Department of Pediatrics — June 2023

PEDIATRICS

PHILANTHROPY

Nurses honor memory of beloved LPN with scholarship for other LPNs

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RESEARCH

Clinical researchers at Dartmouth Health Children’s continue making great strides in vaccinology

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IN MEMORIUM

Remembering Dartmouth alumnus Sam Katz

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Remembering CHaD

neonatologist Bill Edwards

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Celebrating 50 Years of Neonatology

Dartmouth Health Children’s is a leader in the care of sick and premature newborns.

The pediatric subspecialty of neonatology is a relatively new practice of medicine, and Dartmouth Health Children’s has been at the forefront of the care of sick and premature newborns from the beginning. As the first neonatologist in New Hampshire, George Little, MD, was a pioneer in the field, building the neonatal program at Dartmouth Hitchcock Medical Center (DHMC) from the ground up, starting in 1972.

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Steven Ringer, MD, PhD, the current section chief of neonatology, rounds in the Intensive Care Nursery at the Children’s Hospital at Dartmouth Hitchcock Medical Center.

A Message from Our Chair

Welcome to the inaugural Dartmouth Pediatrics alumni newsletter. I’m proud to share with you updates on the great things going on in the Department of Pediatrics at the Geisel School of Medicine and Dartmouth Health Children’s, which may have been called Dartmouth Medical School and Children’s Hospital at Dartmouth (CHaD) when you were here.

This year, we are celebrating 50 years of neonatology at Dartmouth and in New Hampshire. As you will read inside, we created—and still maintain—the first neonatal intensive care unit in the state: the Intensive Care Nursery at the Children’s Hospital at Dartmouth Hitchcock Medical Center (CHaD). Just as we have always done, we also support perinatal care at smaller hospitals all around our region. Now we augment that with telemedicine, or TeleICN. While that’s a recent innovation, we continue to make sure that it, and all of our care, is patient- and family-centered, for which Dartmouth Neonatology has been a national and international leader.

In addition to celebrating the past, we highlight Dartmouth Pediatrics’ contributions to state-of-the-art vaccinology. Not only did Peter Wright, D ’64, MD ’75, collaborate with Geisel researchers who made a landmark discovery that contributed to the rapid development of the mRNA coronavirus vaccine, but he also continues to conduct studies exploring how new vaccines exploiting mucosal immunity can help stop transmission of the virus. Learn more in this newsletter about how our experience and expertise position Dartmouth to lead in the next era of vaccine science.

In this first issue we also recognize the passing of three special members of our Dartmouth Pediatrics family.

Vaccinologist Sam Katz, D ’48, MD ’50, HON ’98, and neonatologist Bill Edwards, MD, RES ’77, FEL ’78, both made significant contributions to their fields, and we are forever grateful for their pursuit of excellence. Jackie Thayer, LPN, cared for patients, families, and us as health professionals, throughout her 50 years of service as a pediatric nurse at DHMC and the former Mary Hitchcock Memorial Hospital. To honor her memory, Jackie’s nursing colleagues created a scholarship fund that will help medical assistants and licensed nursing assistants earn their licensed practical nursing certification.

I enjoyed meeting some of you at the Pediatric Academic Societies’ Annual Meeting in Washington, D.C. I hope to meet more of you at future meetings and when you visit the campuses here at Dartmouth. In the meantime, please be on the lookout for the next newsletter, as there is so much more to tell.

Keith Loud, MD, MSc, RES ’00 Chair, Department of Pediatrics, Geisel School of Medicine

Dartmouth Health Children’s Physician-in-Chief

Join Us in Washington, D.C.

We look forward to hosting an alumni reception during the American Academy of Pediatrics National Conference and Exhibition in Washington, D.C., in October. We invite you, our Dartmouth Pediatrics community, to join us to reconnect and celebrate our collective accomplishments. Keep an eye out for a formal invitation with details in the coming months.

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had Jackie as a colleague, mentor, and friend for all these years.”

Scholarship fund honors the legacy of CHaD nurse

As a powerful testimony to the influence of Jackie Thayer, LPN, a group of nurses at Children’s Hospital at Dartmouth Hitchcock Medical Center (CHaD) established a scholarship fund to honor her memory and to help train new licensed practical nurses. Thayer passed away in May 2021.

“Jackie was a thoughtful teacher and has touched the lives of countless patients, families, and learners,” said Nicole Tadlock, RN, a pediatric nurse manager at Dartmouth Hitchcock Medical Center (DHMC). “Her years of experience, dedication, kind heart, and love for nursing are just a few of the things that made Jackie so special. We are very lucky to have had Jackie as a colleague, mentor, and friend for all these years.”

The Jackie Thayer, LPN Nursing Education Fund already has $50,000 in commitments, with a goal of $100,000 to endow the fund. The fund will support scholarships for medical assistants

and licensed nursing assistants to pursue their licensed practical nursing certification.

Thayer was part of the CHaD family for 50 years, starting at Mary Hitchcock Memorial Hospital in 1971. “Quietly and patiently, she informally taught many physicians over her career,” says Keith Loud, MD, MSc, RES ’00, chair of the Department of Pediatrics and physician-in-chief of Dartmouth Health Children’s. “The vast majority of alumni who went through the residency program were partially taught and trained by Jackie. We knew to pay attention to her because she knew when a kid was sick. Jackie’s legacy will live on and continue to inspire others for generations to come.”

For more information on the Jackie Thayer, LPN Nursing Education Fund, please contact Polly Antol, director of development for Child Health Initiatives, at Polly.Antol@hitchcock.org

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Her years of experience, dedication, kind heart, and love for nursing are just a few of the things that made Jackie so special. We are very lucky to have

Nicole Tadlock, RN pediatric nurse manager

Jackie Thayer, LPN

The Past, Present, and Future of Vaccinology

Researchers at Dartmouth Health Children’s make advancements in vaccine development for COVID-19, polio, and other diseases.

In many people’s view, little good came out of the coronavirus pandemic. However, for virologists and vaccinologists at Dartmouth Health Children’s, the past three years have been full of discovery and exciting medical advancements.

Despite the losses and hardships of the pandemic, the novel mRNA vaccines represent a shining accomplishment in helping to bring the pandemic under control. Jason McLellan, PhD, then-professor at Geisel School of Medicine, started laying the foundation in 2014, collaborating with colleagues at Dartmouth and elsewhere to learn how to stabilize the spike proteins common to all coronaviruses in order to make a better vaccine. McLellan’s breakthrough discovery in 2016 of the structure of the coronavirus spike protein led to the speedy development of the mRNA vaccine for the SARS-CoV-2 outbreak in 2020. Their achievement has saved millions of lives around the world.

“That’s a success story that doesn’t happen every day— some people don’t have it happen in their whole career,” says Peter Wright, D ’64, MD ’65, a pediatric infectious disease specialist at Dartmouth Health Children’s who immediately began studying the immune responses of infected people during the first wave of the pandemic.

The technology McLellan and others developed led to an agreement with Moderna, manufacturer of the vaccine, to generate royalties for Geisel. Wright is already working on research that focuses not only on antibodies that prevent viral infections in vaccinated people, but also those with the potential to reduce transmission of viral infections from person to person.

Expansive Vaccine Research

Dartmouth Health Children’s has a long history of vaccine research and development, far longer than COVID-19 has been around. Wright and other clinical

Remembering Dr. Sam Katz

Dartmouth alumnus Samuel Katz, D ’48, MD ’50, HON ’98, was an influential and world-renowned virologist who helped develop the measles vaccine, which has saved countless lives over the past 60 years. Katz died in October 2022 at age 95.

Born and raised in Manchester, New Hampshire, Katz completed his undergraduate studies at Dartmouth College and then earned his MD degree at Dartmouth Medical School and Harvard Medical School.

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Peter Wright, D ’64, MD ’65, is studying why an oral vaccine that triggers an immune response in the gastrointestinal tract can prevent viral infections in the respiratory tract.

researchers have contributed to vaccine development for many other pediatric diseases, such as polio and respiratory syncytial virus (RSV) infection.

“Polio has been a remarkable model to study because we have two effective vaccines. The inactivated vaccine is highly effective at preventing paralytic disease but doesn’t prevent the virus shedding from the gastrointestinal tract, where it can spread to other people,” Wright says. “We also have a live, oral vaccine that develops mucosal antibodies detected in the stool that limit person-to-person transmission.”

In his research, Wright is trying to determine why vaccines delivered orally—triggering an initial immune response in the GI tract—can be extraordinarily good at preventing infection by a virus that causes respiratory illness. “We’re trying to understand why it works and build on that both in terms of safety and effectiveness,” Wright says.

John Modlin, MD, emeritus professor of pediatrics and of medicine at Geisel, also has been studying polio for decades. An outbreak of poliovirus infections in 2022 among a small group of unvaccinated people in New York has caused him great concern. The disease has been eradicated in the U.S. for many years, so the extensive transmission of this virus—which left one young adult paralyzed—is considered a public health emergency.

Modlin recently took a leave of absence from Dartmouth to work at the Bill & Melinda Gates Foundation on a new oral polio vaccine that reduces the rare risk of polio caused by the current oral vaccine, which is widely used in low-income countries. This vaccine is only for type 2 polio; Wright is currently conducting clinical trials to develop a similar vaccine for types 1 and 3. Wright says this idea is linked to COVID-19: “The concept ties into the

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Live vs. Inactivated Polio Vaccines

The version of the polio vaccine currently used in the U.S. is the injection made from a killed virus. A live vaccine given orally was used decades ago when the disease was widespread. While effective at preventing transmission, the live version could cause polio in very rare cases. When polio was eradicated throughout much of the world, U.S. public policy developed by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics determined that it was appropriate to distribute the inactive vaccine only.

Katz was a resident at Boston Children’s Hospital during a polio outbreak in 1955. The experience led him to join the lab of Nobel Prize–winning John Enders, MD, who was working on a polio vaccine. Together, Enders and Katz developed an attenuated measles virus vaccine, approved by the Food and Drug Administration in 1963.

Katz joined the Department of Pediatrics at Duke University School of Medicine in 1968 and chaired the department for 22 years. During his tenure, John Modlin, MD, emeritus professor of pediatrics and of medicine at Geisel School of Medicine, was a medical student.

“I was drawn to this new and exotic field of viral disease and vaccines,” Modlin said. “As a result of Sam’s influence, I ditched my plan to go into surgery and did my residency and an infectious diseases fellowship at Boston Children’s.”

Peter Wright, D ’64, MD ’65, a pediatric infectious disease specialist at Dartmouth Health Children’s, also knew Katz at Boston Children’s.

“Sam had a tremendous name in terms of vaccine development, including later working in the areas of vaccine hesitancy and acceptance,” Wright said. “We’re building on his legacy.”

At the time, Dartmouth Medical School was re-establishing its four-year medical degree program, and it needed to provide education in the subspecialty. Plus, this expertise was urgently needed in the region.

“Babies started coming immediately, so we had to get ready in a hurry,” remembers Little, emeritus professor of pediatrics and of obstetrics and gynecology at Geisel School of Medicine. “There was a demand clinically and also academically. We created a clinical fellowship in neonatology and established a research component.”

The intensive care nursery (ICN) at Mary Hitchcock Memorial Hospital was equipped with ventilators, incubators, and other hightech equipment to provide specialized care. There were no other neonatology programs in the state, so Little co-founded the Vermont/ New Hampshire Regional Perinatal Program, partnering with the University of Vermont

Contributions to Global Medicine

From early on, many people in the Division of Neonatology have been involved in international health, particularly in Africa and southeastern Europe. In the Republic of Kosovo, Little helped establish a foundation that’s now called Action for Mothers and Children (AMC), and he is still actively involved even after retiring from Dartmouth. Ringer has been involved for 25 years in international care, particularly in Vietnam, Ethiopia, India, and Tanzania.

Medical Center in Burlington to care for sick newborns in the region.

Knowing he could not run the program singlehandedly, Little hired Judith Frank Ketterer, MD, MS ’99, as the second neonatologist in New Hampshire. In addition to physicians, the ICN needed skilled nurses as well as social workers to help parents worried about their sick babies, so training other neonatal staff began right away.

Little understood, as did his successor, the late Bill Edwards, MD, RES ’77, FEL ’78, that neonatology must serve not only newborns, but also their parents and families. So, while other neonatal programs around the country left parents out of staff discussions about their babies, DHMC’s neonatologists welcomed them at every step.

“We became nationally known for inviting parents on rounds when medical teams got together to discuss their baby’s care, which was a major change in the way neonatal care was provided in this country,” Little says. “It involves an understanding of the effectiveness and moral reasons why parents should be involved in the decision-making process for their babies. It also involves helping parents so they can engage in that process while they’re under an extreme amount of stress. Bill Edwards was a leader at this.”

The highly innovative neonatal unit at Catholic Medical Center in Manchester, New Hampshire, can be credited, in part, to Edwards’ devotion to familycentered care. When Dartmouth-based obstetrics

The neonatal intensive care unit at Mary Hitchcock Memorial Hospital.

George Little, MD, founder of the neonatal intensive care unit at Dartmouth Hitchcock Medical Center and co-founder of the Vermont/New Hampshire Regional Perinatal Program.

services moved to Manchester, Edwards saw to it that the facility was equipped to serve both newborns and their parents, including private rooms for families, which was rare at the time.

“Bill made sure the model of care was such that parents could stay with their baby as much as possible during hospitalization,” says Steven Ringer, MD, PhD, who is the third and current section chief of neonatology, taking over the program in 2015. “The majority of hands-on care is done by parents with nurse supervision, which completely changes the dynamic of neonatal intensive care. It improves parent-baby interaction and lessens parents’ anxiety. Involving parents and helping them get through the process has been enormously important for us.”

One of the greatest recent neonatology innovations at DHMC is the telemedicine intensive care nursery, TeleICN, which started around 2018. With advanced technology, neonatologists at the Children’s Hospital at DHMC (CHaD) can be virtually present in the delivery rooms for high-risk births at smaller hospitals. CHaD neonatologists can advise pediatricians with less experience in this subspecialty on the best way to care for sick and premature newborns.

“The doctors and nurses can move an iPad into the delivery room, so it’s almost like we’re right there,” Ringer explains. “So, when the baby is born, we can supervise and monitor and answer questions immediately, whether they’re questions about approach to care or practical questions. They can move the camera right next to the baby, and we can guide them through the process.”

And when the emergency has passed, CHaD neonatologists can review cases with the pediatricians at the smaller hospitals while the event is still fresh in everyone’s mind. Rather than setting up training sessions at multiple referring hospitals months later, telemedicine allows physicians and nurses to review cases anywhere within just a few days. CHaD neonatologists can also set up simulations for training— no matter how far away another hospital is.

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In Memoriam

Remembering Dr. Bill Edwards

William “Bill” Edwards, MD, RES ’77, FEL ’78, neonatologist and emeritus professor of pediatrics at the Geisel School of Medicine, passed away in December 2022 at age 73. He was a hugely influential neonatologist, helping to establish a standard of family-centered care at the Children’s Hospital at Dartmouth Hitchcock Medical Center (CHaD).

Edwards completed his residency in pediatrics at Dartmouth Hitchcock Medical Center (DHMC) and trained in neonatology at DHMC and the University of Texas Southwestern Medical Center. He spent his professional career at Dartmouth Health Children’s, returning to DHMC in 1979 as the medical director of Nursery Services and the Intensive Care Nursery. He served as chief of Neonatology from 1998 until 2015 and became vice chair of the Department of Pediatrics in 2001, where he served as the conscience of the department, providing trusted, wise counsel to trainees, colleagues, and institutional leadership.

An exceptionally compassionate physician and rigorous investigator, Edwards worked tirelessly to improve quality and evidenced-based care at Dartmouth Health Children’s and to establish a practice of involving parents in the care of their newborns. As part of his advocacy for family-centered care, Edwards became a founder and longtime director of the Vermont Oxford Network (VON), one of the leading neonatal quality improvement collaboratives in the world.

Edwards taught and mentored generations of Geisel students, CHaD residents, fellows, and junior faculty, and he continued to do so as active emeritus faculty. “Bill was a wonderful physician and leader,” says George Little, MD, emeritus professor and chair of Maternal Child Health and the founder of CHaD. “His sudden departure devastated not only fellow physicians, but also the nurses, hospital staff, and the entire institution.”

Neonatologist Bill Edwards, MD, RES ’77, FEL ’78, made great contributions to the development of family-centered care in the Department of Pediatrics.

“It’s hard to get enough people together at a particular time for training, but if we can do it for a half-hour over lunchtime, even with just a few people, it’s no big deal,” says Ringer, who adds that they still hold in-person sessions. “It’s an efficient use of everybody’s time.”

Today, the neonatal program is recognized for its high-quality care, especially in reduced nosocomial infections and better skin care, and for its quality improvement efforts. One particular quality improvement Ringer stresses as a critical need to enhance neonatal care at CHaD in Lebanon is an upgraded, state-of-the-art ICN unit, which would improve outcomes for newborns and parents alike.

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coronavirus vaccine. We must develop mucosal antibodies to protect against transmission.”

National and Global Impact

Working with groups such as the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and the World Health Organization, Dartmouth Health Children’s faculty contribute to public policy and the impact of vaccines on human health on a global scale.

Modlin, for example, was chair of the ACIP for six years when the federal government was on high alert

“From a physical standpoint, we’re behind the times, but philosophically, we’re ahead of the times,” Ringer says. “This is an immediate need for better neonatology care, and it will allow us to bring the innovative care practices at Catholic Medical Center here to CHaD.”

Everyone at the hospital—past and present—is proud of how far the neonatology program has come over these 50 years, both clinically and academically.

“We established a truly academic division of neonatology,” Little says. “It provides clinical care and teaches and does research. That was the objective right from the start, and that’s what we did.”

regarding anthrax and smallpox bioterrorism scares. “Our committee made recommendations about how to manage the smallpox vaccine at the time,” he says.

Cody Meissner, MD, an infectious disease physician, also has contributed much to the development of vaccines in his career. Now a professor of pediatrics at Geisel, he advises federal agencies on where to invest resources most effectively in the regulation and licensing of vaccines. He serves on the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) and the Biomedical Advanced Research and Development Authority (BARDA) as an adviser on medical countermeasures to possible threats, such as

smallpox, Ebola, and avian influenza, among other viruses.

“We don’t know when or where the next pandemic will come from— but I’m sure it will come because that’s the history of the world,” Meissner says. “We need to figure out the lessons learned from this coronavirus pandemic so we can better prepare for the future.”

He adds: “It’s exciting for Dartmouth to have the opportunity to contribute in this vital area. In the United States, vaccine development and high vaccine acceptance rates have resulted in the near elimination of many vaccine-preventable infectious diseases. We have a responsibility to ensure the rest of the world has access to the same vaccines.”

We became nationally known for inviting parents on rounds when medical teams got together to discuss their baby’s care, which was a major change in the way neonatal care was provided in this country.”

George Little, MD neonatologist and emeritus professor

Photographer: Mark Washburn

Writer: Ashley Festa

Designer: Linnea Spelman

Department of Pediatrics