University of Chicago Department of Pediatrics 2016 Annual Report

TO EACH

Child A PROMISE Department of Pediatrics 2016 ANNUAL REPORT

TO EACH

Child A PROMISE

To treat every disease no matter how rare To prevent illness and injury To pursue the knowledge to advance pediatric medicine To make the world a better place for kids To maximize every child’s full potential

Each child holds the promise to create a “better tomorrow. We promise to help them achieve that potential. ”

To honor these promises, we strive to be at the forefront of transformative discovery and innovation in pediatric medicine. This report showcases some of the achievements of our physicians, physician-scientists, and scientists. Focused on four key areas of child health: The Developing Child, Cancer & Host Defense, Genomics & Organ Physiology, and Community Health, we set a high bar for exceeding current clinical outcomes, especially for children in our community who face significant health disparities on a daily basis.

Neonatologist Erika Claud, for example, is investigating how the microbiome affects the neurodevelopment of young underprivileged children as part of a $157-million National Institutes of Health (NIH) study of the role of environmental and socioeconomic factors in children’s health outcomes. Bradley Stolbach’s $2 million grant from the Substance Abuse and Mental Health Services Administration allows us to directly help children recover from the psychological and physical trauma of violence.

The Department of Pediatrics has access to unparalleled academic resources and multidisciplinary collaborations across the university campus. Last year, the University of Chicago launched the Genomic Data Commons, providing the ability to compute unprecedented amounts of cancer data. By leveraging this architecture, pediatric oncologists Susan Cohn and Sam Volchenboum have developed the world’s largest clinical database on neuroblastoma patients, with other pediatric diseases soon to be added.

Our clinical milestones and medical “firsts” have been many. One recent example is our newly built pediatric hybrid cardiac catheterization lab, which offers the new technology of real-time dose tracking of radiation exposure to patients. Last year, interventional cardiologists Melissa Webb, Daniel Gruenstein and Sandeep Nathan performed a transradial cardiac catheterization in the youngest and smallest patient in the world.

We take pride in training pediatricians who are not merely outstanding physicians, but also national and international leaders and scholars in child health. The University of Chicago Pritzker School of Medicine, ranked eleventh among the nation’s medical schools by U.S. News & World Report, includes such dedicated educators as H. Barrett Fromme, who received the 2016 Pediatric Hospital Medicine Award for Educational Achievement and Innovation. The award recognizes her establishment of the National Pediatric Nighttime Curriculum, now in approximately 75% of all U.S. residency programs.

We are an academic pediatric community committed to achieving excellence in clinical care, encouraging innovative scholarship, and maximizing the promise of every child in our community.

John Cunningham, MD Donald N. Pritzker Professor Chair, Department of Pediatrics Physician-in-Chief, The University of Chicago Medicine Comer Children’s Hospital John Cunningham, MD, with two-year-old patient Leah Hart 2 2016 ANNUAL REPORT Department of Pediatrics

Table of Contents EDUCATION 4 DEVELOPING CHILD

8

Neonatology 9 Developmental & Behavioral Pediatrics

10

Kennedy Center

11

Neurology 12

CANCER & HOST DEFENSE

14

Allergy & Immunology

15

Hematology & Oncology

16

Critical Care

18

Rheumatology 20 Infectious Diseases

20

Dermatology 21

GENOMICS & ORGAN PHYSIOLOGY

22

FY16 YEAR IN REVIEW

5,143

admissions

,774 31 emergency room visits

43,769

patient days

56,476

ambulatory visits

Endocrinology 22 Gastroenterology, Hepatology & Nutrition

23

Cardiology 24 Nephrology 25 Pulmonology 25

COMMUNITY HEALTH

26

Emergency Medicine

26

Chronic Diseases

27

Academic Pediatrics

28

Medical Ethics

29

Community Service & Science

30

SURGICAL PARTNERS

32

COMER CHILDREN’S HOSPITAL

34

1,832 190 staff 179 faculty & academics

residency applications 100% fill rate

67

active clinical trials

252

grants awarded

Department of Pediatrics 2016 ANNUAL REPORT 3

Education Is Our Foundation Pediatrics, one of 13 clinical departments in the Biological Sciences Division, is committed to a mission of rigorous scholarship characteristic of the University of Chicago. We cultivate leaders in pediatric medicine and research through innovative teaching, experiential learning and cross-disciplinary debate. Trainees of our programs are critical thinkers who never stop asking “why” or “why not” as they continually strive to push beyond current scientific and medical boundaries.

From left: Nancy B. Schwartz, PhD, with Arnold Olali, post-baccalaureate research education fellow, and Glory Velazquez, research assistant 4 2016 ANNUAL REPORT Department of Pediatrics

Our patients are best “served by a diverse group of physicians and scientists.”

As one of only four women in her chemistry program in the 1960s, Nancy B. Schwartz, PhD, knows what it’s like to be underrepresented in a community.

Since then, a focus of her career has been on promoting diversity among scientific scholars, not just at the University of Chicago, but across the United States.

“We’re giving underrepresented individuals the skills they need to be competitive and successful, so ultimately, we can enhance the diversity of the biomedical workforce, develop research capacity and better serve our diverse patient population,” says Schwartz.

training and educational opportunities for underrepresented graduate and postgraduate students in the biomedical and behavioral sciences.

As faculty advisor to the Biological Sciences Division’s Postdoctoral Association, she advocates for postdocs with the administration, organizes career development and ethics training, and helps counsel postdocs. Schwartz also promotes the value of creating such training opportunities to her faculty colleagues, partnering with them to design education programs that emphasize diversity.

A professor of pediatrics, and of biochemistry and molecular biology, her leadership as dean and director of postdoctoral affairs has created an environment that fosters diversity and equality. In 2016, University of Chicago President Robert J. Zimmer presented Schwartz with the Diversity Leadership Faculty Award for her support of research training and mentorship opportunities for minority groups, who still face challenges in academia and the workforce.

Nationally, Schwartz has served on the National Postdoctoral Association’s advisory board and was recognized in 2016 by the organization’s Distinguished Service Award. In the Midwest, she is principal investigator for the National Research Mentoring Network–Committee on Institutional Cooperation Academic Network, which sponsors professional development and grant-writing conferences for underrepresented scientists, as well as mentor training, across 15 academic institutions.

Through the years, Schwartz has secured millions of dollars of funding from the NIH for such programs as the Initiative for Maximizing Student Development and the Post-Baccalaureate Research Education Program. These initiatives provide

In 2016, Schwartz’ various diversity programs resulted in the training of 14 post-baccalaureate students, 15 graduate students, 62 postdoctoral scholars and 66 faculty members at the University of Chicago and other institutions.

“

The next generation of physicians will be even better prepared to care for hospitalized children.

”

From left: Afsaneh Talai, MD, pediatric neurology fellow; Natalia Genere, MD, resident; H. Barrett Fromme, MD, MHPE; Kathy Harold, MD, resident; and Justin Triemstra, MD, chief resident

next generation of physicians will be even better prepared “toThe care for hospitalized children.”

Most pediatric hospitalists educate residents and students as part of the job. Yet few get any formal training in teaching skills.

H. Barrett Fromme, MD, MHPE, is helping to change that.

Fromme developed the Advancing Pediatric Educator Excellence program, an initiative that teaches pediatric hospitalists nationwide how to become successful clinical educators. She also helped write the National Pediatric Nighttime Curriculum—clinically focused modules for learning/teaching on night rotations—now in use at 75% of residency programs.

“There is a world of theory, science and data showing us how to teach and learn better that most of us haven’t been exposed to,” says Fromme, director of Pediatric Hospital Medicine at Comer Children’s. “My mission is to teach others to be evidence-based in their educational strategies.”

The daughter of a teacher, Barrett first became interested in education while in med school. “I designed my first piece of curriculum in my fourth year because I felt poorly prepared for our teaching role as residents,” she says.

From there, Fromme built a Residents-Are-Teachers program for the Pediatric Residency Training Program as a junior faculty member, which eventually led to her leadership of faculty development programs in teaching and education.

Today, she is co-director of the Medical Education Research, Innovation, Teaching, and Scholarship fellowship and teaches in the Faculty Advancing in Medical Education series of workshops that gives faculty practical teaching skills. In 2014, Fromme was named a master of the University of Chicago Pritzker School of Medicine Academy of Distinguished Medical Educators. Through the academy, she started the

Teaching Consult Service, where trained faculty observe the teaching of peers and give formative feedback.

“We can help each other be better, and, in turn, model the value of continued improvement at any stage of a career, which benefits those we teach,” says Fromme.

“I am humbled every time I think that my actions as an educator or clinician can inspire a medical student or resident to do something different, something better.”

Fromme is also co-director of the Pritzker Scholarship & Discovery Track for Medical Education, which trains students in the skills needed to be medical educators and to complete a mentored scholarly project by graduation.

In recognition of her exceptional career in training medical educators, Fromme received the Pediatric Hospital Medicine Award for Educational Achievement and Innovation in 2016.

Department of Pediatrics 2016 ANNUAL REPORT 5

Interprofessional simulation “training is now part of our culture.

As director of the pediatric simulation core, Diana L. Mitchell, MD, can often be found in the PICU’s in situ simulation room dedicated to real-time training of medical care teams. Here, she has facilitated nearly 40 small-group simulation sessions for more than 325 pediatric residents, PICU fellows and nurses, pharmacy residents and respiratory therapists since 2012.

Simulated cases focus on medical resuscitation of critically ill children and communication between team members to promote optimal patient outcomes.

“This training allows real teams to acquire and perfect new clinical skills without compromising patient care.

We practice high-risk, low-frequency events so we’re ready when they occur,” Mitchell said.

”

In addition to these monthly interprofessional sessions, she directs a bootcamp for PICU and pediatric emergency medicine fellows; transport simulations with the University of Chicago Aeronautical Network and PICU team; pediatric trauma simulations; and the simulation-based Pediatric Advanced Life Support course. Recently, she helped design and facilitate a simulation outreach program in the NICU at Little Company of Mary Hospital, a Comer Children’s partner.

Based on her significant contributions to medical education and excellence in teaching, Mitchell was recently named a fellow of the Pritzker School of Medicine Academy of Distinguished Medical Educators.

Diana L. Mitchell, MD

Behind every innovative residency/fellowship program is a strong coordinator committed to medical education. For University of Chicago Medicine Pediatrics, that’s Thea Sinton StrangerNajjar. This year, she was one of only five program coordinators to receive the GME Program Coordinator Excellence Award from the Accreditation Council for Graduate Medical Education.

“I’m here to listen to our residents and fellows, monitor their compliance with accreditation standards, and help make our program one of the best in the country,” says Stranger-Najjar, who began her career 12 years ago as a work/study student in the medical education office.

Thea Sinton Stranger-Najjar with resident Adnan Haque, MD 6 2016 ANNUAL REPORT Department of Pediatrics

What draws trainees to the University of Chicago Medicine for their pediatrics residency? Rochelle Naylor, MD, associate director, Pediatric Residency Training Program, believes it’s the opportunity to train in a program that “delivers highquality medicine in state-of-the-art facilities, often to children from resourcepoor communities.” Among her many roles, Naylor practices as a pediatric endocrinologist and serves as an advisor to residents like Geetha Sridharan, MD. “The advisor-advisee program is a strong component of our residency to support each resident’s development into an outstanding pediatrician.”

From left: Rochelle Naylor, MD, and resident Geetha Sridharan, MD

offer pathways “toWe any possible career goal.”

Many medical residents strive not only to be strong clinicians, but also great physician-scientists, policy makers and child advocates, health economists, or diagnosticians. Our Pediatric Residency Training Program offers a place for residents to gain the skills necessary to become leaders in their chosen fields.

“The curriculum allows residents to learn the core fundamentals, while giving them the flexibility and creativity to meet their individual career needs,” says Alisa McQueen, MD, associate chair for education, and director of both the Pediatric Residency Training Program and Fellowship in Pediatric Emergency Medicine. “Letting physicians be clinicians and academicians is how we’re going to propel child health forward from an economic, environmental and epidemiologic perspective.”

The program combines both inpatient and outpatient experiences caring for some of the country’s most medically complex patients from some of the most challenging urban neighborhoods. ”Here, we think about children’s health in a larger context,” McQueen says. “For example, when we treat a child with gunshot wounds, we not only deal with the physiologic impact, but also the public health implications of gun violence. In addition to developing a high skill level, we’re called upon to become advocates for our patients.”

UChicago Medicine’s Pediatric Residency Training Program is the only one in the country integrating scholarship tracks into a four-year curriculum that lets residents choose to get a master’s degree in addition to an MD degree. The two tracks are health services, resulting in a master’s degree in public policy or health economics, and medical education for a master’s degree in health professions education.

An energetic teacher and champion of residents, McQueen has received several teaching awards since joining the University of Chicago in 2008, including being named a fellow of the Pritzker School of Medicine Academy of Distinguished Medical Educators. She also helped create a high-fidelity simulation-based curriculum with colleagues in pediatric surgery and critical care specifically for pediatric trauma.

“Being a medical educator allows me to help shape how future generations of pediatricians will care for children,” says McQueen. “When I see our residents develop into highly trained doctors and experts in their fields, it is incredibly rewarding to have had a role in their evolution.”

Alisa McQueen, MD, with residents

Since 2005, we have graduated more than:

Medical careers our residents pursue:

250 pediatric residents

60% subspecialty training

35 pediatric chief residents

22% outpatient primary care

150 pediatric subspecialty fellows

18% inpatient hospital medicine Department of Pediatrics 2016 ANNUAL REPORT 7

Developing Child

We envision the perfect “journey home. ”

A “tag team” of physicians is offering intensive outpatient care and mobilizing community resources for critical care “graduates” as they transition back into their homes.

No matter how premature or how small, babies aim to grow. No matter the challenges they face, kids aim to discover and learn. Our experts in Neonatology, Developmental & Behavioral Pediatrics, and Child Neurology promise to help. With comprehensive clinical care and groundbreaking research, we work to unlock the boundless potential in every child—for life.

Bree Andrews, MD, MPH, director of Comer Children’s Center for Healthy Families, says, “We provide a cocoon of support for the families of preemies and babies with complex medical conditions once they leave the NICU.” The team addresses a host of concerns, including medical needs, development, motor skills, speech, growth, and nutrition. Team members are available by pager 24 hours a day and assist in coordinating home services to help caregivers adapt the environment to the child’s needs.

DEVELOPING CHILD SECTIONS

Neonatology »W illiam Meadow, MD, PhD, received the American Academy of Pediatrics 2016 William Bartholome Award for Ethical Excellence

Developmental & Behavioral Pediatrics »L arry Gray, MD, received ongoing support from the Harris Foundation to improve early childhood development »P eter J. Smith, MD, MA, appointed national liaison to the AAP Council on Disability »M ichael E. Msall, MD, appointed to the AAP-CDC Task Force that will write guidelines for following infants with congenital Zika virus exposure

Kennedy Center »G lyn Dawson, PhD, authored “Quantum dots and potential therapy for Krabbe’s disease” in the Journal of Neuroscience Research, highlighting potential therapies for pediatric neurological diseases

Neurology »R eceived funding for more than 15 IRB-approved research studies »S ho Yano, MD, accepted into the NIH’s Genetic Fellowship Program

8 2016 ANNUAL REPORT Department of Pediatrics

Bree Andrews, MD, MPH, and three-month-old Charles Kemp

These children transition to general pediatricians or to a new complex care clinic led by Arlene Roman, MD. “Our goal is to continue caring for children with complex medical problems as they grow, giving them the best chance for a healthy life,” Roman says.

The Family Birth Center The University of Chicago Medicine’s new Family Birth Center is located inside Comer Children’s, providing babies immediate access to the NICU. The Family Birth Center, which opened in 2016, houses nine private delivery suites, five triage rooms and two operating room suites that provide in-room neonatal resuscitation.

Obstetricians, maternal-fetal medicine specialists, midwives, obstetric nurses, obstetric anesthesiologists, and lactation specialists staff the center. Last year, more than 2,000 babies were born at UChicago Medicine.

Jo Allen, RN, cares for a newborn in a family-friendly room at the new Family Birth Center

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ACADEMIC APPOINTMENTS Michael D. Schreiber, MD Professor of Pediatrics Executive Vice-Chair, Pediatrics Chief, Neonatal Intensive Care

Ameth Aguirre, MD, MPH Clinical Associate

Martin Kelly, MD Clinical Associate

Bree Andrews, MD, MPH Assistant Professor of Pediatrics

Richard C. Krueger, MD Clinical Associate

Ansul Asad, MD Clinical Associate

Jeremy D. Marks, MD, PhD Associate Professor of Pediatrics

Gillian M. Brennan, MD Assistant Professor of Pediatrics

Tina Mathai-Taube, MD Clinical Associate

Erika C. Claud, MD Associate Professor of Pediatrics

William Meadow, MD, PhD Professor of Pediatrics

Neonatology

Jaideep Singh, MD, MPH Professor of Pediatrics Medical Director, NICU Sudhir Sriram, MD Associate Professor of Pediatrics Masayoshi Uemura, MD, MPH Clinical Associate

Oussama Itani, MD Clinical Associate

Our NICU babies get home faster and safer.

The length of stay for our very low birth-weight infants who survive is

59 days vs. 64 days

per Vermont Oxford Network benchmark data.

12+ hospitals.

The NICU provides developmental follow-up as well as primary care for

Our Perinatal Network covers

high-risk NICU graduates.

Erika C. Claud, MD

“We can help preterm babies thrive by optimizing their microbiome health.”

A premature infant born into poverty represents one of the greatest opportunities for us to make a positive lifelong difference. These infants are at risk for neurodevelopmental deficits that can linger throughout life. And while the family’s socioeconomic status may not be amenable to change, the infant’s microbiome can be, leading to better cognitive, motor and emotional outcomes.

Environmental influences on Child Health Outcomes (ECHO). The seven-year study will follow more than 50,000 children from diverse racial, geographic and socioeconomic backgrounds and will investigate how exposure to a range of environmental and socioeconomic factors in early development influences their health outcomes.

“The microbiome has been linked to the development of autism, depression and lack of school readiness,” says Erika C. Claud, MD. Her lab has demonstrated that manipulation of the microbiome of mice has measurable effects on neuron number and myelination, crucial aspects of brain development.

Claud’s team has enrolled nearly 200 former preterm infants in the study and will regularly follow them in their home until they start school. The researchers will examine the microbiomes of the children and their parents, and gather detailed data about each child’s environment, such as number of caregivers, whether the child was fed formula or breast milk, and the ability of the child to play outside.

Now Claud will be leading a study of a pediatric cohort at the University of Chicago Medicine and four other medical centers as part of a new NIH $157-million initiative called

“We expect to be the first to study which factors affect

the microbiome of these children and how large an impact their microbiomes have on their neurodevelopment,” says Claud. “Particularly for infants from economically disadvantaged families, it’s exciting to think we can potentially alter environmental factors to modify their microbiomes and improve their neurodevelopment.”

This microbiome research project leverages unique strengths of the University of Chicago, says Claud.

“We have a fabulous microbiome center here, which among other resources provides access to germ-free mice and genetic sequencing platforms at Argonne National Laboratory. We also have a team of specialists focused on the neurodevelopment of preterm infants, and our world-renowned economics school provides expertise in how poverty affects health outcomes in children. By asking the right questions, we can give a lifelong boost to these extremely vulnerable children.”

Department of Pediatrics 2016 ANNUAL REPORT 9

Developmental & Behavioral Pediatrics CONDITIONS WE TREAT » Developmental delays » Cognitive delays » Speech-language delays » Motor delays » Communication delays » Difficulty socializing » Learning disabilities » Challenges in behavior » Intellectual disability

ACADEMIC APPOINTMENTS Larry Gray, MD Associate Professor of Pediatrics Medical Director, Adoption Center Scott J. Hunter, PhD Associate Professor of Psychiatry & Behavioral Neuroscience and Pediatrics

» Attention deficit disorder with/without hyperactivity

Michael E. Msall, MD Professor of Pediatrics Chief, Developmental & Behavioral Pediatrics

» Regulatory skills impacting development and learning at home

Peter J. Smith, MD, MA Associate Professor of Pediatrics

» Autism spectrum disorders » Down syndrome and other chromosomal disorders » Cerebral palsy » Complex, multiple disabilities

Sarah Sobotka, MD, MSCP Instructor Bradley Stolbach, PhD Associate Professor of Pediatrics Karin E. Vander Ploeg Booth, MD Assistant Professor of Pediatrics Program Director, Fellowship in Developmental & Behavioral Pediatrics Sarah Sobotka, MD, MSCP, (right) discusses a research project with a patient’s grandmother, Phyllis McCurry

“I mentor because the needs of vulnerable children are so great.”

In presenting Michael E. Msall, MD, with the prestigious Mentorship Award from the American Academy for Cerebral Palsy and Developmental Medicine in 2016, mentees Sarah Sobotka, MD, MSCP, and Colleen Peyton, DPT, spoke of Msall’s deep faith in the potential of both his mentees and the children with developmental disabilities he treats and manages. Peyton quoted one father who said, “Dr. Msall was the only one who said that my child could go to college.”

Michael E. Msall, MD, with Colleen Peyton, DPT, (left) and Sarah Sobotka, MD, MSCP, upon receiving the Mentorship Award from the American Academy for Cerebral Palsy and Developmental Medicine 10 2016 ANNUAL REPORT Department of Pediatrics

About 2% of children have developmental vulnerabilities and/or medical complexities—cerebral palsy, autism, neonatal diabetes, congenital heart disease—and another 12% have disorders of learning, attention or anxiety that affect their daily lives at home and school.

Yet there are less than a thousand developmental and behavioral pediatricians in the country to provide the clinical care, translational research, family support and

advocacy these children need to live “with differences, not disabilities,” says Msall, a nationally recognized authority on childhood disability.

To ensure that these children don’t get left behind, Msall has made it his mission to train medical fellows and researchers from the fields of developmental pediatrics, child neurology, physical, speech and occupational therapy, developmental psychology and public health— more than 300 individuals so far—to focus their care on neuroprotection and resiliency.

“With many more neonates surviving extremely preterm birth today, it’s critical to have interdisciplinary teams providing proactive neurodevelopmental surveillance and family support,” says Msall. “And that approach makes all our pediatric interventions—cardiology, neonatology, neurology, pediatric critical care medicine, pediatric surgery—better.”

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Children’s learning learning Children’s “and development development happens at at home, home, happens hospital bed. bed.”” not in aa hospital

No one really knows the impact that prolonged hospitalizations have on the neurodevelopment of children, but it’s probably not good, says Sarah Sobotka, MD, MSCP. Children with medical complexity are often dependent on ventilators, gastronomy tubes and other medical technologies. And they are in the hospital for extended periods instead of at home where much of a young child’s learning occurs. Much of this hospital stay requires intensive care, which can be traumatic for the child and the entire family, further disrupting development.

ACADEMIC APPOINTMENTS Glyn Dawson, PhD Professor of Pediatrics Miriam Domowicz, PhD Associate Professor (Research Associate) Robert L. Perlman, MD, PhD Professor Emeritus Jingdong Qin, PhD Associate Professor (Research Associate) Nancy B. Schwartz, PhD Professor of Pedatrics Director, Kennedy Center

Kennedy Center The Growth, Development, and Disabilities MD/PhD Training Program has been funded by the NIH for over 50

years and has graduated over 130 physician-scientists.

The program continues to train 12 current Pritzker medical students annually.

In new research published in Hospital Pediatrics, Sobotka found that a cohort of ventilator-dependent children had a median hospital length of stay of 141 days when they first received a tracheostomy, most often for chronic lung disease due to prematurity. Medically stabilizing these children accounted for only 13 days of the hospitalization; the rest of the time the children waited in the Pediatric Intensive Care Unit for nonmedical reasons, such as state funding approval, home nursing assignment, or parent training on the medical equipment. “Getting through the red tape of public community funding is a tragedy because these children are losing developmental skills as they sit and wait in an ICU bed instead of getting interventions to support speech and feeding and motor skills at home,” says Sobotka.

Committed to shortening hospitalizations and preventing readmissions, Sobotka is studying a transitional care program that simulates a home environment. Here, kids play and sleep in regular-looking bedrooms and living rooms, and parents learn medication management at kitchen counters. This intensive training occurs while parents wait for medical equipment and nursing services to be arranged for their child at home.

After technology-dependent children are discharged from the transitional care program and return home, Sobotka is assessing their parents’ comfort managing the medical technologies and the parents’ physical and mental health over time. She is also examining the children’s access to rehabilitation services and primary care providers.

“If we can show that these transitional care centers are safe and effective places to coordinate care and provide training for patients, children can live in a more developmentally stimulating environment than a hospital and we can open our critical care beds for kids who need active medical management,” says Sobotka.

Miriam Domowicz, PhD, (left) with Miranda Munoz, a scholar in the Post-Baccalaureate Research Education Program

Funded primarily by the NIH, the Joseph P. Kennedy Jr. Intellectual and Developmental Disabilities Research Center supports scientists studying brain function and the cause of developmental abnormalities.

The Kennedy Center’s longstanding research project, with Director Nancy B. Schwartz, PhD, as PI, is focused on defining the principles governing normal nervous system developmental processes that may lead to brain dysfunction and intellectual disabilities.

Other research includes studies of mechanisms of neurodegeneration, traumatic brain injury, skeletal dysplasias, and certain genetic disorders and signaling pathways that affect brain development and function.

Department of Pediatrics 2016 ANNUAL REPORT 11

Neurology

ACADEMIC APPOINTMENTS Julia Henry, MD

Assistant Professor of Pediatrics

David M. Frim, MD, PhD

Ralph Cannon Professor of Surgery Professor of Neurology and Pediatrics Chief, Neurosurgery

Carol Macmillan, MD

Associate Professor of Pediatrics

Charles Marcuccilli, MD, PhD

Associate Professor of Pediatrics

Chalongchai Phitsanuwong, MD

CONDITIONS WE TREAT » Pediatric epilepsy

» Tuberous sclerosis

» Autism

» Neurofibromatosis

»D evelopmental delay

»C ortical malformations

»N eurogenetic disorders

» Headaches

»N eurocutaneous disorders

» Strokes » Tic disorders

Assistant Professor of Pediatrics Director, Child Neurology Residency Training Program

James H. Tonsgard, MD

Associate Professor of Pediatrics and Neurology Director, Ambulatory Program for Neurofibromatosis Named a Top Doctor in 2016 by Chicago magazine

Andrew Tryba, PhD

Research Assistant Professor

Wim Van Drongelen, PhD

Professor of Pediatrics Technical Director and Research Director, Pediatric Epilespy Center Senior Fellow, Computation Institute

Darrel J. Waggoner, MD

Professor of Human Genetics and Pediatrics Director, Neurogenetics Clinic

Darrel J. Waggoner, MD Darrel J. Waggoner, MD, serves as director of the Neurogenetics Clinic and medical director for the Department of Human Genetics Molecular Diagnostic Laboratory—one of very few in the United States offering whole exome sequencing (WES) to patients. He is involved nationally in the establishment of recommendations on the clinical use of WES and the development of educational tools to assist clinical geneticists in interpreting the results. WES is increasingly useful in establishing genetic diagnoses and treatment plans for individuals with rare disorders.

New treatments for neurogenetic “disease are just around the corner.”

Most people have never heard of neurofibromatosis (NF) or tuberous sclerosis, but James H. Tonsgard, MD, has made it his life’s work to care for children and adults with these disorders affecting the skin and nervous system.

He directs the largest clinic for NF in the country, having seen around 2,000 patients, as well as a large clinic for tuberous sclerosis.

The most common type of NF, NF1, occurs in one of every 3,000 babies born, and is associated with neurocognitive deficits that can impact the everyday functioning of people with the disease.

To improve the lives of his patients, Tonsgard co-founded a government-funded national consortium researching alternative treatments for NF. His current research is focused on finding new drug therapies and uncovering the genetic causes of NF. He is also co-investigator on a clinical trial to evaluate the effectiveness of the drug everolimus in shrinking tumors in the brain, kidneys and lungs of tuberous sclerosis patients.

“These neurocutaneous disorders require long-term management and follow-up, and our specialists are among the few providing continuity of care as patients progress into adulthood,” Tonsgard said.

James H. Tonsgard, MD, and Brandon Cannon, 7 12 2016 ANNUAL REPORT Department of Pediatrics

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We’re studying live “human brain tissue to develop seizure treatments.

”

In a unique collaboration, David Frim, MD, PhD, and Charles Marcuccilli, MD, PhD, are using instruments and knowledge of networks—not sight—to treat patients with intractable epilepsy. “It’s like flying a small plane at night through a storm,” Frim says.

Seizures can come from multiple areas in the brain. In adults, they start in the temporal lobe about 80% of the time. In children, it’s much more widely distributed and harder to pinpoint. As a level 4 epilepsy center, Comer Children’s provides the highest level of care for children with complex epilepsy, as well as groundbreaking research on medical and surgical treatments.

David Frim, MD, PhD, and his team perform surgery on patient with epilepsy

Frim, an internationally recognized clinical neurosurgeon and neurosciences researcher, has designed a safe surgical approach to disconnecting and removing the human brain tissue causing the seizures. This approach also helps keep the tissue alive for 24 to 48 hours or more after removal. This enables Marcuccilli, the senior-most pediatric surgical epileptologist in Illinois, and a multidisciplinary team of researchers to study the neurophysiology of brain cells in pediatric patients whose seizures are difficult to treat.

During surgery, Frim implants a grid of electrodes directly on the brain to find the “hot spot,” or seizure focus, where the seizures start. The seizure focus tissue is then carefully resected to stop the seizures from occurring.

A small portion of the tissue is sent to the lab for testing. Each cube of tissue is sliced into sections and then placed in a nutrient and oxygen rich fluid to keep it alive as long as possible.

Marcuccilli and colleagues then use a variety of techniques to induce seizurelike activity while simultaneously measuring the generated electrical currents from the tissue slice. He can then screen several anti-seizure drugs to see if they will stop the seizures. In the future, this information may be used to treat the patient’s seizures should they continue following surgery. He is also using the live brain tissue to study the genetic differences between the brain cells that cause seizures and the normal surrounding tissue.

The live brain tissue resected by Frim is also used in a joint research program with Argonne National Laboratory to map up to a million brain cells in networks. “Our goal is to create virtual systems that can predict whether a patient will have seizures,” Marcuccilli says. “This could impact millions of lives.”

David Frim, MD, PhD, and his team place sensitive electroencephalography (EEG) electrodes directly on the human brain to cover the area suspected to be producing seizures (see above image).

These electrodes record the onset of a seizure with millimeter accuracy, precisely identifying the epileptogenic tissue zone (locations of brain cells that cause the seizures). The panel to the left is a sampling of EEG electrode recordings read by Frim’s partner, Charles Marcuccilli, MD, PhD, and his team to pinpoint the epileptogenic zone.

Department of Pediatrics 2016 ANNUAL REPORT 13

Cancer & Host Defense When the inherent resilience of childhood is breached by cancer, infection, or immunity gone awry, we fight back with cross-cutting research and clinical expertise spanning every discipline. From allergy prevention to cancer immunology to big data for sepsis prediction, our brightest minds tackle the biggest problems for the most vulnerable kids. When kids’ native defenses falter, we promise to protect them and work for a cure.

CANCER & HOST DEFENSE SECTIONS

Allergy & Immunology »C hristina Ciaccio, MD, MSc, appointed chair of the Committee on Complementary and Alternative Practices in Allergy from 2017 to 2019 by the American Academy of Allergy, Asthma and Immunology

Hematology & Oncology »T ara O. Henderson, MD, MPH, selected to chair the ASCO Survivorship Committee »R esearch on intercellular communication by Eric C. Beyer, MD, PhD, now in its 27th year of continuous funding by NIH

Critical Care »N amed ECMO Center of Excellence by Extracorporeal Life Support Organization » Published seven articles in medical journals »J ason Kane, MD, MS, FAAP, FCCM, inducted as a fellow of the Institute of Medicine of Chicago

Rheumatology

»M elissa Tesher, MD, started the Integrative Pediatric Chronic Pain Clinic in 2016 with a grant from the Bucksbaum Foundation »L inda Wagner-Weiner, MD, named director for the Consensus Treatment Plan for ANCA-associated diseases in CARRA

Infectious Disease » Received grant funding of more than $2.9 million

Dermatology

» Participated in several Pediatric Dermatology Research Alliance projects » Published two clinical guideline synopses in JAMA Christina Ciaccio, MD, MSc, administers a food challenge to Connor Cheung 14 2016 ANNUAL REPORT Department of Pediatrics

ACADEMIC APPOINTMENTS Christina Ciaccio, MD, MSc Assistant Professor of Pediatrics Clinical Director, Food Allergy Program Nana Fenny, MD, MPH Assistant Professor of Pediatrics Cathryn Nagler, PhD Bunning Food Allergy Professor Professor of Pathology, Medicine, Pediatrics and the College Committee on Immunology Cathryn Nagler, PhD

Raoul L. Wolf, MD Professor of Pediatrics Chief, Allergy & Immunology Named a Top Doctor in 2016 by Chicago magazine

Two years ago, Cathryn Nagler, PhD, reported in PNAS that Clostridia, bacteria that reside in close proximity to the colonic epithelium, protect against sensitization to food allergens. Clostridia cause immune cells to produce high levels of interleukin-22, a signaling molecule that decreases the permeability of the intestinal lining. When Nagler reintroduced Clostridia in germ-free mice with depleted gut bacteria, the mice had significantly reduced allergens in their blood.

In 2016, Nagler founded the company ClostraBio, Inc., with help from numerous institutes and schools at the University of Chicago, to develop microbiome-modulating therapeutics to prevent or treat food allergies in children.

CONDITIONS WE TREAT » Allergic rhinitis » Allergic skin rashes

»F ood allergy and food intolerance

» Angioedema

» Primary immunodeficiency disorders

» Asthma

» Urticaria (hives)

» Atopic dermatitis

» Reactions to devices

» Anaphylaxis

» Drug allergy

Allergy & Immunology After being chosen in 2015 by Food Allergy Research and Education (FARE)

one of 28 Clinical Network Centers of Excellence nationwide, to be

we increased by nearly eightfold the number of food challenges performed in 2016.

The false-positive rate of conventional allergy tests is upwards of 70%. The food challenges we administer distinguish between false-positive results and true food allergies,

saving many children from needlessly restrictive diets.

“Every child should be able to share a family meal without terror.”

The comfort and sociability of a family dinner is all but foreign to kids with food allergies. “A child with even one or two food allergies can have a terrible connotation with food, and they are often terrified to eat outside the home,” says Christina Ciaccio, MD, MSc, clinical director, Food Allergy Program. Up to 6% of kids have food allergies, but no FDA-approved treatment exists. “We can cure the rarest cancers, but food allergy has been neglected for too long, and we’re putting a stop to that right here,” she says.

Allergy skin and blood tests have up to a 70% falsepositive rate, leading allergists to recommend that children avoid eating numerous foods, often unnecessarily.

At UChicago Medicine, Ciaccio sets a high bar for food challenges, which are performed in a high-acuity clinic where kids receive continuous oxygen and heart-rate

monitoring so that any allergic reactions can be quickly stopped. “We can broaden kids’ diets with successful food challenges, which improve the quality of life for entire families,” says Ciaccio.

Dramatic and potentially life-altering are food challenges in infants whose parents have been advised to eliminate several foods from the baby’s diet based on a positive skin test to one food. If a baby tolerates a food challenge, Ciaccio works with the parents to make the food part of the baby’s regular diet. “Without this intervention, about 30% of kids will have an anaphylactic food allergy by age five,” says Ciaccio. “Introducing the food into the baby’s diet drops the risk of developing an allergy to almost zero, allowing us to prevent multiple food allergies.”

As one of only 28 institutions in the country designated as a Clinical Network Center of Excellence by the Food Allergy Research and Education (FARE) advocacy organization, UChicago Medicine serves as a site for highly selective clinical trials. Currently, our patients are participating in a phase 3 peanut-desensitization trial designed to reduce the reaction severity to an accidental exposure to peanuts.

We will soon start a phase I clinical trial testing a peanut vaccine in adults. “We also have a unique bench-to-bedside translational research approach here,” adds Ciaccio. “The first-in-human studies of a novel biotherapeutic agent being developed here by immunologist Cathryn Nagler, PhD, for example, will be conducted exclusively at the University of Chicago Medicine and offers the exciting potential of finding a new way to prevent or treat food allergy.”

Department of Pediatrics 2016 ANNUAL REPORT 15

Hematology & Oncology

CANCERS WE TREAT » Hematological malignancies » Neuroblastoma, sarcoma and other solid tumors » Brain and spinal cord tumors » Familial cancer and cancer susceptibility syndromes

ACADEMIC APPOINTMENTS Mark Applebaum, MD, Clinical Instructor Viviana Berthoud Barrandeguy, PhD Professor (Research Associate) Eric C. Beyer, MD, PhD, Professor of Pediatrics Vice Chair of Pediatrics Named a Top Cancer Doctor in 2016 by Chicago magazine

Alexandre Chlenski, PhD Associate Professor (Research Associate) Susan L. Cohn, MD, Professor of Pediatrics Dean, Clinical Research Chief, Pediatric Hematology & Oncology

BLOOD DISEASES WE TREAT » Acquired hematological defects

Susan L. Cohn, MD, discusses the GDC with Vice President Joe Biden

» Aplastic anemia and bone marrow failure syndromes

In announcing the launch of University of Chicago’s Genomic Data Commons (GDC) last June, Vice President Joe Biden spoke of the “profound promise” that unprecedented access to 4.1 petabytes of genomic data from NCI-supported studies and more than 14,000 anonymized patient cases will have on accelerating cancer research and individualizing treatment. Susan L. Cohn, MD, and Samuel L. Volchenboum, MD, PhD, have built upon the GDC architecture to house data on pediatric cancer beyond that collected from NCI research. “We now house the world’s neuroblastoma clinical data and we will expand to other pediatric cancers, allowing us to ask research questions only possible with very large cohorts of patients,” says Cohn.

» Hemophagocytic and Langerhans cell histiocytosis » Immunodeficiencies » Inherited blood cell disorders

Named a Top Doctor in 2016 by Chicago magazine Named a Top Cancer Doctor in 2016 by Chicago magazine

» Hemolytic anemias

Rena M. Conti, PhD, Associate Professor of Pediatrics John M. Cunningham, MD

» Platelet disorders

Donald N. Pritzker Professor Chair, Department of Pediatrics Director, Hematopoietic Stem Cell Transplantation

» Sickle cell disease

» Coagulation disorders

Named a Top Doctor in 2016 by Chicago magazine Named a Top Cancer Doctor in 2016 by Chicago magazine

Wendy S. Darlington, MD, Clinical Instructor Jill de Jong, MD, PhD, Assistant Professor of Pediatrics Named a Top Cancer Doctor in 2016 by Chicago magazine

Ami V. Desai, MD, MSCE, Assistant Professor of Pediatrics Joanna Gemel, PhD, Associate Professor (Research Associate) Tara Henderson, MD, MPH, Associate Professor of Pediatrics James L. LaBelle, MD, PhD, Assistant Professor of Pediatrics Named a Top Cancer Doctor in 2016 by Chicago magazine

Gabrielle Lapping-Carr, MD, Assistant Professor of Pediatrics Jennifer L. McNeer, MD, MS Associate Professor of Pediatrics Director, Fellowship Program Named a Top Cancer Doctor in 2016 by Chicago magazine

Megan McNerney, MD, PhD Assistant Professor of Pathology and Pediatrics Radhika Peddinti, MD, Assistant Professor of Pediatrics Medical Director, Sickle Cell Disease Program Ruth Rudinsky, MD, Clinical Associate

Samuel L. Volchenboum, MD, PhD Associate Professor of Pediatrics Associate Chief Research Informatics Officer Director, Center for Research Informatics Associate Director, Institute for Translational Medicine Named a Top Cancer Doctor in 2016 by Chicago magazine

Xinan (Holly) Yang, PhD Assistant Professor (Research Associate)

16 2016 ANNUAL REPORT Department of Pediatrics

While allogeneic stem cell transplantation (HSCT) is effective immunotherapy for pediatric leukemias, the antitumor immunologic effects of HSCT is less for other pediatric tumors. “To amplify the immunotherapeutic potential of HSCT and improve survival, we’re giving children with high-risk diseases prophylactic donor lymphocyte infusions or targeted maintenance therapy post-transplant,” says James L. LaBelle, MD, PhD. “And in the lab, we’re studying how novel targeted peptides and small-molecule therapeutics can further modulate the immune system to boost the effectiveness of HSCT.”

Paradigm Shift in Pediatric HSCT Allogeneic Stem Cell Transplant -> Graft Versus Tumor Effector Cells

Allogeneic Stem Cell Transplant + Targeted Therapies

Leading-Edge Approaches B Cell

Antibody, CAR T-cells, Bispecific Antibodies

T Cell Targeted Peptide/ Small Molecule Therapeutics

Natural Killer Cell Leukemia/Lymphoma/ Solid Tumor

Graft versus tumor effect Chronic Myeloid Leukemia

Acute Myeloid Leukemia

Acute Hodgkin’s and Solid Lymphoblastic Non-Hodgkin’s Tumors Leukemia Lymphoma

Donor Lymphocyte Infusion

25 Words vel ipsust eos eum quiaspellam que incit doluptam esci dolupid ut la nusda corem quos voluptatus andelitium hicipsandi ius mossum latquuntur mincipsae voluptia soloribea veribus

inspired every day by “myI’mpatients and their families to develop more effective cancer therapies.

”

Susan L. Cohn, MD, gave credit to “all my pediatric oncology colleagues” in accepting ASCO’s 2016 Pediatric Oncology Award for Leadership in Neuroblastoma Research. If not for the long history of collaboration among international pediatric oncology communities, Cohn said, the advances we have made in treating children with neuroblastoma would not have been possible. The group effort to collect and bank large numbers of clinically annotated tumor and germline samples for research studies has led to a deeper understanding of the oncogenic drivers of neuroblastoma, more precise prognosticators and an expanding portfolio of promising therapies that target actionable genomic mutations.

But it is Cohn who, for several years, has played a leading role in bringing together neuroblastoma experts and leveraging their research in groups such as the International Neuroblastoma Risk Group (INRG) Task Force and the Children’s Oncology Group Neuroblastoma Disease Committee. Recently Cohn, who is also dean for clinical research in the Biological Sciences Division, and her colleagues analyzed INRG data to advance our understanding of the genomic and environmental factors that contribute to the development of second malignant neoplasms in neuroblastoma survivors.

In 2007, Susan L. Cohn, MD, treated four-year-old Abigail for neuroblastoma

Children with neuroblastoma have access to therapies at the University of Chicago Medicine only available at a handful of medical centers in North America and nowhere else in Chicago. In addition to being a member of the Children’s Oncology Group, we are one of the 14 member institutions in the New Approaches to Neuroblastoma Therapy Phase I Consortium. We also can treat patients with targeted I131-MIBG (meta-iodobenzylguanidine) therapy and house the only MIBG facility in Illinois.

UChicago Medicine has a very active clinical trial portfolio for all pediatric cancers, and we have developed a program to meet the unique needs of Adolescent and Young Adult (AYA) cancer patients between the ages of 18 and 30. The Leukemia AYA program is co-led by pediatric oncologist Jennifer L. McNeer, MD, MS, and medical oncologist Wendy Stock, MD. Stock pioneered the field of AYA oncology after her seminal study, published in 2008 in Blood with the late pediatric oncologist James Nachman, MD, demonstrated superior survival of AYA patients treated on pediatric versus adult clinical trials.

We are expanding our solid tumor AYA program and are collaborating with our medical oncology colleagues in the adult phase I program to offer novel treatments for AYA cancer patients. “Our medical and pediatric oncologists also collaborate with other subspecialty providers to ensure that every AYA patient with cancer receives optimized care,” says Cohn.

Tara Henderson, MD, MPH, monitors a healthy Abigail, 13, for late effects of neuroblastoma treatment

Not so long ago, less than 10% of children with high-risk neuroblastoma survived.

As new treatments have emerged— immunotherapy, stem cell transplants, biologic therapy, novel chemotherapy agents—the survival rate has dramatically increased to about 50%. “But we have no idea what immunotherapy, for example, does to children’s bodies as they grow older,” says Tara Henderson, MD, MPH, who directs the Childhood Cancer Survivors Center. As a recipient of a $2 million, five-year grant from the St. Baldrick’s Foundation, Henderson is leading a study of 700 children who have survived high-risk neuroblastoma.

“Understanding the adverse long-term effects of new cancer therapies gives us an opportunity to minimize those late effects or to identify and treat them early,” says Henderson.

Department of Pediatrics 2016 ANNUAL REPORT 17

Critical Care

ACADEMIC APPOINTMENTS Mark K. Abe, MD Associate Professor of Pediatrics Medical Director, Pediatric Sedation and Procedure Services Melanie Brown, MD Associate Professor of Pediatrics Assistant Program Director, Pediatric Residency Training Program Medical Director, Pediatric Comfort Team

CONDITIONS WE TREAT » Surgical disease and trauma » Heart-lung failure » Cancer and blood disease » Complicated diabetes » Life-threatening infection and sepsis » Liver failure » Kidney failure » Complex neurologic disease » Complex congenital cardiac conditions

Grace Chong, MD Assistant Professor of Pediatrics Enzo J. Garcia, MD Clinical Associate Catherine A. Humikowski, MD Assistant Professor of Pediatrics Medical Director, PICU Priti Jani, MD Assistant Professor of Pediatrics Jason Kane, MD, MS, FAAP, FCCM Associate Professor of Pediatrics Interim Chief, Pediatric Critical Care Director, Quality and Outcomes, Pediatric ICU

Nadia Khan, MD Assistant Professor of Pediatrics Tracy K. Koogler, MD Associate Professor of Pediatrics Vice Chair, Institutional Review Board Assistant Director, Clinical Medical Ethics Romeen Lavani, MD Clinical Associate Diana L. Mitchell, MD Assistant Professor of Pediatrics Director, Pediatric Critical Care Fellowship Program Christopher P. Montgomery, MD Assistant Professor of Pediatrics Neethi Pinto, MD Assistant Professor of Pediatrics Director, Clinical Research L. Nelson Sanchez-Pinto, MD, MBI Assistant Professor of Pediatrics Rachel K. Wolfson, MD Assistant Professor of Pediatrics

“Big data can help us pinpoint kids at risk for sepsis.”

Sepsis—the very word terrifies physicians caring for kids with complex medical and surgical conditions. Despite advances in methods of detection, the response to life-threatening infection is usually reactive rather than proactive; diagnostic and therapeutic interventions aren’t generally initiated until signs and symptoms of infection are present. For children with an underlying disease, infection can progress rapidly to death within hours.

Now, a research team led by pediatric critical care specialist L. Nelson Sanchez-Pinto, MD, MBI, and Samuel L. Volchenboum, MD, PhD, director of the Center for Research Informatics (CRI), is mining “big data” to predict which patients are at high risk for infection.

The team also includes CRI Senior Research Scientist Anoop Mayampurath, PhD. “Our long-term goal is to develop highly refined risk

18 2016 ANNUAL REPORT Department of Pediatrics

stratification models that pinpoint features of ensuing infection in an individual patient hours or days before symptoms are manifest,” Sanchez-Pinto says. “Early identification and intervention will allow us to limit multisystem organ compromise and hopefully save lives.”

The team has started evaluating computational analysis of large patient databases, predictive modeling of electronic medical records, investigation of human genomic variation, and analysis of the host microbiome as methods to predict infection risk. The platform developed

by Sanchez-Pinto and Mayampurath will integrate these approaches for individual patients.

In November 2016, the team, along with an interdisciplinary group of collaborators with expertise in computational modeling, biomedical informatics, genomics and human microbiome analysis, began

collecting preliminary data in a multiethnic population of adult and pediatric patients receiving hematopoietic stem cell transplantation for advanced treatment of oncologic disease.

“The Comprehensive Cancer Center at the University of Chicago offers a strong team of physicians with expertise in transplantation and translational research, providing an optimal patient population and research environment for collaboration,” Sanchez-Pinto says.

“Studies like this one are enabled by the rich data contained in CRI’s research data warehouse,” Volchenboum says.

“By building models on data from many patients, we can create algorithms that will run in real time, possibly detecting infection earlier and saving lives. We also hope to apply these models to the onset of other conditions seen in intensive care units.”

This bellwether tool “helps identify clinically relevant data.”

Just because a study is published in a major medical journal, should it change the way physicians provide bedside critical care?

Probably not, says a research team led by fellow Travis Matics, DO, and his mentor, Jason Kane, MD, MS, FAAP, FCCM. The group applied a fragility index statistic to findings from select pediatric critical care RCTs over the last 15 years. “We found that the great majority of the trials are statistically fragile, with results often hinging on a small number of events,” Matics reports.

The fragility index—never previously applied to pediatric RCTs—can be used to assess whether a study’s findings are both statistically significant and clinically relevant. “This will help clinicians discriminate between clinical trials that are most likely to be of benefit, and avoid those that may be ineffective for critically ill children,” Kane says.

From left: Travis Matics, DO, and Jason Kane, MD, MS, FAAP, FCCM

Annual admissions:

1,129

Average daily census:

17.1

Patient days:

6,258

ICU beds:

30

ACGME-approved fellowship positions:

9

From left: Sam L. Volchenboum, MD, PhD, and L. Nelson Sanchez-Pinto, MD, MBI Department of Pediatrics 2016 ANNUAL REPORT 19

Rheumatology

Infectious Diseases

ACADEMIC APPOINTMENTS Deirdre De Ranieri, MD Assistant Professor of Pediatrics Melissa Tesher, MD Assistant Professor of Pediatrics Interim Chief, Rheumatology Linda Wagner-Weiner, MD Associate Professor of Pediatrics

CONDITIONS WE TREAT »J uvenile idiopathic arthritis »J uvenile dermatomyositis »S ystemic lupus erythematosus »V asculitis »U veitis

Named a Top Doctor in 2016 by Chicago magazine

CONDITIONS WE TREAT

»S ystemic sclerosis »L ocalized scleroderma »S arcoidosis »S jogren’s syndrome »P eriodic fever syndromes »P ediatric fibromyalgia

» Blood Blood infections infections

“

Musculoskeletal ultrasound allows us to provide precision therapy for better outcomes.

”

“Let’s see if Pokémon is hiding in there?” That is one of the things Deirdre De Ranieri, MD, says to make her younger patients feel more comfortable when using musculoskeletal ultrasound during clinic. “Kids like to see parts of themselves on the screen,” she says. “And it’s a way for me to educate parents about their child’s condition. They often have an ‘aha’ moment when I show them a swollen joint or an inflamed tendon.”

De Ranieri has had extensive training and is the only pediatric rheumatologist in the region certified by the American College of Rheumatology in the use of musculoskeletal ultrasound. She uses it to diagnose, monitor and treat patients with diseases such as juvenile idiopathic arthritis that affect their joints and tendons. For her, “don’t leave home without it” means bringing the machine to her outpatient clinics in Comer Children’s and the western suburbs.

There’s a growing interest in using musculoskeletal ultrasound in pediatric rheumatology, De Ranieri says.

It is faster, less invasive and less expensive than MRI, and does not require sedation. The point-of-care service is helpful in diagnosing disease and monitoring response to therapy. Furthermore, ultrasound-guided joint injections have been shown to be more accurate than blind injections and less painful. “Ultimately, all of this this leads to a better quality of life for our patients,” she says.

Deirdre De Ranieri, MD, and Alexandra Lim, 17 20 2016 ANNUAL REPORT Department of Pediatrics

» HIV/AIDS HIV/AIDS » Respiratory Respiratoryinfections infections » Pneumonia Pneumonia » Skin Skin and andsoft softtissue tissueinfections infections » O Other ther illnesses illnessescomplicated complicated by by acute acuteinfections infections

ACADEMIC APPOINTMENTS Allison H. Bartlett, MD Associate Professor of Pediatrics Robert S. Daum, MD Professor of Pediatrics Michael David, MD, PhD Assistant Professor of Medicine Barbara Hendrickson, MD Clinical Associate Daniel Johnson, MD Professor of Pediatrics Chief, Pediatric Infectious Disease Rima McLeod, MD Professor of Ophthalmology & Visual Science and Pediatrics Medical Director, Toxoplasmosis Center Colleen Nash, MD Clinical Associate Julia C. Rosebush, DO, FAAP Assistant Professor of Pediatrics Karl Oliver Yu, MD Instructor

Dermatology

ACADEMIC APPOINTMENTS Adena Rosenblatt, MD, PhD Assistant Professor of Medicine Sarah Stein, MD Associate Professor of Pediatrics and Medicine Director, Pediatric Dermatology

CONDITIONS WE TREAT »H ereditary disorders of the skin, hair and nails » Eczema » Acne » Psoriasis » Rashes » Pigmented birthmarks » Vascular birthmarks

» Blistering disorders » Skin infections »P hotosensitivity disorders »D isorders of pigmentation » Hair loss » Skin growths

Julia C. Rosebush, DO, FAAP, cares for HIV-exposed babies

Youth with HIV “can have healthy, fulfilling lives.”

Many teens and young adults newly diagnosed with HIV believe they are going to die—until Julia Rosebush, DO, FAAP, convinces them otherwise. As medical director of Care2Prevent (C2P) Pediatric/Adolescent HIV Program, Rosebush treats HIV-positive South Side Chicago youth facing major life challenges, such as homelessness and discrimination as members of the LGBTQ community. “Our team goes above and beyond to help our patients get what they need, from life-saving medications and stable housing to behavioral health counseling,” says Rosebush. “It’s amazing to see their transformation, both mentally and physically.”

C2P also provides high-risk youth with pre-exposure prophylaxis to prevent HIV transmission, and staff conducts testing for HIV and other STIs in South Side neighborhoods with a high incidence and prevalence of HIV, as well as at C2P’s drop-in center for homeless and street-based LGBTQ youth.

From left: Adena Rosenblatt, MD, PhD, and Sarah Stein, MD, with Cassandra Rose Brown

We keep kids “comfortable in their skin.”

“Children with skin conditions often feel powerless,” says Sarah Stein, MD. “As pediatric dermatologists, we address skinassociated issues such as itching, pain, discomfort, anxiety and embarrassment, in hopes of improving self esteem and confidence, and empowering these special young people.” Medical management, surgical interventions, education and support result in a much-improved quality of life for these children. Adena Rosenblatt, MD, PhD, joined the practice in 2016, expanding the capacity for surgical and laser procedures, and enhancing the inpatient consultation service. Three outpatient offices serve Chicago’s South Side and south suburbs.

Rosenblatt and Stein are participating in an industry-sponsored, multicenter, double-blind RCT of a new systemic medication for the treatment of psoriasis in pediatric patients. They also are involved in several research projects sponsored by the Pediatric Dermatology Research Alliance. These include mapping morphea lesions, studying outcomes of patients with cutaneous lupus erythematosus, and testing novel therapies for alopecia areata.

Department of Pediatrics 2016 ANNUAL REPORT 21

Genomics & Organ Physiology The Department of Pediatrics at the University of Chicago Medicine includes experts in all major subspecialties who offer patients comprehensive care and multidisciplinary expertise. We interrogate beyond organ system pathology to the cellular and genetic basis of disease to achieve not only sustainable treatment but a lasting cure. Our clinicians and researchers promise a future where there is no such thing as “idiopathic disease.”

ACADEMIC APPOINTMENTS

Endocrinology

Ronald Cohen, MD Associate Professor of Medicine and Pediatrics Chief, Endocrinology, Diabetes and Metabolism Dianne Deplewski, MD Associate Professor of Pediatrics Siri Atma Greeley, MD, PhD Assistant Professor of Pediatrics

CONDITIONS CONDITIONS WE WE TREAT TREAT »» G rowth Problems Growth problems

»» T Dhyroid Disease isorders of sex

»» P uberty Disorders Puberty disorders

» Ddevelopment isorders of sex development » Adrenal disease

»» D iabetes Mellitus, Diabetes mellitus, including type including type 1 and 1type diabetes, type 2 diabetes 2 diabetes, and » Monogenic MODY, neonatal and

monogenic diabetes

»D iabetes (MODY, » neonatal Pituitary disease diabetes) Tituitary hyroid disease »» P Disease

»» A Mdrenal Disease enstrual disorders »» M enstrual Disorders Hypoglycemia »» H Cypoglycemia hildhood obesity »» C Ehildhood Obesity ndocrine » Ecomplications ndocrine Complications ofCancer cancer of

GENOMICS & ORGAN PHYSIOLOGY SECTIONS

Elizabeth Littlejohn, MD Associate Professor of Pediatrics Rochelle Naylor, MD Assistant Professor of Pediatrics Associate Director, Pediatric Residency Training Program Louis Philipson, MD, PhD Professor of Medicine and Pediatrics Director, Kovler Diabetes Center Samuel Refetoff, MD Professor Emeritus of Medicine and Pediatrics Christine Yu, MD Assistant Professor of Pediatrics

Endocrinology »A dult and Pediatric Endocrinology received approximately $7 million in total grant funding during FY 2016 »T he Kovler Diabetes Center celebrated its 10th anniversary as a world-class center for diabetes care, scientific research and community engagement

Gastroenterology, Hepatology & Nutrition »F aculty members presented their research as invited speakers to the World Congress of Gastroenterology, Hepatology and Nutrition; the Pediatric Academic Societies; and the Elite Pediatric GI Congress in 2016

Cardiology » I van Moskowitz, MD, PhD, published “Cilia gene mutations cause atrioventricular septal defects by multiple mechanisms” in Human Molecular Genetics

Nephrology

» Shireen Hashmat, MD, co-authored chapters on acute kidney injury and nephrotoxic medications in the Essential Guide to Clinical Neonatology

Pulmonology

» B. Louise Giles, MD, co-authored eight articles published in medical journals, and received the Distinguished Service Award in Health Sciences from Fanshawe College, London, ON

22 2016 ANNUAL REPORT Department of Pediatrics

“Beta cells in kids with some

forms of diabetes can start making insulin again.”

As Siri Atma Greeley, MD, PhD, was creating the first national registry of patients with monogenic diabetes, the award-winning documentary Journey to a Miracle: Freedom from Insulin was being produced. Greeley and his colleagues had diagnosed Lilly Jaffe’s monogenic diabetes at age six, allowing her to disconnect her insulin pump and live a normal life. Today, the Monogenic Diabetes Registry includes more than 2,000 patients, providing Greeley data for his longitudinal studies, such as correlating children’s neurodevelopmental deficits to specific diabetes genotypes.

Siri Atma Greeley, MD, PhD, with 19-month-old Frances Jackson

As many as 2% of diabetes patients have a monogenic form of the disease but are often incorrectly diagnosed with type 1 or type 2 diabetes. Understanding the etiology of a child’s diabetes can be transformative, says Greeley. Half of children with monogenic diabetes will start secreting insulin again when treated with sulfonylurea pills, and the earlier the initiation of therapy, the better the response. “Now these kids can take a few pills a day instead of getting insulin injections, checking their blood sugars 10 times a day, and carefully counting carbohydrates,” says Greeley.

ACADEMIC APPOINTMENTS Ruba Azzam, MD Associate Professor of Pediatrics Director, Pediatric Hepatology Medical Director, Pediatric Liver Transplant Program Ranjana Gokhale, MD Associate Professor of Pediatrics Director, Pediatric Gastroenterology Fellowship Program Stefano Guandalini, MD Professor of Pediatrics Chief, Pediatric Gastroenterology, Hepatology & Nutrition Founder and Medical Director, University of Chicago Celiac Disease Center Named a Top Doctor in 2016 by Chicago magazine

Bana Jabri, MD, PhD Professor of Pathology and Pediatrics Director, Celiac Disease Research Hilary Jericho, MD, MSCI Assistant Professor of Pediatrics Barbara Kirschner, MD Professor Emerita of Pediatrics and Medicine Named a Top Doctor in 2016 by Chicago magazine

Tiffany Patton, MD Assistant Professor of Pediatrics

Stefano Guandalini, MD, with celiac patient Sofia Cruz, 6

Timothy A. S. Sentongo, MD Associate Professor of Pediatrics Director, Pediatric Nutrition Support Service Director, Pediatric Gastrointestinal Endoscopy

Gastroenterology, Hepatology & Nutrition CONDITIONS WE TREAT » Celiac disease

» Food allergies

»C hronic and recurrent diarrhea

» Small bowel disorders

» Intestinal infections »M alabsorption syndromes » Failure to thrive » I nflammatory bowel disease

hort bowel syndrome »S and intestinal failure » Eosinophilic esophagitis »F ecal microbiota transplantation » Constipation

» Hepatobiliary diseases

»G astroesophageal reflux disease

» Liver transplantation

» Long-tern TPN therapy

» Pancreatic diseases

“In the next ten years, we will cure celiac disease.”

Once a year for the last 15 years, the Celiac Disease Center picks up the cost to screen 500 people at high risk of celiac disease. As Stefano Guandalini, MD, personally calls the 5% of children who screen positive for the disease, he hears parents’ relief that the frustrating search for a diagnosis is finally over. “Celiac disease doesn’t always present with classic symptoms, and patients’ suffering can fall on deaf ears,” says Guandalini, who has passionately led a crusade to rectify the rampant under-diagnosis of celiac disease (CD).

An estimated 1% of the U.S. population has CD, yet 85% of those with the disease remain undiagnosed. That’s still a big improvement from the 97% of celiacs who were undiagnosed in 2001, when Guandalini launched the Celiac Disease Center, one of the most prominent in the

world. “I’d like to think we’re partly responsible for the increased awareness of celiac disease and for igniting the fire for more screening and research,” says Guandalini.

Advocacy and education are crucial to improving the lives of celiacs. The center has sent more than 6,000 packages of gluten-free foods to newly diagnosed celiacs to help them jump start a gluten-free diet and dispel myths about CD. An e-book on CD management on the center’s website has been downloaded more than 260,000 times, and every year, providers from around the country come to the center for a two-day intensive course on CD. When Bana Jabri, MD, PhD, an internationally known basic science researcher in CD, joined the faculty, the center’s reputation as a premier CD research center

was firmly established. “We’re the only celiac center in the world that can brag about publishing two papers in Nature, and our development of the only mouse model of celiac disease was a giant step forward in research,” says Guandalini.

A cure for CD is in sight, according to Guandalini. In collaboration with other researchers, the center is working on a vaccine that will act on the innate and adaptive branches of the immune system to restore lost tolerance to gluten. Other research includes identifying a microbial signature that predisposes kids to the disease— paving the way for probiotics to prevent the disease—and interventions for teenagers, who typically have poor compliance with a gluten-free diet and are at higher risk of morbidity and clinically severe depression.

Department of Pediatrics 2016 ANNUAL REPORT 23

Cardiology

ACADEMIC APPOINTMENTS

CONDITIONS WE TREAT » Heart murmurs » Chest pain

» Acquired heart disease:

Cardiomyopathy/congestive heart failure

» Syncope

» Arrhythmias: SVT, pacemakers

»C ongenital heart disease

»G enetic syndromes with heart disease

PROCEDURES WE PERFORM » Non-invasive imaging

» Cardiac surgery

›T ransthoracic and transesophageal echocardiography (TTE and TEE)

›P ediatric congenital cardiac repairs

› Fetal echocardiography

› Hybrid surgery

› 3D echocardiography

› Robotic surgery

› Cardiac CT

›P acemaker/defibrillator implantation

› Cardiac MRI

dult congenital ›A cardiac repairs

» Cardiac catheterization/minimally invasive cardiac repair

Daniel Gruenstein, MD, in the pediatric cardiac catheterization lab

› ASD, VSD device closure

› Pulmonary artery stenting

› PDA closure

›P ercutaneous valve implantation/replacement

oarctation of the aorta ›C stenting

› Hybrid procedures

Brojendra Agarwala, MD Professor of Pediatrics

Named a Top Doctor in 2016 by Chicago magazine

Umesh Dyamenahalli, MD Associate Professor of Pediatrics Abraham Groner, MD Assistant Professor of Pediatrics Daniel Gruenstein, MD Associate Professor of Pediatrics Chief, Pediatric Cardiology Director, Pediatric Cardiac Catheterization Lab Co-Director, Chicago Pediatric Heart Center Kohta Ikegami, PhD, Instructor Ivan Moskowitz, MD, PhD Associate Professor of Pediatrics, Pathology and Human Genetics Associate Chair for Research, Pediatrics Melissa Webb, MD Assistant Professor of Pediatrics Paula Williams, MD, MS Assistant Professor of Pediatrics

Repairing a child’s heart shouldn’t create the additional “problem of exposing a child to too much radiation.”

For the first time ever, more adults than kids have congenital heart disease (CHD), creating profound implications for the way the cardiac defect is treated.

“In the past, the amount of radiation kids with complex heart disease received was less of a concern because they didn’t live long,” says Daniel Gruenstein, MD, who directs the pediatric cardiac catheterization lab.

“Today, however, the number of diagnostic studies and interventional procedures some patients with CHD require increase their risk of developing radiationinduced cancers.”

When UChicago Medicine’s newly built pediatric hybrid cardiac catheterization lab opened in late 2015, it included one-of-a-kind technology that provides realtime dose tracking of radiation exposure to patients.

“Reducing radiation exposure is vitally important to all patients, but especially in children with complex

24 2016 ANNUAL REPORT Department of Pediatrics

heart disease who may require multiple cardiac catheterizations, X-rays and CT scans,” says Gruenstein.

We also have a dedicated clinic for adults with congenital heart disease. These patients may need Interventional cardiac devices or surgical repair of their hearts as valves and stents placed during childhood begin to fail, as well as lifestyle counseling. “Some women with CHD were told never to get pregnant, which may not be true, while others were told nothing and becoming pregnant could be life-threatening to them,” says Gruenstein, who is the only interventional cardiologist in Chicago who is boardcertified to care for adults with congenital heart disease and one of only a handful of physicians in Chicago with the designation. “These adult patients require a boardcertified adult CHD specialist to address their ongoing cardiac needs instead of seeking care only when they are very sick, which is often the case,” says Gruenstein.

In collaboration with adult cardiac interventional colleagues, Gruenstein is performing leading-edge minimally invasive cardiac interventions and repairs in the smallest of children and in adults. Gruenstein and Sandeep Nathan, MD, performed a transradial cardiac catheterization in the youngest and smallest patient in the world, and Gruenstein and Atman Shah, MD, perform percutaneous heart valve replacement in some of the youngest as well as some of the oldest patients in Chicago.

Fixing the hearts of the youngest patients also requires better cardiac devices made specifically for kids. “There are very few pediatric-specific trials for cardiac devices, since device-makers have greater financial incentive in adults with heart problems,” says Gruenstein, who has helped develop several pediatric transcatheter cardiac devices and was the national PI for a trial on a new occlusion device for patent ductus arteriosus in kids.

“We can’t cure congenital heart

disease, but we hope to help people live better with the defect.

”

Although congenital heart disease (CHD) is quite common—up to 1 in 20 people have a structural heart abnormality—the genetic determinants of CHD are largely unknown. Ivan Moskowitz, MD, PhD, and the CHD scientific community have been building a bridge between how the heart develops and how heart development goes awry to cause CHD. “Surprisingly, most genes involved in CHD actually play their role in cardiac progenitor cells, before they are part of the heart itself,” says Moskowitz. “And defects that result in CHD cause cardiac progenitor cells to fail to generate the heart normally.”

Another surprising discovery from his lab: The lungs tell some cardiac progenitors how to behave and what parts of the heart to make, such as the pulmonary artery and atrial septum, to ensure efficient handling of oxygenated blood from the lungs.

Atrial Septum Morphogenesis

Pu En lmo do na de ry rm

Atrial Septum Progenitor Specification

Hedgenog Signaling

Atria

Nephrology

CONDITIONS WE TREAT

CONDITIONS WE TREAT »A cute and chronic kidney failure

» Hydronephrosis

» Glomerular diseases

»U rinary tract infections

»H emolytic uremic syndrome

»O bstructions along the urinary tract

»P olycystic kidney disease

»A bnormalities present at birth

Cardiac progenitor cells receive instructions from the lungs (pulmonary endoderm) early (left) that instruct them to make the atrial septum later (right).

Understanding the genetics of CHD will provide insight into the natural history of the disease as well as to comorbidities involving other organs or the heart, such as cardiac rhythm problems, says Moskowitz. Defects in the cilia genes accompany some CHD, for example, causing adults to have predictable problems with lung infections. “Understanding the genetics of CHD will allow us to predict the likely complications and do a better job preventing them, allowing kids to grow up and lead normal lives,” says Moskowitz.

»A pnea, or abnormal breathing pattern » Asthma » Pulmonary birth defects » Bronchiectasis »B ronchopulmonary dysplasia » Cystic fibrosis

»N euromuscular disorders leading to chronic lung problems »R ecurrent and persistent pneumonias »S leep-related breathing problems »U nusual respiratory infections

ACADEMIC APPOINTMENTS

ACADEMIC APPOINTMENTS

Christopher Clardy, MD Associate Professor of Pediatrics Chief, Nephrology

Maria L. Dowell, MD Associate Professor of Medicine and Pediatrics

Leila Kheirandish Gozal, MD Research Professor Director, Clinical Sleep Research

Shireen Hashmat, MD Assistant Professor of Pediatrics

B. Louise Giles, MD Assistant Professor of Pediatrics Medical Director, Pediatric Respiratory Therapy

Satyanarayan Hegde, MD Assistant Professor of Pediatrics

Izhar Ul Qamar, MD Associate Professor of Pediatrics Atrial Septum

Pulmonology

At many medical centers, children with end-stage renal disease have to suffer through inconvenient, unpleasant dialysis treatments before getting a kidney transplant. However, at Comer Children’s, Christopher Clardy, MD, is helping these patients skip dialysis and go straight to transplantation.

Last November, Yolanda Becker, MD, performed a kidney transplant on Gabrielle Mukenschnabl, 12.

Her mom, Tamara, says, “Dr. Clardy moved quickly to help us find a donor kidney and avoid dialysis.

And Gabrielle’s new kidney is working great.”

Abdelnaby Khalyfa, PhD Research Associate Professor

Julian Solway, MD Walter L. Palmer Distinguished David Gozal, MD Service Professor of Medicine Herbert T. Abelson and Pediatrics Professor of Pediatrics Director, Pediatric Pulmonology Fellowship Program

Chicago’s South Side children have the highest risk of asthma and the highest hospitalization rates due to asthma in the entire country. “We’re facing an epidemic,” says B. Louise Giles, MD, medical director of the new South Side Chicago Children’s Asthma Center. With support from the Urban Health Initiative, the asthma center is a partnership between Comer Children’s, La Rabida Children’s Hospital, St. Bernard Hospital, and the Friend Family Health Center.

The center provides asthma care and management, as well as education for families. “Our goal is to keep every child’s asthma under control so they can play, go to school—and stay out of the emergency room.”

Department of Pediatrics 2016 ANNUAL REPORT 25

Community Health

Emergency Medicine

Our promise to invest in the whole child requires that we also work toward improving the health of the communities in which our children live. We know that our research and state-of-the art clinical resources don’t matter if they don’t benefit children beyond our doors. Situated on the city’s South Side, in a neighborhood of vast social, cultural and economic complexity, the University of Chicago Medicine bears a special responsibility for child health in the context of community health.

“

COMMUNITY HEALTH SECTIONS

Emergency Medicine »S . Margaret Paik, MD, is editor for the online Peds EM Curriculum for undergraduate medical education »T imothy Ketterhagen, MD, and Michele McKee, MD, MS, FAAP, are leading an AAP Section of Emergency Medicine project evaluating the current state of disaster readiness in the U.S.

Chronic Diseases »E dith Chernoff, MD, served as president of the medical staff at La Rabida Children’s Hospital

Academic Pediatrics »S ection members received national appointments in the Society of Hospital Medicine, Association of Pediatric Program Directors, Association of American Medical Colleges, and the National Academies of Sciences, Engineering, and Medicine

We train medical teams to keep kids safe and well cared for during disasters.

ACADEMIC APPOINTMENTS Patrick Dolan, MD Clinical Associate Benjamin Heilbrunn, MD Associate Director, Fellowship in Pediatric Emergency Medicine Assistant Professor of Pediatrics

”

Michele McKee, MD, MS, FAAP, was first introduced to disaster preparedness during the 1996 Olympics in Atlanta, where she served with a Chemical Biological Incident Response Force as a U.S. Navy general medical officer.

Now McKee builds on that experience to enhance the readiness of emergency responders and a broad care team to meet the emergency and critical care needs of children and their families during a disaster.

As Comer Children’s director of Emergency Services and Disaster Preparedness, McKee oversees internal preparedness policy development and training exercises targeting highly specialized or large-scale medical and trauma needs due to a variety of scenarios, including exposure to “dirty bombs” or loss of resources due to manmade or naturally occurring events.

McKee also works with city and state agencies to create disaster-planning resources for children and families.

“Encouraging families to assist in readiness planning is a great way to establish personal plans that can be incorporated into a community response,” she says.

Michele McKee, MD, MS, FAAP Associate Professor of Pediatrics Pediatric Emergency Medical Director University of Chicago Medicine Medical Director for Emergency Preparedness Alisa McQueen, MD Associate Professor of Pediatrics Associate Chair for Education Director, Fellowship in Pediatric Emergency Medicine Director, Pediatrics Residency Training Program S. Margaret Paik, MD Associate Professor of Pediatrics Course Director, Pediatric Emergency Medicine Elective Pediatric Site Director, Emergency Medicine Clerkship Veena Ramaiah, MD, MD, FAAP Assistant Professor of Pediatrics Taaha Shakir, MD Clinical Associate Alison Tothy, MD Associate Professor of Pediatrics

6 physicians serve on a Comer Children’s team

Medical Ethics

participating in the AAP’s

»L ainie Friedman Ross, MD, PhD, appointed to the National Academies of Sciences, Engineering, and Medicine’s Committee on Issues in Organ Donor Intervention Research

Value in Inpatient Pediatrics Network on

»P eter J. Smith, MD, MA, testified on behalf of the Down Syndrome Information and Awareness Act, which was signed into Illinois law effective Jan. 1, 2016

a qualitative improvement

Community Service & Science

Excessive Variability in

»T he ECHO-Chicago network grew by 35% in FY 2016 with the addition of 177 new participants

26 2016 ANNUAL REPORT Department of Pediatrics

project, Reducing From left: Gabrielle (Gail) Aranda, MSW, LSW; Michele Harris-Rosado, RN, BSN; Michele McKee, MD, MS, FAAP; Starla Hudgins, RN;here Gabe Campos, RN, MSN, CEN Photo caption

Infant Sepsis Evaluation

ACADEMIC APPOINTMENTS Edith Chernoff, MD Assistant Professor of Pediatrics Nancy E. Fritz, MD Assistant Professor of Pediatrics

Chronic Diseases

Paula Jaudes, MD Clinical Professor of Pediatrics Izhar Ul Qamar, MD Associate Professor of Pediatrics

CONDITIONS WE TREAT » Cerebral palsy » Down syndrome University of Chicago Pediatric Specialists at La Rabida Children’s Hospital

553 Inpatient admissions 30,000+ Outpatient & rehab visits

» Asthma » Chronic pulmonary diseases » Sickle cell disease » Diabetes » Other chronic diseases

Radhika R. Peddinti, MD, with sisters Ahlem Issiakou, 2, (left) and Achwak Imorou, 4

With the right care, children with sickle cell disease “can accomplish their dreams.”

Radhika Peddinti, MD, has been taking care of patients with sickle cell disease since she was a medical student in western India in the early 1990s. Patients would come in needing strong pain medications and frequently, blood transfusions. “In a resource-poor region, all of those interventions, even antibiotic prophylaxis which we take for granted in the United States, were hard to come by,” Peddinti says.

Now, Peddinti is director of the comprehensive Sickle Cell Disease Clinic at La Rabida Children’s Hospital, the largest program of its kind in Chicago. This medical home for 450 children with sickle cell disease is staffed by a physician and nurse practitioner, and as needed, a family advocate, nutritionist, dietician, physical therapist, social worker and psychologist. The team provides disease management for acute and chronic complications,

education for families and patients, genetic counseling, and a liaison with schools.

Children’s Adolescent and Young Adult Clinic to ease their transition to adult providers.

Sickle cell disease is a chronic disease with many acute and chronic complications. Patients usually come to the Sickle Cell Disease Clinic as newborns diagnosed through state-required screening. “Being able to educate and counsel parents and follow our patients through childhood and the teen years is a true privilege,” Peddinti says. “Establishing trust and rapport with these children, and helping them navigate through their school years while coping with the unpredictable crises that is a hallmark of sickle cell disease, are of utmost importance.”

Peddinti is working on a unique sickle cell disease registry that pulls patient information from electronic medical records at La Rabida Hospital and the Comer Children’s Emergency Department so data can be mined from one single source for clinical research trials.

For example, she is studying patient biomarkers to determine why some patients with sickle cell disease have more complications, such as acute chest syndrome, than others do.

Because a large number of patients take hydroxyurea, an effective “controller” medication for sickle cell disease, a separate clinic provides them with more intensive follow-up. Patients ages 18 to 25 are seen at the Comer

Besides Peddinti, several Comer Children’s specialists provide comprehensive services at La Rabida Children’s Hospital for children with chronic illness and long-term disabilities, including cerebral palsy, Down syndrome, asthma and chronic pulmonary diseases, and diabetes.

Department of Pediatrics 2016 ANNUAL REPORT 27

Let’s acknowledge that not all “orders improve a child’s health.”

Academic Pediatrics

Overuse of health care is a major problem in adult medicine. According to a new study by Kao-Ping Chua, MD, PhD, published in the November 2016 issue of Pediatrics, wasteful care is also widespread in pediatrics.

He reports that at least one in 10 privately insured children received unnecessary services in 2014—resulting in potential harm to patients and at a cost of more than $9 million for their families. Heading the list of dubious care are antibiotics for respiratory infections and cough and cold medications for kids younger than six.

Total grant funding for Academic Medicine was more than

$2 million in FY 16.

787 1,922 patient days.

The General Care Nursery had admissions and

Chua joined UChicago Medicine after receiving a PhD in health policy evaluation at Harvard University. While he spends 80% of his time on research, he is also an attending physician in Comer Children’s Emergency Department. ”In an emergency, it is easy for us to order a lot of tests to get

1,010 2,694 patient days.

Our hospitalists were responsible for admissions and

Kao-Ping Chua, MD, PhD

ACADEMIC PEDIATRICS & HOSPITALISTS Maria (Lolita) Alcocer Alkureishi, MD Assistant Professor of Pediatrics Director, Pediatric Clerkship Holly J. Benjamin, MD, FACSM Professor of Pediatrics and Orthopaedic Surgery Director, Primary Care Sports Medicine Veena Bhamre, MD Clinical Associate Michael Walter Boettcher, MD Clinical Associate Paul Bottone, MD, Clinical Associate Donald K. Brown, MD, Clinical Associate Deborah Burnet, MD Professor of Medicine and Pediatrics Chief, General Internal Medicine Icy Cade-Bell, MD Associate Professor of Pediatrics Medical Director, Pediatric Mobile Medical Unit Rachel M. Cane, MD, Clinical Associate Kao-Ping Chua, MD, PhD Assistant Professor of Pediatrics

H. Barrett Fromme, MD Associate Professor of Pediatrics Associate Director, Pediatric Residency Training Program

Daniel Johnson, MD Professor of Pediatrics Chief, Academic Pediatrics Associate Chair, Clinical Services

Melissa Gilliam, MD, MPH Professor of Obstetrics/Gynecology and Pediatrics Ellen H. Block Professor of Health Justice Vice Provost for Academic Leadership, Advancement, and Diversity

Jannine Joyce, MD, Clinical Associate

Jill C. Glick, MD Professor of Pediatrics Medical Director, Child Advocacy & Protective Services

Caroline Olaleye, MD, Clinical Associate

Karen Goldstein, MD, MPH Associate Professor of Pediatrics Associate Director, Pediatric Residency Training Program Mark J. Greenwald, MD Professor of Ophthalmology & Visual Science and Pediatrics Director, Pediatric Ophthalmology

Laura Clarke, MD, Clinical Associate

Melanie Harris-Smith, MD Clinical Associate

Lauren K. Conti, MD, Clinical Associate

Margie M. Hartfield, MD, Clinical Associate

Megan A. DeFrates, MD, Clinical Associate

Joseph Henderson, III, DO Clinical Associate

Joy Elion, MD, Clinical Associate Nancy E. Fritz, MD Assistant Professor of Pediatrics

28 2016 ANNUAL REPORT Department of Pediatrics

Sneha Iyer, MD, Clinical Associate Aisha Jameel, MD, Clinical Associate

Poj Lysouvakon, MD Assistant Professor of Pediatrics James W. Mitchell, MD Associate Professor of Pediatrics Nicola M. Orlov, MD Assistant Professor of Pediatrics Associate Director, Pediatric Residency Training Program Valerie Press, MD, MPH Assistant Professor of Medicine Hospitalist Scholar

Rita Rossi-Foulkes, MD Associate Professor of Medicine Nina A. Santos, DO, Clinical Associate Sachin D. Shah, MD Assistant Professor of Medicine Yingshan Shi, MD, Clinical Associate Jeanmarie Schied, MD Assistant Professor of Pediatrics Heidi So, MD Assistant Professor of Pediatrics Sarah Stein, MD Associate Professor of Pediatrics and Medicine Director, Pediatric Dermatology Carl B. Toren, MD, Clinical Associate Justin D. Triemstra, MD, Clinical Associate

Whitney Richie, MD, Clinical Associate

Anitha Vinod, MD, Clinical Associate

Arlene Roman, MD, Clinical Associate

Anna Volerman Beaser, MD Assistant Professor of Medicine and Pediatrics

Mark L. Roome, MD Assistant Professor of Pediatrics Lainie Friedman Ross, MD, PhD Carolyn and Matthew Bucksbaum Professor of Clinical Medical Ethics Professor of Pediatrics, Medicine, Surgery and The College Associate Director, MacLean Center for Clinical Medical Ethics

Darrel J. Waggoner, MD Professor of Human Genetics and Pediatrics Medical Director, Human Genetics Diana Yan, MD, Clinical Associate

quick answers. But we always have to ask ourselves whether these tests could do more harm than good,” he says.

Until now, the extent and financial burden of overuse in pediatrics was unknown. In his study, Chua and his team reviewed recommendations from evidence-based sources to compile a list of more than 200 low-value services in pediatrics. They listed 20 services that could be identified as inappropriate in claims, including diagnostic and imaging tests and prescription drugs—then calculated spending on these services for 4.4 million privately insured children. The total cost to the health care system was $27 million.

“Ultimately, providers are the gatekeepers to health care overuse,” Chua says. “But families can also help reduce wasteful care by asking why specific tests or treatments are being ordered and at what cost.”

Jill C. Glick, MD, (right) visits with colleague Maria Alcocer Alkureishi, MD, and her baby

Medical Ethics Each Wednesday, faculty and fellows from the MacLean Center for Clinical Medical Ethics gather to discuss and resolve challenging patient care issues. The clinical case conference is co-led by assistant director Tracy K. Koogler, MD, a pediatric intensivist. Several times a year, a research ethics consultation is led by associate director Lainie Friedman Ross, MD, PhD, a general pediatrician.

Last year, Ross and Robert M. Veatch, PhD, co-wrote Defining Death: The Case for Choice, which examines the controversy about defining death by neurological criteria.

They examine the current criteria that requires death of the whole brain and suggest an additional alternative criteria of death that focuses on the upper brain functions. They also argue in support of individual choice in determining by which criteria death should be pronounced.

Like Ross, Koogler is involved in organ transplant issues and served as the ethicist for the Gift of Hope’s Critical Care Advisory Group, which discusses ethical dilemmas related to organ donation across the state. She also serves on a research ethics review board for 10 institutions, including the University of Chicago Medicine.

Rena M. Conti, PhD

Our work will lead to more “affordable drug treatments for patients.”

Whether testifying before Congress, being interviewed by the Washington Post, or publishing her research in the New England Journal of Medicine, social scientist Rena M. Conti, PhD, is in the midst of a national debate on escalating pharmaceutical costs that make treatment out of reach for many sick children and adults.

“My research focuses on the causes of high prescription drug prices and spending, and its consequences for patients and payers,“ Conti says. “I regularly interact with decision makers— patient advocates, drug companies, insurers, state and federal policymakers—to help improve the accessibility of these treatments for patients and their families.”

Thanks to the tireless advocacy of Jill C. Glick, MD, Chicago is the only place in the country where every child under age three reported for suspected inflicted head, skeletal or internal injuries is mandated to be evaluated by a child-abuse pediatrician. Glick, medical director of UChicago Medicine’s Child Advocacy and Protective Services, and Veena Ramaiah, MD, are two of 15 board-certified child-abuse pediatricians in Illinois who are promoting the growth of this limited but urgently needed expertise. At Comer Children’s, every inpatient under age two admitted due to injuries is screened for potential abuse. “Mandatory screening relieves pediatricians and medical staff of having to figure out which kids and injuries to worry about,” says Glick.

Last year, Conti and a team of health policy experts encouraged policymakers to either ensure the packaging of drugs in multiple vial sizes to reduce waste, or require that companies give refunds for leftover drugs. “This will keep payers and patients from spending $3 billion dollars each year on drugs that are ultimately discarded,” Conti says.

Tracy K. Koogler, MD (standing) Department of Pediatrics 2016 ANNUAL REPORT 29

Community Service & Science Comer Children’s

Pediatric Mobile Medical Unit —a state-of-the-art doctor’s office on wheels— serves children across Chicago’s South Side

24 public schools visited More than 1,000 patient encounters Daniel Johnson, MD, discusses ECHO-Chicago

working to provide kids the right care, “inWe’re the right place, at the right time.”

Stephanie Hair, LCSW, fits child for bike helmet

Local families now have a fun, friendly resource for helping prevent injuries and accidents. Safe Kids South Chicagoland organizes events that teach car seat and bike safety, and show families how to create safe environments for their infants. In 2017, the team will launch an Aetna-funded initiative featuring a mobile computer lab that educates parents and kids about how to prevent cyberbullying. “The most important thing we can do is care for our underserved neighbors,” says Program Director Poj Lysouvakon, MD. Above, the team is giving out free bicycle helmets.

30 2016 ANNUAL REPORT Department of Pediatrics

Kids often have to wait to receive subspecialty care, with appointment times running several months out for some pediatric subspecialists and up to a year for a developmental and behavioral pediatrician. Daniel Johnson, MD, has every confidence that primary care physicians can provide care to some of these children in their offices, thereby overcoming barriers that limit access to subspecialty care. “Our goal is to improve the quality and capacity of care that children receive at their primary care medical home, which allows us to expand subspecialty capacity and treat more medically complex children,” says Johnson.

That’s not wishful thinking. Since 2010, Johnson has led Extension for Community Healthcare Outcomes in Chicago (ECHO-Chicago), a program of weekly or biweekly clinical training sessions that connect UChicago Medicine subspecialists with primary care providers throughout Chicago via high-definition videoconferencing. Using a format that mimics traditional case-based rounds, a subspecialist gives a brief lecture via videoconference, which is followed by an interactive discussion as primary care providers assembled at multiple clinics present their cases.

Studies show the advanced training is having significant impact. One of Johnson’s studies examined prescribing patterns of practitioners before and after receiving ECHO training on pediatric ADHD. Although dramatically more kids at the clinics were diagnosed with ADHD—from 1% to 6% over three years—the number of first-time prescriptions of ADHD medications fell as much as 73% post-ECHO training, apparently reflecting the curriculum’s emphasis on behavioral approaches to managing ADHD, according to Johnson.

ECHO-Chicago has trained more than 620 providers working in 134 clinics. Several pediatric-specific disease areas are currently being covered in the 12- to 15-session series and more will be added this year: obesity, ADHD, child and youth epilepsy (in partnership with the American Academy of Pediatrics), headache and concussion, complex asthma, and care for children exposed to violence. Diagnosing and treating AfricanAmerican children with hypertension is an additional telehealth education project, funded by the Agency for Healthcare Research and Quality in collaboration with ECHO-Chicago. Sessions on adult diseases are also available.

Youth can overcome “even the most horrible violence when we provide the support they need to recover.”

The statistics are staggering: In Chicago in 2015 one person was shot every three hours. That same year, one-quarter of Comer’s trauma patients had violent injuries, mostly from shootings—a rate five times higher than at children’s trauma centers nationally.

The psychological trauma of violence can be especially devastating for kids, says Bradley Stolbach, PhD. Beyond symptoms of PTSD, children can experience learning problems, chronic stress, drug abuse, trouble with the law, and fatalism about the future. “Kids who constantly feel under threat are in survival mode and don’t expect a future in which they’re safe, happy and productive,” says Stolbach. “Unless we help kids deal with their righteous rage and grief, those feelings may be expressed in ways that are destructive to them and the people around them.”

Healing Hurt People-Chicago (HHP-C), which Stolbach co-directs, is a hospitalbased violence intervention program that provides intensive case management to help kids recover from the psychological and physical trauma of violent injury. Since its inception in 2013, in collaboration with the Cook County Trauma Unit at Stroger Hospital, HHP-C provides services to 250 children a year, ranging from hospitalbased psychoeducation and support to accompanying the child to court or medical appointments, enrolling them in school, helping them find a job and referring them for psychotherapy.

Some violently injured teens also participate in Project FIRE (Fearless Initiative for Recovery and Empowerment), a glassblowing, mentoring and psychoeducation program to further support trauma recovery and create jobs. Initially funded by UChicago Medicine’s Urban Health Initiative, Project FIRE was co-created by Stolbach and glass artist Pearl Dick with inspiration from Alisa McQueen, MD, who directs the Pediatrics Residency Training Program.

In 2016, Stolbach received a $2 million, five-year grant from the Substance Abuse and Mental Health Services Administration to provide support and therapy to an estimated 1,300 children and families touched by violence. The Recovery and Empowerment After Community Trauma Program will screen patients in the Emergency Department and pediatric ICU for exposure to violence and offer services, including a brief cognitive-behavioral intervention to reduce PTSD symptoms.

Bradley Stolbach, PhD, (right) with Mark Thrasher at Project FIRE Department of Pediatrics 2016 ANNUAL REPORT 31

Surgical Partners PEDIATRIC SURGERY Jessica Kandel, MD Mary Campau Ryerson Professor of Surgery Chief, Pediatric Surgery Named a Top Doctor in 2016

by Chicago magazine Named a Top Cancer Doctor in 2016

by Chicago magazine

PEDIATRIC ANESTHESIOLOGY Ellen Choi, MD, Medical Director Assistant Professor of Anesthesiology PEDIATRIC BURNS/COMPLEX WOUNDS SURGERY Lawrence J. Gottlieb, MD, Director Professor of Surgery PEDIATRIC CARDIAC SURGERY Gerhard Ziemer, MD, PhD, Director Professor of Surgery Director, Adult Congenital Heart Surgery Co-Director, Chicago Pediatric Heart Center PEDIATRIC COCHLEAR SURGERY Dana Suskind, MD, Director Professor of Surgery and Pediatrics Founder and Director, Thirty Million Words Initiative Founder and Director, Project ASPIRE PEDIATRIC HEPATOBILIARY SURGERY Talia Baker, MD Associate Professor of Surgery Director, Living Donor Liver Transplant Program John Fung, MD Professor of Surgery Chief, Transplantation Director, Transplantation Institute Mark Slidell, MD, MPH Assistant Professor of Surgery PEDIATRIC LIVER TRANSPLANTATION Talia Baker, MD Associate Professor of Surgery Director, Living Donor Liver Transplant Program John Fung, MD Professor of Surgery Chief, Transplantation Director, Transplantation Institute J. Michael Millis, MD Professor of Surgery Vice Chair, Global Surgery

32 2016 ANNUAL REPORT Department of Pediatrics

PEDIATRIC NEUROSURGERY David Frim, MD, PhD Ralph Cannon Professor of Surgery Professor of Neurology and Pediatrics Chief, Neurosurgery Peter Warnke, MD Professor of Surgery Director, Steriotactic and Functional Neurosurgery Bakhtiar Yamini, MD Professor of Surgery Director, Neurosurgical Oncology PEDIATRIC OPHTHALMOLOGY Mark J. Greenwald, MD Professor of Ophthalmology & Visual Science and Pediatrics Sarah M. Hilkert, MD, MPH Assistant Professor of Ophthalmology and Visual Science and Pediatrics Hassan Shah, MD Assistant Professor of Ophthalmology & Visual Science PEDIATRIC ORTHOPAEDICS Jovito Angeles, MD Assistant Professor of Orthopaedic Surgery Robert J. Bielski, MD Associate Professor of Orthopaedic Surgery Christopher Sullivan, MD, MPH Associate Professor of Orthopaedic Surgery PEDIATRIC OTOLARYNGOLOGY SURGERY Fuad Baroody, MD, Director Professor of Surgery and Pediatrics

help children “We canfeel better about themselves and thrive.

”

Since 2014, Russell Reid, MD, PhD, has led a team of more than 50 surgeons, nurses and anesthesiologists who volunteer their time three weekends a year to provide no-cost reconstructive surgeries to kids whose insurance companies have denied coverage, deeming the procedures cosmetic. “These kids have congenital and acquired deformities—cleft lip and palate, congenital nevi, amniotic band syndrome, gynecomastia—and many of them have been teased, bullied or forced to change schools,” says Reid, a pediatric plastic surgeon.

Fresh Start Caring for Kids Foundation, a joint charitable venture between San Diego-

ADVANCED CANCER THERAPIES Neuroblastoma Surgery, Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Thomas K. Lee, MD Professor of Surgery Grace Mak, MD, Director Associate Professor of Surgery Program Director, Pediatric Surgery Fellowship Named a Top Cancer Doctor in 2016

by Chicago magazine

PEDIATRIC PLASTIC/ CRANIOFACIAL SURGERY Russell Reid, MD, PhD Associate Professor of Surgery Bernard Sarnat Scholar of Craniofacial Research

COLORECTAL RECONSTRUCTION Grace Mak, MD, Director Associate Professor of Surgery Program Director, Pediatric Surgery Fellowship

Named a Top Doctor in 2016

by Chicago magazine

based Fresh Start Surgical Gifts and The Plastic Surgery Foundation, underwrites the children’s expenses and estimates that UChicago Medicine physicians and nurses have donated $1.3 million in medical care to treat 45 children.

Pediatric Surgery Special Programs:

Named a Top Doctor in 2016

by Chicago magazine

PEDIATRIC UROLOGY SURGERY Mohan S. Gundeti, MD, Director Professor of Surgery, Pediatrics and Obstetrics & Gynecology

Russell Reid, MD, PhD, with patient Ty Arroyo, who had a Le Fort III midface distraction to treat Crouzon syndrome

ECMO AND SURGICAL CRITICAL CARE Nikunj K. Chokshi, MD Assistant Professor of Surgery Named a Top Cancer Doctor in 2016

by Chicago magazine

FETAL CONSULTATION Erik Barthel, MD, PhD Assistant Professor of Surgery Deborah Loeff, MD Assistant Professor of Surgery Named a Top Cancer Doctor in 2016 by Chicago magazine

General Surgery Team INFLAMMATORY BOWEL DISEASE Andrea Lo, MD, Director Assistant Professor of Surgery Named a Top Cancer Doctor in 2016

by Chicago magazine

TRAUMA Mark Slidell, MD, Director Assistant Professor of Surgery

Named a Top Cancer Doctor in 2016

by Chicago magazine

VASCULAR ANOMALIES Jessica Kandel, MD Mary Campau Ryerson Professor of Surgery Chief, Pediatric Surgery

“Our goal as surgeons is

to give you the best care today and the promise of better care tomorrow.”

Remarkable discoveries are possible when the basic research of scientists interested in the diseases of children intersect, according to Jessica Kandel, MD. For Kandel, one of those serendipitous moments came from a pediatric colleague’s research on Staphylococcus aureus. “Her insights caused me to look at the interplay between the microbiome and the vasculature in a new way,” says Kandel, an internationally recognized authority in the surgical treatment of childhood cancers and in pediatric vascular nomalies.

“We’ve discovered that bacterial toxins can trigger changes in vessel function, causing children with lymphatic malformations to have leakage from their skin, pain, and edema in their extremities,” says Kandel. “We’ve also found that propranolol blocks these deranged signaling pathways, relieving the symptoms of some children who have been incredibly disabled by their disease for years.”

Kandel, along with numerous pediatric and adult specialists, treat children with vascular anomalies in a dedicated clinic Kandel created. “We’re fulfilling a large unmet need by coalescing into a unique resource for children with these malformations,” she says.

UChicago Medicine surgeons also have some of the broadest experience treating many other complex pediatric patients, says Kandel. We perform more pediatric veno-venous ECMO procedures than any other center in Chicago and are designated an ECMO Center of Excellence. “Delivering support to a critically ill child entirely through the venous side of the circulation avoids having to ligate the carotid artery,” says Kandel. We also have the sole pediatric ECMO fellowship in the city.

Comer Children’s is one of only two hospitals in the U.S. that provides heated intraperitoneal chemotherapy to children with malignancies that spread over the inner surface of the abdomen. In a surgery that can last 24 hours, surgeons remove all visible tumor before delivering chemotherapy directly into the abdomen to destroy remaining cancer cells. “The life-extending surgery has salvaged cure for some of our patients who now have no residual disease,” says Kandel.

Our surgeons also have extensive experience in operative and penetrating trauma, servicing one of only two level 1 pediatric trauma centers in the state. And this year, an expert in minimally invasive surgery for babies will join the faculty.

“I’m also proud of the diversity of our researchers,” says Kandel. “I firmly believe that having different voices around the table builds a stronger research enterprise.”

Jessica Kandel, MD, with surgical patient Danylah

Anesthesiology Anesthesiologists at Comer Children’s administer anesthetics for children of all ages—from critically ill neonates to healthy teens. The staff has experience in a wide range of pediatric surgical specialties: neurosurgery, craniofacial, cardiac, OHNS, ophthalmology, general surgery, orthopaedic, urology, plastic surgery, burn, transplant, and neonatal surgery.

In addition to the operating room, NICU and PICU, Anesthesiology provides services to the cardiac catheterization lab, interventional radiology unit, and MRI and CT suites.

Administering anesthetics for

4,000 surgical cases a year Department of Pediatrics 2016 ANNUAL REPORT 33

Comer Children’s Hospital The University of Chicago has provided comprehensive, innovative medical care to children since its first pediatric facility opened in 1930. Thanks to generous gifts by Gary and Frances Comer, a new acute care facility opened in 2005. Today, the University of Chicago Medicine Comer Children’s Hospital unites advanced technology with a family-centered, child-friendly philosophy to provide state-of-the-art care for children from Chicago, the Midwest, and around the world.

Inpatient The child-friendly inpatient rooms in Comer Children’s feature comfortable sleeping accommodations for parents, art to disguise and hide medical equipment, a wireless call system that reduces overhead noise, and a room service approach for ordering meals. Each of the floors has poetry-inspired art, creating an environment of hope and healing.

Comer Children’s cares for critically ill and injured children in its technologically advanced 30-bed pediatric intensive care unit. The designated tertiary care (level III)

30 ICU beds

beds in the neonatal Intensive care unit and the convalescent (level II) beds in our transitional care unit provide premature and critically ill infants with the most advanced medical care and life support systems.

The hospital’s Child Life Program offers educational, developmental and therapeutic services, such as art, music and pet therapy, medical bingo, a cooking program, and more. A playroom, teen room, outdoor playground, and central play areas on three inpatient floors offer refuge where no medical procedures are performed.

5 OR suites

47 level III NICU beds

Aeromedical transport for critically ill patients

Ambulatory The Comer Center for Children and Specialty Care serves as the main outpatient facility for our pediatric patients. Located in Comer Children’s Hospital, the ambulatory center features exam rooms for most pediatric specialties, labs, radiology, a day treatment room, a special procedures area, an infusion suite, and cardiac and neurologic testing areas.

The University of Chicago Medicine Comer Children’s at Little Company of Mary Hospital brings care in a dozen pediatric

Six-floor, 242,000-square-foot Comer Children’s Hospital, with Center for Care and Discovery in the background 34 2016 ANNUAL REPORT Department of Pediatrics

specialties to families in the southwest suburbs. Additionally, many of our experts see patients in other offsite locations across Chicago’s suburbs and in northwest Indiana.

The pediatric emergency department, located on the first floor of Comer Children’s Hospital, offers the latest diagnostic and treatment equipment for the care of acutely ill or injured children and teens. It is the only level 1 pediatric trauma center on the South Side of Chicago.

15 Comer Children’s offsite locations

From left: Mohan Gundeti, MD; Suja Stanley, RN; patient Gregory, 4; resident Hannah Lee, MD; Jennie Ott, MS, CCLS; and resident Ysabella Esteban, MD

Radiology

Advanced Practice Nurses

Many childhood diseases can be diagnosed with little or no discomfort for young patients. The members of the Comer Children’s radiology team—physicians, nurses and technologists—have advanced training in pediatric radiology and work exclusively with children. Each year, our pediatric radiologists perform and interpret routine and complex imaging studies on children of all ages and sizes. Diagnostic studies performed at Comer Children’s include: conventional X-rays, fluoroscopy, ultrasound, CT, MRI and ultrasound-guided interventional procedures, such as thoracentesis, biopsy and joint aspiration.

Comer Children’s care team members include 400 nurses who provide around-the-clock assessments and care. Highly specialized in complex care, our 35 advanced practice nurses (APNs) are also researchers, educators on the latest standards of care delivery, and leaders in policy at the institutional and national levels. As independent providers of primary care, APNs expand the reach of our pediatric care by allowing us to see more patients and perform more procedures. APN Stacy Ward-Beran, for example, treats lower-acuity patients in the Comer Emergency Department (ED), which allows all ED patients to be seen more quickly.

40,000 imaging studies per year

400 nurses

As educators and researchers, APNs Caitlin Cohen and Hillary Hecktman created Comer’s Sibling Donor Advocacy Program to protect the interests and well-being of children who are hematopoietic stem cell donors. Neonatal nurse practitioner (NNP) Jill Colontuono is an authority on improving response times for NICU transports, while NNP Christine O’Malley teaches the Neonatal Resuscitation Provider Course to ED attendings and fellows.

Kelly Kramer, RN, MSN, CPON, CPNP, teaches classes in pediatric chemotherapy and is an investigator of a new study on educating newly diagnosed oncology patients and families.

35 advanced practice nurses Department of Pediatrics 2016 ANNUAL REPORT 35

TO EACH

Child A PROMISE

To treat every disease no matter how rare To prevent illness and injury To pursue the knowledge to advance pediatric medicine To make the world a better place for kids To maximize every child’s full potential

The University of Chicago Medicine Comer Children’s Hospital 5721 S. Maryland Avenue Chicago, IL 60637

UCM Physician Connect 1-800-824-2282 Referrals

uchicagokidshospital.org

Patient appointments or consultations

UCM Connect

1-888-824-0200

Front cover, clockwise from top left: Abir Mukherjee, PhD; Nylah Washington; Allison Tamblyn and Jackie Miller, RN; Tara Henderson, MD, and Abigail; Remoc. Back cover, clockwise from top right: Erika Claud, MD; Rachel Simon, RN, BSN, CPN, and Eric DelaTorre; Violet Rivera; Daniel Gruenstein, MD, and Jeremiah Banks ©2017 The University of Chicago