition or ADOS-2) within the primary care integrated medical home.

PUBLICATIONS

Hollenbach J, Collins M, Wasser C, Fedele D. Implementation of standardized asthma management programs in outpatient settings. Annals of Allergy, Asthma & Immunology 2023.

STAFF

Catherine Wiley, MD, Division Head

Anton Alerte, MD

Brooke Bohn, MD

Andrew Carlson, MD, Medical Director

Jennifer Haile, MD, Medical Director, Lead Poisoning Treatment and Prevention Program

Shannon Hogan, DO, MPH

Jaye Ladinsky Horowitz, MD

Abraham Khorasani, MD

Ashok Kottarathara, MD

Douglas MacGilpin, MD

Eileen Mercurio, MD

Lisa Menillo, MD

Amira Mohamed-Ahmed, MD

Grael O’Brien, MD, MPH

Chinyere Okoronkwo, MD, MSc

Aruna Ramanan, MD

Marie Sanford, MD

Larry Scherzer, MD, MPH, Medical Director, John Dempsey Hospital Nursery

Jody Terranova, DO, MPA

Latesha Dawson Thomas, MD, CLC

Nancy Trout, MD, MPH

Keri Wallace, MD

Caleb Wasser, DO

Keri Herlan, PhD

Amy Signore, PhD

Heather Wimmer-Haman, PsyD

Darlene Abbate, APRN

Keith Ellis, APRN

Kimberly Griffith, PA-C

Monica Joyce-Montaudy, APRN

HEMATOLOGY–ONCOLOGY

The Hematology-Oncology Division strives to improve the lives of children with cancer and blood disorders by delivering high-quality family-centered academic health care. We continuously improve what we do through discovery and partnerships. We have three broad areas of focus: Family Centered Care, Quality & Safety, and Research & Teaching.

The Division of Hematology-Oncology has continued to excel in our ability to provide the highest quality of care with our focus on the patient and family experience. A talented group of advanced practitioners and nurses are a key component of our service model. Over the past year, we have broadened our programs and further developed several areas of expertise. We have continued to develop and expand our programs in Survivorship, Supportive Care, and Hemophilia and Thrombosis. We also maintained our focus on expanding disease expertise in neuro-oncology, sarcomas and other solid tumors, hematologic malignancies, and in adolescent and young adult oncology. In addition, we also have provided cutting-edge research clinical trials within our Advanced Cancer Program for novel therapeutics.

Highlights of our programs include the Comprehensive Fertility and Sexual Health Program at Connecticut Children’s, which aims to meet with all newly diagnosed patients and their families to discuss the potential impact of cancer treatment on fertility and potential fertility preservation opportunities. In partnership with the Center for Advanced Reproductive Services, we offer sperm banking, oocyte and embryo cryopreservation, and ovarian tissue cryopreservation. We are also able to offer patients testicular tissue cryopreservation as part of a research program with the University of Pittsburgh.

In addition, our Brain Tumor Program has continued to expand, led by Evan Cantor, MD, as the Director of Neuro-oncology. In coordination with our Neurosurgical team, we provide comprehensive care for patients with brain tumors. The program is supported by Kim Roche, APRN, who helps to coordinate care along with nursing, social work, and psychology specialists. A goal of this

program includes bringing novel therapeutics to patients with difficult to treat brain tumors and is supported by the laboratory research of Dr. Ching Lau, MD, PhD, who has continued to make new discoveries, and during 2023 provided critical data to lead to the development of a new trial for relapsed medulloblastoma that is being prepared and will be opened in the next year.

Additionally, our Hemostasis and Thrombosis program is a federally funded Hemophilia Treatment Center (HTC). The program is thriving in four locations including Hartford, Farmington, Shelton and South Hadley, MA. Our team includes administrative support in addition to three physicians, two advanced practice providers, two dedicated HTC nurses, a program manager and a data manager. We continue to work closely within our region on advancing care for bleeding disorder patients and have a successful 340B pharmacy program which is reinvested into the program to benefit patients. Our center participates in national research programs including ATHN and the CDC Community Counts Registry.

Our Adolescent Bleeding and Clotting (ABC) Disorders clinic was started in 2021 to benefit patients with bleeding and clotting disorders and has been an incredible resource to provide interdisciplinary care for this population of young women with our adolescent medicine colleagues.

Our fellowship program continues to thrive under the leadership of Andrea Orsey, MD, MSCE. We were pleased to welcome Paul Tomlinson, MD, into the program during 2023. He has joined Shruthishree Sukumar, DO, and Erin Pastor, MD. We also continue to expand our psychology services, including neuropsychology, which has been supported by Jenine Tulledge-Wolff, PhD, our psychology fellow.

Many of our staff have been recognized within our region and beyond:

• Lauren Ayr-Volta, PhD, was interviewed as an expert in the field by Yahoo!life. The article was posted on February 26 and received >1.5M views!

• Natalie Bezler, MD, completed the Stanford Physician Leadership Program through Stanford School of Medicine in July 2023.

• Dr. Bezler also was elected to be Vice Chair of the American Society of Pediatric Hematology/ Oncology’s Quality Improvement and Patient Safety Special Interest Group.

• Donna Boruchov, MD, was elected as Co-Chair of the New England Sickle Cell Consortium Education and Clinical Practice Committee.

• Megan Coco, APRN, earned her PhD!

• Joanna Gell, MD, participated on the Systematic Evidence-based Review (SER) Committee for the Cancer risk in Differences of Sex Development/ Intersex for the American College of Medical Genetics and Genomics (ACMG).

• Dr. Gell also continued her role as Biology Chair of the Children’s Oncology Group Germ Cell Tumor Committee.

• Ching Lau, MD, PhD, was given the Chair’s Award for Innovation.

• Kerry Moss, MD, received a Community Service Award from Hartford County Medical Association, which acknowledges some of the most outstanding physicians in our region.

• Andrea Orsey, MD, MSc, Graduated with Master of Science in Health Profession Education from Massachusetts General Hospital Institute of Health Professions 9/1/2023.

• Dr. Orsey was presented with the Chair’s Award for Teaching.

Additionally, a number of us were invited to be speakers at regional and national meetings:

• COG Bone Tumor Committee, Fall Meeting, New PI Orientation (Dr. Michael Isakoff)

• 2023 Sunshine Project Virtual Summit; “Digoxin in Medulloblastoma” (Dr. Michael Isakoff)

• Osteosarcoma MIB Agents FACTOR Meeting; Comparative Oncology Moderator (Dr. Michael Isakoff)

• Invited panelist discussing Careers in Medical Education. Career Development series, VirtualSymposium of Pediatric Hematology/Oncology (v-SYMPHONY) of New York, New Jersey and Connecticut. 2023 May 24. Virtual Presentation. (Dr. Andrea Orsey)

• Parallel Session: Nutritional Challenges, Practices and Approaches Across the Cancer Continuum. Nara, Japan; 2023 June 24. (Co-Chaired by Dr. Andrea Orsey)

• Parallel Session: Pediatric Supportive Care Clinical Practice Guidelines (CPGs): Global Perspectives. Nara, Japan; 2023 June 24. (Co-Chaired by Dr. Andrea Orsey)

Research activities were maintained at a high level in our division leading to the publication of multiple papers outlined below and the receipt of external research grants including:

• DOD Career Grant for $663,430 over 3 years: “Identification of new diagnostic biomarkers for intracranial germ cell tumors” to Joanna Gell, MD

• CureSearch Young Investigator Award for $225,000 over 3 years to Joanna Gell, MD

• West Charitable Trust Grant - $1,000,000 three-year grant for investigation, research, and/or treatment of Acute Myeloid Leukemia (AML) to Dr. Lau

• Alex’s Lemonade Stand POST Grant for $5,000 and a St Baldrick’s Program Development Grant for $50,000 to Natasha Frederick, MD

• American Thrombosis & Hemostasis Network, $20,000 to Donna Boruchov, MD

• Department of Public Health, $25,000 to Donna Boruchov, MD

• National Pediatric Cancer Foundation, $40,000 to Michael Isakoff, MD

• Reid R. Sacco AYA Cancer Alliance, $75,000 to Michael Isakoff, MD

PUBLICATIONS

Bezler NS, Zuse A, McKay L, Gardner J. Improving the Safety of Discharge on Enoxaparin. Connecticut

Children’s Medical Center Illuminations Patient Safety & Quality Conference Hartford, June 2023.

Tory H, Sander P, Bezler NS, Im J, Bailie E, Williams J, Vachhani. Inpatient Medication Reconciliation Quality Audit Monitoring System. Connecticut Children’s Medical Center Illuminations Patient Safety & Quality Conference Hartford, June 2023.

Carlson AJ, Pruden CM, Nardozza M, deMayo R, Smith S, Bezler NS, Demirci CS, Edelheit B, Smith K, Weaver L, Presnick N, Colpas E. Improving Competency and Equitable Care through a Novel Residency Telemedicine Curriculum. Pediatric Academic Societies Annual Meeting Washington, DC, April 2023.

Segbefia C, Campbell J, Tartaglione I, Asare EV, Andemariam B, Zempsky W, Colombatti R, Boatemaa GD, Boruchov D, Rao S, Piccone CM, Smith A, Haile H, Kim E, Wilson S, Farooq F, Urbonya R, Rivers A, Manwani D, Gai J, Sey F, Inusa B, Antwi-Boasiako C, Strunk C, Campbell AD. Pain Frequency and Health Care Utilization Patterns in Women with Sickle Cell Disease Experiencing Menstruation-Associated Pain Crises. J Womens Health (Larchmt). 2023 Dec;32(12):1284-1291. doi: 10.1089/ jwh.2023.0023. Epub 2023 Nov 23. PMID: 38011013; PMCID: PMC10712351.

Gillard A, Gagnon R, Pashankar F, Balsamo L, Grafft N, Miranda J, Boruchov D, Neri C, Sprinz P, Longyear C. Sense of mastery and attitude towards illness: Examining longitudinal benefits of a medical specialty camp for youth with sickle cell disease. Clin Child Psychol Psychiatry. 2023 Jul;28(3):1012-1023. doi: 10.1177/13591045221145425. Epub 2022 Dec 11. PMID: 36503316.

Cantor E, Berkovich R, Navalkele P, Brossier NM. Rapid symptomatic improvement in two patients with ganglioglioma after restarting BRAF inhibitor therapy. Pediatr Blood Cancer. 2023 Mar 14:e30296. doi: 10.1002/pbc.30296. Epub ahead of print. PMID: 36916822.

Cherven BO, Demedis J, Frederick NN. Sexual Health in Adolescents and Young Adults With Cancer. J Clin Oncol. 2023 Oct 19:JCO2301390. doi: 10.1200/ JCO.23.01390. Epub ahead of print. PMID: 37856773.

Frederick NN, Lehmann V, Ahler A, Carpenter K, Cherven B, Klosky JL, Nahata L, Quinn GP. Psychosexual functioning in cancer survivorship: What the pediatric oncologist needs to know. Pediatr Blood Cancer. 2023 Sep;70 Suppl 5:e30611. doi: 10.1002/pbc.30611. Epub 2023 Aug 7. PMID: 37548483.

Frederick NN, Klosky JL, Meacham L, Quinn GP, Kelvin JF, Cherven B, Freyer DR, Dvorak CC, Brackett J, Ahmed-Winston S, Bryson E, Su HI, Chow EJ, Levine J. Fertility Preservation Practices at Pediatric Oncology Institutions in the United States: A Report From the Children’s Oncology Group. JCO Oncol Pract. 2023 Apr;19(4):e550-e558. doi: 10.1200/OP.22.00349. Epub 2023 Feb 10. PMID: 36763922; PMCID: PMC10113112.

Harris CJ, Rowell EE, Jayasinghe Y, Cost C, Childress KJ, Frederick NN, McNally O, Appiah L, Anazodo A. Pediatric, adolescent, and young adult breast and reproductive tumors. Pediatr Blood Cancer. 2023 Sep;70 Suppl 5:e29422. doi: 10.1002/pbc.29422. Epub 2022 Dec 2. PMID: 36458682.

Gell JJ, Shioda T. Maintenance of Human Primordial Germ Cell-Like Cells in a Long-Term Culture System. Methods Mol Biol. 2023;2677:259-267. doi: 10.1007/978-1-0716-3259-8_15. PMID: 37464247.

Bhuta R, Shah R, Gell JJ, Poynter JN, Bagrodia A, Dicken BJ, Pashankar F, Frazier AL, Shaikh F. Children’s Oncology Group’s 2023 blueprint for research: Germ cell tumors. Pediatr Blood Cancer. 2023 Sep;70 Suppl 6(Suppl 6):e30562. doi: 10.1002/pbc.30562. Epub 2023 Jul 14. PMID: 37449938; PMCID: PMC10529374.

Gupta A, Riedel RF, Shah C, Borinstein SC, Isakoff MS, Chugh R, Rosenblum JM, Murphy ES, Campbell SR, Albert CM, Zahler S, Thomas SM, Trucco M. Consensus

recommendations in the management of Ewing sarcoma from the National Ewing Sarcoma Tumor Board. Cancer. 2023 Nov 1;129(21):3363-3371. doi: 10.1002/ cncr.34942. Epub 2023 Jul 5. PMID: 37403815.

Eslin D, Zage PE, Bergendahl G, Lewis E, Roberts W, Kraveka J, Mitchell D, Isakoff MS, Rawwas J, Wada RK, Fluchel M, Brown VI, Ginn K, Higgins T, BeeravallyNagulapally A, Dykema K, Hanna G, Ferguson W, Saulnier Sholler GL. A phase II trial of nifurtimox combined with topotecan and cyclophosphamide for refractory or relapsed neuroblastoma and medulloblastoma. Int J Cancer. 2023 Sep 1;153(5):1026-1034. doi: 10.1002/ijc.34569. Epub 2023 May 29. PMID: 37246577.

Whiteway SL, Weiss AR, Ahmed SK, Allen-Rhoades WA, Avutu V, Cardona K, Davis LE, Davis EJ, Indelicato DJ, Isakoff MS, Janeway KA, Livingston JA, Patel SR, Reed DR, Riedel RF, Thornton KA, Kopp LM. Joint Adult and Pediatric Working Group as a Successful Platform to Strengthen Adolescent and Young Adult (AYA) Clinical Trial Collaboration: A Report from the NCTN/SARC AYA Clinical Trials Sarcoma Working Group. J Adolesc Young Adult Oncol. 2023 Oct;12(5):792-793. doi: 10.1089/ jayao.2022.0179. Epub 2023 Feb 1. PMID: 36724495.

Saulnier-Sholler G, Duda DG, Bergendahl G, Ebb D, Snuderl M, Laetsch TW, Michlitsch J, Hanson D, Isakoff MS, Bielamowicz K, Kraveka JM, Ferguson W, Carmeliet P, De Deene A, Gijsen L, Jain RK. A Phase I Trial of TB-403 in Relapsed Medulloblastoma, Neuroblastoma, Ewing Sarcoma, and Alveolar Rhabdomyosarcoma.

Clin Cancer Res. 2022 Sep 15;28(18):3950-3957. doi: 10.1158/1078-0432.CCR-22-1169. PMID: 35833850; PMCID: PMC9481695.

Johnson KJ, Bauchet L, McKean-Cowdin R, Kruchko C, Lau CC, Ostrom QT, Scheurer ME, Villano J, Yuan Y. Impact of environment on pediatric and adult brain tumors: The 2023 Brain Tumor Epidemiology Consortium meeting report. Clin Neuropathol. 2023 Dec 5. doi: 10.5414/NP301590. Epub ahead of print. PMID: 38050756.

Sun JM, Chow WY, Xu G, Hicks MJ, Nakka M, Shen J, Ng PKS, Taylor AM, Yu A, Farrar JE, Barkauskas DA, Gorlick R, Guidry Auvil JM, Gerhard D, Meltzer P, Guerra R, Man TK, Lau CC, On Behalf Of The Target Osteosarcoma Consortium. The Role of FAS Receptor Methylation in Osteosarcoma Metastasis. Int J Mol Sci. 2023 Jul 29;24(15):12155. doi: 10.3390/ ijms241512155. PMID: 37569529; PMCID: PMC10418590.

Johnson KJ, Bauchet L, Francis SS, Hainfellner JA, Kruchko C, Lau CC, Ostrom QT, Scheurer ME, Yuan Y. Pediatric brain tumors: Origins, epidemiology, and classification - The 2022 Brain Tumor Epidemiology Consortium meeting report. Clin Neuropathol. 2023 Mar-Apr;42(2):74-80. doi: 10.5414/NP301520. PMID: 36633374.

Sutter PA, Anderson MG, Sahyouni R, Plonsker J, Ravindra VM, Gonda DD, Levy ML, Dziugan K, Votoupal M, DeCuypere M, Leclair NK, Angelo SJ, Halloran PJ, Martin JE, Bookland MJ, Michelow IC, McKay L, Hersh DS. Anticoagulation for the treatment of septic cerebral venous sinus thrombosis in the setting of pediatric sinogenic and otogenic intracranial infections. Neurosurg Focus. 2023 Oct;55(4):E8. doi: 10.3171/2023.7.FOCUS23374. PMID: 37778041.

Freedman JL, Beeler DM, Bowers A, Bradford N, Cheung YT, Davies M, Dupuis LL,Elgarten CW, Jones TM, Jubelirer T, Miller TP, Patel P, Phillips CA, Wardill HR, Orsey AD. (2023) Supportive Care in Pediatric Oncology: Opportunities and Future Directions. Cancers. Nov 23.15, 5549. https://doi.org/10.3390/ cancers15235549.

Hogeland EW, Somers TS, Yip L, Doyon S, Redlich CA, Orsey AD, Woda CB, Swan ST, Feder HM. (2023). Thrombocytopenia associated with elemental mercury poisoning in two siblings – Connecticut, July 2022. MMWR Morb Mortal Wkly Rep. 2023 Sep 22;72(38):1027-1031. doi: 10.15585/mmwr. mm7238a2.

Patel P, Robinson PD, Phillips R, Baggott C, Devine K, Gibson P, Guilcher GMT, Holdsworth MT, Neumann E, Orsey AD, Sppinelli D, Thackray J, van de Wetering M, Cabral S, Sung L, Dupuis LL. (2023). Treatment of breakthrough and prevention of refractory chemotherapyinduced nausea and vomiting in pediatric cancer patients: Clinical practice guideline update. http://doi. org/10.1002/pbc.30395. PMID 37178438.

Tal AL, Bailey KA, Chou A, Offer K, Rosenblum J, Moerdler S, Askew M, Roberst S, Vagrecha A, Orsey AD, Robbins G, Satwani P, Pierro J, Levine J. (2023). v-SYMPHONY career development series: A collaboration to enhance professional awareness for pediatric hematology oncology trainees. Pediatric Blood Cancer. https://doi.org/10.1002/pbc.30118. PMID 36573297.

Roche K, Mulchan S, Ayr-Volta L, Elias M, Brimacombe M, Morello C, Hinderer KA. Pilot Study on the Impact of Gratitude Journaling or Cognitive Strategies on Health Care Workers. J Pediatr Health Care. 2023 JulAug;37(4):414-424. doi: 10.1016/j.pedhc.2023.02.002.

Epub 2023 Mar 5. PMID: 36882351; PMCID: PMC9985770.

MacDonell-Yilmaz RE, Sampino EV, Moynihan L, Chang WI, Sprinz PG. Prolonged Survival Using Outpatient Palliative Chemotherapy in Two Children With Refractory Acute Myelogenous Leukemia. J Pediatr Hematol Oncol. 2023 Aug 1;45(6):e764-e767. doi: 10.1097/ MPH.0000000000002704. Epub 2023 Jul 3. PMID: 37494613.

Vistica Sampino E, Morgan J, Chorzalska A, Nguyen L, Yu C, Rodriguez A, Pardo M, Bonal D, Liang O, Kim M, De Vito R, Lulla RR, Dubielecka PM. Comparative flow cytometry-based immunophenotyping analysis of peripheral blood leukocytes before and after fixation with paraformaldehyde. J Immunol Methods. 2022 Dec;511:113379. doi: 10.1016/j.jim.2022.113379. Epub 2022 Oct 21. PMID: 36279962.

STAFF

Michael Isakoff, MD, Division Head

Ching Lau, MD, PhD, Scientific Director

Taylor Aglio, MD

Erin Barthel, MD

Natalie Bezler, MD

Donna Boruchov, MD

Evan Cantor, JD, MD

Natasha Frederick, MD, MPH

Joanna Gell, MD

Laura McKay, MD

Kerry Moss, MD

Andrea Orsey, MD, MSCE

Emily Vistica-Sampino, MD

Patrick Ng, PhD

Lauren Ayr-Volta, PhD

Megan Coco, APRN

Grace Clark, PA

Keri Curtis, PA

Karina Engelke, APRN

Jennifer Grande, APRN

Susanne Johnson, APRN

Meredith Lake, APRN

Christine Longyear, APRN

Morgan McCarthy, APRN

Siddika Mulchan, PsyD

Victoria Pohl, APRN

Kimberly Roche, APRN

Katherine Steven, APRN

Amanda Zuse, APRN

Hematology and Oncology Fellows

Erin Pastor, DO

Shruthishree Sukumar, MD

Paul Tomlinson, MD

Psychology Fellows

Jenine Tulledge-Wolff, Ph.D.

INFECTIOUS DISEASES & IMMUNOLOGY

The Division of Infectious Diseases and Immunology provides outstanding care for children with infections and immune deficiencies, for individuals seeking preventive therapies and vaccines, for pregnant women with suspected infections that could impact their newborns, and for children and families who require travel advice. Members of the division are also involved in several NIH-funded research projects including spirochetal infection, COVID-19-related inflammatory disorders, antimicrobial resistance, vaccine development and congenital infections.

CLINICAL PROGRAMS

The Division of Infectious Diseases and Immunology (ID) provides extensive inpatient and outpatient consultation for neonates, children, and young adults with common and complex infectious diseases, travel medicine, long-term complications of COVID-19, and congenital and acquired immunodeficiencies, including HIV care. The division, in addition to routine clinical duties, continued to have an expanded role for the organization:

Development of multiple pathways such as the bone and joint infection slated to go live in early 2024, blood cultures obtained in the ED guidance as well as maintenance and updates of many infectious diseases related pathways, including but not limited to, COVID-19, community acquired pneumonia and neonatal fever and sepsis.

1. Inpatient consultation: Inpatient consultations continued and have slowly and steadily transitioned to pre-pandemic ID related patient problems. However, we continue to see patients who present with COVID-19 as well as mutliinflammatory syndrome in children(Figure 1 and 2). The ID faculty have obtained consulting privileges at Hartford Hospital facilitating care for patients in the normal nursery who may present with a variety of ID related issues including

congenital infections or perinatal exposures concerns.

2. Consultation for ambulatory patients:

The division continued to provide telemedicine visits to ensure that our patients had ongoing convenient access to high-quality care. We also provided ambulatory in-person visits and travel clinic visits (Figure 3).

3. Refugee Clinic: The Division also offered continued ambulatory clinical care and initial evaluation for new refugees to the Hartford area.

4. Congenital/Neonatal Infectious Diseases

Clinic: Ashley Howard, DO, continues to work on establishing a clinic that will focus on congenital and neonatal infections such as CMV, syphilis, Hepatitis B, Hepatitis C and HIV.

Figure 1. Number of in-patients seen.

Figure 2. Number of charges for in-patient consultations.

5. Friday Ask the Experts: John Schreiber, MD, MPH, continued to provide updates to community pediatricians through our bi-weekly Ask the Experts series, keeping our community informed of the latest scientific and clinical updates regarding COVID-19. The lecture series has maintained strong ratings particularly in the Clinically Integrated Network and reaches hundreds of participants during each session.

ANTIMICROBIAL STEWARDSHIP PROGRAM

Under the leadership of Jennifer Girotto, PharmD, and under the leadership of Jennifer Girotto, PharmD, and Ian Michelow, MD, MMed, the Antimicrobial Stewardship Program (ASP) at Connecticut Children’s provides prospective review and feedback on the use of antimicrobial therapies. The program supports the established Connecticut Children’s-specific Firstline Antimicrobial App. The app has allowed the delivery of ASP resources including pathways, antibiograms, and antimicrobial dosing recommendations to all clinicians throughout the network via mobile and/or the web app (https://firstline.org/connecticutchildrens/). We continue to add new resources, including various clinical pathways and antimicrobial use guidelines.

ASP members continue to work closely with a group of neonatologists and other specialists involved in neonatal care to standardize and improve infectious disease and antimicrobial recommendations and care of our neonate patients.

Other areas of focus this year have been improving documentations of specific reactions for inpatients with beta-lactam allergies, as well as continued refinement of inpatient and outpatient stewardship activities. In addition, the team is working on establishing allergy de-labeling protocols for eligible patients. This project is the core of the scholarly activity for our fellow, Laura Kvenvold, MD. The ASP continues to work with the pharmacy to include area-under-the-curve or AUCbased monitoring for vancomycin dosing.

PEDIATRIC AND YOUTH HIV PROGRAM AND SERVICES

The Pediatric, Youth and Family HIV Program at Connecticut Children’s is a multidisciplinary team of physicians, case managers, nurses, social workers, and health advocates. They continued to provide timely, family-centered, and culturally sensitive care to children, adolescents, and parents infected with and affected

by HIV. Our team offers medical, nursing, nutritional, psychosocial, and mental health services to youth in the region and facilitates appropriate community referrals with partner agencies for our patients and their families. We also offer a variety of programs designed to prevent the transmission of HIV and improve health outcomes in addition to those who are interested in and eligible forr HIV pre-exposure prophylaxis regimens (PrEP).

The program has been continuously funded through the Ryan White program for almost three decades, having been awarded over $20 million from the federal government for the provision of direct HIV patient care services. The Ryan White-funded medical case management team stays abreast of cutting edge, innovative, and evidence-based practice modalities, augmenting their skills through trainings and workshops such as Motivational Interviewing, Couples Testing, Functional Behavioral Assessment, Adolescent Opioid Screening, Brief Intervention and Referral to Treatment (S-BIRT), and Youth Mental Health First Aid.

Many of the children, youth, and families continue to be impacted by the pandemic, including the loss of family members, jobs, and stable housing, resulting in increased stress, anxiety, and other mental health challenges. The Pediatric and Youth HIV Program staff has worked tirelessly to respond to our patient’s needs while also taking measures to promote education and promotion of vaccinations for COVID-19 and Influenza. Our program provides protective measures, virtual preventive education and training, HIV testing, and access to emergency housing/shelter services. In total, we serve as an invaluable resource to at-risk youth on HIV transmission prevention.

The HIV team has established and implemented an evidenced-informed psycho-educational peer-topeer group that enhances the overall mental health of our patients. The peer-to-peer model has been demonstrated to be effective, cost-efficient, and is looked upon favorably by the Health Resource Services Administration. We are currently engaged in a DPH Integrated HIV Testing and PrEP Navigation Project. The utilization of pre-exposure prophylaxis (PrEP) as a prevention tool has been incorporated into both the

Figure 3. Number of out-patient consultations.

medical treatment side and the Hartford Youth HIV Identification and Linkage (HYHIL)/HIP prevention efforts at our program. Our HYHIL continues to coordinate with and collaborate in community efforts with participating agencies. The Ryan White Program established the Hartford Teen Pregnancy Prevention Project and continues to provide the Health Interactive Project to Connecticut’s high schools.

In addition to HIV prevention teaching, we continue to educate vulnerable communities and pediatric practitioners on how to prevent the spread of the coronavirus, mpox, RSV and other respiratory viruses.

We are in the process of establishing a partnership with Qcare+, a TelePrEP Solution for Community Partners. The partnership will make PrEP services, including providing HIV medications to individuals with high-risk exposures in order to prevent HIV infection, easier to access for patients while enhancing our 340B program. Qcare+ will enroll patients receiving TelePrEP services through their agency into our 340B program. The HIV program at Connecticut Children’s will receive cost savings for prescriptions, increasing program income which will be utilized for additional HIV prevention services.

FELLOWSHIP

Under the direction of Hassan El Chebib, MD, Fellowship Program Director, the division undertook a fellow recruitment effort in 2023 to fill the second of two positions. The program interviewed seven applicants and matched Sarah McCullough, DO. Dr. McCullough is a combined Medicine-Pediatrics fellow. She will be starting with the UConn Department of Medicine infectious diseases fellowship program in July 2024 and will continue her training in the pediatric infectious diseases fellowship program in July 2026 at Connecticut Children’s.

FACULTY RECRUITMENT

The Division continues to work on recruiting a Hospital Epidemiologist during 2023 to take on the role of Medical Director of Infection Control & Prevention,

and Antimicrobial Stewardship. This individual will also assume a clinical role in our division.

RESEARCH

Team members continued to be highly productive in research activities during 2023, as indicated by multiple active grants from the National Institutes of Health (NIH) and various foundations totaling more than $9 million (see Table). The Division members and their collaborators published 20 peer-reviewed papers in prestigious journals.

The Spirochetal Research Laboratories, co-directed by Justin Radolf, MD, and. Juan C. Salazar, MD, entered the sixth year of a five-year $11 million award from the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) to develop a vaccine for syphilis. The international study team is comprised of researchers from the UConn School of Medicine, Connecticut Children’s, the Duke Human Vaccine Institute, the University of North Carolina (UNC) at Chapel Hill Institute for Global Health and Infectious Diseases, UNC Project-Malawi, CIDEIM in Cali, Colombia, Masaryk University in the Czech Republic, and Southern Medical University in Guangzhou, China. Melissa Caimano, PhD, and Kelly Hawley, PhD, are lead investigators. They are mapping the global diversity of various Treponema pallidum in preparation for a proper vaccine formulation.

Additionally, the Spirochetal Research Laboratories continues to engage in a multicenter international project supported by the Bill & Melinda Gates Foundation. Dr. Hawley, along with an international study team composed of researchers, is focused on the genomic epidemiology of Treponema pallidum strains infecting populations in low- and middle-income countries to inform syphilis vaccine development.

Dr. Salazar also leads a multicenter, international project funded by the NIH. The project focuses on the epidemiologic, clinical, and laboratory predictors of progression toward severe forms of acute infection with SARS-CoV-2 and MIS-C among children, an urgently needed tool in the fight against COVID-19

in this population. To target this discovery initiative, Dr. Salazar and his team are using a battery of biological, immunological, and molecular tests to study children and young adults under 21 years of age with mild, moderate, or severe SARS-CoV-2 infection.

Dr. Michelow is the site PI for an NIH-funded study entitled “Combating AntiMicrobial Resistance in Africa Using Data Science (CAMRA)”, a 5-year multicenter international study to discover new mechanisms of antimicrobial resistance.

Dr. Howard and Dr. Michelow are currently setting up a new NIH-funded multicenter study to study congenital CMV, enterovirus, and parechovirus.

Michelow NIH/UAB Neonatal Enterovirus and Human Parechovirus Viral Sepsis: Natural History and Predictors of Morbidity and Mortality $4K per subject Howard NIH/UAB

of Biomarkers of Audiologic Outcomes in Congenital Cytomergalovirus Infection

El Chebib Pfizer Foundation, Inc.

Antimicrobial Stewardship in Pediatrics: Targeting Providers in the Community

* Corresponding author

# Authors contributed equally

Yang L, Zhang X, Chen W, Seña AC, Zheng H, Jiang Y, Zhao P, Chen R, Wang L, Ke W, Salazar JC, Parr JB, Tucker JD, Hawley KL, Caimano MJ, Hennelly CM, Aghakanian F, Zhang F, Chen JS, Moody MA, Radolf JD, Yang B. Early syphilis in Guangzhou, China: presentation, molecular detection of Treponema pallidum, and genomic sequences in clinical specimens and isolates obtained by rabbit infectivity testing. medRxiv [Preprint]. 2023 Oct 19:2023.10.17.23297169. doi: 10.1101/2023.10.17.23297169. PMID: 37905017; PMCID: PMC10614984.

Seña AC, Matoga MM, Yang L, Lopez-Medina E, Aghakanian F, Chen JS, Bettin E B, Caimano MJ, Chen W, Garcia-LunaJA, Hennelly CM, Jiang Y, Juliano JJ, Pospíšilová P, Ramirez L, Šmajs D, Tucker JD, Cely FV, Zheng H, Hoffman IF, Salazar JC, Hawley KL, Parr JB. (2023). Clinical and genomic diversity of Treponema pallidum subsp. pallidum: A global, multicenter study of early syphilis to inform vaccine research. medRxiv : the preprint server for health sciences, 2023.07.19.23291250.

Cabana MD, de Alarcon PA, Allen E, Bean XD, Brophy PD, Degnon L, First LR, Dennery PA, Salazar JC, Schleien C, St Geme JW, 3rd Parra-Roide L, & WalkerHarding LR. (2023). Diversity in Pediatrics Department Leadership Positions. The Journal of pediatrics, 113557.

Maltz-Matyschsyk M, Melchiorre CK, Herbst KW, Hogan AH, Dibble K, O’Sullivan B, Graf J, Jadhav A, Lawrence DA, Lee WT, Carson KJ, Radolf JD, Salazar JC, Lynes MA, & Connecticut Children’s COVID Collaborative (2023). Development of a biomarker signature using grating-coupled fluorescence plasmonic microarray for diagnosis of MIS-C. Frontiers in bioengineering and biotechnology, 11, 1066391.

García Luna JA, Romero-Rosas N, Silva Peña SA, Oviedo Sarmiento O J, Galindo Orrego X, Lenis Quintero W, Perea LC, Martínez Buitrago E, Osorio

L, Salazar JC, Smith AD, & Alexander N. (2023). Diagnostic performance of two rapid tests for syphilis screening in people living with HIV in Cali, Colombia. PloS one, 18(3), e0282492.

Wozniak, P. S., Cantey, J. B., Zeray, F., Leos, N. K., Michelow, I. C., Sheffield, J. S., Wendel, G. D., & Sánchez, P. J. (2023). The Mortality of Congenital Syphilis. The Journal of pediatrics, 263, 113650.

Thomas, S. J., Anderson, M. S., Adderson, E. E., Edgar, L., Curtis, D., Dong, S. W., Fatemi, Y., Hecht, S. M., James, S. H., Lehman, A., Michelow, I. C., Perez, N., Sattler, M. M., Myers, A. L., & Martin-Blais, R. (2023). Pediatric Infectious Diseases Milestones: A Step in the Right Direction to Evaluate Subspecialty Learners. Journal of the Pediatric Infectious Diseases Society, 12(11), 564–571.

Sutter, P. A., Anderson, M. G., Sahyouni, R., Plonsker, J., Ravindra, V. M., Gonda, D. D., Levy, M. L., Dziugan, K., Votoupal, M., DeCuypere, M., Leclair, N. K., Angelo, S. J., Halloran, P. J., Martin, J. E., Bookland, M. J., Michelow, I. C., McKay, L., & Hersh, D. S. (2023). Anticoagulation for the treatment of septic cerebral venous sinus thrombosis in the setting of pediatric sinogenic and otogenic intracranial infections. Neurosurgical focus, 55(4), E8.

Michelow, I. C., & Obaro, S. K. (2023). Unraveling Neonatal Sepsis: Sharper Tools Needed for Unexpected Organisms. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 77(5), 776–778.

Angelo, S. J., Anderson, M. G., Sutter, P. A., Halloran, P. J., Kavanagh, K. R., Paro, M. R., Martin, J. E., Bookland, M. J., Michelow, I. C., & Hersh, D. S. (2023). Changes in the epidemiology of pediatric sinogenic and otogenic intracranial infections during the COVID-19 pandemic: a single-institution study. Journal of neurosurgery. Pediatrics, 32(2), 231–241.

Keogh, A., Goldberg, A., Schroeder, C., Slingsby, B., Hardy, E., & Michelow, I. C. (2023). Anogenital HSV in Children: Should Providers Be Concerned for Sexual

Abuse?. Journal of pediatric and adolescent gynecology, 36(3), 263–267.

Park, S., Go, Y. Y., Michelow, I. C., & Yeh, J. Y. (2023). Increasing seroprevalence of Japanese encephalitis virus in even-toed hoofed mammals (Artiodactyla species) associated with an upsurge of human cases in South Korea. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 130, 101–107.

Hogeland, E. W., Somers, T. S., Yip, L., Doyon, S., Redlich, C. A., Orsey, A. D., Woda, C. B., Swan, S. T., & Feder, H. M., Jr (2023). Thrombocytopenia Associated with Elemental Mercury Poisoning in Two SiblingsConnecticut, July 2022. MMWR. Morbidity and mortality weekly report, 72(38), 1027–1031.

Kaszycki, M., Cohen-Abbo, A., & Feder, H. M., Jr (2023). A Painful Eruption Following Multiple Scratches From a Pet Rat. The Pediatric infectious disease journal, 42(6), e218–e219.

Weinstein, A., MacPherson, P., Schmidt, S., Van Opstal, E., Chou, E., Pogemiller, M., Gibbs, K., & Held, M. (2023). Needs assessment for enhancing pediatric clerkship readiness. BMC medical education, 23(1), 188.

Ferguson, M. R., Delgado, K. N., McBride, S., Orbe, I. C., La Vake, C. J., Caimano, M. J., Mendez, Q., Moraes, T. F., Schryvers, A. B., Moody, M. A., Radolf, J. D., Weiner, M. P., & Hawley, K. L. (2023). Use of Epivolve phage display to generate a monoclonal antibody with opsonic activity directed against a subdominant epitope on extracellular loop 4 of Treponema pallidum BamA (TP0326). Frontiers in immunology, 14, 1222267.

Foor, S. D., Brangulis, K., Shakya, A. K., Rana, V. S., Bista, S., Kitsou, C., Ronzetti, M., Alreja, A. B., Linden, S. B., Altieri, A. S., Baljinnyam, B., Akopjana, I., Nelson, D. C., Simeonov, A., Herzberg, O., Caimano, M. J., & Pal, U. (2023). A unique borrelial protein facilitates microbial immune evasion. mBio, 14(5), e0213523.

Reddy, P. J., Sun, Z., Wippel, H. H., Baxter, D., Swearingen, K., Shteynberg, D. D., Midha, M. K.,

Caimano, M. J., Strle, K., Choi, Y., Chan, A. P., Schork, N. J., & Moritz, R. L. (2023). Borrelia PeptideAtlas: A proteome resource of common Borrelia burgdorferi isolates for Lyme research. bioRxiv : the preprint server for biology, 2023.06.16.545244.

Coleman, S., Unterhauser, K., Rezaul, K., Ledala, N., Lesmes, S., Caimano, M. J., Zhou, Y., Jackson, E., Gratalo, D., Driscoll, M. D., & Matson, A. P. (2023). Highresolution microbiome analysis reveals exclusionary Klebsiella species competition in preterm infants at risk for necrotizing enterocolitis. Scientific reports, 13(1), 7893.

Grassmann, A. A., Tokarz, R., Golino, C., McLain, M. A., Groshong, A. M., Radolf, J. D., & Caimano, M. J. (2023). BosR and PlzA reciprocally regulate RpoS function to sustain Borrelia burgdorferi in ticks and mammals. The Journal of clinical investigation, 133(5), e166710.

STAFF

Ian C. Michelow, MD, MMed, FCPaed, DTM&H, FPIDS, Division Head

Hassan El Chebib, MD, FAAP, Infectious Diseases

Jennifer Girotto, PharmD, BCPPS, BCIDP, Pharmacy

Henry M. Feder, Jr., MD, Infectious Diseases

Melissa Held, MD, Infectious Diseases

Hillary Hernandez-Trujillo, MD, MSCE, Allergy/Immunology

Grace Hong, APRN, Infectious Diseases, Allergy/Immunology

Ashley Howard, DO, FAAP, Infectious Diseases

Juan C. Salazar, MD, MPH, Infectious Diseases

John R. Schreiber, MD, MPH, Medical Director of Infection Control

Gavin Schwarz, MD, Allergy/Immunology

Danielle Warren-Dias, SW, Infectious Diseases

Ryan Manthey, RN

Alexander Atkinson, RN

Current Fellow

Laura Kvenvold, MD, Infectious Diseases

Basic Science Faculty

Melissa J. Caimano, PhD, Infectious Diseases

Kelly Hawley, PhD, Infectious Diseases

Collaborator

Justin D. Radolf, MD, Internal Medicine, Infectious Diseases

MEDICAL GENETICS

The mission of the Division is to provide high quality, timely, and state-of-the-art genetic consultations, counseling, and interventions for patients from the prenatal period through childhood, adolescence, and into adulthood. Our team diagnoses and manages patients with a broad range of rare, often complex disorders, including metabolic and neurogenetic diseases. The Division of Medical Genetics at Connecticut Children’s works jointly with members of the Department of Genetics and Genome Sciences and the Department of Obstetrics and Gynecology at UCONN Health.

DIVISIONAL STRUCTURE & STAFFING

A multidisciplinary Genetics Care Team comprised of clinical geneticists, genetic counselors, and metabolic dieticians provides genetics/genomics expertise and services across the life continuum at Connecticut Children’s and UConn Health. The consolidated care team is comprised of three clinical medical geneticists, genetic counselors, metabolic nutritionists, and a genetic counselor assistant.

CLINICAL PROGRAMS

The academic, administrative, and clinical offices reside at 11 South Road, Farmington. Pediatric-aged general genetic patients and both adult and pediatric metabolic patients are seen at the Connecticut Children’s specialty care center at 11 South, and adult general genetics patients are seen at a UConn Health office in Avon, CT. Prenatal and hereditary cancer genetic counseling services are provided in the outpatient pavilion on the main UConn Health campus. Geneticists also participate in multidisciplinary fetal consults at the new Fetal Care Center.

The Neurogenetics Clinic, directed by Louisa Kalsner, MD, is housed within the Connecticut Children’s Genetics office at 11 South. Children with a broad range of developmental, neurological, and neurodegenerative disorders, including intellectual

disability, gait abnormalities, structural brain abnormalities, movement disorders and epilepsy, undergo comprehensive genetic evaluation.

The Autism Neurogenetics Clinic (ASAP Neurogenetics) is the only program of its kind in the region, offering genetic and other testing when indicated for children diagnosed on the spectrum. Families also receive education including recurrence risk counseling for their future pregnancies. Led by Dr. Kalsner, the ASAP Neurogenetics Clinic evaluated 218 children with autism in 2023.

Patients with inborn errors of metabolism are seen in a comprehensive specialty care center at 11 South Road. Joseph Tucker, MD, leads this program with support from Sharon Gray, Katelyn Ware and our newest dietician Amanda Mullane. Children and adults with a variety of conditions, including urea cycle disorders, fatty acid oxidation defects, and PKU are closely managed by a multi-disciplinary team.

EDUCATIONAL MISSION

Teaching responsibilities begin for students in the first year of medical school and extend through the post-graduate years. A substantial number of medical students, residents, fellows, and genetic counselor learners rotate through genetic clinics and/or attend educational sessions provided by genetics faculty. Drs. Kalsner and Tucker participate in medical student education, giving didactic lectures to UConn students on a range of topics related to pediatric genetics on a monthly basis.

PARTICIPATION ON A NATIONAL COMMITTEE

Dr. Kalsner is a member of the IDMC for an AAV delivery gene therapy treatment, designed to deliver a functional GBL1 gene encoding-galactosidase to the brain and peripheral tissues for the treatment of early infantile and late infantile GM1 gangliosidosis (GM1).

COLLABORATION WITH THE DPH NEWBORN SCREENING (NBS) LAB & THE CONNECTICUT

NEWBORN DIAGNOSIS & TREATMENT NETWORK

Connecticut Children’s Genetics division has assumed an expanded role in newborn screening (NBS) since the statewide network model went live in 2019 with an electronic NBS Registry. The network, funded through the Connecticut DPH, is housed in the Pediatric Clinical Genetics Program at 11 South Road in Farmington.

It was planned and implemented by Connecticut Children’s under the leadership of Karen Rubin, MD, and serves as the communication link between the DPH NBS laboratory, primary care providers or hospital based medical providers, five subspecialty clinical care teams at both Connecticut Children’s and Yale New Haven Hospital (Genetics, Endocrinology, Hematology, Neurology, and Immunology), and families. The network responds to all NBS results that are abnormal in the state of Connecticut. Connecticut now screens for more than 60 disorders. Almost half of the abnormal NBS results are for genetic/metabolic disorders, and these are reviewed and interpreted by the genetics team at Connecticut Children’s.

In the past year, the network received 433 referrals from the DPH NBS lab, with 207 abnormal screens in genetics. Our geneticists provided real-time interpretation for these 207 cases, ordered further diagnostic testing when appropriate, and ensured timely initiation of care. In 2023, 42 cases were confirmed as affected or disease carriers. To support the expanded roles of our geneticists, the network provides genetic counseling services and metabolic dieticians to assist patients and their families identified through NBS as having metabolic disorders. The network team includes two nurse coordinators and a dedicated genetic counselor.

COLLABORATIONS WITH FETAL MEDICINE AT UCONN HEALTH AND CONNECTICUT CHILDREN’S

The Medical Genetics division supports UConn’s Maternal-Fetal Medicine Program and the Ray Neag Comprehensive Cancer Center in Farmington. Increased

adoption of non-invasive prenatal genetic testing and of expanded and improved test offerings for patients with hereditary cancers continue to drive up patient volumes in the prenatal service and the hereditary cancer counseling program.

The division also participates in fetal consultations with the newly developed Fetal Medicine Program at Connecticut Children’s. A fetus identified to have malformations often has an underlying genetic disorder. Our geneticists participate in collaborative cross specialty consultations with members of the fetal medicine team to discuss results of prenatal genetic testing and options for testing and management of suspected genetic diagnoses during pregnancy and after delivery.

RESEARCH/GRANTS/AWARDS

Dr. Kalsner (co-investigator) and genetic counselor Michael Peracchio are involved in an ongoing research study in collaboration with the Jackson Laboratory utilizing a new form of technology for whole genome sequencing called long read sequencing. The study involves identification and recruitment of children and young adults with high suspicion for a genetic disorder, that has not been diagnosed, despite extensive clinical testing.

In 2023, we have enrolled nine individuals and their families and along with the team at Jackson Laboratory, we are beginning to review genomic results. We anticipate continued study enrollment in 2024 and further results leading to a diagnosis for many children who have long awaited a genetic explanation for their disease.

This study is funded in part by the Connecticut Children’s Genomic Allseq Award with a budget of $135,000 over two years.

PUBLICATIONS

Graf W, Cohen B, Kalsner L, Pearl P, Sarnat H, Epstein L. Fetal anomaly diagnosis and termination of pregnancy. Dev Med Child Neurol. 2023 Jul;65(7):900-907.

STAFF

Medical Geneticists

Louisa Kalsner, MD Division Head

Joseph Tucker, MD

Jaclyn Beirne, MD

Pediatric Genetic Counselor

Michael Peracchio, MS, LCGC

Virginia Casola, MS, LCGC

Pediatric Genetic Counselor Assistant

Catherine Silva

Pediatric Metabolic Dietitians

Sherry Gray, MS, MPH, CD-N

Kaitlyn Ware, MS, RD, CNSC, CD-N

Amanda Mullane MS, RD

Newborn Screening Network Team providing direct support to Genetic on NBS cases:

Genetic Counselor

Ginger Nichols, MS, LCGC

RN Coordinators

Debra Ellis

Meghan Criscuolo

NEONATAL-PERINATAL MEDICINE

The Division of Neonatal-Perinatal Medicine provides state-of-the-art, high quality care to our state and region within our own Connecticut Children’s Neonatal Intensive Care Units (NICUs) and also in our Neonatal Care Alliance of NICUs and local Hospital Birthing Centers. Our expanding network remains anchored by our Level 4 NICU in Hartford. Our division members continuously improve newborn care in our region by advancing education, training, collaboration and cutting-edge research.

Faculty in the Division of Neonatal-Perinatal Medicine provide neonatal care and support clinical operations and research activities across our region within:

• Our flagship Connecticut Children’s Level 4 NICU in Hartford, CT

• Our Connecticut Children’s Level 3 NICU at the UConn Health/John Dempsey Hospital in Farmington, CT

• The Level 3 NICU at the Hospital of Central Connecticut in New Britain, CT

• The Level 3 NICU at Eastern Connecticut Health Network in Manchester, CT

• The Level 3 NICU at Danbury Hospital

• The Level 3 NICU at Norwalk Hospital

• The Level 3 NICU at St Vincent’s Hospital in Bridgeport, CT

• The Level 3 NICU at Vassar Brother’s Medical Center in Poughkeepsie, NY

• The Level 2 Special Care Nursery at Backus Hospital in Norwich, CT

• Level 1 Birthing Centers and Nurseries in CT at Hartford Hospital, Midstate Medical Center in Meriden, Charlotte Hungerford Hospital in Torrington, and Day Kimble Hospital in Putnam

• Level 1 Birthing Centers and Nurseries in NY at Northern Dutchess Hospital in Rhinebeck, and Putnam Hospital in Carmel Hamlet

Our faculty members work collaboratively within these centers to bring Connecticut Children’s standard of highest quality neonatal care to patients in centers close to their homes. This year, the division welcomed four new faculty members to provide services at our major academic centers and neonatal units throughout Connecticut. Additionally, our partnerships with Hartford Healthcare and Nuvance Health continued to increase regional access to expert pediatric and neonatal care in Connecticut and New York. James Moore, MD, PhD, Jeffrey Shenberger, MD, Annmarie Golioto, MD, and Edward James, MD, led the development of a new Level II NICU at Backus Hospital, which opened in October. Under the leadership of System Medical Director for Neonatal Services, Adam Czynski, DO, our partnership with Nuvance Healthcare continued to expand. To keep pace, we promoted Dr. Czynski to Senior Health Systems Development Office in order to cultivate new hospital-based sites, design novel care models, and foster service line integration.

In June, the Division welcomed Jeffrey S. Shenberger, MD, as the new Division Head and the Ross Mayer Endowed Chair for Neonatal Intensive Care. Dr. Shenberger is the former Section Chief of Neonatology and Vice Chair of Research as Atrium Health Wake Forest Baptist in Winston-Salem, NC. The Division’s former Division Head, James Moore, MD, PhD, assumed a primary role as President of the Connecticut Children’s Specialty Group.

In September, the division hosted the 7th Annual Symposium on Neonatal Advances at the University of Connecticut School of Medicine. This regional event, organized by Mariann Pappagallo, MD, showcases national leaders in neonatal clinic care and research to discuss advances in chronic lung disease, genomics, hemodynamics, and bedside ultrasound. This year’s in-person event drew nearly 100 attendees from five states.

MAJOR RESEARCH ACTIVITIES

Adam Matson, MD, MSc, continues to investigate the microbiome and processes whereby bacterial populations and/or bacterial products influence gut health and

neonatal outcomes. His most recently published works integrate state-of-the-art sequencing technology to unique properties of the most pathogenic strains of bacterial contributing to necrotizing enterocolitis (NEC) in premature infants. Dr. Matson’s work is supported by grants from Connecticut Children’s, the University of Connecticut School of Medicine, and most recently, the Jackson Laboratory as the lead for a new project using advanced genomic sequencing technologies. Additionally, Dr. Matson serves as Director of Connecticut Children’s Neonatal Biorepository.

Naveed Hussain, MBBS, MD, research uses epidemiological and data analytic approaches to evaluate factors associated with improved neonatal outcomes. He is the Research Director of the Neonatal Division and serves as Connecticut Children’s Global Health Director for Education. He is also a recipient of the iCATCH grant (2021-2023) from the American Academy of Pediatrics for training traditional birth attendants in India.

James I. Hagadorn, MD, MSc, is the Chair the National Institutes of Health’s Pediatrics Study Section and a member of the NICHD Scientific Review Groups and Special Emphasis Panel on Multicenter Cooperative Neonatal Research Network.

Shabnam Lainwala, MBBS, PhD, research interests focus on preterm infants’ neurodevelopmental outcomes. Her publications investigate the relationship between nutrition and feeding practices in preterm infants and their short and long-term clinical outcomes. She is a co-investigator on studies evaluating the timing of inguinal hernia repair in newborns, the developmental impact of reading books to premature infants, and INCHIP, a Uconn, Storrs collaboration evaluating the impact of stress of telomere length in mother-infant pairs. Dr. Lainwala also helps lead the New England Neonatal Follow-up Network, a subsection of Vermont Oxford Network.

Jeffrey S. Shenberger, MD, areas of research center on novel therapeutics and neonatal outcomes. He is a member of the Data Safety Monitoring Boards for studies evaluating transfusion-related gut injury in premature infants and for the use of neurostimulation to minimize opioid withdrawal in newborns. He is the

principle clinical investigator of the Health Analytics and Research Translations Center (HART) grant, a collaboration between Uconn School of Medicine, The Jackson Laboratory, and Connecticut Children’s which assesses the practicality of universal advanced genomic sequencing in newborns. In addition, Dr. Shenberger is a member of the NIH Extremely Low Gestational Age Newborn (ELGAN) study analysis and writing team. Ted Rosenkrantz, MD, continues to collaborate with Uconn Storrs investigators on hypoxic-ischemic injury in newborns, using both clinical data and translational models. His team examines the effect of gestational age, sex and neuroprotective therapies to determine mechanisms of brain injury and assess the effectiveness of therapies in afflicted infants. Dr. Rosenkrantz also includes Uconn undergraduate and graduate students on numerous projects examining neonatal chronic lung disease, feeding, and bone growth.

Annmarie Golioto, MD, was appointed to the role of Associate Chair for Clinical Affairs, Department of Pediatrics effective September 1, 2023. She was the principal investigator at Connecticut Children’s for a multisite study testing use of a catheter for Less Invasive Surfactant Administrations (LISA) for use in infants less than 29 weeks gestational age at birth. In addition, Dr. Golioto was the Connecticut Children’s investigator for the National Perinatal COVID-19 Registry Study Group that pooled novel outcomes information from the pandemic for publication.

QUALITY & SAFETY IMPROVEMENT

Neonatology division members continue to promote and achieve the highest quality and safety outcomes for our neonatal patients and families. Our faculty members lead local quality and safety improvement teams within international collaboratives including Solutions for Patient Safety, the Vermont Oxford Network and the Children’s Hospital Neonatal Consortium. Dr. Golioto and David Sink, MD, lead our NICU Central Line Associated Bloodstream Infections (CLABSI) Prevention Team. The committee responded to CLABSI events in the NICU in 2022 by evaluating the latest research and updating our recommendations

for care. Their work was presented at Connecticut Children’s Illuminations Conference in June 2023 and was selected as the QI project award winner of that conference. Because of their work, zero patients in our Level IV Hartford NICU and our Level III Farmington NICU experienced a CLABSI in 2023. Dr. Sink, Kendall Johnson, MD, and Les Wolkoff, MD, continue to lead efforts to decrease Unplanned Extubations (unintentional dislodging of breathing tubes) in our NICUs to levels below national benchmarks.

Our Division supports efforts to improve care across our regional Neonatal Network. This year Alaina Pyle, MD, led a multidisciplinary, multisite effort to improve neonatal antibiotic prescribing practices. Dr. Pyle’s team brought together our division’s seven NICU Medical Directors, in collaboration with other Connecticut Children’s subspecialists and our Antimicrobial Stewardship Team. Her team developed and implemented evidence-based antibiotic use guidelines, which are now in use across our network of NICUs and birthing centers. Available on a mobile app platform, these best-practice guidelines are available to our neonatal providers at the point of care in all of our locations. Building on this successful model of network quality improvement, Drs. Sink and Golioto are aligning with a large New England NICU Quality Collaborative aiming to improve neonatal respiratory care. The respiratory care taskforce at our Level IV Hartford NICU has used the knowledge they have gained from the collaborative as well as previous device-study experience to launch LISA as an option for our premature infants in the NICU as an effort to minimize mechanical ventilation and resultant BPD as of September 2023.

Dr. Lainwala’s multidisciplinary team implemented evidence-based feeding guidelines in our level IV NICU. Her team continues to collaborate with surgical and GI teams to implement further feeding guidelines for intestinal failure patients.

Marilyn Sanders, MD, continues to lead the Connecticut Children’s Multidisciplinary Bronchopulmonary Dysplasia (BPD) Collaborative to address the clinical care of

infants at risk for requiring long-term positive pressure ventilation. This multidisciplinary team includes medical and nursing leadership from the NICU and Pediatric ICU, neonatologists from 5 referral hospitals, critical care attendings and specialists from pulmonary, cardiology, otolaryngology, surgery, and palliative care. The team serves to optimize care of patients with severe chronic lung disease and to help their family’s transition from the NICU to the next appropriate location for ongoing care.

LEVEL IV HARTFORD NICU EXPANSION

A multidisciplinary team including Drs. Shenberger and Golioto have been working to expand access to beds in our Hartford based NICU. This includes planned work for a 16 bed NICU in the Children’s Hospital at 282 Washington Street opening in Jan 2024 as well as future work for a single-bed NICU in Connecticut Children’s new tower expected in 2025.

FETAL MEDICINE

Neonatology is collaborating with our fetal surgeon, Timothy Crombleholme, MD, and our Maternal Fetal Medicine colleagues to provide coordinated management in the Fetal Care Center for pregnant patients referred fetuses with anomalies or complex conditions anticipated to require in-utero interventions or NICU care after birth. A small group of dedicated neonatologists, led by DonnaMaria Cortezzo, MD, provide consultative support to families prior to delivery.

NEONATAL-PERINATAL MEDICINE FELLOWSHIP

Under the leadership of Program Director Jennifer Trzaski, MD, we successfully recruited two first-year fellows in 2023: Dr. Surabhi Khasgiwala, MBBS, a former pediatric resident at the University of Hawaii and Dr. Zohaib Sayyed, MBBS, who completed residency at the Children’s Hospital of Michigan in Detroit. This marks the expansion of our fellowship to two each year. Our fellows presented their academic projects at several regional, national and international meetings on topics including hyperoxic lung injury, stem cells, and pain management.

NEONATAL CRITICAL CARE TRANSPORT TEAM

Under the direction of Marilyn Sanders, MD, the Neonatal Critical Care Transport Team continues to respond to transport needs of critically ill neonates from referring hospitals across New England to newborn NICUs within our network. With an eye on improving responsiveness, we have made improvements to team pathways and activation to ensure the most efficient access to care. Our team provides state-of-the-art technologies during transport, including high frequency ventilation, inhaled nitric oxide, and therapeutic hypothermia. By leveraging our regionalized clinical neonatal network to provide the right care, at the right place, at the right time, we meet the immediate care needs of our patients as close to home as possible.

Using our 24-hour One Call system, health care providers from other locations have ready access to a Level 4 neonatologist to arrange transport of their neonatal patients to the appropriate level of care. Neonatal Advanced Practitioners and NeonatalPerinatal Medicine Fellows (PGY4-6) are actively involved in the transport program and managed in excess of 400 patients during 2023.

NEONATAL NEURODEVELOPMENTAL FOLLOWUP PROGRAM

Connecticut Children’s Neonatal Neurodevelopmental Follow-Up Program (NNFP) is a regional service supporting all high-risk infants born and discharged from NICUs in the Greater Hartford and Eastern and Central Connecticut region. The program receives referrals from NICUs at Connecticut Children’s in Hartford and Farmington, St. Francis Hospital, the Hospital for Central Connecticut and Eastern Connecticut Health Network, as well as the Connecticut Children’s ECMO program, Cardiology, Neurosurgery, General Surgery services and from community pediatricians. In 2023, Dr. Lainwala’s team conducted nearly 1,000 visits.

The NNFP continues to be an integral part of research at Connecticut Children’s Neonatology division. The NNFP provides training to the neonatal fellows as

well as to pediatric residents as a continuity clinic experience. Fellows, residents, as well as medical and undergraduate students have ongoing research projects within the program, leveraging the extensive NNFP database and many trainees have presented their work at international conferences. Introduction of the Ages and Stages questionnaire in 2023 provided a new means to detect early developmental delays during clinic visits. A similar concept advanced in the coming year is the Hammersmith Infant Neurologic Examination tool for the early detection of cerebral palsy.

PUBLICATIONS

Coleman S, Unterhauser K, Rezaul K, Ledala N, Lesmes S, Caimano MJ, et al, (Matson AP 11/11). Highresolution microbiome analysis reveals exclusionary Klebsiella species competition in preterm infants at risk for necrotizing enterocolitis. Sci Rep. 2023 May 16;13(1):7893.

Chhikara A, Hagadorn JI, Lainwala S. Effect of maternal voice on proportion of oral feeding in preterm infants. J Perinatol 2023 Aug 43:68-73.

Sarkar S, Brimacombe M, Herson V. Fresh frozen plasma and cryoprecipitate: Can we safely reduce their use in the NICU? J Perinatol 2023 Feb;43(2):226-230.

Czynski A, Laptook A, Das A, Smith B, Simon A, Greenberg R, et al. Pragmatic, randomized, blinded trial to shorten pharmacologic treatment of newborns with neonatal opioid withdrawal syndrome (NOWS). Trials. 2023 Jul 21;24(1):466.

Devlin LA, Hu Z, Ounpraseuth S, Simon AE, Annett RD, Das A, et al, (Czynski AJ, 11/20). Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and the NIH Environmental influences on Child Health Outcomes (ECHO) Program Institutional Development Awards States Pediatric Clinical Trials Network. The Influence of Mediators on the Relationship Between Antenatal Opioid Agonist Exposure and the Severity of Neonatal Opioid Withdrawal Syndrome. Matern Child Health J. 2023 Jun;27(6):1030-1042. Epub 2023 Mar 11.

Trzaski JM. General Cardiovascular Physiology. Organization of Neonatal-Perinatal Medicine Training Program Directors’ National Neonatal Flipped Classroom Curriculum Program. MedEd On The Go - Neo Flip Classroom Cardiology – Cardiovascular Physiology of the Fetus and Neonate. American Academy of Pediatrics, 2023.

Trzaski JM. Fetal Circulation and Transition to Extrauterine Life. Organization of Neonatal-Perinatal Medicine Training Program Directors’ National Neonatal Flipped Classroom Curriculum Program. MedEd On The Go - Neo Flip Classroom Cardiology – Cardiovascular Physiology of the Fetus and Neonate. American Academy of Pediatrics, 2023.

Trzaski JM. Effects of Fetal Stress and Hypoxia on Cardiovascular Function. Organization of NeonatalPerinatal Medicine Training Program Directors’ National Neonatal Flipped Classroom Curriculum Program. MedEd On The Go - Neo Flip Classroom Cardiology –Cardiovascular Physiology of the Fetus and Neonate. American Academy of Pediatrics, 2023.

Trzaski JM. Techniques and Modalities to Assess Cardiovascular Anatomy and Function in the Fetus and Newborn. Organization of Neonatal-Perinatal Medicine Training Program Directors’ National Neonatal Flipped Classroom Curriculum Program. MedEd On The Go - Neo Flip Classroom Cardiology – Cardiovascular Physiology of the Fetus and Neonate. American Academy of Pediatrics, 2023.

Garg PM, Lett K, Ansari AY, Cunningham H, Ware J, Pittman I, et al, Shenberger J 11/15). Outcomes by Disease Onset, Sex, and Intervention in Neonates with SIP and Surgical NEC. Pediatr Res, July, 2023.

Garg PM, Shenberger JS. Surgical NEC, Randomized Trials, Missed Opportunity. J Neonatal-Perinatal Med 2023 June 27:16(2):193-194.

Cardona VQ, Rao R, Zaniletti I, Joe P, Johnson YR, et al, (Shenberger JS 17/20) for Children’s Hospitals Neonatal Consortium. Association of Hospital Resource Utilization with Neurodevelopmental Outcomes in Neonates with Hypoxic-Ischemic Encephalopathy JAMA Netw Open. 2023 Mar 1;6(3):e233770.

Eaves EA , Enggasser AE, Camerota M, Gogcu S, Gower WA, Hartwell H, et al, (Shenberger JS 13/18). CpG Methylation Patterns in Placenta and Neonatal Blood are Differentially Associated with Neonatal Inflammation. Pediatr Res 2023 Mar;93(4):1072-1084.

O’Shea TM, Register HM, Yi JX, Jensen ET, Joseph RM, Kuban KCK, et al (Shenberger J, 12/20). ELGANECHO Pulmonary/Obesity Group. Growth During Infancy After Extremely Preterm Birth: Associations with Later Neurodevelopmental and Health Outcomes. J Pediatr. 2023 Jan;252:40-47.e5.

Pattnaik P, Nafday S, Angert R. Neonatal Intensive Care Unit to Home Discharge Communication: A Quality Improvement Project. Pediatr Qual Saf. 2023 Jul 10;8(4):e669.

Totapally BG, Raju, NVS, Hussain, N. Neonates with an Extremely Prolonged Length of Stay: an Analysis of Kids Inpatient Database”. Newborn 2023 (10.5005/jpjournals-11002-0067).

Vidavalur, R and Hussain, N. Interstate Practice Variation and Factors Associated With Antibiotic Use for Suspected Neonatal Sepsis in the United States. Am J Perinatol. 2023. (in press).

McLeod RM, Rosenkrantz TS, Fitch RH and Koski RR. Sex Differences in Microglia Activation in a Rodent Model of Preterm Hypoxic Ischemic Injury with Caffeine Treatment. Biomedicines 2023, 11, 185.

McLeod R, Rosenkrantz T, Fitch RH. Therapeutic Interventions in Rat Models of Preterm Hypoxic Ischemic Injury: Effects of Hypothermia, Caffeine, and the Influence of Sex. (Basel). 2022 Sep 28;12(10):1514.

Zhao T, Starkweather AR, Matson A, Lainwala S, Xy W, and Cong X. Nurses experience of caring for preterm infants in pain. A meta-ethnography. International Journal of Nursing Science. 16: 533-541. 2022.

Chhikara A, Hagadorn JI and Lainwala S. Effect of maternal voice on proportion of oral feeding in preterm infants. Journal of Perinatology. 2022

Chapters

Rosenkrantz T, Sarkar S, Oh W. Polycythemia and Fetomaternal Hemorrhage. Chapter in Hemostasis. In Bonifacio et al: Fetal and Neonatal Brain Injury, 6th edition.

Invited Book Review

Sanders, MR. Book Review: Polyvagal Safety: Attachment, Communication, Self-Regulation. Psychology of Women Quarterly, 46(2), 242–243. 2022

https://doi.org/10.1177/03616843221079730.

STAFF

James E. Moore, MD, PhD, Division Head (through June 2024)

Jeffrey S. Shenberger, MD, Division Head (starting June 1, 2024)

Annmarie Golioto, MD, Regional Clinical Director Associate Chair for Clinical Affairs for the Department of Pediatrics

David W. Sink, MD, Regional Clinical Director

Adam Czynski, DO, Regional Clinical Director

Caroline Amin, MD

Tina Rita Bafumi, MD

James Belisle, MD

Arvin Bundhoo, MD

Sonia Chaudhry, MD

Jean Chelala, MD

Brett Citarella, MD

Denise Clark, MD

DonnaMaria Cortezzo, MD

Ahmet Gork, MD

Emily Gritz, MD

Shruti Gupta, MD

James Hagadorn, MD

Catherine Hansen, MD

Naveed Hussain, MBBS, MD

Carla Jacobson-Kiel, MD

Edward James, MD

Kendall Johnson, MD

Abraham Khorasani, MD

Isabella Knox, MD

Shabnam Lainwala, MD

Nancy Louis, MD

Mishika Malik, MD

Adam Matson, MD

Arpana Mohnani, MD

Sandra Motta, MD

Mariann Pappagallo, MD

Amy Patel, MD

Priyam Pattnaik, MD

Melissa Posner, MD

Usha Prasad, MD

Alaina Pyle, MD

Ted S. Rosenkrantz, MD

Marilyn Sanders, MD

Hala Saneh, MD

Shikha Sarkar, MD

Meltem Seli, MD

Julie Sheehan, MD

Amanda Smith, MD

Morgan Spaight, MD

Poonam Thakore, MD

Phyllis Wan-Huen, MD

Leslie I. Wolkoff, MD

Heather Champagne, PA-C

Sabrina Colangelo, PA-C

Kaitlyn Jones, PA-C

Erin Leishman, PA-C

Matthew Light, PA-C

Kelsey Vilarino, PA

Danielle Waite, PA-C

Nora Croll, PA

Beth Cross, PA

Pamela Fanning, PA

James Gerace, PA

Kimberly Orzech, PA

Sara Renna, PA

Philip Roach, PA

Elizabeth Seils, PA

Lauren Smith, PA

Jacqueline Talbot, PA

Heather Walsh, PA

Mackenzie Babb, ARN

Jennifer Battle, APRN

Carol Bogdanowicz, APRN

Renee Brockett, APRN

Heather Brown, APRN

Stephanie Capps, APRN

Jessica Cauchon, APRN

Julia Christofori, APRN

Cristina Clark, APRN

Karen Cleaveland, APRN

Sheryl Combs, APRN

Joan Crotty O’Groman, APRN

Caroline Dempsey, APRN

Brittany Dispensa, APRN

Megan Dushek, APRN

Katie Dwyer, APRN

Megan Fitzimons, APRN

Michelle Foell, APRN

Jeanne Franza, APRN

Krista Ganim, APRN

James Gerace, APRN

Katherine Goncharov, APRN

Kalin Haley, APRN

Jill Herr, APRN

Krista Kusinski, APRN

Kelley Lavine, APRN

Erin Leishamn, APRN

Matthew Light, APRN

Laura Lissner, APRN

Jennifer Long, APRN

Colleen Low, APRN

Joanne McConnell, APRN

Karen McGuiness, APRN

Suanne Menick, APRN

Sandy Narciso-Owen, APRN

Lalainya O’Connell, APRN

Karen O’Brien, APRN

Rebecca Pappalardo, APRN

Arti Patel, APRN

Terry Poppiti, APRN

Victoria Pryputniewicz, APRN

Heather Remy, APRN

Megan Richardson, APRN

Jennifer Rogers, APRN

Stacey Rubin, APRN

Rubi Ruiz-Bruzos, APRN

Amy Sienko, APRN

Jessica Simao, APRN

Tayler Simmons, APRN

Kayla St. Hilaire, APRN

Patricia Trehey, APRN

Jenna Trenbeath, APRN

Lindsay Tucker, APRN

Rebecca Valentine, APRN

Jillian Vitale, APRN

Laura Van Dyke, APRN

Erin Vlahakis, APRN

Alyssa Weiss, APRN

Mary Young, APRN

Kristi Zuniga Aguilar, APRN

Fellows

Jacob Kelner, MD

Nazifa Rahman, MD

Allison Sadowski, MD

Kinga Zgutka, MD

Surabhi Khasgiwala, MBBS

Zohaib Sayyed, MBBS

NEPHROLOGY

The Division of Nephrology is committed to being the leader in Pediatric Nephrology services throughout the region providing holistic care of infants, children and adolescents with a wide range of renal and urological disorders while assisting them to reach their best level of health.

Advancement in healthcare calls for transformation in the delivery of services. Our Division of Pediatric Nephrology has been working diligently to transform the health of all children with kidney disease and hypertension. Towards that end, we have expanded our services throughout New England to provide close to home care for patients and families. This approach has become more crucial with the advent of the COVID-19 pandemic and children presenting with more complex illnesses. Beginning this year our own Robyn Matloff, MD, MPH, has successfully grown clinical services, including infusion care, in the newly opened Westport Subspecialty Care Center. In recognition of her exemplary accomplishment, Dr. Matloff has recently been promoted to Senior Ambulatory Pediatric and Community Development Officer for Fairfield County.

Our Nephrology providers continue to provide comprehensive diagnostic services and treatment for the entire range of kidney disorders, including disease and injury in close collaboration with medical, surgical divisions and community liaisons. Hanan Tawadrous, MD, Pediatric Kidney Transplant Director has strengthened our program in partnership with the Hartford Hospital transplant team. Dr. Tawadrous, in collaboration with Hassan El Chebib, MD, of Pediatric Infectious Disease, is working to transform the management of patients who develop opportunistic viral pathogens that threaten renal graft survival after transplantation. Leonela Villegas, MD, MSCE, spearheads our Reduction of Children’s Kidney Stones (ROCKS) Clinic in collaboration with Urology and who, with use of standardized clinical pathways, aims to improve clinical care in pediatric kidney stone disease at Connecticut Children’s. Nephrology specialty care center in our South Hadley Massachusetts location has also grown with clinical services provided under the leadership of Juliann Reardon, MD, MHS.

Under the visionary leadership of Sherene Mason, MD, MBA, our Nephrology Division continues to grow and delivers high quality care with our multidisciplinary clinical services in chronic kidney disease/dialysis, spina bifida, systemic lupus erythematosus and posterior urethral valve. We have provided over 6,000 outpatient clinic visits throughout the region in our main hospital and satellite locations. Along with five board-certified Pediatric Nephrologists, we have advanced practice providers, a registered dietician, a dialysis nurse manager, Nephrology and Dialysis nurses and a licensed social worker. Within the next year, we anticipate the addition of another Pediatric Nephrologist and advanced practice provider to expand the care being delivered to patients in Connecticut, New York, and Massachusetts.

ROBERT R. ROSENHEIM FOUNDATION DIALYSIS CENTER & EXTRACORPOREAL THERAPIES

Since its opening in 2020, the Robert R. Rosenheim Foundation Dialysis Center has provided state-of-theart, specialized dialysis care for our pediatric patients who have kidney failure. We have pioneered the use of TABLO system being the only Pediatric Dialysis Center across the country with this advanced technology. As the first and only Pediatric Dialysis Center in Connecticut we have realized considerable growth with delivery of dialysis treatments, providing over 800 individual treatments during the past fiscal year (30% increase from previous year). Additionally, we have been able to successfully deliver over 20 treatments of life-saving plasma exchange therapy to patients whose autoimmune or inflammatory conditions resulted in abnormal brain function or movement disorders. In the upcoming year, we anticipate building our home dialysis program and services.

We are tremendously proud to embark on our collaboration with Neonatology and the Fetal Care Center and provide the opportunity for neonatal renal replacement therapy (RRT) to the most vulnerable of our patients who have kidney failure from birth. Through the generosity of the Robert R. Rosenheim Foundation, we have acquired Carpediem Dialysis machines to be used in the treatment of kidney failure in infants weighing between 5.5 to 22 pounds. We will continue to

provide RRT services in collaboration with our pediatric ICU colleagues to provide continuous veno-venous hemodiafiltration for older children.

AMBULATORY BLOOD PRESSURE MONITOR PROGRAM (ABPM)/ HYPERTENSION

The Division of Nephrology continues to grow the Hypertension and Ambulatory Blood Pressure Monitoring Program (ABPM). To extend the program’s reach and in line with our commitment to keeping care close to home, ABPM placement is now available in six easily accessible locations with over 400 studies performed annually. In addition to serving primary Nephrology patients, the program is now being utilized by general pediatricians, pediatric subspecialists and a regional pediatric organ transplantation program. The program has grown to expand its research capabilities both nationally and in partnership with multiple divisions within Connecticut Children’s.

SCHOLARLY ACHIEVEMENTS & ACADEMIC EXCELLENCE

Our division members continue their engagement in scholarly activity through premier research consortiums (Pediatric Nephrology Research Consortium, The Childhood Arthritis and Rheumatology Research Alliance) and Standardizing Care to Improve Outcomes for Pediatric ESRD (SCOPE) and Children’s Hospitals’ Solution for Patients Safety collaborative to improve care in pediatric acute and chronic kidney disease. Dr. Mason is the site Principal Investigator for the Cure Glomerulonephropathy Network (CureGN), a multi-site, NIH-funded study on glomerular kidney disease in children and adults.

Key highlights include:

• Dr. Tawadrous was invited to speak regionally at the Hartford Hospital Transplant Grand Rounds on outcomes in Pediatric Renal Transplantation over the past 50 years. She actively participates in a national Transplant Interest Group advancing knowledge in pediatric renal transplants and associated conditions.

• Sonal Fisco, DNP, APRN, presented on the topic of Pediatric Hypertension at the Annual Connecticut Children’s APP Summit this summer was lauded and well-received.

• Dr. Matloff has shared her expertise in Nephrology regionally as an invited speaker for the Annual Joint Pediatric Symposium organized by Connecticut Children’s/Nuvance Health. Additionally, Dr. Matloff created and moderated the first Annual Connecticut Pediatric Health Symposium, a 1-day virtual CME event with over 160 providers in attendance throughout the region.

• On a national level, Dr. Villegas has presented her work on Clinical and Social Determinants of Readmissions in Children with Chronic Kidney Disease at the spring Pediatric Academic Societies Meeting (PAS). Her research on Chronic Kidney Disease and Health Equity was presented to the Yale Nephrology, Clinical and Translational Research group. In fall 2023 her poster presentation on Membranous Nephropathy Outcomes among Children and Adults: Cure Glomerulonephropathy Study from a NIH-funded consortium was accepted at the American Society of Nephrology Kidney Week, reaching a global audience of pediatric and adult kidney specialists.

• Sherene Mason, MD, was an invited speaker and panelist at the Annual Medical Education Conference (AMEC) conference, the largest meeting of underrepresented minority medical and premedical students across the United States and Caribbean. Programs during this meeting are focused on promoting academic success in medicine for these trainees and students.

• Juliann Reardon, MD, has delivered lectures to Yale Pediatric fellows on mental and behavioral health in chronically ill children with enhanced communication strategies. She has also presented a lecture to Yale University Neonatology fellows on the Assessment of Renal Function in Neonates and was a guest speaker for Holyoke Pediatric Associates Physician group on “Updates on Pediatric Hypertension and UTIs.”

Each year the Nephrology Division provides training for Adult Nephrology fellows from UConn Health. Additionally, our faculty are dedicated to training a new generation of Pediatric Residents and medical students from the University of Connecticut School of Medicine and the Frank H. Netter School of Medicine at Quinnipiac University. For their excellence in teaching, both Drs. Matloff and Villegas have received Pediatric Resident Didactic Teaching Awards. We strive to maintain a keen commitment to diversity and inclusion initiatives for our trainees. Dr. Mason has been a Steering Committee member of the Residency DEI and has co-developed and co-led workshops around related topics given at the annual professionalism sessions.

PROFESSIONAL RECOGNITION AND ENGAGEMENT

In recognition of her commitment to advocacy for children with kidney disease, Dr. Villegas has the distinction of being selected as one of two 2023 John E. Lewy Fund (JELF) Advocacy Scholars by the American Society of Pediatric Nephrology (ASPN). She will be immersed in leadership development and gain advocacy skills with government and regulatory expertise.

Other Divisional members sit on various institutional and national committees as chair or co-chair. Dr. Reardon serves as Chair of the American Academy of Pediatrics (AAP) Section of Nephrology DEI Subcommittee and is an AAP FLEXpeds representative. Dr. Matloff serves as Co-Chair for the Hypertension workgroup within the Pediatric Nephrology Research Consortium. Within Connecticut Children’s and the University Of Connecticut School of Medicine, Dr. Mason has served as Co-Chair of the Neurology Division Head search committee.

GRANTS

National Kidney Foundation: Young Investigator Research Award - Principal Investigator: Leonela Villegas, MD, MSCE. Caregivers’ Experience of Readmissions in Children with Chronic Kidney Disease: A Mixed-Methods Study.

American Academy of Pediatrics: Section on Early Career Physicians Health Equity Grants – Principal Investigator: Juliann Reardon, MD, MHS. GRaCEful Patient Care Discussions: A mixed methods exploration of physician’s willingness to explore patients’ Gender, Race, Cultural/ Class Experiences (GRaCE) in clinical care.

PUBLICATIONS

Misurac JM, Grinsell MM, Hansen Narus J, Mason S, Kallash M, Andreoli SP. NSAID-Associated acute kidney injury in Hospitalized Children – A Prospective Pediatric Nephrology Research Consortium Study. Pediatr Nephrol. 2023 March 21; doi: 10.1007/s00467-02305916-y. PMID:36943469.

Vermette, D, Reardon J, Israel, H, Zhen, S, Windish, D, White, M. Development and Validation of a Novel Instrument to Measure the Community WellBeing of Residency Programs. Academic Medicine. 2023 May 1;98(5):614-622. doi: 10.1097/ ACM.0000000000004987. PMID: 36731081.

Xiao N, Starr M, Stolfi A, Hamdani G, Hashmat S, Kiessling SG, Sethna C, Kallash M, Matloff R, Woroniecki R, Sanderson K, Yamaguchi I, Cha SD, Semanik MG, Chanchlani R, Flynn JT, Mitsnefes M. Blood Pressure Outcomes in NICU-Admitted Infants with Neonatal Hypertension: A Pediatric Nephrology Research Consortium Study. J Pediatr. Epub 2023 Sep 29. doi: 10.1016/j.jpeds.2023.113765. PMID: 37778410.

Mazo A, Kilduff S, Pereira T, Solomon S, Matloff R, Zolotnitskaya A, Samsonov D. Mycophenolate Mofetil Versus Prednisone for Induction Therapy in SteroidSensitive Idiopathic Nephrotic Syndrome in Children: An Observational Study. Kidney Medicine. Epub 2023 Dec 10. https://doi.org/10.1016/j.xkme.2023.100776.

STAFF

Dr. Sherene Mason, MD, MBA, FAAP, Division Head

Robyn Matloff, MD, MPH

Juliann Reardon, MD, MHS

Hanan Tawadrous, MD

Leonela Villegas, MD, MSCE

Sonal Fisco, DNP, APRN, FNP-BC, CPN

NEUROLOGY

The mission of the Neurology Division is to provide comprehensive evaluation and treatment for all pediatric patients with neurological diseases in the region. The highly skilled clinicians utilize state of the art care and collaborate with all pediatric specialists in the institution. Several cutting edge treatments are employed for many diseases of the nervous system including epilepsy, neurogenetic conditions as well as muscle and nerve diseases. Furthermore, the Neurology Division participates in pediatric and neurology education. Several division members are active in clinical research and publish peer reviewed articles.

In 2023, we continued to expand the outpatient clinical volume, which reached 11,000 and added further clinics in various locations, particularly in Westport, where we also provide electrodiagnostic services.

The Epilepsy Center under the direction of Jennifer Madan Cohen, MD, FAES, has increased significantly the epilepsy surgery evaluations and collaboration with Neurosurgery, Neuropsychology and Neuroradiology. The EEG Monitoring Unit (EMU) works at capacity given bed availability on MS7 which is a limiting factor. The epilepsy team also includes Krista Grande, MD, Lila Worden, MD, Mark Schomer, MD, and Niall Mitchel, APRN. Dr. Worden has increased the ketogenic diet program and now offers it for adult epilepsy patients as well. Dr. Madan Cohen started a multidisciplinary clinic with Kimberly Maynard, PsyD, to provide advanced specialty care to children with Psychogenic Non-Epileptic Spells/ Seizures (PNES). Children with epilepsy may receive the newest antiepileptic treatments. Connecticut Children’s is an active member of the Pediatric Epilepsy Research Consortium, and has participated in several joint research projects with the consortium including a funded study of Biomarkers of Infantile Spasms and a survey of PNES centers. These have led to abstracts and a platform presentation at the American Epilepsy Society meeting in December 2023.

Elizabeth Ng, MD, FAAP, has expanded the electrodiagnostic (EMG/NCV) by providing diagnostic studies for nerve injuries.

The Movement Disorder program led by William Yorns, DO, offers chemodenervation treatment (BOTOX). Dr. Yorns has collaborated with Jonathan Martin, MD, from Neurosurgery on the first case of dorsal rhizotomy procedure.

Cognitive behavioral intervention therapy (CBIT) is offered by Dina Conley, APRN, for headache and Tourette patients.

Multidisciplinary clinics include the Pediatric CMT Center of Excellence as part of the Inherited Neuropathy Consortium; MDA Care Center supported by a grant from the Muscular Dystrophy Association (MDA), and SMA Care Center sponsored by CureSMA. The Neurocutaneous Clinic directed by Francis DiMario, Jr., MD, is recognized by the TS Alliance (TSA) and Children’s Tumor Foundation as part of the Neurofibromatosis Clinic Network (NFCN). The Neuromuscular program offers gene therapy for spinal muscular atrophy and Duchenne’s muscular dystrophy.

The Neurology Division has been involved in various clinical trials to treat various central and peripheral nervous system diseases.

The neurology faculty continues to teach medical students, pediatric residents, adult neurology residents and psychiatry fellows. Dr. Yorns and Dr. Ng started training the residents in Danbury from the Nuvance adult neurology residency program. In the future we hope to start a pediatric neurology training program.

The Academic Activity of faculty members continued to expand by presentation at national/international conferences, committee memberships, and editorial board participation in several periodicals as highlighted below.

Several division members serve in various functions for national professional organizations, such as Electrodiagnostic Medicine Committee, Child Neurology Society (CNS) Ethics Committee, American Academy of Neurology (AAN) Ethics, Law, and Humanities Committee (ELHC), Scientific Review Committee of the Child Neurology Society; and Care Center Committee of CureSMA.

PUBLICATIONS

Õunpuu S, Pierz K, Mack WJ, Rodriguez-MacClintic J, Acsadi G, Wren TAL. Natural history of ankle function during gait in your with Charcot-Marie-Tooth disease types 1 and 2. Gait Posture. 2023 Jun; 103:146-152. doi: 10.1016/j.gaitpost.2023.05.008. Epub 2023 May 5. PMID:37167760.

Record CJ, Skorupinska M, Laura M, Rossor AM, Pareyson D, Pisciotta C, Feely SME, Lloyd TE, Horvath R, Sadjadi R, Herrmann DN, Li J, Walk D, Yum SW, Lewis RA, Day J, Burns J, Finkel RS, Saporta MA, Ramchandren S, Weiss MD, Acsadi G, Fridman V, Muntoni F, Poh R, Polke JM, Zuchner S, Shy ME, Scherer SS, Reilly MM; Inherited Neuropathies Consortium—Rare Disease Clinical Research Network. Genetic analysis and natural history of Charcot-MarieTooth disease CMTX1 due to GJB1 variants. Brain. 2023 Oct 3;146(10):4336-4349. doi: 10.1093/brain/ awad187. PMID: 37284795; PMCID: PMC10545504.

Krithpalli N, Hersh D, Yorns W, DiMario Jr., FJ. Spinal Epidural Collection after Lumbar Puncture in a Patient without Coagulopathy. J Ped Neurol 2023 April 10; doi:10.1055/s-0043-57012.

Brenton JN, Beslow LA, Brumback AC, Desai J, DiMario FJ, Wu Y. Pediatric Neurology Trainee Award. Ped Neurol. 2023:146;A6-A7.

Graft WD, Cohen BH, Kalsner L, Pearl PL, Sarnat HB, Epstein LG. Fetal Anomaly Diagnosis and Termination of Pregnancy. Dev Med Child Neurol. 2023 July;65(7):900-907. doi:10.1111/dmcn.15528. PMID:36732680.

Fong SL, Utidjian L, Kaur M, Abend NS, Wainwright MS, Grande KM, et al. Safety of intravenous lacosamide in hospitalized children and neonates. Epilepsia. 2023 Sep;64(9):2297-2309. doi: 10.1111/epi.17676. Epub 2023 Jun 19. PMID: 37287398.

BOOK CHAPTERS

Graf WD, Epstein LG. “Practical Bioethics in Child Neurology.” Swiman Pediatric Neurology – Principles and Practice. 7th Edition, Part II Care of the Child with Neurologic Disorders / Chapter 14; 2023.

Grande K, Venkatesan C. Hypoxic Ischemic Encepalopathy. In: Hershey A, ed. CURRENT diagnosis and Treatment Pediatric Neurology. 1st ed. New York: McGraw-Hill; 2023.

Grande K, Holland K. Status Epilepticus. In: Hershey A, ed. CURRENT Diagnosis and Treatment Pediatric Neurology. 1st ed. New York: McGraw-Hill; 2023.

FUNDED RESEARCH

Dr. Acsadi: NIH RO3 for continued gait studies in CMT patients.

Dr. Madan Cohen: PERF (Pediatric Epilepsy Research Consortium) funded multisite study: Biomarkers for Infantile Spasms.

STAFF

Gyula Acsadi, MD, PhD, FAAN, Division Head

Francis J. DiMario, Jr., MD

William D, Graf, MD, FAAP, FAAN

Krista Grande, MD

Louisa Kalsner, MD

Jennifer Madan Cohen, MD, FAES

Elizabeth A. Ng, MD, FAAP, FAANEM

Mark Schomer, MD

Lila Worden, MD

William Yorns, DO

Richard Young, MD, MPH, FAAN

Edwin Zalneraitis, MD

Constandina Conley, APRN

Niall Mitchell, APRN

PAIN & PALLIATIVE MEDICINE

The mission of the Pain and Palliative Medicine Division is to utilize our multidisciplinary expertise to alleviate pain and stress in children afflicted with acute, chronic or terminal illness.

The division continues to be actively engaged in clinical care, education and research. This year we welcomed two new palliative care physicians to the division, Taylor Aglio, MD, and Shannon Michel Wynn, MD. Dr. Aglio completed her fellowship at St. Judes and Dr. Michel Wynn at Nationwide Children’s Hospital. They will support our growing palliative service.

OTHER MAJOR ACCOMPLISHMENTS

Kerry Moss, MD, was awarded the Hartford County Medical Foundation Community Service Award.

Taryn Hamre, APRN, DNP, was awarded one of the inaugural Popik Quality Fellowships.

Mallory Fossa, APRN, was nominated to the AAHPM Pediatric State of the Science Committee.

Dr. Emily Wakefield’s poster on pain-related stigma in adolescents with juvenile fibromyalgia was nominated for an early career poster award at the International Symposium on Pediatric Pain conference. She was also invited to present on an NIH panel focused on educating NIH-funded researchers about stigma among pain populations, and webinar on stigma in youth with chronic illnesses for the Society of Pediatric Psychology.

William Zempsky, MD, presented grand rounds at Rainbow Babies in Cleveland and three talks at the 2023 International Pediatric Pain Masters course in San Francisco.

PUBLICATIONS

Wakefield, E.O., Sandhu, P., & Zempsky, W.T. (2023). Describing the challenges for school nurses managing students with chronic pain. Topics in Pain Manage. 2023 July;38(12), 1-8. https://doi.org/10.1097/01. TPM.0000946460.70411.a0.

Wakefield EO, Belamkar V, Sandoval A, Puhl RM, Edelheit B, Zempsky, WT, Rodrigues HA, Litt MD. Does diagnostic certainty matter?: Pain-related stigma experiences in adolescents with juvenile idiopathic arthritis. J Pediatr Psychol. 2023 Apr 20;48(4):341351. https://doi.org/10.1093/jpepsy/jsac092.

Wakefield EO, Kissi A, Mulchan SS, Nelson S, Martin, SR. Pain-related stigma as a social determinant of health in diverse pediatric pain populations. Front Pain Res (Lausane). 2022 Nov 14;3:1020287. https://doi. org/10.3389/fpain.2022.1020287

Boileau, N.R., Thompson, K.A., Lynch-Milder, M.K., Evans, C.T., Adetayo,T., Rudolph, A.F., Stoll, M.L., Weiser, P., Fobian, A.D., Gowey, M.A., Goodin, B.R. & Wakefield, E.O. Pain-related stigma and its associations with clinical and experimental pain severity in youth with chronic musculoskeletal pain conditions. J Pediatr Psychol. Published online July 27, 2023. https://doi. org/10.1093/jpepsy/jsad048.

Lee, R. R., McDonagh, J. E., Rapley, T., Farre, A., Connelly, M., Palermo, T. M., Toupin-April, K., Wakefield, E. O., Peters, S. & Cordingley, L. (2023). “My gut feeling is…”: An ethnography study investigating healthcare professionals communication about children and young people with chronic musculoskeletal pain in paediatric rheumatology. J Pain. 2023 July 16. https://doi. org/10.1016/j.jpain.2023.07.010.

Lynch-Jordan AM, Connelly M, Guite JW, King C, Goldstein-Leever A, Logan DE, Nelson S, Stinson JN, Ting TV, Wakefield EO, Williams AE, Williams SE, Kashikar-Zuck S; Fibromyalgia Integrative Training for Teens Clinical Trial Study Group and the Childhood Arthritis and Rheumatology Research Alliance Pain Workgroup Investigators. Clinical Characterization of Juvenile Fibromyalgia in a Multicenter Cohort of Adolescents Enrolled in a Randomized Clinical Trial. Arthritis Care Res (Hoboken). 2022 Dec 20. doi: 10.1002/acr.25077. Epub ahead of print. PMID: 36537193.

Kashikar-Zuck, S., Barnett, K. A., Williams, S. E., Pfeiffer, M., Thomas, S., Beasley, K., Chamberlin, L. A., Mundo, K., Ittenbach, R. F., Peugh, J., Gibler, R. C., Lynch-Jordan,

A., Ting, T. V., Gadd, B., Taylor, J., Goldstein-Leever, A., Connelly, M., Logan, D. E., Williams, A., Wakefield, E. O., & Myer, G. D. (2022). FIT Teens RCT for juvenile fibromyalgia: Protocol adaptations in response to the COVID 19 pandemic. Contemp Clin Trials Commun. 2022 Nov 29;30. https://doi.org/10.1016/j. conctc.2022.101039.

Zempsky WT, Campbell-Yeo M, Chambers CT, Cohen LL, Gagliese L, Kwok CHT, Trang T, Stevens B, Taddio A, Voepel-Lewis T, Schechter NL. Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain SocietyAmerican Academy of Pain Medicine Pain Taxonomy Diagnostic Criteria for Acute Needle Pain. J Pain. 2023 Mar;24(3):387-402. doi: 10.1016/j.jpain.2022.09.018. Epub 2022 Oct 13. PMID: 362433173.

Theriault CB, DiPlacido J, Zempsky WT, Santos M. The Relationship Between Experiences of Pain Among Youth with Obesity and Health-Related Quality of Life: The Role of Functional Limitation, Sleep, and Depressive Symptoms. Child Obes. 2023 Mar 6. doi: 10.1089/chi.2022.0203. Epub ahead of print. PMID: 36877538.

Zempsky W, Bell J, Mossali VM, Kachroo P, Siddiqui K. Common Selfcare Indications of Pain Medications in Children. Paediatr Drugs. 2023 May;25(3):321-341. doi: 10.1007/s40272-023-00562-1. Epub 2023 Mar 16. PMID: 36928608; PMCID: PMC10019440.

Gross R, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Witvliet MG, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MC, Bogie AL, Buchbinder NC, Bueler E, Bükülmez H, Casey BJ, Chang L, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D’Sa V,

Dapretto M, Dasgupta S, Dehority W, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Harahsheh AS, Heath AC, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TKF, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Iacono WG, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, Mendelsohn AL, Metz TD, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Oster ME, Payne RM, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Shakti D, Sharma K, Squeglia LM, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ 2nd, Thacker D, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. medRxiv [Preprint]. 2023 May 12:2023.04.27.23289228. doi: 10.1101/2023.04.27.23289228. Update in: PLoS One. 2023 Jun 23;18(6):e0286297. PMID: 37214806; PMCID: PMC10197716.

Thaweethai T, Jolley SE, Karlson EW, Levitan EB, Levy B, McComsey GA, McCorkell L, Nadkarni GN, Parthasarathy S, Singh U, Walker TA, Selvaggi CA, Shinnick DJ, Schulte CCM, Atchley-Challenner R, Alba GA, Alicic R, Altman N, Anglin K, Argueta U, Ashktorab H, Baslet G, Bassett IV, Bateman L, Bedi B, Bhattacharyya S, Bind MA, Blomkalns AL, Bonilla H, Bush PA, Castro M, Chan J, Charney AW, Chen P, Chibnik LB, Chu HY, Clifton RG, Costantine MM, Cribbs SK, Davila Nieves SI, Deeks SG, Duven A, Emery IF, Erdmann N, Erlandson KM, Ernst KC, Farah-Abraham R, Farner CE, Feuerriegel EM, Fleurimont J, Fonseca V, Franko N, Gainer V, Gander JC, Gardner EM, Geng LN, Gibson KS, Go M, Goldman JD, Grebe H, Greenway FL, Habli M, Hafner J, Han JE, Hanson KA, Heath J, Hernandez C, Hess R, Hodder SL, Hoffman MK, Hoover SE, Huang B, Hughes BL, Jagannathan P, John J, Jordan MR, Katz SD, Kaufman ES, Kelly JD, Kelly SW, Kemp MM, Kirwan JP, Klein JD, Knox KS,

Krishnan JA, Kumar A, Laiyemo AO, Lambert AA, Lanca

M, Lee-Iannotti JK, Logarbo BP, Longo MT, Luciano

CA, Lutrick K, Maley JH, Marathe JG, Marconi V, Marshall GD, Martin CF, Matusov Y, Mehari A, MendezFigueroa H, Mermelstein R, Metz TD, Morse R, Mosier J, Mouchati C, Mullington J, Murphy SN, Neuman

RB, Nikolich JZ, Ofotokun I, Ojemakinde E, Palatnik A, Palomares K, Parimon T, Parry S, Patterson JE, Patterson TF, Patzer RE, Peluso MJ, Pemu P, Pettker

CM, Plunkett BA, Pogreba-Brown K, Poppas A, Quigley

JG, Reddy U, Reece R, Reeder H, Reeves WB, Reiman

EM, Rischard F, Rosand J, Rouse DJ, Ruff A, Saade

G, Sandoval GJ, Schlater SM, Shepherd F, Sherif ZA, Simhan H, Singer NG, Skupski DW, Sowles A, Sparks JA, Sukhera FI, Taylor BS, Teunis L, Thomas RJ, Thorp JM, Thuluvath P, Ticotsky A, Tita AT, Tuttle KR, Urdaneta AE, Valdivieso D, VanWagoner TM, Vasey A, VerduzcoGutierrez M, Wallace ZS, Ward HD, Warren DE, Weiner SJ, Welch S, Whiteheart SW, Wiley Z, Wisnivesky JP, Yee LM, Zisis S, Horwitz LI, Foulkes AS; RECOVER Consortium (Zempsky). Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

JAMA. 2023 Jun 13;329(22):1934-1946. doi: 10.1001/jama.2023.8823. PMID: 37278994; PMCID: PMC10214179.

Lane IA, Zempsky WT. Capturing the experiences of sexual and gender minorities with migraine headache. Headache. 2023 Jul-Aug;63(7):971-974. doi: 10.1111/ head.14595. Epub 2023 Jun 27. PMID: 37367081.

Buono FD, Larkin K, Pham Q, De Sousa D, Zempsky WT, Lalloo C, Stinson JN. Maintaining Engagement in Adults with Neurofibromatosis Type 1 to Use the iCanCope Mobile Application (iCanCope-NF). Cancers (Basel). 2023 Jun 16;15(12):3213. doi: 10.3390/ cancers15123213. PMID: 37370823; PMCID: PMC10296339.

Palermo TM, Lalloo C, Zhou C, Dampier C, Zempsky W, Badawy SM, Bakshi N, Ko YJ, Nishat F, Stinson JN. A cognitive-behavioral digital health intervention for sickle cell disease pain in adolescents: a randomized, controlled, multicenter trial. Pain. 2023 Sep 21. doi: 10.1097/j.pain.0000000000003009. Epub ahead of print. PMID: 37733479.

Statton C, Vassilopoulos A, Brenton JN, Potter K, Vargas W, Rumm H, Bartels A, Bailey M, Odonkor C, Stoll S, Zempsky WT, Yeh EA, Makhani N. Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis. Front Neurosci. 2023 Sep 14;17:1235945. doi: 10.3389/fnins.2023.1235945. PMID: 37781253; PMCID: PMC10536169.

Paul TK, Aglio T, Dalgo A, Kaye EC. Narrative Medicine in Hospice and Palliative Care: A Longitudinal Fellowship Curriculum Pilot. Am J Hosp Palliat Care. 2023 Dec 21:10499091231223717. doi: 10.1177/10499091231223717.

NEW GRANTS

Title: The Impact of Social Rejection: Investigating Painrelated Stigma in Adolescents with Chronic Widespread Musculoskeletal Pain (Supplement)

Project Number: K23 AR073934-04 NIAMS

Name of PD/PI: Wakefield, Emily.

Title: An Intervention to Reduce Illicit Bias in Pediatric Sickle Cell Disease

Funded by: Hartford Foundation for Public Giving

Name of PI: Zempsky, William 12/01/2023 - 12/01/2024.

STAFF

William T. Zempsky, MD, MPH, Division Head

Taylor Aglio, MD

Richelle deMayo, MD

Danielle Gutman Lapin, PhD

Eapen Mathew, MD

Shannon Michel Wynn, MD

Kerry Moss, MD

Kalyani Raghavan, MD

Clare Riotte, DO

Preeti Sandhu, PsyD

Emily Wakefield, PsyD

Taryn Hamre, APRN, DNP

Mallory Fossa, APRN

Melissa Jenkins APRN

PEDIATRIC & ADOLESCENT GYNECOLOGY

The members of the Division of Gynecology at Connecticut Children’s continue to provide state-of-theart pediatric and adolescent gynecology consultative services in our four offices, the Connecticut Children’s operating rooms, the Connecticut Children’s emergency room, and in inpatient settings. Outpatient consultations in all areas of pediatric and adolescent gynecology are available in our Farmington, Hartford, Glastonbury, and Rocky Hill offices of Gynecology and Obstetrics, a Division of Women’s Health Connecticut.

The clinical services provided at Connecticut Children’s and our offices include specialty care in all areas of medical and surgical gynecologic care for children and adolescents. These include reproductive health issues, vulvar and vaginal infections in children and adolescents, management of abnormal uterine bleeding and pelvic pain, adolescent endometriosis, congenital abnormalities of the reproductive tract, ovarian cysts and masses, and adolescent hormonal and contraceptive issues. Our team of gynecologists from Gynecology and Obstetrics, a Division of Women’s Health, provides 24/7 coverage of the Connecticut Children’s emergency room, operating room, and inpatient floors.

Our surgical services include da Vinci robotically assisted minimally invasive gynecologic procedures at Connecticut Children’s for selected patients. Division Head Frederick Rau, MD, performs robotically assisted laparoscopic procedures for reproductive tract anomalies and other complex reproductive tract disorders.

Office evaluations and follow-up of pediatric and adolescent patients are done at Gynecology and Obstetrics, a Division of Women’s Health, by Drs. Rau, Emily Rosenbush, MD, Kerrie Henry, MD, Catherine Graziani, DO, Kelley Sturrock, MD, Erin Pickett, MD, Marlaine Miller, MD, Elizabeth Purcell, MD, Ellen Lamb, MD, and Ashley Young, MD, and Pallvi Singh, DO at locations in Farmington, Glastonbury, and Rocky Hill.

Our extensive range of pediatric and adolescentfriendly providers has improved the ability of community physicians to refer families for age-appropriate gynecologic care. We work closely with community pediatricians and Connecticut Children’s subspecialty team members to provide best-practice care.

Our physicians are members of the North American Society for Pediatric and Adolescent Gynecology, an international organization dedicated to the gynecologic care of children and teenagers. They collaborate at Connecticut Children’s with the University of Connecticut School of Medicine obstetrics/gynecology and pediatrics residents and the University of Connecticut School of Medicine and Dartmouth Medical School medical students for inpatient, emergency room, and operating room patient care. Our physicians emphasize a supportive and minimally intrusive strategy while seeing children, adolescents, and families.

In 2023, the division maintained and improved our patients’ access to superior specialty care in pediatric and adolescent gynecology to promote reproductive health and wellness for our community’s children and teenagers.

STAFF

Frederick J. Rau, MD, Division Head

Catherine Graziani, DO

Kerrie Henry, MD

Erin Pickett, MD

Elizabeth Purcell, MD

Emily Rosenbush, MD

Kelley Sturrock, MD

Marlaine Miller, MD

Ellen Lamb, MD

Ashley Young, MD

Pallvi Singh, DO

PEDIATRIC HOSPITAL MEDICINE

The Division of Pediatric Hospital Medicine (PHM) provides world class, family-focused care for the hospitalized children of our region. Now spanning five inpatient sites across two states, we direct one of the largest PHM programs in New England. At all of our locations, we emphasize an evidence-based approach driven by best practice. We lead in educational achievement with the highest number of teaching awards to date of any division at Connecticut Children’s, including winning the overall Faculty Excellence in Teaching award again in 2023. We oversee students from four different medical schools, as well as pediatric and family medicine residents from the University of Connecticut and three other programs. The division has seen rapid growth over the two decades since our inception, and this past year that growth has escalated. We are happy to expand along with Connecticut Children’s itself, and our team has helped to make that growth possible. As the field of PHM continues to evolve, we as a division will keep evolving as well. At Connecticut Children’s, we have a great story to tell, one which demonstrates clinical excellence, dedication to learning, and strong academic achievement, while maintaining our core priority of care for the hospitalized child and family.

For the Division of Hospital Medicine, 2023 brought incredible growth and change. We again broke all previous records for our clinical volume in Hartford, with a nearly 80% increase in revenue in comparison to five years prior. Our regional inpatient locations also grew, especially in the area of well newborns, as more primary care providers entrusted our hospitalists with the care of their newborns. In partnership with our psychiatry colleagues, the PHM division embarked upon a novel project — creation of a 12-bed inpatient medical/ psychiatric unit at Connecticut Children’s, the first of its kind in the state. Under the leadership of Catherine Sullivan, MD, and Cristin McDermott, MD, this state-ofthe-art “Integrated Care Unit” will bring an innovative and holistic approach to help children who suffer at once with

both medical and psychiatric conditions. Beth Natt, MD, continued to lead our Nuvance team, which now includes our location in New York at Vassar Brothers Medical Center, as well as our existing sites at Danbury Hospital, Norwalk Hospital, and within our Saint Mary’s unit in Waterbury.

We could not accomplish what we do as a division without our Advanced Practice Provider (APP) colleagues. The group’s leader, Basia Adams, DNP, APRN, co-directs the Office of Advanced Practice, which oversees professional development for more than 200 APPs at our institution. The Connecticut Children’s Specialty Group (CCSG) Board of Directors recognized Ms. Adams for her leadership by electing her to their Board this past year. Another member of the APP group, Christina Giudice, APRN presented her work on Somatic Symptom Disorders in the Nursing Research and Evidence Based Practice Fellowship. The APP group expanded in the past year, adding Erin Clark, APRN, Victoria Thomson, PA-C, and Julie Quistorff, APRN, as we work towards a full 24/7 PHM service model. This huge and challenging development reflects our growth as a service, and allows Connecticut Children’s to keep pace with its expansion. We are incredibly proud of our APP group. We realize that fostering their talents in Hartford and regionally will help their professional development while also benefitting our organization and the patients we serve.

This past year included another major milestone for our division. Under the leadership of Allyson McDermott, MD, we successfully matched our first-ever Pediatric Hospital Medicine Fellow, who is due to start in July 2024. This new Fellow will join a division widely recognized in the past year for its teaching excellence. Members of the division won an unprecedented number of teaching awards or nominations. For the 11th time since its inception, a member of the division won the overall Faculty Award for Excellence in Teaching. In 2023, that honor went to Melanie Rudnick, MD, for the second year in a row! This award is given to the single faculty member, out of over 200, who exemplifies the highest standards of teaching excellence, as voted upon by the pediatric residents. Four of the seven runners-up for this award came from our division: Christine Skurkis,

MD, Alex Hogan, MD, Ebla Abd Alrahman, MD, and Hayley Wolfgruber, MD. Dr. Skurkis also earned the prestigious Milton Markowitz/ Edwin Zalneraitis Award for Outstanding Contribution to House Staff Education and Career Development.

Members of the division continue to lead in a number of educational positions. Joanne Crowley, MD, serves as director of Undergraduate Pediatric Education for the University of Connecticut School of Medicine, and was joined this year by Emily Hogeland, MD, in the role of Associate Clerkship Director. Dr. Rudnick was promoted to Pediatric Clerkship Director for the Quinnipiac University Frank H. Netter MD School of Medicine, and continues to teach in many venues.

On the quality improvement front, we continued to lead in promotion of best practice, via our nationally recognized Clinical Effectiveness program. Under the leadership of Ilana Waynik, MD, assisted by APRNs Grace Hong and Jill Herring, we now have over 65 standardized, evidence-based clinical pathways, which span the specialties of pediatrics and surgery. We implement these pathways in our regional sites as well, driving best practice around the region. Our pathways expand across hospital units, exemplified by our high flow nasal cannula pathway, led by Kathy Kalkbrenner, MD, and which allows us to provide safe care for high acuity cases on our inpatient units. Our internet site for pathways received over 70,000 hits in 2023, an unprecedented number. Clinicians from around the country utilize our clinical pathways and by doing so, extend our impact far beyond our doors. Maria Ramirez Tovar, MD, one of our regional hospitalists based in New York was a recipient of the Popik Fellowship in Quality & Safety.

The year included great strides in clinical research and academic presentations. Our faculty published multiple articles in peer-reviewed publications, and also delivered talks or led workshops at the national level for a number of organizations: Pediatric Academic Society, Pediatric Hospital Medicine, the Association of Pediatric Program Directors, the Council on Medical Student Education in Pediatrics, the American Academy of Pediatrics, and the American Association of Child and Adolescent Psychiatry. Dr. Hogan joined with Juan C. Salazar, MD, our Chair of

Pediatrics, in leadership of a multi-million dollar NIHfunded grant, as one of eight sites nationally to seek biomarkers for MIS-C disease. Dr. Hogan also received a Clinical Research and Innovation Seed Program (CRISP) grant from Connecticut Children’s, to better target interventions for bronchiolitis care. Dr. Waynik continued to hold her Pfizer antibiotic stewardship grant and won the “Organizational Excellence 4.0” Abstract Award for her work on topical anesthetics. Dr. Skurkis’ article on Pediatric boot camps in training was recognized as a “top 10 article in medical education” at the 2023 PAS meeting.

Fostering leadership across the continuum has been a priority for our division for many years. Division Head Anand Sekaran, MD, received the American Academy of Pediatrics (AAP) Special Achievement award in 2023 for his years of service on the PREP Hospital Medicine Editorial board. He also became Chair of Pediatrics for Nuvance Health, a 7-hospital network that provides care for children in both Connecticut and New York. Dr. McDermott served in the role of PHM Clinical Director, bringing her own professionalism and poise to help sustain and nourish our growing group. Marta Neubauer, MD, continued her leadership role as Site Director of our Saint Mary’s unit, establishing a high level of quality in that location. Dr. Natt served as System Director of PHM within Nuvance Health while earning her executive MBA at Yale. Jane Im, MD, earned a national role in clinical informatics, as the Library editor for the Society of Hospital Medicine listserv, the main communication venue for the specialty.

As pediatric hospitalists, we continue to provide the best in value-based care for our patients. The future is bright as we look forward to the new Integrated Care unit, our first foray into a true 24/7 hospitalist service, arrival of our first PHM Fellow, and continued expansion into our growing regional sites. Our goal is not only to measure ourselves against national standards, but to be at the top of those standards. Yet as we continue to grow and thrive, we strive to maintain our greatest core value of putting our patients and families first in all we do.

PUBLICATIONS

Rogerson CM, Hogan AH, Waldo B, White BR, Carroll CL, Shein SL. Wide Institutional Variability in the Treatment of Pediatric Critical Asthma: A Multicenter Retrospective Study. Pediatr Crit Care Med. 2023 Aug 24;. doi: 10.1097/PCC.0000000000003347. [Epub ahead of print] PubMed PMID: 37615529.

Hogan AH, Espinoza Salomon JC. Challenges and Opportunities in Geospatial Research on Pediatric Social Determinants of Health. Hosp Pediatr. 2023 Aug 1;13(8):e216-e217. doi: 10.1542/hpeds.2023-007284. PubMed PMID: 37455668; PubMed Central PMCID: PMC10375030.

Maltz-Matyschsyk M, Melchiorre CK, Herbst KW, Hogan AH, Dibble K, O’Sullivan B, Graf J, Jadhav A, Lawrence DA, Lee WT, Carson KJ, Radolf JD, Salazar JC, Lynes MA; Connecticut Children’s COVID Collaborative. Development of a biomarker signature using gratingcoupled fluorescence plasmonic microarray for diagnosis of MIS-C. Front Bioeng Biotechnol. 2023 Mar 31;11:1066391. doi: 10.3389/fbioe.2023.1066391. PMID: 37064248; PMCID: PMC10102909.

Hogeland EW, Somers TS, Yip L, et al. Thrombocytopenia Associated with Elemental Mercury Poisoning in Two Siblings — Connecticut, July 2022. MMWR Morb Mortal Wkly Rep 2023;72:1027–1031.

Freeman RE, Qi YS, Geller RJ, Cohen AR, Iyer SS, Waynik IY, Sullivan AF, Camargo CA Jr. Parental Mental Health and Childhood Respiratory Outcomes in a Severe Bronchiolitis Cohort. Clin Pediatr (Phila). 2023 Oct;62(9):1067-1079. doi: 10.1177/00099228221150608. Epub 2023 Jan 30. PMID: 36715245.

Schissler KA, Stewart S, Phamduy T, Brimacombe M, Waynik I, Hoppa E. High-Risk Markers and Infection Rates in Febrile Infants Aged 29-60 Days Presenting to an Emergency Department During the COVID-19 Pandemic. Pediatr Emerg Care. 2023 Nov 1;39(11):895899.

STAFF

HARTFORD-BASED TEAM

Anand Sekaran, MD, Division Head

Allyson McDermott, MD, Clinical Director

Ebla Abd Al-Rahman, MD

Amanda Begley, MD

Joanne Crowley, MD, MSEd

Kari Edelson, DO

Alex Hogan, MD, MS

Emily Hogeland, MD

Jane Im, MD

Kathy Kalkbrenner, MD

Danice Kuruvilla, MD

Marta Neubauer, MD

Melanie Rudnick, MD, MAcM

Christine Skurkis, MD

Catherine Sullivan, MD

MacDara Tynan, MD, MBA

Ilana Waynik, MD

Hayley Wolfgruber, MD

Basia Adams, APRN, DNP, lead APP

Rachel Caplan, APRN

Kara Denz-Fluck, PA-C

Christine Giudice, APRN

Jill Herring, APRN

Julie Quistorff, APRN

Victoria Thomson, PA-C

Alexis Veith, PA-C

SAINT MARY’S TEAM

Marta Neubauer, MD, Clinical Director

Marisa Shaker, PA-C, lead APP, Saint Mary’s Crystal Bastedo, APRN

Tammie Carey, APRN

Julia Sileo, PA-C

NUVANCE HEALTH® TEAM

Beth Natt, MD, MPH, Nuvance System Director of PHM

Danbury/Norwalk:

Donald Sampson, MD

Alicia Briggs, MD

Jacqueline Talbot, PA-C, Danbury PA lead

Beth Cross, PA-C

Alexis D’Aloisio, PA-C

Josh Evans, PA-C

Pamela Fanning, PA-C, Norwalk PA lead

Jacquelyn Brown, PA-C

Nora Croll, PA-C

Jennifer Napolitano, PA-C

Kimberly Orzech, PA-C

Leslie Zalesny, PA-C

Vassar Brothers Medical Center:

Karla Dixon, MD

Anila Krovvidi, MD

Maria Ramirez Tovar, MD

Brandy Arnold-Kreuter, PA-C

Hannah Zeitlin-Wong, PA-C

PEDIATRIC SEDATION

The Center of Procedural Excellence (CoPE) is a six-bed unit within Connecticut Children’s dedicated to providing high-quality procedural sedation for pediatric patients. This is one of only a few centers in New England with space and staff dedicated to non-operating-room pediatric sedation. The CoPE was opened in March 2016 with generous donations from the Connecticut Children’s Foundation and the UConn HuskyThon. The Sedation Service provides comprehensive high-quality care with a focus on the patient and family experience. In 2023, we provided care for over 1,650 patients requiring sedation for procedures outside of the operating room.

The Sedation division works with nearly all subspecialties within Connecticut Children’s to provide sedation for painful procedures outside of the operating room including: bone marrow aspiration/biopsy in Oncology patients, kidney biopsies for Nephrology, imaging for Radiology, catheter placement and minor surgical procedures for Urology and Surgery, central line placement for the PICC line service, and vaccination/ lab draws for patients with developmental delays and autism spectrum disorders. In 2023, we expanded our service to provide additional care for patients with chronic pain and chronic headaches needing injections and infusions for longer term symptom control. Our service utilizes a mixture of intravenous, oral, and inhaled sedative agents to provide mild to deep sedation, scaled to meet the developmental and procedural needs of each patient.

Connecticut Children’s CoPE continues as a Sedation Center of Excellence as designated by the Society for Pediatric Sedation. The designation is a highly competitive award given annually to centers of pediatric sedation that create an “ideal environment for the delivery of safe, effective, efficient, timely and equitable patient-centered pediatric procedural sedation.” The Society for Pediatric Sedation is the international multidisciplinary leader in the advancement of pediatric sedation. Applications are reviewed in a blinded fashion by a panel of experts and Center of Excellence

designations are awarded for a four-year period, with ours running from 2020 to 2024. We are currently the only pediatric hospital in New England with this Center of Excellence designation.

We are humbled by our high commendations from patients and families, a testament to our continued efforts to develop a family centered approach to care delivery. To that end, associate medical director Kalyani Raghavan, MBBS, MD, DCH, continues to develop strategies to serve the needs of our patients with autism spectrum disorders. Working with colleagues in Developmental Pediatrics at Connecticut Children’s and with state and national experts, Dr. Raghavan has developed social stories to help prepare patients and families for their procedural sedation. These social stories are available online and can be viewed by families to prepare their child for the visit to Sedation. Dr. Raghavan has received grant funding from Autism Speaks® and other outside foundations to continue her very important work. Further developing her expertise in alternative approaches to management of pain and anxiety, Dr. Raghavan is initiating a program to offer options for aromatherapy for patients hospital-wide. To help families prepare for a visit, our child life specialist is available for phone consultations in advance to help develop individualized approaches with the input of family members.

Members of the Sedation team are involved in leadership and committees at Connecticut Children’s. Leonard Comeau, MD, is chairperson of the Sedation and Analgesia Committee and is responsible for writing and updating sedation policies, updating and overseeing credentialing of the house staff, and monitoring safety and quality of sedation hospital-wide. Members of the Sedation service also participate on hospital committees focused on pain management, the patient and family experience, pediatric palliative care, and quality and safety.

Our educational commitment remains strong. Every UConn Pediatric and Emergency Medicine intern (35 per year) spends a week on a dedicated Sedation rotation. Residents participate in all aspects of patient care, are given hands-on training in airway management,

and become credentialed to independently provide moderate sedation.

Our mission is to provide the highest quality care for children undergoing tests and procedures outside the operating room. We aim to utilize not just sedation medications but distraction techniques, alternative therapies, and a family centered approach to minimize anxiety and unnecessary discomfort for our patients.

STAFF

Jesse Sturm, MD, MPH, Division Head

Kalyani Raghavan, MBBS, MD, DCH

Kathy Kalkbrenner, MD

Leonard Comeau, MD

PSYCHOLOGY

The mission of the Division of Pediatric Psychology is to be on the forefront of improving the mental health of all of Connecticut’s children through clinical innovation, treatment, research and education. With new programming, collaborations, research and trainees, 2023 has been a banner year for the division.

DIVISION OVERVIEW

The Division of Pediatric Psychology is comprised of 23 pediatric psychologists. We are embedded in 12 areas including the Pediatric Obesity Center, Pain & Palliative Medicine, GI, the Consultation/Liaison Service, Rheumatology, Adult Congenital Heart Disease, Feeding Team, Hematology-Oncology, Primary Care, Sleep Medicine, the Gender Program and the NICU. In addition, we lead work in four other areas including Neuropsychology, the Medical Coping Clinic, The Medical and Mental Wellness Program and Employee Mental Health. Our division continues to grow as we have three new pediatric psychologists who will be joining us in 2024 to support the newly opening Med-Psych Inpatient Unit. Our pediatric psychologists are clinicians, innovators, researchers with funding at the national and local levels and educators to trainees, colleagues and the community. We are dedicated to improving treatment options, testing new therapies, being the voice or mental health in the state of Connecticut, identifying and addressing disparities to care and training the next generation of pediatric psychologists.

CLINICAL

Much focus this year was spent on strengthening the continuum of mental health services in anticipation of the opening of our Med-Psych Inpatient unit in early 2024. We have strived to make sure that kids get the right care, at the right time, at the right intensity level. We have done this through innovation of the work of our embedded psychologists, strengthening our ability to see children and families quickly in our psychology clinics and taking care of our team members.

Preeti Sandhu, PsyD, and Danielle Guttman-Lapin, PhD, have been able to implement and run the first Comfort Ability program here at Connecticut Children’s. This is a child/adolescent and parent group designed to provide preliminary pain education, functional strategies, and offer social support to teens living with chronic pain. This group allows teens all across the state of Connecticut to come together and learn and engage with peers that may otherwise be unknown to them in their day to day interactions, while also allowing parents to find support in each other as they learn how to parent and support function to these teens in collaboration with their medical providers. The program will continue to be adapted with groups run throughout the year with hopes to disseminate involvement to other clinical pediatric populations across the institution within a 2-3 year timeframe. Similarly, Siddika Mulchan, PsyD, has extended this work with Comfort Ability for Sickle Cell Pain providing more youth and families the opportunity to connect. In addition, Dr. Mulchan received her certification in Parent-Child Interaction Therapy, a highly intensive training program dedicated to caring for young children with behavioral concerns. We increased our services in Employee Mental Health with the hiring of Leah Morgan, PsyD, which also allowed for expansion of the type of care, which could be provided. We also launched a new mental health service with Whit Ryan, PsyD, hired to care for youth within the Gender Program.

TRAINING

This year our division was proud to support four postdoctoral fellows – our largest class ever! Jenine Tulledge-Wolff, PhD, continues in her second year of a neuropsychology fellowship within the Division of Cancer and Blood Disorders under the supervision of Lauren Ayr-Volta, PhD. Abigail Sharer, PhD, joins us from Texas A&M to support Melissa Santos, PhD, with research in transgender youth and supporting clinical care in the Pediatric Obesity Center. Jessica Simmons, PhD, from Syracuse University is completing her fellowship with an emphasis in eating disorders through the Division of Adolescent Medicine. Finally, Anna Weis, PsyD, from the University of Hartford is completing her fellowship with an emphasis in pediatric psychology within several service lines at Connecticut Children’s.

RESEARCH

Emily Wakefield, PsyD, continues to work on her NIH-funded research on pain-related stigma among adolescents with chronic musculoskeletal pain. She obtained additional NIH supplemental funding in collaboration with Dr. Santos to improve racial equity in pain-related stigma research for Black youths with chronic pain. Dr. Wakefield was also invited to present on an NIH panel focused on educating NIH-funded researchers about stigma among pain populations. Dr. Sandhu worked alongside Dr. Wakefield to understand the challenges school nurse’s face when working with children and adolescents living with chronic pain and functioning within the school environment. Dr. Mulchan continued her work in provider implicit bias and submitted her K23 application this year. Dr. Santos continued her focus on health equity and outcomes research. She was named Director for the child health equity and outcomes center of the Research Institute alongside co-director Kevin Borrup, DrPH, JD. She expanded her research in transgender youth, particularly around improving access to care and understanding decision-making around receiving gender-affirming services. She also continued her focus on improving mental health screening and eliminating healthcare disparities. Dr. Santos was asked to edit a special issue on adolescent bariatric surgery. Our team presented topics related to our work at various national conferences including the Society of Pediatric Psychology Annual Conference, NASPGHAN and the ASMBS Annual Conference. In addition, our team published widely throughout 2023 and served as reviewers for top tier journals.

REACHING OUTSIDE CONNECTICUT CHILDREN’S

Dr. Santos spent this year as President of the Society of Pediatric Psychology (SPP), the professional organization for our discipline. Kelly Maynes, PsyD, continued her work as clinical co-chair for SPP’s Functional Neurological Symptom Disorder Special Interest Group (SIG) and Dr. Wakefield continued as the Pain SIG Chair. Outside SPP, Bradley Jerson, PhD, remains an integral member of the Rome Foundation

Psychogastro Group. Dr. Wakefield serves on the steering committee for PoWER – the affinity group for women in pediatrics. Dr. Santos remains on the governance board of the Pediatric Obesity Weight Evaluation Registry (POWER), the national registry for pediatric obesity, and is leading the committee writing the psychological guidelines for adolescents undergoing bariatric surgery. She serves on the Integrated Health Committee for the American Society of Bariatric and Metabolic Surgery. Dr. Santos continued her role as the Associate Chair for Diversity, Equity and Inclusion for the Departments of Pediatrics and Surgery, serves on the Diversity Committee for the Connecticut Hospital Association, and is the pillar lead for patient healthcare inequities at Connecticut Children’s. Kelly Weber, PsyD, serves on the Task Force for Training Guidelines in Clinical Child and Adolescent Psychology. Lynelle Schneeberg, PsyD, continues to serve as a valuable voice in sleep psychology having contributed to multiple news outlets including the New York Times and the Washington Post.

THE FUTURE

2023 was a time of rapid growth for the Division of Pediatric Psychology focused on improving mental health care for Connecticut’s children. As we move into 2024, we do so with excitement of the continued expansion of mental health services and being able to provide a true mental health continuum of care. We remain committed to our mission to provide the finest mental health treatment through our focus on clinical care, innovation, research and education.

GRANTS

• Wakefield: NIH supplement

• Wakefield: NIH K23

• Mulchan: Hartford Foundation for Public Giving

• Santos & Finck: American Diabetes Association Grant

• Santos: R00

• Santos: Cardinal Grant

• Santos: SAMHSA Grant

• Santos: Connecticut Health Foundation Grant

• Santos: CVS Grant

• Santos: Tow Foundation

PUBLICATIONS

Darling KE, Warnick J, Guthrie KM, Santos M, Jelalian E. Referral to Adolescent Weight Management Interventions: Qualitative Perspectives from Providers. J Pediatr Psychol. 2023;48(10):815-824. doi:10.1093/jpepsy/jsad068.

Theriault, C. B., DiPlacido, J., Zempsky, W. T., & Santos, M. (2023). The Relationship Between Experiences of Pain Among Youth with Obesity and Health-Related Quality of Life: The Role of Functional Limitation, Sleep, and Depressive Symptoms. Childhood obesity (Print), 10.1089/chi.2022.0203. Advance online publication. https://doi.org/10.1089/chi.2022.0203.

Darling, K. E., Warnick, J., Guthrie, K. M., Santos, M., & Jelalian, E. (2023). Weight Management Engagement for Teens from Low-Income Backgrounds: Qualitative Perspectives from Adolescents and Caregivers. J pediatric psychology, jsad008. Advance online publication. https://doi.org/10.1093/jpepsy/jsad008.

Christison A, Ariza A, Fernandez C, Kumar S, Novick M, Santos M, Stratbucker W, Sweeney B, Vidmar A & Kirk S. (2023). Challenges and solutions to sustaining paediatric weight management programs in the United States. Clinical Obesity.

Wakefield, E.O., Sandhu, P., & Zempsky, W.T. (2023). Describing the challenges for school nurses managing students with chronic pain. Topics in Pain Manage. 2023 July;38(12), 1-8. https://doi.org/10.1097/01. TPM.0000946460.70411.a0.

Boileau, N.R., Thompson, K.A., Lynch-Milder, M.K., Evans, C.T., Adetayo,T., Rudolph, A.F., Stoll, M.L., Weiser, P., Fobian, A.D., Gowey, M.A., Goodin, B.R. & Wakefield, E.O. Pain-related stigma and its associations with clinical and experimental pain severity in youth with chronic musculoskeletal pain conditions. J Pediatr

Psychol. Published online July 27, 2023. https://doi. org/10.1093/jpepsy/jsad048.

Wakefield EO, Belamkar V, Sandoval A, Puhl RM, Edelheit B, Zempsky, WT, Rodrigues HA, Litt MD. Does diagnostic certainty matter?: Pain-related stigma experiences in adolescents with juvenile idiopathic arthritis. J Pediatr Psychol. 2023 Apr 20;48(4):341351. https://doi.org/10.1093/jpepsy/jsac092.

Lee, R. R., McDonagh, J. E., Rapley, T., Farre, A., Connelly, M., Palermo, T. M., Toupin-April, K., Wakefield, E. O., Peters, S. & Cordingley, L. (2023). “My gut feeling is…”: An ethnography study investigating healthcare professionals communication about children and young people with chronic musculoskeletal pain in paediatric rheumatology. J Pain. 2023 July 16. https://doi. org/10.1016/j.jpain.2023.07.010.

Dreyer, R., Berkowitz, A., Yaggi, H., Schneeberg, L. et al (2022). Prescription Digital Therapeutic for Patients with Insomnia (SLEEP-I): A Protocol for a Pragmatic Randomized Controlled Trial. Sleep Medicine, Volume 100, Supplement 1, 2022, pages S133-S134, ISSN 1380-9457, https://doi.org/10.1016/j. sleep.2022.05.365.

Jerson, B., Hale. A. (2023) Caring for youth and families with complex medical and psychosocial concerns. In B. Reed, M. van Tilburg, S. Knowles (Eds.). Pediatric Psychogastroenterology: A Handbook for Mental Health Professionals.

STAFF

Melissa Santos, PhD, Division Head

Lauren Ayr-Volta, PhD

Bradley Jerson, PhD

Brian Farrell, PsyD

Danielle Guttman-Lapin, PhD

Keri Herlan, PhD (Village Employee)

Alicia Hoffman, PhD

Vanessa Laurent, PhD

Kimberly Maynard, PsyD

Kelly Maynes, PsyD

Leah Morgan, PsyD

Siddika Mulchan, PsyD

Jennifer Paul, PhD

Mike Reiss, PsyD

Whit Ryan, PsyD

Preeti Sandhu, PsyD

Lynelle Schneeberg, PsyD

Ellen Sejkora, PhD

Amy Signore, PhD

Emily Wakefield, PsyD

Heather Wimmer-Hamman, PsyD (Village Employee)

Kelly Weber, PsyD

Jennifer Wolpaw, PhD

Pediatric Psychology Postdoctoral Fellows

Jenine Tulledge-Wolff, PhD

Abigail Sharer, PhD

Jessica Simmons, PhD

Anna Weiss, PsyD

PULMONOLOGY & SLEEP MEDICINE

The Division of Pulmonology and Sleep Medicine pursues the following vision in alignment with the institution’s mission: delivering exceptional clinical care for children in connecticut and beyond.

Our unwavering commitment is to redefine pediatric clinical care, extending our impact throughout Connecticut and neighboring states. Our primary focus is on delivering exceptional care for respiratory and sleep-related illnesses, and we employ a dynamic approach that involves both the establishment and expansion of cutting-edge clinical programs and centers.

At the forefront of our initiatives is the Asthma Center and the severe asthma clinic, a cornerstone of support for patients and their families within the community. Going beyond conventional care, we actively engage in research to unveil the root causes of asthma, with a specific emphasis on exploring allergic exposures.

In addition, we have developed other specialty respiratory centers. These include the Neuromuscular Disease Center in collaboration with Neurology, and the Technology-Dependent Children Program. Further collaborations exist in our Sickle Cell Disease Clinic with Hematology and Recurrent Croup Clinic with ENT.

Our commitment extends to multi-specialty care with centers such as the Aerodigestive Center, providing comprehensive services for patients requiring ENT, GI, and pulmonary expertise.

For rare pulmonary conditions like Cystic Fibrosis (CF) and Primary Ciliary Dyskinesia (PCD), we have established specialized and accredited centers. These centers ensure that patients receive all-encompassing care tailored to their unique needs.

Championing Medical Education:

A core part of our mission is the education of medical

students and residents. This year, we are creating a collection of dynamic and interactive learning modules for those rotating through pulmonary training. These modules aim to establish a solid foundation of pulmonary knowledge.

In collaboration with the University of Connecticut Sleep Division, we are excited to unveil a new Sleep Fellowship program. This initiative signifies our commitment to enhancing expertise in sleep medicine.

Pioneering Research:

Our commitment to research is evident through The Asthma Center, Division of Sleep Medicine, and the accredited Central Connecticut Cystic Fibrosis Center. These initiatives underscore our dedication to advancing scientific understanding and improving patient outcomes.

ADMINISTRATIVE UPDATES

Haviva Veler, MD, who joined in June 2022 as the head of the Divsion of Pulmonary and Sleep Medicine, has been a transformative force. Her expertise spans both pulmonary and sleep medicine, bringing a wealth of knowledge and innovation to our institution.

The Division of Pulmonology and Sleep Medicine expanded significantly to be able to answer the need for pulmonary care throughout the state. A new attending physician was hired, Corey Wynn, MD, who graduated from his Pulmonology Fellowship at Cincinnati Children’s and brought his expertise in bronchoscopy and passion for the care of children with sickle cell disease. Two new APPs were added to the outpatient team, Sabrina Lachowicz, PA, and Nick Mudry, APRN. To improve inpatient care of pulmonary patients, as well as to provide excellent consult service, we hired a new APRN, Lindsey Watkins who supports our inpatient service and is the liaison to the bronchopulmonary dysplasia (BPD) consortium.

PULMONARY FUNCTION TESTING

Melanie Sue Collins, MD, the director of the Department of Cardiopulmonary Diagnostic Services’ (CDS), and

Lynn Dougherty, RRT, were instrumental in helping the CDS maintain American Thoracic Society (ATS) accreditation this year for its pulmonary function laboratory. The lab also was able to upgrade its equipment for breathing, exercise and cardiac stress tests. The new complement of laboratory devices provides more accurate testing for a diverse population of patients. Our patients also say the equipment is easier to use and more “kid-friendly” than ever. This year, the Pulmonary Function Lab achieved accreditation to conduct nasal nitric oxide (NO) testing, a crucial component of the recently accredited Primary Ciliary Dyskinesia Center (PCD). We proudly stand as the sole center offering this specialized service between New York City and Boston.

PULMONARY FELLOWSHIP/DIVISION DIVERSITY COMMITTEE

Our division’s diversity committee has integrated multiple activities into the department to raise awareness of our similarities and differences. We celebrate and decorate for various ethnically themed months and, based on the theme, daily explore a historical figure thanks to the efforts of Anita Cruz. We continue to expand our Spanish-speaking skills though our daily word-of-the-day.

INPATIENT/CONSULTATIVE PULMONARY SERVICE

Our commitment to comprehensive care is exemplified by the expansion of our Inpatient/Consultative Pulmonary Service. With the invaluable addition of dedicated Nurse Practitioner Emily Tyskinski, APRN, and Lindsey Watkins, APRN, we are well-equipped to meet the escalating demand for ongoing consultative requests.

Specialized Focus on NICU Patients and

Collaborative Initiatives: Ms. Tyskinski and Ms. Watkins play a pivotal role, focusing on providing longitudinal consultative care to NICU patients. Their efforts are geared towards facilitating a seamless transition from the NICU to home or to Connecticut Children’s main inpatient hospital. In a strategic move, our division has become part of

the Severe BPD Consortium Group, collaborating with neonatology, cardiology, and pulmonology. This collective effort ensures the provision of optimal support and care for the growing patient population facing severe (BPD).

Enhancing Inpatient Care:

The addition of Advanced Practice Providers (APPs) to our inpatient service is a key initiative to streamline our consult service. This not only allows us to respond promptly to consult requests but also ensures continuity of care for patients admitted for prolonged periods, frequent admissions, or those in the ICU.

We expanded and upgraded our outpatient care services by retrofitting providers’ workspaces to enhance telemedicine visits, which facilitate care for patients who continue to have access to our specialists without leaving the comfort of their homes. Telehealth visits continue to be valuable, especially for complex patients where travel is a challenge.

SEVERE ASTHMA PROGRAM

Our program is dedicated to providing compassionate care to individuals whose lives are profoundly impacted by severe asthma on a daily basis. Led by Caleb Wasser, MD, this multidisciplinary clinic takes a holistic approach, ensuring comprehensive evaluation and support for patients. Under the guidance of Dr. Wasser, the clinic benefits from leadership that combines medical expertise with a commitment to innovative solutions. The clinic operates as a collaborative effort, featuring a nurse coordinator, Ms. Debby Foster, and a dedicated social worker. This multidisciplinary team is essential for addressing the diverse needs of patients. Upon arrival at the clinic, patients undergo a thorough evaluation from medical, social, and Diversity, Equity, and Inclusion (DEI) perspectives. This comprehensive approach allows us to tailor our support to each patient’s unique circumstances. The clinic offers a range of support encompassing medical, environmental, and pharmacological interventions, including the latest advancements in biologic medications. This ensures that patients receive personalized care aligned with the latest innovations in asthma management. By adopting a team-based approach, we strive to extend innovative

solutions through practical implementation. This ensures that patients not only receive cutting-edge medical care but also benefit from a holistic support system that addresses the broader aspects of their well-being.

CYSTIC FIBROSIS CENTER

Connecticut Children’s Central Connecticut Cystic Fibrosis (CF) Center has proven to be one of the best in the country based on clinical outcomes of lung function, nutrition, and adherence to CF guidelines. Our CF Newborn Screening Program remains one of the top in the nation and Dr. Collins is now serving in an advisory capacity on a Cystic Fibrosis Foundation Grant due to the success of incorporating genetic counseling by telemedicine in our program.

Our team was busy this past year and added a new team member with our CF nurse, Alyson Alissi. Our CF social worker and our nutritionist, Lisa Devine, RD, offer nutrition screening for familis across our CF clinic to ensure all families had adequate supplies to feed their families. In addition, CF coordinator, R.B. Curtis, worked to revitalize our patient and family advisory board and served as CF XoC (Experience of Care) Champions. Ms. Curtis continues to serve on a number of other national committees at the CF Foundation, as do Dr. Collins and center director Craig Lapin, MD. This year Dr. Collins published an article about the center’s experience in improvement in cystic fibrosis newborn screening program outcomes with genetic counseling via telemedicine.

PRIMARY CILIARY Dyskinesia Center

This year marks a significant achievement as the Primary Ciliary Dyskinesia (PCD) Center, under the leadership of Dr. Collins, received accreditation. Representing a pioneering effort, this center operates as a multidisciplinary collaboration, bringing together expertise from various fields. Under the guidance of Dr. Collins, the PCD Center has achieved accreditation, showcasing leadership excellence in the field. The center operates as a collaborative effort, engaging adult pulmonology at the University of Connecticut,

genetics, social work, and nutrition. This multidisciplinary approach ensures a comprehensive understanding and management of PCD. Equipped with state-ofthe-art technology, the center is adept at assessing patients suspected to have a diagnosis of PCD. Utilizing advanced tools such as the nasal NO device, the center provides accurate diagnoses, facilitating timely and targeted interventions. The PCD Center is committed to offering a comprehensive evaluation and management strategy for individuals diagnosed with PCD. This encompasses a holistic approach to address the varied aspects of the disease. As the only accredited PCD center in Connecticut, our facility stands as a unique resource dedicated to providing specialized care and support to individuals affected by PCD.

Sickle Cell Program

Dr. Wynn, in collaboration with DonnaBoruchov, MD, in Hematology, has taken a pioneering step underlining their commitment to patients with a rare and complex disease. Together, they have established a combined clinic, addressing the unique challenges presented by this condition. This initiative reflects a passion for patients facing this rare and complex disease. His commitment extends beyond routine care, aiming to create a dedicated pathway for the evaluation and management of respiratory and sleep illnesses in these individuals. The combined clinic is designed not only to address immediate medical needs but also to prevent future morbidity and mortality. Dr. Wynn’s dedication ensures that patients receive comprehensive care, fostering their well-being beyond the present, and enhancing their quality of life.

SLEEP MEDICINE PROGRAM

Under the steadfast leadership of Jay Kenkare, MD, the Sleep Medicine program has experienced remarkable growth, expanding by an additional 25% despite facing challenging times in the last year.

The program continues its commitment to teaching and education, introducing new diagnostic and therapeutic indications at the sleep lab. Notably, high flow nasal cannula (HFNC) is now used as a treatment for patients with poor adherence to continuous positive airway

pressure (CPAP). Pulmonary fellows and residents from various specialties, including Otolaryngology and Developmental Pediatrics, now rotate through the Sleep Medicine program, fostering a multidisciplinary approach.

The Sleep fellowship program, in collaboration with the University of Connecticut, welcomed its first fellow this year.

Niddya F. Mishra, a registered polysomnographic technologist, has been recognized as a subject matter expert by the American Academy of Sleep Medicine educational programming team.

Lynne Schneeberg, PhD, continues her impactful outreach through local media and blog posts, expanding the division’s footprint, particularly in the Fairfield area. The Multidisciplinary Sleep Clinic has reached its oneyear milestone, successfully combining expertise from Sleep, Pulmonary, Otolaryngology, and Behavioral Sleep to address the most challenging cases.

A new clinic, specializing in children needing CPAP devices, has been established. This multidisciplinary clinic, including a sleep technician, child-life specialist and a sleep physician, addresses every aspect of CPAP use, aiming to improve adherence.

From an academic standpoint, the Sleep Center has contributed to publications and presentations, including a study on the efficacy of seizure montages as part of polysomnography.

NEUROMUSCULAR RESPIRATORY DISEASE PROGRAM

Under the leadership of Jamie Harris, MD, the Neuromuscular Respiratory Disease Program has been established. This initiative represents a new and exciting approach, offering a multidisciplinary clinic for patients with neuromuscular respiratory disorders. In collaboration with Neurology, Dr. Harris brings his wealth of experience, coupled with a commitment to excellence, and is laying the foundation for this pioneering initiative. The Neuromuscular Respiratory Disease Program takes a comprehensive approach,

providing a multidisciplinary clinic to cater to the unique needs of patients with neuromuscular respiratory disorders.

Dr. Harris is actively involved in the revision of both inpatient and outpatient airway clearance protocols. These revisions are designed to enhance the quality of life for patients and, importantly, reduce the length of stay for inpatients.

AERODIGESTIVE PROGRAM

Dr. Harris, as the lead pulmonologist at the Aerodigestive Center, together with Dr. Wynn, continue to be a cornerstone of excellence in our institution. In the past year, the Aerodigestive Center has experienced exponential growth in the number of patients served. This reflects the increasing indications for referral and management, highlighting the center’s pivotal role in addressing complex aerodigestive conditions. To meet the diverse needs of patients, new protocols have been developed to address specific aerodigestive conditions, including but not limited to esophageal atresia and laryngeal cleft. These protocols serve as a foundation for delivering targeted and effective care.

Technological Advancements:

Dr. Harris actively pursues technological upgrades for bronchoscopy equipment, aiming to transition into the digital era. This initiative will enhance the center’s capabilities, allowing procedures on even smaller patients, by purchasing and using a “microbronchoscope.” Dr. Harris’ commitment to advancing interventional bronchoscopy is evident through his participation in the first pediatric interventional bronchoscopy course. Acquiring crucial skills in cryotherapy, he continues to collaborate with adult pulmonology attending at the University of Connecticut to further refine his expertise. Plans to purchase a cryobronchoscope underscore his dedication to expanding and enhancing interventional bronchoscopy services within the center. Bronchoscopic cryotherapy, a cuttingedge technique, holds promise for a variety of clinical scenarios. This includes the treatment of malignant and benign central airway obstruction, low-grade airway

malignancy, foreign body removal or cryoextraction, endobronchial biopsy, and transbronchial biopsy.

PATIENT HELP CENTER

The pulmonary nurses are available in clinic daily to help you with questions regarding a whole range of issues, including but not limited to:

• Medication administration and side effects

• Review of treatment plans

• Symptoms that require medical attention

• Equipment use

• Access to medications prescribed

• Vaccination and biologic therapy

PEDIATRIC PULMONOLOGY FELLOWSHIP/ EDUCATION

Please refer to Graduate Medical Education report.

PUBLICATIONS

Peer Reviewed Publications:

Hollenbach JP, Collins MS, Wasser C, Fedele D. Implementation of standardized asthma management programs in outpatient settings. Ann Allergy Asthma Immunol. 2023 May;130(5):571-576. doi: 10.1016/j. anai.2023.01.016. Epub 2023 Jan 23. PMID: 36702245.

Banasiak NC, Keil Heinonen SA, Filippelli AC. The Perfect Storm: Thunderstorm-Related Asthma. The Journal for Nurse Practitioners. Volume 18. April 2022, 399-402.

Banasiak NC, Keil Heinonen SA, Filippelli AC. A SMART Shift in Pediatric Asthma. The journal for nurse practitioner. Volume 19, June 2023.

Kim J, Gueye-Ndiaye S, Mauer E, Modi VK, Perlman J, Veler H. Polysomnography use in complex term and preterm infants to facilitate evaluation and management in the neonatal intensive care unit. J Clin Sleep Med. 2021 Aug 1;17(8):1653-1663. doi: 10.5664/ jcsm.9264. PMID: 33755011; PMCID: PMC8656904.

Morse E, Pereira N, Liu K, Veler H, Maresh A. Management and outcomes of obstructive sleep apnea in infants. Int J Pediatr Otorhinolaryngol. 2023 May;168:111558.

Kochhar R, Modi V, de Silva N, Gueye-Ndiaye S, Neugarten JM, Ward MJ, Gerber LM, An A, Mauer E, Veler H. Polysomnography-guided mandibular distraction osteogenesis in Pierre Robin sequence patients. J Clin Sleep Med. 2022 Jul 1;18(7):1749-1755. doi: 10.5664/jcsm.9960. PMID: 35332870; PMCID: PMC9243279.oi: 10.1016/j. ijporl.2023.111558. Epub 2023 Apr 15. PMID: 37075592.

Kenkare J, Schramm C, Ahmad S, Mishra N. Performing in-center titration studies amid the Philips Respironics medical device recall. J Clin Sleep Med. 2022 Jan 1;18(1):337. doi: 10.5664/jcsm.9602. PMID: 34398747; PMCID: PMC8807916.

Brumer E, de Ángel Solá DE, Hogan MJ, Chen L. Persistent Hypoxemia in an Asymptomatic 4-year-old Boy. Pediatr Rev. 2023 May 1;44(5):290-293. doi: 10.1542/pir.2021-005293. PMID: 37122046.

Lee S, Zhang A, Flores MA, de Ángel Solá D, Cao L, Bolanos-Rosero B, Wang L, Godoy-Vitorino F, Matos NR, Wang L. Prenatal exposure to Hurricane Maria is associated with an altered infant nasal microbiome. J Allergy Clin Immunol Glob. 2022 Aug;1(3):128-137. doi: 10.1016/j.jacig.2022.05.001. Epub 2022 Jun 2. PMID: 36091489; PMCID: PMC9461092.

C. W. Wynn, , A. George, H. Sawnani, G. Burg; Persistent Air Leak Treated With Endobronchial Valve in an Adolescent With Hyper-IgE Syndrome, American Thoracic Society Presentation May 2023.

C. W. Wynn, G. Burg, M. Hjelm; Chronic Cough, Wheezing, and Eosinophilia in a Preschool-aged Boy, American Thoracic Society Presentation May 2023.

Kenkare JD, Schramm CM, Veler H, McLaughlin AV, Mishra N. Utility of Extended EEG Testing during

Pediatric Polysomnography. SLEEP 2023 Meeting, Indianapolis.

Z. Kenkare, T. Murray, C. Schramm, M. Collins. Partnership in education—cystic fibrosis center patient education practices on home nebulizer care in relationship to published guidelines, North American Cystic Fibrosis Conference, November 2022, Philadelphia, PA.

N. Banasiak, S. Heinonen, A.Filippelli. A SMART Shift in Pediatric Asthma Therapy, Trinity Health and Education International Research Conference 2023 (THEconf2023): ‘Back to normal or forward to better? New horizons in healthcare’, Dublin, Ireland, March 7th –9th 2023.

Hollenbach J, Hogan A, Carroll C, Sturm J, Wasser C, Collins M “The Disappearance and Return of the September Asthma Peak” 2023 Pediatric Academic Societies Meeting, Washington, DC.

Civitello M, Hogan A, Wasser C, Flores G, Collins M, Hollenbach J, “Feasibility and Acceptability of an Electronic Monitoring Device in Children with Asthma” 2023 Pediatric Academic Societies Meeting, Washington, DC.

Book Chapters:

P. Gardiner, A.Filippelli, T. Low Dog. 2023. ‘Prescribing Botanicals’ in D. Rakel. (ed.) Integrative Medicine. 5th edition. Philadelphia, PA. pp. 836-841.

Veler H. Sleep and Inflammation: Bidirectional Relationship. Sleep Med Clin. 2023 Jun;18(2):213-218. doi: 10.1016/j.jsmc.2023.02.003. Epub 2023 Mar 28. PMID: 37120163.

Veler, H: Guest editor: Pediatric Sleep Clinics 2023.

Review articles:

Bieniek JM, Lapin CD, Jarvi KA. Genetics of CFTR and male infertility. Transl Androl Urol. 2021 Mar;10(3):1391-1400. doi: 10.21037/tau.2020.04.05. PMID: 33850775; PMCID: PMC8039587.

Oral Presentations:

Collins, Melanie Sue. Optimization of Pediatric Asthma Management-Ask the Experts. Connecticut Childrens. October 21, 2022.

Veler, Haviva. Sleep in Adolescents-The Perfect StormGrand Rounds Connecticut Children’s. January 17, 2023.

Filippelli, Amanda. The Intricacies of Asthma Diagnosis and Management. Connecticut Children’s Pediatric Health Symposium. February 2nd 2023.

Awards:

Amanda Filippelli, MSN, MPH, APRN, PPCNP-BC, AE-C: NAPNAP’s 50Forward Emerging Leader Award an award recognizing leaders in the field of pediatrics in celebration of NAPNAP’s 50th Anniversary.

Collins, Melanie Sue, MD: Special Achievement Award for work in advocacy in Vaping/E-cigarettes, American Academy of Pediatrics, September 2022.

ADVOCACY/COMMUNITY SERVICE

Dr. Lapin and the CF Team work with CF Foundation to advocate for patients and research with CF.

Dr. Collins advocates for vaping legislation in the state and received an award for this work from the American Academy of Pediatrics.

Dr. Collins advocates for the early diagnosis and treatment of patients with PCD.

QUALITY IMPROVEMENT PROJECTS

The division participated in two quality improvement projects:

• Improved patient’s flow in the pulmonary clinic at Hartford.

• Morbidity and mortality conference discussing two lethal asthma cases.

STAFF

Haviva Veler, MD, Division Head

Melanie Sue Collins, MD

Director, Cardiopulmonary Function Laboratory

Medical Director, Division of Pediatric Pulmonary and Sleep Medicine Program

Director, Pediatric Pulmonology Fellowship

Co-Director, Asthma Center at Connecticut Children’s Associate Director, Central Connecticut Cystic Fibrosis Center

Director, Primary Ciliary Dyskinesia Center

Umit Emre, MD

Jamie Harris, MD

Director, Neuromuscular Respiratory Program

Jay Kenkare, MD

Director, Sleep Medicine Program

Craig Lapin, MD Director, CF Center

Corey Wynn, MD

Director, Pulmonology Sickle Cell Clinic

Lynelle Schneeberg, PhD

Director, Behavioral Sleep Clinic

Tracy Allen, PA-C

Caleb Wasser, MD

Director, Severe Asthma Clinic

Amanda Filippelli, APRN

Director, Pulmonary COVID Long-Hauler Clinic

Co-Director, Recurrent Croup Clinic

Emily Tyksinski, APRN

Lindsey Watkins, APRN

Clinical Directors, pulmonology inpatient operations

Sabrina Lachowicz, Physician Assistant

Nicholas Mudry, APRN

RHEUMATOLOGY

In 2023, the Division of Rheumatology experienced clinical growth with a significant presence in South Hadley, MA, as well as Specialty Care Centers in six locations throughout Connecticut: Danbury, Shelton, Westport, Farmington, Glastonbury, and Hartford. We have four board-certified pediatric rheumatologists. We have a psychologist on our team who addresses the critical biopsychosocial factors affecting our patients. Our team also includes two nurses who provide outstanding clinical care and participate in research through the Rheumatology Nursing Society.

The Division of Rheumatology completed 3,765 outpatient visits this year and cared for 70 complex inpatients. Our physicians have returned to mainly seeing patients in person, but we continue to provide care via telemedicine if preferable for families.

Barbara Edelheit, MD, is proud to lead a division in which each physician has a specific area of expertise and focus, thereby forming the basis of a robust team.

Dr. Edelheit has maintained her focus on education and mentorship. Dr. Edelheit mentors a Clinical Longitudinal Immersion in the Community (CLIC) student, Frukan Ileaasu, a third-year medical student at University of Connecticut School of Medicine. Dr. Edelheit leads the Connecticut Children’s Women in Medicine group called PoWER (Pediatric Women Relate), whose goal is to foster a community of women physicians, psychologists, and leaders at Connecticut Children’s by providing leadership, professional and personal development, and support. The group has now completed a successful third-year with many well-attended events and greater visibility in our Connecticut Children’s community. Dr. Edelheit remains the faculty advisor for the student chapter of the University of Connecticut chapter of the American Medical Women’s Association, (AMWA) a national organization whose mission is to advance women in medicine and improve women’s health. Dr. Edelheit has now taken on a national role in AMWA

serving as the National Physician Mentorship Chair. Dr. Edelheit continues her role as Board Chair of the Connecticut Children’s Specialty Group (CCSG). Dr. Edelheit also continues to serve as a member of the Connecticut Children’s Care Network Development and Credentialing Committee. Dr. Edelheit serves as PI for inclusion in our national research organization Childhood Arthritis and Rheumatology Research Alliance (CARRA) with participation in their registry and related studies.

Heather Tory, MD, MPH, continues her focus on safety and quality within the Rheumatology division, while serving as Associate Chief Quality and Patient Safety Officer at Connecticut Children’s. Within the medical center, Dr. Tory continues to serve as Co-chair of the hospital’s Medication Safety Committee and much of her work is focused on medication safety and computerized order entry-related enhancements, on which she has presented nationally. She is the Program Manager and has been co-designing the curriculum for the newly formed Popik Family Quality and Patient Safety Fellowship. She is a coach in the Organizational Excellence program and oversees the Maintenance of Certification (MOC) facilitation for the program, as well as for Rheumatology-specific MOC projects, including the division’s participation in a national quality improvement MOC project through the Childhood Arthritis and Rheumatology Research Alliance (CARRA). She also continues to serve as chair of the CARRA Juvenile Dermatomyositis (JDM) Quality of Care Workgroup. Regionally, she is a member of the Care Network Quality and Medicaid Committee and on the Medical Advisory Council for the Make-A-Wish Foundation in Connecticut.

Blaine Lapin, MD, continues his focus on advocacy and education. He is engaged with the American College of Rheumatology on projects addressing the rheumatology workforce shortage, as well as grant-funded work, that is aimed at improving delivery of telehealth to patients with rheumatic diseases. Dr. Lapin remains in his role as medical director for the Local Leadership Board of the Connecticut Chapter of the Arthritis Foundation. Dr. Lapin serves as a member of the Connecticut Children’s

PEC and CCC committees as the Core Faculty Leader for the Rheumatology Division. Within the Rheumatology division, he is leading a collaborative project reviewing the Connecticut Children’s cohort of children diagnosed with Tubulointerstitial Nephritis and Uveitis Syndrome, in conjunction with Nephrology and Ophthalmology, and mentoring a resident’s research project, that is analyzing Connecticut Children’s patients diagnosed with Systemic Onset Juvenile Idiopathic Arthritis.

Our newest division member, Jessica Fennell, MD, joined us in August 2022 and is focused on enhancing our Fairfield County presence. She has a clinical interest in Pediatric Lupus and has taken over as the Rheumatology lead in our combined lupus clinic. Dr. Fennell also has an interest in transition of care. She is working with a multidisciplinary team, led by Carolyn Macica, MS, PhD, to formalize and improve our transition to adult care for our patients. She volunteers with the Lupus Foundation of America and has been on the Walk to End Lupus Now planning committee this past year. She remains interested in medical education.

The Division of Rheumatology remains committed to collaborative care at Connecticut Children’s and Dr. Fennell together with Sherene Mason, MD, FAAP, MBA, in the division of Nephrology, have successfully completed the fourth year of our Combined Lupus Clinic to provide continued state-of-the-art care for children and young adults with systemic lupus erythematosus in a multidisciplinary setting. This clinic offers patients and families collaborative care from specialists in a variety of divisions that include Rheumatology, Nephrology, Psychology, and Adolescent Medicine.

PUBLICATIONS

Sherman MA, Kim H, Banschbach K, Brown A, Gewanter HL, Lang B, Perron M, Robinson AB, Spitznagle J, Stingl C, Syverson G, Tory HO, Spencer CH, Tarvin SE. Treatment escalation patterns to start biologics in refractory moderate juvenile dermatomyositis among members of the Childhood Arthritis and Rheumatology Research Alliance. Pediatr Rheumatol Online J. 2023 Jan 6;21(1):3. doi: 10.1186/s12969-022-00785-5. PMID: 36609397; PMCID: PMC9825021.

Wakefield EO, Belamkar V, Sandoval A, Puhl RM, Edelheit B, Zempsky WT, Rodrigues HA, Litt MD. Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis. J Pediatr Psychol. 2023 Apr 20;48(4):341-351. doi: 10.1093/jpepsy/jsac092. PMID: 36892594; PMCID: PMC10118850.

STAFF

Barbara Edelheit, MD, Division Head

Jessica Fennell, MD

Blaine Lapin, MD

Heather Tory, MD, MPH, CPPS

Ann Mendicino-Wrynn, RN

Tegan Willard, RN

Kelly Maynes, PsyD

PEDIATRIC SURGICAL SUBSPECIALTIES

ANESTHESIOLOGY

The Division of Anesthesiology successfully continued its mission in 2023 to provide outstanding clinical care to our surgical patients. In collaboration with the various surgical subspecialties, our division follows the mission of Connecticut Children’s: to improve the physical and emotional health of children through family-centered care, research, education and advocacy. We are committed to advancing pediatric anesthesia care, providing cutting edge therapies for the management of acute and chronic pain, as well as educating the next generation of anesthesiologists and nurse anesthetists.

The Division of Pediatric Anesthesiology draws on the long history of anesthesia excellence in Hartford to provide superb clinical care, innovative teaching, academic achievement, and a commitment to patient safety. The division’s success depends on the close collaboration of our physicians, nurse anesthetists, advanced practice nurses, and staff.

Our division has seen tremendous growth over the past year, aligning with the ever-increasing demands of a robust surgical volume. The division now boasts 15 full time board certified pediatric anesthesiologists, led by Division Head Edward (Ted) Cortland, MD, FAAP, Medical Director Amy Bouchard, DO, and Director of Ambulatory Services Michael Archambault, MD. We were pleased to add Joanna Rothstein, MD, who comes to us from New York University (NYU) Medical Center with over 10 years of experience, and Emma LeWinter, MD, a recent graduate of Boston Children’s Pediatric Fellowship program. We also have over nine highly skilled, experienced, and talented Certified Registered Nurse Anesthetists adding their expertise, led by Thomas Miller, CRNA. We were thrilled to join the Connecticut Children’s family as employees of the organization in 2023, making the seamless transition from private practice. This move has allowed us to more closely align ourselves with the medical center’s mission, and has allowed our practice to flourish.

It was a highly productive year clinically for our group, as we saw a record number of cases across our clinical locations. The division provides services at our main operating room at Connecticut Children’s Hartford campus, as well as other sites throughout the area, including our Ambulatory Surgery Center in Farmington and off-site cases at Hartford Hospital. We provided anesthesia for a record number of surgical cases this year, as we approached 13,000 cases in 2023, up nearly 18% from last year. The division provided anesthetic care for patients across the pediatric spectrum, from premature newborn to young adult, as well as providing care for adult congenital patients. We covered cases of varying complexity in all subspecialties, including elective and emergent surgery, trauma, GI endoscopy, radiologic imaging, and cardiac catheterization. Our cardiac anesthesia team, led by Dr. Bouchard, provided advanced expertise to a record number of cardiac patients. This year also included the launch of the Fetal Care Center program. In collaboration with our obstetrical anesthesiology colleagues from Woodland Anesthesia Associates, we provided care for the Fetal Center, led by Timothy Crombleholme, MD. Overall, it was an extremely busy year for our service, as we provided world-class clinical care to an unprecedented number of patients at Connecticut Children’s.

Our comprehensive perioperative care would not be possible without the tremendous care and support from our two full time APRNs, Tracy Kunkel and Mallory Breitmaier. These two advanced practice nurses work tirelessly to prepare complex patients for surgery. They do exhaustive chart reviews, patient and family interviews, and data-gathering, all to ensure a safe and smooth surgical experience for our patients. Without Tracy and Mallory, our division would not be able to provide the advanced care that we do.

Education is one of the key missions of our division, as we strive to prepare the next generation of physicians, anesthetists, and allied health professionals. Every year, our division educates not only Uconn anesthesiology

residents (as their primary pediatric site) but pediatric, emergency medicine, and oral and maxillofacial (OMF) trainees as well. We are also the primary pediatric site for most of the state’s nurse anesthetist students, hosting the Hartford Hospital/IAA trainees, as well as the Quinnipiac SRNAs. Instrumental to our teaching structure is Dr. Archambault, who serves as both our Site Director for the Uconn Residency Program, and is the Uconn Anesthesiology Residency Simulation Director. He serves on several committees within the Uconn residency program, and works closely with leadership at both Uconn and Connecticut Children’s to ensure an optimal learning environment for our students and residents. Dr. Archambault collaborates with Katherine Kavanagh, MD, from the Division of Otolaryngology to provide simulation-based training to anesthesia residents, ENT residents, medical students, and other learners. All members of the anesthesiology faculty participate in resident and student education in and out of the OR, through clinical teaching, lecturing, and mentorship. We value our role in advancing our field through the education of our future clinicians.

The members of the Pediatric Anesthesiology Division have a strong presence in various arenas throughout Connecticut Children’s, as well as the city, state, and national landscape. Our members serve on various key committees throughout the hospital. Some examples include Anil Mathew, MD, who continues as Chair of the Credentials Committee, Drs. Archambault and Cortland, who serve on the Peer Review Committee, and Mark Indelicato, MD, MSc, and Dr. Archambault, who participate with Brendan Campbell, MD, MPH, on the Trauma Committee. Eapen Mathew, MD, plays a vital role in Connecticut Children’s acute and chronic pain management. As the only board certified Pediatric Anesthesiologist and Pain Specialist, Dr. Mathew offers unique expertise in managing complex pediatric patients with chronic pain, both as outpatients and in the perioperative setting. He has also participated in several research endeavors, and will be presenting at the World Congress of Anesthesia forum this upcoming year. Dr. Cortland began a term as the Vice President

of the Medical Staff at Connecticut Children’s. On the Connecticut state level, Greg Rutkowski, MD, serves as the President of the Connecticut State Society of Anesthesiology. Our staff is fully invested in the fabric of Connecticut Children’s, and we are committed to leading the growth and development of our specialty.

PUBLICATIONS

Accepted Abstract (World Congress of Anesthesia): Promulgating Routine Use of LMA in Prone Position Through Anesthesiology Resident Education: Barriers and Strategies. Presenting Author: Eapen Mathew, MD.

Accepted Abstract (World Congress of Anesthesia): Utility of Regional Analgesia Strategies for Treating Sickle Cell Pain Crises in the Pediatric Inpatient Setting.

Presenting Author: Eapen Mathew, MD,

Accepted Abstract (World Congress of Anesthesia): Collaboration between Anesthesiologist and Hospitalist Teams Can Impact the Incidence of Futile Procedures

Being Performed in the Hospital Setting. Presenting Author: Eapen Mathew, MD.

STAFF

Edward Cortland MD, FAAP, Division Head

Michael Archambault MD Director of Ambulatory Anesthesia

Amy Bouchard DO, Medical Director

Christina Biello, DO

Cheryl Bline, MD

Mark Facchin, MD

John Garrison, MD

Thomas Golembeski, MD

Mark Indelicato, MD, MSc

Peter Lam, MD

Emma LeWinter, MD

Anil Mathew, MD

Eapen Mathew, MD

Joanna Rothstein, MD

Greg Rutkowski, MD

Thomas Miller CRNA (Lead Nurse Anesthetist)

Heather Allen, CRNA

Samantha Anzalone, CRNA

Lauren Barth, CRNA

Kelly Gorski, CRNA

Wendy Lord, CRNA

Thomas Moore, CRNA

Laura Pelullo, CRNA

Rachel Petree, CRNA

Christine Rouleau, CRNA

Michelle Stevens, CRNA

Joshua Yoffe, CRNA

OPHTHALMOLOGY

The Division of Ophthalmology had a great start in 2023. We started the year with the onboarding of a new Optometrist in March 2023 and hiring a new PA with a start date of October 2023 after her graduation from PA school.

We continue to move through patients and strive to provide the best patient care in our division with two ophthalmologists, three optometrists and two physician assistants – with the onboarding training of a third physician assistant who will be seeing patients on her own at the end of the year or starting in the new year. The final physician assistant will add to our already well-trained physician assistants for a total of three ophthalmology physician assistants. Pediatric ophthalmology physician assistants are rare in and of itself and for Connecticut Children’s to have three such PAs who are trained in house by the division ophthalmologists speaks to the uniqueness of our division and our desire to teach and train mid-levels.

We are currently interviewing for an Optometrist, a new Pediatric Ophthalmologist and for a Division Head.

CLINICAL INITIATIVES

• In 2023, we continued to expand Connecticut Children’s ophthalmology beyond Hartford County. We just renewed our contract with Baystate Medical Center to continue our retinopathy of prematurity (ROP) services and expanded those services to be able to see all of the NICU babies requiring eye exams in person rather than splitting the services between ROP telemedicine from another hospital system and in person services from Connecticut Children’s.

• Our plan for 2024 is to expand ROP services into Fairfield County. We are currently working on developing a contract with Danbury Hospital.

• We trained the physician assistants in the NICU at Danbury Hospital to take retinal images in preparation for ROP telemedicine in the New Year.

• In January 2023, we started and have continued our combined clinic with craniofacial surgery. This has allowed patients who require the expertise of both an ophthalmologist and a craniofacial surgeon as well as a neurosurgeon for their medical care to essentially have all these appointments at once thereby avoiding multiple visits to Connecticut Children’s clinics.

• We have expanded our Contact Lens Clinic to once a week from twice a month as this has helped us retain our patients with simple refractive errors who would leave our practice because of their desire to wear contact lenses. With the addition of this clinic and a second optometrist, we were able to expand these services.

• Our physicians actively participate in various monthly conferences and are part of institution wide committees.

• We continue to provide Emergency Department Fellow rotations annually.

• We continue to provide medical student rotations in ophthalmology throughout the year to UConn Medical students – recently we had a visiting medical student from Virginia who rotated with us for 2 weeks.

• We mentor UConn medical students interested in Ophthalmology. Students are involved in various research projects leading to poster presentations at national meetings and publications.

• Published article in Journal of the American Association for Pediatric Ophthalmology and Strabismus (JAAPOS).

• Recently accepted manuscript in JAAPOS.

• Winner of photo submission for Rare and Unusual Diseases category, Cataract & Refractive Surgery Today Nov/Dec 2023 issue.

• Majida Gaffar, MD, is an active participant of the Ophthalmology Interest Group that works to mentor medical students who are interested in medical students. The group meets quarterly and discusses various subspecialties in ophthalmology.

PUBLICATIONS/PRESENTATIONS

Mullane, Elias and Majida Gaffar, MD. The Role of Informational Videos in Parental Education concerning Retinopathy of Prematurity Examinations. J AAPOS 2023. June; 27 (3): 135.el-135.e4.

Edwards, Christopher, Elefant, Daniel, MD, Isakoff, Michael, MD, Gaffar, Majida, MD. Bilateral Tonic Pupils secondary to anti-GD2 antibody therapy for Neuroblastoma – manuscript accepted for publication in Journal of AAPOS December 2023. Due for publication in 1-2 months.

Desia, Sarishka, BA and Majida Gaffar, MD. Endophthalmitis in a Patient with Presumed AxenfeldReiger Syndrome. CRST Photo Contest Winner Nov/ Dec 2023 issue.

OTHER ACCOMPLISHMENTS

• Marnie Smith, OD, and Sona Hamelin, PA-C, have both received promotions and now hold leadership positions in our division.

• Marnie Smith, OD – Lead Optometrist.

• Sona Hamelin, PA-C – Lead Physician Assistant.

• Dr. Smith, OD, has also recently been invited to be on the Advisory Board for Luminopia which is a relative new FDA approved device for treating children with Amblyopia.

• We are one of the first groups to start using this technology regularly.

STAFF

Majida Gaffar, MD, Medical Director/Interim Division Head

Marianna Flores Pimentel, MD

Sonia Hamelin, PA-C

Tiffanie Richardson, PA-A

Michelle Reichle, OD

Marnie Smith, OD

Maria Varela, OD

ORTHOPEDIC SURGERY

The Division of Orthopedic Surgery consists of three services: the General Orthopedic service, Sports Medicine service, and the Center for Motion Analysis. The General Orthopedic service provides the full spectrum of care for children and young adults with orthopedic conditions such as scoliosis and spinal deformities, limb deformity, congenital hip dislocations, clubfeet, congenital hand deformities, children’s fractures, as well as neuromuscular conditions such as cerebral palsy, spina bifida, and muscle diseases. The Sports Medicine service provides expert care for injured athletes, ligament and cartilage injuries, and offers a variety of injury prevention programs.

The Division of Orthopedic Surgery and Sports Medicine is led by Mark Lee, MD, and has a total of 22 clinical providers. There are nine single or dual-fellowshiptrained surgeons: Matthew Brown, MD, Sonia Chaudry, MD, Allison Crepeau, MD, Mark Lee, MD, Philip Mack, MD, Kristen Pierz, MD, Jeffrey Thomson, MD, Donna Pacicca, MD and Janet Zahradnik, MD. Imran Hafeez, MD, is a non-operative Sports Medicine physician who spearheads our efforts in concussion management. Our twelve advanced practice providers (APPs) remain vital in delivering excellent and compassionate patient care, in both inpatient and outpatient settings, while advancing our research mission: Marta Berube, PA-C, Nicole Chaves, PA-C, Katelyn Colosi, PA-C, Kevin Connolly, PA-C, Kevin Fitzsimmons, PA-C, Rebecca Gotthelf, PA-C, Connor Halloran, PA-C, Erin Malone, PA-C and A.J. Ricciuti, PA-C support the offices and surgical centers in the Greater Hartford Area. Jennifer Hope, APRN, Anthony Pastore, PA-C, and Kimberly VanPelt, PA-C, dedicate their efforts to the Southern Connecticut offices, located in Westport, Shelton and Danbury. Kevin Fitzsimmons, PA-C, provides unwavering support and guidance to this group as the lead APP.

The Division explores a range of pediatric orthopedic pathologies through clinical studies based at Connecticut Children’s or through multicenter projects,

resulting in 15 peer-reviewed publications this year on such topics as gait abnormalities in patients with Charcot Marie Toothe disease, national consensus opinions on the surgical management of neuromuscular disorders and novel blood flow restriction approaches to recovery after sports injury. Further, the Division is an active participant in pediatric orthopaedic-specific international study groups focused on understanding the pathophysiology and treatment options for Perthes disease, as well as pediatric spine pathologies.

The Division values its collaborations with other services at Connecticut Children’s and believes such interactions drive research creativity. Joint work with Gyula Acsadi, MD, from the neurology service has led to advances in understanding gait mechanics in Charcot-MarieTooth disease. Collaboration with our neurosurgeons, Jonathan Martin, MD, David Hersh, MD, and Markus Bookland, MD, has not only allowed the provision of world-class care for a variety of spine pathologies, but has also fueled the development of a state-of-the-art brachial plexus treatment program and creative uses for virtual reality in patient pain management.

THE CENTER FOR MOTION ANALYSIS

The Center for Motion Analysis (CMA), one of the few labs in the nation to be fully certified by the Commission for Motion Laboratory Accreditation, is under the medical direction of Dr. Pierz and is supported by world-renowned kinesiologist Sylvia Õunpuu, along with experienced physical therapist Jennifer RodriguezMacClintock and bioengineer Lauren Bargmann. The CMA provides a wide variety of clinical diagnostic services, from the evaluation of children with neurologic disorders that affect walking to understanding the recovery of normal coordination and strength in athletes who have undergone orthopedic surgery. Core to its mission, the CMA strives to improve the understanding of human motion through a robust research program. In 2023, the CMA published 3 peer-reviewed articles, two of which were multicenter efforts in collaboration with other children’s hospitals and participated in numerous podium presentations.

SPORTS MEDICINE

The Sports Medicine team provides high quality care to athletes from youth sports to the collegiate level and beyond. The service is composed of Drs. Crepeau, Brown, and Hafeez, along with a number of outstanding athletic trainers and the Connecticut Children’s Sports Medicine Physical Therapy group. The team offers care to patients with the range of sports-related injuries, including ligament or meniscal injuries, joint or patellar instability, concussion, and cartilage injury. The team offers the state-of-the-art in patella stabilization techniques, as well as novel, biologically-enhanced anterior cruciate ligament repair techniques, and have been simultaneously studying the outcomes of these interventions. In combination with the physical therapy service and the motion analysis lab, the Sports Medicine providers continue to push the envelope in injury recovery, allowing pediatric athletes to return to sports more rapidly and with a lower likelihood of repeat injury.

The Sports Medicine team is also involved in expanding our knowledge of pediatric sports injuries through a keen focus on research within the institution and as a component of large multicenter collaborations. The team members are part of a large national study group on juvenile osteochondritis dissecans (JOCD) of the knee and elbow, as well as combined efforts on meniscus injuries through the PRISM groups.

EDUCATION AND RESEARCH

Education is primary to the mission of the Division and is instrumental to our research efforts, as the next generation of surgeons provides insights into current practice and fuels inquiry. Our orthopedic surgeons train and educate orthopedic residents from the University of Connecticut Health Center and Maimonides Medical Center in New York. In addition, the Division maintains an ACGME-accredited/POSNA-accredited one-year Fellowship in Pediatric Orthopedics.

The Pediatric Orthopedic Surgery Fellowship, directed by Mark C. Lee, MD, is entering its eighth year of formal ACGME accreditation and has thus far graduated five fellows, three of whom are currently in independent

practice. Recent graduates have all contributed peer-reviewed works to orthopedics. Our most recent Fellow, Chong Weng, MD, has submitted a manuscript on the effect of physical therapy on scoliosis bracing compliance.

The Division also welcomed Adam Weaver, DPT, as the research coordinator for research efforts. Adam will support the research endeavors of the Division and advance his own research interests in the field of sports medicine and injury recovery.

HONORS & ACHIEVEMENTS

Notable achievements in the Division during 2023 include the following:

• Becker’s recognized the Division as a Top 100 Orthopaedic program in the nation.

• Drs. Pierz and Acsadi, and Ms. Ounpuu received an R03 grant, with CHLA, to study the Natural History of Charcot Marie Tooth Gait Changes.

• Dr. Pierz and Ms. Õunpuu provided two instructional lectures at the annual American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) meeting and two podium presentations at GCMAS.

• Drs. Crepeau and Brown presented their research on ACL reconstruction and blood flow restriction at the PRISM and AOSSM national conferences.

• Dr. Chaudhry participated in 9 invited lectures and podium presentations, including serving as the Upper Extremity Session moderator in the American Academy of Pediatrics annual meeting.

PUBLICATIONS

Shore BJ, McCarthy J, Shrader MW, Graham K, Veerkamp KM, Rutz E, Chambers H, Davids JR, Narayanan U, Novacheck TF, Pierz K, Dreher T, Rhodes J, Shilt J, Theologis T, Van Campenhout A, Kay RM. Anterior distal femoral hemiepiphysiodesis in children with cerebral palsy: Establishing surgical indications and techniques using the modified Delphi method and literature review. J Child Orthop. 2023 Jun 1;17(3):292294.

Õunpuu S, Pierz K, Mack WJ, Rodriguez-MacClintic J, Acsadi G, Wren TAL. Natural history of ankle function during gait in youth with Charcot-Marie-Tooth disease types 1 and 2. Gait Posture. 2023 Jun;103:146-152.

Ho, CA, Gottschalk HP, Samora JB, Freese K, Chaudhry S, & POSNA QSVI Hand/Upper Extremity Committee. (2023). Diagnosis and Management of Nerve Injuries Caused by Pediatric Upper Extremity Fractures: Current Concept Review. Journal of the Pediatric Orthopaedic Society of North America, 5(2). https://doi. org/10.55275/JPOSNA-2023-708.

Rutz E, Novacheck TF, Dreher T, Davids JR, McCarthy J, Kay RM, Shore BJ, Shrader MW, Veerkamp M, Chambers H, Narayanan U, Pierz K, Rhodes J, Shilt J, Theologis T, Van Campenhout A, Graham K: Distal femoral extension osteotomy and patellar tendon advancement or shortening in ambulatory children with cerebral palsy: A modified Delphi consensus study and literature review. J Child Orthop. 2022 Dec;16(6)442-453.

Ulman S, Loewen AM, Erdman AL, Õunpuu S, Chafetz R, Tulchin-Francis K, Wren TAL. Lower-extremity kinematics and kinetics differ based on drop vertical jump variation: An assessment of methodology for a return-to-play protocol using motion analysis. Gait Posture. 2023 Nov 28;108:132-138.

Gibler RC, Peugh JL, Pfeiffer M, Thomas S, Williams SE, Beasley K, Bonnette S, Collins S, Beals-Erickson SE, Õunpuu S, Briggs M, Stinson JN, Myer GD, KashikarZuck S; FIT Teens Trial Study Group. Associations between patient-reported functional disability and measures of physical ability in juvenile fibromyalgia. Pain. 2023 Aug 25.

de Beer A, Brown MJ. Pediatric cartilaginous lateral femoral condyle Hoffa fracture: a case report and review of the literature. BMC Pediatr. 2023 Dec 11;23(1):626.

Giampetruzzi N, Weaver AP, Roman DP, Cleland JA, Ness BM. Which Tests Predict 6-Month Isokinetic Quadriceps Strength After ACL Reconstruction? An Examination of Isometric Quadriceps Strength and

Functional Tests at 3 Months. Int J Sports Phys Ther. 2023 Dec 1;18(6):1261-1270.

Roman D, Burland J, Fredericks A, Giampetruzzi N, Prue J, Lolic A, Pace JL, Crepeau A, Weaver A. Early- and Late-Stage Benefits of Blood Flow Restriction Training on Knee Strength in Adolescents Following Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. Accepted June 2023.

Weaver AP, Walaszek MC, Roman DP, Harkey MS, Kuenze C. The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2023 Jun 5:3635465231177626.

Wagner KJ 3rd, Beck JJ, Carsen S, Crepeau AE, Cruz AI Jr, Ellis HB Jr, Mayer SW, Niu E, Pennock AT, Stinson ZS, VandenBerg C, Ellington MD. Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction. J Pediatr Orthop. 2023 Apr 1;43(4):e278-e283.

Kuenze C, Weaver A, Grindstaff TL, Ulman S, Norte GE, Roman DP, Giampetruzzi N, Lisee CM, Birchmeier T, Triplett A, Farmer B, Hopper H, Sherman DA, Ness BM, Collins K, Walaszek M, Baez SE, Harkey MS, TulchinFrancis K, Ellis H, Wilson PL, Chang ES, Wilcox CL, Schorfhaar A, Shingles M, Hart JM. Age-, Sex-, and Graft-Specific Reference Values From 783 Adolescent Patients at 5 to 7 Months After ACL Reconstruction: IKDC, Pedi-IKDC, KOOS, ACL-RSI, Single-Leg Hop, and Thigh Strength. J Orthop Sports Phys Ther. 2023 Apr; 53(4):1-8.

Rohde MS, Shea KG, Dawson T 2nd, Heyworth BE, Milewski MD, Edmonds EW, Adsit E, Wilson PL; SCORE Group; Albright J, Algan S, Beck J, Bowen R, Brey J, Cardelia M, Clark C, Crepeau A, Edmonds EW, Ellington M, Ellis HB, Fabricant P, Frank J, Ganley T, Green D, Gupta A, Heyworth BE, Latz K, Mansour A, Mayer S, McKay S, Milewski M, Niu E, Pacicca D, Parikh S, Rhodes J, Saper M, Schmale G, Schmitz M, Shea K, Storer S, Wilson PL, Ellis HB. Age, Sex, and

BMI Differences Related to Repairable Meniscal Tears in Pediatric and Adolescent Patients. Am J Sports Med. 2023 Feb;51(2):389-397.

Niu EL, Milewski MD, Finlayson CJ, Stinson ZS, Joughin E, Nepple JJ, Schmale GA; PRiSM Meniscus Research Interest Group; Beck JJ. Reliability of MRI Interpretation of Discoid Lateral Meniscus: A Multicenter Study. Orthop J Sports Med. 2023 May 30;11(5):23259671231174475.

Anderson KG, Carsen S, Stinson Z, Kushare I, Finlayson CJ, Nault ML, Lee RJ, Haus BM; PRiSM Meniscus Research Interest Group; Schmale GA. Medial Discoid Meniscus in Children: A Multicenter Case Series of Clinical Features and Operative Results. Am J Sports Med. 2023 Apr;51(5):1171-1176.

SELECT NATIONAL AND INTERNATIONAL PODIUM PRESENTATIONS

Society of Biomechanics meeting, Fukuoka, Japan 7/308/3/23

Nandhini Krishnasamy, Trent Guess, Antonis Stylianou, Dana Duren, Donna Pacicca, Tinashe Ernest Muzvidzwa Mutsvangwa, Bhushan Borotikar. Automatic Multistructure pediatric knee bone segmentation using optimal multi-level otsu thresholding technique. International.

AOSSM Annual Meeting, July 2023

Drummond M, Weaver AP, Colosi K, Fitzsimmons, K, Conde A, Brown MJ, Crepeau A. Early clinical outcomes following anterior cruciate ligament reconstruction with quadriceps tendon autograft in an adolescent population suggest higher rates of arthrofibrosis with bone-block than all soft tissue.

Orthopaedic Research Society Annual Meeting, Dallas, TX, February 2023

Kuenze C; Collins K; Weaver A; Giampetruzzi N; Grindstaff T; Farmer B; Walaszek M; Baez S; Harkey M. Biologic Sex and Age Influence Quadriceps Strength 6 Months Post-Anterior Cruciate Ligament Reconstruction.

American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) 77th Annual Meeting; Chicago, IL; Sept 13, 2023.

Rethlefsen S, Hanson A, Õunpuu S, RodriguezMacClintock J, Pierz K, Wren T. The foot posture index: Are three components as good as six?

Pediatric Orthopedic Society of North America (POSNA) Annual Meeting; Nashville, TN; April 26, 2023. Pierz, K*, Õunpuu S, Wren T, Acsadi G: Gait changes over time in children with Charcot-Marie-Tooth disease.

STAFF

Orthopedics

Mark C. Lee, MD, Division Head

Sonia Chaudhry, MD

Philip W. Mack, MD

Donna Pacicca, MD

Kristan Pierz, MD

Jeffrey Thomson, MD

Janet Zahradnik, MD

Sports Medicine

Mathew Brown, MD

Allison E. Crepeau, MD

Imran Hafeez, MD

APP

Kevin Fitzsimmons, PA-C, Lead

Marta Berube, PA-C

Nicole Chaves, MHS, PA-C

Katelyn Colosi, PA-C

Kevin Connolly, PA-C

Nicole Chaves, PA-C

Rebecca Gotthelf PA-C

Connor Halloran, PA-C

Jennifer Hope, MSN, APRN

Erin Malone, PA-C

Anthony Pastore, MS, PA-C

Kimberly VanPelt, PA-C

Fellow

Chong Weng, MD

OTOLARYNGOLOGY – HEAD AND NECK SURGERY

The Division of Otolaryngology – Head and Neck Surgery provides cutting edge and innovative clinical care of infants, children and adolescents. We are national leaders in our field and educate the next generation of pediatric otolaryngologists through our collaboration with the University of Connecticut School of Medicine Otolaryngology Residency and Pediatric Otolaryngology fellowship. We have active outpatient offices at the Hartford campus, as well as satellite locations in, Farmington, Glastonbury, Westport, CT and South Hadley, MA.

Over the past year, we have seen a tremendous growth in our ambulatory services. Referrals for otolaryngology services surged this past year with continued challenges to meet the level of requested consultations. Overall, the Division provided record numbers with 15,469 outpatient visits and 3,763 surgeries. Moreover, we expanded services in the previously underserved areas of western Massachusetts and Fairfield County, CT. We also continue to have an active telehealth presence, which enables our division to expand access to subspecialty care while maintaining convenience for patients and families. Academically, our faculty won numerous teaching awards, created new modules for resident and staff wellness, established new medical simulation models for otolaryngology resident education, and presented at meetings locally, regionally and nationally.

Christopher Grindle, MD, serves as the Medical Director of the division of Otolaryngology and oversees the continued development of the division and its growth. He is the Fellowship Director for Pediatric Otolaryngology and has spearheaded the development of our curriculum for developing future pediatric otolaryngologists. Dr. Grindle was presented with the Faculty Teaching Award for Outstanding Teaching from the University of Connecticut School of Medicine. He has ongoing research projects on the microbiome of middle ear effusion.

Nancy Grover, MD, continues as the co-medical director of the Connecticut Children’s multidisciplinary sleep apnea clinic in collaboration with sleep medicine, sleep psychology and weight management. The program has demonstrated year over year growth, expanding their reach and offering expert, collaborative care to even more patients. The program is specifically geared toward implementing leading edge medical and surgical therapy in treatment of children with persistent sleep apnea. Dr. Grover has presented in national conferences and completed projects on the quality of online resources for common pediatric otolaryngology conditions and the relevance of generative AI “ChatGPT” as an online resource for parents of children with common ENT problems. She continues to work on the randomized controlled study for children with mild obstructive sleep apnea.

Katherine Kavanagh, MD, serves as the director of simulation for the University of Connecticut Otolaryngology residency program and the Director of Research for the division of Pediatric Otolaryngology. She is the chair of the Simulation Education Committee for the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF). Dr. Kavanagh co-directed a simulation course entitled “Worst Case Scenarios” at the 2023 annual meeting of the American Academy of Otolaryngology – Head and Neck Surgery. She is on the executive board of the Connecticut ENT Society where she serves as Treasurer. She has expanded our Voice Clinic services and continues as director of the monthly multidisciplinary Airway Conference. Dr. Kavanagh is the co-director for Connecticut Children’s Office of Faculty Development. She is the recipient of the AAO-HNSF 2023 Honor Award.

Amy Hughes, MD, leads the division’s efforts to care for patients with sialorrhea (drooling). The number of outpatient visits and surgical procedures for drooling continues to increase year over year. She serves on the Academy of Cerebral Palsy and Developmental Medicine sialorrhea care pathway team and is a member of the American Academy of Otolaryngology – Head and Neck Surgery salivary gland committee. Dr. Hughes is active

academically, having presented at several local and international meetings in 2023.

Nicole Murray, MD, is the director of Connecticut Children’s Aerodigestive team and the division head for the division of Airway, Voice and Swallowing Disorders. Under her leadership, the division continues to expand its ability to care for these complicated patients. Dr. Murray is the co-chair of the Connecticut Children’s COVID PPE Task Force, which has provided vital guidance to all of Connecticut Children’s through the COVID-19 pandemic. She is the president of the Children’s Medical Staff Executive Committee. She also serves as the chair of the Clinical Competency Committee for the University of Connecticut Otolaryngology residency program.

As Division Head - Head and Neck Surgery, Scott R. Schoem, MD, MBA, FAAP oversees the strategic marketing and expansion of the Division. He continues in his role as Associate Director of Surgical Clinical Affairs mentoring other division heads and young surgeons, and maximizing operating room efficiency. He is now immediate Past-President of the Connecticut AAP Chapter providing assistance and mentorship. He reached the milestone this year of having performed his 10,000th surgical procedure at Connecticut Children’s. He performed the first successful trans-canal cochlear implant at Connecticut Children’s for a child with abnormal temporal bone anatomy. He was the recipient of the Uconn Otolaryngology Residency Model Faculty Award for 2023. He continues his passion on advocacy for children’s healthcare with focus on HPV vaccination. He was appointed by the CT DPH Commissioner to serve as consultant to the state congenital CMV Taskforce.

PEDIATRIC OTOLARYNGOLOGY FELLOWSHIP PROGRAM

The Pediatric Otolaryngology Fellowship Program, led by Christopher Grindle, MD, is entering its 5th year as an accredited program and this year, welcomed its second fellow, Ruwaa Samarrai, MD, who joined the program in July 2023 after completing her otolaryngology residency at the UConn School of Medicine.

PUBLICATIONS

Peer-Review Journals

Greenlund L, Borden A, Nickel A, Arms J, Kavanagh KR, McCoy J, Shaffer A, Snyder V, Tobey A, Roby B. Pediatric peanut aspirations before and after 2015 recommendation for early peanut exposure. Int J Pediatr Otorhinolaryngol. 2023 May;168:111518. doi: 10.1016/j.ijporl.2023.111518. Epub 2023 Mar 24. PMID: 37023556.

Kreicher KL, Rutherford KD, Goldstein TA, Trahan SC, Kavanagh KR. Development of a Three-Dimensional Printed Model for Rhinoplasty Simulation in Surgical Education. Facial Plast Surg Aesthet Med. 2023 JulAug;25(4):358-360. doi: 10.1089/fpsam.2022.0042. Epub 2022 Sep 9. PMID: 36083277.

Angelo SJ, Anderson MG, Sutter PA, Halloran PJ, Kavanagh KR, Paro MR, Martin JE, Bookland MJ, Michelow IC, Hersh DS. Changes in the epidemiology of pediatric sinogenic and otogenic intracranial infections during the COVID-19 pandemic: a single-institution study. J Neurosurg Pediatr. 2023 May 26;32(2):231241. doi: 10.3171/2023.4.PEDS23130. PMID: 37243559.

Brandt K, Dukleska K, McKeown M, Brancato J, Grossi V, Schoem S, Sacco T, D’Amato J, Bourque M, Campbell B. Utilizing a critical airway response team expedites esophageal button battery removal. J Pediatr Surg 2023;58(5):810-813.

Waldman EH, Ingram A, Vidrine DM, Gould AR, Zeiders JW, Ow RA, Thompson CR, Moss JR, Mehta R, McClay JE, Brenski A, Gavin J, Ansley J, Yen DM, Chadha NK, Murray MT, Kozak FK, York C, Brown DM, Grunstein E, Sprecher RC, Sherman DA, Schoem SR, Puchalski R, Hills S, Harfe D, England LJ, Syms CA, Lustig LR. TwoYear Outcomes After Pediatric In-Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System. Otolaryngol Head Neck Surg. 2023 Sep;169(3):701-709. doi: 10.1002/ ohn.336. Epub 2023 Apr 1. PMID: 37003297.

Schiff E, Propst EJ, Balakrishnan K, Johnson K, Lounsbury DW, Brenner MJ, Tawfik MM; Pediatric Tracheostomy Emergency Readiness Workgroup; Yang CJ. Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations. Laryngoscope. 2023 Dec;133(12):3588-3601. doi: 10.1002/lary.30674. Epub 2023 Apr 28. PMID: 37114735; PMCID: PMC10710770.

Book Chapters

Murray N. Sinonasal Manifestations of Cystic Fibrosis. In: Otolaryngology and Facial Plastic Surgery, Medscape Reference (formerly eMedicine World Medical Library), eMedicine.medscape.com, Inc. 2022, 2015, 2011, 2005, 2000.

STAFF

Scott Schoem, MD, MBA, FAAP, Division Head

Christopher Grindle, MD, FAAP

Nancy Grover, MD

Amy Hughes, MD, FAAP

Katherine Kavanagh, MD, FAAP

Nicole Murray, MD, FAAP

Rebecca Strong, APRN

Christine Harrington, PA-C

Elizabeth Oblon, PA-C

Cristina Agusto, DNP, FNP, CLC

Irsa Wenceslao, APRN

Fellow

Ruwaa Samarrai, MD

PEDIATRIC & ADULT CONGENITAL CARDIOTHORACIC SURGERY

The Cardiothoracic Surgery team led by Dennis Mello, MD, provides world-class surgical care and support to the children and adults of Connecticut born with congenital heart disease.

Our program provides state-of-the-art management of complex congenital heart defects across the entire age spectrum from newborns to adults, including a collaboration with the adult cardiothoracic surgery team at Hartford Hospital. The Pediatric Cardiothoracic Surgery service strives for discovery, teamwork, integrity, and excellence in cardiac surgical care. Cardiothoracic Surgery, Pediatric Cardiac Anesthesia, the Pediatric Intensive Care Unit (PICU), and Pediatric Cardiology work together in a strong collaborative effort to provide a uniform standard of care to patients with congenital heart disease who are seeking surgery.

Dr. Mello, Division Head is board-certified congenital heart surgeon and provides perioperative cardiac surgical care to all patients with congenital heart disease. Dr. Mello is supported by two excellent and highly skilled physician assistants, Jill Sullivan, PA-C, and Kathleen Kellerman, PA-C, who help navigate the operative and post-operative care, respectively, of our patients. We have been able to safely perform complex procedures in the operating room as well as cardiac catheterization lab with appropriate surgical coverage at all times. Despite COVID-19, our surgical volumes continue to increase with each year, and we are performing the most congenital heart surgeries of any program within the state.

NEONATAL AND PEDIATRIC HEART SURGERY

Our team has regularly been performing numerous complex congenital heart surgeries, including Norwood operations for hypoplastic left heart syndrome as well as other neonatal operations such as an arterial switch and truncus arteriosus repair with excellent outcomes.

Furthermore, we have had an increase in the level of case complexity across our patient spectrum – whether it is a successful ventricular septal defect closure in a baby weighing less than 3 kg, a valve-sparing aortic root operation in young adults, or a fourth time redooperation in an adult patient to repair complex left ventricular outflow tract obstruction.

ADULT CONGENITAL HEART DISEASE SURGERY

We strive to attain excellence in our surgical care of adults with congenital heart disease (ACHD), in collaboration with adult congenital cardiology as well as the adult cardiothoracic surgeons at Hartford Hospital. Robert Hagberg, MD, an experienced adult heart surgeon and Chief of Cardiac Surgery at Hartford Hospital, is an integral partner in helping provide care for adult patients with congenital heart disease. He and his partners often collaborate with our Connecticut Children’s congenital heart surgeons to perform ACHD surgeries. This association further strengthens our commitment to provide surgical services to all congenital heart disease patients, regardless of age, within the region and statewide.

CONGENITAL CARDIAC INTENSIVE CARE

Monika Gupta, MD has started as our first cardiactrained intensivist and D’Anna Obey, PA-C as our first cardiac ICU midlevel provider. Their hires represent an important step toward the creation of a dedicated congenital cardiac intensive care unit.

QUALITY & OUTCOMES

Our surgical data and operative outcomes are periodically submitted to the Society of Thoracic Surgeons (STS) Congenital Cardiac Surgery Database (www.sts.org). This database includes more than 94 percent of the congenital cardiac surgery programs in North America and helps establish outcome and quality benchmarks. We continue to rank very well within these objective benchmarks.

In order to improve communications and enhance patient care efficacy, we implemented cardiac

surgery ICU rounds. Monthly mortality and morbidity presentations and quarterly quality STS reviews are performed for continuous review of the surgical program.

EDUCATION

We continue to provide ongoing educational support to PICU nursing and ancillary staff through a congenital heart surgery lecture series on a monthly basis. These efforts have been extended to our NICU colleagues as well, in order to continue to improve care for patients with congenital heart disease. We are also in the process of establishing our first UConn Integrated Cardiac Surgery Residency Program.

STAFF

Dennis Mello, MD, Division Head, Pediatric and Adult Congenital Cardiac Surgery Co-Director, Connecticut Children’s Cardiovascular Institute

Kenneth Warner, MD, Congenital Heart Surgeon

Robert Hagberg, MD, Chief of Cardiac Surgery, Hartford Hospital

Monica Gupta, MD, Cardiac Intensivist

Jill Sullivan, MS, PA-C

Kathleen Kellerman, PA-C

D’Anna Obey, PAC

PEDIATRIC NEUROSURGERY

The Division of Pediatric Neurosurgery is committed to the following core values:

• We are dedicated to the delivery of comprehensive, compassionate, and timely, family centered care to our patients and families.

• We collaborate with and respect all members of our regional community.

• We are regional, national, and international leaders in advocacy and scholarship.

The Division of Pediatric Neurosurgery had another outstanding year in 2023, with continued contributions to Connecticut Children’s and the UConn School of Medicine. We provided more than 4,000 outpatient clinic visits and nearly 250 surgical procedures to children in Western New England, delivering unparalleled service and setting a standard for institutional patient and family satisfaction at Connecticut Children’s. Our division broke new ground

this year with the first fetal myelomeningocele closure as well as the first hybrid neurovascular surgery. We have expanded our outpatient clinic reach to span from Westport Connecticut to South Hadley, Massachusetts.

The neurosurgery division benchmarks our quality and safety metrics against programs nationally through participation in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP-P) and the Hydrocephalus Research Network’s quality program (HCRNq). We have also expanded our national collaboration with researchers on topics to include Chiari malformation, craniosynostosis, early onset scoliosis, and neuro-oncology. We currently enjoy membership to the Park-Reeve Syringomyelia Research Consortium, the Synostosis Research Group (SynRG), the Pediatric Spine Study Group (PSSG), and the Advancing Treatment for Pediatric Craniopharyngioma

Neurosurgery continues to set the standard for divisional contributions to research, mentorship and advocacy. Highlights include:

• 13 publications in peer-reviewed journals

• Publications selected for feature on the covers of two major neurosurgical journals in 2023

• Awarded a Connecticut Children’s Connection Grant for modeling fetoscopic myelomeningocele closure

• Three medical students presenting oral abstracts at the upcoming 2023 AANS/CNS Section for Pediatric Neurosurgery in December of 2023

PUBLICATIONS

Kilbourn KJ, Leclair NK, Martin JE, Bookland MJ, Kureshi IU, Bulsara KR, Hersh DS. Incorporating simulation into the neurosurgical residency curriculum: a program director survey. J Neurosurg. 2023 Mar 3:1-6. doi: 10.3171/2023.1.JNS222589.

Leclair NK, Chern J, Ahn ES, Chamis M, Paro MR, Lambert WA, Stoltz P, Hersh DS, Martin JE, Bookland MJ. Clinical metrics and tools for provider assessment and

tracking of trigonocephaly. J Neurosurg Pediatr. 2023 Apr 7;32(1):82-90. doi: 10.3171/2023.2.PEDS22511. Print 2023 Jul 1.

Anderson MG, Jungbauer D, Leclair NK, Ahn ES, Stoltz P, Martin JE, Hersh DS, Bookland MJ. Incorporation of a biparietal narrowing metric to improve the ability of machine learning models to detect sagittal craniosynostosis with 2D photographs. Neurosurg Focus. 2023 Jun;54(6):E9. doi: 10.3171/2023.3.FOCUS2349.

Anderson MG, Lambert W, Leclair N, Athar D, Martin JE, Bookland MJ, Hersh DS. Telemedicine Utilization in an Outpatient Pediatric Neurosurgical Clinic: A Prospective Survey of Patient and Family Preferences. World Neurosurg. 2023 Jun 1:S1878-8750(23)00748-9. doi: 10.1016/j.wneu.2023.05.102.

Angelo SJ, Anderson MG, Sutter PA, Halloran PJ, Kavanagh KR, Paro MR, Martin JE, Bookland MJ, Michelow IC, Hersh DS. Changes in the epidemiology of pediatric sinogenic and otogenic intracranial infections during the COVID-19 pandemic: a single-institution study. J Neurosurg Pediatr. 2023 May 26:1-11. doi: 10.3171/2023.4.PEDS23130.

Sun LR, Hersh DS, Smith ER, Aldana PR, Jordan LC. Practice variability in the perioperative management of pediatric moyamoya disease in North America. J Stroke Cerebrovasc Dis. 2023 Apr;32(4):107029. doi: 10.1016/j.jstrokecerebrovasdis.2023.107029. Epub 2023 Jan 25.

Rallo MS, Zappi KE, Koller GM, Guadix SW, Kortz MW, Hersh DS, Pannullo SC. Letter: Addressing Barriers to Student Participation in Neurosurgical Conferences: Experiences From the Inaugural Early Career Neuroscience Virtual Research Symposium. Neurosurgery. 2023 Mar 1;92(3):e66-e68. doi: 10.1227/ neu.0000000000002315. Epub 2023 Jan 4.

Hersh DS, Martin JE, Bulsara KR, Ollenschleger MD. In Reply: Middle Meningeal Artery Embolization for Primary Treatment of a Chronic Subdural Hematoma in a Pediatric Patient: A Systematic Review of the Literature

and Case Report. Oper Neurosurg (Hagerstown). 2023 Feb 20. doi: 10.1227/ons.0000000000000660.

Koller GM, Reardon T, Kortz MW, Shlobin NA, Guadix SW, McCray E, Radwanski RE, Snyder HM, DiGiorgio AM, Hersh DS, Pannullo SC. Shared Objective Mentorship via Virtual Research and Education Initiatives for Medical Students and Residents in Neurosurgery: A Systematic Review and Methodological Discussion of the Neurosurgery Education and Research Virtual Group Experience. World Neurosurg. 2023 Jan 13;172:20-33. doi: 10.1016/j.wneu.2023.01.035.

Romano R, Dean J, Bageac DV, Galske J, Anderson T, Kadian S, Modi Y, Paro M, Lambert W, Leclair NK, Hersh DS, Bulsara KR. Recruitment into academic neurosurgery using a model for successful cross-campus research collaboration: a pre-medical student survey. World Neurosurg. 2023 Jun 20:S1878-8750(23)00814-8. doi: 10.1016/j.wneu.2023.06.046.

Aarabi B, Neal CJ, Hersh DS, Harrop JS, Fehlings MG, Toups EG, Guest JD, Ugiliweneza B, Akhtar-Danesh N, Kurpad SN, Grossman RG. Mortality in ASIA Impairment Scale grade A to D Patients With Odontoid Fracture and Magnetic Resonance Imaging Evidence of Spinal Cord Injury. Neurotrauma Rep. 2023 Jun 1;4(1):375-383. doi: 10.1089/neur.2023.0005. eCollection 2023.

Hersh DS, Martin JE, Kureshi IU, Bulsara KR. Letter to the Editor. Tracking neurosurgery resident performance on simulation-based training tasks. J Neurosurg. 2023 May 26:1-2. doi: 10.3171/2023.3.JNS23610.

CreveCoeur TS, Alexiades NG, Bonfield CM, Brockmeyer DL, Browd SR, Chu J, Figaji AA, Groves ML, Hankinson TC, Harter DH, Hwang SW, Jea A, Kernie SG, Leonard JR, Martin JE, Oetgen ME, Powers AK, Rozzelle CJ, Skaggs DL, Strahle JM, Wellons JC, Vitale MG, Anderson RC. Building consensus for the medical management of children with moderate and severe acute spinal cord injury: a modified Delphi study. J Neurosurg Spine. 2023 Mar 17:1-14. doi: 10.3171/2023.1.SPINE221188.

STAFF

Jonathan Martin, MD, FAANS, FACS, FAAP, Division Head

Associate Director of Trauma, Connecticut Children’s Secretary, Section on Neurological Surgery, American Academy of Pediatrics

Markus Bookland, MD, FAANS, FAAP Associate Director of Research and Academic Affairs, Department of Surgery, Connecticut Children’s

David Hersh, MD, FAANS, FAAP

Allison Labelle, APRN Petronella Stolz, APRN, DNP Bethany Simonetti, APRN

Affiliated Faculty

Evan Cantor, MD, Neuro-oncology

Mark Lee, MD, Orthopaedic Surgery/Complex Spine Service

Charles Castiglione, MD, Craniofacial Surgery

Christopher Hughes, MD, Craniofacial Surgery

Belachew Tessema, MD, Otolaryngology / Endonasal Sinus Surgery

Martin Ollenschleger, MD, Neurointerventional Radiology

Sonia Chaudhry, MD, Orthopaedic Surgery/ Peripheral Nerve

Jennifer Madan Cohen, MD, Epilepsy / Neurology

Helaine Bertsch, MD, Radiation Oncology

PEDIATRIC SURGERY

The mission of the Pediatric Surgery division is to provide high quality family-centered surgical and trauma care. The Division of Pediatric Surgery offers a full range of clinical services for pediatric patients from newborns to young adults. This includes prenatal consultations, the treatment of congenital anomalies, head and neck surgery, surgery of the chest and abdomen, pediatric gynecology, non-reconstructive urology, surgical oncology, bariatric surgery, treatment of chest wall deformities, and trauma including burn care. Pediatric surgeons see patients in Hartford, Farmington, Danbury, and Westport, allowing easier access for the convenience of our patient families. The Pediatric Surgery team performs outpatient procedures at the Connecticut Children’s Ambulatory Surgery Center in Farmington. Same-day outpatient visits continue to be available at our Hartford office for any urgent problems and at our satellites whenever a pediatric surgeon is there. Additionally, we are committed to offering families outpatient appointments within one week of referral for non-urgent problems

The Division of Pediatric Surgery continues to develop innovative ways to provide high quality acute and elective surgical care for infants, children and adolescents in southern New England across a broad range of surgical conditions. The division remains steadfastly committed to providing family-centered, evidence-based care of the highest quality, along with innovative research and topnotch clinical education. The breadth and scope of the pediatric surgical care we provide makes our division a foundational part of the clinical care Connecticut Children’s provides.

Connecticut Children’s continues as one of only two centers in New England that is verified by the American College of Surgeons as Level I Pediatric Trauma Center and a Level I Children’s Surgery Center. Data collected through both the pediatric trauma (TQIP) and children’s surgery programs (NSQIP) allow us to track important Connecticut Children’s quality metrics and to compare against other US children’s hospitals. These insights guide institutional quality improvement work and improve

patient outcomes. In October, Jacob Campbell, DO, MPH, joined the Division after completing his Pediatric Surgery fellowship in July 2023.

The Bariatric Surgical Program continued to expand this year, and was re-accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) which is the combined accreditation program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS). Connecticut Children’s is the first and so far only pediatric program in Connecticut to receive this distinction, and one of very few pediatriconly centers in the nation. This year, our program completed its 150th sleeve gastrectomy, and instituted a robotic surgery program, led by Christine Finck, MD, FACS, and James Healy, MD, MHS. The program has completed 22 robotic gastric sleeve procedures, and expanded the robotics program to include cases such as teenage robotic inguinal hernia repairs with mesh, Heller esophagomyotomies, cholecystectomies, and urachal cyst excisions.

The Multidisciplinary Thyroid Group, led by Drs. Finck and Healy, Richard Weiss, MD, FACS, Nordie Bilbao, MD, and Rebecca Riba-Wolman, MD, enables children with thyroid diseases to be rapidly and simultaneously evaluated by a surgeon and an endocrinologist.

Brendan Campbell, MD, MPH, has held the Donald W. Hight Endowed Chair in Pediatric Surgery since 2017, and continues in the role of Clinical Director for the Division of Pediatric Surgery. He has led efforts to standardize work in the division and to ensure that patients have prompt access to outpatient care, working collaboratively with Lori Pelletier, PhD, MBS, and Heather Tory, MD, MPH, to align medical and surgical quality priorities. Since 2020, Dr. Campbell has served as one of 100 surgeons nationally selected to serve on the American College of Surgeons Committee on Trauma, where he chairs the Injury Prevention and Control Committee and serves on the Executive Committee.

Christine Rader, MD, continues in her role as Assistant Dean for Academic Affairs at Connecticut Children’s which involves the educational oversight of both the

medical and surgical house staff. She also leads the Chest Wall Deformities Program, which provides stateof-the-art care for children with chest wall deformities, specifically pectus excavatum and pectus carinatum.

Dr. Healy serves as the UConn Integrated Surgical Residency Site Director. He was awarded the Joseph M. Civetta Best Faculty Teacher Award “in recognition for his outstanding contributions to Surgical Resident Education” this year. Dr. Healy continues to work with the multidisciplinary weight management program to increase safety and efficiency of care for the bariatric patients presenting for weight loss surgery. This included multiple quality improvement projects aimed at addressing patient comfort, reduction of narcotic usage, decreased length of stay, and avoidance of complications and nutrient deficiencies. He was elected Vice President of the Connecticut Chapter of the American Society for Metabolic and Bariatric Surgery and serves on the American Pediatric Surgical Association (APSA) bariatric program building subcommittee.

Dr. Weiss participates as an ex officio member of the American Pediatric Surgical Association (APSA) Practice Committee, which monitors the practice of pediatric surgery in North America, reports trends in practice patterns, and offers guidance to APSA members for improvements and optimization of care delivery. He continues his role as an advisor for the American Pediatric Surgical Association to the AMA/Specialty RVS Update Committee (RUC), and is a member of the executive council of the Connecticut Chapter of the American College of Surgeons.

J. Leslie Knod, MD, cultivates her passion for advocacy as a member of the American Pediatric Surgical Association Health Policy and Advocacy Committee, and locally through Connecticut Children’s Public Policy Council. At an institutional level, Dr. Knod has been involved with our NICU antimicrobial stewardship program, and has been working collaboratively with Corey Baker, MD, to standardize our institutional approach to caring for children with esophageal atresia and to create a surgical bowel management guideline.

Katerina Dukleska, MD, continues in her role as the Surgical Site Director for the Quinnipiac University Pediatrics clerkship and the UConn Pediatric Surgery Rotation. She is a Core Faculty Leader for the UConn General Surgery Residency and has organized the Intern Boot Camp for the last three years. She was selected to participate in the Popik Family Quality and Patient Safety Fellowship, which is a two year fellowship designed to develop future leaders in quality improvement science through the Division of Quality and Patient Safety at Connecticut Children’s. Locally, Dr. Dukleska is the Chair of the Connecticut Chapter of the American College of Surgeons Junior Women in Surgery Committee, and is a member of the Education and Industry Committees of the American Pediatric Surgical Association. She also serves as a member of the Surgical Advisory Council in pediatric surgery for the American College of Surgeon National Quality Improvement Program (NSQIP).

PEDIATRIC SURGERY FELLOWSHIP PROGRAM

In August of 2023, Danielle Dougherty, MD, began her two year clinical fellowship in pediatric surgery after receiving additional subspecialty surgical training at the University of Michigan in Surgical Critical Care and Fetal Medicine.

EDUCATION

We create outstanding learning opportunities in pediatric surgery and trauma for general surgery and surgical subspecialty residents from the University of Connecticut affiliated residency programs, and for rotating general surgery residents from Stamford Hospital, Waterbury Hospital, St. Mary’s Hospital, and Danbury Hospital. Each year, several UConn Pediatric residents participate in elective rotations on the pediatric surgery service. We also incorporate medical students from both UConn and Quinnipiac University. The fellowship program in pediatric surgery has been offered at Connecticut Children’s since 2011.

All eight pediatric surgeons are Advanced Trauma Life Support (ATLS) Instructors, and participate as instructors at ATLS courses taught throughout the year for residents, fellows, APPs, and physicians from around the region and state. Drs. Campbell and Knod are both instructors for

the Advanced Trauma Operative Management (ATOM) course that is a live-animal model course that teaches proper operative techniques for managing penetrating injuries to the chest and abdomen.

RESEARCH

Dr. Finck’s research laboratory focuses on innovation and tissue engineering of organs, including the lungs and the esophagus. Over the last year, her lab partnered with a lab at the University of Vermont and received a new grant from the Department of Defense for work on the clinical development of a novel pleural and tracheal sealant. Additionally, she submitted a patent for a prosthetic device for tissue regeneration.

The division is participating in several clinical studies through the Eastern Pediatric Surgical Network (EPSN) which is a consortium of children’s hospitals on the East Coast that are working together to study low-frequency childhood diseases. Connecticut Children’s is the lead site for esophageal atresia evaluating cases of long gap/pure esophageal atresia (Dr. Finck) and post-repair surveillance (Dr. Knod). Other EPSN studies include central line infection (Dr. Knod), appendicitis (Drs. Campbell & Dukleska), and pediatric thyroid disease (Dr. Healy). The division is active in several other IRBapproved studies related to pediatric trauma, quality improvement, health services, and injury prevention research under the leadership of Drs. Campbell and Dukleska, and basic science research through Dr. Finck’s lab at the UConn Health Center.

THE FUTURE

For 2024, the Division of Pediatric Surgery will continue to expand its regional footprint in Southern New England, with a continued emphasis on Fairfield County with satellite clinics in Danbury and Westport. We will expand our niche programs that leverage our expertise in minimally invasive surgery, chest wall deformities, pediatric burn care, bariatric surgery, thyroid disease, and pilonidal sinus disease. Finally, we are continuing to facilitate in-person access for patients by offering outpatient clinic visits within one week, along with evening and weekend clinic options to make it easier for families to have easy access to pediatric surgical care

PUBLICATIONS

Cramm SL, Graham DA, Blakely ML, Chandler NM, Cowles RA, Kunisaki SM, Russell RT, Allukian M, DeFazio JR, Griggs CL, Santore MT, Scholz S, Aronowitz DI, Campbell BT, Collins DT, Commander SJ, EngwallGill A, Esparaz JR, Feng C, Gerall C, Hanna DN, Keane OA, Lamoshi A, Lipskar AM, Orlas Bolanos CP, Pace E, Regan MD, Tracy ET, Williams S, Zhang L, Rangel SJ, Eastern Pediatric Surgery Network. Outcomes and resource utilization associated with use of routine predischarge white blood cell count for clinical decisionmaking in children with complicated appendicitis: a multicenter hospital-level analysis. J Pediatr Surg. 2023 Jun;58(6):1178-1184. doi: 10.1016/j. jpedsurg.2023.02.039. Epub 2023 Feb 23.

Sakran JV, Bornstein SS, Dicker R, Rivara FP, Campbell BT, Cunningham RM, Betz M, Hargarten S, Williams A, Horwitz JM, Nehra D, Burstin H, Sheehan K, Dreier FL, James T, Sathya C, Armstrong JH, Rowhani-Rahbar A, Charles S, Goldberg A, Lee LK, Stewart RM, Kerby JD, Turner PL, Bulger EM. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. J Am Coll Surg. 2023 June 1;236(6):1242-1260. doi: 10.1097/ XCS.0000000000000662. Epub 2023 Mar 6.

Brandt K, Dukleska K, McKeown M, Brancato J, Gross V, Schoem S, Sacco T, D’Amato J, Bourque MD, Campbell BT. Utilizing a critical airway response team expedites esophageal button battery removal. J Pediatr Surg. 2023 May;58(5):810-813. doi 10.1016/j. jpedsurg.2023.01.037. Epub 2023 Jan 19.

Saito JM, Barnhart DC, Grant C, Brighton BK, Raval MV, Campbell BT, Kenney B, Jatana KR, Ellison JS, Cina RA, Allori AC, Uejima T, Roke D, Lam S, Johnson EK, Goretsky MJ, Byrd C, Iwaniuk M, Nayak R, Thompson VM, Cohen ME, Hall BL, Ko CY, Rangel SJ. The past, present and future of ACS NSQIP-Pediatric: evolution from a quality registry to a comparative quality performance platform. Semin Pediatr Surg. 2023 Apr;32(2):151275. doi: 10.1016/j.sempedsurg.2023.151275. Epub 2023 Apr 11.

Thirunavukkarasu M, Swaminathan S, Kemerley A, Pradeep SR, Lim ST, Accorsi D, Wilson R, Campbell J, Saad I, Yee SP, Palesty JA, McFadden DW, Maulik N. Role of Pellino-1 in Inflammation and Cardioprotection following Severe Sepsis: A Novel Mechanism in a Murine Severe Sepsis Model.” Cells. 2023 Jun 1;12(11):1527. doi: 10.3390/cells12111527.

PMID: 37296648 Free PMC article.

Pradeep SR, Thirunavukkarasu M, Accorsi D, Swaminathan S, Lim ST, Cernuda B, Kemerley A, Hubbard J, Campbell J, Wilson RL, Coca-Soliz V, Tapias L, Selvaraju V, Jellison ER, Yee SP, Palesty JA, Maulik N. Novel approaches to determine the functional role of cardiomyocyte specific E3 ligase, Pellino-1 following myocardial infarction. Biochim Biophys Acta Mol Basis Dis. 2024 Jan;1870(1):166899. doi: 10.1016/j. bbadis.2023.166899. Epub 2023 Sep 29. PMID: 37778482.

Cramm SL, Graham DA, Feng C, Allukian M, Blakely ML, Chandler NM, Cowles RA, Kunisaki SM, Lipskar AM, Russell RT, Santore MT, Campbell BT, Commander SJ, DeFazio JR, Dukleska K, Echols JC, Esparaz JR, Gerall C, Griggs CL, Hanna DN, He K, Keane OA, McLean SE, Pace E, Scholz S, Sferra SR, Tracy ET, Zhang L, Rangel SJ; Eastern Pediatric Surgery Network. Use of Antipseudomonal Antibiotics is not Associated with Lower Rates of Postoperative Drainage Procedures or More Favorable Culture Profiles in Children with Complicated Appendicitis: Results from a Multicenter Regional Research Consortium. Ann Surg. 2023 Nov 16. doi: 10.1097/SLA.0000000000006152. Epub ahead of print. PMID: 37970676.

Rauh J, Dantes G, Wallace M, Collings A, Sanin GD, Cambronero GE, Bosley ME, Ganapathy AS, Patterson JW, Ignacio R, Knod JL, Slater B, Callier K, Livingston MH, Alemayehu H, Dukleska K, Scholz S, Santore MT, Zamora IJ, Neff LP. Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis: A Multi-Center Study. J Pediatr Surg. 2023 Oct 21:S0022-3468(23)00657-7. doi: 10.1016/j. jpedsurg.2023.10.046. Epub ahead of print. PMID: 37957103.

Cramm SL, Graham DA, Allukian M, Blakely ML, Chandler NM, Cowles RA, Feng C, Kunisaki SM, Russell RT, Rangel SJ; Eastern Pediatric Surgery Network (EPSN). Predictive Value of Routine WBC Count Obtained Before Discharge for Organ Space Infection in Children with Complicated Appendicitis: Results from the Eastern Pediatric Surgery Network. J Am Coll Surg. 2023 Jun 1;236(6):1181-1187. doi: 10.1097/ XCS.0000000000000520. Epub 2022 Dec 12. PMID: 36503868.

Morrisroe K, Nakayama DK, Dukleska K. Gertrude Herzfeld: The woman who dared to be a surgeon. J Pediatr Surg. 2023 Feb;58(2):350-353. doi: 10.1016/j. jpedsurg.2022.10.037. Epub 2022 Oct 22. PMID: 36384938.

Hamilton-Hall 3rd MN, Jungbauer D, Finck C, Middlesworth W, Zendejas B, Alaish SM, Griggs CL, Russell RT, Shieh HF, Scholz S, Kunisaki SM, Feng C, Danko ME, DeFazio JR, Smithers CJ, Zamora IJ, Knod JL, Eastern Pediatric Surgery Network. Esophageal surveillance practices in esophageal atresia patients: a survey by the Eastern Pediatric Surgery Network. J Pediatr Surg. 2023 Jun;58(6):1213-1218. doi: 10.1016/j.jpedsurg.2023.02.030. Epub 2023 Feb 23.

Skarda DE, Danko ME, Glick RD, Guner YS, Le HD, Rich BS, Robertson DJ, Short SS, Weiss RG, Van Arendonk KJ, Raval MV. Dollars and sense: the business of pediatric surgery. J Surg Res. 2023 May;285:220-228. https://doi.org/10.1016/j.jss.2022.12.038. Online ahead of print.

Predictive Value of Routine WBC Count Obtained Before Discharge for Organ Space Infection in Children with Complicated Appendicitis: Results from the Eastern Pediatric Surgery Network. Cramm SL, Graham DA, Allukian M, Blakely ML, Chandler NM, Cowles RA, Feng C, Kunisaki SM, Russell RT, Rangel SJ; Eastern Pediatric Surgery Network (EPSN).J Am Coll Surg. 2023 Jun 1;236(6):1181-1187. doi: 10.1097/ XCS.0000000000000520. Epub 2022 Dec 12.PMID: 36503868.

Association Between Antibiotic Redosing Before Incision and Risk of Incisional Site Infection in Children With Appendicitis. Cramm SL, Chandler NM, Graham DA, Kunisaki SM, Russell RT, Blakely ML, Lipskar AM, Allukian M, Aronowitz DI, Campbell BT, Collins DT, Commander SJ, Cowles RA, DeFazio JR, Esparaz JR, Feng C, Griggs CL, Guyer RA, Hanna DN, Kahan AM, Keane OA, Lamoshi A, Lopez CM, Pace E, Regan MD, Santore MT, Scholz S, Tracy ET, Williams SA, Zhang L, Rangel SJ.Ann Surg. 2023 Oct 1;278(4):e863-e869. doi: 10.1097/SLA.0000000000005747. Epub 2022 Nov 1.PMID: 36317528.

Surgeon Views on Firearm Safety Counseling in Clinical Practice: A Cross-sectional Survey. Kirkendoll SD, Silver C, Stey A, Nathens A, Jackson K, Campbell BT.J Trauma Acute Care Surg. 2023 Nov 7. doi: 10.1097/ TA.0000000000004197. Online ahead of print.PMID: 37934626.

Foster C, Jensen T, Finck C, Rowe CK. Development of a Wound-Healing Protocol for In Vitro Evaluation of Urothelial Cell Growth. Methods Protoc. 2023 Jul 5;6(4):64. doi: 10.3390/mps6040064. PMID: 37489431; PMCID: PMC10366823.

Krishnaswami S, Polites SF, Dekany G, Gaines BA, Nwomeh BC, Huang EY, Finck CM, Lopushinsky SR, Puligandla PS, Feliz A, Mak GZ, Anderson SA, Fairbanks T, Alaish SM. The First Two Years of the Association of Pediatric Surgery Training Program Directors (APSTPD) Transition to Fellowship Course: Lessons Learned and Future Directions. J Surg Educ. 2023 Jan;80(1):62-71. doi: 10.1016/j.jsurg.2022.08.006. Epub 2022 Sep 29. PMID: 36085115.

Finck C, Zendejas B, Knod JL, Tramontozzi P, Jungbauer D, Anderson M, Middlesworth W, Scholz S, Kunisaki SM, Perioperative management and outcomes in long-gap esophageal atresia: A retrospective analysis from the Eastern Pediatric Surgery Network, Journal of Pediatric Surgery Open, Volume 3, 2023.

STAFF

Christine Finck, MD, FACS, Surgeon-in-Chief

Brendan T. Campbell, MD, MPH, FACS, FAAP

Clinical Director, Pediatric Surgery Division Medical Director, Pediatric Trauma Program Medical Director, Injury Prevention Center

Jacob Campbell, DO, MPH

Katerina Dukleska, MD

James Healy, MD, MHS

Donald W. Hight, MD, Emeritus

J. Leslie Knod, MD

Christine Rader, MD

Medical Director, Chest Wall Deformities Program

Richard G. Weiss, MD, FACS, FAAP

Elisabeth Campbell, PA

Nicole Dietzel, PA

Evan Fusaro, PA

Abby Theriaque, APRN

Alyssa Gersten, APRN

Anthony Angotta, PA

Sarah Wende, PA-C

Fellow

Danielle Dougherty, MD

PEDIATRIC UROLOGY

The Division of Pediatric Urology continues to provide comprehensive and cutting-edge care to the children of Connecticut. We are proud to be ranked amongst the top 50 Pediatric Urology programs in the nation by the U.S. News & World Report in 4 of the last 5 years. Our team sees patients in Hartford, Farmington, Glastonbury, Danbury, and in Westport at the new Outpatient Children’s Subspecialty Center. We continue to perform surgical procedures in Hartford and Farmington, and this is soon to be expanded to Stamford, Connecticut. We are committed to providing world-class urologic care close to home.

ATTENDING STAFF

Daniel Herz, MD, FAAP, FACS, is the new Head of the division of Urology since April of 2023. He brings his expertise in Robot Assisted Surgery to Connecticut Children’s after starting and developing three such programs in three different children’s hospitals around the country since the year 2012. In addition, on a national level, Dr. Herz was recently chosen, along with eight other colleagues, to serve as a coaching mentor for current Pediatric Urology Fellows at the last Societies of Pediatric Urology (SPU) Annual National Meeting in Houston, Texas. Dr. Herz was also chosen, along with just 13 other colleagues, as a fellow for the inaugural class of the new Popik Family Quality and Safety Fellowship at Connecticut Children’s Medical Center.

Courtney Rowe, MD, FAAP, is the director of Surgical Research for the division of Urology. She continues her active research career, receiving the first Connecticut Children’s Connection Grant from the Foundation for her work to develop a novel urethra stent to improve healing after surgery or injury, as well as an implantable biodegradable 3D printed disc for delivery of perioperative analgesia. On a national level Dr. Rowe now serves as the chair of the Patient Education Committee of the Urology Care Foundation, the nonprofit arm of the American Urologic Association.

Anne Dudley, MD, FACS, is the Pediatric Urology site director for the University of Connecticut Urology Residency Program and continues to serve on the Medical Staff Executive Committee. She continues to expand the clinical volume and geographical reach of the multidisciplinary Spina Bifida Clinic, which serves as the only clinic in the state that is a Spina Bifida Association Clinic Care Partner. Dr. Dudley has also been chosen as a fellow for the inaugural class of the new Popik Family Quality and Safety Fellowship at Connecticut Children’s Medical Center, as well as being elected Vice-Chair of the Epic Subspecialty Steering Board, for Pediatric Urology.

APPOINTMENTS AND LEADERSHIP

Anne Dudley, MD: “RISE” Mid-Career Leadership Program, Connecticut Children’s - 2022-2023

Medical Staff Executive Committee, Surgical Representative (elected) – 2023

Young Urologist Committee- Elected New England Section Representative - 2023

Diversity, Equity and Inclusion Task Force Member, New England AUA – 2023

Daniel Herz, MD

Appointed to the Care Network Finance Committee (Subspecialty Member) -2023

PANELS

Daniel Herz: 2023 Societies of Pediatric Urology –Pediatric Urology Fall Congress. Moderator - Scientific Session IV: Bowel/Bladder Dysfunction/ Urinary Tract Infection/ Vesicoureteral Reflux. September 22, 2023, Houston, TX.

Anne Dudley: 2023 AUA National Meeting Future Technology Panel Moderator - Society for Pediatric Urology, Chicago, IL.

Courtney Rowe: 2023 Urology Care Foundation National Podcast: Is Your Child’s Penis Size Healthy?

Courtney Rowe: 2023 Faculty Development Series: Don’t be Afraid of Self Promotion. Connecticut Children’s, Hartford CT.

Courtney Rowe: 2023 Connecticut Children’s Hospital Faculty Development Series. Bridging Bench to Bedside to Improve Surgical Care. Connecticut Children’s, Hartford CT.

Courtney Rowe: Pediatric Health Symposium. Current Management of Urinary tract Infections in Young Children & The Impact of Reflux Nephropathy.

VIRTUAL VISITS

Courtney Rowe: New England Section of AUA 2023 National meeting. Moderator: Women in Urology Panel. Brenton Woods, NH.

Courtney Rowe: American Urologic Association (AUA) 2023 National Annual Meeting. Moderator Pediatric Video Presentation Session, SPU Chicago, IL.

TEACHING

Anne Dudley:

• 2023 New England Section - Surgical Skills Instructor: Microsurgery American Urologic Association Resident Skills Lab

• 2023 Myelomeningocele Clinic Case Based Panel: Tethered Spinal Cord Academic Conference, Connecticut Children’s

• 2023 Myelomeningocele Clinic Spina Bifida and Nutrition: Surgical Aspects Academic Conference, Connecticut Children’s

• 2023 Connecticut Children’s - Male and Female Genital Anomalies including Micropenis Pediatric Resident Teaching Conference

• 2023 UCONN School of Medicine - Gender Affirming Care Reach Out Student Group

Courtney Rowe:

• 2023 Uconn School of Medicine – Medical Student Project Literature Review on Small Animal Perioperative Pain Management Strategies and Research.

• 2023 New England Section - Surgical Skills Instructor: Simulation Course at Center for Education Simulation and Innovation (CESI), Hartford CT.

• 2023 Pediatric Lectureship – Hypospadias, Phimosis, and Cryptorchidism. Connecticut Children’s Medical Center.

Daniel Herz:

• 2023 Uconn School of Medicine – Grand Rounds Presentation. Robot Assisted Surgery in Pediatric Urologic Surgery: A Historical Perspective and Lessons Learned.

PRESENTATIONS

Foster C, Burke K, and Rowe CK. A Novel Customizable Drug Delivery Biomaterial for Pediatric for Pediatric Surgical Pain Control. Poster Presentation –CCRI Meeting 2023.

Herz DB, Carter-Threlkeld, A, Stokes, K, Tonzi M, Walker J, Floyd K. Intestinal Clean Out And Maintenance (ICOM) Program In Children With Lower Urinary Tract Dysfunction: Using Novel Indices On Abdominal X-rays To Guide Treatment And Predict Outcome. Pediatric Urology Fall Congress – SPU 2023, Houston TX.

Herz D, Walker J, Floyd K, Stokes K, Bao S, Sammer M, Carlson L. Comparison Study of DMSA Scintigraphy and Non-Contrast MRI in Detecting Renal Scarring in Children after Acute Pyelonephritis. Pediatric Urology Fall Congress – SPU 2023, Houston TX.

DIVISIONAL HIGHLIGHTS OF 2023

One of the highlights of the year was hosting the second annual Howard I. Hochman, MD, PhD, Endowed Lectureship in Pediatric Urology in October 2023. This lectureship is in honor of Dr. Hochman, a founding member of our division who retired in 2021, and sadly

passed away in 2022. Initially spearheaded by Carlos Medina, MD, and funded through generous donations from grateful former trainees, the latest iteration was organized by our own Dr. Dudley and featured our first invited speaker, Dr. David Chalmers, the Residency Director, and Chief of the Division of Pediatric Urology at Maine Medical Center. This annual lectureship will remain a durable legacy of the dedicated resident teaching and patient care that Dr. Hochman provided through his long-distinguished career.

OTHER EVENTS IN 2023

• Connecticut Children’s Pediatric Urology joined the NSQIP Testicular Torsion Collaborative, studying outcomes of testicular torsion.

• Our division also joined the Fetal Care Center team, offering joint multidisciplinary prenatal visits for myelomeningocele. We expanded our Spina Bifida Multidisciplinary Clinic to include Orthopedics, now offering Neurosurgery, Gastroenterology, Nephrology, Urology and Physical Therapy in joint comprehensive visits.

• On October 19, 2023, UConn Department of Urology and Division of Pediatric Urology hosted Dr. Stacey Tanaka as the invited speaker for the Annual Walzak Lectureship Series. Dr. Myron Walzak was a Professor of Urology and the second Chair of Urology at the University of Connecticut. He was a renowned and beloved educator and clinician who passed away in January 1999.

CLINICAL CARE

The Division of Urology is a leader in providing the full range of next-generation urologic care to our community. We offer robotic surgical procedures with a dedicated pediatric Da Vinci Xi, and have partnered with our colleagues in the Division of Radiology to provide the most advanced options including MR Urogram using a dedicated 3T MRI and Contract Enhanced Voiding Ultrasound (CEVUS) for radiation-free diagnosis of vesicoureteral reflux. We formed Connecticut’s first multi-institutional regional partnership focused on care for children with bladder and cloacal exstrophy. We provide families with the latest collaborative care within

multidisciplinary clinics. These include the Genetics, Urology, Psychiatry, Psychology and Endocrinology (GUPPE) Clinic for patients with variations of sexual development, the Spina Bifida Clinic for patients with myelomeningocele, the Reductions of Children’s Kidney Stones (ROCKS) Clinic for patients with kidney stones, the Prenatal Clinic for patients noted to have urologic conditions on prenatal ultrasound, and the Posterior Urethral Valves Program (PUV) Clinic for patients with posterior urethral valves. In 2023 we have strengthened our partnership with the division of Nephrology with an ultimate goal of creating the multidisciplinary center for Uronephrological care (MCUC) where children of Connecticut can receive comprehensive Urological and Nephrological care. We also offer the Connecticut Children’s Continence Program for the management of non-neurogenic voiding issues, included comprehensive visits with both a physician and an advanced practice provider (APP). We continue to leverage telehealth opportunities, providing urologic care from the comfort of home.

ADVANCED PRACTICE PROVIDERS IN THE DIVISION OF PEDIATRIC UROLOGY:

Nick Rodrigue, NP, continued to manage our advanced video urodynamics suite. Our cutting-edge equipment now includes air catheters which have streamlined this complex procedure, allowing for efficient evaluation of neurogenic and non-neurogenic voiding. This program is being expanded to the Connecticut Children’s Westport facility where Kelly Sosensky, APRN, will manage this program along with Dr. Herz and Robyn Matloff, MD, in a combined subspecialty Urodynamic Program called “Achieve Continence Together”. This program will expand Urodynamic care to the children of the Fairfield County region. Erin Floridia, PA-C, continued to be an invaluable resource as a first assist in the operating room and expanding her training to learn hypnosis for patients with voiding concerns, and has started this program in the Hartford campus clinic and expanded to the Farmington satellite facility as well. All of our APPs are beloved by the patients and families who see them for non-surgical urologic concerns and have consistently high scores and positive remarks on PresGainey surveys.

EDUCATION

Our division is dedicated to providing education to the next generation of surgeons. We work with residents from the University of Connecticut, providing initial exposure to pediatric care to incoming interns, experience in basic and advanced pediatric urology for our junior residents and opportunities for our senior residents to serve as mentors and teachers to rotating juniors.

As the Residency Pediatric Site Director, Dr. Dudley has streamlined evaluations for trainees, and she serves as an examiner for mock oral boards. She works closely with University of Connecticut medical students, serving as a Capstone mentor for research and a Clinical Longitudinal Immersion in the Community (CLIC) flex instructor for surgical experience and training. Dr. Dudley is also involved in national educational efforts, authoring the core curriculum for American Urologic Association Resident Reference on cryptorchidism.

RESEARCH

Dr. Rowe’s lab continues its work in translational research and regenerative medicine. With the strong support of Christopher Foster, MS, our lab current holds two patents and continues to collaborate with local and national investigators.

This year, Dr. Rowe submitted three grant applications.

1. Re-Submission NIH NIDDK K08: Slow-release growth factor to improve urethral healing.

2. Second Submission NIH NICD R01: Implantable Degradable Films for Right-Size Psot-Operative Pediatric Pain Control.

3. First Submission NIH NIDDK R21: Biodegradable Films for Intravesical Bladder Pain Therapy.

Dr. Dudley is the Site Director for the Society of Fetal Urology Prenatal Hydronephrosis Registry. This national multi-institutional collaboration remains a publication powerhouse and is reshaping national perspective on care for patients with hydronephrosis. Dr. Dudley also serves as co-principal investigator of the testicular tissue cryopreservation protocol, which preserves fertility options for children undergoing oncologic treatment.

Dr. Herz will expand the Robot Assisted Surgical Committee whose focus will be on promoting safety, teaching, and innovation in Robot Assisted Pediatric Subspecialty Surgery. The mission will be centered on an unrelenting focus on safety of robot assisted surgery and adequate training of robotic surgeons such that Connecticut Children’s Robot Assisted Surgery Program will serve as an example and shining beacon for other Children’s Hospitals to follow.

PUBLICATIONS

Foster C, Jensen T, Finck C, and Rowe CK. Development of Wound Healing Protocol for In-Vitro Evaluation of Urothelial Cell Growth. Methods Protoc 2023 July 6(4) dio: 103390/mps6040064. Pubmed PMID 3748943.

2023 Society for Pediatric Urology. Variation and Opportunities to Improve Testicular Torsion Fall Congress Care: The National Surgical Quality Improvement Program Houston, TX. Part of the Pediatric Testicular Torsion Collaborative.

2023 AUA National Meeting Association between the Hydronephrosis Outcome Society for Pediatric Urology Prediction Score and Obstruction on MAG-3. Chicago, IL.

Book Chapters

Dudley AG, Johnson EK. Disorders of Sexual Differentiation, AUA Core Curriculum, AUA University, (update submitted Sept 2023).

Ellison JS, Rowe C. (2023) Proximal and mid-ureteral reconstruction in the pediatric population. In: Stifelman MD, Zhao LC, Eun DD, Koh CJ, editors. Techniques of robotic urinary tract reconstruction. Springer. https://doi. org/10.1007/978-3-030-50196-9_13.

Herz D, Choi K, Robertson R. Chapter 28 - Renal Parenchymal Imaging in Children. The Kelalis-KingBelman Text Book of Clinical Pediatric Urology – 7th Edition (2023). Edited by: Steven Docimo, Douglas Canning, and Antoine Khoury. Taylor and Francis Publishing.

STAFF

Daniel Herz, MD, Division Head of Urology

Courtney Rowe, MD, Director of Urological Research

Anne Dudley, MD, Residency Pediatric Site Director

Erin Floridia, PA-C

Nicolas Rodrigue, APRN

Kelly Sosensky, APRN

PLASTIC SURGERY

The Division of Plastic Surgery showed continued growth and development in 2023. Ema Zubovic, MD, was recruited to join our staff from Sick Kids, and she will start September 1. Her specialty training is in pediatric plastic surgery and cleft-related surgery. With her arrival, we will be able to expand our current clinical offerings and grow new services for the future. We have also hired another MA – Breana Keene-Lafogg – to provide clinical and administrative support for our team. Jacqueline Marquart, RN, also joined us this year, and she will serve as another nursing resource for our Division to complement and support Jennafer Euen. Lauren Schmidtberg, PA-C, and Melissa Condren, APRN, continue to share duty as full-time division advanced practitioners. Nichole Buswell, APRN, remains largely based in the Westport region, expanding our continuity of care for Fairfield County.

Division clinical services were expanded, and new clinical pathways in plastic surgery and craniofacial surgery were introduced. Christopher Hughes, MD, MPH, continues as Division Head of both Plastic Surgery and Craniofacial Surgery. Education and research remain a priority of the division. We provide clinical education and guidance for general surgery residents, orthopedic residents, and oral and maxillofacial surgery (OMFS) residents. With Division mentorship, one OMF resident is applying into a craniofacial fellowship program this year, and one successfully matched last year. Several research projects with medical students and residents are ongoing. We published in peer-reviewed journals over the past year, and we presented our data at both local and national conferences. Dr. Hughes provided educational lectures for residents and peers at a local, regional, state, national, and international levels over the past year as well.

In both Plastic Surgery and Craniofacial Surgery, our surgical volume has continued to increase, comprising a full spectrum of plastic and reconstructive procedures. Our plastic surgeons frequently collaborate with

other surgical specialists, providing state-of-theart multidisciplinary surgical care. Common surgical procedures performed include complex wound closures including flaps and grafts, craniofacial reconstruction, craniofacial fracture repair, cleft lip/ palate reconstruction, breast surgery/reconstruction, body contouring, skin/soft tissue tumor excision/repair, upper extremity/hand surgery/reconstruction, genderaffirming care, and treatment of vascular anomalies. We continue to routinely incorporate telehealth visits for consults and follow-up visits whenever necessary and appropriate.

Ms. Schmidtberg, Ms. Condren, and Ms. Buswell shared division duties in 2023, and they facilitated the expansion of services provided. The division has increased and streamlined the treatment of breast and chest wall deformities, as well as post-bariatric-surgery weight-loss deformities. Ear molding for infants with protruding or malformed ears continues to be offered, and we have expanded treatment options. The division continues to participate in the Vascular Anomalies Team. Our gender care clinics continue to expand, and our ability to address gender dysphoria through gender affirming chest reconstruction (“top surgery”) and gender affirming facial surgery continues to grow. We have created a multidisciplinary wound clinic Pediatric and Adolescent Wound (PAWs) Clinic in collaboration with Christine Rader, MD, from Pediatric Surgery. The expansion of the Fetal Care Center has created additional, downstream volume, and we have been actively partnering with Neurosurgery to provide surgical reconstruction for a growing number of babies born with myelomeningocele defects. Across the spectrum of service offerings, we continue to see demand for growth beyond clinical capacity.

Our Craniofacial Team provides comprehensive evaluation and treatment for patients of all ages with congenital or acquired deformities of the head and neck. Active team members come from many disciplines including Plastic Surgery, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Ophthalmology, Pediatric Dentistry, Orthodontics, Oral and Maxillofacial Surgery, Pediatric Development, Social Work, and

Speech and Language Pathology. Clinical pathways for cleft lip and palate patients have been updated and modified with excellent results. We will be presenting our clinical pathways at regional conferences in 2024. Clinical research protocols have been established for the common cleft lip and palate operations. Craniosynostosis reconstruction, performed by Drs. Hughes and Charles Castiglione, MD, MBA, and by Jonathan Martin, MD, Markus Bookland, MD, and David Hersh, MD, of Pediatric Neurosurgery, is also common. Virtual surgical planning for cranial reconstruction and for mandibular distraction is now routine. In addition, the multidisciplinary Craniofacial Trauma Team, under the leadership of Drs. Castiglione and Norman Cavanagh, MD, DMD, provides cutting-edge treatment for all craniomaxillofacial injuries at both Connecticut Children’s and Hartford Hospital.

Four affiliate staff plastic surgeons, Duffield Ashmead, MD, Alan Babigian, MD, David Bass, MD, and Steven Smith, MD, are fellowship-trained hand surgeons, and they perform all types of upper extremity and hand surgery. Upon her arrival, Ema Zubovic, MD, will be able to supplement clinical expertise in pediatric handrelated disease. This includes trauma surgery, and reconstruction for acquired and congenital deformities. These surgeons also provide coverage for hand call at Hartford Hospital and Connecticut Children’s.

Plastic surgeons continued their involvement in global surgery this past year. Our efforts were beginning to rebound after COVID, but political instability in Ecuador has caused us to pause our efforts there in 2024. We do anticipate continuing to provide surgical care in collaboration with our partner NGO, Hands Across the World in the future. Dr. Hughes is a member of the Center for Global Health at Connecticut Children’s, and heads the global surgical arm. He has and continues to provide educational and research opportunities for students and residents interested in global surgery.

Education is a large component of our division’s activities. Residents from General Surgery and Oral and Maxillofacial Surgery participate in clinical experiences in Plastic Surgery. We have established

a visiting plastic surgery resident rotation for this upcoming year, and we have established shadowing experiences for undergraduate and medical students from the University of Connecticut. Active teaching occurs during daily patient rounds, in the clinic/office setting, the emergency room, the operating room, and during planned teaching conferences. Several residents and medical students are involved in research projects with Drs. Babigian, Hughes, and Castiglione. In addition to publishing, Drs. Babigian, Hughes, and Castiglione presented papers locally, regionally, and nationally this past year. Presentations focused on the management of complex craniofacial anomalies and the use of small mobile operating room spaces for global surgery. Dr. Hughes is the plastic surgery editor for Connecticut Medicine, The Journal of the Connecticut State Medical Society, and is a reviewer for the Journal of Craniofacial Surgery, Cleft Palate-Craniofacial Journal, and Plastic and Reconstructive Surgery Global Open. Dr. Castiglione is a reviewer for three journals: the American Journal of Cosmetic Surgery, Craniomaxillofacial Trauma & Reconstruction, and the Journal of Oral and Maxillofacial Surgery. Drs. Babigian, Hughes, and Castiglione are members of the executive council of the New England Society of Plastic and Reconstructive Surgery, and Dr. Hughes was elected to be a Counselor for 2024.

PUBLICATIONS

Hughes CD. Cleft Lip and Cleft Palate (ENT Resident Lecture), Department of Otolaryngology, University of Connecticut, June 2024; Farmington, CT (anticipated).

Hughes CD. Cleft Palatoplasty (or, How I Learned to Stop Worrying and Love the Furlow). Plastic and Reconstructive Surgery Grand Rounds, Harvard Plastic Surgery January 2024; Boston, MA.

Hughes CD. Surgical Considerations in Gender Affirming Care. PFLAG-Hartford, October 2023; Hartford, CT.

Schmidtberg LC, Maloney M, Anderson M, Gulati G, Hersh DS, Bookland M, Martin J, Castiglione CL, Hughes CD. Optimal outcome reporting for

single-suture craniosynostosis: a novel metric for benchmarking quality. ISCFS September 2023; Seattle, WA.

Singh R, Weitzman RE, Cunningham M, Meara JG, Castiglione CL, Hughes CD, Hughes AL. A comprehensive assessment of otologic disease in children with repaired cleft palate and the role of surgical technique. ASPO, June 2023; Boston, MA.

Hughes CD. Surgical Decision-Making Panel, New England Society of Plastic and Reconstructive Surgeons Annual Meeting, Groton, CT. June 2023.

Hughes CD. Gender Dysphoria in Adolescence and Young Adulthood: The role for Reconstructive Surgery. CT Children’s Grand Rounds, May 2023; Hartford, CT.

STAFF

Christopher Hughes MD, MPH, Division Head

Charles Castiglione MD, MBA

Lauren Schmidtberg, PA-C

Melissa Condren, APRN

Nichole Buswell, APRN

AFFILIATE STAFF

Brian Allen, MD

Duffield Ashmead, MD

Alan Babigian, MD

David Bass, MD

Alex Cech, MD

Orlando Delucia, MD

Steven Smith, MD

Daneilla Vega, MD

CENTERS

AERODIGESTIVE MEDICINE

“Aerodigestive,” also known as The Center for Airway, Voice, and Swallowing, was born at Connecticut Children’s in 2011, and has grown ever since. We were designated in 2017 as a subdivision within Otolaryngology, and in 2021, we grew into an independent multidisciplinary division, which was the first of its kind at Connecticut Children’s. The mission of the division is to provide state of-the-art care for children with complex disorders affecting airway, breathing, feeding, swallowing, and growth.

This multidisciplinary division consists of pediatric medical and surgical subspecialists from Otolaryngology, Pulmonology, Gastroenterology, Speech/Language (Swallow) Pathology, and General Surgery. We see outpatients in several ways, from our full team with all above specialists down to smaller and less comprehensive visits. Our clinical services begin with a coordinated visit with pertinent specialists and concurrent diagnostic tests or interventions. For many patients, the next step in evaluation and treatment is coordinated surgical endoscopy (also called a “triple scope”). Our synchronized approach offers many advantages for patients and families, including fewer doctor visits and missed days of school/work; fewer exposures to anesthesia; less time to effective treatment; and, by combining surgical procedures and minimizing off-target testing, families generally see fewer out-of-pocket medical costs. The ultimate advantage is that our collaboration yields more comprehensive, sophisticated, and effective treatment for this complex and vulnerable population.

We offer aerodigestive appointments in Farmington, Glastonbury, and Hartford. Full aerodigestive team clinics are held four times monthly (Hartford, Farmington). In addition, focused specialty clinics are also offered: airway clinics are held twice weekly (Hartford), voice clinics are held twice monthly (Glastonbury, Farmington), and swallow clinics are held twice monthly (Hartford, Farmington). We offer telemedicine for these visit types as well. Our team performs coordinated surgical endoscopies together twice monthly (Hartford).

In terms of growth this year, we remain excited about our growing Esophageal Atresia Collaborative which we have developed with our pediatric surgery colleagues. With this collaboration, we have broken down the older silo approach to these patients and provided advanced multidisciplinary care for this population, from birth through adulthood. We introduced this work to our community with an extraordinarily well attended Grand Rounds in January 2023 (available on our website). We are proud to note that this means our Aerodigestive Division is branching into more inpatient services, which means increased specialized care for our complex patient population.

This post-pandemic year did continue to challenge us all with impediments. We are so grateful that our PPE and COVID testing supplies remain plentiful, but we still face scarcities nearly everywhere else. There was a crisis in trach tube supply last year, and we were proud to lead the charge for local and national response and we included national societies as well as our governmental representatives as we navigated safely through that crisis with zero patient harm. We have had to continue that approach of conservation, as medical grade silicone remains in short supply and this has now affected many other types of medical equipment that our population depends on. We continue to employ conservation strategies and national discussions with leaders in government and industry to navigate these new waters in post pandemic medicine to advocate for our patients and their needs. Our team members continue to serve our community in ways over and above their commitment to our clinical services:

Nicole Murray, MD, has served this past year as the President of the Connecticut Children’s Medical Staff and has contributed to refining our mission of advocacy for patients first and for providers a strong second, and compliance a strong third in our commitment to do the right thing for our patients and our healthcare providers.

Katherine Kavanagh, MD, has served our Academy (AAO-HNS) as the Chair of the Simulation Education Committee AAO-HNSF, and she was awarded the AAO-HNSF 2023 Honor Award.

SCHOLARLY ACTIVITY

Book Chapters

Murray N. Sinonasal Manifestations of Cystic Fibrosis. In: Otolaryngology and Facial Plastic Surgery, Medscape Reference (formerly eMedicine World Medical Library), eMedicine.medscape.com, Inc. 2022, 2015, 2011, 2005, 2000.

Peer Reviewed Publications

Kreicher KL, Rutherford KD, Goldstein TA, Trahan SC, Kavanagh KR. Development of a Three-Dimensional Printed Model for Rhinoplasty Simulation in Surgical Education. Facial Plast Surg Aesthet Med. 2023 JulAug;25(4):358-360. doi: 10.1089/fpsam.2022.0042. Epub 2022 Sep 9. PMID: 36083277.

Angelo SJ, Anderson MG, Sutter PA, Halloran PJ, Kavanagh KR, Paro MR, Martin JE, Bookland MJ, Michelow IC, Hersh DS. Changes in the epidemiology of pediatric sinogenic and otogenic intracranial infections during the COVID-19 pandemic: a single-institution study. J Neurosurg Pediatr. 2023 May 26;32(2):231241. doi: 10.3171/2023.4.PEDS23130. PMID: 37243559.

Schiff E, Propst EJ, Balakrishnan K, Johnson K, Lounsbury DW, Brenner MJ, Tawfik MM; Pediatric Tracheostomy Emergency Readiness Workgroup; Yang CJ. Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations. Laryngoscope. 2023 Dec;133(12):3588-3601. doi: 10.1002/lary.30674.

Epub 2023 Apr 28. PMID: 37114735; PMCID: PMC10710770.

Greenlund L, Borden A, Nickel A, Arms J, Kavanagh K, McCoy J, Shaffer A, Snyder V, Tobey A, Roby B. Pediatric peanut aspirations before and after 2015 recommendation for early peanut exposure. Int J Pediatr Otorhinolaryngol. 2023 May;168:111518. doi: 10.1016/j.ijporl.2023.111518. Epub 2023 Mar 24. PMID: 37023556.

Presentations

Murray N, Finck C, Knod L, Baker C. Esophageal Atresia: Care through the Ages. Pediatric Grand Rounds, Connecticut Children’s Medical Center, Hartford, CT. January 2023.

STAFF

Nicole Murray, MD, Director

Claribel Vega, Practice Coordinator

Rebecca Strong, CPNP, APRN Clinical Coordinator

Barbara Mulholland, RN, BSN, CPN, CNRN Nursing Coordinator

Pediatric Otolaryngology

Nicole Murray, MD

Katherine Kavanagh, MD

Amy Hughes, MD

Pediatric Gastroenterology

Bella Zeisler, MD

Corey Baker, MD

Victoria Grossi, DO

Peter Townsend, MD

Pediatric Pulmonology

Craig Lapin, MD

Jamie Harris, MD

Corey Wynn, MD

Pediatric Surgery

Leslie Knod, MD

Speech/Language Pathology

Sara Burnham, MA, CCC-SLP

Kerri Byron MS, CCC-SLP

Kamie Chapman, MS, CCC-SLP

Kathryn Fields, MS, CCC-SLP

Katie McLoughlin, MS, CCC-SLP

Jodi Urzua MS, CCC-SLP

Family Support Clinician

Anna Maria Mennella, LMSW

Registered Dietician

Alexis Cascone, RD, CSP, CD-N

ASTHMA CENTER

The Asthma Center is the region’s leader in pediatric asthma research and its premier resource for evidencebased asthma programs. We are dedicated to improving the health and well-being of children and families through community-based collaborative research and programs, and we work to encourage, facilitate, and deliver a mechanism for program dissemination and outcomes assessment of clinical and translational research conducted by investigators within community settings, including schools, homes, community organizations, hospitals and ambulatory practice settings. The Asthma Center is committed to the training of investigators and community stakeholders in community-based research.

The Asthma Center in 2023 continued work to reduce asthma health disparities and their determinants by conducting multifaceted, interdisciplinary collaborative research on critical contemporary health issues facing children with asthma, and to establish optimal models of health management and best practices. We also re-invigorated our relationship with the Department of Public Health and look forward to furthering that relationship in 2024.

EASY BREATHING

In 2023, the Easy Breathing program responded to numerous requests from the primary care community to receive education on the 2020 Focused Updates to the Asthma Management Guidelines. A continuing medical education (CME) module on how to implement single maintenance and reliever therapy (SMART) was developed and delivered by Caleb Wasser, DO, an asthma expert from the Division of Primary Care. With this SMART CME module in hand, Dr. Wasser, the Easy Breathing Physician Champion, as well as Melanie Sue Collins, MD, Co-director of the Asthma Center, delivered more than ten SMART therapy CME modules to pediatric practices across the state.

SMART therapy is a paradigm shift in asthma management where, rather than prescribe two therapies

(an inhaled corticosteroid ICS and a short-acting-betaagonist SABA) for maintenance and relief, the new approach is to use a single combination inhaler for both maintenance and relief. This shift in the guidelines has spurred significant confusion in the medical community. To address this confusion, several Lunch & Learns, Evening Lectures, and other webinars were delivered to the primary care community by experts in the Asthma Center. Specific highlights include Dr. Collins delivering a Grand Rounds on the updated asthma guidelines to Day Kimball Hospital as well as the annual lecture with the Connecticut Children’s Care Network. We gained national exposure when Jessica Hollenbach, PhD, presented to the Weitzman Institute’s Pediatrics ECHO program twice in 2023.

In addition, for those practices who actively use our Easy Breathing program, our asthma experts continued to provide peer-to-peer feedback on the quality of SMART asthma treatment plans.

Work outside of Connecticut led us to continue the development of a digital Easy Breathing project in rural areas of Florida. Led by investigators from the University of Florida (David Fedele, PhD, ABPP), a UF Clinical and Translational Science Institute (CTSI) grant was awarded to develop and conduct usability testing on a digital Easy Breathing program. Throughout 2023, key stakeholders ranging from EPIC IT programmers, to pediatricians, to families of children with asthma have co-designed a digital Easy Breathing version integrated into an enterprise electronic health record (EPIC). The user-centered design principals will be used to build a clinical decision support system (eEasy Breathing) that will seamlessly integrate into primary care providers’ busy workflow. Results from this pilot testing will be used to submit a grant to provide funding to test the efficacy of digital Easy Breathing in improving pediatric asthma outcomes.

EASY BREATHING FOR SCHOOLS

The Asthma Center’s Easy Breathing for Schools program is a multipronged asthma education toolkit that reduces asthma-related school absenteeism and improves both asthma control and inhaler technique. In 2023, with support from the Department of Education’s North Hartford Ascend grant (Ascend, PI Paul Dworkin, MD), Asthma Center staff continued to build capacity to support school nurses serving students with asthma in the North End of Hartford. Capacity building efforts led to establishing standardized workflows for data collection and sharing.

MENTORSHIP

Dr. Hollenbach provided mentorship to a second-year medical student, Ms. Abigail Tulchinsky. Ms. Tulchinsky’s project is focused on field-testing a novel asthma treatment plan that adheres to the focused update of the asthma guidelines, and that is understandable to the end-user – patients with asthma and their caregivers. Ms. Tulchinsky presented her findings at the Connecticut Children’s Research Institute Annual Research Day. Her project will culminate with obtaining consensus on the new asthma treatment plan by conducting focus groups with families of children with asthma.

PUBLICATIONS

Implementation of a pediatric asthma management program in rural primary care clinics.

Fedele DA, Hollenbach J, Sinisterra M, LeFave E, Fishe J, Salloum RG, Bian J, Gurka MJ.J Asthma. 2023 Jun;60(6):1080-1087. doi: 10.1080/02770903.2022.2132954. Epub 2022 Oct 20.PMID: 36194428.

Implementation of standardized asthma management programs in outpatient settings.

Hollenbach JP, Collins MS, Wasser C, Fedele D.Ann Allergy Asthma Immunol. 2023 May;130(5):571-576. doi: 10.1016/j.anai.2023.01.016. Epub 2023 Jan 23.PMID: 36702245.

Improvement in cystic fibrosis newborn screening program outcomes with genetic counseling via telemedicine. Stalker HJ, Jonasson AR, Hopfer SM, Collins MS.Pediatr Pulmonol. 2023 Dec;58(12):34783486. doi: 10.1002/ppul.26678. Epub 2023 Sep 15.PMID: 37712603.

STAFF

Jessica Hollenbach, PhD, Co-Director, Asthma Center

Melanie Sue Collins, MD, Co-Director, Asthma Center

Michelle M. Cloutier, MD, Founder, Asthma Center, Professor Emeritus Caleb Wasser, DO, Physician Champion, Easy Breathing

Sigrid Almeida, BS, Research Associate Kailee Martin, Data Entry Specialist

CENTER FOR GLOBAL HEALTH

The Center continues to collaborate in efforts to improve the lives of infants and children living in resource-limited settings by partnering in the development of sustainable capacity-building activities. Through the participation of trainees, staff and faculty, the Center for Global Health (CGH) creates a culture at Connecticut Children’s that acknowledges that our place as world citizens and that our knowledge and skills can improve the lives of children around the world. We develop influential activities that increase global health participation and appreciation. We work to increase cultural humility, resilience and engagement within our community, resulting in healthier children locally and internationally.

The CGH continues to be led by its director, Adam Silverman, MD. Leadership continues to be provided by Stephen Mahier, RN, who is responsible for nursing activities; Naveed Hussain, MD, who is responsible for newborn/neonatal capacity-building and research; Lisa LeBon, RRT, who is responsible for allied health professionals; and Christopher Hughes, MD, who is responsible for surgical activities. All of the work is supported by Lisa Roberts, administrative assistant to the team. The CGH continues to benefit from its status as a program of the Office for Community Child Health (OCCH) through which it can share innovations and methods developed in resource-limited settings with local programs in Connecticut as well as benefit from the resources, structures and methodologies developed by OCCH programs.

Global health activities are expanding in the postCOVID19 era with multiple new partnerships. We are developing a new relationship with the Jamaican North-East Regional Health Authority and the Issa Trust Foundation to identify pediatric health outcomes that would benefit from the sustainable involvement of our pediatric learners, staff and faculty. The Center continues building on the relationship established by Arvin Bundhoo, MD, with the Ministry of Health and Wellness for the Republic of Mauritius to improve the care of

critically ill infants and children. We have expanded our support of Janvier Hitayezu, MD, of CHUK, the University Teaching Hospital of Kigali, Rwanda by increasing accessto pediatric critical care education and building on the relationship developed through the Neonatal Nurse’s Essential Training and Skills (NNETS) training program created by Dr. Hussain and his Ugandan colleague Dr. Dickson Tumusiime at Nakasero Hospital in Kampala by participating in the establishment of a PICU at that hospital as well.

In addition, the yearly university-wide Global Health Symposia was once again held in collaboration with three partners: the student-led Global Health Spaces on Campus organization in Storrs, CT, the leaders in global health at the UConn Health Center in Farmington, and the Center for Global Health. The theme for the Symposia focused on “The Price of Life” and the turnout was once again outstanding.

OUR TEAM

Adam Silverman, MD, FAAP – Director, Connecticut Children’s Center for Global Health, Emergency Medicine and Critical Care physician

Brendan Campbell, MD, MPH, FACS – Director of Trauma, Pediatric Surgeon, Pediatric Surgical Quality and Safety Officer

Nancy Dunbar, MD, MPH, FAAP –Endocrinologist

Christine Finck, MD, FACS – Connecticut Children’s

Surgeon-in-Chief, Division Head, Pediatric Surgery

Melissa Held, MD – Infectious Diseases & Immunology Physician

Victor Herson, MD – Neonatologist

Support for our partners continued this year as ease of travel improved. Remote lectures provided by CGH team members as well as interactive sessions were held at pediatric training programs in Haiti, Uganda, Ghana, Rwanda, Nigeria and Ethiopia. New strategies and technologies were leveraged, so that great significant educational activities were provided despite the reality of having partners who are thousands of miles away. The number of partners and educational sessions held significantly increased as did the quality of the teaching provided. The foundation of these capacitybuilding activities includes collaborations, partnerships, and sustainable volunteering opportunities with several organizations including:

• Justinien University Hospital as volunteers with Konbit Sante in Cap-Haitian, Haiti

• St. Damien Pediatric Hospital as members of the St. Damien Collaborative in Port-au-Prince, Haiti

Christopher Hughes MD, MPH – Pediatric Plastic Surgery & Global Surgery Associate Director of the CGH

Naveed Hussain, MD – Neonatologist and Associate Director of the CGH

Lisa LeBon, RRT – Respiratory Therapist and Associate Director of the CGH

Cliff O’Callahan, MD, PhD, FAAP – Pediatric faculty and Director of Nurseries, Middlesex Hospital; Associate Professor, Pediatrics, University of Connecticut School of Medicine; Assistant Professor, Family Medicine, Frank H. Netter MD School of Medicine, Quinnipiac University

Andrea Orsey, MD – Director, Cancer Supportive Care Program, Oncologist

Hareem Park, MD – Pediatric Hospital Physician and Associate Director of the CGH

• Hospital Sacre Coeur Pediatric Diabetes Program as volunteers with CRUDEM in Milot, Haiti

• NICE Foundation “Cool the Kids” program in Hyderabad, India

• The University Teaching Hospital of Kigali (CHUK) in Kigali, Rwanda

• Nakasero Hospital as the site for Neonatal Nurse training in Kampala, Uganda

• St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia

Juan C. Salazar, MD, MPH, FAAP – Physicianin-Chief and Executive Vice President, Academic Affairs, Connecticut Children’s

Kristin Welch, MD – Emergency Medicine Physician

Stephen Mahier, BSN, RN – Pediatric Intensive Care Unit (PICU) Nurse and Associate Director of the CGH

Ian C. Michelow, MD, FCPaed – Division Head, Pediatric Infectious Diseases and Immunology

FETAL CARE CENTER

The mission of the Fetal Care Center is to provide state of the art cutting edge fetal surgical interventions for the entire range of prenatal conditions which may benefit from fetal intervention. The Center offers clinical services for fetal patients from diagnosis as early as 15 weeks’ gestation to delivery. This includes prenatal consultations covering the entire spectrum of prenatal diagnoses from anomalies of the central nervous system such as myelomeningocele, to fetal chest lesions such as congenital pulmonary airway malformations, congenital diaphragmatic hernia, and bronchopulmonary sequestrations, to genitourinary conditions such as bladder outlet obstruction and fetal renal failure. In addition, Fetal Surgery treats complications in twins and high order multiples with Twin-Twin Transfusion Syndrome, Twin Anemia Polycythemia Sequence, and Twin Reversed Arterial Perfusion Sequence. Fetal Surgery also performs Exutero Intrapartum Treatment (EXIT) procedure for a broad range of conditions compromising the fetus at birth.

Fetal Surgery was established in May 2023 and has made significant progress in terms of volume of prenatal consultations as well as performing open fetal surgery for myelomeningocele, fetoscopic surgery for twin-twin transfusion syndrome, ultrasound guided radiofrequency ablation for twin reversed arterial perfusion sequence and fetoscopic and fetal thoracoscopic treatment of hydropic congenital pulmonary airway malformations. Fetal Surgery has led the Fetal Care Center at Connecticut Children’s in gaining admission to the North American Fetal Therapy Network (NAFTnet) and is actively participating in multiple research efforts sponsored by NAFTnet. We are the only fetal center in New England to have obtained IRB and FDA approval for the IDE for the use of Fetoscopic Endoluminal Tracheal Occlusion balloon which we now can offer to the most severe cases of congenital diaphragmatic hernia.

MATERNAL FETAL MEDICINE FELLOWSHIP

Kristen Moriarty, MD, began her fellowship in August 2023 after completing her residency in Obstetrics and Gynecology at the University of Connecticut. She will be rotating through the Fetal Care Center as part of her fellowship training in Maternal Fetal Medicine. In addition, Dr. Moriarty is working in Dr. Timothy Crombleholme’s laboratory on placental gene therapy for pre-eclampsia and is enrolled in the Translational Research Master’s Program with Dr. Crombleholme as her advisor. In addition, we are in discussion with the Maternal Fetal Medicine fellowship program at Lehigh Valley Hospital to have their fellow rotate through the Fetal Care Center.

EDUCATION

We create outstanding learning opportunities for trainees at all levels in pediatric surgery, maternal fetal medicine, neonatology, pediatric cardiology, obstetrics and gynecology, pediatric radiology, neurology and neurosurgery. Twice a month we have an educational conference, which alternates between a journal club and a presentation on specific topics. These are web-based meeting that are open to all members of the Connecticut Children’s community. Recent talks have included topics such as Fetoscopic Endoluminal Tracheal Occlusion for Severe CDH, Fetal Surgery for Myelomeningocele, and Fetal Surgery for Bladder Outlet Obstruction.

INTERNATIONAL PRESENTATIONS

Prenatal Recognition of Hepatopulmonary Fusion in Right-Sided Congenital Diaphragmatic Hernia for Successful Operative Planning presented at the 40th Annual International Fetal Medicine and Surgery Society, Visby Island 9-5-2023 Crombleholme TM.

Vascular dysregulation via NF-kB in fetal growth restriction presented at the 40th Annual International Fetal Medicine and Surgery Society, Visby Island 9-52023 Crombleholme TM.

RESEARCH

Laboratory Research

Endothelial cell dysfunction mediated by NF-kB in placental insufficiency

This work follows on our preliminary data demonstrating that the placental insufficiency in animal models of fetal growth restriction is mediated by a previously unrecognized endothelial cell dysfunction mediated by NF-kB due to deficiency of IGF-1.

Placental gene therapy with IGF-1 to correct placental insufficiency

We have demonstrated the ability of intra-placental gene transfer of IGF-1 to not only correct placental insufficiency but also prevent development of obesity, diabetes and cardiovascular disease in adult animals. We have replicated this work in rat, mouse and rabbit models.

Placental gene therapy with IGF-1 to correct preeclampsia

The endothelial cell dysfunction that we have found to play a role in placental insufficiency may well be operative in pre-eclampsia. In collaboration with Jennifer Somme, PhD, at LSU in the BPH/5 mouse model of pre-eclampsia we are applying the mesenteric uterine artery ligation model of placental insufficiency to create a model of both pre-eclampsia and placental insufficiency which clinically often go together. We plan to examine the role of NF-kB and the response to intra-placental gene transfer of IGF-1 to prevent preeclampsia.

Fetal gene therapy to correct glycogen storage disease 1a

Youngmok Lee, PhD, has developed AAV gene transfer to successfully treat GSD postnatally. There is however a mouse model so severe that the mice do not survive the immediate postnatal period due to profound hypoglycemia. Together we are developing a fetal gene transfer strategy using codon optimized and serotype specific AAV for fetal liver gene transfer in this severe GSD-1a mouse model.

Robotic fetoscopic repair of myelomeningocele in sheep

David Hersh, MD, has a Connecticut Connection grant to study the development of a robotic fetoscopic repair of fetal myelomeningocele in fetal lambs. This work is focused on improving outcomes of fetal MMC repair through a single 15 mm port.

Clinical Research

FETO for Severe CDH

We have IRB and FDA approval for an IDE to perform fetoscopic endoluminal tracheal occlusion (FETO) in high risk left and right CDH. We are part of the North American FETO Consortium, which is a 10-member group of fetal centers that perform FETO who are pooling their patients in a North American FETO registry sponsored by NAFTnet.

Gastroschisis Outcomes of Delivery (GOOD) study

This is an NIH sponsored prospective randomized trial comparing early to late delivery of gastroschisis on a battery of outcomes.

fMMC

The fetal MMC registry is sponsored by NAFTnet and includes all MMCs repaired at fetal centers including both prenatal and postnatal outcomes. Drs. Hersh and Crombleholme are reviewing data on outcomes of mothers with BMI >35<40 who undergo fetal MMC repair.

Fetal Pacemaker

In collaboration with Shailendra Upadhyay, MD, Irfan Warsy, MD, Dennis Mello, MD, and Dr. Crombleholme we are developing a team to perform fetal pacemaker placement for immune mediated complete heart block and in structural heart disease associated with complete heart block to improve survival in cases which currently are not treated in utero and are associated with a very high mortality.

CURRENT GRANT FUNDING

Gastroschisis Outcomes of Delivery (GOOD) Study

Project Number: R01 HD104607

Name of PD/PI: Amy Wagner (Contact PI)

Source of Support: NIH/Medical College of Wisconsin

Primary Place of Performance: Hartford, CT.

Connecticut Children’s Internal Support – Research Protected Time

Connecticut Children’s has dedicated protected time and support for Dr. Crombleholme to focus on grant proposal development, writing, and expanding his research.

Name of PD/PI: Crombleholme, Timothy

Source of Support: Connecticut Children’s

Primary Place of Performance: Connecticut Children’s Medical Center, Hartford, CT

OMB No. 0925-0001 and 0925-0002 (Rev. 10/2021 Approved Through 09/30/2024).

Community Project Funding/Congressionally Directed Spending – Construction

Connecticut Children’s has received DHHS funding to support the replacement of a Magnetic Resonance Imaging (MRI) Facility for the purpose of f non-invasively imaging the body’s internal structures to aid in the diagnosis, treatment planning, and monitoring of various pediatric health conditions, ranging from congenital abnormalities and injuries to neurological disorders and cancers

Status of Support: Active Project Number: CE152413

Name of PD/PI: Schicker, Reaghan

Role: Clinical Lead

Source of Support: DHHS, Congressionally Directed Spending

Primary Place of Performance: Connecticut Children’s Medical Center, Hartford, CT.

Performing robotic (fetoscopic) techniques for pregnant mothers of fetuses with spinal dysraphism (spina bifida)

Name of Individual: Hersh, David, Crombleholme, Timothy Commons ID: CROMBLEHOLME

Status of Support: Pending

Project Number: N/A

Name of PD/PI: Hersh, David (Primary); Crombleholme, Timothy (Co-PI).

Source of Support: Connecticut Children’s

Primary Place of Performance: Connecticut Children’s Medical Center, Hartford, CT

Project/Proposal Start and End Date: (MM/YYYY) (if available): 12/1/2023-11/30/2024 (ongoing)

Total Award Amount (including Indirect Costs): salary only.

PENDING GRANTS

Placental Gene Therapy for Treatment of Severe Fetal Growth Restriction

Co-PI: Crombleholme TM, Gessler D (UMass) coinvestigators: Lee Y, Gau G (UMass), Nold C, DeMarco GARPA-H.

NF-kB Mediated Endothelial Cell Dysfunction in Placental Insufficiency:Correction by IGF-1 Placental Gene Transfer

PI: Crombleholme TM, Co-investigators: Lee Y, Majumder S

Burroughs Wellcome Fund: Next Gen Pregnancy Initiative.

UConn Clinical Research and Innovation Seed Program (CRISP)

Status: In process

Dates: 6/1/2023 – 6/1/2024

Award amount: $6,900

Project: “Application of virtual reality interventions in post-operative recovery of a pediatric scoliosis patient population”.

THE FUTURE

Fetal Surgery and the Fetal Care Center at Connecticut Children’s only started in May 2023. We anticipate significant growth in volume of consultations and fetal surgeries in the coming years. To meet this need we anticipate expansion of our staff to fill the new Fetal Care Center and Special Delivery Unit when the new tower is completed in 2025.

PUBLICATIONS

Terp, K. L., Roberts, B. K., Alonso, D., Pevsner Crum, R. M., Crombleholme, T., Karakas, S. P., & Alkhoury, F. (2023). Prenatal Recognition of Hepatopulmonary Fusion in Right-Sided Congenital Diaphragmatic Hernia for Successful Operative Planning. Fetal Diagnosis and Therapy, 49(11–12), 451–458. https://doi. org/10.1159/000527802.

Crombleholme TM, Smith JD, Eapen R, Al-Kubaisi M, Magee K: Successful Postnatal Tracheobronchoplasty for Unilateral Congenital High Airway Obstruction Syndrome (CHAOS) due to Mainstem Bronchial Atresia. Fetal Diagn Ther: 2023, 49(11-12), 451-455.

Cooper, SM, Borgida, S, Thacker,A, Hammer,E, Hariharan, A, Kuo, C-L, Blanck, Hanshu N, Yuan, PH, Lin, Q, Maas, K, Campbell, WA, Zhou Y: Oral Origin of the Placenta Microbiome in Pregnant Women with Preeclampsia. Frontiers in Bacteriology, Molecular Bacteriology and Microbiome. In press 2023.

Bergh, E, Baschat AA, Sanz Cortez M, Hedrick HL, Ryan G, Lim FY, Zaretsky M, Schenone M, Crombleholme TM, Ruano R, Gosnell K, Johnson A: Fetoscopic endoluminal tracheal occlusion (FETO) for severe left congenital diaphragmatic hernia, the North Amercian Fetal Therapy Network (NAFTnet) FETO Consortium experience. Obstet Gyncol In press 2023.

Sutter PA, Anderson MG, Sahyouni R, Plonsker J, Ravindra VM, Gonda DD, Levy ML, Dziugan K, Votoupal M, DeCuypere M, Leclair NK, Angelo SJ, Halloran PJ, Martin JE, Bookland MJ, Michelow IC, McKay L, Hersh DS*. Anticoagulation for the treatment of septic cerebral venous sinus thrombosis in the setting of pediatric sinogenic and otogenic intracranial infections. Neurosurg Focus. 2023 Oct;55(4):E8. doi: 10.3171/2023.7.FOCUS23374.

Anderson H, Hersh DS, Khan Y. The potential role of mechanotransduction in the management of pediatric calvarial bone flap repair. Biotechnol Bioeng. 2023 Sep 5. doi: 10.1002/bit.28534. Online ahead of print.

Xu S, Leclair NK, Angelo S, Paro M, Stoltz P, Anderson M, Martin JE, Hersh DS, Bookland MJ. Natural history of mild trigonocephalic deformities. J Neurosurg Pediatr. 2023 Jul 28:1-6. doi: 10.3171/2023.6.PEDS23201.

Online ahead of print.

Sun LR, Jordan LC, Smith ER, Aldana PR, Kirschen MP, Guilliams K, Gupta N, Steinberg GK, Fox C, Harrar DB, Lee S, Chung MG, Dirks P, Dlamini N, Maher CO, Lehman LL, Hong SJ, Strahle JM, Pineda JA, Beslow LA, Rasmussen L, Mailo J, Piatt J, Lang SS, Adelson PD, Dewan MC, Mineyko A, McClugage S, Vadivelu S, Dowling MM, Hersh DS. Pediatric Moyamoya Revascularization Perioperative Care: A Modified Delphi Study. Neurocrit Care. 2023 Jul 20. doi: 10.1007/ s12028-023-01788-0. Online ahead of print.

Aarabi B, Neal CJ, Hersh DS, Harrop JS, Fehlings MG, Toups EG, Guest JD, Ugiliweneza B, Akhtar-Danesh N, Kurpad SN, Grossman RG. Mortality in ASIA Impairment Scale grade A to D patients with odontoid fracture and magnetic resonance imaging evidence of spinal cord injury. Neurotrauma Rep. 2023 Jun 1;4(1):375-383. doi: 10.1089/neur.2023.0005. eCollection 2023.

Romano R, Dean J, Bageac DV, Galske J, Anderson T, Kadian S, Modi Y, Paro M, Lambert W, Leclair NK, Hersh DS, Bulsara KR. Recruitment into academic neurosurgery using a model for successful crosscampus research collaboration: a pre-medical student survey. World Neurosurg. 2023 Jun 20:S18788750(23)00814-8. doi: 10.1016/j.wneu.2023.06.046. Online ahead of print.

Anderson MG, Jungbauer D, Leclair NK, Ahn ES, Stoltz P, Martin JE, Hersh DS, Bookland MJ. Incorporation of a biparietal narrowing metric to improve the ability of machine learning models to detect sagittal craniosynostosis with 2D photographs. Neurosurg Focus. 2023 Jun;54(6):E9. doi: 10.3171/2023.3.FOCUS2349.

Anderson MG, Lambert W, Leclair N, Athar D, Martin JE, Bookland MJ, Hersh DS*. Telemedicine utilization in an outpatient pediatric neurosurgical clinic: a prospective survey of patient and family preferences. World Neurosurg. 2023 Jun 1:S1878-8750(23)007489. doi: 10.1016/j.wneu.2023.05.102. Online ahead of print.

Angelo SJ, Anderson MG, Sutter PA, Halloran PJ, Kavanagh KR, Paro MR, Martin JE, Bookland MJ, Michelow IC, Hersh DS*. Changes in the epidemiology of pediatric sinogenic and otogenic intracranial infections during the COVID-19 pandemic: a singleinstitution study. J Neurosurg Pediatr. 2023 May 26:111. doi: 10.3171/2023.4.PEDS23130. Online ahead of print.

Hersh DS*, Martin JE, Kureshi IU, Bulsara KR. Letter to the Editor. Tracking neurosurgery resident performance on simulation-based training tasks. J Neurosurg. 2023 May 26:1-2. doi: 10.3171/2023.3.JNS23610. Online ahead of print.

Leclair NK, Chern J, Ahn ES, Chamis M, Paro MR, Lambert WA, Stoltz P, Hersh DS, Martin JE, Bookland MJ. Clinical metrics and tools for provider assessment and tracking of trigonocephaly. J Neurosurg Pediatr. 2023 Apr 7:1-9. doi: 10.3171/2023.2.PEDS22511. Online ahead of print.

Kilbourn KJ, Leclair NK, Martin JE, Bookland MJ, Kureshi IU, Bulsara KR, Hersh DS*. Incorporating simulation into the neurosurgical residency curriculum: a program director survey. J Neurosurg. 2023 Mar 3:16. doi: 10.3171/2023.1.JNS222589. Online ahead of print.

Sun LR, Hersh DS, Smith ER, Aldana PR, Jordan LC. Practice variability in the perioperative management of pediatric moyamoya disease in North America. J Stroke Cerebrovasc Dis. 2023 Apr;32(4):107029. doi: 10.1016/j.jstrokecerebrovasdis.2023.107029. Epub 2023 Jan 25.

Rallo MS, Zappi KE, Koller GM, Guadix SW, Kortz MW, Hersh DS, Pannullo SC. Letter: Addressing barriers to student participation in neurosurgical conferences: experiences from the inaugural Early Career Neuroscience Virtual Research Symposium. Neurosurgery. 2023 Mar 1;92(3):e66-e68. doi: 10.1227/neu.0000000000002315. Epub 2023 Jan 4.

Koller GM, Reardon T, Kortz MW, Shlobin NA, Guadix SW, McCray E, Radwanski RE, Snyder HM, DiGiorgio AM, Hersh DS, Pannullo SC. Shared objective mentorship via virtual research and education initiatives for medical students and residents in neurosurgery: a systematic review and methodological discussion of the NERVE experience. World Neurosurg. 2023 Apr;172:20-33. doi: 10.1016/j.wneu.2023.01.035. Epub 2023 Jan 13.

Paro MR, Ollenschleger MD, Fayad MF, Bulsara KR, Stoltz P, Martin JE, Bookland MJ, Hersh DS*. Middle meningeal artery embolization for primary treatment of a chronic subdural hematoma in a pediatric patient: a systematic review of the literature and case report. Oper Neurosurg (Hagerstown). 2023 Jan 1;24(1):3-10. doi: 10.1227/ons.0000000000000446. Epub 2022 Nov 3.

Pindrik JA, Hersh DS. “Early recognition, aggressive treatment vital for intracranial infections,” AAP News. 2023;44:27.

Hersh DS*, Martin JE, Bulsara KR, Ollenschleger MD. In Reply: Middle Meningeal Artery Embolization for Primary Treatment of a Chronic Subdural Hematoma in a Pediatric Patient: A Systematic Review of the Literature and Case Report. Oper Neurosurg (Hagerstown). 2023 Feb 20. doi: 10.1227/ ons.0000000000000660. Online ahead of print.

Book Chapters

Hersh DS* and Hughes CD. Endoscopic Correction of Coronal Synostosis. Chapter in: Comprehensive Craniosynostosis Care. Taub PJ, Morgenstern P (ed). In press.

Hersh DS* and Boop FA. Diastematomyelia. Chapter in: Neurosurgical Operative Atlas: Pediatric Neurosurgery, 3e. Kobets A, Keating R (ed). In press. Leclair NK and Hersh DS*. Pediatric Central Nervous System Infections. Chapter in: Pediatric Neurosurgery Board Review – a Comprehensive Guide. Shimony N, Jallo G (ed). 2023; Springer Nature Switzerland AG, Cham, Switzerland.

STAFF

Timothy M Crombleholme, MD, Director

Fetal Care Center, Fetal and Pediatric Surgery

Erica Hammer, MD, Maternal Fetal Medicine

David Hersh, MD, Fetal and Pediatric Neurosurgery

Sanjukta Majumder, PhD, Assistant Professor of Surgery

Kristen Moriarty, MD, Maternal Fetal Medicine Fellow

Jennifer Humphrey, RN, MSN, Coordinator Fetal Care Center

Allie Madden, RN, Hartford Hospital Coordinator for Fetal Care Center

Leeza Swierzewski, RDMS, RDCS, Sonographer

Angela Bower, RDMS, Sonographer

Jamila Howes, Administrative Coordinator

THE PEDIATRIC OBESITY CENTER FOR TREATMENT, RESEARCH

weight management programs, bariatric surgery, nutrition, and psychology services.

& EDUCATION

The vision of the Pediatric Obesity Center is to be at the forefront of the care of families with obesity by providing innovative clinical service, cutting-edge research initiatives, and tailored education of the next generation of providers. Our mission is to treat the whole child and our specialists help children and their families change behaviors to accomplish their goals. In our second decade of providing care, we reflect on 2023.

CENTER OVERVIEW

The Pediatric Obesity Center comprises an interdisciplinary team of surgeons, pediatric psychologists, pediatricians, endocrinologists, dietitians and physical therapists. Our team members are clinicians and researchers with funding at the national and local level and educators to both trainees, colleagues and the community. We are dedicated to improving, and creating new, effective and culturally responsive treatment options for youth and their families. Our team addresses health care disparities daily with the families we are fortunate to serve and publish our work and findings to expand the reach of our care. We lead as educators of the next generation of providers. Finally, we serve as content experts to the community on the many ways obesity impacts families, advancing science and decreasing the myths of obesity that lead to stigma.

PEDIATRIC OBESITY CENTER: CLINICAL

We offer several treatment programs that help children and families achieve a healthier lifestyle. Connecticut Children’s is the only hospital in the state that provides adolescents with a surgical option for weight management that has been designated as a Center of Excellence for Adolescent Bariatric Surgery by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American College Surgery and the American Society of Metabolic and Bariatric Surgery. Our services include

Over the last year, we are proud to share that we have seen unprecedented volumes in our clinics and have completed 34 surgical weight loss procedures. We were able to successfully recruit Megan Trudel, our new practice coordinator, who was instrumental in leading a successful site visit for re-accreditation of our Center of Excellence.

Medical weight management has grown in team membership as well as geographic coverage. We are thrilled to serve patients all across Connecticut and surrounding states. We have embraced the updated national obesity care guidelines and integrated these best practices into our comprehensive treatment of children with obesity. We have collaborated with many of our referring pediatricians and family practitioners to help them adopt these new guidelines in their daily work. Jessica Williams, MD, A-BOM was an invited speaker to present at the Hartford Hospital pediatric quality care symposium on treatment best practices; and Dr. Williams and James Healy, MD, MHS, were invited speakers to the CT chapter American Academy of Family Practitioners annual meeting. We are a trusted referral center, providing excellent care to children with obesity, especially who have higher complexity or more severe cases. We have been selected as the pediatric care delivery partner for children of Blue Cross state employees to provide multidisciplinary care and medication treatment. Our focus on improving health for our children translates into improvements not only in weight but also social, emotional, physical and metabolic health for our children.

Our surgical team surpassed a milestone this year having completed more than 150 sleeve gastrectomy cases since the initiation of our program. This volume represents an accumulation of safety improvements, patient experience improvements, and advances in efficiency. Our Enhanced Recovery After Surgery(ERAS) protocol has decreased average length of hospital stay from four days to less than two days, with most patients only receiving 1-2 doses of narcotics in the immediate perioperative time, and none once they

reach the floor. This year we began a robotic surgical program, which allows greater patient comfort, greater precision, enhanced view of anatomy, and articulating laparoscopic instruments, furthering our ability to provide patients the best possible care. Dr. Healy was elected as Vice President of the CT Chapter of the American Society for Metabolic and Bariatric Surgery, and has been planning the 2024 Obesity Summit, which will take place in January. He also serves on the national APSA bariatric program building subcommittee.

Drs. Williams, Healy, Christine Finck, MD, FACS, and Melissa Santos, PhD, investigated the impact of pre-operative use of anti-obesity medications in preoperative patients and were selected to present this at the national ASMBS society meeting in June 2023.

PEDIATRIC OBESITY CENTER: EDUCATION

This year the Pediatric Obesity Center welcomed its first research postdoctoral fellow. Abigail Sharer, PhD, joined our team to support the research of Dr. Santos and continue our long history of training the next generation of pediatric psychology learners in obesity. This continues with pediatric residents who are now rotating within obesity as part of their required behavioral health rotations.

PEDIATRIC OBESITY CENTER: RESEARCH

Dr. Santos continued to expand her research in the care of transgender youth with obesity with funding from the American Diabetes Association. This is accompanied by funding from other organizations including SAMHSA, the Tow Foundation and the Connecticut Health Foundation to focus on improving care for the whole child. She was an invited speaker to multiple outlets to share her expertise in pediatric obesity including: WNPR, CTHit and CT Latino News. Nationally, she is on the editorial board of several journals including Eating Behaviors and Childhood Obesity and was asked to serve as the guest editor for a special issue on bariatric surgery in the journal Children. Dr. Santos has presented her research on transgender youth with obesity at the annual ASMBS conference where she was also invited to be the course director for the symposium on adolescent bariatric surgery.

PEDIATRIC OBESITY CENTER: SERVICE

Dr. Santos’ commitment to the underserved was highlighted in her selection in several critical statewide initiatives including the State of Connecticut’s Racial Equity Taskforce, Comptroller Scanlon’s Healthcare Disparities Group and two committees through the Connecticut Hospital Association. In addition, she led Connecticut Children’s Joint Commission National Patient Safety Goal to reduce patient healthcare disparities by developing a food insecurity-screening pathway within the obesity program. In addition, Michael Reiss, PsyD, focused much of this year on improving care for our non-English speaking patients to ensure that our work was based in cultural humility and culturally responsive care.

GRANTS

American Diabetes Association: Developing a patient and provider evidence based care pathway for transgender youth with obesity.

ACTIVE STUDIES

• Obesity Program Prospective Database

• Establishment of the Pediatric Obesity Weight Evaluation Registry (POWER): A Prospective Pilot Project of Children and Adolescents Presenting For Weight Management

• Pain and Obesity: The Development of PAW (Pain And Weight) Treatment

• Understanding the key differences between the different sources of mesenchymal stem cells

• Observing efficacy of weight-based management in adolescents with gender dysphoria

• Adolescent Bariatric Surgery: Teen and Provider Perspectives

• Bariatric Mobile (Bari-Mobile) Study

• Bariatric Surgery Data and Outcome Registry

• Developing a patient and provider evidence based care pathway for transgender youth with obesity

PUBLICATIONS

Theriault, C. B., DiPlacido, J., Zempsky, W. T., & Santos, M. (2023). The Relationship Between Experiences of Pain Among Youth with Obesity and Health-Related Quality of Life: The Role of Functional Limitation, Sleep, and Depressive Symptoms. Childhood obesity (Print), 10.1089/chi.2022.0203. Advance online publication. https://doi.org/10.1089/chi.2022.0203.

Darling, K. E., Warnick, J., Guthrie, K. M., Santos, M., & Jelalian, E. (2023). Weight Management Engagement for Teens From Low-Income Backgrounds: Qualitative Perspectives From Adolescents and Caregivers. Journal of pediatric psychology, jsad008. Advance online publication. https://doi.org/10.1093/jpepsy/jsad008.

Christison, A., Ariza, A., Fernandez, C., Kumar, S, Novick, M., Santos, M., Stratbucker, W., Sweeney, B., Vidmar, A. & Kirk, S. (2023). Challenges and solutions to sustaining paediatric weight management programs in the United States. Clinical Obesity.

STAFF

Medical Providers

Jessica Williams, MD, D-ABOM

Robert Rosenberg, MD, D-ABOM

Surgical Providers

Christine Finck, MD, FACS

James Healy, MD, MHS, FACS

Endocrinology Providers

Priya Phulwani, MD

Psychology Providers

Melissa Santos, PhD

Michael Reiss, Psy.D

Vanessa Laurent, PhD

Abigail Sharer, PhD, Postdoctoral Fellow

Advanced Practice Providers

Anthony Angotta, PA-C

Darlene Abbate, APRN

Nutrition Providers

Valerie Becker, MS, RD, CDN

Haley Duscha, RD, CDN

Anastasia Stergos, RD, CDN

Physical Therapy Providers

Micaela Sturm, PT, DPT

Emily Briganti, PT, DPT

Ashley Barnas, PT, DPT

Jennifer Garcia, PT, DPT

DEPARTMENTS

PATHOLOGY & LABORATORY MEDICINE

It was another productive and busy year for the Department of Pathology and Laboratory Medicine. We have been able to achieve several milestones in our projects and have developed innovative solutions to some of the most pressing issues.

In Anatomic Pathology, we have continued to recruit pathologists with subspecialty training. We successfully recruited Tony El-Jabbour, MD, (gastrointestinal/liver pathologist) who trained at Mt Sinai, NYU and Memorial Sloan Cancer Center. He joined us in early July 2023. Koorosh Haghayeghi, MD, (dermatopathologist) who trained at Warren Alpert Medical School of Brown, RI and Geisel School of Medicine at Dartmouth, NH. He joined us in late July 2023. Additionally, Vandita Johari, MD joined us as a Hematopathologist supporting Transfusion Medicine. was previously the Director of Clinical Pathology at Baystate Medical Center, MA and holds leadership roles nationally including the College of American Pathologists (CAP). Lastly, we recruited an Associate Director in molecular pathology, Dr. Yong Shi, who came to us from Sema4 where he was the Director of the Oncology Molecular Laboratory. He joined us on Jan. 1, 2023.

We continue to support the Cytology Fine Needle Aspiration (FNA) and Columbia renal biopsy adequacy needs of the Connecticut Children’s. Fiscal year (FY) 2023 Cytology volume for Connecticut Children’s increased approximately, 26% in FY 2023 with a total volume of 132 cytology specimens. Of those, 25 rapid onsite evaluations were performed, representing a slight increase from FY 2022 of five cases. We evaluated 28 Columbia renal biopsy cases in FY 2023 in comparison to 22 cases in FY 2022.

Connecticut Children’s surgical specimen volume totaled 3,235, representing a 3% increase from FY 2023. The number of specimens requiring on site frozen sections at Connecticut Children’s totaled 83 in FY 2023, four fewer than the previous FY 2022. The Department of Pathology and Laboratory Medicine (DPLM) at Hartford Hospital provided Pathology Services to Connecticut Children’s, including on-site frozen sections; handling of anatomic and clinical pathology specimens including neuropathology and cytopathology; hematopathology services; performance of pediatric autopsies; and pathology support for multiple interdisciplinary conferences including Pediatric Solid Tumor Board, Pediatric Neuropathology Tumor Board, Pediatric Hematopathology conference, Pediatric GI pathology conference, Pediatric Thyroid Program meeting, and Neonatal/Perinatal conference. In addition, our department performs triaging of pediatric tumors for Children Oncology Group, assessment and triaging of pediatric medical renal biopsies, and provides samples of pediatric tumors for Connecticut Children’s Biorepository Bank.

We continue to expand the laboratory offerings in immunohistochemistry and molecular pathology, expanding markers used for diagnostic pathology and ones that have therapeutic implications. Additionally we have implemented on slide controls for IHC testing which has reduced cost of testing. Hartford Hospital (HH) IHC laboratory continues to be the central hub of all IHC testing for majority of Hartford HealthCare (HHC) hospital laboratories.

NEW PROGRAMS

Anatomic Pathology

As part of the standardization across the HHC system, weekly meetings have resulted in many changes and improvements across all the HHC hospitals and a few examples include:

3. Standardize cutting/staining and reporting of Temporal Artery Biopsies

4. Standardize the handling of Creutzfeldt-Jakob disease (CJD) cytology specimens and developing a system wide CJD policy (in process)

5. Standardize the process for how NonGynecological cytology results are integrated and reported into EPIC

6. Ongoing standardization of histology protocols across the system to maximize usage of biopsy tissues and reduce wastage for potential future studies (e.g. molecular)

7. Updated the specimen grossing manual with standardizing protocols and number of sections submitted for histologic examination according to specimen type

Subspecialty sign-outs implemented at HH so that individuals with training and expertise in a subspecialty review cases in their areas of expertise. This is a quality measure, which improved efficiency of sign-outs, and appreciated by the trainees in the residency program.

We are continuing research study collaborating with the vendor, Cytoveris. Jonathan Earle, MD, and Ronald Araneta, MD, were co-principal investigators (with Anoop Meraney, MD, PI) in an Institutional Review Board (IRB)-approved proof-of concept study investigating CytoverisTM artificial intelligence (AI)enabled multispectral imaging for detrusor muscle identification in transurethral resection of bladder tumour (TURBT) specimens, to support intraoperative staging and resection adequacy of bladder cancer. Findings were presented at the Society of Urological Oncology annual meeting in November 2023 (poster #109) and will be presented at the Optica Biophotonics Congress: Biomedical Optics meeting in April 2024.

Hartford Hospital surgical specimen volume totaled 26,316, representing a 5% increase from FY 2022. The number of specimens requiring frozen sections increased by 3% in FY 2023, totaling 2,315.

1. Standardize the format and information provided in the headers on Pathology Reports

2. Backus Histology consolidation to Hartford Hospital

Margaret Assaad, MD, and Srinivas Mandavilli, MD, who had participated along with their colleagues in the validation study for an AI-tool in evaluating breast biopsies, presented their work at the 2023 United States and Canadian Academy of Pathology meeting in New Orleans.

Drs. Earle (HHC principal investigator). Ronald Araneta, MD, Krzysztof Glomski, MD, and Xianyuan Song, MD, PhD, participated in two IRB-approved Multi-Institutional industry-funded clinical studies investigating AI in the diagnosis of prostate carcinoma (AIDER-1 and AIDER-2). Both studies relied on whole slide digital imaging of prostate biopsy samples and compared standard reads with AI-assisted reads (IBEX Galen TM Prostate). Studies were designed to demonstrate both safety (AIDER-1 showed noninferiority) and efficacy/clinical utility (AIDER-2 showed improved detection of missed cancers), and study data are being used to support an FDA 510(k) Premarket Notification submission. Dr. Earle presented a summary at the HHC Research Symposium in November 2023. Efforts to continue the collaboration between HHC, IBEX and the department of pathology are ongoing, as we evaluate how to incorporate AI into clinical workflows for prostate cancer in 2024.

Informatics

A lot of background work went into implementation of expanding the scope and capability of whole slide digital scanning. Various vendors were evaluated, information technology leadership was engaged, and a large capacity scanner purchased. The scanner has been installed and validated. The above mentioned AI project is being performed utilizing the scanner. This scanner is also being utilized for the research study assessing spatial transcriptomics in mouse patientderived xenograft (PDX) melanoma samples, where the scanned hematoxylin and eosin stain (H&E) slides are also assessed by AI methods.

Dr. Sheridan continues to support multiple projects to improve the utilization of deep learning artificial intelligence (AI) techniques in the automated analysis of histopathologic images, as well as projects employing spatial transcriptomics and AI methods. Analysis was completed on the study of patient-derived xenograft (PDX) models of melanoma. The work assessed patient-derived melanoma tissue from two patients grown in mouse hosts undergoing treatment, with samples taken before, during and after treatment. Molecular profiling with spatial localization of tumor cells at different time points identified resistant and persistent clones, providing insight into the behavior of melanoma during the course of treatment and recurrence. A manuscript “Spatiotemporal profiling defines persistence and resistance dynamics during targeted treatment of melanoma” has been submitted and is pending acceptance.

Another ongoing project using spatial transcriptomics evaluates spatial characteristics of colorectal cancer in a cohort of 40 patients with previously collected molecular data and long-term clinical follow-up. The work also uses AI methods for clustering and comparison with molecular data, including molecular subtypes. The goal is to find characteristics relating to survival.

“A pan-cancer patient-derived xenograft histology image repository with genomic and pathologic annotations enables deep learning” was recently accepted for publication by Cancer Research. The article is the culmination of multiple years of work with numerous collaborators. The repository includes

PDX images of multiple tumor types, and pathologist annotations were used to train and assess AI methods such as Inception and Hover Net.

A novel method for fast, unsupervised deep learning called SAMPLER was also developed, and recently published in eBioMedicine. Assessment showed comparable or improved recognition of subtypes of breast, lung and renal cancers relative to other attention-based deep learning models at a much faster rate (>100 times). Pathologist annotations were used to assess regions of interest identified by SAMPLER.

Another project just underway will utilize AI methods to segment and separate pediatric sarcomas into rhabdomyosarcoma and non-rhabdomyosarcoma. The study includes a large image repository from St. Jude’s, Yale New Haven Hospital and Massachusetts General Hospital, and will include pathologist annotation and available molecular data.

LABORATORY MEDICINE

TRANSFUSION MEDICINE/BLOOD BANK

2023 was a very busy year for HH transfusion services, with a 2% increase of Type and Screens processed, and very significant increases in the total number of products transfused. Increased component volume was led by platelets (14.5%), followed by red cells (11.1%), followed by plasma and cryoprecipitate (7.5%). The increased volumes were in large part to support the continued success of the Heart and Vascular Institute, which is among the highest ranked in the Nation. Over the past 10 years, the volume of major Heart and Vascular Institute (HVI) procedures has essentially tripled, increasing by 6% to 7% each year, with 1,867 performed in FY 2023. Colleagues in our structural heart program kindly facilitated decreased wastage by agreeing to set up two rather than four red cells for the ever-increasing number of Transcatheter aortic valve replacement (TAVR) procedures.

Additional support for Life Star’s pre-hospital transfusion program began this fiscal year by adding two units of plasma to the two red cells carried in the helicopters based at MidState Medical Center and Backus Hospital.

An initiative is now being planned system-wide to introduce “liquid plasma” to HHC’s trauma inventory. While it costs a bit more than fresh frozen plasma (FFP) (and subsequent “thawed plasma”), the outdate

is significantly longer, generally 25 days rather than five, which will greatly facilitate inventory management. The composition of liquid plasma differs from FFP/thawed plasma only in that it lacks labile factors such as complement and labile coagulation factors 5 and 8, which are not essential to promote hemostasis or to stem fibrinolysis.

UPDATES/LAB STANDARDIZATION

Laboratory teams by each discipline continued to participate in system-wide standardization. FY 2023 brought the unexpected challenge and opportunity of major leadership changes of the Backus and Plainfield ED in the east region. Hartford provided transitional staffing and leadership to support the operations of Backus and bring them into regulatory compliance, culminating in full accreditation by the College of American Pathologists.

Laboratory consolidation continues with integration of less “time-sensitive” testing in the Hartford region, facilitated by the upgrade to the two Roche Cobas 8000 instruments. High sensitivity Troponin T rollout continues system wide, and a major practitioner/patient “dissatisfier” was rectified by extending the consensually validated normal range for “Mean Platelet Volume” down to 7.5 rather than 9.5 femtoliters. The “L” flags generated in otherwise entirely normal CBCs decreased significantly, resulting in fewer worried patients and clarifying phone calls.

A significant challenge for the laboratory system-wide has been the instability of the new Sysmex middleware (Caresphere), which has caused frequent unexpected downtimes for the hematology analyzers. HHC laboratory information Technology. (Information T) and pre-emptive communication have largely minimized the clinical impact while the vendor struggles to rectify the vulnerabilities of their powerful but temperamental “cloud-based” middleware.

Point of Care

SunQuest, auto discharge of patient records went live in March 2023.

In September 2023, the Point of Care team successfully completed their three day Joint Commission Inspection with minimal findings.

The Medical Mission event in Hartford on Nov. 4, 2023 supported the testing of 325 patients for Glucose and cholesterol screening.

Point of Care Hemoglobin testing utilizing HemoCue instrumentation was implemented on November 20, 2023 for the Pulmonary Lab. This provides faster results than the standard blood gas testing. This golive was the first phase. The second phase will include connectivity (go-live TBD).

Annual volumes for POC testing at HH sites are summarized below:

MICROBIOLOGY

Over the course of FY 2023, the Hartford HealthCare Ancillary Microbiology Laboratory at Newington implemented the following instruments and/or assays.

• Microbiology Ordering Standardization for Operating Room (OR) during CY 2023.

• Electronic ordering

• Electronic ordering with labels for microbiology implemented within EPIC Optime Navigator for Bone and Joint Institute (BJI) and Charlotte Hungerford Hospital (CHH) on April 11, 2023; Backus Hospital (BAK) and Windham Hospital (WND) on June 6, 2023 and St. Vincent’s Medical Center (SVMC) on Sept. 26, 2023.

• The negative pressure section of AFB (Mycobacteriology) renovated in December 2023 due to safety reasons.

• Three Phoenix M100 antibiotic susceptibilitytesting instruments were replaced with six Phoenix M50 instruments in September 2023 at cost savings since panel and reagent pricing were reduced due to increased volume associated with consolidation of hospital microbiology testing to Newington.

• Implemented a combined Legionella & Streptococcus pneumoniae urine antigen test, replacing single tests. This also reduced supply costs and reduced hands-on time, improving workflow and colleague satisfaction (Nov. 08, 2022).

• Began offering the Biofire Joint Infection PCR Panel for synovial fluid (June 6, 2023).

• CMV viral load was added to the Panther Plus (November 1, 2022). This test was previously sent out to a reference lab due to COVID-19 volume on the previous analyzer.

• Updated or created new culture test codes for the following: updated miscellaneous aerobic culture (June 6, 2023), created a miscellaneous anaerobic culture (June 6, 2023), created a combined tissue aerobic and anaerobic culture (TISANC) allowing

for the same accession number for this order on the same specimen and for more streamlined ordering.

• Validated addition of a simple processing (centrifugation) step for blood cultures positive with a Gram-negative bacteria for setup of antibiotic susceptibility directly from blood culture bottle. This improves the time to an antibiotic susceptibility result by 24 hours, improving time to target antibiotic therapy.

• Applied and awarded Hartford Hospital Auxiliary funds for a 3’ wide Biological safety cabinet (BSC) at the HH STAT lab to improve Cepheid Testing Turnaround time.

• Full renovation to the HH STAT laboratory and update of the Cepheid 16 module GeneXpert with the 32 module Infinity, which will improve throughput, capacity, and reduce hands-on time. Install and verification of assays complete August 2023.

• Presented to Wound Council regarding wound culture protocol and also created Wound Culture newsletter with Antimicrobial Stewardship (released April 27, 2023).

• Laboratory Developed test for Anaplasma phagocytophilum & Ehrlichia chaffeensis Nucleic Acid Amplification (NAA) went live on June 27, 2023, replacing send out of these NAA tests and improving turnaround time to on average 20 hours compared to 4 to 10 days at a reference laboratory.

• Updated the HIV BPA for the ED locations since incorrect information was previously displaying leading to incorrect use of the STAT HIV test.

• Laboratory developed test Babesia microti NAA (BABNAA) assay went live September 26, 2023.

• Reviewed microbiology breakpoints and rules for each bug drug combination to develop strategy for 2024 requirement for breakpoint adoption per CAP.

• Situation, Background, Assessment, and Recommendation (SBAR) submitted and approved for mapping of Pathology (and other nonmicrobiology) tests within the OR Optime ordering

system (May 18, 2023). Mapping ongoing and conjunction with pathologist subject matter experts and updates to the master library for source and type within EPIC.

• Updated Syphilis ordering algorithm to remove treponema pallidium (TPPA) if the rapid plasma reagin (RPR) was confirmed positive. This is in alignment with the CDC algorithm and required creation of a new test code. This also reduced clinician confusion and delays in patient discharge. Go-live: April 11, 2023.

• LEUKO EZ Vue for fecal lactoferrin was implemented on October 4, 2022.

• Two Fusion modules were obtained as part to the Hologic Panther Plus instruments to facilitate open channel assay development.

• SunQuest (SQ) setup time documentation was activated on April 25, 2023 in order to compare receive time at the affiliate laboratories versus time actually received at Newington.

MOLECULAR PATHOLOGY

The Molecular Pathology department successfully completed the first half of the validation to convert existing custom solid tumor NGS panels to Pan Solid Tumor RNA/DNA panels, which will expand NGS content to include 137 gene targets on the FusionPlex (RNA) panel and 185 gene targets on the VariantPlex (DNA) panel. The expanded FusionPlex panel, which includes sarcoma panel content, went live in May 2023. The 185-gene DNA VariantPlex panel, which will include an algorithm for assessing tumor mutational burden (TMB), microsatellite instability (MSI) and a complete list of genes required for homologous recombination deficiency (HRD) will go live in the first quarter of 2024.

The NGS analysis software - Archer Analysis Unlimited – has been upgraded to a cloud-based platform to streamline the analysis for all NGS assays. This update provides faster analysis runtimes, additional workflows for TMB, and new settings within DNA structural variants, and better filtering of background variants.

The new Rapid Myeloid Panel with FLT3 for use on the MassARRAY system went live on October 1, 2023. This custom-designed panel includes 67 assays covering 46 actionable variants spread over the genes CALR, IDH1, IDH2, JAK2, KRAS, MPL, NPM1, and NRAS and provides actionable results to clinicians in 48-72 hours. A similar panel for solid tumors is in the planning stages for the Molecular Division and will include targetable variants critical for initiating therapy in several tumor types that will include, lung, melanoma, colorectal and others.

Additionally, to facilitate ease of ordering Cytogenetic and Molecular testing, orders were created in Hartford Hospital’s EPIC. In response to the United HealthCare requirement, the department is in the application process for obtaining Z-Codes that will be tied to the corresponding CPT codes to assist billing for procedures.

DEPARTMENT GOALS

Plans to renovate the frozen section room to meet demand got underway as planned but were delayed due to the Covid-19 pandemic. The renovation and move to the new frozen section room was completed successfully, and now includes a state-of-the-art cutting stations and expanded work space.

In Anatomic Pathology, some of the goals include: building up on the subspecialization of review and sign-out of surgical and biopsy specimens, standardize monitoring of TRT/TIF/CIT of specimens to meet new CAP requirements and communication of these changes to clinical teams, and standardize autopsy paperwork and process of receiving autopsy requests. In digital pathology, we look to go-live with sign-out in a subspecialty or two and continue to explore possibility of implementing AI tools in diagnosis.

Lastly, we plan to expand OR Optime Navigator for Microbiology ordering and label printing to The Hospital of Central Connecticut, MidState Medical Center, and Hartford Hospital followed by updates to the source and type database with mapping for pathology orders within the Optime Navigator beyond legacy mapping.

STAFF CHANGES & PLANNED RECRUITMENT

We successfully recruited Tony El-Jabbour, MD and Koorsh Haghayeghi, MD in anatomic pathology, Vandita Johari, MD in clinical pathology and Yong Shi, PhD in molecular pathology.

Pertinent subspecialization

1. There is a wide range of subspecialization in the department broadly as Anatomic and Clinical Pathology. Within Anatomic Pathology, there is subspecialization as follows: neuropathology (3), cytopathology (6), pediatric pathology (1), molecular pathology (1), and dermatopathology (1). Additional members within AP have specialty skills in organ systems for which there is no board certification. These include breast pathology, GI pathology, GU pathology, gynecologic pathology, pulmonary pathology, head and neck pathology and soft tissue/bone tumor pathology. Additionally four members of the department are boardcertified in hematopathology to provide support in Hematology and Hematopathology.

2. In other areas of Clinical Pathology, two staff members provide support in transfusion medicine. One is board-certified in transfusion medicine and the other has specialty expertise in coagulation. There is one PhD board-certified member in each of the following disciplines: microbiology, chemistry, molecular pathology/cytogenetics, and immunopathology.

PUBLICATIONS/PRESENTATIONS

Lockwood C, Borsu L, Cankovic M, Earle J, Gocke C, Hameed M, Jordan D, Lopategui J, Pullambhatla M, Reuther J, Rumilla K, Tafe L, Temple-Smolkin R, Terraf P, Tsimberidou A, Recommendations for Cell-Free DNA Assay Validations: A Joint Consensus Recommendation of the Association for Molecular Pathology and the College of American Pathologists, J Molecular Diagnostics, September 2023, ISSN 1525-1578, https://doi.org/10.1016/j.jmoldx.2023.09.004, JMDI-D23-00165R1.

and Prostate Biopsies, Hartford HealthCare Research Symposium. November 8 2023; Hartford CT.

Meraney A,(presenter), Araneta III R, Earle J, Pandey R, Root G, O’Connor T, Shirvalkar A, Fournier D, Grandpre K, Tolkacheva K. Artificial Intelligence-enabled Labelfree Multispectral Imaging for Improving the Quality of Transurethral Resection of Bladder Tumor Procedures, Poster presentation at Society of Urologic Oncology meeting, November 2023, Washington DC, Poster #109.

Pandey R (presenter), Fournier D, OConnor T, Grandpre K, Root G, Shirvalkar A, Tolkacheva K, Meraney A, Araneta III R, Earle J. Artificial Intelligence-Enabled Label-free Multispectral Imaging for Detrusor Muscle Identification in Transurethral Resection of Bladder Tumor Procedure, Control Number: 4045543, to be presented at Optica Biophotonics Congress: Biomedical Optics meeting in April 2024 in Fort Lauderdale FL.

Wang K-W, Caruso A, Mnayer L, Shi Y, Earle J Comparison of ERBB2 and MDM2 Gene Amplification Analysis by Next-Generation Sequencing Copy Number Variation and Fluorescence In Situ Hybridization in Solid Tumors. Presented at Association for Molecular Pathology Annual Meeting, November 2023; Salt Lake City UT. Poster number ST148, Abstract Number 1577496.

Assaad M, Mandavilli S, et al. Validation and Clinical Deployment of an Artificial Intelligence Solution for Diagnosis Support in Breast Biopsies”, Presented at USCAP Meeting, 2023; New Orleans LA

7. Saad A, Ibrihim E, Sheridan T, Araneta R. Syphilitic Epididymo-Orchitis Mimicking Testicular Mass. Presented at the 2023 CAP Annual Pathologists Meeting, October 7-10, 2023; Chicago IL.

Earle J. Validation and Clinical Deployment of an Artificial Intelligence Solution for Diagnosis Support in Breast

Ibrahim E, Akrmah M, Ligato S. Does a positive Appendiceal Resection Margin in Low- Grade Appendiceal Mucinous Neoplasms, Warrant Additional Surgery? Our Institution Experience and Literature Review. Annals of Surgical Oncology Journal. July 21, 2023. PMID: 37477747 DOI: 10.1245/s10434-02313930-5.

Ibrahim E, Akrmah M, Ligato S. Does a Positive Appendiceal Resection Margin in Low- Grade Appendiceal Mucinous Neoplasms, Warrant Additional Surgery? Our Institution Experience and Literature Review Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT. Presented at USCAP Meeting, 2023; New Orleans LA.

Ibrahim E, Repollet Otero P, Ligato S. Effect of Neoadjuvant Chemotherapy on the Accuracy of IntraOperative Frozen Section Evaluation of Pancreatic Resection Margin in Patients with Pancreatic Ductal Adenocarcinoma. Presented at USCAP Meeting, 2023; New Orleans LA.

Ivashkevich Y, Kenney B, Ligato S. Are Clinical Requests for “Up-Front” Immunohistochemistry for quantification of Mast Cells in Biopsies from the Gastrointestinal Tract to Rule our Mast-Cell Disease Justified? Poster presentation at ASCP 2023 Meeting, Chicago IL.

STAFF

Srinivas Mandavilli, MD, Head of Pathology & Laboratory Medicine

Ronald Araneta, MD

Margaret Assaad, M.D

Fabiola Balarezo, MD

Program Director of residency program

Joseph A. DiGiuseppe, MD, PhD

Division Director, Hematopathology

Jonathan Earle, MD

Torsten Ehrig, MD

Tony El Jabbour, MD

Mary Fiel-Gan, MD

Director, Anatomic Pathology

Krzysztof Glomski, MD, PhD, Director of Immunohistochemistry Lab

Koorosh Haghayeghi, MD

Vandita Johari, MD

Saverio Ligato, MD

Gregory S. Makowski, PhD, DABCC, FACB

Vice-President of Laboratory Services, HHC

Laila Mnayer, PhD

Director of Molecular Pathology

Amity Roberts, PhD, D (ABMM)

Director of Microbiology

Peter Shen, MD

Bradford Sherburne, MD

Director of Transfusion Medicine; Medical Director of Laboratory

Todd Sheridan, MD

Yong Shi, PhD

Xianyuan Song, MD, PhD

Dean Uphoff, MD

Theresa Voytek, MD

Director of Cytopathology

RADIOLOGY

The Department of Radiology provides a full spectrum of imaging services and minimally invasive imageguided procedures and is integral to the clinical activities at Connecticut Children’s. We continuously strive to optimize image quality and the patient/family experience, balancing the unique needs and challenges of our pediatric patients with the responsibility of reducing radiation dose and usage of sedation or anesthesia. Our dedicated and interdisciplinary teams of skilled and experienced technologists, sonographers, nurses, practitioners, and physicians work every day to help our young patients obtain the best care safely and smoothly.

Our department participates in the Image Gently Alliance, seeking to minimize radiation exposure to patients by utilizing best practice techniques. We utilize the American College of Radiology (ACR) Appropriateness Criteria® for evidence-based guidance to optimize diagnostic imaging for children. Using digital radiography and other low-dose imaging equipment, such as the EOS imaging system in our Division of Orthopedic, we are able to bring down the radiation dose for our most commonly performed exams.

We are committed to maintaining the highest quality throughout the wide range of our imaging modalities, from digital radiography to state-of-the-art magnetic resonance imaging. The department has taken steps to remain continuously accredited through the ACR in ultrasound, computed tomography, CT, and magnetic resonance imaging, MRI. Our teams are dedicated to providing diagnostic and interventional services with around-the-clock coverage, allowing for uninterrupted care to the children entrusted to us.

ULTRASOUND

The Ultrasound section provides fast, accessible, and high quality imaging without the need for radiation or sedation. We offer extended appointment times at our Hartford campus on weekdays and on the weekends to meet the scheduling needs of our

patients and families. Ultrasound imaging by our subspecialty-trained sonographers is available at our Farmington, Danbury, and Westport locations, allowing communities greater access to these expertly performed examinations. We have also incorporated the relatively new technique of contrast-enhanced ultrasound using microsphere bubbles, to evaluate urological conditions or characterization of tissue abnormalities, providing an alternate or complementary imaging strategy to fluoroscopy, CT, and MRI. We are also developing other innovative applications of ultrasound, such as for gastrointestinal pathologies.

FLUOROSCOPY

Fluoroscopy is an important tool for diagnosis and procedural guidance in a variety of conditions including gastrointestinal, genitourinary, cardiopulmonary and musculoskeletal disorders. Fluoroscopy provides benefits to children of all ages from neonates in our intensive care to young adults. We perform this examination at the Hartford campus using flat-panel technology with pulsed fluoroscopy, allowing for significant radiation dose reduction with improved image quality. Fluoroscopy is also used in the operating room to help our surgical teams every day. The equipment we use is in alignment with our philosophy to “Image Gently and Step Lightly” to minimize ionizing radiation to our patients and staff. This goal is facilitated by rigorous monitoring and technical adjustments guided by advanced dose monitoring software.

COMPUTED TOMOGRAPHY

Our department has recently upgraded our CT system to a state-of-the-art ultra-fast scanner. This versatile new CT scanner provides increased speed, better image quality, and further dose-lowering capabilities including advanced intelligent deep learning reconstruction and spectral imaging. The new technology allows more robust CT angiographic studies that are crucial for the evaluation of complex congenital heart disease and other vascular pathologies that require exquisite spatial resolution. Rapid acquisition helps to minimize the need for sedation and anesthesia when performing these exams. Our CT scanning techniques are monitored

to ensure dose optimization for children of all sizes. We participate in the ACR Dose Index Registry, which enables us to benchmark our CT doses with other facilities.

MRI

The MRI section offers sophisticated facilities with both 1.5T and 3T field strength units at Connecticut Children’s Hartford campus. The 3T MRI system provides advanced cardiac and neurologic imaging, including functional brain MRI. Other specialized imaging protocols include quantitative liver imaging, whole body MRI, and functional imaging of the urinary tract. Additionally, we have expanded our fetal MRI services to support the mission of the new Fetal Care Center. We aim to continuously refine the quality of our studies and evaluate newer techniques to optimize our examinations. For example, we have piloted the usage of an iron-based intravenous (IV) contrast agent, Ferumoxytol that allows for advanced MR angiographic imaging with results that are superior to conventional gadolinium-based IV contrast. We are seeking to leverage newer MRI techniques to expand non-IV contrast and rapid diagnostic examinations, which would decrease the need for IV catheter placement and pharmacological sedation.

Our team of dedicated MRI technologists are highly skilled at working with children and expectant mothers, helping to put them at ease before, during, and after an MRI examination. The ability to provide movie and music streaming during the examinations helps both children and adult patients undergo their MRI studies comfortably, without sedation when possible. For more technically challenging or lengthy studies, the Sedation Service and the Division of Anesthesia offer outstanding resources to help our children undergo their examinations in all modalities. A full-time Child Life Specialist is a new addition to the team to enhance the patient and family experience during their visit.

INTERVENTIONAL RADIOLOGY

Interventional Radiologists (IR) and Advanced Practitioners with specialized expertise perform minimally invasive image-guided procedures on site at Connecticut

Children’s. Advanced technologies including a hybrid operating room and CT fluoroscopy help us optimize the care we provide. The range of medical conditions amenable to image-guided therapeutic and diagnostic procedures is extensive and constantly evolving. Our highly skilled teams are able to provide interventions encompassing, but not limited to, diseases affecting the vascular, gastrointestinal, hepatobiliary, genitourinary, pulmonary, musculoskeletal, and central nervous systems. The IR section is particularly valuable in collaborating with other medical and surgical specialties to support our sickest patients, be it providing minimally-invasive procedures to alleviate difficult to treat infections, helping to guide our colleagues through complex anatomy, or providing a crucial diagnosis in order to guide future treatment. The IR team receives full support from nursing as well as sedation and anesthesia services to deliver care to our patients with the least amount of discomfort.

EDUCATION

Education is a major component of the activities of the Division of Pediatric Radiology.

Radiology residents from Hartford Hospital, University of Connecticut (UConn), and St. Vincent’s Hospital Bridgeport receive pediatric radiology training in our department. We host elective rotations for UConn pediatric residents, pediatric subspecialty fellows, and medical students. Additionally, the department engages in the education of sonography and radiography technology students. Didactic lectures and case presentations provide teaching to our residents, medical students and radiology staff. We actively participate in clinical care and teaching conferences in collaboration with the other divisions throughout the hospital. Through these activities, the Division of Radiology seeks to deliver optimized, patient- and familycentered care to the children we serve

PROFESSIONAL RECOGNITION

Douglas Moote, MD, is on the Connecticut Children’s Medical Staff Executive Committee.

Lindsay Griffin, MD, is the Vice chair of the Society of Pediatric Radiology (SPR) MRI committee and a member on the SPR cardiac committee.

Dr. Griffin is a member on the ACR pediatric education committee and participates on the Radiology Society of North America pediatric education exhibit committee

Pamela Ketwaroo, MD, was the recipient of the Radiologist-in-Chief Award, Texas Children’s Hospital, 2023.

PUBLICATIONS

Cepeda De Jesus GN, Al-Ani M, Martillotti J. Intrathymic bronchogenic cyst. ACR Case in Point. Status: Published; November 1, 2023.

Morin CE, Karakas P, Vorona G, Sreedher G, Brian JM, Chavhan GB, Chung T, Griffin LM, Kaplan SL, Moore M, Schenker K, Subramanian S, Aquino M. The Society for Pediatric Radiology Magnetic Resonance Imaging and Emergency and Trauma Imaging Committees’ consensus protocol recommendation for rapid MRI for evaluating suspected appendicitis in children. Pediatr Radiol. 2024 Jan;54(1):12-19. doi: 10.1007/s00247-023-05819-y. Online ahead of print.

Sodhi A, Markl M, Popescu AR, Griffin LM, Robinson JD, Rigsby CK. Highly accelerated compressed sensing 4D flow MRI in congenital and acquired heart disease: comparison of aorta and main pulmonary artery flow parameters with conventional 4D flow MRI in children and young adults. Pediatr Radiol.2023 Dec;53(13):25972607. doi: 10.1007/s00247-023-05788-2. Epub 2023 Oct 26.

Lawson AA, Watanabe K, Griffin L, Laternser C, Markl M, Rigsby CK, Sojka M, Robinson JD, Husain N. Lategadolinium enhancement is common in older pediatric heart transplant recipients and is associated with lower ejection fraction. J Cardiovasc Magn Reson. 2023 Nov 6;25(1):61. doi: 10.1186/s12968-023-00971-8. PMID: 37932797; PMCID: PMC10626738.

Shah R, VanSyckel A, Popescu AR, Rigsby CK, Griffin LM. Guide to use of ferumoxytol for hepatic vascular assessment as part of dual contrast MRI. Pediatr Radiol. 2023 Oct;53(11):2180-2187. doi: 10.1007/s00247023-05737-z. Epub 2023 Aug 21.

Bedoya A, Ketwaroo P, Mehollin-Ray A, Ndibe C, Taylor S. Congenital Chest Lesions and Interventions, Invited MRI Clinics Article, complete and submitting December 2023.

Olutoye OO II, Hammond JD II, Gilley J, Beckman RM, Bulathsinghala M, Keswani SS,Davies J, Mazziotti MV, Donepudi R, Belfort MA, King A, Ketwaroo PM, Lee TC. Fetal malrotation with midgut volvulus: Prenatal diagnosis and planning. J Pediatr Surg Case Rep. 2023 Jun;93:102654. Epub 2023 Apr 28. PMID: 37292252; PMCID: PMC10249907.

Salman R, Huynh TL, More SR, Botelho MPF, Ketwaroo PM, Masand PM, Jadhav SP. Cardiac Computed Tomographic Angiography Evaluation of Right VentriclePulmonary Artery Conduits with Surgical Correlation. Pediatr Cardiol. 2023 Oct;44(7):1566-1572. Epub 2023 Jun 16. PMID: 37326858.

Salman R, More SR, Ferreira Botelho MP, Ketwaroo PM, Masand PM, Molossi S, Jadhav SP. Detection of anomalous aortic origin of a coronary artery (AAOCA) by echocardiogram: When does computed tomographic angiography add value? Clin Imaging. 2023 Mar;95:7479. Epub 2023 Jan 13. PMID: 36657378.

Salman R, More SR, Ferreira Botelho MP, Ketwaroo PM, Masand PM, Jadhav SP. Evaluation of paediatric pulmonary vein stenosis by cardiac CT angiography: a comparative study with transthoracic echocardiography and catheter angiogram. Clin Radiol. 2023 Oct;78(10):e718-e723. Epub 2023 Jun 20. PMID: 37394393.

Sanz Cortes M, Tidwell E, Doughty C, Ketwaroo P, Sundgren N, Belfort M. Simulation-based clinical rehearsal in preparation for delivery of conjoined twins.

Ultrasound Obstet Gynecol. 2023 Apr;61(4):533-534. doi: 10.1002/uog.26115. PMID: 36350051.

PRESENTATIONS

Griffin LM. Contrast-Enhanced MRA/MRV: Tips and Tricks. Society for Pediatric Radiology Body MRI course. Virtual 2023.

Griffin LM. Minimizing Artifacts in Patients with Coils, Stents, & Other Metallic Devices. International Society for Magnetic Resonance in Medicine Annual Meeting, Toronto ON Canada 2023.

Griffin LM. Vascular imaging: The wall and the lumen. Society for Pediatric Radiology Annual Meeting, Austin TX 202.

Ketwaroo PM. Texas Radiological Society Fetal Webinar, Invited Speaker and Panelist, October 2023.

Ketwaroo PM. Texas Radiological Society Fetal Webinar, Invited Panelist, June 2023.

Ketwaroo PM. “Perfectionism and the Power of Self Compassion,” Invited talk, Society for Pediatric Radiology Annual Meeting, Austin, TX, May 2023.

Ketwaroo PM. “Eyes, Ears, and Other Facial Abnormalities,” Invited talk, Society for Pediatric Radiology Fetal Imaging Course (virtual), January 2023.

Robinson S, Gonzalez A, Patel P. “A Rare Case of Wandering Spleen Torsion.” Presented at: American Society of Emergency Radiology Annual Conference, San Diego, CA. October 2023.

POSTER

G Baum, S Robinson. “Caught Red Handed: A QuickFire Case Series of Incidental Findings on Bone Age Studies.” Poster displayed at Asian and Oceanic Society for Paediatric Radiology Conference, Sept 2023.

G. Cepeda, G Baum, D Zimmerman, M Tripathi. “Neonatal lingual teratoma: a case report.” Poster presented at American Society of Head & Neck Radiology Conference, Sept 2023.

Patel N, Huber T. “Anticoagulation Management of Hereditary Hemorrhagic Telangiectasia for the Interventional Radiologist.” Global Embolization Oncology Symposium Technologies, New York, NY. May 2023.

Patel A, Peterson S, Hynecek R. Imaging Findings of Cerebral Fat Embolism Syndrome in Sickle Cell Crisis. Oral presentation at American Society of Neuroradiology 61st Annual Meeting, April 2023.

STAFF

Douglas Moote, MD, Division Head Pediatric Radiology, Connecticut Children’s

Shanshan Bao, MD, Clinical Director for Body Magnetic Resonance Imaging

Johanna Chang, MD, Assistant Clinical Director for Body Magnetic Resonance Imaging

Lindsay Griffin, MD, Clinical Director for Computed Tomography Services

Pamela Ketwaroo, MD, Clinical Director for Fetal MRI

Anna Golja, MD, Pediatric Radiology and Pediatric Neuroradiology

Frederick Conard, MD, Body Imaging and Ultrasound

Pallavi Nadendla, MD, Clinical Director for Interventional Radiology

Prasanta Karak, MD, Clinical Director for Nuclear Medicine and Molecular Imaging

Ryan Kaliney, MD, Clinical Director for Musculoskeletal Imaging

Gregory Wrubel, MD, Clinical Director for Neuroradiology Imaging

Robert Hynecek, MD, Clinical Director of Functional Neuroimaging

Steven Lee, MD, Chief of Radiology, Hartford Hospital

David Zimmerman, MD, Clinical Director of Head and Neck Imaging

Martin Ollenschleger, MD, Clinical Director of Neurointerventional Radiology

Michael O’Loughlin, MD, Body Magnetic Resonance Imaging and Safety

Molly Mable, PA-C, RT(R), Fluoroscopy and Interventional Radiology

ACADEMIC AFFAIRS & RESEARCH

VICE PRESIDENT OF ACADEMIC AFFAIRS & RESEARCH LETTER

It is with great pride that we present the 2023 Academic Annual Report showcasing the numerous achievements across our academic and research teams. This report is a true testament to the dedication, hard work, collaboration, and passion of team members to advance Connecticut Children’s mission of improving the health and wellbeing of children through family centered care, research, education and advocacy. Our teams continue to exemplify One Team Culture, as evidenced by our shared successes throughout the

last year. Our contributions in support of the strategies outlined in the Health Compass 2027 helped to ensure a successful first year of our institutional strategic plan.

In the pages that follow I would like to share just a few of our many academic and research accomplishments that made 2023 the ground breaking year it was. In May, the Scientific Advisory Committee of the Connecticut Children’s Research Institute (SACCRI) participated in a retreat that led to the organization of research across the institution into five Scientific Centers. In November, we held the CCRI’s third annual Research Symposium with our largest turnout to date and a tremendous increase in abstract submissions from our faculty and trainees. We welcomed Carolyn Macica, PhD, who hit the ground running in her promoted role to Director of Research Operations and Development. We increased our presence at the Pediatric Academic Societies meeting in Washington, DC, with our new and improved exhibition booth which garnered an incredible amount of national interest from attendees. After an almost four year hiatus, we’re excited to re-boot our Center for Innovation by formalizing an application and review process that includes a planning committee and advisory and executive councils to ensure the advancement of the intellectual property of our talented faculty, and the development of new partnerships with promising external ventures. Our CME program maintains accreditation through the Accreditation Council for Continuing Medical Education. We welcomed 53 new faculty members to the Departments of Pediatrics and Surgery and celebrated seven new faculty academic promotions and seven new appointments. Throughout the annual report many more achievements are described, too numerous to list here.

I am sincerely grateful to be surrounded by an incredible team of dedicated and talented leaders and colleagues in academic affairs and research. A special thank you to the following team members for always going above and beyond in your efforts to transform children’s

health and wellbeing: Markus Bookland, MD, Ali Borgert, MRA, MBA, CRA, Neal Breen, MBA, Michael Brimacombe, PhD, Stacy Chandna, MS, CIP, Danielle Chenard, MPH, Marianne Custer, BS, C-TAGME, Kim Davey, MBA, James Hansberger, PhD, Kathy Herbst, MS, Jessica Hollenbach, PhD, James Gallagher, JD, Dana Jungbauer, MD, Garry Lapidus, PA-C, MPH, Esperanza Lesmes, Carolyn Macica, PhD, Hendriana Nielsen, RD, RN, Tokuji Okamoto, BA, Alison Oville, CCRC, CHRC, Justin Radolf, MD, Senior Scientific Advisor, James Santanelli, MS, MPH, Julie Vigil, MS, MPH, FACHE, CHC, CHRC, William Zempsky, MD, and Carrie Zevetchin, MS. I am continually energized and inspired to work alongside this talented group and I’m grateful to have the opportunity to serve under the steadfast leadership of Surgeon-in-Chief Christine Finck, MD, FACS, and Chair, Department of Pediatrics and Physician-in-Chief Juan C. Salazar, MD, MPH.

2023 proved to be a historic year for Connecticut Children’s with the groundbreaking for construction of the new tower. The tremendous growth seen across the organization is a reflection of the diligence and commitment of our teams. It is with optimism and excitement that we look to the future and continue our tradition of excellence in training the next generation of pediatric healthcare providers.

Annamarie Beaulieu, MPH, MBA Vice President, Academic Affairs, Connecticut Children’s Research Institute

ACADEMIC ADMINISTRATION

The Department of Pediatrics has a very strong presence and administrative support on both the University of Connecticut Health Center (UConn Health) and Connecticut Children’s campuses. With faculty based at multiple institutions, administration of the Department of Pediatrics is comprised of centrally managed academic functions for affiliated faculty, and decentralized business and research management functions for all faculty.

ACADEMIC ADMINISTRATION

The Academic Administration team manages academic appointments, reappointments and promotions; coordinates the academic merit plan for affiliated faculty, academic faculty contracts; and in collaboration with the Vice President for Academic Affairs and the Marketing & Communications Department at Connecticut Children’s produces the Departments of Pediatrics and Surgical Subspecialties Annual Report and the Faculty Resource Guide.

The Pediatric academic staff based at UConn Health serves as the key support and logistical link between the decentralized offices within other institutions/ departments, and UConn Health’s administrative and financial offices. Research and other faculty activity is administered by office staff where the faculty members are based, such as the Office for Sponsored Programs, and the Department of Research at Connecticut Children’s.

Julie Vigil, MS, MPH, Administrative Director of the Department of Pediatrics and her team at UConn Health manage the academic budgets, including inresidence faculty, tenured faculty support, components of the residency budget, discretionary accounts, and the UConn Health-based sponsored programs. The administrative team at UConn Health consists of Administrative Officer, Laurie Papacs, MA, MBA and Administrative Program Assistant 2, Satophia Brown.

FACULTY APPOINTMENTS

New Faculty Members

Anesthesia: Michael Archambault, MD, Cheryl Bline, MD, Christina Biello, MD, Amy Bouchard, MD, Edward Cortland, MD, Mark Fachin, MD, John Garrison, MD, Thomas Golembeski, MD, Mark Indelicato, MD, Peter Lam, MD, Emma LeWinter, MD, Anil Mathew, MD, Eapen Mathew, MD, Johanna Rothstein, MD, Gregorio Rutkowski, MD; Cardiology: Irfan Warsy, MD; Developmental and Behavioral Pediatrics: Elizabeth Janofsky, MD; Digestive Diseases, Hepatology and Nutrition: Panamdeep Kaur, MD, Sunpreet Kaur, MD; Emergency Medicine: Candice Jersey, DO, Andrew Heggland, MD; Hospital Medicine: Daniel Ebbs, MD, Anila Krovvidi, MD, Danice Kuruvilla, MD, Maria Ramirez Tovar, MD, Catherine Sullivan, MD; Neonatology: DonnaMaria Cortezzo, MD, Saneh Hala, MD, Amy Patel, MD, Jeffrey Shenberger, MD, Amanda Smith, DO, Poonam Thakore, MD; Nephrology: Leonela Villegas, MD; Neurology: Krista Grande, MD; Pain and Palliative Medicine: Shannon Michel Wynn, MD, Aglio Taylor, MD; PICU: Mark Dexter, MD, Andrea Guardenier, MD, Monika Gupta, Debra Hillier, MD, Sholeen Nett, MD; Plastic Surgery: Charles Castiglione, MD; Psychology: Danielle Gutman-Lapin, PhD, Kelly T. Weber, PsyD; Psychiatry: Christin McDermot, MD, Lynn Mangini, MD, Lisa Namerow, MD, Mariela Podolski, MD, Robert Stine, MD; Pulmonary Medicine: David de Angel Sola, Corey Wynn, MD; Urology: Daniel Herz; Weight Management: Robert Rosenberg, MD.

Community-based Faculty

Sherry Banack, MD, Carla Bystricky, MD, Gabriela Izzo, MD, Christopher Lawrence, MD, Ruth Loomis, MD, Christopher Schuck, MD, Persis Thomas, MD, Jennifer Young, MD, Manuel Orta, MD, from the Clinical Longitudinal Immersion in the Community (CLIC), UConn Health. Also, Harem Park, MD; Krista Matsen, MD from the UConn Storrs Student Health and Wellness program. Our 2023-24 chief residents, Samuel Crooks, MD, Kayla Gonzalez, MD, and Harley Markel, MD were granted faculty appointments in the Department of Pediatrics.

Appointment Track Transfers

• From Affiliated to Community-based

Owen Kahn, MD, Harem Park, MD, Joseph Vitterito, MD: Assistant Professor to Assistant Clinical Professor

• From Community-based to Affiliated

Robert Stine, MD, Assistant Clinical to Affiliated Assistant Professor

Joint Appointments

Michael Archambault, MD, Cheryl Bline, MD, Christina Biello, MD, Amy Bouchard, MD, Edward Cortland, MD, Mark Fachin, MD, John Garrison, MD, Thomas Golembeski, MD, Mark Indelicato, MD, Peter Lam, MD, Emma L. LeWinter, MD, Anil Mathew, MD, Eapen Mathew, MD, Johanna Rothstein, MD, Gregorio Rutkowski, MD.

PROMOTIONS

Melissa Held, MD, James Hagadorn, promoted to Professor of Pediatrics. Nicole Murray, MD, promoted to Professor of Surgery. Alyssa Bennett, MD, Mariann Kelley, MD, Dennis Mello, MD, and Catherine Sullivan, MD, were promoted to Associate Professor.

Ian Michelow, MD, and Timothy Crombleholme, MD, appointed as Professor of Pediatrics. Allison Cowl, MD, Adam Czynski, MD, Stewart Mackie, MD, Shikha Sarkar, MD, Haviva Veler, MD, were appointed as Associate Professor of Pediatrics.

STAFF

Annamarie Beaulieu, MPH, MBA

Vice President, Academic Affairs, Connecticut Children’s Research Institute

Tokuji Okamoto, BA Administrative Assistant IV

Esperanza Lesmes

Senior Program Manager, Academic Administration, Connecticut Children’s

Julie Vigil (through November 2023)

Administrative Director, Department of Pediatrics, UConn Health

Laurie Papacs

Administrative Officer, Department of Pediatrics, UConn Health

MEDICAL EDUCATION

The Office of Medical Education at Connecticut Children’s is inclusive of Undergraduate (UME), Graduate (GME), and Continuing Medical Education (CME). The office celebrated many successes in 2023 as outlined in each of the respective areas and continuously provides dedicated support and guidance to the institution on all matters relating to medical education.

In academic year 2023, our office partnered with 67+ sponsoring programs and facilitated the registration, onboarding and scheduling for 588 medical students, 442 residents, and 72 fellows. We provided 105,019 CME credits reaching 745 physician and 502 nonphysician learners.

The Edwin Zalneraitis Teaching Academy was launched to bring together promising and passionate educators, promote their pursuit of excellence in scholarship & education, and build a home for committed educators. Through a partnership with the Mayo Clinic College of Medicine & Science, our educators benefit from cuttingedge resources.

Alexxus Hall accepted the Administrative Assistant II role with the Office of Medical Education starting Aug. 28, 2023. Alexxus’ former role as Resident Team Assistant with our team has provided her with a broad understanding of our medical education needs and a strong foundation for her new role.

STAFF

Andrea Orsey, MD, MSCE, MS-HPEd Associate Chair for Education

Edwin Zalneraitis, MD

Advisor to the Chair

Marianne Custer, BS, C-TAGME

Administrative Director Medical Education

Alexxus Hall, BS Administrative Assistant II

Thalia Flores

Medical Education Registration Coordinator (through September 17, 2023)

CONTINUING MEDICAL EDUCATION (CME)

The office of Continuing Medical Education (CME) at Connecticut Children’s made great strides in 2023. The office had a year of positive change and process clarity to ultimately affect learner knowledge and improve patient care. Building upon an already strong portfolio, the office introduced several new symposiums over the last year.

The Connecticut Children’s Pediatric Health Symposium took place on February 2, 2023 and was a full day, virtual conference highlighting Connecticut Children’s pediatric specialists speaking on interdisciplinary topics to improve patient care. The symposium attracted 162 participants in its first year. A highlight of 2023 was certainly our first Pediatric Women Relate (PoWER) Symposium, on November 30, 2023. 30 attendees were able to discuss gender bias in the workplace and how to implement strategies to eradicate sexism from the culture of medicine, over a delicious dinner. Lastly, our office hosted the first in-person community town hall dinner at the Pond House Café since the beginning of COVID-19. 54 community pediatricians joined us for dinner and an evening of conversation surrounding Mental and Behavioral health topics from three of our leading Connecticut Children’s specialists in the field. The symposium had rave reviews and we look forward to hosting a spring session with our partners in the western part of the state in 2024.

Our office made impactful and thoughtful enhancements to two of our new series in 2023. Our office expanded the popular “Ask the Experts”, formerly a solo series with Dr. John Schreiber, to include experts in areas of pediatric medicine and behavioral and mental health, who provide clinically relevant updates on the third Friday of every month. Our on-demand Pediatric Podcast Pearls series, where a faculty member records a podcast of clinically important information, recommendations, and/or guidelines, increased in duration by 10 minutes, in order to offer .50 CME credits, and introduce an interview style format. Our CME Medical director, Kenneth Spiegelman, MD, engaged in an interview style format with our specialists, in which we received great feedback.

The office achieved the goal of 50,000 podcast downloads to-date across Pediatric Grand Rounds, Ask the Experts: Practical Updates in Pediatric Care, and Pediatric Podcast Pearls. Our Pediatric Grand Rounds podcast has reached 28 countries to-date, and our office is proud to be able to share the great knowledge and work with the community near and far.

Compliance was at the forefront of our efforts over the past year. Our office worked diligently to update the speaker disclosure form and conflict of interest mitigation process per our governing body, ACCME, to ensure all education is free of commercial bias. Our office focused on auditing our educational activities based on quality instead of quantity, to provide the highest quality of education to our learners.

The marketing and promotion of our CME offerings was an important focus in 2023. We established a partnership with the Hezekiah Beardsley Connecticut chapter of the American Academy of Pediatrics (AAP), in order to promote our upcoming symposiums on their website events calendar, to reach out and engage with more learners across the state.

The Connecticut Children’s Office of CME is proud to be a part of the world of medical education. At Connecticut Children’s, we continue to improve and build upon what we have already accomplished and created, using innovation and thoughtfulness to provide clinically relevant education in hopes to improve the care for children and families in our community and beyond.

STAFF

Vivian Bronson

Continuing Medical Education Program Coordinator I

Nicole Capsolas

Continuing Medical Education Program Coordinator III (through August 4, 2023)

Katherine Joy

Continuing Medical Education Program Coordinator III

GRADUATE MEDICAL EDUCATION

In 2023, the Graduate Medical Education program directors and program coordinators effectively managed our accredited pediatric residency program in addition to 12 pediatric and surgical subspecialty fellowship programs (11 accredited and one non-accredited), and supported 63 pediatric residents and 24 fellows. All GME programs successfully achieved continued accreditation through 2024.

The coordinator team demonstrated ingenuity and innovation by continuously updating the recruitment processes to align with national trends and provide a unique recruitment experience to applicants. Through frequent updates of the websites and content, they have increased the marketability of programs across the continuum of graduate medical education and effectively conducted 346 residency applicant interviews across 32 days and 199 fellowship applicant interviews across 61 days. The pediatric residency program successfully filled 20 of 20 available residency positions and graduated 20 residents. The pediatric fellowship programs successfully filled six of nine available fellowship positions and graduated nine fellows.

The continued success of our residency and fellowship programs would not be possible without the efforts and commitment of our incredible program leadership and administration team.

Amanda Ross, BS, C-TAGME was appointed the new Graduate Medical Education (GME) Manager in March 2023. Amanda joined the medical education team as a fellowship program coordinator in 2016 and has dedicated her career to improving both the training experience for her fellows as well as the working environment for her fellow coordinators. In 2020, Amanda was promoted to senior program coordinator where she has continued to serve as an integral member for our team of both fellowship and residency program coordinators at Connecticut Children’s. Amanda completed additional leadership

training through the APPD Leadership Empowerment for Advancing Pediatric Education Specialists (LEAPES) program and was appointed as one of only 12 positions nationally, to serve on the Accreditation Council for Graduate Medical Education (ACGME) Coordinator Advisory Group from 2022-2025.

Vivian Bronson assumed a new joint role as a Pediatric Fellowship Program Coordinator I in April 2023 while continuing to provide exemplary support to the Office of CME in a limited capacity.

Thalia Flores joined as the Pediatric Residency Program Coordinator I in September 2023. Thalia excelled as the medical education central registrar over the last year and was instrumental in organizing the onboarding and registration processes for the department.

Crista Aresti joined the Pediatric Residency Program in November 2023 as a Pediatric Residency Program Coordinator II. Crista joined with more than years of program coordination experience with the Middlesex Health IM Residency Program and more than years of medical administrative experience prior to that.

PEDIATRIC RESIDENCY

The Pediatric Residency Program continued with its uninterrupted record of full, continuing accreditation, with no citations from the Pediatric Review Committee of the Accreditation Council for Graduate Medical Education (ACGME). This represents one of the strongest records of accreditation standing in the nation.

The program had an extremely successful recruitment adding 20 high-quality new interns to the program and two excellent additions to the second year resident class. Graduates were, once again, placed in competitive fellowship programs and outstanding pediatric practices both in Connecticut and across the country. The program continues to have a strong three year pass rate above the national mean at 84% with the national average being 83%. ACGME program surveys

of faculty were notably positive. ACGME survey of residents identified opportunities for improvement which prompted the development of a special Connecticut Children’s Task Force led by Andrea Orsey, MD, MSCE, MS-HPEd. The task force and program leadership have worked tirelessly to address these identified challenges with meaningful changes to ensure balance between service and education to optimize resident education. Changes have already been implemented in the educational curriculum and rotation experiences such as non-resident support for boarder coverage, more computer availability, and a weekly academic half-day for residents on outpatient rotations. The program has implemented weekday caps on the inpatient floor as a measure for this and anticipate implementing weekend caps by the start of the next academic year.

The program has continued its efforts in preparing residents for the boards and in ensuring structured learning. The program has taken a multi-prong approach to improve this over the past academic year including giving all residents a subscription to a board preparation question database called NEJM Knowledge plus, incorporating these board questions into all rotations, modifying the didactic lecture series to include areas covered on the American Board of Pediatrics (ABP) content specifications with a focus on those low performing areas on the ITE for our trainees, and adding more interactive case based education in general pediatrics including adopting the Yale Curriculum and a new outpatient case based series. The program has worked with nursing as well to create a RN-resident committee to identify and solve barriers for residents having protected time during our lecture periods.

The GME Diversity, Equity and Inclusion Committee continues its work with residents, fellows, faculty, team members, and the larger community. This committee is led by Sharon Smith, MD, and Rob Keder, MD. In February 2023, residents, faculty and guests from Connecticut Children’s participated in a Professionalism Workshop on developing skills to address implicit bias in the health-care environment. Dr. Keder and Sherene Mason, MD, ran this multidisciplinary workshop for all of the UConn residency programs. Pediatric residents

have partnered with undergraduate and medical student organizations such as the Latino Medical Student Association (LMSA) and Student National Medical Association (SNMA), and attended both local and national conferences. Residents also celebrated Black History and Hispanic Heritage months. Residents have a presence as part of Connecticut Children’s at the Hartford Pride. Drs. Smith, Keder and Kayla Gonzalez, MD, are active members of the UConn Graduate Medical Education (GME) Diversity Oversight Committee. They participated in review of all residency programs’ Annual Program Evaluation related to DEI efforts and made recommendations.

Specific aims for the program have been implemented and are reviewed annually for the accreditation process and to allow alignment with the Department of Pediatrics strategic plan:

Through flexibility and individualization, the Pediatric Residency Program prepares residents for success in any of the career possibilities in Pediatrics. The University of Connecticut Pediatric Residency Program strives to provide the broadest possible spectrum of core and discretionary activities and allows its residents to take advantage of any opportunities they might choose. The graduates’ career choices historically have reflected this intent, and it is the aim of the program to sustain its “pluripotential” educational experience as the

landscape of Pediatrics evolves.

The Pediatric Residency Program offers a resident learning environment that promotes wellness and reduces burnout to sustain wellness and meaning in residents’ professional and personal lives throughout their careers. We continue our commitment to promoting diversity, equity, inclusion and social justice to this aim. The Pediatric Residency Program embrace the challenge of creating a learning environment that promotes wellness through proper self-care, connectedness, and meaning in work that includes progress in establishing diversity, equity, inclusiveness and justice for our learning community. Residents and faculty are learning to maintain their health and wellbeing despite all that challenges them, and to renew themselves in the face of the challenges brought on by their profession. They learn to bring meaning to their professional and personal lives through thoughtful and innovative changes in the conduct of their activities.

The graduates from the Pediatric Residency Program are able to advocate effectively for their patients and families, and for the populations they serve during their residency experience and throughout their careers. Engagement in community advocacy through the core community longitudinal experience prepares pediatric residents to reach beyond the provision of care to address social determinants of health for their individual

patients and families and for the populations they serve as a whole. The program’s Resident Advocacy and Community Health (REACH) pathway further educates those whose career focus is advocacy at the highest possible level of community and child health.

Graduates of the program acquire advanced skills and ability in quality improvement and safety activities. The Pediatric Residency Program develops and promotes a strong resident commitment to reduce error and harm, and to promote the highest quality of care possible. Residents demonstrate the acquisition of knowledge in these areas as reflected on their standard examinations, but more importantly, they actively identify safety opportunities and participate in addressing them.

Scholarly Accomplishments

Residents who presented abstracts at regional, national and international meetings included Lauren Weaver, MD, Nancy Presnick, DO, Emily Jonker, DO, Elizabeth Flerlage, DO, Timothy Phamduy, DO, Sidney Stewart, DO, Suzannah Swan, MD, Hayley Talboy, DO, MS, Mathew Cummins, MD, Jessica Serventi-Gleeson, MD, MPH, Nickolas Mancini, MD, Marissa Rodenstein, MD, and Courtney Stark, DO.

Chief Residents Post-Graduate

Nancy Presnick, DO Academic Primary Care

Emily Jonker, DO Emergency Medicine Fellowship

Lauren Weaver, MD Private Practice

PL-3 Graduated 2023

Sobia Aamir, MB, BS Primary Care

Christie Devoe, DO Primary Care

Elizabeth Flerlage, DO Cardiology Fellowship

Devon Godek, DO Pediatric Emergency Medicine

Kayla Gonzalez, MD Chief Resident

Amanda Guzikowski, DO Primary Care

Trenten Lancaster, MD Primary Care/Hospitalist

Brook Martell, DO Pediatric Emergency Medicine Fellowship

Khushboo Modi, MB, BS Primary Care

Maria Teresa Peralta, MD Hematology/Oncology Fellowship

Timothy Phamduy, DO Pediatric Emergency Medicine

Geoffrey Ryan, DO Primary Care

Amanda Smith, DO Newborn Nursery Attending

Kelly Smith, MD Pediatric Endocrinology Fellowship

Sidney Stewart, DO Neonatal Intensive Care

Suzannah Swan, MD Urgent Care

Hayley Talboy, DO, MS Pediatric Cardiology

Elyssa Wiegand, MD Primary Care/Urgent Care

Rawah Zeiad, MD Pediatric Endocrinology

Chief Residents Cont.

PL-2

Neveen Al-Said, DO

Kaitlyn Anderson, MD

Adriana, Bodlak, MD

Sarah Burley, DO

Lauren Costigan, MD

Matthew Cummins, MD

Lindzey Faust, DO

Sravya Gourishetti, DO

Einar Helgason, MD

Omar Ibarra Aleman, DO

Jordan Johnstone, DO

Megan Kabara, DO

Andrea Lizarazo, DO

Eugenia Loverde, MD

Christina Mallery, DO

Nickolas Mancini, MD

Lindsay, Oliver DO

Marissa Rodenstein, MD

Grace Schwantes, MD

Sydney Sherman, DO

Susan Washburn, MD

STAFF

Stewart Mackie, MD Program Director

Eric Hoppa, DO Associate Program Director

Jonah Mandell, MD Associate Program Director

Christine Skurkis, MD Associate Program Director

Sharon R. Smith, MD Associate Program Director

Amanda Ross, BS, C-TAGME

Graduate Medical Education (GME) Manager

PL-1

Kriti Badola, DO

Rebecca Basch, DO

Nicholas Bhaskaran, DO, MBS

Melanie Byra, DO

Timothy Counce Jr., DO, MPH, MS

Elisabeth Ekman, DO

Antoinette Farrell, MD

Annina Giannuzzi, DO

Shanze Gilani, DO

Paolyne Meza, DO

Genesis Michel, DO, MS

Katherine Murphy, MD

Risa Park, DO

Haya Qutob, DO, MS

Jessica Serventi-Gleeson, MD, MPH

Amanpreet Singh, MD

Frederique Sirois, DO

Courtney Stark, DO

Jenna Sugar, DO

McKenna Tierney, DO

Crista Aresti

Residency Program Coordinator II

Thalia Flores

Residency Program Coordinator I

Zuleyka Bonilla

Resident Team Assistant I

Osarieme Oni, MPH

Resident Team Assistant I

Cameron Welch

Resident Team Assistant I

Alexxus Hall, BS (through August 27th, 2023)

Resident Team Associate

PEDIATRIC SURGICAL AND SUBSPECIALTY FELLOWSHIP PROGRAMS

The University of Connecticut School of Medicinesponsored 11 accredited pediatric surgical and subspecialty fellowship programs and one nonaccredited pediatric surgical research fellowship at Connecticut Children’s. These programs continue to graduate exceptionally trained specialty physicians who enter practice throughout the country. Our fellows continue to make strides in the medical education community by being awarded multiple travel grants and awards to attend national and international meetings. Their perseverance and commitment to excellence are highlighted throughout their work and contributions to the educational learning environment.

PEDIATRIC CARDIOLOGY

The Pediatric Cardiology Fellowship Program, led by Alex Golden, MD, MMM, is entering its 2nd year as an accredited program.

PEDIATRIC EMERGENCY MEDICINE

Led by Matt Laurich, MD, the Pediatric Emergency MLed by Matt Laurich, MD, the Pediatric Emergency Medicine Fellowship is in its 23nd year. The fellowship has six fellows and two tracks: a three-year fellowship for graduates of Pediatric residencies, and a two-year track for graduates of Emergency Medicine residencies.

Kathryn Schissler, DO, graduated from the fellowship in June of 2023. As a fellow at UCONN/Connecticut Children’s, Dr. Schissler served as the representative for the American Academy of Pediatrics on the Federal Emergency Management Agency’s working group on EMS and ambulance assets, as well as a Prehospital Domain Fellow at the Emergency Medical Services for Children’s Innovation and Improvement Center. She was involved in multiple research projects which resulted in several publications (see below). She was active in Quality Improvement developing multiple ED protocols.

Upon graduation, Dr. Schissler began a fellowship in Emergency Medical Services at Brown University School of Medicine Department of Emergency

Medicine, and will be working as an attending in the Pediatric Emergency Department at Hasbro Children’s Hospital in Providence, RI.

Shaheen Andreas, DO, graduated from the fellowship in June of 2023. As a fellow, Dr. Andreas led multiple quality improvement and clinical research projects. In 2023, she presented her research at the Pediatric Academic Society-Pediatric Readiness Showcase, Pediatric Academic Society Annual Meeting, and Eastern Society for Pediatric Research, and the International Meeting on Simulation in Healthcare.

Upon graduation, Dr. Andreas accepted a position with Boston Children’s Hospital and will work as attending within the Pediatric Emergency Departments at their South Shore Hospital and Boston locations. She will be an Instructor in Pediatrics and Emergency Medicine at Harvard School of Medicine.

Edgar Flores, MD, is currently a third-year fellow. In 2023, he presented his research on the Utility of Urinalysis in the Evaluation of Pediatric Males

Presenting with Acute Scrotal Pain at the Eastern Society of Pediatric Research and Pediatric Academic Society Annual Meetings.

Susana Collazo, MD, is currently a third-year fellow. In 2023, she presented her research on Pediatric opioid poisonings in Connecticut and changes in pediatric toxic ingestions during the COVID-19 pandemic at the Eastern Society of Pediatric Research and Pediatric Academic Society Annual Meetings.

Kathleen Felisca, MD, and Meghan Wilson Frost, MD, are our second-year fellows.

The fellowship program welcomed two excellent new arrivals in July 2023. Prior to joining us, Emily Colpas, DO, completed her Pediatric Residency and Chief Residency at UConn/ Connecticut Children’s. Sarah McHugh, MD, completed her Emergency Medicine residency training at Baystate Medical Center/UMass Chan Medical School, where she served as one of her program’s Chief Residents.

On Match Day, November 29, 2023, we successfully matched with two of our top fellowship candidates who will be joining us in July 2024. Alexandra Clement, MD, is currently completing her Pediatric Residency at Children’s Hospital at Montefiore after having graduated from the University Of Connecticut School Of Medicine. Nicholas Davis, DO, is currently completing his Emergency Medicine Residency at SUNY Upstate in Syracuse, NY.

FELLOW PUBLICATIONS

Schissler K, Stewart S, Phamduy T, et al. High-Risk Markers and Infection Rates in Febrile Infants aged 29-60 days presenting to an Emergency Department during the COVID-19 Pandemic. Pediatric Emergency Care. 2023 May. PMID: 37205837.

Cohen N, Schissler K, Stathas A, et al. Change in Pediatric Adenotonsillectomy Postoperative Visit Patterns After Opioid Food and Drug Administration

Warning. Pediatric Emergency Care. 2023 Mar. PMID: 36972489.

Schissler K, Gonzalez K, Chicaiza H. Identification of Papilledema in Pediatric Patients with Meningitis using Ocular Point of Care Ultrasound. Pediatric Emergency Care. 2023 Feb. PMID: 36811554

FELLOWS

Edgar Flores, MD

Susana Collazo, MD

Kathleen Felisca, MD

Meghan Wilson Frost, MD

Emily Colpas, DO

Sarah McHugh, MD

PEDIATRIC ENDOCRINOLOGY

Led by Sunitha Sura, MD, and Associate Program Director Christine Trapp, MD, the Pediatric Endocrinology Fellowship is now in its 26th year. We were successful in recruiting excellent fellows who are engaged in meaningful research experiences mentored by well-published, National Institutes of Health (NIH)-

funded investigators in basic and translational research. Their research has culminated in publication in peerreviewed journals and invitations to national meetings to present their work. We continue to place fellows in academic positions upon graduation. Graduates of our fellowship program had a 100 percent pass rate on first attempt taking the pediatric endocrinology boards.

Ana Menendez, MD, successfully graduated from the fellowship program in August 2023 and was recruited as faculty member in our division. Her research interest is in studying adipocyte physiology in morbidly obese patients undergoing bariatric surgery under the mentorship of Christine Finck, MD, FACS. She authored a review article “Obesity and Adipose Tissue Dysfunction: From Pediatrics to Adults” published in Genes, October 2022.

She presented her research work at the Pediatric Endocrine Society (PES) in May 2023 in addition to two presidential poster presentations. One on the modified McGill Thyroid nodule score in assessing the risk of pediatric thyroid cancer and a second one on showing significant BMI z-score improvement in a rare patient with hyperphagia and genetic obesity from BDNF mutation treated with topiramate and lisdexamfetamine.

Dr. Menendez will continue her research work as a faculty member with Dr. Finck. She was accepted into the Diversity, Equity and Inclusion leadership track at UConn Health.

Caroline Figgie, MD, is a second year fellow who joined us in July 2022. She completed her pediatric residency at Case Western Reserve University School of Medicine/Rainbow Babies in Cleveland, OH. She is pursing clinical research under the mentorship of Cem Demirci, MD, Christine Trapp, MD, and Rebecca Puhl, PhD. Her research focus has been on studying the prevalence and correlation of weight bias internalization and disordered eating behaviors in children and adolescents with Type 1 diabetes mellitus.

She presented on the management of diabetes insipidus with dilute vasopressin infusion during

chemotherapy hyperhydration at the Pediatric Endocrine Society in May 2023 and at the Connecticut Children’s Research Institute (CCRI) research symposium in November, 2023.

Mofesola Modupe, DO, will be joining us as a first-year fellow in July 2024. She is completing her pediatric residency at the University of Illinois College of Medicine, Peoria, IL.

PUBLICATIONS

Ana Menendez, Heather Wanczyk, Joanne Walker, Beiyan Zhou, Melissa Santos, Christine Finck. Obesity and Adipose Tissue Dysfunction: From Pediatrics to Adults. Genes (Basel). 2022 Oct 15;13(10):1866. doi: 10.3390/genes13101866. PMID: 36292751

FELLOWS

Ana Menendez, MD Caroline Figgie, MD

PEDIATRIC GASTROENTEROLOGY

Led by Bella Zeisler, MD, and associate program director Katherine Baldwin, MD, the fellowship program in Pediatric Gastroenterology is in its 13th year. Our faculty has grown in size over recent years and our practice now includes a number of subspecialties within GI. Our growth in clinical programming has served to expand the clinical and research educational opportunities for our fellows. Our fellowship program is growing in response. In July 2022, we increased to four total fellowship positions (from three). We have continued to succeed in recruiting excellent fellows to our program.

Jeffrey Hyams, MD, an internationally recognized clinician and researcher in inflammatory bowel disease (IBD) and division head of Digestive Diseases, Hepatology, and Nutrition, continues to act as primary research mentor to many of our fellows and graduates. Our fellows also are supported by a number of faculty members with strong backgrounds in research. Our graduates have continued to receive recognition and awards for their research at international and national

meetings and successfully transition into faculty positions or independent practice:

Mariyam Hashmi, MBBS, (2023 graduate) completed additional training in advanced motility procedures under the leadership of Corey Baker, MD. She also completed research projects in motility as well. She presented her poster “The effects of anxiety on pediatric high resolution anorectal manometry and its association with reported constipation symptoms” at the American Neurogastroenterology and Motility Society meeting in 2023; this was also selected for a podium presentation at Connecticut Children’s Research Day in May 2023. She also was awarded a travel grant to the American Neurogastroenterology and Motility Society meeting for 2023 for her work entitled “Functional Dyspepsia: A five year follow up of symptom severity and burden in pediatric patients.” Dr. Hashmi was recruited to the University of Kentucky to develop and lead their Neurogastroenterology and Motility program and recently performed the first anorectal manometry on a pediatric patient in the history of the state!

Jing Marrero, MD, our current third year fellow has made excellent progress on two research projects under the mentorship of Dr. Hyams. Her primary project is an educational project for school nurses around the care of IBD patients. Her secondary project is examining Dupilumab in the use of eosinophilic esophagitis. She has been recruited to stay on as Faculty next year and we are thrilled!

Viven Solomon, DO, our current second year fellow has begun on her primary research project investigating Fibroscan results in inflammatory bowel disease patients maintained on Methotrexate under the direction of Dr. Hyams and Karan Emerick, MD. She and her cofellow Sydney Kuzoian, DO, have also been working on a retrospective review of our patients transitioned from Infliximab to Inflectra (a Remicade biosimilar).

Sydney Kuzoian, DO, our other current second year fellow, has begun her primary research project on investigating and then intervening on fatigue and sleep habits in our patients with inflammatory bowel disease

under the direction of Dr. Hyams. She is also working with Dr. Solomon as above on a retrospective review of our patients transitioned from infliximab to a biosimilar. Lastly, she has demonstrated a strong interest and aptitude in procedures so is currently also obtaining additional training in advanced motility procedures such as ESMO and ARM under the direction of Dr. Baker.

Pyae Naing, MD, our first-year fellow, joined the program in July 2023 after completing her pediatric residency at The Herman & Walter Samuelson Children’s Hospital/ Pediatric Residency Program in Baltimore, MD in June 2023. She completed her medical education at University of Debrecen Medical School and Health Science Centre in Hungary. She will launch her first research project in June 2024.

The Pediatric Gastroenterology Fellowship will welcome Giselle Davila Bernardy, MD, in July 2024. Dr. Davila Bernardy graduated from the University of Medicine and Health Sciences in St. Kitts and Nevis and is currently completing her Residency at Centro Medico Episcopal San Lucas Pediatric Residency Program in Ponce, PR.

RECENT FELLOW PUBLICATIONS

Dailey J, Kozhaya L, Dogan M, Hopkins D, Lapin B, Herbst K, Brimacombe M, Grandonico K, Karabacak F, Schreiber J, Liang BT, Salazar JC, Unutmaz D, Hyams JS. Antibody Responses to SARS-CoV-2 after Infection or Vaccination in Children and Young Adults With Inflammatory Bowel Disease. Inflamm Bowel Dis. 2022 Jul 1;28(7):1019-1026.

Lepus CA, Samela K, Mokha JS. Efficacy and safety of intravenous iron sucrose in children younger than 2 years with intestinal failure. Nutr Clin Pract. 2022 Nov 28.

Lepus CA, Moote DJ, Bao S, Mosha MH, Hyams JS. Simplified Magnetic Resonance Index of Activity Is Useful for Terminal Ileal but not Colonic Disease in Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr. 2022 May 1;74(5):610-616.

Lepus CA, Moote DJ, Bao S, Mosha MH, Hyams JS. Simplified Magnetic Resonance Index of Activity Is Useful for Terminal Ileal but not Colonic Disease in Pediatric

Crohn Disease. J Pediatr Gastroenterol Nutr. 2022 May 1;74(5):610-616.

Lepus CA, Hyams JS. Barriers from Third-Party Payers to Biologic Use in Pediatric Inflammatory Bowel Disease. JPGN Rep. 2022 Jun 21;3(3):e215.

FELLOWS

Jing Marrero, MPH, MD

Sydney Kuzoian, DO

Viven Solomon, DO

Pyae Naing, MD

PEDIATRIC HEMATOLOGY-ONCOLOGY

The Pediatric Hematology-Oncology Fellowship Program is led by Andrea Orsey, MD, MSCE, MSHPEd, and is entering its seventh year as an accredited program.

Erin Pastor, DO, third-year fellow, is leading a multiinstitutional quality improvement project aimed at diagnosing and evaluating hypertension to develop a standard of care process. She was accepted to the Intermediate Improvement Science Series (I2S2) through Cincinnati Children’s and began the course work in December 2023. Dr. Pastor presented two posters at the May 2023 American Society of Pediatric Hematology Oncology (ASPHO) annual meeting in Fort Worth, TX entitled “A Rare Presentation of Central Nervous System Diffuse Large B-Cell Lymphoma” and “Impact of reported fever on outcomes of febrile neutropenia in children with cancer.” Her poster “Outcomes of Febrile Neutropenic Children with Cancer” also was presented at the June 2023 Annual meeting for Multinational Association of Supportive Care in Cancer (MASCC) in Nara, Japan. Dr. Pastor was awarded in October 2023 the inaugural fellow Reach and Teach award for teamwork and dedication to outstanding medical education!

Shruthishree Sukumar, DO, second-year fellow, presented a poster at the May 2023 ASPHO annual meeting in Fort Worth, TX entitled “Thrombocytopenia in siblings with mercury poisoning”. Under the mentorship

of Joanna Gell, MD, at the Jackson Laboratory for Genomic Medicine, Dr. Sukumar is evaluating the genetic risk factors which increase the propensity to develop cisplatin-inducted ototoxicity/hearing loss.

Paul Tomlinson, DO, first-year fellow, joined the program in July 2023 after completing his pediatric residency program at Connecticut Children’s.

FELLOWS

Erin Pastor, DO

Shruthishree Sukumar, DO

Paul Tomlinson, DO

PEDIATRIC INFECTIOUS DISEASES

Under the direction of Hassan El Chebib, MD, Fellowship Program Director, the division undertook a fellow recruitment effort in 2023 to fill the second of two positions. The program interviewed seven applicants and matched Sarah McCullough, DO. Dr. McCullough is a combined Medicine-Pediatrics fellow. She will be starting with the UConn Department of Medicine infectious diseases fellowship program in July 2024 and will continue her training in the pediatric infectious diseases fellowship program in July 2026 at Connecticut Children’s. Dr. Laura Kvenvold continues her training at Connecticut Children’s as she finishes her combined infectious diseases training and pediatric infectious diseases training program in collaboration with the infectious diseases fellowship program at UConn. She is currently in her 3rd year of training out of a total of 4 years. In addition to her clinical training, Dr. Kvenvold has undertaken the project of antibiotic allergy de-labelling under the guidance of Dr. Jennifer Girotto and Dr. Ian Michelow.

FELLOW

Laura Kvenvold, MD

NEONATAL-PERINATAL MEDICINE

Under the leadership of Program Director Jennifer Trzaski, MD, we successfully recruited two firstyear fellows in 2023: Surabhi Khasgiwala, MBBS,

who joins the program after completing her pediatric residency at the University of Hawaii, and Zohaib Sayyed, MBBS, who completed pediatric residency at the Children’s Hospital of Michigan. Our fellows complement our academic productivity and in 2023, they presented their research at several regional, national, and international meetings on topics including using clonidine for sedation and pain control in premature infants and impact of extracellular vesicles from human pluripotent stem cells on hypoxic lung injury in the preterm mouse model.

FELLOWS

Kinga Zgutka, MD

Allison Sadowski, MD

Jacob Kelner, DO

Nazifa Rahman, MD

Surabhi Khasgiwala, MBBS

Zohaib Sayyed, MBBS

PEDIATRIC PULMONOLOGY

Melanie Sue Collins, MD, the program director, has continued her work with the ACGME Milestones Committee for Pediatric Pulmonology and has expanded to work with the American Board of Pediatrics to help translate the milestones to work with the entrustable professional activities (EPA). The fellowship and the division of pulmonary medicine successfully mentored a URIM resident to participate in the American Thoracic Society program for residents at the National Conference.

In a desire to improve the basic pulmonary fellowship lecture series, the program launched a boot camp series where we recorded and reviewed boot camp lectures and included an information sheet with each with preferred references. This is now posted on blackboard for our fellows/learners to review. The Fellowship Diversity Committee has been active as well continuing the activities of the diversity wall, warm clothing, school supplies drives as well as interdepartmental lectures which this year were focused on Kindness.

PEDIATRIC ORTHOPEDIC SURGERY

The Pediatric Orthopedic Surgery Fellowship, directed by Mark C. Lee, MD, is entering its eighth year of formal ACGME accreditation and has thus far graduated five fellows, three of whom are currently in independent practice. Recent graduates have all contributed peer-reviewed works to orthopedics. Our most recent Fellow, Chong Weng, MD, has submitted a manuscript on the effect of physical therapy on scoliosis bracing compliance.

FELLOW

Chong Weng, MD

PEDIATRIC OTOLARYNGOLOGY

The Pediatric Otolaryngology Fellowship Program, led by Christopher Grindle, MD, is entering its 5th year as an accredited program and this year, welcomed its second fellow, Ruwaa Samarrai, MD, who joined the program in July 2023 after completing her otolaryngology residency at the UConn School of Medicine.

PEDIATRIC SURGERY

Led by Christine Finck, MD, FACS and associate program director Richard Weiss, MD, FACS the Pediatric Surgery Fellowship is now in its 13th year.

Jacob Campbell, DO, MPH, began his fellowship in August 2021 after completing his chief residency at the University of Connecticut Integrated Surgical Residency. Jacob graduated in July 2023 and has stayed on as faculty as of October 2023.

In August of 2023, Danielle Dougherty, MD, began her fellowship after receiving additional subspecialty surgical training at the University of Michigan in Surgical Critical Care and Fetal Medicine.

FELLOWS

Jacob Campbell, DO, MPH Danielle Dougherty, MD

PEDIATRIC SURGERY RESEARCH FELLOWSHIP

This year we welcomed two surgical research fellows, Elizabeth Hughes, MD, and Nicolle Burgwardt, MD. Elizabeth Hughes began her fellowship in July of 2023 joining us from Lehigh Valley Health Network residency. In September of 2023, Dr. Burgwardt joined us after completing her fellowship in Pediatric Surgery Critical Care Fellowship in July of 2023.

FELLOWS

Elizabeth Hughes, MD

Nicolle Burgwardt, MD

STAFF

Amanda Ross, BS, C-TAGME

GME Manager

Vivian Bronson

Fellowship Program Coordinator I

Kierstyn Connors

Fellowship Program Coordinator II

Brittany Valentine

Fellowship Program Coordinator I

Allison Williams

Fellowship Program Coordinator I

UNDERGRADUATE MEDICAL EDUCATION

Connecticut Children’s is the sole clinical teaching site for inpatient pediatric education for the University of Connecticut School of Medicine. Our faculty educate the entire student population of the third-year class during inpatient pediatrics, in addition to offering a unique advanced clinical experience (sub-internship) for fourth year medical students entering pediatrics. We also host and educate students in our outpatient clinical sites and pediatric subspecialty clinics during elective rotations.

The mission of the Division of Undergraduate Medical Education (UME) at Connecticut Children’s is to provide inclusive and engaging experiential and didactic education for the University of Connecticut medical students with teachings centered around the unique medical needs of the child, the importance of a patient- and family-centered approach to care, and a holistic view of the child in relation to their family and community. The goals of the pediatric clerkship, led by Joanne Crowley, MD, MSEd, Clerkship Director, are to engage the third-year medical students in the active multidisciplinary and patient-and family-centered care of pediatric patients across the spectrum, from newborn to early adulthood. This is done through acute inpatient care for common and subspecialty conditions, as well as the care of children with medical complexity.

To accomplish this goal, third-year students spend their inpatient pediatrics clerkship time rotating on the inpatient medical and surgical floors, working with general pediatric and subspecialty teams, coupled with experiential learning in the pediatric emergency department and newborn nursery, and in case-based sessions about clinical topics, interactive casebased sessions on curricular topics, and high-fidelity simulation. Fourth year medical students participate in advanced clinical experiences in the inpatient pediatrics sub-internship, serving as essential providers fully in the role of an intern in preparation for the transition to residency. Pediatric subspecialty electives support a breadth and depth of pediatric-specific medical education for students spanning medical and surgical specialties and different clinical environments.

On a curricular level, Dr. Crowley and the pediatric clerkship leadership team are heavily involved and invested in faculty development and curricular development, currently focusing on several innovative curricular developments focused on feedback and evaluation.

In other exciting news, the UConn School of Medicine is planning an increase in class size, with the goal of enrolling 120 students per year by August 2025. This increase in class size will coincide nicely with the building and opening of our new tower at Connecticut Children’s, which will bring a new patient population we can help serve and bring or return to health. We look forward to collaborating with the School of Medicine (SOM) leadership, Graduate Medical Education (GME) leadership, and site leaders to continue to offer an innovative, enriching, and memorable experience in Pediatrics, as we continue to shape the pediatric experience of more than half of the state’s medical graduates.

STAFF

Joanne Crowley, MD, MSEd

Director, Pediatric Undergraduate Medical Education Clerkship Director, Inpatient Pediatrics, AIE/Sub-I

Jessica MacCormac, DO, MS Clerkship Director, Ambulatory Pediatrics

Emily Hogeland, MD

Assistant Clerkship Director, Inpatient Pediatrics

Eileen Mercurio, MD

Assistant Clerkship Direct, Ambulatory Pediatrics

Andrea Richardson Clerkship Coordinator, Pediatrics

CONNECTICUT CHILDREN’S RESEARCH INSTITUTE (CCRI)

As the research arm of Connecticut Children’s, the Connecticut Children’s Research Institute (CCRI) is the home of our team of scientist-champions who advance the discovery of life-saving treatments that alleviate the suffering of children and youth worldwide. Our physicians, nurses, clinical providers, researchers, and faculty form an ecosystem of innovation that emerged organically from Connecticut Children’s longstanding culture of operational excellence.

Founded in 2021, the CCRI is advancing life-saving, innovative treatment models utilizing the research expertise and clinical experience of our physicians, researchers, and faculty. From inflammation biology, infectious disease and regenerative medicine research to clinical research focused on hematology/oncology, rare diseases and behavioral health studies, the CCRI is home to cutting edge discovery across the research continuum from bench to bedside and in support of population health. Connecticut Children’s researchers are experts in their respective specialties and at the forefront of innovative therapies and healthcare delivery. Through our commitment to high-quality care and scientific research, we provide every child across our region and beyond with an opportunity to grow and thrive.

OUR MISSION & VISION

Across all areas of the CCRI, our daily mission is to utilize discovery, inquiry and curiosity towards achieving excellence in research and clinical breakthroughs for our patients and their families. We never stop imagining the brighter future that is possible for all children thanks to the expertise and dedication of our clinical and research scientists. We value integrity, diversity, and advocacy for pediatric medicine in all that we do.

BASIC & TRANSLATIONAL RESEARCH

Our expertise in basic & translational research promotes the exploration of basic science from the lens of our

clinical expertise to facilitate next-generation treatments for pediatric diseases and disorders.

POPULATION HEALTH & OUTCOMES

Our expertise in population health and outcomes research aims to advance the understanding of population health through research, education, interventions, policy, and community partnerships. With special focus on suicide prevention, asthma management, social determinants of health, and clinical pathways to improve health outcomes, we are a recognized leader of this important work across Connecticut and New England.

CLINICAL RESEARCH

Our focus on clinical research is pursuing breakthrough studies through groundbreaking clinical trials to improve care for infants, children, and adolescents with acute and chronic medical conditions. CCRI supports rigorous clinical trials for rare diseases/endocrinology, gastrointestinal disorders, and hematological/ oncological disorders. Our Fetal Care Center is home to cutting edge research for fetal anomaly diagnostics and surgery.

CENTER FOR INNOVATION

Connecticut Children’s Center for Innovation is dedicated to improving child health beyond imagination. Our pediatric innovation ecosystem includes: 3,000 pediatric team member innovators, entrepreneurs, investors, established companies, legislative officials along with community and corporate partners. Together, we foster, validate and improve care we bring to children. Our partnerships are created to clinically validate and co-develop innovations that improve child health in Connecticut and beyond.

CORE SERVICES & ADMINISTRATION

Connecticut Children’s Research Institute is supported by an incredible team of administrators and research staff through our Clinical Trials Core, Human Research Protection Program (HRPP), Office for Sponsored Programs (OSP), and Research Operations

& Development. Other support programs include our Geographic Information Systems (GIS) Lab, biostatistical and natural language processing cores.

OUR FOUNDATION

Over the past 25 years, Connecticut Children’s has developed fertile groundwork for the CCRI’s current robust research program. In 1996, we joined with The University of Connecticut School of Medicine to form the Department of Pediatrics, which instantly strengthened research and academic relations to help inform and guide clinical decisions for children across the state. Since then, this relationship grew to involve joint faculty, academic sub-specialty rotations, and a multitude of funded collaborations such as Mighty Mice in Space and our most recent U19 award from the NIH to support the development of a vaccine to treat syphilis. In 2016, we pursued a similar institutional relationship with the Jackson Laboratory for Genomic Medicine to hire joint faculty who could focus on translational pediatric research. Connecticut Children’s also forged a new standing within the greater Hartford community, working with collaborators such as the Village, Hartford Public Schools, and the Connecticut Department of Housing. These partnerships, in turn, have yielded substantial external support, such as our $30M Department of Education award in 2021 to expand the Promise Neighborhoods Program to Hartford, and most recently a $14M National Institutes of Health award for CAMEO: Clinical, imaging, and endoscopic outcomes of children newly diagnosed with Crohn’s disease.

CCRI formally unites investigators to discover and evaluate biological mechanisms and agents for the treatment of disease and the improvement of health. Our scientists collaborate across five active scientific centers:

• Cancer and Blood Disorders: Ching Lau, MD, PhD, Director; Michael Isakoff, MD, Co-Director

• Immunobiology, Microbiology and Vaccinology: Justin Radolf, MD, Director; Jeffrey Hyams, MD, Co-Director

• Rare Disease: Emily Germain-Lee, MD, Director; Carolyn Macica, PhD, Co-Director

• Fetal/Neonatal and Regenerative Medicine: Timothy Crombleholme, MD, Director; Joanne Walker, MS, Co-Director

• Child Health Equity and Outcomes Research: Melissa Santos, PhD, Director; Kevin Borrup, DrPHD, JD, Co-Director.

OUR FUTURE IS BRIGHT

CCRI researchers are at the forefront of the future of healthcare. Through our commitment to high-quality care and scientific research, we provide every child with an opportunity to grow and thrive. We understand that excellence in pediatric research is Connecticut Children’s engine of evolutionary edge, and the wellspring for tomorrow’s treatments that astonish, that are “no longer beyond imagination.”

CLINICAL TRIALS

The mission of the Clinical Trials Division is to support Connecticut Children’s Research Institute (CCRI) investigators in advancing pediatric health care by

STAFF

Alison Oville, BA, CCRC, CHRC, Director

Michael Isakoff, MD, Medical Director

Hendriana Nielsen, RD, RN, BSN, CCRP, CPN, Clinical Research Nurse Manager

Robin Arens, BS, CCRP, Lead Clinical Research Associate

James Santanelli, MS, MPH, CCRP, Lead Clinical Research Associate

Julieta Bonvin-Sallago, MS, Lead Clinical Research Associate

Jennifer Querim, BSN, RN, CCRP, Senior Clinical Research Coordinator

conducting innovative life-saving and/or increased quality of life trials that offer equitable access to investigational treatments for patients and families. Our highly skilled, multispecialty team ensures the successful execution of phase I-IV interventional trials and observational studies for neonates, children, and adolescents through 18 years of age.

We provide support for 30 investigators across 12 divisions including outpatient and inpatient trials in Endocrinology, Fetal Medicine, Neurology, NICU, Gastroenterology, and Hematology/Oncology. We continue to maintain our nationally recognized status through the Children’s Oncology Group, allowing us to offer the latest investigational treatments to pediatric cancer patients.

In addition, we provide support for compassionate use protocols for our sickest patients. Compassionate use allows patients/families to access investigational treatments for life- threatening conditions that otherwise would be unavailable to them outside a clinical trial.

We presented on a regional and national level this year, including participating in Quinnipiac’s ninth annual Rare Disease Day Symposium at Frank H. Netter School of Medicine in a roundtable session “Providing Hope: Clinical Trials for Rare Diseases….It Takes a Village.” This provided us an opportunity to showcase the collaboration that occurs between sponsors, investigators, clinical trial team members, and patients and families participating in rare disease trials.

Our Clinical Research Nurse Coordinator team, led by Hendriana Nielsen, RD, RN, BSN, CCRP, CPN, presented at the International Association of Clinical Research Nurses national conference highlighting our development of an Inpatient Start-up Guidance Tool that streamlines the launch of inpatient clinical trials.

We are pleased to announce promotions for the following Clinical Trials Team Members:

• Mark D. Ferreira, BA was promoted from Clinical Research Assistant 2 to Clinical Research Associate I.

Jennifer Twachtman-Bassett, MS, CCC-SLP, CCRP, Research Coordinator, Autism Specialist

Masai McIntosh, BA, Clinical Research Associate II

Dayna Kennedy, MPH, CCRC, Clinical Research Associate II

Mark Ferreira, BA, Clinical Research Associate I

Alexzandrea Buscarello, BS, Clinical Research Assistant II

Bunly Kuoch, Clinical Research Laboratory Coordinator

Lisa Little, Clinical Research Study Start-up Manager

Sean Hanrahan, MPH, Clinical Research Associate I

Sarah Brungard, BSN, RN, Clinical Research Nurse Coordinator I

Eliza Baker, BSN, RN, SCRN, CNRN Clinical Research Nurse Coordinator I

Nicole McCracken, BS, Clinical Research Associate I

Ebone Daire, BS, Clinical Research Assistant II

Natalija Marosz, MA, Clinical Research Associate I

Adam Barselau, MS, Clinical Research Associate I

RESEARCH OPERATIONS & DEVELOPMENT DEPARTMENT

For the Research Operations & Development department, the fiscal year 2023 was marked by the continued growth of our core services and new opportunities in the areas of community service and research dissemination. The department is made up of the director, administrators, and research support staff (Table 1). Historically, we have served our clinical divisions with regulatory support, protocol development, study start-up to study close-out, study logistics (recruitment, consenting, and standardized operating procedures), database builds, and database management. This year, we supported 30 investigators at Connecticut Children’s, and most team members were supported by grant funding (Table 2). In addition, many of our team members authored/co-authored peer-review research articles (Publications).

In 2023, Carolyn M. Macica, MS, PhD, assumed the role of Director of Research Operations and Development. Concurrently maintaining a rare disease research program and affiliations as a professor at Yale University School of Medicine and the Frank H. Netter MD School of Medicine at Quinnipiac University, Dr. Macica brought transformative leadership to the department. She successfully implemented quality improvement processes for research support, such as streamlined mechanisms for requesting assistance, which allowed the department to become more efficient and organized. With her guidance, the department was able to develop and promote a standardized system for research operations and development, which has been well received. Dr. Macica’s leadership has provided an example of how research operations and development can be improved to maximize efficiency, and her vision has created a culture of excellence within the department.

The introduction of evaluations for departmental research support enabled systematic monitoring of success and identification of opportunities for enhancement. This data-driven approach helped the Connecticut Children’s Research Institute take

stock of the existing situation and discover areas for improvement. Upon closer analysis, it became evident that there was an increased demand for student research support services and REDCap platform assistance. To address this surge, Dr. Macica made the strategic decision to create and fill two half-time positions within the department—Research Student Core Services (Mary-Kate Nowbilski) and REDCap Core Services (Vashali Belamkar). This was an effective way to cater to the rising needs while also contributing to the professional development of the team. The new roles have enabled the department to meet the growing demands for their services, with Mary-Kate and Vashali providing valuable assistance and guidance. Furthermore, their expertise has helped streamline the research support system as well as the REDCap platform. This has resulted in improved efficiency and enhanced research support services provided by the department. The successful implementation of this initiative has enabled the department to meet the current demands and prepare for future needs. It is clear that the introduction of evaluations and the strategic hires have allowed the Connecticut Children’s Research Institute to provide better research support and REDCap platform assistance.

The expansion of processes was effectively facilitated by Danielle Chenard, Sr. Research Program Manager, who played a pivotal role in identifying improved student processes. This effort became the focus of her Greenbelt training, a professional development program at Connecticut Children’s. In addition, Dana Jungbauer, MD, was internally promoted from a Research Associate 2 position to Research Manager, entrusted with overseeing staff and the hiring process. Dr. Jungbauer’s experience positions her to make evidence-based decisions crucial to supporting both staff and principal investigators. This collective leadership and strategic decision-making have significantly strengthened the department’s ability to meet the evolving demands of research support at Connecticut Children’s Research Institute. Furthermore, we have effectively recruited and onboarded several new research staff members in direct response to heightened request demands. Each of our new hires brings a distinctive educational and

experiential background, demonstrating a collective commitment to assisting principal investigators in successfully implementing and completing their research studies.

Under the meticulous direction of Danielle Chenard with outstanding administrative support from Rosa Rodrigues, the onboarding process has been standardized to ensure a seamless integration for new team members. New hires are also provided with a comprehensive orientation session to help them gain an understanding of the organization’s goals, values, and expectations. During this time, they are also introduced to the team and given the opportunity to ask questions. In addition, they receive one-on-one mentorship from an experienced team member to help them navigate the new environment. The implementation of this standardized process has garnered positive feedback, with satisfaction surveys overwhelmingly illustrating investigators’ high levels of contentment with the support they receive. The standardized onboarding process has been integral in helping new team members feel comfortable and confident in their roles and has contributed to the success of the team.

To ensure that our team members have the best chance of success in their professional development, we have implemented an innovative algorithm to support our team. This algorithm provides data-driven insights into each team member’s skill competency, enabling objective evaluations and allowing us to identify areas of potential growth. With this tool, we can now more accurately assess team members’ progress and ensure that our team members are consistently developing and improving their skills. Moreover, this data-driven approach further demonstrates our commitment to excellence in our research support services. With the help of our algorithm, we are able to provide our team with the best chance of success, helping them to continually improve and reach their career goals.

The Research Operations & Development Department has been committed to expanding its support for student research, especially at the high school level. Last year, we proudly participated in the 3rd annual

STRIVE program, hosted by Bloomfield High School (BHS). The STRIVE program is designed to provide students with valuable experiences that will help them in their future endeavors. Our team collaborated with BHS to create a Career Panel series that was tailored to match the three distinct academic tracts at the high school: Business and Finance, Healthcare, and STEM. The goal of the Career Panel series was to expose students to a wide variety of healthcare-related careers and allow them to obtain a more comprehensive understanding of allied health fields. The panel series was an immense success, as it provided students with the opportunity to gain insight from professionals in the medical and healthcare fields. Additionally, the panel series provided students with the chance to ask questions and engage in meaningful conversations with the professionals present.

Under the visionary leadership of Dr. Macica, our team engaged in a hands-on experiential learning series during the summer of 2023. This series provided a unique opportunity for students to gain a deeper understanding of genetics, inheritance patterns, phenotype, and molecular genotypes related to Duchenne Muscular Dystrophy. It also served as a platform to promote the importance of scientific research. Simultaneously, we sustained our partnership with Hartford Promise, a college success program for students in the Hartford public school system. This year, we launched our first internship program within our department in conjunction with Hartford Promise. The

objective of the internship program is to not only provide students with valuable research experience but also to increase the number of graduates securing employment as research assistants, diversifying our hiring practices. We are proud to have successfully piloted and executed this program and look forward to continuing the progress in the years ahead.

Our team has been working diligently to promote the growth of student core services. We have continued to partner with the Frank H. Netter MD School of Medicine with the Scholarly Reflection and Capstone Concentration (SRCC) course where medical students can connect with faculty members who have similar scholarly interests. We have also been collaborating with faculty to develop more effective student mentorship programs and to enhance the availability of resources. Our team is dedicated to advancing the quality of student core services and to continuing to create opportunities for students to engage in meaningful research and build upon their skills and knowledge. Additionally, we have continued to support the Undergraduate Research Assistant Program (URAP) to provide University of Connecticut undergraduates with the opportunity to gain research design skills in a clinical setting. Our goal is to provide educational opportunities and diversify the talent pipeline within the field of research. To achieve this, we are committed to an ongoing effort to bridge the gap between students and faculty and to create more meaningful research experiences.

Our department leads and manages the Scientific Review Committee (SRC) which provides a structured review of investigator-submitted study protocols to ensure that studies conducted at Connecticut Children’s have the highest scientific quality. In FY23, the SRC reviewed 72 study protocols. The SRC is composed of 14 committee members who have expertise in the development of research protocols and methodology. This committee works hard to ensure that the research conducted at Connecticut Children’s is of the highest quality and is helping to further the advancement of scientific knowledge. The SRC provides an important service to the research community and is essential to the success of research projects at Connecticut Children’s.

TABLE 1

Principal Investigator Research area

Carolyn M. Macica, MS, PhD Director

Jolene Addi, BS Research Assistant 1

Megan Anderson, BS Research Assistant 1

Amiral Anuar, MS Biostatistician

Emily Bean, MPH Research Associate 1

Vaishali Belamkar, BA Research Associate 1

Gretchen Blume, BS Research Assistant 1

Michael Brimacombe, PhD Senior Advisory Biostatistician

Sarah Cameron, BS Research Assistant 1

Danielle Chenard, MPH Senior Research Program Manager

Rosalie Chuckta, BS Research Associate 2

Mouhamadou Cisse, BS Research Assistant 1

Carlie DeFelice, BA Research Assistant 1

Carissa DelGaudio, BS or BA? Research Assistant 2

Damilola Egbewole, MPH Research Associate 1

Lily Grady, BS Research Assistant 2

James Harnsberger, PhD Scientific Grant Writer

Katherine Herbst, MS Senior Scientific Research Advisor

Cameron King, BA Research Assistant 1

Dana Jungbauer, MD Research Manager

Stephanie Lesmes, BS Research Assistant 2

Makayla Murphy, MPH Research Associate 1

Mary-Kate Nowobilski, BS Research Associate 2

Kathy Oyola-Cartagena, MPH Research Program Coordinator

Rosa Rodrigues Administrative Project Coordinator

Brianna Sarcos, BA Research Assistant 1

Natalia Suarez, MA Research Assistant 2

Noah Schulman, BS Research Assistant 2

Christopher Theriault, BA Research Associate 1

Kristen Volz, MS Research Assistant 2

Kevhanna Whyte, BS Research Assistant 1

Carolyn Wolf, BA Research Assistant 1

TABLE 2

Principal Investigator Research area

Adam Matson, MD Neonatology

Alex Hogan, MD Hospital Medicine

Allison Cowl, MD PICU

Allison Matthews-Wilson, LCSW Care Coordination

Brooke Davey, MD Cardiology

Christine Finck, MD Surgery

Christopher Carroll, MD PICU

Courtney Rowe, MD Surgery

David Hersh, MD Neurosurgery

Emily Wakefield, PhD Psychology

Ilana Waynik , MD Hospital Medicine

Jennifer Knod, MD Surgery

Juan Salazar, MD Infectious Disease

Kathy Herbst, MPH Research

Kevin Borrup, DrPH Injury Prevention

Leonela Villegas MD Nephrology

Mallory Perry-Eaddy, PhD, RN School of Nursing, UConn Storrs

Mariann Kelley, MD Emergency Medicine

Markus Bookland, MD Neurosurgery

Melissa Santos, PhD Psychology

Nancy Trout, MD Primary care

Natasha Frederick, MD Hematology/Oncology

Olga Toro-Salazar, MD Cardiology

Sharon Casavant, PhD Nursing

Sharon Smith, MD Emergency Medicine

Sherene Mason, MD Nephrology

Siddika Mulchan, MD Psychology

Steven Rogers, MD Suicide Prevention-ED

Thyde Dumont-Mathieu, MD Development & Behavioral Pediatrics

William Zempsky, MD Pain and Palliative Medicine

PUBLICATIONS

Smith SR, Nguyen A, Chenard D, Burnham K, Albert A. (2023). Impacts of a University Research Assistant Program: The First Decade. Medical science educator, 33(5), 1139–1146. 2023 September. https://doi. org/10.1007/s40670-023-01852-6.

Anderson MG, Lambert W, Leclair N, Athar D, Martin JE, Bookland MJ, Hersh DS. Telemedicine Utilization in an Outpatient Pediatric Neurosurgical Clinic: A Prospective Survey of Patient and Family Preferences. World Neurosurg. 2023 Aug;176:e557-e568. https:// doi.org/10.1016/j.wneu.2023.05.102.

Szymanski KM, Kaefer M, Fossum M, Kalfa N, Herbst KW, Braga LH, Cascio S, Garriboli M, Nelson CP, Nieuwhoff-Leppink A, Bagli D, Harper L; ESPU Research Committee. What are validated questionnaires and which ones measure quality of life? J Pediatr Urol. 2023 Aug;19(4):469-470. https://doi.org/10.1016/j. jpurol.2023.03.034.

Roche K, Mulchan S, Ayr-Volta L, Elias M, Brimacombe M, Morello C, Hinderer KA. Pilot Study on the Impact of Gratitude Journaling or Cognitive Strategies on Health Care Workers. J Pediatr Health Care. 2023 Jul-Aug;37(4):414-424. https://doi.org/10.1016/j. pedhc.2023.02.002.

Xu S, Leclair NK, Angelo S, Paro M, Stoltz P, Anderson M, Martin JE, Hersh DS, Bookland MJ. Natural history of mild trigonocephalic deformities. J Neurosurg Pediatr. 2023 Jul 28:1-6. https://doi. org/10.3171/2023.6.PEDS23201.

Macica CM, Tommasini SM. Biomechanical Impact of Phosphate Wasting on Articular Cartilage Using the Murine Hyp Model of X-linked hypophosphatemia. JBMR Plus. 2023 Jul 11;7(10):e10796. https://doi. org/10.1002/jbm4.10796.

Anderson MG, Jungbauer D, Leclair NK, Ahn ES, Stoltz P, Martin JE, Hersh DS, Bookland MJ.

Incorporation of a biparietal narrowing metric to improve the ability of machine learning models to detect sagittal craniosynostosis with 2D photographs. Neurosurg Focus. 2023 Jun;54(6):E9. https://doi. org/10.3171/2023.3.FOCUS2349.

Hamilton-Hall MN 3rd, Jungbauer D, Finck C, Middlesworth W, Zendejas B, Alaish SM, Griggs CL, Russell RT, Shieh HF, Scholz S, Kunisaki SM, Feng C, Danko ME, DeFazio JR, Smithers CJ, Zamora IJ, Knod JL; Eastern Pediatric Surgery Network. Esophageal Surveillance Practices in Esophageal Atresia Patients: A Survey by the Eastern Pediatric Surgery Network. J Pediatr Surg. 2023 Jun;58(6):1213-1218. https://doi. org/10.1016/j.jpedsurg.2023.02.030.

Angelo SJ, Anderson MG, Sutter PA, Halloran PJ, Kavanagh KR, Paro MR, Martin JE, Bookland MJ, Michelow IC, Hersh DS. Changes in the epidemiology of pediatric sinogenic and otogenic intracranial infections during the COVID-19 pandemic: a single-institution study. J Neurosurg Pediatr. 2023 May 26;32(2):231241. https://doi.org/10.3171/2023.4.PEDS23130.

Schissler K, Stewart S, Phamduy T, Brimacombe M, Waynik I, Hoppa E. High-Risk Markers and Infection Rates in Febrile Infants Aged 29 to 60 Days Presenting to an Emergency Department During the COVID-19 Pandemic. Pediatr Emerg Care. 2023 May 22. https:// doi.org/10.1097/PEC.0000000000002968.

Wakefield EO, Belamkar V, Sandoval A, Puhl RM, Edelheit B, Zempsky WT, Rodrigues HA, Litt MD. Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis. J Pediatr Psychol. 2023 Apr 20;48(4):341-351. https://doi. org/0.1093/jpepsy/jsac092.

Davey BT, Lee JH, Manchester A, Gunnlaugsson S, Ohannessian CM, Rodrigues R, Popp J. Maternal Reaction and Psychological Coping After Diagnosis of Congenital Heart Disease. Matern Child Health J. 2023 Apr;27(4):671-679. https://doi.org/10.1007/s10995023-03599-3.

Maltz-Matyschsyk M, Melchiorre CK, Herbst KW, Hogan AH, Dibble K, O’Sullivan B, Graf J, Jadhav A, Lawrence DA, Lee WT, Carson KJ, Radolf JD, Salazar JC, Lynes MA; Connecticut Children’s COVID Collaborative. Development of a biomarker signature using gratingcoupled fluorescence plasmonic microarray for diagnosis of MIS-C. Front Bioeng Biotechnol. 2023 Mar 31;11:1066391. https://doi.org/10.3389/ fbioe.2023.1066391.

Theriault CB, DiPlacido J, Zempsky WT, Santos M. The Relationship Between Experiences of Pain Among Youth with Obesity and Health-Related Quality of Life: The Role of Functional Limitation, Sleep, and Depressive Symptoms. Child Obes. 2023 Mar 6. https://doi.org/10.1089/chi.2022.0203.

Pace JL, Drummond M, Brimacombe M, Cheng C, Chiu D, Luczak SB, Shroff JB, Zeng F, Kanski GM, Kakazu R, Cohen A. Unpacking the Tibial Tubercle-Trochlear Groove Distance: Evaluation of Rotational Factors, Trochlear Groove and Tibial Tubercle Position, and Role of Trochlear Dysplasia. Am J Sports Med. 2023 Jan;51(1):16-24. https://doi. org/10.1177/03635465221125780.

RESEARCH AT UCONN DEPARTMENT OF PEDIATRICS

Julie Vigil, MS, MPH, administrative director of the Department of Pediatrics and her team at UConn Health, manage the academic budgets, including in-residence faculty, tenured faculty support, and components of the residency budget, discretionary accounts, and the UConn Health-based sponsored programs. The administrative team at UConn Health consists of administrative officer, Laurie Papacs, MA, MBA and administrative program assistant 2, Satophia Brown.

During the past year, there have been many exciting developments within the research labs and clinical trials.

CLINICAL TRIALS

Our clinical trials team, led by Shaylee King, MS, clinical trials manager and assisted by study coordinators Vi Nguyen, MPH, and Julieta Bonvin-Sallago, MS, have had another successful year. In 2023 the team completed all the final infusions for their Phase III Trial (DTX401-CL301), with Rebecca Riba-Wolmaaylee MD, as the principal investigator and Karen Loechner, MD, PhD, as co-principal investigator, as well as the continuation of our original GSD Clinical Trial (401GSDIa02), both sponsored by Ultragenyx Pharmaceuticals, Inc. This investigational AAV8 gene therapy was engineered to deliver stable expression and activity of glycose-6-phosphatase (G6Pase) using a single intravenous infusion.

The team also continues to recruit for the first-inhumans for the Balance Trial, sponsored by Moderna, with Dr. Loechner, as principal investigator and Narinder Maheshwari, MD, MS, from UConn Health’s Department of Medicine, as Co-Principal Investigator. The purpose of this trial is to use mRNA technology to instruct the body to make the protein that is missing in people with GSD-Ia. In this Phase I trial, the mRNA is administered as a single intravenous infusion.

Shaylee King is also assisting the Department of Medicine at UConn Health on several clinical trials related to Pulmonary Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease Secondary to Systemic Sclerosis and Primary Ciliary Dyskinesia.

GLYCOGEN STORAGE DISEASE RESEARCH LABORATORY

Youngmok Lee, PhD leads the basic science Glycogen Storage Disease (GSD) Research Laboratory at the University of Connecticut Cell and Genome Sciences building, assisted by Yasir Ameen, BS and graduate student, Charles Arend, MS. The Laboratory has made progress on finding treatments for various types of Glycogen Storage Diseases. In 2023, the lab published an article, “Aberrant glucose metabolism underlies impaired macrophage differentiation in glycogen storage disease type Ib. The FASEB J. 37 (11), e23216”. Through this article, the team found a major cause of the functional impairment of GSD-Ib macrophage. In addition, the lab continues to make efforts to initiate clinical trials for GSD-Ib patients with the gene therapy vector developed in their lab.

SPIROCHETAL RESEARCH LABORATORIES

The Spirochetal Research Laboratories co-directed by Justin D. Radolf, MD and Juan C. Salazar, MD, MPH entered the fifth year of a five-year $11 million award from the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH to develop a vaccine for syphilis. The international study team is comprised of researchers from UConn School of Medicine, Connecticut Children’s, the Duke Human Vaccine Institute, the University of North Carolina (UNC) at Chapel Hill Institute for Global Health and Infectious Diseases, UNC Project-Malawi, CIDEIM in Cali, Colombia, Masaryk University in the Czech Republic, and Southern Medical University in Guangzhou, China. In addition, Kelly L. Hawley, PhD and Melissa J. Caimano, PhD are lead investigators for this grant. They are mapping the global diversity of various Treponema pallidum clinical strains and optimizing recombinant protein and mRNA based vaccinogens in preparation for a proper vaccine formulation.

Drs. Hawley and Caimano entered the second year of a five-year $4.5 million dollar award from the Good Ventures Foundation for the formulation and assessment of a de novo designed, multivalent syphilis vaccine. Within this study, they are exploring novel methods to engineer chimeric vaccinogens for the formulation of a highly protective syphilis vaccine.

Additionally, the Spirochetal Research Laboratories has engaged in a multicenter, international project supported by the NIAID to develop a syphilis biorepository. Dr. Hawley, along with an international study team comprised of researchers, is focused on the collection of biological specimens from diverse anatomical sites from individuals with early syphilis. This biorepository of specimens will be made available to researchers for the investigations related to syphilis diagnostics.

Lastly, a multicenter, international project led by Dr. Salazar entered the third year of a four-year $4.8 million award from the National Institute of Child Health and Human Development (NICHD) at the NIH, with an additional $281 thousand awarded in special supplements. The project focuses on the development of a tool that can easily diagnose children at high risk for Multisystem Inflammatory Syndrome in Children (MIS-C), a rare, severe, and sometimes fatal after-effect of SARS-CoV-2 infection. The study is a collaborative effort involving researchers from the University of Connecticut Health Center, University of Connecticut Storrs, the Jackson Laboratory for Genomic Medicine, New York Department of Health, New York University, the University of Hawaii, the Food and Drug Administration, and Centro de Estudios en Infectología Pediátrica in Cali, Colombia. To target this discovery initiative, Dr. Salazar and his team, which includes Dr. Hawley, are using a battery of biological, immunological, and molecular tests to study children and young adults under 21 years of age with mild, moderate, or severe SARS-CoV-2 infection.

PEDIATRIC REGENERATIVE MEDICINE: TISSUE ENGINEERING

The Pediatric Regenerative Medicine: Tissue Engineering laboratory, led by Christine Finck, MD and managed by Joanne Walker, MS, assisted by graduate student Heather Wanczyk, MS, Hala Saneh, MD, Ana Menendez, MD and Elizabeth Hughes, MD have been working on several projects over the past year:

ESOPHAGEAL REGENERATION USING TISSUE ENGINEERED SCAFFOLDS

Their previous work has demonstrated esophageal tissue growth in a piglet model of esophageal loss (4–5 cm gap) treated with an implanted synthetic scaffold seeded with stem cells, most commonly adipose-derived mesenchymal stem cells (AD-MSCs). However, the mechanism by which this regeneration occurs in the esophagus and the cells responsible for the tissue regeneration have not been described. Currently, they are investigating the epithelial-to-mesenchymal transition in wound healing. The lab is in the process of characterizing the secreted factors in AD-MSCs and esophageal epithelial cells (EECs) alone or in response to stimulation with different concentrations of TGFB1 and EGF which are factors that help transition epithelial cells to mesenchymal (EMT). The data we collected this year has led us to question how the process of regeneration occurs and how secreted factors from AD-MSCs help drive a more organized esophageal epithelialization and subsequent tissue regeneration. Specifically, can this process be manipulated to advance epithelial and tissue regeneration? The mechanism behind AD-MSC-derived secreted factors driving EMT has not been explored in esophageal tissue regeneration and this study will reveal novel interactions that may potentially lead to improved therapies and treatments for esophageal replacement. Ongoing study.

TESTING A NOVEL 4 IN 1 MEDICAL DEVICE IN A PEDIATRIC MODEL OF ESOPHAGEAL SURGERY

We have developed a 4-in-1 medical device that contains conduits for feeding drug delivery and balloon

dilation. This all-in-one device is a feeding tube and balloon dilator, which can dilate strictures at the bedside as needed. Our study demonstrates device compatibility with gastric and salivary fluids, and functionality and general tolerability in a rabbit model. The 4-in-1 device was tested in gastric and salivary fluids and phosphate buffered saline (control) for 7 weeks, with balloon dilation tests at 1 and 7 weeks. In a cadaver rabbit, the device was tested by dilating against a rubber band (stricture simulation). We aim to demonstrate feasibility of a multi-functional nasogastric tube that can perform 4 functions without the need for anesthesia: nutrition delivery, on demand balloon dilation at the bedside, drug delivery at the site of the stricture and esophageal effluent aspiration. Feasibility testing has demonstrated device integrity and tolerability in vivo in a rabbit pilot study. Our goal is to demonstrate reproducible device functionality and long-term use in vivo in a validated rabbit model of benign esophageal stricture. We have intellectual property in this device under the name Esophadex. An NIH STTR grant has been submitted to support further development. Ongoing study

Submissions/Presentations - Abstract:

• SAGES 2023 Mtg - Abstract Accepted for Podium

Presentation - Abstract ID 124793, “A Novel 4-in-1 Medical Device for the Treatment of Esophageal Atresia”

• CT ACS – Abstract Accepted for Podium Presentation – “In vitro Testing of a Novel 4-in-1 Device to Treat Neonatal Esophageal Stricture”

• CCRI – Abstract Poster Presentation – “In vivo Testing of a Novel 4-in-1 Device to Treat Neonatal Esophageal Stricture”

• APSA – Abstract Submitted for poster presentation

“In vitro and In vivo Testing of a Novel 4-in-1 Device Used in a Pre-clinical Model of Neonatal Esophageal Stricture”

• PAS – Abstract submission - Work in Progress –“Novel 4-in-1 Device Testing in a Pre-clinical Model of Neonatal Esophageal Stricture

» Started a company “Esophadex”

» Grants: NIH STTR Application # 11

DK139859-01 – “Multifunctional esophageal device that reduces need for surgical procedures in babies”

CLINICAL DEVELOPMENT OF A NOVEL TRACHEAL SEALANT

The goal of this study is to develop a pleural and tracheal sealant that will have optimized mechanical and biological properties, coupled with low cost, ease-of use, appropriate storage, and other logistical considerations, this project is in collaboration with Daniel J. Weiss, MD, PhD, from the University of Vermont State and Agricultural College. Our focus this year on the DOD project was to continue analyzing data from tracheal samples that have been collected. To date, 67 animals in the patch group (10%, 25% and 50% defect, and 1, 2 and 3 rings) and 33 control animals (10% and 50% defect, and 1, 2 and 3 rings). All completed animals with patches have demonstrated intact seal and normal histology with minimal inflammatory cell infiltrate, while suture controls have also demonstrated intact seal, but disorganized closure of tissue. Further histologic, immunohistology, and toxicologic evaluations are ongoing. Ongoing research.

Submissions/Presentations:

• Abstract

» Military Health Research Symposium (MHSRS) 2023 – “Development of Novel Pleural and Tracheal Sealants” – poster presented

» CCRI – Poster Presentation

» PAS – Abstract Submission

• Grants: Department of Defense (DOD) Award Funding Opportunity Number: HT9425-23-PRMRPTTDA “Continued Clinical Development of a Novel Pleural and Tracheal Sealant”

EVALUATION OF THE INCREASED SUSCEPTIBILITY OF OBESE PEDIATRIC PATIENTS TO SARS COV-2 INFECTION

The goal of this research project is to understand the role obesity contributes to SARS CoV-2 infection.

This year, we have been able to obtain patient specific data from a cohort of non-obese (control) and obese patients to investigate the implications of obesity and its role in membrane saturated fatty acids and altered lipid metabolism.

Data is continuously being collected to build a database of information from an at-risk population. Recruitment, screening, and enrollment of patients for adipose tissue (visceral and subcutaneous) collection has been ongoing for the last year to evaluate the metabolic parameters and in-vitro expression of the abundance of ACE2 and DPP-4 associated receptors in membrane rafts of cells derived from obese and non-obese adolescent patients. For each sample collected, the team has completed tissue digestion utilizing aseptic techniques, isolation of adipose derived mesenchymal stem cells (ADMSCs), and passaging of cells for further characterization techniques (flow cytometry, RNA isolation and ELISA). One of the major characteristics of obesity is fat accumulation, including hyperplasia and hypertrophy. Associations of mean adipocyte size with body mass index (BMI), glucose, HbA1C, blood lipids as well as mature adipocyte mitochondrial respiration have been previously investigated. Adipose tissue dysfunction was evaluated by measuring cell diameter, area, and volume of obese adipocyte vs control. As part of the evaluation of dysfunctional adipocyte, we have been evaluating coulometric assays for lipolysis. In lipolysis quantification of glycerol has been measured at basal and stimulated conditions. This project is fundamental in developing a lab environment that supports the growth and development of surgical residents and junior faculty interested in research specifically bariatric research. Ongoing research.

Submissions/Presentations:

• Abstract to the Pediatric Endocrine Society 2023 meeting: “Peripheral blood mononuclear cells lineage and Lipopolysaccharide induced activation potential in childhood obesity.”

INVESTIGATING CELL THERAPIES FOR TREATMENT OF NEONATAL LUNG DISEASES

The goal of this research is to assess the effectiveness of stem cells and their secreted extracellular vesicles (EVs) in repairing hyperoxia-induced injury in preterm lung tissue. Our study has been conducted so far on hiPSCs in an in vitro mouse lung model. Murine lung lobes were harvested on embryonic day 17.5 (at the canalicular stage of lung development) and maintained in air-liquid interface. Following exposure to hyperoxia, media was supplemented with EVs isolated from hiPSCs or their alveolar progenies. To date, there are no standardized protocols for EVs isolation and characterization. After comparing different isolation techniques, we opted to proceed with size-exclusion chromatography (SEC) given its high yield and specificity. On day 3 of in vitro culture, explants were assessed using mean linear intercept (MLI) measurements, and VEGFa and antioxidant gene expression. Exposure of fetal lung explants to hyperoxia induced airspace enlargement, increased MLI, upregulation of anti-oxidants Prdx5 and Nfe2l2 with decreased VEGFa expression. Treatment with hiPSC-EVs improved histologic changes. VEGFa and anti-oxidant genes were upregulated with diPSC-EVs, suggesting pro-angiogenic and cytoprotective potential. EV proteomic analysis provided new insights regarding potential pathways influencing lung regeneration.

Our current focus is on evaluating the effects of EVs in vivo in an animal model of premature lung disease. Our goal is to demonstrate the safety of EVs derived from both hiPSCs and bone marrow MSCs and their efficacy at a transcriptomic, structural, and functional level. We will proceed with the evaluation of both parenchymal and angiogenic lung changes. EV safety assessment will focus on risk for immunogenicity and tumor development, since these are the concerns associated with whole cell therapies. This project might pave the way for a novel stem-cell free approach to improve the quality of life of surviving preemies, and ultimately reduce the global burden of bronchopulmonary dysplasia. Ongoing research.

Submissions:

• Review paper submitted for publication: Saneh H, Wanczyk H, Walker J, Finck C. Stem Cell-Derived Extracellular Vesicles: A Potential Therapy for Premature Lung Disease. Submitted and Under Review in Advanced Therapeutics Journal.

• Research paper submitted for publication: Saneh H, Wanczyk H, Walker J, Finck C. Effectiveness of Extracellular Vesicles Derived from hiPSCs in Repairing Hyperoxia-Induced Injury in a Fetal Murine Lung Explant Model. Submitted and Under Review in Stem Cell Research & Therapy Journal.

Grant applications:

• Application for the Charles Hood Foundation grant: Evaluating the Efficacy and Safety of Stem Cell-Derived Extracellular Vesicles in a Preclinical Animal Model of Premature Lung Disease. We will hear back from the Charles Hood Foundation in December 2023.

• Application for the Connecticut Children’s Connection Award: Evaluating the Efficacy and Safety of Stem Cell-Derived Extracellular Vesicles in a Preclinical Animal Model of Premature Lung Disease. Invitation received to submit a proposal in January 2024.

Presentations:

• Platform presentation: Effectiveness of Extracellular Vesicles Derived from Human-Induced Pluripotent Stem Cells (hiPSCs) in Repairing HyperoxiaInduced Injury in a Fetal Murine Lung Explant. Pediatric Academic Societies (PAS) Meeting, D.C., April 2023.

• Platform presentation: Stem Cell-Derived Extracellular Vesicles: Effectiveness in Repairing Hyperoxia Injury in the Preterm Lung. Brown-YaleUConn Annual Meeting (BYCONN), CT, March 2023.

• Poster presentation: Stem Cell-Derived Extracellular Vesicles: A Potential Therapy for Premature Lung Disease. CCRI meeting, November 2023.

INVESTIGATING NOVEL APPROACHES TO LUNG TISSUE ENGINEERING

The overall goal of this project is to bioengineer functional biomimetic airways for treatment of neonatal and pediatric respiratory conditions. Mechanical optimization of human decellularized extracellular matrix (dECM) 3D bioprinted airway structures. The goal is to produce airways of comparable dimensions and physical characteristics to those of native large and medium sized airways. We were able to demonstrate the feasibility of printed a simplified airway structure using the FRESH support bath. We then printed a pediatricsized airway using this approach as well. Constructs were printed at high resolution and held their shape following the post-processing period. However, it was difficult to completely remove the slurry bath support material. This step will need to be optimized in further studies. Optimization of cell viability and phenotype in 3D bioprinted dECM airway structures. Effects of dECM hydrogels on growth, differentiation, and function of both differentiated as well as stem/progenitor airway epithelial cells will be further delineated. This year we have optimized protocols for cell differentiation of iPSCs to distal and airway epithelial phenotypes; demonstrated viability, growth, and differentiation of anterior foregut endoderm cells in decellularized human lung matrix. Ongoing research.

Submissions/Presentations:

• Poster Presentation: Bioengineering PediatricSized Airways using 3D Bioprinting Technology, Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Diseases Conference, Burlington, VT, July 2023.

• Abstract Presentation: 3D Bioprinting to Treat Pediatric Lung Disease. CCRI Research Symposium, Hartford, CT. November 2023.

• Poster Presentation: Bioengineering Lung Tissue using Advanced 3D Bioprinting Technology. Rockstars of Regenerative Engineering. San Diego, CA. April 2023.

• Invited Speaker: Bioengineering Lung Tissue using Advanced 3D Bioprinting Technology. Rising Stars of Regenerative Engineering: The Dynamic of Students and Research Mentors. Virtual Talk. April 2023.

DEVELOPMENT OF A FUNCTIONAL TISSUE ENGINEERED IMPLANT TO TREAT GASTROINTESTINAL MOTILITY DISORDERS

The overall goal of our project is to bioengineer a 3D printed polypropylene-based scaffold wrapped with decellularized pig esophagus (3DE) and seeded with subcutaneous adipose tissue (SAT)-derived neural progenitors and adipose-derived mesenchymal stem cells (AD-MSCs) differentiated to myocytes.

We have been able to decellularize pig esophagus, physically separate the musculature from the submucosal-mucosal layers, and then individually seed each layer with the appropriate cell type. Decellularized esophagus is an optimal substrate as it is immunologically inert and contains functional proteins, instructive cues, neurotrophic factors and structural layers important for growth and differentiation of seeded cells. AD-MSCs promote re-epithelialization of esophageal tissue in vivo and can be differentiated to smooth muscle cells in vitro. SAT-derived NPs have excellent neurogenic properties, can successfully integrate and align into circular and longitudinal muscle layers of the GI tract and rescue motility deficits when transplanted into mice with gastroparesis and Hirschsprung’s disease. Ongoing research.

Submissions/Presentations:

• Grant: NIH Opportunity Number: PA-20-185 -

GRANT14008354 – Re-submitted February 2023

“Development of a functional tissue engineered impact to treat gastrointestinal motility disorders.”

• Presentation: Bridging the Gap: Novel Methods to Treat Long-gap Esophageal Atresia. Surgical GI Retreat. October 2023.

FETAL MEDICINE RESEARCH

Timothy Crombleholme, MD, and assistant professor Sanjukta Majumder, PhD, are investigating the molecular mechanisms of endothelial dysfunction leading to placental insufficiency and subsequent fetal growth restriction (FGR). Their goal is to study molecular mechanisms of endothelial cell dysfunction in placental insufficiency leading to FGR. They are specifically looking at the hierarchy of IKK- /NF- B mediated IGF-1 signaling pathways in vitro in primary cultured placental endothelial cells from normal and growth-restricted mice. Secondarily, they will utilize human placental endothelial cells from normal and growth-restricted pregnancies to test the above hypothesis, which they will then test in three different mouse models, each specific for its role in FGR.

PEDIATRIC REGENERATIVE MEDICINE

The Rowe Laboratory, led by Courtney Rowe, MD, and managed by Chris Foster, MS, continues to explore novel methods to improve surgical outcomes through a number of projects.

A NOVEL STENT TO TRANSFORM URETHRAL HEALING

The urethra is the only pathway for urine to exit the body. We have designed and patented a novel urethral stent that releases growth factor to the urethra to improve healing after injury or surgery. This work is supported by the Connecticut Children’s Connections Grant.

Submissions/Presentations:

• Peer-Reviewed Publication: The methodology developed by the Rowe Laboratory to evaluate urethral healing in vitro was accepted into Methods and Protocols. Foster, C., T. Jensen, C. Finck and C. K. Rowe (2023). “Development of a WoundHealing Protocol for In Vitro Evaluation of Urothelial Cell Growth.” Methods Protoc 6(4).

• Entrepreneurship: The urethral stent technology was accepted into the Accelerate UConn program in the Fall of 2023. Spearheaded by Chris Foster, MS, this workshop allowed for an in-depth market analysis via interviews with urologists, pediatricians and parents, concluding that there is a robust market for this new stent technology.

• Grant Submission: A K08 Mentored Scientist grant was resubmitted for 2023 after helpful feedback from reviewers and the grant program officer.

BIODEGRADABLE, IMPLANTABLE PAIN FILM

Current postoperative pain control strategies leave children and adults with uncontrolled pain. We have designed and patented an implantable pain film that will provide non-addictive local anesthetic to the surgical site for 3 days.

Submissions/Presentations:

• Poster Presentation: This work was presented as a poster at the Connecticut Children’s Research Institute Retreat. Foster C, Burke K, Rowe CK. “A Novel, Customizable Drug Delivery Biomaterial for Pediatric Surgical Pain. Poster Presentation, CCRI Meeting, 11/2023.

• Entrepreneurship: The pain film was accepted into the Accelerator for Biosciences in CT (ABCT.) This competitive, 6-month program will provide entrepreneurial education in finding grant funding and strengthening future investment opportunities. Classes will begin in 2024.

• Grant Submission: An R01 grant was submitted in 2023 in collaboration with UConn Storrs and not funded; this is planned for resubmission in early 2024.

RARE BONE DISORDERS

Emily Germain-Lee, MD, Dr. Germain-Lee’s translational research program is focused on the molecular, cellular, and physiological mechanisms underlying the pathogenesis of diseases affecting the endocrine system with a particular focus on rare bone

disorders. With the assistance of Qingfen Yang and Benjamin Hoffman, her overarching goal is to develop new therapies and improve the health and quality of life for children and adults with these disorders. Through this work, she has built an extensive clinical and basic science research program that has also provided insights into general bone biology, given that the focus on rare bone disorders has shed light on fundamental pathways and processes.

During this past year, Dr. Germain-Lee has furthered her work in several areas. (i) Her group has continued investigations of the pathophysiology of Albright hereditary osteodystrophy, a rare bone condition caused by heterozygous inactivating mutations in GNAS, a gene which encodes a key signaling component utilized by many G protein-coupled hormones. A major focus of her laboratory’s research during the past year has been to continue their investigations of the role of GNAS in regulating overall bone homeostasis, including the mechanisms underlying the development of heterotopic subcutaneous ossifications caused by loss of GNAS function as well as the aberrant bone regulation that contributes to craniofacial abnormalities occurring in Albright hereditary osteodystrophy. (ii) In addition, Dr. Germain-Lee and her collaborators are examining the role of the myostatin/activin A signaling pathway in regulating both muscle and bone. In recent studies, they have shown that targeting key receptors for myostatin and activin A can lead to dramatic increases in both muscle and bone mass. They are pursuing strategies to target this signaling pathway for applications in bone, muscle, and metabolic disorders. Dr. Germain-Lee is currently one of two Principal Investigators on an NIH R01 grant to continue work examining this pathway in bone. (iii) Dr. Germain-Lee is also one of two Principal Investigators on an NIH R21 grant investigating extragonadal functions of follicle stimulating hormone (FSH), specifically in regulating bone density and adiposity. Given that FSH secretion is regulated by activin A and that FSH utilizes G proteincoupled signaling, this project directly relates to many of the other projects Dr. Germain-Lee is investigating

regarding the signaling pathways in Albright hereditary osteodystrophy. The goal of this project is to develop the best strategies to target FSH signaling to treat osteoporosis and/or metabolic dysfunction, including diabetes and obesity. (iv) Finally, Dr. Germain-Lee and collaborators have been investigating the role of myostatin, activin A, and related signaling molecules in regulating metabolism, with the goal of developing new strategies to enhance the ability of the pancreas to produce insulin as well as to improve the responsiveness of peripheral tissues to insulin. The overall goal of this research is to find a novel therapeutic approach to diabetes.

NEONATAL RESEARCH

Adam Matson, MD, MSc, is conducting basictranslational research on the neonatal gut microbiome, with the assistance of his post-doctoral fellow, Katrin Unterhauser, PhD, and his research assistant, Rezaul Karim. His work is focused on elucidating the pathogenic potential of Klebsiella species in the gut lumen as inciting agents of necrotizing enterocolitis, a devastating intestinal inflammatory disease of premature infants. Dr. Matson is also conducting studies to identify gut microbial populations that impact neonatal growth and neurodevelopmental outcomes and utilizing novel long-read genomic sequencing approaches to identify and track bacterial strains in the hospital setting. In a collaborative study between Connecticut Children’s and the Jackson Laboratory for Genomic Medicine, Dr. Matson is helping to lead an initiative exploring the diagnostic capability of longread whole genome sequencing in the undiagnosed neonatal and pediatric population.

OFFICE OF SPONSORED PROGRAMS (OSP)

The Office for Sponsored Programs (OSP) supports the research community at Connecticut Children’s by facilitating the preparation, submission, and management of extramural funding. Our services include pre-award, post-award, contract management, and clinical research finance. We are dedicated to providing outstanding customer service in an environment that embraces teamwork, integrity and compliance.

OSP strives to help Connecticut Children’s become a top-tier institution by leveraging technology to provide best in-class research administration. Doing so will help allow discovery that improves the lives of children and their families in Connecticut and throughout the region.

OSP sustained continued growth in 2023 and managed over $34 million in external funding. In its most impressive year yet, Connecticut Children’s had a record breaking year for prime NIH funding of over $6 million.

OSP has spent much of the year preparing for a new ERP system that we anticipate will greatly enhance the services from the OSP team, streamline functionality and provide top-level service to all the faculty and staff we support.

OSP welcomed a new addition to the team, Nicole White, as a Senior Contracts Specialist. Under the direction of James Gallagher, Nicole will assist with all external contracts that flow through OSP.

OSP TEAM

Kimberly Davey, MBA, Office for Sponsored Programs and Research Finance

Neal Breen, MBA, Senior Manager Post Award and Research Finance

Pre-Award

Alixandra Borgert, MRA, CRA, Lead Pre-Award Specialist

Gena Dixon, MS, CRA, Senior Pre-Award Specialist

Contracts

James Gallagher, Esq., Assistant General Council

Nicole White, MBA Senior Contracts Specialist

Clinical Research Finance

Karen Long, BS, Senior Clinical Revenue Specialist

Aubree Siebert, MS, Lead Clinical Research Finance Specialist

Post Award

Marlene Tzickas, Lead Post-Award Specialist

Evana Nasse, BS, CPhT, Senior Post-Award Specialist

Suzanne Setterberg, BS, CPA Senior Post-Award Specialist

Jackie Yeo, MS, Senior Post-Award Specialist

OFFICE OF FACULTY DEVELOPMENT (OFD)

The Office of Faculty Development’s (OFD) purpose is to champion the personal and professional growth of faculty at each stage of their career while promoting a culture of well-being and resilience.

OFD celebrated continued growth in 2023. While the OFD focuses on academic faculty, we define our target audience as all physicians, APPs, and psychologists regardless of academic standing. OFD addresses key issues facing faculty – such as well-being, burnout, personal effectiveness, gender disparities, diversity and inclusion–through innovative educational offerings.

The Reflect-Inspire-Strengthen-Empower) (RISE) Program for mid-career physicians and psychologists launched its inaugural cohort under the direction of Hayley Wolfgruber, MD, Katherine Kavanagh, MD, and Lisa Marella. This program, designed for midcareer faculty who have been in practice between 5 and 15 years, aimed to enhance and maintain faculty engagement and retention, assure a solid foundation and career trajectory, and promote joy in work. Additional programs including the second cohort of the highly successful Transition into Practice (TiP) program is planned for the 2023-2024 academic year.

National presentations:

• Dr. Kavanagh gave a presentation at the American Academy of Otolaryngology – Head and Neck Surgery Foundation annual meeting in Nashville, TN entitled “Strategies for Teaching and Enhancing Wellness.”

• Dr. Wolfgruber and Rebecca Moles, MD presented their findings from the Transition into Practice (TiP) program in a talk entitled “Transition into Practice: Building a Career Development Program for Early Career Physicians” at the New England Pediatric Hospital Medicine Conference.

OFD offerings to faculty in 2023 included:

• Dr. Wolfgruber and Ms. Marella continued our successful Virtual Faculty Lounge, a bimonthly open Zoom meeting where faculty gather for connection and support. This platform has fostered connections across the institution that have positively impacted patient care and provider well-being.

• Ms. Marella provided individual coaching to faculty to support personal and professional growth.

• Ms. Marella provided leader onboarding, team effectiveness, and engagement consultation to division leaders and faculty.

• Stephanie Futtner facilitated the expansion of the Office of Faculty Development internal webpage.

• Drs. Kavanagh and Wolfgruber, and Ms. Marella continued the monthly Faculty Development Series, a lunch and learn offering encompassing a wide variety of faculty development topics featuring institutional experts.

The OFD looks forward to continued innovation and definition in 2023 and beyond as we strive to support faculty across the institution.

STAFF

Hayley Wolfgruber, MD Katherine Kavanagh, MD

Lisa Marella, Sr. Director of Organizational Effectiveness, Learning & Culture

Stephanie Futtner, Executive Assistant

OFFICE FOR COMMUNITY CHILD HEALTH

OFFICE FOR COMMUNITY CHILD HEALTH (OCCH)

Connecticut Children’s Office for Community Child Health (the Office) is nationally recognized as a pioneer in promoting children’s optimal health, development and well-being by utilizing a cross-sector approach to build stronger child-serving systems, strengthen families and advance equity. Under the leadership of Paul H. Dworkin, MD, the Office helps shape federal, state and local policy regarding child services; builds partnerships between internal and external programs across all sectors that influence child health and development; and cultivates innovations to support children and families that are at risk for adverse health and life outcomes. The Office oversees 17 communityoriented programs that strive to meet the various needs of children and families, which include both medical and basic needs, as part of Connecticut Children’s commitment to keeping children healthy.

Highlights of the Office’s work in 2023 include work of the Help Me Grow National Center to explore the adoption of goal concordant care principles, which have been used successfully in palliative care settings, to pediatric care. Help Me Grow (HMG) completed a project with a Goal Concordant Care Learning Community, which defined and tested goal concordant approaches to early childhood care utilizing the HMG model. It also launched the Goal Concordant Care and the Well Visit project to adapt, develop, and test clinical workflows and protocols to tailor and individualize the goals of pediatric primary care in partnership with families.

Connecticut Children’s Injury Prevention Center (IPC) completed the second year of a three-year, $2 million grant from the City of Hartford to oversee a citywide hospital-based violence intervention program designed to break the cycle of gun violence and other crimes in Hartford. As part of the grant, the IPC is working with two other hospitals and three community-based organizations to engage victims of firearm violence as they recover from injuries in the hospital to deter retaliation and improve outcomes.

Also, the North Hartford Ascend continued its work under a five-year, $30 million grant from the U.S. Department of Education’s Promise Neighborhoods Program in which Connecticut Children’s Office for Community Child Health is leading a multi-partner, cross-sector initiative designed to improve academic outcomes, developmental trajectories, long-term well-being and quality of life for children living in North Hartford. Notable accomplishments in 2023 included hosting monthly community conversations with attendance from 30 to 70 participants, launching marketing and communications activities and engaging residents in workgroups supporting all aspects of the work.

In addition to the above-mentioned work, the Office is excited to share the following updates from a majority of its programs during the past year:

OCCH PROGRAMS

Center for Global Health (CGH): The Center for Global Health (CGH) improves the lives of infants and children living in resource-limited settings by partnering in the development of sustainable capacity-building activities. Through the participation of trainees, staff and faculty, the CGH creates a culture at Connecticut Children’s that acknowledges that we are world citizens and our knowledge and skills can improve the lives of children around the world.

The CGH continues to be led by Adam Silverman, MD, along with Stephen Mahier, RN, Naveed Hussain, MD, Lisa LeBon, RRT, and Christopher Hughes, MD. PostCOVID19 global activities have expanded with multiple new partnerships. The Center is developing a new relationship with the Jamaican North-East Regional Health Authority and the Issa Trust Foundation to identify pediatric health outcomes that would benefit from the sustainable involvement of our pediatric learners, staff and faculty. The center is also building on the relationship established by Dr. Arvin Bundhoo with the Ministry of Health and Wellness for the Republic of Mauritius to improve the care of critically ill infants and children.

In addition, the yearly university-wide Global Health Symposia was once again held in collaboration with three partners: the student-led Global Health Spaces on Campus organization in Storrs, CT, the leaders in global health at the UConn Health Center in Farmington, and the Center for Global Health. The theme for Symposia focused on “The Price of Life” and turnout was once again outstanding.

The Center’s work includes collaborations, partnerships, and sustainable volunteering opportunities with organizations including:

• Justinien University Hospital (Cap-Haitian, Haiti)

• St. Damien Pediatric Hospital (Port-au-Prince, Haiti)

• Hospital Sacré Coeur Pediatric Diabetes Program as volunteers with CRUDEM (Milot, Haiti)

• NICE Foundation “Cool the Kids” program (Hyderabad, India)

• The University Teaching Hospital of Kigali (CHUK) (Kigali, Rwanda)

• Nakasero Hospital as the site for Neonatal Nurse training (Kampala, Uganda)

• St. Paul’s Hospital Millennium Medical College (Addis Ababa, Ethiopia)

Childhood Prosperity Lab (the Lab): The Childhood Prosperity Lab (the Lab) guides the development of social innovations that support children, families, and communities where they live, learn, work, play, and pray. The Lab engages changemakers in consultation sessions; guides innovations through technical assistance and capacity building; connects changemakers to professionals across Connecticut Children’s; collaborates with organizations to employ human-centered design in their work with children and families; and trains organizations of child- and youth-oriented service in the Strengthening Families Protective Factors. Key activities include:

• Certified two team members in the Strengthening Families Protective Factors Framework through the Children’s Trust Fund Alliance and facilitated three trainings.

• Abstract acceptance at the Northeast Summit for a Sustainable Built Environment (NESSBE) on how human-centered design can be leveraged to cocreate sustainable systems with service providers and those with lived experience in those systems.

• Developed a program-specific five-year strategic plan.

• A Lab team member attended Mayor Muriel Bowser’s 6th Annual Maternal and Infant Health Summit as a nominated SparkDC speaker in the District of Columbia.

• Started to develop a cohort technical assistance strategy and framework to engage changemakers in a community of practices.

• Leveraged human-centered design methodologies to co-design the process of Building for Health, which informed the final innovation model.

CLASP Co-Management:

The CLASP Program has had continued success via new processes of continual improvement focusing on direct input from community pediatricians. Our program now boasts 44 active CLASP tools. By the end of 2023, we will have updated approximately 23 tools and developed three new ones. Moreover, through our new system of regular communication with community providers, we have increased our reach to 691 verified CLASP users, an 11% increase from 2022.

Additionally, CLASP founder Karen Rubin, MD, participated in the 2023 Accelerator Bioscience Connecticut Program to acquire skills for commercialization of CLASP. The start-up “EmpoweCare”, in partnership with Connecticut Children’s, will turn CLASP into an integrated, AIenhanced digital condition management platform. A compelling need for such a platform was validated by our survey of the Children’s Hospital Associationsponsored national learning collaborative representing the leading pediatric care networks. Dr. Rubin is seeking seed funds to make it possible to move forward with this vision. EmpoweCare will be a testament to the exceptional talent at Connecticut Children’s and improve timely access to quality care for children nationwide.

Connecticut Children’s Center for Care Coordination (the Center): The Center for Care Coordination (the Center) provides supportive and targeted care coordination for children and youth with high-risk medical conditions and complex social stressors, specifically working with community providers, Connecticut Children’s patients, and Connecticut Children’s Care Network of community pediatricians. Activities included:

• Providing targeted, comprehensive and culturallycompetent care coordination to children who screen positive for rare conditions during newborn screening.

• Partnering with Healthy Homes to provide care coordination to children and youth identified through the Hartford Neighborhood Environmental Assessments and Restoration (NEAR) grant.

• Providing care coordination support and consultation to children and youth with special health care needs and their community pediatric practices through the North Hartford Ascend grant as well as the Help Me Grow, Goal Concordant Care/JPB grant.

• Expanding behavioral health care coordination to support Emergency Department discharges, Zero Suicide screenings, and complex inpatient referrals.

• Supporting three outpatient mental health clinics at Connecticut Children’s – the Behavioral Health Transitions Clinic, the Medical Coping Clinic and the Intensive Outpatient Clinic – by connecting families to outpatient care.

• Distributing over $58,000 to almost 650 families facing economic challenges for basic needs, medication and equipment not covered by insurance.

• Continuing active participation with the Care Coordination Collaborative Model, which is also a program of the Office, to improve efficiency and effectiveness of care coordination throughout the north central part of Connecticut.

• Providing care coordination support through the newborn Screening Network with a focus on the

following areas: Genetics, Hematology (Sickle Cell), and Endocrinology.

• Staff training in Motivational Interviewing (MI) to support families receiving care coordination; use of MI supports families identifying meaningful goals when working with care coordinator staff.

Connecticut Children’s Healthy Homes Program (Healthy Homes): In 2023, Healthy Homes continued to collaborate with multiple grant partners across Connecticut to make homes lead safe and healthy for Connecticut families. Healthy Homes was selected to participate in numerous state and regional presentations focusing on the importance of housing as a platform for health, culminating with a presentation, in collaboration with the American Academy of Pediatrics, to the Children’s Hospital Association. During the presentation we showcased our Building for Health initiative, and informed health care institutions and pediatric practices on the ways they can implement a healthy homes lens in their systems.

Connecticut Newborn Screening Network: The Connecticut Newborn Screening Network (the Network) completed year 2 of a Health Resources and Services Administration (HRSA) funded project to implement a comprehensive, family-centered, longterm follow-up (LTFU) model and was approved for a no-cost extension. This success catapulted the Network to the forefront of federal efforts to expand newborn screening (NBS) LTFU, evidenced by an invitation to a national workgroup to establish a uniform definition of LTFU and define standardized metrics for data collection. In addition, the Network collaborated with the Connecticut DPH NBS Program to become a recipient of a HRSA NBS Propel grant to expand LTFU efforts and support the development of a system to improve family knowledge of sickle cell trait.

The Network funded the development of a parentfacing social determinants of health (SDoH) screener in EPIC that is being piloted in Genetics. This screener will enhance family-centered care and optimize health outcomes. Understanding the social factors affecting the Connecticut NBS community can help providers

determine the best strategies for addressing them. Similarly, the Network built a Transition to Adult Care module in EPIC and is evaluating its usage in the Sickle Cell Disease population. These population health tools have applicability to many patient populations.

Easy Breathing (EB): In 2023, demand for Easy Breathing increased dramatically as the primary care community continues to adapt to the 2020 Focused Updates to the Asthma Management Guidelines. Guided by content experts in the pediatric pulmonary and sleep division, Easy Breathing developed a continuing medical education module on how to implement single maintenance and reliever therapy (SMART) in the pediatric primary care setting. With this continuing medical education (CME) module in hand, Caleb Wasser, DO, the Easy Breathing Physician Champion, Melanie Sue Collins, MD, and Jessica Hollenbach, PhD, AE-C, (Co-Directors, Asthma Center) delivered more than 10 SMART therapy CME sessions to pediatric practices across the state, including New York and Massachusetts. Our team also conducted five new trainings in how to implement the Easy Breathing program.

In conjunction with training practices in the updated asthma guidelines, the Easy Breathing program has been working closely with families of children with asthma to re-design the asthma treatment plan. Led by 3rd year UConn medical student (MS-3) Abigail Tulchinsky, the asthma treatment plan has been fieldtested for readability and understandability. This usercentered-design approach will lead to a SMART asthma treatment plan that is at the appropriate reading level for families with the low health literacy whose children suffer disproportionately from poor asthma outcomes.

Finally, crucial work continues to move Easy Breathing into the digital age. In collaboration with investigators from the University of Florida, Easy Breathing will be integrated into an enterprise electronic health record system. The integrated Easy Breathing will then be tested and evaluated for adherence to the asthma guidelines and improvements in pediatric asthma outcomes.

Educating Practices: The program continues to receive valuable support from the Connecticut Department of Public Health to continue to provide pediatricians with timely, evidence-based clinical information and office tools, and help them connect to community and state resources so they are able to implement practice changes. Between January 1 and December 31, 2023 the program has given 25 presentations focused on 13 different topics to 16 different practices and over 325 participants.

Hartford Youth HIV Identification and Linkage Consortium (HYHIL): The Hartford Youth HIV Identification and Linkage Consortium (HYHIL) continues to leverage the care continuum to increase positive outcomes and improve health equity for individuals/families affected by HIV, experiencing homelessness or at-risk of experiencing homelessness. Our program received funding for the enhancement of routine HIV testing and PrEP Navigation Services, Youth Recovery CT and for ambulatory/medical case management services.

• HYHIL reached over 3,200 middle and high school students across Connecticut with HIV prevention and PrEP Navigation Services to students in traditional and non-traditional education settings through interactive preventive education.

• HYHIL screened over 500 adolescents/young adults for HIV, provided 100 individuals with HIV Home Testing Kits and enrolled 17 youth into PrEP Navigation Services.

• Presented the Youth Housing Stabilization Project Entitled: Healthier Housing Systems - Healthier Youth Living with HIV at a HRSA Clinical Hot Topics and at the CT HIV Planning Council Statewide Quality Improvement Summit.

• Program staff participated in an Interagency Roundtable Discussion with the United States Council on Homelessness (USICH) led by Nichele Carver, USICH Senior Regional Adviser to create a CT Interagency Council on Homelessness aligned with the Federal Strategic Plan to Prevent and End Homelessness.

• The Routine HIV Testing/PrEP Navigation initiative will be expanded to the Emergency Room (at Connecticut Children’s). Grace A. Hong, APRN, championed a clinical pathway in EPIC in collaboration with Information System that will ensure a seamless process where patients will be linked to critical support services via Infectious Disease medical case managers and PrEP Navigators.

• Program staff has engaged in numerous outreach efforts with a focus on the North End Ascend neighborhoods thus reaching over 400 individuals with HIV/substance use prevention information.

Help Me Grow National Center: The Help Me Grow (HMG) National Center, the implementation hub for the HMG Model which has been implemented in over 120 communities across 30 states, had the following successes in 2023:

• Publication of the Roadmap to Advance FamilyEngaged Developmental Monitoring, which defines and reflects best practice across the early childhood field for partnering with families to better support positive developmental outcomes.

• Growth of the HMG National Center Team, including two new associate directors.

• Completion of the Goal Concordant Care Learning Community, which defined and tested goal concordant approaches to early childhood care utilizing the HMG model.

• Launch of Goal Concordant Care and the Well Visit project to adapt, develop, and test clinical workflows and protocols to tailor and individualize the goals of pediatric primary care in partnership with families.

• Presentations at national and international conferences, including the Transformations Conference, World Association of Infant Mental Health, Zero to Three, and Association for University Centers on Disabilities.

• Hosting of “Forum Week,” an annual convening that this year included both virtual and in-person components, with 550 unique registrants across events.

Injury Prevention Center (IPC): Founded in 1990, for more than thirty years the Injury Prevention Center (IPC) has been serving the children and families of Connecticut through research, community programs, education/training, and policy advocacy. Our mission is to keep children and families safe and injury free. In fulfilling its academic role, the IPC is focused on research to prevent suicide, community violence, firearm violence, domestic violence, and child maltreatment. Our community programs address a broad spectrum of safety issues and are focused on bringing evidencebased interventions to bear. Safe Kids Connecticut, a program undertaken in collaboration with the Connecticut Elks Association, is a hallmark of our safety work. Safe Kids CT works to prevent injury in children ages 0-19. The Hayley Petit Injury & Violence Prevention Fellowship, an educational program for undergraduate women, is key to our education/training goals to inspire the next generation of researchers. Finally, our policy and advocacy work continues to support meaningful change in Connecticut, with our most recent advocacy efforts supporting a greater focus on ending firearm violence and the establishment of an office within the Department of Public Health to take on this role.

Notably, in 2022 with support from the City of Hartford, in response to a striking increase in firearmrelated fatalities, the IPC formed the Hospital-based Violence Intervention Program (HVIP) Strengthening Collaborative in an effort to enhance ongoing efforts to intervene with those presenting to one of Hartford’s three trauma centers with a gunshot wound. This evidence-based effort is enhancing services, centralizing data collection efforts, and bringing additional resources to our community partners. As a Center member of the Society for the Advancement of Violence and Injury Research (SAVIR), the IPC participates in national and regional discussions of research opportunities and priorities and remains a leading voice advocating for the strengthening of our collective approach to living lives that are injury free.

North Hartford Ascend (Ascend): The North HartfordAscend (Ascend) is a place-based, prenatal through career initiative ensuring children and families

living in the North Hartford Promise Zone have the supports they need to reach their full potential. Leveraging a U.S. Department of Education Promise Neighborhoods Grant, Connecticut Children’s Office for Community Child Health is leading the multi-partner, cross-sector initiative as it:

• Develops a comprehensive, integrated continuum of services

• Facilitates the implementation of a parent-, family, and community-driven agenda

• Leverages targeted universalism to support equity

• Strengthens families’ protective factors

• Enhances early identification, referral, and linkage to services

Over the last year, Ascend:

• Hosted 22 community conversations with attendance from 30 to 70 participants.

• Launched a Facebook social media platform.

• Attended and displayed at 11 community events.

• Developed a communications guide to ensure consistent messaging among all partners.

• Planned the launch of a Neighborhood Survey by 2024.

• The Family Navigation System Building Work group has created a Geographic Information System Mapping of populations and programs and services.

• The Partner Engagement Work group launched Provider Monthly Meetings to establish a connection between organizations who currently provides programs, services, and supports to residents in the North Hartford Promise Zone to Ascend.

• A Community and Family Engagement Workgroup launched and executed “ Road Shows” with principals at NHAP 5 targeted schools to introduce NHAP and discuss absenteeism and solutions to ensuring students are safe.

• NHAP partner United Way of Central and Northeastern CT hosted, in collaboration with

the CT Data Collaborative, a data workshop for residents.

Person-Centered Medical Home (PCMH):

The National Committee for Quality Assurance (NCQA) recertified the Connecticut Children’s Primary Care East (East Hartford) and West (Farmington) locations as Person-Centered Medical Homes (PCMH) in May 2023. This year, our newest site, Connecticut Children’s Primary Care South (100 Retreat Avenue, Hartford), completed the DSS Glide Path and achieved NCQA PCMH recognition as well. In keeping with the PCMH model, we conduct universal screenings to identify and evaluate behavioral and developmental concerns at all well-child visits. In response to the ongoing mental health crisis amplified by the COVID-19 pandemic, we follow a model of integrated behavioral-medical care, with psychologists and care coordinators on site. This year Amy Signore, PhD, received a grant from Antioch University to support training and increase the early detection of autism evaluation within the medical home.

All three Connecticut Children’s Primary Care sites participate in the Connecticut Children’s Care Network and serve as laboratories for many programs of the Office. We are the first department at Connecticut Children’s to implement a documentation platform for social determinants of health in our Electronic Health Record. This work dovetails with participation in a learning community project to enhance goal-concordant care, supported by funding from the Help Me Grow National Center.

Resident Education in Advocacy and Community Health (REACH):

The Resident Education in Advocacy and Community Health (REACH) program continues to be active in advocacy. The introduction to Advocacy was offered during the year for our residents and medical students. During this time, a resident published an oped and participated in the state legislative session by submitting testimony for various bills. We continue to discuss the implementation of structural competency in our residency rotations. The REACH program continues to work with different community groups including Hands on Hartford, the YMCA nursery schools, Capitol Squash, and KNOX community garden. We recently have also partnered with the Capitol Region Education

Council (CREC) to increase residents’ knowledge of school based health care and optimizing patients for returning to the school system. The residency program, with the leadership of our wellness committee is starting a food drive for organizations within our community. We had three grant submissions from residents during this year on various topics including a program for teaching adolescents valuable basic life support skills and for funding a drive for appropriate fitting helmets. The residency advocacy committee continues to meet with the goal of increasing the global awareness of initiatives related to advocacy and the creation of an advocacy newsletter.The REACH program continues to work with different community groups, including Hands on Hartford, the YMCA nursery schools, Capitol Squash, and KNOX community garden. We participate in national and local initiatives including Wear Orange to advocate for gun safety. We also formed an advocacy committee to further residency involvement and awareness within advocacy. Dr. Nancy Presnick was awarded the Capitol Area Health Consortium community award and Dr. Kayla Gonzalez gave a family medicine grand rounds presentation on adverse childhood experiences.

Start Childhood Off Right (SCOR):

To help combat rising levels of food insecurity and promote increased consumption of fruits and vegetables, Start Childhood Off Right (SCOR) continued the produce prescription program that screens families for food insecurity in the Connecticut Children’s Emergency Department (ED) utilizing funding from the Healthier Kids for Our Future grant from the Cigna Foundation. Families with a positive screen receive a voucher for fresh fruits and vegetables. In 2023, SCOR expanded this program to the Connecticut Children’s primary care office in Hartford. To date, the initiative has screened 1,823 families and distributed 689 vouchers, showing a food insecurity rate of about 38%. Of these vouchers provided, 204 have been redeemed. SCOR has partnered with the Hartford Food System, which has provided fresh produce that is bagged for families to take home with them, and with local Hartford grocery

stores which accept the vouchers for redemption of fruits and vegetables. In 2023, posters for this study were accepted and presented at both the Eastern Society for Pediatric Research (ESPR) and the Pediatric Academic Society (PAS) meetings and earned the ESPR advocacy award. SCOR was just awarded a $50,000 grant from the Rite Aid Foundation to expand this program so that all families coming to the ED and primary care can be screened for food insecurity and connected with resources.

OCCH PUBLICATIONS (INCLUSIVE OF GREY LITERATURE)

Administration

Nasir A, Dworkin PH, Lavin A. Healthy families and communities support healthy children. Commentary from the AAP Committee on the Psychosocial Aspects of Child and Family Health. Pediatrics (June 28, 2023) https://publications.aap.org/pediatrics/ resources/24899/healthy-families-and-communitiessupport-healthy.

Childhood Prosperity Lab

Spark DC: A Platform for Innovation, authored by Annika Anderson, MPH on the Advancing Kids site.

Help Me Grow National Center

Passarelli M, Howe E, Walchenbach S, Therriault C. (2023). A Roadmap for Advancing Family-Engaged Developmental Monitoring. Help Me Grow National Center & Association of University Centers on Disabilities. https://helpmegrownational.org/wpcontent/uploads/2023/01/A-Roadmap-for-AdvancingFamily-Engaged-Developmental-Monitoring-FINAL.pdf.

Miller M, Passarelli M, Zucker S, Ake W, MartiniCarvell K, Dworkin P. (2023). Help Me Grow: A Model of Targeted Universalism to Advance Equity and Promote the Well-Being of All Children. Social Innovations Journal, 20. Retrieved from https:// socialinnovationsjournal.com/index.php/sij/article/ view/6595.

Injury Prevention Center

Beebe R, Fish MC, Grasso D, Bernstein B, DiVietro S, Stover CS. Reducing Family Violence Through Child Welfare Intervention: A Propensity ScoreMatched Study of Fathers for Change. J Interpers Violence. 2023 Jul 20:8862605231186121. doi: 10.1177/08862605231186121. Epub ahead of print. PMID: 37470201.

Brewer JM, Carpenter S, Rogers S. Clinton H, Borrup K, DeJoseph ME, Campbell BT. (2023). The Epidemiology of Pediatric Suicide Deaths in Connecticut, a Ten-Year Review. Connecticut Medicine, 87(2).

Cook NE, Gaudet CE, Kissinger-Knox A, Liu BC, Hunter AA, Norman MA, Saadi A, Iverson GL. Race, ethnicity, and clinical outcome following sport-related concussion: a systematic review. Front Neurol. 2023 Jun 14;14:1110539. doi: 10.3389/fneur.2023.1110539. PMID: 37388549; PMCID: PMC10306165.

Dukleska K, Borrup K, Campbell BT. Childhood injury prevention: Where we’ve been and where we need to be. Semin Pediatr Surg. 2022 Oct;31(5):151220. doi: 10.1016/j.sempedsurg.2022.151220. Epub 2022 Nov 9. PMID: 36371841.

Hunter AA, Schwab-Reese L, DiVietro S, Green C. An examination of factors contributing to the racial disparity and disproportionality of paediatric firearm-related homicide: a mixed-methods analysis using the national violent death reporting system (NVDRS). Inj Prev. 2023 Jun;29(3):268-271. doi: 10.1136/ip-2022-044733. Epub 2023 Mar 2. PMID: 36863855.

McGuire A, Beebe R, Stover C, Clough M, DiVietro S, Grasso DJ. (2023). Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A): Validation in a child welfare sample of mothers and fathers with active domestic violence. Psychological trauma: theory, research, practice, and policy, 15(1), 163.

McCollum S, Feinberg TM, Clinton HA, Hunter AA (2023). Poisoning-related emergency department visits in children Aged 0 to 9 Years, 2016 to 2018. Connecticut Medicine, 87(2).

O’Neill KM, Dodington J, Gawel M, Borrup K, Shapiro DS, Gates J, Gregg S, Becher RD. The effect of the COVID-19 pandemic on community violence in Connecticut. Am J Surg. 2023 Apr;225(4):775-780. doi: 10.1016/j.amjsurg.2022.10.004. Epub 2022 Oct 7. PMID: 36253316; PMCID: PMC9540704.

Resident Education in Advocacy and Community Health Washburn, Susan. “Childhood obesity is scary, not the new guidelines for treating it” 13 Sept 2023. CT Mirror.

Start Childhood Off Right (SCOR)

Reducing Weight Bias, Stigma and Discrimination –Advancing Kids

White House Conference on Hunger Nutrition and Health – Advancing Kids

GRANTS, GIFTS AND AWARDS

Connecticut Children’s Center for Care CChildhood Prosperity Lab

• The Lab received funding to provide technical assistance to the Building for Health Sustainability and Expansion Planning project, a one-year initiative of the Office for Community Child Health.

• The Lab also collaborated with the Help Me Grow National Center on a community of practice that explored integration of a goal concordant care framework into the system model.

Connecticut Children’s

Center for Care Coordination

• The Center for Care Coordination (the Center) has concluded its third year of a five-year Department of Public Health (DPH) grant for Children and Youth with Special Health Care Needs. These State and Federal dollars, $425,119.82 awarded yearly to the Center, allows for the expansion of communitybased supports for which the Center provided

care planning support to over 2,000 children in FY23. The DPH grant award, along with smaller grant and endowment dollars support efforts to engage in pediatric practices through Connecticut Children’s Care Network. Total grant award (5 year): $2,090,005.

Connecticut Newborn Screening Network

• State Newborn Screening System Priorities Program (NBS Propel) Funding Opportunity Number: HRSA-23-065.

Help Me Grow National Center

• The JPB Foundation: Goal Concordant Care and the Well Visit

• The JPB Foundation: Building Capacity for Goal Concordant Early Childhood Systems

• The Pritzker Children’s Initiative

• Health Resources and Services Administration (HRSA): Early Childhood Developmental Health Systems

• HRSA: Infant-Toddler Court Program National Resource Ctr.

Injury Prevention Center

• CT Elks Association, Safe Kids Connecticut, $75,000

• Petit Family Foundation, Hayley Petit Injury & Violence Prevention Fellowship, $75,000

• Connecticut Coalition Against Domestic Violence, Intimate Partner Violence and Maternal Mortality in Connecticut, $15,000

• CT Department of Children and Families, Intimate Partner Violence Support Project, $240,000

• City of Hartford, Hospital-based Violence Intervention Program (HVIP) Strengthening Collaborative, 2022-2026, $2.4 million over three years

• CT Department of Public Health, Community Violence Intervention Grant Program, $2.1 million over three years

• Connecticut Department of Transportation, Watch for Me CT, $380,000

• Connecticut Department of Transportation, Look Before You Lock, $225,000

• Connecticut Department of Transportation, Child Passenger Safety (CPS) Supports, $75,000

• Hartford Hospital, Injury and Violence Prevention Program, $122,000

Start Childhood Off Right

• Rite Aid grant

• Hartford Food System Access, Education and Advocacy award for helping to fight hunger in the Hartford Community

CORE FACULTY

Administrative

Lauren Dominique, MA

Paul Dworkin, MD Executive Vice President for Community Child Health, Connecticut Children’s; Founding Director, HMG National Center; Professor Emeritus of Pediatrics at the University of Connecticut School of Medicine

Laura Marin Ruiz, DDS, MHA

Kimberly Martini-Carvell, MA

Scott Orsey

Luis Rivera, MSW

Center for Global Health

Adam Silverman, MD, Associate Professor of Pediatrics

Naveed Hussain, MD, Professor of Pediatrics

Christopher Hughes, MD, Assistant Professor of Pediatrics

Stephen Mahier, BSN, RN

Lisa LeBon, MAE, RRT

Lisa Roberts, AS, AAIII

Childhood Prosperity Lab

Jacquelyn Rose, MPH, Director of Childhood Prosperity Lab

Annika Anderson, MPH, Program Coordinator for Childhood Prosperity Lab

CLASP Co-Management

Ilana Waynik, MD, Director of Clinical Effectiveness, Connecticut Children’s Medical Center; Associate Professor of Pediatrics, University of Connecticut School of Medicine

Karen Rubin, MD, Program/CLASP Founder, Professor Emeritus Pediatrics, Pediatric Endocrinology, University of Connecticut School of Medicine

Grace Hong, AP, Senior Development Specialist, Clinical Effectiveness Program

Mellissa Molcan, BSN, RN, CCRN, Clinical Data Coordinator

Children’s Center for Care Coordination

Allison Matthews-Wilson, LCSW, Director, Center for Care Coordination

Kristin McCormack, Manager Regional Care and Care Management Operations

Ann Riley MSN, RN, Care Coordination Team Lead

Nancy Caperino, LCSW

Damaris Rodriguez

Rachelle Tirrell, BSN, RN

Jaclyn Donahue, BSN, RN

Kerri Zimmerman, LMSW

Connecticut Children’s Healthy Homes Program

Chris Corcoran, Manager

Alba Cruz, MPH, Relocation Education Coordinator

Amalyn Morales, Program Coordinator

Esther Figueroa, Program Manager

Jessica Rios, Program Coordinator

Natalie Knight, Administrative Assistant II

Pam Sanchez, Relocation Education Coordinator

Rosa Alvarado, Administrative Assistant II

Tavanna Hansberry, Relocation Education Coordinator

Tom Rotchford, Construction Manager

Connecticut Newborn Screening Network

Karen Rubin, MD, PI/Medical Director, Professor Emeritus Pediatrics, Pediatric Endocrinology, University of Connecticut School of Medicine

Debra Ellis, RN BSN

Katie Raboin, RN MSN

Ginger Nichols, MS LCGC

Meghan Criscuolo, RN BSN

Niharika Locke, RN, BSN

Easy Breathing©

Jessica P. Hollenbach, PhD, AE-C, Assistant Professor, Co-director

Educating Practices

David Krol, MD, MPH, FAAP, Program Director

Cassie Yaiser, MS, Program Associate

Katie Wilson, Program Coordinator

Hartford Youth Identification and Linkage Consortium

Danielle Warren-Dias, MS

Nilda Fernandez, MSW

Help Me Grow® National Center

Paul H. Dworkin, MD, HMG Founding Director

Kimberly Martini-Carvell, MA, Executive Director

Sara Sibley, MBA, Associate Director of Business Development & Operations, HMG National Center

Melissa Passarelli, MA, Associate Director of Implementation & System-Building, HMG National Center

Melissa Miller, MPH, PMP, Associate Director of Impact & Network Performance

Chelsea Neelon, BA, Associate Director of Policy & Community Change

Sarah Zucker, BA, Manager of Communications & Network Relations

Morgan Reiss, LMSW, Program Specialist of Communications & Policy

Nadia King, MHA, Program Specialist of Implementation & System-Building

Noshin Ahmed, MPH, Program Specialist of Impact & Network Performance

Skyley Parizek, Program Specialist of Business & Administration

Injury Prevention Center

Kevin Borrup, DrPH, JD, MPA, , Executive Director & Assistant Professor in Pediatrics

Kelsey Alexander, MPH, Program Coordinator, Community Violence Intervention Grant Program

Renee Beavers, LMSW, Hospital-based Violence Intervention Program (HVIP) Specialist

Rebecca Beebe, PhD, Research Scientist & Assistant Professor in Pediatrics

Bruce Bernstein, PhD, Affiliated Faculty & Research Scientist

Brendan Campbell, MD, MPH, Donald W. Hight

Endowed Chair in Pediatric Surgery, Chief Surgical Quality Officer, Research Scientist, Professor of Surgery and Pediatrics, Medical Director of the Injury Prevention Center

Meghan Fish, MA, Research Associate

Susan DiVietro, PhD, Research Scientist & Assistant Professor of Pediatrics

Katerina Dukleska, MD, Research Scientist & Assistant Professor of Pediatric Surgery

Sarah Gedeon, MSW, Hospital-based Violence Intervention Program (HVIP) Research Assistant II

Damion Grasso, PhD, Research Scientist & Associate Professor of Psychiatry

Amy Hunter, MPH, PhD, Research Scientist & Assistant Professor of Public Health Sciences

J. Leslie Knod, MD, Research Scientist & Assistant Professor of Surgery and Pediatrics

Amalyn Morales, ASCEND Program Coordinator

Mary-Kate Nowobilski, Research Associate II

Sydney Osborne, MPH, Program Coordinator, Child Passenger Safety

Mayra Pino, Research Assistant I

Steven C. Rogers, MD, Research Scientist & Associate Professor of Emergency Medicine

Elizabeth Sagan, Program Specialist, Safe Kids Connecticut

Sharon Smith, MD, Research Scientist & Professor of Pediatrics

Amy Watkins, MPH, Assistant Manager, Injury Prevention Center

Kristen Volz, MS, Research Assistant II

North Hartford Ascend

Paul Dworkin, MD, Project Director

Jacquelyn Rose, MPH, Deputy Project Director

Michelle Safo-Agyeman, MS, Program Manager

Asiah Stewart, BS, Program Coordinator

Person-Centered Medical Home

Catherine Wiley, MD, Program Medical Director, Professor of Pediatrics

Cynthia O’Brien RN, Consulting Program Manager, Nurse Manager

Andrew Carlson, MD, Primary Care Medical Director, Assistant Professor of Pediatrics

Shana Lowery, MBA, Practice Manager

Amaris Delgado, MA, PCMH, QI Team Representative

Assistant Professors of Pediatrics:

Brooke Bohn, MD, Jennifer Haile, MD

Shannon Hogan, DO, MPH

Abraham Khorasani, MD Ashok Kottarathara, MD

Jaye Ladinsky, MD,

Douglas MacGilpin, MD, Amira Mohamed-Ahmed, MD, Chinyere Okoronkwo, MD, MSc, Esther Oziel, MD, Aruna Ramanan, MD, Marie Sanford, MD, Larry Scherzer, MD MPH, Latesha Dawson Thomas, MD, CLC, Nancy Trout, MD, MPH, Keri Wallace, MD, Caleb Wasser, DO

Darlene Abbate, APRN

Keith Ellis, APRN

Monica Joyce-Montaudy, APRN

Kimberly Griffith, PA-C

Keri Herlan, PhD

Amy Signore, PhD

Heather Wimmer-Haman, PsyD

Angela Easterling, Care Coordinator

Sheyla Rosado, Care Coordinator

Darwin Garcia-Nunez, LMSW, Social Work Care Coordinator

Resident Education in Advocacy and Community Health

Jonah Mandell, DO, Assistant Professor Pediatrics University of Connecticut School of Medicine

Start Childhood Off Right (SCOR)

Stacey Chandna, MS, CIP

Nancy Trout, MD, MPH, Assistant Professor Pediatrics, University of Connecticut School of Medicine

GRANTS

Acsadi,

An Open-Label Extension Study for Patients With Spinal Muscular Atrophy Who Previously Participated in Investigational Studies of ISIS 396443

Acsadi, Gyula Open label, long- term safety, tolerability, and efficacy study of GIVINOSTAT in all DMD patients who have been previously treated in one of the Givinostat studies.

patients who have been previously treated in one of the Givinostat studies.

Acsadi,

double blind, placebo controlled, multicenter study to evaluate the efficacy and safety of givinostat in ambulant patients with Duchenne Muscular Dystrophy

Bezler, Natalie Protocol # 54767414ALL2005 An Openlabel, Multicenter, Phase 2 Study Evaluating the Efficacy and Safety of Daratumumab in Pediatric and Young Adult Subjects greater than or equal to 1 and less than or equal to 30 Years of Age With Relapsed/ Refractory Precursor B-cell or T-cell Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma

Hawley, Kelly Multivalent Syphilis Vaccine

Hyams, Jeffrey A Long-Term Non-Interventional Registry to Assess Safety and Effectiveness of Humira® (Adalimumab) in Pediatric Patients with Moderately to Severely Active Crohn's Disease (CD) – CAPE

Hyams, Jeffrey A Multicenter, Prospective, Long-term, Observational Registry of Pediatric Patients with Inflammatory Bowel Disease, DEVELOP®

Hyams, Jeffrey A Phase 2b, Extension Study to Determine the Long-term Safety of Vedolizumab IV in Pediatric Subjects With Ulcerative Colitis or Crohn’s Disease Long-term Safety With Vedolizumab IV in Pediatric Subjects With Ulcerative Colitis or Crohn’s Disease

Isakoff, Michael A Phase 2 Study of the JAK1/JAK2 Inhibitor Ruxolitinib With Chemotherapy in Children With De Novo High-Risk CRLF2-Rearranged and/or JAK Pathway–Mutant Acute

Isakoff,

Loechner,

Evaluate the Safety, Tolerability,

Ounpuu, Sylvia A study of the correlation between gait abnormalities, activity monitoring parameters, CMTPedS and a biomarker in children with Charcot-Marie-Tooth disease

Riba-Wolman, Rebecca

Follow-up Study to Evaluate the Safety and Efficacy of Adeno-Associated Virus (AAV) Serotype 8 (AAV8)-Mediated

Transfer

Glucose-6-Phosphatase (G6Pase) in Adults with Glycogen Storage Disease Type Ia (GSDIa)

Riba-Wolman, Rebecca A Phase 3, Randomized, Double-blind, Placebo-controlled Study of Adenoassociated Virus Serotype 8-mediated

Transfer of Glucose-6-phosphatase in Patients with Glycogen Storage Disease Type Ia

Salazar, Juan Prevalence of Syphilis and Other Sexually Transmitted Infections in Men and Transgender Women Who Have Sex with Men in Cali, Colombia

Juan Expanded Access IND Program to Provide Stamaril® Vaccine to Persons in the United States for Vaccination Against Yellow Fever

Tory, Heather Patient and Physician Discordance of Global Disease Assessment in Juvenile Dermatomyositis: Findings from the Childhood Arthritis & Rheumatology Research Alliance Legacy Registry